MEDICAL SERVICE IN THE 

EUROPEAN THEATER OF OPERATIONS 

UNITED STATES ARMY IN WORLD WAR 11 

The Technical Se rvices 

THE MEDICAL DEPARTMENT: 

MEDICAL SERVICE IN THE 

EUROPEAN THEATER OF OPERATIONS 

by 

Graham A. Cosmas 

and 

A tbert E. Cowdrey 

CENTER OF MILITAR Y HISTOR Y 

UNITED STATES ARMY 

WASHINGTON, D.G., 1992 





Foreword

Although readily admitting the importance of combat service support forces, military students and historians alike tend to concentrate

on combat and combat support units when studying operations, giving

only passing attention to the vital work of the logisticians, signalmen,

transport troops, and the rest. This is regrettable, for the operations of

combat service support units—especially in a global conflict like World

War II with its vast distances and varied terrains—have much to teach

us about modern warfare, lessons that remain of surpassing importance

to our profession. The Medical Department: Medical Service in the European

Theater of Operations supports the proposition that the experience of

medical personnel in war directly stimulates advances in medical science. More importantly, it demonstrates that the organization of health

care in the combat zones, including evacuation of the wounded, control

of disease among troops and civilian populations, and care of prisoners

of war, contributed directly to the Allied victory. The exploits of the

doctors, corpsmen, and medical support units provide a model for the

planning and organization of medical support in today's Army.

This volume continues a subseries begun in 1966 with the study of

medical support of the Army in the Mediterranean Theater. The

Center of Military History will soon complete this project with the publication of a similar study of the very different challenges faced by the

Medical Department in the Pacific. I urge our officers and noncommissioned officers to consult these histories and to use them, not only because they provide a clear example of the best in combat service support in wartime but because the principles of medical organization that

they examine remain of vital importance to today's military planners

and students.

Washington, D.C.

1 September 1990

HAROLD W. NELSON

Brigadier General, USA

Chief of Military History

ix
The Authors

Graham A. Cosmas was born in Weehawken, New Jersey, and received his education from the schools of Leonia, New Jersey, and from

Columbia University, Oberlin College, and the University of Wisconsin.

After teaching at the Universities of Texas (Austin) and of Guam he

joined the staff of the U.S. Marine Corps' History and Museums Division and, since 1979, that of the U.S. Army Center of Military History,

serving in 1984-85 as the Harold Keith Johnson Visiting Professor of

Military History at the U.S. Army Military History Institute, Carlisle

Barracks, Pennsylvania. Dr. Cosmas is the author of An Army for Empire:

The U.S. Army in the Spanish-American War, 1898-1899, and coauthor of

U.S. Marines in Vietnam: Vietnamization and Redeployment, 1970-71. He also

has published numerous journal articles and book reviews.

Albert E. Cowdrey was born in New Orleans, Louisiana, and received his education from the schools of that city and from Tulane and

Johns Hopkins Universities. He served in the Army as an enlisted man

during the years 1957-59. After teaching at Tulane University and at

Louisiana State University he entered the government historical programs, working for the Corps of Engineers historical office and, since

1978, for the U.S. Army Center of Military History. His continuing interest in southern history brought him the 1984 Herbert Feis Award of

the American Historical Association for his book This Land, This South.

His prizewinning history of Army medicine in the Korean war, The

Medics' War, has been widely adopted as a text in military medical

schools. He also has contributed articles on a variety of historical topics

to American, British, Canadian, and international journals.

x
Preface

The Medical Department: Medical Service in the European Theater of Operations is the second of three volumes recounting the overseas activities

of the U.S. Army Medical Department in World War II. Charles M.

Wiltse's volume on the Mediterranean and minor theaters was published in 1963, and a completed manuscript dealing with the war

against Japan now exists in the Center of Military History. These volumes deal primarily with the operational and organizational history of

Army medicine in the theaters, as distinguished from the clinical volumes published by the Office of the Surgeon General. In each case the

combat narrative has been drawn from relevant volumes in the United

States Army in World War II series, as well as from the large body of

subsequent scholarship. Our aim has been to show how the military

medical system organized itself in a combat theater; how medical planning was integrated with logistical and tactical planning; how medical

troops were organized, trained and deployed; how hospitals were built

and supplies assembled and moved forward; and how casualties were

treated and evacuated from the field of battle. The volume deals only

peripherally with medical support for the Army Air Forces, in view of

the fact that a lengthy published official history already exists.

Army medicine has long possessed a consciousness of its own history. ETO medics were especially concerned with recording their

achievements in the largest and most complex American land campaign

of World War II. Well before D-Day the theater chief surgeon established a historical section in his office under Col. Sanford V. Larkey.

The manuscript history that Colonel Larkey's office produced during

and immediately after the war formed the starting point for an extended effort by the Office of the Surgeon General to publish a history

of the campaign. Among the various manuscripts written during the

subsequent three decades, a study by George Garand, Hubert E.

Potter, and Pauline Vivette stands out for its length and detail. Nevertheless, the present volume in many ways represents a new start; a

fresh conception of the theme and organization led us into much additional research in manuscripts, recent secondary works, and interviews

with participants.

xi
Yet we gladly acknowledge our debts to the many people who contributed their efforts and expertise to this volume. Members of the

review panel included Col. Richard O. Perry, David F. Trask, Tom F.

Whayne, MD, Charles B. MacDonald, Col. Roger H. Wichelt, MC, and

Arnold G. Fisch, Jr. Their comments and suggestions contributed much

to the final form of this volume. We are especially grateful to the following veterans of the campaign interviewed by us and other members

of the Medical History Branch: Honorable Elliot Richardson, Maj. Gen.

Thomas J. Hartford, Maj. Gen. Collin F. Vorder Bruegge, Brig. Gen.

Sam F. Seeley, Brig. Gen. Crawford F. Sams, Col. Virginia Brown, Col.

Tom F. Whayne, Joseph A. Gosman, M.D., Lester Wallman, M.D., Herbert G. Wing, and Jane A. Lee. Their reminiscences added color and

human detail to the documentary record. We are grateful to Dr.

Gosman for allowing us to consult his manuscript "War Without

Blood" and to Mrs. Lee for providing us with personal snapshots of

nurses and hospitals in Great Britain. Robert J. T. Joy, M.D., and Col.

Charles J. Simpson contributed expert knowledge, encouragement, and

counsel.

Archivists in the Washington, D.C., area and at Carlisle Barracks,

Pennsylvania, provided unstinting help during our research. Among the

many to whom we owe our gratitude, Fred W. Pernell, Richard L.

Boylan and Victoria Washington of the National Archives, and Richard

Sommers of the Military History Institute, were particularly generous

with their time and expertise. Among our present and former colleagues at the Center of Military History, Hannah M. Zeidlik, Charles

Ellsworth, Geraldine K. Harcarik, Carol I. Anderson, James B. Knight,

and Mary J. Sawyer helped us obtain needed materials. Arthur S. Hardyman and Linda M. Cajka oversaw the preparation of maps and

charts, and Howell C. Brewer searched out photographs. Mr. Hardyman was in overall charge of the visual aspects of the volume. Terrence

L. Offer was our rapid and helpful manuscript typist.

Our greatest debt, of course, is owed to our meticulous and hardworking editor, Joanne M. Brignolo, whose technical proficiency and

attention to detail contributed immeasurably to the smooth flow of the

manuscript and the accuracy of its citations. Any errors of fact or interpretation remaining in the book, however, are ours alone.

Washington, D.C.

1 September 1990

GRAHAM A. COSMAS

ALBERT E. COWDREY

xii
Contents

Page

PROLOGUE: THE ONSET OF WAR......................................................... 3

Chapter

I. BEGINNINGS.................................................................................. 5

Early Activities in Britain................................................................. 6

Chief Surgeon, USAFBI................................................................... 12

Medical Plans and Programs ............................................................ 14

II. FROM BOLERO TO TORCH ....................................................... 25

Theater Reorganization .................................................................... 25

The Office of the Chief Surgeon......................................................... 27

The Hospital Program...................................................................... 36

Medical Manpower and Supplies....................................................... 44

Supporting TORCH .......................................................................... 55

III. THEATER CHIEF SURGEON....................................................... 60

Command Problems Solved................................................................ 62

Office Expansion.............................................................................. 73

IV. HOSPITALIZATION AND EVACUATION .................................. 80

Hospital Construction: The Final Drive ............................................. 80

Organizing a Hospital System ........................................................... 91

The Flow of Patients........................................................................ 98

Transatlantic Evacuation ................................................................. 103

V. MEDICS IN BRITAIN..................................................................... 109

The Personnel Buildup ..................................................................... 110

The Status of Nurses........................................................................ 119

Black Medics in the ETO ................................................................. 122

Hospitals at Work............................................................................ 124

Organizing the Dental Service ........................................................... 127

Training......................................................................................... 130

Preventive Medicine......................................................................... 137

xiii
Chapter Page

VI. PREPARATIONS FOR INVASION................................................ 149

Early Planning Efforts..................................................................... 149

OVERLORD: The Planning Process .................................................... 152

The NEPTUNE Campaign ................................................................. 161

Technical Aspects............................................................................. 174

Readying Medical Supply ................................................................. 177

Mounting the Attack ........................................................................ 191

VII. INTRODUCTION TO BATTLE.................................................... 201

The Assault..................................................................................... 203

First Army Medical Buildup ............................................................. 219

Cherbourg and the Hedgerows ........................................................... 224

VIII. COMZ REACHES THE CONTINENT .......................................... 239

Cross-Channel Evacuation................................................................ 240

Air Evacuation Begins...................................................................... 256

ADSEC Medics in Normandy ........................................................... 259

IX. BREAKOUT AND PURSUIT ......................................................... 273

First Army Medical Support.............................................................. 278

Third Army Medical Support............................................................ 284

Seventh and Ninth Armies Medical Support........................................ 289

Adapting to Mobile Warfare ............................................................. 292

Supporting Operation MARKET ......................................................... 305

At the West Wall............................................................................. 310

X. THE EXPANDING COMZ.............................................................. 312

Hawley Moves to Paris..................................................................... 313

Forging the Evacuation Chain .......................................................... 316

General Hospitals to the Front.......................................................... 336

Medical Supply in the Pursuit........................................................... 341

Supplying Whole Blood..................................................................... 348

On the Eve of New Battles................................................................ 352

XI. HARD FIGHTING AT THE WEST WALL................................... 354

Organizing for the Offensive.............................................................. 356

Medics on the Line........................................................................... 360

From Battle Line to Hospitals ........................................................... 372

Army Hospitals at Work ................................................................... 377

Sources of Supply............................................................................. 389

The System in Full Stride ................................................................. 391

xiv
Chapter Page

XII. A TIME OF ADVERSITY............................................................... 393

Medics in Retreat............................................................................ 396

Medical Realignments ...................................................................... 409

Bastogne: Encirclement and Relief..................................................... 414

The Third Army Attack .................................................................... 424

Southern Encore: Operation NORDWIND......................................... 426

Overcoming Adversity....................................................................... 428

XIII. COMPLETING COMZ.................................................................... 430

The Chief Surgeon and Command Relations ....................................... 430

The Continuing Buildup................................................................... 440

Morale Problems.............................................................................. 453

Medical Supply................................................................................ 457

XIV. HOSPITALIZATION AND EVACUATION CRISIS ..................... 468

Persistent Problems........................................................................... 473

Trenchfoot: The Other Enemy............................................................ 488

Coping With the Crisis ..................................................................... 496

XV. THE LAST CAMPAIGN ................................................................. 507

Medics in the Attack ........................................................................ 508

Lessons Learned............................................................................... 531

Supporting the Front........................................................................ 533

Triumph of Preventive Medicine........................................................ 538

XVI. VICTIMS OF WAR......................................................................... 544

Civil Affairs.................................................................................... 545

Military Government........................................................................ 550

The Typhus Epidemic....................................................................... 553

Uncovering the Reich ....................................................................... 557

The POWs...................................................................................... 561

DPs and Slave Laborers ................................................................... 569

XVII. FROM WAR TO OCCUPATION................................................... 579

Public Health.................................................................................. 581

Medical Intelligence.......................................................................... 589

Who Goes Where, When, and How?.................................................. 596

A New Upheaval............................................................................. 601

Hospitalization and Evacuation ........................................................ 603

Medical Supply................................................................................ 608

Health of the Troops ........................................................................ 611

xv
Page

EPILOGUE: THE THEATER IN RETROSPECT ..................................... 614

BIBLIOGRAPHICAL NOTE ...................................................................... 621

LIST OF ABBREVIATIONS....................................................................... 625

BASIC MILITARY MAP SYMBOLS........................................................... 629

INDEX.......................................................................................................... 631

Tables

No.

1. Hospital Bed Requirements and Provisions, Second Key Plan,

July 1942............................................................................................ 41

2. Chief Surgeon's Recommended Troop Basis, January 1944 ............... 113

3. Planned Landing of Medical Units, 6-14 June 1944............................ 170

4. Key Depot System, United Kingdom, 1944.......................................... 188

5. Personnel and Patient Capacity of Hospital Carriers........................... 245

6. Casualty Reception at Ports, June 1944 ............................................... 247

7. Cross-Channel Evacuation, June-July 1944.......................................... 257

8. Trends in Evacuation From the Armies and Advance Section............ 331

9. Medical Personnel Strength, ETOUSA, Late 1944.............................. 441

Charts

1. Organization of the Office of the Chief Surgeon, USAFBI,

May 1942............................................................................................ 15

2. Organization of the Office of the Chief Surgeon, ETOUSA-SOS,

September 1942................................................................................. 35

3. Organization of the Office of the Chief Surgeon, ETOUSA,

June 1944........................................................................................... 75

4. Organization of the Consultant System, ETOUSA, 1944 ......... Facing 78

5. Planned Command Arrangements for OVERLORD................................ 158

6. Organization of the Office of the Surgeon, ADSEC, COMZ,

ETOUSA, May 1944.......................................................................... 162

7. Organization of the Office of the Surgeon, FECOMZ, ETOUSA,

June 1944........................................................................................... 163

8. Causes and Locations of Wounds, Battle of Normandy,

June-July 1944................................................................................... 225

9. Organization of the Medical Section, Third Army, 1944..................... 285

10. Organization of the Office of the Chief Surgeon, ETOUSA,

February 1945........................................................................ Facing 432

11. Evacuation to the Zone of Interior, October 1944-July 1945 ............. 505

12. Organization of the Office of the Chief Surgeon, TSFET,

October 1945..................................................................................... 609

xvi
Diagrams

No. Page

1. Infantry Division Landing Phase Evacuation Plan................................ 169

2. Casualty Reception System in Great Britain, June 1944...................... 196

3. ETO Evacuation System, Late 1944..................................................... 335

4. Field Armies and COMZ Evacuation Responsibility............................ 376

5. Typical Divisional Evacuation and Medical Supply Plan for

Rhine Crossing .................................................................................. 517

6. DDT Dusting Procedure ....................................................................... 556

Maps

1. British Isles, 1942.................................................................................. 20

2. Hospital Locations, United Kingdom, 31 December 1942 .................. 45

3. Hospital Centers, Great Britain, 1944.................................................. 93

4. Operation OVERLORD Plan, 1944.......................................................... 154

5. Medical Depots, United Kingdom, December 1943............................. 180

6. Casualty Reception Facilities, June 1944.............................................. 197

7. Clearing Stations at UTAH Beach, 6 June 1944 .................................... 207

8. Clearing Stations at OMAHA Beach, 7 June 1944 ................................. 217

9. Battle for Normandy, 6 June-24 July 1944 .......................................... 220

10. Advance Section Medical Units, Late July 1944................................... 262

11. Allied Advance, 24 July-16 September 1944 ....................................... 276

12. Operation MARKET Medical Support, 17-26 September 1944............. 307

13. COMZ Base Sections, August-October 1944....................................... 314

14. General Hospitals and Depots, November 1944.................................. 326

15. Blood Route, 1944 ................................................................................ 351

16. Army Holding and Supply Units, 16 September-15 December

1944................................................................................................... 378

17. First Army Medical Units in the Ardennes, 16 December 1944.......... 403

18. Bastogne, 19-27 December 1944 ......................................................... 416

19. COMZ Base Sections, January 1945 ..................................................... 435

20. Continental Medical Depots, November 1944-April 1945 .................. 460

21. Evacuation System, Late 1944-Early 1945........................................... 469

22. Crossing the Rhine, March-April 1945 ................................................ 510

23. Invasion of Germany, 7 March-7 May 1945......................................... 526

24. POW Transient Enclosures, Spring 1945............................................. 564

25. Major Concentration Camps, Spring 1945........................................... 573

26. Occupation Boundaries, August 1945.................................................. 580

27. Hospital Distribution in the American Zone, Late 1945...................... 604

xvii
Illustrations

Page

The Man Without a Gun ................................................................... Frontispiece

Lt. Gen. Sir Alexander Hood...................................................................... 7

Col. Arthur B. Welsh................................................................................... 9

Maj. Gen. Paul R. Hawley ........................................................................... 11

Lt. Gen. John C. H. Lee.............................................................................. 27

Col. James C. Kimbrough............................................................................ 32

Col. Charles B. Spruit ................................................................................. 33

Lt. Col. James B. Mason.............................................................................. 34

EMS Hospital at Bristol............................................................................... 38

Theater Chief Surgeon and Staff, Cheltenham, November 1942 .............. 47

Maj. Gen. Albert W. Kenner ....................................................................... 64

Col. Alvin L. Gorby ..................................................................................... 66

Brig. Gen. Thomas D. Hurley..................................................................... 67

Brig. Gen. Malcolm C. Grow....................................................................... 69

Col. Joseph R. Darnall................................................................................. 83

Fourth Key Plan Medical Facilities.............................................................. 84

Nissen-Hut 834-Bed Station Hospital......................................................... 89

Tented Expansion Wards............................................................................ 91

British-Supplied Ambulance Bus................................................................. 101

Medical Personnel Enjoying the Amenities of British Life......................... 115

Lt. Col. Ida W. Danielson............................................................................ 120

Nurses of the 250th Station Hospital.......................................................... 121

Black Medics Prepare for Evacuating Casualties ........................................ 123

London Central Dental Laboratory and Mobile Clinic .............................. 129

U.S. Army Medical Officer on Temporary Duty at a British

Civilian Hospital....................................................................................... 133

Col. John E. Gordon.................................................................................... 138

Prophylactic Station and Procedure............................................................ 145

British Hospital Carrier Naushon ................................................................. 151

Col. Thomas J. Hartford ............................................................................. 156

LSTs Readying for the Invasion.................................................................. 166

Gas Decontamination Equipment................................................................ 174

Expeditionary Hospital at Carmarthen ....................................................... 178

Col. Tracy S. Voorhees ............................................................................... 185

Col. Silas B. Hays ........................................................................................ 187

Col. Byron C. T. Fenton ............................................................................. 187

Medics Administering First Aid to Invasion Casualties on UTAH

and OMAHA............................................................................................... 209

Men and Equipment in Support of the Normandy Buildup....................... 215

Nurses of the 13th Field Hospital............................................................... 222

xviii
Page

Infantrymen in Action in the Hedgerows ................................................... 227

Medics With Improvised Red Cross Insignia.............................................. 230

Removing a Casualty From an LST............................................................ 244

Transferring Casualties From a DUKW to a Water Ambulance................ 246

Casualty Reception in Britain...................................................................... 249

Col. Fred H. Mowrey................................................................................... 254

Detraining a Casualty in Britain for Transport to a General Hospital...... 255

Col. Charles A. Beasley ............................................................................... 260

Constructing the 5th General Hospital Tented Plant at Carentan ............ 269

Awaiting Evacuation From the Third Army's Air Holding Unit at Toul... 289

Col. Myron P. Rudolph ............................................................................... 290

Brig. Gen. William E. Shambora................................................................. 291

Medic Aiding a Casualty of the Moselle Fighting....................................... 295

Typical Half-Track....................................................................................... 297

Medics Treating Wounded German Soldiers ............................................. 304

Installation of Air Holding Unit at Toul..................................................... 321

French Civilian Litterbearers Preparing To Unload a Hospital Train

at Gare St.-Lazare .................................................................................... 324

UC-64 of the "Grow Escadrille"................................................................. 333

Civilian Hospital in Paris Vacated by Retreating Germans........................ 339

Maneuvering a Captured German Tractor Through the Mud at

Medical Depot M-402.............................................................................. 344

Flight Nurse Lifting Marmite Can of ETO Blood Onto a

Continent-Bound C-47............................................................................ 349

Medics on the Line...................................................................................... 360

Preparing an Emergency Medical Tag........................................................ 362

Litterbearers Meeting the Challenge of the Huertgen Fighting ................ 365

Battalion Aid Station Personnel Readying Casualties ................................ 367

Workhorses of Battlefield Evacuation......................................................... 371

Evacuation Hospital Receiving Ward.......................................................... 381

Packing Medical Supplies in a 155-mm. Howitzer Shell ............................ 383

American Victims of the Malmedy Massacre .............................................. 394

Bullet-Riddled Army Ambulance ................................................................ 398

Caring for an Infantryman Injured in the Ardennes Fighting ................... 401

Brig. Gen. John A. Rogers .......................................................................... 402

Former School Facility Housing the 130th General Hospital at Ciney ..... 413

Bundles of Medical Supplies ....................................................................... 421

Army Ambulance in Bastogne..................................................................... 423

General Kenner on One of His Many Inspection Trips............................. 433

Col. Charles F. Shook.................................................................................. 439

Troops Undergoing a Physical Examination .............................................. 449

German POWs Unloading Casualties From a Hospital Train at Reims .... 452

xix
Page

American Red Cross Workers Supplying Doughnuts for Casualties ......... 455

Station Hospital Dayroom........................................................................... 456

Medical Supplies at Medical Depot M-407................................................. 461

Gare St.-Lazare, Paris .................................................................................. 473

Tents of the 76th General Hospital............................................................ 475

Cross-Channel Evacuation on Hospital Carrier Prague............................... 478

Sea Evacuation on U.S. Army Hospital Ship St. Olaf.................................. 485

Care of the Feet........................................................................................... 491

Sentry Wearing Improvised Boots of Straw-Filled Blankets ...................... 493

Wreckage of Hospital Train After Gare St.-Lazare Bombing .................... 499

Hospital Emergency Beds ........................................................................... 501

Air Evacuation of Wounded in a C-47 ....................................................... 513

Airborne Medics Loading Medical Equipment for Assault Drop............... 518

Litterbearers Carrying a Casualty Back Through a Minefield.................... 519

Medics Pulling an Assault Boat Filled With Medical Supplies................... 523

Jeep Ambulance Evacuation ........................................................................ 532

A Job for Civil Affairs: St.-Lo...................................................................... 547

Malnourished American RAMP................................................................... 560

Prisoner-of-War Transient Enclosure at Remagen..................................... 563

German Medics Treating a German POW.................................................. 567

Last Shipment to Dachau ............................................................................ 575

German Civilians Awaiting Their Food Rations......................................... 587

Food Assistance for German Refugees ....................................................... 589

POW Laborers at Delta Base Section Staging Area ................................... 598

German Hospital Taken Over by Occupation Forces ................................ 607

Illustrations courtesy of the following sources: p. 7, National Library of

Medicine; pp. 11, 32, 34, 47, 66, 67, 138, 145 (top/bottom), 187 (right), 244,

and 254, Armed Forces Institute of Pathology; pp. 115 (bottom) and 121, Mrs.

Jane Lee; p. 185, National Archives and Records Administration; and p. 333,

Smithsonian Institution. All other illustrations are from the files of the Department of the Air Force, the Department of the Army, and the U.S. Army Center

of Military History.

The works of Lawrence Beall Smith (1909-) depicted on p. ii—The Man

Without a Gun, 1944, oil on masonite, 361⁄2" x 22"—and on the paperback

cover—Normandy Sabbath, 1944, oil on masonite, 233⁄4" x 37"—are from the

Army Art Collection.

xx
MEDICAL SERVICE IN THE

EUROPEAN THEATER OF OPERATIONS

PROLOGUE

The Onset of War

In the late summer of 1939, as

World War II opened in Europe, the

Medical Department of the United

States Army comprised medical field

units, fixed hospitals, laboratories,

and schools, a complex whose center

was the Office of the Surgeon General in Washington, D.C. The surgeon

general commanded his own office

and the general hospitals. He advised

the chief of staff and the secretary of

war on all matters relating to the

health and medical care of the Army,

and he provided technical guidance to

all the men and women of the department in the continental United States

and its overseas possessions.

By later standards the Medical Department was few in numbers, comprising about 10,000 officers and

men. Its officers were organized into

Medical, Dental, Veterinary, and Medical Administrative Corps; members

of the Army Nurse Corps, exclusively

female, held quasi-officer status

known as relative rank. Another

23,000 doctors, dentists, administrators (a title which included specialists

in some ancillary fields, such as pharmacists), and sanitarians made up the

Medical Department Reserve Corps.

In the laboratories and general hospitals a small elite group of physicians

preserved the department's traditional devotion to medical science, which

derived from the days of Walter Reed

and William C. Gorgas.1 But most

Army doctors were in the broadest

sense general practitioners. They

guarded the public health of the

Army, gave aid to injured soldiers,

and provided treatment at unit sick

calls, at dispensaries, and at unit and

post hospitals. In addition, Army doctors were soldiers who commanded

medical units, advised their commanders, sat on courts-martial, stood

formations, conducted inspections,

and—if considered worthy—attended

Army schools like the Infantry School

at Fort Benning or the Command and

General Staff School at Fort Leavenworth. They participated in the active

if somewhat stiff and formal social life

of the officer corps, with its teas, its

balls, and its near-obsessive devotion

to sports and horsemanship. Many

practiced a kind of medicine that was

elementary and repetitive, but developed a broad grasp of Army ways and

1

 Walter Reed (1851-1902) was the Army doctor

who headed and supervised the work of the U.S.

Army Yellow Fever Commission that proved mosquitoes carried yellow fever. William C. Gorgas

(1854-1920) was the Army doctor who systematically applied this discovery in public health campaigns

that rid Havana and later the Panama Canal Zone of

the disease.
4 EUROPEAN THEATER OF OPERATIONS

wide acquaintance with their fellow

officers. Even for junior officers,

military medicine offered definite rewards, especially during the Depression years of the 1930s—a secure paycheck, travel, a round of usually

undemanding duties, and slow advance up the ladder of rank.

The limited mobilization proclaimed by President Franklin D. Roosevelt in September 1939 brought

quick and drastic changes to this insular life. During the twenty-one years

since the end of World War I, the

Medical Department had supported a

garrison army of less than 200,000

men, and the field medical establishment had dwindled to only five

units—four medical regiments and a

medical squadron. Tables of organization and equipment (T/O&Es) for

both fixed and mobile medical units

had remained unchanged for a

decade. The military buildup, escalating into full mobilization and conscription as France fell and England

stood alone, transformed the Medical

Department along with the rest of the

Army. In the seventeen months

before Pearl Harbor medical strength

grew to 131,586 officers and men, a

rate of increase slightly more rapid

than that of the Army as a whole.

Concurrently, the surgeon general,

Maj. Gen. James C. Magee, and his

staff reworked the medical annexes to

national mobilization plans, expanded

training programs, and revised unit

T/O&Es. Among other changes they

replaced horse-drawn with motor vehicles. Reviving a successful World

War I expedient, the Medical Department formed affiliated reserve hospital units of both fixed and mobile

types, each staffed and sponsored by

a civilian hospital or medical school.

By 7 December 1941 the Medical Department had created the cadre of an

organization able to care for a vastly

expanded national Army.2

Although the Japanese attack on

Pearl Harbor unexpectedly confronted the United States with an immediate crisis in the Pacific, President

Roosevelt continued to view Nazi

Germany as the principal enemy. Attempts to inform the American military about the British war effort and

to assist Prime Minister Winston S.

Churchill's government in resisting

the common foe predated U.S. entry

into the war. It was through these

early moves to aid Britain that the

foundations of the European Theater

of Operations and its medical support

system were first laid.

2

 For details on mobilization, see Clarence McKittrick Smith, The Medical Department: Hospitalization and

Evacuation, Zone of Interior (hereafter cited as Hospitalization and Evacuation), United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1956),

pp. 3-43.
CHAPTER I

Beginnings

The European Theater of Operations, which was to conduct the

United States Army's largest and

most complex land campaign of the

Second World War and complete the

destruction of Nazi Germany, had

modest beginnings. Its initial objectives were to establish Army forces in

the British Isles in order to protect

them from invasion; to relieve British

troops for operations in the Mediterranean; and to reinforce the Royal Air

Force (RAF) Bomber Command in its

strategic air offensive against the

Third Reich.

Preparation for establishment of

the theater began early in 1941. At

that time, almost a year before Pearl

Harbor, the United States, which had

undertaken limited mobilization soon

after the outbreak of war in September 1939, advanced its support of

Great Britain to the stage of direct

matériel aid and combined contingency planning. While Congress debated

and passed the Lend-Lease Act, authorizing direct government transfers

of American military equipment to

anti-Axis nations, American and British staff officers met secretly in Washington. They drew up an agreement,

known as ABC-1, outlining AngloAmerican worldwide strategy in the

event the United States entered the

war. Under ABC-1 and the subsequent War Department RAINBOW-5

plan of April 1941, the U.S. Army initially would play a limited role in the

North Atlantic and Western Europe.

Army troops were to replace the British garrison in Iceland. An Army air

force would deploy to Great Britain

to join the Royal Air Force in bombing Germany, while ground elements

protected U.S. Navy bases in Scotland

and Northern Ireland and a reinforced regiment took station to help

defend southern England. Altogether,

the contingents in the United Kingdom were to include about 87,000 officers and men, almost half of them in

the bomber command.1

1

 Maurice Matloff and Edwin M. Snell, Strategic

Planning for Coalition Warfare, 1941-1942, United

States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1953), pp. 43-46; Roland G. Ruppenthal, Logistical Support of the Armies, United States

Army in World War II, 2 vols. (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1953-59), vol. 1, May 1941-September

1944 (1953), pp. 2 and 19-20; An. 2, ABC-1 (American-British Conversations), 27 Mar 41, quoted in

Historical Section, ETO, "The Special Observer

Group Prior to the Activation of the European Theater of Operations" (hereafter cited as "SPOBS

Hist"), October 1944, p. 13. Depository codes used

in citations in this volume are as follows: CMH (U.S.

Army Center of Military History, Washington, D.C.);

MHI (U.S. Army Military History Institute, Carlisle Continued
6 EUROPEAN THEATER OF OPERATIONS

Early Activities in Britain

While President Roosevelt justified

early mobilization measures in terms

of Western Hemisphere defense, the

United States from the beginning

based its preparations on the probability that, if drawn into the war, it

would fight as the ally of Great Britain. For this reason, as well as to keep

abreast of wartime technical developments, the armed services and other

government agencies sent official observers to study the British war effort.

British medical problems and achievements drew their share of attention.

Military and naval attaches at the

London embassy transmitted medical

information along with other intelligence. The National Research Council, part of the U.S. National Academy

of Sciences, which advised the surgeon general on medical research and

therapy, pooled information with

counterpart British and Canadian organizations. The Army Medical Department dispatched its own observer,

Col. Raymond W. Bliss, MC, who

went to London during late 1940. Although injured in a November air

raid, Bliss sent back reports on subjects ranging from hospitalization and

evacuation of bombing casualties to

the incidence of combat fatigue

among RAF flight officers.2

These American observers found in

Great Britain a medical profession as

fully developed and highly institutionalized as that in the United States,

and one ahead of its American counterpart in many war-related areas of

research and clinical practice. British

medicine—part of a nation which

German bombers had made into a

single combat zone—was fully mobilized for war. Under the Ministry of

Health the Emergency Medical Services (EMS) controlled about 300,000

beds in existing private and governmental hospitals and in newly constructed semipermanent plants. Working closely with the civil defense organization, it evacuated and treated civilian air raid casualties and provided

most station and general hospitalization for the armed services.3

The medical services of the British

Army, Royal Navy, and Royal Air

Force paralleled in structure and

functions, though not in nomenclature, those of the United States

armed forces. The Royal Army Medical Service, with which the U.S. Army

medical establishment was to work

most closely, was headed by Lt. Gen.

Barracks, Perm.); NARA (National Archives and

Records Administration, Suitland, Md.); and NLM

(National Library of Medicine, Bethesda, Md.)

Manuscript sources cited without any depository

code are in the custody of CMH and, upon publication of this volume, will be returned to the collection of Army records in the custody of NARA. See

Bibliographical Note. 2

 For a summary of early contacts, see Sanford V.

Larkey, "Administrative and Logistical History of

the Medical Service, Communications Zone, European Theater of Operations" (hereafter cited as

Larkey "Hist") (Historical Division, United States

Forces, European Theater, 1945), ch. 1, pp. 1-3;

Col R. W. Bliss, MC, Compiled Reports of Medical

Observer in London, October-December 1940

(hereafter cited as Bliss Rpts), file ETO 7/1. 3

 The EMS secured beds by discharging or

moving patients, crowding more beds into wards

and buildings, and adding hut annexes to permanent hospitals. The British radically overestimated

air raid losses, expecting 35,000 dead and injured a

day for the first two weeks of heavy bombing. In

fact, they suffered about 43,000 civilians killed and

50,400 severely injured in the entire period June

1940-May 1941. See C. L. Dunn, The Emergency Medical Services (hereafter cited as EMS), History of the

Second World War, United Kingdom Medical

Series, 2 vols. (London: Her Majesty's Stationery

Office, 1952-53), vol. 1, England and Wales (1952),

pp. 114-15 and passim; Bliss Rpts, file ETO 7/1.
BEGINNINGS 7

LT. GEN. SIR ALEXANDER HOOD

Sir Alexander Hood, director general

of Army Medical Services. General

Hood served on the staff of the adjutant general, who in turn sat on the

Army Council, the British Army's central administrative body. General

Hood's office consisted of a number

of functional directorates, with responsibilities much like those of the

divisions of the U.S. Army's Office of

the Surgeon General. In geographical

area commands and field armies a

deputy or assistant director of Medical Services, depending on the size of

the organization, advised the commander on medical matters and exercised technical and administrative

control over hospitals and medical

units. Tactical medical units, from

field ambulances to general hospitals,

made up a chain of evacuation similar

in operations and principles to that of

the U.S. Army. The British in 1940-

41 were in the process of reorganizing these elements to achieve greater

mobility and to bring emergency surgery closer to the firing line. For

home base fixed hospitals, the British

Army, like the other services, had to

rely primarily on the Emergency Medical Services, since the Cabinet in

1939 had all but forbidden construction of new military hospitals in the

United Kingdom. EMS hospitals cared

for the sick and injured of units stationed in Britain, and they were the

final link in the chain of evacuation

from overseas battlefields.4

By late 1940 the Royal Army Medical Service was suffering from a shortage of medical officers, and throughout the British war effort the demand

for qualified practitioners had begun

to exceed the supply. The British, accordingly, welcomed American and

other foreign civilian doctors and employed these volunteers in the Emergency Medical Services to release

British doctors for military service.

American medical people came to

Britain as individuals, and they also

came in organized hospitals, two of

which were destined for close association with the U.S. Army. The first of

these, the American Hospital in Great

Britain, which was organized by New

4

 In May 1940 the British Army had 9,000 beds

available in Great Britain in its own hospitals, all enlarged prewar plants. See Dunn, EMS, 1:96. For

army medical organization and its wartime development, see F. A. E. Crew, The Army Medical Services

(hereafter cited as AMS), History of the Second

World War, United Kingdom Medical Series, 2 vols.

(London: Her Majesty's Stationery Office, 1953-55),

vol. 1, Administration (1953), chs. 3, 8 and pp. 458-

79.
8 EUROPEAN THEATER OF OPERATIONS

York City doctors and laymen and financed by the British War Relief Society in America, went into operation

late in 1940. Its British-American-Canadian staff occupied a 300-bed wing

of an EMS hospital at Basingstoke

and specialized in orthopedics and

plastic surgery. In January 1942 the

unit, renamed the Churchill Hospital,

moved to a larger facility, taking over

an entire new 600-bed EMS hospital

near Oxford.5

At the time the American Hospital

was taking shape, the Harvard Medical School and the American Red

Cross, in cooperation with the Ministry of Health, established a contagious disease treatment and control

unit. Named the American Red

Cross-Harvard Field Hospital Unit,

this facility included a laboratory,

mobile investigating teams, and a

125-bed hospital, staffed except for

nurses by Harvard and equipped

largely by the Red Cross, which also

recruited the nurses. The unit's director, Dr. John E. Gordon, professor of

Epidemiology at Harvard, and many

of the professional staff began work

in Britain in mid-1940. They assisted

the Ministry of Health in combating

disease outbreaks, which were a constant threat in the crowded and

bomb-damaged cities; they also completed plans for the hospital. The rest

of the unit arrived in Britain during

early 1941. Five of the staffs Red

Cross nurses and their chaperone

died at sea when a U-boat torpedoed

their ship in the North Atlantic. Dr.

Gordon also became a war casualty,

injured when bombs demolished his

London apartment, but he soon returned to work. In September the

unit opened its 22-building complex

near Salisbury in southern England.

Its field teams and laboratory helped

the British suppress outbreaks of

paratyphoid and scabies, among other

diseases. Dr. Gordon, besides overseeing the unit, advised the minister

of health on epidemiology, served on

Ministry of Health committees, and

transmitted information between British and American public health agencies. After the unit had been in operation for a year, Sir Wilson Jameson,

chief medical officer of the Ministry

of Health, declared that Gordon and

his colleagues "have come to be regarded not as a group of workers

from America but more as a part of

the general public health staff of this

country" and that the volunteer unit

would be "a model for the post-war

development of epidemiological studies" in Britain.6

Medical Department activity in Britain expanded and became more systematic after the signing of ABC-1.

To execute and maintain that agreement, the United States and Great

Britain exchanged military missions.

The members of these missions collectively represented their country's

chiefs of staff. Individually, each mission member exchanged information

and developed contacts with counterparts in his own branch of service.

5

 Larkey "Hist," ch. 1, pp. 3-7; Sheila M. Dwyer,

"A Base Hospital in England," The American Journal

of Nursing 41 (August 1941): 877-79; Bliss Rpts, file

ETO 7/1.

6

 Ltr, Sir Wilson Jameson to Dean Burwell, Harvard Medical School, 16 Sep 42, in The American Red

Cross-Harvard Field Hospital Unit (Cambridge, Mass.:

Harvard University, 1943), pp. 38-40. This publication sketches the history of the unit. On Gordon's

injury, see New York Times, 7 May 41, p. 6.
BEGINNINGS 9

COL. ARTHUR B. WELSH

(1953 photograph)

The United States Army mission to

England established its headquarters

in London on 19 May 1941, setting

up offices in the United States Embassy on Grosvenor Square. Maj. Gen.

James E. Chaney, an Air Corps officer

who earlier had observed the Battle

of Britain for the War Department,

headed the delegation, designated the

Special Observers Group (SPOBS) to

conceal its actual, unneutral functions. Chaney's seventeen subordinates, called special assistant Army

observers, were carefully selected

field-grade officers whose branches

and specialties included most of those

required to staff a theater headquarters. Wearing civilian clothes and carrying British identification and ration

cards, they collected much military

information while carrying out their

primary task of making preliminary

preparations for the Army forces earmarked for Great Britain in ABC-1

and RAINBOW-5; they selected locations for bomber bases and other

installations and surveyed transportation facilities and supply sources.

General Chaney, who reported directly to Army Chief of Staff General

George C. Marshall, had responsibility for recommending changes in the

details of the basic plan. At the

proper time he was to advise the chief

of staff on actual force deployments.7

Initially, Maj. Arthur B. Welsh, MC,

represented the Medical Department

in the Special Observers Group. A

Regular Army medical officer since

1926, Welsh had attended the Com- mand and General Staff College and

taught at the Medical Field Service

School at Carlisle Barracks. Since October 1939, as assistant chief of the

Planning, Plans, and Training Division, Office of the Surgeon General,

he had helped make Medical Department emergency and war plans. He

was thus a logical choice for the

SPOBS assignment.8

Welsh spent much of his time at

first meeting with British civil and

military medical officials and collecting information as preparation for his

medical planning tasks. He conferred

regularly with counterparts from the

7 Ministry of Health, the British Army The operations of this group, which also included coordinating the allocation of lend-lease equipment and participation in early military discussions

with the Soviet Union, are described in ETO,

"SPOBS Hist," passim.

8

 Biographical data from Name-Rank file, CMH;

Interv, OSG with Col A. B. Welsh, 28-29 Oct 47,

file HD 000.71, CMH.
10 EUROPEAN THEATER OF OPERATIONS

and Royal Air Force, and the Colonial

Medical Service; accumulated material

on medical and sanitary conditions

and hospitals in the United Kingdom,

Iceland, and Africa; became familiar

with British Army and RAF medical

organization; and compiled reports

on such subjects as the proper goggle

lense colors for the desert and Arctic,

the most common types of bombing

injuries, and the special problems of

evacuating wounded men from tanks.

During July and August 1941 Welsh

completed his medical plans for the

U.S. Army forces to be stationed in

Iceland, Northern Ireland, Scotland,

and England. These plans, in accord

with ABC-1 and RAINBOW-5, provided for static garrison and antiaircraft

defense units and for air commands

operating from fixed bases. Because

of their limited scale, they soon

became obsolete by the rush of

events.

Welsh's medical plans, despite their

quick demise, contained hospitalization and evacuation principles that

were to reappear in subsequent more

elaborate programs. For example,

Welsh emphasized that the Army in

the British Isles should establish "its

own complete medical service with

10% fixed beds and sufficient medical

units and transport to collect and

evacuate sick and wounded. ... "

While he arranged for the initial care

of American casualties in British hospitals, his plans called for early construction of U.S. Army hospitals for

the entire command. Welsh outlined

a hospitalization scheme based on

unit dispensaries, station hospitals

with 250 to 750 beds, and general

hospitals with 1,000 beds. Under his

proposed evacuation policy units

would treat sick and wounded needing less than 72 hours of care in their

own dispensaries, more serious cases

would go to station hospitals, and

those needing over 120 days of hospitalization would be evacuated to the

United States by air or hospital ship.

In addition to these hospitalization

and evacuation programs Welsh submitted lists of medical units for the

ABC-1 and RAINBOW-5 forces, as well

as a proposed table of organization

for a small theater chief surgeon's

office; recommended the use of

American rations to feed U.S. troops

stationed in Great Britain and the

need for various preventive medicine

measures, such as venereal disease

suppression; and warned that all hospital equipment and medical supplies

would have to come from the United

States, an assumption which turned

out to be wrong.9

In mid-September illness forced the

relief of Major Welsh.10 To replace

him, the War Department, on Welsh's

recommendation, selected Col. Paul

R. Hawley, MC, at that time assistant

commandant of the Medical Field Service School at Carlisle Barracks,

Pennsylvania. Fifty years old in 1941,

Hawley had served in France in

World War I as a regimental surgeon

"Larkey "Hist," ch. 1, pp. 11-15, 19-26, 30-31.

Ch. 1, app. 1, reproduces Welsh's major plans. See

also ETO, "SPOBS Hist," pp. 30-31 and 34-35.

Army medical service in the Iceland occupation,

which began in late 1941, is covered in an earlier

volume of this series. See Charles M. Wiltse, The

Medical Department: Medical Service in the Mediterranean

and Minor Theaters (hereafter cited as Mediterranean),

United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History, Department of the Army, 1965), pp. 10-18. 10 Welsh spent the rest of the war in the Office of

the Surgeon General in high-level planning and supervisory assignments.
BEGINNINGS 11

MAJ. GEN. PAUL R. HAWLEY

(Rank as of 27 February 1944)

and as sanitary inspector of the Intermediate Sector, Services of Supply.

Between the wars he held varied assignments in the United States, the

Philippines, and Nicaragua; taught

biostatistics and epidemiology at the

Army Medical School; and earned a

doctorate in Public Health from Johns

Hopkins University. Hawley also possessed military staff training, having

attended both the Command and

General Staff School, at Fort Leavenworth, Kansas, and the Army War

College in Washington, D.C. Genial

but strong-willed, Hawley, more than

any other one man, was to dominate

medical service in the European Theater of Operations.11

Hawley received a hectic introduction to the Special Observers Group.

Departing for England on less than

two days' notice, he took along little

spare clothing and no passport. He

crossed the Atlantic in a B-24

bomber being ferried over for the

Royal Air Force. "The pilot and I

shared the same experience," he recalled. "Neither one of us had flown

over the ocean before." Having traveled in uniform, Hawley bought a civilian suit off the rack in a London

department store in order to conceal

his military identity. By this time, he

observed, the group's disguise had

worn thin. Even a woman passerby

who directed the Americans back to

their hotel in the blackout seemed to

know who they were.12

As Welsh had done, Hawley worked

out of a single small room in the

American embassy without even a

personal secretary to assist him.

Quickly, he picked up the threads of

Welsh's activities. He revised the

Northern Ireland medical plan to relieve the Navy of any responsibility

for medical care of Army troops near

naval bases, and he recommended establishment of fewer and larger fixed

hospitals than Welsh had proposed.

Hawley drafted a medical plan of his

own for the Army forces to be stationed in Scotland, generally following the principles of Welsh's earlier

England and Scotland plans. Late in

November, he completed tentative

plans for medical support of the

11

 Biographical data from Name-Rank file, CMH;

Memo, Maj A. B. Welsh to Gen McNarney, 11 Sep

41; AGO Orders to Col Paul R. Hawley, 16 Sep 41,

box 1, Paul R. Hawley Papers, MHI. 12

 Interv, OSG with Maj Gen Paul R. Hawley, 16

and 18 Jun 62 (hereafter cited as Hawley Interv,

1962), pp. 5-7, CMH.
12 EUROPEAN THEATER OF OPERATIONS

American bomber command, which

was to operate from airfields in eastern England already designated for

turnover by the Royal Air Force. For

this command, then expected to include about 36,000 officers and men,

Hawley recommended provision of

hospital beds for 1 percent of troop

strength in local dispensaries, 4 percent in area station hospitals, and 3

percent in general hospitals, with

beds for another 1.3 percent in convalescent facilities.13

 Besides making

plans, Hawley arranged for the turnover of British Army medical supplies

to American troops in Iceland. He negotiated informally with the War

Office and the Ministry of Health for

free-of-charge treatment of American

personnel in British military and EMS

hospitals, promising the British reciprocal privileges in U.S. Army hospitals if and when such were built in the

United Kingdom.14

Hawley assiduously cultivated his

British counterparts. Except when out

of London on inspection trips, he

paid daily visits to General Hood,

Army Medical Services, and to

Hood's directorate chiefs; he also attended Hood's weekly staff confer- ences. The British gave Hawley their

equivalent of a Top Secret security

clearance, admitting him to the deliberations of their most sensitive medical research committees. In return,

the British drew on Hawley's knowledge of the U.S. Army's field medical

organization to aid their own army

medical service reorganization planning. Outside London Hawley visited

British Army regional commands and

became the "good friend" of their

medical officers. Hawley was junior to

the British generals with whom he

had to deal. Nevertheless, he said,

"the British just adopted me down in

the Surgeon's Office. . . . These were

major generals and I was just an unknown colonel [but] they took me

in."

 15

Early in the morning of 8 December 1941 Hawley, who intended to

visit the British Army Southern Command that day, walked from his

London apartment to the nearby

Baker Street tube station on his way

to Waterloo Station. He had not had

his radio on the night before. As he

entered the subway, large black newspaper headlines told him that the Japanese had bombed Pearl Harbor,

ending American neutrality. Hawley

abruptly changed plans. "I went right

back to my apartment . . . [and] got

into uniform. That morning, Monday

morning, was always conference in

the [Director] General's office—all of

his department heads. . . . And I

walked into that conference room in

uniform and they got up and yelled

and cheered. . . ."

 16

Chief Surgeon, USAFBI

As Colonel Hawley had signified by

donning his uniform, Pearl Harbor

13

 Medical planners usually established hospital requirements in terms of beds, assuming that each

bed carried with it a proportional amount of personnel, supplies, and equipment. 14

 Hawley Interv, 1962, p. 12, CMH; Larkey

"Hist," ch. 1, pp. 15, 26-29, and ch. 2, pp. 11-12;

Memo, Hawley to AG, SPOBS, 4 Dec 41, file HD

ETO 400.22 Exchanges, Shipments, & Transfers;

Ltr, OofCSurg, SOS, ETO, to General Purchasing

Agent, SOS, 29 Jul 43, file HD 008 ETO O/CS

(Policy Book); An. 10 (Medical) to Rpt, U.S. Army

in Scotland, 6 Oct 14, file 091-711 ETO.

15

 Quotation in Hawley Interv, 1962, pp. 10-11,

CMH. See also Larkey "Hist," ch. 1, pp. 31-32. 16

 Hawley Interv, 1962, pp. 11-12, CMH.
BEGINNINGS 13

permitted the Army observers to

reveal their true military colors. When

the War Department, on 8 January

1942, activated Headquarters, United

States Army Forces in the British Isles

(USAFBI), the observers became the

nucleus of a theater staff. General

Chancy assumed command of this

new headquarters, which was to control all Army elements sent to the

United Kingdom under ABC-1 and

RAINBOW-5. Chaney's SPOBS subordinates took corresponding general

and special staff positions. Colonel

Hawley, for example, switched designation from Chief Surgeon, SPOBS,

to Chief Surgeon, USAFBI.17

The plans that USAFBI was to

carry out also changed. During late

December 1941 and early January

1942 President Roosevelt, Prime Minister Churchill, and their chiefs of

staff met in Washington at the ARCADIA conference. Among other decisions, they agreed to deploy a large

American ground combat force to

Northern Ireland. In contrast to the

30,000-man garrison and antiaircraft

contingent contemplated in RAINBOW5 this new force, designated MAGNET,

was to consist of one armored and

three infantry divisions with support

elements, in all about 105,000 men.

MAGNET was to replace British combat

troops in Northern Ireland, allowing

their redeployment to North Africa

and other active theaters. At the same

time American armor and infantry

were to be ready to move into the

neighboring Republic of Eire -if the

Germans invaded that weak neutral

country.18

While the War Department enlarged the Northern Ireland force and

revised its mission, it scrapped plans

for the Army garrison in Scotland and

for the token mobile regiment in

southern England. The Army Air

Forces buildup, however, remained a

firm commitment. Late in January the

War Department activated in the

United States the Eighth Air Force,

which was to be the senior American

air headquarters in Great Britain, as

well as subordinate bomber, fighter,

and base commands. On 20 February

the bomber commander, Brig. Gen.

Ira C. Eaker, and six staff officers arrived in England to begin plans and

preparations for the air offensive.

General Chancy two days later established an Advance Detachment, VIII

Bomber Command, under General

Eaker.19

As USAFBI chief surgeon, Colonel

Hawley had to revise medical plans to

conform to the overall changes in the

RAINBOW-5 deployment, as well as

prepare for medical support of the

troops soon to arrive. He had to do

this in the first months, without even

the semblance of an adequate staff.

Hawley's first assistant, 1st Lt. Dean

S. Fleming, MC, a reservist activated

from the Red Cross-Harvard unit, reported on 7 January. On 10 March,

when Hawley formally organized his

office, he had a staff of three: Lieu17

 GO Nos. 1 and 2, HQ, USAFBI, 8 Jan 42; Ruppenthal, Logistical Support, 1:21-22. Chaney and his

staff at the same time assumed the title of Army

Members, U.S. Military Mission, London, and were

supposed to continue their liaison and observation

activities, but these functions quickly declined in importance and the mission went out of existence in

mid-1942. See GO No. 13, HQ, ETOUSA, 20 Jul

42.

18

 Matloff and Snell, Strategic Planning, pp. 108-09;

Ruppenthal, Logistical Support, 1:21. ARCADIA was the

code name for the Allied summit conference. 19

 GO No. 5, HQ, USAFBI, 22 Feb 42.
14 EUROPEAN THEATER OF OPERATIONS

tenant Fleming and two other Medical

Corps officers, Capt. John T. Martin

and 1st Lt. Barron D. Knox, both

fresh from the United States. Knox

initially assumed the tasks of executive officer, liaison officer, and supply

officer. Fleming, an epidemiologist,

took charge of preventive medicine,

personnel, physical standards, and

medical reports and returns; and

Martin, a recent Medical Field Service

School graduate, became flight surgeon.20

With the exception of Fleming,

whom Hawley considered a "very

good young epidemiologist," Hawley's first assistants were of only limited use. Martin and Knox, Hawley reported, "are both good youngsters

and will make someone a good assistant; but they are quite incapable of

taking over any section of this office

and operating it, and there simply

isn't time to devote long hours to

training them from the ground up."

Repeated pleas to the surgeon general's office for experienced executive

and supply officers elicited little but

promises, as the Medical Department

as a whole was short of qualified men

in these fields. As a result, until late

April, Colonel Hawley had to do most

of his planning and administration

himself. He lamented: "I can do the

administration, the preventive medicine, the medical planning. But I can't

keep on doing all of them.

And ... I am not qualified to do the

detailed supply planning."

 21

Additional officers gradually straggled in. By mid-May Hawley's commissioned staff had grown to nine, including an executive officer of field

rank, a dentist, a veterinarian, and a

supply officer, the latter transferred

from duty with the Canadian Army.

With these reinforcements Hawley

was able to place at least one man in

seven of the planned nine divisions of

his office (Chart 1). Many of his new

assistants, nevertheless, lacked experience in their jobs, and the staff shortage would continue to grow worse as

the chief surgeon's responsibilities expanded.22

Medical Plans and Programs

During early 1942 Hawley revised

his Air Force medical support plans

to conform to the evolving requirements of General Eaker's projected

bomber command. Hawley reiterated

his recommendation that each air station have an infirmary with enough

beds for 1 percent of the troops located there, while a base command serving all ground and air forces furnished station and general hospitals

and supply depots. By 13 March

Hawley had selected locations for

three station hospitals to support the

first bombardment groups scheduled

for deployment. Additional site selections had to await completion of

Eighth Air Force plans and the arrival

20

 Office Order No. 2, OofCSurg, USAFBI, 10

Mar 42. 21

 Quoted words from Ltr, Hawley to TSG, 4 Apr

42. See also Ltrs, Hawley to TSG, 12 Feb and 29

Apr 42; Ltr, Col F. A. Blesse, MC, to Hawley, 21

Mar 42. All in file HD 024 ETO O/CS (HawleySGO Corresp). Hawley shared his staff shortage

with the rest of USAFBI, which included a total of

twenty-four officers and thirteen enlisted men in

January 1942 and received no significant augmentation until April. See Ruppenthal, Logistical Support,

1:31-32, and Msg, Chaney to TAG, WD, 17 Jan 42,

file ETO Admin 388. 22

 Office Orders Nos. 5, 7, 12, OofCSurg,

USAFBI, 29 Apr, 11 May, and 19 May 42, respectively; Larkey "Hist," ch. 3, pp. 3-5.

16 EUROPEAN THEATER OF OPERATIONS

of troops. The latter were slow in

coming, due to shipping shortages

and the diversion of men and aircraft

to meet urgent needs in the Pacific.

The first contingent of 1,800 Air

Force soldiers did not reach England

until 11 May, and major movements

of men, equipment, and aircraft were

delayed until June.23

Besides reworking his Air Force

medical plans, Hawley expanded

upon his overall hospital program for

the United Kingdom. On 16 January

he recommended provision of hospitals for the entire command on the

formula earlier established for the Air

Force: infirmary beds for 1 percent of

strength, station hospital beds for 4

percent, general hospital beds for 3

percent, and convalescent beds for

1.3 percent. He declared that few

British hospitals would be available

for transfer to the American Army

and ruled out conversion of other

buildings as expensive and unlikely to

produce satisfactory results. Hawley

favored instead constructing new

semipermanent hospitals from the

ground up. He advocated use of the

British 20-by-40-foot wood and metal

Nissen hut as the basic unit for such

hospitals, as the hut could be adapted

for wards, operating rooms, mess

halls, or any other purpose and afforded some protection against

bombing. By late February Hawley

had established definite hospital requirements for the forces in England.

The Air Force would need thirtyseven battalion-size infirmaries and

five station hospitals, each with 125 to

500 beds. The base command, for logistics and support troops, would require twenty-five battalion infirmaries;

two station hospitals; two general

hospitals, each with 1,000 beds; and

one convalescent hospital, with 2,000

beds. The general and convalescent

hospitals were to serve both the base

and the bomber commands.24

Throughout the short organizational life of USAFBI, reception and accommodation of the MAGNET force

absorbed much of the effort of all

staff sections. Plans called for the initial MAGNET troop contingent—the

first significant American force to

reach the United Kingdom—to arrive

late in January. More troops were to

follow as rapidly as the limited

amount of shipping and the demands

of global war permitted.

Colonel Hawley quickly revised his

and Major Welsh's Northern Ireland

medical plans. Between 6 and 15 January Hawley surveyed British medical

facilities in Northern Ireland. He arranged with the commander of British

troops in Northern Ireland for

MAGNET to take over the hospitals

and medical supplies of redeploying

British units and also secured an

agreement that this force would treat

MAGNET casualties in its hospitals

until the Americans established their

own. Hawley set the MAGNET hospital

23 requirements on the same 1-4-3-per- Larkey "Hist," ch. 2, pp. 12-16. For the beginning of the Air Force buildup, see Ruppenthal, Logistical Support, 1:26-31, and Wesley F. Craven and

James Lea Cate, eds., The Army Air Forces in World

War II (hereafter cited as AAF), 7 vols. (Chicago: University of Chicago Press, 1948-58), vol. 1, Plans and

Early Operations, January 1939 to August 1942 (1948),

pp. 618-42.

24

 Memo, Hawley to CEngr, HQ, USAFBI,

via G-4, 16 Jan 42, in Larkey "Hist," ch. 2. app. 1;

Ltr, Hawley to CSurg, GHQ, WD, 12 Feb 42, file

HD 024 ETO O/CS (Hawley-SGO Corresp); Msg,

USAFBI to AGWAR, 28 Feb 42, file ETO Admin

388.
BEGINNINGS 17

cent basis as he had recommended

for England. He estimated that the

British hospitals to be taken over

would provide about 2,000 general

and perhaps 170 station hospital

beds, while U.S. Navy hospitals at

Londonderry and Lough Erne, to be

acquired by the Army, would account

for another 600 station beds. The rest

of the approximately 7,000 fixed beds

needed would have to come from new

construction of 1,000-bed general and

500-bed station hospitals. In addition,

the existing British hospitals would

require some construction to bring

operating theaters, X-ray facilities,

mess hall refrigeration, and staff

quarters up to American standards.

Because MAGNET was to be a

mobile field force, Hawley proposed

that three of the projected 500-bed

station hospitals be occupied by 750-

bed evacuation hospitals. Each evacuation hospital so employed would

keep its field equipment in storage

and use a separate set of station hospital equipment. During active operations the evacuation hospital would

pick up its stored equipment and

follow the troops, while a station hospital complement, sent from the

United States, took over the fixed facility. Hawley advocated this arrangement as a way of economizing on

scarce hospital units, but the War Department delayed approval until further changes in MAGNET plans made

the proposal obsolete.25

On 19 January a 36-man (18 officers and 18 enlisted men) headquarters advance party from the V Corps,

the principal MAGNET command, arrived in Great Britain. The group included Lt. Col. Charles E. Brenn,

MC, the corps surgeon. Brenn went

to London with the rest of the party

and at once conferred with Hawley.

The two surgeons discovered an embarrassing misunderstanding. Brenn,

before leaving for England, had spent

several days at the surgeon general's

office developing his own Northern

Ireland medical plan in consultation

with Major Welsh. Surgeon General

Magee had directed Brenn to do so

on the mistaken assumption that

MAGNET was to be a separate force,

independent of USAFBI. A similar

misunderstanding of their position

prevailed among other MAGNET officers who, according to Hawley,

considered USAFBI "a bunch of

interlopers trying to usurp the divine

authority of MAGNET." In spite of

these difficulties Hawley and Brenn at

once developed a smooth working relationship. They adopted Hawley's

plan for Northern Ireland, because it

was based on current firsthand information and included agreements with

the British. Once established in Belfast, Brenn exercised much independent authority, but he deferred to

Hawley as theater chief surgeon.

Hawley later said of Brenn: "He is

completely proper and he is doing a

fine job."

 26

25

 Memo, Hawley to CEngr, HQ, USAFBI, via G4, 16 Jan 42, in Larkey "Hist," ch. 2, app. 1; An. 6

(Medical Plan) MAGNET, 19 Jan 42, in Larkey

"Hist," ch. 2, app. 2 (see also ch. 2, pp. 4-6); Msg,

USAFBI to AGWAR, 3 and 28 Feb 42, file ETO

Admin 388; Ltr, Hawley to CSurg, GHQ, WD, 12

Feb 42, file HD 024 ETO O/CS (Hawley-SCO Corresp); Memo, Surg, V Corps, to TSG, sub: Medical

History, 10 Jan 44; "History of Medical Service,

SOS, ETOUSA, from Inception to 31 December

1943" (hereafter cited as "Med Svc Hist, 1942-43"),

ex. C, file HD 314.7-2 ETO. 26

 First quotation in Ltr, Hawley to Blesse, 18

Apr 42, and second quotation in Ltr, Hawley to Continued
18 EUROPEAN THEATER OF OPERATIONS

On 24 January Hawley and Brenn

left London for Belfast to meet the

first MAGNET troop contingent. That

same day General Chancy issued

orders creating the U.S. Army Northern Ireland Force (USANIF) to control all MAGNET troops under

USAFBI. Two days later about 4,000

United States soldiers, most of them

members of the 34th Infantry Division, became the first American fighting men of World War II to disembark in the United Kingdom. The division commander, Maj. Gen. Russell

P. Hartle, who accompanied the

troops, assumed command of both

USANIF and V Corps.27

This initial MAGNET contingent

brought with it the first Army medical

troops to enter the European Theater

of Operations. They included the

10th Station Hospital; an element of

the 136th Medical Regiment; and

medical detachments of the 133d Infantry, the 151st Field Artillery, the

109th Quartermaster Regiment, the

112th Engineer Battalion, and the

63d Signal Battalion—in all 41 officers, 42 nurses, and 322 enlisted

men. As a result of mismanagement

at the New York Port of Embarkation

and a shortage of shipping, these

units landed at Belfast without most

of their equipment. Hence, the first

MAGNET troops had to depend on the

British for all medical services. While

the Allies provided generously, the

Americans' total dependency, according to Hawley, "made a very bad impression upon the British." A second

MAGNET contingent of about 7,000

men, including the 7th General Dispensary and elements of the 109th

Medical Battalion, arrived on 2 March

no better supplied, although "driblets" of medical equipment addressed

to units in the Caribbean and Iceland

came in on various transports.28

With extensive British assistance

the first MAGNET contingents settled

in. The troops crowded into Nissen

huts in camps turned over by the

British. Initially, the Americans ate

British Army rations, received their

mail from the British postal service,

and had their clothes cleaned and

shoes repaired in local establishments. Field artillerymen, sent over

without their 105-mm. howitzers,

learned to fire and maintain the British 25-pounder. Gradually, as supply

ships arrived, USANIF established its

own mail, laundry, and post exchange

services. By late March the mess halls

were beginning to serve American rations instead of the unfamiliar and

nutritionally less satisfactory British

menu.29

As rapidly as possible, USANIF set

up its own hospitals. On 9 March the

10th Station Hospital took over a

British military hospital at Ebrington

Barracks, Londonderry, complete with

its existing equipment and patients.

By rearranging the wards and acquiring additional buildings the American

staff increased the capacity of this

plant from 150 to 350 beds. To furnish additional fixed hospitals,

USANIF pressed mobile medical units

CSurg, GHQ, WD, 12 Feb 42 (see also Ltr, Blesse

to Hawley, 21 Mar 42), all in file HD 024 ETO

O/CS (Hawley-SGO Corresp); Larkey "Hist," ch. 2,

p. 9.

"Ruppenthal, Logistical Support, 1:22-26.

28

 An. 6 (Medical Plan) MAGNET, 19 Jan 42, in

Larkey "Hist," ch. 2, app. 2; Ltrs, Hawley to CSurg,

GHQ, WD, 12 Feb 42, Blesse to Hawley, 21 Mar 42,

and Hawley to TSG, 4 Apr 42, all in file HD 024

ETO O/CS (Hawley-SGO Corresp). 29

 Ruppenthal, Logistical Support, 1:23-26.
BEGINNINGS 19

into service. The clearing company of

the 34th Division's 109th Medical

Battalion and later those of the 1st

Armored Division's 47th Medical Battalion and the V Corps' 503d Medical

Battalion all operated small temporary station hospitals. The 109th's

company staffed a former U.S. Navy

hospital at Lough Erne until September, when the newly landed 160th

Station Hospital relieved it (see Map

1).30

The 5th General Hospital, the first

unit of its kind scheduled for deployment with MAGNET, had been included in the second troop contingent;

but it did not open in Belfast until

late May, after a long, frustrating odyssey. A 500-bed affiliated unit sponsored by Harvard University, the hospital embarked at New York on 19

February with its equipment and a

staff of 37 officers, 60 nurses, and

275 enlisted men.31 Most of the personnel, including the hospital commander, Lt. Col. Maxwell G. Keeler,

MC, embarked on a single vessel; but

7 officers, 28 nurses, and 14 enlisted

men sailed on other ships to provide

medical care on the voyage. Soon

after leaving port, a mechanical

breakdown crippled the transport carrying the main body, forcing the ship

to turn back to Halifax, Nova Scotia,

and eventually to Boston, Massachusetts, where the 5th disembarked; the

group spent the next month and a

half at Camp Edwards awaiting space

on another ship. The rest of the unit

landed at Belfast early in March.

While the nurses assisted in various

American and British hospitals, the

officers and enlisted men collected

the hospital's equipment at the intended location, the British Army's

31st General Hospital at Musgrave

Park on the outskirts of Belfast.

The main body embarked again on

30 April and reached Belfast on 12

May. Nine days later the 5th General

Hospital opened it first wards at Musgrave Park. The unit's plant, a threestory brick building formerly used as

a boys' reformatory with attached

Nissen-hut wards, had room for about

800 beds. At the outset, crated equipment and supplies filled most of the

wards. About the time of the hospital's opening a major serum hepatitis

epidemic hit the Northern Ireland

forces. As a result, according to Colonel Keeler, "it was just a constant

run-around to see whether we could

get beds set up fast enough each day

to accommodate the number of patients that had to be admitted. . . ."

Within two weeks, the staff had twelve

wards in operation, caring for over

400 patients. In June, as the Musgrave Park facility filled to its 800-bed

capacity, the 5th opened a 900-bed

convalescent annex in a nearly completed former EMS hospital in Waringfield, about 20 miles away. The

hospital's patient load reached a peak

of 1,500 in the two facilities during

late August. Supporting some 60,000

American and British troops, the 5th

General Hospital provided training as

30

 10th Station Hospital Annual Rpt, 1942; "Med

Svc Hist, 1942-43," ex. C, file HD 314.7-2 ETO. 31

 The unit initially was overstaffed for its 500-bed

capacity, and the commanding general of the New

York Port of Embarkation attempted to transfer its

28 excess officers to tactical units of the 34th Division that lacked medical officers. The unit bitterly

resisted this, on grounds that the Office of the Surgeon General had promised affiliated units, when

organized, that they would serve together. Eventually, the OSG resolved the problem by transferring

the excess officers in a body to Walter Reed Army

Medical Center. See 5th General Hospital Annual

Rpt, 1942.

BEGINNINGS 21

well as medical care. Under an exchange program, division medical officers worked for brief periods in the

wards and hospital staff members

were temporarily assigned to units.

This arrangement "gave those medical officers of the 5th . . . who had

come straight from civilian life a

much better understanding of what

the soldier goes through within his

own organization," while affording

unit officers a chance for hospital and

professional experience.32

For USANIF Colonel Brenn established an evacuation policy on the

principles earlier prescribed by

Hawley. As soon as they could, unit

medical detachments set up dispensaries to treat patients requiring less

than 72 hours of care. Using ambulances, organic vehicles, and sometimes buses and trains, units sent men

requiring more extended treatment to

British hospitals; to the 10th Station

and 5th General Hospitals; or to the

smaller facilities operated by the

clearing companies. A disposition

board of medical officers established

by order of USAFBI determined

which sick and injured men should be

evacuated to the United States. Initially located at the 10th Station Hospital and later moved to the 5th General Hospital, the board sent some

psychotics, patients needing locally

unavailable special therapies or diets,

and men unable to return to duty

within 180 days. Evacuees who could

care for themselves crossed the Atlantic on returning troopships, usually

the fast liners Queen Mary and Queen

Elizabeth. Mental and litter patients

traveled on British or Canadian hospital ships, as the United States had

no such vessels of its own in the Atlantic.33

Early in the Northern Ireland occupation Colonel Brenn issued elaborate sanitary regulations, based on the

plans Colonel Hawley had developed

in January. Brenn emphasized the responsibility of unit commanders and

medical officers for protecting troop

health. He banned the use of locally

produced fresh milk, because Irish

cattle often were infected with tuberculosis and few dairies practiced

proper pasteurization, and the use of

private water supplies, enjoining

troops to treat them as polluted until

proven otherwise. He also prescribed

procedures for keeping mess halls

and kitchens clean and for disposing

sewage and garbage. ("Garbage removal by pig keepers in adjacent

areas will be arranged for.") Troops

were to bathe and change clothing

"at least twice a week," and units

were to make every effort to keep

their men in dry clothes to reduce the

incidence of respiratory ailments in

the damp climate. Venereal disease

prevention received Brenn's special

attention. Convinced of the need to

provide cheap, plentiful prophylactic

devices for the troops, he directed

units, in cooperation with municipal

authorities and the Royal Ulster Constabulary, to establish off-base prophylactic stations and to trace the

contacts of men who became infected.

32

 Ibid.; Interv, OSG with Col Maxwell G. Keeler,

MC (hereafter cited as Keeler Interv), 17 Jul 45, box

223, RG 112, NARA.

33

 "Med Svc Hist, 1942-43," pp. 18-19, file HD

314.7-2 ETO; Ltr, Hawley to TSG, 25 Apr 42, file

HD 024 ETO O/CS (Hawley-SGO Corresp), in

which the chief surgeon expresses his determination

to keep helpless patients off transports subject to Uboat attacks.
22 EUROPEAN THEATER OF OPERATIONS

Mindful of local sensitivities, Brenn

warned that such arrangements must

be made "tactfully and unostentatiously" by using, for example, such

terms as "Aid Station, U.S. Army,"

rather than more descriptive ones, on

the signs identifying prophylactic stations.34

The Army force in Northern Ireland never reached its full projected

strength. Two more contingents arrived during May, including the rest

of the 34th Division and the entire 1st

Armored Division, as well as the bulk

of the V Corps headquarters and

corps troops. Their arrival brought

USANIF to its peak strength of about

32,000 officers and men. On 30 May,

however, the War Department

dropped the other two divisions from

MAGNET. On 1 June USANIF and V

Corps headquarters merged into

Headquarters, U.S. Army Northern

Ireland Forces and V Corps (Reinforced). USANIF at the same time

established a provisional Northern

Ireland Base Command, staffed as an

additional duty by officers from the

main headquarters. Colonel Brenn

served as chief surgeon of both new

commands.35

As the medical service in Northern

Ireland took shape, Colonel Hawley

in London negotiated for the U.S.

Army's acquisition of the American

Red Cross-Harvard Unit and the

Churchill Hospital. During April

Hawley reached an understanding

with the Emergency Medical Services

and the Harvard unit. The unit, with

its doctors and nurses given Army

commissions, was to become a general medical laboratory as soon as

American forces in the United Kingdom expanded enough to need its

full-time services. The Army absorbed

the unit on 15 July. Until then, Dr.

Gordon and his staff informally assisted Hawley in epidemiology and preventive medicine.36

Concurrent negotiations for the

Churchill Hospital, newly moved into

its EMS-constructed facility near

Oxford, went less well. The hospital

director, Dr. Harlan Wilson, refused

to deal with any American authority

in Britain below the ambassador.

Hawley at the same time became disenchanted with the Churchill staff,

which, he reported, had "played more

with the 'Lords and Lydies' than with

the E.M.S." Yet he wanted their hospital plant. Eventually, Hawley arranged with the surgeon general to

have a 500-bed general hospital sent

from the United States to take over

the Churchill building and incorporate some members of the civilian

staff. This plan broke down. In July

the War Department sent the 1,000-

bed 2d General Hospital to occupy

the Oxford facility; however, the unit

was too large for the hospital building

and had no personnel vacancies for

the volunteer doctors and nurses.

Most of the eligible members of the

Oxford staff, who were unwilling to

be dispersed to other units, there34

 Quotation in GO No. 6, HQ, USANIF, 2 Feb

42. See also ETO, "SPOBS Hist," p. 149; An. 6

(Medical Plan) MAGNET, 19 Jan 42, in Larkey

"Hist," ch. 2, app. 2. 35

 ETO, "SPOBS Hist," pp. 134-39; GO No. 28,

HQ, USANIF, 31 May 42, and SO No. 1, HQ,

USANIF, and V Army Corps (Reinf), 1 Jun 42, in

file Orders (GO, SPO), HQ, V Corps, USANIF,

USAFBI, 1942.

36

 ETO, "SPOBS Hist," pp. 169-70; Ltr, Hawley

to TSG, 29 Apr 42, file HD 024 ETO O/CS

(Hawley-SGO Corresp); Larkey "Hist," ch. 1, pp.

10-11.
BEGINNINGS 23

upon refused to join the Army. The

2d General Hospital finally established itself in the Oxford plant,

which the British enlarged to accommodate the unit.37

The 2d General Hospital arrived in

time to help USAFBI and USANIF

cope with their first major medical

crisis, an epidemic of serum hepatitis.

This epidemic had begun in February

and quickly incapacitated large numbers of troops in the United States

and overseas. By late April the Preventive Medicine Service, Office of

the Surgeon General, had traced the

source of the epidemic to several lots

of contaminated yellow fever vaccine

made with human serum. The Army

at once stopped using vaccine from

that particular manufacturer, but by

that time men who had received the

vaccine earlier in the year were

coming down with hepatitis,38 including many who arrived in Northern

Ireland in the May troop shipments.

Before the epidemic passed its peak

in late July 1,950 soldiers in the European Theater were stricken, 2 of

whom died. About 100 suffered permanent liver damage, which rendered

them unfit for further military service,

and those who recovered required

long periods of recuperation. To help

care for the sudden influx of sick,

Colonel Hawley in July sent part of

the 2d General Hospital staff, who

were awaiting expansion of their

Oxford plant, to Belfast to reinforce

the 5th General Hospital. The 2d

General Hospital personnel helped

operate the 5th's convalescent facility

at Waringfield. With this augmentation and with continued British help,

the Northern Ireland hospitals satisfactorily met the emergency. At

USAFBI direction, the Red CrossHarvard Unit and the 5th General

Hospital conducted their own search

for the source of the epidemic. They

independently reached the same conclusion as investigators in the United

States, that it was a post-vaccinal infection. This finding reassured British

health authorities, who feared the

spread of a possible infectious hepatitis epidemic to the civilian population.39

While the epidemic ran its course,

more ambitious deployment plans superseded RAINBOW-5 and MAGNET,

and USAFBI gave way to a new theater command. These changes nullified

most of the plans and many of the

preparations of Colonel Hawley and

his slowly expanding medical establishment. The chief surgeon and his

staff would have to do most of their

work over again on a grander scale.

37Larkey "Hist," ch. 1, pp. 3-8; ETO, "SPOBS

Hist," p. 170; Ltrs, Hawley to TSG, 29 Apr and 17

Jul 42, and TSG to Hawley, 25 May 42, file HD 024

ETO O/CS (Hawley-SGO Corresp); Ltr, Maj Gen J.

C. H. Lee to CG, SOS, WD, 21 Sep 42, file HD 024

ETO CS (Hawley Chron); file 322.15 (Churchill

Hospital, Misc. Papers) on Churchill transfer. 38

 Serum hepatitis has an incubation period of 60-

154 days.

39

 The course of the epidemic, which caused over

49,000 cases in the Army throughout the world, is

recounted in Ebbe Curtis Hoff, ed., Communicable

Diseases Transmitted Through Contact or by Unknown

Means, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1960), ch.

XVII. See also "Med Svc Hist, 1942-43," p. 37, file

HD 314.7-2 ETO; Interv, Harlan B. Phillips with

Dr. Stanhope Bayne-Jones, 21 Mar-28 Jul 66 (hereafter cited as Bayne-Jones Interv, 1966), vol, 3, p.

692, NLM; Keeler Interv, 17 Jul 45, box 223, RG

112, NARA; Ltrs, Hawley to TSG, 9 Jun, 1 and 17

Jul, and 7 Aug 42, file HD 024 ETO O/CS (HawleySGO Corresp).
24 EUROPEAN THEATER OF OPERATIONS

Yet they had gained valuable experience in these first months of war, especially in supporting the MAGNET

force. They had worked out the general principles for organizing an Army

medical service in Great Britain. Most

important, they had established a

close cooperative relationship, based

on mutual professional respect and,

in many cases, personal friendship,

with British military and civilian medical officials.
CHAPTER II

From BOLERO to TORCH

From the start of war preparations

the United States intended to make

its major military effort in the Atlantic, with the aim of destroying Nazi

Germany. RAINBOW-5 and MAGNET

were only preliminary steps toward

that end. During March 1942, searching for a more decisive course of

action and for definite goals to guide

Army mobilization, Chief of Staff

Marshall and the Operations Division

of the General Staff drafted a proposal for a full-scale assault on Nazi-occupied Europe. Their plan called for

expansion of the bomber offensive

and for deployment of 1 million

American combat and support troops

in Britain by April 1943. The buildup

was to proceed rapidly enough to

permit small cross-Channel attacks in

late summer 1942. It was to culminate

in the spring of the following year in

an invasion of France, followed by a

drive into Germany.

President Roosevelt approved this

plan and in mid-April sent Harry L.

Hopkins, his personal troubleshooter,

and Marshall to London to present it

to the British. Marshall and Hopkins

secured tentative British assent. The

two governments at once set up

Anglo-American combined committees in Washington and London to

direct the huge troop buildup, codenamed BOLERO. Other committees

began planning the late-1942 attack

(SLEDGEHAMMER), to be launched if

necessary to relieve pressure on the

Russians, and the major invasion

(ROUNDUP) for early 1943.1

Theater Reorganization

To carry out these new plans, the

War Department reorganized the

Army command structure in the

United Kingdom. On 14 May 1942 it

directed USAFBI to establish a services of supply, which was to control

all the technical services and assume

most theater logistics functions. The

Services of Supply (SOS) in Britain

would be the counterpart of the War

Department Services of Supply (later

renamed Army Service Forces),

formed earlier under Maj. Gen.

Brehon B. Somervell as one of three

1

 BOLERO initially referred to the entire buildup

and invasion plan; but, to avoid confusion, President Roosevelt in July restricted use of that code

name to measure for the establishment of American

forces in the United Kingdom. Development of the

BOLERO plan is traced in Matloff and Snell, Strategic

Planning, pp. 174-91. See also Ruppenthal, Logistical

Support, 1:52-55, and Gordon A. Harrison, CrossChannel Attack, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1951), pp. 11-19.
26 EUROPEAN THEATER OF OPERATIONS

overall Army functional commands.2

On 8 June USAFBI itself ceased to

exist. The War Department redesignated it the European Theater of Operations, United States Army

(ETOUSA), and included within the

boundaries of this new theater Great

Britain, Western Europe, and Iceland.

Providing an explicit definition of authority that USAFBI had lacked, the

War Department gave ETOUSA operational control of all United States

military forces within its boundaries,

as well as administrative and logistical

authority over the Army elements.

ETOUSA, under the strategic direction of the Anglo-American Combined Chiefs of Staff, was to "prepare

to carry on military operations in the

European Theater against the Axis

Powers and their Allies." General

Chancy headed the new command

until 24 June, when Maj. Gen. Dwight

D. Eisenhower replaced him.3

While the new theater command

structure was taking shape, Allied war

plans again changed. The British had

agreed to attempt SLEDGEHAMMER and

ROUNDUP only with hesitation and

many reservations. As planners in

Washington and London studied the

tactical and logistical problems involved, the feasibility of SLEDGEHAMMER and even of a 1943 ROUNDUP

came increasingly into question, confirming earlier British doubts.4

 At the

same time the military situation demanded some sort of Anglo-American

initiative. The Russians were pressing

for the opening of a European

"second front," and British forces in

North Africa were retreating under

heavy German-Italian attack. During

June Churchill and his chiefs of staff

began urging President Roosevelt to

drop plans for SLEDGEHAMMER in

favor of an invasion of Northwest

Africa (GYMNAST), a project long advocated by the British. The American

chiefs of staff fought hard to save

SLEDGEHAMMER, but the British eventually convinced Roosevelt—who

above all wanted an offensive somewhere in Europe or the Mediterranean in 1942—to undertake the

North African attack. By the end of

July the Allies had decided to launch

a combined assault on Northwest

Africa (Morocco, Algeria, and Tunisia) before December 1942, even

though this meant the cancellation of

SLEDGEHAMMER and the probable

postponement of ROUNDUP for up to

a year. At the same time the Allies

would continue the BOLERO buildup,

drawing from it part of the troops

and supplies for the African campaign, now renamed Operation

TORCH.

To direct the new operation, the

Americans and British late in July selected the ETO commander, General

Eisenhower, and enlarged ETOUSA

to include North Africa. Under Eisen2

 The other two were the Army Air Forces and

Army Ground Forces. 3

 The basic directive establishing the Services of

Supply is Memo, CofS, U.S. Army, to CG, USAFBI,

14 May 42, sub: Organization of Services of Supply,

file HQ, ETOUSA AGO 320.3 SOS. See also Ruppenthal, Logistical Support, 1:33-40, 43, 47-48. Quotation on p. 40. Chaney had disagreed with the War

Department on, among other things, Air Force organization in Britain, and General Marshall preferred a commander in closer touch, as Eisenhower

was, with Washington thinking and plans.

4

 For the medical difficulties of attempting to support SLEDGEHAMMER, see Larkey "Hist," ch. 4, pp.

2-6 and apps. 2-3.
FROM BOLERO TO TORCH 27

LT. GEN. JOHN C. H. LEE

(1945 photograph)

hower an Anglo-American staff in

London, later designated Allied Force

Headquarters (AFHQ), planned and

organized the invasion. American personnel for this headquarters came from

ETO and SOS headquarters, which

were responsible for supporting

TORCH until the invasion force secured its North African lodgement.

For the European Theater of Operations and the Services of Supply, this

double effort—simultaneously to receive large forces in Britain and

mount an invasion of Africa—led to

months of confusion and improvisation. The theater medical service

would undergo its share of the

strain.5

The Office of the Chief Surgeon

For Colonel Hawley theater reorganization brought both personal and

institutional challenges in 1942. Formation of the theater Services of

Supply at first threatened him with

loss of his position as ETO chief surgeon. The War Department permitted

the newly designated SOS commander, Maj. Gen. John C. H. Lee, an experienced Engineer officer, to select

key members of his staff from men

recommended by the various War Department chiefs of services. Surgeon

General Magee proposed Hawley as

"best fitted" for the position of SOS

chief surgeon, the equivalent of the

job Hawley then was filling; but Lee,

before he left for London late in May,

chose Magee's recommended first alternate, Col. John F. Corby, MC, previously surgeon of the Fourth Army.

Corby arrived in England early in

June but promptly succumbed to the

hepatitis epidemic and spent his first

two weeks in the theater in a London

hospital. Lee in the meantime became

acquainted with Hawley and with the

extent of Hawley's knowledge of the

theater and preparatory work. He also

discovered that Hawley was senior to

Corby. Lee, therefore, invited

Hawley, who had expected to be relieved and sent home, to stay on as

both the ETO and SOS chief surgeon. Hawley, not surprisingly,

agreed to do so. Corby, after a brief

period as medical liaison officer to

the British Southern Command,

became deputy force surgeon of

5

 Harrison, Cross-Channel, pp. 21-32; Ruppenthal,

Logistical Support, 1:91-92.
28 EUROPEAN THEATER OF OPERATIONS

Allied Force Headquarters and eventually went to North Africa.6

Chain-of-Command Problems

Less easily resolved were the questions of authority and jurisdiction

arising from the interposition of another headquarters—the Services of

Supply—between special staff section

heads, such as the chief surgeon, and

the theater commander. The chiefs of

the technical services now were in a

different echelon from the commander they were supposed to advise. Further, being incorporated within one

of several coordinate commands

under the theater, the service chiefs

lacked the authority to give technical

direction to subordinate elements operating outside the Services of

Supply, for example, medical units attached to the Eighth Air Force or the

ground armies.

This latter problem especially concerned Colonel Hawley. Even before

formation of the Services of Supply,

Hawley had maintained that the ETO

chief surgeon required theater-wide

technical control in at least four

areas. First, the theater surgeon must

be able to supervise medical unit operations and training in all echelons

to ensure adequate, uniform treatment of casualties throughout the

chain of evacuation. Second, he

should have authority to coordinate

evacuation between the several echelons of command. Casualties, Hawley

pointed out, "are perishable. . . .

They require continuous care and

treatment during the entire journey

from front to rear; and this can only

be accomplished if one agency coordinates the entire operation."

Third, the theater surgeon also

should supervise preventive medicine,

because "communicable diseases recognize no echelon of command" and

because it was not practicable to establish the necessary expert staff at

every headquarters. Finally, he should

collect medical reports and statistics,

to avoid burdening nonmedical channels with this information. Commenting early in June on a draft general

order defining SOS functions, Hawley

warned that subordination of the

ETO chief surgeon to the SOS commander effectively would prevent him

from performing any of the aforementioned tasks, unless the commander himself were empowered to

issue theater-wide directives on some

matters. Privately, he expressed himself bluntly: "From where I set [sic],

everybody seems to have gone completely nuts in the field of staff organization."

 7

6

 Memo, TSG to Maj Gen J. C. H. Lee, 7 May 42,

file SPMC 322.051-1; Hawley Interv, 1962, pp. 12-

14, CMH; MFR, Col Joseph T. McNinch and Dr.

Nora V. Lewison, 24 May 49, sub: Interview With

Col James B. Mason, MC (Ret.), file HD 000.71,

CMH; Ltrs, Hawley to TSG, 10 and 15 Jun 42, HD

024 ETO O/CS (Hawley-SGO Corresp). Hawley

was a close friend of Dr. Frederick W. O'Donnell,

with whom Lee had served in the 89th Division in

World War I, and the sentimental tie weighed heavily with Lee. See Lt Gen J. C. H. Lee, "Service Reminiscences," pp. 82, 97, P-1, box 1, Hawley

Papers, MHI. Corby, who lacked staff experience

and suffered from emotional problems, was relieved

from the Allied Force Headquarters in early February 1943. See Interv, OSG with Maj Gen Albert W.

Kenner, MC (Ret.), 9 Jan 52 (hereafter cited as

Kenner Interv, 1952), file HD 000.71, CMH.

7

 Chief surgeon's views on his authority, including

quotations in body of paragraph, from: Memo,

Hawley to Gen Larkin, 29 May 42, sub: Definition of

Medical Responsibility, Hawley Big Picture file,

SGO HistDivFiles; and Memos, Hawley to G-1,

USAFBI, 17 Apr 42, Hawley to AG, USAFBI, 1 Jun

42, sub: Comments on Draft of General Order Es- Continued
FROM BOLERO TO TORCH 29

Relocation of the SOS headquarters

complicated the question of the special staffs status. In mid-July, to

obtain space for his growing establishment, General Lee moved the Services of Supply from crowded London

to an unused British office complex at

Cheltenham, a resort and retirement

community of about 50,000 people,

90 miles northwest of the capital.

This relocation included all sections

(except the Procurement Branch) and

their chiefs. It physically separated

Hawley and his colleagues from the

ETO headquarters, which remained

in London.8

During June and July General

Chaney and his successor, General Eisenhower, issued a series of orders

and circulars attempting to clarify the

dual position of the special staff. On

20 July, as the Services of Supply was

completing its move to Cheltenham, Eisenhower established the policy that

would prevail until early 1943. His

General Order No. 19 reaffirmed

General Lee's broad responsibility for

logistics planning and operations in

the theater and authorized Lee to

communicate directly with the War

Department and the British on supply

matters. Within ETOUSA Eisenhower

set up eighteen staff sections. The

heads of eight were to be stationed at

theater headquarters in London. The

other chiefs, including Hawley, also

were considered members of the theater staff, but they were to stay at

Cheltenham and "for the time being,

will operate under the immediate direction of the Commanding General,

SOS." Each Cheltenham-based staff

section was to maintain a liaison officer at the ETO headquarters, and its

chief was to advise the theater commander as required. On the question

of supervision of the technical services Eisenhower authorized the service chiefs to correspond directly with

their subordinates in other commands

"insofar as technical instructions, requests for technical reports, and matters of general routine . . . are concerned"; but they would have to send

proposed "orders, policies, or other

instructions, pertaining to the services

for the theater as a whole," first to

SOS headquarters for approval and

then to the ETO adjutant general for

issue in the name of the theater commander.9

While General Order No. 19 in

principle established theater-wide

technical authority for the service

chiefs, Colonel Hawley remained dissatisfied with both his physical location and his position in the chain or

command. The stationing of a liaison

tablishing the Service of Supply, and Hawley to

G-1, USAFBI, 8 Jun 42, sub: Comments on Directive for SOS, USAFBI, all in Hawley File of Memos,

Letters, etc., 1941-1942. Final quotation from Ltr,

Hawley to TSG, 6 Jul 42, HD 024 ETO O/CS

(Hawley-SGO Corresp). See also Ruppenthal, Logistical Support, 1:37-39. The establishment of a War

Department-level SOS had similar effects on the

position of the surgeon general. See Blanche B.

Armfield, Organization and Administration in World War

II, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1963), pp.

72-83. 8

 Memo, Acting AG, SOS, to Chiefs of Sections,

HQ, SOS, 17 Jul 42, sub: Change of Station of

Headquarters, SOS; Ruppenthal, Logistical Support,

1:81-83. The new office complex consisted of two

groups of one-story temporary buildings with over

500,000 square feet of space. Built by the British to

house the War Office if it were bombed out of

London, it was never fully occupied.

9

 Quotations from GO No. 19, HQ, ETOUSA, 20

Jul 42, in Larkey "Hist," ch. 3, app. 18. See also

Ruppenthal, Logistical Support, 1:40-44; Ltr, Hawley

to TSG, 11 Sep 42, file HD 024 ETO O/CS

(Hawley-SGO Corresp).
30 EUROPEAN THEATER OF OPERATIONS

officer in London only partially overcame the separation of theater and

SOS staffs, for the ETO chief surgeon's representative was out of

touch with day-to-day activities and

decisions at Cheltenham and lacked

independent authority of his own. In

addition, Hawley found it difficult to

deal from Cheltenham with the British medical services in London.

"Many time-consuming trips," he reported, "have not effected proper liaison." More fundamentally, Hawley

continued to complain of "the difficulty, if not complete inability, of controlling the technical operations of

medical units in echelons of ETOUSA

other than SOS." Other commands,

and even the theater staff, persistently

misunderstood Hawley's position.

"Regardless of published directives,"

he declared in mid-November, "the

Chief Surgeon is rather generally regarded as solely a staff officer of the

S.O.S commander." At the ETO

headquarters it was "common practice ... to refer direct recommendations of the Chief Surgeon to his representative at ETO 'for remark and

recommendation.' " 10

On 14 November, therefore,

Hawley proposed that he, as ETO

chief surgeon, be moved to London

and given his own staff to oversee

medical operations, training, and preventive medicine. A separate SOS

chief surgeon, with his own staff,

Hawley suggested, should take charge

of such theater-wide functions as hospital construction and administration,

supply, personnel procurement, and

medical records. Several ETO staff

section heads, who themselves found

the service chiefs' exile to Cheltenham an obstacle to business, endorsed Hawley's proposal. General

Lee, however, vetoed it, arguing that

the theater surgeon "can best perform his primary mission of coordination, supply and evacuation from HQ,

SOS," while maintaining a London

deputy of the "highest obtainable

quality" for ETO planning and liaison. Lee on 30 November presented

a reorganization plan of his own with

the opposite objective to Hawley's.

The SOS commander wanted to concentrate all but a few theater staff sections and all supply and administrative responsibilities in the Services of

Supply. The theater staff, in turn, rejected this plan, insisting that theater

headquarters had to retain certain administrative and logistics functions,

especially in Great Britain, where

clearly defined geographical combat

and communications zones did not

exist. With this stalemate General

Order No. 19 remained in effect, and

Hawley stayed at Cheltenham.11

Within the Services of Supply General Lee delegated operational responsibility to geographical base sections. On 20 July he designated the

Northern Ireland Base Command

(Provisional) as the Northern Ireland

Base Section and ordered establishment of Eastern, Western, and Southern Base Sections. Each of these

10

 Memo, Hawley to Brig Gen Ray W. Barker, 14

Nov 42, box 1, Hawley Papers, MHI; Memo, Hawley

to CEngr, CCWOff, CSigOff, COrdOff, and CQM,

10 Nov 42, file HD 024 ETO CS (Hawley Chron).

11

 Quotations from Memo, Lee to CG, ETOUSA,

10 Dec 42, file HD 320 ETO (Reorganization). See

also Ruppenthal, Logistical Support, 1:159; Memo,

Hawley to Barker, 14 Nov 42, box 1, Hawley

Papers, MHI; Memos, Barker to CofS, ETO, 30 Nov

42, sub: Reorganization, Medical Services, and Col

Ralph Pulsifer to CG, SOS, 22 Dec 42, file HD 320

ETO (Reorganization).
FROM BOLERO TO TORCH 31

territorial divisions encompassed that

portion of the United Kingdom implied by its name, and the boundaries

of each roughly coincided with those

of the British regional administrative

and defense commands. Each base

section commander, directly under

General Lee, controlled all SOS

troops, installations, and activities

within his area; served as SOS point

of contact for U.S. ground and air

forces; and maintained liaison with

British authorities.

Lee gave his base section commanders operational control over all

general and station hospitals, medical

supply depots, and SOS medical units

and personnel within their bound- aries. This authority brought the section commanders into conflict with

Colonel Hawley, who was supposed

to direct technical activities of SOS

medical units through the base section staff surgeons. In practice,

Hawley declared, "every instruction

of a base section commander interferes with technical operations. No

person can serve two masters; and

with technical instructions requiring

time and effort to follow coming from

one source and other instruction from

another . . . , confusion is inevitable." As American forces increased in

size during the second half of 1942,

Hawley complained that base section

commanders were imposing inappropriate training and detrimental extra

duties on his hospitals. He agitated

continuously for centralized control

by his office of all general hospitals,

insisting that "when battle casualties

begin to arrive, complete control . . .

is imperative" to ensure rapid distribution of patients and efficient employment of staffs. General Lee rejected Hawley's pleas on this point, in

accord with Army regulations that

vested authority over general hospitals outside the United States in the

geographical department or tactical

commander. Instead, Lee urged

Hawley and the other service chiefs to

establish informal cooperation with

the base sections. The conflict of authority remained unsettled in principle, with each new problem requiring

another ad hoc compromise.12

The theater command structure established in mid-1942, especially that

part of it affecting the medical and

other technical services, thus had conflict of authority built into it. In spite

of this fact the commanders involved

made it work, more by informal cooperation than by following the organization chart. Colonel Hawley excelled

at this kind of personal give-and-take.

He collaborated effectively, if not cordially, with General Lee, although

they had occasional disagreements.

He later said of Lee, whom many in

the European Theater regarded as arrogant and difficult to deal with,

"He's nobody I'd ever want to go

fishing with for a week. . . . But . . .

I never went to ... Lee with a problem that I didn't get complete support." Hawley established cordial relations with the other SOS special

staff sections. "Whatever success we

12

 Quotations from Note, Hawley, 10 Oct 42, and

Ltr, Hawley to AG, SOS, 15 Oct 42, both in file HD

024 ETO CS (Hawley Chron). See also Ruppenthal,

Logistical Support, 1:84-87; Armfield, Organization and

Administration, pp. 317-18. Authority over general

hospitals is established in AR No. 40-600, 6 Oct 42,

Medical Department: General Hospitals. Hawley had

ailed early for central control of general hospitals.

See Larkey "Hist," ch. 2, p. 6. Base section commanders in their turn complained of interference by

service chiefs. See Interv, ETO with Brig Gen Leroy

P. Collins, CG, Northern Ireland Base Section

(hereafter cited as Collins Interv), 8 Apr 44, CMH.
32 EUROPEAN THEATER OF OPERATIONS

COL. JAMES C. KIMBROUGH

(1959 photograph)

had as a staff," he recalled, "was due

entirely to personalities. We were all

friends. We all were mutually helpful." Eventually, he developed a similar rapport with the base section commanders. Wide acquaintanceship

among the Engineer officers who held

many key SOS positions—the result

of a tour as surgeon of the Army

Nicaragua canal survey in the 1930s—

greatly assisted Hawley in all these relationships, as did his command and

general staff training, which enabled

him to discuss medical requirements

in terms soldiers understood.13

Hawley set up his own line of communication to the Office of the Surgeon General, an action made necessary by the latter's submergence in

the War Department Services of

Supply and consequent removal from

the main flow of reports from overseas theaters. In mid-June Hawley

began a series of weekly letters to

General Magee, describing his activities and calling attention to problems

on which he needed help from Washington. "I feel that I can say more in

a personal letter than I can in an official letter," he declared in the first of

these communications, "and I shall be

quite frank and chatty in my personal

letters. ... " Hawley more than kept

this promise, for he continued these

semiofficial reports until the end of

the war in Europe.14

Office Organization

As the European Theater of Operations and the Services of Supply

began to function, the Office of the

Chief Surgeon expanded and took

more elaborate formal shape. A

number of medical officers came over

with Colonel Corby early in June and

stayed on with Hawley, and the surgeon general sent a few others at

Hawley's special request. By 20 July,

when the office moved to Cheltenham, Hawley's staff had grown to

13

 Quotations from Hawley Interv, 1962, pp. 12-

13 and 74-77, CMH. See also Ltr, Lee to Hawley,

16 Jun 44, box 2, Hawley Papers, MHI. Lee's "Reminiscences," passim, reveal his character. 14

 Quotations from Ltr, Hawley to TSG, 9 Jun 42,

HD 024 ETO O/CS (Hawley-SGO Corresp). See

also, in same file, Ltr, TSG to Hawley, 26 Jun 42,

and MFR, Conference with Gen Hawley, 18 Apr 50,

file HD 000.71, CMH. Armfield, Organization and Administration, p. 83, discusses the surgeon general'sdifficulty in obtaining up-to-date information on

theater medical affairs.
FROM BOLERO TO TORCH 33

COL. CHARLES B. SPRUIT

twenty-two officers and fourteen enlisted men.15

These June and July reinforcements

included some capable administrators.

Col. Charles B. Spruit, MC, who

headed a newly formed Operations

Division and then represented Hawley

on the theater staff in London,

proved especially valuable. He had

worked on war plans in the surgeon

general's office and, like Hawley, had

been through command and general

staff training. The two men "thought

alike" so that Hawley "was able to

turn over to [Spruit] the planning and

training." Although Spruit had an abrasive personality, Hawley considered

him "good, . . . loyal [and] unquestionably the ablest officer I have."

 16

In June Dr. Gordon of the Red

Cross-Harvard Unit, now commissioned a lieutenant colonel, MC,17

took charge of the Preventive Medicine Division, bringing to the staff his

invaluable contacts with the British

medical profession. Lt. Col. James C.

Kimbrough, MC, whom Hawley de- scribed as a "tower of strength," arrived to organize the Professional

Services Division; he headed a growing staff of medical and surgical consultants, all eminent in their fields. Lt.

Col. Eli E. Brown, MC, displayed initial promise as head of the Hospitalization Division. In Medical Records

Lt. Col. Joseph H. McNinch, MC,

"worked into his job very quickly" so

that the chief surgeon "stopped worrying about medical records." With

these and other competent subordinates on hand, Hawley began to delegate much of the planning and administration he hitherto had had to

do himself. One area that remained

weak, however, was leadership in key

functions, including supply, and some

staff members were to prove unequal

15

 Larkey "Hist," ch. 3, pp. 7-8, 11-21, 52-53,

apps. 2-7, and ch. 5, pp. 3-4. 16

 Quotations from Ltrs, Hawley to TSG, 17 Jul

42, and Hawley to Brig Gen Charles C. Hillman, 5

Feb 43, file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Interv, OSG with Col C. B. Spruit,

MC, 31 Oct 47, and MFR, Conference with Gen

Hawley, 18 Apr 50, both in file HD 000.71, CMH;

Hawley Interv, 1962, p. 15, CMH. 17

 Gordon's appointment ran into both military

and academic seniority problems. Hawley at first

wanted to commission him a colonel in recognition

of his ability and unique relationship with the British; however, this would have made Gordon senior

on the staff to Col. Elliott C. Cutler, who had been

appointed ETO chief surgical consultant and was

senior to Gordon on the Harvard faculty. Hence,

Gordon had to come into the Army at the lower

rank, with Hawley's promise of promotion later. See

Ltrs, Hawley to TSG, 13 Jun 42, and TSG to

Hawley, 27 Jun 42, file HD 024 ETO O/CS

(Hawley-SGO Corresp).
34 EUROPEAN THEATER OF OPERATIONS

LT. COL. JAMES B. MASON

to the steadily increasing demands of

the BOLERO buildup.18

On 26 August, with his staff further

enlarged to thirty-two officers, one

warrant officer, and eighty-three enlisted men, Hawley issued a directive

formally constituting eleven divisions

in the chief surgeon's office and defining the responsibility of each (Chart

2). The Administration Division had

charge of office routine and recordkeeping. The Personnel Division dealt

with promotions and reductions in

rank, reclassified medical officers and

enlisted people, requested individual

orders, and drafted requisitions for

additional manpower. The Operations

Division, organized by Colonel Spruit

and later headed by Lt. Col. James B.

Mason, MC, oversaw medical unit allocations and movements; controlled

SOS medical units not assigned to

base sections; made medical operational plans; and supervised training.

The Finance and Supply Division performed fiscal and accounting functions and coordinated receipt, storage, and issue of medical supplies.

Colonel Gordon's Preventive Medicine Division looked after troop

health, diet, and sanitation and maintained contact with British public

health and preventive medicine agencies. The Hospitalization Division

oversaw hospital construction and arranged for care of American troops in

U.S. Army and British facilities; it supervised all but the professional aspects of hospital administration and

coordinated medical evacuation. The

Medical Records Division, besides

preparing and collating reports and

returns, made statistical analyses of

theater medical experience. Kimbrough's Professional Services Division directed the activities of the

medical and surgical consultants and

kept in touch with British medical research and development. The Dental,

Nursing, and Veterinary Divisions supervised the activities and training of

the members of their respective corps

and were responsible for liaison with

their counterpart British organizations.

Colonel Hawley gave his division

chiefs broad authority and responsibility and expected them to take initiative in their areas of activity. He encouraged his subordinates to consult

directly with each other on the inevitable problems that cut across divi18

 For evaluations see Ltrs, Hawley to TSG, 1 Jul,

17 Jul, and 7 Aug 42, file HD 024 ETO O/CS

(Hawley-Corresp).

36 EUROPEAN THEATER OF OPERATIONS

sion lines, "submitting to the Chief

Surgeon for decision . . . cases in

which the Chiefs concerned are

unable to agree." He especially

stressed the need for cooperation,

declaring:

It is ... fatal to attempt a military op- eration without complete cooperation

between responsible officers. Although a

cooperate and friendly spirit will not

compensate for want or ability in an offi- cer, inability to play in a team renders an

officer useless, regardless of his other

Qualification. Each officer must study the

individual characteristics of the other offi- cers with whom he deals and adjust his

approach accordingly. . . . Each officer

must study his own peculiarities and curb

such traits that interfere with his relations

with his fellows. . . .19

The organization established in

Hawley's 26 August memorandum remained stable in structure for the rest

of the year, although some divisions

underwent one or more changes of

chief and all received driblets of additional personnel. Hawley himself received a brigadier general's star on 10

September. He needed both the additional staff and the rank, first to negotiate with the British on medical plans

for BOLERO and then to cope with the

demands of TORCH upon an inexperienced, undermanned, undersupplied

medical service.

The Hospital Program

As BOLERO planning began, provision of hospitals for the million-man

ETOUSA force claimed much of the

chief surgeon's time and attention.

This medical challenge had two parts.

First, the army required a garrison

medical establishment to care for its

sick and injured during the buildup

and waiting period before the invasion, as well as additional hospitals

for Air Force battle casualties.

Second, when the cross-Channel assault began, it would need almost as

many hospitals again to accommodate

the expected flood of wounded from

the decisive—and hence undoubtedly

the bloodiest—campaign of the war.

All of these hospitals would have to

be fitted into overcrowded Britain

and, if possible, combined with the

additional housing required for the

American troops.

The exact number, size, and location of hospitals depended on the

overall plans developed by the Washington and London BOLERO Combined Committees. The Washington

committee, in consultation with ETO

headquarters, determined the force

structure and set movement schedules

and shipping priorities. The London

committee, consisting of representatives of ETOUSA and the British

armed forces and civilian ministries,

decided on ports of entry and troop

billeting areas and arranged for housing, transportation, storage facilities,

and hospitals. This committee reported to the administrative heads of the

British armed forces and relied on the

War Office and other ministries to

implement its recommendations.

Working with the strength estimates and shipping schedules from

the Washington committee, and on

what little had been decided thus far

about the tactics of ROUNDUP, the

London Combined Committee between May and July 1942 developed

the First and Second Key Plans for

19

 Memo No. 7, OofCS, HQ, SOS, 26 Aug 42,

filed 519 Admin Med Hist (ETO), in Larkey "Hist,"

ch. 3, app. 19.
FROM BOLERO TO TORCH 37

BOLERO. These plans were comprehensive programs, embodied in directives to British civilian and military

agencies, for the reception of American troops and supplies and for the

building of the British invasion base.

The First Key Plan, issued on 31 May,

and the Second Key Plan, issued on

25 July, differed in the troop numbers

used as the basis for planning

(1,049,000 versus 1,147,000) but

were similar in assumptions and principles. Both plans assumed that in the

cross-Channel invasion U.S. troops

would constitute the Allied right wing

and the British the left. Hence, the

Americans, entering England through

the west coast ports, would concentrate the bulk of their ground forces

in southwestern England and eventually embark for the assault from ports

in that region. Under the Key Plans,

accordingly, the British Army was to

turn over its Southern Command to

the Americans, complete with all

camps, hospitals, and supply depots.

To accommodate the American

ground troops in southern England,

as well as the Air Force in the northeast, the British would construct additional facilities as required, using

their own labor and both their own

and American materials. Hospitals

were to be a major element of this

new construction.20

Colonel Hawley began his hospital

planning before the formal establishment of the BOLERO committees.

During late April Hawley, in consultation with the medical chiefs of the

British Army, the Canadian Expeditionary Force, and the Emergency

Medical Services, surveyed existing

hospital facilities. The survey reaffirmed his earlier conclusion that U.S.

forces in Great Britain would have to

rely for hospitals primarily on new

construction. He also evaluated a

flood of offers of English country

houses, whose owners wanted to turn

them over to the Army for hospitals,

either out of patriotism or to escape

real estate taxes. Hawley disappointed

most of these gentry. He rejected

their mansions as too small or requiring too much alteration for efficient

use.21

During May Hawley and his British

colleagues reached a number of significant understandings. The British

already had turned over two hospitals—those at Musgrave Park and

Ebrington Barracks in Northern Ireland—to the U.S. Army and had

agreed to turn over three more—the

American Red Cross-Harvard Unit

and the EMS plants at Oxford (the

Churchill Hospital) and Mansfield.

These facilities contained in all about

2,200 beds. On the eleventh the British Army promised to transfer all its

Southern Command hospitals to the

Americans—another 4,500 beds in

units of 50 to 1,000. The Emergency

Medical Services at the same time offered three more 600-bed hospitals,

then under construction, at Odstock,

Taunton, and Bristol. Hawley accepted all these facilities.

In a conference on 21 May Hawley,

the USAFBI chief engineer, and representatives of the British Ministry of

20

 Ruppenthal, Logistical Support, 1:53-74, describes

the general course of BOLERO planning.

21

 Ltr, Hawley to TSG, 29 Apr 42, file HD 024

ETO O/CS (Hawley-SGO Corresp); Hawley Interv,

1962, p. 25, CMH; Ltr, Hawley to Surg, HQ, Eighth

Air Force, 28 Sep 42, file HD 024 ETO CS (Hawley

Chron).
38 EUROPEAN THEATER OF OPERATIONS

EMS HOSPITAL AT BRISTOL

Works decided to enlarge the five

EMS hospitals earmarked for the

Americans to 1,000 beds each. At the

same time Hawley secured British

concurrence on the nine proposed locations for new station hospitals, and

he and the British established procedures for selecting additional sites.

The Allies also agreed on the agencies and methods of BOLERO hospital

construction. Hawley initially had

wanted American hospitals built by

U.S. Army Engineers following standard plans made by the surgeon general's office. In the face of limited

transatlantic shipping for men and

matériel, however, he accepted a plan

under which British civilian contractors, employed by the Ministry of

Works, would erect the plants using

British designs and specifications

modified to meet American requirements.22

On 27 May the London Combined

Committee established the Provision

of Medical Services Subcommittee to

take charge of hospital planning. This

action merely gave formal status to

the consultations already under way

between Hawley, the British military

medical chiefs, and the EMS director—all members of the subcommittee. Later, representatives of the Canadian Army medical service and the

22

 Larkey "Hist," ch. 2, pp. 22-30, and ch. 7, pp.

2-3 and app. 1; Hawley Interv, 1962, p. 24, CMH.
FROM BOLERO TO TORCH 39

Department of Health for Scotland

joined the group.23

During the drafting of the First and

Second Key Plans Hawley worked out

the total number of hospital beds that

would be needed to support both

BOLERO and ROUNDUP. He based his

estimate on U.S. Army experience in

World War I and on British Army

casualty rates in the interwar years

and in the French, Norwegian, and

North African fighting. Hawley assumed that before the invasion, the

Army would have 2.25 sick and nonbattle injured per day for each 1,000

troops. Active operations would result

in at least another 2.5 combat casualties per 1,000 men per day. Hawley

then calculated the probable patient

accumulation in hospitals under a

180-day theater evacuation policy and

established his bed requirement as a

percentage of total troop strength.

For the static preinvasion period

Hawley asked for dispensary beds sufficient for 1 percent of the entire

force and station hospital beds for 3

percent. On top of this, the Air Force

should have beds for an additional

1.5 percent of its strength for its

battle casualties. Black troops, whom

Hawley expected to have a higher sick

rate than whites, would need beds for

an extra 2.5 percent of their total

numbers. For ROUNDUP and the ensuing continental operations Hawley

wanted beds for 10 percent of the

number of men actually committed to

combat. In all, he requested about

90,000 station and general hospital

beds, about half of which—mostly in

station hospitals—would be needed

before the invasion.24

The Medical Services Subcommittee, after what Hawley described as "a

lot of diplomacy," accepted his statement of requirements as the basis for

planning. Disagreements developed,

however, about ways and means.

Hawley insisted, correctly, that the

British were overestimating the bed

capacity of the hospitals they were

turning over and hence underestimating the amount of new building

needed. The extent of new construction worried the British quartermaster

general, who not only expressed concern at the cost in scarce funds, materials and labor but also urged more

use of converted camps, requisitioned

buildings, and tent hospitals. Hawley

firmly rejected the latter two alternatives, but he decided that some troop

housing, existing and to be built,

could be adapted for hospitals after

the units left for France.25

The medical annex of the Second

Key Plan incorporated the agreement

reached by Hawley and the British on 23

 Larkey "Hist," ch. 2, p. 25. Initial members of

the subcommittee were: Maj. Gen. H. M. Gale,

MGA Home Forces, Chairman (replaced in September by Maj. Gen. R. H. Lorie, MGA Home Forces);

Surgeon Vice Admiral S. F. Dudley, MDG, Admiralty; Lt. Gen. A. Hood, DGAMS, War Office; Air Marshal Sir H. W. Whittingham, DGMS, Air Ministry;

Brigadier W. Hartgill, DDG Operations, War Office;

Prof. F. R. Fraser, DGEMS, Ministry of Health; and

Col. P. R. Hawley, Chief Surgeon, HQ, USAFBI. At

this time separate planning committees began work

on medical aspects of SLEDGEHAMMER and ROUNDUP.

This planning, in which Colonel Spruit was heavily

involved, is covered in Chapter VI of this volume.

24

 Memos, Hawley, 1 Jun 42, sub: Hospitalization

Required by USAFBI, and Hawley to Provision of

Medical Services Subcommittee, 14 Jun 42, sub: Restatement of U.S. Requirements, in Larkey "Hist,"

ch. 2, apps. 3-4; Ltr, Hawley to TSG, 9 Jun 42, file

HD 024 ETO O/CS (Hawley-SGO Corresp). 25

 Quotation from Ltr, Hawley to TSG, 9 Jun 42,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Larkey "Hist," ch. 2, pp. 26-36 and app. 4,

and Memo, Hawley to CG, SOS, 20 Jan 43, in ibid.,

ch. 7, app. 1.
40 EUROPEAN THEATER OF OPERATIONS

the number of hospital beds needed

and the means of providing them

(Table 1). Following Hawley's percentage-of-strength requirements, the

Second Key Plan called for provision

of 40,240 beds during the buildup to

accommodate sick, nonbattle injured,

and Air Force combat casualties.

Roughly 12,000 of these beds were to

be in enlarged former British Army

and EMS hospitals; newly constructed

beds in thirty-five 750-bed station

hospitals and two 1,000-bed general

hospitals would account for the rest.

To support ROUNDUP, the Allies

agreed to furnish 50,750 additional

beds—18,000 of them in new general

hospitals to be built before D-Day

and the remainder after D-Day in

vacated British militia camps and

American hut cantonments. These installations would have structures for

operating rooms, clinics, and laboratories added to them before the invasion so that they could be converted

quickly into 750-bed station or 1,000-

bed general hospitals.26

Separately from the BOLERO discussions, Hawley and Surgeon General

Magee decided to use, as far as possible, only 750-bed station and 1,000-

bed general hospitals in the United

Kingdom. Hawley asked for inclusion

of a few 250- and 500-bed station

hospitals in the early troop shipments, to occupy small facilities taken

over from the British or designed

before BOLERO to serve the Air Force,

but for the new plants he desired only

the larger units.27

Selection of sites for station and

general hospitals had begun before

publication of the Second Key Plan in

July and accelerated during the following month. For station hospitals

Hawley, after obtaining troop locations from the ETO G-3, asked the

British War Office for a site within 5

miles of each center of concentration.

The War Office and the Ministry of

Agriculture then chose the ground,

usually in a park or estate to avoid

building over farmland. By midAugust Hawley and the British had

agreed on sites for thirty-three of the

projected thirty-five station hospitals,

most of them in southern England

and East Anglia. Hawley wanted to

group his general hospitals in centers

of four or five units for greater efficiency. He allowed the British to determine locations for these centers so

as to ensure adequate rail connections

for hospital trains without disrupting

overall traffic patterns. After consulting the railway authorities, the War

Office placed the first three centers in

the west of England—at Cirencester,

Great Malvern, and Whitchurch.

Construction also got under way.

By the end of July the War Office had

given orders for all the required expansions of military and EMS plants

and for one 750-bed and two 1,000-

bed Nissen-hut installations. In addition, the British began building ten

1,250-man troop camps in Southern

Command, designed for conversion

into hospitals, and they made plans

and preparations for altering a

number of existing camps. During

August the British promised to have

the five EMS hospitals, each enlarged

to 1,000 beds, ready for American occupancy between 1 October and 31

26

 Larkey "Hist," ch. 2, pp. 36-40, and ch. 7,

app. 1. 27

 Ltr, Hawley to TSG, 6 Jul 42, file HD 024 ETO

O/CS (Hawley-SGO Corresp).
FROM BOLERO TO TORCH 41

TABLE 1—HOSPITAL BED REQUIREMENTS AND PROVISIONS, SECOND KEY PLAN, JULY 1942

a

 For battle casualties of forces on the Continent. b

 For nonbattle casualties of forces in the United Kingdom. Source: Adapted by authors from Larkey "Hist," ch. 2, pp. 36-40.

December. The War Office ordered

construction of fifteen general hospitals in groups of five at the three previously chosen locations. By the end

of the month the British Army had

evacuated twelve of its hospitals for

turnover to the Americans.28

After the decision to attack Northwest Africa, the United States gradually scaled down its short-range

BOLERO deployment objectives. In

October, with TORCH preparations

under way on both sides of the Atlantic, the War Department decided to

base troop and supply shipments to

Britain on a post-TORCH maximum

strength there of only 427,000 men,

which might be increased later. The

authorities in Great Britain, nevertheless, at first tried to keep the full

BOLERO construction program going.

Around midmonth, in the face of the

cutback in American deployment

goals, General Lee and the British

deputy quartermaster general (liaison), who represented the War

Office, agreed to continue construction at the levels established in the

First and Second Key Plans. This construction was primarily a British task

in any event, and both sides assumed

that the million-man buildup eventually would resume.

General Hawley, in accord with this

approach, continued to press for his

full requirement of over 40,000 preROUNDUP and of nearly 51,000 postROUNDUP hospital beds. He increased

28

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1942; Larkey "Hist," ch. 2,

pp. 38-44, and ch. 7, pp. 7-13; Hawley Interv,

1962, pp. 45-46, CMH; Ltr, Hawley to TSG, 15 Jun

42, file HD 024 ETO O/CS (Hawley-SGO Corresp).
42 EUROPEAN THEATER OF OPERATIONS

his station hospital capacity request

from 3 percent of strength to 4 percent, citing as justification the absence of convalescent facilities, troop

overcrowding in camps and the concomitant higher sick rate, and the lack

of hospital ships to carry out a 180-

day theater evacuation policy. The

London Combined Committee, in its

initial revision of the Key Plans to

take into account the slower U.S.

buildup, reaffirmed Hawley's 90,000-

bed hospital request.29

The demands of the North African

expedition for shipping and supplies

forced retreat from these ambitious

intentions. On 19 November General

Eisenhower, implementing a decision

reached jointly with Marshall and

Somervell, announced that the European Theater would use its men and

matériel only for construction actually

needed for the 427,000-man force.

Construction by the British in excess

of American requirements, he declared, must be accomplished with

their own labor and materials, with no

use of lend-lease matériel.

The London Combined Committee's Third Key Plan of that same day,

while it incorporated Hawley's 4 percent-of-strength request for station

hospitals, accordingly reduced the

total construction program to 37,900

beds, including 5,000 for expected

TORCH casualties. Final provision

plans, issued on 3 January 1943,

called for about 7,000 beds in British

military and EMS hospitals, 19,000 in

twenty-three new 750-bed station hospitals, 13,000 in twelve 1,000-bed

general hospitals, and 2,000 in two

converted militia camps. In these

plans Hawley, at British insistence, included in his calculations the fact

that, as built to British specifications,

a 750-bed station hospital actually

had a capacity of 834 beds while a

1,000-bed general hospital had room

for 1,084. Hawley previously had

rated the capacity of these plants

strictly by the table-of-organization

bed strength of the units slated to

occupy them. Now he gave way to the

British in order to obtain more beds

for the same amount of construction

and planned to reinforce units to operate the odd-size hospitals.30

In spite of these reductions in

American goals, the British informally

promised to keep on with the entire

BOLERO hospital program. Their

promises exceeded their performance.

During the last months of 1942 hospital construction by the Ministry of

Works fell steadily farther behind

even the reduced schedule of the

Third Key Plan. Not a single hospital

promised for October or November

came anywhere near completion

during those months. The construction delays resulted in large part from

unavoidable shortages of labor and

material and from inclement weather,

but British administrative sluggishness and lack of a sense of urgency

also retarded progress. With troop

transports in limited supply Hawley

had to cut back shipment of hospital

units because he had no buildings in

which to put them, assuring the theater a unit shortage later on when the

delayed plants were finished. Making

29

 Ruppenthal, Logistical Support, 1:89 and 104-06;

Larkey "Hist," ch. 2, pp. 41-45.

30

 Ruppenthal, Logistical Support, 1:106-10; Larkey

"Hist," ch. 2, pp. 45-48, and ch. 7, pp. 14-15; Ltr,

Hawley to CG, SOS, ETO, 7 Dec 42, file HU 312

(Corresp File, Hospitalization Div, O/CS, ETO)

1942.
FROM BOLERO TO TORCH 43

the situation still worse, changes in

military plans forced the British Army

to slow down the turnover of its hospitals.

Concerned about the delays,

Hawley forced a confrontation with

the Ministry of Works. On 22 October he asked for a special meeting of

the Medical Services Subcommittee,

which had discontinued regular sessions at the onset of TORCH preparations, to discuss hospitals. The subcommittee chairman, Maj. Gen. R. H.

Lorie of the British Home Forces,

evaded Hawley's request with a promise to refer the problem to the War

Office. The chief surgeon persevered

with a second—and, ultimately, a

move convincing—request to General

Lorie on 13 November. Emphasizing

the disruptive effect of the delay on

the entire American medical buildup,

Hawley added a few words of polite

blackmail when he reminded the

chairman that

above all else . . . the American people

demand in war . . . that their soldiers be

given superior medical service. No one

thing can cause such a furor in the

United States as the knowledge that adequate and proper hospital facilities are

not being provided for their troops. Thus

far, the status of provision of hospitals

has been kept a confidential matter; but I

am afraid that I shall not be able to conceal the situation much longer. Already

certain news correspondents are inquiring

when hospitals will be ready for U.S.

troops.31

The subcommittee finally met on

25 November, with representatives of

the Ministries of Works and Labor in

attendance. Hawley expressed concern at the construction lag and asked

for firm completion dates on which

he could plan. The Ministry of Works

representatives offered what Hawley

called the "most amazing statement,"

that all projects were on schedule and

those due for December were nearing

completion. Hawley, who had visited

the sites in question and obtained accurate assessments of progress—or

the absence of it—from the local construction superintendents, quickly refuted this argument. The subcommittee in the end agreed in principle that

"the demands at present submitted by

Brigadier General Hawley must be

met." It invited Hawley to prepare a

new set of completion deadlines for

the BOLERO Accommodations Subcommittee, which set construction

priorities. Through this submission

Hawley and the Ministry of Works negotiated a revised schedule, which

Hawley accepted as "the best I could

possibly get," although it was still far

less than what he considered necessary. The Ministry of Works, however,

failed to meet even these deadlines.32

By the end of 1942 four U.S. Army

general hospitals, four station hospitals, and one evacuation hospital tem31

 Ltr, Hawley to Chairman, Provision of Medical

Services Subcommittee, BOLERO Combined Committee, 13 Nov 42, file HD 024 ETO CS (Hawley

Chron). The same file contains Hawley's request for

22 Oct 42. See also Memo, Hawley to CG, SOS, 20

Jan 43, in Larkey "Hist," ch. 7, app. 1.

32

 First and second quotations from BOLERO

Combined Committee (London) Provision of Medical Services Subcommittee M.P.S. (42) 12th Meeting—25 Nov 42—Minutes of Meeting, and Memo,

Hawley to CG, SOS, 20 Jan 43, both in Larkey

"Hist," ch. 7, pp. 15-16 and app. 1. Third quotation from Memo, Hawley to CEngr, SOS, 7 Dec 42,

file HD 024 ETO CS (Hawley Chron). See also, in

same file, Ltr, Hawley to Chairman, Provision of

Medical Services Subcommittee, BOLERO Combined Committee, 30 Nov 42.
44 EUROPEAN THEATER OF OPERATIONS

porarily serving as a station hospital

were in operation in the British Isles

(Map 2). They occupied former British Army plants and fully or partially

renovated EMS buildings. The 4,950

beds provided by these hospitals

barely met the ordinary needs of the

troops then in Great Britain. The

Eighth Air Force, with four bombardment groups committed to combat,

relied almost entirely on RAF and

EMS hospitals to care for its wounded. Hawley declared of the first six

months of the hospital construction

effort: "The only thing that has prevented a terrible debacle is the modification of the BOLERO plan."

 33

Although they produced only limited immediate practical results, the

planning and initial construction efforts of 1942 laid the foundation of

the European Theater hospital program. Through close cooperation,

Hawley and his British colleagues

identified the general requirements

for supporting BOLERO and ROUNDUP,

as well as the provisions for meeting

them; selected hospital locations; and

settled on building types and construction procedures. The principles

they successfully worked out would

govern hospital construction when

the BOLERO buildup resumed in full

force.

Medical Manpower and Supplies

During the summer and autumn of

1942 the BOLERO buildup rapidly

gathered momentum. American troop

strength in the European Theater increased from about 55,000 at the end

of June to a peak of over 233,000 in

October. The 1st and 29th Infantry

Divisions and the II Corps headquarters augmented the ground contingent. The Services of Supply expanded from 1,900 officers and men to

41,000, as engineer, quartermaster,

motor transport, signal, ordnance,

chemical warfare, and medical units

arrived. The SOS reinforcements

were needed to handle an increasing

flow of incoming cargo—over 75,000

tons in July, 186,000 in August,

240,000 in September, and 143,000

in October.

The Eighth Air Force established

itself in England and went into

combat. In mid-June Maj. Gen. Carl

Spaatz, the Eighth's commander, arrived with his headquarters and

11,000 ground and service troops.

Transatlantic ferrying of bombers,

fighters, and transport aircraft began

later that month. On 17 August

Eighth Air Force B-17's flew their

first mission over Nazi-controlled

Europe, striking railroad yards in occupied France. Other raids followed,

70- to 100-bomber attacks on transportation targets, airfields, and submarine bases in France and the Low

Countries. Testing the Air Force

tactic of daylight high-altitude precision bombing, the B-17 and B-24

crews met increasingly heavy German

33

 Quotation from Memo, Hawley, to CG, SOS, 20

Jan 43, in Larkey "Hist," ch. 7, app. 1. See also in

ibid., pp. 18-19; and Mae Mills Link and Hubert A.

Coleman, Medical Support of the Army Air Forces in

World War II (hereafter cited as AAF Medical Support)

(Washington, D.C.: Office of the Surgeon General,

U.S. Air Force, 1955), pp. 543-45. The hospitals

were: 2d General Hospital, Oxford, 1,000 beds;

30th General Hospital, Mansfield, 600 beds; 298th

General Hospital, Bristol, 500 beds; 67th General

Hospital, Taunton, 1,000 beds; 3d Station Hospital,

Tidworth, 250 beds; 152d Station Hospital, Bath,

250 beds; 38th Station Hospital, Winchester, 250

beds; 10th Station Hospital, Belfast, Northern Ireland, 350 beds; and 2d Evacuation Hospital, Diddington, 750 beds.

46 EUROPEAN THEATER OF OPERATIONS

fighter and antiaircraft opposition. By

the end of 1942 nearly 190 wounded

officers and men of the Eighth Air

Force had been evacuated to U.S.

Army and RAF hospitals.34

As the buildup accelerated, the

ETO medical service struggled to

overcome a personnel shortage and a

chaotic supply system. The growing

responsibilities of the chief surgeon's

office, combined with the requirement to staff the offices of four base

section surgeons and to furnish medical planners and administrators for

the Allied Force Headquarters,

stretched General Hawley's small

corps of capable assistants to the

breaking point. Reinforcements were

few. Unit medical officers were competent in their clinical fields, and the

professional consultants who joined

Hawley's staff were some of the best

in their specialties. But most of these

new arrivals lacked the experience

and training for high-level planning

and administration. Hawley sent repeated pleas to the surgeon general

for more qualified administrators,

only to be told that "we are scratching the bottom of the pot and . . .

the pickings are very, very thin."

Hawley had to place unqualified men

in some key posts and hope they

would learn on the job, and he threw

ever more work on such stalwarts as

Spruit, Kimbrough, Gordon, and

McNinch. In September he resorted

to borrowing medical officers from

the V Corps for both his own and the

base section surgeons offices. Later

that same month he reported: "All

my officers are working very hard and

are accomplishing miracles. ... If

any one of my key officers—and every

Regular I have is a key officer—goes

sick on me, we are sunk."

 35

By the end of December Hawley's

staff included fifty-one officers, fiftysix enlisted men, and sixty-two civilian employees, but the shortage of

qualified administrators had not eased

and some division chiefs had proven

unequal to their expanding responsibilities. Hawley declared on 31 December: "I simply have to have fifteen

good soldiers soon or this place is

going to pot. . . . I'll stay in here and

pitch but I've got to have someone

who can bat in some runs."

 36

The offices of the base section surgeons, which were supposed to oversee most day-to-day medical service

to the troops, suffered from even

more serious manpower deficiencies

in both quantity and quality. Hawley

and the SOS G-1 agreed in August

that each base section headquarters

34

 Ruppenthal, Logistical Support, 1:100 and 103;

Maurice Matloff, Strategic Planning for Coalition Warfare,

1943-1944, United States Army in World War II

(Washington, D.C.: Office of the Chief of Military

History, Department of the Army, 1959), pp. 551-52;

Craven and Cate, eds., AAF, 1:640-48; ibid., vol. 2,

Europe: TORCH to POINTBLANK, August 1942 to December

1943 (1949), pp. 209-60; Surg, Eighth Air Force,

Annual Rpt, 1942, file HD 319 ETO (8thAForce)

1942.

35

 Quotations from Ltrs, TSG to Hawley, 24 Oct

42, and Hawley to TSG, 11 Sep 42, file HD 024

ETO O/SC (Hawley-SGO Corresp). In same file,

see Ltrs, Hawley to TSG, 17 Jul and 7 Aug 42; Ltr,

Hawley to Col George F. Lull, MC, 28 Aug 42; and

Ltr, TSG to Hawley, 17 Jul 42. See also Ltrs,

Hawley to Col Charles E. Brenn, MC, 4 and 18 Sep

42, and Memo, Hawley to Brig Gen Davis, 19 Oct

42, sub: Information for Gen Snyder, all in file HD

024 ETO CS (Hawley Chron); Hawley Interv, 1962,

pp. 15 and 18, CMH; MFR, Conference with Gen

Hawley, 18 Apr 50, and Memo, Graves H. Wilson to

D. O. Wagner, 10 Nov 50, sub: Interview With Maj

Gen James C. Magee, both in file HD 000.71, CMH. 36

 Quotation from Ltr, Hawley to TSG, 31 Dec 42,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also "Med Svc Hist, 1942-43," p. 1, file HD

314.7-2 ETO.
FROM BOLERO TO TORCH 47

THEATER CHIEF SURGEON AND STAFF, CHELTENHAM, NOVEMBER 1942. To oversee the

medical requirements of BOLERO, General Hawley (1) relied on such able administrators as

Col. Eli E. Brown (2), chief of the Hospitalization Division; Col. William S. Middleton (3),

chief consultant in medicine; Colonel Mason (4), chief of the Operations Division; Lt. Col.

John E. Gordon (5), chief of the Preventive Medicine Division; Capt. Margaret E. Aaron

(6), chief of the Nursing Division; Lt. Col. Rex L. Diveley (7), senior consultant in orthopedic

surgery; Col. Kimbrough (8), chief of the Professional Services Division; Col. Elliott C. Cutler

(9), chief consultant in surgery; Lt. Col. Paul Padget (10), senior consultant in venereal

disease; and Lt. Col. Joseph H. McNinch (11), chief of the Medical Records Division.

should have at least ten medical officers. Until late in the year each actually had received no more than one

or two—often borrowed from units—

and a handful of enlisted men. Only

the Southern Base Section reached

the desired strength, with eleven

medical officers and forty-one enlisted men at the end of 1942. The

Western Base Section, responsible for

the American ports of entry into the

United Kingdom, finished the year

with eight medical officers. The Eastern Base Section, which supported

the Eighth Air Force, had only four.

To furnish even this slim complement, Hawley perforce employed men

of inferior ability, a number of whom

had failed in other assignments. The

Western Base Section surgeon, according to Hawley, "was recommended by his first C.O. for reclassification. I had to give him another job

and Surgeon, Western Base Section,

was the only place I could put him

with his rank. . . . You can gauge the
48 EUROPEAN THEATER OF OPERATIONS

others by him—he is no worse than

they."

 37

The original BOLERO plans called

for an SOS medical establishment of

about 55,000 people, in hospitals of

various types, ambulance battalions,

sanitary and depot companies, hospi- tal train units, laboratories, and other

organizations. These units were in addition to the medical detachments of

ground, air, and service forces and to

the attached medical formations of divisions, corps, and armies. Hawley

had no direct responsibility for the

deployment of the non-SOS medical

troops, who moved with their parent

commands, but he did have to secure

shipping space for SOS medical units

and to determine the order of their

coming. He sought to assure the arrival of medical troops in numbers

proportional to the overall buildup,

but in the intense competition for

scarce transport the Medical Department received low priority.38

Medical troops, accordingly,

reached England at a slower rate than

did those of the other SOS technical

services. By late July the ETO medical

service, with about 2,300 men on

hand or scheduled for shipment, had

fallen over 50 percent behind its projected strength for that point in the

buildup, while the Services of Supply

as a whole had exceeded its buildup

target. Hawley attempted to limit his

monthly requests for units to what he

absolutely needed; he asked for hospitals, for example, only as buildings

became ready for them to occupy.

Nevertheless, he pointed out that

"every requisition for medical troops

has been cut—most of them severely." Compounding the shortage,

many units arriving from the United

States lacked organic medical detachments, forcing Hawley to request

hundreds of nonattached doctors,

nurses, and medical soldiers ("casuals") to staff temporary dispensaries,

as well as to reinforce his own office

and those of the base section surgeons. These requests, also, usually

failed to survive the monthly battle

for shipping allocations.39

By 1 September, when the European Theater and the Services of Supply

as a whole had reached 15 percent of

their planned troop strength, the

ETO medical service had attained

only 7 percent. Its buildup rate was

the slowest of any of the technical

services, lagging behind even Chemical Warfare. "In view of the fact that

no chemicals have been used in this

war," Hawley observed, "I cannot

help considering this an eloquent

fact." The autumn BOLERO force reduction, which cut planned SOS medical strength from 55,000 to 25,000,

did nothing to speed the arrival of

37

 Quotation from Ltr, Hawley to TSG, 31 Dec 42;

see Ltr, Hawley to Lull, 28 Aug 42. Both in file HD

024 ETO O/CS (Hawley-SGO Corresp). See also

Surgs, Eastern, Western, and Southern Base Sections, Annual Rpts, 1942. Other base section staff

sections had similar manpower shortages; see Collins Interv, 8 Apr 44, CMH. 38

 For the establishment of SOS medical troop

strength, see Memos, Hawley to Plans Section, GS,

16 May 42, and Hawley to G-4, SOS, 21 Jul 42, in

Larkey "Hist," ch. 4, apps. 1 and 3; Memo, Hawley

to G-4, SOS, 29 Jul 42, sub: The Medical Situation,

file 370 (Bible File of Troop Requirements, Early

Planning).

39

 Quotation from Memo, Hawley to G-4, SOS, 29

Jul 42, sub: The Medical Situation, file 370 (Bible

File of Troop Requirements, Early Planning). See

also Larkey "Hist," ch. 4, pp. 22-25 and apps. 3-4;

Ltrs, Hawley to TSG, 31 Jul and 7 Aug 42, file HD

024 ETO O/CS (Hawley-SGO Corresp); Memo,

Hawley to Personnel Division, OofCS, SOS, 14 Sep

42, sub: Casuals in Troop Basis of Medical Service,

SOS, file HD 024 ETO CS (Hawley Chron).
FROM BOLERO TO TORCH 49

immediately needed units and troops.

By early October the medical service

"was relatively so weak that not only

could it not furnish adequate support

in any operation but it was unable to

care for the routine sick and nonbattle injured in a static situation." In response to urgent pleas from General

Hawley, who now faced the loss of

some of his hospitals to TORCH, the

ETO chief of staff on the twentieth

called a special conference on medical

personnel. The conferees, who included Hawley and the ETO deputy

chief of staff and G-4, agreed that the

medical manpower shortage was critical. As a result of the conference

Hawley and the theater G-4, at the

direction of the chief of staff, drew up

plans for bringing the medical service

to its proper relative strength by

adding about 4,500 hospital beds and

3,500 people per month during November and December and 3,500

beds and 2,900 personnel a month

during early 1943.40

This plan, while it also fell victim to

the worldwide shortage of shipping,

did result in deployment of more

medical troops. By the end of November SOS medical strength had increased to over 7,000; enough

additional reinforcements arrived in

December to keep the service at

6,500 people, even after the departure of some hospitals for North

Africa. Besides the one evacuation,

four general, and four station hospitals in operation, SOS medical units

in the United Kingdom at the end of

1942 included one general and five

station hospitals, changing location or

waiting for buildings; a medical

supply depot company; two general

dispensaries; and an auxiliary surgical

group. The SOS medical buildup,

nevertheless, still was proceeding

more slowly than that of the organization as a whole. General Hawley estimated early in December that when

the Services of Supply reached 59

percent of its projected strength, the

medical service would have expanded

to only 43 percent. "In the troops

priorities now set up," he concluded,

"the medical service becomes proportionately weaker and weaker until

near the very end of the buildup,

when it is suddenly built up to

strength."

 41

From the start of the BOLERO buildup shortages and administrative deficiencies hampered medical supply efforts. Many of the administrative

shortcomings originated in the Supply

Division of General Hawley's office.

Hawley, by his own admission, was

"less familiar with the technique of

medical supply than with other aspects of medical service" and "there40 fore, more dependent upon the As of 1 September, the Engineers were 86 percent of planned strength; the Signal Corps had

reached 22 percent and Chemical Warfare 8.5 percent. Memos, Hawley to CG, SOS, 6 Oct 42 (source

of quotation), and Hawley to G-4, ETO, 21 Oct 42,

in Larkey "Hist," ch. 4, apps. 6 and 15 (see also pp.

10-11); Memos, Hawley to G-4, SOS, 10 Sep 42,

and Hawley to Col Charles B. Spruit, MC, 11 Sep

42, file 370 (Bible File of Troop Requirements,

Early Planning); Memos, Hawley to Gen Littlejohn,

21 Oct 42, and Hawley to G-4, ETO, 23 Oct 42, file

HD 024 ETO CS (Hawley Chron).

41

 Quotation from Memo, Hawley to G-1, SOS, 2

Dec 42, sub: Troop Unit Priorities for SOS, file HD

024 ETO CS (Hawley Chron). In December another

3,400 medical personnel were in non-SOS units and

detachments in Great Britain. See John H. McMinn

and Max Levin, Personnel in World War II, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 308-09; "Med

Svc Hist, 1942-43," p. 15, file HD 314.7-2 ETO.
50 EUROPEAN THEATER OF OPERATIONS

advice and action of my supply chief

than upon other chiefs of division."

Unfortunately, throughout 1942, his

Supply Division chiefs were among

the least capable of his subordinates.

Hawley's first supply officer, Col.

Earle G. C. Standlee, MC, came

highly recommended by the surgeon

general, but in Hawley's opinion

lacked the ability to do large-scale

planning and could not make decisions rapidly. In August Hawley

seized the opportunity to transfer

Standlee to the Allied Force Headquarters, but the supply chiefs successor, Lt. Col. Clarence E. Higbee,

SC, was no improvement. Higbee,

Hawley reported, "seems to understand how supplies get out of a

depot, but hasn't the faintest idea of

how they get in." The floundering division head "did the very best he

could," but "the job was simply too

big for him." Nevertheless, for lack of

a better replacement, Hawley left

Higbee in his post until late December.42

Neither Standlee nor Higbee had

much manpower with which to work.

Established in mid-June with only two

officers and one enlisted man, the

Supply Division included 8 officers

and 13 enlisted men at the end of the

year. In the field a detachment of the

8th Medical Depot Company arrived

in May with the MAGNET troops and

operated the medical section of the

Belfast quartermaster depot. Aside

from this element the only trained

medical supply personnel in the European Theater were the 16 officers and

227 men of the 1st Medical Depot

Company, which landed in England in

July and eventually was spread among

five separate depots. A second depot

company reached England during the

autumn, only to embark immediately

for North Africa.43

All medical supplies from the

United States destined for the European Theater passed through the

New York Port of Embarkation. At

New York a port medical supply officer, on the staff of the port commander, ensured that embarking

medical detachments and units had

full initial allowances of equipment

and supplies. He and his staff, under

direction from the Office of the Surgeon General, edited theater requisitions, after which the Port Overseas

Supply Division called matériel forward from depots and arranged for

its embarkation. Most resupply was

supposed to go forward without theater requisition, in the form of medical

maintenance units, each an assembly

of basic supplies for 10,000 men for

thirty days. On the basis of troop

strength reports the port medical

supply officer was responsible for

requisitioning and shipping enough

of these units to keep a prescribed

number of days' supply always on

hand in the theater.44

42

 Quotations from Ltrs, Hawley to Col Francis D.

Tyng, MC, 7 Nov 42 and 3 Mar 43, file HD 024

ETO O/CS (Hawley-SCO Corresp). See also Ltr,

Tyng to Hawley, 19 Jun 42, in same file, and

Charles M. Wiltse, ed., Medical Supply in World War

II, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1968), pp.

265-66.

43

 "Med Svc Hist, 1942-43," p. 5, file HD 314.7-2

ETO. The 1st Medical Depot Company was organized as a tactical unit but had to be used to operate base depots. See Ltr, Tyng to Hawley, 19 Jun

42, file HD 024 ETO O/CS (Hawley-SGO Corresp). 44

 To handle the expected huge volume of wartime supplies, the War Department in January 1942 Continued
FROM BOLERO TO TORCH 51

Throughout 1942 the Port of Embarkation had only scarce medical

supplies upon which to draw. The

Army Medical Department possessed

few reserves of the 5,000 or so items

that it procured and issued. Its contractors, who had to compete with

other vital industries for scarce raw

materials, could not quickly fill huge

war orders and often fell seven to

nine months behind their delivery

schedules. Indispensable items, such

as surgical instruments, had been imported before the war from Germany

and occupied Europe; American efforts to start domestic production

took time to yield results. The Medical Department had to share what

stocks were available with the voracious lend-lease program, the demands of which, given top priority by

presidential directive, steadily increased. In mid-June Col. Francis C.

Tyng, MC, chief of the Finance and

Supply Division, Office of the Surgeon General, informed Hawley: "We

have a daily shortage of some 2,000

items at all times in our depots." The

Medical Department apportioned

these shortages among the United

States and overseas theaters by cutting all requisitions and allowances to

a minimum.45

Availability of supplies did not

guarantee their orderly arrival in the

theaters, as the Medical Department

learned when it attempted to provide

the European Theater with complete

hospital assemblies. Each deploying

hospital was supposed to embark with

a full allowance of furniture, instruments, and medicines; and the Medical Department sent additional outfits, tailored to various hospital types

and sizes, to England in advance of

units to establish a reserve. Few assemblies, however, left New York all

at the same time on one vessel. For

that to occur, shipments from medical

and other depots throughout the eastern United States had to reach the

port within at most a few days of each

other. Inevitably, some matériel failed

to appear on schedule. The port authorities, rather than delay a convoy,

shipped out whatever partial assemblies were on hand. Making matters

worse, inexperienced packers often

failed to mark properly the crates belonging to a single assembly so that

collecting the matériel and dispatching it to its proper destination in

Great Britain were all but impossible.

By early November ETO depots contained partial assemblies for one surgical, nineteen station, eleven general, and eight evacuation hospitals. To

equip any one unit, the depots had to

take apart two or three outfits. "Obviously," Hawley complained, "it is

much better to get a few units complete than to get parts of many."

 46

But the requirements for rapid port

clearance and convoy movement took

had decentralized most overseas supply operations

to a designated embarkation port for each theater,

that for the European Theater being New York. See

Ruppenthal, Logistical Support, 1:92-94. A medical

maintenance unit contained 700-900 items, depending on the theater; weighed 15 tons; occupied 1,500

cubic feet of space; and was worth about $10,000.

See Wiltse, ed., Medical Supply, pp. 146-47 (also pp.

143-46 and 148-53). 45Quotation from Ltr, Tyng to Hawley, 19 Jun

42, file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Wiltse, ed., Medical Supply, p. 15.

46

 Quotation from Ltr, Hawley to Brig Gen W. M.

Goodman, 7 Oct 42, file HD 024 ETO CS (Hawley Continued
52 EUROPEAN THEATER OF OPERATIONS

precedence over Medical Department

convenience.

The buildup of theater supply reserves was the subject of constant disagreements between Hawley's office

and that of the surgeon general. Due

to confusion on the part of both

Hawley and his Supply Division

chiefs, the theater repeatedly sent

large requisitions to the Port of New

York for reserve supplies. The surgeon general's office, trying to husband scarce matériel, after review disallowed most of these requisitions as

duplicating both initial unit allowances and the automatic resupply

contained in the medical maintenance

units. Hawley, in turn, complained

that the maintenance units, which

were not designed for any particular

theater, failed to meet all his needs

and at any event were not arriving on

schedule.47

For the ETO medical service, as for

the rest of the Services of Supply, industrialized Great Britain was a logical alternative supply source, especially as British support could reduce the

burden on scarce transatlantic shipping and give the U.S. industry time

to mobilize. To obtain British medical

supplies, Hawley's Supply Division at

Cheltenham worked through the SOS

general purchasing agent, who had

opened an office in London in May.

The medical procurement officer on

the purchasing agent's staff, Lt. Col.

George W. Perkins, Chemical Warfare

Service, transmitted specific ETO

medical requests to the purchasing

agent. That official then passed them

to the British Ministry of Supply,

which arranged for manufacture or

purchase of the items under a reciprocal aid program known as reverse

lend-lease.48

Procurement from the British had

problems and uncertainties of its

own. The British, early in the BOLERO

planning, agreed to provide most

nonmedical equipment for the hospitals they were to build for the Americans. Implementation of this arrangement went smoothly, aside from the

overall construction delays, but unit

medical equipment and medical resupply proved more difficult to

secure. The British themselves were

short of vital items and always had

imported other key pieces of equipment, for example, X-ray tubes. They

were reluctant to turn over any of

their own large reserve medical

stocks, which consisted in good part

of lend-lease supplies, and instead

preferred to manufacture new items

for the Americans. The British, accordingly, while promising to meet all

Chron). See Memo, Edward Reynolds to Maj Gen

LeRoy Lutes, 8 Dec 42, sub: Shipments of Incomplete Hospital Assemblages to England and Delays

in Shipment of Maintenance Medical Supplies, file

HD 024 ETO O/CS (Hawley-SGO Corresp). In

same file, see also Ltrs, Tyng to Hawley, 18 Oct 42,

and Hawley to Tyng, 7 Nov 42. 47

 Ltrs, Tyng to Hawley, 19 Jun and 18 Oct,

Hawley to TSG, 31 Jul 42, and Hawley to Tyng, 7

Nov 42; Memo, Reynolds to Lutes, 8 Dec 42, sub:

Shipments of Incomplete Hospital Assemblages to

England and Delays in Shipment of Maintenance

Medical Supplies. All in file HD 024 ETO O/CS

(Hawley-SGO Corresp). See also Memo, Hawley to

Maj Gen Styer, 10 Sep 42, and Ltr, Hawley to TSG,

3 Nov 42, sub: Medical Supply, both in file HD 024

ETO CS (Hawley Chron).

48

 Perkins, a pharmaceutical company executive in

civilian life, initially was a member of the SOS Procurement Division. In August he was transferred to

Hawley's staff, but he continued to serve as liaison

officer between the chief surgeon and the general

purchasing agent. See "Med Svc Hist," 1942-43, p.

56, file HD 314.7-2 ETO; Wiltse, ed., Medical

Supply, pp. 267-68.
FROM BOLERO TO TORCH 53

their Allies' needs, requested largescale orders far in advance of the desired delivery dates, to give their

plants time to plan production and

tool up. Colonel Perkins had difficulty

formulating such orders, as he could

not obtain reliable early information

on requirements from Standlee and

Higbee. Changes in buildup plans

forced frequent revision of what estimates he did receive. Perkins also discovered that the Americans and British used different names for many of

the same items; the resulting breakdown of communication made it difficult to determine exactly what American requirements the British could

fill. In an effort to resolve this problem, General Hawley put his professional consultants to work on a

catalog of equivalent British and

American medicines and equipment,

but this catalog was not available

during most of 1942.

In spite of these difficulties, the

SOS Procurement Division between

June and October placed several large

orders for British medical supplies,

including complete hospital assemblies. Colonel Perkins, whom Hawley

considered "a fine gentleman and

. . . unusually capable," combined

tact with firmness in moving the British from general promises to particular commitments. He also ferreted

out untapped commercial reserves of

operating room furniture, surgical instruments, and other needed matériel.

During the last months of 1942 a

growing amount of British supplies

flowed into American depots, in time

to be of indispensable help in outfitting the TORCH forces. Even with the

initial delays British medical supply

deliveries during the last half of 1942

amounted to 84,000 ships' tons, far

exceeding the 28,000 tons received

from the United States. At the beginning of 1943 Hawley expressed confidence that he could obtain almost 90

percent of his hospital equipment and

general medical supplies from his

Allies—nearly everything, in fact,

except field chests and other articles

for mobile units. Nevertheless, due to

the slow start and uncertain reliability

of local procurement, the chief surgeon's Supply Division customarily

sent duplicate requisitions to the

United States for everything it ordered from the British, intending to

cancel these requisitions if the British

delivered. This practice only compounded the resupply misunderstandings between Hawley's office and that

of the surgeon general.49

Whether American or British in

origin, medical supplies, once procured, had to run a gauntlet of obstacles before reaching the troops who

needed them. During the summer and

early autumn the flood of BOLERO

and TORCH cargo swamped the already heavily taxed western British

ports through which most American

goods arrived. Shipments were split

up during unloading and some items

smashed by unskilled stevedores.

Much matériel from the United States

came without bills of lading and in

containers wrongly labeled, if labeled

at all, and never reached the depots

for which it was intended. As a result,

49

 "Med Svc Hist, 1942-43," pp. 56-58, file HD

314.7-2 ETO; Wiltse, ed., Medical Supply, pp. 268-

70; Larkey "Hist," ch. 5, pp. 6-11. See also Ltrs,

Hawley to TSG, 9 Jun 42, 6 Jul 42, and 3 Mar 43;

Ltr, Hawley to Tyng, 7 Nov 42; Memo, Col Elliott

C. Cutler, MC, to TSG, 26 Nov 42; Ltr, Hawley to

General Purchasing Agent, ETOUSA, 15 Oct 42;

Note, Hawley, 6 Nov 42. All in file HD 024 ETO CS

(Hawley Chron).
54 EUROPEAN THEATER OF OPERATIONS

General Hawley complained continually of the nonarrival of promised

supplies, while the surgeon general's

office and the Port of New York

claimed that the stores had been

shipped. British medical supplies,

sent directly from a factory or warehouse to a particular depot, more

often reached their intended destinations; however, due to the terminological confusion, depot staffs often

failed to issue them, out of ignorance

of what requirements the items could

fill.

The burden of distributing supplies

fell upon the 1st Medical Depot Company, which by early September was

operating medical sections of five

Army general depots. The company

augmented its overstretched manpower with unattached (and usually untrained in supply) officers and men

and eventually with British civilian

employees. Its depot medical sections

labored heroically to put together

hospital assemblies, to sort and store

supplies, and to make issues to units

in their geographical areas. But inexperienced personnel and inadequate

facilities hampered them, as did the

failure of the Supply Division to establish a uniform inventory and stock

control system.50

Especially as it struggled to meet

the supply demands of TORCH, the

European Theater medical service

lived from hand to mouth, with shortages and uncertainty the rule. Hawley

reported in September: "We have no

way of knowing how many medical

maintenance units have been shipped;

but the number that has arrived is far

too little for actual maintenance, not

to speak of building up the prescribed

reserve." Hospitals and other organizations went from depot to depot

seeking supplies and equipment and

usually not finding them, either because of shortages or because of the

lack of reliable inventories. At least

one medical officer gave up on the

Army system and ordered some urgently needed items from the Red

Cross without even attempting to

obtain them through the ETO chief

surgeon. This action drew a stinging

rebuke from Hawley, who called it

"the worst outrage that has been perpetrated in ETOUSA." At about the

same time the chief surgeon informed

the surgeon general: "The medical

supply problem in this theater has

been acute since 1 February 1942 and

is now becoming critical."

 51

As the year ended, the first influx

of British supplies into the depots enabled the medical service to meet the

most pressing demands. On both

sides of the Atlantic, efforts got under

way to improve the supply systems.

During November and December representatives of Surgeon General

50

 The five depots were located at Thatcham (G45), Burton-on-Trent (G-20), Bristol (G-35), Liverpool (G-14), and Taunton (G-50). General depots,

administered by the Quartermaster Corps, all had

the "G" prefix. See Wiltse, ed., Medical Supply, pp.

270-74; Larkey "Hist," ch. 5, pp. 5-6 and 25-27;

Ltrs, Tyng to Hawley, 18 Oct 42, and Hawley to

Tyng, 7 Nov 42, filed HD 024 ETO O/CS (HawleySGO Corresp); Memo, Hawley to G-4, ETO, 16 Oct

42, file HD 024 ETO CS (Hawley Chron). For a description of overall ETO supply problems during

this period, see Ruppenthal, Logistical Support, 1:91-

96.

51

 First quotation from Memo, Hawley to Styer, 10

Sep 42. Second quotation from Ltr, Hawley to Surg,

Northern Ireland Base Section, 6 Nov 42. Third

quotation from Ltr, Hawley to TSG, 3 Nov 42, sub:

Medical Supply. All in file HD 024 ETO CS (Hawley

Chron). See also Larkey "Hist," ch. 5, pp. 26-27.
FROM BOLERO TO TORCH 55

Magee worked out with the New York

port commander a new method for

shipping hospital assemblies in more

nearly complete condition. In response to Hawley's reports that the

medical maintenance unit did not

fully meet ETO resupply requirements, the surgeon general's office

arranged for the dispatch of supplementary matériel. Surgeon General

Magee began a search for a better

qualified supply officer for Hawley.

The chief surgeon himself, in late December, replaced Higbee with Lt. Col.

Howard Hogan, MC, an officer already in the European Theater.

Hogan, who had previous though

brief experience as a medical procurement officer, showed early signs of

being more effective than his predecessors. As a result of Hogan's efforts, Hawley reported early in 1943

thae suppl t y situation is greatly improved.

We know what we have in depots (at least

I am given figures which are said to be

correct). Our units are getting medical

supplies promptly. Hospitals are being

equipped without delay as fast as build- ings become available. Local procure- ment, while not completely satisfactory, is

very much improved and British supplies

are rolling into our depots by the car

load.

"Yet," he concluded, "I am far from

being completely happy with the situation." Hawley's unhappiness with his

medical supply service was to continue for another year.52

Supporting TORCH

As the ETO medical service struggled with its personnel shortage and

supply problems, it also had to furnish manpower and matériel for the

invasion of North Africa. General Eisenhower and his AFHQ staff began

planning for TORCH early in August,

but Anglo-American disagreements

over the timing, number and location

of landings delayed until September

publication of the overall concept of

operations. Under the final plan an

ail-American Western Task Force, organized and equipped in the United

States, was to assault Casablanca on

the Atlantic coast of Morocco on or

about 8 November. Simultaneously,

the Anglo-American Center and

Eastern Task Forces, fitted out in

England, would strike from the Mediterranean respectively at Oran and

Algiers. The Center and Eastern Task

Forces were to draw logistics support

from the United Kingdom until the

Allies consolidated their position;

then support responsibility for all

three task forces would shift to the

United States.

During September and October,

under general guidance from the

Allied Force Headquarters, the task

forces completed their own tactical

and logistics planning. In Great Britain embarkation of troops and stores

of the Center and Eastern Task

Forces began late in September. The

52 loaded transports assembled in the Ltr, Hawley to Tyng, 3 Mar 43, and Memo,

Reynolds to Lutes, 8 Dec 42, sub: Shipments of Incomplete Hospital Assemblages to England and

Delays in Shipment of Maintenance Medical Supplies, both in file HD 024 ETO O/CS (Hawley-SGO

Corresp); Memo, Brig Gen R. M. Littlejohn, QMC,

to Lee, 4 Dec 42, sub: Maintenance Stocks of Medical Supplies, and Ltr, Hawley to TSG, 19 Dec 42,

sub: Maintenance Stocks of Medical Supplies, both

in file HD 024 ETO CS (Hawley Chron). Hogan,

who relieved Perkins in Procurement on 20 November, previously had been a special assistant to the

chief of Supply in the surgeon general's office. See

Name-Rank file, CMH.
56 EUROPEAN THEATER OF OPERATIONS

Firth of Clyde and, after a final landing rehearsal off the Scottish coast,

departed for the Mediterranean on 22

and 26 October. On 8 November the

landings took place on schedule.

Follow-up convoys left England on

the eighth, eleventh, and twentyfirst.53

This simply described sequence of

plans and preparations was a trying

time for the ETO medical service.

General Hawley, although responsible

for furnishing troops and supplies,

had no direct role in medical planning for the 40,800-man Center Task

Force, the logistical support of which

was the primary task of ETOUSA.54

Instead, the Allied Force Headquarters, with Colonel Corby acting as

deputy to a British chief surgeon, and

the U.S. II Corps, of which Col. Richard T. Arnest, MC, was surgeon, prepared the plans with little coordination with ETOUSA and even less with

the other task forces. Delay in completing the overall Allied operation

plan further confused matters, because the task force had to start planning without a final directive, a

procedure which led to repeated lastminute changes. The Allied Force

Headquarters did not issue its logistics plan for the whole operation until

December. Until then Hawley had to

proceed without definite answers to

such vital questions as the duration

and extent of ETO responsibility for

care of North African casualties.

Hawley eventually lost patience with

the chaotic procedures, as revealed in

his 11 December letter to the surgeon

general:

I watched the muddled medical planning

until I could stand it no longer and then

went to the Chief of Staff, ETO and told

him that the stage was all set for the big- gest medical scandal since the Spanish- American War. That jolted them a little,

and General Eisenhower told me to step

in and straighten things out. I did, but

within a week things were right back to

where they were—each separate task

force doing its own planning without the

least coordination. . . ,55

The theater Services of Supply had

to provide hospitals and other medical units, primarily for the Center

Task Force, as directed by the Allied

Force Headquarters. While meeting

these requirements, Hawley struggled

successfully to retain his important

operating units. An early AFHQ

troop list, for instance, included the

3d and 10th Station Hospitals, both

full of patients, and a detachment of

the overextended 1st Medical Depot

Company. The chief surgeon secured

deletion of these organizations and

their replacement with others due in

from the United States. By the end of

the year the Services of Supply had

given up to TORCH five station and

two general hospitals and a medical

supply depot company. In addition, a

medical regiment, a medical battalion,

53

 TORCH plans and preparations are described in

Matloff and Snell, Strategic Planning, pp. 286-93 and

315-516; George F. Howe, Northwest Africa: Seizing

the Initiative in the West, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1957),

pp. 46-47, 70-72, app. A. 54

 The Eastern Task Force, British in composition

except for two American regimental combat teams,

received medical and other logistical support almost

entirely from the British Army.

55

 Quotation from Ltr, Hawley to Hillman, 11 Dec

42, file HD 024 ETO O/CS (Hawley-SGO Corresp).

Wiltse, Mediterranean, pp. 105-08, summarizes

TORCH medical planning. See also Howe, Northwest

Africa, pp. 32-33 and 63-67; MFR, McNinch and

Lewison, 24 May 49, sub: Interview With Col James

B. Mason, MC (Ret.) file HD 000.71, CMH.
FROM BOLERO TO TORCH 57

and one surgical and three evacuation

hospitals passed through the United

Kingdom on their way to North

Africa. The II Corps, the 1st Armored

Division, and the 1st and 34th Infantry Divisions took away their own organic medical units and detachments.

From his own office Hawley lost

seven officers and eighteen enlisted

men; SOS and non-SOS medical units

that stayed in Great Britain also surrendered personnel to fill up TORCH

organizations. In spite of these losses

increased arrivals from the United

States kept total SOS medical

strength at between 6,000 and 6,500

through early 1943; nevertheless, the

departure of experienced key people

and temporary personnel shortages

hindered the work of hospitals and

other units.56

The supply demands of TORCH on

the ETO medical service were more

extensive and crippling than those for

personnel. The Services of Supply

was required to equip all North

Africa-bound ETO units and medical

detachments, as well as furnish a

sixty-day reserve of supplies. Difficulties abounded. Many hospital and

other units designated for TORCH arrived in Great Britain with 25 percent

or less of their basic allowances, a fact

of which Hawley received no advance

warning. As each command tried to

remedy its own shortages, requisitions poured into the chief surgeon's

office from a variety of sources. At

one point the Supply Division was receiving requisitions, many of them

duplicates, from three separate

TORCH headquarters—AFHQ the II

Corps, and the Twelfth Air Force

(which was being formed out of the

Eighth for North African service).

Hawley, lacking authority to coordinate TORCH supply, could do no

more than suggest that all commands

channel their requisitions through

Colonel Corby at the Allied Force

Headquarters "so that he may detect

these duplications and establish appropriate priorities." Units at times

made almost impossible demands.

The 16th Medical Regiment, alerted

on 7 October for embarkation in a

November convoy, failed to requisition needed equipment until 1 November and then complained of

delays in delivery.57

In an attempt to coordinate TORCH

supply, the theater G-4 set up a committee of representatives from each of

the technical services. Maj. Clark B.

Meador, MC, the most active ETO

medical service member of this committee, "practically unaided, undertook the whole calculation of medical

requirements, of shipping requirements, of phasing of supply and the

checking of unit shortages against

T/E allowances." Meador formed

special teams to inspect all medical

units designated for TORCH and determine exactly what they had and

what they needed. Because much matériel 

56

 Memo, Hawley to Larkin, 7 Sep 42, in Larkey

"Hist," ch. 4, app. 5 (see also ch. 4, pp. 4, 8, 11,

and app. 7; and ch. 5, p. 35); Ltr. Hawley to Col J.

F. Corby, MC, 6 Oct 42, box 2, Hawley Papers,

MHI; "Med Svc Hist, 1942-43," p. 53, HD 314.7-2

ETO; Administration Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1942, p. 6

57

 Ltrs, Hawley to Col A. L. Hamblen, 26 Sep 42,

and Hawley to TSG, 3 Nov 42, sub: Medical Supply;

Memo, Hawley to CO, 16th Medical Regt, 4 Nov 42,

sub: Requisition No. MR-114-3(F); and Ltr, Hawley

to Corby, 5 Nov 42. All in file 024 ETO CS (Hawley

Chron). See also Wiltse, ed., Medical Supply, pp.

204-05.
58 EUROPEAN THEATER OF OPERATIONS

from the British and no catalog of

Anglo-American equivalents and substitutes yet was available, Meador improvised his own. Through his efforts

and those of others, the medical service managed to outfit the units embarking for TORCH. Equipment for

some organizations arrived in time

from the United States. For others,

the medical service transferred articles from non-Torch units or used

British supplies.58

To assemble equipment for the

eleven hospitals dispatched from Britain to North Africa, the depot medical

sections broke up most of the thirtyodd partial outfits that had arrived

from the United States and, where

necessary, added British matériel.

Until TORCH preparations began, only

the medical section of Depot G-45 at

Thatcham had assembled hospitals.

As demands increased and time ran

short, the Supply Division shifted

some assembly work to the other four

depot medical sections, which until

then had only stored and issued supplies. The short-handed, inexperienced staffs learned rapidly on the

job. A warrant officer at Depot G-35

in Bristol, tasked with putting together a 1,000-bed general, a 750-bed

evacuation, and a 250-bed station

hospital, recalled: "The only things I

had to help me was one Basic Equipment List and a prayer. ... I

needed both of them, as no one in

the Medical Section at that time had

any idea of the procedure used in assembling a hospital, and no one even

knew what an assembled hospital

looked like."

 59

In the course of mounting TORCH

the ETO medical service assembled

and shipped five station, three evacuation, one surgical, and two general

hospitals. It completed the equipment

of all embarking organizations and

sent out twenty-two medical maintenance units. Hawley reported:

"We . . . got the North Africa units

out fully equipped and, in that show,

were probably the best of the services." The cost to the European

Theater, however, was substantial.

TORCH stripped the depots of supplies and left many medical units

short of equipment. Replenishment

was slow in coming, as the North African campaign received priority in

shipping. Viewing the aftermath,

Hawley declared: "The mess that is

left will take months to straighten

out." His chief of Preventive Medicine, Colonel Gordon, observed that

the theater "had much the appearance of a plucked fowl. . . ."

 60

The shift of forces and attention to

North Africa reduced the European

Theater of Operations temporarily to

a backwater and made uncertain the

58

 Quotation from Memo, Hawley to CG,

ETOUSA, 11 May 44, sub: Recommendation for the

Award of the Legion of Merit, file HD 024 ETO CS

(Hawley Chron). See also Memos, Hawley to CofS,

SOS, 14 Sep 42, and Hawley to Lee, 19 Sep 42, in

same file, and Wiltse, ed., Medical Supply, pp. 266-

67.

59

 WO(jg) Lewis H. Williams is quoted in Wiltse,

ed., Medical Supply, p. 274. See Larkey "Hist," ch. 5,

pp. 35-37; Memo, Hawley to Lt Col C. E. Higbee,

SC, 9 Oct 42, file HD 024 ETO CS (Hawley Chron);

Ltr, Hawley to Tyng, 7 Nov 42, file HD 024 ETO

O/CS (Hawley-SGO Corresp). 60

 First and second quotation from Ltrs, Hawley to

Tyng, 7 Nov 42, and Hawley to Hillman, 5 Feb 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

Third quotation from John E. Gordon, "History of

Preventive Medicine in the European Theater of

Operations, USA, 1941-1945" (hereafter cited as

Gordon "Hist"), vol. 1, pt. 10, p. 10, CMH. See also

"Med Svc Hist, 1942-43," pp. 57-58, file HD 314.

7-2 ETO. For the general difficulties of TORCH

supply, see Ruppenthal, Logistical Support, 1:96-99.
FROM BOLERO TO TORCH 59

future of BOLERO. TORCH took out of

England all but one combat unit, the

29th Division. The Eighth Air Force

lost four fighter and two bombardment groups, much equipment, and

25,000 officers and men. In all, over

150,000 troops left England for North

Africa. Total ETO strength, even with

reinforcements from the United

States, dropped to 105,000 and would

remain at that level until well into

1943. Monthly cargo deliveries declined from 240,000 long tons in September 1942 to only 20,000 in February 1943. ETO headquarters and the

BOLERO Combined Committee suspended most of their buildup and

cross-Channel assault planning. After

a year-end visit to medical installations in Great Britain, Surgeon General Magee observed: "One could not

escape the feeling that service there

represented a back-eddy since the

opening of activities in Africa."

 61

For the medical service, as for the

rest of ETOUSA, 1942 proved to be a

year of large plans and false starts,

culminating in a convulsive flurry of

improvisation that left the theater impoverished and temporarily outside

the mainstream of wartime events.

Yet in spite of these vicissitudes, the

theater medical service succeeded in

completing its basic organization and

implementing medical programs,

some with systemic problems. The

chief surgeon, with the cooperation of

the British, organized a comprehensive American hospital system and

saw construction begin, however haltingly. U.S. Army hospitals, once in

operation, furnished medical care that

the surgeon general described as

"adequate and in some instances superior."

 62

 The supply system still

needed to be overhauled. Supply

shortages remained severe, causing

the Allies to meet most medical

supply requirements from sources

within the United Kingdom. In

mounting TORCH the ETO medical

service gained valuable, if often painful, administrative and logistics experience, readying it for continued

growth with the European Theater

when the latter resumed its place as

the focal point of the American war

effort in the new year. 61

 Memo, Magee to CG, SOS, 12 Jan 43, file HU:

Experience in Medical Matters F/Overseas Force.

For the impact of TORCH on the European Theater,

see Harrison, Cross-Channel, pp. 46-47; Ruppenthal,

Logistical Support, 1:99-104, 110; and Craven and

Cate, eds., AAF, 2:50-52, 231-32, 235.

62

 Memo, Magee to CG, SOS, 12 Jan 43, file HU:

Experience in Medical Matters F/Overseas Force.
CHAPTER III

Theater Chief Surgeon

During 1943 strategic initiative in

Europe and the Mediterranean passed

to the Allies. After the surrender of

250,000 Germans and Italians in Tunisia in May, the Americans and British followed up their North African

victory with a successful invasion of

Sicily that precipitated the collapse of

Mussolini's government. Italy, under

new rules, deserted the Axis early in

September, as United States and British Empire troops landed on its mainland. German divisions, however,

poured into Italy to continue the

battle. By the end of the year the

Allies were pushing slowly and painfully toward Rome, against tenacious

Nazi resistance. Meanwhile, the Allied

bombing of Germany expanded in

scale and destructiveness. At sea U.S.

and British naval forces gradually

secured the upper hand over the

U-boats. On the eastern front the

Russians, after major victories at Stalingrad and Kursk, began a counteroffensive that would end only in the

rubble of Berlin.

While the Mediterranean offensive

continued, the Americans during

1943 maneuvered the initially reluctant British, step by step, toward a

firm commitment to a cross-Channel

invasion aimed at the liberation of

France and the conquest of Germany.

At the Casablanca conference in January President Roosevelt, Prime Minister Churchill, and their Combined

Chiefs of Staff agreed in principle to

launch a full-scale cross-Channel

attack in 1944. They created the

Anglo-American staff known as

COSSAC to draft detailed plans for

the operation, as well as for smallscale raids and a limited attack in

1943. The conference also decided to

enlarge the bombing offensive and to

resume the full million-man BOLERO

buildup. In May, at the TRIDENT conference in Washington, the Allied

leaders set 1 May 1944 as the target

date for the invasion, initially codenamed Roundhammer but soon given

its permanent and historic title: OVERLORD. In August, at the QUADRANT

conference in Quebec, the president,

the prime minister, and their military

staffs approved COSSAC's outline

OVERLORD plan and directed

COSSAC to proceed with detailed

planning and preparations. They accorded OVERLORD first priority for

1944 among European and Mediterranean operations. Finally, at the

combined Cairo and Teheran conferences (22 November-7 December

1943), Soviet Premier Josef Stalin declared his support for OVERLORD; and
THEATER CHIEF SURGEON 61

the British and Americans decided to

undertake an invasion of southern

France with forces from the Mediterranean to supplement the main blow

on the Normandy coast.1

For the European Theater of Operations the year's developments in

strategy led to boundary and command changes. On 4 February 1943,

as the result of agreements reached at

Casablanca, the U.S. Joint Chiefs of

Staff created a new North African

Theater of Operations (NATOUSA),

encompassing the former Mediterranean and North African portions of

ETOUSA. The latter theater now

consisted of Iceland, the United Kingdom, Scandinavia, France, the Low

Countries, Germany, and most of

Central and Eastern Europe; and it

gradually ended its logistical support

of North African operations. Also in

February General Eisenhower, who

had moved his headquarters to Algiers late in 1942, assumed command

of the North African Theater. He was

succeeded as ETO commander first

by Lt. Gen. Frank M. Andrews,

former commander of U.S. forces in

the Middle East, and then, after Andrew's death in an airplane crash on 3

May, by Lt. Gen. Jacob L. Devers.

Devers remained at the head of

ETOUSA until 16 January 1944,

when Eisenhower returned to London

to take over the Supreme Headquarters, Allied Expeditionary Force

(SHAEF), an Anglo-American organization built on COSSAC to conduct

OVERLORD under direction of the

Combined Chiefs of Staff. Eisenhower

had under him Allied air, naval, and

ground commands. At the same time

he functioned as commanding general

of ETOUSA, responsible for administrative and logistical purposes to the

U.S. War Department.2

By the time General Eisenhower returned to London, the renewed

BOLERO buildup, initiated at Casablanca, was approaching its climax.

The buildup had gotten off to a slow

start. Although the Casablanca conferees called for deployment of 1.1

million Americans, including fifteennineteen divisions, in the United

Kingdom by the end of 1943, the

manpower, supply, and shipping requirements of the North African campaign, continuing U-boat depredations, and the persistent tentativeness

of the Allied commitment to the

cross-Channel assault curtailed the

movement of men and matériel to

Britain during the first five months of

the year. ETO strength remained at

less than 150,000. The floodgates

opened after the TRIDENT conference

set the OVERLORD target date and directed the establishment of a U.S.

force of 1.3 million in Great Britain

by that time. By mid-1943 the Allies

were winning the Battle of the Atlantic, and the combination of declining

losses and rising production alleviated

the shipping shortage that for so long

had crippled BOLERO. The buildup

1

 This account of Anglo-American strategic deliberations is based on Matloff, Strategic Planning, chs. I,

V, VI, VIII, X, XV, and XVI; Harrison, Cross-Channel,

chs. I, II, and III. COSSAC means Chief of Staff to

the Supreme Allied Commander (Designate). TRIDENT and QUADRANT were code names for the Allied

summit conferences.

2

 Matloff, Strategic Planning, pp. 60-63 and 403-04;

Ruppenthal, Logistical Support, 1:111-13 and 193-95;

and Harrison, Cross-Channel, ch. III, cover in detail

the evolution of the complex OVERLORD command

structure. The European Theater relinquished jurisdiction over southern France to NATOUSA on 6

February 1944; responsibility for Iceland passed to

the Eastern Defense Command on 30 July 1944.
62 EUROPEAN THEATER OF OPERATIONS

rate now depended more on British

port capacity than on availability of

bottoms.

Accordingly, during the last quarter

of 1943, over 100,000 American

troops per month disembarked in

Britain, bringing ETO strength at the

end of the year to over 770,000, including eleven divisions. Cargo flow

increased in proportion, from

348,900 measurement tons in June to

over 1 million tons in December. Between January and May 1944 the

buildup further accelerated. American

troop strength doubled to over 1.5

million men, with an average of two

divisions, plus supporting units, arriving each month, along with almost

1.5 million measurement tons of

freight. By the end of May 1944

BOLERO substantially had reached its

targets. In the process large tracts of

the English countryside were transformed into American cantonments,

vehicle parks, and storage depots.3

Command Problems Solved

During the decisive months of strategy-making and mobilization in 1943

General Hawley's position in the theater chain of command remained illdefined. The chief surgeon and the

other service chiefs continued to be

under the Services of Supply and

physically separated from theater

headquarters. They could issue technical directions to their subordinate

elements operating outside the Services of Supply only through the cumbersome process of drafting instructions for review and endorsement first

by SOS and then by ETO headquarters. Hawley, attempting to explain

the system to his staff, indicated the

operating difficulties:

In all technical directions, directives and

functions this office deals directly with

the surgeons of all echelons in the thea- ter as a whole . . . [but directives affect- ing the theater as a whole] must be pub- lished by the theater headquarters and go

to them for publication. Now, occasional- ly, to expedite getting something started,

we have had a command directive published in S.O.S. and sent the same direc- tive to ETO to be published for the

entire theater and that was merely to get

things going in the theater. . . . Any

paper that comes up, weigh it carefully— is this a theater matter or is this a S.O.S. matter . . . and having decided that, it is

very simple.4

The other service chiefs and, more

importantly, General Lee recognized

the inadequacy of the existing structure. When General Andrews became

ETO commander, Lee pressed upon

him the desirability of giving the Services of Supply clear-cut theater-wide

logistical and administrative authority.

He won his point. On 21 March 1943,

in a general order and accompanying

letters of instruction, Andrews designated the headquarters as "the Commanding General's agency for administrative service and supply of the

theater." Andrews gave General Lee

authority, within his area of delegated

responsibility, to issue instructions to

non-SOS elements by order of the

theater commander. Hawley and the

other technical service chiefs re3

 Matloff, Strategic Planning, pp. 53-54 and 407;

Ruppenthal, Logistical Support, 1:115 and 118-22.

4

 Notes of Conference Held in Chief Surgeon's

Room, 0830 Hours, 25 January 1943, prepared by

Col O. H. Stanley, MC, 29 Jan 43, file 323.362

Power and Duties (Office of the Chief Surgeon),

ETOUSA. For a general discussion of this problem

in the Services of Supply, see Ruppenthal, Logistical

Support, 1:160-61.
THEATER CHIEF SURGEON 63

mained under the Services of Supply

"for coordination, supervision, operational control, and direction," but

they were to move back to London so

as to function more effectively as theater staff officers.5

The 21 March redefinition of SOS

authority benefited the chief surgeon.

Hawley transferred himself and a portion of his staff to London in May,

while the bulk of his office stayed at

Cheltenham. Return to the capital

solved most of the chief surgeon's difficulties in liaison with the British and

improved his access to the ETO staff.

The increase of General Lee's authority—which Andrews' successor, General Devers, further expanded in May

by assigning Lee to additional duty as

the ETO G-4—enlarged the effective

powers of Hawley and the other technical chiefs. Hawley, for example,

now could shift medical personnel

within the ground and air forces by

means of directives from General Lee

acting for the theater commander.6

Andrews' restructuring of theater

command relations, while favorable

from the SOS viewpoint, still did not

definitively settle the question of SOS

authority over the ground and air

forces. In July, as a result of protests

from the Eighth Air Force, General

Devers revoked Lee's authority to

issue orders outside the Services of

Supply. Hawley and other service

chiefs continued to plead for "an unbroken chain of technical control

through all the echelons" of the European Theater. Over and above this

long-standing issue, the shift of tactical control of ground forces—and of

most operational planning—to newly

established U.S. army group and army

headquarters and to SHAEF left

ETOUSA with little to do but duplicate the administrative and logistical

functions of the Services of Supply.7

General Devers recognized that he

had one command echelon too many

in the theater. During late 1943 his

staff, in consultation with representatives of General Eisenhower, developed a plan for merging ETO and

SOS headquarters. Following this

plan Eisenhower, as commander of

both SHAEF and ETOUSA, on 17

January 1944 issued an order consolidating the theater headquarters and

staff with those of the Services of

Supply. Eisenhower appointed his

SHAEF chief of staff, Maj. Gen.

Walter Bedell Smith, also chief of

staff of the new headquarters, which

continued to be known as the European Theater of Operations. At the

same time Eisenhower made General

Lee deputy theater commander for

supply and administration, with authority to "act, in all appropriate

cases, for the Theater Commander,"

5

 GO No. 16, HQ ETOUSA, 21 Mar 43; ETO

LOI to CG, SOS, ETOUSA, 21 Mar 43; Staff Memo

No. 29, HQ ETOUSA, 8 Apr 43, sub: Organization

of HQ ETOUSA, and HQ SOS, ETOUSA. All in

file HD 024 ETO O/CS (Spruit Policy Notebook).

See also Ruppenthal, Logistical Support, 1:161-63. 6

 Col Charles B. Spruit, MC, Diary, JanuaryAugust 1943 (hereafter cited as Spruit Diary), 1 Apr

43; Administration Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943. For the question of

authority over personnel transfers, see Memos,

CSurg to G-1, SOS, 22 Apr 43; G-1, SOS, to

CSurg, 24 Apr 43; CSurg to CofS, SOS, 27 Apr 43;

and CofS, SOS, to CSurg, via G-1, 3 May 43. All in

file HD 008 ETO O/CS (Policy Book).

7

 The overall development of SOS authority is recounted in Ruppenthal, Logistical Support, 1:163-68.

Hawley's continuing concern is expressed in SOS

Minutes of Command and Staff Conference, 29 Nov

43 (Supplement), pp. 6-7, file HD 337 (Command

and Staff Conferences), and in Ltr, Hawley to TSG,

6 Jan 44, file HD 024 ETO O/CS (Hawley-SGO

Corresp).
64 EUROPEAN THEATER OF OPERATIONS

MAJ. GEN. ALBERT W. KENNER

and with direct control over all SOS

forces. Lee now clearly outranked

ground and air component commanders and could give directives to them;

the heads of his special staff sections

possessed confirmed theater-wide

technical authority over their services.8

The January 1944 reorganization,

which remained in effect until V-E

Day, at last placed General Hawley in

what he considered a satisfactory position in the chain of command.

Hawley, who had had differences with

General Smith during the TORCH

preparations, at first feared that Eisenhower would bring in a new theater chief surgeon. This apprehension

proved groundless. The entire SOS

staff continued in placed in the revamped ETO-SOS headquarters.

Writing in early February to Brig.

Gen. Norman T. Kirk, the surgeon

general as of May 1943, Hawley explained that

our organization here seems to have been

completely cooked and has now

jelled. . . . All Chiefs of Services, includ- ing myself, are Chiefs of Services of ETO

and, in addition to their other duties, are

Chiefs of Services of SOS. This is an

exact reversal of the previous organiza- tion in which the Chiefs of Services were

assigned to the SOS and, in addition to

their other duties, were Chiefs of Services

of the ETO. This is, of course, a small

point but [it] is proving to be a most important point.9

Hawley, who received his second

star on 27 February 1944, needed this

reinforcement of his authority to

maintain ascendancy amid the proliferation of high-level American staffs

that accompanied the BOLERO buildup. His most formidable potential

rival for theater medical predominance was Maj. Gen. Albert W.

8

 Quotation from GO No. 5, HQ ETOUSA, 17

Jan 44. See also Ruppenthal, Logistical Support,

1:198-201. Eisenhower, as Allied Supreme Commander, directed operations of air, ground, and

naval forces of all nationalities and in this capacity

was responsible to the Anglo-American Combined

Chiefs of Staff. His SHAEF staff included British

and other Allied officers as well as Americans. The

various national forces under Eisenhower looked to

their own national authorities for supply and administration. As ETO commander Eisenhower was responsible to the War Department for performing

those functions for U.S. forces. In fact, he delegated

most of the task to General Lee and the combined

ETO-SOS headquarters.

9

 Quotation from Ltr, Hawley to TSG, 4 Feb 44,

file HD 024 ETO O/CS (Hawley-SGO Corresp); in

same file, see Ltr, TSG to Hawley, 12 Feb 44. For

the threat to Hawley's position, see Interv, OSG

with Brig Gen Charles B. Spruit, MC (Ret.), 20 May

49 (hereafter cited as Spruit Interv, 1949), file HD

000.71, CMH; Ltrs, Hawley to Brig Gen Fred W.

Rankin, 26 Nov 43, and Hawley to TSG, 4 Dec 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp).
THEATER CHIEF SURGEON 65

Kenner, MC, SHAEF's chief medical

officer, who took up his duties in

London in February. Kenner, a Regular Army medical officer and close acquaintance of Marshall, Eisenhower,

and Lt. Gen. George S. Patton, Jr.,

had accompanied the latter to North

Africa in November 1942 as surgeon

of the Western Task Force. As the African campaign developed, Kenner

advanced to the dual position of

AFHQ chief surgeon and NATOUSA

chief surgeon. He served Eisenhower

as a personal front-line inspector and

emissary, as well as a medical staff officer. Returning to the United States

early in 1943, Kenner narrowly

missed becoming surgeon general to

replace the retiring General Magee.

His relationship with Eisenhower, seniority in rank, and military medical

experience brought Kenner the

SHAEF assignment.10

As SHAEF's chief medical officer

Kenner reported directly to Eisenhower, and thus was higher in the

chain of command than Hawley. He

advised the "Supreme Commander

and the Staff of Supreme Headquarters, on all matters pertaining to the

Medical Service within the areas

under the command of the Supreme

Commander, Allied Expeditionary

Force," and coordinated "medical

policy on an inter-allied basis." He

also had the right to inspect medical

installations and units and to investigate and report on any aspect of the

medical service that he chose. The

exact boundary between Kenner's

sphere of interest and that of General

Hawley—and indeed the overall demarcation line between the activities

of the American staff of SHAEF and

the ETO staff—never was very clear.11

Kenner and Hawley, nevertheless,

maintained a harmonious working relationship. In the preinvasion months

Kenner and his four-man AngloAmerican staff concentrated on reviewing and coordinating British and

American OVERLORD medical plans,

especially those for cross-Channel

evacuation. Kenner declared that his

relationship to the U.S. Army medical

service was "policy-making and inspectional, never operational. ... I

never interfered with Hawley's work; I

never issued Hawley any orders." Participants later differed in their recollections of the extent to which

Kenner, directly or indirectly, influenced ETO medical policies and operations. Most of the time the chief

medical officer appears to have left

Hawley to his own devices. If nothing

else, the small size of Kenner's staff,

and his resulting dependence on

Hawley's much larger office for information and the execution of directives, would have limited his ability to

intervene. When Kenner did choose

to step in, he had the authority to 10

 Name-Rank file, Special History Branch, CMH;

Kenner Interv, 1952, file HD 000.71, CMH. General

Marshall strongly supported Kenner for the position

of surgeon general because of Kenner's administrative ability and combat theater experience, and for a

while his appointment seemed assured. President

Roosevelt, however, insisted on someone more eminent in the estimation of the civilian medical profession, and General Kirk, also an able administrator,

received the appointment. See Armfield, Organization

and Administration, pp. 200-202.

11

 Kenner's duties are established in Memo,

CMedOff, SHAEF, to ACofS, G-3, via ACofS, G-4,

1 Mar 44, sub: Functional Chart of Medical Division,

and Admin Memo No. 3, SHAEF, 24 Apr 44, both

in Medical Division, COSSAC/SHAEF, War Diary,

March-April 1944. See the same source, JanuaryJune 1944, for a running account of the chief medical officer's activities.
66 EUROPEAN THEATER OF OPERATIONS

COL. ALVIN L. GORBY

make his wishes prevail, but he used

this power sparingly. Such restraint,

combined with frequent conferences

and exchanges of views with the ETO

chief surgeon, and with the maintenance on both sides of an atmosphere

of mutual respect, prevented what

could have been a disruptive conflict

of authority.12

During late 1943 and the first

months of 1944 the U.S. Army

ground forces completed their organization for OVERLORD. As invasion

preparations intensified, the War Department in October 1943 established

headquarters of the U.S. 1st Army

Group at London and the U.S. First

Army at Bristol, both initially under

Lt. Gen. Omar N. Bradley, to act in

planning as opposite numbers of the

British 21 Army Group and its two

subordinate field armies. On the

twenty-third the First Army assumed

operational control of all American

ground combat elements in Great

Britain, superseding the V Corps,

which until then had been the senior

ground command. In January of the

following year the European Theater

set up another U.S. army, the Third,

under General Patton. This headquarters helped administer the divisions

now pouring into the United Kingdom and began planning for continental operations after establishment

of the initial lodgement.

The surgeons of these headquarters

meshed their activities smoothly with

those of Hawley and his staff. Col.

Alvin L. Gorby, MC, arrived in England in January 1944 for duty in Hawley's office, but then was reassigned

as the 1st Army Group surgeon. He

had to develop his own charter of responsibility. "We'd never had a group

in the U.S. Army before," he recalled,

"and the concept of what the Group

Surgeon's office would do, and what

its organization should be, we just

had to pull it out of the air and set it

in." Gorby decided early that his role

would be analogous to that of a corps

or division surgeon, "a tactical setup,

rather than administrative, and that

12

 Quotations from Kenner Interv, 1952, file HD

000.71, CMH. For views of the Kenner-Hawley relationship, see Spruit Interv, 1949, and Interv, OSG

with Col Alvin L. Gorby, MC, 10 Nov 49 (hereafter

cited as Gorby Interv, 1949), both in file HD

000.71, CMH; Interv, OSG with Col John K. Davis,

MC (hereafter cited as Davis Interv), 19 Jun 45, box

222, RG 112, NARA; and Interv, NLM with William

S. Middleton, July and November 1968, February

1969 (hereafter cited as Middleton Interv, 1968-69),

vol. 1, p. 261, NLM. Ruppenthal, Logistical Support,

1:200-201, outlines the continuing SHAEF-ETO

problem of staff jurisdiction.
THEATER CHIEF SURGEON 67

BRIG. GEN. THOMAS D. HURLEY

(Rank as of 20 March 1945)

we ought to ... just ride herd, and

only take over and jump in when it

seemed like there was some need."

To this end, he limited the size of his

staff to eight or ten officers and about

the same number of enlisted men.

Until D-Day Gorby and his assistants

concentrated on OVERLORD planning;

they worked closely with 21 Army

Group, with Kenner and Hawley, and

with the First Army that was preparing the detailed assault plans for the

American landings. "All we did," the

army group surgeon declared, "was

go down and pat them on the back

and ask them if we could be of

aid."

 13

The army surgeons, Col. John A.

Rogers, MC, of the First and Col.

Thomas D. Hurley, MC, of the Third,

came out from the United States with

the cadres of their respective headquarters. Under the Army Ground

Forces organization then prevailing, a

field army performed most logistical

and administrative services for its

component units, leaving corps and

divisions a strictly tactical role. Each

army surgeon, accordingly, had a staff

about twice as large as Colonel

Gorby's, with specialized divisions

covering roughly the same range of

functions as those of the theater chief

surgeon's office. During the buildup

the army surgeons devoted much attention to invasion and operations

planning. They directed the training

of the medical units and personnel assigned to their armies, supervised

supply, and conducted active preventive medicine programs. Especially in

the latter two functions, they worked

closely with the SOS base section surgeons. The army surgeons were

under Hawley's technical direction

and generally deferred to him on

matters of policy. Hawley declared of

Colonel Rogers: "With all these new

heresies of staff control that have suddenly burst upon our Army, it is refreshing to have a surgeon in a subordinate echelon who adheres to the

old and tried doctrine of technical

control through staff channels as dis13

 Quotations from Historical Unit, U.S. Army

Medical Service, Advisory Editorial Board for the

History of Medical Service in the European Theater

in World War II, Minutes of Sessions, 9-10 October

1962 (hereafter cited as Editorial Advisory Board,

1962), pp. 75-77. See also 12th Army Group Report

of Operations, vol. XIII (Medical Section), pp. 7-8

and 15-20; in CMH, both Gorby Interv, 1949, file

HD 000.71, and Interv, OSG with Maj Gen Alvin L.

Gorby, MC, 8 Oct 62 (hereafter cited as Gorby

Interv, 1962), pp. 2-3.
68 EUROPEAN THEATER OF OPERATIONS

tinct from command control through

command channels."

 14

The most significant challenge to

unified medical service in the European Theater was a theater-level manifestation of the worldwide Air Force

struggle for autonomy. In 1941 the

newly formed Army Air Forces (AAF)

headquarters had secured its own

medical division under Air Surgeon

Lt. Col. David N. W. Grant, MC.

Grant was nominally subordinate to

the surgeon general, but he waged a

series of increasingly bitter bureaucratic conflicts and gradually won effective independence. To justify this

drive for autonomy, Grant and his

colleagues argued that the unique

clinical and technical problems of

air warfare could be dealt with only

by a specialized aviation medical service. In 1943 the surgeon general disagreed, insisting that treatment of air

crew casualties in most respects involved the same medical and surgical

practice as treatment of any other casualties. Step by step the air surgeon

gained ground. By the end of the year

Grant, now a major general, controlled what amounted to an independent personnel procurement

system and a separate supply service.

In the United States the Air Force

had its own convalescent centers and

station and general hospitals, and the

air surgeon had begun pushing for

similar hospitals in the overseas theaters.15

In the European Theater the Air

Force expanded rapidly under the

impact of the Casablanca decision to

intensify the bombing offensive

against Germany. By mid-1944 AAF

strength in the United Kingdom had

reached almost 427,000 officers and

men of the Eighth (strategic) and

Ninth (tactical) Air Forces and various

support and service commands, under

the overall control of Headquarters,

United States Strategic Air Forces

(USSTAF). Of these troops almost

13,000 were members of the Army

Medical Department, headed by

USSTAF surgeon, Brig. Gen. Malcolm C. Grow, MC.16

From the early days of the buildup,

when the Eighth Air Force, with Colonel Grow as surgeon, was the senior

air headquarters in the theater, the air

service waged a running battle with

14

 Quotation from Ltr, Hawley to TSG, 4 Dec 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also First U.S. Army Report of Operations, 20

Oct 43-1 Aug 44, bk. I, pp. 13-15, and bk. VIII, an.

16 (Medical Section); Surg, Third U.S. Army,

Annual Rpt, 1944; Editorial Advisory Board, 1962,

pp. 85-86.

15

 For the general development of the AAF medical service, see Armfield, Organization and Administration, pp. 47-48 and 79-82, and Link and Coleman,

AAF Medical Support, passim. See also Ltr, TSG to

Hawley, 7 Aug 43, file HD 024 ETO O/CS

(Hawley-SGO Corresp). 16

 Air command arrangements were complicated

by the fact that the Combined Chiefs of Staff retained direct control over the strategic bombing offensive until the final months before OVERLORD,

while General Eisenhower, through SHAEF, controlled British and American tactical air. Hence,

USSTAF had both operational and administrative

control of the Eighth Air Force in England, operational control of the Fifteenth in the Mediterranean, and administrative control of the Ninth,

formed in Britain early in 1944 to furnish tactical air

support to the American armies. Eisenhower had

operational control of the Ninth through the Allied

Expeditionary Air Forces, a division of SHAEF. For

the air buildup and command relations, see Ruppenthal, Logistical Support, 1:192-93 and 202-03;

Craven and Gates, eds., AAF, 2:639; and ibid., vol.

3, Europe: ARGUMENT to V-E Day, January 1944 to May

1945 (1951), pp. 107-19. See also Link and Coleman, AAF Medical Support, pp. 558-59 and 580.
THEATER CHIEF SURGEON 69

BRIG. GEN. MALCOLM C. GROW

the Services of Supply for administrative and logistical independence. In

the medical sphere the issues were

hospitalization and supply. Under

agreements reached early in 1942,

SOS station and general hospitals

were to treat all Air Force sick and

wounded who required more than

short-term care. The Air Force was to

have no hospitals of its own except

25-bed unit dispensaries. The Services of Supply was to furnish all

medical supplies except items used

exclusively by air surgeons, which

would come from the United States

through Air Force channels. Grow

and his staff steadily undermined

these arrangements, taking advantage

of early SOS delays in hospital construction and slow supply deliveries

to justify independent action. Before

the end of 1942 Grow, over strenuous

objections from Hawley, had obtained

theater authorization for separate Air

Force convalescent centers and an Air

Force medical service school, although the Eighth Air Force surgeon

lost a battle to set up 50-bed air base

hospitals. Grow also managed to

open his own supply pipeline from

the United States for common items

as well as for those peculiar to the Air

Force. To Hawley's continuing irritation, the Air Force as a result always

seemed able to obtain matériel when

the chief surgeon could not. Hawley

repeatedly demanded a halt to "this

pernicious practice." But he never

could shut off the flow, and the continuing ineffectiveness of his own

Supply Division afforded the Air

Force an excuse for its irregularities.17

General Hawley consistently opposed the setting up of an independent Air Force medical service, and especially the establishment of separate

Air Force-controlled station and general hospitals. While he recognized

17

 For overviews of the AAF-SOS jurisdictional

conflict, see Ruppenthal, Logistical Support, 1:170-71;

Craven and Cates, eds., AAF, 1:648-49; Armfield,

Organization and Administration, pp. 331-32; and Link

and Coleman, AAF Medical Support, pp. 555-71. On

rest homes and schools, see Ltrs, Hawley to Brig

Gen David N. W. Grant, 30 Mar 43, and Hawley to

TSG, 8 Jul 43, both in file HD 024 ETO O/CS

(Hawley-SGO Corresp); Items 47 and 55, file HU

312.3 (Corresp File, ETO Chief Surgeon). On the

dispensary fight, see file 320.2 ETO (T/O Medical

Dispensary). On supply, see Ltrs, Hawley to Tyng, 7

Oct 42, Hawley to G-4, SOS, 14 Oct 42, and 1st

End, Hawley to CG, SOS, 9 Nov 42, file HD 024

ETO CS (Hawley Chron); see also Ltrs, Tyng to

Hawley, 18 Oct 42, Hawley to Tyng, 7 Nov 42, and

Hawley to TSG, 19 Aug, 9 Sep, and 14 Oct 43, file

HD 024 ETO O/CS (Hawley-SGO Corresp). The

AAF in the United States had secured a supply of

common medical items, held in its own depots, from

which it filled Grow's requisitions.
70 EUROPEAN THEATER OF OPERATIONS

the "special medical problems" of air

crew care, he insisted: "There is not

the slightest technical difference between an air soldier wounded by fragments of a 20mm cannon shell and an

infantryman wounded by fragments

of an 88mm artillery shell." A hospital capable of treating one also could

treat the other. ETO station and general hospitals, Hawley pointed out,

cared for all American patients from a

given area, so if the Air Force took

over any existing fixed hospitals, its

flight surgeons would spend most of

their time working on ground and

service troops. Establishment of additional hospitals solely for Air Force

casualties would result in diversion of

scarce manpower and matériel to underused specialist institutions. Hawley

summed up:

If we turn over any hospitals in this Thea- ter to the Air Force, it will result either in

the Air Force being required to care for

thousands of sick and injured in the

Ground Forces or in constructing at least

$10,000,000 worth of new hospitals. . . . Regardless of such a waste of money, this

additional construction cannot be accom- plished in this Theater because both

labor and materials for hospital construc- tion have now been exhausted.18

While adamant in principle against

separate Air Force medical facilities,

Hawley tried to make the SOS medical service as responsive as possible

to Air Force requirements. He added

aviation medicine specialists to the

staffs of station and general hospitals

that treated large numbers of airmen,

and he pressed the British hard for

early completion of hospital plants

near the major AAF bases and troop

concentrations. He badgered his

Supply Division for prompt response

to Air Force requisitions. In his unsuccessful campaign to block creation

of a separate AAF medical service

school, Hawley went so far as to offer

command of the SOS medical school

to an Air Force medical officer.

Hawley kept up a friendly relationship

with General Grow and worked hard

to win over Air Surgeon Grant when

the latter visited England in September 1943. Other members of Hawley's

staff were less conciliatory. Colonel

Spruit, the chief surgeon's representative in London until Hawley's move

from Cheltenham in May 1943, always

abrasive, irritated Eighth Air Force officers to the point where they unsuccessfully tried to have him relieved.

Nevertheless, Hawley's approach paid

dividends. Grow made no real attempt to press for independent Air

Force station or general hospitals and

repeatedly expressed to Grant his satisfaction with SOS medical support.19

The Air Force hospital issue came

to a head early in 1944. By that time

Eighth Air Force bombers were flying

daily missions deep into Germany,

suffering a heavy toll of air crew fatalities, wounds, and mental and physical exhaustion. The confrontation in

18

 Quotations from Ltr, Hawley to TSG, 10 Aug

43, file HD 024 ETO O/CS (Hawley-SGO Corresp);

see other letters in same file. See also Ltr, Hawley

to Brig Gen Ray W. Barker, 5 Mar 43, box 2,

Hawley Papers, MHI; Ltr, Hawley to G-1, ETO, 15

Oct 42, file HD 024 ETO CS (Hawley Chron).

19

 Link and Coleman, AAF Medical Support, pp.

566-67, summarize Grow's reports to Grant. Hawley's relationship with Grant and Grow and Spruit's

feud with the Eighth Air Force are reflected in many

letters for 1943-44 in file HD 024 ETO O/CS

(Hawley-Corresp) and in MFR, Conference with

Gen Hawley, 18 Apr 50, file HD 000.71. Hawley

Operational Directive No. 13, 25 Jun 43, box 2,

Hawley Papers, MHI, shows his concern for Air

Force supply; in the collection, see Ltr, Hawley to

Barker, 5 Mar 43, and Operational Directive No. 34,

18 Aug 43.
THEATER CHIEF SURGEON 71

this instance originated in Washington, where acquaintances hinted privately to President Roosevelt—whose

son Elliot was an Air Force officer—

that aviator casualties in the European Theater were receiving medical

care inferior to that given British

fliers in RAF hospitals. Roosevelt directed Surgeon General Kirk, Air Surgeon Grant, and Dr. Edward A.

Strecker, a civilian consultant to the

Navy and Air Force, to go to England

and investigate the problem.

During February and March the

three men toured Army and RAF hospitals in the United Kingdom. They

conferred with USSTAF and Eighth

Air Force commanders and with

Hawley, Grow, and other medical officers. Their unanimous report, issued

on 20 March, amounted to a ringing

vindication for General Hawley. Kirk,

Grant, and Strecker concluded that

Air Force patients—and all other U.S.

troops—were receiving "superior"

medical and surgical care and that

RAF hospitals were inferior in most

respects to American ones. SOS station and general hospitals were sufficient in number and properly located

to meet Air Force requirements, according to the investigators, and the

professional staffs "very definitely realized Air Forces problems and met

them effectively." The board noted

with approval the "close cooperation"

prevailing between the staffs of the

USSTAF and ETO surgeons. Kirk,

Grant, and Strecker did criticize

delays in returning recovered airmen

to duty through the SOS replacement

system, a long-standing Air Force

grievance, and they recommended

adding flight surgeons to the disposition boards of general hospitals treating Air Force patients. Hawley and

Grow quickly implemented this suggestion. In the face of Air Force commanders' expressions of preference

for totally Air Force-run hospitals,

the board concluded: "In view of the

long established system of hospitalization in the ETO and contemplated

new operations, . . . any change in

the general principle of hospitalization ... at this time should not

be recommended." Although the air

surgeon continued to agitate for his

own overseas hospitals, the KirkGrant-Strecker report effectively

closed the question in the European

Theater. SOS hospitals continued to

care for Air Force patients until the

end of the war. The Air Force theater

medical establishment, in this important respect at least, remained firmly

within Hawley's control.20

Within the Services of Supply the

chief surgeon had to define his relationship to the base section headquarters, which steadily expanded in

number, size, and administrative importance. At the beginning of 1943

the United Kingdom was divided into

three base sections—the Southern,

Eastern, and Western (which included

Northern Ireland). During the year

the SOS headquarters added two

more sections: a Central Base Sec20

 Quotations from Memo, Maj Gen N. T. Kirk,

Maj Gen D. N. W. Grant, and Dr. E. A. Strecker to

CofS, via DepTheaterCdr, ETOUSA, 20 Mar 44,

copy in file HD 024 ETO O/CS (Hawley-SGO Corresp). For background of this investigation, see Link

and Coleman, AAF Medical Support, pp. 88-91, 563-

66, 568, and Hawley Interv, 1962, p. 32, CMH. The

question of returning AAF patients to duty involved

both reducing the time during which they were lost

to their parent units and determining accurately fitness to resume flying. For the role of the air surgeons in disposition boards, see Mins, 23d Meeting

of Base Section Surgeons, 5 Jun 44, p. 5, file HD

337.
72 EUROPEAN THEATER OF OPERATIONS

tion, encompassing the London area,

and a revived Northern Ireland Base

Section.21

General Lee, in a directive issued

on 24 August, resolved the longstanding special staff-base section

conflict over control of the technical

services in favor of the base section

commanders. Each base section commander, Lee declared, was responsible for "all SOS operations" within

his area and had "the authority of

command . . . over all SOS individuals, units and installations ... in his

base section." A base section was to

provide most logistical services for all

American forces within its boundaries, including hospitalization and

evacuation. Under this order General

Hawley lost all formal control over

SOS medical units and installations,

including general hospitals. Even the

right to transfer medical personnel

within a base section, hitherto a prerogative of the chief surgeon's Personnel Division, now belonged to the

base section commanders, although

the chief surgeon still controlled assignments of new medical units to

base sections and could transfer officers and men between sections.22

As a result of Lee's policy, which he

called centralized control and decentralized operation, most day-to-day

direction of SOS medical service

rested with the base section surgeons

and their staffs. Initially undermanned and lacking qualified administrators, the offices of the base section surgeons by late 1943 possessed

at least adequate manpower and had

established a divisional organization

that corresponded closely to that of

the chief surgeon's office. Each base

section surgeon acted as both a staff

officer of the section commander, informing his superior of the health of

the command and administering the

medical service under his direction,

and as the technical representative of

the chief surgeon. In the latter capacity a base section surgeon collected

information and disseminated technical directives, policies, and procedures. By early 1944 each base section surgeon had under his purview

an establishment that was larger than

the entire ETO medical service

scarcely a year before. The Western

Base Section alone contained almost

10,500 medical troops in eighty-five

units and had seven station and six

general hospitals in operation.23

To maintain uniformity of medical

policy and practice in the base sections, General Hawley in August 1943

instituted twice-monthly conferences

of section surgeons and his office division heads. Individual divisions held

their own regular meetings with base

section counterparts and helped train

and indoctrinate base section medical

staffs. The Hospitalization Division,

for example, instructed base section

21

 The original Northern Ireland Base Section was

reduced to a district of the Western Base Section on

9 December 1942, for lack of troops, but was revived again with the buildup of forces in Northern

Ireland. See Ruppenthal, Logistical Support, 1:168-70. 22

 Cir No. 49, HQ SOS, 24 Aug 43, and Cir No.

1, HQ SOS, 8 Jan 44, define base section authority

and functions. See also Memo, Lee to CG,

ETOUSA, 15 Jun 43, sub: Report on Structural Organization of the SOS, file 129 Admin (ETO). For

the question of medical personnel transfers, see

Spruit Diary, 20 Apr 43; Personnel Division,

OofCSurg, HQ ETOUSA, Annual Rpt, 1943; Notes

of Base Section Surgeons Conference, 2 Aug 43.

23Mins, 14th Meeting of Base Section Surgeons,

31 Jan 44, p. 14, file HD 337. For base section surgeon's office organization and activities, see Eastern, Western, Southern, Central, and Northern Ireland Base Sections Annual Rpts, 1943 and 1944.
THEATER CHIEF SURGEON 73

hospital inspectors in standard procedures. Although Lee's 24 August

order formally placed general hospitals under the base sections, General

Hawley managed to retain effective

control over them. He and members

of his staff regularly visited—in effect,

inspected—these hospitals. When

necessary, Hawley used his personal

influence with General Lee to pressure base section commanders to improve substandard hospitals or to

block detrimental base section interference. "For all practical purposes,"

Hawley recalled, "even though the

base section commanders commanded the general hospitals . . . , we got

pretty much what we wanted."

 24

Office Expansion

As other headquarters multiplied,

the chief surgeon's office expanded in

both manpower and number of functional divisions. Between May 1943,

when BOLERO resumed in full force,

and the eve of invasion the office

force grew from 64 officers, 63 enlisted men, and 81 civilian employees to

135 officers, 335 enlisted men, and

122 civilians. Most of the additional

officers entered the theater as casuals,

and the vast majority were non-Regulars. Until late 1943 General Hawley

continued to complain about a shortage of administrators. But the increasing number of qualified men available, and a more determined effort by

the surgeon general's office to send

the best to the European Theater, assured the arrival of sufficient managerial talent. By early 1944 only the

Supply Division still lacked adequate

staff.25

Hawley's office at the beginning of

1943 contained eleven divisions—Administration, Hospitalization, Supply,

Personnel, Preventive Medicine, Professional Services, Operations and

Training, Medical Records, Nursing,

Dental, and Veterinary, all located at

Cheltenham. During the next year

and a half these divisions multiplied,

combined, recombined, and gravitated toward London. The geographical

movements resulted in part from an

effort to place in the capital those divisions most involved in theater-wide

planning and operations, and in part

from the fact that the shift of any one

division created almost irresistible

pressure for other closely associated

divisions to follow.

On 13 May 1943, when General

Hawley returned to the capital, he

formally divided his office into

London and Cheltenham echelons.

The London office at 9 North Audley

Street, headed in person by the chief

surgeon, had responsibility for "formulation of policy and broad planning" and for "administration and

technical supervision of the medical

24

 Quotation from Editorial Advisory Board, 1962,

pp. 38-40. For an example of his pressure on a base

section commander, see Ltr, Hawley to Brig Gen C.

O. Thrasher, CG, Southern Base Section, 16 May

44, and Memo, Hawley to Lee, 16 May 44, both in

file HD 024 ETO CS (Hawley Chron). See also

MFR, OofCSurg, ETOUSA, 26 Jul 43, sub: Notes

From the Chief Surgeon, file HD 024 ETO O/CS

(Spruit Policy Notebook); Mins, 1st Meeting of Base

Section Surgeons, 2 Aug 43, file HD 337; Ltr, Col

Liston to Col Abner Zehm, General Board, USFET,

14 Aug 45.

25

 Personnel Division, OofCSurg, HQ ETOUSA,

Annual Rpts, 1943 and 1944. For the gradual resolution of the administrative personnel shortage, see

January-December 1943 correspondence in file HD

024 ETO O/CS (Hawley-SGO Corresp). The problems of the Supply Division are covered in Chapter

VI of this volume.
74 EUROPEAN THEATER OF OPERATIONS

service of the theater as a whole."

The Cheltenham office, under the

acerbic but able Colonel Spruit, who

thus was removed from hostile contact with the Air Force, consisted of

the bulk of the staff and supervised

the SOS medical service; it also collected the information required for

theater medical planning. In July

Hawley created two new Londonbased divisions. The Planning Division, set up in conformity to general

SOS policy, took over from Operations and Training the tasks of coordinating medical planning and of

keeping abreast of overall theater

planning. At the same time the new

Evacuation Division assumed charge

of that function, hitherto overseen by

Operations and Training. Earlier, the

chief surgeon had organized a Gas

Casualty Division at Cheltenham to

direct medical preparations for defense against and care of casualties

from chemical warfare, then still considered a significant threat.26

Additional changes and moves occurred during early 1944, aimed

mostly at improving medical planning

and coordination as D-Day approached. In February the Operations

and Training Division transferred to

London. Renamed the Operations Division, it absorbed Planning, the functions of which it overlapped, as a

branch and at the same time again

took over Evacuation. Preventive

Medicine, now concerned with preparing for continental operations as

well as protecting the health of troops

in England, moved to the capital in

February, followed in March by Hospitalization, which also had to plan

for post-invasion activities. Early in

June a Rehabilitation Division, headquartered in London, split off from

Hospitalization to direct an increasingly elaborate convalescent reconditioning program. Meanwhile, a Historical Division had begun operations

at 9 North Audley Street, overseeing

public relations and the medical photographic laboratory as well as undertaking the work that led ultimately to

the present volume. On D-Day the

chief surgeon's office (Chart 3) consisted of fourteen divisions, five of

which were located in London and

nine in Cheltenham.27

The Professional Services Division,

which included the theater medical

and surgical consultants, played a crucial role in tying together the entire

medical establishment. General

Hawley, following the Army's precedent in the use of consultants in

World War I, as well as the example

of the British, had activated this division on 19 June 1942. The division

chief was Colonel Kimbrough, formerly the head of the Urology Section at Walter Reed Army Medical

Center. By early 1944 Kimbrough,

promoted to full colonel, headed the

division's Cheltenham office, consist26

 For an example of the considerations governing division moves, see Ltr, Hawley to Spruit, 1 Oct

43, file HD 024 ETO O/CS (Spruit Policy Notebook); Office Order No. 1 (source of quotations),

OofCSurg, HQ ETOUSA, 13 May 43, and Planning

Directive No. 8, 10 Jul 43, ends. 1 and 2 to Planning Division, OofCSurg, HQ ETOUSA, Annual

Rpt, 1943. See also annual reports, 1943, for the

Administration, Evacuation, Operations, Hospitalization, and Gas Casualty Divisions. Evacuation had

been under the Hospitalization Division until October 1942, when Operations and Training took it

over.

27

 Administration and Preventive Medicine Divisions, OofCSurg, HQ ETOUSA, Annual Rpts,

1944; Larkey "Hist," ch. 8, pp. 2-5 and app. 2.

76 EUROPEAN THEATER OF OPERATIONS

ing of seventeen officers, six enlisted

men, and ten civilian employees.28

Kimbrough's immediate subordinates were Chief Consultant in Surgery Col. Elliott C. Cutler and Chief

Consultant in Medicine Col. William

S. Middleton. Arriving in the European Theater in mid-1942, both had

served in the Army Medical Department in the previous war before attaining civilian professional eminence—Cutler as Moseley professor

of surgery at Harvard and Middleton

as dean of the University of Wisconsin Medical School. Each chief consultant had under him a number of

senior consultants in particular surgical or medical specialties. Cutler kept

most of his senior consultants on duty

in his own office, using them as a personal staff. Middleton, who thought

that consulting in most fields did not

require the full time of scarce experts,

maintained only his dermatology and

neuropsychiatry consultants at Cheltenham. For other specialties he

relied on general hospital chiefs of

service assigned to additional duty.

Regardless of how organized, the

senior consultants, authorities in the

civilian profession and mostly new to

the Army, required careful handling.

Kimbrough, according to Middleton,

had to employ "unusual talents" in

managing his "prima donnas." In moments of crisis "he would first cajole

them. Then he would quote Shakespeare and then the Scripture. Finally

he'd burst out into the vilest profanity

you have ever heard."

 29

The consultants' primary task was

to ensure uniformity and high quality

in theater surgical and medical practice, but General Hawley used them

for much more than that. He made

them his personal advisers, agents,

and inspectors and involved them in

most aspects of ETO medical policy

and administration. The Professional

Services Division, Hawley declared,

"was an operating division. And probably, except for the Operations and

Training Division, was the really controlling division in the office." At the

consultants' first general meeting, in

October 1942, Hawley told them:

I expect advice from this group, not only

when I ask for it, but when any member

of this group thinks that I need it. ... You people, within your specialties, are to

represent me and act with my complete

authority. . . . You have technical control

of the practice of your specialties in this

Theater. ... I do want you to correct

things I spot. . . . You have my complete

authority to make corrections in technical

procedures right on the spot. . . .30

28

 Professional Services Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1944. For the origins and

World War I background of the consultant system,

see W. Paul Havens, Jr., ed., Activities of Medical Consultants, Medical Department, United States Army in

World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1961), pp.

1-4 and 231-32, and B. Noland Carter, ed., Activities

of Surgical Consultants, Medical Department, United

States Army in World War II, 2 vols. (Washington,

D.C.: Office of the Surgeon General, Department of

the Army, 1962-64), 2:1-5. For British consultants,

see Crew, AMS, Administration, 1:136-45.

29

 Quotations from Middleton Interv, 1968-69,

vol. 1, pp. 195-96, NLM. See also ibid., pp. 197-98

and 228-30; Havens, ed., Medical Consultants, pp.

232-34; Carter, ed., Surgical Consultants, 2:5-9, 19-

21, 28; Larkey "Hist," ch. 3, pp. 54-59. 30

 First quotation from Hawley Interv, 1962, pp.

24-26, CMH. Second quotation from Verbatim

Report of First Meeting of the Chief Surgeon's Consultants Committee, 16 Oct 42, in Professional Services Division, OofCSurg, HQ ETOUSA, Annual

Rpt. 1942. See also Carter, ed., Surgical Consultants,

2:6-8, 13-14, 22; Ltrs, Hawley to Hillman, 5 Feb

43, and Hawley to TSG, 28 Sep and 14 Oct 43, file

HD 024 ETO O/CS (Hawley-SGO Corresp). The

position of the consultants in the European Theater

contrasted sharply with that in the Pacific. See Armfield, Organization and Administration, pp. 421-23.
THEATER CHIEF SURGEON 77

The theater consultants involved

themselves in most aspects of the

medical service. Colonel Cutler's surgical consultants, free of other duty,

were especially active. They visited

each arriving medical unit; evaluated

the professional qualifications of the

staff; and recommended to the Personnel Division assignments and

transfers, to make the best use of talents and to assure balanced strength

in each hospital. Cutler and his staff

reviewed the medical supply tables,

eliminating superfluous or obsolete

drugs and instruments, and put together a catalog of British and American supply equivalents. Late in 1942

Cutler discovered severe deficiencies

in division surgical equipment and

recommended supplementary issues,

all of which could be made with items

obtainable in England. The consultants performed research on surgical

problems and oversaw the development of specialized treatment facilities and convalescent rehabilitation

programs. They supervised professional training in the hospitals and

advised and assisted in general medical unit training. They helped organize a theater blood collection and

transfusion system, directed the introduction of penicillin into ETO medical practice, and devised a simplified

patient record. Before the invasion

the surgical consultants designed prototypes of a truck-mounted field surgical unit and a mobile X-ray unit.

The medical consultants also evaluated personnel, inspected hospitals, and

advised other divisions of the chief

surgeon's office. Colonel Middleton

held periodic conferences for the

chiefs of medical service from all operating hospitals "in the interest of

the coordination and consolidation of

medical practice."

 31

As the ETO medical service expanded and the Services of Supply

delegated operating responsibility to

the base sections, General Hawley established a system of base section

consultants in general surgery and

medicine. He also arranged for the

appointment of regional and later

hospital center or group consultants

in various special fields. Many of the

base section consultants were theater

senior consultants on additional duty;

regional and center consultants usually were general hospital chiefs of service. These consultants, who worked

under the base section surgeons but

sent copies of all reports to the Professional Services Division, took on

much of the task of supervising clinical practice in their areas of responsibility. The base section consultants

also evaluated unit personnel and

oversaw hospital operations and evaucation. In addition to these SOS consultants each field army headquarters

had consultants in surgery, medicine,

and neuropsychiatry, often personally

selected by the army commander.

The higher AAF headquarters also

maintained its own group of consultants.32

31

 Professional Services Division, OofCS, HQ

ETOUSA, Annual Rpt, 1944, especially Medical

Consultation Service sec.; Carter, ed., Surgical Consultants, 2:11-17 and 38-40; Havens, ed., Medical

Consultants, pp. 241-45 and 266-70; Middleton

Interv, 1968-69, vol. 1, p. 208, NLM. 32

 Base section surgeons selected their consultants, under guidance from the chief surgeon. Initially, the chief surgeon's office designated all regional consultants, but this procedure became too

cumbersome and General Hawley in February 1944

delegated this task to the base section surgeons. See

Professional Services Division, OofCSurg, HQ Continued
78 EUROPEAN THEATER OF OPERATIONS

The Professional Services Division

bound all these experts into a unified

network (Chart 4). The division conducted weekly meetings for theater,

base section, army, and air force consultants, at which the participants exchanged information and reached

consensus on professional matters.

General Hawley held similar monthly

conferences with consultants from all

commands. The chief surgeon encouraged consultants at every level to

deal directly with each other on

"purely professional" subjects, outside regular command and technical

channels. Because "professional"

matters were broadly defined in the

ETO medical service, and because civilian reputation lent great weight

among doctors to even informal suggestions from the senior consultants,

these experts constituted, in effect, a

separate medical line of communications into every major headquarters.

According to Colonel Middleton,

"You could, in a period of minutes by

telephone . . . carry out any professional policy. One did not have to

communicate through chains of military command. ... " The effect, Middleton noted, "was centripetal . . .

since General Hawley's office,

through this medium, was constantly

in touch with all medical echelons of

the theater."

 33

In the two and a half years before

D-Day General Hawley established effective central control over the potentially fragmented ETO medical service. His ascendency resulted in part

from the success of General Lee's efforts to secure theater-wide logistics

authority for the Services of Supply,

but it also depended heavily on intangible personal elements. Longevity

worked in Hawley's favor. Having

been in England since late 1941,

Hawley knew the country and its

medical facilities better than any

other senior American medical officer

except possibly Grow; he had unmatched British official and professional contacts. Hawley worked hard

at his job. He kept thoroughly informed about even minor details of

his service's operations, and he spent

as much time as he could visiting

medical units and installations, especially favoring unannounced descents

on hospitals. At the same time

Hawley readily delegated responsibility to subordinates and won their firm

personal loyalty even as he drove

them hard. His consultants, and

former members of his staff at other

headquarters, provided him with an

informal communication network covering most of the theater.34

ETOUSA, Annual Rpt, 1944, especially Chief Consultant in Surgery and Medical Consultation Service

sees.; Carter, ed., Surgical Consultants, 2:118-21;

Havens, ed., Medical Consultants, pp. 238-39. Col. J.

B. Coates, in Editorial Advisory Board, 1962, pp.

85-90, describes the personality problems attending

General Patton's choice of a Third Army surgical

consultant. 33

 First quotation from Middleton Interv, 1968-

69, vol. 1, pp. 197-98, NLM. Second quotation from

Havens, ed., Medical Consultants, pp. 239-40. See also

Professional Services Division, OofCSurg, HQ

ETOUSA, Annual Rpts, 1943 and 1944. 34

 On Hawley's grasp of detail, see file Hawley

Planning Directives, box 2, Hawley Papers, MHI,

and Ltr, Hawley to Col Mack M. Green, MC, 11 May

44, file HD 024 ETO CS (Hawley Chron). For an

example of an officer who went from Hawley's staff

to SHAEF, see Davis Interv, 19 Jun 45, box 222, RG

112, NARA. For Hawley's effect on subordinates,

see Middleton Interv, 1968-69, vol. 1, pp. 193-95,

NLM, and Interv, Medical History Branch, CMH,

with Brig Gen Sam F. Seeley, MC, 14 Aug 79 (hereafter cited as Seeley Interv, 1979), sess. 2, cassette

4, p. 2, HSF (Seeley-1979), Medics' War Ms, Accession no. 319-88-055, RG 319, NARA.

THEATER CHIEF SURGEON 79

Always skilled in political maneuver, Hawley maintained profitable

contacts with those above him in the

chain of command. He kept on good

terms with his imperious immediate

superior, General Lee. "We gave on

small things," he recalled, including

agreement to Lee's pet project of

using osteopaths in patient rehabilitation, "and always won our point on

the large issues." Through correspondence and a brief Washington

visit early in 1944, Hawley maintained

close ties to Surgeon General Kirk. A

more forceful administrator than his

predecessor, Kirk gave Hawley all the

support he could, although he noted:

"This office doesn't have much to say

about what happens in these theaters.

We are told." Effective medical planning and control depended in the end

on the theater chief surgeon. Hawley

was equal to the task.35

35

 First and second quotations from copy of Ltr,

Hawley to Col E. C. Cutler, 5 Jun 46, Misc NotesETO file, CMH. Third quotation from Ltr, TSG to

Hawley, 3 Dec 43, file HD 024 ETO O/CS (HawleySGO Corresp); in same file, see Ltrs, Hawley to

TSG, 4 Dec 43 and 20 Apr 44.
CHAPTER IV

Hospitalization and Evacuation

The ETO chief surgeon's largest,

most complex task during the buildup

was the establishment of a system of

hospitals and a chain of evacuation in

Great Britain. The system had to be

capable both of supporting the expanding American Army in the British

Isles and of receiving and treating

mass casualties from the European

battlefront. In a steadily more crowded island General Hawley, competing

for manpower and matériel with other

equally urgent projects, secured construction of more than 100 large hospital plants and moved staffs, furniture, and equipment into them. He

worked through and alongside the

military chain of command to link

these plants into a unified, mutually

supporting network of general and

specialized patient care, and he

sought to maintain within his hospitals the highest possible standards of

military discipline and professional

practice. At the same time Hawley

forged hospitals and transportation—

air, road, and rail—into an evacuation

chain able to handle swiftly, yet

gently, a steadily increasing flow of

sick and wounded soldiers. He established a theater evacuation policy that

attempted to balance patient welfare

against ETO manpower needs and

the availability of intratheater and

transatlantic transportation.

Hospital Construction: The Final Drive

In early 1943 hospital construction

was very nearly at a standstill. Initial

BOLERO plans for establishment of

over 90,000 beds in the United Kingdom to support a force of 1 million

or more men had given way, under

the impact of TORCH, to a program of

about 40,000 beds, for a total theater

strength of 427,000. Implementation

of even this reduced program scarcely

had begun. Only 4,900 of the projected beds were in operation; construction of the rest by the British Ministry

of Works lagged far behind schedule.

Hawley's pleas and exhortations to

his sluggish Allies, as well as his suggestion that the available labor and

materials be concentrated at a few of

the most urgently needed plants instead of spread over all the projects,

had produced few visible results. Fortunately, the theater troop buildup

had fallen equally short of objectives,

preventing a critical shortage of hospitals.1

Hospitalization Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943, p. 7; Larkey "Hist,"

ch. 7, pp. 17-18 and app. 1. Hawley's efforts to Continued
HOSPITALIZATION AND EVACUATION 81

British and American BOLERO planning resumed after the Casablanca

conference. General Lee, even before

that conference, ordered his SOS staff

to start preparing supply and accommodation estimates for an army of 1.1

million. On 5 February he directed all

staff sections to develop complete

plans for this larger force. At about

the same time, the London Combined

Committee and its subcommittees reopened their discussions, which

TORCH had interrupted. Work intensified in May, after TRIDENT, and culminated on 12 July with publication of a

complete Fourth Key Plan. This plan,

issued by the British War Office, pro- vided for accommodation of 1.34 million American troops (later increased

to over 1.4 million) in Great Britain

by 30 April 1944. It governed the

final buildup for invasion.2

The chief surgeon and his staff

began hospital planning for the expanded force in January 1943. As he

received each new projection of final

ETO troop strength, Hawley calculated the number of hospital beds

needed to support it, using a slightly

modified version of his 1942 planning

formula: 4 percent of the total

strength, plus an additional 2 percent

of black troops for sick and nonbattle

injured; 1.5 percent of the air forces

for aircrew wounded; and 7 percent

of the ground forces for their battle

casualties. Under this formula 1.1 million troops required about 90,600

fixed beds. As estimates of ultimate

theater strength steadily increased

during the first half of 1943, so did

bed requirements, rising to 103,690

for the 1.34 million troops of the

Fourth Key Plan. Early in June

Hawley, in order to give the British

definite goals for their construction

planning, put a ceiling of 95,000 on

the number of fixed beds to be procured in the United Kingdom. These,

the chief surgeon estimated, would be

enough to support the buildup and

the first weeks of combat, after which

additional hospitals could be established on the Continent.3

To provide the 95,000 required

beds, Hawley and his staff revived

their original BOLERO plan. They arranged to resume construction of the

facilities—twelve 834-bed station hospitals, five 1,084-bed general hospitals, and thirty convertible troop

camps—for which the Americans and

British already had agreed on sites

and plans but which had been deleted

from the program in the late-1942 reduction. In general, the plant sizes

and locations earlier specified required few alterations beyond adding

a few station and general hospitals to

serve the enlarged air force in East

Anglia and new troop concentrations

in Wales and extreme western England. During July, at the insistence of

Surgeon General Kirk, Hawley substispeed British construction can be followed in Hospitalization Division O/CS Hospital Construction Correspondence, 18 May 42-31 May 43 (hereafter cited

as HospDivConstCorresp, 1942-43), file HD 600.1

ETO (Construction). For a discussion of initial

BOLERO plans, see Chapter II of this volume. 2

 For details of the renewed BOLERO planning, see

Ruppenthal, Logistical Support, 1:115-17, 122-23,

240-43. The Fourth Key Plan essentially brought up

to date the earlier plans.

3

 For the start of planning, see Memo, Col R.

B. Lord to CQM, COrdOff, CSigOff, CSurg,

CTransOff, 4 Feb 43, HospDivConstCorresp, 1942-

43, file HD 600.1 ETO (Construction); Spruit Diary,

12 Feb 43; Hospitalization Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943, pp. 7-8 and 13;

Larkey "Hist," ch. 2, pp. 48-49; Hawley Planning

Directive No. 1, 11 Jun 43, box 2, Hawley Papers,

MHI.
82 EUROPEAN THEATER OF OPERATIONS

tuted general hospital units for a

number of station hospitals requisitioned for the theater. This change

entailed no major alteration in construction because a British-built 834-

bed plant, with minor additions to

wards and staff quarters, could accommodate a 1,000-bed general hospital. To reduce his demands on

scarce British construction labor and

material, Hawley tried to secure existing EMS buildings, but to no avail.

The Emergency Medical Services,

hard-pressed to support British invasion forces, insisted on retaining

thousands of empty beds for possible

air raid casualties and offered only a

few hospitals large enough or wellenough equipped for American use. It

also tendered blocks of beds in hospitals it would continue to operate, but

these Hawley summarily rejected.

Except in the direst emergencies, he

wanted only beds in plants entirely

under U.S. control.4

Reflecting these negotiations and

rearrangements, the Fourth Key Plan

provided for 94,108 beds—14,896 of

them in former British and EMS hospitals; 51,220 in newly constructed

plants, mostly 834- and 1,084-bed;

and 27,992 in convertible troop

camps. The exact number, location,

and types of hospitals continued to

change almost until D-Day, in response to alterations in troop deployment and to delays and difficulties in

construction. As the head of the Hospitalization Division, Col. Joseph R.

Darnall, MC, put it, "The constant

shuffling of work priorities, and of

plans, made it necessary to build and

rebuild our . . . program in a recurring administrative fog and on the

shifting sands of uncertainty." Nevertheless, the broad outlines established

in mid-1942 and reaffirmed in the

Fourth Key Plan remained generally

intact.5

Most of the over 100 plants eventually built or acquired under this program represented a few standard

types. Commonest were the new 834-

bed station and 1,084-bed general

hospitals. Almost invariably consisting

of semicylindrical metal Nissen huts

on concrete foundations, each such

installation sprawled over up to fifty

acres of ground, often in the park of

a country estate where the bleak military construction incongruously adjoined a medieval manor house or

Georgian mansion. Convertible troop

cantonments included British militia

camps and dual-purpose camps. The

militia camps consisted of hut barracks arranged in spider-like clusters

radiating from a central core, as well

as operating rooms, laboratories, and

administration buildings constructed

by the Ministry of Works on the

parade grounds; the dual-purpose

4

 Ltrs, Hawley to Brig Gen H. McC. Snyder, 21

Jul 43, and Hawley to TSG, 21 Jul 43, file HD 024

ETO O/CS (Hawley-SGO Corresp); correspondence

in HospDivConstCorresp, 1942-43, file HD 600.1

ETO (Construction); Memos, Hospitalization Division to Chief, Installations Branch, G-4, SOS, 24

May 43, and Hospitalization Division to DepCSurg,

14 Oct 43, Hospitalization Division O/CS General

Correspondence file, 1943 (hereafter cited as HospDivGenCorresp, 1943), file HD 312 ETO; Hospitalization Division, OofCSurg, HQ ETOUSA, Annual

Rpt, 1943, p. 3; Larkey "Hist," ch. 2, pp. 50-51,

and ch. 7, p. 20.

5

 Quotation from Joseph R. Darnall, "Hospitalization in the European Theater of Operations, U.S.

Army, World War II," The Military Surgeon 103 (December 1948): 427-28. Colonel Darnall, a Regular

Army medical officer since 1919, relieved Col. Eli E.

Brown as head of the Hospitalization Division on 1

July 1943. The Fourth Key Plan is reproduced in

Larkey "Hist," ch. 2, pp. 49-50.
HOSPITALIZATION AND EVACUATION 83

COL. JOSEPH R. DARNALL

camps, built of brick and cinderblock, contained all structures needed

for general hospitals but doubled as

housing for the troops until D-Day. In

fact, none of the latter were completed before the invasion and only

hospital units ever occupied them.

Conversion camps, of Nissen-hut construction, were designed primarily as

barracks and required the addition of

operating rooms, clinics, and laboratories to become 750-bed station hospitals. Five American general hospitals occupied former EMS plants and

used Nissen-hut additions to expand

each permanent brick structure to a

1,000-bed capacity. Other American

units took over British Army hospitals

of various sizes, as well as converted

barracks and schools, modern municipal hospitals in Bath and Liverpool,

and the cavernous old Royal Victoria

Hospital at Southampton, later turned

over to the U.S. Navy. Many general

and station hospitals were widely scattered to cover troop concentrations,

ports, and airfields; other newly built

general hospitals were grouped in

previously planned centers around

Cirencester, Great Malvern, and

Whitchurch in the west of England.6

The layout and facilities of these

Army hospitals, whether newly constructed or taken over from the British and remodeled, incorporated a

series of compromises between American and British standards of design.

General Hawley in May 1942 had

agreed to allow the British to build

his hospitals to their plans and specifications, with changes to meet particular American requirements. Because British standards of hospital

accommodation were lower in many

respects than American, and the Ministry of Works resisted alterations

calling for additional labor and materials, each modification became the

subject of hard bargaining. Results

were mixed. The Americans won out

on floor space per patient (72 square

feet as opposed to the British 60), on

enlarged bathing facilities, and on operating room design and equipment,

among other issues. The British had

their way on kitchens, on the omission of central heating, and on the location of nurses quarters. The Ameri6

 Hospitalization Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943, pp. 2-3; Larkey

"Hist," ch. 7, pp. 1-2, 5, 7; Darnall, "Hospitalization," pp. 427-30; Memo, Col J. H. McNinch to

Surgs, Eastern and Southern Base Sections, 16 Nov

43, sub: Militia Camp Conversion, HospDivGenCorresp, 1943, file HD 312 ETO.
FOURTH KEY PLAN MEDICAL FACILITIES. The British militia camp is typical of those

converted into hospitals. One wing of the British Royal Victoria Hospital housed a U.S. Army

general hospital.
HOSPITALIZATION AND EVACUATION 85

cans insisted upon and obtained dual

110- and 230-volt wiring systems, to

accommodate both U.S. and British

electrical equipment. They also secured flush toilets and sewage treatment plants. Hawley and his staff took

pains to ensure ample, pure water for

each hospital, either from a nearby

municipal system or from a carefully

tested and inspected stream. In spite

of these improvements American

hospital staffs still found their new facilities austere and in some ways

primitive. They had to learn to use

soft coal-burning stoves for heat and

to adapt to what seemed to them

scanty and spartan toilets and

showers.7

The Hospitalization Division of

General Hawley's office bore the

main burden of securing plants of all

types. As the division head, Colonel

Darnall, put it, the process was "dubious—and often devious." All requests

for new hospitals, after approval by

General Lee and the ETO commander, went to the theater Engineers

chief, who had charge of construction

and quartering. The Engineers, in

consultation with the British War

Office and other ministries, the Hospitalization Division, and the appropriate base section surgeon, selected

sites and arranged with the War

Office for construction. The War

Office then passed the project on to

the Ministry of Works, which let the

actual contract and supervised the

job. Darnall's division, in close cooperation with the base sections, kept

track of construction progress and

notified the British, through the Engineers, which plants should have the

highest priority. The entire process

entailed almost daily conferences at

Cheltenham and London, involving

Hawley; Darnall; other division heads;

the Engineers, both American and

British; the theater G-4; and Ministry

of Works representatives. "Conferences were not always in accord,"

Darnall recalled. "Confusion, in some

degree, was seldom lacking and

disagreement . . . was apt to be just

around the corner."

 8

Most of the disagreements concerned construction delays, as the

British failed to meet deadline after

deadline. As had been the case since

the start of the buildup, shortages of

labor and materials caused the majority of these delays. Hospital construction, in contrast to any other type of

BOLERO project, required not only a

large number of workers (as many as

1,200 to finish an 834-bed station

hospital in reasonable time) but also a

higher proportion who were skilled

artisans. These men, essential to

build a hospital's many vital and complicated systems, were few and in

high demand. Reports of delays in

hospital completion repeatedly carried the notations "shortage of

7

 Interv, ETO with Maj Gen P. R. Hawley, 23 Mar

44 (hereafter cited as Hawley Interv, 1944), CMH;

Larkey "Hist," ch. 7, pp. 3-6; Memo, Capt I. A.

Marshall, MC, to Surg, Southern Base Section, 22

Feb 43, HospDivGenCorresp, 1943, file HD 312

ETO; Middleton Interv, 1968-69, vol. 1, p. 221,

NLM.

8

 Quotations from Joseph R. Darnall, "Sidelights

on the Hospital Program, European Theater of Operations," The Military Surgeon 104 (January 1949):

22. See also Hospitalization Division, OofCSurg,

HQ ETOUSA, Annual Rpt, 1943, pp. 2 and 19-20;

Memo, Hospitalization Division to DepCSurg (Cheltenham), 28 Jun 43, HospDivGenCorresp, 1943, file

HD 312 ETO; Hawley Planning Memo No. 1, 7 Feb

43, HospDivConstCorresp, 1942-43, file HD 600.1

ETO (Construction). The latter file contains examples of notifications of which plants should have priority.
86 EUROPEAN THEATER OF OPERATIONS

plumbers and electricians" or "shortage of skilled labor." In competition

for building material, whether furnished locally or shipped from the

United States, hospitals had a low priority when compared, for example, to

airfields. As construction went on, the

Americans discovered innumerable

small omissions or defects in British

plans and demanded corrections.

These corrections entailed use of

more labor and material, and hence

still more delay. Then, too, the other

agencies, both British and American,

through which the medical service

had to work all faced conflicting demands on their own resources and

had to set their own priorities, in

which hospitals seldom ranked first.

At times, only the personal intervention by Hawley—and, on occasion,

Lee—kept the hospital program

moving at all.9

Once a hospital was completed the

British Army area command in which

the plant was located appointed a

"Taking Over Board" for it. This

board, which included representatives

of the War Office, the Ministry of

Works, the theater chief surgeon's

office, and the base section surgeon's

office, examined the plant to ensure

that it met plans and specifications

and then either recommended acceptance or ordered the additional work

needed to correct any deficiencies.

After the base section surgeon, who

had authority in the matter under the

SOS decentralization plan, accepted

the facility, the chief surgeon's office

arranged for its occupation by a medical advance party of one officer and

fifteen enlisted men. These troops

guarded the plant until arrival of the

hospital unit assigned to it. With the

advance party on the premises, the

British Army, as part of the reverse

lend-lease supply arrangement, furnished and equipped the new hospital

up to the standard for a comparable

British unit. Hawley's Supply Division

sent in additional material to bring

the facility up to the higher American

standard. In an effort to speed up this

process Hawley, in August 1943, authorized the dispatch of advance parties and supplies to still incomplete

hospitals where essential construction

could be finished within three weeks

of the initial party's arrival. At the

same time he insisted that no hospital

be formally accepted as complete

until the facility was actually ready for

a unit to occupy.10

After a similar inspection and approval process, American units took

over existing British military hospi9

 Ltr, Brig R. A. Riddell to Hawley, 16 Jan 43;

OofCEngr, ETOUSA, Construction and Quartering

Division Monthly Rpt, 31 Jan 43; Hawley Planning

Memo No. 1, 7 Feb 43; Ltr (synopsis), Lee to CG,

ETOUSA, 3 Mar 43, sub: Sites—VIII Air Force;

Memo, Col E. E. Brown to CEngr, SOS, 10 Mar 43.

All in HospDivConstCorresp, 1942-43, file HD

600.1 ETO (Construction). See also Darnall, "Hospitalization," p. 429; Hospitalization Division,

OofCSurg, HQ ETOUSA, Annual Rpts, 1943, p.

22, and 1944, encl. 4; Hawley Interv, 1944, CMH;

Ruppenthal, Logistical Support, 1:246-47.

10

 Memo, Brown to CSurg, SOS, 22 May 43, sub:

Current Policies and Procedures of the Hospitalization Division, in Hospitalization Division, OofCSurg,

HQ ETOUSA, Annual Rpt, 1943; Memos, Brown

to DQMG(L), 12 May 43, sub: Advance Guards for

Hospitals, Hospitalization Division to DepCSurg

(Cheltenham), 28 Jun 43, Col P. D. Berrigan to

Engrs of Southern, Western, and Eastern Base Sections, 14 Aug 43, sub: Minimum Hospital Facilities,

all in HospDivGenCorresp, 1943, file HD 312 ETO;

Memo, Hawley to Hospitalization Division, 1 Jun 43,

and Ltr, Hawley to Col E. G. Plank, 2 Jan 43, both

in HospDivConstCorresp, 1942-43, file 600.1 ETO

(Construction). The latter file contains many examples of requests for advance parties and British supplies for new plants.
HOSPITALIZATION AND EVACUATION 87

tals, complete with patients and

equipment, by gradual infiltration.

U.S. doctors and nurses, a few at a

time, relieved British counterparts;

the soldiers being treated remained,

under American care, until recovery

and discharge. New EMS plants, although usually empty of staff and patients, required complicated turnover

transactions, because the Emergency

Medical Services legally handed the

facilities over, not to the Americans,

but to the War Office. The latter, as

an EMS tenant, then in effect sublet

the plants to the U.S. Army. Three

ministries—Health, Works, and the

War Office—provided portions of the

furnishings and equipment, creating

bewildering accountability requirements.11

In spite of these elaborate turnover

procedures, defects in design and

workmanship in many of the hastily

built hospitals annoyed staffs; hindered operations; and required expensive, time-consuming corrections.

Many hospital units had to repaint

poorly painted buildings. Most had to

use their own personnel to complete

roofs over outside walkways. Floors

were a perpetual source of irritation.

The Allies initially had planned to

cover all hospital floors with linoleum

to ensure a hard, smooth, easily

cleaned surface—required both for

good appearance and proper sanitation. Linoleum was in short supply,

however, leaving many new plants

with bare floors of poor-quality concrete, which the British contractors

had put in in anticipation of another

covering being laid on top of it.

Often rough and not level, these

floors crumbled under foot, creating

large amounts of dust. They were impossible to keep clean, and the irregular surfaces damaged delicate equipment that was wheeled over them.

Hawley pressed the British hard for

suitable floor coverings. After unsuccessful experiments with various coatings, the Ministry of Works settled on

pitch mastic, a synthetic black material, spread in liquid form, which congealed into a hard, smooth, waxable

surface. While adequate, floors of this

substance showed every scratch and

dust particle, softened around hot

stoves, and would not support heavy

furniture unless it had wide pads

under each leg. American doctors and

nurses learned to live with pitch

mastic floors but not to like them.12

Still other defects appeared. The

new EMS hospital at Odstock, near

Salisbury, one of the first turned

over, had "tremendous difficulties"

with roof leaks and water seepage.

The 5th General Hospital, which

moved from Belfast to Odstock in late

1942, found that the facility had neither heat nor running electricity and

11

 Memo, Brown to CSurg, SOS, 22 May 43, sub:

Current Policies and Procedures of the Hospitalization Division, in Hospitalization Division, OofCSurg,

HQ ETOUSA, Annual Rpt, 1943. For an example

of takeover arrangements, see Memo, Brown to Operations and Training Division, OofCSurg, 12 Feb

43, HospDivGenCorresp, 1943, file HD 312 ETO.

Crew, AMS, Administration, 1:406-07, gives the British view of hospital turnovers.

12

 Hawley Operational Directives No. 16, 29 Jun

43, and No. 32, 6 Aug 43, box 2; Ltr, Hawley to

Surg, Southern Base Section, 20 Sep 42, and Memo,

Hawley to CEngr, SOS, 24 Jul 43, sub: Effects of

Poor Walks in New Hospital Construction, box 3.

All in Hawley Papers, MHI. HospDivGenCorresp,

1943, file HD 312 ETO, contains exhaustive coverage of floor and other problems. See also Darnall,

"Sidelights," p. 22; Hawley Interv, 1962, p. 31,

CMH; Col Lee D. Cady, MC, USAR, "Notes on the

21st General Hospital (AUS)," p. 570, Lee D. Cady

Papers, MHI.
88 EUROPEAN THEATER OF OPERATIONS

that the grounds were "just a mass of

mounds and hummocks of building

material and excavated dirt. . . ." At

another EMS hospital the brick buildings began to settle and threatened to

collapse on the 1,100 patients. Investigating, Colonel Darnall discovered

that a coal mine had caved in 800 feet

under the plant. Heavy shoring saved

the building, allowing continued use

of a badly needed facility. General

Lee, inspecting a new 834-bed hospital near Cheltenham, smelled feces

around one of the grease traps. An

investigation revealed that the builders mistakenly had connected the

sewer line to both the grease traps

and the water pipes, contaminating

the entire plumbing system.13

For all the delays and deficiencies,

the construction program made impressive progress during 1943. By the

end of the year the European Theater

had fifty-eight fixed hospital plants

open, with 41,131 beds in operation,

about 20,000 of them occupied. Of

the projected new construction,

plants containing roughly half of the

general hospital beds and all but

3,800 of the station hospital beds

were completed.14

While the hospitals in service by

the end of 1943 more than sufficed to

care for the nonbattle sick and injured of the entire BOLERO force, the

prospects for finishing by D-Day the

additional 50,000 beds needed for

battle casualties appeared much less

promising. Shortages of construction

labor and materials persisted and

British authorities continued to relegate hospital construction to the

lowest priority. As a result, ETO

medical officers seriously doubted

that the remaining station and general hospitals, not to mention the convertible troop camps, would be completed, as planned, by mid-May. Early

in March 1944 the newly appointed

SHAEF chief medical officer, General

Kenner, estimated that, at the existing

rate of progress, the theater would

have only 61,000 of its projected

94,000 beds ready on D-Day.15

General Hawley, supported at

SHAEF by Kenner, resorted to a

number of expedients to bring more

beds into service by the invasion

deadline. The chief surgeon arranged

for earlier removal of troops form militia and conversion camps to make

way for construction. He authorized

base section surgeons to accept and

open any hospital plant capable of

functioning at any fraction of capacity. Hospital personnel and engineer

troops augmented the overextended

British labor force at most construction sites. Medical troops roofed outdoor walkways, poured concrete foundations, painted, laid brick, and even

installed wiring and plumbing.16

13

 Quotations from Keeler Interv, 17 Jul 45, box

223, RG 112, NARA. See also Darnall, "Sidelights,"

pp. 23-24. 14

 Hospitalization Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943, pp. 1, 10-13, 15, 22;

Hospitalization Division Bed Status Rpt, as of 31

Dec 43, HospDivGenCorresp, 1943, file HD 312

ETO.

15

 Memos, Kenner to CAdminOff, via ACofS, G-4,

SHAEF, 8 Mar 44, and Kenner to ACofS, G-4,

SHAEF, 13 Apr 44, in Medical Division, COSSAC/

SHAEF, War Diary, March-April 1944. Kenner conferred frequently with Hawley on hospital construction problems. See ibid., February, March, and April

1944. 16

 Hospitalization Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1944, p. 5 and encl. 4;

Memo, Hawley to Gen Crawford, 4 Mar 44, file HD

024 ETO CS (Hawley Chron); Mins, 14th Meeting

of Base Section Surgeons, 31 Jan 44, p. 10,
NISSEN-HUT 834-BED STATION HOSPITAL and one of its medical wards
90 EUROPEAN THEATER OF OPERATIONS

Abandoning his earlier opposition

to fixed hospitals under canvas,

Hawley directed the addition of

tented expansion wards to most station and general hospitals. The chief

surgeon had begun planning for this

measure as early as July 1943, surveying each hospital to find out how

many beds over its table-of-organization (T/O) capacity it could add without overtaxing its operating rooms,

messes, and lavatories. The tents,

preferably erected at the rear of each

hut ward, were to have concrete

floors, stoves, and insulation against

winter cold. To protect the overall

BOLERO program, Hawley secured

British concurrence that such enlargements were a supplement to—not a

replacement for—the planned beds in

semipermanent buildings. Construction of the tented additions began in

December and continued through the

eve of the invasion, with the British

War Office and the U.S. Army Engineers furnishing material and the hospitals providing labor. Despite delays

in securing British consent for the

necessary grading at the sites and the

slow arrival of supplies, hospital units

put almost 25,000 expansion beds

into operation before D-Day, in annexes to hutted wards and in three

complete tented 750-bed station hospitals. By this means, most 1,084-bed

general hospitals in the United Kingdom increased their capacity to between 1,100 and 1,500 beds; many

834-bed station hospitals (often occupied by 1,000-bed general hospital

units) made room for up to 1,300 patients.17

On 6 June 1944, as a result of this

accelerated effort, the European Theater of Operations had over 84,000

fixed hospital beds ready to receive

patients, only 26,000 of them in use.

These beds included about 59,000 in

regular BOLERO installations plus the

25,000 in tented expansions. The first

militia, conversion, and dual-purpose

camps became available for occupancy in mid-May, with the rest following

in June and July. With these, and the

gradual completion of other planned

installations, Generals Kenner and

Hawley could count on having

enough hospital space for the casualties of each stage of the projected

campaign. Although by a narrow

margin, the BOLERO hospital construction program had reached its

goal.18

and 19th Meeting of Base Section Surgeons, 10 Apr

44, p. 1, file HD 337; Surg, Western Base Section,

Rpt, 1 Jan-31 Aug 44, p. 10.

17

 Larkey "Hist," ch. 7, pp. 25 and 27-29; Hospitalization Division, OofCSurg, HQ ETOUSA,

Annual Rpt, 1944, pp. 5-6; Ltr, Hawley to TSG, 13

Dec 43, HD 024 ETO O/CS (Hawley-SGO Corresp); Ltrs, Hawley to Base Section Surgs, 5 Jan 44,

sub: Preparation for Expansion of Hospitals, and

Hawley to CO, Eastern Base Section, 23 Feb 44,

HD 024 ETO CS (Hawley Chron); Memo, McNinch

to Base Section Cdrs, 6 Jul 43, sub: Expansion of

Existing Hospitals, and Ltr, McNinch to Surgs, Eastern, Western, and Southern Base Sections, 2 Dec

43. sub: Preparation for Tented Expansion, both in

HospDivGenCorresp, 1943, file HD 312 ETO; Mins,

16th, 17th, 18th, 20th, and 22d Meetings of Base

Section Surgeons, respectively 28 Feb, 13 Mar, 27

Mar, 24 Apr, and 22 May 44, file HD 337. 18

 Larkey "Hist," ch. 7, pp. 27-29; Memo, Kenner

to ACofS, G-4, SHAEF, 5 Jun 44, in Medical Division, COSSAC/SHAEF, War Diary, June 1944;

Mins, 23d Meeting of Base Section Surgeons, 5 Jun

44. pp. 1-2 and 4, file HD 337. In addition to these

fixed beds, large numbers of beds in tactical units

were available as transit, holding, and other specialpurpose hospitals. See Chapter VI of this volume

for details of their activities.
HOSPITALIZATION AND EVACUATION 91

TENTED EXPANSION WARDS. Note the adjoining Nissen hut (far left).

Organizing a Hospital System

In the months before D-Day the

ETO medical service organized its

separate plants into a unified hospital

system that could enforce uniform

professional standards and ensure efficient handling of casualties. In cooperation with the base sections, it

refined the hospitals' military and

technical chains of command; redistributed both personnel and functions

among hospitals so as to employ most

effectively scarce medical and surgical

specialists; concentrated patients requiring difficult, long-term care at selected specialized facilities; and, to

free beds for the more severely ill and

injured as well as to facilitate the recovery of soldiers on the mend, established a network of convalescent rehabilitation and reconditioning camps.

The seventy-five fixed SOS hospitals in operation on D-Day answered

to a number of authorities. They were

under the military command of the

base sections. At the same time they

received technical direction—which in

fact covered most of their activities—

from the Hospitalization and Professional Services Divisions of the chief

surgeon's office. The Hospitalization

Division issued instructions on all

nonclinical aspects of hospital operations. Its directives, enforced by

quarterly and, for delinquent units,

monthly inspections, dealt with

supply, general administration, staff

military training and discipline, and

disaster plans, among many other

matters. The divisions' inspectors, reflecting General Hawley's soldierly

approach to military medicine, em-
92 EUROPEAN THEATER OF OPERATIONS

phasized the minutia of military courtesy and appearance. To hospital

staffs, especially veteran ones from

the Mediterranean Theater, the frequent inspections and many spit-andpolish requirements seemed like

"unnecessary show and 'play-war'

procedures." Medical people searching in haste for shined shoes, with an

inspector at the gate, coined a new

name for the ETO: "European Theater of Inspections."19

To regulate medical and surgical

practice, the Professional Services Division drafted and enforced directives

on treatment procedures and on the

use of drugs and surgical techniques.

Its network of senior, base section,

and regional consultants, besides advising hospital staffs on particular

cases, also supervised the general

conduct of their specialties and saw to

it that deficiencies were corrected.

Colonel Cutler, the chief surgical consultant, enjoined his base section surgical consultants to "keep familiar

with the level of professional work

... at all hospitals in your base section. This means constant personal

visits. Written directions . . . can

never take the part of the influence of

a real surgeon at the bedside of the

patient." Cutler's medical counterpart, Colonel Middleton, declared

that he "made medical rounds each

time I went into a hospital and that

was with my stethoscope and not with

the white gloves and towel. So that I

knew what medicine was doing." Supplementing the efforts of his consultants, General Hawley kept in close

touch with hospital operations

through informal contacts, as well as

his own often unannounced visits,

and through reports. He exhorted,

and occasionally threatened, his base

section surgeons and individual hospital commanders in an effort to enforce his principle that "there is nothing satisfactory in a hospital here

except 'superior.'"

 20

To simplify control of the largest

geographical clusters of general hospitals, the chief surgeon in 1944 activated three hospital centers (Map 3).

These were regular T/O medical

units,21 each designed to coordinate

and assist the work of a variable

number of general hospitals. Two of

these units, the 12th and 15th Hospital Centers, arrived in Britain during

March. General Hawley in early June 19

 The base section surgeons actually did the inspecting, using men trained by the Hospitalization

Division and working under its guidelines. See Darnall, "Hospitalization," p. 431; Hospitalization Division, OofCSurg, HQ ETOUSA, Annual Rpts, 1943,

pp. 1 and 14-17, and 1944, pp. 1-2; Cir Ltr No. 80,

OofCSurg, HQ ETOUSA, 10 Jun 44, sub: Policies

and Procedures Governing Care of Patients in ETO,

ex. M, which digests earlier policy directives; Ltrs,

McNinch to Surgs, Eastern, Western, and Southern

Base Sections, 6 Sep 43, sub: Inspection Reports of

Fixed Hospitals and General Dispensaries, and

McNinch to Surg, Western Base Section, 22 Sep 43,

same sub, HospDivGenCorresp, 1943, file HD 312

ETO. For complaints about spit-and-polish, see Max

S. Alien, ed., Medicine Under Canvas: A War Journal of

the 77th Evacuation Hospital (Kansas City, Mo., 1949),

pp. 96-97. Quotation from latter source.

20

 Cutler quotation from Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt,

1944, Chief Consultant in Surgery sec., pp. 1-2.

Middleton quotation from Middleton Interv, 1968-

69, vol. 2, p. 209, NLM. Hawley's remark from

Mins, 21st Meeting of Base Section Surgeons, 8 May

44, p. 10, file HD 337. See also Professional Services Division, OofCSurg, ETOUSA, Annual

Rpt, 1943. General Hawley's relationship to his hospitals can be followed in file HD 024 ETO CS

(Hawley Chron), file HD 024 ETO O/CS (HawleySGO Corresp), file HD 024 ETHQ O/CS (Spruit

Policy Notebook), and Hawley Operational and

Planning Directives, box 2, Hawley Papers, MHI. 21

 Each included some 30 medical officers and 230

enlisted men in a headquarters and service company, a convalescent camp, and a laboratory.

94 EUROPEAN THEATER OF OPERATIONS

activated a third, the 6810th Hospital

Center (Provisional), from personnel

in the theater. The 12th and 15th

Hospital Centers established themselves respectively at Great Malvern

and Cirencester in the Western Base

Section, to control the hospitals, clustered around those two places. The

6810th set up at Whitchurch, also in

western Britain, the center of a third

group of general hospitals.

At the outset the exact functions of

these centers were uncertain. Hospital

centers had existed in the American

Expeditionary Forces in World War I,

but few ETO medical officers had had

any experience with their operations.

The table of organization provided

only that each center was to coordinate hospital administration and to

establish a supply depot and convalescent camp. When the 12th and 15th

Hospital Centers began setting up in

May, after a period of orientation,

they found no plans or standard operating procedures (SOP) to guide

them. Col. Asa M. Lehman, MC, the

12th Hospital Center commander,

drafted an SOP of his own, which

General Hawley adopted and published on 5 May as an SOS directive.

Under this directive a hospital center

would "act as Headquarters for a

group of general hospitals; to correlate and coordinate their activities, to

relieve them insofar as possible from

administrative details and supply

problems; to supervise evacuation and

reception of patients[;] and by frequent inspections, [to] aid and assist

them in maintaining the highest possible degree of professional, administrative and training excellence." Each

center would maintain a central

supply depot upon which its hospitals

could draw, thereby eliminating the

need for the individual hospital to

deal with base sections and SOS

depots. Center receiving and evacuation officers would oversee all movement of patients into and out of the

attached hospitals, as well as select

patients for evacuation to the United

States. Center commanders would

monitor professional activities in their

hospitals, and they could designate

hospitals to specialize in particular

types of cases. Beyond these prescribed functions, Hawley's directive

encouraged center commanders to

adopt any expedient for pooling hospital resources and for freeing the operating units from administrative

chores. Hospital centers constituted

an intermediate headquarters between

the base section and the individual

hospital. Hawley told base section

surgeons: "You can use these center

commanders and it will cut down

your work."

 22

By mid-June the 12th and 15th

Hospital Centers each had seven general hospitals attached, and each

center controlled (with tented expansion of many plants) about 9,500

beds. For the most part, the centers

performed the administration, supply,

and evacuation functions specified in

the 5 May directive. Center commanders tried to keep out of the internal administration and practices of

their hospitals, playing the role of

helpers rather than inspectors, but

22

 First quotation from Admin Memo No. 63,

OofCSurg, HQ ETOUSA, 5 May 44, sub: Operation of Hospital Centers, ETO, in Hospitalization

Division, OofCSurg, HQ ETOUSA, Annual Rpt,

1944. Second quotation from Mins, 21st Meeting of

Base Section Surgeons, 8 May 44, pp. 3-4, file HD

337. See also 12th and 15th Hospital Centers

Annual Rpts, 1944.
HOSPITALIZATION AND EVACUATION 95

they gradually established many uniform procedures. They also became

involved in efforts to balance professional staffs. According to Colonel

Lehman of the 12th, most of his general hospitals displayed a "tendency

toward internal specialization." One

hospital "might have a surplus of capable surgeons, but be entirely wanting of an officer . . . competent . . .

as chief of medical service. In contrast, another hospital would be overstaffed with exceptional medical

service personnel, the surplus being

used in positions for which they had

no special qualifications." To build

up weak services, Lehman transferred

doctors temporarily between hospitals; he arranged with the base sections and the chief surgeon's office

for permanent reassignments if the

changes proved beneficial. The center

headquarters soon found that they

needed less than one-third of their assigned personnel for administration;

they used their extra medical and

dental officers to reinforce hospital

staffs and their extra enlisted men to

aid in patient rehabilitation. Even

before the invasion, hospital centers

were proving effective in simplifying

control over the many plants. Their

value in coordinating evacuation

would become apparent as soon as

trainloads of wounded from France

began moving inland from the Channel ports.23

A network of specialized hospitals

took shape. During 1943 General

Hawley designated certain general

and station hospitals to receive severe

cases of particular types from other

hospitals. The 36th Station Hospital

at Exeter, for example, became the

theater's treatment center of psychotics and men with other noncombatrelated mental disorders; the 5th

General Hospital, in addition to its

normal functions, established special

facilities for care of soldiers suffering

from combat fatigue. Other general

hospitals set up facilities for burns

and cold injury. Under an arrangement with the ETO medical service, a

British facility, Saint Dunstan's Institute for the Blind, began the retraining and rehabilitation process for

American servicemen who had lost

their sight prior to evacuation to the

United States. In 1944 each hospital

center arranged to concentrate burn

treatment, neurosurgery, and thoracic, urological, plastic, and maxillofacial surgery at one or two of its attached hospitals. At the same time

General Hawley, on the advice of his

senior consultants, designated nine

hospitals not attached to centers as

specialized neurosurgical facilities and

seven hospitals for plastic and maxillofacial surgery and burns. Station

and general hospitals were to transfer

to these installations any patient

whose condition, in the hospital commander's judgment, required unusually complicated or lengthy treatment.

Specialized-care hospitals made efficient use of scarce medical and surgical talent and eased the burden of

difficult cases upon general-care hospitals. The consultants, however, constantly had to combat the tendency of

hospital commanders to treat those

patients who would fare better if dis23

 Quotations from 12th Hospital Center Annual

Rpt, 1944, p. 29 (see pp. 1, 27-32, 40). See also

15th Hospital Center Annual Rpt, 1944; Interv,

OSG with Maj Oliver J. Irish, SC, 13 Oct 44, box

220, RG 112, NARA.
96 EUROPEAN THEATER OF OPERATIONS

patched immediately for specialized

care.24

The medical service specialized institutions included a growing number

dedicated to rehabilitating and reconditioning convalescents. Creation of

these facilities owed much to the work

of Col. Rex L. Diveley, MC, senior

consultant in orthopedic surgery. In

the early days of the buildup Diveley

was impressed by the effectiveness of

the convalescent rehabilitation system

the British Army, Royal Air Force,

and Royal Navy had established as a

result of their wartime experience.

British medical officers learned early

in the conflict that carefully controlled and gradually intensified

mental and physical training, begun

while the patient was still in bed and

culminating in hiking, drill, and general military instruction at special reconditioning camps, would speed a

soldier's recovery from wounds or illness. Such training also reduced the

formerly high rate of hospital readmissions among casualties newly returned to duty.

Diveley persuaded General Hawley

to organize a similar program for the

European Theater. Hawley, in turn,

secured the support of General Lee,

although at the cost of including in

the program osteopaths and manipulative therapy, in which Lee had great

faith but the chief surgeon did not.

While the employment of osteopaths

was still under discussion, Diveley, on

19 April 1943, opened Rehabilitation

Center Number 1 at All Saints' Hospital, Bromsgrove, Worcestershire.

The 150-bed 16th Station Hospital

constituted the medical staff of this

institution, reinforced by five medical

officers and six enlisted men trained

in British convalescent depots. The

Bromsgrove facility received ambulatory convalescents from station and

general hospitals and put them

through remedial exercises and general physical conditioning. It contained over 400 patients by 1 September.25

With Diveley informally in charge

in addition to his consultant duties,

rehabilitation expanded rapidly

during late 1943 and early 1944. As

activities rapidly outgrew the Bromsgrove plant, Diveley acquired a general hospital site at Stoneleigh Park,

Warwickshire, for a second and larger

branch of Rehabilitation Center

Number 1. Opened on 5 October,

this facility housed over 1,700 officer

and enlisted trainees by the end of

the year. In February 1944 the medi24 Cir Ltr No. 113, OofCSurg, HQ ETOUSA, 24

Jul 43, sub: Hospitalization and Disposition of

Neuropsychiatric Patients, file HD 024 ETO O/CS

(Operational and Planning Directives); Hospitalization Division, OofCSurg, HQ ETOUSA, Annual

Rpt, 1942, p. 6; Operations Division, OofCSurg,

HQ ETOUSA, Annual Rpt, 1943; Memo, Col O. H.

Stanley, MC, to General Hospitals, 3 Dec 42, file

ETO 700.1 (MiscMedSvc); Ltr, Hillman to Hawley,

26 Jan 43, file HD 024 ETO O/CS (Hawley-SGO

Corresp); Memo, Hawley to DepCSurg (Cheltenham), 16 Dec 43, file HD 024 ETO O/CS (Spruit

Policy Notebook); Professional Services Division,

OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp.

7-8 and Chief Consultant in Neurosurgery sec., pp.

1-2, which comments on the tendency of generalcare hospitals to retain patients needing specializedcare facilities.

25

 For the British program, see Crew, AMS,

Administration, 1:433-38; Rehabilitation Division,

OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp.

1-2; Mins, 3d Conference of Chiefs of Medical Services, HQ SOS, 26 Jan and 4 Feb 44, ex. A, Medical Consultation Service sec., Professional Services

Division, OofCSurg, HQ ETOUSA, Annual Rpt,

1944. For the osteopath issue, see file HD 024 ETO

O/CS (Hawley-SGO Corresp) and file HD 024 ETO

CS (Hawley Chron) for 1943-44. For a description

of the program, see Interv, OSG with Capt. F. E.

LeBaron, MC, 4 Sep 44, box 220, RG 112, NARA.
HOSPITALIZATION AND EVACUATION 97

cal service designated Bromsgrove as

a separate rehabilitation facility for

officers, using Stoneleigh exclusively

for enlisted men, and also established

a new camp at Erlestoke Park, Wiltshire, a general hospital site, for convalescents who required only ordinary

exercise and military training—reconditioning—to make them fit for duty.

Patients needing special remedial exercise as well continued to go to

Bromsgrove, if officers, or to Stoneleigh. To staff these facilities, the

chief surgeon assigned 750-bed station hospitals reinforced with officer

and enlisted casuals. By D-Day two

station hospitals were so employed,

the 307th at Stoneleigh and the 77th,

split between Bromsgrove and Erlestoke. The chief surgeon extended

convalescent reconditioning into station and general hospitals. He instructed the commander of each to

appoint a rehabilitation officer and

set up a training program, similar to

those in the centers, for patients who

needed only a short recovery period

before return to duty. In spite of extensive promotional and training efforts by Hawley and his staff, however, implementation of this part of the

program went slowly before D-Day,

due to the unfamiliarity of medical officers with this approach to convalescent care and to the skepticism of

many about its value.26

Although slow to take hold in the

hospitals, the new rehabilitation

methods were proving their effectiveness by the end of 1943. By that time

over 3,000 officers and men had been

admitted to Bromsgrove and Stoneleigh, about 80 percent of them orthopedic patients and the rest evenly

divided between general surgical and

medical. Of 1,800 men discharged

from the centers, 83 percent went

back to duty, while 17 percent had to

return to hospitals for additional

treatment. Surgeon General Kirk,

when informed about the program,

questioned whether the medical service should be involved in an effort

some phases of which looked like

basic infantry training, but General

Hawley strongly defended rehabilitation and expressed satisfaction with

its results. He pointed out that the

program reduced patients' hospital

convalescence by an average of two

or three weeks and that it revived the

self-confidence and military spirit of

men long confined to bed. In recognition of the value and importance of

the program, Hawley on 3 June 1944

established the Rehabilitation Division in his office under Colonel Diveley, now relieved of duty as orthopedic consultant. Diveley and a small

staff at once began negotiating for

still more facilities and planning for

post-invasion expansion.27

26

 Rehabilitation Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1944, pp. 2-9, and, in ibid.,

Admin Memo No. 68, OofCSurg, HQ ETOUSA, 12

May 44; Operations Division, OofCSurg, HQ

ETOUSA, Annual Rpt, 1943, pp. 17 and 20-21;

Mins, 13th, 14th, and 22d Meetings of Base Section

Surgeons, respectively 17 Jan, 31 Jan, and 22 May

44, file HD 337. The 16th Station Hospital left

Bromsgrove for London in September 1943 and was

replaced temporarily by the 8th Convalescent Hospital, a field army unit, which in turn was replaced

in December by the 307th Station Hospital. In each

change, most of the personnel at Bromsgrove remained there. 27

 Statistics from Carter, ed., Surgical Consultants,

2:495. For different figures, but in roughly the same

proportions, see Mins, 3d Conference of Chiefs of

Medical Services, HQ SOS, 26 Jan and 4 Feb 44,

ex. A, Medical Consultation Service sec., Professional Services Division, OofCSurg, HQ ETOUSA,
98 EUROPEAN THEATER OF OPERATIONS

The Flow of Patients

Besides establishing hospitals, the

chief surgeon laid down policies governing the flow of sick and wounded

men from units and their movement

through the medical system to ultimate return to duty or departure

from the theater. Within his office responsibility for evacuation shifted repeatedly among the Hospitalization

and Operations Divisions and a shortlived Evacuation Division. Eventually,

in February 1944, the latter organization became a branch of the Operations Division, which oversaw evacuation throughout the remaining life of

the theater. Throughout these alterations the same people, for the most

part, remained on the job; for example, the Evacuation Division chief, Lt.

Col. Fred H. Mowrey, MC, continued

in office when his division became a

branch. Actual conduct of evacuation

was divided between the base section

surgeons and General Hawley's office.

The section surgeons, under Hawley's

technical guidance, controlled all patient movement within their sections.

The chief surgeon's office directly

managed all transfers to general hospitals and between base sections, as

well as all evacuation to the United

States.28

For the sick and injured of units in

garrison and training, and for wounded Eighth Air Force bomber crewmen, hospitalization and evacuation

followed the outlines established by

the first SPOBS medical officer,

Major Welsh. In all air, ground, and

SOS commands, sick and injured men

who required less than 4 days of hospitalization went to dispensaries operated by unit medical personnel. Patterned after those of the British

Army, the dispensaries provided practical training for doctors and aidmen

and, by keeping minor casualties out

of the hospitals and replacement

system, reduced the length of time

men were lost to their organizations.

Unit surgeons sent more serious cases

to station hospitals, each of which

served all troops in its geographical

area and could keep patients for up to

30 days. Typically, a division would

evacuate to a single station hospital.

General hospitals were supposed to

receive from station hospitals patients

who required more than 30 days of

treatment or specialized care. In fact,

during the buildup, many general

hospitals acted as station hospitals for

neighboring units, while at times station hospitals performed general hospital work. Early in 1944, to free general hospital beds for battle casualties,

General Hawley authorized station

hospitals to hold patients for up to 60

days. He also authorized five specially

Annual Rpt, 1944. General Kirk's concern resulted

from seeing a color film produced by Diveley's staff.

See Ltrs, Kirk and Hawley, 3 Nov 43, and Hawley to

Kirk, 13 and 26 Nov 43, file HD 024 ETO O/CS

(Hawley-SGO Corresp). See also Rehabilitation Division, OofCSurg, HQ ETOUSA, Annual Rpt,

1944, pp. 8-9. In addition to the rehabilitation

system, there was a separate set of convalescent

homes, one each for officers, nurses, and enlisted

men, run by the Hospitalization Division in cooperation with the Red Cross. Designed for people who

required only short periods of rest before returning

to duty, these homes were not part of the rehabilitation/reconditioning system and provided no systematic physical training. See Hospitalization Division,

OofCSurg, HQ ETOUSA, Annual Rpt, 1944.

28

 Evacuation Division, OofCSurg, HQ ETOUSA,

Annual Rpt, 1943, p. 1 and an. A; Surg, Eastern

Base Section, Annual Rpt, 1943, p. 3; Surg, Southern Base Section, Annual Rpt, 1943, p. 11; Surg,

Northern Ireland Base Section, Annual Rpt, 1943,

p. 2.
HOSPITALIZATION AND EVACUATION 99

reinforced and equipped station hospitals, which treated Eighth Air Force

sick and wounded, to retain men for

180 days—in effect to function as

general hospitals.29

During 1942, with few U.S. hospitals in operation, ETO units often

evacuated sick and injured troops to

nearby British Army, Royal Navy,

Royal Air Force, or EMS institutions,

in that order of preference. These

British hospitals treated Americans

under agreements made early in 1942

by Major Welsh and reconfirmed by

Hawley. The sending of American patients to Allied hospitals gradually

ceased during 1943, as more U.S.

Army facilities opened. Periodically,

the Office of the Chief Surgeon informed base section surgeons how

many Americans were in British hospitals in their areas and directed

transfer of these men, as soon as their

condition allowed, to U.S. Army installations.30

The 700-square mile London metropolitan area, organized in April

1943 as the Central Base Section,

posed special hospitalization and

evacuation problems with its numerous headquarters and service units,

many of which lacked organic medical

personnel, and with its constantly

large transient population of soldiers

on leave or temporary assignment.

During 1943 and 1944 two general

dispensaries—the 7th and 10th—provided outpatient care for casuals and

people from units lacking medical detachments and dispensaries. The general and unit dispensaries evacuated

all enlisted men who needed hospital

treatment directly to the 1st General

Hospital at North Minims, an hour

away from London by ambulance. Officer patients went from the dispensaries to the 16th Station Hospital, a

150-bed unit installed in a former

British civilian plant and reinforced

with extra staff and equipment to

make it a "show-place" for its patients, many of whom were of high

rank. The 16th evacuated officers

needing long-term or specialized care

to the 91st General Hospital at

Oxford, a three-hour ambulance ride

from the capital.31

During late 1942 and early 1943

the ETO medical service temporarily

formed part of the evacuation chain

from North Africa. Under the TORCH

plan patients from the Western Task

Force in Morocco went directly back

to the United States on returning

transports. The Central and Eastern

Task Forces, in the first stages of the

campaign, evacuated their sick and

29

 Admin Order No. 1, HQ SOS, August 1942,

an. E, file ETO 700.1 (MiscMedSvc); Memo, Lt Col

G. D. Newton to CSurg, SOS, ETO, 9 Dec 42, sub:

Policies Affecting Hospitalization, file HD 312

(HospDivChronCorresp, 1942); Ltr, Hawley to TSG,

29 Apr 42, file HD 024 ETO O/CS (Hawley-SGO

Corresp); Cir Ltr No. 70, OofCSurg, HQ ETOUSA,

15 May 44. For examples of overlapping hospital

functions, see 5th General Hospital Annual Rpt,

1944, p. 2; 168th Station Hospital Annual Rpt,

1944, p. 4; Interv, OSG with Maj Ralph Soto-Hall,

MC, 30th General Hospital, 24 Apr 44, box 219,

RG 112, NARA. 30

 Memo, Brown to Surgs of All Units . . . , 26

Jul 42, sub: Tentative Instructions Regarding Hospitalization of U.S. Forces in Great Britain, in Hospitalization Division, OofCSurg, HQ ETOUSA,

Annual Rpt, 1942. For examples of transfer directives, see Ltrs, Brown to Surg, Southern Base Section, copy to Surg, Eastern Base Section, 25 Jan 43,

and Brown to Surgs, Eastern and Southern Base

Sections, 10 Mar 43, sub: Hospitalization in Other

Than U.S. Hospitals, in HospDivGenCorresp, 1943,

file HD 312 ETO.

31

 Surg, Central Base Section, History of Medical

Section, January-July 1944.
100 EUROPEAN THEATER OF OPERATIONS

wounded, American and British alike,

to the United Kingdom in British hospital ships. Under an agreement between General Hawley and the War

Office to divide the labor of unloading these vessels, American Army

medical units handled casualties of

both nations at the Bristol Channel

ports. Between 17 December 1942

and 8 April 1943 Company C, 53d

Medical Battalion, working under the

supervision of the Bristol port surgeon, discharged seven hospital ships

from North Africa at Avonmouth.

The company moved over 2,100 casualties, about 660 of them Americans,

to the nearby 298th General Hospital

for triage and initial treatment. The

British Army then collected its troops

from the 298th for evacuation to its

own as well as EMS hospitals. American casualties ceased arriving from

the Mediterranean in early April, as

NATOUSA fixed hospitals went into

operation. American medical units

continued to unload British hospital

ships at Bristol, however, and the

298th treated those few disembarked

patients who could not be moved immediately to Allied facilities.32

General Hawley's office had responsibility for securing the means of

evacuation by road and rail. In this, as

in so many other areas of BOLERO

preparations, the Americans initially

had to depend heavily on the British.

The British, for example, provided

the American Army with many of its

ambulances. In June 1942 they turned

over to the chief surgeon 600 fourlitter Austins for issue to his units and

hospitals. These two-wheel-drive vehicles were well suited to the road

travel involved in most evacuation

within the United Kingdom. Their

availability permitted Hawley to redeploy his relatively scarce four-wheeldrive U.S. Dodge ambulances, designed for cross-country work, at

hospitals and depots to equip units

going into the field and also at air

stations for removing wounded from

aircraft that crashed in the vicinity of

the airfields. The supply of Americanbuilt ambulances expanded rapidly, as

organizations brought their allowances with them and the War Department shipped extra ambulances, as

well as other vehicles, to outfit laterarriving units and to replace combat

losses. With this inflow from the

United States and the Austins supplied by the British, the theater

maintained a comfortable ambulance

surplus at all times and by D-Day had

accumulated a reserve of over

1,200.33

Besides the small Austin ambulances, the British supplied the Americans with passenger buses converted

for carrying patients. The Emergency

Medical Services, anticipating a need

to move many casualties quickly

during air raids, had refitted 300

32 London Green Line commuter buses The British Army similarly unloaded patients at

Clyde and Merseyside ports. See Operations and

Training Division, OofCSurg, HQ ETOUSA,

Annual Rpt, 1942; Evacuation Division, Oof C Surg,

HQ ETOUSA, Annual Rpt, 1943; "Med Svc Hist,

1942-43," pp. 19-20 and 107, file HD 314.7-2

ETO. For termination of U.S. evacuation to Great

Britain, see messages in Evacuation From Europe

and North Africa file, CMH.

33Troop Movements and Training Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual

Rpt, 1944, p. 43; Memo, Hawley to AG, SOS, via

G-4, 7 Nov 42, sub: Exchange of Field Ambulances

for British-Made Ambulances, file HD ETO 451.8

(Amb), 1942-44. See also other correspondence in

same file.
HOSPITALIZATION AND EVACUATION 101

BRITISH-SUPPLIED AMBULANCE Bus, converted into a mobile dental laboratory

to accommodate nine or ten litters to

a vehicle. In June 1942 Sir Francis

Fraser, the EMS medical director, offered 100 of these buses to Hawley

for handling ROUNDUP casualties.

Hawley accepted only 30 at the

outset. He did not yet need the rest,

and the buses required specially

trained drivers who would have to

come from the scanty ETO pool of

casuals or from hospital enlisted detachments. The Americans soon discovered that the buses were unsatisfactory for moving stretcher cases, as

it was difficult to maneuver litters in

and out of them. However, when

equipped with seats, each bus could

carry comfortably twenty-two ambulatory patients. Accordingly, the medical service arranged with the Ordnance Department to have 28 of the

first 30 buses refitted with seats,

taking a few at a time out of service

for this purpose. The Dental Corps

appropriated the remaining two buses

for a mobile laboratory and clinic. By

D-Day the medical service had procured 35 more buses, all for moving

ambulatory patients. General Hawley

assigned some of these vehicles to

hospitals and pooled others under

control of the base surgeons.34

General Hawley turned to the British again for hospital trains, his

34

 For EMS conversion of buses, see Col R. W.

Bliss, MC, Emergency Medical Services, With Particular Reference to Hospitalization, 9 Dec 40, Bliss

Rpts, file ETO 7/1; Ltr, Hawley to TSG, 9 Jul 42,

file HD 024 ETO O/CS (Hawley-SGO Corresp);

Correspondence, June 1942-June 1944, in file HD

ETO 451.8 (Amb), 1942-44.
102 EUROPEAN THEATER OF OPERATIONS

principal reliance for large-scale,

long-distance patient movement, both

in Britain and in projected continental operations. At the chief surgeon's

request the Ministry of War Transport agreed to assemble, from its own

rolling stock, a total of 39 trains for

American use in Britain and eventually across the Channel. Medical equipment for these trains came partly

from British and partly from American stocks. U.S. Army hospital train

units constituted the on-board medical staff. The trains came in two versions: "home" trains designed to run

in the United Kingdom; and "overseas" trains, with a different braking

system, for use in France. Both types

included kitchen, surgery, pharmacy,

and staff accommodation cars, as well

as 36-litter ward cars, coaches for ambulatory patients, and their own

diesel heating and power plants. General Hawley considered the trains, of

standard British design with American-specified alterations, "the finest

that our Army has ever had." The

problem, as usual in dealing with the

hard-pressed British, was obtaining

delivery on time. By the end of 1943

the Ministry of Transport had turned

over to the Americans 6 out of a

promised 15 home trains and 1 out of

a promised 24 overseas models, along

with 7 separate ward cars (designed

by a U.S. Army Transportation Corps

officer) for attachment to ordinary

freight and passenger trains. Receipt

of the remaining trains was delayed,

and the issue became the subject of

much negotiation and pressure by

Hawley and his staff in the weeks

before D-Day. With some improvisation, the Allies had enough of them

ready in time to meet the initial requirements of the invasion and the

continental campaign.35

As soon as enough trains were

available to meet immediate needs,

General Hawley began using them for

all patient movements of 25 miles or

more. He thus saved patients the discomfort of long ambulance rides, as

well as conserving rationed tires and

gasoline. The chief surgeon's office

centrally controlled all rail movement,

arranging with the theater chief of

transportation to schedule trips at the

request of base sections or to collect

patients for evacuation to the United

States. Each hospital train had a

home siding, or "stable," close to a

station or general hospital. The fixed

installation housed and fed the train's

medical complement and kept the

cars supplied with food, linens, and

other rapidly consumed items. Hospital train and car operations proceeded

with few difficulties, despite occasional complaints of poor food and dirty

cars as well as failures by hospitals to

load the numbers and classes of patients planned on in scheduling a

run.36

35

 Quotation from Ltr, Hawley to TSG, 8 Jul 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Evacuation Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1943; Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1943, p. 18;

Evacuation Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, pp. 2-3; Hawley

Interv, 1944, CMH. A hospital train unit included 4

officers, 6 nurses, and 33 enlisted men. 36

 Essential Technical Medical Data Rpt, HQ,

ETOUSA, June 1944, encl. 4, pp. 6-7; Mins, 2d

Meeting of Base Section Surgeons, 16 Aug 43, p.

13, and 20th Meeting of Base Section Surgeons, 24

Apr 44, pp. 2-5, file HD 337; Surg, Southern Base

Section, Annual Rpt, 1943, p. 11; Surg, Eastern

Base Section, Annual Rpt, 1943, p. 3. For loading

problems, see Memo, Col F. H. Mowrey, MC, to

Surgs, Western and Southern Base Sections, 18 May

44, sub: Evacuation of Patients, in Evacuation Continued
HOSPITALIZATION AND EVACUATION 103

The medical service made limited

use of air evacuation within the

United Kingdom, primarily to move

patients from the Northern Ireland

Base Section to England. Troop

strength in this base section increased

from 3,000 men to 78,000 in the last

three months of 1943, overburdening

the section's hospitals. General

Hawley, therefore, set aside 1,500

beds elsewhere in the United Kingdom for Northern Ireland patients

and arranged with the Ninth Air

Force's IX Troop Carrier Command

for periodic evacuation airlifts. In

Northern Ireland the 79th General

Hospital at Waringfield, near Belfast,

acted as holding and transit unit for

all air evacuees, including men destined for return to the United States

as well as overflow patients. C-47s of

the IX Troop Carrier Command

picked up their first patients on 16

December and by the end of the

month had transported 217 men.

Inclement weather often forced cancellation of scheduled flights, necessitating the return to their original

hospitals of patients who had been

moved as far as 40 miles to meet airplanes. When the system worked,

however, it took only four hours to

transfer a sick or injured soldier from

his bed in Northern Ireland to a new

bed in a general hospital in England.37

Transatlantic Evacuation

Evacuation from the United Kingdom back to the United States was a

controversial, unresolved issue in the

months before D-Day. The controversy involved both policy and ways and

means. From mid-1942 on, General

Hawley advocated a 180-day evacuation policy, meaning that the theater

would send home only those patients

deemed unlikely to return to duty

within that time period. Hawley

pressed his case in spite of the preference of Surgeons General Magee and

Kirk for a 120-day policy for overseas

theaters. He argued that a 180-day

policy reduced losses to the theater of

experienced personnel and required

less shipping for both evacuees and

replacements. The chief surgeon also

realized, although he did not mention

this consideration in discussions with

Magee and Kirk, that adoption of a

120-day policy might lead to attempts

to reduce his large BOLERO hospital

construction requirement, which was

based on 180 days. Col. Eli E. Brown,

Darnall's predecessor as the Hospitalization Division chief, warned Hawley

in May 1943: "If the 120-day policy

does become effective it is very desirable that it not be [instituted] until

our present hospital program is approved and completed." The War Department, in the end, accepted the

chief surgeon's arguments about lack

of shipping and the need to retain

manpower. In August 1943 it formally

authorized a 180-day evacuation

policy for the European Theater.38

Branch, Operations Division, O/CS Correspondence

re Evacuation, February 1944-February 1945 (hereafter cited as EvacCorresp, 1944-45), file HD

370.05 ETO. 37

 Surgeon, Northern Ireland Base Section,

Annual Rpt, 1943, p. 2, and Final Rpt, January-15

Jun 44, pp. 1 and 3; "Med Svc Hist, 1942-43," p.

22, file HD 314.7-2 ETO. For delays, see Mins, 3d

Conference of Chiefs of Medical Services, 26 Jan

and 2 Feb 44, p. 30, in Medical Consultation Service

sec., Professional Services Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944. 38

 Quotation from Memo, Brown to CSurg,

ETOUSA, 29 May 43, HospDivGenCorresp, 1943, Continued
104 EUROPEAN THEATER OF OPERATIONS

Until well after D-Day, the European

Theater and the War Department disagreed on whether mentally ill patients requiring restraint and nonambulatory cases should be evacuated on

returning troopships.39 In contrast to

specially designed hospital ships,

which were protected by the Geneva

and Hague Conventions, troop transports were legitimate targets for

U-boats. For this reason, General

Hawley insisted from the start of

BOLERO planning that "no officer or

soldier who is unable to care for himself in the event of enemy attack upon

the vessel in which he is a passenger,

be evacuated on any but a plainly

marked and regularly operated hospital ship." The theater adopted this

principle as official policy in June

1942. At the same time the London

Combined Committee endorsed Hawley's request for ten U.S. hospital

ships for the European Theater.40

Those hospital ships, however, did

not exist in mid-1942 and were still

lacking two years later, due to vacillating War Department policy. In

June 1942, after an Army-Navy dispute over how many hospital ships

should be obtained and which service

should build and operate them, the

Joint Chiefs of Staff decided to procure only three Army hospital ships,

none for the European Theater. At

the same time the Joint Chiefs,

through General Somervell, instructed ETOUSA and the other theaters to

evacuate their sick and wounded

whenever possible on returning transports. The transports would be

equipped with beds for mental and

nonambulatory patients up to 5 percent of their passenger capacity and

for ambulatory patients up to 20 percent, as well as with surgical, laboratory, pharmacy, and other supporting

facilities, and the ports of embarkation would furnish hospital ship platoons to reinforce the transports' own

medical complements. This policy

prevailed for less than a year. As the

general shipping shortage eased, and

in response to pleas from the surgeon

general and the theaters, the Joint

Chiefs on 11 June 1943 reversed

themselves and ordered evacuation of

nonambulatory men on hospital ships.

The Chiefs now authorized the Army

to develop its own fleet of twentyfour such craft, most of them converted from other passenger and cargo

types. Refitting of the vessels went

slowly so that the first U.S. Army hosfile HD 312 ETO. At this time, in its first effort to

set an official evacuation policy for each theater, the

War Department, with the surgeon general's assent,

authorized 120 days for all theaters but the ETO

and the Pacific, both of which were allowed 180

days. See Smith, Hospitalization and Evacuation, pp.

215-16. The ETO rationale is summarized in

Memo, Lt Col R. P. Fisk, to CG, ASF, 5 Jul 43, sub:

Evacuation Policy for Overseas Commands, file 008

(Policy re Evac for Overseas Cmds). 39

 The Army Service Forces in August 1942 established four patient classes for evacuation: Class I

(mental patients requiring locked wards or other restraints); Class II (bed patients who could not move

about or care for themselves); Class III (ambulatory

but requiring much medical and nursing care, e.g.

the blind, amputees, men with heavy casts, and patients needing special diets); and Class IV (ambulatory patients needing minimal medical attention and

able to travel in ordinary troop accommodations).

See Smith, Hospitalization and Evacuation, pp. 331-32. 40

 Quotation from Larkey "Hist," ch. 2, pp. 52-

54. See also Ltr, Hawley to TSG, 25 Apr 42, sub:

Hospital Ships, file HD 024 ETO O/CS (HawleySGO Corresp); Msgs, Lee to AGWAR, 11 Aug 42,

and ETO to AGWAR, 16 Aug 42, Evacuation From

Europe and North Africa file, CMH. The ETO authorities emphasized that hospital ships also could

carry medical supplies and personnel outbound

from the U.S. without violating international conventions.
HOSPITALIZATION AND EVACUATION 105

pital ship reached British waters only

a short time before D-Day.41

During most of the time that the

evacuate-on-transports policy was in

effect, the European Theater man- aged to avoid following it. Between

August 1942 and December 1943 the

theater sent only 7,800 patients to the

United States. With this relatively

small number of evacuees, and with

hospital space in Great Britain for

long retention of patients, the medical service embarked almost all the

mental and nonambulatory patients it

did evacuate—some 1,600—on British

and Canadian hospital ships and am- bulatory casualties on U.S. and British

transports. In March 1944, as the

number of transatlantic evacuees increased due to the expansion of

American forces and the drive to

clear hospital beds before D-Day, General Hawley—now going against

both his own preference and Armywide policy—obtained temporary War

Department permission to embark

bed patients on troop transports. Hawley regarded this as strictly a temporary expedient. He held to the

principle that helpless evacuees

should be restricted to hospital ships

and, in the absence of enough such

vessels, was willing to keep patients

longer in his own hospitals. The

entire question of using transports to

move casualties remained unresolved

and would arise again in late 1944, as

part of a general review of ETO hospitalization and evacuation policies.42

The actual conduct of transatlantic

sea evacuation was the joint responsibility of the European Theater and its

supporting New York Port of Embarkation. The port provided vessels,

and also medical hospital ship pla- toons to care for patients on the

voyage. The theater selected men to

be evacuated, under the 180-day

policy, and moved them to British

ports for embarkation. In each hospital center and separate general hospital a disposition board, made up of

the chiefs of surgery and medicine

and the ward officer of the patient

concerned, decided which cases merited being sent home. If the casualties

were Air Force troops, Eighth or

Ninth Air Force flight surgeons usually sat with the boards to advise on the

patients' suitability for further aviation duty. Hospital commanders had

final authority to approve or reject

disposition board findings, and the

Professional Services Division of Hawley's office periodically reviewed se- lected proceedings to ensure technical competence and promptness of

decision. The consultants also enforced General Hawley's preference

for holding soldiers in the theater if

they were likely to be fit for even lim41

 For the twists and turns of hospital ship policy,

see Smith, Hospitalization and Evacuation, pp. 394-

411; Msgs, Somervell to CG, U.S. Forces, London,

15 and 24 Aug 42, Evacuation From Europe and

North Africa file, CMH. See also Memo, TAG, WD,

to CGs of Departments, Theater of Operations,

Base Commands, and Task Forces . . . , 25 Jan 43,

sub: Sea Evacuation Operations; Msg, SECWAR, 25

Jan 43, sub: Sea Evacuation; Memo, Col D. E.

Liston, MC, to G-4, ETO, 27 Mar 44. All in Evacuation Branch, Operations Division, O/CS Correspondence re Evacuation, 1942-44 (hereafter cited

as EvacCorresp, 1942-44), file HD 024 ETO. The

War Department at the outbreak of war was uncertain whether the Axis powers would respect the provisions of the Geneva and Hague Conventions on

hospital ships. Increasing evidence that the Axis

powers were doing so strengthened the case for

more hospital ships. 42

 "Med Svc Hist, 1942-43," pp. 18-20 and 108,

file HD 314.7-2 ETO; Memo, Liston to G-4, ETO,

27 Mar 44, with endorsements, EvacCorresp, 1942-

44, file HD 024 ETO.
106 EUROPEAN THEATER OF OPERATIONS

ited duty, so as to conserve all possible manpower.43

Most transatlantic evacuees, whether on transports or hospital ships,

sailed under the British flag because

relatively few U.S. troopships, and initially no hospital ships, operated in

the Atlantic. On British transports the

American patients and their attending

hospital ship platoon constituted a

subordinate command under a British

senior medical officer who had overall

control of the vessel's medical facilities. General Hawley, who wanted to

keep evacuation of American patients

entirely under American authority, accepted this arrangement with reluctance, and only with the proviso that

the evacuees and medical personnel

be under the "immediate control" of

a U.S. Army medical officer. By

American standards British troopships, even the large converted luxury

liners Queen Mary and Queen Elizabeth,

afforded only barely adequate evacuation accommodations. On one

voyage of the Queen Elizabeth, for example, fifty-eight U.S. and Canadian

Class I mental patients were quartered in three separate parts of the

ship, an arrangement which, according to the New York port commander, "handicapped medical supervision

to the extent that there were fights

among some of the . . . patients."

Such incidents merely strengthened

Hawley's determination to move seriously ill and wounded men only on

hospital ships.44

A small but growing number of

medical evacuees crossed the Atlantic

by air. Under a War Department

policy announced in September 1942

the AAF's Air Transport Command

(ATC) was to fly casualties back to

the United States at the request of

theater chief surgeons, who could call

for air evacuation of three categories

of patients: emergency cases for

whom essential treatment was not

locally available, men whose air evacuation the chief surgeons deemed a

"military necessity," and men who required prolonged hospital and convalescent care. The ETO medical service considered blinded patients;

those with severe burns and head,

face, or jaw injuries; and some orthopedic patients as priority candidates

for air movement. When spaces on

planes were available, the Evacuation

Division transferred patients in these

categories from general hospitals to

the transatlantic military air terminal

at Prestwick, Scotland, where Air

Force and SOS medical people

loaded the evacuees on four-engined

C-54s for the flight to the United

States. During late 1942 general and

station hospitals in the United Kingdom had to detach nurses and enlisted men to attend patients on the aircraft, but in 1943 AAF medical air

evacuation transport squadrons began

43

 Smith Hospitalization and Evacuation, pp. 331-36;

Memo, HQ, SOS, 3 Jun 44, sub: Transfer of Patients to General Hospitals, Zone of the Interior, in

EvacCorresp, 1942-44, file HD 024 ETO; Memo,

Professional Services Division, OofCSurg, to CSurg,

ETOUSA, 8 Sep 43, sub: Review of Disposition

Board Proceeding, file HD 024 ETO O/CS (Spruit

Policy Notebook); Mins, 16th Meeting of Base Section Surgeons, 28 Feb 44, p. 5, and 22d Meeting of

Base Section Surgeons, 22 May 44, pp. 7-8, file HD

337; Medical Bulletin No. 16, OofCSurg, HQ,

ETOUSA, 1 Mar 44, pp. 2-3

44

 First quotation from Ltr, Hawley to Maj Gen C.

P. Gross, CofTrans, SOS, WD, 30 Jun 43, EvacCorresp, 1942-44, file HD 024 ETO. Second quotation

from Msg, New York Port of Embarkation to CG,

SOS, ETO, 1 Mar 44, file HD 024 O/CS (HawleySGO Corresp).
HOSPITALIZATION AND EVACUATION 107

arriving in the theater and took over

this task. Ten of these units had

reached Britain by D-Day.45

During the first year and a half of

the buildup very few sick and wounded were evacuated by plane. The War

Department, in its air evacuation instructions of September 1942, enjoined that requests be kept to a minimum, and the ETO medical service

complied. Furthermore, the Air

Transport Command, primarily concerned with carrying troops and supplies, gave medical evacuees a low

priority, and the European Theater

had a constant backlog of higher-priority westbound passengers. Up to

the end of 1943 only 116 patients,

many of them ambulatory convalescents, left the United Kingdom by

air.46

Air evacuation expanded in scale

and increased in tempo in early 1944.

By this time aircraft had proved their

worth in carrying patients in the Mediterranean and Pacific, both for bringing casualties the benefits of early

care and for reducing the number of

medical personnel needed to attend

them in transit. In the European Theater the Air Transport Command had

more planes and aviation medical

people available. It also had improved

its equipment; a new stretcher bracket

for cargo aircraft, for example, increased the carrying capacity of the

C-54 from 10 litter patients to 18. In

March 1944, as part of the final invasion preparations, the command

began enlarging medical facilities at

intermediate stations on its transatlantic routes, a necessary preliminary

to mass patient movements. The following month gave the theaters more

latitude in establishing priorities for

loading U.S.-bound flights. In May

the European Wing, Air Transport

Command, began making long-term

commitments to the ETO medical

service of space for air evacuation, allowing more ambitious planning by

the chief surgeon. About 1,600 patients left England by plane between

1 January and 31 May. The Evacuation Branch looked forward to flying

out 6,000 to 10,000 casualties each

month after the campaign began.47

As air evacuation expanded, the

geographical defects of Prestwick, for

medical purposes, became apparent.

The ATC terminal was located far

from most general and station hospitals and had no facilities to house and

care for patients awaiting planes. In

mid-1943 the medical service acquired the 750-bed Cowglen Hospital, an EMS facility in Glasgow, and

installed there the 2d Evacuation

Hospital, later replaced by the 50th

General Hospital, to operate an air

45

 For the general development of air evacuation,

see Smith, Hospitalization and Evacuation, pp. 337-40;

Link and Coleman, AAF Medical Support, pp. 384-90.

See also Msg, AGWAR to USSOS, ETO, 26 Sep 42;

Air Priorities Instruction No. 4 (source of quotation), Air Priorities Division, HQ, Air Transport

Command, AAF, 26 Feb 43; Memo, 1st Lt D. J.

Twohig, MC, to Medical Field Service School,

American School Center, 21 Apr 43, sub: Air Evacuation; Memo, Fisk to CG, SOS, ETOUSA, 13 Sep

43, sub: Delegation of Authority To Authorize Patients To Travel by Air. All in Evacuation Branch,

Operations Division, O/CS file on Air Evacuation

(hereafter cited as AirEvacCorresp), file HD 580

ETO. 46

 Operations and Training Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1942; "Med Svc Hist,

1942-43," pp. 19-20, file HD 314.7-2 ETO.

47

 Link and Coleman, AAF Medical Support, pp.

391-95; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

14-15 and encl. 11; Evacuation Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Daily Diary, 16

May 44, file HD 024 ETO.
108 EUROPEAN THEATER OF OPERATIONS

evacuee holding unit that eventually

expanded to 1,000 beds. Cowglen,

however, was 32 miles from Prestwick, and the chief surgeon wanted a

holding point closer to the airfield.

Accordingly, the Hospitalization Division and the Evacuation Branch, after

an extensive search and much negotiation with the British, in May 1944

took over Westfield House, an estate

near Prestwick, as a 90-bed facility for

ambulatory patients. At the same time

the medical service secured an abandoned laborers camp, located near

the Prestwick runways, as a 125-bed

holding unit for litter cases. The

Western Base Section provided the

1st Platoon, 29th Field Hospital, to

operate Westfield House; the 18th

Hospital Train, reinforced with

people from the 811th Medical Air

Evacuation Transport Squadron,

manned the airfield unit. Both facilities opened a few weeks after D-Day,

barely in time for the flood of battle

casualties.48

By mid-1944 the theater medical

service had put in place the rearmost

elements of its system for handling

casualties from the future European

battlefields. It constructed and organized a large and complex hospital

network spread over much of Great

Britain; assembled the means for removing casualties from its camps and

installations in the island nation, as

well as the reserves for transporting

the massive flow of sick and wounded

soon to come from the Continent;

and grasped the potentialties of air

evacuation by preparing and employing aircraft for both intratheater and

transatlantic movement of casualties.

Nevertheless, the combination of a

180-day theater evacuation policy,

General Hawley's insistence on

moving helpless patients only on hospital ships, and a shortage of such

vessels threatened to make the theater hospitalization and evacuation

system a rapidly filling tub with only a

very small outlet. As casualties arrived

from the Continent, the system at

some point would reach the limits of

its capacity for evacuation and treatment. That condition, when reached,

would be a most difficult time for the

ETO medical service and General

Hawley.

48

 Cowglen initially was acquired as an ordinary

750-bed station hospital. See Memos, OofCEngr,

ETOUSA, to AG, ETOUSA, via CSurg, 10 Apr 43,

and CSurg, ETO, to AG, ETO, 15 Apr 43, file

HospDivGenCorresp, 1943, file HD 312 ETO. See

also Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 17 May 44,

pp. 1, 3, and 17 Jun 44, file HD 024 ETO.
CHAPTER V

Medics in Britain

During the BOLERO buildup U.S.

Army medics in the United Kingdom

lived and worked on the margin between war and peace.1

 Food rationing, blackouts, occasional air raids,

and the arrival of wounded men from

Eighth Air Force fields reminded

them that they were at war, as did the

constantly expanding number of

American troops, the invasion preparations, and the growing tension as

D-Day approached. Yet embattled

Great Britain still offered many of the

amenities of urban-industrial civilization, and in areas outside the blitzed

cities war at times could seem far

away. Colonel Middleton, the theater

chief medical consultant, lived in a

room in a small Cheltenham hotel

that overlooked a garden, "always

well kept up even during war ... as

a British garden would be." He and

his colleagues, in their infrequent

spare time, attended concerts in the

nearby town hall and took weekend

walks in the Cotswolds. Lower-ranking officers and enlisted medics

subsisted under less comfortable conditions. Still, they resided among hospitable people who spoke more or

less the same language; they could

enjoy the society of British professional counterparts; and they had

access to a wide range of amusements, wholesome and otherwise.2

ETO medics also had work to do.

Besides completing their hospitalization and evacuation system, they conducted their own portion of the

BOLERO personnel buildup. They furnished day-to-day medical service to

the growing American Army in the

United Kingdom. They conducted

militarily and scientifically significant

research, exchanged information and

ideas with British colleagues, trained

for their wartime missions, and

sought to preserve the health of the

fighting forces.

1

 The term medics is used in this volume as shorthand for "the men and women of the U.S. Army

Medical Department." Enlisted medics are identified

either by this term or as aidmen, litterbearers, etc.

2

 Quotation from Middleton Interv, 1968-69, vol.

1, pp. 201-04, NLM. For recollections of the experience of other medics, see Interv, Medical History

Branch, CMH, with Col Virginia Brown, ANC, 5 and

13 Jul 79 (hereafter cited as Brown Interv, 1979),

CMH; Interv, Medical History Branch, CMH, with

Maj Gen Collin F. Vorder Bruegge, MC (Ret.)

(hereafter cited as Vorder Bruegge Interv), 29 Jan

80, tape 1, side 1, pp. 7-8, CMH. See also reminiscences of Mrs. Jane A. Lee, a former nurse, in

Interv, Medical History Branch, CMH, with Lee,

June 1981 (hereafter cited as Lee Interv, 1981),

CMH.
110 EUROPEAN THEATER OF OPERATIONS

The Personnel Buildup

Of the major BOLERO tasks facing

the Office of the Chief Surgeon, securing medical units and personnel

entailed the fewest difficulties. General Hawley and his staff largely determined the number of people and

units required for the theater medical

establishment—what was known as

the troop basis. Certain portions of

the troop basis, such as the medical

detachments of most air, ground, and

SOS units and the medical establishments of the infantry and armored divisions, were prescribed by tables of

organization and automatically deployed with their parent formations.

These, however, accounted for a relatively small proportion of theater

medical manpower. Hawley, as the

ETO and SOS chief surgeon, had an

almost completely free hand in establishing medical unit requirements for

the Services of Supply and for the

ground force echelons above corps,

subject only to the BOLERO plans and

to a War Department ceiling on fixed

and mobile hospital beds as a percentage of troop strength. This manpower planning was, at best, an inexact science. The chief surgeon and his

staff had to work from incomplete

and constantly changing theater

buildup and operational plans.

Hence, they relied heavily on rules of

thumb derived from past experience,

especially that of World War I.3

At the end of 1942 the planned

SOS medical component, designed

for a theater of 427,000 troops, included about 25,000 officers and

men, barely a fourth of whom actually

were in Great Britain. In January

1943, during and after the Casablanca

conference, the medical and other

technical services, at General Lee's direction, began working out new troop

bases for supporting an army of 1.1

million. The operational plan that this

army was to carry out did not yet

exist; nevertheless, the theater needed

at least a tentative troop basis to

guide the BOLERO buildup. In the

absence of a tactical plan the supply

services drew on World War I precedents and tried to comply with repeated War Department and ETO directives to minimize the number of

support troops.

On 8 February General Hawley presented to General Lee a request for

SOS medical units with a total

strength of 74,109 officers and men.

His Operations Division, which drew

up this proposal, based its estimate of

general and station hospital unit requirements on the number of beds

called for in the theater hospitalization plan;

 4 it requested other organi3

 McMinn and Levin, Personnel, p. 384-97; First

Army Report of Operations, 20 Oct 43-1 Aug 44,

bk. VII, p. 61. Until August 1943 each theater established its own hospital bed requirement, which

largely determined its medical manpower requirement, usually working from World War I casualty

statistics. In August 1943 the Office of the Surgeon

General and the General Staff, using the lower casualty rates thus far incurred in World War II, set a

ceiling of fixed and mobile beds for each theater;

those for the European Theater were, respectively,

8 and 4 percent of total troop strength. These limitations had little effect on ETO medical troop planning, since Hawley from the beginning had kept his

requests within them. See Smith, Hospitalization and

Evacuation, pp. 216-18; Memo, Lt Col C. B. Meador,

MC, to DepCSurg (Cheltenham), 27 Sep 43, sub:

Theater Troop Basis, file ETO 320.2 (Strength). 4

At Hawley's instructions, force planners ignored

the 95,000-bed ceiling eventually set on hospital

construction (see Chapter IV) and based unit requests on the full 100,000-plus beds required to

meet the percentage-of-strength hospitalization formula. See Hawley Planning Directive No. 1, 11 Jun

43, box 2, Hawley Papers, MHI.
MEDICS IN BRITAIN 111

zations in proportion to overall ETO

troop numbers. In all, the chief surgeon called for fifty-three general,

sixty-one station (mostly 750 beds),

three convalescent, and ten field hospitals; eleven medical sanitary, six

depot, and two ambulance companies;

twenty-eight hospital train crews; two

medical gas treatment battalions; and

four general dispensaries, as well as

hospital centers, an auxiliary surgical

group, and a medical general laboratory.

Defending this troop basis to General Lee and the ETO staff, Hawley

emphasized that it was the result of

careful study of American Expeditionary Forces (AEF) medical operations

in World War I and of British practice

in the current war. He noted that the

number of medical troops asked for

was a smaller percentage of the

strength of both the total theater and

the Services of Supply than the AEF

medical service had required in 1917-

18. Hawley asked that shipping priority during 1943 be given to the station

and general hospitals needed to care

for sick and nonbattle injured. Other

units should be sent as space permitted, preferably in proportion to the

troop buildup.5

On 19 February Colonel Spruit,

then Hawley's representative in

London, issued a medical troop basis

for the then projected ground force

of 591,000 men in two field armies

and eight corps. Assuming that divisions and smaller formations would

deploy with their organic medical

units and detachments, Spruit called

for an additional 33,000 corps and

army medical troops. This initial list,

which included such soon to be abolished units as medical regiments and

surgical hospitals, would require extensive revision to take into account

the general 1943 reorganization of

Army Ground Forces units, including

medical ones.6

As the TRIDENT and QUADRANT conferences set firm invasion dates and

COSSAC developed an outline operational plan, ETO troop basis discussions became more detailed and definite. In early July the theater's air,

ground, and service components

began working out a definitive twophase list of manpower and unit requirements. Phase One of this new

troop basis set preinvasion buildup

goals; Phase Two specified the forces

needed to break out of the beachhead

and advance across the continent.

This planning process was lengthy

and complex, as the theater tried to

adapt to changing invasion plans and

varying War Department estimates of

what forces would be available. At the

same time, the theater had to achieve

a balance between the often exhorbitant demands of each of its components.

General Hawley, like the other

technical service chiefs, repeatedly revised his troop lists. Besides respond5

 Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 5-6; Larkey "Hist," ch. 4, pp.

11-13 and apps. 8-9; Memo, Lt Col J. B. Mason,

MC, to ACofS, G-1, SOS, 22 Jan 43, sub: Medical

Troops for "B" Plan (Revised), file ETO 320.2

(Strength); Memo, Lt Col J. B. Mason, MC, to

ACofS, G-1, SOS, 6 Feb 43, file HD 024 ETO O/

CS (Planning, Hawley) 1943; Memo, Hawley to CG,

SOS, 8 Feb 43, sub: Medical Troop Basis, SOS, file

370 (Bible File of Troop Requirements, Early Planning). For overall SOS troop planning, see Ruppenthal, Logistical Support, 1:117-20.

6

 Memo, Col C. B. Spruit, MC, to ACofS, G-3,

ETO, 19 Feb 43, sub: Tentative Troop Basis,

Ground Forces, file ETO 024 (Spruit File re Policy).
112 EUROPEAN THEATER OF OPERATIONS

ing to ETO and War Department directives, usually to cut service forces,

the chief surgeon followed General

Kirk's instructions to use more general and fewer station hospitals. He and

his staff also adapted ground force

and SOS troop bases to changes in

medical unit tables of organization,

replacing fixed-T/O medical regiments and battalions with the new

flexible group and battalion headquarters detachments and separate

collecting, clearing, and ambulance

companies. Profiting from experience

in North Africa and Italy, Hawley increased the number of field hospitals

with the ground forces, to provide

forward surgical support for division

clearing stations.7

By late November the European

Theater and the War Department had

settled on a total force of nearly 2.8

million troops and had developed a

month-by-month unit deployment

schedule for reaching this strength by

1 February 1945. Of these forces

about 1.42 million men—417,000 Air

Force, 626,000 ground forces, and

375,000 SOS—were to be in the

United Kingdom before D-Day. The

medical service, which would amount

to 7.5 percent of theater strength, was

to include about 43,600 officers and

men in units attached to the armies

and 127,500 in the Services of

Supply. About half of these troops

were scheduled to reach Great Britain

before the invasion. By mid-December Hawley's Operations Division had

made up detailed lists of the number

and types of units in the ground force

and SOS medical complements (Table

2) and had established a monthly

schedule of arrivals. Among ground

force units 400-bed evacuation hospitals, field hospitals, and collecting,

clearing and ambulance companies

accounted for most of the manpower.

In the SOS troop list 1,000-bed general hospitals—141 of them—made

up the largest single block of personnel. Only 45 station hospitals remained on the list, reflecting the surgeon general's directive to minimize

use of that type of unit. In response

to pleas from General Hawley, 22 of

the 46 field hospitals called for, which

were intended for service with the

armies, were counted against ground

force strength rather than that of the

Services of Supply, even though field

hospitals were not Army Ground

Forces units. In the months remaining

until the assault the exact mixture of

units altered repeatedly, in response

to changing availability in the United

States and to new requirements of the

armies and Services of Supply. Nevertheless, the basic list of unit types,

and the general proportion of medical

manpower absorbed by each, stayed

more or less stable throughout the

buildup and the invasion.8

7

 For the overall establishment of the troop basis,

see Ruppenthal, Logistical Support, 1:123-29; Smith,

Hospitalization and Evacuation, pp. 218-19 and 451-

52; Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 6-7; Larkey "Hist," ch. 4, pp.

16-17 and app. 17; Hawley Planning Directive No.

9, 13 Jul 43, box 2, Hawley Papers, MHI. For an example of adjustment to new T/Os, see Memo,

CSurg to CofOpns, SOS, 21 Oct 43, file ETO 320.0

(Strength). File HD 024 ETO O/CS (Hawley-SGO

Corresp), July-November 1943, includes his negotiations with the surgeon general.

8

 Ground Forces and SOS Medical Troop Bases,

13 Dec 43; MFR, Brig Gen James B. Mason, MC, 4

Aug 67. Both in box 1, James B. Mason Papers,

MHI. See also Troop Movements and Training

Branch, Operations Division, OofCSurg, HQ, Continued
MEDICS IN BRITAIN 113

TABLE 2—CHIEF SURGEON'S RECOMMENDED TROOP BASIS, JANUARY 1944

Source: Adapted by authors from Troop Movements and Training Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, chart A.

By the time ETOUSA completed its

final troop lists, the buildup already

was under way, guided by the earlier

tentative statements of requirements.

The number of American soldiers in

Great Britain increased from 122,000

in January 1943 to 773,000 at the end

of the year. Initially Air Force units

predominated in the transatlantic

flow; later in the year SOS organizations received precedence. The

ground forces, which would be

needed last, built up more slowly,

with only five divisions arriving in

1943. Medical troop strength increased at about the same rate as that

of the theater as a whole, from 10,000

officers and men (6,700 of them in

the SOS) in January to over 65,000

(31,000 in the SOS) in December.

Medical forces continued to build up

rapidly during the first half of 1944,

with the arrival of large numbers of

ETOUSA, Annual Rpt, 1944, pp. 6-9 and charts A,

B, C; Larkey "Hist," ch. 4, pp. 18-20. For the questions of field hospitals, see file HD 024 ETO O/CS

(Hawley-SGO Corresp), November-December 1943.
114 EUROPEAN THEATER OF OPERATIONS

field units paralleling the now rapid

influx of ground combat troops.9

Medical units arriving from the

United States came under the oversight of the Troop Movements and

Training Branch of Hawley's Operations Division. This branch requested orders from the theater G-3 assigning each new unit to a major

command, and, in the case of SOS

units, to a base section. Non-SOS

medical units received their final duty

assignments from Air Force or 1st

Army Group headquarters. The

Troop Movements and Training

Branch also proposed changes in the

unit shipment schedule when necessary, for example, to advance the arrival of urgently needed depot companies for the Supply Division; and it

kept the base sections, which were responsible for moving and housing debarking units, informed of the organizations they could expect to receive.10

Typically, European Theater medical units disembarked at Scottish,

western English, or Welsh ports and

then moved by train to their assigned

locations. Until the final inrush of

units before D-Day most general and

station hospitals spent time in temporary billets awaiting either completion

of their plants or instructions to take

over an already operating hospital.

The Western Base Section, which received most newly arrived hospitals,

quartered them in towns and cantonments around Llandudno, Wales.

Here, the units underwent orientation

to the theater and preliminary professional evaluation of their staffs, under

supervision of the Western Base Section surgeon. While awaiting permanent assignments, medical officers,

nurses, and enlisted men lived in

hutted camps or were billeted with

British families. A nurse who entered

Britain early in 1944 with the 48th

General Hospital recalled: "The policeman took a group of you and

walked down the street and said, 'One

goes here and two goes there,' and

you walked into a stranger's house

and that's where you stayed for about

a month."

 11

Since the beginning of mobilization

in 1940, the Office of the Surgeon

General had fought, in the main successfully, for the activation of enough

medical units of all types for the expanding Army. As a result of these efforts, the units required for the ETO

medical troop basis became available

in the United States at about the

same rate as the forces they were to

support.12 Nevertheless, as the buildup proceeded, General Hawley had to

cope with several persistent manpower problems. By D-Day, shortages of

key personnel had begun to develop,

most resulting from Army-wide—even

9

 For strength, see McMinn and Levin, Personnel,

pp. 308-11; slightly different figures are given in

Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1943, p. 11. For general progress of

the buildup, see Ruppenthal, Logistical Support,

1:130-32 and 231-40, and Matloff, Strategic Planning,

pp. 551-52. Encl. 8 of Troop Movements and

Training Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, details the unit

types arriving in 1944. 10

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 9, 11, 13. Memos, Lt Col J. B.

Mason, MC, to Surgs, Western and Southern Base

Sections, 10 Aug 43, file 320.2 (Strength), are examples of advance information to base sections.

11

 Quotation from Brown Interv, 1979, CMH. See

also Surg, Western Base Section, Rpt, 1 Jan-31 Aug

44, pp. 2-3. 12

 For development of the overall Army medical

troop basis, see Smith, Hospitalization and Evacuation,

pp. 38-39 and 149-51.
MEDICAL PERSONNEL ENJOYING THE AMENITIES OF BRITISH LIFE.

A soldier bicycles through the countryside and nurses take tea in a garden.
116 EUROPEAN THEATER OF OPERATIONS

nationwide—conditions. While these

shortages had little effect on invasion

preparations, they were warning signals of greater difficulties to come as

the campaign progressed.

The chief surgeon labored with

only partial success to meet apparently limitless demands for medical officers and enlisted men not attached to

T/O units. He needed these casuals

to staff his own office and those of

the base section surgeons; to operate

convalescent facilities and the central

dental laboratory and blood bank; to

staff various theater schools; and to

reinforce hospital units whose bed capacities were being expanded. In addition, many nonmedical units, especially of the other technical services,

arrived without T/O medical detachments and had to be provided with

first-echelon support. Finally, in early

1944, General Hawley had to find still

more personnel for new Communications Zone staffs being formed to

complete logistics plans for the invasion. To meet these requirements,

Hawley continually pressed theater

headquarters and the Office of the

Surgeon General for larger allotments

of casuals. By 1 April 1944 his allowance of such personnel had grown to

362 officers and 1,348 enlisted men—

still not enough for all the jobs to be

filled. Hawley also asked for 100

eleven-man medical sections, to be attached to organizations that lacked

their own doctors and aidmen. He

eventually received only 75, added to

the SOS medical troop basis. Requirements continually outstripped

the supply of both individual casuals

and organized detachments, forcing

constant borrowing of people from

hospitals and other units. The chief

of the Personnel Division observed

late in 1943: "Peter must necessarily

be robbed to pay Paul, Peter in each

instance being a T/O unit."13

Compounding the shortage of nonT/O casuals, the ETO medical service

had difficulty obtaining sufficient replacements, especially of doctors,

from the United States. In January

1943 the SOS G-1 put into effect the

supply service's first system for requisitioning replacements. Under it, each

chief of a technical service submitted

a monthly request for people to fill

existing shortages in both T/O and

non-T/O organizations. This system

produced few people from the United

States before the theater terminated it

in June, along with all manpower requisitioning, in an effort to stabilize

the personnel situation. Early in

August the Services of Supply transferred to the base sections responsibility for securing replacements for

their subordinate units. At the same

time it began calling in advance for

people from the United States on the

basis of a standard attrition rate for

each technical service, derived from

expected troop strength and from

World War I loss rates.

This method, like the earlier one,

produced few medical officer replacements. Of 130 Medical Corps (MC)

officer requests for the Services of

13

 Quotation from Personnel Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1943, pp. 9-10.

See also ibid., pp. 5-6, 21, app. B (4); ibid., 1944, p.

12; Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1943, pp. 19-20; Troop Movements

and Training Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 39;

Hawley Planning Directive No. 15, 22 July 43; and

Memo, Hawley to CofAdmin, SOS, 3 Aug 43, both

in file HD 024 ETO O/CS (Operational and Planning Directives); McMinn and Levin, Personnel, p.

103. For discussion of the problem of detachments,

see file 320.2 (Strength).
MEDICS IN BRITAIN 117

Supply during October, November,

and December 1943, none had arrived or was under orders to the European Theater as the year ended.

Replacements for Dental Corps and

Sanitary Corps officers, nurses, and

enlisted men came in at a better rate,

but still in smaller numbers than were

needed. The situation improved not

at all in the following year, especially

for medical officers. Shipments of

doctors, as a percentage of their numbers in the theater, actually declined

during 1944 from the already inadequate 1943 level. Losses, in static

service in Great Britain, fortunately

were far below the rates on which replacement requisitions were calculated, but the diminishing trickle in the

pipeline meant that the theater would

have to rely primarily on its own resources to fill in for combat casualties.14

The dearth of medical officer replacements was only one manifestation of a general shortage of doctors

throughout the Army. By late 1943

the Army Medical Department

claimed to need about 9,000 more

doctors than were available to it, with

the most severe shortages in surgical

and other specialists. Surgeon General Kirk resorted to a variety of expedients to stretch the available trained

professional manpower. During early

1944, for example, the War Department began sending hospitals overseas with general practitioners in

place of some specialists called for by

the tables of organization, on the assumption that the theaters could balance these staffs through transfers

from other better-manned units.

In the case of the European Theater this assumption was correct. General Hawley possessed a rich pool of

talent in his many affiliated hospitals

and had begun raiding these units

during 1943 to obtain chiefs of service for weaker hospitals. He enlarged

upon this practice in the spring of

1944, as the new, inadequately staffed

units began to arrive. Hawley's Personnel Division and consultants facilitated the process by developing a file

of machine-readable records detailing

the training and qualifications of each

MC officer. The chief surgeon overcame the affiliated units' objection to

the breakup of their close-knit staffs

by ensuring that transfer meant promotion for every affected officer.

Eventually, professionally well-endowed affiliated hospitals, such as

Harvard's 5th General Hospital took

pride in the number of executive officers and chiefs of service they furnished to other organizations.15

In late 1943, at Surgeon General

Kirk's suggestions, the War Department began assigning Medical Administrative Corps (MAC) officers, of

whom there was an ample supply, to

14

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1943, pp. 6-7, app. G, pp. 1-2 and

end. 3; ibid., 1944, p. 6; McMinn and Levin, Personnel, pp. 297-98 and 303-05.

15

 For dimensions of the physician shortage and

expedients for overcoming it, see Maj Gen Albert

W. Kenner, MC, et al., Report of Medical Department Personnel Board, 25 Oct 43, file HD 334;

McMinn and Levin, Personnel, p. 316; Ltr, Hawley to

TSG, 29 Jul 43, file HD 024 ETO O/CS (HawleySGO Corresp), and other letters in same collection,

November 1943-May 1944; Personnel Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

1-2, 7-8, app. D, p. 1; Mins, 17th and 21st Meetings

of Base Section Surgeons, 13 Mar 44, p. 2, and 8

May 44, p. 7, file HD 337. Middleton Interv, 1968-

69, vol. 1, pp. 209-13, NLM, describes the reaction

of the 5th General Hospital to transfers. See also

Hawley Interv, 1962, pp. 26-28, CMH.
118 EUROPEAN THEATER OF OPERATIONS

replace one surgeon in each battalion

and fill as many other former MC

slots as did not absolutely require

doctors. General Hawley welcomed

this policy and hoped to use the MC

officers thereby released as a general

theater reserve and replacement pool.

The number of MAC officers in the

European Theater grew from under

900 in November 1943—when the

substitution policy went into effect—

to over 2,400 by D-Day, but most of

them arrived too late to be integrated

into units before the invasion. When

they finally entered service, the MC

officers they relieved barely sufficed

to replace current combat losses.16

As D-Day approached, a nurse

shortage was in prospect, the result,

like the doctor shortage, of recruiting

difficulties in the United States. The

Army Medical Department, anticipating a worldwide lack of nurses, reduced the T/O complements of its

fixed hospitals and announced plans

to send units overseas without nurses

to absorb the paper surpluses thereby

created in the theaters. Accordingly,

under instructions from theater headquarters, General Hawley in May

1944 began cutting the nursing force

of each of his general hospitals from

100 to 83 in order to staff twelve general hospitals coming over with no

nurses. Base section chief nurses prepared lists of women for transfer to

the new units, except for key specialties selecting them by lot to prevent

hospitals from dumping their undesirables. Nurses from units long in the

theater and earmarked for early

movement to France bitterly resented

these transfers, but the process went

inexorably forward. The 10,500

nurses on hand at D-Day were

enough to meet immediate requirements, but General Hawley had to anticipate strains on a limited force and

further T/O reductions as the campaign developed.17

As the troop buildup accelerated,

one category of theater medical manpower diminished in relative importance if not in absolute numbers.

During the TORCH preparations General Hawley had encouraged Army

hospitals to employ British civilians to

replace military personnel detached

for North African service. By mid1943 over 500 British laborers, secretaries, and telephone operators were

working in American hospitals, as

were a few medical professionals, including 4 women contract doctors.

While useful as a temporary expedient, this policy was military undesirable, because a hospital heavily

staffed with local employees would

lose much of its labor force whenever

it moved. The British, at the same

time, objected to the Americans' removal from their economy of scarce,

vitally needed workers. With military

personnel now available to replace

many of the civilians, Hawley's Personnel Division, in conjunction with

the British Ministry of Labor and War

Office, issued on 11 September 1943

16Ltrs, TSG to Hawley, 3 Nov and 3 Dec 43, and

Hawley to TSG, 13 Dec 43, file HD 024 ETO O/CS

(Hawley-SGO Corresp); Personnel Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

8-9; War Department, Strength of the Army, 30 Nov

43, 30 Jun 44.

17

 Ltr, Lt Gen Eisenhower to CGs and Base Section Cdrs, 19 May 44, sub: Release of Nurses From

General Hospitals, file HD 024 ETO CS (Hawley

Chron); Mins, 23d Meeting of Base Section Surgeons, 5 Jun 44, p. 3, file HD 337; Hawley Speech

on Nurse Shortage, 4 Jan 45, file HD 024 ETO

O/CS (Medical Organization in ETO).
MEDICS IN BRITAIN 119

new guidelines that sharply restricted

the number of local workers in each

type of American Army hospitals. A

1,000-bed general hospital, for example, could hire no more than 32 Englishmen. In all hospitals civilians

could perform only nonmedical tasks,

such as manning telephone switchboards and operating sewage treatment and boiler plants. In response

to this directive Army hospitals rapidly reduced their civilian labor components. In May 1943 the theater medical service included 1 hired civilian

for every 7.5 enlisted men; by December, although the total number of

British employees had risen to 986,

their share of the work force had declined to 1 per 22 medical soldiers.18

By 31 May 1944, in spite of imminent shortages of doctors and nurses,

nagging demands for casuals, and the

unsatisfactory replacement flow, the

medical service, like the rest of

ETOUSA, substantially had met its

first-phase buildup goals. About

133,000 medical officers, nurses, and

enlisted men were in Great Britain,

preparing for their multifarious D-Day

tasks. Of these personnel some

71,000 belonged to SOS units, another 49,000 were with the ground

armies, and the remainder supported

the air forces. The theater still fell

short (by 35) of its authorized Medical Corps officer strength. The Dental

Corps also lacked its full complement,

while the Veterinary Corps, Sanitary

Corps, and Medical Administrative

Corps were over strength, as was the

Army Nurse Corps (by virtue of the

reduction in general hospital staffs).19

The Status of Nurses

The morale and welfare of ETO

nurses received considerable command attention during the BOLERO

personnel buildup. According to Lt.

Col. Margaret E. Aaron, the Army

Nurse Corps (ANC) representative in

General Hawley's office, ANC officers

"were not a very happy group" at the

outset of theater operations. Mostly

young and new to the Army, the

women found themselves bewildered

and homesick in a strange country.

Wearing uniforms and work dresses

ill-adapted to the cold, damp climate,

and minimally heated buildings, they

suffered a high rate of colds, flu, and

pneumonia. Many nurses, lacking

enough work to keep them occupied

in the partially filled hospitals, applied for transfer to Mediterranean

bound units in search of more interesting and professionally useful activity.20

Lieutenant Colonel Aaron and her

successor as chief of the Nursing Division, Lt. Col. Ida W. Danielson, labored to improve nurses' morale and

professional performance, assisted by

a gradually expanding number of

base section, army, and hospital

center chiefs of nursing. Training, in 18

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1943, p. 4 and app. E. The 11 September 1943 directive emphasized use of British workers in maintenance and plant operation because

they were familiar with the intricacies and idiosyncracies of the largely British-built hospitals. In the

same manner, it was thought British telephone operators had a better chance of placing calls successfully in their own country's telephone system.

19Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, app. D, pp. 1-2; Larkey "Hist,"

ch. 8, pp. 27-28; McMinn and Levin, Personnel, pp.

105-07. 20

 "Med Svc Hist, 1942-43," p. 60, file HD 314.7-

2 ETO.
120 EUROPEAN THEATER OF OPERATIONS

LT. COL. IDA W. DANIELSON

hospitals and at the theater Army

Nurse Corps School,21 filled idle time

and acquainted nurses with their military duties. Both the theater medical

service and the Red Cross furnished

recreational facilities. The Red Cross,

for example, set up a commodious

London club for nurses on leave. The

arrival of warmer weather and gradual

adjustment to the climate helped

reduce the nurses' sick rate, as did

the issue of more serviceable uniforms. Shortages and inadequacies in

clothing, however, plagued ETO

nurses throughout the war. Over half

the nurses did not receive the olivedrab general service uniform, introduced early in 1943 to replace the

prewar blue in which most of them

arrived in the theater, until well into

1944. The campaign in France was

long under way before the Quartermaster Department could provide an

adequate nurses field uniform.22

The chief surgeon, at the urging of

Surgeon General Kirk, tried to give

his nurses more rank. This was possible as the result of congressional

action in 1942, which, besides substantially equalizing the pay and allowances of nurses and male officers

in the same grades, for the first time

allowed advancement of significant

numbers of nurses to ranks higher

than that of first lieutenant.23 Hawley

welcomed the opportunity to promote

his nurses, as a way of recognizing

the importance of their services and

21

 The theater Army Nurse Corps School is discussed later in this chapter.

22

 "Med Svc Hist, 1942-43," pp. 59-63, file HD

314.7-2 ETO; Pauline E. Maxwell, "History of the

Army Nurse Corps, 1775-1948" (hereafter cited as

"ANC Hist"), ch. XI, pp. 11-13 and 83-86, CMH.

For continuing clothing problems, see Ltr, Lt Col

M. G. Phillips, ANC, to Lt Col Danielson, 2 Feb 45

and Memo, Maj Gen Littlejohn to TSG, 21 Mar 45,

sub: Purchase of Nurses' Clothing in United Kingdom, both in March 1945 Reading File, Robert M.

Littlejohn Papers, MHI. 23

 Nurses since the end of World War I had possessed "relative rank," which meant that they had

military titles, the right to wear officer insignia, and

limited command authority; however, until 1942

they were not entitled to pay and allowances equal

to those of male officers. Congress acted in 1942

under pressure from the Army Medical Department

and civilian nursing organizations. It authorized

promotion of nurses to the relative ranks of major

and lieutenant colonel, whereas previously advancement—except for the War Department superintendent of nurses and her assistant—had been limited to

captain. With well over 90 percent of all nurses in

1942 holding the rank of second lieutenant, the surgeon general, under political pressure to accelerate

promotion, increased the number of higher nurse

grades in hospital tables of organization, urged the

theaters to fill these vacancies rapidly, and set

quotas for increasing the total number of nurses

above the rank of second lieutenant. See McMinn

and Levin, Personnel, pp. 462-64, and Maxwell,

"ANC Hist," ch. VIII, pp. 47-65, CMH.
MEDICS IN BRITAIN 121

NURSES OF THE 250TH STATION HOSPITAL

responsibilities. Furthermore, the new

policy would place U.S. Army nurses

on a more nearly equal footing with

their British counterparts of Queen

Alexandra's Imperial Military Nursing

Service, who held full commissioned

officer status, generally at higher

grades than those of American nurses

in comparable positions. However, in

line with his overall approach to officer promotions, Hawley resisted the

indiscriminate bestowal of higher

rank. He declared: "T/O vacancy is

no excuse for promotion. I think of

nurses the same as I think of an officer. They must be very good to reach

the grade of lieutenant colonel. I am

going to disapprove all wholesale promotions." In response to continued

prodding from the surgeon general

and from Colonel Danielson, Hawley

encouraged hospital commanders to

recommend for promotion to first

lieutenant all properly qualified

nurses who met a theater minimum

requirement of seven months in grade

and three months in a single position

with a performance rating of Excellent. He also used some of the additional hospital field-grade slots to

give his base section chief nurses rank

commensurate with their responsibilities.24

24

 Quotation from Mins, 10th Meeting of Base

Section Surgeons, 6 Dec 43, p. 5, file HD 337. See Continued
122 EUROPEAN THEATER OF OPERATIONS

Under these guidelines ETO nurses

gradually acquired more rank. The

percentage of nurses in grades above

that of second lieutenant increased

from 4.4 in January 1944 to 11.6 in

June, including in the latter month 1

lieutenant colonel, 14 majors, 133

captains, and 1,067 first lieutenants.

By the end of the year 21 percent of

all nurses were above second lieutenant, a proportion still short of the

surgeon general's suggested maximum of 30 percent. In most units,

nevertheless, nurse ranks remained

low. A general hospital nurse remembered: "Our chief nurse was a

captain. . . . Most were second lieutenants, a few were first. And our unit

was overseas about a year before anybody got promoted." In spite of relatively slow promotions the Nursing

Division chief expressed satisfaction

with the military position of ETO

nurses. After Congress, in July 1944,

granted nurses full officer status for

the duration, Colonel Danielson commented: "The change in official status

has had no material effect upon the

actual status of nurses in this theater.

They have been treated as officers

and have been expected to act and

behave as officers."

 25

Black Medics in the ETO

The ETO medical service included

a modest contingent of black officers,

nurses, and enlisted men. Although

the Army Medical Department, following general War Department

policy, enlisted blacks in rough proportion to their total numbers mobilized,26

 General Hawley was less than

forthcoming about employing blacks,

especially medical professionals, in

his theater. He considered such personnel too few to remedy significantly

any of his manpower shortages. In addition, the presence of commissioned

black doctors and nurses—given the

white racial attitudes of the time

which Hawley showed no inclination

to challenge—would create uncomfortable social and administrative

problems. Hence, from the beginning

of BOLERO in mid-1942 Hawley rejected the surgeon general's offer of allblack hospital units, arguing that they

could not care efficiently for the

ETO's widely dispersed black troops

and could not be employed for any

other purpose. As a result of Hawley's policy, most of the 150 black

medical officers and 5,300 enlisted

men who eventually arrived in the

theater served either in the medical

also ibid, for 14th, 15th, and 19th, respectively 31

Jan, 14 Feb, and 10 Apr 44, same file; Ltr, Hawley

to TSG, 16 Jun 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp). For Hawley's general promotion policy, see Notes of Speech Made by General Hawley at Command and Staff Conference, 1 Feb

44, in Hawley Papers, MHI; in same collection, see

Ltr, Hawley to Brig Gen W. B. Smith, 14 Nov 42,

box 2. Crew, AMS, Administration, 2:15, details the

position of British Army nurses. 25

 First quotation from Brown Interv, 1979, CMH.

Second quotation from Nursing Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, p. 22; for promotion statistics, see p. 20 and encl. 13.

26

 The Medical Department employed its limited

complement of black doctors and nurses in a few

all-black hospitals and in black wards of white station hospitals. The majority of Medical Department

blacks went into ambulance and sanitary companies,

the latter units functioning essentially as labor

troops. All-black hospital units were deployed overseas during the war, in Liberia, the Southwest Pacific, and the China-Burma-India Theater. See Ulysses

Lee, The Employment of Negro Troops, U.S. Army in

World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1966), ch. XX and pp. 130-31 and 196-97; and

McMinn and Levin, Personnel, pp. 317-24 and 411-

12.
MEDICS IN BRITAIN 123

BLACK MEDICS PREPARE FOR EVACUATING CASUALTIES

detachments of segregated combat

and support units or in the ten black

ambulance and seventeen sanitary

companies.

The one major exception to this

rule was a group of 63 black nurses.

General Hawley accepted these

women in May 1944, at the personal

request of General Kirk who was

under political pressure to send more

blacks overseas. The nurses reached

Great Britain in July. After training at

the theater ANC school, they began

work in September at the 168th Station Hospital, a 1,700-bed facility

near Manchester, then caring for

wounded German prisoners. The

nurses performed satisfactorily in the

white-officered 168th, but their experience was far from happy. The officers complained that the women were

less efficient and required more supervision than a comparable number

of white nurses. Conducting an official inspection, a black officer found

that the black nurses "feel that they

are a separate group, set apart for a

particular type of service, and have

little hope for advancement or any

variation in the type of service they

are performing." Sadly, that was in

fact the case, not only for the nurses

of the 168th but for the theater's

other black medics as well.27

27

 Quotation from Memo, Brig Gen B. O. Davis to

Maj Gen C. H. Bonesteel, 21 Feb 45, sub: Special

Continued
124 EUROPEAN THEATER OF OPERATIONS

Hospitals at Work

Until mid-1944 station and general

hospitals in the United Kingdom, according to Colonel Darnall, the Hospitalization Division chief, were "operating in a rather inactive theater."

They treated the diseases and accidental injuries of troops in garrison

and training camp and carried on a

large outpatient service for neighboring units. Especially in the Eastern

Base Section, hospitals received a

modest but steady flow of Eighth Air

Force combat casualties—bomber

crewmen with burns and bullet-andshell fragment wounds. These casualties arrived at an average rate of

about 90 a month during 1943 and

then rose to some 800 a month in the

first half of 1944, as Air Force

strength increased and aerial combat

intensified. Under an agreement between General Hawley and the director of the Emergency Medical Services, station and general hospitals

organized emergency surgical teams

to assist nearby British military and

EMS hospitals in air raids and other

disasters and made plans for receiving

mass civilian casualties. The hospitals

never had to carry out these plans.

German bombing continued sporadically throughout the buildup, but

British resources more than sufficed

to care for the injured.28

U.S. Army hospitals themselves underwent only two German bombings,

both of them in 1944. At 0100 on 19

April a 2,400-pound bomb fell on the

121st Station Hospital, a 834-bed unit

near Braintree. The explosion destroyed or damaged fifteen Nissen

huts, slightly injured twenty-five staff

and patients, and temporarily put 280

beds out of service; but the hospital

remained in operation. In the second

incident, on 29 July, a pilotless V-1

exploded in a field close to the 1st

General Hospital at North Mimms,

wrecking thirty-five huts in the enlisted men's living area. Fortunately, the

bomb hit during the work day when

the area was almost deserted; only

twelve medical soldiers suffered

minor injuries. This hospital, also,

kept on with its normal activities

during repairs. In both cases medical

officers attributed the limited casualties and damage to the sturdiness of

the Nissen hut. The Americans regarded these bombings as accidental.

German pilots generally seemed to

avoid hospitals, which were not caminspection 168th Station Hospital, file ETO 322.15.

For additional information on the black nurses, see

168th Station Hospital Annual Rpt, 1944, and

Interv, ETO with 1st Lt Dorothy Smith, ANC (hereafter cited as Smith Interv), 12 Dec 44, box 220, RG

112, NARA. For black numbers, see War Department, Strength of the Army, 1 May 45, p. 50. Hawley's

suggested answer to AGWAR cable on 4 Jan 44 is in

file HD 024 ETO CS (Hawley Chron). See also Ltr,

TSG to Hawley, 16 May 44, file 291.2 ETO (Negro

Personnel, ANC).

28

 Quotation from Hospitalization Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 21.

For outpatient services, see Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, Otolaryngology Consultant sec., p. 2; and

Mins, 15th Meeting of Base Section Surgeons, 14

Feb 44, p. 2, file HD 337. For AAF casualties, see

Link and Coleman, AAF Medical Support, pp. 692 and

699, and Interv, OSG with Maj Ralph Soto-Hall, MC

(hereafter cited as Soto-Hall Interv), 29 Jun 44, box

219, RG 112, NARA. On plans to aid the British,

see Ltr, Hawley to Prof F. R. Fraser, 3 Nov 42; and

Memo, Col J. H. McNinch, MC, to All Base Section

Surgs and Cdrs, U.S. Army Hospitals, 14 Sep 43,

sub: Emergency Medical Assistance to EMS and

British Military Hospitals, both in file ETO 700.1

(Misc Medical Service).
MEDICS IN BRITAIN 125

ouflaged and by their distinctive

layout were easy to spot from the air

even though the British did not

permit them to display Red Cross

markers.29

With their light patient load, hospitals in the United Kingdom devoted

much attention to research. Staff doctors, in close cooperation with General Hawley's consultants, studied the

prevention and treatment of militarily

important diseases, the surgical repair

of wounds, and the properties and effects of new drugs. Often, they collaborated with British colleagues or

drew upon British research and war

experience. General Hawley regularly

incorporated the results of his people's research directly into clinical

and administrative policies.30

The interaction between research,

policy, and administration was especially evident in the case of penicillin,

in 1942 a scarce antibiotic of unexplored but probably great potency.

ETO penicillin investigations centered at the 2d General Hospital, located near the Oxford laboratory of

Professor Howard Florey. Florey

during the late 1930s had developed

a method for producing penicillin in

substantial quantities and had pioneered in clinical trials of the drug. In

mid-1942 Lt. Col. Rudolph N. Schullinger, chief of Surgical Service at the

2d General Hospital, met Professor

Florey at an Oxford University reception. This acquaintanceship led to

visits by Schullinger, and later Chief

Consultant in Medicine Colonel Middleton, to Florey's laboratory and also

to research collaboration between

Schullinger and the British scientist.

As part of Florey's team Schullinger

observed and reported to Professional

Services on British military and civilian use of penicillin. The ETO medics

began their own penicillin tests after

General Hawley, in May 1943, procured from the United States the theater's first 18 million units of the

drug, early fruits of a recently undertaken mass-production effort. Hawley

sent all but 2 million units—given to

the Soviet Union as a medical goodwill gesture—to the 2d General Hospital for use in clinical investigations.

To direct experiments, and to oversee administration of the drug to the

first American patients, Hawley appointed a board that included Chief

Consultant in Surgery Colonel Cutler;

Colonels Middleton and Schullinger;

and the chiefs of Medical and Laboratory Service at the 2d General Hospital. Under a policy worked out by

Hawley and Cutler, hospitals used

penicillin to treat American soldiers

with gas gangrene and other lifethreatening infections, and the board

carefully observed the results. As additional penicillin arrived from the

United States, Cutler in September

began experimenting with local application of the antibiotic during initial

surgical treatment of the wounds of

Eighth Air Force battle casualties, to

determine if such use in front-line

29

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 13; Darnall, "Hospitalization," p. 435; Memo, Hospitalization Division

to DepCSurg (Cheltenham), 22 Jul 43, HospDivGenCorresp, 1943, file HD 312 ETO. The British

forbade display of the Red Cross markers to prevent

the Germans from using them to orient themselves

in attacking nearby legitimate military targets. U.S.

Army hospitals on the Continent would suffer much

greater damage from enemy action. See Chapters

XII and XIV of this volume. 30

 For a summary of research efforts, see Professional Services Division, OofCSurg, HQ, ETOUSA,

Annual Rpts, 1943 and 1944.
126 EUROPEAN THEATER OF OPERATIONS

surgery would prevent or reduce infection. Besides supervising these

clinical trials, the board trained officers form Army general hospitals in

what was then known about the use

and storage of penicillin, so as to

have in each installation at least one

doctor acquainted with the new antibiotic.31

In late 1943 Surgeon General Kirk

was able to promise the European

Theater regular penicillin shipments

of 100 million or more units per

month from the expanding American

production. With a steady supply thus

assured, General Hawley on 7 December authorized the issue of penicillin

to all general and two station hospitals. General hospitals, the staffs of

which had been trained in penicillin

therapy at the 2d General Hospital,

now were to instruct the surgical,

medical, and laboratory chiefs of

neighboring hospitals in preservation

and administration of the drug. While

he distributed penicillin widely, the

chief surgeon restricted its use to patients with life-threatening or persistent infections and to those with sulfaresistant venereal diseases—priorities

suggested by the surgeon general for

all theaters. Hawley threatened disciplinary action against any doctor who

diverted the antibiotic to unauthorized treatments or experiments, declaring that "even as we widen its use,

we must control its use. Otherwise,

some damn fools are going to waste it

trying it on ingrowing toenails so that

they can write a paper on it." Colonel

Cutler in April 1944 completed plans

for using penicillin as a prophylactic

in forward surgery, although he expressed his "firm conviction . . . that

surgery will be responsible for 95 per

cent of the success or failure in battle

casualties."

 32

Professional societies and meetings,

strongly encouraged by the chief surgeon as a means of keeping up

morale and disseminating useful

knowledge, proliferated among ETO

doctors during the months of the

buildup. Much of this activity was

international in character. For example, in mid-1942, Colonel Cutler

helped start the Inter-Allied Conference on War Medicine and Surgery,

31

 U.S. penicillin research and mass production

began after a 1941 visit of Professor Florey to

America. See Wesley W. Spink, Infectious Diseases:

Prevention and Treatment in the Nineteenth and Twentieth

Centuries (Minneapolis, Minn.: University of Minnesota Press, 1978), pp 89-100; Carter, ed., Surgical

Consultants, 2:68-69 and 133-46; Havens, ed., Medical Consultants, 1:265-66; Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1943,

p. 7; Col E. C. Cutler, Lt Col P. C. Morton, and Maj

J. W. Sandusky, "Observations on the Prophylactic

Use of Penicillin in the Wounds of Aerial Warfare,"

ex. H, Chief Consultant in Surgery sec., Professional

Services Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944; Middleton Interv, 1968-69, vol. 1, pp.

218-20, NLM.

32

 First quotation from Ltr, Hawley to Brig Gen

Fred W. Rankin, 16 Feb 44. Second quotation from

Ltr, Cutler to Rankin, 25 Apr 44. Both in file HD

024 ETO O/CS (Hawley-SGO Corresp). See this

source, September-December 1943, for a running

account of the development of penicillin supplies

and policy. See also Memo, Col Kimbrough to

DepCSurg (Cheltenham), 13 Nov 43, file HD 024

ETO O/CS (Spruit Policy Notebook); Professional

Services Division, OofCSurg, HQ, ETOUSA, Annual

Rpts, 1943, p. 7, and 1944, pp. 6 and 8; Carter, ed.,

Surgical Consultants, 2:142-45; Mins, 13th, 14th, and

15th Meetings of Base Section Surgeons, respectively, 17 Jan, 31 Jan, and 14 Feb 44, file HD 337.

Before the advent of sulfa drugs, treatment of gonorrhea and other venereal diseases had been

lengthy and painful for the patient, keeping men

away from duty for long periods and requiring

much hospital space, staff, and equipment. The use

of sulfa and penicillin for a faster, simpler cure

greatly reduced both the logistics burden on the

theater medical service and the Army's noneffective

rate. See Haven, ed., Medical Consultants, 1:24-25;
MEDICS IN BRITAIN 127

which brought American doctors together with British colleagues and

with the exiled medical elite of occupied Europe. At least 100 American

medical officers attended each of the

society's conferences, held in London

under sponsorship of the Royal Society of Medicine, to hear papers and

enjoy cocktail hours and dinners.

British medical associations accepted

Americans into membership. They

opened their meetings and their libraries to their American colleagues.

Hawley's senior consultants met regularly with their British counterparts,

and the chief surgeon hosted occasional dinners at which American officers mingled with distinguished British medical men.33

In July 1943, at General Hawley's

suggestion, U.S. Army doctors

formed their own European Theater

of Operations Medical Society, of

which all Army MC officers were automatically members. At first, the entire

membership met once a month at a

particular general hospital for papers,

ward rounds, and lunch. As the theater expanded in late 1943, the organization perforce broke down into base

section branches, each of which carried on its own social and professional program. Dentists and veterinarians

established similar theater and base

section associations. Local activities

abounded. Station and general hospitals, for example, organized frequent

clinical and pathological conferences

open to medical officers of neighboring hospitals and units. The contribution to the war effort of this constant

round of professional conferences

and socializing was difficult to measure, but it promoted the sharing of

knowledge and experiences and fostered acquaintanceships that eased

working relationships among Army

medical officers and between the

latter and their British colleagues.34

ETO hospitals made the most of

the time and relative leisure afforded

them by the long wait for the beginning of full-scale combat. In March

1944 Surgeon General Kirk, after

touring theater hospitals in the course

of the presidentially directed review of

Air Force patient care, expressed high

praise for what he had seen. Patients

in the European Theater, he told

Hawley,

are receiving superb treatment as a result

of professional efficiency and individual

care. . . . Surgical pavilions are well

planned, the wards bright, cheerful and

immaculate in cleanliness. Your General

Medical Laboratory, dental clinic and lab- oratories, both fixed and mobile, are

ideal. The research work that is being

carried on is outstanding. . . . We are as- sured that the Medical Department will

be ready to do its job on D-Day.35

Organizing the Dental Service

In hospitals and unit medical detachments the ETO dental service

conducted its own buildup, coped

with its own problems, and contribut33

 Maj Gen Sir H. L. Tidy, ed., Inter-Allied Conference on War Medicine, 1942-1945 (London: Staples

Press, 1947), pp. 12-15 and passim; Middleton

Interv, 1968-69, vol. 1, pp. 199-201, 225-27, 231,

NLM; Professional Services Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1943, pp. 12-13;

Hawley Papers, MHI, passim.

34

 American Medical Society, ETO, memoranda

and meeting programs, various dates, box 3, Hawley

Papers, MHI; Hawley Interv, 1962, p. 49, CMH;

Surg, Northern Ireland Base Section, Annual Rpt,

1944, p. 4; Surg, XIX Corps, Annual Rpt, 1944,

p. 2. 35

 Ltr, TSG to Hawley, 19 Mar 44, file HD 024

ETO O/CS (Hawley-SGO Corresp).
128 EUROPEAN THEATER OF OPERATIONS

ed its own technical innovations.

Throughout BOLERO the Dental

Corps labored under a shortage of officers, especially in unit detachments.

The corps was still about 10 percent

understrength in late 1944, although

the bulk of vacant positions now were

in general hospitals. In the early

month of BOLERO dentists often

reached Britain without their basic

field chest. Dental equipment for hospitals arrived only slowly and in small

amounts, due to procurement delays

and difficulties on the other side of

the Atlantic. The first American units

in England, therefore, sent troops

needing dental work to neighboring

British forces for treatment, and

American dentists had prostheses

made in British laboratories. They

also borrowed what supplies they

could from their Allies, whose own

stocks were limited. Dental field and

laboratory chests arrived in adequate

numbers during 1943, but hospital

equipment remained difficult to procure until late in the year, forcing the

Supply Division to outfit newly

opened hospitals by breaking up field

chests. In spite of these obstacles

ETO dentists did a substantial

amount of work. Between November

1942 and November 1943 they held

over 650,000 patient sittings, made

250,000 restorations, extracted more

than 62,000 teeth, and fitted about

15,000 full and partial dentures.36

Besides overseeing the training and

professional work of dentists, the

Dental Division of the chief surgeon's

office improvised central dental laboratories for the theater. The War

Department did not establish a T/O

unit of this type for overseas service,

even though the theaters would need

laboratories for large-scale fabrication

of prostheses and repair of instruments. Instead, each theater was to

develop a laboratory organization tailored to its own needs and requisition

men and equipment from the United

States for it.

The ETO Dental Division, accordingly, in July 1942 prepared a table of

organization that the Services of

Supply and the theater approved and

transmitted to the New York Port of

Embarkation. In the next fifteen

months none of the requested people

and only a few items of equipment

reached Great Britain. The Dental Division nevertheless managed to assemble two central dental laboratories

during 1943, one at London and the

other at Cheltenham. Each had a staff

of four officers and forty enlisted men

drawn from hospitals, dispensaries,

and other SOS medical organizations.

Equipment came from hospitals, from

the British, and from laboratory field

chests. Each central laboratory had attached to it a mobile section with a

clinic, mounted on a bus ambulance

converted by the Ordnance Department. The Dental Division employed

these mobile laboratories to bring

service to organizations in the United

Kingdom that needed large amounts

of extra dental work—for example,

the 9th Infantry Division, redeployed

to England after fourteen months in

the field in North Africa and Sicily.

36

 George F. Jeffcott, United States Army Dental Service in World War II, Medical Department, United

States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1955), pp. 166-68 and 180-85; "Med Svc

Hist, 1942-43," pp. 46-48 and 52, file HD 314.7-2

ETO; Dental Division, OofCSurg, HQ, ETOUSA,

Annual Rpts, 1942, pp. 4-5, and 1944, pp. 3 and 8.
LONDON CENTRAL DENTAL LABORATORY (top) and Mobile Clinic (bottom)
130 EUROPEAN THEATER OF OPERATIONS

The laboratories were to serve a similar purpose on the Continent for

combat units resting behind the

front.37

As a result of the initiative of one

Dental Corps officer, Capt. Stanley F.

Erpf of the 30th General Hospital,

the European Theater developed a

new type of artificial eye, thereby

helping to solve an Army-wide problem of supply and patient welfare.

The Army by 1943 faced a growing

demand for glass eyes, both for men

with empty sockets resulting from accidental and combat injuries and for

one-eyed recruits being inducted

under lowered physical standards.

However, material for glass eyes, previously imported from Europe, was in

short supply. The eyes themselves

took up to two months to make and

fit to the individual and also broke

easily. In September 1943, at the request of a staff opthalmologist whose

patient had broken his glass eye, Captain Erpf devised an artificial eye

made of the clear acrylic resin used in

dentures. Erpf's type of eye, which he

began producing for other patients

on an experimental basis, could be

moulded and fitted to an individual,

using standard dental tools, in no

more than four days. Properly colored and painted, an acrylic eye could

match exactly the patient's good eye,

a feature of great psychological benefit. Further, acrylic eyes irritated

socket tissues less than did glass ones

and were almost indestructable.

Late in 1943, after reviewing Erpf's

initial reports and results, the chief

surgeon, on the advice of the Dental

Division and of his senior opthalmology consultant, adopted the acrylic

eye for theater-wide use. In January

1944 the medical service set up a twoweek course at the 30th General Hospital, taught by Erpf, to train both

U.S. Army and British Army dental

officers in fabricating and fitting the

eyes. By the time the course closed

down for the invasion in late May

thirty-three dentists had graduated

from it. The acrylic eye school later

reopened at the two central dental

laboratories. On the strength of reports from the European Theater, the

War Department adopted the acrylic

eye as a substitute for glass throughout the Army and brought Erpf back

to the United States in June to help

organize production and employment

of his invention.38

Training

ETO medics put many hours into

training. Training, besides filling

time, was in fact much needed, because few doctors, nurses, or aidmen

arrived in the theater fully instructed

in their military tasks. Even Regular

Army medical officers, as Hawley had

pointed out ever since the establishment of the European Theater, lacked

administrative and command experi37

 All the theaters had difficulty obtaining men

and equipment for the central dental laboratories;

see Jeffcott, Dental Service, pp. 327-29; "Med Svc

Hist, 1942-43," pp. 48-50, file HD 314.7-2 ETO;

Dental Service, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 10; Surg, 9th Infantry Division,

Annual Rpt, 1944, p. 4.

38

 The idea of using dental acrylic for artificial

eyes evidently occurred to a number of medical and

dental officers more or less at the same time, but

Erpf probably was the first to complete a satisfactory eye. See Jeffcott, Dental Service, pp. 235-37;

Dental Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 7-8; Soto-Hall Interv, 29 Jun 44, box

219, RG 112, NARA; Mins, 16th Meeting of Base

Section Surgeons, 28 Feb 44, pp. 3-4, file HD 337.
MEDICS IN BRITAIN 131

ence. The reservists and civilians in

uniform who staffed most medical

units were even more deficient in

these fields. In addition, Hawley

pointed out, "few physicians ever see,

in civil practice, injuries of the type

that are incurred in war. They do not

know how to care for such injuries

properly; and, unless given special

training, will care for them improperly." Newly enlisted nurses had come

directly to Army hospitals with no

military orientation, even in such

basics as saluting and proper wear of

the uniform. Enlisted technicians included a mixture of backgrounds and

qualifications. In one general hospital

the chief of Laboratory Service recalled, "The chief of the bacteriology

section had been superintendent of

schools in Albuquerque and the chief

of hematology . . . had been an

orchestra leader in Georgetown."

Units going overseas usually received

their full personnel complements only

shortly before embarkation so that

they had little opportunity to train

their own people or to develop a

sense of group cohesion.39

General Hawley, as both theater

and SOS chief surgeon, established

training objectives and standards of

proficiency for ground force and SOS

medical units, while army and base

section commanders supervised the

conduct of instruction. The Air Force

independently trained its unit and

base dispensary medical personnel.

For the organizations under his purview General Hawley laid down both

military and professional training requirements. On the military side,

medical units were to make sure that

their people mastered basic service

customs and wore the correct uniform. Both male and female personnel were to engage in close-order

drill, calisthenics, and cross-country

marching. They were to learn to read

maps, use compasses, and interpret

aerial photographs, as well as how to

protect their patients and themselves

under air and gas attack. Hospitals

and collecting and clearing companies

were to practice setting up, taking

down, and moving their equipment.

The chief surgeon directed that professional instruction of doctors and

nurses concentrate on practical elements of war medicine and surgery.

He opposed efforts to train people in

specialties for which they had not

been qualified before entering the

Army, although he provided extensive

refresher courses for doctors already

proficient in various fields. Enlisted

medics were to be well versed in basic

anatomy and physiology, medical nomenclature, first aid, and ward management. Hawley also wanted them to

be able to speak and write clear Eng39

 First quotation from Memo, Hawley to G-3,

ETO, 1 Jul 43, file HD 024 ETO O/CS (Operational and Planning Directives); in the same file, see

Memo, Col. J. H. McNinch, MC, to CSurg 12 Jul 43,

and Hawley Operational Directive No. 24, 1 Jul 43.

Second quotation from Vorder Bruegge Interv, 29

Jan 80, tape 1, side 1, p. 6, CMH. See also Maj Gen

Paul R. Hawley, Brig Gen James B. Mason, and Col

Robert E. Peyton, "Training in the European Theater in World War II" (hereafter cited as "ETO

Training"), p. 30; Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1943, p. 14; Study No.

88, General Board, USFET, sub: Training Status of

Medical Units and Medical Department Personnel

Upon Arrival in the European Theater of Operations, pp. 1-4, file 353/2. Smith Interv, 12 Dec 44,

box 220, RG 112, NARA, comments on the nurses'

lack of training.
132 EUROPEAN THEATER OF OPERATIONS

lish so as to make themselves understood to patients and doctors alike.40

In providing medical training facilities General Hawley made every

effort to expose his personnel to the

professional and operational expertise

of their British colleagues. Beginning

in mid-1942, under agreements made

by Colonel Kimbrough with the Royal

armed services and Ministry of

Health, British military and civilian

medical schools allocated places in

their courses for Americans. Hawley's

office distributed these openings

among air, ground, and service commands. U.S. Army doctors took fiveday war medicine and surgery courses

at the British Post-Graduate Medical

School. They studied tropical medicine and parasitology at the London

School of Hygiene, and they attended

a transfusion and shock course at the

British Army blood supply depot in

Bristol. Surgeons and dentists went to

the Queen Victoria Hospital in Sussex

for training in plastic surgery and

repair of jaw injuries. Other surgeons

studied treatment of chest wounds

with Mr. A. Tudor Edwards, the EMS

thoracic surgery consultant, who was

one of the country's leaders in that

field. Groups of medical officers each

week visited the major London teaching hospitals for ward rounds, discussions, and lunch with the professional

staffs.

EMS and military hospitals trained

American operating room nurses to

assist in maxillofacial surgery and

neurosurgery. RAF hospitals gave

nurses two weeks' intensive training

in care of burn patients. The British

Army School of Hygiene at Aldershot

taught field sanitation to enlisted

medics. Under an Anglo-American exchange program, American doctors

and nurses went to British military

hospitals for thirty-day duty tours.

Staff from inactive U.S. hospitals also

worked in British wards. The hundreds of American officers, nurses,

and medical soldiers who attended

these British courses or labored in

British hospitals benefited from the

medical lessons of three years of

combat, as well as learned their British counterpart's methods of operation.41

The ETO medical service lost no

time in setting up its own training facilities. On 8 March 1943 General

Hawley formally opened the European Theater Medical Field Service

School at Shrivenham, in a former

British officer candidates school. Su40

 Hawley et al., "ETO Training," pp. 8 and 10-

14; Mins, 14th Meeting of Base Section Surgeons,

31 Jan 44, pp. 4-5, file HD 337; Operations and

Training Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1942, p. 15. See also Cir Ltr No. 45

(Training Ltr No. 1), OofCSurg, HQ, ETOUSA, 12

Oct 42; Troop Movements and Training Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 23, 27, 36, and encl. 18. Ltr,

Hawley to Brig Gen Charles C. Hillman, 17 Mar 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp), expresses the chief surgeon's opposition to training

people in specialities. For a general view of the

Medical Department's role in training, see Robert J.

Parks, ed., Medical Training in World War II, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1974), pp. 247-51.

41

 Hawley et al., "ETO Training," pp. 44-47; Operations and Training Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1942, pp. 15-16; Operations

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1943, pp. 13-17; Troop Movements and Training

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 21-23; Maxwell,

"ANC Hist," ch. XI, pp. 73-74, CMH. Brown

Interv, 1979, CMH, includes impressions of work in

a British hospital.
MEDICS IN BRITAIN 133

U.S. ARMY MEDICAL OFFICER ON TEMPORARY DUTY AT A BRITISH CIVILIAN HOSPITAL

pervised by the Operations Division

of Hawley's office, this institution was

part of the ETO's American School

Center. It had the mission of instructing medical officers, particularly those

serving with field units, in "aspects of

military medical practice not ordinarily familiar to civilian physicians."

Under the teaching of a small faculty,

assisted by the senior consultants and

other outside lecturers, forty- and

fifty-man classes of medical officers

learned the fundamentals of field hygiene and sanitation, care of casualties under combat conditions, motor

vehicle maintenance, medical recordkeeping, and chemical warfare defense. As D-Day approached, the

school added transportation of sick

and wounded and principles of medical support for and amphibious assault; it brought in doctors who had

campaigned in North Africa and Sicily

to impart battlefield experiences. Besides receiving classroom instruction,

students took part in field maneuvers

with other departments of the school,

establishing and displacing aid stations and evacuating simulated casualties. After one such overnight exercise, according to the school history,

the "exhausted appearing group of

officers . . . had a better understanding of what Medical Department soldiers undergo to bring sick and

wounded to the rear . . . for treatment." Over 1,300 air, ground, and

service force medical officers, most of
134 EUROPEAN THEATER OF OPERATIONS

them captains and first lieutenants,

graduated from this course before the

Medical Field Service School ceased

operations in October 1944.42

In May 1943, an Army Nurse Corps

School began operations at Shrivenham in close association with the

Medical Field Service School and with

an almost identical charter. Chief

nurses and potential chief nurses took

an intensive three-week course designed to remedy their lack of basic

military training, as well as improve

their preparation for professional

duties. The women lived under strict

discipline, receiving demerits for

minor deficiencies in military courtesy

and appearance. They spent so much

time in drill and physical conditioning

that they nicknamed the program

"Commando School for Nurses."

They studied first aid, field sanitation,

chemical warfare defense, Medical

Department and hospital organization

and administration, the types and care

of battle wounds, and major diseases

of military importance. During 1944,

as nurses who had undergone basic

training in the United States began

arriving, the school reduced or eliminated its bootcamp features and emphasized instead advanced military

and professional instruction, concentrating on ETO policies and problems. Almost 800 nurses passed

through the school before it closed in

October 1944. They went back to

their units to help train other nurses

and to set a more military tone

among their colleagues.43

In September 1943, at General

Hawley's request, the European Theater activated the 1st Medical Demonstration Platoon, attached for quarters

and administration to the Shrivenham

school center. The 2 officers and 30

enlisted men of this unit spent two

weeks in each base section in rotation, showing other organizations

how to train medical soldiers. Between trips, the platoon acted as

school troops for the Medical Field

Service School. Early in 1944 the

medical service partially transferred

control of the demonstration platoon

to the Field Force Replacement

System, which began using it to train

medical troop replacements. This arrangement led to disputes between

the chief surgeon's staff and that of

the school center commander, Col.

Walter G. Layman (who also headed

the replacement system), over scheduling of the platoon's activities and,

as a result, substantially reduced its

usefulness to the medical service. In

May 1944, as part of the preparations

for receiving D-Day casualties, the European Theater turned the platoon

42 over to the Southern Base Section, Quotations from Medical Field Service School,

American School Center, "Medical Field Service

School History," pp. 1 and 156, file HD 353 ETO.

See also ibid., pp. 2 and 47-48, same file; Hawley et

al., "ETO Training," pp. 33-35; Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1943,

pp. 14-15; Troop Movements and Training Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 17. For a general history of

the American School Center, set up to remedy training deficiencies of a number of ETO elements, see

Ruppenthal, Logistical Support, 1:335-36.

43

 Hawley et al., "ETO Training," p. 35; Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1943 p. 15; Nursing Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 7-8. In July 1943

the Army Service Forces established ANC basic

training centers in the United States similar in purpose and curriculum to the ETO school. See Parks,

ed., Medical Training, pp. 127-32. For the effect of

the school upon hospitals, see Maxwell, "ANC

Hist," ch. XI, pp. 59-61 and 71, CMH.
MEDICS IN BRITAIN 135

which reorganized it as a provisional

ambulance company.44

As it expanded in numbers and facilities, the theater medical service introduced numerous short specialized

courses and training programs. Five

days to two weeks in duration, these

classes met at the Medical Field Service School, or, more often, at general

and station hospitals; they supplemented and in some instances replaced courses in British institutions.

Officers and nurses took instruction

in anesthesiology, to remedy a theater-wide shortage of people in this

field, as well as studied the latest

theories and techniques in treatment

of combat exhaustion and other neuropsychiatric illnesses. They learned

how to perform blood transfusions in

the field and how to apply plaster of

Paris bandages. Dental Corps officers

received additional training in maxillofacial surgery. Enlisted medics took

courses that would qualify them as

laboratory and surgical technicians

and went to depots for practice in

equipment maintenance and repair.

Some short courses, for example, Detachment Training in the Treatment

of Neuropsychiatric Patients, taught at

the 312th Station Hospital, were designed for teams of officers, nurses,

and enlisted medics from evacuation

or other types of hospitals. Most

working general hospitals functioned

to some degree as teaching institutions, offering specialized instruction,

usually in the form of individual practice with an authority in a particular

field.45

Medical units developed and implemented their own training schedules

under the supervision and inspection

of base section surgeons in the Services of Supply and of field army and

corps surgeons in the ground forces.

Each unit sent its quota of people to

the various ETO schools and courses

and tailored its own activities to its

particular mission. General and station hospitals, for example, held exercises in which they practiced receiving

and caring for hundreds of simulated

casualties. Staffs of general hospitals

expecting early orders to move to

France after D-Day practiced pitching

and striking tents and devoted time to

physical conditioning, often by cross

country marches. Officers and enlisted medics of the 298th General Hospital, by the time of the invasion,

were in good enough shape to cover

12 miles of hilly terrain, carrying full

packs, in three and one-half hours.

Nurses in the same hospital could go

7 miles in two and one-half hours,

wearing combat clothing and laden

with canteens, helmets, and gas

masks.46

44

 Hawley et al., "ETO Training," pp. 39-40; Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1943, p. 16; Troop Movements and Training

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 32; Memo, Anon,

to CSurg, 20 Jul 43, file HD 024 ETO O/CS (Operational Planning Directives).

45

 Hawley et al., "ETO Training," pp. 40-43; Operations and Training Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1942, p. 17; Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1943, pp. 15-16; Troop Movements and Training

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 18-21; Keeler

Interv, 17 Jul 45, box 223, RG 112, NARA; Memo,

HQ, SOS, to CGs, Northern Ireland, Southern, and

Western Base Sections, 18 Jan 44, sub: Technical

Training of Medical Department Enlisted Men of

Field Force Units, HD 024 ETO O/CS (Operational

Planning Directives). 46

 298th General Hospital Annual Rpt, 1944, pp.

284-50. For the role of base sections in training, see

Surg, Western Base Section, Rpt, 1 Jan-31 Aug 44,

pp. 2-3; Surg, Northern Ireland Base Section,

Annual Rpt, 1944, p. 4
136 EUROPEAN THEATER OF OPERATIONS

Medical units and detachments in

the armies concentrated heavily on

preparations for moving and living in

the field. Evacuation and field hospitals, which usually were not caring for

patients before D-Day, repeatedly

packed up their full equipment, transported it to new locations, set it up,

and took it down again. Collecting

and clearing companies also emphasized mobility and gained practical

experience by supporting divisions in

maneuvers and amphibious exercises.

In the First Army two veteran evacuation hospitals from the Mediterranean Theater provided instructors

and acted as demonstration units for

organizations fresh from the United

States, passing on techniques and improvisations proven effective in North

Africa and Sicily. Company aidmen

with the infantry regiments received

much the same tactical training as riflemen, including familiarization

firing of weapons. They accompanied

the troops on all exercises. In field

units gas defense received much attention. An aidman in the army's

120th Infantry recalled that whenever

the troops gathered for a lecture or

demonstration "there would be men

sneaking around with tear gas grenades. These would be thrown at unexpected intervals so that we would

be trained in sudden . . . application

of our gas masks."

 47

A shortage of instructional materials and inadequate inspection and

testing hindered the training effort.

The theater medical service never obtained enough War Department field

and technical manuals, motion pictures, and filmstrips to meet unit requirements; troops often had to improvise such simple but vital teaching

aids as blackboards. Key materials arrived too late to be useful. The training film "Amputations of the Lower

Extremities" did not reach the theater

until after D-Day, by which time the

field and evacuation hospital surgeons

who performed most such amputations already were in or staging for

combat. A film on combat exhaustion,

produced in the European Theater

and intended for first- and secondechelon personnel, had similarly delayed distribution. The chief surgeon's office, the base sections, and

the armies all prescribed proficiency

standards and attempted to enforce

them by frequent inspection and testing; but shortages of staff, especially

in base section surgeons' offices,

often reduced these efforts to sketchy

formalities. In operating units the

pressure of other duties inevitably cut

into training schedules. Col. Angwald

Vickoren, in charge of training in

Hawley's office, complained early in

1944 that hospital commanders "have

been very busy getting hospitals organized and they have forgotten

about . . . training." Hawley himself,

as late as a month before D-Day, still

found many units deficient in first aid

instruction.48

47

 Quotation from Robert B. Bradley, Aid Man

(New York: Vantage Press, 1970), p. 38. See also

ibid., pp. 29-37; First Army Report of Operations,

20 Oct 43-1 Aug 44, bk. VII, p. 61; Surg, Third

U.S. Army, Annual Rpt, 1944, pp. 15-18, 99, 111,

and ex. V; 91st Evacuation Hospital Annual Rpt,

1944, 2-3; 128th Evacuation Hospital Annual Rpt,

1944, pp. 1-2. Typical training programs are described in Surg, XIX Corps, Annual Rpt, 1944, pp.

1-4 and ends. 9-10, and in Surg, 1st Infantry Division, Annual Rpt, 1944, pp. 1-2.

48

 Quote from Mins, 14th Meeting of Base Section

Surgeons, 31 Jan 44, pp. 4-5, file HD 337. See also

ibid, for 21st, 8 May 44, p. 8, same file; Troop Continued
MEDICS IN BRITAIN 137

In spite of these shortcomings, by

the time General Hawley suspended

most instruction in April 1944 the

theater medical service had achieved

its major training objectives. It remedied the lack of military orientation

among medical personnel new to the

Army and acquainted them with the

problems and techniques of war medicine. Constant training helped standardize medical and surgical practice;

it maintained the professional interest

and sharpened the skills of temporarily idle or underemployed staffs; and

above all, it contributed to transforming hastily assembled collections of

medical personnel into units ready to

function as close-knit teams within a

larger whole.49

Preventive Medicine

During the prolonged buildup ETO

medics guarded the health of the expanding American force. To carry out

this mission, the chief surgeon established the Preventive Medicine Division and in June 1942 selected the

newly commissioned Lt. Col. John E.

Gordon as division chief. Gordon, an

epidemiologist, had been working in

public health in the United Kingdom

since 1940, when he arrived with the

Red Cross-Harvard Field Hospital

Unit, and had become a respected

member of the British medical establishment. A U.S. Army colleague considered him "the most efficient civilian turned military I've ever seen."

Gordon, subsequently promoted to

full colonel, headed the division until

V-E Day. The branches—Sanitation,

Nutrition, Epidemiology, and Venereal Disease Control—also benefited

from continuity of leadership; the

same branch chief remained in office

for all or most of the war and, consequently, was able to keep the junior

staff for long periods. Length of service, and the resulting chance to learn

on the job, in part compensated for a

theater shortage of medical officers

with public health experience. Of

thirty officers in key preventive medicine positions, Gordon estimated,

only fifteen had worked in the field

before joining the European Theater;

the rest were trained in other specialties, many as internists or pediatricians.50

Besides the staff at Cheltenham, the

Preventive Medicine Division included

the ETO's central medical laboratory

at Salisbury. The theater, in July

1942, acquired a central laboratory by

the simple expedient of taking over

Gordon's Red Cross-Harvard Unit,

complete with facilities and staff, as

the provisional Medical General Laboratory A. During late 1942 and early

1943 the medical service enlarged the

Salisbury plant to accommodate a

T/O central laboratory unit. This

unit, the 1st Medical General Laboratory, arrived from the United States

in June 1943. Medical General Laboratory A then disbanded, part of its

staff remaining with the new organization and the rest going to other

ETO assignments. From then until

Movements and Training Branch, Operations Divisions, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

pp. 24, 27-28, 32-35. 49

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 23-24 and 28, evaluates the effectiveness and deficiencies of the training effort.

50

 Quotation from Editorial Advisory Board, 1962,

p. 47. See also Gordon "Hist," vol. 1, pt. 1, pp. 7-8,

and pt. 2, pp. 3-4 and 6, CMH.
138 EUROPEAN THEATER OF OPERATIONS

COL. JOHN E. GORDON

the end of hostilities the 1st Medical

General Laboratory served as the central theater facility for pathology, epidemiological investigations, and food

quality control, as well as assisted

hospital laboratories with difficult or

specialized problems and trained laboratory and sanitation technicians.51

During 1943 each base section surgeon's office established its own Preventive Medicine Division, with

branches for epidemiology, nutrition,

sanitation, and venereal disease control. The base sections directed most

preventive medicine operations, with

Gordon's office setting general policy,

advising, and assisting. The ground

armies and air forces also developed

preventive medicine staffs. Until the

invasion, army preventive medicine

officers concentrated largely on planning for the European campaign. Air

force staffs specialized in the health

problems of flying. Both ground and

air forces relied on the SOS base sections for such functions as water quality control and supervision of garbage

and sewage disposal.52

Housing and water supply, on

which the preventive medicine staffs

at various headquarters worked closely with the Corps of Engineers, posed

few health-related problems. The

British Army barracks and cantonments, new hutted camps, converted

civilian buildings, and billets in private homes in which most troops

lived were adequate by American

standards of comfort and cleanliness,

although usually crowded and less

well heated than most Americans

would have liked. Poor ventilation,

caused by troops closing windows and

ventilators to comply with blackout

regulations or to keep in what heat

small stoves and rationed fuel provided, constituted the most severe health

hazard. Water from municipal systems

and wells, which generally met American requirements for purity, was rationed to conform to planned action

by the medical service, the Engineers,

and the British War Office to conserve limited natural supplies, further

reduced by two years of drought. To

protect water quality, the medical

service arranged for added chlorination at most installations, rebuilt stor51

 Gordon "Hist," vol. 2, pt. 7, pp. 3-5, CMH.

52

 Gordon "Hist," vol. 1, pt. 1, pp. 11 and 13-14,

and pt. 2, pp. 7 and 11-12. For details of base section activities, see Surgs, Southern, Eastern, Western, Central, and Northern Ireland Base Sections,

Annual Rpts, 1943 and 1944.
MEDICS IN BRITAIN 139

age tanks in many buildings used for

quarters, and required all commands

to send water samples to station or

general hospital laboratories each

month for bacteriological analysis.53

At all levels of command preventive

medicine officers closely supervised

garbage and sewage disposal. Garbage removal entailed few difficulties.

Following British law and practice,

American units sold their edible

refuse to local contractors for animal

food; they separately salvaged grease

and bones for turnover to their Allies.

Sewage disposal proved to be more

difficult. At hospitals and other large

installations British-built waste treatment plants lacked adequate provision for drying out and disposing of

sludge. Engineers and medical officers had to engage in much rebuilding and improvisation to keep them

sanitary. Units in smaller camps, forbidden to dig pit latrines because of

British fears of ground water contamination, learned the unsavory details

of using and emptying latrine buckets,

the latter a noisome task seldom satisfactorily performed by either troop

details or civilian contractors. Some

units tried burning their feces in incinerators, in the process subjecting

themselves to foul odors. Where possible, the Americans copied a British

expedient called the Otway pit—a

hole in the ground, 10 feet on each

side and 10 feet deep, lined with

canvas or sheet metal and with a flyproof timber cover. A single such pit,

properly maintained, could accommodate the waste of 100 men for a long

period. Medical officers considered

Otway pits more practical and less offensive than other disposal means,

but they were at best the least of

evils.54

General Hawley, in setting up his

office, placed nutrition under Preventive Medicine in order to emphasize

the importance of diet in maintaining

troop health. Officers of the Nutrition

Branch cooperated with those of the

Subsistence Branch of the chief quartermaster's office in planning menus

and overseeing food procurement and

preparation. During the buildup most

units in Great Britain lived on a garrison ("A") ration, modified to take account of shipping limitations and

make use of locally procured foodstuffs. The first troops to arrive in

early 1942 ate the standard British

Army ration. Neither they nor their

medical officers liked it, because it

contained too little meat, milk products, tomatoes, fruit, and coffee; furnished too few calories; and did not

include the amounts of calcium, riboflavin, and ascorbic acid considered

necessary by American nutritionists.

During late 1942, as American supply

depots went into operation, most

commands shifted to a ration jointly

planned by representatives of Preventive Medicine and the chief quartermaster. This ration met American vitamin and calorie requirements, although it included canned milk and

powdered eggs; incorporated British

53

 Gordon "Hist," vol. 2, pt. 9, pp. 4-8, and pt.

10, pp. 2-6, CMH. Mins, 22d Meeting of Base Section Surgeons, 22 May 44, p. 5, file HD 337, is an

example of many exhortations to conserve water.

54

 Gordon "Hist," vol. 2, pt 9, pp. 16-18, CMH.

For technical deficiencies of sewage treatment

plants, see Ralph S. Cleland, "Sanitary Engineering

in the European Theater of Operations," The Military Surgeon 101 (July 1947): 36-40, and 168th Station Hospital Annual Rpt, 1944, p. 14. Crew, AMS,

Administration, 2:100-101, describes the Otway pit.
140 EUROPEAN THEATER OF OPERATIONS

flour, bread, cereals, condiments, and

vegetables; and was short of fresh

fruits and salad ingredients. Hospital

patients received the standard ration,

supplemented with extra chicken,

fruit, and eggs and with British-produced fresh milk, which General

Hawley refused to have issued to all

troops in order not to aggravate local

shortages and because most British

processing plants did not conform to

American hygenic standards.

The resulting diet more than sufficed to nourish the troops, provided

that they ate all the prescribed items.

To ensure that they did so, the Nutrition Branch, and nutrition officers in

the base sections, worked closely with

commands to educate men in proper

eating habits and to train cooks to

make nourishing foods appealing. Officers from the Preventive Medicine

Division attended Quartermaster

mess management conferences, made

nutritional inspections and surveys of

units, and furnished educational posters and material to messes and to the

soldiers newspaper, Stars and Stripes.

In the Western Base Section the surgeon, trying to increase consumption

of canned milk and powdered eggs,

distributed recipes for using these

items in scrambled eggs, lemon cream

pie filling, baked custard, and other

delicacies he hoped would be enticing.55

ETO veterinarians assisted the Preventive Medicine Division in ensuring

food quality. The personnel of the

Veterinary Division, who numbered

118 officers and 282 enlisted men by

D-Day, were parceled out among base

sections, general and Quartermaster

depots, ports of embarkation, the 1st

Medical General Laboratory, and

ground and air forces headquarters.

With no animals for which to care

except a few pigeons and sentry dogs,

veterinarians concentrated on their

other primary task of inspecting food

and supervising its storage and transportation. Although their mission

normally encompassed only foods of

animal origin, veterinarians in July

1943, under an agreement with the

theater chief quartermaster, also

began examining fresh fruit and vegetables and canned and packaged

products. Veterinarians in the ports

functioned as perishable freight officers, supervising the unloading of refrigerator ships. The inspecting officers found few deficiencies in Army

foodstuffs, but the equipment and

sanitary practices of British commercial carriers fell short of American

standards and caused much spoilage.

At the suggestion of the Veterinary

Division, the theater transportation

chief ordered 800 refrigerator cars

from the United States and by the

end of 1943 had 45 of them running

on British railways moving highly perishable items.56

55

 Gordon "Hist," vol. 1, pt. 2, p. 5, and pt. 4,

passim, CMH; Preventive Medicine Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 26;

Surg, Western Base Section, Annual Rpt, 1943. For

the evolution of the ETO ration, see William F.

Ross and Charles F. Romanus, The Quartermaster

Corps: Operations in the War Against Germany, United

States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1965), pp. 290-92.

56

 Veterinary Division, OofCSurg, HQ, ETOUSA,

Annual Rpts, 1943 and 1944; "Med Svc Hist, 1942-

43," pp. 6 and 68-69, file HD 314.7-2 ETO; Everett B. Miller, United States Army Veterinary Service in

World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army,

1961), pp. 271-72.
MEDICS IN BRITAIN 141

Suppression of disease outbreaks

involved every level of command.

Unit surgeons, assisted by base section, army, and air force staff epidemiologists, had primary responsibility

for spotting health problems early

and taking corrective action. In the

chief surgeon's office the Epidemiology Branch of the Preventive Medicine

Division established general policies

for controlling particular diseases,

distributed information, and sent doctors to help meet particularly severe

emergencies. Colonel Gordon received periodical formal reports on

the health of the Army from the Medical Records Division and the base

sections, and he maintained informal

contact with other divisions of the

chief surgeon's office that were concerned with treatment and prevention

of disease. Colonel Middleton, the

chief consultant in medicine, recalled:

"Virtually daily interchanges occurred

between [Gordon] and me or some

members of our staff, so that there

was a ready communication from the

clinical standpoint to preventive medicine." As a result of Gordon's rapport with the British, Preventive Medicine obtained weekly reports from

the Ministry of Health and the War

Office on outbreaks of infectious disease in the British civilian population

and armed forces.57

For U.S. Army forces in the United

Kingdom sickness was more a nuisance than a menace. The troops

lived and worked in a temperate—if

damp and chilly—climate and in a developed industrial country which understood basic sanitation and either

never had had, or long ago had eradicated, most of the deadliest communicable diseases. Insects and vermin

were limited in numbers and constituted no major threat to the health of

the Army. Not only was the environment relatively favorable, most soldiers arrived in Great Britain with

their required immunizations against

smallpox, typhoid, paratyphoid,

typhus, and tetanus. The Preventive

Medicine Division supervised a continuing program of reimmunization

and was prepared to provide additional immunization, as required for

military missions, against a variety of

other disease threats.58

Epidemics did occur, the first being

the serum hepatitis outbreak of mid1942.59

 The climate, and the often

poorly heated and ventilated living

quarters, produced a high continuing

incidence, especially in winter, of influenza and other respiratory infections, which accounted regularly for

about 30 percent of all disease among

ETO troops. To control these infections, medical officers and unit

commanders emphasized personal

cleanliness among their men, tried to

improve barracks heat and ventilation,

and provided extra facilities for

drying clothing. Scattered outbreaks

of diarrhea—sixty between January

and October 1943—and less frequently of dysentery and food poisoning plagued the Army. The medical

service traced most of these to unsanitary mess practices, typically efforts

57

 Quotation from Middleton Interv, 1968-69, vol.

1, pp. 206-07, NLM. See also Gordon "Hist," vol.

1, pt. 2, pp. 2-3, and pt. 3, sec. 1, pp. 5-6, CMH.

58

 Medical Bulletin No. 6, OofCSurg, HQ,

ETOUSA, 15 Jun 43, pp. 7-9; Mins, 15th and 19th

Meetings of Base Section Surgeons, 14 Feb and 10

Apr 44, file HD 337; Gordon "Hist," vol. 2, pt. 3,

sec. 7, pp. 4-5, CMH. 59

 For details, see Chapter I of this volume.
142 EUROPEAN THEATER OF OPERATIONS

to store food too long without adequate refrigeration. Epidemics of a

mild form of hepatitis constantly recurred, especially during the winter of

1943-44, when divisions redeploying

from the Mediterranean for OVERLORD brought the disease with them.

Medical officers never determined

definitely the mode of transmission of

this infection, and the Army would

suffer from occasional hepatitis epidemics until V-E Day.60

The four divisions and an engineer

special brigade that entered the

United Kingdom from the Mediterranean in November 1943 carried with

them a clinically more severe, and

militarily a more potentially disruptive, disease than hepatitis: They

brought malaria. By the beginning of

the twentieth century indigenous malaria very nearly had disappeared

from the British Isles. However, at

least one species of mosquitoes—

Anopheles—lived there, and the

troops from the Mediterranean, as

well as aircraft crews who picked up

the infection at African stopovers on

transatlantic flights, provided a new

reservoir of the parasite, creating conditions for further spread of the disease. As men in the newly arrived

units stopped taking suppressive Atabrine, the European Theater's rate of

hospital admissions for malaria began

rising. All cases, of the vivax variety,

were benign and all, as judged by

medical officers, resulted from infection outside the United Kingdom.

To check the spread of the disease

to the rest of the Army and the British people, hospitals kept malaria patients isolated under mosquito netting

or in screened rooms until treatment

cleared their bloodstreams of the

parasite. Preventive medicine officers

in the base sections started or intensified mosquito eradication efforts

around hospitals and camps. Unit

medical officers tested the blood of

all men who had served in malarial

regions to detect carriers of the parasite. To prepare for the invasion, affected units transferred out the men

most debilitated by malaria, and two

weeks before D-Day they put all soldiers who had had malaria within the

past twelve months back on daily

doses of Atabrine. These measures

prevented the occurrence of new

cases among troops and civilians, but

already infected men in the veteran

units would continue to be incapacitated by the disease during the assault

on continental Europe.61

Venereal disease, in spite of rapid

and effective treatment with sulfa

drugs and penicillin, cost the Army

heavily in lost time from duty and diversion of medical resources, as well

as being a source of political and

social tension between the Americans

and their British hosts. Recognizing

the importance of this health prob60

 Gordon "Hist," vol. 1, pt. 3, sec. 2, no. 1, pp.

8-9, and sec. 3, no. 1, pp. 1-2, 12-15, and vol. 2,

pt. 3, sec. 6, pp. 9-16, 22-25, CMH; Essential Technical Medical Data Rpt, HQ, ETOUSA, October

1943, p. 2. HQ, Eastern Base Section, Directive, 19

Dec 42, sub: Common Respiratory Diseases, in

Surg, Eastern Base Section, Annual Rpt, 1942, is

typical of measures against respiratory diseases.

61

 The affected units were the 1st and 9th Infantry, the 2d Armored, and the 82d Airborne Divisions and the 1st Engineer Special Brigade. See also

Gordon "Hist," vol. 1, pt. 3, sec. 5, no. 2, pp. 1-11,

CMH. On malaria in the Mediterranean, see Ebbe

C. Hoff, ed., Communicable Diseases: Malaria, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1963), pp. 262-64.
MEDICS IN BRITAIN 143

lem, General Hawley in September

1942 organized a separate Venereal

Disease Control Branch in the Preventive Medicine Division. Headed by

Lt. Col. Paul Padget, a venereal disease specialist from John Hopkins

University, this branch had responsibility for control and prevention,

while the Professional Services Division supervised treatment. As the

medical service expanded, base sections, air forces, armies, and lowerechelon headquarters acquired their

own venereal disease control officers.

Padget and his small staff made general policies, gave advice, and held

periodic meetings of control officers

from other commands to exchange

ideas and experiences.62

Padget and his colleagues, as well

as troop commanders at every echelon, employed the standard Army

methods of controlling venereal disease. Commands worked with the Red

Cross and Special Services to provide

wholesome recreation for their troops

and (rarely) took disciplinary action

against men who became infected.

Units emphasized education. Line officers, surgeons, chaplains, and specially trained NCOs lectured on the

dangers of venereal disease and the

methods of preventing it. Films and

posters, the latter often drawn by enlisted men in contests, graphically

presented the same themes. All media

urged men on grounds of patriotism,

unit pride, faithfulness to loved ones

at home, and personal self-interest to

avoid illicit sexual contact, which, it

was emphasized, almost invariably led

to infection. If the soldiers were

unable to comply, the education program urged them to be careful by

using correctly the mechanical and

chemical prophylactics the Army provided. Getting down to basic details,

the Northern Ireland Base Section

surgeon suggested that venereal disease lecturers "secure a model penis

and show the men the exact method

of putting on and taking off a

condom."

 63

The medical service furnished prophylaxis in abundance and in a variety

of forms. It issued condoms without

charge at a rate of six per man per

month and individual chemical prophylactic kits ("V-Packettes") at a rate

of two per man per week. Because

many units, especially in the Air

Force and Services of Supply, were

located some distance away from the

hospitals and dispensaries that served

them, the Preventive Medicine Division arranged for the Quartermaster

Department to distribute individual

prophylactics along with its other supplies so that, as Padget put it, organizations "drew their condoms at the

same time they drew their soap and

62

 Gordon "Hist," vol. 1, pt. 2, pp. 5-6, and vol.

2, pt. 5, pp. 1-2 and 8, CMH; Interv, OSG with Lt

Col Paul Padget, MC (hereafter cited as Padget

Interv), 1 Aug 45, box 223, RG 112, NARA. Padget

later assumed the additional duty of senior consultant in venereal disease.

63

 Quotation from "Suggestions for Venereal Disease Control Program," encl. 6, Surg, Northern Ireland Base Section, Rpt, 1 Jan-15 Jun 44; see encl. 7

for training of NCOs as lecturers. See also Memo,

Col Kimbrough to Brig Gen Hillman, 27 Nov 42,

HD 024 ETO O/CS (Hawley-SGO Corresp); Padget

Interv, 1 Aug 45, box 223, RG 112, NARA; Interv,

OSG with Capt P. B. Pulman (hereafter cited as

Pulman Interv), 9 Mar 44, box 219, RG 112, NARA;

Gordon "Hist," vol. 2, pt. 5, pp. 8-9, CMH. James

P. Pappas, "The Venereal Disease Problem, United

States Army," The Military Surgeon 93 (August 1943):

172-83, sums up then-current Army doctrine. For

typical programs, see Surg, Southern Base Section,

Annual Rpt, 1943, p. 8; Surg, 9th Infantry Division,

Annual Rpt, 1944, pp. 3-4; and Surg, 29th Infantry

Division, Annual Rpt, 1944, p. 3.
144 EUROPEAN THEATER OF OPERATIONS

brushes." Prophylactics for women

soldiers became the subject of delicate negotiations between General

Hawley, General Lee, and the senior

officer of the Women's Army Auxiliary Corps (WAAC). The fact that such

equipment had contraceptive as well

as hygienic uses was, Hawley declared, "political dynamite." Nevertheless, all concerned decided that

the women's health had to receive

priority. The medical service issued

equipment for douches to WAAC organizations while taking pains to emphasize the hygienic purpose and

ruling out measures "primarily contraceptive in nature."

 64

Besides furnishing individual equipment, base sections and other commands set up prophylactic stations in

cantonments and, after much haggling with the British—and, according

to Gordon, "relentless" pressure

upon them—in towns and cities frequented by men on pass. The Red

Cross allowed the Army to place prophylactic stations in its clubs, where

most soldiers on leave stayed. Many

potentially infected men, as a result,

"found a prophylactic station right in

their path when they returned to

quarters." Units posted the locations

of prophylactic stations in neighboring towns on their bulletin boards

and stamped them on passes. The

Central Base Section made free condoms and V-Packettes available at

every London railroad station and at

billeting and transportation offices

and operated sixteen prophylactic stations, many in Red Cross clubs. Reflecting the continued prevalence of

racial segregation, these stations included two especially for black

soldiers, staffed with black medical

personnel. By arrangement with the

provost marshal, every soldier confined in the Central Base Section

guardhouse, unless arrested on duty,

received a prophylactic treatment

during booking. During the first half

of 1944 the Central Base Section by

these methods distributed over

10,000 V-Packettes and 33,500 condoms and gave over 30,000 station

prophylactic treatments.65

The usual Army procedure for

combating venereal disease included

close cooperation with civilian authorities to stamp out prostitution in

areas frequented by troops and to

trace civilian sexual partners of infected soldiers. In Great Britain, law and

social custom stood in the way of

both these efforts. Brothels were rare,

but individual streetwalkers abounded

in London and other large cities.

Under laws that treated even commercial sexual arrangements between

individuals as entirely private, the

police could not interfere with such

women unless they caused public disorder. Compounding the problem,

most soldiers had their sexual contacts with nonprofessional "pickups."

These "enthusiastic amateurs" were

totally out of reach of the police, and

64

 First quotation from Padget Interv, 1 Aug 45,

box 223, RG 112, NARA. Second and third quotations from Memo, Hawley to General Lee, undated

but ca. July 1943, box 1, Hawley Papers, MHI. See

also Medical Bulletins Nos. 4 and 7, OofCSurg, HQ,

ETOUSA, 15 May 43, p. 7, and 1 Jun 43, p. 14;

Gordon "Hist," vol. 2, pt. 5, p. 10, CMH; Hawley

Operational Directive No. 24, 1 Jul 43, with Supply

Division endorsement, 9 Jul 43, box 2, Hawley

Papers, MHI.

65

 Quotations from Gordon "Hist," vol. 2, pt. 5,

pp. 4-5 and 9-10, CMH. See also Surg, Central

Base Section, History of Medical Section, JanuaryJuly 1944, pp. 2-3 and 8-9; Pulman Interv, 9 Mar

44, box 219, RG 112, NARA.
PROPHYLACTIC STATION AND PROCEDURE
146 EUROPEAN THEATER OF OPERATIONS

the Venereal Disease Control Act of

1916, which permitted libel action

against a person who implied that

someone else was infected, effectively

barred British social agencies from

helping the Americans trace them.

The Privy Council, in Defense Regulation 33B, issued in December 1942,

permitted a venereal disease patient

privately to name his or her partner

to a physician, who then could pass

on the information to the appropriate

local public health officer. After two

separate identifications of the same

person as the "source of infection,"

the public health officer could compel

the individual to report for examination and treatment. This regulation

was of little direct use to the theater

medical service, because two soldiers

rarely identified the same woman definitively enough to meet the evidentiary requirements.66

The medical service could do little

to check prostitution, except make occasional informal arrangements with

local police. In London, for example,

American MPs and officers of the

Metropolitan force rigorously restricted loitering by soldiers and civilians

in Piccadilly Circus and Leicester

Square, making pickups at least

harder to arrange. The Americans

had more success with contact tracing, using Regulation 33B as their

opening wedge. Exploiting to the full

his cordial relations with the Ministry

of Health, Colonel Gordon prevailed

on the reluctant British to allow U.S.

Army nurses to take names of partners from infected soldiers and then

visit the women, warn them they

might be infected, and suggest they

go to a British clinic for treatment.

Because the entire action was confidential and informal and the contacts'

responses were voluntary, the Americans by this means could get around

the rigid rules of Regulation 33B.

Colonel Padget launched the program

in February 1943 in six counties in

East Anglia, employing four Army

nurses experienced in public health

work. Much to the surprise of the

sceptical British, the program provoked almost no civilian resentment

and had substantial results. Of the

first 500 women approached, only

one—a professional prostitute—took

offense, and over 75 percent eventually sought medical assistance. The

Preventive Medicine Division expanded the effort throughout the United

Kingdom, doubling the number of

nurses assigned, and in February

1944 transferred administration of it

to the base sections. British county

health officers, impressed with the

U.S. Army's success, organized similar

contact teams and gradually began

exchanging information with their

Allies.67

In reciprocity for British acquiescence in this benign invasion of their

cherished privacy, General Hawley

tried to respond to Ministry of Health

and Army Medical Services protests

against the introduction into the

United Kingdom of American soldiers

66

 Gordon "Hist," vol. 2, pt. 5, pp. 5-7 and 12-

13, CMH; Padget Interv, 1 Aug 45, box 223, RG

112, NARA. For an account of antiprostitution

measures and contract-tracing in the United States,

see Hoff, ed., Diseases Transmitted Through Contact, pp.

179-81.

67

 Gordon "Hist," vol. 2, pt. 5, pp. 6, 13-14, 16,

CMH; Padget Interv, 1 Aug 45, box 223, RG 112,

NARA; Medical Bulletin No. 7, OofCSurg, HQ,

ETOUSA, 1 Jul 43, pp. 6-9; Mins, 14th and 15th

Meetings of Base Section Surgeons, 31 Jan and 14

Feb 44, file HD 337.
MEDICS IN BRITAIN 147

already infected with venereal disease.

He repeatedly called to Surgeon General Kirk's attention the fact that

transports from the United States regularly made port with scores of new

syphilis and gonorrhea cases on

board, and he warned that apparent

American nonchalance on this question jeopardized hard-won British cooperation with his control measures.

The chief surgeon arranged to detect

and hold for treatment all infected

soldiers on arriving vessels. On the

other side of the Atlantic the New

York Port of Embarkation inspected

troops carefully before embarkation

and either kept infected men back for

treatment or provided treatment on

shipboard. Surgeon General Kirk,

however, was reluctant to stop altogether shipment of men with venereal

disease, lest he create a new medical

way for malingerers to avoid overseas

duty. Further, many troops became

infected during their last preembarkation leaves, twenty-four to forty-eight

hours before sailing, and their symptoms did not appear in time to be

noted in boarding inspections or to

be treated and cured on the voyage.

The Army, as a result, continued to

import venereal disease into the British Isles, and its doing so remained

an unresolved irritant in Anglo-American medical relations.68

The medical service's broad-fronted

attack on venereal disease produced

encouraging results. The rate of new

cases per 1,000 troops per year,

which stood at 58 at the end of 1942,

dropped to 21 by late 1943 and to

about 20 in mid-1944. Colonel

Padget attributed part of this decline

to what he called a "dilution factor"

resulting from the rapid influx of new

troops who had not yet had time to

find female company. Nevertheless,

he was "reasonably certain that the

lowering of the rate . . . was an actuality and not just an artifact brought

about by troop movements." As was

true throughout the Army, black soldiers in the European Theater had a

venereal disease rate about four and

one-half times that of white troops,

the result of complex causes largely

not correctable by the theater medical

service. The black rate did respond,

however, to education and prevention

efforts, falling from 127 cases per

1,000 troops per year in February

1944 to 83 in June. Its general rise

and decline paralleled those for other

troops, only at a higher level. Among

overseas theaters, which normally had

higher venereal disease rates than the

continental United States, the European Theater during 1942-44 ranked

lower than all other theaters but the

Southwest Pacific and Pacific Ocean.69

Between the start of BOLERO in

mid-1942 and the end of May 1944

the European Theater of Operations

recorded about 433,000 cases of disease admitted to hospitals and quarters, about 64,000 cases of nonbattle

68

 Ltrs, Hawley to TSG, 19 Aug and 14 Oct 43,

and TSG to Hawley, 25 Aug and 2 Oct 43, file HD

024 ETO O/CS (Hawley-SGO Corresp); Ltrs,

Hawley to CG, New York Port of Embarkation, 3

Feb 44, and to DepCdr, ETO, 27 Mar 44, file HD

024 ETO C/S (Hawley Chron). For the U.S. end of

the problem, see Hoff, ed., Diseases Transmitted

Through Contact, pp. 148 and 155.

69

 Quotation from Padget Interv, 1 Aug 45, box

223, RG 112, NARA. See also Hoff, ed., Diseases

Transmitted Through Contact, p. 266; Mins, 23d Meeting of Base Section Surgeons, 5 Jun 44, p. 4, file

HD 337; Gordon "Hist," vol. 2, pt. 5, pp. 28-33,

fig. 18, table 7, CMH. For the venereal disease

problem among black soldiers and its causes, see

Lee, Employment of Negro Troops, pp. 277-78.
148 EUROPEAN THEATER OF OPERATIONS

injury, and 4,300 of combat wounds.

Throughout the buildup, the theater

had fewer sick per 1,000 troops per

year than any other overseas theater

but the North American and Latin

American. The ETO sick rate declined month by month, except for

temporary winter upsurges reflecting

the prevalence of respiratory infections, from 1,087 admissions per

1,000 in February 1942 to 245 in

June 1944. Deaths from disease per

1,000 men remained consistently

below 0.500 during the preinvasion

period, a rate lower even than that in

the United States and half what the

Army suffered in the tropical Asian

and Pacific areas of operations, with

their greater incidence of deadly sickness. The ETO's daily average noneffective rate for all causes remained

below that in the United States until

the invasion. Clearly, as it awaited the

invasion of Europe, the medical service was carrying out its mandate to

conserve the fighting strength of the

Army.70

70

 These figures are drawn from Frank A. Reister,

ed., Medical Statistics in World War II, Medical Department, United States Army in World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1975), pp. 72-79, 608-09,

630-31. See also tables in Gordon "Hist," vol. 2, pt.

12, CMH.
CHAPTER VI

Preparations for Invasion

Medics in Britain performed their

many and complex BOLERO tasks as

preliminaries to their principal and

most urgent mission: support of the

amphibious assault on continental

Europe. In the early period of the

buildup, planning and preparation for

that assault engaged the attention of

only a few members of the chief surgeon's staff. Then, as 1943 gave way

to 1944, the pace of assault planning

intensified. Medical personnel of all

ranks and in all units were swept up

in invasion preparations. By late

spring of 1944 ETO medics, like everyone else in the theater, were tensely awaiting the rapidly approaching

D-Day.

Early Planning Efforts

Medical planning for a cross-Channel assault started in April 1942, after

tentative approval of the American

ROUNDUP invasion concept, and ran

concurrently with the BOLERO buildup. The British and U.S. ground,

naval, and air commands in London

set up, among other committees on

the ROUNDUP operation, an administrative planning staff to deal with logistical matters. The staff, in turn,

was divided into lettered sections specializing in particular aspects of logistics. Section C, which did most of the

medical planning, included members

of the British War Office, Admiralty,

Air Ministry, Combined Operations

Staff, and Ministry of Health, with the

theater chief surgeon and, more

often, Colonel Spruit, Hawley's

London representative, speaking for

the American forces.1

Section C, in common with the

other logistics planning groups,

worked within uncertain parameters.

By mid-June the ROUNDUP tactical

planners had developed a general

concept for simultaneous landings on

a front stretching from the Pas-deCalais to Cherbourg, with perhaps six

divisions in the initial assault; beyond

that the outlines of the operation remained unclear, clouded with doubt

as to its feasibility. At the same time

Section C had little amphibious warfare experience to guide it. The U.S.

Navy and Marine Corps before the

war had outlined a tentative amphibious doctrine, also adopted by the

Army, but the resulting manuals had

little useful to say about medical op1

 For general ROUNDUP planning, see Harrison,

Cross-Channel, pp. 5-8 and 21-23; Ruppenthal, Logistical Support, 1:175-76; Larkey "Hist," ch. 2, pp. 57-

59. For Spruit's role, see Hawley's recommendation

for award, in file HD 024 ETO CS (Hawley Chron),

April-June 1944.
150 EUROPEAN THEATER OF OPERATIONS

erations. Wartime British Commando

raids, and even the August 1942

attack on Dieppe, offered few medical

lessons but confirmed that heavy casualties were to be expected. In the

face of these uncertainties and areas

of ignorance, Hawley, Spruit, and

their British colleagues plowed ahead

as best they could.2

From the start of their deliberations

the medical planners confronted a

problem that would remain a central

preoccupation until D-Day: treatment

and evacuation of the anticipated

many casualties of the first days of the

invasion. The dilemma was simple.

The assault force would suffer its

largest proportion of wounded at precisely the time when the fewest medical troops would be on shore to care

for them. Section C, on the basis of

informed guess work, assumed that

there would be 22,500 Allied wounded, almost half of them stretcher

cases, during the first two days of

ROUNDUP. Hawley, Spruit, and their

British counterparts quickly ruled out

any attempt to treat these injured on

the French shore (designated in plans

as the "far shore" to distinguish it

from the British "nearshore"), concluding that treatment would require

more medics, hospitals, and equipment than could possibly be landed in

the assault and early buildup and

more space than would be available in

the crowded beachhead.

If the wounded were not to be

cared for on the far shore, they would

have to be evacuated directly from

the beaches to hospitals in Great Britain, but evacuated in what? Few British and no United States hospital

ships were available in the theater,

and in any event these large oceangoing vessels could embark patients

conveniently only at ports. Besides,

such scarce ships should not be risked

under enemy air attack and shore battery fire. The British had developed a

smaller type of hospital ship, the hospital carrier. Converted from shallowdraft coastal steamers, these vessels,

each able to accommodate 100 litter

and 150 ambulatory patients, could

lie close to the beaches and load by

means of water ambulances—motor

boats carried on board the mother

craft. Hospital carriers, however, also

were vulnerable to hostile air and artillery and they took hours to fill to

capacity. The four that would be

available in England in late 1942

could not begin to evacuate all the

expected casualties.

Tactical landing craft that returned

to England after unloading obviously

were the only means for taking many

wounded off the beaches quickly, although the types of such craft in

service during ROUNDUP planning

were small and not well adapted to

handling men on stretchers. Nevertheless, in late 1942, for lack of any

real alternative, the ROUNDUP administrative planning staff, at Section C's

recommendation, established in principle a policy of maximum evacuation

during the initial assault and use of

returning landing craft as the main

2

 For the ROUNDUP plan, see Harrison, Cross-Channel, pp. 22-23 and 54-55. Ruppenthal, Logistical Support, 1:328-30, discusses early U.S. experiments with

the logistics of amphibious assault. At Dieppe, Canadian forces—the bulk of the assault group—suffered 3,367 casualties out of 4,963 troops engaged.

Of the 1,154 wounded, the withdrawing Canadians

had to leave 568 behind as prisoners. See C. F.

Stacey, Six Years of War: The Army in Canada, Britain,

and the Pacific, Official History of the Canadian Army

in the Second World War (Ottawa: E. Cloutier,

1955), pp. 384-89.
PREPARATIONS FOR INVASION 151

BRITISH HOSPITAL CARRIER NAUSHON, a converted American ferryboat

casualty carrier. What types of landing craft to employ for this purpose,

how many could be made available

for medical use (indeed, how many

would be available at all), and whether any could be earmarked exclusively

for evacuation and protected by the

Red Cross—these facts the committee

could not determine. The principle it

adopted, however, would remain in

force throughout the rest of the

lengthy invasion planning process.3

Besides struggling with the problem of beachhead evacuation, the

ROUNDUP medical planners arrived at

basic decisions on a number of other

important questions. They established

an army-navy division of cross-Channel evacuation responsibilities that

applied to both British and American

forces. Under it, the armies were to

collect all wounded on the far shore

and move them to the beaches; the

navies would load evacuation craft

and care for patients on the voyage to

England; the armies then would have

charge of unloading the wounded and

removing them to hospitals. General

Hawley, Colonel Grow of the Eighth

Air Force, and British medical and

RAF authorities agreed on similar

plans for air evacuation from the

Continent to the United Kingdom.

3

 Larkey "Hist," ch. 2, pp. 56-58. For memoranda

detailing the reasoning behind these decisions, see

file HD 024 ETO O/CS (Spruit File re Policy); Recommendations of a Sub-Committee held in ... the

Admiralty, London, 16 Jul 42, in EvacCorresp,

1942-45, file HD 024 ETO; F. A. E. Crew, The Army

Medical Services (hereafter cited as AMS), History of

the Second World War, United Kingdom Medical

Series, 5 vols. (London: Her Majesty's Stationery

Office, 1956-66), vol. 4, Campaigns: North-West Europe

(1962), pp. 45-49.
152 EUROPEAN THEATER OF OPERATIONS

The ground forces and Services of

Supply were to collect evacuees at

French airstrips for pickup by transport planes returning to England. Air

Force medical personnel were to care

for the patients in flight, and the Services of Supply would deplane them

in Britain and transfer them to hospitals. For their own forces the American planners began outlining the

complicated sequence in which field

army and then SOS medical units

would land in France. They also

roughed out a system for receiving

water-evacuated casualties in England,

using field hospitals and clearing stations at the ports for triage and emergency surgery and distributing transportable patients at once to selected

hospitals inland.4

Medical invasion planning, in this

period of limited theater resources, at

times took on an air of unreality.

During July, for example, in a last

effort to avoid the diversion to North

Africa, General Marshall ordered the

European Theater and Services of

Supply to report on the feasibility of

launching a small-scale cross-Channel

attack, code-named SLEDGEHAMMER,

on 15 September. Hawley, in response, informed General Lee that, if

the buildup continued at its present

pace, the medical service would be

short 8,900 beds and 8,616 officers

and men on the projected attack date

and would have no hospital train

units, ambulance battalions, or boats

for water evacuation. Pressed by Lee

to report positively on how he could

support the operation, the chief surgeon reiterated his previous assessment, with the qualification that he

would be able to support the landing

if he could borrow field medical units,

hospitals, and equipment from the

British, who, of course, had none to

spare. Reports such as this helped

scuttle SLEDGEHAMMER and ROUNDUP

and paved the way for the commitment to TORCH.5

Cross-Channel assault planning of

all sorts came to a stop in late 1942,

as TORCH plans and preparations monopolized the attention of British and

American staffs. Yet the ROUNDUP

studies and conclusions—preserved in

memoranda, data books, and individual memories—would constitute a

starting point for the next round of

invasion planning. Many of the principles and concepts of operation first

sketchily outlined in ROUNDUP would

be the foundation of the much more

elaborate plans to follow.6

OVERLORD: The Planning Process

The decision of the Allied leaders

at Casablanca, in January 1943, to

revive the cross-Channel attack

project for execution sometime in

1944 set in motion a lengthy, complex planning process. It began with a

small Anglo-American staff, eventually drew in most British and American

headquarters, and ended in the final

test of strength in the west with Nazi

Germany.

In March 1943, to give organizational substance to the Casablanca de4

 Larkey "Hist," ch. 2, pp. 68-72; Miscellaneous

SPOBS/ROUNDUP Papers file, CMH.

5

 An account of this incident, with documents, is

in Larkey "Hist," ch. 4, pp. 2-6 and apps. 2 and 3. 6

 Harrison, Cross-Channel, pp. 31-32; Larkey

"Hist," ch. 2, p. 73; Memo, CG, SOS, to ACofS,

G-4, and CsofSupSvcs, SOS, 1 Apr 43, sub: Administrative Planning, file HD 024 ETO O/CS (Spruit

File re Policy).
PREPARATIONS FOR INVASION 153

cision, the Combined Chiefs of Staff

established the Anglo-American staff

known as COSSAC to plan the invasion and superintend preparations for

it. Under the guidance of British Lt.

Gen. Sir Frederick E. Morgan,

COSSAC drafted the outline plan for

the invasion, Operation OVERLORD,

which Roosevelt, Churchill, and the

Combined Chiefs approved at the

Quebec conference in August. The

Allies then put together the AngloAmerican combined ground, naval,

and air headquarters that were to fill

in the details of OVERLORD and un- dertake its execution. In mid-January

1944 the arrival of General Eisenhower in London and the activation of

SHAEF around the nucleus of

COSSAC capped the invasion command structure. Eisenhower, after refining and expanding the COSSAC

plan, set 1 June as the attack date. To

obtain more landing craft for the enlarged assault, the Combined Chiefs

canceled the originally contemplated

simultaneous landing in southern

France. On 1 February SHAEF published its outline plan for NEPTUNE,

the code-name for 1944 operations

within OVERLORD. SHAEF's ground,

naval, and air headquarters followed

with their outline plans and various

national forces then got to work on

the details of tactics and logistics.

The final plan, developed by

COSSAC and expanded upon by

SHAEF, selected Normandy as the

point of attack because it possessed

more suitable invasion beaches, was

located within easier reach of major

ports, and was less strongly defended

than the previously favored Pas-deCalais. In contrast to the broad front

contemplated for ROUNDUP, the

OVERLORD plan called for a single

concentrated amphibious assault.

Three British Commonwealth and

two American divisions were to land

north and northwest of Caen, with

one of the American divisions going

in on the east coast of the Cotentin

Peninsula to gain position for a drive

on the key port of Cherbourg. Three

airborne divisions—one British and

two American—were to drop to secure the flanks of the beachhead and

open routes inland. This force, and

follow-up troops, was to secure a

compact lodgement area in which the

Allies could mass men and supplies

and from which they could advance

methodically, first to capture additional Norman and Breton ports, then

to clear the region between the Seine

and the Loire, and finally to take

Paris and go on to the Rhine, in the

process destroying as much of the

German Army as possible (see Map

4).7

With the formation of COSSAC,

medical support planning paralleled

every stage of OVERLORD'S development. The COSSAC medical section

began work in June 1943, under

Chief Medical Officer Lt. Col. G. M.

Denning of the Royal Army Medical

Corps. Besides Denning, the small,

informal section included a Royal

Navy representative and Lt. Col.

Thomas J. Hartford, MC, Hawley's

executive officer. In September, after

Hartford went to 21 Army Group to

keep in touch with ground forces

medical planning, Lt. Col. John K.

Davis, MC, from the ETO Hospitalization Division, assumed the

7

 This account of the OVERLORD plan and its evolution is based on Harrison, Cross-Channel, pp. 47-

59, 63-79, 98-127, 158-73; text of the outline plan

is in Appendix A.


156 EUROPEAN THEATER OF OPERATIONS

COL. THOMAS J. HARTFORD

(Rank as of October 1943)

COSSAC post. Denning and Davis remained in the medical section when it

became part of SHAEF, with General

Kenner as chief medical officer. The

section stayed small under Kenner,

never including more than four officers, evenly divided between British

and Americans.

Under both COSSAC and SHAEF,

the medical section made no comprehensive plans for supporting the invasion. Instead, it drafted administrative

directives on certain inter-Allied and

interservice problems. The section established, for example, uniform casualty-estimation formulas for use by all

Allied planners, and it. set basic evacuation policy and decided upon the

principal means for cross-Channel

transport of wounded. As part of

SHAEF the section reviewed and reconciled the proliferating plans of subordinate headquarters. Most COSSAC

and SHAEF medical decisions in fact

represented a consensus between the

chiefs of the British and American

medical services, reached at frequent

formal and informal conferences.

Throughout the invasion planning the

American medics at COSSAC and

SHAEF drew upon General Hawley's

office for advice and information,

with the staff preparing most of their

studies and position papers.8

Detailed American medical planning for NEPTUNE, covering the invasion and the first ninety days of the

battle for France, began early in February 1944, after publication of the

SHAEF outline plans. Planning took

place within a complex logistics organization created to accommodate national control of supply to overall

British direction of NEPTUNE ground

operations. General Sir Bernard L.

Montgomery's 21 Army Group functioned as both tactical and administrative ground force headquarters for

the invasion. Subordinate to it, the

U.S. 1st Army Group and First Army

had logistical, as well as tactical, responsibility for the American troops

under them, but these commands did

not represent and could not control

the ETO Services of Supply. To give

the latter a voice in invasion planning,

as well as to form the skeleton of a

8

 For medical section activities, see Medical Division, COSSAC/SHAEF, War Diary, June 1943-May

1944; Interv, Medical History Branch, CMH, with

Maj. Gen. T. J. Hartford, MC, USA (Ret.) (hereafter

cited as Hartford Interv), 7-8 Oct 80, tape 1, side 1,

CMH; Davis Interv, 19 Jun 45, box 222, RG 112,

NARA.
PREPARATIONS FOR INVASION 157

continental logistics system, General

Eisenhower, as ETO commander,

early in February activated two new

headquarters: Advance Section, Communications Zone (ADSEC), and Forward Echelon, Communications Zone

(FECOMZ).

Each of these new headquarters

possessed immediate planning and

future operational functions. The Advance Section was attached to the

First Army, which had charge of all

tactical planning for the American

part of the amphibious assault and

also did logistics planning for the first

fifteen day on shore. Besides assisting

with army planning, ADSEC worked

out the details of SOS operations for

the period from the sixteenth through

the fortieth day after D-Day (D+16

through D+40). The Forward Echelon, at the outset an element of 21

Army Group headquarters, supervised

ADSEC planning and itself made SOS

plans for D+41 through D+90.

Operationally, ADSEC was to act as

the supply element of the First Army

until D+15, organizing the beach

behind the advancing troops. From

D+15 through D+40, after the army

established its rear boundary, ADSEC

would constitute the communications

zone under the supervision of 21

Army Group, exercised through the

Forward Echelon. FECOMZ itself was

to become active on D+41, when a

second U.S. army went into operation

and the 1st Army Group, hitherto

subordinate to 21 Army Group,

became a separate command directly

under SHAEF (see Chart 5). The Forward Echelon then would take command of the entire American support

area behind the armies (whether

under the U.S. army group or coordinate with it was never entirely settled). ADSEC at this point was to

revert to the status of a movable base

section under FECOMZ. The section

would follow close behind the armies

and link them to the Services of

Supply, relinquishing supply activities

nearer the shore to other base sections that would be formed as the

campaign progressed. Around D + 90

SHAEF and ETOUSA were expected

to move to France, whereupon

FECOMZ would merge back into the

ETO-SOS headquarters and General

Lee, as Eisenhower's deputy for logistics, would assume direct control of

all elements of the Services of

Supply—to be redesignated the Communications Zone (COMZ).9

Under this administrative arrangement the First Army surgeon, Colonel

Rogers, and his staff, working closely

with the surgeons of the two assault

corps, the V and VII, drew up medical support plans for the initial landing and the first two weeks of combat.

The ADSEC surgeon, Col. Charles H.

Beasley, MC, and the FECOMZ surgeon, Colonel Spruit, prepared plans

for establishing the medical portion

of the continental Communications

9

 The SOS underwent formal redesignation as

Communications Zone, ETOUSA, in GO No. 60,

HQ, ETOUSA, 7 Jun 44, but the term came into increasing use from the end of February, even on

SOS letterheads. COMZ will be used in this chapter

in discussing logistical and medical planning, but

SOS will be used in reference to operations until

the narrative reaches the actual activation of COMZ.

For a description of the convoluted logistics command system, see Ruppenthal, Logistical Support,

1:203-15 and 219-27. See also First U.S. Army

Report of Operations, 20 Oct 43-1 Aug 44, bk. I,

pp. 25-27; HQ, Forward Echelon, COMZ,

ETOUSA, Communications Zone Plan (hereafter

cited as FECOMZ Plan), 14 May 44, pp. 2-5, file

HD 370 ETO.


160 EUROPEAN THEATER OF OPERATIONS

Zone. Roger's First Army medical section had come over from the United

States with its parent headquarters

and had been in operation in London

and Bristol since October 1943, but

the ADSEC and FECOMZ surgeons'

staffs had to be improvised in haste

(see Charts 6 and 7). Of substantial

size—the ADSEC surgeon's office

eventually included forty-three officers and fifty-six enlisted men—these

organizations drew manpower from

casuals, base section headquarters,

and General Hawley's office. Colonel

Beasley, for example, had been surgeon of the Eastern Base Section; his

deputy, Col. James B. Mason, MC,

had served as Hawley's chief of operations; and Colonel Spruit had come

over to FECOMZ from running the

Cheltenham branch of the chief surgeon's establishment. Each of the

COMZ surgeons organized his office

into divisions paralleling those under

the chief surgeon. Spruit's office,

indeed, was for practical purposes an

advance echelon of Hawley's.10

While the First Army, ADSEC, and

FECOMZ surgeons drafted the NEPTUNE plans, many of the decisions incorporated in them came from other

headquarters. General Hawley,

charged with supervising all theater

medical planning, took part in establishing most major policies. His staff

furnished information to the army

and COMZ surgeons and wrote key

portions of their plans, including, for

instance, the basic army-navy agreement on division of cross-Channel

evacuation responsibility. Hawley's

office published its own standard operating procedure for medical service

on the Continent and oversaw base

section planning for support of the

embarking invasion forces and for receiving casualties from the far shore.

At SHAEF General Kenner kept in

close touch with ETO medical planning and intervened in selected aspects of it. Of the higher-level ETO

surgeons, Colonel Gorby of the 1st

Army Group, in accord with the

group's inactive role at this stage, had

the least to do with NEPTUNE planning. He confined himself to keeping

informed of First Army activities, assembling the medical portion of the

troop buildup schedule, and participating in SHAEF medical policy discussions.11

The NEPTUNE medical planners

made use of the data collected by

their ROUNDUP predecessors and

adopted many principles worked out

for the projected earlier invasion.

They also availed themselves of the

medical lessons learned in amphibious operations in North Africa, Sicily,

and Italy. The Fifth Army late in 1943

assembled many of these lessons into

10An. 9, COMZ Medical Plan (hereafter cited as

An. 9—Medical), p. 1, to FECOMZ Plan, 14 May 44,

file HD 370 ETO; An. 8—Medical, p. 4, to HQ,

ADSEC, COMZ, NEPTUNE Operation Plan D to

D+41 (hereafter cited as ADSEC Plan), 30 Apr 44,

file HD 370 ETO; Surg, ADSEC, COMZ, Annual

Rpt, 1944, pp. 1-5; Larkey "Hist," ch. 8, pp. 5-9;

Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 12.

11

 OofCSurg, HQ, ETOUSA, Standard Operating

Procedure for Medical Service in Continental Operations (hereafter cited as O/CS Continental SOP), 4

Apr 44, file 370.02. For activities of Hawley's office,

see annual reports of the Operations Division—especially Planning Branch, Evacuation Branch, Medical Intelligence Branch, Statistics and Requirements

Branch—and of the Hospitalization Division for

1944, as well as Middleton Interv, 1968-69, vol. 1,

p. 218, NLM. On Kenner's activities, see Medical

Division, COSSAC/SHAEF, War Diary, FebruaryMay 1944. On Gorby, see 12th Army Group Report

of Operations, vol. XIII (Medical Section), p. 7.
PREPARATIONS FOR INVASION 161

a manual for amphibious medical support, upon which the ETO planners

drew extensively. Besides using the

manual and other written reports,

some ETO medical officers visited the

neighboring theater for firsthand observation and conferences with army

and SOS surgeons. During the early

1944 planning period, Colonel Hartford of 21 Army Group, Colonel

Davis of SHAEF, Colonel Beasley of

ADSEC, and Colonel Darnall of Hawley's Hospitalization Division made

Mediterranean tours. Their visits, besides affording a change of climate,

produced useful information. Hartford, for example, confirmed from

Fifth Army experience the practicability of evacuating wounded over the

beaches early in amphibious assault

and brought back up-to-date estimates of whole blood transfusion requirements in combat surgery.12

NEPTUNE medical planning extended over about four months, with

the First Army plan appearing in late

February and those of ADSEC and

FECOMZ respectively on 30 April

and 14 May. These plans, while published separately, issued from a seamless process of discussion and negotiation so complex as to defy narration.

The three principal medical planning

staffs worked in constant consultation

with each other, with nonmedical

planners at their own headquarters,

and with the surgeons' staffs of

higher- and lower-command echelons.

They kept in close touch with Navy

and Air Force medical staffs and with

those of their British colleagues. The

ADSEC medical section had British

officers attached to it for planning. In

the end, as a result of this method of

working, the evolution of each plan

was shaped by the evolution of each

of the others. Together, the major

medical plans constituted a comprehensive blueprint for the NEPTUNE

campaign

 13

The NEPTUNE Campaign

The NEPTUNE plans covered the development of a continental medical

service from the time the first wave of

infantry hit the beaches through the

securing of the French lodgement

area. Essentially, the plans addressed

two problems: provision of support

for a strongly opposed amphibious

landing, and development of an army

and then a COMZ medical establishment—all to be done from a crowded

British base, across a narrow but

12

 For general contact between the theaters, see

Ruppenthal, Logistical Support, 1:331-35; Wiltse, Mediterranean, pp. 120-21, 142-43, 147-50, 223-26, and

267-68; 2d Lt Glen Clift, MAC, "Field Operations

of the Medical Department in the Mediterranean

Theater of Operations, U.S. Army" (Office of the

Surgeon, MTOUSA, 1945), pp. 146-74, file HD

314.7-2, which reproduces the Fifth Army manual;

Hartford Interv, 7-8 Oct 80, tape 1, side 1, CMH;

Memo, Col J. K. Davis, MC, to CMedOff, SHAEF,

sub: Abstract of Report on Visit to AFHQ, in Medical Division, COSSAC/SHAEF, War Diary, April

1944; HQ, ADSEC, Operations History of the Advance Section, COMZ, ETOUSA . . . , August 1945

(hereafter cited as ADSEC Hist), p. 4; Hospitalization Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 2-3.

13

 For chronology of planning, see Ruppenthal,

Logistical Support, 1:215-16 and 269; First U.S. Army

Report of Operations, 23 Oct 43-1 Aug 44, bk. VII,

p. 62; Surg, VII Corps, Annual Rpt, 1944, p. 12;

ADSEC Hist, pp. 13-14 and 23; Surg, ADSEC,

COMZ, Annual Rpt, 1944, pp. 1-6, 13, 15, 25, 31;

Capt G. B. Dowling, MC, USN, Special Report to

the Chief of the Bureau of Medicine and Surgery,

USN, of U.S. Naval Medicine Service in the Invasion

of Normandy . . . (hereafter cited as Normandy

Rpt), 11 Jan 45, pp. 2-4, which gives the Navy view

of medical planning.


164 EUROPEAN THEATER OF OPERATIONS

treacherous body of water, with limited shipping and port facilities.14

Support for the initial attack from

the sea required the most complex arrangements and caused the planners

the most controversy and soul-searching. The First Army tactical plan was

straightforward. On D-Day the V

Corps, with elements of the 1st and

29th Infantry Divisions, was to go

ashore on the army's left on OMAHA

beach, a stretch of Normandy coast

backed by low bluffs northwest of

Bayeaux. The VII Corps, with the 4th

Infantry Division, was to land on the

right on UTAH beach, near the base of

the eastern side of the Cotentin Peninsula. The 82d and 101st Airborne

Divisions, also under VII Corps, were

to drop before the main attack, to

secure crossings over the flooded

areas immediately behind UTAH. Logistical support for the seaborne

forces was to come from engineer

special brigades—two, forming a provisional brigade group, for OMAHA

and one for UTAH. These brigades

were to begin landing soon after the

first infantry elements. Assisted by

shore party battalions of Rear Adm.

Alan G. Kirk's Western Naval Task

Force, which was responsible for

transporting, landing, and supporting

the American invasion troops, the

special brigades would clear the

beaches of wreckage, mines, and obstacles; open roads; and establish

supply dumps. Their medical battalions would set up the first nondivisional medical facilities on the far

shore.15

For medical support planners the

number of casualties to be expected

on and immediately after D-Day was

the first crucial consideration. On this

point COSSAC and SHAEF for a long

time could not obtain agreement

among the concerned staffs, although

all expected losses to be very heavy.

Different headquarters held to various

estimates until February 1944, when

General Kenner assembled the chief

medical officers of the major invasion

commands to reach a common figure

"to establish our position for General

Eisenhower." The conferees, after

much debate, decided to assume for

planning purposes that the assault

force would suffer 12 percent wounded on D-Day and 6.5 percent on D+1

and D+2, with a declining proportion

thereafter. Using this ratio, First

Army surgeons had to think in terms

of treating or evacuating over 7,200

wounded on D-Day and another

7,800 in the next forty-eight hours, of

whom about 3 percent—at least

450—would be too severely injured to

14

 Unless otherwise noted, the following discussion is based on An. 6, Medical Plan (hereafter cited

as An. 6—Medical), to First U.S. Army Operations

Plan, Operation NEPTUNE (hereafter cited as

FUSA Plan), 25 Feb 44; An. 8—Medical to ADSEC

Plan, 30 Apr 44; and An. 9—Medical to FECOMZ

Plan, 14 May 44. All in file HD 370 ETO. See also

O/CS Continental SOP, 4 Apr 44, file 370.02. Additional sources are cited where appropriate.

15

 For the assault plan, see First U.S. Army Report

of Operations, 20 Oct 43-1 Aug 44, bk. 1, p. 26;

Harrison, Cross-Channel, pp. 174-97; and Ruppenthal, Logistical Support, 1:178, 269-70, 282-85,

324-44. Each engineer special brigade employed in

NEPTUNE consisted of 1 medical and 3 engineer battalions, a DUKW battalion, and various small signal,

military police, and quartermaster elements. The

brigade group on OMAHA also included the 11th

Port, to operate the MULBERRY artificial harbor. Special brigades could break down into battalion- or

company-size composite beach groups to support

regimental or battalion combat teams. The Western

Naval Task Force, also designated by the U.S. Navy

as Task Force 122, was the U.S. component of the

Allied Naval Expeditionary Force, the overall naval

command under SHAEF.
PREPARATIONS FOR INVASION 165

be transported any distance without

definitive surgery. Even these estimates, the planners realized, were uncertain. Kenner noted: "If gas should

be used, then these figures go by the

board."

 16

On the basis of these estimates

COSSAC, SHAEF, and army planners

confronted the same problem of care

and evacuation during the first days

of the invasion that had preoccupied

their ROUNDUP predecessors.

COSSAC early reaffirmed the ROUNDUP decision to evacuate from the

beaches to England all but the most

lightly wounded and, conversely,

those needing immediate surgery to

keep them alive. COSSAC also reiterated the ROUNDUP staffs conclusion

that most casualties must go out in

returning landing craft. Unlike the

earlier planners, those at COSSAC

and SHAEF had available a vessel

suited to their requirements: the LST

(landing ship, tank), which had come

into service since the end of ROUNDUP. This 330-foot oceangoing craft,

designed to disembark tanks and

other heavy vehicles directly onto a

beach, also could embark large numbers of casualties in a comparatively

short time through its bow doors and

ramp, which could accommodate ambulances, litter-carrying jeeps, and a

newly introduced amphibian truck,

the DUKW. The latter vehicle also

could swim out to and board an LST

offshore. Within the ship the cavernous tank deck, extending the width

and most of the length of the LST,

could hold up to 300 litters, either

fastened to bulkhead racks or lashed

to the deck surface. When not transferred from vehicles directly onto the

tank deck, casualties could be hoisted

on board in small craft or on individual stretchers. The ship's upper decks

and crew's quarters could hold 300

additional walking wounded. Any LST

could be fitted for evacuation, and

could accommodate a small emergency surgical facility, without reducing

its ability to perform its main task of

landing combat vehicles.

On 16 July 1943, at a conference

attended by General Hawley and

General Hood, the British Army medical chief, COSSAC adopted the LST

as its principal evacuation craft. Reinforcing this decision, General Marshall directed in October that all

cross-Channel movement of American

wounded "will be handled in properly

equipped combat LST[s]."

 17

 The

U.S. Navy, which had charge of providing LSTs for the invasion, agreed

to modify for casualty carrying 83 of

the 98 ships allocated to the American forces and 70 of the 113 assigned

to the British. After he became

SHAEF's chief medical officer, General Kenner endorsed these arrangements. He directed medical planners

to assume that only 75 litter and 75

16

 Quotations from MFR, Medical Section,

SHAEF, sub: Meeting Held 26 Feb 44 in Gen Kenner's Office re Casualty Estimates for Operation

OVERLORD, in Medical Division, COSSAC/SHAEF,

War Diary, February 1944. See also VII Corps NEPTUNE Assault Plan and Medical Plan (hereafter

cited as VII Corps Medical Plan), which gives corpslevel casualty estimates using the SHAEF formula,

encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Dowling, Normandy Rpt, 11 Jan 45, p. 9. The OMAHA

and UTAH assault forces included about 60,000 men,

with an assault-loaded follow-up of 26,500 for

OMAHA and further preloaded buildup of 43,500 for

both beaches. See Ruppenthal, Logistical Support,

1:298.

17

 Msg, Marshall to Gen Devers, 30 Oct 43, in

Medical Division, COSSAC/SHAEF, War Diary,

February 1944.
166 EUROPEAN THEATER OF OPERATIONS

LSTs READYING FOR THE INVASION

walking patients would be moved on

each voyage of an LST, to allow for

the fact that few ships would be able

to stay near the beach long enough to

load to full capacity. If practicable, of

course, the vessels were to take on

more than this minimum.

To provide emergency surgery for

casualties taken on board directly

from clearing stations during the first

days of the attack, the Western Naval

Task Force surgeon, Capt. George B.

Dowling, MC, planned to put two

medical officers and twenty hospital

corpsmen on each of his task force's

LSTs. Because few of these Navy

medical officers were experienced

surgeons, General Hawley agreed to

reinforce each LST medical complement with an Army surgical team of

one officer and two enlisted technicians. To place still more emergency

surgery capacity near the beaches,

Kenner assigned 5 hospital carriers

each to the British and American

forces. These ships were to carry

additional medical personnel and supplies to France and then embark patients requiring extensive early

surgery.18

18

 Hawley Planning Directive No. 11, 21 Jul 43,

box 2, Hawley Papers, MHI; Extract from Record of

Meeting of Principal Staff Officers Held on 16 Jul

43, 20 Jul 43, in Medical Division, COSSAC/

SHAEF, War Diary, February 1944; COSSAC

Admin Instruction No. 8, 22 Dec 43, in ibid., DeContinued
PREPARATIONS FOR INVASION 167

COSSAC and SHAEF based their

evacuation plans on the LST reluctantly and in the face of much doubt

about the feasibility of the whole

system for removing wounded from

the beaches. The doubters included

General Hood. After inspecting an

LST at Portsmouth, Hood called the

vessel a "cold, dirty trap" for injured

men. He carried unavailing protests

against its use all the way to Churchill's War Cabinet. Colonel Cutler considered LSTs "rotten ships for care of

wounded American boys," an opinion

shared by many of his colleagues. The

objectors had reason for concern.

When emptied of their vehicular cargoes, LSTs rolled deeply in all but

the calmest seas, creating, to say the

least, an unstable platform for surgery. With any kind of sea running,

DUKWs could not swim out to an

LST and negotiate its ramp. Most important, as combatant vessels carrying

troops and weapons outward bound,

LSTs could not be protected with the

Red Cross and were legitimate attack

targets. If one foundered for any

reason, the litter patients on board inevitably would go down with it.

Kenner and Hawley shared their colleagues' uneasiness about the LST,

Kenner calling use of the vessels "an

improvised method of removing casualties forced upon the Medical Service

by operational necessity." Nevertheless, they had to override all objections to employment of the LST, for

it was the only available means of

large-scale cross-Channel evacuation.

They took comfort from the fact that

LSTs had performed well in evacuation in the Pacific and could only

hope that weather severe enough to

prevent the loading of wounded on

LSTs also would prevent the entire

invasion.19

Until D-Day Allied medical planners considered their evacuation

system a fragile structure, dependent

for success on many uncontrollable

variables. Kenner, in particular,

feared that a "back-log" of unevacuated, untreated wounded would accumulate on the beaches, with demoralizing impact on the combat troops.

He warned:

The whole medical situation during the

first few days hinges on two unknown factors, namely weather and the number of

casualties. If both are in our favor then

evacuation will be satisfactory. If weather

is good and casualties heavy or if weather

is bad and casualties light, the medical

situation while becoming serious will

probably remain under control. But if the

weather is bad and the casualties heavy

then it will be impossible to meet the situation either by local treatment or by

cember 1943; Memo, Kenner to ACofS, G-4,

SHAEF, 25 Apr 44, sub: Casualty Lift of Converted

LSTs, in ibid., April 1944. See also diary entries and

correspondence for September and November 1943

and March 1944. On LST technical details, see

Davis Interv, 19 Jun 45, pp. 2-3, box 222, RG 112,

NARA; Crew, AMS, Campaigns: North-West Europe,

4:49-52; and Dowling, Normandy Rpt, 11 Jan 45,

pp. 4-5, E-8, E-9, E-13. On LST surgeons, see

Larkey "Hist," ch. 8, pp. 30-31, and correspondence in file HD 705 ETO (Medical Care on LSTs,

1944).

19

 Hood words as quoted in MFR, Col Cutler, 28

Feb 44, sub: Visit and Inspection of an LST at

Portsmouth . . . , 21 Feb 44, file HD 705 ETO

(Medical Care on LSTs 1944). Cutler quotation

from Carter, ed., Surgical Consultants, 2:184. Kenner

quotation from his memorandum of 6 Mar 44, in

Medical Division, COSSAC/SHAEF, War Diary,

March 1944; see also other entries and documents

for this month. Crew, AMS, Campaigns: North-West

Europe, 4:52-55, recounts Hood's appeal to the War

Cabinet. See also Hartford Interv, 7-8 Oct 80, tape

1, side 1, CMH, and Davis Interv, 19 Jun 45, box

222, RG 112, NARA.
168 EUROPEAN THEATER OF OPERATIONS

evacuation and a serious medical break- down must inevitably occur.20

Colonel Rogers and his staff built

their First Army medical support

plans around the basic COSSAC- SHAEF evacuation decisions and attempted to provide against a breakdown of seaward evacuation. To this

end Colonel Rogers arranged to reinforce each assault division medical

battalion with an additional collecting

company, to be landed as soon as

possible after D-Day, and to attach six

teams from the army's auxiliary surgical group to the clearing company of

each engineer special brigade medical

battalion. So augmented, these

units—the only hospitals on shore

during the first twenty-four hours or

so of combat—would be able to care

for a substantial number of severely

wounded. On D-Day company aidmen

and battalion medical sections were to

go in with the first infantry waves, followed in close sequence by Navy

shore party medical sections (one officer and eight hospital corpsmen per

army battalion), division collecting

companies, the engineer special brigade medical battalions, and the division clearing companies. This interlacing of division and special brigade

elements, based on Mediterranean

practice, would permit the division

medical service to move inland at

once and begin regular operations,

leaving the shore party and special

brigade medical units, in static beach

positions, to collect wounded who fell

in the first attack, to evacuate division

medical installations, to set up emergency surgical hospitals, and to load

all movable casualties on LSTs and

other landing craft (Diagram 1). The

beach medical elements also were to

evacuate and support the airborne divisions, as soon as the seaborne

forces made contact with them. Until

then the airborne medical companies,

landing by parachute or glider with

attached surgical teams soon after the

infantry touched down, would collect

and treat all paratrooper wounded.21

After the assault and the securing

of the beachhead, American reinforcements were to pour in, over

OMAHA and UTAH beaches and later

through Cherbourg and other captured ports, bringing U.S. strength on

the Continent to over 1 million by

D+90. The First Army and 1st Army

Group before D-Day established a

consolidated movement schedule for

this buildup, detailing the size and

shipping requirements of each unit,

its date and place of embarkation, and

its destination and assignment on the

far shore. They divided each day's

sealift among ground, air, and service

forces so as to maintain a balanced

flow of combat and support elements.

Medical units were interspersed

throughout the schedule, on the basis

of priorities developed by the First

Army, ADSEC, and FECOMZ surgeons and worked into the troop list

after tortuous negotiations with all

the other forces vying for space (see

Table 3). The First Army's nondivisional medical units were to go in

20

 Ltr, Kenner to Lt Gen Sir Humphrey Gale, 29

Feb 44, in Medical Division, COSSAC/SHAEF, War

Diary, February 1944.

21

 VII Corps Medical Plan, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 8; Dowling, Normandy

Rpt, 11 Jan 45, p. 8; Surg, 82d Airborne Division,

Annual Rpt, 1944, an. 1; Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 1-2; Editorial Advisory

Board, 1962, pp. 70-71, 100-101, 112.
PREPARATIONS FOR INVASION 169

DIAGRAM 1—INFANTRY DIVISION LANDING PHASE EVACUATION PLAN

Source: Surg, 1st Infantry Division, Annual Rpt, 1944, p. 8a.

first, between D-Day and D+15, with

field hospitals, auxiliary surgical

teams, and the corps medical battalions leading. Evacuation hospitals

were to follow, beginning on D+5,

along with army medical battalions

(separate) and groups, a supply depot

company, a convalescent hospital, a

laboratory unit, and a gas treatment

battalion. A few ADSEC units were to

be interspersed with those of the First

Army, but most would arrive after

D+12. The first scheduled to come

were additional ambulance companies

and evacuation and field hospitals, intended to function as station hospitals

and holding units. On or about

D+15 the first general hospital in

France, the 298th, was to disembark

and go into operation in Cherbourg.

By D+90 both the Advance Section

and Forward Echelon expected to

have twenty-five general hospitals on

the Continent, at preassigned locations in Normandy and Brittany, besides a full complement of supply

depots and other COMZ medical

units.22

Medical supplies in large quantities

were to start arriving on the beaches

as soon as the troops did. All First

Army combat and support units land22

 In addition to the basic plans previously cited,

see Surg, VII Corps, Annual Rpt, 1944, pp. 3-4 and

6-7. Memo, Surg, FECOMZ, to G-4, FECOMZ, 6

Apr 44, file HD 370 (HQ. ADSEC Plans and Corresp, 1944); Larkey "Hist," ch. 8, app. 4.
170 EUROPEAN THEATER OF OPERATIONS

TABLE 3—PLANNED LANDING OF MEDICAL UNITS, 6-14 JUNE 1944

a

 Small portion of troop buildup schedule, exclusive of brigade and corps units.

Source: First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. II, an. 2, pp. 60-61.

ing on D-Day and the following 3

days were to carry reserves of rapidly

consumable items, in the hands and

on the backs of soldiers and loaded

into vehicles. Each infantry, artillery,

chemical warfare, engineer, and

ranger battalion; each divisional collecting and clearing company; and

each engineer special brigade medical

battalion was to receive a special allowance of dressings, small implements, drugs, morphine, and dried

plasma packed in waterproof containers portable by a single man. Each organization also would bring ashore

extra litters, field medical chests,

splints, and blankets. In the Advance

Section mobile hospitals were to

embark with reserves of expendable

supplies sufficient for 10 days of operations; other medical units were to

carry 3-day reserves.

Medical maintenance supplies were

to be shipped automatically from the

United Kingdom during the first 90

days of continental operations. Before

D-Day the First Army, Advance Section, and Forward Echelon submitted

requisitions to the chief surgeon's

Supply Division for their periods of

primary logistical responsibility, with

allowances calculated to replace lost

and consumed matériel and to establish 14- or 21-day reserves (depending on the echelon and the class of

supplies) in army and COMZ depots

by D+90. The supplies so requested

were to be packed before the assault

and loaded on ships on a daily schedule as the buildup proceeded.

From D-Day until about D+40

most maintenance supplies would

consist of special division assault surgical and medical units, designed by

the First Army and assembled by the

Supply Division. Each of these units

included dressings, drugs, and equipment for treating 500 casualties and

was divided into 100-pound waterproof packages for easy, safe movement and storage. To ensure arrival
PREPARATIONS FOR INVASION 171

of enough supplies on the beaches

while the casualty rate was highest,

the Supply Division based its scheduled shipments of these units on estimated numbers of wounded, rather

than on total troop strength, as was

the practice with regular medical

maintenance units (which were not

adapted to the assault situation in any

case). As the buildup continued,

standard 10,000-men-for-30-days

maintenance units were to supplant

the special ones. When enough depot

companies reached France, the armies

and the Communications Zone were

to establish regular distribution procedures, with division medical supply

officers drawing on army depots that

those of the Advance Section would

replenish. Whole blood, biologicals,

and penicillin were to reach the front

through special channels, delivered by

the theater blood service.23

Hospitalization and evacuation in

France were to evolve as the manpower and supply buildups progressed,

with the aim throughout being to

retain as many patients as possible on

the Continent. From D-Day until

about D+18 the First Army was to

send back to England all sick and

wounded except nontransportables

(defined as men with severe abdominal, chest, and head injuries and compound fractures) and casualties who

could be treated and returned to duty

from division facilities. As First Army

hospitals went into operation, the

forces in France, at the army commander's direction, were to shift to a

7-day evacuation policy. Once COMZ

fixed hospitals became available, the

Advance Section was to evacuate to

them from the armies casualties returnable to duty within 15 days, to be

extended progressively to 30 days as

still more hospitals arrived. Soldiers

needing longer hospitalization, or eligible for return to the United States

under the 180-day theater policy,

were to go directly from army installations to hospitals in England.

Following the principles established

by COSSAC, the NEPTUNE plans

called for evacuation of wounded

over the beaches during and after the

assault, and for their transportation to

Britain in LSTs and, after the first day

or so, in hospital carriers. When the

Allies captured and reopened Cherbourg, the Americans were to use that

port, in addition to the beaches, for

evacuation to the United Kingdom.

U.S. hospital ships, eleven of which

were expected to reach the European

Theater between 29 May and 12

August, also would load wounded at

Cherbourg for direct evacuation to

the United States. Air evacuation to

Britain, from both the field armies

and the Communications Zone, was

to begin as soon as the ground forces

secured airstrips usable by the C-47s

of the IX Troop Carrier Command.

For overland movement or patients,

the NEPTUNE plans provided for improvisation of hospital trains from

captured rolling stock, but the armies

and COMZ were to rely primarily on

ambulances and, in emergencies, on

trucks and jeeps, until about D+56.

At that time hospital trains constructed in England were expected to begin

23

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 74-75; Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec.

IV, pp. 5-6, and sec. VI, pp. 5 and 7-8; Planning

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 8-9; Interv, OSG

with Col B. C. T. Fenton, MC, 7 Jun 45, box 222,

RG 112, NARA.
172 EUROPEAN THEATER OF OPERATIONS

rolling off ships at ports and beaches.24

The NEPTUNE planners concerned

themselves with keeping the troops

on the Continent healthy, as well as

with treating them when sick and injured. Army and COMZ preventive

medicine plans, based on information

collected and collated by the chief

surgeon's Medical Intelligence

Branch, assessed the state of public

health in occupied France and listed

the likely major disease threats on the

Continent. Troop commanders in

France, the plans warned, could

expect to find an ill-nourished, dirty

civilian population whose hospitals

and public health agencies were operating inefficiently because the occupying Germans had stripped them of

much equipment and personnel.

French water purification and sewage

disposal facilities, never the best,

could be assumed to have broken

down under administrative neglect

and combat damage.

Compared to what the Army faced

in the Mediterranean, the Southwest

Pacific, and other non-European tropical theaters, disease in northwestern

Europe posed hardly any threat to the

conduct of operations. Epidemic

louse-borne typhus, which the planners considered likely to be introduced from eastern Europe by

German troops and slave laborers,

loomed as the disease of most potential danger. Commanders and surgeons also would have to guard

against typhoid, but such familiar diseases of troops in the field as dysentery, diarrhea, influenza, venereal diseases, and infectious hepatitis, as well

as a variety of skin ailments and

vermin infestations, were likely to

constitute the campaign's principal

medical problems. Even though

American troops had already been

immunized against typhus, the field

armies and the Communications Zone

planned to issue insecticide powder

to their troops and prepared for mass

inspection and delousing of soldiers,

civilians, and prisoners of war. NEPTUNE plans for combating other diseases depended on the standard immunizations, personal hygiene, mass

sanitation, water treatment, sewage

disposal, and pest eradication procedures, as well as on special supervision of soldier eating habits to prevent vitamin deficiencies among men

subsisting for long periods on C- and

K-rations.25

Preventive medicine planners expected venereal diseases, the incidence of which reportedly had increased threefold in France since

1941, to constitute "one of the most

difficult control problems to be encountered." First Army and COMZ

plans, backed up by a theater circular

drafted by Colonel Gordon's Preventive Medicine Division in cooperation

with the senior medical consultants 24

 Memo, Kenner to ACofS, G-4, SHAEF, 13 Apr

44; see also Mins, Conference of Gen Kenner with

Brig Gen Grow, 11 Apr 44. Both in Medical Division, COSSAC/SHAEF, War Diary, April 1944. For

a definition of nontransportables, see Ltr, Col E. C.

Cutler to Lt Col Crisler, 16 Apr 44, box 3, Hawley

Papers, MHI. See also Memo, Col F. H. Mowrey to

Movements Division, Office of CofTrans, ETO, 29

May 44, EvacCorresp, 1942-45, file HD 024 ETO.

25

 For medical intelligence, see Medical Intelligence Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 2-3, and Ltr,

Hawley to TSG, 29 May 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp). See also Cir Ltr No. 53,

OofCSurg, HQ, ETOUSA, 8 Apr 44, sub: Improvement of Nutrition of Combat Troops, in Larkey

"Hist," ch. 8, app. 17.
PREPARATIONS FOR INVASION 173

and command venereal disease control officers, prescribed essentially the

same precautions tested and proven

in the United Kingdom: troop education, provision of healthful recreation,

widespread issue of condoms and VPackettes (even embarking assault

troops were to be offered them), establishment of prophylactic stations,

and—as far as language and local law

and custom permitted—tracing of

contacts. Repression of prostitution

received special emphasis. In contrast

to the unorganized, barely tolerated

character of the business in Great

Britain, continental prostitution was

an accepted, legally regulated and

sanctioned social institution, featuring

numerous brothels. War Department

policy, confirmed by practical experience in North Africa, Sicily, and Italy,

ruled out any official Army attempt to

license and regulate such establishments. Hence, ETO preventive medicine officers and medical consultants

inserted in NEPTUNE plans and the

theater circular a strongly worded

policy statement:

The practice of prostitution is contrary to

the best principle[s] of public health and

harmful to the health, morale and effi- ciency of troops. No member of this com- mand will, directly or indirectly, condone

prostitution, aid in or condone the estab- lishment or maintenance of brothels, bor- dellos or similar establishments, or in any

way supervise prostitutes in the practice

of their profession or examine them for

purpose of licensure or certification. Every member of this command will use

all available measures to repress prostitu- tion in areas in which troops of the com- mand are quartered or through which

they may pass.26

The NEPTUNE medical planners

sought to anticipate and outline a solution for every foreseeable actual or

potential problem. To keep seasickness from taking the fight out of the

assault troops before they went

ashore, the First Army prepared to

issue newly developed antimotion

sickness capsules—ten of them to be

taken on a fixed schedule—to each

embarking soldier, even though tests

of the remedy in amphibious exercises had produced at best inconclusive results. Medical precautions

against the threat of German gas attacks included intensive training for

all troops in first aid for chemical

warfare casualties and the issue of eye

ointments and impregnated protective

clothing. The various medical plans

set policies and procedures for treating civilian sick and injured in Army

hospitals (to be done only when necessary to save life), caring for and

processing Allied casualties in the

American evacuation chain, treating

and evacuating wounded prisoners of

war, and disposing of captured medical supplies. In detail and comprehensiveness the medical plans

matched those for other aspects of

NEPTUNE. They also shared in the essential rigidity of the overall plan,

based as it was on the assumption

that Allied forces would push the

Germans back at a fairly steady pace.

A radical slowdown or a radical acceleration of Allied progress would require complicated, difficult adjust26

 First quotation from An. 6—Medical to FUSA

Plan, 25 Feb 44, file HD 370 ETO. Second quotation from Cir No. 49, HQ, ETO, 2 May 44, in

Larkey "Hist," ch. 8, app. 19. See also Preventive

Medicine Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 44-45; Middleton Interv,

1968-69, vol. 1, pp. 236-38, NLM. For North African and Italian experience, see Wiltse, Mediterranean,

pp. 215, 257-58, 354.
174 EUROPEAN THEATER OF OPERATIONS

GAS DECONTAMINATION EQUIPMENT, stockpiled at Thatcham supply depot as a precaution

against a German gas attack

ments throughout the elaborate medical support system.27

Technical Aspects

Even before the OVERLORD and

NEPTUNE plans took definite shape,

General Hawley and his staff began

searching for solutions to a variety of

technical problems connected with

the invasion. The chief surgeon and

his assistants paid special attention to

three problems: providing whole

blood to forward medical units, drafting guidelines for combat zone surgical practice, and devising a system for

sheltering fixed hospitals on the Continent.

The Blood Program

U.S. Army surgeons in the European Theater learned from British experience in the Western Desert, and

from early American operations in

North Africa and Sicily, that whole

blood—while highly perishable and

difficult to store and transport—was

indispensable for controlling shock in

severely wounded soldiers. Blood, administered as far forward as possible

in the evacuation chain, saved lives

27

 For the motion sickness preventive, see Medical

Consultation Service sec., Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

p. 15 and apps. J, K, and L; and Planning Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, encl. 6. For antigas precautions,

see Gas Casualty Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, and Memo, Col. C. B.

Spruit to G-2/G-3, FECOMZ, 23 Mar 44, file HD

370 (HQADSEC Plans and Corresp, 1944).
PREPARATIONS FOR INVASION 175

that plasma alone could not. In response to this growing weight of evidence General Hawley in July 1943

decided to establish an ETO whole

blood service, modeled on the highly

successful British Army Transfusion

Service.

The American blood bank took

shape during late 1943 and early

1944, planned and supervised by an

ad hoc committee headed by Colonel

Mason, then chief of the Operations

Division, and including Colonels

Cutler and Middleton, the commander of the 1st Medical General Laboratory, and the chief of the Supply Division. No T/O blood bank unit existed, so General Hawley improvised

one. He reorganized the 250-bed

152d Station Hospital into a base

depot, located at the 1st Medical General Laboratory at Salisbury, and

mobile advance depots—two for the

Communications Zone and two for

the armies. The base depot was to

collect type O blood (the only kind

used) from volunteer SOS donors,

process it, and prepare it for daily

shipment to France, where the advance depots, using truck-mounted

refrigerators, would distribute it as far

forward as the field hospital platoons

attached to division clearing stations.

Equipment for the units came from

the United States, under a special

project for continental operations

(PROCO), and from the British, who

furnished indispensable refrigerators,

as well as bottles, tubing, and needles

for bleeding and transfusion. By midApril 1944 the blood bank, under the

overall command of the 1st Medical

General Laboratory and with Maj.

Robert C. Hardin, MC, in immediate

charge as executive officer, had secured most of its equipment and finished organizing and training the 11

officers and 143 enlisted men of its

base, COMZ, and army depots. General Hawley meanwhile secured from

the theater top priority for shipments

of blood to France and from the

Ninth Air Force a guarantee of daily

space on aircraft.28

As the invasion approached, the

ETO blood service faced a prospective supply shortage. Since whole

blood could be stored for a maximum

of fourteen days, the theater required

a reliable flow of new blood about

equal to the expected usage rate in

the field, a rate which Colonel

Mason's committee, applying the British planning ratio of 1 pint of blood

for each 8-10 wounded, estimated as

averaging about 200 pints per day

during the first three months of

combat. This amount was safely

within the ETO blood bank's 600-

pints-per-day collection and processing capacity. Even as the bank prepared for operations, however, the

medical service, on the basis of reports from the Fifth Army in Italy, increased its estimate of requirements

to 1 pint for every 2.2 casualties.

28

 For development of the concepts of shock and

transfusion, see Douglas B. Kendrick, Blood Program

in World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army,

1964), pp. ix, 15-17, 30-60, 459, 469-500, 508-12.

For development of the ETO blood bank, see file

742 ETO General File (Blood Program). See also

Professional Services Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1943, p. 8; James B. Mason,

"Planning for the ETO Blood Bank," The Military

Surgeon 102 (June 1948): 460-68; O/CS Continental

SOP, 4 Apr 44, pp. 29-32, file HD 370.02. PROCO

was an Army Service Forces system for tailoring

equipment for particular tasks not covered by ordinary unit allowances or T/E. See Ruppenthal, Logistical Support, 1:260-61.
176 EUROPEAN THEATER OF OPERATIONS

On this basis the blood bank, working at full capacity, would not be able

to keep up with daily demands, and it

became apparent that, even if collection and processing could be increased, the supply of raw material in

the theater could not. When General

Lee issued the planned call for volunteer donors early in 1944, response

from the Services of Supply was disappointing. By mid-April the base

sections, in spite of exhortations from

Lee and Hawley, had enrolled only

35,000 of 80,000 potential type O

donors. As early as May 1943 Colonel

Cutler and Major Hardin had suggested flying in blood from the United

States, but Surgeon General Kirk,

until well after D-Day, vetoed this

proposal. His staff underestimated the

need for whole blood in field surgery

and doubted the feasibility of transporting the perishable substance

across the ocean. From the available

donors the ETO blood bank, by starting collection well in advance and

storing blood up to the maximum

safe limit, could meet immediate invasion requirements. But, as the campaign expanded and the limited SOS

donor pool diminished with the

movement of service troops to

France, the blood supply at some

point would fall short of need unless

the theater could find an additional

source. On D-Day, such a source still

was not in sight.29

The Surgical Program

The effort of General Hawley and

his consultants to define uniform surgical practice for each step in the

evacuation process had more satisfactory and definite results. During 1942

Colonel Cutler and the surgical consultants began rewriting War Department Technical Manual 8-210, Guides

to Therapy for Medical Officers, to simplify it and make it more useful to surgeons in the field. Finished late in

1943, the resulting ETO Manual of

Therapy, published as a pocket-sized

booklet, reached medical officers

before D-Day. Of the manual's three

sections, two dealt with surgery in

clearing stations and evacuation and

fixed hospitals. Written in short,

simple sentences, these sections concentrated on specific treatment of

particular types of injury at each point

in the evacuation chain and omitted

lengthy expositions of theory. Generally, the manual emphasized the need

to avoid definitive surgery in the forward areas, unless absolutely necessary to save life. The third section of

the manual covered basic medical

emergencies, from poisoning to

neuropsychiatric disabilities. This

manual, supplemented on 15 May

1944 by an ETO circular on "Principles of Surgical Management in the

Care of Battle Casualties," which reiterated many of the same policies,

constituted a concise practical guide

for surgeons fresh from civilian practice and usually inexperienced at

29

 See file 742 ETO General File (Blood Program); Professional Services Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, pp. 5-6. Hawley

Interv, 1962, pp. 43-44, CMH, recalls the disbelief

with which the ETO surgeons greeted initial reports

on blood use in Italy. For the policies of the Office

of the Surgeon General, see Kendrick, Blood Program, pp. 476-84, 524-26, 530; Editorial Advisory

Board, 1962, pp. 108-09; and Memo, Lt Col B. N.

Carter to Gen Hillman, 28 Oct 43, sub: ETMD,

ETO, and Ltr, Carter to Col E. C. Cutler, 4 Nov 43,

both in file HD 024 ETO O/CS (Hawley-SGO Corresp).
PREPARATIONS FOR INVASION 177

treating severe injuries in primitive facilities under pressure of time.30

The Expeditionary Hospital

General Hawley's staff early took

up the problem of housing general

and station hospitals on the Continent, where they had to assume that

the battle would leave behind few

readily usable buildings. In late 1943,

after almost a year of work, the Hospitalization Division and the ETO

Office of the Chief of Engineers completed draft plans for an expeditionary tented-hutted hospital. Designed

to house a 1,000-bed general or 750-

bed station hospital, this standardized

installation was to consist initially of

tents on concrete bases, on a site improved with paved roads and with

water, sewer, and power lines. Each

tent was to have space beside it for a

parallel hut, which the Engineers

were to erect during hospital operations as circumstances permitted.

Passing through several stages of development, from completely tented

to completely hutted, an expeditionary hospital was supposed to be

able to accommodate its full capacity

of patients at each stage, even as construction and the transfer of facilities

from under canvas to under roofs

went on.

In October 1943, to test the newly

completed plan, the Services of

Supply sent the 12th Evacuation Hospital to Carmarthen, Wales, to erect

and operate an expeditionary 750-bed

station hospital serving troops in that

area. The unit, and an Engineer company, arrived on the site, deliberately

selected for unsuitability, early in November. In spite of rain, snow, obstructing hedgerows, and poorly

drained marshy ground, the hospital

unit and its supporting engineers had

the plant in tented operation before

the end of the year. The hospital was

well into the hutted stage in March

1944, when the 12th turned it over to

a station hospital unit. In March the

Hospitalization Division issued a

manual with construction specifications for the expeditionary hospital,

incorporating lessons learned at Carmarthen. The system proved its worth

even before the invasion, as the Services of Supply used it to set up several temporary plants needed to increase fixed bed capacity or receive

casualties from France.31

Readying Medical Supply

As invasion planning neared completion, General Hawley viewed with

increasing alarm one key element of

his establishment: medical supply.

Throughout the renewed BOLERO 30

 ETO, Manual of Therapy, 5 May 44, file Manual

of Therapy, ETO, box 405, RG 112, NARA. For

comparison, see War Department Technical Manual

8-210, Guides to Therapy for Medical Officers, 20 Mar

42, For the 15 May 44 circular, see Canter, ed., Surgical Consultants, 2:168-73 and app. B, p. 963. See

also Hawley Interv, 1962, pp. 57-61, CMH; Ltrs,

Col E. C. Cutler to Lt Col N. B. Carter, 5 Oct and

15 Nov 43, and Carter to Cutler, 30 Sep and 26 Oct

43, in file HD 024 ETO O/CS (Hawley-SGO Corresp).

31

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpts, 1943, pp. 3-5, and 1944,

pp. 5-6; 12th Evacuation Hospital Annual Rpt,

1944, pp. 1-4; Spruit Diary, 7 Jul 43. See also

Memo, Hospitalization Division to CSurg, ETO,

22 Jan 43; Memos, Hospitalization Division to

DepCSurg (Cheltenham), 24 and 30 Jun 43; and

Memo, Col J. R. Darnall to DepCSurg (Cheltenham), 8 Jul 43. All in HospDivGenCorresp, 1943,

file HD 312 ETO.
178 EUROPEAN THEATER OF OPERATIONS

EXPEDITIONARY HOSPITAL AT CARMARTHEN

buildup persistent shortages and administrative deficiencies had made it

difficult for the supply service even to

support the troops in Britain. The

Supply Division of the chief surgeon's

office lacked qualified manpower and

leadership to meet its expanding responsibilities, and the flow of matériel

from American and British sources

encountered diversions and dams at

many points. By early 1944 both General Hawley and Surgeon General

Kirk had been forced to realize that,

unless drastically reorganized and reinforced, the medical supply service

would fail in its effort to support the

coming offensive.

The Supply Division during 1942

had been the weakest element in

ETO medical administration; it improved only marginally in 1943. In

March Col. Walter L. Perry, MC, arrived to take over the division, replacing the third in a series of unsatisfactory chiefs. General Hawley welcomed

Perry, whom the surgeon general had

picked for the position and who was

experienced in depot operations, and

gave him a free hand in reorganizing

the supply system. Perry, however,

like his predecessors, found the job

too much for him. Most of his difficulties stemmed from a lack of

trained men. Although his Cheltenham staff doubled during the year,
PREPARATIONS FOR INVASION 179

from 8 to 16 officers and from 13 to

47 enlisted men, the size of the task

grew even more rapidly, and few of

the additional personnel possessed

the specialized training needed to

manage what was, in effect, a home

base rather than a field supply service. Perry also lacked direct access to

General Hawley after the latter

moved to London in May. Instead,

the supply chief had to communicate

through Colonel Spruit, the deputy

chief surgeon at Cheltenham, a circumstance which reduced Perry's

ability to call attention to his requirements. Repeated Supply Division requests for more staff, for example,

never went beyond Spruit's office.32

Manpower deficiencies plagued the

theater's medical supply depots (see

Map 5). Between the beginning of

1943 and early 1944 the number of

medical branch depots and medical

sections of Quartermaster general

depots increased from five to sixteen.

Eight of these depots issued supplies

to units and hospitals in their geographical areas; the others held reserve stocks or performed specialized

functions, such as outfitting tactical

units, receiving British supplies, and

repairing medical equipment. Of the

90 officers and 1,200 enlisted men

who staffed these installations, about

half were members of six field depot

companies, units which arrived or

were activated in the theater during

the last half of 1943; the rest were on

temporary assignment from replacement centers. Neither the depot companies, which were organized for

mobile field operations, nor the attached casuals had received any training in the operation of large permanent depots. They learned their jobs

by doing them. All were on temporary assignment—the depot companies awaiting orders for field service

and the casuals subject to transfer on

short notice. Without a sense of permanency and, in the case of the attached men, with no promotion prospects, these troops suffered from low

morale and had little incentive to

excel at their often hard, demanding

work.33

Depot operations were inefficient at

best and chaotic at worst. An officer

who joined the medical section of

Depot G-35 at Bristol early in 1944

reported: "There was no depot organization—it seemed as [if] everyone

was doing what he chose to do. Responsibilities were not defined." Each

depot commander improvised his own

system for filling requisitions and his

32

 "Med Svc Hist, 1942-43," pp. 55-58, file HD

314.7-2 ETO; Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. 1, p. 1. High

hopes for Colonel Perry are expressed in Ltrs, Col

F. C. Tyng, MC, to Hawley, 21 Jan 43, and Hawley

to Tyng, 3 Mar 43, file HD 024 ETO O/CS

(Hawley-SGO Corresp). See also Col T. S. Voorhees, "Resume of Trip to Survey Medical Supplies

in ETO" (hereafter cited as "Resume"), 12 Apr 44,

in Survey of the Medical Supply Situation in the

ETO (hereafter cited as ETO Supply Survey), January-March 1944, file HD 333 ETO.

33

 At this time no standard T/O existed for the

type of large, permanent depot established in the

ETO. The field depot companies did not fit most

depots and often had to be broken up between two

or more installations. See "Med Svc Hist, 1942-43,"

pp. 55-56, file HD 314.7-2 ETO; Memo, Col T. S.

Voorhees, H. C. Hangen, Col B. C. T. Fenton, and

Lt Col L. H. Beers to TSG, 16 Feb 44, sub:

Progress Report (hereafter cited as Progress Report,

16 Feb 44), and Voorhees, Fenton, Beers, and

Hangen, Outline of Presentation to General Hawley

of Supply Division Recommendations (hereafter

cited as Outline Presentation), 7 Feb 44, both in

ETO Supply Survey, January-March 1944, file HD

333 ETO; Interv, ETO with Lt Col Robert R.

Kelley, MC (hereafter cited as Kelley Interv), 27 Jan

45, box 221, RG 112, NARA.

PREPARATIONS FOR INVASION 181

own stock control procedure. In most

depots, record-keeping fell behind

issues, leaving both local commanders

and the Supply Division unaware of

developing shortages until the shelves

were empty. The Supply Division required periodic reports from the

depots of stores on hand; but the

depots' poor record-keeping rendered

this information suspect, and the

Cheltenham office lacked the staff

and tabulating equipment to prepare

up-to-date theater-wide reports on

stock levels and distribution. With incomplete and outdated information,

the Supply Division could not shift

matériel between depots to even out

local shortages and surpluses. The

more enterprising depot commanders

developed their own contacts for this

purpose. Medical units and hospitals,

in spite of instructions to the contrary, went from one depot to another

until they secured not only the items

they needed but also reserves considerably over authorized allowances.

These field improvisations enabled

the medical service to get along from

day to day, but the resulting lack of

accurate information disrupted theater-wide supply planning and hindered General Hawley in dealing with

his sources of medical supply in Britain and the United States.34

During 1943, as American war production reached full momentum and

the shipping shortage eased, the European Theater drew an increasing

proportion of medical items, as well

as other types of supply, from the

United States. Small at the beginning

of the year, the flow of matériel grew

with the accelerating BOLERO buildup,

but it by no means went smoothly.

General Hawley complained throughout the year about delayed or only

partly filled requisitions, while the

surgeon general's office and the Port

of New York insisted that they were

meeting all ETO requirements. The

stock control deficiencies in Hawley's

depots contributed much to these disagreements, both by preventing

timely dispatch of requisitions to the

United States and by making it difficult to ascertain exactly what supplies

actually had arrived.35

Shipment of preassembled and

packed table-of-equipment (T/E) outfits for hospitals and field medical

units continued to be troubleplagued, in spite of War Department

and ETO efforts to improve the

system and in spite of the abandonment by the New York Port of Embarkation of the practice of earmarking

particular outfits for individual organizations. Delivery of assemblies, instead of keeping pace with unit arrivals in Britain, fell behind. ETO

depots then had to deplete their

stocks to outfit disembarking units,

34

 As quoted in Wiltse, ed., Medical Supply, p. 274.

See also Progress Report, 16 Feb 44, in ETO

Supply Survey, January-March 1944, file HD 333

ETO; Kelley Interv, 27 Jan 45, box 221, RG 112,

NARA; Memo, Hawley to DepCSurg (Cheltenham),

22 Sep 43, file HD 024 ETO O/CS (Spruit Policy

Notebook). In latter file Cir Ltr No. 54 (Supply No.

6), OofCSurg, HQ, ETOUSA, 9 Apr 43, sub: Supply

Policies and Procedures, ETO, outlines the prescribed—but often not followed—procedures. Ruppenthal, Logistical Support, 1:152-59, describes the

organization, procedures, and problems of U.S.

depots in Great Britain. The medical service had

many difficulties in common with the other supply

services. 35

 "Med Svc Hist, 1942-43," pp. 58-59, file HD

314.7-2 ETO. For typical complaints, see Ltrs,

Hawley to TSG, 7 Dec 43; Hawley to Col S. B.

Hays, MC, 7 Feb 44; and Hawley to Rankin, 16 Feb

44. All in file HD 024 ETO O/CS (Hawley-SGO

Corresp).
182 EUROPEAN THEATER OF OPERATIONS

with no assurance of early replenishment. Furthermore, most medical unit

assemblies—especially those for hospitals—reached British depots short

15-30 percent of their components, in

spite of strenuous efforts by the New

York port to have them carefully

marked and loaded on one ship. After

much mutual recrimination between

Hawley and the surgeon general's

office, an investigation early in 1944

disclosed that most assemblies were

entering English ports intact but that

the Supply Division had made no special arrangements for keeping them

together as they were unloaded. As a

result, portions of hospitals and unit

outfits turned up in different depots.

These depots, uninstructed in handling this matériel, simply added it to

their general stock without informing

the Supply Division.36

Although shipments from the

United States increased, the medical

service during 1943 procured more

than half of its supplies, by tonnage,

from Great Britain. British matériel,

in fact, comprised 49 percent of all

the goods received by the medical

service between mid-1942 and mid1944. These supplies included most

hospital furniture and housekeeping

equipment, as well as quantities of

over 900 other items, among them

surgical instruments and many drugs.

British procurement had been invaluable in meeting TORCH requirements and in tiding the medical service over its period of low priorities

and limited support from the United

States, but it possessed many unsatisfactory aspects. The British insisted

that the Americans place very large

long-term orders far in advance of deliveries, a procedure that made it all

but impossible to adjust procurement

to changing requirements. At the

same time British deliveries on these

contracts were irregular in both

timing and quantity. Few quality controls existed. In the emergency of

1942 General Hawley had disregarded American specifications in accepting British supplies. He used whatever his consultants, after examining

samples, declared would serve the

purpose. These items underwent no

inspection as they came off the production lines; shipments reaching

American units frequently were

poorly packed, substandard in quality,

or in unusable condition. Even when

British matériel arrived in good condition, U.S. Army medical people

were unaccustomed to its differences

from their own and considered many

items inferior to their American

equivalents. Seemingly small differences in design and markings took

getting used to, and at least one cost

lives. British-supplied carbon dioxide,

used in anesthesia, came in tanks

painted green, the color used in the

United States to denote oxygen. The

resulting mixups caused at least eight

deaths on operating tables before the

Professional Services Division issued

36

 Memo, Col T. S. Voorhees to TSG, 17 Mar 44,

sub: Report as to Splitting Up of Hospital Assemblies in Shipment From the U.S. to the ETO, in

ETO Supply Survey, January-March 1944, file HD

333 ETO; "Med Svc Hist, 1942-43," p. 58, file HD

314.7-2 ETO; Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. IV, pp. 1-4, sec.

V, p. 1, and sec. VI, p. 2; Ltr, Tyng to Hawley, 21

Jan 43, and other 1943 letters, file HD 024 ETO

O/CS (Hawley-SGO Corresp). Ruppenthal, Logistical

Support, 1:132-46, describes the complex problems

of shipping and marking ETO-bound supplies of all

kinds.
PREPARATIONS FOR INVASION 183

warnings and arranged for relabeling

of tanks.37

In August 1943 General Hawley

began trying to reduce his dependency on the British. Aware of deficiencies in quality and slow deliveries, he

also had discovered that his allies,

while furnishing inferior goods to the

European Theater, simultaneously

were obtaining large quantities of

standard American medical supplies

and equipment from the United

States under Lend-Lease. At Hawley's

urging, Surgeon General Kirk authorized the theater chief surgeon to

cancel contracts with the British for

items duplicating lend-lease shipments and to requisition them directly from the New York Port of Embarkation. The War Department, at the

same time, instructed the medical and

other supply services to stop buying

from the British a long list of items

now overstocked in the United States.

In spite of orders from Hawley, however, the Supply Division and its

London procurement office, through

poor coordination, made no real attempt to reduce local purchases. Instead, the procurement office placed

large orders for British goods to be

delivered in the first half of 1944.38

During the last few months of

1943, as more and more troops

poured into the British Isles and invasion preparations got under way, the

Supply Division obviously began to

buckle under its steadily increasing

work load. Disembarking units and

newly opened hospitals waited for

weeks for their basic equipment. The

Air Force, to Hawley's embarrassment

in his fight against an autonomous air

medical service, continued to complain of shortages of field chests and

other vital articles; the flight surgeons

continued to resort, successfully, to

their own channels to remedy these

deficiencies. Early in 1944 the fixed

hospitals in the Southern Base Section, where most American troops

were concentrated, had only 75 percent of their authorized equipment.

In response to complaints from all

quarters, Hawley pressed the Supply

Division for information but received

only incomplete, inconsistent, or inaccurate replies. At the same time the

tone of his correspondence with the

surgeon general's office grew increasingly testy, as each side blamed the

other for shortages and delays. On 7

December Hawley told General Kirk:

"I have had a Hell of a lot of trouble

with supply and am still having

37

 Memo, Col T. S. Voorhees to TSG, 14 Mar 44,

sub: British Procurement, in ETO Supply Survey,

January-March 1944, file HD 333 ETO; Ltr, Hawley

to TSG, 14 Oct 43, file HD 024 ETO O/CS

(Hawley-SGO Corresp). For statistics on British procurement, see Wiltse, ed., Medical Supply, p. 270,

and Ruppenthal, Logistical Support, 1:256-57. See

also Carter, ed., Surgical Consultants, 2:36-37. For the

tank problem, see Senior Consultant in Anesthesiology sec., Professional Services Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1943; Mins, 18th Meeting of Base Section Surgeons, 27 Mar 44, p. 10, file

HD 337; Editorial Advisory Board, 1962, p. 48; and

Col T. S. Voorhees, "A Lawyer Among Army Doctors" (Fort Detrick, Md.: Historical Unit, U.S. Army

Medical Department, n.d.), pp. 92-94.

38

 Ltrs, Hawley to TSG, 10 Aug and 17 Sep 43;

Memo, Edward Reynolds to TSG, 24 Aug 43, sub:

Letter From Gen Hawley . . . ; Ltr, TSG to

Hawley, 24 Aug 43; Memo, Reynolds to TSG, 18

Nov 43, sub: Data for Reply to General Hawley's

Letter. ... All in file HD 024 ETO O/CS (HawleySGO Corresp). See also Voorhees, "Resume," 12

Apr 44, pp. 4-5, and Memo, Col T. S. Voorhees to

CSurg, ETO, 18 Mar 44, sub: Report as to British

Procurement, both in ETO Supply Survey, JanuaryMarch 1944, file HD 333 ETO.
184 EUROPEAN THEATER OF OPERATIONS

trouble. . . . Frankly, I am worried

about my medical supply when I think

of the approach of active operations."

 39

Hawley had reason to worry. His

Supply Division barely was meeting

the routine requirements of the forces

stationed in the United Kingdom.

With much delay and inefficiency it

was equipping newly landed units and

recently completed hospitals, the

pressures of the latter task being

eased by British construction delays.

Additional missions to be accomplished in early 1944 promised to

swamp the floundering division.

Within about five months ETO medical depots would have to assemble

and place on site equipment for all

the hospitals still to be opened before

D-Day. This entailed building thirty

outfits for 1,000-bed general hospitals

and twenty for 750-bed station hospitals, but the most efficient depot in

late 1943 took three months to put

together 60 percent of one 1,000-bed

assembly. As if this were not enough,

the depots would have to outfit still

more incoming units, complete the

equipment of organizations taking

part in the assault, and pack dozens

of waterproof maintenance units to

supply the invasion force in its first

weeks on shore. With the existing organization, personnel, and methods,

these jobs could not be done in

time.40

Fortunately for General Hawley, assistance was on the way. Late in 1943

Surgeon General Kirk, responding to

the chief surgeon's repeated cries for

help in supply, and at the suggestion

of Colonel Gorby—then in Washington preparing to join Hawley's staff—

decided to send a group of experts

from his office to survey the ETO

supply service and recommend comprehensive remedies. In doing so Kirk

acted outside the established chain of

command, which made the theater

chief surgeon responsible only to the

theater commander. The surgeon

general's delegation would possess

little authority beyond the moral force

of its collective expertise. To lead the

group, Kirk appointed the chief of his

Control Division, Col. Tracy S. Voorhees, JAGD, a lawyer who had

become well versed in medical organization and supply. Voorhees picked

the other team members: Lt. Col.

Bryan C. T. Fenton, MC; Lt. Col.

Leonard H. Beers, MAC; and Mr.

Herman C. Hangen, a civilian consultant to the surgeon general. All

these men possessed extensive knowledge of medical supply distribution

and depot operations; all earlier had

helped reorganize the supply system

in the United States.41

39

 Quotation from Ltr, Hawley to TSG, 7 Dec 43,

file HD 024 ETO O/CS (Hawley-SGO Corresp). In

same file, see other letters for late 1943 and early

1944. See also Hawley Interv, 1962, p. 36, CMH;

Hawley Operational Directive No. 40, 13 Sep 43,

box 2, Hawley Papers, MHI; file HD 024 ETO

O/CS (Spruit Policy Notebook); "Med Svc Hist,

1942-43," p. 58, file 314.7-2 ETO; Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec.

IV, pp. 1-2, and sec. VI, p. 3; Mins, 15th Meeting of

Base Section Surgeons, 14 Feb 44, p. 7, file HD

337.

40

 Outline Presentation, 7 Feb 44, in ETO Supply

Survey, January-March 1944, file HD 333 ETO;

Supply Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, sec. V, pp. 1-2; Voorhees, "Lawyer

Among Army Doctors," pp. 85-86. 41

 Fenton was Chief, Issue Branch, and Beers,

Chief, Stock Control Branch, in the Supply Division,

Office of the Surgeon General. Hangen, an executive of J. C. Penney and Company, was a specialist

in warehouse operations. Voorhees, a New York

lawyer and friend of Under Secretary of War Robert Continued
PREPARATIONS FOR INVASION 185

COL. TRACY S. VOORHEES

Voorhees and his party left Washington by plane on 24 January 1944,

all but Beers (who was to join the European Theater to direct stock control), under orders for sixty days of

temporary duty. Once in the theater,

and with the full cooperation and assistance of Hawley and his staff, they

visited the Supply Division at Cheltenham, inspected depots, and talked

with U.S. Army medical officers of the

Services of Supply and the air and

ground forces. Very rapidly they

learned the dimensions of the medical

supply crisis. "Within 10 days," Voorhees recalled, "our team unanimously

reached the conclusion that only a

complete reorganization, undertaken

immediately, would make it possible

to furnish needed hospitals and medical supplies for the invasion." Breaking off any further gathering of evidence, they returned to London to

report to Hawley.42

On 7 February the Voorhees team

met with the chief surgeon to discuss

not only the findings but also a plan

for improvement. Voorhees and his

colleagues disavowed any intention to

"fix fault or blame," and they acknowledged Hawley's "entire executive authority and responsibility" and

his complete freedom to accept or

reject their proposals. However, "to

the extent that the program involves

bringing key people from the U.S.,

stripping The Surgeon General's

Office and Depots of top-notch personnel in this field, we would not feel

justified in recommending this unless

the plan as a substantial whole is

found acceptable by you." The group

then told Hawley: P. Patterson, initially headed the Legal Division,

Office of the Surgeon General, and became involved

in supply through his work on contracts. He became

the confidential agent and troubleshooter of the

surgeon general. The Control Division, which he

headed, oversaw the operations of other divisions of

Kirk's office. See Armfield, Organization and Administration, pp. 85-90 and 203-04, and Wiltse, ed., Medical Supply, pp. 18-21 and 280. See also Voorhees,

"Resume," 12 Apr 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Voorhees,

"Lawyer Among Army Doctors," pp. 83-84; Gorby

Interv, 1962, pp. 2-3, CMH; Editorial Advisory

Board, 1962, p. 32.

42

 Quotation from Voorhees, "Lawyer Among

Army Doctors," p. 84. See also Voorhees,

"Resume," 12 Apr 44, pp. 1-2, in ETO Supply

Survey, January-March 1944, file HD 333 ETO; correspondence for January-February 1944, file HD

024 ETO O/CS (Hawley-SGO Corresp); Hawley

Planning Directive No. 24, 8 Jan 44, box 2, Hawley

Papers, MHI; Memo, Hawley to Chief, Planning Division, 8 Jan 44, file HD 024 ETO O/CS (Spruit

Policy Notebook); Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. I, p. 1.
186 EUROPEAN THEATER OF OPERATIONS

We believe that your own state- ments ... as to the basic inadequacies

of your supply service and the grave con- cern which you expressed as to it, are

fully justified by me facts. . . . Unless

sweeping reforms are immediately insti- tuted, the Supply Division will fail to per- form its mission of furnishing on an even

reasonably adequate basis the hospital

equipment, field equipment and supplies

asked for.43

The committee laid before Hawley

a three-part program, patterned, they

pointed out, on the measures that had

solved similar medical supply problems in the United States fifteen

months earlier. First, to lighten the

depots' impossible work load, they

proposed that 37,000 hospital beds—

almost all the general and station hospital assemblies needed before DDay—and all the required medical

maintenance units for the invasion be

put together in the United States,

where the surgeon general's depots

now had ample stocks and manpower.

The ETO depots then could concentrate on equipping tactical units and

on the regular receipt, storage, and

issue of supplies. Second, to establish

effective stock controls, Voorhees'

group proposed a streamlined but

more comprehensive system of reports, the development of an SOP for

depot operation, reduction of the

number of issuing depots, and the

creation of key depots to hold reserves of scarce items. Third, the delegation addressed quantitative and

qualitative manpower deficiencies,

confirming Hawley's long-standing

belief that here lay the source of most

of his other supply difficulties. They

recommended doubling the Supply

Division staff, to thirty-two officers

and ninety-two enlisted men, and reorganization of the division into four

functional branches: Administration

and Finance, Stock Control, Depot

Technical Control, and Issue. Voorhees and his colleagues urged relief

of Colonel Perry "without reflection

upon him," and Perry's replacement

with Col. Silas B. Hays, MC, who was

then head of the Distribution and Requirements Division in the surgeon

general's office. They presented the

names of other qualified officers

whom General Kirk was willing to

send from the United States to the

European Theater if Hawley requested them. The Voorhees group also

recommended that the existing onthe-job-trained depot complements

be retained and organized in permanent units, both to improve efficiency

and to permit morale-enhancing promotions.44

The chief surgeon without hesitation accepted all of the group's recommendations. To implement them—

following still another Voorhees proposal—he assumed direct supervision

of the Supply Division, superseding

his Cheltenham deputy. On 10 February, in a transatlantic teletype conference, the surgeon general's office

agreed to all the main points, including assembly in the United States of

hospitals and maintenance units and

the assignment of Hays and the other

requested officers. Hangen, Beers,

and Fenton moved to Cheltenham,

where they effectively took over the

Supply Division, with the full cooperation of Colonel Perry, who stayed

on as nominal chief until Hays arrived 43

 Outline Presentation, 7 Feb 44, in ETO Supply

Survey, January-March 1944, file HD 333 ETO. 44

 Ibid.
PREPARATIONS FOR INVASION 187

COL. SILAS P. HAYS COL. BYRON C. T. FENTON

(Rank as of 15 August 1944)

in March. Colonel Voorhees remained

in London, to work on permanent

depot organization and begin a study

of ways to reduce British procurement. The entire team spent February

and March in sustained hard work,

their efforts closely observed by General Kenner. The SHAEF chief medical officer received copies of Voorhees' reports and conferred on the

supply situation with Hawley, Voorhees, and Colonel Fenton; but, as

with hospital construction, he confined himself to supporting the chief

surgeon's program.45

Voorhees' men rapidly reorganized

the Supply Division, establishing the

four new branches. By mid-March

thirteen of the officers promised by

the surgeon general had arrived and

gone to work. The division staff expanded to thirty officers, eighty-four

enlisted men, and thirteen British civilians, and for the first time in the

history of the theater the reinforcements were thoroughly qualified for

their jobs. After earnest and repeated

pleas from Hawley, General Kirk al45

 Voorhees, "Resume," 12 Apr 44, pp. 2-5;

OofCSurg, HQ, ETOUSA, Report of Teleprinter

Conference . . . With Representatives of TSG, 10

Feb 44; Memo, Hawley to DepCSurg (Cheltenham),

11 Feb 44; Ltr, Voorhees to Edward Reynolds, 7

Mar 44. All in ETO Supply Survey, January-March

1944, file HD 333 ETO. See also Voorhees,

"Lawyer Among Army Doctors," pp. 87-90; Ltr,

TSG to Hawley, 12 Feb 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp). For Kenner's activities, see

Medical Division, COSSAC/SHAEF, War Diary,

February-April 1944.
188 EUROPEAN THEATER OF OPERATIONS

TABLE 4—KEY DEPOT SYSTEM, UNITED KINGDOM, 1944

Source: Wiltse, ed., Medical Supply, p. 285.

lowed the chief surgeon to retain

Fenton as deputy Supply Division

chief. Hawley held onto Fenton partly

as a possible replacement for Hays,

who suffered a severe gastric attack

early in May; but, to the chief surgeon's immense relief, his supply

chief recovered and was able to

resume duty before D-Day.46

Depot reorganization went forward

(Table 4). On 2 February Colonel

Voorhees and the chief surgeon prevailed upon the ETO G-1 to halt all

transfers of soldiers then working in

medical supply depots. This action

temporarily stabilized the depot force.

After much negotiation between

Hawley, Voorhees, and the theater

G-1 and G-4, the ETO headquarters

activated in Great Britain or called for

from the United States eight additional field medical depot companies and

assigned all depot personnel to them.

While these field companies rarely

matched in size and composition the

requirements of any particular depot,

and hence usually had to be divided

among several installations, their establishment did end the transiency of

depot personnel. They also provided

an organization in which deserving

soldiers could receive promotions.47

Hangen and Beers revamped depot

operations and stock record-keeping.

To better control supply issues, they

reduced the number of depots distrib46

 Ltrs. Hawley to TSG, 20 Apr and 6 May 44; Ltr,

TSG to Hawley, 26 Apr 44; Ltrs, Col E. Reynolds to

Hawley, 16 May and 8 Jun 44; Ltr, Hawley to Reynolds, 15 Jun 44. All in file HD 024 ETO

O/CS (Hawley-SGO Corresp). See also Supply Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

sec. I, p. 1, ex. III; Kelley Interv, 27 Jan 45, box

221. RG 112, NARA; Fenton Interv, 7 Jun 45, box

222. RG 112, NARA; Memo, Voorhees to Hawley,

25 Mar 44, sub: Review of Situation as to Medical

Supply, in ETO Supply Survey, January-March

1944, file HD 333 ETO.

47

 The chief surgeon tried unsuccessfully to persuade the theater to authorize permanent non-T/O

organizations adapted to the various depots, but the

theater insisted on standard T/O units, leaving the

field companies the only alternative. Each such company included 8 officers and 167 men. Of the fourteen such companies in the ETO by D-Day, eight

were used in fixed depots; the rest were assigned to

field armies or the SOS for mobile operations. See

Supply Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, sec. II, pp. 1-2; Voorhees, "Resume," 12

Apr 44, and Ltr, Voorhees to TSG, 21 Feb 44, in

ETO Supply Survey, January-March 1944, file HD

333 ETO; Kelley Interv, 27 Jan 45, box 221, RG

112, NARA.
PREPARATIONS FOR INVASION 189

uting to units from eight to five. They

designated five key depots, each of

which held the bulk of theater stocks

of certain scarce items and filled requisitions for them passed on from issuing depots. A sixth key depot assembled and issued all tactical unit

equipment. Other nonissuing depots

performed maintenance and repair,

received matériel from the ports, and

stored reserve stocks. Hangen and

Beers published a depot operations

manual, establishing uniform issuing

and inventory procedures that the

Supply Division's Depot Technical

Control Branch saw were carried out.

They also set stock levels for each issuing depot, based on the number of

troops it served, and redistributed onhand matériel among installations to

give each its proper allowance. To

collect theater-wide supply information, Hangen and Beers replaced the

three existing separate depot stock reports with a single comprehensive biweekly one. From this, the Supply Division, employing electric tabulating

machines, compiled statistics on total

supplies on hand and required. At the

same time Hangen and Beers set a

theater stock level of 75 days' supply

of each item and provided for automatic reorder when quantities fell

below that point plus an additional

margin to allow for time taken in ordering and shipment. To bring all

stocks to the 75-day level, the Supply

Division placed large emergency requisitions on the New York port; it also

sent initial orders for over 800 items

in the surgeon general's catalog hitherto not used in the theater to reduce

shipping requirements. With vessels

and supplies now available, the European Theater thus expanded its

supply table. By mid-May the ETO

depots were well stocked, and the

Supply Division knew what and how

much was in them.48

While his associates reorganized

the depots, Colonel Voorhees surveyed the record of British medical

supply. Reviewing the orders placed

late the previous year for 1944 delivery, he and his assistants discovered

that, of over 800 items involved, all

but several varieties of dental burs

either were in oversupply in the

United States or were being shipped

from America under Lend-Lease for

British use. After much negotiation

with the Ministry of Supply and the

War Department, Hawley and Voorhees canceled most supply requests

with the British except those for

dental burs and a few nonstandard articles; they also retained arrangements for small local emergency purchases. The British either stopped

production of the no longer wanted

items or diverted them to their own

forces. To assure more effective control of any additional buying within

the theater, the chief surgeon, at

Voorhees' suggestion, placed the

London procurement office within the

Supply Division's new Stock Control

48

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, pp 2-4, and sec. VI, pp.

6-7; Ltr, Voorhees to Reynolds, 7 Mar 44, in ETO

Supply Survey, January-March 1944, file HD 333

ETO; Memo, Medical Division, SHAEF, to ACofS,

G-4, SHAEF, 7 Apr 44, in Medical Division,

COSSAC/SHAEF, War Diary, April 1944; Kelley

Interv, 27 Jan 45, box 221, RG 112, NARA; Memo,

OofCSurg, HQ, ETOUSA, to Maj Gen LeRoy Lutes,

1 May 44, file HD 024 ETO CS (Hawley Chron);

Wiltse, ed., Medical Supply, pp. 285-87. These additional medical supply shipments were only a small

part of the massive last-minute flow of OVERLORD

and BOLERO cargo into Britain. See Ruppenthal, Logistical Support, 1:234-40 and 258-60.
190 EUROPEAN THEATER OF OPERATIONS

Branch, ending procurement's semiindependent status.49

On both sides of the Atlantic, the

Army Medical Department and the

ETO medical service prepared to assemble and move equipment for hospitals containing a total of 35,000

beds. "This was roughly the equivalent," Voorhees pointed out, "of

shipping about 12 complete New

York City Bellevue Hospitals, except

the buildings." By mid-March the surgeon general's office and the New

York Port of Embarkation had worked

out packing and loading schedules to

ensure arrival of the required assemblies before the end of May. Combined with hospital assemblies requisitioned earlier, the matériel sent in

response to Voorhees' special request

would provide the European Theater

with a large reserve of complete hospitals and components. In the United

Kingdom the Supply Division, cooperating with port commanders, base

section surgeons, and the Transportation Corps, established procedures

for moving hospital assemblies directly from wharf to site, bypassing the

depots and reducing the chance of

units being broken up in transit.

Under this system, between 30 March

and 25 May, assemblies for twentynine 1,000-bed general hospitals and

eight 750-bed station hospitals, as

well as additional equipment for thousands of expansion beds, went from

ships' holds to plants all over Britain

with minimal loss or delay.50

Colonel Voorhees and Hangen returned to the United States early in

April, to report personally to Surgeon

General Kirk and to supervise the dispatch of hospitals and maintenance

units. They left behind a medical

supply service well on the way to

complete transformation—a transformation accomplished in a few months

by effective leadership, sufficient

manpower, first-class priority for

ETO requirements, and high-level

command attention. By mid-May the

depots possessed full, balanced

stocks. The First Army, which would

make the assault, had all its medical

equipment in hand. The depots were

packing for over-the-beach disembarkation maintenance units to sustain

the first two weeks of combat. Additional medical maintenance units at

sea or in depots contained supplies

for the period D+14 to D+90. Most

of the operating fixed hospitals in

49

 The War Department initially hesitated to stop

ordering from the British because of warnings from

the Allies that, without firm American orders, they

would shut down production, thereby foreclosing

later purchases which might become necessary.

Hawley and Voorhees, however, persuaded the

Army Service Forces that the sufficiency of shipping

and supplies and the inadequacies of British procurement more than justified a complete cutoff. See

Voorhees, "Resume," 12 Apr 44, pp. 4-5; Memo,

Voorhees to TSG, 14 Mar 44, sub: British Procurement; Memo, Lt Col L. H. Beers, MAC, to Voorhees, 18 Mar 44, sub: British Procurement; Memo,

Voorhees to Hawley, 25 Mar 44, sub: Review of Situation as to Medical Supply. All in ETO Supply

Survey, January-March 1944, file HD 333 ETO.

50

 Before Voorhees made his request, the Office

of the Surgeon General had plans to pack and ship

twenty-four general hospitals for eventual use in

France; it diverted these to Britain and then sent

Voorhees' full request as well. Quotation from

Voorhees, "Lawyer Among Army Doctors," p. 89.

See also Memo, Voorhees to CSurg, ETO, Col

Liston, Col Hays, and Maj Marshall, 16 Mar 44, sub:

Status of Requirements for Hospital Assemblies,

Dates of Expected Arrival, and Proposed Steps To

Assure Timely Deliveries, in ETO Supply Survey,

January-March 1944, file HD 333 ETO; Supply Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, sec. V, pp. 1-2, and sec. VI, pp. 2-3; Mins,

16th Meeting of Base Section Surgeons, 28 Feb 44,

p. 3, file HD 337; Wiltse, ed., Medical Supply, pp.

297-98.
PREPARATIONS FOR INVASION 191

Britain had received their full equipment and held at least sixty days of

reserve supplies. Even the Air Force

now relied for medical supply more

upon SOS channels than upon its

own. Three days before the invasion,

a still-cautious Hawley declared: "We

have just barely squeaked through on

our supply. ... I shall not, however,

breathe really easily about it for another month." He had no further

cause for worry. ETO medical supply,

as reorganized by the Voorhees mission, was ready for war.51

Mounting the Attack

Preparations for mounting NEPTUNE—equipping, organizing, and

embarking the assault troops and reinforcements so as to ensure their arrival on the far shore in the right

order with the right matériel—

merged with the final stages of invasion planning. For its part in this

process the medical service selected,

assigned, and completed the training

of army and COMZ units, equipped

them, and packed their supplies. It

furnished treatment and evacuation to

troops assembling for embarkation,

and it prepared to receive and care

for wounded from the opening battle

in Normandy.

During the final months before DDay the surgeons of the First and

Third Armies, Advance Section, and

Forward Echelon, in consultation with

General Hawley, developed medical

troop lists for their respective commands. The ETO headquarters then

assigned the requested units from the

huge pool accumulating in the United

Kingdom. The First Army's preinvasion allocation included one 750-bed

and ten 400-bed evacuation hospitals,

five field hospitals, a convalescent

hospital, headquarters of three medical groups and eight medical battalions (separate), a medical gas treatment battalion, an auxiliary surgical

group, a medical laboratory, a medical depot company, and eleven

collecting, six clearing, and seven ambulance companies (separate). These

units underwent personnel augmentations and rearrangements. To provide

ready replacements for invasion casualties, medical elements of the engineer special brigades and of the

assault and early buildup divisions received extra officers and men above

T/O strength. Army mobile hospitals

transferred doctors to balance their

professional staffs. First Army field

and evacuation hospitals had the

painful task of replacing 95 veteran

nurses who were considered too old

or physically unfit for active campaigning.

The Advance Section and Forward

Echelon also received their full allotments of units before D-Day. ADSEC

included over 1,800 medical officers,

2,300 nurses, and 16,000 enlisted

men when the campaign began.

51

 Quotation from Ltr, Hawley to TSG, 3 Jun 44,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Memo, Col T. S. Voorhees and H. C.

Hangen to TSG, 5 Apr 44, sub: Final Report as to

Survey of Medical Supplies in E.T.O., in ETO

Supply Survey, January-March 1944, file HD 333

ETO; Memo, OofCSurg, HQ, ETOUSA, to Lutes, 1

May 44, file HD 024 ETO CS (Hawley Chron). The

medical supply situation more or less paralleled that

in other technical services and the theater as a

whole. See Ruppenthal, Logistical Support, 1:261-66.

52

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, p. 61. For personnel arrangements, see Surg, Third U.S. Army, Annual Rpt,

1944, pp. 16, 102, 105, and Nursing Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 9.
192 EUROPEAN THEATER OF OPERATIONS

Unlike those attached to the armies,

most units assigned to the Communications Zone were operating fixed installations in Great Britain or had

marshaling and casualty reception

duties that would continue until embarkation; hence, they remained

under base section control, except on

matters directly connected with preparing for continental operations—a

dual command chain that forced unit

staffs to thread their way among duplicate, occasionally conflicting, directives and reporting requirements. Especially in selecting the twenty-five

ADSEC and FECOMZ general hospitals, General Hawley recommended

SOS units for early shipment to

France on the basis of superior performance in Britain. He angrily deleted from the list one general hospital

that he found "inexcusably dirty and

disorderly" on a pre-D-Day visit.53

Medical units designated for early

movement to France added instruction and exercises in amphibious warfare and field operations to their already crowded training schedules.

The First Army, at Colonel Roger's

recommendation, attached medical

battalion elements to combat units

early in the attack preparations so

that the medical troops and the battalions they were to support could go

together through the entire invasion

training sequence, including the amphibious landing exercise at the

army's assault training center on the

Devon coast. COMZ organizations

usually trained at their stations, supervised and inspected by their assigned headquarters. They also sent

key people to special courses. Commanders of the twenty-five ADSEC

and FECOMZ general hospitals, for

instance, attended a five-day school

on erecting the expeditionary tentedhutted plant. First Army and COMZ

medical elements participated together in the final division and corps invasion rehearsals covering the entire

process of marshaling, embarkation,

and assault—TIGER, held late in April

for VII Corps; and FABIUS, in early

May, for V Corps and the initial

buildup force. During TIGER U.S.

Army medical units had real casualties

to handle, the result of German torpedo boat attacks in the Channel that

sank two LSTs and severely damaged

a third, with the loss of some 700

American lives. At Portland-Weymouth, in an unplanned but effective

test of the system for receiving

wounded from France, the 33d Medical Battalion, its attached ambulance

and sanitary companies, and the 50th

Field Hospital efficiently met the

emergency under "particularly trying

and difficult conditions."

 54

53

 ADSEC Hist, p. 8; Surg, ADSEC, COMZ,

Annual Rpt, 1944, pp. 3 and 38-39; Larkey "Hist,"

ch. 8, pp. 23-25; file HD 370 (HQ, ADSEC Plans

and Corresp, 1944). For the hospital deletion, see

Ltr (source of quotation), Hawley to Col A. A. Albright, MC, 19 May 44 (marked "not sent"), file HD

024 ETO CS (Hawley Chron), and Hawley Interv,

1962, p. 58, CMH.

54

 For a general account of invasion training and

exercises, see Ruppenthal, Logistical Support, 1:191

and 334-54, and Harrison, Cross-Channel, pp. 162-64

and 269-70. See also remarks of Maj Gen J. L.

Snyder, MC, in Editorial Advisory Board, 1962, pp.

69-70. For examples of training, see Surg, VII

Corps, Annual Rpt, 1944, pp. 4-5; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 2; 53d Medical

Battalion Annual Rpt, 1944, p. 2; and Force U Operations Order 2-44, an. NAN, 18 Apr 44, file HD

370 (Evaluation, Annex JIG); Surg, ADSEC, COMZ,

Annual Rpt, 144, pp. 13-15, 31, 48; Hospitalization

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, p. 5. Description of the medical response to

the torpedo boat incident, from which the quotation
PREPARATIONS FOR INVASION 193

Equipment and supply of the assault and early buildup units required

cooperation between the First Army

and the chief surgeon's Supply Division. On the basis of a First Army

study of assault requirements, the

Supply Division issued supplemental

equipment, above T/E allowances, to

army medical units of all types. In

spite of duplicated and misdirected

shipments, the result of frequent unit

movements during marshaling, most

First Army organizations had received

their extra allotments, as well as

nearly 100 percent of their authorized

equipment, before they embarked, a

tribute to the effectiveness of the

newly reorganized depots. Amphibious packing received careful attention

from all echelons. The Supply Division distributed standard watertight

shipping boxes to First Army field

and evacuation hospitals and sent an

officer to advise units on how best to

protect their matériel against the hazards of sea, weather, and battle. Army

units prepared thousands of handportable assault supply containers,

each a waterproof cylinder 21 inches

long and 9.5 inches in diameter,

originally used to ship 60-mm. mortar

shells. Each case, with a carrying strap

attached and painted with a Red

Cross in a white circle, weighed about

14 pounds when filled with first aid

dressings, sulfa crystals, dried plasma,

and other small items. Each container

would float, serving the medical soldier hauling it as a life preserver that

he could take inland with him as he

advanced or could drop on the beach

for later retrieval. Eight such cases

constituted a single unit of these supplies, and every battalion or company

received an allowance of units. The

4th Infantry Division landed with 285

of these cases, containing over 3,500

pounds of supplies.55

Following theater policy, the

Supply Division loaded all scheduled

maintenance supplies for the first

sixty days on standard wooden skids,

each a sled-like device weighing about

1,700 pounds with cargo, designed to

be dragged across beaches and stored

in open-air depots. By 8 May medical

depots had finished loading these

supplies for D-Day through D+15.

Piled onto 955 skids, this matériel included ninety-two surgical and

twenty-two medical division assault

units and twenty regular maintenance

units, as well as other freight. General

Hawley, meanwhile, secured from the

Ninth Air Force a guarantee to airlift

daily across the Channel 4,000

pounds of blood, penicillin, and other

perishable items, which Depot G-45

at Thatcham was to pack for emplaning at a nearby Army airfield. Late in

May the theater blood bank began

collecting and processing; its detachments made their first deliveries, over

1,100 pints, to LSTs and hospital carriers. The latter vessels, fitting out at

English, Scottish, and Welsh ports,

took on blood and biologicals, both

is taken, is in OofSurg, United Kingdom Base, Historical Resume of the Planning for and Staging of

Operation OVERLORD and the Preceding Exercises

(hereafter cited as Surg, UKB, OVERLORD

Resume), n.d., pp. 1-8, file HD 370.

55

 First U.S. Army Operations Report, 20 Oct 43-

1 Aug 44, bk. VII, pp. 73-74 and 114-16; Supply

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, secs. II, IV, and VI; Kelley Interv, 27 Jan 45,

box 221, RG 112, NARA; Surg, United Kingdom

Base, Annual Rpt, 1944, p. 35; Mins, 18th Meeting

of Base Section Surgeons, 27 Mar 44, pp. 2-3, file

HD 337. Surg, VII Corps, Annual Rpt, 1944, pp. 6-

8, contains a detailed description of the hand-carried container.
194 EUROPEAN THEATER OF OPERATIONS

for their own use and to supply the

beachheads.56

To embark the 130,000 troops and

17,000 vehicles of the assault and initial buildup forces, the U.S. Army

used a system worked out by the British early in the ROUNDUP planning.

Under it each organization, in prearranged sequence, went from its permanent station through a concentration area to a dockside marshaling

camp. In the course of this movement

the unit dropped off men and matériel not needed for the attack, water

proofed its vehicles, and picked up

assault equipment. Finally, in a marshaling camp sealed off by barbed

wire and security patrols, the unit received its mission briefing and organized into ship and landing craft

loads. The First Army directed these

troop movements and the embarkation, while the Services of Supply

built and manned the concentration

and marshaling camps and provided

messing, medical, and other administrative support for the combat units

passing through them. The SOS

headquarters, in turn, delegated most

mounting tasks to the Southern Base

Section, which embarked the OMAHA

and UTAH seaborne attack forces and

the glider elements of the airborne

divisions, and to the Western Base

Section, which loaded the first buildup divisions and the airborne paratroopers. Medical support for the

mounting, accordingly, rested principally with Col. Robert E. Thomas,

MC, the Southern Base Section surgeon, and Col. Mack M. Green, MC,

the Western Base Section surgeon.57

Medical support provisions for the

embarkation were limited and

straightforward. In the marshaling

camps the base sections established

medical supply points to make emergency preembarkation issues and over

150 camp dispensaries, each staffed

with 1 officer and 4 enlisted men, to

serve units that had dropped off or

packed up their own medical detachments. Most of the officers and men

for these dispensaries, and for 24

mess teams that helped feed the transient soldiers, came on temporary assignment from station and general

hospitals throughout Great Britain.

From the same sources the Dental Division of the chief surgeon's office assigned a dentist and an assistant to

the marshaling camps for each 3,000

troops, to do last-minute fillings, extractions, and prosthesis repairs.

Taken as they were from fixed hospitals, many of these temporary camp

doctors had little experience and only

brief predeployment training in field

medicine and sanitation.58

56

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, secs. II and VI; Surg, ADSEC,

COMZ, Annual Rpt, 1944, p. 25; HQ, SOS,

ETOUSA, Mounting Plan, an. 8, Medical Corps

(hereafter cited as SOS Mounting Plan), 20 Mar 44,

in Larkey "Hist," ch. 8, app. 3; Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Daily Diary, 19 May 44, file HD 024 ETO; Kendrick,

Blood Program, p. 512; Kelley Interv, 27 Jan 45, box

221, RG 112, NARA.

57

 For the mounting system, see Ruppenthal, Logistical Support, 1:218 and 357-62, and Southern

Base Section History, August 1943-August 1944,

pp. 6-7. See also Surg, UKB, OVERLORD Resume,

pp. 1-4, file HD 370; SOS Mounting Plan, 20 Mar

44, in Larkey "Hist," ch. 8, app. 3; Planning Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 6. 58

 Each mess team included 1 officer, 4 cooks, and

11 men. The latter medical troops were only a few

of the 4,500 new cooks hastily assembled for the

camps. See Ruppenthal, Logistical Support, 1:361. See

also Larkey "Hist," ch. 8, pp. 28-31; SOS Mounting

Plan, 20 Mar 44, in ibid., app. 3; Surg, UKB, OVERLORD Resume, pp. 11-12, file HD 370; Surg, West- Continued
PREPARATIONS FOR INVASION 195

The abilities of the camp surgeons,

fortunately, were not sorely taxed.

Marshaling and embarkation began

early in May, after General Eisenhower set D-Day for 5 June, and went forward with no major enemy harassment and, from a medical standpoint,

few problems. As planned, the embarking troops enjoyed hot meals of

fresh, tasty food. They donned uniforms treated to resist gas and picked

up seasickness preventives, insecticide

powder, and water purification tablets. They heard a final one-hour preventive medicine lecture that emphasized proper eating habits, personal

cleanliness in the field, and precautions against venereal disease. In

many marshaling camps, sanitation

left much to be desired—the result of

inevitable carelessness among transient soldiers and of mistakes by the

hastily assembled, sketchily trained

camp and mess hall staffs. Base section preventive medicine officers,

aided much of the time by Colonel

Gordon and members of his division,

quickly corrected these deficiencies,

although lapses in mess hall cleanliness caused a few battalion-wide outbreaks of diarrhea. Filing a gap in the

planning, Gordon's officers devised a

system for feeding hot meals to

troops held for hours on the docks by

embarkation delays. One anticipated

problem did not develop. The base

section surgeons, expecting a rash of

preinvasion emotional disorders, assigned psychiatrists to the marshaling

camps. Few cases appeared, and the

psychiatrists spent their time giving

impromptu short courses in battlefield neuropsychiatry to unit medics.59

As the Army embarked, the medical

service completed its preparations for

receiving invasion casualties (see Diagram 2). The chief surgeon's office

and Southern Base Section, working

closely with the British Southern

Command, drafted plans for this operation, which was a complicated task

in itself. Under the final plan, published in mid-March, evacuation LSTs

and hospital carriers were to unload

American wounded at three Channel

coast ports: Brixham, Portland-Weymouth, and Southampton. The arriving patients were to undergo two

stages of triage and emergency treatment. Holding units at the docks and

hards (concrete ramps at which LSTs

could load and unload through their

bow doors) were to give surgical

treatment to men tagged by LST doctors as requiring immediate attention

before further transportation. The

rest of the patients were to go by ambulance directly from the ships to

transit hospitals, designated station

and general hospitals 15-30 miles

inland. These hospitals again were to

separate out wounded who were

unable to travel further and prepare

the transportables for rail movement

to general hospitals for definitive

ern Base Section, Rpt, 1 Jan-31 Aug 44, pp. 5-6;

Mins, 13th and 15th Meetings of Base Section Surgeons, 17 Jan and 14 Feb 44, file HD 337; Surg,

United Kingdom Base, Annual Rpt, 1944, p. 22;

Dental Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 4-5.

59

 For the course of the embarkation, see Harrison, Cross-Channel, pp. 188-90 and 269-74; Ruppenthal, Logistical Support, 1:363-73; and Southern

Base Section History, August 1943-August 1944,

pp. 42-52. See also Surg, UKB, OVERLORD

Resume, pp. 14-15, file HD 370; Surg, Infantry Division, Annual Rpt, 1944, pp. 2 and 5; ADSEC Hist,

p. 8; Surg, United Kingdom Base, Annual Rpt,

1944, pp. 79-81; Surg, Western Base Section, Rpt,

1 Jan-31 Aug 44, pp. 5-6; Gordon "Hist," vol. 2,

pt. 4, pp. 38-39, CMH. For the preventive medicine

briefing, see Larkey "Hist," ch. 8, app. 15.
196 EUROPEAN THEATER OF OPERATIONS

DIAGRAM 2—CASUALTY RECEPTION SYSTEM IN GREAT BRITAIN, JUNE 1944

Source: Evacuation Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, encl. 3.

treatment. Port evacuation officers,

under the base section surgeons, were

to direct patient movements as far as

the transit hospitals; transfers beyond

that point would be controlled by the

chief surgeon's office. During the first

days of combat, when the beachhead

was shallowest, this system not only

would enable holding units and transit hospitals to assume many functions of division clearing stations and

army evacuation hospitals but also

would keep wounded flowing from

the coast to the large hospital centers

in the north and west of England.60

The medical service tested this

evacuation plan in two exercises:

CRACKSHOT, in February 1944, for

movement of wounded into and out

of transit hospitals; and CADUCEUS, in

April for unloading evacuation LSTs.

Then the casualty reception forces

deployed. At each of the three major

receiving ports, and at many minor

ones, the base sections established

field hospitals under canvas or in requisitioned buildings to serve as holding units, often with platoons placed

only a short litter carry from hards

and wharves (Map 6). Separate medi60

 SOS Mounting Plan, 20 Mar 44, in Larkey

"Hist," ch. 8, app. 3; Carter, ed., Surgical Consultants,

2:173-75. See also MFR, 5 Jan 44, sub: Decisions

Made by Gen Hawley at Informal Conference With

Cols Hartford and Peyton; Memo, Lt Col F. H.

Mowrey, MC, n.d. sub: Evacuation and Medical Service at Hards; Memo, Col J. H. McNinch, MC, to

OofCSurg, HQ, ETOUSA, 15 Feb 44; Memo, Chief,

Passenger Branch, Office of CofTrans, ETO, to

ACofTrans, Movements, 2 Mar 44, sub: Evacuation

of Sick and Wounded From the Continent. ... All

in EvacCorresp, 1942-44, file HD 024 ETO.
PREPARATIONS FOR INVASION 197

MAP 6

cal battalions at Brixham and Portland and a gas treatment battalion at

Southampton, each with sanitary, ambulance, and collecting companies attached, prepared to unload ships and

transport patients between holding

units and transit hospitals. Each battalion commander acted as evacuation

officer for his port. Two more medical battalions, at Blandford and

Exeter, held collecting, clearing, and

ambulance companies in reserve for

commitment at General Hawley's direction. At Ramsbury and Membury

airfields, the nearshore terminals for

cross-Channel air evacuation, still

other field hospital platoon holding

units and ambulance detachments

awaited patients. Forty-nine units

(nine field hospitals; one gas treatment and four medical battalions; and

five sanitary, seventeen ambulance,

four collecting, and two clearing companies), all temporarily detached from

the Communications Zone and the

field armies, made ready to receive

wounded from Normandy.61

61

 Surg, UKB, OVERLORD Resume, pp. 4-5, 8-

13, 18, file HD 370; Larkey "Hist," ch. 8, pp. 31- Continued
198 EUROPEAN THEATER OF OPERATIONS

To assist in casualty reception,

treatment, and evacuation, the medical service improvised a variety of

teams and special units. General

Hawley drew almost 500 doctors and

a comparable number of enlisted

technicians from Third Army, the air

forces, and station and general hospitals, to staff marshaling camp dispensaries, to form LST surgical teams,

and to assist the 1st Auxiliary Surgical

Group in reinforcing the staffs of

holding units and transit hospitals.

Hawley and the base section surgeons

tried to distribute the burden of these

details evenly, but some fixed hospitals suffered significant temporary

losses. In the Eastern Base Section,

for instance, the 303d Station Hospital, which treated Eighth Air Force

battle casualties, had to give up 2 officers and 8 men for dispensaries, 2

mess sergeants and 31 enlisted

people for marshaling camp details,

and 1 officer for a district inspection

team. To provide professional staffs

for three of the British-crewed hospital carriers, the Evacuation Branch,

lacking T/O units for this purpose,

placed a hospital train unit and a

medical hospital ship platoon on each

vessel. The Western Base Section,

needing a holding unit for two Welsh

ports, improvised one by augmenting

an engineer regiment's medical detachment with doctors from dispensaries in the marshaling camps.62

The chief surgeon backed up his

receiving units with reserves of transportation and supplies. General

Hawley established a pool of 350

extra ambulances—American 3⁄4-ton

vehicles not yet issued to units and

surplus British Austins. He distributed these, and 18 bus ambulances, to

the Southern and Western Base Sections to reinforce ambulance companies and transit hospitals. The Evacuation Branch, unable to obtain any

more home ambulance trains than the

5 then in service, persuaded the Ministry of Transport to adapt 10 overseas trains to run on British lines, ensuring enough rolling stock to keep

the transit hospitals cleared. The

Supply Division set up temporary advance depots at Plymouth, Torquay,

Winterborne Steepleton, and Lockerley in the Southern Base Section. Besides holding reserves needed by the

hospitals, these dumps, and others on

the docks and hards, stored Navy supplies to replenish evacuation LSTs.

They also contained exchange units

32, 55-56, and ch. 13, p. 7; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 2-4; Surg, United Kingdom Base,

Annual Rpt, 1944, pp. 20-21, 24, 44-46. For unit

procurement, see Planning Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

p. 8; SOS Mounting Plan, 20 Mar 44, in Larkey

"Hist," ch. 8, app. 3; and file HD 370 (HQ,. ADSEC

Plans and Corresp, 1944). On unit activities, see

33d Medical Battalion Annual Rpt, 1944, pp. 5-8;

93d Medical Gas Treatment Battalion Unit History,

1943-44, pp. 3-6; and 12th and 50th Field Hospitals Annual Rpts, 1944.

62

 Larkey "Hist," ch. 8, pp. 28-31; Personnel Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

pp. 10-11; Mins, 14th, 18th, and 19th Meetings of

Base Section Surgeons, respectively 31 Jan, 27 Mar,

and 10 Apr 44, file HD 337; Surg, Western Base

Section, Rpt, 1 Jan-31 Aug 44, p. 6. On LST teams,

see Dowling, Normandy Rpt, 11 Jan 45, pp. 6-8, and

file HD 705 ETO (Medical Care on LSTs, 1944).

On drafts from hospitals, see Ltrs, Hawley to Col R.

E. Thomas, MC, 27 Apr 44, and Hawley to Col M.

M. Green, MC, 5 May 44, file HD 024 ETO CS

(Hawley Chron); see also 5th General Hospital

Annual Rpt, 1944, p. 5, and 12th Evacuation Hospital Annual Rpt, 1944, p. 8. On hospital carriers, see

Evacuation Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Daily Diary, 16-30 May 44, file HD

024 ETO.
PREPARATIONS FOR INVASION 199

of stretchers, blankets, and splints,

designed and assembled jointly by the

Supply Division and the Western

Naval Task Force to prevent the

planned near-total evacuation policy

from stripping the beachhead of these

vital items. LSTs were to deliver 300

of these units—containing in all

30,000 litters, 96,000 blankets, and

quantities of splints and plasma—to

Normandy on their first and subsequent voyages. Permanent Southern

Base Section medical depots accumulated still more supplies of all classes,

among them most of the theater's

available oxygen cylinders, stockpiled

for possible use in treating gas casualties.63

Fixed hospitals made preparations

of their own. The eight station and

four general hospitals assigned to

transit duty cleared out patients,

streamlined admission and evacuation

procedures, and trained extra ambulance drivers and litterbearers. To

provide more transit beds at Portland-Weymouth, where most wounded were expected to arrive, the 12th

and 109th Evacuation Hospitals, detached from the Third Army, established a temporary expeditionary

tented plant. General hospitals, prodded by Hawley and his consultants,

sped up the return of convalescents

to duty and increased the number of

eligible patients evacuated to the

United States. By 1 June the Southern

Base Section had available for invasion wounded over 10,000 beds in

transit hospitals and 18,000 more in

regular station and general hospitals.64

By 3 June the assault forces had

embarked. After a 24-hour delay

caused by storms over the Channel

and Normandy, the 5,000-ship invasion fleet set course for France, for a

landing scheduled for first light on

the sixth. For many medical troops in

southern England not yet embarking

or preparing to do so, the first notice

that the long-awaited invasion was

under way came on the night of 5

June, in the form of a sky filled with

the navigation lights and engine

sound of hundreds of planes heading

for the airborne drop zone behind

UTAH beach. For General Hawley, two

years of planning and preparation had

reached their goal and climax. "We

are all set for the kick-off," he wrote

after a final tour of his holding units

and transit hospitals, "and I, personally, feel as nervous as players usually

feel just prior to the whistle." The 63 chief surgeon and his SHAEF superi- On reserve ambulances and trains, see file HD

ETO 451.8 (Amb), 1942-44; Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Daily Diary, 19, 22, and 27 May 44, file HD 024

ETO. On supplies, see Surg, UKB, OVERLORD

Resume, p. 12, file HD 370; Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec.

VI; Fenton Interv, 7 Jun 45, box 222, RG 112,

NARA; Surg, United Kingdom Base, Annual Rpt.

1944, pp. 34-35. On exchange units, see First U.S.

Army Report of Operations, 20 Oct 43-1 Aug 44,

bk. VII, p. 75; Directive, HQ, ETOUSA, to CG,

FUSAG, and Cdr, US Fleet, TF 122, 19 May 44,

sub: Initial Evacuation of Casualties From Far to

Near Shore . . . , in Larkey "Hist," ch. 8, app. 5.

64

 For number of beds, see Memo, Maj D. J.

Twohig, MC, to CSurg, 1 Jun 44, sub: Status of

Evaucation, EvacCorresp, 1944-45, file HD 370.05

ETO. See also Surg, UKB, OVERLORD Resume,

pp. 13-14, file HD 370; Larkey "Hist," ch. 8, pp.

49-50; Surg, United Kingdom Base, Annual Rpt,

1944, p. 16; Hospitalization Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, p. 21; 12th Evacuation Hospital Annual Rpt, 1944, pp. 6-8. For bed

clearing, see EvacCorresp, 1942-44, file HD 024

ETO; file HD 024 ETO CS (Hawley Chron) for

April-June 1944; and Hawley Interv, 1962, p. 58,

CMH.
200 EUROPEAN THEATER OF OPERATIONS

or, General Kenner, expressed guarded confidence in the sufficiency of

their preparations. Kenner declared:

"The British and U.S. medical services are organized and prepared to

adequately support Operation OVERLORD." Confirmation of the truth of

Hawley's and Kenner's estimates no

longer rested in their hands. It depended on the performance of thousands of aidmen, doctors, technicians,

and nurses on the ships and in the

aircraft heading for Normandy.65

65

 First and second quotations from Ltr, Hawley to

TSG, 3 Jun 44, file HD 024 ETO O/CS (HawleySGO Corresp). Third quotation from Memo,

Kenner to CofS, via ACofS, G-4, and CAdminOff,

20 May 44, sub: Report of Inspection of Medical Facilities, SBS, 9-13 May 44, in Medical Division,

COSSAC/SHAEF, War Diary, May 1944.
CHAPTER VII

Introduction to Battle

On 6 June 1944 U.S. and British

forces went ashore along a 40-mile

stretch of the Normandy coast. Following the NEPTUNE plan, 13,000

parachute and glider troops of the

82d and 101st Airborne Divisions,

who landed just after midnight in the

Cotentin countryside behind UTAH

beach, opened the American part of

the attack. Widely scattered and badly

disorganized in the drop due to navigation errors, high winds, and enemy

antiaircraft fire, each division managed to assemble enough men and

equipment to accomplish at least part

of its D-Day mission. In confused vicious fighting against initially uncoordinated but increasingly stubborn and

aggressive German opponents, the

airborne troops by the end of D-Day

had opened the way inland for the

seaborne forces across the flooded

areas behind UTAH beach, and they

were well on the way to securing the

lodgement's western and southern

flanks.

The amphibious assault task forces,

Force U for UTAH and Force O for

OMAHA, dropped anchor in their assembly areas 12 miles off the coast at

about 0230. H-hour for the first landings was 0630, when low tide would

uncover for demolition the German

obstacles that studded both UTAH and

OMAHA between high and low water

lines. As the troops transferred from

transports to landing craft, a gusty

northwest wind kicked up a choppy

sea, tossing about the smaller craft

and quickly overcoming antiseasickness efforts. At about 0530 the Germans, hitherto passive, opened artillery fire; fifteen minutes later the final

Allied naval bombardment began, as

the assault waves headed for the

beaches. About on schedule, the first

bow ramps went down.

At UTAH Maj. Gen. J. Lawton Collins' VII Corps, the 4th Infantry Division leading, went ashore almost unopposed. Quickly overcoming beach

defenders, who were few in numbers

and were distracted by the airborne

attack behind them, the infantry

pushed inland over causeways crossing the inundated areas. Elements of

the 1st Engineer Special Brigade, supporting this assault, cleared away

mines and obstacles; opened vehicle

routes across the beach; readied the

causeways for heavy traffic; and set up

supply dumps, harassed only by a few

snipers and by sporadic German

shelling. By the end of the day 23,000

of the 32,000 troops of the initial

UTAH assault force were ashore. The
202 EUROPEAN THEATER OF OPERATIONS

4th Division had established contact

with the 101st but, as yet, not with

the 82d.

At OMAHA the V Corps, under Maj.

Gen. Leonard T. Gerow, had the

day's hardest, costliest fight. The

corps landed with two regiments

abreast, both under operational control of the 1st Infantry Division: the

116th Infantry of the 29th Infantry

Division on the right, and the 1st Division's own 16th Infantry on the left.

Two engineer units supported the infantry, the 6th Engineer Special Brigade going in with the 116th and the

5th Engineer Special Brigade with the

16th. The first assault waves ran into

a strong, well-entrenched German infantry division not previously spotted

by Allied reconnaissance, its defense

little affected by preliminary air

strikes and naval bombardments.

Losses among troops and landing

craft were heavy, and the attackers

were pinned down along the high

water mark for much of the day.

Gradually, aided by naval gunfire and

reinforced by later landing waves,

they overcame the defenders and

worked their way inland. By nightfall

about 34,000 troops of the 55,000-

man assault force were ashore. The

corps, however, had fallen far short of

its D-Day objective. Its advance position constituted more a series of islands than a continuous line. German

snipers and strongpoints remained

unsubdued at many points on the

beach, most of which still was under

enemy artillery fire.

The ordeal on OMAHA notwithstanding, the Allies on D-Day had

broken the Nazi coastal defenses.

During the next few days troops and

supplies flowed in over increasingly

secure and well-organized beaches.

Inland from OMAHA the 1st and 29th

Divisions, reinforced by the 2d Infantry Division, expanded their lodgement to the south, southwest, and

west, against weakening resistance.

The 4th Division at UTAH made firm

contact with the airborne divisions

and attacked northward. At the same

time the 82d pushed westward in the

Cotentin, while the 101st drove south

to link up the two beachheads, an objective it achieved on 11 June (D + 5).1

The human cost of securing the

lodgement was substantial, but much

less than expected. On D-Day the

hard-hit V Corps suffered about

2,400 dead, wounded, and missing;

the 4th Division, by contrast, reported

only 200 casualties; and the two airborne divisions together lost about

2,400 men. Of these 5,000 casualties,

perhaps 3,000 were wounded—a total

well under the anticipated 12 percent

of the assault force. This number was

within the treatment and evacuation

capabilities of the medical forces

ashore on D-Day, even though those

forces endured their share of the

losses and vicissitudes of battle.2

1

 This summary of the tactical situation is based

on Harrison, Cross-Channel, chs. VIII and IX; Ruppenthal, Logistical Support, 1:10; First U.S. Army

Report of Operations, 20 Oct 43-1 Aug 44, bk. I,

pp. 40-46; Rpt, Provisional Engineer Special Brigade Group (hereafter cited as ProvESBGp), 30 Sep

44, sub: Operation NEPTUNE, 26 Feb-26 Jun 44,

pp. 75-103. 2

 D-Day casualties are summarized in Charles B.

MacDonald, The Mighty Endeavor: American Armed

Forces in the European Theater in World War II (New

York: Oxford University Press, 1969), p. 279. V

Corps casualties are broken down into dead,

wounded, and missing in Rpt, V Corps, sub: Operations in the ETO, 6 January 1942 to 9 May 1945,

p. 64. For airborne losses, see Harrison, Cross-Channel, pp. 28 n and 300.
INTRODUCTION TO BATTLE 203

The Assault

The burden of treating and evacuating First Army casualties on D-Day

and during the days immediately

thereafter fell largely on the medical

elements of the airborne and infantry

divisions and the engineer special brigades, and on the teams of the 3d

Auxiliary Surgical Group. These

forces worked under control of the

assault corps surgeons: Col. Charles

E. Brenn, MC, of V Corps on OMAHA

and Col. Paul Hayes, MC, of VII

Corps on UTAH.3 Hayes' area of responsibility included the airborne divisions, as well as the seaborne forces.

Until the beachheads joined, these officers performed most of the tasks of

an army surgeon, rather than the

more limited duties usually done at

corps level.

Regimental and battalion surgeons

and aidmen of the two airborne divisions were the first Army Medical Department soldiers to set foot in Normandy. In each division they dropped

by parachute or rode in on gliders

with their organizations—nine officers

and sixty enlisted men with each

parachute regiment and seven officers

and sixty-four men with each regiment of glider infantry. Anticipating

heavy drop losses and days of isolation behind enemy lines, unit medics

landed with all the extra supplies and

equipment they could collect—either

carried on their persons, parachuted

down in special containers, or packed

in glider-borne vehicles. The 101st

Division, for example, went into Normandy with 250 litters and 2,500

blankets above its regular allowance,

25 instead of the regulation 7 aerial

delivery containers per regiment, and

2,000 units of plasma. The 101st's

field artillery battalion brought along

2 complete sets of aid station equipment. Each paratrooper carried 2

British-made individual dressings and

a copper sulphate sponge for use on

phosphorus burns.4

Much of this equipment—and many

of the people carrying it—were lost,

as paratroopers and gliders plunged

into the hedgerow-lined fields and

marshy river bottoms of the Cotentin

and as men in the early morning

darkness began the tense, deadly

hide-and-seek game of finding comrades, assembling units, and getting

on with their missions. Airborne medical personnel were as badly scattered

in the drops as everyone else. In the

82d Division 50 percent of the medical officers were unaccounted for

during the first seventy-two hours of

combat; in one of the 101st's battalions, which landed in swamps, only

two members of a sixteen-man medical detachment initially rallied with

the unit. For some medics the war

ended quickly as they ran into Germans and were captured or—rarely, if

clearly identified—shot. The 101st

during June lost 20 percent of its

medical personnel, most of them in

the first days. Equipment losses were

equally heavy. The 101st recovered

only 30 percent of its air-dropped

supply containers, and its surgeon

later concluded that it was a mistake

to drop so much matériel in the early

3

 Col. Hayes was replaced as VII Corps surgeon

on 4 July 1944 by Lt. Col. Robert H. Barr.

4

 Surg, 82d Airborne Division, Annual Rpt, 1944,

an. I, p. 1; Surg, 101st Airborne Division, Annual

Rpt, 1944, pp. 1-2; Interv, OSG with Capt Ernest

Gruenberg (hereafter cited as Gruenberg Interv), 13

Jun 45, box 222, RG 112, NARA.
204 EUROPEAN THEATER OF OPERATIONS

hours, when the surgeons did not yet

need it and darkness made it almost

impossible to find.

During the first hours on the

ground, medical officers and aidmen

collected what supplies they could

locate. They made contact with other

paratroopers, gave first aid to men injured in the jump or in glider crashes

and in the first firefights, and worked

their way toward battalion assembly

areas. Especially in the 82d Division,

elements of which landed farthest

inland, small groups of paratroopers

were cut off from their units for days.

Injured and wounded soldiers with

these groups received at best improvised care, even if their chance-met

companions included medical officers

and aidmen. Some groups, forced to

maneuver to avoid Germans or driven

from their positions by counterattacks, had to leave their wounded

behind to be captured, frequently

along with medical personnel who

voluntarily stayed with their patients.

At isolated positions, wounded men

died for lack of plasma. Other cut-off

groups were more fortunate. Medical

officers with them managed to salvage

equipment for adequate first aid and

in at least one case secured milk and

food for the wounded from French

farmers.

Medical officers and men who

reached their battalion assembly areas

set up rough-and-ready aid stations,

usually near their unit command

posts. At these stations improvisation

was the common practice, as surgeons

scavenged for supplies and commandeered farm wagons and captured

enemy vehicles to collect wounded

from widespread company positions.

In the 1st Battalion, 502d Parachute

Infantry, a 101st Division unit, the

battalion commander, Lt. Col. Patrick

J. Cassidy, and his surgeon, Capt.

Frank Choy, MC, secured a small cart

and a horse to pull it and drafted a

dental technician to drive it. "All day

long," according to a battalion report,

"this boy drove up and down the

roads, exposing himself to sniper fire,

working like a Trojan, to bring in the

wounded and the parachutists who

had been hurt on the jump; his

energy saved countless lives." During

much of the day Colonel Cassidy,

who had to send his surgeon to treat

an untransportable casualty at an outlying position, acted as his own medical officer. Cassidy, and the medical

sergeant who remained with him, decided which badly wounded men

should receive their limited supply of

plasma, and the battalion commander

personally helped retrieve medical

supply bundles from the surrounding

fields. Because his drop zone was just

inland from UTAH, Cassidy was able

to evacuate many of his casualties to

the beach late in the afternoon, after

making contact with the 4th Division.5

Although a few units, such as Cassidy's, sent casualties directly to the

beach, most airborne wounded went

from battalion aid stations, and often

from where they fell, to the clearing

stations set up by their division medical companies. These companies,

each of which included an attached

team from the 3d Auxiliary Surgical

Group, deployed in Normandy on D5

 This account of unit medical support is based on

Surg, 82d Airborne Division, Annual Rpt, 1944, an.

I, pp. 1-2; Surg, 101st Airborne Division, Annual

Rpt, 1944, pp. 2-6; Gruenberg Interv, 13 Jun 45,

box 222, RG 112, NARA, and in RG 407, NARA,

82d Airborne Division Combat Intervs, box 24057,

and 101st Airborne Division Combat Intervs (source

of quotation), box 24072.
INTRODUCTION TO BATTLE 205

Day in several echelons. An advance

element of each company, with the division surgeon and the auxiliary surgical team, went in by glider around

dawn with enough hand-carried and

air-dropped instruments and equipment for a small emergency surgical

station. The rest of the personnel,

with the company vehicles and the

balance of the clearing station outfit,

arrived during the late afternoon by

glider and, in the case of the 101st

Division, partly by sea.

An advance element of the 101st's

326th Airborne Medical Company

parachuted in with the infantry at

0100. As many of the four officers

and forty-five men of this detachment

as could reach their rendezvous improvised a small hospital in a French

farmhouse near Hiesville, the division

command post site about 5 miles

from UTAH beach. The group performed first aid and emergency surgery here until well into D+1 (7

June), when it joined the rest of the

company. About two hours behind

this advance group two gliders arrived carrying the 326th Company

commander, Maj. William E. Barfield,

MC, and seven officers and twentyone men, including the auxiliary surgical team, with four jeeps and trailers. Although both gliders crashlanded, painfully injuring every

member of the surgical team, the men

retrieved most of their gear and maneuvered around German positions

toward the Chateau Colombierre, just

north of Hiesville, selected on the

basis of preinvasion aerial reconnaissance as the site for the division clearing station. They arrived at about

0700, just as paratroopers were driving German defenders out of the

buildings.

By early afternoon the members of

the original party, reinforced by other

medical officers and men who straggled in, had a rudimentary surgical

hospital and clearing station in operation. Surgeons worked at three

tables, as the chateau courtyard filled

with casualties brought in on improvised litters, horses, and captured

trucks. Living on D-bars and Benzedrine, the surgeons treated about 300

patients during the day. In the

evening another glider lift of the

company and the seaborne element,

which had landed on UTAH, reached

the chateau. But even with this reinforcement, which included Lt. Col.

David Gold, MC, the 101st Division

surgeon, the number of wounded arriving all but overwhelmed the staff.

The surgical team leader, Maj. Albert

J. Crandall, MC, recalled: "We had to

maintain a careful priority system, operating on those who were most in

need of surgery and giving the others

emergency treatment." In surgery,

"first we did the heads and chest and

next the abdomens and extremities."

 6

An advance group of the 82d Division's 307th Airborne Medical Company, with the division surgeon, Col.

Wolcott L. Etienne, MC, and a surgical team, also went in by glider before

dawn. Shrapnel from German antiaircraft fire wounded Colonel Etienne

before he even touched ground; the

same fire caused the gliders to overshoot their planned landing zone at

Blosville near Ste.-Mere-Eglise, a

6

 Surg, 101st Airborne Division, Annual Rpt,

1944, pp. 2-3; 3d Auxiliary Surgical Group Annual

Rpt, 1944, pp. 17-19; Capt W. P. McKee Recorded

Rpt, pp. 2-4. Quotation from Interv, OSG with Maj

A. J. Crandall (hereafter cited as Crandall Interv), 8

Jun 45, box 222, RG 112, NARA.
206 EUROPEAN THEATER OF OPERATIONS

major division objective, and crash

land at Hiesville. Medics were scattered in the landing and lost much

equipment. Some of them, including

the surgical team leader, Maj. James J.

Whitsitt, MC, found their way to Chateau Colombierre, where they assisted

326th Company doctors for the rest

of the day. The bulk of the 307th

Company arrived in gliders near Ste.-

Mere-Eglise in the late afternoon and

also ran into hard luck. Many gliders

plunged into flooded areas, and the

landing zone came under shelling that

killed the company commander. In

spite of these setbacks, the company

pulled itself together and had its

clearing station in operation at Blosville by morning of the seventh.7

During the first few days after DDay the airborne division medical service lost its improvised, irregular

character and gradually came to resemble that of a conventional infantry

division. Both the 82d and the 101st

Divisions remained fully committed to

hard offensive combat, and the flow

of wounded through their aid stations

and clearing companies was steady

and substantial. On 8 June alone the

326th Company treated and evacuated over 400 casualties. On the ninth

the 326th was bombed out of its chateau, fortunately just after evacuating

most of its patients. The company,

however, lost 5 officers and 9 enlisted

men wounded and 8 enlisted men

killed, as well as much of its equipment. Obtaining new equipment and

personnel replacements from VII

Corps, the company resumed work

the next day at a new site near Hiesville. On D-Day the 326th Company

evacuated a few wounded to the 261st

Medical Battalion of the 1st Engineer

Special Brigade at UTAH beach and

then kept up a steady seaward flow of

patients, mostly carried in Quartermaster Corps trucks (Map 7). Ambulances of the VII Corps medical battalion began evacuating the company

on the ninth. The 82d Division's

clearing station had accumulated 300

patients before starting evacuation to

the beach on the seventh, using borrowed trucks and ambulances, many

of them from the 4th Division's 4th

Medical Battalion. The clearing company of the latter unit received, treated, and evacuated many airborne soldiers during its first days on shore; at

times half the wounded passing

through the infantry division clearing

station were parachute and glider

troops.8

On UTAH beach, the landing of

medical units and the establishment

of the initial chain of evacuation went

about as smoothly as an operation

could go under combat conditions.

Company aidmen and battalion medical sections of the 4th Division landed

first, followed closely by the nine officers and seventy-two hospital corpsmen of the 2d Naval Beach Battalion.

Collecting companies of the 4th Medical Battalion came in with the regiments they supported, bringing most

7

 VII Corps Medical Plan, pp. 14-15, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; Surg, 82d Airborne Division, Annual Rpt, 1944, pp. 3-4 and an.

I, p. 1; 3d Auxiliary Surgical Group Annual Rpt,

1944, pp. 16-17; 307th Airborne Medical Company

Annual Rpt, 1944.

8

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 65-66; VII Corps Medical

Plan, p. 15, encl. 1 to Surg, VII Corps, Annual Rpt,

1944; Surg, 82d Airborne Division, Annual Rpt,

1944, an. I; Surg, 101st Airborne Division, Annual

Rpt, 1944, p. 2; Medical Service, 101st Airborne Division, After-Action Rpt, 6-25 Jun 44; Crandall

Interv, 8 Jun 45, box 222, RG 112, NARA.
INTRODUCTION TO BATTLE 207

MAP 7

of their thirty ambulances. In spite of

day-long sporadic artillery fire, which

killed a medical officer and several

enlisted men on the beach, wounded

the regimental surgeon of the 12th

Infantry, and peppered the 4th Medi- cal Battalion's ambulances with shrap- nel, the division medical elements

rapidly moved inland. The Navy

corpsmen organized two beach aid

stations, collected the few casualties

of the assault, and loaded on DUKWs

and landing craft for movement to

LSTs offshore. At about 1000 the

first engineer special brigade unit, Company C, 261st Medical Battalion,

arrived on the beach, followed two

hours later by Company A. These

two "collecto-clearing" companies,

formed by combining the litter and

ambulance elements of a collecting

company with a platoon from the bat- talion's clearing company, set up sta- tions at a crossroads just behind the

flooded area. Their attached surgical

teams began performing operations at

around 1800, carrying out their mis- sion of providing emergency surgery
208 EUROPEAN THEATER OF OPERATIONS

for nontransportable patients. These

clearing stations evacuated few

wounded to the beach during the first

hours, as casualties from the airborne

divisions and the 4th Medical Battalion did not start flowing back in significant numbers until the following

day. Between 2100 and 2130 the VII

Corps surgeon, Colonel Hayes, and

the 4th Division surgeon, Lt. Col.

Robert H. Barr, MC, landed with

members of their staff sections.

During the next three days VII

Corps medical support expanded, as

did the corps and its beachead. The

4th Division's clearing company,

scheduled to land late on D-Day but

held back in favor of additional

combat units, came ashore on 7 June

and went into operation at Hebert, a

crossroads village just beyond the inundated area. Later the company followed the 4th northward. By the

ninth two more infantry divisions—

the 9th and 90th—had disembarked,

each with its full medical complement. Clearing stations of these divisions opened in the general vicinity of

Ste.-Mere-Eglise. The rest of the

261st Medical Battalion, meanwhile,

landed on the seventh. The battalion

established a medical supply depot. Its surgical teams worked around the

clock to handle an increasing flow of

casualties, as the divisions attacking

northward and westward from UTAH

met strong German opposition. Between 8 and 12 June the VII Corps'

50th Medical Battalion disembarked.

The battalion's clearing company, besides supporting corps troops, its

normal role, took part of the burden

of general medical and surgical care

from the 261st's companies, and its

collecting and ambulance companies

evacuated division clearing stations to

the 261st and helped move patients

from that unit to the Navy beach stations. On the ninth the Lady Connaught, first of what was to be a regular series of hospital carriers,

anchored off UTAH. She discharged

supplies and six additional surgical

teams for the 261st Medical Battalion,

allowing relief to the battalion's original teams that had worked for 36

hours with little rest. The carrier took

on board 400 wounded for the return

voyage to England. As the first army

field and evacuation hospitals opened

on 10 and 11 June, the VII Corps

medical service was well into the transition from an amphibious to a conventional land organization and

system of support.9

On OMAHA the story was different.

This beach, about 5 miles from end

to end, consisted of a tidal flat bordered at the high water mark by an

embankment of loose stones, called

shingle, backed on the eastern portion by sand dunes and on the western by a wooden seawall 4-5 feet

high. At varying distances from the

shingle, usually 200-300 yards, rose

low bluffs, too steep to be negotiated

by vehicles except through five draws

that the Germans had mined and

blocked with obstacles. The defenders, entrenched on and in front of the

bluffs in pillboxes and machine-gun

nests, met the first assault waves with

9

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 65-67 and 96; Surg, First

U.S. Army, Annual Rpt, 1944, p. 33; VII Corps

Medical Plan, pp. 13-17, encl. 1 to Surg. VII Corps,

Annual Rpt, 1944; Dowling, Normandy Rpt, 11 Jan

45, pp. 17-18; 3d Auxiliary Surgical Group Annual

Rpt, 1944, pp. 13 and 20; 4th Medical Battalion

Report of Operations, 6-30 Jun 44, box 6727, RG

407, NARA; 50th Medical Battalion Annual Rpt,

1944, pp. 2-3.
MEDICS ADMINISTERING FIRST AID TO INVASION CASUALTIES ON UTAH (top) AND

OMAHA (bottom)
210 EUROPEAN THEATER OF OPERATIONS

heavy fire. As the landing craft nosed

into shore, German machine-gun

nests cut down many Americans

before they even left the bow ramps

and others as they struggled across

the tidal flat. Artillery shells sank, set

on fire, or blew up one landing craft

after another. Wading and crawling

across the sand, pushed by the now

rising tide, dragging their wounded,

and losing or abandoning weapons,

radios, and equipment, the assault

troops sought cover from the searching fire behind the seawall and shingle pile. The American units took

their heaviest losses of the day in this

movement up to the high water line;

one 16th Infantry company suffered

most of its 105 D-Day casualties here.

Exhausted from seasickness and the

struggle ashore, the survivors tried to

clear sand-clogged weapons, to rescue

and tend wounded, to demolish beach

obstacles, and to cut the barbed wire

the Germans had laid along the shingle pile.

Troops and vehicles of the first and

subsequent landing waves remained

bunched along the high water line for

much of the day. Around 0800 small

intrepid groups began pushing across

the beach to the foot of the bluffs and

then working their way up the hills.

One by one, they eliminated German

strongpoints, aided after about 1030

by point-blank naval gunfire. Landing

of reinforcements, temporarily halted

when high tide covered the beach obstacles, resumed when landing craft

commanders discovered that they

could ram through safely. During the

afternoon the trickle of men across

the beach and over the bluff became a

flood. The arrival of two additional

infantry regiments gave still more momentum to the inland drive. As darkness fell, the infantry had partially secured the objective towns of Vierville

on the western end of the beach, St.-

Laurent in the center, and Colleville

on the east. The engineers, using

what equipment they could salvage,

cleared mines, bulldozed openings for

vehicles through the shingle opposite

several of the beach exit draws, and

began developing roads through the

draws themselves.10

The near-catastrophe of D-Day

morning and the resulting delay of

the advance inland telescoped the

elaborately sequenced arrival of medical units. Organizations landed off

schedule and on the wrong beach sectors, often losing much of their

equipment. Regardless of type or intended function, each unit and detachment, as it plunged into the

welter between the low tide line and

the bluffs, dissolved into scattered

groups of men, working desperately

under fire to drag wounded to places

of relative safety, to give first aid, and

to salvage supplies.

The battalion and regimental medical sections and attached divisional

collecting companies of the 16th and

116th Regimental Combat Teams,

closely followed by the officers and

hospital corpsmen of the 6th and 7th

Naval Beach Battalions, came ashore

early in the morning, just after the

first assault companies had been shot

to pieces. The medical soldiers took

their share of casualties. The 2d Battalion, 116th Infantry, lost five

aidmen, killed leaving their landing

craft, and its surgeon, wounded on

10

 This account is based on 1st Infantry Division

Combat Intervs, box 24011, and 29th Infantry Division Combat Intervs, box 24034, RG 407, NARA.
INTRODUCTION TO BATTLE 211

the beach by shrapnel. Other medics

quickly fell as they tried to drag casualties out of the rising water. As

German artillery blasted the landing

craft, medical supplies went up in

flames or disappeared under the

waves; the 116th Infantry lost its

entire regimental supply of plasma in

two LCIs (landing craft, infantry)

sunk off the beach.11

Maj. Charles E. Tegtmeyer, MC,

regimental surgeon of the 16th Infantry, who landed at about 0815, described what faced those medical

troops who survived the wade and

crawl through the obstacles to the

shingle pile:

The shelf on which I rested was about ten

yards in width sloping upward from the

water's edge to a height of from two to

ten feet at an angle of roughly 35 de- grees. Face downward, as far as eyes

could see in either direction were the

huddled bodies of men living, wounded

and dead, as tightly packed together as a

layer of cigars in a box. Some were franti- cally but ineffectually attempting to dig

into the shale shelf, a few were raising

themselves above the parapet-like edge

and firing toward the concrete protected

enemy and those on the cliff above but

the majority merely huddled together

face downward. Artillery . . . and mortar

shells exploded on the beach and in the

water . . . and threw fragments in all di- rections. Uncomfortably close, overhead, machine gun and rifle bullets grazed the

top of the ledge . . . and plunged into

the water behind us with innumerable

sharp hisses or whined away in to the dis- tance as they richocheted off the stones

of the beach. At the water's edge floating

face downward with arched backs were innumerable human forms eddying to and

fro with each incoming wave, the water

above them a muddy pink in color. Floating equipment of all types like flotsam

and jetsam rolled in the surf mingled with

the bodies. . . . Everywhere, the frantic

cry, 'Medics, hey, Medics,' could be heard

above the horrible din.12

Among the company aidmen on

OMAHA, heroism was the only standard procedure. Under the punishing

fire, often themselves wounded, these

soldiers worked up and down the

shingle pile, bandaging, splinting,

giving morphine and plasma if they

had any. Many ventured repeatedly

back into the water to pull in the disabled and drowning or to retrieve

medical supplies. Others went into

minefields to carry out injured men.

A 29th Division staff officer with

116th Infantry recalled: "First-aid

men of all units were the most active

members of the group that huddled

against the seawall. With the limited

. . . facilities available to them, they

did not hesitate to treat the most

severe casualties. Gaping head and

belly wounds were bandaged with the

same rapid efficiency that was dealt to

the more minor wounds." As the infantry filtered in to the base of the

bluff, the medics took additional risks

to drag wounded to the shelter of the

hill. Paradoxically, most evacuation

on OMAHA in these first hours was

forward, toward the enemy.13

11

 For overviews of D-Day medical operations on

OMAHA, see First U.S. Army Report of Operations,

20 Oct 43-1 Aug 44, bk. VII, pp. 62-63; Surg, V

Corps, Annual Rpt, 1944, pp. 2-3; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 9. For medical

losses in the initial assault, see 1st Infantry Division

Combat Intervs, box 24011, and 29th Infantry Division Combat Intervs, box 24034, RG 407, NARA.

12

 Col Charles E. Tegtmeyer, MC, "Personal Military Diary" (hereafter cited as Tegtmeyer "Diary"),

pt. 1, ch. 20, pp. 1-5. 13

 Quotation from Lt. Jack Shea, D-Day Narrative,

in 29th Infantry Division Combat Intervs, box

24034. See also other company narratives in this

collection and in the 1st Infantry Division Combat

Intervs, box 24011. All in RG 407, NARA.
212 EUROPEAN THEATER OF OPERATIONS

The work of Major Tegtmeyer and

his 16th Infantry medical section typified the character of regimental medical support on OMAHA.

 14 Landing with

the regimental commander, Col.

George A. Taylor, and his staff on

Easy Red sector, the left center of the

beach, Tegtmeyer and his aidmen followed the command group back and

forth along the shingle pile as Taylor

tried to organize an advance toward

the bluffs. The medical soldiers, now

wading, now stumbling over prone

men, bandaged and splinted wounded

as they came upon them, then left

them in the shelter of the embankment with instructions to call for help

and evacuation to incoming landing

craft. "I examined scores as I went,"

Tegtmeyer declared, "telling the men

who to dress and who not to bother

with."

At around 1040 the medical section

followed the rifle companies off the

beach and set up an aid station near

the regimental command post, dug

into the seaward slope of the bluff,

which sheltered them from direct

enemy fire. The group used what supplies they had carried ashore, plus

two litters and some other matériel

they picked up on the beach. Troops

from the first waves were still thick on

the shore below Tegtmeyer's position, and landing craft kept bringing

in more under shelling that steadily

added to the number of dead and

wounded littering the sand. Tegtmeyer sent aidmen down to the beach

and along the bluff to collect casualties and by nightfall had over eighty

wounded at his station. Running low

on blankets and plasma, he secured

more from a passing battalion of the

newly landed 26th Infantry, the commander of which he knew. Even with

these supplies, men came in that

emergency care could not save, such

as the infantryman with one leg traumatically amputated and multiple

compound fractures of the other. "He

was conscious and cheerful," Tegtmeyer reports, "but his only hope was

rapid evacuation, and at this time

evacuation did not exist. An hour

later he was dead."

Around 2200 an auxiliary surgical

team, which had become separated

from its engineer special brigade,

reached Tegtmeyer's position, but the

surgeons lacked equipment and did

little but dig foxholes for shelter

against the continuing artillery bombardment. More useful were the

twelve litterbearers of Company A,

1st Medical Battalion, the 16th Infantry's attached collecting company,

who appeared with their commander,

Captain Ralston, shortly after the surgical team. This company was scheduled to land with the regiment in the

morning, but enemy guns had set

their landing craft on fire during two

unsuccessful attempts to beach. Ralston and his men had worked heroically, rescuing soldiers and sailors

from burning holds and compartments and treating the injured who

encumbered the decks. After the craft

limped seaward to a transport and

unloaded its casualties, Ralston rallied

his tired, shocked company; got them

onto another craft; and disembarked

them on OMAHA at about 1700. Then

14

 This account is based on Tegtmeyer "Diary,"

pt. 1, ch. 20, pp. 5-15, from which the quotations

come; Rpt, Maj Charles E. Tegtmeyer, sub: Activities of Medical Detachment, 16th Infantry, and

Company A, 1st Medical Battalion, After-Action

Rpt, both in 1st Infantry Division Combat Intervs,

box 24011, RG 407, NARA.
INTRODUCTION TO BATTLE 213

he and part of his command found

their way to Tegtmeyer.

With the help of Ralston's litterbearers Tegtmeyer began moving his

patients down to the beach, the ambulatory cases walking and the rest laboriously carried on litters. All but

about ten of the most severely injured

arrived at the beach station the Navy

now had in operation before renewed

shelling halted the evacuation. Because no more landing craft were

coming in, the wounded on the beach

stayed there all night, tended by Navy

corpsmen. Tegtmeyer's group and

the remaining patients spent a cold,

damp night in foxholes, during which

time four more of the injured died.

During the early afternoon the

engineer special brigade medical battalions began landing. Both special

brigades—the 6th, responsible for organizing the western half of OMAHA

behind the 116th Infantry; and the

5th, in charge of the eastern half

behind the 16th Infantry—were

formed into battalion beach groups

for the assault, with a group attached

to each regimental combat team. Each

beach group included one or more

companies from the brigade medical

battalion. The 6th Brigade's 60th

Medical Battalion was organized conventionally in one clearing and three

collecting companies; its 500th Collecting Company and a platoon of the

634th Clearing Company came ashore

with the battalion beach group supporting the 116th Infantry. The 5th

Brigade's 61st Medical Battalion, like

its UTAH beach counterpart, had

formed three provisional collectoclearing companies. Of these, the

391st Collecto-Clearing Company

landed first, behind the 16th Infantry.

Each clearing and collecto-clearing

company had attached teams of the

3d Auxiliary Surgical Group. Besides

the clearing station and operating

room equipment packed into their

trucks, each company went in heavily

laden with hand-carried supplies. Men

of the 61st's 393d Collecto-Clearing

Company, for example, landed with

mortar shell casing containers and

waterproofed dufflebags filled with

dressings, bandages, tourniquets,

sulfa powder, and plasma. Every litterbearer took along an extra litter

with a life belt attached, to float the

litter ashore if he lost hold of it.15

During D-Day these medical battalions were only partially able to perform their evacuation tasks, and they

could not undertake emergency surgery at all. For the most part, their

officers and men simply joined in the

general effort at casualty collection,

first aid, and supply salvage. Such was

the fate of the small advance party of

the 60th Medical Battalion, which

landed at 0855 on Easy Green sector

below St.-Laurent, to reconnoiter a

previously selected clearing station

site. German troops still controlled

the site, and the officer and enlisted

men of the advance party worked all

day with regimental and Navy medics

along the beach. Between 1400 and

1500 the bulk of the 500th Collecting

Company and part of the 634th

Clearing Company came ashore on

15

 For the assault, the 5th Brigade had operational

control of all 6th Brigade elements, even as the 1st

Division controlled the first 29th Division elements

on shore. When the brigade group headquarters

landed, which occurred late on D-Day, 6th Brigade

units reverted to control of their parent brigade.

See Rpt, ProvESBGp, 30 Sep 44, sub: Operation

NEPTUNE, pp. 36-38 and 327-28; 61st Medical

Battalion Annual Rpt, 1944, pp. 1-6; 393d CollectoClearing Company Annual Rpt, 1944, p. 8.
214 EUROPEAN THEATER OF OPERATIONS

Easy Green. The units lost men and

equipment on the way in. Casualties

included Lt. Col. Bernard E. Bullock,

MC, the battalion commander, who

landed with the 500th Company, only

to be mortally wounded within minutes. Men of these two companies

spread out along most of the western

half of OMAHA, setting up casualty

collecting points and helping Navy

beach detachments load evacuation

craft. Late in the day the 634th Company platoon, which had managed to

land a truckload of ward and operating room equipment, moved off the

beach through exit D-3 and set up an

aid station part way up the draw

toward St.-Laurent.16

Due to a breakdown of the landing

sequence, the first men of the 61st

Medical Battalion to wade ashore on

Easy Red sector at about 1345 were

members of the headquarters detachment. They landed with typewriters,

files, and office supplies on a beach

still strewn with dead and wounded.

Putting this matériel aside (they later

managed to save the battalion

records), the headquarters men scavenged for medical equipment and

went to work on the casualties around

them. Around 1400 the 391st Collecto-Clearing Company, which

should have landed before the headquarters element, came in on Easy

Red and set up a dressing station in a

captured pillbox; this unit also had to

rely on hand-carried and scavenged

equipment, as its heavy gear remained on board ship. A couple of

hours later the 393d Collecto-Clearing Company disembarked with the

18th Infantry, far to the right of the

391st and almost in the 6th Brigade

sector. This company set up a collecting station in an antitank ditch under

the bluff northeast of St.-Laurent.

These companies, and the 61st Battalion headquarters, suffered five enlisted men killed and five officers and

twenty men wounded on D-Day.17

Forward emergency surgery never

got started on OMAHA during the first

twenty-four hours. Of twelve teams

attached to the 60th and 61st Medical

Battalions, eight succeeded in reaching shore between 1130 and 1730,

after various harrowing adventures on

board misdirected, damaged, and

sunk landing craft. Invariably, they arrived on the beach without operating

equipment. Even if they reached their

assigned collecto-clearing and clearing companies, they could do little

but pitch in with everyone else in

basic first aid, evacuation, and salvage. The Provisional Engineer Special Brigade Group commander commented that, although the auxiliary

surgeons "did heroic work on D-Day

and D+1, their skill probably was not

put to its greatest use."

 18

Throughout the day the naval

beach medical sections, aided during

the afternoon by the engineer special

brigade companies, tried to keep

wounded moving off the beach onto

landing craft. Enemy fire, the inability

of craft to approach some sectors of

the beach, and the reluctance of some

16

 Rpt, ProvESBGp, 30 Sep 44, sub: Operation

NEPTUNE, pp. 328-29; 60th Medical Battalion

Annual Rpt, 1944, pp. 5-6, 8-9, 15.

17

 Rpt, ProvESBGp, 30 Sep 44, sub: Operation

NEPTUNE, pp. 329-31; 61st Medical Battalion

Annual Rpt, 1944, pp. 4-5, 10-11, app. 3. 18

 Rpt, ProvESBGp, 30 Sep 44, sub: Operation

NEPTUNE, p. 334; 3d Auxiliary Surgical Group

Annual Rpt, 1944, pp. 13-14 and 22-29; Tegtmeyer

"Diary," pt. 1, ch. 20, p. 11.
MEN AND EQUIPMENT IN SUPPORT OF THE NORMANDY BUILDUP. Troops, with medical

evacuation vehicles, enter Carentan, and ambulances disembark across a beach.
216 EUROPEAN THEATER OF OPERATIONS

crews to stay exposed near shore long

enough to load, limited seaward evacuation and in many places prevented

it entirely. By the end of the day

medics had cleared about 830 casualties off the beach. Hundreds more remained, huddled under blankets at

collecting points or still lying where

they fell. Long after sunset, carrying

parties and a few ambulances continued to seek and pick up wounded.19

During D+1 (7 June) the organizations that had landed on D-Day

gradually assembled or finished

bringing ashore their men and equipment and began performing more or

less their intended functions (Map 8).

Regimental and battalion aid stations

and collecting companies of the 1st

and 29th Divisions evacuated their accumulated casualties to the beach and

headed inland with their units. Early

in the morning the 1st Medical Battalion's clearing company, which had

landed late on D-Day, opened its station on the bluffs northeast of St.-

Laurent. Reinforced with two auxiliary surgical teams sent up by the 61st

Medical Battalion, this station was

one of the first facilities on OMAHA

able to operate on nontransportable

cases. The 29th Division, on the other

hand, had to rely for clearing for several days on the 60th Medical Battalion, as the clearing company of the

division's 104th Medical Battalion was

slow to disembark its equipment and

could not begin work until 12 June.

Most of the 60th Medical Battalion

came ashore on the seventh. Its collecting companies helped Navy elements remove dead and evacuate casualties from the western half of

OMAHA. In the afternoon the 634th

Clearing Company opened a station

just northwest of St.-Laurent, where

its attached surgical teams began operating at about 2000 under generator-powered lights. The 61st Battalion's two companies on the eastern

half of OMAHA, still unable to bring

most of their equipment ashore, continued to function as aid and collecting stations.

Colonel Brenn, the V Corps surgeon, had landed on D-Day with part

of his section, losing most of his personal equipment and office records in

the process. On the seventh he

toured his units on foot, finding most

of them short of men and matériel

but doing their best with what they

had. Evacuation to the beach and seaward, Brenn reported, was proceeding "in dribbles," but with "no stagnation." Part of the 1st Medical

Depot Company arrived with supplies, which it and the special brigade

units began organizing into rudimentary dumps. At 1900 the hospital carrier Naushon, anchored off the beach,

unloaded a stock of whole blood for

the clearing stations and took wounded on board. The vessel remained

overnight, its surgeons operating on

emergency cases, and sailed for England on the eighth.20

19

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 62-63, estimates the

number evacuated. See also Dowling, Normandy

Rpt, 11 Jan 45, p. 16, and Rpt, ProvESBGp, 30 Sep

44, sub: Operation NEPTUNE, pp. 88 and 331. For

firsthand views, see Maj Gen C. H. Gerhardt,

"Battle Lessons and Conclusions"; and Lt. Jack

Shea, Narrative, both in 29th Infantry Division

Combat Intervs, box 24034, RG 407, NARA.

20

 Quotation from Surg, V Corps, Annual Rpt,

1944, pp. 2-3. See First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 63; Surg,

1st Infantry Division, Annual Rpt, 1944, p. 9; Rpt, Continued
INTRODUCTION TO BATTLE 217

MAP 8

During the period 8-11 June, as the

advance gathered momentum, the V

Corps medical service fully assumed

its planned shape, and its operations

displayed increasing regularity. Division clearing stations moved inland.

The ambulance platoons of the engineer special brigades and of the V

Corps, 53d Medical Battalion, which

disembarked between the seventh and

the ninth, transported wounded over

the increasing distance separating the

divisions and beach clearing stations.

On the eleventh, as the evacuation

network expanded, Colonel Brenn

and the medical section moved with

the corps command post from St.-

Laurent to La Poterie, about 5 miles

deeper in the Norman countryside.

Back at the beach the 60th and 61st

Medical Battalions, no longer under

enemy harassment except for ineffectual night air raids, brought their remaining men and equipment ashore

and developed into full-fledged clearProvESBGp, 30 Sep 44, sub: Operation NEPTUNE,

p. 333; Tegtmeyer "Diary," pt. 2, ch. 1, pp. 1-6;

60th Medical Battalion Annual Rpt, 1944, pp. 6-9,

12, 15-16; 104th Medical Battalion After-Action

Rpt, June 1944; 1st Medical Battalion After-Action

Rpt, May-June 1944, box 5966, RG 407, NARA.
218 EUROPEAN THEATER OF OPERATIONS

ing and emergency surgical facilities. The 60th Battalion clearing station

stayed near St.-Laurent, and the three

61st Battalion companies one by one

moved up from the beach onto the

bluffs east of that town. These movements, and a consolidation of naval

shore medical activities, established a

single line of seaward evacuation

across roughly the center of OMAHA

beach. By 11 June over 3,160 patients

had passed through this chain of

evacuation.21

The NEPTUNE medical planners

concentrated on two objectives in

their arrangements for supporting the

initial assault: the provision of emergency surgery on the far shore during

the first hours of combat, and the

early and complete seaward evacuation of the wounded. Measured by

these objectives, medical results on

D-Day were mixed. The First Army's

decision to place as much consumable

medical matériel—splints, litters,

blankets, plasma, morphine, and

other such items—as possible on

shore with the first troops in a wide

variety of packaging and means of

transportation proved to be a lifesaver, in the most literal sense of the

term. Even medics who reached dry

land with little more than the clothes

they stood up in seem to have been

able to pick up on the beach or, in

the airborne, scattered in the fields,

enough supplies to do their jobs.

Further, the ability of Medical Department officers and men to take individual initiative and improvise in carrying out their missions amid great

danger and confusion testified to the

effectiveness of the months of preattack training and indoctrination,

both military and medical.

On the other hand, especially on

heavily contested OMAHA, evacuation

and forward surgery arrangements

came near collapse. The tactical situation restricted early loading of

wounded on landing craft and prevented the auxiliary surgical teams

from doing any more than could have

been done by battalion medical officers and company aidmen. The commanders of the engineer special

brigade group and the 61st Medical

Battalion later criticized the rigidly

scheduled landing of surgical teams

and clearing companies, arguing that

it had resulted in the unproductive

exposure to danger of valuable specialists and equipment. Instead, they

suggested, the clearing companies

and attached teams should have been

held on vessels offshore, to be called

in when beach conditions permitted

orderly disembarkation and the immediate performance of their intended functions. In the meantime a few

companies and teams could have

staffed shipboard surgical facilities for

care of wounded brought out to them

in landing craft.22

Whatever the merits of these suggestions, experience on OMAHA—

where casualties, though heavy, still

were fewer than planners had antici21

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 63-65 and 69; Dowling,

Normandy Rpt, 11 Jan 45, p. 4; Surg, V Corps,

Annual Rpt, 1944, pp. 3-7; 53d Medical Battalion

Annual Rpt, 1944, pp. 4-5; Rpt, ProvESBGp, 30

Sep 44, sub: Operation NEPTUNE, pp. 333-34;

60th Medical Battalion Annual Rpt, 1944, pp. 6-7,

9-10, 12-14; 61st Medical Battalion Annual Rpt,

1944, p. 5; 104th Medical Battalion After-Action

Rpt, June 1944.

22

 Rpt, ProvESBGp, 30 Sep 44, sub: Operation

NEPTUNE, pp. 334 and 337-38; 61st Medical Battalion Annual Rpt, 1944, pp. 5-6.
INTRODUCTION TO BATTLE 219

pated, and where, after the coastal assault, the rapid collapse of German

resistance allowed early organization

of the beach—did much to substantiate the fears of General Kenner and

other officers that untreated, unevacuated wounded would pile up on the

far shore. In summary, the medical

service on D-Day benefited from careful planning and meticulous preparation, but the success achieved also

owed much to individual courage and

competence, and to good fortune.

First Army Medical Buildup

Between the linkup of the beachheads on 10-11 June and the end of

July, reinforcements enlarged the

First Army to over 437,000 officers

and men in eighteen divisions and

four corps. So augmented, the army

fought a hard, costly battle to take

Cherbourg, to expand its continental

lodgement, and to break out toward

Brittany and the interior of France. In

this same period the army medical

service brought all of its elements

into Normandy, completed its organization, and treated and evacuated a

constant flow of casualties (see Map 9).

Tactically, the First Army shifted its

strength and most of its offensive

effort to its right wing while holding

its ground on the left. Inland from

OMAHA, the V Corps, reinforced after

13 June by the XIX, pushed forward

about 20 miles and then stood fast.

Meanwhile, in the Cotentin, the heavily reinforced VII Corps drove on

Cherbourg, the Americans' most important early objective of the campaign. That major port fell on the

twenty-sixth, after a stubborn German

defense. With the harbor obstructed

and the wharves damaged, full use of

the port by the Allies was delayed for

many weeks.

After the capture of Cherbourg, the

First Army redeployed its Cotentin

forces southward. On 3 July most of

the army attacked into the swamp and

hedgerow country at the base of the

peninsula, with the objective of gaining roads and open ground for an armored breakout. This offensive led to

bitter, apparently inconclusive fighting. The Germans, prevented by

Allied air power and French partisans

from massing for a major early counterattack on the beaches, nevertheless

stiffened their line with a steady

stream of infantry and armor. Taking

advantage of very favorable defensive

terrain and of rainy and cloudy weather, which limited Allied air support,

the Germans fought to confine their

more mobile foes within a narrow perimeter. When the so-called Battle of

the Hedgerows ended on the nineteenth, with the American capture of

the key road center of St.-Lo, it

seemed as though the Nazis had succeeded. They had restricted the First

Army to a maximum advance of 7

miles, at the cost of about 40,000 casualties. In this offensive, and indeed

in the entire campaign thus far, the

Americans, and the British (who were

stalled around Caen), fell far short of

their planned objectives. Their continental lodgement at the end of July

included only a fraction of the territory that NEPTUNE planners had expected to hold by that time. The Germans, however, also lost heavily in

the Cotentin and the hedgerows; their

defensive crust had worn very thin

and was ready to crack, if the Allies
220 EUROPEAN THEATER OF OPERATIONS

MAP 9

could pierce it with a hard enough

blow.23

As the Normandy battle expanded,

medical reinforcements flowed in

across OMAHA and UTAH beaches. The

first medical units not attached to

corps, divisions, or engineer special

brigades to arrive, First Army Medical

Detachments A and B, disembarked

respectively at OMAHA and UTAH on 8

and 9 June, having crossed the Chan23

 This account of tactical developments is drawn

from Harrison, Cross-Channel, chs. IX-X, and Martin

Blumenson, Breakout and Pursuit, United States Army

in World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1961), chs. I-IX.
INTRODUCTION TO BATTLE 221

nel on hospital carriers. Each detachment included station and litter

platoons of two separate collecting

companies, six teams of the 4th Auxiliary Surgical Group, a platoon of a

supply depot company, headquarters

personnel of a medical group, and liaison officers from various medical

and nonmedical commands. The collecting elements and surgical teams,

and many of the other medical officers, temporarily replaced assault casualties in the divisions or reinforced

the special brigade clearing stations.

The group staff and liaison officers

made plans for landing and setting up

hospitals and other facilities and arranged for engineers to clear selected

sites and prepare them for occupation. On the ninth the army surgeon,

Colonel Rogers, and an advance party

of his staff landed on OMAHA and established themselves at the First Army

forward command post near Grandcamp-les-Bains. Rogers at once began

a round of inspections and conferences with his corps surgeons, but

temporarily left those officers in

charge of all medical activities.24

The first field hospitals came

ashore on 7 and 8 June, the 13th and

51st at OMAHA and the 42d and 45th

at UTAH, bringing with them the first

Army nurses to enter the beachhead.

After collecting their equipment, scattered in landing on the congested and

as yet only partially organized beaches, these units went into operation

near the coast on the tenth and eleventh. The engineer special brigade

clearing stations subsequently transferred their auxiliary surgical teams to

them. So reinforced, the field hospitals took over performance of most

emergency surgery. During their first

days on shore they functioned as

evacuation hospitals, receiving and

treating all types of patients.

Even as the field hospitals were

opening, the first evacuation hospital

in Normandy, the 128th, disembarked

at UTAH beach on 10 June and set up

the next day near Boutteville, about 6

miles from the coast. Other evacuation hospitals followed at both

beaches until, at the end of June, the

First Army had fourteen 400-bed

units in operation. The evacuation

hospitals behind V and XIX Corps

were concentrated around Le Cambe,

just east of Carentan, and at Le

Molay, well forward toward the advance V Corps positions around Caumont. Those supporting VII and VIII

Corps moved more frequently during

the first weeks of fighting, advancing

northward up the highways toward

Cherbourg and westward across the

Cotentin. As the evacuation hospitals

arrived, the field hospitals assumed

their intended role, attaching separate

platoons to division clearing stations

to care for nontransportable wounded.25

24

 Surg, First U.S. Army, Annual Rpt, 1944, pp. 30

and 33; First U.S. Army Rpt of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 64 and 70-71; Surg, V

Corps, Annual Rpt, 1944, p. 4; 68th Medical Group

Annual Rpt, 1944, pp. 4-5.

25

 Surg, First U.S. Army, Annual Rpt, 1944, pp.

105-06; First U.S. Army Report of Operations, 20

Oct 43-1 Aug 44, bk. VII, pp. 67-69, 96-97, 104;

Surg, V Corps, Annual Rpt, 1944, pp. 4-8; VII

Corps Medical Plan, pp. 16-22, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; 60th Medical Battalion

Annual Rpt, 1944, pp. 10-11; 13th, 45th, and 51st

Field Hospitals Annual Rpts, 1944; 5th, 24th, 41st,

91st, and 128th Evacuation Hospitals Annual Rpts,

1944.
222 EUROPEAN THEATER OF OPERATIONS

NURSES OF THE 13TH FIELD HOSPITAL, first to land in Normandy to tend the wounded,

take time out for a meal

Still more hospitals entered Normandy during late June and the July

weeks of hedgerow fighting. The First

Army convalescent hospital, the 4th,

disembarked in two detachments, beginning on 24 June, and opened at Le

Cambe. As the army expanded

beyond its planned strength of three

corps, the theater reinforced it with

one field and eleven evacuation hospitals, temporarily transferred from

the Third Army and intended to

revert to that army when it finally

went into operation. All of these units

deployed between 26 June and 1

August.26

As hospitals came ashore on and

after D-Day, so did elements of the

First Army's three medical groups—

the 31st, 68th, and 134th. Rogers organized the 31st and 68th primarily

for evacuation, assigning to them

three medical battalion headquarters

each and all of his separate collecting

and ambulance companies, and the

134th primarily for a variety of tasks,

assigning to it two battalion headquarters and all of his clearing companies. Between 10 and 23 June the

31st and 68th Medical Groups and

their attached units disembarked respectively at UTAH and OMAHA. Each

group deployed to control and conduct evacuation for a wing of the

army, the 68th supporting the V and

XIX Corps and the 31st the VII and

26

 4th Convalescent Hospital Annual Rpt, 1944, p.

1; First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, p. 72.
INTRODUCTION TO BATTLE 223

VIII. During the same period the

134th Medical Group landed on

UTAH. Its 622d Clearing Company,

specially trained for this mission, on

the seventeenth opened holding and

treatment units for neuropsychiatric

casualties at Bernescq in the OMAHA

sector and at Ste.-Mere-Eglise in the

Cotentin. Other clearing companies

reinforced field and evacuation hospitals and division clearing stations, and

one set up an air evacuation holding

unit at Ste.-Mere-Eglise.27

The army medical supply system

also developed, following the general

pattern of temporary beach dumps

during the first week on shore and

then establishment of more permanent, thoroughly organized depots

inland. On D-Day and in the days immediately thereafter, elements of the

1st Medical Depot Company, reinforced with portions of the 31st and

32d Medical Depot Companies, temporarily attached respectively from

the Advance Section and the Third

Army, landed at OMAHA and UTAH.

They issued supplies from improvised

beach dumps near the engineer special brigade clearing stations and then

set up depots in open fields a short

distance inland, at St.-Laurent, Colleville, and later Le Molay behind

OMAHA and at Le Grand Chemin

behind UTAH. Initially, the companies

stocked their dumps with salvage

from the invasion flotsam on the

beaches. The first scheduled medical

maintenance units arrived on OMAHA

on 7 and 8 June, but were lost when

the tide came in and engulfed them

before they could be dragged to the

beach. On UTAH, as the result of early

difficulties in discharging cargo, no

significant amount of medical supplies

came ashore until the twelfth. Supply

deliveries soon increased in volume

and regularity, however, as the engineers by the end of the second week

in France brought cargo flow over

both beaches up to over 95 percent of

its planned tonnage rate. Even the

storm of 19-22 June, which wrecked

or beached numerous landing craft

and destroyed the artificial harbor at

OMAHA, only temporarily disrupted

the accelerating influx. To receive,

store, and issue the medical supplies

arriving in such volume, the ADSEC

31st Depot Company on the thirtieth

opened a new rear facility at Longueville to replace those at St.-Laurent

and Colleville, while a section of the

1st Depot Company on 17 July set up

an advance dump at Lison Junction,

convenient to the units battling for

St.-Lo.28

Well before all these units were in

place, Colonel Rogers established

centralized control of First Army hospitalization, evacuation, and medical

supply. Between 12 and 19 June, after

the headquarters and sufficient companies of his medical groups had

landed for immediate operations,

Rogers relieved the V and VII Corps

surgeons of responsibility for all med27

 VII Corps Medical Plan, p. 22, encl. 1 to Surg,

VII Corps, Annual Rpt, 1944; 31st, 68th, and 134th

Medical Groups Annual Rpts, 1944.

28

 For a general view of the supply situation, see

Ruppenthal, Logistical Support, 1:391-422, 439, 464-

74; Harrison Cross-Channel, pp. 422-23; Supply Division, OofCSurg, HQ, ETOUSA, Annual Rpt, sec. II,

pp. 7-8; Surg, First U.S. Army, Annual Rpt, 1944,

p. 14; First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, p. 76; Surg, V Corps, Annual

Rpt, 1944, pp. 4 and 8; VII Corps Medical Plan, pp.

18-19, encl. 1 to Surg, VII Corps, Annual Rpt,

1944; 1st and 32d Medical Depot Companies

Annual Rpts, 1944; Wiltse, ed., Medical Supply, pp.

307-13.
224 EUROPEAN THEATER OF OPERATIONS

ical support to the rear of the divisions. Evacuation, field, and convalescent hospitals and supply depots now

reported directly to the army surgeon. His office, through the 31st and

68th Medical Groups, directed the

flow of patients from division clearing

stations to the beaches. On the

twenty-first, deviating slightly from

the NEPTUNE plan, Rogers put into

effect a ten-day evacuation policy, allowing retention in France of many

sick and lightly wounded men hitherto sent back across the Channel.29

During the first two months of the

campaign, the buildup of the First

Army medical service went essentially

according to the NEPTUNE plan. By

the end of the period over 35,000

army medical people were on shore.

For them, and for the organization to

which they belonged, these early

summer weeks of activity—the first

combat experience for the majority of

personnel and units—provided a test

of doctrine and training, taught practical lessons, brought forth field improvisations, and revealed certain anticipated and unanticipated problems.

Cherbourg and the Hedgerows

During the fighting for Cherbourg

and St.-Lo, First Army medical units

admitted 95,172 Army personnel;

they returned 22,639 of these patients

to duty, evacuated 60,317 to the

United Kingdom, and lost 2,027 to

death. Sick men, including neuropsychiatric patients, accounted for almost

27 percent of these admissions, soldiers with nonbattle injuries for 8

percent, and combat wounded for the

rest. Of the 60,279 battle casualties,

the majority received their injuries

from shell and bomb fragments, most

often in the arms and legs—a pattern

of causative agents and anatomical locations similar to that in other theaters—and over one-third suffered

multiple wounds (Chart 8).30

Throughout the drive to Cherbourg

and the struggle among the hedgerows, about 90 percent of all battle

casualties occurred in the infantry

rifle companies. For the company

aidmen and battalion and regimental

surgeons who first cared for these injured, as for the riflemen they accompanied, the Normandy hedgerows

became the dominant fact of life, and

too often of death. These earthen

banks, overgrown with trees and

brush, crisscrossed most of the countryside outside the marshes, transforming roads into sunken lanes ideal

for ambush and breaking up the landscape into easily defended terrain

compartments that had to be cleared

one at a time by teams of tanks and

riflemen. Each 100- or 200-yard-long

rectangle of plowed ground, pasture,

or orchard had its price in American

dead and wounded. In five days of

fighting during the July offensive one

4th Division regiment, the 22d Infantry, suffered 729 casualties, including

29

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 70-71 and 87-91; VII

Corps Medical Plan, pp. 18-19, 22-23, 25, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; Surg, V Corps,

Annual Rpt, 1944; 31st Medical Group Annual Rpt,

1944, p. 8.

30

 In addition to U.S. soldiers, the army hospitals

admitted 337 U.S. Navy men, 486 Allied personnel,

6,207 enemy POWs, and 812 civilians. For statistics,

see: First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, apps. 11, 17, 26, and 29; VII

Corps Medical Plan, p. 29, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; Medical Bulletins, 2d Infantry Division, June and July 1944, box 388, RG

112, NARA.

226 EUROPEAN THEATER OF OPERATIONS

a battalion commander, a battalion

executive officer, and five rifle company commanders. In one rifle company, stated a division report, there

were "only five noncoms left who had

been with the company more than

two weeks. Four of these according to

the first sergeant were battle exhaustion cases and would not have been

tolerated as noncoms if there had

been anyone else available."

 31

In this environment company

aidmen who survived for any length

of time acquired many skills and

learned many lessons very quickly.

They mastered the art of going over

hedgerows low and fast. Instead of

jumping up and running under fire at

the first cries of "Medics," they

learned to wait for a lull and then

crawl to their objectives. Once an

aidman reached a group of wounded,

he had to make an instant decision as

to who were beyond any help, who

could help themselves, and who

would benefit most from medical

intervention. "We soon figured out,"

a 30th Infantry Division medic recalled,

that our most useful . . . aids were com- presses and morphine. We usually used

the individual soldier's sulfa powder and

compress. Tourniquets were very rarely

used to control bleeding, since most

wounds were puncture [s] . . . and bled

very little or were amputations or hits

caused by hot and high velocity shell or

mortar fragments which seared the

wound shut.

Aidmen discarded much equipment,

found to be unnecessary, and discovered unplanned use for other items.

The carriers for thrown-away gas

masks conveniently held extra compresses. A patch cut from the tail of a

raincoat, applied with the compress to

a sucking chest wound, helped keep

respiration from drawing in dust and

dirt. Bandage scissors also could cut

through clothing, and carrying an

extra pair proved to be worthwhile.32

With an extensive, if tortuous, road

network behind the front, and with

most medical service jeeps equipped

with litter brackets, division surgeons

early discovered that almost all evacuation to the rear of the battalion aid

stations could be done by motor vehicles. This was fortunate, because

some divisions, to avoid medical personnel casualties from artillery and

mortar fire, placed their battalion aid

stations as far as 1.5 miles behind

their forward elements and their collecting stations, correspondingly, as

much as 5 miles farther to the rear.

Collecting company litter platoons, in

a departure from doctrine, worked

almost entirely forward of the battalion aid stations, functioning in effect

as part of the unit medical detachments and often under operational

control of the battalion surgeons.

Even with the collecting company

squads available for relief and reinforcement, litterbearers were in

chronically short supply in the infantry regiments. Casualties and exhaustion, both physical and emotional,

further thinned their ranks. An

31 Quotation from "Operation 4th Division between Carentan and Terriers, 6-15 July 1944," in

4th Infantry Division Combat Intervs, box 24020,

RG 407, NARA. For general descriptions of hedgerow terrain and combat, see Harrison, Cross-Channel,

p. 284, and Blumenson, Breakout and Pursuit, pp. 12-

13 and 40-45.

32

 Quotation from Bradley, Aid Man, p. 51. See

also ibid., pp. 48-70; Tegtmeyer "Dairy," bk. II, pp.

15-16.
INTRODUCTION TO BATTLE 227

INFANTRYMEN IN ACTION IN THE HEDGEROWS

aidman recalled: "I have picked up a

litter with a wounded man on it and

had my fingers uncurl from the handles, even though I was exerting all

my willpower to keep my hands

closed." For extra litterbearers during

heavy, sustained combat, divisions

regularly had to draw upon collecting

companies of the corps medical battalions and army medical groups, or

they temporarily drafted infantrymen

for the additional duty—an especially

unsatisfactory solution when the rifle

companies were themselves understrength from battle losses.33

The hedgerow fighting imposed

special strains on the first-echelon

medical service of the armored divisions, principally the 2d and 3d.

These divisions, instead of operating

in concentrated mobile combat com33

 Quotation from Bradley, Aid Man, p. 59. See

Surg, First U.S. Army, Annual Rpt, 1944, p. 79;

Surg, VIII Corps, Annual Rpt, 1944, p. 5; Surg, XIX

Corps, Annual Rpt, 1944, encl. 14 and an. E, p. 1;

Memo, CO, 104th Medical Battalion, to Surg, Ninth

Army, 12 Jun 45, sub: Division Medical Service, box

355, RG 112, NARA; Medical Bulletins, 2d Infantry

Division, June and July 1944, box 388, RG 112,

NARA; Rpt, Surg, 9th Infantry Division, 1944, sub:

Medical Activities—Marigny Sector, box 388, RG

112, NARA; 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA;

Interv, Medical History Branch, CMH, with Ambassador Elliot Richardson (hereafter cited as Richardson Interv), 8 Nov 79, tape 1, sides 1 and 2, CMH;

Surg, Ninth U.S. Army, Daily Journal, 9 Jul 44, in

William E. Shambora Papers, MHI; 53d Medical

Battalion Annual Rpt, 1944, pp. 6-7.
228 EUROPEAN THEATER OF OPERATIONS

mands, had to split up their tank and

armored infantry battalions into platoons to help the infantry clear

ground, hedgerow by hedgerow. The

divisions then had to attach aidmen

and litterbearers to each separate

platoon, in violation of their doctrine,

under which tank battalions, especial- ly, kept all their enlisted medical personnel at their aid stations. Because

tank and mechanized infantry battalions included only half as many

enlisted medical people as standard

infantry battalions, the armored divisions had to strip their medical battalions to build up their unit detachments. After the initial weeks of

hedgerow combat, the 3d Armored

Division surgeon, Col. James L.

Salmon, MC, requested an additional

eighty-four medical enlisted men for

his division so that tank and mechanized infantry battalions could maintain what was, in effect, a conventional infantry system of evacuation. In

the absence of such permanent reinforcements the XIX Corps surgeon

temporarily attached men from his

corps medical battalion to the armored units.34

Collecting and clearing station operations conformed closely to doctrine. Collecting stations, usually located near the command posts of the

regiments they supported, changed

bandages on incoming wounded, adjusted splints, administered plasma,

and combated shock while preparing

patients for further evacuation. Clearing stations, 4-6 miles behind the collecting companies, performed triage,

maintained wards for care of shock

and of minor sickness and injuries,

and transferred men needing immediate emergency surgery to adjacent

field hospital platoons. Moving frequently to keep up with their divisions, clearing companies handled a

large volume of casualties. The 4th

Division clearing station, for example,

received, treated, and evacuated over

6,100 patients—an average of about

245 per day—during its first twentyfive days in operation. During the

battle for St.-Lo in July, the 83d Infantry Division clearing station processed 1,600 wounded in three days.

To relieve the exhausted staff of this

company, the VII Corps surgeon reinforced it temporarily with elements of

the corps medical battalion and with

an entire clearing company borrowed

from the 134th Medical Group. As it

had in other theaters, the combination of clearing station and field

hospital platoon worked smoothly,

freeing the clearing company of nontransportable patients and saving the

lives of severely injured men. General

Kenner reported after a mid-July inspection tour: "Many men, wounded

within the hour, were receiving emergency major surgical treatment in

these installations. The forward disposition of these elements is responsible in large measure for the . . . low

mortality rate amongst our casualties."

 35

34

 Surg, XIX Corps, Annual Rpt, 1994, ends. 15-

16.

35

 Quotation from Memo, Kenner, 13 Jul 44, sub:

Report of Inspection of Medical Service in Liberated Areas, in Medical Division, COSSAC/SHAEF,

War Diary, July 1944. For 4th Medical Battalion statistics, see 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA. On

the 83d Division, see VII Corps Medical Plan, pp.

33 and 35, encl. 1 to Surg, VII Corps, Annual Rpt,

1944, and 134th Medical Group Annual Rpt, 1944,

p. 8. For other examples of collecting and clearing

station activities, see Medical Bulletin, 2d Infantry Continued
INTRODUCTION TO BATTLE 229

Division medical elements, especially the infantry regimental detachments and the collecting company

litter platoons, suffered substantial

casualties. Colonel Hayes, the VII

Corps surgeon, reported as early as

14 June: "All divisions in the line

have lost from one to eight medical

officers and from five to forty enlisted

men." Between 10 and 24 July, in the

already understrength regimental detachments of the 9th Division, 1 medical officer and 20 enlisted men were

killed, 4 officers and 155 men wounded, and 2 officers and 19 men captured. The 83d Division, in the July

offensive, had two entire battalion aid

stations overrun and taken prisoner

during a local German counterattack.36

Random artillery and mortar fire

accounted for most medical troop casualties, as well as for frequent damage

to medical service vehicles and installations. However, the killing and

wounding of aidmen, litterbearers,

and aid station personnel by aimed

rifle fire, usually from snipers, raised

the question whether the enemy, as

general policy, was respecting the

Geneva Convention rights of unarmed Red Cross-marked medical

personnel. After two months of

combat and careful analysis of many

incidents, most corps, division, and

lower-echelon surgeons and medical

unit commanders concluded that,

except for isolated cases, the Germans were following the rules. The

commander of the 4th Medical Battalion, which had had men killed and

wounded and ambulances damaged

by artillery and machine-gun fire,

summed up the prevailing opinion:

"It is the consensus . . . that little of

this damage was deliberate and that

for the most part the enemy respects

the Rules of Land Warfare. ... " According to German prisoners, sniper

incidents often resulted from difficulty in seeing Red Cross arm brassards

on men moving along the hedgerows;

medics in some divisions noted that a

high proportion of their small-arms

casualties were shot from the unbrassarded right side. Aidmen and litterbearers accordingly began wearing

brassards on both arms and painted

nonregulation red crosses in white

squares on their helmets. The XIX

Corps surgeon late in July officially

authorized these and other measures

to make Geneva Convention markings

on men and vehicles more conspicuous.37

Division, June 1944, box 388, RG 112, NARA; Rpt,

Surg, 9th Infantry Division, 1944, sub: Medical Activities—Marigny Sector, box 388, RG 112, NARA;

1st Medical Battalion After-Action Rpts, May, June,

and July 1944, box 5966, RG 407, NARA; Richardson Interv, tape 2, side 1, CMH. 36

 VII Corps Medical Plan, p. 20, encl. 1 to Surg,

VII Corps, Annual Rpt, 1944; Rpt, Surg, 9th Infantry Division, 1944, sub: Medical Activities—Marigny

Sector, box 388, RG 112, NARA; Surg, 83d Infantry

Division, Annual Rpt, 1944, p. 3.

37

 Quotation from 4th Medical Battalion Report of

Operations, 6-30 Jun 44, box 6727, RG 407, NARA.

For other expressions of this view, see Memo,

Kenner to CofS, SHAEF, 20 Jun 44, sub: Report of

Inspection ETO, and Memo, Kenner, 13 Jul 44, sub:

Report of Inspection of Medical Service in Liberated Areas, both in Medical Division, COSSAC/

SHAEF, War Diary, June and July 1944; and Medical Bulletin, 2d Infantry Division, box 388, RG 112,

NARA. Less favorable views of the Germans are in

VII Corps Medical Plan, p. 20, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; Tegtmeyer "Diary," bk.

II, p. 15; Richardson Interv, tape 1, side 2, CMH;

and Bradley, Aid Man, p. 49. On Red Cross markings, see Surg, XIX Corps, Annual Rpt, 1944; Surg,

29th Infantry Division, Annual Rpt, 1944, p. 13;

Surg, 35th Infantry Division, Annual Rpt, 1944, pp.

4-5; and Rpt, Lt Col C. L. Milburn, Jr., 28 Jun 44,

sub: Report of Medical Officer Observer in France,

19-26 Jun 1944, in Shambora Papers, MHI.
230 EUROPEAN THEATER OF OPERATIONS

MEDICS WITH IMPROVISED RED CROSS

INSIGNIA on their arms and helmets

Gestures of a chivalry supposedly

dead in mechanized total war occasionally graced the Normandy battlefield. Soldiers of both sides, either as

the result of formal temporary truces

or more often by tacit mutual consent, at times ceased fire to allow

aidmen to reach casualties. A 30th Division aidman remembered "deliberately exposing myself to enemy view

and waiving at machine-gun crews in

order to get them to lift fire so I

could remove wounded. . . . The fire

was often lifted." On D-Day a trooper

in the 82d Division saw German and

American medics rush toward some

wounded lying near a tank that had

just been knocked out. "There was no

firing by either side upon these aid

men as they went to work." Early in

July the First Army returned sixteen

German nurses captured in Cherbourg to their own forces under a

flag of truce. The commander of a

German parachute regiment in the

hedgerows sent back 83d Division

medics his troops had captured. Such

incidents were exceptional in the

bitter fighting, but they did indicate

that, in dealing with wounded and

those who treated and evacuated

them, both sides were following as

best they could the conventions of

civilized warfare.38

To the rear of the divisions the

31st and 68th Medical Groups managed the flow of casualties to evacuation hospitals and then to convalescent facilities and beach holding

units. The groups deployed their attached ambulance companies as well

as the ambulance platoons of their

collecting companies at division clearing stations, at field hospitals, and at

other installations. They placed liaison officers at clearing stations and

hospitals and set up ambulance control points on the roads. Based on

evacuation hospital reports, relayed

through Colonel Rogers' office twice

daily and containing current statistics

on empty beds, on patients awaiting

surgery, and on patients ready for

transportation, the groups routed am38

 First quotation from Bradley, Aid Man, p. 62.

Second quotation from Statement by Lt. Joseph

Kormylo, in 82d Airborne Division Combat Intervs,

box 24057, RG 407, NARA. See also Blumenson,

Breakout and Pursuit, pp. 83-84 and 137; Surg, First

U.S. Army, Annual Rpt, 1944, pp. 117-18; First U.S.

Army Report of Operations, 20 Oct 43-1 Aug 44,

bk. VII, p. 105; 68th Medical Group, Report of

Evacuation of Enemy Casualties From Vicinity Cherbourg, 19 Jul 44, in 68th Medical Group Annual

Rpt, 1944.
INTRODUCTION TO BATTLE 231

bulance convoys from the divisions to

hospitals in their sectors and from the

hospitals to UTAH and OMAHA beaches. Each group transported as many

as 2,500 patients a day, keeping its

ambulances rolling steadily in the

constant bumper-to-bumper traffic of

the congested beachhead. Occasionally, they massed forces to meet sudden

emergencies. Between 28 June and 1

July, for instance, the 68th Group,

which normally worked in the OMAHA

area, sent men, trucks, and ambu- lances to Cherbourg to evacuate to

UTAH beach over 1,300 wounded

German prisoners. During July, as the

intensity of combat and the number

of divisions in Normandy increased,

Colonel Rogers reinforced the medical groups with additional ambulance

and collecting companies temporarily

detached from the Third Army and

with ambulance companies taken

from the corps medical battalions.39

At OMAHA and UTAH the engineer

special brigade medical battalions,

rearmost evacuation elements of the

First Army, received patients from the

medical groups and prepared them

for cross-Channel movement, by ship

and, for an increasing proportion, by

airplane. The NEPTUNE plans called

for the beginning of mass air evacuation from France around D+14 (20

June), but the engineer special brigades managed to complete a temporary airstrip near St.-Laurent on the

eighth. A IX Troop Carrier Command C-47 lifted out the first 13 patients, including 7 wounded POWs,

two days later. With passable flying

weather much of the time and plenty

of returning cargo planes, the 60th

and 61st Medical Battalions on some

days flew out as many as 600 patients,

while the number leaving OMAHA

daily by ship dwindled to less than

20. On UTAH beach, by contrast, sea

evacuation continued to predominate.

A company of the 134th Medical

Group opened an air evacuation holding unit at Ste.-Mere-Eglise on the

eighteenth, but it closed after eleven

days of limited operation because

transport flights there interfered with

combat air activities. Not until 20 July

did the medical service secure more

or less regular evacuation use of an

airfield in the Cotentin. Air evacuation at once proved its worth. With

the flight itself taking no longer than

ninety minutes, General Kenner reported, "men wounded in the morning are often on the operating table

of a general hospital in the UK within

10 hours." With such rapid evacuation available, surgeons could send

to Britain many severely wounded

men hitherto classified nontransportable, reducing the surgical burden on

hard-pressed field and evacuation

hospitals.40

39

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, p. 71; 31st and 68th Medical

Groups Annual Rpts, 1944; Surg, V Corps, Annual

Rpt, 1944, p. 9; Surg, VII Corps, Annual Rpt, 1944,

p. 10; Surg, XIX Corps, Annual Rpt, p. 5.

40

 Quotation from Memo, Kenner to CofS,

SHAEF, 20 Jun 44, sub: Report of Inspection ETO,

in Medical Division, COSSAC/SHAEF, War Diary,

July 1944. In same file, see Memo, Kenner to

CAdminOff, 26 Jul 44, sub: Evacuation of Casualties

by Air. See also Professional Services Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, Chief

Consultant in Surgery sec., pp. 12-13; First U.S.

Army Report of Operations, 20 Oct 43-1 Aug 44,

bk. VII, pp. 69-70; John W. Pace, "Air Evacuation

in the European Theater of Operations," Air Surgeon's Bulletin 2 (October 1945): 324; Dowling, Normandy Rpt, 11 Jan 45, p. 17; Rpt, ProvESBGp, 30

Sep 44, sub: Operation NEPTUNE, pp. 115, 335,

339; VII Corps Medical Plan, pp. 21-22, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; 134th Medical

Group Annual Rpt, 1944, p. 8.
232 EUROPEAN THEATER OF OPERATIONS

On OMAHA the engineer special brigade units reorganized to take maximum advantage of both air and sea

transportation. The Provisional Engineer Special Brigade Group, between

18 and 22 June, consolidated most of

the 60th and 61st Medical Battalions

into an evacuation center under the

command of the group surgeon, Lt.

Col. George D. Newton, MC. The

61st Battalion, of which the 393d Collecto-Clearing Company had acted as

a holding unit for the St.-Laurent

strip since air evacuation began, deployed its other companies with the

393d to form a 750-bed tented holding facility for litter patients. A platoon of the 60th Battalion's 634th

Clearing Company maintained temporary accommodations for 250 walking

wounded, and the 499th Collecting

Company sorted incoming patients

and furnished litterbearers and ambu- lances. Working with attached Air

Force liaison personnel and in direct

telephone contact with the airstrip

and the naval beach station, the center's evacuation control officer, borrowed from the 11th Port, dispatched

patients as LSTs, hospital carriers,

and aircraft became available. The

center normally gave stretcher cases

priority for cross-Channel flights and

sent the walking wounded by ship. As

Captain Dowling, the Western Naval

Task Force surgeon, later reported,

"This system was easily regulated and

maintained, and greatly facilitated

speed and ease in handling casualties. . . ."

 41

While the medical battalions on

OMAHA beach concentrated on air

evacuation, the 261st Medical Battalion on UTAH handled most of the seaward movement of casualties out of

Normandy. Acting almost entirely as a

holding unit after the field and evacuation hospitals opened, the battalion

funneled patients to the 2d Naval

Beach Battalion, which embarked

them on LSTs and hospital carriers.

The naval unit stationed a radioequipped liaison team at each 261st

Battalion clearing company to keep

the Army units promptly informed of

ship arrivals. Evacuation across UTAH

beach proceeded at a steady rate,

averaging about 570 men per week

throughout June and July.42

Most wounded men who passed

through the army evacuation chain

underwent surgery in field or evacuation hospitals. Field hospital platoons, located close to division clearing stations, received the most urgent

nontransportable cases, primarily,

General Hawley observed, "perforating wounds of the belly and sucking

wounds of the chest." Each platoon

had auxiliary surgical teams attached

as operating staff, and between them

the three platoons of a field hospital,

if all were active, could perform about

thirty major and usually complex procedures a day. Death rates in these installations ranged from 11 to 14 percent of surgical admissions, about

three times the rate for evacuation

hospitals, which reflected the desperate nature of the cases the field units

41 received. As the commander of the Dowling, Normandy Rpt, 11 Jan 45, p. 17; Rpt,

ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE,

pp. 335-36; 60th Medical Battalion Annual Rpt,

1944, pp. 11-13; 61st Medical Battalion Annual Rpt,

1944, pp. 6-7 and 10; 393d Collecto-Clearing Company Annual Rpt, 1944, pp. 11-12.

42

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 69-70; Dowling, Normandy Rpt, 11 Jan 45, pp. 17-18 and app. N; 261st

Medical Battalion Annual Rpt, 1944, p. 3.
INTRODUCTION TO BATTLE 233

51st Field Hospital put it, "Exsanguination, eviscerations, cardio-respiratory difficulties, and deep shock"

were the normal fare of his doctors.

For the attached teams, who had complete authority over the surgical service, field hospital work, while hard

and demanding, offered a high level

of professional challenge and satisfaction. With perhaps some exaggeration, a 3d Auxiliary Surgical Group

report referred to this duty as "the

surgeon's paradise." The first weeks

of operation revealed only a few deficiencies in platoon organization and

equipment: a shortage of litterbearers; a need for extra officers and

nurses to stay behind with patients

when the unit moved; and requirements for larger generators and additional suction, anesthesia, and oxygen

apparatus.43

While the field hospitals proved

more than equal to their task, the

400-bed army evacuation hospitals

found themselves consistently overburdened. Processing all patients who

were transportable and needed more

than the most elementary treatment,

these hospitals worked in rotation,

some receiving casualties while

others, cleared of patients, rested or

moved forward behind the divisions.

During the first weeks evacuation hospitals lived from crisis to crisis.

"When a hospital moved in and set

up," the 41st Evacuation Hospital

commander complained, "there

would always be a big influx of patients, which continued until every

bed was filled and this hospital

bogged down. Then the hospital

would be closed and left to work itself

out of the mess."

 44

With the arrival of more evacuation

hospitals the flow of patients evened

out, but in more units a chronic surgical backlog persisted. The majority

of the casualties reaching these hospitals were injured men who needed

surgery—for example, 894 patients

out of 1,302 admitted by the 5th

Evacuation Hospital during its first

two weeks in Normandy and all but

360 out of 3,200 treated at the 128th

Evacuation Hospital in a similar space

of time. The T/O surgical staff of this

type installation, working twelve-hour

shifts and reinforced by as many auxiliary surgical teams as the hospital's

40 nurses and 217 enlisted men could

support, could perform about 100

major operations every twenty-four

hours; the patient influx during heavy

combat occurred at about double that

rate. Inevitably, the less urgent cases

had to wait their turn on the operating tables, often developing infections

in undebrided wounds or suffering

other complications. To help its hospitals overcome this backlog, the First

Army deployed surgical teams and

mobile truck-mounted surgical and Xray units of the 3d Auxiliary Surgical

Group and, when these proved insufficient, added provisional teams from

COMZ hospitals landed but not yet

43

 First quotation from Ltr, Hawley to TSG, 26

Jun 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). Second quotation from 51st Field Hospital

Annual Rpt, 1944, pp. 24-25; see also pp. 8-11.

Third quotation from 3d Auxiliary Surgical Group

Annual Rpt, 1944, p. 33; see also pp. 3-4, 32, 34-

35, 44-46. See First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 72-73 and

96-97; Rpt, Milburn, 28 Jun 44, sub: Report of

Medical Officer Observer in France, 19-26 June

1944, Shambora Papers, MHI.

44

 Quotation from 41st Evacuation Hospital

Annual Rpt, 1944, p. 60. See also First U.S. Army

Report of Operations, 20 Oct 43-1 Aug 44, bk. VII,

p. 72.
234 EUROPEAN THEATER OF OPERATIONS

functioning. The medical groups assigned a collecting company to each

evacuation hospital, to provide reliefs

for ward officers, additional litterbearers, and ambulances to help in

moving out patients. Clearing companies, from the 134th Medical Group

or the corps medical battalions, set up

near evacuation hospitals to relieve

them of the sick and minor surgical

patients. For unskilled labor, the hospitals obtained German prisoners

from the First Army provost marshal.

The First Army tried to manage

evacuation so as to reduce the surgical log jam. The 31st and 68th Medical Groups directed ambulances from

clearing stations to the evacuation

hospitals on the basis of surgical

backlog, rather than proximity or

number of empty beds. As a final expedient, on 28 June, Colonel Rogers,

at the urging of General Hawley and

Colonel Cutler, authorized hospital

commanders to send transportable

minor surgery patients directly to the

beach holding units for air evacuation, whenever, in their judgment,

that course of action would bring the

patient earlier treatment. Under this

policy, evacuation hospitals could relieve themselves of between 15 and

25 percent of their surgical patients;

but, even with this assistance, it was

clear that this type of unit needed

constant augmentation to carry out its

mission.45

Clinically, surgery during the first

two months of combat produced few

surprises. Surgeons were impressed

by the frequency and severity of the

multiple wounds from artillery fire.

On his July inspection trip General

Kenner saw patients "with a penetrating wound of the skull, sucking

wound of the chest, partial evisceration and a compound fracture. This

means that one surgical team, on that

one individual, must perform four

major operations." The rate of use of

whole blood about matched the highest pre-D-Day projections, running

about one pint for each pint of

plasma. According to Colonel Rogers,

the Manual of Therapy "met all expectations" as a practical guide to forward surgery. Rogers' staff, working

closely with the theater consultants,

issued a steady stream of directives to

clarify certain points in the Manual

and to correct surgeons' minor deviations from it. Early debridement and

liberal use of penicillin and sulfa

drugs kept the incidence of serious

wound infection low, in spite of surgical backlog, and in spite of the fact

that many casualties occurred on pastures and farmland contaminated with

animal and human feces. Of the

wounded men treated in First Army

installations and then evacuated

across the Channel less than 1 percent died after reaching England, a

result which Kenner attributed to

"the echeloning of skilled surgical

care throughout the evacuation

chain." Colonel Cutler, after a visit to

45

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 73, 81-82, 98-99; First

U.S. Army Command Journal, 27 Jun 44; Mins, First

U.S. Army Surgeons Conference, 25 Jun 44, in First

U.S. Army Log, D-Day through D+56; Medical

News No. 10, First U.S. Army, 28 Jun 44; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 32-35

and 44-46; 31st Medical Group Annual Rpt, 1944,

pp. 10-11 and 13; Surg, XIX Corps, Annual Rpt,

1944, p. 5 and an. B; Carter, ed., Surgical Consultants,

2:220-22 and 227. For examples of the problem

and its solutions in various units, see 24th, 32d,

41st, 91st, and 128th Evacuation Hospitals Annual

Rpts, 1944.
INTRODUCTION TO BATTLE 235

army hospitals in late June, concluded:

It is my overall opinion that the level of

professional care is very high, certainly

better than in the last war. . . . The low

incidence of serious infection was striking

and must be related to the bacteriostatic

agents . . . now employed in military sur- gery. The incidence of amputations

seemed happily low, the incidence of gas

gangrene also much lower than was ex- pected or was present in the European

War, 1914-1918.46

The First Army suffered little from

disease during its early battles. Minor

outbreaks of diarrhea occurred; the

cool, rainy weather resulted in respiratory ailments; and prolonged diet of

C- and K-rations led to cases of vitamin deficiency. Recurrent malaria

continued to flare up in divisions that

had served in the Mediterranean, with

an Army-wide total of 175-250 hospital admissions each week during June

and July. The affected units put their

men back on prophylactic doses of

Atabrine, and the army evacuated

men with complicated malaria to the

United Kingdom while retaining those

with simple cases in evacuation hospitals. Late in July, to save evacuation

hospital space for the wounded, the

army concentrated its malaria and

other communicable disease patients

at the 16th Field Hospital, a newly arrived Third Army unit. With women

largely absent from the beachhead

towns, the army's venereal disease

rate remained low, 8.5 cases per

1,000 men in June and 4.2 per 1,000

in July. Only 398 new infections appeared in the period, all traceable to

preinvasion contacts in England.47

Neuropsychiatric casualties, increasing in incidence as the fighting intensified, taxed First Army medical facilities. During the July battles most

infantry divisions sent one man to the

rear with combat exhaustion for each

three or four wounded. Before the invasion Colonel Rogers and his staff,

seeking to profit by the experience of

other theaters, made preparations to

treat as many neuropsychiatric patients as possible near the front and

return them promptly to duty. Accordingly, once operations began,

battalion and regimental surgeons

held the mildest cases—those likely to

recover after twenty-four hours or so

of sedation, rest, and food—at their

unit aid stations. Men more severely

disturbed went to clearing stations

where division psychiatrists supervised up to seventy-two hours of

treatment. Setting up and equipping

these facilities taxed the ingenuity of

the officers in charge. The equipment

authorized a division psychiatrist included only "a sphygmomanometer, a

set of five . . . tuning forks, a percus46

 Kenner quotations from Memo, Kenner, 13 Jul

44, sub: Report of Inspection of Medical Service in

Liberated Areas, and Memo, Kenner to CofS,

SHAEF, 20 Jun 44, sub: Report of Inspection ETO,

20 Jun 44, both in Medical Division, COSSAC/

SHAEF, War Diary, June-July 1944. Rogers quotation from First U.S. Army Report of Operations, 20

Oct 43-1 Aug 44, bk. VII, pp. 100-101. Cutler quotations from Carter, ed., Surgical Consultants, 2:220-

21 (see 2:217-18). See also Ltr, Hawley to TSG, 26

Jun 44, file HD 024 ETO O/CS (Hawley-SGO Corresp); VII Corps Medical Plan, p. 30, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944. For environmental conditions, see Company D, 4th Medical

Battalion, Monthly Sanitary Rpts, June and July

1944, box 6730, RG 407, NARA.

47

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 88-93; VII Corps Medical

Plan, pp. 29, 32, 43, encl. 1 to Surg, VII Corps,

Annual Rpt, 1944; Rpt, Milburn, 28 Jun 44, sub:

Report of Medical Officer Observer in France, 19-

26 June 1944, Shambora Papers, MHI. For orders

on Atabrine, see, for example, 1st Medical Battalion

Journal, 19 Jul 44, box 5967, RG 407, NARA.
236 EUROPEAN THEATER OF OPERATIONS

sion hammer, and an ophthalmoscope," and he had to pick up enlisted staff, tentage, cots, blankets, and a

medical chest by the time-honored

Army method of scrounging. Division

clearing stations evacuated soldiers

who required more lengthy treatment

and reconditioning but were still

deemed salvageable to one of the two

First Army exhaustion centers,

opened at Bernescq and Ste.-MereEglise on 19 June by the 622d Clearing Company and staffed with psychiatrists from the evacuation hospitals.

Here, patients underwent extended

sedation, received counseling and

limited individual and group therapy,

and took part in calisthenics and military drill, followed by final examination and either return to duty or evacuation across the Channel.48

The psychiatric toll of the hedgerows forced expansion of both divisional and army facilities. Each of the

army exhaustion centers doubled in

size, from 500 to 1,000 beds, and the

staffs worked sixteen- and eighteenhour days. The army assigned a

second clearing company, the 618th,

to take over the Bernescq center, allowing the 622d to concentrate at

Ste.-Mere-Eglise. Still overcrowded,

even with this reinforcement, the

army facilities in mid-July began turning all but the worst-off patients back

to their divisions. In response, some

infantry divisions, notably the 29th

and 35th, enlarged their clearing station psychiatric facilities into fullfledged 250-bed exhaustion centers,

which kept men for up to seven days

of treatment comparable to that in

the army units. Between them, the division clearing stations and army exhaustion centers returned to combat

duty about 62 percent of the 11,150

neuropsychiatric patients they admitted; they released another 13 percent

to noncombat service and evacuated

the balance to Great Britain.49

The medical supply system, which

had been the subject of so much theater concern until the eve of the invasion, proved efficient and responsive

in Normandy. Between them, the

First Army and Hawley's Supply Division managed to include enough matériel in the assault forces to sustain

the medical service in its first days on

the beach. As the buildup went on,

the arrival of prescheduled shipments

and maintenance units, besides meeting day-to-day needs, allowed the

First Army to accumulate seven-day

reserves of most items by the end of

June. Using theater systems for express air and sea shipment of urgently

needed matériel, the army depots obtained additional oxygen, X-ray, and

transfusion equipment for field and

evacuation hospitals. They put together outfits for improvised non-T/E

installations, such as the exhaustion

centers, and they remedied omissions

and inadequacies in the medical maintenance units. The medical service

encountered such perennial problems

48

 Quotation from Memo, Maj D. L. Weintrob, 20

Oct 44, sub: Meeting the Problem of Combat Exhaustion, in 29th Infantry Division Combat Intervs,

box 24035, RG 407, NARA; in same file, see Weintrob Interv, 2 Oct 44. See also First U.S. Army

Report of Operations, 20 Oct 43-1 Aug 44, bk. VII,

pp. 82-85 and 106; Surg, First U.S. Army, Annual

Rpt, 1944, pp. 130-34; Surg, XIX Corps, Annual

Rpt, 1944, encl. 16; 134th Medical Group Annual

Rpt, 1944, p. 8; 618th and 622d Clearing Companies Annual Rpts, 1944.

49

 For an extended clinical and administrative

review of neuropsychiatry in the ETO, see Chapter

XI of this volume.
INTRODUCTION TO BATTLE 237

as equipment lost and damaged in

landing or separated from the owning

units; unexpectedly high breakdown

rates for key equipment, such as auto- claves; and an unreplaced cross-Channel drainage from Normandy of pajamas, litters, and tracheal tubes with

evacuated casualties. These difficulties however, remained at the nuisance rather than the crisis level.

Medical maintenance units imposed

extra labor on the depots in that most

of the items they included were scattered among a number of containers,

requiring supply people to open as

many as thirty boxes of miscellaneous

goods to fill a single requisition. In

the shallow beachhead, with a nearly

static front, divisions and other units

had little difficulty drawing medical

stores from army depots. Nevertheless, Colonel Rogers expressed concern late in July that the size of the

reinforced army was straining the distribution capacity of his depots and

that they would be unable to sustain

the force if it broke through and

began a rapid advance.50

Whole blood and penicillin reached

the army in ample supply through a

separate logistics channel. Refrigerated trucks of the 152d Station Hospital, the ETO blood bank unit, went

ashore fully loaded on OMAHA beach

on 7 June and on UTAH two days

later; hospital carriers and LSTs

landed some 3,000 additional pints of

blood early in the invasion. On the

twelfth, Detachment A of the blood

bank disembarked and set up at the

St.-Laurent airstrip to receive regular

flights of blood from England, 250

pints a day until 24 June, when the

theater increased the shipment to 500

pints. Refrigerated trucks of the unit,

as planned, carried blood forward to

hospitals and clearing stations. The

same trucks also distributed penicillin,

flown in on the transports that

brought in blood. The First Army suffered from a penicillin shortage in

mid-June, the result of temporary exhaustion of stocks in the United Kingdom, and had to restrict use of the

antibiotic to only the most urgent

cases. But by the end of that month

the chief surgeon's Supply Division,

with its depots in Britain replenished

from the United States, had resumed

air deliveries to Normandy at a rate of

500 million units per day. These shipments continued throughout the

Battle of the Hedgerows.51

The first two months of battle

tested the European Theater version

of a field army medical service and in

the main proved it sound. Except for

the understaffed 400-bed evacuation

hospitals, army medical units functioned as the NEPTUNE planners

hoped and expected. Colonel Rogers,

in his assessment of this period of operations, praised the field hospital

platoon-clearing station combination,

and he also expressed satisfaction

50

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 70, 77-79, 148-53; Rpt,

Milburn, 28 Jun 44, sub: Report of Medical Officer

Observer in France, 19-26 June 1944, Shambora

Papers, MHI; Surg, XIX Corps, Annual Rpt, 1944,

encl. 14; Surg, 1st Infantry Division, Annual Rpt,

1944, p. 10.

51

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 77 and 100; Chief Consultant in Surgery sec., Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

p. 11; Kendrick, Blood Program, pp. 484-86 and 553-

54; Wiltse, ed., Medical Supply, p. 302; HQ,

ETOUSA, Blood Bank (152d Station Hospital)

Annual Rpt, 1944, pp. 3-4; Rpt, Milburn, 28 Jun 44,

sub: Report of Medical Officer Observer in France,

19-26 June 1944, Shambora Papers, MHI.
238 EUROPEAN THEATER OF OPERATIONS

with the flexibility and adaptability of

his medical groups. Nevertheless, unresolved questions existed as the First

Army paused after the capture of St.-

Lo and prepared for new attacks.

Thus far, the army medical service

had supported a static or slow-moving

force; how well prepared was it to

perform if the army broke out of the

beachhead into truly mobile warfare?

Further, if the army did start moving

rapidly away from the beaches, its

medical service would need a continental Communications Zone to fill in

behind it and relieve it of its rearmost

hospitalization, evacuation, and supply tasks. However, as the campaign

approached D+50, a point well

beyond the date the NEPTUNE planners had set for drawing the army

rear boundary, no such boundary yet

existed. The Advance Section barely

had shouldered its way ashore and

was in only limited operation. The

slow advance of the front in June and

July had disrupted COMZ plans for

movement across the Channel, even

as the base sections in England received and cared for the First Army's

wounded as well as supported its operations.52

52

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, pp. 108-09; Rpt, Milburn, 28

Jun 44, sub: Report of Medical Officer Observer in

France, 19-26 June 1944, Shambora Papers, MHI;

Memo, Kenner to ACofS, G-4, SHAEF, 21 Jul 44,

sub: Present Status of Fixed US Hospital Beds, UK

and Continent, in Medical Division, COSSAC/

SHAEF, War Diary, July 1944, which reflects the

concern at the delay in organizing the Normandy

COMZ.
CHAPTER VIII

COMZ Reaches the Continent

When the Battle of the Hedgerows

ended late in July 1944, the British

and American armies controlled a

little over 1,500 square miles of the

Cotentin Peninsula and the Normandy countryside, about one-tenth of

the area the NEPTUNE planners had

expected them to occupy by that time.

This delay in the tactical advance

upset most aspects of the development and operations of the Communications Zone.1

To begin with, SHAEF, on General

Bradley's recommendation, postponed the scheduled cross-Channel

movement of many COMZ units in

order to speed up shipment of the infantry and armor needed to reinforce

the stubbornly resisted attack. When

COMZ troops reached the crowded

beachhead of Normandy, they intermingled with First Army and Air

Force support elements, which had

been unable to move forward. The

Communications Zone had to negotiate with the other commands for

space for its units and often for alternate sites to replace planned locations

still in German hands. With Cherbourg captured ten days behind

schedule and not opened even for

limited traffic until 17 July, COMZ

supply activities, as well as the disembarkation of additional men and

equipment, were sharply restricted.

Slow expansion of the lodgement

telescoped and partially nullified the

elaborate program for transferring

logistical responsibilities at phased intervals from the First Army to the Advance Section and then to the Forward Echelon. ADSEC headquarters

moved to Normandy in increments

during June and established itself at

Catz, a village near Carentan on the

road joining the OMAHA and UTAH

beachheads. ADSEC staff sections

worked closely and harmoniously with

their First Army counterparts. However, the army, with its own support elements still closely intermingled with

the arriving ADSEC units, refused to

draw its rear boundary, as had been

planned, around the end of June. Instead, it retained direct authority over

the entire American portion of the

lodgement area, gradually delegating

particular logistical functions to the

Advance Section. On the twentieth

the First Army drew a forward boundary for ADSEC, giving the section,

which remained a subordinate com1

 From this point on in the narrative, the term

Communications Zone will be used in place of Services of

Supply, in accord with the formal redesignation of

the command. See GO No. 60, HQ, ETOUSA, 7

Jun 44.
240 EUROPEAN THEATER OF OPERATIONS

mand under the army, a narrow strip

of territory along OMAHA beach, later

enlarged to include UTAH beach and

the upper Cotentin around Cherbourg. SHAEF, increasingly impatient

at the army's delay in relinquishing

logistical responsibilities, on 14 July

nominally detached ADSEC from the

First Army and placed it under General Lee, the COMZ commander, but

under provisions that, for practical

purposes, left the section under field

army control.

The Advance Section at least performed its intended functions,

although under different command

arrangements than initially contem- plated. Forward Echelon, organized

to direct all continental COMZ activities from roughly D+41 (17 July) to

D+90, never really went into operation at all. A FECOMZ advance party

occupied a chateau in Valognes, at

the hub of the Cotentin road network,

on 18 June, and the headquarters for- mally opened a month later. However, it had nothing to command, because the Advance Section remained

under the First Army. General Lee, in

mid-July, decided to move the main

COMZ headquarters to France ahead

of schedule and to take direct charge

of the developing rear area.

FECOMZ, as a result, spent its brief

time in operation preparing facilities

at Valognes for its parent headquarters.2

As the Communications Zone

struggled to adapt to the changing

circumstances of the campaign, its

medical service concentrated on two

principal tasks. In the United Kingdom the medical service put into execution preinvasion plans for receiving

and caring for battle casualties from

the Continent. In France it revised

and then tried to implement plans for

evacuating patients from the field

forces, setting up supply depots, and

establishing general hospitals.

Cross-Channel Evacuation

During the invasion COMZ responsibility for battle casualties began at

the water's edge in Normandy, where

Navy shore parties loaded the wounded onto LSTs and other vessels for

the voyage back to England. Under

the NEPTUNE plans the Army and

Navy shared the task of cross-Channel

evacuation, and medical relations between the two services were close and

cordial throughout the operation.

General Hawley characterized his

naval counterpart, Captain Dowling of

the Western Naval Task Force, as "a

man whose middle name is cooperation." Dowling, on his part, praised

the Army Medical Department for

"one of the finest examples of unstinted cooperation I have ever experienced."3

The Army and Navy medical services worked together to make the

LST, upon which the NEPTUNE planners based their arrangements for

early casualty clearance from the

beaches, into an effective carrier of

sick and wounded. The Western

Naval Task Force, which anticipated

transporting 5,000 patients per day 2

 Ruppenthal, Logistical Support, 1:430, 433-37,

449-58; ADSEC Hist, pp. 26-28 and 40; Memo,

Brig Gen R. G. Moses to Gen Bradley, 9 Oct 44,

sub: Responsibility for COMZ, Raymond G. Moses

Papers, MHI.

3

 First quotation from Ltr, Hawley to TSG, n.d.

[1944]. Second quotation from Ltr, Capt G. B.

Dowling to Hawley, 12 Jul 44. Both in file HD 024

ETO O/CS (Hawley-SGO Corresp).
COMZ REACHES THE CONTINENT 241

across the Channel during the first

ten days of the campaign, structurally

converted 54 of its 103 LSTs to accommodate casualties. The task force

installed tiers of removable bulkhead

litter brackets and a platform, lights,

and plumbing for a surgical station

on the tank deck of each vessel. So

equipped, an LST could hold 144

stretcher patients suspended from the

bulkheads and 150 more lashed to the

deck surface. Another 150 walking

wounded could ride in the troop compartments, making a maximum capacity several times the conservative average load of 75 litter and 75 ambulatory patients used in planning. Converted LSTs, and the 49 that were not

converted but were able to take on

casualties if necessary, all received allowances of dressings, morphine,

sulfa, splints, whole blood, plasma,

and penicillin. These supplies came

partly from Army and partly from

Navy stocks, and Southern Base Section medical facilities at the ports and

hards issued and replenished them.

On its first outbound voyage each

LST carried an exchange unit of blankets, litters, splints, surgical dressings,

and plasma, to be deposited on the

beach to replace matériel taken off

with the wounded. Each vessel embarked another such package on subsequent trips until 300 exchange

units, containing in all 30,000 litters

and 96,000 blankets, had been landed

in France.4

Hawley and Dowling anticipated, as

did the NEPTUNE planners, that

during the first days of the assault

many wounded would reach the LSTs

having received only minimal first aid

and requiring emergency surgery to

keep them alive. The Western Naval

Task Force, accordingly, reinforced

the medical complement of each LST,

both converted and unconverted, with

2 additional medical officers and 20

hospital corpsmen. These Navy doctors, although given a short course in

amphibious warfare medical support

at the Navy's training center in Cornwall, were not experienced surgeons.

To ensure adequate shipboard emergency care, Hawley, at Dowling's request, placed 1 Army medical officer

and 2 enlisted surgical technicians on

each LST. Colonel Cutler, the theater

chief surgical consultant, handpicked

the 100-odd officers, mostly captains

and majors, from the Third Army, the

Communications Zone, and the air

forces on the basis of their surgical

training and qualifications. In midMay, before joining their ships, the

officers and their supporting technicians assembled at three station hospitals for orientation to their mission

and for a refresher course, taught by

the ETO senior consultants, in shock,

anesthesia, transfusion, and surgical

management of trauma.

Hawley and Dowling, concerned

lest the LST doctors attempt too

much surgery, issued a directive carefully defining the shipboard officers'

task. In general, they declared, "treatment on board LSTs should be similar to that of a Division Clearing Sta4

 Dowling, Normandy Rpt, 11 Jan 45, p. 19, app.

A, pp. 6-7, app. M, p. 3, app. N, pp. 3-4; Essential

Technical Medical Data Rpt, HQ, ETOUSA, June

1944, encl. 2; Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. VI, p. 6; Directive, HQ, ETOUSA, to CG, FUSAG, and Cdr, US

Fleet, TF 122, 19 May 44, sub: Initial Evacuation of

Casualties From Far to Near Shore ... . in Larkey

"Hist," ch. 8, app. 5; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 75.
242 EUROPEAN THEATER OF OPERATIONS

tion." It should consist principally of

control of bleeding, shock, and pain;

blood and plasma transfusions; immobilization of fractures; and maintenance of airway, if necessary by

tracheotomy. The surgeons were to

perform extensive debridements and

major operations only as "a life

saving measure," decided upon after

"careful consideration in favor of conservatism." During the voyage the

surgeons were to sort and tag their

patients as transportable, that is, able

to travel a distance overland before

undergoing definitive treatment, and

nontransportable, that is, needing attention as soon as they reached the

dock. The chief surgeon felt apprehensive about placing relatively junior

officers in positions of such physical

risk (the combat LSTs had no Geneva

Convention protection) and clinical

discretion. He recalled: "This was a

damn dangerous thing, putting young

surgeons on those LSTs and I felt

very, very concerned about that."5

The activities of 1st Lt. Frank

Davis, Jr., MC, typified the work of

these Army surgeons on Navy vessels

during the first days of the invasion.

Davis, an orthopedist and general surgeon, arrived in England in March

1944 with the 68th General Hospital.

On 10 May, soon after the 68th occupied its plant at Whitchurch, the hospital received orders to send two surgeons to the 316th Station Hospital at

Teingrace, Devonshire, for unspecified detached service. In the absence

of an available senior in rank, Davis

received the assignment. With two accompanying surgical technicians from

the 68th—actually, he recalled, they

were "both PFCs and neither had

ever scrubbed on a major operation

before"—Davis reported to the 316th.

After the training course he and his

technicians traveled to Plymouth,

where they boarded LST No. 496 on

26 May. Davis brought with him an

Army surgical kit, and the Navy furnished him a supplementary one. Because No. 496 had been casualty converted, the vessel had operating room

floodlights installed over a space far

aft on her tank deck, but Davis and

his two Navy colleagues had to improvise a sterilizer from a galley steam

table and put together their own operating table. The ship received a

supply of blood, plasma, and penicillin, delivered to the dock by ambulance, just before it sailed with the invasion convoys.6

LST No. 496 arrived off OMAHA

beach on D-Day and during the afternoon, much behind schedule, began

discharging troops and vehicles of the

29th Infantry Division and its 115 Infantry. Even before the tank deck was

emptied, DUKWs and LCVPs (landing craft, vehicle/personnel), tossing

in the choppy sea, came alongside the

anchored LST with wounded. Navy

crewmen hoisted the casualties on

their litters to the top deck, then laboriously maneuvered the stretchers

down ladders and through passageways to the cavernous vehicle deck

and Davis' surgical station. Patient

loading speeded up after the vessel

5

 First, second, and third quotations from correspondence in file HD 705 ETO (Medical Care on

LSTs, 1944). Fourth quotation from Hawley Interv,

1962, pp. 41-44, CMH. See also Dowling, Normandy Rpt, 11 Jan 45, pp. 6-8, app. E, pp. 8-9, app. N,

p. 2; Mins, 14th and 18th Meetings of Base Section

Surgeons, 31 Jan and 27 Mar 44, file HD 337.

6

 Interv, OSG with 1st Lt Frank Davis, Jr., 24 Nov

44, box 220, RG 112, NARA.
COMZ REACHES THE CONTINENT 243

finished discharging her troops and

cargo, with wounded coming directly

in through the bow doors. LST No.

496 spent three days and nights off

OMAHA. She took on for evacuation

over 100 wounded, and her medics

treated and sent back to the beach another 96 men with minor injuries who

had been embarked by mistake. Davis'

small surgical unit used up their

whole blood, plasma, and penicillin;

performed numerous debridements,

as well as an appendectomy; and

splinted fractures. The Army surgical

technicians, Davis declared, were "all

right" after some initial instruction;

the Navy surgeons acted as anesthe- tists; and a chief pharmacist's mate

also assisted. The LST left French

waters on 9 June and a day later anchored off Weymouth to disembark

her load of wounded, 30 of whom

Davis had tagged as nontransportable. Only 1 death occurred during the

voyage: a crewman accidently killed

by a falling elevator.7

During the first eleven days of the

campaign, LSTs transported about 80

percent of the wounded evacuated

from Normandy. Of the LSTs used in

the operation 95 carried casualties on

one or more return voyages. While

patient loads occasionally exceeded

300, the average number carried per

trip was about 78, and few ships

brought back more than 200 at a

time. LSTs proved easy to load by a

variety of means. Afloat, they hoisted

wounded over their sides on stretchers from smaller craft, or transferred

them through their bow doors. Once

the vessels began beaching and

"drying out" between tides, ambulances, jeeps, and DUKWs simply

drove on board directly from clearing

stations. Especially during the period

immediately after D-Day, LST medical

officers complained that shore evacuation units overloaded some ships

with patients, while others, beached

or anchored nearby, waited for hours,

even days, and then sailed for the

United Kingdom empty. Soon after

D-Day the Navy beach battalion on

OMAHA began designating a single

LST per tide to receive casualties,

thus permitting quick turnaround for

the others.8

On board the LSTs, as Lieutenant

Davis' experience indicated, the

mixed Army-Navy medical staffs, for

the most part, worked as effective

teams. Army doctors on a couple of

vessels complained of conflicts of authority with their Navy counterparts,

but most of the Navy men, as one

Army doctor put it, "made the integration of medical effort between the

two forces a workable and delightful

experience." Navy line officers and

crewmen assisted in loading and unloading the wounded and occasionally

helped with treatment. On at least

one vessel, even ground troops waiting to disembark helped bring casualties on board. The ship medical complements proved adequate in size,

except when the number of litter patients exceeded 200 or so. In such in7

 Ibid. LST No. 496 made only one evacuation

trip. Outbound on her second voyage she hit a mine

in the Channel and sank. Davis survived the sinking,

but with a severe back injury that forced his evacuation to the United States.

8

 Dowling, Normandy Rpt, 11 Jan 45, pp. 16, 25,

app. N, pp. 8-10; 261st Medical Battalion Annual

Rpt, 1944, p. 3; 4th Infantry Division Supplementary Notes—Landing, p. 5, in 4th Infantry Division

Combat Intervs, box 24020, RG 407, NARA; correspondence in file HD 705 ETO (Medical Care on

LSTs, 1944) and file Evacuation on LSTs, June

1944.
244 EUROPEAN THEATER OF OPERATIONS

REMOVING A CASUALTY FROM AN LST

stances officers and corpsmen were

too busy checking dressings, adjusting

splints, and administering medicine

and transfusions to perform much

surgery. LST surgeons, generally following preinvasion directives, avoided

major operations and concentrated

mainly on debridement, immobilizing

fractures, and occasional amputations.

In rare cases they successfully operated on severe chest and abdominal injuries. Most of the wounded survived

the cross-Channel voyage in good

condition. General Hawley, who

boarded one of the first returning

LSTs as soon as it entered harbor, recalled: "I went down on the tank deck

. . . and looked at all those wounded

... . They were in beautiful shape.

The morale was up. Their dressings

were clean. . . ."9

While LSTs continued to transport

patients throughout the first two

months of fighting, the opening of

field and evacuation hospitals in

France quickly eliminated the need

for emergency surgery on board the

ships. In late June, therefore, General

9

 First quotation from correspondence in file

Evacuation on LSTs, June 1944. See also Essential

Technical Medical Data Rpt, HQ, ETOUSA, June

1944, p. 4. Second quotation from Hawley Interv,

1962, p. 54, CMH. On the condition of the wounded, see Memo, Lt Col R. M. Zollinger to Col Kimbrough, 10 Jun 44, sub: Observations on Receipt of

Casualties, file HD 705 ETO (Medical Care on

LSTs, 1944).
COMZ REACHES THE CONTINENT 245

TABLE 5—PERSONNEL AND PATIENT CAPACITY OF HOSPITAL CARRIERS a

a

 On loan to U.S. Navy from Great Britain.

Source: Encl 2, Report of Evacuation Operations, 10 Jul 44, p. 2, of Essential Technical Medical Data Rpt, HQ, ETOUSA, July 1944.

Hawley withdrew his Army surgeons

and technicians from the vessels and

sent them back to their units. By the

time he did so, it was clear to senior

consultants and shipboard surgeons

alike that preinvasion forebodings

about the use of the LST had been

exaggerated. The tank landing ship,

although cold, damp and vulnerable

to attack, had demonstrated its effectiveness for moving casualties.10

Except for 560 men taken out on

assault transports, those sea-evacuated casualties who did not travel on

LSTs crossed the Channel on hospital

carriers (Table 5). Four of these whitepainted, Red Cross-marked converted

ferries and coastal steamers supported the American Army: the Dinard,

Naushon, Lady Connaught, and Prague.

With British crews and, in three, U.S.

Army medical complements, these

vessels operated under the British

Ministry of Transportation, which dispatched them at the request of the

First Army, transmitted through the

Western Naval Task Force and

SHAEF. Beginning soon after D-Day,

the carriers shuttled between Southampton and Normandy, on a schedule

that placed one off each invasion

beach every day. For their size (patient capacities ranged from 62 litter

and 146 ambulatory on the smallest,

the Dinard, to 194 stretcher and 228

ambulatory on the largest, the Prague)

they moved a substantial number of

casualties. The Prague alone, in her

first eleven trips, transported 3,280

patients.

Hospital carriers, which had

Geneva Convention protective markings, were safer from attack than

LSTs. Heated inside and equipped

with bunk beds, they were more comfortable for patients than the landing

vessels and, with fully outfitted operating rooms, could provide more

complete medical and surgical care.

Nevertheless, the carriers had major

deficiencies beyond their limited patient capacity. Outside a regular port

where they could tie up to wharves,

they were difficult to load. The carriers, unlike the LSTs, could not take

casualties on board directly from

DUKWs and other landing craft, forc10

 Correspondence in file Evacuation on LSTs,

June 1944; Ltr, Hawley to TSG, 26 Jun 44, file HD

024 ETO O/CS (Hawley-SGO Corresp); Dowling,

Normandy Rpt, 11 Jan 45, pp. 23-26.
246 EUROPEAN THEATER OF OPERATIONS

TRANSFERRING CASUALTIES FROM A DUKW TO A WATER AMBULANCE for embarkation on the hospital carrier Prague

ing awkward, hazardous offshore

transfers from craft to the carriers'

own small water ambulances. Once

on a carrier, litter cases had to be

manhandled from the top deck down

ladders and passages and then transferred from stretchers to doubledecked bunks. The Army medical

staffs of these ships, drawn from hos- pital train units and hospital ship platoons, lacked experience in working

on carriers. They quarreled with the

British ships' crews and made errors

in loading and care of patients. On

the first voyage of the Lady Connaught

the medical staff reduced the vessel to

"complete chaos" by overcrowding

her with litter patients and trying to

do too much surgery. The complex

Anglo-American chain of command

governing carrier movements made

availability of these vessels always uncertain. Army and Navy evacuation officers perferred the more easily

loaded LST and, as casualty flow diminished late in June, stopped employing the carriers. General Hawley,

however, directed resumption of their

use, if only to transport ambulatory

patients. Hawley believed that the carriers would be of value once Cherbourg opened and wanted to forestall

a British attempt to reclaim them.

The chief surgeon also had public relations in mind. He declared:

The arguments that LSTs are easier to

load and that airplanes are more conven- ient, are no good. Neither LSTs nor

planes are protected by the Geneva Con- vention; and, if we lose a single casualty

by enemy action when we are not using
COMZ REACHES THE CONTINENT 247

TABLE 6—CASUALTY RECEPTION AT PORTS, TUNE 1944

Source: Dowling, Normandy Rpt, 11 Jan 45, app. N, p. 6.

protected transport to its fullest capacity,

we are laying ourselves wide open to terrific criticism. ... I want protected hos- pital carriers used to their fullest capacity.11

After D-Day the seaborne movement of wounded back across the

Channel began slowly. A few casualties, mostly soldiers and sailors hurt

on board ships and landing craft,

reached England during the first

forty-eight hours. On 9 June (D+3)

returning convoys of LSTs made

port, carrying casualties from the initial assaults. Thereafter daily patient

arrivals numbered in the hundreds

and, on some days, in the thousands

(Table 6). Most Americans evacuated

from Normandy landed at Southampton and Portland-Weymouth, although the medical service also had

made major reception preparations at

Brixham and more limited provisions

at other Channel ports. Between 6

11

 First quotation from Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Daily

Diary, 11 Jun 44, file HD 024 ETO. See also 9-10

Jun 44 and 1, 4, and 31 Jul 44. Second quotation

from Ltr, Hawley to Col C. H. Beasley, 4 Jul 44, file

HD 024 ETO CS (Hawley Chron). See also Ltr,

Hawley to TSG, 26 Jun 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp); Dowling, Normandy Rpt,

11 Jan 45, pp. 19, 26, app. N. pp. 5 and 10; Surg,

United Kingdom Base, Annual Rpt, 1944, p. 27;

Professional Services Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, Chief Consultant in

Surgery sec., p. 12; Essential Technical Medical

Data Rpt, HQ, ETOUSA, June 1944; Memo, Col J.

K. Davis to CMedOff, SHAEF, 7 Aug 44, sub: Visit

to Medical Facilities, Southampton, in Medical Division, COSSAC/SHAEF, War Diary, August 1944;

Memo, Col F. H. Mowrey to Hawley, 27 Jul 44, sub:

Report on Trip to Continent, file 370.05.
248 EUROPEAN THEATER OF OPERATIONS

and 22 June Portland-Weymouth disembarked over 12,800 wounded and

Southampton, used jointly with the

British, more than 6,000.12

As casualties arrived, the medical

service put into execution its preinvasion plans for disembarking wounded

and processing them in port holding

units and transit and general hospi- tals. Through the transit hospital

stage the Southern Base Section surgeon, Colonel Thomas, directed evacuation, under close supervision

during the first days from General

Hawley. Hawley and Colonel Cutler,

using the 1st Medical General Laboratory at Salisbury as a field command

post, roved continually among ports

and medical units. They observed dis- embarkation, triage, and treatment;

made sure that units were following

prescribed procedures; and issued

orders or made suggestions for solving unanticipated problems. Further

ensuring direct control of operations

by the chief surgeon's staff, Cutler

stationed a senior surgical consultant

at each main LST port, to aid in separating transportable from nontransportable cases and to keep holding

units from succumbing to the

common hospital tendency to retain

patients for too long. Other surgical

consultants performed a similar function, as well as assisting in professional care, in transit hospitals.13

Before D-Day the Southern Base

Section deployed the 33d Medical

Battalion, with one collecting, six ambulance, and two sanitary companies

attached, at Portland-Weymouth. At

Southampton the base section stationed the 93d Medical Gas Treatment Battalion with elements of its

own organic companies, as well as

one sanitary and two ambulance companies. The battalion commanders,

Lt. Col. Frederick J. Knoblauch, MC,

of the 33d and Col. Joseph W.

Palmer, MC, of the 93d, as port evacuation officers, had immediate charge

of removal of patients from LSTs and

their distribution to holding units and

transit hospitals.

As landing ships pulled in to the

wharves and hards, medical officers

from the receiving battalions boarded

them to recheck the triage done on

the voyage by the LST surgeons and

to make sure that nontransportables

bound for the port holding units were

positioned on the deck for first removal. Teams of sanitary company

men then carried the stretcher patients and helped the walking wounded to lines of ambulances parked near

the ships. The black sanitary company

soldiers, many of whom had arrived

in the theater trained only for malaria

control, distinguished themselves at

this unloading task, for gentleness in

handling the severely injured and for

speed in emptying LSTs. The 724th

Medical Sanitary Company, under the

33d Medical Battalion, could take off

as many as 175 stretcher cases in less

than thirty minutes. Ambulances shuttled constantly between docks and

12

 Dowling, Normandy Rpt, 11 Jan 45, pp. 18-20

and app. N, p. 6; Surg, United Kingdom Base,

Annual Rpt, 1944, pp. 25-26; Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 3, and, in file HD 024 ETO,

ibid., Daily Diary, 7-10 Jun 44. 13

 Ltr, Hawley to TSG, 26 Jun 44, file HD 024

ETO O/CS (Hawley-SGO Corresp); Carter, ed., Surgical Consultants, 2:204-24; Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, Chief Consultant in Surgery sec., pp. 7-9;

Hawley Interv, 1962, pp. 62-63, CMH; correspondence for June-July 1944 in file HD 024 ETO CS

(Hawley Chron).
COMZ REACHES THE CONTINENT 249

CASUALTY RECEPTION IN BRITAIN

hospitals, following routes previously

mapped out and tested. At PortlandWeymouth Colonel Knoblauch combined the vehicles and crews of his

ambulance companies into a single

transportation pool, from which he

dispatched convoys as required. Ambulances of one of Knoblauch's units,

the 590th Medical Ambulance Com- pany, carried 7,000 passengers and

drove over 150,000 miles before the

company was relieved in mid-July to

prepare for shipment to France. When convoys came in, ambulance

and sanitary troops alike worked

around the clock, at times handling

an average of 1 casualty per minute

throughout an entire day. On duty at

the docks for up to sixteen hours

without a break, men snatched what

sleep they could and ate hurried

meals from mobile kitchen trucks.14

At Portland-Weymouth local im- provisation overcame a disembarkation crisis. Between 10 and 13 June

three convoys, including sixty-seven

LSTs with almost 2,000 wounded on

board, reached these ports at the

same time. The wharves and hards

could accommodate only five LSTs at

once. While the ships could be

cleared of casualties in minutes, they

then had to remain docked or

beached until reloaded with troops

and freight vitally needed in France, a

process which took up to six hours. In

the meantime other LSTs, with men

on board urgently requiring medical

care, remained tossing at anchor outside the breakwater. After ineffectual

experiments with small landing and

harbor craft, the port medical officers,

at Colonel Cutler's urging, arranged

with the Navy for LCTs (landing

craft, tank) to go out to the waiting

LSTs and link bow ramps with them.

Sanitary company troops on board

the LCTs transferred patients to the

smaller craft, which could unload at

hards not usable by LSTs. By this expedient, which also kept ambulances

from interfering with cargo movement at the LST hards, the Army and

14

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp. 3-

4; Larkey "Hist," ch. 13, pp. 8-10; Surg, United

Kingdom Base, Annual Rpt, 1944, p. 28; Ltr,

Hawley to TSG, 26 Jun 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp); 33d Medical Battalion

Annual Rpt, 1944, pp. 8-9 and 11-12; 93d Medical

Gas Treatment Battalion Annual Rpt, 1944, p. 4;

724th Sanitary Company Hists, 1 Apr-30 Jun 44, 1

Jul-30 Sep 44, and 1st Semiannual Rpt, 1945; 740th

Sanitary Company Annual Rpt, 1944, pp. 4-5;

570th, 590th, and 598th Ambulance Companies

Annual Rpts, 1944.
250 EUROPEAN THEATER OF OPERATIONS

Navy landed about 1,100 wounded in

a little over three hours.15

Minor inefficiencies plagued casualty disembarkation. The port medical

units never could obtain reliable advance notice when LSTs were returning with casualties. Triage officers

disagreed on which patients were

transportable and which were not, in

spite of the advice of the consultants.

Evacuation officers had a tendency to

overload the nearest transit hospitals

while leaving those farther inland

with few patients. Yet, even with these

difficulties, the disembarkation of patients and their dispatch to hospitals

in the main went smoothly, thanks to

thorough planning and preparation,

sufficient manpower and equipment,

and close high-level supervision. In at

least one respect the U.S. receiving

system proved superior to its general- ly similar British counterpart. The

British relied almost entirely on hospital trains to take wounded from

wharves to transit hospitals, a practice

that often kept men in need of treatment and rest waiting for hours on

the waterfront until a train was filled.

The Americans, on the other hand, by

using ambulances for the first stage of

land evacuation could start the

wounded on their way as soon as they

came off the ships.16

Patients tagged nontransportable

by LST surgeons or dockside triage

officers went at once to holding units

of the 12th and 50th Field Hospitals

at Portland-Weymouth and of the

28th and 46th Field Hospitals at

Southampton. Directly under base

section command, these units placed

detachments only blocks from

wharves and hards to receive the

most urgent cases. At Southampton,

for example, a platoon of the 28th occupied a bombed-out brewery on the

waterfront. The platoon used the

intact cellar for wards, operating

room, and X-ray department and

placed supply, staff quarters, and

other facilities in tents in the rubble

above. The main bodies of the field

hospitals, established under canvas on

the city outskirts, received most of the

nontransportables and were organized for short-notice mass admissions and evacuations. At the 50th

ambulances

pulled up in front of the admitting tents

where wooden horses were placed for the

litters. Here the admitting officer quickly

checked the emergency medical tag and

on the basis of the diagnosis thereon sent

the patient to the appropriate ward

[while] making out a new record. The

number of beds available in any tented

ward was indicated on a board with a cir- cular tab for each bed. As the patient was

allocated to a ward one of these tabs was

pinned to his records and this was re- turned to its place when the patient was

further evacuated. In this way the bed

15

 The LCT could carry several medium tanks and

was the Allies' principal small vehicle landing craft,

in contrast to the LST, an oceangoing ship capable

of beaching. See Dowling, Normandy Rpt, 11 Jan

45, app. N, p. 6; Carter, ed., Surgical Consultants,

2:209 and 213-14; Surg, United Kingdom Base,

Annual Rpt, pp. 27-28; Larkey "Hist," ch. 13, p. 9. 16

 Memo, Kenner, sub: Report of Inspection—Reception of Casualties of Southampton, 7-8 Jun 44,

and Memo, Kenner to CofS, SHAEF, 20 Jun 44,

sub: Report of Inspection ETO During . . . Period

7-17 Jun 44, both in Medical Division, COSSAC/

SHAEF, War Diary, June 1944; Memo, Lt Col M. E.

Glock to Chief, Operations Division, OofCSurg,

HQ, ETOUSA, 6 Jul 44, sub: Report on Medical

Operations, SBS, EvacCorresp, 1942-44, file HD

024 ETO; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 11, 14, 18

Jun 44 and 16, 23 Jul 44, file HD 024 ETO. On the

British evacuation system, see Crew, AMS, Campaigns: North-West Europe, 4:61-69. The U.S. comparison is in Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 5.
COMZ REACHES THE CONTINENT 251

status was instantly known. The whole

procedure of admission took only one or

two minutes and the litter bearers then

carried the patient out through the side

door of the admission tent. The patients

in shock were taken to the shock wards

for transfusion. . . . The patients requir- ing immediate surgery were taken to the

surgical wards and prepared for oper- ation. . . .17

These units, reinforced with auxiliary surgical and shock teams and often

with gas treatment elements, performed much the same function as

did their continental counterparts attached to division clearing stations.

Generally, they kept patients no

longer than twenty-four hours before

sending them by ambulance to the

larger transit hospitals. Field hospitals

did most of their emergency surgery

during the first couple of weeks of the

invasion, before First Army hospitals

were in position to retain nontransportables on the far shore. As the

campaign went on, their work dwindled to dealing with emergencies and

complications developing on the

voyage and to caring for occasional

severe cases that slipped through the

sorting process farther forward. The

field hospitals also were supposed to

handle injured from enemy air attacks

on the embarkation ports or on vessels left off shore, but the number of

these was negligible. Even during the

first weeks after D-Day, lighter than

expected casualties left many holding

units with little to do. The 46th Field

Hospital at Southampton and the

50th at Portland-Weymouth, which

received most of the nontransportables, kept constantly busy. By contrast, the platoon of the 28th in the

Southampton brewery admitted only

81 patients before it closed on 4 July.

The 7th Field Hospital at Brixham,

where casualties had been expected

to land but did not, "ran a hotel for

. . . casual troops . . . engaged in

various duties on the hards" and

treated occasional road accident victims.18

Most of the ambulances leaving the

docks headed directly for the station

and general hospitals that General

Hawley, before D-Day, had designated to serve as transit hospitals. If the

field hospitals at the ports resembled

in mission those at division clearing

stations, the transit units, located

within 30 miles of the coast, acted

much like army evacuation hospitals.

Indeed, two of them actually were

evacuation hospitals—the 12th and

109th, established side by side near

Portland-Weymouth to provide additional transit beds.

The fixed hospitals assigned to

transit duty had to adjust their procedures and routines for rapid reception, short-term treatment, and disposition of patients. During the final

hours before D-Day they cleared out

their wards often hastily and informally because the process, for security

reasons, could start only at the last

minute. A surgeon at the 228th Station Hospital recalled: "We succeed17

 Quotation from Larkey "Hist," ch. 13, pp. 10-

11; as theater medical historian, Larkey was an eyewitness of these operations. See also 50th Field

Hospital Annual Rpt, 1944, pp. 1-8; 28th Field

Hospital Hist, 1944, pp. 27-28, box 412, RG 112,

NARA.

18

 Professional Services Division, OofCSurg, HO,

ETOUSA, Annual Rpt, 1944, Chief Consultant in

Surgery sec., p. 13; 7th, 12th, 46th, and 50th Field

Hospitals Annual Rpts, 1944; 28th Field Hospital

Hist, 1944, box 412, RG 112, NARA. An eyewitness

description of holding unit reception is in Larkey

"Hist," ch. 13, pp. 10-11.
252 EUROPEAN THEATER OF OPERATIONS

ed in emptying the hospital simply by

throwing some of the patients on

trains, loading some on convoys [of

ambulances], and summarily giving

discharges to many others." Some

convalescents, realizing that the invasion was imminent, helped by departing without leave to rejoin their units.

"We knew they were going, but we

didn't try to stop them."

 19

 Transit

hospitals revamped their methods for

admitting patients and initiating their

clinical records, some decentralizing

the entire process to a number of

wards. Staffs reorganized to keep all

departments and services open

around the clock. Shifts for doctors,

nurses, and enlisted men averaged

twelve hours a day. One unit, the

315th Station Hospital, divided its

personnel into three sixteen-hour

shifts, two of which were always on

duty. Station hospitals, especially, received reinforcements of surgical

teams, nurses, and enlisted men. The

110th Station Hospital at Southampton had 80 officers and 150 nurses

from eleven different units attached

at various times, as well as a sanitary

company platoon for litterbearers and

a military police detachment to guard

wounded POWs.

Transit hospitals were supposed to

examine incoming patients, retain

those needing immediate definitive

care or requiring rest before further

travel, and prepare the remainder for

early rail movement to regular general hospitals. In practice, they adopted

flexible evacuation policies. The

228th Station Hospital, for example,

"operated under a very informal

holding policy. . . . When a patient

could be moved, he was moved.

Sometimes that meant 24 hours,

sometimes five days." Individual units

processed large number of casualties

within a short time. One of the most

active, the 834-bed 110th Station

Hospital, only 6 miles from the

Southampton waterfront, handled

7,000 patients during June and July,

admitting and evacuating as many as

1,700 in one week. Another heavily

used unit, the 48th General Hospital

at Stockbridge, processed about 3,000

casualties in eight days. The load,

however, was unequally distributed,

depending on a hospital's location

and the decisions of port evacuation

officers. The 314th Station Hospital

at Truro, well away from the main receiving ports, admitted only two

groups of wounded during a month

of transit operations.20

Early in the campaign, transit hospital staffs were uncertain how much

surgery they were expected to do.

Their preinvasion directives from

General Hawley indicated that they

were not to engage in surgery on patients capable of continued travel;

some hospitals, adhering rigidly to

these instructions, held this category

of cases on their wards for lengthy

periods, awaiting accumulation of a

trainload of evacuees. Appropriate

when casualties were coming in rapidly, this policy at other times resulted

in idle surgical teams and in the

denial of early definitive treatment to

19

 Interv, OSG with Maj Harry R. Grau, 18 Jul 45,

box 223, RG 112, NARA.

20

 Quotations from ibid. See also 110th Station

Hospital, 28th and 48th General Hospitals, and 12th

Evacuation Hospital Annual Rpts, 1944; 28th General Hospital Supplementary Hist, 15 Apr-15 Jul 44;

38th Station Hospital Hist, 1 Jan-31 Dec 44; 314th

Station Hospital Annual Hist, 1944; 305th and

315th Station Hospitals Supplementary Hists, 1

Apr-30 Jun 44.
COMZ REACHES THE CONTINENT 253

men who could have benefited from

it. Within a week of D-Day Colonel

Cutler directed transit hospitals to do

as much definitive surgery as the

availability of staff and their admission rates permitted, which often

turned out to be a great deal. Surgeons of the 48th General Hospital

found that they could operate on

almost all the wounded soldiers they

received and hold them as nontransportable for a day or so of recovery

without clogging the flow of patients

through their unit. On the other

hand, surgeons at the busy 110th Station Hospital confined themselves

largely to "supportive and revisional

surgery in the interests, mainly, of

continued transportability," such as

debridements, fragment extractions,

hemorrhage control, and splint and

cast reconstruction. As did the holding units, the transit hospitals encountered their heaviest surgical

burden during the weeks immediately

after D-Day, often working on men

who "for all practical purposes, were

admitted from the field." The increasing proportion of incoming wounded

who had undergone surgery on the

far shore generally reached the transit

hospitals in good condition, except

for occasional patients with inadequate debridements and improperly

applied casts and for a few prematurely transported chest injury cases.

The transit hospitals' own mortality

rates were low, averaging about 0.2

percent of the patients received.21

Beyond the transit hospitals the

Evacuation Branch of General Hawley's office, headed by Col. Fred H.

Mowrey, MC, controlled the routing

of patients to the general hospitals,

where they would stay until they recovered or were evacuated from the

theater. For this stage of evacuation

the branch employed fifteen Britishbuilt and -operated and U.S. Armystaffed hospital trains based in southwest England. Working with U.S. and

British transportation authorities,

Mowrey's staff dispatched these trains

on the basis of Southern Base Section

reports, received four times each day,

giving the number and location of

transit hospital patients ready to

travel. The transit hospitals used their

own ambulances and trucks, and vehicles borrowed from other units, to

bring prescribed loads of patients to

their assigned railheads. The Evacuation Branch usually kept its trains

running on time, in spite of the complexity and occasional lack of responsiveness of the Anglo-American rail

traffic control system, and in spite of

frequent breakdowns of the ten overseas hospital trains, originally constructed to operate on the Continent

and hastily modified to run on British

tracks. The transit hospitals, on their

side, quickly learned to synchronize

ambulance movements with train

schedules. Their drivers and litterbearers developed proficiency in shifting wounded from ambulances to railroad cars, often filling a train to its

300-patient capacity in less than an

hour. By the end of June the Evacu- 21

 Quotations from 110th Station Hospital Annual

Rpt, 1944, pp. 1-3 and 7. See also Professional Services Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, Chief Consultant in Surgery sec., p. 11;

Carter, ed., Surgical Consultants, 2:208-09; 48th General Hospital Annual Rpt, 1944, pp. 31-33; Memo,

sub: Inspection by Gen Kenner—Transit Hospitals,

SBS, 28-29 June 1944, and Memo, Col J. K. Davis,

10 Aug 44, sub: Visit to UK Transit Hospitals, both

in Medical Division, COSSAC/SHAEF, War Diary,

July-August 1944.
254 EUROPEAN THEATER OF OPERATIONS

COL. FRED H. MOWREY

ation Branch had moved over 23,800

casualties in eighty-four trainloads,

safely and in reasonable comfort.22

Throughout the evacuation chain

property exchanges required constant

attention from the chief surgeon's

Supply Division. In theory, one-forone exchanges of blankets, litters,

sheets, pillows, pajamas, splints, and

tracheal and abdominal tubes were to

occur at each point along the route,

for example, between hospital trains

and transit hospitals. In practice, each

element tried to build up its own reserves so that items steadily disappeared from the system. This process

eventually left the far shore elements

short, in spite of such expedients as

the LST exchange units. The hospitals in Normandy then drew on the

depots in the United Kingdom, which

found their own stocks steadily diminishing. Colonel Hays, the Supply Division chief, partially solved this problem by imposing rigid ceilings (for

example, an average of 3.2 blankets

per bed) on fixed hospitals stocks of

key items. He sent out liaison officers

to make sure that hospitals regularly

turned in excesses to the depots,

which packed the return matériel and

shipped it back to France. Leakage,

nevertheless, continued. At the end of

July Colonel Hays warned base section surgeons of the need for "constant vigilance" to ensure that exchange items "stayed in the stream

and not in the eddies."

 23

Beginning on 10 June, trainloads of

battle casualties reached the end of

the evacuation chain: the European

Theater general hospitals, especially

those grouped under the 12th and

15th Hospital Centers at Great Mal22

 The British had three train types: Ministry of

Health casualty evacuation trains intended for civilian air raid victims, military home ambulance trains,

and military overseas ambulance trains. Of these,

the British used all twenty-one of the first type and

all but five of the second. These five went to the

Americans, as did all ten overseas trains. See Crew,

AMS, Campaigns: North-West Europe, 4:64-65; Dunn,

EMS, 1:287-88; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, pp.

4-5, and, in file HD 024 ETO, ibid., Daily Diary,

June-July 1944; 28th, 48th, and 95th General Hospitals Annual Rpts, 1944; 110th and 315th Station

Hospitals Annual Rpts, 1944; Memo, Lt Col M. E.

Glock to Chief, Operations Division, OofCSurg,

HQ, ETOUSA, 6 Jul 44, sub: Report on Medical

Operations, SBS, EvacCorresp, 1942-44, file HD

024 ETO.

23

 Quotation from Mins, 26th Meeting of Base

Section Surgeons, 31 Jul 44, p. 2, file HD 337. In

same file, see also Mins, 24th and 25th Meetings of

Base Section Surgeons, 19 Jun and 3 Jul 44. See

Kelley Interv, 27 Jan 45, box 221, RG 112, NARA.
COMZ REACHES THE CONTINENT 255

DETRAINING A CASUALTY IN BRITAIN FOR TRANSPORT TO A GENERAL HOSPITAL

vern and Cirencester. The centers

now proved their value in organizing

and directing the rapid transfer of

wounded and sick soldiers from railroad cars to hutted wards. After early

difficulties with late-arriving and unannounced trains and with confusion

in unloading, the centers rapidly reduced mass admissions to routine.

The 15th Hospital Center, for instance, designated one of its attached

general hospitals to receive each

trainload of patients and pooled ambulances and litterbearers from the

others to empty the railcars. By such

means the hospital center could have

a wounded man in bed in a ward

thirty-five minutes after the train carrying him pulled into the station.

Hospital personnel, an observer

noted, "consider this time as their

actual 'battle participation' and all

work long hours and hard on receipt

of the casualties." Indicating the quality of work done at holding and transit units, most patients arrived at the

general hospitals with fractures properly immobilized, wounds debrided

and ready for secondary closure, and

relatively little infection or gas gangrene. Patient deaths on the way to

general hospitals, and after arrival

there, were very few.24

24

 Quotation from Surg, Ninth U.S. Army, Daily

Journal, 9 Jul 44, Shambora Papers, MHI. See also

Professional Services Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, Chief Consultant in

Surgery sec., pp. 9 and 13-14; Rpt, Kenner, 17 Jun

44, sub: Visit of CMO to 91st and 97th General

Hospitals, Oxford, in Medical Division, COSSAC/

SHAEF, War Diary, June 1944; Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Daily Diary, 10 Jun 44, file HD 024 ETO; 12th Hospital Center Annual Rpt, 1944, pp. 31-32; 15th

Hospital Center Hist, 1944, pp. 21-22.
256 EUROPEAN THEATER OF OPERATIONS

The fixed hospital system in Britain

continued to change and expand,

even as it received and treated battle

casualties. In the Western Base Section the number of beds increased

from about 42,000 on D-Day to

50,000 at the end of July, as units finished their planned tented additions

and other organizations occupied

late-completed plants or took over recently vacated militia and conversion

camps. Many plants experienced turnover in occupying units. The 99th

General Hospital, for instance, which

landed at Liverpool on 20 April and

staged at Llandudno, opened a hutted

hospital at Foxley, Hertfordshire, on

12 June. After treating battle casualties for about a month, the unit

turned over its facility and patients to

the 156th General Hospital and then

returned to Llandudno to prepare for

movement to France. Troop departures for the Continent left many station hospitals all but unemployed. To

prevent waste of plants and highly

qualified staffs, the Professional Services, Operations, and Hospitalization

Divisions of Hawley's office, in consultation with the base sections, late

in July designated eight of the professionally strongest station hospitals to

function as general hospitals and

made plans for using others to care

for lightly wounded, sick, and convalescents.25

Air Evacuation Begins

A separate system of holding units

and transit hospitals handled the

growing number of wounded evacuated to Great Britain by air. All the

NEPTUNE plans called for early, extensive use of returning cargo planes to

carry casualties, but the actual scale

and effectiveness of air evacuation remained uncertain as the campaign

began. Throughout the planning

General Grow, the USSTAF surgeon,

made only the most conservative air

evacuation commitments. He insisted

that the field armies and the Communications Zone operate on the assumption that they would have to

move all their wounded by sea, with

provisions for use of aircraft if available. Experience quickly showed that

Grow had been overly pessimistic.

Cross-Channel casualty flights began

on 10 June, sooner than expected,

and proved both efficient and beneficial for the patients. Air evacuation

grew rapidly in volume so that by the

end of July over 25,900 American

wounded, more than one-third of the

total number evacuated, had returned

from France by plane (Table 7). As envisioned in the NEPTUNE plans,

ground and air forces shared responsibility for air evacuation. The First

Army's engineer special brigade medical battalions delivered patients to

designated landing fields in Normandy. The IX Troop Carrier Command

assigned an air evacuation officer to

coordinate its efforts with those of the

army and also furnished C-47 transports to care for the wounded in

flight. In Britain the Communications

Zone unloaded casualties from air25

 Surg, Western Base Section, Rpt, 1 Jan-31 Aug

44, pp. 10-12; Larkey "Hist," ch. 8, p. 25; 99th

General Hospital Annual Rpt, pp. 2-3. The reassigned station hospitals were the 49th, 115th, 121st,

136th, 208th, 231st, 303d, and 327th. See Evacuation Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Daily Diary, 4, 12 and 29 Jul 44, file HD

024 ETO; Mins, 25th Meeting of Base Section Surgeons, 3 Jul 44, pp. 12-13, file HD 337.
COMZ REACHES THE CONTINENT 257

TABLE 7—CROSS-CHANNEL EVACUATION, TUNE-JULY 1944

Source: Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, encl. 10.

craft and dispatched them to hospitals.26

Most air-evacuated casualties

landed at the Ramsbury and Membury airfields in the Southern Base

Section, which the Ninth Air Force

had designated for this purpose

before D-Day. At each base a field

hospital platoon (the 3d of the 6th at

Ramsbury and the 2d of the 28th at

Membury), reinforced by an auxiliary

surgical team, acted as a holding unit.

Set up in tents close to the runways,

these hospitals retained nontransportables selected by plane-side triage officers for emergency surgery and resuscitation. Ambulances, from the

field hospitals and an attached ambulance company, took evacuees able to

travel to two station and two general

hospitals within a 30-mile radius,

which served as transit facilities. From

then on, the evacuation pattern was

the same as that for seaborne patients. The airstrip holding units,

which could remove a C-47's cargo of

24 litter cases in no more than eight

minutes, between them could process

1,000 wounded a day, although actual

daily flow averaged about half that

number. Patients generally showed no

ill effects from their flight, except for

a few with chest and abdominal injuries who were evacuated too early

after surgery in France.27

As the logistical efficiency and medical advantages of air evacuation

became apparent, the medical service

and the Air Force opened additional

receiving facilities at Merryfield, Rednail, and Tarrant Rushton airfields.

Located close to general hospitals,

these fields required no elaborate

holding and transit arrangements.

The medical service, accordingly, stationed only a small holding element

at Merryfield and placed detachments

of litterbearers and ambulances at the 26

 Link and Coleman AAF Medical Support, pp.

598-600; Surg, Ninth Air Force, Annual Rpt, 1944,

pp. 16 and 21-22; Surg, IX Troop Carrier Command, Annual Rpt, 1944, p. 9. On the NEPTUNE

plans, see An. 6—Medical, pp. 13-14, to FUSA Plan,

25 Feb 44; An. 8—Medical, p. 8, to ADSEC Plan, 30

Apr 44; and An. 9—Medical, pp. 13-14, to

FECOMZ Plan, 14 May 44. All in file HD 370 ETO.

See also O/CS Continental SOP, 4 Apr 44, pp. 12-

13, file 370.02. On statistics, see Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 13 and encl. 10; Memo,

Kenner, 26 Jul 44, sub: Evacuation of Casualties by

Air, in Medical Division, COSSAC/SHAEF, War

Diary, July 1944.

27

 Surg, United Kingdom Base, Annual Rpt, 1944,

p. 24; 6th Field Hospital Annual Rpt, 1944, pp. 3-4;

28th Field Hospital Hist, 1944, pp. 5-6 and 30, box

412, RG 112, NARA; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Daily

Diary, June-July 1944, file HD 024 ETO; 98th General Hospital Annual Rpt, 1944, pp. 2 and 38-39;

598th Ambulance Company Annual Rpt, 1944, p. 3;

correspondence in Medical Division, COSSAC/

SHAEF, War Diary, June-August 1944; Ltr, Hawley

to Col Thomas, 28 Jul 44, file HD 024 ETO CS

(Hawley Chron).
258 EUROPEAN THEATER OF OPERATIONS

other two fields. Meanwhile, the two

original evacuation air bases, Ramsbury and Membury, continued in operation, with the 6th Field Hospital

during July taking over the entire

holding mission at both places. The

number of nontransportable wounded

arriving at these fields dwindled

steadily, reducing the hospital to the

tasks of triage and ambulance-loading, much to the discontent of the

unit's professional staff. With all these

bases available, the medical service by

late July had the capacity to handle

6,000 air-evacuated casualties per day.

General Kenner and Colonel Cutler

hoped that air transportation on this

scale would permit the service to

abandon the LST as a means of carrying wounded, especially as the opening of continental ports facilitated use

of the hospital carriers. Air evacuation, however, was subject to other

limitations than the capacity of receiving fields in England, and Kenner's

and Cutler's hopes were not to be realized.28

The expansion of air evacuation,

combined with the lighter-than-expected invasion casualties and the

opening of First Army hospitals, rendered superfluous much of the elaborate network of port holding units

and transit hospitals. Accordingly, the

Communications Zone during June

redeployed two of the four field hospitals, the 12th and 28th, from Portland-Weymouth and Southampton

and gradually detached ambulance

and collecting companies from the

33d Medical and 93d Medical Gas

Treatment Battalions. All the medical

receiving units left the smaller Channel ports. In late June General Hawley's office returned all but five of the

Southern Base Section transit hospitals to regular duty. Nevertheless, sea

evacuation by LSTs was to continue.

On 18 July the theater commander

and the commander of the United

States Naval Forces in Europe agreed

that the Navy would furnish landing

ships, in diminishing numbers, for

transport of wounded through 1 October, by which date French ports

should be open for hospital ships and

carriers and the autumn storms would

cause all logistical activity on the

beaches to cease.29

During the first two months of the

campaign over 65,000 casualties

28

 Surg, United Kingdom Base, Annual Rpt, 1944,

pp. 24-25; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, June-July

1944, file HD 024 ETO; Surg, Western Base Section, Rpt, 1 Jan-31 Aug 44, pp. 9-10; 6th Field

Hospital Annual Rpt, pp. 3-4 and 6; Memo, Kenner,

26 Jul 44, sub: Evacuation of Casualties by Air, in

Medical Division, COSSAC/SHAEF, War Diary, July

1944; Memo, Cutler to Hawley, 30 Jun 44, in Professional Services Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, Chief Consultant in

Surgery sec., p. 12.

29

 The remaining transit hospitals, all station hospitals, were: 38th (Winchester), 110th (Netley),

228th (Sherbourne Park), 305th (Warden Hill), and

315th (Axminster), with a total of 5,093 beds. This

list does not include the hospitals doing air evacuation transit duty, usually in addition to regular

functions. See Essential Technical Medical Data Rpt,

HQ, ETOUSA, June 1944, encl. 2; 33d Medical and

93d Medical Gas Treatment Battalions Annual Rpts,

1944; 7th and 12th Field Hospitals Annual Rpts,

1944; 28th Field Hospital Hist, 1944, box 412, RG

112, NARA; 48th General Hospital Annual Rpt,

1944, p. 5; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 22 Jun 44,

file HD 024 ETO; Memo, Col D. E. Liston to G-4,

ETO, 10 Jun 44, EvacCorresp, 1942-44, file HD

024 ETO. See also in EvacCorresp, 1944-45, file

HD 370.05 ETO, the following: Memo, Liston to

Capt J. H. Chambers, MC, USN, 13 Jul 44, sub: LST

Requirements for Evacuation of Patients; Ltr, Cdr,

NAVFOREU, to CG, ETO, 18 Jul 44, sub: IntraTheater Evacuation of Casualties; Ltr, Liston to G4, ETO, 30 Jul 44.
COMZ REACHES THE CONTINENT 259

passed across the Channel into the

hospitals so laboriously constructed

under the BOLERO program. Except

for the fact that the casualty receiving

system turned out to have been overbuilt for the number of patients it

handled, this portion of COMZ medical support went essentially according

to plan. The same could not be said

for the effort to establish COMZ medical support in Normandy. On the

Continent the medical service, like

the other technical services, ran afoul

of the slow progress of the attack. By

late July the resulting delays in opening facilities, especially general hospitals, had compelled major revisions in

the COMZ medical plan.30

ADSEC Medics in Normandy

Shortly before D-Day the ADSEC

surgeon, Colonel Beasley, and his

staff were alerted and began staging

for movement to France. Officers of

Beasley's section landed at OMAHA

and UTAH beaches on 12 June, and

Beasley himself came ashore on the

sixteenth. Two days later Beasley and

the advance elements of his office established themselves at Auville-sur-leVey near Carentan, close by the main

ADSEC headquarters at Catz. During

the next month the rest of the 100- man section, in prearranged increments, disembarked at UTAH;

marched to concentration areas; and

then rode in trucks to Auville.

Housed in battle-damaged dwellings

and in tents in an apple orchard, the

medical section until late in July was

only a few miles behind the front,

shaken constantly by the blast of

nearby American artillery and in

danger from German shelling and air

raids aimed at a nearby bridge.31

During their first month in Normandy, Beasley and his growing staff,

in keeping with the subordinate status

of ADSEC, worked under Colonel

Rogers, the First Army surgeon. Beasley, who initially had little to do but

keep up with army activities, attended

Rogers' daily conferences. The heads

of the various divisions of Beasley's

office established close liaison with

their First Army counterparts, and

with the medical staffs of 21 Army

Group and the Ninth Air Force.

Gradually, they found employment in

overseeing the disembarkation and

positioning of ADSEC medical units,

and they prepared to take over particular support functions as Rogers

directed. The latter process began on

19 July, when Rogers transferred to

Beasley responsibility for the receipt,

storage, and issue of medical supplies

arriving on the beaches and at Cherbourg.32

In the crucial matter of evacuation

the ADSEC surgeon's role was still

evolving when the Battle of the

Hedgerows ended. In accordance with

NEPTUNE plans the Advance Section

was to assume command of the engineer special brigades around D+25

(1 July) and was to be directing most

30

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, encl.

10.

31

 Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 6-

7 and 14-15; Joseph R. Darnall, "Scouting for Hospital Sites in Normandy," The Military Surgeon 101

(September 1947): 192-93 and 196. 32

 Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 7

and 26. See also in Charles H. Beasley Papers, MHI,

the following: Surg, ADSEC, Daily Activities Rpts,

June-July 1944; Supply Division, OofSurg, ADSEC,

Weekly Activities Rpts, weeks ending 8 and 22 Jul

44.
260 EUROPEAN THEATER OF OPERATIONS

COL. CHARLES A. BEASLEY, the ADSEC surgeon, receiving a decoration from the French in

April 1945

evacuation to the rear of the army

hospitals by the forty-first day of the

campaign. In practice, the transfer

went more slowly and in a less orderly manner. Not until 8 July did Beasley's office begin receiving daily First

Army reports on the number of patients being evacuated by air and sea.

As the army finally drew an ADSEC

forward boundary, Beasley assumed

control of most evacuation in the

northern Cotentin, for both army and

COMZ units, and on the twentyfourth the First Army turned over to

the Advance Section command of its

holding facility at OMAHA and of the

evacuation center at UTAH. At the end

of the month, however, no single

headquarters coordinated the flow of

patients out of Normandy. Evacuation

officers of the Advance Section, First

Army, and Ninth Air Force, as well as

the engineer special brigade medical

battalion commanders, all had a hand

in the process. As a result, according

to General Hawley's chief of evacuation,

there is no clear delineation of responsi- bility, and evacuation just occurs ... . In

the Omaha sector casualties are evacuat- ed from evacuation hospitals, field hospi- tals, and the 4th Convalescent Hospital to

the 'holding unit' . . . whenever the re- spective hospital commanders feel like

evacuating patients. In some instances, individual hospitals have put patients di- rectly on planes without passing through

the 'holding unit'. ... In the Utah

sector, ASCZ [ADSEC] has allotted ten . . . ambulances to each evacuation hos-
COMZ REACHES THE CONTINENT 261

pital. These hospitals evacuate patients

whenever they desire to either the 'holding unit' [set up by ADSEC] near the air- strip at Binniville [sic] or to the holding

unit at Utah Beach. ASCZ attempts to

designate which 'holding unit' will be

used ... . The problem is a difficult one

and all appear to be cooperating, but

there is no central control [to] coordinate

all evacuation operations which is most

essential.33

During the last days of June, as the

First Army completed the conquest of

Cherbourg and the northern Cotentin

Peninsula, ADSEC medical units

began landing and going into operation (see Map 10). Medical battalions

and field and evacuation hospitals led

the way, their mission to support the

other ADSEC troops pouring into

Normandy and to supplement army

facilities as required. Most of these

units arrived behind schedule, their

sailings from England postponed to

make way for combat forces. Many,

their planned sites still German-occupied or in use by other organizations,

waited in temporary bivouacs while

the ADSEC G-4 went through the

complicated process of negotiating

with his First Army counterpart for

new locations. Because the army allowed troops to stay only twenty-four

hours in its beach assembly areas,

Colonel Beasley used early-arriving

field hospitals to run transit camps

for his units at OMAHA and UTAH.34

One of the first ADSEC medical organizations to reach Normandy, the

12th Field Hospital, had no need to

wait long in transit camp. This hospital, early relieved from duty as a holding unit at Portland-Weymouth, disembarked at OMAHA beach on 26

June and three days later went directly to its previously assigned location:

the French Naval Hospital at Cherbourg, where the 12th was to care for

patients while preparing the premises

for later occupation by a general hospital. The men and women of the

12th rode to Cherbourg in vehicles of

the 68th Medical Group, which was

clearing wounded German prisoners

from the port city. When they entered

the Naval Hospital, they found filth

and chaos. The building, a huge

quadrangle dating from the 1860s

with flanking modern pavilions, had

housed one of the three large

German medical installations overrun

when Cherbourg fell. During the

siege an inadequate German staff,

augmented by two captured U.S.

Army doctors, had tried to care for

over 1,000 of their own wounded and

about 150 American prisoners. Before

the 12th moved in, the 68th Medical

Group had evacuated all the freed

Americans and the transportable Germans, but about 400 POW patients

remained, many of them nontransportables shifted from the other two captured hospitals. The Naval Hospital

33

 Quotation from Memo, Col Mowrey to Hawley, 27 Jul 44, sub: Report on Trip to Continent, file 370.05. See also An. 8—Medical, pp. 4-5, to ADSEC Plan, 30 Apr 44, file 370 ETO; Evacuation Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 5-6; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44,

bk. VII, p. 72; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 8 and 16; and, in the Beasley Papers, MHI, Surg, ADSEC, Daily Activities Rpts, 3, 10, 13 and 17 Jul 44, and Evacuation Branch, OofSurg,

ADSEC, Weekly Activities Rpts, weeks ending 23

Jun and 10 Jul 44.

34

 Surg, ADSEC, Daily Activities Rpts, 5-31 Jul 44,

Beasley Papers, MHI; ADSEC Hist, pp. 28-30; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 7-8 and 14. See also An. 8—Medical, p. 6 and encls. 1-2, to ADSEC Plan, 30 Apr 44, file 370 ETO, which gives original unit location and missions.

COMZ REACHES THE CONTINENT 263

had had no running water for the last

week of the siege; discipline had

broken down; and French civilian

doctors, who had used part of the

building under the occupation, now

were looting the supplies of their

former conquerors. According to the

12th's commander,

the sanitary facilities were virtually non- existent—bed pans and urinals were used

again and again without being cleaned

and . . . were at the bedside of the pa- tients; no attempt has been made to pro- vide for any form of laundry facilities and

thus filth was evident on the bedding and

on the patients themselves. The stench

which emanated from these wards is one

that can never be dismissed from the

minds of those who worked therein. Per- haps the operating theater, an under- ground set-up, presented the most ghast- ly scene. Surgeons of the German staff

had been operating for ... 72 hours

non-stop and with water unavailable, no

attempt had been made to clean up the

place. Debris from amputations lay in var- ious receptacles about the operating . . . tables and blood and filth was evident

throughout the rooms. On the grounds in

back of the hospital, as well as in the

morgue, still remained the unburied

bodies of soldiers and civilians; and

dumped on the ground near the mess

hall, amputated extremities were in abun- dance, brought there from the operating

room.35

Medics of the 12th Field Hospital

fell to work, cleaning up and repairing wards, operating rooms, kitchen,

and mess hall. They restored the

water supply. They supervised captured German medical personnel, assembled from all three overrun hospitals, in caring for their wounded

countrymen until the last POWs were

evacuated early in July. Supplementing their equipment and medical supplies with confiscated German articles, the Americans opened 400 beds

for their own patients on 30 June.

The 12th functioned as a small general hospital, receiving sick and injured

from the Cherbourg area, including

many mine and booby-trap casualties

from the port clearing operations.

Under the First Army evacuation

policy the hospital retained men returnable to duty within ten days; it

sent other patients by ambulance to

UTAH beach for transportation to

England. In addition to its other

tasks, the 12th housed and fed medical organizations awaiting deployment

in the upper Cotentin.36

Other ADSEC medical units went

into operation throughout the Cotentin and in the crowded space inland

of OMAHA beach. Typically, these organizations moved to their assigned

locations in their own vehicles, or in

transport borrowed from other units,

over roads marked "Mines Cleared to

Hedges Only." Usually setting up in

hedged fields, the medical people had

to clear away battle debris—discarded

equipment, glider wreckage, and occasionally bodies or parts of bodies—

before they could erect their facilities.

The more enterprising organizations

found uses for some of the litter. Salvaged wood from glider frames, for

example, went into floors and furniture for living quarters and work

spaces.37

35

 Quotation from 12th Field Hospital Annual

Rpt, 1944, p. 5. See also Surg, ADSEC, COMZ,

Annual Rpt, 1944, p. 7; Darnall, "Hospital Sites in

Normandy," p. 194. On clearing captured hospitals, see VII Corps Medical Plan, pp. 27-28, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; 68th Medical

Group Annual Rpt, 1944.

36

 12th Field Hospital Annual Rpt, 1944, pp. 5-6. 37

 For typical descriptions of countryside, cleanup,

and salvage, see 8th Field Hospital Annual Rpt,

1944, p. 5, and Alien, ed., Medicine Under Canvas, pp.

108-11.
264 EUROPEAN THEATER OF OPERATIONS

The 428th Medical Battalion, with

four attached ambulance companies,

disembarked between 28 June and 8

July. With its headquarters at Cherbourg and its companies spread

throughout the Cotentin, the battalion evacuated First Army and ADSEC

units and hospitals. The 7th Field

Hospital opened at Osmanville, in the

OMAHA area, early in July; it treated

patients from the Advance Section,

received some battle casualties, and

administered one of the medical transit camps. Another field hospital, the

8th, set up one of its platoons at

Montebourg in the Cotentin to perform similar functions. On 12 July

still another field hospital, the 9th,

occupied a site at Tourlaville, on the

outskirts of Cherbourg, but it could

not go into operation until the thirtieth, when its equipment, lost in disembarkation, at last was delivered.

The 77th Evacuation Hospital, a 750- bed unit, again after a frustrating wait

for a misdirected equipment assembly, opened near Ste.-Mere-Eglise on

the fifteenth. This unit admitted casualties from First Army evacuation hospitals so that the latter could clear

their wards and move forward; it also

received wounded directly from division clearing stations.38

Under an agreement with the First

Army, made on 17 July, the Advance

Section opened an air evacuation

holding unit at Biniville, about 15

miles south of Cherbourg, to support

the army's right wing. For this purpose Colonel Beasley employed the

93d Medical Gas Treatment Battalion,

which had landed on the fifteenth, reinforced for emergency surgery by a

platoon of the 8th Field Hospital.

The units opened their installations

on the twentieth, in a tented camp

spread over several hedgerow-lined

fields. Later augmented by the rest of

the 8th, the Biniville holding unit

could accommodate almost 900 patients. It received casualties from

army hospitals, and at times from battalion aid stations; held them for

treatment when required; and, when

they were ready to travel, loaded

them on aircraft at a nearby airstrip

used exclusively for evacuation. The

unit assembled planeloads and moved

them out on short notice, to minimize

waits by the C-47s on a runway still

subject to Luftwaffe attacks. This

ADSEC holding unit supplemented

the OMAHA beach facility operated by

the 60th and 61st Medical Battalions.

The latter installation, which had

moved on the sixteenth from its St.-

Laurent site to an airfield 2 miles

south of Colleville, came under

ADSEC command on the twentyfourth.39

38

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. VII, p. 72; ADSEC Hist, p. 19;

Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 14,

16, ex. J; 7th Field Hospital Annual Rpt, 1944, pp.

1-2; 8th Field Hospital Annual Rpt, 1944, pp. 3-7;

9th Field Hospital Annual Rpt, 1944, pp. 3-6; 77th

Evacuation Hospital Annual Rpt, 1944, pp. 1-7;

Alien, ed., Medicine Under Canvas, pp. 108-11; Darnall, "Hospital Sites in Normandy," p. 198. See also

in Beasley Papers, MHI, the following: Surg,

ADSEC, Daily Activities Rpts, 8 and 12 Jul 44; Evacuation Division, OofSurg, ADSEC, Weekly Activities

Rpts, weeks ending 10 and 22 Jul 44; Hospitalization Division, OofSurg, ADSEC, Weekly Activities

Rpt, week ending 9 Jul 44.

39

 Surg, ADSEC, Daily Activities Rpts, 16-17 and

20 Jul 44, and Evacuation Division, OofSurg,

ADSEC, Weekly Activities Rpt, week ending 22 Jul

44, in Beasley Papers, MHI; 93d Medical Gas Treatment Battalion Annual Rpt, 1944, pp. 6-9; 8th Field

Hospital Annual Rpt, 1944, pp. 6-7; Memo, Mowrey

to Hawley, 27 Jul 44, sub: Report on Trip to Continent, file 370.05.
COMZ REACHES THE CONTINENT 265

In connection with its assumption

of responsibility for medical supply to

the rear of First Army, the Advance

Section during July reclaimed from

the army command of its 30th and

31st Medical Depot Companies and

brought in another, the 13th, to reinforce them. Colonel Beasley's Supply

Division set up three new depots. On

the tenth a platoon of the 30th Company established Depot M-1 (later redesignated M-401T) in a taken-over

building in Cherbourg, to distribute

medical supplies to units in the northern Cotentin and to receive and store

matériel landed at the port once it

opened. Ten days later, the 32d Medical Depot Company, a Third Army

unit soon replaced by the 13th Company, organized Depot M-2 (M402T) at Chef-du-Pont, to receive,

store, and issue supplies brought in

over UTAH beach. This depot drew its

initial stock from the First Army

dump at Le Grand Chemin, which

then closed. To handle supplies

coming in at OMAHA, the 31st Compa- ny set up Depot M-3 (M-403T) at

L'Etard on the nineteenth. This depot

also replaced the rearmost First Army

dumps and took over their stocks.

Both the Chef-du-Pont and L'Etard

depots, part of larger ADSEC storage

areas, consisted simply of open fields

in which crated supplies were stacked,

with a few ward tents sheltering loose

items and administration offices.40

For the most part, the establishment of ADSEC supply facilities and

field and evacuation hospitals in Normandy followed preinvasion NEPTUNE

plans, with modifications due to delayed movement and the occasional

need to find alternate locations. The

same could not be said of the section's effort to set up 1,000-bed

general hospitals on the Continent.

Execution of this part of the medical

program became snarled in confusion

and delay, resulting largely from the

First Army's failure to attain its

planned tactical objectives.

Before D-Day the Advance Section

and the Forward Echelon had made

detailed plans for moving twenty-five

general hospitals, selected by General

Hawley on the basis of performance

in Great Britain, into various French

cities during the first ninety days of

the campaign. Early in May, following

a schedule contained in the plans, the

first of these general hospitals began

turning over their British plants, complete with furnishings and supplies, to

units newly arrived from the United

States. Relieved about a month before

their sailing dates, the deploying hospitals went into temporary billets,

usually in the Western Base Section.

There, they conducted training and

prepared vehicles and personal equipment for the cross-Channel voyage.

For each hospital Hawley's Supply Division set up a complete equipment

assembly—a block of matériel filling

almost sixty small British freight

cars—at one of its depots, where the

unit medical supply officer checked it

for completeness and oversaw its crating for shipment. While hospitals

waited to be called forward for embarkation, they furnished surgical

40

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, pp. 1-2 and 7-8; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 25-26 and

ex. K; Supply Division, OofSurg, ADSEC, Weekly

Activities Rpts, weeks ending 15 and 22 Jul 44, and

ADSEC Stock Control Team Progress Rpts, 25 Jul

and 1 Aug 44, in Beasley Papers, MHI. Ruppenthal,

Logistical Support, 1:431-33, covers overall development of ADSEC depots.
266 EUROPEAN THEATER OF OPERATIONS

teams, nurses, and enlisted men for

mounting and casualty reception assignments; and they provided custodial details for newly completed but not

yet occupied hospital plants.41

The first two general hospitals to

reach Normandy, the 5th and 298th,

stood down from operations in Britain respectively on 7 and 10 May.

Col. Maxwell G. Keeler's 5th General

Hospital, the initial unit of its type to

enter the European Theater back in

1942, staged at Tidworth until its embarkation on 3 July. Three days later

the unit's 58 officers, 102 nurses, and

500 enlisted men, with their vehicles,

came ashore at OMAHA beach; however, its hospital assembly, sent from

England on a different vessel, did not.

Keeler's supply officer searched

beachhead dumps to no avail, only to

discover eventually that the assembly,

scheduled to be landed at still unusable Cherbourg, had been held on

shipboard awaiting discharge at one

of the beaches. Even if the equipment

had been immediately available, the

5th would have had no place to set it

up; the hospital's assigned location at

St.-Lo still was German-held. Fortunately, the unit was prepared to operate in an expeditionary tented plant.

On the tenth Colonel Keeler and

Colonel Beasley decided to place it

on a new site, a low-lying field near

Carentan. The 5th spent the next

twenty-one days bivouacked with the

7th Field Hospital at Osmanville,

waiting for engineers to complete

construction of its facility. In the

meantime it detached surgical and

shock teams to First Army evacuation

hospitals and sent most of its remaining medical officers, all its nurses,

and 100 enlisted men to help the

12th Field Hospital with cleaning and

repairs at Cherbourg.42

The second general hospital to land

in Normandy, the 298th, a University

of Michigan-affiliated unit under Lt.

Col. Walter G. Maddock, MC, was assigned to occupy the Cherbourg

Naval Hospital that the 12th Field

Hospital was rehabilitating. A victim

of shipping schedule changes, the

298th spent two months shuttling between camps in Wales and England,

ending up only a few miles from its

former site at Frenchay Park, near

Bristol. The unit personnel at last

embarked at Plymouth on 15 July and

waded ashore on UTAH beach the

next day, again separated from their

equipment assembly. They moved

into billets in houses and barracks in

Cherbourg on the seventeenth. The

298th at least had a plant to occupy.

It prepared to relieve the 12th in the

Naval Hospital and continued the

smaller unit's work of cleaning and

refurbishing, while engineers began

the extensive alternations needed to

fit the old plant for a 1,000-bed general hospital.43

41

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 13-14 and encl. 15; Surg, ADSEC,

COMZ, Annual Rpt, 1944, p. 14; Technical Directive No. 1, OofCSurg, HQ, ETOUSA, 17 May 44,

sub: Procedure for Equipping General Hospitals To

Be Utilized in Continental Operations, in Supply Division, OofCSurg, HQ, ETOUSA, Annual Rpt, sec.

V, ex. 1 (see also sec. II, p. 6).

42

 Darnall, "Hospital Sites in Normandy," pp.

191-92; 5th General Hospital Annual Rpt, 1944, pp.

4-7; Keeler Interv, 11 Jul 45, box 223, RG 112,

NARA; Surg, ADSEC, Daily Activities Rpts, 9-11 Jul

44, Beasley Papers, MHI. 43

 298th General Hospital Annual Rpt, 1944, pp.

1, 61-65, 72-74, 78, 233-34, 299-300.
COMZ REACHES THE CONTINENT 267

Even as the 298th was settling

down in Cherbourg, the Advance Section and the chief surgeon's office undertook a major revision of fixed hospital plans. Those plans had called for

twelve of the continental general hospitals, including the two already

landed, to be functioning in France

by mid-July; but at that time the 5th

and 298th still were not open. The

ground forces had yet to capture the

sites of the other ten hospitals. General Hawley now confronted a sudden

fixed bed shortage. His plans for providing beds to care for the still expanding American force in the theater

depended on the prompt establishment of hospitals in France, since

completion of the pre-D-Day program

would use up the supply of available

United Kingdom locations. Twentyfive of Hawley's best general hospitals, those staging for movement,

were out of action. At the same time,

with no fixed COMZ beds in France,

the field forces had to evacuate even

their lightly wounded back across the

Channel, threatening to overload the

nearshore hospitals. Colonel Mowrey,

the Evacuation Branch chief, warned

Hawley on 21 July that the general

hospitals had room for only about

6,900 more patients. "The patient

census has increased 14,533 in the

past two weeks," he reported, "or an

average increase of 1,032 per day;

hence, it is anticipated that general

hospitals will be filled within approxi- mately eight days." At SHAEF General Kenner, whose calculations of the

impending bed shortage reached

about the same conclusion as Mowrey's, pressed for speed in setting up

fixed hospitals in Normandy. Even

before receiving Kenner's and Mowrey's pessimistic forecasts, Hawley

adopted the only feasible solution to

the problem: He scrapped the originally planned sites and ordered Colonel Beasley immediately to set up as

many general hospitals as possible

wherever they would fit in the existing beachhead. "We simply must get

beds operating over there," he told

Beasley, "regardless of changes in locations."

 44

The chief surgeon and his staff intervened directly to get the revised

hospitalization program moving. Between 15 and 19 July Hawley's Hospitalization Division chief, Colonel Darnall, conferred at Auville with Beasley

and his staff. In these discussions

Darnall emphasized the need for

rapid action, and in company with

ADSEC and First Army officers he

did preliminary reconnaissance

throughout the beachhead for general

hospital sites. Hawley himself visited

the Advance Section on the seventeenth, escorting Secretary of War

Henry L. Stimson, Surgeon General

Kirk, and General Lee. Shortly thereafter, the chief surgeon by letter exhorted Beasley, whom he considered

overly influenced by geographical

phase lines, to move rapidly and flexibly. On 22 July Colonel Mowrey flew

over to coordinate plans with the

44

 First quotation from Ltr, Mowrey to DepCSurg,

HQ, ETOUSA, 21 Jul 44, sub: Evacuation Policy to

ZI, EvacCorresp, 1944-45, file HD 370.05 ETO.

Mowrey's calculations included only fixed beds for

definitive long-term care, excluding transit and

holding beds. Second quotation from Ltr, Hawley to

Beasley, 19 Jul 44, file HD 024 ETO CS (Hawley

Chron). See also Memo, Kenner to ACofS, G-4,

SHAEF, 21 Jul 44, sub: Present Status of Fixed US

Hospital Beds, UK and Continent, in Medical Division, COSSAC/SHAEF, War Diary, July 1944; Darnall, "Hospital Sites in Normandy," p. 191; Hospitalization Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 8.
268 EUROPEAN THEATER OF OPERATIONS

ADSEC and First Army medical and

engineer authorities and again to

press for swift action. Working under

this high-level pressure, Beasley's

staff, between the twenty-third and

twenty-ninth, secured from the First

Army ten sites for expeditionary-type

tented general hospitals. In the

OMAHA area the Advance Section obtained five locations: three at Lison

Junction, on a rail line to Cherbourg;

and two at Carentan, including the

one previously selected for the 5th

General Hospital. The remaining five

sites were in the Cotentin: three at La

Haye-du-Puits, at the base of the peninsula, and two at Tourlaville, just

outside Cherbourg.45

The ADSEC surgeon, under peremptory direction from Hawley, expedited the opening of the two general

hospitals already in Normandy, the

5th and 298th. Construction of the

5th's tented plant at Carentan had

begun on 14 July, but neither that

unit nor the 298th had received its

equipment assembly. On the twentysecond Colonel Beasley's Supply Division finally released to these units two

hospital assemblies that had arrived

for other organizations not yet

landed. This action resulted in the

opening of the 298th on the twentyninth and that of the 5th two days

later. Both units initially had less than

half their beds in operation. The

298th began work amid the noise and

debris of construction, as engineers

struggled to renovate "a building for

which they had no ... plans, whose

wiring and plumbing was a composite

of 80 years' development, a continental hodgepodge that often defied

analysis." Major alterations continued

until shortly before the 298th left in

October. In the meantime the staff,

besides caring for patients in temporary facilities, kept busy with a host of

minor repairs and tried to make do

with barely adequate, always unreliable, water and power supplies. At

Carentan the 5th also began operations while still under construction,

receiving patients before it had either

electric lights or running water. Its

hastily chosen, poorly drained site

was mosquito infested and turned

into a quagmire with every rainstorm.46

Both general hospitals eventually

expanded beyond their rated capacities, each attaining a size of about

1,500 beds. Under a First ArmyADSEC agreement on 1 August the

5th and 298th, besides acting as area

station hospitals, admitted lightly

wounded men returnable to duty

within ten days. They thereby relieved

45 army installations of these patients Darnall, "Hospital Sites in Normandy," pp.

191-201; Ltr, Hawley to Beasley, 19 Jul 44, and

Memo, Hawley to G-4, ETO, 5 Aug 44, sub: Hospitalization and Evacuation—Cherbourg Peninsula,

file HD 024 ETO CS (Hawley Chron); Memo,

Mowrey to Hawley, 27 Jul 44, sub: Report on Trip

to Continent, file 370.05; Surg, ADSEC, COMZ,

Annual Rpt, 1944, pp. 8 and 21-22; Hospitalization

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, pp. 8-9; Surg, ADSEC, Daily Activities Rpts,

23 and 25 Jul 44, and Hospitalization Division,

OofSurg, ADSEC, Weekly Activities Rpt, week

ending 29 Jul 44, Beasley Papers, MHI.

46

 Quotation from 298th General Hospital Annual

Rpt, pp. 78-81. See also 5th General Hospital

Annual Rpt, 1944, pp. 7-8, 10-11, 13-15; Hospitalization Division, OofSurg, ADSEC, Weekly Activities

Rpt, week ending 29 Jul 44, and Supply Division,

OofSurg, ADSEC, Weekly Activities Rpt, week

ending 30 Jul 44, Beasley Papers, MHI; Lt Col J. E.

Dunphy and Maj. S. O. Hoerr, "A General Hospital

in the Normandy Campaign," The Bulletin of the U.S.

Army Medical Department 6 (November 1946): 594-

602.
CONSTRUCTING THE 5TH GENERAL HOSPITAL TENTED PLANT AT CARENTAN.

Engineers prepare concrete for the ward platforms, and a completed ward tent with beds.
270 EUROPEAN THEATER OF OPERATIONS

while ensuring their retention on the

Continent, a manpower conserving

measure strongly desired by General

Bradley. The 5th, located close to the

fighting line, also became a collecting

point for combat exhaustion patients

and for soldiers with suspected selfinflicted wounds, a circumstance that

led General Kenner to complain that

the unit's surgical capabilities were

being wasted on the mission of a convalescent hospital. By contrast, the

298th had no lack of emergency surgical patients, mostly mine casualties

from the Cherbourg port. For its

short-term patients the 298th, without

guidance on the point from higher

headquarters, during the first weeks

followed an informal evacuation procedure. The hospital used its own ambulances to return recovered men directly to their units, or, if the organization were nearby, simply discharged

patients and let them find their own

way back. Casualties requiring extended care went by ambulance to the

Biniville holding unit for evacuation

to England.47

Establishment of the other nine

general hospitals, meanwhile, got

under way. General Hawley worked

with SHAEF and ETOUSA to hasten

the dispatch of more 1,000-bed units

to Normandy; and, as these organizations arrived, the Advance Section

sent them to bivouac at their assigned

operating sites. Most were in position

by 5 August. While they awaited completion of their facilities and delivery

of their equipment, these general hospitals furnished surgical teams to field

force installations and enlisted details

to aid the engineers preparing their

plants.

ADSEC engineers began construction at the sites between 21 July and

2 August. At each installation the engineer officer in charge and the hospital commander cooperated in adapting standard plans, developed and

tested in Britain before D-Day, to

ground conditions and to unit preferences. Enlisted medics and engineers

labored side by side, pouring concrete tent bases, grading roads and

paths, and installing wiring and

plumbing. They worked under handicaps. Engineers, few in numbers and

in heavy demand, frequently were

abruptly transferred to other jobs.

Building supplies arrived irregularly,

forcing periodic work stoppages at

most plants. Short of American materials, the engineers substituted

German and French cement and pipe,

among other items. The cement often

failed to set properly, requiring timeconsuming tearing up and repouring

of foundations. The mixture of ill-fitting pipe that made up water and

sewage systems had to be welded at

every joint. Engineers and enlisted

medics overcame these obstacles, but

slowly. By the third week of August

the engineers had managed to finish

one plant and had completed 65 to

47

 Surg, ADSEC, Daily Activities Rpt, 1 Aug 44,

Beasley Papers, MHI; Memo, Hawley to G-4, ETO,

5 Aug 44, sub: Hospitalization and Evacuation—

Cherbourg Peninsula, file HD 024 ETO CS (Hawley

Chron); Rpt, Kenner, sub: Inspection of Medical

Troops and Installations—12th AG, ADSEC, CZ,

and 21 AG, 2-13 August 1944, in Medical Division,

COSSAC/SHAEF, War Diary, August 1944; 5th

General Hospital Annual Rpt, 1944, p. 8; 298th

General Hospital Annual Rpt, 1944, pp. 101-03 and

107; Keeler Interv, 11 Jul 45, box 223, RG 112,

NARA.
COMZ REACHES THE CONTINENT 271

75 percent of the work on most of the

others.48

Besides construction delays, missing unit assemblies plagued the hospital program. The transportation

system simply could not deliver the

personnel of a general hospital and

their assigned equipment to the same

place at the same time. Changes in

unit movement dates, timely notice of

which often failed to reach the sending depots, helped to desynchronize

shipments. Even when a unit and its

assembly left England together, they

rarely traveled on the same vessel;

frequently, the assembly would be

split among several ships that discharged cargo on different beaches.

The theater chief of transportation

never permitted hospital detachments

to accompany their assemblies; hence,

equipment arrived on the beaches

unescorted and disappeared into various dumps unless a unit representative was there to claim it immediately.

Colonel Beasley and his supply officer, Maj. Thomas A. Carilia, MAC, repeatedly remonstrated with the

ADSEC G-4 and the Transportation

Corps about the assembly problem,

but to little avail. Beasley finally resorted to sending one of his officers

to visit the OMAHA and UTAH dumps

on alternate days, for the sole purpose of finding and redirecting lost

equipment. His staff continued the

practice, begun with the 5th and

298th, of assigning whatever general

hospital assembly was available to any

unit otherwise ready to open. This

expedient delivered equipment to

hospitals that could use it, but it required much exchanging later between organizations that had packed

personal property with their assemblies.49

The new general hospitals gradually went into operation, most of them

initially at less than their rated 1,000

beds. Two Lison units, one at La

Haye-du-Puits, and the second Carentan hospital opened on 15 August;

another hospital at La Haye became

active on the twenty-fourth. The remaining four units, however, did not

open until September and October.

Long before they did, it had become

apparent that the continental Communications Zone would not meet its

NEPTUNE goal of having 25,500 fixed

hospital beds in operation by

D+90.50

48

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 9-10; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 22 and 63;

Surg, ADSEC, Daily Activities Rpts, 11-12, 26 and

28 Jul 44, and Hospitalization Division, OofSurg,

ADSEC, Weekly Activities Rpts, weeks ending 5 and

19 Aug 44, Beasley Papers, MHI; Keeler Interv, 11

Jul 45, box 223, RG 112, NARA; Memo, Mowrey to

Hawley, 27 Jul 44, sub: Report on Trip to Continent, file 370.05; Memo, Maj S. Blumenthal to Lt

Col Meador, 1 Aug 44, EvacCorresp, 1942-44, file

HD 024 ETO.

49

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. V, pp. 2-3; Supply Division,

OofSurg, ADSEC, Weekly Activities Rpts, weeks

ending 15 and 22 Jul 44, and Hospitalization Division, OofSurg, ADSEC, Weekly Activities Rpt, week

ending 19 Aug 44, Beasley Papers, MHI; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 26-27; Ltr,

Hawley to Beasley, 19 Jul 44, file HD 024 ETO CS

(Hawley Chron). For the exchange problem, see

298th General Hospital Annual Rpt, 1944, pp. 233-

34.

50

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 9; Surg, ADSEC,

Daily Activities Rpts, 14-15 Aug 44, and Hospitalization Division, OofSurg, ADSEC, Weekly Activities

Rpts, weeks ending 5 and 19 Aug 44, Beasley

Papers, MHI; Rpt, Kenner, sub: Inspection of Medical Troops and Installations—12th AG, ADSEC, CZ,

and 21 AG, 2-13 August 1944, in Medical Division,

COSSAC/SHAEF, War Diary, August 1944.
272 EUROPEAN THEATER OF OPERATIONS

At the end of July the Advance Section medical service gradually was

carving out its sphere of influence in

the Normandy beachhead. Colonel

Beasley and his staff were acquiring

an increasing amount of control over

supply, evacuation, and hospitalization. ADSEC depots and field and

evacuation hospitals were in operation, beginning to relieve First Army

units of part of the support task. Establishment of general hospitals, delayed by slow adaptation of preinvasion plans to the tactical situation, at

last was under way. Ironically, even as

the Advance Section thus adjusted to

operations in a constricted lodgement, the battlefront broke wide

open, initiating a period of mobile

warfare that again would force radical

change in COMZ medical plans and

hasty improvisation in operations.
CHAPTER IX

Breakout and Pursuit

On 25 July 1944, after a week of

rest and refitting following the capture of St.-Lo, the First Army

launched a new offensive, Operation

COBRA, planned by General Bradley

as an effort to break completely

through a narrow segment of what

was looking discouragingly like a stabilized front. The VII Corps, heavily

reinforced with infantry and armor

and supported by all the artillery that

the First Army could assemble, conducted the breakthrough attack.

Ahead of the VII Corps, yet so close

that misdirected bombs killed 111

American soldiers and wounded 490,

were all the available Eighth Air

Force heavy bombers and over 1,000

smaller tactical aircraft, which saturated the German front with high explosives and napalm, nearly obliterating

the defending division. After a slow

start on the twenty-fifth, caused in

part by the bombing errors, the

COBRA attack and its exploitation by

massed American armor rapidly escalated from a breakthrough into a

breakout.1

The German Seventh Army, weakened by the earlier attrition battles

and with most of its reserves drawn

away by British attacks at Caen, disintegrated before the fast-moving

American tank-infantry combat teams

and their supporting tactical air

power. Coutances, the initial objective

of the attack, fell on the twentyeighth. The VIII Corps, attacking on

the right of the VII, took Avranches,

30 miles farther south, on 1 August,

positioning American troops to move

either westward into Brittany or eastward toward Paris and the Seine. The

German armies, now pressed all along

the line by the First Army and by

Montgomery's British and Canadian

forces, had lost their western anchor.

Hitler's effort to bottle up the Allies

in the Cotentin had collapsed.

With their Normandy confinement

at an end, the Americans implemented their NEPTUNE plans for activating

a second field army and an army

group. On 1 August General Bradley

placed in operation General Patton's

Third Army, the headquarters of

which had moved into the Cotentin

during July. Bradley gave the Third 1

 This section is based on Blumenson, Breakout and

Pursuit, chs. X-XXII; Charles B. MacDonald, The

Siegfried Line Campaign, United States Army in World

War II (Washington, D.C.: Office of the Chief of

Military History, Department of the Army, 1963),

chs. I-VIII; and Hugh M. Cole, The Lorraine Campaign, United States Army in World War II (Washington, D.C.: Historical Division, Department of the

Army, 1950), chs. I-VI.
274 EUROPEAN THEATER OF OPERATIONS

Army control of the already committed VIII Corps and of the newly arrived XV and XX Corps. Most divisions and supporting elements of the

new army had been in France for

some time, attached to the First

Army; they now reverted to their

original command. Also on the first

Bradley activated the 12th Army

Group (actually the 1st Army Group

headquarters, redesignated as part of

the Allied effort to convince the Germans that another invasion still was

coming in the Pas-de-Calais). Bradley

took command of this army group,

while Lt. Gen. Courtney Hodges replaced him at the First Army. General

Montgomery remained in overall

Allied ground command for another

month, until SHAEF opened its continental headquarters on 1 September.

The reorganized Allied ground

forces rapidly exploited the success of

COBRA. Departing from the original

plan so as to take advantage of

German disintegration in the western

Cotentin, the Third Army used only

one of its corps, the VIII, to secure

Brittany. This corps, which met only

disorganized resistance, quickly overrun the entire peninsula, captured

Nantes without a fight, and took St.-

Malo after a stubbornly contested

siege. By the end of August it had

penned up the remaining major

German forces in Lorient and Brest.

However, the Brittany ports, considered essential as entry points for supplies and reinforcements, were either

too badly damaged for early use or,

as in the case of Brest, were occupied

by garrisons determined to hold them

as long as militarily possible.

To the eastward of Brittany, the

Allies fanned out to seize their

planned lodgement area between the

Seine and the Loire and in the process destroyed much of the German

army opposing them (see Map 11). On

the American right, the Third Army

rolled ahead almost unimpeded; its

XV Corps took Le Mans on 8 August

after driving 75 miles in three days.

On the Third Army's left, the First

Army pushed forward slowly against a

still solid German line. The Germans

now compounded their own difficulties. On the seventh they had attacked

westward toward Avranches with most

of their remaining armor, trying to

cut the Third Army's line of communications at its narrowest point, but

after five days of bitter fighting

around Mortain the 30th Infantry Division and other First Army units

blocked the German thrust. Eisenhower, Montgomery, and Bradley,

meanwhile, set in motion a large-scale

envelopment of the attackers, turning

Third Army elements north from Le

Mans while the British and Canadians

pushed southward from Caen. The

ensuing battle of the Falaise pocket

between 16 and 20 August, eliminated the German army in Normandy as

an effective fighting force, the First

and Third Armies, quickly following

up success, reached and bridged the

Seine, respectively east and west of

Paris, by the twenty-fifth. The French

capital itself fell to the Allies on the

twenty-ninth.

The OVERLORD and NEPTUNE planners had assumed that the Germans

would form a strong defense line

along the Seine and that the Allies

would halt at that river for a month

or so, to reorganize and bring forward supplies. However, the completeness of the German collapse
BREAKOUT AND PURSUIT 275

compelled continuation of the pursuit. Accordingly, during the last days

of August and the first two weeks of

September the British and Americans

swept forward over 200 miles. They

overran or outflanked weak German

rear guards, gathered in tens of thousands of prisoners, and liberated town

after town to the tumultuous delight

of the inhabitants, who pressed

liquor, food, flowers, and kisses on

the passing soldiery. On the Allied

left, 21 Army Group cleared the

Channel coast and captured Brussels

and Antwerp before halting at the

Belgian-Dutch border. To the right of

the British and Canadians, Hodges'

First Army followed the historic invasion route to the Ruhr along the

northern edge of the Ardennes. First

Army troops encircled another 25,000

Germans at Mons, then took Liege

and by 11 September were fighting

on the German frontier. Patton's

Third Army, meanwhile, headed eastward through Orleans, Troyes, and

Verdun toward Lorraine and the

upper Rhine. Early in September,

before halting for lack of gasoline, the

Third Army's XII and XX Corps

seized bridgeheads over the Meuse.

As the pursuit went on, the roster

of Allied armies further expanded.

On 15 August the U.S. Seventh and

French First Armies landed on the

French Riviera and advanced up the

Rhone valley, making contact with the

Third Army on 11 September and extending the Allied front to the Swiss

border. The U.S. Ninth Army, activated on 5 September, relieved the

Third Army of responsibility for

the forces in Brittany and protected

the Americans' southern flank along

the Loire. This new army had as its

principal element the VIII Corps, engaged since 25 August in a bunkerby-bunker assault on Brest. At a cost

of about 9,800 American casualties,

the VIII Corps forced the 30,000 defenders of Brest to surrender on 19

September. The Ninth Army then

began preparations to move into the

main line in Belgium.

By the time Brest fell, the pursuit

had given way to a slow, laborious advance against stiffening resistance.

The rush across France left the Allied

supply depots far behind near the

beaches so that army and COMZ

motor transport barely sufficed to

haul forward enough fuel and ammunition to keep the combat elements

going, with nothing to spare to build

up advance dumps. By mid-September daily replenishment of gasoline,

ammunition, food, and other vital

commodities had fallen below the

minimum requirements for sustaining

an offensive. At the same time the

Germans began to recover from their

August rout. Aided by rough terrain,

by the partially built fortifications of

the West Wall,2 and by clouds and

rain which diminished air support,

hastily improvised battle groups first

slowed and then halted the weakening

British and American drives. Behind

this screen the Nazi regime, in a display of ruthless efficiency, collected

men and equipment to rebuild divisions around the cadres that had escaped from Normandy and to form

new ones. By late September these

2

 According to MacDonald, Siegfried Line, p. 30,

"this was the fortified belt extending along the western borders of Germany from the vicinity of Kleve

on the Dutch frontier to Lorrach near Basle on the

Swiss border." Americans referred to this man-made

obstacle as the Siegfried Line. However, from a

World War II standpoint, this was a misnomer, derived from the fact that there had been a similarly

designated position in World War I.


278 EUROPEAN THEATER OF OPERATIONS

units were moving into and reinforcing the line.

Renewed First and Third Army offensives, accordingly, produced heavier casualties and disappointing results. Between 10 and 22 September

the First Army penetrated the West

Wall in the Ardennes and partially encircled Aachen, the first major

German city to come under attack,

but supply shortages and enemy reinforcements stalled the offensive short

of a breakthrough. South of the Ardennes the Third Army forced its way

across the Moselle against desperate

resistance and fierce counterattacks. Patton's troops captured Nancy, but

they failed to take the fortress of Metz

and from 19-30 September had to

fight off a major armored assault on

their southern flank. Then the Third

Army, too, had to halt for rest and replenishment.

On the British front, General Montgomery persuaded SHAEF to try a

final audacious effort to maintain the

momentum of the pursuit. On 17

September, in Operation MARKETGARDEN, one British and two American airborne divisions dropped into

Holland, to seize bridges over the

rivers between the Belgian border

and the lower Rhine and to open a

corridor through which the British

XXX Corps could drive to secure a

bridgehead in Germany and flank the

West Wall. The airborne assault

achieved most of its objectives. However, the British 1st Airborne Division, which had landed farthest north,

could not hold its Rhine bridgehead

at Arnhem against armored counterattack, and the tanks and mechanized

infantry of the XXX Corps could not

get through the corridor before the

paratroopers' perimeter collapsed. By

the twenty-fifth, as the survivors of

the shattered 1st withdrew to the

south bank of the lower Rhine, it was

clear that MARKET-GARDEN, too, had

failed to break the solidifying German

defense.

These final setbacks notwithstanding, the Battle of France was a substantial Allied victory. In four months

of campaigning, the British and

Americans killed, captured, or penned

up in coastal fortresses about 500,000

German soldiers, at a cost to themselves of about 40,000 dead, 164,000

wounded, and 20,000 missing. The

German debacle in Normandy permitted the Allied advance to surge far

ahead of schedule. By 11 September

(D+97) the Anglo-Americans already

had reached a line that the OVERLORD

planners had not expected them to

attain until D+330 (2 May 1945).

This sharp acceleration of Allied

progress, while a tactical triumph,

forced upon the theater medical service, as upon all the technical services, a period of often frantic adjustment and improvisation.

First Army Medical Support

Since D-Day the First Army medical

service had supported a slow-moving

advance with high casualty rates and

short lines of evacuation. The army's

larger medical units had changed position only a few at a time and at long

intervals. In the breakout and pursuit

the medical service had to adapt itself

to just the opposite conditions: a rapidly moving front, low casualty rates,

long lines of evacuation, and frequent

repositioning of even the least mobile

medical units. Colonel Rogers, the

army surgeon, assembled his forces to
BREAKOUT AND PURSUIT 279

support the breakthrough attack, reorganized them to keep up with the

accelerating pursuit, and finally regrouped them behind another solid,

slow-moving front.

Operation COBRA confronted the

army medical service with a support

problem hitherto not encountered in

the campaign. In the First Army's

previous broad frontal attacks, each

division could receive medical support along a separate axis of communications. In COBRA, by contrast,

medical units and supplies for seven

divisions would have to go forward,

and casualties come back, along a few

roads through a corridor no more

than 5 miles wide. If the attack went

as planned, the distance to be covered in this corridor between front

and rear medical installations steadily

would increase, as would the flow of

traffic through the constricted communications arteries.

The task of finding a solution to

this problem fell primarily to the VII

Corps surgeon, Colonel Barr. Under

a plan developed by him, the First

Army made preparations on the assumption that the assault divisions,

once they broke through, would

suffer relatively low casualties—a

maximum of 300 severely wounded

and the same number of lightly

wounded per day for each division.

To move these casualties up the corridor, the army attached 15 extra ambulances and 15 trucks (for ambulatory patients) to each assault division

clearing station. It worked into its

complex traffic control plan provision

for rearward movement of as many as

1,300 ambulances a day and also

planned for holding patients up to

twenty-four hours in clearing stations

and field hospital platoons if traffic

congestion temporarily blocked evacuation. The evacuation vehicles, besides carrying casualties back, were to

haul medical supplies forward to the

divisions from an advance dump set

up close to the breakthrough point.

As the hedgerow fields of the VII

Corps sector filled with infantry,

armor, and artillery massing for the

attack, the army reequipped the assault division medical elements and

brought them up to strength with replacements. It assembled numerous

evacuation hospitals in rear of the

corps, ready either to receive casualties or to follow the pursuit. Colonel

Barr at the same time established

communications and coordinated

plans with the commanders of the

31st and 68th Medical Groups, which

were to evacuate respectively the left

and right wings of the VII Corps. He

visited each division surgeon to explain the corps medical plan and to

ensure that all preparations were

complete. In the divisions the regimental surgeons, briefed at the last

moment, hurriedly made their own

plans and preparations, usually in informal coordination with the commanders of their supporting collecting companies.3

In the light of these elaborate preliminaries, the execution of COBRA,

from the standpoint of the theater

medical service, was anticlimactic.

The preparatory bombing killed, injured, or stunned dozens of infantrymen in a few battalions, and the

breakthrough area presented an ap3

 VII Corps Medical Plan, pp. 36-43 and 52, encl.

1 to Surg, VII Corps, Annual Rpt, 1944; 68th Medical Group Annual Rpt, 1944, p. 7. Tegtmeyer

"Diary," bk. II, pp. 34 and 38-40, illustrates regimental preparations.
280 EUROPEAN THEATER OF OPERATIONS

palling spectacle of craters, shattered

trees, flattened villages, smashed vehicles, and dismembered, disemboweled German corpses. Nevertheless, from the beginning, the VII

Corps suffered far fewer casualties

than the planners had estimated it

would. During the first two days of

COBRA the clearing stations of the

three lead infantry divisions, the 4th,

9th, and 30th, handled respectively

171, 362, and 480 patients. In the 1st

Infantry Division, part of the exploitation force, aidmen and battalion

surgeons occasionally had difficulty

evacuating wounded from units temporarily surrounded in the increasingly fluid combat, but the division clearing station received so few patients

that its attached field hospital platoon

seldom even had to set up. While casualties were light for individual divisions, the cumulative flow of wounded through the breakthrough corridor

quickly filled the foremost evacuation

hospitals and forced the medical

groups to divert ambulances to installations farther to the rear. As the penetration deepened, the road distance

between open evacuation hospitals

and division clearing stations expanded to as much as 60 miles. The medical groups had to commit an evergrowing larger number of ambulances

to move the same or a diminishing

number of patients. By 30 July the

57th Medical Battalion, which supported the left half of the VII Corps,

was using 95 ambulances to evacuate

a single fast-moving armored division.4

On 4 August, as breakthrough

became breakout, Colonel Barr in his

diary summed up the developing

medical problem of the next stage of

the campaign:

Everything seems to be going well except

that the ambulance hauls are becoming

longer as the front progresses and hospital installations are left to the rear. The

transportation of sick and wounded . . . is becoming a problem. We are daily

more concerned at the possibility that the

system might bog down owing to the in- herent difficulties of supporting a rapid

and sustained advance.5

After the capture of Avranches the

First Army, now composed of three

corps, attacked continuously, protecting the flank of the Third Army as it

broke out to the west, south, and

east. For better control of evacuation

as the distance between clearing stations and hospitals increased and as

medical units became dispersed over

a wider area, Colonel Rogers on 2

August redefined the missions of his

31st and 68th Medical Groups. In the

campaign thus far, each group had

managed all stages of evacuation,

from clearing stations to the beaches,

for about half the army. Under the

new arrangement the 68th Medical

Group evacuated division and corps

clearing stations and field hospitals

across the entire army front; the 31st

conducted all patient movement to

the rear of the evacuation hospitals,

as well as reinforcing them with elements from its collecting companies.

The army's third medical group, the

134th, continued to control all the

4

 VII Corps Medical Plan, pp. 44-52, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; 31st Medical

Group Annual Rpt, 1944, p. 14; 68th Medical

Group Annual Rpt, 1944, p. 7; Surg, 1st Infantry

Division, Annual Rpt, 1944, pp. 12-14; Bradley, Aid

Man, pp. 65-66; Tegtmeyer "Diary," bk. II, pp. 43-

48; 57th Medical Battalion Annual Rpt, 1944, pp.

11-13. 5

 VII Corps Medical Plan, p. 56, encl. 1 to Surg,

VII Corps, Annual Rpt, 1944.
BREAKOUT AND PURSUIT 281

separate clearing companies, including the two treating neuropsychiatric

casualties.6

Preparing for the pursuit across the

Seine, Colonel Rogers regrouped his

medical units, which the Falaise encirclement left spread out in an arc from

the beaches to the outskirts of Paris.

Between 25 and 31 August Rogers

collected most of his hospitals, depot

companies, and groups around Senonches, 50 miles southeast of the

French capital, on the line of evacuation from the advancing infantry and

armor to the beaches. Such concentration of the evacuation hospitals

and other less mobile units was to be

the First Army's practice for the rest

of the campaign; it facilitated communications and control, made handling

of casualties more efficient, and simplified forward movement. Most of

the units at Senonches, not immediately needed to treat the few sick and

wounded of the early pursuit, went

into bivouac for a welcome rest. They

gave their people time off from

duty—in many organizations the first

since early June—and also repaired

and replaced equipment.7

The concentration at Senonches included the First Army's five field

hospitals, which Colonel Rogers detached from the division clearing stations and assigned a new mission. It

had become obvious to Rogers and

his staff early in the advance that the

400-bed evacuation hospitals could

not move rapidly enough to stay

within a practicable ambulance haul

of the clearing stations. On the other

hand, with casualty rates falling, fewer

but more mobile forward-area beds

would be needed. To provide these

beds, Rogers pressed his field hospitals into service as evacuation rather

than emergency surgery units and attached them to the 68th Medical

Group. (Hitherto, Rogers' own office

had directed deployment of these

units.) On 27 August Rogers instructed the group to assign a complete

field hospital to each of the three

corps while keeping two in reserve.

The units supporting corps were to

receive all types of casualties. While

performing surgery on nontransportable and emergency cases, they were

to avoid definitive treatment of other

patients and promptly send them

rearward—those deemed returnable

to duty within ten days to army evacuation, convalescent, or specialized

hospitals, and the rest directly to the

Communications Zone.8

With the field hospitals attached,

the 68th Medical Group, under Col.

Francis P. Kintz, MC, included 2,400

officers and men and 90 nurses and

was, Kintz claimed, "the largest medical group in the history of the . . .

6

 Ibid., p. 59; 31st Medical Group Annual Rpt, pp

14-16; 68th Medical Group Annual Rpt, 1944, pp.

7-11; 134th Medical Group Rpt, 1944, pp. 7-9. 7

 Surg, First U.S. Army, Annual Rpt, 1944, pp. 44

and 59; VII Corps Medical Plan, p. 68, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; 31st Medical

Group Annual Rpt, 1944, p. 16; 68th Medical

Group Annual Rpt, 1944, pp. 8-9. For samples of

unit activity, see 5th Evacuation Hospital Annual

Rpt, 1944, pp. 11-12, and 41st Evacuation Hospital

Annual Rpt, 1944, p. 10.

8

 Surg, First U.S. Army, Annual Rpt, 1944, pp. 42,

44, 64-65; Memo, Col J. L. Snyder to CO, 68th

Medical Group, 18 Aug 44, sub: Employment of

Field Hospitals, and Memo, Snyder to COs of Army

Hospitals, 68th Medical Group, and Army Medical

Units, 27 Aug 44, sub: Utilization of Field Hospitals,

both in 68th Medical Group Annual Rpt, 1944. Division and corps surgeons initially protested the loss

of their attached field hospital platoons. See Surg, V

Corps, Annual Rpt, 1944, p. 16, and VII Corps

Medical Plan, p. 61, encl. 1 to Surg, VII Corps,

Annual Rpt, 1944.
282 EUROPEAN THEATER OF OPERATIONS

Medical Department." The group

oversaw most medical support operations north of the Seine as the pursuit accelerated. It maintained contact

with the fast-moving combat forces; it

coordinated hospitalization, evacuation, and medical supply; and it reconnoitered hospital and depot sites

for the heavier units struggling up

from the rear.9

The group's field hospitals, operating under control of the 177th Medical Battalion, leapfrogged platoons

forward across northern France and

into Belgium, using trucks borrowed

from other medical and nonmedical

units. Ordinarily, only one of a hospital's three platoons (often called

"hospitalization units") set up at a

time, reinforced by the personnel of a

second. The third platoon held itself

ready for the next advance. When an

active platoon closed, it turned over

its remaining nontransportable patients to a clearing platoon from the

134th Medical Group. Each field hospital, augmented with half a dozen

auxiliary surgical teams, could keep

six operating tables, and in emergencies nine, working around the clock.

A collecting company traveled with

each hospital to provide clerks, litterbearers, and general labor for mass

triage, treatment, feeding, and evacuation of transportable wounded and

sick. Employed in this fashion until 19

September, the field hospitals maintained treatment and evacuation facilities within 20 miles of the forward

clearing stations. They efficiently handled the light casualties of the pursuit, some 300-600 a day for the

entire army.10

As the forces north of the Seine

rolled forward almost 200 miles in fifteen days, First Army medical units

other than those of the 68th Medical

Group fell steadily farther behind.

The speed of the pursuit outran army

medical planning. Early in September

Colonel Rogers began shifting evacuation hospitals northward from Senonches to a new concentration point

at La Capelle on the Franco-Belgian

border. However, by the time the first

units, delayed in movement by shortages of trucks and gasoline and by

heavy traffic, reached La Capelle, the

area already was too far behind the

line for convenient use and the

medics had to pack up and move

again to another site further on. At

the end of the first week of September army medical units were strung

out along the entire path of the pursuit. A few evacuation hospitals—too

few for the peace of mind of corps

surgeons anticipating heavier casualties from the intensified German resistance—were in the process of

opening in Belgium. The least movable installations, such as the 4th Convalescent Hospital, still were trying to

assemble at Senonches.

The abrupt slowing of the advance

in mid-September (see Map 11), while

it caused tactical frustration, paradoxically improved the position of the

theater medical service by allowing

the slower units to close up behind

9

 68th Medical Group Annual Rpt, 1944, pp. 15-

16.

10

 Ibid., p. 11; Surg, First U.S. Army, Annual Rpt,

1944, pp. 44 and 60; 177 Medical Battalion Annual

Rpt, 1944, pp. 17-20; 13th, 42d, 45th, 47th, and

51st Field Hospitals Annual Rpts, 1944; 57th,

175th, and 176th Medical Battalions Annual Rpts,

1944.
BREAKOUT AND PURSUIT 283

the front line. Colonel Rogers designated Eupen, Belgium, behind the

army's center, as a medical concentration area and directed the assemblage

there of his supply depot, exhaustion

centers, convalescent hospital, gas

treatment battalion, and medical

group headquarters. He also concentrated around Eupen most of his

evacuation hospitals, except for one

or two supporting each wing of the

army. Moving by truck, and in a few

instances by rail over recently rebuilt

lines, all the army medical units had

arrived within convenient supporting

distance of the front by early October.11

As the First Army advanced, the

point at which it turned casualties

over to the Communications Zone

shifted eastward, then northward. In

the initial stage of the offensive, patients went by ambulance from army

hospitals to the OMAHA beach holding

unit, now under the Advance Section's control, or to the ADSEC 77th

Evacuation Hospital, which opened at

St.-Lo on 9 August. The latter unit

relieved army installations of an immobilizing burden of lightly wounded, and it sorted casualties of all types

for air and sea evacuation. As the

army moved farther from the beaches,

it sent evacuees successively to an airstrip near Avranches, to ADSEC holding units at Le Mans and Chartres,

and to general hospitals and an airfield at Paris. In Belgium, with

ADSEC facilities temporarily left far

behind, the army turned some of its

field and evacuation hospitals, and for

a brief period an exhaustion center,

into improvised holding units. These

units received patients from mobile

hospitals nearer the front and retained them until ADSEC ambulances

could transfer them to airstrips and

railheads near or below the French

border.12

On 19 September Colonel Rogers

again reorganized his medical groups

and redefined their missions. Departing from the earlier pattern of specialized functions, Rogers placed each

of his three groups in charge of evacuation for a particular corps, from

clearing stations to the forwardmost

ADSEC element. He reassigned units

so as to give each group an identical

composition—two battalion headquarters and one clearing, three collecting, and four ambulance companies.

Rogers delegated to the groups responsibility for deploying field and

evacuation hospitals in their sectors,

tasks hitherto performed largely by

the army surgeon's office. Directly

under Rogers' control, two separate

medical battalions evacuated the convalescent hospital and the specialized

11

 Surg, First U.S. Army, Annual Rpt, 1944, pp.

17-19, 42-46, 60, 161-65; Surg, V Corps, Annual

Rpt, 1944, pp. 16-18; VII Corps Medical Plan, pp.

69-71, 77-83, 88, encl. 1 to Surg, VII Corps,

Annual Rpt, 1944; Surg, XIX Corps, Annual Rpt,

1944, pp. 5-6; 4th Convalescent Hospital Annual

Rpt, 1944, pp. 1-2; 1st Medical Depot Company

Annual Rpt, 1944, pp. 5-6; Editorial Advisory

Board, 1962, p. 142; Memo, Kenner to CofS,

SHAEF, 20 Sep 44, sub: Report of Inspection of

FUSA Medical Service . . . , in Medical Division,

COSSAC/SHAEF, War Diary, September 1944.

12

 31st Medical Group Annual Rpt, 1944, p. 16

and an. C; 134th Medical Group Annual Rpt, 1944,

p. 9; Kenner, 12 (sic) Aug 44, sub: Report of Inspection of Medical Troops and Installations . . . , 2-

13 Aug 44, and Memo, Kenner to CofS, SHAEF, 20

Sep 44, sub: Report of Inspection of FUSA Medical

Service . . . , both in Medical Division, COSSAC/

SHAEF, War Diary, August and September 1944;

Surg, ADSEC, Daily Activities Rpt, 12 Aug 44, and

Operations Division, OofSurg, ADSEC, Weekly Activities Rpt, week ending 19 Aug 44, both in Beasley

Papers, MHI.
284 EUROPEAN THEATER OF OPERATIONS

treatment installations and performed

such miscellaneous tasks as overseeing the army's Provisional Medical

Department Truck Company, a pool

of vehicles used primarily for moving

evacuation hospitals. So reorganized,

the First Army medical service confidently prepared to care for the casualties of the impending battle for the

West Wall.13

Third Army Medical Support

For the medical troops of the Third

Army, the army's activation on 1

August was the culmination of half a

year of planning and preparation.

The army surgeon, Colonel Hurley,

and his section of twenty-five officers

and thirty-five enlisted men had been

with the headquarters since its formation at Fort Sam Houston, Texas, and

traveled with it to England in March

1944 (Chart 9). When General Patton

took command of the army, he replaced a number of key officers, including the chief of staff, with veterans of his Mediterranean campaigns.

In the surgeon's office he made only

one change; he substituted his close

friend and personal physician, Lt.

Col. Charles B. Odom, MC, for the

surgical consultant who had come out

from the United States. This shift,

and general unfamiliarity with the

forceful, idiosyncratic Patton, initially

caused tension and uncertainty

among the Fort Sam Houston contingent. Smooth working relationships

soon developed, however, and

Odom's combat experience was welcome leavening for a medical staff

that had spent the war to this point

training troops in the United States.14

During the four-month stay at Patton's headquarters in the village of

Knutsford, the surgeon's section drew

up a Third Army NEPTUNE medical

plan and completed the equipment

and training of the army's over 100

nondivisional medical units. With the

rest of the headquarters, the medical

section crossed the Channel in two

echelons on 6 and 18 July. Colonel

Hurley set up his office near St.-Sauveur-le-Vicomte, in the Cotentin,

about 8 miles from what was then the

First Army front line. Slightly behind

schedule, most of the army medical

units disembarked in Normandy between 7 and 31 July. The evacuation

hospitals, a field hospital, the auxiliary surgical teams, and a few other

units went into operation at once

under the First Army's control, most

of them in support of the VIII Corps.

Other organizations, including the

medical groups and battalions, bivouacked in a concentration area

around Barneville in the western Cotentin.

During the weeks before commitment to action, the army surgeon,

and his corps surgeons, when they arrived, devoted much time to medical

contingency planning. Colonel Hurley

13

 The assignments were: 31st Medical Group to

support the XIX Corps; the 68th Medical Group,

the VII Corps; and the 134th Medical Group, the V

Corps. Specialized treatment units were the 618th

and 622d Clearing Companies (NP) and the 91st

Medical Gas Treatment Battalion (contagious diseases, venereal disease, and self-inflicted wounds).

See also Surg, First U.S. Army, Annual Rpt, 1944,

pp. 43-46; 31st, 68th and 134th Medical Groups

Annual Rpts, 1944; 57th and 177th Medical Battalions Annual Rpts, 1944.

14

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

1-13, 19, 59-66, ex. VI; Editorial Advisory Board,

1962, pp. 85-90 and 98. The army staff came to the

theater expecting to be commanded by General

Hodges.

286 EUROPEAN THEATER OF OPERATIONS

and his staff also paid attention to

supply. Third Army units, like those

of other commands, often crossed the

Channel separately from their equipment. To reduce loss and misdirection, Hurley's medical supply officer,

in cooperation with his ADSEC counterpart, stationed men on the beaches

to watch for incoming Third Army

medical gear and to ensure its prompt

unloading and delivery. Elements of

the two army medical depot companies, the 32d and 33d, had been in

Normandy since D-Day, attached to

the First Army and ADSEC. Late in

July these companies reassembled

under the Third Army's control. The

32d, at Bricquebec in the concentration area, replenished supplies and

replaced equipment for army medical

units. The 33d, at Besneville close

behind the VIII Corps, received and

stored for the beginning of operations ten medical maintenance units

made up by the Advance Section,

which contained fifteen days of supplies for 200,000 men.15

On 1 August the Third Army went

into operation and resumed control

of its medical units and surgical teams

that had been attached to the First

Army. Colonel Hurley at once organized his forces to support simultaneous offensives in Brittany and in the

interior of France. He had ample resources with which to work. Compared to the First Army, the Third

was lavishly endowed with nondivisional medical support, especially for

evacuation. Its initial medical troop

allocation, more than double that of

the First Army for about the same

number of divisions, included five

groups, seventeen battalions, and

twenty-one ambulance, eighteen collecting, and ten clearing companies.16

The Third Army kept the same

medical organization throughout the

pursuit and the transition to static

warfare on the Moselle. Its medical

system, like its general method of administration and command, emphasized simplicity, informality, and the

assumption of responsibility by lower

echelons. The army employed its

medical groups solely to control evacuation, assigning to them all of its

ambulance companies and also the

ambulance platoons of its collecting

companies. A different group evacuated the clearing stations of each of the

army's varying number of corps—normally two or three in the eastward advance plus the VIII Corps in Brittany.

A single group, the 69th, transferred

patients between evacuation and convalescent hospitals and holding units.

When necessary, it also evacuated

casualties from these installations to

the Communications Zone. The

15

 Surg, First U.S. Army, Annual Rpt, 1944, p. 15;

Surg, Third U.S. Army, Rpt, 1944, pp. 12-25, 99,

103-06, 153-59, ex. III; Third U.S. Army Outline

Plan, Operation NEPTUNE, Annex 16: Medical

Plan, in CMH; Editorial Advisory Board, 1962, pp.

85-86; Memo, Lt Col H. Reinstein to Surg, Ninth

U.S. Army, 9 Sep 44, sub: Observation of Medical

Service in Operation, TUSA, Shambora Papers,

MHI (in same collection, see Third US Army fldr);

Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 26;

Surg, XII Corps, Annual Rpt, 1944, p. 3; 67th Medical Group Annual Rpt, 1944, p. 6; Supply Division,

OofSurg, ADSEC, Weekly Activities Rpts, weeks

ending 30 Jul and 5 Aug 44, Beasley Papers, MHI;

32d Medical Depot Company Annual Rpt, 1944, pp.

4 and 6.

16

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

15-16. For First Army figures, see Chapter VI of

this volume. Even as reorganized in September

1944, the First Army included only three groups,

eight battalions, and fourteen ambulance, eleven

collecting, and six clearing companies. See Surg,

First U.S. Army, Annual Rpt, 1944, pp. 45-46.
BREAKOUT AND PURSUIT 287

group commanders, according to a

Ninth Army observer, possessed "an

extreme degree of latitude" in directing patient flow from clearing stations

to the rear. Army collecting and clearing companies, directly under the surgeon's office, usually reinforced evacuation hospitals; they treated the sick

and lightly wounded and stayed

behind with nontransportables to free

the larger units for forward movement. The army's seven-eight field

and eleven-fourteen evacuation hospitals (the numbers varied during the

campaign) functioned in what was by

now the conventional manner. Corps

surgeons controlled the movements

of the field hospitals supporting their

divisions, and, as the campaign went

on, they assumed, in cooperation with

the unit commanders, most of the

task of deploying evacuation hospitals. The three army gas treatment

battalions served at different times as

holding units and improvised convalescent hospitals, and they provided

trucks to move other organizations.17

In Brittany the VIII Corps surgeon,

Col. Richard H. Eckhardt, MC, managed an independent medical service

for a force separated by a rapidly widening distance from the main body of

the army. To support three infantry

divisions attacking Brest, another

patrolling along the Loire, and an

armored division containing the garrison at Lorient, the Third Army

attached to the VIII Corps a medical

group (the 64th), three medical battalions, one field and four evacuation

hospitals, and several ambulance, collecting, and clearing companies. The

corps drew medical supplies from a

section of the 33d Medical Depot

Company at Rostrenen in central

Brittany. It maintained a ten-day evacuation policy for combat exhaustion

patients, the sick, and the slightly

wounded and sent all other casualties

directly to England by plane or LST.

A clearing company holding unit at

Morlaix, on the north shore of the peninsula, received these evacuees from

corps hospitals and prepared them

for further movement. At the height

of the fighting for Brest VIII Corps

medical installations handled 300-400

casualties per day.18

Medical units supporting the main

Third Army drive to the Moselle, like

their First Army counterparts, had

difficulty keeping up. Field hospitals,

by borrowing trucks from divisions

and corps, managed to push at least

some of their platoons well forward,

but in spite of their best efforts distances of as much as 100 miles

opened between their leading and

rearmost elements. Third Army evacuation hospitals, each of which moved

an average of four times during

17

 Quotation from Memo, Reinstein to Surg,

Ninth U.S. Army, 9 Sep 44, sub: Observation of

Medical Service in Operation, TUSA, Shambora

Papers, MHI. See also Surg, Third U.S. Army,

Annual Rpt, 1944, pp. 25, 27, 31, 39, 73-78, 87-93;

4th Auxiliary Surgical Group Annual Rpt, 1944, pp.

9-12; Surg, XX Corps, Annual Rpt, 1944, pp. 24-

25; 66th Medical Group Annual Rpt, 1944, pp. 4-5

and 9; 67th Medical Group Annual Rpt, 1944, pp.

9-10; 95th Medical Gas Treatment Battalion Annual

Rpt, 1944, pp. 3-5. For a well-known summary of

Patton's view of command and organization, see

George S. Patton, Jr., War as I Knew It, an. by Colonel Paul D. Harkins (Boston: Houghton Mifflin Co.,

1947), pp. 399-400.

18 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

27-28 and 160; Surg, VII Corps, Annual Rpt, 1944,

pp. 4-7; 64th Medical Group Annual Rpt, 1944, p.

5; 33d Medical Depot Company Annual Rpt, 1944,

an. 1; Memo, Kenner to CofS, SHAEF, 4 Sep 44,

sub: Inspection Report, Brittany Sector, 3 September 1944, in Medical Division, COSSAC/SHAEF,

War Diary, September 1944.
288 EUROPEAN THEATER OF OPERATIONS

August alone, advanced more rapidly

than those of the First Army, al- though with increasing difficulty. At

least a few always were close to the

corps rear boundaries, and many had

reached or crossed the Meuse by

early September. The 32d and 33d

Medical Depot Companies leap- frogged their advance and base platoons forward, so as to have issuing

facilities open most of the time with

convenient reach of the combat units.

The 32d Company set up at Verdun

on 8 September, and the 33d arrived

at Toul twelve days later. The Third

Army's convalescent hospital, the 6th,

fared less well. It had opened at Vitre

on 8 August and then advanced by

sections, hampered by the need to

carry along patients ready for duty

who could not be returned to their

units for lack of transportation. By

early September the hospital was split

into three echelons, the easternmost

at St.-Mihiel and the rearmost still at

Vitre, almost 500 miles away. As the

army halted along the Moselle in September, Colonel Hurley was able to

bring his medical units up close

behind the front. Instead of concentrating them in a single area, the

Third Army surgeon spread his forces

out along a line roughly from Verdun

to Nancy, with evacuation hospitals

paired for alternate movement and a

depot company supporting each wing

of the army.19

In mid-August Colonel Hurley established a fifteen-day evacuation

policy for the army, which he extended to thirty days after the front

stabilized in late September. To

remove casualties requiring longer

care, Hurley relied almost entirely on

air transportation until the end of the

pursuit. On the assumption that

COMZ installations would fall behind

the advance, the Third Army surgeon

organized his own rear holding unit,

consisting of the 94th Medical Gas

Treatment Battalion reinforced with

an ambulance company and a collecting element and with a field hospital

platoon attached for emergency surgery. Using six different forward airstrips, this unit evacuated over 9,700

patients, most of them in C-47s of

the IX Troop Carrier Command. It

stayed at each strip only until an

ADSEC unit arrived to take over evacuation there and then moved on. The

army holding unit finally settled down

at Toul on the eighteenth, sharing the

evacuation task with an ADSEC facility at Etain, just east of Verdun. As

railheads reached Verdun and Toul,

both units sent casualties out by hospital train as well as by plane. These

units, supplemented by the army's

750-bed evacuation hospital, the 12th,

which had opened at Verdun on the

seventh, kept the forward evacuation

hospitals continually cleared, even

when weather and shortages of aircraft temporarily halted the flow of

patients to the Communications Zone

and Great Britain.20

19

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

27-29, 33-36, 94-96, 159-64; Surg, XII Corps,

Annual Rpt, 1944, p. 4; Surg, XX Corps, Annual

Rpt, 1944, pp. 22-24; 32d and 33d Medical Depot

Companies and 6th Convalescent Hospital Annual

Rpts, 1944; Memo, Reinstein to Surg, Ninth U.S.

Army, 9 Sep 44, sub: Observation of Medical Service in Operation, TUSA, Shambora Papers, MHI.

The 12th Army Group surgeon considered the

Third Army more effective in pushing up its hospitals than the other armies. See Gorby Interv, 1962,

pp. 10-11, CMH. 20

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

72-73, 77-78, 81-84, 95; Memo, Kenner to CofS, Continued
BREAKOUT AND PURSUIT 289

AWAITING EVACUATION FROM THE THIRD ARMY'S AIR HOLDING UNIT AT TOUL

Seventh and Ninth Annies

Medical Support

The Seventh and Ninth Army medi- cal departments initially had different

tasks. Seventh Army medics participated in an amphibious assault and

wide-ranging exploitation. The Ninth

Army medical service, in contrast, began its existence supporting a siege

and preparing forces for later movement into the front line. By the end

of September, as their parent armies

joined, or got ready to join, the array

facing the West Wall, both army medical services were on the verge of incorporation into a more or less uniform system of support.

On 15 August elements of Maj.

Gen. Alexander M. Patch's U.S. Seventh Army and General Jean de

Lattre de Tassigny's French Army B

(later redesignated the French First

Army) assaulted the Riviera beaches

in Operation DRAGOON, beginning the

long-delayed campaign for southern

France. These armies went into action

under the Supreme Allied Commander in the Mediterranean and drew

their logistical support from NATOUSA headquarters. Overwhelming

weak opposition on the beaches, the

American VI Corps, the only one

under the Seventh Army, pursued the

withdrawing German Army Group G up

the Rhone valley; after securing the

SHAEF, 16 Oct 44, sub: Report of Inspection of

TUSA Medical Service, in Medical Division,

COSSAC/SHAEF, War Diary, October 1944; 94th

Medical Gas Treatment Battalion Annual Rpt, 1944,

pp. 2-6.
290 EUROPEAN THEATER OF OPERATIONS

COL. MYRON P. RUDOLPH (seated), with his evacuation and operation officers

major ports of Toulon and Marseilles,

the French army joined the northward

advance. On 3 September the Allies

took Lyon and a week later Dijon,

near which, on the eleventh, Seventh

and Third Army patrols made contact. Four days later the U.S. 6th

Army Group, under General Devers,

assumed control of the two armies

from the Riviera. This army group, in

turn, was under the operational control of SHAEF but logistically still

tied to the Mediterranean.

Both the Seventh Army surgeon,

Col. Myron P. Rudolph, MC, and the

VI Corps surgeon, Col. Rollin L.

Bauchspies, MC, were veterans of earlier Mediterranean operations, Bauchspies having been with the corps at

Anzio. Hence their medical support

arrangements were based on welltried methods and hard-learned lessons. In the landings medical units

came ashore in a sequence similar to

that in Normandy: divisional elements

and a beach support group medical

battalion first, followed by field and

then evacuation hospitals. Once engaged in mobile operations, the Seventh Army employed its field and

evacuation hospitals in the usual

manner. Without a medical group, it

used one separate battalion to empty

division and corps clearing stations

and another to move patients to the

rear of the evacuation hospitals.

Between 15 August and 29 September Seventh Army medical installations admitted about 28,000 patients,

of whom 20,000, including 6,700
BREAKOUT AND PURSUIT 291

BRIG. GEN. WILLIAM E. SHAMBORA

(1950 photograph)

battle casualties, were U.S. troops.

The army transferred people needing

extended care to NATOUSA hospitals

in Italy and later in southern France.

At the outset most evacuees went by

ambulance to the beaches for transfer

to landing craft and hospital ships;

but, as the distance between army facilities and the coast increased, air

evacuation came to predominate. By

late September the army was sending

most patients by plane from Besancon

to a COMZ holding unit at Istres,

which in turn dispatched them to

fixed hospitals in Naples or around

Marseilles. Besides receiving Seventh

Army casualties, the North African

Theater furnished medical supplies,

including whole blood. To control its

growing number of facilities in southern France, the theater, as the campaign developed, established two base

sections encompassing the Riviera

and the Rhone and Saone valleys.21

In contrast to the veteran Seventh

Army medical staff, that of Ninth

Army, which arrived in England

during May and June 1944 fresh from

activation at Fort Sam Houston,

lacked operational experience. The

army surgeon, Col. William E. Shambora, MC, did have one distinctive

qualification for his post: as chief

medical officer of the Army Ground

Forces, he had helped to develop the

types of field medical units he now

was to direct in action. At Bristol,

awaiting movement to France, Shambora and his section availed themselves at every opportunity of the

battle experience of those who had

preceded them into the field. They

visited the First and Third Armies to

observe the medical service in action

and COMZ hospitals to study the

treatment of casualties, and they incorporated what they learned in their

plans and training directives.22

21

 This account summarizes the more extensive

treatment in Wiltse, Mediterranean, ch. X. See also

Memo, Col J. K. Davis to CMedOff, SHAEF, 26 Sep

44, sub: Visit to Hq, 6th Army Group, in Medical

Division, COSSAC/SHAEF, War Diary, September

1944. The French First Army had its own divisional

and corps medical units and, once in its home country, relied for fixed hospitals on local civilian facilities.

22

 In Shambora Papers, MHI, see Surg, Ninth U.S.

Army, Daily Journal, 31 Jul 44; Medical Encl to

Training Memo No. 1, Ninth U.S. Army, n.d.;

Orders, 12th Army Group to CG, Ninth U.S. Army,

28 Jul 44. See also Surg, Ninth U.S. Army, Annual

Rpt, 1944, pp. 1-6 and 26; Interv, OSG with Maj

Gen William E. Shambora (hereafter cited as Shambora Interv), 8 Oct 62, pp. 5 and 14-17, CMH; Editorial Advisory Board, 1962, pp. 134-35.
292 EUROPEAN THEATER OF OPERATIONS

The army headquarters enbarked

for France on 29 August. After a

short period in billets in Normandy, it

went into operation on 5 September,

at Mi Foret, near Rennes at the base

of the Brittany peninsula. During the

rest of the month the medical section

had relatively little to do. Colonel

Shambora left support of the attack

on Brest largely to the VIII Corps

surgeon, while he oversaw the evacuation of the few sick and injured from

the forces patrolling along the Loire.

Shambora also arranged for the reception of additional Ninth Army

medical units that arrived from England, including two group headquarters, an auxiliary surgical group, and

a number of ambulance, collecting,

and clearing companies. The army

surgeon set up camps for these units,

administered by the 95th Medical Gas

Treatment Battalion, in the army service troops concentration area at

Melun, south of Paris. After Brest surrendered, he supervised the evacu- ation of over 4,700 sick and wounded

Germans from the fortified city's underground hospitals and regrouped

VIII Corps medical elements for

movement to the north.23

During the pursuit the First, Third,

and Ninth Army medical services operated under the supervision of the

12th Army Group surgeon, Colonel

Gorby. Gorby and his section moved

to Normandy late in July with the rest

of group headquarters and established themselves initially in "tents

and self-dug foxholes" in an apple orchard. Until the 12th Army Group

went into operation on 1 August, its

surgeon largely confined his activities

to establishing communication with

the army surgeons and planning for

future operations. Thereafter, Colonel Gorby played a gradually expanding role in allocating medical units

among the armies, supervising and

coordinating their medical services,

and assisting them in dealing with the

Communications Zone. As the lines of

communication lengthened, General

Hawley sought Gorby's assistance in

coordinating evacuation from the

armies. "You are in closer touch with

the situation than any officers from

my own office," he told Gorby on the

eleventh, "and I wish that you would

keep them advised of the needs of the

two Armies and help them in the solution of the problem." The group

surgeon, however, advised army surgeons rather than dictating their policies, and it was the army surgeons

who carried the main burden of improvising solutions to the evacuation

and hospitalization problems of the

pursuit.24

Adapting to Mobile Warfare

For all the armies, especially those

exploiting the breakout from Nor- 23

 The Ninth Army acquired from the Third,

along with the VII Corps, the 64th Medical Group,

three medical battalions, four evacuation hospitals, a

gas treatment battalion, and four ambulance, four

collecting, and three clearing companies. See Surg,

Third U.S. Army, Annual Rpt, 1944, pp. 34-35 and

75-76; Surg, Ninth U.S. Army, Annual Rpt, 1944,

pp. 1-2 and 6-8; 64th Medical Group Annual Rpt,

1944, p. 6; Surg, Ninth U.S. Army, Daily Journal, 5-

30 Sep 44, Shambora Papers, MHI.

24

 First quotation from Comments on Draft Ms by

Col Thomas F. Whayne, USA (Ret) (hereafter cited

as Whayne Comments), 4 Dec 86, p. 14, CMH.

Colonel Whayne was chief of Preventive Medicine

and the Medical Intelligence Branch in Gorby's

office. Second quotation from Ltr, Hawley to Gorby,

11 Aug 44, file HD 024 ETO CS (Hawley Chron).

See also 12th Army Group Report of Operations,

vol. XIII (Medical Section), pp. 7-8.
BREAKOUT AND PURSUIT 293

mandy, the German collapse in

France created a new set of medical

support problems. The strain on certain elements of the treatment and

evacuation system eased, but that on

other elements increased. In general,

as the First Army surgeon put it, the

problems of pursuit were "more logistical than medical in nature. . . .

Service rendered to battle casualties

was regulated to a lesser extent by

surgical skill and experience and

more by such factors as distance, available transportation, and

supply."

 25

A decline in casualty rates accompanied the near-disintegration of

German resistance. In the First Army

the rate of battle-caused hospital admissions, measured in patients per

1,000 men per year, fell from over

1,100 in July to 890 in August and

445 in September. Similarly, neuropsychiatric admission rates declined

from over 230 in July to about 190 in

August, and to 100 in September.

The statistical trend was evident from

day to day in field installations. The

VIII Corps surgeon noted as early as

22 August: "Where five or six hundred patients were passing through

. . . clearing stations in a single day,

not so long ago, now 12 or 15 battle

casualties are the maximum." In the

Third Army, which had not experienced the hard static fighting of the

First, battle casualty rates were moderate throughout August and September, remaining at about 550 per 1,000

men per year. During August Third

Army casualties included an unusually

high proportion of bullet wounds to

those from bomb and shell frag- ments—another indication of the fluid

small-scale character of the fighting.

This proportion became more normal

in September, as German artillery reinforced the solidifying defense of the

Moselle. Nevertheless, the field army

medical service in the pursuit still had

to handle a significant number of patients. First Army hospitals admitted

over 19,000 wounded between

1 August and 12 September, not

counting sick and injured. Those of

the Third Army received about

23,000 battle casualties in the same

period, and another 18,000 from

other causes.26

In the infantry divisions the pursuit

produced no major changes in the

medical system. When the advance

was rolling ahead, impeded only by

feeble rear guards, unit doctors and

aidmen, as the 16th Infantry surgeon

recalled, often "were along for the

ride." At times the only casualties

were those Americans bruised by welcoming civilians who, in their enthusiasm, threw fruit, wine bottles, and

other solid gifts into fast-moving

trucks and jeeps. Aid stations and collecting companies kept most of their

men and equipment loaded on their

vehicles, dismounting only the minimum needed to care for the few casualties as they occurred. Clearing companies, which lacked trucks to move

all their elements at once and had to

25

 Surg, First U.S. Army, Annual Rpt, 1944, p. 64.

26

 Quotation from VII Corps Medical Plan, p. 67,

encl. 1 to Surg, VII Corps, Annual Rpt, 1944. Statistics from Surg, First U.S. Army, Annual Rpt, 1944,

pp. 169 and 171; First U.S. Army Report of Operations, 1 Aug 44-22 Feb 45, bk. IV, p. 198; and

Surg, Third U.S. Army, Annual Rpt, 1944, pp. 37,

87, exs. XIX, XX, XXVII. See also Kenner, 12 (sic)

Aug 44, sub: Report of Inspection of Medical

Troops and Installations . . . , 2-13 Aug 4

Medical Division, COSSAC/SHAEF, War Diary,

August 1944.
294 EUROPEAN THEATER OF OPERATIONS

shuttle forward by alternate platoons,

had difficulty keeping up but managed advances of up to 190 miles in

four or five days. First Army division

clearing stations dropped off their accompanying field hospital platoons

for the pursuit. Third Army field hospital elements, which stayed with the

clearing stations, scrambled constantly to obtain trucks from corps medical

battalions and evacuation hospitals. In

the army's XII and XX Corps provisional holding units, formed from elements of the corps medical battalions,

took over postoperative care of nontransportable patients, allowing the

field hospital platoons to move

promptly with their clearing stations.27

When divisions encountered hard

fighting, as at Mortain, Falaise, Brest,

and the Moselle crossings, their

aidmen and medical officers continued to use the treatment and evacuation methods worked out in the

hedgerows; however, they had to

make adaptations and improvisations

to meet the varied tactical and terrain

conditions of mobile combat. In the

Mortain battle, for instance, the 2d

Battalion, 120th Infantry (30th Division), lost its entire aid station, captured by a German armored column,

and was surrounded for five days

under constant attack. Aidmen with

the isolated companies gave the many

wounded what treatment they could

and placed them in deep slit trenches

for protection against fire. To remedy

a critical supply shortage, artillery

supporting the battalion fired 105-

mm. and 155-mm. smoke shells filled

with bandages, tape, and morphine

into the perimeter. While some of the

most severely injured died, the

aidmen kept the majority alive until

American counterattacks ended the

siege.28

In the Third Army's battle for

bridgeheads east of the Moselle,

medics engaged in complicated, dangerous boating of wounded across a

wide river under fire, from lodgements often too constricted or too

thoroughly swept by German artillery

to accommodate battalion aid stations, not to mention collecting and

clearing elements. In this intense

close-quarters fighting, aidmen and

litterbearers suffered heavily. At

Dornot, near Metz, where the 5th Infantry Division gained a bridgehead

only to be forced out by savage counterattacks, "medics went out after the

wounded but the enemy] would

either shoot them down or ... let

the medic get up to the wounded and

then shoot the medic and the wounded man." Displays of endurance and

valor were common, such as that of

William G. Rea, aidman in Company

K, 11th Infantry. During the withdrawal from the Dornot bridgehead

"Rea crossed the river three times in 27

 Quotation from Tegtmeyer "Diary," bk. II, p.

54. See also Interv, OSG with Capt. E. G. Asherman

(hereafter cited as Asherman Interv), 3 Feb 45, box

221, RG 112, NARA; VII Corps Medical Plan, p. 65,

encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Surg,

XII Corps, Annual Rpt, 1944, p. 4; Surg, XX Corps,

Annual Rpt, 1944, p. 22; 30th Field Hospital

Annual Rpt, 1944, pp. 14-15. For examples of

clearing station movement, see Surgs, 1st, 28th,

30th, and 90th Infantry Divisions Annual Rpts,

1944.

28

 Blumenson, Breakout and Pursuit, pp. 488-90;

VII Corps Medical Plan, pp. 61 and 63, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; Surg, 30th Infantry Division, Annual Rpt, 1944, p. 4. Bradley, Aid

Man, describes the capture of the aid station. On

the activities of the 120th Infantry during 6-12

August 1944, see 30th Infantry Division Combat Intervs, box 24038, RG 407, NARA.
BREAKOUT AND PURSUIT 295

MEDIC AIDING A CASUALTY OF THE MOSELLE FIGHTING

evacuating litter patients. One time

he carried a wounded man 300 yards,

unaided, walking erect through small

arms fire, after having crawled 300

yards to reach the man." Other

medics at Dornot were as heroic, but

less fortunate. Four men of the 5th

Medical Battalion appropriated an

abandoned engineer assault boat and

crossed the fire-swept Moselle to

bring back a couple of casualties, only

to be blown out of the water by a

tank shell as they began a second

trip.29

In the breakout and pursuit armored division medical units, for the

first time in the campaign, performed

the function for which they had been

designed: treatment and evacuation of

casualties in fast-moving independent

combat commands. The armored division medical service, completely motorized and lavishly equipped with

radios, worked on the same general

principles as that of the infantry, but

with variations in organization and

procedures. Combat units—except for

29

 First quotation from Narrative by Lt Harry A.

Morris. Second quotation from Narrative ("Crossing

of the Moselle") by 2d Battalion, 11th Infantry.

Both in 5th Infantry Division Combat Intervs, box

24023, RG 407, NARA. See also Surg, 5th Infantry

Division, Annual Rpt, 1944, pp. 17-21. Surg, 80th

Infantry Division, Annual Rpt, 1944, pp. 6-8, describes medical support of a more successful Moselle crossing.
296 EUROPEAN THEATER OF OPERATIONS

the armored infantry battalions, which

usually secured non-T/O company

aidmen from corps or army—concentrated their medical detachments in

battalion aid stations, from which

men in jeeps and half-tracks went forward to pick up casualties. Each of

the three-lettered companies of an armored division medical battalion included both collecting and clearing

elements and was capable by itself of

providing evacuation and emergency

surgery for a combat command. Especially during a rapid deep penetration

of enemy lines a combat command

medical service, consisting of unit detachments and the attached collecting

and clearing company, functioned independently, directed by the command surgeon (selected from the

medical battalion or a unit of the

command) and the medical company

commander.

Tank battalions, for front-line casualty handling, relied on crews thoroughly trained in first aid and in

escape and rescue from damaged or

burning vehicles. Tankers were often

heroic in taking care of their own. A

4th Armored Division bow gunner,

Pvt. Theodore T. Liscavage, in

combat east of the Moselle, returned

twice under fire to his knocked-out

tank in an ultimately successful attempt to pull out the injured driver;

Liscavage eventually received the

Silver Star. In extreme danger, even

badly wounded tank crewmen extricated themselves. Near Avranches an- other division soldier, hurt in both

legs and badly burned, still managed

to crawl out of his flaming tank and

reach a ditch, where he lay in agony

until picked up, at some risk to themselves, by a graves registration officer

and an enlisted man who happened to

be nearby. In the 2d Armored Division, according to the surgeon, the

burn casualty rate was unexpectedly

low, largely because of the speed with

which men piled out of any hit or

smoldering tank.

When armored vehicles unloaded

casualties, they notified their battalion

aid station. The aid station then sent

ambulance jeeps or half-tracks to the

reported location of the wounded. As

observed by Lt. Col. Roosevelt Cafarelli, MC, the 6th Armored Division

surgeon, "The litter bearers and medical technicians with their ambulance

jeeps, equipped with plasma, morphine, splints, blankets and litters,

functioned courageously as finger-like

projections of the aid stations. . . 

The aid station was brought to the

patient, and the dictum 'Splint them

where they lie' was fulfilled." These

aidmen often drove into danger.

During the St.-Lo breakthrough a 2d

Armored Division medical half-track

advanced along a hedgerow lane to

pick up two injured crewmen, removed from a wrecked Sherman by

infantrymen. The aidmen, and some

assisting riflemen, "were just starting

to load [the casualties] into the halftrack when a German mortar shell

landed right on top of the group. All

were wounded, none killed." Especially at night, battalion aidmen often

used jeeps in preference to half-tracks

for collecting wounded, as the noise

of the larger vehicles could draw

random fire.30

30

 First quotation from Surg, 6th Armored Division, Annual Rpt, 1944, encl. 2. Second quotation

from Narrative by Company E, 22d Infantry, 25 Jul2 Aug 44, in 4th Infantry Division Combat Intervs,

box 24021, RG 407, NARA. The other incidents are Continued
BREAKOUT AND PURSUIT 297

TYPICAL HALF-TRACK

Armored medical company commanders, working with combat commands, used radio and also liaison

officers (frequently dentists underemployed in combat) to keep themselves

informed of the rapidly changing tactical situation so that they could react

promptly to the vicissitudes of mechanized battle. Ambulances of the medical company normally traveled with

the armored column, their distribution within it depending on the preferences of the tactical commander

and the surgeon. The clearing element, built around a truck-mounted

surgical unit, followed close behind—

disconcertingly close in the view of an

infantry officer who saw an armored

treatment station (as clearing stations

in these divisions were called) calmly

setting up near St.-Lo within 500

yards of a fire fight. Moving too rapidly for field hospital platoons to keep

up with them, the treatment elements

generally did a minimum of surgery;

instead, using attached ambulances

from army medical groups, they

promptly dispatched even the most

severely injured to field or evacuation

hospitals often scores of miles behind

them. Nevertheless, they could operate when they had to. A 2d Armored

Division surgeon recalled

one instance when we were unable to get

ambulances back and had a patient

brought in with a partial evisceration, perforated bowel and extensive intra-ab- dominal hemorrhage. We were able to

arrest the hemorrhage, resected a portion

of the ileum and gave copious amounts of

plasma and blood (from our own men). The next morning the road back was

clear and we were moving on so we had

to evacuate him. Although we did not ac- tually expect him to survive the operation

we got a letter from him the other day

from England.31

During action, armored medical

battalion commanders usually maintained only administrative oversight

of their committed companies. If the

division, as it usually did, kept a

combat command in reserve, the division surgeon often employed that

command's attached medical company

to hold sick, lightly wounded, and

from 4th Armored Division Combat Intervs, box

24092, RG 407, NARA. See also Surg, 2d Armored

Division, Annual Rpt, 1944, pp. 13-14 and 45-54.

31

 Quotation from Ltr, Lt Col J. S. Weire to TSG,

10 Oct 44, file HD:ETO:370.05:Evacuation and

Movement of Troops. The armored clearing station

episode is in Rpt, 2d Battalion, 2d Infantry, sub:

Counterattack on Hill 211, in 4th Infantry Division

Combat Intervs, box 24021, RG 407, NARA.
298 EUROPEAN THEATER OF OPERATIONS

combat exhaustion patients. The

medical battalion headquarters companies acted as rolling supply depots;

they issued expendable items to active

companies, which in turn replenished

battalion aid stations. Such was the

system that proved itself in action

during the breakout from Normandy.

Using it, the 6th Armored Division,

for example, during its six day 200-

mile drive through Brittany, managed

to get most of its wounded back to

army hospitals, even though the

country beyond its immediate lines of

march remained in German hands.32

During the advance the First and

Third Army surgeons, with their executive officers and those in charge of

hospitalization, evacuation, and

supply, usually accompanied the forward echelon of army headquarters,

which kept as close as possible to the

front. The rest of the medical section

followed, as much as 100 miles

behind, with the rear headquarters

echelon. Corps and division surgeons

similarly divided their staffs. Wherever located, it required constant effort

and much improvisation for surgeons

to maintain contact with and control

over their widespread units. As the

pursuit outran the construction of

telephone lines and even the range of

radios, surgeons had to rely largely

on couriers to transmit orders and

collect information. In the Third

Army the surgeon's executive officer

recalled that "individual officers . . .

had to go out [and] contact units and

find out where they were. The use of

ambulances, the use of jeep messengers, all of these things come into

play in controlling an army that's

moving rapidly." During September,

to ensure prompt response to the

constantly changing situation, Colonel

Rogers of the First Army sent his executive officer with a small advance

medical party into Belgium ahead

even of the army's forward echelon.

These officers, who accompanied the

1st Division much of the time, made

on-the-spot decisions on such matters

as selection of Eupen for a medical

concentration area.33

Securing transportation to move

evacuation hospitals and larger medical units constantly taxed the ingenuity of army surgeons. These organizations, unlike divisional and corps

elements and army medical groups

and their subunits, had to obtain

extra vehicles to lift all their people

and equipment at once. A 400-bed

evacuation hospital, for instance, required 30 more trucks than its standard allowance if it were to move in a

single convoy. Such units could, and

often did, shift position by shuttling

in their organic vehicles, but this

process was time-consuming and

wearing on drivers and machines

alike.

Because all other parts of the field

armies also were moving and had no

32

 Surgs, 2d, 4th, 5th, and 6th Armored Divisions,

Annual Rpts, 1944; Asherman Interv, 3 Feb 45, box

221, RG 112, NARA; Surg, XX Corps, Annual Rpt,

1944, p. 21.

33

 Quotation from Editorial Advisory Board, 1962,

pp. 148-49. See also ibid., pp. 143-47 and 150;

First U.S. Army Report of Operations, 1 Aug 44-22

Feb 45, bk. IV, pp. 133-34; Surg, Third U.S. Army,

Annual Rpt, 1944, pp. 26, 32-33, 69, 74; VII Corps

Medical Plan, pp. 54-55, encl. 1 to Surg, VII Corps,

Annual Rpt, 1944; Surg, VIII Corps, Annual Rpt,

1944, p. 6; Surg, 5th Infantry Division, Annual Rpt,

1944, pp. 16-17; Briefing (untitled and n.d.), ca.

August 1944, and Memo, Reinstein to Surg, Ninth

U.S. Army, 9 Sep 44, sub: Observation of Medical

Service in Operation, TUSA, both in Shambora

Papers, MHI.
BREAKOUT AND PURSUIT 299

vehicles to spare, army medics had to

rely on their own transportation. The

First Army surgeon, after concentrating his forces at Senonches, formed a

Provisional Medical Department

Truck Company, composed of over

200 vehicles detached from evacuation hospitals and gas treatment battalions. (The 96 trucks of the latter

were an invaluable asset that army

surgeons occasionally had to defend

against diversion to other uses.) This

unit provided a pool of trucks for

rapid concentration where needed,

but hospital commanders objected to

what amounted to the permanent removal of most of their vehicles. The

Third Army formed a similar truck

pool, also taken from evacuation hospitals and gas treatment battalions,

but, in keeping with its more informal

organization, left the vehicles with

their parent units except when required for army missions. In ordinary

movements Third Army evacuation

hospitals often simply borrowed

trucks from one another, rather than

going through army channels. However they obtained vehicles, medical

units of both armies had to compete

with everyone else for gasoline, especially when forward-area supplies ran

short in early September. The army

surgeons, by vigorous wheeling and

dealing, secured enough fuel for essential transportation and evacuation.

Individual units used ingenuity, such

as salvaging the residue in discarded

jerry cans, to keep their own tanks

from running dry.34

In both field armies the evacuation

hospitals, the large units that moved

most frequently, became expert at the

process. Typically, once the army directed a hospital to a new general

area, the unit sent an advance party

to locate and begin preparing a specific site, usually after securing approval for it from the nearest corps

headquarters. Veteran location scouts

learned to pick high ground, preferably a pasture, because cultivated

fields were dusty when dry and a

morass of mud when wet. The preparatory parties often worked under

fire, as the armies tried to push evacuation hospitals as far forward as possible in anticipation of further advances by the combat elements. The

main body, meanwhile, usually

stopped receiving patients several

days before a movement; turned

those left in its wards over to another

hospital or a holding unit; and then

took down its tents and packed personal and unit equipment. When

transportation arrived, often after a

frustrating wait, the unit loaded up

and set off, the personnel riding in

ambulances and jeeps and, occasionally, in the open backs of trucks.

Movement, over crowded roads,

often at night under blackout or air

attack, produced its share of accidents

and lost vehicles and property. Depending on circumstances, army

traffic control directions, and the

commander's preference, hospitals

34

 For unit truck requirements, see Memo, Reinstein to Surg, Ninth U.S. Army, 9 Sep 44, sub: Observation of Medical Service in Operation, TUSA,

Shambora Papers, MHI; Surg, First U.S. Army,

Annual Rpt, 1944, pp. 59-60; Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 34-91; Surg, V Corps,

Annual Rpt, 1944, p. 17; VII Corps Medical Plan, p.

79, encl. 1 to Surg, VII Corps, Annual Rpt, 1944;

31st Medical Group Annual Rpt, 1944, p. 16; 68th

Medical Group Annual Rpt, pp. 11-12; 12th, 41st,

91st, 106th, and 109th Evacuation Hospitals Annual

Rpts, 1944; 57th Medical Battalion Annual Rpt,

1944, pp. 17 and 19-20; Editorial Advisory Board,

1962, pp. 119, 138, 142-43.
300 EUROPEAN THEATER OF OPERATIONS

traveled either in large convoys or by

infiltration, which meant: "Load the

vehicles and start them forward

toward their destination as single

units. Supply each driver with a strip

map and leave him to his own skill

and determination." At least some

hospitals preferred the latter method,

as it avoided the difficulties of keeping many trucks together amid the

general stream of traffic. Hospitals

usually tried to arrive at their new

sites around noon, and an experienced unit could unpack, pitch tents,

set up equipment, and be ready to receive patients in three-five hours. As

did other units, hospitals on the move

through liberated France and Belgium

encountered an enthusiastic popular

welcome. In Belgium, civilians gathered to watch hospitals being put up,

brought gifts and food and wine, and

at times volunteered to help as workers and guards.35

Army medical supply in the pursuit

was concerned not only with trying to

keep depot companies within practicable distance of the forward hospitals and clearing stations but also with

replenishing the depots from COMZ

installations that fell steadily farther

behind. The army depot companies

had to borrow trucks from other units

to transport themselves and their supplies—a two- to three-week reserve,

including over 2,000 inventory items

and weighing between 500 and 1,200

tons. In both field armies the advance

sections of the depot companies, normally carrying 50-100 tons of the

most frequently issued supplies, leapfrogged ahead close behind the divisions. The base depots moved less

often and more laboriously. The First

Army's 1st Medical Depot Company

had special difficulty, for it had accumulated large stocks during the

hedgerow battles. After its first move

to St.-Lo early in August, which required three days and 180 trucks to

move over 1,300 tons of matériel, the

company began stripping down for

the pursuit. It issued to units or

turned back to the Advance Section

hundreds of tons of supplies, including refrigerators and other bulky

items. Even with these reductions in

load, the company still required large

vehicle reinforcements for each advance, as well as additional manpower, borrowed from the medical

groups. As supply lines lengthened in

spite of such expedients, several

corps formed small subdepots in their

medical battalions, from which they

issued to subordinate units.

The theater medical service was

more successful than the other technical services in replenishing its depots

in the field armies. Medical supplies

were small in tonnage compared to

fuel and ammunition, and, with the

low casualty rate, issues were limited.

In the Third Army, for example, a

ten-day reserve, calculated on normal

usage, sufficed in the pursuit for

twenty or thirty days. Delays and diffi35

 Quotation from 106th Evacuation Hospital

Annual Rpt, 1944, p. 11. See also 12th, 41st, and

91st Evacuations Hospitals Annual Rpts, 1944;

Abraham Katz, ed., Fifth Evac (Fulda, FRG, 1945),

pp. 37-38; A. W. Kuhlmann et al., A Narrative Style

Report of the Activities of the 41st Evacuation Hospital,

Semimobile (Bad Neuheim, FRG, 1945), pp. 89-90

and 94-95; Surg, First U.S. Army, Annual Rpt,

1944, pp. 59-60; Briefing (untitled and n.d.), ca.

August 1944, and Memo, Reinstein to Surg, Ninth

U.S. Army, 9 Sep 44, sub: Observation of Medical

Service in Operation, TUSA, both in Shambora

Papers, MHI; 68th Medical Group Annual Rpt,

1944, p. 14; Interv, Medical History Branch, CMH,

with Dr. J. A. Gosman, MD (hereafter cited as

Gosman Interv), 24 Mar 82, CMH.
BREAKOUT AND PURSUIT 301

culties did occur. Army surgeons had

to send their own trucks back to the

Communications Zone to pick up requisitioned supplies. Other matériel

came forward on replacement vehicles

bound for the combat units. In both

the First and Third Armies the surgeons arranged special airlifts, directly from the United Kingdom, of such

urgently needed items as penicillin,

sutures, intravenous solution, and

plasma. Early in September both

armies suffered from an acute shortage of blankets and litters, as evacuation drained hospitals and clearing

stations of these mundane but vital

commodities. Emergency shipments

from COMZ remedied the deficiency

by the end of the month, but at one

point the First Army had in reserve

only 800 litters and 10,000 blankets,

all captured from the Germans.

The armies in fact made up many

deficiencies from enemy stocks. As

troops overran what had been

German logistical support areas, they

seized medicines, hospital equipment,

and surgical supplies. During August

the Third Army alone captured over

100 tons of this matériel. Whenever

possible, the armies turned captured

supplies over to their depots. There,

soldiers translated labels and tried to

determine which German items had

equivalents in the U.S. supply table;

these they added to stock for issue.

The residue went to civil affairs units,

to meet local civilian needs, or to

POW enclosure dispensaries. At times

the armies, unable to move captured

supplies, simply turned them over to

units on a first-come-first-served

basis, and divisions also helped themselves to much that their own troops

found. In the Third Army rush across

France, for instance, the 5th Division

supplied itself by capture with, among

other things, dental instruments, bandages, gauze, adhesive tape, tetanus

antitoxin, bottles, corks, paper bags,

cognac, and brandy. The division's attached field hospital picked up rubber

sheeting, instrument trays, and plaster

of Paris.36

The circumstances of mobile warfare that complicated forward movement of medical units and supplies

created, if anything, greater difficulties in evacuation, both within and

from the field armies. According to

General Hawley, in a rapid advance

"we may get only one-fifth as many

casualties, but it takes five times the

effort to get each casualty out."

 37

Within their areas the field armies

had to move substantial numbers of

helpless men over growing distances.

During September alone ambulances

of the 68th Medical Group in the

First Army made over 20,000 patientcarrying trips, in the course of which

the vehicles traveled over 311,000

miles. Evacuation of the wide-ranging

armored divisions accounted for a

good part of this mileage in both

armies. The 6th Armored Division,

36

 Surg, First U.S. Army, Annual Rpt, 1944, pp.

16-19 and 59; First U.S. Army Report of Operations, 1 Aug 44-22 Feb 45, bk. IV, pp. 152-54;

Surg, Third U.S. Army, Annual Rpt. pp. 159-65;

31st Medical Group Annual Rpt, 1944, pp. 16-17;

68th Medical Group Annual Rpt, 1944, pp. 10 and

14; 32d and 33d Medical Depot Companies Annual

Rpts, 1944; Surgs, V, XII, and XIX Corps, Annual

Rpts, 1944; Surgs, 1st and 5th Infantry Divisions

Annual Rpts, 1944; Medical Division, COSSAC/

SHAEF, War Diary, August-September 1944; Editorial Advisory Board, 1962, pp. 151-52; Ruppenthal,

Logistical Support, 1:519. Supply problems in the Seventh Army were similar. See Wiltse, Mediterranean,

pp. 405-06. 37

 Notes Taken at Press Conference, Paris, 4 October 1944, ... by the Chief Surgeon, ETOUSA,

in Hawley Papers, MHI.
302 EUROPEAN THEATER OF OPERATIONS

for example, during its dash across

Brittany, within days opened a 100- mile distance between its clearing sta- tion and the nearest Third Army hospitals. With no field hospital platoon

able to keep up with it and receive

nontransportable casualties from

small engagements, the division stationed part of an armored medical

company at roughly the midpoint of

its evacuation route to immobilize

emergency cases. Even with this expedient a few men died who might have

been saved by earlier surgery; others

reached evacuation hospitals in poor

condition. Elsewhere, especially in

early September, when lines of evacuation were stretched to the utmost, both infantry and armored divisions

occasionally left wounded in civilian

hospitals rather than risk the patients'

lives in long ambulance rides. Evacuation over long distances tied

up army ambulances in numbers out

of proportion to the casualties car- ried. In the 2d Armored Division, according to one surgeon, "the maximum run from our station to the

nearest hospital . . . was one hun- dred forty miles. Travelling those dis- tances over unknown roads,

the . . . drivers were able to take

their patients to the hospital but were

unable to get back to us as they had

to find our new location. . . . We

considered an ambulance sent to the

rear lost to use for one day." Some

ambulances were more permanently

lost on these runs, which often passed

through unsecured areas infested with

armed Germans. Ambulances came

under fire; others were captured with

drivers, attendants, and wounded. Sometimes the Germans left rear- ward-moving ambulances alone but

attacked or detained those returning

empty to the front. During the Third

Army tank battle at Arracourt in September, the 4th Armored Division lost

fourteen drivers, twenty-one patients,

and seven ambulances and trucks in a

single German ambush on a road erroneously reported safe.38

With both clearing stations and

evacuation hospitals widely separated

and moving frequently, the medical

groups perforce adopted new expedients for controlling the flow of patients. They found that the standard

fixed ambulance control points were

inefficient, because ambulances had

to make lengthy detours on already

long runs to check in with them. To

prevent this waste of time and gasoline, the Third Army's 66th Medical

Group sent jeep-mounted liaison

teams to reconnoiter every evacuation

hospital in its sector twice daily and

then distributed instructions for ambulance drivers to each medical battalion and division clearing station.

Other medical groups placed traffic

control officers at clearing stations or

formed mobile regulating teams able

to set up and move control points on

short notice.39

38

 Quotation from Asherman Interv, 3 Feb 45, box

221, RG 112, NARA. See also VII Corps Medical

Plan, pp. 74-75 and 78-79, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; Surg, 4th Armored Division, Annual Rpt, 1944, p. 9 and encl. 6; Surg, 6th

Armored Division, Annual Rpt, 1944, encl. 7; 64th

Medical Group Annual Rpt, 1944, p. 2; 66th Medical Group Annual Rpt, 1944, p. 11; 57th Medical

Battalion Annual Rpt, 1944, pp. 12 and 16; 4th Armored Division Combat Intervs, box 24092, RG

407, NARA; 104th Evacuation Hospital Annual Rpt,

1944, pp. 7-8. 39

 66th Medical Group Annual Rpt, 1944, pp. 11-

12 and encl. 6; 67th Medical Group Annual Rpt,

1944, p. 9; 57th Medical Battalion Annual Rpt,

1944, pp. 13-14.
BREAKOUT AND PURSUIT 303

In spite of the lengthening distances to be covered and the limited

supply of vehicles and fuel, the field

armies, thanks to low casualty rates, encountered no major internal evacu- ation bottlenecks. The only evacuation emergencies of the pursuit involved disposition of large numbers

of wounded German prisoners taken

in the Falaise and Mons encirclements. Some of these wounded hobbled into the American lines under

white flags carried by their own

aidmen. U.S. troops overran others in

German aid stations and hospitals or

found them lying on the battlefield, often suffering from exposure and infection. This sudden flood of enemy

casualties (the 90th Infantry Division

clearing station at Falaise admitted

1,500 in one week) temporarily overwhelmed and immobilized divisional

medical units and the few hospitals

not left far to the rear. At the 103d

Evacuation Hospital German litter patients from Falaise covered the

ground around the tents, reminding

the hospital commander of scenes

from the Civil War motion picture

Gone with the Wind. Clearing stations

and hospitals pressed captured

German doctors and aidmen into service to help care for the prisoners, but the language barrier and general

disorganization limited the Germans'

usefulness. Under a First Army policy,

announced on 12 August, medical

units treated only nontransportables

and the most severely injured and

sick. They sent all the rest on to

POW enclosures in vehicles hastily

collected by corps surgeons and the

68th Medical Group. In spite of the

attenuation of evacuation forces, corps and army medics moved these

casualties out rapidly. At Mons, for

example, the 68th and the VII Corps

relieved the 1st Infantry and 3d Armored Divisions of about 1,500 Germans in three days, although not

before the division surgeons had developed a desperation plan for putting the enemy wounded in a French

Resistance-run civilian hospital.40

The other field armies also had to

handle German wounded. The Third

Army, while it evacuated no big pockets, hospitalized over 5,400 Germans

during August and September and

also cared for almost 600 sick and

wounded Allied soldiers found in a

captured hospital in Rennes. The

Ninth Army's VIII Corps evacuated

over 4,700 POW casualties and

almost 1,000 enemy medical personnel from Brest after the fortress capitulated, and its 83d Infantry Division

sent ambulances over 90 miles south

of the Loire to bring out the casualties among the 20,000 Germans who,

cut off from the rest of their forces in

France, had agreed to surrender.41

40

 On First Army policy, see Surg, First U.S.

Army, Annual Rpt, 1944, p. 46; Cir No. 106, HQ,

First U.S. Army, 12 Aug 44, file HD 383.6. On Falaise, see Surg, V Corps, Annual Rpt, 1944, p. 14;

Surg, 90th Infantry Division, Annual Rpt, 1944, pp.

14-15 and encl. 5; 41st Evacuation Hospital Annual

Rpt, 1944, pp. 8-9; 103d Evacuation Hospital

Annual Rpt, 1944, p. 14; Narrative ("The Chambois

Gap, 15-26 August 1944") by 90th Infantry Division, in 90th Infantry Division Combat Intervs, box

24065, RG 407, NARA. On Mons, see VII Corps

Medical Plan, pp. 76-77, encl. 1 to Surg, VII Corps,

Annual Rpt, 1944; Surg, 1st Infantry Division,

Annual Rpt, 1944, pp. 14-15; 47th Field Hospital

Annual Rpt, 1944, p. 5; 57th Medical Battalion

Annual Rpt, 1944, p. 17; 177th Medical Battalion

Annual Rpt, 1944, pp. 19-20. 41

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

30-31 and 87; Surg, VIII Corps, Annual Rpt, 1944,

p. 7; Surg, 8th Infantry Division, Annual Rpt, 1944,

pp. 7 and 11-12; Surg, 83d Infantry Division,

Annual Rpt, 1944, p. 5; 64th Medical Group Annual

Rpt, 1944, p. 6. For a general discussion of ETO

care of POWs, see Chapter XVI of this volume.
MEDICS TREATING WOUNDED GERMAN SOLDIERS, a few of the thousands swept up in the

pursuit across France and Belgium
BREAKOUT AND PURSUIT 305

The First and Third Armies both

had difficulty clearing their evacuation hospitals of patients destined

for the Communications Zone. The

problem stemmed from largely unavoidable ADSEC delays in moving

up its own medical units and hospitals. Of the two field armies, the

Third was the more fortunate in evacuation. Throughout the pursuit it was

able regularly to send off patients by

air from a succession of forward airstrips, using its own holding unit, and

still more through ADSEC facilities

once they caught up. The First Army,

on the other hand, did not maintain a

permanent holding unit and could

not arrange for continuous air evacuation until mid-September, when the

Advance Section opened a facility

within convenient distance. Until

then, the army used both its own and

ADSEC ambulances to transfer patients to the Communications Zone

and also pressed inactive field and

evacuation hospitals, and at one point

a combat exhaustion center, into use

as provisional holding units. Both

armies underwent an evacuation crisis

during late September, resulting from

a spell of bad weather and diversion

of transport planes to Operation

MARKET-GARDEN. Within a few days

the First Army accumulated about

3,000 casualties awaiting evacuation

and the Third Army about half that

number. Fortunately, a return of clear

weather and release of aircraft from

the offensive in Holland permitted air

evacuation to resume. By the end of

September the advance of COMZ railheads to Liege behind the First Army

and to Toul and Verdun behind the

Third made possible all-weather mass

evacuation by hospital train. Nevertheless, the army surgeons—and also

General Kenner, who closely followed

this situation—were not easy in their

minds about evacuation until well into

the autumn. In the south the Seventh

Army had similar difficulty, also as a

consequence of slow development of

its communications zone. By late September its hospitals contained over

1,400 patients awaiting transportation.42

Supporting Operation MARKET

In Operation MARKET, the airborne

portion of General Montgomery's

September breakthrough attempt in

Holland,43 American medics had to

provide treatment and evacuation for

two divisions landed behind enemy

lines and dependent for logistical

support on a British army. Medical

planning for MARKET, therefore, was a

cooperative effort. The American

team consisted of the surgeons of the

XVIII Airborne Corps and 82d and

101st Airborne Divisions; the British

team was composed of senior-ranking

medical officers from the Headquarters-Airborne Troops, the Second

Army, and the XXX Corps. Under

the overall Headquarters-Airborne

Troops medical plan, each of the

three assault divisions was to be prepared to collect and hold its own

wounded and to perform essential

42

 Surg, First U.S. Army, Annual Rpt, 1944, pp.

46-47, 162, 165; Surg, Third U.S. Army, Annual

Rpt, 1944, pp. 36 and 80-84; Briefing (untitled and

n.d.), ca. August 1944, and Memo, Reinstein to

Surg, Ninth U.S. Army, 9 Sep 44, sub: Observation

of Medical Service in Operation, TUSA, both in

Shambora Papers, MHI; Medical Division,

COSSAC/SHAEF, War Diary, August-September

1944. 43

 The entire operation was known as MARKETGARDEN, with the latter portion denoting the

ground attack by the British XXX Corps.
306 EUROPEAN THEATER OF OPERATIONS

life-saving surgery on them until air

evacuation became possible or until

the ground force, the XXX Corps, reached them in its drive up the corri- dor that the parachute and glider

troops were to open. The XXX Corps

was to move medical installations for- ward and evacuate its own wounded

and those of the British 1st Airborne

Division. Attached to the British

corps, U.S. First Army ambulance, collecting, and clearing companies, and an evacuation hospital, were to

handle American casualties.44

The U.S. XVIII Airborne Corps

and the 82d and 101st Divisions

based their medical plans on lessons

learned in the D-Day drop. They re- vamped the equipment and supply al- lowances of regimental and battalion

medical detachments and aid stations, removing items that had proved use- less and adding others, such as glider- carried jeeps and trailers, that experi- ence indicated would be of value. Corps and division surgeons paid spe- cial attention to increasing the air- borne medical companies' capacity for

emergency surgery, which had been

barely adequate in Normandy. Be- sides reinforcing each company with

an auxiliary surgical team, as had

been done in the earlier operation, the airborne corps attached for

MARKET a field hospital platoon, to go

in by glider with the rest of the com- pany. These platoons came from the

50th Field Hospital, which had been

receiving water-evacuated casualties at

Weymouth. Attached in August, they

had little time for training before

MARKET began and flew in gliders for

the first time on the way to Holland.45

Tactically, the American part of

MARKET went generally according to

plan (Map 12). On D-day, 17 Septem- ber, the daylight parachute and glider

landings were models of precision

compared to those in Normandy, with

few losses in men and aircraft. The

101st Division, committed farthest

south, secured its lodgement area and

the bridges around Eindhoven and

Veghel. Just north of it, the 82d Divi- sion, after a hard fight and a daring

cross-river assault, captured intact the

vital span over the Waal at Nijmegen. Holding the ground taken was more

difficult, and more costly in casualties, as the Germans counterattacked re- peatedly and in force to cut the XXX

Corps line of communications. By the

twenty-fifth the two American divi- sions had lost a total of 530 dead, 2,038 wounded, and 974 missing— significant casualties but hardly com- parable to the more then 6,000 suf- fered by the British 1st Division.46

The airborne division medical ele- ments shared in the general good for- tune of the drop, arriving on the

ground with almost all their men and

with their equipment substantially

intact. Unit first aid and evacuation

proceeded about as smoothly as such

44

 For British planning and arrangements, see

Crew, AMS, Campaigns: North-West Europe, 4:294 and

299-306; Col Renfro Interv, 10 Oct 44, in 101st

Airborne Division Combat Intervs, box 24073, RG

407, NARA; 31st Medical Group Annual Rpt, 1944,

p. 18; 134th Medical Group Annual Rpt, 1944, p. 9.

45

 The airborne divisions had been pulled out of

Normandy in July and returned to England, where

they refitted and planned for operations rendered

unnecessary by the speed of the pursuit. See Surg,

XVIII Airborne Corps, Annual Rpt, 1944, p. 2;

Surg, 82d Airborne Division, Annual Rpt, 1944, an.

III; Surg, 101st Airborne Division, Annual Rpt,

1944, p. 8; 50th Field Hospital Annual Rpt, 1944,

pp. 1-2; Crandall Interv, 8 Jun 45, box 222, RG

112, NARA. 46

 MacDonald, Siegfried Line, chs. VI-VIII. Casualties are tabulated on p. 199.

308 EUROPEAN THEATER OF OPERATIONS

activities could in actual combat. Nevertheless, in Holland as in Normandy,

improvisation and courage came near

to being standard procedure for the

airborne medics. On 22 September,

for example, during one of the major

German attempts to cut the corridor

in the 101st Division sector, elements

of the 3d Battalion, 327th Glider Infantry, made a successful local counterattack and then received orders to

fall back and regroup. Before doing

so, the battalion had to retrieve its

wounded, scattered in buildings and

open ground. The battalion commander, Lt. Col. Ray C. Allen, recalled:

We just couldn't walk off and leave our

wounded. That was when our medical de- tachment under . . . Maj Martin Wisley

did its stuff. . . . They had to advance all

the way under fire, crawling most of the

time in ditches. Not having enough litters

to carry out all the wounded at one time, they had to dart from house to house, dodging fire from artillery and mortars

and small arms, procuring ladders and

tearing doors from houses to use as lit- ters. . . . Several men were evacuated

from houses through the windows, be- cause fire on the doorways was too in- tense. The medics then had to drag each

improvised litter down ditches for two or

three hundred yards to safety.47

As they had in Normandy, the division medical companies landed small

advance parties on D-day, to scout

clearing station sites and to begin collecting and treating wounded. The

main body of the companies, with

their attached field hospital platoons, came in by glider during the afternoon of 18 September. Collecting

elements moved out to contact the

regiments, while the rest of each company, helped by Dutch civilians, set

up its clearing and surgical station.

The 101st Division's 326th Airborne

Medical Company worked at two locations: a commandeered tuberculosis

sanitarium in Zon, occupied by the

company itself, at the southern end of

the division area of responsibility; and

a tented facility near Veghel at the

northern end, composed of the field

hospital platoon and a surgical team.

In the 82d Division zone the 307th

Airborne Medical Company and its attached forces established a single station south of Nijmegen, in a school

that the Germans had converted into

an obstetrical hospital for "Hitler

Mothers."

The clearing stations treated a

steady stream of casualties, mostly

American troops and also a few British dropped off by XXX Corps units

hurrying toward Arnhem. The 101st

Division's medical company accumulated over 400 patients and that of

the 82d Division about 300 before

ambulances reached them, respectively on 19 and 20 September. Especially

when German attacks temporarily

stopped road evacuation, the airborne

doctors operated on all types of patients, including men with severe

chest and abdominal injuries. Working under roofs in relatively favorable

conditions, the surgeons obtained satisfactory results. One of them commented: "Only two or three . . . 

racic cases that reached surgery [in

the 101st Division] didn't survive.

The ones that did not survive were

very severe injuries, of the type that

47

 Allen quoted in Leonard Rapport and Arthur

Norwood, Jr., Rendezvous with Destiny: A History of the

101st Airborne Division (Greenville, Tex., 1948), pp.

356-57.
BREAKOUT AND PURSUIT 309

couldn't have been saved anywhere."

 48

Throughout the campaign the divisions received at least adequate medical resupply, initially through air

drops and later by road. When American supply deliveries did fall short,

the British more than made up the

deficiencies. According to the 82d Division surgeon, Lt. Col. William C.

Lindstrom, MC, British "generosity

and whole hearted cooperation"

during the offensive "left nothing to

be desired." Overall, the airborne division medical service, as revised after

Normandy, proved effective during

MARKET, although Colonel Lindstrom

recommended at the end of the campaign that the division medical company be enlarged into a small battalion.49

As the airborne assault began, the

American medical contingent with the

British XXX Corps moved into position close behind the line of departure. The 384th Collecting Company

(actually an ambulance unit in spite of

its designation) established its headquarters at Hechtel and attached platoons to the British evacuation elements scheduled to advance up the

corridor. Nearby, at Bourg-Leopold,

the 24th Evacuation Hospital opened,

reinforced by elements of the 662d

Clearing and 493d Collecting Companies.

Ambulances of the 384th and 493d

Companies closely followed the XXX

Corps' advance. On 19-20 September

platoons made contact with the two

airborne division clearing stations and

relieved them of about 600 casualties.

Ambulance evacuation during the following week entailed running the

gauntlet on what was aptly called

"Hell's Highway," the single two-lane

road that was the artery of the advance. Southbound ambulances battled a constant northward flow of

British troop and supply trucks; often,

they had to take to sidewalks, shoulders, and the fields to get around

huge traffic jams. Periodically,

German attacks blocked sections of

the highway, and the enemy artillery

fire posed a never-ending hazard. A

384th Company driver received the

Silver Star for pulling an injured British soldier out of an ammunition

truck set afire by a shell. The ambulance platoons evacuated over 1,600

patients from the 101st Division to

Bourg-Leopold during the first nine

days of MARKET-GARDEN; but evacuation over the 75-mile run from the

82d stopped altogether for four days

and was sporadic thereafter until

SHAEF and the British Second Army

arranged late in September for airlifts

from Eindhoven and Nijmegen.50

Almost all the wounded Americans

who traveled "Hell's Highway"

48

 Crandall Interv, 8 Jun 45, box 222, RG 112,

NARA. 49

 Quotation from Surg, 82d Airborne Division,

Annual Rpt, 1944, an. III; Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 5-6, 9, 18; Crew,

AMS, Campaigns: North-West Europe, 4:233; Memo,

Col. J. K. Davis to CMedOff, SHAEF, 28 Sep 44,

sub: Visit to British Second Army (hereafter cited as

MARKET-GARDEN Rpt), in Medical Division,

COSSAC/SHAEF, War Diary, September 1944.

50

 Crew, AMS, Campaigns: North-West Europe, 4:294-

97; Surg, 82d Airborne Division, 1944, an. III;

Davis, MARKET-GARDEN Rpt, 28 Sep 44, in Medical

Division, COSSAC/SHAEF, War Diary, September

1944; 493d Collecting Company Annual Rpt, 1944;

384th Collecting Company (956th Ambulance Company) Annual Rpt, 1944, in 57th Medical Battalion

Annual Rpt, 1944. Reorganized under the 956th's

T/O&E in November 1943, the 384th was not redesignated until after MARKET-GARDEN.
310 EUROPEAN THEATER OF OPERATIONS

passed through the 24th Evacuation

Hospital. This 400-bed unit, commanded by Col. Carl M. Rylander,

MC, had been one of the first of its

type to go into operation on OMAHA

beach. It set up and went to work in

Belgium under difficult conditions.

The unit's vehicles, moving by infiltration, journeyed from Dijon to

Bourg-Leopold through heavy fog

and rain, over slippery roads crowded

with British tanks and trucks. On 18

September the hospital pitched tents

in what the unit historian described as

"a marshy field of heather." During

the first twenty-four hours of operation the 24th received 512 casualties;

during the following week it admitted

over 1,600 patients and evacuated

about 1,300. In spite of requests by

Colonel Rylander, the hospital had no

reinforcing surgical teams during its

busiest period. Its own surgical staff,

working sixteen- and eighteen-hour

days, performed over 540 operations,

with 26 deaths. Besides caring for patients, the 24th furnished medical

supplies to the airborne divisions. To

replenish its stocks, the hospital arranged through the British Second

Army and 21 Army Group for an

emergency resupply flight of eight C47s from Cherbourg, which brought

in enough matériel for a small temporary depot. Using American and British ambulances, the 24th evacuated

patients to British general hospitals

and a triage unit at Diest, northeast of

Brussels. From there, men able to

travel went either to the Belgian capital for air evacuation across the

Channel or, by train and ambulance,

to Dieppe for embarkation on hospital carrriers.51

After MARKET-GARDEN ended, the

82d and 101st Airborne Divisions

continued fighting in Holland until

late November, defending the eastern

flank of the salient they had helped to

create. The separate medical companies and the 24th Evacuation Hospital, still attached to the British Second

Army, remained to support them.

During October the 24th moved into

Holland. It established itself first in a

waterlogged field near Uden and

later, to the joy of the staff, took over

a modern steel and glass hospital

building in Nijmegen. The unit

worked there, uncomfortably close to

the combat zone and constantly

shaken—and occasionally hit—by

German shells aimed at the nearby

Nijmegen bridge, until the airborne

divisions left the line.52

At the West Wall

In the period between COBRA and

MARKET-GARDEN the field army medical service expanded dramatically in

size, geographical extent, and variety

of missions. Medical forces of three

additional American armies went into

operation alongside the veterans of

51

 British general hospitals were much smaller

than American units of that designation and performed a variety of tasks, including, as in this instance, a mission more typical of a U.S. evacuation

hospital. Quoted words from "Lest We Forget":

The 24th Evacuation Hospital (hereafter cited as

24th Evac Hist), October 1945, pp. 56-58, 60-61,

92-94. See also 24th Evacuation Hospital Annual

Rpt, 1944, pp. 6-7; Davis, MARKET-GARDEN Rpt, 28

Sep 44, in Medical Division, COSSAC/SHAEF, War

Diary, 1944, September 1944. 52

 MacDonald, Siegfried Line, ch. VIII; 57th Medical

Batallion Annual Rpt, 1944, p. 20; 24th Evac Hist,

October 1945, pp. 58-61.
BREAKOUT AND PURSUIT 311

the First. Army medical facilities by

late September were spread throughout Holland, Belgium, and northeastern France, from Nijmegen through

Eupen, Verdun, and Toul to Besancon. During the advance from Normandy the doctors and aidmen with

combat units met and overcame a variety of tactical situations, from the

brief meeting engagements of nearly

unopposed pursuit to bitterly contested cross-river assaults. Medical

groups improvised solutions to the

problems of evacuation over long distances. Army hospitals and supply

units learned how to move frequently

and quickly. Medical units of many

types proved able to perform a variety

of functions beyond their standard

missions, at different points in the

evacuation chain. Colonel Rogers

summarized one major lesson of the

pursuit: "A fixed or standard operational set up of medical units, however efficient for a certain type of

warfare, cannot be maintained during

all phases of combat. Flexibility and

adaptability to the tactical situation

are essential."

 53

The field army medical service

made the transition from static to

mobile warfare, but with difficulty. Its

larger units, especially, were far from

self-sufficient in transportation and

fell behind the general advance. Forward hospitalization and evacuation

facilities had become thin on the

ground by the end of the pursuit.

However, the low casualty rate prevented this circumstance from having

noticeably adverse effects on the care

of the sick and wounded. By the time

revived German resistance began to

increase American casualties, most

army facilities had closed up behind

the new battle line. As the armies prepared to attack the West Wall in

force, the principal uncertainty confronting their surgeons was how soon

the Communications Zone would

overcome its own difficulties in the

advance and be ready to provide adequate support.

53

 Surg, First U.S. Army, Annual Rpt, 1944, pp.

64-65.
CHAPTER X

The Expanding COMZ

As the field armies lunged across

France and the Low Countries in the

summer of 1944, the first task of the

Communications Zone was to organize the newly captured territory

behind them. For this purpose COMZ

established continental base sections,

identical in function to those in the

United Kingdom. Under plans made

before the invasion, each base section

headquarters in Great Britain created

from its personnel the nucleus of a

new section, to be deployed across

the Channel as the campaign developed. The parent base sections, at the

same time, prepared for a realignment as districts within a single headquarters, known as the United Kingdom Base. Covering all the British

Isles, this headquarters was to go into

operation as a substantial portion of

COMZ moved to France.

During August, after the armies at

last had established their rear boundaries on the second, three continental

sections went into operation. The

Brittany Base Section, with headquarters at Rennes, supported the siege of

Brest; the Normandy Base Section,

assembled partly from the Advance

Section and partly from a base section

in Britain, assumed jurisdiction over

the Cotentin and the area inland from

OMAHA beach; and the Seine Section

oversaw U.S. activities in newly liberated Paris. Still more base sections

took shape in September, as the continental lodgement expanded and

lines of communications lengthened.

The Loire Base Section, initially intended to take over the port of Brest,

instead set up headquarters at Le

Mans; its boundaries encompassed a

130-mile-wide swath of France between the Seine and the Loire. North

of the Seine, the Oise Base Section

went into operation at Reims, encompassing territory between Paris and

the rear boundary of ADSEC. The

Channel Base Section took control of

U.S. logistical activities at Rouen and

Le Havre, major ports in the British

communications zone that the Americans had permission to use for disembarking troops and cargo. The

Advance Section, meanwhile, moved

forward in the wake of the armies,

furnishing immediate COMZ support

to the combat forces and establishing

depots and other facilities that it relinquished to the static sections filling

in behind it. By mid-September

ADSEC controlled an elongated territory in eastern France and Belgium.

In the United Kingdom the Eastern

Base Section had reverted to a district

of the Western Base Section a month
THE EXPANDING COMZ 313

before D-Day; the Northern Ireland

Base Section did likewise nine days

after the invasion. On 10 September

the United Kingdom Base went into

operation, with the remaining three

original base sections—Southern,

Central, and Western—reorganized as

subordinate districts (see Map 13).1

Most of the continental base section surgeons had served in the same

capacity in their sections' parent

headquarters in Great Britain. As in

their previous posts they supervised

hospitals, depots, and other medical

service units and installations in their

areas; they provided hospitalization,

evacuation, and medical supplies for

troops stationed there; and they advised section commanders on preventive medicine and sanitation. On the

Continent several base section surgeons had additional responsibilities

at crucial points in the theater chain

of evacuation. Lt. Col. Raymond E.

Duke, MC, in the Normandy Base

Section, had charge of sea evacuation

to England, of the disembarkation

and storage of most medical supplies

reaching the Continent, and of a large

group of general hospitals. Because

of the importance of this position,

General Hawley prevailed on the section commander to appoint Duke,

who had been theater hospital inspector on the chief surgeon's staff, to replace a less experienced base surgeon

brought from England.

In the Brittany Base Section Col.

Robert B. Hill, MC, provided evacuation and medical supply for the

forces besieging Brest. The Seine

Section surgeon, Lt. Col. Thair B.

Rich, MC, left the Central Base Section in London expecting to oversee

in Paris only a few hospitals and dispensaries serving headquarters and

troops on leave. When he reached

France, he found himself in charge of

several thousand general hospital

beds, a major depot, and rail and air

holding units at what rapidly became

the medical supply and evacuation

center of the entire continental Communications Zone. Rich's staff from

the Central Base Section perforce received hasty augmentation from General Hawley's office, 12th Army

Group, Advance Section, and a general hospital. In the Channel Base

Section Col. Mack M. Green, MC,

managed the medical affairs of American enclaves in a British zone, including eventually the great port of Antwerp. Besides caring for the sick and

injured of local service units, Green

and his assistants set up hospitals and

dispensaries for the large RED HORSE

troop staging area that COMZ established at Le Havre.2

Hawley Moves to Paris

The Office of the Chief Surgeon

had begun its move to France in midJune. At that time an advance element

under Colonel Spruit, formerly Hawley's deputy at Cheltenham, crossed

the Channel with the headquarters of

the abortive Forward Echelon of

COMZ and established itself at Va1

 Ruppenthal, Logistical Support, 1:216-18; ibid., vol. 2, September 1944-May 1945 (1959), pp. 24 and

32-38; Surg, United Kingdom Base, Annual Rpt,

1944, p. 59.

2

 Surg, Seine Section, and Surgs, Normandy, Brittany, Channel, Loire, and Oise Base Sections,

Annual Rpts, 1944. For Duke's appointment, see

Ltr, Hawley to Col Theodore Wyman, Jr., 1 Aug 44,

file HD 024 ETO CS (Hawley Chron). Rich recalls

the expansion of his mission in Editorial Advisory

Board, 1962, pp. 123-24.

THE EXPANDING COMZ 315

lognes in the central Cotentin, the

planned COMZ headquarters site.

Awaiting the activation of FECOMZ,

Spruit and his group observed medical operations and assisted (and

sometimes, at Hawley's behest, pres- sured) the Advance Section on such

matters as setting up general hospitals. FECOMZ never went into operation. Instead, in mid-August, the

main COMZ headquarters moved to

Valognes so that General Lee could

take personal charge of his expanding

continental establishment. As part of

this movement, General Hawley and

his London and Cheltenham staffs—

less about 50 officers and 150 enlist- ed people left behind for the United

Kingdom Base—transferred to Va- lognes in a series of echelons. Spruit

and several of his men, much to their

disappointment, now went back to

England to join the new base headquarters. Housed in a spacious tent

and hut camp, in woodlands almost

untouched by combat, Hawley and his

assistants worked in pleasant surroundings. However, the disruption

attendant on uprooting personnel,

furniture, and records, and a lack of

communications, put the chief surgeon's staff almost completely out of

action during the weeks when Paris

fell and the armies crossed the Seine.3

Hardly had the office settled in at

Valognes when it moved again, this

time to Paris. As soon as the Allies

liberated the French capital, General

Lee, without prior SHAEF authorization, and to General Eisenhower's annoyance, precipitately rushed COMZ

headquarters into the city. SHAEF reluctantly accepted Lee's fait accompli.

Lee acted in order to place his headquarters at what he expected to be

the center of continental logistics and,

his detractors claimed, in order to

secure the most comfortable accommodations available. Hawley was only

a few steps behind his commander. A

day or two after the liberation, he

sent his executive officer and his

chiefs of hospitalization and supply

into Paris by jeep to secure locations

for, respectively, offices, general hospitals, and a major medical depot. All

three men accomplished their missions with dispatch and some disregard for formal procedure. Swift

action had side benefits: The depot

building turned out to be a warehouse for the German officers club's

liquor, all of which for medicinal purposes, became U.S. Army property.

The main body of the chief surgeon's

staff transferred to Paris by truck and

hospital train and opened in a requisitioned hotel on the Avenue Kleber on

14 September. By the end of 1944 all

divisions of Hawley's establishment

were in Paris except Rehabilitation,

which remained in London to supervise its extensive facilities in Britain.4

3

 Administration Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 8-14 and ends.

5-6; Evacuation Branch, Operations Branch,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

6-7; Planning Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

12-13; Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 8; Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec. I,

p. 1. For descriptions of the site at Valognes, see

Ltr, Hawley to TSG, 24 Aug 44, file HD 024 ETO

O/CS (Hawley-SGO Corresp); Joseph R. Darnall,

"Fixed Hospitals Follow the Breakthrough to Paris,"

The Military Surgeon 101 (October 1947): 276-77.

Middleton Interv, 1968-69, vol. 1, p. 228, NLM, describes Spruit's disappointment. 4

 Ruppenthal, Logistical Support, 2:31-32; Administration Division, OofCSurg, HQ ETOUSA, Annual

Rpt, 1944, pp. 8-14; Evacuation Branch, Operations Continued
316 EUROPEAN THEATER OF OPERATIONS

In England the residue of the chief

surgeon's staff, reinforced by medical

people from the Southern Base Section, formed the United Kingdom

Base surgeon's office. Initially, the

staff was located at Cheltenham, but

it soon took over General Hawley's

old London quarters at 9 North

Audley Street. The United Kingdom

Base medical department, which included over 100 general and station

hospitals and scores of other facilities,

possessed higher status and more independence of action than those of

ordinary base sections. Colonel

Spruit, the base surgeon, also served

as a deputy chief surgeon, ETO. He

exercised within the British Isles most

of the chief surgeon's authority over

the medical service, including the

right, in consultation with base and

district authorities, to remove or

transfer hospital commanders. Spruit

also directed the reception and treatment of casualties from the Continent, as well as air and sea evacuation

from the theater to the United

States.5

Hawley, Spruit, and the base section surgeons, even as they tried to

move and reorganize their own staffs,

grappled with the conflicting tasks

that all elements of the Communications Zone confronted during the

rapid advance. On the one hand,

COMZ had to furnish to the combat

forces enough ammunition, food, and

gasoline to enable them to continue

their victorious drive as long as possible. Yet at the same time, to sustain

the full-scale offensive to the Rhine

and beyond, COMZ had to advance

its own troops and matériel so as to

build a network of intermediate facilities between the armies and, by now,

the well-developed Normandy ports

and supply dumps. With limited

transportation and steadily lengthening distances to overcome, the Communications Zone could not do both

jobs at once. Necessarily, it put support of the armies—at a minimal

level—first and used what resources

were left over to develop its logistical

base in northern France and Belgium.

The end result was less than satisfactory, tactically and logistically. The

armies had to halt for a month at the

West Wall, for lack of supplies,

affording the Germans invaluable

recovery time, while the Communications Zone established at least rudimentary advance facilities. Even then,

an underdeveloped structure hampered operations throughout most of

the fall and winter. The COMZ medical service shared this dilemma with

the rest of COMZ, and it faced the

added problem of moving masses of

casualties to the rear as well as support units and supplies to the front.6

Forging the Evacuation Chain

Until the breakout from Normandy,

evacuation from the armies to the

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, p. 9. Hawley and several other officers recount their entry into Paris in Hawley Interv, 1962,

pp. 74-76, CMH, and Editorial Advisory Board,

1962, pp. 120 and 123. See also Carter, ed., Surgical

Consultants, 2:251, and Middleton Interv, 1968-69,

vol. 2, p. 560, NLM. 5

 Surg, United Kingdom Base, Annual Rpt, 1944;

Memo, Hawley to Surg, United Kingdom Base, 16

Sep 44, sub: Scope of ETO Medical Operations in

UK Base, file HD 024 ETO CS (Hawley Chron); Administration Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 4 and 14.

6

 Ruppenthal, Logistical Support, 1:481-89, summarizes the logistics dilemma.
THE EXPANDING COMZ 317

Communications Zone was a simple

matter. ADSEC ambulances transferred patients from army hospitals to

beach holding units, the air holding

unit at Biniville, and eventually the

tented general hospitals at Carentan,

La Haye-du-Puits, and Cherbourg. As

the distance widened between these

facilities and the armies, the Communications Zone confronted its particular version of the general logistics

dilemma: how to construct an intermediate chain of hospitals and

evacuation facilities across France and

Belgium while at the same time daily

relieving the armies of their casualties. General Hawley summed up the

problem: "How the hell [do] you

keep up with the evacuation of three

fast-moving armies with absolutely no

communications, railroads that operate at two miles per hour, and airplanes that are never to be had when

they are needed?"

 7

As transportation became more difficult, triage became more complicated. From the beachhead all sick and

wounded not curable in army hospitals had been sent back to England

but the opening of COMZ hospitals

in Normandy permitted retention of

more patients on the French side of

the Channel. Accordingly, on 22

August the Communications Zone extended its continental evacuation

policy from ten to fifteen days; on

1 September it further extended the

policy to thirty days. Army and

ADSEC surgeons, under this policy,

had to designate early in the evacuation process those patients they

deemed returnable to duty on the

Continent for transfer to general hospitals in Normandy or elsewhere in

France. They continued to dispatch

all other casualties to Great Britain,

directly by air from forward areas

whenever possible and by land

through a series of intermediate installations when necessary. These

basic sorting principles largely determined the structure of the continental

evacuation system as it evolved, in

haste and much confusion, during the

pursuit.8

The task of removing patients from

the armies and starting them on their

journeys through the Communications Zone belonged primarily to the

ADSEC surgeon, Colonel Beasley.

Beasley and his staff, who also did

much of the initial planning and development of the entire medical

COMZ, worked closely with, and

under pressure from, General

Hawley. The chief surgeon, concerned that the Advance Section was

too slow in responding to the changing tactical situation, repeatedly exhorted Beasley to "think mobility,

mobility, MOBILITY. You must keep

up with the armies." Mobility Beasley's own office certainly possessed.

With ADSEC headquarters, it shifted

in rapid communications-disrupting

succession from Normandy to Le

7

 Quotation from Ltr, Hawley to Brig Gen A. B.

Davis, 15 Sep 44, box 2, Hawley Papers, MHI. See

also Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt. 1944, p. 7.

8

 Admin Memo No. 2, Surg, ADSEC, 5 Aug 44, in

Essential Technical Medical Data Rpt, HQ,

ETOUSA, August 1944 (see also p. 1 of September

1944 report); Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

p. 16; Ltrs, OofCSurg, HQ, ETOUSA, to Base Section and Hospital Cdrs, 22 Aug and 1 Sep 44, sub:

Evacuation Policy in the COMZ, file HD:370.05:

Evacuation and Troop Movements; Memo, Hawley

to G-4, COMZ, 1 Sep 44, sub: Distribution of Patients Among Hospitals in France, file HD:ETO:

370:Evacuation, September-December 1944.
318 EUROPEAN THEATER OF OPERATIONS

Mans, Etampes, Reims, and finally

Namur, which it reached on 22 October. To oversee medical activities

throughout the extensive Advance

Section, Beasley set up suboffices in

Liege and Bar-le-Duc as the armies

paused at the West Wall. The ADSEC

surgeon maintained direct personal

contact with the field army commanders and their surgeons. He also attached medical liaison officers, selected before D-Day for the First and

Third Armies, to the army headquarters. These officers transmitted medical support and supply requests and

complaints to Beasley; they also reported daily to him the positions of

the army medical units and the

number of casualties in them awaiting

evacuation.9

Under Beasley's technical supervi- sion, the medical evacuation sections

of the 24th and 25th Regulating Stations controlled the day-to-day movement of sick and wounded across the

army rear boundaries. With their

parent regulating stations, which

managed the flow of traffic into and

out of the army areas, the medical

sections went into operation late in

July, that of the 24th supporting the

Third Army and that of the 25th the

First. Like the rest of the station personnel, the four officers and four enlisted men of each evacuation section

began work with the sketchiest of

training, no experience, and only

World War I precedents to guide

them. They learned on the job and by

mid-September had established effective working relations with the armies

and ADSEC. This was especially the

case after Colonel Beasley obtained

field-grade MC officers from COMZ

headquarters to command the sections, Lt. Col. Maurice E. Glock for

the 25th Regulating Station and Maj.

Sidney Blumenthal for the 24th.

Glock and Blumenthal and their assistants allocated ADSEC hospital and

holding unit beds to the armies and

dispatched ambulances to collect patients from army facilities. They also

helped select locations for air and rail

holding units. They supervised the

loading of hospital trains, once these

came into use, although dispatch of

the trains, contrary to original plans,

remained the responsibility of the

Evacuation Branch in General Hawley's office. Supplementing the efforts

of the ADSEC liaison officers, the

medical regulators formed another

channel of communications between

COMZ and army surgeons.10

ADSEC holding units constituted

the indispensable link between mobile

army evacuation hospitals and the

usually distant railheads and airfields.

They received sick and wounded by

ambulance from the army units, per9

 Quotation from Ltr, Hawley to Beasley, 22 Aug

44, file HD 024 ETO CS (Hawley Chron). See also

Ltrs, Hawley to TSG, 24 Aug 44, and TSG to

Hawley, 1 Sep 44, file HD 024 ETO O/CS (HawleySGO Corresp); Surg, ADSEC, COMZ, Annual Rpt,

1944, pp. 5, 8-9, 11; Ltr, Beasley to Col W. E.

Shambora, 14 Oct 44, Shambora Papers, MHI;

Surg, ADSEC, Daily Activities Rpts, August-October

1944, and Rpts, Liaison Offs, First, Third, and

Ninth Armies, August-December 1944, all in Beasley Papers, MHI; Editorial Advisory Board, 1962,

pp. 129-30; Interv, OSG with Maj Gen Paul R. Hawley, 18 Apr 50 (hereafter cited as Hawley

Interv, 1950), file HD 000.71, CMH.

10

 For general development of regulating stations,

see Ruppenthal, Logistical Support, 1:497-99; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp. 8-9, and, in file

HD 024 ETO, ibid., Daily Diary, 31 Aug 44; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 17 and 60;

Ltr, Lt Col M. E. Glock to Col F. E. Mowrey, 12 Sep

44, file HD:ETO:370:Evacuation, September-December 1944.
THE EXPANDING COMZ 319

mitting the latter to clear out patients

promptly and move forward. The

holding units provided shelter, food,

and minimal supportive and emergency care for a large, rapid turnover of

casualties, whom they retained only

long enough to accumulate efficient

loads for air and rail transportation.

These organizations had to be put together in the field; no T/O unit for

this purpose existed, and the NEPTUNE planners had not anticipated the

size and importance such facilities

would assume in a fast-moving

mechanized advance. At the outset

the theater made the Communications

Zone solely responsible for setting up

holding units close to the army rear

boundaries. However, as COMZ fell

behind the pursuit, the armies perforce improvised their own units to

function until replaced by those of

the Advance Section. The theater in

late September formally directed this

sharing of the task. In practice, when

lines of evacuation were longest, the

armies and ADSEC both had holding

units in operation, relaying casualties

toward the rear.11

For holding units behind the

armies, the Advance Section used the

7th, 9th, 12th, and 28th Field Hospitals; the 77th Evacuation Hospital, its

only 750-bed unit; and the 93d Medical Gas Treatment Battalion. The first

real holding units, aside from those

established earlier on the beaches,

went into operation in mid-August.

The 77th, succeeded by the 7th, set

up near St.-Lo for reception and

triage of First Army casualties. At

roughly the same time, elements of

the 12th and the 93d opened an air

evacuation facility for the Third Army

at an airstrip near Avranches. From

then on, as the Allies overran France

and the Low Countries, holding units

opened and closed with bewildering

frequency. They advanced successively to Le Mans, Chartres, Orleans, and

Reims, always trying to stay within

something resembling a practicable

ambulance haul of the rearmost army

hospitals. By late September the holding units serving the First Army were

well up into Belgium; those supporting the Third Army had reached

Etain and Toul. ADSEC medical battalions, the 428th in support of the

First Army and the 425th following

the Third, traveled with the holding

units. Their attached ambulance companies, under control of the regulating stations, collected patients from

the armies and furnished transportation between holding units and airfields. Far to the southwest of the

main battlefront, the 29th Field Hospital and 666th Clearing Company,

under the Brittany Base Section, evacuated the VIII Corps. With detachments at an airfield and on the beach

near Morlaix, these units shipped cas11

 Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 3-4; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 8 and encl. 6; Surg, ADSEC, COMZ,

Annual Rpt, 1944, pp. 15 and 56-57; Memo, HQ,

12th Army Group, to Surgs, First and Third Armies,

ADSEC, and COMZ, 8 Aug 44, AirEvacCorresp, file

HD 580 ETO; Memo, HQ, ETOUSA, to CGs of Air,

Ground, and Service Forces, 24 Sep 44, sub: Evacuation of Army Medical Installations, in Planning

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944. In proportion to their

strength, the World War II field armies contained

fewer hospital beds than did their World War I

counterparts; hence, they had almost no long-term

patient-holding capacity. See Hospitalization Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

pp. 23-24.
320 EUROPEAN THEATER OF OPERATIONS

ualties directly to Great Britain by

plane and LST.12

Wherever they were set up, holding

units built around field hospitals

struggled with similar problems. The

field hospitals, like their counterparts

in the armies, had to scour the countryside for trucks for every movement.

Usually expanded to 600 or more

beds in the holding role, they found

themselves with a surplus of professional staff and shortages of cooks,

admission and evacuation clerks, ward

attendants, and litterbearers. To

remedy this deficiency, ADSEC attached gas treatment and sanitary

companies, and occasionally groups

of combat exhaustion convalescents,

to the field hospitals. Lacking enough

mess equipment, tentage, cots, and

bedding for their expanded capacity,

field hospitals borrowed matériel

from other medical units or appropriated captured German supplies.

While it accomplished the mission,

the field hospital, in the words of the

7th's commander, was "not an ideal

unit for holding and mass evacuation

of patients. It is necessary to supplement it with personnel from various

organizations and the result is a

hybrid affair with many complications,

frictions, and multiplicities in overhead."

 13

The forward holding units sent off

most of their patients by air, longterm cases directly to Great Britain

and those falling within the continental time limit to a field near La Hayedu-Puits for transfer to the Normandy

general hospitals. For the medical service, during the height of the pursuit,

air transport was the only means

available for spanning the steadily

widening gap between the combat

forces and the COMZ treatment and

evacuation facilities still clustered

near the beaches and in England.

During August and September C-47s

flying from British bases carried

about 54,000 patients across the

Channel and another 6,300 to destinations in France. The Advance Section, after it moved out of Normandy,

for practical purposes did all its evacuation by air until late September.14

While extremely efficient, and beneficial to the patients, air evacuation

in the European Theater rested administratively on foundations of sand.

Under SHAEF policy, transportation

of casualties had no status as a separate mission; instead it was consid12

 7th, 9th, 12th, and 28th Field Hospitals, 77th

Evacuation Hospital, 93d Medical Gas Treatment

Battalion, and 425th and 428th Medical Battalions

Annual Rpts, 1944; Surg, ADSEC, Daily Activities

Rpts, August-September 1944, and Operations and

Evacuation Divisions, OofSurg, ADSEC, Weekly Activities Rpts, August-September 1944, all in Beasley

Papers, MHI; Memo, Evacuation Division, OofSurg,

ADSEC, to Surg, ADSEC, 17 Sep 44, sub: Daily Situation and Activities Rpts, file HD:ETO:370: Evacuation, September-December 1944; Evacuation

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 9; Surg, Brittany

Base Section, Annual Rpt, 1944, pp. 2-3; 29th Field

Hospital Annual Rpt, 1944, pp. 13-16.

13

 Quotation from 7th Field Hospital Annual Rpt,

1944, p. 3. See also Surg, ADSEC, COMZ, Annual

Rpt, 1944, p. 65; 8th Field Hospital Annual Rpt,

1944, p. 7; 9th Field Hospital Annual Rpt, 1944, pp.

9-14 and 19-20. 14

 Msgs, HQ, COMZ (FWD), to 24th and 25th

Regulating Stations, 29 Aug 44, EvacCorresp, 1942-

44, file HD 024 ETO; Memo, Hawley to G-4,

COMZ, 1 Sep 44, sub: Distribution of Patients

Among Hospitals in France, file HD:ETO:370:

Evacuation, September-December 1944; Essential

Technical Medical Data Rpt, HQ, ETOUSA, September 1944, p. 2; Evacuation Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, pp. 7-8; Link and Coleman, AAF Medical Support, p. 609; Surg, ADSEC, COMZ, Annual Rpt,

1944, ex. H.
THE EXPANDING COMZ 321

INSTALLATION OF AIR HOLDING UNIT AT TOUL, consisting of elements of a gas treatment

battalion and two field hospitals

ered strictly a side benefit of emergency resupply. If transport planes

carried cargo for the armies to forward airstrips, they could take out

wounded and sick on their empty

return flights. But as Hawley succinctly summarized, "Where there is no

supply by air, there is no evacuation

by air."

 15

Air resupply itself possessed uncertain priority, and responsibility for it

was divided. Two separate air headquarters, each with other primary

missions than logistical supply of the

ground forces, controlled most ETO

transport planes. Under the Ninth Air

Force the IX Troop Carrier Command, with over 1,400 aircraft, flew

supply missions and also was formally

in charge of air evacuation. However,

its principal task was transporting airborne troops; SHAEF withdrew its

planes from supply and evacuation

whenever a major air drop was in

prospect. The other command, the

302d Air Transport Wing, directly

under USSTAF, had about 180 aircraft and did a disproportionately

large share of both supply and evacuation, even though its main mission

was logistical support of the air

forces. SHAEF assigned tasks to both

these commands through the Combined Air Transport Operations

15

 Memo, Hawley to Kenner, 30 Aug 44, sub:

Evacuation by Air, file HD:ETO:370:Evacuation,

September-December 1944.
322 EUROPEAN THEATER OF OPERATIONS

Room (CATOR), an agency of the

Allied Expeditionary Air Forces. Located at Stanmore, England, CATOR

received transport mission requests

from the Allied armies and allocated

British or American aircraft to them.

However, it had little authority over

the operating air headquarters and no

capacity to plan and coordinate transport activities. Further, CATOR

worked under a SHAEF policy of

minimizing nonemergency air resup- ply of ground forces whenever alter- native means were available.16

The IX Troop Carrier Command

was responsible for coordinating air

evacuation with the armies and Com- munications Zone. For this purpose

the command assigned an air evacuation officer to General Hawley's staff

and maintained liaison with the prin- cipal ground force headquarters.

Early in the pursuit, for example, IX

Troop Carrier Command and the

Third Army directly negotiated evacuation and air supply arrangements.

However, no means existed by which

Hawley, as theater chief surgeon,

could assemble the total daily evacu- ation requirements of the armies and

the Advance Section and present

them to CATOR for matching with

the day's planned resupply flights,

except by impossibly time-consuming

transmission through several intermediate headquarters. His air evacuation

officer, Hawley complained, "has no

authority to act and is able to get air

evacuation only through personal

contacts, and then only when resupply is in operation. He has been

unable to obtain much information in

advance." Late in August Hawley

began a campaign for the establishment of air evacuation as a separate

mission independent of resupply and

for a direct channel of communications between his office and the authorities controlling the planes. He

also suggested the assignment of

C-47s exclusively to medical evacuation and supply. On the latter proposal Hawley received support from

General Grow, the USSTAF surgeon,

and from General Kenner, who called

for the placement of "a certain

number of C-47s . . . under th

mediate control of the Medical Department . . . organized as a 

air unit, marked with the Red Cross

and employed only for medical mis- sions." SHAEF and USSTAF took no

immediate action on these recommendations.17

General Hawley, aware as he was of

the fragility of his long air-dependent

evacuation chain, worked diligently

during the pursuit to implement

preinvasion plans for using hospital

trains, running on repaired continental lines, as the primary means of

mass long-distance casualty move16

 The Ninth Air Force provided tactical and logistical support to the U.S. armies. Air transport organization and problems are summarized in Craven

and Cates, eds., AAF, 3:554-62. See also Ruppenthal, Logistical Support, 1:572-73.

17

 First quotation from Memo, Hawley to CG,

COMZ, 15 Sep 44, sub: Status of Means for Evacuation, file HD 024 ETO CS (Hawley Chron). Second

quotation from Memo, Kenner to ACofS, G-4,

SHAEF, 2 Sep 44, sub: Evacuation by Air, in Medical Division, COSSAC/SHAEF, War Diary, September 1944. See also MFR, 28 Aug 44, sub: Conference Between Representatives of Third Army and

Troop Carrier Command at HQ, TUSA, EvacCorresp, 1942-44, file HD 024 ETO; Memo, Hawley to

Kenner, 30 Aug 44, sub: Evacuation by Air, file

HD:ETO:370:Evacuation, September-December

1944; Memo, Hawley to CofS, COMZ, 8 Sep 44,

sub: Request for Planes, and endorsements,

AirEvacCorresp, file HD 580 ETO; Link and Coleman, AAF Medical Support, pp. 599-604.
THE EXPANDING COMZ 323

ment. Early in July, accordingly,

SHAEF, the 12th Army Group, and

the Communications Zone worked

out a schedule for cross-Channel ferrying of the British-built overseas

hospital trains that the medical ser- vice had been using in England, but

the delayed opening of the Cher- bourg docks and marshaling yards

prevented early movement of the

equipment. Meanwhile, the Transportation Corps by the end of the month

had restored most of the Cotentin rail

network. Taking advantage of this cir- cumstance, the Advance Section on 4

August put a locally improvised ambulance train into service. The train,

with the 11th Hospital Train personnel as staff, consisted of French

freight cars fitted with litter brackets,

with openings cut in the ends of the

boxcars to permit movement between

them during runs, and with one car

converted into a primitive kitchen. It

carried loads of about 100 stretcher

and 125 ambulatory patients from St.- Lo and the Normandy general hospitals to Cherbourg. On 14 August,

with Cherbourg now open, the first

overseas train to reach the Continent,

Number 27, carrying the 43d Hospital

Train, rolled off a British car ferry

onto French tracks. Three days later

it made its inaugural trip from Lison

Junction to Cherbourg.18

Outside Normandy, the deficiencies

of hastily repaired railroads, and even

more a shortage of rolling stock, restricted rail evacuation throughout

the pursuit. The lines between Normandy and Paris, never the most

highly developed part of the French

system, had been heavily bombed

before D-Day to keep German reinforcements out of the invasion battle;

they had suffered also from German

demolitions as the enemy retreated.

Engineer units, nevertheless, opened

a circuitous route into Paris on 30

August and had portions of the much

more extensive but less damaged network north and east of the capital

usable as far as Liege, Verdun, and

Toul by late September. On 2 September the first hospital train,

Number 27, with the 203d General

Hospital crowded on board as passengers, entered Paris. It arrived after an

eighty-hour journey by way of St.-Lo,

Coutances, Avranches, Folligny,

Mayenne, Le Mans, Dreux, Chartres,

Rambouillet, and Versailles, which included a day spent waiting for a derailed train to be cleared off the

tracks and also other halts to reconnoiter the ramshackle line ahead.

Based on the Gare St.-Lazare, the

train at once began a grueling series

of runs between the forward railheads

and Paris, alternating with slow

bumpy trips to Cherbourg. On the

Normandy runs it carried casualties

back and medical units, usually general hospitals, forward.19

18

 For preinvasion plans, see An. 9—Medical, p.

14, to FECOMZ Plan, 14 May 44, file HD 370 ETO.

Ruppenthal, Logistical Support, 1:544-53, traces the

restoration of continental trackage. See also Surg,

ADSEC, Daily Activities Rpts, 26, 29 July and 4, 17

Aug 44, and Evacuation and Hospitalization Divisions, OofSurg, ADSEC, Weekly Activities Rpts,

weeks ending 5 and 19 Aug 44, all in Beasley

Papers, MHI; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

encl. 4, and, in file HD 024 ETO, ibid., Daily Diary,

3, 5, 11, and 31 Jul 44; Memo, Col F. H. Mowrey to

Surg, Southern Base Section, 6 Jul 44, sub: Hospital

Trains, EvacCorresp, 1944-45, file HD 370.05 ETO;

Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 17;

11th Hospital Train Annual Rpt, 1944; 43d Hospital

Train Hist, 1944, pp. 2-3. 19

 43d Hospital Train Hist, 1944, pp. 3-5.
324 EUROPEAN THEATER OF OPERATIONS

FRENCH CIVILIAN LITTERBEARERS PREPARING To UNLOAD A HOSPITAL TRAIN AT

GARE ST.-LAZARE

In spite of urging by General

Hawley, few additional trains crossed

the Channel during August and early

September. The high-roofed passenger cars of the overseas trains had to

compete for space on the few rail ferries that could carry them with even

more urgently needed locomotives,

and the locomotive shortage in

France often idled what trains were

available. As late as 18 September the

medical service had only five hospital

trains in continental operation, two in

Normandy and three stabled in Paris.

With a capacity of about 300 patients

each, these trains could make no

more than one round trip to the front

or Cherbourg every couple of days.

Hence, they could not begin to met

the evacuation needs of the armies.20

Besides trying to reduce his dependency on air transportation,

Hawley attempted to shorten his lines

of evacuation, and secure more flexibility in distributing patients, by aggressively pushing forward his general

hospitals. Under preinvasion plans

the twenty-five general hospitals ear20

 Memos, Hawley to G-4, ETO, 5 Aug 44, and

Hawley to CG, COMZ, 18 Sep 44, sub: Status of

Evacuation as of 1200 Hours, file HD 024 ETO CS

(Hawley Chron); Memo, Hawley to Kenner, 30 Aug

44, sub: Evacuation by Air, file HD:ETO:370:

Evacuation, September-December 1944; Ltr,

Hawley to TSG, 24 Aug 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp); Editorial Advisory Board,

1962, p. 188; Essential Technical Medical Data Rpt,

HQ, ETOUSA, September 1944, p. 2.
THE EXPANDING COMZ 325

marked for early continental deployment were to have been located well

south of the Seine, with the largest

clusters at Rennes, Vitre, Laval, and

Le Mans. The course of the campaign

nullified these plans. Hawley, as the

pursuit accelerated, started advancing

general hospitals as far toward the

front as possible for the purpose of

opening the maximum number of

continental fixed beds within convenient supporting distance of the armies

(see Map 14). Because the cumbersome 1,000-bed units took time to

move and prepare for operation,

whether in tents or taken-over buildings, they had to occupy their chosen

sites almost before the infantry had

driven out the last Germans. The

chief surgeon was willing to risk

losing units in order to have them in

the right places at the right time. He

told Beasley: "There are uncommitted general hospitals in the C[OM]Z.

You should ask my office to send

them forward to you so that you can,

in turn, establish them as far forward

as possible. But you should commit

no more of these in any one place

than is absolutely necessary. . . .

Save some to move forward to other

sites." To the surgeon general,

Hawley declared: "We are throwing

general hospitals forward as fast as

we can get transport to move

them."

 21

In late August, besides the six general hospitals established in the Cotentin, Hawley had about a dozen

others in bivouac near the beaches

awaiting plant assignments, the landing of their equipment, or both. At

the chief surgeon's instructions

ADSEC on 20 August opened the

127th General Hospital in Rennes

and the 19th in Le Mans, both in

former French civilian hospital buildings. Hawley devoted his main effort

to establishing several thousand fixed

beds in newly liberated Paris. His

Hospitalization Division chief, Colonel Darnall, entered the capital as

Allied troops still were mopping up

German resistance. Darnall secured

from the Gaullist authorities options

on most of the city's largest hospitals,

many of them only recently evacuated

by the Germans. The chief surgeon

rushed units forward from Normandy

by every available conveyance to

occupy these plants. Advance elements of the 108th General Hospital,

the first to begin operations, took

possession of Beaujon Hospital on 31

August; the unit opened 400 beds on

2 September, so near the fighting that

patients came in directly from division

clearing stations. Two more general

hospitals, the 203d and 217th, went

into limited operation within the next

couple of days. By the third week of

September a total of six hospitals

(five general and one station) were in

place and functioning. Officers of

Hawley's and Beasley's staffs were

21

 First quotation from Ltr, Hawley to Beasley, 22

Aug 44, file HD 024 ETO CS (Hawley Chron).

Second quotation from Ltr, Hawley to TSG, 24 Aug

44, file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Memo, Hawley to G-4, COMZ (Fwd), 15

Aug 44, EvacCorresp, 1942-44, file HD 024 ETO;

Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 23; Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 4; Darnall, "Breakthrough to Paris,"

pp. 276-77; Hawley Interv, 1962, p. 82, CMH.


328 EUROPEAN THEATER OF OPERATIONS

scouting for additional sites around

Paris and in northern France and Belgium.22

Paris, as the stabling of hospital

trains and the concentration of general hospitals there indicated, rapidly

became the hub of the continental

evacuation system. The principal rail

lines from Belgium and eastern

France converged at the capital, and

it possessed two major airports. On 5

September representatives of the

chief surgeon and the surgeons of

ADSEC, Seine Section, and the

armies initialed an evacuation plan

under which most casualties not flown

directly from the Advance Section to

Britain and Normandy would pass

through Paris. An air holding unit

and ambulance directing point at Le

Bourget field in the northern outskirts was to receive and sort patients

from ADSEC and the armies—then

only a short distance away. The unit

was to send over-30-day patients directly to England by air and those

destined for COMZ either by plane to

Normandy or by ambulance to the

Paris general hospitals. Those hospitals, in turn, were to evacuate by air

to the United Kingdom through Le

Bourget and, as trains became available, by rail to the Normandy Base

Section.23

Two companies of Advance Section's 93d Medical Gas Treatment

Battalion opened the Le Bourget

holding unit on 5 September; ten

days later, they turned it over to the

8th Field Hospital, which the gas

treatment battalion's trucks had

hauled up from Normandy. As the

Paris evacuation system went into full

operation, the hospital soon found

itself running one of the busiest holding units on the Continent. Housed in

tents near the runways and later in a

converted school building, the 8th,

with the 426th Medical Ambulance

and 706th Medical Sanitary Companies attached, routinely handled over

1,000 patients a day—incoming casualties from the First and Third Armies

and outgoing evacuees from the Paris

general hospitals.24

The Paris hospitals and holding

unit were barely in place when the

need for them became urgent.

Throughout the first couple of weeks

after the armies crossed the Seine,

SHAEF had committed most of its

transport planes to their resupply;

hence, the medical service had been

able to rely almost entirely on air

evacuation. On 15 September this situation abruptly changed. Supreme

Allied Headquarters, without advance

warning to the medical service, withdrew the IX Troop Carrier Command

from logistical missions to prepare for

22

 The five general hospitals were the 108th

(Beaujon), 217th (La Pitie), 203d (Garches), 40th

(Le Vesinet), and 62d (Eaubonne); the station hospital was the 365th (American Hospital of Paris).

See Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 10-11. See also

Essential Technical Medical Data Rpt, HQ,

ETOUSA, August 1944, encl. 1; Surg, ADSEC,

Daily Activities Rpts, August-September 1944, Beasley Papers, MHI; Surg, Seine Section, Annual Rpt,

1944, p. 27; 108th General Hospital Annual Rpt,

1944, p. 14; 127th General Hospital Annual Rpt,

1944, p. 3; Ltrs, Hawley to TSG, 24 Aug and 14

Sep 44, file HD 024 ETO O/CS (Hawley-SGO Corresp); Darnall, "Breakthrough to Paris," pp. 280-81.

23

 Memo, Maj D. J. Twohig to DepCSurg, HQ,

COMZ (Fwd), 5 Sep 44, sub: Plan for Evacuation

Through Paris Area, file HD:ETO:370:Evacuation,

September-December 1944; Surg, Seine Section,

Annual Rpt, 1944, p. 26. 24

 8th Field Hospital Hist, 1943-44, pp. 7-8; 93d

Medical Gas Treatment Battalion Hist, 1943-44, pp.

10-11.
THE EXPANDING COMZ 329

MARKET-GARDEN, just as the first attacks on the West Wall increased

combat casualties. For the next

couple of weeks the airborne operation tied up most Allied transport

planes when bad weather did not

ground them. Patients, many needing

early definitive treatment, filled army

and ADSEC holding units and then

backed up into the evacuation hospitals. By the twentieth at least 5,000

sick and wounded were awaiting evacuation in and just to the rear of the

armies, and the Advance Section was

removing them at a rate of only 1,500

a day. COMZ evacuation officers improvised frantically to compensate for the

near-total loss of air transport. What

hospital trains were available shuttled

continuously between the forward

areas and Paris. The ADSEC holding

units behind the First Army sent casualties all the way from Belgium to the

French capital by ambulance. These

expedients, however, quickly filled the

Paris general hospitals, which themselves had few means of sending off

patients. From the 302d Transport

Wing, General Hawley obtained some

evacuation planes, no more than a

quarter of those he needed. He finally

resolved the immediate crisis by arranging informally, through General

Grow, for an indeterminate but substantial number of off-the-record IX

Troop Carrier Command evacuation

flights.25

Hawley took the evacuation crisis as

an occasion to bring to a head his

campaign for more reliable, responsive air support. Through General

Lee, he asked SHAEF immediately to

assign 200 C-47s daily to evacuation

until the patient backlog was cleared

up, which should take about three

days. Thereafter, Hawley wanted 50

planes a day, which would give him a

daily capacity of about 2,000 casualties. SHAEF rejected this proposal.

On 21 September Lt. Gen. Walter

Bedell Smith, Eisenhower's chief of

staff, informed General Lee that airborne operations then in progress

ruled out the proposed medical airlift

and that "in any event, your medical

evacuation plans must not be predicated on any fixed air evacuation.

Rather, air evacuation must be considered as a bonus to be available

from time to time as conditions

permit." Smith held firm even in the

face of an appeal from General Bradley. He explained to the army group

commander that C-47s for the medical service would have to come from

air commands "created to meet specific operational needs, and their permanent diversion to another mission

could only be accomplished at the expense of their original purpose." In

place of improved air evacuation

Smith, after consulting with Kenner

and Hawley, gave the medical service

high priority for transportation and

other support so that it could set up

more general hospitals north and east

25

 Memo, Evacuation Division, OofSurg, ADSEC,

to Surg, ADSEC, 17 Sep 44, sub: Daily Situation

and Activities Report, file HD:ETO:370:Evacuation,

September-December 1944; various memos, September 1944, in file HD 024 ETO CS (Hawley

Chron); Evacuation Branch, Operations Divsiion,

OofCSurg, HQ, ETOUSA, Daily Diary, 3, 16, and

22 Sep 44, file HD 024 ETO; 428th Medical Battalion Annual Rpt, 1944, p. 4; Gorby Interv, 1962, pp.

90-93, CMH; Ltr, Hawley to Col E. L. Bergquist, 28

Sep 44, box 2, Hawley Papers, MHI; Surg, ADSEC,

COMZ, Annual Rpt, 1944, p. 18.
330 EUROPEAN THEATER OF OPERATIONS

of Paris and put additional ambulance

trains in operation.26

Taking advantage of SHAEF interest and support, Hawley lost no time

in strengthening his ground evacuation system. He quickly pushed general hospitals across the Seine. By

mid-September he already had two of

these units bivouacked at Reims and

three more at Paris, ready for assignment. Five more general hospitals in

Normandy awaited disembarkation of

their equipment. Hawley obtained a

speedup in landing the latter units'

assemblies at Cherbourg. He deployed the hospitals already in northern France, and others as soon as

they came up, in positions close

behind the First and Third Armies.

To provide more beds for the First

Army, the 15th General Hospital

opened in Liege on the twenty-first in

a former Belgian military hospital and

the 28th General Hospital went into

operation in the same city about two

weeks later. In Paris, meanwhile, a

sixth general hospital, the 48th, began admitting patients on the

twenty-third and the 99th General

Hospital opened in Reims on the

twenty-ninth. However, an effort to

move three general hospitals into

Nancy and another into Verdun ran

afoul of the Third Army, which still

had those cities within its area and refused to turn over hospitals and other

structures occupied by its own medical units. The Advance Section finally

opened three general hospitals (the

90th, 95th, and 100th) in Bar-le-Duc,

considerably to the west of Nancy, between 18 and 28 October. Wherever

located, these and the previously established continental general hospitals functioned essentially as large

professionally well-endowed holding

and transit facilities. The hospitals in

and to the north of Paris gave definitive treatment only to very short-term

patients; they evacuated all others as

soon as transportable. The Normandy

general hospitals retained casualties

returnable to duty within thirty days.

This was an inefficient use of general

hospitals. But a shortage of evacuation hospitals in the COMZ troop

basis, and the seemingly limitless

demand for holding beds, made it

necessary (see Map 14).27

The medical service and the Transportation Corps cooperated to put

more hospital trains in service. Maj.

Gen. Frank S. Ross, the theater chief

26

 First quotation from Memo, Smith to Lee, 21

Sep 44, sub: Medical Evacuation, file HD:

370.05:Evacuation and Movement of Troops.

Second quotation from Ltr, Smith to CG, 12th

Army Group, 30 Sep 44, sub: Evacuation of Casualties, file HD:ETO:370:Evacuation, September-December 1944. See also September 1944 correspondence in file HD 024 ETO CS (Hawley Chron);

Memo, Col V. A. Rapport to Lee, 20 Sep 44, sub:

Air Evacuation of Casualties, AirEvacCorresp, file

HD 580 ETO; Medical Division, COSSAC/SHAEF,

War Diary, September 1944; Link and Coleman,

AAF Medical Support, p. 606.

27

 Ltrs, Hawley to TSG, 14 Sep 44, and Hawley to

Inspector General, WD, 10 Oct 44, file HD 024

ETO O/CS (Hawley-SGO Corresp); September-October 1944 correspondence in file HD 024 ETO CS

(Hawley Chron); Surg, ADSEC, Daily Activities

Rpts, September-October 1944, Beasley Papers,

MHI; Memo, Hawley to G-4, ETO, 21 Sep 44,

AirEvacCorresp, file HD 580 ETO; Ltr, Brig Gen H.

R. Gay to Hawley, 1 Oct 44, box 2 Hawley Papers,

MHI; Essential Technical Medical Data Rpt, HQ,

ETOUSA, September 1944, pp. 7-8 and encl. 1;

Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 4; Hospitalization Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 12;

Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 68;

Surg, Normandy Base Section, Annual Rpt, 1944,

pp. 8-9; 15th General Hospital Annual Rpt, 1944,

pp. 3-4 and 16-17; 76th General Hospital Annual

Rpt, 1944, p. 34.
THE EXPANDING COMZ 331

TABLE 8—TRENDS IN EVACUATION FROM THE ARMIES AND ADVANCE SECTION

Source: Surg, ADSEC, COMZ, Annual Rpt, 1944, ex. H.

of Transportation, spurred by SHAEF

and COMZ and by direct appeals

from Hawley, within twenty-one days

moved seventeen trains across the

Channel. Ross also improvised expedients, such as coupling empty hospital trains to those hauling supplies

and ammunition, to move this vitally

needed equipment forward from

Cherbourg to Paris. At Paris the

Transportation Corps, late in September, assembled three additional improvised trains from French hospital

and passenger cars, with medical

equipment cobbled together from

American and captured German

stocks. By the end of October the

medical service had twenty-five hospital trains running on the Continent—

enough by themselves, Hawley estimated, to meet the armies' daily evacuation requirements. The chief

surgeon arranged with the railway

scheduling authorities for daily highpriority runs between Paris and the

front and from the capital to Cherbourg. With the means thus enlarged,

rail evacuation attained its originally intended predominance (Table 8).

The number of patients transported

by train grew from less than 1,400 in

August to 13,700 in September and

35,000 in October. In September six

hospital trains from Paris entered the
332 EUROPEAN THEATER OF OPERATIONS

Normandy Base Section; in October

the base section received thirty-five. Other evacuation elements redeployed to take maximum advantage of

the railroads. At Paris an entire medical ambulance company, the 553d,

went into operation late in September, transferring patients between

railway stations and general hospitals.

The Advance Section relocated its

holding units for easier access to the

railheads and, beginning early in October, consistently evacuated more

casualties by rail than by air.28

While rail evacuation increased in

scale and effectiveness, air evacuation

remained for the medical service an

important and, in many respects, a

preferred alternative. General

Hawley, for example, considered air

movement of casualties less costly, in

terms of cargo space taken up, than

rail transportation. Surgeons still favored air evacuation for the most severely wounded. By that method a

man could go from the Advance Section to his place of definitive treatment within a few hours, whereas

evacuation by rail through Paris to

Cherbourg and then by ship across

the Channel took about four days.

With such considerations in mind, the

medical service and the air forces

during the autumn worked to make

air evacuation more efficient and continuously available.29

Late in September the chief surgeon acquired an air evacuation unit

of his own, the 320th Squadron, 302d

Transport Wing. This squadron,

based at Le Bourget, flew twenty UC64s, single-engine high-wing monoplanes designed for freight and passenger service in the Canadian arctic

and purchased by the Army for observation, liaison, and light cargo-carrying. The UC-64s had not proved particularly satisfactory for any of their

intended missions. Hence, USSTAF

was willing to place the aircraft, and

their underemployed, bored crews, at

the disposal of General Hawley, in

partial compensation for the C-47s it

could not give him. The chief surgeon employed the UC-64s, each of

which could accommodate three litter

and a couple of sitting patients, not

only for emergency evacuation from

the armies to Paris but also to haul

forward urgently needed medical supplies. In their first three months of

service the "Grow Escadrille," as the

pilots nicknamed themselves, transported 1,100 casualties, 30,000 pints

of blood, and about 460 tons of other

medical supplies.30

28

 September-October 1944 correspondence in

file HD 024 ETO CS (Hawley Chron); Evacuation

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, ends. 4 and 9, and, in

file HD 024 ETO, ibid., Daily Diary, 3, 5, 6, and 9

Oct 44; Essential Technical Medical Data Rpt, HQ,

ETOUSA, September 1944, p. 2, and October 1944,

p. 2; Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 15; Surg, ADSEC, COMZ, Annual

Rpt, 1944, p. 57 and ex. H; Surg, Normandy Base

Section, Annual Rpt, 1944, pp. 6-7; Surg, Seine

Section, Annual Rpt, 1944, p. 27; 552d Ambulance

Company Annual Rpt, 1944, pp. 9-11; 12th Field

Hospital Annual Rpt, 1944, pp. 8-9; 77th Evacuation Hospital Annual Rpt, 1944, p. 7; Hawley

Interv, 1950, file HD 000.71, CMH; Hawley Interv,

1962, pp. 84-85, CMH.

29

 Ltr, Hawley to CG, COMZ, 4 Oct 44, sub: The

Effect of Rail Evacuation Upon Rail Cargo Capacities, file HD 024 ETO CS (Hawley Chron); Essential Technical Medical Data Rpt, HQ, ETOUSA, October 1944, p. 2. 30

 Memo, Hawley to Operations Division,

OofCSurg, HQ, ETOUSA, 28 Sep 44, sub: Policies

Governing Use of UC-64 Planes, file HD 024 ETO

CS (Hawley Chron); Memos, Col K. R. Bendetsen to

G-4, COMZ, 2 Oct 44, sub: Supplemental Air Evac- Continued
THE EXPANDING COMZ 333

UC-64 OF THE "GROW ESCADRILLE"

During the autumn the theater significantly improved its procedures for

requesting C-47s for evacuation. On

8 September SHAEF transferred

oversight of U.S. air evacuation from

the Ninth Air Force to USSTAF,

thereby elevating responsibility for

the task to the senior theater air

headquarters. The IX Troop Carrier

Command remained the principal implementing agency. At General

Smith's suggestion the air forces,

armies, and Communications Zone

early in October revamped their medical evacuation liaison and communications systems. As a result of this

effort General Hawley's office at last

could collect daily reports of the

number and locations of casualties

awaiting evacuation and transmit the

information to CATOR in time for

the transport agency to correlate it

with the next day's supply flights.

Evacuation still had no status as a

separate mission and remained dependent on aerial resupply, but cooperative officers in the IX Troop Carrier Command and the 302d Transport

uation Service, and Maj R. S. Gilfilian to CSurg,

ETO, 13 Dec 44, sub: Inter-Continental Evacuation

by UC-64s, AirEvacCorresp, file HD 580 ETO;

Kendrick, Blood Program, pp. 535-36; Link and Coleman, AAF Medical Support, p. 607. Medical use of

UC-64s was contemplated well before D-Day. See

Summary of Gen Kenner-Gen Grow Conference, 4

Apr 44, in Medical Division, COSSAC/SHAEF, War

Diary, April 1944.
334 EUROPEAN THEATER OF OPERATIONS

Wing often evaded this restriction, to

the benefit of the medical service.

When the medics desperately needed

planes, their aviation colleagues, with

a little ingenuity, usually could dis- cover an urgent requirement for

cargo somewhere, or they could send

a replacement aircraft just arrived in

the theater on an extra mission

before it reported to its assigned

squadron. By such formal and informal means the Army Air Forces,

within the confines of SHAEF policy, always made at least some evacuation

aircraft available to the medical service.31

The medical service rapidly eliminated its late September evacuation

backlog, assisted by the almost daily

arrival of additional hospital trains; by

the resumption of large-scale air resupply after MARKET-GARDEN; and,

above all, by a lull in combat and its

attendant reduction in casualties. At

the end of September no more than

800 patients were awaiting evacuation

in the armies and ADSEC, and the

Paris hospitals were clearing out their

own accumulations by air and rail.

Evacuation continued to improve

during October. On the nineteenth

the Evacuation Branch of Hawley's

office reported that the situation was

"excellent in forward areas" and that

the Paris hospitals had 2,000 empty

beds.32

By late October, as the armies prepared for a new assault on the West

Wall, the continental evacuation

system was complete in outline (Diagram 3), although elaboration and expansion would continue. Army and

ADSEC holding units sent very shortterm patients to the general hospitals

at Liege, Reims, and Bar-le-Duc, for

definitive treatment close to the front

and early return to duty. Whenever

possible, they dispatched severe cases

directly to the United Kingdom by

air. Now, however, the majority of

long-term patients left the forward

area by hospital train, bound for

Paris. At the capital the Seine Section

detrained all incoming casualties for

sorting and rest. The Paris general

hospitals retained a few patients for

treatment, but they evacuated most as

soon as they were able to travel in

order to maintain large reserves of

empty beds for sudden surges of casualties from the front. Evacuees from

Paris might go by ambulance to Le

Bourget, for loading on United Kingdom-bound aircraft. More likely, they

would be taken to the Gare St.-Lazare

and placed on trains again, for the up

to three-day run to the Normandy

Base Section general hospitals or to

Cherbourg and embarkation on hospital carriers for the voyage to Southampton. While surgeons continued to

prefer air evacuation whenever they

31

 Ltr, Smith to CG, 12th Army Group, 30 Sep 44,

sub: Evacuation of Casualties, file

HD:ETO:370:Evacuation, September-December

1944; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

13-14, and, in file HD 024 ETO, ibid., Daily Diary,

18 Sep and 1, 2, 4, 6 Oct 44; Link and Coleman,

AAF Medical Support, pp. 606-07 and 616. See also

Memo, Col F. H. Mowrey to G-4, ETO, 4 Oct 44,

sub: Communications for Air Evacuation; SOP, IX

Troop Carrier Command, 18 Oct 44, sub: Medical

Air Evacuation of Casualties; Ltr, Col F. H. Mowrey

to CSurg, ETO, 22 Nov 44, sub: Air Evacuation. All

in AirEvacCorresp, file HD 580 ETO.

32

 Quoted words from Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Daily

Dairy, 19 Oct 44, file HD 024 ETO. See also ibid.,

entries for 29 Sep-31 Oct 44, same file; Memos,

Hawley to Kenner, 26 and 29 Sep 44, file HD 024

ETO CS (Hawley Chron); Essential Technical Medical Data Rpt, HQ, ETOUSA, October 1944, p. 1.

336 EUROPEAN THEATER OF OPERATIONS

could obtain it, the medical service on

the Continent now appeared to possess the resources and flexibility to

get along without it.33

General Hospitals to the Front

Between the St.-Lo breakout and

the end of October the medical service placed 18,000 general hospital

beds in operation on the Continent.

The majority of these were in units

hastily moved forward and established

in northern France and Belgium, to

help relieve army facilities and hold

patients for air and rail evacuation.

Deploying these large, cumbersome

hospitals was a complicated task, involving inter-Allied politics as well as

American logistics. The hospitals

themselves, besides overcoming the

problems of movement, had to adapt

to new, often unsuitable quarters and

to take on functions different from

those usually performed by general

hospitals.34

Several divisions of the chief surgeon's office had a hand in setting up

general hospitals. The Operations Division selected the areas in which they

were to be established and oversaw

the entire deployment procedure to

ensure that hospitals opened where

they were supposed to more or less

on time. The Hospitalization Division

located, and secured permission to

use, particular buildings or pieces of

land and directed the movement and

setting up of units. The Supply Division put together and shipped the

bulky unit equipment assemblies,

trying, not altogether successfully, to

bring them together in France with

the people who were to use them.35

Colonel Darnall did much of the

site reconnaissance in person, assisted

by Lt. Col. Irving A. Marshall, the

head of his Construction Branch, and

by officers from the Advance Section

and the newly formed Allied governments. During August Darnall selected hospital locations around Rennes

and then entered Paris in the first

days of liberation to stake medical

service claims there. Early in September he traveled eastward from the

capital over the old American World

War I battlefields, where he himself

had worked in an evacuation hospital,

to choose sites close behind the Third

Army. As the pursuit ended at the

West Wall, he made a four-day 800-

mile swing through Belgium and Luxemburg. Riding in jeeps and

equipped, Darnall recalled, "with

maps, K-rations, full canteens, and

jerricans of gasoline," the hospital reconnaissance parties kept up with the

forward combat troops and occasionally, in the confusion, entered towns

ahead of them. Darnall and his assistants inspected dozens of buildings

and tramped over acres of pasture

and cultivated land, marking usable

locations on maps to guide subsequent planning. Whenever possible,

they selected sites grouped together

on roads and railways, for organization later into hospital centers.36

33

 Memo, Col. F. H. Mowrey to DepCSurg, ETO,

8 Nov 44, AirEvacCorresp, file HD 580 ETO; Evacuation Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 9-11; Essential

Technical Medical Data Rpt, HQ, ETOUSA, October 1944, p. 2. 34

 The number of beds is from Ltr, Hawley to Inspector General, WD, 10 Oct 44, file HD 024 ETO

O/CS (Hawley-SGO Corresp).

35

 Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 4. 36

 Quotation from Joseph R. Darnall, "Hunting

Hospital Sites beyond Paris, September 1944," The Continued
THE EXPANDING COMZ 337

Once Darnall and his associates

found suitable locations, they negotiated with COMZ and army headquarters, and with Allied civil authorities,

for permission to occupy them. Under

theater policy, hospitals had first

claim on existing buildings, which the

medical service, for obvious reasons

of patient comfort and operating convenience, preferred to use whenever

available. Nevertheless, in the army

areas COMZ general hospitals at

times took second place to medical

units of the organization in control of

the ground, as in the case of the

Third Army's exclusion of general

hospitals from Verdun and Nancy. In

liberated towns and cities the medics

had to deal, through SHAEF, with reestablished French or Belgian civil administrations. These governments,

understandably, often put their own

peoples' health and social needs

ahead of U.S. Army requirements,

and SHAEF frequently deferred to

their wishes. Fortunately for the medical service, the overrunning of much

of France and the Low Countries

without heavy fighting left a larger

than anticipated stock of intact structures. In most places the Hospitalization Division simply took over facilities formerly appropriated by the

Germans. The division thereby avoided any new displacement of civilians

and at the same time made it politically awkward for local officials to

deny to the Allies what they previously had yielded to the enemy. As an

added benefit, this policy provided

the Americans with many of the best

hospitals, because those were precisely the buildings the Germans had

seized.37

When Darnall and Marshall entered

Paris in the last days of August seeking hospital buildings, they made immediate, beneficial contact with the

newly installed acting French minister

of health, Dr. Pasteur Vallery Radot.

According to Darnall, Radot, a Resistance member and grandson of the

famous scientist Louis Pasteur, "realized that the salvation of France lay

not in quickly grabbing back the

properties vacated by the retreating

Germans, but in helping the Americans to acquire and utilize these facilities until the war was won." The

Americans, with Radot's help, within

days secured five of the largest and

best-equipped civilian hospitals, all of

which had been occupied by the Germans until the liberation. During the

late September evacuation crisis

Radot's successor unhesitatingly evicted a recently installed French staff

from a sixth facility, Lariboisiere, to

make room for the 48th General Hospital. The Count de Chambrun, the

German-appointed French administrator of the American Hospital of Paris,

an American-financed private institution, was less accommodating. A suspected collaborator, as were many of

Military Surgeon 103 (August 1948): 85-93. See also

ibid., "Breakthrough to Paris," pp. 271-81; Hospitalization Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 3 and 10-12; Surg, ADSEC,

Daily Activities Rpts, August-September 1944, Beasley Papers, MHI.

37

 For hospital priority, see An. 8-Medical, pp. 5-

6, to ADSEC Plan, 30 Apr 44, and An. 9-Medical,

pp. 39-40, to FECOMZ Plan, 14 May 44, file HD

370 ETO; Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 5; ADSEC Hist, pp.

73-74; Darnall, "Breakthrough to Paris," pp. 273-

74; Hospitalization Division, OofCSurg, HQ

ETOUSA, Semiannual Rpt. January-June 1945. Ltr,

Hawley to Kenner, 3 Nov 44, file HD 024 ETO CS

(Hawley Chron), illustrates difficulties with civilian

authorities.
338 EUROPEAN THEATER OF OPERATIONS

his staff, Chambrun first appealed to

General Hawley not to take over his

well-appointed 150-bed facility. That

failing, Chambrun asked Hawley to let

the existing international staff stay on

as U.S. Army employees. Hawley refused both requests and took the hospital, less because he absolutely

needed it than as a symbolic compensation to the French for the expropriation of so many of their facilities.

The chief surgeon installed the 350th

Station Hospital in the plant, where it

cared for officer and female patients

from the U.S. headquarters in the

capital.38

As it secured buildings and openfield sites, the Hospitalization Division moved units forward to occupy

them. To achieve this, the division

first coordinated with medical service

channels and then forwarded a request to the COMZ G-4 to issue directives to the appropriate base sec- tions, which actually conducted the

movement. Most general hospitals

that went into operation during the

pursuit came to the Continent from

the United Kingdom, although late in

September units began arriving directly from the United States. All the

hospitals spent varying lengths of

time encamped in Normandy, in

hedgerow fields that still bore the

scars and debris of battle. Most staging hospitals sent doctors and nurses

off on detached service, usually with

auxiliary surgical teams. The rest of

their people whiled away the time in

training, physical conditioning, and

bargaining with neighboring civilians

for Calvados and souvenirs.39 Two of

the first hospitals into Paris, the

108th and 203d, were preparing to

open tented plants near Cherbourg

when they received orders to stop

work and pack again for movement.

The personnel of hospitals bound

for Paris and points north and east of

it usually traveled on empty hospital

trains, except for detachments driving

the unit vehicles. For the nearly 1,000

men and women of a general hospital, crowded into a single train along

with the on-board medical unit, it was

an uncomfortable trip, memorable for

the shortage of seats, berths, toilets,

and cooking facilities and for the interminable delays. Inevitably, units

became separated from their equipment assemblies; the 48th General

Hospital, for example, went to Paris

while its outfit went to Liege. Hospitals arriving early in newly captured

cities underwent a variety of adventures. The 62d General Hospital,

which entered Paris on 30 August,

spent three days trying to find a headquarters to assign it a location and

then—without maps—the locations

itself. Bivouacked at a chateau south

of the capital, unit personnel heard

nightly rifle shots as Free Frenchmen

rounded up German stragglers in the

nearby woods. They also found several Germans living in their own attic

on stolen American rations. With no

38

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 11; Darnall, "Breakthrough to Paris," pp. 277-81 (quotation on p.

281); ibid., "Sidelights," p. 26; Surg, Seine Section,

Annual Rpt, 1944, pp. 16-17; Ltr, Hawley to General Purchasing Agent, ETO, 24 Sep 44, file HD 024

ETO CS (Hawley Chron); Editorial Advisory Board,

1962, pp. 123-124 and 192-93; Hawley Interv,

1962, pp. 77-79; CMH. The 350th Station Hospital

in fact employed many of the nurses, clerical

people, and general laborers of the American Hospital. See 350th Station Hospital Annual Rpt, 1944.

39

 Calvados was a French brandy from the Department of Calvados.
THE EXPANDING COMZ 339

CIVILIAN HOSPITAL IN PARIS VACATED BY RETREATING GERMANS

supply depots yet in operation, the

hospital sent its own trucks back to

the beaches for food and gasoline,

only to have several cargoes hijacked

on the return trip, reportedly by

Third Army troops.40

Whether in buildings or tented

camps, general hospitals labored to

place their facilities in operation in

the shortest possible time. Units occupying existing hospitals often had to

contend with the results of German

vandalism. In many of the large Paris

hospitals the departing enemy ripped

out wiring, plugged toilets, sabotaged

plumbing, carried off or smashed furnishings and equipment, and created

a revolting welter of rotten garbage,

soiled dressings, and overflowing urinals and bedpans. Yet the Germans

left other plants almost undamaged,

with furniture, instruments, and X-ray

and other machines in good order,

ready for use. In a few instances the

Americans found well-stocked pharmacies. Even in the more severely

vandalized premises, general hospitals

could begin receiving patients within

days of moving in, after a thorough

cleanup and limited repairs.

Units that had to remodel barracks

and schools or construct expedition40

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 14-15; Surg. Normandy Base Section, Annual Rpt, 1944, pp. 2-4 and 16-17; Surg,

ADSEC, Daily Activities Rpt, 17 Aug 44, Beasley

Papers, MHI; 15th, 40th, 48th, 62d, 95th, 99th,

108th, and 203d General Hospitals Annual Rpts,

1944; 15th General Hospital Unofficial Hist, 1943-

44; Brown Interv, 1979, CMH.
340 EUROPEAN THEATER OF OPERATIONS

ary tented plants took much longer to

go into full operation. Even though

the theater gave hospital construction

high priority, units had difficulty obtaining engineer support and building

materials, especially when hardpressed base section commanders

chose to put other projects ahead of

those for the medical service. Torrential rains, which began in mid-October, turned open-field sites into seas

of mud, further slowing the work.

General hospitals facing long construction delays concentrated on getting their people and equipment

under shelter and opening wards for

emergency care and holding purposes. To speed the opening of the

general hospitals at Bar-le-Duc, the

Advance Section temporarily attached

field hospital platoons to them. These

platoons set up tented operating facilities for the larger hospitals, which

otherwise could not have performed

surgery until the engineers finished

extensive renovation of their plants.41

The forward general hospitals, accustomed to providing comparatively

leisurely long-term treatment, had to

reorganize on the job for mass casualty reception, emergency care, and

evacuation. The first hospitals to

open were inundated with wounded,

many fresh from division clearing stations. In Paris the 108th General Hospital admitted about 1,000 patients—

the majority German prisoners who

had received little more than first

aid—during its initial forty-eight

hours of operation. The hospital responded to the crisis with rapid improvisation. According to the unit's

report:

Our own U.S.A. supplies had not come

up from Le Mans, many of our surgeons

and shock teams . . . were still away 

detached service, no penicillin was available, the hospital communications systems had been destroyed by the retreating Germans, and we had no practical

experience as a group in handling large

numbers of casualties as an evacuation

hospital. We used German paper dressings and other material they had left

behind. . . . We put dentists, ch

and bacteriologists to work in the wards

with the medical men who were not

giving anesthetics or assisting in surgery.

We worked 36 hours straight, hoping to

catch up, but were still 500 cases, needing operation, behind schedule. We then

organized 12-hour day and night shifts

and operated only upon the most severely

wounded. . . .

For the 108th, and the other hospitals

that followed it into operation, the

flow of casualties directly from aid

and clearing stations soon ended.

Nevertheless, most general hospitals

on the Continent continued to give

only the simplest of care to a rapid

turnover of patients. Only those farthest to the rear, in the Normandy,

Brittany, and Loire Base Sections,

performed anything like their textbook functions.42 41

 Surg, ADSEC, COMZ, Annual Rpt. 1944, pp.

49-50; Surg, Brittany Base Section, Annual Rpt,

1944, p. 2; 15th, 40th, 62d, 76th, 99th, 100th, 203d,

and 217th General Hospitals Annual Rpts, 1944;

Darnall, "Breakthrough to Paris," pp. 279-80;

Hawley Interv, 1962, pp. 76-77, CMH; Memo,

Hawley to G-4, ETO, 5 Oct 44, sub: Hospital Construction—Le Mans, file HD 024 ETO CS (Hawley

Chron); 58th Field Hospital Annual Rpt, 1944, pp.

11-18.

42

 108th General Hospital Annual Rpt, 1944, pp.

19-20 and 24-25; 127th General Hospital Annual

Rpt, 1944, p. 4. These units also acted as station

hospitals for neighboring COMZ troops. See Surg,

Oise Base Section, Annual Rpt, 1944, pp. 4-5 and

8-9.
THE EXPANDING COMZ 341

Medical Supply in the Pursuit

The unanticipated rapidity of the

advance upset COMZ plans for an orderly flow of supplies from the coast

through intermediate depots to the

Advance Section and from the latter

to the armies. The Communications

Zone disembarked sufficient stores at

Cherbourg, at the minor Normandy

ports, and at OMAHA and UTAH beaches, all of which, thanks to the hard

work and ingenuity of engineer and

port troops, greatly exceeded their

expected cargo-handling capacity. The difficulty lay in establishing and

stocking depots in the widening distance between the initial lodgement

area and the front. The Advance Section projected, then abandoned, several logistical support areas as the

armies left them far behind. Supreme

Allied Headquarters, anticipating an

early Rhine crossing, temporarily delayed the setting up of depots in Paris

so that development of this key logis- tical center began only as the offensive slowed down in mid-September.

When the Advance Section did

open forward depots, the trailing base

sections lacked transportation to

move goods to them. With the railroads, especially those south and west

of Paris, able to carry only a fraction

of the required tonnage, and with air

transport limited in capacity and uncertain of availability, the Communications Zone had to rely on trucks for

most long-distance hauling until well

into the autumn. Its vehicle complement, not intended for such use, was

barely adequate for the task. To make

the most of what they had, COMZ

and ADSEC late in August assembled

most of their own truck companies

and others borrowed from the

armies—over 120 in all—for the Red

Ball Express. Running around the

clock on specially marked highways

closed to all other traffic, Red Ball vehicles carried supplies from the Normandy dumps to a terminal area near

Chartres, and later to forward transfer points at Soissons behind the First

Army and at Sommesous in the rear

of the Third. In a month of strenuous

operation Red Ball convoys moved

forward over 135,000 tons of freight

and aircraft perhaps another 13,000.

These deliveries, however, fell short

of the amounts the armies needed to

fight at full effectiveness. The 12th

Army Group, and later SHAEF, in

mid-September began allocating the

daily tonnage that reached the front

among the armies and ADSEC so as

to maintain at least a limited offensive

and ensure balanced distribution on

the basis of tactical plans. Most of the

time the higher headquarters gave

priority to the First Army. The tonnage allocation system, although

plagued by confused record-keeping,

duplicate requisitions, disputes between the armies and COMZ about

who was receiving how much, and occasional unauthorized appropriation

of shipments, more or less met minimum operational requirements. However, it did not allow the Communications Zone to build up forward

reserves. Only in October and November, when the railroads at last

started hauling significant tonnage,

did the depots north and east of the

Seine begin to fill.43

43

 Ruppenthal, Logistical Support, 1:488-99 and

553-83; ibid., 2:3-8, 17-21, 53, 57, 88, 134-41,

169-80, 355-57; ADSEC Hist, pp. 74-75 and 102-

03.
342 EUROPEAN THEATER OF OPERATIONS

Medical supplies accounted for only

a small proportion of the tonnage

handled by the Communications

Zone. In mid-August, for example,

out of 395,000 long tons of stores in

ADSEC dumps, only 5,100 tons be- longed to the medical service. Nevertheless, the medical service encountered its full share of supply

problems. As did the other technical

services, it set up a string of depots

across France and Belgium and then,

with limited transportation and under

constant pressure of time, tried to

stock them while still meeting the

day-to-day needs of field army and

COMZ units.44

The Advance Section established

medical supply depots in the track of

the armies in a network radiating

from the pre-breakthrough facilities at

Cherbourg, Chef-du-Pont, and

L'Etard. During late August medical

depot companies successively opened

Depots M-404 and M-405. Located in

a factory building and warehouses in

Rennes, M-404 supplied the troops in

Brittany; located in Le Mans but

never fully stocked, M-405 served

mainly local COMZ units. Supplies

initially intended for Le Mans, which

was to be part of a major logistical

support area but was never completed

as the advance left it far behind, went

instead to Depot M-406T, set up on

26 August in stubble fields near

Chartres. Part of a major Red Ball Express terminal, M-406T received and

distributed about 4,000 tons of medical supplies before closing on 29 September. On 6 September the 31st

Medical Depot Company moved into

two large warehouses formerly belonging to the Paris Chamber of

Commerce and transformed them

into Depot M-407. Conveniently located alongside a rail spur and a

canal, M-407 became the single most

important continental medical supply

facility. It received matériel from Normandy and from M-406T at Chartres,

shipped supplies forward to the

armies and ADSEC, and supported

the hospitals and holding units in

Paris. Beyond the Seine, Depot

M-408 began operations in a takenover warehouse in Reims on the

twentieth, issuing to the armies and

to neighboring COMZ units. Finally,

as the Advance Section established a

forward logistical base at Liege,

Depot M-409 opened on 27 October

in a Belgian customs warehouse and

nearby garages to serve the First and

Ninth Armies. Depots farther to the

rear, meanwhile, closed down, M-401

at Cherbourg in late August, M-404

at Rennes in mid-October, and M403 at L'Etard in mid-November.

Depot M-402 at Chef-du-Pont expanded into the main Normandy receiving point for supplies arriving on

the Continent from England and

America.45

The continental depots labored

under handicaps (see Map 14). As had

been true in Great Britain, T/O

depot companies seldom had enough

men to operate large COMZ installations. They augmented their strength

with German prisoners (who, howev44

 ADSEC Hist, p. 75.

45

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, pp. 8-15; Surg, ADSEC,

COMZ, Annual Rpt, 1944, pp. 27-29 and ex. K;

Surg, Brittany Base Section, Annual Rpt, 1944, pp.

4-5; Surg, Seine Section, Annual Rpt, 1944, pp. 40-

42; 13th and 30th Medical Depot Companies

Annual Rpts, 1944. Medical depots exclusively had

an "M" prefix, while general depots, which might

have medical sections, carried a "G" prefix.
THE EXPANDING COMZ 343

er, required depot company men to

guard them), with enlisted men detailed from staging medical units, and

with French civilians. At M-407 the

31st Company eventually employed

over 200 Parisians. The depot companies needed all the manpower they

could obtain because, except for

M-407, they were short of cranes, forklifts, and other machinery for

moving heavy weights. Much of their

initial stock arrived on the massive

sled-like skids intended for beach disembarkation and open-air storage.

Lacking equipment for lifting these

skids, depot troops often had to

unpack them on the trucks that

brought them, thereby delaying the

release of scarce vehicles. At Le Mans

and Chartres they hit upon the expedient of digging pits into which trucks

could back, bringing the decks of

their cargo compartments level with

the ground and permitting other vehicles, or men with ropes, to drag off

the skids. Open-field depots dissolved

into quagmires, as heavy traffic destroyed the surfaces of dirt roads and

as the fall rains soaked the country- side. The mud became so deep at

M-406T that Red Ball trucks at times

simply unloaded where they bogged

down. After much effort, the 30th

Company, which operated this depot,

managed to pave two roads with

gravel and obtained a portable conveyor to move freight from trucks to

the fields, where it rested on dunnage

made of brush and timber from the

nearby woods. At busy M-402, deep- ening mud finally defeated the efforts

of the 11th Medical Depot Company

to keep supplies moving, even though

the company reconditioned several

abandoned French and German tractors to free mired vehicles. During

November the depot shifted operations to Carentan, where it obtained

buildings and hard-surfaced open

storage on an abandoned airstrip.46

Control of depot operations and

supply issues changed as the lines of

communications lengthened. At the

start of the pursuit the ADSEC and

FECOMZ surgeons supervised all

medical supply functions, including

reception of incoming goods and

issues to the Communications Zone

and the armies. The ADSEC medical

supply division processed all requisitions from the armies, either filling

them from its own dumps or calling

for emergency shipments from Great

Britain. As it moved away from the

coast, the Advance Section turned

over its beach installations to the

Normandy Base Section, the surgeon

of which thereafter oversaw reception

and forwarding of medical supplies

that arrived by sea. The Advance Section set up the depots at Rennes, Le

Mans, Chartres, and Reims, and then

left them to other base sections as it

continued to follow the armies. From

mid-August on, the Supply Division

of the chief surgeon's office assumed

direct technical supervision of receiving, storage, stock control, and issuing by all COMZ depots. The armies

then requisitioned directly from the

depots through the regulating stations, entirely bypassing the ADSEC

surgeon.47

46

 Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 29;

Surg, Normandy Base Section, Annual Rpt, 1944, p.

19; Surg, Seine Section, Annual Rpt, 1944, pp. 40-

41; 11th, 13th, and 30th Medical Depot Companies

Annual Rpts, 1944. 47

 Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 27

and ex. K; Supply Division, OofSurg, ADSEC,

Weekly Activities Rpt, week ending 19 Aug 44, Continued
344 EUROPEAN THEATER OF OPERATIONS

MANEUVERING A CAPTURED GERMAN TRACTOR THROUGH THE MUD AT MEDICAL

DEPOT M-402

Beginning in September the 12th

Army Group-SHAEF tonnage allocation systems dominated medical

supply of the armies and ADSEC.

Under these systems each army and

the Advance Section received a daily

allowance of supplies, which they divided among their own technical services as the basis for their requisitions. For the medical service First

Army, Third Army, and ADSEC allotments together varied from 20 to 90

tons a day, depending on the period

of the pursuit. At COMZ headquarters medical supply officers, working

with the G-4, reconciled army and

ADSEC requisitions with the Red Ball

space assigned to the medical service

for that day. The Normandy Base

Section loaded the supplies and started them forward, initially to the

Chartres terminal area and later to

Soissons and Sommesous. At the

latter two places ADSEC medical intransit storage points (MISPs),

manned by detachments from the

regulating stations, checked incoming

Red Ball trucks for medical service

freight and either directed the drivers

to final destinations or unloaded the

cargo and held it for pickup by the

armies.

Through tonnage allocation and

the Red Ball Express, the medical service was guaranteed transportation

Beasley Papers, MHI; Surg, Normandy Base Section,

Annual Rpt, 1944, pp. 18-19; Fenton Interv, 7 Jun

45, box 222, RG 112, NARA.
THE EXPANDING COMZ 345

for a limited amount of its supplies,

but the systems had their drawbacks.

Tonnage allocation, while it worked

well for uniform bulk shipments, such

as rations, ammunition, and POL, was

ill-adapted to the variety of small

items the medics had to move. The

daily transportation allowance, measured in total weight and volume, did

not always match the day's requisitions, forcing the Supply Division to

leave out some articles while including others, not wanted by the armies,

to fill the assigned space. Stock control broke down in both the armies

and Communications Zone. The

Supply Division chief, Colonel Hays,

reported that the "armies were constantly in a quandary as to the quantities yet due in and had difficulty in

preparing their requisitions." Medical

service supplies, seldom enough on a

given day to fill an entire convoy,

usually went forward in single truckloads. In spite of the best efforts of

the MISPs, shipments often disappeared en route, as the vehicles carrying them broke down or were misdirected. The Red Ball system as a

whole suffered from deficiencies in

convoy control so that the Supply Division rarely could trace missing cargoes.48

During the pursuit air transport

played as vital a role in medical

supply of the armies as it did in evacuating casualties, and in the supply

function it was more reliable. Unlike

evacuation, aerial resupply of ground

forces possessed status as a recognized mission, which the chief surgeon could request through a liaison

officer at CATOR. In addition, before

D-Day, General Hawley persuaded

the theater to assign one C-47, reinforced in late June by a second, exclusively to the medical service each day

to fly whole blood, biologicals, and

emergency cargoes across the Channel. These aircraft picked up their

loads at Greenham Common airstrip,

conveniently close to Depot G-45 at

Thatcham, a major medical supply facility, and to the ETO blood bank at

Salisbury. They discharged freight at

army and ADSEC fields, and also at

Le Bourget, for transfer to the UC64s. During August, September, and

October the regularly assigned transports, and others on occasional missions, hauled several hundred thousand pounds of medical supplies each

week. According to Lt. Col. Robert R.

Kelley, MC, one of Hays' assistants,

"During nip-and-tuck phases of the

operations, we were able in all instances to adequately make supplies

available through ... air lift." Airlift, however, also had its disruptive

aspects. Most air shipments, particularly emergency ones, duplicated supplies previously requisitioned and

delayed somewhere in the line of

communications, thereby contributing

to record-keeping confusion and to

the misallocation of matériel.49 48

 Quotation from Supply Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, sec. II, ex. III

(Memo, Col S. B. Hays to Hawley, 24 Dec 44, sub:

Difficulties in Moving Medical Supplies and Equipment), pp. 1, 8-9, 11. See also Surg, ADSEC,

COMZ, Annual Rpt, 1944, pp. 28 and 59-60; Surg,

ADSEC, Daily Activities Rpt, 13 Sep 44, Beasley

Papers, MHI; ADSEC Hist, pp. 75-76.

49

 Quotation from Kelley Interv, 27 Jan 45, box

221, RG 112, NARA. See also Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec.

II, pp. 20-22 and exs. X and XI; Kendrick, Blood

Program, p. 533.
346 EUROPEAN THEATER OF OPERATIONS

While the Red Ball Express and

aerial resupply kept army and COMZ

medical units going from day to day,

they were no substitute for full, balanced continental stocks, properly

distributed among rear, intermediate,

and forward depots. The Supply Division, before the invasion, had made

detailed plans for establishing such

stocks, initially by pre-scheduled shipments from Great Britain and, after

about 1 September, by deliveries directly from the United States to

France. The army's delay in opening

Cherbourg, and its failure to open the

Brittany ports at all, caused the entire

supply buildup to fall behind schedule. In Britain, goods intended for

cross-Channel movement backed up

in ports and depots; cargoes from the

United States had to be diverted to

England from Normandy added to

the congestion. Other medical supplies remained unreachable for weeks,

even months, on vessels anchored offshore awaiting access to limited unloading facilities. One ship from New

York, which arrived in French waters

on 17 August, did not begin discharging her cargo until 10 December. Because the New York Port of Embarkation usually placed all of a given shipment of a particular item on only a

few vessels, such diversions and unloading delays totally upset the effort

to accumulate balanced stocks. Reserves never reached the desired

D+180 level of sixty days, and surpluses in some categories were

matched by persistent shortages in

others. The Supply Division repeatedly had to make emergency requisitions upon the United Kingdom Base

to replace continental stores or meet

immediate needs.50

The difficulties of landing supplies

on the Continent were minor compared with those of moving goods

forward, especially for the purpose of

filling COMZ depots. With the Red

Ball Express and air transport almost

entirely employed in day-to-day support of operations, medical supply officers and depot commanders relied

on improvisation and the seizure of

every random opportunity to build up

their advance reserves. To stock

Depot M-404 at Rennes, Colonel

Hays and his staff collected trucks

from the Normandy Base Section

general hospitals for a shuttle from

Chef-du-Pont. In late September the

Supply Division transferred about 800

tons of freight from Normandy to

Paris in over 560 replacement jeeps,

trucks, and weapons carriers destined

for the armies. Hays provided drivers,

detailed from staging medical units,

for these vehicles, in return for Ordnance service permission to fill them

with medical cargo for a one-way trip.

When closing M-406T, the commander of the 30th Depot Company,

unable to round up trucks to shift

supplies to Paris and Reims, finally

secured 17 tank retrievers. A single

one of these large flatbeds could haul

over 30 tons at a time, either directly

to a destination depot or to a railhead. As hospital trains began running out of Paris, the depot there

50

 Ltr, Hawley to TSG, 14 Sep 44, file HD 024

ETO O/CS (Hawley-SGO Corresp); An. 9—Medical, p. 4 and encl. 1, to FECOMZ Plan, 14 May 44,

file HD 370 ETO; Wiltse, ed., Medical Supply, pp.

265-390; Kelley Interv, 27 Jan 45, box 221, RG

112, NARA; Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. II, ex. HI, pp. 1

and 3-4, and sec. V. p. 4.
THE EXPANDING COMZ 347

hitched loaded freight cars onto them

for their forward trips. The Advance

Section, early in October, set up a

medical in-transit storage point at

Liege to receive cargoes thus transported; the same installation sent

emergency requisitions back to Paris

on southbound trains. Use of such expedients declined as the railroads carried increasing tonnages, but the

struggle adequately to stock the

depots continued throughout the rest

of 1944.51

Like the field armies, the Communications Zone augmented its supplies

and overcame some temporary scarcities with captured German instruments, dressings, hospital equipment,

and drugs. In Paris alone the Seine

Section discovered 127 separate

caches of enemy medical matériel—in

warehouses, office buildings, tunnels,

barracks, barges, railroad cars, and

hospitals. The American collected

these supplies, made inventories,

checked medicines for safety and correct labeling, and separated out items

already in the medical service catalog

or which could substitute for standard

Army goods. They issued the rest of

the matériel to civil affairs units, local

health authorities, and POW camp

dispensaries. In September, elements

of the 13th Medical Depot Company

set up in Reims a central collecting

point for captured supplies in what

had been a major German medical

depot. This facility, designated Depot

M-412, received enemy medical matériel 

prepared it for American and Allied

use. It eventually helped to equip and

supply twenty-eight U.S. Army hospitals, fourteen POW enclosure dispensaries, and eighteen displaced person

camps, as well as sent selected articles

to the Medical Field Service School at

Carlisle Barracks, Pennsylvania, for

study. For Army medical units, captured goods alleviated some shortages

and provided supplementary items.

Hospital trains, for example, used

German aluminum milk cans and

mess equipment for feeding patients

during runs.52

During the pursuit the Communications Zone kept supplies flowing to

the armies at a rate sufficient to meet

the fortunately reduced requirements

of a period of mobile warfare with

light casualties. It also filled the dayto-day needs of its own holding units,

general hospitals, and other installations. Only COMZ medical units in

army areas reported difficulty in securing supplies; not permitted to

draw for expendables on scanty army

stocks, these organizations had to

send their own trucks long distances

back to ADSEC or the beaches, or to

call for emergency air shipments.

Medical supply officers, by loading

stores on anything they could find

that was moving forward, made at

51 least a start on building reserves close Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, ex. III, pp. 1-2 and 14-

15; Fenton Interv, 7 Jun 45, box 222, RG 112,

NARA; Surg, Normandy Base Section, Annual Rpt,

1944, pp. 20-21; Surg. Seine Section, Annual Rpt,

1944, pp. 39-40; Surg, ADSEC, COMZ, Annual Rpt,

1944, p. 29; Surg, ADSEC, Daily Activities Rpt, 31

Aug 44, Beasley Papers, MHI; 30th and 66th Medical Depot Companies Annual Rpts, 1944.

52

 Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 28

and ex. K; Supply Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, sec. II, pp. 16-17;

Surg, Seine Section, Annual Rpt, 1944, pp. 38-39;

Surg, Oise Base Section, Annual Rpt, 1944, pp. 3-4;

13th Medical Depot Company Annual Rpt, 1944,

pp. 15-16.
348 EUROPEAN THEATER OF OPERATIONS

to the front. As was true for evacuation, the framework of a continental

medical supply system was in place by

the end of October.53

Supplying Whole Blood

The European Theater whole blood

distribution system, carefully planned

and organized before D-Day, was in

full operation by the time of the St.-

Lo breakout. Behind each of the

armies, an ADSEC blood bank detachment, located at a resupply airfield, received daily planeloads of

blood from the Salisbury bank, which

sent it across the Channel packed in

ice in insulated Marmite cans designed originally as Quartermaster

food containers. Refrigerator trucks

of the ADSEC detachments delivered

the blood to counterpart units with

the First and Third Armies; the army

detachments in turn distributed the

precious fluid to evacuation hospitals

and clearing stations. Colonel Beasley's deputy surgeon, Colonel Mason,

who had helped set up the system,

now directed its operation, working

closely with the army group and army

surgeons. The blood supply service

encountered typical difficulties of the

pursuit, such as diversion of its vehicles to other missions and inability of

truck drivers to find rapidly moving

evacuation and field hospitals. In general, though, the whole blood system

worked smoothly, even as supply lines

lengthened and one ADSEC detachment was taken away from support of

the main advance to supply the VIII

Corps in Brittany.54

For General Hawley and his assistants, the question late in July was

whether the detachments would have

enough blood to distribute. The first

two months of combat surgery in

evacuation and field hospitals confirmed what medical officers had anticipated before D-Day: that the rate

of blood usage would be high and

that the theater, from its own sources,

would not be able to meet the

demand. Whereas the writers of the

Manual of Therapy envisioned surgeons

administering approximately 1 pint of

whole blood to every 2 of plasma, the

actual ratio was nearer 1 to 1. Surgeons in Normandy used an average

of 1 pint of whole blood for every 4

casualties. On visits to the forward

hospitals Hawley and his consultants,

after careful observation, concluded

not only that such lavish (as they

thought) transfusion of whole blood

was clinically justified, especially in

combating shock, but that patients

probably would benefit from even

more blood than surgeons were administering. At first sceptical, Hawley

was later to recall that doctors in the

Normandy evacuation hospitals

53

 For COMZ unit supply problems, see 9th Field

Hospital Annual Rpt, 1944, p. 13; 15th General

Hospital Annual Rpt, 1944, p. 8; and 127th General

Hospital Annual Rpt, 1944, p. 7.

54

 Assignments were: First Army - Detachment A,

with Detachment B in COMZ; Third Army - Detachment C, with Detachment D in COMZ. See Kendrick, Blood Program, pp. 518-21, 532-35, 549-51;

Supply Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, sec. II, p. 20; Surg, ADSEC, COMZ,

Annual Rpt, 1944, pp. 55-56; Surg, ADSEC, Daily

Activities Rpts, 22 Jul and 16 Aug 44, Beasley

Papers, MHI; Surg, Brittany Base Section, Annual

Rpt, 1944, p. 5. On operating difficulties, see Ltr,

Hawley to Col J. A. Rogers, 19 Jul 44, file HD 024

ETO CS (Hawley Chron); Surg, XII Corps, Annual

Rpt, 1944, p. 6; Surg, XX Corps, Annual Rpt, 1944,

p. 24; Joseph B. Mason, "The Role of ADSEC in

the Supply of Whole Blood to the Twelfth Army

Group," The Military Surgeon 103 (July 1948): 9-14.
FLIGHT NURSE LIFTING MARMITE CAN OF ETO BLOOD ONTO A CONTINENT-BOUND C-47
350 EUROPEAN THEATER OF OPERATIONS

"made a Christian out of me. They

convinced me." Accordingly, army

blood requirements increased. By the

end of June the First Army was consuming about 500 pints a day, in

effect the entire production capacity

of the Salisbury bank. The Third

Army, as it prepared to go into

action, requested 300 pints a day initially, to be increased to 550 as its

front expanded, an amount that the

theater blood bank, with its donor

pool of COMZ troops shrinking as

units moved to France, could not possibly furnish. With a shortage imminent, the 12th Army Group surgeon

early in August began daily allocation

of the available blood to the armies to

ensure its most efficient use. Evacuation and general hospitals set up

their own blood banks, drawing from

their personnel and the lightly

wounded. They used German POWs

as donors for their injured countrymen.55

These expedients, however, were

but stopgaps. Hawley and his assistants realized that the theater needed

an additional source of whole blood

and that the only possible one was

the United States. Surgeon General

Kirk, before the invasion, had rejected as unnecessary and impractical a

theater proposal to fly blood across

the Atlantic. Nevertheless, under

pressure of necessity, Hawley revived

it, even though he himself feared that,

given the time required for shipment,

blood from the United States would

have only a short usable life in the

European Theater. After a final conference with his consultants on 28

July, Hawley four days later radioed

to General Kirk a request for a daily

transatlantic blood airlift of up to

1,000 pints. In a follow-up letter he

informed the surgeon general that the

Air Transport Command had agreed

to provide long-range C-54s for the

mission, and insisted that blood was

being used economically and that it

was "saving lives and hastening recovery of patients."

 56

 Hawley also arranged to fly Colonel Cutler, his chief

surgical consultant, Major Hardin, officer in charge of the ETO blood

bank, and Col. William F. MacFee,

MC, a veteran evacuation hospital

commander, to Washington to plead

the theater case in person. The three

men left Prestwick on 12 August.

Even as the delegation was airborne, the issue was all but settled. In

early August General Kirk, on the

basis of additional study and of firsthand observation on a trip to the

Mediterranean Theater in July 1944,

reversed his earlier decision against

shipping blood overseas and put his

Surgery Division to work on tentative

plans for a blood airlift to Europe. By

the time Cutler and his colleagues

landed in Washington, Kirk's consultants already had worked out a

method for shipping blood and had

tested it by flying sample lots to

Prestwick, Bermuda, Los Angeles, and

Hawaii. All that remained for the

55

 Quotation from Editorial Advisory Board, 1962,

pp. 107-08. See also Kendrick, Blood Program, pp.

484-87 and 556-65; Surg, ADSEC, COMZ, Annual

Rpt, 1944, pp. 53-54; Admin Memo No. 2, Surg,

ADSEC, 5 Aug 44, in Essential Technical Medical

Data Rpt, HQ, ETOUSA, August 1944; Medical Division, COSSAC/SHAEF, War Diary, August 1944;

Ltr, Hawley to Rogers, 19 Jul 44, file HD 024 ETO

CS (Hawley Chron). For a dissenting view of blood

use, see Keeler Interv, 17 Jul 45, box 223, RG 112,

NARA.

56

 Ltr, Hawley to TSG, 5 Aug 44, file HD 024

ETO O/CS (Hawley-SGO Corresp).
THE EXPANDING COMZ 351

MAP 15

ETO representatives to do was to

help work out detailed arrangements,

which they promptly did.57

Blood flights began on 21 August,

with a shipment of 258 pints from

New York, via Newfoundland, to

Prestwick (Map 15). Under the formula worked out by Cutler in Washington, the daily amounts were to increase to 500 pints on 28 August and

1,000 by 11 September. Actual deliveries reached a little over 500 pints

per day in late October, the reduction

from the scheduled goal resulting

from a decrease in demand. The Red

Cross collected the fresh blood at

centers on the East Coast and in the

Midwest, processed it, and put it up

for shipment in 1,000 cc. bottles containing equal amounts of blood and

Alsever's solution, a preservative. So

prepared, the blood could be flown

without refrigeration, which saved

weight. Air Transport Command C54s unloaded the blood at Prestwick,

for movement by truck to Salisbury

and transfer to C-47s for the crossChannel flight. Late in October transatlantic planes carrying blood began

landing at Orly Field, near Paris,

eliminating the time-consuming extra

handling in Great Britain. Kept refrigerated except while actually on the

airplane, the preserved American

blood could be used safely for at least

eight or nine days after it reached the

theater. Blood from the United States

soon predominated in ETO stocks.

During September, for example, the

armies received about 11,000 pints

from America and only 5,600 from

within the theater. Ironically, the beginning of shipments from the United

States coincided with a decline in casualty rates. In late September the

medical service possessed a surplus of

about 6,000 pints and made special

efforts to use up the oldest blood

before it had to be discarded.58

57

 Kendrick, Blood Program, pp. 487-93; Ltrs, TSG

to Hawley, 11 Aug and 1 Sep 44, file HD 024 ETO

O/CS (Hawley-SGO Corresp); Hawley Interv, 1962,

p. 62, CMH.

58

 Unlike ETO blood, which contained no preservative and was shipped in food cans packed with ice, Continued
352 EUROPEAN THEATER OF OPERATIONS

The theater blood bank reorganized and expanded for continental

operations. Under plans made back in

April, the medical service converted

the newly arrived 127th Station Hospital into a second blood bank unit.

On 26 August the 127th took over

the Salisbury collection and processing plant. The veteran 152d Station

Hospital then moved to Paris, first to

temporary quarters at the 203d General Hospital and then to a permanent facility at Vitry. This unit, beginning early in November, received all

blood sent to the Continent from

Britain and the United States and distributed it to ADSEC detachments. It

also collected blood locally from

COMZ troops. At the front the four

detachments serving the First and

Third Armies were augmented on

1 November by Detachments A and B

of the 127th Station Hospital, which

supported the recently deployed

Ninth Army. Refrigerator trucks of

these units regularly distributed as

many as 20,000 pints of blood a

month, with losses of less than 10

percent from breakage, refrigerator

failure, and deterioration from lack of

use. The latter wastage was unavoidable, for army medical units requisitioned daily on the basis of casualty

estimates and thus preferred to err on

the high side. Clearly, the whole

blood service, with its supplies now

assured, had proved to be one of the

ETO medical service's major logistical

successes.59

On the Eve of New Battles

During the three months following

the breakout from Normandy, the

medical service, like the other technical services, saw its preinvasion plans

for orderly development of the Communications Zone swept aside by

events. The chief surgeon and his assistants constructed evacuation, hospitalization, and medical supply systems

on the run, while trying to meet the

daily needs of the armies and to push

people and equipment forward along

the axes of advance. By late October

they had completed the framework of

a medical Communications Zone

stretching from the beaches to the

army rear boundaries. General hospitals were in operation at key points in

France and Belgium, supply depots

were being stocked, and rail and air

evacuation channels were increasing

in variety and efficiency.

Nevertheless, the medical support

system gave evidence of its hurried,

disorderly origins. It incorporated

major inefficiencies, such as employment of many of the theater's best

staffed general hospitals as holding

and transit units. Air evacuation, the

most rapid and clinically beneficial

means of moving patients, remained

at the mercy of weather and administrative uncertainties. There existed

American blood traveled all the way to the front in

cardboard containers, each holding six bottles. See

Kendrick, Blood Program, pp. 208-10, 493-96, 538-

41, 554-55; Essential Technical Medical Data Rpts,

HQ, ETOUSA, August 1944, pp. 13-14, September

1944, p. 13, and October 1944, p. 4; Supply Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

sec. II, p. 22; Medical Bulletin No. 25, OofCSurg,

HQ, ETOUSA, 1 Nov 44, sub: The Supply of Preserved Blood From the Zone of Interior to the European Theater of Operations; Ltr, Hawley to TSG,

14 Sep 44, file HD 024 ETO O/CS (Hawley-SGO

Corresp).

59

 Kendrick, Blood Program, pp. 513-17 and 566-

67; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp.

54-56; Essential Technical Medical Data Rpt, HQ,

ETOUSA, October 1944, p. 4.
THE EXPANDING COMZ 353

within the medical service, also, other

organizational weaknesses and personnel and matériel shortages largely

overlooked in the triumphant forward

rush of the summer. The effects of all

these deficiencies would become apparent, and provoke vigorous efforts

to overcome them, during the winter

of hard, costly fighting that lay ahead

at the West Wall.
CHAPTER XI

Hard Fighting at the West Wall

During the autumn and early winter

of 1944 the Allied armies reorganized

and drove forward all along a front

that now extended from the Channel

to the Swiss border. They collided

with a revived and reinforced Wehrmacht in what became at many points

a bitter, costly battle of attrition. In

this battle the European Theater field

army medical service, taking the strain

of a continuous high casualty rate,

reached full development in organization and technique.

By mid-September the U.S. 12th

and 6th Army Groups formed respectively the center and right of the

Allied line. They included twentyseven of the forty-nine divisions then

at the disposal of SHAEF on the Continent. Americans—in the army

groups and their supporting air and

service forces—made up about half of

the 2 million men under Eisenhower's

command. The American army

groups paused at the West Wall and

the Moselle, to build up their attenuated supply system and to reorganize

for the new offensive. When these

troop rearrangements were completed late in October, the 12th Army

Group had three armies on line—

from left to right, the Ninth, First,

and Third. To the right of the 12th

Army Group General Devers' 6th

Army Group, which came under

SHAEF's operational control on 15

September, placed the two corps of

the French First Army on its right

wing and the U.S. Seventh Army,

composed only of the three-division

VI Corps, on its left. SHAEF, late in

September, reinforced the Seventh

Army with the rightmost corps of the

Third Army and also with new divisions shipped directly from America

to southern France.1

The American and French armies,

and the British and Canadian elements of Montgomery's 21 Army

Group on the Allied left, launched

their new attacks between 8 and 16

November. SHAEF, still reflecting

some of the optimism of the summer,

when hopes for an early German collapse had run high, set ambitious objectives for this drive: reaching the

Rhine, destroying the German armies

west of that river, and perhaps securing bridgeheads across it. At the minimum, a continued fall-winter offensive would deny the enemy leisure to

rebuild his armies, strengthen his for1

 The Ninth Army brought the VIII Corps up

from Brittany early in October and initially entered

the line in the Ardennes. It shifted to the 12th Army

Group's left after relinquishing the corps to the

First Army and in turn taking over the latter's leftmost corps, the XIX.
HARD FIGHTING AT THE WEST WALL 355

tifications, and introduce new weapons. The Germans, however, had

used all too well what breathing space

the September and October pause in

Allied attacks had given them. By the

time the new offensive started, their

desperate late-summer mobilization

had produced enough troops to contain the Allied advance while accumulating a 25-division reserve for Hitler's projected grand counterattack.

Gone were the days of swift breakthroughs and hell-for-leather armor

exploitation. The battle became one

of attrition, as British, French, and

American divisions crawled forward

against tenacious resistance. The Germans drew upon the hard-learned defensive experience of five years of war

and made lavish, effective use of

mines and artillery; they exacted a

fearful price in men and time for

every town, village, ridgeline, river

crossing, and pillbox. The rain, snow,

and freezing temperatures of one of

the earliest and severest winters on

record in that part of Europe reduced

Allied mobility and air support and

added to the misery of the combatants on both sides.

Nevertheless, through hard pounding and steady pressure the Allies

made limited territorial gains. On

their left wing the British Second and

Canadian First Armies conquered the

German forces blocking the seaward

approaches to Antwerp, thus opening

that great port to shorten Allied

supply lines; then they liberated most

of southern Holland. The U.S. Ninth

and First Armies, attacking side by

side, forced their way well inside the

German frontier and drove almost to

the Roer River, the last major water

barrier between them and the Rhine.

On the southern flank of this attack

the First Army fought possibly the

bitterest battle of the campaign for

the Huertgen Forest, a gloomy roadless tangle of fir trees, hills, and ravines. Although the Americans

cleared the woodlands in the end,

combat for the infantrymen of five divisions who battled there was a nightmare of endless minefields, treetop

shellbursts, hidden pillboxes and machine-gun nests, and fierce German

counterattacks. A rifle company in the

Huertgen Forest could lose 100-200

percent of its original strength in a

week's fighting; battalion and company officers and NCOs were killed and

wounded or broke down in near-disastrous proportions. A 4th Infantry

Division soldier summed it up:

You can't get all of the dead because you

can't find them, and they stay there to

remind the guys advancing as to what

might hit them. You can't get protection. You can't see. You can't get fields of fire. The trees are slashed like a scythe by ar- tillery. Everything is tangled. You can

scarcely walk. Everybody is cold and wet, and the mixture of cold rain and sleet

keeps falling. Then they jump off again

and soon there is only a handful of the

old men left.2

South of the Ardennes the enemy

defended with similar tenacity, but

American troops gained more

ground. Patton's Third Army crossed

the rain-swollen Moselle in force;

took Metz on 22 November; and a

month later, after liberating 5,000

square miles of Lorraine, reached the

German border at the Saar River. On

the right of the Third Army the 6th

2

 Interv, T5g George Morgan, 1st Battalion, 22d

Infantry, in 4th Infantry Division Combat Intervs,

box 24021, RG 407, NARA.
356 EUROPEAN THEATER OF OPERATIONS

Army Group cleared the west bank of

the Rhine from the Swiss border to

Strasbourg, except for a German-held

bridgehead around Colmar. While the

French First Army battered at this

pocket, the U.S. Seventh Army in

early December pushed northeastward though the old Maginot Line

fortifications and prepared to assault

the West Wall. The American armies

thus captured significant territory,

though less than their commanders

had hoped to secure. In addition,

they inflicted tens of thousands of

German casualties, destroyed large

quantities of equipment, and took

almost 200,000 prisoners.3

The four American armies paid a

high price for this ground and the

wearing down of German forces. Between them, they suffered over

140,000 battle casualties, more than

85 percent of them in the infantry

rifle companies. Among the approximately 100,000 wounded, the pattern

of cause and location of injury resembled that in earlier phases of the campaign. About 65 percent fell victim to

shell, bomb, and grenade fragments,

and a similar proportion were hit in

the arms and legs. Besides combat

casualties, army hospitals during November and December admitted another 150,000 cases of injury, sickness, and combat fatigue. The cold

damp weather increased the incidence

of respiratory ailments. An epidemic

of trenchfoot crowded clearing stations and evacuation hospitals with

crippled soldiers, many permanently

incapacitated for combat duty, and

further diminished the already casualty-thinned ranks of the infantry.4

Organizing for the Offensive

Redeployments and exchange of

medical units accompanied the reorganization of the American armies for

the November offensive. New ground

force medical formations continued to

arrive in the theater, increasing the

number of medical personnel in the

armies to over 65,000 by mid-December. The 12th and 6th Army Group

surgeons, in consultation with those

of the armies and with Generals

Kenner and Hawley, distributed the

new arrivals and reshuffled the forces

already on the ground to give each

army a medical complement proportional to its strength.5

The Ninth Army, for example, initially entered the line in the Ardennes

with the 64th Medical Group, sup3

 This account is based on MacDonald, Siegfried

Line, passim; Cole, Lorraine Campaign, passim; Robert

R. Smith and Jeffrey J. Clarke, The Riviera to the

Rhine (Washington, D.C.: U.S. Army Center of Military History, forthcoming), chs. XVI-XXVI; Seventh

U.S. Army Report of Operations, France and Germany, 1944-1945, vol. II, pp. 456-94, 505-13, 529.

4

 MacDonald, Siegfried Line, p. 617; Cole, Lorraine

Campaign, pp. 592-93; Surg, First U.S. Army,

Annual Rpt, 1944, pp. 5-6; First U.S. Army Report

of Operations, 1 Aug 44-22 Feb 45, bk. IV, pp. 139,

179, 201, 205; Surg, Third U.S. Army, Annual Rpt,

1944, pp. 43-44, 104, 108, ex XXVII; Surg, Seventh

U.S. Army, Annual Rpt, 1944, pp. 29-32 and 37d37f; Seventh U.S. Army Report of Operations,

1944-1945, vol. III, p. 1,029; Surg, Ninth U.S.

Army, Annual Report, 1944, pp. 20-22; Surg, Ninth

U.S. Army, Combat Experience Tables of Casualties, Ninth U.S. Army, October-December 1944

(hereafter cited as Combat Experience Rpt, with

month), file HD 319.1-2. For typical casualty distribution among arms, see Surg, XIX Corps, Annual

Rpt, 1944, encl. 20. 5

 Ground forces medical personnel amounted to

about 32-38 percent of the total theater medical

strength of over 212,000 in late December. See Personnel Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, app. D. MFR, Col B. A. Holtzworth, 8

Jan 45, sub: Notes on Service Troops, Moses

Papers, MHI, gives 12th Army Group standards for

field army medical troop strength.
HARD FIGHTING AT THE WEST WALL 357

porting the VIII Corps, as well as several former Third Army field and

evacuation hospitals and other units

taken over in Brittany. When it

moved to Holland and joined the

12th Army Group's left wing, the

army relinquished these organizations, except for two field hospitals,

to the First Army and assumed command in turn of the 31st Medical

Group, which supported the XIX

Corps (taken over from the First

Army) and three evacuation hospitals.

The new army also inherited several

evacuation hospitals and field hospital

platoons serving American divisions,

including the 82d and 101st, which

were fighting in Holland under 21

Army Group in the aftermath of

MARKET-GARDEN. Other Ninth Army

medical units, arriving from the

United States and Great Britain, assembled at concentration areas in

France and Belgium and then moved

into Holland to support the army's

second corps, the XIII, when it began

operations late in November.6

The Seventh Army came ashore on

the Riviera with a complement of

medical battalions, of ambulance,

clearing, and collecting companies,

and of field and evacuation hospitals

sufficient only for a single corps. As

SHAEF added to that army's combat

strength, it also reinforced the medical service—a process involving multilateral consultations among the surgeons of the two army groups, four

field armies, and two separate communications zones. During September

the Seventh Army acquired from the

Third Army an additional medical

battalion headquarters, three collecting companies, a clearing company,

and a field hospital, as well as the

Third's XV Corps. SHAEF at the

same time directed the European

Theater and 12th Army Group to

provide the southern army with three

additional ambulance companies,

three evacuation hospitals, a depot

company, and part of an auxiliary surgical group. Both headquarters complied, in part by transferring units already in France to the 6th Army

Group and in part by diverting new

units then still in the continuing flow

of troops across the Atlantic. Late in

November, with planning under way

to expand Seventh Army to three

corps and nine divisions, SHAEF

called on the northern forces for still

more field medical units, and they

again responded with redeployments,

to include, whenever possible, redirecting reinforcements already at sea

to the French Mediterranean ports.

Augmentation of the Seventh Army

medical service did not go altogether

smoothly. Colonel Gorby, the 12th's

surgeon, resisted turning over an auxiliary surgical group, insisting he

needed it for his own still expanding

army group, but in the end he complied with SHAEF directions. The 6th

Army Group surgeon, Col. Oscar S.

Reeder, MC, and the Seventh Army

surgeon, Colonel Rudolph, at times

disagreed in estimating their requirements. Reeder, for example, accepted

a medical group headquarters, taken

from the Third Army, for which the

Seventh Army surgeon had no use,

but withdrew a request for a gas

treatment battalion that Rudolph

wanted. The medical units assigned

6

 Surg, Ninth U.S. Army, Annual Rpt, 1944, pp.

8-9 and 11-13; Surg, First U.S. Army, Annual Rpt,

1944, p. 48; First U.S. Army Report of Operations,

1 Aug 44-22 Feb 45, bk. IV, p. 136.
358 EUROPEAN THEATER OF OPERATIONS

to the Seventh Army took a while to

arrive. Those allocated in September,

for instance, joined only in late No- vember. The three evacuation hospi- tals that arrived immediately after

being activated in the United States

needed additional training before

they could become operational. While

the unwanted medical group headquarters, the 67th, waited for a new

assignment, the Seventh Army conducted most of the autumn campaign

with a shortage of field and evacuation hospitals, only partially alleviated by borrowing from the southern

communications zone. These difficulties, however, were only temporary.

By late December the Seventh Army

included ten evacuation and four field

hospitals, a convalescent hospital, portions of two auxiliary surgical

groups, six separate medical battalions with attached collecting and

clearing companies, six ambulance

companies, a depot company, and assorted laboratory and veterinary units

(the latter loaned to the French First

Army to care for its pack animals).7

The French First Army, the other

major component of the 6th Army

Group, possessed its own separate

medical service. This army, organized

and equipped in North Africa with

American assistance, included a full

complement of ground forces medical

units with American tables of organization and equipment and with

French personnel. Its hospitalization

and evacuation system closely resembled those of the U.S. field armies. By

late 1944 the French had about 7,000

field and evacuation hospital beds in

operation for their two corps and

seven divisions; up to that point in

the campaign they had cared for

about 23,000 casualties. They evacuated their long-term patients by rail

to fixed hospitals, many of them civilian, in liberated southern France and

had their own supporting communications zone organization, Base 901, in

the same area. The French relied

heavily on American medical supplies,

which they delivered to their forward

units through their own depot system.

General Kenner, after a mid-December inspection, pronounced the

French First Army medical situation

"quite satisfactory, sufficient medical

units are available, and civilian facilities and personnel augment them

throughout the area."

 8

Except in allocating medical units,

the army group surgeons—Colonel

Gorby of the 12th and Colonel

Reeder of the 6th—guided their subordinate army surgeons with a loose

rein. The group surgeons confined

their activities largely to keeping informed about operations, collecting

medical reports and statistics, disseminating and interpreting SHAEF

7

 Surg, Seventh U.S. Army, Annual Rpt, 1944, pp.

15-17, 19-22, 112-14; 12th Army Group Report of

Operations, vol. VIII (Medical Section), pp. 57 and

116; Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 8 and 11; Gorby Interv, 1962, pp.

54-55, CMH; 67th Medical Group Annual Rpt,

1944, p. 17. For negotiations on medical reinforcements for the Seventh Army, see correspondence in

DRAGOON 1944 file, CMH.

8

 Quotation from Medical Division, COSSAC/

SHAEF, War Diary, December 1944. See also Surg,

Seventh U.S. Army, Annual Rpt, 1944, pp. 6-7;

MFR, Lt Col J. H. Voegtly, 29 Sep 44, sub: Organization of Sixth Army Group and Medical Services of

Sixth Army Group, in Surg, 6th Army Group,

Annual Rpt, 1944-1945. For a general account of

the formation of the French First Army, see Marcel

Vigneras, Rearming the French, United States Army in

World War II (Washington, D.C.: Office of the

Chief of Military History, Department of the Army,

1957), chs. X and XI.
HARD FIGHTING AT THE WEST WALL 359

and theater medical directives, and

occasionally assisting the army surgeons in dealing with COMZ. However, they encouraged the armies to

work directly with the Communications Zone whenever possible on

evacuation and supply matters, and

most of the time the army surgeons

did so. Colonel Reeder's small (two

officers and three enlisted men) medical section was especially limited in

functions and influence. It had only

one American army to oversee and,

until May 1945, was submerged

within the group G-4 office instead of

constituting a separate special staff

section.9

Day-to-day direction of activities,

both administrative and clinical,

rested primarily with the army surgeons and their fifty- to sixty-person

staffs. The surgeons of all four armies

had satisfactory working relationships

with their army commanders, who

generally paid little attention to the

medical service except on the exceedingly rare occasions when something

went drastically wrong. Usually located with the forward, or tactical, echelon of army headquarters, the surgeons participated in all stages of

operational planning. For practical

purposes, they had operational control of nondivisional medical units, although the formal definition of this

authority varied from army to army.

Their medical and surgical consultants supervised patient care and enforced the principles of the ETO

Manual of Therapy, as well as apportioning auxiliary surgical teams

among army hospitals. Army surgeons

spent much effort on communications. In the 12th Army Group they

maintained liaison officers at group

headquarters, and they had attached

to them liaison officers from the Advance Section. Army surgeons kept in

touch with their own medical units by

telephone and courier. The Third

Army surgeon at Nancy, for example,

had eleven telephones in his office

and nineteen drivers and vehicles at

his disposal, all in constant use.10

For the army surgeons, and for

those at corps and division levels,

planning and coordinating medical

support for the November-December

offensive was a comparatively

straightforward task. The surgeons

confronted a problem similar to that

in the hedgerow battles: evacuation of

a large but steady volume of casualties over relatively short distances

from slowly advancing combat units.

Until the German Ardennes counterstroke, the Allies held the tactical initiative; hence, surgeons generally

could forecast accurately the rates

and locations of casualties and the

supply and evacuation requirements

of each stage of the attack. The absence of major breakthroughs, although disappointing to tactical com9

 Gorby Interv, 1962, p. 5, CMH; Hartford Interv,

7-8 Oct 80, tape 1, side 2, CMH; Surg, 6th Army

Group, Annual Rpt, 1944-1945, pp. 1-3.

10

 First U.S. Army Report of Operations, 20 Oct

43-1 Aug 44, bk. 1, pp. 16-17; Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 37-38 and 68-70;

Surg, Ninth U.S. Army, Annual Rpt, 1944, pp. 3 and

6; Surg, Seventh U.S. Army, Annual Rpt, 1944, pp.

116 and 129; Hartford Interv, 7-8 Oct 80, tape 1,

side 2, CMH; Editorial Advisory Board, 1962, pp.

97-98. In Shambora Papers, MHI, see Surg, Ninth

U.S. Army, Daily Journal, 1 Nov 44; Memo, Col W.

E. Shambora to ACofS, G-4, Ninth U.S. Army, 12

Jun 45, sub: Organization of the Medical Section,

HQ, NUSA; Memo. Reinstein to Surg, Ninth U.S.

Army, 9 Sep 44, sub: Observation of Medical Service in Operation, TUSA; and Memo, HQ, ADSEC,

COMZ, to Surg, Ninth U.S. Army, 28 Sep 44, sub:

Liaison Officer.
360 EUROPEAN THEATER OF OPERATIONS

MEDICS ON THE LINE

manders, simplified the army medical

service's task by reducing the need to

move large installations. Third Army

evacuation hospitals, for example,

changed position an average of slightly more than once each month during

this offensive; in the pursuit they had

moved three times as often.

The army medical service, accord- ingly, readily took the strain of the

hard autumn and winter fighting.

Army medical people at each link in

the evacuation chain elaborated upon

the expedients and adaptations of

standard procedure introduced earlier

in the campaign; they relearned old

lessons and occasionally learned new

ones. Above all, for army medics at

every echelon the November and

early December battles meant long

hours of hard labor, physical and

emotional stress, and—for some—

deadly danger.11

Medics on the Line

Divisional unit detachments and

medical battalions at the forward end

of the entire evacuation chain collected casualties under fire, stabilized

their condition, and started them

toward safety and healing in the rear.

Increasingly, by late 1944, the latter

function—evacuation—was becoming

the primary one for all medical personnel forward of the clearing stations. By army policy medics confined

treatment to the bare minimum

needed to fit casualties for immediate

further transportation: controlling

bleeding, pain, and infection; immobilizing broken limbs; and administering plasma.12

First Aid

Medical treatment of wounded soldiers began even before they reached

their battalion aid stations. Casualties

received first aid at or near the spot

on the battlefield where they were injured, administered either by themselves and their buddies or, much

more often, by their company

aidmen. Each soldier carried an indi- 11

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

46 and 91-92, gives hospital movement statistics;

for offensive plans and preparations, see p. 38. For

an example of corps-level assault medical planning,

see VII Corps Medical Plan, pp. 93-95, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944.

12

 For examples of army policy, see First U.S.

Army Report of Operations, 1 Aug 44-22 Feb 45,

bk. IV, pp. 166-67, and Cir Ltr No. 2, Surg, Seventh U.S. Army, 18 Jul 44, sub: Surgery, in Surg,

Seventh U.S. Army, Annual Rpt, 1944.
HARD FIGHTING AT THE WEST WALL 361

vidual first aid packet, containing field

dressings and sulfa powder and tablets, and was supposed to know how

to improvise and apply splints and

tourniquets. First aid procedures

called for a wounded man, if able, to

seek protection from fire, examine his

injury and assess its severity, sprinkle

it with sulfa powder, apply a dressing,

and swallow his sulfa tablets. Then he

was to get back to the aid station on

his own or call for the aidman.

In practice, a large proportion of

the wounded forgot to do, or could

not do, any number of these things.

Of casualties polled in COMZ general

hospitals, for example, about onethird did not take their sulfa pills

before they reached the aid station,

claiming that they lacked water to

wash them down; doubted the tablets'

usefulness; or were incapacitated by

their injuries. Soldiers often did not

have their belt first aid packets on

their persons when hit. "They'd take

them off," an aidman reported, "for

example to be more comfortable in a

fox hole, and we'll usually find the

belts [and packets] lying close by."

Hurt, frightened soldiers yelled frantically for the aidman even when only

slightly wounded and capable of leaving the field under their own power.

Many, in panic, further injured themselves, at times fatally. A company

aidman recalled the actions of

a lieutenant. He got hit and just had a

little bit of gut hanging out and he sits up

and lies down and hollers and thinks he is

going to die and we fix him up but he's

still excited and pretty soon air gets in

and he dies. That same day there's a

Jerry with all his guts hanging out. He

puts his hand down there and holds it in. We get him to the aid station and we

hear later that the son-of-a-bitch still

lives. He just held it there and didn't get

excited.13

Fortunately, comparatively few

wounded men—only one in five, according to one hospital survey—had

to give themselves first aid. Most

found a company aidman at their

sides within less than half an hour of

being hit. Besides bandaging, splinting, applying tourniquets, administering sulfa powder and tablets, and

injecting morphine, aidmen were

supposed to fill out an emergency

medical tag (EMT) for each casualty,

providing the basic record of his

identity and initial treatment. Many

divisions in practice transferred this

chore to the battalion aid stations, for

the company medics, amid the urgency and danger of combat, were hardly

in an ideal position to do paper work.

Company aidmen had a deserved reputation for bravery but they complained that some of their heroics

were unnecessary, the result of panic

calls for help by the slightly injured

or of poor judgment by line officers

in sending out their medics under

fire. One medic commented: "If a

man is hit, he's hit, and it may be

better to leave him there for a while

than to send the aid man to him on a

suicide job—for example, I've seen it

done when mortars were pounding

the area and every foot was covered

with [machine-gun] fire."

 14

13

 Rpt No. E-81, Research Branch, Special Services Division, ETO, September 1944, sub: Opinions of Wounded Combat Veterans on Battlefield

First Aid Treatment (hereafter cited as ETO, Battlefield First Aid Rpt, 1944), pp. 2-5, file HD:ETO:

350.07:Battle Experiences. Quotations from app.,

pp. ii and iii. 14

 Quotation from ETO, Battlefield First Aid Rpt,

1944, app., p. ii, file HD:ETO:350.07:Battle Experi- Continued
362 EUROPEAN THEATER OF OPERATIONS

PREPARING AN EMERGENCY MEDICAL TAG

Most demands for courage on the

par of aidmen, however, were legitimate and essential to their mission,

and the medics responded with dedication and self-sacrifice. During the

Third Army fighting along the Moselle, for example, Technician 5th

Class Alfred L. Wilson, a company

aidman in the 328th Infantry, moved

about under heavy shelling treating

his unit's many wounded until badly

hurt himself. He refused evacuation

and, in great pain and slowly bleeding

to death, continued dragging himself

from one casualty to the next. Finally

too weak to move, he instructed other

soldiers in giving first aid until unconsciousness overcame him. His unit

credited Wilson, who received a posthumous Medal of Honor, with helping to save the lives of at least ten

men. A 4th Division captain reported

of another aidman in the Huertgen

Forest who similarly stayed on duty

after being injured: "This man was

perhaps an even greater morale aid

than a physical aid" to the hardpressed riflemen around him.15

ences. On EMTs, see Surg, 5th Infantry Division,

Annual Rpt, 1944, pp. 34-35, and Rpt No. 368,

Army Ground Forces Board, 18 Nov 44, sub: Medical Information, 8th Infantry Division, p. 4.

15

 Quotation from Interv, Capt D. Faulkner, in 4th

Infantry Division Combat Intervs, box 24021, RG

407, NARA. Wilson's citation is in U.S. Congress, Continued
HARD FIGHTING AT THE WEST WALL 363

Not surprisingly, in the light of

such performance, aidmen were

among the most popular and respected soldiers in their companies.

Aidmen and infantry troops alike bitterly resented the War Department

refusal—based on the need to maintain the medics' Geneva Convention

noncombatant status—to grant eligible enlisted medics the Combat Infantryman Badge and the ten dollars a

month extra pay that went with it. In

some ETO divisions riflemen collected money from their own wages to

give their aidmen the combat bonus.

The War Department, however, did

not remedy this inequity until barely

two months before V-E Day. Medical

Department soldiers—mostly aidmen

and litterbearers—did collect their

share of decorations for valor. Four

ETO enlisted medics besides Wilson

received Medals of Honor; hundreds

of others won Silver or Bronze

Stars.16

In the judgment of doctors farther

to the rear, aidmen and front-line

troops gave generally competent first

aid, although they made a few persistent errors. Soldiers—whether medical

or nonmedical—regularly misused

tourniquets. They applied them unnecessarily; left them unloosened for

too long; and occasionally evacuated

patients with tourniquets concealed

by blankets or clothing, and hence

not discovered until the limb was

doomed. Trying to prevent such

abuses, the Seventh Army surgeon directed that the "sole indication" for

applying a tourniquet should be

"active spurting hemorrhage from a

major artery" and that medics in the

field or at battalion aid stations

should note the presence of a tourniquet on a patient's EMT in capital letters. With the morphine Syrette then

in use, aidmen easily could overdose

casualties, especially in cold weather

when slow blood circulation delayed

absorption of the initial shot and the

patient received more at an aid or

collecting station. To guard against

such mistakes, front-line medics who

did not fill out EMTs often attached

their used morphine Syrettes to soldiers' clothing before evacuating

them. In the First Army the surgeon,

Colonel Rogers, recommended abandonment of the practice of sprinkling

sulfa powder on open fresh wounds

as an anti-infection precaution. Combined with the taking of sulfa pills,

this treatment resulted in excessive

doses, and it also made wounds generally dirtier without reaching the

deepest portions most in need of prophylaxis.17

Senate, Committee on Veterans' Affairs, Medal of

Honor Recipients, 1863-1978 (hereafter cited as MOH

Recipients), 96th Cong., 1st Sess. (Washington, D.C.:

U.S. Government Printing Office, 1979), pp. 715-

16. Surg, XIX Corps, Annual Rpt, 1944, an. E, contains a typical tribute to company aidmen. 16

 The General Staff, on 1 March 1945, authorized

a special combat medical badge and ten dollars

extra pay a month for Medical Department personnel "daily sharing with the infantry the hazards and

hardships of combat." See McMinn and Levin, Personnel, pp. 337-38. For views of field troops, see

Medical Division, COSSAC/SHAEF, War Diary, December 1944, and ETO, Battlefield First Aid Rpt,

1944, app., p. v, file HD:ETO:350.07:Battle Experiences. For an example of awards received, see Surg,

XII Corps, Annual Rpt, 1944, p. 11.

17

 Quotation from Cir Ltr No. 2, Surg, Seventh

U.S. Army, 18 Jul 44, sub: Surgery, in Surg, Seventh

U.S. Army, Annual Rpt, 1944. See also First U.S.

Army Report of Operations, 1 Aug 44-22 Feb 45,

bk. IV, pp. 166-67; ETO, Battlefield First Aid Rpt,

1944, app., p. iii, file HD:ETO:350.07:Battle Experiences; Rpt. No. 368, Army Ground Forces Board,

18 Nov 44, Medical Information, 8th Infantry Division, p. 4.
364 EUROPEAN THEATER OF OPERATIONS

Evacuation

From the place on the battlefield

where the aidmen treated a casualty

and marked his position, ETO divisional medical installations—and

hence the chain of evacuation—

stretched rearward over a considerable distance. By late 1944 battalion

aid stations typically set up at least a

mile behind the engaged infantry and

armor elements, to reduce losses

from artillery and mortar fire among

essential, hard-to-replace doctors and

technicians. Collecting stations usually took position about a mile back of

the aid stations. Clearing stations remained 3 to as many as 15 miles

behind the fighting line, to be free of

the patient-disturbing noise and

counterbattery fire danger or their

own corps and division artillery.18

Mass movement of patients over

these distances was possible largely

because the divisions, by late 1944, in

effect had motorized their entire

chain of evacuation. Since the Battle

of the Hedgerows they had used

collecting company ambulances, supplemented by trucks for walking

wounded, to evacuate their battalion

aid stations. By late autumn they routinely extended motor transport forward of the aid stations as well, whenever possible right to the place where

casualties lay on the battlefield.

Medics now used jeeps, belonging to

battalion aid stations and collecting

companies, in preference to litterbearers, for moving wounded in the

forward areas. Fitted with brackets for

carrying litters, these small sturdy vehicles could go most places men on

foot could; they could accommodate

two or three litters each, and as many

ambulatory patients as ingenious drivers could crowd on board. One 4th

Division litter platoon commander

claimed to have hauled fourteen walking wounded on a single trip. On

more typical runs, he recalled, "there

would be ... two litter cases side by

side on the rear half of the jeep, then

usually one across the hood, and then

I would have sitting beside me a severely wounded man, or a couple of

them, who could . . . sit up."

 19

When their jeeps bogged down in

mud and snow, medics often switched

to the M-29 Weasel, a small tracked

cargo vehicle that had about the same

litter capacity as the jeep. Armored

division surgeons used light tanks and

tank retrievers to move their wounded over ground impassable to jeeps

and regular ambulances. On one occasion the 5th Armored Division

picked up casualties on the field in

medium tanks when heavy shelling

prevented any other approach to

them. The Shermans maneuvered

astride the wounded men; then the

crews drew the casualties up inside

the tanks through the escape hatches

in the bottoms of the hulls. During

the Third Army attack on Metz the

95th Infantry Division temporarily

pressed an artillery spotter plane into

service to fly wounded directly off the

battlefield from a point where minefields and enemy fire blocked evacuation by any other means. The aircraft, with a regimental surgeon

riding with the pilot to select cases,

18

 For examples of divisional evacuation systems,

see Surg, XIX Corps, Annual Rpt, 1944, ans. C and

E; Surg, XX Corps, Annual Rpt, 1944, pp. 18-19;

and Surg, 10th Armored Division, Annual Rpt,

1944, pp. 30-32 and encl. 14. 19

 Richardson Interv, tape 1, side 2, CMH.
HARD FIGHTING AT THE WEST WALL 365

LlTTERBEARERS MEETING THE CHALLENGE OF THE HUERTGEN FIGHTING

lifted out nine men in the same

number of trips. Clearly, machines

rather than human muscle now were

moving most casualties most of the

time.20

Divisions were insatiable consumers

of medical manpower, especially when

weather and terrain forced them to

rely extensively on litterbearers forward of battalion aid stations. The

task of litter-bearing in such circumstances was both dangerous and exhausting, for the distances litterbearers had to traverse—often over

rugged, wooded country—ranged

from 1,000 yards to 4 miles. In the

Huertgen Forest 16th Infantry bearers, according to the regimental surgeon, "would work until they were

exhausted and then drop. A twelve

hour relief and they'd be off on another seventy-two hour shift." Bearers

displayed dedication comparable to

that of the aidmen with whom they

closely cooperated. A 4th Division enlisted medic made two 1,000-yard

hauls after a glancing blow from a

shell fragment had fractured his skull.

Yet even the bravest and strongest

men needed frequent rest, and litterbearers suffered a steady drain of casualties from enemy fire and mines. A

few broke down emotionally. Another

4th Division litterbearer, after carry20

 Surg, 1st Infantry Division, Annual Rpt, 1944,

pp. 22 and 32; Surg, 90th Infantry Division, Annual

Rpt, 1944, pp. 20-23; Medical Bulletin, 95th Infantry Division, 1-30 Nov 44, pt. II, in Surg, 95th Infantry Division, Annual Rpt, 1944; Surg, 4th Armored Division, Annual Rpt, 1944, p. 11; Surg, 5th

Armored Division, Annual Rpt, 1944, p. 54.
366 EUROPEAN THEATER OF OPERATIONS

ing to the rear on his back two men

from an infantry company with which

he had worked for some time and to

which he had grown closely attached,

began muttering, "They're killing my

boys; they're killing my boys." He

tried to find a rifle with which to fight

back and "had to be evacuated for

combat exhaustion."

 21

Infantry battalion and collecting

company litterbearers (the latter all

but supplanted by ambulances for

work to the rear of the aid stations)

customarily combined forces to

remove wounded from the battlefield.

They were far too few for the job

during intense combat and when

weather, terrain, or the tactical situation prevented vehicles from assisting

them. The Huertgen fighting, in particular, absorbed bearers at an almost

intolerable rate. The 1st Infantry Division, during its time in the forest,

used 240 additional litterbearers; the

4th Division employed 140. Under

prearranged procedures division surgeons obtained these extra men, and

also casualty replacements, from their

corps medical battalions and the army

medical groups. These units drafted

bearers from their own attached organizations and, in emergencies, drew

upon any other medical personnel

within reach. The 68th Medical

Group, for example, which supported

the VII Corps, provided infantry divisions in the Huertgen Forest with

over 450 reinforcement bearers, including the enlisted personnel of two

entire collecting companies. Running

out of spare medical troops, the

group obtained 190 nonmedical infantry replacements from one of the

depots. It issued them Red Cross

brassards; sketchily trained them in

first aid, evacuation, and Geneva Convention rights and duties; and threw

them into the line for several weeks.

On another occasion the Advance

Section sent the First Army a contingent of litterbearers combed out of

staging general hospitals. Even with

all this extra help, the rifle companies

often had to draft combat soldiers

from their own thin ranks to carry

wounded at least part of the way to

their battalion aid stations. These expedients met the immediate requirements. The necessity for them, however, pointed up the inadequacy of

the existing division complement of

bearers and also underscored how indispensable, under the prevailing conditions, evacuation by vehicle had

become.22

With so much first aid being performed on the field, battalion aid stations concentrated more on evacuating casualties than on treating them.

The aid stations, by the time the November offensive began, had honed

and perfected their operational tech21

 Quotation from Tegtmeyer "Diary," pt. II, p.

90. Second and third quotations from Intervs, Assistant Surgeon and Aidmen, 1st Battalion, 22d Infantry, in 4th Infantry Division Combat Intervs, box

24021, RG 407, NARA. See also Richardson Interv,

tape 1, sides 1 and 2, CMH.

22

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 130-40 and 144; Surg, V

Corps, Annual Rpt, 1944, p. 19; VII Corps Medical

Plan, pp. 89-91 and 97-98, encl. 1 to Surg, VII

Corps, Annual Rpt, 1944; 68th Medical Group

Annual Rpt, 1944, pp. 16, 19-21, 25; 134th Medical

Group Annual Rpt, 1944, p. 19; Surg, 1st Infantry

Division, Annual Rpt, 1944, pp. 22-23; Surg, 3d Infantry Division, Annual Rpt, 1944, encl. 1; Surg, 4th

Infantry Division, Annual Rpt, 1944, p. 3; Surg, 8th

Infantry Division, Annual Rpt, 1944, pp. 14-16;

Surg, 28th Infantry Division, Annual Rpt, 1944,

encl. 5; Intervs, Company G, 22 Infantry, in 4th Infantry Division Combat Intervs, box 24021, RG 407,

NARA.
HARD FIGHTING AT THE WEST WALL 367

BATTALION AID STATION PERSONNEL READYING CASUALTIES for the next stage of their

rearward evacuation

niques. Because the stations, for

safety reasons, had to keep their distance from the rifle companies, battalion surgeons often established small

advance collecting points nearer the

infantry. These typically consisted of

an officer (frequently the assistant

battalion surgeon), a few litter teams,

and a couple of jeep ambulances.

They gathered casualties and evacuated them to the main aid stations. The

latter almost invariably found shelter

under roofs and preferably underground, in solidly constructed cellars

or abandoned dugouts, which afforded protection from shelling as well as

the elements. To better direct evacuation, battalion surgeons, whenever

they could, established telephone or

radio contact with the company command posts. At night the telephone

wires, and sometimes white tape

stretched along the ground, guided

the rearward traffic of litterbearers

and walking wounded. When casualties reached them, the surgeons and

their enlisted technicians checked and

replaced dressings, splints, and tourniquets and dispensed additional

morphine. They filled out EMTs if

company aidmen had not done so.

They normally administered the first

plasma the wounded received. When

casualties came through in large numbers, the aid stations, to get patients

out quickly, suspended tagging the

wounded and limited transfusion and

resuscitation to the minimum re-
368 EUROPEAN THEATER OF OPERATIONS

quired to keep injured men alive

during the next stage of their rearward journeys. In the First Army, especially, "the rule was to sacrifice full

resuscitation for early evacuation."

 23

By the time the autumn battles

began, most battalions had Medical

Administrative Corps (MAC) officers

as assistant surgeons. Usually sent in

to replace Medical Corps (MC) casualties, the MAC lieutenants, by most

accounts, performed creditably. The

regimental surgeon of the 16th Infantry, for example, commented: "The

doctors could take care of the wounded and the [MAC] lieutenants could

keep the evacuation going. . . . They

had been well taught in first aid and

were skillful in bandaging and splinting and were able to assist the surgeons in their work." At least one

battalion surgeon, in the 3d Infantry

Division, proposed replacing all MCs

at battalion level with MACs. He

argued that little actual need existed

in the battalions for the doctors' professional skills and that regimental

surgeons, if necessary, could assist

their aid stations in diagnosing and

treating difficult cases. The armies,

nevertheless, retained their MC battalion surgeons.24

Divisional collecting companies

worked closely in evacuation with the

regimental and battalion detachments,

often pooling men and equipment

with them, as in litter-bearing forward

of the aid stations. A collecting company normally operated continuously

with the same infantry regiment.

During action the company set up its

station as close to the regimental

command post as safety and the

maintenance of noncombatant status

allowed and also tied into the regimental telephone system for direct

communications with the battalion

surgeons. Many companies found it

convenient to divide their ambulances

into two groups. One, dispatched by

an advance loading post, shuttled between aid stations and the collecting

station; the second ambulance element picked up patients at the collecting station for the usually longer

run to the clearing company and field

hospital platoon. Under this arrangement, drivers in the forward contingent gained familiarity with the frequently tortuous, hazardous routes to

the aid stations. Collecting station

personnel at the same time gave patients whatever refreshment and stabilizing treatment they needed and

grouped them into efficient ambulance loads for the next stage of their

journey.25

In especially difficult tactical situations, infantry battalion and collecting

company medics resorted to all

manner of expedients to keep evacuation going. Such was the case during

23

 Quotation from First U.S. Army Report of Operations, 1 Aug 44-22 Feb 45, bk. IV, p. 166; see

also p. 164. For examples of aid station operations,

see Surg, 3d Infantry Division, Annual Rpt, 1944,

encl. 2; AGF Rpt No. 892, War Department Observers Board, ETO, 30 Apr 45, sub: Combat Experiences (hereafter cited as AGF, Combat Experiences

Rpt, 1945), pp. 9-10, file HD:ETO:350.07:Battle

Experiences; Interv, Assistant Surgeon and Aidmen,

1st Battalion, 22d Infantry, in 4th Infantry Division

Combat Intervs, box 24021, RG 407, NARA. 24

 Quotation from Tegtmeyer "Diary," pt. II, pp.

90-91. For the recommendation to replace MCs

with MACs, see Surg, 3d Infantry Division, Annual

Rpt, 1944, encl. 2. Richardson Interv, tape 1, side 2,

CMH, describes the role of MACs in evacuation.

25

 Surg, 3d Infantry Division, Annual Rpt, 1944,

ends. 1 and 2; Surg, 5th Infantry Division, Annual

Rpt, 1944, pp. 35-36; AGF, Combat Experiences

Rpt, 1945, pp. 9-11, file HD:ETO:350.07:Battle Experiences.
HARD FIGHTING AT THE WEST WALL 369

the disastrous attack of the 28th Infantry Division in the Huertgen Forest

early in November. In this operation

the 1st and 3d Battalions of the 112th

Infantry seized a salient of key high

ground around the villages of

Schmidt and Kommerscheidt, deep in

German-held territory, and then came

under heavy infantry, tank, and artillery counterattack from three sides.

The battalions' route of supply and

evacuation consisted of a narrow trail,

muddy from the incessant rain, which

wound its way down into the gorge of

the Kall River and then up another

ridge to the American-held town of

Vossenack, some 2 miles northwest of

Kommerscheidt. Vossenack itself was

under intense German infantry attack,

as well as artillery bombardment from

high ground to its northeast.

The battalion surgeons, Captains

Paschal A. Linguiti, MC, of the 1st

and Michael De Marco, MC, of the

3d, faced a difficult evacuation problem. Ambulances from their supporting collecting company—C, 103d

Medical Battalion, which had its station near Vossenack—could not negotiate the trail across the Kall. Hence,

the battalions had to send casualties

back in jeeps and weasels (the division had large numbers of the latter

attached for this operation) to an ambulance loading point near the top of

the ridge at Vossenack. Linguiti initially set up his 1st Battalion aid station in a basement in Kommerscheidt;

De Marco, with his 3d Battalion station, took position about a mile farther to the rear, west of the Kall,

sheltered in a cave-like 18-by-12-foot

dugout built into the steep hillside

that bordered the trail. The station in

Kommerscheidt in effect functioned

as an advance collecting point; it sent

wounded in whatever vehicles were

available to the 3d Battalion installation for relay on up the hill to the

ambulance loading point.

As the American position at

Schmidt and Kommerscheidt deteriorated, so did the evacuation situation.

Linguiti and De Marco consolidated

their two aid stations in the dugout.

Disabled American tanks and other

vehicles along the trail and German

shelling of the ambulance loading

point effectively halted evacuation of

all but walking wounded, whom the

surgeons sent to the rear in parties

led by medical troops. Litter patients,

eventually about sixty-five of them,

accumulated in and around the

dugout. Linguiti and De Marco cared

for them as best they could, helped

by their MAC assistant surgeons, the

battalion chaplains, a dwindling contingent of enlisted medics, and infantry stragglers whom the surgeons

disarmed and pressed into service as

attendants and litterbearers. The

medics had adequate food for their

patients and enough medical supplies

for what little treatment they were attempting, but they were short of blankets and shelter. The dugout could

accommodate only about twenty-five

patients. The remainder, wrapped in

what coverings were available, lay

along the trail in the cold, rain, and

snow, protected by soldiers holding

Red Cross flags. This protection was

needed because, during the final days

of the battle, German troops infiltrating behind the 1st and 3d Battalions

periodically visited the aid station.

However, except for announcing that

the medics were captured and making

sure that no armed Americans were

present, the Germans left the facility
370 EUROPEAN THEATER OF OPERATIONS

unmolested. They allowed American

walking wounded from Kommerscheidt to reach the station and at

one point offered Linguiti and De

Marco food and medicine, which the

surgeons declined. Nevertheless, the

Germans did confiscate the aid station's few vehicles.

After the survivors of the 1st and

3d Battalions withdrew from Kommerscheidt on the night of 8-9 November, in the process inundating the

aid station with a final stream of walking and litter-borne casualties, Linguiti and De Marco and their staff

and patients remained within German

lines. The enemy evidently had neither the means nor the inclination to

remove the American doctors and

wounded. The local German commander agreed to a truce, proposed

by the 112th Infantry's surgeon, Maj.

Albert L. Berndt, MC, for removal of

both sides' casualties from the Kall

valley. Under this arrangement the

battalion surgeons, after further adventures with a German unit not

party to the truce, eventually managed to assemble a makeshift truck

and weasel convoy to carry themselves, the other medical officers and

men, the chaplains, and the severely

wounded back to American lines.

However, they had to surrender the

lightly wounded and their nonmedical

personnel as prisoners of war.26

The experience of Captains Linguiti

and De Marco, besides illustrating the

vicissitudes of forward area evacuation, pointed up another circumstance of the campaign very important to Army medics: the enemy's

continued adherence to the international laws and customs of war affecting wounded and those who cared for

them on the battlefield. As had been

true since Normandy, German troops,

at least until the Ardennes offensive,

rarely engaged in aimed fire at

aidmen, litterbearers, or Red Crossmarked medical facilities. Infantry of

both sides, on many occasions, temporarily ceased fire or made short

local truces to allow their medics to

clear casualties from the field. During

a counterattack in the Huertgen

Forest the Germans captured a 22d

Infantry, 4th Division, aidman. They

put him to work caring for American

casualties and then employed him,

and a German medical soldier, to

carry the wounded GIs to a point

near American lines while both sides

held their fire. American units provided reciprocal courtesies. During an

attack at Frenzerburg Castle on the

fringes of the Huertgen Forest, for instance, elements of the 47th Infantry,

9th Division, observed a three-hour

truce so that a German ambulance

could remove thirty severely wounded

enemy defenders. On the other hand,

the 47th Infantry took prisoner eight

less seriously injured Germans who

would have been able to return to

combat.27

26

 This narrative is based on reports of Major

Berndt, Captains Linguiti and De Marco, 2d Lt. A. J.

Muglia, and 1st Lt. L. C. Johnson, all in 28th Infantry Division Combat Intervs, box 24032, RG 407,

NARA. For tactical and logistical details of this

battle, see MacDonald, Siegfried Line, ch. XV, and

Charles B. MacDonald and Sidney T. Mathews,

Three Battles: Arnaville, Altuzzo, and Schmidt, United

States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1952), pp. 251-418.

27

 Intervs, Assistant Surgeon and Aidmen, 1st Battalion, 22d Infantry, in 4th Infantry Division Combat

Intervs, box 24021; Intervs, Lt Col Lewis E.

Maness and Capt W. L. McWaters, in 9th Infantry Continued
WORKHORSES OF BATTLEFIELD EVACUATION. Much of the work for transporting casualties fell to the jeep, fitted with brackets for carrying litters. When these sturdy vehicles bogged

down in mud and heavy snow, medics switched to the tracked M-29 Weasel.
372 EUROPEAN THEATER OF OPERATIONS

In response to repeated claims by

German prisoners that they often

could not see the Red Cross arm

brassard on the battlefield, the army

medical service adopted more conspicuous Geneva Convention markings. Late in November the 12th

Army Group, at the request of Colonel Shambora, the Ninth Army surgeon, formally authorized medical

troops to paint large red crosses in

white fields on their helmets, a practice already widespread among

aidmen and litterbearers. The 7th Armored Division determined in tests

that men so marked stood out from

other soldiers at distances of up to

750 yards. Medics in some divisions

either carried Red Cross flags with

which to signal their identity when

moving under fire or wore improvised

Red Cross tabards and vests modeled

on those of German aidmen. The

army medical service also scrupulously guarded its noncombatant status

against encroachment by its own side.

Division surgeons and other medical

officers registered vehement protest

against use of Red Cross-marked vehicles for nonmedical purposes and

against the placing of artillery, tanks,

and combat-related supplies too close

to their aid stations. More conspicuous Geneva Convention insignia

probably saved the lives of many

front-line medics in the mud, snow,

and mist of the autumn and winter

battlefields, and mutual respect for

international usage diminished somewhat the dangers they faced. Hazards,

however, remained in plenty. As one

medical soldier put it, "Artillery and

mortars don't know the difference between a rifleman and a guy with a red

cross brassard on his arm."

 28

From Battle Line to Hospitals

To the rear of the divisions the

medical organizations of the different

armies retained the varying forms

they had assumed at the end of the

pursuit. The First Army, and the

Ninth Army following its example, attached most nondivisional medical

units except hospitals to their medical

groups; the First Army also attached

to its groups the field hospitals working with the division clearing stations.

These armies placed one medical

group in charge of evacuation and

various other support activities for

each of their corps, with an area of

responsibility extending from the division rear boundaries to that of the

army. The Third Army, by contrast,

employed all but one of its medical

groups strictly for evacuation, attaching only ambulance units to them;

one group evacuated the division

clearing stations of each corps and an

additional group transferred patients

among and to the rear of evacuation

and convalescent hospitals. The Third

Army's employment of its medical

groups seemed to General Hawley

and others to be inefficient. Indeed,

Division Combat Intervs, box 24027. For other

comments, see also reports of Linguiti and De

Marco, in 28th Infantry Division Combat Intervs,

box 24032, All in RG 407, NARA.

28

 Quotation from ETO, Battlefield First Aid Rpt,

1944, app., p. v, file HD:ETO:350.07:Battle Experiences. On markings, see Surg, Ninth U.S. Army,

Daily Journal, 13, 21 and 25 Nov 44, Shambora

Papers, MHI, and Surg, 95th Infantry Division,

Annual Rpt, 1944, pp. 11-12. For examples of protests, see Surg, 101st Airborne Division, Annual

Rpt, 1944, p. 19, and Memo, Capt P. A. Linguiti to

Surg, 112th Infantry, 16 Nov 44, sub: Misuse of Aid

Station Site, in 28th Infantry Division Combat Intervs, box 24032, RG 407, NARA.
HARD FIGHTING AT THE WEST WALL 373

the commander of one of the army's

groups pointed out that his headquarters, with two medical battalions attached, during most of the campaign

controlled only four ambulance companies. The Seventh Army got along

without medical groups altogether.

Separate medical battalions, often

with as many as eight companies attached, evacuated its corps, and the

army surgeon directly controlled hospitals and other facilities. Offered a

medical group from the Third Army,

the Seventh Army surgeon, Colonel

Rudolph, refused it. He declared that

"no necessity existed for such a unit

since the functions of ... a group

could be and were being performed

either by the battalion clearing corps

or by the Operations Section of the

Surgeon's Office." Whatever their differences and drawbacks, all these systems worked well enough that neither

theater nor army group surgeons considered it necessary to interfere with

them.29

Especially in the First and Ninth

Armies, medical groups performed a

number of miscellaneous but vital

functions. They operated dispensaries

and prophylactic stations for nondivisional army troops. They deployed

collecting and clearing companies to

reinforce evacuation hospitals; provided additional litterbearers to the divisions; and collected trucks to move

the larger army medical units. Because the groups' role in evacuation

required constant liaison with tactical

headquarters, these units served as

communications centers and intelligence clearinghouses for other army

medical service organizations. The

commander of the 68th Medical

Group in the First Army, for example,

opened up his morning staff briefing

on the military situation and evacuation plans to all medical unit commanders in his area of operations.

Other groups distributed periodical

news and information bulletins, one

inevitably entitled "Poop from

Group." The 69th Medical Group in

the Third Army ran a daily courier

service, which collected statistical reports from all the hospitals for the

army surgeon and distributed his

messages and circulars to every medical facility. Similarly, in the Seventh

Army the medical battalions also augmented hospitals and reinforced the

division medical service, as well as

operated a neuropsychiatric treatment

facility for each corps.30

Whatever their subsidiary activities,

the principal function of the medical

groups, and of the battalions that

substituted for them in the Seventh

Army, was evacuation of the division

clearing stations. At the height of the

offensive the groups transported

wounded in large numbers. During

November, for example, the Third

Army's 66th Medical Group handled

over 12,000 XX Corps patients; its

29

 Quotation from Surg, Seventh U.S. Army,

Annual Rpt, 1944, pp. 17, 20-21, 115-16. See also

Surg, Third U.S. Army, Annual Rpt, 1944, pp. 75-

76; Surg, Ninth U.S. Army, Annual Rpt, 1944, p. 17;

Surg, Ninth U.S. Army, Daily Journal, 1 Nov 44,

Shambora Papers, MHI; 1st, 31st, 67th, 68th, 69th,

and 134th Medical Groups Annual Rpts, 1944. For

additional detail on group functions and organization, see Chapter IX of this volume. Hawley's concern about the Third Army's use of groups is in Ltr,

Hawley to Col A. L. Gorby, 23 Nov 44, file HD 024

ETO CS (Hawley Chron). Gorby Interv, 1962, pp.

36-37, CMH, expresses general satisfaction with

army employment of groups.

30

 1st, 66th, 67th, 68th, 69th, and 134th Medical

Groups Annual Rpts, 1944; Surg, Seventh U.S.

Army, Annual Rpt, 1944, p. 116
374 EUROPEAN THEATER OF OPERATIONS

67th Medical Group, in the same

period, evacuated over 19,000 XII

Corps casualties. The groups' attached battalions, each of which usually supported one or more divisions,

normally placed a platoon of ten ambulances at each active infantry clearing or armored treatment station

while holding other vehicles in a reserve pool to meet sudden casualty

surges. The battalions set up ambulance control points at key road junctions to direct the flow of patients to

particular evacuation hospitals. The

66th tried to avoid detouring ambulances through these points. It established an elaborate system for issuing

frequent evacuation plans to its battalions, on the basis of which the battalions could send ambulances directly from clearing stations to their final

destinations. This system, however,

never achieved full acceptance by

army authorities. In December, when

the group shifted position to help

evacuate Third Army forces in the Ardennes, army headquarters ordered it

to establish a standard regulating

post.

The groups by late 1944 had

learned to control casualty flow with

increasing sophistication, seeking to

shorten as much as possible each patient's time on the road while not

overloading any evacuation hospitals.

Most of the groups distributed

wounded primarily on the basis of

what they called "surgical lag" or

"surgical backlog," which the Seventh

Army typically defined as "the time,

expressed in hours, required for a

hospital to complete the surgery

required on all moderately to severely wounded . . . casualties then

present." Medical groups found from

experience that this figure, although

subject to inconsistencies in the estimating methods of individual chiefs

of surgical service, indicated more reliably than did the simple number of

empty beds the actual remaining capacity of a hospital. Depending on the

situation and army directives, medical

groups at times sorted casualties by

type or severity, for example, sending

surgical cases needing early operation

to evacuation hospitals nearest the

front. As hospitals moved into buildings during the autumn, groups had

to take into account such details as

the limited capacity of receiving wards

no longer expandable by pitching

more tents. When they could, groups

deferred to the wishes of hospital

commanders; some wanted a steady

stream of new patients, while others

preferred to receive them in periodic

batches. Juggling such factors and

considerations in constantly changing

patterns, the groups kept the evacuation system within the armies operating with few interruptions, even in

the face of deteriorating weather and

road surfaces. They suffered late in

the year from a shortage of ambulances and ambulance companies, but

General Hawley remedied this by

speeding up the transatlantic flow of

machines and units and by stripping

ambulances from the Communications Zone for the field armies.31

Each army established an evacuation policy that governed the movement of casualties from its hospitals

to those of the Communications Zone

31

 Quotation from Surg, Seventh U.S. Army,

Annual Rpt, 1944, pp. 126-28. See also ibid., pp. 16

and 116-17; 1st, 66th, 67th, 68th, and 134th Medical Groups Annual Rpts, 1944. On the ambulance

shortage, see 12th Army Group Report of Operations, vol. XIII (Medical Section), p. 57, and correspondence in file HD ETO 451.8 (Amb), 1942-44.
HARD FIGHTING AT THE WEST WALL 375

(see Diagram 4). Normally, the armies

evacuated all patients who needed

more than 10 days, on the average, of

hospitalization. But they varied this

limit in response to the incidence of

casualties and the number of empty

beds, with an eye always to keeping as

many salvageable men as possible

within army boundaries until they returned to duty. Accordingly, during

the October lull in combat, the First

and Third Armies adopted, respectively, 20- and 21-day evacuation policies. Under these they could retain

the increasing number of soldiers

who came down with respiratory ailments as the weather turned cold and

wet, as well as their lightly wounded,

their venereal disease cases, and

many neuropsychiatric patients. As

casualties increased again in November, the armies reverted to 14-day,

10-day, and even shorter policies.

The Ninth Army at one point ordered

the daily evacuation of all its transportable patients, to clear beds for

fresh wounded from the front. At various times during the offensive the

First, Third, and Ninth Armies, their

evacuation hospitals rapidly filling to

capacity, all resorted to "bypassing."

When this policy was in effect, evacuation hospitals stopped performing

surgery on all but the most severe

and urgent cases. They sent other

surgical patients, after brief stabilizing

treatment, immediately to COMZ

general hospitals close in rear of the

armies. By this means the army installations reduced their own surgical

backlogs, while low-priority patients

actually reached the operating table

sooner than they would have in the

evacuation hospitals. First Army hospitals, at the height of the offensive,

bypassed well over 50 percent of the

battle casualties they admitted.32

As the front stabilized, so did the

locations at which patients passed

from the armies to the Communications Zone. The First and Ninth

Armies, during the fall and winter,

sent casualties to ADSEC holding

units and general hospitals at Liege

and to a holding unit at Verviers. The

Third Army evacuated through Toul,

Etain, Nancy, and, as it approached

the German border, Thionville. The

Seventh Army, which continued to

rely on the separate Southern Line of

Communications (SOLOC) for evacuation and long-term hospitalization,

evacuated through Luxeuil and Besancon to Marseilles and Naples.

Later in the campaign its holding

units shifted northward to Bayon and

Tantonville, about 10 miles south of

Nancy. With SOLOC slow to build up

and short of hospital beds, the Seventh Army sent limited numbers of

patients by air and rail to northern

COMZ general hospitals in Paris, the

Oise Base Section, and the United

Kingdom. Increasingly, during late

1944, ADSEC and its southern counterpart, Continental Advance Section

(CONAD), took over the operation of

holding units in rear of the armies

and the ambulance evacuation of casualties from army hospitals. Only the

Third Army continued to maintain

32

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 137 and 163-64; Surg,

Third U.S. Army, Annual Rpt, 1944, pp. 45 and 79;

Surg, Ninth U.S. Army, Annual Rpt, 1944, p. 28;

Surg, Ninth U.S. Army, Combat Experience Rpt,

November 1944, file HD 319.1-2; Memo, Kenner to

CofS, SHAEF, 5 Dec 44, sub: Report of Inspection,

Medical Service, First and Ninth U.S. Armies, Inclusive Period 20-30 Nov 44, in Medical Division,

COSSAC/SHAEF, War Diary, December 1944.

HARD FIGHTING AT THE WEST WALL 377

its own air-rail holding unit, and

its 69th Medical Group shared with

ADSEC the work of transporting patients to the Communications Zone

(see Map 16).

All the armies continued to evacuate their severely wounded by air

from forward fields whenever possible. However, as flying weather worsened and rail service steadily expanded, hospital trains carried the greater

proportion of patients leaving the

army areas. On the whole, the flow of

casualties from the armies went

smoothly during the November and

December battles. Interruptions of

evacuation, such as had clogged army

facilities at the end of the pursuit,

became increasingly rare as ADSEC

and CONAD enlarged the quantity

and variety of their means of transportation, and as the slow progress of

the offensive reduced the need to

move forward holding units and

extend rail lines. In evacuation, as in

other aspects of medical support, bad

news for the tactician was, paradoxically, good news—in terms of operational efficiency—for the logistician.33

Army Hospitals at Work

In each field army, during late

1944, the hospital system reached full

development. Field hospital platoons

attached to division clearing stations

worked on the most urgent emergency surgical cases. Evacuation hospitals

handled the transportable severely

wounded, the patients with minor injuries, and most of the sick. A convalescent hospital in each army relieved

the evacuation hospitals of nearly recovered patients and reconditioned

them for return to duty. Improvised

special facilities cared for soldiers

with contagious or communicable diseases and venereal infections, as well

as for neuropsychiatric casualties.

Surgical work in the armies centered in the field and evacuation hospitals. Field hospital surgeons spent

most of their time operating on men

with massive chest and abdominal injuries, severe compound fractures,

and traumatic amputations. Their

principal objective was to keep their

patients alive and to place them in

condition for further evacuation.

Postoperative death rates in these installations ran between 12 and 25

percent, higher than in any other type

of hospital, and reflected the all but

hopeless condition of many of the

wounded who arrived on their operating tables. All too common were

cases such as the Ninth Army soldier

who died twenty-four hours after surgery in the 2d Platoon, 53d Field

Hospital: "S[hell] Fragment]

W[ound] multiple with complete amputation right foot; C[ompound]

33

 Medical Division, COSSAC/SHAEF, War Diary,

October-December 1944; First U.S. Army Report of

Operations, 1 Aug 44-22 Feb 45, bk. IV, pp. 136-

37 and 140; Surg, Third U.S. Army, Annual Rpt,

1944, pp. 80-85; Surg, Ninth U.S. Army, Annual

Rpt, 1944, pp. 12-13; 69th Medical Group Annual

Rpt, 1944, pp. 11-12 and 16-17; 134th Medical

Group Annual Rpt, 1944, p. 12; 41st Evacuation

Hospital Annual Rpt, 1944, pp. 59-60, which gives

a hospital view on improving evacuation; HQ,

SOLOC, History of the Medical Section, Headquarters, Southern Line of Communications, ETO, U.S.

Army, 20 November 1944-1 January 1945 (hereafter

cited as SOLOC Medical Hist), pp. 20-26; Surg,

CONAD, Annual Rpt, 1944, pp. 8-10; MFR, Col J.

H. Voegtly, 16 Nov 44, sub: Medical Service, Southern Group of Armies, and Memo, Anon, to Col

Peyton, 18 Nov 44, sub: Notes Taken at Conference

on Medical Service for Southern Group of Armies,

both in DRAGOON 1944 file, CMH. See also appropriate pages in Chapter XIX of Smith and

Clarke, Riviera to the Rhine.

HARD FIGHTING AT THE WEST WALL 379

F[racture] left fibula, soft tissue

wounds [right] thigh and left

leg; . . . severe muscle damage both

legs. . . ."

 34

Evacuation hospital surgeons operated on the great majority of orthopedic patients, who usually were transportable enough to bypass the field

hospital platoons. By debridement

and the application of plaster casts,

the surgeons prepared these casualties for further transportation and laid

the groundwork for definitive treatment in COMZ general hospitals. In

compound fractures, according to a

Third Army surgeon, "what we had

to do was create a clean, organizable

wound out of an indiscriminately

smeared up, messed up situation."

Evacuation hospital surgeons, while

they handled a large number of minor

and moderately severe injuries, also

encountered massive wounds, some

of which gruesomely illustrated the

macabre mischances of modern

combat. The same Third Army surgeon recalled:

The French manure pile . . . came into

the operating room. An infantryman had

hidden next to one when the shell blew

up in the pile filling his thigh from knee

to buttocks with manure, all tightly

packed in as into a sausage, [and] smash- ing muscle and femur bone. He was in

critical condition. ... I started debrid- ing after the second set of bottles of

blood was partly in. ... After a major

debridement, pockets containing manure

kept appearing in deeper and deeper

layers in all directions until there was not

much left of the limb. Reluctantly I had

to disarticulate [amputate] the limb at the

hip and debride the buttock. This man

developed kidney failure and died on the

ninth day. . . .35

Field and evacuation hospitals alike

depended for surgical reinforcements

upon teams from the auxiliary surgical groups; indeed such teams made

up the entire operating room staff of

the field hospital platoons. The European Theater by late 1944 possessed

five complete auxiliary groups, attached to the field armies and army

groups, and the equivalent of half of

another, assigned to COMZ. Each

group included about twenty-five

teams of doctors, nurses, and enlisted

technicians, the majority organized

for general surgery and the rest for

neurosurgery, maxillofacial work, Xray, and dental prosthetics. These

teams contained an impressive array

of professional talent, and the theater

took pains to maintain the quality of

their personnel. Accordingly, when

the Ninth Army's 5th Auxiliary Surgical Group arrived in France with a

substantial number of young, inexperienced medical officers, the army had

no difficulty restaffing it with better

qualified men transferred from the

Communications Zone and the

ground forces. Besides the teams, the

auxiliary groups included varying

34

 Quotation from Surg, Ninth U.S. Army, Daily

Journal, 9 Nov 44, Shambora Papers, MHI. For

other statistics, see Surg, Seventh U.S. Army,

Annual Rpt, 1944, pp. 118-20; 11th Field Hospital

Annual Rpt, 1944, app. B; 13th Field Hospital

Annual Rpt, ends. 4-5; 48th Field Hospital Semiannual Rpt, January-June 1945, p. 15; 51st Field Hospital Annual Rpt, 1944, p. 13; and Memo, Kenner to

CofS, SHAEF, 5 Dec 44, sub: Report of Inspection,

Medical Service, First and Ninth U.S. Armies, in

Medical Division, COSSAC/SHAEF, War Diary, December 1944.

35

 First quotation from Gosman Interv, 24 Mar 82.

Second quotation from Joseph A. Gosman, MD,

"War without Blood" (1982), p. 150. Both in CMH.

For other examples of evacuation hospital work, see

3d Auxiliary Surgical Group Annual Rpt, 1944, pp.

33-35; 5th Evacuation Hospital Annual Rpt, 1944,

pp. 12-13; and 41st Evacuation Hospital Annual

Rpt, 1944, p. 11.
380 EUROPEAN THEATER OF OPERATIONS

numbers of truck-mounted mobile

operating rooms and X-ray facilities,

designed for temporary expansion of

busy hospitals. The operating trucks

proved to be of only limited use, as

the hospitals' capacity for surgery was

restricted more by shortages of

nurses and other postoperative support than by a lack of theater space.

The X-ray units, however, effectively

reinforced roentgenological departments swamped by sudden floods of

patients.

Auxiliary groups normally attached

most of their general teams, heavily

weighted with thoracic and abdominal

specialists, to field hospital platoons.

Maxillofacial, neurosurgical, and

other specialized teams went to evacuation hospitals, which received most

of the type of patients they treated.

During heavy fighting a single auxiliary group could not meet an army's

demand for extra surgeons. At such

times evacuation hospitals, especially,

drew additional temporary teams

from staging COMZ units, an arrangement that at once solved the

armies' surgical manpower problem

and gave useful experience to the

fixed hospital personnel.36

The presence in units of doctors,

nurses, and technicians who administratively and in part professionally answered to another organization created problems of command and

human relations. This was especially

true in field hospital platoons. The

commander of the 3d Auxiliary Surgical Group summed up: "Platoon commanders are irked that teams create

awkward problems of supply and

transportation, that teams do not

come under the administrative control of the hospital, and that teams

are neither fish nor fowl." On their

side, team members "feel that they

are always last in line, that they get

second-best, and that they are the unwanted children." Permanent unit

staff also resented being relegated to

routine ward duties, while auxiliary

teams did all the surgery and ran the

operating theaters. Even in evacuation hospitals, where the auxiliary

teams worked under the unit chiefs of

surgical service, the reinforcements

had an aura of elitism and professional independence that set them apart.

An officer in the 109th Evacuation

Hospital observed: "The 'Aux' teams

acted like doctors and nurses doing

their job, but in uniform. The Evac

teams . . . were more members of

a military echelon, heirarchy,

order ... in the lower rank of such

an order. ... " Auxiliary surgical

group commanders devoted much

effort and diplomacy to smoothing

out these undercurrents of conflict.

Aided by a shared sense of a common

professional mission, they usually succeeded.37

36

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 168-69; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 33, 35-36, 40,

44-46; 4th Auxiliary Surgical Group Annual Rpt,

1944, p. 7; Surg, Third U.S. Army, Annual Rpt,

1944, pp. 99-102; Surg, Ninth U.S. Army, Annual

Rpt, 1944, p. 28.

37

 First and second quotations from 3d Auxiliary

Surgical Group Annual Rpt, p. 34. Third quotation

from Gosman, "War without Blood," p. 143, CMH.

For typical auxiliary team control arrangements, see

Medical News No. 1, Ninth U.S. Army, 30 Oct 44,

file HD:ETO:300.41, and Cir Ltr No. 7, Surg, Seventh U.S. Army, 28 Sep 44, sub: SOP for the Use

and Control of Surgical and Allied Teams of an

Auxiliary Surgical Group, in Surg, Seventh U.S.

Army, Annual Rpt, 1944. Surg, Ninth U.S. Army,

Annual Rpt, 1944, pp. 36-37, and 48th Field Hospital Semiannual Rpt, January-June 1945, p. 17, typify

some of the conflicts and complaints.
HARD FIGHTING AT THE WEST WALL 381

EVACUATION HOSPITAL RECEIVING WARD

Field and evacuation hospitals alike

arranged their physical plants and

streamlined their procedures for

rapid reception, sorting, and treatment of a large volume of patients.

Most units, whether in tents or buildings, tried to lay out their facilities so

that a casualty would move in a more

or less straight line from receiving

through surgery to postoperative care

and evacuation. Many, by converting

cots to work stands for litters, were

able to keep a patient on the same

stretcher from the time he came off

the ambulance until he reached the

postoperative ward. Hospitals, after

initial episodes of confusion, learned

to put their most capable officers in

charge of reception and triage. These

officers quickly examined each arriving casualty and dispatched him to

the shock, preoperative, medical, or

immediate evacuation wards. In the

shock and preoperative wards, doctors, nurses, and enlisted technicians,

working with all possible speed, took

the necessary resuscitation and stabili-
382 EUROPEAN THEATER OF OPERATIONS

zation measures and moved the patient to and from X-ray. Roentgenology constituted a perennial bottleneck

when casualties were coming in rapidly, and hospital technicians taxed

their ingenuity to the limit to expedite the taking and development of

pictures. One unit, the 107th Evacuation Hospital, sent patients in shock

to X-ray before resuscitation, in the

belief that a slight delay in starting

the latter process would be less harmful to the casualty than a subsequent

interruption of it. Using such expedients, hospitals could process masses

of casualties. On the night of 16 November, for example, the 111th Evacuation Hospital, located at Heerlen,

Holland, behind the Ninth Army, admitted 272 patients in four hours; its

people examined, sorted, and placed

under shelter more that 1 wounded

man each minute.38

Field and evacuation hospitals organized their surgical staffs to operate

on the maximum number of cases

within the shortest possible time. In

field hospital platoons the attached

surgical teams, and in evacuation hospitals normally the chiefs of surgical

service or the senior surgeons on

shift, scheduled patients for operation. While each army set general

guidelines for establishing surgical

priority, the officers actually managing the traffic applied these rules with

great flexibility, their aim being to

keep all available surgeons and tables

continually busy. Surgeons, nurses,

and technicians worked in more or

less permanent teams. A field hospital

platoon with two attached teams

could complete perhaps twenty major

operations a day. A 400-bed evacuation hospital could keep eight to ten

operating tables in action around the

clock; the number of cases they

turned out depended on the severity

of the casualties then being received.

In theory, surgical teams working

twelve hours and resting twelve hours

could keep up this pace almost indefinitely; in practice, the regimen quickly

took its toll. During periods of heavy

action the 9th Evacuation Hospital reported that "the staff was nearly

always tired and too often lacking in

sleep." A surgeon in the 109th Evacuation Hospital recalled: "I began to

tire physically and psychologically

from the twelve hour operating

stretch every day; then, eating after

the last surgery, writing letters and

going to sleep. ... I worked on instinct when tired."

 39

38

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 161-63, gives a general

view of triage and resuscitation in that army. For examples of hospital operations, see 48th Field Hospital Semiannual Rpt, January-June 1945, pp. 5, 8,

11-12; 91st Evacuation Hospital Annual Rpt, 1944,

pp. 56-57 and 69; 107th Evacuation Hospital

Annual Rpt, 1944, pp. 10-12; and 111th Evacuation

Hospital Annual Rpt, 1944, pp. 11 and 13-14.

39

 First quotation from 9th Evacuation Hospital

Annual Rpt, 1944, p. 16. Second quotation from

Gosman, "War without Blood," pp. 151-52, CMH.

See also Gosman Interv, 24 Mar 82, CMH; First

U.S. Army Report of Operations, 1 Aug 44-22 Feb

45, bk. IV, p. 162; Surg, Third U.S. Army, Annual

Rpt, 1944, pp. 102-03; 3d Auxiliary Surgical Group

Annual Rpt, 1944, pp. 33-34. For examples of surgical organization and operations, see 47th Field

Hospital Annual Rpt, 1944, pp. 9 and 11; 48th Field

Hospital Semiannual Rpt, January-June 1945, p. 8;

59th Field Hospital Annual Rpt, 1944, pp. 10-11;

11th Evacuation Hospital Annual Rpt, 1944, p. 4;

59th Evacuation Hospital Annual Rpt, 1944, p. 4

and sec. III, p. 8; 91st Evacuation Hospital Annual

Rpt, 1944, pp. 59-61; 107th Evacuation Hospital

Annual Rpt, 1944, p. 16; 111th Evacuation Hospital

Annual Rpt, 1944, pp. 15-16; and 24th Evac Hist,

October 1945, p. 93.
HARD FIGHTING AT THE WEST WALL 383

PACKING MEDICAL SUPPLIES IN A 155-MM. HOWITZER SHELL, to be fired to troops cut

off by the Germans

Inevitably, with surgery being done

under forced draft, errors occurred.

Surgeons, especially in hospitals

newly placed in operation, debrided

wounds improperly or inadequately.

They neglected to split casts to allow

for swelling and permitted too early

evacuation of patients with abdominal

wounds or severe vascular damage.

The army surgeons and their consultants, who kept close watch on the

quality of professional practice in

their hospitals, labored continually to

reduce the incidence of such mistakes.

The First Army temporarily stationed

medical officers in ADSEC general

hospitals, to check on the condition

of patients arriving from the army.

On the basis of these officers' reports

Colonel Rogers, the army surgeon,

among other changes revised his

evacuation policies for men with chest

and vascular injuries. Hospitals constantly reviewed their own surgical

practice, for example, by conducting

autopsies whenever possible in cases

of postoperative death. In general,

the quality of field and evacuation

hospital surgery stood the test of

review farther to the rear. During October, at a Paris meeting of Allied

medical officers to discuss battle casualty treatment, COMZ surgeons, with

only minor reservations, pronounced

themselves satisfied with the condition of the patients reaching them

from the armies. Colonel Cutler, the

ETO chief surgical consultant, de-
384 EUROPEAN THEATER OF OPERATIONS

clared that earlier and more effective

surgery—combined with widespread

use of whole blood and antibiotics

and the generally more robust physical condition of the troops—accounted for the higher recovery rate of the

wounded in this war as compared to

World War I.40

Mobile army hospitals tried to evacuate patients within as short a time as

possible after their condition was stabilized, the minor postoperative cases

almost as soon as they recovered

from the effects of anesthesia. The

operating surgeon normally had the

final say in determining when his patient was transportable, but he had to

take into consideration available beds,

how many new casualties were arriving, and army policies. The armies,

usually in response to COMZ complaints about evacuating too early, required their hospitals to hold certain

postoperative patients—notably chest,

abdominal, and neurosurgical cases

and men with severe extremity

wounds involving vascular damage—

for a fixed number of days. Hospitals

set up separate wards, with surgeons

in charge, for such patients and

placed the rest in wards designated

for immediate evacuation, usually

staffed by officers of their medical

services. Evacuation hospitals sent off

the majority of their patients within

less than ten days; field hospitals, because of the severity and complicated

nature of their cases, had to retain

theirs for longer periods, a requirement that perennially conflicted with

their need for mobility. The Third

Army attached thirty-man holding

units, drawn from collecting and gas

treatment companies, to its field hospital platoons to stay behind with

nontransportable patients when the

main units moved.41

Getting a patient out of a hospital

was itself a complicated task. The

commander of the 110th Evacuation

Hospital pointed out:

When a patient is said to be ready for

evacuation, it is not just a matter of put- ting him in an ambulance. . . . The pa- tient must be made ready as far as cloth- ing is concerned, then there [are] his

valuables, and his x-rays. The problem is

increased when you have from one

hundred ... to two hundred patients, spread all over the hospital, ready for

evacuation.

Each hospital developed its own

system for sending off patients. The

110th, for example, used two enlisted

men as evacuation clerks, with four

litterbearers to collect evacuees from

40

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 138 and 158; Surg, Ninth

U.S. Army, Annual Rpt, 1944, pp. 28-32; Surg,

Third U.S. Army, Annual Rpt, 1944, p. 41; Ltr,

Hawley to Brig Gen J. A. Rogers, 9 Dec 44, file HD

024 ETO CS (Hawley Chron); Memo, Kenner to

CofS, SHAEF, 24 Dec 44, sub: Report of Inspection

of 3d US Army Medical Service and Supporting CZ

Installations . . . , in Medical Division, COSSAC/

SHAEF, War Diary, December 1944. For an example of hospital policy on autopsies, see 48th Field

Hospital Semiannual Rpt, January-June 1945, pp.

10-11. Cutler's remarks are in Notes Taken at Press

Conference, Paris, 4 Oct 44, ... by the Chief Surgeon, ETOUSA, in Hawley Papers, MHI.

41

 For typical war operations and evacuation policies, see 48th Field Hospital Semiannual Rpt, January-June 1945; 110th Evacuation Hospital Semiannual Rpt, January-June 1945; 54th Field and 91st

and 111th Evacuation Hospitals Annual Rpts, 1944;

and Surg, Ninth U.S. Army, Daily Journal, 31 Dec

44, Shambora Papers, MHI. For army policies, see

First U.S. Army Report of Operations, 1 Aug 44-22

Feb 45, bk. IV, pp. 163-64; Medical News No. 1,

Ninth U.S. Army, 30 Oct 44, file HD:ETO:300.41;

and Cir Ltr No. 2, Surg, Seventh U.S. Army, 18 Jul

44, sub: Surgery, in Surg, Seventh U.S. Army,

Annual Rpt, 1944. On holding units, see Surg,

Third U.S. Army, Annual Rpt, 1944, p. 89; 30th and

60th Field Hospitals Annual Rpts, 1944.
HARD FIGHTING AT THE WEST WALL 385

the wards. When the time came to

move patients, the registrar alerted

the clerks and bearers and the affected wards and sent the evacuation list

to the offices in charge of patient valuables and X-ray files. Those offices

packed up the appropriate items for

each man for attachment, with his

records, to his litter when the bearers

brought him to a central point in the

hospital. After a Red Cross worker

made sure that each soldier had cigarettes, candy, and toilet articles, then

litter teams began manhandling their

charges into waiting ambulances.42

By late 1944 each army had a full

system of specialized medical facilities

in operation, designed to relieve

clearing stations and field and evacuation hospitals of certain categories of

nonsurgical patients and to keep as

many salvageable soldiers as possible

within army boundaries and out of

the COMZ replacement system. Convalescent hospitals—T/O 3,000-bed

units in the First, Third, and Seventh

Armies and a 400-bed facility improvised from a gas treatment company

in the Ninth—admitted ambulatory

patients transferred from evacuation

hospitals. They put these men

through usually about ten days of

physical therapy and reconditioning

before sending them back to line

units. Other facilities treated men

with specific ailments who came to

them directly from division clearing

stations. The First Army used two

clearing companies as 500-bed treatment centers for soldiers with combat

fatigue; its gas treatment battalion operated hospitals for malaria, communicable and contagious disease, and

self-inflicted-wound patients. The

Third Army established venereal disease and neuropsychiatric sections in

its 6th Convalescent Hospital, and the

Ninth Army employed its gas treatment battalion to care for these casualties and also malaria cases. In the

Seventh Army one clearing company

and a platoon of another treated

neuropsychiatric patients; another

clearing company—reorganized for

the purpose before the DRAGOON invasion—operated a 250-bed venereal

disease hospital. These facilities, besides caring for many nonbattle casualties, helped the armies conserve

manpower. In four months, for example, Third and Seventh Army convalescent hospitals returned to duty respectively 11,000 and 10,000 veteran

troops.43

All the armies made special efforts

to salvage as many as possible of their

neuropsychiatric casualties—soldiers

who suffered emotional breakdowns,

of varying symptoms and severity,

under the stress of battle. The incidence of such casualties fluctuated, as

did that of physical wounding, with

the intensity and nature of combat.

During heavy fighting, such as that of

42

 Quotation from 110th Evacuation Hospital

Semiannual Rpt, January-June 1945, p. 8. For other

examples of evacuation systems, see 91st and 107th

Evacuation Hospitals Annual Rpts, 1944.

43

 Convalescent hospitals were the 2d (Seventh

Army), the 4th (First Army), and the 6th (Third

Army). See Surg, First U.S. Army, Annual Rpt,

1944, p. 5; First U.S. Army Report of Operations, 1

Aug 44-22 Feb 45, bk. IV, pp. 134 and 185; Surg,

Third U.S. Army, Annual Rpt, 1944, pp. 36, 79-80,

95-97, 111; Surg, Ninth U.S. Army, Annual Rpt,

1944, pp. 12-14 and 18; Surg, Ninth U.S. Army,

Combat Experience Rpt, November 1944, file HD

319.1-2; Surg, Seventh U.S. Army, Annual Rpt,

1944, pp. 18-19, 21, 49, 51, 122-25; 2d, 4th, and

6th Convalescent Hospitals Annual Rpts, 1944; 92d

and 95th Medical Gas Treatment Battalions Annual

Rpts, 1944.
386 EUROPEAN THEATER OF OPERATIONS

the autumn and winter offensive,

neuropsychiatric cases accounted for

between 9 and 25 percent of total

monthly hospital admissions.

The armies, taking advantage of

lessons learned in North Africa and

Italy and of the First Army's early experience in Normandy, treated the

emotional casualties of battle as tem- porarily disabled soldiers rather than

mental patients, normally categorizing

them with the neutral diagnosis "exhaustion." For the sake of both prevention and cure they attempted to

treat such patients as close as possible

to the fighting line. Typically, infantry

battalion surgeons, trained in this

work and supervised by their division

psychiatrists, held all but the most severely disturbed men at their aid stations for up to twenty-four hours of

rest (often under sedation), hot food,

a change of clothing, and rudimentary

individual and group therapy. Such

treatment sufficed for an unrecorded

but very high proportion of men with

combat reactions, allowing their im- mediate return to their units.

Men needing a longer period to

rest and more intensive therapy were

evacuated to their division clearing

stations. There, the division psychiatrist, with a pickup staff and improvised facilities, operated an "exhaustion center" that could hold patients

for up to seventy-two hours of treatment. The clearing stations also returned to duty a substantial portion

of the men they received. The rest

went to the various specialized army

facilities mentioned above and, in the

Third Army, to the neuropsychiatric

wards of regular evacuation hospitals,

for periods of up to seven days of

therapy and reconditioning, ending in

a period of refresher training in a

military camp rather than a hospital

environment. The Third Army used a

section of its convalescent hospital as

still another echelon of army-level

treatment that could hold patients for

as long as two or three weeks. However, the other armies evacuated men

still unfit for duty directly from their

neuropsychiatric hospitals to the

Communications Zone.

In the United Kingdom Base most

general and station hospitals maintained fully staffed and equipped psychiatric services. In addition, the

312th Station Hospital (NP) and the

96th General Hospital (NP), specialized psychiatric facilities, received the

most severely disturbed soldiers from

other installations for prolonged, intensive treatment and rehabilitation.

The 96th also selected mental patients for evacuation to the United

States. On the Continent the Communications Zone attempted to set up

neuropsychiatric hospitals close

behind the armies to take patients

from their exhaustion centers and to

complete their treatment so that they

could reenter the replacement system.

For this purpose ADSEC in mid-November opened the 1,000-bed 130th

General Hospital (NP) at Ciney, Belgium, to serve the First and Ninth

Armies. At about the same time

CONAD established the 500-bed 51st

Station Hospital (NP) at Luneville to

support the Third and Seventh

Armies. However, given the shortage

of forward general hospitals, both

units were pressed into service to care

for medical and surgical patients

during the American offensive and

the German December counterattacks. They began functioning primarily as neuropsychiatric facilities only
HARD FIGHTING AT THE WEST WALL 387

during the last weeks of hostilities.

Even without them, the armies and

COMZ made an impressive record of

success in rehabilitating emotionally

damaged soldiers. According to a

later estimate, out of every 100 psychiatric casualties in the theater, the

armies and the Communications Zone

restored 90 to some form of duty.

 44

Army hospitals, of whatever type,

coped daily with manpower and

equipment deficiencies. Ingenuity and

improvisation facilitated their overcoming innumerable logistical and

operational problems. Field hospitals

made do with standard allowances of

people and equipment intended for a

very different function from the one

they were performing. They had a

constant battle to secure transportation for their many moves. The six

nurses in each platoon were stretched

to the limit of their endurance, caring

for as many as sixty-five postoperative

patients any of whom, in a civilian institution, would have required the exclusive attention of one or more

nurses. The Seventh Army, in an attempt to alleviate these problems, reduced the bed capacity of each of its

field hospital platoons to 60 and increased the nurse complement to

eight with ANC officers borrowed

from the Communications Zone. This

army also issued additional trucks,

trailers, and weapons carriers to each

field hospital, giving the unit enough

vehicles to move a platoon without

outside help. All the armies employed

collecting and clearing company elements, POWs, and French and Belgian civilians to meet the insatiable

requirements of their evacuation hospitals for additional attendants and laborers. By late 1944 the typical 400-

bed evacuation hospital had between

fifty and eighty prisoners or civilians

attached to it. Civilians replaced the

German POWs as units neared the

borders of the Reich.45

Mud, rain, cold, and snow became

major adversaries for army medical

installations as the harsh winter

closed in. Frequent downpours transformed hospital areas into seas of

mud, in spite of the best efforts of engineers and medical troops with

gravel and bulldozers. In one Third

Army hospital "a plow came in and

scraped mud into piles as if it were

dealing with snow." As the days and

nights grew colder, steam rose from

abdominal incisions in unheated surgical tents. One unit resorted for

warmth to potbelly stoves placed

close to its operating tables. "Probably due to the closed system of anesthesia and good outdoor ventilation,"

a surgeon recalled, "and adding a

44

 The foregoing discussion is based on Albert J.

Glass, ed., The Overseas Theaters, Medical Department, United States Army in World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1973), chs. VIII and IX; restoration-to-duty estimate is on pp. 273-74. See also

Surg, Ninth U.S. Army, Annual Rpt, 1944, pp. 32-

33. The 130th General Hospital was caught up in

the German Ardennes counteroffensive. See Chapter XII of this volume.

45

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

92-93, 101, 124; Surg, Ninth U.S. Army, Annual

Rpt, 1944, p. 19; Surg, Seventh U.S. Army, Annual

Rpt, 1944, pp. 43 and 46; 68th Medical Group

Annual Rpt, 1944, p. 21; 134th Medical Group

Annual Rpt, 1944, pp. 11-12; Surg, XX Corps,

Annual Rpt, 1944, pp. 22-23; 48th Field Hospital

Semiannual Rpt, January-June 1945; 47th Field

Hospital Annual Rpt, 1944; 9th, 11th, 41st, 59th,

91st, 104th, and 111th Evacuation Hospitals Annual

Rpts, 1944; Memo, Lt Col A. W. Shiflet to CG,

AGF, 11 Nov 44, sub: AGF Report No. 364—Medical Information.
388 EUROPEAN THEATER OF OPERATIONS

factor of luck, there were no ether explosions." With wind and snow came

additional tribulations. Work details

swept accumulated snow off tents to

keep them from collapsing, and they

struggled to secure stovepipes and

tent pegs against battering gusts.46

To remove staffs and patients from

such hardships, the armies during November and December gave their hospitals and other medical units first

claim on requisitioned buildings. Hospitals under roofs—in casernes,

schools, hotels, monasteries, and even

a former German slave labor camp—

encountered new problems. Unlike

tents, buildings could not be moved

to the most convenient points on the

routes of evacuation. Thus field hospital platoons, for the sake of shelter,

often perforce set up some distance

away from the clearing stations they

supported. Hospitals usually had to

do extensive cleaning and disinfecting

to make their quarters habitable. Enlisted medics of one evacuation hospital jokingly suggested that the letters

"SM" (Semimobile) in their unit designation really meant "Scrubbing and

Mopping." In nonmedical structures

floor plans left much to be desired

from the hospital point of view. Dispersal of patients among many small

rooms, for example, as in schools,

meant harder work for nurses, ward

attendants, and litterbearers. Units

required additional people and equipment, not included in T/O&Es

designed for tented operation, to perform plant maintenance and engineering. With these augmentations,

evacuation hospitals, especially,

needed still more transportation to

move them.47

As army hospitals acquired campaigning experience, their medics

became adept at improvising, and at

obtaining—by one means or another—what they needed. Each unit

developed its own individual plan for

setting up. Colonel Gorby declared:

"I don't think I had a field hospital

commander, or an evac hospital commander, that would set [up] his operating pavillion and his ward tents and

pre-ops and post-ops and receiving

and all that in exactly the same

way. . . . We indicated that as long

as it was effective it was all right."

Foraging, as one hospital report put

it, "by now had become instinctive."

Medics regularly turned the refuse of

war into objects that saved their patients' lives or enhanced their own

comfort. In the 59th Field Hospital

discarded 5-gallon food tins, cut in

half, became operating room light fixtures, their polished interiors readymade reflectors. A large box, a 20-

gallon gasoline tank, two faucets, a

length of pipe, and a galvanized

trough, all salvaged, became a surgeon's scrub sink. Scrap lumber went

into back rests for chest-wound pa46

 Gosman, "War without Blood," pp. 121 and

130, CMH.

47

 Quotation from 111th Evacuation Hospital

Annual Rpt, 1944, p. 10. For hospital problems

from the army viewpoint, see An. 6—Medical Plan,

p. 14, to FUSA Plan, 25 Feb 44, file HD 370 ETO;

First U.S. Army Report of Operations, 1 Aug 44-22

Feb 45, bk. IV, pp. 139 and 155; Surg, Third U.S.

Army Annual Rpt, 1944, pp. 39, 91, 122, 167; Surg,

Seventh U.S. Army, Annual Rpt, 1944, p. 23; and

Surg, Ninth U.S. Army, Annual Rpt, 1944, pp. 19-

20 and 23. For examples of unit difficulties, see

Surg, XX Corps, Annual Rpt, 1944, p. 23; 48th

Field Hospital Semiannual Rpt, January-June 1945;

93d Evacuation Hospital Unit Hist, 1944; 110th

Evacuation Hospital Semiannual Rpt, January-June

1945; and 5th, 51st, and 104th Evacuation Hospitals

Annual Rpts, 1944.
HARD FIGHTING AT THE WEST WALL 389

tients. Other hospitals built their own

suction apparatus, as well as ward

desks and tables, folding water

towers, and portable showers. They

mounted their generators on captured

enemy trucks and appropriated whatever other usable German matériel

came their way, including in one unit

a couple of truckloads of liquor seized

in Cherbourg and carried across

France. Hospitals followed the campaign philosophy: "Take what you

can get and hang onto it; each set-up

will be a little different, a little better

than the last; make your comfort and

your amusements now—who knows

when you can again?"

 48

Sources of Supply

By the time the offensive began in

November, the army supply depots

had settled into positions within convenient supporting distance of the

front. They gradually edged forward

as the attacking divisions gained

ground. The Ninth Army brought

with it from Brittany a single medical

supply unit, the advance section of

the 33d Medical Depot Company,

temporarily attached from the Third

Army. This supply element, which established itself at Valkenburg, Holland, taking over stock of a former

First Army dump, distributed supplies

to all of the Ninth Army until the last

days of December, when the advance

section of the 35th Medical Depot

Company relieved it. Beginning in

late November, another Ninth Army

depot company, the 28th, located at

Maastricht, assumed the task of receiving supplies from the Communications Zone and forwarding them to

the advance element at Valkenburg.

Elsewhere in the 12th Army Group,

army depots underwent little change.

The 1st Medical Depot Company, in

the First Army, shifted its base to

Dolhain, just west of its former site at

Eupen, in order to find suitable buildings. Advance sections of this company operated medical supply points at

Malmedy and Bastogne. The Third

Army's 32d and 33d Medical Depot

Companies, located respectively at

Verdun and Toul when the offensive

started, moved eastward, the 32d to

Metz in late November and the 33d to

Chateau-Salins in mid-December.49

The Seventh Army had its own separate line of medical supply. Its 7th

Medical Depot Company followed the

army across the Riviera beaches and

up the Rhone valley successively to

Epinal, Luneville, and Sarrebourg.

Throughout the summer and early

fall this company bore most of the

burden of hauling supplies the entire

distance from the Mediterranean

coast. During November the Southern

Line of Communications finally relieved the 7th Company of that task

48

 First quotation from Gorby Interv, 1962, pp.

28-29, CMH. Second quotation from 106th Evacuation Hospital Annual Rpt, 1944, pp. 14-15. Third

quotation from 8th Field Hospital Annual Rpt,

1944, p. 4, attributing the words to the 91st Evacuation Hospital. See also 59th Field Hospital Annual

Rpt, 1944, p. 10. For other comments on improvisations, see Surg, Third U.S. Army, Annual Rpt, 1944,

pp. 126-27; remarks of evacuation hospital commanders in file HD:ETO:350.07:Battle Experiences;

and 91st, 105th, 106th, and 111th Evacuation Hospitals Annual Rpts, 1944. On liquor supply, see

Gosman Interv, 24 Mar 82. CMH.

49

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 154-55; Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 165 and 168-69; Surg,

Ninth U.S. Army, Annual Rpt, 1944, p. 12; Surg,

XIX Corps, Annual Rpt, 1944, encl. 19; 32d Medical

Depot Company Annual Rpt, 1944, pp. 2-3; 33d

Medical Depot Company Annual Rpt, 1944, p. 7

and an. 1.
390 EUROPEAN THEATER OF OPERATIONS

by setting up an intermediate medical

depot at Dijon, which in turn was replenished from a base facility at Marseilles. Matériel to stock these depots

came from the Mediterranean Theater during the first sixty days of the

southern France campaign and thereafter directly from the United States.

The Seventh Army also possessed an

independent blood service, provided

by the 6703d Blood Transfusion Unit.

An advance element of this unit distributed blood, initially flown in from

Naples and, after 29 October, drawn

from service troops at Marseilles and

forwarded, via rail, to field and evacuation hospitals. Late in October, as

demand exceeded the capacity of the

6703d, the army also began receiving

shipments of ETO blood from

Paris.50

Within the armies, medical supply

distribution presented few difficulties

beyond those inherent in the conditions of combat. Divisional and corps

medical units and detachments drew

expendable items on informal requisition from the nearest army supply

point, usually an advance section of

the depot company or a small dump

maintained by the corps. Hospitals,

depending on their locations, requisitioned either from the advance points

or from the main army depots.

Among their liaison functions, the

medical groups often assisted hospitals and other nondivisional units in

obtaining supplies and resolving logistical difficulties. Divisions employed all types of vehicles and resorted to every conceivable expedient

to keep battalion aid stations and

front-line medics supplied. They delivered plasma, dressings, and other

urgently needed items to temporarily

cut-off units by parachute and on a

couple of occasions fired matériel to

them in specially refilled artillery

shells. The 90th Infantry Division,

which had several units isolated

during its battle for a Saar River

bridgehead in December, sent medical supplies to them in remodeled aircraft wing tanks. Fighter-bombers,

flying in at treetop level, dropped the

tanks accurately into the infantry perimeter.51

When the offensive began, the flow

of medical supplies from both communications zones into the army

depots was still, from the armies'

standpoint, less than satisfactory. In

the 12th Army Group medical supply

deliveries to the armies regularly fell

short of the daily SHAEF tonnage allocations. The army depots constantly

reported shortages; those of the First

Army at one point had zero balances

in over 400 inventory items. The

50

 Surg, Seventh U.S. Army, Annual Rpt, 1944,

pp. 7-8, 48-49, 117; Surg, CONAD, Annual Rpt,

1944, pp. 13-14; Surg, Delta Base Section, Annual

Rpt, 1944, p. 1; Kendrick, Blood Program, pp. 447-

52; Wiltse, Mediterranean, p. 409; Memo, Kenner to

CofS, SHAEF, 12 Oct 44, sub: Report of Inspection

of Medical Service of 6th US Army Group . . . , in

Medical Division, COSSAC/SHAEF, War Diary, October 1944; 7th Medical Depot Company Combat

Supply Operations Rpt, [1944], pp. 3-5. For details

on the development of SOLOC, see Chapters IX

and XIII of this volume.

51

 Surg, Third U.S. Army, Annual Rpt, p. 169;

Surg, Seventh U.S. Army, Annual Rpt, 1944, pp.

48-49; Surg, Ninth U.S. Army, Annual Rpt, 1944, p.

38; Surg, Ninth U.S. Army, Daily Journal, 1 Nov 44,

Shambora Papers, MHI; 7th Medical Depot Company Combat Supply Operations Rpt, [1944], p. 9. For

examples of corps supply points, see Surg, XII

Corps, Annual Rpt, 1944, p. 6, and Surg, XIX

Corps, Annual Rpt, 1944, p, 19. For group supply

activities, see 68th Medical Group Annual Rpt,

1944, p. 28. On wing tanks, see Surg, XX Corps,

Annual Rpt, 1944, pp. 7-8; Surg, 90th Infantry Division, Annual Rpt, 1944, pp. 18-19.
HARD FIGHTING AT THE WEST WALL 391

Ninth Army during November had to

rely entirely on salvage for spare

parts for its medical equipment. In

spite of these conditions, all the

armies kept their operating units supplied with enough of the things they

immediately needed to perform their

missions. Army surgeons usually

could obtain air shipments to meet

emergencies, for example, to remedy

the drain of litters and blankets

caused by evacuation. They regularly

employed their own trucks to haul additional matériel forward from COMZ

depots. In the 12th Army Group the

army surgeons worked continually

with the ADSEC regulating stations

and the chief surgeon's Supply Division to speed up the processing of

requisitions and to trace lost or misdirected cargo. The northern and

southern communications zones

steadily improved rail transportation

and built up their advance depot

stocks. In the north the opening of

the port of Antwerp late in November

drastically shortened American supply

lines and permitted full use of

ADSEC medical depot M-409 at

Liege, close behind the First and

Ninth Armies. Signaling the end of

the long supply famine, SHAEF on 9

December abolished its tonnage allocation system. By that time the army

depots, although still short of some

items, were well on the way to accumulating their planned fourteen-day

reserves.52

The System in Full Stride

The medical service of the American field armies reached a high level

of efficiency and effectiveness during

the November-December offensive.

The armies had perfected their evacuation systems to the point where most

battle casualties arrived at division

clearing stations or their attached

field hospital platoons within one or

at most two hours of being injured.

Transportable patients usually

reached evacuation hospitals no more

than eight hours after they suffered

their wounds. Men who entered the

army hospitals had an excellent

chance of surviving. In all four armies

less than 3 percent of the battle casualties admitted to medical facilities

died, with the majority of the fatalities

occurring in the field hospital platoons. Counting nonbattle as well as

combat casualties, the death rate in

army clearing stations and hospitals

amounted to some 1.5 percent of admissions. The armies evacuated their

patients to the Communications Zone

in generally good condition. The 28th

General Hospital at Liege, for example, reported only 2 deaths among

4,000 surgical patients it received

from the First and Ninth Armies and

only 1 man with gas gangrene, who

recovered. Following one of his many

52

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 154-55; Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 163-66 and 168-70;

Surg, Seventh U.S. Army, Annual Rpt, 1944, p. 118;

Surg, Ninth U.S. Army, Annual Rpt, 1944, pp. 37-

38; Surg, Ninth U.S. Army, Daily journal, 1, 24, 30

Nov and 22 Dec 44, Shambora Papers, MHI; Surg,

Delta Base Section, Annual Rpt, 1944, pp. 1-2; 7th

Medical Depot Company Combat Supply Operations Rpt, [1944], pp. 3-4. For armies hauling their

own supplies, see 32d Medical Depot Company

Annual Rpt, 1944, p. 5. Medical Division, COSSAC/

SHAEF, War Diary, October-December 1944, contains numerous inspection reports illustrating gradual supply improvement. For details on COMZ

supply efforts, see Chapters IX and XIII of this

volume.
392 EUROPEAN THEATER OF OPERATIONS

inspections, General Kenner declared

flatly: "The medical service in the forward area has been excellent."

 53

Thus far in the campaign the field

armies possessed the tactical initiative, but in mid-December that condition abruptly changed. Ground force

medics were about to undergo what

was, for most of them, a new experience: that of retreat before an enemy

temporarily and locally superior in

numbers and firepower and enjoying

the advantage of surprise. The army

medical service had proved its ability

to support forces engaged in set-piece

battles and headlong pursuit. Now its

adaptability was to be tested in withdrawal, encirclement, and hastily improvised counterattack.

53

 Quotation from Memo, Kenner to CofS,

SHAEF, 5 Dec 44, sub: Report of Inspection, Medical Service, First and Ninth US Armies . . . , in

Medical Division, COSSAC/SHAEF, War Diary, December 1944. This document also gives the 28th

General Hospital statistics. On evacuation times, see

Kenner memo previously cited and his other reports

in ibid., as well as Surg, 4th Armored Division

Annual Rpt, 1944, pp. 21-22. On army death rates,

see First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, pp. 199-200 and 204; Surg,

Third U.S. Army, Annual Rpt, 1944, pp. 97-99;

Surg, Seventh U.S. Army, Annual Rpt, 1944, p. 28;

and Surg, Ninth U.S. Army, Combat Experience

Rpts, October-December 1944, file HD 319.1-2.
CHAPTER XII

A Time of Adversity

In the early morning darkness and

fog of 16 December 1944 three painstakingly marshaled German field

armies attacked the weakly defended

Ardennes sector of the First Army

front in Belgium and Luxembourg.

Over 250,000 troops with 1,000

armored fighting vehicles and 1,900

artillery pieces, in 25 armored and infantry divisions, took part in this desperate counterstroke, for which Hitler

and his military advisers had been

planning and preparing since the late

summer. The Germans intended to

pierce the thin American line in the

Ardennes, a wooded, hilly sector used

by the First Army, with most of its

strength concentrated farther north

for a drive toward the Roer River, to

rest battle-worn divisions and to introduce green ones to combat.

Mechanized columns then were to

cross the Meuse River and capture

Liege and Antwerp. If successful,

their drive would destroy many Allied

units; disrupt supply lines; and, Hitler

optimistically believed, induce the

British and Americans to break their

"unnatural" alliance with Communist

Russia and make peace on terms acceptable to Germany.1

The enemy achieved complete surprise. Aided by several days of fog,

rain, and snow, which kept the Allied

air forces out of the battle, and by unorthodox tactics, including the use of

special commando units disguised in

American uniforms and civilian clothing, the Germans made their initial

breakthrough and gained considerable ground. They destroyed one

American infantry division, effectively

crippled two others, and eliminated

an armored combat command; and

they killed, wounded, and captured

thousands of American soldiers. Nevertheless, the German advance almost

at once fell behind schedule, slowed

by the narrow roads and difficult terrain and by the tenacious resistance

of the American front-line units.

On the northern wing of the offensive the Sixth Panzer Army, with a substantial component of SS troops, supposedly the main breakthrough force,

pushed back but failed to rout the 2d

and 99th Infantry Divisions on the

right flank of the American V Corps.

These divisions, rapidly reinforced by

1

 The following summary of operations is drawn

from Hugh M. Cole, The Ardennes: Battle of the Bulge,

United States Army in World War II (Washington,

D.C.: Office of the Chief of Military History, Department of the Army, 1965), passim, and Ruppenthal,

Logistical Support, 2:25-26. The German plan, in fact,

was overambitious and even under the best of conditions could not have been carried to success with

the available forces.
394 EUROPEAN THEATER OF OPERATIONS

AMERICAN VICTIMS OF THE MALMEDY MASSACRE

others, held firm around Elsenborn

and fixed the northern shoulder of

the developing "Bulge." Kampfgruppe

Peiper, an advance element of the 1st

SS Panzer Division, extricated itself

from this fighting early on 17 December and drove 20 miles into First

Army territory, in the process massacring over 100 American prisoners

near Malmedy, but the U.S. 7th Armored Division came in behind

Kampfgruppe Peiper to hold the St.-Vith

road junction for six crucial days.

This division and the units that rallied

around it held up the advance of

most of the Sixth Panzer Army, while

other American elements isolated the

Peiper force and broke it up.

The Seventh Army, on the far southern wing of the German attack, soon

was brought to a standstill by the

rightmost VIII Corps formations,

which held the longer portion of the

American line in the Ardennes. In the

center of the VIII Corps front, however, the Fifth Panzer Army enveloped

the green 106th Infantry Division,

awkwardly deployed in a salient in the

Schnee Eiffel (the extension of the Ardennes into Germany), capturing two

American regiments, and broke

through the 28th Infantry Division, a

battered Huertgen Forest veteran,

which was spread thin along the Our

River. The Fifth Panzer Army now was

in position to roll northwestward
A TIME OF ADVERSITY 395

toward the Meuse. Fortunately for the

Americans, the 101st Airborne Division, released from SHAEF reserve,

came into the gap on 19 December,

just in time to deny to the onrushing

Germans the important road junction

of Bastogne. Completely encircled for

the better part of a week, the airborne

troops, aided by elements of two armored combat commands and a miscellany of artillery and support units

that had straggled into Bastogne, held

the town and further restricted

German maneuver.

The Allied high command, although surprised by the initial

German onslaught, reacted to it swiftly and effectively. SHAEF early committed its main ground troop reserve,

the XVIII Airborne Corps, then recuperating after leaving the line in Holland. While the 101st Division of this

corps secured Bastogne, the corps

headquarters, with the 82d Airborne

Division, helped extend the American

line to the right of the V Corps, along

the northern flank of the German salient. On 20 December, to improve

coordination of the forces on both

sides of the breakthrough, General

Eisenhower temporarily gave operational control of the First and Ninth

Armies to Field Marshal Montgomery's 21 Army Group. Montgomery

was to redeploy British and U.S. divisions to stop the Germans at or in

front of the Meuse and then counterattack. South of the Bulge, the Third

Army took over VIII Corps and prepared to push forward to relieve Bastogne and help pinch off the salient.

The Allies gradually regained the

tactical initiative, assisted mightily by

a period of clear weather after 23 December, which allowed their air forces

to intervene with decisive effect. The

First Army shifted divisions from its

left flank to its right to check the continuing German advance, bringing the

Fifth and Sixth Panzer Armies to a stop

well short of the Meuse. The Third

Army, in a remarkable display of tactical and logistical flexibility, within

days turned its axis of advance 90

degrees and attacked the enemy's

southern flank. On the twentyseventh, elements of Patton's army

opened a corridor to the besieged

101st Division. The Germans had

driven a wedge into the First Army

front that was 60 miles deep and 50

miles wide at the base, but they had

fallen hopelessly short of their ambitious objectives. During the first

weeks of 1945 the First and Third

Armies counterattacked in bitter cold

and snow. They steadily forced back

the by now exhausted, dispirited

enemy. The Wehrmacht in mid-February was fighting on or behind its

16 December start line. It had left

behind on the ground so briefly won

over 100,000 men and uncounted

quantities of equipment, and it had

lost its ability ever again to resume

the offensive.

For the American armies the

human cost of the Battle of the Ardennes was substantial but difficult to

determine exactly, due to the number

of commands involved and the reporting of casualties by unit and time

period rather than by engagement.

According to one authoritative estimate, American combat losses in the

period of the German attack, 16 December to 2 January, amounted to at

least 41,000 officers and men, including some 4,100 known killed in

action, 20,200 wounded, and over

16,900 missing. Many of the missing
396 EUROPEAN THEATER OF OPERATIONS

likely were wounded who fell into

enemy hands. First Army hospitals,

between 16 December and 22 February, admitted over 78,000 patients,

24,000 of them wounded. Third Army

hospitals reported some 70,000 admissions in December and January,

including almost 30,000 battle casualties.2

For the field army medical service

that treated and evacuated these casualties, the Battle of the Ardennes

posed some unaccustomed challenges. First Army medics in units

and detachments directly in the path

of the German assault underwent the

new and unwelcome experiences of

retreat and, in some instances, capture. Medical units outside the immediate breakthrough area had to relocate in haste as the army fell back

before the onslaught and then shifted

forces to hold and counterattack. Surgeons with the surrounded 101st Airborne Division at Bastogne resorted

to improvisation to provide emergency treatment for the growing accumulation of wounded within the perimeter, trying to keep their patients alive

until they could be evacuated. Other

medics with the relieving forces attempted to reinforce and resupply

their besieged colleagues. The Third

Army medical service, besides managing the relief of Bastogne, redeployed

dozens of units and rearranged its

lines of evacuation as the army swung

around and attacked into the Bulge.

Medics in Retreat

The German attack for the most

part missed the heaviest concentration of First Army medical units and

overran few even of those in its direct

path. Most of the large, relatively immobile facilities, such as the convalescent hospital and the base supply

depot, were located well to the north

of the breakthrough, positioned to

support a renewed advance toward

the Roer River. The hitherto quiet

Ardennes sector held only the installations required for immediate support of the V and VIII Corps. Those

installations, due to the previous inactivity of that part of the front, had a

very light patient load when the assault began, a circumstance that facilitated their evacuation and withdrawal.

In addition, the Germans' mechanized

exploitation of their breakthrough

started much more slowly than

planned; enemy armored columns did

not push any distance into the American rear during the first twenty-four

hours or so of the battle. This delay,

besides contributing to the Germans'

ultimate tactical failure, gave many

First Army medical units just enough

time to escape the blitzkrieg.3

Some medical units, nevertheless,

suffered severely during the first few

days of the offensive, notably those of

the infantry divisions that absorbed

the initial shock. On the northern

shoulder of the Bulge the 99th Division and elements of the 2d fought a

bitter three-day battle in woods and

2

 Cole, Ardennes, p. 674; First U.S. Army Report of

Operations, 1 Aug 44-22 Feb 45, bk. IV, p. 202;

Surg, Third U.S. Army, Annual Rpt, 1944, ex.

XXVII, and Semiannual Rpt, January-June 1945, an.

XIX.

3

 For an example of the light patient load, see Intervs, sub: Medical Units in vic Clervaux, in 28th Infantry Division Combat Intervs, box 24033, RG 407,

NARA. Cole, Ardennes, pp. 668-71, analyzes the Germans' delay in exploitation.
A TIME OF ADVERSITY 397

villages, losing men and ground but

denying the Sixth Panzer Army a clean

breakthrough. The infantry regiments, their thin lines repeatedly infiltrated by enemy troops and tanks,

their battalions at times temporarily

surrounded, fell back in often chaotic

combat. Their surgeons and aidmen,

those of the 99th experiencing their

first major action, had to cope with a

number of difficulties. The cold

caused even slightly injured men to

go into shock so that litter squads had

to carry extra blankets and aid stations had to administer larger than

usual amounts of plasma. Battalion

aid stations, sheltered in the crossroads villages that were a principal

enemy objective, came under intense

artillery and mortar bombardment. At

times, medics worked on the wounded while tank and infantry firefights

raged in the streets around them. The

Germans, who included many SS

troops, displayed less regard than

hitherto for the niceties of civilized

warfare. According to the 99th Division surgeon,

Medical Department soldiers were delib- erately killed in spite of Red Cross bras- sards on both arms and four red crosses

on white, circular backgrounds ... on

the helmets. It is further known that vehi- cles transporting wounded and plainly

marked with Geneva Red Cross flags

were deliberately riddled by enemy small

arms fire and in one instance, a tank at

close range fired an armor-piercing shell

through an ambulance. ...

The infantry battalions struggled to

evacuate their wounded even as they

fell back from position to position. As

waves of attacking Germans inundated the foxhole lines, aidmen and litterbearers risked their lives to rescue

every injured GI they could reach. Inevitably, wounded men were overrun

or had to be abandoned; in some instances, medics voluntarily stayed

behind to care for them. Most withdrawing battalions managed to bring

their aid stations and their accumulated patients back with them. Battalion

medical officers had first call on the

available vehicles; they loaded casualties on everything that would roll and

sent them out near the front of the

retreating columns that groped their

way, usually in darkness, along firebreaks and winding roads. Surgeons

and aidmen brought up the rear, to

collect casualties of the troops covering the retreat. Losses of medics, patients, and station equipment did

occur. One regimental aid station,

short of transportation, abandoned its

equipment to fill its truck with patients. A 99th Division infantry battalion, withdrawing from a nearly surrounded position on 17 December,

discovered that it had a dozen or so

more casualties than its vehicles could

carry. The battalion surgeon, Capt.

Frederick J. McIntyre, MC, and his

detachment remained in place with

these wounded men. According to the

regimental surgeon, the aid station

"when last seen that day . . . was

being overrun by the enemy and was

operating under a Geneva flag and a

white flag."

 5

4

 Surg, 99th Infantry Division, Annual Rpt, 1944,

p. 17.

5

 Quotation from ibid., app. VIa. See also ibid.,

pp. 15-16 and apps. VIb-VIc; Intervs, Capt R. C.

McElroy, Capt R. R. McGee, and 1st Battalion,

394th Infantry, in 99th Infantry Division Combat Intervs, box 24069, RG 407, NARA, which provide

additional medical support details; and Medical Bulletin, 2d Infantry Division, December 1944, in Surg,

2d Infantry Division, Annual Rpt, 1944.
398 EUROPEAN THEATER OF OPERATIONS

BULLET-RIDDLED ARMY AMBULANCE, a casualty of the Ardennes fighting

Although forced to retreat, the 2d

and 99th Divisions held together a

solid enough line to permit their

medical battalions (respectively, the

2d and 324th) to maintain more or

less continuous evacuation of their

battalion and regimental aid stations.

Nevertheless, the first days of the

battle were hectic, at times desperate

ones, especially for the collecting

companies. The companies sandbagged their stations against the

point-blank fire of infiltrating German

tanks; they prepared to hold wounded

for extended periods if evacuation

were blocked; they hauled casualties

over constantly changing, endangered

routes; and they made precipitate retreats with losses in men and matérie

cal Battalion had to abandon its

entire station equipment; the battalion as a whole reported eighteen men

wounded or missing in December.

Less heavily engaged, the 2d Medical

Batallion had one of its collecting

companies put out of action by matériel 

As division frontages contracted,

the 324th Medical Battalion consolidated elements of its battered collecting companies into a single provisional unit, which evacuated all three

infantry regiments. Both division

clearing stations pulled back in leapfrogging sections, that of the 2d Division's medical battalion leaving

behind a significant amount of equipment. As the divisions reoriented

their main supply routes from an

east-west to a north-south axis, the
A TIME OF ADVERSITY 399

clearing companies temporarily had

difficulty obtaining army medical

group ambulances for evacuation. On

several occasions they sent wounded

to the rear in trucks. On 19 December, as the front stabilized, the 134th

Medical Group reestablished reliable

ambulance service between the clearing stations, now located near Elsenborn, and the army hospitals at

Eupen. Thereafter, the medical services of the 2d and 99th Divisions,

and of the others reinforcing the

northern shoulder of the Bulge, rapidly returned to normal.6

The medical service of the 106th

Infantry Division was engulfed in the

catastrophe that befell that inexperienced, exposed unit. During the first

four days of the offensive the entire

medical complements of the 422d and

423d Infantry, the 589th and 590th

Field Artillery Battalions, two engineer companies, and a reconnaissance

troop—encircled in the Schnee Eiffel—

fell into German hands, along with

their wounded, numbering in the

hundreds. Details of the fate of these

surgeons and aidmen are fragmentary, as are those of the entire action.

The infantry regiments apparently left

behind many of their aid stations,

filled with nontransportable patients,

during abortive breakout attempts. In

the final encirclements the presence

of untended wounded, and a lack of

people and supplies for their care,

probably hastened the surrender of

the main body of the 422d Infantry

and contributed to the decisions of

other isolated American groups to

give up.7

The 331st Medical Battalion, 106th

Division, came off better. On the first

day of the attack the battalion's collecting companies kept casualties

moving rearward from all three regiments, although Company A, supporting the 422d Infantry, was forced

to make an early retreat by one of the

encircling German columns. The following day, the extent of the disaster

became apparent. Company A lost

contact with the 422d and withdrew

to St.-Vith. Company B, with the

423d Infantry, was surrounded and

eventually captured; Company C, retreating with the division's only surviving regiment, the 424th, evacuated

its casualties during its participation

in the defense of St.-Vith. The division surgeon and clearing company

moved westward from their original

position at St.-Vith to Vielsalm, where

they handled casualties of a number

of divisions blocking the advance of

the Sixth Panzer Army. As the Germans

gradually worked around to the westward of the St.-Vith defenders, the

clearing company, on 19 December,

shifted a platoon farther west to La

Roche, only to have it overrun by an

enemy column. The remaining 106th

Division medical elements withdrew

from Vielsalm on the twenty-second,

as American forces under orders re6

 For tactical developments, see Cole, Ardennes,

chs. V and VI; Surg, 99th Infantry Division, Annual

Rpt, app. VId; Medical Bulletin, 2d Infantry Division, December 1944, in Surg, 2d Infantry Division,

Annual Rpt, 1944.

7

 For accounts of this disaster, see Cole, Ardennes,

ch. VII, and Richard E. Dupuy, St. Vith: Lion in the

Way. The 106th Infantry Division in World War II

(hereafter cited as The 106th) (Washington, D.C.: Infantry Journal Press, 1949), passim. For medical details, see pp. 129-30, 143-44, and 148-50 of the

latter work. See also Surg, 106th Infantry Division,

Annual Rpt, 1944, p. 4. Other medical details are in

the 106th Infantry Division Combat Intervs, box

24081, RG 407, NARA.
400 EUROPEAN THEATER OF OPERATIONS

luctantly gave up their St.-Vith salient.8

The 28th Division, stretched thinly

over a 20-mile front immediately to

the right of the 106th, gave way

under the full weight of the Fifth

Panzer Army assault. During the first

three days of the battle the division's

two flank regiments, the 112th Infantry on the north and the 109th on the

south, pulled back in reasonably good

order and joined the American forces

rallying on the shoulders of the

breakthrough. Their surgeons and aid

stations accompanied them and maintained more or less normal operations

throughout the offensive. In the division center, however, the 110th Infantry was all but destroyed in delaying

the enemy advance on Bastogne. Its

surgeon, Maj. L. S. Frogner, MC, located with the regimental command

post at Clervaux, lost all contact with

his battalion aid stations during the

afternoon of 16 December, as those

installations were overrun or cut off

in the general wreck. Frogner and his

aid station were captured late the following day, after German tanks and

infantry overwhelmed the patchwork

of headquarters and service elements

defending Clervaux.9

The division's 103d Medical Battalion, during the quiet period before

the attack, had split its clearing company into three separate detachments,

each of which handled casualties of a

single regiment. This arrangement,

adopted to save time and transportation in evacuating sick and wounded

from the extended division front, fortuitously was of benefit during the

German offensive. It ensured continuous clearing company support of the

flanking regiments even as they

became separated from the division

and were attached for a time to other

commands. The 103d Battalion managed to extricate all of its elements,

although it lost twenty-one men captured in the retreat. Company B, the

collecting company behind the 110th

Infantry, had to abandon much of its

equipment, as did one platoon of the

clearing company. Battalion headquarters withdrew with the division

command post from Wiltz to a position near Neufchateau, southwest of

Bastogne.10

The V and VIII Corps surgeons reacted quickly to the emergency. They

tried to extricate their corps medical

battalions from danger while keeping

contact with their divisions and coordinating evacuation. Colonel Brenn,

the V Corps surgeon, and his medical

section remained at Eupen throughout the battle, under intermittent

German shelling and for a time

threatened by enemy paratroopers.

The headquarters, the clearing company, and one collecting company of

the corps' 53d Medical Battalion—the

rear elements, ironically, as the battalion was oriented to support an American attack toward the northeast—

8

 Surg, 106th Infantry Division, Annual Rpt, pp.

4-5 and encl. 7; Dupuy, The 106th, pp. 61, 89-90,

98-99. Surg, 7th Armored Division, Annual Rpt,

1944, pp. 21-22, gives additional details of evacuation from St.-Vith. 9

 Cole, Ardennes, ch. VIII; Surg, 28th Infantry Division, Annual Rpt, 1944, p. 4; History of the 110th

Infantry Regiment (hereafter cited as 110th Infantry

Hist), sec. III, pp. 61-74, box 8596, RG 407, NARA;

Intervs, sub: Medical Units in vic Clervaux, in 28th

Infantry Division Combat Intervs, box 24033, RG

407, NARA.

10

 Surg, 28th Infantry Division, Annual Rpt, 1944,

ends. 5-6; Col D. B. Strickler, Action Report of

Germans' Ardennes Breakthrough, ... in 110th Infantry Hist, app., box 8596, RG 407, NARA.
A TIME OF ADVERSITY 401

CARING FOR AN INFANTRYMAN INJURED IN THE ARDENNES FIGHTING

were in more danger; their location at

Heppenbach was in the middle of the

99th Division battlefield. On 17 December the battalion, by making two

trips using all available vehicles, evacuated its personnel, its 180 patients,

and about 95 percent of its equipment to Eupen. The trucks had to

travel over roads already under

German observation, but the enemy

did not interfere with them. The battalion, however, did lose three ambulances and five men in an apparent

ambush during a separate evacuation

mission. With his medical battalion

safely repositioned, Brenn concentrated during the rest of the battle on supervising evacuation and trying to determine how many medical personnel

and how much equipment his divisions had lost.11

The VIII Corps surgeon, Colonel

Eckhardt, lost contact early with the

flank divisions of his hard-hit corps.

His own section, with the corps headquarters, moved in haste from Bastogne to Neufchateau on 18 December and then on the twenty-first to

Florenville, still further south. There,

"a very unmerry Christmas was faintly

observed and a not very joyous New

Year was welcomed." The corps'

169th Medical Battalion, which had its

11

 Surg, V Corps, Annual Rpt, 1944, pp. 21-22;

53d Medical Battalion Annual Rpt, 1944, p. 14.
402 EUROPEAN THEATER OF OPERATIONS

BRIG. GEN. JOHN A. ROGERS, decorating a field hospital medic

headquarters and clearing station at

Troisvierges, close behind the center

of the corps front, and its collecting

companies widely spread out, withdrew relatively intact and eventually

reassembled near Florenville. This

battalion, besides supporting the remaining units of the VIII Corps, also

served the 101st Airborne Division

after it moved into Bastogne.12

In addition to divisional and corps

units, the breakthrough area contained a number of First Army medical installations. They included the

headquarters and attached battalions

of two medical groups: the 134th, located at Malmedy, which evacuated

the V Corps; and the 64th, at Troisvierges, supporting the VIII Corps.

Platoons of two field hospitals, the

42d and 47th, were spread across the

front, receiving nontransportable casualties from the infantry divisions.

Evacuation hospitals were clustered

on the northern and southern fringes

of the Bulge. In the north the 44th

and 67th, at Malmedy, were receiving

wounded from a local attack by the

left-wing divisions of the V Corps.

Behind the VIII Corps the 107th

Evacuation Hospital, as the German

offensive began, had just ceased operations at Clervaux and was preparing

to move. The 102d at Echternach and

12

 Quotation from Surg, VIII Corps, Annual Rpt,

1944, p. 8. See also 169th Medical Battalion Annual

Rpt, 1944, pp. 10-12.
A TIME OF ADVERSITY 403

MAP 17

the 110th at Esch were open for patients from the VIII Corps right wing.

The Bulge also contained a couple of

specialized army hospitals. At Malmedy the 618th Clearing Company

operated a center for treatment of

combat exhaustion casualties; at

Grand-Halleux, west of St.-Vith,

Company C, 91st Medical Gas Treatment Battalion, cared for malaria,

contagious disease, and self-inflicted

wound patients. Advance sections of

the 1st Medical Depot Company

maintained supply dumps at Malmedy

and Bastogne.13

The First Army surgeon, Brig. Gen.

John A. Rogers, MC, located at army

headquarters at Spa, north of the

breakthrough area, received his first

hint of the enemy offensive early in

the morning of 16 December (Map

17). It came in the form of reports of

heavy shelling from the evacuation

13

 This section is based on the annual reports,

1944, of the units mentioned.
404 EUROPEAN THEATER OF OPERATIONS

hospitals at Eupen and Malmedy.

Around 1900 Rogers learned that the

Germans during the day had made

"some penetration" of the VIII Corps

line and along the boundary between

it and V Corps. "A request for information to the army G-3 elicited the

response that the action was thought

to be local, and the penetration not

considered serious." Three hours

later, however, the G-3 indicated to

Rogers that the Germans attacking

the VIII Corps were gaining ground.

On the basis of this information

Rogers gave orders for the withdrawal of the platoon of the 42d Field

Hospital at Wiltz and of the 102d and

107th Evacuation Hospitals, his most

exposed units in the rear of the VIII

Corps. The next day, as word came of

growing pressure on the V Corps, the

army surgeon also began sending retreat orders to medical units in the

path of the Sixth Panzer Army." 14

Most immediately threatened by the

German breakthrough were four field

hospital platoons. In the V Corps

area the 1st and 3d Platoons of the

47th Field Hospital, located respectively at Waimes and Dom Butgenbach, received wounded from the 2d

and 99th Divisions. Behind the VIII

Corps the 1st Platoon of the 42d

Field Hospital at Wiltz supported the

28th Division clearing station; the 3d

Platoon, in St.-Vith, served the 106th

Division. These units, unlike the division clearing stations with which they

were located, did not possess organic

transportation for rapid withdrawals.

Further, although working closely

with the divisions, the platoons were

under the command of the medical

groups. In the confusion of the first

days of the battle they had difficulty

in obtaining timely orders and information; their movements were not

always well coordinated with those of

the divisions. Surgeons with the platoon at St.-Vith, for example, learned

of the offensive only when the hospital was engulfed by 106th Division

wounded, by which time, according to

them, the division clearing station already had left for Vielsalm. The division surgeon, on the other hand,

claimed that the platoon "took off"

without warning, leaving him with no

emergency surgical capability. On 17

December all these units extricated

themselves from their exposed positions, but with a nearly total loss of

equipment and, in some instances,

with casualties among patients and

staff. Regrouped in rear areas, they

were out of action for the rest of the

battle, their personnel in bivouac or

temporarily attached to other medical

units.15

Two platoons, the 1st of the 47th

Field Hospital at Waimes and the 1st

of the 42d at Wiltz, had particularly

dramatic and, in the latter case, tragic

experiences. The 1st Platoon at

Waimes continued working throughout the morning of the seventeenth,

the staff increasingly agitated by the

stories told by incoming wounded of

14

 Rogers was promoted to brigadier general effective 10 November 1944. Surg, First U.S. Army,

Annual Rpt, 1944, pp. 53-54, gives a chronology of

the surgeon's initial decisions.

15

 42d Field Hospital Annual Rpt, 1944, pp. 4-5

and encl. 1; 47th Field Hospital Annual Rpt, 1944,

ans. 7-8; 64th Medical Group Annual Rpt, 1944, p.

8. On the platoon at St.-Vith, see Clifford L. Graves,

Front Line Surgeons: A History of the Third Auxiliary Surgical Group (San Diego, Calif.: Frye & Smith, 1950),

p. 242, and Interv (source of quotation), Lt Col Carl

Belzer, 6 Jan 45, in 106th Infantry Division Combat

Intervs, box 24081, RG 407, NARA.
A TIME OF ADVERSITY 405

overwhelming German attacks.

Orders to evacuate patients and

nurses preparatory to withdrawal arrived from the 134th Medical Group

around midday. Early in the afternoon, the unit sent its eighteen patients off to the 67th Evacuation Hospital at Malmedy. However, when the

nurses, a short time later, tried to

follow the same road to the rear, they

found it blocked by artillery fire and

the proximity of Kampfgruppe Peiper.

The women, forced by the shelling to

leave the ambulance in which they

had been riding, walked and hitchhiked back to Waimes. Trucks dispatched by the 134th to transport the

platoon failed to arrive; but ambulances from the front, filled with

wounded, did.

The 1st Platoon medics, who had

packed their equipment for movement, unpacked it again, set up operating theater and wards, and went

back to work. They continued treating

patients until about 1100 the next

day. At that time two armed Germans,

one in an American uniform, appeared and announced that the hospital, and a large number of nonmedical stragglers who had collected there

during the night, were prisoners. Also

caught were the commanding officer

of the 180th Medical Battalion, his

S-3, and his driver. They had stayed

behind in Waimes to help evacuate

the hospital after the battalion, a

134th Medical Group unit, had withdrawn from the town. Armed Americans at the hospital considerably outnumbered the enemy, but they made

no resistance for fear of compromising the installation's Geneva Convention protection. The hospital platoon

commander, Maj. Earl E. Laird, MC,

talked the Germans into leaving

thirty-six patients where they were,

along with the nurses, four medical

officers, and a few enlisted technicians to care for them. The enemy

lined up everyone else to wait for

trucks to carry them into captivity.

Fortunately, an alert battalion ambulance driver managed to escape in his

vehicle. He brought back troops from

a nearby American unit, who chased

away the Germans in a brief firefight.

With a road to the rear now open, the

1st Platoon evacuated its patients.

The personnel then headed for Spa,

leaving behind all their hospital

equipment but the kitchen. When the

unit members reached the First Army

rear, they were dispersed among several general and field hospitals for

work and lodging.16

At Wiltz the 1st Platoon of the 42d

Field Hospital, directly in the path of

the enemy drive toward Bastogne, received no definite information or

order until the afternoon of 18 December. Toward evening, with

German columns already threatening

to encircle the town, the 28th division

passed word that the platoon should

prepare for evacuation by a 64th

Medical Group truck convoy that was

on the way. The hospital confronted a

dilemma. It had twenty-two patients

whose condition was such that, under

the regulations, they should not be

moved. Maj. Charles A. Serbst, MC,

the senior auxiliary surgical team

leader, urged that these wounded

men be evacuated anyway, because

German captivity would be more hazardous to their survival than a truck

16

 47th Field Hospital Annual Rpt, 1944, an. 7;

Graves, Front Line Surgeons, pp. 247-49; 180th Medical Battalion Annual Rpt, 1944, p. 3; 575th Ambulance Company Annual Rpt, 1944, p. 9.
406 EUROPEAN THEATER OF OPERATIONS

ride. The hospital platoon commander, Major Huber, however, insisted

that these patients had to stay put. According to the auxiliary surgical

group historian, "Serbst was right but

Huber prevailed." If patients stayed,

it was First Army policy that medical

personnel must remain to care for

them. Huber, to his credit, adhered to

the letter of this regulation also. He,

with another officer and sixteen men

of the platoon, and with Serbst and

his auxiliary team, remained with the

casualties and went into captivity

early on the nineteenth, when

German troops entered Wiltz. The

rest of the personnel, with several

truckloads of hospital equipment, left

during the night of the eighteenth.

The medics, running a gauntlet of

American roadblocks and German

fire, made their way back to VIII

Corps lines. However, the trucks carrying the equipment, diverted to another mission, unloaded their cargo

in Bastogne, an occurrence for which

101st Airborne Division medics soon

would have cause to be grateful.17

Both medical groups moved hurriedly to escape the attack. The 134th

Medical Group, which evacuated the

V Corps, retreated to Spa during the

afternoon of the seventeenth. This

group lost several ambulance crewmen killed in the Malmedy massacre.

Nevertheless, its 179th and 180th

Medical Battalions withdrew generally

intact and continued evacuating, respectively, the left and right flank divisions of the corps. The 64th Medical Group, supporting the VIII Corps,

pulled out of Troisvierges early on

the seventeenth. While an advance

group command post remained with

the corps surgeon at Bastogne, the

balance of the unit continued on farther south to Martelange. Several

more retreats followed until the

group, on the twenty-first, finally

reached Sedan. Four days later, as the

VIII Corps front at last stabilized, the

64th Group moved to Gerouville, on

the Franco-Belgian border east of

Sedan, more centrally located for

control of evacuation. Throughout

the crisis of the battle the attached

ambulance and collecting companies

of these groups, in spite of frequent

displacements and bewilderingly rapid

changes in the divisions to be supported, managed to keep casualties

moving back from the clearing stations. The groups also did much of

the work of mustering trucks to move

field hospital platoons and other less

mobile organizations.18

On the northern edge of the Bulge

the westward drive of Kampfgruppe

Peiper compelled a series of medical

unit withdrawals. On 17 December

the 44th and 67th Evacuation Hospi17

 The First Army considered the decision on removal of patients from an endangered hospital to

be "a command function," but insisted that "from a

medical viewpoint, if patients are not evacuated, sufficient medical personnel must stay behind to care

for the patients even at the risk of capture." See

Surg, First U.S. Army, Annual Rpt, 1944, p. 70.

Quotation from Graves, Front Line Surgeons, p. 259.

See also ibid., pp. 258 and 260-61; 42d Field Hospital Annual Rpt, 1944, pp. 4-5; 64th Medical

Group Annual Rpt, 1944, p. 8; Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 55-56; 110th Evacuation Hospital Semiannual Rpt, January-June 1945,

p. 12; 240th Medical Battalion Annual Rpt,

1944, p. 7.

18

 134th Medical Group Annual Rpt, 1944, pp.

14-17; 64th Medical Group Annual Rpt, 1944, and

Semiannual Rpt, January-June 1945, p. 1. For examples of the work of attached medical battalions,

see 180th Medical Battalion Annual Rpt, 1944, p. 3,

and 240th Medical Battalion Annual Rpt, 1944, pp.

7-10.
A TIME OF ADVERSITY 407

tals, the 618th Clearing Company exhaustion center, and the 2d Advance

Section, 1st Medical Depot Company,

retreated in haste from Malmedy,

generally heading for Spa. The following day, the contagious disease

and malaria hospital, Company C,

91st Medical Gas Treatment Battalion, pulled out of Grand-Halleux. All

these units removed their personnel

and patients, most of them in ambulances and trucks provided by the

134th Medical Group and the First

Army Provisional Medical Department

Truck Company. They also made

much use of self-help. The 618th

Company, for instance, secured rides

for about half of its 200 patients by

flagging down passing trucks. For lack

of time and transportation, the units

for the most part left in place their

equipment and, in the case of the

depot section, their stock. On the

twenty-first and twenty-second, after

the battle line stabilized just south of

Malmedy, the 134th Medical Group,

using vehicles and men of several

evacuation hospitals, retrieved most

of the outfit of the units withdrawn

from that town. The depot section, by

sending in a few trucks at a time,

managed to haul its stores back to the

base depot at Dolhain. A salvage detachment of the gas treatment company, on the other hand, came under

German fire at Grand-Halleux and

only secured a portion of that unit's

equipment. Regardless of how much

of their equipment was recovered, the

withdrawn hospitals effectively were

out of action for the rest of the battle.

Most had to retreat a couple of times

more as the First Army regrouped.

Their people remained in billets or

were detailed to work in other medical installations.19

By midmorning on 18 December

elements of Kampfgruppe Peiper's SS armored force had reached Stavelot,

less than 10 miles by road from Spa.

Few American troops then were between the Germans and First Army

headquarters with its cluster of service installations. The army, accordingly, directed all logistical units in

Spa, including those of its medical

service, to withdraw to Huy, a city on

the Meuse about 25 miles to the west,

where they would be well situated

either to support a new defense line

or for further retreat. Army headquarters at the same time moved to the

environs of Liege.

This withdrawal involved a number

of working medical units and others

earlier displaced from farther south.

The 134th Medical Group, previously

pushed out of Malmedy, joined the

new exodus. So did the 57th Medical

Battalion, heretofore located at Spa,

which constituted the army reserve of

collecting and ambulance companies

and controlled the now heavily committed Provisional Truck Company.

The commander of the 57th prudently had stationed liaison officers at

19

 Surg, First U.S. Army, Annual Rpt, 1944, pp. 22

and 53-54; First U.S. Army Report of Operations, 1

Aug 44-22 Feb 45, bk. IV, p. 156; 134th Medical

Group Annual Rpt, 1944, pp. 14-15; Surg, V Corps,

Annual Rpt, 1944, p. 22; 44th Evacuation Hospital

Annual Rpt, 1944; 67th Evacuation Hospital Annual

Rpt, 1944, and Semiannual Rpt, January-June 1945;

618th Clearing Company Annual Rpt, 1944, pp. 5-

6; 91st Medical Gas Treatment Battalion Annual

Rpt, 1944, p. 5; 1st Medical Depot Company Annual

Rpt, 1944, p. 7. For an example of trucks used in

equipment recovery, see 45th Evacuation Hospital

Annual Rpt, 1944, p. 175. For the origin of the First

Army Provisional Medical Department Truck Company, see Chapter IX of this volume.
408 EUROPEAN THEATER OF OPERATIONS

General Rogers' office and at other

headquarters in Spa, to ensure that

he would receive up-to-date intelligence and timely orders. He started

his battalion off as soon as the enemy

was reported at Stavelot. Most important of these new displacements was

that of the 4th Convalescent Hospital

at Spa. Since the offensive this large

installation, besides performing its

main mission of patient reconditioning, had housed and fed the personnel of withdrawing medical units.

Within less than twenty-four hours

the 4th disposed of its 1,400 patients,

either returning them to duty or

transferring them to COMZ facilities.

Then the staff packed up their essential records and unit housekeeping

equipment and took the road to Huy.

How they managed all this in so short

a time, the commanding officer, Col.

John W. Claiborne, Jr., MC, was not

sure; apparently, he wrote later, it was

"a case of team work with all players

clicking." At first bivouacked at Huy

and later at Tirlemont, the 4th could

not resume operations for lack of a

suitable site. Its removal from action

was a crippling blow to the entire

First Army hospitalization and evacuation system.20

In the VIII Corps area the 1st Advance Section, 1st Medical Depot

Company, pulled out of Bastogne on

18 December. The unit was able to

take along only a portion of its stock,

even though it commandeered empty

ambulances and the trucks that had

brought the 42d Field Hospital equipment from Wiltz. A four-man detachment stayed behind with the rest of

the supplies. The main body of the

unit halted briefly at Libin, some 20

miles west of Bastogne, then retreated again southwestward to Carlsbourg on the twenty-first. Five days

later, after the Third Army had taken

over medical support of the southern

flank of the Bulge, the section moved

north and rejoined the base depot at

Dolhain.21

Of the three evacuation hospitals in

the rear of VIII Corps, two were displaced by the German attack. On 16

December the 102d Evacuation Hospital relinquished its position at Echternach, only 6 miles from the front

lines, and made a long march right

across the battle area to Huy, which it

reached on the eighteenth. "A withdrawal of this nature," the unit report

declared, "is an experience that all

the personnel will long remember."

This unit brought along all of its

equipment and opened for patients

on the twenty-first. The 107th Evacuation Hospital, which had been closed

when the offensive started, worked

while withdrawing. It first fell back

from Clervaux to Libin, where it admitted over 780 patients in eighty-two

hours. Assisted by a platoon of the

92d Medical Gas Treatment Battalion,

the hospital evacuated 300 patients

on the twenty-first, then moved with

100 more to Carlsbourg, where it partially set up again. The next day it retreated for a final time to Sedan.

There, after hasty reconnaissance, the

20

 Quotation from 4th Convalescent Hospital

Annual Rpt, 1944, pp. 2 and 8. See also First U.S.

Army Report of Operations, 1 Aug 44-22 Feb 45,

bk. II, p. 120; Surg; First U.S. Army, Annual Rpt,

1944, p. 54; 134th Medical Group Annual Rpt,

1944, p. 15; 57th Medical Battalion Annual Rpt,

1944, pp. 22-24.

21

 First U.S. Army Report of Operations, 1 Aug

44-22 Feb 45, bk. IV, p. 156; 1st Medical Depot

Company Annual Rpt, 1944, p. 7.
A TIME OF ADVERSITY 409

unit found shelter in a former vocational school and resumed operations

on Christmas Eve. During the following week, it handled over 1,000 patients.22

The remaining evacuation hospital

in rear of the VIII Corps, the 110th at

Esch, well south of the breakthrough,

stayed in place. During the first week

of the German offensive this 400-bed

hospital received most of the American casualties from the southern flank

of the Bulge, and in addition it fed

and temporarily sheltered thousands

of troops separated from their units.

Patients arrived at a rate of about 300

a day. The surgical backlog at one

time also exceeded 300. As no field

hospitals any longer were in front of

the 110th, these surgical patients included many men with severe chest

and abdominal injuries. To cope with

this influx, the hospital pitched tents

in the paved courtyard of its building

to house the sick and lightly wounded. The receiving section culled all

the immediately transportable patients from among the incoming casualties, filled out the basic medical

forms on them, and at once placed

them in ambulances and sent them

toward the rear. By such expedients,

and by strenuous round-the-clock

effort, the staff, heavily reinforced

with auxiliary surgical teams, coped

with the overload. The 110th handled

over 5,000 patients within a month,

with a mortality rate of a little less

than 1.5 percent among the over

2,200 admitted for surgery.23

Medical Realignments

Even as the last medical units extricated themselves from the breakthrough area, the First and Ninth

Armies were shifting forces to build a

solid line between the Germans and

the Meuse. The Ninth Army relinquished four infantry and two armored divisions to its southern neighbor. At the same time its XIX Corps

extended to its right to take over

most of the territory and several divisions of the First Army's VII Corps,

freeing the latter headquarters and its

corps troops for commitment on the

northern flank of the Bulge. The First

Army on 19 December transferred the

VIII Corps, with which its headquarters no longer had effective communication, to the Third Army for both

operational control and logistical support. At the same time the First Army

acquired the XVIII Airborne Corps,

which went into line immediately to

the right of the V Corps controlling

the 82d Airborne Division and others

from the Ninth Army and VIII Corps.

Finally, on the twenty-fourth, the VII

Corps shifted its headquarters from

Aachen to Huy. With one armored

and two infantry divisions it formed

the right wing of an army front anchored on Elsenborn Ridge, and extending from there generally southwestward.

Medical rearrangements accompanied this reorganization. In the Ninth

Army the 31st Medical Group and 22

 Quotation from 102d Evacuation Hospital

Annual Rpt, 1944, p. 2. See also 107th Evacuation

Hospital Annual Rpt, 1944, pp. 6-8; 92d Medical

Gas Treatment Battalion Annual Rpt, 1944, pp. 6-7;

Surg, Third U.S. Army, Annual Rpt, 1944, p. 56.

23

 110th Evacuation Hospital Semiannual Rpt, January-June 1945, pp. 3, 18, 42 and encl. 3.
410 EUROPEAN THEATER OF OPERATIONS

several field and evacuation hospitals

changed position to support the

southward extension of the XIX

Corps and to evacuate casualties of

divisions formerly under the First

Army. At the same time the Ninth

Army surgeon, Colonel Shambora,

and his staff made preparations for

withdrawal in the event that the Germans extended their offensive to their

army's hitherto quiet front or broke

clear through the First Army and

crossed the Meuse. Shambora selected an alternate medical concentration

area just east of Brussels. He rede- ployed two evacuation hospitals, and

platoons of two field hospitals closed

and pulled back. Shambora also had

his forward evacuation hospitals send

all their unused heavy equipment,

such as tentage, back to the 35th

Medical Depot Company for storage,

thereby reducing the transportation

requirements in any retreat. The

Ninth Army front, however, remained

largely inactive.24

The First Army, in addition to relinquishing its VIII Corps to the

Third Army, transferred its 64th Medical Group (to include its two battalion headquarters, a collecting company, four ambulance companies, and a

clearing company) and the corps'

medical battalion and one field and

three evacuation hospitals. In return,

on 21 December, the First Army

picked up from the Ninth Army a

medical battalion, the 187th, with one

ambulance and three collecting companies. The companies went to reinforce the 134th Medical Group, now

responsible for evacuating both the V

and XVIII Airborne Corps. The army

used the additional battalion headquarters, with a collecting company

and a clearing company platoon attached, as a provisional medical battalion for the airborne corps, which

hitherto had lacked one. During the

VII Corps redeployment the 68th

Medical Group, which supported the

corps, moved its headquarters 50

miles; disengaged from support of

five divisions and as many evacuation

hospitals; and assumed responsibility

for eight new divisions, belonging to

the VII and XVIII Airborne Corps, as

well as two evacuation hospitals. The

group commander observed: "Probably at no previous time had the flexibility and ease of adaptability of a

Medical Group been more clearly illustrated than during this emergency. . . ."

 25

To the rear of the fighting line

General Rogers attempted to put

back together an army evacuation and

hospitalization system disrupted by

the rapid movement of the front and

the displacement of so many medical

units. Even though most threatened

installations, or at least their personnel, escaped the advancing Germans,

Rogers within forty-eight hours of the

start of the attack no longer had

enough beds in operation for normal

hospitalization and evacuation of his

24

 Surg, Ninth U.S. Army, Annual Rpt, 1944, pp.

10-11 and 13-16; 31st Medical Group Annual Rpt,

1944, pp. 19-20.

25

 Quotation from 68th Medical Group Annual

Rpt, 1944, p. 22. On 21 December the 134th Medical Group moved forward from Huy to Verviers to

be closer to the V Corps. See 134th Medical Group

Annual Rpt, 1944, pp. 15-16. See also Surg, First

U.S. Army, Annual Rpt, 1944, pp. 54-55 and 57-78;

VII Corps Medical Plan, pp. 103-04, encl. 1 to

Surg, VII Corps, Annual Rpt, 1944; 187th Medical

Battalion Annual Rpt, 1944, p. 2; Surg, XVIII Airborne Corps, Semiannual Rpt, January-June 1945,

pp. 1-3.
A TIME OF ADVERSITY 411

casualties. Well over half of the First

Army's dozen evacuation hospitals by

that time had closed for movement, had lost their equipment, or—in the

VIII Corps area—had become inaccessible to the majority of divisions.

In addition, the displacement of the

4th Convalescent Hospital, the 618th

Clearing Company exhaustion center,

and the 91st Medical Gas Treatment

Battalion communicable disease facility left the army unable to retain and

care for short-term cases. Perforce,

then, Rogers on 19 December established a total evacuation policy in

place of the ten-day one hitherto in

effect. Under the new policy, army

hospitals evacuated all their patients

as soon as they were able to travel

and sent new arrivals whose condi- tions permitted it, without treatment,

directly to COMZ facilities. Most of

the bypassed patients, under an

agreement between Rogers and the

ADSEC surgeon, Colonel Beasley,

went to the by now well-developed

cluster of general hospitals around

Liege. Those hospitals, according to

General Hawley, "saved the First

Army medical service during the

counteroffensive," for without them

Rogers could not have kept his remaining evacuation beds open for

fresh casualties or cleared his endangered units for withdrawal.26

Two ADSEC units close to the

combat zone temporarily served as

army evacuation hospitals, receiving

wounded brought from division clearing stations. One of these, the 77th

Evacuation Hospital, a 750-bed unit

located at Venders, had been functioning as a holding unit and hastily

reorganized to perform its original

mission. Just behind the center of the

new First Army front, the 77th, assisted for a time by the 9th Field Hospital, for about a week handled most of

the casualties from divisions trying to

stop the German advance toward the

Meuse. The staff, augmented with

auxiliary surgical teams and medics

from nonoperating First Army hospitals, worked eighteen-hour and longer

days to sort, treat, and evacuate the

flood of patients. They keep eight operating and two fracture tables busy

day and night. Verviers, a major road

center, came under daily enemy artillery fire, V-1 bombardment, and

Luftwaffe raids. This danger forced

off-duty personnel to spend their few

hours of rest in crowded, fetid underground shelters. On 20 December a

shell blew off a corner of the school

building that housed the 77th, wrecking a bathroom; damaging the nurses

quarters, laboratory, and pharmacy,

and one medical ward; and mortally

wounding a Red Cross worker. The

hospital staff cleaned up the wreckage

and continued in operation. A week

later, in addition to the regular patient influx, the 77th had to care for

the 14 dead and 50 wounded from a

direct bomb hit on the 9th Field Hospital. "For hours the receiving room

was in a turmoil as the differentiation

and treatment went on. Among the

dead, decapitations and amputations

made the task gruesome, even for the

men who had seen many hundreds of

wounded." Enemy bombardment for

a time prevented hospital trains from

26

 Quotation from Ltr, Hawley to TSG, 27 Jan 45,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Surg, First U.S. Army, Annual Rpt, 1944,

pp. 54, 56-57, 69-70. Some individual hospitals

went to total evacuation even before the army

change of policy. See 5th Evacuation Hospital

Annual Rpt, 1944, p. 15, for example.
412 EUROPEAN THEATER OF OPERATIONS

reaching Verviers. The Advance Section maintained evacuation of the

77th with ambulances, which shuttled

patients back to the Liege general

hospitals. The burden on the weary

77th staff eased only in the last days

of the year, as First Army hospitals

began opening in Verviers.27

The 130th General Hospital, al- though an ADSEC unit, lay just within

the First Army area. As it turned out,

this hospital, set up in a large school

building at Ciney, was positioned

almost exactly at the westernmost tip

of the Bulge and was well placed to

receive casualties from the VIII

Corps. That, however, was not its

function. The 130th had been reorganized before leaving England as a

specialized neuropsychiatric facility.

At Ciney it treated combat exhaustion

casualties from the First and Ninth

Armies. The hospital's mission

changed abruptly on 19 December,

when ambulance loads of wounded

began arriving, both from retreating

evacuation hospitals, such as the

107th, and directly from division

clearing stations. According to the

unit report, the hospital found itself

"acting as a cross between a clearing

company and an evacuation hospital

which required revamping . . . [the]

entire setup." The 130th discharged

its exhaustion patients to an ADSEC

replacement depot, sent its psychiatric staff to the rear, and enlarged its

surgical service with people from the

12th Field Hospital and the 3d Auxil- iary Surgical Group. Between the

twentieth and twenty-third the hospital received and treated or bypassed

over 3,000 patients. It evacuated most

of them by train from a nearby siding.

The unit performed surgery on about

200 casualties. The German advance

rolled almost literally up to the door;

fighting occurred in the hospital

grounds as the 2d Armored Division

and other units moved in to engage

and throw back the enemy. On the

twenty-third the 130th evacuated all

but a skeleton staff and its nontransportables. The remaining staff and

patients all left or were evacuated

during the next four days, along with

the most vital items of equipment. An

armored combat command treatment

station temporarily occupied the plant

until the twenty-eighth, when an advance party of the 130th moved back

in.28

While these ADSEC hospitals, and

the few First Army ones still active,

coped with the immediate flow of casualties, General Rogers tried to redeploy and reopen his evacuation hospitals. He worked within the constraints

of an army G-4 order, issued on

Christmas Day, to withdraw all logistical units except those absolutely essential for operations to positions

north and west of the Meuse. Under

this directive First Army hospitals and

other medical units redeployed to a

concentration area about 15 miles or

so west of Liege. These included two

of the three evacuation hospitals that

had been working in Eupen throughout the battle, under bombardment

comparable to that endured by the 27

 Quotation from Allen, ed., Medicine Under

Canvas, pp. 142-48. See also Surg, ADSEC, COMZ,

Annual Rpt, 1944, p. 20; 77th Evacuation Hospital

Annual Rpt, 1944, pp. 7-8; 134th Medical Group

Annual Rpt, 1944, p. 16.

28

 Quotation from 130th General Hospital Annual

Rpt, 1944, pp. 4, 11, 16-17, 28-30. See also Surg,

ADSEC, COMZ, Annual Rpt, 1944, p. 10.
A TIME OF ADVERSITY 413

FORMER SCHOOL FACILITY HOUSING THE 130TH GENERAL HOSPITAL AT CINEY

77th at Verviers. This final withdrawal

crowded First Army units back into

towns already occupied by numerous

ADSEC facilities. As a result, the hospitals sent there could not reopen for

lack of usable buildings, tented openfield operation being out of the question in the cold wet weather. By the

end of the year the First Army had a

few evacuation hospitals working: the

102d and 51st (field acting as an

evacuation) at Huy, the 97th and

128th at Verviers, and the 2d at

Eupen. The other six evacuation hospitals then under the army, however,

remained inactive, as did the convalescent hospital and most of the specialized medical facilities. General

Rogers, accordingly, kept a total evacuation policy in effect until mid-January.29

The First Army also redeployed its

medical supply installations during

the last week of December and began

rehabilitating those of its units that

had lost equipment in the retreat.

Under the 25 December withdrawal

order the base depot, with most of its

stock, moved by rail from Dolhain to

Basse Wavre, southeast of Brussels.

As later described by the army surgeon, "A series of incidents, some humorous and some serious, including

29

 Surg, First U.S. Army, Annual Rpt, 1944, p. 56;

First U.S. Army Report of Operations, 1 Aug 44-22

Feb 45, bk. IV, pp. 144-45; 68th Medical Group

Annual Rpt, 1944, p. 23; 134th Medical Group

Annual Rpt, p. 16; 2d, 5th 45th, 97th, and 102d

Evacuation Hospitals Annual Rpts, 1944; 51st Field

Hospital Annual Rpt, 1944.
414 EUROPEAN THEATER OF OPERATIONS

an international dispute as to right of

tenancy, misrouted cars, and lost ve- hicles," prevented supply issues from

this depot for the rest of the year.

The two advance sections of the 1st

Medical Depot Company kept most of

the army supplied. The 2d Advance

Section, earlier withdrawn from Malmedy, on the twenty-sixth set up a

dump at Huy to support the army's

right wing corps and divisions. At

Dolhain the 1st Advance Section

issued to the V Corps, and the army

blood bank detachment, also located

there, remained in operation. First

Army medical units farther to the rear

for a while drew directly upon COMZ

depots, notably M-409 at Liege. By

the end of the year the base depot

was engaged in replenishing its much

depleted stock. General Rogers sent

liaison officers to divisions and other

organizations to determine the extent

of their medical equipment losses, which in many units approached 100

percent of their basic allowances. His

office then worked directly with the

chief surgeon's Supply Division to

speed replacement items forward.30

Throughout the medical unit movements resulting from the Ardennes

battle, the First Army Provisional

Medical Department Truck Company

performed indispensable service. This

unit, attached to the 57th Medical

Battalion, had been formed during

the pursuit by pooling vehicles, primarily taken from evacuation hospitals, as a transportation reserve for

moving the larger army installations.

Its work, and vehicle strength, had diminished in scope during the relatively static autumn and winter battles,

but in the late-December crisis the

company again came into its own. Expanding quickly from 50 trucks to

100, in two weeks it transported nine

evacuation and three field hospitals,

the convalescent hospital with 1,400

patients, a depot company section,

and a gas treatment company, as well

as tons of supplies. The company significantly increased the ability of the

First Army medical service to respond

rapidly to the changing military situation.31

During the first two weeks of the

German offensive, the First Army

medical service redeployed most of its

nondivisional units while maintaining

continuous evacuation of the regrouping combat forces. Its relative success

in both endeavors may be attributed

to a favorable starting position, to the

delays in the German advance, to an

abundance of transportation, and to a

high standard of unit and individual

initiative and resourcefulness. By the

end of December, however, the army

for all practical purposes had lost its

ability to hold and treat casualties; its

medical service perforce had been reduced to little more than a conduit

between division clearing stations and

COMZ hospitals.

Bastogne: Encirclement and Relief

The battle for Bastogne began on

19 December, when the 101st Airborne Division went into action to the

east of that strategic road junction. 30

 Quotation from Surg, First U.S. Army, Annual

Rpt, 1944, p. 22. See also ibid., p. 23; First U.S.

Army Report of Operations, 1 Aug 44-22 Feb 45,

bk. IV, pp. 156-57; 1st Medical Depot Company

Annual Rpt, 1944, p. 7.

31

 Surg, First U.S. Army, Annual Rpt, 1944, p. 61;

57th Medical Battalion Annual Rpt, 1944, pp. 22-

23.
A TIME OF ADVERSITY 415

The following day the VIII Corps

gave Brig. Gen. Anthony C. McAuliffe, acting division commander, overall charge of the defense, with

control also of Combat Command B, 10th Armored Division; of Combat

Command R, 9th Armored Division;

and of an assortment of artillery, tank

destroyer, and other units that had

collected in Bastogne. On the twentyfirst the Germans closed their ring

and made their first attacks on the

American perimeter. The enemy surrender demand came on the twentysecond and elicited General McAuliffe's immortal one-word rejection.

For another four days the defenders

fought off repeated assaults by the

Fifth Panzer Army, making effective use

of well-directed artillery fire to break

up German attacks. At night they endured Luftwaffe bombing raids on the

city. The American units within the

perimeter had enough food, ammunition, and other necessities, brought in

with them or foraged from abandoned First Army and VIII Corps

dumps, to carry them through until

23 December, when large-scale supply

airdrops began just in time to avert a

critical shortage of artillery shells. At

1645 on the day after Christmas elements of the 4th Armored Division of

the Third Army opened a road into

Bastogne from the south. This break- through ended the siege, although

heavy fighting continued around the

city for several more weeks.32

American casualties during the

siege amounted at least to 189 officers and men killed, 1,040 wounded,

407 sick and injured, and 412 missing—the loss reported by the 101st

Division. In addition, Combat Command B of the 10th Armored Division

suffered about 500 battle casualties,

and there were still more among the

other commands, and fragments of

commands, that defended the city.

The great majority of the sick and

wounded were trapped in Bastogne

for the duration of the encirclement.33

The 101st Division medical service

was organized and equipped for selfsufficient operations out of contact

with the normal ground chain of evacuation. Its medical detachments went

into action at full strength in men and

equipment and carrying along extra

reserves of litters and blankets. The

division's 326th Airborne Medical

Company included both collecting

and clearing elements and had an

auxiliary surgical team attached so

that it could perform the functions of

a field hospital platoon (see Map 18).

An early stroke of misfortune deprived the division of its hospital. The

326th Company, accompanied by the

division surgeon, Colonel Gold, and

his staff, set up its clearing and surgical station early on 19 December at a

crossroads about 8 miles west of Bastogne. Gold, in consultation with the

division supply officer, placed the station there, in what he expected would

be the division service area, on the assumption that the 101st would be

fighting as a part of a continuous

front line. Around 1030 the company

deployed its collecting elements,

32

 For tactical developments, see Cole, Ardennes,

ch. XIX.

33

 101st Airborne Division After-Action Rpt, IT27 Dec 44, box 14335, RG 407, NARA. Cole, Ardennes, pp. 480-81, provides figures on casualties in

other organizations. His figures for the 101st Division differ from those in the report first cited, as do

those given in Surg, 101st Airborne Division,

Annual Rpt, 1944, pp. 12-13.
416 EUROPEAN THEATER OF OPERATIONS

MAP 18

sending four or five ambulance jeeps

and an evacuation officer to each of

the four infantry regiments. The first

patients arrived at about 1100. Late

that afternoon the 326th Company

commander, Major Barfield, left the

crossroads with an ambulance convoy

to take patients to the 107th Evacuation Hospital at Libin and to contact

the 64th Medical Group about additional ambulances for the clearing station. On the return trip Barfield and

his group found their road to Bastogne blocked by a blown bridge and

columns of tanks and spent the night

at the 107th.34

34

 Surg, 101st Airborne Division Annual Rpt,

1944, pp. 9-10; 326th Airborne Medical Company

After-Action Rpt, Belgium and France, 17-28 Dec

44, p. 3; G-3 Account of Bastogne Operation, in

101st Airborne Division Combat Intervs, box 24075,

RG 407, NARA; Crandall Interv, 8 Jun 45, box 222,

RG 112, NARA.
A TIME OF ADVERSITY 417

At around 2200 a German force of

perhaps half a dozen armored vehicles and 100 troops, some dressed in

civilian clothing, attacked the 326th

Company clearing station. Evidently a

reconnaissance element of one of the

columns beginning to encircle Bastogne, it had come down a road from

the northeast and caught the medical

company totally by surprise. After a

few minutes of sporadic automatic

weapons fire, the Germans realized

that they had run into a medical installation. An enemy officer came forward and demanded the Americans'

surrender. Colonel Gold, who had no

alternative, complied, but a few officers and men on the west side of the

company area ran off into the nearby

woods. As the Germans were rounding up their prisoners, a truck column

headed out of Bastogne to pick up

supplies rolled unsuspectingly into

the crossroads. Firing broke out

again, from the Germans and from at

least one of the trucks. The medics,

caught in the crossfire, ducked for

cover. Some were killed or wounded

by stray bullets; a few managed to

escape in the confusion. Soon the

flames of burning American vehicles

lighted the area. Americans and Germans alike made futile efforts to save

the screaming wounded trapped

inside the wrecks. The Germans withdrew toward the northeast, taking

with them the remaining medical personnel and patients, as well as any

equipment and supplies they decided

not to destroy. The prisoners included Colonel Gold and his staff, an

entire auxiliary surgical team, and 11

officers and 119 men of the 326th

Company. With them, the 101st Airborne Division lost its hospital and its

emergency surgical facility.35

Division headquarters learned of

this misfortune shortly after midnight,

from infantry patrols sent to investigate the shooting at the crossroads

and from escapees of the 326th Company who made their way into Bastogne. The G-4 and the evacuation

officers of the medical company in

town, together with the regimental

surgeons and Major Barfield, now

acting division surgeon, quickly improvised a new evacuation system.

They designated the regimental aid

station of the 501st Parachute Infantry, centrally located within the city in

a convent, as the collecting point for

all division casualties. Meanwhile, the

VIII Corps surgeon, at division request, deployed a collecting company

and the clearing company of the

corps medical battalion to move patients from Bastogne to evacuation

hospitals. Some 170 men passed

through this improvised evacuation

chain on the twentieth. By 2330 on

that day, however, the Germans had

blocked the last road out of Bastogne.

Completion of the encirclement left

the VIII Corps collecting and clearing

units outside the ring, along with

Major Barfield, who had gone back to

corps headquarters to report on the

loss of the medical company and

35

 101st Airborne Division After-Action Rpt, IT27 Dec 44, box 14335, RG 407, NARA; Surg, 101st

Airborne Division, Annual Rpt, 1944, pp. 10-11;

326th Airborne Medical Company After-Action Rpt,

Belgium and France, 17-28 Dec 44, p. 4. For eyewitness stories, see Crandall Interv, 8 Jun 45, box

222, RG 112, NARA; Rapport and Northwood, Rendezvous with Destiny, pp. 467-68; Graves, Front Line

Surgeons, p. 278; and Statement of Pfc E. E. Lucan,

in 101st Airborne Division Combat Intervs, box

24075, RG 407, NARA.
418 EUROPEAN THEATER OF OPERATIONS

bring forward additional supplies and

equipment. Wounded soon began to

accumulate in the regimental aid station; as early as 0630 on the twentyfirst about 150 were on hand.36

The 101st Division now was totally

cut off from evacuation. Its medical

officers, to give the steadily growing

number of casualties at least essential

life-saving treatment until American

forces broke the German siege, improvised a hospital at the convent

housing the regimental aid station.

Maj. Martin S. Wisely, MC, regimental surgeon of the 327th Glider Infantry, headed a pickup staff made up of

doctors and aidmen from the division

antiaircraft, engineer, artillery, and

tank destroyer units. To obtain more

space and better protection from artillery and air attack for his patients,

Wisely moved the hospital from the

convent to the basement garage of a

Belgian Army barracks. As the hospital population increased, he placed

ambulatory patients in the barracks

rifle range and used still another

building for trenchfoot cases. Eventually, patients were distributed among

basements all over the city, with the

barracks garage reserved for the most

severely wounded.

These facilities were, to say the

least, primitive. The main garage

ward, for instance, had no latrine and

only a single electric light. A field

kitchen set up at one end of the large

room fed both staff and patients. The

wounded "were laid in rows on sawdust covered with blankets. Each row

had a shift of aidmen, and an attempt

was made to segregate incoming cases

into specified rows depending upon

the seriousness of their wounds."

Those deemed unlikely to survive lay

nearest the wall. "As they died they

were carried out to another building

where an impromptu Graves Registration Office was functioning." Wisely

and his assistants worked 24-hour

shifts trying to keep their patients fed,

reasonably warm, and in stable condition. They attempted no major surgery. According to the participants,

morale among the casualties was "extremely high." On Christmas Eve a

ration of cognac and the voice of

Bing Crosby singing "White Christmas" from a salvaged civilian radio

provided some holiday atmosphere.37

Although the 101st Division hospital handled most of the casualties of

the siege, it was not the only improvised medical facility in Bastogne.

Combat Command B, 10th Armored

Division, a Third Army unit that had

entered the city from the south, improvised its own holding and treatment station after being cut off from

its supporting armored medical company. On Christmas Eve the hospital

took a direct hit from a German

36

 Surg, VIII Corps, Annual Rpt, 1944, p. 8; Surg,

101st Airborne Division, Annual Rpt, 1944, p. 11;

326th Airborne Medical Company After-Action Rpt,

Belgium and France, 17-28 Dec 44, pp. 3-5; G-3

Account of Bastogne Operation and Narrative,

"Medical Evacuation and Supply," both in 101st

Airborne Division Combat Intervs, box 24075, RG

407, NARA; 169th Medical Battalion Annual Rpt,

1944, p. 12; 429th Collecting Company Annual Rpt,

1944, p. 3.

37

 Quotations and most details from Rapport and

Northwood, Rendezvous with Destiny, pp. 469-71. See

also Surg, 101st Airborne Division, Annual Rpt,

1944, p. 11; 326th Airborne Medical Company

After-Action Rpt, Belgium and France, 17-28 Dec

44, p. 5; 501st Parachute Infantry Draft After-Action

Rpt, in 101st Airborne Division Combat Intervs,

box 24075, RG 407, NARA. History of the 12th

Evacuation Hospital, 25 August 1942 to 25 August

1943 (hereafter cited as 12th Evac Hist), pp. 111-

12, contains additional eyewitness reports.
A TIME OF ADVERSITY 419

bomb. The resulting roof cave-in and

fire killed a number of patients and

also a Belgian woman nurse, who had

volunteered to help tend the American wounded.38

Around the perimeter the infantry

battalions set up their aid stations in

the standard manner, with the main

installations well sheltered in farmhouses or other structures and forward collecting elements close to the

foxhole line. Short of litterbearers,

the airborne units relied heavily on

their ambulance jeeps to move their

casualties. Where jeeps could not go,

some units used toboggans, made of

sheet metal torn off roofs, to slide

wounded men across the snow. Jeeps

of the division's 326th Company carried patients from the battalion aid

stations to the central hospital in Bastogne. One regimental surgeon, Maj.

Douglas Davidson, MC, of the 502d

Parachute Infantry, thought he could

do as much for his wounded as the

ill-equipped division facility; hence,

he maintained his own holding hospital in the barn of the chateau housing

the regimental command post. Davidson used horse stalls for wards and

pressed the chaplains and a dentist

into service as cooks. He estimated

that "only about 5 men died of

wounds who might have been saved

had they been given medical care."

On Christmas Day, when German

tanks and infantry broke through the

main line of resistance and momentarily threatened the command post,

Davidson routed out all of his wounded men who were able to walk, gave

them all rifles, and led them to join a

scratch force of headquarters personnel in repelling the attack.39

During this week of encirclement

the hospitals in Bastogne faced two

major problems: medical supply and

the provision of emergency surgery.

Of these the supply problem proved

the easier to solve. A few tons of

stores and a small issuing detachment

of the 1st Medical Depot Company

remained in Bastogne, and paratroopers also found an abandoned VIII

Corps medical supply point. From

these sources the surgeons obtained

necessities for the first few days. Nevertheless, by the end of the third day

of the siege, the hospitals were running short of penicillin, plasma, morphine, dressings, litters, and blankets.

To keep patients warm in the unheated wards, the division collected the

blankets of its dead and sent parties

of men to salvage quilts and bed

clothing from ruined dwellings. Food

also was short, although the division

reserved for the hospitals the limited

available quantities of sugar, coffee,

Ovaltine, and ten-in-one rations. The

large-scale airdrop, which began on

23 December, alleviated most medical

supply deficiencies. Penicillin and

other medicines, plasma, Vaseline

gauze, anesthetics, morphine, distilled

water, syringes, sterilizers, litters, and

blankets arrived in the parachuted

bundles. The parachute cloth itself,

and the wrapping of the bundles,

went to the hospitals to provide addi38

 Surg, 10th Armored Division, Annual Rpt,

1944, p. 15; 101st Airborne Division After-Action

Rpt, 17-27 Dec 44, box 14335, RG 407, NARA;

Rapport and Northwood, Rendezvous with Destiny, pp.

471 and 546.

39

 Rapport and Northwood, Rendezvous with Destiny,

pp. 470-71. For Davidson, see S. L. A. Marshall,

"Bastogne," pp. 197-98, and Narrative (source of

quotation), 592d Parachute Infantry, both in 101st

Airborne Division Combat Intervs, respectively box

24074 and box 24075, RG 407, NARA.
420 EUROPEAN THEATER OF OPERATIONS

tional warm covering for patients.

Whole blood also was among the airdelivered supplies, but the bottles

broke on landing or were destroyed

when a German shell blew up the

room where they were stored.40

As the days of encirclement went

by, the division surgeons realized that

the number of wounded awaiting

treatment was increasing and that

they were going to die unless they underwent major operations immediately. Equipment for such surgery was at

hand: the operating theater outfit of

the 42d Field Hospital platoon that

had withdrawn from Wiltz. However,

the few surgeons in Bastogne either

could not be spared from other tasks

or lacked the qualifications to perform the work required. Seeking a

way out of this dilemma, Major

Wisely on 26 December obtained authority from the division to try to negotiate the passage of the most severely wounded through German

lines. Wisely, assisted by a captured

German medical officer, made contact

with the enemy commander opposite

the southwest sector of the perimeter.

The German responded favorably to

the evacuation proposal but postponed a final answer until the next

day. By that time Third Army troops

had ended the siege.41

Even as Wisely was trying to arrange for the wounded to come out

of Bastogne, Third Army efforts to

send surgeons in bore fruit. The army

surgeon's office obtained six medical

officers and four enlisted technicians,

all volunteers, from the 4th Auxiliary

Surgical Group and the 12th Evacuation Hospital to go into Bastogne

and set up an emergency surgical facility. The army at first intended to

drop these men into the perimeter by

parachute; but, to their relief, they

were able to travel by less hazardous

means. One officer was flown in on

Christmas Day in a light plane and

the rest followed by glider during the

afternoon of the twenty-sixth.

When the main body of the surgical

group walked into the garage hospital, about 150 patients, all severe

cases, remained, the rest having been

moved elsewhere. The need for the

reinforcements' services was all to apparent, as "the odor of gas gangrene

permeated the room." Using the 42d

Field Hospital equipment, which included an operating lamp and an

autoclave, the surgeons and technicians set up a four-table theater in a

small tool room adjoining the garage.

They examined and sorted the patients and by nightfall had the first

men on the tables. The volunteers,

assisted by three Belgian women and

by a 10th Armored Division battalion

surgeon who was a qualified anesthetist, operated all through the night

and until around noon of the twentyseventh, trying to repair wounds that

had gone from two to as many as

40 Surg, First U.S. Army, Annual Rpt, 1944, p. 22;

Surg, Third U.S. Army, Annual Rpt, 1944, p. 171;

Surg, 101st Airborne Division, Annual Rpt, 1944,

pp. 11-12; Rapport and Northwood, Rendezvous with

Destiny, pp. 469-71; Narrative, "Medical Evacuation

and Supply," and Interv, ACofS, G-4, and Others,

both in 101st Airborne Division Combat Intervs,

box 24075, RG 407, NARA; 101st Airborne Division

After-Action Rpt, 17-27 Dec 44, box 14335, RG

407, NARA. 41 Rapport and Northwood, Rendezvous with Destiny,

p. 471; Narrative, "Medical Evacuation and Supply,"

and 327th Glider Infantry Journal, 26 Dec 44, both

in 101st Airborne Division Combat Intervs, box

24075, RG 407, NARA. The Third Army's chief of

staff had plans for moving surgeons into Bastogne

under a white flag. See Cole, Ardennes, p. 609.
BUNDLES OF MEDICAL SUPPLIES, air-dropped from C-47s over a field near Bastogne and

retrieved by 101st Airborne Division troops
422 EUROPEAN THEATER OF OPERATIONS

eight days without surgical attention.

Of necessity, they performed many

amputations. Evacuation of casualties

from Bastogne began on the twentyseventh, but the surgeons, after a rest

around midday, operated for another

twenty or so hours. Even after a nearmiss by a German bomb blew in the

operating room door and brought

down part of the ceiling, they kept

on, working for a time by flashlight.

The volunteer group, every member

of which—both officer and enlisted—

received the Silver Star, completed

about fifty major operations, with

three postoperative deaths.42

As early as 21 December the surgeons of the VIII Corps and the

101st Division, together with the commander of the 64th Medical Group,

had begun planning for the medical

relief of Bastogne. After the Third

Army took control of the VIII Corps,

the army surgeon and the surgeon of

the III Corps, which led the attack to

break the encirclement, joined in the

preparations. Besides arranging for

aerial resupply and surgical reinforcement of the besieged division, the

Third Army and its subordinate commands prepared to evacuate an anticipated 1,000 sick and wounded as

soon as a way out of Bastogne was

opened. After a couple of false starts,

resulting from reports that there was

to be an evacuation under flag of

truce, the army set up triage and

emergency treatment facilities at

Attert and Villers-devant-Orval, south

of Bastogne, on the most likely routes

by which wounded would come out of

the city. The armored medical company attached to Combat Command B,

10th Armored Division, and a platoon

of the 61st Field Hospital took position at Attert. At Villers-devant-Orval

the 635th Clearing Company and a

collecting company, both from the

VIII Corps' 169th Medical Battalion,

constituted the receiving elements. In

addition, the III Corps formed a provisional medical battalion for the

101st Division, consisting of a field

hospital platoon, a collecting company, and a gas treatment company (to

function as a clearing station). All

these units were in position by the

time the lead tanks of the Third Army

contacted the Bastogne defenders.43

As it turned out, all the accumulated casualties came out through

Villers-devant-Orval. Early on 27 December the first evacuation convoy of

twenty-two ambulances and ten trucks

rolled out of Bastogne carrying 260

patients. Men of the 635th Clearing

Company unloaded the casualties,

tagged them, and transferred them to

64th Medical Group ambulances for

movement to evacuation hospitals.

The vehicles from Bastogne then

went back to the city for another load.

In two days the medical units evacuated all of the 964 patients in the Bas42

 Quotation from 12th Evac Hist, pp. 111-12. See

also ibid., pp. 63 and 110; Surg, Third U.S. Army,

Rpt, December 1944, p. 31, in Third U.S. Army

After-Action Rpt, 1 Aug 44-9 May 45; 4th Auxiliary

Surgical Group Annual Rpt, 1944, p. 16; 101st Airborne Division After-Action Rpt, 17-27 Dec 44, box

14335, RG 407, NARA; Surg, 101st Airborne Division, Annual Rpt, 1944, p. 12; 326th Airborne Medical Company After-Action Rpt, Belgium and

France, 17-28 Dec 44, p. 5; Rapport and Northwood, Rendezvous with Destiny, p. 471; Editorial Advisory Board, 1962, pp. 211-12.

43

 Surg, Third U.S. Army, Annual Rpt, 1944, p.

79; Surg, III Corps, Annual Rpt, 1944, an. 1; 169th

Medical Battalion Annual Rpt, 1944, p. 12; 240th

Medical Battalion Annual Rpt, 1944, pp. 8-9.
A TIME OF ADVERSITY 423

ARMY AMBULANCE IN BASTOGNE, standing ready to load casualties of the siege

togne hospitals.44 At the same time,

elements of the provisional medical

battalion moved into the city to provide clearing station and forward surgical support for the airborne troops,

who still were engaged in intense

combat.45

In the defense and relief of Bastogne the field army, corps, and division medical services displayed a high

degree of resourcefulness and adaptability. Medics inside the perimeter,

after the initial disaster of the loss of

the 101st Division clearing station,

put together a new second-echelon facility in the midst of combat, using

what human and matériel resources

they had on hand. They kept most of

the casualties alive until evacuation.

Medics outside the ring made every

effort to send in needed supplies and

to reestablish forward surgical support for the besieged troops; they lost

no time in evacuating the Bastogne

hospitals after the relief. For the casualties, nevertheless, the siege was an

ordeal. How many patients died in

44

 This figure is less than the total reported casualties of the siege. Men evacuated before the encirclement, or who returned to duty during the siege,

or who died, probably account for the discrepancy. 45

 Surg, Third U.S. Army, Annual Rpt, 1944, p.

79; Surg, III Corps, Annual Rpt, 1944, an. 1; Surg,

101st Airborne Division, Annual Rpt, 1944, p. 12;

64th Medical Group Annual Rpt, 1944, p. 8-9;

326th Airborne Medical Company After-Action Rpt,

Belgium and France, 17-28 Dec 44, pp. 5-6; 169th

Medical Battalion Annual Rpt, 1944, p. 12; 240th

Medical Battalion Annual Rpt, 1944, pp. 9-10; Narrative, "Medical Evacuation and Supply," in 101st

Airborne Division Combat Intervs, box 24075, RG

407, NARA; 16th Field Hospital Annual Hist, 1944,

encl. 3; 92d Medical Gas Treatment Battalion

Annual Rpt, 1944, p. 7.
424 EUROPEAN THEATER OF OPERATIONS

Bastogne for lack of early surgery or

as the result of other deficiencies of

the improvised hospitals cannot be

determined from the fragmentary

records of those ephemeral organizations. One firm figure is the 101st

Airborne Division report of 33 deaths

under treatment in its facilities between 19 and 31 December. The

Third Army surgical consultant, after

examining the wounded brought out

of Bastogne, concluded that "other

than the physical discomforts, the casualties had not unduly suffered for

lack of Medical Department treatment

and that the mortality was extremely

low." Whatever the clinical verdict, a

Stars and Stripes correspondent who

watched one of the first evacuation

convoys come out of Bastogne expressed the human reality of the

siege:

The convoy of wounded came out of Bas- togne in a slow trickle. The day was beau- tiful if you like Belgium in the winter

time. The snow on the hills glistened in

the sun, and the planes towed vapor trails

across the big, clean sky. The wounded

sat stiffly in the trucks, and they rose

tautly when they came to a rut in the

frozen road. The dust of the road had

made their hair gray, but it did not look

strange because their faces were old with

suffering and fatigue.46

The Third Army Attack

The relief of Bastogne was one

consequence of the Third Army counterattack against the southern flank of

the Bulge. To launch this attack, General Patton's army performed the considerable tactical and logistical feat of

disengaging from a planned offensive

northeastward across the Saar River,

shifting a good part of its combat

strength from its right to its left wing

and making a 90-degree change in the

axis of its line of communications.

Patton received directions for this

movement from SHAEF and the 12th

Army Group on 18-19 December and

at the same time took over the VIII

Corps from the First Army. Three

days of hasty consultation, planning,

and staff work ensued. On the morning of the twenty-second, the day

Patton had promised Eisenhower he

would attack, the III Corps,47 with the

4th Armored and the 26th and 80th

Infantry Divisions, opened its drive

toward Bastogne. The XII Corps rearranged its forces and attacked on

the right of the III Corps. The remaining Third Army corps, the XX,

extended its line to defend what had

been the main army front east of the

Moselle.

With the other army staff agencies,

the army medical service hastily made

plans and preparations to support the

new attack. The army surgeon, Colonel Hurley, with his staff section,

throughout the campaign remained at

Nancy with the rear echelon of Third

Army headquarters. A small medical

liaison group, headed by the chief

surgical consultant, Colonel Odom,

joined Patton's forward tactical command post at the city of Luxembourg.

Hurley also dispatched liaison officers

46

 Surgical consultant quoted in Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 12-13. Stars

and Stripes quotation from Rapport and Northwood,

Rendezvous with Destiny, pp. 596-97.

47

 The III Corps joined the Third Army just

before the Ardennes battle and controlled the

troops reducing the last forts around Metz until the

army's turn northward.
A TIME OF ADVERSITY 425

to the III and VIII Corps, to keep

him informed about the rapidly

changing situation. He especially

needed information about the newly

acquired and badly disorganized VIII

Corps. Hurley's executive officer, Lt.

Col. John B. Coates, MC, who now,

as he had throughout the campaign,

bore the burden of directing day-today army medical operations, reported that at first "nobody in Third

Army knew where VIII Corps was,

specifically. We didn't even know

where the VIII Corps headquarters

was." The corps, in turn, was equally

uncertain of the whereabouts of its

medical units. Coates, therefore, sent

two officers of his section forward to

find the corps and establish communications with them, a task which took

three or four days.48

With the VIII Corps the Third

Army acquired a few nondivisional

medical units in its new main area of

operations, notably the 64th Medical

Group and the 107th and 110th Evacuation Hospitals. To reinforce these,

the army surgeon conducted a rapid

large-scale redeployment of forces. As

of 16 December the army's eleven

evacuation hospitals and three medical groups all were located along or

east of the Moselle; a number of hospitals were moving, or preparing to

move, still farther to the eastward to

support the projected attack across

the Saar. One medical depot company, the 33d, also was shifting eastward from Toul to Chateau-Salins.

Within about a week Hurley and

Coates transferred six evacuation hospitals to Arlon, the city of Luxembourg, Longuyon, and Montmedy,

close behind the III and VIII Corps.

Two medical groups, the 65th and

69th, went to Esch, south of the Luxembourg capital and on the new main

line of evacuation to the army and

ADSEC holding units at Etain and

Thionville. The 33d Medical Depot

Company changed its destination to

Longuyon.

To make these movements in so

short a time, over a constricted roadnet jammed with thousands of other

troops, Colonel Hurley and his subordinates dispensed with most administrative formalities. Organizations

acted on verbal instructions. "The

written orders," Hurley reported,

"were confirmatory." Colonel Coates,

who directed much of the operation,

recalled that "everybody picked up as

they could pick up, and started

moving as quickly as possible. ... It

was first come almost first served that

got on the roads." Much depended

on the resourcefulness of veteran

medical group, hospital, battalion,

and depot commanders. These men,

according to Coates, "with minimum

direction . . . were able to p

and on their own carry out a broad

directive to get to some place at such

and such a time the best you can."

Evacuation hospitals, for instance,

rushed advance parties, often recalled

from scouting trips east of the Moselle, to the new locations to find

usable buildings. They borrowed

trucks from each other to haul people

and equipment. Their personnel

48

 Quotation from Editorial Advisory Board, 1962,

pp. 209-10. See also Surg, Third U.S. Army, Annual

Rpt, 1944, pp. 57-58. For tactical developments, see

Cole, Ardennes, chs. XX, XXI, and XXIV. Martin Blumenson, The Patton Papers, 2 vols. (Boston: Houghton Mifflin Co., 1972-74), vol. 2, 1885-1940, pp.

595-604, recounts army headquarters conferences

and planning.
426 EUROPEAN THEATER OF OPERATIONS

worked hard and rapidly to adapt

often less than suitable accommodations for hospital use.49

As a result of this rapid redeployment of army medical forces, the divisions attacking northward had little

difficulty with evacuation, even

though they suffered heavy casualties.

The clearing stations of the 4th Armored Division, for example, handled

450-500 patients every twenty-four

hours for five days. Early in the offensive the III Corps had to send some

of its wounded by ambulance 60

miles back to Metz, for lack of facilities nearer the front. Within days,

however, evacuation hospitals were

pushing up close behind the corps.

The 64th and 65th Medical Groups

established ambulance regulating

stations at Virton, Arlon, and Luxembourg City to control the flow of patients rearward from the clearing stations. Evacuation from the army to

the Communications Zone continued

with little change, because the Etain

and Thionville rail and air holding

units set up earlier in the campaign

could receive patients from the north

as easily as from the east.50

Even as the counteroffensive went

on, the Third Army surgeon undertook an emergency effort to reequip

the VIII Corps units that had been hit

hardest in the initial German attack.

These included two platoons of the

42d Field Hospital, several elements

of the 28th Division, and the 326th

Airborne Medical Company, all of

which needed complete new outfits.

Other organizations, such as the

107th Evacuation Hospital, had suffered less total but still significant

losses. Colonel Hurley arranged for

VIII Corps units to draw matériel directly from the COMZ medical depot

at Reims, as well as from his two

army depot companies. He also set up

a temporary VIII Corps supply dump,

stocked from the 32d Medical Depot

Company at Metz, to fill emergency

requisitions from the 64th Medical

Group and the evacuation hospitals.

For the airborne medical company

Hurley had a set of equipment flown

to Metz, where 101st Division trucks

picked it up. As a result of these efforts all the worst-depleted organizations were in the process of reconstituting themselves by the beginning of

the new year.51

Southern Encore: Operation NORDWIND

On the last day of 1944, as the Ardennes offensive was losing momentum, German forces in northern

Alsace and along the Rhine launched

Operation NORDWIND, a major assault

on the Seventh Army. That army was

spread thin along a right-angled front

of over 100 miles, recently extended

49

 Hurley quotation from Surg, Third U.S. Army,

Annual Rpt, 1944, p. 53; pp. 47-58 and 169-70

detail unit movements. Coates reminiscences in Editorial Advisory Board, 1962, pp. 208-10. See 64th

Medical Group Annual Rpt, 1944, p. 9. For examples of evacuation hospital movements, see 101st

and 104th Evacuation Hospitals Annual Rpts, 1944,

and 12th Evac Hist, pp. 64-66. 50

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

79 and 90; Surg, III Corps, After-Action Rpt, December 1944, in Surg, III Corps, Annual Rpt, 1944;

Surg, 4th Armored Division, Annual Rpt, 1944, p.

12 and encl. 6; Surg, 10th Armored Division,

Annual Rpt, 1944, pp. 11-14; 436th Medical Battalion Annual Rpt, 1944, p. 3.

51

 Surg, Third U.S. Army, Annual Rpt, 1944, pp.

170-72; 64th Medical Group Rpt, 1944, p. 9; 326th

Airborne Medical Company After-Action Rpt, Belgium and France, 17-28 Dec 44, p. 6.
A TIME OF ADVERSITY 427

to cover part of the ground formerly

held by the Third Army. The Germans planned to exploit American

weakness in this area by a threepronged drive from the north, from

the east across the Rhine, and from

the south out of their Colmar bridgehead, aimed at destroying divisions

and recapturing the politically symbolic city of Strasbourg. SHAEF, the

6th Army Group, and the Seventh

Army anticipated this blow. Late in

December the army developed contingency plans for withdrawing its rightflank corps, the VI from the Alsatian

plain to a better defensive position on

the eastern slope of the lower Vosges.

When the Germans launched their

attack form the north, around midnight on 31 December, hitting the

junction between the XV and VI

Corps, the 6th Army Group, at

SHAEF recommendation, directed the

Seventh Army to execute the withdrawal. The Free French government

of General Charles de Gaulle, however, objected vehemently to this maneuver, which entailed abandonment

of Strasbourg. At the same time the

front-line divisions of the Seventh

Army contained and blunted the

initial German assault while surrendering a minimum of ground. On 4

January 1945, in light of these facts,

the Allies reversed their earlier decision. The Seventh Army received

orders to hold its line in Alsace and

defend Strasbourg. It did so in a

month of bitter fighting, which ended

in the complete defeat of the NORDWIND attack.52

The abortive general withdrawal resulted in much marching and countermarching of Seventh Army medical

units. Under the late-December contingency plan the Seventh Army was

to pull back almost all its medical installations in the Alsatian plain to

towns on the western side of the

Vosges. Accordingly, during the first

days of January, the 2d Convalescent

and 9th Evacuation Hospitals fell back

from relatively exposed Sarrebourg,

respectively to Epinal and Rambervillers. The 117th Evacuation Hospital at the same time retreated from its

advanced position at Phalsbourg to

Epinal. At that point, cancellation of

the strategic withdrawal interrupted

the medical redeployment, to the confusion of some units. The 95th Evacuation Hospital, for example, left

Mutzig, just west of Strasbourg, on 3

January and made its way to Epinal in

bitter cold, over mountain roads slippery with ice. Hardly had it reached

its destination when the commanding

officer received telephone orders to

return to Mutzig at once, as the Seventh Army wanted forward hospitals

after all. The 95th left that night for

its old station and the next day was

back in at least limited operation

there. It continued work in Mutzig

until the eighth, when it moved

northwestward to Sarrebourg to help

handle casualties from the main

German attack on the XV and VI

Corps. The 132d Evacuation Hospital, also located at Mutzig, withdrew

to Epinal on the third, spent one

night in bivouac there, and then

52

 Seventh U.S. Army Report of Operations 1944-

1945, vol. II, chs. XXII and XXIII, and vol. III, pp.

943 and 977-78; History of the Medical Activities of

VI Corps, January-June 1945 (hereafter cited as VI

Corps Hist), p. 1.
428 EUROPEAN THEATER OF OPERATIONS

moved to Sarrebourg, where it went

into operation.53

In spite of all this backing and fill- ing, Seventh Army medical units handled the roughly 9,000 wounded and

17,000 sick and injured of the NORDWIND battles with no more difficulty

than was to be expected in winter

combat. Several infantry regiments

gave ground under the impact of the

German assault; they did so gradually,

evacuating their wounded and pulling

back their aid stations in good order. As had been the case in the Ardennes

withdrawals, the field hospital platoons attached to clearing stations

had difficulty coordinating their

movements with those of the divisions

and complained of a shortage of

transportation, but Seventh Army

field hospital elements, in contrast to

those in the Ardennes, suffered no

equipment or personnel losses. The

lot of the casualties in this winter

fighting, nevertheless, was far from

easy. Cold and exposure worsened

the condition of many wounded men,

as did the long ambulance hauls necessitated by the early retreat of some

field hospital platoons and evacuation

hospitals. Yet thanks to the Seventh

Army's success in checking the

German drive almost before it got

started, the medical support problems

of this southern encore to the Ardennes counterblow were minor ones

and rapidly solved.54

Overcoming Adversity

Taken as a whole, the field army

medical service suffered comparatively little damage from, and responded

efficiently to, the German counteroffensive. The First Army lost significant numbers of patients, medical

personnel, and equipment in the divisions initially overrun, although the

great depth of the division support

areas normally permitted collecting

and clearing stations to extricate

themselves more or less intact. As a

result of unit withdrawals and redeployment, the First Army also temporarily became unable to hold and

treat its sick and wounded. Nevertheless, emergency care and evacuation

within the army went on throughout

the battle, and, when necessary,

COMZ facilities assumed some of the

functions of army hospitals. The

Third Army medical service speedily

altered its focus of operations and

took over support of those First Army

elements cut off from their parent

command by the enemy breakthrough. In addition, it assembled

medical personnel and supplies for

the relief of Bastogne. Within Bastogne 101st Airborne Division medics

overcame an initial disaster, successfully improvised hospitals, and kept

most of their wounded in reasonably

good condition until they could be

evacuated.

These achievements resulted in

large part from a high order of army

medical service performance, on the

53

 Surg, Seventh U.S. Army, Annual Rpt, 1944, p.

22, and the Semiannual Rpts, January-June 1945,

for the following units: Seventh U.S. Army, pt. 1;

95th Evacuation Hospital, encl. 1; 116th Evacuation

Hospital, p. 1; 117th Evacuation Hospital, p. 1; and

132d Evacuation Hospital, p. 8 (see also pp. 1-2). 54

 Seventh U.S. Army Report of Operations,

1944-1945, vol. II, pp. 563-74, and vol. III, pp.

1,033-34; Surg, Seventh U.S. Army, Semiannual

Rpt, January-June 1945, pt. I and pt. III, p. 34;

Surg, 44th Infantry Division, Semiannual Rpt, January-June 1945, pp. 1-2; Surg, 45th Infantry Division, Periodic Rpt, January-June 1945, pt. 1; VI

Corps Hist, p. 1; 57th Field Hospital Semiannual

Rpt, January-June 1945, pp. 1-3 and 6-7.
A TIME OF ADVERSITY 429

part of both individuals and organ- izations, but a number of other circumstances also contributed to the

outcome. One was German tactical

failure. The enemy never penetrated

beyond the rear boundaries of the

First Army and fell entirely short of

their goal of disrupting the Allies' logistics system. In addition, the Germans lacked the air power to interdict

American road movements, including

movement of casualties and medical

units. The medical service benefited

from the lavish transportation resources of the American army. The

First Army alone had the use of

almost 50,000 vehicles during the

first week of the offensive. By regular

or irregular means, enterprising

medics obtained enough of these,

most of the time, for themselves, their

patients, and their equipment. The

medical service itself had a plethora

of resources at every level. At Bastogne, for instance, the 101st Airborne Division could spare enough

doctors and technicians from its tactical units to staff a hospital and could

equip and supply it with the residue

left from earlier retreats. In this

aspect of the battle as in others, "the

much criticized weight of the American logistic 'tail'" enhanced the

army's capacity to cope with unanticipated contingencies.55

The army medical service in the Ardennes possessed still another advantage: the proximity of well-developed

COMZ evacuation facilities, hospitals,

and supply depots. By mid-December

the long effort to fill out the logistical

support system attenuated by the

summer pursuit largely had achieved

its objective. The medical Communications Zone was in a position to relieve the armies of their casualties and

replace promptly their personnel and

equipment losses. The effort to do so,

however, combined with the strains of

supporting the earlier American offensive and building up COMZ facilities, brought to a head for the COMZ

medical service a number of problems

and deficiencies that had existed since

the beginning of continental operations.

55

 For discussion of American transportation and

logistical advantages, see Cole, Ardennes, pp. 665-66.

Quotation on p. 666.
CHAPTER XIII

Completing COMZ

When the heavy fall and winter

fighting began in November 1944, the

Communications Zone still was in the

process of developing intermediate

and forward logistical support facilities and moving men and matériel

inland from the beaches. It continued

these efforts during the months of

Allied attack and German counterattack, and at the same time it shifted

its main logistics axis northward from

Normandy to Antwerp and kept ne- cessities flowing to the hard-pressed

armies. As the First and Third Armies

completed the eradication of the

Bulge late in February 1945, the

Communications Zone at last was

coming into its full powers. Having

mastered most of its major problems

of supply, transportation, and evacuation, it was ready to provide the

wherewithal for the coup-de-grace

against Nazi Germany. This achievement, however, came at the cost of a

winter of turmoil, controversy, and

crisis.

The theater medical service endured and overcame its share of these

troubles and contributed its share of

the achievements. During the winter

ETO medics completed their organization and established and confirmed

command relations among their own

elements and with other COMZ and

field force agencies. They finished

their troop buildup and coped with a

variety of personnel shortages and

problems. They rounded out their

continental depot structure, established uniformity and efficiency in

depot operations, and transferred the

bulk of their supplies forward from

the beaches and ports. They expanded and filled in their continental hospitalization and evacuation systems

and managed, though with difficulty,

to accommodate the heavy, sustained

flow of casualties from the winter battles. At the same time they resolved

policy controversies over evacuation,

especially from the theater to the

United States, which had persisted

since D-Day.

The Chief Surgeon and Command

Relations

Throughout the vicissitudes of the

continental campaign General Hawley

maintained his dominance over the

increasingly widespread and organizationally compartmentalized theater

medical service. By early 1945 he had

under his supervision almost a quarter of a million people—in two army

groups, four field armies, a fluctuating number of base sections, and

hundreds of individual units. To hold
COMPLETING COMZ 431

onto his authority over all these

forces, Hawley had to navigate

through continuing crosscurrents of

administrative conflict.

He had the advantage of a large,

comparatively stable, and expert

corps of assistants. His Paris staff consisted, in December 1944, of 102

officers, 269 enlisted men, and 26

civilians—the largest in the Medical

Department outside that of the Office

of the Surgeon General (see Chart 10).

Key division chiefs, such as Gordon in

Preventive Medicine, Hays in Supply,

and McNinch in Medical Records, had

learned their jobs during the long

buildup in Great Britain and stayed in

their positions throughout the campaign. The most significant high-level

change came in February 1945, when

Colonel Kimbrough left Professional

Services to return to the United

States; he was replaced by the equally

experienced Colonel Cutler, who also

continued as chief consultant in surgery. The staff divisions also remained stable, except for the addition, early in January, of a new Field

Survey Division, created by Hawley to

seek out and report deficiencies in all

nonclinical aspects of the medical service. This able staff, with a wealth of

information and an extensive network

of acquaintances and contacts

throughout the American and Allied

forces, decisively strengthened Hawley's hand in the persistent

theater squabbling over administrative authority.1

Combining the ETO and COMZ

headquarters early in 1944 did not

end the jockeying for power between

air, ground, and service commands.

Indeed, the SHAEF and 12th Army

Group staffs asserted their claims with

increasing force. As a result, the

United States high command went

into operation on the Continent amid

continued wrangling about the distribution, boundaries, and dimensions

of authority, especially in matters of

theater administration and logistics.

Shortly before D-Day the American

staff at Supreme Headquarters made

an attempt, which General Lee

blocked, to take over the theater-level

functions of the Communications

Zone. On D-Day itself Eisenhower, in

his order formally redesignating the

Services of Supply as the Communications Zone, relieved Lee of his duties

as deputy ETO commander. But

Lee's headquarters continued to perform most theater administrative

tasks, and Lee's chiefs of technical

services, such as Hawley, remained

the theater chiefs of services. Nevertheless, the Americans on the SHAEF

staff claimed extensive but loosely

defined rights to intervene in ETO

matters, especially those involving coordination or resolution of disputes

between the air forces, the 12th Army

Group and its component armies, and

COMZ.

Resentment and distrust abounded

between General Bradley's 12th Army

Group headquarters and that of the

1 Communications Zone. The tension Armfield, Organization and Administration, p. 341;

Professional Services Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, p. 2;

Field Survey Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, pp. 1-7 and

10-11. Administration Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, encl. 3, lists Hawley's

principal subordinates at the end of 1944. Personnel

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, encl. 4(b), gives the strength of the staff. Middleton Interv, 1968-69, vol. 1, pp. 249-50, NLM,

comments on Kimbrough's removal.

432 EUROPEAN THEATER OF OPERATIONS

stemmed from the army group staffs

conviction that, like its British counterpart, it should control COMZ,

rather than being coordinate with the

service forces under a theater headquarters that in fact was also the logistical headquarters. For a month

after its activation on 1 August the

12th Army Group actually possessed

authority over COMZ, but this arrangement ended when SHAEF

moved to Versailles in September and

took direct command of land operations. Essentially, the army group

staff accused the Communications

Zone of conflict of interest. They

claimed that COMZ consistently favored its own requirements, and often

its creature comforts, over the needs

of the fighting forces and blamed this

fact for the supply shortages that

dogged the armies throughout late

1944. They condemned Lee's early

transfer of COMZ headquarters to

Paris for disrupting the supply services at a crucial point in the campaign. Similar resentment of the service command permeated the armies.

The field forces tried to promote

their interests by increasing SHAEF's

involvement in theater affairs, especially in the allocation of supplies.2

Throughout the arguments over

administrative authority General

Hawley consistently asserted the principle that "there is no Chief Surgeon

C[OM]Z. There is a Chief Surgeon,

ETO, who is also Surgeon, C[OM]Z."

He made his position prevail through

a judicious mixture of firmness and

conciliation. With General Kenner at

SHAEF, Hawley had what he later

characterized as "very friendly

associations . . . , but no

close." On the Continent, as in Britain, Kenner and his small staff kept

busy with a constant round of inspections of British and American medical

installations. He conferred frequently

with Hawley and Hawley's division

heads on ETO problems of hospitalization, evacuation, and supply.

Kenner reported regularly to Eisenhower, who considered him "one of

the finest medical officers I have ever

met."

 3

Nevertheless, Kenner's authority

over U.S. Army medical matters remained more formal than substantive.

His office transmitted policy directives to the armies; he tried to impose

his views in a few instances, notably

in reducing theater evacuation policy

from 180 to 120 days and in changing

the cross-Channel sea evacuation

route. For the most part, however, his

instructions and recommendations

paralleled or repeated those of General Hawley, and Hawley managed to

sidetrack them when they did not.

Hawley, on his part, appears to have

2

 Ruppenthal, Logistical Support, 1:222-27, 2:26-27

and 349-51, summarizes the continuing conflicts.

For an example of the 12th Army Group's view, see

Memo, Brig Gen R. G. Moses to Gen Bradley, 26

Sep 44, and Paper by Moses, October 1945, both in

Moses Papers, MHI. The Supreme Commander's

views on how the system should work can be found

in Dwight D. Eisenhower, The Papers of Dwight David

Eisenhower (hereafter cited as Eisenhower Papers), eds.

Alfred D. Chandler, Jr., et al. (Baltimore: Johns

Hopkins Press, 1970-), vols. 1-5, The War Years

(1970), 4:2,206. Memo, Maj Gen LeRoy Lutes to Lt

Gen Somervell, 31 Dec 44, box 24, RG 160, NARA,

reflects SHAEF's dissatisfaction with COMZ.

3

 First quotation from Ltr, Hawley to CofS,

ETOUSA, 29 Sep 44, file HD 024 ETO CS (Hawley

Chron). Second quotation from Editorial Advisory

Board, 1962, p. 224. Third quotation from Ltr, Eisenhower to Gen Marshall, 28 Sep 44, in Eisenhower

Papers, 4:2,196.
COMPLETING COMZ 433

GENERAL KENNER ON ONE OF HIS MANY INSPECTION TRIPS in northern France

worked through Kenner, or gone

around him as he thought expedient

in particular situations. Yet American

medical officers, in the armies and

COMZ alike, generally thought of

themselves as working primarily for

Hawley and recalled Hawley as the

dominant individual in shaping theater medical policies.4

Hawley's success in maintaining

cordial working relationships with the

army groups and armies, despite the

general field force mistrust of COMZ,

removed what could have been the

occasion for more frequent and forceful intervention by General Kenner in

ETO medical affairs. Colonels Gorby

and Reeder, respectively, the 12th

and 6th Army Group surgeons, maintained liaison with both Kenner and

Hawley, although Reeder's relations

with the latter were attenuated by the

connection of 6th Army Group to the

separate Southern Line of Communications. In spite of the tension between the 12th Army Group and

COMZ Gorby, relatively junior in

rank and with a small staff, showed

no disposition to assert his indepen4

 Kenner's activities can be followed in Medical

Division, COSSAC/SHAEF, War Diary, August

1944-February 1945. For medical officer views, see

Davis Interv, 19 Jun 45, box 222, RG 112, NARA,

and, in file HD 000.71, CMH, the following: Interv,

OSG with Maj Gen Albert W. Kenner, MC, 12 Jul

49; Gorby Interv, 1949; Interv, OSG with Brig Gen

Alvin L. Gorby, MC, 22 Jun 53 (hereafter cited as

Gorby Interv, 1953); Interv, OSG with Col Charles

H. Beasley, 29 Sep 50; and Spruit Interv, 1949. Also

in CMH, see Hartford Interv, 7-8 Oct 80, tape 1,

side 1. On the theater evacuation policy, see Chapter XIV of this volume.
434 EUROPEAN THEATER OF OPERATIONS

dence of the theater chief surgeon.

Hawley, on his part, carefully respected the position of the group surgeons, such as it was, in the medical

chain of command and sometimes

called on them for assistance in resolving difficulties with the armies,

which dealt directly with the Communications Zone on many medical as

well as other logistical matters.5

Hawley dealt circumspectly with the

army surgeons. When necessary, he

emphatically reminded them that he

was the theater, not merely COMZ,

chief surgeon and that the entire

medical service, from front to rear,

had to work as a unified system. How- ever, he preferred to rely on conciliation to secure cooperation, exploiting

to the limit his range of contacts and

acquaintances within and outside the

Medical Department. He was willing

to overlook minor infringements

upon his prerogatives. He commented after the war: "I just rode out

these little things and they all eventually straightened out. I thought it

would do more harm in the long run

than good to make an issue out of

things." As often as he could, Hawley

visited the army surgeons and their

medical units. Several times he

worked his way forward as far as the

infantry battalion aid stations and

came under German fire. He made

these trips partly, he admitted, because "I was curious. . . . I'd gone to

war. I wanted to see the fighting." He

believed that when "you go forward

to the battalion aid station and what's

ahead of the battalion aid station,

. . . you really find out what's g

on." Most important, he sought to

demonstrate his concern for the

front-line surgeons and aidmen who

bore such a disproportionate share of

the hardship and danger. When at the

front, Hawley emphasized helpfulness

to the field army medical service,

rather than criticism of it. This attitude, which the chief surgeon tried to

instill throughout the COMZ medical

organization, at least minimized in the

theater medical service the endemic

combat force distrust of the Communications Zone.6

Within the Communications Zone,

base section boundaries changed repeatedly as the armies advanced and

the Allied logistical base moved

northward from Normandy toward

the Channel ports and Antwerp (Map

19). On 1 December 1944 the Brittany Base Section absorbed the territory of the underemployed Loire Base

Section, and the Normandy Base Section extended its jurisdiction toward

the northeast, to include the American installations at Le Havre and

Rouen, which had become major disembarkation ports for troops and

supplies. The Channel Base Section,

after giving up Rouen and Le Havre

to Normandy, oversaw American activities in Antwerp and in a strip of

Belgian territory between the British

logistical area and the Advance Section. The other three base sections—

ADSEC, Oise, and Seine—continued

5

 Ltr, Hawley to Gorby, 11 Aug 44, file HD 024

ETO CS (Hawley Chron); Gorby Intervs, 1949 and

1953, file HD 000.71, and 1962, pp. 7, 9-11, 13-14,

37, CMH; Hartford Interv, 7-8 Oct 80, tape 1, side

1, CMH.

6

 Quotations from Hawley Interv, 1962, pp. 68-

71, 87-88, 98-102, CMH, which also contains comments from army-level medical officers. For Hawley's sterner approach, see Ltr, Hawley to Gorby, 11

Aug 44, file HD 024 ETO CS (Hawley Chron). See

also Hartford Interv, 7-8 Oct 80, tape 1, side 1,

CMH.

436 EUROPEAN THEATER OF OPERATIONS

their earlier functions, in some cases

with slight boundary revisions.7

Authority over COMZ medical units

and installations continued to be divided between the base section commanders, who had formal operational

and administrative control over them,

and General Hawley, who exercised

technical supervision. In practice,

Hawley, as he had in Great Britain,

managed to expand technical supervision into what amounted to day-today direction, especially of the work

of base section general hospitals. He

resisted vigorously, and usually with

success, occasional base section efforts to interfere in hospital command

and administration. When necessary,

Hawley appealed directly to the ETOCOMZ staff to overrule encroaching

section commanders, but he relied

more often on his ability to convince

the commanders that they would

serve their own interests best by

doing what he wanted. He demonstrated this method in persuading the

Normandy Base Section commander,

Col. Theodore Wyman, to replace an

inexperienced section surgeon with

one better qualified and selected by

him. The chief surgeon wrote to

Wyman:

I am too old a soldier not to know that

the authority of a commander is practical- ly unlimited, and that, if he so desires, he

can dictate the technical operations of the

services without regard to the policies of

the Chiefs of Services. I also have great

respect for the responsibilities and pre- rogatives of command.

However, I have also a great responsi- bility to my own commander. So long as

my technical policies are carried out in

any echelon, and medical units are not

hampered in their functions, I shall

accept full responsibility for all medical

failures. But, if the technical operations of

the medical service are interfered with by

the commander of any echelon, I have no

alternative than to place squarely upon

him the responsibility for any medical

failure in his echelon.8

After moving to Paris in June 1944,

Hawley enlarged upon his formal and

informal techniques for keeping close

watch over the medical service and

enforcing high standards of professional care and compassion for the individual casualty. He continued to

employ his consultants, and those of

the armies and base sections, as a

communication and control network,

and he supplemented them in early

1945 with the new Field Survey Division. This division, Hawley told its

chief, Lt. Col. Clark B. Meador, MC,

one of his veteran troubleshooters,

was to "act as the eyes and ears of the

Chief Surgeon; and to assist Medical

commanders in the field in carrying

out the policies dictated by this office

or higher headquarters." Hawley responded forcefully to patient complaints, from whatever source. For example, late in 1944 a number of GIs

in letters to the Stars and Stripes made

allegations of poor food, excessive inspections, and lack of amenities in

general hospitals. Hawley at once directed members of his staff and the

base section surgeons to survey the

7

 Troops Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Semiannual Rpt, January-June 1945,

p. 10; Surg, Normandy Base Section, Semiannual

Rpt, January-June 1945, p. 2. Ruppenthal, Logistical

Support, 2:37-38, summarizes base section boundary

changes.

8

 Quotation from Ltr, Hawley to Col Theodore

Wyman, Jr., 1 Aug 44, file HD 024 ETO CS

(Hawley Chron). For other examples of his methods, in same file, see Memos, Hawley to AG Personnel, ETO, 27 and 29 Jul 44, and Memo, Hawley to

CofS, ETO, 30 Nov 44.
COMPLETING COMZ 437

nonclinical aspects of patient care.

Then he pressed section surgeons

and hospital commanders to correct

the minor but irritating deficiencies

the surveys revealed.9

Hawley himself frequently inspected COMZ medical installations. When

doing so, the chief surgeon, besides

making ward rounds and discussing

professional matters with commanders and chiefs of services, also paid

attention to aspects of unit operations

that many medical officers would have

overlooked. At the 21st General Hospital, for instance, Hawley and his

staff were invited to inspect the guard

detachment.10 To the amusement of

the hospital commander, Hawley "did

a good infantry officer's job of the details of seizing the rifles and upending

them to squint through the barrels.

Then he slammed the rifles almost viciously into the guard's hands. The

guard and all the onlookers were surprised and pleased. He did not neglect to say a few words to the officer

and his detail which made them feel

well flattered." Hawley came down

hard on the commanders of installations that fell short of his standards,

on the principle that "there are no

poor units; there are only poor leaders." He wrote personal letters of admonition to delinquent commanders

and, if deficiencies in their units persisted, had the officers reassigned.

Even minor lapses by medical personnel did not escape the chief surgeon's

sharp eye. He warned the commander

of the 12th Field Hospital: "A group

of your nurses was seen in Paris a few

days ago in improper uniform and

generally untidy. I am very sorry to

have heard this and I do not want to

hear such a report again."11

During the autumn and winter of

1944-45 Hawley maneuvered to

extend his authority over the medical

units of the separate communications

zone behind the 6th Army Group.

That group, while it came under

SHAEF operational control in midSeptember, continued to draw its

logistical support largely from the

Mediterranean Theater of Operations,

which had mounted the invasion of

southern France. By 1 October the

Mediterranean Theater had established two base sections to operate

the line of communications running

from Marseilles northward up to the

Rhone valley. The Delta Base Section,

under Brig. Gen. John P. Ratay, controlled the installations around Marseilles. The Continental Advance Section (CONAD), under Maj. Gen.

Arthur R. Wilson, performed functions for the 6th Army Group similar

to those of ADSEC. Both sections

were part of the Mediterranean Theater Communications Zone, which established a forward headquarters at

Dijon to supervise their work.

9

 Quotation from Field Survey Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, p. 1. For hospital complaints and

Hawley's response, see letters and memorandums

for December 1944 in file HD 024 ETO CS (Hawley

Chron). 10

 Hospital units maintained armed guard forces

to protect their property and to supervise POW laborers.

11

 First and second quotations from Cady, "Notes

on the 21st General Hospital (AUS)," pp. 507-09,

Cady Papers, MHI. Third quotation from Ltr,

Hawley to CO, 12th Field Hospital, 14 Sep 44, file

HD 024 ETO CS (Hawley Chron). For examples of

Hawley's dealing with delinquent commanders, see

Ltrs, Hawley to CO, 90th General Hospital, 14 Sep

44, and Hawley to Col H. H. Price, 10 Nov 44, file

HD 024 ETO CS (Hawley Chron).
438 EUROPEAN THEATER OF OPERATIONS

General Lee and his staff wanted to

assume command over the southern

line of communications as soon as

possible. They intended to enforce

uniform policies and procedures

throughout supply organizations that

they assumed would become increasingly interdependent. The SHAEF

staff, however, preferred to delay the

merger in order to take maximum advantage of the surplus supplies available in the Mediterranean Theater

during a period when the northern

Communications Zone barely could

support the 12th Army Group, not to

mention the 6th. After weeks of negotiation the two theaters agreed on a

compromise. They created a new organization, the Southern Line of

Communications (SOLOC) around

the nucleus of the Mediterranean

COMZ advance headquarters at

Dijon. This agency, activated on 20

November under Maj. Gen. Thomas

B. Larkin, was a subdivision of the

ETO Communications Zone, with

Larkin designated a deputy commander COMZ under General Lee.

However, SOLOC had the right to

communicate directly with the Mediterranean Theater on matters of logistical support, and it was the sole

channel for contact between the

ETO-COMZ headquarters and

CONAD, the Delta Base Section, and

their subordinate units.12

Under the terms of this agreement,

and of General Lee's letter of instructions to General Larkin, Hawley could

deal with the CONAD surgeon, Col.

Harry A. Bishop, MC; the Delta Base

Section surgeon, Col. Vinnie H. Jeffress, MC; and the commanders of

the fifteen fixed hospitals, two depots,

and other medical installations in

southern France only through Col.

Charles F. Shook, MC, the SOLOC

surgeon. Hawley's staff division chiefs

could not correspond directly with

their southern counterparts on any of

the innumerable details of bringing

SOLOC medical policies and procedures, derived from the Mediterranean Theater, into line with ETO

practices. Problems resulted, for differences among the theater medical

organizations were many, ranging

from broad matters of supply management to questions of clinical

procedure. SOLOC hospitals, for

instance, treated many long-bone

fractures by internal fixation (plating

and pinning), whereas those in the

European Theater followed the preferences of Surgeon General Kirk by

relying exclusively on traction, followed by application of casts. Distressed at this and other SOLOC

practices, Hawley periodically lamented the limitations on his authority in

the southern area. He complained

that the Southern Line of Communications "was given what amounts to

complete autonomy. Believe it or not,

I practically have to be invited before

I can visit SOLOC."

 13 12

 Southern France, until September 1944, had

been part of the North African (later Mediterranean) Theater; it reverted to the ETO on 18

September. Larkin had been commander of the

Mediterranean Theater COMZ before taking over

SOLOC. For details on the formation of SOLOC,

see Ruppenthal, Logistical Support, 2:29-30 and 38-

42.

13

 Quotation from Ltr, Hawley to Maj Gen J. E.

Dahlquist, 11 Jan 45, box 2, Hawley Papers, MHI.

See also Ruppenthal, Logistical Support, 2:42-45; Ltr,

Lt Gen Lee to Chiefs, General and Special Staff Continued
COMPLETING COMZ 439

COL. CHARLES F. SHOOK

As in so many other instances, internal diplomacy within the theater

medical service reduced the ill effects

of divided authority. On 15-16 November Colonel Shook and his assistant visited Paris. They worked out an

agreement with Colonel Cutler and

other members of Hawley's staff on

COMZ-SOLOC medical relations,

covering general administrative principles and the details of hospitalization, evacuation, supply, records and

reports, and the establishment of a

consultant system for the southern

base sections. The agreement reaffirmed Hawley's responsibility for

"overall supervision of Medical Department technical matters" for all

United States forces in the theater. It

declared that Colonel Shook in

SOLOC "will be guided by the technical policies and procedures that

have been laid down by the Chief

Surgeon, European Theater of Operations," that all ETO medical resources "will be considered as a pool

of medical means, and [that] neither

the Communications Zone in support

of ... [the 12th Army Group] nor

that in support of the Southern

Group of Armies will be considered

as acting independently or as being

self-sufficient."

 14

Personal and administrative relations between the two communications zones soon smoothed out. By

late December Hawley was calling

Shook's attitude "100 per cent" cooperative. After careful preparation, and

after a delay caused by the Ardennes

crisis, Hawley and Cutler made a fiveday visit to the Southern Line of

Communications in January. They

Secs, ETO-COMZ, 3 Nov 44, sub: Administrative

Support for Southern Group of Armies and Attached Air Forces, copy in Planning Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944; Notes, Col R. E. Peyton, 17 Oct 44, sub:

Visit to Dijon, DRAGOON 1944 file, CMH; Wiltse,

Mediterranean, pp. 399-403. On internal fixation of

fractures, see Ltrs, TSG to Hawley, 13 Dec 44 and

13 Jan 45, and Hawley to TSG, 29 Dec 44 and 27

Jan 45, file HD 024 ETO O/CS (Hawley-SGO Corresp).

14

 Quotation from MFR, Col D. E. Liston, 4 Dec

44, sub: Agreements Made at Conference, 15-16

November 1944, DRAGOON 1944 file, CMH. In

same file, see MFR, Planning Branch, Operations

Division, OofCSurg, HQ, ETOUSA, 10 Nov 44, sub:

Support of DRAGOON Forces, and Memo, Lt Col J.

H. Voegtly to Col Peyton, 18 Nov 44, sub: Notes

Taken at Conference on Medical Service for Southern Group of Armies. See also Carter, ed., Surgical

Consultants, 2:280-82, and Planning Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 13. Among other things, SOLOC

committed itself at this time to adopt the ETO

system of medical statistical reports.
440 EUROPEAN THEATER OF OPERATIONS

conferred with Shook and his base

section surgeons, and also with Colo- nel Rudolph, the Seventh Army surgeon, and they inspected numerous

medical installations. During this trip

Cutler secured SOLOC's agreement

that its base section consultants could

communicate directly with their ETO

counterparts, integrating the southern

consultants into the informal network

so important in holding the theater

medical service together. Hawley and

Cutler at the same time gave a little

ground on internal fixation of fractures, authorizing use of the procedure in certain types of cases.

Through such arrangements the chief

surgeon and his staff cleared the way

for a full merger, and the two communications zone medical services

became ever more closely integrated

in supply, evacuation, and other activities. Formal merger followed on 6

February 1945, when the theater disbanded SOLOC and placed CONAD

and the Delta Base Section directly

under the northern Communications

Zone. Colonel Shook then moved to

Paris and became the ETO deputy

chief surgeon.15

By the time the ETO-COMZ absorbed SOLOC, theater medical administrative and command relations

had assumed the shape they would

retain during the rest of the war in

Europe. The primacy in the medical

service that General Hawley had established during the buildup survived

the entry into combat, the full activation of SHAEF and the 12th Army

Group, and the incorporation of the

forces from the Mediterranean.

Throughout, the chief surgeon, while

surrendering none of his prerogatives, managed to keep up smooth

working relations with such potential

rivals as General Kenner. Hawley's

success earned the ETO medical service the praise of Surgeon General

Kirk, who declared that this organization, compared to those of other theaters, was the "only [one] ... set up

and operating the way it should

[be]. ... It is so far ahead of the

others there is no comparison."

 16

The chief surgeon attained this favorable result despite blurred lines of authority and persistent feuds. His

system, in the end, depended more

on personal and professional doctorto-doctor relationships than on sound

structure. Nevertheless, it was sufficient to support the armies in their

drive to final victory.

The Continuing Buildup

During the six months after D-Day

the European Theater medical establishment expanded from about

130,000 officers, nurses, and enlisted

men to over 212,000—an average of

5.5 doctors, 1.2 dentists, 6.3 nurses,

and 68.35 medical enlisted men for

each 1,000 soldiers (Table 9). It was,

by the end of 1944, the largest single

theater medical service, containing

nearly 40 percent of all the Medical

Department personnel in the Army.

15

 Hawley's remarks on Shook in Ltr, Hawley to

Kenner, 19 Dec 44, file HD 024 ETO CS (Hawley

Chron); in same file, see Ltr, Hawley to Col C. F.

Shook, 23 Dec 44. Hawley's January visit is recounted in detail in Carter, ed., Surgical Consultants, 2:292

and 301-06. Ltrs, Hawley to TSG, 24 Jan 45, and

TSG to Hawley, 17 Mar 45, file HD 024 ETO O/CS

(Hawley-SGO Corresp), reflect the compromise on

internal fixation. See also Ruppenthal, Logistical Support, 2:45.

16

 Ltr, TSG to Hawley, 18 Aug 44, file HD 024

ETO O/CS (Hawley-SGO Corresp).
COMPLETING COMZ 441

TABLE 9—MEDICAL PERSONNEL STRENGTH, ETOUSA, LATE 1944

Source: Personnel Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, chart 5(d).

About 60 percent of the ETO medical

personnel worked in the Communications Zone, another 35 percent served

in the field armies, and the remainder

were in the air forces.17

The composition of the medical

service, in numbers and types of

units, more or less conformed to the

troop basis established before the invasion. However, the theater and the

War Department continually added, deleted, formed, and disbanded organizations as they reconciled the projected with the actual needs of the

campaign. The theater, for example,

gained ten more general hospitals

and almost fifty ground force medical

units to support nine additional infantry divisions assigned during 1944. It

broke up several station hospitals to

create new T/O convalescent rehabilitation units and constantly shuffled

manpower to meet the seemingly insatiable need for separate medical detachments and for casuals to staff

base section and hospital center headquarters. Accounting changes brought

troop basis alterations. Late in 1944

the War Department reclassified

14,400 field hospital beds as mobile

instead of fixed, allowing the ETO

the same number of additional beds

in general or station hospitals. To

absorb part of this extra allowance,

the theater disbanded three

newly arrived general hospitals in

order to reorganize eight veteran

ones as 1,500-bed hospitals and another as a 2,000-bed installation.18

New medical units of all types

flowed into the theater during the last

17

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, app. D; McMinn and Levin, Personnel, p. 358.

18

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 6-10 and 38-39; Personnel Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

5-6 and 12-13; Troops Branch, Operations Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt,

January-June 1945, pp. 4, 6, 8-17, 34. Ruppenthal,

Logistical Support, 2:289-90, describes the general

changes in the service troop basis.
442 EUROPEAN THEATER OF OPERATIONS

half of 1944 and the first few months

of 1945, adhering generally to reinforcement schedules worked out

before D-Day. Once these reinforcements reached Europe, General Hawley's Troop Movements and Training

Branch staff, in coordination with the

ETO G-4 and the base sections for

COMZ units and with the 12th Army

Group and later the Fifteenth Army

for field force organizations, directed

their movement and assignment.

During the autumn of 1944 the

Southern Line of Communications repeatedly demanded more field and

communications zone medical units to

support the additional divisions being

sent to the 6th Army Group. The

ETO-COMZ, in negotiations with

SHAEF and SOLOC, managed to

scale down these requests, on the

grounds that all theater medical resources should be treated as a single

pool, rather than each communications zone being set up as a self-sufficient entity. Medical reinforcements,

nevertheless, did go to SOLOC, either diverted to Marseilles while at

sea or sent across France after landing at Channel ports.19

Preinvasion plans called for new

medical units, like most other reinforcements from America, to bypass

the United Kingdom after about

D+60 and land at ports on the Continent. Delays in opening deep-water

French and Belgian harbors, however,

compelled diversion of most units to

Great Britain during the last half of

1944. Most medical units, therefore,

entered the ETO at Scottish ports,

staged in Britain for periods varying

from a few hours to a couple of

months, then went by train to the

south coast, where they boarded landing craft or other shallow-draft vessels

for the cross-Channel voyage. During

the summer the reinforcements

landed at Cherbourg or the Normandy beaches and bivouacked in the Cotentin until called forward to begin

operations. Units arriving after the

beginning of November usually disembarked at Le Havre and staged in

the nearby RED HORSE cantonment

area, which included a theater transient camp for medical troops at Etretat, a small seashore resort.

For the new arrivals life in the staging areas was often difficult. Frequently, units became separated from

their personal baggage and TAT (to

accompany troops) equipment during

their journeys to France. Without

cooking and mess gear, tentage, bedding, or vehicles, the unfortunate personnel set up housekeeping with what

they could salvage and borrow. Officers, nurses, and enlisted men alike

prepared C-rations over driftwood

fires, shivered under too few blankets,

and at times went for weeks without a

change of clothing until their equipment finally caught up with them.

Medical personnel awaiting movement orders at Etretat lived austerely

in requisitioned homes, chateaus, and

hotels, contending with shortages of

fuel for cooking and heating and

coping with insufficient latrine and

bathing facilities. A few units suffered

major accidents during disembarka19

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 13-15 and ends. 5 and 8; Troops

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, pp.

2-3, 12, 14, and encl. 1. For negotiations about

units for SOLOC, see correspondence in DRAGOON 1944 file, CMH. For similar arguments

about field units for the Seventh Army, see Chapter

XI of this volume.
COMPLETING COMZ 443

tion, staging, and forward movement.

The 553d Medical Ambulance Company lost fifty-six men (thirty-two

killed, twenty-four injured) in a train

wreck near Le Havre. Staging could

be prolonged, especially for general

hospitals, which had to wait for sites

to become available, for equipment

assemblies to arrive, and for transportation to appear. The base sections

tried to keep units busy during their

time in staging, conducting orientation and training programs and sending personnel, particularly from

hospitals, to reinforce hard-pressed

organizations already in operation.20

The medical troop buildup substantially achieved its objectives, in terms

of gross numbers of personnel and

units. Strength totals, however, concealed many quantitative shortages

and qualitative deficiencies. To begin

with, the War Department, in order

to place units in the theater on schedule, sent many of them overseas

before they had completed their training. In all, 78 of the 151 general hospitals called for in the troop basis arrived "short-trained," as did 7 of the

46 400-bed evacuation hospitals, 11

of the 61 ambulance companies, and

smaller proportions of other unit

types. The short-trained organizations

varied greatly in readiness for operations. Those that landed in Britain

just before D-Day were short-trained

only in the sense that a few individuals had not completed all requirements or that the unit perhaps lacked

a week or so of field exercises. Such

organizations could, and did, go right

to work. The units that arrived later

in 1944 were in worse shape. Most,

activated only three-four weeks

before embarkation, were random aggregations of medical officers and

nurses with limited Army experience;

the enlisted detachments, except for a

few key men, came directly from basic

Medical Department training. One

such unit, the 166th General Hospital, which arrived in the Loire Base

Section in November, "had never

functioned as a hospital and

only a small percentage of the enlisted men had ever worked in a

hospital. . . . The nurses had 

the unit at the Port of Embarkation.

They had never worked as a group."

As these units reached the United

Kingdom and France, base section

and army surgeons surveyed their

state of training; prescribed remedial

programs of instruction; and, whenever possible, put their personnel to

work in functioning installations of

the same type, remedying manpower

shortages while providing on-the-job

training for the new arrivals. Eventually, most short-trained organizations

went into satisfactory operation,

though a few of the worst were

broken up and their manpower used

to reinforce more experienced units.21

20

 Operations Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, p. 5; Troop Movements and

Training Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, pp. 26-27;

Troops Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, pp. 2-3, 6, 12-14; Surg, Channel

Base Section, Annual Rpt, 1944, pp. 9-10 and 86-

89. For examples of units in staging, see John C.

Burwell, Jr., "Memoir," pp. 3-10, John C. Burwell

Papers, MHI, and 170th General Hospital Annual

Rpt, 1944, pp. 2-6 (this unit also was separated

from its TAT equipment).

21

 Quotation from Surg, Loire Base Section,

Annual Rpt, 1944, p. 3. See also ibid., p. 5; Troop

Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, Continued
444 EUROPEAN THEATER OF OPERATIONS

Most late-arriving medical units, besides being short of training, were

short of people, either in absolute

numbers or in important specialities.

As a result of the policy forced on

Surgeon General Kirk by the doctor

shortage in the United States, most

new hospitals arriving in Europe after

D-Day lacked qualified chiefs of surgical and medical services and contained general practitioners in place

of many specialists. Some general

hospitals arrived in the theater with

only 16 of their authorized 32 MC officers. Kirk expected the theaters—especially the ETO with its large complement of affiliated units top-heavy

in professional talent—to make up

these deficiencies by redistributing

their own personnel. Typical of the

units that this policy created, the

170th General Hospital embarked for

Europe in September with "no Chief

of Surgery, Medicine, Orthopedics,

Neuropsychiatry, [and no] Urologist

who was considered professionally

qualified"; the orthopedic staff consisted of "two young officers with limited experience."

 22

The arrival of an increasing number

of, in effect, undermanned organizations aggravated shortages in many

categories of ETO medical personnel.

MC specialists were spread ever more

thinly. For instance, in early 1945, the

theater had available only 63 boardcertified orthopedic surgeons out of

the 460 called for in the T/Os of

army and COMZ hospitals and auxiliary surgical groups. They were supplemented by 95 partially trained orthopedic surgeons and by 85 others

who had some background in trauma.

Shortages also existed among dentists

and MAC officers. The theater nurse

complement had fallen 345 below authorized strength by the close of

1944, partly because the War Department, confronting a slowdown in recruiting and the probable need for a

nurse draft, as a conservation measure dispatched 12 general hospitals to

Europe without nurses, to be staffed

from theater resources. Medical enlisted personnel also fell below

strength at the end of 1944, largely as

a result of heavy casualties among infantry division aidmen and litterbearers.23

The ETO medical service did its

best to remedy the shortages and deficiencies from its own resources.

Colonels Cutler and Middleton and

their assistants visited each newly

landed general hospital to evaluate its

professional staff. Using the Personnel Division's machine readable pp. 9-10 and 25-26; Training Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Semiannual

Rpt, January-June 1945, pp. 5-6. On training efforts, see Surg, Normandy Base Section, Annual

Rpt, 1944, p. 3; Surg, Seine Section, Semiannual

Rpt, January-June 1945, pp. 21-22; Surg, Seventh

U.S. Army, Annual Rpt, 1944, p. 20. 22

 Quotation from 170th General Hospital Annual

Rpt, 1944, pp. 1-2. See also Ltr, TSG to Hawley, 6

Oct 44, file HD 024 ETO O/CS (Hawley-SGO Corresp); Personnel Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 7 and app. D;

McMinn and Levin, Personnel, pp. 316-17. On the

doctor shortage, see Chapter V of this volume.

23

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, app. D; Professional Services Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt,

January-June 1945, pp. 4-5; Troop Movements and

Training Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, p. 9; McMinn

and Levin, Personnel, pp. 227-31; Ltrs, TSG to

Hawley, 6 Oct 44, and Hawley to TSG, 13 Apr 45,

file HD 024 ETO O/CS (Hawley-SGO Corresp);

Memo, Hawley to DepTheaterCdr, 6 Jun 44, sub:

Shortage of Nurses, file HD 024 ETO CS (Hawley

Chron).
COMPLETING COMZ 445

records of the qualifications and experience of every MC officer in

Europe, the consultants arranged for

transfers from veteran organizations

to give the new hospitals at least adequate chiefs of surgery and medicine

and as many needed specialists as

possible. Army surgeons and their

consultants, aided by the chief surgeon's office, similarly balanced and

reinforced evacuation hospital staffs.

To ensure full employment of scarce

specialists, the Hospitalization Division, continuing on the Continent a

practice begun in England, designated certain heavily staffed general hospitals as treatment centers for particular types of difficult cases. Staging

medical units provided doctors,

nurses, and enlisted men on temporary assignment to flesh out many organizations. By full exploitation of

this source the theater maintained an

adequate ratio of nurses to patients in

its wards, in spite of the persistent

numerical shortage. The ETO medical service relieved some scarcities by

enhancing the skills of people it already had; the Nursing Division of

General Hawley's office, for instance,

established a four-week school to

train hospital chief nurses. The

United Kingdom Base and the Third

Army both set up courses, with instructors drawn from their own hospitals, to develop additional officer and

nurse anesthetists, partially remedying another perennial personnel scarcity. The 107th Evacuation Hospital,

in order to take some of the burden

from its one fully qualified orthopedic

surgeon, trained its general surgeons

in basic procedures for treating compound fractures and organized two

teams of enlisted men skilled in applying plaster casts.24

The T/O reductions, ordered by

the War Department for general and

evacuation hospitals and for most

other types of medical units, statistically erased many personnel shortages and actually freed people to fill

vacancies. Thus a July 1944 cut in

general hospital MC officer complements from 37 to 32 released over

450 ETO doctors for other assignments. To obtain nurses for the

dozen general hospitals sent without

them, the theater reduced all general

hospital nurse complements from 83

to 73. Similar trimming of the enlisted strength of most unit types prevented, on paper at least, a shortage

until late 1944. These and other reductions, however, left medical units

with fewer people to do the same

amount of work, and with reduced internal ability to compensate for staff

casualties or to expand patient capacity in emergencies. In some instances

the cuts severely hampered units in

carrying out their basic missions. The

commander of the 95th Evacuation

Hospital complained, after a 5 percent reduction in his enlisted force:

24

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, pp. 7-8; Professional Services Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, Medical Consultation Service sec., pp. 3-4,

and Chief Consultant in Orthopedic Surgery sec.,

pp. 4-5; Surg, United Kingdom Base, Annual Rpt,

1944. pp. 67-68, and Semiannual Rpt, January-June

1945. vol. 1, pp. 51-53; Surg, Seventh U.S. Army,

Annual Rpt, 1944, p. 40. On the chief nurses, see

Nursing Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 8 and 18, and Semiannual Rpt, January-June 1945, p. 1. On the anesthetists, see Professional Services Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, Chief Consultant in Anesthesia

sec., pp. 1-2; Surg, Third U.S. Army, Annual Rpt,

1944, pp. 102-03; 107th Evacuation Hospital

Annual Rpt, 1944, p. 22.
446 EUROPEAN THEATER OF OPERATIONS

"It is inconceivable that anyone

would think that an evacuation hospital could possibly function on a 24-

hour schedule with only four men

designated in the T/O as litter bearers."25

Such expedients enabled the ETO

medical service to fill, at least partially, the ranks of its expanding number

of units. Another personnel problem

was more intractable: replacing over

560 officers, 400 nurses, and 4,900

enlisted men lost from various causes

during 1944. Of these, about 160 officers and 3,100 men were killed,

wounded, or captured in combat—the

majority while serving as infantry battalion surgeons, company aidmen,

and litterbearers. Attrition among

these front-line medical people, who

also contributed their share of nonbattle casualties, was heavy and constant. In six months of fighting the

9th Infantry Division had to replace

over 100 percent of its aidmen. Division medical losses approached the

crisis point during the Ardennes and

NORDWIND offensives; each of the

field armies fell some 500 medical enlisted men understrength, and there

was an urgent demand for over 300

replacement MC officers.26

The ETO medical service labored

throughout the campaign under a

chronic shortage of both officer and

enlisted replacements. Replacements

for the medical service, as for all

other arms and technical services,

were supposed to come from three

sources: recovered sick and wounded

released from the hospitals; personnel

from units rendered surplus by T/O

changes or transferred out for other

reasons; and casuals sent from the

United States in predetermined numbers, on theater requisition, specifically to replace losses. Early in 1944 the

chief surgeon's Personnel Division

worked up casualty projections for all

categories of medical troops, based

on World War I loss rates modified

by World War II experience up to

that point, and, on this basis, periodically requisitioned replacements from

the United States. Due to the medical

manpower shortage, however, the

War Department never came close to

filling these requisitions; throughout

the campaign the replacement flow

across the Atlantic was more like a

trickle. Of 2,300 Medical Department

officers entering the ETO replacement system between D-Day and V-E

Day, only about 800 (34 percent)

were casuals from the United States.

The proportion of enlisted replacements from outside the theater (6,300

out of 42,000) was even smaller.

Making matters worse, the officers

25

 Quotation from 95th Evacuation Hospital

Annual Rpt, 1944, p. 11. See also Personnel Division, OofCSurg, HQ, ETOUSA, Annual Rpt, 1944,

p. 10; Operations Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 6; Surg, Normandy

Base Section, Annual Rpt, 1944, p. 15; Training

Branch, Operations Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, p. 4.

Hawley laments T/O reductions in Ltr, Hawley to

TSG, 14 Sep 44, file HD 024 ETO O/CS (HawleySGO Corresp). McMinn and Levin, Personnel, pp.

96-97 and 301-02, discusses the general background of T/O reductions. 26

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, encl. 9, and Semiannual Rpt, January-June 1945, pp. 2-3; Surg, First U.S. Army,

Annual Rpt, 1944, p. 58; Surg, 9th Infantry Division, Annual Rpt, 1944, p. 15. For examples of casualty figures for other divisions, see Surg, 1st Infantry Division, Annual Rpt, 1944, p. 30, and Surg, 4th

Armored Division, Annual Rpt, 1944, p. 22. General

Kenner constantly expressed concern at high frontline medical losses. See various inspection reports in

Medical Division, COSSAC/SHAEF, War Diary,

July-December 1944.
COMPLETING COMZ 447

and men who were sent generally

were unsuited for assignment to the

divisions, where they were most

needed. Most had received training

almost exclusively for work in COMZ

medical installations; they lacked

knowledge of infantry tactics and battlefield survival techniques required

for effectiveness as battalion surgeons

or company aidmen. The 5th Infantry

Division surgeon summed up a universal complaint: "As a rule, Medical

Department replacements have been

received not adequately trained to

function under fire. . . . Many . . .

had no idea of how to take care of

themselves in the field in ... darkness, rain and mud."

 27

Largely thrown back upon its own

resources, the ETO medical service

arranged to use its available people

with maximum efficiency and to fill

vacancies, especially in the armies, as

expeditiously as possible. While still

at Cheltenham before the invasion,

the staffs of the Personnel Division

and the Troop Movements and Training Branch had cultivated friendly

working relations with the nearby

Ground Force Reinforcement Command, which handled replacements of

all services. This mutually beneficial

alliance continued throughout the

campaign, ensuring the medical service maximum flexibility in controlling its own personnel. The Reinforcement Command referred the

names of all medical officers entering

its depots to the Personnel Division

for suggestions as to reassignment,

thereby giving it the unique privilege

of what amounted to complete assignment jurisdiction over its own officer

personnel in this theater. In processing unit requisitions for medical

replacements the Reinforcement

Command, in the interests of speed,

waived its standard procedure of waiting for the requisition to make its

way up the chain of command and

acted on informal certification that a

vacancy existed. The medical and

Reinforcement Command staffs cooperated to establish a constantly replenished replacement pool of ten

nurses in each army, again reducing

the time required to fill vacancies.

During the Ardennes crisis they delegated to army and base section surgeons the assignment of all but a few

categories of officers entering replacement depots and arranged for

the automatic return of most of the

recovered medical service sick and

wounded to their former organizations.28

The chief surgeon's office and the

Reinforcement Command responded

jointly to field army complaints of a

shortage of qualified replacement

aidmen. Investigation showed that the

armies themselves were creating part

27

 Quotation from Surg, 5th Infantry Division,

Annual Rpt, 1944, pp. 32-33. McMinn and Levin,

Personnel, pp. 297-300 and 303-05, describes the

worldwide problem of Medical Department replacements. See also Personnel Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 6; Study No. 88,

General Board, USFET, sub: Training Status of

Medical Units and Medical Department Personnel

Upon Arrival in the European Theater of Operations, pp. 5-8, file 353/2.

28

 Personnel Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, app. B, and Semiannual Rpt, January-June 1945, pp. 2, 6-7 and encls. V-VI; Nursing Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 10; Surg, Third U.S. Army, Annual

Rpt, 1944, pp. 125 and 150; Surg, Ninth U.S. Army,

Annual Rpt, 1944, p. 36; Ltrs, Hawley to Surgs,

First, Third, Ninth U.S. Armies, 18 Dec 44, sub:

Medical Department Replacements, and Hawley to

Col C. F. Shook, 24 Dec 44, file HD 024 ETO CS

(Hawley Chron).
448 EUROPEAN THEATER OF OPERATIONS

of the shortage by requisitioning

medical and surgical technicians for

inappropriate slots, such as drivers

and cooks, and that great confusion

existed throughout the replacement

system in matching actual tasks with

military occupational specialty numbers. Early in 1945 Hawley's people

and the Reinforcement Command

issued new enlisted replacement and

requisitioning rules to prevent misassignment of highly trained medics,

and they arranged conferences to

teach army medical personnel officers

to use the revised system.29

These measures promoted efficient

use of what medical replacements

were available in the theater, but they

did not themselves produce any more

people. Especially to replace combat

losses, the theater continually robbed

Peter to pay Paul, Peter in this instance being rear-area medical units.

The process began within the armies.

Corps medical battalions and medical

groups routinely loaned officers and

enlisted men to the divisions to replace casualties until regularly requisitioned replacements arrived from the

depots. COMZ units also loaned doctors, nurses, and enlisted men to the

armies, and they gave up people permanently for reassignment forward.

During the Ardennes battle COMZ

hospitals and other installations furnished over 300 officers and 3,100

enlisted men to fill the gaps left by

army casualties. Such replacements,

however, were less than satisfactory to

the divisions. The officers often were

overage or physically unfit for the

strenuous life of infantry battalion

surgeons; both they and the enlisted

men, like replacements from the

United States, lacked training as

front-line medics. Of 21 medical officer replacements in the 2d Armored

Division during 1944, for example, 8

had to be evacuated or kept in the division rear because they were unsuited to combat. The arrival during the

summer of significant numbers of

MAC assistant battalion surgeons created a large pool of medical officers

available to serve as battalion surgeons, but the pool was emptied

almost immediately to cover the

losses of the first two months of fighting. By late 1944 a MAC officer

shortage had developed in turn, in

spite of army efforts to commission

qualified Medical Department NCOs

in this corps.

To meet the constant need for

more aidmen, the Troop Movements

and Training Branch and the Ground

Force Reinforcement Command early

in 1945 established a school at the

19th Reinforcement Depot to retrain

Medical Department cooks, clerks,

and drivers, who were in oversupply,

as medical and surgical technicians. Within the armies several corps and

divisions set up similar courses of

their own, to make aidmen out of selected infantry replacements and less

skilled medical soldiers. The willingness of combat units to divert riflemen, who also were scarce, for this

purpose indicated the value they

placed upon their aidmen.30

29

 Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, pp. 30-31; Training Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Semiannual

Rpt, January-June 1945, pp. 1-2 and encl. 1; First

U.S. Army Report of Operations, 1 Aug 44-22 Feb

45, bk. IV, p. 194.

30

 McMinn and Levin, Personnel, pp. 302-03; Personnel Division, OofCSurg, HQ, ETOUSA, Annual Continued
COMPLETING COMZ 449

TROOPS UNDERGOING A PHYSICAL EXAMINATION to determine their fitness for reassignment to combat duty

Some of the riflemen so retrained

may well have been former medical

soldiers. The medical service, even

while straining to replace its own casualties, also had to help fill the ranks

of the infantry, dangerously depleted

by the autumn offensive and the

German counterattacks. Since the

hedgerow battles, the European Theater had conducted a running argument with the War Department over

its requisitions for infantry replacements, which the department considered excessive. The theater finally

acceded to demands from Washington that it make infantrymen out of

some of the tens of thousands of

General Assignment soldiers (those

physically and mentally qualified for

combat) in its Communications Zone

and that it replace them in rear-area

installations with Limited Assignment

men (unfit for front-line duty).

Accordingly, in January 1945, the theater began combing General Assignment men out of all the technical serRpt, 1944, pp. 8-10, and Semiannual Rpt, JanuaryJune 1945, pp. 2-3; Training Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Semiannual

Rpt, January-June 1945, pp. 2-3; Surg, ADSEC,

COMZ, Semiannual Rpt, January-June 1945, p. 8;

First U.S. Army Reports of Operations, 20 Oct 43-1

Aug 44, bk. VII, p. 107, and 1 Aug 44-22 Feb 45,

bk. IV, p. 194; Surg, Third U.S. Army, Annual Rpt,

1944, pp. 148-52; Surg, Seventh U.S. Army, Annual

Rpt, 1944, pp. 39-42. For an example of the intraarmy borrowing system, see Surg, V Corps, Annual

Rpt, 1944, p. 8. For examples of corps and division

medics training, see Surg, XII Corps, Annual Rpt,

1944, p. 10; Surg, 2d Armored Division, Annual

Rpt, 1944, pp. 2-3 and encl. 4; Surg, 4th Armored

Division, Annual Rpt, 1944, p. 10; and Surg, 80th

Infantry Division, Annual Rpt, 1944, p. 9.
450 EUROPEAN THEATER OF OPERATIONS

vices for retraining as riflemen. It

tapped the Medical Department for

12,000 enlisted men, a quota which

the chief surgeon's office divided

among the base sections. General

Hawley and his staff managed to

soften this blow to their already bur- dened personnel system through informal arrangements with the Ground

Force Reinforcement Command and

the newly created Theater Manpower

Section, under which a majority of the

men taken, especially the technicians,

in fact went to the divisions as aidmen

and litterbearer replacements instead

of ordinary infantry. COMZ medical installations still

suffered substantial quantitative and

qualitative manpower losses as a

result of the theater policy. The

ADSEC medical service between January and March gave up over 1,300

men, 540 of them enlisted specialists,

and received only 260 Limited As- signment men in return. The United

Kingdom Base in the same period lost

over 2,300 medical soldiers to the infantry and 1,200 more as Medical Department replacements, with only

1,000 Limited Assignment personnel

arriving in exchange. Individual general hospitals surrendered up to 15

percent of their technicians; some fell

as many as 50 or 60 men below their

already barely adequate T/O enlisted

strength of 450. The Limited Assignment men who arrived as replacements usually had no previous Medical Department service. Many were

former infantrymen, reclassified after

being wounded. They often were less

than enthusiastic at becoming medics;

many held noncommissioned ratings

inappropriate to unskilled hospital assignments. ADSEC units received

large numbers of combat exhaustion

convalescents, who broke down again

under the shelling and bombing to

which many forward holding units

and hospitals were subjected and who

had to be returned to the replacement depots. Hospitals and other

units trained their new men as best

they could, on the job whenever possible, and many eventually developed

into first-rate medical soldiers. The

training effort, however, further taxed

already overworked and undermanned organizations.31

With their total work force steadily

being reduced and their skilled

people spread ever more thinly, army

and COMZ medical units, especially

hospitals and supply depots, got

through the winter by making extensive use of civilian and prisoner-ofwar (POW) labor. In France and Belgium evacuation hospitals regularly

employed 80-100 local people, general hospitals hired as many as 500-

1,000, and some depots used up to

200. These men and women, usually

selected by their national government's labor agencies and paid by

their governments under reverse

lend-lease, took over much of the

menial work in wards, kitchens, and

31

 McMinn and Levin, Personnel, pp. 240-41; Personnel Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, p. 3; Training Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, pp. 3-4; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 64-65, and

Semiannual Rpt, January-June 1945, pp. 16-17 and

41; Surg, United Kingdom Base, Semiannual Rpt,

January-June 1945, vol. 1, pp. 106-08 and 112. For

general background on the infantry replacement

issue, see Ruppenthal, Logistical Support, 1:458-63

and 2:304-32. For typical effects of the manpower

drain, see Surg, Seine Section, Semiannual Rpt, January-June 1945, pp. 36 and 45-47; 5th General

Hospital Annual Rpt, 1945, pp. 3-4; 298th General

Hospital Annual Rpt, 1945, p. 237; and 15th Medical Depot Company Annual Rpt, 1945, p. 2.
COMPLETING COMZ 451

warehouses. They also maintained

hospital buildings, provided clerical

help, and operated telephone switchboards. Some general hospitals employed French or Belgian nurses; but,

because of the language barrier and

limits of their training, the Americans

generally confined these women to

only the most elementary nursing

chores. Not all civilian helpers were

paid. In Holland the 111th Evacuation Hospital drew volunteer nurse's

aides from the Dutch Red Cross.

These women, who came from the

"leading families" of their community, provided "invaluable" assistance

on the wards and also in central

supply and the laboratory. In recognition of their social status, they were

allowed to eat in the officers mess.32

Working with civilians had its difficulties. Units had to hire interpreters

or conduct English classes in order to

maintain effective communication

with their local help. Some reported

instances of theft, absenteeism, and

security violations, not to mention demands, in one instance instigated by

the Resistance, for higher wages and

more days off. Efforts to train civilians had mixed results. At Depot M402 in Normandy, "when an officer

or enlisted man endeavors to explain

errors, the civilians apparently interpret explanations as reprimands and

in several cases the officer has found

himself with crying civilians on his

hand[s]." On balance, nevertheless,

these employees proved indispensable

in supplementing theater medical

manpower.33

POW laborers, exclusively Germans

in the 12th Army Group and the

northern Communications Zone and

both Germans and Italians in

SOLOC, proved as useful as civilians

and better disciplined. First Army

evacuation hospitals in Normandy

began using POWs during June and

July as litterbearers and for other unskilled tasks. The experiment worked

so well that in August the Advance

Section began attaching prisoners to

its general hospitals and arranged for

construction of a POW enclosure at

each new hospital plant. By late 1944

most evacuation and general hospitals

and depots on the Continent employed POWs, in numbers ranging

from 40 or so in the evacuation hospitals to as many as 500 in the general hospitals.

Each facility obtained prisoners

from its army or base section provost

marshal, housed them in a barbed

wire enclosure on its grounds, and

guarded them with medical enlisted

men, who bore arms for this duty but

not their brassards or their Geneva

Convention identification cards. The

Germans, in keeping with general theater policy, lived in tents or huts

32

 111th Evacuation Hospital Annual Rpt, 1944, p. 10.

33

 Quotation from Memo, 1st Lt J. E. Holuneyer,

MAC, to OofCSurg, HQ, ETOUSA, 5 Feb 45, sub:

Depot Personnel, in 26th Medical Depot Company

Hist File, 1945. See also McMinn and Levin, Personnel, pp. 255 and 260-62; Nursing Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 6,

and Semiannual Rpt, January-June 1945, pp. 5-6;

Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 39;

Surg, Seine Section, Annual Rpt, 1944, p. 24, and

Semiannual Rpt, January-June 1945, pp. 45-46 and

87; Surg, CONAD, Semiannual Rpt, January-June

1945, p. 11. For a sampling of unit experience, see

9th Evacuation Hospital Annual Rpt, 1944, pp. 10-

11; 59th Evacuation Hospital Annual Rpt, 1944, sec.

XIII; 111th Evacuation Hospital Annual Rpt, 1944,

p. 10; 5th General Hospital Annual Rpt, 1945, p. 4;

99th General Hospital Annual Rpt, 1944, p. 7;

127th General Hospital Annual Rpt, 1944, p. 5; and

298th General Hospital Annual Rpt, 1945, pp. 231-

32.
452 EUROPEAN THEATER OF OPERATIONS

GERMAN POWs UNLOADING CASUALTIES FROM A HOSPITAL TRAIN AT REIMS

under austere conditions; hospitals

tried to provide medical care and limited amenities, such as weekly hot

showers and sports equipment, to

maintain their health and morale. On

and off the job, the prisoners were

supervised by their own noncommissioned officers and, in the case of the

Italians, were organized into sanitary

companies and engineer platoons.

While the great majority did manual

labor, prisoners with special skills—

for example, former members of their

army medical services—worked in

almost all departments of hospitals

and depots, although they never administered treatment to Allied patients. Innovative hospital commanders put their prisoners' talents to

good use. Col. Lee Cady, MC, of the

21st General Hospital found enough

musicians among his contingent for a

small orchestra, which played for the

enjoyment of staff and patients. Most

hospitals preferred POW laborers to

civilians. The Germans, in particular,

were orderly, obedient, harshly punished any of their own who stole or

misbehaved, and uncomplainingly

worked long hours. Although rumors

of uprisings and escape plots circulated during the Battle of the Bulge, the

POWs displayed no defiance of American authority. As later recalled by

Colonel Cady, "The 21st could have

won the rest of their war with

POWS."

 34

34Quotation from Cady, "Notes on the 21st General Hospital (AUS), p. 485, Cady Papers, MHI. See Continued
COMPLETING COMZ 453

Morale Problems

For ETO medical personnel,

whether in the armies or in the Communications Zone, the demands of

active operations left little time for

the training and professional activities

that had been so prominent a part of

their pre-D-Day life in Great Britain.

The Medical Field Service and Army

Nurse Corps Schools at Shrivenham

graduated their last classes in October. Efforts to move them, and the

rest of the school center, to France

were frustrated by the theater's inability to secure a suitable site. Within individual units, except for those that

arrived "short-trained" and went

through accelerated catch-up cycles,

regular refresher and professional enhancement courses were a casualty of

the campaign. Some base sections attempted to enforce minimal training

requirements, and both the armies

and COMZ conducted conferences

and courses for especially vital categories of personnel, for example, hospital chief nurses. When they could,

theater medics tried to continue professional meetings and conferences

with each other and foreign colleagues. Thus the staff of the 15th

General Hospital at Liege held meetings with the medical faculty of the

local university, who were eager to

catch up on the latest development in

their fields after the long intellectual

drought of the Nazi occupation. At

theater level the Inter-Allied Conference on War Medicine resumed its

London sessions in October. Later

that same month, in Paris, American

and British consultants held the first

of what they hoped would be periodic

Allied conferences.35

While most medical units coalesced

into smoothly functioning teams,

human nature and the circumstances

of war occasionally strained personal

and professional relationships and organizational cohesion. Rank and promotion were a cause of much bitter

feeling among MC specialists, who resented the fact that unit T/Os did not

always allocate officer grades in conformity to the professional heirarchies

of medicine and surgery. Factionalism, based on clashing personalities

or differences of professional opinion,

divided some unit staffs. In one evacuation hospital, according to its commander, the chief of the operating

section "does not understand the

handling of officers and men," causing "widespread resentment" and

"considerable discord," and had

also ibid., pp. 437-38, 494, 506, 587-88; McMinn

and Levin, Personnel, pp. 326-28; Troop Movements

and Training Branch, Operations Branch,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 40;

Surg, United Kingdom Base, Semiannual Rpt, January-June 1945, vol. 1, p. 112; Surg, CONAD,

Annual Rpt, 1944, pp. 12-13; Surg, ADSEC, Daily

Activities Rpts, 5-7 Aug 44, and Hospitalization Division, OofSurg, ADSEC, Weekly Activities Rpts,

weeks ending 12 and 19 Aug 44, Beasley Papers,

MHI; Surg, ADSEC, COMZ, Annual Rpt, 1944, p.

68. For an example of use of POWs, see 298th General Hospital Annual Rpts, 1944, pp. 270-71, and

1945, pp. 232-36.

35Troop Movements and Training Branch, Operations Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, p. 17; Troops Branch, Operations Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt,

January-June 1945, pp. 4-5; Nursing Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, p. 1; Training Memo No. 1, Surg,

Seine Section, 29 Jan 45, in Surg, Seine Section,

Semiannual Rpt, January-June 1945, pp. 81-92;

Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 49-50;

First U.S. Army Report of Operations, 1 Aug 44-22

Feb 45, bk. IV, p. 193; 15th General Hospital

Annual Report, 1944, pp. 19-20; Professional Services Division, OofCSurg, HQ, ETOUSA, Annual

Report, 1944, Medical Consultation Service sec., pp.

4-5; Carter, ed., Surgical Consultants, 2:256-57.
454 EUROPEAN THEATER OF OPERATIONS

failed to enforce orders against

"drinking of liquor during operations." The chief nurse, while "efficient above reproach," had "a poor

understanding of human nature" and

did not "possess satisfactory qualities

of tact and leadership." Over and

above promotions and personalities

the oppressive realities of war loomed

strong. In a Third Army field hospital

the ward nurses, "in a period of

heavy operation, do little but work

and catch sleep as they can." They

"see so much death, have so many

problems regarding proper care of

patients and so many patients to care

for . . . that they tend to grow depressed. . . . Very excellent nurses

become short tempered and difficult. . . ,"36

By late 1944 the morale problems

of front-line medical officers and enlisted men, especially those in infantry

battalion and regimental detachments,

had become a matter of concern to

the army surgeons and General

Hawley. Many of these combat medics

had been under fire in North Africa,

Sicily, and Italy before D-Day and in

nearly constant action since then.

They were approaching the limits of

emotional and physical endurance. Inaddition, the medical officers, who

had little opportunity to practice their

professional specialties, feared that

they were falling behind their hospital

colleagues, with whom they would

have to compete when they returned

to civilian life.

Division, corps, and army surgeons

tried to transfer their oldest, tiredest

officers and men to less arduous duty,

with medical detachments of artillery

and support units in divisions and

corps and in evacuation or other hospitals in the armies. In October General Hawley instituted a theater-wide

system for rotating commissioned and

enlisted medical personnel between

the ground forces and COMZ, both

to replace veterans of prolonged

front-line service with fresh men from

the rear and to give specialists from

general and station hospitals threemonth tours of duty with evacuation

and field hospitals and auxiliary surgical groups. This program got off to a

promising start, although commanders inevitably took advantage of it to

discard their least desirable men, including in one draft from the First

Army a cocaine addict and a chronic

alcoholic. However, the midwinter

manpower crisis soon submerged the

rotation program, forcing its replacement by a one-way flow of people

from COMZ to the armies. As the

tactical and personnel situations stabilized in early 1945, General Hawley

revived rotation, setting a monthly

transfer quota from each army of ten

officers and twenty-five enlisted men,

but hostilities ended before the

system could make its beneficial effects felt on any significant scale.37

36Comments on evacuation hospital from Memo,

Col C. D. Goodiel to Surg, Ninth U.S. Army, 7 Sep

44, Shambora Papers, MHI. Comments on field hospital from 60th Field Hospital Annual Rpt, 1944,

pp. 6-7. For other unit morale problems, see Cady,

"Notes on the 21st General Hospital (AUS), pp.

463-64, Cady Papers, MHI, and Gosman, "War

without Blood," passim. In fixed hospitals neurosurgeons complained that the highest-ranking slots

open to them were captaincies while chief dentists

were lieutenant colonels. See Professional Services

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, Chief Consultant in Surgery sec., p. 19, Chief

Consultant in Orthopedic Surgery sec., p. 7, and

Chief Consultant in Anesthesia sec., p. 15.

37

 On forward area morale, see Surg, Seventh U.S.

Army, Annual Rpt, 1944, pp. 40-42; Surg, XII Continued
COMPLETING COMZ 455

AMERICAN RED CROSS WORKERS SUPPLYING DOUGHNUTS FOR CASUALTIES to improve morale while traveling on a hospital train

Whether in the armies or the Communications Zone, medical units employed every resource provided by

the theater and of their own devising

to give staff and patients some respite

from the often grim daily routine.

They sent officers, nurses, and enlisted men on pass to nearby towns,

when such were not off limits to

American personnel. Other medical

people received much-coveted 48-

hour passes to Paris, and a few extremely fortunate individuals went

home to the United States on thirtyday leaves. Within units, Special Service detachments scheduled films and

an occasional traveling USO show for

staff and patients. Radios and recordplayers, both government issued and

"liberated," were precious possessions. Clubs, for officers, nurses, and

enlisted men, ranged from austerely

furnished recreation tents to comCorps, Annual Rpt, 1944, p. 11; Surg, 1st Infantry

Division, Annual Rpt, 1944, p. 34; Surg, 5th Infantry Division, Annual Rpt, 1944, p. 39. On rotation

within the armies, see First U.S. Army Report of

Operations, 1 Aug 44-22 Feb 45, bk. IV, p. 194;

Surg, V Corps, Annual Rpt, 1944, pp. 16-17; Surg,

2d Armored Division, Annual Rpt, 1944, p. 49;

Surg, 3d Infantry Division, Annual Rpt, 1944, p. 10.

On theater rotation, see McMinn and Levin, Personnel, pp. 332-36; Personnel Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, p. 13; Professional

Services Division, OofCSurg, HQ, ETOUSA, Annual

Rpt, 1944, Chief Consultant in Surgery sec., ex. L,

Medical Consultation Service sec., p. 14, and Chief

Consultant in Anesthesia sec., pp. 2-3; Middleton

Interv, 1968-69, vol. 1, pp. 205-06; Surg, 1st Infantry Division, Annual Rpt, 1944, pp. 24 and 34-35;

Editorial Advisory Board, 1962, pp. 215-17. On

cases of addiction and alcoholism, see Ltr, Hawley

to Col J. A. Rogers, 20 Nov 44, file HD 024 ETO

CS (Hawley Chron).
456 EUROPEAN THEATER OF OPERATIONS

STATION HOSPITAL DAYROOM, used by staff and patients for recreational purposes

paratively well-appointed barrooms

and lounges, depending on the type

of unit, how long it had been in one

place, and the foraging skill of the

staff. When time and weather permitted, sports teams and leagues made

their appearance. Amateur theatricals

provided a showcase for homegrown

talent. In the hospitals Red Cross

workers supplied the patients with

reading material, small toilet articles

and luxuries; wrote letters for them;

organized games and parties; and

acted as counselors and sympathetic

listeners. Holiday celebrations, especially at Thanksgiving and Christmas,

brought out the best of everyone's ingenuity. In the 93d Evacuation Hospital, a Seventh Army unit,

trees were decorated in every ward. Sprigs of pine were hung from doors,

windows, and light fixtures. In the chapel

a manger scene was set up behind the

altar, and a large unit tree was decorated

with colored paper and 'balls' made by

inflating the fingers of old rubber operat- ing room gloves, and then dipping them

in paint. There were candle light services, singing of carols, Red Cross stockings for

the patients, and a couple of turkey din- ners. [At a Christmas night dance] there

was an orchestra, and a 'snack bar' con- tributed from boxes from home.38

38

 Quotation from 93d Evacuation Hospital Unit

Hist, 1944, p. 51. For other examples of unit recreation and morale building, see Surg, Ninth U.S.

Army, Annual Rpt, 1944, p. 37; Surg, Seventh U.S.

Army, Annual Rpt, 1944, p. 46; Surg, Third U.S.

Army, Annual Rpt, 1944, p. 125; Surg, ADSEC,

COMZ, Annual Rpt, 1944, p. 51; 32d Medical Depot

Company Annual Rpt, 1944; 66th, 67th, and 68th

Medical Groups Annual Rpts, 1944; 12th, 41st, and

91st Evacuation Hospitals Annual Rpts, 1944; 99th,

101st, 130th, and 298th General Hospitals Annual Continued
COMPLETING COMZ 457

Medical Supply

While key medical personnel

became scarcer during the winter of

1944-45, supplies in the theater grew

more abundant, and the Communications Zone placed more of them

where most needed. The medical service, like the other supply services,

benefited from the November opening of Le Havre, Rouen, and Antwerp, deep-water ports much nearer

the front than Cherbourg and the no

longer usable invasion beaches. The

Communications Zone, with an enlarged port capacity and a steadily expanding railroad network, brought

more tonnage ashore and pushed

more of it forward, ending the supply

famine that had stalled the armies in

September. On 9 December, when

SHAEF discontinued its tonnage allocation system, ADSEC and 12th Army

Group supply reserves each were approaching a quarter of a million tons.

The Southern Line of Communications, meanwhile, increased the flow

of goods through Marseilles so that

by mid-December the Continental

Advance Section had stockpiled over

50,000 tons and the Seventh Army

about 80,000 tons. Yet the theater supply system continued to work only with friction, inefficiency, and disagreement among

commands. Delays in discharging the

huge backlog of ships that had built

up in European waters during the

summer caused shortages of particular items throughout the fall and

winter. COMZ stocks still were geographically ill-distributed, with too

large a proportion concentrated at

the ports or—as the result of a lateyear forward movement—in advanced

depots that were congested by toorapid, indiscriminate deliveries. When

the German Ardennes breakthrough

jeopardized these depots, the Communications Zone reacted by temporarily stopping shipments to forward

installations. This action, in turn,

caused renewed backups at the ports.

As these events indicated, supply

movement planning was not a COMZ

strongpoint. Neither were documentation and control of shipments on the

still ramshackle, overburdened continental railroads. Commands complained constantly of delayed, misdirected, and lost cargoes. The armies,

as ever distrustful of the Communications Zone, padded their requisitions

to accumulate excessive reserves; sent

their own vehicles to collect supplies;

and dealt unilaterally and disruptively

with the various technical services.

COMZ supply accounting left much

to be desired. Its depots were little

more than huge dumps, lacking systems and facilities for classifying and

keeping track of the goods they

received, stored, and issued. The theater had not imposed any uniform

systems for stock control and the calculation of requisitioning requirements. Working with the resulting unreliable information, the European

Theater and the War Department

could not agree on how much of such

key items as artillery ammunition the

theater had on hand and how much it

Rpts, 1944. See also Cady, "Notes on the 21st General Hospital (AUS)," pp. 454 and 491, Cady

Papers, MHI; Brown Interv, 1979, CMH; Gosman

Interv, 24 Mar 82, CMH; and Lee Interv, 1981,

CMH. On Red Cross work, see Surg, Third U.S.

Army, Annual Rpt, 1944, pp. 175-77; 60th Field

Hospital Annual Rpt, 1944, p. 7; 91st Evacuation

Hospital Annual Rpt, 1944, pp. 34-35.
458 EUROPEAN THEATER OF OPERATIONS

needed. The theater insisted that the

War Department was not sending

enough; the Washington authorities

replied that they were furnishing sufficient supplies and demanded that

the theater put its own administrative

house in order so that it could find

them.

In December General Somervell, at

Eisenhower's request, sent the Army

Service Forces director of operations,

Maj. Gen. LeRoy R. Lutes, to survey

the ETO supply situation. Lutes and

his delegation spent several weeks in

the theater. They documented the logistical deficiencies and recommended remedies that the Communications

Zone, under constant pressure from

SHAEF and the War Department, gradually implemented. By the time

the armies prepared to cross the

Rhine, the supply system behind them

was functioning in relatively good

order.39

By contrast with the general situation in the theater, the ETO medical

service had already gone through its

own experience of mismanagement

and reform. Thanks to the work of

the Voorhees mission early in 1944,

and to the subsequent efforts of Colonel Hays and his assistants, the medical service had solved before D-Day

many of the supply problems that still

plagued the other technical services

and the theater as a whole six months

after the invasion. It possessed, for

instance, an efficient system of depot

management and stock control. General Hawley, as agent of the theater

commander, directed the disposition

of all medical stores in continental

depots, treating them as a single pool

of goods rather than as the property

of the individual base sections. He

also exercised technical supervision

over depot operations. This amounted in practice very nearly to full operational control, as neither the base

section commanders nor their surgeons had the staff or the expertise to

manage the details of depot work.

Closely overseen by the chief surgeon's Supply Division, COMZ

depots, including eventually those of

SOLOC, all followed uniform operating procedures prescribed in the

Medical Department Depot Manual,

which the Supply Division revised late

in 1944 to incorporate the lessons of

continental experience. These procedures included a simple, accurate

method for determining and reporting regularly the amount of stock on

hand, due in, and issued. In Paris the

Stock Control Branch of the Supply

Division consolidated reports from

the depots on automatic data processing machines to produce timely statistics for a variety of purposes. Among

other things, this information helped

Supply Division transfer stock between depots, maintaining adequate

working levels computed on the basis

of the number of troops and the type

of installations the depot served.40

Because the Supply Division could

furnish stock information that all con39

 Discussion based on Ruppenthal, Logistical Support, 2:96, 103-16, 126-33, 176-86, 348-63. Lutes

report and supporting documents in Maj Gen

LeRoy R. Lutes, Official Report: Mission to European Theater of Operations, 4 December 1944-13

January 1945 (hereafter cited as ETO Rpt, 1944-

45), box 44, RG 200, NARA.

40

 Supply Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, sec. II, pp. 5-

7, sec. III, pp. 4-6, sec. IV, pp. 5-6; Wiltse, ed.,

Medical Supply, pp. 314-17; Kelley Interv, 27 Jan 45,

box 221, RG 112, NARA.
COMPLETING COMZ 459

cerned judged reliable, the requisitioning and shipment of medical supplies from the United States involved

little confusion or conflict between

Washington and the theater. For its

initial continental buildup the Supply

Division, before D-Day, ordered large

prescheduled shipments of goods for

delivery to French ports beginning

about 1 September 1944. Thereafter,

the division issued biweekly maintenance and replacement requisitions to

keep up a 60-day reserve of all items

as well as a 120-day reserve to cover

ordering and shipping time. During

late autumn Colonel Hays' office integrated the Southern Line of Communications into this system. Under a

provision of the mid-November

agreements SOLOC computed its requirements on the same basis as its

northern counterpart and submitted

its requisitions through the theater

Communications Zone, which partially filled them from its own surpluses

before passing the reduced, or

"edited," requisitions on to the New

York Port of Embarkation. After the

February 1945 merger of COMZ and

SOLOC, the Supply Division developed requirements for the entire theater and arranged for deliveries to

Marseilles and the Channel ports in

proportion to the respective troop

strengths of the 6th and 12th Army

Groups and their supporting base

sections. This procedure kept supplies flowing across the Atlantic with

a minimum of delay, duplication, and

dispute. In December the Lutes mission had reported that an average of

45 days elapsed between the requisitioning of medical supplies from

America and the first deliveries to

COMZ depots; the corresponding

time for Quartermaster stores was

145 days. The mission had also found

only three minor medical items in

short supply in the theater. Separate

from the rest of the supply system,

transatlantic blood flights also went

without a hitch, reaching a delivery

rate of over 8,000 pints per week

during January.41

The distribution network kept pace.

By late October 1944 a chain of

depots stretched from Normandy

and the Riviera to Belgium and

northeastern France (see Map 20).

Depot M-402, at Chef-du-Pont and

Carentan, besides supporting the

Normandy Base Section, received

supplies landed at Cherbourg and

shipped them forward to other

depots. Depot M-405 at Le Mans distributed supplies to the Loire and

Brittany Base Sections. At the center

of the supply network Depot M-407

at Paris, in addition to serving the

many Seine Section medical installations, received matériel sent forward

by rail from M-402, by barge up the

Seine from Rouen and Le Havre, and

by air from Great Britain and the

United States. This depot, largest in

the system, forwarded supplies to the

Advance Section and the armies by

41

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, ex. III (Memo, Col S. B.

Hays to Hawley, 24 Dec 44, sub: Difficulties in

Moving Medical Supplies and Equipment), and

Semiannual Rpt, January-June 1945, sec. II, pp. 1-

3; Wiltse, ed., Medical Supply, pp. 315-16. For

SOLOC arrangements, see correspondence in DRAGOON 1944 file, CMH. On Lutes report and shortages, see Ruppenthal, Logistical Support, 2:353;

Lutes, ETO Rpt, 1944-45, box 44, RG 200, NARA;

and Memo, Lutes to CG, SHAEF, via CG, COMZ,

25 Dec 44, sub: Report on Supply Situation—Northern France, tab 2E, box 44, RG 200, NARA. On

blood flights, see Ltr, Hawley to TSG, 27 Jan 45,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

COMPLETING COMZ 461

MEDICAL SUPPLIES AT MEDICAL DEPOT M-407, the largest facility of this type on the

Continent served by barges as well as railroads

air, road, and rail; it was the central

continental issuing point for Medical

Department forms, spare parts, and

items in short supply; and it repaired

major pieces of hospital equipment.

Two advance depots—M-409 at

Liege, which went into operation

early in November, and M-408 at

Reims—directly supported ADSEC

and the First, Third, and Ninth

Armies. Depot M-412, also at Reims,

continued its specialized work of collecting, processing, and issuing captured German medical supplies. With

SOLOC the theater acquired two additional depots: M-352 (later redesignated M-452) at Marseilles, with functions similar to those of M-402, and

M-351 (later M-451) at Dijon, which

supported CONAD and the U.S. Seventh and French First Armies.42

The theater medical service possessed both sufficient supplies and

well-located depots for their storage

and issue. What was lacking during

the autumn and winter was reliable

transportation. Difficulties began at

the overworked continental ports,

where the theater gave unloading priority to ammunition, rations, and

42Fenton Interv, 7 Jun 45, box 222, RG 112, NARA. Locations and functions of depots summarized in Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, pp. 10-17 and ex. VIII. The SOLOC depots were redesignated in February

1945 to conform to the ETO numbering system. See Supply Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, sec. III, p. 16, and Wiltse, Mediterranean, pp. 406-08.
462 EUROPEAN THEATER OF OPERATIONS

POL while cargoes of medical supplies remained offshore in vessels'

holds for as long as four months.

When this logjam finally broke in November with the opening of the Seine

ports and Antwerp, it did so with disruptive suddenness. Within a few

days a dozen ships discharged

over 9,000 tons of medical freight at

Cherbourg, overwhelming the Chefdu-Pont receiving facilities. Other

medical matériel destined for the

Continent went to Great Britain instead, as the theater diverted ships to

reduce its backlog. The United Kingdom Base, with its limited allotment

of cross-Channel shipping already

committed to prescheduled transfers

of supplies from its own depots to the

Continent, could not readily transship the diverted cargo. The base also

had little warehouse room available,

for it was reducing the number and

capacity of its depots as part of a general scaling down of American installations in Britain. Base medical supply

officers sent as much tonnage as they

could to France by air, or by expedients, such as loading goods on trucks

and hospital trains being ferried

across the Channel. They perforce

stacked the rest of the overflow in

open fields. Fortunately, the New

York Port of Embarkation packed

ETO-bound medical supplies to withstand at least 90 days of outdoor storage. In both the United Kingdom and

France large quantities survived exposure to the elements for much longer

than that.43

On the Continent the railroads supplanted trucks for most long-distance

supply hauling, a shift signaled by

theater discontinuance, on 14 November, of Red Ball operations. The

change from trucks to trains did not

eliminate difficulties with transportation. After the end of the Red Ball

Express the COMZ G-4 daily authorized the medical service to send a certain number of tons of supplies from

Normandy to the front by train. Days

went by, but no rail cars appeared at

Depot M-402 and no supplies moved.

Finally, late in November, Colonel

Hays discovered the reason: The daily

medical tonnage was not enough to

fill an entire train, and "because of

rail operating difficulties" the transportation authorities moved from

Normandy only fully loaded trains

bound for a single destination. "In

other words," Hays stressed in his

report to General Hawley, "although

G-4 was setting up tonnage allocations and forwarding them to Normandy Base, no provision was made

to move these supplies." The Supply

Division chief negotiated with the

G-4 a rearrangement of his allocation,

under which, every few days, the Normandy Base Section could send a full

trainload to Paris, where Depot M407 then would reconsign individual

cars to the armies and ADSEC. Such

small shipments, however, were prone

to loss and delay. One group of eight

cars dispatched from M-407 took

three to fourteen days, depending on

the individual car, just to get through

the Paris switching yards. On another

occasion, only fourteen cars of a special forty-car train from Chef-du-Pont

43

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, p. 11 and ex. III, pp. 2-4;

Wiltse, ed., Medical Supply, p. 321; Kelley Interv, 27

Jan 45, box 221, RG 112, NARA.
COMPLETING COMZ 463

actually reached their destination at

Reims.44

To keep tonnage moving forward,

the Supply Division, the base sections, and the armies continued to

employ the expedients of the summer

pursuit. The Supply Division late in

1944 borrowed 150 trucks from the

Ninth Air Force to haul 300 tons of

badly needed items from Chef-duPont to Reims. The armies, as they

had earlier, sent their own vehicles

long distances back to the Communications Zone to collect what they

needed. Between 1 and 15 December

Third Army trucks picked up 50 tons

of medical supplies in Paris and about

100 in Reims. Hospital trains evacuating casualties from Liege to Paris carried emergency supplies for the First

and Ninth armies, and for Depot

M-409 and the Liege general hospitals on their northbound runs. At

times, also, the Paris depot coupled

regular freight cars to these trains for

the trip to Liege. Aircraft—C-47s

across the Channel to Le Bourget

field and the UC-64s of the 320th Air

Transport Squadron from Paris to the

front—hauled millions of pounds of

blood, biologicals, and high-priority

cargo. All these expedients, however,

contributed little to the heavy-duty

job of filling the forward depots. Because of lack of transportation, at the

end of November the great bulk of

reserve medical supplies still were

concentrated at Chef-du-Pont and

Paris, with only comparatively small

stock accumulated in the COMZ

depots nearest the front.45

During the last weeks of 1944 and

the early months of the new year the

ETO medical service, assisted by a

general improvement in the theater

logistical situation, largely resolved its

supply movement and distribution

problems. The port of Antwerp went

into full operation, in spite of harassing bombardment by German Vweapons, and the shipping backlog

rapidly diminished, as did the frequency of cargo diversions to Great

Britain. The United Kingdom Base

managed to move across the Channel

much of the excess stock it had accumulated. On the Continent the end of

the SHAEF tonnage allocation system

freed more of the available transportation for the movement of reserve

supplies.. To expedite medical shipments and reduce losses in transit,

the Supply Division in December established a Movement Control Section. Officers of this section, stationed

at strategic road and rail junctions,

followed each truck convoy or rail car

carrying medical supplies from originating depot to final destination.

Colonel Hays admitted that these efforts duplicated "to a large extent the

work of the Transportation Corps but

44

 Quotations from Supply Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, sec. II, ex. III,

pp. 9-10 and 12-13. See also ADSEC Hist, p. 76;

Wiltse, ed., Medical Supply, pp. 339-40.

45

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, pp. 19-22 and ex. III, pp.

13-15, and Semiannual Rpt, January-June 1945,

sec. II, p. 11 and exs. X and XI; Surg, Seine Section, Annual Rpt, 1944, pp. 39-41, and Semiannual

Rpt, January-June 1945, p. 40. Hawley thanks the

Air Force for its support in Ltr, Hawley to Lt Gen

Carl T. Spaatz, 14 Nov 44, file HD 024 ETO CS

(Hawley Chron). For continental reserve distribution, see Memo, Col S. B. Hays to Operations Division, OofCSurg, HQ, ETOUSA, 25 Nov 44, sub:

Tonnage Reports at Depots, box 63, RG 112,

NARA.
464 EUROPEAN THEATER OF OPERATIONS

it has been found to be necessary,

and ... it has paid dividends."

 46

The efficiency and reliability of railroad freight service improved steadily, partly because of continuing physical rehabilitation of the French and

Belgian lines and partly because of

better medical service and Transportation Corps documentation of shipments. Under a new cargo identification system, for instance, each carload

of medical supplies had a distinctive

exterior label—the familiar Red Cross

on a white field—placed on it. With

more efficient transportation available, and greater freedom to use it,

the medical service within a couple of

months evened out the distribution of

its reserves. Of the about 40,700 tons

of medical stores on the Continent,

only 6,000 or so remained at Chefdu-Pont and Marseilles by the end of

February. The rest of the supplies

were at Paris, the largest single concentration, and in intermediate and

advance depots.47

As had been the case since the beginning of BOLERO in 1942, movement of equipment assemblies for the

many new medical units arriving in

the theater, especially the 4,000-piece

outfits of the general hospitals, continued to be plagued with difficulties.

Equipment became separated from

units during transshipment in Britain

or split between depots there and on

the Continent when port congestion

forced diversion of vessels. Rail and

road movement in France and Belgium suffered from the vicissitudes of

the overloaded transportation systems, including the usual losses and

diversions. Medical units newly arrived on the Continent often waited

weeks for Communications Zone to

locate and deliver their assemblies.

Without equipment, General Hawley

complained, these organizations constituted "merely . . . more mou

feed and bodies to shelter, without

any return in service," an exaggeration since many of them reinforced

operating units. Nevertheless, when

the theater during November and December was racing desperately to set

up more continental beds to take care

of ever-increasing casualties, it helped

little to have nineteen general hospitals sitting idle for lack of equipment.

During the Ardennes emergency the

Paris supply depot built two general

hospital outfits from its own stock, to

hasten activation of units. Such expedients used up replacement equipment reserves and could not begin to

compensate for nondelivery of the

original assemblies.48

Even the persistent assembly problem, however, gradually yielded to 46

 Quotation from Supply Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, sec. II, ex. III, p.

16. See also ibid., sec. I, p. 2, sec. II, p. 22 and ex.

III, pp. 11 and 13, and Semiannual Rpt, 1945, sec.

II, p. 5. 47

 Supply Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, sec. III, p. 20;

Surg, United Kingdom Base, Semiannual Rpt, January-June 1945, vol. 1, p. 127. The movement of

stocks can be followed in Memos, Col S. B. Hays to

Operations Division, OofCSurg, HQ, ETOUSA, 9

and 30 Oct, 27 Nov, 5 Dec 44 and 28 Jan, 26 Feb

45, sub: Tonnage Balances at Depots, box 63, RG

112, NARA.

48

 Quotation from Ltr, Hawley to G-4, ETOUSA,

14 Nov 44, sub: Delays in Movement of Medical

Units and Unit Equipment, in Supply Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, sec.

V, ex. VI. See also ibid., sec. II, ex. HI, pp. 5-7 and

11, sec. IV, pp. 6-7 and ex. VII, sec. V, pp. 2-6 and

exs. IV(a), VI, and XI; Surg, Normandy Base Section, Annual Rpt, p. 20; Surg, Seine Section, Annual

Rpt, 1944, p. 41; Wiltse, ed., Medical Supply, pp.

337-39; Ltr, Hawley to Maj Gen W. M. Goodman,

14 Nov 44, file HD 024 ETO CS (Hawley Chron).
COMPLETING COMZ 465

theater remedial efforts and improving transportation facilities. Under

new staging procedures, adopted on 1

November, units that disembarked in

Britain remained there until both

their TAT equipment and their assemblies were on hand and ready to

accompany them across the Channel.

The New York and Boston port authorities, after a barrage of letters,

telegrams, and teletype messages

from Hawley, on the twenty-ninth

agreed to a plan that at least ended

the practice of splitting general hospital outfits among several ships and

ensured delivery of "functionally

complete" assemblies. Diversion of

assemblies to Great Britain ended

early in 1945, and they received

higher unloading priority at continental ports. The Supply Division established procedures for following each

assembly from its departure from the

United States to an operating site. It

also secured permission from the

Transportation chief to send escort

officers from the owning unit with

each assembly during both crossChannel and continental movement.

This practice, long informally followed by veteran units, greatly increased the chances that an assembly

would arrive at its destination complete and on time.49

Meanwhile, the major medical

depots improved their operating efficiency and solved a variety of practical problems, sometimes by sheer

hard work. At Depot M-402 the 11th

Medical Depot Company used bulldozer-drawn mud sleds and 750 POW

laborers to sort out and ship forward

the mass of supplies suddenly unloaded at Cherbourg during November.

In mid-January 1945 the same company took over Depot M-407 at Paris.

Here its men, reinforced by a second

company and by more than 260

French civilians, in six weeks unloaded a backlog of 120 freight cars and 7

barges. Working in cold and snow,

they filled over 850 accumulated requisitions and thereafter more or less

kept abreast of the new ones, which

arrived at a rate of about 100 a day.

They acquired additional buildings

for the equipment repair shop and for

storage of slow-moving items, and

they rearranged the shipping and receiving sections for more efficient operation in less space. At Depot M-452

in Marseilles the 46th Medical Depot

Company, an ETO unit, early in January reinforced the 231st Composite

Medical Battalion, a veteran Mediterranean Theater organization. The

new company, besides providing

badly needed additional manpower

for this busy port depot, introduced

the European Theater stock control

system. With the 231st Battalion it

developed M-452 into the most completely mechanized depot in the theater, with stock stored on pallets for

movement by forklift trucks and with

over 3,000 feet of roller conveyor.50

49

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, ex. III, pp. 16-17, sec.

IV, p. 7, sec. V, pp. 5-6 and exs. VI and VII, and

Semiannual Rpt, January-June 1945, sec. IV, pp. 2-

3 and 6-8; Surg, Normandy Base Section, Annual

Rpt, p. 20. For an example of the practice of escorting assemblies, see 28th Field Hospital Annual Rpt,

1944, pp. 15-16.

50

 Supply Division, OofCSurg, HQ, ETOUSA,

Annual Rpt, 1944, sec. II, p. 12, and Semiannual

Rpt, January-June 1945, sec. III, pp. 9-11 and 16;

Surg, Delta Base Section, Annual Rpts, 1944, p. 1,

and 1945, p. 4; Surg, Normandy Base Section,

Annual Rpt, 1944, encl. 8; Surg, Seine Section,

Annual Rpt, 1944, p. 41, and Semiannual Rpt, Janu- Continued
466 EUROPEAN THEATER OF OPERATIONS

Two COMZ depots, M-409 at

Liege and M-408 at Reims, felt the

direct impact of the Ardennes counteroffensive. For the better part of a

month the 66th Medical Depot Company at M-409 worked under constant V-1 and V-2 bombardment and

nightly air raids. Near-misses damaged the depot buildings and destroyed some supplies, but the company and its reinforcing detachment

of the 165th Medical Battalion suffered no casualties and never had to

cease operations. Besides its regular

work of supplying the Liege hospitals

and the First and Ninth Army depots,

M-409 for a couple of weeks acted

as base depot for the First Army. At

Reims, amidst air attacks, Depot

M-408, reinforced by 45 POW laborers (double guarded to prevent breakout or mutiny), worked under blackout conditions in subfreezing weather

to supply the divisions holding the

southern flank of the Bulge. M-408

provided medical supplies and equipment for the 82d and 101st Airborne

Divisions before they entered the

battle, and later helped to replace

their combat losses. It also outfitted

six provisional collecting companies

and established two advance supply

points for COMZ units preparing a

last-ditch defense line along the

Meuse, as well as making contingency

plans for its own withdrawal.51

To take advantage of the northern

ports and to facilitate supply of the

armies, the medical service established three additional depots. Depot

M-409 on 29 November 1944 opened

a satellite facility (M-411) at Liege to

handle the expected large volume of

incoming stores from Antwerp, which

lacked space for extensive supply

dumps. However, German bombardment of Liege forced closing of this

subdepot after less than a month of

operation and its replacement by a

new depot, M-413, in a less exposed

position at Noirhat, near Brussels.

Another depot, eventually designated

M-417, went into operation near

Rouen in January 1945, to hold general hospital assemblies landed at the

Seine ports. The third new depot,

M-414, opened in mid-February in an

unused foundry at Foug, just west of

Toul, after a prolonged COMZ effort

to obtain from Third Army a usable

site closer to that army's rear than

M-408 at Reims. When finally

opened, M-414, in Continental Advance Section territory, issued to both

the Third and Seventh Armies, and

also to the general hospitals clustered

around Nancy, Commercy, and Barle-Duc. Through it the Seventh Army

and CONAD began drawing the bulk

of their medical supplies from the

Channel ports and Antwerp instead of

from Marseilles.52

ary-June 1945, pp. 39-40; 11th Medical Depot

Company Hist, January-June 1945, pp. 1-3; 46th

Medical Depot Company Semiannual Rpt, JanuaryJune 1945, pp. 1-4. 51

 Surg, ADSEC, COMZ, Semiannual Rpt, January-June 1945, p. 37; 66th Medical Depot Company

Annual Rpt, 1944, p. 4; 165th Medical Battalion

Annual Rpt, 1944, pp. 2-3, and Semiannual Rpt,

January-June 1945, p. 2; 13th Medical Depot Company Annual Rpts, 1944, p. 13, and 1945, pp. 4 and

33-34.

52Wiltse, ed., Medical Supply, pp. 328-29; Supply

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, sec. II, pp. 15-17, and Semiannual Rpt, January-June 1945, sec. III, pp. 6 and 13-15; Surg,

ADSEC, COMZ, Annual Rpt, 1944, pp. 29-30; Surg,

CONAD, Semiannual Rpt, January-June 1945, pp.

12-13; 13th Medical Depot Company Annual Rpt,

1944, p. 12; 30th Medical Depot Company Annual

Rpt, 1944, p. 7; 66th Medical Depot Company

Annual Rpt, 1944, p. 4.
COMPLETING COMZ 467

With its depot network in place and

with reserve stocks well forward, the

ETO medical service early in 1945 at

last could implement the system for

supplying the armies long envisioned

in plans and SOPs. Every ten days

each army dispatched a requisition,

covering anticipated maintenance and

replacement requirements, to a single

designated COMZ advance depot

through the appropriate regulating

station; it could also make emergency

requisitions as necessary. The supporting depot filled orders from its

own stock and was automatically replenished in turn by the Communications Zone. Emergency shipments and

supplies from rear COMZ depots normally went forward by air. Advance

depots usually dispatched goods to

the armies by truck, for road transport took less time than rail over

short distances. Forward depots responded rapidly to army demands,

sometimes within seventy-two hours.

The Supply Division, through a set of

simple reports from the issuing

depots, monitored service to the

armies.53

By the beginning of 1945 the medical service possessed a fully functioning continental supply system. It had

established advance, intermediate,

and rear depots, efficiently and uniformly administered, and with reliable

stock accounting and control. Supplies from the United States flowed

steadily and in ample quantities into

this depot system and, to an increasing extent, smoothly through it to the

armies. After a January visit to the

theater by General Somervell, Hawley

noted with gratification that the Army

Service Forces commander and his

entourage "had no criticism of medical supply" and that one officer,

"after inspecting Medical Depot No.

409, said that he had never seen a

finer depot."

 54

 Hawley, unfortunately, could not report such optimistic

comments, from visitors and from

within the theater, on the most

important functions of the medical

service, for which organization, personnel, and supply were simply the

foundations. The chief surgeon's hospitalization and evacuation systems

and policies came under increasing

strain and mounting criticism as the

Communications Zone struggled to

cope with the flood of casualties from

the fall and winter battles. 53

 Supply Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, sec. II, pp. 8-

9, sec. III, p. 6, sec. IV, pp. 4-5; Surg, ADSEC,

COMZ, Semiannual Rpt, January-June 1945, pp.

36-37.

54

 Ltr, Hawley to TSG, 27 Jan 45, file HD 024

ETO O/CS (Hawley-SGO Corresp).
CHAPTER XIV

Hospitalization and Evacuation Crisis

By late 1944 the hospitalization and

evacuation system had become a complex, dynamic chain of many links.

Closest to the front were the Advance

Section air and rail holding units.

Those at Verviers and Liege served

the First and Ninth Armies, and those

at Nancy, Etain, and Thionville supported the Third. Behind the holding

units were two forward clusters of

general hospitals at Liege and Bar-leDuc, astride the principal lines of

communication north and south of

the Ardennes. Backing up these hospital centers, the medical complex at

Paris, hub of the entire system, consisted of seven general hospitals, extensive rail and air evacuation facilities, and a large convalescent camp.

To the rear of Paris the Normandy

and Brittany Base Sections contained

additional general hospitals, the majority located in the Cotentin Peninsula and on the old battlefields inland

from OMAHA beach. The Normandy

Section also maintained a holding

unit and casualty embarkation facilities at Cherbourg, the only crossChannel evacuation port used by the

American forces. Across the water, in

the United Kingdom Base, a medical

battalion and transit hospital at

Southampton and field hospital platoon holding units at nearby Membury and Ramsbury airfields received

casualties from France and transferred them to the final links of the

chain: the dozens of general hospitals

spread over the countryside of southern and western England.

From his Paris office, Colonel

Mowrey, General Hawley's chief of

evacuation, and his small, usually

overworked staff regulated patient

flow through these facilities in accord

with a 30-day policy for the Continent

and a 180-day policy (reduced in October to 120) for the theater as a

whole. The system at each stage

featured much sorting and many alternate movement paths. Forward

holding units first divided incoming

casualties into two groups: those requiring less then 30 days of hospitalization, and those needing longerterm care or evacuation to the United

States. They dispatched the latter directly to Britain by air whenever

planes were available. Of the under30-day patients, those requiring less

than two weeks of hospitalization

went by rail and road to the Liege

and Bar-le-Duc general hospitals. The

rest, and longer-term cases for whom

aircraft space was not available, were

loaded on trains for the run to Paris,

where Seine Section medics detrained
HOSPITALIZATION AND EVACUATION CRISIS 469

MAP 21

and sorted them. Continental patients, if not retained in the Paris general hospitals, traveled by rail to hospitals in the Normandy and Brittany

Base Sections. Patients destined for

the United Kingdom and the United

States went directly to Britain by air

from Le Bourget field or to Normandy by train for embarkation at Cherbourg.

The entire system was highly flexible and opportunistic. It gave preference to air evacuation whenever craft

could be obtained and weather permitted, but it also could move a large

volume of casualties by surface means

alone. By varying the evacuation policies of the general hospitals in Paris,

Liege, and Bar-le-Duc Colonel

Mowrey could open up reserves of

beds for sudden surges of casualties

from the armies, while in quieter

times he could keep many short-term

patients near the front for rapid

return to duty (Map 21).1

1

 Memo, Hawley to G-4, ETO, 19 Jan 45, file

705:Admission to and Operations in Hospitals;

Evacuation Branch, Operations Division, OofCSurg,

HQ, ETOUSA, Annual Rpt, 1944, pp. 5 and 10; Continued
470 EUROPEAN THEATER OF OPERATIONS

Behind the 6th Army Group, the

Southern Line of Communications

maintained a separate but similar

evacuation system. From air and rail

holding units in the Continental Advance Section, patients, depending on

their expected length of time in the

hospital, went to forward general hospitals around Epinal, Besancon, and

Dijon or to rear installations at Marseilles, which was also the evacuation

port for SOLOC patients bound for

the United States. SOLOC initially

did not send casualties to Great Britain or to the northern Communications Zone, but this practice changed

under the November agreement between the two logistical commands.

From then on, SOLOC, while retaining its separate line of evacuation, accepted the principle that all its facilities were part of a single theater pool.

In return, it received assurance that

COMZ would evacuate and hospitalize a portion of its patients if the limited facilities in southern France

became overloaded. When this occurred, aircraft and hospital trains

from Paris collected the overflow directly from forward CONAD installations.2

At each link in the evacuation

chain, medical units, as they gained

experience, steadily improved and refined their techniques for maximum

efficiency and patient comfort and

safety. Holding units learned to place

in different wards their "COMZ

short," "COMZ long," and "UK"

cases. They took hourly patient censuses to facilitate the rapid makeup of

train- and planeloads. By various expedients they mastered the always difficult problem of keeping each man

and his records together through reception, sorting, and evacuation.

Through channels both official and

unofficial, evacuation officers secured

the earliest possible notice of the arrival of planes and trains. This information was necessary to prepare for

air evacuation, because flights of C47s often landed on a few minutes'

warning and could stay on the ground

for only a short time. Also important

were such details as the number of incoming "strap" and "bracket" craft,

for the method of on-board litter suspension was critical in load planning—the two types had different

patient capacities. Once the transportation was at hand, quick transfer of

patients from wards to airstrips and

platforms and then to airplanes and

rail cars became the main consideration. Ambulance crews and litter detachments, their every movement precisely choreographed, became expert

at combining speed and gentleness in

this process.3

In Paris Colonel Mowrey's Evacuation Branch, after some initial confusion, delegated most of the day-to-day

conduct of evacuation to Colonel

Rich, the Seine Section surgeon, and

Surg, Seine Section, Annual Rpt, 1944, pp. 18-19;

Surg, Normandy Base Section, Annual Rpt, 1944,

pp. 5, 8-9 and encl. 3; 819th Hospital Center

Annual Rpt, 1944, pp. 5-6; 15th General Hospital

Annual Rpt, 1944, pp. 4-5; 94th Medical Gas Treatment Battalion Annual Rpt, 1944, p. 34; 186th Medical Battalion Annual Rpt, 1944, pp. 14-16; 552d

Ambulance Company Annual Rpt, 1944, pp. 6-7. 2

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, p. 14;

Wiltse, Mediterranean, pp. 401-04; MFR, Col D. E.

Liston, 4 Dec 44, sub: Agreements Made at Conference, 15-16 November 1944, DRAGOON 1944 file,

CMH.

3

 94th Medical Gas Treatment Battalion Annual

Rpt, 1944; 28th Field Hospital Annual Rpt, 1944, p.

21.
HOSPITALIZATION AND EVACUATION CRISIS 471

his staff. The two offices jointly established an evacuation priority for each

class of patients so that the Seine Section, by loading low- as well as highpriority cases when large numbers of

casualties were due in from the front,

could fill all available outgoing transportation and quickly clear hospital

beds. Late in the year the Seine Section placed the headquarters of the

343d Medical Battalion in administrative and operational control of its

hospital train units, ambulance companies, litter detachments, and air

holding units. This action relieved the

overburdened section surgeon's staff

of most details of evacuation management, and it permitted more efficient

use of resources. The battalion organized a centrally dispatched pool of

more than 100 ambulances, drawn

from units throughout the section, for

mass movement of patients between

medical installations, airfields, and

railway stations. The Seine Section

made the most efficient use possible

of its general hospitals. Those closest

to the stations were assigned to casualty reception and triage, while others

performed specialized surgical work,

reducing the waste of professional

talent that resulted when the big hospitals were used as holding and transit facilities.4

Means of casualty transportation

were in steadily increasing supply. Air

evacuation, the first choice of surgeons for moving the seriously ill and

injured, continued on a large scale

throughout the late autumn and

winter, in spite of worsening weather

and persistent administrative uncertainties. C-47s of the IX Troop Carrier Command and the 302d Air Transport Wing during the last three

months of 1944 carried the majority

of patients who crossed the Channel.

On one peak day in November they

evacuated more than 3,000 casualties

from France to Great Britain. By late

1944 the air forces and the chief surgeon's office had established workable procedures for timely transmission of aircraft requests from forward

holding units to SHAEF's Combined

Air Transport Operations Room. Air

Force authorities were increasingly

generous in allocating planes for

evacuation, and the basing of a C-47

wing at Le Mans made more craft

regularly available.

By formal or informal means,

medics and cooperative air liaison officers almost always managed to

produce planes where and when they

were needed. Late in the year the

302d Wing converted the theater's

only designated aeromedical transport

squadron, the Paris-based 320th,

from single-engine UC-64s, which

had proved less than totally suitable

for evacuation and resupply, to the

larger C-47s, further increasing medical service airlift capacity. SHAEF periodically reiterated that air evacuation should be considered only a

4

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 16 and 25-

26 Oct 44, file HD 024 ETO; Surg, Seine Section,

Annual Rpt, 1944, pp. 21-22, 28-29, 49-50; 40th

General Hospital Annual Rpt, 1944, pp. 55 and 81;

48th General Hospital Annual Rpt, 1944, pp. 35-36;

425th Ambulance Company Annual Rpt, 1944, pp.

2-3, and Hist, January-June 1945, pp. 3-4. See also,

in file HD:ETO:370.05:Evacuation, Sep-Dec 44,

MFR, Col Mowrey, n.d.; Memo, Col Cutler to Chief,

Professional Services Division, OofCSurg, 26 Oct

44, sub: Meeting of Surgical Chiefs, Paris Hospitals . . . ; Memo, Maj D. J. Twohig to Chief, Evacuation Branch, Operations Division, OofCSurg, 31

Oct 44, sub: Evacuation of Patients From Paris General Hospitals to Cherbourg.
472 EUROPEAN THEATER OF OPERATIONS

bonus, but by the end of the year its

transportation agencies were treating

medical evacuation flights as a permanent and indispensable element in

their planning.5

The ETO medical service acquired

more hospital trains during the fall

and winter and operated them with

increasing efficiency. Between 30 September and the end of the year the

northern Communications Zone doubled its medical rolling stock from 17

trains to 34. Most of the additional

trains were brought over from Great

Britain; others were built on the Continent, to medical service specifications, by the reconstituted French

railway authorities. The Southern

Line of Communications in the same

period acquired six trains of its own,

four shipped directly from the United

States and two constructed by the

French. The trains of both zones had

an aggregate capacity of over 8,000

litter and 3,700 ambulatory patients

and well exceeded in numbers the

theater's planned ratio of trains to divisions. Except for a chronic lack of

heat in the cars, the equipment was

adequate for the task, especially when

improved by the ingenuity of the

medical crews, who added furniture

and enlarged kitchens and water storage facilities.

Train running times remained irregular and usually slow. The French

railroads were battle-damaged and

congested, and subject to interruption

by accidents and occasional enemy air

attacks. Nevertheless, General

Hawley, by constant pressure on the

Transportation Corps, gradually secured higher scheduling priority for

his trains. In late December the average round trip between Paris and

Cherbourg took about 47 hours, compared to 96 to 120 earlier in the campaign. Hospital train units and dispatching and receiving hospitals and

holding units, as they acquired greater proficiency in their work, steadily

reduced turnaround times in the forward areas and at Paris. The Seine

Section, which provided stabling and

servicing for the entire COMZ train

complement, during October acquired trackage at a second station,

the Gare de l'Est, as the terminal for

trains shuttling between the capital

and the Third Army area. The section

thus reduced congestion at the Gare

St.-Lazare, which continued to handle

all trains from the First and Ninth

Armies and also those running between Paris and Cherbourg. To speed

the turnaround of trains, the section

set up a medical supply point for

them at the Gare St.-Lazare, as well

as rest and bathing facilities at both

terminals for the hard-worked staffs.

Even with these improvements, the

combination of slow runs and increasing casualty flow kept every train in

5

Admin Memo No. 147, OofCSurg, HQ,

ETOUSA, 2 Nov 44, AirEvacCorresp, file HD 580

ETO; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 30 Dec 44,

file HD 024 ETO, and Annual Rpt, 1944, pp. 12-14

and encl. 10; Robert F. Futrell, Development of Aeromedical Evacuation in the USAF, 1909-1960, USAF Historical Study no. 23 (Maxwell Air Force Base, Ala.:

USAF Historical Division, Research Studies Institute, Air University, 1960), pp. 238, 240, 242-43.

On SHAEF acknowledgement, see Extract from

Thirtieth Weekly Military Shipments Priority Meeting, 16 Dec 44, EvacCorresp, 1944-45, file HD

370.05 ETO, and Memo, HQ, COMZ, to SHAEF,

26 Dec 44, file 370.05 Evacuation (Planning).
HOSPITALIZATION AND EVACUATION CRISIS 473

GARE ST.-LAZARE, PARIS

almost constant service, with little

time between trips for maintenance of

the equipment or leave for the medical personnel.6

Persistent Problems

Despite much progress, three persistent problems hampered—and, on

occasion, almost paralyzed—the theater hospitalization and evacuation

system during the winter battles of

1944-45. The theater faced a shortage of fixed hospital beds, largely resulting from delays in setting up

enough general hospitals on the Continent. At the same time a lack of

cross-Channel shipping, combined

with the long, inefficient line of evacuation through Cherbourg, jeopardized the smooth flow of patients to

the more numerous hospital beds in

England. Finally, the United Kingdom

6

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 6, 9, 10, 23

Oct 44, file HD 024 ETO, and Annual Rpt, 1944,

pp. 10-11 and encl. 4, and Semiannual Rpt, January-June 1945, encl. 2, pp. 2-3; Surg, ADSEC,

COMZ, Annual Rpt, 1944, pp. 17-18; Surg, Seine

Section, Annual Rpt, 1944, pp. 39-40; Memo,

Kenner to G-4, SHAEF, 11 Nov 44, Medical Division, COSSAC/SHAEF, War Diary, November 1944;

Memo, HQ, COMZ, to SHAEF, 26 Dec 44, file

370.05:Evacuation (Planning). For details of train

operations, see 14th, 16th, 18th, 43d, and 45th Hospital Trains Annual Rpts, 1944; 99th General Hospital Annual Rpt, 1944, p. 17; and 552d Ambulance

Company Annual Rpt, 1944, p. 10.
474 EUROPEAN THEATER OF OPERATIONS

hospitals themselves were becoming

overloaded, due to a combination of

General Hawley's 180-day evacuation

policy, a shortage of transatlantic

shipping for casualties, and disputes

within the theater and between the

theater and the War Department over

the proper method of using what

shipping there was. Throughout the

autumn Generals Kenner and Hawley

and their superiors in Paris, London,

and Washington argued and worried

about these problems. By mid-December they were beginning to hammer

out solutions to some of them. The

solutions, however, were only partially in effect when winter and war imposed on the medical service the most

severe challenge yet to confront it.

Establishing hospitals on the Continent as close as possible behind the

advancing armies had been a major

concern of General Hawley since

before D-Day. During the last three

months of 1944 alone the Hospitalization Division put twenty-two new continental plants in operation, the majority in the advanced clusters around

Liege and Bar-le-Duc. Other general

hospitals opened in Paris, Le Mans,

Rouen, and Antwerp. The Southern

Line of Communications effectively

doubled its fixed bed capacity during

the same period, with most of the

new beds in general hospitals close

behind the Seventh Army. Late in the

year the two communications zones

between them had about 50,000 general, station, and convalescent hospital beds in operation, roughly twothirds of them in the northern

COMZ. The United Kingdom Base,

with the BOLERO hospital construction

program fully completed, contained

over 96,000 T/O and about 35,000

emergency expansion beds. On the

Continent two hospital centers went

into operation in December, the

818th at Liege and the 819th at Barle-Duc. In the United Kingdom Base

seven centers were at work, coordinating the activities of dozens of general hospitals. At each center the

headquarters, by consolidating administration, supply, and evacuation and

redistributing professional staff when

necessary, greatly increased the efficiency of its attached units.7

Yet the continental hospitalization

program, progress notwithstanding,

had fallen considerably short of its

objectives. Before D-Day the Hospitalization Division had set the goal of

having twenty-five general hospitals

open in France by 31 August; it did

not reach that objective until late October. By the end of December the division was less than halfway to its new

target of seventy-nine continental

plants in operation by 30 April 1945.

Not all the units opened during the

autumn were of direct use in handling

battle casualties. In the Channel Base

Section, for example, new general

hospitals served primarily COMZ

units in Antwerp and other ports, or

received sick and injured from the

tens of thousands of incoming troops

7

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 11-12 and 15-20,

and Semiannual Rpt, January-June 1945, encl. 34;

Surg, CONAD, Annual Rpt, 1944, pp. 4-7; Memo,

HQ, COMZ, to SHAEF, 26 Dec 44, file

370.05:Evacuation (Planning); Surg, Normandy Base

Section, Semiannual Rpt, January-June 1945, p. 13.

On hospital centers, see James B. Mason, "The Surgeon of the Higher Echelon and the Hospital

Center," The Military Surgeon 3 (November 1952):

321, and 819th Hospital Center Annual Rpt, 1944,

pp. 1-2.
HOSPITALIZATION AND EVACUATION CRISIS 475

TENTS OF THE 76TH GENERAL HOSPITAL near Liege

who passed through the vast RED

HORSE staging area around Rouen.8

The delay in setting up more hospitals was not due to a lack of operating

units. At most times during the

autumn and winter between twelve

and twenty general hospitals were idle

on the Continent and in Britain,

awaiting equipment and plants. The

latter proved increasingly difficult to

secure. The Hospitalization Division

reconnoitered and requested more

than enough sites, almost all with

suitable standing buildings, at locations as far forward as Aachen,

Verdun, and Luxembourg. However,

as winter descended, the medics had

to compete for space under roofs with

other Army elements and with French

and Belgian civilian agencies. Elaborate negotiations, conducted through

SHAEF, were often needed before the

civilian authorities grudgingly gave

way. The field armies, needing shelter

for their own medical and other units,

also resisted handing over facilities,

and the slowed pace of the advance in

late autumn further delayed medical

service occupation of forward sites.

Hospitals that did get into their

plants then had to cope with the effects of battle damage and German

sabotage; the difficulty of obtaining

engineer construction support; the

8

 Hospitalization Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945,

encl. 4; Surg, Channel Base Section, Annual Rpt,

1944, pp. 7-9 and enclosures.
476 EUROPEAN THEATER OF OPERATIONS

shortage of building materials; and

the vagaries of scarce, unreliable civilian labor. For units setting up or operating in tents, like some in Normandy and Liege, cold winds, rain, snow,

and mud compounded all other difficulties.9

In early December General Kenner

opined that the hospital bed shortage

was approaching crisis proportions.

He pointed out that the fixed hospitals of COMZ, SOLOC, and the

United Kingdom Base were already

treating 7,000 patients more than

their operating capacity. In addition,

a large backlog of casualties awaited

evacuation across the Channel and to

the United States. The SHAEF chief

surgeon recommended that the theater give highest priority to establishing 100,000 fixed beds on the Continent. He pressed Hawley both to find

a way of speeding cross-Channel

transportation and to reduce his evacuation policy, clearing more patients

out of the United Kingdom. While

Hawley fully concurred with Kenner's

call for more beds on the Continent,

he insisted that the situation was not

as critical as it seemed, because

Kenner counted only the T/O bed capacities of hospitals, which could accommodate larger emergency patient

loads if necessary. By COMZ's reckoning, which included over 35,000

emergency expansion beds in Great

Britain and 20,000 on the Continent,

the theater still had a thin but viable

cushion of unused capacity. Inconsistent counting methods obscured the

entire issue. Both Kenner and Hawley

ignored COMZ's thousands of holding and transit beds, nor did they

consider the fact that many patients

in the continental fixed hospitals were

actually short-term cases, rather than

true general hospital patients requiring prolonged and elaborate treatment. Nevertheless, it was clear that

the system was operating somewhere

near the upper limit of its capacity.10

Over and above the question of

whether the hospitals could accommodate all the American Army's casualties was another issue: that of caring

for the sick and wounded among the

nearly 300,000 German troops taken

prisoner since D-Day. During the

summer and fall the United Kingdom

Base designated a steadily lengthening list of station hospitals to provide

minimal treatment for these patients,

before they were evacuated to the

United States under a 30-day theater

policy for POWs. Many Germans

eventually wound up in hospitals in

such exotic places as Tennessee and

Arizona. The European Theater al9 ready was having difficulty finding Memo, Hawley to CofS, COMZ, 14 Dec 44, file

HD:ETO:370.05:Evacuation, Sep-Dec 44; Memo,

HQ, COMZ, to SHAEF, 26 Dec 44, file

370.05:Evacuation (Planning); Surg, ADSEC,

COMZ, Annual Rpt, 1944, p. 11; Surg, Seine Section, Annual Rpt, 1944, pp. 17-21; Surg, Normandy

Base Section, Annual Rpt, 1944, p. 8; Darnall, "Sidelights," p. 27, and "Breakthrough to Paris," pp.

271-72. For examples of general hospital difficulties, see 167th General Hospital Annual Rpt, 1944,

p. 6; 170th General Hospital Annual Rpt, 1944, pp.

4-8; and Cady, "Notes on the 21st General Hospital

(AUS)," pp. 437-38, 446, 466, 484, 487-89, Cady

Papers, MHI.

10

 Quotation from Memo, Kenner to CofS,

SHAEF, 7 Dec 44, file HD:ETO:370.05:Evacuation,

Sep-Dec 44. In same file, see Ltr, AG, SHAEF, to

CG, COMZ, ETO, 9 Dec 44, sub: Status of US Hospitalization and Evacuation. . . . See also MFR,

Kenner and Hawley, 2 Dec 44, sub: US Hospital

Bed Situation, Casualty Evacuation and Other Medical Matters, in Medical Division, COSSAC/SHAEF,

War Diary, December 1944; Memo, HQ, COMZ, to

SHAEF, 26 Dec 44, file 370.05:Evacuation (Planning).
HOSPITALIZATION AND EVACUATION CRISIS 477

beds for its POW patients, and personnel to attend them, when the War

Department in mid-November compounded its troubles. Anticipating an

early collapse of the Reich, the department ordered a halt to movement

of almost all prisoners, including patients, across the Atlantic. As a result,

by late December United Kingdom

Base hospitals contained over 14,000

Germans. General Hawley's planners,

looking ahead to another Allied

breakthrough, produced astronomical

estimates of the number of captured

enemy to be cared for and warned

that a high proportion would likely be

severely ill or suffering from untreated, infected wounds. The stabilization

of the front and the German counterattacks made this a future rather than

a present problem. Nevertheless, the

need to make decisions and take

measures on POW hospitalization

hung ominously over all discussions

of the theater bed shortage.11

Whether for POWs or American

casualties, additional hospital beds on

the Continent obviously were needed.

But no quick way could be found to

put more plants in operation. General

Kenner, through SHAEF, pressed the

12th Army Group to give up some

sites in its possession and expedited

negotiations with the Allies to obtain

others. He and Hawley both worked

through every possible channel to win

the hospitals higher priority in the allocation of engineer support and

transportation. Hawley's Supply Division improved the handling of hospital assemblies. Nevertheless, command attention and directives could

not at once overcome manpower and

matériel shortages, ice and snow, and

tactical setbacks.12

Inefficiencies in cross-Channel sea

evacuation also concerned General

Kenner. Under army-navy arrangements made soon after D-Day, all casualty movement over the Normandy

beaches and most transportation of

patients on LSTs ended in late

autumn. At the same time the United

Kingdom Base discontinued casualty

reception at Portland-Weymouth.

From then on, all American patients

not sent to Great Britain by air traveled on British hospital carriers shuttling between Cherbourg and Southampton. The Normandy Base Section

surgeon, who had charge of embarkation, established the 280th Station

Hospital at Cherbourg to hold trainloads of patients from Paris until a

carrier came in; he employed ambulance and sanitary companies to move

evacuees to the docks. Late in the

autumn he acquired hospital train stabling facilities at the dockside Gare

Maritime, which in peacetime served

passengers on the French transatlantic liners. This arrangement permitted

direct transfer of patients from rail

cars to ships when schedules dovetailed. When they did not, the station

hospital in Cherbourg, and in emergencies the Normandy general hospi11

 Smith, Hospitalization and Evacuation, pp. 234-35;

Surg, United Kingdom Base, Annual Rpt, 1944, p.

15; MFR, Planning Branch, Operations Division,

OofCSurg, ETO, 29 Nov 44, file HD 383.6 (Hospitalization and Medical Services for Prisoners of War,

1942-45).

12

 For examples of efforts to speed up the establishment of new hospitals, see MFR, Kenner and

Hawley Conference, 22 Dec 44, sub: Evacuation and

Medical Problems, in Medical Division, COSSAC/

SHAEF, War Diary, December 1944; Memo, HQ,

COMZ, to SHAEF, 26 Dec 44, file 370.05:Evacuation (Planning).
478 EUROPEAN THEATER OF OPERATIONS

CROSS-CHANNEL EVACUATION ON HOSPITAL CARRIER PRAGUE

tals, temporarily housed and cared for

the evacuees. During the last three

months of 1944 the Normandy Base

Section embarked over 50,000 sick

and wounded GIs; the section sent off

another 3,500 by air from a field near

La Haye-du-Puits in the Cotentin.13

Casualty embarkation at Cherbourg

was about as efficient as port congestion and increasingly treacherous

Channel weather allowed. However,

there simply were not enough ships

to carry all the evacuees, especially if

the Communications Zone took literally the periodic SHAEF injunctions

to plan for evacuation entirely by surface means. After much negotiation,

General Hawley by late autumn had

secured from the British seven of

their hospital carriers and two small

hospital ships for the cross-Channel

run. These vessels, on the rare occasions when all were in service at the

same time, could carry about 1,000

patients per day, roughly half the rate

13

 Memos, Cdr, U.S. Naval Forces, Europe, to CG,

ETOUSA, 18 Jul 44, sub: Inter-Theater Evacuation

of Casualties, and Lt Col E. C. Andreassen to G-4,

United Kingdom Base, 15 Sep 44, sub: Responsibility of Surgeon, UK Base, for ... Evacuation . . .

thru . . . Portland-Weymouth, EvacCorresp, 1944-

45, file HD 370.05 ETO; Evacuation Branch, Operations Division, OofCSurg, HQ, ETOUSA, Daily

Diary, 5 Oct 44, file HD 024 ETO, and Annual Rpt,

1944, p. 11; Surg, Normandy Base Section, Annual

Rpt, 1944, pp. 4-6; 298th General Hospital Annual

Rpt, 1944, p. 108 (the 298th preceded the 280th as

the holding unit at Cherbourg).
HOSPITALIZATION AND EVACUATION CRISIS 479

required if COMZ were to function

without air evacuation. The theater

could increase the ships' effective

capacity by opening a shorter crossChannel route than the three-day,

350-mile round trip between Cherbourg and Southampton. Accordingly, at General Kenner's direction, various Allied committees and agencies

explored alternative routes, such as

that between Calais and Dover. All involved a shorter sea passage, and in

some cases a shorter rail haul from

Paris as well, but each possessed difficulties of its own. Docking and bunkerage for vessels and holding unit

space for patients were limited on

both sides of the Channel. On the

British side, rail movement from east

coast ports inland to the general hospitals would be longer and more complicated than from Southampton.

Hospital trains from Dover would

have to pass through the congested

London metropolitan complex, a

prospect that dismayed the British

railway authorities. In addition, as

long as numerous general hospitals

were in operation in Normandy, some

sea evacuation from Cherbourg would

have to continue, regardless of what

other routes were opened. Taking all

these considerations into account,

Allied evacuation and transportation

officers, among them Colonel

Mowrey, concluded at a mid-December London conference that they

would have to make do for the time

being with the Cherbourg-Southampton route, supplemented by continued maximum use of aircraft.14

Moving patients more efficiently

within the system, even when it was

possible, threatened to transfer the

overload from the continental COMZ

hospitals to those in Great Britain. If

the medical service could not set up

more beds, preferably in France, it

could relieve the pressure only by

getting patients out of the system

more rapidly. Aside from death (so

rare outside the forward emergency

surgical units as to be statistically insignificant), a patient could leave the

system in only two ways: by return to

duty or by being evacuated to the

United States.

Many patients leaving COMZ hospitals by the first route passed through

the convalescent camps and centers

administered by Colonel Diveley's Rehabilitation Division. By the time

Colonel Diveley moved his office

from London to Paris in January

1945, the program he had been instrumental in instituting had grown

into a formidable complex. Its installations in Great Britain, after much

exchanging of sites with other agencies, consisted of five rehabilitation

and reconditioning centers with a

total capacity of more than 12,000

men, staffed by medical personnel

and nonmedical Limited Assignment

officers and men from the Ground

Force Reinforcement Command

14

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 2 Oct, 17

and 29 Nov, and 1, 10, 11, 16 Dec 44, file HD 024

ETO, and Annual Rpt, 1944, pp. 11-12; Memo,

HQ, COMZ, to SHAEF, 26 Dec 44, file

370.05:Evacuation (Planning); and, in file EvacCorresp, 1944-45, file HD 370.05 ETO, Memo, CSurg,

ETO, to CofTrans, ETO, 13 Dec 44, sub: CrossChannel Sea Evacuation; Memo, Hawley to

CMedOff, SHAEF, 12 Dec 44, sub: Cross-Channel

Sea Evacuation; Extract from Thirtieth Weekly Military Shipments Priority Meeting, 16 Dec 44. All the

shorter routes would have involved moving American casualties into or across the lines of communications of the 21 Army Group, something Allied logistical planners had tried to avoid throughout the

campaign.
480 EUROPEAN THEATER OF OPERATIONS

(GFRC). Late in 1944, after the War

Department adopted a T/O for convalescent center units, the medical

service organized five to operate the

United Kingdom facilities, using personnel from four disbanded station

hospitals. Besides the centers, the Rehabilitation Division in Great Britain

oversaw reconditioning activities in

thirteen station hospitals assigned to

relieve general hospitals of nearly recovered patients, as well as programs

in many of the general hospitals

themselves. On the Continent the 7th

and 8th Convalescent Hospitals, field

army units under COMZ control, located respectively at Etampes near

Paris and at Valognes in the Cotentin,

prepared recovered soldiers from two

of the largest general hospital clusters

for return to the front. The facilities

in the United Kingdom Base and on

the Continent could accommodate in

all about 31,500 trainees. About 85

percent of their graduates returned to

some form of duty.15

But moving patients out of convalescent centers and hospitals into

GFRC depots did not always go

smoothly. General hospital commanders at times were less than prompt in

clearing their wards, either out of

professional desire to follow through

on particularly interesting cases or

because able-bodied convalescents

helped to solve their perpetual shortage of labor. The chief surgeon,

through his consultants, made constant efforts to suppress such practices. Some delays were not the hospitals' fault. General hospitals in the

Normandy Base Section, for example,

had difficulty obtaining clothing and

equipment for soldiers ready for discharge; at times they had to hold fit

men for as long as a week for lack of

small but indispensable items, such as

canteen cups. Making matters still

more difficult for the Normandy hospitals and convalescent camp, the

Ground Force Reinforcement Command closed its Cotentin depot

during the autumn. The medics then

had to secure rail transportation for

the returnees to the Paris reinforcement depot, and also find them rations and mess gear for the trip.16

When discharged patients entered

the reinforcement system, the medical

service still had some responsibility

for them. The close relationship between the Reinforcement Command

and General Hawley has already been

noted.17 In England the command's

headquarters and Hawley's office had

occupied adjacent buildings in Cheltenham and were only a block apart

in Paris. Physical proximity made

easier the informal cooperation that,

here as elsewhere in the European

Theater, took up the slack caused by

organizational confusion. Each GFRC

depot centralized and controlled the

flow of replacements—former hospital patients and also new arrivals from

the States and returning AWOLs—

and each had a depot surgeon and a

small complement of enlisted corpsmen, themselves often Limited Assignment men retained by the depot

15

 Rehabilitation Division, OofCSurg, HQ,

ETOUSA, Annual Rpt, 1944, pp. 10-21, 23-24, and

Semiannual Rpt, January-June 1945, p. 1.

16

 For use of convalescent labor, see Cady, "Notes

on the 21st General Hospital (AUS)," p. 449, Cady

Papers, MHI, and Ltr, Hawley to Consultants, 10

Dec 44, box 3, Hawley Papers, MHI. On Normandy

difficulties, see Surg, Normandy Base Section,

Annual Rpt, 1944, p. 9, and 298th General Hospital

Annual Rpt, 1944, pp. 108-09. 17

 See Chapter XIII of this volume.
HOSPITALIZATION AND EVACUATION CRISIS 481

to free able-bodied medics for frontline duty. The surgeons, under technical direction from both the base

sections and the GFRC surgeon, Col.

George G. Durst, MC, were the only

medical men in daily contact with the

stream of replacements.18

Depot surgeons spent much of their

time on preventive medicine, because

the pooling of men from many different sources raised the specter of communicable disease and demanded

constant vigilance. "Repo depot"

transients were particularly apt to

catch and spread venereal disease, to

which depot surgeons responded with

the customary devices of propaganda,

physical inspection, and treatment as

necessary.

More fundamental was the depot

surgeons' task of examining each replacement, making a medical profile

of the man, and rating him as either

General or Limited Assignment, if

screening revealed a more permanent

defect. In many instances, it did. According to the GFRC commander,

Brig. Gen. Walter G. Layman, about

18 percent of hospital returnees had

"some physical or emotional condition," usually directly related to the

injuries that had caused their evacuation, and required "special consideration in reassignment." Limited Assignment men piled up in the depots

because many jobs were closed to

them and because commanders preferred to take General Assignment

men, if possible. For a time in mid1944 the theater brought chaos to the

depots by allowing combat exhaustion

centers to dump on the replacement

system thousands of men recently released from narcosis therapy but

unable to control their tremors long

enough to stand inspection—and still

far from able to resume combat. General Layman insisted that such cases

not be sent to his facilities until they

had "completed their full period of

convalescence in suitable Medical Department installations," and he won

his point. The General Assignment

men sent forward to the divisions

were again checked by unit surgeons

and dentists, and complaints came

back to the depots if any were found

unfit for duty. In spite of difficulties

the system moved men in large numbers. During November, December,

and January about 207,000 U.S. Army

patients returned to duty through

COMZ hospitals, about half of them

in the United Kingdom and half on

the Continent.19

Compared to the flow back to duty

via the Reinforcement Command, the

number of patients evacuated from

the theater to the United States, a

little over 78,000 during all of 1944,

was small. General Hawley, in adopting his 180-day evacuation policy, had

intended it to be, for he wanted to

18

 Depot surgeons received technical direction on

routine matters from the base section surgeons and

special guidance on physical standards and other

such questions from Colonel Durst. This somewhat

anomalous dual responsibility worked out well in

practice and, at Durst's recommendation, survived

the July 1944 redesignation of the Reinforcement

Command as a major command of ETOUSA.

19

 Quotations from Medical History of the Ground

Force Reinforcement Command, ETO, 23 October

1943-30 June 1945, pp. 4, 13, 16, 18, 32-34, file

319.1-2 (GFRC). For an example of division processing, see 76th Infantry Division SOP (Medical

Processing of Division Reinforcements), in Surg,

76th Infantry Division, Semiannual Rpt, JanuaryJune 1945. See also Memo, Anon, to Col Doan, 22

Feb 45, sub: Status of Hospitalization and Evacuation, file 705:Admission to and Operations in Hospitals.
482 EUROPEAN THEATER OF OPERATIONS

retain in Europe as many salvageable

veteran soldiers as possible. His

policy, however, required a very large

hospital system in the theater, and for

that and other reasons it came under

serious attack by late 1944. Beginning

soon after D-Day, General Kenner repeatedly urged Hawley to reduce the

policy to 120 days. The SHAEF chief

medical officer wanted to lighten the

load of patients he saw building up in

the hospitals, especially those of the

United Kingdom Base. Also, anticipating an early German collapse and

a large post-surrender demand for

beds for POWs and recovered Allied

prisoners, Kenner wanted to clear out

as many American patients as possible

before the end of hostilities, when the

European Theater was certain to lose

its high priority for shipping. Hawley,

throughout the summer, stuck by his

position. He reiterated the desirability

of conserving experienced manpower,

and also argued that medical sea- and

airlifts were only barely adequate for

the number of men to be moved

under the 180-day policy; hence, a

shorter policy would do nothing but

enlarge the backlog of patients awaiting transatlantic evacuation.20

Hawley's resistance prevailed because Kenner was unwilling to seek a

SHAEF directive forcing a change. In

the end, therefore, the decisive action

came from the Office of the Surgeon

General and the Army Service Forces

in Washington, Surgeon General Kirk

from the beginning had preferred a

120-day policy and had enforced it in

all overseas theaters except the European Theater, where he had deferred

to Hawley's wishes. By midsummer of

1944, however, Kirk had problems of

his own. He possessed in the United

States an embarrassing surplus of

thousands of empty general hospital

beds and was under pressure to close

excess facilities to ease the nationwide doctor shortage. At the same

time Kirk was having difficulty staffing all the hospital units requested by

the theaters. Because overseas hospital bed requirements would decrease

with a shorter evacuation policy and

because the number of patients returning to fill zone-of-interior beds

would correspondingly increase, a cut

in the theater's evacuation policy was

an obvious way to solve both problems. Accordingly, in August General

Kirk recommended a reduction of the

ETO policy from 180 to 120 days.

Army Service Forces headquarters, to

which Kirk was subordinate, after its

own study of the problem, concurred

in the recommendation. On 5 October the War Department instructed

the theater to make the change.21

General Hawley considered the new

evacuation policy "a fine example of

an order that cannot be carried out"

for lack of transportation. In the

case of transatlantic air movement of

patients, he clearly was correct. Evacuation by long-range four-engine

C-54s of the Air Transport Command, initially promising, proved dis20

 Figures from Evacuation Branch, Operations

Divison, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, encl. 11. On Kenner's views, see Notes of

Kenner-Hawley Conference, SHAEF Main, 14 Aug

44, and MFR, Kenner, 4 Sep 44, sub: Evacuation

Policy . . . , in Medical Divison, COSSAC/SHAEF,

War Diary, August-September 1944. On Hawley's

views, see Memo, Hawley to Inspector General,

WD, 10 Oct 44, and Ltr, Hawley to TSG, 13 Oct 44,

file HD 024 ETO O/CS (Hawley-SGO Corresp).

21

 For background to this decision, see Smith, Hospitalization and Evacuation, pp. 228-30, and Ltr, TSG

to Hawley, 4 Sep 44, file HD 024 ETO O/CS

(Hawley-SGO Corresp).
HOSPITALIZATION AND EVACUATION CRISIS 483

appointing after D-Day. Before the invasion the Transport Command assured the medical service of space on

its planes for 6,000-10,000 patients

per month; at its best, it delivered

only about one-third of that. Making

matters worse, the command, for lack

of medical attendance on board and

at stopovers, would take litter patients—those most needing air evacuation—up to only 30 percent of the

average planeload. The medical service, too, encountered difficulty in

moving patients from hospitals to the

remote transatlantic air terminal at

Prestwick.22

Most important, the theater Air

Transport Board gave relatively low

priority for space to casualties as opposed, for example, to air crews rotating back to the United States after

completing their required number of

combat missions. During autumn the

board actually cut medical evacuation

space allocations to a little over 1,000

a month. In partial compensation the

Air Transport Command in October

committed itself to move 2,000 patients per month directly from France

to the United States via its new transatlantic terminal at Orly Field, just

south of Paris. While the Air Force

restored the heavily sabotaged airport, the Seine Section established a

400-bed holding unit for United

States-bound casualties at a nearby

general hospital. The new airlift

began on 7 December when a C-54

took off, carrying 16 patients. Other

flights soon followed, but inclement

weather during the rest of the month

restricted the total number of men

lifted to 351. As 1944 ended, transatlantic air evacuation remained more

promise than reality.23

With airlift negligible, most evacuees to the United States had to travel

by ship. Sea transportation, especially

of bed patients and of ambulatory

cases who still required considerable

medical attention (respectively Classes II and III in the War Department

classification system) long had been a

matter of contention between General

Hawley and his Washington and ETO

superiors. The chief surgeon from the

earliest days of the theater had insisted, on grounds of patient welfare and

safety, that bed-confined men should

be sent to sea only on specially outfitted hospital ships, marked and protected as required by the Geneva

Convention. During 1943 the War

Department had adopted Hawley's

position as its own and had undertaken an ambitious hospital ship procurement program. The effort, however, fell far short of its goals during

1944, and most of the vessels that

were obtained were sent to the Pacific. With too few hospital ships to

move even the nonambulatory fraction of its over-180-day patients, the

European Theater obviously had to

rely for further evacuation on westbound troop transports. These were

in ample supply due to the continuing

flow of reinforcements to Europe.

Following standard War Department

22

 Quotation from Ltr, Hawley to TSG, 13 Oct 44,

file HD 024 ETO O/CS (Hawley-SGO Corresp). In

same file, see also Memo, Hawley to Inspector General, WD, 10 Oct 44.

23

 Memo, Col. F. H. Mowrey to Chief, Hospitalization Division, OofCSurg, 26 Sep 44, sub: Air Evacuation to the U.S., AirEvacCorresp, file HD 580

ETO; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Annual Rpt, 1944, pp.

15-16; Surg, Seine Section, Annual Rpt, 1944, p.

28; Futrell, Aeromedical Evacuation, pp. 379-82; Darnall, "Sidelights," p. 26.
484 EUROPEAN THEATER OF OPERATIONS

procedures, surgeons at the ports of

embarkation surveyed each of these

vessels to determine its carrying capacity for each of the four classes of

patients. The ports then furnished

hospital equipment and supplies to

each transport, as well as assigning

on-board medical personnel.24

Until very late in 1944 the theater

consistently made use only of a fraction of the sealift thus provided.

There were practical reasons for this.

Glasgow, Liverpool, and Bristol, the

ports at which most troopships from

the United States unloaded, were a

considerable train ride from the

United Kingdom Base hospital centers and provided no space for holding units of any size. The base surgeon was obliged to collect patients

from the widely dispersed hospitals

and to move them to the ports just in

time to meet the vessels; yet, he

rarely received sufficient notice of

convoy arrivals for patients to be

moved before the rigidly scheduled

return sailing dates. The hospital ship

platoons that provided on-board care

often were short of professional personnel—nurses, for example—whom

the theater had to furnish from its

own limited reserves. A similar lack of

advance sailing notice, remoteness of

home ports from Army hospitals, and

inadequate shipboard medical attendance restricted American use of British transports, notably the huge liners

Queen Elizabeth and Queen Mary, each

of which could carry 1,000 or more

patients on every rapid, unescorted

crossing. In addition, the big ships,

which loaded from lighters in the

Firth of Clyde, required prohibitively

time-consuming efforts to embark

litter patients, who had to be manhandled through side ports and up

elevators and stairways not designed

to accommodate them.

Policy questions also entered in.

General Hawley's staff and the port

surgeons frequently disagreed about

the patient-carrying capacity of particular ships, with the European Theater generally producing the lower

estimates, and loading vessels accordingly. Patient classification also was

an issue. Hawley persistently designated patients as Class IIs or IIIs, requiring care and assistance, whom the

port authorities and General Kenner

thought could be considered Class

IVs, able to travel as ordinary troops.

The chief surgeon had grounds for

his position. He pointed out that an

amputee with one leg, who might be

ambulatory on crutches in a hospital

ward, became a bed patient on a ship,

where he could not negotiate ladders

or manage a tray in a mess line on a

rolling deck. Hawley refused to place

men whom he considered helpless in

troop accommodations even if the

result was a vessel that sailed halfempty.

Authorities in the United States and

Great Britain tried manfully and, in

the main, successfully to eliminate the

practical obstacles to full use of the

transports and also to reach a meeting of minds with Hawley and his

staff on vessel capacities and patient

classification. Nevertheless, Hawley

dragged his feet throughout the

autumn, and transport space continued to go unused while patients accu24

 The four classes (see Chapter IV) were: I

(mental patient); II (hospital bed patient); III (ambulatory hospital patient); and IV (troop class patient, that is, able to travel in ordinary troop accommodations and take care of himself).
HOSPITALIZATION AND EVACUATION CRISIS 485

SEA EVACUATION ON U.S. ARMY HOSPITAL ST. OLAF

mulated in Britain. Behind the neardeadlock, reported an inspecting officer sent by the surgeon general, was a

fundamental difference in outlook.

Washington saw transoceanic evacuation as "basically an ambulance

ride" on a grand scale, while Hawley

viewed it as a continuation of the "definitive general hospitalization" that

had begun in the United Kingdom

Base or the big continental hospitals.

A tenacious fighter on what he considered matters of principle, Hawley

was also a shrewd administrator who

kept a close eye on public relations.

Very likely he held out in order to

force the higher authorities to take

unequivocal (and documented) responsibility for sending sick and

wounded men to sea under conditions that he deemed to be substandard and unsafe.25

25

 Quotations from Rpt (to TSG), Lt Col John S.

Poe, 12 Nov 44, sub: Visit to ETOUSA, box 256,

RG 112, NARA. See also Memo, Chief, Passenger

Branch, ETO, to ACofTrans (Movements), ETO, 2

Mar 44, sub: Evacuation of Sick and Wounded From

the Continent . . . , EvacCorresp, 1942-44, file 

024 ETO; Notes of Kenner-Col Davis-Col Mowrey

Conference, 20 Oct 44, and Memo, Kenner to CofS,

SHAEF, 26 Oct 44, sub: ZI Evacuation Problem, in

Medical Division, COSSAC/SHAEF, War Diary, October 1944; Ltr, Hawley to TSG, 25 Oct 44, file HD

024 ETO O/CS (Hawley-SGO Corresp); Memo, Col

F. H. Mowrey to CSurg, ETO, 2 Oct 44, sub: Utilization of the Queens, EvacCorresp, 1944-45, file

HD 370.05 ETO; Evacuation Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, pp. 14-15. For background on the shipping

problem, see Joseph Bykofsky and Harold Larson, Continued
486 EUROPEAN THEATER OF OPERATIONS

The War Department, after weeks

of inconclusive exchanges, finally

gave Hawley the direct order he appeared to want. On 3 December the

Army chief of staff, General Marshall,

instructed the European Theater to

make full use of United States transports for evacuation, filling them to

their capacities as defined by the War

Department. The theater was to do

the same with the Queen Elizabeth and

Queen Mary, as soon as it could make

satisfactory arrangements with the

British. If necessary to fill transport

space, the theater was to reduce its

evacuation policy temporarily to 90

days.26

Marshall's order had immediate effects. General Hawley on 10 December instructed United Kingdom Base

and SOLOC surgeons to use 100 percent of the available evacuation lift

and to include patients who needed

90 days of hospitalization, or even

less, if necessary. He directed his consultants to scrutinize hospital disposition procedures, to make certain that

commanders sent off promptly all

evacuable patients. Even before the

Marshall directive arrived, Hawley

and the ETO Transportation chief,

Maj. Gen. Frank S. Ross, completed

arrangements with the British to augment the medical staffs of the Queens

and to improve their hospital facilities

so that each liner could accommodate

about 1,700 Class II and III patients.

To speed movement of evacuees to

the embarkation ports, the United

Kingdom Base borrowed six British

hospital trains to supplement the

eight already in its possession. Evacuation from the European Theater visibly accelerated. Under Washington's

prodding, even before Marshall's

order, the theater, which had evacuated a little over 8,200 men in September, shipped out over 12,500 in October and 11,300 in November. After

the chief of staffs directive, the outward flow during December increased

to 20,800.27

At the end of 1944 the theater and

the War Department also made basic

policy decisions on POW hospitalization. General Hawley late in the year

sent a request to the War Department

for 100,000 additional general hospital beds to accommodate POWs and

the large number of displaced persons expected after the surrender of

Germany. However, realizing that the

chances of obtaining such a medical

reinforcement were slim, he and his

staff also explored the only remaining

alternative: use of the over 350 captive German medical officers, 390

nurses, and 7,200 medical enlisted

men in the theater to care for their

own countrymen, either in separate

wards of American hospitals or in allprisoner facilities. Theater hospitals

already had begun using limited numbers of Germans for this purpose.

One SOLOC general hospital, the

21st, in November organized an

entire prisoner section with a German

The Transportation Corps: Operations Overseas, United

States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1957), pp. 365-66. 26

 Msg, Marshall to ETOUSA, 3 Dec 44, copy in

file HD:ETO:370.05:Evacuation, Sep-Dec 44. See

also Smith, Hospitalization and Evacuation, p. 236.

27

 Ltr, Hawley to Surgs, SOLOC and United Kingdom Base, 10 Dec 44, sub: Evacuation to the ZI, file

HD:ETO:370.05:Evacuation, Sep-Dec 44; Ltr,

Hawley to Consultants, 10 Dec 44, box 3, Hawley

Papers, MHI; Bykofsky and Larson, Transportation

Corps, pp. 366-67; Memo, HQ, COMZ, to SHAEF,

26 Dec 44, file 370.05:Evacuation (Planning).
HOSPITALIZATION AND EVACUATION CRISIS 487

professional staff. Hawley approached

this solution with caution, as did most

other medical officers. Early reports

on the performance of German

medics were mixed; some proved

insubordinate and poorly trained.

Further, this policy would entail retention of German POW medical personnel for the duration of hostilities,

in technical violation of the Geneva

Convention requirement for the earliest possible repatriation. No belligerent power in this war had honored

that provision of the Convention, but

deliberate large-scale disregard of it

by the United States might afford the

Germans a pretext for violating other

provisions, to the detriment of

wounded Allied prisoners and those

who cared for them. Necessity, however, left no alternative. Early in December Hawley approved a study by

his Operations Division calling for

broader, more systematic use of captured talent. Three weeks later, he

endorsed the idea of hospitals staffed

entirely by Germans, with only a

small American supervisory cadre.

The United Kingdom Base late in December reorganized the 327th Station

Hospital as the first such all-POW facility.28

General Marshall, even more aware

than Hawley that the bottom of the

American medical manpower barrel

had been reached, came to the same

conclusion as the ETO chief surgeon.

Just before Christmas, he and Secretary of War Henry L. Stimson decided, in spite of misgivings about the

Geneva Convention, that the European Theater must use German medical

personnel and entirely POW-staffed

hospitals to care for prisoners. The

Army simply could not provide staffing for Hawley's requested 100,000

beds. To confirm the feasibility of

prisoner hospitals, and to investigate

other aspects of the theater medical

service, Marshall dispatched to

Europe a medical officer then serving

in the War Department G-4, Lt. Col.

Crawford F. Sams.

Sams flew to Paris in a snowstorm,

visited SHAEF, and embarked on a

grand tour. He trekked through forward areas where the Ardennes battle

was raging, he visited the POW

camps of COMZ and SOLOC, and he

saw the hospitals of both the northern

and southern lines of communications. (In a curious coincidence, he

was able to tell a German nurse working in SOLOC that her doctor husband was alive and well, working in

another American hospital in northern France.) Everywhere, Sams found

among the prisoners an abundance of

medical talent. Some of the doctors

had not been well trained by current

American standards, for the once excellent German medical education

system had suffered under the Nazis.

But prisoners preferred to be cared

28

 Memo, Col Cutler to CSurg, ETO, 17 Nov 44,

sub: Care of POWs by German Medical Officers;

Memo, Professional Services Division, OofCSurg, to

Operations Division, OofCSurg, 30 Nov 44; Staff

Study No. 1, OofCSurg, HQ, ETOUSA, 1 Dec 44,

sub: Medical Service for Enemy Prisoners of War

(and related memo for Hawley, with his concurrence, 2 Dec 44); Ltr, Hawley to Surg, United Kingdom Base, 27 Dec 44; Memo, Hawley to ACofS,

G-4, ETO, 20 Dec 44, sub: Medical Means Required for Prisoners of War. All in file HD 383.6

(Hospitalization and Medical Services for Prisoners

of War, 1942-45). See also Surg, United Kingdom

Base, Annual Rpt, 1944, p. 15; Cady, "Notes on the

21st General Hospital (AUS)," pp. 455-56 and 470-

71, Cady Papers, MHI. For discussion of the Geneva

Convention issue, see Crawford F. Sams, "Medic,"

pp. 295-96, CMH.
488 EUROPEAN THEATER OF OPERATIONS

for by their own people. Sams concluded, confirming what Marshall already had decided, that equipment

for the 100,000 additional beds

should be sent to Europe, but no

staff. As the new equipment arrived,

it should be issued to the rearmost

American hospitals that would be sent

forward to support the armies. The

equipment and plants left behind

should be turned over to the POW

medics, who would work under no

more than general American supervision.29

On 28 December, even before

Sams returned and reported, the War

Department directed the European

Theater to implement essentially the

policy he recommended. General

Hawley, with a new flood of prisoners

in prospect from the cleanup of the

Bulge and the resumption of the

Allied offensive, lost no time in doing

so. The United Kingdom Base converted half a dozen more station

hospitals into POW facilities. On

the Continent the Normandy Base

Section in January 1945 began reorganizing its general hospitals in the

Cotentin and near OMAHA beach into

prisoner hospitals. Except for one

unit, which remained to supervise the

Germans, the American hospitals that

had occupied these sites moved to

new plants nearer the front, leaving

behind their tentage and equipment

and receiving new outfits as they went

forward.30

By breaking the transatlantic evacuation deadlock and deciding to establish German-staffed POW hospitals,

the War Department assured the

eventual solution of two major ETO

medical logistical problems. These actions, however, had only a marginal

impact on the medical service's ability

to respond to the German attack in

the Ardennes. Indeed, setting up

POW hospitals depended upon the

ability of American general hospitals

to occupy new sites farther forward.

The delay in securing such sites was a

principal component of the winter

crisis. Theater medical personnel had

to rely on resources and facilities already on hand, as they coped not

only with battle casualties but also

with victims of a pernicious combination of severe weather, poor supply

planning, and inadequate health precautions.

Trenchfoot: The Other Enemy

The winter of 1944-45 was the

coldest and wettest that Europe had

seen in many years. To plague the already miserable American front-line

infantry, winter brought an undramatic but crippling ailment: trenchfoot.

Cases began to appear in October,

and rapidly increased thereafter. In

December, when the systems of evacuation and hospitalization were straining under the weight of wounded, the

casualties of cold injury resulting

from the Ardennes battle arrived in

numbers that exceeded all expectations.

29Sams, "Medic," pp. 293-322, CMH. 30

 MFR, Planning Branch, Operations Division,

OofCSurg, ETO, 10 Feb 45, sub: Prisoners of War

Held by U.S. Forces in ETO; Memo, Planning

Branch, Operations Division, OofCSurg, to Chief,

Operations Division, OofCSurg, 13 Jan 45; Ltr, Col

D. E. Liston to G-1, ETO, 13 Jan 45. All in file HD

383.6 (Hospitalization and Medical Services for Prisoners of War, 1942-45). See also Smith, Hospitalization and Evacuation, p. 236; Surg, Normandy Base

Section, Semiannual Rpt, January-June 1945, pp. 2-

4.
HOSPITALIZATION AND EVACUATION CRISIS 489

Cold injury took various forms depending on the depth of the chill and

the length of exposure. Severe cold,

notably at high altitudes where some

bomber crewmen were subject to the

direct blast of freezing winds, could

cause quick tissue death. Milder frostbite occurred among the infantry as

well. Slower and subtler was the

ground type of cold injury, which did

not even require especially low temperatures. In chilled feet the small

blood vessels initially contracted, reducing the oxygen supply to the tissues; in serious cases the arterioles

and the nerve endings were "irreversibly damaged" so that the effect of

the injury persisted. Wetness increased the speed and severity of

injury by conducting heat away from

the body. Anything, such as tight

shoelaces, that obstructed the flow of

blood likewise hastened the onset of

trenchfoot's unpleasant symptoms—

numbness followed by swelling; then

by intense pain; and, in some cases,

by tissue death, with gangrene. Once

injury occurred, the victim could look

forward to a long course of treatment, and possible recurrence of the

condition caused by the inability of

damaged tissue to resist cold. Trenchfoot proved to be most dangerous to

the front-line troops, who lived for

long periods without shelter or dry

clothing and who were often immobilized under enemy fire. No one died

of trenchfoot, but its impact was

heavy, both upon fighting regiments

that lost their riflemen and upon the

hospitals that cared for them.31

Americans met cold injury in three

areas during the war—the Aleutians,

Italy, and the European Theater.

Little information moved from one

theater to another and the lessons

learned in one region had to be relearned elsewhere. Troops in Italy

underwent their most severe trial in

the winter of 1943-44, when more

than 5,700 cases occurred. By the

time of D-Day the Mediterranean

Theater had worked out methods of

control that reduced the number of

cases in the following winter by

almost three-fourths: Cases fell to

1,572, and admission rates tumbled

from 54 per 1,000 troops per annum

to 20. Better equipment and more

rigorous discipline were the primary

factors. Commanders ensured that

boots were not laced too tight, that

socks were changed as frequently as

possible, that feet were massaged

daily, and that warm tents were available where forward troops could gain

a few hours' rest, whenever possible.

The Mediterranean Theater's official

report on trenchfoot was in the hands

of its chief surgeon in January 1944

but failed to reach the European Theater until a year later, and then only

in response to a direct request. The

ETO chief consultant in surgery,

Colonel Cutler, visited the Mediterranean and returned to urge timely

preparations for meeting cold injury.

But ETO medical officers were too

preoccupied to heed his warning.

Cold injury approached the European Theater as a silent crisis, its pos31 sibility dimly foreseen but its poten- Unless otherwise noted, this section, to include

statistics, is based on Tom F. Whayne and Michael

E. DeBakey, Cold Injury, Ground Type, Medical Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1958), pp. 127-210. Quotation from Whayne Comments, 4 Dec 86, p. 17,

CMH.
490 EUROPEAN THEATER OF OPERATIONS

tial for havoc unappreciated. The

problem became lost in the vast complexity of the planning and buildup

for invasion, when medical planners

were occupied with more pressing

needs. The medical annex to OVERLORD did not mention cold injury;

COMZ's NEPTUNE plan remarked only

that "the cold, wet weather prevailing

during the winter season in the area

will predispose combat troops to this

affection" and that "supplying seasonal changes of clothing opportunely, giving particular attention to the

furnishing of proper footwear" was

important in preventing trenchfoot.32

Several ETO publications recommended that shoes be laced tightly.

The 1944 Manual of Therapy, issued

over Hawley's signature, summed up

its contribution to the prevention of

cold injury in a single sentence: "The

importance of a footbath with soap

and water cleansing, vigorous massage (20 minutes), dry socks, and a

change of shoes in the prophylaxis of

foot disability resulting from exposure to cold and moisture, cannot be

overemphasized."

 33 A comprehensive

command directive on care of the

feet, prepared by Colonel Gordon,

the Preventive Medicine Division chief

was disapproved for publication by

the Adjutant General, ETOUSA, on

the ground that existing manuals covered the subject and that, in any case,

cold injury prevention was the responsibility of subordinate commands. By the time publication of a

circular letter took place on 24 November, massive losses from cold

injury had already been sustained.

Conceptual problems helped to

confuse the issue. To many doctors

"injury" seemed a different category

from "disease." Forms used to report

cold injury were ambiguous and nomenclature varied; at one time or another trenchfoot and immersion foot

were reported as nonbattle injuries or

as disease, and frostbite as battle or

nonbattle injury, all depending on the

outlook of the individual unit or command. In consequence, the dimensions of the problem were not at first

perceived.34

While commanders and surgeons

alike thought of other things, American soldiers in the European Theater

entered the winter fighting inadequately clothed. Disagreements in

the hierarchy, errors fostered by the

course of battle, and inadequacies in

the footgear on hand contributed to

the situation. The theater Quartermaster chief, Maj. Gen. Robert M.

Littlejohn, disagreed with the quartermaster general in Washington over

the composition of the winter uniform. This circumstance, combined

with optimistic midsummer expectations of an early end of hostilities—

the First Army commander asked a

medical officer in mid-September,

"Don't you know that this war is

going to be over in a few weeks?"—

led to delayed and insufficient winter

clothing requisitions by the theater.

Making matters worse, the armies

during the pursuit gave low priority

to the shipment forward of what cold 32

 An. 9—Medical, p. 23, to FECOMZ Plan, 14

May 44, file HD 370 ETO. 33

 ETO, Manual of Therapy, 5 May 44, file Manual

of Therapy, ETO, box 405, RG 112, NARA.

34

 Above paragraphs based on Cir No. 108, HQ,

ETOUSA, 24 Nov 44, reproduced in Whayne and

DeBakey, Cold Injury, pp. 525-28.
HOSPITALIZATION AND EVACUATION CRISIS 491

CARE OF THE FEET

weather clothing was available. General Bradley of the 12th Army Group

later candidly described the calculated

risk he took in pressing the foe:

When the rains first came in November

with a blast of wintry air, our troops were

ill-prepared for winter-time campaigning.

This was traceable in part to the Septem- ber crisis in supply for, during our race to

the Rhine, I had deliberately by-passed

shipments of winter clothing in favor of

ammunition and gasoline. As a conse- quence, we now found ourselves caught

short, particularly in bad-weather footgear. We had gambled in our choice and

now were paying for the bad guess.35

Winter footgear was especially inadequate, in both quantity and type.

Later investigators concluded that

feet could be kept in condition by

heavy socks or foot wrappings to wick

away moisture, worn inside water-repellent shoes or boots that were loose

enough not to constrict the blood

flow. During his European inspection

tour Colonel Sams kept his boots

loosely laced and had no problem,

despite the fact that he spent much

time in the field and, for experimental

purposes, never changed his socks.

American field shoes and combat

boots were not waterproof, though a

substance called dubbin was supplied

to make them so. (Hawley emphatically declared that dubbin was useless.)

Both forms of footwear could be

laced tightly, as could a winterized

rubber-soled boot called the shoepac.

Supply problems multiplied difficulties. The theater Quartermaster chief

did not have sufficient galoshes, and

troops who received them often discarded them during good weather as

an encumbrance. In December the

theater cabled for 500,000 additional

pairs of Shoepacs over and above the

446,000 pairs already shipped and the

90,000 pairs that had been issued to

Seventh Army. Production and transport problems, however, ensured that

none arrived until mid-January 1945.

Distribution foul-ups then imposed

new delays. The emergency order of

Shoepacs did not reach the troops in

great numbers until the problem of

cold injury had ended.

Even men who received Shoepacs,

the most sophisticated form of winter

footgear available to American forces,

had difficulty using them. The tops

were permeable to water; the rubber

35

 First quotation from Whayne Comments, p. 18,

CMH. Second quotation from Omar N. Bradley, A

Soldier's Story (New York: Henry Holt and Co.,

1951), p. 445. For a general account of the clothing

controversy, see Ruppenthal, Logistical Support,

2:218-35.
492 EUROPEAN THEATER OF OPERATIONS

soles wore out quickly in field use;

most were too large; and the need to

wear multiple socks and felt insoles

made them unsuitable for men in

battle. Inside the Shoepacs the soldier's feet were not ventilated and excessive sweating soaked the skin as

thoroughly as if the wet had come

from the outside. In time, a form of

injury—shoepac foot—was named for

the footgear; surgeons complained

that sweating and maceration of the

skin produced "a foot which is as bad

as any seen thus far," often bringing

hospitalization for ten to fifteen days.

When the victim returned to duty, the

cycle then repeated itself. In February

the perspiration problem caused the

8th Infantry Division to order its

troops to turn in Shoepacs previously

issued. In other units, surgeons rendered more favorable verdicts on the

shoepac; unquestionably, it was the

best footwear that the American Army

then possessed for wet and cold

weather. But there was also much to

be said for Hawley's blunt assessment: "The plain truth is that the

footwear furnished U.S. troops is, in

general, lousy."

 36

In late November and early December 1944 many factors, large and

small, combined to produce a crisis.

Startled officers—in the medical service, the supply chain, and the line—

learned first-hand how General

Winter could disable an army. Then

the Germans launched their counteroffensive, and troops pinned down in

the snow and mud suffered the equivalent of a major epidemic. Soon the

Army faced the loss of what amounted to several divisions of front-line

soldiers.

Reports in November painted a picture of radical discomfort for the riflemen. Heavy rains ran off over saturated ground, streams and marshes

flooded, and the first frosts struck at

men who were almost never dry or

warm. In the Third Army, men waded

rather than marched, fought in deep

mud, and rested in water-filled foxholes. As the month advanced, night

frosts became commoner. Vehicles

churned roads into sloughs. The 5th

Infantry Division ordered 11,000

pairs of galoshes that were badly

needed. In the 90th Infantry Division

all trenchfoot victims were evacuated

as litter cases. In the Seventh Army's

3d Infantry Division the surgeon

wrote a sharp criticism of the shoepac: With the issue of the winterized

boots he had anticipated that trenchfoot would decrease; instead, ill-fitted

water-soaked Shoepacs were themselves injuring feet. All along the line

dry socks became a critical item and

units struggled to obtain supplies and

to provide some means of drying and

cleaning wet socks. Unit reports often

spoke reassuringly of corrective measures; men were instructed to remove

their shoes or boots daily, massage

their feet, and so forth. But the 79th

Infantry Division of the Seventh Army

had 1,400 battle casualties and 210

cases of trenchfoot for the month. In

the Third Army six men were evacuated for cold injury for every ten

evacuated as battle casualties. Losses

of 10 to 15 percent of unit strength

became common.

36

 First quotation from Essential Technical Medical Data Rpt, HQ, ETOUSA, December 1944, p. 9.

Second quotation from Ltr, Hawley to TSG, 29 Dec

44, file HD 024 ETO O/CS (Hawley-SGO Corresp).

See also Surg, 8th Infantry Division, Annual Rpt,

1945, p. 10.
HOSPITALIZATION AND EVACUATION CRISIS 493

SENTRY WEARING IMPROVISED BOOTS OF STRAW-FILLED BLANKETS

Too often men on the line were

obliged to improvise their own protective gear while the battle raged. In

the Third Army, officers of the 35th

Infantry Division had been unable to

get Shoepacs for their men. Combat

boots and overshoes proved inadequate protection for front-line soldiers pinned down by hostile fire.

Men tried putting paper between two

pairs of socks, but found it insufficient; besides, their boots were not

large enough to permit wearing more

than two pairs of socks without constricting the feet, reducing the blood

supply, and causing cold injury. Overshoes were so unsatisfactory when

worn over combat boots that 60 percent of the cold injury victims in the

division were found to have become

disabled while wearing them. The

best protection resulted from discarding the combat boots altogether and

wearing six or eight pairs of wool

socks or a kind of homemade boot

made out of two thicknesses of a GI

blanket, inside the overshoes, which

were waterproof and large enough to

hold such a mass of material. But the

clumsy multilayered wrappings reduced the soldier's mobility, and the

overshoes were noisy and unsuitable

for stealthy movements in close

combat. From the end of December
494 EUROPEAN THEATER OF OPERATIONS

to mid-January the division lost 479

front-line riflemen to cold injury.37

Many units could have told similar

stories. Fighting in Lorraine during

the German offensive, the 328th Infantry lost 500 men to trenchfoot and

exposure during the first days of the

battle. One company of the 11th Infantry had only 14 men available for

duty, and the chief cause of ineffectiveness was trenchfoot. Cold injury

combined with heavy battle losses to

render the 358th Infantry unable to

continue an attack on the German

line. For the same reason the 357th

Infantry had to be pulled back.

During November and December

losses to cold numbered 23,000,

almost all combat infantrymen. Because an infantry division contained

about 4,000 such soldiers the loss was

equivalent to the total infantry

strength of at least five and a half divisions. Striking selectively, cold

injury, said General Bradley, "sapped

assault strength and thus weakened

the offensive."

 38

In this respect Americans seemingly

fared worse than both their Allies and

their enemies. The British record,

among the few units engaged in the

winter fighting, was far better and resulted, at least in part, from their

practice of rotating units on the line

to rest areas. The enemy's situation

was less clear. German regular units

apparently prevented cold injury

more successfully than Americans because their veterans, at least, had

longer experience of winter warfare.

Yet the many replacements who filled

the ranks appeared to suffer severely.

Some enemy front-line units reported

10 to 15 percent losses to cold injury.

The German Army possessed a field

boot without laces, but most of its

men who fell prisoner to the Americans were found to be wearing laced

leather field shoes. German surgeons

understood, as did their American

counterparts, the importance of not

constricting the blood flow and

placed some faith in an ointment

called Pernionin. The salve was

simply oil of wintergreen and aromatics in a lanolin base, but its smell and

feel may well have encouraged more

frequent massage. Nevertheless, 12th

Army Group medical officers who

surveyed four POW enclosures concluded that, in most enemy units, foot

discipline was poor and the "preventive program . . . similar t

own." 3 9

The impact of cold injury losses

upon American hospitals and the

evacuation system was heavy. During

October and November more than

11,000 trenchfoot casualties were admitted to the Paris general hospitals

from the four American field armies.

Cold injury accounted progressively

for 1.3, 4, 20, and 24 percent of

weekly admissions during November.

The nature of the injury worsened its

effects upon the patients, the hospital

staffs, and the capabilities of the field

37

 Surg, 35th Infantry Division Semiannual Rpt,

January-June 1945, p. 1. 38

 Quotation from Bradley, Soldier's Story, p. 445.

See also Essential Technical Medical Data Rpt, HQ,

ETOUSA, December 1944.

39

 Quotation from "Frostbite Problems in the

German Army During World War II," OCMH Ms

P-602, pp. 25-27, MHI. See also Surg, 303d Medical Battalion, After-Action Rpt, February 1945, pp.

5-7, encl, to History of the Medical Units of the

78th Infantry Division for the Year 1945; Surg, 12th

Army Group, Hist, January-June 1945, an. 16, p. 7;

Army Service Forces Monthly Progress Rpt, 31 Mar

45, sec. 7 (Health), p. 6, file HD 700 (Health).
HOSPITALIZATION AND EVACUATION CRISIS 495

armies alike. Victims, unable to walk

upon exquisitely painful feet, required

litter carry at the front and bed care

in the hospitals. As already noted, the

disability was long-term, and apt to

recur upon exposure—nature's most

ingenious contrivance for the embarrassment of the foot soldier and those

who cared for him.

As early as September and October

the medical service attempted to

make up for earlier omissions by distributing War Department publications that gave concise instructions to

troops and commanders for avoiding

injury. Various command directives

and memoranda followed, drawing attention to the problem, repeating official policies, and underlining the

fact that (as a Third Army circular

dated 9 November phrased it) "excessive development of trenchfoot in an

organization will be considered as indicative of inadequate [command] supervision and control."

 40

 Unfortunately, such action came late in the

day for an army in which large numbers of officers, NCOs, and enlisted

men were ignorant of the nature and

potential seriousness of the threat.41

November found General Bradley

taking action at the urging of his surgeon, Colonel Gorby. Bradley followed up a command directive with

personal letters to the commanders of

his field armies. In turn, the commanders ordered immediate action to

control the epidemic. General Patton's memorandum to the Third

Army's corps and division commanders declared with characteristic vigor

that "the most serious menace confronting us today is not the German

Army, which we have practically destroyed, but the weather which, if we

do not exert ourselves, may well destroy us through the incidence of

trench foot."

 42

By December, admission of past

errors and assumption of responsibility by commanders was general. To

Gorby, Hawley admitted, "I am not

sure that the Medical Department has

been aggressive enough. . . . 

have published long dissertations on

the prevention of trench foot which

are too long for anyone to read." In

January General Eisenhower emphasized the need for commanders to pay

"unremitting attention" to the problem, and officers of lesser rank followed their chiefs lead. A barrage of

publicity began, with articles and editorials in the Stars and Stripes and

other publications widely read by theater soldiers. Radio broadcasts carried

the message to front-line troops. The

theater prepared and circulated millions of copies of a brochure and initiated efforts to indoctrinate replacements. The armies set up trenchfoot

control teams.43

Yet all of these measures, necessary

and helpful as they were, came too

late to modify the impact of cold

injury upon the winter fighting. Instead, after reaching a new high in

January, the cold injury casualty rate

40

 As quoted in Whayne and DeBakey, Cold Injury,

p. 167. 41

 Polls of the overseas army, wrote Assistant Secretary of War John J. McCloy to the surgeon general on 16 August, showed that 85 percent of those

questioned felt that they had received little training

in avoiding or treating trenchfoot. The only other

training failure equally marked was in the handling

of land mines. See ibid., pp. 66, 166-67, 509-15.

42

 Quotation from the memorandum (21 Nov 44)

reproduced in ibid., p. 529. See also Gorby Interv,

1962, p. 20, CMH. 43

 Whayne and DeBakey, Cold Injury, p. 169.
496 EUROPEAN THEATER OF OPERATIONS

fell in response to the reduced level

of combat, perhaps aided by a thaw

that arrived providentially during the

second week of February. (Because

the weather remained chilly and the

thaw increased wetness, its effects are

difficult to assess.) By that time the

European Theater had suffered a

medical misfortune that cost the

ground forces a total of 45,283 casualties at a most critical period. In

searching for the causes of that extraordinary failure, no simple assignment of blame is possible. Errors,

mainly of omission by medical, quartermaster, staff, and line, gave a new

meaning to the old formula for disaster of too little and too late. Now the

medical service could only try to deal

with the results.44

Coping With the Crisis

During the autumn and winter discussions of hospitalization and evacuation policy, none of the participants

expected a major enemy counterattack. Their concern rather was with

the implications for the ETO medical

service of the imminent German collapse that all anticipated. The Ardennes attack caught senior theater

medical officers, like everyone else,

off guard. General Hawley recalled

his own complete surprise. "All I can

remember," he said, "is the

chaos. . . . Nobody knew anything.

We were pretty much in the dark."

Hawley hastily issued instructions for

evacuation of hospitals in danger of

being overrun, and the ADSEC surgeon, Colonel Beasley, made plans

for withdrawing his people and equipment. But neither had to be implemented. As a result of the stout defense put up by the First Army, the

German attack columns barely penetrated the fringes of COMZ territory.

Some disorder followed; the 130th

General Hospital at Ciney was temporarily displaced, and another field

hospital holding unit closed and

moved because of bomb damage. But

all other COMZ medical units remained in place, and continued working.45

Yet the impact of the offensive

spread far and wide. Some units, hospitals and holding units in and

around Liege, suffered casualties and

plant damage from enemy V-weapons, conventional bombing, and longrange artillery fire. Hardest hit was

the 76th General Hospital, struck on

8 January 1945 by a V-1 that killed

24 patients and staff, injured 20, and

heavily damaged buildings and equipment. This unit, and most others that

were struck, cared for their own casualties, cleared away rubble, and kept

on working. These same Liege hospitals, because of the closing and movement of most First Army medical

units, in effect assumed the functions

of that army's evacuation hospitals

and holding units. Occasionally re- 44

 Ltr, HQ, ETOUSA, to CGs, 30 Jan 45, sub:

Trenchfoot Control Officers, reproduced in 12th

Army Group Report of Operations, vol. XIII (Medical Section), pp. 204-05. The rate per 1,000 troops

per year was 127.7 in November, 135.2 in December, 139.8 in January, and 84.9 in February, after

which it rapidly declines. See Preventive Medicine

Division, OofCSurg, HQ, ETOUSA, Semiannual

Rpt, January-June 1945, pp. 43-44.

45

 Quotation from Hawley Interv, 1962, pp. 106-

07, CMH. See also Memos, Hawley to CofS, ETO,

22 Dec 44, sub: Destruction of Medical Supplies To

Prevent Capture by the Enemy, and Hawley to Surg,

ADSEC, 24 Dec 44, sub: Abandonment of Fixed

Hospitals, file HD 024 ETO CS (Hawley Chron);

Surg, ADSEC, COMZ, Semiannual Rpt, JanuaryJune 1945, p. 8.
HOSPITALIZATION AND EVACUATION CRISIS 497

ceiving wounded directly from the

battlefield without any preliminary

treatment except first aid, the general

hospitals and the controlling 818th

Hospital Center, which had been in

operation for only two days when the

offensive began, hastily reorganized

for quick triage, rapid-fire stabilizing

surgery, and mass evacuation. The

Battle of the Bulge also affected medical communications, especially the

Advance Section, where telephone

contact with the armies became sporadic due to bad weather as well as

enemy action. To keep in touch with

the army surgeons, Colonel Beasley

had to send liaison officers on frequent dangerous journeys over the

snow and ice-clogged roads, often

under fire.46

Throughout the weeks of bitter

fighting, all COMZ medical elements

had one overriding task: keeping the

field armies cleared of casualties and

free to maneuver. Conditions as the

battle began were relatively favorable:

a temporary pileup of casualties in

the armies during late November,

caused mainly by a shortage of transportation, had soon been alleviated

and the flow of patients from the

front went relatively smoothly until

16 December. By that time enough

hospital trains were in service to

permit idling some for crew rest and

equipment maintenance; cross-Channel air and sea evacuation were proceeding with only minor delays and

mishaps; the Paris general hospitals

had 3,600-5,600 empty beds each

day; and the Liege and Bar-le-Duc

hospitals were far from full. Farther

to the rear, the situation was less favorable. The Normandy Base Section

reported few empty beds, except in

the Cherbourg holding unit, and

United Kingdom Base hospitals contained almost 117,000 patients.47

On 17-18 December large numbers

of casualties, including about 2,000

patients hastily unloaded by First

Army installations, began flowing

toward Paris from the Ardennes battlefields. On the nineteenth the Evacuation Branch reported that the situation was "becoming tense." The

Liege hospitals were filling; thirteen

trains were on the Liege-Paris shuttle;

and the weather was curtailing both

air and sea evacuation. Colonel

Mowrey, trying to minimize the patient load in endangered First Army

hospitals and in the ADSEC holding

units immediately behind them, gave

those facilities priority for evacuation,

further increasing the pressure on

transportation and on installations

farther to the rear.48

For the rest of the month the Evacuation Branch and the Seine Section

lived from hand to mouth. As trainload after trainload of wounded from

Liege rolled into the Gare St.-Lazare

and a lesser but increasing flow from

the Third Army arrived at the Gare

de l'Est, the reserve of empty beds in

the capital dwindled to 2,600 or fewer

46

 Surg, ADSEC, COMZ, Semiannual Rpt, January-June 1945, p. 8; Evacuation Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Annual Rpt,

1944, p. 12; 818th Hospital Center Semiannual Rpt,

January-June 1945, p. 9; 298th General Hospital

Annual Rpt, 1945, pp. 8, 11, 137; 32d General Hospital Semiannual Rpt, January-June 1945, pp. 1-6.

Liege, a major target because of its key logistics

role, was hit by over 1,000 V-bombs between midSeptember 1944 and early 1945. See MacDonald,

Siegfried Line, pp. 229-30.

47

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 16-30 Nov

and 1-16 Dec 44, file HD 024 ETO. 48

 Ibid., 16-19 Dec 44, file HD 024 ETO.
498 EUROPEAN THEATER OF OPERATIONS

per day. To keep the Paris regulating

tank from overflowing, the Seine Section rushed patients to Le Bourget

field whenever the skies cleared and

C-47s came in; it sent daily trainloads

to Cherbourg, where patients at times

waited twenty-four hours or more in

the ward cars for the arrival of fog or

storm-bound hospital carriers. Enemy

action compounded the section's difficulties. On the night of 26 December

German bombs destroyed a hospital

train at the Gare St.-Lazare and put

the station out of service for fortyeight hours. With all medical rail operations shifted to the Gare de l'Est,

the loading of trains for Cherbourg

temporarily stopped due to yard and

station tieups. By the twenty-eighth

the Seine Section, with 14,000 patients in its wards, effectively was out

of empty beds. Then, as was to

happen repeatedly during the crisis,

the jam broke. Planes began flying

again from Le Bourget and the forward airstrips; trains for Cherbourg

began moving; and carriers pulled

into the harbor. The Seine Section

hastily opened two more general hospitals, one a temporary convalescent

facility in a commandeered Paris hotel

formerly used as a SHAEF officers

club. By the thirty-first, with 1,200

empty beds reported in Liege and

3,600 in Paris, evacuation officers

could breathe a little easier.49

During January 1945 evacuation

continued at a hectic pace. "Hospital

trains were overworked," the Evacuation Branch reported, "all available

planes were utilized; Paris was a hub

of activity; and the port of Cherbourg

was busy day and night outloading

patients. . . ." The Communications

49

 Ibid., 20-31 Dec 44, file HD 024 ETO.

Zone routinely transferred 2,000 patients per day from forward areas to

its continental and United Kingdom

hospitals. On a record day, the

twenty-first, over 4,800 casualties

crossed the Channel, 2,200 of them

by air. These patients included a

growing number from the 6th Army

Group, diverted to the northern

COMZ from SOLOC, where casualties of the NORDWIND offensive had

swamped the available medical facilities. To keep the ADSEC holding

units clear and to maintain empty

beds in Liege, Bar-le-Duc, and Paris,

the Evacuation Branch tried to crowd

the system toward the rear, filling the

Normandy and Brittany Base Section

general hospitals and deliberately

overloading the United Kingdom

Base. This policy worked, but at the

cost of evacuating many less serious

casualties too far back for convenient

return to duty. Inclement weather,

which hampered both air and sea

transportation, periodically blocked

the rearward flow of patients, causing

the Paris bed reserve to shrink alarmingly. On two occasions during the

month, when the Continent had more

beds open than the United Kingdom,

General Hawley temporarily halted

cross-Channel evacuation. At the end

of the first of these embargoes, deteriorating weather prevented an immediate resumption of air and sea movement, giving the Evacuation Branch

its worst days of a bad month. After

each natural or man-made stoppage,

however, the patient flow resumed

and evacuation conditions returned to

normal—if a constant high volume of

casualties, interminable hard work for

all hands, and the need to stretch

human and material resources to and
HOSPITALIZATION AND EVACUATION CRISIS 499

WRECKAGE OF HOSPITAL TRAIN AFTER GARE ST.-LAZARE BOMBING

beyond the limit could be so characterized.50

The Ardennes crisis put the medical service's rail transportation facilities to the severest test they yet had

faced. Hospital train personnel and

equipment operated at full capacity

day after day, week after week. They

did so in spite of cold and snow that

froze steam lines and switches and exposed the inadequacies of car heating

systems, in spite of equipment breakdowns from overuse and lack of maintenance and in spite of damage and

casualties from air raids and accidents. (On 11 January, for example,

an ammunition dump explosion in

Normandy temporarily put three

trains out of action and caused 70

casualties.) The Evacuation Branch

tried to shorten running times on the

most important routes, but an effort

in January to establish regular schedules governing the Paris-Cherbourg

and Paris-Nancy runs brought little

improvement. Only in late February,

after the shift of cargo shipments to

50

 Quotation from Evacuation Branch, Operations

Division, OofCSurg, HQ, ETOUSA, Semiannual

Rpt, January-June 1945, pp. 3-4. See also ibid., pp.

1-2, and Daily Diary, 1-31 Jan 45, file HD 024

ETO; Surg, Seine Section, Annual Rpt, 1944, p. 28;

Surg. CONAD, Annual Rpt, 1944, pp. 9-10, and

Semiannual Rpt, January-June 1945, p. 7. On the

triage problem see Ltr, Brig Gen T. J. Davis, AG,

SHAEF, to CG, COMZ, 13 Jan 45, file 705:Admission to and Operations in Hospitals.
500 EUROPEAN THEATER OF OPERATIONS

Antwerp reduced freight traffic on the

lines radiating from Paris, did the

Evacuation Branch notice any major

change for the better. The Seine Section, meanwhile, further streamlined

and decentralized train loading and

unloading procedures. In mid-February, for greater efficiency, the section

moved all reception of incoming hospital trains to the Gare de l'Est and

used the Gare St.-Lazare only for

loading outgoing trains bound for

Cherbourg. During January General

Hawley requested still more trains

than the forty he had in operation,

both to compensate for slow running

times and to allow sidetracking of the

older rolling stock for now urgently

needed repairs. Three trains previously ordered from the French came

into service early in the new year. In

addition, the theater Transportation

chief agreed to provide a dozen more

for delivery during the next several

months; the first three became available in February. To staff them, and

the others to be delivered, the Seine

Section had to comb doctors, nurses,

and enlisted men out of its general

hospitals to form provisional hospital

train units.51

Fog and clouds grounded most

transport planes during the first week

of the Battle of the Bulge. But when

clear skies returned on 23 December,

so did the C-47s, to drop supplies to

beleaguered American troops and to

pick up casualties at Le Bourget and

the forward airstrips. Throughout the

battle, aircraft, often flying in marginal weather, moved large numbers of

patients—14,000 in the last days of

December and about 17,000 in each

of the ensuing months. In spite of

hazardous flying conditions, they accomplished this feat with only one

major mishap. On 30 December a

plane on a night evacuation flight,

lost in the fog and out of fuel, crash

landed near Le Havre. Thanks to

"heroic action" on the part of the

flight nurse, Lt. Ann M. Krueger of

the 817th Medical Air Evacuation

Squadron, the 27 patients on board

were extricated before the wreck

burst into flames.52

In spite of storms and fog, hospital

ships and carriers—all that SHAEF

and the European Theater could

obtain—maintained the sea shuttle

between Cherbourg and Southampton, moving almost 85,000 patients

during December, January, and February. Though General Kenner continued to press the search for a shorter cross-Channel evacuation route, his

efforts led to no real improvements.

Early in February, after weeks of deliberation, a SHAEF committee of

medical, engineer, and transportation

officers recommended opening a line

between Boulogne and Dover. Colonel Mowrey, Hawley's Evacuation

Branch chief, objected to this proposal. He pointed out that Boulogne

could accommodate only two of the

smallest carriers at a time, that the

train run from Liege would take fifteen hours, and that a large holding

51

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, pp. 3-5 and encl. 2, pp. 1-2; Surg,

Seine Section, Semiannual Rpt, January-June 1945,

pp. 12-13 and 46-47.

52

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, encl. 6; Futrell, Aeromedical Evacuation, pp. 241-42 and 244-45. Quoted words from

Memo, Maj Wesley C. Oliver, HQ, IX Troop Carrier Command, to CO, 9th History Unit, U.S. Army,

31 Jan 45, box 407, RG 112, NARA. Krueger was

recommended for the Soldier's Medal.
HOSPITALIZATION AND EVACUATION CRISIS 501

HOSPITAL EMERGENCY BEDS

unit would have to be set up at the

port—all to move no more than 450

additional patients a day. American

and British transportation officers

also were unenthusiastic about the

new route. Nevertheless, Kenner in

mid-February directed the theater to

initiate the service. Due to delays in

preparing the facilities, and probably

to some medical service foot-dragging, it took another month to begin

operations. By that time the need for

an additional cross-Channel sea route

long had passed.53

Throughout the midwinter battles,

Generals Kenner and Hawley anxiously watched the fixed hospital patient census inexorably rise. Yet the

Communications Zone always managed to have a bed for every casualty

and maintained a surplus, razor-thin

at times, of beds over patients. Hospitals in the United Kingdom Base and

on the Continent expanded their capacities by a variety of expedients.

The United Kingdom Base made permanent and fitted for winter use most

of the 30,000 supposedly temporary

tented expansion beds it had set up at

its general and station hospitals

before D-Day. The base also reassigned to regular patient care a

number of station hospitals previously

employed to hold convalescents. To

add still more beds, each hospital,

both in Britain and on the Continent,

packed more patients into its existing

space, first by filling its wards to their

actual rather than T/O capacity, then

by reducing the floor space per bed

in the wards, and finally by placing

still more emergency beds in laboratories, barracks, offices, and hallways.

By such means most theater general

hospitals operated at 50 percent or

more above their rated capacity.54

53

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 2 Jan, 3 and

16-17 Feb, 1 Mar 45, file HD 024 ETO, and Annual

Rpt, 1944, encl. 10, and Semiannual Rpt, JanuaryJune 1945, p. 6 and encl. 6; Surg, Normandy Base

Section, Semiannual Rpt, January-June 1945, pp.

10-11; Ltr, Brig Gen T. J. Davis, AG, SHAEF, to

CG, COMZ, 13 Jan 45, file 705:Admission to and

Operations in Hospitals; Memos, Lt Col I. A. Marshall, MC, to Chief, Operations Division, OofCSurg,

6 Feb 45, sub: Cross-Channel Evacuation, and Col

F. H. Mowrey to Chief, Operations Division,

OofCSurg, 7 Feb 45, sub: Cross-Channel Evacuation, Boulogne-Dover, file HD:ETO:370.05:Evacuation, Jan-Oct 45.

54

 Rehabilitation Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, 1945, pp. 2-3; Surg,

United Kingdom Base, Annual Rpt, 1944, pp. 11-13

and app. 9; Surg, Normandy Base Section, Semiannual Rpt, January-June 1945, pp. 13-14; Surg,

Seine Section, Annual Rpt, 1944, pp. 24 and 27,

and Semiannual Rpt, January-June 1945, pp. 30-31 Continued
502 EUROPEAN THEATER OF OPERATIONS

Throughout the theater, extra patients overcrowded recreational and

Red Cross facilities in many hospitals

and overtaxed water and sewage disposal systems. They also placed a

strain on hospital personnel who,

after the various T/O reductions,

were barely adequate to handle even

their regular patient loads. To staff

additional beds, hospitals drew heavily upon civilian and POW labor and

obtained additional people from hospital units not yet in operation. The

21st General Hospital at Mirecourt,

operating 3,500 beds despite its T/O

strength of 2,000, for a while had the

personnel of an entire newly arrived

1,000-bed unit attached to it as reinforcements and for on-the-job training. Some augmentations became permanent. The War Department late in

December allowed the theater to add

14,400 general and station hospital

beds, provided it could find within its

boundaries the required plants and

personnel. Due to a lack of both, the

theater made only limited use of this

authority. However, it did expand

nine veteran 1,000-bed general hospitals, the majority in Paris, which

already were working above rated

capacity, into T/O 1,500- and 2,000-

bed units. To increase their personnel, the theater disbanded three inadequately trained general hospitals not

yet in operation.55

Besides enlarging existing hospitals, General Hawley and his Hospitalization Division chief, Colonel Darnall, struggled to place more units

and plants in operation. They received considerable assistance from

General Kenner and his staff, especially in prevailing upon the armies

and Allied governments to turn over

sites. As a result of these efforts,

during January and February, the

Communications Zone opened

twenty-six new continental general

hospitals at locations selected in late

fall, around Verdun, Nancy, Toul,

Evreux, and Soissons. Between midDecember and mid-February the total

number of T/O fixed beds in COMZ

and SOLOC, exclusive of emergency

beds, rose from about 50,000 to over

76,000. Planning for still further expansion of the hospital system to support the eventual push across the

Rhine, Hawley's staff picked out additional locations along the lines of

communication radiating from Paris

and made plans with the theater G-4

and Engineer chief for their phased

development. These sites, clustered

around Aachen, Luxembourg, Mourmelon, and Chalons, would accommodate all the remaining general hospiand 84; Surg, CONAD, Annual Rpt, 1944, pp. 7-8;

Cady, "Notes on the 21st General Hospital (AUS),"

p. 492, Cady Papers, MHI. For policy on use of

emergency expansion beds, see, Ltr, HQ, SHAEF,

to CG, COMZ, 6 Feb 45, and MFR, Col D. E.

Liston, DepCSurg, ETO, 12 Feb 45, both in file

705:Admission to and Operations in Hospitals. Dayto-day figures on beds and patients may be found in

Status of Hospitalization, UK-Continent, March

1944-February 1945.

55

 For plant problems of expansion, see Surg,

United Kingdom Base, Annual Rpt, 1944, pp. 11-

13; Cady, "Notes on the 21st General Hospital

(AUS)," pp. 477-78, 495, 501, Cady Papers, MHI.

On hospital reorganization, see Smith, Hospitalization

and Evacuation, pp. 236-37; Troops Branch, Operations Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, p. 34; Surg, Seine

Section, Semiannual Rpt, January-June 1945, p. 10.

Enlarged units were the 1st, 48th, 50th, 62d, 108th,

178th, 191st, 217th (1,500 beds), and 203d (2,000

beds). Disbanded units were the 190th, 252d, and

253d.
HOSPITALIZATION AND EVACUATION CRISIS 503

tals in the ETO troop basis scheduled

to arrive through mid-April, as well as

some veteran organizations brought

forward from Normandy and the

United Kingdom. When all these

plants were occupied, the Communications Zone would have over

118,000 fixed beds in operation on

the Continent, well in excess of the

number declared necessary by General Kenner back in December.56

Additional hospital centers went

into operation during the crisis. The

811th and 812th, activated in January,

took control of hospitals and other

medical installations in the Normandy

Base Section. The Seine Section by

late February also contained two centers. The 814th coordinated hospital

activities north of the Seine, while the

815th did the same south of the river.

Other center headquarters were projected to oversee the new hospital

clusters forming north and east of

Paris.57

Providing limited relief to the

crowded theater hospitals, transatlantic evacuation increased during the

winter. General Kenner especially

concerned himself with this problem.

He repeatedly pressed Hawley to designate more Class II and III patients

as Class IVs so that fuller use could

be made of the ordinary troop accommodations on returning transports.

Hawley, successfully in the main, resisted these pressures. More productive were efforts to obtain additional

hospital-type accommodations. Early

in 1945 the British, at American

urging, further enlarged the capacity

of the Queens to accommodate 2,500

Class Us and IVs and 1,000 Class Ills

on the Elizabeth and a slightly smaller

number on the Mary. The Joint Chiefs

of Staff, meanwhile, authorized the

conversion of six troopships into ambulance vessels, less completely

staffed and equipped medically than

hospital ships but better able to care

for patients than regular transports.

These ships, however, were not available until March.

Of more immediate help was air

evacuation, which finally came into its

own. Beginning in February the Air

Transport Command, dispatching

C-54s from both its Orly and Prestwick terminals, finally achieved its

long-promised evacuation rate of over

2,000 patients a month. The airborne

flow of casualties from Europe

became so rapid that it overloaded

Air Force medical reception facilities

at New York, compelling diversion of

flights to other East Coast points. In

March, at the request of SHAEF, the

Transport Command more than doubled even this rate, moving nearly

4,700 patients across the ocean. By

plane and ship 24,666 evacuees

crossed the Atlantic in January,

29,743 in February, and 30,410 in

March. Yet, despite continuation of

the 90-day theater evacuation policy,

the United Kingdom Base patient

56

 Status of Hospitalization, UK-Continent, March

1944-February 1945; Memo, Hawley to G-4, ETO,

19 Jan 45, file 705:Admission to and Operations in

Hospitals; Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Daily Diary, 5 and 12

Feb 45, file HD 024 ETO; Surg, CONAD, Semiannual Rpt, January-June 1945, p. 5; 819th Hospital

Center Semiannual Rpt, January-June 1945, pp. 1-

2; Staff Study, OofCSurg, HQ, ETOUSA, 20 Feb

45, sub: Medical Service in the Operation to, and

East of, the Rhine, pp. 8-10. 57

 Surg, Normandy Base Section, Semiannual Rpt,

January-June 1945, p. 3; Surg, Seine Section, Semiannual Rpt, January-June 1945, pp. 32-33; Staff

Study, OofCSurg, HQ, ETOUSA, 20 Feb 45, sub:

Medical Service in the Operation to, and East of,

the Rhine, pp. 9-10.
504 EUROPEAN THEATER OF OPERATIONS

census declined only slowly, apparently because the accelerated outflow

during December and January served

mainly to remove a backlog of men

awaiting evacuation under the old

120-day policy. Only the figures for

February and subsequent months represented a real increase attributable

to the December War Department

mandate (Chart 11).58

Throughout late December and

January Colonel Sams, General Marshall's representative on the POW

hospitalization question, circulated

around the theater on his other larger

mission: examining the overall workings of the medical service. Hawley

viewed Sams' activities with considerable suspicion. He feared that Sams

represented an effort within the War

Department to undermine and possibly unseat both himself and Surgeon

General Kirk. Hawley's assessment

contained a grain of truth. Marshall's

sending of Sams to Europe did reflect

the chief of staffs distrust of Kirk, as

well as his dissatisfaction with the

Army Service Forces in general.

These internal War Department political machinations, however, in the

end had little effect on the ETO medical service. Sams expressed the highest regard for both Kenner and

Hawley. At the end of his trip he reported to General Marshall that Medical Department deficiencies in the European Theater were the result, not

of personal failures by either man,

but rather of the absence of a true

theater headquarters able to control

both the armies and the Communications Zone. He emphasized that

Kenner and Hawley were working together effectively to overcome their

problems. Indeed, Sams could find

few things in the medical service to

criticize. His major recommendations,

that general hospitals be set up closer

behind the armies and that the intermediate medical COMZ between

ADSEC and the United Kingdom

Base be strengthened, were simply reiterations of what Kenner and Hawley

had been recommending, and working to accomplish, since the breakout

from Normandy.59

The anticlimactic outcome of Sams'

mission was only one indication of a

fundamental reality: By early February the ETO hospitalization and evacuation crisis was over. Lighter battle

casualties, a declining number of

trenchfoot cases, and the opening of

more continental general hospitals

produced a steadily growing bed sur58

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, encl. 8; Memos, Kenner to CofS,

SHAEF, 31 Jan 45, sub: Evacuation of Casualties to

ZI, and Hawley to CG, COMZ, 24 Mar 45, sub: Casualty Evacuation to ZI and Conservation of Theater

Manpower, EvacCorresp, 1944-45, file 370.05 ETO;

Memo, Col R. E. Peyton to DepCSurg, ETO, n.d.

fca. February 1945], file 705:Admission to and Operations in Hospitals; Bykofsky and Larson, Transportation Corps, pp. 367-68; Futrell, Aeromedical Evacuation, pp. 383-84; Theater Service Forces, ETO,

Progress Rpt, July 1945, sec. 1, p. 35.

59

 Marshall's distrust of Kirk stemmed from the

political battle in 1943 over the replacement of Surgeon General Magee, in which Marshall and his candidate, Kenner, had been outmaneuvered by the civilian and medical profession, which backed Kirk.

See Chapter III of this volume and Interv, OSG

with Brig Gen Crawford F. Sams, USA (Ret.), 18 Jan

50, CMH. For Sams' mission and recommendations,

see Sams, "Medic," pp. 293-324, CMH. For Hawley's suspicions, see Ltr, Hawley to TSG, 27 Jan 45,

with postscript, 2 Feb 45, file HD 024 ETO O/CS

(Hawley-SGO Corresp). Kirk, ironically, welcomed

Marshall's intervention in Army Service Forces affairs, on the grounds that the Medical Department

had "pretty near lost our pants to ASF." See Ltr,

TSG to Hawley, 7 Mar 45, file HD 024 ETO O/CS

(Hawley-SGO Corresp).
HOSPITALIZATION AND EVACUATION CRISIS 505

CHART 11—EVACUATION TO THE ZONE OF INTERIOR, OCTOBER 1944-JuLY 1945

Source: HQ TSFET, Progress Rpt, July 1945, sec. 1, p. 35.

plus, even though SOLOC continued

to evacuate large numbers of its patients to the main Communications

Zone. With little strain on continental

hospitals, General Hawley again

stopped cross-Channel evacuation for

a couple of days in order to relieve

the United Kingdom Base, whose patient census had at last begun to decline. By mid-February, as the railheads advanced behind the armies,

hospital trains began picking up

wounded as far to the east as Aachen.

A surplus of medical rolling stock

now was available; the Evacuation

Branch stabled the majority of its

trains for long-needed repairs and

welcome rest for crews and medical

staff. Late in the month, with over

30,000 T/O and expansion beds

empty in France and Belgium, Hawley

and his staff adopted a sixty-day evacuation policy for the Continent, to go

into effect on 1 March. Even though

new First and Ninth Army attacks

during the last week of February

again increased the flow of casualties,

the new evacuation policy went into

effect on schedule.60

Throughout the winter battles the

COMZ medical service accomplished

its principal task of keeping casualties

moving steadily rearward from the

armies. General Rogers, the First

Army surgeon, attested: "Evacuation

to the rear of First U.S. Army kept

pace with all demands placed upon

it."

 61

 The medical service overcame

in this process the effects of bad

weather, delays in completing its continental hospitals, an unplanned-for

volume of cold injury victims, and the

shutdown of most of one field army's

hospital system. The favorable result

stemmed in good measure from the

basic soundness of the hospitalization

and evacuation structure that General

Hawley and his associates had built

60

 Evacuation Branch, Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, pp. 5-7, and Daily Diary, 1-28 Feb

45, file HD 024 ETO. See the 19 Feb 45 diary entry

for the decision on the sixty-day policy.

"Surg, First U.S. Army, Annual Rpt, 1944, p. 58.
506 EUROPEAN THEATER OF OPERATIONS

since the St.-Lo breakout. It also

stemmed from the fact that those portions of the structure in place when

the crisis erupted had been substantially overbuilt, thanks to Hawley's

consistent practice of setting the highest attainable quality standards and

making the largest possible demands

for personnel, units, and matériel. As

a result, the medical service by late

1944 had enough extra at so many

points that it could ride out temporary setbacks and overloads with minimal loss in efficiency or quality of patient care. Then, too, throughout the

winter, Hawley, strongly supported at

SHAEF by General Kenner, was able

to continue building his medical infrastructure; he set up new hospitals and

supply depots, obtained additional

hospital trains, and further improved

air and sea evacuation. War Department decisions and interventions also

helped. This was especially true of

General Marshall's breaking of the

transatlantic evacuation deadlock,

which increased the flow of patients

out of the United Kingdom at just the

right time.

Finally, as at every stage of the

campaign, credit belonged to the

ETO medics of all ranks and in all

jobs. They willingly endured weeks of

overwork, discomfort, and occasional

personal danger in order to provide

their wounded comrades with an improved chance for life. Their days of

adversity now were ending. With

ample resources at last on hand, they

began planning and preparing to support the final offensive against the exhausted and depleted German armies.
CHAPTER XV

The Last Campaign

Allied campaign plans for the

spring of 1945 looked to simultaneous pressure against Germany from

east and west. General Eisenhower

planned and Field Marshal Montgomery's 21 Army Group would make the

first push into Germany, and the British commander, after overrunning

part of the Rhineland, embarked on

elaborate preparations for his grand

assault. But the actual course of the

last campaign featured opportunism

and bold exploitation. German forces

were so depleted that the American

field armies were able to win quick

gains. Once across the Rhine, a nearblitzkrieg developed that tested to the

full the ability of medical units to

keep up with the rapidly advancing

armies.

The U.S. First Army, having borne

the brunt of the enemy's offensive in

the Ardennes in February, prepared

for a renewed attack. Its surgeon,

General Rogers, routinely attended

G-2 and G-3 briefings, and map

overlays of interest to his personnel

were posted in the medical section.

His veteran units made their own

preparations with a high degree of

professionalism. Basic organization

had not changed markedly since the

early days of the fighting. Each corps

was supported by a medical battalion,

under the corps surgeon, and by a

medical group, which controlled evacuation and a variety of miscellaneous

units, under the army surgeon. Hospitals too were under the operational

control of the army surgeon. While

organizing medical evacuation from

the divisions back, the medical groups

kept Rogers informed of a variety of

operational details—the state of the

roads, planned hospital sites, division

casualty rates, and a wealth of information gathered by divisional medics.

Evacuation hospitals were alerted and

their commanders given a rundown

on their future locations and duties;

buildings behind enemy lines that

might prove suitable as hospitals were

identified via aerial photography for

subsequent medical use.

Intelligence on enemy troop concentrations and defensive works indicated the areas where the greatest

number of wounded might be encountered. Plans were laid for evacuation, and arrangements for delivering additional supplies to forward

elements. Air evacuation required

much coordination, for SHAEF provided the planes, and First Army

holding units had to be alerted to

take up their posts as new airstrips

were cleared for use. Reinforcements
508 EUROPEAN THEATER OF OPERATIONS

ranging from medical officers to litterbearers were called up for the divisions that were expected to bear the

brunt of the fighting. The commander of the auxiliary surgical group

planned the most effective disposition

of his teams to provide support for

the field hospitals. The engineers

were alerted to medical needs for

hospital construction, road building,

and repair. Ambulance control posts

were established to ensure an even

flow of casualties to the various hospitals, and medical truck companies

readied their vehicles to move the

evacuation hospitals forward as

ground was gained and as new sites

were selected. In armored divisions

special arrangements were necessary,

because these units normally did their

fighting divided into three combat

commands, one of which remained in

reserve. Medical support followed

suit, one company supporting each

command, while the division psychiatrist served with the reserve in order

to care for combat exhaustion cases.1

Encouraging were the weather and

the state of enemy morale. The end

of the deep snow and bitter frosts

meant much reduced danger of cold

injury. Among the German troops, a

spreading fatalistic acceptance of

defeat likewise brought hopes for less

bitter fighting and fewer wounded.

"Noncommissioned officers and men

had reached a state of indifference,"

and even battalion and regimental

commanders increasingly faced up to

the inevitability of losing the war.

Almost the only exceptions to the

general rule were young junior officers, some of whom still believed Nazi

promises of ultimate victory. Civilians

in the Rhineland were "totally passive" and content to have their

villages taken with as little fuss as

possible. While some enemy troops

continued desperate rearguard actions, most lacked spirit and the Volkssturm militiamen were "of no military

value and reverted to civilian life at

our approach." Americans would still

be wounded and would die in the last

battles, but the outcome was not

really in doubt, even to the enemy.2

Medics in the Attack

First Army Units

Under these conditions the First

Army struck at Cologne. Early attacks

over clogged roads and through

sometimes waist-deep snow brought

the forward units toward the Roer

River with its seven flood-control

dams. Volkssturm battalions, replacements, and other makeshift forces

only partly manned the West Wall defenses in the army's path, and many

pillboxes and bunkers were captured

empty. Yet stiff resistance developed

in some areas. In the first week of

February 1945 the VII, XVIII Airborne, and V Corps led the way. The

last, under Maj. Gen. A. Ralph

Huebner, struck at the dams. Here

early good fortune quickly faded in

the face of a dogged defense. Advancing troops fought in gloomy forests of

wintry fir trees, slowed by mines

hidden by the snow. Nevertheless, by

Combat Operations Data, First U.S. Army, sub:

Europe, 1944-1945, file 319.1-2 (12th Army

Group).

2

First U.S. Army Report of Operations, 23 Feb-8

May 45, p. 11.
THE LAST CAMPAIGN 509

10 February the dams had fallen to

the American advance.

Evacuation problems met varied responses. The West Wall proved to be

"a mass of dragon's teeth, pill boxes,

barbed wire, and mine fields." The

First Army's 2d Infantry Division, attacking toward the Schwammenauel

Dam, had sleds especially made to

pull the wounded over the snow.

Mounted on broad runners to reduce

friction, and fitted with litter stirrups,

the devices were a marked improvement over the simple toboggans furnished by the medical supply depots.

The weasels again put in an appearance, winning praise especially for

their performance in deep snow.

Moving forward to the battle line, the

"strange looking contraptions" carried blankets, litters, drugs, bandages,

plasma, food and water. Returning,

they brought two patients on litters

and pulled one or more on sleds over

landscape so rough and snowy that

hours would have been required for a

litter carry. Broad treads, spreading

their weight, enabled the weasels to

move over minefields without setting

off a blast. They were, to be sure,

cranky vehicles, and the rule in the

78th Infantry Division was 2 running

to 1 undergoing repairs. But for supporting the advance against the dams

they proved indispensable. Working

together, weasels and sleds were

judged by the 2d Division surgeon "a

'must' in deep over-snow operations."

The First Army also experimented

with light planes—cub liaison craft—

to evacuate the seriously wounded.

But the attempt encountered great

difficulties: Dispatching the planes

when and where needed was a problem and casualties had to endure

lengthy trips by road to the landing

strips.3

On 1 March the First Army won

new crossings over the Roer River

and followed the enemy as he withdrew toward the Rhine. Resistance

varied from none to bitter house-tohouse fighting that left some villages

in ruins. As American forces invested

Cologne during early March—the

city, except for its ancient cathedral,

was all but leveled by bombing and

artillery fire—the importance of the

remaining Rhine bridges increased.

Four still stood, at Cologne itself and

at Bonn, Engers, and Remagen.4

Then, on the seventh, quick-moving

First Army forces seized intact a

planked railway bridge at Remagen.

Fortunately, two elements of the 51st

Field Hospital were moving by chance

in the direction of Remagen, and

within a week of the capture, hospital

personnel were at work east of the

Rhine (see Map 22).

American troops poured across, reinforcing the first foothold the invaders had won. Typical of many were

the adventures of division medics in

Maj. Gen. Walter E. Lauer's 99th Infantry Division. Elements of the 99th

began crossing the Rhine on 10

March, using the newly captured Ludendorff Bridge. Applying steady

pressure, they reached the Wied River

twelve days later, assaulted the defenders' line, and established a beach3

First quotation from History of Medical Units of

the 78th Infantry Division for the Year 1945, p. 2.

Second quotation from Surg, 303d Medical Battalion, After-Action Rpt, February 1945, pp. 2-3, encl,

to ibid. Third quotation from Surg, 2d Infantry Division, Annual Rpt, 1945, pp. 4-5. 4

 The Hohenzollern Bridge at Cologne and the

spans at Engers and Bonn were destroyed by

German engineers.

THE LAST CAMPAIGN 511

head beyond it. Medics quickly found

that the light casualties typical of the

new campaign could suddenly

become concentrated around surviving enemy strongpoints and especially

at the rivers, all of which had to be

crossed under fire. Thus enemy

planes and artillery zeroed in on the

Ludendorff Bridge, and many wounded had to be carried back. At the

crossing of the Wied litterbearers

splashed through fords, hand-carrying

the injured until ponton bridges

could be thrown across to facilitate

ambulance evacuation. Meanwhile,

field hospital units set up in villages

near Remagen to receive casualties

from the expanding front.5

The growth of the bridgehead

brought the 45th Evacuation Hospital

across the Rhine to Honnef, where it

opened on 25 March. Four more

evacuation hospitals followed, while

five clustered near the west bank to

receive casualties from both sides of

the river. The First Army had evacuated all its casualties to the Communications Zone during the height of

the Ardennes offensive but, faced

with personnel losses and inadequate

replacements, had been quick to reestablish a convalescent capability as

the level of fighting dropped. For a

time, when the advance left the 4th

Convalescent Hospital far to the rear,

two evacuation hospitals, a clearing

company, and the 91st Medical Gas

Treatment Battalion inherited the

task of holding the lightly injured

through brief periods of recovery

within the army area. On 22 March,

however, the convalescent facility

reopened in the Rhineland at Euskirchen, and the other units moved forward to resume their primary functions.6

As the hospitals moved up, a powerful three-corps attack broke out of

the Remagen bridgehead and shattered the thin crust of defending

units. The first days of April found

the First Army fighting in two directions: Two corps sought to make contact with the Russians to the east,

while the other two cooperated with

the Ninth Army in the encirclement of

enemy forces caught in the Ruhr

pocket. Five evacuation hospitals, the

51st Field Hospital, and the 64th

Medical Group supported the action

in the Ruhr, while the 68th and 134th

Medical Groups and the remaining

field hospitals backed up the eastward

line of advance. In either case, the

evacuation hospitals encountered the

usual difficulties of semimobile organizations operating in a blitzkrieg.

Leapfrogging in two echelons was the

best method that had been found to

compensate for insufficient organic

transport; only half the hospital had

to be moved at a time, and in theory

half was always in service. Despite this

expedient, the speed of the advance

and the lack of adequate Transportation Corps support often left the

evacuation hospitals out of contact

with the fighting units. Hence,

throughout the campaign, the autonomous units into which the field hospitals had been split served as evacuation hospitals, while the latter some- 5

 Surg, 99th Infantry Division, Hist, JanuaryAugust 1945, pp. 28-29; Francis P. Kintz and John

Edgar, "Medical Group ... of First U.S. Army in

European Campaign: Siegfried Line, Ardennes,

Rhine River, and German Collapse," The Military

Surgeon 106 (February 1950): 139-47.

6

 Surg, First U.S. Army, Annual Rpt, 1945, pp.

23-24.
512 EUROPEAN THEATER OF OPERATIONS

times lost all mobility, becoming

holding units at airstrips or station hospitals for the care of noncombatants.

The problem posed by such patients appeared early and swiftly grew

larger. Already in March hospitals

were being diverted from the support

of operations to care for recovered

Allied military personnel (RAMPs).

The 99th Division began to liberate

Allied prisoners while still in the Remagen bridgehead, where its troops

overran a train with 227 sick and

wounded Americans aboard, freed a

POW enclosure, and overtook a

column of some 1,200 American and

British airmen on the road near Giessen, scattering the guards. More discoveries followed as the advance to

the east began. Conditions in camps

where Allied prisoners had been held

ranged from acceptable to indescribable; quick action was demanded to

delouse, clean, immunize, and treat

the inmates. At Nordhausen the VII

Corps liberated a concentration camp,

where personnel of the medical

groups viewed—for the first but not

the last time—scenes that they found

"very difficult to describe";

 7

 some

2,500 emaciated bodies were strewn

over the camp or piled like firewood

for disposal in the crematory. But the

liberated formed only part of the

burden. New throngs of POWs were

also swept up from the beginning of

the advance, growing to an inundation as the Ruhr pocket collapsed.

German soldiers began to surrender

en masse—"in some cases straglers

[sic] trying to reach their own lines

and in other cases . . . deserters or

individuals who were content to let

the war roll by them."

 8 Some

300,000 POWs, many ill or wounded,

swamped the two victorious armies as

they attempted to finish the war.

Three evacuation hospitals took on

the rapidly increasing burden of supervising German military hospitals

that had been overrun by the advance. The quality of these enemy facilities varied greatly. The 110th

Evacuation Hospital moved into a

plant that was "splendidly

equipped,"

 9

 and the ingenuity of

German surgeons in using nails to fix

fractures of the long bones won

praise from American doctors. But

other captured hospitals were small,

housed in schools or in the cellars of

public buildings, and suffered from

vermin, deficient supplies, and unskilled staffs whose doctors had received preferment on political not

medical grounds. Patients had to be

sorted and moved, and dumps of

enemy medical supplies had to be

taken over, inventoried, moved and

reissued for the care of prisoners and

displaced persons (DPs). After a highranking German medical officer, Maj.

Gen. Walter Scherf, surgeon of the

enemy's Army Group B, was captured,

he was placed in a central headquarters at Weimar and given charge,

under American oversight, of civilian

and military patients from his own

nation. While Scherfs group struggled to organize itself, and to find

personnel and transport to carry out

its duties, First Army medical groups

increasingly took on the responsibilities it was unable to assume. By the

'First U.S. Army Report of Operations, 23 Feb-8

May 45, p. 28.

8

 Ibid., an. 11, p. 104. 9

 110th Evacuation Hospital Semiannual Rpt, January-June 1945, p. 4
THE LAST CAMPAIGN 513

AIR EVACUATION OF WOUNDED IN A C-47, en route from a holding unit in Germany to a

general hospital in France

end of April First Army groups controlled 216 German military hospitals,

4 POW camps, 22 DP centers, and 3

RAMP hospitals—in all, about 90,000

patients. Several evacuation hospitals—notably the 5th, 45th, 67th,

96th, 118th, and 127th—served both

the combat forces and the noncombatants, the changeover from direct

support to the care of noncombatants

and prisoners coming for most about

1 May. Thereafter, the 5th aided transient RAMPs at Gotha; the 45th

became a station hospital for the Buchenwald Concentration Camp near

Weimar; and the others saw similar

service.10

The fighting of March and April

and the changeover to occupation

duties in early May demanded utmost

flexibility in evacuation as well. All

cases requiring 10 or less days of

treatment were retained in the army

area while the fighting continued. For

more seriously wounded soldiers the

first reliance was now upon air evacuation. Even west of the Rhine poor

road conditions gave new importance

to air, and the First Army arranged

with the IX Troop Carrier Command

to make C-47s available to carry

wounded. East of the Rhine the rail

10

 Surg, First U.S. Army, Annual Rpt, 1945, pp.

26-27; First U.S. Army Report of Operations, 23

Feb-8 May 45, pp. 43-84 and 105-07; Surg, V

Corps, Annual Rpt, 1945; Kintz and Edgar, "Medical Groups," p. 142. The typhus threat and the

treatment of liberated prisoners and DPs are recounted in some detail in Chapter XVI.
514 EUROPEAN THEATER OF OPERATIONS

system, due to the bombing of its

tracks and bridges, could no longer

support the armies. Motor transport

could not entirely compensate.

Bridges over the Rhine were few, with

priorities given to the eastward flow

of men and supplies in support of the

attack; and roads were poor, with distances to the front ever increasing because of the rapid advance.

Various expedients were tried. In a

few cases L-5 reconnaissance aircraft

were exploited as light litter planes to

concentrate casualties at the airfields.

In an experiment on 22 March a

C-47 picked up two gliders, each

holding twelve litter patients, from a

small airstrip on the east bank near

the 51st Field Hospital and successfully delivered them to an airfield on

the west. But the main reliance was

upon the "big birds," and upon their

now proven ability to take over the

routine movement of patients hitherto

entrusted to railways. New airfields at

Eudenbach and Giessen became casualty shipment points, each with its

holding unit—the 618th Clearing

Company and Company A, 91st Medical Gas Treatment Battalion, respectively—and hard-driven ambulances

brought in the wounded from the

rapidly moving front.

Medical supplies proved adequate

to the needs of the army. February

was a time devoted largely to restocking after the Ardennes. When the

First Army moved into the Roer

region, supply operations were handicapped by the miserable roads, the

winter weather, the ruin of the rail

lines, and the destruction of buildings

that left few protected places to store

medical matériel, whose packaging

was not waterproof. Nevertheless, the

1st Medical Depot Company moved

its advance section across the Roer,

from Malmedy to the German town of

Zuelpich, with 50 tons of supplies. On

16 March the section crossed the

Rhine, to provide close support to the

units in the newly created Remagen

perimeter. As other depot advance

sections moved deeper into Germany

they encountered damaged and congested rail lines and widespread

bomb and shell damage to potential

warehouses. Clearances at the crowded bridgeheads were hard to get, but

toward the end of the month trucks

were able to move two sections forward to Dollendorf and Honnef.

Though low-priority items were often

stranded along the railways to the

rear, essential supplies were kept

moving from the ADSEC depots into

the fighting zone. Air evacuation, a

blessing to the wounded, brought a

new version of one familiar problem

for medical supply: Casualties were

put aboard on litters covered with

blankets, essential items which thereupon vanished into the COMZ, depleting supplies needed for the fighting men. Hence, special supply points

had to be set up in conjunction with

holding units at the airstrips.

Despite every effort, during April

the front moved too rapidly for medical supply to keep pace. Supply officers would select a site for a forward

depot; clear their choice with division,

corps, and army headquarters, and

with the military government; get

transport; pack their goods; and

move—only to find that the new location had become obsolete before

issue could begin. The main depot

chose a site at Giessen, but on opening for business found itself too far to

the rear to supply the forces ade-
THE LAST CAMPAIGN 515

quately. It moved again to Korbach,

leaving behind some 20 long tons of

excess and slow-moving items to be

taken over by the Advance Section. In

this case air transport came to the

rescue in supporting the fight for the

Ruhr pocket. Forty-eight tons of medical matériel—enough to stock a complete depot advance section—were

flown in from the United Kingdom,

enabling the 47th Medical Depot

Company's first advance section to

open at Siegen in support of the

XVIII Airborne Corps. One big

German dump became an American

base, where captured supplies were

concentrated. During April alone,

more than 100 tons were issued for

the care of POWs and DPs. German

supplies were all-important to the

care of noncombatants. Without

them, the First Army surgeon reported, meeting the needs of such unfortunates "would have been impossible." Another massive enemy depot

was turned over to the Third Army,

and the stock transported by ADSEC

vehicles and labor to the American

forces then engaged in liberating the

newly discovered concentration camps

in Bavaria and Austria.11

Overall, the final campaign experience of the First Army was one of

great difficulties overcome by a

medical service that had reached its

highpoint of clinical and military competence. The need to fight in two directions at once, with half the army

engaged in a headlong advance,

stretched to the limit medical capacities for communication and evacuation. Yet, though stressed, the

medics contrived to meet their commitments, aided by the declining

needs of a victorious and largely

healthy army. Ironically, triumph was

followed almost immediately by dissolution. On 15 May the First Army's

role in the European fighting came to

an end, as all assigned and attached

medical units were transferred to the

Ninth Army. The army surgeon and

his office departed with the rest of

the headquarters for the United

States, and then Manila, there to command a new First Army in the

planned invasion of Japan.

Ninth Army Units

To the north of the First Army

zone, medics of the U.S. Ninth Army,

after spending the Ardennes battle in

defensive positions with Montgomery's 21 Army Group, experienced a

spectacular final campaign. Preparations began in January as the Bulge

disappeared. The Ninth Army shifted

to the American-led 12th Army

Group, and units that had been sent

south to aid the First Army's stand returned. Medical organization in the

Ninth Army had not changed significantly from earlier campaigns. Seven

evacuation hospitals supported the

army, and field hospital platoons attached to clearing stations provided

direct support to its five divisions

spread along the west bank of the

Roer River from Wuerm to Monschau. Three medical groups controlled a variety of separate battalions, companies, and small cellular

units, such as laboratories and dental

prosthetic units. Divisional units managed evacuation up to the clearing

"Quoted words from Surg, First U.S. Army,

Annual Rpt, 1945, p. 70. See also ibid., pp. 62 and

78; First U.S. Army Reprt of Operations, 23 Feb-8

May 45, pp. 111-13.
516 EUROPEAN THEATER OF OPERATIONS

station level; above, the groups were

in charge. Delayed by floods on the

Roer (the Germans had expertly damaged the dams before yielding them,

to ensure high water), the army

moved from its positions on 23 February, at 0330, as elements began to

cross in a three-corps front.

Initially, tough enemy resistance

cost 6,000 casualties. While medics

evacuated the injured and some 4,300

cases of disease, German resistance

faded and the army swung north to

meet Canadian forces that had broken

out of their own bridgehead. Moenchen-Gladbach fell on 1 March, and

the Ninth Army reached the Rhine

the next day. By midmonth the bank

from Neuss to Wesel was under its

control. The medical section moved

with the forward echelon of the army

command post to Moenchen-Gladbach, where planning for the invasion

of the inner Reich began. Among

other plans, Colonel Shambora, the

army surgeon, projected the use of

provisional holding detachments on

the east bank to allow divisional units

to remain mobile, once the invasion

had begun (Diagram 5). However,

early success and the role of air evacuation soon ended all problems

except those of supporting a rapid

advance.12

After a thunderous artillery barrage, Ninth Army forces crossed the

Rhine on 24 March and poured into

the Westphalian plain. An airborne

drop had been planned to support

the movement by seizing a strategic

area on the east bank near Wesel.

Maj. Gen. Matthew B. Ridgway's

XVIII Airborne Corps was to carry

out the action; its chief American

component was the 17th Airborne Division, blooded in the Ardennes. Division medics began their preparations

during March in rest billets near Chalons in France. Two surgical teams

were attached to the division; their six

surgeons and four enlisted corpsmen

were to accompany the medical company into combat by glider, to perform stabilizing surgery on the

wounded who would necessarily be

cut off for a time behind enemy lines.

Gliders were equipped with blankets

and litters, and every officer and man

in the division received additional

first aid packets and bandages. Medics

laid in ample plasma supplies, and on

D-1 the ETO blood bank delivered

whole blood in thermos containers.

Between 0700 and 0800 on 24 March

the first combat elements took off, accompanied by their own medical detachments and liaison men from the

medical company, who would jump or

glide in with them. Ground troops,

then engaged in forcing their way

across the Rhine, raised their eyes to

see an awesome sight—a "vast air

armada" that required two and a half

hours to pass overhead.13

Across the Rhine the medical company, surgical teams, and the division

surgeon in their gliders encountered

intense fire from small arms, machine

guns, and 20-mm, and 88-mm, antiaircraft guns. Some medical gliders

burst into flame. The surviving

medics landed in their designated

12

 Surg, Ninth U.S. Army, Semiannual Rpt, January-June 1945, pp. 1-2, 14 and sec. Ill, p. 4; ibid.,

Daily Journal, 1 Feb 45, p. 3, Shambora Papers,

MHI.

13

 Charles B. MacDonald, The Last Offensive, United

States Army in World War II (Washington, D.C.:

Office of the Chief of Military History, Department

of the Army, 1973), p. 309.

518 EUROPEAN THEATER OF OPERATIONS

AIRBORNE MEDICS LOADING MEDICAL EQUIPMENT FOR ASSAULT DROP

drop zone only to find that combat

troops had not yet cleared it of the

enemy, and they took heavy casualties

until the zone was secured. Small

groups of medics, which grew in size

as isolated personnel found one another, made their way across 2 miles

of enemy-held fields and woods to set

up a clearing station at a predetermined site. Within an hour of landing

the station was functioning under

canvas; within two, major surgery was

under way. Meanwhile, combat forces

had contacted British paratroopers to

the north, and by 1800 had linked up

with ground troops in the Rhine

bridgehead. Throughout the night a

platoon of infantry guarded the clearing station, while enemy patrols blundered past in the darkness. Firefights

erupted, and enemy artillery blocked

a truck and ambulance convoy trying

to reach the embattled division from

the west bank of the Rhine to evacuate its wounded. Despite the alarms,

the hours of darkness passed without

further injury or death among the

wounded, though the ground was

covered with helpless patients. By

0800, 25 March, the convoy was rolling, and by 1000 hours the wounded

were being loaded into ambulances,

some American issue, some captured

German machines; into jeep ambulances; and into enemy trucks that

now displayed the Red Cross. In the
THE LAST CAMPAIGN 519

LlTTERBEARERS CARRYING A CASUALTY BACK THROUGH A MINEFIELD

convoy rode German as well as Amer- ican wounded, for all prisoners had

received treatment either by their

own captive doctors and aidmen or by

clearing station personnel.

Now armored units swept through

the bridgehead into the roadnet

around captured Wesel, and the race

to the east began. The airborne

troopers did more walking than

flying, and the chief task of their medical support was the usual one of

trying to keep up. The initial drop

had exhibited bravery and skill, but

the cost was high—392 casualties the

first day, with many more to follow—

and the necessity for the bravura

show would later be seriously questioned. The medics themselves suffered heavily, but were able to save

many lives nevertheless. Able execution of a doubtful tactical plan

marked the last hurrah of airborne

medics in the European war.14

Henceforth the course of the invasion was an itinerary of sites famous

in German history—Muenster, the

Teutoburg Forest (on whose ridge

line the 2d Armored Division met stiff

resistance), Magdeburg, the Elbe

River—as the Americans gained 225

miles in nineteen days. The problems

encountered by the medics were the

technical ones of supporting two

corps advancing through a third that

14

 Surg, 17th Airborne Division, Final Rpt, 1 Jan-6

Sep 45.
520 EUROPEAN THEATER OF OPERATIONS

was engaging the enemy; then of supporting a divided army as two corps

attacked eastward against little opposition, while a third struck south into

the Ruhr, against stiff resistance; and

finally and always of keeping contact

with line units that felt victory in their

grasp. Evacuation distances stretched

out despite the common practice of

splitting the divisional medical battalions into forward and rear elements.

In the 2d Armored Division average

ambulance hauls in early April

reached 93 miles, and in the 15th Armored Division medical companies

reported ambulance roundtrips of

200 miles. Linking up to the First

Army in the south, Ninth Army forces

helped to complete the liquidation of

the Ruhr pocket. During ten days, 4-

14 April, its hundreds of thousands of

defenders were killed or captured. At

1330 on 30 April troops of the XIX

Corps encountered Russian forces,

halted, and began to scoop up thousands of Germans who were in flight

from the Red Army. By this time the

enemy forces had virtually dissolved,

and ceasefire orders came a little after

sunrise on 7 May.

Few innovations marked the campaign. Instead, practice in 1945 represented the matured employment of

methods earlier developed. The Ninth

Army's three medical groups, besides

coordinating the activities of their

component units, provided Shambora's medical section a means of

maintaining liaison with the medical

service at all echelons. Each group

headquarters ran a courier system,

enabling the army surgeon to keep

abreast of the changing tactical situation when signal communications

became overloaded or failed. The

chief problems noted with the groups'

many cellular units were in personnel

administration, vehicle maintenance,

and messing; for these flexible units,

despite their fitness for operations,

the lack of a settled home in the command structure still created unresolved difficulties.

The theater-directed practice of rotating Medical Department officers

and enlisted men, initiated in November 1944, continued to demonstrate

its value. Each month the Ninth Army

transferred five Medical Corps officers, five other Medical Department

officers, and twenty-five enlisted men

to the Communications Zone, attempting to select those who had endured the "most prolonged and

trying combat experiences." In turn,

COMZ supplied replacements whose

quality drew praise from Colonel

Shambora. The need for physically fit

replacements meant that professional

skills alone could not exempt a physician from forward service, if he was

otherwise qualified. This produced

some problems in utilizing specialists

in forward units. Overall, however,

the program's main difficulty was that

many more officers and men applied

for transfer to COMZ than could be

accommodated.15

Evacuation took many forms. As in

the other field armies, evacuation

hospitals proved in practice to be

somewhat less than semimobile, and

field hospitals augmented by auxiliary

surgical group personnel took over

15

 Surg, Ninth U.S. Army, Semiannual Rpt, January-June 1945, sec. II, p. 1. Similar limited rotation

policies were adopted by the Third Army, extending

in some cases to the level of corpsmen, who were

rotated to service companies out of artillery range

of the enemy for a few days of rest.
THE LAST CAMPAIGN 521

many of their normal duties. For the

most seriously wounded, the bombbattered but still functioning general

hospitals of Liege were the usual destination, with ADSEC ambulances

providing transport. For the Ninth

Army air evacuation from Germany

began in March 1945. The army surgeon selected airstrips near field and

evacuation hospitals, and SHAEF dispatched a flight surgeon to each to

supervise the loading of wounded.

Holding units capable of handling

300 to 600 patients were set up and

staffed by the medical gas treatment

battalions and the field hospitals. For

reasons that are unclear, communications presented a difficulty. The holding units requisitioned aircraft from

the army, which in turn forwarded requests to SHAEF's air evacuation section. Because radio communication

between forward units and the army

surgeon failed, TWX (teletype) messages had to be used to dispatch

planes. Movement of wounded continued, however, and by mid-May

RAMPs and some western European

DPs were also being flown out of

Germany. Except during a brief gas

warfare alert, the medical gas treatment battalions performed their usual

variety of tasks—mainly setting up

and staffing provisional centers for

treatment of venereal and communicable diseases, self-inflicted wounds,

neuropsychiatric cases, or convalescents. Aided by elements of the

army's 3,000-bed convalescent hospitals, such centers absorbed casualties

who might otherwise have been evacuated out of its control.16

From the hard-fought opening of

the campaign, losses declined rapidly.

In the first half of March the army recorded about 5,600 casualties from

wounds, injuries, and stress. Despite

the Rhine crossing, the number fell in

the second half of the month to

5,200. Sometimes, desperate lastditch resistance raised the total for

early April to about 6,600, but it fell

to 4,300 in the second half of the

month and in early May to 1,900, of

whom only 284 were wounded.

Instead, POWs, DPs, and RAMPs

burdened the evacuation system. Occupation duties began to replace the

problems of speed, changing front,

communications breakdowns, and

long ambulance hauls that had bedeviled the invasion. Medical supply kept

up with the rapidly moving front by

the well-tried device of leapfrogging

depot sections. As supply lines

lengthened and railroads became unusable, the inadequacy of the depot

companies' organic transport became

increasingly evident and compelled

them to depend upon the Quartermaster truck companies. But, though

spot shortages developed in all classes of supplies, no critical failures occurred to impede operations.17

As in the other armies, the changeover to occupation duties in the Ninth

Army began even as the attack proceeded. By V-E Day army units had

taken on aspects of area commands

and were carrying out many duties of

military government. In June the ex16

 Surg, 2d Armored Division, Semiannual Rpt,

January-June 1945, pp. 6 and 30; Surg, 5th Armored Division, Semiannual Rpt, January-June

1945, p. 39; Surg, Ninth U.S. Army, Semiannual

Rpt, January-June 1945, sec. II, p. 45. 17

 Surg, Ninth U.S. Army, Semiannual Rpt, January-June 1945, sec. Ill, pp. 18, 22, 26, 31, 33, 37

and sec. IX, p. 1.
522 EUROPEAN THEATER OF OPERATIONS

istence of the Ninth Army as a separate force ended, much of its area

passing to the British Zone of Occupation, and the remainder to the Seventh Army, along with its soldiers.

Third Army Units

Meanwhile, General Patton's Third

Army had written its own epic. Following the reduction of the Bulge,

many of its units were shifted north

to support the planned main attack.

Those that remained were assigned a

limited defensive mission. The VIII,

III, and XII Corps confronted the

flood-swollen Our River, beyond

which lay the rugged snowy uplands

of the Eifel. Here the fixed fortifications of the West Wall were anchored

in the towns of Pruem to the north

and Bitburg to the south. The country was "studded with steep broken

hills and ravines," roads were poor,

and the "cold, wet, muddy February

weather" lowered over all. Seldom

had a roof and walls been more desirable for the wounded, but buildings

for hospital use were few. Fierce

fighting had reduced most to rubble,

and "ventilated [the others] to such

an extent that they were unusable."

Under these conditions the advance

into Germany began, an aggressive

defense aimed at preventing the

enemy from consolidating and

moving his own forces to meet the

northern threat.18

While the VIII Corps pushed forward into the West Wall east of St.-

Vith, aiming at Pruem, the XII Corps

moved against Bitburg. By 5 February

the 4th Infantry Division had

breached the main line of resistance.

On the twelfth Pruem fell, while in

the XII Corps sector the 5th and 80th

Infantry Divisions, crossing the Our,

consolidated a wide beachhead whose

depth of more than 2 miles promised

a durable lodgement. Meanwhile, the

XX Corps assaulted an enemy salient

called the Saar-Moselle Triangle,

gaining the high ground overlooking

the Saar River by the twentieth. So

far the campaign featured a grinding

advance in dreadful weather against

prepared defenses, and the Third

Army was fortunate that the foe was

already more than half beaten. Mines

and booby traps were a continuing

danger, for the defenders wired explosives to corpses, both German and

American. The army counted nearly

16,000 evacuees, of whom more than

10,000 had to be moved out by road.

Weather and war combined in familiar fashion to harass the troops; cold

injury remained common; and the

Shoepacs issued in January caused the

usual difficulties.

The problems of evacuation mirrored those of the fighting. Road conditions were wretched. Heavy traffic

during the Ardennes battle had

churned the roadbeds, and in the

second week of February a sudden

thaw turned them into channels of

mud and slush. Carrying wounded

over the soft, slippery surfaces

became one of the major difficulties

of the advance. Ambulances labored

hub-deep toward evacuation hospitals

that, impeded by the same conditions,

were until midmonth located too far

to the rear. Hence, division medical

officers experimented with weasels

and made use of litter sleds or tobog18

 Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, pp. 13 and 20.
THE LAST CAMPAIGN 523

MEDICS PULLING AN ASSAULT BOAT FILLED WITH MEDICAL SUPPLIES for wounded

troops on the other side of a nearby stream

gans. In the 90th Infantry Division it

was "necessary to relieve litterbearers

at frequent intervals because of physical exhaustion brought on by travelling in the deep snow." The Third

Army ordered thirteen dog teams

from the Air Rescue Squadron in

Labrador, but by the time the contingent of 130 dogs, 14 enlisted men,

and 13 officers arrived at Thionville,

on 13 February, the weather had

broken, the snow was melting under

the thaw, and the teams were never

employed.19

Typical of the campaign were the

experiences of medics in the 80th Division. Serving with the XII Corps,

the division on 7 February attacked

across the Our River and its tributary,

the Sauer, into prepared defenses. In

the 318th Infantry's sector only one

passable road led down to the river,

and it was under heavy fire. While litterbearers manhandled the wounded

up the banks of a steep ravine to

avoid the road, medics pulled back

the aid station as enemy artillery

zeroed in. From the head of the

ravine, over ground too muddy to

support a jeep, a weasel carried the

patients back to an advance ambulance loading point. Not until the

second day of the attack were the

Germans pushed back far enough to

allow a collecting point to be established on the riverbank. The road

19

 Quotation from Surg, 90th Infantry Division,

Periodic Rpt, January-June 1945, p. 6. See also

Surg, Third U.S. Army Semiannual Rpt, JanuaryJune 1945, pp. 16-22.
524 EUROPEAN THEATER OF OPERATIONS

became fairly secure, and litter jeeps

took over the task of hauling casualties from the collecting to the loading

point.

Meanwhile, the troops had passed

east of the Sauer, fighting in harsh

mountainous terrain. Here evacuation

was entirely by litter, an exhausting

hand-carry that ultimately stretched

out to 4 miles. At its end, while shells

crashed into the woods, the wounded

were loaded on rafts for passage of

the swift flood-swollen waters. Even

at the assembly point on the west

bank danger continued; here "a battalion surgeon who attempted to provide medical care for the casualties

. . . soon became a casualty himself."

Still more difficult were conditions

where the ground was less broken

and enemy observation better. In

some areas the wounded could be

moved only under cover of darkness;

surgical technicians, accompanying assault troops across the river, turned

captured pillboxes into daytime refuges for the wounded until nightfall

allowed litterbearers to resume their

labor. In these most difficult circumstances the advance continued: On 22

February a platoon of the clearing

company opened its station on

German soil. Shortly thereafter the

enemy's fierce resistance came to an

end as his weakened forces withdrew

to the east.20

March brought spring and a taste

of victory. The sorely tried infantry

and armor won a series of rapid

break-throughs. In the central XII

Corps area a tank-led column sent

back reports that "read like a bus or

railroad timetable—0845: Orsfeld;

1135: Steinborn. . . ."

 21

 Confused

and disheartened Germans surrendered in thousands, so many that at

one point a German general fell into

American hands because he thought a

large crowd of prisoners was a Wehrmacht unit still in being. In two and a

half days the 4th Armored Division,

leaving the nearest evacuation hospital far to the rear, drove 44 airline

miles and halted on high ground

overlooking the Rhine. Meanwhile,

the Third Army's XII and XX Corps

pushed south into the Saar. Fighting

on the high ground overlooking the

river, Third Army forces captured

Saarburg on 20 February and Trier in

early March. The last German industrial area west of the river that was

still under the Reich's control rapidly

passed into Allied hands as the SaarMoselle Triangle ceased to exist. On

the Rhine, Koblenz fell on 19 March.

With support from the Supreme

Commander, the Third Army now

moved to exploit its successes, embarking with his blessing on a plan to

invade the Reich with ten divisions.

At 2200 on 22 March, as a bright

spring moon illuminated the famous

river and the broad open fields

beyond, XII Corps troops, supported

by four evacuation hospitals at Bad

Kreuznach and Alzey, crossed the

Rhine at Nierstein, without serious

opposition. The surgeon of the 5th

Division, the assault force, established

a collecting point on the east bank to

gather the light casualties and an unloading point on the west bank; both

were operated by the collecting com20

 Surg, 80th Infantry Division, Semiannual Rpt,

January-June 1945, pp 2-4. Quotation on p. 2.

21

 MacDonald, Last Offensive, p. 201. See also pp.

202, 205, 259.
THE LAST CAMPAIGN 525

panics of the first medical battalion to

cross. The first wounded were evacuated by assault boats; later, when the

bridgehead had been firmly established, by DUKWs and LVT-1s. Ferrying operations continued for four

days, because engineer-built ponton

bridges were filled with eastbound

traffic.22

A swift advance followed, through

Bavaria into Austria and Czechoslovakia—one which, as far as the medics

were concerned, created a repetition

of the difficulties they had faced in

the sweep across France in August

1944. Yet the thrill of approaching

victory compensated for many problems. "It was France all over again,"

recalled Col. James C. Van Valin, MG,

commander of the 110th Evacuation

Hospital, "save that this time the end

was in sight, once and for all." Trucks

loaded with medics and hospital gear

thundered down "the fabulous autobahns, which brought back the sight

and smell of the Jersey plains" to

homesick soldiers who had undergone their first military training at

Fort Dix nearly two years before.23

Three days after the Rhine crossing, Patton's armor bridged the river

Main. The 80th Division crossed at

Mainz in darkness, in an operation

bearing little resemblance to its epic

struggles at the small rivers of the

Eifel a month before. Resistance

faded quickly, and the aid stations

crossed and set up in buildings near

the water's edge. Each had a litter

jeep, ferried by an LCVP across the

Rhine to speed evacuation to the collecting stations on the west bank.

When the aid stations moved east,

following the troops, a collecting

point at the site of the original landing received casualties by ambulance.

Meanwhile, the engineers constructed

a treadway bridge, and in due course

the collecting stations shifted to the

far shore. With fewer casualties and

excellent roads opening out before it,

the Third Army evacuated about 75

percent of its 23,192 patients by road,

about 5,700 by air, and only 2,000 by

rail.24

Patton's forces slashed across

southern Germany (see Map 23). Behind armored spearheads the motorized or marching infantry followed

(the 80th Division, for example, covered 125 miles in six days). In general, casualties were few, the problems

of field medicine reduced to a matter

of logistics—keeping up with the advance, moving supplies, hauling evacuees over long distances. Three medical groups supported the advance:

The 65th evacuated casualties of the

VIII and XII Corps; the 66th supported the XX Corps; and the 69th,

strengthened by ambulances from

ADSEC, evacuated wounded from

Third Army hospitals. On 1 April,

however, the 65th, strengthened by

an additional battalion headquarters,

undertook to provide evacuation for

all tactical units of the army. By this

time casualties were low but liaison

difficult, because of the fluidity of the

front. With one battalion headquar22

 Surg. Third U.S. Army, Semiannual Rpt, January-June 1945, pp. 28-30 and 32; Surg, 4th Armored Division, Semiannual Rpt, January-June

1945, p. 4: Surg, 5th Infantry Division, Semiannual

Rpt, January-June 1945, pp. 3-4. 23

 110th Evacuation Hospital Semiannual Rpt, January-June 1945, p. 5.

24

 Surg, 80th Infantry Division, Semiannual Rpt,

January-June 1945, p. 5.

THE LAST CAMPAIGN 527

ters for each corps, the group commander, Col. Carl G. Griesecke, felt

that "the ideal utilization of a Medical

Group was at last being carried out,"

enabling him to exercise maximum

flexibility in shifting vehicles and subordinate units as needed. Internally,

the group, having no fixed makeup,

needed firm control as well, if its

array of separate medical units was to

function as a team. Unified evacuation

had come late to the Third Army in

response to the problems of the rapid

advance and the reassignment of

medical personnel to the care of prisoners and DPs. Under the special

conditions of the campaign, it succeeded well.25

Despite the organizational simplicity, the speed of the advance created

unorthodox situations. Evacuation

was more than ordinarily confused. In

some divisions, clearing stations got

ahead of aid and collecting stations so

that casualties were evacuated forward. In others, ambulances absent

for a few hours found on their return

only empty fields where their units

had been. At one point six Third

Army evacuation hospitals found

themselves in what had newly been

defined as the First Army zone, and

the closing, moving, and reopening

that resulted put all out of operation

for a time, leaving only three to support all of General Patton's forces.

Struggling to stay mobile, medical

units pressed into service every available vehicle; they set up as seldom as

possible, under the least amount of

canvas that would protect them and

their patients. Only the weather aided

them, for as the season warmed they

were freed of the necessity to search

out suitable buildings to house the

wounded.26

Fighting continued. Despite light

casualties the ratio of serious wounds

was high, with many puncture wounds

of the chest and abdomen caused by

small arms. Bloody little actions developed to mar the general picture of

minor resistance and few losses. The

last gestures of the Luftwaffe were

random strafing attacks by Hitler's

new jet planes. On the ground, resistance took many forms—from absurd

wooden barricades to sharp skirmishes with determined fighters. Disorganized groups of enemy, cut off by

the advancing armor, lingered in the

woods and mountains between Wiesbaden and Bad Nauheim. On 1 April

SS troops ambushed a platoon of the

16th Field Hospital, supporting the

4th Armored Division. The Germans

killed the chief of surgery and captured the unit, only to see it liberated

the following day by American forces.

Despite such alarms, the Third

Army found itself changing willy-nilly

into an occupation force as it conquered German cities, liberated

prison camps, and entered Hitler's

homeland, Austria. The confused last

days of the war overlapped the

coming postwar period; both had

urgent problems demanding the same

scarce resources, and neither could

be ignored. "The scope of governmental problems, including much

needed treatment of those suffering

from illnesses, both Allied and 25

 Quotation from 65th Medical Group Semiannual Rpt, January-June 1945, p. 3. See also ibid., pp.

12-13; 94th Medical Gas Treatment Battalion Semiannual Rpt, January-June 1945.

26

 Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, p. 42.
528 EUROPEAN THEATER OF OPERATIONS

enemy, were the most complex that

have been faced, perhaps, in all history," recalled the Third Army surgeon.

"[Yet] the operational end of the war

was a dire necessity. Each problem

was huge in itself."

 27

In clearing casualties from the army

area, air evacuation played a larger

role during April. Nearly four-fifths of

the 15,000 patients rode by ambulance to five airfields, where ADSEC

or army holding units waited to receive and send them on. As usual,

such units were frequently drawn

from medical gas treatment battalions. The 94th had served in this way

before crossing the Rhine, and might

have continued to do so until the end

of the war. But in March, alarms over

possible use of gas by the Nazis

caused the Third Army to order the

unit and its counterpart, the 92d

Medical Gas Treatment Battalion, to

resume close support of the divisions.

Failure of the Germans to resort to

chemical weapons then sent the 94th

back to its former occupation, and it

established a holding unit at Rothenbergen beside an airfield designated

Y-67. Here almost 6,000 recovered

American and British prisoners were

processed along with 3,000 U.S.

Army patients.

As elsewhere east of the Rhine, arrival of the "big birds" signaled quick

evacuation for many a wounded man.

The workhorse cargo-carriers were

equipped either with roll-down straps

or with brackets to hold litters in

place. A flight nurse and a medical

technician waited aboard. Each plane

could hold either 24 litter cases or 27

"walkers" (ambulatory patients). In

loading, litterbearers arranged patients under the flight nurse's direction for the most convenient care

during the trip; men with bulky casts,

for example, were placed in the

lowest litter row, at floor level. When

all was secure, the plane returned

to the United Kingdom or to COMZ

airfields.28

Seventh Army Units

Among the 6th Army Group forces

to the south, the Seventh Army began

to prepare for its advance in the lull

that followed clearance of the Colmar

pocket. For a time its units operated

in a sea of mud caused by the February thaw, for many rivers were swelling and water rose in low-lying areas

and swampy bottoms. Drainage

became a medical problem; sanitation

was difficult in unit areas, and constant vigilance by the trenchfoot control teams was needed. Though cold

injury fell off rapidly in consequence

of the thaw, the teams were obliged

to remain active throughout March.29

Meanwhile, the medical units readied themselves. Three 750-bed evacuation hospitals moved forward as far

as possible in the XV and XXI Corps

areas, where the advance was to

begin, and a supply buildup brought

all stocks to the maximum operating

levels. The medical section acquired

27

 Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, pp. 26 and 35 (source of quotation);

Surg, 10th Armored Division, Semiannual Rpt, January-June 1945, p. 16; Surg, 76th Infantry Division,

Semiannual Rpt, January-June 1945, tab April, p. 1.

28

 On air evacuation, see 94th Medical Gas Treatment Battalion Semiannual Rpt, January-June 1945,

Evacuation app. 29

 Surg, Seventh U.S. Army, Semiannual Rpt, January-June 1945, p. 1, and Preventive Medicine sec.,

pp. 1 and 3-5.
THE LAST CAMPAIGN 529

two pilots for air evacuation missions

and two boats to move the wounded

by water. Resuming its attack in midMarch, the Seventh Army rapidly advanced to the Rhine's left bank. On

the twenty-sixth the XV Corps

crossed the river near Worms, and

soon a blitzkrieg advance like that of

the First, Third, and Ninth Armies

was under way. As with those forces,

the basic medical problem was soon

reduced to one of keeping up. In the

4th Division, where combat elements

were making 20 miles a day, "the

Clearing Station moved almost every

day and the Field Hospital about once

in five days." With each advance, hospitals faced the chores of packing,

loading, unpacking, and setting up

again. Nurses found their hours "long

and busy . . . under great strain,"

for new casualties often arrived while

the unpacking was under way, and

there was no break between the labor

of movement and the care of patients.30

Fresh wounded continued to arrive.

The 10th Armored and 44th Infantry

Divisions rolled through Ulm, across

the Danube and into the Tyrolean

Alps, only to encounter dynamited

roads and machine-gun nests, where

diehard Germans offered "fanatic

hostile resistance." Infantry outflanked the defenders on steep slopes

and in defiles, where no vehicle could

follow them. Litterbearers accompanied the assault forces, and unit

medics packed in supplies on their

backs. When the wounded had been

manhandled to an open section of

road, ambulances shuttled them back

to the next roadblock, where they

were unloaded, carried to other vehicles waiting beyond, and reloaded

again for the trip to the clearing station. The bitter skirmishes were brief.

On the following day the remnants of

the German Nineteenth and Twentyfourth Armies surrendered, and the

Americans resumed their march.31

Evacuation hospitals apparently

moved every ten to fourteen days

during the campaign, aided by the

Seventh Army surgeon who obtained

more than a hundred trucks. With

adequate transport, the hospitals frequently moved as units, rather than

leapfrogging by echelons. Medical

groups played a role like that in the

northern armies, evacuating corps

and division casualties to Seventh

Army installations, strengthening the

evacuation hospitals with additional

personnel as needed, and performing

a variety of other duties, including venereal disease control through prophylactic stations that they staffed and

operated. Combat had not ended

when other duties crowded in. The

31st Medical Group took on the

added mission of setting up hospitals

for POWs, RAMPs, and DPs, to include a 10,000-bed hospital at Goslar

to serve the German wounded. The

Seventh Army's line of advance

through southern Germany enabled

its forces to liberate (or uncover, as

the records usually say) many concentration camps and to occupy and administer others after initial liberation

by Third Army spearheads. Here doctors, nurses, and corpsmen worked 30

 First quotation from Surg, 4th Infantry Division,

Semiannual Rpt, January-June 1945, p. 2. Second

quotation from Surg, Seventh U.S. Army, Semiannual Rpt, January-June 1945, ANC sec., p. 1.

31

 Surg, 44th Infantry Division, Medical Hist,

1945, p. 2.
530 EUROPEAN THEATER OF OPERATIONS

fourteen-hour days over patients

more dead than alive, in a cresendo

of fatigue made more difficult to bear

by emotions of anger, revulsion, and

horror. To administer hospitals, evacuate western Europeans, run the

camps, fight disease, establish quarantines, and prevent epidemics were

formidable problems that overlapped

the purely military ones in the chaos

of April 1945.32

Air evacuation again played an important role in the attack. During the

approach to the Rhine an air holding

station was set up at Goellheim. After

the crossing, another opened at

Darmstadt, where Seventh Army air

evacuation thenceforth originated.

Inside Germany, only airplanes were

available to carry out American casualties, for no railroad bridge was constructed over the upper Rhine.

Though spells of bad weather occasionally interrupted the airlift of

wounded, no serious problems were

encountered until heavy rains in early

May, and by that time the German

railroad system was again in operation.33

Fifteenth Army Units

Supporting the field armies during

the spring campaign was a new organization, the U.S. Fifteenth Army.

Last of the Allied armies to enter the

conflict, the Fifteenth, under Lt. Gen.

Leonard T. Gerow, took on a variety

of tactical and logistical duties. Following the army's arrival on the Continent in December 1944, it was ordered to contain two surviving

German enclaves on the western coast

of France; to receive, train, and equip

units arriving from the United States

and the United Kingdom; and to provide operational control for the

SHAEF reserve.

During the March 1945 assaults the

Fifteenth Army took over a section of

the Rhineland between the First and

Ninth Armies, which included the

cities of Aachen and Cologne, and

began to restore order by performing,

amid the confusion of a newly conquered region, the tasks of military

government. Its forces occupied and

defended the western bank of the

Rhine from Bonn northward almost

to the Wesel, preventing the escape

of the German forces trapped in the

Ruhr pocket. However, its surgeon,

Col. L. Holmes Ginn, Jr., MG, was

concerned primarily with support for

the troops in the Rhine Province Military District—the area occupied by

the army—which grew during March

and April to include areas abandoned

by the First, Third, Seventh, and

Ninth Armies stretching from the

Saar in the south to the Maas in the

north. Though Fifteenth Army hospitals received almost 15,000 patients,

who were evacuated to the Communications Zone, the army's most distinctive work consisted in providing a

transition to peace in what would

later become the British and French

Zones of Occupation.34

32

 Surg, Seventh U.S. Army, Semiannual Rpt, January-June 1945, p. 2, and ANC sec., p. 3; Surg,

94th Infantry Division, Semiannual Rpt, JanuaryJune 1945, pp. 12-14; 31st Medical Group Annual

Rpt, 1 Jan-31 May 45. For further information on

these topics, see Chapter XVI of this volume. 33

 Surg, Seventh U.S. Army, Semiannual Rpt, January-June 1945, Evacuation sec. and Medical Supply

sec., p. 8.

34

 History of the Fifteenth United States Army, 21

August 1944 to 11 July 1945, especially pp. 18-19;

Continued
THE LAST CAMPAIGN 531

Lessons Learned

Despite the overall picture of competence and success, the last campaign turned up some medical problems that related to command and

others that concerned mobility. At the

divisional level the separation between the division surgeon and the

commander of the medical battalion

caused difficulties, and brought proposals from many medical officers to

combine the two. During action, some

division surgeons solved the problem

ad hoc by staying with the battalion

throughout the advance. The practice

of dividing field hospitals into three

hospitalization units continued to

work well; even in the fast-moving armored columns, nontransportables

continued to receive treatment well

forward. The surgical teams were furnished with two 21⁄2-ton trucks and

with sufficient tentage, instruments,

and supplies for their needs. Team

members rode the same trucks and

set up their own tents beside those of

the clearing station they supported.

The third element in the combination, the field hospital unit, arrived

last and took over the job of holding

and caring for the wounded as the

surgical team finished with them.

When time came for the whole divisional support system to move forward again, a group from the collecting company remained behind with

the patients who were still not able to

travel. Some surgeons in the Third

Army were so satisfied with this

method of treating nontransportables

that they declared: "The problem of

handling the casualties of armored divisions was solved." Others, however,

wondered whether a new unit might

not perform the job better than an

improvisation using portions of

three.35

The Third Army surgeon made

some suggestions that have, in retrospect, a prophetic ring. "A completely

mobile surgical hospital," he wrote,

"was a necessity for the support of a

division." The T/O of such a unit

should provide a "two-platoon arrangement which would permit leapfrog movement of the platoons or

forward displacement of one while

the second retain[s] the post-operative cases until they become transportable." In such proposals the

duties and typical movement of the

future MASH (mobile army surgical

hospital) seem to be foreshadowed.36

Underlining the emphasis on mobility was the continued realization

that in practice "the 400-bed evacuation hospital is not semi-mobile."

With only its organic vehicles, the

unit proved unable to move itself

even in two echelons. Because about

half the evacuation hospitals were

closed and in motion at any given

time, their patients were thrown upon

the others, which handled the load by

expanding their bed capacity and augmenting their equipment—and so reducing their own ability to move

when the time came. Though the hospitals shuffled transport back and

forth among themselves, there was

seldom enough to permit them to opFifteenth U.S. Army in Germany, 16 April-10 July

1945, pp. 37-38. On the Occupation, see Chapter

XVII of this volume.

35

 Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, p. 92. 36

 Ibid., p. 83.
532 EUROPEAN THEATER OF OPERATIONS

JEEP AMBULANCE EVACUATION

erate as theory demanded. The hospitals also lacked surgeons to handle

peak loads so that surgical teams had

to be added to their complements to

cope with the demands of heavy fighting. Inadequate holding capacity

during forward displacement also

meant adding a clearing company platoon as a holding unit. The tendency

of the "semi-mobile" evacuation hospital to grow in size and decrease in

mobility apparently was not solved,

for ambulance hauls increased whenever the army was in rapid motion,

and only the fact that casualties usually decreased at the same time kept serious problems from developing.37

For evident reasons, army surgeons

judged that the even larger 750-bed

evacuation hospital had "little or no

place in a field campaign in a war of

movement." On the other hand, the

convalescent hospital, "large and immobile though it may be," was an important unit when well-trained replacements for the wounded were not

available. It sopped up patients who

would have been lost to field army

control and returned them to their

units with a minimum of fuss. Here

too venereal disease cases often were

concentrated and treated, relieving

the evacuation hospitals of a burden

while preventing patients from being

evacuated to the COMZ.38

37

 Ibid., pp. 82-83 (quoted words on p. 82); Surg,

10th Armored Division, Semiannual Rpt, JanuaryJune 1945, p. 37; Surg, 5th Infantry Division, Semiannual Rpt, January-June 1945, p. 5.

38

 Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, p. 85.
THE LAST CAMPAIGN 533

Ambulance evacuation required

special attention in warfare like that

of the spring of 1945. The durable,

ubiquitous jeep again proved its

worth as an impromptu ambulance.

But methods changed as the initiative

for evacuation shifted forward. The

notion that the higher echelon in

each case could evacuate the lower on

request proved to be nonsense when

the front was in such rapid motion.

Instead, each echelon had to consign

its vehicles to the next lower one so

that evacuation could be constant and

instantly responsive to need. The

Third Army surgeon reported:

This same concept of constant evacuation

carried down to the first and second ech- elon medical service. Collecting company

ambulances were kept or near battalion

aid stations where possible or the one- quarter-ton truck ambulance was used. Litter bearers of the medical detachments

were kept available near company CP's

and aid stations, rather than waiting for

someone to locate the aid stations prior

to sending up litter bearers.

Overall, however, the lessons of medical mobility had proved hard to

learn, easy to forget, and difficult to

implement when a whole army cried

simultaneously for transport in a

lightning campaign.39

Supporting the Front

Behind the Fifteenth Army the

Communications Zone reached its

final form. The Advance Section,

which supported the 12th Army

Group, had been little affected by the

Ardennes fighting. In thinly populated, hilly regions of the front there

were few depots or supply lines to be

disrupted. The German advance had

been halted short of the Meuse River,

and thus of the main logistical network. What losses did occur were

easily replaced: some forward dumps,

a few rail lines and trains damaged by

strafing or bombing, lost equipment

in a few truck companies. At the rear

the most serious damage to ADSEC

generally and to the medics in particular was caused by V-l "buzz

bombs," for almost 2,500 beds suffered some degree of injury, especially in and around Liege. Yet the Advance Section was able to begin its

planning for the new campaign without the need of a period of recovery

and without replacing extensive

losses.40

Certain installations were regrouped to provide backup for the

anticipated Allied offensive. Thus the

12th Field Hospital moved to Namur,

where it opened a railhead holding

unit to serve the evacuation hospitals

of the First Army. The 77th Evacuation Hospital relocated to La Louviere to speed the return of the lightly wounded to replacement centers.

The hard-pressed 130th General Hospital, driven out of Ciney by the

German attack, resumed operation in

mid-January. But the primary change

was a shift in the character of ADSEC

itself. Recognizing the need for mobility to support the invasion of Germany, the Communications Zone

began to restructure its Advance Section, transferring to the rear base sections the chain of general hospitals

39

 Ibid., p. 86. See also Surg, 10th Armored Division, Semiannual Rpt, January-June 1945, p. 36. 40ADSEC Hist, p. 111.
534 EUROPEAN THEATER OF OPERATIONS

running south from Liege to Nancy.

Between January and May ADSEC

lost 82 percent of its general hospitals

but almost doubled its number of

field hospitals, and also increased its

ambulance companies, sanitary companies, and its medical and dental detachments. This was a lesson the Ardennes fighting had taught. The

effort to support a rapid advance with

fixed facilities had ended.41

Transport, despite the battle and

the winter weather, promised to be

adequate for the advance to the

Rhine. The area of the Bulge itself

was devastated by Allied bombing

and by demolitions carried out systematically by both sides. The rail

bridges were mostly gone, the lines

out of commission. However, repair

got under way quickly. The lines had

been pushed as close to the front as

ADSEC engineers could manage,

often within medium artillery range.

Maintenance crews had kept roads

and tracks fairly clear even during the

deep snows, and the only real obstacle to resupply by rail had been

caused by frozen switches. The

coming of warmer weather both aided

and slowed the buildup. The Meuse

thawed in February, and thereafter

dropping flood stages permitted the

gradual resumption of barge traffic

that moved heavy bulk supplies south

from Antwerp. However, heavy vehicles had to be barred from roads

made impassable by the thaw. Meanwhile, express supply trains—called

"Toot Sweet Express"—rolled into

Liege daily at 1000 hours. From

Liege and Verdun in turn came virtually all the supplies that fueled Bradley's 12th Army Group.42

Under General Lee's orders, planning began in the latter part of February. The medical plan went to G-4

a few days later. The assumption at

the time was that the main attack

would be launched north of the Ruhr,

with a secondary thrust south of the

Moselle. The opportunistic character

of the actual Rhine crossings could

not be foreseen, but many of the

problems presented by the river were.

The medics asked for 125 C-47s a

day for air evacuation. Colonel Beasley, the ADSEC surgeon, planned to

establish holding units both east and

west of the Rhine. Those to the east

would receive the wounded by jeeps

or, if necessary, by returning supply

vehicles, such as the weasel. West of

the river the holding units were to be

set up at railheads. As the Rhine

bridges were repaired and trains

began to run again, the need for the

western units would gradually cease.43

The events of March demonstrated

that the end of the war was rapidly

approaching. In April the Advance

Section prepared its ECLIPSE plan, following SHAEF's more general plan

for dealing with the final collapse of

Germany. Rapid occupation of the

Reich, followed by redeployment to

the borders of the American Zone,

formed the two phases of the plan. At

the collapse or capitulation of the

major German forces—or the surrender of the government or high command—the Supreme Commander

"Surg, ADSEC, COMZ, Semiannual Rpt, January-June 1945, pp. 1 and 9-10.

42ADSEC Hist, p. 115. The name was a pun on

the French phrase toute de suite (quickly). 43

 Directive, COMZ, ETO, 19 Feb 45, sub: Emergency Plan for Support of Rapid Advance, with

ends., file HD:ETO:320.
THE LAST CAMPAIGN 535

would announce "A-Day," when the

plan would go into effect. By that

time ADSEC expected the First,

Third, and Ninth Armies to be completely east of the Rhine; the Fifteenth to be performing occupation

duties west of the river; and its own

sphere of action to be entirely inside

Germany.44

The actual course of operations allowed the Advance Section to turn

over its former territory and responsibilities to other base sections, to enter

Germany, and to establish its headquarters at Bonn during April. Here

it was no longer an area command—

territorial control was swiftly vested in

the armies—but it continued to be a

logistical command. In consequence,

control of road and rail traffic also

passed largely to the armies. ADSEC

found that its supply responsibilities

were least burdensome in the north,

where the reduction of the Ruhr

pocket slowed the invaders; in the

south, where American armor pressed

deep into central Europe, supply was

far more difficult. The major techni- cal problem, however, came from the

capture of vast quantities of German

matériel. As already noted, such supplies were crucial to meeting the

needs of sick and injured noncombatants of all types, but the job of inventorying and controlling the vast stocks

proved too much for ADSEC's medical supply officers. Completing the

work would be a task for the occupation authorities to come.

Evacuation mirrored the experience

of the field forces. Two 1,000-bed

holding units at Aachen represented

the effective limit of rail transport.

During the advance to the Rhine

ever-lengthening ambulance hauls,

improving weather, and the conquest

of enemy airfields brought increased

evacuation by plane. Near MoenchenGladbach both rail and air holding

units were established. When the

armies crossed the Rhine, forward airfields were used whenever weather

permitted, and as soon as the engineer-built bridges spanning the river

were operational, casualties were carried by ambulance to the railheads on

the west bank. Even when trains

began to cross the Rhine, however,

priorities denied passage to hospital

trains. Not until late April, when the

armies were deep in Germany and the

war nearly ended, did the first hospital train cross into the inner Reich.

Beasley's medics found themselves

facing few surprises in hospitalization.

Plans for new construction went

ahead as long as the fighting continued. ADSEC officers sought out

hospital sites in the wake of the advancing armies, and construction or

rehabilitation got under way with the

aid of the engineers. But such problems belonged essentially to the

period of occupation. The complex

and very rapid changes in ADSEC's

status brought on by the last campaign gave way to the general transformation brought by peace and civil

governance of a conquered people.45

The Continental Advance Section

provided immediate support to the

Seventh Army—fixed hospitalization,

44

 ADSEC, COMZ, Operation Plan "ECLIPSE," in

ADSEC Hist.

45

 Ibid., pp. 131 and 149. For the problems presented by POWs, RAMPs, and DPs, as well as an account of the military government, see Chapter XVI

of this volume.
536 EUROPEAN THEATER OF OPERATIONS

evacuation, and medical supply—and

to the French First Army after it entered Germany. Like ADSEC, it underwent a process of lightening in

preparation for the advance. As its

surgeon remarked, the section began

the year adhering to the established

policy of locating fixed hospitals as

far forward as possible. Indeed,

toward the end of January it acquired

six general hospitals in the NancyToul area, giving it briefly the luxury,

which it had not enjoyed before, of

accepting casualties without first evacuating a similar number to empty the

necessary beds. But by March the

spring offensive had made the policy

impractical. When CONAD moved

into Germany in early April, it turned

its fixed installations over to the Oise

Base Section. Unlike ADSEC, its hospitalization henceforward was limited

to the care of its own troops and that

of increasing numbers of displaced

persons and prisoners of war.

Its experience with rail and air

evacuation resembled closely that of

the northern section, intensified, perhaps, by geography: Southern Germany is mountainous, the north an

extensive plain. A hospital train base

was moved to the west bank of the

Rhine, but rail evacuation "lagged far

behind" the need, and the rail holding units were converted to air holding units, which were then leapfrogged as necessary to keep up with

the movement of the Seventh Army.

Flying weather was excellent, and the

lack of functioning rail facilities east

of the Rhine merely underlined the

advantages of the new system.46

Both ADSEC and CONAD drew

their support from the Oise Base Section, which expanded rapidly by gathering in areas and installations as the

advance sections left them behind.

Fixed hospitals were established no

further forward, and air transport increasingly was used to return casualties to the west bank of the Rhine.

Hence, the Oise medical section,

which controlled one general hospital

in January, operated forty-three of the

latter plus three station hospitals in

April, with a concurrent expansion in

depots and dispensaries. At its highpoint that month medical personnel

in the base section numbered 2,700

male officers, 3,900 nurses, and

26,000 enlisted men. Its general hospitals were organized into two hospital centers, and its medical facilities

all told employed some 30,000 DPs

and 300,000 POWs. To the rear the

Seine Section remained the key to the

medical logistics system, for it contained the city of Paris, COMZ headquarters, a system of general hospitals

also organized by two hospital centers

north and south of the Seine, and the

elaborate transport hub centered in

and around the French capital. Here

conditions did not change essentially

during the last offensive; as before,

base section medical personnel were

occupied primarily with triage and

evacuation. Each center had a holding

hospital, where arriving patients were

assigned to one of three basic categories: COMZ (less than 30 days hospitalization until 1 March, then less

than 60), United Kingdom (60-90

days), and zone of interior (over 90

days). By mid-March few patients

were being received by rail, marking

not only the transit of the Rhine by

46

 Surg, CONAD, Semiannual Rpt, January-June

1945, pp. 4 and 8. Quoted words on p. 5.
THE LAST CAMPAIGN 537

the fighting forces but the fact that air

transport often returned casualties

direct to the Paris airfields, skipping

the system of railheads and hospital

trains entirely. COMZ patients went

to the hospital appropriate for their

injury within the center where they

were triaged; United Kingdom patients were usually evacuated by air;

and zone-of-interior patients were

sent to the air holding unit of the 1st

General Hospital, at Le Bourget airport, for loading on planes bound for

the United States. Like ADSEC and

the other base sections closer to Germany, the Seine Section also handled

an increasing burden of sick and injured Allied nationals, though here

mainly civilian DPs. Russians had to

be sent to Germany for transfer to

their own medical services, while hospital trains bore Belgians to Liege

and Italians to Marseilles, while airplanes returned recovered British and

Canadian prisoners to the United

Kingdom.47

The Normandy Base Section, like

Oise, grew rapidly in 1945, absorbing

the Brittany Base Section, taking over

the ports of Le Havre and Rouen

from the Channel Base Section, and

providing support to Fifteenth Army

troops whose mission was to contain

the holdout German garrisons in the

coastal enclaves of Lorient and St.-

Nazaire, on the Bay of Biscay. In

March an influx of German battle casualties compelled the conversion of

hospitals serving Americans to POW

facilities and in April the liberation of

large numbers of Allied prisoners

caused the section to redesignate

Camp Lucky Strike, heretofore used

by replacements entering the Continent, as RAMP Camp No. 1. Meanwhile, the Channel Base Section advanced into Belgium, taking over

areas formerly controlled by the Advance Section. Its surgeon was responsible for American medical needs

in the area of British control along

the Channel coast that included Antwerp. Indeed, by the end of the war a

good third of the section's medical installations lay in British areas. Its RED

HORSE expansion staging area mushroomed, becoming for a time the key

debarkation point for reinforcements

arriving from the United States; DP

camps were established, using civil affairs medical supplies, and staffed by

Belgian nurses and doctors; and section doctors and nurses, working at

Camp Lucky Strike, treated liberated

Americans whose condition they

found to be worse than anticipated.

At COMZ's request the section sent

six teams—each consisting of three

doctors, a medical administrative officer, and twelve enlisted technicians—

to ADSEC in Germany to aid in providing immediate medical care for

RAMPs. Thus the burden of aiding

noncombatants stretched from the

most forward areas back to the rear

sections. Even in the Delta Base Section, around Marseilles, whose small

medical establishment served primarily its own forces, the number of

POWs rapidly increased, and German

prisoners built a model 1,000-bed

general hospital adjacent to their en47

 Surg, Oise Intermediate Section, Semiannual

Rpt, January-June 1945, pp. 2-3 and 10-11; Surg,

Delta Base Section, Annual Rpt, 1945, p. 1. See also

Surg, Seine Section, Semiannual Rpt, January-June

1945, pp. 16-17.
538 EUROPEAN THEATER OF OPERATIONS

closure, where their own medical personnel cared for their needs.48

No aspect of the medical system

saw more striking changes than evacuation during the last offensive. The

transformation from the crisis conditions of midwinter was extraordinary.

Even when casualties began to rise in

late February as a result of action

along the West Wall, Paris still counted 11,000 empty beds and the hospitals of the United Kingdom recorded a

falling census. With ample bed

strength, the temptation for forward

surgeons was to evacuate too many

patients, rather than too few. Complaints registered at Colonel Mowrey's Evacuation Branch indicated

that triage decisions were also being

distorted by an overabundance of

transport—a remarkable fact, given

the conditions of the months just

past. Air evacuation was, with few and

brief exceptions, consistently good

throughout the system. Poor weather

in late April did impose some delays,

but the first week of May found hospital trains at last across the Rhine,

while improving weather enabled

C-47s to join in clearing out the

choked forward holding units, evacuating nearly 5,000 patients on the

third of the month. Air evacuation to

Great Britain became ever more important, not because alternatives were

unavailable but because it was better

for the wounded. In an effort to fill

its empty beds on the Continent,

ETOUSA raised the evacuation

policy. The planes flying out of Liege,

Paris, and Thionville were able to

handle all the severely wounded who

still required treatment in the United

Kingdom, and whole weeks passed in

which no casualty had to endure the

delays and frequent rough water of

the Channel crossing.

By 8 May, when Mowrey noted in

his diary that "La Guerre est finis,"

he and Hawley had formulated and

set in motion a new policy for the immediate postwar period. Patients on

the Continent were to be held there,

until their cases could be reviewed by

medical boards. Those tagged for

quick return home were then to be

taken to the 1st General Hospital at

Paris, airlifted to the embarkation

hospitals at Cherbourg and Marseilles, and returned to the United

States by sea. The status of some DP

patients and the disposition of POW

patients remained to be decided, and

some shuffling of cases among the

various hospitals in Germany would

become necessary as soon as occupation authorities determined the fate of

various categories. But these were

little more than details. The systems

of evacuation and hospitalization,

overbuilt in the planning phase and

stretched to their limits during the

winter, provided a surplus of everything for the casualties of the last

campaign.49

Triumph of Preventive Medicine

Despite appearances to the contrary, the same good fortune accompanied the Army in regard to

sickness. By comparison with the 48

 Surg, Normandy Base Section, Semiannual Rpt,

January-June 1945, p. 4; Surg, Channel Base Section, Hist, January-June 1945, pp. 2 and 5-6; Surg,

Delta Base Section, Annual Rpt, 1945, p. 2.

49

 Above paragraphs based on Evacuation Branch,

Operations Division, OofCSurg, HQ, ETOUSA,

Daily Diary, May 1944-May 1945, file HD 024 ETO.
THE LAST CAMPAIGN 539

Mediterranean, Pacific, and Asiatic

theaters, the European Theater was

the healthiest in which Americans

served. It was true that a year of

fighting, a hard winter, and the collapse of Germany set the stage in

1945 for unusually high numbers of

casualties from disease. Of the

1,950,812 admissions for disease recorded in the theater from January

1942 to December 1945, 1,027,500

(or 58 percent) occurred in 1945

alone. During the months of fighting—-January through April—the

number of fixed beds occupied by

disease and nonbattle-injury victims

consistently ran ahead of those occupied by battle casualties, while the reverse had been true in 1944. By comparison with 1944, half of which had

also been devoted to fighting, syphilis

increased among American soldiers in

the theater from 9,190 to 25,520;

gonococcal infections from 36,850 to

162,785; chancroid, from 2,500 to

12,550—a VD epidemic unleashed by

the conditions of devastated Europe

and the release of many troops from

front-line duty. But most other diseases increased as well (malaria and

certain types of pneumonia were exceptions). Diarrheal diseases increased from 33,125 to 46,585; skin

afflictions from 43,840 to 73,170; infectious hepatitis from 4,310 to

20,530. Diphtheria, by reason of its

virulence, brought concern to Army

physicians despite its comparatively

low incidence.

However, comparison of admission

rates—the number of admissions for

disease per 1,000 average strength

per year—indicates that the impressive absolute increase resulted largely

from the growth in the number of

troops in the theater. Admission rates

that had increased in 1943 declined

sharply in 1944 and rose only slightly

in 1945, never regaining the levels of

the two years spent largely in training

in the United Kingdom. In sum, the

effects of acclimatization and the influenza outbreak of 1943 were more

severe than those of combat. On the

Continent the health problems with

greatest impact on operations were

psychoneurosis, or combat fatigue,

and cold injury. Americans, well fed

and cared for, formed probably the

healthiest population in devastated

Europe; their death rate from all diseases in 1944 was only .52 and in

1945 only .59 per 1,000 average

strength per year. Typhus epidemics,

worst in eastern Europe, flared also in

occupied Germany, but only five

Americans caught the disease, and

none died. Many factors contributed

to this picture of success in the control of disease, which contrasted so

strongly with the failure to prevent

widespread cold injury. Fundamental

were the European environment, with

its temperate climate and freedom

from most exotic diseases; the generally adequate diet and equipment of

the American soldier; and the program of preventive medicine that

guarded his health.50

Successfully controlling disease on

a continent torn by war presented

complex problems to Colonel Gordon

and the Preventive Medicine Division.

None were more difficult than those

surrounding venereal disease, a traditional plague of soldiers and a persistent outrider of war. The work done in

50

 Statistics for above paragraphs from Reister,

ed., Medical Statistics, pp. 608, 804, 826.
540 EUROPEAN THEATER OF OPERATIONS

England during the buildup provided

few useful guides on the Continent,

where, even apart from the prevailing

disorder, cultural norms differed

widely from those of the British Isles.

On the Continent prostitution was a

recognized endeavor, legally protected and regulated, and brothels

formed a normal part of the urban

scene. Medical officers, looking primarily to the health of the troops,

tried to control disease by suppressing the brothels. Commanders, on the

other hand, often viewed sex as a

recreation needed and deserved by

fighting men, and some attempted to

provide it through regulated prostitution. On 6 July 1944 Colonel Gordon,

visiting France, found in Cherbourg

"houses of prostitution being run for,

and indirectly by, U.S. troops." One

establishment had been designated

for black soldiers, the others for

whites, and "military police [were]

stationed at the doors to keep order

in the queues which formed." The

next day Cherbourg passed to

ADSEC's control, and the new commander, on advice of his surgeon,

Colonel Beasley, closed the houses.51

During the summer campaigns,

policy continued to depend largely

upon the attitudes of local commanders. War Department and ETO policy

requiring that prostitution be suppressed was not always enforced. In

the medical view, inspection of prostitutes formed no real protection

against the spread of venereal disease, for a woman could harbor the

disease with no apparent symptoms.

The stubborn belief in licensed brothels, protested some medical officers,

"is based on the sort of faith that

leads a small boy to believe that if he

places a horsehair in a bottle of water

it will turn into a snake."

 52

 But the

existence of an official policy merely

inhibited open and rational debate,

without securing compliance. It was

fortunate, then, that many factors

conspired to keep continental sick

rates from venereal disease low—

indeed, lower than those of the British Isles. Many women of the type

who would normally have served the

needs of the Army had compromised

themselves with the Germans and fled

to escape the wrath of the Resistance.

Friendly, noncommercial sex was inhibited by the language barrier, which

made the early stages of acquaintanceship difficult, especially for GIs

on the move. Americans who did succeed in finding partners had seemingly been sufficiently impressed by the

perils graphically presented to them

during training to make use of excellent prophylactic stations, which the

Germans had built and equipped for

their own forces and which now fell

to the Allies as prizes of war.

Behind the lines, however, the potential for future trouble was easy to

see. Some commanders remained adamant in favor of military brothels.

Civil affairs officers held varied opinions and seemingly had no consensus

on which policy was best. French civil

officials, while anxious to please their

liberators, viewed efforts to suppress

prostitution as "mildly mad" and in

any case tended to follow the norms

of their own country. Often the men 51

 Information on venereal disease, except as otherwise noted, from Hoff, ed., Diseases Transmitted

Through Contact, pp. 242-66. Quoted words on p.

243. "Ibid., p. 245.
THE LAST CAMPAIGN 541

themselves could give little practical

help in tracing their sexual contacts.

In a foreign country where the soldier is

contacting a girl who speaks a different

language, lives on a dark street, has a

name which the soldier cannot spell or

pronounce, it is difficult for him to have

her name and address. The towns are all

blacked out, the streets are not laid out in

squares but in a circular fashion and it is

not unusual for a street to have six un- pronounceable and unspellable names in

six blocks.53

The liberation of Paris in August

1944 brought within Allied lines a

world metropolis that quickly became

SHAEF headquarters and a gigantic

magnet for every soldier on furlough.

Medical officers told of entire convoys

that "got lost" on their way to this or

that objective and wound up in Paris.

Traditionally an easygoing city, the

French capital in 1944 was particularly attractive to Americans in search of

sex, for food was in short supply and

even the lowliest GI found himself in

"an unbeatable bargaining position."

Wartime psychology was a factor:

"The soldier cannot possibly worry

about venereal disease when he has to

worry about getting shot," remarked

the Ninth Army surgeon. GIs on leave

sought a last fling before possible

wounding or death.54

When the fighting man who had

undergone a lengthy period of enforced continence found himself presented with the opportunities of Paris,

some remarkable performances resulted. A private from a Quartermaster company picked up, according to

his VD contact form, nine different

women in the vicinity of the same

corner, took them to six different

hotels, and actually managed seven

sexual exposures. Total time elapsed:

eight hours. The VD rate in the European Theater doubled during the

year, and studies showed that more

than two-thirds of all venereal infections acquired in France originated in

Paris. The Seine Section officers were

less than sympathetic to medical

alarms. One medic recalled that in

September 1944 the provost marshal

of the section made a tour of Paris

brothels to select some for officers,

others for white, and still others for

black enlisted men. Despite their reputation for sexual puritanism, Americans showed a marked preference for

the other national faith of pragmatism, tempered by racial taboos.55

However, VD control officers succeeded in setting up additional prophylactic stations, often in Red Cross

hostels, and programs of education

and propaganda got under way with

an assist from Stars and Stripes. The

French government was cooperative

and helpful, and its aid proved to be

essential, not only for reasons of language but because familiarity with

French cultural norms was necessary

in overcoming the reluctance of

women to admit the problem and

seek treatment. In fact, the police and

the theater medical service were

closely tied together despite the ef53

 Quotation from Surg, Ninth U.S. Army, Daily

Journal, 30 Jan 45, p. 7, Shambora Papers, MHI.

See also Ltr, Hawley to CG, ETOUSA, 9 Jan 45,

sub: Official Recognition of House of Prostitution,

file HD 024 ETO CS (Hawley Chron). Further information on civil affairs will be found in Chapter

XVI of this volume. 54Hoff, ed., Diseases Transmitted Through Contact, p.

246.

55

 Surg, Ninth U.S. Army, Daily Journal, 30 Jan

45, p. 7, Shambora Papers, MHI.
542 EUROPEAN THEATER OF OPERATIONS

forts of the latter to claim otherwise.

Medics did not as a rule supply information directly to the police, but they

turned their information on venereal

contacts over to French health agencies, knowing that they would do so.

Belgian authorities were similarly

helpful in prevention and treatment,

especially in the road and rail hub of

Liege. Throughout the war, rates remained highest among base section

troops, replacement commands, and

in the Air Force units that continued

to operate from the British Isle a.56

But the most important developments in VD control during the war

were in the area of treatment, not of

prevention. Even as late as 1943 an

uncomplicated case of gonorrhea

could occupy a hospital bed for 30

days, while the treatment of syphilis

remained a tedious six-month ordeal.

While sulfa drugs improved the picture, sulfathiazole rapidly lost its effectiveness as resistant strains of the

gonococcus developed. Then the surgeon general's Preventive Medicine

Service learned that the new antibiotic, penicillin, had proved useful

against sulfa-resistant gonorrhea. A

large-scale study led to the adoption

of penicillin treatment throughout the

Army. The results were startling: The

number of days needed to treat the

average case of gonorrhea was reduced from 20 to 5, and many cases

could be treated while the patient remained on duty status. Penicillin

treatment of syphilis began in 1944.

In the Ninth Army a VD center operated by the 95th Medical Gas Treatment Battalion returned 99.9 percent

of its patients to duty within the army

area, underlining the fact that reduced treatment time enabled line

units to exploit forward holding facilities to prevent manpower loss.

The revolution in treatment gained

in significance as the end of the war

approached in the spring of 1945.

Command support for VD control

continued to vary from one organization to another, with the First and

Ninth Armies providing strong support for the control efforts of the

12th Army Group surgeon, while the

Third Army manifested little interest

in the problem. The impending end

of the conflict meant that soldiers of

the field forces would soon enjoy the

same opportunities to find sex as the

support troops and could be expected

to take advantage of them in the same

manner. But even as the postwar VD

epidemic impended, the significance

of the venereal diseases had been

radically transformed by improved

therapy to the point that gonorrhea,

at least, had become an insignificant

cause of ineffectiveness among the

men of the European Theater.57

Apart from venereal disease, few illness afflicted the troops. Influenza

failed to reappear in epidemic form;

the incidence of primary atypical

pneumonia remained low; meningococcal infections did not become

widespread; and even the fatalities

56

 Medical History of the Ground Force Reinforcement Command, ETO, 23 October 1943-30 June

1945, file 319.1-2 (GFRC); Ltr, Hawley to Le Ministre, Ministere de la Sante Publique, 3 Mar 45, file

HD 024 ETO CS (Hawley Chron).

57

 VD Control Branch, Preventive Medicine Service, OSG, WD, Annual Rpt, 1943, pp. 135-57;

Memo, sub: Penicillin Treatment of VD, in Preventive Medicine Service, OSG, WD, Annual Rpt, 1945.

Both in box 24, RG 112, NARA. See also Technical

Bulletin MED 106, 11 Oct 44, sub: Penicillin Treatment of Syphilis, CMH.
THE LAST CAMPAIGN 543

among American troops caused by

diphtheria apparently resulted mainly

from the fact that the younger American doctors had never encountered

the disease and, awaiting positive laboratory diagnosis, delayed too long

before administering antitoxin. Careful screening of American soldiers

helped to keep tuberculosis from becoming a significant problem, though

liberated American POWs were an exception, their susceptibility apparently

caused by exposure to the disease and

by malnutrition while in the enemy's

hands. Soldiers from the Mediterranean Theater brought not only malaria

but also infectious hepatitis to the European Theater, spreading the disease

to units new from the States and

causing 12,509 cases between October 1944 and early May 1945. A few

cases of typhoid and paratyphoid occurred, and units suffered occasional

outbreaks of food poisoning. Diarrheal diseases, after reaching epidemic

peaks in December 1944 and February 1945, were sharply reduced

among the troops, perhaps by tighter

water discipline in the forward zones.

Frequently of obscure origin, this

class of ailments caused about 45,000

hospital admissions in the European

Theater throughout the war, but only

about 5 deaths.

Overall, this was an extraordinary

record for a combat zone. Undergirding the health of the troops was good

nutrition. A new C-ration proved

more palatable than the old; hot B-rations became commoner in the field;

and fresh fruits and vegetables were

often available, especially for hospital

patients. Well fed, inoculated, fighting in the heartland of their civilization, American soldiers faced no significant peril of disease for which

medical science lacked an answer.58

The last campaign was a showpiece

for the ETO medical service, rather

than a test. The innovations that appeared—the abandonment of fixed

hospitals in forward areas; and the

heavy, in some areas exclusive, dependence on air evacuation—indicated a willingness to learn and to improvise. But no severe test of the service occurred in the handling of

American sick and wounded. The true

test of the system came rather in the

care of noncombatants of every type,

and it was here that Army medics

found their most poignant experiences, their worst failures, and some

of their finest hours during the memorable spring of 1945.

58

 Larkey "Hist," ch. XVI, pp. 1-6; Army Service

Forces Monthly Progress Rpt, sec. 7 (Health), 30

Apr 45, p. 12, file HD 700 (Health). See also Preventive Medicine Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, Nutrition Branch sec., p. 2; Grodon "Hist", vol. 1, pt.

3, pp. 10 and 32; Surg, Ninth U.S. Army, Semiannual Rpt, sec. IV, p. 3, and sec. VI, p. 3. On the Third

Army and venereal disease, see Surg, 12th Army

Group, Hist, January-June 1945, p. 16. On hepatitis,

see also Surg, Seventh U.S. Army, Semiannual Rpt,

January-June 1945, Preventive Medicine sec., p. 1.
CHAPTER XVI

Victims of War

How were noncombatants to be

cared for once the tide of battle had

passed them by? Facing the prospect

of fighting in many populated regions

around the world, American policymakers from the early days of World

War II were aware that some provision must be made for the governance of liberated peoples (civil affairs)

and ultimately for that of conquered

nations (military government). Yet

Americans traditionally viewed civil

rule by the military almost as a contradiction in terms, limited to extraordinary times—the aftermath of natural

disaster or civil war. At first opposed,

President Roosevelt, because he could

see no other way, committed himself

to a period of military rule in order to

avoid having both a military commander and a civil governor at work

in the same territory at the same time.

"It is quite apparent," he remarked in

1943, "that if prompt results are to

be obtained the Army will have to

assume the initial burden."

 l

So much had long been clear to

military planners. The Army embodied its basic policy in Military Government, Field Manual 27-5, and in

early 1942 it established a school of

military government at the University

of Virginia, with public health experts

as part of its faculty. Army policy

made the commanding general of a

theater of operations the "military

governor of the occupied territory,"

his "supreme authority . . . limited

only by the laws and customs of war."

He was to select personnel to be

charged with establishing a government that was "just, humane, and as

mild as practicable." Their

work included many medical responsibilities: to oversee sanitation; to control communicable diseases; to protect food, milk, and the water supply

from contamination; to manage the

hospital system; and to organize the

health care professions. Under Army

guidance the civilian health officers of

states, provinces, counties, and cities

were to continue their duties. Anyone

who failed to obey the laws and regulations promulgated by the military

government faced punishment by a

military tribunal.2

Yet civil affairs and military government remained a concept, rather than

a functioning part of the Army J

As quoted in Earl F. Ziemke, The U.S. Army in the

Occupation of Germany, 1944-1946, Army Historical

Series (Washington, D.C.: U.S. Army Center of Military History, 1975), p. 22.

2

 Basic Field Manual 27-5, Military Government, 30

Jul 40, pp. 4, 8, 44-45. The first class at the Charlottesville school met on 1 May 1942.
VICTIMS OF WAR 545

system. In any combat area military

imperatives were likely to conflict

with the care of civilians. The idea of

a separate civil affairs organization

was new to American military doctrine and formed no part of Army

training, either in staff exercises or

maneuvers. If it was to become a

functioning aspect of the Army's activities, its practice had to be worked

out in the field.

Civil Affairs

Civil affairs, in General Eisenhower's view, was critical "not merely

from a humanitarian viewpoint, but to

the success of our armies."

 3For most

of the ETO's existence the American

field armies operated within the borders of Allied nations. The civil affairs

structure, weak in resources yet complex in organization, carried out its

mission at all levels of command—

from the division to the Supreme

Headquarters. By 1944 SHAEF had a

fully functioning Civil Affairs (G-5)

Section. The latter's Public Health

Branch bore responsibility for advising the Supreme Commander on the

dangers to civilian health, for establishing theater-wide standards for

remedial action, and for providing

technical supervision to civil affairs

units. Subordinate commands also

had similar G-5 sections.

The umbrella organization for civil

affairs field workers of all types was

ETOUSA's European Civil Affairs Division (ECAD). The division was organized into four component regiments, and each of these units had its

own surgeon. In September 1944 all

ECAD medical personnel were gathered into the European Civil Affairs

Medical Group. At this time the

ECAD surgeon, Lt. Col. James P.

Pappas, MG, a meticulous organizer

who demanded superior work ("I

shall not tolerate lackadaisical nor satisfactory nor even very satisfactory

performance on anyone's part," he

warned) also assumed command of

the group.4

Civil affairs detachments were

formed from the European Civil Affairs Division at the request of field

force commanders. Their makeup depended on local needs, and many had

public health responsibilities. While

in the field, they served under the

local commander, with policy guidance from his G-5 section. Small

groups of experts, they worked as

advisers to the liberated civilians, provided liaison with the military authorities, sought out medical supplies to

aid local recovery, and did all in their

power to reestablish sanitation and

normal health discipline after the disruption of battle.5

Regulations and common sense

both required civil affairs personnel

to cooperate closely with the field

force medics. In turn, many unit surgeons were sympathetic to the con3

 Dwight D. Eisenhower, Crusade in Europe (Garden

City, N.Y.: Doubleday, 1948), p. 192.

4

 Pappas was a Regular Army medical officer

whose work with the European Civil Affairs Division

led to a diversified career in preventive medicine.

Ultimately, he became the inspector general in the

Office of the Surgeon General. Quoted words from

Memo, Pappas to All Officers and EM, EGA Medical

Group, 13 Mar 45, sub: EGA Medical Group Efficiency—Discipline—Morale, Corresp fldr, file

816541, box 59, RG 338/332, NARA. 5

Ebbe Curtis Hoff, ed., Civil Affairs/Military Government Public Health Activities, Medical Department,

United States Army in World War II (Washington,

D.C.: Office of the Surgeon General, Department of

the Army, 1976), p. 405-29.
546 EUROPEAN THEATER OF OPERATIONS

cept of civil affairs, if only because

the health of troops was closely linked

to that of the people among whom

they lived and fought. But sources of

friction also existed. The theater chief

surgeon did not set civil affairs policy,

and yet unit surgeons, controlling

most manpower and transport, were

often called upon to aid at least the

emergency care of civilians. Confusion, if not conflict, was systemic

because civil affairs units had the mission but not the means to meet civilian needs and the field forces had the

means but not the mission.

Despite a situation prolific of minor

irritants, civil affairs personnel made

many positive contributions to the

Allied cause, from the beaches of

Normandy to the borders of the

Reich. The first physician with a civil

affairs detachment came ashore on 14

June 1944 and, shortly afterward,

began work in newly liberated Cherbourg. Here the detachment made

contact with the French authorities

and assisted in the repair of the water

system. Finding medical supplies was

an important duty. Civil affairs personnel broke down medical maintenance units, obtained captured supplies from German dumps, and made

French stocks that had survived the

Occupation available to the towns and

refugee camps of Normandy. They

also tracked down reports of communicable disease outbreaks and served

as middlemen between the civil authorities and the military commanders.6

Problems were varied. Many civilians felt more than a little bitterness

over the destruction of lives and

property—beyond the demands of

military necessity, many inhabitants of

Normandy believed—and over the

loss of often profitable arrangements

by which local farmers had supplied

German occupiers with food. Nonetheless, cooperation developed out of

necessity. Within a few days after a

town's liberation, refugees began to

filter back. With homes wrecked, and

often with heavy rains falling (the

summer of 1944 was wet), French authorities and civil affairs personnel

found shelter for the returnees in

ruined buildings, which were often

dangerous as well as cheerless lodgings because of German booby traps.

Only limited quantities of Army food

were needed because Normandy, a

farming region, possessed resources

of its own, even in the aftermath of

battle. The end of fighting brought

better health conditions. Venereal disease declined as the troops moved

out, and outbreaks of diarrhea among

the refugees ended as sanitation improved.

 7

As they worked, civil affairs officers

came to appreciate their own good

fortune in finding a farming region,

rather than a populous industrial

area, as the first place to put their

classroom lessons into practice. The

region produced much of its own

food, and the people were sturdy and

self-reliant. "Stolid, almost impossible

to panic," the tough, durable Norman

6

Thomas B. Turner and Glen W. McDonald,

"Civil Health in Theaters of Operations," The Military Surgeon 96 (January 1945): 131-34.

7

 Rpt, G-5, SHAEF, 1 Jul 44, sub: Summary of CA

Field Operations for Period Ending 30 Jun 44, file

HD 014 (CA/Public Health, ETO-CA Branch, May

44-Mar 45); Study No. 35, G-5, USFET, sub:

Report of General Board, USFET, on Displaced

Persons, Refugees, and Recovered Allied Military

Personnel, pp. 4-5, file HD 319.4
VICTIMS OF WAR 547

A JOB FOR CIVIL AFFAIRS: ST.-Lo

peasants—even with their large proportion of children, women, and the

aged—proved to be thoroughly

"imbued with the will to live despite

the catastrophe that [had] swept down

upon them."

 8

Difficulties were greater in towns,

where heavy bomb damage and the

organizational confusion caused by

the presence of multiple occupying

units plagued efforts at reconstruction. In Le Havre an EGA detachment's public health officer was at

work. But so were many others. An

EGA regimental surgeon reported

that not only the public health officer

but his French counterpart, a military

port surgeon, and the surgeon of the

Channel Base Section were all attempting to do related and overlapping tasks and that none were talking

to the others. Yet there was work in

plenty for all of them. One section of

the town had been totally demolished;

thirty of the fifty-two local doctors

had been bombed out of their offices,

and three had been killed; a third of

the water supply was nonpotable. The

problem was coordination, and for

this no comprehensive solution existed.9

8

 Surg, ECA Medical Group Annual Rpt, 1944,

sec. 3, p. 11.

9

 Rpt to CO, 1st ECA Regiment, 30 Nov 44, sub:

Assistance at Channel Base Section, Corresp fldr,

file 816541, box 59, RG 338/332, NARA.
548 EUROPEAN THEATER OF OPERATIONS

During the breakout and pursuit

the number of people for whom civil

affairs was responsible expanded with

the size of the liberated area. Yet its

medics seemingly kept abreast of civilian needs, if only because the bitter

fighting of the Battle of Normandy

was over. The major diseases were

enteric infections—dysentery, diarrhea, and typhoid fever.

Other widespread ills—venereal disease, diphtheria, tuberculosis, and

scabies—reflected the conditions of

the German occupation and the pres- ence of both enemy and Allied

armies. Lack of penicillin for combating venereal disease among civilians

was a persistent difficulty. The war- time spread of diphtheria, caused by

the lapse of vaccinations, was more

easily met. Civil affairs personnel labored to stimulate programs of immunization, especially among children, using military supplies of toxoid

until civilian laboratories could

reopen and reestablish production.

Paris fell with little fighting. Alarming forecasts of mass hunger proved

to be greatly exaggerated, though deficiencies were real enough and civil

affairs officers dispatched 11,000 tons

of food in truck convoys as an emergency measure. Shortages of fuel

were serious notwithstanding the

summer weather, for without fuel the

city could not cook its food, pump its

water, light its streets, or flush out its

sewage. Yet Paris' own resources

were great, and were quickly applied

to its medical needs. The Pasteur Institute supplied serums, medical and

surgical equipment was abundant,

and trained personnel were numerous

and sophisticated. Meanwhile, in

southern France an EGA regiment accompanying the Seventh Army labored at Nice and Cannes, fighting a

typhoid epidemic traceable to broken

sewer lines. Despite the impact of

war, however, the public health situation had begun to stabilize by autumn

in both the cities and the rural towns

of liberated France.10

While EGA detachments operated

in localities affected by war, other

civil affairs organizations offered

advice to the governments of liberated nations as they sought to restore

normal conditions. SHAEF established special missions to provide liaison between national governments

and the Allied military authorities.

Headed by an American or British officer, each mission had two medical

officers plus a variety of specialists

(venereologists, sanitary engineers,

nutritionists), who were added as

needed. The missions served under

two headquarters: ETOUSA, for

France and Luxembourg; and the 21

Army Group, for the conquered nations of northern Europe. However,

the European Civil Affairs Division

loaned the British twenty-four American experts—fourteen doctors and

ten Sanitary Corps officers—to serve

with Montgomery's headquarters.

Problems varied from nation to

nation. Belgium requested consultants in nutrition, while France wanted

experts in veterinary medicine and

10John W. Bailey, "An Outline Administrative

History of Civil Affairs in the ETO" (hereafter cited

as "Civil Affairs Hist"), p. 198, file 314.7-2; Rpt, Lt

Col H. R. Hennessy, G-5, COMZ, 30 Dec 44, sub:

Summary of Public Health, COMZ, ETO, box 1, H.

R. Hennessy Papers, MHI; Harry L. Coles and

Albert K. Weinberg, Civil Affairs: Soldiers Become Governors, United States Army in World War II (Washington, D.C.: Office of the Chief of Military History,

Department of the Army, 1964), pp. 722 and 759-

82; Surg, ECA Medical Group, Annual Rpt, 1944,

sec. 3, p. 13.
VICTIMS OF WAR 549

narcotic drug control, among others.

In all nations the missions determined from civilian authorities what

medical supplies were needed and

sought to obtain adequate quantities

from military depots and other

sources. They also recruited medical

workers for refugee camps, investigated sanitary conditions, and monitored

disease outbreaks. The commonest

problems among civilians were those

classic accompaniments of war, malnutrition and venereal disease, and

both entailed policy recommendations

to Allied governments as well as efforts to obtain supplies of food and

medication. At the top as at the

bottom, civil affairs medics proved an

essential lubricant in the process of

starting once more the paralyzed

wheels of civil government health

care. By September French public

health departments had resumed operation in many areas, and officials

had once again begun to collect communicable disease reports.11

To this point success keynoted the

civil affairs story, for much good was

accomplished with modest means. Yet

organizational problems lingered.

Contradictory directives emanated

from ETOUSA and SHAEF. In late

September ETOUSA attempted to

clarify the chief surgeon's civil affairs

responsibilities. Hawley was thenceforth to be responsible for the requisitioning, storage, and bulk issue of

medical supplies for civilian use; for

supervising public health and sanitation, as necessary, to safeguard the

health of the military command; and

for furnishing tactical advice and support to civil affairs personnel. Apparently, the distinction between military

and civil affairs medicine was breaking down at the ETOUSA level. At

the level of the field forces, however,

unit surgeons continued to resent the

civil affairs medics who operated in

their commands, demanding their assistance but on occasion rejecting

their advice.

For their part, civil affairs medical

officers sometimes expressed foreboding over the inadequacy of their

organization in view of the monumental tasks that lay ahead. "I feel," emphasized one high-ranking officer of

the Public Health Branch, G-5,

SHAEF, "that the Tables of Organization have been totally inadequate

from the top to the bottom in our

public health program. They have

been inadequate in SHAEF and at

every staff level below us." As the reconquest of Europe proceeded, men

and supplies not only were spread

thinner but encountered worse problems. In the late autumn severe fighting began again, and in December the

Ardennes attack fell with full fury

upon disordered regions, where recovery had only begun.12

The German eruption during one

of Europe's coldest winters pushed

hordes of suffering refugees and DPs

into the region just behind the lines,

already crowded with Allied troops.

In front-line cities like Liege, bombing forced the homeless into underground air raid shelters that

were potential incubators of epidemic

louse-borne typhus. Food stores were

lost; freezing weather impeded transport; military needs monopolized

11Hoff, ed., Civil Affairs/Military Government, pp.

427-29 and 452-67.

12

 Interv, OSG with Lt Col Leonard A. Scheele,

USPHS, 8 Dec 44, file HD 000.71, CMH.
550 EUROPEAN THEATER OF OPERATIONS

whatever vehicles still moved on rail

or road; and the waterways were

frozen. Some local officials, fearing

German reprisals if recaptured, hastily

decamped, and at least one military

government detachment was overrun

and captured.13

Public health efforts continued

through the attack, though under

great difficulties. In the hard-hit First

Army area an EGA detachment sur- veyed the hospitals and moved injured civilians into facilities at Verviers and Liege or, when none were

available, into private homes. Its

public health officer drew up a sanita- tion plan, and military and civilian

police strove to enforce it. When

diphtheria broke out, the First Army

provided antitoxin. Civilians gave critical assistance to the slender civil affairs cadres by helping to care for

themselves; the local Red Cross provided evacuation, and some local doctors braved the battle to aid survivors.

As the enemy withdrew, soldiers

aided in reopening local hospitals,

and the SHAEF mission turned over

supplies of drugs, dressings, and ambulances to Belgian public health

workers. But even as the battle

ended, a new and unprecedented

challenge loomed as the invasion of

Germany impended.14

Military Government

American troops seized small areas

of western Germany as early as September 1944. The first military government teams were at work in

Aachen, "a fantastic, stinking heap"

of snow-clad ruins, as the Ardennes

offensive swept close by.15 Widespread occupation of enemy territory,

however, followed the collapse of the

Bulge in January 1945. During February almost the entire Rhineland fell,

and invasion of the German heartland

followed in March. Hitherto the chief

duty of civil affairs personnel had

been that of advising and assisting

friendly governments. Now it became

that of helping to rule a conquered

people.

Policy guidance for the effort was

less than satisfactory. A handbook

prepared by SHAEF was rejected by

President Roosevelt as too lenient.

Guided by the ideas of Secretary of

the Treasury Henry J. Morganthau,

Jr., the Joint Chiefs of Staff determined to treat Germany as a conquered, not a liberated, territory; not

to rehabilitate its economy, except as

required by military necessity; and

not to provide any relief to its people,

except to prevent disease or disorder.

Immediately following the conquest

of German soil, the Supreme Commander was to become responsible

for establishing military government.

He was to delegate his power to army

group commanders, and so on down

the line; in short, military units were

to administer the areas they occupied.

At some time following the surrender,

power was to pass to a control commission representing the United

States, Great Britain, and the U.S.S.R.

13 Meanwhile, order had to be reestab- Hoff, ed., Civil Affairs/Military Government, p.

451; Study No. 35, G-5, USFET, Report of General

Board on Displaced Persons, Refugees, and Recovered Allied Military Personnel, p. 9, file HD 319.4. 14Hoff, ed., Civil Affairs/Military Government, pp.

451-52.

15

 Robert Wolfe, ed., Americans as Proconsuls: United

States Military Government in Germany and Japan, 1944-

1952 (Carbondale, 111.: Southern Illinois University

Press, 1977), p. 56.
VICTIMS OF WAR 551

lished, the will of the Allies imposed,

Naziism eliminated, war criminals apprehended, and a civil administration

free of Nazi taint set up to work

under military direction. Contacts,

other than necessary official ones, between Americans and Germans were

forbidden, to the end that aloof and

formally correct behavior might make

the conquered sensible of the detestation in which they were held by all

decent peoples.16

Under these general provisions,

Nazi party members and ardent sympathizers were to be removed from

public health organizations. Medical

care would be extended to civilians to

the extent necessary to control communicable disease and to prevent its

spread across German boundaries. As

far as possible, German supplies were

to be used, and German needs to be

met only after the wants of the occupiers and DPs had been satisfied.

While austere, this prescription was

by no means barbarous, and in some

respects worked fairly well; in others,

it proved highly unrealistic, as medical personnel soon discovered. According to Deputy Military Governor

General Lucius D. Clay, the planners

of American policy had led a "cloistered and academic life" and none

had gotten out into the "mud." But

now theory had to be tested against

German realities.17

But who was to direct medical

policy during this first phase of the

Occupation, when field armies still

fought on German soil? Already inadequate for their task, the ECA regiments were divided—two to Germany, one to Belgium, and one to

France. The tasks in Germany proved

to be familiar ones, for the distinction

between conquered and liberated territory, which seemed so clear to planners in London and Paris, amounted

to much less on the ground. As

before, public health personnel provided emergency care to sick and

wounded civilians, restored sanitation,

tried to rebuild civilian medical services, arranged for the transport and

distribution of medical supplies, cared

for DPs and refugees, and fought

against real and threatened epidemics.

German problems differed, however, in their magnitude, their political

dimension, and their entanglement

with the policies of multiple occupying powers. Local governments were

full of Nazis, and purges deprived

them of their most experienced workers at the time when the collapse of

the central government made their

functions more than ever important.

Similarly, the German health professions had never had more urgent

tasks, but all, especially the medical

profession, were tainted with Naziism.

Western Germany was large and contained heavily industrialized areas,

where the infrastructure of power,

water, and sewage disposal lines was

forbiddingly complex, hard to com16

 Directive, G5, HQ, 12th Army Group, sub: Military Government of Germany Prior To Defeat or

Surrender, in Rpt No. 33, General Board, USFET,

sub: Procedures Followed by Civil Affairs and Military Government in the Restoration, Reorganization

and Supervision of Indigenous Civil Administration,

p. 21. 17

 Quotation from John Gimbel, The American Occupation of Germany: Politics and the Military, 1945-1949

(Stanford, Calif.: Stanford University, 1968), p. 7.

See also HQ, SHAEF, Handbook for Military Government in Germany, 15 Sep 44, paras. 396-430;

Ziemke, Occupation of Germany, pp. 31-33 and 89-90;

Hoff, ed., Civil Affairs/Military Government, pp. 468-

69.
552 EUROPEAN THEATER OF OPERATIONS

prebend and to repair. As a whole, the region conquered by the Western

Allies was a food-deficit area, accustomed to draw sustenance from the

East, now devastated by war and occupied by the Russians.

To meet such unprecedented difficulties, SHAEF was obliged to turn to

the field forces because they alone

had the necessary medical troops, trucks, and supplies. The change

came quickly in the early spring of

1945. Apparently the immediate

cause was pressure form the field

force surgeons, notably Colonel

Gorby of the 12th Army Group and

his preventive medicine officer, Col.

Tom F. Whayne, MC. These two persuaded General Kenner, already convinced by his own observation that

civil affairs could not meet its new responsibilities, to seek new directives

from the Supreme Commander. In

orders issued on 12 and 14 April

SHAEF determined that "partial

ECLIPSE conditions" existed and

concluded that civilian health must

henceforth be a command responsibility.18

Field army surgeons now took

direct supervision and control of

ECAD medical personnel. The responsibility for achieving results also

passed to the field forces, for each

commander became responsible for

plans, policies, and supervision of

public health work in his area within

the existing framework of policy. This

departure was and remained controversial. Some G-5 officers were bitter,

for they were well aware of the many

essential tasks still performed by

trained military government personnel. They still provided guidance and

advice, worked with the field forces in

a variety of jobs, investigated reports

of disease outbreaks, and aided in

medical supply. Through G-5,

SHAEF, they retained a direct wire to

the Supreme Commander and

through European Headquarters,

United States of America Typhus

Commission, a direct connection to

the organization that provided most

of the vaccine and other antityphus

supplies used in the theater. Unworthy gloating by some of those who

had now taken charge did nothing to

salve their feelings. Hawley himself

averred that "the medical service of

Civil Affairs broke down completely

at the first small problems," perhaps

the only time that the difficulties of

conquered Germany were described

as small.19

Implementation of the new arrangement varied in detail from one

headquarters to another. In the 12th

Army Group, discussion between

Colonel Gorby and the G-5, Brig.

Gen. Cornelius E. Ryan, led to an amicable agreement. On 26 April 12th

Army Group G-5 medical officers

18

 Directive, HQ, SHAEF, to CGs, 6th and 12th

Army Groups, and HQ, 21 Army Group and COMZ,

ETO, 14 Apr 45, sub: Public Health Functions in

Occupied German Territory, file G-5/OMGUS

Records, PHB/PWB, box 471, RG 260, NARA.

19

 Quoted words from Ltr, Hawley to TSG, 20

Apr 45, file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Ltr, Draper to "Steve" [Brig Gen

James S. Simmons, Chief, Preventive Medicine

Service, OSG, WD], 9 Apr 45; Rpt, Col Philip R.

Beckford, Surg, 99th Infantry Division, to Chief,

Public Health and Welfare Branch, OMGUS, 3 May

46, sub: Experiences in and Impressions of Military

Government Public Health Operations in Germany,

May 1945 to May 1946; 12th Army Group Report of

Operations, vol. XIII (Medical Section), pp. 238 and

240; Hoff, ed., Civil Affairs/Military Government, pp.

472-81.
VICTIMS OF WAR 553

shifted over to Gorby's medical section, and on 1 May a Public Health

Branch was established under Colonel

Whayne. In the Ninth Army active

management of public health passed

to the corps surgeons, and the corps

boundaries became the basic geographical limits of control. The Ninth

Army surgeon's Operations Branch

supervised public health, and his preventive medicine staff submitted communicable disease reports. In the

Third Army Patton's surgeon assumed direct control over all public

health personnel attached to the

army; he established a public health

subsection in his own office and organized three public health teams, attaching one to each corps. Each team

consisted of one medical officer, one

Sanitary Corps officer, three Army

nurses, and two drivers with vehicles.

Under operational control of the

corps surgeons, the teams organized

and supervised health work at DP

camps, found German health workers

to assist, advised the corps on civil

public health problems, and aided

lower echelons down to regimental

level in meeting day-to-day crises.

The division of responsibility had

ended, and the medical resources of

the field forces, relieved from many

customary duties by rapidly falling

casualty rates, became available to aid

in the care of noncombatants. For all

the ill feeling it had caused, the

change was right and timely. Even as

the reorganization took place, field

forces and military government personnel alike were meeting major challenges posed by epidemic disease

among liberated captives within the

Reich.

The Typhus Epidemic

For centuries, epidemic louse-borne

typhus had been a classic disease of

disorderly times. Caused by rickettsiae—pathogenic organisms intermediate in size between bacteria and viruses—typhus was typically a disease

of winter, when people seldom

bathed or removed their clothing.

Anything that made cleanliness more

difficult, caused crowding, or increased privation might contribute to

an outbreak. Hence its ancient association with war. Often victims infected themselves by scratching louse

bites, rubbing the feces of the insects

into the abrasions in their skin. Rickettsiae in dry louse feces carried on

the skin or hair of others might also

be inhaled. The course of the disease

featured high fever; a rash on the

body; and, in severe cases, delirium,

stupor, and death. Prevention was difficult, requiring elaborate machinery

to bathe large numbers of people and

to steam their clothing. During and

after World War I the disease had

caused millions of deaths in eastern

Europe and Russia.

The American government

launched the fight against typhus

early in the war, establishing the

United States of America Typhus

Commission in 1942 and staffing it

with medical officers drawn from the

Army, Navy, and Public Health Services. Prevention must be the key, for

the disease could not be effectively

treated with any existing drug. Experimental work by the commission, and

especially by the Rockefeller Foundation in North Africa, established a

new method of controlling the disease

by dusting fully clothed people with
554 EUROPEAN THEATER OF OPERATIONS

an insecticide, DDT, whose lethality

and staying power had recently been

proven in Department of Agriculture

laboratories. A crucial test of the

method came during a major outbreak in Naples during the winter of

1943-44. Originating among refugees

huddled in caves and crowded tenements, the epidemic threatened

wholesale loss of life. The commission organized a campaign, with the

assistance of the Rockefeller Foundation and the military occupation authorities, that applied control measures to the whole population of

Naples. The outbreak was halted in

midwinter and in the midst of war—

an extraordinary episode in the history of preventive medicine. Now, however, a new and more severe test

loomed in Germany, for conditions

there, as much as any that history

records, favored the spread of

typhus.20

Attacking prisoners and laborers

from the endemic regions of eastern

Europe, the disease had increased

steadily in Germany from 1939 on.

Some 2,700 cases were reported to

the Nazi government in 1942 and

3,300 the following year. Though

typhus struck German soldiers on the

Eastern Front, and spread widely

among concentration camp inmates,

as long as the Reich held together

normal control measures sufficed to

keep incidence to a relatively low

level. In 1944, however, failure of the

system for reporting typhus foreshadowed a coming debacle, as the once

excellent public health system buckled under the pressures of war. Failing transport meant malnourishment

among military and civilians alike—

and typhus had always been a disease

especially dangerous to the ill-fed. As

the final collapse began, louse-infested slave laborers, many of whom were

already infected, escaped from their

pens and took to the roads. In cities

devastated by bombing, hungry

people huddled for warmth in cellars

and tunnels or abandoned their

homes to become refugees. "Here

were the Four Horsemen, riding

abreast, on the move," wrote Lt. Col.

Sanford V. Larkey, chief of Hawley's

Historical Division, "and the third

[pestilence] was in the lead."

 21

The Allies first met typhus in the

Rhineland, the part of Germany,

shaped like a mutton bone, that lies

west of the river. "The Rhineland in

these days of March 1945," wrote

Colonel Larkey, "could scarcely be

believed by those who saw it—it

cannot be appreciated by those who

did not. It was [the] Wild West, [the]

hordes of Genghis Khan, the Klondike Gold Rush and Napoleon's retreat from Moscow all rolled up into

one." The region seethed with people

wandering this way and that, heading

for home or simply seeking food and

shelter. Roving bands moved mostly

on foot, pulling carts loaded with

their belongings. DPs gathered in

20

 Ebbe Curtis Hoff, ed., Communicable Diseases:

Arthropodborne Diseases Other Than Malaria, Medical

Department, United States Army in World War II

(Washington, D.C.: Office of the Surgeon General,

Department of the Army, 1964), pp. 176-94; Sir

Arthur Hurst, Medical Diseases of War (Baltimore:

Williams & Wilkins, 1944), pp. 235-60; Wiltse, Mediterranean, pp. 362-65; Charles M. Wheeler, "Control of Typhus in Italy, 1943-1944, by Use of

DDT," American Journal of Public Health 36 (February

1946): 119-29.

21

 Quoted words from Larkey "Hist," ch. 14, p.

56. See also Hoff, ed., Arthropodborne Diseases Other

Than Malaria, p. 233.
VICTIMS OF WAR 555

great camps, sometimes 15,000 or

more together, building little fires to

warm themselves and cook their

food.22

In early March a party of Italian laborers trekking home from a camp in

Holland fell into the hands of the

Ninth Army. Four who were sick were

turned over to the 91st Evacuation

Hospital and later transferred to a civilian maternity hospital in Aachen.

Here, a First Army medical officer

spotted them, made a quick diagnosis

of typhoid or typhus, sent the men to

a local contagious disease hospital,

and forwarded sera to the 10th Medical Laboratory. The laboratory confirmed that all four—now in convalescence and out of personal danger—

had typhus.23

A few more cases turned up in

Aachen, all among DPs who had entered the city when already ill. But on

5 March Ninth Army troops encountered more in Moenchen-Gladbach,

30 miles to the northeast. A Dutch laborer, misdiagnosed as a diphtheria

victim, died after passing on his real

illness to the staff and patients at the

local hospital. In turn, he may have

brought the disease from Neuss, a

city on the Rhine across from industrial Duesseldorf, where it had been

introduced the preceding November

by Russians working for the Nazi

labor office, Organization Todt. In

Moenchen-Gladbach the Americans

counted 183 cases among the heavy

concentrations of foreign labor

brought by the Germans to work on

the defenses of the West Wall. Suspicions that the disease might still be

active in Neuss were confirmed when

an officer looking for hospital space

found 21 more cases at the city hospital, where their illness had been misdiagnosed as paratyphoid. Typhus

then spread rapidly to the hospital

staff.

General Hawley, learning of the

outbreak, sent two officers to the

Ninth Army to guide typhus control,

while a representative of the United

States of America Typhus Commission was attached to the First Army.

The system of military government

public health teams proved useful in

meeting the typhus threat; doctors

did on-the-spot examinations of suspect cases, and team members dusted

and isolated contacts of the victims.

Ninth Army medical officers, aided by

German doctors and police, sought to

isolate the centers of infection by

mass dusting and selective vaccination. Meanwhile, the First Army

discovered serious conditions in Cologne. Here public health officers carried out a typhus survey and found 65

cases scattered throughout the bombwrecked city in air raid shelters, prisons, and hospitals. Most were DPs or

former inmates of a Gestapo prison;

the remainder were German civilians.

Members of the local police, in conveying prisoners to the Buchenwald

Concentration Camp, had become infected; 20 fell ill. By early March a

total of 120 cases had developed, 35

of whom died.24

22

 Quoted words from Larkey "Hist," ch. 14, p.

56. See also ibid., p. 55; Rpt, Military Government

Detachment E1-H2, Co H, 2d ECA Regiment, to

CSurg, HQ, ETOUSA, 28 May 45, sub: Typhus Epidemic, Koln, Germany, 1945. 23

 Preventive Medicine Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, pp.

5-7.

24Hoff, ed., Arthropodborne Diseases Other Than Malaria, pp. 242-43.
556 EUROPEAN THEATER OF OPERATIONS

The Americans cleaned out the Ge- stapo prison, moving the sick to hos- pitals and dusting and immunizing

the healthy former inmates (Diagram

6). German civilians were organized

into teams to assist. Spot checks on

the streets of Cologne showed that

typhus was commoner among labor- ers and prisoners simply because they

were far more likely than German ci- vilians to be infested with lice. Again

and again, the spread of the disease

proved to be directly caused by the

large drifting population. A party of

Ukrainian laborers left Cologne early

in March and stopped for two days in

the town of Hermuelheim, sleeping in

a small air raid shelter. On 24 March

thirty residents who shared the shel- ter came down with the disease. Hurriedly, the military government teams

dusted the entire town and immu- nized those who had used the shelter. Other outbreaks flared in the Mo- selle region and the Palatinate, only

to be stamped out by similar quick

action. Reports of new cases declined

rapidly during April and May and

vanished during June. About 700

cases had been spotted in all. By the

first week of summer the Rhineland

was substantially free of the disease. Two-thirds of the cases occurred

among DPs, a group only one-tenth

the size of the German population. But because previous infections had

served to create some degree of im- munity, the DPs who became sick

were more than ten times as likely to

survive as infected Germans (3 per-
VICTIMS OF WAR 557

cent mortality as against 35 percent).25

For the result, credit went to DDT,

the accidents of battle, and the reorganized medical service. The Ardennes battle had delayed the eruption of the Allied armies until the end

of winter, allowing the Reich to maintain some measure of control through

the season when typhus might have

been most devastating. When the

Rhineland fell, Americans were ready

to take charge. Adequate personnel,

guided by experts and employing the

technique of isolating contacts, mass

dusting, and selective immunization,

had knocked out the epidemic. Only

two Americans caught typhus. Both

were medical officers engaged in control work, and their cases were mild.

As the military government took

hold, orders were issued to keep DPs

in their camps pending repatriation to

their own countries. The roads emptied, except for necessary military and

civilian traffic, and the turmoil of the

late winter and early spring came to

an end. The Allies now turned the

Rhine itself into a barrier against the

reintroduction of typhus. The danger

that the disease might spread westward, created by the first crossing at

Remagen on 7 March, caused the

chief surgeon's office to seek a verbal

agreement with the First and Ninth

Armies to prohibit movement of civilians across the river. On the twentieth

the armies established a cordon sanitaire from the Swiss border to the

North Sea along the east bank of the

Rhine and its distributary, the Waal.

All who crossed from east to west,

except Allied military personnel, were

dusted with DDT. Anyone showing

symptoms was sent at once to U.S.

Army medical installations. Shortly

afterward, Brig. Gen. Leon A. Fox,

field director of the Typhus Commission, met with representatives of

ETOUSA and the 12th Army Group

at Hawley's office in Paris to formalize the policy, and a SHAEF directive

followed on 31 March. Hundreds of

thousands of refugee Rhinelanders

returning from the inner Reich were

deloused at ports of entry established

in Oberkassel, Wiesbaden, Mannheim,

and Wesel. POWs were deloused in

prison enclosures, and sometimes

issued dust guns and taught to delouse their comrades. But even as

these measures took shape, medical

personnel knew that a new test would

come to the east of the river.26

Uncovering the Reich

"It was France all over again,"

wrote an American medic in April

1945, "save that this time the end was

in sight. Across the Rhine were the

famous autobahns . . . , spe

back to travel, and distances were not

so important anymore." American

forces liberated Allied soldiers who

had endured anything from days to

years as POWs. Not surprisingly,

most were in poor condition. The

Germans had moved prisoners about

on forced marches, trying to prevent

them from falling into Allied hands;

those who were sick or injured they

25

 Essential Technical Medical Data, HQ,

ETOUSA, April 1945, pp. 3-4.

26

 Preventive Medicine Division, OofCSurg, HQ,

ETOUSA, Semiannual Rpt, January-June 1945, pp.

28-29; Ltr, HQ, ETOUSA, to CGs, Section Cdrs,

and COs, 12 Apr 45, sub: Establishment of a

"Cordon Sanitaire," file 383.7 (DPs: General Policies and Procedures).
558 EUROPEAN THEATER OF OPERATIONS

left behind, to be overtaken by the invaders and to become a burden upon

them. In either case, a new medical

task fell to American field units and

to ADSEC and COMZ hospitals:

Wounded, ill, or hungry, the RAMPs

required quick attention.27

What nearly all had in common was

malnutrition. But differences were

marked between Westerners and east

Europeans. Both the Germans and

their own nations had treated the two

groups quite differently. Western

countries had attempted to support

their soldiers in enemy hands, manifesting interest in their welfare and

sending them great quantities of supplies through the Red Cross. The

Soviet Union, on the other hand, had

not signed the Geneva accords; disowned its prisoners; and, until the

end of the war, showed no concern

for their fate. Poles, Serbs, and many

other captives had no spokesman at

all, for their nations had disappeared

before the Nazi invaders.

The experiences of American

POWs were complex and contradictory. Within the camps poor and inadequate food was a perennial problem,

perhaps the worst that prisoners

faced. Moreover, the ration declined

steadily from the fall of 1944, as air

strikes disrupted German transport.

Red Cross packages provided an essential supplement (supposedly

1,000-2,000 calories a day), but delivery was irregular and became less reliable as the ration declined, for the

same cause. Sanitary conditions

varied greatly from camp to camp,

but they were generally deficient and,

in combination with overcrowding

and an erratic diet, produced much

sickness. Medical treatment usually

conformed to Geneva Convention

norms; the less serious cases were

treated in camp by Allied medics, the

more serious in well-equipped

German hospitals. But generalization

is difficult in the face of variations so

great that a prisoner's life, as well as

his comfort, might depend on whether he was sent to the "remarkably

well equipped" Stalag II-B or to the

"notorious Stalag IX-B," where "one

needle holder, one pair of forceps,

one pair of scissors, and a spool of

black cotton thread" were said to represent all the surgical equipment

available. Overall, however, American

prisoners did well in German camps;

only about one-half of 1 percent

died.28

A report by three army doctors, repatriated in September 1944,

provided a glimpse of life in an Oflag

(officers camp) in the Polish Corridor.

Red Cross and YMCA packages arrived regularly. In consequence,

Americans could buy delicacies on the

black market with cigarettes, trading

with Polish laborers in the camps or

through friendly guards. "The prisoner of war," reported Capt. H. J. Weintraub, MC, "is the richest man in

Germany." Though buildings were illheated, clothing was old and poor,

and medicine was in short supply,

Americans were constantly reminded

of their relatively prosperous lot by

27

 Quoted words from 110th Evacuation Hospital

Semiannual Rpt, January-June 1945, pp. 5-6. See

also Surg, Third U.S. Army, Semiannual Rpt, January-June 1945, p. 35.

28

 David A. Foy, For the War Is Over: American Prisoners of War in Nazi Germany (New York: Stein and

Day, 1984), pp. 114-15. See also pp. 17-81. By

comparison, about 38 percent died in Japanese

prison camps.
VICTIMS OF WAR 559

observing their fellow prisoners. The

British were worse off in their camps;

the French and Poles fared miserably;

and "horrible conditions" existed

among the Russians, caused by starvation, tuberculosis, and typhus. When

Russians were sent to the American

camp as hospital workers, the doctors

put the worst cases to bed, ignoring

German orders to make them work.29

Beginning with the Ardennes, however, treatment of American prisoners

declined and soon approximated that

endured by the Russians for many

years. The reason lay not in any

change of policy, but in the advanced

state of disintegration of the German

Army and nation. Americans captured

in the Bulge were in poor condition

when retaken. "Many," noted a hospital report, "were nothing more than

wraiths of skin and bone, too weary

to rise from their cots, and too emaciated to be able to eat a solid meal."

Ceaseless marching without sufficient

food or rest was the basic cause. "We

marched, starved, froze, scratched

lice, suffered from sickness and . . .

marched some more," recalled one

American. "We lived in fields, slept in

barns or fields, and dodged aerial

strafings. We covered 600 miles in 87

days, and I had joined the Air Force

so I wouldn't have to walk."

 30

As prisoners of a retreating army,

they had also been subjected to

random brutality by individual guards

or officers. At Heppenheim the Seventh Army overran a German camp

for Allied prisoners, where 283 American patients were found in "terrible

condition due to brutal treatment

rendered by a German Major, Medical

Corps, who admitted his hate for

Americans." After a Good Friday visit

by General Devers, the 6th Army

Group commander, the men were

quickly transferred to general hospitals. In custody, the German medical

officer committed suicide.31

Initially, policy emphasized holding

all RAMPs in place, as long as military operations continued. Responsibility fell upon the American and

British medical services, but other

Allied nations were encouraged to

provide medical assistance, to the

extent possible, and to evacuate their

compatriots "expeditiously" in order

to relieve the two principal western

Allies to the burden. Because no Russian or Yugoslav hospitals existed,

their RAMPs were cared for in

German facilities. Russians were retained in the western zones of Germany, pending the junction of American

and British forces with the Soviet

armies. By international agreement

the Russians were separated from

others, granted special privileges, and

placed in camps where soldiers and

civilians were mixed together.32

29

 Quoted words from Interv, ETO with Capt

H. J. Weintraub, 30 Sep 44, file 383.6 (Intervs, Repatriated POWs) ETO. See also W. Paul Havens,

Jr., ed., Infectious Diseases, Medical Department,

United States Army in World War II (Washington,

D.C.: Office of the Surgeon General, Department of

the Army, 1963), pp. 390-92; Larkey "Hist," ch. 14,

p. 15; Havens, ed., Medical Consultants, pp. 452-55. 30

 First quotation from 110th Evacuation Hospital

Semiannual Rpt, January-June 1945, p. 5. Second

and third quotations from Foy, For You the War Is

Over, p. 144.

31

 Surg, Seventh U.S. Army, Semiannual Rpt, January-June 1945, p. 7. 32

 Admin Memo No. 48, HQ, SHAEF, 26 Feb 45,

sub: Hospitalization and Evacuation of RAMPs, in

Book II, Planning Branch, Operations Division,

OofCSurg, HQ, ETOUSA, 1945, file 383.6 (ETO);

ADSEC Hist, p. 158; Historical Division, European

Continued
560 EUROPEAN THEATER OF OPERATIONS

MALNOURISHED AMERICAN RAMP

In March 1945, however, a staff

conference in the Office of the Assistant Chief of Staff, G-4, ETOUSA,

modified the policy by providing for

quick evacuation of British and American RAMPs. A system of "buffer

camps" was set up in Belgium and

France—at Liege, Epinal, Stenay, Le

Havre, and Rouen—and at Bournemouth, England, to receive 60,000 to

70,000 men. For Americans, Camp

Lucky Strike in the Normandy Base

Section near Rouen became the largest reception center. Here the 77th

Field Hospital opened on 8 April,

with an initial capacity of 350 beds.

Patients arrived in such numbers,

however, that the 306th General Hospital moved in to care for convalescents—an additional 1,000 beds. Of

the first 12,000 RAMPs to arrive at

Camp Lucky Strike, 18 percent required hospitalization. As usual, malnutrition, with its many complications, was the root cause.

Some problems developed in handling these cases. A newspaper report

alleging intolerable conditions at the

camp brought General Eisenhower

and five visiting U.S. senators on an

inspection trip. Complaints among

the physically fit centered on their

urgent desire to go home. Some men

were dissatisfied with the food, particularly the bland diet served to new

arrivals without salt or seasoning. The

problem with diet reflected the lack of

knowledge among well-fed Americans

of how to handle starvation victims.

Earlier, the Red Cross and the post

exchanges, with misguided kindness,

had plied RAMPs with candies and

other food their depleted systems

were unable to handle. Reacting to

the bad results, doctors at Camp

Lucky Strike enforced small though

frequent feedings of food that seemed

tasteless to men whose dreams, for

many months, had featured rich and

heavy meals. Medical personnel also

may have exaggerated the condition

of their charges. Despite the long

lapse, their digestive processes revived with use. Men ate in four successive messes, each presenting a

more elaborate menu; they took between-meal feedings of cocoa and

eggnog and swallowed multivitamins

with their food. A daily intake of

some 5,000 calories brought a rapid

gain in weight, while enteric sympCommand, "RAMPs: The Recovery and Repatriation of Liberated Prisoners of War," 1947, pp. 38-

74, Ms. no. 8-3.1 CA 8, CMH.
VICTIMS OF WAR 561

toms disappeared under the regimen.

The high-powered inspection team,

finding no basis for the charges, departed satisfied.33

By May the treatment of RAMPs

had become less pressing. The malnourished had been fed; the sick had

either recovered or died. Even in the

last phase of the story the Russians

faced the hardest fate, for upon repatriation to their own country the

prison camps of the Gulag apparently

received not only collaborators who

had served the enemy but also soldiers and laborers merely suspected

of collaboration. For the ETO medical service, however, the emphasis

was shifting noticeably. In the

summer of 1945 the Third Army operated 237 hospitals: 3 for RAMPS;

13 for DPs; and the rest for German

POWs, who by then constituted the

main burden of care.34

The POWs

German soldiers had been taken

prisoner in increasing numbers since

the first days of the invasion, but the

collapse of the Ruhr pocket in April

1945 signaled a new avalanche:

325,000, in place of an anticipated

150,000. This was, however, only a

downpayment on the vast tactical triumph to come. In the same month

the First Army took 389,000 prisoners; the Third Army, 237,000; and the

Ninth Army, 324,000. By 2 June 1945

more than 3 million prisoners were in

American hands; nine days later a

SHAEF report placed the total at

more than 4 million. What was to be

done with a whole captured army?

 35

Despite good intentions, years of

planning for the assault on Europe

had not provided an answer. The obligations of the United States toward

enemy prisoners were defined in the

Geneva accords of 1929 and embodied in the 1940 field manual Rules

of Land Warfare. Both enjoined

humane treatment of POWs, and provided for their medical care.

ETOUSA consigned its POWs to the

Services of Supply, with actual responsibility resting upon the theater

provost marshal. He, in turn, adopted

high-minded rules for the medical

care of prisoners. They were to receive a physical examination upon

their arrival in camp; to be immunized; and, when ill, to be cared for

on the same basis as American

troops. Rigorous sanitary measures

also were prescribed to prevent the

spread of disease in POW camps.36

33

 MFR, Planning Branch, Operations Division,

OofCSurg, HQ, ETOUSA, 16 Mar 45, sub: Handling of RAMPs, in Book I, Planning Branch, Operations Division, OofCSurg, HQ, ETOUSA, 1944-45,

file 383.6 (ETO); MFR, Operations Division,

OofCSurg, HQ, ETOUSA, 9 Apr 45, sub: Policy

Pertaining to Evacuation of Allied Prisoners of War,

file 383.6; Eisenhower, Crusade in Europe, pp. 420-

21; Bayne-Jones Interv, 1966, vol. 4 p. 773, NLM;

Essential Technical Medical Data, HQ, ETOUSA,

April 1945, apps. 22-29. 34

 298th General Hospital Annual Rpt, 1945, pp.

118 and 255; Surg, Third U.S. Army, Semiannual

Rpt, July-December 1945. See also Coles and Weinberg, Civil Affairs, pp. 854-55.

35

 Eisenhower, Crusade in Europe, p. 406; OofTPM,

HQ, ETOUSA, Weekly PW Status Rpt, 2 Jan 45, file

383.6, box 316, RG 112, NARA; Rpt, G-1, SHAEF,

11 Jun 45, sub: Totals on Prisoners of War Taken

and Disarmed Enemy Forces Rounded Up, file

383.6/1-3, box 26, RG 331, NARA. 36

 Field Manual 27-10, Rules of Land Warfare, 1940;

Technical Manual 19-500, Prisoners of War, 5 Oct 44,

pp. 1-3; Ltr, HQ, SOS, ETOUSA, to Provost Marshal, SOS, and Cdr, SOS, 26 Nov 42, file 383.6

(POW Hospitalization, 1942-44); in same file, Regulations Governing Prisoners of War, OofTPM, HQ,

ETOUSA, 10 Jul 43.
562 EUROPEAN THEATER OF OPERATIONS

Before D-Day Axis prisoners were

transported to remote rear areas, including Great Britain and the United

States, where their treatment was in

general excellent. Similarly, the first

prisoners taken after the invasion

were shipped back across the Chan- nel. But when large numbers began

to fall under the Army's control

during the breakout and pursuit,

POW camps were set up on the Continent, some in the very buildings earlier used by the Germans to house

Allied prisoners. Military police units

ran the camps, and provisional POW

overhead detachments saw to the

prisoners' medical needs, which were

usually great. POWs arrived in

masses, many ill or injured in battle.

Camp construction went slowly, and

overcrowding, insufficient shelter, and

cold rations were the rule. For these

camps in liberated France, the coming

of the year 1945 at first meant vastly

improved conditions of life, while establishment of the POW hospital

center near Cherbourg offered expert

treatment for those needing medical

or surgical care.37

Yet some basic problems were not

addressed. Field forces often stripped

POWs of their personal equipment, including tents and even mess gear,

apparently in order to cram the maximum number into the available transport. Because the camps often had no

equipment to issue, many prisoners

lived without shelter and ate canned

rations with sticks for spoons. Enteric

and respiratory illnesses followed.

Major lacks existed in the medical

support system through the early

stages of capture, detention, and

transport to the rear. Neither the

military police battalion, the escort

guard company, nor the POW processing company had organic medical

elements. Added to the confusion and

disorder of war, and the battered

state of many railways, the lack of

professional advice to commanders

helped to make for some rough journeys. Prison trains rolled for days

without adequate provisions for

water, sanitation, rest, or even ventilation, and their arrival in the rear

threw new waves of sick and exhausted men upon the prison camps.38

The masses who surrendered in the

spring of 1945 presented a new and

stunning challenge. ETOUSA planners had failed either to foresee the

dimensions of an unconditional surrender or to allow for the disintegration of the German Army that

accompanied it. Treatment of

German prisoners by Americans mirrored the experience of Americans in

enemy hands: Those captured last

suffered most. Improvisation became

the rule in Germany and resulted in

the creation of POW transient enclosures—institutions that did no credit 37

 On POW camp conditions, see 2029th PWOD

Annual Rpt, 1944, pp. 2-3, and Semiannual Rpt,

January-June 1945, pp. 7-8. See also 2021st PWOD

Annual Rpt, 1944, p. 5; 2018th PWOD Periodic

Rpt, April-December 1944, p. 3; 6832d PWOD

Periodic Rpt, 25 Aug 44-30 Jun 45, pp. 2-3; and

2024th PWOD Semiannual Rpt, January-June 1945,

p. 2. All in box 383, RG 112, NARA. Information

on POW general hospitals will be found in file

319.1-2, box 440, RG 112, NARA.

38

 For the makeup of military police formations,

see T/O&E 19-35 (August 1943), T/O&Es 19-47,

19-55, 19-57, 19-237 (November 1943); T/O&E

19-500 (April 1944); and T/O&E 19-7 (September

1944). In March 1945 124 POWs suffocated in transit, provoking an IG investigation and an American

apology to the German High Command. See report

of investigation in file 383.6/3-16, box 26, RG 331,

NARA.
VICTIMS OF WAR 563

PRISONER-OF-WAR TRANSIENT ENCLOSURE AT REMAGEN

to the humanity or competence of the

victor.

Early in April the theater provost

marshal decided that the approaching

inundation (which he underestimated

by almost 2 million) would have to be

absorbed in great part by four enclosures to be established along the

Rhine. The surrenders of that month

and May, however, soon raised the

number of transient enclosures to

seventeen (see Map 24). In most if not

all, sanitary conditions were wretched;

"the dysenteric feces of the penned-in

thousands were trampled and emulsified in the muddy surface of the

ground." In one barbed-wire pen

near Remagen a mass of louse-infested men, ranging in number up to

169,000, endured the cold European

spring with no shelter whatever.

Their guards, untrained for the task,

were temporary-duty men pulled from

infantry units. Colonel Mason, the

ADSEC deputy surgeon, viewed the

result with amazement:

April 20th was a blustery day with alter- nate rain, sleet and snow and with bone

chilling winds sweeping down the Rhine

Valley . . . over the flats where the e

sure was located. Huddled close together

for warmth, behind the barbed wire was a

most awesome sight—nearly 100,000 hag- gard, apathetic, dirty, gaunt, blank-staring

men clad in dirty field gray uniforms and

standing ankle deep in mud. Here and

there were dirty white blurs which, upon

VICTIMS OF WAR 565

a closer look, were seen to be men with

bandaged arms or standing in shirt

sleeves! The . . . that the men had not

eaten for at least two days, and the provi- sion of water was a major problem—yet

only 200 yards away was the Rhine River

running bank full.39

Conditions in the transient enclosures bore heavily upon men already

malnourished and ill-clad, and caused

extraordinary sick rates. From 1 May

to 15 June POW admissions to hospitals were about eight times those of

American troops; the POW death rate

from disease was about 20.5 times as

great. Almost a quarter of all prisoners in the Advance Section showed up

on sick call every week. The fact that

the sick could be hospitalized was a

tribute to Colonel Beasley, the

ADSEC surgeon. Strengthened by a

command decision giving him control

of the medical units within the command, Beasley established dispensaries within the enclosures—in buildings, if available, or in tents—and

staffed them with German medics.

Field hospital sections moved up to

the wire and made a practice of holding patients until doctors were convinced that they could endure life in

the open. When a case of typhus appeared at the Remagen camp, Beasley

assigned three officers from ADSEC's

Preventive Medicine Division and sixteen five-man teams, drawn from the

423d and 480th Fumigation and Bath

Companies, to dust all the prisoners

and the Americans who had been in

contact with them. While the pen was

quarantined for twenty-one days, the

dispensaries segregated and sent to

the hospitals for observation any sick

who appeared likely to have typhus.40

In view of the harsh conditions in

the transient facilities, medical intervention may have prevented mass

deaths. Elements of the 9th, 50th,

61st, 62d, 78th, and 83d Field Hospitals supported the enclosures, and

new POW hospital centers were

established with German medics

working under the general superintendence of American medical battalions. During the period from 1 May

to 15 June American medics reported

a death rate among POWs in the enclosures of 35.6 per thousand, or 3.6

percent per year, with diseases—diarrhea and dysentery heading the list—

as primary causes of mortality.41

With the end of the fighting, running the transient enclosures became

the mission of several divisions of the

field armies, but ultimately of the

106th Infantry Division alone. The

primary duty of providing medical

care fell to the division surgeon. The

burden was great. Food was "not

plentiful"; sanitation remained poor.

According to the surgeon, "PWTEs

containing up to 160,000 louse infested people, a high percentage of

whom were either sick or wounded,

39

 First quotation from Ebbe Curtis Hoff, ed., Special Fields, Medical Department, United States Army

in World War II (Washington, D.C.: Office of the

Surgeon General, Department of the Army, 1969),

p. 375. Second quotation from James B. Mason and

Charles H. Beasley, "Medical Arrangements for

Prisoners of War En Masse," The Military Surgeon

107 (December 1950): 345.

40

 Hoff, ed., Special Fields, p. 394; ADSEC Hist, p.

162; Surg, ADSEC, COMZ, Semiannual Rpt, January-June 1945, pp. 6-7; Gordon Hist, vol. 1, pt. 3,

p. 19, CMH. 41

 Memo, Seventh U.S. Army, 13 May 45, sub:

Consolidated List of PW, PWX & DP Installations,

box 316; Surg, ADSEC, 13 May 45, sub: Report on

PWTEs, box 313. Both in RG 112, NARA. See also

Essential Technical Medical Data, HQ, ETOUSA,

July 1945, pp. 4-5 and encl. 11.
566 EUROPEAN THEATER OF OPERATIONS

crammed into spaces initially meant

for 20 to 50 thousand was not a

pleasant picture." Shelter was nonexistent, even for the old and young.

Rain soaked the prisoners, and the

nighttime cold indirectly caused the

deaths of a few by carbon monoxide

from the small fires they had built

inside the foxholes where they lived.42

Medical progress was halting—rich

in personnel, poor in supplies.

German medics were rapidly screened

and organized, and delousing teams

were set to work. But neither the

106th Division nor the camp commanders could obtain medical supplies from higher headquarters during

April and May, though all the vehicles

controlled by the division surgeon

and the medical battalion "were on a

constant 24-hour medical supply

hunt." The division obtained some civilian nurses through the German

Red Cross and local officials. Hospitals were set up in buildings or tents.

All were in close proximity to the enclosures, and all had an adequate

supply of water. The primary causes

of admission were dysentery and

upper respiratory infections, as might

be expected. "Thank God for this

mercy!" exclaimed a POW who found

himself in a hospital on 28 May. "I

rest again—for the first time since the

beginning of April—in a bed! I can

cover myself with a good big brown

American blanket!"

 43

By June the 106th Division was running all seventeen POW transient enclosures, two of which contained not

POWs but Russian and Czech DPs.

The surgeon counted 10,000 beds in

the fifteen attached hospitals, staffed

largely by German medics. On the

twelfth the British took over the enclosures, with some 200,000 inmates,

in their zone. Rapid discharges in the

camps that remained combined with

warm weather to bring about a sharp

decline in sick rates. On 10 July the

French 10th Infantry Division took

over the remaining POW enclosures

along the Rhine in what was now the

French Zone. Adding up the totals of

its prisoner patients, the 106th Division recorded 1,817,393 cases on sick

call and 1,697 deaths, of which 1,404

had occurred in May, 214 in June,

and 79 in July.44

Complicating prisoner health problems in the European Theater were

changes in the food ration. During

the early fighting on the Continent

prisoners had been more than adequately fed, receiving under Geneva

rules rations equivalent to those of

American soldiers. As a result, even

nonworking prisoners ate better than

Allied civilians. In response to an

outcry against coddling POWs, the

ration was reduced in December

1944. Yet prisoners were still reported to be gaining weight in captivity.

They were also increasing in number,

42

 Surg, 106th Infantry Division, Annual Rpt,

1945, pp. 5-6, file 319.1-2, box 392, RG 112,

NARA. 43

 First quotation from ibid., p. 8, file 319.1-2,

box 392, RG 112, NARA. Second quotation from

Kurt W. Boehme, Die deutschen Kriegsgefangenen in

amerikanischer Hand: Europa (Munich: Verlag Ernst

and Werner Gieseking, 1973), p. 316.

44

 Surg, 106th Infantry Division, Annual Rpt,

1945, p. 17, file 319.1-2, box 392, RG 112, NARA.

On the internal economy of the camps, see policy

memoranda in ibid., plus Daily PWTE situation reports in Medical Branch, COMZ, ETO, POW Enclosure Rpts, box 17, RG 332, NARA. See also Fred

Clinger, Arthur Johnston, and Vincent Masel, The

History of the 71st Infantry Division (Augsburg: E.

Kieser KG, Druckerei und Verlag, 1946), p. 101.
VICTIMS OF WAR 567

GERMAN MEDICS TREATING A GERMAN

POW in a military hospital

for optimism among the Allies over a

quick end to the war caused outshipments of POWs to the United States

and England to be suspended from

October 1944 to February 1945.

Then in the spring of 1945 a worldwide food shortage, caused in great

measure by transport problems,

brought warnings from the War Department. In March ETOUSA ordered strict food conservation in U.S.

Army messes. The question of how to

feed the German Army when it surrendered also became acute, especially in view of the Geneva rules to

which all Allied nations had committed themselves. Realizing the problems that impended, SHAEF's Prisoner-of-War Division proposed to hold

Germans who surrendered after the

capitulation as disarmed enemy

forces, rather than as POWs, feeding

them a reduced ration drawn as far as

possible from the German economy.

General Eisenhower recommended

paroling farm and industrial workers

promptly, not only to relieve the

Army but also to get the German

economy moving again. Yet this sensible proposal, which was reminiscent

of Lt. Gen. Ulysses S. Grant's method

of handling the Confederate Army in

the spring of 1865, ran afoul of denazification requirements, under which

each POW had to be interviewed several times by G-2 officers, and of the

continental Allies' demands for POW

labor to speed up postwar reconstruction.45

In mid-May SHAEF met the problem by defining the prisoners as

workers or nonworkers, placing the

former on a 1,500-2,000-calorie

ration and the latter on a 2,900-calorie ration. While the nonworker

ration was about the same as the official civilian issue, civilians were able

to supplement their dole by bargaining or keeping gardens, options not

usually open to prisoners.

The consequences were quick to

appear. Carrying out the orders of

SHAEF's chief medical officer, General Kenner, a nutrition survey team in

May inspected the POW transient enclosures and reported that the condition of the prisoners was good. Some

POW detachment surgeons in the

same month even boasted of weight

gains among their prisoners. By the

45

 Staff Mins, Col P. C. Bullard, SHAEF-PWX, 19

Mar 45; Msg, Eisenhower to G-1, SHAEF-PWX.

Both in file 383.6/3-17, box 26, RG 331, NARA.
568 EUROPEAN THEATER OF OPERATIONS

end of the month, however, a report

from the Koblenz camp surgeon

revealed that nonworkers were receiving inadequate rations. Extensive malnutrition was recorded in the stockades of the Third and Seventh Armies

and the Communications Zone in

August. Avitaminosis appeared in

florid deficiency syndromes, caused

by not only the reduced ration but

also the fact that fine-ground unenriched American flour formed a large

part of it. Prisoners showed early

symptoms of pellagra and beriberi,

and weight loss was common. Conditions also varied widely from one

camp to another, making a mockery

of official policy. A new survey, ordered in August by Kenner with the

concurrence of the provost marshal,

found that nonworkers received anywhere from 1,250 to 2,040 calories a

day, workers from 1,450 to 2,882.

Furthermore, worker and nonworker

were variously defined. In some

camps young prisoners received dietary supplements in recognition of

their greater metabolic needs; in

others they did not.46

This survey resulted in immediate

action. Kenner issued a letter ordering the surgeons of all major commands to provide multivitamin capsules to all prisoners with signs of

malnutrition. At his instance Eisenhower's headquarters sent a letter to

all commanding generals, revising the

categories of prisoners into workers,

light workers, and nonworkers, and

prescribing menus for feeding each

group. Working rations were ordered

for all prisoners under 21 years of

age, and dietary supplements were

specified for all prisoners found by

medical officers to be malnourished.

A survey team was ordered to make

periodic checks to ensure compliance.47

With many hospitals under their

control, and a variety of liberated

peoples to provide care for, the

armies continued to use both captured supplies and captive labor.

German medical supplies were inventoried and consolidated, and

ETOUSA notified its units that captured stocks were available for POW

enclosures, DP camps, RAMP facilities, and German civilian hospitals,

and set forth a standard procedure

for ordering needed items.

Under Geneva rules enlisted POWs

could be required to work at specified

jobs, and many found employment in

the hospitals. Hospital centers housed

German laborers in their own compounds, or drew them daily from

local POW enclosures. DPs served

also, sometimes as guards for the

Germans. By and large the captive

workers made good records, and on

occasion were rewarded with letters

46

 Kenner became theater chief surgeon in July.

See Rpt, Nutrition Survey Team, SHAEF, to CSurg,

ETOUSA, 15 May 45, sub: Nutritional Survey of

German Prisoners of War Under Control of United

States Army on the European Continent, p. 2, in Essential Technical Medical Data, HQ, USFET, July

1945; Hoff, ed., Special Fields, pp. 389-94; Memo,

Nutrition Survey Team, SHAEF, to Chief, Preventive Medicine Division, OofCSurg, ETO, 31 Aug 45,

sub: Report of Nutritional Survey of German Prisoners of War and Disarmed Enemy Elements Under

Control of the United States Army on the European

Continent, box 327, RG 112, NARA; CampSurg,

PWTE A-10 [Koblenz], Weekly Sanitary Rpt, 21

May 45, box 392, RG 112, NARA.

47

 Ltr, CSurg, TSFET, to Surgs, All Major Commands and Sectors, 15 Sep 45, sub: Multivitamin

Capsules for Prisoners of War and Disarmed Enemy

Elements, and Ltr, HQ, USFET, to CGs, 25 Sep 45,

sub: POW Menu #2, Fifth Revision. Both in box 36,

RG 112, NARA.
VICTIMS OF WAR 569

of appreciation from grateful commanders. Some kept hospital medical

records, but apparently none provided hands-on care to Allied soldiers.

When in May Kenner complained to

Hawley of the great number of POW

and DP workers, Hawley pointed out

that the command had no alternative

to employing them. "Demands upon

the enlisted personnel of fixed hospitals," he wrote, "have made it impos- sible to operate ... on an acceptable standard without additional help."

Because many prisoners were only

too happy to work under the better

living conditions of the hospitals, and

to eat the more abundant food, and

because the hospitals needed the prisoners, there was in fact no alternative

to the system, even if one had been

desirable.48

DPs and Slave Laborers

Wherever they went in Germany

during the spring of 1945, Americans

wondered at the numbers of displaced persons. The historian of the

108th Evacuation Hospital remarked

upon "the great migration of these

liberated people" as they "made haste

to leave this hateful country which

had been their prison for many

years." Some trudged afoot; others

rode bicycles; some crowded into

German Army vehicles. Some

dragged rickety homemade carts,

heaped with personal belongings—or

with loot, for the DPs were not scrupulous in dealing either with German

property or with German lives. Neither tractable nor gentle, the wanderers exhibited what Americans came to

call the "Liberation Complex," a mingling of hunger, exultation, and

vengefulness that made them a

danger to their onetime rulers and a

burden to their liberators.49

DPs had been drawn into Germany

from almost every nation of Europe

to labor for Hitler's war effort. Some

had been volunteers, some conscripts,

some little better than slaves. Their

treatment varied widely. Farm laborers fared best, sharing the food they

helped to raise or, at worst, finding

opportunities to glean or steal sustenance. In Prussia a Western correspondent covering the Russian advance heard a Frenchman boast, "It

was we ... who ran the agriculture

of East Prussia in the last two years."

At Hadamar, in the state of Hesse, a

former insane asylum turned Gestapo

prison held both well-fed Poles and

starving Germans. The Poles were

farm workers; the Germans were political prisoners restricted to the

prison ration. Civilian and military

prisoners were often found mixed together, for some RAMPs had been

compelled to labor and some had

sought it as an alternative to starvation. Though the overall state of millions of individuals defies summary,

DPs and RAMPs in good physical

48

 Quoted words from Ltr, Hawley to Kenner, 1

May 45, box 2, Hawley Papers, MHI. See also GO

No. 29, Oise Section, COMZ, 4 Mar 45, sub: Estimate of Labor Service Companies, file 383.6; 803d

and 819th Hospital Centers Semiannual Rpts, January-June 1945; Cady, "Notes on the 21st General

Hospital (AUS)," p. 585, Cady Papers, MHI; Gorby

Interv, 1962, CMH. On SHAEF opposition to allowing POWs to provide medical care for Allied soldiers, see Ltr, HQ, ETOUSA, to Section Cdrs,

COMZ, 9 Feb 45, sub: Utilization of German Protected Medical Personnel. For information on earlier POW service in hospitals, see Chapter XIV of

this volume.

49

 The 108th Evacuation Hospital Travelogue,

June 1945.
570 EUROPEAN THEATER OF OPERATIONS

condition were rare, with the Russians

among them having suffered the

worst.50

Dealing with severely malnourished

and often tubercular patients in the

midst of war proved a difficult task.

With their own wounded to care for,

the field forces often turned for as- sistance to doctors and nurses among

the DPs. They also moved patients

into German hospitals and, in some

cases, when Allied nurses and doctors

were available, set up special hospitals. More rarely, mobile hospital

units took on the task of caring for

sick and starving DPs.51

Typhus was common east of the

Rhine, just as it had been to the west.

Every effort was made to delouse DPs

in their camps and at shipping points,

where they gathered to go home.

Teams equipped with power dusters

set to work at Neubau, where many

western Europeans were evacuated by

air, or at Wuerzburg and Bamberg,

where rail transport to countries east

of the Rhine was centered. As the

number of hospitals for POWs and

American military fell, those for DPs

increased, reaching a total of twentytwo in the Third Army area in September 1945. But depleted American

manpower made consolidation of the

patients and the discharge of as many

as possible to their own countries desirable. An international organization,

the United Nations Relief and Rehabilitation Administration (UNRRA),

began making plans to assume control of the remaining DP hospitals,

except those holding Soviet citizens

who were to be returned to their own

nation.52

With the end of the fighting, the

field armies became occupying forces

responsible for defined regions in the

American Zone of Occupation. Their

division surgeons were now responsible for the DP, RAMP, and POW hospitals in their division areas and for

medical care of the camps. Even with

the advent of UNRRA, the Army

found itself still in charge of many facilities—even of the DP camps, because the international organization

could not at first find the manpower

to assume full responsibility. Thus the

surgeon of the 2d Armored Division

was still charged with two RAMP hospitals, ten DP hospitals, and fiftythree German military hospitals.

Because Army personnel were clearly

inadequate to handle the load—645

RAMP patients, 937 DPs, and 11,409

POWs—dependence upon the various

groups to help care for their own

members also continued. DP dispensaries were maintained by camp inmates under the eye of the division

surgeon, and the Americans viewed

with gratification and surprise the

"high standards of sanitation . . 

maintained by the same people who

had been taken out of the indescribable filth of the concentration camps

50

 Quoted words from Alexander Werth, Russia at

War (New York: E. P. Dutton, 1964), p. 958. See

also Coles and Weinberg, Civil Affairs, p. 858, and

surveys at end of Larkey "Hist," ch. 14, pp. 104 et

seq. General policy is set forth in Ltr 383.7-1, AG,

SHAEF, to HQ, 21 Army Group (Rear), CG, 6th

Army Group (Rear), and CG, COMZ, 27 Mar 45,

sub: Medical Care for DPs and Refugees in Germany, in ETOUSA. 51Havens, ed., Infectious Diseases, pp. 347-48; Rpt,

Sr Consultant in TB to CSurg, ETOUSA, 3 Apr 45,

sub: Tuberculosis in Russian RAMPs at 46th General Hospital, p. 1.

52Surg, Third U.S. Army, Semiannual Rpts, January-June 1945, pp. 90 and 140, and July-December

1945, pp. 1-2 and 33-34.
VICTIMS OF WAR 571

and [prison] hospitals under German

control."

 53

Yet DP camps, because discipline

was less severe and because they con- tained many women, formed a tougher problem for the occupation authorities than either the hospitals or

the POW camps, especially as the

postwar VD rate began to rise. DPs

were not responsible for all, or even

most, of the venereal disease that afflicted defeated Germany: American

troops and German civilians were the

most numerous victims and carriers.

Yet, of the ten DP hospitals in the 2d

Armored Division area, one was for

venereal disease alone. The atmosphere of the camps was not conducive

to high personal standards in any respect. DPs differed greatly from one

another in culture and education; intellectuals and plain folk mingled with

peasants from the most primitive regions of eastern Europe. Inevitably,

though unfairly, the image too many

Americans carried away was of an indistinguishable mass of "sleeping,

eating and scratching people," infested with lice and defecating at

random. Though systematic attention

to cleanliness changed the picture in

some camps, others, especially those

marked for transients, showed little

lasting improvement. The soldiers

were happy to see UNRRA take over

care of the DPs in the fall of 1945

and still happier to see the majority

of the displaced depart to their

homes.54

Mingled with the DPs, Americans

also began to find concentration

camp inmates. Some were on the

roads, in flight with their guards from

advancing Russian spearheads: In the

small south German town of Cham,

Third Army units found 6,000 survivors of a march from the Flossenbuerg Concentration Camp and assigned the 120th Evacuation Hospital

to their care. Others had reached a

temporary haven. At a Luftwaffe airfield in Austria, designated by military

government units to receive the liberated, the 121st Evacuation Hospital

found about 14,000 people whose

condition was that of "starved, halfcrazed animals." Thousands had already been hospitalized in hangars

and barracks by the 646th Clearing

Company, the first medical unit on

the scene. The evacuation hospital

admitted 3,000 patients during the

first week. Medics drew supplies from

a large consolidated depot at St. Florian and also scoured the countryside

for milk and food. Over 300 cases of

typhus were identified, as well as tuberculosis and dysentery. Despite all

efforts, the mortality rate was high

during the first days, and a tenth of

the patients died overall. But many

survivors owed their lives to the

American units and to a German

Army field hospital that had arrived

to give assistance. "Order replaced

chaos," reported the commander of

the evacuation hospital, "and it was

gratifying to see the improvements in

the patients, both physically and mentally."

 55 53

 Surg, 2d Armored Division, Semiannual Rpt,

January-June 1945, p. 7. 54Quoted words from Surg, 29th Infantry Division, Semiannual Rpt, January-June 1945, p. 8. See

also Surg, 5th Armored Division, Semiannual Rpt,

January-June 1945, and Surg, 4th Armored Division, Semiannual Rpt, July-December 1945.

55

 Quoted words from the 121st Evacuation Hospital Semiannual Rpt, January-June 1945. See also

120th Evacuation Hospital Semiannual Rpt, JanuContinued
572 EUROPEAN THEATER OF OPERATIONS

Most inmates, however, were still

behind wire when the Americans arrived. April brought the opening of

two major concentration camps, or

rather camp systems, around Buchenwald and Dachau. In early May Army

units "uncovered" (as the records

usually say) Mauthausen, near the

Austrian town of Linz, where Adolf

Hitler had spent much of his

boyhood. Meanwhile, British troops

captured two large camps at Bergen- Belsen in Hannover (Map 25). Medical conditions among many inmates

were outside the experience of the

medical personnel compelled to deal

with them; the tasks they faced

proved to be loathsome and laborious

in the extreme.

The general history of the concentration camps is well known. The

first, the main camp at Dachau, was

established in 1933, a few months

after the Nazis took power. During

the 1930s concentration camps served

no purpose but to confine, torment,

and destroy enemies of the regime

and members of groups defined as

antisocial. Inmates produced little, in

order not to compete with free labor.

When war came, German conquests

brought an international influx of

prisoners. By 1942 increasing shortages of manpower in the Reich began

to transform camp inmates into true

slave labor. Satellite camps sprang up.

At the war's end Dachau and many

other camps ran industries that were

profitable to the SS and important to

the war effort. Among the prisoners,

conditions of life remained bad because endless new labor was available

to replace the dead. While none of

the western camps was an extermination facility, like Auschwitz and other

camps in the east, killing undesirables

remained an important function. Russian POWs were shot on occasion

and, like Poles and Jews, used by Nazi

doctors as human guinea pigs in bizarre experiments.

In the spring of 1945 the primitive

discipline of the camps enforced by

the SS broke down. The food ration,

always inadequate, apparently fell

from about 1,000 calories a day to

600 or less. Mains, broken in some

cases by Allied bombs, ceased to deliver water. The invasion of the Reich

caused the SS to shuffle prisoners

from one camp to another in unheated boxcars or in forced marches

afoot, to prevent their capture. Overcrowding increased in the barracks,

where the well, the sick, and the dead

sprawled together indiscriminately.

Fuel shortages slowed the incineration of bodies. Filled with people

who were starving and ill, the remaining camps became charnel houses,

whose images confronted an unbelieving world in the photographs and

newsreels made by journalists who

followed the Allied armies.56

Administratively, the concentration

camps fell first under the field armies

The early days following liberation

were chaotic. Quarantine was imposed, and available medical units

ary-June 1945. Both in file 319.1-2, box 408, RG

112, NARA.

56

 Heinz Hoehne, The Order of the Death's Head: The

Story of Hitler's SS (New York: Coward-McCann,

1970), pp. 88 and 199-203. On Buchenwald, see

Rpt, 3 May 45, sub: Visit to Buchenwald Concentration Camp, Weimar, Germany, file 383.6 ETO (Buchenwald Camp). On Bergen-Belsen, see William A.

Davis, "Typhus at Belsen," The American Journal of

Hygiene 46 (July 1947): 66-83. Information on the

medical experiments in the camps may be found in

Chapter XVII of this volume.

574 EUROPEAN THEATER OF OPERATIONS

were thrown in, using their own supplies and calling on the armies for rations to feed the starving. At some

camps German medics were brought

in; at others inmates were sent to civilian or German Army hospitals.

Throughout, former prisoners with

medical training were called upon to

help their fellows. Inmate doctors,

who had been working for years with

virtually no supplies, provided knowledgeable assistance.57

Liberated prisoners suffered from

complex interacting pathologies, advanced starvation, and frequently

traumatic injury as well. Those at Buchenwald were the first in a haunting

army tens of thousands strong.

"There was no adipose tissue on

these people," reported the Third

Army surgeon, "and nutritional

edema . . . was present in all individuals." At Dachau the workers had

received enough food for survival, but

other prisoners were in poor shape.

Many exhibited ulcerated gums,

pallor, and swollen feet; their skin,

thin and fragile, had been worn by

the hard wooden slabs they slept

upon. Abrasions became infected, resulting in boils, abscesses, and ulcers.

Small local infections, under camp

conditions, resulted in "massive nonpurulent edema . . . with sloughing

and gangrene." Tuberculosis was

widespread, diarrhea ubiquitous.

Some inmates, shot or beaten, bore

injured limbs in makeshift slings.

Morbidity ran about 25 percent of the

32,000-odd men and 300 women in

the main camp. The prison hospital,

wrote one of the first doctors into

Dachau, was surprisingly clean and

orderly under inmate control.58

Autopsies on the bodies of typhus

victims revealed widespread and

varied ills: local hemorrhages, liver

and kidney damage, the mucosa of

the colon and rectum eroded or

deeply ulcerated, tuberculosis of the

lungs, and pneumonia. "The heart,"

reported the 116th Evacuation Hospital commander, "was generally pale

and very soft so that a finger could

easily be thrust through it." Doctors

concluded that the patients' typhus

was fairly mild, but superimposed

upon tuberculosis, severe malnutrition, and chronic diarrhea. Under

such conditions the ubiquity of death

was hardly surprising. Troops of the

42d Infantry Division entering

Dachau found the last shipment of

prisoners still at the railhead—apparently Polish Jews from Birkenau who

were sent west to evade the Red

Army. Flatcars and open boxcars held

about 2,500 emaciated bodies, piled

on one another. "Their cadaverous

arms and legs seem[ed] disproportionately long compared to their

sunken abdomens, narrowed bony

chests, visible ribs, protruding shoulder blades, and withered necks. ... "

57

 120th Evacuation Hospital Semiannual Rpt, January-June 1945, file 319.1-2, box 408, RG 112,

NARA; Havens, ed., Medical Consultants, p. 452;

Press Release, "Underground Medical Unit Operated in Nazi Prison Camp," file 383.6 ETO (Buchenwald Camp). The head inmate surgeon at Buchenwald had unique status: The SS guards, respecting

his skill, had required him to treat their own men.

58

 First quotation from Surg, Third U.S. Army,

Semiannual Rpt, January-June 1945, p. 139. Second

quotation from Rpt, 1st Lt Marcus J. Smith, MC, to

PostSurg, Dachau Concentration Camp, 5 May 45,

sub: Health and Sanitation Rpt, file 383.6 ETO

(Dachau Camp), in Source Materials Collected by

Col M. P. Rudolph, MC, box 312, RG 112, NARA.

See also Marcus J. Smith, The Harrowing of Hell:

Dachau (Albuquerque: University of New Mexico

Press, 1972), p. 91.
VICTIMS OF WAR 575

LAST SHIPMENT TO DACHAU. The bodies of starved prisoners, who died en route from

another camp, lie grotesquely in a boxcar.

Some wore striped pajama-like garments; many were naked. Bodies and

freight cars were lightly coated with

white morning frost.59

Survivors gave their liberators

guided tours of the camps. Living

quarters were squalid: "The well, the

sick, the dying, and the dead lie next

to each other in ... poorly ventilated, unheated, dark, stinking buildings." The dead were everywhere. A

nurse at Dachau saw bodies in "huge

stacks like so much kindling wood."

Each camp had a crematory, for, as

the universal joke went, the only way

out was through the chimney. At

Flossenbuerg a little hand-operated

railway ran from the camp to the crematory. Each morning, those who had

died the night before were collected,

dumped into the cars, and pushed to

the furnace. When the Americans arrived, fifteen or twenty naked skeletal

bodies lay stacked and waiting to be

burned. "It was a weird place," recalled a battalion surgeon, "the crackling furnace and the naked corpses

with their lolling heads and stiff arms

and legs. ... I opened the door of

the blazing furnace and inside I saw

three corpses sizzling and burning."

 60

59

 First quotation from 116th Evacuation Hospital

Semiannual Rpt, January-June 1945, an., p. 12.

Second quotation from Smith, Dachau, p. 79.

60

 First quotation from 116th Evacuation Hospital

Semiannual Rpt, January-June 1945, an., p. 2.

Second quotation from Smith, Dachau, p. 80 (see

also pp. 90-91). Third quotation from William M.

McConahey, Battalion Surgeon (Rochester, Minn.: Privately published, 1966), p. 145. See Surg, Seventh

U.S. Army, Semiannual Rpt, January-June 1945.
576 EUROPEAN THEATER OF OPERATIONS

Burial parties—mainly German civilians, working under duress—disposed of the bodies. A journalist at

Dachau shortly after liberation saw

peasants climb the mounts of corpses,

bring down bodies and "heave-ho"

them into wagons. Such unwilling

sextons had to work from the tops of

the heaps—"they could not pull the

bodies out from lower down because

pieces would come off." Wagonload

by wagonload, they were moved to

mass graves. Among the dead were

former guards. In the first hours of

freedom able-bodied prisoners had

taken revenge on their onetime tormentors, holding hunts for SS men

and beating to death those they

found. Some accounts of the Dachau

liberation assert that American troops

machine-gunned several hundred

guards.61

Care of the sick followed essentially

the same pattern in all camps. At Buchenwald the 120th Evacuation Hospital took over the SS barracks as a

hospital: sturdy buildings, with latrines and heated showers. Inmates

had already occupied the barracks,

however, and in consequence the furniture, rugs and bedding were infested with lice. Hospital personnel

stripped the rooms and scrubbed

walls and tile floors with soap and

water. Canvas cots were moved in and

covered with German or American

army blankets. German civilians were

drafted and instructed in the use of

DDT hand dusters. When everything

was ready, patients were brought by

ambulance, unloaded, and dusted

under their clothing. They were carried into the hallway of the barracks,

stripped, and bedded down. Their

clothes either were burned or put

through a steam delousing machine.

By the third day someone—possibly

Army engineers—had repaired the

water system, and the admission procedure changed to include a thorough

bath after the first delousing. Americans handling the sick doused themselves and their bedding with powder,

and no cases of infestation or sickness

occurred.62

At Dachau the 116th and 127th

Evacuation Hospitals worked in the

SS barracks, after tearing out partitions to make large wards. The kitchens of the excellent SS mess hall provided food for patients and staff.

From this center, order began to

spread to the shambles outside.

Thirty-two thousand prisoners were

crowded into an area intended for

about 10,000; water, sewers, and

lights had all failed; starving inmates

had broken into SS warehouses and

gorged themselves on food they could

not digest. A sanitary company, a

quartermaster laundry, an engineer

unit, and a fumigation and bath unit

arrived to help out. Healthy inmates

set up an International Prisoners

Committee to present their grievances to the Americans, to defuse national antagonisms, and to assist the

cleanup. Inmates removed rubbish,

and the committee ensured that all

61116th Evacuation Hospital Semiannual Rpt, January-June 1945, an., p. 5. See also Howard A.

Buechner, Dachau: The Hour of the Avenger (New Orleans: Thunderbird Press, 1986), and Nerin E. Gun,

The Day of the Americans (New York: Fleet Publishing

Co., 1966). Buechner was a 45th Division medical

officer, and Gun was an inmate of Dachau at the

time.

62

 120th Evacuation Hospital Semiannual Rpt, January-June 1945, p. 20, file 319.1-2, box 408, RG

112, NARA.
VICTIMS OF WAR 577

water was boiled, until chlorination of

a restored water supply could begin.

By the end of May it was possible to

assume, for the first time in Dachau's

twelve-year history as a concentration

camp, that the well would not needlessly become sick.

Yet scenes within the hospitals were

grim. When the Seventh Army liberated the camp, about 140 inmates

were dying every day. The 127th

Evacuation Hospital admitted about

1,900 patients during May, of whom

900 had multiple diseases, and another 260 in June. From early May

until mid-June the unit lost 246 patients. The 116th Evacuation Hospital

admitted over 2,000 patients, of

whom nearly 1,800 either had typhus

or were suspect. Bacillary dysentery

was common. During May 140 patients died of typhus, 28 of tuberculosis, 15 of starvation, and 7 of enteritis

(inflammation of the bowels). Malnutrition was a contributory factor in all

deaths, and the hospital staff struggled not only to feed their patients—

at first GI rations supplemented by

milk chocolate, and eggnog, and later

German Army rations—but also to

keep them from eating too much.

Multivitamins were given to counteract the effects of starvation, plasma to

increase body proteins, and intravenous fluids to reestablish fluid balance. All who survived gained weight

rapidly, and within two weeks the

living skeletons that had filled the

camp at the end of April had recovered their human appearance.63

The typhus threat caused the Seventh Army, upon taking over the

camp, to quarantine it and appoint a

camp surgeon. Soon representatives

of the Typhus Commission arrived to

observe, investigate, and assist. A

commission officer reached Dachau in

May and took over a section of one

ward for study and treatment of selected cases. The commission arranged for supplies of vaccine and

para-aminobenzoic acid, then the

most effective medicine known for

treating the disease. Another of its officers assisted the British at BergenBelsen. Abandoning an early attempt

to do research under the conditions

of Dachau, the commission instead

emphasized measures of treatment

and especially of prevention. General

Fox, its field director, declared that

the concentration camp represented a

"menace to the whole of northwestern Europe" because of conditions

outside the barbed wire as well as

within.64

As stories of the camp spread,

Allied journalists arrived to explore

the homes of the SS officers and the

scoured but still oppressive and illsmelling barracks. A woman reporter,

Elizabeth May Craig, penned a description of the place on V-E Day. At

the 116th Evacuation Hospital the

nurses wore olive drab trousers and

shirts, aprons and gauze masks. As a

penicillin squad was giving injections,

its blonde leader complained: "I can't

63

 116th Evacuation Hospital Semiannual Rpt, January-June 1945, an., p. 8.

64

 Ibid., an., p. 7; Hoff, ed., Arthropodborne Diseases

Other Than Malaria, pp. 206-07; Davis, "Typhus at

Belsen." In Records of the USA Typhus Commission, RG 112, NARA, see Ltr, Brig Gen Bayne-Jones

to Col K. R. Lundeberg, 7 Sep 44, box 69, and Ltr

(source of quotation), Fox to Bayne-Jones, 18 May

45, box 70.
578 EUROPEAN THEATER OF OPERATIONS

find enough muscle to get a hypodermic in." A surgeon remarked that he

could not perform operations; the

shock would kill the patients. The

chief nurse, in a soft South Carolina

drawl, told Craig that as yet no hospitalized patients had recovered.

"There is no disposition except

death," she said.65

Gradually Dachau was cleared, the

epidemic controlled, the living placed

under treatment, and the dead

buried. Cheering groups of prisoners

began to depart for home. Allied soldiers who had liberated the camp and

Army medics who had worked there

were left to record in official reports,

private letters, and diaries their recol- lections of a situation that is fortunately without an exact parallel in

recent, or perhaps any, history.

A system of organized inhumanity

fell apart in a chaos almost worse

than what had gone before. Uncovering the camps and political prisons of

the Third Reich revealed conditions

to which even a war-jaded world responded with disbelief. Medical work

was grim and summary, but its significance went beyond even the saving of

lives. The compassionate treatment of

the camp survivors marked the restoration of moral order amid the worst

scenes that Nazi tyranny had been

able to devise.

68

 116th Evacuation Hospital Semiannual Rpt, January-June 1945, an.
CHAPTER XVII

From War to Occupation

On 8 May 1945 the war that had

devastated Europe and claimed millions of human lives came to an end

with the unconditional surrender of

the German forces. For many medical

personnel in the American Army, the

tasks of reconstruction had already

begun. During the spring and

summer military government detachments were hard at work throughout

the American Zone—"the harbingers

of a new order and the only stable influence in a world turned upside

down."1

Composed of three or four officers

and five enlisted men apiece and

equipped with two jeeps with trailers,

the detachments represented the Occupation to Germans everywhere

except in the big cities. They arranged burial for corpses lying in the

streets, restored a system of rationing

that guaranteed civilians a small basic

allowance of food, returned local

police to their duties, and sought to

restore electricity and water supplies.

American public health officers surveyed the disease situation, spotted

potential sources of infection, and

recommended remedial action. Since

the American Zone comprehended all

of Bavaria, part of Berlin, and parts of

prewar Wuerttemberg, Baden, Hesse,

Kurhessen, Nassau, and the cities of

Frankfurt, Bremen, and Bremerhaven

(see Map 26), some 19 million Germans, millions of POWs, and a large

but decreasing number of DPs had

become dependent upon the American Army.2

Despite earlier fears of guerrilla

warfare, German armed resistance

was over by the end of May. But

problems were immense, and were

not made easier by upheaval within

the Army itself. On 1 July ETOUSA

was redesignated United States

Forces, European Theater (USFET);

on 16 July SHAEF was inactivated;

and on 1 August COMZ became Theater Service Forces, European Theater (TSFET). The change of names

was accompanied by a change in personnel that began at the top but permeated all ranks. On 1 August General Hawley departed for the United

States, and a distinguished postwar

career in civilian medicine. For the

month of July General Kenner bore

1

 Ziemke, Occupation of Germany, p. 186.

2

 See Hoff, ed., Civil Affairs/Military Government, p.

494; Wolfe, ed., Americans as Proconsuls, pp. 52-57;

Medical Plan for Preliminary [sic] Occupation of

Germany, in Miscellaneous file, Shambora Papers,

MHI. Military government detachments were organized in July and August 1944, and the first entered

Germany on 15 September of that year.

FROM WAR TO OCCUPATION 581

the title of Surgeon, Occupation

Forces, Germany. On the day Hawley

left, Kenner became both TSFET and

USFET surgeon, and chief medical

adviser to his old commander, General Eisenhower, who now commanded

USFET. To Kenner fell the duties of

guiding the medical service through a

time when it must give direction to a

conquered nation while undergoing

constant change itself.3

Public Health

The danger of disease was acute.

Food and fuel were in short supply

for civilians, and homelessness was

common in a land of shattered buildings. Great movements of population

continued as DPs left the country and

Germans expelled from the east

trekked in. Cold and hungry, the mass

of wanderers faced the danger of epidemics, even in rural areas. Refugees

from the cities thronged many country towns, drinking water from shallow wells fouled by the runoff from

latrines and manure piles. In May an

outbreak of typhoid occurred at Moringen, a town of 2,000, which was accommodating twice that number of

people. But the greatest problems afflicted the bombed cities.

Nowhere were they greater than in

Berlin. When the Western Allies entered the former capital to share occupation duties with the Soviets who

had conquered it, they had to cope

with the ruin wrought by 75,000 tons

of British and American bombs, plus

Russian artillery shells. Over the

rubble hung the stink of unburied

dead. Four of every five dwellings

were in ruins, transport was at a

standstill, bridges over the many

canals had been destroyed, and

broken sewers poured their contents

into the water below. The canals and

the water-filled bomb craters were

nurseries for clouds of mosquitoes,

and a plague of flies beset the city as

the weather warmed. In the first

months of the Occupation, epidemics

of dysentery, typhoid, and diphtheria

swept the population. Most adults

and older children survived, but dysentery, which the people called

hunger typhoid, killed 65 percent of

the newborn babies. Berliners subsisted on about 800 calories a day.

Remarkably, the city's Central

Health Office still existed, with subsidiary organizations in each administrative district. All services, however,

were at a standstill when the Americans arrived in July. Of 240 peacetime

hospitals, only 150 were in operation,

and these lacked ether, narcotics, alcohol, and sulfa drugs. There was

little transport and no telephone service. Communicable disease reports

had to be delivered by messenger,

and patients were borne to hospitals

through rubble-mounded streets on

stretchers or primitive carts. The

city's water supply was still potable at

the source, but contamination from

some 1,600 breaks in the mains

caused the Central Health Office to

order all drinking water to be boiled.

The four-power government of Berlin

agreed on some basic actions to prevent disease, especially typhus. The

Russians began to isolate and treat

3

 On the change in command, see GO No. 3130,

HQ, ETOUSA, 20 Jun 45, and GO No. 167, HQ,

USFET, 21 Jul 45. Hawley became, in turn, chief

medical director of the Veterans Administration,

chief executive officer for Blue Cross and Blue

Shield, and president of the American College of

Surgeons.
582 EUROPEAN THEATER OF OPERATIONS

typhus cases, and Maj. David Greely

of the United States of America

Typhus Commission drew up a comprehensive program that, once accepted by the Americans, Russians,

British, and French, became part of

the city's law. Under direction of the

Central Health Office, dusting teams

and medical workers in every district

were immunized; refugees and bathhouses were deloused; all cases were

isolated; and their contacts were

dusted and observed.4

By such vigorous action the occupying powers suppressed the immediate

threat of epidemic outbreaks. Aiding

them was the tradition of discipline

among the Germans, who, to the surprise of the Americans, remained

law-abiding except in the areas of

prostitution and the black market. Encouraged by the Potsdam agreement,

the military government sought the

maintenance of good health and medical services by the Germans. With

combat over and conditions less

threatening, the influence of military

government specialists grew steadily,

and in August Kenner decided to relieve the field commands of direct responsibility for public health.

The result was the emergence in

late summer of a reorganized medical

service and the reemergence of a civil

public health establishment. Kenner

made public health a function of the

ECA detachments attached to the two

military districts into which the American Zone had been divided—the

Western, under the Third Army, with

headquarters at Munich; and the Eastern, under the Seventh Army at Heidelberg. G-5, USFET, set policy; the

chief surgeon provided overall technical supervision. Each district commander, through his own G-5 section, set policy for public health work

in his own area, while the military district surgeon, who was also the field

army surgeon, provided technical

oversight. To ensure adequate personnel, General Eisenhower ordered

that field command medical personnel were to be made available to the

military government as necessary.

With the approval of military public

health experts, the German system of

organizing public health began to

revive at the local level, and by September 1945 efforts were under way

to reestablish the German Red

Cross.5

But the revival of the German medical profession—an absolutely essential element in restoring and safeguarding public health—was a more

complex problem. Many factors conspired to weaken the profession's

4

 Ziemke, Occupation of Germany, p. 304; Rpt, USA/

MC, 3 Aug 45, app. A, file U.S. Group Control

Council, and Ltr, Greely to Bayne-Jones, 24 Aug 45,

file Paris #III, box 70, Records of the USA Typhus

Commission, RG 112, NARA; Memo, HQ, USFET,

7 Sep 45, sub: Program for the Prevention and Control of Typhus Throughout Berlin, file Preventive

Medicine, box 471, and HQ, USFET, Weekly MC

Rpt, 20 Jul 45, file Weekly CA/MG Rpts, box 541,

OMGUS, PHB/PWB, RG 260, NARA. For a general

study of bombing and German health, see Special

Rpt, HQ, USFET, January 1947, sub: The Effect of

Bombing on Health and Medical Care in Germany,

file Preventive Medicine (General), box 541,

OMGUS, PHB/PWB, RG 260, NARA.

5

 Directive, HQ, USFET (to CGs, Eastern and

Western Military Districts and Berlin District), 6

Aug 45, sub: Public Health Functions in the U.S.

Zone of Germany, in Kenner Diary, bk. 3, following

p. 408. See also Memo, Wilson, DepC, PHB, G-5,

USFET, to DepACofS, G-5, USFET, 21 Aug 45,

sub: Military Government Conference, 9 August

1945, file Public Health, box 471; HQ, USFET

(OMGUS), Weekly Rpts, 9 Aug and 21 Sep 45, file

Weekly CA/MG Rpts, box 541. Both in OMGUS,

PHB/PWB, RG 260, NARA.
FROM WAR TO OCCUPATION 583

ability to serve its people at a time of

great need. Before Hitler's rise to

power German medicine had written

a distinguished record, especially in

research, winning, up to 1930, thirtyfive Nobel prizes, more than any

other nation to that time. Freedom of

inquiry had prevailed in the universities. After 1933 the profession was

forcibly organized by the Nazis, pro- vided with subsidies, and given a national leader and a party-line publication. Doctors in administrative posts

were usually compelled to join the

Party, and after September 1938 Jews

were purged from the profession's

ranks. During the war military demands increased; at a conference with

General Kenner, the assistant chief

surgeon of the German Supreme

Headquarters averred that 45 percent

of the German doctors were in the

Wehrmacht, 55 percent in civil practice. Hence, at the war's end many

doctors were in POW pens, and many

others were deeply compromised for

political reasons. The 6th Army

Group captured the personnel files of

the medical association of the State of

Baden, whose membership comprised

all the doctors and dentists and many

of the public health officials. Less

than a quarter lacked significant Party

connections. Of all professions, the

medical had one of the highest percentages of Nazis, leading law, teaching, and even public administration.6

In consequence, denazification hit

the medical profession particularly

hard, especially when a major purge

of former Nazis began at the end of

September 1945. In the town of Wasserburg a military government detachment, acting on new regulations,

disqualified twenty medical doctors,

fifteen dentists, fifty-one teachers, ten

mail carriers, and twenty policemen.

In the rural township of Alzenau the

detachment operating there found

only three of seventeen local doctors

politically clean. In Baden the efficiency of medical and public health

services was "greatly reduced"; in

Pforzheim a tuberculosis center had

to be closed; and in Karlsruhe the di- rectors of both hospitals were dismissed. The large industrial city of

Stuttgart faced a "serious public

health problem" because twenty-two

of the twenty-five top members of the

public health staff, as well as most of

its hospital chiefs, had been ousted.

"The situation [in Stuttgart]," reported the military government, "threatened to become chaotic," for no

replacements were found despite a

prolonged search.7

Supposedly, Germans who had

been active party members or ardent

supporters were forbidden to practice

any profession, to hold any post of

honor, or to perform any work above

the level of manual labor. But reality

intruded. The sick could hardly be allowed to die because their doctors

had joined the Nazi party. In practice,

therefore, the situation rapidly

became more destructive to the denazification law than to the medical profession. The military government detachments issued so-called temporary

work permits to people whose services were needed, and because the

permits were never revoked, doctors

6

 Bailey, "Civil Affairs Hist," pp. 201-30, file

314.7-2; Kenner Diary, bk. 3, pp. 333-34.

7

Quoted words from HQ, USFET (OMGUS),

Weekly CA/MG Field Rpt, 1 Nov 45. See also ibid.,

11 Oct 45. Both in file Weekly CA/MG Rpts, box

541, OMGUS, PHB/PWB, RG 260, NARA.
584 EUROPEAN THEATER OF OPERATIONS

and dentists continued to care for

their patients as before.8

The efforts of all health workers

were needed. Long-term problems

demanded attention. Public health

laboratories had to be rebuilt and

pharmacies reopened. Veterinary services also were needed, for, in a

nation short of food, control of

animal diseases was more than ever

essential. Drugs and sera for inoculating farm animals were hard to obtain, and a wartime lapse in efforts to

combat tuberculosis left much milk

infected. Moreover, one of the postwar epidemics continued, and indeed

intensified. Venereal disease emerged

as a complex and durable problem,

one closely intertwined with American

occupation policy.

Experts had long predicted a sharp

rise in venereal diseases when hostilities ended. Events soon proved them

right. Among the remaining DPs,

poor and demoralized females yielded

readily to their liberators, whose

mood, after months of battle, was to

enjoy as much sex as possible as soon

as possible. Rape by American soldiers was common, often requiring

neither violence nor threats. ("A man

who enters a strange house, carrying

a rifle in one hand," ruled the judge

advocate general of the Seventh

Army, "is not justified in believing he

has accomplished a seduction."9)

Military courts punished soldiers convicted of rape, but found the crime

hard to prove. The German women

were needy, and susceptible to the

food and other gifts soldiers could

provide. The VD rate among former

combat troops, only a fourth that of

COMZ forces while the fighting continued, rose rapidly after V-E Day,

equaling and then surpassing the rate

among support troops.10

The end of the war, however,

tended to change the character of

many liaisons. Peaceful rather than

armed conquest became the rule, and

relationships developed that were

based on personal preference, mutual

pleasure, and the hope of marriage.

This biological and human process

soon caused the Army's nonfraternization policy to collide head-on with

its policy on venereal disease. The

notion that American soldiers could

be transformed into aloof poster figures had never borne much relation

to reality. Nonfraternization continued after the war in response to the

vengeful feelings of American public

opinion, and not to that of the soldiers, some of whom were soon

grousing that "the policy is just to

give the brass the first crack at all the

good looking women." Immured

behind barbed wire, American military compounds caused the Germans

to remark that their conquerors were

the only people in the world who put

themselves into concentration

camps.11

Meanwhile, the rising VD rate

mocked the ability of officialdom to

enforce nonfraternization. Efforts by

the chief surgeon's office to get a

ruling from the high command on

whether venereal disease could be

8

 Ziemke, Occupation of Germany, pp. 182 and 387-

88.

9

 As quoted in ibid., p. 220.

10

 12th Army Group Report of Operations, vol.

XIII (Medical Section), pp. 244-45 and 256-58;

Padget Interv, 1 August 45, box 223, RG 112,

NARA. 11

 As quoted in Ziemke, Occupation of Germany, p.

324.
FROM WAR TO OCCUPATION 585

considered evidence of fraternization

at first produced no clear policy.

Some commanders refused to set up

prophylactic stations lest soldiers be

encouraged to fraternize, and some

men were court-martialed and fined

$65 merely for going on sick call with

venereal disease. Contradictions

abounded, as SHAEF's judge advocate pointed out in May:

The very establishment of prophylactic

stations and the directives requiring re- ports of the contraction of venereal dis- ease are indicative of the realistic view

which the Army has heretofore taken of

the problem. Soldiers will fraternize in

the manner indicated, in spite of any

rules to the contrary, and should they, fearful of being tried by court martial for

such fraternization, avoid the use of pro- phylaxis or checkup, venereal disease may

become rampant and completely out of

control.12

In fact, the VD rate among troops in

the theater rose from 56 in April to

177 per 1,000 per year in August

1945, and to 233 in January 1946.

On 4 June, bowing to the inevitable, SHAEF issued orders that contracting venereal disease could not be

used either directly or indirectly as

evidence of fraternization. In July

General Eisenhower modified theater

rules to allow fraternization in public

places, and on 1 October the policy

ended. Nonfraternization split and

sank upon the reef of sex, but not

until it had allowed the Germans,

during the particularly trying year, to

enjoy the spectacle of their conquerors "engaged in the most widespread

violation of their own laws since Prohibition."

 13

The end of nonfraternization did

not, however, halt the VD epidemic.

Despite the rapid repatriation of hundreds of thousands of DPs during the

summer, some 500,000 remained in

Germany, at least half nonrepatriable

for political reasons. The fundamental

source of the epidemic, however, was

the poverty of the Germans that made

sex easy to obtain, as well as the confusion and upheaval that attended the

organizational changes in the theater

and the dispatch of troops to the Pacific or to home. Commands disappeared, boundaries shifted, new organizations were erected in the place of

old, and green troops replaced veterans. Control of venereal disease had

always depended upon command responsibility. For the moment, lines of

authority were hopelessly confused,

and low-score men were undisciplined

and disorderly.14 To add to the problem, the War Department suddenly

withdrew the familiar V-Packette prophylactic kit and substituted a new,

supposedly more effective, item without providing adequate supplies. Only

penicillin therapy prevented venereal

disease from becoming a serious

drain on job performance, for personnel turbulence, supply failures, and

the conditions of postwar Germany

defeated the traditional methods of

prevention.

12

 Ibid., p. 325. 13

 Ibid., p. 324. See also Preventive Medicine Division, OofCSurg, HQ, ETOUSA, Semiannual Rpt,

January-July 1945, VD Control Branch sec., p. 1;

Ltr, HQ, ETOUSA, to CGs of Major Commands, 4

Jun 45, sub: Policy on Relations Between Allied Occupying Forces and Inhabitants of Germany, in 12th

Army Group Report of Operations, vol. XIII (Medical Section), pp. 225-29. VD rates are given in Essential Technical Medical Data Rpts, HQ, TSFET,

October 1945 and April 1946, boxes 36 and 37, file

350.05, RG 112, NARA. 14The subject of redeployment is covered later in

this chapter.
586 EUROPEAN THEATER OF OPERATIONS

With good reason, the military government sought to attack the VD

problem among civilians. In August

USFET directed compliance with a

1927 public health law, enacted by

the Weimar Republic. As a result, facilities for isolation and treatment of

victims were established in hospitals,

physicians were ordered to report

cases, and German health officials

were tasked with promoting a VD

education program. Because penicillin

was not yet available for German

use, treatment for syphilis followed

the old course, with patients taking

arsenicals or mercury preparations.

Gonorrhea patients received sulfa

drugs; unfortunately, many cases resisted treatment, and hospital space

set aside for venereal disease cases

filled rapidly, all the more so because

shelter and food were available there.

On 28 October the Army made penicillin available to the detention hospitals on the grounds that curing gonorrhea was essential to the protection

of American troops.15 The detention

wards and buildings now cleared rapidly, and soon cases were being treated on an outpatient basis, enabling

working-men who caught the disease

to seek treatment without leaving

their families to starve. One ironic

side effect of penicillin treatment was

noted: Prostitutes were able to ply

their trade with briefer interruptions

because their "turn-around time" in

hospitals had been shortened.16

The most serious long-run danger

to German health was the shortage of

food. The medics could do little but

monitor the situation. Apparently, occupation authorities did not at first

grasp the dimensions of the problem.

During the war German civilians had

fared better than those of conquered

nations. Especially in towns and small

cities that had escaped bombing,

survey teams in the spring and

summer had found shops well stocked

with basic foods and streets thronged

with people who appeared adequately

clothed and nourished.

However, wrecked transport systems had, in fact, created a spotty pattern of local excess and local need.

Early reports from the cities were

bleak. In April a nutrition survey

team, sent by ETOUSA, had found

only a ten-day supply of food on hand

in major cities; in industrial Duesseldorf and Essen children were in poor

condition and civilians were receiving

a basic ration of only 1,000 calories a

day. But Allied policy-makers at the

time were convinced that the problem

of the German economy was to prevent its resurgence, rather than to restore it to meet the calamitous

changes that defeat entailed.

The Occupation intensified supply

problems by drawing arbitrary military boundaries that divided farm

from market areas. Remaining food

stocks in the cities were looted by

Allied troops, DPs, and the Germans

15 themselves. And throughout western Because penicillin also cured other and more

serious illnesses, the military government instituted

strict controls to prevent German physicians from

diverting it for unauthorized purposes. 16Quoted words from Ziemke, Occupation of Germany, p. 422. See also Directive, HQ, USFET (to CGs,

Western and Eastern Military Districts and Berlin

District), 28 Oct 45, sub: Penicillin for Treatment of

Gonorrhea Among Civilians, file Penicillin Directives, box 539, OMGUS, PHB/PWB, RG 260,

NARA; Morrison C. Stayer and William A. Brumfield, Jr., "Venereal Disease Control in the United

States Occupied Zone of Germany," The Military Surgeon 100 (May 1947): 375-81.
FROM WAR TO OCCUPATION 587

GERMAN CIVILIANS AWAITING THEIR FOOD RATIONS

Germany, an area too heavily populated to feed itself even in normal times,

fields lay abandoned while the DPs

who had worked them took to the

roads and the German men who had

plowed and harvested them before

the war sat in prison pens.17

At the end of August Maj. Gen.

Morrison C. Stayer, director of Public

Health and Welfare for the military

government, reported that nutritional

survey teams had found "60 percent

of the Germans living on a diet that

would inevitably lead to diseases

caused by malnutrition." Though

workers doing heavy labor got up to

2,800 calories a day, normal consumers received rations whose caloric

value apparently varied from about

800 to about 1,150. As a result of

quantitative and qualitative deficiencies, avitaminosis and marked weight

loss had already appeared in both

adults and children. The inevitable

consequence of hunger was a vast

black market, to which farmers sent

their surplus crops and city dwellers

sacrificed their prized possessions.

GIs, too, were quick to make money

by selling food and cigarettes, and as

a consequence Quartermaster depots

suffered major losses. In this way

Americans supported Germans with

Army food supplies, but in such a way

1712th Army Group Report of Operations, vol.

XIII (Medical Section), pp. 267-74 and 280-82.
588 EUROPEAN THEATER OF OPERATIONS

as to allow both German and American criminals to profit in the process.18

In October G-5, USFET, summarized bleakly the nutritional state of

the civil population in the American

Zone: The worst conditions were

among children, pregnant and nursing women, and city dwellers. Street

weighing indicated losses among

males of up to 13 percent of body

weight, depending on age, and up to

15 percent among women. Vitamin

and protein deficiencies were also observed. The worst conditions were in

Berlin; the best, as might be expected, in the rural regions of Bavaria.

In general, no reserves of body weight

exist and caloric intakes remain inad- equate. Protein is often relatively, if not

absolutely, inadequate. Such improvement as has occurred is mainly in vita- mins and minerals, the cumulative effect

of the summer's supply of non-rationed

fruit and vegetables, a source which

cannot be depended on in the coming

months. The effects of deficiencies are

cumulative and often not at once apparent.19

Vigorous efforts by Clay and the

Germans produced supplies to raise

the ration to an official 1,550 calories.

Yet, as matters developed, the American Zone squeaked past the time of

worst privation as much by luck as by

policy. In contrast to the previous

year, the winter was mild. The harvest

was unexpectedly good. Washington

provided imports to maintain the new

ration. An expected influx of German

refugees from the East did not materialize until late in the winter. Many

individual Americans proved to be

more generous to their former enemies than the formal policies of their

government might have suggested.

Private contributors in the United

States organized under the Council of

Relief Agencies Licensed To Operate

in Germany and, with official sanction, consigned substantial tonnages

of food and medical supplies to

German church and labor groups. By

the spring of 1946 a German Central

Committee for the Distribution of

Foreign Charitable Gifts was in operation, and the military government

had begun to accept contributions

from non-American voluntary agencies, notably in Switzerland. Most

gifts came from people of German

background and language, and from

labor and religious groups, many of

which—like the Mennonites and Lutherans—had ties to a Germany that

long antedated Hitler.20

Nevertheless, hand-to-mouth living

was the rule. By March 1946 food

stocks were available for only sixty

days, and on 1 April Clay was obliged

to reduce the ration again, under

pressure from a worldwide food

shortage caused by the disruptions of

the war. In May and June the normal

consumer received only about 1,180

18 calories a day, and even this low level As quoted in Ziemke, Occupation of Germany, p.

352. See also p. 353. Stayer's position is misidentified in this source. On Stayer, see Name-Rank file,

CMH. 19

 Special Rpt, HQ, USFET, 3 Oct 45, sub: Summary of Nutritional State of the Civilian Population

in the American Zone of Germany, file CA/MG

Rpts, box 541, OMGUS, PHB/PWB, RG 260,

NARA.

20

 Ltr, Edward M. O'Connor to Lt Col Alden E.

Bevier, PH&W Branch, OMGUS, 25 Mar 46, sub:

CRALOG, in file Public Health, box 472. See also

Memo, PH&W Branch, OMGUS, 4 Mar 46, sub: Importation of Relief Supplies, in file Centre d'Entr'Aide, box 477. Both in OMGUS, PHB/PWB, RG

260, NARA.
FROM WAR TO OCCUPATION 589

FOOD ASSISTANCE FOR GERMAN

REFUGEES from the East

could be sustained only by distributing Army surplus stocks. In May a

health survey in Mannheim showed

that 60 percent of infants had rickets,

and random weighing of adults provided evidence of malnutrition in the

general population as well. A famine

had been avoided, but only a general

revival of the German economy could

prevent recurrence of the danger.

Though a new crisis would strike in

the spring of 1947, the best sign for

the future of the American Zone was

that the United States government

had tacitly come to accept the need

for such a revival.21

Medical Intelligence

While most Army medical personnel concerned themselves with the

health of the troops, or with that of

the civil population, a select group

helped to carry out an elaborate program of technical intelligence. During

the war medical intelligence units had

developed both in the surgeon general's office and in the medical sections

of theater and field commands. In

Washington the wartime mission of

collecting health information on foreign countries grew into a complex

effort, highly integrated with the

Army Staff's other technical intelligence-gathering programs. Ultimately, the once modest files of the surgeon general's unit constituted a

worldwide geography of disease. On

the war fronts medical matériel was

collected and forwarded to the Medical Equipment Laboratory at Carlisle

Barracks, Pennsylvania, where captured drugs, biologicals, and equipment were assembled, tested, and

analyzed. In ETOUSA Hawley's Medical Intelligence Branch sought out information on German diseases and

methods of control, on enemy casualty statistics, and on the Nazi biological warfare program. In the 12th

Army Group an elaborate field program developed, as army surgeons attached technical intelligence teams to

their S-2 sections and the gathering

of information and matériel extended

down to the medical groups and battalions.22

21

 Lucius D. Clay, Decision in Germany (Garden City,

N.Y.: Doubleday, 1950), pp. 266-69.

22See Preventive Medicine Division (or Service),

OSG, WD, Annual Rpts, 1943-45, boxes 17 and 18,

RG 112, NARA; James M. Simmons et al., Global Epidemiology: Geography of Disease and Sanitation (Philadel- Continued
590 EUROPEAN THEATER OF OPERATIONS

A second effort developed in quite

a different way and for different purposes. Interest in Germany's industrial and technical secrets was not

wholly a concern of the military. The

potential economic value of enemy

discoveries aroused the interest of the

American research establishment, and

of drug and medical supply manufacturers, among many others. By the

end of the war the Allies had determined to treat ideas, processes, and

to some extent the personnel of the

German industrial and scientific machine as prizes of war.

During preinvasion planning

SHAEF set up the T (for Technical)

Subdivision in its G-2 section to plan

the exploitation of scientific and industrial targets, a term which included both technical processes and individuals who might possess useful

knowledge. A detention center for

special prisoners was set up, first in

Paris and then in Kransberg Castle

outside Frankfurt, and code-named

DUSTBIN. The prime catch were the

rocket builders from Peenemuende,

but medical experts, like Dr. Karl

Brandt, the Reich's commissioner for

sanitation and health, were likewise

sought out. Ultimately a broad

program emerged, guided by the interAllied Combined Intelligence Operations Subcommittee, headquartered

in London, which included both theater personnel and experts sent by the

Technical Industrial Intelligence

Committee, an agency of the Joint

Chiefs of Staff.23

Biological warfare remained a topic

of great interest. Wartime had seen

much Allied concern over reports of

German efforts in the field. The British and American governments, overestimating Nazi interest in such weapons, justified elaborate programs for

the research, development, manufacture, and stockpiling of biological

weapons on the need to defend and

retaliate against an enemy attack. In

preparing for the invasion of Europe

the Medical Department collected

blood samples from German prisoners, with the aim of learning whether

group immunizations had been given

against botulism, plague, cholera, epidemic typhus, psittacosis, and lymphocytic choriomeningitis, as a prelude to infecting Allied soldiers. No

evidence was discovered. For a time

considerable excitement reigned west

of the Atlantic over stories spread by

a refugee doctor in Switzerland that

the Germans planned to use the toxin

of botulism in shells. Supplies of

toxoid had been developed at the

main American biological warfare installation in Camp Detrick, Maryland,

and Surgeon General Kirk urged the

inoculation of all Allied soldiers destined to participate in the D-Day landings. But American and British authorities in England both discounted

the stories, and Hawley recommended

only that the toxoid be stockpiled in

case of need.24

The fall of Germany produced a

flurry of activity by the Americans and

British, aimed at uncovering the

whole story of the German biological

phia: J. B. Lippincott Co., 1944); Hoff, ed., Special

Fields, pp. 288-89; Surg, 12th Army Group, Hist,

January-June 1945, pp. 18-19. 23Ziemke, Occupation of Germany, p. 314.

24

 Ltrs, Col John E. Gordon to Col Karl E. Lundeberg, Chief, Preventive Medicine Service, OSG, WD,

24 Jun 44, and Lundeberg to Gordon, 7 Jun 44, file

17, box 4, RG 112, NARA.
FROM WAR TO OCCUPATION 591

warfare effort. The results were disappointing. A research office existed

within the Heermsanitaets Inspektion, the

German equivalent of the surgeon

general's office, under Prof. H.

Kliewe. About 45 years old, Kliewe

was an agreeable and informative

prisoner, "unassuming and talkative,"

who impressed his captors as "a good

hard [scientific] worker without much

imagination." The program he

headed had received little encouragement from either Hitler or the Wehrmacht high command, who viewed biological weapons as impractical and

hard to control. Kliewe's files, seized

intact in the vault of a monastery at

Niederviehbach, Bavaria, yielded a detailed picture of a confused and ineffectual effort, carried out largely

under the patronage of Hermann

Goering. Until 1940 Germany had

been wholly inactive in the field. But

in 1943 intelligence reports of Allied

work led Hitler to order the study of

defensive measures. A committee was

set up under the German Army's

Ordnance Department; but, in view of

Goering's interest, the State Research

Council also took a hand, and Heinrich Himmler, ever ready to expand

the functions of his own empire, offered to provide experimental facilities at a concentration camp.25

Though Hitler forbade research in

offensive weapons, work began under

a committee code-named BLITZABLEITER (Lightning Rod). "In order

to give suitable protective regulations," its members explained, "the

enemy's technique of introduction

must be tested. Therefore the experiments planned are not at variance

with the Fuehrer's order." Himmler's

influence may have appeared as one

member of the committee urged "experiments on human beings." Trials

were actually scheduled with agents

that might damage agricultural production, including hoof and mouth

disease, potato beetles, and Japanese

beetles.26

But meetings of the committee

were irregular, and various research

groups went their own way without

central direction. Kliewe carried out

studies with aerosols, the method

most favored by American researchers

at Camp Detrick, Maryland. Goering's

man in the field, a Dr. Blome,27 was

chief of cancer research for the State

Research Council. When the organization took over the Nesselstedt Monastery for cancer studies, Blome

planned to construct laboratories

nearby for biological warfare experiments, as well. Work began in 1944,

but little had been accomplished by

the following year, when the Red

Army arrived. Another experimental

station at Gersberg had barely been

started; when the Americans captured

the site, they found only a few excavations among a stand of pine trees. All

in all, the German program amounted

to very little compared with American, British, and (presumably) Russian endeavors, and to almost nothing

compared with the contemporary Jap25

 See Rpt, ALSOS, 12 Sep 45, sub: A Review of

German Activities in the Field of Biological Warfare,

in file 22, RG 112, NARA. Quotation on p. 20. This

comprehensive report was prepared by American

and British medical intelligence officers.

26

 Ibid., p. 26, file 22, RG 112, NARA. 27

 It is unclear whether the "Doctor Blome" mentioned here is identical with Kurt Blome, a longtime

Nazi.
592 EUROPEAN THEATER OF OPERATIONS

anese development and use of biological warfare agents against China.28

More portentous was a surprise development: the German invention of

nerve gases. In May 1945 Colonel

Beasley, the ADSEC surgeon, received from a liaison officer with the

Ninth Army a report of a large, wellcamouflaged chemical warfare plant

at Lossa. A new war gas, believed to

be an organic phosphorus compound,

had been found in cylinders and

bombs. "The chemical is very persistent with a very distinctive 'bon-bon'

odor," the officer wrote, and atropine

sulphate was the only known antidote.

Neither German nor American gas

masks offered adequate protection,

and rubber clothing was needed to

prevent it from penetrating the skin.

Japanese chemical warfare officers

were said to have visited the plant

and "undoubtedly have the gas."

 29

Later, after grilling I. G. Farbenindustrie employees at the cartel's

Frankfurt headquarters, a team representing the Combined Intelligence

Operations Subcommittee was able to

develop a basic picture of the new

weapon, its chemical structure, production methods, and medical effects.

Of the lethality of the gases the Germans had invented—Tabun, Sarin,

and Soman—there could be no

doubt: In the Farben plant at Dyhernfurth, later seized by the Russians,

four pipefitters had died in convulsions despite protective clothing. According to the Farben workers, the

first gas, Tabun, had been discovered

in the 1930s during routine studies of

organophosphate insecticides. A

chemist had complained of difficulty

with seeing and feared that he was

losing his sight. A chemical he was

working with proved to be affecting

his nervous system, causing contraction of his pupils, and the military implications of the discovery were realized soon after.

Officers of the Chemical Warfare

Service and their British counterparts

led the investigation, but the nerve

gases posed an evident medical problem. Their physiological effects were

little short of spectacular. The gases

prevented the body from breaking

down acetylcholine, a chemical produced by the motor nerves to contract the muscles. Because a victim's

muscles could contract but could not

relax, violent cramps, nausea, and involuntary defecation and urination occurred, followed by convulsions and

death when paralysis reached the

muscles that control breathing.

Tabun's lethality was twenty times

that of phosgene, a common agent of

World War I; Sarin was twice as toxic

as Tabun; and Soman was two to

three times as toxic as Sarin. The

Russians also discovered the nerve

gases in Germany and quickly dismantled and shipped east a plant devoted

to their manufacture. Thus a new and

deadly weapon entered the arsenals

28

 On Allied and Japanese endeavors, see Robert

Harris and Jeremy Paxman, A Higher Form of Killing:

The Secret Story of Chemical and Biological Warfare (New

York: Hill and Wang, 1982), pp. 83-135, 141-43,

and 152-54. See also Intel Rpt C-H/30A, sub:

Resume of Russian BW Intelligence Gathered by

German Intelligence Organization, pp. 53-56, file

14 (BW), box 3, ETO-Surgical Section, RG 332,

NARA. 29

 Memo, George R. Gallagher to Surg, ADSEC,

[May 1945], in Ninth U.S. Army Liaison Rpts file,

Burwell Papers, MHI. The story that the Japanese

had the gas was false.
FROM WAR TO OCCUPATION 593

of all the major powers that survived

the war.30

Medical intelligence officers were

also interested in the once splendid

German medical profession, its fate in

wartime and its recent discoveries. Investigators reported that medical institutions were in sad shape. Many

hospital buildings, schools, and laboratories had been heavily damaged

and medical faculties militarized or

dispersed. The Luitpold Hospital of

the University of Wuerzburg had

been battered by an air raid in March

1945; at Marburg the surgical and

ophthalmological building had been

destroyed and some laboratories

looted. The famed medical faculty of

the University of Vienna had been

dispersed, most into the lake region

of Upper Austria, and other skilled

workers and teachers had likewise

been scattered by the war.31

Nevertheless, research continued,

though isolated from international

medicine. The most striking evidence

of the provincialism of the Germans

was their relative ignorance of penicillin, which they knew only from

reprints of British and American journal articles. Progress occurred in laboratories, but the secrets of largescale production had never been

learned. Yet able men, despite all difficulties, had continued to make interesting discoveries. American doctors

interviewed Prof. Dr. Gerhardt

Kuentscher, who had made his name

as an orthopedic surgeon by developing the use of nails in treating fractures of the long bones. Kuentscher,

45 years old, spoke English fairly well

and was very cooperative. Basically,

his method was to drive V-shaped

nails down the marrow channels of

the broken bones, where they served

as internal splints, eliminating the

need for postoperative traction, casts,

and exterior support. Kuentscher emphasized the need for caution and for

special training before surgeons used

the technique, which in inexpert

hands had produced many failures.

Though attracted, the Americans continued to view his method with reserve, remarking with a touch of

chauvinism that "the method needs

extensive trial in American hands."

 32

Examination of the well-equipped

Physiology Institute at the University

of Goettingen, where aeromedical research had been carried on, brought

out the extent to which the war, by

dividing the scientific world, had induced duplication of effort. The

American and British investigating

team—medical officers of the Army,

Navy, and Air Force of both countries—concluded that German aviation medicine was largely inferior to

that of the Allies. Nevertheless,

30

 Intel Rpts, CIOS, subs: The Medical Aspects of

German Chemical Warfare, app. III of Chemical

Warfare Installations in the Munsterlager Area, file

XXXI-86, box 687; Chemical Warfare, I. G. Farbenindustrie A. G., Frankfurt/Main, file XXX-19, box

681; Technical Information on Tabun and Sarin, file

XXIII-24, box 672. All in Army Staff G-2-P

Records, 1946-51 (CIOS), RG 319, NARA. See also

John Cookson and Judith Nottingham, A Survey of

Chemical and Biological Warfare (New York: Monthly

Review Press, 1969), pp. 213-20. On the discovery

of Tabun, see also Harris and Paxman, A Higher

Form of Killing, p. 53. 31

 A Series of Interviews With Members of

German Medical Schools, Research Institutes and

Hospitals, file XXVI-32, box 676. See also Intel

Rpt, CIOS, sub: German Medical Schools, file XXX50, box 681. All in Army Staff G-2-P Records,

1946-51 (CIOS), RG 319, NARA.

32

 Miscellaneous Interviews on Medical Practice

and Research in Germany, file XXIX-13, box 679,

Army Staff G-2-P Records, 1946-51 (CIOS), RG

319, NARA.
594 EUROPEAN THEATER OF OPERATIONS

USSTAF found ongoing experiments

on high-speed jet and rocket flying of

sufficient interest to take over a wing

of the Kaiser Wilhelm Institute in

Heidelberg, permitting German scientists to continue their work under

American direction. In this case

German aircraft technology had outstripped the Allies, and medical research had followed suit.33

The many misuses of medicine fostered under the Third Reich emerged

in a series of war crimes trials, notably the "doctors' trial" at Nuernberg

in 1946-47 and, almost twenty years

later, the Auschwitz trial prosecuted

by the Federal Republic of Germany.

Doctors had taken part in human experimentation and in attempts to

devise quick methods of mass sterilization—as one defendant put it, "not

only to defeat the enemy but to exterminate him." Though the full story of

these atrocities lies outside the scope

of this study, Army doctors played a

role in the preliminary investigations,

in gathering evidence, and in attempting to assess the medical value of experimental results that had been

gained at terrible cost.34

Experimentation on the living had

been a feature of several concentration camps. At Buchenwald First and

Third Army medical officers heard

stories, later confirmed, of experiments on prisoners aimed at standardizing a typhus vaccine. At Dachau

experimental work had been carried

out in Bunker No. 5, from which few

prisoners emerged alive. Favored

guinea pigs had been Russian prisoners of war, German and Polish Jews,

and Polish Roman Catholic priests.

After sufficient training in the camp,

the victims proved to be excellent experimental subjects, obeying orders

"wie auf Draht gezogen, widerspruchslos"—like puppets, making no objection. Brought close to suffocation by

one experiment, a prisoner continued

to beg permission to breathe: "One

moment, please . . . may I breathe?

Is it all right if I breathe?" He took a

deep breath and said, "Thank you

very much. . . ."

 35

The doctors who carried out the

experiments were a varied lot. Seventy-four-year-old Dr. Klaus Schilling,

director of the SS Malaria Experimental Station at Dachau, had in happier

years been chief of the Department of

Tropical Diseases at the Robert Koch

Institute in Berlin. In the concentration camp he accepted the prisoners

chosen for him by the commandant—

33

 Intel Rpt, CIOS, sub: Aviation Medicine, General Medicine, Veterinary Medicine, Chemical Warfare, p. 19, file XXVIII-59, box 679, Army Staff G2-P Records, 1946-51 (CIOS), RG 319, NARA. See

also Ltr, Col J. B. Gordon, AG, USAFE, to CG,

USFET, 1 Aug 45, sub: Exploitation of German

Aviation Medicine Research, file Aviation, box 471,

OMGUS, PHB/PWB, RG 260, NARA. 34

 On Nazi medical atrocities, see Andrew C. Ivy,

Doctors of Infamy (New York: Henry Schuman, 1949);

Jack S. Boozer, "Children of Hippocrates: Doctors

in Nazi Germany," The Annals of the American Academy

of Political and Social Science 450 (July 1980): 83-97

(quotation on p. 85); Trials of War Criminals Before the

Nuernberg Military Tribunals Under Control Council Law

No. 10, October 1946-April 1949, Washington, D.C.,

vols. I-II; Bernd Naumann, Auschwitz: A Report on the

Proceedings Against Robert Karl Ludwig Mulka and Others

Before the Court at Frankfurt, intro. Hannah Arendt

(New York: Frederick A. Praeger, 1966); and Robert

Jay Lifton, The Nazi Doctors: Medical Killing and the

Psychology of Genocide (New York: Basic Books, 1986). 35

 First quotation from Intel Rpt, CIOS, sub: The

Treatment of Shock From Prolonged Exposure to

Cold, Especially in Water, p. 40, file XXVI-37, box

675. Second quotation from Intel Rpt, CIOS, sub:

Aviation Medicine, General Medicine, Veterinary

Medicine, Chemical Warfare, p. 12, file XXVIII-59,

box 679. Both in Army Staff G-2-P Records, 1946-

51 (CIOS), RG 319, NARA.
FROM WAR TO OCCUPATION 595

"definitely not volunteers," his interrogators noted. Schilling sought to

produce immunity to malaria by repeated infections; as soon as the patient's temperature rose, he instituted

therapy with Atabrine or quinine.

Though admitting that "these afebrile

attacks of malaria were pretty hard on

the patients," he protested that "only

a few" had died. Emphasizing that the

experimental subjects had better

treatment than the average prisoner,

he claimed to have known nothing of

the horrors of the camp in which he

worked. "It was difficult," said one interrogator, "to get a straight story

from him."

 36

Some of the most horrifying experiments had been carried out during

1942 with a low-pressure chamber.

The aim, as the two doctors involved

explained in a secret report to Himmler, was to clarify the question of how

the human body would respond to a

blowout in a pressurized aircraft

cabin. To answer this "purely scientific" question, victims were subjected

to rapid decompression, inducing agonizing cases of the bends. Among

other results, the experimenters

noted "severe symptoms of anoxic

cerebral dysfunction . . . clonic convulsions, respiratory disturbances

similar to the convulsive respiration

of agony, temporary blindness and

paralysis of limbs, and severe post-hypoxemic confusional 'twilight' states."

Recommending that all involved in

the experiments be tried as war criminals, medical officer Maj. Leo Alexander remarked that the suffering involved had "failed to add one iota" to

what other investigators had already

learned from more conventional

methods of scientific inquiry.37

A series of experiments directed by

an SS doctor, Sigmund Rascher, represented another venture into aviation medicine—in this case, with the

aim of discovering the best means to

revive crash victims downed at sea.

Some features of the protocol approached a kind of satanic farce. After

long immersion in ice water, naked

victims were placed between the

bodies of women from the brothel at

Ravensbrueck Concentration Camp.

In the background hovered Doctor

Rascher, rectal thermometer in hand,

ready to take the temperature of any

who revived enough to attempt intercourse. Yet, under the direction of

another and more competent physiologist, experiments with hot baths

turned up useful experimental data.

"The method of rapid and intensive

rewarming in a hot water bath of

45°C of people in shock from exposure to cold, especially in water,"

wrote Major Alexander, "should be

immediately adopted as the treatment

of choice by the Air-Sea Rescue Services of the United States Armed

Forces."

 38

36

 Quoted words from Intel Rpt, CIOS, sub:

Tropical Medicines and Other Medical Subjects in

Germany, p. 11, file XXXV. See also Miscellaneous

Interviews on Medical Practice and Research in Germany, file XXIX-13. All in box 679, Army Staff G2-P Records, 1946-51 (CIOS), RG 319, NARA.

37

 First quotation from Intel Rpt, CIOS, sub: Miscellaneous Aviation Medical Matters, app. 20, p.

139. Second quotation from ibid., p. 14. See also

pp. 12-13. In file XXIX-21, box 680, Army Staff G2-P Records, 1946-51 (CIOS), RG 319, NARA.

Those involved became defendants in the "doctors'

trial"; some were executed. 38

 Quoted words from Intel Rpt, CIOS, sub: The

Treatment of Shock From Prolonged Exposure to

Cold, Especially in Water, p. 68, file XXVI-37, box

675, Army Staff G-2-P Records, 1946-51 (CIOS),

RG 319, NARA. Rascher was shot two weeks before

Continued
596 EUROPEAN THEATER OF OPERATIONS

Who Goes Where, When, and How?

The work done by Army doctors

ranged from protecting the health of

the German people to uncovering the

details of war crimes. But for most

medical personnel, officers and enlisted alike, the months that followed

V-E Day had little to do with the conquered people. For the majority the

central concerns were the war that

still went on in the Pacific, and the

seemingly endless processes of redeployment and readjustment that accompanied the transfer of troops to

battlegrounds on the other side of the

world.

Invasion of the Japanese home islands impended, and the desperate

struggle waged by the defenders of

Okinawa in the spring of 1945 promised resistance of suicidal fury. But

for some fortunate veterans of the

European and African fighting, demobilization rather than a new war

seemed to be in the cards. In particular, the surgeon general was feeling

"urgent pressure by Congress and civilian communities to relieve from

active duty all medical officers not actually professionally engaged." Faced

with demands both from the Pacific

and from the home front, General

Kirk drew the obvious conclusions:

"ETO repeat ETO—MTO repeat

MTO—alone is [sic] surplus."

 39

Medical Department personnel

formed, of course, only a small part

of the vast redeployment that impended. The logistical problem was

immense, but official policy made it

more complex still. For years the

Army had been developing a scheme

based on the general principle that

those who had fought longest and

hardest should be returned home for

discharge. Termed readjustment, this

attempt at fairness led quickly to

monumental practical difficulties and

endless paperwork. When combined

with the transfer of units, it created a

logistical nightmare.40

The Army divided units of the European Theater into four categories.

In the first were those (like the Third

and Seventh Armies) designated as

occupation forces. In the second were

those overseas less than one year that

were to be transferred to the Pacific,

either directly or by way of the United

States. In the third were units to be

organized in the theater, either as occupation forces or as transferees to

the Pacific. In the fourth were units

with long overseas service that were

to remain in the theater only while

needed and then to be returned to

the zone of interior for demobilization. Green troops from American

training camps would arrive to replace departing veterans. Millions of

tons of equipment awaited crating

the liberation of Dachau, apparently on Himmler's

orders, either because he had attempted to fake experimental results or because he knew too much.

See also ibid., pp. 41 and 47; A. Mitscherlich and F.

Mielke, The Death Doctors, trans. James Cleugh

(London: Elek Books, 1962), pp. 23-91. 39TWX Conference, 7 Aug 45.

40

 On the planning process for redeployment, see

Readjustment Regulation 1-1, WD, 15 Feb 45, sub:

Personnel Plan for Readjustment of Military Personnel After the Defeat of Germany; Readjustment

Regulation 1-2, WD, 15 Sep 44 and 5 Mar 45 (rev.),

sub: Personnel Procedures for Readjustment Movements, file HD 300, HQ, ETOUSA; and Basic Plan

for Redeployment for Readjustment, 31 May 45. All

in file Redeployment Directives ETO '45. See also

Rpt, Richards and Fenton to CSurg, HQ, ETOUSA,

15 Apr 45, sub: Visit to Headquarters, Army Service

Forces, on Redeployment Problems, file 334 (Redeployment Problems).
FROM WAR TO OCCUPATION 597

and shipment to the Asian battlegrounds.41

Some inevitable blunders occurred

in the movement of units. Through a

War Department error, affiliated hospital units like Harvard's 5th General

Hospital, some of which had served in

the theater for years, were placed in

Category II (transfer to the Pacific)

rather than IV (marked for demobilization). Often medical personnel were

pulled out of the redeployment process to lend a hand in forwarding

other units. On 9 April 1945 COMZ

established the Assembly Area Command to operate the camps and staging areas designated to receive units

marked for redeployment and to

house them during processing. Each

camp in each assembly area needed a

dispensary, and fixed hospital beds

equal to 4 percent of the troop capacity had to be provided and staffed.

The new command had its own medical personnel, but too few for the job

to be done. Hence, Medical Department transients joined the work as

they passed through the camps on

their way either to home or to the Pacific.

Some of the assembly areas were

huge, and their medical support

needs considerable. One of the largest operated near Marseilles under

the Delta Base Section. Here in late

May Kenner found, overlooking the

port city, three engineer regiments

more than halfway finished with the

construction of a cantonment that

sprawled over 10.5 square miles of

high arid terrain. Buildings were a

mixture of prefabricated and cement

block structures and tents; in a nearby

quarry, German POWs labored to

produce the blocks. About 12,000

people were already staging for departure—not only American military

but liberated Russians bound for

Odessa. A camp population of 60,000

was expected when construction was

complete. A 250-bed central infirmary

handled short-term cases, while the

seriously ill were evacuated to the

43d General Hospital at St.-Pons. The

engineers had erected concrete-block

showers, and were laying out athletic

fields, tennis courts, a horseshoe

pitch, PXs, a beer garden, Red Cross

clubs, and an open-air theater seating

10,000. In the base section as a whole

60,000 Americans waited for their

orders; 150,000 German POWs

worked, if not at jobs, then at suntans. The Germans had their own

2,000-member medical establishment—doctors, nurses, and enlisted

men. Eventually the Delta Base Section had five general and three station

hospitals operating between Biarritz

and Nice, most to serve the transients—more than 13,000 beds, of

which almost 9,000 were occupied.42

Yet with all its difficulties, the

movement of units was simply a large

version of a familiar task. What raised

it to a new level of complexity was the

41 Army's determination to deal fairly On redeployment plans and methods, see SOP,

OofCSurg, HQ, ETOUSA, 15 May 45, sub: Readjustment of Medical Department Officers for Redeployment, and also AGO, WD, 4 Nov 44, sub: War

Department Policies and Procedures Governing the

Redeployment of the Army Upon the Cessation of

Hostilities in Europe. Both in file HD 370.5 (Redeployment Directives), box 307, RG 112, NARA.

42

 Memo, Kenner to ACofS, G-4, SHAEF, 10 Jun

45, sub: Report of Inspection of Medical Service,

Delta Base Section, during Inclusive Period 14-22

May 1945, in Medical Division, COSSAC/SHAEF,

War Diary, July 1945; Surg, Delta Base Section,

Annual Rpt, 1945, p. 7.
598 EUROPEAN THEATER OF OPERATIONS

POW LABORERS AT DELTA BASE SECTION STAGING AREA near Marseilles

with the individual soldier, by demobilizing those with the longest and

most difficult service. The Army

planned a partial demobilization of

about 1 million men to follow the

defeat of Germany. Not only units but

men and women had to be categorized, on the basis of individual adjusted service ratings (ASR). Elements

of this point score included total time

of service since 1941, number of

months served overseas, combat service, decorations, and number of dependent children. With 85 points an

enlisted man or woman would be discharged; with fewer, further service

would be required. While no similar

critical score was established for officers before the surrender of Japan,

their point score had to be taken into

account in determining whether they

would serve again in combat. Provided that no pressing need existed, the

high-score officer might reasonably

hope for early discharge.43

But how, in practice, was readjustment to be combined with redeployment? Personnel officers from major

commands—the Army Air Forces, the

field armies and army groups, and the

43John C. Sparrow, History of Personnel Demobilization in the U.S. Army, DA Phamphlet 20-210 (Washington, D.C., 1954), pp. 64-84. The critical score

was reduced to 80 points after V-J Day and, in response to political pressures, repeated downward

revisions followed.
FROM WAR TO OCCUPATION 599

Ground Force Reinforcement Command—got a look at the theater's

plan at a conference held in Paris on

15 May 1945. Individuals with lower

than the critical score first had to be

shifted from Category IV units to Categories I or II, that is, either to the

occupation forces or to those marked

for the Pacific. Similarly, high-score

men and women had to be moved

from Category I and II units to Category IV. In preparing a unit for the

Pacific, personnel experts first withdrew all who were physically unqualified for combat; then transferred the

high-score people; then filled their

places with low-score soldiers or, in

the case of officers, with other highscore men who were to be retained

on the grounds of their essential

qualifications.44

Much confusion resulted. By 1945

most units were composites of regulars and draftees, veterans and replacements. The long-service men

were far more likely to be in positions

of authority, and disproportionate

losses in experience and skill, leadership and expertise loomed on every

side. "You suddenly lost the chief of

surgery," complained a senior medical officer who had observed the

effect on the hospitals. "You suddenly

lost the chief of medicine. . . . And

they were ordered to Camp Lucky

Strike or they were ordered to Camp

Chesterfield, where they sat, in many

cases."

 45

 One hard-hit example was

the 127th General Hospital at Nancy,

France, which lost the assistant chief

of the surgical service, the chief of the

orthopedic section, the chief of the

general surgical section, an orthopedic ward officer, and an anesthetist.

Some exceptions to the redeployment rules had to be taken into account. A special case was represented

by the so-called Green Project, under

which 38,000 men and women with

skills needed at home were selected

and dispatched to the zone of interior

by air. For evident reasons, many

were medical personnel required by

the Army hospitals inundated by the

huge lift of battlefield casualties. An

early task of the chief surgeon's office

was to select 1,000 medical officers of

especially long service or urgently

needed skills.46

For nurses, a critical score of 55

separated those who could be transferred to the Pacific from those who

could not. Nurses who had been overseas for two years, or in two theaters

of operations, were not required to

serve further in combat (though they

might, of course, volunteer, and many

did—at the 127th, 14 nurses volunteered for duty in the China-BurmaIndia Theater). Volunteers, however,

could not meet the demands of the

War Department; 5,300 nurses in all

asked for service in the Pacific theaters, but 8,900 were required. Theater policy required that married

44

 OofCSurg, HQ, TSFET, Quarterly Report of

Operations, 8 May-30 Sep 45, pp. 26-28; HQ,

ETOUSA, 2 Jun 45, sub: Report of G-3 Training

Conference, p. 2, file HD 370.5 (Redeployment

Training). 45

 Shambora Interv, 8 Oct 62, p. 32, CMH.

46

 See Draft Directive, COMZ, ETOUSA (to CGs,

Seine, Delta, and United Kingdom Base Sections),

11 May 45, sub: Green Project for Return of Military Personnel From Europe to ZI, in box 311, RG

112, NARA; Memo, TSG to ACofS, Operations Division, WD, thru CG, ASF, 19 May 45, sub: Period I

Requirements of Medical Department Personnel

Within War Department Readjustment and Redeployment Regulations, file Green Project.
600 EUROPEAN THEATER OF OPERATIONS

nurses be placed in occupation or reserve units, setting off a flurry of

weddings.47

Between War Department policy,

theater rules, and the needs of the

Pacific War, personnel officers struggled with a system that was as complex as a Bach fugue but far less harmonious. As of V-E Day the mere

calculation of ASR scores, on which

everything else depended, was slow

and imperfect. The chief surgeon's

office found itself drawing upon a

pool of less than half its medical officers—those for whom scores were

available—to meet demands for immediate full staffing of units scheduled for departure. Lack of information worked injustice at both ends of

the scoring range; because their

scores had not been computed, some

low-point men escaped reassignment

to the Pacific and some high-point

soldiers missed going home.

On 12 July 1945 the situation

reached gridlock. Reassignment of

Medical Department officers came to

a halt, while the chief surgeon's harassed staff tried to discover which officers were available, where they

might be found, and what their scores

might be. A central card file was set

up by military occupational specialty

(MOS). Thereafter, a requisition for a

Category II unit—direct transfer to

the Pacific—could be met simply by

selecting the lowest-score men from

the required MOS. The fact that the

system was again functional did not,

however, make it just. No individual

officer could predict his fate on the

basis of his score, and those deprived

of an anticipated visit home by direct

reassignment were apt to be unhappy

soldiers.

Moreover, MOS numbers did not

really reflect exact gradations of professional skill and experience. Some

medical units continued to be readjusted by nonmedical personnel officers at the major commands and, as a

result, showed up at assembly areas

with professionally unbalanced staffs,

requiring new rounds of reorganization that lasted in some cases up until

the very moment of sailing. Nurses

received separate but not equal treatment; their problems were shunted to

the Nursing Division to handle, and

"special readjustments of nurses occurred only when deficiencies were

noted and reported." Despite such

problems, Kenner's staff contrived to

impose a measure of rough justice

upon readjustment. Nothing, however, could alter the fact that the reassignment process tore veteran units

to pieces and destroyed, all too often,

the morale it was meant to sustain.48

Throughout the upheaval medical

personnel, even as they attempted to

straighten out their own problems,

also examined and provided physical

profiles for all troops. Because the

profile was essential in determining

fitness for future combat service, the

theater called for all soldiers to be

rated by 1 July. The method in use

contained six elements, abbreviated

PULHES—physical condition, upper

extremities, lower extremities, nearing, eyes, and psychiatric diagnosis.

Ratings from one to four were given

47127th General Hospital Annual Rpt, 1945, p. 5;

Army Nurse Corps Division, HQ, USFET, Report of

Activities, 8 May-30 Sep 45, pp. 15-16.

48

 Army Nurse Corps Division, HQ, USFET,

Report of Activities, 8 May-30 Sep 45, pp. 34-40.

Quotation on p. 39.
FROM WAR TO OCCUPATION 601

for each element on a scale that ran

from "normal" to "serious defect."

The resulting score, in turn, was

translated into the profile: A or B indicated General Assignment troops;

C, Limited Assignment troops; and D,

disqualified for future assignment.

Doctors involved in the work needed

sharp eyes, not only to spot malingerers but to prevent collusion between

commanding officers and unit surgeons who sought to rid their units of

men who were physically fit but maladjusted. While profiling implied

much tedious routine work, and while

errors did occur (the chief surgeon

cited a frostbite victim whose L-3

rating did not prevent a reinforcement depot from rating his general

condition P-1), the system was fundamentally simple and workable, a fortunate circumstance under the conditions that existed in the theater

during the summer of 1945.49

A New Upheaval

Army planners anticipated that a

year would elapse between the surrender of Germany and the fall of

Japan. The explosion of two atomic

bombs during August 1945 left the

whole structure of planning—for partial demobilization, systematic readjustment, the Pacific buildup, and the

invasion of the enemy's home islands—one ruin among many.

The vast medical establishment

built for the war must now, in large

part, be collapsed like a tent and disposed of. The first task was to reverse

the schedule of deployment. Instead

of hastening low-score units to the

Pacific, the theater must retain them.

High-score units took their place in

the pipeline, bypassing the Assembly

Area Command and moving directly

to ports for shipment home. While

most Category II units returned to

their former commands, a few, already in transit to the Pacific, were diverted home to the indignation of

high-score men still awaiting transportation in Europe. By the end of

September the categories had been

abandoned, and the War Department

redesignated its units in Europe as

occupation forces; as redeployment

forces, whose next stop was home; or

as liquidation forces, technical service

units whose special task consisted in

closing out facilities that were no

longer needed.50

Under the new dispensation, the

ASR continued to be of some importance. Those with the highest scores

supposedly returned home; those with

the middling scores (60-79 points)

served as liquidation forces; and those

with the lowest scores, along with

professional soldiers who volunteered

to stay in Europe, entered the Occupation. However, theory often failed

to square with practice. Because the

theater had precipitately shipped out

its lowest-score men, many were now

permanently lost to the occupation

forces that needed them. Their loss,

the departure of high-score personnel, and normal attrition caused by

49 sickness, compassionate leaves, and Charles M. Wiltse, ed., Physical Standards in

World War II, Medical Department, United States

Army in World War II (Washington, D.C.: Office of

the Surgeon General, Department of the Army,

1967), pp. 68-71; Surg, Channel Base Section, Hist,

January-June 1945, p. 6.

50

 Resume of Activities of Divisions of Medical

Section, HQ, TSFET, p. 1; Directive, HQ, USFET,

6 Oct 45, Redeployment and Readjustment Following Cessation of Hostilities.
602 EUROPEAN THEATER OF OPERATIONS

so forth, seriously compromised some

essential services. Among medical

specialists, orthopedic surgeons in

particular were depleted by the process, a misfortune for many young soldiers whose method of driving jeeps

resulted in large numbers of broken

bones. By the end of 1945 shortages

also developed or threatened in

otolaryngology, ophthalmology, and

radiology.

Overall, however, the worst effect

was the continuing loss of experienced line officers and NCOs. Green

men, ill-led, accumulated in occupation units, and the results showed up

through the medical and legal statistics in high rates of disorder, crime,

and venereal disease. Quantitatively,

however, medical personnel were able

to keep up with those they served. Of

15,770 medical officers in the theater

on V-E Day, 14,012 returned home

by the end of December 1945. In all,

some 224,000 officers and men departed by the year's end, and the

258,000 medical troops present when

Germany surrendered shrank to

34,000. Yet similar changes transformed the forces they served. At

year's end theater strength still

topped 600,000 and authorized beds

numbered 24,400, but the chief surgeon reckoned the supply of doctors,

nurses, and dentists adequate to the

reduced demand. Though further reductions were on the way for the theater's medical personnel, the troop

basis too was destined to shrink by

one-half during the first six months of

1946.51

Helping to offset losses of medical

officers was the arrival in early 1946

of about 200 replacements, most of

them products of the Army Specialized Training Program (ASTP). Established during the war to ensure a

continuing supply of new doctors and

other professionals, the ASTP since

1942 had provided a free education

and living expenses to selected draftees. In return, the 13,000-odd young

physicians graduated under the program owed the nation three years of

active military service. A godsend

during the throes of readjustment,

the new arrivals were "enthusiastically

received at the various hospitals" of

the European Theater.52

More serious was the drain on

MAC officers. As separation criteria

were lowered, personnel officers calculated that by the end of March the

theater would have less than half the

MACs required to fill its T/O vacancies. Though 150 replacements were

dispatched from the zone of interior,

the gap that remained obliged the

chief surgeon's office to utilize officers without special medical training.

An adequate supply of administrative

officers could have relieved some of

the pressure on the physicians, but in

1945-46 the number of MACs was

small. Continuing losses to civilian

51

 Professional Services Division, OofCSurg, HQ,

USFET, Periodic Rpt, 8 May-30 Sep 45, p. 5, file

319.1-2, Shambora Papers, MHI. On VD in the occupation units, see below. See also Resume of Activities of Divisions of Medical Section, HQ, TSFET,

pp. 3-5. 52

 Quoted words from Essential Technical Medical

Data Rpt, HQ, TSFET, March 1946, p. 5, file

350.05, box 37, RG 112, NARA. On the ASTP program, see Marvin A. Kreidberg and Merton G.

Henry, History of Military Mobilization in the U.S. Army,

1775-1945, DA Pamphlet 20-212 (Washington,

D.C., 1955), p. 635; Col Francis M. Fitts, MC,

"Training in Medicare, Dentistry, and Veterinary

Medicine . . . Under the Army Specialized Training

Program, 1 May 1943 to 31 December 1945, Ms no.

3-4BA, RG 319, NARA.
FROM WAR TO OCCUPATION 603

life were especially painful because

the war had demonstrated the value

of these officers as never before.53

Hospitalization and Evacuation

Hospitals throughout the theater

were also caught in the successive upheavals of 1945. At a conference on

30 April medics and engineers had

agreed to hold planned construction

to a minimum in view of the impending end of the war. Bed requirements,

equal to 6 percent of troop strength

on V-E Day, were projected as being

equal to 5.5 percent on D + 30, the

same on D + 60, and to 4 percent on

D + 90. In May the theater established

an evacuation policy of 60 days to

speed the movement of the warwounded home. Immediately after

V-E Day a second conference resulted in an agreement to end all construction in Great Britain and the liberated countries, except for two

facilities near Le Havre that were intended to receive patients awaiting

shipment to the zone of interior.

Meanwhile, the theater sought to

utilize its best plants as long as possible, restaffing when the units originally in possession were redeployed. In

Germany fixed hospitals were established only as needed to support the

Army of Occupation. Pending their

departure, the large forces marked for

redeployment sent their sick and injured to mobile hospitals or to facilities along the line of communications

that had not yet been closed. As

troop strength fell, many mobile units

also left, until only the minimum

needed by the occupation forces remained. In practice, the so-called

mobile hospitals that remained in

Germany worked out of fixed installations and provided service to area

commands; their mobility consisted in

the capability to move to the field on

short notice, if the units they served

were suddenly called out. Whenever

possible, the Army used German civilian or military plants to house its patients, though the chief surgeon had

first call on other buildings if needed

for medical use.

As matters worked out, twenty sites

for fixed hospitals were quickly acquired, thirteen in existing civilian or

military buildings (see Map 27). The

work of making the structures suitable

for use involved a great deal of

scrounging; plumbing, for example,

often had to be salvaged from

bombed-out structures to enable repairs to get under way at once. Food

was cooked on field stoves, until regular fuel shipments could be restored,

and Quartermaster laundry platoons

continued for the time being to clean

pajamas, bedding, and other supplies.54

In the Allied nations hospital closures were the order of the day. As

previously noted, both POW and civilian labor had become essential to

the operation of many large hospitals,

both on the Continent and in the

United Kingdom Base. An example

was the 819th Hospital Center at

Verdun. In January 1945 the headquarters, housed in a "spacious, well

53

 Personnel Division, OofCSurg, HQ, TSFET,

Hist, 10 Oct-31 Dec 45, p. 2. On the postwar personnel problems of the Army Medical Department,

see Albert E. Cowdrey, The Medics' War (Washington, D.C.: U.S. Army Center of Military History,

1987), ch. I.

54

 OofCSurg, HQ, TSFET, Quarterly Report of

Operations, 8 May-30 Sep 45, pp. 13-16.

FROM WAR TO OCCUPATION 605

appointed" chateau at Bar-le-Duc, su- pervised the operation of eight general hospitals with a combined bed ca- pacity that grew to exceed 13,000. Each hospital had its own 500-man

POW enclosure, the Germans supplying "many services including those of

a technical nature." DPs guarded the

captives, and some 300 French civilians worked in each hospital. Every

hospital had farms—in all, over 300

acres were in cultivation, and DPs and

POWs worked together, planting,

tending, and harvesting fresh vegetables for the hospital patients and

staff, with the surplus going to the

local Quartermaster depot for general

issue to the troops. After V-E Day the

center became a staging area for medical units destined for the Pacific and

also for the Army of Occupation.

Here general and station hospitals

were processed by center personnel,

whose regular duties had disappeared

as occupied beds plummeted below

2,000. But the center was a part of

the process its staff guided. Hence

the month of June was taken up, not

with preparing others to move, but

with internal redeployment and readjustment. The center's hospitals had

varied fates. One, the 95th General

Hospital, went to strategic reserve;

two went directly, and one indirectly,

to the Pacific; one replaced another

unit leaving the Continent; and two

remained in operation where they

were. The prisoners were sent to

camps and the DPs to their homes,

and the French civilians were dismissed gradually "in order not to disturb the economic stability of the

[neighboring] communities."55

As closures took place, plants were

often returned to the host nation on a

lend-lease basis, some with their

American equipment intact. In the

United Kingdom a few closings preceded V-E Day in response to British

requests for the return of specific

buildings, but many more resulted

from the end of the fighting. Evacuation from the Continent to Great

Britain ceased in May, and during

that month eight facilities were returned, followed by twenty-six in

June. By autumn sixty-eight hospital

plants had been closed in Great Britain and forty-four on the Continent;

in the Allied countries only fifty-six

remained operational in American

hands and fourteen others, already

empty, awaited formal disposition.

Provisional POW hospitals in France

were either closed down or concentrated in the Oise Base Section. In

June redeployment of units emptied

building after building, as ten 1,000-

bed general hospitals and twenty-six

smaller units departed. During July,

August, and September the outflow

was continuous and very large.56

The closure of large units with intricate equipment charged to their

accounts was anything but easy. In

England personnel equipped with

checklists, issued by the United Kingdom Base, went through a complex

ritual. A vexing problem, especially

noticeable after V-E Day, when numbers of units were on the move simultaneously, was the lack of timely information from higher headquarters.

"On one occasion," noted General

55

 819th Hospital Center Semiannual Rpt, January-June 1945, p. 3.

56

 Memo, Col S. B. Hays to Beers, Pappas, and

Parker, 10 May 45, sub: June Redeployment, file Redeployment, box 304, RG 112, NARA.
606 EUROPEAN THEATER OF OPERATIONS

Kenner, "ten hospital units were ordered to be ready for movement

within ten days." Indecision, followed

by sudden demands for mass movement, posed special problems to medical units that had to assist the processing of others.57

Disposition of patients depended

primarily on whether or not they were

battle casualties. The latter departed

quickly for home, 42,000 in May

alone. RAMPs likewise headed for the

zone of interior. On the other hand,

the theater had obvious reasons to

retain patients from among its occupation troops and, despite the hospital closings, ample resources to do so.

Normally, few who were injured

during peacetime found any quick

road home. For this reason, evacuation totals fell rapidly after the departure of the battle wounded. By

autumn the theater was virtually

empty of the men whose injuries had

helped to bring the victory. However,

a considerable patient load remained.

Theater hospitals were filled with not

only the sick and those with commonplace injuries but also collectors who

shot themselves with souvenir weapons and new replacements who were

ill-trained and unhandy in the use of

firearms. The disorderly state of Germany was also a source of injuries, for

some casualties resulted from "skirmishes with the civil population or

Displaced Persons."

 58

After the defeat of Japan the pace

of hospital closures slowed. In Germany the system stabilized at a level

much reduced since the war; in Austria it expanded. In August 1945 the

American Zone of Occupation was

created in Hitler's homeland, bringing the 124th General Hospital to

Salzburg, the 110th Station Hospital

to Vienna, and a medical depot to

Wels. Revised post-V-J Day plans for

hospitalization in Germany provided

38 hospital units to serve the occupation forces, including 8 general hospitals, 10 field hospitals, and 1 convalescent facility. This was a far cry

from V-E Day, when the theater had

contained 200 fixed hospitals, with

195,000 beds; 118 evacuation, field,

and convalescent hospitals, with

63,000 mobile T/O beds; and over

700 other medical units of all types.

And in time the new estimates were

revised downward as well. By January

1946 the theater held 35 evacuation,

field, and convalescent hospitals, with

19,955 beds; of these, 16 were nonoperational, awaiting redeployment or

inactivation. By mid-1946 only 4 such

units remained, with 1,600 beds, and

17 fixed hospitals, with 10,400. With

declining numbers went consolidation, as USFET took over the remaining medical services of the Mediterranean Theater.59

Medical training was obliged to

keep pace with the rapidly changing

course of redeployment and readjustment. With the coming of V-E Day,

special courses began to prepare doctors, nurses, administrators, and enlisted men for service in the Pacific.

Tropical medicine, the effects of Japanese weapons, and the problems of

sanitation and preventive medicine in

the Pacific were taught until 15 57

 OofCSurg, HQ, TSFET, Quarterly Report of

Operations, 8 May-30 Sep 45, p. 31. 58

 Chief Consultant in Surgery Rpt, January-June

1945, file Professional Services 1945/1, Shambora

Papers, MHI.

59

 Resume of Activities of Divisions of Medical

Section, HQ, TSFET, Operations Division sec., p. 3.
FROM WAR TO OCCUPATION 607

GERMAN HOSPITAL TAKEN OVER BY OCCUPATION FORCES

August 1945, then dropped. But the

main theme and most significant

problems of the time were those connected with the training of new arrivals in the theater. Of these there

seemed to be no end. Heavy emphasis upon on-the-job training reflected

the haste and confusion of the process, which left no time (and very

often, no qualified instructors) to give

formal courses in the many duties the

newcomers had to learn. The rapid

loss of experts in all fields and in all

ranks made training more and more

burdensome and difficult as the year

advanced. Not only were veteran

Americans leaving the hospitals, but

the German POW workers who had

proven so useful were being rapidly

sent to their homes. Some discharged

Americans also stayed in the theater

to work as civilians in Army installations. But this, too, was a stopgap.

To fill the gaps, hospitals turned

increasingly to German civilians, especially for record-keeping and secretarial work. Thus the 101st General

Hospital at Berlin on 10 July opened

a civilian labor office, which quickly

hired 125 Germans as kitchen helpers, laborers, typists, electricians,

plumbers, cabinetmakers, tailors, and

carpenters, among other jobs. As personnel losses continued, more were

hired, and by early December 651 civilians were being "used in almost
608 EUROPEAN THEATER OF OPERATIONS

every department of the hospital."

General Kenner recognized the need

that existed, and throughout the occupation zone German civilians took

clinical as well as support positions,

serving as laboratory, X-ray, and

dental technicians and as male

nurses.60

Meanwhile, however, the War Department had announced two policy

changes: The total bed allotment for

the theater was reduced to 4 percent

of the total troop strength, formerly

the allotment for fixed beds alone;

and the troop basis for the Army of

Occupation was shortly afterward reduced to 300,000. The theater's efforts to speed construction and Washington's troop reductions appeared to

be headed in opposite directions.

Kenner began to reduce the number

of field and evacuation hospitals in

order to retain his fixed beds, and

sought to hold on to hospital sites by

limiting the size of the units (station

and general hospitals) that were to

occupy them. He knew that War Department authorizations took no account of 90,000 civilian dependents

expected to arrive during the spring

and summer of 1946. Hence, he

sought to keep actual beds, to satisfy

War Department demands by paper

reductions, and to equip his permanent hospitals (if necessary from local

sources) for the ten-year period that

Army planners then viewed as the

minimum length of the Occupation.

Amid daily and almost hourly changes

in personnel, plans, readjustment

standards, and the like, the physical

basis for a long-term American presence began to take form.61

Medical Supply

Medical supply was a tangle of difficulties. At V-E Day the job of supplying the armies became secondary to

the transshipment of supplies to the

Pacific. Depot workers, instead of

handing out items as needed, turned

to a thousand complex details of documentation, marking, and packing. In

the process seemingly insignificant

matters—obtaining wood for crating

was an example—became baffling obstacles for men working amid war-battered civilian economies. Then in

September the goal changed again.

Allocation to occupation troops remained a duty, but most supplies

were either to be returned to the

United States or handed over to the

liberated nations. Despite the shift in

course, the mastery over medical supplies established long ago under

ETOUSA was still in evidence, aided

by a variety of technical improvements. The field armies consolidated

their depots under four major centers—Bremen, Berlin, Weinheim, and

Furth. A centralized stock system was

set up in August. When TSFET took

over, medical supply was centralized

in the Office of the Chief Surgeon

(Chart 12), and electric accounting

machines kept tabs, through bimonthly reports from the depots, of stocks

on hand and issues throughout the

theater.

During redeployment, units on

their way to the four main ports of

60

 101st General Hospital Annual Rpt, 1945, pp.

21-22.

61

 OofCSurg, HQ, TSFET, Quarterly Report of

Operations, 1 Oct-31 Dec 45, pp. 9-10.

610 EUROPEAN THEATER OF OPERATIONS

Marseilles, Rouen, Le Havre, and

Antwerp carried their authorized

equipment with them, replacing lost

or unserviceable items from base section depots in the staging areas. Hospitals turned in their equipment and,

in exchange, received complete pre- packed assemblies that were prepared

at the main depots and shipped to the

ports. Some of these procedures

changed after the Assembly Area

Command began to function, but the

general shape of redeployment remained unchanged until V-J Day.

After that units no longer needed any

but basic equipment, for they no

longer faced the possibility of combat.

The outmovement of supplies dwindled, and tonnages on hand in medical depots rose dramatically.62

Until V-J Day the War Department,

after receiving reports of goods on

hand, forwarded shipping orders to

guide their redistribution. But after

V-J Day most of the orders were canceled. The theater now forwarded to

the Government Procurement Agency

declarations of surplus items. Goods

obtained under reverse lend-lease

were especially likely to be in this category, because the implements and

supplies were unsuitable for use in

the United States. The wartime Allies

were the main beneficiaries of surpluses, though arranging for payments with their financially strapped

governments interposed many delays.

Nevertheless, even in 1945 USFET

turned over fifty 1,000-bed general

hospital assemblies to the French government, eight to the Belgian, and

three to the Dutch.

Additionally, mountains of captured

German war matériel required control. Between July and October the

Supply Division prepared a master

catalogue of some 6,400 medical

items, with standard nomenclature

and stock numbers. Instead of handling out supplies as needed, medical

supply officers brought to former

Wehrmacht stocks the same sort of

centralized management that now

characterized the handling of American goods, and with it more effective

means of preventing losses and supplying the needs of German civilians

through the military government.

Captured stocks were consolidated,

first to nine and then to six installations; by the end of September the

total tonnage of medical supplies on

hand had sunk from a high of 31,000

tons to about 18,000.

In the onetime arsenal of Great

Britain the seventeen depots of early

1945 were rapidly consolidated to six

after V-E Day. As the almost 100 hospitals and dispensaries that had drawn

upon them began to close, and as

troops were shipped away, the familiar outflow of matériel reversed. Closing hospitals turned in their equipment, and the depots used turn-ins,

plus stocks on hand, to fabricate new

assemblies for shipment to the Pacific

and returned British items to the

Government Procurement Agency.

While the three major duties of receiving equipment, constructing assemblies, and issuing supplies went

on, the workers were themselves

being pulled away for redeployment.

German POWs were essential during

this period, readying equipment for

use against their former allies. Their

numbers rose steadily at Depot M-24,

the last to survive, until 1,200 prisoners and their American supervisors 62

 Wiltse, ed., Medical Supply, pp. 383-87.
FROM WAR TO OCCUPATION 611

were working around the clock. At

V-J Day all except routine activity

ceased for a month, then resumed—

now with the object of closing the

whole wartime medical establishment

down for good.63

Health of the Troops

Personnel turbulence and loss of

manpower also dominated the field of

preventive medicine among the occupation forces. Stability was the great

need, for whenever it could be attained, the health of the troops improved. Settled cantonments were a

plus because area control was possible, and the attention of commanders,

engineers, and medics could be concentrated upon enforcing the rules of

sanitation, obtaining a potable water

supply, and so forth. A rapid decline

in the case rate of infectious hepatitis,

from 22.8 per 1,000 per annum in

March to 6.4 in June, reflected the

fact that troops again were drinking

chlorinated water. Theater forces

were reimmunized against typhus

and—a novelty—against influenza as

well, in a move dictated by memories

of the pandemic that had followed

World War I and the development of

a vaccine during wartime by the Army

Epidemiological Board. Close cooperation with the Typhus Commission

and the military government helped

to ensure both civilians and military

against the development of any new

foci of the disease. During all of 1945

only five cases of typhus were reported among Americans, and some

doubt existed as to the diagnosis in

two of these. The prime Army concern was to guard against complacency. A pool of personnel trained in

control had to be maintained, power

dusters stockpiled, and DDT supplies

kept on hand. Such vigilance was warranted, not by conditions within Army

cantonments, but by the presence of a

cold, hungry, and crowded civilian

population outside.64

The chief negative factor was the

continuing personnel upheaval. The

redeployment camps, the staging and

assembly areas, the troop trains, and

the arrival and departure points all

presented problems in disease control. A mitigating circumstance was

the fact that more space was available

to house the troops who remained.

By the time cold weather arrived in

1945 most American soldiers were

living in permanent buildings, and

those still under canvas—primarily

men in the assembly and staging

areas—kept warm in winterized quarters.

American troops, healthy during

the fighting, in general remained so

in peacetime, except for continuing

problems with diphtheria and venereal disease. Common diarrhea among

the troops increased during the

summer of 1945, but not enough to

cause alarm. In the Mediterranean

area an old enemy, malaria, posed a

threat because one of the major ports

through which troops were funneled

63

 Above paragraphs based upon OofCSurg, HQ,

TSFET, Quarterly Report of Operations, 8 May-30

Sep 45, pp. 59-69; Wiltse, ed., Medical Supply, p.

374.

64

 OofCSurg, HQ, TSFET, Quarterly Report of

Operations, 8 May-30 Sep 45, p. 73; Resume of Activities of Divisions of Medical Section, HQ, TSFET,

Preventive Medicine Division sec., p. 6; Rpt, OofCSurg, HQ, TSFET (to Theater CSurg), 19 Jan 46,

sub: Brief Resume of Major Items of Interest and

Activities in Preventive Medicine Division Since VE

Day, pp. 1-2.
612 EUROPEAN THEATER OF OPERATIONS

was Marseilles. Lying amid an endemic malarious region, the old port city

of southern France and its environs

were filled with natural breeding

places for Anopheles mosquitoes.

The theater launched an all-out malaria prevention program, employing

airplanes to spray the local area with

DDT and forming a provisional malaria control unit with Italian POWs

to augment the effort on the ground.

The program, supplemented by an information campaign among the

troops and by French authorities

among the population, forestalled an

outbreak.

Diphtheria, a nagging problem

since the previous year, remained a

medical burden during the Occupation. No epidemic broke out, but incidence remained high and the illness

was highly virulent and life-threatening, especially because of complications such as myocarditis (inflammation of the heart muscle). Indeed,

thirty-eight deaths were recorded

among the 1,195 cases that occurred

among American troops in the first

ten months of 1945—a case fatality

rate of 3 percent. Immunization programs among German children

seemed the best bet for long-term

control of a disease that had grown

steadily on the Continent during the

war years. For soldiers, early diagnosis and quick treatment were essential, and medical efforts were largely

directed toward this end.65

Exacerbating the medical problems

was the heavy influx of green troops

during early 1946. Struggling to find

quick replacements for the departing

veterans, the Army reduced the

length of the basic training cycle for

new recruits and pushed them quickly

through the training centers. Crowding, rapid turnover, and cold weather

resulted in epidemic outbreaks of respiratory complaints and childhood

diseases—chiefly measles, German

measles, scarlet fever, mumps, and

meningitis. Many men who were incubating such complaints filed aboard

the troopships bound for Europe.

Here crowding was at its maximum

during voyages prolonged by bad

weather. Either on shipboard or soon

after arrival many fell ill, spreading

their contagions to others. To this situation there was no fundamental

answer, except to isolate and treat the

sick. By April the declining incidence

in zone-of-interior training centers

promised a healthier crop of young

soldiers to fill depleted formations

overseas.66

In general good health, Americans

settled down to enjoy the amenities of

the Continent. Despite the ruin of

war, much remained undestroyed in

the European treasure house. Medical

officers, hoping to improve their professional skills, studied at dozens of

institutions, including the universities

of Oxford, Edinburgh, and Paris.

Nurses found educational opportunities in France and Great Britain. In a

less weighty vein, the Third and Seventh Armies opened ski schools.

Winter sports in Switzerland and the

summertime beaches of the Riviera

beckoned. Men and women who had

65 come to make war stayed to learn and Cir Ltr No. 69, OofCSurg, HQ, TSFET, 28 Sep

45; Resume of Activities of Divisions of Medical Section, HQ, TSFET, Professional Services Division

sec., p. 3.

66

 Ltr, TSG to CG, USFET, 26 Apr 46, box 1497,

RG 112, NARA.
FROM WAR TO OCCUPATION 613

to enjoy. The troops began a long,

peaceful residence in Germany, first

as occupiers and later as allies, that

continues at this writing, when those

who were young men and women in

1945-46 have reached the threshold

of old age.67

67

 See, for example, Army Nurse Corps Division,

HQ, USFET, Report of Activities, 8 May-30 Sep 45, pp. 7-8.
EPILOGUE

The Theater in Retrospect

The American medical service that

supported the invasion of Europe and

the conquest of Hitler's Germany was

a successful but paradoxical organization. Given the unresolved problems

of command that afflicted not only

the medics but the whole theater, it

probably worked better than it should

have. Hawley's position under the

service forces required strengthening

before he could exercise fully the prerogatives of a theater chief surgeon.

The creation of SHAEF, establishing

Kenner in a supranational headquarters, might have made for serious

trouble. Practical accommodations

and the sheer force of Hawley's personality resolved issues that, under a

less able or less personable chief surgeon could have led to bitter jurisdictional conflicts but—except in the

case of the fledgling air forces, struggling toward independence—did not.

Similarly, the position of the chief

surgeon vis-a-vis base section and

ground force commanders and their

surgeons might have led to sterile or

destructive squabbles. There can be

little doubt that the history of Army

medicine in the European Theater

was given an ineradicable stamp by

Paul Hawley's strength and by Albert

Kenner's forbearance.

The ETO medical service differed

from that of other combat theaters in

the long period of preparation that

preceded the fighting.1 Even granting

the hiatus caused by the North African invasion, the buildup in Great

Britain was elaborate and lengthy.

Here inter-Allied cooperation received its first test, as a vast American

army took up residence in the British

Isles. Hawley's early contacts with

British military leaders and physicians

helped to establish a successful pattern of professional interaction that

continued throughout the war. Yet

some serious problems surfaced. The

logistics of the medical buildup were

staggeringly complex, and the resolution of the supply problems that developed proved to be beyond the capacity of the chief surgeon and his

staff, requiring expert help from the

United States. But the adoption and

implementation of reforms put the

medics ahead of the game: In later

days, when the theater supply problems on the Continent were most tangled, the medical system worked well.

1

 The contrasting situation in the Pacific theaters

will be explored in Mary Ellen Condon-Rall and

Albert E. Cowdrey, The Medical Department: Medical

Service in the War Against Japan, United States Army

in World War II (Washington, D.C.: U.S. Army

Center of Military History, forthcoming).
THE THEATER IN RETROSPECT 615

Other aspects of the buildup caused

sharp, though transient, difficulties.

The program of American hospital

construction in England burdened the

resources of the host nation, and the

ensuing delays strained Hawley's patience. Demands by the theater for

medical personnel were large, perhaps excessive, and the priorities accorded to service troops in general

and to medics in particular were low.

The result was a buildup that moved

by fits and starts. In succession, the

theater had too few medical facilities

for the rapidly expanding army; then

too few professionals to staff its hospitals; and, finally, too many and too

much of everything to support forces

largely engaged in training, not fighting.

In its prime mission—the accumulation of overwhelming forces to strike

a knockout blow—the buildup was a

great success, in which the medical

service shared fully. Yet some of

Hawley's decisions cast long shadows.

Presented with some two and a half

years to prepare his forces, the chief

surgeon was able to devise and implement a correspondingly elaborate

plan of medical support. One of the

most questionable parts of the plan

provided for the transportation of

large numbers of fixed hospitals to

the Continent after D-Day and for

their utilization as far forward as the

Advance Section of the Communications Zone. Early movement forward

was essential for such units, because

general hospitals required time to

make their bed strength operational.

But the effort to advance their complex equipment and marry it to the

units encountered great difficulties.

Hawley consistently overestimated the

ability of the bomb-shattered European transport system to handle the demands of war. Many general hospitals

became separated from their gear,

and when they arrived near the front,

they were difficult to house and subject to enemy attack. In the event, the

advanced general hospitals were used

in ways that had not been foreseen,

some as "little more than holding

units."2 Hawley's somewhat cumbersome and grandiose conceptions,

based perhaps on the experience of

World War I, might have fared better

under a commander like Britain's

Montgomery than under Bradley and

Patton, masters of improvisation and

the armored thrust.

Indeed, as the chief surgeon's Operations Division admitted after the

war, the struggle waged in Europe

was so unlike World War I that "comparison is hardly of value." The Medical Department learned that availability of fixed beds meant little in the

absence of transport. Hence, reported

the medical section of the General

Board established after the war to

analyze the theater's accomplishments

and failings, "the experience of the

European Theater of Operations indicates that field hospitals and semimobile, 750-bed evacuation hospitals

can be used much more effectively by

the Advance Section . . . and that

general hospitals should be established only in the base, and possibly

the intermediate, section of the Communications Zone."3

2

 Study No. 95, General Board, USFET, sub: Medical Service in the Communications Zone in the European Theater of Operations, Medical Section, p.

4, file HD 334. 3

 Ibid., p. 3, file HD 334. The General Board was

established in ETOUSA in June 1945 and continued

by USFET. See GO No. 128, HQ, ETOUSA, 17 Jun

45; GO No. 128, HQ, USFET, 7 Aug 45; and GO

No. 312, HQ, USFET, 20 Nov 45.
616 EUROPEAN THEATER OF OPERATIONS

Aircraft provided essential support

to the medical system, speeding evacuation both within Europe and from

the Continent to Great Britain.

Though Hawley launched planning in

November 1943, skepticism extended

up to the Supreme Commander, and

air evacuation began as an emergency

measure and no more. Yet it proved

to be a logical complement to the armored thrusts that carried line units

beyond the reach of the railroads. Despite fickle weather and the lack of

dedicated medical aircraft, the speed

and the advantage of a smooth ride to

the patient ultimately caused the

whole theater to become "completely

'air conscious.' " On the ground as

well, increased mobility demanded innovations that ETOUSA planners

foresaw only in part. While they

grasped the need for holding units at

airfields, the extent of the need there

and at every transfer point along the

lines of evacuation was not fully appreciated. Many units had to be improvised during the breakout and

pursuit, field and evacuation hospitals

frequently being pressed into service.

The fact that the theater had prepared for gas warfare and that none

occurred freed the medical gas treatment battalions to become holding

units—a happy accident. Meanwhile,

those mobile hospitals that followed

the armies often proved in fact to be

less than their designation implied.

The whole question of mobility deserved reconsideration. Perhaps significantly, when the surgeon general

in August 1945 issued a T/O&E for a

forward hospital to treat nontransportables, the new sixty-bed unit bore

the name of mobile army surgical

hospital (MASH). The experience of

the European Theater in hospitalization and evacuation alike pointed to

the need for a medical service as

supple as the shifting battlefields of

mechanized war.4

Other problems arose because the

theater's obsessive demands for more

and more medical units seemingly

took little account of the war going

on in the Pacific or the needs of the

home front. A mixture of high clinical

standards, bureaucratic empire building, and reluctance to see the wounded pass beyond theater control

evidently contributed to Hawley's resistance to the evacuation of casualties on troopships. Of a piece with his

other aims was Hawley's endeavor to

hold the theater evacuation policy as

high as possible. All these policies

tended to maximize the need for

American medical personnel in the

European Theater; in the end, direct

orders from the War Department

were needed in late 1944 to speed

evacuation, to turn over prisoners to

the care of their own medical service,

and to limit the commitment of new

medical manpower from a declining

national pool. Yet, in the Ardennes

crisis, the sheer redundancy of medical units proved the key factor in enabling the straining system to handle

the influx of wounded.

Some problems similar to those of

the American medical service also afflicted the wartime Allies. The establishment inherited by the British from

World War I was not mobile enough,

a lesson driven home in the opening

days of the war in Europe when medical units and supplies were overrun

4

 Quoted words from Operations Division,

OofCSurg, HQ, ETOUSA, Semiannual Rpt, January-June 1945, pp. 4-5. See also Table of Organization and Equipment No. 8-571, August 1945.
THE THEATER IN RETROSPECT 617

and all too many wounded were abandoned to the enemy. Persistent shortages in vehicles and fuel stymied attempts to improve mobility. A special

case was the air transport of the

wounded. The Royal Air Force

blocked efforts by the British Army to

gain dedicated aircraft for medical

use. Ad hoc air evacuation developed

anyway during the African campaigns,

with Britain's wounded riding transport planes—many of them American—on return trips. The usual problems had to be faced in moving the

wounded to airfields, in holding

them, and in responding to the often

unpredictable arrivals and departures

of nondedicated aircraft. In the event,

reforms in the British medical service

were not fully implemented in any

theater prior to the D-Day invasion,

and throughout the war dedicated

medical aircraft never played the role

they might have. The British Army as

a whole adapted less to the era of the

blitzkrieg than that of any other major

combatant, and the Americans,

during their years of residence in

Great Britain, may well have learned

bad lessons from their hosts as well as

good ones.5

Uniquely American, however, was

the way that replacement policy interacted with the stresses of the European fighting to produce a large and, in

substantial part, probably preventable

burden of neuropsychiatric casualties.

While some units had been hard used

in all American wars, the experience

of continuous combat by large forces

against a determined, well-equipped

enemy was rare in the nation's annals.

The lessons that other armies, including the British, had learned on the

Western Front in World War I seemingly had little effect on the Americans in the European Theater. Here

the same units were committed to

battle, month after month, by a theater that possessed a huge support

system but few reserve combat forces.

The result was extremely wearing on

the men who bore the brunt of the

fighting.

In February 1945 the 12th Army

Group surgeon, Colonel Gorby, invited the attention of his superiors to

the "continued high loss of manpower from combat exhaustion." Key personnel were beginning to be affected,

including small unit leaders with excellent records in combat. Studies

carried out in the harassing conditions of the Italian campaign had already shown that healthy men could

endure combat stress only for 200-

240 days, after which their efficiency

declined sharply. Studies in the European Theater confirmed these findings, and Gorby compared the needs

of men to those of trucks: "Relief

after 130 to 150 combat days," he

wrote, "is comparable to the 10,000

mile overhaul." He argued that rotation was necessary to retain men in

service. The British rotated personnel

out of the line after 12 days, for a rest

period of 4 days, and the U.S. Air

Force rotated fliers home after a certain number of combat missions. The

medical service in various units made

provision for its own personnel, so far

as it was able, returning doctors in

front-line units to COMZ hospitals

and replacing them with men who

had not seen combat, and in some

cases rotating hard-pressed unit

medics at least out of the range of

enemy shells. But no comprehensive 5

 Crew, AMS, Administration, 1:462-505
618 EUROPEAN THEATER OF OPERATIONS

system of rotation for the troops was

installed during World War II in the

theater.6

Despite its errors, the theater could

point to a superlative achievement in

lifesaving under what were often most

difficult circumstances. The job it did

was of staggering size. Direct hospital

admissions for all causes between 6

June 1944 and 11 May 1945 totaled

1,052,659, by far the highest for any

theater of operations. A total of

381,433 patients were evacuated to

the United Kingdom during that time:

148,229 by sea and 233,204 by air. Of

183,121 patients carried to the zone

of interior, 154,383 went by sea and

28,738 by air. The First Army, with

249,090 casualties from all causes,

suffered far more than the other field

forces. The Third Army had 139,240;

the Seventh Army, 80,099; and the

Ninth Army, 54,877. Despite the evacuation crisis of the winter, the theater

could properly boast at the end of

1944 that "at no time have any of the

armies we supported been embarrassed, hindered, or their combat efficiency adversely affected by an inability to clear themselves of casualties."

The European Theater enjoyed the

lowest nonbattle and disease death

rates of all overseas theaters. Of

393,987 battle wounded admitted to

its hospitals, 12,523 died—a mortality

rate of 3.2 percent, the lowest for any

theater of operations.7

Not all of this distinguished record

can be credited to the medical system

that Hawley built. The European

Theater profited by the experience of

other theaters in many respects, including the care of neuropsychiatric

casualties. Above all, it was fortunate

in its environment, despite the cold

injuries that marked its one great failure to heed and apply preventive

measures. Northwestern Europe was

comparatively compact, contained

many friendly people who aided their

liberators, lacked jungles, and possessed (even if in damaged form) all

the physical substructure of industrial

civilization.

Nevertheless, medical organization

and clinical skill exploited the advantages and compensated for many of

the failings of the wartime environment. In the early critical phases of

evacuation, when the wounded man

had to be dragged, carried, or assisted to safety under fire, the basic contribution of the medics was physical

strength and raw courage. Hailing the

aidman at the end of the struggle,

Hawley's headquarters declared that

he "must face the same danger as

armed troops without recourse or dependence upon weapons of any sort.

He 'takes,' he never 'gives'—except

that he gives himself in order that his

mission may be accomplished."8

6

 Quoted words from Surg, 12th Army Group,

Hist, January-June 1945, an. 18, p. 1. See also ibid.,

an. 19. A limited policy of granting leaves to the

United States and to rear areas was in force in the

European Theater at the time. On neuropsychiatric

rates, see Albert J. Glass and Robert J. Bernucci,

eds., Zone of Interior, Medical Department, United

States Army in World War II (Washington, D.C.:

Office of the Surgeon General, Department of the

Army, 1966), p. 406.

7

 Quoted words from Extract, Operations Rpt,

1944, attached to Study No. 95, General Board,

USFET, sub: Medical Service in the Communications Zone in the European Theater of Operations,

Medical Section, file HD 334. See also Reister, ed.,

Medical Statistics, pp. 32 and 322-23. 8

 Operations Division, OofCSurg, HQ, ETOUSA,

Semiannual Rpt, January-June 1945, p. 6. The fact Continued
THE THEATER IN RETROSPECT 619

Above all, the technical competence

of the Medical Department could

hardly be faulted. "In the ETO,"

Hawley was to admit later, "I never

hurt for clinical talent but I was constantly hurting for leadership of this

talent half as good as the talent

itself." Throughout the theater Regular Army medical officers assumed

command positions, turning over

hands-on care to the highly qualified

civilians who, as reserve officers or as

wartime volunteers, brought to the

Army a multitude of sophisticated

skills. Their efforts on behalf of the

wounded and sick were eased immensely by new discoveries that

either accompanied the war or immediately preceded it. The development

of sulfa drugs in the late 1930s by

French researchers exploiting a

German discovery "opened the treasure house of bacterial chemotherapy," in the words of a recent historian

of medicine. During the early 1940s

mass production methods turned penicillin, discovered in 1928, into a revolutionary new weapon against bacterial infections and made it available to

the theater from D-Day on. The discovery in 1938 of the insecticidal

properties of DDT made control of

typhus incomparably easier than in

the past, and aided the control of

mosquito-borne and fly-borne diseases as well. The number of lives

saved by these innovations alone was

beyond computation. The introduction of synthetic antimalarials and advances in vascular surgery likewise impacted upon the battlefield. The development of the blood program was

a landmark, and the increased use of

whole blood as well as plasma was

fundamental to medical success in

saving the lives of wounded men.9

A distinctive feature of the theater

was the fact that virtually all its fighting was done in heavily populated

areas. Among the Allied nations of

Europe, close ties developed between

the civil and military medical establishments. Venereal disease control

was a sensitive sociomedical issue that

demanded tactful handling on the

Continent, as it had in Great Britain,

in the face of social norms that varied

drastically from one nation to the

next. Devastation by Allied bombs, as

well as by German shells, left formidable problems in public health and

disease prevention. Army medics

trained in civil affairs took the lead in

confronting these problems, but command responsibility and the intervention of the field forces was essential

to their solution.

In Germany the Medical Department met a situation new to American

armies: the surrender and imprisonment of a whole enemy army, numbering in the millions; the liberation

of other millions of prisoners and displaced persons; and the care of a

conquered people who were both industrialized and highly urbanized. Official American policy in the form of

nonfraternization and the initial decithat the European Theater was the last theater to

see major combat apparently was the reason why

the basic studies on combat stress and preventive

psychiatry, which helped to prepare the way for

later rotation policies, were all based on data from

the Mediterranean and Pacific theaters.

9

 First quotation from Press Release, "Better Federal Medical Service," 13 Dec 49, box 5, General

Green's Office Reference Files, AGO, RG 112,

NARA. Second quotation from Harry F. Dowling,

Fighting Infection: Conquests of the Twentieth Century

(Cambridge, Mass.: Harvard University Press, 1977),

p. 107.
620 EUROPEAN THEATER OF OPERATIONS

sion to impose a harsh peace obstructed medical efforts to suppress

disease. The practice of giving POW

doctors and nurses charge of their

sick and injured countrymen proved

to be more important than ever in the

last days of the war—and would have

been even more so if the desperate

last-ditch resistance foreseen by

American policy-makers had materialized. American medical personnel

were freed to work among DPs,

RAMPs, and concentration camp inmates; to aid civilians; and to guide

the German hospital system during

the transition to peace. By the

summer of 1945 all efforts were being

hampered by the demands of the ongoing Pacific war and partial demobilization. Forces had to be dispatched

halfway around the world, experienced men and women readied for

discharge, and mountains of supplies

disposed of in accord with rapidly

changing demands from Washington.

In meeting these complications, Kenner's quiet hand was no less important than Hawley's brusque one had

been earlier.

Throughout, the doctors, nurses,

corpsmen, administrators, and specialists of the Medical Department

were privileged to repair much of the

human havoc wrought by the war. On

the Normandy beaches, among the

hedgerows, in hospital wards that

filled the grand hotels of Paris, in the

cellars of battered Liege, and among

the living skeletons of Dachau and

Buchenwald, they brought a measure

of practical compassion into the most

ruinous of wars. For that, all who

were concerned in the prodigious

effort could, in the glow of victory,

look back upon their work and find it

good.
Bibliographical Note

The Medical Department: Medical Service in the European Theater of Operations

is a volume that had a long gestation

in the Historical Unit of the Office of

the Surgeon General (OSG). Though

an earlier draft by George Garand,

Hubert D. Potter, and Pauline Vivette

was frequently consulted by us, this

volume was written under the aegis of

the U.S. Army Center of Military History largely from primary sources collected by the Historical Unit, and now

in the custody of the Center in Washington, D.C., and from Army records

in the custody of the National Archives and Records Administration

(NARA) in Suitland, Maryland. Most

of the NARA records, unless otherwise noted, are located in Record

Group (RG) 112, Records of the

Office of the Surgeon General

(Army). Identification of sources, by

depository codes, is explained in

Chapter I, footnote 1.

The variety and sheer bulk of available primary sources at NARA are

somewhat daunting. The footnotes to

this volume detail the various types of

periodic reports consulted for a wide

range of medical offices, activities,

and units, ranging from the ETO

chief surgeon's staff downward to the

smaller field units. We also made extensive use of the comprehensive

medical history of the European Theater, prepared by Lt. Col. Sanford V.

Larkey of the chief surgeon's office,

and of the many official documents it

reproduces. Col. John E. Gordon's

manuscript history of preventive medicine in the theater provided a reliable guide to this area of military

medicine. A collection of letters representing backchannel communications between the theater chief surgeon and the surgeon general

(Hawley-Kirk Correspondence) was

most helpful in gaining perspective

on the ETO medical service, its accomplishments and its failings. The

Medical Division, COSSAC/SHAEF,

War Diary, covering the years 1943-

45, was also exceptionally useful. The

chapters that deal with the opening of

the Reich were enhanced by the reports of the units that aided the concentration camp survivors; by the

records of various intelligence organizations, notably those of the Combined Intelligence Operations Subcommittee; and by the records of the

Office of the Military Government

(OMGUS), which may be found in RG

260, Records of United States Occupation Headquarters, World War II.

The records of the United States of

America Typhus Commission are voluminous and well organized. RG 112

also contains transcripts of interviews

with medical personnel, completed in

the European Theater at the end of

the war; these supply many personal

touches and much operational detail.

Division combat narrative files, in RG
622 EUROPEAN THEATER OF OPERATIONS

407, Records of the Adjutant General's Office, 1917-, provided extensive

human interest detail on division-level

medical service. The reader should

note that, upon publication of this

volume, all materials deposited in the

Center of Military History will be returned to the Army collection at

NARA for refiling into the appropriate record groups in accordance with

NARA's record-keeping system.

The sources in other repositories

are less voluminous but no less valuable. The collections of the U.S. Army

Military History Institute at Carlisle

Barracks, Pennsylvania, were essential

in many ways. This repository contains numerous medical unit histories

and also the papers of Paul R.

Hawley, Charles H. Beasley, John C.

Burwell, William E. Shambora, and

Lee Cady, which are both of a personal and an official nature. No one

writing on medical history can fail to

take advantage of the remarkable collections of the National Library of

Medicine in Bethesda, Maryland.

Here we found many important insights in the William S. Middleton

Papers, diary, and interview transcript. Further materials on the fight

against typhus are abundant in the

Stanhope Bayne-Jones Collection.

The Center of Military History has

in its custody, in addition to the Historical Unit's collection of documents,

other pertinent records. These include several groups of oral history

materials. The oldest are memoranda

of interviews with key medical personnel, completed by the Historical Unit,

OSG, as well as transcripts of the discussions of the Editorial Advisory

Board during the early planning

stages of this volume. This material

offered revealing insights into personalities and policy at a time when the

theater's problems were still fresh in

the minds of those who had been its

leaders. In addition, we conducted

other very helpful interviews with

Honorable Elliot Richardson, Col.

Virginia Brown, Col. Tom F. Whayne,

Brig. Gen. Crawford F. Sams, Maj.

Gen. Thomas J. Hartford, Brig. Gen.

Sam F. Seeley, Maj. Gen. Collin F.

Vorder Bruegge, Jane Lee, Joseph A.

Gosman, M.D., Lester Wallman, M.D.,

and Herbert F. Wing. General Sams

also supplied a valuable manuscript

autobiography. Again, with the publication of this volume, these documents (except Sams' manuscript) will

be transferred to Carlisle or retired to

NARA.

The emphasis upon primary

sources should not obscure the importance of secondary materials as

well. The vast literature that covers

the military history of the European

Theater offered us a framework

within which the medical events could

be made meaningful. While a variety

of sources will be found in the footnotes, we must emphasize the special

importance of the earlier volumes in

the Center's United States Army in

World War II series. Especially useful

in gaining an understanding of strategy, theater structure, and logistics

were Roland G. Ruppenthal's twovolume work Logistical Support of the

Armies; Maurice Matloff and Edwin M.

Snell's Strategic Planning for Coalition

Warfare, 1941-1942; and Maurice

Matloff's Strategic Planning for Coalition

Warfare, 1943-1944. The combat histories were used as guides to the

course of events, once the invasion

had begun. Essential to this study

were Gordon A. Harrison's Cross-
BIBLIOGRAPHICAL NOTE 623

Channel Attack, Martin Blumenson's

Breakout and Pursuit, Charles B. MacDonald's The Siegfried Line Campaign

and The Last Offensive, and Hugh M.

Cole's The Lorraine Campaign and The

Ardennes: Battle of the Bulge. Of great

importance in shaping this volume

were the earlier medical works in the

series by Charles M. Wiltse, The Medical Department: Medical Service in the

Mediterranean and Minor Theaters, and

by Clarence McKittrick Smith, The

Medical Department: Hospitalization and

Evacuation, Zone of Interior. We also

drew extensively upon the forty-odd

volumes of the Medical Department,

United States Army in World War II,

series. These exhaustive accounts,

written in great measure by physicians

who were participants in the events

they describe, provided the clinical

and technical background for this

volume. Finally, the volumes of

Wesley Frank Craven and James Lea

Cate, The Army Air Forces in World War

II, were used as appropriate, as were

Mae Mills Link and Hubert A. Coleman's Medical Support of the Army Air

Forces in World War II and the official

histories of the Royal Army Medical

Services and the Emergency Medical

Services published by Her Majesty's

Stationery Office.

List of Abbreviations

AAF

ACofS

ADSEC

AFHQ

AG

AFG

An

Anon

App

ASR

ASTP

ATC

Bde

Bn

BTNI

CAdminOff

CATOR

CCWOff

Cdr

CEngr

CG

Chron

CIOS

Cir

CMedOff

CMH

CO

COMZ

CONAD

CofOpns

COrdOff

Corresp

COSSAC

CofPMS

CQM

CSigOff

Army Air Forces

Assistant chief of staff

Advance Section

Allied Force Headquarters

Adjutant general

Army Ground Forces

Annex

Anonymous

Appendix

Adjusted service rating

Army Specialized Training Program

Air Transport Command

Brigade

Battalion

British Troops in Northern Ireland

Chief administrative officer

Combined Air Transport Operations Room

Chief chemical warfare officer

Commander

Chief engineer

Commanding general

Chronological

Combined Intelligence Operations Subcommittee

Circular

Chief medical officer

Center of Military History

Commanding officer

Communications Zone

Continental Advance Section

Chief of operations

Chief ordnance officer

Correspondence

Chief of Staff to the Supreme Allied Commander (Designate)

Chief of Preventive Medicine Service, OSG

Chief quartermaster

Chief signal officer
626 EUROPEAN THEATER OF OPERATIONS

CsofSupSvcs

CSurg

CTransOff

Dep

DPs

DUKW

ECAD

EMS

EMT

Engr

ETO

ETOUSA

FECOMZ

G-1

G-2

G-3

G-4

G-5

GFRC

GO

Hist

HC

Hosp

HU

JAGD

LC-1

LCI

LCT

LCVP

LOI

LST

LVT-1

MAC

MC

MedGasTr

Memo

MFR

Chiefs of Supply Services

Chief surgeon

Chief transportation officer

Deputy

Displaced persons

Amphibian truck

European Civil Affairs Division

Emergency Medical Service

Emergency medical tag

Engineer

European Theater of Operations

European Theater of Operations, United States Army

Forward Echelon, Communications Zone

Personnel officer or section of divisional or higher staff

Intelligence officer or section of divisional or higher staff

Operations officer or section of divisional or higher staff

Supply officer or section of divisional or higher staff

Civil affairs officer or section of divisional or higher staff

Ground Force Reinforcement Command

General Order

History

Hospital center

Hospital

Holding unit

Judge Advocate General's Department

Landing craft

Landing craft, infantry

Landing craft, tank

Landing craft, vehicle/personnel

Letter of instruction

Landing ship, tank

Landing vehicle, tracked ("Alligator")

Medical Administrative Corps

Medical Corps

Medical Gas Treatment Battalion

Memorandum

Memorandum for the Record
LIST OF ABBREVIATIONS 627

MHI

MISP

MOS

NARA

NATOUSA

OofCSurg

OofTPM

Opns

OSG

POW(s)

PROCO

ProvESBGp

PWOD

RAF

RAMP

Regt

Rpt

S-2

S-3

SC

Sec

Sess

SHAEF

SO

SOLOC

SOS

Spec

SPOBS

TAG

T/E(s)

T/O(s)

T/O&E(s)

TSFET

TSG

UNRRA

USAFBI

USANIF

U.S. Army Military History Institute

Medical in-transit storage point

Military occupational specialty

National Archives and Records Administration

North African Theater of Operations, United States Army

Office of the Chief Surgeon

Office of the Theater Provost Marshal

Operations

Office of the Surgeon General

Prisoner(s) of war

Special project for continental operations

Provisional Engineer Special Brigade Group

Prisoner-of-War Overhead Detachment

Royal Air Force

Recovered Allied military personnel

Regiment

Report

Intelligence officer or section of regimental or lower staff

Operations officer or section of regimental or lower staff

Sanitary Corps

Section

Session

Supreme Headquarters, Allied Expeditionary Force

Special Order

Southern Line of Communications

Services of Supply

Special

Special Observers Group

Schutzstaffel (Elite Guard)

The Adjutant General

Table(s) of equipment

Table(s) of organization

Table(s) of organization and equipment

Theater Service Forces, European Theater

The Surgeon General

United Nations Relief and Rehabilitation Administration

United States Army Forces in the British Isles

United States Army Northern Ireland Force
628 EUROPEAN THEATER OF OPERATIONS

USFET

USPHS

USSTAF

VD

WAAC

United States Forces, European Theater

United States Public Health Service

United States Strategic Air Forces

Venereal disease

Women's Army Auxiliary Corps
Basic Military Map Symbols1

Basic Medical Symbols

Medical treatment facility, operating 2

Medical treatment facility, not operating

 2

Medical supply unit

Veterinary treatment facility, operating 2

Veterinary treatment facility, not operating2

Hospital train

Hospital ship

Other medical units

 3

Basic Military Symbols

Section,

Platoon or detachment

Company

Battalion

Regiment or group; combat team (CT following identifying

numeral)

Brigade

Division; command of an air force

Corps; Air Force

For complete listing of symbols in use during World War II period, see FM 21-20, dated October

1943, from which these are taken. 2

 Includes collecting and clearing elements. 3

 includes nontreatment facilities, other than supply, such as laboratories and headquarters of various

medical facilities.
Army

Army group,

Service command, department, or section of a communications

zone

Communications zone

Airfield

EXAMPLES

9th Evacuation Hospital, assigned to a corps

16th Field Hospital, assigned to a service command

3d Convalescent Hospital, assigned to an army

6th Station Hospital, assigned to a base section (not operating)

38th General Hospital, assigned to a communications zone

Fifth Army Medical Depot

17th Veterinary Evacuation Hospital, assigned to an army

213th Veterinary General Hospital (Italian), assigned to a

base section

41st Hospital Train

Hospital ship Acadia

54th Medical Battalion

Company B, 47th Armored Medical Battalion

309th Airborne Medical Company

Company A, 3d Medical Battalion.

Clearing Station, 34th Division (2d platoon, clearing

company, organic medical battalion)

15th Medical General Laboratory, assigned to a base section
Index

Aachen, 278, 530, 550

Aaron, Lt. Col. Margaret E., 119

Abdominal specialists, 380

Acrylic eyes, 130

Adjusted service ratings (ASR), 598, 600

Advance Section, Communications Zone (ADSEC)

and advance into Germany, 533-37

areas controlled by, 312, 434, 436

communications problems in, 497

delays in moving medical units and hospitals, 305

evacuation units of, 317, 377, 468

general hospitals opened by, 330

under Lee, 240

limited operation of, 238

manpower losses in medical service of, 450

medical planning by, 161, 168-71, 191-92

medics in Normandy from, 259-61, 263-68, 270-

72

operation of holding units and ambulance

evacuation by, 318-19, 375, 377

regulating stations of, 391

responsibilities of, 157

supplies and equipment for, 341-45, 347, 457

work with First Army, 239, 305

Africa. See North Africa

African-American troops. See Black military

personnel

Aidmen

attached to separate platoons, 228

bravery of, 294-96, 361-63

Hawley's concern for, 434

replacement of, 446-48, 450

shortage of, 226-27

training for, 448

Aid stations, 226, 293

Airborne Divisions

17th, 516

82d, 161, 201, 203-06, 305-06, 308, 310, 395,

409, 466

101st, 161, 201, 203-06, 305-06, 308, 310, 395,

402, 414-15, 418, 422-24, 426, 428-29, 466

Airborne Medical Companies

307th, 308

326th, 308, 415-17, 419, 426

Air evacuation

administration of, 320-22

British, 617

COMZ and, 256-59

from France, 171, 305

from Germany, 503, 516, 521, 528, 530, 536, 538

by late 1944, 469-72

Air evacuation—Continued

medical equipment used in, 107

methods of, 103, 106-07, 151

problems in, 482-83

role of IX Troop Carrier Command in, 328-29

for severely wounded, 377

squadron for, 332

from St.-Laurent, 231-32

terminals for cross-Channel, 197

Air surgeons, 68

Air transport

for air crews, 483

for blood, 175, 193, 345, 350-51, 390, 420, 459

importance of, 616

role of IX Troop Carrier Command in, 321-22,

328-29, 333-34

for supplies, 345-46, 390-91, 500

Air Transport Board, 483

Air Transport Command (ATC), 106-07

role in blood shipments, 350-51

role in evacuation, 483, 503

Air Transport Squadron, 320th, 363, 471

Air Transport Wing, 302d, 321, 471

Alexander, Maj. Leo, 595

Alien, Lt. Col. Ray C., 308

Allied Force Headquarters (AFHQ), invasion of

Africa, 27, 55-57

Allied prisoners

conditions for, 557-59

in German camps, 558

liberation of, 512, 557

All Saints' Hospital, 96

Ambulance companies

black medics working for, 122n, 123

casualty handling by, 249-50

projected needs for, 111

Ambulance evacuation

coordinated with air evacuation, 257-58

long-distance, 302

during MARKET, 309

problems encountered in, 533

Ambulances

delivery of, 198

trains used as, 323. See also Hospital trains

use of British, 100

vehicles used for, 100, 533

water, 150

American Hospital (Great Britain), 7-8

American Hospital of Paris, 337

American School Center (ETO), 133
632 EUROPEAN THEATER OF OPERATIONS

Amphibious warfare medical support, 149-50, 160-

61, 241

Andrews, Lt. Gen. Frank M., 61

Anesthesiology, 135, 445

Anopheles mosquitoes, 142

Antibiotics. See Penicillin

Antimalarials, synthetic, 619

Antimotion sickness capsules, 173

Antwerp, 275, 457

Ardennes, Battle of the, 359, 370

attack by Third Army during, 424-26

battle for Bastogne during, 414-20, 422-24

casualties of, 395-96

combat during, 393-95

impact on medical communications, 497

impact on medics during, 396-409

medical realignments during, 409-14

and Operation NORDWIND, 426-28, 446

results of, 428-30, 550

Armies. See First Army; Third Army; Fifth Army;

Seventh Army; Ninth Army; Fifteenth Army. See

also names of enemy and Allied armies

Armored divisions, 295-97

Armored Divisions (individual)

1st, 19, 22, 57

2d, 227-28, 296, 302, 412, 448, 519-20

3d, 227-28

4th, 302, 424, 426, 524

5th, 364

6th, 298, 301-02

7th, 372, 394

9th, 415

10th, 415, 418, 420, 422, 529

15th, 520

Army, U.S. See names of individual armies

deployment schedule for, 112

English headquarters of, 9

and ETO units divided into redeployment

categories, 596-97

infantry divisions of. See Infantry Divisions

Army Air Forces (AAF)

activation of, 13

Air Transport Command (ATC), 106-07

consultants maintained for, 77

medical services and equipment for, 69-70, 183

plans to join with British Air Force, 5

struggle for autonomy, 68

transatlantic evacuation of, 105

troop buildup of, 112-13

Army Air Forces (individual)

Eighth, 13-14, 28, 44, 59, 68, 70-71, 98-99, 124-

25, 198, 273

Ninth, 68, 103, 175, 193, 257, 259-60

Twelfth, 57

Fifteenth, 68n

Army Ground Forces units, 112

organization of, 67

reorganization of, 111

Army Groups

1st, 66, 156-57, 160, 168

6th, 290, 354, 357-58, 427, 433, 442, 459

Army Groups—Continued

12th, 274, 292, 313, 323, 344, 354, 357, 359, 372,

389-91, 424, 431, 433, 442, 451, 457, 459, 515,

533, 557, 589

Army Nurse Corps (ANC), 119, 387

Army Nurse Corps School (ETO), 134, 453

Army Specialized Training Program (ASTP), 602

Arnest, Col. Richard T., 56

Arracourt, 302

Assembly Area Command, 597

Atabrine, 142, 235

Auschwitz Concentration Camp, 572

Autopsies, 383, 574

Auxiliary surgical groups, 379-80

Auxiliary Surgical Groups (individual)

1st, 198

3d, 203-05, 213, 233-34, 412

4th, 221

5th, 379

Avitaminosis, 568, 587

Avranches, 273-74, 280, 283

B-17's, 44

Baden, 583

Barfield, Maj. William E., 205, 416-18

Barr, Lt. Col. Robert H., 208, 279-80

Base sections, 47

boundary changes in, 434

preventive medicine divisions within, 138

purpose and control of, 71-72

responsibility for operation of, 77

Base section surgeons

continental, 313

responsibilities of, 72, 86

Bastogne, 395, 414-20, 422-24

Battalion aid stations

function of, 366-67

location of, 226, 364

Battle casualties

at battle for Bastogne, 415, 424

at Battle of the Ardennes, 395-96

Cherbourg and St.-Lo, 224, 235-36

during COBRA operation, 275

D-Day, 202

decline in, 293

at end of evacuation chain, 254-55

at end of first two months, 258-59

fatality rate for, 391

during invasion of Germany, 516

from MARKET, 308

from NORDWIND, 428

during offensive, 356

treatment for, 383-84

Bauchspies, Col. Rollin L., 290

Beasley, Col. Charles H., 157, 160-61, 259, 261,

264, 266, 271, 411, 497, 534, 540, 592

care of POWs by, 565

role in planning medical COMZ, 317-18

Beaujon Hospital, 325
INDEX 633

Bed capacity

changes in, 608

in field hospital platoons, 387

in general and station hospitals, 39, 42, 90

in Western Base Section, 256

Bed requirements

drafting of, 39

for forces in theater, 267

invasion planning and, 152

NEPTUNE, 271

projected, 88, 110

Second Key Plan, 41

shortages during 1944-45 in, 473, 476-77

Beds, expansion, 90, 476

Beers, Lt. Col. Leonard H., 184-86, 188-89

Belgians

employment of, 387, 419, 450-51

transport of injured, 537

working in DP camps, 537

Belgium, 275, 283

assistance in venereal disease prevention, 542

Channel Base Section in, 537

holding units in, 319

medical facilities in, 311, 336

state of liberated, 548

transporting hospitals to, 300

Bergen-Belsen Concentration Camp, 572, 577

Beriberi, 568

Berndt, Maj. Albert L., 370

Bernescq, 236

Biologicals, shipments of, 345

Biological warfare, 589-92

Bishop, Col. Harry A., 438

Black military personnel

estimate of hospital beds needed for, 39

houses of prostitution for, 450, 541

prophylactic stations for, 144

status of, 122-23

unloading casualties from LSTs, 248

venereal disease rate among, 147

Bliss, Col. Raymond W., 6

Blood

shipments of, 175, 193, 345, 350-51, 390, 420,

459

supplies of, 237, 345

transfusion requirements, 161

use of whole, 234

Blood banks

behind armies, 348

Detachment A, 237

set up by hospitals, 350

Blood distribution program

operation of, 174-76, 193, 516

success of, 619

supplies for, 348, 350-52

Blood Transfusion Unit, 6703d, 390

Blumenthal, Maj. Sidney, 318

BOLERO

buildup for, 60-62, 73, 109-10, 149, 178, 464

Dental Corps during, 128

establishment of, 25-26, 34

BOLERO—Continued

First Key Plan, 37, 39, 41

hospital program for, 37-44, 88, 90

plans for, 34, 48, 80, 81

Bomber Command, VIII, 13

Botulism, 590

Bradley, Lt. Gen. Omar N., 66, 270, 329, 615

and COBRA operation, 273-74

and cold injury, 491, 494-95

Brandt, Karl, 590

B-rations, 543

Brenn, Col. Charles E., 17-18, 21-22, 203, 216-17,

400

Brest, 275, 287, 292, 294, 303, 312-13

Bristol, 37, 66

Bristol Channel ports, 100

British Army

blood supply depot of, 132

blood transfusion service of, 175

and COBRA operation, 274-75

evacuation of casualties of, 537

medical service of, 6-7

rations supplied by, 139

at West Wall, 354-55

British Army units

1st Airborne Division, 278, 306

Headquarters-Airborne Troops, 305-06

Second Army, 305-06, 310, 355

XXX Corps, 278, 305-06, 308-09

21 Army Group, 66-67, 153, 156-57, 259, 275,

310, 354, 357, 395

British hospitals

general, 310n

overloading of, 474

recommendations for, 16

31st General, 19

training of Americans at military, 132

use of, 7-8, 99

British hospital ships

availability of, 150

evacuation on, 100, 106

British Post-Graduate Medical School, 132

British War Office, 40-41

Brittany, 274-75, 286-87

Brittany Base Section, 312-13, 319, 434

absorbed within Normandy Base Section, 537

hospitalization and evacuation system in, 468

Brixham, 195

Bromsgrove rehabilitation facility, 96-97

Brown, Col. Eli E., 33, 82n, 103

Brussels, 275

Buchenwald Concentration Camp, 513, 555, 572,

576, 594

Bulge, Battle of the. See Ardennes, Battle of the

Bullock, Lt. Col. Bernard E., 214

Burn treatment, 95

Buses, use of British passenger, 100-101
634 EUROPEAN THEATER OF OPERATIONS

C-47s, 231, 256, 264, 288, 310, 320, 322, 329, 332-

33, 463, 470-71, 514, 534, 538

C-54s, 350, 482

CADUCEUS, 196

Cady, Col. Lee, 452

Caen, 273

Cafarelli, Lt. Col. Roosevelt, 296

Camp Detrick, 590-91

Camp Lucky Strike, 537, 560, 599

Camps. See also Concentration camps

conversion, 83, 88, 90

convertible troop, 88

DP, 537. See also Displaced persons (DPs)

dual-purpose, 82

militia, 42, 82, 88, 90

reconditioning, 91

Canadian Army

and COBRA operation, 274-75

First Army, 355

in invasion of Germany, 516

medical service of, 38-39

at West Wall, 354

Carbon dioxide tanks, 182-83

Cargo identification system, 464

Carilia, Maj. Thomas A., 271

Cassidy, Lt. Col. Patrick J., 204

Casualties. See Battle casualties; German casualties;

Medical personnel casualties

Casualty-estimation formulas, 156

CATOR. See Combined Air Transport Operations

Room

Catz, 239

Center Task Force, 56

Central Base Section, 71-72, 313

hospitalization and evacuation problems of, 99

prophylactic distribution by, 144

Central Task Force, 99-100

Chain of command

changes in 1943, 62-65

problems in, 28-32

Chancroid, 539. See also Venereal diseases

Chaney, Maj. Gen. James E., 9, 13, 26, 29

Channel Base Section, 312-13, 434

advance into Belgium, 537

hospitals in, 474-75

Chaplains, 369

Chemical warfare, 592

Chemical Warfare Service, 592

Cherbourg, 477-78

Cherbourg, Battle of, 219, 221, 224, 226-39, 261

Chief surgeon

chain of command and, 62

requirements for ETO, 28

Chief Surgeon, Office of the

Administrative Division, 34, 73

Dental Division, 34, 73, 128, 130, 194

Evacuation Division, 74, 98, 106

expansion of, 32-36, 73-79

Field Survey Division, 431, 436

Gas Casualty Division, 74

Historical Division, 74

Chief Surgeon, Office of the—Continued

Hospitalization Division, 33-34, 72-73, 85, 91,

98, 108, 177, 336-38, 445, 474-75

location of, 73-74

Medical Records Division, 33-34, 73, 141

move to Paris of, 313, 315-16, 436

Nursing Division, 34, 73, 119, 445, 600

Operations Division, 33-34, 73-74, 98, 110, 112,

114, 336, 487

Paris staff of, 431

Personnel Division, 34, 73, 77, 117-18, 446-47

Planning Division, 74

Preventive Medicine Division, 34, 73-74, 137,

139-41, 143, 146, 172-73

Professional Services Division, 34, 73-74, 76-78,

91-92, 105, 143, 182-83

Rehabilitation Division, 74, 97, 315, 479

Supply Division, 34, 49-52, 54, 73, 86, 128, 171,

178, 181, 183, 186-87, 190, 193, 198, 236-37,

254, 265, 336, 345-46, 414, 458-59, 463, 467,

477

Veterinary Division, 34, 73, 140

Choy, Capt. Frank, 204

Churchill Hospital, 8, 22, 37

Cirencester, 40, 83

Civil affairs, 545-50

Civil Affairs Section (G-5) (SHAEF), 545, 549, 552

Civilians

availability of penicillin among, 548, 586

diseases among, 548

employment of Belgian, 387, 419, 450-51

employment of British, 118

employment of French, 387, 450-51

employment of German, 607

inoculation programs for, 548

malnutrition among, 549, 574, 577

venereal diseases among, 549, 586. See also

Prostitution; Venereal diseases

working in COMZ medical units, 450-51

working in evacuation hospitals, 387

Claiborne, Col. John W., Jr., 408

Clay, General Lucius D., 551, 588

Clearing Companies (individual)

4th Division, 208

618th, 236, 403, 407, 411, 514

622d, 223, 236, 309

634th, 213-14, 216

635th, 422

646th, 571

662d, 309

666th, 319

Clearing company mobility, 293-94

Clearing stations

in armored units, 297

death rate in, 391

division, 228, 236

opening of, 208

operation of, 228

surgery in, 176

Clothing, cold weather, 490-91
INDEX 635

Clubs

operated by Red Cross, 144

recreational, 455-56

Coates, Lt. Col. John B., 425

COBRA

medical support for, 279

planning and execution of, 273-75, 278

Cold injury. See also Trenchfoot

forms of, 489

impact of, 494-96, 539

prevention of, 490

Cold weather clothing, 490-91

Collecting companies

litter platoons, 226

mobility of, 293

working with regimental and battalion

detachments, 368

Collecting Companies (individual)

384th, 309

493d, 309

499th, 232

500th, 213-14

Collecting stations

location of, 364

operation of, 228

Collecto-Clearing Companies

391st, 213-14

393d, 213-14, 232

Colleville, 210

Collins, Maj. Gen. J. Lawton, 201

Cologne, 509, 530

Combat exhaustion. See also Neuropsychiatric

casualties

centers treating, 236

during early battles, 235

reassignments for convalescents who suffered

from, 450, 481

rotation system and, 617-18

treatment of, 95, 135-36, 403

Combat Infantryman Badge, 363

Combined Air Transport Operations Room

(CATOR), 321-22, 333, 345, 471

Combined Intelligence Operations Subcommittee,

590, 592

Command. See Chain of command

Communicable diseases. See also names of individual

diseases

eradication of, 141

treatment for patients having, 377, 385, 411

Communications Zone (COMZ), 157, 283

base section organization of, 312-13

blood distribution to, 348, 350-52

continuing buildup and, 440-52

evacuation and, 240-59, 316-25, 328-34, 336,

352, 375, 391, 498, 530, 532

facilities near the Ardennes, 429

flow of supplies to, 341-48

headquarters of, 313, 315-16

invasion preparation and, 192

medical supply and, 457-59, 461-67

morale problems and, 453-56

Communications Zone (COMZ)—Continued

preventive medicine plans of, 172-73

problems with completion of, 430

redesignation of, 579

relationship with 12th Army Group, 431-32

rotation of officers and enlisted personnel with,

520

support for surgeons by, 311

Communications Zone (COMZ) hospitals

fixed, 171

functioning as army hospitals, 428

general, 336-40

provisional teams from, 233-34

COMZ. See Communications Zone (COMZ)

CONAD. See Continental Advance Section

(CONAD)

Concentration camps

conditions in, 512, 572, 574-78

conditions of inmates from, 571

experimentation on living at, 594

liberation of, 512, 529-30, 572, 574-76

Condoms. See Prophylactics

Construction. See Hospital construction

Contagious diseases. See also names of individual

diseases

British treatment and control units for, 8

care of patients having, 377, 385

Continental Advance Section (CONAD), 440

evacuation by, 375, 377

hospital established by, 386

and invasion of Germany, 536

supply availability and, 457

Convalescent hospitals, 91. See also Rehabilitation

hospitals

function of, 377, 532

operation of, 385

projected needs for, 111

Convalescent Hospitals (individual)

2d, 427

4th, 222, 282, 408, 411, 511

6th, 385

7th, 480

8th, 97n, 480

Convertible troop camps, 88

Corby, Col. John F., 27-28, 32, 56-57

Corps

III, 422, 425-26, 522

V, 17-18, 22, 46, 66, 164, 192, 202, 217, 219,

222, 393, 395-96, 402, 414

VI, 289, 427

VII, 164, 192, 201, 208, 219, 222-23, 273, 275,

279-80, 409

VIII, 221, 273-75, 284, 286-87, 292, 303, 319,

348, 357, 394-96, 402-04, 406, 409, 415-17,

422, 424-26, 522

XII, 424, 522-24

XV, 274, 427, 428-29

XVIII Airborne, 305-06, 395, 409, 515-16

XIX, 221-22, 228, 333, 357, 409, 520

XX, 274-75, 424, 522, 524
636 EUROPEAN THEATER OF OPERATIONS

Corps—Continued

XXI, 528-29

COSSAC

creation of, 60-61, 61n, 153

invasion planning by, 153, 156, 164-65, 167-68,

171

Cotentin Peninsula, 219, 312, 325

Coutances, 273

Cowglen Hospital, 107-08

CRACKSHOT, 196

Craig, Elizabeth May, 577-78

Crandall, Maj. Albert J., 205

C-rations, 543

Cross-Channel evacuation, 156, 471

by air, 197, 497, 538

from Communications Zone, 240-56

problems in, 473-74, 476

by sea, 477, 497

temporary halt in, 498

Cutler, Col. Elliott C., 76-77, 92, 234-35, 241, 431,

444

and cold injury, 489

involvement in evacuation, 248-49

involvement in COMZ-SOLOC medical relations,

439-40

and penicillin use, 125-26

on quality of treatment, 383-84

role in blood distribution, 175-76, 350-51

and transit hospital surgery, 253

view of LSTs by, 167

Danielson, Lt. Col. Ida W., 119, 121-22

Darnall, Col. Joseph R., 82, 85, 88, 124, 161, 267,

325, 336-37, 502

Dachau Concentration Camp, 572, 574, 576-78, 594

Davidson, Maj. Douglas, 419

Davis, 1st Lt. Frank, Jr., 242-43

Davis, Lt. Col. John K., 153, 156, 161

D-Day. See also Invasion planning; Normandy, Battle

of

assault on, 203-08, 210-14, 216-19

events of, 201-02

medical service on, 218-19

organization of chief surgeon's office on, 74

projected bed capacity for, 88

DDT, 554, 557, 576, 619

Death rate, 148, 617

Decorations for valor, for aidmen and litterbearers,

363

de Lattre deTassigny, General Jean, 289

Delta Base Section, 437, 440, 537-38, 597

De Marco, Capt. Michael, 369-70

Demobilization process, 596-98

Denning, Lt. Col. G. M., 153, 156

Dental burs, 189

Dental Corps

associations established by, 127

fabrication and fitting of acrylic eyes by, 130

organization of, 127-28, 130

ratio of soldiers to, 440

Dental Corps—Continued

replacements for, 117

shortages in, 119, 444

Dental laboratories, 128

Depots. See Medical Depots (individual)

Devers, Lt. Gen. Jacob L., 61, 63, 354, 559

Diarrhea, 141, 172, 195, 235, 539, 543, 546, 548,

565

Dieppe, 150

Diet, 139-40, 539, 543

Dijon, 290

Diphtheria, 539, 542-43, 547, 550, 611-12

Discrimination. See also Black military personnel

of black medics, 122-23

of nurses, 119-22

Disease. See also Communicable diseases; Preventive

medicine; Venereal diseases

during 1945, 539

during early battles, 235

in northwestern Europe, 172

outbreaks of, 141-42, 548

rate of, 147-48, 618

Dispensaries

for preinvasion period, 39

use of, 98

Displaced persons (DPs)

camps established for, 537

hospital beds for, 486

medical care for, 512

overview of, 569-72, 574-78

POW transient enclosures housing, 566

public health and, 553

status of, 538

supplies for, 515

typhus among, 555-57

venereal diseases among, 571, 584

Diveley, Col. Rex L., 96-97, 479

Dog teams, 523

Dornot, 294-95

Douches, 143

Dowling, Capt. George B., 166, 232, 240-41

DPs. See Displaced persons (DPs)

DRAGOON, 289-90, 385

Drivers, 448

Dual-purpose camps, 82-83

Duke, Lt. Col. Raymond E., 313

DUKWs, 165, 167, 207, 242-43, 525

Durst, Col. George G., 481

DUSTBIN, 590

Dutch Red Cross, 451

Dysentery, 141, 172, 548, 565, 571, 577, 581

Eaker, Brig. Gen. Ira C., 13

East Anglia, 40, 81, 146

Eastern Base Section, 71, 312-13

flow of Eighth Air Force casualties to, 47, 124

responsibilities of, 47

Eastern Task Force, 55, 99-100

Easy Green sector, 213-14
INDEX 637

Easy Red sector, 212, 214

Ebrington Barracks, 18, 37

Eckhardt, Col. Richard H., 287, 401

ECLIPSE plan, 534-35

Education. See also Training

to combat venereal disease, 143, 147, 541

military government, 544

Eindhoven, 309

Eisenhower, General Dwight D., 26-27, 315, 395,

424, 432, 458

activation of headquarters by, 157

on captured Germans, 567

on chain-of-command issues, 29

and COBRA operation, 274

as commander of USFET, 581-82

control of tactical air by, 68n

D-Day and, 195

on hospital construction, 42

inspection of buffer camps by, 560-61

and invasion of Germany, 507

and invasion planning, 153

in North African Theater, 26-27, 55, 61

and prevention of trenchfoot, 495

responsibilities of, 61

view of civil affairs, 545

Electrical equipment, 85. See also Medical supplies

and equipment

Emergency Medical Services (EMS) (Great Britain)

buses supplied by, 100-101

function of, 6-7

hospitals transferred by, 6, 37

support of British invasion forces by, 82

turnover transactions by, 87

Emergency medical tag (EMT), 361, 367

Emotional disorders, 195. See also Combat

exhaustion; Neuropsychiatric casualties

EMS hospitals

evacuation of British to, 100

planning for, 37, 40-41

Engineer Battalion, 112th, 18

Engineers, U.S. Army

hospital construction responsibilities of, 85, 90

housing and water supply responsibilities of, 138

Engineer Special Brigade Group, Provisional, 232

Engineer Special Brigades

Advance Section command of, 259-60

ambulance platoons of, 217

clearing stations, 221

reorganization at OMAHA, 232

Engineer Special Brigades (individual)

1st, 201, 206-07

5th, 202, 213

6th, 202, 213

Enteritis, 577

Epidemics

hepatitis, 19, 23, 141

outbreaks of, 141-42

typhus, 539, 553-57

Epidemiologists, 141

Equipment. See Medical supplies and equipment

Erpf, Capt. Stanley F., 130

Etienne, Col. Wolcott L., 205

ETOUSA. See European Theater of Operations,

United States Army (ETOUSA)

Eudenbach, 514

European Civil Affairs Division (ECAD) (ETOUSA),

545, 548, 552

European Theater of Operations, United States

Army (ETOUSA)

assessment of, 614-20

buildup of medical establishment in, 440-52, 615

and command relations, 431

countries in 1943, 61

early moves to aid Britain as foundations for, 4

European Civil Affairs Division (ECAD), 545, 548,

552

hospital program for, 36-44

impact of North Africa preparation on, 58-59

initial objectives and establishment in Great

Britain of, 5

organization of, 26, 29

policy regarding typhus control, 557

post-D-Day buildup of, 440-52, 615

redesignation of, 579

reorganization of, 25-27

stock control system of, 465

strength of, 61-62, 614

European Theater of Operations Medical Society,

127

Evacuation

by air. See Air evacuation

attempts to shorten lines of, 324-25, 328

during Cherbourg battle, 230-31

COMZ, 240-56, 316-25, 328-34, 336, 352

cross-Channel. See Cross-Channel evacuation

during D-Day, 213

from Germany, 513-14, 520-21, 525, 527-28,

536-37

of invasion casualties, 171, 195-98, 211-13, 216-

18, 222, 230-31, 260-61. See also Normandy,

Battle of

invasion plans for, 165-73

on the line, 364-70, 372

mobile warfare and difficulties of, 301

during the Occupation, 603, 605-08

over long distances, 302-03

responsibility and procedures for, 98-100

by road, 100-101

by train, 101-02, 250, 253, 323-24, 332. See also

Hospital trains

transatlantic, 103-08, 483-86, 488, 503

by water, 150, 245-51, 256, 306, 477

Evacuation hospitals

750-bed, 17, 532

by end of 1943, 43-44

function of, 377

mobility of, 298-99, 532-33

operation of, 381-82

overburdened, 233-34, 237

postoperative discharge from, 384

specialists at, 380
638 EUROPEAN THEATER OF OPERATIONS

Evacuation hospitals—Continued

surgery in, 176

Evacuation Hospitals (individual)

2d, 107-08, 413

5th, 233, 513

9th, 382, 427

11th, 451

12th, 177, 199, 251, 288, 571

24th, 309-10

44th, 406-07

45th, 511, 513

51st, 413

67th, 405-07, 513

77th, 264, 283, 319, 411, 533

91st, 555

93d, 456

95th, 427

96th, 513

97th, 413

102d, 402-04, 408, 413

103d, 303

107th, 382, 402, 404, 408-09, 412, 416, 425-26,

445

108th, 569

109th, 199, 251

110th, 402-03, 409, 425, 512

111th, 382

116th, 576, 577

117th, 427

118th, 513

120th, 571, 576

121st, 571

127th, 513, 576-77

128th, 221, 233, 413

132d, 427-28

Evacuation policy

of Arthur Welsh, 10

during Battle of the Ardennes, 411, 413, 417

efficiency of, 391

established by individual armies, 374-75

postwar, 538

reduction in, 481-82

ROUNDUP, 150-52

of Royal Army Medical Service, 7

for USANIF, 21

Evacuation system

by late 1944, 468-73

problems during 1944-45 with, 473-88, 496-506

Expeditionary hospital plans, 177

Eyes, artificial, 130

FABIUS, 192

Falaise, 274, 294, 303

FECOMZ. See Forward Echelon, Communications

Zone (FECOMZ)

Fenton, Lt. Col. Bryan C. T., 184, 186-88

Field Artillery, 151st, 18

Field Artillery Battalions

589th, 399

590th, 399

Field Force Replacement System, 134

Field hospital platoons

command problems in, 380

death rate in, 391

function of, 377

injured to, 232

location of, 388

operation of, 382

Field hospitals

division into three hospitalization units, 531

emergency surgery in, 251

operation of, 250-51, 381-82

postoperative discharge from, 384

projected needs for, 111-12

Field Hospitals (individual)

7th, 251, 264, 266, 319

8th, 264, 328

9th, 264, 319, 411, 565

12th, 250, 258, 261, 263, 266, 412, 437, 533

13th, 221

16th, 235, 527

28th, 250, 258, 319

29th, 108, 319

42d, 221, 402, 404-05, 420, 426

45th, 221

46th, 250-51

47th, 402, 404, 408

50th, 192, 250-51, 306, 565

51st, 509, 511

59th, 388

61st, 565

82d, 565

77th, 560

78th, 565

83d, 565

Fifteenth Army, 442, 530-31, 537

Fifth Army, 160-61, 175

First aid, administered on the line, 360-63

First aid packs, 360-61

First Army, 66, 136, 156-57

at Aachen, 278

agreements with Advance Section, 264, 268

battle casualty rates for, 293

in Battle of the Ardennes, 393-95, 409-14, 428-

30

blood distribution by, 348, 350

clearing evacuation hospitals by, 305

in COBRA operation, 273-75

disease in early battles of, 235

dump at Le Grand Chemin, 265

efforts to control venereal disease among, 542

evacuation of casualties by, 203, 234, 260, 375,

468

exhaustion centers for, 236

in invasion of Germany, 508-09, 511-15

invasion planning involving, 160-61, 164, 168-70,

191-94

medical buildup of, 219-24

medical matériel placed with first troops of, 218

medical support of, 278-84, 319, 330, 372, 385
INDEX 639

First Army—Continued

prisoners taken by, 561

return of captured German nurses, 230

surgery in hospitals of, 251

Third Army vs., 286

truck pool formed by, 299

at West Wall, 354

First Army Medical Detachments, A and B, 220

First Key Plan, 37, 39, 41

Firth of Clyde, 56

Fixed hospitals, 90-91

in Communications Zone, 171

invasion planning by, 199

revision of plans for, 267

surgery in, 176

Fleming, 1st Lt. Dean S., 13-14

Flight surgeons, 71, 105

Floor coverings, hospital, 87

Floor space, hospital, 83

Florey, Howard, 125

Flossenbuerg Concentration Camp, 571

Flying, health problems related to, 138

Food inspections, 140

Food poisoning, 141-42, 543

Food shortages. See also Malnutrition

in occupied Germany, 586-89

worldwide, 567

Footgear, 491-93

Forward Echelon, Communications Zone

(FECOMZ)

medical planning by, 161, 168-70, 191-92

move to Valognes of, 313, 315

responsibilities of, 157

work in France by, 240

Fourth Key Plan, 81-82

Fox, Brig. Gen. Leon A., 557, 577

France. See also Paris

COBRA operation in, 273-75, 278

decision to liberate, 60-61

hospital construction in, 270-71

hospitals in, 192, 325, 328, 336, 339-40

prostitution in, 173

shipments of blood to, 175, 193

state of liberated, 546-49

state of occupied, 172

transporting hospitals through, 300

venereal diseases in, 172, 541-42

Fraser, Sir Francis, 101

French Army

First, 275, 289, 354, 358, 536

reliance on American medical supplies, 358

French Naval Hospital, 261-62

Frenzerburg Castle, 370

Frogner, Maj. L. S., 400

Fumigation and Bath Companies,

423d, 565

480th, 565

Gangrene, gas, 125

Garbage disposal, 139

Garrison rations, 139

Gas attacks, 173, 616

General Assignment personnel, 449-50, 481, 601

General dispensaries

7th, 18, 99

10th, 99

General hospitals

1,000-bed, 17, 40, 42, 82, 119

ADSEC and FECOMZ, 192

arriving short-trained, 443

bed-capacity increases in, 90

common types of, 82

construction in France, 270-72

in Cotentin Peninsula, 325

by end of 1942, 43-44

flow of patients to, 98-99

on the front, 336-40

grouping of, 40

hosting of professional conferences by, 127

personnel needed for projected, 112

plan to move twenty-five, 265-66

projected needs for, 111-12

projections for completion of, 88

return of convalescents to duty by, 199

shipment of, 465

station hospitals to function as, 256

tented expansion wards in, 90

training programs in, 135

General Hospitals (individual)

1st, 99, 124, 538

2d, 22-23, 125-26

5th, 19, 21, 23, 87-88, 95, 117, 266-68, 270, 597

15th, 330, 453

19th, 325

21st, 437, 502

28th, 330, 391

30th, 130

43d, 597

48th, 252-53, 330, 337-38

50th, 107-08

62d, 338

68th, 242

76th, 496

79th, 103

90th, 330

91st, 99

95th, 330, 605

96th, 386

99th, 256, 330

100th, 330

101st, 607

108th, 325, 338, 340

124th, 606

127th, 325, 599

130th, 412, 533

156th, 256

166th, 443

170th, 444

203d, 323, 325, 338, 352

217th, 325
640 EUROPEAN THEATER OF OPERATIONS

General Hospitals (individual)—Continued

298th, 100, 135, 169, 266-68, 270

306th, 560

General practitioners, 3, 444

Geneva Convention, 104

protections under, 229, 242, 372, 483

requirement for early repatriation, 487

on treatment of prisoners, 558, 561

German Army

attack on Ardennes sector of First Army, 393

cold injury in, 494

on D-Day, 201-02

defensive experience of, 355

disintegration of, 274-75, 293, 562

losses at Normandy, 219

at OMAHA, 208, 210

rebuilding of, 275, 278

vandalism of, 339

German Army units

Army Groups

B, 512

G, 289

Armies

Fifth Panzer, 394-95, 400, 415

Sixth Panzer, 393-96, 399, 404

Nineteenth, 529

Seventh, 273, 394

Twenty-fourth, 529

Kampfgruppe Peiper, 394, 405-07

German casualties, 123, 356, 477, 486-88, 537. See

also Prisoners of war (POWs)

German military hospitals, 512-13

German prisoners. See also Prisoners of war (POWs)

conditions of, 561-63, 565-69

growing numbers of, 512, 524

hospitals treating, 123, 477

working in hospital units, 450-52, 568, 605

German Red Cross, 566, 582

German supplies, 301, 347, 515

Germany

adherence to international law regarding

wounded, 370

Allied bombing of, 60, 68

evacuation from, 513-14, 520-21, 525, 527-28,

536-37

military government in, 550-53

NORDWIND attack by, 426-28

surrender of, 579

threat of gas attacks by, 173

torpedo boat attacks by, 192

Germany, invasion of

Fifteenth Army's, 530-31

First Army units in, 508-09, 511-15

lessons from, 531-33

needs for, 507-08

Ninth Army's, 515-16, 518-22

and preventive medicine, 538-43

Seventh Army's, 528-30

and support at the front, 533-38

Third Army's, 522-25, 527-28

Germany, occupation of

hospitalization and evacuation during, 581-89

medical intelligence during, 589-95

movement of troops during, 596-601

public health during, 581-89

Gerow, Maj. Gen. Leonard T., 202, 530

Giessen, 514-15

Ginn, Col. L. Holmes, Jr., 530

Glock, Lt. Col. Maurice E., 318

Gold, Lt. Col. David, 205, 415, 417

Gonococcal infections, 539, 542. See also Venereal

diseases

Gorby, Col. Alvin L., 66, 160, 184, 292, 357-58,

388, 433, 495, 552, 617

Gordon, Col. John E., 8, 22, 33, 46, 58, 137-38,

141, 144, 146, 195, 431, 490, 539-40

Grant, Maj. Gen. David N. W., 68, 70-71

Great Britain. See also British Army units

early activities in, 6-12

early support for, 5

evacuation assistance by, 100

evacuation to U.S. from, 103

invasion of France, 60-61

living conditions for medics in, 109

medical profession in, 6

as part of ETOUSA, 26

supply procurement from, 52-53, 59, 182-83,

189, 190n

troop buildup in, 113

Great Malvern, 40, 83

Greely, Maj. David, 582

Green, Col. Mack M., 194, 313

Greenham Common airstrip, 345

Griesecke, Col. Carl G., 527

Ground Force Reinforcement Command (GFRC),

447-48, 479-80

Grow, Brig. Gen. Malcolm C., 68-71, 78, 151, 256,

322, 329

"Grow Escadrille," 332

Guides to Therapy for Medical Officers (War

Department), 176

Hague Convention, 104

Hangen, Herman C., 184, 186, 188-90

Hardin, Maj. Robert C., 175-76, 350

Hartford, Lt. Col. Thomas J., 153, 161

Hartle, Maj. Gen. Russell P., 18

Harvard Medical School, 8, 19, 117, 597. See also

General Hospitals (individual), 5th

Hawley, Maj. Gen. Paul R., 232, 552

and Air Force medical service, 69-71

background of, 10-11

and base section commands, 72-73

and black medics, 122-23

and blood supplies, 175, 348, 350

as chief surgeon, 13-14, 22-23, 27-32, 46-55, 67,

78-80, 127, 313, 614-15

and chief surgeon's office, 33-34, 36, 73-74, 76-

79
INDEX 641

Hawley, Maj. Gen. Paul R.—Continued

and command relations, 430-34, 436-40

concern with morale problems, 454

departure for U.S. of, 579

on Dowling, 240

and evacuation, 98-106, 108, 248, 292, 317, 321-

22, 324-25, 329-32, 472, 478, 481-88, 498,

500-06, 616

and hospital planning and construction, 37-44,

80-83, 85-88, 90, 338, 615

and hospital system organization, 91-92, 94-97,

267, 270, 474

invasion planning and, 150-52, 160, 165-67, 191-

93, 197-200, 241

move to Paris by, 315-16, 436

and penicillin use, 125-26

and personnel buildup, 110-12, 114, 116-18

and personnel system, 450

place in chain of command, 62-64

postwar planning by, 538

and preventive medicine, 139-40, 143-44, 146-

47, 555

relationship with Kenner, 65, 432, 440, 506

representing Medical Department in Special

Observers Group, 11-12

and status of nurses, 120-21

and supply situation, 177-79, 181-90, 458, 464-

65, 467

on surgery in transit hospitals, 252

on Third Army's use of its medical groups, 372

and TORCH preparation, 56-58

and training, 131-32, 134, 136-37

and trenchfoot, 495

and use of LSTs, 240, 245-47

use of medical research, 125

work with MAGNET force, 17-18

Hayes, Col. Paul, 203, 208, 229, 254, 431

Hays, Col. Silas B., 186-88, 345, 462-64

Heating, 83, 141

Hedgerows, Battle of the, 219, 224, 226-39, 364

Hepatitis, 19, 23, 141-42, 172, 539, 543

Higbee, Lt. Col. Clarence E., 50-51, 55

Hill, Col. Robert B., 313

Hodges, Lt. Gen. Courtney, 274-75

Hogan, Lt. Col. Howard, 55

Holding units

ADSEC, 318-19

around field hospitals, 320

at Biniville, 264

by late 1944, 468, 470

Le Bourget, 328

pre-evacuation, 232

Holland, 278

army medical facilities in, 311

liberation of southern, 355

MARKET-GARDEN operation in, 305-06, 308-10

offensive in, 357

volunteer nurses in, 451

Hood, Lt. Gen. Sir Alexander, 6-7, 12, 165

Hospital centers

organization of, 94-95

Hospital centers—Continued

projected crew needs for, 111

Hospital Centers (individual)

12th, 92, 94, 254-55

15th, 92, 94, 254-55

811th, 503

812th, 503

814th, 503

815th, 503

818th, 474, 497

819th, 474, 603-04

6810th, 94

Hospital construction

deficiencies in, 86-88, 90, 615

delays in, 41-43, 85-86, 88

final drive for, 80-85

in France, 270-71, 339-40

labor shortages for, 85-86, 88

orders for, 40

projections for, 39

shortages in materials for, 87-88

Hospital inspections

by Lee, 88

for new facilities, 86-87

responsibility for, 91-92

Hospital planning

for ETOUSA force, 36-44

for expanded force in 1943, 81

Hospital requirements

establishment of, 12n

estimates of, 39-40, 111

Hospitals. See also Bed capacity; Bed requirements

admissions to, 618

American vs. British design standards for, 83, 85-

86

from battle line to, 372-75, 377

for blacks, 122

British. See British hospitals

capacity of, 90

convalescent. See Convalescent hospitals

for DPs, 570

evacuation. See Evacuation hospitals

fixed. See Fixed hospitals

general. See General hospitals

German bombs hitting, 124-25

German vandalism in, 339

need for mobile, 531

during Occupation, 603, 605-08

operation of, 124-27, 377, 379-89

for POWs, 486-88, 537-38, 565-66

specialized-care, 95-96

station. See Station hospitals

Hospital ships, 21

availability of, 150

British, 100, 106, 150, 477-79

invasion casualties moved by, 195, 245-48

medical staff on, 246

production of, 104-05

shortage of, 108
642 EUROPEAN THEATER OF OPERATIONS

Hospital ships—Continued

transatlantic evacuation by, 104-06, 483-86, 488,

503

used for helpless patients, 108

Hospital site selection, 40

and Eighth Air Force plans, 14, 16

at the front, 336-37

in Normandy, 267-68

pre-Second Key Plan, 40

responsibility for, 85

Hospital system

coping with problems during 1944-45, 496-506

by late 1944, 468-73

organization of, 91-92, 94-97, 267, 270

Hospital trains

British use of, 250

converging on Paris, 328

coordination of, 253-55, 331-32

for evacuation, 101-02, 171-72, 198, 305, 323-

24, 329, 472-73, 479, 499

for transport of hospital personnel, 337

for transport of medical cargo, 346-47

Hospital Trains (individual)

11th, 323

18th, 108

43d, 323

Huebner, Maj. Gen. A. Ralph, 508

Huertgen Forest, 355, 365, 369, 370

Hurley, Col. Thomas D., 67, 284, 286-87, 424-25

Huts, Nissen, 18-19, 40, 82-83

Iceland, 61

Army troops to replace British garrison in, 5

medical supplies to American troops in, 12

as part of ETOUSA, 26

Immunization, 23

of Germans, 590

programs for, 548

against typhus, 172

of U.S. soldiers, 141

Infantry Divisions

1st, 44, 57, 164, 202, 280, 298, 366

2d, 202, 393-94, 396-99, 509

3d, 368, 492

4th, 164, 193, 201-02, 204, 206, 208, 280, 522

5th, 294, 492, 522

8th, 492

9th, 128, 208, 229, 280, 446

26th, 212, 424

28th, 369, 394, 400

29th, 44, 59, 164, 202, 236

30th, 226, 274, 280

34th, 18-19, 22, 57

35th, 236, 493

42d, 574

44th, 529

78th, 509

79th, 492

80th, 424, 522, 525

83d, 228-30, 303

Infantry Divisions—Continued

90th, 208, 390, 492, 523

95th, 364-65

99th, 393-94, 396-99, 401, 509, 512

106th, 394, 399-400, 404, 565-66

Infantry Regiments

11th, 294, 494

16th, 202, 210, 212-13, 365

18th, 214

22d, 224, 370

47th, 370

109th, 400

110th, 400

112th, 369-70, 400

115th, 242

116th, 202, 210-11, 213, 365, 368

120th, 294

133d, 18

318th, 523

327th Glider, 308, 418

328th, 362, 494

357th, 494

358th, 494

422d, 399

423d, 399

424th, 399

501st Parachute, 417

502d Parachute, 204, 419

Infection

respiratory, 141

use of penicillin and sulfa drugs to control, 126,

234

Infectious hepatitis. See Hepatitis

Influenza, 141, 172, 542

Insecticide powder, 172

Insects, 141-42

Inspections

of COMZ medical installations by Hawley, 437

food, 140

hospital, 86-87, 91-92

lice, 172, 555

shortages of, 136

for venereal disease, 147

Instructional materials, shortages in, 136

Inter-Allied Conference on War Medicine and

Surgery, 126-27, 453

Invasion planning. See also D-Day

blood program and, 174-76

early, 149-52

and expeditionary hospitals, 177

final stages of, 191-200

and medical supplies, 177-79, 181-91

and NEPTUNE campaign, 161, 164-74

OVERLORD, 152-53, 156-61

surgical program and, 176-77

Ireland. See Northern Ireland

Jameson, Sir Wilson, 8

Jeffress, Col. Vinnie H., 438
INDEX 643

Jews, purge from medical profession, 582

Kaiser Wilhelm Institute, 594

Keeler, Col. Maxwell G., 19, 266

Kelley, Lt. Col. Robert R., 345

Kenner, Maj. Gen. Albert W., 65, 88, 90, 228, 231,

234, 267, 270, 305, 322, 329, 358, 432, 506,

552, 606, 608, 620

and authority over medical matters, 432-33, 440,

614

background of, 64-65

and bed shortage, 476-77

and evacuation, 477, 482, 500-01, 503-04

and POWs, 567-69

role in invasion planning, 156, 160, 164-66, 187,

199-200, 219

as Surgeon, Occupation Forces, Germany, 579,

581, 583

view of LSTs by, 167

view of medical service, 391-92

Kimbrough, Col. James C., 33, 46, 74, 76, 132, 431

Kintz, Col. Francis P., 281

Kirk, Rear Adm. Alan G., 164

Kirk, Brig. Gen. Norman T.

and nurses, 120, 123

penicillin provided by, 126

praise for medical services by, 127, 440

and supply of blood from U.S., 176, 350

and supply problems, 178, 183-84

as surgeon general, 64, 71, 79, 81, 97, 103, 112,

117, 147, 187-88, 267, 438, 444, 482, 504, 590,

596

Kitchens, hospital, 83

Kliewe, Prof. H., 591

Knoblauch, Lt. Col. Frederick J., 248-49

Knox, 1st Lt, Barren D., 14

Kommerscheidt, 369-70

Korbach, 515

Krueger, Lt. Ann M., 500

Kuentscher, Gerhardt, 593

Kursk, 60

L-5 reconnaissance aircraft, 514

Laboratories

dental, 128

projected need for medical general, 111

La Capelle, 282

Laird, Maj. Earl E., 405

La Poterie, 217

Larkey, Lt. Col. Sanford V., 554

Larkin, Maj. Gen. Thomas B., 438

Lauer, Maj. Gen. Walter E., 509

Layman, Brig. Gen. Walter G., 134, 481

LCIs, 211

LCVPs, 242, 525

Lee, Maj. Gen. John C. H.

authority of, 62-63, 79, 431-32

on base sections, 72

call for volunteer blood donors by, 176

Lee, Maj. Gen. John C. H.—Continued

command over southern line of communications

and, 438

control of Communications Zone by, 157, 240,

267, 315, 329, 534

hospital inspection by, 88

and rehabilitation hospitals, 96

role in hospital construction, 41, 85-86

as SOS commander, 27, 29-31, 81, 110-11

Le Grand Chemin, First Army dump at, 265

Le Havre, 312-13, 457

Lehman, Col. Asa M., 94-95

Le Mans, 274, 312

Lend-lease, 183, 189

reverse, 52, 86, 450

Liberation complex, 569

Liege, 275, 496-97

Limited Assignment personnel, 449-50, 479-81

classifying, 481, 601

in depots, 481

working in rehabilitation and reconditioning

centers, 479

working in reinforcement system, 480-81

Lindstrom, Lt. Col. William C., 308

Linguiti, Capt. Paschal A., 369-70

Linoleum, 87

Liscavage, Pvt. Theodore T., 296

Litterbearers

dangers for, 365

need to relieve, 523

replacement, 450

Litter suspension, 470

Littlejohn, Maj. Gen. Robert M., 490

Loire Base Section, 312, 434, 443

London Combined Committee, 38, 42, 81, 104

Lorie, Maj. Gen. R. H., 43

Lorraine, 355

LSTs

blood shipments to, 193

No. 496, 242-43

operation of, 165-67, 171, 195, 198, 240-45,

249-50, 477

sinking of, 192

used during Normandy invasion, 207

LST surgeons, 241-42, 244, 248

Luftwaffe raids, 264, 411, 415, 527

Luitpold Hospital, 593

Lutes, Maj. Gen. LeRoy R., 458-59

LVT-1s, 525

Lyon, 290

M-29 Weasel, 364

McAuliffe, Brig. Gen. Anthony C., 415

MacFee, Col. William F., 350

McIntyre, Capt. Frederick J., 397

McNinch, Lt. Col. Joseph H., 33, 46, 431

Maddock, Lt. Col.Walter G., 266

Magee, Maj. Gen. James C., 4, 17, 27, 32, 40, 55,

59, 103
644 EUROPEAN THEATER OF OPERATIONS

MAGNET force, 25, 50

arrival of, 18

deployment of, 13, 16, 22

hospital requirements for, 16-17

misunderstanding regarding, 17

Malaria, 142, 235, 543, 595, 611-12

Malnutrition

among Allied prisoners, 558

among civilians, 549

among concentration camp inmates, 574, 577

among German prisoners of war, 543, 568

Manipulative therapy, used in rehabilitation

facilities, 96

Mansfield, 37

Manual of Therapy (ETO), 176, 234, 348, 359, 490

MARKET-GARDEN, 278, 334

role of IX Troop Carrier Command in, 329

support of, 305-06, 308-10

Marshaling camps, 194-95

Marshall, General George C., 9, 486, 504, 506

and cross-Channel attack, 152, 165

on hospital construction, 42, 337

and medical manpower, 25, 487

proposal for assault on Nazi-occupied Germany,

25

Marshall, Lt. Col. Irving A., 336

Martin, Capt. John T., 14

MASH (Mobile army surgical hospital), 531

Mason, Col. James B., 34, 160, 175, 348, 563, 565

Maxillofacial surgery

Dental Corps officers training in, 135

at evacuation hospitals, 380

as hospital specialty, 95

training for nurses to assist in, 132

Meador, Lt. Col. Clark B., 57, 436

Medical Administrative Corps (MAC), 368

assignment of officers from, 117-18

assistant battalion surgeons from, 448

staffing and, 119, 602-03

Medical Air Evacuation Squadron, 817th, 500

Medical Air Evacuation Transport Squadron, 811th,

108

Medical Ambulance Companies

426th, 328

522d, 332

553d, 443

590th, 249

Medical Battalions

1st, 212, 216

2d, 398

4th, 206, 208, 229

5th, 295

33d, 192, 248, 258

47th, 19

50th, 208

53d, 100, 217, 400-401

57th, 280, 407, 414

60th, 213-14, 216-18, 231-32, 264

61st, 213-14, 216-18, 231-32, 264

103d, 400

104th, 216

Medical Battalions—Continued

109th, 18-19

165th, 466

169th, 401-02, 422

177th, 282

179th, 406

180th, 405-06

187th, 410

231st Composite, 465

261st, 206-08

324th, 398

331st, 399

343d, 471

425th, 319

428th, 264, 319

503d, 19

Medical Corps (MC)

Medical Administrative Corps as replacements for,

368

officer requests, 116-17

officer shortage in, 119

Medical Demonstration Platoon, 1st, 134

Medical Department, U.S. Army

organization of, 3

post-World War I, 4

pre-World War II buildup of, 4

role in supply and equipment problems, 51, 190

Medical Department Depot Manual, 458

Medical Depot Companies

1st, 50, 54, 223, 300, 389, 403, 407-08, 414, 419,

514

7th, 389-90

8th, 50

11th, 343, 465

13th, 265, 347

28th, 389

30th, 265, 343

31st, 265, 342

32d, 223, 265, 286, 288, 389, 426

33d, 286-88, 389, 425

35th, 389, 410

46th, 465

47th, 515

66th, 466

Medical depots

across the Continent, 342-43

location of, 54n

manpower deficiencies on, 179

prisoners of war working in, 342-43, 465-66

problems in, 179, 181

projected needs for, 111

reorganization of, 188-89

transporting, 300

Medical Depots (individual)

G-35, 58, 179

G-45, 58, 193

M-351 (M-451), 461

M-352, 461

M-401, 342

M-401 (M-1), 265
INDEX 645

Medical Depots (individual)—Continued

M-402, 343, 459, 461-62, 465

M-403, 342

M-403 (M-3), 265

M-404, 342, 346

M-405, 342, 459

M-406T, 342-43, 346

M-407, 342-43, 459, 462, 465

M-408, 342, 461, 466

M-409, 342, 461, 463, 466-67

M-411, 466

M-412, 347, 461

M-413, 466

M-414, 466

M-417, 466

M-452, 461, 465

Medical enlisted personnel

rotation of, 454

shortages of, 444-46

Medical Equipment Laboratory, 589

Medical Field Service School (ETO), 132-35, 453

Medical gas treatment battalions

multiple functions of, 287

projected crew needs for, 111

Medical Gas Treatment Battalions (individual)

91st, 403, 407, 411, 511, 514

92d, 528

93d, 248, 258, 264, 319, 328

94th, 288, 528

95th, 292, 542

Medical General Laboratory, 1st, 137-38, 140, 175,

248

Medical Groups

31st, 222-23, 230, 234, 279-80, 357, 409-10, 529

64th, 356-57, 402, 405-06, 410, 416, 422, 425-

26, 511

65th, 425-26, 525, 527

66th, 302, 373, 525

67th, 374

68th, 222-24, 230-31, 234, 261, 279-82, 301, 303, 373, 511

69th, 373, 377, 425, 525

134th, 222-23, 228, 231, 233-34, 280-82, 399,

402, 405-07, 410, 511

Medical intelligence, 589-95

Medical in-transit storage points (MISPs), 344-45

Medical laboratories, 111

Medical personnel casualties

causes, 229

during Battle of the Ardennes, 397, 417

shortages due to, 446

Medical profession, in Germany, 582-83, 593-95

Medical Regiments

16th, 57

136th, 18

Medical replacements

rules governing, 448

sources of, 446-48

Medical Sanitary Companies

706th, 328

724th, 248

Medical Services Subcommittee, 39, 43

Medical supplies and equipment

Advance Section responsibility for, 265

for Air Force, 69-71

to American troops in Iceland, 12

during Battle of the Ardennes, 419-20

breakdown rate of, 237

from British sources, 52-53, 59

capture of enemy, 301, 347

for Dental Corps, 128

distribution during Normandy invasion, 203-04,

223, 236-37

distribution in Germany, 514-15

invasion planning and, 169-70, 177-79

North African needs for, 41

during Occupation, 608, 610-11

production problems, 181-91

in the pursuit, 341-48

shipping difficulties for, 51, 53-55

shortages and administrative deficiencies in, 33,

49-52, 59

sources of, 389-91

for TORCH, 54, 57-58

transfer to anti-Axis nations, 5

transporting, 300-301

unplanned uses for, 226

use of captured German, 301, 347, 515

during winter of 1944-45, 457-59, 461-67

Medical technicians, 448

Medical units

arriving during last half of 1944, 441-42

assemblies for, 182

buildup rate of, 44-55

late-arriving, 444

short-trained, 443

transportation to move large, 298

Medics

ability to improvise, 388-89

arm brassards of, 229, 372

assistance with construction by, 88

black, 122-23

buildup of, 110-14, 116-19

captured during Normandy invasion, 203

deployment schedule for, 112

difficulties in obtaining replacements of, 116-17

employment of POW, to care for own

countrymen, 486-88, 538-39, 620

first aid administered by, 360-63

increase in qualified, 73

living conditions of, 109, 442

LST, 241-42, 244, 248

in Normandy, 259-61, 263-68, 270-72

POW, 486-88

professional societies used by, 126-27

ratio of soldiers to, 440

retreat in Ardennes, 396-409

shortages of, 45-50, 114, 116, 118-19, 128, 152,

445

Mediterranean Theater

cold injury in, 489
646 EUROPEAN THEATER OF OPERATIONS

Mediterranean Theater—Continued

Communications Zone of, 437

diseases carried by troops from, 142

hospital staffs from, 92

supplies from, 390

supply surpluses in, 438

training provided by evacuation hospitals from,

136

Membury, 197, 257-58, 468

Meningococcal infections, 542

Merryfield, 257

Metz, 355

Middleton, Col. William S., 76-78, 92, 109, 125,

141, 175, 444

Military government, 550-53

as concept, 544-45

training in, 544

Military Government, Field Manual 27-5, 544

Militia camps

British, 82

provision plans for, 42

removal of troops from, 88

Ministry of Agriculture (Great Britain), 40

Ministry of Health (Great Britain), 146

Ministry of Labor (Great Britain), 118-19

Ministry of Supply (Great Britain), role in supply

procurement for SOS, 51

Ministry of War Transport (Great Britain), 102

Ministry of Works (Great Britain), role in hospital

construction, 42-43, 83, 85-87

Mobile warfare

adapting to, 292-303, 305

hospital needs for, 531-33

transition from static to, 311, 616

Moenchen-Gladbach, 516

Mons, 275, 303

Montgomery, General Sir Bernard L., 156, 274,

278, 507, 615

Morale problems

among black medics, 123

among medical depot personnel, 179

among nurses, 119

dealing with, 454-56

professional societies and meetings used to avoid,

126

Morgan, Lt. Gen. Sir Frederick E., 153

Morphine Syrettes, 363

Mortain, 294

Moselle crossings, 294

MOS numbers, 600

Mosquitoes, 142

Motion sickness capsules, 173

Mowrey, Col. Fred H., 98, 253, 267-68, 468, 500,

538

Musgrave Park, 19, 37

Nancy, 278

Nantes, 274

Narcosis therapy, 481

NATOUSA. See North African Theater of

Operations (NATOUSA)

Naval Beach Battalions

2d, 206, 232

6th, 210

7th, 210

Navy, U.S.

amphibious doctrine written by, 149-50

cooperation with Army, 240

invasion planning by, 165

role in evacuation of casualties, 258

Navy hospitals, in Great Britain, 17

NEPTUNE

D-Day events and, 201

description of, 164-72

outline plan for, 153

plan for, 156, 160-61, 191, 218, 224, 231, 240,

256, 265, 490

preventive medicine as concern of, 171-72

problems addressed by, 161, 164

Neuropsychiatric casualties, 21, 95. See also Combat

exhaustion

during battles, 235, 386

care of, 377, 618

decline in, 293

evacuation policy and, 375

during fight for Cherbourg and St.-Lo, 224

rehabilitation of, 387

transatlantic evacuation of, 104, 385

treatment for, 223, 385

Neuropsychiatric hospitals, 95, 385-86, 412

Neuropsychiatry, 195

Neurosurgery

as hospital specialty, 95

specialists at evacuation hospitals, 380

training for nurses to assist in, 132

Newton, Lt. Col. George D., 232

Nijmegen, 309

Ninth Army, 275, 354

during Battle of the Ardennes, 409

distribution of supplies to, 389, 391

efforts to control venereal disease by, 542

evacuation policy of, 375

invasion of Germany by, 511, 515-16, 518-22

management of public health by, 553

medical support of, 289, 291-92, 303, 352, 356-

57, 372-73, 385, 515-16, 520

prisoners taken by, 561

IX Troop Carrier Command, 103, 171, 288

role in air transport, 321-22, 328-29, 333-34,

471, 513-14

role in MARKET-GARDEN, 328-29

Nissen huts, 18-19, 40, 82-83, 124

Nonfraternization policy, 584-85, 619

NORDWIND, 426-28, 498

Normandy

ADSEC medics in, 259-61, 263-65

in aftermath of war, 546-47

food availability in, 546

hospitals in, 265-68, 270-72, 330
INDEX 647

Normandy—Continued

as site of attack, 153

Normandy, Battle of. See also D-Day; Invasion

planning

casualties of, 202, 224, 235-36

Cherbourg and Hedgerows and, 224, 226-38

entry into, 203-08, 210-14, 216-19

First Army medical buildup and, 219-24

supply distribution during, 203-04, 223, 236-37

Normandy Base Section, 312-13, 328, 332, 334,

343-44, 346

growth of and changes within, 537

hospitalization and evacuation in, 468, 478, 497

North Africa

British civilians replacing military personnel

detached for service in, 118

interest in invasion of, 26-27

preparation for invasion of, 55-59

role of ETO medical service in evacuation from,

99

victory in, 60

North African Theater of Operations (NATOUSA)

creation of, 61

operation of fixed hospitals for, 100

shipping and supply demands of, 42

in support of DRAGOON, 289, 291

Northern Ireland. See also United States Army

Northern Ireland Force

deployment of MAGNET force in, 13

protection of Navy bases in, 5

revision of medical plans for, 11, 16-17

Northern Ireland Base Section, 30-31, 72, 103, 313

Nurses

black, 122-23

civilian, 451

employment of POW, to care for own

countrymen, 486-88

first entering beachhead, 221

physical conditioning of, 135

within platoons, 387

ratio of soldiers to, 440

for reassignment, 599-600

return of captured German, 230

shortages of, 118, 445-46

status of, 119-22

training needs of, 131

training of, 134, 445

Nutrition, 139-40, 539, 586-87

Observers, sent to Great Britain, 6-12

Odom, Lt. Col. Charles B., 284, 424

Odstock, 37, 87

Oise Base Section, 312, 375, 434, 436, 536

OMAHA

ADSEC at, 259-60

evacuation from, 231-32

invasion planning and, 164, 168, 194

Normandy invasion at, 201-02, 208, 210-14, 216-

19, 223

reinforcements to, 220-21

Operating trucks, 380

Operation room design, 83

Orthopedic patients, 379

Orthopedic surgeons, 444

Osteopaths, 96

Otway pit, 139

Outpatient care, general dispensary, 99

OVERLORD, 60-61, 490

planning process for, 152-53, 156-57, 160-61

plans for, 65-67

readiness for, 199-200

troops carrying hepatitis, 142

Oxford, 37

Oxygen tanks, 182

Packing, amphibious, 193

Padget, Lt. Col. Paul, 143, 146-47

Palmer, Col. Joseph W., 248

Pappas, Lt. Col. James P., 545

Paratyphoid, 543

Paris, 312

evacuation system in, 328, 468

as haven for soldiers on furlough, 541

hospitals in, 325, 330, 339-40, 468, 538

liberation of, 541, 548

state of liberated, 548

Pas-de-Calais, 153, 274

Patch, Maj. Gen. Alexander M., 289

Patients

litter, 21

mental. See Combat exhaustion; Neuropsychiatric

casualties

organization of flow of, 98-103. See also

Evacuation

post-hospital release inspection of, 383

Patton, Lt. Gen. George S., Jr., 65-66, 284, 424,

495, 615

Pellagra, 568

Penicillin, 125-26

availability for civilians, 548, 586

discovery of, 619

German knowledge of, 593

liberal use of, 234

shipments of, 193, 237

shortages in, 419

for treatment of venereal disease, 542

Perkins, Lt. Col. George W., 52-53

Pernionin, 494

Perry, Col. Walter L., 178-79, 186-87

Personnel. See Medical enlisted personnel; Medics

Pitch mastic, 87

Plasma, 175, 619

Plastic surgery

British hospitals specializing in, 8

as hospital specialty, 95

training in, 132

Pneumonia, 542

Portland-Weymouth, 192, 195, 199, 247-49

Port of New York, 50, 52, 54
648 EUROPEAN THEATER OF OPERATIONS

Ports, unloading priority at, 461-62

Postoperative patients

death rates for, 377, 422

evacuation of, 384

POWs. See Prisoners of war (POWs)

Prestwick, 106-07, 483

Preventive medicine

to combat venereal disease, 142-44, 146-47

as concern of NEPTUNE planners, 172-73

to control disease outbreaks, 141-42

depot surgeons and, 481

diet and, 139-41

for embarking troops, 195

and last campaign, 538-43

organization of, 137-39

research in, 125

"Principles of Surgical Management in the Care of

Battle Casualties" (ETO), 176-77

Prisoners. See Allied prisoners; German prisoners;

Prisoners of war (POWs)

Prisoners of war (POWs)

as blood donors, 350

camps for Allied, 512

capture of, 356

conditions of, 561-63, 565-69

disposition of, 303, 537-38

growing numbers of, 512

hospitals staffed by POWs for treatment of, 486-

88, 538-39, 620

medical care for, 123, 476-77, 486-88

supervision of camps for, 513

supplies for, 515

working in depots, 342-43, 465-66

working in medical units, 450-52, 568, 605

Professional societies, 126-27, 453

Prophylactics, 143-44

Prophylactic stations, 21-22, 144, 173, 373, 540-41,

585

Prostheses, 128

Prostitution, 144, 146, 173, 540-41, 586

Provisional Medical Department Truck Company,

284, 299, 407, 414

Psychiatric services, 386. See also Neuropsychiatric

casualties

Psychiatrists, 195

Psychoneurosis. See Combat exhaustion;

Neuropsychiatric casualties

Public health

during Occupation, 581-89

restoration of, 547-54

Quartermaster general depots, medical sections of,

179

Quartermaster Regiment, 109th, 18

Queen Alexandra's Imperial Military Nursing

Service, 121

Queen Victoria Hospital, 132

Radot, Pasteur Vallery, 337

Railroads

repair of French, 323

site selection and location of, 40

Railroad trains

for evacuation. See Hospital trains

for hauling supplies to Continent, 341

to move perishable food, 140

projected crew needs for, 111

RAINBOW-5, 5, 9, 10, 13, 25

RAMP Camp No. 1, 537

RAMPs. See Allied prisoners; Recovered Allied

military personnel (RAMPs)

Ramsbury, 197, 257-58, 468

Rank

as cause of bitter feelings, 453

of nurses, 120-22

relative, 120n

Rascher, Sigmund, 595

Ratay, Brig. Gen. John P., 437

Rations, 543, 567

Ravensbrueck Concentration Camp, 595

Rea, William G., 294-95

Reconditioning camps, 91

Recovered Allied military personnel (RAMPs)

care for, 512-13, 537

condition of, 570

evacuation of, 521, 560, 606

hospitals for, 570

Russian, 559

Recreational activities, 455-56

Red Ball Express, 341-42, 344-46, 462

Red Cross, 8

assistance to civilian populations, 550

Dutch, 451

German, 566, 582

hospital markers, 125, 167

involvement in blood distribution, 351

prophylactic stations in facilities operated by, 144,

541

protection of ships by, 151

recreational activities sponsored by, 120, 143

supplies for prisoners through, 558

Red Cross flags, 369-70, 372

Red Cross-Harvard Field Hospital Unit, 8, 22-23,

37, 137

Redeployment, 598-601

RED HORSE, 313, 442, 475, 537

Rednall, 257

Reeder, Col. Oscar S., 357-59, 433

Regimental Combat Teams

16th, 210

116th, 210

Regulation Stations

24th, 318

25th, 318

Rehabilitation Center Number 1, 96-97

Rehabilitation hospitals, 96-97

Reims, 312

Reinforcement Depot, 19th, 448

Relative rank, 120n
INDEX 649

Replacements. See also Medical replacement

difficulties in obtaining, 116-17

training medical troop, 134

Replacement system

effects of, 617

problems in, 480-81

Respiratory ailments, 141

among POWs, 561

in combat troops, 356

during early battles, 235

evacuation policy and, 375

Rich, Lt. Col. Thair B., 313, 470-71

Rickets, 589

Rickettsiae, 553

Ridgway, Maj. Gen. Matthew B., 516

Riflemen, shortage of, 448-50

Rogers, Brig. Gen. John A.

assessment of first two months of battle by, 237-

38

during Battle of the Ardennes, 403-04, 408, 410,

412-14

evacuation policy for chest and vascular injuries,

383

as First Army surgeon, 67-68, 157, 192, 221,

223-24, 231, 234-35, 237, 278-83, 298, 311,

363, 505, 507

work with Beasley, 259

Ross, Maj. Gen. Frank S., 330-31, 486

Rotation program, 454, 520, 617-18

Rouen, 312, 457

ROUNDHAMMER, 60. See also OVERLORD

ROUNDUP, 25-26, 36, 149

bus use for, 101

data collected by, 160

evacuation policy of, 150-51

hospital beds needed to support, 39-40

Section C, 149-50

studies and conclusions derived from, 152, 194

Royal Air Force (RAF)

evacuation by, 151, 617

medical service of, 6-7

Royal Army Medical Service, 6-7

Royal Society of Medicine, 127

Royal Victoria Hospital, 83

Rudolph, Col. Myron P., 290, 357, 373, 440

Russian Army

in Germany, 520, 552

POWs, treatment of, 537, 558-59

Ryan, Brig. Gen. Cornelius E., 552

Rylander, Col. Carl M., 310

Saarburg, 524

Saar-Moselle Triangle, 522, 524

Saint Dunstan's Institute for the Blind, as hospital

specialty, 95

St.-Laurent, 210, 213-14, 216, 232, 237

St.-Lo, 219, 223-24, 228, 238, 273, 283, 296

St.-Malo, 274

Ste.-Mere-Eglise, 231

Salmon, Col. James L., 228

Sams, Lt. Col. Crawford F., 487, 491, 504

Sanitary Corps, 548

black medics working for, 122n, 123

projected needs for, 111

replacements for, 117

staffing of, 119

Sanitation

among former concentration camp inmates, 570-

71

in marshaling camps, 195

in POW camps, 561, 563

in prison camps, 558

as problem for Seventh Army, 528

reestablishment of, 545

regulations in Northern Ireland regarding, 21

Sarin, 592

Scabies, 548

Scherf, Maj. Gen. Walter, 512

Schilling, Klaus, 594-95

Schullinger, Lt. Col. Rudolph N., 125

Second Key Plan, 37, 39-41

Seine Base Section, 312-13, 334, 434, 436, 472, 541

evacuation and hospitalization in, 471, 497-98,

500

handling of sick and injured Allied nationals by,

537

as key to medical logistics system, 536

Self-inflicted wounds, 385

Senonches, 281

Serbst, Maj. Charles A., 405-06

Services of Supply (SOS). See also Communications

Zone (COMZ)

and Air Force needs, 70

building and manning concentration and

marshaling camps by, 194

chain of command and, 28-32, 62

deployment schedule for, 112

establishment of, 25

expansion of, 44

geographical base sections within, 30-31

hospitals in operation by D-Day, 91

organization of, 27

relocation of, 29

replacement system of, 71

role in evacuation, 152

support of TORCH by, 25, 27

Seventh Army

Eastern Zone under, 582

evacuation needs of, 305, 375

invasion of Germany by, 528-30, 535

liberation of Dachau by, 577

medical support of, 289-91, 303, 357-58, 373,

385

NORDWIND assault on, 426-28

preparation to assault West Wall, 356

supplies distributed to, 389-90, 457

SHAEF. See Supreme Headquarters, Allied

Expeditionary Force (SHAEF)

Shambora, Col. William E., 291-92, 310, 516, 520
650 EUROPEAN THEATER OF OPERATIONS

Shipping

by air. See Air transport

amphibious packing for, 193

difficulties in, 51, 53-55

to North African expedition, 42

Ships. See Hospital ships

Shoepacs, 491-93, 522

Shook, Col. Charles F., 438-40

Siegfried Line, 275n

Signal Battalion, 63d, 18

Site selection. See Hospital site selection

Skin afflictions, 539

SLEDGEHAMMER, 25-26, 152

Smith, Lt. Gen. Walter Bedell, 63-64, 329, 333

Soman, 592

Somervell, Maj. Gen. Brehon B., 25-26, 104, 458,

467

Southampton, 195, 247-48, 250

Southern Base Section, 71, 134-35, 183, 194-95,

198-99, 248, 313

Southern Command

building of troop camps in, 40

hospitals in, 37

preparations for receiving invasion casualties, 195

Southern Line of Communications (SOLOC), 375,

389, 433

and ETO practices, 438-40

field and communications zone medical units

needed by, 442

hospital and evacuation system of, 470, 472, 474

medical policies and procedures of, 438

supply system and, 457, 459

Spaatz, Maj. Gen. Carl, 44

Specialized-care hospitals, organization of, 95-96

Special Observers Group (SPOBS), 9-13

Spruit, Col. Charles B., 33-34, 46, 70, 74, 111, 149-

50, 157, 160, 179, 313, 315-16

Standlee, Col. Earle G. C., 50, 53

Station hospitals

250-bed, 40

500-bed, 17, 40

750-bed, 40, 42, 83

bed capacity for, 39, 42, 90

by end of 1942, 43-44

flow of patients to, 98

to function as general hospitals, 256

general hospitals substituted for, 82

hosting of professional conferences by, 127

projected needs for, 111-12

projections for completion of, 88

selection by Hawley of, 14

tented expansion wards in, 90

training programs in, 135

Station Hospitals (individual)

3d, 56

10th, 18, 56

16th, 96, 97n, 99

36th, 95

51st, 386

77th, 97

110th, 252-53, 606

Station Hospitals (individual)—Continued

121st, 124

127th, 352

152d, 175, 237, 352

160th, 19

168th, 123

228th, 252

280th, 477

303d, 198

307th, 97, 97n

312th, 135, 386

314th, 252

315th, 252

316th, 242

327th, 487

350th, 337

Stayer, Maj. Gen. Morrison C., 587

Stoneleigh rehabilitation facility, 96-97

Strasbourg, 427

Strecker, Edward A., 71

Stuttgart, 583

Sulfa drugs

discovery of, 619

excess doses of, 363

in first aid packs, 361

liberal use of, 234

to treat venereal disease, 126n, 542, 586

Supplies. See Medical supplies and equipment

Supreme Headquarters, Allied Expeditionary Force

(SHAEF), 61-62, 245

Civil Affairs Section (G-5), 545, 549, 552

and command relations, 431

dealings with civil administrations by, 337

demarcation between activities of ETO and, 65

directions during Battle of the Ardennes, 424

on fraternization, 585

and invasion planning, 153, 164-65, 167-68, 590

and military government in Germany, 552

missions established to provide liaison between

Allies and national governments, 548

and move of COMZ headquarters to Paris, 315

policy regarding typhus control, 557

postponement of COMZ units by, 239

Public Health Branch, 545

role in evacuation, 321-23, 329-30, 521

tonnage allocation system and, 344-45, 357, 391,

463

withdraw of IX Troop Carrier Command from

logistical missions by, 328-29

Surgeon General, Office of the

Hawley's line of communication to, 32, 53

role in obtaining adequate medical units, 114, 116

Surgeons

administrative and clinical responsibilities of, 359

base section, 72, 86, 313

depot, 481

division, 531

evacuation hospital, 379

flight, 68, 71

Hawley's relationship with, 433-34
INDEX 651

Surgeons—Continued

infantry battalion, 448

shortages of, 117

techniques for fractures used by German, 512,

593

Surgery

blood transfusions during, 161

errors in, 383

during evacuation process, 176-77

in field and evacuation hospitals, 377

during first two months of combat, 234

regulation of procedures used in, 92

in transit hospitals, 252-53

use of penicillin as prophylactic in, 126

Surgical lag, 374

Surgical technicians, 448

Syphilis, 539. See also Venereal diseases

Tabun, 592

Tarrant Rushton, 257

Taunton, 37

Taylor, Col. George A., 212

Tegtmeyer, Maj. Charles E., 211, 213

Tented expansions, 90

Theater Service Forces, European Theater

(TSFET), 579, 608

Third Army, 66, 191, 198, 222-23, 231, 355-56

battle casualty rates for, 293

in Battle of the Ardennes, 395, 408, 415, 418,

422, 424-26, 428, 430

blood distribution by, 348, 350

capture of Nancy by, 278

clearing evacuation hospitals by, 305

in COBRA operation, 273-75

efforts to control venereal disease by, 542

evacuation policy of, 375

First Army vs., 286

holding units maintained by, 375, 377, 384, 468

hospital admissions following Battle of the

Ardennes, 396

invasion of Germany by, 522-25, 527-28

medical support of, 284, 286-88, 290, 319, 330, 372-73, 385

prisoners taken by, 561

supplies captured by, 301

tank battle at Arracourt, 302

training of officer and nurse anesthetists by, 445

truck pool formed by, 299

Western Zone under, 582

at West Wall, 354

Third Key Plan, 42

Thomas, Col. Robert E., 194, 248

Thoracic surgery, 95, 380

TIGER, 192

Tonnage allocation, 344-45, 357, 391, 463

"Toot Sweet Express," 534

TORCH, 26-27, 49, 80

effect on ETO of, 58-59

evacuation plans for, 99-100

preparations for, 41

TORCH—Continued

supply needs for, 54, 57-58, 182

support for, 55-57, 152

Tourniquets, 363

Training. See also Education

aidmen, 448

in amphibious warfare, 241

for civilians, 451

need for, 130-31

for nurses, 134, 445, 453

for officer and nurse anesthetists, 445

programs instituted for medics, 131-37

Trains. See Evacuation, train; Hospital trains;

Railroad trains

Transatlantic evacuation, 103-08, 483-86, 488, 503

Transit hospitals, 258

function of, 252

surgery in, 252-53

Transport. See Air evacuation; Air transport;

Ambulances; Evacuation; Railroad trains

Transportation Corps, 271, 323, 330-31, 464, 472,

511

Transport Wing, 302d, 329, 332-33

Trenchfoot, 356, 418, 488-96, 504, 528

Trier, 524

Troop camps, convertible, 88

Troop Carrier Command, IX, 231, 256

Truces, to collect wounded, 370

TSFET. See Theater Service Forces, European

Theater (TSFET)

Tuberculosis, 543, 548, 571, 574, 577, 584

Tyng, Col. Francis C., 51

Typhoid, 172, 543, 548, 581

Typhus, 172, 539, 549, 553-57, 565, 570-71, 574,

577, 581-82, 619

Typhus Commission, See United States of America

Typhus Commission

Typhus vaccine, 594

U-boats, 60-61, 104

UC-64s, 332, 463, 471

Uniforms

cold weather, 490-91

inadequacy of nurses', 119-20

United Kingdom. See Great Britain

United Kingdom Base Section, 313, 316, 346, 386,

445, 450, 462-63

hospitalization and evacuation in, 468, 474, 501

POWS in hospitals in, 468, 474, 477, 487-88

United Nations Relief and Rehabilitation

Administration (UNRRA), 570-71

United States Army Forces in the British Isles

(USAFBI)

activation of, 13

end of, 26

organization of medical support plans for, 13-24

services of supply established by, 25

United States Army Northern Ireland Force

(USANIF), 18-24
652 EUROPEAN THEATER OF OPERATIONS

United States Forces, European Theater (USFET),

579

United States of America Typhus Commission, 552-

53, 582

United States Strategic Air Forces (USSTAF), 68,

321, 332

on nutritional status, 588

responsibility for air evacuation, 333

Urological surgery, 95

USAFBI. See United States Army Forces in the

British Isles

USFET. See United States Forces, European Theater

(USFET)

UTAH

ADSEC at, 259-60

evacuation from, 231-32

invasion planning and, 164, 168, 194, 199

Normandy invasion at, 201, 206, 223

reinforcements to, 220-21

Vaccines. See Immunizations

Valognes, 313, 315

Van Valin, Col. James C., 525

Vascular surgery, 619

Venereal diseases

among civilians, 549, 586

among DPs, 571

control of, 21, 142-47, 539-40, 619

in depot transients, 481

during early battles, 235

evacuation policy and, 375

during Occupation, 584-86

prevention of, 172-73

rate of, 539-41, 546-47, 611

treatment of, 126, 377, 385, 532, 542

troop education regarding, 143, 145, 541

Ventilation problems, 138, 141

Vermin, 141, 172

Verviers, 411-12

Veterinarians

assistance in food quality matters, 140

associations established by, 127

need for, in occupied Germany, 584

Veterinary Corps, 119

Vickoren, Col. Angwald, 136

Vierville, 210

Vision problems, 95

Vitamin deficiencies. See also Malnutrition

during early battles, 235

prevention of, 172

Voorhees, Col. Tracy S., 184-90, 458

Vossenack, 369

V-Packettes, 143-44, 173, 585

Wales, 81

Wards, tented expansion, 90

War medicine, training in, 131-32

Waste treatment plants, 139

Water ambulances, 150

Water quality control

by base sections, 138

hospital, 85

methods of, 138-39

in Northern Ireland, 21

in occupied France, 172

Weather conditions

and air evacuation, 377

as concern in invasion planning, 165

in Great Britain, 141

during invasion of Germany, 522-23

presenting difficulties for hospitals, 387-88

trenchfoot and, 488, 492

Weintraub, Capt. H. J., 558

Welsh, Maj. Arthur B., 9-10, 17, 98-99

Western Base Section, 71, 108, 194, 198, 256, 312-

13

hospitals for, 114

nutrition concerns in, 140

responsibilities of, 47

size of, 72

Western Naval Task Force, 164, 240-41, 245

Western Task Force, 55, 65, 99

West Wall, 275, 278

difficulties faced at, 509, 522

organizing for defensive at, 356-60

preparation for assault on, 311, 334

reorganization at, 354-55

rise in casualties due to action along, 538

Whayne, Col. Tom F., 552-53

Whitchurch, 40, 83

Whitsitt, Maj. James J., 206

Whole blood. See Blood

Wilson, Alfred L., 362

Wilson, Maj. Gen. Arthur R., 437

Wilson, Harlan, 22

Wiring systems, hospital, 85

Wisely, Maj. Martin S., 308, 418, 420

Women's Army Auxiliary Corps (WAAC), 143

Wyman, Col. Theodore, 436

U.S. GOVERNMENT PRINTING OFFICE: 1992 275-131

PIN : 068164-000