MEDICAL SERVICE IN THE 

MEDITERRANEAN 

AND MINOR THEATERS 

UNITED STATES ARMY IN WORLD WAR II 

The Technical Services 

THE MEDICAL DEPARTMENT: 

MEDICAL SERVICE IN THE 

MEDITERRANEAN AND 

MINOR THEATERS 

by 

Charles M . Wiltse 

CENTER OF MILITARY HISTORY 

UNITED STATES ARMY 

WASHINGTON, D.C., 1987 





Foreword

Improvements in medical practice and in standards of living in the

U.S. Army in World War II meant for the American soldier better medical

service than during any previous war. Improved techniques in the treatment

of wounds and in the prevention and cure of disease went far toward preserving the lives and bodies of Army men and women both at the fighting

fronts and in the bases and lines of communication that led to them. The

author in this volume tells first about the medical provisions for the Atlantic

outposts of the United States established before the substantial deployment

and engagement of Army forces in Mediterranean and European areas, and

then devotes major attention to the Army medical service in the Mediterranean campaigns in North Africa, Sicily, the mainland of Italy, and southern

France. An appendix suggests some similarities and contrasts between German and American practice during the war.

The book is a natural sequel to one published in this series in 1956

entitled, The Medical Department: Hospitalization and Evacuation, Zone

of Interior, and is to be followed by two dealing with medical service in the

European Theater of Operations and in Pacific-Asiatic areas. Other related

volumes are being published in the series, "Medical Department United

States Army in World War II." While the author of this work has addressed

himself primarily to the interests and needs of the military student and

reader, a wider audience should find in his account both practical lessons in

the provision of mass medical care and assurance that such care was adequately given to those who fought in the largest of American wars.

Washington, D.C. HAL C. PATTISON

23 September 1963 Brigadier General, USA

Chief of Military History

Introductory Note

The invasion of North Africa on 8 November 1942 was the first ground

offensive for U.S. troops against the European Axis Powers, and so the

beaches of Algeria and Morocco, the barren hills and dry wadies of Tunisia,

became the proving grounds for equipment, for tactics, and for men. From

North Africa the battle line moved up to Sicily, to Italy, and into southern

France, but for the Medical Department the Mediterranean remained a

"pilot" theater whose accumulated experience saved countless lives on other

fronts. Medical units that had served well in the static warfare of World

War I were modified or discarded on the basis of their performance in the

Mediterranean. New techniques, such as the treatment of psychiatric casualties in the combat zone, and the use of penicillin in forward surgery,

were tested. The smaller, more mobile field and evacuation hospitals became the workhorses of the theater. Jeeps fitted with litter racks served as

front-line ambulances, while transport planes, their cargoes delivered at

forward airfields, were pressed into service to evacuate the wounded.

In the grand strategy of the war the bloody Italian campaign was a diversion, to engage as many enemy troops as possible with the smallest possible commitment of Allied strength. This meant, for the combat troops,

being always outnumbered. It meant over and again, for medical and line

commanders alike, giving up formations with priceless battle experience in

exchange for willing but untried replacements. In physical terms the

theater imposed the extremes of desert, marsh, and mountain barrier; of

exposed plains crossed by swollen rivers; and the hazards of rain, snow,

sleet and mud, each demanding of the supporting medical complements

revised techniques and new expedients. In no other American combat zone

was there anything comparable to the desert warfare of Tunisia, to the long

martyrdom of Anzio, or to the bitter ridge-by-ridge encounters of the

Apennines. Small wonder that the medical service described in these pages

was often improvised and always pushed to the very limit of its means, yet

nowhere did the Medical Department attain a higher level of effectiveness.

The author of Medical Service in the Mediterranean and Minor Theaters, Charles M. Wiltse, is a graduate of West Virginia University, earned

his Ph. D. at Cornell, and holds an honorary Litt. D. from Marshall University. In addition to numerous articles, essays, reviews, and government

reports, Dr. Wiltse is the author of The Jeffersonian Tradition in Amer-
lean Democracy; of a three-volume historical biography of John C. Calhoun,

completed with the aid of two Guggenheim Fellowships; of a volume in

the "Making of America" series, The New Nation: 1800—1845; and is coauthor of the official War Production Board history, Industrial Mobilization for War.

Washington, D.C. LEONARD D. HEATON

23 September 1963 Lieutenant General, U.S. Army

The Surgeon General

xii
Preface

Medical Service in the Mediterranean and Minor Theaters is one of

three volumes dealing with the overseas administrative history of the United

States Army Medical Department in World War II. Companion studies

will deal respectively with the European Theater of Operations and the war

against Japan in the Pacific and China-Burma-India Theaters. These

volumes differ from the more extensive clinical series, separately published

by the Office of The Surgeon General, in that they are concerned primarily

with the support given by the Medical Department to the actual combat

operations: the collection of the wounded on the battlefield; the establishment of hospitals; the chain of evacuation from the point of contact with

the enemy back to the communications zone and on to the zone of interior;

and the methods and problems of medical supply in the field. Clinical matters, such as the incidence of disease, the types of wounds predominating,

and problems of sanitation, are subordinated to the less technical story of

the Medical Department in action. The administrative volumes thus relate

both to the general combat history told elsewhere in the series UNITED

STATES ARMY IN WORLD WAR II and to the medical story proper

recorded in the 40-odd volumes of the clinical series appearing under the

imprint of the Office of The Surgeon General. They are complemented by

Clarence McKittrick Smith's Hospitalization and Evacuation, Zone of Interior; and by four functional volumes, being published by the Office of

The Surgeon General, which deal respectively with Organization and Administration of the Medical Department, Personnel, Training, and Medical

Supply.

The manuscript of this volume was submitted in draft form to a substantial cross section of those who participated in the actions described.

Those who offered substantiation, corrections, or additions were: Abram

Abeloff, M.D.; Lt. Col. James J. Adams, MSC; William H. Amspacher, M.D.;

Col. Richard T. Arnest, MC, USA (Ret.) ; Col. Rollin L. Bauchspies, MC,

USA (Ret.); Col. Charles H. Beasley, MC, USA (Ret.); Austin W. Bennett,

M.D.; Lt. Col. Stephen D. Beradinelli, MC; Col. Daniel J. Berry, MC, USA

(Ret.) ; Frank B. Berry, M.D.; Col. Albert A. Biederman, MC; Col. Charles

O. Bruce, MC; Col. Gordon G. Bulla, MC, USAF; J. P. Cameron, M.D.;

Col. Joseph Carmack, MSC, USA (Ret.) ; Lt. Col. Dan Crozier, MC; Brig.

Gen. Henry C. Dooling, MC, USA (Ret.); Col. Daniel Franklin, MC, USA

xiii
(Ret.); Frank P. Gilligan, M.D.; Brig. Gen. L. Holmes Ginn, Jr., MC, USA

(Ret.) ; Michael Q. Hancock, M.D.; Norman L. Heminway, M.D; Col. John

A. Isherwood, MC; Maurice M. Kane, M.D.; Col. Paul A. Keeney, MC,

USA (Ret.); Col. Emmett L. Kehoe, MC; Maj. Gen. Albert W. Kenner,

MC, USA (Ret.); Col. William F. Lawrence, MSC; Col. George E. Leone,

MC; Col. John F. Lieberman, MC, USA (Ret.); Gunnar Linner, M.D.;

John R. McBride, M.D.; John C. McSween, M.D.; Col. William C. Munly,

MC, USA (Ret.); Robert Bruce Nye, M.D.; Col. Forrest R. Ostrander, MC,

USA (Ret.); Benjamin M. Primer, M.D.; Col. Matthew C. Pugsley, MC, USA

(Ret.); Maj. Gen. Clement F. St. John, MC; Brig. Gen. Crawford F. Sams,

MC, USA (Ret.) ; Col. John W. Sherwood, MC, USA (Ret.); Charles F.

Shook, M.D.; Maj. Gen. Earle Standlee, MC, USA (Ret.); Maj. Gen. Morrison C. Stayer, MC, USA (Ret.); William S. Stone, M.D.; Col. John H.

Sturgeon, MC, USA (Ret.); Col. E. M. P. Sward, MC, USA (Ret.); Brig.

Gen. Lynn H. Tingay, DC, USA (Ret.); Col. Hall G. Van Vlack, MC, USA

(Ret.); Col. Dean M. Walker, MC, USA (Ret.); and Thomas G. Ward,

M.D. To each of these the author wishes to express his thanks. Without

their considerable help much authenticity would be lacking.

Sections of the volume dealing with strictly military events were checked

by knowledgeable members of the Office of the Chief of Military History

(OCMH) staff, including Martin Blumenson, Ernest F. Fisher, Jr., and

Robert Ross Smith. If the combat narrative lacks at any point in accuracy,

it is through no fault of these conscientious reviewers.

The manuscript was read in its entirety by Dr. Donald O. Wagner,

former Chief Historian, The Historical Unit, U.S. Army Medical Service

(USAMEDS), before his retirement early in 1960; by Col. John Boyd

Coates, Jr., Director of The Historical Unit; and by Dr. Stetson Conn, Chief

Historian, Office of the Chief of Military History. Each of these critics

offered pertinent and valuable suggestions for improvement.

Mr. William K. Daum did much of the research for chapters I and II

and prepared preliminary drafts of both.

For expert and unfailing aid in locating and procuring the thousands

of documentary sources on which the work is based, the author makes

special acknowledgment to Mrs. Josephine P. Kyle, former chief of the

General Reference and Research Branch of The Historical Unit, and to

her assistant, the late Mrs. Eleanor Alfonso, whose cheerful willingness never

faultered despite the constant presence of fatal illness. Mrs. Kyle's successors, Maj. Albert C. Riggs, Jr., MSC, and Mr. Roderick M. Engert, did

not participate until the book had reached the stage of review and final revision, but both were unstinting of their time and expert knowledge.

The author is also indebted to the Medical Statistics Division, Office of

The Surgeon General, and especially to Mr. Carroll I. Leith, Jr.,—himself

a veteran of the Mediterranean campaigns—who verified figures and tabulations, and in many instances proposed better ways of presenting them.

xiv
Preliminary editorial work was done by Mrs. Cyrilla E. Hickey of The

Historical Unit, USAMEDS, and the final publications editing by Miss

Mary Ann Bacon of OCMH. Copy editor for the volume was Mrs. Marion

P. Grimes. The book is undoubtedly the better for having passed through

the capable hands of these three editors. The excellent medical situation

maps that make the text so much easier to follow were prepared by Miss

Elizabeth P Mason, assisted by Miss Jean A. Saffran, both of The Historical

Unit, USAMEDS. The photographs were selected by the author. The

index was compiled by Susan Stevens New.

Washington, D.C. CHARLES M. WILTSE

23 September 1963

Contents

Chapter Page

PROLOGUE: THE GIFT OF LIFE ................................ . 1

I. MEDICAL SERVICE IN THE ATLANTIC DEFENSE AREAS . . 7

The Atlantic Approaches to War .......................... . 7

The North Atlantic Bases ................................. . 10

Bermuda Base Command ................................... . 26

U.S. Army Forces in the Azores ............................. . 29

U.S. Army Forces in Eastern and Central Canada .............. 30

The Caribbean Defense Command .......................... . 34

The South Atlantic Theater ............................... . 46

II. ARMY MEDICAL SERVICE IN AFRICA AND THE MIDDLE

EAST ..................................................... . 56

The Beginnings of Medical Service in the Middle East ......... 56

The Middle East as an Active Theater of Operations, 1942-43 ... 60

The Middle East as a Supply and Service Theater, 1944-45 .... . 80

Medical Supplies and Equipment ............................ . 87

Professional Services ...................................... . 88

Decline of Medical Activities in the Demobilization Period .... . 103

III. CONQUEST OF NORTH AFRICA ........................... . 104

Prelude to Invasion ........................................ 104

Medical Support in the Landing Phase ....................... 108

Medical Support of II Corps in the Tunisia Campaign ......... 121

Evacuation From II Corps ................................. . 137

Medical Supplies and Equipment .......................... . 141

Professional Services ....................................... 142

IV. SICILY AND THE MEDITERRANEAN ISLANDS ............ . 147

Medical Preparations for Operation HUSKY ................. . 147

Medical Support of Seventh Army in the Field ................ 150

Hospitalization and Evacuation ............................. 163

Medical Supplies and Equipment ............................ . 168

Professional Services ...................................... . 170

Medical Support in the Seizure of Sardinia and Corsica ........ 174

xvii
Chapter Page

V. THE NORTH AFRICAN COMMUNICATIONS ZONE 177

Theater Organization ...................................... 177

Hospitalization in the Communications Zone ................. 185

Evacuation in the Communications Zone ..................... 203

Medical Supplies and Equipment .......................... . 207

Professional Services ...................................... . 210

Army Public Health Activities .............................. 219

VI. SALERNO TO THE GUSTAV LINE ... . 222

Medical Plans for AVALANCHE ............................ 223

Medical Support in the Conquest of Southern Italy ............ 226

Hospitalization in the Army Area ........................... 247

Evacuation From Fifth Army ................................ 250

Medical Supplies and Equipment ............................ 251

Professional Services in the Army Area ...................... . 252

VII. ANZIO BEACHHEAD ............. . 26 6

Medical Planning for Operation SHINGLE .................. 266

Combat Medical Service ................................... . 268

Hospitalization on Anzio Beachhead ......................... 275

Evacuation From the Beachhead ............................. 278

Medical Supplies and Equipment ............................ 280

Professional Services on the Beachhead ..................... . 282

VIII. FROM THE GARIGLIANO TO THE ARNO ........ . 289

Preparations for the Offensive ............................... 289

Combat Medical Service ................................... . 291

Hospitalization in the Army Area .......................... . 303

Evacuation From Fifth Army .............................. . 310

Medical Supplies and Equipment .......................... . 312

Professional Services in the Army Area ...................... 314

Medical Support for the Eastern Command ................. . 320

I.. THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN

PHASE ................................................... . 323

Changes in Theater Organization ............................ 323

Hospitalization in the Communications Zone ................ . 327

Evacuation ............................................... . 340

Medical Supplies and Equipment ........................... . 343

Professional Services ...................................... . 350

Army Public Health Activities .............................. 360

X. INVASION OF SOUTHERN FRANCE .......... . 366

Preparations for the Invasion .............................. . 366

Medical Support of Seventh Army in the Field ............... . 374

xviii
Chapter Page

X. INVASION OF SOUTHERN FRANCE-Continued

Hospitalization in the Army Area ........................... . 386

Evacuation From Seventh Army ............................ . 395

Extension of the Communications Zone ................... . . . 399

Medical Supplies and Equipment ........................... . 404

Professional Services in Southern France .................... . . 408

XI. THE NORTHERN APENNINES ........................... . . . 415

Preparations for the Offensive .............................. . 415

Combat Operations ....................................... . 419

Medical Support in the Field ............................ . . . 425

Hospitalization in the Army Area .......................... . 435

Evacuation From Fifth Army .... . ........................ . 445

Medical Supplies and Equipment ............................ 448

Professional Services in the Army Area ....................... 449

XII. ADVANCE TO THE ALPS .................................. . .457

Preparations for the Final Drive ............................. 457

The Po Valley Campaign .................................. . 460

Hospitalization in the Army Area .......................... . 468

Evacuation From Fifth Army .............................. . 479

Medical Supplies and Equipment ........................... . 481

Professional Services in the Army Area ...................... . 482

XIII. THE ITALIAN COMMUNICATIONS ZONE: NORTHERN

PHASE ................................................... . 486

Organizational Changes Affecting the Medical Service .......... 486

Hospitalization in the Communications Zone ................. 489

Evacuation .............................................. . 502

Medical Supplies and Equipment ......................... . . 506

Professional Services ...................................... . 513

Army Civil Public Health Activities ........................ . 519

XIV. CONTRACTION AN D REDEPLOYMENT ........ . 52 1

Redeployment Policies and Plans .......................... . . 521

Medical Support of Fifth Army .............................. 523

Hospitalization and Evacuation ............................ . 528

Hospitalization and Repatriation of Prisoners of War .......... 534

Redeployment and Inactivation of Medical Units ............ . . 543

Close-out in the MTO .................................... . 548

XV. THE MEDITERRANEAN IN RETROSPECT ........ . 552
Appendix Page

A. HOSPITAL STATISTICS .55 9

1. Fixed Beds and Bed Ratios, Atlantic Defense Areas, July

1941-December 1945 ............................... . .559

2. Fixed Beds and Bed Ratios, Africa and the Middle East

(Includes Persian Gulf Command), June 1942-December 1945 ........................................... . 562

3. Bed Strength and Bed Occupancy, North African Communications Zone, November 1942-February 1945 ... . 564

4. Bed Strength and Bed Occupancy, Mediterranean Islands

August 1943-April 1945 ................ . 56 5

5. Bed Strength and Bed Occupancy, Italian Communications

Zone, October 1943-September 1945 .................. . 566

6. Fixed Bed Strength and Bed Occupancy, Mediterranean

Theater, November 1942-September 1945 ............. . 567

B. PRINCIPAL MEDICAL UNITS ACTIVE IN THE MEDITERRANEAN THEATER OF OPERATIONS, THE ATLANTIC

DEFENSE AREAS, AFRICA, AND THE MIDDLE EAST 569

C. OBSERVATIONS ON HOSPITALIZATION AND EVACUATION SYSTEM, FRENCH EXPEDITIONARY CORPS, ASSIGNED FIFTH ARMY ................................ . ... 598

D. THE GERMAN MEDICAL ESTABLISHMENT .............. . 601

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

GLOSSARY ...................................................... . . 624

BASIC MILITARY MAP SYMBOLS ............................... . . 628

INDEX ........................................................... . 633

Tables

No.

1. Hospital Admissions and Dispositions, II Corps, 1 January-15 May

1943 ........................................................ . 136

2. Air Evacuation From Tunisia, 16 January-23 May 1943 ........... . 140

3. Intratheater Evacuation by Air, North Africa, 16 January-23 May 1943. . 205

4. U.S. Army Patients Evacuated by Sea From North Africa to the Zone

of Interior, 1943 ............................................ . 207

5. Hospital Admissions From Fifth Army, 9 September 1943-30 April

1944 ........................................................ . 250

xx
No. Page

6. Disposition of Neuropsychiatric Cases in Fifth Army, September 1943-

April 1944 ............................................... . ... . 25 6

7. Venereal Disease Rate per Thousand per Annum, by Divisions, September 1943-April 1944 ....................................... . 259

8. Disposition of Patients, Fifth Army Venereal Disease Diagnostic and

Treatment Center, January-April 1944 ......................... . 259

9. Dental Service in Fifth Army, September 1943-April 1944 ........... . 264

10. Disposition of Problem Cases in the 3d Division, 4 March-30 April

1944 ........................................................ . 285

11. Admissions to Hospital and Quarters From Fifth Army, May-August

1944 ........................................................ . 310

12. Air Evacuation From Fifth Army Hospitals, 26 May-31 August 1944 ... 311

13. Evacuation From Fifth Army to PBS Hospitals, 1 January—31 August

1944 ........................................................ . 312

14. Disposition of Neuropsychiatric Cases in Fifth Army, May—August

1944 ........................................................ . 316

15. Venereal Disease Rates by Divisions, Fifth Army, May—August 1944 ... . 317

16. Dental Service in Fifth Army, May-August 1944 ................... . 319

17. Admissions to PBS Hospitals, 14 October 1943-31 August 1944 ....... . 338

18. Disposition of Patients in PBS Hospitals, 14 October 1943-31 August

1944 ........................................................ . 338

19. Evacuation From Italy to North Africa, 9 September 1943-21 January

1944 ........................................................ . 343

20. Evacuation From Italy to North Africa, January-August 1944 ....... . 344

21. Evacuation From the Mediterranean to the Zone of Interior, JanuaryAugust 1944 .................................................. . 344

22. Venereal Disease Rates, NATOUSA, January-August 1944 .......... . 354

23. Admissions and Dispositions, Seventh Army Medical Installations, 15-

18 August 1944 ............................................... . 381

24. Admissions and Dispositions, Seventh Army Medical Installations, 15

August-29 September 1944 .................................... . 394

25. Air Evacuation From Seventh Army and Delta Base Section, 22 August-7 November 1944 ........................................ . 398

26. Summary of Evacuation to the Communications Zone, 15 August3 November 1944 ........................................... . 400

27. Establishment in Southern France of Fixed Hospitals From North

Africa, Italy, and Corsica ..................................... . 401

28. Requisitions and Tonnage, 7th Medical Depot Company, AugustNovember 1944 .............................................. . 406

29. Receipts and Issues, 231st Medical Composite Battalion, SeptemberNovember 1944 .............................................. . 408

30. Venereal Disease Rates, Seventh Army, July-September 1944 ........ . 411

xxi
No. Page

31. Disposition of Neuropsychiatric Cases, Fifth Army, September 1944-

March 1945 .............................................. . ... . 45 2

32. Dental Service in Fifth Army, September 1944-March 1945 .......... . 454

33. Wounded in Action in the Po Valley Campaign, Fifth Army, 1 April15 May 1945 .............................................. . 468

34. Evacuation From MTOUSA to the Zone of Interior, September 1944-

April 1945 .................. . 50 5

35. Evacuation of Brazilian Patients to Brazil, September 1944-April 1945 . . 506

36. Medical Supplies on Hand in PBS Depots, September 1944-April 1945 .. 512

37. Noneffective Rates per Thousand of Troop Strength per Annum, September 1944-April 1945 ...................................... . 515

38. Intratheater Evacuation: U.S. and Allied Personnel, May-September

1945 ........................................................ . 531

39. Evacuation From MTOUSA to the Zone of Interior, May-December

1945 .............................................. . ........ . 53 3

Maps

1. U.S. Army Hospitals Supporting North Atlantic Bases, 1 June 1943. . 13

2. U.S. Army Hospitals in the Caribbean ............................ . 36

3. U.S. Army Hospitals Supporting South Atlantic Bases, 1943-45 ...... . 48

4. U.S. Army Hospitals in USAFIME, 1 July 1943 .................... . 69

5. U.S. Army Hospitals in the Persian Gulf Service Command, 1 July

1943 ........................................................ . 75.

6. Medical Support of Eastern Task Force ............................ . 109

7. Medical Support of Center Task Force ............................ . 112

8. Medical Support of Western Task Force ........................... . 116

9. II Corps Medical Installations, 14 February 1943 ................... . 125

10. II Corps Medical Installations, 24 February 1943 ................... . 128

11. II Corps Medical Installations, 11 April 1943 ...................... . 130

12. II Corps Medical Installations, 23 April 1943 ...................... . 133

13. II Corps Medical Installations, 12 May 1943 ...................... . 135

14. Seventh Army Hospitals, 16 July 1943 ............................. . 154

15. Seventh Army Hospitals, 26 July 1943 ............................. . 158

16. Seventh Army Hospitals, 5 August 1943 ......................... . 160

17. Seventh Army Hospitals, 15 August 1943 ........................... . 161

18. Fixed Hospitals and Base Medical Supply Depots in North Africa,

November 1942-February 1945 ................................ . 184

19. Fixed Hospitals and Base Medical Supply Depots on Sicily, August

1943-July 1944 .............................................. . 198

xxii
No. Page

20. Fixed Hospitals and Base Medical Supply Depots on Sardinia and

Corsica, November 1943-May 1945 ................ . 20 0

21. Fifth Army Hospitals and Medical Supply Dumps, 9 October 1943 ... . 232

22. Fifth Army Hospitals and Medical Supply Dumps, 15 November 1943. . 236

23. Fifth Army Hospitals and Medical Supply Dumps, 15 February 1944 . . 242

24. Anzio Beachhead and Surrounding Areas .......................... . 269

25. Fifth Army Hospitals and Medical Supply Dumps on the Cassino

Front, 11 May 1944 .............................. . 290

26. Fifth Army Hospitals and Medical Supply Dumps, 10 June 1944 ..... . 305

27. Fifth Army Hospitals and Medical Supply Dumps, 15 July 1944 ..... . 308

28. Fifth Army Hospitals and Medical Supply Dumps, 15 August 1944 .... . 309

29. Fixed Hospitals in Southern Italy, October 1943-October 1947 ...... . 330

30. Seventh Army Hospitals and Medical Supply Dumps, 20 August 1944. . 378

31. Seventh Army Hospitals and Medical Supply Dumps, 1 September

1944 ........................................................ . 389

32. Seventh Army Hospitals and Medical Supply Dumps, 15 September

1944 ..................................................... . 39 0

33. Seventh Army Hospitals and Medical Supply Dumps, 30 September

1944 ...................................................... . 391

34. Fixed Hospitals Transferred From MTO to ETO, 20 November 1944. . 403

35. Fifth Army Hospitals and Medical Supply Dumps, 18 September 1944. . 436

36. Fifth Army Hospitals and Medical Supply Dumps Supporting II

Corps, 25 October 1944 ........................................ . 438

37. Fifth Army Hospitals and Medical Supply Dumps on the IV Corps

and 92d Division Fronts, 15 January 1945 ....................... . 441

38. Fifth Army Hospitals and Medical Supply Dumps on the II Corps

Front, 15 January 1945 ....................................... . 443

39. Hospitals and Medical Supply Dumps Supporting the Fifth Army

Offensive, 18 April 1945 ...................................... . 470

40. Fifth Army Hospitals and Medical Supply Dumps, 26 April 1945 ..... . 472

41. Fifth Army Hospitals and Medical Supply Dumps, 2 May 1945 ....... . 474

42. Fixed Hospitals in Northern Italy, July 1944-October 1947 .......... . 492

43. Medical Installations Supporting Fifth Army, 1 June 1945 ........... . 524

Illustrations

. . . the Unsung Heroes of the War ............................... . .Frontispiece

Lt. Col. Charles H. Beasley .......................................... . 11

167th Station Hospital, Iceland ......................... . ........... . 14

BLUIE WEST 1, Greenland ........................................... . 20

308th Station Hospital, Fort Pepperrell, Newfoundland ................. . 24

xxiii
Page

Convalescent Patients, Bermuda ...................................... . 27

Col. Gordon G. Bulla ............................................... . 34

Brig. Gen. Morrison C. Stayer ....................................... . 35

Air Evacuation, Panama .......................................... . 40

Col. George E. Leone ............................................... . 46

Malaria Control Unit, Brazil ......................................... . 52

Col. Crawford F. Sams .............................................. . 58

Col. Hall G. Van Vlack ............................................. . 59

DC-3 Over Pyramids ............................................. . 61

King George of Greece at 38th General Hospital, Heliopolis ............. . 70

Hospital Train, Benghasi Area ....................................... . 71

Partially Dug-In Hospital Tents Near Tripoli ......................... . 72

113th General Hospital at Ahwaz, Iran ................................ . 74

167th Station Hospital at Accra, Gold Coast ........................... . 78

Loading a Patient by Fork Lift, Casablanca ........................... . 85

Brig. Gen. Leon A. Fox ............................................. . 96

Dental Clinic at Khorramshahr, Iran .................................. . 101

Brig. Gen. Albert W. Kenner and General George C. Marshall ............ . 106

Col. Richard T. Arnest .............................................. . 107

Nurses Arriving in Arzew, Algeria .................................... . 114

Soldier Being Evacuated at Fedala, French Morocco ..................... . 118

Camouflaged Aid Station, Algeria .................................... . 126

Mobile Surgical Truck, Tunisia ...................................... . 131

Wrecked Ambulance, Tunisia ........................................ . 137

2d Lt. Aleda E. Lutz in Converted C-47 .............................. . 141

Medical Supplies on Beach, Algeria .................................. . 143

Lt. Gen. George S. Patton, Jr., and Brig. Gen. Theodore Roosevelt, Jr. .... . 148

Col. Daniel Franklin ................................................ . 150

Col. L. Holmes Ginn, Jr. ............................................ . 151

Evacuating Wounded to Landing Craft, Sicily ......................... . 156

Administering Plasma, Sicily ........................................ . 163

Evacuation by Muleback ............................................ . 164

Holding Hospital, Termini Airfield, Sicily ............................ . 166

Forward Surgical Unit, Sicily ........................................ . 171

Pack Train in Sicily ................................................ . 175

Maj. Gen. Ernest M. Cowell ......................................... . 178

Brig. Gen. Frederick A. Blesse ........................................ . 180

6th General Hospital, Casablanca .................................... . 187

26th General Hospital Near Constantine, Algeria ...................... . 191

Aerial View of Hospital Groupment, Algeria ........................... . 195

Prison Stockade of the 180th Station Hospital Near Oran ............... . 203

Interior View of Hospital Train ...................................... . 207

Col. William S. Stone ............................................... . 211

xxiv
Page

Malaria Control Measures Near Algiers ............................... . 212

Brig. Gen. Joseph I. Martin .......................................... . 224

Litter Bearers Wading to Landing Craft, Salerno ...................... . 228

Planners of the Invasion of Italy ..................................... . 229

Medics Treating Italian Girl, Volturno Area .......................... . 234

Rough Going ...................................................... . 23 5

Digging Out Wounded Man, Cassino ................................. . 241

Casualties From Rapido Crossing ..................................... . 246

Aid Station in Sant'Elia Area ........................................ . 247

Wounded German Soldier at 94th Evacuation Hospital ................. . 254

Treating Moroccan Mountain Troops, Venafro Area ................... . 261

Col. Rollin L. Bauchspies . ........................................ . 267

Evacuation of Wounded, Anzio ...................................... . 272

Pfc. Lloyd C. Hawks ...................................... . 274

Hospital Area, Anzio ............................................... . 276

Brig. Gen. Frederick A. Blesse Congratulating Col. Henry S. Blesse ....... . 278

Anzio Hospitals Digging In .......................................... . 280

Protecting Operating Tents, Anzio .................................... . 281

56th Evacuation Hospital After Bombing ............................. . 283

Treating Casualty at Forward Aid Station ............................. . 293

Italian Civilians Help Carry Casualty Down Mountain ............. . 294

Half-Track Ambulance .............................................. . 297

German POW Giving First Aid .................................... . 298

Wheeled Litter .............................................. . 300

Administering Plasma in Jeep Ambulance .......................... . 301

Institute of the Good Shepherd, Rome ................................ . 306

Ambulance Plane, Nettuno Airstrip .................................. . 313

Field Unit of Dental Clinic .......................................... . 318

Col. Charles F. Shook ............................................ . 324

Medical Section of NATOUSA at Caserta, 26 July 1944 ................ . 325

Medical Center at Mostra Fairgrounds ................................ . 328

Repatriating Wounded German POW's .............................. . 341

41st Hospital Train ................................................. . 345

Storing Medical Supplies ............................................ . 348

Blood Donors, Naples ............................................... . 353

Dusting for Mosquitoes, Cassino ...................................... . 356

Brig. Gen. Edgar Erskine Hume ....... . ............................. . 361

Delousing Station, Naples ........................................... . 364

Lt. Gen. Alexander M. Patch and Col. Frank B. Berry ................... . 368

Lt. Col. Robert Goldson, Col. Myron R. Rudolph, and Col. Joseph Rich ... 370

Medics on Beach, Southern France ................................... . 380

Ambulance in Wrecked Village ...................................... . 383

Jeep Ambulance Crossing the Moselle ................................. . 385
Page

Evacuating Wounded, Southern France Beaches ....................... . 396

Evacuating; Southern France Casualties by Sea ......................... . 399

Last Stages of Whole Blood Pipeline .................................. . 410

General Martin Receiving OBE From Gen. Sir Harold R. L. G. Alexander. . 416

Collecting Point, Mt. Altuzzo ........................................ . 420

317th Medical Battalion Collecting Station ............................ . 431

Aid Station on Mt. Belvedere ........................................ . 433

Tramway, Mt. Mancinello-Pizzo di Campiano Ridge ................... . 434

38th Evacuation Hospital Flooded .................................... . 439

Brazilian Nurses ................................................... . 442

8th Evacuation Hospital, Pietramala .................................. . 445

Ambulance on Icy Road ............................................. . 446

Treating a Wounded Mule .......................................... . 455

Lt. Gens. Mark W. Clark and Lucian K. Truscott, Jr. ................ . 459

"Ohio Ridge" .................................................. . 464

Medics Evacuating Wounded by Jeep ................................ . 465

Medics at Pianoro .................................................. . 467

German Receiving Plasma ........................................... . 476

German Clearing Station ........................................... . 477

Lake Garda ........................................................ . 479

Ambulances Fording Reno River ..................................... . 481

Maj. Gen. Morrison C. Stayer ........................................ . 487

12th General Hospital, Leghorn ...................................... . 494

70th General Hospital, Pistoia ....................................... . 495

Italian Partisans at Bari ............................................ . 497

37th General Hospital on the Move .................................. . 500

Loading Patients, Leghorn .......................................... . 503

Storage Area, Leghorn .............................................. . 508

Captured Horse at Veterinary Hospital ................................ . 518

Col. Charles O. Bruce .............................. . 526

7029th Station Hospital (Italian) at Pisa ............................. . 534

German Medical Center in the Alps .................................. . 536

Hotel-Hospital at Merano ........................................... . 537

German POW Ward Tents, Ghedi ......................... . 539

POW Ward, Aversa ................................ . 540

Readying Medical Supplies for the Southwest Pacific .................... . 547

Col. Earle Standlee ................................................ . .548

All photographs are from the Department of Defense files except the

Frontispiece, which is an adaptation of a painting by Joseph Hirsch in the Abbott

Collection and was drawn especially for this volume by Esther E. Rohlader.
MEDICAL SERVICE IN THE

MEDITERRANEAN

AND MINOR THEATERS

PROLOGUE

The Gift of Life

The soldier struck down on the field

of battle, if his wounds are more than

superficial, may count his life expectancy

in hours, or even minutes, unless he receives prompt medical aid. To give him

that succor, and with it the gift of life,

is the responsibility of the Army Medical Service, still called in World War II

the Medical Department. Most of those

whose wounds are not immediately mortal may be saved if the flow of blood is

quickly stanched, the onset of infection

halted, the effects of shock minimized,

and, above all, if the casualty is speedily

but gently moved to a place of safety

where needful surgery can be performed.

These "ifs" are many, but all of them

fall within the medical mission. Each has

its place in one of the most smoothly

functioning organizations ever devised.

So well did the Medical Department do

its work in the Mediterranean theater

that the chances of surviving battle

wounds were 27 to 1: of 112,000

wounded, only 4,000 died.1

The cry "Medic!" uttered by a

wounded man, or by a fellow soldier

who has paused long enough to mark

the spot, sets the machinery in motion

and begins the chain of evacuation, officially defined as "the entire group of

successive installations engaged in the

collection, transportation, and hospitalization of the sick and wounded." If the

casualty is conscious and has some mobility, he may help himself with antiseptics from his own first aid packet, or

perhaps a tourniquet fashioned of a

handkerchief or of a strip torn from his

clothing. If he cannot help himself, and

the tide of battle leaves no one else

nearby, he waits. It will not be for long.

A company aidman will soon be there,

guided by voice, by some conspicuous

marker such as a rifle stuck upright in

the ground or a helmet hung from a low

branch, or by instinct sharpened through

months of combat. To illustrate the

process, let us assume a case in which

the wound is abdominal and severe, and

let us say that the wounded man has

applied sulfanilamide crystals and a

dressing before consciousness begins to

fade.

The wounded soldier will probably

be found in ten to thirty minutes, depending on the movement of the battle,

the number of wounded, the nature of

1

 These figures do not include 35,000 killed in

action, 20,000 taken prisoner, nor some 9,000

missing. All of these, by definition, were "battle

casualties," but did not come within the purview

of the Medical Department.
2 MEDITERRANEAN AND MINOR THEATERS

the terrain, and similar factors. The aidman (there were normally two such men

attached to each infantry company in

World War II) is trained as a surgical

technician. He has earned by repeated

demonstrations of selflessness and endurance the respect he receives from his

fellow soldiers. His mere presence in the

company is a morale builder, because

the men know that as long as "Doc" is

there, they will not be left to die on the

battlefield.

In this hypothetical case, a quick

check is enough to tell the aidman the

casualty is in shock. He calls at once for

one of the four-man litter squads already

moving out from the battalion aid station some 500-800 yards to the rear,

where water and a measure of natural

protection are available. Although he

carries morphine, he will not use it

because the casualty is unconscious. If it

is toward the latter part of the Italian

campaign, however, he will have plasma

with him, which he begins to administer without delay. When the needle is

taped in place and the flask suspended,

perhaps from the same rifle butt that

guided him to the spot, the aidman will

check the wound, replacing the dressing

if it seems necessary, and perhaps adding

tape to make transportation easier. He

then fills out an Emergency Medical Tag

(EMT), copying the man's name and

serial number from his dog tag, and indicating the nature of the wound, the

approximate time it was inflicted, and

the treatment so far given. The EMT is

conspicuously attached to the patient

and will go with him along the whole

chain of evacuation.

By this time the litter bearers have

reached the scene. The litter bearers,

along with the aidmen, are the unsung

heroes of the war. They have no weapons

save strength, courage, and dedication

beyond the call of duty; they have no

protection save a steel helmet painted

front and back with the red cross, and

a red cross brassard on the sleeve; yet

they move among fighting men and

whining shells on the battlefield, concerned only for the safety and comfort

of the man they lift so carefully onto a

litter and carry so gently, avoiding any

unnecessary jar or change of angle, back

to a place of relative security—for the

casualty but not for them. They will

return at once to the battlefield.

At the battalion aid station, the

wounded man will be examined for the

first time by a medical officer, generally

the battalion surgeon. Perhaps an hour

has now passed since the wound was

inflicted. The man is still alive, thanks

to the plasma given him on the field, but

he will not be for long without extensive

surgery. If the battle is strongly contested—and what battle was not, in that

"forgotten theater"?—there will be many

casualties at the aid station, brought in

from the various companies of the battalion by the four litter-bearer squads

available or walking if their injuries

permit that luxury. Let us assume that

the case we are following is the most

serious, and so receives the immediate

attention of the battalion surgeon. In

this late stage of the war, the other officer at the aid station will be nonmedical, generally Medical Administrative

Corps, whose duties will include first

aid, but will be primarily to keep the

wounded moving—to hospitals farther

to the rear if hospitalization is indicated,

or back to the front with a bandage if

the wound is slight. Manpower is never

so plentiful that it can be dissipated by
PROLOGUE: THE GIFT OF LIFE 3

evacuating men still able-bodied. In addition to the litter bearers, there will

be a group of enlisted technicians, who

will change dressings, administer drugs,

keep records, and perform such other

duties as may be required.

There is nothing rigid about the field

medical service. Improvisation and adaptation were the rule in World War II

as they are today. There is a job to be

done, and quickly, with whatever means

are at hand. The job, in the case we are

considering, is to get a man to surgery

with the least possible delay consistent

with keeping him alive. The battalion

surgeon will probably not change the

dressings the company aidman has applied, but will administer more plasma

and perhaps morphine if the man shows

signs of returning consciousness. The

wound will be immobilized so far as its

location permits to minimize the shock

of further transportation, additional entries will be made on the EMT, and the

patient will be speeded on the next

stage of his journey. His destination now

will be the clearing station of his division, located five to ten miles behind

the front, and the field hospital set up

adjacent to it specifically for forward

surgery. When he leaves the battalion

aid station he will pass from first to second echelon medical service—from regimental to divisional control.

Before we move on to the division

clearing station with our hypothetical

casualty, some further explanation may

be in order. In the Mediterranean, as in

other overseas theaters in World War II,

each division was served by two different

bodies of medical troops. Up to this

point we have been dealing with personnel of the medical detachment,

headed by the division surgeon. In the

medical detachment of an infantry division toward the end of 1944 there were

32 officers, including dental and administrative as well as medical, and 383 enlisted men. Each regiment and each

battalion had its medical section under

a medical officer, with enlisted technicians attached as aidmen at the company

level. In addition to the medical detachment, each division had an organic

medical battalion, organized into a headquarters, three collecting companies, and

a clearing company. The collecting companies, generally attached one to each

regiment of the division, were basically

ambulance and litter-bearer units. The

clearing company, on the other hand,

was equipped to function as a small—

and sometimes not so small—hospital; or

rather, two hospitals, for its two platoons

were always prepared to set up independently. The usual procedure was to

have one platoon in operation, the other

packed and ready to "leapfrog" forward

as the line of battle advanced. Between

the clearing station and the battalion aid

stations there might or might not be a

collecting station, set up by the appropriate collecting company. In Italy,

where the roads were relatively good and

rugged country offered protection for

clearing stations close to the front, the

intermediate step was often bypassed.

Ambulances, or jeeps fitted with litter

racks, picked up casualties at the battalion aid stations, or if these were not

accessible to vehicles, at ambulance loading posts within reasonable litter carry

of the aid stations. If a collecting station

were established, it would be located to

serve two aid stations, or three if all the

battalions of the regiment were engaged.

At the clearing station patients were

again sorted—the French term triage is
4 MEDITERRANEAN AND MINOR THEATERS

still used in the medical service to refer

to this process—so that those whose

wounds were critical might be cared for

first; so that specialized needs would be

referred to specialized skills; and as at

the aid station, so that no man would be

sent farther to the rear than his bodily

condition required. Here there would

be medical cases as well as battle wounds

and injuries, for the clearing station was

in effect the most forward hospital serving the division and therefore the most

accessible from the front lines, where

disease might claim as many victims as

bullets. The system that developed in

the Mediterranean about the middle of

1943 was to set up as close as possible to

each division clearing station a platoon

of a field hospital to receive those casualties in need of immediate surgery. The

field hospital itself was a versatile new

unit, capable of operating as a single

400-bed hospital, or as three separate

100-bed hospitals. When split three ways

the surgical staff was wholly inadequate,

but the deficiencies were made up by

attaching teams from an auxiliary surgical group, some general, some specialized, but each a fully functioning unit

with its own equipment as well as its

own personnel.

Now let us get back to the casualty

whose progress we are following along

the chain of evacuation. He is picked up

at the battalion aid station by a squad

of litter bearers from the collecting company, sent forward from an ambulance

loading post that might be only 300 or

400 yards away as the crow flies, but half

to three-quarters of a mile by the narrow, winding trail that must be used.

The tedious and difficult hand carry

once completed, he will be delivered at

the clearing station along with other

wounded men of his regiment in a matter of minutes. It is now two hours or

more since he received his wound, but

he is still alive and his chances are now

good, for he is only moments away from

the finest in surgical skill and facilities.

The field hospital to which he is immediately carried is a tent with packed

earth floor, heated if necessary by oil

stoves and lighted by generator-driven

electric lamps. In physical appearance it

is not at all like the fine modern hospitals at home, but in its equipment and

in the skill and motivation of the two

surgeons, anesthetist, and surgical nurse

who with two enlisted technicians make

up a surgical team, it is as good or

better.

From the field hospital rearward progress is relatively standardized. The patient will be retained until he is strong

enough to be moved without damagepossibly as much as a week. If the front

advances significantly in that time, another field hospital platoon will set up

adjacent to the new site of the division

clearing station, leaving the old hospital

or a detachment from it to operate

where it is until all its patients are transportable. Our casualty, along with other

holdovers, will next be moved to an

evacuation hospital, still in the combat

zone, in all probability still under canvas, but considerably farther to the rear.

These units in World War II Tables of

Organization were of two types: a 400-

bed hospital that could be moved quickly in two installments with its own

organic transportation, and a 750-bed

hospital in which mobility was sacrificed

for somewhat more complete facilities.

Ideally one 400-bed "evac" backed up

each division, some eight to twelve miles

behind the clearing station, with one of
PROLOGUE: THE GIFT OF LIFE 5

the larger units supporting two divisions.

Both types of evacuation hospital were

prepared to give definitive treatment to

all casualties. They were staffed and

equipped, that is, to do whatever might

be necessary for the recovery of the patient. The primary difference between

these hospitals and the so-called "fixed"

hospitals of the communications zone

was their proximity to the front lines.

For that very reason, however, they

could not hold patients for any great

length of time. As a rule only those who

could be returned to duty within a week

or two or, alternatively, passed on to a

convalescent hospital, were retained.

The convalescent hospital was another

combat zone unit, where the man no

longer in need of constant medical or

surgical care but not yet strong enough

to fight could regain his vigor. It conserved both professional and combat

manpower by operating with a low ratio

of medical officers to beds, and by retaining in the army area men whose

services might otherwise have been lost

indefinitely in the complex machinery

of the replacement center. Those whose

treatment would require a longer period

of time were transferred to the communications zone. The particular casualty whose treatment and evacuation

we are discussing will be one of these.

Had he been less severely wounded

his injuries would have been dressed

and rebandaged at the clearing station

and he would have been moved to an

evacuation hospital for surgery. As it is,

he will be a transient at the evac, on his

way to the communications zone. When

he moves from the field hospital unit to

the evacuation hospital he will pass from

division to army control, at the same

time entering the third echelon in the

chain of evacuation. He will be brought

to the evac by an ambulance of a collecting company, but this time it will

be a company of a medical battalion

(separate) —not organic to any formation, but in this case assigned to army

and under control of the army surgeon.

The next stage of his journey, which will

bring him into the fourth echelon of the

chain, will be in all probability too long

for an ambulance run.

After a day or two at the evacuation

hospital, with a fresh dressing on his

wound and a new entry on his Emergency Medical Tag, our casualty will

be moved by ambulance to a nearby

railhead, port, or airstrip to continue

rearward by whichever mode of transport is most convenient to the location.

In Italy, except for Anzio where all

transportation was by water, it would

have been by hospital train, or by C-47

cargo plane rigged with litter racks to

hold 18 or 20 nonambulatory patients

and staffed by personnel of a medical

air evacuation transport squadron.

Either way, responsibility and control

would have rested with the communications zone, most likely in the Mediterranean with a base section. This

particular casualty will require further,

probably extensive, surgery before his

damaged organs are restored to relatively normal use, so that a general hospital

is indicated.

The numbered general hospital overseas (as distinct from the named general

hospital in the zone of interior), singly

or in a grouping or center, enjoys the

relative safety of the communications

zone. It had in World War II 1,000 to

2,000 beds, with many specialties represented on its staff and equipment adequate for almost any situation it might
6 MEDITERRANEAN AND MINOR THEATERS

be called upon to meet. A less difficult

case than the one we are following might

go to a station hospital, which would

perform most of the functions of a general hospital—indeed might be acting as

a general hospital—but would be smaller,

with fewer specialists and less complete

equipment. The World War II station

hospital had anywhere from 25 to 900

beds; in the Mediterranean most were

500 beds. The station hospital normally

serves a post or garrison, referring its

more serious cases to a general hospital,

but in a theater of operations requirements dictate use. In the Mediterranean

the station hospital in practice was often

indistinguishable from the general hospital, although a larger proportion of its

patients were apt to be service or other

rear echelon troops. In both types medical cases usually outnumbered surgical.

In the general hospital our casualty

might have another, more leisurely, operation, but this will depend on the

probable length of his stay, which will

be determined by the theater evacuation

policy and by the judgment of the medical officers on his case. An evacuation

policy establishes the number of days

of hospitalization the theater medical

authorities feel they can give to any one

case. The policy in the Mediterranean

Theater varied from 30 to 120 days, but

for most of the time it was 90. This

meant that if a patient admitted to a

communications zone hospital would in

the opinion of his doctors be fit for duty

in 90 days or less he would be retained

and treated, being returned to his unit

or sent to a replacement center when he

was recovered. If, on the other hand, the

chances of his recovery within that time

were remote or nonexistent, he would

be sent to the zone of interior as soon as

he could safely be moved so great a distance. It is clearly to the advantage of a

theater to have as long an evacuation

policy as possible, because the longer the

policy the more sick and wounded will

be kept in the theater for future combat

operations. It is the availability of beds

and of trained personnel in relation to

the incidence of battle wounds, injuries,

and disease that determines the policy.

Full recovery, in the case we are following, will take months or possibly

years of prolonged and specialized treatment. The patient will therefore not

stay long at the general hospital, but will

be sent home to the United States as

quickly as possible. When he boards

hospital ship or plane, according to the

availability of transportation and the

urgency of his case, he will enter the

fifth and final echelon of the chain of

evacuation. Thus it may well be that

two weeks after being severely wounded

in the mountains of northern Italy, this

particular soldier will be admitted to

Walter Reed Army Hospital in Washington, or to one of the other named

general hospitals that may be closer to

his home. There he will remain until

cured, or until everything that can be

done for him has been done. If his doctors believe he is still in need of medical

attention, he will be transferred to a

Veterans' Administration hospital. He

is perhaps not quite as whole as he was,

but he is alive and capable of useful

citizenship. That gift of life he owes to

the dedication and skill of the men and

women who make up the medical service of the U.S. Army.
CHAPTER I

Medical Service in the Atlantic

Defense Areas

The war against Germany, which began for United States ground forces with

the invasion of North Africa on 8 November 1942, could never have been

won if the Atlantic approaches had not

first been secured. Although less spectacular than combat operations, the

establishment and defense of sea and air

routes to Europe, Africa, and the Middle

East were no less essential to the final

victory. The few permanent installations

in the Panama Canal Zone and Puerto

Rico were supplemented in the early

years of the war by new bases stretching

from the Arctic Circle to the Equator

and from central Canada to the Azores.1

The area involved is tremendous, and

the diversity of climate and socioeconomic conditions great. Each base where

Army troops served had its own special

problems, but there was a common pattern. Together, the bases formed a screen

of defensive outposts. They were also

land links in three major transatlantic

air routes, and some had additional

strategic value as jumping-off points for

future operations.2

The Atlantic Approaches

to War

Establishment of Atlantic Bases

The German conquest of France in

May 1940, with its immediate threat to

Great Britain, stimulated the formulation in the United States of detailed

plans for a dynamic defense of the Western Hemisphere that would include outposts far from the shores of the American

1

 This account excludes Alaska, Hawaii, and

western Canada, which are treated in connection

with the war against Japan. 2

 There is pertinent background material in the

following volumes of UNITED STATES ARMY IN

WORLD WAR II: (1) Mark Skinner Watson, Chief

of Staff: Prewar Plans and Preparations (Washington, 1950); (2) Kent Roberts Greenfield, Robert R.

Palmer, and Bell I. Wiley, The Organization of

Ground Combat Troops (Washington, 1947); (3)

Ray S. Cline, Washington Command Post: The Operations Division (Washington, 1951); (4) Maurice

Matloff and Edwin M. Snell, Strategic Planning for

Coalition Warfare, 1941-1942 (Washington, 1953);

(5) Stetson Conn and Byron Fairchild, The Framework of Hemisphere Defense (Washington, 1960);

(6) Stetson Conn, Rose C. Engelman, and Byron

Fairchild, Guarding the United States and Its Outposts (Washington, 1963). Also valuable for background are: (7) Samuel Eliot Morison, "History of

United States Naval Operations in World War II,"

vol. I, The Battle of the Atlantic, September 1939-

May 1943 (Boston: Little, Brown and Company,

1947); and (8) the following volumes from "The

Army Air Forces in World War II," edited by

Wesley Frank Craven and James Lea Cate, and

published by the University of Chicago Press: vol. I,

Plans and Early Preparations: January 1939 to

August 1942 (1948), vol. II, Europe: TORCH to

POINTBLANK, August 1942 to December 1943

(1949), and vol. VII, Services Around the World

(1958).
8 MEDITERRANEAN AND MINOR THEATERS

continents. The swiftly moving events

of the summer culminated on 2 September in a U.S.-British agreement to exchange fifty overage U.S. destroyers for

bases on British soil in the Caribbean

and the Atlantic. The agreement covered Army, Navy, and Air Corps bases

in the Bahamas, Jamaica, Antigua, St.

Lucia, Trinidad, and British Guiana on

99-year lease. At the same time the right

to establish U.S. bases in Newfoundland

(then a crown colony) and in Bermuda

was granted as a gift. Early in 1942 the

British Government also authorized

establishment of an American air base

on Ascension Island, between Brazil and

Africa. Studies of possible sites began in

the fall of 1940 and early the next year

American troops began moving into

some of the new bases.

In mid-1941 American forces began

relief of the British garrison in Iceland,

after diplomatic arrangements with the

Icelandic Government. A similar movement of U.S. forces into Greenland was

authorized by the Danish minister in

Washington, D.C., who functioned with

his staff as a government in exile after

the absorption of his country by the

Nazis. Agreements with representatives

of the Dutch Government led to American relief of British troops on Aruba

and Curaçao Islands, Netherlands West

Indies, and to an American occupation

of Surinam. The establishment of air

routes across both the North and the

South Atlantic led to stationing considerable numbers of Army Air Corps and

other service personnel in central and

eastern Canada, and in Brazil.

During the period before American

entry into the war, U.S. Army strength

was built up in Panama and Puerto

Rico, and the number of troops in the

newly acquired bases also increased

rapidly. An Axis attack across the South

Atlantic against Brazil was regarded by

both the Army and the Navy as a distinct possibility, whereas a Japanese

attack on Pearl Harbor was thought to

be less likely because of the presence of

the Pacific Fleet. When the less likely

attack came on 7 December 1941, attention shifted abruptly to the Pacific, and

estimates of Army strength necessary to

maintain the security of the Atlantic

were revised in the light of the new

conditions. Expansion continued, but at

a relatively slower pace. Nevertheless,

by December 1942 there were 175,000

U.S. troops in the defensive bases along

the eastern coasts of North and South

America and on the islands linking the

Western Hemisphere to Europe and

Africa. This figure exceeded the American strength in the United Kingdom

at that time, and was half of the U.S.

Army strength in the Pacific, where actual combat had been in progress for a

year. Troop strength in some areas began to decline while others were still

building, so that the over-all figure never

was much above that at the end of 1942.

The peak month was May 1942, when

181,867 U.S. soldiers garrisoned the Atlantic bases.

These bases were set up as semitactical

organizations, with enough ground combat troops in most instances to hold off

a hostile landing force until help could

be sent. Engineer troops were usually

present in considerable numbers in the

early stages of occupation, giving way

to Air Forces units, mostly Air Transport Command (ATC) personnel, when

the construction work was finished.

Naval forces were also stationed at many

of the bases. Administratively, the new
THE ATLANTIC DEFENSE AREAS 9

bases in the Caribbean were brought

under the pre-existing military departments having jurisdiction over Puerto

Rico and the Panama Canal Zone. In

Brazil a theater-type organization was

set up to supersede control by the Air

Transport Command. In the North Atlantic, however, the various major bases

were established as independent commands and were only brought together

under the Eastern Defense Command in

the middle of 1944. All of the North

Atlantic bases ultimately passed to control of the Air Transport Command.

Medical Service in the Atlantic Bases

In Puerto Rico and the Panama Canal

Zone, medical facilities were part of the

Army's peacetime establishment. Wartime needs were met primarily by expansion of units, just as they were in

the zone of interior. In the new bases,

however, all medical facilities had to be

sent in. For the most part, buildings

were constructed by the Corps of Engineers, whose troops generally preceded

both ground and air personnel. Indeed,

the engineers often supplied medical

service as well as buildings for a time

after the combat troops arrived. To care

for thousands of civilian workers on its

various airfield and other projects at the

new bases, the engineers had been forced

to establish a medical service of their

own. Directing it for the eastern division

was Col. (later Brig. Gen.) Leon A. Fox.

Usually by the time ground troops arrived at a base, the engineers had in

operation an infirmary or small hospital,

which served until Medical Department

units could be unpacked and housed.3

The Air Transport Command similarly had its own medical service, which at

some bases co-existed with the Army

medical service, and at others merged

with it. Where command of the base itself passed to the ATC after the war,

Army medical facilities and installations

were transferred to the new jurisdiction.

Bed requirements for the new bases

were computed on the same 5-percent

ratio used for hospitals in the United

States, but in practice the ratio was never

more than a rough rule of thumb, more

nearly true in the aggregate than in detail. Initially, hospital care at the bases

was provided by medical detachments,

the provisional hospitals established being activated in place later on as numbered station hospitals. It was not until

the fall of 1941 that the first numbered

hospital units activated in the United

States were shipped out to Iceland. Before the war was over, the number of

such units in the Atlantic defense areas

increased to a peak of 5 general hospitals, 45 numbered station hospitals, a

handful of unnumbered hospitals of

varying sizes, and 10 or more dispensaries equipped to function as small

hospitals. Excluding dispensaries and

hospital expansion units, the Table of

Organization (T/O) bed strength

totaled a maximum of 10,145 in June

1943, at which time the bed ratio (percentage of the command for which beds

were available) was 5.8.4

Medical Department activities at all

of the Atlantic bases included dental and

3

 For more detailed treatment, see Blanche B.

Armfield, "Medical Department, United States

Army," Organization and Administration, in World

War II (Washington, 1963), ch. II. 4

 See app. A-1. For various other comparisons,

including Medical Department strength, see John

H. McMinn and Max Levin, "Medical Department,

United States Army," Personnel in World War II

(Washington, 1963), ch. XL
10 MEDITERRANEAN AND MINOR THEATERS

veterinary work, but for the most part

no special problems were encountered in

carrying out these functions.

The North Atlantic Bases

Iceland Base Command

As a precaution against possible German occupation, the British in May 1940

sent troops to garrison Iceland. By the

spring of 1941, however, the British were

too hard pressed in Africa to waste manpower on a purely defensive situation.

After some hesitation, but with the approval of the Icelandic Government (Icelanders felt there would be less risk in

being occupied by a nonbelligerent)

President Franklin D. Roosevelt decided

early in June 1941 to relieve the British

garrison with American troops. An initial force of 4,100 marines landed in Iceland on 7 July. The marines were

followed on 6 August by the 33d Pursuit

Squadron, whose P-40's were flown in

from an aircraft carrier. The first increment of ground troops—some 6,000 officers and men of the 5th Divisionarrived on 15 September. The Iceland

Base Command (IBC) was established

as the British garrison was relieved, and

U.S. forces prepared to protect the transatlantic air transport and ferry routes

and the vital sea lanes to the British

Isles, less than 800 miles away.6

Command headquarters was established at Camp Pershing, about two

miles east of Reykjavík. Several other

camps lay north of headquarters, within

a 10-20-mile strip close to the coast and

centering around Alafoss. Eighty percent

of the U.S. force was concentrated in

these camps. The remainder was scattered at isolated airfields and radar stations around the rim of the island.

The IBC reached peak strength in

May 1943 when, with 40,712 ground,

air, and service troops, it was exceeded

in size only by the Panama Canal Zone

among Atlantic defense areas. Ground

forces included engineer and service

troops and the entire 5th Division. Air

combat strength was augmented, as soon

as suitable fields could be made available, by the 9th Bomber Squadron (H)

and the 1st Observation Squadron. The

bulk of the Air Forces units in Iceland,

however, were elements of the Air Transport Command, whose home base, shared

with the bombers, was Meeks Field near

Keflavik on the southwest tip of the

island.

By the time peak strength was reached,

the threat of German invasion of Iceland

was negligible. In August 1943 the garrison was cut by more than 25 percent;

the entire 5th Division was withdrawn.

Thereafter, a steady decline in troop

strength brought the total to less than

1,800 men by the end of 1945, more

5

 Principal sources for this section include: (1)

Conn, Engelman, and Fairchild, Guarding the

United States and Its Outposts, chs. XVIII, XIX;

(2) Narrative Hist, Iceland Base Comd, Always

Alert, 16 Sep 41-1 Dec 45, MS, OCMH files; (3)

Lt. Col. William L. Thorkelson, The Occupation

of Iceland during World War II, MA Thesis, Syracuse University, September, 1949; (4) Annual Rpts,

Surg, IBC, 1941-44; (5) Annual Rpts, Surg, 5th

Div, 1942-43; (6) Annual Rpts, 208th Gen Hosp,

1942, 1943; (7) Annual Rpts, nth, 167th, 168th

Sta Hosps, 1941-43; (8) Annual Rpts, 14th, 15th,

49th, 72d, 192d Sta Hosps, 1942, 1943; (9) Annual

Rpts, 92d Sta Hosp, 1942-45; (10) Annual Rpts,

365th Sta Hosp, 1943, 1944; (11) Annual Rpts,

366th Sta Hosp, 1943-45; (12) Arctic Laboratory,

Sep 41-Jun 44, AAF, N Atl Wing, ATC, app. F;

(13) Med Hist Rcd, Oct 44-Dec 44, app. E, AAF,

N Atl Wing, ATC; (14) Hist of Med Dept, ATC,

May 41-Dec 44; (15) Ltr, Col Charles H. Beasley

(Ret) to Col O. F. Goriup, 10 Aug 59, commenting

on preliminary draft of this volume.
THE ATLANTIC DEFENSE AREAS 11

COLONEL BEASLEY

than a third of them Air Forces personnel. The Iceland Base Command, which

was under the European Theater of

Operations (ETO) from June 1942 on,

passed to control of the Eastern Defense Command in the middle of 1944.

The Air Transport Command, which

retained an interest in Iceland after the

war was over, assumed control of all

remaining U.S. Army activities there on

1 January 1946.

Medical Organization—The strength

of the Medical Department in Iceland

rose from 749 at the end of 1941 to

2,959 a year later. By the end of 1943

the total number of officers, nurses, and

enlisted men of the Medical Department

had declined to 1,163 and was down to

429 by the end of 1944. T/O bed

strength went through a corresponding

expansion and decline, from an initial

750 to a peak of 2,600 in October 1942,

declining to 400 by the middle of 1944.

The base command surgeon during

the most active period was Lt. Col.

(later Col.) Charles H. Beasley, who had

accompanied the initial Marine contingent in July in order to make a medical

evaluation of the island. Colonel Beasley

returned to Iceland with the Army

ground troops, remaining until August

1943, when he was relieved by Col. John

F. Lieberman. Lt. Col. John C. McSween

became IBC surgeon in early 1944. In

addition to its regular function as guardian of the health of the U.S. troops in

the command, the base surgeon's office

did much to win over the Icelandic

people. Army hospitals treated large

numbers of Icelandic citizens who had

been injured in the vicinity of American

camps, and also cared for civilians who

were struck by military vehicles. Members of the Medical Department co-operated freely with the local public health

authorities, and Army veterinarians helped their Icelandic colleagues examine,

test, and treat livestock, and aided them

in other agricultural matters. Many of

the most prominent doctors of Iceland

inspected U.S. Army hospitals and attended Army medical meetings. In turn

American medical officers visited Icelandic patients in consultation. On several occasions the Army supplied local

hospitals with urgently needed drugs and

biologicals, while the American Red

Cross contributed hospital and medical

supplies to its Icelandic counterpart.

The work of the surgeon's office revolved around the system of hospitalization and evacuation and the related

medical supply function, each of which

will be discussed under a separate heading. Supplementing these activities at

the base command level was the divisional medical service, which operated
12 MEDITERRANEAN AND MINOR THEATERS

camp dispensaries and treated 5th Division personnel wherever they were

stationed. The organic 5th Medical

Battalion furnished routine evacuation

service from unit dispensaries to nearby

station hospitals and from the hospitals

back to the dispensaries. The medical

battalion also operated a dispensary for

the port of Reykjavík and ran a provisional hospital in the Keflavik area until

a permanent station hospital was established there. Air Forces units maintained

their own dispensaries and operated

crash aid stations for emergency treatment at the various airfields. Engineer

troops, which preceded the Army combat

elements by about a month, had their

own medical detachments, but anything

of a serious or complicated nature went

to Marine and later to Army installations.

Hospitalization—The disposition of

U.S. Army hospitals in Iceland was

dictated by the combination of mountains, lava beds, and glaciers that circumscribed roads and airfields, and by the

rugged coast line, turbulent seas, and

icebergs that made water evacuation hazardous much of the year. Although the

bulk of the beds were in the ReykjavíkAlafoss area to serve the largest concentration of troops, it was still necessary

to supply hospital facilities wherever

American soldiers were stationed. Three

numbered station hospitals arrived with

the main body of troops in mid-September 1941, and two of these were in operation before the close of the year. The

168th Station Hospital was established

in Reykjavík in a permanent building

formerly used by a British hospital. The

main frame structure held 100 beds,

and Nissen huts were used to bring the

hospital up to its 250-bed T/O capacity.

The first patient was admitted on 24

September. The following week the nth

and 167th Station Hospitals, both 250-

bed units, which had arrived in Iceland

at the same time as the 168th, were attached to the latter until suitable sites

could be prepared. The 11th Station

Hospital opened on 22 December in a

section of a British hospital at Camp

Helgafell, some ten miles north of

Reykjavík. The 167th remained attached to the 168th until April 1942,

when it moved into newly erected Nissen

huts at nearby Alafoss. (Map I.)

During 1942 six more station hospitals

and one general hospital arrived on the

island to serve an increasing number of

Army troops coming in from the United

States. The 1,000-bed 208th General

Hospital came in March and began operating before the end of the month at

Camp Helgafell, where it shared quarters with a British general hospital and

the U.S. 11th Station Hospital. The 11th

moved in June to Kaldadharnes, some

twenty-five miles southeast of Reykjavík,

where it served personnel of an airfield.

The British hospital was withdrawn to

the United Kingdom in August, leaving

the 208th General in sole possession of

the hospital plant.

The 72d and 92d Station Hospitals

both arrived in August 1942. The 92d,

with 75 beds, began operating in September at Reykjaskoli near the head of

Hnitafjordhur on the north coast of Iceland. The 72d—a 50-bed unit—was

scheduled for Borgarnes about thirty

miles north of Reykjavík but, because

of a variety of construction difficulties,

did not get into operation until the beginning of January 1943. By then changes

in troop dispositions had made a hospital
THE ATLANTIC DEFENSE AREAS 13

MAP 1—U.S. Army Hospitals Supporting North Atlantic Bases, 1 June 1943

at Borgarnes unnecessary, and the unit

was moved later in January to Kaldadharnes, where air activity was increasing.

The 75-bed 14th Station Hospital and

the 500-bed 49th both reached Iceland

in September 1942 and went into operation the same month. The 14th was at

Seydhisfjordhur on the eastern coast; the

49th enlarged a 200-bed hospital plant

taken over from the British near Akureyri on the north coast, the second largest

city in Iceland and the site of a large seaplane base. The 15th Station, another

75-bed unit that also arrived in September, began operating at Budhareyri,

about forty miles south of the 14th, in

November. The 75-bed 192d Station

Hospital arrived in October and was
14 MEDITERRANEAN AND MINOR THEATERS

167TH STATION HOSPITAL at Alafoss, Iceland, showing hot springs used to heat buildings.

attached to the 168th Station at Reykjavík until its own hospital plant at Höfn

on the southeastern coast was ready in

January 1943.

With the exception of the 168th Station at Reykjavík, all U.S. hospital

plants, including those taken over from

the British, were Nissen, Quonset, or

similar types of corrugated steel huts.

Even with prefabricated buildings, however, construction was difficult. Materials

for drains, plumbing, and electrical fixtures were not always available. Little

could be accomplished during the winter

months, when the nights were twenty

hours long, and even the brief periods of

daylight were often marred by cold,

dampness, and winds up to 130 miles an

hour. A civilian labor shortage forced

reliance on troop labor, including that

of Medical Department personnel. In the

vicinity of Alafoss natural hot springs

were used for heating hospital buildings.

The officers, nurses, and enlisted men

of Iceland Base Command's hospitals, in

addition to caring for all U.S. Army personnel in the command, provided hospitalization for members of the American

Red Cross and for U.S. civil service employees. They also treated and hospitalized on occasion U.S. Navy and Marine

Corps personnel, certain British Army,

Air Force, and Navy men, some members

of the Norwegian Army and Navy, and
THE ATLANTIC DEFENSE AREAS 15

American and Allied merchant marine

casualties and survivors from sea mishaps. However, the bulk of patients were,

of course, from the various camps of the

command.

As the threat of German invasion of

Iceland faded during 1943, the withdrawal of troops and relocation of remaining forces brought a number of

changes in hospital dispositions. In April

the 192d Station left Höfn for the

Reykjavík area, where most of its personnel were already on detached service

with the 168th Station, but the hospital

did not resume independent operation.

Further shifts came in June when the

15th Station, no longer needed at

Budhareyri, was attached to the 49th at

Akureyri, and the 92d Station, including

patients, was transferred from Reykjaskoli to Alafoss.

On 24 June the 192d Station Hospital

was disbanded and its personnel and

equipment were transferred to the 92d,

which was reorganized as a 150-bed unit.

On the same date the 208th General

Hospital at Camp Helgafell was reduced

from 1,000 to 750 beds, and the 168th

Station in Reykjavík was expanded from

250 to 500 beds, in preparation for a

mission elsewhere.

A few days later, on 2 July 1943, the

208th General was redesignated the 327th

Station Hospital, without change of site

or mission. On the same day the 500-bed

49th Station closed at Akureyri, leaving

the smaller 15th Station to care for remaining patients in that area, and a week

later sailed for the United Kingdom. It

was followed by the 168th Station on 3

August.

The 11th Station, meanwhile, had

shifted from Kaldadharnes to Reykjavík

to replace the 168th. It was joined there

by the 72d Station on 19 August. Two

days later the 92d Station Hospital

opened near Keflavik, adjacent to the

Meeks Field headquarters of the Air

Transport Command.

By this time the bulk of the ground

force troops had left, as had many of the

air and service forces. When the 15th

Station from Akureyri and the 14th from

Seydhisfjordhur both moved to the

Alafoss Helgafell 

all U.S. hospitals were concentrated in

the Reykjavík area. It remained only to

consolidate the units for more efficient

operation.

The first step in this direction was

taken on 30 October when the 327th Station sailed for England. A consolidation

of the remaining hospitals was effected

on 6 December 1943. The 11th and 72d

Station Hospitals were combined at

Reykjavík to form the 150-bed 366th

Station, while the 14th, 15th, and 167th

Stations were combined at Camp Helgafell to form the 365th Station Hospital,

with a T/O of 500 beds. At the end of

1943 only the 92d, 365th, and 366th Station Hospitals remained in Iceland, with

a combined bed strength of 800. Seven

months earlier there had been one general and nine station hospitals, with an

aggregate of 2,600 T/O beds.

Except for Iceland's strategic function

as a stop on the air route to Europe, the

war there was over. Hospitalization was

on a garrison basis, with the garrison

steadily decreasing in size. The 365th

Station transferred to the United Kingdom on 26 June 1944. On the first of that

month the 92d Station had increased its

bed strength from 150 to 250, but the

number of beds on the island was still

halved. The 366th was inactivated early

in 1945, leaving the 92d Station the only
16 MEDITERRANEAN AND MINOR THEATERS

U.S. Army hospital in Iceland. It was

transferred to the jurisdiction of the Air

Transport Command on 1 January 1946,

along with the remains of the Iceland

Base Command.

Evacuation—From most of the army

camps in Iceland patients were evacuated

by ambulance from the unit dispensary

to the nearest station hospital. Those

who required general hospital care were

moved on to the 208th General Hospital

at Camp Helgafell, by ambulance from

station hospitals in the western part of

Iceland, by sea or air from those in more

isolated areas. Evacuation by boat

through coastal waters proved to be a

very efficient method of handling patients from the eastern and northern

parts of the command except during the

long winter season, and was more frequently used than air evacuation.

The 120-day evacuation policy set up

by the War Department for evacuation

from Iceland to the United States proved

to be entirely satisfactory. Both air and

water transportation were used. In either

case, patients to be evacuated to the zone

of interior were cleared through the

208th General Hospital or, after its

departure, through a station hospital acting as a general. Although the number of

evacuees was not unduly large—327 in

1942, 1,180 in 1943, and 248 in 1944—

there was generally a backlog because of

unavailability of transportation or lack

of proper facilities, especially for neuropsychiatric and other cases requiring

medical attendance. Psychiatric cases

amounted to 33 percent of those evacuated in 1942, 32 percent in 1943, and

56 percent in 1944.

The medical facilities of the Iceland

Base Command were also available, to

the extent needed, to care for 19,589

transient patients who were flown from

the ETO to the zone of interior by

way of Iceland between 1 January 1944

and 1 July 1945. To accommodate these,

an unnumbered holding hospital was set

up at Meeks Field, including mess facilities for walking patients. Litter cases

were served hot meals aboard the planes.

If a plane were held because of poor flying conditions, the 92d Station took care

of the patients until they could continue

their journey. The hospital also took care

of any patients whose condition made

it unsafe to continue. Medical attention

was similarly available to 5,930 ablebodied men from the ETO who passed

through Iceland between June and September 1945 on their way to the States.

Medical Supplies and Equipment—

Medical supplies for the Iceland Base

Command were handled through a main

depot in Reykjavík and a subdepot and

a package storage depot in the Alafoss

area. The main depot—two fish-drying

houses leased for the purpose—had more

than 11,000 square feet of floor space for

storage; the subdepot, in three prefabricated huts, had 2,880 square feet of storage space; and the package warehouse

about a mile distant had 4,000 square

feet. Individual hospital and other medical units maintained supply levels of

from 90 to 180 days, the larger stocks

being held by installations on the northern and eastern coasts, which were not

readily accessible in bad weather. The

depots held a 120-day supply by the end

of 1942.

Six officers and 75 enlisted men were

authorized for operation of the medical

supply system in Iceland, but this number was never reached. Five officers and
THE ATLANTIC DEFENSE AREAS 17

50 enlisted men were sent, but even these

figures were reduced by attrition to 4 and

45 respectively before the end of 1942.

The supply system was reorganized early

in August 1943 and again in mid-December. In August a Base Depot Section,

20th Medical Depot Company, was organized to carry on the medical supply

function, but was supplanted in December by the 300th Medical Composite

Platoon. Under the latter form of organization the depots were operated by two

supply teams, one with an officer and 11

enlisted men, the other with 2 officers

and 27 enlisted men.

While some medical units encountered

a number of delays in getting their normal equipment, medical supplies as a

whole were plentiful. Some items, such

as quinine, mosquito bars, and various

combat items, were never required in

Iceland, and other items became surplus

as the strength of the command declined.

During 1943 excess British medical supplies to a total of 130,000 pounds, and

2,325,000 pounds of excess U.S. medical

supplies were shipped to the United

Kingdom. The year's end still found the

depots bulging with supplies for 60 days

of operation, 90 days' maintenance, and

a further 90-day final reserve of certain

necessary items, held in dispersed locations. These levels were sharply reduced

during 1944 to a 30-day operating and

30-day maintenance level.

Professional Services—In spite of unfamiliar and unfavorable climatic conditions, the incidence of disease among

U.S. troops in Iceland was exceptionally

low. There were no diseases peculiar to

the country, no mosquitoes, few insects

of any kind. Common respiratory diseases constituted overwhelmingly the

largest single cause for hospitalization.

Half of all hospital admissions in 1942

were for respiratory diseases. In 1943 the

respiratory disease rate was 190 per 1,000

per annum, including mild cases treated

in quarters as well as those hospitalized.

The 1944 rate, similarly computed, was

down to 95. The command experienced

a sharp rise in rates for such diseases

after the arrival of each new troop contingent, but the situation would return

to normal in about a month.

An outbreak of jaundice in May 1942

claimed 478 in that month. In June the

number of cases climbed to 661, dropping to 170 in July and only 11 in August. The total number of cases for the 4-

month period was 1,320. There were no

deaths from jaundice. The cause was not

determined. Large numbers of the rats

that abounded in Iceland were examined, but none were found to be diseased.

There appeared, however, to be some

connection with yellow fever inoculations. All but 7 of the 1,320 men who

came down with jaundice had been inoculated for yellow fever from the same lot

of vaccine before leaving the United

States.

An epidemic of mumps in the civilian

population in 1942 was kept from spreading to the troops by prompt preventive

measures. Only 128 sporadic cases were

reported. Venereal disease, scourge of the

Mediterranean and European theaters,

was notable in Iceland chiefly for its almost total absence. Venereal rates for

the base command were 4.4 per 1,000

per annum in 1942; 5.3 in 1943; and 6.2

in 1944. Only mental disorders showed a

significant rise as time went on. Isolation,

boredom, lack of recreation, adjustment

problems, and a feeling of contributing

little to the war effort combined to pro-
18 MEDITERRANEAN AND MINOR THEATERS

duce relatively high neuropsychiatric

rates.

The general health of the U.S. troops

in Iceland, excellent at all times, steadily

improved throughout the war. The noneffective rate for 1942 was 29.5 per 1,000;

in 1943 it was only 25.37; and in 1944 it

was a startling 16.28. There were, of

course, no combat wounds, and the accident rate-primarily plane crashes—was

relatively low.

The dental service in the Iceland Base

Command encountered no unusual difficulties. Dispersal of troops made it

expedient to assign dentists to areas

rather than to clinics, but for the most

part the work itself was routine. The

Veterinary Corps encountered more

serious problems, stemming largely from

inadequate sanitary standards on the part

of the local authorities. From their

arrival on the island, U.S. veterinary

personnel worked with the Icelandic

authorities and with individual farmers

and food processers to improve methods

and standards.

Greenland Base Command

After months of indecision, officials

of the State, War, and Navy Departments

agreed early in February 1941 that airfields and other facilities in Greenland

would be needed for hemisphere defense,

and that in view of the Monroe Doctrine

the United States could permit no other

power—not even friendly Canada—to

take the initiative there. A survey expedition sailed in March. Less than a month

later, on 9 April, the project received

formal sanction when the Danish Minister in Washington (still recognized by

the United States) and the Secretary of

State signed an agreement under which

the United States guaranteed the security

of Greenland in return for the right to

construct, maintain, and operate the required facilities. The first echelon of the

Greenland force—469 officers and mensailed from New York on 19 June and

anchored off Narsarssuak on the southwest coast of Greenland on 6 July.6

To the United States and Great Britain, Greenland was considerably more

than the "raw structure of rock and salt

water and ice, all united by the eternal

cold" that Col. Bernt Balchen had described. It was a potential stop on an air

ferry route that could enable fighter

planes to move from American factories

to British bases under their own power;

it was the only known commercial source

of natural cryolite, invaluable as an

electrolyte in the production of aluminum; and it was the gathering point for

the storms that would influence air and

naval activity in western Europe. The

Germans had recognized the importance

of obtaining weather data in Greenland

and had established several meteorological stations that were subsequently eliminated by the British in the summer of 6

 Sources for this section are: (1) Conn, Engelman, and Fairchild, Guarding the United States

and Its Outposts, ch. XVII, ch. XX; (2) Craven

and Cate, eds., Plans and Early Operations, pp.

122-23, 157-58, 342-48, 641-44; (3) Bernt Balchen,

Corey Ford, and Oliver LaFarge, War Below Zero:

The Battle for Greenland (Boston: Houghton Mifflin Company, 1944); (4) Annual Rpts, Med Dept

Activities, Greenland Base Comd, 1941-44; (5) Annual Rpt, Base Hosp, Greenland Base Comd, 1946;

(6) ETMD's (Essential Technical Medical Data),

Greenland Base Comd, Jul 43-Nov 45; (7) Interv

with Lt Col Otho R. Hill, 6 Sep 44; (8) Interv

with Lt Col Norman L. Heminway, Dec 43; (9)

Annual Rpts, 188th, 190th, 191st Sta Hosps, 1943-

44; (10) Annual Rpt, 189th Sta Hosp, 1943; (11)

Med Hist Rcd, Oct-Dec 44, app. E, AAF N Atl

Wing, ATC; (12) Ltr, Norman L. Heminway to

Col Goriup, 16 Aug 59; (13) Ltr, John R. McBride

to Goriup, 28 Jul 59. Both letters comment on preliminary draft of this volume.
THE ATLANTIC DEFENSE AREAS 19

1940. Later, however, another German

weather station was believed to be in

operation. This was located and destroyed by an American force, but the

Germans continued to obtain Greenland

weather reports from a submarine kept

in the area for that purpose.

In addition to its responsibility for the

health of Army and Air Corps personnel

and employees of civilian contractors

stationed there, the Medical Department

in Greenland supplied hospital facilities

for the crews of Navy, Coast Guard, and

merchant vessels and of transient aircraft. A small detachment of Medical

Department officers and enlisted men

arrived with the first contingent at Narsarssuak, where the first U.S. military

post, BLUIE WEST 1, was established. In

August 1941 the medical detachment

there set up a 10-bed field-type tent hospital, which operated for two months before a suitable building could be erected.

A 5-wing cantonment-type building was

eventually built. The wings were connected by heated corridors. Supply rooms

and the mess hall were off the main

corridor, opposite the clinic and hospital

wings. Initially, only one wing with

twenty beds was required for inpatients.

It was not until January 1943, when survivors from the torpedoed USAT Dorchester were brought to BLUIE WEST 1,

that two other wings were made ready,

expanding capacity to approximately

sixty beds.

In October 1941 a post was established

at the head of Søndre Strømfjord on the

west coast of Greenland about fifteen

miles inside the Arctic Circle. Known as

BLUIE WEST 8, this post was under command of the famed arctic explorer, Capt.

(later Col.) Bernt Balchen, with Maj.

(later Col.) John R. McBride as surgeon. BLUIE WEST 8 included civilian

construction workers, who had been

there since September, and Army engineers. The engineer medical officer,

Capt. (later Lt. Col.) Stephen W. Ondash, was responsible for the health of

the civilians. The first hospital set up on

the post, an engineer unit available to

all, opened on 10 December 1941.

In November a post was established

at Angmagssalik on the eastern coast of

Greenland about forty miles below the

Arctic Circle. BLUIE EAST 2, as the new

post was called, was primarily a weather

and communications station. It included

a medical officer and an engineer dispensary operated by civilians. In March

1942 a post was set up at Ivigtut, about

100 air miles west of Narsarssuak, where

the cryolite mine was located. The Ivigtut base was called BLUIE WEST 7. By

June a small building had been erected

for a dispensary.

The Greenland Base Command, with

headquarters at BLUIE WEST 1, had meanwhile been formally activated on 26 November 1941, although Army forces in

Greenland had been using that designation since their arrival. There was no

surgeon for the whole command, however, until November 1942, when Colonel McBride, as the senior Air Forces

medical officer on the island, was assigned

that responsibility. He was succeeded in

March 1943 by Maj. (later Col.) Norman

L. Heminway, commanding officer of the

188th Station Hospital and surgeon of

the BLUIE WEST 1 base. In December

Colonel Heminway was transferred,

being succeeded in each of his three

capacities by Maj. (later Lt. Col.) Otho

R. Hill.

Under War Department authority

granted in September 1942, four num-
20 MEDITERRANEAN AND MINOR THEATERS

BLUIE WEST 1, Narsarssuak, Greenland, May 1943, with the 188th Station Hospital under

construction in right foreground.

bered station hospitals were activated to

replace the makeshift units then functioning. (See Map I.) Cadres were

drawn from Medical Department personnel already on the ground and actually

operating the existing hospitals and dispensaries that were to be elevated to

numbered status by the new arrangement. Authorizations were given for hospitals of 250, 200, 150, and 25 beds, for

BW-1, BW-8, BE-2, and BW-7 respectively. Construction of buildings began in the fall of 1942, continuing into

the late months of 1943. The bulk of the

work was completed by the end of that

year, when the troop build-up reached

its maximum strength of about 5,300.

The unduly long construction time was

due in part to weather hazards, in part to

low priority in a very restricted labor

market, and in part to the necessity for

importing all building materials from

the United States.

Largest of the hospitals, the 188th Station, opened at BLUIE WEST 1 in its new

buildings in December 1943. One of the

finest examples of an overseas hospital,

the installation was located for maxi-
THE ATLANTIC DEFENSE AREAS 21

mum terrain protection. It was built at a

cost of $1,769,022. Its 32 cantonmenttype buildings on 22.5 acres were connected by heated and insulated corridors.

Central heating, electricity, running hot

and cold water, and a modern sewage

system made it a comfortable haven in

the frozen wasteland of Greenland. The

188th Station, in addition to its function

as post hospital, received patients from

other units, mostly by air, who required

further observation or treatment. It also

acted as clearing and processing point for

cases being evacuated to the United

States.

Additional hospital construction at the

smaller posts in Greenland during 1943

made conditions less crowded, but bed

requirements were never as great as had

been anticipated. The 190th Station

Hospital, originally authorized as a 200-

bed unit, was reduced to a 50-bed hospital by the time it moved into its

permanent quarters at BLUIE WEST 8.

The 191st Station at BLUIE EAST 2 also

operated as a 50-bed unit, although its

original authorization had been for 150

beds. The smallest of the four Greenland hospitals, the 189th at BLUIE WEST

7, remained a 25-bed unit throughout its

period of operation. At none of the four

post hospitals was medical service seriously interrupted during the period of

construction. New plants were occupied

by echelon, as space became available,

without closing down the old until the

new was functioning. Such unavoidable

curtailment of minor services as occurred

was compensated for by treating as many

cases as possible on a "quarters" basis.

During the greater part of the year,

transportation by water was very difficult

or impossible. Therefore, each of the

four main Army bases in Greenland had

to be largely self-sufficient from the standpoint of supply. In practice this imposed

no handicap as supplies for the base command as a whole were more than ample

throughout the war. The months of isolation envisaged by the planners never

materialized.

In addition to the four bases themselves, there were a dozen or more

weather observation and radio posts

operating out of one or another of the

BLUIES. For the larger outposts of this

type a medical officer was provided; for

the smaller, only a trained Medical Department enlisted man could be spared.

Although the climate was much more

severe and the setting far more bleak

than anything the men had before experienced, there were no adverse effects

on health. There were no indigenous

diseases. The native Eskimos suffered

heavily from tuberculosis, but contacts

between the natives and the U.S. troops

were so infrequent as to remove the hazard. The only venereal cases were among

those who had been infected outside of

Greenland. Respiratory diseases made

up the largest item in the disease category, with newly arrived troops the most

frequent victims. On the whole, however,

the incidence of disease in Greenland

was very low. Injuries, directly related

to the treacherous and rugged terrain,

ship loading and unloading, and construction work accounted for the largest

number of patients admitted to hospitals,

as well as about a quarter of all those

evacuated to the zone of interior. The

second largest group returned to the zone

of interior, accounting for about 18 percent of the total, were the neuropsychiatric cases, stemming from the prolonged service in an isolated, unpleasant

environment, combined with constant
22 MEDITERRANEAN AND MINOR THEATERS

monotony and a complete lack of normal

social contacts. A general apathy, called

by the men stationed in Greenland,

"The Arctic Stare," developed in a majority of troops after a year's stay on the

island. It was notable, however, that even

in the most difficult year, 1944, neuropsychiatric cases constituted only about 4

percent of hospital admissions. The suicide rate was also relatively low. Admissions for all causes to the main hospital

of the command, the 188th Station Hospital, numbered 1,821 in 1943 and 2,137

during 1944.7

Evacuation of patients within Greenland moved from the outposts to the

main bases, where the permanent hospitals were established, and thence, if more

elaborate treatment or ZI evacuation

were indicated, to the 188th Station Hospital. Patients could be evacuated to the

188th from other parts of Greenland only

by air and by sea, while those within

BW-1 came in by bus or ambulance.

Most of the patients sent to the zone of

interior for further treatment were transported there by air; a few went by ship.

Weather problems frequently complicated evacuation procedures in Greenland. Poor flying conditions or ice packs

—which prevented the passage of shipswere responsible for many delays. Greenland Base Command sent an average of

15 to 25 patients a month to the United

States for general hospital treatment. Beginning in 1944 the personnel of the

188th Station Hospital and the Air

Transport Command fed and furnished

professional services to transient patients

being evacuated by air from Europe to

the United States. From May to October,

471 such cases passed through the command, 34 of which were temporarily

hospitalized.

General reductions in strength during

1944 resulted in practically all ground

force units being withdrawn from the

command, leaving mostly air and service

personnel. The base established to protect the cryolite mine at Ivigtut closed

during the summer, and the 189th Station Hospital, which was located there,

ceased operations in August. At the end

of that month, Colonel Hill left the

Greenland Base Command, being succeeded as post surgeon and commanding

officer, 188th Station Hospital, by Capt.

(later Maj.) John A. Jones, and as

Greenland Base Command surgeon by

Maj. Andrew W. Shea. Medical units operated below T/O authorizations when

possible. Excess medical personnel and

large amounts of surplus medical supplies were returned to the United States.

Greenland Base Command had become primarily an Air Transport Command stopover and a weather forecasting

center a year before the ATC assumed

full responsibility for all U.S. activities

on the island in January 1946. Only the

hospital at BLUIE WEST 1 continued active at this time.

Newfoundland Base Command

The island of Newfoundland lies on

the great circle route between New York

and the British Isles, controlling both sea

and air lanes and blocking the mouth of

the St. Lawrence. Its strategic importance had made its defense an object of

concern to the United States and Canada

early in the war. The right to establish

U.S. bases there was given at the time of

7

 No detailed admission statistics are available for

the other hospitals of Greenland Base Command,

but admissions to the 188th Station Hospital constituted the bulk of all hospital admissions.
THE ATLANTIC DEFENSE AREAS 23

the destroyers for bases agr

early September 1940, and an engineer

survey party arrived on the island on 13

October. The first of the garrison troops

followed late in January 1941 when the

21,000-ton USAT Edmund B. Alexander, first ship of her size to attempt

the narrow, rocky entrance to the harbor,

anchored at St. John's. The transport carried 58 officers and 919 enlisted men,

including personnel to operate a 40-bed

hospital, which was activated on shipboard.

 8

The St. John's base, to be known as

Fort Pepperrell, was not yet ready to

receive either troops or hospital. For the

next four and a half months the Alexander served as a floating barracks, while

the hospital continued to function on

the ship. Medical supplies could not be

reached until the ship was partially unloaded, but needed items were procured

ashore. Civilian hospitals in St. John's

cared for engineer troops and civilian

construction workers until late February,

when an engineer medical officer arrived

and opened a small dispensary at the

base. The dispensary grew into a 25-bed

hospital, opened 16 June 1941. By this

time the transport had been recalled, and

the station hospital had moved from its

shipboard quarters to a country estate

about two miles from the city. Equipment for a 50-bed hospital had been unloaded from the transport, but could not

be uncrated until covered storage space

was found. At the beginning of December another move put the hospital, then

known as Station Hospital, Newfoundland Base Command, into a newly

completed barracks at Fort Pepperrell.

Designed to accommodate 125 men, the

building was readily converted into a 60-

bed hospital, to be occupied pending

completion of a suitable hospital building. (See Map I.) The commanding

officer of the hospital, Maj. (later Col.)

Daniel J. Berry, also acted as Newfoundland Base Command surgeon.

A second U.S. hospital had meanwhile

been established at Newfoundland Air

Base near Gander. The base, still under

construction but already occupied by

units of the Royal Canadian Air Force,

was one of the largest in the world. The

American portion of the base, called

officially U.S. Army Air Base, Newfoundland, but unofficially known as Gander

Field, was occupied in May 1941. A 25-

bed hospital to serve the base was activated at the same time and sited in a

portion of the RCAF hospital functioning there. Evacuation was to Fort Pepperrell, 250 miles away by rail but only half

of that distance by air. The hospital

moved into its own building in December 1942 with a rated capacity of 150

beds.

A third U.S. Army hospital was set up

originally as a 25-bed dispensary in January 1942 at Fort McAndrew, near the

naval base of Argentia, seventy-five miles

8

 The main sources for this section are: (1) Conn,

Engelman, and Fairchild, Guarding the United

States and Its Outposts, ch. XIV; (2) Watson, Chief

of Staff, pp. 479-81; (3) Annual Rpt, Sta Hosp,

Newfoundland Base Command, 1941; (4) Annual

Rpt, Med Activities, Newfoundland Comd, 1942;

(5) Med Bases in Newfoundland District doc included in Health Service, Caribbean, Apr 42; (6)

Annual Rpt, Sta Dispensary, U.S. Army Air Base,

Newfoundland, 1941; (7) Annual Rpts, 308th Sta

Hosp, 1943, 1944; (8) Annual Rpt, 309th Sta Hosp,

1944; (9) Annual Rpts, 310th, 311th, Sta Hosps,

1943; (10) Arctic Laboratory, Sep 41-Jun 44, AAF,

N Atl Wing, ATC, apps. I, J; (11) ETMD's, Newfoundland Base Comd, Jul 43-Dec 45; (12) Ltr,

Col Daniel J. Berry (Ret) to Col Goriup, 2 Aug

59; (13) Ltr, Col Emmett L. Kehoe to Col Goriup,

5 Aug 59; (14) Ltr, Gunnar Linner to Goriup, 10

Aug 59. Last three letters comment on preliminary

draft of this chapter.
24 MEDITERRANEAN AND MINOR THEATERS

308TH STATION HOSPITAL AT FORT PEPPERRELL, Newfoundland. The basement,

shown rising above ground level, was a completely self-contained bombproof unit to which

patients could quickly be moved down ramps.

west of St. John's. For the time being a

small engineer hospital already on the

ground handled cases beyond the capabilities of the dispensary, but a station

hospital was formally activated in May

and opened in June 1942, eventually absorbing the engineer unit. Last of the

U.S. bases to get into operation was Harmon Field near Stephenville on the

western coast of Newfoundland. Here a

medical officer, a dental officer, and four

enlisted men opened a 25-bed hospital

in a small barracks in March 1942.

At each of the four U.S. bases, the

hospital commander served also as surgeon of the base and as commander of

the medical detachment.

The four U.S. Army hospitals were

designated as numbered station hospitals

on 1 April 1943. At that time the base

unit at Fort Pepperrell became the 308th

Station Hospital with a Table of Organization calling for 250 beds. With this

enlargement of the hospital, its commanding officer, Lt. Col. Gunnar Linner

since October 1942, was relieved as Newfoundland Base Command surgeon by

Lt. Col. William J. Eklund. The 308th

Station moved in June into a permanent

all-concrete building designed for its

special needs. There were two stories

above ground, with a basement blasted

from solid rock and protected by a thick

concrete slab. The basement, which
THE ATLANTIC DEFENSE AREAS 25

could be immediately converted into an

underground hospital should the upper

portion of the building be bombed, had

complete facilities, including operating

rooms, kitchens, refrigerators, stored

food supplies, and a diesel electric power

plant. It could be completely sealed and

supplied with air drawn in through decontamination canisters. Patients could

be moved down ramps from the main

hospital in a matter of minutes. Located

at base command headquarters and adjacent to the capital and principal port of

Newfoundland, the 308th took patients

by transfer from the smaller and less

well-equipped units and processed all

patients being evacuated to the United

States.

The post hospital at Fort McAndrew

became the 309th Station Hospital, with

a T/O of 100 beds. The 310th Station

(150 beds) succeeded the post hospital

at Gander Field, and the small Harmon

Field unit became the 25-bed 311th Station Hospital. Maximum T/O bed

strength of 450 was reached at this time,

to serve a troop strength of approximately 9,000. Troop strength increased

to a peak of 10,500 in June 1943 but

soon fell back below the 9,000 level. The

310th and 311th both passed to the jurisdiction of the Air Transport Command

in September but continued to report to

the base surgeon until July 1944, when

both were disbanded. The bulk of the

personnel and equipment were allotted

to newly organized dispensaries, which

were really small hospitals under the

North Atlantic Wing of the Air Transport Command.9

By mid-1944 the Newfoundland Base

Command was little more than a stop on

the air route to Europe. Lt. Col. Emmett

L. Kehoe, who had relieved Colonel

Eklund as base surgeon in January 1944,

also relieved Colonel Linner as commanding officer of the 308th Station Hospital in March, thus recombining the two

positions. In December 1944 the 308th

Station was reduced to 150 beds and the

309th to 75. In September 1945 the

309th was disbanded and the 308th reduced to 25 beds. On 1 January 1946 all

remaining installations were turned over

to the Air Transport Command.

Evacuation from Newfoundland was

never a problem, though evacuation

within the island was often difficult

owing to the virtual absence of roads.

Gander and Harmon Fields were connected with St. John's by railroad but

the distances were considerable—250

rail miles from Gander and close to 500

from Harmon—and the service in winter

was erratic because of the heavy snowfalls. Air evacuation was faster, but it

was even more subject to the hazards of

unpredictable weather. For this reason,

a medical officer of better than average

surgical skill was assigned at each hospital. Evacuation to the United States was

by sea until late 1942, when transport

planes equipped with litter racks also

began to be used.

After the invasion of Normandy in

June 1944, Harmon Field became increasingly important as a stopover point

for patients being evacuated from Europe. A 72-bed transient hospital was

built to accommodate these patients

when poor weather conditions made it

impossible to continue the flight. A new

post hospital of 75-bed capacity, completed in March 1945, also had more than

9

 See Clarence McKittrick Smith, The Medical

Department; Hospitalization and Evacuation, Zone

of Interior, UNITED STATES ARMY IN WORLD

WAR II (Washington, 1956), pp. 174-75.
26 MEDITERRANEAN AND MINOR THEATERS

half of its beds available for transients.

When flights were not interrupted, litter patients were given a warm meal on

the planes. Plasma and whole blood were

available for those who needed them.

Fresh milk was flown up from Presque

Isle, Maine, especially for use of evacuees passing through Harmon Field.

In general the health of the command

was good. The climate was relatively

mild, resembling that of northern New

England. Although the winters were

characterized by sudden changes from

sunshine to snow or sleet, with a penetrating northeast wind, the thermometer

seldom dropped below zero. The troops

were housed in permanent buildings and

had proper clothing. The incidence of

respiratory diseases was not unduly high,

and intestinal diseases were at a minimum. In 1942 there were 25 cases of

catarrhal jaundice, which, like the parallel but more severe outbreak in Iceland,

were apparently related to yellow fever

immunization.

A venereal disease rate that climbed

to 35 per thousand per annum in October 1942 and averaged in the neighborhood of 20 during 1943 was considered

excessive by Medical Department officers in Newfoundland, although that

rate compared very favorably with those

in other areas.10 The establishment of

prophylactic stations and the issue of

individual prophylactics to the men, together with a stepped-up educational

program and excellent co-operation from

the local authorities, brought the rate

down to a negligible figure by 1945. A

local health problem was tuberculosis,

which was widely prevalent among the

Newfoundlanders and thus constituted

a serious threat to U.S. troops. Diphtheria, also common among the residents,

never seriously menaced the American

forces.

On the supply side, there were early

difficulties brought about more by lack of

storage facilities than by lack of supplies

themselves. After the bases were well

established, medical supplies were quite

adequate—large quantities were even

returned to the United States during

1944. The base medical depot at Fort

Pepperrell was discontinued late in 1943,

the function passing to the 308th Station

Hospital.

Bermuda Base Command

Geographically, Bermuda was the key

to the North Atlantic defenses. It lies

near the center of a line from Nova Scotia

to Puerto Rico, which is to say the center

of an arc shielding the Atlantic coast of

North America whose ends are Newfoundland and Trinidad. Only Newfoundland preceded Bermuda among

the bases acquired from Great Britain.

As in Newfoundland, engineer troops

were first to reach the island, the vanguard arriving in November 1940. An

engineer medical officer reached Bermuda in January 1941, but no engineer

hospital was established until August.

The Bermuda Base Command, meanwhile, had been activated on shipboard

on 18 April 1941 and established headquarters two days later in the Castle Harbour Hotel some two miles across the

water from the site selected for the U.S.

Army base and airfield near the eastern

end of the islands. (See Map I.)

 11

10

 See pp. 92-94, below.

11

 Chief sources for this section are: (1) Conn,

Engelman, and Fairchild, Guarding the United

States and Its Outposts, ch. XIV; (2) Watson, Chief
THE ATLANTIC DEFENSE AREAS

CONVALESCENT PATIENTS ON THE SUNDECK OF THE 221ST STATION HOSPITAL,

Bermuda.

27

A small station hospital landed with

the original troop complement and established itself in the headquarters hotel,

where it eventually occupied rooms on

ground, mezzanine, second, and third

floors. The first patient was received on

23 April. The hospital commander, Col.

E. M. P. Sward, also served as surgeon,

Bermuda Base Command. He was responsible for the health of all Army

troops, including Air Corps, in Bermuda;

for U.S. civilian construction workers;

and for the on-the-job health of locally

procured labor. The Navy had a hospital

of its own at the naval base and air station at Kings Point projecting into Great

Sound at the western end of the main

island.

of Staff, pp. 481-82; (3) Annual Rpts, Surg, Bermuda Base Comd, 1941, 1942-45; (4) ETMD's,

Bermuda Base Comd, Jul 43-Dec 45; (5) Hist

Monograph, U.S. Army Base, Bermuda, by N Atl

Div, CE, OCMH files; (6) Hist of Preventive Medicine in World War II, Eastern Defense Comd, Tab:

Bermuda Base Comd; (7) Med Hist Rcd, Oct 44-

Dec 1944, app. L, AAF, N Atl Div, ATC; (8) Ltr,

Col. E. M. P. Sward (Ret) to Col Goriup, 27 Jul

59; (9) Ltr, Col Paul A. Keeney (Ret) to Col John

Boyd Coates, Jr., 29 Oct 59. Both letters comment

on preliminary draft of this chapter.
28 MEDITERRANEAN AND MINOR THEATERS

On 1 December 1942 the base hospital was designated the 221st Station Hospital, with a T/O capacity of 250 beds.

Army medical personnel in Bermuda at

this time numbered 29 officers and 137

enlisted men; troop strength in the

islands was approximately 4,000 climbing to a peak of about 4,500 in March

1943. The hospital moved from the Castle

Harbour Hotel on 1 May 1943 to a new,

modern building of concrete and coral

only a quarter of a mile from the Air

Transport Command terminal at Kindley Field, the newly completed American air base that was the principal installation of Fort Bell. A dispensary

previously maintained at the field was

closed, but the hospital continued to

maintain other dispensaries wherever

the troop population warranted.

Since by mid-1943 construction was

largely finished and military activities

were of a routine nature, the need for

hospital beds was beginning to decline.

An agreement with the Navy was reached

during the summer, and in September

1943 the naval hospital transferred all

patients to the 221st Station, preparatory

to closing. Thereafter all Navy personnel

requiring more than dispensary care, including transients from the Atlantic

Fleet, were treated at the base hospital.

Col. Paul A. Keeney was hospital commander and base surgeon.

The work load had lightened appreciably before the end of 1943, with troop

strength standing at 2,800 in November.

As of 1 June 1944, with less than 2,300

U.S. troops still in the command, the

221st Station Hospital was reorganized

as a 150-bed unit, and in August 1945

was further reduced to 100 beds. Troop

strength was then below 2,000. On 1

January 1946 the hospital passed to control of the Air Transport Command.

Evacuation to the United States was

irregular. In the absence of hospital

ships or medical air evacuation planes,

patients were evacuated by commercial

airline or by any available ship equipped

with adequate hospital facilities. There

might be weeks between planes and

months between ships. In these circumstances, the 120-day evacuation policy was

sometimes exceeded, and the 221st

found it necessary to give more comprehensive medical care than was normal

for station hospitals.

In August 1944 Bermuda became a

stop on one of the main air evacuation

routes from Europe, Africa, the Middle

East, and the China—Burma—India Theater. A medical air evacuation detachment consisting of nurses and enlisted

men was stationed at Kindley Field to

rotate with personnel of incoming planes

of the 830th Medical Air Evacuation

Transport Squadron. At the Bermuda

base, the 221st Station Hospital was responsible for feeding transient patients,

treating them where necessary, and, if

circumstances required, hospitalizing

them. Although the hospital had been

reduced to 150 beds before this time,

ample accommodations were available.

Indeed, in January 1945, when the

USAHS St. Mihiel ran aground in the vicinity, the 221st Station cared for more

than 500 patients of the hospital ship for

two weeks. From September 1944 until

several months after the end of the war,

well over 1,000 patients a month passed

through Bermuda on their way to the

zone of interior. March 1945 was the

peak month with 1,837.

The medical service of the 221st Station Hospital saw only routine cases, with
THE ATLANTIC DEFENSE AREAS 29

even the venereal disease rate relatively

low. The surgical service dealt with a

number of accident cases, but the only

combat wounds hospitalized there were

suffered at sea by personnel of the Atlantic Fleet or one of the Allied naval

units based on Bermuda.

U.S. Army Forces in the Azores

U.S. planners in 1941 contemplated

the occupation of the Portuguese Azores

by a U.S. military force, but the project

was postponed in favor of relieving the

British garrison in Iceland, where the

urgency seemed greater. In mid-1943,

after defeat of the German and Italian

forces in North Africa and the subsequent conquest of Sicily, the use of the

Azores as a link in a new central Atlantic

route to Europe, the Middle East, and

Asia was definitely planned, pending

agreement with the Portuguese Government. In October 1943 the British succeeded in getting permission to use the

islands for military purposes under the

terms of an old treaty. A British naval

base and an air base near Lagens on

Terceira Island, were quickly established, and in December American personnel began to share the airfield with

the British. This joint occupancy continued until September 1944, when the

Portuguese finally gave the United

States permission to establish an exclusively American base on Santa Maria

Island, about 150 miles southeast of Terceira.12

Organizationally, the U.S. base in the

Azores was set up as part of the North

African theater, but did not long remain

in that status. In May 1944, under the

designation U.S. Army Forces in the

Azores, jurisdiction over American personnel and installations in the islands

passed to the Eastern Defense Command.

In February 1945 the North Atlantic

Division of the Air Transport Command

took over control of all U.S. interests in

the Azores.

Medical support of U.S. Army troops

on Terceira Island consisted initially of

a dispensary with evacuation to a British

hospital for cases requiring more than a

few days' confinement. By February 1944

the dispensary had grown until it occupied several Nissen huts. Other prefabricated buildings were added between

February and May. Forty-four regular

beds enabled American troops to be hospitalized in their own area, which greatly

facilitated the operation of the medical

service. In addition, another 35 or 40

beds were available to accommodate

evacuees from other theaters on their

way to the zone of interior. A 170-bed

medical installation was requested by

the Azores Base Command, but no such

unit was established there until after the

war. On Santa Maria Island the Medical

Department began operating a dispensary with the arrival of the first troops in

September 1944. During the remainder

of the year the Medical Department on

the island acquired frame buildings and

tentage to maintain a 120-bed dispensary.

The dispensaries on Terceira and Santa

Maria remained in operation through

the end of the war and into the postwar

12

 Sources for this section are: (1) Matloff and

Snell, Strategic Planning for Coalition Warfare, pp.

44-455 (2) Hist of the Med Dept, ATC, May 41- Dec 44; (3) Arctic Laboratory, Sep 41-Jan 44, AAF,

N Atl Wing, ATC, pt. I, pp. 40-43, pt. II, pp. 1-5,

and app. L; (4) Med Hist Rcd Oct 44-Dec 44,

AAF, N Atl Div, ATC, pt. I, pp. 30-35, pt. II, pp.

2-6, and apps. K and P; (5) Annual Rpt of Med

Dept Activities, Base Hosp, Azores Air Transport

Sta, Atl Div, ATC, 1947.
30 MEDITERRANEAN AND MINOR THEATERS

period, when the one on Terceira Island

became a 50-bed hospital. Both installations had been in effect hospitals from

the start, but continued to be called dispensaries because of the reluctance of

the Medical Department to assign hospitals to Air Forces commands. They

served a combined U.S. troop population

that averaged about 1,200, plus an indefinite number of transients.

The threat of plague was the most

serious medical problem facing the Medical Department in the Azores. It had

occurred sporadically for a number of

years in all three forms: bubonic, pneumonic, and septicemic. The latter two

types invariably proved fatal. All troops

destined for the Azores received one

inoculation of plague vaccine before

departure from the United States and

another after arriving in the islands. The

Medical Department in the Azores conducted a vigorous rat extermination

program and regularly inspected the

quarters and all other buildings used by

the Army. Not a single case of plague

developed among U.S. Army troops in

the Azores. Typhoid fever and venereal

diseases were two other dangers to the

health of troops, but control measures

prevented the former and lessened the

latter disease. As in most of the other

North Atlantic bases, respiratory diseases

and injuries accounted for the majority

of cases requiring hospitalization.

Air evacuation to the United States

through the Azores began on a large

scale after the invasion of western Europe. When most of France fell into

Allied hands, it was possible to evacuate

casualties direct from the Continent to

the United States. By the end of 1944 a

winter evacuation route using the Azores

rather than Iceland was adopted, thus

offsetting the disadvantages of cold

weather operations in northern latitudes

and reducing evacuation time from

France to the United States. About 2,000

patients a month passed through the

Azores during the winter of 1944-45.

U.S. Army Forces in Eastern

and Central Canada

The primary mission of the U. S. forces

in eastern and central Canada was to

speed delivery of planes to the United

Kingdom—first lend-lease planes for the

hard-pressed Royal Canadian Air Force,

then fleets of bombers and fighters to be

flown in combat by American crews.

The quickest, and in the long run the

safest, way to deliver a plane was under

its own power. It needed only a line of

bases close enough together to be within

the range of fighter craft, and adequate

weather information. A direct route for

heavy and medium bombers from Newfoundland to Scotland had been pioneered in 1940, but it was hazardous at

best. Greenland was the key, and the

way was cleared for its use in the spring

of 1941. The first U.S. troops in the areas

designated for bases in eastern and central Canada were Engineer Corps personnel under direct command of the

General Staff.13

13

 Principal sources for this section are: (1) Conn

and Fairchild, Framework of Hemisphere Defense,

ch. XV; (2) Samuel Milner, "Establishing the

Bolero Ferry Route," Military Affairs, vol. XI

(Winter 1947), pp. 213-22; (3) Craven and Cate,

eds., Plans and Early Operations, pp. 313-18; (4)

Colonel Stanley W. Dziuban, Military Relations

Between the United States and Canada, 1939-1945,

UNITED STATES ARMY IN WORLD WAR II

(Washington, 1959); (5) Arctic Laboratory, Sep

41-Jun 44, AAF N Atl Wing, ATC, pt. I, chs. 1

and 2, and apps. D, G, H, and K; (6) Med Hist

Rcd, Oct 44-Dec 44, AAF N Atl Wing ATC, apps.
THE ATLANTIC DEFENSE AREAS 31

The Air Ferry Routes

An air ferry route from Presque Isle,

Maine, to Prestwick, Scotland, was well

along by the end of 1941. The first hop

would be to Gander, Newfoundland, or

alternatively, because of crowding at

Gander, to Goose Bay, Labrador, where

the Canadian Government began construction of an airfield late in September.

BLUIE WEST 1 at the southern tip of

Greenland, under construction since

July, would be the second stop, and

Reykjavík, Iceland, the third. Air distances were approximately 570 miles

from Presque Isle to Goose Bay, 775

miles from Goose Bay to BLUIE WEST 1,

another 775 miles to Iceland, and the

final and longest hop of 840 miles from

Reykjavík to Prestwick. Fighter planes

would need extra fuel tanks, but they

would make it. Weather stations established in September 1941 at Fort Chimo

in northern Quebec Province, at Frobisher Bay on Baffin Island, and on Padloping Island off the shore of Baffin

Island just above the Arctic Circle were

to supply information for the guidance

of pilots. These weather stations were

designated respectively CRYSTAL 1, CRYSTAL 2, and CRYSTAL 3.

The air ferry route through Labrador,

Greenland, and Iceland was barely operational when the whole program was revised and enlarged in the middle of 1942.

The enlarged project was known as

CRIMSON. Entry of the United States into

the war had increased the pressure to

get planes to the British Isles, and the

entire Eighth Air Force was to be flown

to its British base. The new plan in no

way canceled out the old, but added to

it a route through central Canada that

would tap the aircraft production centers in California and the middle west.

Stations on the central route would be

Great Falls, Montana, The Pas in west

central Manitoba, Churchill on Hudson

Bay in northern Manitoba, Coral Harbour on Southampton Island just below

the Arctic Circle, and thence to BLUIE

WEST 8, the northernmost Greenland

base, and on to Iceland and Scotland.

Additional airfields were to be located

at Mingan on the north shore of the Gulf

of St. Lawrence, about midway between

Presque Isle and Goose Bay, and at the

weather posts at Fort Chimo and Frobisher Bay. Nine additional weather observation posts were to be established in

the central area.

Work on these arctic bases went forward feverishly during the brief summer

season of 1942. Engineer troops were

supplemented by Air Corps ground

crews as runways neared completion, and

before the winter of 1942-43 closed in,

nearly 900 planes of the Eighth Air

Force were flown to Scotland by one or

another of these routes. The number of

U.S. military personnel in central and

eastern Canada, including those assigned

to the CRYSTAL and CRIMSON projects,

climbed from 1,891 in March 1942 to

more than 17,000 in August, then

dropped abruptly to 2,571. For the first

six months of 1943 the average troop

strength was about 1,350. By that date

the project stage was past. In July 1943

the United States Army Forces in Central Canada was set up as an independent

D, G, and J; (7) ETMD's, USAFCC, Oct 43-Sep

45, and USAFEC, Oct 43-Sep 44; (8) Annual Rpt,

4th Sta Hosp, 1943; (9) Final Rpt, Surg, USAFCC,

29 Sep 45; (10) Annual Rpt, Surgeon, USAFEC,

1943; (11) Rpt of Inspection, Med Serv, Crimson

Project, Eastern Sector, by Brig Gen Albert W. Kenner to TSG, n.d., inspection between 20 and 30

Jul 43.
32 MEDITERRANEAN AND MINOR THEATERS

command. At the same time jurisdiction

over the bases in eastern Canada was assigned to the North Atlantic Wing of the

Air Transport Command. A theater-type

organization, the U.S. Army Forces in

Eastern Canada was created early in September, but with little change in anything but name. The Commanding

General, North Atlantic Wing, ATC,

doubled as Commanding General,

USAFEC, until October 1944, when the

theater organization was discontinued

and the Air Transport Command resumed direct control.

Medical Support on the

Air Ferry Routes

No Army hospitals went into either

eastern or central Canada until November 1942, when the airfields and weather

stations had assumed the character of

permanent operating posts. The construction and maintenance crews that

had swelled the personnel totals in the

summer of that year had been cared for

in temporary engineer hospitals and in

dispensaries set up by Air Forces medical

detachments.

While the eastern route was in use first,

the earliest U.S. medical support, other

than the transient engineer and air units,

went to bases in central Canada. Adequate hospital facilities were available in

the eastern sector at Presque Isle, at

Gander, and in Greenland. Of the major

fields along this route, only Goose Bay

was without U.S. hospital facilities, but

for the time being the Royal Canadian

Air Force hospital there served personnel of both nations.

On the central route, every effort was

made to supply medical service for all

bases before the winter of 1942-43

brought varying degrees of isolation.

A 25-bed dispensary was set up at Coral

Harbour, Southampton Island, on 17

August 1942. The 131st Station Hospital,

of 100 beds, opened at The Pas on 10

November, and two days later the 4th

Station, also a 100-bed unit, got into

operation at Churchill. The theater

surgeon, Capt. (later Maj.) Michael

Q. Hancock, was based at the Winnipeg headquarters of the U.S. Army

Forces in Central Canada, where a

one-man dispensary supplemented the

facilities available in Canadian Army

and Air Force hospitals. The various

weather observation posts, each in charge

of a noncommissioned officer with 5 to 9

men, relied on the skills of medical enlisted men. Emergencies were diagnosed,

and treatment was prescribed by radio

until one of the theater's 4 medical officers could reach the spot, or until the patient could be brought out.

By the end of 1943, with the submarine menace virtually eliminated and

good alternative air routes to share the

load, the air ferry route through central

Canada declined in importance. The two

hospitals were inactivated in December

and moved from the theater, each being

replaced by a 10-bed dispensary, operated

by a medical officer and eight enlisted

men. In April 1944 Capt. (later Maj.)

Alien G. Thurmond succeeded Hancock

as theater surgeon, and was relieved in

turn by Capt. Werner Lehmann, formerly post surgeon at Churchill, at the

end of the year. The dispensaries at

Churchill and The Pas were both inactivated in July, as was the dispensary at

Coral Harbour in August. The headquarters dispensary, last U.S. medical installation in central Canada, closed late

in September 1944 as the theater itself
THE ATLANTIC DEFENSE AREAS 33

passed out of existence.

In eastern Canada the 6th Station

Hospital (150 beds) was established at

Goose Bay in April 1943. In the same

month two 50-bed units were opened

farther north—the 133d Station Hospital at Fort Chimo, Quebec, and the

134th at Frobisher Bay on Baffin Island.

In August a 10-bed dispensary was set

up at Mingan, Quebec, south of Goose

Bay. The 6th Station, meanwhile, had

been reduced to 75 beds. The authorized

bed strength of the 133d and 134th

Station Hospitals was similarly halved in

September. A medical officer and a quantity of medical supplies continued to be

maintained on Padloping Island because

of its remote and isolated position.

All of the Army medical installations

in eastern Canada were withdrawn in

July 1944, so that the reorganization of

October did not affect the Medical Department as such. Medical service at

Goose Bay and such other fields in the

sector as remained in use was thereafter

exclusively supplied by the North Atlantic Wing, Air Transport Command. The

change in command, so far as the medical

service was concerned, was nominal,

since the wing surgeon, Col. Gordon G.

Bulla, had served also as theater surgeon

throughout the life of USAFEC.

The problems faced by the Medical

Department in Canada were initially

those of getting established in an unfamiliar and often inhospitable environment. In arctic and subarctic stations,

weather was always a factor. Clothing

originally issued quickly proved inadequate, but the men were not long in

adopting the Eskimo mukluks, Indian

moccasins, or the heavy felt shoes sold

by the Hudson Bay Company as preferable to the shoes issued by the Quartermaster. There were similar difficulties

with mittens and parkas. Suitable housing for medical installations offered another problem. The 4th Station Hospital

at Churchill, for example, occupied buildings without insulation, with unheated

corridors, and with cracks in eaves and

window ledges through which snow sifted. A modern, completely insulated hospital plant, with hot and cold running

water, electric lights, and steam heat was

constructed, but owing to labor shortages

and low priority it was not finished until

January 1944, after the hospital had been

inactivated.

In addition to Army and transient Air

Forces personnel, all the Army hospitals

treated civilian construction workers.

Those farthest north also treated local

Eskimos and Indians, who were at first

sent to the American doctors by the

Royal Canadian Mounted Police and

later came of their own accord.

Once the difficulties of adjustment

were overcome, the health record was

remarkably good. Cold injury was a

rarity, upper respiratory diseases were

less frequent than experience in cold

climates would have indicated, and

venereal diseases, though by no means

unknown, were largely the result of exposures outside of the theater. Even

neuropsychiatric disorders—a frequent accompaniment of service in isolated posts

—were relatively infrequent.

Evacuation was by plane from the remote areas such as Coral Harbour and

Padloping Island, and emergency evacuation was always by plane if feasible. In

Manitoba routine evacuation was by rail,

with one train a week between Churchill

and The Pas, and on alternate days from

The Pas to Winnipeg. The more isolated

weather stations could be reached only
34 MEDITERRANEAN AND MINOR THEATERS

COLONEL BULLA

by planes equipped with skis or pontons,

and at times only by tractor or dog sled.

A plane normally based in Winnipeg was

available on call for emergency evacuation and could be notified by radio when

on a mission. Evacuation from the post

hospitals and dispensaries was normally

direct to Army hospitals in the United

States, but Canadian hospitals were

always available in emergency.

Medical supplies were adequate, even

abundant—at times large surpluses piled

up and eventually had to be returned to

supply depots in the United States.

The Caribbean Defense

Command

The Caribbean Defense Command,

authorized by the Secretary of War in

January 1941, was officially activated the

following month, but its organization was

not completed until 29 May 1941. It included the existing Panama Canal and

Puerto Rican Departments, and U.S.

bases and other Army operations in Central America, the British and Dutch

West Indies, the Guianas, Venezuela,

Colombia, and Ecuador. For administrative purposes the command was set up

with three main subdivisions: a Puerto

Rican Sector, a Panama Sector, and a

Trinidad Sector. The Puerto Rican

and Trinidad Sectors were merged in

June 1943. The top command and its

administrative divisions supplemented

rather than supplanted the existing commands in Panama and Puerto Rico,

which remained throughout the war the

two major administrative elements in

the Caribbean area.

The Caribbean Defense Command

had no surgeon until October 1943, when

Brig. Gen. (later Maj. Gen.) Morrison

C. Stayer assumed the duties as its surgeon, but without giving up his assignment as chief health officer of the

Panama Canal Zone. He had been advising the Commanding General, Caribbean Defense Command, informally since

the activation of the command. General

Stayer was succeeded in both capacities

1 March 1944 by Brig. Gen. Henry C.

Dooling.

The Panama Canal Department

By the beginning of World War II the

Panama Canal Department had functioned as a military organization for

more than a quarter of a century. It was

therefore one of the well-established,

permanent garrisons of the U.S. Army.

Army planners regarded the canal as the
THE ATLANTIC DEFENSE AREAS 35

GENERAL STAYER

keystone of Western Hemisphere defenses. Indeed, as early as 1938 the Chief

of Staff had sought to increase the

Panama garrison on the ground that

troops could be quickly dispatched from

the Canal Zone to any threatened area in

South America. Basically, however, the

Army's mission in Panama was to guard

the canal itself from attack by air, sea,

or land, and to protect it from raids by

enemy commandos or saboteurs. The

better to carry out this mission, the jurisdiction of the Panama Canal Department

was extended to the various countries of

Central America and the Pacific slope of

South America as it became necessary

for U.S. forces, primarily Air Corps and

Engineer Department troops, to move

into these areas. The initial task of providing proper defenses also involved the

expansion of all the necessary supporting services, including the Medical

Department.14 Hospitalization—Military strength in

the Panama Canal Department remained at a fairly constant level in the

first half of the decade before World War

II, ranging between 9,000 and 10,000

troops. In 1936 the average strength rose

to about 14,000, where it remained until

1940, when it again increased markedly.

Six small hospitals and four dispensaries

provided most of the necessary medical

service. In 1939 there were approximately 260 dispensary and station hospital beds in the department, but only 50

were actually in a hospital building. The

rest were housed with other activities,

usually in post administrative buildings,

which were noisy and inadequate in size.

In addition to these hospitals and dispensaries, which provided beds for less

than 2 percent of the command, the

14

 General sources for this section are: (1) Conn,

Engelman, and Fairchild, Guarding the United

States and Its Outposts, ch X; (2) Caribbean Defense Comd, Organization, Development and Reorganization, MS, OCMH files; (3) Hist of the

Panama Canal Dept, vols. I-IV, MS, OCMH files;

(4) Organization and Reorganization [Panama

Canal Dept, 1911-47], MS, OCMH files; (5) War

Plans and Defense Measures [Caribbean Defense

Comd], MS, OCMH files; (6) Annual Rpt of TSG,

U.S. Army, 1940; (7) A Hist of Med Dept Activities

in the Caribbean Defense Comd in World War II,

vols. I-III; (8) Annual Rpts, Dept Surg, Panama

Canal Dept, 1940-45; (9) Clarence McK. Smith,

Monograph, Building Army Hospitals in Panama,

A Prewar Construction Problem, 1939-1940; (10)

Annual Rpts, Off of Surg, Caribbean Defense

Comd, 1943-44; (11) ETMD's, Caribbean Defense

Comd, Oct 43-Dec 45; (12) Annual Rpts, 218th

Gen Hosp, 1941-42; (13) Annual Rpts, 210th Gen

Hosp, 1942-43; (14) Annual Rpts, 262d Gen Hosp,

1944-45; (15) Annual Rpt, 333d Sta Hosp, 1943;

(16) Historian's Rpt, 368th Sta Hosp, 1946; (17)

Rpt of Med Activities, Pan American Highway, to

30 Jun 43; (18) Ltr, Brig Gen Henry C. Dooling

(Ret) to Col Goriup, 5 Aug 59; (19) Ltr, Col John W. Sherwood (Ret) to Col Goriup, 2 Aug 59. Both

letters comment on preliminary draft of this chapter.

THE ATLANTIC DEFENSE AREAS 37

Army had an allotment of some 400 beds

in two hospitals operated by the Panama

Canal Health Department—the Gorgas

Hospital on the Pacific side of the canal

and the Margarita Hospital on the Atlantic side. It was the continuous availability of these hospitals—especially the

Gorgas Hospital—for handling unusual

or difficult cases that kept the medical

service at a high level despite inadequate

bed strength at the military posts. The

policy of allocating beds in the Panama

Canal Health Department hospitals continued during the war, but with the

allotment reduced to 250 beds after 1943,

by which time new Army hospitals had

become available. (Map 2) The Panama

Canal Department surgeon when the

United States entered the war was Col.

John W. Sherwood, who was succeeded

in May 1943 by Col. Wesley C. Cox.

A plan for the construction of permanent Army hospitals in the Panama

Canal Zone was developed in 1935 by

the Panama Canal Department surgeon

in co-operation with The Surgeon General of the Army. Congress approved the

plan in 1937, authorizing the construction of a 528-bed hospital at Fort Clayton

on the Pacific side of the canal, a 401-bed

hospital at Fort Gulick on the Atlantic

side, and a 60-bed hospital for the combined posts of Fort Kobbe and Howard

Field in the Pacific sector. Funds for the

hospital construction program did not

materialize until a year later, by which

time construction costs had so increased

that it became necessary to reduce the

capacity of the two larger hospitals by

150 beds each. The War Department approved the plans on that basis in 1939,

but there were further delays. The Medical Department was not satisfied that

the program as approved was adequate;

the governor of the Canal Zone thought

the construction of Army hospitals unnecessary; there were delays in the preparation of plans and specifications; funds

were inadequate for the number of beds

desired; there were difficulties in obtaining materials and equipment; the heavy

rainfall hampered construction.

By June 1940 the Panama Canal Department had doubled its 1939 strength,

but still no beds were added to the already insufficient number. The bed

shortage was reported critical by representatives of the Medical Department

returning from the Canal Zone. As an

expedient, temporary beds were installed in a converted barracks, while

station hospitals were expanded, pending the construction of permanent medical facilities. In general, expansion of the

department dictated that hospitals be

operated at nearly all posts in the command.

The new Army hospitals at Fort Gulick and Fort Clayton, finally completed

in September 1943, opened with rated

capacities of 251 and 378 beds, respectively. By making full use of the very

spacious porches, the hospitals almost

doubled their capacities. A third new

hospital, located at Fort Kobbe and ready

for use in June 1943, never functioned

as originally intended, but served as a

dispensary through the war years. The

maximum strength of the Army in Panama, about 65,000, had been reached

late in 1942, well before the completion

of the permanent hospitals. As a result,

hospitals operating in converted barracks and other nonhospital buildings

cared for the peak loads of patients. With

the two largest hospitals completed and

occupied by the end of the summer of

1943, the other post, or station, hospitals
38 MEDITERRANEAN AND MINOR THEATERS

in the Canal Zone were reduced to dispensaries. The Panama Canal Department had an average of 2,120 beds available during 1943, roughly 4 percent of

the average strength of the command.

The Medical Department units that

operated the major hospitals in the

Panama Canal Department did considerable shifting about, both in place and in

designation, because of construction delays and reorganizations. The two largest

units, the 210th and 218th General Hospitals, arrived in Panama in January

1942. The 210th upon arriving at Fort

Gulick, the site of the new permanent

hospital then still in the process of construction, immediately occupied fourteen

recently finished permanent barracks on

the post and began admitting patients

three weeks later. The 218th General

Hospital, which was to occupy the new

permanent hospital building at Fort

Clayton, could not do so because construction on this post was far from completed. Its personnel was thereupon

split up and dispersed on temporary

duty mainly to post hospitals at Fort

Amador and Fort Kobbe on the Pacific

side of the canal, and in smaller numbers

to several other posts in the Canal Zone,

pending the completion of the Fort Clayton hospital.

The 218th General was redesignated

the 353d Station Hospital in April 1943,

but the hospital's personnel were not

brought together until September 1943,

when it moved into the newly completed

Fort Clayton hospital. It continued operating this plant as the 333d Station

Hospital until April 1944, when the unit

again became a general hospital with a

capacity of 750 beds. The 262d General

Hospital, as it was then called, ran the

Fort Clayton hospital for the remainder

of the war. Over on the Atlantic end of

the canal, the 210th General Hospital,

which had operated in barracks buildings since January 1942, moved into the

new hospital plant on the Fort Gulick

post in September 1943. This general

hospital was reorganized as the 368th

Station Hospital (450 beds), in April

1944, the chief reason being the decrease

in the number of troops in the Atlantic

sector of the Canal Zone. It continued

operating at Fort Gulick throughout the

remainder of the war, but was further

reduced to 300 beds in December 1944.

The new hospital construction in the

Canal Zone followed the pattern of the

Gorgas Hospital, that is, tropical construction of reinforced concrete, with

broad overhanging eaves on each floor

for protection against the sun, and wide

porches with jalousies to keep out the

driving tropical rains. The solidly constructed buildings compared favorably

with any hospital in the United States

and satisfied the needs of the Army in

Panama for years to come.

In the Central American and South

American countries under the jurisdiction of the Panama Canal Department,

medical service was supplied largely by

small hospitals and dispensaries under

control of the Sixth Air Force or the

Corps of Engineers. During 1942 hospitals with capacities of 25 beds each

were established at David, Republic of

Panama; Guatemala City, Guatemala;

Salinas, Ecuador, and Talara, Peru. The

Air Forces had a 75-bed hospital constructed on Seymour Island in the Galapagos Island group, strategically located

1,000 miles from Panama in the Pacific

Ocean, protecting the western approaches

to the canal. (See Map 2.) All of these

hospitals were constructed as tempo-
THE ATLANTIC DEFENSE AREAS 39

rary, theater-of-operations-type buildings. Eight dispensaries of temporary

construction, having 10 beds each, were

built at other locations in the Republic of Panama during 1942. Most of

the hospitals expanded their capacities

during 1943, and an additional 25-bed

hospital and two 10-bed dispensaries

opened during that year. In 1944 the

hospital at David and those in Ecuador

and Peru became station dispensaries.

Most of the dispensaries had ceased operating by 1945, but three of the hospitals and two dispensaries remained open

through the greater part of the year.

Still another Army group maintained a

medical service in the area: the Corps of

Engineers, who were responsible for

building the Pan American Highway. In

December 1942 and January 1943 medical personnel arrived to operate dispensaries at various points along the

route of the highway in Guatemala, El

Salvador, Honduras, Nicaragua, Costa

Rica, and Panama. The health of between 1,500 and 2,500 American workers and technicians employed on the

highway, together with that of thousands of local laborers was the chief concern of the Pan American Highway

medical service, under the direction of

Lt. Col. E. T. Norman. At the end of

August 1943 there were 13 medical officers, 2 dental officers, a sanitary officer,

and 50 assorted male nurses, attendants,

technicians, and pharmacists supporting

the highway builders.

Health Problems—Malaria and venereal disease were the two major medical problems in the Panama Canal

Department. The work of the Medical

Department during 1940-45 succeeded

in bringing the admission rates for these

diseases down to an all-time low. The

admission rate per thousand per year for

malaria in 1940 was 57,2. It reached a

peak of 116.4 in 1942, but declined

steadily thereafter, to the rate of only 9.3

in 1945. A primary factor in the upward

spurt early in the war was the establishment of antiaircraft batteries in remote

jungle areas; and the removal of

troops from screened barracks in sanitated zones to tent camps in more distant

locations as a precaution against anticipated air raids. Venereal disease rates

amounting to 71.7 per thousand per year

in 1940 were also steadily brought down

to 17.6 in 1945, the lowest ever recorded

in the Panama Canal Department up to

that time. The malaria and venereal

disease control programs were operated

under the guidance of the Medical Department in co-operation with civil

health authorities, but basically control

measures rested with the individual

Army units, whose command responsibility in these matters consisted of thoroughly indoctrinating their personnel.

Medical Supply—Some difficulty was

experienced in obtaining medical supplies in adequate quantities during

1940-42, the period of rapid growth of

military strength in the Canal Zone. Production facilities were being expanded,

shipping was short, and there were many

claimants for each item available. In

1942 German submarine activity in the

Caribbean was responsible for the destruction of some medical supplies and

for delay in the delivery of others. By

1943, however, shortages in medical supplies had disappeared. The system of

automatic supply through the shipment

of medical maintenance units, which had

prevailed during the early period, was
40 MEDITERRANEAN AND MINOR THEATERS

LOADING A SICK SOLDIER ONTO A SMALL PLANE in Darien Province, Panama, for

evacuation to one of the Canal Zone hospitals.

discontinued in September 1943 when

the department began making monthly

requisitions for all supplies. In common

with the usual experience of noncombat

areas, an excess eventually accumulated,

which was shipped back to the United

States in 1943 and 1944. Because of the

high humidity, certain medical supplies,

notably metal instruments and canvas,

were vulnerable to deterioration. The

use of dry rooms, equipped with electrical heating units to reduce the moisture

in the air, prevented the loss of much

valuable equipment.

Evacuation—The volume of evacuation from Panama to the United

States never reached a very high level.

Hospital admissions consisted largely of

disease cases, with a lesser number of

injuries, and no battle casualties. Many

cases that would have to be evacuated

from more isolated areas in the Western

Hemisphere could easily be treated in

the modern general hospital facilities in

the Canal Zone. Proximity to the United

States facilitated the evacuation of

patients when necessary. A 90-day hospitalization policy existed in the early
THE ATLANTIC DEFENSE AREAS 41

part of the war, but by 1943 it had increased to a 120-day policy, which, in

effect, precluded evacuation unless protracted treatment was needed. In general, only men deemed unfit for further

duty were returned to the zone of interior. Within the Canal Zone the

Medical Department moved sick and injured men from their units to points of

hospitalization by motor ambulance. In

most instances this procedure meant a

trip of less than twenty miles. Boat evacuation was used to transport patients

from installations around Gatun Lake

and from otherwise inaccessible locations

in the interior of Panama. The Panama

Canal Railroad transported most of the

patients requiring movement from one

end of the canal to the other. The air

bases in the Republic of Panama and in

Central and South America evacuated

their patients to Canal Zone hospitals

by air. The department sent most of its

ZI patients to New Orleans by ship,

but a small number of cases made the

trip to the United States by air. The

latter method was used especially in

those cases requiring an immediate

change of environment and climate, or

for patients needing very specialized

treatment of a type not available in

Panama.

Puerto Rico and the Antilles

The U.S. Army had maintained a

garrison on Puerto Rico from the time

that island was ceded to the United

States at the conclusion of the SpanishAmerican War. In the period before

World War II troops there were under

the jurisdiction of the Second Corps

Area. This attachment to the zone of

interior ceased when the War Department established Puerto Rico and the

Virgin Islands as a territorial department on 1 July 1939. The Puerto Rican

Department, as the new command was

named, served a dual role: first, as the

most advanced U.S. possession from

which American sea and land operations

could be projected southward or eastward; and, second, as a forward defensive barrier protecting the eastern

approach to the Panama Canal. After

the destroyers-for-bases agreement of

1940, the U.S. Army extended its fringe

defenses of the canal into other islands in

the Caribbean, providing at the same

time a defense of the bauxite "lifeline"

from the Guianas to Trinidad and the

United States. Included were bases

leased from the British on Jamaica, Antigua, St. Lucia, and Trinidad, and bases

on Aruba and Curaçao leased from the

Dutch Government. Other bases for

American troops were established in the

Guianas and in Cuba, while U.S. soldiers

remained for a considerable time in

Venezuela, on training mission. The

Puerto Rican Department, renamed the

Antilles Department in June 1943, absorbed all the above named-areas during

the course of the war.15

15

 (1) Conn and Fairchild, Framework of Hemisphere Defense, ch. X. (2) War Plans and Defense

Measures [Caribbean Defense Comd]. (3) A Hist

of Med Dept Activities in the Caribbean Defense

Comd in World War II, vols. I-III. (4) Annual

Rpts, Med Dept Activities, Puerto Rican Dept, 1941

and 1942. (5) Annual Rpts, Medical Dept Activities, Antilles Department, 1943-45. (6) ETMD's,

Caribbean Defense Comd, Oct 43-Dec 45. (7) Annual Rpt, Med Dept Activities, Trinidad Sector and

Base Comd, 1942 and 1943. (8) Annual Rpt, Med

Dept Activities, British Guiana Base Comd, 1942.

(9) Health Service, Caribbean, 1942. (10) Annual

Rpts, Sta Hosps, Borinquen Field, P.R., Losey Field,

P.R., Ft. Read, Trinidad, and Aruba, N.W.I., 1942.

(11) Annual Rpt, 161st Gen Hosp, Ft. Brooke, San

Juan, P.R., 1945. (12) Annual Rpt, Med Dept Activities, U.S. Army Forces in Surinam, 1942. (13)
42 MEDITERRANEAN AND MINOR THEATERS

Puerto Rico eventually had the

largest concentration of U.S. Army troops

in the Caribbean, outside the Panama

Canal Zone. When formed as a territorial department in July 1939, the total

strength amounted to 931 officers and enlisted men, serving at the main post of

Fort Brooke in San Juan and at the

subpost of Henry Barracks near Cayey.

By December the strength had risen to

2,913 and continued upward through

1940, reaching more than 13,000 in December of that year. These troops were

divided among six posts in Puerto Rico

and one in the Virgin Islands. Army

strength in the Puerto Rican Department continued to enlarge beyond any

legitimate military need, mainly because

the operation of the Selective Service

System brought more Puerto Ricans into

the Army than could be used elsewhere.

Military strength doubled in 1941 over

that of the previous year and doubled

again during 1942. At the time of the

formation of the Antilles Department,

the command had a strength of over

50,000. It reached a peak of more than

57,000 in September 1943, which

amounted to only about 8,000 less than

the maximum strength attained by the

Panama Canal Department.

Hospitalization—The most important

prewar Medical Department facility in

Puerto Rico was the old station hospital

at Fort Brooke housed in buildings

turned over to the United States by the

Spanish Government at the conclusion

of the Spanish-American War. The hospital buildings dated back to the i8th

century, but during the course of World

War II, approximately a million dollars

was spent to modernize and improve the

buildings and to make them more suitable for modern hospital use. In 1941

the hospital had a capacity of about 600

beds and acted as a general hospital for

the entire Puerto Rican Department. At

Fort Buchanan, about seven miles south

of San Juan, another station hospital,

originally activated as a medical detachment on the post of Fort Buchanan in

October 1939, became the post hospital

in late 1941, with a capacity of 150 beds.

(See Map 2.)

Borinquen Field, the main air base,

located in the northwest corner of

Puerto Rico, had a Medical Department dispensary servicing the field from

the time the first troops arrived there in

September 1939. In May 1941, a 150-bed

station hospital began operating at the

field. Another airfield, known as Losey

Field, situated near Ponce in the south

central part of the island, was the location of a 100-bed station hospital, which

began operating for the garrison there

in April 1941. The old established post

of Henry Barracks served as a subpost of

Fort Brooke until December 1939. In

March 1940, a station hospital of 10 beds

was established for the post, and by October of 1941 it had a capacity of 55 beds.

Most troops stationed at Camp Tortuguero, a post in the northern part of the

island west of San Juan, used the Fort

Brooke station hospital. A hospital ward,

completed at Camp Tortuguero in July

1941, took care of mild medical and surgical cases. A dispensary, opened in

March 1941, administered to the needs

of the garrison at Benedict Field, located

on St. Croix, Virgin Islands.

In the year before Pearl Harbor, the

Medical Department had operated these

Ltr, Col Dean M. Walker (Ret) to Col Goriup,

18 Jul 59, commenting on preliminary draft of this chapter.
THE ATLANTIC DEFENSE AREAS 43

seven stations with a minimum of personnel. There were less than 400 officers

and enlisted men of the Medical Department in the command at the beginning

of 1941, but the number had more than,

doubled by the end of the year. Col.

Walter P. Davenport was the surgeon of

the Puerto Rican Department.

Growing troop strength in Puerto

Rico in 1942 resulted in the expansion

of most existing medical facilities and

the establishment of others. The Medical Department had little choice in the

selection of hospital sites since medical

installations had to be located at points

where large concentrations of troops

existed. New hospital construction in

Puerto Rico and other islands of the

Antilles was characterized by the use of

temporary, wooden, theater-of-operations-type structures. Where a post was

planned as a permanent military installation, as in the case of Borinquen Field,

hospital construction was eventually of

a permanent type.

The main hospital at San Juan increased its capacity to 750 beds during

1942. To it were evacuated all neuropsychiatric patients in the department,

all cases requiring lengthy hospitalization, and all those destined for the zone

of interior. Most of the other hospitals

increased their capacities in 1942, and a

new 100-bed station hospital, completed

during the year, began serving the troops

stationed at Camp O'Reilly in eastern

Puerto Rico near the town of Gurabo.

In late 1941 and 1942 garrisons were

sent to Jamaica and Antiqua after the

Puerto Rican Department was expanded

to include these British islands. Temporary hospitals of 25 beds each served

the U.S. Army troops there. A small hospital of 18 beds was established on St.

Thomas, Virgin Islands, in 1942, and the

dispensary that had operated on the island of St. Croix became a 25-bed hospital during the same year.

Medical service in the southern half

of the Caribbean area, which included

bases in Trinidad, St. Lucia, Aruba,

Curaçao, British Guiana, and Dutch

Guiana, did not come under the jurisdiction of the headquarters in Puerto

Rico until the establishment of the

Antilles Department in June 1943. Prior

to that time, U.S. bases in the area were

under the jurisdiction of the Trinidad

Sector and Base Command, of which Col.

Dean M. Walker was surgeon. American

troops moved into Trinidad, southern

anchor of a defensive arc that included

Newfoundland and Bermuda, in May

1941, but for several months had no medical support other than that supplied by

their own medical detachments, backed

up by British hospitals. In December

1941 construction was begun on a plant

to house a 500-bed station hospital at

Fort Read, the principal U.S. base on the

island, but it was September 1942 before

the hospital opened. By that date an additional temporary hospital plant was

under construction to provide transient

hospitalization should it be necessary to

evacuate substantial numbers of casualties from the forthcoming invasion of

North Africa. Since operations in

Morocco and Algeria produced only a

minimal number of casualties, the temporary hospital was never called upon to

serve its original purpose. The main unit

meanwhile was redesignated on 1 December 1942 as the 41st General Hospital, and was to have an ultimate capacity

of 1,000 beds. The first commanding

officer was Col. John A. Isherwood.

The 41st General Hospital served as
44 MEDITERRANEAN AND MINOR THEATERS

regional unit for the whole command,

taking patients from all the southern

Caribbean and the Guianas. It was supplemented at Port-of-Spain, Trinidad,

by a small 20-bed unit established early

in 1941 and supplanted in the spring of

1942 by a 200-bed hospital activated as

the 255th Station Hospital on 1 January

1943. Both Trinidad hospitals were constructed of wood and regarded as semipermanent structures. St. Lucia had a

25-bed permanent Army hospital, which

began operating in November 1942. On

the two Dutch islands of Aruba and

Curaçao, the Army maintained station

hospitals of 75 beds each beginning in

early 1942. The base in British Guiana

had a 50-bed permanent-type station hospital located at Atkinson Field, near

Georgetown. Two station hospitals operated at bases in Dutch Guiana, one 50-

bed unit at Paramaribo and a 25-bed

hospital at nearby Zanderij Field. (See

Map 2.)

Coincident with the creation of the

Antilles Department in June 1943, many

of the post hospitals scattered along the

Caribbean island chain and the north

coast of the South American mainland

were activated as numbered station hospitals, often with T/O bed capacities in

excess of those then existing. The post

hospital at Fort Simonds, Jamaica, became the 292d Station Hospital, with a

capacity of 75 beds. At Antigua the post

hospital was converted into the 293d Station Hospital, also of 75 beds. The 294th

Station (25 beds) absorbed the post

hospital at St. Thomas, Virgin Islands.

In Puerto Rico the 295th Station Hospital, of 150 beds, supplanted the post

hospital at Henry Barracks; the Camp

Tortuguero hospital was redesignated

the 296th Station (50 beds); at Fort

Buchanan the 297th Station (75 beds)

replaced the existing unit; and the 100-

bed hospital at Camp O'Reilly was redesignated the 326th Station Hospital

with a T/O of 250 beds. Two new station hospitals were also established in

Cuba supplanting earlier installations:

the 299th (150 beds) at San Julian, and

the 300th (50 beds) at Batista Field.

Most important of the midyear designations was that of the post hospital at San

Juan, which became the 298th Station

Hospital with an authorized capacity of

600 beds. Attached to it in September

was the newly activated 301st Station

Hospital (100 beds) which was moved to

Losey Field when the Air Forces resumed

operations there in June 1944. At that

time the unit was reduced to 25 beds.

Another group of hospitals had their

designations, and sometimes their sizes,

altered in November 1943. These included the post hospital at Borinquen

Field, Puerto Rico, which became the

150-bed 330th Station Hospital; the 41st

General Hospital at Fort Read, Trinidad, which was redesignated the 359th

Station Hospital with a T/O strength of

600 beds; and the small post hospitals at

Zanderij Field, Surinam (352d Station,

25 beds) ; Atkinson Field, British Guiana

(353d Station, 75 beds) ; Paramaribo,

Surinam (354th Station, 50 beds); St.

Lucia, British West Indies (355th Station, 50 beds) ; Curaçao, Netherlands

West Indies (356th Station, 75 beds); and

Aruba, Netherlands West Indies (358th

Station, 50 beds).

With the Axis virtually no threat to

the Western Hemisphere by mid-1943,

except for occasional U-boat raids on

shipping, the strategic importance of

Puerto Rico and other islands in the

Caribbean declined. The Medical De-
THE ATLANTIC DEFENSE AREAS 45

partment was at peak strength when the

Puerto Rican Department and the Trinidad Sector were merged to form the

Antilles Department, with Col. Clyde C.

Johnston as its surgeon. There were at

this time more than 2,200 officers and enlisted men serving in medical installations from Cuba through the Guianas. A

steady contraction began in 1944, which

continued to the end of the war. The

298th Station Hospital at San Juan became the 161st General Hospital in June

1944, serving the entire Antilles Department, but its T/O still called for only

600 beds. Other hospitals throughout the

area reduced bed strength, converted to

dispensary status, or disbanded altogether. By the end of 1945, only nine

hospitals remained in the Antilles Department, with a total of 1,225 beds. The

161st General Hospital in San Juan, with

600 beds, accounted for almost half of

the total. Outside Puerto Rico only the

292d Station Hospital (25 beds) in

Jamaica, the 300th (25 beds) at Batista

Field in Cuba, and the 359th on Trinidad remained in operation.

Evacuation—Evacuation activities in

the Antilles Department followed a pattern much like that of the Panama Canal

Department. It was necessary to evacuate

only a small number of men during the

entire war. Within the various island

bases, men needing medical attention

were taken to the nearest dispensary or

hospital, usually by ambulance but occasionally by air in the case of isolated

units. Further evacuation to a larger hospital was normally accomplished by ship,

although air transport came into play if

great distances were involved. The large

hospitals in Puerto Rico and Trinidad

enabled the Antilles Department to give

fairly definitive care to most serious illnesses, and since the situation was not

one of combat there was no pressing

need for evacuation to the zone of interior. About half of the patients moreover,

were Puerto Ricans, and so would not

normally have been evacuated to the

mainland under any circumstances.

Medical Supply—Problems of medical

supply in the Antilles proved similar to

those in Panama, but tended to be somewhat more difficult in the early days. The

lack of a well-developed military establishment in Puerto Rico at the beginning

of the emergency period in 1939 and the

extreme dispersion of island bases in the

Antilles were important factors in creating supply problems. The absence of a

major United States activity comparable

to the Panama Canal also complicated

matters. The new island bases felt the

scarcity of supplies in the early days of

the war much more strongly than the

established facilities in Panama.

Common Diseases—As in Panama, the

two major health problems throughout

the Antilles Department were malaria

and venereal disease, and in both cases

the answer was found in improved preventive measures. The malaria rate for

the department as a whole was cut from

84 per thousand per annum in 1941 and

88 in 1942 to 37 in 1943, 12 in 1944, and

9 in 1945. Measures taken included larviciding, drainage, use of atabrine, and

constant education and experimentation.

A unique problem existed around Fort

Read, Trinidad, where a water-catching

parasite on shade trees planted to protect

the cocoa plantations proved a prolific

breeder of mosquitoes. It was eventually

discovered that a copper sulfate spray
46 MEDITERRANEAN AND MINOR THEATERS

COLONEL LEONE

would destroy the parasites. In the fight

against venereal disease, eternal reiteration of the danger was primary, together

with the establishment of well-located

prophylactic stations and steady co-operation with local authorities where local

laws and customs permitted some measure of control. The venereal rate was reduced from 81 per thousand per annum

in 1942 to 72 in 1943, 47 in 1944, and 31

in 1945.

The South Atlantic Theater

It was clear to U.S. and Brazilian military leaders by the summer of 1939 that

only the United States could provide the

forces necessary to defend the Brazilian

bulge in the event of an attack from

Africa, a short 1,800 miles across the

South Atlantic. Military planning in

both countries accepted this reality, although Brazil accepted it with reluctance. The fall of France a year later and

the subsequent control of French West

Africa by the collaborationist Vichy regime, gave renewed urgency to preparations for defense of the strategically most

vulnerable point in the hemisphere.

Army and Navy staff agreements were
THE ATLANTIC DEFENSE AREAS 47

negotiated in the fall of 1940. By specific

agreement between the two countries in

the spring of 1941, Pan American Airways undertook development of airfields

in Brazil at Amapa, Belem, Sao Luis,

Fortaleza, Natal, Recife, Maceio, and

Bahia. Such a route, jumping off from

bases in the Guianas, would permit even

short-range planes to fly to the threatened sector. The work had hardly gotten

under way before Pan American, at the

request of the U.S. Government and with

Brazilian concurrence, undertook to

ferry lend-lease planes to British forces

in the Middle East.16 After U.S. entry

into the war, the South Atlantic ferry

route passed to military control. Plans

were prepared for setting up a theater of

operations in Brazil, but were not realized until after Brazil, too, had declared

war on Germany and Italy, 22 August

1942.17

The theater organization had its inception in late June 1942, under the aegis of

the South Atlantic Wing, Air Transport

Command, of which Brig. Gen. Robert

L. Walsh was commanding officer and

Maj. (later Col.) George E. Leone was

surgeon. Wing headquarters was set up

at Atkinson Field, British Guiana, on 9

July, moving to Recife, Brazil, in December after formal activation of United

States Army Forces, South Atlantic, on

24 November 1942. A few days earlier

the Air Transport Command had established its own headquarters at Natal, but

the two headquarters were bound together by having the same commander.

General Walsh served in both capacities,

as did Maj. Gen. Ralph H. Wooten, who

relieved Walsh in May 1944. In October

of that year, however, the two commands

were separated at the request of the Air

Transport Command. General Wooten

continued as theater commander, while

the South Atlantic Division, ATC, passed

to Col. Cortlandt S. Johnson. Leone, on

the other hand, was replaced as ATC

South Atlantic Wing surgeon when he

took over the theater surgeon's office.

The two positions remained separated

until August 1943, when Leone was

again named to the ATC post while retaining his position as USAFSA surgeon.

He had in the interval returned to the

United States long enough to attend the

School of Aviation Medicine at Randolph Field, Texas, in order to qualify

as a flight surgeon. Throughout the life

of the theater close liaison was maintained with the medical service of the

Fourth Fleet, and with Brazilian doctors,

military and civilian.

During the British Guiana interlude,

Leone, who was promoted to lieutenant

colonel at this time, surveyed the medical

situation in Brazil. Valuable information, particularly as to the incidence of

malaria and venereal disease, was secured from the two U.S. flight surgeons

already stationed at Brazilian airfields—

Capt. Fred A. Heimstra at Natal and 1st

16

 See p. 360, below. 17

 The main sources for this section are: (1)

Watson, Chief of Staff, ch. IV; (2) Conn and Fairchild, Framework of Hemisphere Defense, chs. XI,

XII; (3) Hist, USAFSA, MS, OCMH files; (4) Official Hist of the S Atl Div, ATC, MS, OCMH files;

(5) Med Hist, World War II, USAFSA; (6) Annual Rpts, Med Dept Activities, USAFSA, 1942-44;

(7) Annual Rpt, Med Dept Activities, S Atl Div,

ATC, 1944; (8) Annual Rpt, Surgeon, Composite

Force 8012, Ascension Island, 1943; (9) Annual

Rpts, 175th Sta Hosp, 1943 and 1945; 193d Sta

Hosp, 1943-45; 194th Sta Hosp, 1943-45; and 200th

Sta Hosp, 1943-45. (10) ETMD's, USAFSA, Jul

44-Oct 45; (11) A Med Hist of the Brazilian Expeditionary Force in Brazil, by Maj R. H. Lackay;

(12) Ltr, Col George E. Leone, to Col Coriup, 30

Jul 59; (13) Ltr, J. P. Cameron, to Goriup, 5 Aug

59; (14) Ltr, Frank P. Gilligan, to Goriup, 18

Aug 59. Last three letters comment on preliminary

draft of this chapter.
48 MEDITERRANEAN AND MINOR THEATERS

MAP 3—U.S. Army Hospitals Supporting South Atlantic Bases, 1943-45

Lt. Francis M. Dougherty at Belem. The

successful invasion of French North Africa at that time by American and British ground troops removed any danger

that may still have existed of an attack

against the South American mainland.

Hospitalization

Other than small dispensaries set up at

stopping points along the Air Transport

Command route, there were no U.S.

Army medical facilities operating in

Brazil until after activation of the theater. Patients requiring more care than

these dispensaries could provide were

generally flown to British Guiana or

Trinidad. Emergency surgery was performed in Brazilian military hospitals.

In his capacity as surgeon, USAFSA,

Colonel Leone asked for three station

hospitals in October 1942, but the units

requested did not leave the port of embarkation until 29 December, arriving in

Brazil in late January 1943. The hospitals were distributed to the major bases
THE ATLANTIC DEFENSE AREAS 49

of the theater—the 193d Station Hospital

(50 beds) to Belem, the 194th Station

Hospital (100 beds) to Natal, and the

200th Station Hospital (150 beds) to

Recife. None of the hospital buildings

had been completed at the time the units

arrived, but by May and early June all

began operating. The 175th Station Hospital (150 beds), arrived on Ascension

Island, some 1,250 miles east of the

Brazilian coast, in March 1942, before

the creation of the South Atlantic theater. The U.S. Army had landed some

2,000 men on this British possession with

the mission of protecting it from attack

and building an airfield. The 175th was

under the control of a composite force

headquarters until November 1942,

when the South Atlantic theater assumed jurisdiction over U.S. troops on

the island. (Map 3)

Hospital construction in Brazil followed closely the standard U.S. Army

cantonment-type plant common in the

United States. The use of local materials,

especially hollow tile blocks, which were

stuccoed on the outside and plastered on

the inside, and red tiles for roofing, resulted in more permanent structures

than the wooden ZI-type station hospitals. The 193d Station Hospital at

Belem, just below the mouth of the

Amazon River, was situated in a tropical

location almost on the equator. It furnished care to the immediate area and

received patients from the jungle air

base at Amapa, the airfield at Sao Luis,

and weather stations at Clevelândia and

Camocim.

Nine hundred miles east on the Brazilian coastal "hump," the 194th Station

Hospital at Natal administered medical

care to patients from the air bases at

Fortaleza, Fernando de Noronha Island,

and from the vicinity of Natal itself. The

194th also accommodated all patients en

route from other theaters to the United

States. It was a very active unit because

of the great number of transients and

daily landings and takeoffs.

The 200th Station Hospital, just 150

miles south of Natal near the city of

Recife, served as a "theater" hospital

since no general hospital operated in

Brazil. It received patients from all other

medical installations in the command

that required prolonged hospitalization

or ultimate evacuation to the United

States. The 200th was especially well

equipped and had a very well-balanced

professional staff. Specialists from the

200th made trips to other stations in the

theater where they consulted on patients

who could not be transferred to Recife.

The hospital laboratory was supplemented to function as a provisional theater laboratory.

On Ascension, the steppingstone between Brazil and Africa, the 175th Station Hospital had started operating in a

newly constructed hospital in May 1942,

providing medical care for U.S. Army

and Navy personnel stationed there,

transients passing through, and survivors

of torpedoed ships. Its buildings consisted of wood-frame tarpaper-covered

structures, which lasted satisfactorily

through the war. Except for a very small

dispensary operated by a retired British

naval officer, no other medical facility

existed on the island. The 175th ministered to about one-fourth of the total

strength of the South Atlantic theater.

The medical service for the South Atlantic theater maintained itself with a

minimum of personnel, but still made

medical care equally available to all permanent and transient Army personnel, as
50 MEDITERRANEAN AND MINOR THEATERS

well as to members of the U.S. Navy and

certain civilians at each base. The theater strength reached its wartime peak

of about 8,000 in January 1944. There

were approximately 600 Medical Department personnel in the theater at that

time, and an aggregate of 500 T/O beds

in fixed hospitals.18 In keeping with a declining military population, medical

strength was cut to 450 in July 1944

when the 175th Station Hospital on Ascension was reduced to 100-bed capacity;

and to 350 in November when the 175th

lost another 50 beds and the 200th Station at Recife was reduced to 100 beds.

In addition to the beds provided by the

station hospitals, dispensaries of from 10

to 20 beds each operated at Amapa, Sao

Luis, Fortaleza, Bahia, Fernando de

Noronha, and Rio de Janeiro. Except

for the unit at Rio, which existed primarily to provide medical care to U.S.

personnel of the Joint Brazil-United

States Military Commission, these dispensaries were operated by medical personnel of the Air Transport Command.

At Clevelândia, Camocim, and Porto

Alegre, very small stations where a dispensary could not be justified, Medical

Department enlisted men provided emergency medical care.

Evacuation

While there was limited air evacuation

of nonbattle casualties from Africa, the

Middle East, and even from the ChinaBurma-India theater before the beginning of 1943 over the air ferrying route

by way of Brazil, it was on an individual

basis and records as to its extent are not

available. Similarly, patients were flown

informally from Brazil to British Guiana

or Trinidad without being officially recorded. As the war in the Mediterranean

spread during 1943 from Africa to Sicily

and Italy, air evacuation through Brazil

became more general. Late in September

of that year the 808th Medical Air Evacuation Transport Squadron took over

the flights from northern Brazil to

Miami, continuing in operation until

the patient load declined sharply late in

1944. All together, 957 patients from

other theaters passed through the South

Atlantic theater by air on their way to

the zone of interior in 1943, and 2,092 in

1944. Only 165 patients followed the

Brazilian route in 1945 before the service

was discontinued in July in favor of the

more direct North Atlantic routes.

For the South Atlantic theater itself,

the evacuation policy for all hospitals,

except the 200th Station Hospital, was

60 days. Other hospitals sent patients

whose condition precluded recovery

within this period to the 200th for more

extended treatment, or for evacuation to

the United States if recovery within 120

days seemed unlikely. Because of the

abundance of air transportation available, patients usually traveled to the

United States by plane. A smaller number, notably mental cases, sailed aboard

ships from the port of Recife. In 1943

the number evacuated from the South

Atlantic theater to the ZI was 189, of

whom 29 went by sea; in 1944 there were

78 evacuated by water and 268 by air, or

a total of 346; and in 1945 the figures

were 64 by sea and 151 by air, for a total

of 215. The 3-year aggregate was 750,

with more than three-fourths being sent

by air.

18

 See app. A-1. Theater strength exceeded 10,000

for the immediate postwar months of June, July

and August 1945, when evacuation from the Mediterranean and redeployment brought about a substantial increase in Air Transport Command

strength at Brazilian bases.
THE ATLANTIC DEFENSE AREAS 51

U.S. medical officers and enlisted Medical Department personnel helped train

Brazilian medical troops before the departure of the Brazilian Expeditionary

Force for Italy in July-November 1944,

but neither time nor facilities were available to do a completely satisfactory job.

Medical personnel of the theater also

assisted the Brazilian Army by unloading

sick and wounded members of the Brazilian Expeditionary Force returning from

Italy by ship and plane.

Medical Supply

In the early days the theater experienced some difficulty in procuring medical supplies in sufficient quantities, but

by mid-1943 enough stocks had been accumulated to meet the needs of all medical installations in the command. In only

two instances were large shiploads of

supplies from the United States delayed

for so long that emergency air shipments

had to be made. A general depot established at Recife in early 1943, provided

medical supplies for the entire theater

and distributed them to the widely separated medical installations of the command by air and sea transportation. Most

items of supply came from the United

States, but the Army bought some of the

heavier equipment such as chairs, desks,

tables, and X-ray units, and also a small

quantity of drugs from Brazilian dealers.

Before the Recife depot was established,

the Trinidad Sector depot at Fort Read

was often called upon to send medical

supplies both to Brazil and to Ascension

Island.

Professional Services

Common Diseases Because of the absence of land combat in the South

Atlantic theater, the operation of a satisfactory hospital system posed no unusual

difficulties. The operation of medical installations was generally routine, with

emphasis on the control of venereal and

tropical diseases. Patients stayed in the

hospital for only short periods, since

acute diseases of brief duration accounted for most of the admissions.

Injuries from plane crashes and other accidents made up the remainder. The general health of the troops was excellent,

and tropical diseases never became a

problem, due mainly to the preventive

measures employed by the Medical Department. The largest single medical

problem was the great reservoir of venereal disease near the U.S. Army bases.

Prostitution flourished freely with very

little being done about infected carriers

of venereal diseases. Control measures

proved difficult because the Army, being

only a visitor in a friendly foreign country, did not have control over the civilian

population. Areas and individual houses

could be placed "off limits" but residents of these houses could and did find

other places to carry on their trade. Consequently, the Army directed its control

program at the individual soldier by

means of education. The incidence of

venereal disease on Ascension Island was

zero because of the absence of women,

but for the theater as a whole the venereal rate was 83 per thousand per

annum for December 1942, averaged

101 for 1943, and 72 for 1944. The rate

dropped to a low of 36 in May 1945 but

shot up again to 99 in August with the

influx of transients. The everpresent

danger of malaria in northeastern Brazil

resulted in a vigorous control program

in collaboration with the Brazilian
52 MEDITERRANEAN AND MINOR THEATERS

MEMBERS OF MALARIA CONTROL UNIT SPRAYING A SWAMP AREA IN BRAZIL

health authorities. Individual malaria

control measures were also practiced

with highly successful results. At no time

did malaria become a serious threat to

the physical fitness of U.S. Army troops

in the theater, although the rate per

thousand per annum reached a high of

98 in March 1943. The worst month in

1944 was June, when the rate was 34.

The 1945 peak was reached in May and

June, with rates of 24.9 and 27.2, respectively.

A good example of how the Army

overcame the deteriorative effects of

tropical diseases in Brazil was the work

accomplished by the Medical Department at the jungle outpost of Amapa.

This location is among the most unfavorable of any in the world for the maintenance of good health. During 1943 the

rainfall measured around fifteen feet,

and in 1944 it totaled almost thirteen

feet. The entire swampy area was alive

with malaria, which took a heavy toll

among personnel of survey teams entering the vicinity in 1942. A small dispensary that arrived there in early 1943

helped keep the state of health of Army

troops and Brazilian workers on a reasonably high level, mainly because of

immediate evacuation to Belém of all

patients needing bed care. During 1944

the dispensary's staff increased, and more

supplies and equipment arrived, which
THE ATLANTIC DEFENSE AREAS 53

made it possible to care for many more

patients on the spot. The men assigned

to the dispensary had to be versatile.

Each enlisted medical assistant was at

some time a laboratory technician, nurse,

or even a doctor. In 1944 the base surgeon delivered six babies for Brazilian

workers, and in every case the enlisted

men assisted the surgeon during delivery.

The Brazilians at the Amapa base

suffered from many chronic diseases

rarely found among American soldiers.

The surgeon explained each case entering the dispensary to the enlisted assistants, who were required to participate

in the treatment. With all the bad environment caused by the heat, tremendous rainfall, and poor sanitation of the

local population, the dispensary records

showed only 600 per thousand illnesses

or injuries among Army personnel,

which amounted to 131 per thousand less

than the South Atlantic theater rate as

a whole. Not a single case of malaria

developed among American troops during 1944, despite the fact that this disease

had previously been highly endemic. At

the end of that year this small group,

composed of one officer and tour enlisted

men, were giving valuable medical service to approximately 1,000 people.

The Disinsectization Program—In

1930 a very severe epidemic of malaria

had ravaged the area around Natal. The

disease proved to be carried by the

Anopheles gambiae mosquito, a species

common in equatorial Africa but previously unknown in Brazil. It was

believed that the vector had been introduced by fast French destroyers from

Dakar. It had taken ten years of hard

work on the part of the Brazilian Health

Department to stamp out the gambiae,

and the Brazilian Government was not

prepared to see the scourge re-introduced

by aircraft from infested areas of Africa.19

Colonel Leone and his staff worked on

the problem with Brazilian health officials, representatives of the Rockefeller

Foundation, and ground and air commanders. Brazilian officials were not satisfied with the routine spraying of planes

after they had landed in Brazil. Between

October 1941, when Pan American Airways began its flights between Brazil and

Africa, and July 1942, when U.S. Army

medical service was established in Brazil,

gambiae were found on seven occasions

on planes arriving in Natal from Africa.

As a result aircrews were given strict

regulations on the subject, which included spraying before departure from

Africa. Early in 1943, by Presidential

decree, the Brazilian health authorities

took over responsibility for ridding incoming planes of arthropods. Procedures

were stringent, including the closing of

all vents and shutting off air renovation

apparatus before the plane landed, and

disinfestation before any passengers or

crewmen were allowed to deplane or any

freight was unloaded. In August Colonel

Leone accompanied Dr. Fabio Carneiro

de Mendonca, Director of the Brazilian

Port Sanitary Service, on a visit to Africa

to study conditions at the fields from

which planes left for Brazil. At a conference early in November 1943, it was

agreed that U.S. Medical Department

personnel should supervise the disinfestation at African points of departure, and

that qualified Brazilian observers should

19

 Elliston Farrell, "The Anopheles Gambiae Problem in Brazil and West Africa, 1941-44," Bulletin,

U.S. Army Medical Department, vol VIII, (February 1948), pp. 110-24.
54 MEDITERRANEAN AND MINOR THEATERS

be present at these points, most important of which were Dakar and Accra.

With these practices in effect, the record was impressive. In 1943, gambiae

were found on 100 out of 819 planes

from Africa. The total number of gambiae found was 281, of which 8 were still

living. Although the number of flights

increased in 1944 to 2,552, only 30 gambiae, one living, were found, distributed

among 9 planes. In 1945 only 9 gambiae

were found, all of them dead, distributed

among 9 planes out of 4,841.

Dental Service—Dental service began

in the South Atlantic before a theater

organization was set up. On Ascension

Island there was a dental officer with the

175th Station Hospital, but early arrivals

at the Brazilian bases relied on local

civilian dentists until September 1942.

At that time 1st Lt. (later Maj.) Julian

M. Rieser of the Air Transport Command arrived with one incomplete Chest

MD No. 60. Deficiencies were made up

by local purchase or improvisation, and

Lieutenant Rieser established his headquarters at Natal, flying the rounds of

the other bases.

The station hospitals arriving early in

1943 had dental officers on their staffs

but little or no dental equipment. The

dentist attached to the 193d Station Hospital at Belem was unable to function

until March. The dental officer of the

200th Station Hospital at Recife carried

on as best he could in the field dispensary set up by the Air Transport

Command until enough equipment was

received from the United States to open

the hospital dental clinic in May. The

194th Station was somewhat more fortunate in procuring equipment for its

dental officer, whose presence freed the

ATC Wing dental surgeon for more extended visits to other bases.

For a time the dentist of the 194th

Station also served as theater dental surgeon. In September, with additional dental officers available, a policy of rotation

was put into effect, and dentists were

shifted from one base to another. At this

time Rieser, now a captain, became theater dental surgeon with headquarters

in Recife. By the end of 1943 there were

eight dental officers in the theater, and

equipment was adequate to maintain a

clinic at each of the four station hospitals. Complete dental service was available to the entire command and

continued to be throughout the remaining life of the theater. The number of

dental officers increased to 10 in 1944,

and the service became more mobile,

dental officers going as far afield as

Asuncion, Paraguay, and Montevideo,

Uruguay.

Veterinary Service—Like his dental

counterpart, the first veterinary officer in

the theater, Capt. (later Maj.) James R.

Karr, was assigned to the South Atlantic

Wing, Air Transport Command. Captain

Karr reached Natal in November 1942

and was at once placed on detached service in the theater surgeon's office. Additional veterinary officers arrived in 1943,

together with a few trained enlisted men.

Their task, in a country of lax sanitary

standards, was immense. All meat, eggs,

milk, and many other food products had

to be inspected before they could be

used. Supervision of slaughterhouses and

pasteurization plants was included in

the veterinarians' work, and before the

end of 1943 they were themselves raising

chickens and hogs.

For purposes of food inspection, the
THE ATLANTIC DEFENSE AREAS 55

Brazilian bases were divided into three

areas, centering at the three station-hospital cities. The Belem area included

the Amapa and Sao Luis bases; the Natal

area included Fortaleza and Fernando

de Noronha; and the Recife area included Bahia. One veterinarian served

each area, the Recife man serving also as

theater veterinarian and making trips as

needed to Ascension Island.

Close-out in Brazil

The Army started planning a general

reduction and eventual discontinuance

of its activities in Brazil and on Ascension

Island in March 1945. The Green Project, which was an air redeployment

movement of combat troops from the

European and Mediterranean theaters

to the United States, for transshipment

to the Pacific, suddenly increased activities in the South Atlantic during that

summer, but this operation came to an

end after the defeat of Japan. Almost

half of those sent to the United States

under the "Green Project" traveled via

the South Atlantic theater. Medical facilities handled the extra load by obtaining

additional medical personnel from the

Air Transport Command and from

among those being redeployed. In early

September, preparations for inactivating

all station hospitals began, and the plans

made the previous spring were put into

operation. By the end of the month the

175th and 193d Station Hospitals had

been inactivated, followed by the 194th

and 200th in early October. The theater

itself disbanded on 31 October 1945, and

the South Atlantic Wing of the Air

Transport Command assumed responsibility for the administration and operation of the remaining personnel and

facilities.
CHAPTER II

Army Medical Service in Africa and the

Middle East

The U.S Army entered the scene of

conflict in the Middle East on a limited

scale in 1941 as a result of the urgent

need of the British and Russian Armies

for military supplies and equipment. Aid

to the British in the Middle East began

with the first deliveries of American

planes to the Royal Air Force in the

spring of that year, and the arrival of

U.S. Army Signal Corps and Ordnance

Department technicians during the summer to instruct the British in the use and

maintenance of American equipment.

Aid to Russia by way of the Persian Corridor began in November, but was held

to a minimum pending the enlargement

of port and rail facilities and the construction of roads in Iran. Military

planes were ferried from the United

States to the Middle East by way of

Brazil and central Africa before the end

of 1941. Transport planes following the

same route carried both American civilian and military personnel.

The Beginnings of Medical Service

in the Middle East

The U.S. Military North African

Mission

The expanding needs of the British

forces in the Middle East were met by

the creation in September 1941 of the

United States Military North African

Mission, with Brig. Gen. Russell L. Maxwell as its chief. The mission surgeon,

Maj. (later Col.) Crawford F. Sams,

joined the group in October and prepared a medical plan based on information available in Washington before

personnel of the mission went overseas.

The group traveled by air across the

Pacific, arriving in Cairo on 22 November. Major Sams was joined there on the

27th by his assistant surgeon, 1st Lt.

(later Maj.) Dan Crozier.1

Projects to be carried out under control of the U.S. Military North African

Mission included construction of port

facilities and establishment of shops for

the repair and maintenance of aircraft,

tanks, locomotives, and signal equipment. Because the United States was not

a belligerent, the work was to be done

1

 Principal sources for this section are: (1) Hist,

Med Sec, Africa-Middle East Theater, Sep 41-Sep

45; (2) Annual Rpt, Med Dept Activities,

USAFIME, 1942; (3) Annual Rpt, Med Dept Activities, Eritrea Serv Comd, USAFIME, 1942; (4)

Hist of AMET to 1 Jan 46, Summary Outline, MS,

OCMH files; (5) Matloff and Snell, Strategic Planning for Coalition Warfare, 1941-42, pp. 250-55;

(6) Edward R. Stettinius, Jr., Lend-Lease: Weapon

for Victory (New York: Macmillan Company, 1944) ,

pp. 89-98; (7) Ltr, Brig Gen Crawford F. Sams

(Ret) to Col Coates, 12 Mar 59, commenting on

preliminary draft of this chapter.
AFRICA AND THE MIDDLE EAST 57

under lend-lease by civilian contractors,

but the mission surgeon was responsible

for the medical care of all civilians employed, as well as for the health of American military personnel in the area.2

Within a few weeks, Major Sams had

completed sanitary surveys of Egypt,

Eritrea, Anglo-Egyptian Sudan, and

Palestine, using local civilian, British,

and captured Italian records as well as

personal reconnaissance. The information so developed was used to locate

bases for medical operations and to modify preliminary plans in terms of actual

conditions. Port Sudan was eliminated

as a hospital location, and plans to establish a 100-bed unit at Port Elizabeth,

near Capetown on the long Cape of

Good Hope route to India and the Far

East, were indefinitely deferred. For the

time being the British supplied hospitalization of all U.S. personnel, both

civilian and military, although 2,150

U.S. beds were scheduled for the area.

Medical supplies from the United States

reached the area through three different

channels: the various contractors were

responsible for procuring supplies

needed by civilians employed by them;

medical supplies for American civilian

and military personnel under military

control were requisitioned by the mission surgeon; British forces in the area

were supplied under the Lend-Lease

Act. Entry of the United States into the

war resulted in some interruption to deliveries until the future status of the

various construction projects about to

get under way could be determined, but

no immediate change of medical plans

was required.

In Egypt, a headquarters dispensary

was set up in Cairo in mid-December

1941 with Lieutenant Crozier as attending physician. Another dispensary in

Heliopolis, a Cairo suburb where repair

and maintenance shops were under construction, was established in February

1942. Hospitalization for all U.S. personnel continued to be provided in British hospitals, while native workers were

cared for in Egyptian hospitals.

In Eritrea, where a naval base at Massaua, an air depot at Gura, and an arsenal and signal installations at Asmara

were the principal projects, medical

service began early in February 1942

with the arrival of Capt. (later Maj.)

Thomas C. Brandon. With a male nurse,

an X-ray technician, and six hospital

attendants—all civilians—Captain Brandon established dispensaries at Asmara

and Gura in February and, the following month, at Massaua and at Ghinda,

where a large housing project for

Massaua personnel was under development. Until additional medical officers

arrived late in April, Brandon made the

rounds of all four stations himself, covering a circuit of about 120 miles of mountainous country. American personnel

were hospitalized in British hospitals,

while Italian hospitals cared for Italian

and native workers under insurance

carried by the contractors.

The War Department, meanwhile,

had directed on 18 February that all proj2

 Military personnel, although not yet engaged in

actual combat, were not immune to combat wounds.

The first U.S. battle casualty in the Middle East

occurred less than a week after Major Sams's arrival. S. Sgt. Delmar E. Park, a Signal Corps observer and instructor with a British combat unit,

was killed by German machine-gun fire near Sidi

'Omar, Libya, on 27 November 1941, ten days before the United States entered the war. The Signal

Corps has erected a plaque to Sergeant Park's

memory at Fort Monmouth, N.J. Annual Rpt, Med

Dept Activities, USAFIME, 1942, with confirmation

from a Signal Corps historian.
58 MEDITERRANEAN AND MINOR THEATERS

COLONEL SAMS

ects sponsored by the U.S. Military

North African Mission be converted

from civilian to military status within six

months. Two months proved sufficient.

The mission was completely militarized

by 10 April. By special arrangement, some

2,500 civilian employees of the Douglas

Aircraft Corporation were to continue

operating the Gura depot for another six

months, and about 2,000 employees of

engineer contractors were to remain on

civilian status, but all projects were

brought under military control.

Following militarization, three area

commands were organized to supervise

construction work in the three main

centers of activity. These were the Heliopolis Area; the Eritrea Area, with headquarters at Asmara; and the Palestine

Area, with headquarters at Tel Aviv.

Medical plans under the new organization called for military hospitals in these

areas with an aggregate capacity of 2,450

beds. Since work had not yet been started

in Palestine and medical personnel was

at a premium, surgeons were named only

for Eritrea and Heliopolis.

In Eritrea, Captain Brandon was succeeded as area surgeon on 1 May by Maj.

(later Lt. Col.) William A. Hutchinson,

who had arrived with two other medical

officers a few days earlier. The area was

organized at that time into four districts

—Gura, Massaua, Asmara, and Ghinda—

each with its own dispensary. The first

U.S. hospital in Eritrea was a 250-bed

unit established at Gura by the Douglas

Aircraft Corporation on 17 June 1942.

Although all personnel were civilians,

the Army furnished the supplies and

equipment, and the hospital functioned

under control of the area surgeon. Its

services were available to all Americans

in Eritrea. In addition to this unit, plans

called for a 500-bed station hospital at

Asmara, 250 beds at Ghinda, and 100

beds at Massaua.

The Heliopolis Area medical section

was set up by Crozier, now a captain, on

12 May. Captain Brandon succeeded

Captain Crozier as Heliopolis Area

surgeon on 22 May. Dispensary and outpatient service was provided for Americans and for native workmen, but

hospitalization continued to be provided

by the British, pending construction of a

900-bed station hospital planned for the

Heliopolis depot. The Palestine area was

to be served by a 450-bed station hospital

in the vicinity of Camp Tel Litwinsky,

near Tel Aviv, whenever it should be required.

In his capacity as Surgeon, U.S. Military North African Mission, Crawford F.

Sams, by then lieutenant colonel, took
AFRICA AND THE MIDDLE EAST 59

COLONEL VAN VLACK

part as American observer in the fourth

and fifth Libyan campaigns, in March,

May, and June 1942. Particularly concerned with the problem of forward evacuation from rapidly moving armored

units, Colonel Sams was attached to the

British 7th Armoured Division.3

The U.S. Military Iranian Mission

While the North African mission was

operating in Egypt and Eritrea and was

preparing to move into Palestine, another prewar mission, formed in October

1941 to help the British deliver supplies

to Russia through the Persian Corridor,

was laying the groundwork for extensive

port and rail construction work in Iran

and Iraq. The chief of the U.S. Military

Iranian Mission, Brig. Gen. Raymond A.

Wheeler, arrived in Basra, Iraq, with

the first contingent of officers late in

November. The mission surgeon, Lt.

Col. (later Col.) Hall G. Van Vlack, did

not reach the area until March 1942,

after militarization had been ordered.

Every effort was made to select medical

personnel who had some familiarity with

the area, and Colonel Van Vlack was no

exception. He had directed missionary

hospitals in the Persian Gulf area for

several years before serving in World

War I and knew well both the language

and the people. The medical staff was

soon augmented by the arrival of a dental officer, and by a few medical officers

and enlisted men sent from the United

States or transferred from the Russian

mission, which dissolved in May.4

The surgeon's office was located with

the mission headquarters near Basra at

the head of the Persian Gulf, but headquarters of the Iranian Engineer District

was some 30 miles south at Umm Qasr,

Iraq. The surgeon made the round trip

across the desert each day to hold sick

call at the mission headquarters, at the

encampment of 600 men at Umm Qasr,

and at a motor and equipment assembly

plant at Rafidiyah. In addition to a headquarters dispensary at Basra, a small dispensary was maintained at Umm Qasr

for emergency patients. The British 61st

Combined General Hospital at Shu

'aybah, 10 miles southwest of Basra, was

available to all U.S. personnel.

The first U.S. hospital in the Persian

Gulf area was a 50-bed unnumbered sta- 3

 Ltr, Col Sams to TSG, 20 Jun 42, sub: Armored

Forces Med Servs in the Western Desert. 4

 Principal sources for this section are: (1) Narrative Hist of Med Activities in the PGC; (2) Annual Rpt, Med Dept Activities, PGSC, 1942; (3)

Hist, Med Sec, AMET, Sep 41-Sep 45; (4) T. H.

Vail Motter, The Persian Corridor and Aid to

Russia, UNITED STATES ARMY IN WORLD

WAR II (Washington, 1952) ; (5) Ltr, Hall G. Van

Vlack, to Col Coates, 23 Mar 59, commenting on

preliminary draft of this chapter.
60 MEDITERRANEAN AND MINOR THEATERS

tion hospital (later designated the 256th

Station Hospital), originally destined for

Umm Qasr but diverted to Ahwaz, Iran,

where it opened on 6 June 1942. Under

command of Colonel Van Vlack, the hospital was staffed by U.S. Army medical

officers, civilian male nurses from the

construction companies, Polish refugee

nurses, and a few first aid men borrowed

from their regular construction jobs.

Air Routes to Africa and the

Middle East

Late in June 1941 Pan American Airways, at the request of the United States

Government, took over the task of ferrying lend-lease planes to British forces in

the Middle East. The route followed ran

from Florida across the Caribbean to

Natal, Brazil, and thence over the narrowest point of the South Atlantic to

Bathurst in the British colony of Gambia

in West Africa. From Gambia the planes

were flown to Khartoum in AngloEgyptian Sudan by way of Nigeria and

French Equatorial Africa. A regular

transport service over this route and on

to Cairo was opened in mid-November at

the request of the U.S. Military North

African Mission.5

After Pearl Harbor, the AAF took

over operation of the ferrying and

transport services. Roberts Field, Liberia, became the west African terminus of

the route, which was extended east to

Karachi, India, over alternative courses.

One route ran from Khartoum to Cairo,

Palestine, and Basra; the other was by

way of Eritrea and Aden. Before medical

service along the route was established,

aircrews and passengers were treated for

malaria, dysentery, and other ills at the

headquarters dispensary of the U.S. Military North African Mission in Cairo.

The Middle East as an Active Theater of

Operations, 1942-43

Both the North African and the Iranian missions passed out of existence late

in June 1942. They were replaced by

the United States Army Forces in the

Middle East (USAFIME), organized as

a theater of operations under command

of General Maxwell. Headquarters was

in Cairo. Under USAFIME, the North

African Service Command took over

operations in Egypt and Palestine, while

the Iran-Iraq Service Command supplanted the existing organization in the

Persian Gulf area, now commanded by

Col. Don G. Shingler, without change

of functions. At the same time, a newly

organized U.S. Army Middle East Air

Force, commanded by Maj. Gen. Lewis

H. Brereton, former commander of the

Tenth Air Force in India, was brought

under theater control.6

Coincident with activation of USAFIME, Generalfeldmarschall Erwin

Rommel's Afrika Korps broke through

British positions in Libya and drove to

within 70 miles of Alexandria. Work

was hastily suspended on all U.S. Army

projects in Egypt and Palestine. Civilian

construction workers and many military

personnel were moved to relative safety

in Eritrea. The North African Service

Command shifted its headquarters to

Gura early in July, and the theater head5

 Craven and Cate, eds., Plans and Early Operations, pp. 320-27.

6

The chief sources for this section are: (1) Hist,

Med Sec, AMET; (2) Hist of AMET to 1 Jan 46,

Summary Outline; (3) Motter, Persian Corridor

and Aid to Russia, pp. 85-93; (4) Craven and Cate,

eds., Plans and Early Operations, pp. 341-42.
AFRICA AND THE MIDDLE EAST 61

AIR TRANSPORT COMMAND DC-3 OVER PYRAMIDS

quarters staff began burning its files in

preparation for the evacuation of Egypt.

By August, however, Rommel had been

contained at El 'Alamein and work was

resumed in the Cairo and Palestine

Areas.

After the resumption of activities in

Egypt, the theater was reorganized to

simplify the command structure. The

North African Service Command was

abolished, and the three existing areas

formerly under its jurisdiction became

service commands responsible directly to

the theater headquarters. The Heliopolis

Area became the Delta Service Command, including all of Egypt. The Palestine Area, with boundaries enlarged to

include the Levant States, Transjordan,

and a wedge-shaped segment of western

Arabia, became the Levant Service Command. Boundaries of the Eritrea Service

Command were drawn to include AngloEgyptian Sudan, Eritrea, French Somaliland, Aden, and all of Arabia south of

the Persian Gulf. The Iran-Iraq Service

Command was renamed the Persian Gulf

Service Command, with jurisdiction over

Iran, Iraq, Kuwait, and that portion of
62 MEDITERRANEAN AND MINOR THEATERS

Arabia not included in other command

areas. A short-lived and never important

Army Ground Forces Command was also

added to the theater organization in August to provide administrative supervision over U.S. tank crews operating with

the British Eighth Army. Plans to move

an American armored corps into the theater were dropped when invasion of

Morocco and Algeria received priority,

and the Army Ground Forces Command

was eventually inactivated. That portion

of Libya reconquered from the Axis

forces was set up as the Libyan Service

Command in December 1942.

Organization at the theater level was

completed early in November with the

creation of a Services of Supply headquarters, to which the service commands

were thereafter responsible. General

Maxwell became commanding general

of the theater Services of Supply (SOS),

being replaced briefly as USAFIME commander by Lt. Gen. Frank M. Andrews.

In January 1943 Andrews was succeeded

by General Brereton, who also retained

his command of the Ninth U.S. Air

Force into which the Middle East Air

Force had been merged. As in the European theater at this time, the air mission was the primary combat function of

USAFIME between May 1942 and September 1943.

Organization of the Medical

Service

Theater Headquarters—The surgeon

of the North African Mission, Crawford

F. Sams—promoted to the rank of lieutenant colonel in February and colonel

in August 1942—became USAFIME surgeon on the creation of the theater. In

November he was also made Services of

Supply surgeon, carrying out both assignments with a single staff. The dual

assignment favored centralized control of

the medical service, but the distance of

some of the service commands from

Cairo, and the lack of good rail and road

communications put obstacles in the

way. The surgeon was forced in large

measures to rely on air travel as a means

of co-ordinating the medical affairs of

the widely dispersed commands.7

Contact with health department representatives of the various countries of

the Middle East, and particularly with

the Egyptian Ministry of Health, was

an essential part of the medical section's

activities. The theater surgeon was a

member of a medical advisory committee of the Middle East Supply Council

(and of its executive committee), which

controlled the requisitions of medical

supplies for the civilian populations of

the countries within the theater. He

kept in close touch with the medical authorities of the various Allied armies,

especially with the Medical Directorate

at General Headquarters, British Army

Middle East Forces, and the Surgeon

General, Egyptian Army.

The theater surgeon's office supervised the provision of medical services,

the operation of the medical supply system, and the program for prevention of

disease. The staff provided professional

information to the theater commander;

prepared medical records and reports,

co-ordinating those sent in by the service

commands; and inspected medical installations. It assigned personnel to the

7

 Principal sources for this section are: (1) Hist,

Med Sec, AMET; (2) Annual Rpts, Med Dept

Activities, USAFIME, 1942 and 1943; (3) Interv,

W. K. Daum, Historian, with Col Eugene W. Billick, 11 Jul 52; (4) Intervs, Blanche B. Armfield,

Historian, with Gen Sams, 18 Jan and 30 Jan 50.
AFRICA AND THE MIDDLE EAST 63

offices of service command surgeons and

the Ninth Air Force and advised them

on local medical problems. It also supervised the medical service supporting the

Ninth Air Force in its movement across

the Western Desert. As U.S. Army troops

engaged in little fighting in the Middle

East theater, many of the activities undertaken by the theater surgeon's office

were those directed at prevention of disease. The provision of a supply of pure

food and water and the establishment

and maintenance of good facilities for

disposal of waste were two important undertakings.

The Service Commands—The service

commands set up under the U.S. Army

Forces in the Middle East remained relatively stable until near the end of 1943,

when the mission of the theater underwent considerable change. The headquarters of each service command had a

medical section in charge of a surgeon

who was under the direction of Colonel

Sams in his Services of Supply capacity.8

The administrative center of medical

service in Delta Service Command was at

the command's headquarters in Heliopolis, where a medical staff section operated an office patterned on the theater

headquarters medical section. It also controlled an antimalaria unit and a general

dispensary. A few miles from Heliopolis,

at Camp Russell B. Huckstep, the site of

a large quartermaster depot, was a small

medical section consisting of a post surgeon, a veterinarian, and a dental officer.

Three dispensaries operated by unit surgeons, a dental dispensary, and a medical

subdepot were located there. When the

surgeon's office of Delta Service Command moved from Heliopolis to Camp

Huckstep in May 1943, it absorbed the

post surgeon's office. The 38th General

Hospital, which was to be the leading

hospital of the theater, was established

at Camp Huckstep in late 1942.

Delta Service Command served a number of other areas in some phase or other

of its medical programs. The medical

subdepot at Camp Huckstep frequently

furnished medical supplies to the whole

Middle East area. American air forces

battle casualties occurring over Libya,

Tunisia, Sicily, Italy, and southeastern

Europe were cared for in the command's

hospitals. Medical care for U.S. Army

personnel stationed in the vicinity of the

Suez Canal ports was provided by Delta

Service Command, except for a brief period from March to October 1943 when

an independent Suez Port Command was

active. A port surgeon's office, a general

dispensary, and the platoons of a field

hospital served troops in the canal area.

A medical staff section of Eritrea Service Command was located at the command headquarters, which was established in August 1942 at Asmara, the

capital city of Eritrea. A surgeon placed

in each of four districts of the command

maintained the health and sanitation of

his particular area. Medical Department

personnel stationed throughout the command were responsible for the health of

Army personnel, American civilians, and

8

 This section is based primarily on the following

documents: (1) Hist, Med Sec, AMET; (2) Annual

Rpt, Med Dept Activities, USAFIME, 1942; (3)

Med Hist, Delta Serv Comd, 1942; (4) Annual

Rpts, Med Dept Activities, Eritrea Serv Comd,

1942, 1943; (5) Annual Rpt, Med Dept Activities,

Levant Serv Comd, 1942; (6) Narrative Hist, Med

Activities, PGC; (7) Annual Rpt, Med Dept Activities, PGC, 1943; (8) Ltr, Gen Sams to Col

Coates, 12 Mar 59; (9) Ltr, Van Vlack to Col

Coates, 23 May 59; (10) Ltr, Lt Col James J. Adams

to Col Coates, 7 Apr 59. Last three letters comment

on preliminary draft of this chapter.
64 MEDITERRANEAN AND MINOR THEATERS

Italian laborers working for the U.S.

Army. By the end of 1942 about 150

American military hospital beds were

available to troops of the command; the

civilian hospital of the Douglas Aircraft

Corporation relieved the Army of the

necessity of caring for civilians. With the

decrease in construction of port and air

base facilities in 1943, personnel strength

in Eritrea was cut back to the minimum

necessary for servicing bases and fuel

dumps of the Air Transport Command,

and for operating extensive radio installations. The need for medical service

diminished proportionately.

In Levant Service Command, a medical staff section was set up in August

1942 at Tel Aviv, Palestine. The section

included the surgeon of the command

and a staff of veterinary, sanitary, and

administrative officers, assisted by several

enlisted men. Because of the lack of supplies and incomplete construction of

American hospital facilities in 1942,

British military hospitals in the area

furnished most of the hospitalization of

U.S. Army patients. For a time Levant

Service Command was important as a

base for the operation of American Air

Forces units, but activities never developed to the extent originally anticipated, and by June 1943 the command

was on the decline. The headquarters of

the command moved from Tel Aviv to

Camp Tel Litwinsky, some eight miles

away, the site of a repair depot for engineer and ordnance equipment and of a

steel container manufacturing plant. At

this time the members of the medical

section were relieved from duty with

the exception of the veterinarian, and

the commanding officer of the 24th Station Hospital (a unit that had arrived in

February 1943) assumed the additional

assignment as service command surgeon.

Libyan Service Command, established

in early December 1942, did not have a

medical staff section until March 1943.

The surgeon's office was composed of a

surgeon, a medical inspector, a veterinary officer, a Medical Administrative

Corps officer, and a medical officer in

charge of the headquarters general dispensary. This command functioned only

until the end of active operations against

the Axis in North Africa. In late May it

was divided into Tripoli Base Command

and Benghasi Base Command.9 The new

commands were disbanded in the fall of

1943, and their areas and installations

were absorbed by Delta Service Command.

The medical section of the Persian

Gulf Service Command (PGSC) was inherited with little change from the Iranian mission. Headquarters remained at

Basra, Iraq, until January 1943, then

moved to Tehran, Iran, pending completion of permanent headquarters at

Camp Amirabad two miles from that

city. A surgeon's office, responsible to

Colonel Van Vlack, the command surgeon, was maintained in each of the

three districts into which the gulf area

was divided. The command surgeon's

office instituted the medical policies for

the whole command, but the emphasis

was on the operating agencies—the hospital units. The headquarters medical section consisted only of the surgeon, a

small staff, and a minimum of enlisted

personnel to handle reports and records.

The district headquarters also operated

9

 In the Middle East theater a base command was

normally one step below a service command. Since

Libyan Service Command no longer existed, Tripoli

and Benghasi Base Commands dealt directly with

their next highest echelon, SOS USAFIME.
AFRICA AND THE MIDDLE EAST 65

with minimum staffs. In April 1943

Colonel Van Vlack was succeeded as

PGSC surgeon by Col. Forrest R. Ostrander, former commanding officer of

the 38th General Hospital.

Although it was administratively

bound to the Middle East theater, the

first major step toward autonomy came

for the command in January 1943 when

Cairo headquarters gave PGSC permission to requisition supplies directly upon

the War Department, handle its own

personnel procurement, assignments,

and promotions; and deal with the British and Iranians without reference to

theater headquarters. While the command still remained in the Middle East

theater organization, this decisive action

gave it a very independent status. Complete autonomy came with an order from

Washington on 10 December 1943,

which redesignated the command the

Persian Gulf Command and made it directly responsible to the War Department through the Operations Division of

the General Staff. With a simplified command relationship solidly established,

the Persian Gulf Command was better

able to carry on its mission of aid to the

Soviet Union.

The Ninth Air Force—The Ninth Air

Force, which at its peak had about 25,-

000 troops, was the major American combat force in the Middle East theater. It

was organized in August 1942 by General Brereton, at which time the headquarters of U.S. Army Middle East Air

Force was discontinued. During 1942

and 1943 the Ninth Air Force operated

against enemy targets in Libya, Tunisia,

Sicily, Italy, Greece, and Rumania. Under supervision of the theater surgeon,

Col. Edward J. Kendricks, Jr., who had

served as surgeon of the U.S. Army Middle East Air Force became General

Brereton's Ninth Air Force surgeon. At

the Cairo headquarters of the air force,

Colonel Kendricks organized an office

containing an assistant surgeon, a dental

officer, a plans and training officer, a

sanitation team, an adjutant, and some

enlisted men. At first Colonel Kendricks

doubled as Ninth Air Force Service Command surgeon, but a separate surgeon

was later appointed to that element of

the air force. The bomber and fighter

commands had their own surgeons from

the outset. Colonel Kendricks and his

staff left the Middle East for England

with the Ninth Air Force in October 1

943.10

The Air Transport Command—In

July 1942 a headquarters to administer

Army activities in the vast reaches of

central Africa was organized at Accra,

Gold Coast, and named United States

Army Forces in Central Africa (USAFICA) . Its major mission was to maintain bases for the Air Transport Command. Although it never had a large

number of troops, the command was

originally organized like a theater. Under the theater headquarters was SOS

USAFICA, an organization that furnished supplies and services needed for

the operation of Air Transport Command units throughout Africa.11

10

 (1) Hist, Med Sec, AMET. (2) Annual Rpts,

Med Dept Activities, USAFIME, 1942, 1943. See

also p. 80, below. 11Major sources for this section are: (1) Hist,

Med Sec, AMET; (2) Annual Rpt, Office of Surg,

USAFICA, 1942; (3) Hist of the ATC in Central

Africa and the Middle East, pt. 2, Hist of the

AMEW, ATC (30 Jun-14 Dec 43) , vol. III, Hist

of Supply and Servs, Files of Hist Br, MATS; (4)

Annual Rpt, Med Sec, West African Serv Comd,

USAFIME, 1943; (5) Annual Rpt, Sta Surg's Of-
66 MEDITERRANEAN AND MINOR THEATERS

As in other areas where transportation

was the Army's primary mission, command of the theater was given to the

AAF, in this case to the Commanding

General, Africa-Middle East Wing, Air

Transport Command, Brig. Gen. Shepler

W. Fitzgerald. The Army retained control of the supply function through Col.

James F. C. Hyde, commanding the SOS

USAFICA, and for the time being of the

medical function, which was in the hands

of Lt. Col. (later Col.) Don. G. Hilldrup,

simultaneously surgeon of the theater,

the SOS headquarters, and the AfricaMiddle East Wing of ATC. By December 1942, however, activities had grown

to a point that made this triple duty no

longer feasible. Following an inspection

by Brig. Gen. (later Maj. Gen.) David

N. W. Grant, the air surgeon, Lt. Col.

(later Col.) James G. Moore was made

surgeon, AMEW, relieving Hilldrup of

all responsibility for Air Transport Command medical service except for furnishing hospitalization and medical supplies,

both included among his SOS functions.

Colonel Hilldrup was relieved in mid1943 by Col. Thomas E. Patton, Jr.

Later in the year the central African

command was dissolved and its territory

absorbed by the Middle East theater. In

its place theater headquarters established

the West African Service Command,

with headquarters at Accra. The commanding officers of the 67th Station Hospital at Accra, Maj. George F. Piltz and,

from early 1944, Maj. (later Lt. Col.)

Leslie E. Knapp, served also as surgeons

of the West African Service Command.

At the end of 1943 the Africa-Middle

East Wing of the Air Transport Command was split into Central African and

North African wings, with Maj. (later

Lt. Col.) James W. Brown and Lt. Col.

(later Col.) Clarence A. Tinsman the

respective surgeons.

Another important base in the West

African Service Command was the city

of Dakar, in French West Africa.12 Soon

after control of the area passed to the

Allies with the invasion of North Africa,

a complete airport had been constructed

that could handle up to 100 planes a day,

and a camp for all permanent personnel

had been built and fully equipped. It

was later necessary to move the airport

to a new site because the swampy mosquito-infested surroundings contributed

to an excessively high malaria rate.

The command, known as U.S. Army

Forces in Liberia, which established its

headquarters in mid-1942, was to provide

services along the ATC route through

Liberia, defend the U.S. Army installations as well as the facilities of the Firestone Tire and Rubber Co. plantation,

and carry out certain diplomatic commitments for training Liberian military

forces and for the construction of roads.

The presence of a force of about 2,000

men in Liberia in this early period had

the added advantage of posing some

threat to the pro-Vichy French around

Dakar and in French Guinea and the

Ivory Coast.

Medical activities in Liberia were administered at the station surgeon's office

at Roberts Field, some thirty miles east

fice, Roberts Field, Liberia, Hq, USAFIL, 1943; (6)

Interv, Blanche B. Armfield with Lt Col Stephen D.

Berardinelli; (7) Ltr, Col Berardinelli to Col

Coates, 24 Mar 59, commenting on preliminary

draft of this chapter.

12

 Dakar was actually within the boundaries of

the North African theater, but the city and a small

area around it came under control of U.S. Army

Forces in Central Africa and later of the West

African Service Command.
AFRICA AND THE MIDDLE EAST 67

of Monrovia, where central control over

medical matters was maintained and

medical reports on the Liberian force

were completed. The 25th Station Hospital (250 beds) near the field cared for

the medical needs of the entire command. From June 1942 until April 1943,

Lt. Col. (later Col.) Loren D. Moore

served as station surgeon. Under the experienced direction of Lt. Col. (later

Col.) Justin M. Andrews, Colonel Moore

carried out extensive malaria survey and

control work. When the entire Liberian

Task Force, commanded by Brig. Gen.

Percy L. Sadler, arrived in the spring of

1943, both Moore and Andrews were

transferred to the new North African

theater. Lt. Col. Stephen D. Berardinelli,

commanding officer of the 25th Station

Hospital, succeeded Moore as station surgeon. Medical department personnel in

Liberia were responsible for the medical

care of a large force of construction engineers during the period when the base

was being built, and later gave support

to all elements of the defense forces in

Liberia. Air Transport Command personnel, some members of the Royal Air

Force, and natives working for the Army

also received medical care. In September

1943, the Liberian command was subordinated to the Middle East theater, but

this action did not change its basic mission.

Hospitalization and Evacuation

The extreme heat of the Africa-Middle East area, originally thought to be

one of the greatest problems in planning

for hospitalization, proved to be less important than anticipated. Except in the

Persian Gulf, the experience of the Medical Department demonstrated that adverse climatic factors were overrated as

to their effect on the general health of

troops. Excessive heat lasting for 24

hours of the day during the long summer

season occurred in only a few locations,

but the appalling list of diseases endemic

in the population of the area caused

great concern on the part of medical officers. Malaria, yellow fever, typhus,

smallpox, dysentery, all forms of venereal diseases, and many other diseases

represented a serious danger to troops

working in close contact with the inhabitants of the region. In the face of

centuries of ignorance, maintaining good

sanitation was a major task.13

Medical officers tried to create "isolated foci of cleanliness" in and around

the immediate areas of hospital plants

and other U.S. Army installations. This

method proved to be the only practical

way to handle the sanitation problem,

since troops were concentrated in places

widely separated from each other, making a comprehensive program impossible. Hospitalization in the Middle East

theater was almost entirely associated

with the service commands, and reararea-type hospitals predominated

throughout the theater. No mobile hospitals operated in the Middle East, although platoons of the field hospitals

supporting the Ninth Air Force during

its operations over Libya and Tunisia

moved about more frequently than most

other hospitals.

13

 General sources for hospitalization and evacuation in the theater as a whole are: (1) Hist, Med

Sec, AMET; (2) Annual Rpts, USAFIME, 1942,

1943; (3) Hist of Preventive Medicine in the

Middle East, 19 Oct 41-23 Jun 44, by Lt Col

Thomas G. Ward; (4) Hist of AMET to 1 Jan 46,

Summary Outline.
68 MEDITERRANEAN AND MINOR THEATERS

Delta Service Command—Delta Service Command occupied a central position

in the theater. The most important U.S.

Army medical installation in the theater,

the 38th General Hospital (1,000 beds),

arrived in the command in late October

1942 and moved into partially completed

buildings in the desert near Heliopolis,

adjacent to a large Quartermaster depot.

It began admitting patients on 11 November, and by early 1943 was the focal

point for fixed hospitalization in the

Middle East. (Map 4} Until September

1943, when a general hospital was set up

in the Persian Gulf Service Command,

there was no other hospital with comparable resources in the theater. The

chiefs of the medical, surgical, and neuropsychiatric services of the 38th also

acted as consultants in their respective

specialties to the theater surgeon.14

Beginning in the spring of 1943, platoons of the 16th Field Hospital were set

up as small hospitals along the route of

the Suez Canal, to give medical care to

U.S. troops stationed there. (See Map

4.) Another hospital unit served the

Ninth Air Force for a short time at an

airfield near Alexandria. The command

also established dispensaries in scattered

places having only small garrisons. A

medical supply depot operating as the

medical section of the quartermaster depot at Heliopolis served as the main distribution point for medical supplies and

equipment for all parts of the theater

except the Persian Gulf area.

Medical Department facilities in Delta

Service Command used permanent buildings, with the exception of the field hospital platoons, which were under canvas.

The Egyptian climate on the whole did

not hinder operations, but spells of extreme heat and dust storms caused some

difficulties. An adequate supply of pure

water was often lacking, except in large

cities such as Cairo and Alexandria. To

avoid using the contaminated and heavily silted water of the Nile, the command

had sunk deep wells and extended pipelines. A water purification plant was installed at Camp Huckstep.

The general line of evacuation for the

command, as well as for the whole theater, pointed toward the 38th General

Hospital, whether a patient was an Ordnance Department soldier from the Suez

Canal region sick with malaria, or an

Air Force pilot wounded over Libya.

Patients journeyed by ambulance from

nearby places such as the Suez Canal, but

if coming from Libya, Syria, Eritrea, or

Iran, they traveled by air to Cairo and

then by ambulance to the 38th General.

Delta Service Command also served as

the focal point for shipment of patients

to the zone of interior by ship and plane,

the latter method being employed most

of the time.

Eritrea Service Command—Most of the

U.S. Army medical installations in Eritrea Service Command were within

Eritrea itself, although the boundaries of

the command embraced the Anglo-Egyptian Sudan and the southern half of

Arabia as well. In addition to the civilian

hospital operated by the Douglas Aircraft Corporation at Gura, two hospitals

were established in Eritrea. The 21st

Station Hospital (500 beds), the first

complete Army unit to arrive, debarked

at Massaua on 13 November 1942. It was

14

 (1) Annual Rpts, Med Dept Activities, Delta

Serv Comd, 1942, 1943. (2) Annual Rpts, 38th Gen

Hosp, 1942, 1943. (3) Annual Rpt, 16th Field Hosp,

1943. (4) Ltr, Gen Sams to Col Coates, 12 Mar 59,

commenting on preliminary draft of this chapter.
AFRICA AND THE MIDDLE EAST 69

MAP 4—U.S. Army Hospitals in USAFIME, 1 July 1943

sited the following day at Mai Habar, a

town in the mountains between Asmara

and Gura, and took over hospital buildings formerly occupied by the medical

services of the Italian and British Armies. Some of the personnel of the 21st

were detached to operate dispensaries at

Asmara, Decamere, Ghinda, and Massaua. The second U.S. Army hospital to

be established in Eritrea was the 104th

Station Hospital, which arrived in late

January 1943. It relieved the detachment of the 21st Station Hospital at Massaua, setting up a 100-bed unit there.13

By the spring of 1943 U.S. Army activities in Eritrea had diminished to the

point where there was little need for a

500-bed hospital. Consequently, the 21st

Station Hospital moved on to the Persian

Gulf area in May 1943. During the previous month the 104th had turned over

to the British Navy the hospital that the

unit had been operating at Massaua and

moved to the Gura air depot to share in

the operation of the Douglas Aircraft

hospital there. The depot finally closed

in November, resulting in the disbanding of the Douglas hospital and the ship15

 (1) Annual Rpts, Med Dept Activities, Eritrea

Serv Comd, 1942, 1943. (2) Annual Rpt, 21st Sta

Hosp, 1943. (3) Annual Rpt, 104th Sta Hosp, 1943.

(4) Annual Rpt, 15th Field Hosp, 1943. (5) Annual Rpt, 16th Field Hosp, 1943.
70 MEDITERRANEAN AND MINOR THEATERS

KING GEORGE OF GREECE, COLONEL VAN VLACK, AND GENERAL ROYCE at 38th

General Hospital, Camp Huckstep, Egypt.

ment of the 104th to Asmara (the location of the headquarters of Eritrea

Service Command), where it established

a 25-bed hospital. This small installation

remained in operation for some time as

the only U.S. Army hospital in Eritrea.

A 50-bed hospital at Wadi Seidna, an important junction near Khartoum along

the Air Transport Command's central

African route, cared for the ATC personnel stationed there, as well as for the

transients who passed through on their

way to and from the Middle East and

India. It was operated by a platoon of

the 15th Field Hospital beginning in

June 1943, and taken over by a platoon

of the 16th Field Hospital in September.

(See Map 4.)

Aside from the town of Massaua,

which is one of the hottest and most

humid seaports in the world, hospitals in

Eritrea operated installations at places

with fairly moderate climates due to elevations of 5,000 to 7,500 feet. The scarcity of potable water caused some trouble

for these hospitals, and the task of maintaining good sanitary standards proved

to be a constant battle, as in most other

parts of the theater. The command was

fortunate enough to secure permanent

buildings for all its hospitals. It evacuated almost all of its patients by air.
AFRICA AND THE MIDDLE EAST 71

HOSPITAL TRAIN IMPROVISED FROM PASSENGER CARS, BENGHASI AREA

Levant Service Command—No U.S.

hospital facilities were available in the

Levant Service Command until February

1943, nearly eight months after the command was activated. General dispensaries at Tel Aviv and at Camp Tel Litwinsky, both in Palestine, served the area

from July 1942. In mid-November the

4th Field Hospital arrived at the camp,

took over operation of the dispensary

there, and established a small infirmary.

Lack of equipment prevented it from

operating as a hospital, but many medical officers from its staff worked for short

periods at two British general hospitals

in Jerusalem. The 24th Station Hospital

(250 beds) relieved the remaining elements of the 4th Field Hospital in February 1943. The latter then joined the

parent unit, which had been assigned a

few weeks earlier to the Ninth Air

Force-Libya.16

The buildings of the 24th Station Hospital at Camp Tel Litwinsky were ideally situated on a small hill with a beautiful view of the countryside. The water

supply was adequate and the drainage

good. The equable Mediterranean climate and the fresh air and sunshine

made the 24th a perfect place for convalescing patients, and it operated as such

for men who had received treatment elsewhere in the theater. It also performed

the usual functions of a station hospital

for Levant Service Command personnel.

Most patients arrived at the hospital by

air, but some of those from Delta Serv16

 (1) Annual Rpts, Med Dept Activities, Levant

Serv Comd, 1942, 1943. (2) Annual Rpt, 4th Field

Hosp, 1942. (3) Annual Rpt, 24th Sta Hosp, 1943.
72 MEDITERRANEAN AND MINOR THEATERS

PARTIALLY DUG-IN HOSPITAL TENTS of the 3d Platoon, 4th Field Hospital, near Tripoli,

May 1943.

ice Command came in by rail. (See Map

4.)

Military activities in the command

began declining by mid-1943. The command headquarters moved from Tel

Aviv to Camp Tel Litwinsky, and the

commanding officer of the 24th Station

Hospital started serving as surgeon of the

command in addition to his duties at the

hospital. By October, the 24th Station

Hospital closed, evacuated its patients to

the 38th General Hospital in Egypt, and

made ready to depart for the ChinaBurma-India Theater.

Libyan Service Command—By the

time that the British Eighth Army had

passed Benghasi in its advance through

the Western Desert, a new service command was added to the original five. A

short-lived command—formed on 7 December 1942 and disbanded on 26 May

1943—the Libyan Service Command included the area within the territorial

boundaries of Libya not occupied by

enemy forces. At first comprising only

eastern Libya, the command grew in area

as the Eighth Army advanced westward.

The major American participants in the

sixth Libyan campaign were members of

the U.S. Ninth Army Air Force. Hospital care for the personnel of the force

was provided first by British Army hospitals and later by hospitals of the Middle

East theater.17

Beginning in January 1943 the pla17

 (1) Annual Rpt, 4th Field Hosp, 1943. (2) Annual Rpt, 15th Field Hosp, 1943.
AFRICA AND THE MIDDLE EAST 73

toons of the 4th Field Hospital, assigned

to the Libyan Service Command, had

the job of receiving Ninth Air Force

patients from their squadron aid stations

and evacuating them back to Egypt. The

4th Field also cared for Services of Supply troops stationed in the Libyan

Service Command. The first unit of the

4th Field Hospital to begin work in

Libya was the 1st Platoon, which arrived

at Gambut on 26 January 1943 and

began receiving patients three days later.

It relieved pressure on the British hospitals in the area by taking American

patients of the IX Bomber Command

and Services of Supply personnel in the

vicinity. It changed location on 28 February, moving forward to Benghasi

where it established another hospital.

The 3d Platoon and the headquarters

section of the 4th Field Hospital arrived

in Tripoli on 26 March 1943 and set up

a hospital for units of the Ninth Air

Force and Services of Supply troops in

western Libya and southeastern Tunisia.

The 2d Platoon entered the field last,

opening on 19 April at Sfax, Tunisia,

where it supported two bombardment

groups. Soon after the surrender of the

Axis forces in Africa in mid-May, it

moved back to Benghasi. Another field

hospital, the 15th, arrived in Libya on

13 May and relieved the 1st Platoon of

the 4th Field Hospital at Benghasi. (See

Map 4.}

The most characteristic feature of

field hospital operations in Libya was

the independent functioning of the platoons, often separated by hundreds of

miles. Except for buildings obtained by

one of the platoons of the 4th Field

Hospital, all hospital installations used

tents. British tropical-type tents supplemented the regular ward tents with good

results. The extreme heat of the desert

was 15° to 20°F. less inside the British

tent. During the period of active fighting, the platoons of the 4th Field Hospital habitually dispersed and dug their

tents in for maximum protection from

bomb fragments. Life in the desert under field conditions made it necessary to

get along with what was on hand—nothing was wasted that could be turned into

a useful item for the hospital. Water,

though fairly adequate in quantity, had

to be hauled for considerable distances.

Evacuation from southern Tunisia and

Libya was generally by ambulance or

plane from squadron aid stations of the

Ninth Air Force and dispensaries of

Services of Supply units to the platoons

of the field hospitals, where planes

picked up patients for delivery to the

38th General Hospital in Egypt. A curiosity of the situation was the parallel

existence of an evacuation system under

the control of the North African theater

moving casualties from Tunisia westward to Algiers, so that two supply and

evacuation routes ran at an angle of 180°

to each other. A similar situation prevailed during the invasion of Sicily when

the Ninth Air Force again supported the

British Eighth Army. The Middle East

theater ran its chain of evacuation from

Sicily by way of Tripoli to Egypt, while

the North African Theater evacuated

from Sicily to Bizerte and thence westward.

Persian Gulf Service Command—In

the Persian Gulf area the first substantial shipment of U.S. troops arrived at

Khorramshahr, Iran, on 11 December

1942. With them came the personnel of

2 station hospitals, the first major increment of Medical Department troops
74 MEDITERRANEAN AND MINOR THEATERS

113TH GENERAL HOSPITAL AT AHWAZ, IRAN, laid out in radial pattern with connecting

wings.

to arrive in the command. The 2 hospitals, the 19th and 30th Station Hospitals,

both 250-bed units, began operating in

early January 1943, the 19th at Khorramshahr and the 30th at Tehran. Later in

January the temporary 50-bed hospital

at Ahwaz was designated the 256th Station Hospital. Between January and the

end of June, 3 more station hospitals

(the 21st, 113th, and 154th) and 3 field

hospitals (the 18th, 19th, and 26th) were

established in Iran. No additional hospital units arrived there during the existence of the command.18

 (Map 5)

The 113th Station Hospital (750

beds), the largest American hospital in

Iran, began acting as a general hospital

for the command soon after it arrived at

Ahwaz in May. It offered complete treatment for all diseases and injuries and

served as a clearinghouse for patients

being evacuated to the zone of interior

through the 38th General Hospital in

Egypt. It also provided station hospital

care for nearby troops. In September

the unit was reorganized as the 113th

General Hospital and was given personnel to operate a 1,000-bed plant. Another

18

 (1) Hist, Med Activities, PGC. (2) Annual

Rpts, Med Dept Activities, PGSC, 1942, 1943. (3)

Annual Rpt, 113th Gen Hosp, 1943. (4) Annual

Rpts, 19th, 21st, 30th, 154th, 256th Sta Hosps,

1943- (5) Annual Rpts, 18th, 19th, 26th Field

Hosps, 1943.
MAP 5—U.S. Army Hospitals in the Persian Gulf Service Command, 1 July 1943
76 MEDITERRANEAN AND MINOR THEATERS

of the larger units in the command, the

21st Station Hospital (500 beds), began

functioning at Khorramshahr in midMay, replacing the 19th Station Hospital, which moved to Tehran. The 154th

Station Hospital, a smaller unit of 150

beds, first established a tented hospital

at Ahwaz in February, but moved north

to its permanent station at Hamadan in

June. The 50-bed 256th Station Hospital,

displaced at Ahwaz by the 113th General,

moved late in August to Abadan on the

Shatt-al-Arab near the Persian Gulf.

With one exception—the 19th Field

Hospital at Andimeshk—the field hospitals in Iran dispersed their platoons to

scattered locations where each was able

to run a hospital of at least 100 beds.

Installations operated by field hospital

platoons were, in effect, small station

hospitals and were usually housed in permanent buildings. They shifted from

place to place much more frequently

than the command's station hospitals.

During 1943 the 18th and 26th Field

Hospitals used all their platoons separately most of the time, the 18th operating hospitals at Sultanabad, Ahwaz, and

Bandar Shahpur, and the 26th functioning at Abadan, Kazvin, and Khorramabad.

By early December 1943 almost 2,700

beds, provided by one general, four station, and three field hospitals, were in

operation in the Persian Gulf Command.

Provisional dispensaries and aid stations

had also been set up as they were needed

at road camps, railway installations, and

other work sites along the supply routes

to the Soviet Union. These small units

supplemented those maintained by the

Ordnance Department and the Engineer, Quartermaster, and Signal Corps

for their own personnel. Where the installation was large enough to justify it,

a medical officer was placed in charge.

Where the installation was no more

than an aid station, it was generally in

charge of a trained enlisted man, sharing

with other such stations the supervision

of one medical officer. In the southern

part of the command, dispensaries operated heatstroke centers consisting of airconditioned rooms with beds and special

facilities for heat cases.

Few hospitals in the Persian Gulf area

operated under conditions that approached those prevailing in the United

States or even in some overseas theaters.

All of the locations were deplorable as

far as sanitation was concerned, and

many were at the mercy of the sweltering

heat for a good part of the year. Dust

storms, combined with temperatures of

150° and 160° F. in the sun (one station

reported a reading of 183°F.), made

service in some parts of Iran an ordeal

to bear. To make matters worse Iran

was a land of pestilence, the population

being a reservoir of malaria, typhus, venereal diseases, intestinal infections, smallpox, and a variety of other diseases.

Scarcely a place could be found where

the water supply was not heavily contaminated. Water had to be filtered and

then either boiled or chlorinated before

it was safe to drink. Because of the practice of fertilizing with human feces, most

of the locally grown vegetables and

thin-skinned fruits required thorough

cooking or dipping in boiling water before they could be safely eaten. Flies,

mosquitoes, and other insects provided

another source of disease as well as a

constant annoyance.

Housing for hospitals posed a serious

problem. Tented hospitals functioned

briefly, but eventually almost all hospi-
AFRICA AND THE MIDDLE EAST 77

tal construction rose from the ground up,

using native mud, brick, and stone. Window ramps and doors fashioned from

cratings of automobiles and trucks sent

to the USSR, and plastic for glass windowpanes put the finishing touches on

many hospital buildings. Men of the

hospital detachments made many of their

own items of equipment such as tables,

chairs, and desks. The buildings themselves were always one storied and

frequently were built in a rosette pattern

with central rotundas from which five

wards radiated. In the southern part of

Iran, hospitals had air conditioning units

in some of their buildings, making the

heat of summer more endurable for both

patients and hospital personnel.

By the fall of 1943 the Persian Gulf

Command had reached a strength of

some 29,500, a figure that varied no

more than 2,000 during the following

year. Although the command had hospital beds available for 10 percent of the

strength during most of 1943, at no time

was it necessary to use the full bed capacity. The average of hospitalization

varied from 4.5 to 6.5 percent of the total

strength. From the time the command

was formed until 1 October 1943, total

admissions numbered 24,889. The average rates per 1,000 per annum for disease

and injury admissions in 1943 were 1,172

and 155 respectively. During the first

nine months of 1943 the three main

communicable diseases treated in PGSC

hospitals were common diarrhea, which

accounted for 4,348 admissions with a

rate of 293 per 1,000 per annum; common respiratory disease, with 2,511 admissions and a rate of 169; and venereal

disease, accounting for 1,563 admissions

with a rate of 104. Specific dysentery,

amebic dysentery, and pappataci fever

were three other important causes for

admission to hospitals.

Evacuation within the command was

by rail, motor, and air transport, the

more serious cases being sent from the

station and field hospitals to the 113th

Station Hospital at Ahwaz. Patients needing prolonged treatment traveled to

Cairo by air for care at the 38th General

Hospital. Soon after the 113th officially

became a general hospital in mid-September 1943, it cared for many more

serious and complicated cases. Here a

board of medical officers examined

patients and their records, and if it decided that an individual could not be

successfully treated in the Persian Gulf

Service Command, he would be shipped

directly to the zone of interior by the

air transport route across Africa. Although patients from the Persian Gulf

area would frequently stop at the 38th

General Hospital while waiting for a

plane, their status was strictly transient,

and the 38th could not change the decision made by the 113th General Hospital in Iran.

Central and West Africa—Except for

a few dispensary beds at places along the

route of the Air Transport Command,

there were no U.S. Army hospital facilities under the U.S. Army Forces in Central Africa until early December 1942,

when the 67th Station Hospital (250

beds) arrived at Accra.19

The following month another medical

unit, the 93d Station Hospital (150

19

 The 23d Station Hospital had been set up in

Léopoldville, Belgian Congo, in September 1942 to

provide medical care for a southern branch route

of the ATC, but it never got into full operation

because the proposed route was abandoned by the

end of the year. The idle 23d was finally sent to

the North African theater in April 1943.
78 MEDITERRANEAN AND MINOR THEATERS

167TH STATION HOSPITAL AT ACCRA, GOLD COAST

beds) debarked at Dakar, French West

Africa. The major function of both hospitals was to give medical support to the

bases of the Air Transport Command.

Between Dakar and Accra a third hospital, the 25th Station (250 beds), had

been operating since June 1942 near

Roberts Field, Liberia, a major airfield

of the Air Transport Command.20

The three major points of U.S. Army

hospitalization remained at Accra, Dakar,

and Roberts Field throughout the war.

Since all three station hospitals were

well within the tropics, their personnel

were subject to high temperatures, malaria, venereal disease, and a host of tropical diseases. Malaria in particular took

its toll in thousands of man-days lost.

The hospital buildings built or acquired

for these units followed a simple onestoried hospital plant layout. The dispensaries at the stations of the Air

Transport Command sent patients needing hospital care by air to the hospital

nearest their landing fields. During 1943

west African hospitals evacuated some

300 patients to the United States, most

of them by air transport. Since all those

evacuated were general-hospital cases,

shipment west to the United States on

20

 (1) Annual Rpt, Med Dept Activities,

USAFICA, 1942. (2) Annual Rpt, Med Dept Activities, West African Serv Comd, 1943. (3) Annual

Rpts, Med Dept Activities, USAFIL, 1942, 1943.

(4) Annual Rpt, Med Dept Activities, Central

African Wing, ATC, 1943. (5) ETMD Rpt,

USAFICA, Aug 1943. (6) Mae Mills Link and

Hubert A. Coleman, Medical Support of the Army

Air Forces in World War II (Washington, 1955),

pp. 588-90.
AFRICA AND THE MIDDLE EAST 79

the return air route was preferable to

sending patients farther away from the

zone of interior by going east across

Africa to the nearest general hospital in

Egypt.

Summary—From the beginning of the

theater, the medical service in the Middle East was one that had served widely

dispersed troop concentrations. The

prevailing pattern of small station hospitals and field hospital platoons operating

in the same capacity was the most logical

approach to supplying medical service to

one of the largest U.S. Army theaters in

the world in terms of land area. In physical plant the hospitals of the Middle

East theater compared favorably with

many cantonment-type hospitals in the

United States, considering the difficulties imposed by unfavorable climate,

poor sanitary standards, and endemic

diseases. All these factors caused extra

work that would be largely unnecessary

in some theaters. Hospital plants often

took the additional precaution of enclosing their areas with barbed wire fences

to prevent pilfering.

The theater reached its peak strength

in July 1943, when it had 66,483 troops.

Maximum hospital bed strength was

reached at the same time, with 6,600

fixed beds scattered from Liberia to

Tehran.21 Approximately half of the total, or 3,200, were in the Persian Gulf Service Command. Delta Service Command

had 1,000; Eriterea Service Command

had 450, including those in the civilian

hospital of the Douglas Aircraft Corporation; and U.S. Forces in Central Africa

were served by 400 beds. There were 400

beds under jurisdiction of the short-lived

Suez Port Command; 400 in the Libyan

Base Command; 500 in the Tripoli Base

Command; and 250 each in the Levant

Service Command and in Liberia.

Although the ratio of fixed beds to

troop strength was high—9.9 in the peak

month—the general average of beds occupied at any one time rarely exceeded

5 percent of theater strength.

Admissions to fixed hospitals in the

Middle East theater during the period

of greatest activity—1 July 1942 through

30 September 1943—totaled 53,863, of

which 24,889 were in the Persian Gulf

Service Command. The five leading

causes of admissions were intestinal disease, respiratory disease, injury (exclusive of battle casualties), cutaneous disease, and venereal disease. The 120-day

evacuation policy originally planned for

the medical service of the theater proved

adequate. Evacuation within the theater

emphasized the use of airplanes because

of the wide dispersal and lack of other

adequate facilities. No special ambulance planes operated for this purpose,

but regular transport planes were used

when available. During the period under

consideration most evacuees to the zone

of interior traveled by Air Transport

Command plane from Cairo. By October

1943, approximately 1,000 patients had

made the trip to the United States.

At no time were U.S. hospital ships

available for evacuation from the Middle East. In the early period, a few

patients were sent to the zone of interior

from the Persian Gulf on cargo ships by

way of the Cape of Good Hope. Space

on British hospital ships in the eastern

Mediterranean was sometimes available.

The British hospital ships, however,

generally excluded psychotics, and the

ATC planes would carry patients of this

class only when accompanied by a medi- 21

 See app. A-2.
80 MEDITERRANEAN AND MINOR THEATERS

cal officer or nurse. As a result, some

psychotics were held at the 38th General

Hospital for more than a year. In other

instances a medical officer who could not

easily be spared was nevertheless detailed

for this service.22

The Middle East as a Supply and

Service Theater, 1944-45

The United States Army Forces in the

Middle East reached a peak strength of

more than 65,000 in midsummer of 1943,

but combat activities in the area were

rapidly coming to a close. Ground Forces

headquarters was discontinued during

the summer because no American ground

combat troops remained in the Middle

East. The Ninth Air Force supported the

British Eighth Army in the invasion of

Sicily early in July, and later that month

participated in the bombing of Rome,

but the successful raid on the Ploesti oil

fields of Rumania in August was the

last combat mission for the Ninth Air

Force in the Middle East. Transfer of

personnel to the Twelfth Air Force in

North Africa began in July, and headquarters moved to the United Kingdom

in October.

After departure of the Ninth Air

Force, operations in the Middle East

were those characteristic of a large communications zone, consisting almost exclusively of maintaining supply lines and

transporting supplies and personnel.

Organizational Changes

Theater Headquarters—With the departure of General Brereton in September 1943, Maj. Gen. Ralph Royce assumed command of the United States

Army Forces in the Middle East. The

separate services of supply headquarters

was discontinued at this time, but without in any way affecting the work of the

Medical Department in the theater. Colonel Sams, who had returned to the

United States in August, was succeeded

as theater surgeon by Col. Eugene W.

Billick.

While activity declined in the eastern

Mediterranean in the fall of 1943, activity in the Persian Gulf area was still

increasing. The independent mission of

the Persian Gulf Service Command was

recognized early in December when its

administrative tie with Cairo was cut and

the command was made directly responsible to the War Department. In effect,

the redesignated Persian Gulf Command

remained an independent theater until

1 March 1945, when it was merged with

USAFIME and the Mediterranean Base

Section from the Mediterranean theater

to form the Africa-Middle East Theater of Operations.

The staff of the theater surgeon's office

in Cairo underwent numerous changes

during 1944 and 1945. Many of the original officers on Colonel Billick's staff returned to the United States, their duties

being carried on either by newly appointed officers (of lower rank than

their predecessors), absorbed by other

subsections of the office, or handled by

officers assigned to Medical Department

installations. The head of the dental

section, for example, had a triple assignment, since he was also dental surgeon of

a service command and of a general hospital. The preventive medicine section,

the one element where expansion occurred, had a malariologist (stationed in

22

 Ltr, Van Vlack to Col Coates, 23 Mar 59, commenting on preliminary draft of this chapter.
AFRICA AND THE MIDDLE EAST 81

West Africa) assigned to it, as well as a

nutrition officer.

A contingent of the Women's Army

Corps, which arrived in the middle of

1944, replaced practically all the enlisted

men in the theater surgeon's office. The

turnover in commissioned personnel was

heavy in 1945, and the loss acutely felt,

especially since the theater had experienced a substantial expansion in territory. A new development during early

1945 was the appointment of medical,

surgical, dental, and neuropsychiatric

consultants. They worked not only as

members of the theater surgeon's staff

but also as chiefs of services in the 38th

General Hospital. During the course of

the year many sections of the surgeon's

office were merged, and it was common

to find medical staff officers combining

two or more assignments.

The Service Commands—With the

Persian Gulf Command autonomous by

the beginning of 1944, the remaining

service commands in Africa and the Middle East were regrouped into two major

commands. The Middle East Service

Command was established in February,

merging the Delta, Levant, and Eritrea

Service Commands. The Levant Service

Command was disbanded, while Eritrea

became a base command subordinate to

the new headquarters. The West African

Service Command remained substantially as it had been organized in the fall

of 1943.23

The medical service in the Middle

East Service Command was responsible

for the care of all American troops and

associated personnel in Egypt, the AngloEgyptian Sudan, Eritrea, Libya, Palestine, Syria, and Arabia. When formed,

the commanding officer of the 38th General Hospital at Camp Huckstep, Egypt,

assumed the additional job of service

command surgeon. Various other officers

of the command surgeon's office also had

primary assignments with Medical Department units and installations. The

surgeon's office was located at the 38th

General Hospital. Eritrea Base Command was a subcommand of the Middle

East Service Command during most of

1944, but was established as a separate

command directly under theater headquarters in December. The commander

of the 104th Station Hospital at Asmara

served as the base command surgeon

throughout the year. Activities in the

West African Service Command centered

around the command headquarters in

Accra and the base command at Dakar.

The medical service, primarily for the

benefit of Air Transport Command personnel, continued to provide hospitalization, medical supplies, sanitary services,

and malaria control. The command

surgeon was also the commanding officer

of the 67th Station Hospital at Accra.

The Medical Department in Liberia

experienced some difficulties in carrying

on medical and administrative measures

for controlling malaria and venereal disease because of reductions in medical

personnel.

Coincident with the territorial expansion of 1 March 1945, French Morocco,

Algeria, and Tunisia were organized into

a new command, the North African Service Command, under the Africa-Middle

23

 The main sources for this section include: (1)

Hist, Med Sec, AMET; (2) Hist of AMET, Summary Outline; (3) Annual Rpt, Med Dept Activities, Middle East Serv Comd, 1944; (4) Annual

Rpt, Med Dept Activities, West African Serv Comd,

1944; (5) Annual Rpt, Sta Surg, Roberts Field,

Liberia, 1944; (6) Hist, Med Activities, Persian

Gulf Comd; (7) Annual Rpt, Med Dept Activities,

PGC, 1944.
82 MEDITERRANEAN AND MINOR THEATERS

East theater. The offices of the Mediterranean Base Section at Casablanca

became the new command's headquarters, and the commanding officer of the

56th Station Hospital in that city received the additional assignment of

North African Service Command surgeon. By the end of June 1945, all U.S.

Army activities in the West African

Service Command were placed under the

control of the North African Service

Command. Medical Department units

in West Africa were thereafter administered by the Southern Town Command, a subcommand whose function

it was to handle the liquidation of

U.S. Army installations in that area.

Southern Town Command, with headquarters at Accra, was one of four subdivisions under North African Service

Command, the others being Eastern

Town Command, Center Town Command, and Western Town Command,

with headquarters at Tunis, Algiers, and

Oran, respectively. After the Central African Wing of the Air Transport Command had been inactivated in July,

installations along its route through

the Southern Town Command and the

Middle East Service Command were

either closed or greatly reduced. The

bulk of air traffic passed through the

northern part of Africa for the remainder of the year.

The Persian Gulf Command reached

the peak of deliveries of war materials

to the USSR during 1944. The separation

of the command from the Middle East

theater in December 1943 had no effect

upon the medical service other than the

forwarding of reports, which no longer

required routing through Cairo. The

Medical Department of the command

continued to provide the best possible

care for troops and carried on its neverending task of refining preventive measures to combat the numerous diseases

of Iran. Col. John E. McDill became

PGC surgeon in January 1944. In the

summer of that year, when the command

was near its greatest strength, Colonel

McDill exercised staff supervision over

more than 2,400 Medical Department

officers and enlisted men.

By the end of 1944 the motor transport

routes to the Soviet Union started closing

down, narrowing the major supply activities to the more confined route of the

railroad from Khorramshahr to Tehran.

Progressive reductions in tonnage

through the first half of 1945 completed

the primary mission of the Persian Gulf

Command by 1 June, after which it

packed and shipped excess supplies,

turned over surpluses to a liquidation

commission, provided security detachments for remaining fixed installations

until they could be disposed of, and continued to supply the Air Transport Command. These residual duties required

fewer troops and many soon began moving out of the command. The Medical

Department's responsibility was to reduce its own personnel and installations

to conform with the command's program without impairing the efficiency of

its services to the remaining troops.

Air Transport Command—During

1943 the Africa-Middle East Wing of

the Air Transport Command had developed stations at many towns and

cities in northern, central, and eastern

Africa, and in countries of the Middle

East, which lay along the ATC routes

to Karachi, India. The northern arm

of its system stretched across French

West Africa, French Morocco, Algeria,
AFRICA AND THE MIDDLE EAST 83

Tunisia, and through the Middle East to

India, the most important stations being

within the North African theater. All

the airfields of the central route lay within the boundaries of the Middle East theater, passing through the countries of

west, central, and eastern Africa, across

southern Arabia, and on to India. By the

end of 1943 the Africa-Middle East

Wing had been split in two—the North

African Wing with headquarters at Marrakech, French Morocco, and the Central African Wing with headquarters at

Accra, Gold Coast. Since the latter was

most closely associated with the Middle

East theater, it is discussed here in more

detail than the northern route.24

The primary objective of the Central

African Wing was the delivery of highpriority freight and of military and

civilian personnel, mail, and military

aircraft across Africa. It transferred its

cargoes to the North African Wing at

Dakar and Cairo and to the India-China

Wing at Karachi. The Central African

Wing surgeon's medical responsibilities

were limited to preventive medicine

measures and the maintenance of dispensaries at the stations, including stations at which theater service command

hospitals were located. The territorial

command within which the wing operated furnished medical supplies as well

as hospitalization. Near the end of 1943

the Central African Wing was relieved

of the major medical problem of malaria control, which was placed under

the direction of the theater command.

Nineteen officers and seventy-one enlisted men of the Medical Department

served at the thirteen stations of the

wing in December 1943. At some of the

smaller stations a medical officer could

be on duty only part of the time, but

Medical Department enlisted men

served at all the dispensaries. Some dispensaries had facilities to handle personnel with minor illnesses and injuries,

but serious cases were evacuated by air

to the nearest U.S. Army hospital.

Transportation of patients homeward

from the Middle East along the route of

the Central African Wing was handled

by detachments of the 805th and 808th

Medical Air Evacuation Transport

Squadrons. Each air evacuation flight

was composed of a medical officer, six

nurses, and eight enlisted men. From

March 1943 to August 1944, 2,500 patients traveled westward across midAfrica, then on to Brazil and the United

States. Beginning in September 1944,

however, air evacuation activities were

transferred to the North African Wing.

Preventive medical problems constituted the chief concern of medical men

stationed at the bases of the Central

African Wing. Many of its stations were

in highly malarious areas and on the

edge of jungles and bush country, both

insect ridden. Despite the presence of

a large variety of tropical and other diseases (yaws, yellow fever, filariasis, typhus, dysentery, bubonic plague,

smallpox, and so forth), malaria caused

more illness among wing personnel than

any other disease. Aircraft accidents resulted in the death of more wing person24

 (1) Hist, Med Sec, AMET. (2) Hist of AMET,

Summary Outline. (3) Rpt of Med Dept Activities

in the Africa-Middle East Wing, ATC, for 1943,

Off of Surg, Sta #1. (4) Med Hist, Central African

Div, ATC, 22 Sep 44, by Maj Ralph N. Green, Jr.,

Div Med Historian, Air Staff files. (5) Hist of Central African Wing, ATC, AAF, by Capt John W.

Dienhart, Wing Historian, on file at Hist Br,

MATS. (6) Hist of the Med Dept, ATC May 1944,

Cpl Celia M. Servareid, editor, Off of Surg, Hq,

ATC, Air Staff files.
84 MEDITERRANEAN AND MINOR THEATERS

nel than any other cause, and the medical

care of pilots flying the Central African

route was an important matter to the

medical service. Flight surgeons required

that pilots take a semiannual flight

physical examination to determine the

flyer's fitness for duty. All airports had

emergency plans in readiness in the

event of crashes, including specially

equipped ambulances and other crash

vehicles. Near the coast, air-sea rescue

teams used motor launches and amphibious planes when an aircraft fell into

the sea. Trained Medical Department

enlisted men extricated patients from

downed planes and gave first aid treatment to the crash victims.

As the much shorter trans-African

route across North Africa developed, the

importance of the more southern route

under the Central African Wing diminished. However, the latter was still

thought to be a military necessity since

it provided a sure contact with India,

and it continued in operation until July

1945. Its dispensaries were inactivated

as the wing closed its stations during

June and early July, and the dispensary

equipment was shipped to the nearest

hospital or medical supply depot. The

medical service provided along the northerly route, under the North African

Wing, now lay within the boundaries of

the Middle East theater since the theater

had absorbed all of northern Africa in

March. The North African Wing operated dispensaries from Dakar and Casablanca in the west, across the coast of

northern Africa to Egypt, and on through

the Persian Gulf Command to India.

During 1945 it was responsible for evacuating a large number of patients from

the Mediterranean, India-Burma, and

China theaters to the United States.

Hospitalization and Evacuation

The need for hospitalization in the

Middle East declined with the changing

mission of the theater. Toward the end

of 1943 the 4th and 15th Field Hospitals

were shifted to the Mediterranean theater. In January 1944 the 24th Station

Hospital left Palestine for Jorhat, India;

and the following month the 16th Field

was transferred to the European theater.

In other hospitals, bed strength was reduced as patient loads became minimal.25

In Eritrea the 104th Station Hospital

continued to operate a 25-bed unit at

Asmara through 1944. Late in 1943 personnel not needed by this hospital were

detached to form the 367th Station Hospital, activated as a 50-bed unit in January 1944 and sent to Wadi Seidna, near

Khartoum, Anglo-Egyptian Sudan, where

it relieved a platoon of the 16th Field

Hospital. In Egypt, the 38th General

Hospital at Camp Huckstep was reduced

from 1,000 to 750 beds early in 1944. In

West Africa the 67th Station Hospital

(250 beds) at Accra, the 93d Station

(150 beds) at Dakar, and the 25th Station

at Roberts Field, Liberia, remained in

place throughout 1944. The 25th Station

was reduced from 250 to 50 beds in

January 1944, then increased to 75 beds

in September.

The acquisition of Northwest Africa

from the Mediterranean theater on 1

March 1945 brought three additional

25

 (1) Hist, Med Sec, AMET. (2) Annual Rpt,

Med Dept Activities, Middle East Serv Comd, 1944.

(3) Annual Rpt, West African Serv Comd, 1944.

(4) Hist, Med Activities, PGC. (5) Annual Rpt,

Med Dept Activities, PGC, 1944. (6) Unit Rpts of

hospitals mentioned in the text. (7) ETMD's for

1944, 1945.
AFRICA AND THE MIDDLE EAST 85

FORK-LIFTING A PATIENT aboard a

transport plane, Casablanca, May 1945.

hospitals under jurisdiction of the Middle East theater, and offered an opportunity to relocate some of the hospitals

already serving in the command. Those

acquired were the 56th Station (250

beds) at Casablanca; the 57th Station

(150 beds) at Tunis; and the 370th Station (25 beds) at Marrakech. At this

time the 150-bed 93d Station was transferred from Dakar to Tripoli, being

replaced at Dakar by the 50-bed 367th

Station from the Khartoum area. The

25-bed 104th Station from Asmara replaced the 367th at Khartoum, leaving a

medical composite platoon in charge of

the hospital at Asmara.

The end of the war in Europe brought

a further reduction of activity in the

Middle East, but air traffic through the

theater increased, both from the Far

East by way of India and from Europe

by way of North Africa. In order to provide medical care for thousands of

transient patients en route from India

and Burma to the zone of interior, the

38th General Hospital—a 500-bed unit

since June 1945—was moved to Casablanca in August. The 56th Station,

which had been more than two years at

Casablanca, took over the Camp Huckstep site of the 38th General near Cairo.

Also in August, the 53d Station Hospital

was reactivated as a 50-bed unit and was

established at Oran.26

The evacuation of patients to the zone

of interior rose considerably during

1944, due primarily to the inauguration

in August of an evacuation service

through the Africa-Middle East theater

for patients from the China-Burma-India theater. The Persian Gulf Command

also sent many homeward-bound patients through the theater. While these

transient cases were not formally admitted to a hospital, they put a strain upon

the theater's small number of medical

installations because in some instances

they had to be held several days while

awaiting a plane. Total evacuations to

the United States including patients

from the China-Burma-India theater,

the Persian Gulf Command, and the

Africa-Middle East theater itself, numbered well over 3,000 during 1944. This

figure rose to more than 5,000 for 1945,

the transient patients constituting most

of the total. The evacuation policy

changed from 120 days to 60 days in

August 1945 in order to filter patients

back to the United States more rapidly.

In the Persian Gulf Command a general reduction in bed strength, based on

26

 See pp. 497-98, below.
86 MEDITERRANEAN AND MINOR THEATERS

the experience of a year and a half of

operation, began before the end of 1943,

while activity in the area was still increasing. The 30th Station Hospital, with

250 beds, left the Persian Gulf area for

the China-Burma-India theater in November 1943. In January 1944 the 150-

bed 154th Station was transferred to the

Mediterranean theater, and the following

month the 113th General Hospital was

reduced from 1,000 to 750 beds. The

18th Field Hospital left the command

in July 1944, and the 26th Field in

December.

By the beginning of 1944, practically

all hospital construction in the Persian

Gulf area had been completed. The

need for air-conditioned wards was recognized early, especially for hospitals located in the gulf and desert areas, but

only a limited number of cooling units

were available during the first year of

operation. Installation of additional

equipment in hospitals was begun in

March 1944 and completed by the first

of July, resulting in many completely

air-conditioned wards at five hospitals.

Approximately 1,248 beds in hospitals

located at Andimeshk, Ahwaz, Khorramshahr, Bandar Shahpur, and Abadan had

the benefits of air conditioning readily

available.

The year 1944 saw a progressive reduction of illness in the command. At

no time during the year did disease rates

approach the peak rates of 1943. After

July 1944 all the curves followed a steady

downward trend. This decline, in a

country rife with diseases, was a direct

result of the effectiveness of the Medical

Department's preventive medicine program.

By the beginning of 1945 there were

1,850 T/O beds remaining in the Persian

Gulf Command, or a ratio of 6.9 to troop

strength. Hospitals still operating at this

time were the 113th General (750 beds)

at Ahwaz, the 21st Station (500 beds)

at Khorramshahr, the 19th Station (250

beds) at Tehran, and the 256th Station

(50 beds) at Arak. The 19th Field

Hospital had 200 beds in operation at

Andimeshk and 100 beds at Bandar

Shahpur.

Early in February the 21st Station was

transferred to Italy, being replaced at

Khorramshahr by the 113th General. A

platoon of the 19th Field took over the

Ahwaz site. At the beginning of April

the 113th General was further reduced

to 500 beds and was closed for movement

out of the theater later that month. The

end of June 1945 found only the 19th

and 256th Station Hospitals and one

platoon of the 19th Field Hospital still

active in the command, with an aggregate of 400 beds.

Patients were evacuated from the

Persian Gulf Command to the zone of

interior on a 180-day policy, moving

through the 113th General Hospital.

For the period January 1943-September

1945, 1,168 patients were returned to

the zone of interior. All patients were

transported by air to Cairo and from

there by air or water to the United

States. Up to September 1944 the Persian

Gulf Command furnished attendants

for patients being evacuated to Cairo,

but after that date Air Transport Command planes had one flight nurse and

one enlisted man as attendants. A flight

surgeon examined all patients before

departure from Iran. The four leading

causes for evacuation were neuropsychiatric diseases, injuries, cardiovascular

diseases, and respiratory diseases. Most

of the evacuation within the command,
AFRICA AND THE MIDDLE EAST 87

that is from the station and field hospitals to the general hospital, was by a

weekly railroad ambulance car, motor

ambulance, or a combination of the two.

The command used air evacuation for

emergency cases occurring within its

boundaries.

Medical Supplies and Equipment

When early in the war, American units

arrived in the Middle East short of medical equipment, the British furnished the

necessary supplies, sometimes from

lend-lease stores. Occasionally difficulties

developed in the use of British supplies

since American medical officers did not

always regard British standards as equal

to those of the U.S. Army. During the

latter part of 1942, supplies in larger

quantities began arriving from the

United States, having been shipped by

automatic issue of medical maintenance

units. The supply situation was one of

general disorder in the early period, as it

was in most new theaters. Thousands of

unlabeled boxes had to be opened to discover what had been received. To make

matters worse, many Medical Department hospital units arrived without any

supplies and equipment, their assemblies having been shipped separately.

Fortunately, acquisitions from the British, improvisations from materials on

hand, and a small number of local purchases enabled hospitals to operate without waiting for all their equipment to

arrive.27

The theater experienced some shortages during 1942 and the early part of

1943, but medical supply conditions improved after the middle of the year. The

4th Medical Depot Company, which had

arrived on 1 November 1942, established

three medical supply subdepots in the

Middle East theater—at Camp Huckstep,

Egypt; Decamere, Eritrea; and Tel Litwinsky, Palestine. By February 1943 the

military situation in the theater had so

changed that the subdepots in Eritrea

and Palestine were closed. All medical

supply depot work was then concentrated

at Camp Huckstep, where the 4th

Medical Depot Company became the

medical section of the theater's quartermaster general depot. Automatic supply

from the zone of interior was discontinued in October 1943, and thereafter

the theater ordered medical supplies by

quarterly requisitions on the United

States.

The medical supply authorities in the

Middle East theater found that the experience gained during the theater's

most active period indicated that a better

plan to equip medical troops would have

been to establish an assembly depot well

stocked with all types of medical supplies

at or near the port of debarkation. Such

a depot could have assembled equipment

for each unit after notification of its

embarkation from the United States had

been received. In effect, the Middle East

theater used this plan for all medical

units arriving after February 1943, and

the units so equipped were better able

to perform their duties than those

equipped with assemblies sent them

from the zone of interior. The action

taken within the theater helped medical

units begin efficient operation sooner,

since otherwise some units would have

27

 The chief sources for this section are: (1) Hist,

Med Sec, AMET; (2) Annual Rpts, Med Dept Activities, USAFIME, 1942, 1943; (3) Hist of Med

Activities, PGC; (4) Annual Rpts, Med Dept Activities, PGC, 1943, 1944, 1945; (5) ETMD.

USAFIME, Jan 1944.
88 MEDITERRANEAN AND MINOR THEATERS

had to wait many months before certain

essential items arrived. Furthermore,

unit assemblies from theater supplies

had fewer shortages because the element

of loss through handling was reduced to

the minimum. Only items actually required by the unit to perform its mission

were issued, thereby saving both equipment and transportation from depot to

station.

Medical supply presented no serious

problems in the Persian Gulf Service

Command. Although the flow of supplies

was slow in 1942 and early 1943, this

situation improved by the middle of

1943, and adequate quantities of supplies were on hand after this time. A

great deal of breakage and spoiling of

perishable items occurred because of

improper packing, poor handling, and

exposure to the terrific heat of the Persian Gulf climate. Stock levels that had

been built up during 1943 were reduced

by 50 percent in January 1944, and the

final reserve (a 90-day level of supplies

set aside for emergency use) was abolished. About this time the automatic

shipment of selected medical supplies

was discontinued. Supplies were thereafter requisitioned on the basis of Table

of Organization and Equipment (TOE)

authorization and consumption. The

overstockage that resulted was corrected

by declaring excesses, which were eventually shipped back to the United States.

Vaccines, which had previously been

shipped by water, arrived in the Persian

Gulf Command by air beginning in

1944, thus eliminating considerable loss

in spoilage of vaccine before it could be

used. In 1945 all surplus supplies and

equipment not in use by medical installations were reported to an Army-Navy

Liquidation Commission for disposition.

Professional Services

Major Medical Problems

The relatively limited combat activity,

the difficult climatic conditions, and the

low health and sanitary standards of the

native populations all combined to channel the activities of the Medical Department in the direction of preventive

medicine. In Central and West Africa

the most serious problem was malaria;

in the Persian Gulf area, respiratory diseases were common. Gastrointestinal

disorders, venereal disease, and neuropsychiatric problems swelled the noneffective rates throughout the theater.

Disease patterns in the Middle East were

observed by medical officers with the

original North African and Iranian military missions and the problems that

would be encountered were fully appreciated from the start.

Malaria—American medical officers in

the Middle East had first hand experience with malaria and other insect-borne

diseases months before the standard

malaria control and survey units developed by the Surgeon General's Office

were available for overseas duty. Based

on this experience, an antimalaria unit

consisting of one Sanitary Corps officer

and five enlisted men was developed in

the theater late in 1942. One such unit,

supplemented by civilian laborers,

worked in each service command.28

28

 (1) Hist, Med Sec, AMET. (2) Rpt of Gambiae

Control and Malaria Prevention at U.S. Army Bases

in West Africa, by Maj Elliston Farrell, 1944. (3)

Rpt of Malaria Control at U.S. Army Installations

in West Africa, 1941-44, Hq, West African Serv

Comd, USAFIME, to CG, USAFIME, attn Chief

Surg. (4) Malaria: Its Prevalence, Control, and Prevention in the Africa—Middle East Area, by J. W. H.

Rehn.
AFRICA AND THE MIDDLE EAST 89

In March 1943 the standard, more

specialized units developed by the Surgeon General's Office for the purpose of

malaria control were requested after the

theater was informed of their existence.

The one survey unit and two control

units asked for did not reach the theater,

however, until September 1943 because

of shipping delays. About that date

malaria became the most important disease in terms of man-days lost in this

theater where disease problems were

now paramount and combat injuries

nonexistent. This was the date when two

highly malarious areas, those of the

Central African and Liberian commands,

were included in the theater's boundaries. In October the malaria rate at

Dakar reached almost 2,000 per thousand

men per year; in Accra it reached 580

and in Liberia over 800. Half of all hospital admissions in West Africa were

caused by malaria. In Dakar 50 percent of

the enlisted men of the 93d Station Hospital came down with the disease at the

height of the 1943 malaria season.

Efforts to control malaria were concentrated in western Africa, particularly

at Dakar, in Liberia, and at Accra, the

three worst areas. At the end of 1943 a

malaria survey unit was at work in each

of the three locations. In addition, Liberia and Accra each had a malaria

control unit, two control units were assigned to Dakar, and a fifth one was

assigned to Delta Service Command.

Early in 1944 all these units were placed

under more centralized control at theater headquarters, largely as a result of a

visit to the theater by a group of officers

from the Surgeon General's Office and

the Medical Inspector, USAFIME. This

malaria control commission made its

investigation in West Africa in November and December 1943.29

 It was primarily concerned with ridding the West

African coastal airports of anopheles

gambiae mosquitoes in order to prevent

the introduction of this malaria vector

by plane into Brazil.30 A secondary purpose was to check on the accuracy of reports of excessively high malaria rates

among Eighth Air Force combat crews

who passed through Air Transport Command installations in Africa on the way

to England. A third matter for investigation was the appalling malaria rates

among U.S. military personnel stationed

on the West African coast. These were

among the highest in the entire Army,

not excepting the rates for combat troops

in New Guinea, Guadalcanal, and Sicily.

The fact that the troops were living in

relatively permanent installations made

the theater medical inspector, Lt. Col.

Thomas G. Ward, term the situation "a

disgrace to the U.S. Army."

The causes were pointed out by Colonel Ward in a report to the Chief

Surgeon, USAFIME. The Central African command had failed to organize and

maintain malaria control even after high

rates had developed. The Africa-Middle

East Wing, ATC, had similarly failed

to provide a sound malaria control organization and policy after it had agreed

with the Central African command to

take over malaria prevention measures

at the West African airfields. Shortages

of personnel and equipment had prevented the wing from carrying out effective control measures. The Corps of

29

 Members of the commission were Col. William

A. Hardenbergh, SnC, SGO, Washington, D.C.;

Col. Paul F. Russell, Malariologist, NATOUSA;

Lt. Col. Karl R. Lundeberg, MC, SGO, Washington,

D.C.; and Maj. Elliston Farrell, MC, Office of the

Air Surgeon, Washington, B.C. 30

 See pp. 53-54, above.
90 MEDITERRANEAN AND MINOR THEATERS

Engineers and those charged with the

maintenance of post utilities were in

part responsible because of their failure

to make the buildings mosquitoproof

where the permanent personnel lived and

where combat aircrews and passengers

stayed while in transit. Finally, the

medical and line officers at the West

African posts had not developed an effective educational program to acquaint

permanent and transient personnel with

the dangers of malaria.31

The commission concluded in its report to The Surgeon General that

malaria control in the theater was the

responsibility of the theater commander

and that personnel engaged in it should

be part of the theater organization. The

commission pointed out that, with available air transportation, one malariologist could maintain close supervision over

malaria control work in the widely

separated malarious areas around Dakar,

Roberts Field, and Accra.32

The special malaria control organization that developed was headed by Maj.

Elliston Farrell, the Army Air Forces

representative on the visiting commission. He was assigned in February 1944

to the Medical Section, USAFIME, as

theater malariologist, succeeding Lt.

Col. Daniel Wright who had held that

post since early 1942. Major Farrell was

stationed in Accra, where he could direct operations on the coast of West

Africa. He also acted as disinsectization

officer for the South Atlantic, North

African, and Central African Wings of

the Air Transport Command and as liaison officer with the Brazilian Port

Health Service. Two doctors of the Brazilian Department of Public Health

were stationed at Dakar and Accra as

liaison officers with the U.S. Army authorities. They were permitted to visit

other Army airports in Africa that

routed planes to Brazil, all in the interest of keeping Brazil free of gambiae.33

Working with the theater malariologist at the Accra, Liberia, and Dakar

bases were assistant malariologists, entomologists, engineers, and the enlisted

personnel of the control and survey units.

Malaria control measures were usually

restricted to a perimeter or protected

area around a U.S. military installation.

In some areas the U.S. Army and the

British and French carried out successful co-operative schemes. The interallied

scheme for malaria control developed by

the British and American forces stationed

in and around Accra was one of the

larger efforts along these lines. It

achieved integration of British and

American direction, engineering, survey, and control activities.

Although the theater malariologist

was responsible for co-ordinating and supervising malaria control activities in

West Africa, he had no power of command. Consequently he found it difficult

to deal with station commanders. Major

Farrell revealed some of the trouble he

had in Accra when he stated:

Directives were not followed and as ex- ample the station commander was interested in building an officers' club and we 31

 Memo, Col Ward, Med Insp, USAFIME, to

Chief Surgeon, USAFIME, 21 Dec 43, sub: Malaria

in West Africa. 32

 Memo, Col Hardenbergh, Col Lundeberg, and

Maj Farrell for The Surgeon General, 4 Dec 43,

sub: Mosquito and Malaria Control at West African

Airfields.

33

 Elliston Farrell, "The Anopheles Gambiae Problem in Brazil and West Africa, 1941-44," Bulletin,

U.S. Army Medical Department, vol. VIII, (February 1948), pp. 110-24.
AFRICA AND THE MIDDLE EAST 91

were interested in having screened buildings in the camp. . . . The officers' club was

opened for general use the 5th of October

[1944]. It was started the 29th of May

and was built by men working 12 hours a

day, 7 days a week, during the height of

our [malaria] season. It was built at a

time when lumber was not available for

essential screening work. When the officers'

club was finished the screening was done

and by that time it was September and we

didn't need it. ... We are educating the soldiers in the

malaria program, but we are not sufficiently

educating the Generals and Colonels. I am

actually convinced, from the reaction of

the station commander, that he had no

idea that malaria could be eliminated from

the base. I had breakfast with him a few

days before he was reassigned and he asked

me how many cases of malaria we had last

week. I told him two and that in the same

time in 1943 there were forty or fifty. He

was so obviously astonished that I realized

for the first time that he had thought we

were just pestering him. He had thought

that when he had put in a good system of

malaria discipline, nothing further could

be done about it. He didn't know that by

attacking malaria at its source it could be

eliminated.34

Major Farrell also believed that the

efficacy of the malaria program could

have been greatly increased if there had

been a single battalion attached to theater headquarters under the direction of

the theater malariologist in lieu of a

larger number of scattered malaria units.

In his opinion a theater battalion for

malaria control would have provided a

much better system of centralized control

over the movement of units. Such a battalion could have had a commander responsible for the flow of orders. Major

Farrell found it a disadvantage to be

3,000 miles from the theater headquarters in Cairo and thus out of touch with

the top command. It would have been

better, he thought, if he had had someone else to do the supervisory work on

the West African coast and had himself

remained in Cairo nearer the source of

authority. He concluded that the effectiveness of a malaria control program

"depends on the success with which you

attain the support of the highest authority in the theater. The only way to

reach lower commanders is to get action

from above."35

The 1944 malaria control program in

West Africa followed traditional lines

(insecticiding, larviciding, and malaria

discipline) except for the use of DDT,

which was introduced during the spring

and summer months. By the close of 1944

the rates for Army personnel at Accra

and Dakar were reduced to the lowest

ever known at those stations. Although

they dropped in Liberia too, a reasonably low rate was not attained at Roberts

Field until late the following year. By

1945 malaria incidence throughout the

entire theater had decreased greatly, the

highest theater-wide rate being only

about 15 per 1,000 per annum in January. The majority of cases continued to

occur in Liberia.

The program went on to the close of

the war, the malaria control organization

assisting, as in other theaters, with the

control of various insect-borne diseases

besides malaria—bubonic plague, sleeping sickness, filariasis, and yellow fever.

By the end of the war it had become

evident that the small number of U.S.

Army installations remaining in the the34

 Interv, Oprs Serv, SGO, with Maj Farrell, 1

Dec 44, Rpt of Med Dept Activities in Accra, Gold

Coast, West Africa. See also, Ltr, Van Vlack, to

Col Coates, 23 Mar 59, commenting on preliminary

draft of this chapter. 35

 Farrell Interv.
92 MEDITERRANEAN AND MINOR THEATERS

ater would no longer require a malaria

control organization of the size that had

developed. After the surrender of Japan,

most of the survey and control units were

scheduled for inactivation with the exception of a survey unit located in Casablanca at the headquarters of the North

African Service Command and a control

unit at Roberts Field.

Venereal Diseases—The control of

venereal disease was one of the most important medical problems in the Middle

East theater. No reliable statistics existed as to the local incidence of venereal

diseases, but Medical Department officers knew that the populations of all of

the Middle Eastern countries were heavily infected. It was believed that in some

areas almost 100 percent of the women

with whom American soldiers came in

contact had one or more venereal diseases. The Medical Department warned

U.S. personnel of the danger through

lectures, demonstrations, motion pictures, and other educational devices. It

established prophylactic stations, used

special investigation teams, and co-operated with civil public health authorities

in finding the sources of infection.36

From an average of about 40 per 1,000

per annum for the period July-December 1942, the rate increased in 1943,

exceeding 80 per 1,000 per annum in

September, October, and November.

Many factors other than the heavily infected population contributed to the

high rate in the Middle East theater,

among them being a general moral laxness common among men in overseas stations, and carelessness, forgetfulness, and

refusal to accept advice. The Army was

further handicapped because it was unable to command the aid of governments

that were independent or were under

the jurisdiction of another power.

In Delta Service Command, troops

during the first part of 1942 were allowed to patronize houses of prostitution

regulated by the Egyptian Government.

The careless supervision of the houses

and the cursory periodic medical examination given the inmates could hardly

be classed as a controlled system according to officers of the U.S. Army Medical

Department. The Egyptian Government

next eliminated the houses of prostitution by law, but this action actually

worsened the situation since "undercover

houses," streetwalkers, and "taxicab

prostitutes" increased in number. Venereal disease control activities were for

the most part confined to U.S. Army

troops, the commanders of units enforcing such measures as were practicable.

Through an improved system of prophylactic treatment the venereal disease rate

dropped from an average of 44.2 per

1,000 per year for the period JanuaryJuly 1943 to a low of 33.75 in December.

Control of venereal disease was one

of the most vexing problems facing the

Medical Department in the Persian Gulf

Service Command. During 1943 rates

averaged 105 per 1,000 per annum, with

a peak of more than 120 in September.

36

 General sources for this section are: (1) Annual Rpts, Med Dept Activities, USAFIME, 1942,

1943: (2) Annual Rpt, Med Dept Activities, Levant

Serv Comd, 1942; (3) Hist of Med Activities,

Persian Gulf Comd; (4) Annual Rpts, Med Dept

Activities, PGC, 1943, 1944, 1945; (5) Annual Rpts,

Med Dept Activities, Eritrea Serv Comd, 1942, 1943,

1944; (6) Annual Rpts, Med Dept Activities, West

African Serv Comd, 1943, 1944; (7) Annual Rpt,

Med Dept Activities, Task Force 5889 (Liberia),

1942; (8) Annual Rpts, Med Dept Activities,

USAFIL, 1943, 1944, 1945; (9) Annual Rpts of

Venereal Disease Control Activities, USAFIL, 1942-

45; (10) Med Stat Div, SGO, Morbidity and Mortality in the United States Army, 1940-45.
AFRICA AND THE MIDDLE EAST 93

Control was very difficult since a system

of publicly countenanced prostitution

prevailed throughout Iran. Medical Department officers believed that over 95

percent of Iranian prostitutes were infected. Rates during 1944 showed some

improvement, chiefly because of more

satisfactory housing, better recreational

facilities, and increased activities in

delivery of supplies to the USSR. With

the slackening of activities in the fall of

1944, rates again assumed an upward

movement. The venereal disease control

program was intensified, and in addition

to providing convenient prophylactic stations and supplying ample stocks of

mechanical and chemical prophylactic

devices, it employed educational measures on a large scale. Venereal disease

films were shown regularly in conjunction with talks by medical officers.

In one district in late 1944 three badly

infected prostitutes agreed to participate

in a demonstration for which they received medical treatment in return.

Their lesions were shown to the troops

in that area in combination with the

usual talk on venereal disease. Controversial though it was, the idea of using

diseased prostitutes for demonstrations

spread to other parts of the command,

but no appreciable lowering of the rates

resulted.37 In spite of energetic efforts to

reduce the incidence of these diseases,

rates continued undesirably high. No

significant lowering of the rate occurred

until the summer of 1945.

In the Levant, Eritrea, and West African Service Commands, the venereal

disease problem was not as serious, but

when the U.S. forces in Liberia came

under the jurisdiction of the theater in

September 1943, a command having an

extremely high incidence of venereal

disease added its excessive rates to the

theater totals. The situation in Liberia

was bad from the start. The venereal disease rate among personnel stationed

there averaged 650 per 1,000 per year for

the period August—November 1942. A

plan to control venereal disease among

troops and the native population was

formulated in September 1942 by the

U.S. Army with the Liberian health authorities. It resulted in the establishment of areas known as "tolerated

women's villages" conveniently located

near the barracks of the troops, but just

outside the military reservation of Roberts Field. A health center for treatment

of women in the villages was also established. Once begun, the command venereal disease officer and his assistant carried out the control program.

By December 1942, with the controlled native women's villages in full

operation, the rate for Army personnel

in Liberia had decreased to 470 per

1,000 per annum for the last month of

the year. During 1943 control measures

were intensified by giving more frequent

instructions to all enlisted men, issuing

prophylactic packets and giving sulfathiazole tablets to men going on pass,

establishing more prophylactic stations,

and making chemical prophylaxis compulsory for all men visiting the tolerated

women's villages. The incidence of venereal disease decreased to an average rate

of 180 per 1,000 per annum for the last

seven months of 1943.

Venereal disease rates continued to

decrease during the early part of 1944,

a low of 63.2 per 1,000 per annum being

recorded for February 1944, but later in

the year a rise developed which reached

37

 Ltr, Abram J. Abeloff to Col Coates, 16 Mar 59,

commenting on preliminary draft of this chapter.
94 MEDITERRANEAN AND MINOR THEATERS

658.8 during November. One of the main

reasons for the increase was that troops

had started making contact with women

in ten "off limits" villages near the military area. The refusal to accept advice

and the failure to use available mechanical and chemical prophylaxis also contributed to the increase. The command

thereupon undertook a more comprehensive control program that included

treatment for women outside the tolerated villages. This extended coverage

helped reduce the rate temporarily, but

during 1945 venereal disease became so

serious that it displaced malaria as the

outstanding medical problem in Liberia. The elimination of the tolerated

women's villages in June, low morale,

general indifference, and constant turnover in personnel all contributed to a

marked rise in the venereal disease rate.

In 1945, monthly rates ranged from

about 400 to almost 1,200 per 1,000 per

annum.

As in other theaters, the use of sulfa

drugs, and, from early 1944, of penicillin, greatly reduced the number of mandays lost because of venereal disease.

Typhus—Medical officers in the Middle East regarded typhus fever as one of

the major problems of preventive medicine in the theater. During 1943 in

Egypt alone over 25,000 cases occurred

in the civilian population. Protective

measures such as frequent inspections of

immunization records to be certain that

all personnel received a booster inoculation every three months, provision of

bathing and delousing facilities, and the

placing of native sections out of bounds

contributed to the small number of cases

that occurred among members of the

U.S. Army and American civilians. Only

22 cases were found during 1943, none

of them proving fatal.38

In recognition of the threat of typhus

in many areas of the world, the USA Typhus Commission was created in Washington in December 1942, and its work

was an important phase of the medical

program in the Middle East theater in

1943 and 1944. A forward echelon of the

commission arrived in Cairo in January

1943 and established the field headquarters of the commission. The field staff

was made up of U.S. Army, Navy, Public

Health Service, and Rockefeller Foundation personnel, all under the administrative control of the Middle East theater

headquarters but not a part of the theater organization. Experts of the commission worked in various theaters, but

the Cairo group was the most active, as

typhus posed a greater threat in the

Middle East and the adjacent North African theater than elsewhere.

The Typhus Commission group

worked closely with the theater surgeon

and also with medical officers of the British Army Middle East Forces and with

officials in the Egyptian Ministry of

Public Health. The commission had the

use of a laboratory at a government

serum and vaccine institute and a clinical ward in a local fever hospital, and

soon began testing vaccine and louse

powders in field experiments. During

the first months of 1943 members of the

commission made surveys of the typhus

38

 (1) Hist, Med Sec, AMET. (2) Stanhope BayneJones, "The United States of America Typhus Commission," Bulletin, U.S. Army Medical Department

(July 1943), pp. 4-15. (3) Folder Typhus Mission,

1943-46, in Maj Gen LeRoy Lutes's personal files.

(4) Interv, Blanche B. Armfield with Gen Sams,

30 Jan 50. (5) Condensed Rpts of the U.S.A.

Typhus Commission.
AFRICA AND THE MIDDLE EAST 95

situation in many areas of the Middle

East and North Africa, visiting Syria,

Lebanon, Palestine, Iran, Iraq, Libya,

Algeria, Morocco, and Tunisia.

The field director of the commission

during most of its existence was Brig.

Gen. Leon A. Fox.39 The Cairo field

headquarter was well situated so as to

move easily to Europe, other African and

Middle East locations, and the Far East.

General Fox traveled during the late

summer and fall of 1943 to North Africa, India, Burma, China, Iran, Iraq,

and Turkey, making typhus surveys. His

reports on the typhus situation in these

areas were forwarded to the commission

headquarters in Washington, and copies

given to the Middle East theater surgeon

and to U.S. Army surgeons of the North

African and China—Burma—India theaters.

Activities of the Typhus Commission

benefiting the population in Middle

East countries consisted of the distribution of about 3,000,000 individual doses

of typhus vaccine, repeated typhus surveys, and extensive dusting of populations with louse powders. The commission also handled a large-scale program

to instruct personnel of the United Nations Relief and Rehabilitation Administration in modern and effective delousing methods. UNRRA was planning

relief work in the Balkans, an area with

a well-known history of typhus epidemics.

The commission maintained contact

with French scientists at several of the

Pasteur Institutes in North Africa and

the Middle East. It also kept in touch

with the Egyptian Ministry of Public

Health, and co-operated with it in various projects. The surgeons general of the

Egyptian and Iranian Armies agreed to

a vaccination program administered by

the Typhus Commission. The allocation

of typhus vaccine to the various Middle

East countries was handled by the Allied

organization that governed the flow of

lend-lease supplies, the Middle East

Supply Council. As both the theater

surgeon and the field director of the

Typhus Commission were members of

the council they were able to control the

allocation, a point vital to the success of

the program, as otherwise typhus vaccine could easily have become a monopoly of the privileged or have found its

way into the black market.

The Typhus Commission participated

in control activities at Naples during the

outbreak of typhus in that city during

the winter of 1943-44. The work of the

commission was continued throughout

the Middle East and Africa during

1944, and in 1945 it put into effect a

typhus control program in the Balkans.

The possibility of dissolving the commission's field headquarters at Cairo was

brought up during the summer of 1944,

but this did not take place until midsummer of 1945, when it was closed and

its facilities and equipment transferred

to a U.S. Navy epidemiology unit.

39

 The first director of the Typhus Commission

was Rear Adm. Charles S. Stephenson, MC, USN.

On a survey trip to Lebanon and Palestine during

January 1943, Admiral Stephenson became ill and

later returned to the United States. In February

1943 Colonel Fox relieved Admiral Stephenson of

the directorship of the commission and arrived in

Cairo late the following month to assume control of

the overseas program, having been promoted to

brigadier general en route. He served as director

until August 1943 when his title was changed to

field director, and another Army officer, Col. (later

Brig. Gen.) Stanhope Bayne-Jones, became director

of the commission with headquarters in Washington, D.C.
96 MEDITERRANEAN AND MINOR THEATERS

GENERAL Fox

Neuropsychiatric Disorders—American soldiers in the Middle East theater

had to accommodate themselves to

widely divergent environments and cultural patterns. They also were exposed

to climates completely dissimilar to

those in their homeland. While the difficulty of adjustment in an overseas station

in itself presented some problems stemming from separation from loved ones,

familiar work, and the relative freedom

of civilian life, long periods of exposure

to the tropical climate imposed psychological and physiological stresses that frequently resulted in neuropsychiatric

disorders.40

In the Persian Gulf area, for example,

40

 (1) Maj John M. Flumerfelt, Hist of Neuropsychiatry in the Middle East. (2) Ltr, Lt Col

Baldwin L. Keyes to Chief Surgeon, USAFIME, sub:

Mental Fixtures in Tropics, 18 Feb 44, in ETMD

Rpt, Feb 44. (3) Ltr, Maj Flumerfelt and Capt

John T. Delehanty to Surg, Delta Serv Comd, sub:

Discussion of (a) Effect of Climate upon Personnel

(b) Neuropsychiatric Diseases, 9 Aug 44, in ETMD

Rpt, USAFIME, Aug 44. (4) ETMD Rpts,

USAFIME, May 44, Jan-Apr 45. (5) ETMD Rpt,

West African Serv Comd, USAFIME, Aug 43. (6)

ETMD Rpt, Central African Wing, ATC, Feb 44.

(7) Hist of Med Activities, PGC.
AFRICA AND THE MIDDLE EAST 97

the difficult climate and the initially poor

living conditions troops endured resulted in neuropsychiatric casualties.

The rate per 1,000 per annum was above

40 for most of 1943, but with the completion of semipermanent barracks, mess

halls, and recreational facilities, the rate

dropped to 16 in October 1943. Medical

officers of the command considered it

remarkable that in the early days the

rate was not higher. At first many of

these cases were repeatedly hospitalized

in an attempt to salvage them for further

duty, but it soon became apparent that a

more liberal policy was needed in caring

for them. More neuropsychiatric patients were evacuated to the zone of interior during the last half of 1943 and

the first half of 1944.

The chief psychiatrist of the Middle

East theater and the chief of the psychiatric section of the 38th General Hospital studied the effect of climate upon

personnel and found that a definite tropical syndrome developed among many individuals assigned to tropical areas. The

time required to develop the more severe

syndromes varied with the individual and

the area. Service in small isolated units

in the desert or the jungles of central

Africa produced some breakdowns in 3

months. In larger units stationed closer

to centers of population and the more

varied environments along the coast, the

breaking point was reached in 6 months

to a year or longer. After 18 to 24 months

under tropical conditions the efficiency

of almost anyone was greatly reduced.

Characteristically, an individual affected

with a tropical syndrome showed evidence of listlessness, slow speech, defective memory, poor thought content,

and narrowed perspective. Although no

obvious loss of intelligence occurred, the

ability to use one's faculties was considerably impaired.

Col. Baldwin L. Keyes, head of the

neuropsychiatric service in theater headquarters, after investigating cases of mental deterioration caused by lengthy tropical service, recommended that personnel

be returned to the United States on rotation after not more than two years' service in the Middle East, and also advised

that a rotation policy be established

within the theater. The 2-year-rotation

plan was favorably considered by the

theater commander in the spring of

1944, but a new commanding general

of the theater who arrived soon afterward

did not back the recommendation of the

chief neuropsychiatrist.

The depressing effect of having the

2-year-rotation plan scrapped was reflected in the rise in the hospital admission

rates for neuropsychiatric diseases, which

reached a peak of 31 per 1 ,000 per annum

for July 1944. The increased admissions

were mostly personnel who had been

making borderline adjustments, building

up hope for return on the proposed rotation policy. Rotation was again considered later in 1944, but the difficulty

of getting replacements for those eligible

for return precluded any effective application of the policy. Intratheater rotation

finally began in 1945 when many were

shifted from the more undesirable stations in the theater to places having a

comparatively favorable climate.

Evacuation of mental patients to the

United States was a serious problem in

the early days of the theater, since no

American hospital ships were available.

Psychotics and severe psychoneurotics

whose return to the zone of interior had

been recommended clogged the theater's

hospital wards for periods up to six
98 MEDITERRANEAN AND MINOR THEATERS

months before they could be evacuated

by infrequently departing American

troop transports equipped with sick bays

and medical personnel. The more numerous British hospital ships were also

used, when they could be induced to

accept this class of patient, but carried

U.S. personnel only to North Africa or

England for transshipment on U.S. vessels. In 1944, when the Air Transport

Command routes through the Middle

East to the China-Burma-India theater

were well established, returning aircraft

could be used for patients en route to the

United States. Air evacuation worked

admirably, and mental patients were responsible for no serious accidents to patients or personnel. From July 1942 to

the end of 1944 neuropsychiatric disease

led the list of causes for return of patients from the Middle East to the

United States, and constituted over 35

percent of the total number returned.

About a third of the neuropsychiatric

cases evacuated had some history of psychiatric disorder before military service,

the stresses present in the theater causing recurrences.

Beginning in the latter part of 1944,

as many psychiatric cases as possible—including alcoholics—were treated on an

outpatient basis, with only those wholly

unable to perform their duties being admitted to the hospitals. It was felt that

long periods of hospitalization tended to

intensify symptoms rather than effect

cures. The result of this policy was reflected in a substantial reduction in

psychoneurotic patients presented to

disposition boards for evacuation to the

zone of interior.

Other Diseases—Gastrointestinal diseases constituted one of the greatest

sources of lost manpower in the Middle

East theater. Nonspecific diarrheas, bacillary and amebic dysentery, bacterial

food poisoning, and the typhoid-paratyphoid group of infections were found

in all areas. The factors contributing to

the high incidence of these infections

among natives of the Middle East were

contaminated water supplies, lack of

sewage disposal systems, generally insanitary conditions that promoted extensive

fly breeding, and the personal habits of

the individuals. These diseases, however, need not have been nearly as prevalent as they were. Men continued to

arrive in the theater without proper

training or discipline in hygiene and

sanitation and continued to suffer a high

diarrhea rate until the defects were

made good. On the calendar-year average, this group of diseases accounted for

more man-days lost than any other, and

constituted 20 percent of hospital admissions for the period 1 July 1942 to 1

October 1943. The rates for intestinal

diseases declined from year to year,

owing in part to the intensive program

of education in preventive medicine instituted in the theater by the Medical

Department and in part to the use of

sulfanilamide and later of Sulfaguanidine.41

Contrary to most of the intelligence

reports, which had indicated that respiratory diseases in the Middle East were

of minor importance, this group of diseases constituted 15 percent of hospital

admissions during the period 1 July 1942

to 1 October 1943. Infectious hepatitis

41

 (1) Annual Rpts, MD Activities, USAFIME,

1942, 1943. (2) Col Ward, Hist of Preventive Medicine in the Middle East, 19 Oct 41-23 Jun 44. (3)

Hist, Med Sec, AMET. (4) Hist, Med Activities,

PGC. (5) Ltr, Gen Sams to Col Coates, 12 Mar 59,

commenting on preliminary draft of this chapter.
AFRICA AND THE MIDDLE EAST 99

caused some difficulty in late 1942 and

early 1943, particularly among Ninth

Air Force personnel stationed in the

Western Desert of Egypt and Libya.

Smallpox and bubonic plague, the former being widespread among the population, and the latter causing epidemics

among the natives of Dakar, French West

Africa, and the people living along the

Suez Canal, were potential hazards to

American troops. Immunization and control measures instituted by the Medical

Department protected American troops

so that the two diseases were of little

military consequence.

A group of diseases that puzzled medical authorities in the Middle East resulted in a request by the theater surgeon

to The Surgeon General for special assistance. A small organization known informally as the Virus Commission

stemming from the Army Epidermiological Board arrived in Cairo in April

1943, and soon set to work collecting information about Sandfly (pappataci)

fever, poliomyelitis, and infectious

hepatitis—three epidemic diseases, presumably of virus origin, prevalent in the

Middle East. Members of the commission set up a laboratory and office in the

38th General Hospital, where they conducted experiments on the transmission

of the various virus diseases. Members

of the commission made field trips

to nearby Egyptian areas as well as to

more distant places during the year. By

mid-December 1943 the commission

closed its Middle East laboratory after

making valuable contributions to the

literature of the diseases they studied.

The intense heat of the Persian Gulf

area was responsible for various forms

of discomfort, including heatstroke, heat

exhaustion, and prickly heat. Medical

Department officers fought the effects of

heat in a variety of ways. A liberal daily

intake of water and fruit juices was recommended, and the men were advised

to take a salt tablet with each glass of

water. Alcohol, recognized as one of the

greatest contributory factors, could not

be entirely eliminated, but the danger

was constantly emphasized in the slogan

"If you want to live, don't drink." Intravenous injections of normal salines

were used in treatment of heatstroke and

heat exhaustion. In the summer of 1942,

before the U.S. medical authorities had

learned the use of salines, ice packs,

wrapped in toweling and soaked in ice

water, together with electric fans adjusted to blow across the beds, served to

reduce body temperatures by two or

three degrees.42

To make living conditions more bearable, the Engineer Corps installed air

conditioning equipment when available,

but most of the time "desert coolers"

were used. These improvised devices

consisted of crates filled with straw,

camel thorn, or excelsior, which were set

in windows. They operated by having a

fan blow air through them while water

trickled down through the filler material.

This equipment reduced temperatures

of rooms from twenty to thirty degrees.

The adoption of special morning working hours for the summer months also

helped reduce casualties. Heatstroke

centers, where men could go at the first

signs of heatstroke or heat exhaustion,

cured many potentially serious cases.

Another problem that was common

to the whole Middle East area early in

the period was that of chronic vitamin

deficiency. Detailed plans for the Persian

42

 Ltr, Van Vlack to Col Coates, 23 Mar 59, commenting on preliminary draft of this chapter.
100 MEDITERRANEAN AND MINOR THEATERS

Gulf included vegetable gardens for

which land and water rights had already

been obtained, but these were canceled

when the troops arrived because the

normal ration was supposed to contain

an adequate supply of vitamins. Many

men, however, did not eat all of the rations issued. Very few uncontaminated

green vegetables were obtainable locally,

and the effects of vitamin deficiency

were clearly observable. This situation

was remedied in 1943, after a nutritional

officer had been sent to the theater and

had testified to the need for vitamins.43

Still another disease problem peculiar

to the area was leishmaniasis, or Bagdad

sore. The disease was classified as exotic

and so the drug required to cure it could

be had only by special order "as required," and then only in small quantities, so that it was impossible to combat

the condition effectively.44

Dental Service

The dental service of the Middle

East theater began with the formation

of the theater in 1942, but it was not

until well into 1943 that the service could

be considered adequate. A high noneffective rate because of adverse climatic

conditions reduced the number of dental

officers available at any one time, and

the wide dispersal of units made it

necessary to place dentists with units too

small for the most economical functioning. To compensate, certain dentists

were frequently moved from one small

station to another. During the period of

growth in the Middle East theater there

was a strong tendency to overburden dental officers with work not connected with

their professional training. Dentists usually received such nonprofessional assignments when they were not able to

work full time because of lack of equipment. Once this practice started, it

became difficult to get dentists relieved

of such jobs even when the burden of

dental treatment increased.45

In the Persian Gulf area, dental officers arrived with the first major shipment of troops in December 1942, although one Dental Corps officer had

been in Iran with the Iranian Mission

since March. About eleven dental officers were in the area in December 1942,

but eventually their number in proportion to the troop strength of the command became large compared to other

overseas areas. More were needed because in addition to those stationed with

hospitals and dispensaries, others had to

minister to the needs of units strung

along the transportation routes to the

Soviet Union.

Although the British allowed U.S.

Army dentists to use dental facilities in

British Army hospitals pending completion of American installations, a serious

problem in the early days was the lack

of facilities. The shortage of dental

equipment, which lasted until mid-1943,

seriously handicapped the dental service

4 3 Ibid. 44

 Ltr, Col Adams to Col Coates, 7 Apr 59, commenting on preliminary draft of this chapter.

45

 (1) Annual Rpt, Med Dept, USAFIME, 1942

and 1943. (2) Hist, Med Sec, AMET. (3) Ltr, Maj

George F. Jeffcott, Dental Surg, USAFIME, to Brig

Gen Robert H. Mills, Asst to the SG, 29 Sep 42.

(4) Hist of Med Activities, PGC. (5) Dental Hist

of PGC, Dec 42-Aug 44, and 1 Jan-31 Mar 45. (6)

Dental supplement to Annual Rpt, Surg, PGC,

1943. (7) Annual Rpt, Med Dept Activities, PGC,

1944. (8) Annual Rpts, Med Dept Activities, Delta,

Eritrea, and Levant Serv Comds, 1942 and 1943. (9)

Annual Rpt, Med Dept Activities, Middle East

Serv Comd, 1944. (10) Annual Rpt, Med Dept Activities, Central African Wing, ATC, 1943.
AFRICA AND THE MIDDLE EAST 101

POST DENTAL CLINIC, KHORRAMSHAHR. TRAN

of the theater. In December 1942 the

thirty-nine dental officers then in the theater had a total of 6 field sets, 2 units and

chairs, 1 incomplete laboratory, and a

few miscellaneous items purchased locally. The British loaned field chests to

U.S. Army units arriving in the Middle

East without dental equipment. During

1943 adequate facilities were established

and enough equipment arrived so that

the dentists could establish a program of

improving the dental health of the soldiers in the theater.

Dental service throughout the Central

African Wing of the Air Transport Command was provided by ATC dental officers and local station hospitals. A dental

officer and an enlisted man with portable

equipment flew to stations that did not

have resident dentists.

The greatest difficulty experienced by

the dental service related not to hardships or shortages in equipment, but to

the lack of promotions. The Dental

Corps suffered from Table of Organization troubles about which very little

could be done within the theater. Dental

officers found themselves passed at regular intervals by men of other branches

who often had less experience and ability. Enlisted assistants had similar morale-destroying problems, for many of
102 MEDITERRANEAN AND MINOR THEATERS

them served on detached service to dental clinics that had no Tables of Organization.

The chief dental officer of the U.S.

Army Forces in the Middle East was Lt.

Col. George F. Jeffcott, who was succeeded at the beginning of 1944 by Lt.

Col. Thomas A. McFall, already dental

surgeon of the Delta Service Command

and chief of the dental service for the

38th General Hospital. The dental activities of the Persian Gulf Command, during the period of its autonomy, were

directed by Lt. Col. Herbert L. Gullickson, who came to the theater as dental

surgeon of the 21st Station Hospital.

Veterinary Service

Except for a small number of horses

used for recreational and military police

purposes, the Middle East theater did

not use animals for carrying on its duties.

Consequently, members of the U.S.

Army Veterinary Corps were chiefly concerned with meat and food inspection

and supervision over animals and other

food products raised for consumption of

theater troops. The veterinary service

conducted meat and dairy hygiene activities at various stations in the commands

of the theater. Because of the low sanitary standards prevailing throughout the

Middle East, veterinary officers experienced considerable difficulty in obtaining

suitable food products of local origin.

All meat, dairy, and other food products

had to be inspected with great care to

ensure strict compliance with U.S. Army

standards. Whenever establishments

maintaining satisfactory standards were

located, the veterinary service recommended them as sources of supply. Products most commonly obtained in this way

were poultry, eggs, and seafood. However, the majority of food products came

in by ship from the United States, and

large quantities of beef were secured

through the British Government from

Australia and New Zealand.

Various enterprises for the production

of food for American troops were supervised by the veterinary service. A Cairo

chicken dealer built a sanitary poultrykilling and dressing establishment with

the advice and suggestions of the Delta

Service Command veterinary officer. The

U.S. Army obtained fresh milk that was

pasteurized under the supervision of the

veterinary service in Palestine. In

Eritrea, the veterinary service of the

Eritrea Service Command and the theater veterinarian put into operation a

small but modern slaughterhouse, constructed especially for U.S. military use.

In the opinion of Veterinary Corps officers in the theater, it was superior to any

abattoir found anywhere in the Middle

East. In Eritrea and Palestine the veterinary service operated pig farms, and in

Egypt a veterinary officer rendered assistance in the operation of a piggery. These

pig-raising projects helped dispose of garbage and provided a source of reliable

pork. At the various stops along the Central African Wing, ATC, route two

veterinary officers and an enlisted man

inspected the food supplies of the personnel.

Veterinary officers arrived in the Persian Gulf area late in 1942 and quickly

began the tasks of inspecting the food

supplies of the troops. They also made

surveys and recommendations regarding

storage, refrigeration, and slaughterhouses. By the end of 1943, the veterinary strength of the command had

reached its peak of 8 Veterinary Corps
AFRICA AND THE MIDDLE EAST 103

officers and 12 enlisted men, distributed

in the northern, central, and southern

areas of Iran. The veterinarians were of

the opinion that an oversupply of their

profession existed in the command and

that 2 officers and 15 enlisted men would

have been sufficient. Although Veterinary Corps officers were officially charged

only with the inspection of meat, eggs,

and other food products, the command

authorized them to establish several animal clinics to care for pets acquired by

members of the Army. Veterinary care

was provided for these animals whenever

time could be spared from food inspection.

Decline of Medical Activities in the

Demobilization Period

Immediately after the surrender of

Japan on 14 August 1945, the medical

service of the Africa-Middle East theater began a program designed to keep up

with the demobilization instructions

issued by the War Department. The theater surgeon carried out a policy of reducing or reorganizing all medical

installations in proportion to reductions

in theater strength. Most medical units

were either inactivated or transferred

from the theater between September and

December 1945. By the end of the year

only the 38th General Hospital at Casablanca, the 25th Station Hospital at

Roberts Field, the 56th Station Hospital

at Camp Huckstep, and the 367th at

Wadi Seidna in the Sudan remained in

the theater. During this period the Persian Gulf Command completed its mission, and its liquidation was entrusted to

the Africa-Middle East theater. The theater disposed of the Persian Gulf's surplus personnel and equipment and

inactivated the command the last day of

December.46

Although most of the theater's commands were still in existence at the end

of 1945, they were working toward an

early close-out date. Where station hospitals had formerly served, medical

detachments operated to handle the

diminishing military population of

the commands. The two largest

commands of the theater, the North

African and the Middle East Service

Commands, as well as the minor command in Liberia, were inactivated during the first quarter of 1946, and the

theater itself disbanded on 31 May 1946.

The 56th Station Hospital, the last remaining theater hospital, closed its doors

the day the theater was inactivated. The

personnel of the service commands were

assigned to 26 residual teams established

to act as custodians of U.S. Government

property awaiting sale by the Foreign

Liquidation Commission. Some of the

teams had one medical or surgical technician assigned, and every team had

either Air Transport Command, British,

or local civilian hospital facilities available for the medical care of its personnel.

The remaining responsibility of the

Medical Department was simply to provide sufficient medical attendance for the

few remaining troops.

46

 (1) Med Hist, AMET, vol. II, pp. 319-23. (2)

Final Rpt, Med Sec, AMET, Oct 45-Mar 46. (3)

Hist of AMET, Supplement, Tab, Med Sec, AMET,

separate rpts for following periods: Oct-Dec 45,

1 Jan-10 Mar 46, 11 Mar-30 Apr 46, MS, OCMH.

(4) An. C, Chief Surgeon, Final Hist Rpt, Hq,

AMET, through 31 May 1946, in ETMD Rpt, May

46.
CHAPTER III

Conquest of North Africa

The invasion of French North Africa

on 8 November 1942 was the first action

of World War II by U.S. ground forces

against the European Axis. The beaches

of Morocco and Algeria and the rugged

mountains and barren wastes of Tunisia

were the testing grounds both for the

combat forces and for the medical troops

that supported them in the field and

behind the lines. It was in North Africa

that officers, nurses, and enlisted men of

the Army Medical Department perfected

the techniques and developed the organizations that were to save thousands of

lives in Italy and France.

Prelude to Invasion

Genesis of the North African

Campaign

As early as January 1942, when Prime

Minister Winston S. Churchill and his

Chief of Staff, General Sir Alan Brooke,

were in Washington for high-level strategic discussions, the possibility of launching an Allied military campaign in

northwest Africa was suggested, but resources available at that time were clearly

inadequate for such an undertaking. The

matter was again discussed in June, in

connection with the dangerous situation

on the Russian front and the precarious

position of the British forces in Africa,

where the Germans had been halted

barely short of Cairo. In July, the Combined Chiefs of Staff in London, under

strong pressure from the President, made

the decision to mount the operation at

the earliest possible date. D-day was later

set for 8 November. Allied landings in

Morocco and Algeria were to be co-ordinated with a planned offensive by the

British Eighth Army, to be launched

from the El 'Alamein line in the fall. Lt.

Gen. Dwight D. Eisenhower was designated to command the operation, known

by the code name TORCH, and was

directed to begin planning at once. Allied Force Headquarters (AFHQ) for the

North African campaign was set up at

Norfolk House in London in mid-August, with primary responsibility for

planning delegated to Maj. Gen. Mark

W. Clark, Eisenhower's deputy commander.1

1

 Sources for the genesis and military planning of

TORCH are: (1) Biennial Report of the Chief of

Staff of the United States Army, July 1, 1941 to

June 30, 1943, to the Secretary of War (Washington, 1943) , pp. 18—20; (2) History of Allied Force

Headquarters, August 1942—December 1942, vol. I;

(3) Winston S. Churchill, The Hinge of Fate

(Boston: Houghton Mifflin Company, 1950); (4)

Dwight D. Eisenhower, Crusade in Europe (Garden

City, New York: Doubleday and Company, 1948);

(5) Mark W. Clark, Calculated Risk (New York:

Harper and Brothers, 1950); (6) George F. Howe,

Northwest Africa; Seizing the Initiative in the

West, UNITED STATES ARMY IN WORLD WAR

II (Washington, 1957); (7) Craven and Cate, eds.,

Europe; TORCH to POINTBLANK; (8) Leo J.

Meyer, "The Decision To Invade North Africa

(TORCH)," Command Decisions (Washington,

1960), pp. 173ff; (9) Samuel Eliot Morison "History of United States Naval Operations in World
CONQUEST OF NORTH AFRICA 105

The strategical and psychological importance of the operation can scarcely be

overestimated. A successful TORCH would

relieve the hard-pressed Russians by

opening a diversionary front much earlier

than an invasion of continental Europe

could be launched; it would forestall the

possibility of a German breakthrough into the oil-rich Middle East to join hands

with the Japanese; it would open the

Mediterranean to Allied shipping and

render more secure the sea and air

routes over the South Atlantic; it

would put U.S. ground troops into action

against the Germans; and, finally, if it

could be accomplished without fatally

embittering the French, it would open

the way for France to re-enter the war on

the Allied side. By the same reasoning,

however, the venture was hazardous. To

fail would spell disaster.

Plans for Operation TORCH

The plans developed by General Clark

and his collaborators called for simultaneous landings at three separate points.

British naval units were to support operations inside the Mediterranean; U.S.

units those in the Atlantic. The Twelfth

U.S. Air Force, under command of Brig.

Gen. James H. Doolittle, was activated

and trained to give necessary air support

as soon as airfields could be captured and

made operational.

The Western Task Force, which was

to storm the beaches on the Atlantic

coast of Morocco in the vicinity of Casablanca, was commanded by Maj. Gen.

George S. Patton, Jr. Totaling approximately 34,000 men, it consisted of the 2d

Armored Division, the 3d Infantry Division, and two regimental combat teams

of the 9th Infantry Division. The Western Task Force trained in the United

States and sailed for Africa under convoy

of the U.S. Navy.

The Center Task Force, under command of Maj. Gen. Lloyd R. Fredendall,

was to go ashore on beaches flanking

Oran, some 250 miles inside the Mediterranean. This force was made up of elements of II Corps, built around the 1st

Infantry Division, half of the 1st Armored Division, and a force from the

509th Parachute Infantry Regiment, reinforced by corps troops to a strength of

more than 40,000. The Center Task

Force trained in England and was convoyed by British warships.

The Eastern Task Force, with a complement of 23,000 British and 10,000

U.S. troops and commanded by Lt. Gen.

K. A. N. Anderson of the British First

Army, was to attack Algiers. Maj. Gen.

Charles W. Ryder, commander of the

34th Infantry Division, led the American

element, which consisted of two reinforced regimental combat teams (RCT),

one each from the 9th and 34th Infantry

Divisions, and a Ranger battalion. Like

the Center force, the Eastern Task Force

trained in England and was accompanied

to its destination by units of the British

Navy. In the hope of securing more willing co-operation from the French, who

were still resentful toward their former

British allies for the earlier sinking of

French vessels at Oran, General Ryder

and his American troops were to spearhead the Eastern Task Force assault.

Both personnel and equipment for

medical support of the task forces were to

be held to the absolute minimum. The

medical section of Allied Force HeadWar II, vol. II, Operations in North African Waters,

October 1942-June 1943 (Boston: Little, Brown

and Company, 1950), pp. 3-42, 181-186.
106 MEDITERRANEAN AND MINOR THEATERS

GENERAL KENNER RECEIVING THE

DSM from General George C. Marshall.

quarters was headed by a British Director of Medical Services, Brigadier, (later

Maj. Gen.) Ernest M. Cowell. The ranking American medical officers were

Cowell's deputy, Col. John F. Corby, and

Corby's executive officer, Lt. Col. (later

Col.) Earle Standlee. The decentralized

nature of the operation, however, placed

primary responsibility for planning and

organizing combat medical support on

the task force surgeons. Col. Richard T.

Arnest, II Corps surgeon, conducted

planning for the Center Task Force in

England, while Col. (later Maj. Gen.)

Albert W. Kenner, surgeon of the Western Task Force, worked in Washington.

Medical service for the Eastern Task

Force was planned and largely supplied

by the British, the force surgeon being

the Deputy Director of Medical Services

of the British First Army, Brigadier E.

W. Wade. Each force surgeon operated

pretty much on his own, within a broad

policy framework; there was little or no

co-ordination between the forces. The

Twelfth Air Force surgeon, Col. Richard

E. Elvins, functioned independently of

both AFHQ and the task force surgeons

in the preparation of medical plans, including plans for air evacuation.2

From the medical point of view, the

North African campaign was difficult and

largely extemporized. The distances were

vast: 445 miles by air from Casablanca to

Oran; 230 miles from Oran to Algiers;

and another 400 air miles from Algiers to

the ultimate objective, the Tunisian

ports of Tunis and Bizerte. By way of the

antiquated, single-tracked rail line that

connected the coastal cities, the distances

were considerably greater. Highways

were few in number and poor in quality,

not built to withstand the punishment

inflicted by tanks and heavily loaded

trucks moving in steady streams from

ports to supply depots and to the fighting

fronts. Water was scarce and always subject to suspicion; sanitation was primitive; malaria, typhus, dysentery, cholera,

and venereal diseases were known to be

widely prevalent, with plague a constant

threat in the seaports. All of these factors

had to be taken into account in medical

preparations for the invasion and for the

subsequent campaign in Tunisia.

2

 General sources for medical planning of Operation TORCH, in addition to general sources cited

above, are: (1) 2d Lt. Glenn Clift, MS, Field Operations of the Medical Department in the Mediterranean Theater of Operations, United States

Army (hereafter cited as Clift, Field Opns), pp.

1-20; (2) Hist of the Twelfth Air Force Med Sec,

Aug 42-Jun 44; (3) F. A. E. Crew, "History of the

Second World War," The Army Medical Services;

Campaigns (London: Her Majesty's Stationery Office, 1957), vol. II; (4) Link and Coleman, Medical

Support of the Army Air Forces in World War II,

pp. 419-24.
CONQUEST OF NORTH AFRICA 107

COLONEL ARNEST

Planning for the initial assault also

had to take into account a shortage of

shipping space that would limit supplies

and restrict medical support to little

more than could be given by the divisional medical units organic to the participating formations. For the U.S.

increment, supplies were to be in the

form of the standard medical maintenance units, each sufficient to support

10,000 men for thirty days, augmented

by special drugs and biologicals appropriate to the conditions anticipated.

In bed strength the Eastern Task

Force, which was to lead the advance

into Tunisia, fared better than either

of the other landing groups. In addition

to the organic units, the D-day troop list

included a British field ambulance, comparable to an American clearing company; 2 light casualty clearing stations

(200 beds each), equivalent to small

evacuation hospitals, each with a field

transfusion unit and 2 field surgical units

attached; 2 British general hospitals,

more mobile than their U.S. counterparts, of 600 beds each; and 4 teams

of the U.S. 2d Auxiliary Surgical Group,

with enlisted men substituted for nurses.

Beds would thus be available for about

4.8 percent of the command during the

first four days. The second convoy, which

was to reach Algiers on D plus 4, was to

carry 2 British general hospitals of 200

beds each and one of 1,200 beds, but the

ratio would not be raised since troop

strength would also be doubled by that

time.

The Center Task Force was to carry

two hospitals in the assault—the 400-bed

48th Surgical and the 750-bed 38th Evacuation—or beds for less than 3 percent of

the command. Another 750-bed unit, the

77th Evacuation Hospital, was scheduled

for the second convoy, which would

reach Oran on D plus 3 along with the

51st Medical Battalion, but a 50-percent

increase in troop strength would keep the

bed ratio barely above 3 percent.

For the Western Task Force, sailing

from the United States, shipping was

even more restricted, and no hospitals of

any kind were included in the D-day

troop list. Since the second convoy for

the Western Task Force was not due for

several days, transports were to be supplied with equipment and personnel to

serve as floating hospitals during the first

days of the assault.

In each of the landing operations the

Navy—British or American—was to be

responsible for all medical care between

the port of embarkation and high water

on the landing beaches, and naval beach

groups were to help in the collection and

care of casualties. British hospital ships
108 MEDITERRANEAN AND MINOR THEATERS

were to evacuate patients from Algiers

and Oran to the United Kingdom. Since

no U.S. hospital ships were available,

there would be no alternative for the

Western Task Force but to evacuate

casualties by returning transports or hold

them ashore for future disposition.

Plans for combat medical service in

the landing phase were spelled out in

considerable detail, but were based

largely upon manuals prepared without

realistic knowledge of amphibious operations. Participation by U.S. observers in

the costly Dieppe raid of 19 August 1942

was the nearest approach to a seaborne

landing on a hostile shore in modern

U.S. Army experience.3 It is therefore

not surprising that casualty estimates

were too high, or that conditions under

which medical troops would operate

were misjudged.

Medical Support in the

Landing Phase

The Allied assault on the Moroccan

and Algerian coasts took place as scheduled in the early hours of 8 November

1942. It was hoped that the French would

not resist the landings. Secret negotiations to this end were carried on right up

to D-day itself, climaxed by a personal

appeal from President Roosevelt, which

was broadcast in French over shortwave

radio as the troops began to go ashore.

On most of the beaches, the first waves

of combat troops did get ashore without

encountering more than sporadic small

arms fire, but before objectives were

gained there was fighting in every sector.

Eastern Task Force

Algiers was first to surrender, owing

largely to secret contacts with military

commanders there and to the unexpected

presence in the city of Admiral JeanFrançois Darlan, Vichy naval commander, whose authority was second only

to that of Marshal Henri Pétain himself.

The city lies along the western rim of a

half-moon-shaped bay, whose eastern extremity is Cap Matifou. Seven or eight

miles west of the city the coast dips

sharply to the south, interrupted only by

Cap Sidi Ferruch, which juts into the

Mediterranean on a line with the center

of Algiers and about ten miles distant.4

(Map 6}

The 39th Regimental Combat Team

of the 9th Division, with elements of the

British 1st Commando attached, went

ashore east of Cap Matifou in the early

hours of 8 November. Landing craft used

were small and fragile by later standards,

and boat crews were inexperienced. It is

not surprising, therefore, that many of

them piled up in the surf and others

3

 Lt. Gen. Lucian K. Truscott, Jr., the chief U.S.

observer at Dieppe, gives his own account in Command Missions, A Personal Story (New York: Button, 1954), pp. 62-72. The medical story of the

raid, which suffered over 50 percent casualties in

killed, wounded, and missing, is in W. R. Feasby,

Official History of the Canadian Medical Services,

1939-1945 (Ottawa: E. Cloutier, Queen's Printer,

pp. 113-22.

4

 Sources for military operations of the Eastern

Task Force are: (1) Opns Rpt, Eastern Task Force;

(2) Howe, Northwest Africa; (3) Morison, North

African Waters. Medical sources primarily relied

upon are: (4) Rcd of Events, 15 Oct—8 Nov 42, by

various officers of the 109th Med Bn, Co C; (5)

Diary, Surg Teams 1 and 2, Ortho Team 1, Shock

Team 1, 2d Aux Surg Gp, in Rpts of Professional

Activities of Surg Teams, vol. I; (6) Clift, Field

Opns, pp. 52-57. (7) Crew, Army Medical Services:

Campaigns, pp. 293-97. Negotiations with the

French, both before and after the landings, are

detailed in (8) Robert Murphy, Diplomat Among

Warriors (Garden City, N.Y.: Doubleday, 1964),

pp. 108-43.
CONQUEST OF NORTH AFRICA 109

MAP 6—Medical Support of Eastern Task Force

were brought ashore at the wrong

beaches. Aside from sporadic fire from

coastal batteries on Cap Matifou, however, no opposition was encountered at

the beaches, and the combat team

quickly pressed inland and captured

Maison Blanche airfield.

The 168th RCT of the 34th Infantry

Division and the bulk of the British 1st

Commando landed just north of Cap

Sidi Ferruch, but here, too, the invaders

were widely scattered because of faulty

navigation. Only the absence of opposition enabled the force to regroup and

move inland toward Algiers by daylight.

The commandos, meanwhile, had received the surrender of the fort at Sidi

Ferruch without a fight, and, with the

aid of friendly French officers, the airfield at Blida had been neutralized. The

British 11th Infantry Brigade landed

without opposition some twenty miles

south of Cap Sidi Ferruch simultaneously with the more northerly landings

and moved inland to protect the flank of

the 168th RCT.

The only seriously opposed landings

were those of the 6th Commando north

and west of Algiers, where difficulties in

assembling and loading the assault boats

delayed the landings until after daylight.

Here the commandos had to call for the
110 MEDITERRANEAN AND MINOR THEATERS

support of naval gunfire and of carrierbased planes to win their objective by

late afternoon. An attempt by two British destroyers to enter the harbor before

dawn had proved unsuccessful. One of

the vessels was forced to withdraw after

suffering severe damage from shore batteries. The other succeeded in ramming

the boom and landing a detachment of

the 135th RCT, 34th Division, but the

troops were pinned down and taken

prisoner, while the destroyer withdrew

so severely damaged that she later sank.

By late afternoon of D-day Algiers was

surrounded, its airfields were in the

hands of the Allies, and those of its

coastal fortifications that had not capitulated were at the mercy of Allied naval

guns and bombers. Darlan, who had

been in contact with Robert Murphy,

the U.S. diplomatic representative in

North Africa since the eve of the landings, met with General Ryder early in

the evening and agreed to a local ceasefire. After two days of negotiation an

armistice was signed, to be effective

shortly after noon on 11 November. Negotiations continued until 13 November,

when Darlan was recognized as de facto

head of the French Government in

North Africa.

In addition to its own medical detachment, each of the U.S. regimental combat teams that spearheaded the Algiers

landings was accompanied by a collecting

company and a clearing platoon of the

medical battalion organic to its parent

division—Company A and the 2d Platoon

of Company D, 9th Medical Battalion,

with the 39th RCT; and Company C and

the 2d Platoon of Company D, 109th

Medical Battalion, with the 168th.

On the beaches east of Cap Matifou,

where the 39th RCT made its landings,

the collecting company was put ashore

during the morning of D-day, but most

of its equipment remained on shipboard.

Without vehicles to follow the combat

troops and with little in the way of medical supplies, the company remained of

necessity close to the landing area in the

vicinity of the beach dressing station set

up by British naval personnel. Casualties were held at the dressing station because the sea was too rough to permit

evacuation to the ships and no hospital

facilities were available on shore.

A radio call for more medical personnel early in the afternoon brought Capt.

(later Maj.) Paul L. Dent and Capt.

(later Maj.) William K. Mansfield of

Surgical Team No. 1, commanding officer and executive, respectively, of the 2d

Auxiliary Surgical Group detachment, to

the beach about 1600, but they were unable to bring equipment with them. A

bombing raid, rough seas, and the coming of darkness prevented the landing of

more surgical group personnel or of the

clearing station they were to support, so

Captains Dent and Mansfield worked

through the night at the naval beach

dressing station.

The quick end of hostilities on the 8th

enabled the two surgical group officers to

evacuate more than twenty patients the

next morning to the dispensary at Maison Blanche airfield about fifteen miles

inland, using trucks and borrowed

French ambulances. The clearing platoon of the 9th Medical Battalion and

the remaining eighteen officers and enlisted technicians of the 2d Auxiliary

Surgical Group did not come ashore until 11 November, when the ships carrying

them docked at Algiers. A hospital was

then set up in a schoolhouse in Maison

Carree, about midway between the air-
CONQUEST OF NORTH AFRICA 111

field and Algiers. On 13 November the

hospital moved to Fort de l'Eau on the

bay north of Maison Blanche, where it

was operated jointly by the collecting

company and the clearing platoon of the

9th Medical Battalion and the four surgical teams.

On the beaches west of Algiers, where

the 168th RCT landed, the first collecting company personnel came ashore at

0730 on D-day, but were landed at the

wrong beach and were forced to make a

10-mile march carrying equipment on

litters to reach the battalion aid station

they were to support. The clearing platoon, meanwhile, had landed at 0800,

and set up station in conjunction with

the British 159th Field Ambulance in

the basement of a winery near Sidi Ferruch.

The remainder of the collecting company came ashore about 1000, but the

only ambulance to be unloaded on D-day

was not available until evening and did

not reach the forward station until 0900,

D plus 1. A British surgical team joined

the clearing station on 9 November.

Later that day the clearing platoon and

the field ambulance took over the

Mustapha civil hospital in Algiers, which

quickly expanded from 100 to 300 beds,

functioning as an evacuation hospital.

Fortunately, there were few casualties

on D-day when the medical service in

landing areas would not have been prepared to deal adequately with them. Most

of those occurring in the next few days

resulted from German bombings and

from land mines. Only 93 U.S. soldiers

were hospitalized during the first week

of the Algiers campaign. Of these, 58

were admitted for battle wounds, 13 for

injuries, and 22 for disease.5

Center Task Force

In the central sector the strategy employed by General Fredendall was in all

respects similar to that used by the Eastern Task Force. Like Algiers, Oran lies

on a crescent-shaped bay, protected by

headlands on either side. Here the strongpoints were the fortified military harbor

at Mers el Kebir, three miles west of

Oran; and the town of Arzew, twenty-five

miles to the east. Both positions were

outflanked.6 (Map 7)

One armored column, comprising

about one-third of Combat Command B,

5

 Rpt, Hq SOS ETO, Off of the Chief Surgeon,

15 Feb 43. These figures cannot be fully reconciled

with those given in the Final Report, Army Battle

Casualties and Nonbattle Deaths in World War II.

The official tabulation shows 1,017 U.S. Army (including Air Forces) personnel wounded or injured

in action for the whole North African theater for

the month of November 1942. The combined

wounded and injured figure for the three task

forces for the week of 8-14 November as given in

the document cited above is 1,224. The time is

relatively comparable, since U.S. forces were not

engaged before 8 November or during the remainder of the month after 14 November. The

larger figure in the SOS report is presumably owing

to the inclusion of some naval personnel in the

Western Task Force figures, but these are not

separable. Hospital admissions for injury in the

TORCH operation were not differentiated as to battle

or nonbattle origin. 6

 Combat sources for the Center Task Force are:

(1) Opns Rpt, Center Task Force; (2) Howe,

Northwest Africa; (3) H. R. Knickerbocker and

others, Danger Forward: The Story of the First

Division in World War II (Washington: Infantry

Journal Press, 1947); (4) George F. Howe, The

Battle History of the 1st Armored Division, "Old

Ironsides" (Washington: Combat Forces Press,

1954): (5) Morison, North African Waters. Medical

sources primarily relied upon are: (6) Annual Rpt,

Surg, II Corps, 1942; (7) After Action Rpt, 1st Med

Bn, 20 Nov 42; (8) Hist, 47th Armd Med Bn, 1

Oct 42-9 May 43; (9) Annual Rpt, 48th Surg Hosp,

1942; (10) Annual Rpt, 38th Evac Hosp, 1942;

(11) Clift, Field Opns, pp. 40-48. See also, (12)

Ltr, Col Rollin L. Bauchspies to Col Coates, 15

Apr 59, commenting on preliminary draft of this

volume.
112 MEDITERRANEAN AND MINOR THEATERS

MAP 7—Medical Support of Center Task Force

1st Armored Division, landed some thirty

miles west of Oran. The landing was unopposed, but difficulties in getting the

vehicles ashore delayed any advance until

about 0900. The column then struck

eastward to Lourmel and followed the

north rim of the Sebkra d'Oran, the long

salt lake that parallels the coast about ten

miles inland. Against only sporadic opposition, the column reached and seized La

Senia airfield, south of Oran, on the

morning of 9 November.

A simultaneous landing at Les Andalouses 15 miles west of Oran by the 26th

RCT, 1st Infantry Division, was only

briefly interrupted by an unexpected

sand bar, and the men were moving inland by daylight when French coastal

guns began shelling the transport area.

By the end of the day, elements of the

26th had pushed beyond Mers el Kebir,

and that strongpoint was cut off from the

west and south.

The main point of attack was in the

vicinity of Arzew. There the 1st Ranger

Battalion got ashore undetected just

north of the town and quickly seized the

two forts dominating the harbor. The

16th and 18th RCT's of the 1st Division

and the larger portion of Combat Command B were then able to land from

transports moved close to shore. There

was no opposition until daylight, by

which time the assault units were well on

their way to their first objectives. Combat Command B raced southwest some

twenty-five miles to seize Tafaraoui airfield and held it against French counterattacks the following day. The 16th and

18th RCT's moved on Oran by parallel
CONQUEST OF NORTH AFRICA 113

routes, the 18th being delayed by stubborn resistance at St. Cloud before bypassing that town.

A direct assault on Oran itself was

attempted at H plus 2 by two British

destroyers carrying more than 400 combat troops, most of them from the 1st

Armored Division, but both ships were

destroyed inside the breakwater and all

men aboard were killed or captured.

Equally unsuccessful, though less disastrous, was an attempted airdrop on

Tafaraoui airfield by 556 men of the 2d

Battalion, 509th Parachute Infantry Regiment, flying from England. Faulty navigation and a mix-up in signals dropped a

number of the men in Spanish Morocco,

where they were interned. Others

dropped at various points far west of

their objective. Only one plane reached

the field, but it met with antiaircraft fire

and turned back without dropping its

men. Almost half of the paratroopers

were still missing by 15 November.

The end of the day, 9 November,

found the invaders converging on Oran

from all sides. Armored spearheads entered the city the next morning, the

10th, and a cease-fire order was issued

at 1215.

The combat elements of the Center

Task Force received varying degrees of

medical support. The armored column

landing west of Oran was accompanied

by its own medical detachment and by a

small group from the organic 47th Armored Medical Battalion. The 26th

Regimental Combat Team, 1st Division,

which hit the beaches east of Oran, received medical support from a collecting

company and a clearing platoon of the

organic 1st Medical Battalion, and from

a detachment of 6 officers, 6 nurses, and

20 enlisted men of the 48th Surgical Hospital. The 16th and 18th RCT's of the

1st Division, landing at Arzew, were each

accompanied by a collecting company of

the 1st Medical Battalion, with one clearing platoon backing up both regiments.

Combat Command B was supported by

Company B of the 47th Armored Medical Battalion, less the detachment with

the western column. Third-echelon support came from the 400-bed 48th Surgical Hospital and, after the surrender,

from the 38th and 77th Evacuation Hospitals.

Arzew was already in Allied hands by

the time most of the medical personnel

came ashore. About noon of D-day a

clearing platoon of the 1st Medical Battalion, although most of its equipment

was still afloat, took over a dirty and inadequate civil hospital capable of accommodating 75 patients. The French doctors in attendance remained to care for

natives already there, and for French

and native prisoners as they were

brought in. Personnel of the 48th Surgical Hospital came ashore in landing craft

during the afternoon, but without equipment and scattered over a 2-mile area.

As soon as the unit was consolidated, 3

of its surgeons and 3 nurses were sent to

the civil hospital.7 The detachment was

augmented during the night by 4 operating teams of 2 surgeons and a nurse

each. These teams worked throughout

the night of 8—9 November by flashlight.

The 48th Surgical set up its own hospital in nearby French barracks on D

plus 2, taking over operation of the

7

 "Having nurses arrive with the 48th Surgical

Hospital at Arzew on D-day was very helpful in caring for the wounded. However, I did not feel

afterwards that the risk was fully justified and

would not do it again." Ltr, Col Arnest to Col

Coates, 10 Nov 58, commenting on preliminary

draft of this volume.
114 MEDITERRANEAN AND MINOR THEATERS

NURSES OF THE 48th SURGICAL HOSPITAL marching from the Arzew docks to join their

unit, 9 November.

Arzew civil hospital at the same time.

Equipment and supplies were secured

from the British Navy, Army units in the

area, the French, and the 38th Evacuation Hospital—which had arrived at

Arzew on 9 November but was not yet

in operation. The 48th Surgical's own

equipment did not come ashore until 13

November. The maximum number of

patients treated at any one time was 480

and included American, British, French,

and native.

About noon of D-day elements of

Company B, 47th Armored Medical Battalion, assisted by a detachment from the

Twelfth Air Force surgeon's office, set

up an aid station in the city hall at St.

Leu, four or five miles southeast of

Arzew. The detachment moved to

Tafaraoui airfield on 10 November, and

the St. Leu station was turned over to

Air Forces control two days later.

On 11 November, the day after the

surrender of Oran, the 38th Evacuation
CONQUEST OF NORTH AFRICA 115

Hospital moved inland to St. Cloud,

where heavy fighting had overtaxed the

available medical facilities. While equipment was being gathered together at the

prospective site, surgical teams from the

38th joined elements of the 1st Division

Clearing Company at the civil hospital

in Oran, where about 300 casualties, including survivors of the ill-fated H plus

2 attempt to land troops in the harbor,

had been turned over by the French

authorities. Personnel of the 77th Evacuation assumed responsibility for the operation of the Oran hospital on 12

November. The surgical teams of the

38th rejoined their parent unit the following day when it opened under canvas at St. Cloud. Responsibility for evacuation was

taken over by the 51st Medical Battalion,

which had arrived with the 77th Evacuation on the D plus 3 convoy. Up to that

time there had been very little evacuation from the combat zone because of the

blocked harbor and the delay in arrival

of hospital ships.

In keeping with the longer and more

determined French resistance, combat

casualties of the Center Task Force were

considerably higher than those in the

Algiers area. Of the 620 U.S. patients

hospitalized during the week ending 14

November, 456 had combat wounds, 51

had injuries, and 113 were disease cases.8

Western Task Force

The Western Task Force made three

separate landings along more than 200

miles of the Atlantic coast on both sides

of Casablanca, at Safi, Fedala, and PortLyautey. These landings encountered the

most determined opposition of any of the

three task forces. Subtask Force BLACKSTONE, commanded by Maj. Gen. Ernest

N. Harmon of the 2d Armored Division

and built around the 47th Regimental

Combat Team, 9th Division, and two

battalion landing teams of the 2d Armored, touched shore at Safi, 140 miles

south of Casablanca, about 0445, 8 November. The first waves met only intermittent small arms fire, but the French

had been alerted by the earlier landings

inside the Mediterranean.9

When the destroyer USS Bernadou

slipped into Safi harbor with a battalion

landing team of the 47th Infantry aboard,

she met raking cross fire. USS Bernadou

replied successfully and managed to land

the men, who quickly swarmed into the

town. The destroyer USS Cole followed

with more combat troops, but by this

time coastal guns from a nearby fort

were sweeping the transport area. The

battleship USS New York replied, and

the guns were silenced. The beachhead

8

 Rpt, Hq SOS ETO, Office of the Chief Surg,

15 Feb 43. See also n. 5, p. 111, above.

9

 Principal sources for the combat history of the

Western Task Force are: (1) Opns Rpt, Western

Task Force; (2) Howe, Northwest Africa; (3)

Morison, North African Waters; (4) George S.

Patton, Jr., War As I Knew It (Boston: Houghton

Mifflin Company, 1947), pp. 5-14; (5) Truscott,

Command Missions; (6) E. A. Trahan, ed., A History of the Second United States Armored Division,

1940-1946 (Atlanta: Albert Love Enterprises, 1946) ,

pp. 31-45; (7) Donald G. Taggart, ed., History of

the Third Infantry Division in World War II

(Washington: Infantry Journal Press, 1947). Medical sources primarily relied upon are: (8) Clift,

Field Opns, pp. 21-39; (9) Albert W. Kenner,

"Medical Service in the North African Campaign,"

Bulletin, U.S. Army Medical Department (May,

June 1944) ; (10) Hist of the 9th Med Bn 1942;

(11) Annual Rpt, 3d Med Bn, 1942; (12) Med

Hist Data, 56th Med Bn, 31 Oct 44.
116 MEDITERRANEAN AND MINOR THEATERS

MAP 8—Medical Support of Western Task Force

and harbor area were sufficiently secure

by midmorning to bring tanks ashore,

and the town surrendered at 1530, about

eleven hours after the action had started.

French planes from Marrakech came

over Safi in the early morning of D plus

1, but heavy fog kept all but one plane

from dropping bombs. The one plane

destroyed an ammunition dump, with

considerable damage to port installations. Allied carrier-based planes neutralized the Marrakech field that afternoon
CONQUEST OF NORTH AFRICA 117

and broke up a truck convoy carrying

French reinforcements to Safi. Tanks of

Combat Command B, 2d Armored Division, which had landed during the

night of 8-9 November were immediately dispatched to engage the French

column. There was sharp fighting in the

vicinity of Bou Guedra in the late afternoon of 9 November and early the next

morning. After dark on the 10th the

tanks withdrew and started for Casablanca, where they were sorely needed.

The largest of the three subtask forces

—BRUSHWOOD—landed at Fedala, about

fifteen miles north of Casablanca.

(Map 8) The force consisted of the 3d

Infantry Division, reinforced by a battalion landing team of the 2d Armored

Division and was commanded by Maj.

Gen. Jonathan W. Anderson of the 3d

Division. Fedala lies on the southern

edge of a shallow bay, enclosed by Cap de

Fedala jutting out behind the town and

the Cherqui headland about three miles

to the northeast. The landing beaches

actually used were all inside the bay, and

all within range of batteries on cape or

headland. Fortunately, the defenders

were taken by surprise. Despite inexpert

handling of landing craft that took several waves of assault troops to beaches

miles north of the objective and piled

many of the small boats onto rocks, there

were 3,500 troops ashore before dawn

brought organized French resistance. All

initial objectives were quickly seized and

the beachhead was secure by sunrise.

The batteries were silenced later in

the day, and BRUSHWOOD Force began to

move inland, swinging south toward

Casablanca. The movement was hampered by delays in unloading transport

and communications equipment, and

supporting weapons, as well as by French

resistance, but the force was poised in

the outskirts of Casablanca by midnight

of 10-11 November. In the interval,

French warships at Casablanca, including the battleship Jean Bart, had joined

the fight, inflicting considerable damage

on the supporting naval units before

being blockaded in the harbor. The final

attack on Casablanca had still not been

launched when word arrived that the

French were willing to lay down their

arms.

Most vigorously contested of all the

Western Task Force landings were those

of Subtask Force GOALPOST in the

Mehdia-Port-Lyautey area, commanded

by Maj. Gen. Lucian K. Truscott, Jr.

(See Map 8.) GOALPOST'S primary mission was to seize an airfield where P-40's,

brought on the carrier USS Chenango,

could be based to aid in the assault on

Casablanca some 75 miles to the southwest. The airfield lay in a bend of the

Sebou River, with the town of PortLyautey south of it, on another and

sharper bend. The airfield was about 3.5

miles inland, or twice that far up the

winding river, with the town another 3

or 4 miles upstream, but about equidistant from the coast as the crow flies. The

village of Mehdia was just above the

mouth of the river, which was closed beyond that point by a boom.

The landing force consisted of the

60th RCT of the 9th Division and a light

tank battalion of the 66th Armored Regiment, 2d Armored Division, with supporting units that included nearly 2,000

ground troops of the XII Air Support

Command. Landings on both sides of the

river mouth were marred when a number of boat crews missed their beaches,

landed the men as much as five miles out

of position, and lost many boats in the
118 MEDITERRANEAN AND MINOR THEATERS

HOISTING WOUNDED SOLDIER ONTO A

TRANSPORT for medical care, 8 November.

surf. French authorities, moreover, had

been alerted, like those at Safi, by the

President's broadcast and by news of the

actions already in progress at Oran and

Algiers.

Coastal batteries opened up after the

first wave reached shore, and French

planes strafed the beaches at dawn.

Ground opposition increased as the day

advanced, and darkness found only the

3d Battalion of the 60th RCT more than

a mile inland, opposite the airfield but

north of the river. Units landing south

of the river converged toward the airfield

the following day and one company of

the 3d Battalion crossed the Sebou in

rubber boats, but all units were stopped

short of their objectives.

The airfield was taken early on 10 November when the destroyer USS Dallas

rammed the boom and carried a raiding

party up the river to take the defenders

of the field from the unprotected flank.

About 1030, planes from the USS

Chenango began landing at the field.

There was little fighting the rest of that

day, and French resistance was formally

ended at 0400 on D plus 3.

For medical support the Safi force, in

addition to attached personnel, was accompanied by a collecting company of

the 9th Medical Battalion and a detachment of the 56th Medical Battalion consisting of two officers and sixty-nine

enlisted men. During the first hours,

casualties were held at aid stations for

which sand dunes furnished the only

cover. Early capture of the waterfront

area made it possible to establish aid and

collecting stations in a warehouse on the

dock about H plus 8. From this point,

casualties were evacuated for temporary

hospitalization aboard the USAT Titania. Two days after the assault began,

an improvised hospital staffed by medical battalion personnel was in operation

in a school building with equipment

borrowed from local doctors and merchants and from the Navy. Patients to be

retained in the theater under a 30-day

evacuation policy were brought to this

provisional hospital from as far away as

Port-Lyautey.

The 3d Division and its reinforcing

armored battalion at Fedala were supported by the organic 3d Medical Battalion and by a detachment of the 56th

Medical Battalion similar in size and

composition to the detachment with the

Safi force. Like the combat troops, medical soldiers were scattered by poor navigation of the landing craft. Units

experienced considerable delay in making contact with their headquarters, as

well as in the matter of receiving supplies. Evacuation was also a slow and uncertain process until medical units were
CONQUEST OF NORTH AFRICA 119

assembled and vehicles were made available, and the wounded were held at battalion aid stations for twenty-four and

sometimes thirty-six hours. A clearing

station was set up by the afternoon of

D-day in a beach casino at Fedala with

capacity for 150 litter cases, the overflow

being cared for in school buildings and

private homes. Additional supplies were

borrowed from the Navy. During the

night of 12 November the station cared

for survivors of a U-boat attack, including over 400 burn cases, 100 of them so

severe as to require repeated transfusions. Flashlights furnished the only illumination until floodlights could be

borrowed from Ordnance repair units.

All available medical officers, including

Colonel Kenner himself and Lt. Cols.

Huston J. Banton and Clement F. St.

John of the headquarters staff, worked

through the night at the clearing station.

Supplies and personnel were inadequate,

and many of the more severe cases were

lost.10

The Mehdia landings were supported

by a collecting company and a clearing

platoon of the 9th Medical Battalion and

a detachment of the 56th Medical Battalion. The medical force was about half

the size of those with the other two subtask forces. Throughout the three days

of fighting it was possible to do no more

than set up beach aid stations. Evacuation by land was out of the question for

want of vehicles and a place to go; evacuation to the transports was hazardous

and at times impossible because of heavy

seas and the excessive loss of landing

craft in the assault. On 12 November,

after the armistice, the clearing platoon

took over a Red Cross hospital in Mehdia, which was operated as an evacuation

hospital until the regular installations

arrived nearly a month later.

For the Western Task Force as a

whole, 694 cases were hospitalized during

the first week of the invasion. Of these,

603 were combat wounds, 43 injuries,

and 48 disease.11

Hospitalization and Evacuation

of Task Force Casualties

Hospitalization and evacuation of task

force casualties remained the responsibility of the force surgeons until the medical section of Allied Force Headquarters

was established in Africa and base section

organizations were set up. For the Western Task Force the provisional hospitals

at Safi and Mehdia continued to operate

as long as they were needed. The Safi

hospital was still in operation when the

Atlantic Base Section was activated late

in December. The first U.S. Army hospitals to reach western Morocco were the

750-bed 8th and the 400-bed 11th Evacuation Hospitals, which arrived at Casablanca together on 18 November on the

delayed second convoy. The 8th opened

three days later in buildings of the Italian consulate, which soon proved too

small and inadequately equipped. The

11th moved on to Rabat, where it opened

on 8 December, permitting return of the

Mehdia Red Cross hospital to civilian

control. The 59th Evacuation, another

750-bed unit, began receiving patients

under canvas at Casablanca on 30 Decem- 10

 (1) Memo, Brig Gen Arthur R. Wilson for A/S,

12 Dec 42, sub: Rpt of Opns in N. Africa. (2)

Ltr, Brig Gen Clement F. St. John to Col Coates,

28 Oct 58, commenting on preliminary draft of

this volume.

11

 Rpt, Hq SOS ETO, Off of Chief Surg, 15 Feb

43. See also n. 5, p. 111, above.
120 MEDITERRANEAN AND MINOR THEATERS

her. The 400-bed 91st Evacuation was

also in the area before the end of the

year, but was not established under task

force control. All of these evacuation

hospitals functioned as fixed installations

rather than as mobile units.12

In the Oran area the three mobile

hospitals that came in with the combat

troops—the 48th Surgical and the 38th

and 77th Evacuation—were supplemented on 21 November by the 9th

Evacuation, with an additional 750 beds,

and by the 1st Battalion, 16th Medical

Regiment. Since all of its equipment was

lost at sea, the medical battalion operated

a staging area for other units until February 1943. The Mediterranean Base

Section was activated on 8 December,

and fixed hospitals under base section

control quickly supplanted the mobile

units of the Center Task Force, which

began staging for the next phase of the

North African campaign.

Aside from the clearing platoons of

the 9th and 109th Medical Battalions, all

hospitalization for the Eastern Task

Force was British. Although they were

not able to land on D-day as planned,

the 1st and 8th Casualty Clearing Stations were established promptly after the

surrender of the city and, together with

the provisional casualty clearing station being operated by the 159th Field

Ambulance and the clearing platoon of

the 109th Medical Battalion, were able

to care for all casualties until a sufficient

number of general hospital beds was

established between 15 and 20 November. All British units took U.S. patients,

but the bulk of them went to the 94th

General, largest and best equipped of the

British hospitals assigned to the Eastern

Task Force.13

Evacuation from the Western Task

Force was by troop transport to the

United States. From the Center and Eastern Task Forces, evacuation was by British hospital ship to the United Kingdom.

There was very little of either, however,

before the period of task force control

ended.

Evaluation of TORCH Medical

Service

From the medical point of view, Operation TORCH was relatively easy only

because casualties were far lower than

had been anticipated and because medical officers and enlisted men of the Medical Department met unexpected situations with ingenuity and skill. In no

instance did the collecting or clearing

elements get ashore early enough, or

have enough equipment with them. Supplies hand-carried by medical personnel

accompanying the assault waves included

some unnecessary items and omitted

other items that would have been useful.

Additional medical supplies were scattered over the beaches, where quantities

were lost. Ambulances, in particular,

were unloaded far too slowly, and when

they finally became available they proved

to have poor traction in sand and a

dangerously high silhouette. The jeep,

on the other hand, was found to be readily adaptable for carrying litters over

difficult terrain.14

12

 Unit reports of hospitals and base sections

mentioned in the text.

13

 (1) Diary, Surg Teams 1 and 2, Ortho Team 1,

Shock Team 1, 2d Aux Surg Gp, in Rpts of Prof

Activities of Surg Teams, vol. I. (2) Crew, Army

Medical Services: Campaigns, pp. 90-93. 14

 (1) Kenner, "Medical Service in the North

African Campaign," Bulletin, U.S. Army Medical

Department (May, June 1944). (2) Annual Rpt,
CONQUEST OF NORTH AFRICA 121

Hospital facilities provided for the

Western Task Force aboard the transports proved unusable except in a single

instance because of the heavy surf and

the heavy loss of landing craft during the

assault. Mobile hospitals provided for

the Center Task Force were adequate as

to bed strength, but the unloading of

equipment was not co-ordinated with the

debarkation of personnel. Hospital

equipment, moreover, often proved to be

incomplete when unpacked.15 The Center and Western forces found it impossible to obtain records of casualties

evacuated by naval beach parties, or

even to learn how many there were.

Both the planning and the execution

of the operation were at fault. Those who

drew the medical plans in Washington

and London had very little communication with each other, had only meager

intelligence reports as to the conditions

they would actually meet, and were for

the most part either without combat experience on which to base their judgments or had experience limited to

the static warfare of World War I. Medical personnel with the assault troops

were equally inexperienced and at least

equally ignorant of what war in North

Africa would be like.

Medical Support of II Corps

in the Tunisia Campaign

Expansion Into Tunisia

Armistice negotiations were still going

on in Algiers and fighting still raged at

Casablanca and Oran when the Eastern

Task Force resumed its identity as the

British First Army and turned toward

Tunisia. The French commander there

was unwilling or unable to obey Darlan's

cease-fire order, and Axis reinforcements

were coming in through the ports and

airfields of Tunis and Bizerte. First Army

units occupied Bougie, 100 miles east of

Algiers, on 11 November. The following

day British paratroops and a seaborne

commando group took Bone, 150 miles

farther east, unopposed. Advance elements were within 60 miles of Tunis before encountering German patrols on 16

November. With French co-operation,

forward airfields were occupied in the

Tébessa area, just west of the Tunisian

frontier and 100 miles south of the coast.

Medjez el Bab was captured on 25 November. The airfields at Djedeida, a bare

15 miles from Tunis, were occupied

three days later, but could not be held

against strong counterattacks.16

Surg, II Corps, 1942. (3) Recommendations of

Surg, Western Task Force, 24 Dec 42, in Med Annex to Final Rpt of Opns. 15

 "Equipment was packed and shipped with the

notation on the packing case, 'Complete except for

the following items.' The 'following items' were

pieces of equipment that would deteriorate in

storage—particularly rubber items. These should

have been included before shipment as pieces of

equipment—notably anesthesia machines—could not

be used until the missing items had been received

from the U.S. It took many months to make up

these deficiencies." Ltr, Col Bauchspies to Col

Coates, 15 Apr 59, commenting on preliminary

draft of this volume. Colonel Bauchspies was commanding officer of the 38th Evacuation Hospital in

the North African invasion.

16

 Military sources for the first phase of the

Tunisia Campaign are: (1) Field Marshal the

Viscount Alexander of Tunis, "The African Campaign from El Alamein to Tunis," Supplement to

the London Gazette, 5 February 1948, pp. 864-66;

(2) Howe, Northwest Africa; (3) Howe, 1st

Armored Division; (4) Craven and Cate, eds.,

Europe; TORCH to POINTBLANK; (5) Albert

Kesselring, Kesselring: A Soldier's Record (New

York: William Morrow and Company, 1954). The

more important medical sources are: (6) Crew,

Army Medical Services; Campaigns; (7) Clift, Field
122 MEDITERRANEAN AND MINOR THEATERS

By early December General Anderson's troops were exhausted and his supplies critically short. Before a direct

attack on Tunis could be mounted the

winter rains set in, and the campaign

bogged down in mud. After a month of

futility, during which the enemy

achieved superior build-up by virtue of

his larger ports, all-weather airfields,

and shorter supply lines, the front was

stabilized from Medjez el Bab in the

north to Gafsa in the south. The First

Army dug in to wait.

The first phase of the Tunisia Campaign began in mid-November with the

piecemeal commitment of American

troops in support of the British First

Army. It ended with the concentration of

II Corps in the Constantine-Tébessa area

during early January 1943 in preparation for a large-scale offensive. Immediately after the armistice elements of the

34th Division that had participated in

the Algiers landings relieved British

units occupying Bougie and Djidjelli.

The 39th Regimental Combat Team,

9th Division, was detailed to guard the

line of communications from Algiers to

the rapidly advancing front. Elements of

the 9th Medical Battalion that had

landed with the 39th RCT operated an

ambulance service and a clearing station

in Baba Hassen, some twelve miles southwest of Algiers. The four teams of the

2d Auxiliary Surgical Group that had

been part of the Eastern Task Force continued to function in British hospitals

and other medical installations close to

the front.

As rapidly as the situation permitted,

elements of II Corps that had made up

the Center Task Force were also deployed to eastern Algeria and Tunisia.

Combat Command B of the 1st Armored

Division was at the front in time to

participate in the long seesaw battle for

Medjez el Bab that began around the

first of December. The 2d Battalion,

509th Parachute Infantry, flown out

from Oran, was operating in the Gafsa

area in conjunction with Twelfth Air

Force units and French ground troops.

Before the end of December elements of

the 1st Division were also in action in

the Medjez el Bab sector. In addition to

attached medical personnel, Company B

of the 47th Armored Medical Battalion

was in Tunisia in support of units of the

1st Armored Division. The 2d Battalion

of the 16th Medical Regiment which had

landed at Oran on 8 December, reached

the front shortly before Christmas on detached service with First Army.17

 In this

early phase of the campaign the U.S.

forces fought in relatively small units,

with supporting medical detachments

correspondingly divided.

Hospitalization and evacuation in the

British First Army area were exclusively

British responsibilities. As the first phase

of the Tunisia Campaign came to a close

in muddy stalemate, there were approximately 250,000 Allied troops under First

Army control, for which 11,000 beds in

Opns, pp. 62-68; (8) Hist, 47th Armed Med Bn,

1 Oct 42-9 May 43; (9) Opns Rpt, 1st Med Bn,

11 Nov 42-14 Apr 43; (10) Rpt, Brig Gen Albert

W. Kenner to CinC, AFHQ, 7 Jan 43, sub: Inspection of Med Troops and Installations, First Army

Area; (11) Rpt, Brig Gen Howard McC. Snyder

to IG, 8 Feb 43, sub: Inspection of Medical Service,

Eastern Sector, Western Theater of North Africa.

17

 The 16th Medical Regiment was reorganized

immediately upon landing in Africa into two composite battalions, which functioned independently

in essentially the same manner as the separate

medical battalions. Ltr, Brig Gen Frederick A. Blesse

(Ret) to Col J. H. McNinch, 4 Apr 50, commenting

on MS draft of Crew, Army Medical Services: Campaigns.
CONQUEST OF NORTH AFRICA 123

British military hospitals were available.

Although the bed ratio was thus only 4.4

percent, no serious overcrowding was observed. Mobile units were close to the

front lines and treatment was prompt.

The Western Task Force surgeon, A. W.

Kenner, who had been promoted to brigadier general and assigned to AFHQ as

medical inspector, visited the front between 27 December and 4 January and

concluded that American casualties were

receiving the best medical care possible

under the circumstances. He noted, however, that British hospitals were often

lax in forwarding records of U.S. patients, so that commanders lost track of

their men and returns to duty were unnecessarily slow; and that morale was impaired by absence of mail from home and

failure to receive pay, though British

wounded in the same hospitals received

both. Other adverse morale factors were

failure to receive the Purple Heart and

the loss of personal toilet articles.

A month later Brig. Gen. (later Maj.

Gen.) Howard McC. Snyder made similar observations, noting also that forward

hospitals were unheated, lacking in all

but the barest essentials in equipment,

and understaffed by American standards.

Nevertheless, he found treatment to be

of a high order. While some installations

had few patients, others were overburdened, resulting in a highly flexible evacuation policy. In some instances patients

who could have been quickly returned

to duty were sent to the rear simply to

make room for new casualties. In others,

men who should have been evacuated

were held near the front because fixed

beds were not available for them in the

still rudimentary communications zone.

Evacuation was by ambulance from

aid stations and other forward installations to railheads at Souk el Khemis,

where a clearing platoon of the 2d Battalion, 16th Medical Regiment, shared

the load with a British casualty clearing

station, and at Souk Ahras, where facilities included a casualty clearing station

and a 200-bed British general hospital.

Michelin cars with capacity for 14 litter

cases ran over the narrow-gauge line

from Souk el Khemis to Souk Ahras;

from there three British hospital trains

made the 24-hour run to Algiers. Hospital trains were not yet available for evacuation west of that city.

In the Tébessa sector a British casualty

clearing station and a small dispensary

operated by the Twelfth Air Force furnished hospitalization. Both installations

were at Youks-les-Bains, a few miles west

of Tébessa and adjacent to a large airfield. Evacuation was by air, but was not

formally organized. Up to early January,

most of the casualties flown out were Air

Forces personnel.

The Kasserine Withdrawal

At the turn of the year, U.S. units

operating with the British First Army,

together with forces from the Casablanca

and Oran areas, were transferred to II

Corps under General Fredendall, and

various changes were made in the overall command structure. General Clark

was detached from Allied Force Headquarters to train the newly activated

U.S. Fifth Army for future operations in

the Mediterranean. He was succeeded as

Deputy Supreme Commander in North

Africa by General Sir Harold R. L. G.

Alexander. Lt. Gen. Sir Bernard L.

Montgomery's British Eighth Army,

fighting its way through Libya, was to

come under General Eisenhower's com-
124 MEDITERRANEAN AND MINOR THEATERS

mand when it reached the Tunisian border. A new 18 Army Group was then to

come into being, made up of the British

First and Eighth Armies, the U.S. II

Corps, and the French 19th Corps under

General Louis-Marie Koeltz. General

Alexander was to be the army group

commander.

Early in January General Fredendall

established II Corps headquarters at

Constantine and began moving his

forces into the vicinity of Tébessa. Additional elements of the 1st Armored and

34th Infantry Divisions, as they arrived

from England, were sent to the II Corps

sector, while all remaining elements of

the 1st Division were brought up from

Oran. The three divisions were substantially assembled by 1 February, with the

scattered regiments of the 9th Division

being moved into position as reserves.

Medical units based around Tébessa included, in addition to attached medical

personnel, the 1st and 109th Medical

Battalions and the 47th Armored Medical Battalion, organic to the combat divisions; the 51st Medical Battalion; the

2d Battalion, 16th Medical Regiment;

the 1st Advance Section of the 2d Medical Supply Depot; the 48th Surgical Hospital; and the 9th and 77th Evacuation

Hospitals.18

The Germans seized the initiative

when the rainy season ended in February.

Early in the month Generaloberst Juergen von Arnim's army in Tunisia was

joined by Field Marshal Rommel's

famed Afrika Korps, and Rommel himself was in command when the Axis

forces attacked savagely toward Faïd Pass

in the center of the II Corps front on

the 14th. Intelligence expected the attack

farther north, and the Americans were

caught off balance. Fredendall prepared

to stand at Kasserine Pass, some forty

miles west of the breakthrough, but his

armor was out of position and poor

weather conditions prevented air support

or even reconnaissance. Enemy tank

columns forced the pass on 20 February

and debouched onto the plain beyond in

a three-pronged drive that reached its

maximum extent, only twenty miles

from Tébessa, two days later. There the

drive was contained. The Germans, running low on fuel and ammunition,

realized they had not the strength to

break through the Allied lines in the

face of reinforcements moving in from

Le Kef and Tébessa, and withdrew to

their original positions.

Before the Faïd breakthrough there

had been relatively heavy fighting in the

18

 Military sources for the Kasserine phase of the

Tunisia Campaign are: (1) Howe, Northwest

Africa; (2) Opns Rpt, II Corps, 1 Jan-15 Mar 43;

(3) Truscott, Command Missions; (4) Howe, 1st

Armored Division; (5) Knickerbocker and others,

Story of First Division in World War II, pp. 58-64,

81-92; (6) Craven and Cate, eds., Europe; TORCH

to POINTBLANK; (7) Eisenhower, Crusade in

Europe, pp. 140-48; (8) Kesselring, Soldier's Record, pp. 177-84; (9) Alexander, "African Campaign," Suppl to London Gazette, 5 February 1948,

pp. 866-73. Medical sources primarily relied upon

are: (10) Annual Rpt, Surg, II Corps, 1943; (11)

Annual Rpt, Med Sec, NATOUSA, 1943; (12) Annual Rpt, 51st Med Bn, 1943; (13) Annual Rpt,

Surg, 1st Armd Div, 1943; (14) Annual Rpt, Surg,

1st Div, 1943; (15) Annual Rpt, Surg, 34th Div,

1943; (16) Annual Rpt, Surg, 9th Div, 1943; (17)

Hist, 47th Armd Med Bn, 1 Oct 42-9 May 43; (18)

Opns Rpt, 1st Med Bn, 11 Nov 42-12 May 43;

(19) Hist, 9th Med Bn, 1943; (20) Diary, Hq

Detach, 109th Med Bn, 1 Feb-1 Mar 43; (21)

Cowell, Kenner, Rpts of Visit to II Corps, 29 Jan2 Feb 43; (22) Unsigned Rpt of Observations of

Visit to II Corps, 13-19 Feb 43; (23) Annual Rpt,

9th Evac Hosp, 1943; (24) Annual Rpt, 77th Evac

Hosp, 1943; (25) Annual Rpt, 128th Evac Hosp

(48th Surg Hosp), 1943; (26) Annual Rpt, 2d Aux

Surg Gp, 1943; (27) Clift, Field Opns, pp. 74-94.
CONQUEST OF NORTH AFRICA 125

MAP 9—II Corps Medical Installations, 14 February 1943

Ousseltia Valley, where the II Corps sector approached British positions in the

north, and around Gafsa, more than a

hundred miles distant on the southern

flank. These actions had served to disperse collecting and clearing companies

over hundreds of miles of rough and

largely roadless country. The 9th and

77th Evacuation Hospitals were about

ten miles southeast of Tébessa, far to the

rear, while the 48th Surgical was operating one 200-bed unit at Thala and the

other at Fériana, each more than fifty

miles from the combat lines as of 14

February. (Map 9)

A general withdrawal of medical in-
126 MEDITERRANEAN AND MINOR THEATERS

CAMOUFLAGED AID STATION of a fighter squadron at Youks-les-Bains, Algeria, January

1943.

stallations paralleled the mid-February

German advance. On the first day of the

advance an entire collecting company of

the 109th Medical Battalion was captured, together with most of the medical

detachment of the 168th Infantry regiment-in all, 10 medical officers and more

than 100 enlisted men. On the same day,

14 February, an officer of the 47th Armored Medical Battalion was captured

with four ambulances loaded with casualties.19

 Aid stations in both Faïd and Gafsa sectors were hastily leapfrogged to the

rear, one section caring for patients

while another moved to a safer location.

Lines of evacuation were long and circuitous, over roads that could be safely

traveled only at night. Trucks and litterjeeps were freely used to supplement the

ambulances that were never available in

sufficient numbers.

During the night of 14-15 February

the Feriana section of the 48th Surgical

Hospital moved to Bou Chebka about

midway along the road to Tebéssa, using

trucks and ambulances of the corps medical battalions. Patients were placed in

the 9th Evacuation Hospital, which

shifted 107 of its own patients to beds

set up for the purpose by the still inoperative 77th. By February 17th the

48th Surgical was on the road again,

moving this time to Youks-les-Bains just

west of Tébessa. Within six hours of ar19

 Interv with 1st Lt Abraham L. Batalion, and

Capt Wilbur E. McKee.
CONQUEST OF NORTH AFRICA 127

rival it was receiving patients from both

evacuation hospitals, which were themselves in process of moving.

When weather conditions made air

evacuation to the communications zone

impossible, a section of the British 6th

Motor Ambulance Convoy was rushed to

Youks, where it was placed at the disposal of the 48th Surgical Hospital on 18

February. The twenty-five ambulances

and two buses of this unit were able to

move 180 patients at a time, and succeeded in clearing the Tébessa area of

casualties by the time the Germans broke

through Kasserine Pass. Both the 9th

and the 77th Evacuation Hospitals were

back in operation by 20 February, at new

sites in the Aïn Beida—La Meskiana area

on the road to Constantine. The Tébessa

section of the 2d Medical Supply Depot

moved into the same area on 19 February, followed by the Thala section of

the 48th Surgical. The remainder of the

48th went from Youks to Montesquieu

on 22 February, while the 9th Evacuation shifted from Aïn Beida to Souk

Ahras, fifty miles to the north. (Map 10)

All of these moves were carried out

rapidly and in good order, although

hundreds of patients were involved. In

this acid test of mobility, commanders

were duly impressed by the fact that a

200-bed section of the 48th Surgical Hospital could evacuate its patients, dismantle and load its installations, and be on

the road in four and a half hours, while

the 750-bed evacuation hospitals, because

they had no organic vehicles of their

own, were able to move only when transportation could be provided by corps.

In a disintegrating situation their priority was low and the danger of their being

overrun by the enemy was proportionately great. The relative immobility of

these large units kept them so far behind

the fighting fronts that ambulance runs

of a hundred miles or more between

clearing station and hospital were not

infrequent. In the absence of hospitals

closer to the lines, teams of the 2d Auxiliary Surgical Group were attached to

the clearing stations.

Operations in Southern Tunisia

During the first week of March, General Fredendall was relieved, and command of II Corps was given to General

Patton; Maj. Gen. Omar N. Bradley was

appointed his deputy. The shift in leadership coincided with the penetration of

Tunisia from the south by the British

Eighth Army and activation of the 18

Army Group under Alexander. The II

Corps' next mission was to attack in the

Gafsa-Maknassy area in support of

Eighth Army's drive up the coast.20

Mindful of the Kasserine experience,

and with troop strength brought up to

90,000 by assignment of the 9th Division, Colonel Arnest, the II Corps surgeon, asked for one of the new 400-bed

field hospitals capable of operating in

three 100-bed units, a 400-bed evacuation hospital, and more ambulances.

Only the ambulances arrived before the

southern phase of the Tunisia Campaign

20

 Military sources for the campaign in southern

Tunisia are: (1) Opns Rpt, II Corps, 16 Mar-10

Apr 43; (2) Howe, Northwest Africa; (3) Howe,

1st Armored Division; (4) Knickerbocker and

others, Story of First Division in World War II,

pp. 64-72, 92-95; (5) Omar N. Bradley, A Soldier's

Story (New York: Henry Holt and Company, 1951),

pp. 43—55; (6) Kesselring, Soldier's Record, pp.

184-88; (7) Alexander, "African Campaign," Suppl

to London Gazette, 5 February 1948, pp. 873—78.

Medical sources are the same as those cited in n.

18, above, with the addition of: (8) Annual Rpt,

15th Evac Hosp, 1943; (9) Annual Rpt, 3d Aux

Surg Gp, 1943; (10) Clift, Field Opns, pp. 98-112.
128 MEDITERRANEAN AND MINOR THEATERS

MAP 10—II Corps Medical Installations, 24 February 1943

was over, and those only a few days before the pressing need for them had

passed. The only medical reinforcements

received were five teams of the 3d Auxiliary Surgical Group, flown in without

nurses on 18 March. Eleven teams of the

2d Auxiliary Surgical Group were

already active in the II Corps area.

Shortage of beds made it impossible to

maintain any fixed evacuation policy,

even the 15-day policy originally

planned.

The corps jumped off on 17 March.

The 1st Division occupied Gafsa the

same day, took El Guettar on the 18th,

and seized Station de Sened on the 21st.
CONQUEST OF NORTH AFRICA 129

Maknassy fell to the 1st Armored on 22

March. After a brief respite for revision

of plans and regrouping, all four divisions of II Corps went into action on 28

March. The 9th Division attacked along

the road from El Guettar to the coastal

city of Gabes; the 1st turned northeast

toward Maknassy, where the 1st Armored

was concentrating on a strongly held

pass east of the town; and the 34th, together with British First Army units,

attacked Fondouk on the left flank.

Fighting in all sectors was heavy, and

for ten days almost continuous. Contact

with the British Eighth Army was established on 7 April, and the enemy began

withdrawing to the north. When the

34th Division and its British allies broke

through at Fondouk two days later, the

southern campaign was over.

In the interval between recovery of

the ground lost in the Kasserine withdrawal and the launching of the II Corps

offensive, hospitals and other medical installations were again moved forward to

the Tébessa area. The 9th Evacuation

Hospital set up this time at Youks-lesBains, where proximity to the field used

for air evacuation to the communications

zone was the primary consideration. Both

sections of the 48th Surgical were back at

Feriana by 19 March. Two corps clearing stations established on 22 March

remained in place until the end of the

southern campaign, compensating in

part for the shortage of mobile hospital

beds. These were the clearing stations

of the 51st Medical Battalion at Gafsa

and of the 2d Battalion, 16th Medical

Regiment, near Maknassy. Each was reinforced by surgical teams and was adjacent to clearing units of the organic

medical battalions. They functioned in

effect as front-line hospitals for forward

surgery and for holding cases that could

not be safely moved. Evacuation from

both stations was to the 48th Surgical

Hospital, fifty miles from Gafsa and almost twice that far from Maknassy.

Coinciding with the renewal of the

offensive on 28 March, the 77th Evacuation returned to Tébessa and one section

of the 48th Surgical went on to Gafsa.

At Sbeitla, on the evacuation route

from the 34th Division, 2d Battalion of

the 16th Medical Regiment set up a

clearing station that, like the other two

corps clearing stations, functioned as a

forward hospital. It was relieved on 11

April, after the southern campaign had

ended, by the 400-bed 15th Evacuation

Hospital.

Facilities of the 48th Surgical Hospital,

and of the corps clearing stations, were

wholly inadequate for the steady stream

of casualties from the three divisions

operating in the El Guettar-Maknassy

sector during the final drive. Evacuation

to Tébessa and Youks by ambulance and

truck was virtually a continuous process.

To make room for new arrivals, the 77th

and 9th Evacuation Hospitals were compelled to send patients to the communications zone with little reference to their

hospital expectancy, and many were thus

lost who could have been returned to

duty in a reasonable time.

In the El Guettar-Maknassy area, terrain was often too rough for vehicles,

even for jeeps and half-track ambulances.

Litter carries, especially on the 9th Division front, were long and generally possible only at night. In many instances

both patients and medical attendants

waited in slit trenches for darkness. The

corps medical battalions supplied additional litter bearers, as many as 75 being

needed by one combat team. Only in the
130 MEDITERRANEAN AND MINOR THEATERS

MAP 11—II Corps Medical Installations, 11 April 1943

Fondouk sector was evacuation from the

battlefield relatively easy. There, a good

road net and adequate cover permitted

location of aid and collecting stations

close to the lines. The ambulance haul

from the clearing station at Sbeitla to

the evacuation hospitals at Tébessa and

Youks-les-Bains was approximately eighty

miles. (Map II)

The Drive to Bizerte

Following withdrawal of the enemy

from southern Tunisia, General Patton

was detached to train the force that

would become the U.S. Seventh Army

on the scheduled invasion of Sicily.

Command of II Corps passed to General

Bradley, whose first task was to shift his

troops 150 miles to the north. Although

the movement involved passing close to

100,000 men, with all their equipment,

across the communication lines of the

British First Army, it was accomplished

without interruption to any supply or

military service, and without detection

by the enemy.21

21

 Military sources for the northern phase of the

Tunisia Campaign are: (1) Opns Rpt, II Corps,

23 Apr-9 May 43; (2) Howe, Northwest Africa;

(3) Howe, 1st Armored Division; (4) Knickerbocker and Others, Story of First Division in World

War II, 72-81, 95-98; (5) Bradley, Soldier's

Story; (6) Craven and Cate, eds., Europe.- TORCH

to POINTBLANK; (7) To Bizerte with the II Corps
CONQUEST OF NORTH AFRICA 131

SETTING UP A TENT OVER A MOBILE SURGICAL TRUCK IN TUNISIA. Truck and

tent furnished facilities and operating space for three surgical teams.

The final phase of the North African

campaign began on 23 April, with II

Corps and attached French elements

pushing east along the Mediterranean

coast, First Army advancing northeast in

the center, and Eighth Army attacking

northward on the right flank. The

French 19th Corps, under General

Koeltz, operated between the two British

armies. By this time the Allies had control of the air and the end was swift and

sure. One after another, strongly held

hill positions were stormed. The 1st

Armored swept through the Tine Valley

to capture the important communications city of Mateur on 3 May. Bizerte

fell to the 9th Division on 7 May, simultaneously with the entry of British units

into Tunis. The 3d Division was brought

up at this time, but was too late to participate in more than mopping-up operations. All enemy forces in the II Corps

sector surrendered on 9 May. British

armor quickly closed the escape route

to the Cap Bon peninsula, and the remaining Axis forces, trapped between

the British First and Eighth Armies,

(Washington, 1943) ; (8) Alexander, "African Campaign," Suppl to London Gazette, 5 February 1948,

pp. 878-84. Medical sources are substantially the

same as those already cited for the Kasserine and

southern phases of the campaign, to which should

be added: (1) Annual Rpt, 10th Field Hosp, 1943;

(2) Clift, Field Opns.
132 MEDITERRANEAN AND MINOR THEATERS

surrendered on 13 May. About 275,000

prisoners were taken in the last week of

the campaign.

With an independent combat mission

and five divisions under its command by

the date of the German surrender, II

Corps resembled a field army both in

size and role. Colonel Arnest functioned

more as an army than as a corps surgeon.

His staff of eleven officers and sixteen

enlisted men was of a size appropriate

to the responsibilities entailed.

In northern Tunisia, Tabarka served

as the nerve center for medical activities,

as Tébessa had in the south. The use and

disposition of mobile hospitals was

drastically modified on the basis of previous experience. The semimobile 400-

bed evacuation hospitals, with surgical

teams attached, were placed directly behind the advancing troops, with the

larger evacuation units farther to

the rear where they took patients from

the more forward installations. Before

the attack was launched, the 11th Evacuation was shifted more than a thousand

miles from Rabat to a site nine miles

south of Tabarka, and the 48th Surgical

was established some ten miles farther

to the east. The 750-bed 77th Evacuation

was set up at Morris, near Bone, where it

was detached from II Corps and assigned

to the Eastern Base Section, the forward

element of the North African Communications Zone.

On 21 April the 15th Evacuation

moved up from Sbeitla to a location ten

miles north of Bédja, and the following

day the 11th relieved the 48th Surgical,

which closed for reorganization. The

larger 9th Evacuation occupied the

former site of the 11th. (Map 12) The

48th Surgical, converted into the 400-bed

128th Evacuation Hospital, returned to

combat duty southwest of Mateur on

4 May. The 15th Evacuation, displaced

by the 128th, moved two days later to

a site west of Mateur.

The 750-bed 38th Evacuation Hospital

moved from the Telergma airfield west

of Constantine, where it had been operating as a communications zone unit

since early March,22 to the vicinity of

Bédja on 4 May; and on 7 May the 9th

Evacuation moved forward to the vicinity of Mateur. The 77th Evacuation

remained throughout the campaign at

Morris, where it possessed air, rail, and

water outlets to the communications

zone, though its usefulness was impaired

by an ambulance run of 85 to 110 miles

over roads too rough for the transportation of seriously wounded men.

In the northern phase of the campaign, II Corps was thus supported by

three 400-bed and three 750-bed evacuation hospitals, in contrast to the campaign in the south where one 400-bed

unit and two 750-bed units had served

substantially the same troop strength. In

the northern campaign, moreover, forward hospitals were only 5 to 20 miles

from the combat areas, contrasted with

distances of 25 to 100 miles in southern

Tunisia. Despite these shortened lines of

evacuation, the 2d Battalion of the 16th

Medical Regiment and the 51st Medical

Battalion were reinforced by elements

of the 56th Medical Battalion and were

given additional ambulances. The 10th

Field Hospital, which reached Tabarka

on 30 April, was also assigned to II Corps,

but did not go into operation until 7

May, when it was used exclusively as a

holding unit for air evacuation, and to

serve personnel of an air base.

22

 See p. 190, below.
CONQUEST OF NORTH AFRICA 133

MAP 12—II Corps Medical Installations, 23 April 1943

During the first ten days of the Bizerte

drive, fighting was in mountainous country, often covered with thick, thorny

underbrush and largely without roads.

Evacuation was particularly difficult on

the 9th Division front, to the left of the

corps sector. For a time mules were used,

harnessed in tandem with a litter swung

between poles attached to the saddles.

Difficult hand litter carries up to three

and a half miles necessitated the use of

200 additional bearers, drawn in part

from corps medical battalions but mainly

from line troops. At one point, where a

railroad cut the 9th Division front, two

half-ton trucks were fastened back to

back with rims fitted over the rails. One

truck powered the vehicle on its way

to the rear, the other on the return trip.

Twelve litters could be carried at a time,

but the exposed position of the railroad

made it usable only at night. One collecting company of the 9th Medical Battalion operated a rest camp in the rear of

the division area, to which approximately

seventy-five front-line soldiers were

brought each evening for a hot shower,

a full night's sleep, and a chance to write

letters. Exhaustion cases were held at the

clearing stations, under heavy sedation.

Similar conditions prevailed on the

narrower fronts assigned to the other

divisions of II Corps. The 1st Division

borrowed litter bearers from the 51st
134 MEDITERRANEAN AND MINOR THEATERS

Medical Battalion; the 1st Armored

drafted cooks, clerks, and other noncombat personnel into service as bearers.

Half-track ambulances proved unable to

enter the narrow wadis where casualties

occurred most frequently, and had to be

replaced by jeeps. In the bloody battle

for Hill 609, litter bearers of the 34th

Division brought out casualties in daylight from positions closer to the enemy

lines than to their own.

In the final week of the campaign,

medical support of the combat forces

more closely approximated the pattern

laid down in the manuals. (Map 13)

The coastal plain was adapted to easy

movement in vehicles, and the road net

was good. The 400-bed evacuation hospitals were closed to admissions between

9 and 15 May, new patients being sent

thereafter only to the 9th Evacuation.

The staff of this unit was reinforced by

a detachment from the 16th Medical

Regiment and by captured German

medical personnel, who helped with

prisoner-of-war patients. Two captured

German field hospitals were allowed to

continue in operation, under supervision

of the 51st Medical Battalion, until 15

May, when all prisoners still requiring

hospitalization were turned over to the

9th Evacuation. As of 12 May there were

1,145 patients, including prisoners of

war, in II Corps hospitals, and twice

that number in the two evacuation hospitals assigned to the Eastern Base Section.

All hospital units and corps medical

battalions passed to control of EBS as

of midnight, 15 May.

Immediately after the end of hostilities

the 9th Evacuation Hospital, on its own

initiative, began to function as a station

hospital for all troops in the area. Members of the hospital staff were soon

treating 100 or more a day in the outpatient clinic, where their specialized

skills made up for the limitations of

battalion medical sections left with the

combat and support troops in the vicinity.23

Summary of Tunisian Experience

Like the combat troops, the medical

units and personnel of the medical detachments went into the Tunisia Campaign without battle experience, or with

experience limited to the two or three

days of action in the TORCH landings.

Deficiencies in training had to be made

up while operating under combat conditions, and in intervals when the units

were in bivouac. More important still

was the training of replacements. Virtually no trained medical replacements

were available, yet losses were high.

More than a hundred Medical Department officers and men were captured in

the Faïd Pass breakthrough alone, while

disease, injury, and battle wounds also

took their toll. Indeed, the personnel

problem was perhaps the most difficult

one faced by the surgeon's office during

the campaign. Constant juggling of

medical officers, and continuing training

of line troops as replacements, were

necessary to keep the II Corps medical

service in operation at all. Other difficulties included much obsolete equipment

in the early stages of the campaign, and

generally inadequate lighting and power

facilities.

Casualties were progressively heavier

23

 Recorded interv, Col Coates, with ASD Frank

B. Berry, 4 Nov 58, commenting on preliminary

draft of this volume. Dr. Berry—then a colonel

was chief of the Surgical Service, 9th Evacuation

Hospital, in North Africa.
CONQUEST OF NORTH AFRICA 135

MAP 13—II Corps Medical Installations, 12 May 1943

with each stage of the campaign. Hospital admissions for the period 1 January

through 16 March were 4,689. During

the campaign in southern Tunisia, 17

March through 9 April, 6,370 men were

admitted to II Corps hospitals. For the

northern campaign, 10 April through 15

May, there were 8,629 hospital admissions. The consolidated casualty figures,

shown in Table 1, offer tangible evidence

of the magnitude of the task successfully

carried through by Colonel Arnest and

his staff.

The early use of the 750-bed evacuation hospital as a forward unit was a

holdover from the relatively static warfare of World War I, and was at least

in part responsible for the siting of

hospitals so far to the rear. Another

reason for the failure of II Corps to give

close hospital support in the Kasserine

and southern phases of the campaign

was the absence of any fixed battle line

and the necessity of giving ground before

an enemy superior both in numbers and

in combat experience.24

The organization of the corps medical

service underwent numerous changes as

the campaign progressed and more experience was gained with the requirements of modern combat. Initially the

corps surgeon's office was located at the

24

 Ltr, Col Arnest to Col Coates, 10 Nov 58.
136 MEDITERRANEAN AND MINOR THEATERS

TABLE 1—HOSPITAL ADMISSIONS AND DISPOSITIONS,

II CORPS, 1 JANUARY-15 MAY 1943

Source: Annual Rpt, Surg, II Corps, 1943.

corps rear echelon, where information

filtered back too slowly to permit adequate advance planning. Delay in establishing a base section close to the combat

zone complicated both supply and evacuation problems in the early stages of the

campaign. The 61st Station Hospital,

located at El Guerrah just south of

Constantine early in February at the request of the British First Army surgeon

and under British control until March,

was the only U.S. fixed hospital closer

than Algiers until the end of March.

This 500-bed unit, and the British 12th

Casualty Clearing Station at Youks-lesBains, aided immeasurably in the orderly

withdrawal of II Corps medical installations at the time of the Kasserine

breakthrough. The contrast between the

medical support available to the corps

at that time and that available during

the final phase of the campaign in late

April and early May shows how quickly

and how well the lesson of Kasserine

Pass was learned.25

Air Force Medical Installations

In addition to the mobile hospitals

serving II Corps in the field, the Twelfth

Air Force maintained various installations of its own, which gave first- and

second-echelon medical service to combat

fliers, their counterparts in the Air

Transport Command, and the supporting ground crews. Air Forces medical

personnel were administratively distinct

from the organization serving the ground

forces, although the two groups worked

closely together. Air Forces installations

were confined to squadron aid stations

and dispensaries, but both types of unit

frequently had to assume hospital functions. At the more important airfields,

such as Marrakech, La Senia, and

Telergma, hospitals were set up by the

base sections, while combat zone airfields,

such as Youks-les-Bains, generally had

25

 (1) Ltr, Surg. II Corps, to TSG, 1 Jun 43, sub:

Care of Wounded. (2) Ltr, Surg, NATOUSA, to

TSG, 15 May 43, sub: Observations, North African

Theater. (3) Clift, Field Opns, pp. 129-36. (4)

Observations made on a visit to II Corps, 13-19

Feb 43. (5) Deputy Surg, AFHQ, to G-4, Orders,

61st Sta Hosp, 20 Jan 43; and attachment, DBMS,

First Army, to Surg, AFHQ, 15 Jan 43. See also

p. 189, below.
CONQUEST OF NORTH AFRICA 137

WRECKED AMBULANCE in northern Tunisia. The red cross was not always respected.

mobile hospital units of the ground

forces in the immediate vicinity. Fixed

hospitals in the communications zone

served Air Forces personnel as well as

ground troops.26

Evacuation From II Corps

The chain of evacuation from the

Tunisian battlefields went from forward

evacuation hospitals by ambulance and

rail to Eastern Base Section installations,

and by air direct to fixed hospitals in

Algiers and in the vicinity of Oran. During the Kasserine and southern Tunisian

campaigns, Tébessa and the nearby airfield at Youks-les-Bains served as the

starting points for evacuation to the

communications zone. In the final stages

of the campaign, and the readjustment

period immediately following the close

of hostilities, evacuation was from

Tabarka to Bone, from the railhead at

Souk el Khemis to Constantine, and from

26

 For description of Air Forces medical units, see

Link and Coleman, Medical Support of the Army

Air Forces in World War II, pp. 455-57.
138 MEDITERRANEAN AND MINOR THEATERS

airfields at Souk el Arba and Sidi Small

to Oran.

Evacuation by Road and Rail

The 1st Battalion of the 16th Medical

Regiment, with the assistance after 18

February of the British 6th Motor Ambulance Convoy, operated an ambulance

shuttle from Tébessa to Constantine,

approximately 140 miles. The same road

served as a main supply route for II

Corps. Beginning in mid-March, the

16th Medical Regiment also staffed and

operated a French hospital train, which

ran from Tébessa to Ouled Rahmoun,

just south of Constantine, where the

narrow-gauge Tébessa line intercepted

the main east-west railroad. A traffic

control post at Aïm M'lilla distributed

patients from ambulance convoys and

hospital trains to vacant beds in the area.

In the northern sector the ambulance

route of the 16th Medical Regiment ran

eighty-five miles from Tabarka to Bone.

Rail evacuation from the northern sector

was by two British hospital trains from

Souk el Khemis, each with capacity for

120 litter and 200 sitting patients.27

Evacuation from the combat zone by

road and rail was under control of II

Corps, although the 1st Battalion of the

16th Medical Regiment, which was

primarily responsible for the operation,

was assigned to the Eastern Base Section.

For the Kasserine period, 1 January to

16 March 1943, the II Corps Surgeon

reported 1,740 patients evacuated to the

communications zone by road, none by

rail. During the campaign in southern

Tunisia, 17 March to 9 April, 1,742

patients were evacuated by road and

1,052 by rail. From the northern sector,

10 April to 15 May, the evacuation

figures included 5,628 by road and 436

by rail.

Air Evacuation From II Corps

With the concentration of II Corps in

the Tébessa area in January, it was immediately clear that the informal and

infrequent use of air evacuation prevalent up to that time would be inadequate. The logistical demands upon the

single-track, narrow-gauge rail line and

the one motor road between Tébessa

and Constantine would preclude the extensive use of either for evacuation, even

had hospital cars and ambulances been

available at that early stage of the campaign. In an effort to solve the evacuation problem, General Kenner and

Colonel Corby met with General Doolittle and Colonel Elvins, respectively

commanding officer and surgeon of the

Twelfth Air Force, and the corresponding officers of the 51st Troop Carrier

Wing in Algiers on 14 January.28

A comprehensive plan for air evacuation was agreed upon, and was put into

27

 (1) Annual Rpt, Med Sec, EBS, 1943. (2) Annual Rpt, Med Sec, NATOUSA, 1943. (3) Med

Hist Data, 161st Med Bn (1st Bn, 16th Med Regt),

22 Oct 44. (4) Unsigned Memo, n.d., sub: Notes

on General Kirk's Observations of Med Serv in

North Africa, May 43.

28

 (1) Link and Coleman, Medical Support of the

Army Air Forces in World War II, pp. 473-81. (2)

Hist of 12th Air Force Med Sec, ch. VIII. (3) M

Sgt A. I. Zelen, Med Dept, Hospitalization and

Evacuation in the Mediterranean Theater of Operations (MS draft), p. 51. (4) Med Hist, 802d

Med Air Evac Trans Squadron. (5) Statement of Gen

Kenner to author, 26 Mar 59. See also, Ltr, Maj

Gen Earle Standlee (Ret) to Col Coates, 15 Jan 59,

commenting on preliminary draft of this volume.
CONQUEST OF NORTH AFRICA 139

effect without delay. It differed in fact

but little from the plan Colonel Elvins

had prepared before the invasion, but

at that time it had met with a cold

reception from ground surgeons, who

believed air evacuation to be impractical. The plan called for the corps surgeon to establish holding hospitals near

forward airfields, with the air surgeon

responsible for supervision and the

theater surgeon for over-all co-ordination. It was in this connection that the

38th Evacuation Hospital was established

at Telergma.29

The planes used were C-47's,

equipped with litter supports, which

made it possible to carry 18 litter patients

and attendants. There were no regular

schedules, since the planes were used for

evacuation only on their return runs

after discharging cargo or passengers in

the combat zone. Requests were made

through the medical section, AFHQ, and

evacuation officers in the combat areas

were notified each evening as to how

many planes would be available the

following day. Communication was by

teletype, telephone, radio, and air courier. Patients were assembled near the

airfields so they could be loaded with

a minimum of delay.

Although planes were not marked

with the Geneva Cross, and flew at low

altitudes, there were no enemy attacks.

Before 10 March the medical personnel

handling air evacuation were enlisted

men from the medical sections of various

groups of the 51st Troop Carrier Wing.

After that date personnel—including

nurses as well as enlisted men—were

supplied by the 802d Medical Air Evacuation Transport Squadron. Surgeons on

the ground supervised loading and unloading. The surgeon of the 51st Troop

Carrier Wing was responsible for records,

supplies used in flight, and property

exchange. The ratio was two planes used

for resupply for every ten loads of patients, although one plane could be made

to serve if returning personnel were dispersed among cargo transports.

In the Kasserine phase of the campaign, air evacuation was from Youksles-Bains, with the British 12th Casualty

Clearing Station serving as holding unit

for evacuees. During the II Corps operations in southern Tunisia the same

airfield was used, with the holding

function shifted to the 9th Evacuation

Hospital. One planeload of 16 patients

was flown direct from Thelepte. When

operations shifted to the northern sector,

the lines of evacuation ran from Souk el

Arba and Sidi Smail. The 38th Evacuation Hospital was close to both airfields.

In the final days of the campaign, the

10th Field Hospital served as a holding

unit at Souk el Arba. The overcrowded

hospitals of the Eastern Base Section

were bypassed, the planes returning directly to their own bases at Algiers and

Oran, sometimes by an inland route and

sometimes flying low over the water.

Figures for air evacuation from the

Tunisian fronts between 16 January and

23 May 1943, as reported by the 802d

Medical Air Evacuation Transport

Squadron (MAETS), are broken down

by points of origin and destination in

Table 2.

The Air surgeon estimated that 887

patients had been evacuated by air in

North Africa before the formal service

was inaugurated on 16 January 1943, but 29

 See also p. 132, above, and pp. 204-05, below.
140 MEDITERRANEAN AND MINOR THEATERS

TABLE 2—AIR EVACUATION FROM TUNISIA, 16 JANUARY-23 MAY 1943

by no means all of these came from

Tunisia.30

It was this experience in North Africa

that gave both ground and air surgeons

some idea of the immense capabilities

of air evacuation, which continued to be

used increasingly through the rest of the

war.

Medical Supplies and Equipment

Shipping shortages and the speed with

which Operation TORCH was mounted

held medical supplies and equipment

carried by the task forces to the lowest

possible level consistent with safety.

There also were difficulties in getting

together all of the items scheduled for

follow-up convoys. Hospitals destined

for North Africa arrived in England with

no more than 25 percent of their medical

equipment and none of their quartermaster equipment. Deficiencies were

made up in the United Kingdom, but

only by stripping the European theater

of much of its reserve stock.31

Until the arrival of trained medical

supply personnel late in December 1942,

supplies for the Western Task Force were

handled by division medical supply

officers and by personnel of a hospital

ship platoon. For the Center Task Force,

the 51st Medical Battalion took over the

medical supply function shortly after its

arrival on the D plus 3 convoy. Here

trained medical supply personnel were

available within two weeks. The 1st

Advance Section, 2d Medical Supply

Depot, arrived in Oran on 21 November

and carried on the medical supply func30

 The II Corps surgeon, in his annual report for

1943, gives a figure of 3,313 patients evacuated by

air between 1 January and 15 May. The larger figure shown in Table 2 is due in part to the additional week included at the heavy end of the

period, and in part to the inclusion of Air Forces

casualties, not reported by II Corps.

31

 Ltr, Brig Gen Paul R. Hawley, Surg, ETOUSA,

to Col Corby, 5 Nov 42. Except as otherwise noted,

primary sources for this section are: (1) Med Hist,

2d Med Supply Depot Co, 1942, 1943; (2) Annual

Rpt, Surg, II Corps, 1943; (3) T Sgt William L.

Davidson, Medical Supply in the Mediterranean

Theater of Operations, United States Army, pp.

1-29; (4) Rpt of Med Supply Activities,

NATOUSA, Nov 42-Nov 43.
C-47 CARGO PLANE CONVERTED TO AMBULANCE DUTY in North Africa. The attending nurse is 2d Lt. Aleda E. Lutz, one of eight U.S. nurses killed in action in the MTO.
142 MEDITERRANEAN AND MINOR THEATERS

tion for the growing body of troops in

the area until a base section organization

was established early in December.32

The U.S. components of the Eastern

Task Force were supplied, like the

British components, through the British

First Army. Even items not available in

British depots were requisitioned from

ETO sources by the British. This dependence upon British supplies continued through the first phase of the

Tunisia Campaign, creating many difficulties because of differences in practice

between the two medical services. Supply

levels deemed adequate by the British

were insufficient by the more lavish

American standards.33

Medical supply in Tunisia passed into

American channels with the concentration of IareI Corp a at ths i e beginnin n the Constantine-Tébess g of 1943a.

The 1st Advance Section of the 2d

Medical Supply Depot opened in Constantine on 8 January, moving a few days

later to Telergma, where it relieved

elements of the 16th Medical Regiment.

The section shifted to Bekkaria, east of

Tébessa, on 20 January, and thereafter

remained as close as possible to the II

Corps medical installations. The supply

depot withdrew to Am Beïda on 20

February, following the Kasserine breakthrough, then moved up to Souk Ahras

for a brief time, but was back at Bekkaria

before the Gafsa-Maknassy-El Guettar

campaign began in mid-March. The

depot was in operation east of Tabarka

by 23 April in support of the drive to

Bizerte. On 15 May, immediately after

the German surrender in Tunisia, the

1st Advance Section, 2d Medical Depot

Company, moved to Mateur, where it

was later relieved by a base section

depot.

After activation of the Eastern Base

Section late in February, medical supplies for II Corps were received through

the base depot at Aïn M'lilla, south of

Constantine, or one of the two subdepots

at Philippeville and Bone. Distance and

transportation difficulties always complicated the supply problem, but there were

no serious shortages of any necessary

item at any time during the Tunisia

Campaign.

Medical supplies in North Africa were

furnished initially on the basis of the

Medical Maintenance Unit (MMU),

designed to meet the medical requirements of 10,000 men for thirty days.

Deliveries to the theater were automatic,

determined by troop strength. Combat

experience quickly revealed deficiencies

and overstocks in the MMU, which was

supplanted midway through the Tunisia

Campaign by the Balanced Depot Stock,

worked out by supply experts in the

Office of The Surgeon General.

Items of basic equipment were the

most difficult to replace, but in spite of

depot stringencies, hospitals assigned to

the combat zone usually managed to get

there with equipment in excess of their

organizational allowances, and so were

able to weather loss and breakage.

Professional Services

Combat Medicine and Surgery

The amphibious phase of the North

African campaign was too brief, and the

32

 See pp. 207-09, below, for base section medical

supply activities. 33

 Rpt, Gen Kenner to CinC, AFHQ, 7 Jan 43,

sub: Inspection of Med Troops and Installations,

First Army Area.
CONQUEST OF NORTH AFRICA 143

MEDICAL SUPPLIES ON THE INVASION BEACH AT LES ANDALOUSES, west of Oran,

9 November.

nature of the fighting too restricted, to

provide positive experience in combat

medicine and surgery. The primary

lesson for the Medical Department was

the necessity in future landing operations of establishing clearing stations and

hospitals ashore at the earliest possible

date, with sufficient equipment and

adequate personnel for emergency surgery and medical care. In Tunisia, invaluable experience was gained in the

management of wounds, in the equipping and staffing of facilities for forward

surgery, and in the handling of psychiatric cases. Even before the campaign

was over, much of this experience was

applied toward the improvement of

medical and surgical care in the combat

zone.

Forward Surgery—In the early phases

of the Tunisia Campaign, mobile hospitals were located so far to the rear—often

50 to 100 miles—that a far heavier

surgical load fell on the clearing stations

than had ever been contemplated. Plasma

as a guard against shock was given in

the collecting stations and often in the

aid stations, but as a general rule only

emergency surgery was performed in the

division area. Surgeons in the division

clearing stations administered plasma,

controlled hemorrhage, and closed sucking chest wounds, but completed trau-
144 MEDITERRANEAN AND MINOR THEATERS

matic amputations only where necessary

to stop hemorrhage.34

After emergency treatment, surgical

cases went to the clearing stations of the

corps medical battalions, which were set

up through necessity as forward surgical

hospitals despite the fact that they were

inadequately equipped and staffed for

this purpose. Surgical and shock teams

worked together effectively in these installations with minimal equipment,

but there were neither beds nor personnel for postoperative care. Intravenous

fluids could not be administered; special

diets were not available; whole-blood

transfusions were possible only with detachment personnel as donors and without means of checking blood for malaria

or syphilis. As a result, patients were

evacuated as rapidly as possible, the majority in six to eight hours after surgery

and some while still under anesthesia.

Col. Edward D. Churchill, surgical

consultant in the theater, explored the

situation during the southern campaign,

and his recommendations had much to

do with the improvement of conditions

in the northern sector, where smaller

evacuation hospitals were set up closer

to the front. Associated with Colonel

Churchill in the evaluation of II Corps

surgery was Maj. (later Col.) Howard E.

Snyder, of the 77th Evacuation Hospital,

who reported to corps headquarters for

temporary duty on 15 March 1943, and

remained as surgical consultant to the

corps.35 In the Sicily Campaign, as will

be seen later, the whole concept of forward surgery was altered as a result of

the Tunisian experience.

One of the lessons quickly driven home

in the Tunisia Campaign was that plasma

was not a complete substitute for blood

in combat surgery. No supply of whole

blood was available, nor had any provision been made to fly it in. To meet

the immediate and pressing need, an

informal blood bank was established at

the Gafsa section of the 48th Surgical

Hospital, where 25 to 50 troops were

detailed each day as donors. Out of the

II Corps blood bank of 1943 grew the

theater blood bank of 1944.

 36

The Psychiatric Problem—The outstanding medical problem of the Tunisia Campaign was the unexpectedly

high incidence of psychiatric disorders.

Originally diagnosed as shellshock, following World War I terminology, or as

battle fatigue, these cases constituted a

heavy burden on forward medical units.

In the absence of specialized knowledge

on the part of regimental and division

medical personnel, most of the psychiatric cases in the early stages of the campaign were evacuated to communications

zone hospitals, from which less than 3

percent returned to combat duty.37

34

 Sources for this section are: (1) Annual Rpt,

Med Sec, NATOUSA, 1943; (2) Annual Rpt, Surg,

II Corps, 1943; (3) Rpt to CO, 2d Aux Surg Gp,

by Maj Kenneth F. Lowry, and Capt Forrest E.

Lowry, 13 Aug 43, sub: Forward Surgery; (4) Rpt

to Surg, NATOUSA, by Col Edward D. Churchill,

16 Apr 43, sub: Memoranda on Forward Surgery;

(5) Surg, NATOUSA, Cir Ltr No. 13, 15 May 43,

sub: Memoranda on Forward Surgery; (6) Surg,

NATOUSA, Cir Ltr No. 18, 14 Jun 43, sub: Forward Surgery and Aux Surg Teams.

35

 Howard E. Snyder, "Fifth U.S. Army," vol. 1,

Activities of Surgical Consultants, "Medical Department, U.S. Army," subseries Surgery in World

War II (Washington, 1962), ch. XVI. 36

 Ltrs, Col Arnest to Col Coates, 17 Nov 58; and

Gen Standlee to Col Coates, 15 Jan 59, both commenting on preliminary draft of this volume. See

also pp. 352-53. below. 37

 Major sources for this section are: (1) Annual

Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt,

Surg, II Corps, 1943; (3) Surg, NATOUSA, Cir

Ltr No. 4, 22 Mar 43, sub: Psychotic and Neurotic
CONQUEST OF NORTH AFRICA 145

In the battles of El Guettar and

Maknassy in southern Tunisia, psychiatric reactions were responsible for 20

percent of all battlefield evacuations, and

for days at a time the proportion ran as

high as 34 percent.38 Experimenting with

these cases at the corps clearing station

near Maknassy late in March 1943, Capt.

(later Col.) Frederick R. Hanson, who

had been sent out from the theater surgeon's office to investigate the problem,

found that 30 percent of all psychiatric

cases could return to full duty within

thirty hours if properly treated close to

the combat lines. The treatment Captain

Hanson developed was heavy sedation at

the clearing station, followed by transfer

to an evacuation hospital where sedation

and intensive psychotherapy were continued for three days. At the end of that

time, the patient was returned to duty

or was evacuated to the communications

zone for further treatment.

In the Bizerte phase of the campaign,

division surgeons were made responsible

for the initial treatment, and psychiatrists for the follow-up were attached to

the 9th, 11th, 15th, and 128th Evacuation Hospitals, all functioning in the

forward area. Hanson himself was attached to the 48th Surgical Hospital,

later reorganized as the 128th Evacuation. Cases returned to full duty without

leaving the combat zone ranged from 58

to 63 percent.

Common Diseases—Aside from surgical and psychiatric problems, the Tunisia

Campaign revealed little of a medical

nature that had not been anticipated.

Dysentery and diarrhea were prevalent

among II Corps troops, but outbreaks

were controlled by screening and by

destruction of flies. Respiratory infections were a frequent occurrence, but

were not particularly severe. Malaria was

not a source of difficulty, since the campaign ended before the onset of the

malaria season, and combat exposure

was therefore not extensive. As a preventive measure, II Corps troops began

taking atabrine on 4 April, with good

compliance and minimal reactions.

Dental Service

The Tunisia Campaign revealed that

the standard dental chest was not sufficiently portable to be carried close

behind the lines. During periods of comPatients, Their Management and Disposition; (4)

Surg, NATOUSA, Cir Ltr No. 17, 12 Jun 43, sub:

Neuropsychiatric Treatment in the Combat Zone;

(5) Col. Frederick R. Hanson, comp. and ed.,

"Combat Psychiatry," Bulletin, U.S. Army Medical

Department, Suppl Number, (November 1949) . For

a nonprofessional, but perceptive study see Brig.

Gen. Elliot D. Cooke, All But Me and Thee (Washington: Infantry Journal Press, 1946). 38

 This terminology requires some explanation.

Although the terms "casualty" and "battle casualty"

were consistently applied in the Mediterranean

theater to psychiatric disorders occurring in the

combat zone, these cases are officially tabulated as

"disease." Not to establish a new policy but to make

explicit one supposedly already in effect, War Department Circular No. 195, dated 1 September

1943, stated: "Psychoneurosis or mental diseases

developing under battle conditions (commonly but

improperly designated battle neurosis, hysteria,

shellshock, etc.) will not be classified as a

battle casualty or reported as wounded or injured

in action." By that date, however, the practice in

the theater had become fixed, as will be seen from

the documents cited in the preceding footnote. As

late as 1949, Colonel Hanson and his collaborators

were still employing the term "psychiatric casualty"

in the sense in which they had used it prior to

September 1943. For the sake of uniformity, all psychiatric disorders will be statistically treated as

"disease" in this volume; but in deference to views

widely held among psychiatrists, the term "disease"

will not be used in the text to categorize cases

falling under the general classification of "combat

exhaustion."
146 MEDITERRANEAN AND MINOR THEATERS

bat, cases requiring emergency dental

treatment were cared for at division

clearing stations, and as much routine

work as possible was done in the division area. For the most part, however,

the routine work was deferred until

periods of combat inactivity. During

periods of actual contact with the enemy,

when little dental work could be done,

dental personnel usually served in other

capacities such as assistant battalion

surgeon; supply, mess, records, motor,

and admissions officer; and anesthetist.

Enlisted dental technicians served as

medical technicians and as company aidmen.39

A need for dental prosthetics was

observed throughout the Tunisia Campaign, but no facilities for such work

were available in the II Corps area, and

only inadequate facilities appeared anywhere in the theater. The 34th Division

dental surgeon found a partial solution

of this problem in March when captured

German equipment was used to set up a

prosthetics laboratory for the division.40

Veterinary Service

The veterinary service of II Corps

during the Tunisia Campaign was

largely confined to routine food inspections by division veterinarians. Since no

fresh meat was available until April, the

duties were not arduous, and veterinary

personnel, like dental personnel, were

frequently used in administrative and

other capacities. Veterinary functions

included the care of animals only for a

brief interval in late April when mules

were used for evacuation of the wounded

in the 9th Division area. The veterinary

officer attached to the Twelfth Air Force

headquarters in Algiers carried on food

inspection work for the air force units.41

39

 Sources for this section are: (1) Annual Rpt,

Med Sec, NATOUSA, 1943; (2) Memo for Supply

Serv, from Brig Gen R. B. Mills, 10 May 43; (3)

MS, History of the United States Army Dental

Corps in the North African Theater of Operations,

World War II, pp. 1-24. The use of dental personnel under combat conditions in ways similar to

those mentioned in the text was general, despite

regulations against it. See (4) Hq, NATOUSA, Cir

Ltr No. 36, 17 Mar 43; and (5) Ltr, Brig Gen

Lynn H. Tingay to Col Coates, 25 Feb 59, commenting on preliminary draft of this volume.

40

 Annual Rpt, Surg, 34th Div, 1943. 41

 Major sources for this section are: (1) Annual

Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt,

Surg, 9th Div, 1943; (3) Annual Rpt, Twelfth Air

Force Med Activities, 1943.
CHAPTER IV

Sicily and the Mediterranean Islands

Sicily was selected as the next Allied

target in the Mediterranean at the Casablanca Conference, 14-23 January 1943.

The choice reflected both the British

predilection for a Mediterranean strategy and the American reluctance to

detract in any way from the ultimate invasion of northern France. The conquest

of Sicily was justified for both groups on

the ground that it would relieve some

of the pressure on the Russian front, help

knock Italy out of the war, and open the

Mediterranean to Allied shipping. In

British eyes Sicily was also a step along

Churchill's "soft underbelly" route to

the Continent, while the American

strategists looked upon such a campaign

as the most profitable way to employ

troops already in Africa, at a minimum

cost in shipping. There was also disagreement on plans, which were not finally

approved by the Combined Chiefs of

Staff until May. Like the Tunisia Campaign, operations in Sicily (known by

the code name HUSKY) were to be

carried out by an Allied force under

field command of General Alexander,

this time designated the 15th Army

Group. The components were Montgomery's British Eighth Army, reinforced by the 1st Canadian Division, and

a U.S. Seventh Army commanded by

Patton, with Maj. Gen. Geoffrey Keyes

as his deputy. The date ultimately fixed

for the invasion was 10 July.1

Medical Preparations for

Operation HUSKY

Medical Planning for the Assault

Medical planning for the Sicily Campaign began early in March 1943 under

1

 Military sources for the Sicily Campaign as a

whole are: (1) Field Marshal the Viscount Alexander of Tunis, "The Conquest of Sicily, 10th July,

1943 to 17th August, 1943," Supplement to the

London Gazette, 12 February 1948; (2) Rpt of

Opns, U.S. Seventh Army in Sicilian Campaign, 10

Jul-17 Aug 43; (3) Opns of II Corps, U.S. Army, in

Sicily, 10 Jul-17 Aug 43; (4) Samuel Eliot Morison,

"History of United States Naval Operations in

World War II," vol. IX, Sicily-Salerno-Anzio, January 1943-June 1944 (Boston: Little, Brown and

Company, 1954); (5) Craven and Cate, eds.,

Europe-. TORCH to POINTBLANK; (6) Eisenhower, Crusade in Europe; (7) Patton, War As I

Knew It; (8) Bradley, A Soldier's Story; (9) Truscott, Command Missions; (10) Kesselring, A Soldier's Record; (11) Knickerbocker and others,

Story of the First Division in World War II; (12)

Trahan, ed., History of the Second United States

Armored Division, pp. 47-59; (13) Taggert, ed.,

History of the Third Infantry Division in World

War II, pp. 51-76; (14) The Fighting Forty-Fifth,

the Combat Report of an Infantry Division (Baton

Rouge: Army and Navy Publishing Company,

1946) ; (15) W. Forrest Dawson, ed., Saga of the

All American (Atlanta: A. Love Enterprises, 1946),

unpaged; (16) Lt Col Albert N. Garland and

Howard McGaw Smyth, Sicily and the Surrender of

Italy, UNITED STATES ARMY IN WORLD WAR

II (Washington, 1965).
148 MEDITERRANEAN AND MINOR THEATERS

GENERAL PATTON and Brig. Gen. Theodore Roosevelt, Jr., deputy commander of

the 1st Division.

the general direction of Col. Daniel

Franklin. Colonel Franklin had succeeded General Kenner as Western Task

Force surgeon in December 1942 and

continued in the same position after the

task force was redesignated I Armored

Corps in January 1943 and assigned to

occupation duties in Morocco. During

the training period, the corps was known

simply as Force 343, the designation

Seventh Army being applied only after

the troops were at sea on the way to

Sicily. Colonel Franklin then became

Surgeon, Seventh Army.2

The Seventh Army medical section

evolved from a nucleus carried over with

Colonel Franklin from the Western Task

Force. By April the section was split between a forward echelon headquarters in

Mostaganem, Algeria, and a rear echelon

headquarters in Oran. The surgeon, 2

officers, and 2 enlisted men at forward

echelon headquarters were occupied

with medical planning for the invasion

of Sicily. Rear echelon personnel, including 3 officers and 9 enlisted men,

were engaged with matters of medical

supply, preventive medicine, and routine

administration.

Others concerned at the staff level

with medical planning for HUSKY were

Colonel Arnest, II Corps surgeon; and

Col. L. Holmes Ginn, Jr. who left the

1st Armored Division in March to become chief surgeon of the 15th Army

Group. The Services of Supply medical

section assigned an officer to the Sicilian

planning group the last week in March,

and preparation of requisitions for supplies from the zone of interior began in

mid-April.

Plans for medical support could be

made specific only after the Tunisia

Campaign ended, when it became possible to complete assignment of troops

and to set a timetable for the invasion.

Primary emphasis was placed on mobility and the shortening of evacuation

lines.

2

 Sources for medical preparations for the Sicily

Campaign, including both planning and training,

are: (1) Annual Rpt, Med Sec, NATOUSA, 1943;

(2) Rpt of Opns, U.S. Seventh Army, in Sicilian

Campaign, an. N; (3) Annual Rpt, Surg, Seventh

Army, 1943; (4) Interv with Col Franklin, Surg,

Seventh Army, 28 Jun 44; (5) Surg, II Corps, Rpt

of Med Activities, Sicilian Campaign; (6) Annual

Rpt, Surg, 1st Div, 1943; (7) Annual Rpt, Surg,

2d Armd Div, 1943; (8) Med Hist, 3d Div, 1943;

(9) Annual Rpt, Surg, 9th Div, 1943; (10) Annual

Rpt, Surg, 45th Div, 1943; (11) Annual Rpt, Surg,

82d A/B Div, 1943; (12) Annual Rpt, 54th Med

Bn, 1943; (13) Annual Rpt, 11th Fld Hosp, 1944;

(14) Clift, Field Opns pp. 145-79.
SICILY AND THE MEDITERRANEAN ISLANDS 149

Medical battalions under corps and

army control were reorganized to give

each collecting company a clearing element, the two platoons of the clearing

company being supplemented for this

purpose by a third clearing platoon made

up of the station sections of the three

collecting companies. Each regimental

combat team in the assault was to be

accompanied by one of these collectingclearing companies, which had demonstrated their efficiency in training

exercises. Each task force was to have

one ambulance platoon in addition to

those of the medical battalions, and at

least one field hospital unit. The field

hospital platoons were to be used for

forward surgery and as holding units for

nontransportables, combining the functions performed in Tunisia by the surgical hospital and the corps medical

battalion clearing stations.

Attached medical troops were to land

with unit equipment, augmented by

such special supply items as blood

plasma, morphine syrettes, and extra

dressings. A balanced medical supply

adequate for seven days of maintenance

was to be on the D-day convoy. Those

supplies not hand-carried by the debarking medical troops were to be unloaded

on the beaches as rapidly as the situation

permitted.

After the initial landings, each division was to be supported by one 400-bed

evacuation hospital. When they were

needed, 750-bed evacuation hospitals

were to be sent to the island, each to back

up two of the smaller units. Evacuation

from the beaches was to be by troop

carrier or LST (Landing Ship, Tank)

until hospital ships were available, with

air evacuation beginning at the earliest

possible date after suitable fields had

been secured. No fixed hospitals were to

be brought into Sicily until the conquest

of the island was complete, all casualties

with hospitalization expectancy of more

than seven days being returned to North

Africa.

Limited shipping space made it necessary to mount the invasion in three

separate convoys, to be landed at 4-day

intervals, the estimated turnaround time

from Tunisian ports. Attached medical

troops, the medical battalions, and the

field hospitals with their surgical teams,

were scheduled for the assault group; the

400-bed evacuation hospitals were to be

on the second, or D plus 4 convoy; and

the 750-bed evacuations were to be sent

on call of the Seventh Army surgeon.

Medical service at sea was to be supplied

by the Navy on the larger vessels, but the

LST's, which were to sail from Tunis

and Bizerte, were to be staffed by medical personnel detached from the 77th

Evacuation Hospital, then relatively inactive near Bone. The 77th Evacuation

also assigned personnel to the naval base

at Bizerte to assist with the returning

casualties.

Training of Medical Troops

Medical units designated to participate in the Sicily Campaign were assigned initially to the task forces.

Attached medical troops, organic and

separate medical battalions, and field

hospitals all received special training

with the combat forces they were to

serve. Training for landing operations

began 10 May at the Fifth Army Invasion Training Center at Arzew near

Oran. Here all medical personnel of

Force 343 learned how to waterproof

equipment and gained realistic experi-
150 MEDITERRANEAN AND MINOR THEATERS

COLONEL FRANKLIN

ence under simulated combat conditions

in debarking from landing craft, setting

up and operating beach installations,

and shore-to-ship evacuation of the

wounded.3

In addition to this assault training,

all units were given physical conditioning and instruction in the prevention of

diseases likely to be encountered.

Malaria came in for special attention,

since the assault was to be made at the

height of the season. Where appropriate,

the men received specialized medical

training such as the application of

splints, treatment of shock, control of

hemorrhage, and transportation of the

wounded. Both medical and combat

personnel received instruction in first

aid.

Similar training for medical personnel accompanying the 45th Division,

which sailed for Sicily directly from the

United States, was conducted in the zone

of interior, the division stopping at Oran

just long enough for a rehearsal on the

Arzew beaches.

A special problem was posed by elements of the 82d Airborne Division that

were to spearhead the invasion, since

the organic 307th Airborne Medical

Company normally moved by glider or

by more conventional means of travel

and was not included in the assault plans.

Four officers and twenty-five enlisted

men from the medical company, all volunteers, were trained as parachutists to

augment the regimental medical detachments.

Medical Support of Seventh Army

in the Field

Preliminary Operations

Off the coast of Tunisia, northeast of

Cap Bon, lies rocky, inhospitable Pantelleria Island. In mid-1943 Pantelleria

was a heavily fortified Italian air base

that dominated the invasion route to

Sicily and so had to be taken before

HUSKY could be mounted. Only fortytwo square miles in area, the island rises

precipitously from the sea. There was

just one beach on which a seaborne landing could be made, and that one was

narrow, with tricky offshore currents and

a heavy surf. The only harbor was small

and too shallow for any but light-draft

vessels. Should troops succeed in forcing

a landing in spite of these difficulties,

the surface of the island, with its rock

masses and layers of volcanic ash, its

stone fences and square stone houses,

3

 See Medical Aspects of Amphibious Operations,

prepared at this center. With only minor modifications, the same manual was later used to train

medical troops for the Normandy landings. Reproduced in full in Clift, Field Opns, pp. 146-74.
SICILY AND THE MEDITERRANEAN ISLANDS 151

COLONEL GINN

was ideally adapted for defense by its

garrison of more than 10,000.4

The British 1st Division was selected

for the assault on Pantelleria, but the

troops were to go in only after the island

had been bombed to rubble. The air

offensive against the "Italian Gibraltar"

opened on 18 May, less than a week after

the German surrender in Tunisia, and

continued with mounting fury to D-day,

set for 11 June. Heavy naval guns joined

in the bombardment the night of 10-11

June as the convoy carrying the assault

troops moved into the assembly area.

The first wave of landing craft hit the

beach a few minutes before noon, to be

met by trifling small arms fire and a rush

of white flags. The surrender of the island had in fact been ordered by its

commander for 1100, before a single

soldier set foot upon it.

The British Army medical units in the

assault were thus not called upon to function in combat. The airfields on Pantelleria were quickly converted to Allied

use, and within a week an American

station hospital under base section control took over the medical service of the

island.5

The reduction of Pantelleria was

followed immediately by a bombardment of the island of Lampedusa, between Malta and the east coast of

Tunisia, which resulted in the surrender

of the island on 12 June, again without

the intervention of ground troops. The

neighboring island of Linosa surrendered the next day without waiting to

be bombed. A British naval party took

possession of uninhabited Lampione on

COLONEL GINN

14 June, completing the Allied occupation of the Pelagies.

From that date until 9 July the North

African Air Force and the RAF, joined

by the U.S. Ninth Air Force from its

bases in the Middle East, concentrated

on the ports and airfields of Sicily. The

greatest amphibious operation in all

history, measured by its initial landing

strength, was already at sea when the

bombers finally retired. High winds

hampered but did not stop the parachutists who led the way, and rough seas did

not deter the landing craft. The invasion

of Sicily proceeded on schedule.

The Assault Phase

The Allied assault on Sicily was concentrated in the southeast corner of the

island. British and Canadian forces

landed at the southern tip of the Sicilian

triangle, and at various points on the

4

 (1) Craven and Cate, eds., Europe: TORCH

to POINTBLANK, pp. 419-42. (2) Eisenhower,

Crusade in Europe, pp. 164-66. 5

 See p. 193, below.
152 MEDITERRANEAN AND MINOR THEATERS

east coast. The Americans enveloped a

70-mile strip along the southern shore, to

the left of the British.6

Seventh Army stormed the beaches at

three separate points in the early morning of 10 July 1943. CENT Force, built

around the untested 45th Division,

straddled Scoglitti on the right flank,

while the DIME Force, spearheaded by

two regimental combat teams of the

veteran 1st Division and two Ranger

battalions, landed in the vicinity of Gela

about ten miles farther west. These two

forces made up a reorganized II Corps

under General Bradley. The Joss Force

commanded by Maj. Gen. Lucian K.

Truscott, Jr., and composed of the reinforced 3d Division, a Ranger battalion,

and a combat command of the 2d Armored Division, went ashore at Licata

on the left flank of the American sector.

The remainder of the 2d Armored, and

the remaining RCT of the 1st Division,

stood offshore as a floating reserve until

mid-afternoon of D-day, then debarked

near Gela where the fighting was heaviest. The 505th Regimental Combat

Team and the 3d Battalion of the 504th

RCT, 82d Airborne Division, which

were dropped behind the beaches a few

hours ahead of the assault, were under

army control.

The task force surgeons were, for the

CENT Force, Lt. Col. Nesbitt L. Miller

of the 45th Division; for the DIME Force,

Lt. Col. (later Col.) James C. Van Valin

of the 1st Division; and for the Joss

Force, Lt. Col. (later Col.) Matthew C.

Pugsley of the 3d Division. The floating

reserve, called the KOOL Force, was

under command of Maj. Gen. Hugh J.

Gaffey and the force surgeon was Col.

Abner Zehm, both of the 2d Armored

Division.

Scoglitti Landings—On the CENT

beaches landings were delayed an hour

by the heavy seas. Many units landed on

the wrong beaches and about 20 percent

of the landing craft were destroyed on

the rocks. All assault units were nevertheless ashore by 0600. Early opposition

came from Italian home guards, who

fought only halfheartedly or not all,

giving the 45th Division time to establish itself firmly before air activity and

and German counterattacks began.

The beachhead was secure by the end of

the day.

D plus 1 saw counterattacks on the

extreme right repulsed by the 180th

Infantry and the 505th Parachute Combat Team—which had been forced down

in the area instead of at its designated

drop north of Gela. In a parallel action

elements of the 157th and 179th Regimental Combat Teams captured Comiso

airfield against strong opposition. By the

end of the third day, 12 July, the Scoglitti beachhead was fifteen miles deep

and the U.S. forces made contact with

the Canadians on the left flank of the

British Eighth Army. The capture of

Biscari (Acati) airfield northwest of

Comiso on D plus 4 completed the

initial mission of the CENT Force.

The medical complement of the CENT

Force included the 120th Medical Bat6

 Military sources for the assault are those cited

at the beginning of this chapter. Medical sources

primarily relied upon for the assault phase are:

(1) Rpt of Opns, U.S. Seventh Army in Sicilian

Campaign, an. N; (2) Annual Rpt, Surg, Seventh

Army, 1943; (3) Surg, II Corps, Rpt of Med Activities in Sicilian Campaign; (4) Annual Rpt,

Med Sec, NATOUSA, 1943; (5) Clift, Field Opns,

pp. 180-86; (6) Unit rpts of div surgs, med bns,

and hosps mentioned in the text. The British side

of the story is in Crew, Army Medical Services:

Campaigns, vol. III.
SICILY AND THE MEDITERRANEAN ISLANDS 153

talion, organic to the 45th Division; the

54th Medical Battalion; one platoon of

the 11th Field Hospital; and seven teams

of the 3d Auxiliary Surgical Group.

Medical detachments went ashore with

their respective combat units, and battalion aid stations were established half

a mile to a mile inland within the first

two hours. Collecting elements of the

organic medical battalion followed about

an hour later, moving casualties from

the aid stations directly to the beach,

where naval shore groups took over.

Trucks borrowed from the infantry were

substituted for the ambulances that had

not yet been unloaded from the ships.

The scattered collecting units reassembled into their companies and established their own collecting stations

shortly after noon. By 1600 hours the

120th Medical Battalion had a clearing

station set up about three miles inland

in support of the 179th and 180th Regimental Combat Teams on the left.

Casualties from the 157th RCT on the

right and from the paratroop force fighting around Comiso airfield were evacuated from aid stations directly to the

beach until early afternoon of D plus 1,

when the 54th Medical Battalion opened

a clearing station in that area.

All medical units were ashore with

their equipment by 12 July, although the

field hospital platoon was not in operation until the 14th. Collecting and

clearing stations moved frequently during the first few days of combat as troops

pushed forward rapidly against crumbling opposition. A clearing platoon of

the 120th Medical Battalion, established

in an Italian military hospital in Vittoria

on 13 July, served as a temporary surgical

center, while the 54th Medical Battalion

took over all responsibility for beach

evacuation. Shoreward movement of

casualties was stopped on 15 July because

available LST's were not properly prepared to receive them, but resumed the

next day after arrival of the British

hospital carrier Leinster. Nineteen

nurses of the 15th Evacuation Hospital

helped care for patients in the clearing

stations from 14 July until their own

unit went into operation on the 20th.

Surgical teams worked in the field hospital unit and with the clearing stations

of both the medical battalions. (Map

14)

Gela Landings—The DIME Force got

ashore in the vicinity of Gela beginning

at 0245 according to schedule against

relatively light opposition. Only the

Rangers, who landed in Gela itself, ran

into trouble in the form of Italian tanks,

but managed to seize and hold the town.

Enemy air activity was sporadic during

the day, and resistance stiffened around

the perimeter of the beachhead. The

first counterattack came on the morning

of D plus 1, when twenty enemy tanks

broke through the 26th Infantry and

got within 2,000 yards of the beach before they were stopped by artillery fire.

Another forty tanks cut across the 16th

RCT, but those too were turned back by

artillery, bazookas, and grenades before

the two tank columns could join and

isolate the beachhead. The last counterattack, at 1630 that afternoon, was only

stopped by accurate and deadly fire from

the naval guns offshore.

The task force moved inland against

less vigorous opposition the next day,

taking Ponte Olivo airfield and extending the beachhead to a depth of four

miles. That night the second airlift of

the 82d Airborne arrived simultaneously
154 MEDITERRANEAN AND MINOR THEATERS

MAP 14—Seventh Army Hospitals, 16 July 1943

with a group of enemy bombers, and in

the confusion a number of the troop

carriers were shot down by U.S. fire. All

assault phase objectives were secured by

D plus 4, 14 July.

Medical battalions supporting the

Gela operation, including both the landing units and the reserve, were the 1st

and elements of the 48th Armored, organic to the combat units; two collectingclearing companies of the 51st; and the

261st Amphibious Medical Battalion,

initially attached to the 531st Engineer

Shore Regiment as part of the beach

group. Supplementing these were two

platoons of the nth Field Hospital;

seven teams of the 2d Auxiliary Surgical Group and three teams of the 3d;

and two ambulance platoons of the 36th

Ambulance Battalion.

Except for battalion medical detachments and naval beach parties, the

landing of medical personnel and equipment on the Gela beaches was unduly

delayed. One company of the 261st Amphibious Medical Battalion managed to

set up a clearing station in support of

the 26th RCT some seven hours after

the assault began by using the equipment of another company. The 1st Medical Battalion established a clearing station for the 16th RCT at H plus 13, but

had no equipment other than one medical chest. Casualties from this station

were evacuated to the beach by ambulances of the 51st Medical Battalion, one

company of which was ashore but inoperative. The field hospital platoons

landed at H plus 6, but on the wrong

beaches. The invasion was in its fourth
SICILY AND THE MEDITERRANEAN ISLANDS 155

day before the hospital was functioning

at Gela.

Casualties were relatively heavy on

the DIME beaches, where enemy counteraction was most violent. Some medical equipment, including ambulances,

was lost at sea and by enemy action on

the beach. The medical battalions were

nevertheless in normal operation by 12

July. The 51st, reinforced by surgical

teams, held nontransportables until the

field hospital opened, while the 261st

cared for cases expected to return to duty

within a week. Wherever possible, surgery was performed on the ships rather

than in shore installations during the

first two or three days, but all clearing

stations handled surgical cases when

evacuation from the beach was interrupted. The withdrawal of the transports on 12 and 13 July halted evacuation in the DIME sector, but air

evacuation from the Ponte Olivo field

began on the 14th. A hospital ship was

available the following day, and on 16

July the 400-bed 93d Evacuation Hospital opened near Ponte Olivo. (See Map

14.)Licata Landings—The Joss Force,

which had crossed the Strait of Sicily

from Tunisian ports in LST's, made the

first real shore-to-shore landing craft operation, such as would later be used to

cross the English Channel. Rough seas

held up the landings until shortly before

dawn, and the low gradient of the

beaches forced the craft aground too far

from dry land. The assault troops nevertheless got ashore in good order against

only nominal opposition. The town fell

quickly, and before the first day was over

strong combat patrols were 4 or 5 miles

inland. The beachhead was 15 miles in

depth and all initial objectives were

taken by D plus 2.

Medical units organic to the combat

divisions were the 3d Medical Battalion

and a company of the 48th Armored

Medical Battalion. Supporting these

were the 56th Medical Battalion and a

collecting-clearing company of the 51st;

the 10th Field Hospital; nine teams of

the 3d Auxiliary Surgical Group; and

a platoon of the 36th Ambulance Battalion. As in the CENT and DIME landings,

medical detachments of Joss followed

their combat units ashore within two

hours. Collecting companies were only

an hour or two behind. Casualties were

brought directly to the naval beach installations until clearings stations could

be set up on D plus 1. Congestion on

the beaches prevented earlier unloading

of equipment. The field hospital also

opened on D plus 1. Troops in the Licata

sector moved rapidly, and medical installations kept pace, leaving only elements

of the 56th Medical Battalion at the

beach to handle evacuation from the

island. By 15 July, when the 11th Evacuation Hospital opened northwest of

Licata, a normal chain of evacuation was

functioning smoothly. (See Map 14.}

In all sectors the treatment of civilians

wounded or injured as a result of the

invasion was an acute problem. Local

hospital facilities were inadequate, even

to care for routine illnesses, and in the

landing phase Seventh Army medical

supplies and beds could be spared to

treat only emergency cases.

The Campaign in Western Sicily

By 16 July the U.S. Seventh and British Eighth Armies had reached the line

marking the end of the amphibious
156 MEDITERRANEAN AND MINOR THEATERS

EVACUATING WOUNDED TO LANDING CRAFT for return to transports, Gela area, 12 July.

phase, and 15th Army Group headquarters issued field orders for completing

the conquest of Sicily. Eighth Army was

to drive up the eastern coast to Messina;

Seventh Army, which now numbered

about 142,000 troops, was to capture

Palermo and reduce the western end of

the island. To accomplish this mission,

II Corps was to strike north from Gela

with the 1st and 45th Divisions, while a

newly constituted Provisional Corps under General Keyes was to operate in the

less rugged area northwest of Licata with

the 3d Infantry, 2d Armored, and 82d

Airborne Divisions, the last operating as

infantry. The recently arrived 39th Regimental Combat Team of the 9th Division was also attached to the Provisional

Corps at this time, the remainder of the

division being left in reserve in Africa.7

The 261st Amphibious Medical Battalion remained in the Gela area under

army control to handle evacuation to

Tunis and Bizerte. The 54th Medical

Battalion and a collecting-clearing company of the 51st were attached to II

Corps, while the 56th and two companies

of the 51st went to the Provisional Corps.

Two platoons of the 11th Field Hospital

and the 93d and 15th Evacuation Hospitals came under II Corps control, leaving

the 10th Field, one platoon of the 11th

7

 Military sources are the same as those already

cited. Medical sources include: (1) Clift, Field

Opns, pp. 187-92; (2) Surg's rpts already cited at

the theater, army, and corps levels; (3) Unit rpts

of div surgs, med bns, hosps, and other med organizations mentioned in the text.
SICILY AND THE MEDITERRANEAN ISLANDS 157

Field, and the 11th Evacuation Hospital

to serve the three divisions under Keyes.

The surgical teams remained with the

field hospital platoons and clearing companies to which they were already attached.

The Provisional Corps overran the

whole western end of Sicily in a week.

The enemy in this area fought only delaying actions, using reluctant Italian

troops to cover the withdrawal of German units to the more mountainous

northeastern sector, which provided

both suitable terrain for a defensive

stand and an escape route to the Italian

mainland by way of the Strait of Messina. From Agrigento and Porto Empedocle, some 25 miles west of Licata,

the 3d Division struck northwest for

Palermo on the other side of the island,

while the remainder of the corps followed the southern coast to Castelvetrano. Here the 2d Armored veered

northeast to complete the envelopment

of the capital, while the 82d Airborne,

the 39th Infantry, and the 3d Ranger

Battalion continued around the coast to

take the western ports of Marsala and

Trapani.

So rapid was the advance of the 2d

Armored, and so disorganized the opposition, that the division surgeon, Colonel

Zehm, personally brought in eight prisoners who had surrendered when intimidated by the colonel's flashlight.8

Advance elements of the 2d Armored

entered Palermo late in the evening of

22 July, and accepted the peaceful surrender of the city. Combat teams of both

3d and 45th Divisions were already in

the outskirts.

Throughout this rapid movement,

medical installations had great difficulty

in keeping pace with the combat units.

Organic medical battalions, by frequently changing position, managed to

keep clearing stations in operation from

4 to 10 miles behind the constantly shifting points of contact with the enemy.

The hospitals and corps clearing stations, however, were often left 25 to 50

miles in the rear of the action.

The heterogeneous nature of the

forces involved also made it necessary

to use the corps medical battalions in

unorthodox ways. The 56th Medical

Battalion left one collecting-clearing

company at Licata to serve as a holding

unit for air evacuation. Another company of the 56th was attached to the

3d Division, performing second-echelon

medical service for the 30th Regimental

Combat Team. The battalion's third

collecting-clearing company went with

the 82d Airborne around the western tip

of Sicily to Trapani, using its own ambulances and captured enemy vehicles

to make up for the transportation deficiencies inherent in paratroop medical

detachments. On 21 July the 51st Medical Battalion established a clearing station at Menfi, on the southern line of

march, and another at Castelvetrano,

where the 3d Platoon of the 11th Field

Hospital also went into operation the

the next day. By this time, however, the

infantry spearhead was at Marsala thirty

miles farther west, while the 2d Armored

was closer to Palermo than it was to

Castelvetrano.

The 10th Field Hospital shifted from

Licata to Agrigento on the 19th, where

it was joined the following day by the

holding unit of the 56th Medical Battalion from Licata. The 10th Field moved

8

 Statement of Colonel Zehm to the author, 17

Aug 55.
158 MEDITERRANEAN AND MINOR THEATERS

MAP 15—Seventh Army Hospitals, 26 July 1943

on to Corleone along the 3d Division's

line of advance on the 22d, but forward

elements of the division it supported

were already in Palermo 25 miles away.

The 11th Evacuation Hospital, supporting both prongs of the Provisional Corps'

advance, did not move from Licata until

21 July, and then only to Agrigento, by

that time 60 or more miles in the rear.

(Map 15)

Following the conquest of western

Sicily, gaps in the evacuation chain were

quickly closed. A clearing platoon of the

3d Medical Battalion took over an Italian military hospital in Palermo the day

the city fell; a clearing platoon of the

51st Medical Battalion arrived a day

later; and on 27 July the newly landed

91st Evacuation Hospital opened in

buildings of the University of Palermo

Polyclinic Hospital.

II Corps, pushing northwest across

central Sicily, matched the pace of the

Provisional Corps. The drive began on

16 July, by which date the 45th Division

had moved across the rear of the 1st

to a position on the left flank of the

corps sector. The three combat teams of

the 45th then leapfrogged one another

in a continuous advance to the northern

coast of the island. A patrol made contact

with the 3d Division in the outskirts of

Palermo on the afternoon of 22 July.

The following day the vital coast road

was cut at Termini and Cefalii, and the

45th turned east toward Messina.

In a parallel advance, the 1st Division

captured Enna, communications hub of
SICILY AND THE MEDITERRANEAN ISLANDS 159

Sicily, on 20 July, and established contact

with the Canadians on the right. Three

days later the 1st was astride the NicosiaTroina-Randazzo road, running east and

west about twenty miles inland. Nicosia

fell on the 28th and Cerami, less than

ten miles from Troina, on the 30th. Between those two dates the 39th RCT of

the 9th Division, recently withdrawn

from the now quiet western sector, was

attached to the 1st Division. By 31 July

II Corps had reached and passed the

boundary originally assigned to Seventh

Army.

Medical support for II Corps in this

phase of the campaign followed a normal, if accelerated, pattern. In hill fighting aid stations were kept from 100 to

300 yards behind the troops; on open

ground they were 500 to 1,000 yards behind. The organic battalions were almost

continuously in motion, backed by the

corps battalion whose collecting-clearing

companies bypassed each other to keep

within 10 miles of the front. Hospital

units moved less frequently, but in accordance with the same leapfrog pattern.

The 11th Field opened at Pietraperzia

in the center of the front and perhaps

a third of the way across the island on

18 July. Two days later the 15th Evacuation was receiving patients at Caltanissetta, 10 miles farther north. July 22

saw a platoon of the nth Field in operation 15 miles beyond Caltanissetta.

The 93d Evacuation opened at Petralia

on the Nicosia road on 25 July, while

the 11th Field moved on to Collesano,

less than 10 miles from the sea, the following day. (See Map 15.) The 128th

Evacuation Hospital collected its scattered equipment and personnel in time

to open at Cefalii on 31 July.

The Etna Line and Messina

While the Americans swept over western and central Sicily, the British were

virtually stalled on the eastern coast

where Mt. Etna rose steeply from the

Catanian plain. The rugged northeastern

corner of the island was ideally adapted

to defense, with the escape port of Messina protected by a series of strongly fortified positions in contracting arcs. By

the end of July, therefore, General Alexander abandoned his original strategy.

Seventh Army was ordered to fight its

way to Messina along the northern coast

road, and to a junction with Eighth

Army along the Troina-Randazzo road,

which skirted the northern slopes of the

classical volcano. The key to the Etna

Line was Troina, a natural fortress-city

built of stone on top of a rocky hill.

The 1st Division, with the 39th RCT

of the 9th, launched an assault against

the position on 1 August, while the 3d

Division relieved the 45th near San Stefano and prepared to attack the coastal

anchor of the German line. The British

hammered simultaneously at the right

flank between Mt. Etna and the sea.9

The battle of Troina, lasting until 6

August, was the most bitterly contested

of the campaign. Before it was over

twenty-four separate counterattacks had

been repulsed. The remaining regiments of the 9th Division were brought

up early in the battle, with the 60th combat team executing a wide flanking

movement to threaten the enemy's rear

and the 47th leading the advance

through the battered town to the next

objective. Both 1st and 9th Divisions

were slowed by difficult terrain and ex9

 See sources cited n. 7, p. 156, above.
160 MEDITERRANEAN AND MINOR THEATERS

MAP 16—Seventh Army Hospitals, 5 August 1943

tensive enemy demolitions, but met only

nominal opposition after Troina.

The 3d Division, meanwhile, was encountering determined resistance. A

strong enemy position on high ground

around San Fratello was finally outflanked by an amphibious operation in

the early morning of 8 August. A second

seaborne landing behind enemy lines

near Brolo on 11 August was less successful, but the beleaguered landing force

was relieved the following day. A third

leapfrog movement by sea on the night

of 15-16 August, involving elements of

the 45th Division, found resistance

broken and the ground forces already

beyond the point of the landing. Advance elements of the 3d Division entered Messina early on 17 August, preceding Eighth Army patrols by no more

than an hour.

Medical units, including field and

evacuation hospitals, followed closely behind the combat forces along the two

lines of advance—so closely, in fact, that

evacuation hospitals were sometimes

ahead of clearing stations.10 The heaviest

concentration was in the vicinity of

Nicosia, 5 to 15 miles behind the Troina

front. The 15th Evacuation Hospital

opened in this area on 1 August, as did

two platoons of the nth Field on the

3d. The 11th Evacuation was attached to

II Corps and joined the group on 5 August. (Map 16) Over the next ten days,

10

 Ltr, Lt Col Perrin H. Long, Med Consultant,

to Surg, NATOUSA, 26 Aug 43, sub: Random Observations From EBS and Sicily, July 6th to August

14th 1943.
SICILY AND THE MEDITERRANEAN ISLANDS 161

MAP 17—Seventh Army Hospitals, 15 August 1943

platoons of the nth Field Hospital displaced one another forward to Cesarò

and Randazzo. (Map 77) The 54th Medical Battalion and one company of the

51st operated along the same line of advance, clearing platoons being used during the battle of Troina to augment the

facilities of the evacuation hospitals.

For the most part aid stations in the

Troina sector were within 400 to 800

yards of the fighting and accessible to

vehicles, though roads were often under

enemy fire. Only the 60th Regimental

Combat Team, circling the left flank

over roadless mountains, experienced

unusual difficulty in evacuation. Corps

medical battalions supplied eighty additional litter bearers, while thirty more

came from noncombat divisional units.

Litter squads were stationed at intervals

of 300 to 400 yards to relay casualties

back to the stations. Mules requisitioned

from local farmers were also used to

carry litters, both in tandem between

lance poles, as had been done in Tunisia,

and by a device similar to the French cacolet whereby one mule carried two litters. Neither method was fully satisfactory but the cacolet was considerably less

so than the tandem. The care and management of the animals fell to the 9th

Division veterinarian and his assistants.

The 47th RCT, operating east of Troina,

had hand carries up to four miles,

mainly because road demolitions prevented the use of vehicles.

Along the narrow and precipitous

north coast road, the 3d Division was

fighting what Ernie Pyle called a "bulldozer campaign," the pace of the ad-
162 MEDITERRANEAN AND MINOR THEATERS

vance being limited by the speed with

which the engineers could repair the

damage done by German demolitions.

In this final drive the division was materially aided by a provisional mounted

troop and a provisional mule pack train.

In the two weeks between 3 and 16 August, 219 horses and 487 mules were

used, of which 43 percent were listed as

battle casualties. The animals were acquired by capture, requisition, and confiscation. Despite inexperienced handlers and improvised equipment, the

expedient was credited by General

Truscott, himself a former cavalry officer, with speeding the advance and reducing losses. The division veterinarian,

Maj. Samuel L. Saylor, was responsible

for care and provisioning of the animals,

and helped train personnel to manage

them.11

The 3d Division received medical

support from the 10th Field Hospital,

whose platoons leapfrogged one another

from Cefalii to Barcellona, and from one

platoon of the nth Field. The 93d Evacuation Hospital moved to San Stefano

on 7 August, and a week later the 11th

Evacuation shifted from Nicosia to a position between San Fratello and Brolo.

On the latter date, 14 August, the 128th

Evacuation displaced half of its facilities

and staff from Cefalii to Coronia some

8 miles east of San Stefano. (See Map

1 7 )

The most difficult evacuation problem

encountered by the 3d Division was during the battle for San Fratello Ridge,

where litter carries took from 5 to 7

hours. One patient was carried for 9

hours by 50 bearers in relays. Corps supplied 40 additional litter bearers, and

Italian and Czechoslovak prisoners were

also used. Some slightly wounded men

were evacuated sitting on pack mules.

The long litter carries were stopped

when Colonel Churchill, the theater

surgical consultant, concluded that the

wounded suffered more from the journey

than they would have by waiting. The

last 52 casualties brought down from the

ridge were left for 24 to 48 hours in the

aid stations, while bulldozers cleared a

road for the ambulances.12

The two amphibious landings in the

3d Division sector, both made by the 2d

Battalion of the 30th Infantry, were supported by personnel of the battalion medical detachment, reinforced by medical

and surgical technicians from the 54th

Medical Battalion. In the Brolo operation of 11 August, where the landing

force was ambushed by the Germans,

a medical corpsman was killed and five

wounded in action. The American

wounded were treated by German doctors and left behind to be picked up by

their own organizations when the enemy

withdrew the next day.

Hospitalization and Evacuation

Hospitalization in the

Combat Zone

Hospitalization in the Sicily campaign

showed marked improvement over prac11

 (1) Truscott, Command Missions, p. 230; (2)

Vet Rpts, Sick and Wounded, Animals, 1943, 3d

Div.

12

 Ltr, Col Churchill, Surgical Consultant, to

Surg, NATOUSA, 19 Aug 43, sub: Tour Rpt,

Sicily, D+2 4 to D+35.
SICILY AND THE MEDITERRANEAN ISLANDS 16.8

ADMINISTERING PLASMA TO WOUNDED MAN at 7th Infantry aid station, Sant'Agata.

tices in Tunisia, even though preinvasion

plans were not always carried out to the

letter. With occasional exceptions resulting from rapid movement of the troops,

each division clearing station under combat conditions had at least one field hospital unit adjacent to it and a 400-bed

evacuation hospital within easy ambulance haul. Cases that could not stand

the strain of further transportation went

to the field hospitals, where surgery was

performed as required by attached surgical teams. A majority of all those seriously wounded in Sicily received definitive treatment in these units. As soon as

a patient needing further care could be

safely moved, he was sent back to the

nearest evacuation hospital. Patients still

immobilized when a field hospital unit

was ordered forward were left in charge

of a small detachment that rejoined the

parent unit as soon as all of its patients

had been evacuated. Transportable cases

at the division clearing stations, including most cases of disease, were sent

directly to the evacuation hospitals,

where they were held for treatment or

evacuated to the North African com-
164 MEDITERRANEAN AND MINOR THEATERS

EVACUATION BY MULEBACK

munications zone, as circumstances dic- tated.18

The intermediate step visualized by

the planners whereby one 750-bed evacuation hospital was to back up each two

400-bed units never materialized. Although 750-bed evacuation hospitals

were to come on call and were repeat- edly requested by Colonel Franklin,

shipping space was at such a premium

that only one reached Sicily before the

end of the campaign. This was the 59th,

which landed at Palermo on 6 August

with much of its equipment still at sea.

The hospital joined the 91st in buildings of the University of Palermo Polyclinic Hospital and was in operation by

the 8th, but never functioned as planned.

Its activities for the remaining ten days

of the campaign were primarily those of

a station hospital and holding unit for

evacuation to Africa.

The complete absence of fixed hospitals, and the presence of only one evacuation hospital large enough to hold

slightly wounded men and disease cases

for return to duty, was made up in part

by evacuating many short-term patients

to Africa, and in part by enlarging the

400-bed units. During periods of heavy

fighting, clearing platoons of the corps

medical battalions were attached to the

evacuation hospitals. Each clearing platoon so used was able to set up and

operate five or six wards with its own

equipment and staff, augmenting the

capacity of the hospital by 100 to 200

beds. During the battle for Troina the

15th Evacuation Hospital expanded by

this means to a total capacity of 950 beds.

In areas where the fighting had ceased

and conditions were relatively stable,

corps and army medical battalions operated holding hospitals for evacuation.

One such unit, operated at Gela

throughout the campaign by the 261st

Amphibious Medical Battalion, also

served as a station hospital for service and

other troops in the area. A holding hospital set up by the 56th Medical Battalion

functioned first at Licata, then at Agrigento, and finally at Termini on the north

coast, where the entire unit was carried

by air on 4 August. Loading required only twenty-one minutes, and the flight itself half an hour. The hospital was set up

13

Ibid. See also, Memo, Churchill to Surg,

NATOUSA, 5 Sep 43, sub: Use of Field Hosps in

Forward Surgery. General sources for hospitalization in the Sicilian campaign are: (1) Annual Rpt,

Med Sec, NATOUSA, 1943; (2) Rpt of Opns, U.S.

Seventh Army in Sicilian Campaign, an. N; (3)

Clift, Field Opns, pp. 193-95; (4) Surg II Corps,

Rpt of Med Activities, Sicilian Campaign; (5)

Unit rpts of individual evacuation and field hosps

and med bns mentioned in the text.
SICILY AND THE MEDITERRANEAN ISLANDS 165

to receive fifty patients in less than four

hours from the time loading began.14

The 51st Medical Battalion operated

holding hospitals at Castelvetrano and

Palermo. At the latter site, the hospital

was expanded to 400-bed capacity and

was used also for malaria and jaundice

convalescents. In another instance a division clearing company acted as a station hospital. This was a unit organic to

the 82d Airborne Division, which took

over an Italian military hospital in Trapani while the division performed occupation duties in western Sicily. The

same company also set up a clearing station in Castelvetrano after other medical

units had been withdrawn from that

city.

The original 7-day evacuation policy

was extended to ten days and eventually—for malaria cases—to two weeks before the campaign ended. During most

of the period, however, no fixed policy

was possible. Hospital facilities were so

overcrowded that patients had to be

evacuated as soon as they could be

moved in order to make room for new

ones. A 24-hour evacuation policy in

front-line hospitals was not uncommon.

Even those expected to return to duty

within a week had to be removed to the

rear in many instances, either to the

59th Evacuation at Palermo or out of

Sicily altogether. As a result, a considerable number of patients were sent to

North Africa who could have returned

to duty if it had been possible to hold

them on the island. Malaria cases, which

outnumbered battle wounds despite

atabrine therapy, and Sandfly fever cases

were often returned to their units for

convalescence, simply to retain physical

control of the men.

Some indication of the strain placed

upon medical facilities in Sicily may be

gathered from the statistics. With a maximum troop strength of approximately

200,000, and an average strength of

approximately 166,000, U.S. hospital

beds in Sicily probably never exceeded

5,000 during the period of fighting, even

with generous allowance for those operated by clearing platoons. Between 10

July and 20 August 1943, a total of

20,734 American soldiers, 338 Allied,

and 1,583 enemy troops were admitted

to U.S. Army hospitals, with another

20,828 Americans admitted to quarters.

Of the U.S. troops hospitalized, 13,320

were diseased, 5,106 had suffered battle

wounds, and 2,308 cases were injuries.

The quarters admissions included

14,635 cases of disease and 6,193 minor

wounds and injuries. A further drain on

hospital facilities came from the necessity of caring for a number of civilians

who had no other means of treatment.

Military patients discharged from U.S.

hospitals in Sicily, including American

and Allied troops returned to duty and

prisoners transferred to the stockades,

totaled 7,168.

All prisoners of war, except Italian

medical personnel and chaplains and

Italian soldiers of Sicilian birth who

were paroled to their homes, were evacuated to North Africa as rapidly as

possible. The medical officers and enlisted men retained in Sicily were used

to care for sick and wounded prisoners

in captured facilities and in Italian Red

Cross hospitals, five of which were taken

over by II Corps.

Two mobile Italian army hospitals

were captured, in addition to a number

14

 Ltr, Col Churchill to Surg, NATOUSA, 19 Aug

43, sub: Tour Rpt, Sicily, D+84 to D+35.
166 MEDITERRANEAN AND MINOR THEATERS

HOLDING HOSPITAL OPERATED BY THE 56TH MEDICAL BATTALION adjacent to the

Termini airfield.

of civilian hospitals and other medical

installations. The 304th Field Hospital,

captured on 30 July at Mistretta, had

400 beds, 60 of them occupied, and a

staff of 8 officers and 46 enlisted men.

Located in buildings, the hospital continued in operation under U.S. supervision. A larger Italian hospital, the

10th Reserve, was taken near Barcellona

on 15 August with 47 officers, 143 enlisted

men, and 522 patients. This unit was in

the area assigned for occupation by the

British, and reverted almost immediately to British control. In addition to

personnel of captured hospitals, large

numbers of enemy medical personnel

were captured with the field troops. Approximately 100 enemy medical enlisted

men and a similar number of prisoners—

all Italian—from among line troops,

were used to augment the staffs of II

Corps hospitals, while others were attached to the two evacuation hospitals

in Palermo.

Evacuation

Evacuation within Sicily was controlled by the Seventh Army surgeon,

who also arranged with the proper authorities for evacuation from the island.

Hospital ships and carriers were under

control of Allied Force Headquarters,

and air evacuation was the responsibility
SICILY AND THE MEDITERRANEAN ISLANDS 167

of the Surgeon, North African Air Force

Troop Carrier Command.15

Lines of evacuation shifted with the

progress of the campaign. Until late

July the bulk of those destined for the

communications zone were carried by

ambulance and truck to evacuation hospitals on the south coast. The 93d Evacuation served II Corps at Gela until 21

July, while the 11th Evacuation, at Licata until 20 July and at Agrigento

between 22 July and 4 August, served

the Provisional Corps. After 21 July, II

Corps casualties also cleared through the

11th, by way of a rough 4-hour ambulance run from the 15th Evacuation at

Caltanissetta. Soon after the capture of

Palermo, that city became the focal

point for evacuation to Africa, and II

Corps casualties were moved north from

Nicosia to enter a coastal chain of evacuation. A captured Italian hospital train,

staffed by U.S. medical personnel, began

running from Cefalii to Palermo on 1

August, the 128th Evacuation Hospital

at Cefalii serving as holding unit. The

system worked smoothly, despite a continuous shortage of ambulances and

often badly damaged roads.

Evacuation from Sicily to North Africa was fairly evenly divided between

sea and air. For the first four days of the

campaign all evacuation was by returning troop carriers and LST's. Although

plans called for the delivery of all these

early casualties to Tunisian ports, many

were carried to Algiers where base section facilities were inadequate to care

for them.16 Air evacuation began from

fields around Gela and Licata on 14 July,

but was unorganized, with both U.S. and

British planes participating as they happened to be available. Approximately

100 casualties were flown out in this way,

without medical attendants, before the

802d Medical Air Evacuation Transport

Squadron took over on 16 July. Evacuation by hospital ship began from Gela on

15 July, from Scoglitti the following day,

and from Licata on the 17th. Air evacuation began from Agrigento on 23 July,

and one load was flown from Castelvetrano on the 24th. As the campaign

shifted to the northeast, Palermo and

Termini became the principal evacuation centers. Air evacuation began from

Palermo on 27 July, and sea evacuation

two days later, when the port was

cleared. Air evacuation from Termini

began 5 August. One planeload of patients was flown to Africa direct from

San Stefano.

Between 10 July and 20 August a

total of 5,391 patients were evacuated

by sea and 5,967 by air—11,358 all told.17

Sea evacuation was by two American

and three British hospital ships, with

15

 The main sources for this section are: (1) Rpt

of Opns, U.S. Seventh Army in Sicilian Campaign,

an. N; (2) Surg, II Corps, Rpt of Med Activities,

Sicilian Campaign; (3) Annual Rpt, 54th Med Bn,

1943; (4) Annual Rpt, Med Sec, NATOUSA, 1943;

(5) Annual Rpt, 91st Evac Hosp, 1943; (6) ETMD,

NATOUSA, Jul 43; (7) Clift, Field Opns, pp. 195-

97; (8) Col Criswell G. Blakeney, ed., Logistical

History of NATOUSA-MTOUSA (Naples: G. Montanino, 1945), passim.

16

 Surg, NATOUSA, Journal, 16 July 1943. See

also p. 196, below. 17

 The figures are from the 1943 annual reports

of the Surgeon, Seventh Army, and the Surgeon,

NATOUSA. Medical History, 802d MAETS, gives

6,170 for air evacuation, a figure that presumably

includes Air Forces personnel and possibly some

Allied personnel and civilians, none of whom are

included by the Seventh Army surgeon. Colonel

Elvins, Air Surgeon, Twelfth Air Force, in Report

of Air Evacuation, 12 September 1943, gives 5,819

through 21 August. In relation to the total, these

variations seem too minor to justify rejecting the

official Army figure.
168 MEDITERRANEAN AND MINOR THEATERS

capacities ranging from 370 to 800 patients; and five British hospital carriers,

each capable of moving between 350 and

400 patients. The larger ships were used

to evacuate only from Palermo, where

the harbor was deep enough to accommodate them. Even in Palermo, however, the condition of the docks did not

permit direct loading. The U.S. vessels,

Acadia and Seminole, carried no water

ambulances. Litters were individually

winched aboard from smaller craft in

rhythm with the waves. By early August a regular schedule was in effect, a

ship arriving in Palermo harbor at dawn

every other day. For the most part American patients were routed to Bizerte,

but at least one load was diverted to

Oran and one load of 125 patients went

to Tunis. The British hospital carriers,

because of their shallow draft, were preferred for evacuation from beaches and

small harbors. Each carried six water

ambulances, which could be lifted to the

deck for unloading.18

Air evacuation from Sicily followed

the pattern developed in Tunisia, but

was more highly organized. Medical authorities were notified in advance approximately when each new airfield

would be usable, so that a holding hospital could be set up. Personnel of the

802d MAETS stationed at the fields

passed on information as to available

planes and arrival times, supervised

loading, and provided attendants including nurses for each flight. These attendants were flown back to Sicily by Troop

Carrier Command, but litters, blankets,

and splints for property exchange came

by ship. Most of the patients flown to

Africa were landed at Mateur, but a few

were routed to fields around Tunis.

Where an evacuation hospital was close

to the airfield, as at Palermo, the more

serious cases were moved direct from

hospital to plane, with only the walking

and less urgent cases passing through

the holding unit.

Medical Supplies and Equipment

While shortages of particular items occurred and there were occasional delays,

medical supplies presented no serious

problems in the Sicily Campaign. Approximately no dead-weight tons of

medical supplies were landed on the

beaches between D-day and D plus 2.

These initial supply loads consisted of

combat medical maintenance units,

heavily augmented by items that experience in North Africa had shown to be

required. Supplies not carried ashore by

personnel of the medical units to which

they belonged were unloaded wherever

room to put them could be found. They

were picked up by the beach group,

which issued them as needed until medical supply depot personnel came

ashore.19

In the landing phase a lack of co-ordi18

 (1) ETMD, NATO, for Jul 43, 11 Aug 43. (2)

Edith A. Aynes, "The Hospital Ship Acadia," American Journal of Nursing, XLIV, (February 1944),

98-100. The carrier had a draft of only fourteen

feet compared with twenty-five feet for the hospital ship. Although Oran was included as a port

of debarkation for patients in the original planning,

it was quickly abandoned in favor of the shorter

route to Bizerte. See: (3) Ltr, Col William C.

Munly (Ret) to Col Coates, 7 Nov 58, commenting

on preliminary draft of this volume; (4) Ltr, Col

Bauchspies to Col Coates, 15 Apr 59.

19

 Principal sources for this section are: (1) Rpt

of Opns, U.S. Seventh Army in Sicilian Campaign,

an. N; (2) Surg, II Corps, Rpt of Med Activities,

Sicilian Campaign; (3) Rpt of Med Supply Activities, NATOUSA, Nov 42-Nov 43; app. K; (4)

Davidson, Med Supply in MTOUSA, pp. 30-41; (5)

Clift, Field Opns pp. 197-98.
SICILY AND THE MEDITERRANEAN ISLANDS 169

nation was evident. Some of the LST's

did not carry litters, blankets and splints

as called for in the medical plans for

the operation, while other landing craft

returned to their African bases without

leaving their supplies of these items on

the beaches. In the Scoglitti area medical supplies dumped on the beaches

were so widely scattered that collecting

them was a slow and difficult process.

About 10 percent of the initial medical

supply load was lost due to enemy action,

while supplies on the follow-up convoys

were poorly packed. Many boxes were

only half filled and padded with straw;

there was undue breakage of bottles; and

some 20 percent of the packing lists did

not agree with the contents of the boxes

they accompanied.

Supplies, nevertheless, proved generally adequate, even in the early stages

of the campaign, thanks to careful planning and advance requisitioning. Medical supplies and equipment estimated to

be adequate for current maintenance

plus a go-day reserve were ordered

months in advance of the assault and

were delivered in batches by the successive follow-up convoys. Immediate shortages of such items as tincture of opium,

hydrogen peroxide, litters, and cots were

quickly overcome by emergency requisitions on base depots in North Africa,

deliveries being made by air if the need

was urgent. The only articles that could

not be immediately procured were items

of replacement equipment and certain

equipment items over and above those

normally allowed, which had been authorized but could not be procured before leaving Africa.

Two supply depot units distributed

medical supplies in Sicily. An advance

detachment of the 4th Medical Supply

Depot went ashore at Licata with the

Joss Force on D plus 2; the 1st Advance

Section of the 2d Medical Supply Depot

landed at Gela with the CENT Force the

following day.

The detachment of the 4th Medical

Supply Depot established a distribution

point at Licata, then on 27 July set up

a base depot for the island at Palermo.

On 30 July an advance dump to serve the

3d Division fighting along the northern

coast road was set up in Cefalii, the

Licata dump being closed on 1 August.

The Cefalù dump remained in operation

until 25 August, a week after the end of

hostilities.

The 1st Advance Section of the 2d

Medical Supply Depot established its

first distribution point at Gela, stocked

with supplies collected from the beach

group and from the beaches themselves,

where boxes had been dumped as they

were taken from the ships. Trucks used

were borrowed from the 1st Medical Battalion, since the supply depot's own vehicles were not yet unloaded. A forward

issue point was set up at Caltanissetta on

21 July in a captured Italian medical depot. A small dump was also operated by

this unit at Agrigento between 22 July

and 31 July. Personnel from Agrigento

established an advance depot at Nicosia

on 2 August, where they were joined on

12 August by personnel of the Gela

depot, which was closed at that time.

Personnel of the Caltanissetta depot also

moved to Nicosia early in August, leaving one officer and three enlisted men to

operate the Italian depot until it could

be transferred to the Allied Military

Government organization. The Nicosia

depot remained in operation until 27

August.

The Licata depot was reopened on 24
170 MEDITERRANEAN AND MINOR THEATERS

August by personnel of the 1st Advance

Section, 2d Medical Supply Depot, and

operated until 21 October, serving evacuation hospitals and troops bivouacked

in the area. All personnel of the 2d Medical Supply Depot in Sicily then moved

to Palermo, relieving the advance detachment of the 4th for service in Italy.

In the course of the campaign, 365

tons of medical supplies and 60 tons of

field hospital equipment were captured.

This material was used to resupply civilian, Red Cross, and captured military

hospitals.

Professional Services

Combat Medicine and Surgery

While the problems encountered by

the Medical Department in Sicily were

in some respects merely an extension of

those already familiar in Tunisia, in

other respects they were unique. Lack of

sanitation, scarcity of potable water, a

vermin-infested and undernourished

population, and inhospitable terrain

were an old story to American medical

personnel by the summer of 1943, but

the problems of a large-scale amphibious

operation and the hazards of the malaria

season were new. Sicily was at once a

proving ground for the lessons learned

in Africa and a dress rehearsal for Italy.

Front-Line Surgery—In the Sicily Campaign organization and facilities for

front-line surgery were greatly improved

over those of the Tunisia Campaign.

The most important single development

was the use of field hospital platoons,

with attached surgical teams, for treatment of nontransportable casualties in

the division area. Despite careful analysis of Tunisian experience and a full

explanation of the preferred procedure

in a circular letter from the theater surgeon a month before the invasion, however, various difficulties were still encountered. Field hospital commanders

were reluctant to undertake dispersed

operation by platoons, and were generally unfamiliar with the technique of

functioning in that manner. There was

also some resistance to accepting the attachment of surgical teams, as implying

some degree of reflection on the competence of the regular hospital staff.20

As a result, the auxiliary teams were

not used as effectively as they might have

been. Many teams continued to work in

clearing stations, where they were handicapped as they had been in Tunisia by

lack of equipment and absence of facilities for postoperative care. Still other

teams were required to work in the 400-

bed evacuation hospitals, because these

units were not adequately staffed in the

subspecialties. This diversion of surgical

teams was a direct consequence of the

failure to get 750-bed evacuation hospitals to the island in time to carry a

share of the combat load. Another problem arose from the fact that many of the

surgical teams employed, as well as the

field hospitals themselves, had little or no

previous combat experience, and sur20

 Sources for this section are: (1) Annual Rpt,

Med Sec, NATOUSA, 1943; (2) Surg, NATOUSA,

Cir Ltr No. 18, 14 Jun 43, sub: Forward Surgery

and Aux Surg Teams; (3) Surg, II Corps, Cir Ltr

No. 3, 7 Aug 43, sub: Care of the Wounded in

Sicily; (4) Memo, Churchill to Surg, NATOUSA,

5 Sep 43, sub: Use of Field Hosps in Forward

Surgery; (5) Ltr, Col Long to Surg, NATOUSA,

26 Aug 43, sub: Random Observations from EBS

and Sicily, July 6th to August 14th 1943; (6) Annual Rpt, 2d Aux Surg Gp, 1943; (7) Clifford L.

Graves, Front Line Surgeons (San Diego [privately

printed] 1950), pp. 86-87.
SICILY AND THE MEDITERRANEAN ISLANDS 171

FORWARD SURGICAL UNIT, 2d Platoon, 11th Field Hospital, near Nicosia.

geons were unfamiliar with general policies as to the management of wounds.

In addition to the employment of field

hospital platoons as forward surgical

units, extensive use was made of surgical

consultants during the campaign. II

Corps had the services of its own surgical

consultant, Major Snyder, detached from

the 77th Evacuation Hospital, while

Colonel Churchill, the theater consultant

in surgery, served unofficially in a similar

capacity with Seventh Army. Colonel

Churchill spent more than half of his

time in Sicily during the period of active

hostilities.

Neuropsychiatric Reactions—The basic

principle worked out in Tunisia of treating psychiatric reactions in the combat

zone was the policy laid down for Sicily.21

In the early stages of the campaign, however, owing to the normal confusion consequent upon rapid movement, many

cases did not go through the evacuation

hospitals for triage22 but were evacuated

to North Africa from the clearing stations with no treatment except sedation.

Of those that did reach the evacuation hospitals, many had been three or

four days in getting there, a delay that

served only to fix the symptoms and

make treatment more difficult. As a re- 21

 Surg, NATOUSA, Cir Ltr No. 17, 12 Jun 43, sub:

Neuropsychiatric Treatment in the Combat Zone. 22

 Triage is the process of sorting casualties by

type of wound or disease and by urgency. See pp.

3-4, above.
172 MEDITERRANEAN AND MINOR THEATERS

sult, only 15 percent were returned to

duty.23

Later in the campaign, after the evacuation system had become more stabilized, half of all psychiatric cases were

returned to full combat duty. For the

campaign as a whole, 39 percent went

back to the lines. Sicilian experience thus

reinforced the conclusions of North

Africa that treatment of psychiatric reactions must begin at once and that patients must be retained in the combat

zone if they were to have a reasonable

chance of returning to duty.

The most publicized psychiatric case

in Sicily was that of a soldier slapped by

General Patton in the receiving tent of

the 93d Evacuation Hospital at San

Stefano on 10 August. There had been a

similar incident in which Patton had

cursed and struck with his gloves a patient with a clearing station diagnosis of

"psychoneurosis anxiety state." Patton's

motivation in these cases was the sincere,

if mistaken, belief that if he could make

the men angry enough with him they

would redeem themselves.24 The incidents were investigated by Brig. Gen.

Frederick A. Blesse, Surgeon, North

African Theater of Operations, U.S.

Army (NATOUSA), and Patton apologized to all concerned. Without in any

way attempting to extenuate his actions,

it should be noted that Patton himself

was probably suffering from the accumulated tensions of the preceding weeks of

intensive combat. He was on his way back

from the front, where every available

man was needed, when he stopped at the

93d Evacuation Hospital on 10 August,

and was told by an apparently ablebodied man that he was not wounded

but only scared.25

Diseases of Special Interest—In Sicily

the American soldier encountered varieties of subtropical diseases for which not

even his experience in North Africa had

prepared him. The island harbored flies,

fleas, lice, bedbugs, and mosquitoes. Local water and food supplies were likely

to be contaminated. Even elementary

sanitation seemed unknown to the local

population. Dysentery, Sandfly fever,

and most of all, malaria, were constant

threats.26

Preventive measures included immunization of all personnel destined for

Sicily against smallpox, typhoid, paratyphoid, typhus, and tetanus. Atabrine

was distributed with rations four times

weekly beginning on 22 April, with quinine substituted for flying personnel and

for those sensitive to atabrine. There was

23

 Annual Rpt, Med Sec, NATOUSA, 1943. 24

 (1) Memo, Patton to Corps, Div, and Separate

Brigade Commanders, 5 Aug 43. (2) Ltr, Col

Franklin to Col Coates, 10 Nov 58, commenting on

preliminary draft of this volume.

25

 The incidents have been fully documented. Firsthand accounts are in two memorandums from Col.

Donald E. Currier, commanding officer of the 93d

Evacuation Hospital, one dated 12 August 1943 and

addressed to the Surgeon, II Corps; the other dated

7 September 1943 and addressed to the Inspector

General, NATOUSA. The official position is stated

in letter, Henry L. Stimson, Secretary of War, to

Senator Robert R. Reynolds, 3 December 1943; and

in General Eisenhower's report to the Senate Committee on Military Affairs, dated 26 November 1943.

For more personal accounts, see (1) Eisenhower,

Crusade in Europe, pp. 179-83; (2) Bradley, A

Soldier's Story, pp. 160-61; Capt. Harry C. Butcher,

USNR, My Three Years with Eisenhower (New

York: Simon and Schuster, 1946), pp. 390-91, 393,

396, 450; (3) Garland and Smyth, Sicily and the

Surrender of Italy, pp. 425-31. 26

 General sources for this section are: (1) Rpt of

Opns, U.S. Seventh Army in Sicilian Campaign,

an. N; (2) Annual Rpt, Surg, Seventh Army, 1943;

(3) Surg, II Corps, Rpt of Med Activities, Sicilian

Campaign; (4) Annual Rpt, Med Sec, NATOUSA,

1943.
SICILY AND THE MEDITERRANEAN ISLANDS 173

intensive indoctrination on sanitary

measures before embarkation, with stress

on food and water supplies and waste disposal.

On the whole, these preventive measures were effective, except for malaria.

There discipline broke down in what

was essentially a command problem, and

the disease became one of the major

hazards of the campaign.

The reasons were various. Of the two

malaria control units and one survey

unit earmarked for Seventh Army, only

one arrived before the end of hostilities.

This was the 20th Malaria Control Unit,

which landed on D plus 4, but could do

little of an effective nature while the

army was moving at a rate of ten to

thirty-five miles a day. There were undoubtedly times when adequate supplies

of atabrine did not reach all troop units,

but the greater failure was on the part

of the men themselves, who found ways

to avoid taking the atabrine when issued,

and on the part of the command that

permitted the laxity. To most Americans, malaria was not a reality. The

Tunisia Campaign had ended before the

season started, and experience with the

disease was strictly limited. Some cases

were also breakthroughs of therapy, since

the proper dosage was not well understood. It was stepped up from four to

seven times a week on 12 August, with

supervision to ensure that the drug was

taken, but by that time the damage was

already done.

The Seventh Army surgeon reported

4,480 cases of malaria and 6,172 cases of

"fever undetermined origin" for the 7-

week period 10 July-20 August, as compared with 5,106 combat wounds. The

larger portion of the FUO cases were believed to be Sandfly fever, more correctly

known as pappataci fever, and the bulk

of the remainder was probably malaria.

American doctors were generally unfamiliar with both diseases in their civilian

experience, and many faulty diagnoses

were inevitable under combat conditions

such as those found in Sicily. Revised

figures based on later study of the records

placed the Seventh Army malaria cases at

9,892 for the period 9 July—10 September, compared with 8,375 battle casualties. Eighth Army, occupying the highly

malarious Catanian plain, had 11,590 malaria cases in the same period.27

Dental Service

Dental service in the Sicily Campaign

also showed considerable improvement

over that in Tunisia. Both 10th and nth

Field Hospitals were equipped to do

prosthetic dental work, supplementing

the facilities of corps and division medical battalions. A team consisting of one

prosthetic operator and two assistants,

with its own equipment and tentage, was

set up by II Corps to visit all corps troop

units where the number of cases was

sufficient to justify the procedure. Rest

periods for combat troops were short,

however, and so prosthetic work while

hostilities were actually in progress was

mainly confined to repairs.28

At the end of the campaign, two dental officers from the 11th Field Hospital

27

 (1) Rpt of Opns, U.S. Seventh Army in Sicilian

Campaign, an. N. (2) Ltr, AG-AFHQ, to CinC,

15th Army Gp, and others, 6 Nov 43, sub: Malaria

in the Sicilian Campaign, 9 Jul-10 Sep 43. The

battle casualty figure in the AG letter includes

slightly wounded cases treated in quarters as well

as the 5,106 hospital cases noted in the Surgeon's

report. See also, Lt Col William A. Reilly, Sandfly

Fever in the 59th Evacuation Hospital. 28

 (1) Surg, II Corps, Rpt of Med Activities in

Sicilian Campaign.
174 MEDITERRANEAN AND MINOR THEATERS

were placed on detached service with the

9th Division to catch up on general operative work, particularly in the division

artillery, which was too large to be adequately cared for by the single dental

officer assigned. The 1st Division at this

time set up its own prosthetic clinic and

laboratory in conjunction with the division clearing station. In September personnel and facilities for carrying on

prosthetic work were installed in the 91st

Evacuation Hospital at Palermo.29

As had been the case in Tunisia, dental officers and enlisted men performed

numerous nonprofessional functions during combat operations, when conditions

made it impossible to carry on dental

work.

Veterinary Service

Two veterinary food inspection detachments accompanied Seventh Army to

Sicily, performing routine inspections of

rations and of captured food supplies.

One detachment operated a cold storage

and refrigeration plant in Palermo during the latter part of the campaign. Care

of animals was a function of the veterinary service at the division level, primarily in the 3d Division, which boasted

both a provisional cavalry troop and a

provisional pack train, and in the 9th

Division where mules were used to carry

supplies and to evacuate wounded. No

hospital facilities for animals were available.30

Medical Support in the Seizure of

Sardinia and Corsica

The island of Sardinia had been deliberately bypassed in planning Mediterranean operations, and the threat it had

once held against Allied supply lines had

been largely neutralized by the conquest

of Sicily. The invasion of Italy by the

British Eighth Army on 2 September,

and the Salerno landings a week later,

once more changed the picture. Once

substantial forces were committed to a

campaign in Italy, the strategic positions

of both Sardinia and Corsica could not

be overlooked.

The fact that no American or British

ground forces were available proved no

barrier to conquest. With the Italian

Fleet no longer at their disposal, the

German garrison on Sardinia was virtually isolated. The two Italian divisions

on the island needed only a minimum of

naval support to rout their former Axis

partners, and within ten days of the

Salerno landings the Germans had fled to

Corsica. In a parallel movement directed

from Algiers, the French underground

on Corsica seized the island capital of

Ajaccio three hours after word of the

Italian surrender—announced the night

of 8 September—was received. In Corsica

the Germans made a more determined

stand, but the 80,000 Italian troops

quickly surrendered while French reinforcements were brought in from Africa.

With the aid of Allied sea and air power,

the last German had been expelled by 5

October.31

29

 (1) Annual Rpt, Surg, 9th Div, 1943. (2) Annual Rpt, Surg, 1st Div, 1943. (3) MS, Dental History, MTO. 30

 (1) Med Hist, 3d Div, 1943. (2) Annual Rpt,

Surg, 9th Div, 1943. (3) MS, Veterinary History,

MTO.

31

 (1) Lt. (jg) S. Peter Karlow, USNR, Notes on

Corsica, OSS Rpt, 15 Nov 43, Navy: S. E. Morison

file. (2) Lt. Harold Wright, USMCR, "The Trojan

Sea Horse," Sea Power (April 1946).
SICILY AND THE MEDITERRANEAN ISLANDS 175

PROVISIONAL PACK TRAIN OF 3D DIVISION VETERINARIAN IN SICILY

No Army medical units took part in

the seizure of Sardinia or Corsica, both

operations being confined, so far as U.S.

troops were concerned, to Air Forces personnel. The first hospitals to move into

these islands were therefore assigned to

the Army Air Forces. The hospitals initially selected were the 60th Station, a

250-bed unit that had been operating at

Tunis since July, and the 15th Field, recalled from the Middle East.32

In the interest of speed, equipment of

the 60th Station Hospital was loaded on

trucks, which were driven onto LST's,

ferried to Cagliari on the southern end

of Sardinia, and before unloading were

moved directly to the modern Italian

hospital building that was to house the

60th. Nurses were flown to Cagliari in

combat planes, the rest of the personnel

going with the equipment by LST. The

hospital opened with 500 beds—double

its Table of Organization capacity—on 3

November 1943.

The 15th Field Hospital was somewhat

later in getting into operation. The 2d

Platoon opened 100 beds at Bastia, on

the east coast of the Corsican panhandle,

on 1 December; the 3d was established

near Alghero in northwestern Sardinia

32

 For details of the assignment of hospitals to

the Air Forces, see p. 182, below. The remainder

of this section is based on: (1) Med Hist,

Twelfth Air Force, 1942-44; (2) Annual Rpt, 60th

Sta Hosp, 1943; (3) Annual Rpt, 15th Field Hosp,

1943.
176 MEDITERRANEAN AND MINOR THEATERS

on the 13th of that month. The 1st Platoon, which lost most of its equipment

when the LST carrying it was beached

due to enemy action, was not ready to

receive patients at Ajaccio until 19 January 1944, after a base section had been

established on the island.33

33See p. 199, below.
CHAPTER V

The North African Communications Zone

Theater Organization

The Medical Section, AFHQ and

NATOUSA

Allied Force Headquarters moved

from Gibraltar, from which the landing

operations for TORCH had been directed,

to Algiers on 25 November 1942. Key

staff members were already in Africa, including the ranking U.S. medical officer,

Colonel Corby, but the bulk of the personnel of the various staff sections did

not come from England until December

and January. Personnel of the U.S. component of the medical section arrived

aboard a destroyer on 23 December, two

days after their ship had been torpedoed

and sunk off Oran.1

The section functioned no more

smoothly in Algiers than it had in London. Under the British concept, the

Director of Medical Services, Maj. Gen.

Ernest M. Cowell, was responsible for

the administration of all medical activities in the theater. American practice

made the surgeon at each echelon responsible to the commanding general of

his formation. This doctrinal divergence

was aggravated by personal friction between Cowell and Corby, his American

deputy.2

An additional complication was introduced in December when Colonel Kenner, the Western Task Force surgeon,

became a brigadier general. Cowell had

been promoted to major general in November, so that his seniority was not

jeopardized, but Corby's position became

increasingly difficult. General Kenner,

who now had too much rank for a task

force surgeon, was attached to AFHQ as

medical inspector, with authority so

broad that he functioned in fact as inspector general for the theater commander, General Eisenhower. In this

capacity, he exercised varying degrees of

control over both Corby and Cowell.

The staff of the American component

of the medical section, like other U.S.

elements in AFHQ, was inexperienced

in meeting the demands of a combat situation and was quickly bogged down in

a welter of operational detail not contemplated in the preinvasion planning.

The four officers and four enlisted men

assigned were unable to establish any effective control over Army medical service

in North Africa, or to carry out responsibility for hospitalization, evacuation, and

supply. Neither could they exercise any

decisive influence on Allied policy, since

they were consistently outnumbered and

outranked by their better informed Brit1

 Ltr, Gen Standlee to Col Coates, 15 Jan 59,

commenting on preliminary draft of this volume. 2

 (1) Hist of AFHQ, pp. 66, 538. (2) Ltr, Gen

Snyder to Inspector General, 8 Feb. 43, sub: Inspection of Med Serv Eastern Sector, Western Theater

of North Africa. Throughout this chapter the author is indebted to Armfield, Organization and

Administration, pp. 245-301.
178 MEDITERRANEAN AND MINOR THEATERS

ish counterparts. Personnel were attached

from subordinate units to make up the

minimum strength required, but there

was no way to compensate for the fact

that the British held higher ranks and

received intelligence information not

available to the U.S. component.3

These difficulties were resolved only

when a strictly American theater was

created to handle all purely American

affairs. For purposes of the invasion,

North Africa had been considered a part

of the European Theater of Operations,

whose boundaries had been extended

south to the Tropic of Cancer and east

into Libya. Once AFHQ was set up on

African soil, however, and supplies began to come directly from the United

States, the ETO connection ceased to

serve any useful purpose. It was severed

entirely early in February 1943 with the

establishment of the North African Theater of Operations, United States Army

(NATOUSA) .4

Under the new arrangement, Eisenhower became American theater commander as well as Allied Commander in

Chief, and the senior United States officer of each AFHQ staff section, including

the medical section, became chief of the

corresponding segment of NATOUSA.

This administrative reorganization paralleled the command changes on the

Tunisian front, whereby II Corps was

given its own combat mission and its

own battle sector.5 It also offered an

opportunity to resolve the internal diffiGENERAL COWELL

culties of the AFHQ medical section. On

4 February, the date of the activation of

NATOUSA, General Kenner replaced

Colonel Corby as Deputy Director of

Medical Services—Deputy Chief Surgeon,

AFHQ, in American terminology—becoming at the same time Surgeon,

NATOUSA, with Colonel Standlee,

Corby's executive officer, as his deputy.

General Kenner also retained his functions as medical inspector.

Except for broad policy matters, the

American medical service in the Mediterranean was exempt from British control after 4 February 1943. Thereafter

the U.S. component of the AFHQ medical section functioned primarily in its

NATOUSA capacity, having administrative and operational supervision over all

U.S. Army medical services in the theater.

For another three months the medical

3

 (14) Annual Rpt, Med Sec, NATOUSA, 1943.

(2) 1st Lt Kenneth W. Munden, MS, Administration of the Medical Department in the Mediterranean Theater of Operations, United States Army,

pp. 21-22. (3) Ltr, Gen Standlee to Col Coates,

cited above. 4

 Hist of AFHQ, pp. 183-84. 5

 See pp. 123-24, above.
THE NORTH AFRICAN COMMUNICATIONS ZONE 179

section continued to operate on a shoestring. The original four officers and four

enlisted men who made up the American

medical staff of AFHQ had been increased by one in each category by the

time NATOUSA came into existence,

but that was all. With the Tunisia Campaign in full swing and a steady stream

of casualties flowing back to the communications zone, the 10-man staff of the

medical section worked without regard

to hours.

It was late in March before a plan of

organization, prepared by Colonel Standlee, was presented, and a month later before it was approved. The plan called for

four operating subsections: administration; preventive medicine; operations

and planning, further divided into hospitalization, evacuation, and training;

and consultants. The personnel requirements were 23 officers and 30 enlisted

men.6

While the organization was being

worked out, General Kenner left the theater on 23 March for another assignment.

He was replaced on 16 April by General

Blesse, surgeon of Fifth Army, which

was then training in western Algeria.

General Blesse had been detailed to

NATOUSA headquarters during March.

Like Kenner, Blesse performed the function of Deputy Surgeon and Medical

Inspector, AFHQ, as well as those of

Surgeon, NATOUSA. His relations with

General Cowell were good, and close cooperation between the British and American staffs continued, even after the two

groups moved into separate offices in

June.7

As the theater expanded during 1943,

new subsections were added to the medical section, and personnel increased correspondingly. In addition to close liaison

with the major theater commands, the

other staff sections of the North African

theater headquarters, and the British, coordination with the medical service of

the French Army also became necessary

as French combat units began to participate in the Italian campaign. Representatives of the American, British, and

French medical services met in Oran in

November, and thereafter the consulting

surgeon of the French Army made frequent visits to the office of the Chief Surgeon, NATOUSA.

With the growth of the theater and the

increasing dispersion of medical units,

more formalized means of communication became necessary. A series of circular letters, initiated in March, provided

instructions on theater medical policy

and approved technical procedures for

the various medical installations. Beginning in July, theater medical experience

was detailed in monthly Essential Technical Medical Data reports, or ETMD's,

prepared for the Surgeon General but

serving to bring together a wide variety

of information of use within the theater.

A professional journal, the Medical Bulletin of the North African Theater of

Operations, began monthly publication

in January 1944.

The North African Base Sections

By the time NATOUSA was set up

early in February 1943, two U.S. base 6

 (1) Annual Rpt, NATOUSA, 1943. (2) Munden,

Administration of Med Dept in MTOUSA, pp. 30-

46. (3) Intervs, with Gen Kenner and Gen Standlee,

10 Jan 52. 7

 Memo, Brig Gen Fred W. Rankin to TSG, 2

Nov 43, Sub: Remarks on Recent Trip Accompanying Senatorial Party.
180 MEDITERRANEAN AND MINOR THEATERS

GENERAL BLESSE

sections were already operating in the

theater. The first in point of time, as

well as the longest lived, was the Mediterranean Base Section (MBS), with

headquarters in Oran. Made up originally of Services of Supply elements

attached to the Center Task Force,

MBS was activated on 8 December 1942.

Its medical section was headed by Lt.

Col. (later Col.) Howard J. Hutter, who

served until December 1943. Col. John

G. Strohm, commanding officer of the

46th General Hospital, acted as MBS

surgeon until March 1944, when he was

succeeded by Col. Harry A. Bishop. The

section boasted 20 officers, 1 nurse, and

31 enlisted men by the beginning of

1943, expanding thereafter as circumstances required. A subdivision of the

Mediterranean Base Section, known as

the Center District, was set up in Algiers

on 7 June 1943, its initial medical staff

consisting of Lt. Col. Joseph P. Franklin,

surgeon, and 3 enlisted men. Beginning

in March 1944 no surgeon was assigned

to the Center District other than the

MBS surgeon.8

The second North African base section to be established was the Atlantic

Base Section (ABS), activated at Casablanca 30 December 1942. Again the section was built around SOS elements that

had accompanied the task force. The ABS

medical section included ten officers and

four enlisted men. The surgeon was Col.

(later Maj. Gen.) Guy B. Denit, who was

recalled to the zone of interior in April en

route to the Pacific. He was succeeded by

his deputy, Lt. Col. (later Col.) Vinnie

H. Jeffress, who joined the group preparing a communications zone organization

for the coming invasion of Italy in August. At that time Col. Burgh S. Burnet

became ABS surgeon. Colonel Burnet

was replaced in January 1944 by Col.

Thomas R. Goethals, who combined the

duties of base surgeon—by that date

greatly diminished—with those of commanding officer of the 6th General Hospital.9

Both base sections were placed under

the jurisdiction of AFHQ on 30 December 1942, but in the absence of effective

supervision both developed more or less

independently until brought under the

NATOUSA organization in February.

The last of the base sections in North

Africa proper, the Eastern Base Section

(EBS), was established 13 February 1943

and activated a week later, at Constantine in northwestern Algeria, to meet

8

 (1) Annual Rpts, Med Sec, MBS, 1943, 1944. (2)

Annual Rpt, Med Sec, Center Dist, MBS, 1943. 9

 Annual Rpts, Med Sec, ABS, 1943, 1944.
THE NORTH AFRICAN COMMUNICATIONS ZONE 181

the need for an American base closer to

the Tunisian combat zone. The EBS surgeon was Lt. Col. (later Col.) William

L. Spaulding, whose original staff consisted of five officers and seven enlisted

men drawn from MBS and ABS. With

the extension of the war in the Mediterranean, the Eastern Base Section became

the largest and most important of the

three by virtue of its greater proximity

to Sicily and Italy, and a man of more

rank and experience than Spaulding then

possessed seemed needed. Col. Myron P.

Rudolph, the man General Blesse selected for the job, became EBS surgeon

in July 1943. Headquarters was moved

to Mateur immediately after the end of

the Tunisia Campaign, and to Bizerte in

August.10

As of 6 October 1943, the boundaries

of the various base sections were shifted

to conform to territorial borders, ABS

being made contiguous with French

Morocco, MBS with Algeria, and EBS

with Tunisia.

On 1 September 1943, two weeks after

the successful conclusion of the Sicily

Campaign, an Island Base Section (IBS)

was activated at Palermo. Like the base

sections in Africa, IBS was responsible to

NATOUSA. Its medical section was

headed by Lt. Col. (later Col.) Lewis W.

Kirkman, who had come direct from the

zone of interior. Boundaries were drawn

to include only those portions of Sicily

still being used by U.S. forces: the

Palermo-Termini area, the AgrigentoPorto Empedocle area, Licata, and

Caltanisetta.11

By the end of 1943, preliminary plans

for an invasion of southern France were

being drawn up at Seventh Army's new

headquarters in Algiers, and Corsica, by

accident of geography, assumed more importance in Allied strategy. A Northern

Base Section (NORBS), confined to that

island, was accordingly established on 1

January 1944. The NORBS surgeon was

Lt. Col. (later Col.) Albert H. Robinson, formerly deputy surgeon of ABS.12

The base section surgeons were responsible to the base section commanders, but their policies were determined

and their work supervised by the theater

surgeon, and their offices were generally

organized along a line closely paralleling

the organization of the NATOUSA

medical section. Only in their medical

supply activities, which were directly

under the Services of Supply, were they

exempt from control by the theater surgeon, and even here close co-ordination

existed.

Air Forces Medical Organization

The Army Air Forces in the Mediterranean had its own medical organization,

distinct from that of the theater but operating in harmony with it. Col. Elvins,

surgeon of the Twelfth Air Force, set up

his office at Tafaraoui airfield near Oran

two days after the Center Task Force

landings, moving to Algiers on 19 November 1942. Under Colonel Elvins, in

addition to his own headquarters, were

medical sections for the Bomber Command, the Fighter Command, the Air

Service Command, and the Troop Carrier Wing. Medical supply and veterinary (food inspection) functions were 10

 (1) Annual Rpt, Med Sec, EBS, 1943. (2) Surg,

NATOUSA, Journal, 12, 16, 17 Jul 43. 1 1Annual Rpt, Med Sec, NATOUSA, 1943. No

reports of the IBS itself have been located.

12

 (1) Annual Rpt, Med Sec, NATOUSA, 1944.

(2) Annual Rpt, Med Sec, NORBS, 1944.
182 MEDITERRANEAN AND MINOR THEATERS

under the Air Service Command, which

had subheadquarters, each with a small

medical section, at Casablanca, Oran,

and Constantine.13

A reorganization in December 1942

merged the Twelfth Air Force with British and French air units to form the

Northwest African Air Forces (NAAF) ,

but the medical organization remained

substantially unchanged. The Twelfth

Air Force again became a separate unit

just before the invasion of Italy in September 1943, though it continued to be

under the operational control of the

NAAF. After capture of the great Foggia

air base in southern Italy in early October, the Twelfth was reconstituted as a

tactical force and a new heavy-bomber

group, the Fifteenth United States Air

Force, was activated. Both forces were

subordinated to a new U.S. air command

at the theater level—the Army Air Forces,

Mediterranean Theater of Operations—

in January 1944. An Air Service

Command, Mediterranean Theater of

Operations, was established at the same

time, and both were brought under control of the Mediterranean Allied Air

Forces, which superseded the NAAF.

Headquarters of all major U.S. air units

except the North African Wing of the

Air Transport Command were in Italy

by this time.14

Experience in North Africa, where Air

Forces personnel were dependent on base

section installations for fixed hospitalization, demonstrated a need for attaching

a minimum number of fixed beds directly to the Air Forces as the Mediterranean

campaign expanded. Air bases were often

remote from hospitals located near concentrations of ground troops, yet Air

Forces personnel were no less subject to

disease and suffered casualties commensurate with an increasing tempo of activity. It was therefore agreed in October

1943 between General Blesse and Colonel Elvins that fixed hospitals should be

attached to Air Forces units operating in

southern Italy and from the newly occupied islands of Sardinia and Corsica.

Hospitalization in the

Communications Zone

While the North African campaign

was still in the planning stage, The Surgeon General had recommended a fixedbed ratio of 12 percent of troop

strength, on the basis of World War I

experience. British experts on military

medicine believed 6 percent would be

adequate in terms of their own combat

experience up to that date. Colonel Corby asked for fixed beds for 10 percent

of the command, with a minimum ratio

of 8 percent. The British basis was

adopted, with many misgivings, simply

because it was believed that shipping

space for more beds would not be available.15

Hospitalization During the Tunisia

Campaign

Fighting incidental to the landings in

North Africa was over and the build-up

13

 (1) Hist, Twelfth Air Force Med Sec, 1942-44.

(2) Link and Coleman, Medical Support of the

Army Air Forces in World War II, ch. VI. 14

 Air Forces medical organization subsequent to

January 1944 is treated in connection with the

Italian communications zone. See pp. 326-27, below.

15

 (1) Ltr, Col Corby to Gen Cowell, 1 Jan 43.

(2) Zelen, Hospitalization and Evacuation in

MTOUSA, pp. 10, 21. For more detailed discussion

of bed ratios, see Smith, Hospitalization and

Evacuation, Zone of Interior, pp. 215-18.
THE NORTH AFRICAN COMMUNICATIONS ZONE 183

for the campaign in Tunisia was well

under way before any fixed hospitals arrived in the theater. With the single exception of the 48th Surgical, attached to

the Center Task Force, even the mobile

units arrived too late to be used in the

assault phase and were therefore employed initially as fixed hospitals.16

Atlantic Base Section—Remote as it

was from the combat zone, the Atlantic

Base Section was the first to achieve relative stability in its hospital program.

For the most part hospitals were sited in

existing buildings and remained in place

for considerable periods of time. Casualties received were mainly cases evacuated

from other base sections for further treatment, or en route to the zone of interior.17

When ABS took over responsibility

from the Western Task Force at the end

of 1942 there were three evacuation hospitals functioning in the area as fixed

units, with an aggregate T/O strength of

1 ,900 beds. A minimum number of additional beds, probably not exceeding 25,

were available in a provisional hospital

at Safi. Another 400-bed evacuation hospital, the 11th, and the 51st Station Hospital with 250 beds, were in the area but

not yet operating. (Map 18)

The 51st Station Hospital went into

operation in Rabat on 31 January 1943,

while the 6th General, with 1,000 beds,

arrived in Casablanca on 20 February

and opened in that city a week later.

Both of these hospitals occupied school

buildings. Arrangements were also completed in February for a 25-bed provisional hospital at Marrakech to serve Air

Forces units stationed in that vicinity,

although the hospital did not open until

15 March. The Marrakech hospital occupied one wing of a French hospital

building. It was initially staffed by a

team of the 2d Auxiliary Surgical Group,

withdrawn at that time from Safi, but

was taken over in June by a detachment

from the 56th Station Hospital, supplemented as occasion required by personnel on temporary duty from the 6th

General Hospital. Early in August 1944

the Marrakech unit was redesignated the

370th Station Hospital.

The 69th Station Hospital began operating 500 beds at Casablanca on 28

March, in school and dispensary buildings. A month later, on 29 April, the

1,000-bed 45th General opened in Rabat, taking over the quarters previously

occupied by the 51st Station. In anticipation of the shift, the 51st had moved

into various structures connected with a

racetrack on the outskirts of the city that

had just been vacated by the nth Evacuation Hospital. The 51st Station remained until 17 August, while the 45th

General continued to receive patients

until 15 November.

The last group of fixed hospitals to

be established in ABS began operating

early in May 1943, coinciding with the

final phase of the Tunisia Campaign.

The 50th Station, with 250 beds, opened

in Casablanca on 5 May in tents and

hastily constructed temporary buildings.

The 23d Station, brought by air from

the Belgian Congo, opened 250 beds

under canvas at Port-Lyautey on 9 May,

expanding to 500 beds late in July. The

250-bed 66th Station began operating at

Casablanca on 12 May, in the buildings

16

 See pp. 119-20, above. 17

 Major sources for this section are: (1) Annual Rpt, Med Sec, ABS, 1943; (2) Annual Rpt,

Med Sec, NATOUSA, 1943; (3) Unit Rpts of hosps

and other med installations mentioned in the text.
MAP 18—Fixed Hospitals and Base Medical Supply

FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945

Port-Lyautey

91st Evacuation (as station), 2 February-25 April

1943. 400 beds.

23d Station, 9 May-19 September 1943. 250/

500 beds.

Rabat

11th Evacuation (as station), 8 December 1942-

3 April 1943. 400 beds.

51st Station, 31 January-17 August 1943. 250

beds.

45th General, 29 April-15 November 1943.

1,000 beds.

Casablanca

8th Evacuation (as general), 22 November 1942-

19 June 1943. 750 beds.

59th Evacuation (as station), 30 December 1942-

30 June 1943. 750 beds.

6th General, 27 February 1943-14 May 1944.

1,000 beds.

69th Station, 28 March-15 August 1943. 500

beds. 50th Station, 5 May 1943-19 May 1944. 250

beds.

66th Station, 12 May-6 December 1943. 250

beds.

56th Station, 14 May 1943-28 February 1945.

250 beds.

Marrakech

370th Station, 25 March 1943-28 February 1945.

(Unnumbered provisional hospital to 4 August

1944) 25 beds.

Oujda

52d Station, 13 January-28 November 1943.

250-500 beds.

95th Evacuation (as station), 24 May-4 July 1943.

400 beds.

Tlemcen

9th Evacuation (as station), 12-26 December

1942. 750 beds.

32d Station, 28 February-28 November 1943.

500 beds.

Oran Area

48th Surgical (as station), Arzew, 9 November

1942-18 January 1943. 400 beds.

77th Evacuation (as station), Oran, 12 November-1 December 1942. 750 beds.
Depots in North Africa, November 1942-February 1945

38th Evacuation (as station), St. Cloud, 13 November 1942-6 February 1943. 750 beds.

151st Station, La Senia, 25 November 1942-31

May 1944. 250 beds.

7th Station, Oran, 1 December 1942-31 July

1944. 750 beds.

180th Station, Ste. Barbe-du-Tlelat, 7 December

1942-30 September 1943; Bouisseville, 1 October 1943-15 April 1944. 250/500 beds. 64th Station, Sidi Bel Abbes, 28 December 1942-

31 May 1944. 250 beds.

21st General, Sidi Bou Hanifia, 29 December

1942-30 November 1943. 1,000 beds.

12th General, Ain et Turk, 14 January-3 December 1943. 1,000 beds.

40th Station, Arzew, 18 January-4 March 1943;

Mostaganem, 4 March 1943-15 January 1944.

500 beds.

2d Convalescent, Bouisseville, 28 February 1943-

31 May 1944. 3,000 beds.

91st Evacuation (as station), Mostaganem, 2

May-27 June 1943. 400 beds.

94th Evacuation (as station), Perregaux, 22 May29 August 1943. 400 beds.

16th Evacuation (as station), Ste. Barbe-du-Tlelat,

23 May-8 August 1943. 750 beds.

95th Evacuation (as station), Ain et Turk, 6

July-16 August 1943. 400 beds.

69th Station, Assi Bou Nif, 30 September 1943-

16 September 1944. 500 beds.

23d Station, Assi Bou Nif, 4 October 1943-28

August 1944. 500 beds.

51st Station, Assi Bou Nif, 28 October 1943-15

April 1944. 250 beds.

43d General, Assi Bou Nif, 31 October 1943-

15 June 1944. 1,000 beds.

70th General, Assi Bou Nif, 31 October 1943-

27 October 1944. 1,000/1,500 beds.

46th General, Assi Bou Nif, 4 November 1943-

31 July 1944. 1,000/1,500 beds.

54th Station, Assi Bou Nif, 2 October-23 December 1944. 250 beds.

Algiers

29th Station, 30 January 1943-25 August 1944.

250 beds.

79th Station, 17 June 1943-30 June 1944. 500

beds.
186 MEDITERRANEAN AND MINOR THEATERS

FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945—Continued

St. Arnaud

35th Station, 30 March-12 August 1943. 500

beds.

Constantine Area

61st Station, El Guerrah, 12 February-22 October

1943. 500 beds.

38th Evacuation (as station), Télergma, 9 March30 April 1943. 750 beds.

73d Station, Constantine, 23 April 1943-20 January 1944. 500 beds.

26th General, Bizot, 26 April-31 October 1943.

1,000 beds.

57th Station, Oued Seguin, 5 May-5 September

1943; 20 January-25 September 1944. 250

beds.

Bone

77th Evacuation (as station), 16 April-25 June

1943. 750 beds.

105th Station, 25 July-7 September 1943. 500

beds.

57th Station, 7 September 1943-19 January 1944.

250 beds.

Bizerte-Tunis Area

38th Evacuation (as station), Bédja, 4 May-19

June 1943; Tunis, 20 June-24 August 1943.

750 beds.

9th Evacuation (as station), Michaud, 10 May7 July 1943; Ferryville, 9 July-6 September

1943. 750 beds.

56th Evacuation (as station), Bizerte, 20 June17 September 1943. .750 beds.

53d Station, Bizerte, 27 June 1943-12 January

1944. 250 beds.

54th Station, Tunis, 28 June 1943-30 August

1944. 250 beds.

78th Station, Bizerte, 1 July 1943-15 March 1944.

500 beds.

114th Station, Ferryville, 2 July 1943-10 May

1944. 500 beds.

58th Station, Tunis, 5 July-29 December 1943.

250 beds.

81st Station, Bizerte, 12 July 1943-4 April 1944.

500 beds.

3d General, Mateur, 13 July 1943-22 April 1944.

1,000 beds.

43d Station, Bizerte, 19 July 1943-12 January

1944. 250 beds.

60th Station, Tunis, 23 July-21 October 1943.

250 beds.

74th Station, Mateur, 29 July-17 November 1943.

500 beds.

103d Station, Mateur, 2 August-9 December

1943. 500 beds.

35th Station, Morhrane, 28 August-22 December 1943. 500 beds.

33d General, Bizerte, 15 September 1943-10 May

1944. 1,000 beds.

24th General, Bizerte, 28 September 1943-31 May

1944. 1,000 beds.

37th General, Mateur, 1 October 1943-12 April

1944. 1,000 beds.

105th Station, Ferryville, 21 October 1943-29

May 1944. 500 beds.

64th General, Ferryville, 23 October 1943-29

February 1944. 1,000 beds.

57th Station, Bizerte, 15 July-31 October 1944;

Tunis, 1 November 1944-28 February 1945.

250/150 beds.

Pantelleria

34th Station, 18 June-21 September 1943. 250

beds.

Kairouan

55th Station, 26 June-11 October 1943. 250

beds.

North African Medical Supply Bases

Atlantic Base Section

4th Medical Supply Depot, Casablanca, 27 January-16 August 1943.

Mediterranean Base Section

2d Medical Supply Depot, Oran, 8 December

1942-15 August 1944.

60th Medical Base Depot Company, Oran, 15

August-15 December 1944.

Eastern Base Section

4th Medical Supply Depot, Am M'lilla in the

Constantine Area, with subdepots at Bone and

Philippeville, 19 March-8 June 1943.

2d Medical Supply Depot, Mateur in the BizerteTunis area, 15 May-8 June 1943.

7th Medical Supply Depot, Mateur, 8 June

1943-12 May 1944.

of the Italian consulate vacated when

the 8th Evacuation moved into tents in

March. The 56th Station opened 250

beds on 14 May in a prisoner-of-war enclosure at Berrechid, temporary buildings being supplemented by tents when

the patient load required.

The 56th Station moved in August to

the site of a French orphanage in Casablanca, where it operated a convalescent
THE NORTH AFRICAN COMMUNICATIONS ZONE 187

500-BED WARD OF 6TH GENERAL HOSPITAL AT CASABLANCA

camp for the 6th General Hospital. The

23d Station left ABS in September, and

the 66th in December 1943. The 50th

remained until 1 May 1944. Only the

56th Station at Casablanca and the 370th

at Marrakech were still in operation

when the area passed to control of the

Africa—Middle East Theater on 1 March

!945.18

Hospitals in the Atlantic Base Section

were supplemented by the 2d Medical

Laboratory, which arrived in Casablanca

24 December 1942, and by the 5th General Dispensary, which reached that city

on 20 February 1943. The 2d Medical

Laboratory remained in the area until

15 June, operating mobile units at Marrakech, Fes, and other Moroccan cities.

The 5th General Dispensary functioned

in Casablanca until 30 August 1943.

Maximum bed strength in ABS was

reached in May 1943 when 7,025 T/O

beds were available, with expansion

units capable of adding 50 percent to

that total. The greatest patient load came

in June and July, the peak being reached

early in the latter month when 5,700

beds were occupied. Evacuation to the 18

 See pp. 80, 84-85, above.
188 MEDITERRANEAN AND MINOR THEATERS

United States brought the figure down

sharply before the end of the month,

and there was a steady decline thereafter.19

Mediterranean Base Section—Until

the second phase of the Tunisia Campaign got under way in February, the

largest concentration of United States

troops was in the area served by the

Mediterranean Base Section, and the

build-up of fixed hospitals was both more

rapid and more extensive than was the

case in ABS. Oran and its environs were

well within range of enemy bombers

based on Sardinia and in the TunisBizerte area. The initial policy, therefore, was one of dispersal. Most hospital

sites, many of them selected before the

base section itself was activated, were

considerable distances from the city.20

Here mobile hospitals that arrived immediately after the assault were quickly

replaced by fixed units. First in the area

was the 151st Station, which set up its

250 beds in the infirmary building at La

Sénia airport, five or six miles south of

Oran, on 25 November. Although supplemented by tents, the site proved inadequate, and the hospital moved at the

beginning of April 1943 to a college

plant somewhat nearer the city. The 7th

Station Hospital, with a T/O of 750

beds, took over operation of a civilian

hospital in Oran on 1 December, relieving the 77th Evacuation. The 7th Station

was the only U.S. military hospital in

Oran itself during the North African

campaign. (See Map 18.)

The 180th Station Hospital opened at

Ste. Barbe-du-Tlelat on 7 December, its

250 beds being housed in Nissen huts

and tents. The 64th Station, another 250-

bed unit, began operating on 28 December in buildings of the College Laperrine

at Sidi Bel Abbes, near the home barracks of the famed French Foreign Legion. The last fixed hospital to receive

patients in MBS before the end of 1942

was the 21st General, which opened on

29 December in a group of resort hotels

at Sidi Bou Hanifia.

The 2,500 fixed beds in MBS on 1

January 1943 were doubled by the end

of the month. The 250-bed 52d Station

Hospital opened on 13 January at Oujda,

where it was assigned to serve Fifth

Army, then beginning the long period of

training that would lead to Salerno and

on to the Alps. The 12th General, with

1,000 beds, opened on 14 January, occupying 105 villas in the resort village

of Am et Turk overlooking the Mediterranean west of Oran. It was then hoped

to establish a hospital center there. The

40th Station operated 250 beds in the

Foreign Legion barracks at Arzew from

18 January to 4 March, taking over from

the 48th Surgical. The 40th then moved

into a miscellaneous group of buildings

in Mostaganem where its full T/O of

500 beds was set up. Last of the mobile

units to depart the area was the 38th

Evacuation Hospital, which had operated

as a station hospital at St. Cloud from

13 November 1942 to 6 February 1943.

The Center District was served by the

29th Station Hospital of 250 beds, which

took over a small civilian hospital in Algiers. Its first patients were transferred

from a British hospital on 30 January.

19

 See app. A-3. 20

 Principal sources for this section are: (1)

Annual Rpt, Med Sec, NATOUSA, 1943; (2)

Annual Rpt, Med Sec, MBS, 1943; (3) Annual

Rpt, Med Sec, Center Dist, MBS, 1943; (4) Unit

Rpts of hosps and other med installations mentioned in the text; (5) H. J. Hutter, "Medical

Service of the Mediterranean Base Section,"

Military Surgeon (January 1945), pp. 41-51.
THE NORTH AFRICAN COMMUNICATIONS ZONE 189

Hospital facilities in MBS were considerably augmented when the 2d Convalescent Hospital began receiving

patients on 18 February. Though assigned to the base section rather than to

a combat element, the 3,000 beds of this

unit were not reported as "fixed." They

served, however, to free an equivalent

number of beds in other hospitals. After

diligent search, a suitable location for

the 2d Convalescent was found at Bouisseville, close to Ain et Turk. The hospital was in part under canvas and in part

housed in 122 villas requisitioned for the

purpose.

The 32d Station Hospital, of 500 beds,

was in the theater a month before it

opened on 28 February in school buildings at Tlemcen. The only other fixed

hospital to be established in MBS before

the end of the fighting in North Africa

was the 91st Evacuation, which operated

under canvas as a station hospital at

Mostaganem from 2 May until 27 June

1943.

In addition to these fixed hospitals,

there were two general dispensaries functioning in MBS during the period of hostilities. The 8th General Dispensary

opened on 6 December 1942 in what had

been the British Cottage Hospital in

Algiers, where it was the only U.S. medical installation until the arrival of the

29th Station nearly two months later.

The 6th General Dispensary opened on

13 February in the French Clinique

Générale at Oran.

The T/O bed strength of fixed hospitals in the Mediterranean Base Section

when combat operations in North Africa

came to an end on 13 May 1943 was

5,400.21 The number of beds established,

however, was considerably greater, since

most of the units were operating beyond

their normal capacity, with tents and

Nissen huts frequently being used to

house expansion beds.22 In addition to

these fixed beds, the 3,000 beds of the 2d

Convalescent Hospital were fully occupied.

Eastern Base Section—The first American hospital in the Eastern Base Section

preceded the organization of the base

section itself. This was the 500-bed 61st

Station Hospital, which arrived at El

Guerrah, some twenty-five miles south of

Constantine, on 2 February 1943. (See

Map 18.) The hospital was brought forward in response to a request from the

Director of Medical Services, First Army,

to relieve pressure on the British 31st

General Hospital in the same area.23 It

was set up under canvas and received its

first patients on 12 February. The 61st

operated under British control until 1

March, when it was formally transferred

to EBS. In its early weeks of operation,

before the rainy season ended, mud was

so deep on the hospital site that ambulances could not leave the road and patients had to be carried by litter to the

receiving tent. "Often the bed would

sink to the springs under the weight of

the patient. This condition was cor21

 The figure for T/O beds as of 13 May 1943,

given in the text is the 30 April figure from Appendix A-3, less the 250 nonoperating beds of the

57th Station Hospital, transferred out of the MBS

in the interval, and includes the addition of the

400 beds of the 91st Evacuation Hospital, which

opened in MBS as a station hospital on 2 May 1943. 22

 See app. A-3. 23

 (1) Deputy Surg, AFHQ, to G-4, Orders, 61st

Sta Hosp, 20 Jan 43, and atchmt, DDMS, First

Army, to Surg, AFHQ, 15 Jan 43. (2) Memo,

ADMS, No. 1 LofC Subarea, to DDMS, First Army,

3 Jan 43.
190 MEDITERRANEAN AND MINOR THEATERS

rected by placing rocks or large tin cans

under the legs of the bed."

 24

The 750-bed 38th Evacuation Hospital moved into the Constantine area

early in March, opening on the 9th of

that month at Telergma. Housed in

tents, the 38th Evacuation served primarily as a station hospital for Air

Forces personnel and as a holding unit

for air evacuation during the campaign

in southern Tunisia. A week before the

northern campaign ended, the 38th

shifted to the vicinity of Bédja a few

miles behind the fighting front, but continued to be assigned to EBS, functioning as a station hospital again as soon as

the fighting was over. The 35th Station

established its 500 beds at St. Arnaud,

about fifty miles west of El Guerrah, on

30 March, with two school buildings and

a theater serving as housing.

The 77th Evacuation Hospital, which

had served as a combat unit in the southern phase of the Tunisia Campaign, was

assigned to EBS on 14 April, opening

in tents at Morris near Bone two days

later. There the 750-bed unit functioned

in a dual role, as an evacuation hospital

for II Corps and as a rear installation,

receiving patients from other hospitals

closer to the front. The 73d Station Hospital, with a T/O of 500 beds, opened

at Constantine in three school buildings

on 24 April.

The 26th General, with 1,000 beds,

reached EBS late in March but was not

ready to receive patients until 26 April.

During the intervening month engineers

had to lay out roads, build cement platforms for tents and Nissen huts, and install water and sewage facilities. The site

of the hospital was Bizot, a railhead a

few miles north of Constantine. The

26th General was the first U.S. general

hospital to function under canvas in the

theater. The 250-bed 57th Station, which

opened on 5 May at Oued Seguin near

the Telergma airfield, completed the

fixed hospital installations in the Eastern

Base Section up to the close of the Tunisia Campaign. The 57th was housed in

tents and hutments. Also at Oued Seguin

from 29 April was the 1st Medical Laboratory.

Counting the two assigned evacuation

hospitals, there were 4,250 T/O beds in

EBS as of 15 May 1943.25

Bed Shortages—T/O bed strength in

communications zone hospitals during

the Tunisia Campaign never approached

the 6-percent ratio approved before the

invasion. The actual ratio of T/O fixed

beds to troop strength was only 3.2 percent at the end of January 1943,26

 when

Tunisian casualties began flowing back

to the fixed hospitals, and had climbed

only to 5.1 percent by the end of May.27

In order to carry the patient load,

evacuation hospitals were pressed into

service as fixed units, and emergency

beds were established in hospitals already

in operation. The 21st General at Sidi

Bou Hanifia, for example, reached a

maximum patient census of 4,000 and

cared for an average of 1,750, although

24

 Med Hist, 61st Sta Hosp, 1943.

25

 This figure represents the T/O bed strength

assigned to the EBS as of 30 April 1943, plus the

250 beds of the 57th Station Hospital, which

opened as an EBS unit on 5 May 1943. See app.

A-3. 26

 "On several occasions I heard that the hospital

situation at the beginning was almost scandalous.

It has been greatly improved, due to the energy

and ability of a man named Blesse, whom I did not

meet until later." Ltr, John J. McCloy, ASW, to

Maj Gen Wilhelm D. Styer, CofS SOS, 22 Mar 43. 27

 See app. A-6.
THE NORTH AFRICAN COMMUNICATIONS ZONE 191

26TH GENERAL HOSPITAL NEAR CONSTANTINE, ALGERIA, the first U.S. general hospital to be set up in tents in the North African theater.

its T/O called for only 1,000 beds. The

necessity of operating for considerable

periods at greater than normal capacity

meant heavy demands on power, water,

and mess facilities, as well as on personnel. Maintenance and repair were constant problems, with the need for

carpenters, plumbers, and electricians

often acute. Civilians were employed in

considerable number wherever possible,

while prisoners of war were used in various permitted capacities.

On the professional side, the primary

personnel problem was one of making

the best use of the skills available. The

affiliated units, of which there were

eleven in the theater during the period

of active combat, were uniformly staffed

with a disproportionate number of specialist personnel. Promotions within the

unit were usually dependent on attrition,

which was a slow and uncertain process.

There were thus pressures both from

within and outside these hospitals to

transfer men to other units, where their

skills could be used to better advantage

and advance in rank would be more

rapid. Personnel shifts between hospitals

had become fairly common by the close

of the Tunisia Campaign, the affiliated

units, and especially the large general

hospitals, being in effect raided to build

up the staffs of smaller installations.28

28

 For more detailed, discussion of the personnel

problem in the affiliated units, see McMinn and

Levin, Personnel in World War II, pp. 206-10.
192 MEDITERRANEAN AND MINOR THEATERS

Temporary additions to the staffs of a

number of fixed hospitals were also

secured by the use of personnel not yet

permanently assigned who were drawn

from staging areas. Many hospitals arriving in the theater during the campaign were not immediately placed in

operation, either because sites had not

yet been prepared or because equipment

had been delayed. Personnel of these

units, both professional and enlisted,

were usually assigned to temporary duty

at some other hospital in the port area.

This technique served the dual purpose

of breaking in the newcomers, and of

relieving the staff of established units of

some of the burdens entailed when operating above normal capacity. Because

most of the hospitals debarked at Oran,

the greatest use of staging personnel was

in the Mediterranean Base Section.

Development of North Africa

as a Hospital Base

The Hospital Build-up—Short air

routes, all-weather landing fields, ports,

and rail connections all combined to

make the Bizerte-Tunis area the logical

hospital base to support the invasion of

Sicily, scheduled for 10 July. With less

than two months for preparation, the

hospital build-up in the northeastern corner of Tunisia went forward as rapidly

as the debris of battle could be cleared

away. The final mopping up of Axis

forces was still going on when the largest hospital convoy yet to reach the

Mediterranean arrived at Oran on 11

May. The units included five 500-bed

station hospitals, seven 250-bed station

hospitals, a 400-bed field hospital, and a

400-bed evacuation hospital. The 1,000-

bed 3d General Hospital debarked simultaneously at Casablanca. On 23 May 3

more 500-bed station hospitals arrived at

Oran, bringing the total increment of

beds to more than 7,500.29

The selection of hospital sites began as

soon as an advance echelon of EBS headquarters had been established at Mateur

on 12 May. At this time there were a

general and four station hospitals in EBS,

all of them in the Constantine area, with

an aggregate T/O capacity of 2,750

beds. The three 750-bed evacuation hospitals employed during the campaign in

northern Tunisia—the 9th, 38th, and

77th—continued to care for patients at

normal or greater than normal capacity,

bringing the minimum bed strength for

the base section to 5,000. This total had

been increased to 7,500 by the date of

the invasion of Sicily, and to 12,000 by

the beginning of August.30

The largest concentration was around

Bizerte, where the 250-bed 53d Station

Hospital was the first to open, on 16

June. The 750-bed 56th Evacuation Hospital, which had operated briefly at

Casablanca, opened as a station hospital

near Bizerte on 20 June. The 78th Station opened in the same area on 1 July,

followed by the 43d, the 81st, and the

80th Stations on 11, 12, and 13 July, respectively. The 43d was a 250-bed unit,

the other three were 500-bed hospitals.

(See Map 18.)

In Tunis the 54th Station opened with

250 beds on 19 June, followed the next

day by the 38th Evacuation, which had

moved from its Bédja location. Two

more 250-bed station hospitals, the 58th

29 Except as otherwise noted, this section is based

on: (1) Annual Rpt, Med Sec, NATOUSA, 1943;

(2) Annual Rpt, Med Sec, EBS, 1943; (3) Annual

Rpts, Med Sec, MBS, 1943; (4) Unit Rpts of the

hosps mentioned in the text. 30

 See app. A-3.
THE NORTH AFRICAN COMMUNICATIONS ZONE 193

and 60th, opened in Tunis on 5 and 23

July, respectively. The 77th Evacuation

Hospital closed at Morris on 25 June,

but remained in the area for another two

months. The 114th Station, of 500 beds,

opened in the vicinity of Ferryville on 2

July, and a week later the 9th Evacuation

moved from Mateur to Ferryville. Three

more fixed hospitals were established at

Mateur—the 1,000-bed 3d General on 15

July, in the quarters vacated by the 9th

Evacuation; the 74th Station on 29 July;

and the l03d Station on 2 August. Both

station hospitals had 500 beds.

In addition to these four points of

concentration, the 250-bed 55th Station

Hospital opened in the Holy City of

Kairouan on 19 June and the 105th

Station, of 500 beds, at Am Mokra near

Bone on 25 July. The latter unit moved

to Ferryville late in October. Between 18

June and 21 September the 34th Station

Hospital was attached to the Twelfth

Air Force and operated 250 beds for Air

Forces personnel on Pantelleria Island.

The rapid expansion of bed capacity

in the Bizerte-Tunis area posed the most

difficult siting problem encountered in

the theater. Water was scarce, the region

was poorly drained, and the malaria season was at its height. There were few

usable buildings available, and materials

for construction were almost equally difficult to procure in the brief time at the

disposal of the engineers. In addition to

these physical limitations, the military

situation required an extensive build-up

of troops and supplies in the same area,

with competing demands for facilities,

space, and engineering manpower. The

3d General Hospital at Mateur occupied

former French military barracks, supplemented by tents and prefabricated huts,

but the station hospitals had to rely for

the most part upon canvas and such more

stable structures as could be improvised.

Water supply, sewage disposal, and power facilities all had to be installed.31

So great was the pressure upon the

engineers for purely military construction that although the hospitals were

physically in the area, only a portion of

those relied upon to care for Sicily casualties were ready when the first patients

were returned from the invasion coast.

The situation was critical enough to send

the theater surgeon, General Blesse, on a

hasty flight to Mateur to size up the difficulties for himself. Before he returned

to his Algiers headquarters, Blesse got

the hospital program moving again, and

took steps to strengthen the EBS medical

section.32

Approximately 2,000 additional beds

were also established in the Mediterranean Base Section between the end of

the Tunisia Campaign and the assault

on Sicily. The only fixed installation,

however, was the 500-bed 79th Station

Hospital, which opened at Cap Matifou

just east of Algiers on 17 June. The

others were evacuation hospitals serving

temporarily as fixed units while staging

for more active roles in future combat

operations. The 94th Evacuation Hospital of 400 beds functioned as a station

hospital at Perregaux between 22 May

and 29 August before taking part in the

invasion of Italy, while the 400-bed 95th

Evacuation, also destined for Salerno,

served Fifth Army at Oujda from 24 May

to 4 July. The 95th then moved to Am

et Turk where it took casualties from

31

 A. I. Zelen, MS, Hospital Construction in the

Mediterranean Theater of Operations, United

States Army, pp. 38-40. 32

 Surg, NATOUSA, Journal, 15, 16, 17 Jul 43.

See also pp. 180-81, above.
194 MEDITERRANEAN AND MINOR THEATERS

Sicily until 16 August. The 750-bed 16th

Evacuation Hospital operated as a station hospital for prisoners of war at San

Seno Wells, near Ste. Barbe-du-Tlelat,

between 23 May and 8 August. (See Map

18.)

After the Sicily Campaign was over,

there was a further concentration of

hospitals around Bizerte and Oran in

support of expanding operations in Italy.

North Africa achieved its maximum

strength of approximately 25,000 T/O

beds plus 14,000 expansion beds about

the first of November. Even counting

fixed beds already in Sicily and Italy,

however, the ratio to troop strength remained below the original authorization

of 6 percent and well below the 6.6-percent figure authorized in September.33

The Eastern Base Section reached the

saturation point during September and

October with the establishment of four

additional 1,000-bed general hospitals.

The movement started with an internal

shift of the 35th Station Hospital from

Saint-Arnaud near Constantine to Morhrane in the vicinity of Tunis. The

33d General opened in tents and hutments on "Hospital Road" just outside

Bizerte on 15 September. The 24th General, which opened in the same area two

weeks later, was more fortunate, being

partially housed in French military barracks. The 37th General Hospital, which

opened at Mateur on 12 September, and

the 64th General, which began receiving patients at Ferryville on 23 October,

were both under canvas supplemented

by prefabricated units. (See Map 18.)

With no further hospital sites available in Tunisia, such additional buildup as was required was made in the

Mediterranean Base Section, where conditions were good and a substantial degree of permanence was anticipated. An

elaborate hospital groupment was laid

out at Assi Bou Nif, about eight miles

southeast of Oran. The 69th Station Hospital was shifted from Casablanca to the

new site on 30 September, the 23d Station from Port-Lyautey on 4 October,

and the 51st Station from Rabat on the

28th of the same month. In addition to

these units from the Atlantic Base Section, two new 1,000-bed generals, the

43d and the 70th, opened at Assi Bou

Nif on 31 October. The groupment was

completed with the opening of the 46th

General Hospital on 4 November.

The Assi Bou Nif project was planned

for long-term use. Starting with open

fields, the engineers installed complete

power, water, and waste disposal facilities

for a potential capacity of double the

4,250 beds actually installed. Buildings

were mostly of permanent construction,

many of them of stone. Those ward tents

used had wood floors and frames. Nissen

and Boyle huts were insulated. Much of

the actual labor was performed by Italian

prisoners of war, whose full utilization

ceased to be restricted after Italy

achieved the status of a cobelligerent.

Local sandstone and cement were more

readily available than lumber, and given

unlimited supplies of manpower, were

more economical.34

Hospitalization of Sicily Casualties in

North Africa—For the first time in any

U.S. theater in World War II, selective

hospitalization was attempted for casualties from Sicily. With most of the

available surgical teams assigned to the

33

 See apps. A-3, A-6.

34

 Zelen, Hospital Construction in MTOUSA, pp.

30-31.
THE NORTH AFRICAN COMMUNICATIONS ZONE 195

HOSPITAL GROUPMENT AT ASSI BOU NIF, NEAR ORAN

combat zone, it was clear that there

would not be enough skilled surgeons

left to staff all of the Eastern Base Section hospitals, either for general work or

for specialties. Careful plans were therefore made to assign patients to hospitals

by type of case.

Craniocerebral, spine, and cord injuries were to go to the 78th Station

Hospital, eye injuries to the 114th Station, chest cases to the 53d Station, and

neuropsychiatric cases to the 43d Station.

Compound fractures were to be handled

by the 9th and 56th Evacuation Hospitals, and by the 74th, 80th, and 81st

Stations. For emergency periods the two

evacuation hospitals and the 3d General

were qualified to treat cases of all types.

Triage for those brought by sea was to

be carried out by the 56th Evacuation

at Bizerte, and for those flown from Sicily

by the 9th Evacuation near Mateur airfield.35

It was possible to carry out these plans

only in part. When the first casualties

arrived on D plus 1 many of the EBS

hospitals were not yet ready for patients.

The road to the 9th Evacuation was too

rough for transporting serious cases.

There were not enough ambulances

available for the extra carry involved in

35

 (1) Ltr, Col Churchill to Surg, NATOUSA, 19

Aug 43, sub: Tour Rpt, Sicily, D+24 to D+35. (2)

Annual Rpt, Med Sec, EBS, 1943.
196 MEDITERRANEAN AND MINOR THEATERS

moving patients from the evacuation to

the station hospitals. And finally, there

were not enough beds to permit complete selectivity. The planning, moreover, had not taken into consideration

the high incidence of malaria, or the accident rate consequent upon the staging

of large numbers of troops. On the first

day of the Sicily Campaign, more than a

third of the approximately 6,500 beds

established in northeastern Tunisia were

already filled.

In actual practice, therefore, patients

were sorted at the Bizerte docks by personnel of the 8th Port Surgeon's office

and at Mateur airfield by personnel of

the 802d Medical Air Evacuation Transport Squadron.36

 Representatives of the

EBS surgeon assigned patients in terms

of daily bed status reports from each

hospital. Transportation was by the 16th

Medical Regiment. Hospital specialties

were observed so far as possible, but bed

space was the overriding consideration.

The geography was such that there was

in fact no alternative to initial hospitalization of casualties from Sicily in EBS,

and so no attempt was made to build up

bed strength elsewhere than in northeastern Tunisia. When wounded from Sicily

were carried by returning shipping to

Algiers instead of Bizerte, the 250-bed

29th Station Hospital was unable to carry the extra load. The still inoperative

79th Station had to set up tents to take

the overflow. The 38th Evacuation Hospital at Tunis handled the relatively

small number of U.S. casualties reaching

that city, but its location was poor. At

times, when the wind blew in from the

desert, the temperature in the operating

tent rose to 135° F. Needless, perhaps, to

say the hospital did not remain in Tunis

long.37

Hospitalization of Italy Casualties in

North Africa—The establishment of additional hospitals in the Tunis-Bizerte

area shortly after the Salerno landings of

9 September 1943 led to various changes

in the disposition of patients being received by air and water in EBS.38

On 20 September a triage center was

set up in the vicinity of the 33d General

Hospital, approximately four miles from

the Bizerte clocks, a mile from the Sidi

Ahmed airport, and 300 yards from the

operating base of the 2670th Ambulance

Company (Provisional). The triage center was conducted by 2 Medical Corps

officers, and 2 Medical Administrative

Corps officers, drawn from the various

installations in the area and rotated

monthly; and 6 nurses and 6 enlisted

men from the 33d General Hospital.

The center received a bed-status report

each morning from the base surgeon's

office. When a hospital ship arrived, the

Port Surgeon notified the ambulance

company, and word was passed along to

the triage center, to which the patients

were brought when unloaded. The 802d

Medical Air Evacuation Transport

Squadron at Sidi Ahmed airport was in

direct telephonic communication with

the 33d General Hospital, the triage

center, and the 2670th Ambulance Company.39

36

 Annual Report, Medical Section, EBS, says

807th MAETS, but this squadron did not arrive

in the theater until September. See Med Hist,

807th MAETS, 1 Jan 45.

37

 (1) Surg, NATOUSA, Journal, 16 Jul 43. (2)

Annual Rp 38th Evac Hosp, 1943. 38

 Except as otherwise noted, this section is based

on: (1) Annual Rpt, Med Sec, EBS, 1943; (2)

Annual Rpt, Med Sec, NATOUSA, 1943; (3) Unit

rpts of hosps mentioned in the text. 39

 Memo, Capt Carl Schanagel, to Lt Col Oscar

Reeder, 31 Oct 43.
THE NORTH AFRICAN COMMUNICATIONS ZONE 197

The sorting station at Mateur airfield

some 20 miles farther south continued

to be available until the field was closed

late in November, but received only one

patient after 5 October.

The 33d General Hospital at this time

took all craniocerebral, spine and cord,

and maxillofacial cases. Chest and neck

cases continued to go to the 53d Station

Hospital until 21 October, and thereafter to the 24th General. Neuropsychiatric patients continued to go to the 43d

Station until 16 November, when the

unit was relieved by the 114th Station.

Compound fractures continued to go to

the 81st Station. All general hospitals,

however, were authorized to take the

overflow of both psychiatric and fracture

cases when no space remained in the

designated station hospitals. Eye injuries

went to the nearest general hospital. All

other types of surgical and medical cases

were distributed according to the availability of beds.

Navy personnel went to the 80th Station Hospital at Bizerte or to the 54th at

Tunis, whichever was closer; or to specialized hospitals if the type of injury

so required. Prisoner-of-war patients also

went to the specialized hospitals if triage

so indicated, otherwise to the 78th or

103d Station.

Late in October the 105th Station

Hospital opened as a convalescent hospital and venereal disease treatment center,

gradually increasing its capacity to 3,000

beds. The 105th took patients only by

transfer from other hospitals, under suitable controls to prevent "dumping." At

this time, with an adequate number of

beds available in EBS, a 90-day evacuation policy was established for general

hospitals and a 30-day policy for station

hospitals.

After the middle of December, with

hospital facilities rapidly building up

in Italy, the influx of patients into North

Africa fell off sharply. There was a large

movement of patients during the week of

15-21 January 1944, when hospitals in

the Naples area were being cleared preparatory to launching the Anzio operation, but after that period the major

burden of communications zone hospitalization was carried in Italy.40

Hospitalization in Sicily, Sardinia,

and Corsica

Island Base Section—With the cessation of hostilities in Sicily, the 93d Evacuation Hospital closed in preparation for

a Fifth Army assignment. The 15th Evacuation was moved to a new site a few

miles east of Licata on the Gela road,

while the 128th Evacuation went to Castellammare, west of Palermo, and the

11th replaced the 128th at Cefalii. Newly

arrived from the Middle East, the 1st

Platoon of the 4th Field Hospital was

established three days before the end of

the campaign at Palagonia, on the southwestern edge of the Catanian plain.

These locations were selected with a view

to providing station hospital service for

troops remaining in Sicily, and the hospitals retained their Seventh Army assignments, with IBS exercising only a

co-ordinating function.41

The 9th Evacuation Hospital was

brought from North Africa early in September, opening at Termini on 1 Octo40

 Hq, ETOUSA, Rpt on PBS, 10 Feb 44. See also

p. 343, below. 41

 This section is based generally on: (1) Annual

Rpts, Med Sec, NATOUSA, 1943, 1944. (2) Unit

rpts of the hosps mentioned in the text. No

medical section reports for the IBS have been

found.
MAP 19—Fixed Hospitals and Base Medical Supply Depots on Sicily, August 1943-

July 1944

FIXED HOSPITALS IN SICILY, JULY 1943-JULY 1944

Castellammare-AIcamo

128th Evacuation (as station), 19 August-31 October 1943. 400 beds.

Palermo

91st Evacuation (as station), 27 July-31 October

1943. 400 beds.

59th Evacuation (as general), 8 August 1943-

6 May 1944. 750 beds.

34th Station, 1 November 1943-9 July 1944.

250 beds,

11th Evacuation (as station), 23 November-31

December 1943. 400 beds.

154th Station, 6 May-30 June 1944. 150 beds.

Termini

9th Evacuation (as station), 1 October-31 December 1943. 750 beds.

Cefalii

11th Evacuation (as station), 19 August-23 November 1943. 400 beds.

Licata

15th Evacuation (as station), 19 August-29 September 1943. 400 beds.

77th Evacuation (as station), 27 September-26

October 1943. 750 beds.

Palegonia

4th Field, 1st Platoon (as station), 14 August19 November 1943. 100 beds.

Island Base Section Medical Supply

Installations

Palermo

4th Medical Supply Depot, 1 September-21 October 1943.

2d Medical Supply Depot, 21 October 1943-10

February 1944.

Provisional Depot Company, 10 February-1 June

1944.

684th Quartermaster Base Depot Company, 1

June-15 July 1944.
THE NORTH AFRICAN COMMUNICATIONS ZONE 199

ber. On the same date the 77th

Evacuation supplanted the 15th at Licata, the latter unit being withdrawn for

service in Italy. The 128th Evacuation

moved into buildings in Alcamo on 9

October, a week after a hurricane had

leveled virtually all of its tentage at Castelammare. The 250-bed 34th Station

Hospital, only fixed installation on the

island, opened at Palermo on 1 November. The maximum fixed-bed strength in

Sicily was reached at this time—3,700

counting both IBS and Seventh Army

installations.42 (Map 19)

Evacuation of the remaining casualties

from Sicily, reduction in the strength of

occupation troops, and the departure of

staging units about this time greatly reduced the demand for hospital beds. The

77th and 128th Evacuation Hospitals, together with the 91st, which had remained in place in Palermo, left the

theater for England early in November.

Later that same month the 1st Platoon

of the 4th Field Hospital was attached

to the Air Forces and shifted to Italy,

while the nth Evacuation moved to

Palermo. Both the 9th and nth Evacuation closed on 31 December preliminary to departure for Italy. Left in Sicily

at the beginning of 1944 were the 59th

Evacuation, acting as a general hospital,

and the 34th Station, both at Palermo.

The 59th was replaced in May 1944 by

the 150-bed 154th Station, but both this

hospital and the 34th Station left Sicily

two months later. The Island Base Section passed out of existence on 15 July

1944.

Northern Base Section and Sardinia—

As of 1 January 1944, the two platoons

of the 15th Field Hospital on Corsica

were reassigned to the Northern Base

Section. The NORBS surgeon, Colonel

Robinson, began a survey of the island

for hospital sites immediately after his

arrival on 8 January and prepared plans

calling for the addition of 1,250 fixed

beds, to be dispersed in relation to airfields and troop concentrations. Transportation shortages stemming from the

requirements of the Anzio Campaign

forced some delay, but the 500-bed 35th

Station Hospital opened at Cervione,

midway up the eastern coast of Corsica,

on 1 March. Ten days later the 40th

Station, also with 500 beds, replaced the

1st platoon of the 15th Field at Ajaccio.

The latter unit shifted to Calvi in the

northwestern part of the island, but operated there only a few weeks before being

supplanted by the 250-bed 180th Station

on 28 April 1944. The field hospital

platoon then went to Ghisonaccia, some

twenty miles below Cervione. All three

station hospitals on Corsica came from

North Africa. In the absence of suitable

buildings, all American hospitals on the

island were set up under canvas, supplemented by prefabricated huts as the engineers found time to erect them.43

The two hospitals on Sardinia—the 3d

Platoon of the 15th Field, and the 60th

Station—remained as Air Forces units

until the first week in May, when they

were assigned to the Allied garrison on

Sardinia. The 60th Station opened a second 250-bed expansion unit in January,

but no further increase in U.S. hospital

42See app. A-4.

43

 (1) Annual Rpt, Med Sec, NORBS, 1944. (2)

Unit rpts of hosps mentioned in the text. (3) See

app. A-4.
FIXED HOSPITALS ON SARDINIA AND CORSICA,

NOVEMBER 1943-MAY 1945

Cagliari, Sardinia

60th Station, 3 November 1943-31 October 1944.

250/500 beds.

Alghero, Sardinia

15th Field, 3d Platoon (as station), 13 December

1943-30 August 1944. 100 beds.

60th Station, Detachment, 30 August-22 September 1944. 100 beds.

Ajaccio, Corsica

15th Field, 1st Platoon (as station), 19 January11 March 1944. 100 beds.

40th Station, 11 March-4 October 1944. 500

beds.

60th Station, Detachment, 23 October 1944-20

January 1945. 150 beds.

Calvi, Corsica

15th Field, 1st Platoon (as station), 20 March28 April 1944. 100 beds.

180th Station, 28 April-10 September 1944. 250

beds.

Bastia, Corsica

15th Field, 2d Platoon (as station), 1 December

1943-16 October 1944. 100 beds.

60th Station, Bigulia, 6 November 1944-4 March

1945. 350/500 beds.

40th Station, Bigulia, 1 February-3 May 1945.

200/500 beds.

Cervione, Corsica

35th Station, 1 March-10 September 1944. 500

beds.

40th Station, Detachment, 14 October 1944-14

April 1945. 350/150 beds.

Ghisonaccia, Corsica

15th Field, 1st Platoon (as station), 28 April-28

October 1944. 100 beds.

40th Station, Detachment, 28 October 1944-8

April 1945. 150 beds.

Northern Base Section Medical Supply

Installations

Ajaccio, Corsica

7th Medical Depot Company, 1 March-1 June

1944.

684th Quartermaster Base Depot Company, 1

June-1 September 1944.

Cervione, Corsica

7th Medical Depot Company, 1 May-1 June

1944.

684th Quartermaster Base Depot Company, 1

June 1944-21 March 1945.

80th Medical Base Depot Company, 21 March10 April 1945.

MAP 20—Fixed Hospitals and Base Medical Supply Depots on Sardinia and

Corsica, November 1943-May 1945
THE NORTH AFRICAN COMMUNICATIONS ZONE 201

capacity on Sardinia was required.44

(Map 20}

Hospitalization of Prisoners

of War in North Africa

The 275,000 prisoners taken at the

close of the Tunisia Campaign exceeded

all expectations and created a problem

with which the Allied authorities were

inadequately prepared to deal. By agreement between Generals Cowell and

Blesse and the Provost Marshal General,

captured medical and sanitary personnel

were divided between the U.S. and British medical organizations according to

need, but in the confusion of mass transfers to less congested areas, it was not at

once possible to make use of those men

to any great extent in caring for their

own sick and wounded. Initially, Tunisian prisoners were given medical care in

regular U.S. Army hospitals, normal

staffs being supplemented as extensively

as possible by prisoner personnel. Where

fixed hospitals were not available, dispensary service was given by protected

enemy personnel under supervision of

the medical sections of the administrative companies operating the prisoner-ofwar camps.45

The largest single cause for hospitalization of prisoners in the summer and

early fall of 1943 was malaria, with dysentery also high on the list. Many of

those taken in the Tunisia Campaign

were suffering from malnutrition, which

undoubtedly increased the disease rate,

as also did unsanitary conditions in the

hastily improvised prison camps and

along the crowded transportation routes

to the rear. Battle wounds were a significant factor only in May.46

German and Italian prisoners taken in

the final days of the Tunisia Campaign

were cared for in EBS by the 61st Station

and the 26th General Hospitals, both of

which remained in the Constantine area

through October 1943. At the 26th General prisoner wards were set up inside a

barbed-wire enclosure, with guards initially assigned from the medical detachment. These were later replaced by military police.47

In the Mediterranean Base Section,

two hospitals cared for prisoner patients

from Tunisia, and later from Sicily.

The 21st General at Sidi Bou Hanifia

opened a prisoner-of-war section on 29

April to care for the sick and injured in

POW Enclosure 130. The section continued to operate as such until the hospital closed in Africa at the end of November. In 200 days of operation, 2,285

prisoner patients were admitted, more

than 13 percent of all patients for the

period. The largest daily census was 538.

Both German and Italian prisoners were

treated, and medical personnel of both

enemy countries assisted in their care.

At Ste. Barbe-du-Tlelat, the 16th Evacuation operated a hospital in prisoner-ofwar Enclosure 129 between 23 May and

8 August. Between the latter date and 30

September the hospital was operated by

the 180th Station. Patients here were

predominantly Italian, as were the pro44

 (1) Annual Rpt, Med Sec, AAFSC MTO, 1944.

(2) Annual Rpt, 15th Field Hosp, 1944. (3) Annual Rpt, 60th Sta Hosp, 1944. (4) See app. A-4. 45

 (1) Annual Rpt, Med Sec, NATOUSA, 1943.

(2) Hist, Med Detach, 6619th POW Administrative Co, 1943. The figure 275,000 for prisoners

taken in Tunisia is from Howe, Northwest Africa

p. 666.

46

 ETMD, NATOUSA, Oct 43. 47

 (1) Annual Rpt, Med Sec, EBS, 1943. (2) Annual

Rpt, 61st Sta Hosp, 1943. (3) Annual Rpt, 26th

Gen Hosp, 1943.
202 MEDITERRANEAN AND MINOR THEATERS

tected personnel who augmented the

U.S. hospital staff.48

Largest of the hospitals for Tunisia

prisoners was the 56th Station in ABS,

which was set up between 4 and 14 May

inside POW Enclosure 100 at Berrechid,

some twenty miles south of Casablanca.

Almost half of all prisoners taken in

Africa passed through this camp, which

had an average population of 20,000

with a maximum of 28,000. Germans

and Italians there were about equal in

numbers. The patient census varied from

205 to 978, averaging about 750. The

hospital had nine prefabricated buildings, supplemented by tents. In addition

to hospital care, the 56th Station maintained small dispensaries in various parts

of the compound, where outpatient service was given to between 300 and 400 a

day.49

The inadequate hospital staff was supplemented by detachments of 3 officers,

6 nurses, and 22 enlisted men each from

the 34th, 36th, and 37th Hospital Ship

Platoons; by 2 German medical officers,

each of whom had charge of a ward; and

by 100 to 120 German medical soldiers

who worked under their own noncommissioned officers. Nurses were quartered

outside the compound. Their duties

were largely supervisory, with actual

nursing confined to seriously ill and surgical cases. They performed no night

duty.

The 56th Station Hospital closed at

Berrechid on 15 August when the prison

camp was closed.

The bulk of the prisoner-of-war patients from Sicily who were not retained

on the island went initially to the 80th

Station Hospital at Bizerte, where they

were guarded by French military personnel. Prisoner patients from the Italian campaign that were received in the

EBS were routed to the 78th Station

Hospital at Bizerte or to the 103d Station

at Mateur.

After Italy became a cobelligerent,

Italian prisoners in Africa were organized into service units of various types.

Their status made it necessary to keep

them completely separated from the

German prisoners. At the same time,

their numbers and the assignments given

them increased their hospitalization requirements.

On 26 September, therefore, the

Italian wards of the hospital then being

operated by the 180th Station in prisoner-of-war Enclosure 129 was redesignated the 7029th Station Hospital (Italian) . It was staffed by Italian medical

personnel under U.S. supervision, assisted for the first two months by

detachments from two U.S. hospital ship

platoons. The maximum census before

the end of 1943 was about 800.50

The German wards of the hospital in

POW Enclosure 129 were reorganized

at the same time into a German station

hospital, under U.S. supervision but

staffed, like the Italian hospital, by captured medical personnel. In December

the German hospital moved to neighboring POW Enclosure 131, and the 7029th

moved back into the quarters previously

occupied in Enclosure 129. Prisoner-ofWar Hospital 131, as the German unit

was thereafter known, was equipped at

48

 (1) Annual Rpt, Med Sec, MBS, 1943. (2)

Annual Rpt, 21st Gen Hosp, 1943. (3) Annual Rpt,

16th Evac Hosp, 1943. (4) Annual Rpt, 180th Sta

Hosp, 1943. 49

 (1) Annual Rpt, Med Sec, ABS, 1943. (2) Annual Rpt, 56th Sta Hosp, 1943. 50

 Hist, 7029th Sta Hosp (Italian.), 27 Jul 45.
THE NORTH AFRICAN COMMUNICATIONS ZONE 203

PRISON STOCKADE, 180th STATION HOSPITAL, STE.-BARBE-DU-TLELAT, NEAR ORAN

this time to care for 500 patients, but

gradually expanded as more German

medical officers became available.51

The 56th Station Hospital opened a

75-bed unit for prisoner personnel of

Italian service companies in the Casablanca area late in 1943. This unit was

formally designated the 7393d Station

Hospital (Italian).

Only cases that could not be handled

by one of these prisoner-of-war hospitals

went to U.S. installations.

Although 3,066 sick and wounded

prisoners of war were evacuated to the

zone of interior during 1943, an aggregate of 1,982 remained hospitalized in

North Africa at the end of the year.

Evacuation in the Communications

Zone

Evacuation Between Base Sections

The geographical distribution of fixed

hospital beds in North Africa in relation

to the changing combat zones and to

ports of embarkation made it necessary

to keep patients moving steadily from

one base section to another in order to

accommodate new casualties as close as

possible to the area of combat. Evacuation from east to west went on as long

as the North African communications

zone itself remained in existence.

51

 (1) Annual Rpt, Med Sec, MTOUSA, 1944, an.

B. (2) Annual Rpt, Med Sec, MBS, 1943. (3) Hist,

7029th Sta Hosp (Italian).
204 MEDITERRANEAN AND MINOR THEATERS

Tunisia Campaign—Evacuation between base sections in North Africa was

a continuous process after the Tunisia

Campaign got well under way. The

established evacuation policy for the

Eastern Base Section of thirty days and

of ninety days for the other two North

African base sections was impossible to

observe rigorously in practice. EBS hospitals functioned in fact as little more

than evacuation units, sending a constant

flow of patients back to Algiers and

Oran. To make room for these, Mediterranean Base Section hospitals were

forced to send other patients still farther

back, to the Casablanca area or to the

zone of interior. Casualties from the

Tunisian battle fronts began arriving in

the Atlantic Base Section toward the end

of April, continuing in a steady stream

until midsummer.52

During the southern phase of the

Tunisia Campaign the 61st Station

Hospital at El Guerrah was the principal

distributing point in the Eastern Base

Section. Each day patients from the 61st

were moved by Air Forces ambulances a

distance of twenty miles to the 38th

Evacuation Hospital at Telergma airfield to make room for the next convoy

arriving from the front. "Admissions

were as high as 350, and evacuation by

air totaled 350, in a single 24 hour

period.53 It was not until 30 March that

another U.S. hospital, the 35th Station at

Saint-Arnaud, was available in the area,

and this installation took only one trainload of 228 patients from II Corps.

In the northern phase of the campaign, the 77th Evacuation Hospital

near Bone served as both a base section

fixed unit and a combat zone hospital.

Patients received from the front were

sent either to the Mediterranean Base

Section or to the Constantine area,

where the 73d Station and 26th General

Hospitals opened late in April and the

57th Station early in May. Evacuation to

MBS from the 77th Evacuation was by

air and by British hospital ship. To Constantine it was by motor ambulance.

For the period 1 January to 15 May

1943, according to figures reported by

the NATOUSA medical section, 12,616

patients were evacuated by air from the

combat zone to MBS, either direct or

through EBS hospitals; 2,660 were evacuated by sea and 707 by rail. In addition

to these, 665 patients were flown from

MBS to ABS, and 900 came from MBS

to ABS by rail. The 802d Medical Air

Evacuation Transport Squadron reported a total of 16,300 patients evacuated by air, including both the 4,806

flown directly from the combat zone. (See

Table 2, p. 140.) and those moved to

more rearward areas within the theater.

(Table 3) The higher MAETS figure is

accounted for, at least in part, by the

somewhat different time span—16 January-23 May—and by the inclusion of Air

Forces casualties which were frequently

not cleared through normal hospital

channels.

Rail evacuation between base sections

became increasingly important toward

the close of the Tunisia Campaign. The

first U.S. hospital train in the theater

was assembled in March from French

rolling stock. Second- and third-class

passenger cars and box cars were converted into ten-litter cars, four for sitting

52

 Principal sources for this section are: (1)

Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Med Sec, EBS, 1943; (3) Annual Rpt,

Med Sec, MBS, 1943; (4) Annual Rpt, Med Sec,

ABS, 1943; (5) Unit rpts of individual med installations mentioned in the text. 53

 Annual Rpt, 61st Sta Hosp, 1943.
THE NORTH AFRICAN COMMUNICATIONS ZONE 205

TABLE 3—INTRATHEATER EVACUATION BY AIR, NORTH AFRICA, 16 JANUARY-23 MAY 1943

Source: Med Hist, 802d MAETS, 1942-44.

patients, a train personnel car, a kitchen,

and a kitchen supply car. Manned initially by personnel of the 5th Hospital

Ship Platoon, the train carried 120 litter

and 180 sitting patients. The first run,

from Oran to Casablanca, was completed on 31 March. A second hospital

train, converted and operated by personnel of the 41 st Hospital Train, was

placed in operation on 15 May. Shortly

thereafter the first train was taken over

by personnel of the 42d Hospital Train.

A third American hospital train, converted from French rolling stock, went

into operation in July, in time to help

clear casualties from Sicily through EBS

and MBS. A boarding party from the

6th General Hospital at Casablanca met

each incoming train at Fes, collecting

valuables, checking records, and assigning patients to wards while they were

still in transit.54

Sicily and Italy Campaigns—From

mid-July 1943 through the remainder

of the year, movement of the sick and

wounded out of the Bizerte-MateurTunis area to hospitals farther to the

rear was almost as rapid as the inflow

of casualties from Sicily and Italy. In the

early stages of the Sicily Campaign, there

were not enough beds available to permit extended hospitalization in Tunisia.

Even the addition of 2,500 beds before

the end of the Sicilian fighting did not

appreciably improve the situation,

because of the requirements of the

forthcoming invasion of Italy. One consequence was the evacuation of many

patients with limited hospital expectancy, who were virtually well by the

time they reached the Mediterranean

Base Section.

During the 2-month interval between

the Sicilian and Italian D-days, EBS

forward hospitals received 5,713 patients from Sicily by sea and 7,603 by

air, or 13,316 all told. In the same

54

 (1) Annual Rpt, 41st Hosp Train, 1943. (2)

Annual Rpt, 6th Gen Hosp, 1943. (3) ETMD,

NATOUSA, Jul 43.
206 MEDITERRANEAN AND MINOR THEATERS

period a total of 10,720 patients was

evacuated to installations farther removed from the combat zone.55

The first patients from Italy were

carried to EBS by returning transports

on 12 September, and the first arrivals

by air were received on the 23d. After

28 September much of the air evacuation

from Italy was routed by way of Sicily

with an overnight stop at Termini airfield near Palermo, but hospitalization

was not involved except in emergencies.

Patients were kept in an air evacuation

holding unit and flown on to Africa the

next day.

For movement out of the forward area

of EBS, hospital ships were used between

Bizerte and Oran; planes to Algiers; and

hospital trains to Constantine, which was

included in MBS in October. From

Constantine further rearward movement

was by train or plane.56

Between 10 July and 31 December

1943, 34,116 patients were received in

EBS from Sicily and Italy, 12,902 by

sea, and 21,214 by air. In the same

period, 16,116 were transferred to rear

areas of the North African communications zone, 9,238 by sea, 3,577 by air, and

3,301 by rail. In addition to these

intratheater transfers, 801 patients were

evacuated from EBS directly to the

United States by sea. French casualties

from Italy began entering the U.S. evacuation channels in December but were

separated on arrival in North Africa and

passed to French control.57

In January 1944, as part of the process

of clearing fixed hospitals in Italy in

anticipation of heavy casualties at Anzio

and along the Rapido, 5,538 U.S. patients were evacuated to EBS, 3,232 by

sea and 2,306 by air.58 This was the last

heavy demand upon the North African

communications zone, which declined

steadily in importance thereafter.

Evacuation from Corsica and Sardinia

was by air to North Africa during the

period before the fall of Rome, but was

of relatively minor significance.

Evacuation to the Zone of Interior

In the early stages of the Tunisia Campaign, American litter patients destined

for the zone of interior were evacuated

from Oran to the United Kingdom on

British hospital ships, while neuropsychiatric, ambulatory, and troop-class

patients went directly to the United

States by unescorted troop transport.59

Instructions were changed at the beginning of May to permit evacuation of all

classes of patients in transports, with

Casablanca the primary port of embarkation for this purpose. Later in the

year, convoyed troopships took occasional loads from Oran, while two U.S.

hospital ships, the Acadia with a capacity

of 806 and the Seminole with a capacity

of 468, became available for evacuation

from ports farther east in the Mediterranean. The Acadia, however, was too

large to dock at Bizerte. A total of 20,358

U.S. Army patients were evacuated from

North Africa to the zone of interior during 1943. (Table 4) Only a handful were

evacuated to the United States by air in

this period, each case being a matter for

separate negotiation.

55

 Annual Rpt, Med Sec, EBS, 1943. 56

 Surg, NATOUSA, Journal, 12 Jul, 17 Aug 43. 57

 Ibid., 37 Dec 43.

58

 Rpt of Surg, MTOUSA, 1944, an. B, app. 20. 59

 Troop-class patients were those who needed

little medical care en route and were able to care

for themselves even in emergencies.
THE NORTH AFRICAN COMMUNICATIONS ZONE 207

INTERIOR OF HOSPITAL TRAIN on run

from Oran to Casablanca.

Medical Supplies and Equipment

Medical supplies and equipment for

U.S. forces operating in the North African theater were originally the responsibility of the task forces. The supply

function passed to the base sections when

they were activated, with centralized coordination through the Medical Section,

AFHQ, and later NATOUSA. After 14

February 1943, central direction of theater supply activities was through the

Medical Section, SOS, NATOUSA.

Medical Supply in the Base Sections

The task forces making the North

African landings included no trained

personnel for handling medical supplies,

which were scattered in chaotic fashion

over the Moroccan and Algerian beaches.

Records were inadequate or nonexistent, and there were no supply depots

TABLE 4—U.S. ARMY PATIENTS EVACUATED BY SEA FROM NORTH AFRICA TO THE ZONE OF

INTERIOR, 1943

Source: Annual Rpt, Med Sec, NATOUSA, 1943, p. 184.
208 MEDITERRANEAN AND MINOR THEATERS

until the base section organizations took

control.60

In the Atlantic Base Section, warehouses and issue points were operated

during January 1943 by personnel of

hospital ship platoons, but no inventories

were attempted. The 4th Medical Supply Depot took over the function on 27

January, establishing an orderly system

of distribution centered in Casablanca.

This organization remained in ABS until 16 August, after which personnel of

hospital ship platoons again resumed the

supply function. By that date, however,

ABS had so far declined in importance

as to make the work a routine operation.

The development of a medical supply

system in the Mediterranean Base Section followed a similar pattern. A section

of the 2d Medical Supply Depot was

functioning in Oran before the end of

November 1942. As rapidly as possible

scattered supplies were brought together and suitably housed in and

around Oran, while inventories were

corrected and brought up to date. A

shortage of organizational equipment—

not included in the initial automatic

delivery of supplies on the basis of troop

strength—was made up in large part by

diverting to depot stock a complete

1,000-bed hospital assembly that had

been shipped for the 26th General. The

equipment arrived several weeks before

the hospital could be set up, and the

needs of operating units were too great

to permit the material to remain idle.

For example, the first abdominal operation at the 21 st General Hospital after

that unit was set up at the end of December was performed "with three or four

borrowed clamps, a scalpel, and a pair

of scissors."61

In the Eastern Base Section, a section

of the 4th Medical Supply Depot set up

a major supply base at Ain M'lilla, about

twenty-five miles south of Constantine,

on 19 March, with subdepots at Bone

and Philippeville. This unit was relieved

after the close of the Tunisia Campaign

by elements of the 7th Medical Supply

Depot, which also supplanted personnel

of the 2d Medical Supply Depot at

Mateur. The latter group had served II

Corps in the field during the active

fighting, but had been reassigned to EBS

in May.

The section of the 4th Medical Supply

Depot, which had gone to Sicily with

Seventh Army,62 was reassigned to the

Island Base Section on 1 September. The

4th continued to operate the supply base

at Palermo until late in October, when

the function was transferred to the 1st

Advance Section of the 2d Medical Supply Depot. In Corsica a supply dump for

the Northern Base Section was established at Ajaccio about 1 March 1944 by

the 7th Medical Depot Company.63

In general, medical supplies and

equipment were adequate throughout

the North African and Sicilian campaigns. Shortages in specific items, such

as prosthetic dental supplies and optical

equipment, were owing in part to in60

 Except as otherwise noted, this section is based

on (1) Annual Rpt, Med Sec, NATOUSA, 1943;

(2) Annual Rpts, Med Secs, of the base sections;

(3) Rpt, Med Supply Activities, NATO (Nov

42-Nov 43) ; (4) Davidson, Med Supply in

MTOUSA, pp. 1-49; (5) Rpts of individual med

units mentioned in the text.

61

 Diary of Col Lee D. Cady 62

 See pp. 169-70, above. 63

 The 2d, 4th, and 7th Medical Supply Depots

were reorganized 3 December 1943 into medical

depot companies, under TOE 8-661, dated April

1943.
THE NORTH AFRICAN COMMUNICATIONS ZONE 209

adequacies in the original medical maintenance units and in part to the

unexpectedly high need for dental

replacements and for glasses among

troops sent to the theater. In the case of

prosthetic supplies, shortages in the zone

of interior further delayed the filling of

requisitions, but supplies in both categories were reaching Africa in sufficient

quantities by the end of the year.

Shortages of various items reported

by hospital commanders were in part

owing to the fact that many hospitals

reached the theater without all their

equipment, in part to breakage as a result of faulty packing, and in part to the

necessity of operating above normal

capacity. The Tables of Equipment

themselves were not entirely suitable to

the needs of the theater, but deficiencies

were quickly made up. Hospitals arriving during the first four or five

months, for example, did not have adequate generating equipment, but here,

as in many other instances, the Corps of

Engineers made up the deficiencies.

Ordnance and Quartermaster units were

also ready at all times to improvise

equipment or to requisition missing

items for hospital use.

Another problem arose because some

medical officers, particularly surgeons,

who were fresh from civilian practice,

found it hard to adjust themselves to

the more limited range of equipment

it was possible to carry into a combat

theater, and the items available did not

always correspond to individual preferences in drugs and instruments. There

is no evidence, however, that the medical service rendered in North Africa was

ever seriously curtailed or impaired for

lack of supplies or equipment. Even

those hospitals that were most distant

from supply points managed to get what

was needed, by air if necessary.64

Where essential equipment was lacking, hospital staffs showed considerable

ingenuity in improvising substitutes.

Cabinets and laboratory benches were

built of waste lumber; heating units,

sterilizers, laundry equipment, and

showers were fashioned from empty

gasoline drums and odd bits of pipe;

soap was made from discarded kitchen

fats; parts were salvaged from worn-out

equipment and reused for the same or

other purposes. In the cities it was sometimes possible to procure local equipment, but more frequently equipment

had to be made out of available

materials. In Casablanca, for example,

such items as wash basins, toilet bowls,

and sinks were made with locally procured cement.65

Theater Services of Supply

Supply and maintenance activities for

U.S. forces in the theater were centralized after mid-February 1943 in a

NATOUSA Services of Supply organization, with headquarters at Oran. As in

other theaters the Services of Supply in

MTO was subordinate to theater headquarters, but differed from comparable

organizations elsewhere in that it did

not control the fixed hospitals. The SOS

medical section was responsible only for

64

 In addition to general sources cited above,

see: (1) Hq, SOS, ETO, Impressions of Medical

Service in NATOUSA, by Brig Gen Paul R. Hawley, Chief Surg, ETO; (2) Ltr, Lt Col Ryle A.

Radke to TSG, 28 Apr 43, sub: Inspection of North

Africa and the United Kingdom; (3) Surg,

NATOUSA, Journal, 16-21 Jul 43. 65

 See especially unit rpts of the 26th and 45th

Gen Hosps, and the 7th and 35th Sta Hosps; Diary

of Col Cady. See also, Annual Rpt, Med Sec, ABS,

1943.
210 MEDITERRANEAN AND MINOR THEATERS

medical supply. Lt. Col. Theodore L.

Finley, formerly medical supply officer

in ABS, headed the section briefly, being

succeeded in May by Col. Benjamin

Norris. Col. Charles F. Shook became

head of the section in August. His opposite number in the NATOUSA medical

section was Lt. Col. (later Col.) Ryle

A. Radke, who had first visited the

theater in February on an inspection

tour of supply installations and services

for The Surgeon General, and joined the

NATOUSA staff on 18 July.66

In carrying out its supply functions,

the SOS medical section requisitioned

on the zone of interior and distributed

the supplies and equipment received

among the base sections and combat formations in the theater. Semimonthly

stock reports submitted by the base sections, and firsthand inspections, provided a basis for adjustment between

depots to ensure balanced stocks in all

parts of the theater. As the staff of the

SOS medical section was built up during

the summer, its activities broadened to

include statistical reporting and research

into the actual consumption of medical

supplies looking toward modification of

maintenance factors. Shortages revealed

were made up by special requisitions on

the zone of interior, and overstocks were

disposed of by reshipment to the ZI, by

transfer to Allied Military Government,

and by diversion to fill French lendlease requisitions.

The theater medical supply level was

based on a 30-day working supply and a

45-day reserve, plus a final reserve medical unit consisting of a 90-day supply of

items that might become critical in

event of blockade or siege. The final

reserve was discontinued in August 1943

and taken into depot stock, resulting in

temporary excesses in some categories.

Professional Services

The administration of the various

professional services of the Medical Department in the North African Theater

of Operations was centralized in the

office of the surgeon, NATOUSA, and

was carried out through the appropriate

subsections of the medical section.

The Medical and Surgical

Consultants

In medicine and surgery the key figures on the professional side were the

consultants. Lt. Col. (later Col. ) Perrin

H. Long, recently of the Johns Hopkins

faculty, assumed the duties of medical

consultant on 3 January 1943. Before the

end of the month, Lt. Col. Stuart F.

Alexander joined Long's staff as consultant in chemical warfare and liaison

officer with G-1. Early in June Capt.

(later Lt. Col.) Frederick R. Hanson

became consultant in neuropsychiatry,

having acted in that capacity in fact

since the southern phase of the Tunisia

Campaign in March.67

The surgical consultant, Colonel

66

 This section is based chiefly on: (1) Hist, Med

Sec, SOS, NATOUSA, Feb 43-Jan 44; (2) Annual

Rpt, Med Sec, NATOUSA, 1943; (3) Rpt. Med

Supply Activities NATOUSA, Nov 42-Nov 43, by

Lt Col Finley; (4) Munden, Administration of Med

Dept in MTOUSA, pp. 76-87. (5) Davidson, Med

Supply in MTOUSA, pp. 21-27.

67

 (1) Munden, Administration of Med Dept in

MTOUSA, App. A, p. 212. (2) Perrin H. Long,

M.D., "Mediterranean (Formerly North African)

Theater of Operations," vol. I, Activities of Medical Consultants, "Medical Department, United

States Army," subseries Internal Medicine in World

War II (Washington, 1961) , ch. III. For Hanson's

activities, see p. 145, above.
THE NORTH AFRICAN COMMUNICATIONS ZONE 211

COLONEL STONE inspecting clothing of a

lice-infested Arab in Tunisia.

Churchill of the Harvard Medical

School joined the staff of the NATOUSA medical section on 7 March 1943.

Colonel Churchill's office was enlarged

shortly before the Salerno landings to

meet the increased demands of the Italian campaign. At this time Maj. (later

Lt. Col.) Fiorindo A. Simeone became

assistant to the surgical consultant; Maj.

(later Lt. Col.) Henry K. Beecher became consultant in anesthesia and resuscitation; and Maj. John D. Stewart

became consultant in general surgery.

Early in January 1944, in order to make

full use of the new drugs and techniques,

Capt. (later Maj.) Champ Lyon became

consultant in wound infections', chemotherapy, and penicillin therapy. He was

assisted in the study of bacterial flora of

wounds and wound recovery by 2d Lt.

Robert Rustigan.68

The consultants made frequent inspections of medical installations within

the theater. On the basis of their observations and contacts, they kept the

theater surgeon informed as to professional standards in medicine and surgery. They gave professional advice on

the management of patients, the procedures to be followed at various echelons of medical service, and the most

suitable assignments for specialists in

their respective fields in terms of proficiency, training, and experience. They

also reported on the incidence and nature of wounds and injuries occurring

throughout the theater.

Additional consultants were used at

the headquarters of the base sections and

tactical commands. Some were assigned

within the Table of Organization, but

it was the more normal practice to attach

to the theater medical section as acting

consultants officers from various installations, primarily hospitals, for the purpose of appraising and standardizing

technical procedures within many of the

subspecialties of surgery and medicine.

Thus, without having a large assigned

staff of specialists, the theater medical

section was able to cover a wide range of

service and study in both the broad subjects and the subspecialties.

II Corps, when operating independently, and both Fifth and Seventh

Armies had consultants assigned during

the Tunisian, Sicilian, and Italian campaigns. Inspection of hospitals by the

consultants and other members of the

medical staff, including the preventive

medicine officers, the medical inspector,

68

 (1) Munden, Administration of Med Dept in

MTOUSA. (2) Annual Rpt, Med Sec, NATOUSA,

1943.
212 MEDITERRANEAN AND MINOR THEATERS

ITALIAN POW's DRAINING SWAMPY GROUND near Algiers as a malaria control measure.

and the theater surgeon, resulted in the

establishment of theater-wide professional policies and procedures. Exchange

of information was facilitated by visits

to British as well as U.S. installations.

Preventive Medicine

The numerous health hazards that

were likely to be encountered in North

Africa were fully appreciated while the

campaign was still in the planning stage.

A preventive medicine subsection was

established under the medical section

before Allied Force Headquarters left

London, and was carried over into

NATOUSA. The first preventive medicine officer, Maj. (later Lt. Col.) John

W. R. Norton, transferred to the Services of Supply organization in February

1943. Colonel Long, the medical consultant, filled in until May when Lt. Col.

(later Col.) Hugh R. Gilmore took over

the functions. Lt. Col. (later Col.)

William S. Stone became preventive

medicine officer in August 1943 when

Gilmore went to Fifth Army. Throughout the planning and early operating

phases the major problems anticipated

were malaria, intestinal disorders, and

venereal diseases.

Malaria Control Measures—Early in

January 1943 a small British-American

malaria committee was named by General Cowell to study the malaria problem

and to recommend preventive measures.
THE NORTH AFRICAN COMMUNICATIONS ZONE 213

The group was gradually enlarged to

include Air Forces and Navy representatives and French malariologists familiar

with the local situation. On 20 March

the committee was reconstituted as the

Malarial Advisory Board, AFHQ. Colonel Long headed the American group.69

During the early months of 1943 an

Allied policy on malaria control was

worked out and measures initiated to

carry it into effect. Malaria control and

survey units were requested to carry out

drainage and larviciding in mosquitobreeding areas but until the units arrived, Medical Corps and Sanitary Corps

officers under supervision of base section

medical inspectors were made responsible for environmental control measures.

In addition to this general approach, all

military personnel were to take atabrine

twice weekly beginning 22 April and

continuing through November. The

men were to sleep under netting wherever it was feasible to carry such equipment, and those on outside duty at night

were to wear gloves and head nets.

Repellents were also to be issued to all

personnel. Infested places, such as

wooded and watered ravines, were to be

avoided, as were native habitations. At

the same time medical officers were to

be given refresher courses in diagnosis

and treatment of the disease, and troops

were to be indoctrinated as to its cause,

control, and gross manifestations.70

Entomological detachments of the

10th and 13th Malaria Survey Units

(MSU's) reached North Africa early in

March, being assigned to MBS and ABS,

respectively. Similar elements of the

11th and 12th MSU's, arriving at about

the same time, were assigned to the

Center District and to EBS, but did not

go into operation until May, when the

rest of all four units reached the theater.

The 2655th Malaria Control Detachment (MCD) was brought up from

Roberts Field, Liberia, in May, and was

given responsibility for control work

around Algiers. The 2655th MCD also

gave technical assistance to other malaria

units in the theater. By 1 July the 19th,

20th, 21st, and 22d Malaria Control

Units (MCU's) were also in North Africa. The 14th MSU and the 23d MCU

arrived in September; the 28th and 42d

Malaria Control Units joined the

NATOUSA antimalaria forces in October.71

 Assignments were divided between

the base sections and the two armies in

the theater, units being shifted from one

location to another in terms of need.

Col. Loren D. Moore, commanding

officer of the 2655th Malaria Control

Detachment, was named theater malariologist in June, with Colonel Andrews

of the same organization as assistant

malariologist. Colonel Moore was relieved in September by Col. Paul F.

Russell. The theater malariologist was

responsible for all malaria control activities, including liaison with British and

69

 (1) Perrin H. Long, Historical Survey of the Activities of the Section of Preventive Medicine, Office of the Surgeon, NATOUSA, 3 January to

15 August 1943. Except as otherwise noted, this

section is based on the above document and on the

following: (2) Annual Rpt, Asst Malariologist,

NATOUSA, 1943; (3) Justin M. Andrews, "North

Africa, Italy, and the Islands of the Mediterranean,"

vol. VI, Communicable Diseases, Malaria, "Medical

Department, United States Army," subseries Preventive Medicine in World War II (Washington,

1963), ch. V; (4) Annual Rpt, Med Sec,

NATOUSA, 1943; (5) Rpts of the base sections for

1943; (6) Unit rpts of hosps, med bns, and army,

corps, and div surgs functioning in the Mediter- ranean in 1943.

70

 NATOUSA Cir No. 38, 20 Mar 43. 71

 Ltr, Blesse to TSG, 18 Oct 1943, Sub: Malaria

Organization, NATOUSA.
214 MEDITERRANEAN AND MINOR THEATERS

French authorities, and for the direction

of all organizations and personnel engaged in such work. This control extended to airplane crews engaged in the

dusting of breeding places. The malaria

program was thus highly centralized at

the theater headquarters level. Implementing the program was a command

responsibility, delegated by the Commanding General, NATOUSA, to the

Commanding General, Services of Supply, and the base section commanders,

who were periodically reminded of their

roles in the control of the disease. At the

same time, Colonel Russell used every

medium the theater afforded to educate

medical personnel in the fundamentals

of malaria control.72

Malaria control in North Africa and

Sicily during the period of greatest troop

concentration was only moderately successful. Experience with atabrine had

not been extensive enough to yield positive knowledge of the quantity to be

administered or the frequency with

which it should be taken, and the entire

suppressive therapy program received a

rude jolt from the violent reaction that

generally followed the third dose, taken

30 April 1943. Men who were already

reluctant avoided taking the drug whenever they could, with results that were

all too evident in the morbidity figures

for the Sicily Campaign.73

Other factors in the comparatively

poor showing of the first year in the

Mediterranean were the late arrival of

the malaria control units, which did not

get into effective operation until the

breeding season was well advanced; a

continuous shortage of trained malariologists; and numerous competing demands on engineering manpower, which

delayed drainage work and forced various improvisations. The groundwork

was nevertheless laid for an effective

control program in the 1944 and 1945

seasons, in the equally malarious Italian

communications zone.74 In the Mediterranean as a whole, noneffectiveness from

the disease was never great enough to

threaten the success of any military operation.

Diarrhea and Dysentery—North Africa

was a region, to quote the NATOUSA

consultant in medicine, "in which the

native considered practically every

square foot of ground a privy."75 Flies

were so thick in parts of Tunisia that it

was risky business to open one's mouth

to speak.76 Water was scarce and likely

to be contaminated. These conditions

made diarrhea and dysentery extremely

prevalent.

Among troops from countries such as

the United States and Great Britain,

where sanitation is taken so much for

granted that the individual feels little

personal responsibility for it, outbreaks

of these diseases were probably inevitable. They reached major proportions

in May, June, and July 1943, affecting

especially units newly arrived in the

theater and Tunisian veterans who

tended to let down after severe fighting.

72

 CG NATOUSA, to CG's, SOS, MBS, EBS, ABS,

and CD-MBS, 25 Jun 43 and 8 Jul 43. 73

 See p. 173, above.

74

 See pp. 354-57, below. Malaria control in the

combat zones is treated in the chapters dealing with

combat operations. 75

 Long, Hist Survey of Preventive Medicine. This

report and Annual Report Medical Section,

NATOUSA, 1943, are the primary sources for this

section. 76

 Brig. Gen. Albert W. Kenner, "Medical Service

in the North African Campaign," Bulletin U.S.

Army Medical Department (May 1944), pp. 83-84.
THE NORTH AFRICAN COMMUNICATIONS ZONE 215

It was apparent that sanitary discipline

among U.S. troops was poor, but sanitation improved rapidly once an organization had been "burned." Line officers,

as a rule, needed only one demonstration

to remind them of their responsibilities

in this regard.

Another factor in the high diarrhea

and dysentery rates in the summer of

1943 was the shortage of certain necessary equipment. Screening for mess halls,

kitchens, and latrines was not in adequate supply until August. Halazone

tablets for water purification by individuals were not always available in sufficient quantity, while facilities for boiling

water to cleanse mess kits were inadequate for most of the year.

Although both diarrhea and dysentery

continued to plague troops under combat conditions, they had ceased to be a

communications zone problem by the

late months of 1943.

Venereal Diseases—Venereal diseases

were widely prevalent in North Africa

and Sicily, and the opportunities for

contact were numerous. A full-time

venereal disease control officer, Lt. Col.

Leonard A. Dewey, was added to the

staff of the NATOUSA preventive medicine section early in March 1943, and a

month later similar officers were assigned

to each of the base sections and to the

major combat units, II Corps, Fifth

Army, and Twelfth Air Force.77

The initial control procedure in all

occupied areas was to allow troops to

have access to some or all of the local

brothels, and to establish prophylactic

stations in the immediate vicinity. After

extensive trial, during which there appeared to be no decrease in the number

of contacts made outside the houses, all

brothels were placed "off limits," with a

noticeable decline in the VD rate.

Both mechanical and chemical prophylactic kits were always available except for brief intervals in certain forward

areas, although the chemical kit was

found to be of little value. Considerable

difficulty was experienced, however, in

securing sufficient competent personnel

to operate "pro" stations in the numerous areas accessible to U.S. troops. Hospitals and other medical units were the

usual sources of such personnel, but the

heavy load being carried by all medical

installations in the North African communications zone precluded the detachment of enough trained men for the

purpose. During the last phase of the

Tunisia Campaign the clearing company

of the 1st Battalion, 16th Medical Regiment, operated a venereal disease diagnostic and treatment hospital south of

Constantine.

Other Preventive Medicine Problems—Aside from the special problems

discussed in the preceding pages, there

were no serious outbreaks of preventable

diseases in North Africa or Sicily before

the scene of primary activity shifted to

77

 Main sources for this section are: 1st Annual

Rpt, Med Sec, NATOUSA, 1943; (2) Pers Ltr,

Maj Gen James C. Magee, TSG, to Kenner, 1 Mar

43; (3) Ltr, Lt Col Leonard A. Dewey to Surg,

NATOUSA, 9 Apr 43, sub: Rpt of Inspection of

Venereal Disease Control Facilities in MBS and

ABS; (4) Ltr, Dewey to Surg, NATOUSA, 11 May

43, sub: Trip Rpt to MBS, ABS, and Hq, Fifth

Army; (5) Ltr. Dewey to Standlee, 22 Jul. 43, sub:

Problems in Venereal Disease Control in

NATOUSA; (6) Ltr, Gen Blesse, Surg, NATOUSA,

to Deputy Theater Commander, NATOUSA, 11

Aug 43, sub: Off Limits for Houses of Prostitution

as a Venereal Disease Control Measure; (7) Ltr,

Dewey to Surg, NATOUSA, 20 Oct 43, sub: Rpt

of Inspection of Venereal Disease Control and

Treatment Problems in the Palermo Area, Oct 13

to 17.
216 MEDITERRANEAN AND MINOR THEATERS

the Italian peninsula. Some 16,000 cases

of infectious hepatitis reported during

1943 among U.S. Army personnel led to

intensive study of the disease, which appeared considerably more prevalent in

Tunisia and Sicily than in Algeria or

Morocco, but, except for the last three

months of 1943, the rate was not excessive. Cases did not exceed 7 per 1,000

per year until September, climbing

rapidly to 108 in November and declining to 71 the following month.78

Although always a potential threat in

the Mediterranean, only twenty cases of

typhus were reported among U.S. personnel in the theater during 1943. An

outbreak of the disease in Naples toward

the end of the year is discussed elsewhere.79

 Preventive measures included

use of insecticide powders to control

body insects, and delousing of clothing.

Malaria control and survey units were

trained in mass delousing methods, as

were combat medical units and operating personnel of prisoner-of-war camps.

The Rockefeller Typhus Team aided

materially in demonstrating powdering

methods.

While respiratory diseases accounted

for a larger number of cases than any

other cause—63,899 in 1943—the overwhelming bulk of these were mild infections, following nonepidemic seasonal

trends and not seriously affecting military efficiency.80

The Reconditioning Program

Early in 1943 the 21st General Hospital at Sidi Bou Hanifia near Oran inaugurated a reconditioning program for its

convalescent patients, under which physical therapy was supplemented by light

work in and around the hospital. While

the program worked reasonably well, it

posed a serious problem of control as the

patients neared the time of discharge.

A similar but more difficult problem was

encountered at the 2d Convalescent Hospital, after that unit was set up in February, because of the smaller number of

officers in proportion to patients. From

a disciplinary point of view, it was simply impossible for a second lieutenant of

the Medical Administrative Corps to

control a convalescent company of 500

combat wounded men. In the line, even

a major would not be expected to control that many men without a complete

staff.81

The problem had become acute by

the end of the Tunisia Campaign. In

June the Commanding General, Mediterranean Base Section, authorized the

establishment of a Provisional Conditioning Battalion of four companies with

175 men each, to be operated by the

2d Convalescent Hospital. Lt. Col.

Lawrence M. Munhall, a field artillery

officer who was a patient in the hospital

was detailed to command the battalion,

which came to be known as the Combat

Conditioning Camp. Patients were used

as a training cadre, in a course lasting

three weeks. At the end of this time, the

78

 (1) Annual Rpt, Med Sec, NATOUSA, 1943

(2) Rpt on Study of Epidemic Hepatitis in

Tunisia, by Maj Guy H. Gowan. More serious outbreaks of hepatitis occurred among Fifth Army

troops in Italy. See pp. 256-57, 513, below. 79

 Annual Rpt, Med Sec, NATOUSA, 1943. See

pp. 362-65, below. 80

 Annual Rpt, Med Sec, NATOUSA, 1943.

81

 (1) Annual Rpt, 21st Gen Hosp, 1943. (2)

Recorded Interv Lt Munden, and Sgt Zelen, with

Lt Col Lawrence M. Munhall, 28 Jun 45. (3)

Clift, Field Opns, pp. 397-99.
THE NORTH AFRICAN COMMUNICATIONS ZONE 217

men were transferred to a replacement

center.82

The Surgeon General, Maj. Gen.

Norman T. Kirk, visited the theater in

June 1943 and took cognizance of the

problem. He undertook to have a Table

of Organization for a convalescent center, similar to those operated by the

British, prepared in his office. The units

were to be set up near parent general

hospitals. In line with the Surgeon General's directions, British convalescent

facilities were visited to study their

organization and operations.83

As a result of these various approaches

to the problem, the Combat Conditioning Camp of the 2d Convalescent Hospital was activated as the 6706th Conditioning Company Pool on 1 November

1943, with its own Table of Organization. It was thus cut off from the hospital

entirely and was moved to a new area

about a mile away, where it remained

until it was transferred to Italy in the

spring of 1944. All patients in need of

reconditioning on discharge from the

hospital were transferred to this unit,

which remained under command of Colonel Munhall.84

A similar reconditioning center for

the Eastern Base Section was set up at

the 105th Station Hospital in Ferryville.

Normally a 500-bed unit, the 105th Station became an acting convalescent

hospital in September 1943 and by January 1944 had a census of 2,500 patients.

In order to control these men and to

restore as many as possible to active duty,

an EBS Conditioning Center was set up

under command of Col. Gerald P. Lawrence, including both the hospital and a

replacement battalion. As rapidly as

their physical condition permitted, the

men were placed in one of four training

companies, physically removed from the

hospital and its atmosphere. While medical officers kept close check on "trainees"

as they were now called, the primary

supervision was by personnel of the replacement battalion. The EBS Reconditioning Center declined in importance

with the decline of the base section and

was closed out early in May, having

handled 5,000 trainees in three

months.85

Dental Service

The chief dental officer for the North

African theater was Lt. Col. (later Col.)

Egbert W. D. Cowan until the end of

February 1943, when personnel limits in

the NATOUSA medical section necessitated his transfer to the Services of Supply. Colonel Cowan returned to his old

assignment on 1 June, when the position

of dental surgeon was authorized for the

medical section of theater headquarters,

but was assigned to Fifth Army in August. He was succeeded as NATOUSA

dental officer on 17 August 1943 by Col.

Lynn H. Tingay.86

At the theater level, the functions of

82

 (1) Lt Col William C. Munly, Med Inspector,

NATOUSA, to Surg, NATOUSA, 2 Jul 43, sub:

Inspection of Medical Activities, ABS and MBS.

(2) Munhall Interv. (3) Annual Rpt, 2d Conv

Hosp, 1943. 83

 (1) Memo, Col Stone to Gen Blesse, 7 Aug 43.

(2) Ltr, Maj James H. Townsend and Capt Lewis

T. Stoneburner to Surg, NATOUSA, 30 Aug 43,

covering rpt on British rehabilitation program.

(3) Ltr, Blesse to Deputy Theater Commander, 12

Sep 43, sub: Study of Convalescent Care Facilities,

NATOUSA. 84(1) Annual Rpt, 2d Conv Hosp, 1943. (2)

Munhall Interv. See also p. 357, below.

85

 Rpt on Experimental Conditioning Center:

Operations, Results, Conclusions, and Recommendations. By Col Lawrence, 14 Apr 45. 86

 Annual Rpt, Med Sec, NATOUSA, 1943.
218 MEDITERRANEAN AND MINOR THEATERS

the dental surgeon were primarily administrative and supervisory. He was responsible for the provision of adequate

dental service to all military personnel

within the jurisdiction, which in 1943

was a considerable undertaking. There

were 310 dental officers in the North

African theater at the end of January

1943 and 703 at the end of December,

but this increase in numbers was proportionately less than the over-all rise in

troop strength. In January there was one

dental officer for each 740 military personnel; in December only one for each

861.

The problem was further complicated

by the presence of a considerable number of units with no dental officer in

their T/O's. These units were given outpatient care by Army hospitals when

such were available, but where no hospital was established in the vicinity, it was

necessary to detach dental personnel for

temporary duty with the unit.

The drastic lowering of dental standards for induction into the Army during

1942, reaching the irreducible minimum

in October just before the TORCH operation was launched, put a severe and unexpected strain on the facilities of the

theater. In the troop build-up of 1943,

numbers of men reached North Africa

with insufficient teeth to masticate the

Army ration, but prosthetic equipment

for dealing with these cases was not available until late in the year.87

The dental service in the theater

showed progressive improvement with

each campaign as personnel gained experience and facilities came to correspond more closely with needs.88

Veterinary Service

The veterinary section of the

NATOUSA medical organization was

slow in getting started. The first theater

veterinarian, Lt. Col. (later Col.) Solon

B. Renshaw, served only from December

1942 through February 1943. He was

transferred at that time to SOS, NATOUSA, because there was no provision

for a veterinarian in the limited allotment of personnel to the medical section. The position of theater veterinarian was approved late in April 1943,

but was not filled until February 1944,

when Col. James E. Noonan was assigned.89

A group of twelve veterinary officers

arrived in the theater in September, having been requested by the quartermaster

for inspection work in connection with

local slaughterhouses, but until this program got under way, they were assigned

to replacement pools and used for temporary duty. Since there was no central

organization for placing veterinary personnel where they were needed, a considerable amount of waste was entailed,

with some impairment of morale.

There was also a disproportionately

87

 (1) Ibid. (2) Col George F. Jeffcott, United

States Army Dental Service in World War II, "Medical Department, United States Army" (Washington, 1955), pp. 211-12. (3) Ebbe Curtis Hoff, M.D.

ed., Personal Health Measures and Immunization,

"Medical Department, United States Army" subseries Preventive Medicine in World War II

(Washington, 1955), p. 4.

88

 For dental service in combat operations see

the chapters devoted to specific campaigns. 89

 (1) Mundon, Administration of Medical Dept

in MTOUSA, p. 213. (2) Annual Rpt, Med Sec,

NATOUSA, 1943. See also, Lt. Col. Everett B.

Miller, "Medical Department, United States Army,"

United States Army Veterinary Service in World

War II (Washington, 1961).
THE NORTH AFRICAN COMMUNICATIONS ZONE 219

high loss of food items through improper

packaging, handling, and storage, which

can be attributed only in part to the

greater activity of the Mediterranean as

compared with other theaters of operation. The comparative weakness of the

veterinary service in NATOUSA was

clearly apparent by the end of the year,

when positive steps were taken to reorganize veterinary activities at theater

and base section levels.

 90

Nursing Service

Until 14 August 1943, when the position of Director of Nurses, NATOUSA,

was created, the chief nurse of the Mediterranean Base Section, 2d Lt. (later Lt.

Col.) Bernice M. Wilbur acted in that

capacity. Colonel Wilbur became director of nurses when the position was set

up. She made regular inspections of

nursing activities throughout the theater, advised the surgeon as to policy matters, and recommended assignment and

transfer of nursing personnel.91

Nurses began arriving in the theater

on 8 November 1942, D-day for the

North African landings. There were

more than 2,000 by the end of the Tunisia Campaign, with a peak strength of

4,398 in October 1943. This figure had

dropped to 4,000 by the end of January

1944, owing to the transfer of three evacuation hospitals and an auxiliary surgical group to the European theater in

November.

While the number of nurses in the

North African theater was adequate in

terms of hospital T/O's, the recurrent

necessity for operating above normal bed

capacity brought considerable strain on

the nursing service. Wherever possible

nurses from staging units were detached

for temporary duty with operating hospitals. After October 1943, when the

required authority was received from

the War Department, promotions were

made to raise half of all front line nurses

to the rank of first lieutenant.

Training was a continuous process,

with frequent changes in assignment to

assure proper balance of specialties. The

only severe shortages during the active

period in the North African communications zone were nurses trained in

anesthesia and in psychiatry. To make

up these shortages, several general hospitals gave individual training in anesthesia, while a school of psychiatric nursing

was conducted by the 114th Station

Hospital. The courses ran for 6 weeks,

taking fifty nurses at a time. Three

classes completed the training during

1943. Twenty-four British nurses took

the course.

Army Public Health Activities

Allied Force Headquarters as originally organized in London in the summer and early fall of 1942 included a

civil affairs section, which combined

with its military functions others of a

political, diplomatic, and economic nature. It was headed after the invasion

by Robert Murphy, the principal U.S.

diplomatic representative in French

North Africa. Public health activities

90

 (1) Memo, Col Noonan to Surg MTOUSA, 11

Apr 45. (2) Ltr, Lt Col (later Col) Duance L.

Cady to Surg, NATOUSA, 21 Dec 43, sub: Investigation and Survey of Veterinary Activities in

NATOUSA. 91

 Annual Rpt, Med Sec, NATOUSA, 1943. See

also, Maj Anne F. Parsons, and others, MS, History

of the Army Nurse Corps in the Mediterranean

Theater of Operations, 1942-1945.
220 MEDITERRANEAN AND MINOR THEATERS

were administered by a subsection of the

civil affairs section.92

The situation in North Africa was

without precedent. The political objectives, and to a considerable extent the

military objectives as well, demanded

that the local population be treated as

allies. Civil officials were not always cordial, and co-operation was often grudging, but in the public health area

especially it was essential for the protection of American forces that elementary

sanitary measures be extended to the

civilian inhabitants.98

At Mr. Murphy's request, three United

States Public Health Service doctors

were detailed to AFHQ late in February

1943 and assigned on their arrival a

month later to the nominally independent North African Economic Board.

Shortly thereafter they were attached to

the office of the NATOUSA surgeon, to

serve as liaison between that office and

the local health authorities. Another doctor and a sanitary engineer joined the

group in July.94

Before the arrival of the Public

Health Service officers, representatives

of the U.S. component of the medical

section, AFHQ, had met with French

officials and had agreed upon supplies to

be furnished, particularly for control of

malaria and such potential threats as

cholera and typhus. The surgeons of the

Mediterranean and Atlantic Base Sections also maintained informal liaison

with local health authorities. After the

attachment of Public Health Service

representatives to the NATOUSA surgeon's office, the over-all direction of a

civil public health program passed to

them, but Army personnel continued to

play the dominant role in carrying out

such measures as were required.95

By the date of the invasion of Sicily,

a special organization for Allied Military Government of Occupied Territory

(AMGOT) had been set up under a

British major general, Lord Rennell,

who was also chief civil affairs officer on

the staff of the Allied Military Governor

of Sicily, General Alexander of the 15th

Army Group. The senior civil affairs

officer of Seventh Army, Col. Charles A.

Poletti, headed a group of seventeen

civil affairs officers who went in with the

invasion forces, setting up military government organizations behind the advancing troops. The principal U.S. public health officer for the Sicily Campaign

was Maj. (later Lt. Col.) Leonard A.

Scheele. Major Scheele participated in

the planning for the Sicilian operation,

serving as executive officer and later as

deputy to Col. D. Gordon Cheyne, the

British officer in charge of public health

activities for the 15th Army Group. In

the latter capacity, Scheele succeeded

92 Col. (later Brig. Gen.) Edgar Erskine (1) Robert W. Komer, MS, Civil Affairs and

Military Government in the Mediterranean Theater, ch. I, in OCMH files. (2) Harry L. Coles and

Albert Weinberg, Civil Affairs; Soldiers Become

Governors, UNITED STATES ARMY IN WORLD

WAR II (Washington, 1963). 93

 For the attitude of French officials, see Eisenhower, Crusade in Europe, pp. 111-12. 94

 Ralph C. Williams, The United States Public

Health Service, 1798-1950 (Washington, 1951), pp.

95

 (1) Annual Rpt, Med Sec, NATOUSA, 1943.

(2) Long, Hist Survey of Activities of Section of Preventiv Aug 43e. Medicine (3) Surg,, NATOUSA Off of Surg, Journal NATOUSA , 12,, 1 37 Jan-1 Aug,5 6

Sep 43. (4) Hutter, "Medical Service of the Mediterranean Base Section, Military Surgeon (January

1945). PP. 41-51.
THE NORTH AFRICAN COMMUNICATIONS ZONE 221

Hume, who was to accompany Fifth

Army to Italy.96

In both Africa and Sicily, Medical Department officers assigned to AMGOT

worked to restore local public health

departments, to rebuild water and sewerage systems, and revitalize normal public health services. Local officials were

reinforced by Army medical personnel

and supplies wherever necessary to protect the health of troops in the area.

Among the problems commonly dealt

with were sanitation, threatened epidemics, care of destitute refugees, and

the control of such ever-present scourges

as malaria and venereal disease.97

Public health officers at the theater

level made surveys to determine the

status of hospital facilities, the need for

medical supplies for relief purposes, the

nutritional needs of the population, the

presence of epidemic diseases, and the

possibility of the introduction of new

diseases by insect vectors on planes and

by returning refugees. As combat operations by the Allies produced relatively

little devastation in the French colonies

in North Africa, U.S. Army participation

in the public health program in these

areas was largely limited to aid given by

a few men trained in public health work

to the French authorities after the cessa96 tion of hostilities. (1) Komer, Civil Affairs and Military Government in the Mediterranean Theater, ch. II. (2)

Williams, The United States Public Health Service,

pp. 698-99. (3) Ltr, D. Gordon Cheyne to

DCCAO, 4 Jul 43, sub: Territorial Assignment of

Public Health Div Personnel. 97

 See: (1) Ltr, Col Long to Surg, NATOUSA, 27

Mar 43, sub: Rpt on the Sessions of the Committee

on Hygiene and Epidemiology Technical Section

for Public Health, French High Commissioner

of North Africa; (2) Proceedings of Public Health

Meeting, 13 Aug 43.
CHAPTER VI

Salerno to the Gustav Line

By 10 July 1943, when the invasion of

Sicily was launched, Lt. Gen. Mark W.

dark's Fifth Army had been training in

North Africa for six months without any

specific objective. Alternative plans had

been prepared for operations against

Sardinia and for landings at various

points in southern Italy, but a final

choice was deferred until the end of the

Sicily Campaign was in sight. The successful bombing of Rome on 19 July

helped tip the scales in favor of the Italian mainland. The Combined Chiefs of

Staff approved Operation AVALANCHE

for the Naples area on 26 July, the day

after the fall of Mussolini.1 The site was

eventually narrowed to Salerno and the

target date fixed as 9 September.

The Italian campaign was never an

end in itself. It was not intended to

strike a decisive blow at Germany

through the back door. Two of its purposes were to tie down enemy troops and

acquire additional bases for air attacks

on German centers of production and

communications. After strategic air bases

in southern Italy were secured, the

campaign would become a giant holding

operation, the success of which would

be measured not in territory gained but

by the size of the enemy force immobilized. It was recognized from the

beginning that Italy would require appreciable quantities of food, clothing,

fuel, and medical supplies to maintain

her civilian population. The anticipated

gains nevertheless appeared to outweigh

this additional logistical burden.2

As in earlier Mediterranean campaigns, operations in Italy were to employ both American and British troops.

The invading force was again to be the

15th Army Group, under command of

General Alexander, although Fifth

1

 General sources for the Salerno-Gustav Line

campaigns are: 1st Fifth Army History, pt. I,

From Activation to the Fall of Naples, pt. II,

Across the Volturno to the Winter Line, pt. III,

The Winter Line, pt. IV, Cassino and Anzio (Florence, Italy: L'lmpronta Press, 1945; (2) Chester

G. Starr, ed., From Salerno to the Alps; A History

of the Fifth Army, 1943-1945 (Washington: Infantry Journal Press, 1948); (3) AMERICAN

FORCES IN ACTION, Salerno; American Operations from the Beaches to the Volturno (Washington, 1944), From the Volturno to the Winter Line

(Washington, 1944), and Fifth Army at the Winter

Line (Washington, 1945); (4) Craven and Cate,

eds., Europe-TORCH to POINTBLANK; (5)

Morison, Sicily-Salerno-Anzio; (6) Field Marshal

the Viscount Alexander of Tunis, "The Allied

Armies in Italy from 3rd September, 1943, to 12th

December, 1944," Supplement to the London Gazette, 6 June 1950, pp. 2879-2918; (7) Mark W.

Clark, Calculated Risk (New York: Harper and

Brothers, 1950), pp. 183-282, 311-33; (8) Truscott,

Command Missions; (9) Eisenhower, Crusade in

Europe; (10) Kesselring, A Soldier's Record; (11)

S. Sgt. Richard A. Huff, ed., The Fighting Thirtysixth (San Angelo, Tex: Newsfoto Publishing Co.,

1946), unpaged; (12) Taggart, ed., History of the

Third Infantry Division in World War II; (13)

Dawson, ed., Saga of the All American; (14) The

Fighting Forty-fifth; (15) Howe, 1st Armored Division. 2

 (1) Clark, Calculated Risk, p. 3. (2) Army

Service Forces, Final Report, Logistics in World

War II (Washington, 1947), p. 39. (3) Logistical

History of NATOUSA-MTOUSA, pp. 331-40.
SALERNO TO THE GUSTAV LINE 223

Army would replace Seventh Army with

some reshuffling of combat elements.

Montgomery's British Eighth Army

was to cross the Strait of Messina and

move over the instep of the Italian boot

to seize the important Foggia air base on

the Adriatic side of the peninsula. Clark's

Fifth Army was to expand northward

from the Salerno beachhead to occupy

the vital port of Naples. Operations in

Italy thereafter would be determined by

circumstances and by Allied strategy for

the war as a whole.

Fifth Army was to consist initially of

two corps, one British and one American. The British 10 Corps, commanded

by Lt. Gen. Sir Richard L. McCreery,

included an armored and 2 infantry

divisions, augmented by 2 Commando

units and 3 American Ranger battalions.

The U.S. VI Corps, under Maj. Gen.

Ernest J. Dawley, included 1 airborne,

1 armored, and 4 infantry divisions. The

assault troops were to be the British

46th and 56th Infantry Divisions, the

Commandos, the Rangers, and the

American 36th Infantry Division, the

last without previous combat experience

but fresh from intensive training in both

amphibious and mountain warfare.

Two regimental combat teams of the

45th Division, which had been diverted

to Fifth Army midway through the

Sicily Campaign, were to constitute a

floating reserve. The 34th, which had

seen hard fighting in Tunisia, and the

3d, which had participated in the TORCH

landings and fought throughout the campaign in Sicily, were to be brought in as

rapidly as shipping became available.

The British 7th Armoured and the U.S.

1st Armored Divisions were to be held

back for later use, when terrain and

circumstances warranted.

Medical Plans for AVALANCHE

Fifth Army was activated on 5 January 1943, with headquarters at Oujda,

French Morocco. It was the first American field army organized overseas during

World War II. The medical section,

drawn in part from personnel of the

task forces and in part from the United

States, was initially headed by General

Blesse. Col. (later Maj. Gen.) Joseph

I. Martin became Fifth Army surgeon in

April when Blesse became Surgeon,

NATOUSA.3

By way of preparation for its still unspecified mission, Fifth Army established

various specialized training centers, including the Invasion Training Center at

Arzew, Algeria, devoted to amphibious

tactics. Medical personnel participated

in all training exercises. The surgeon

and members of his staff made frequent

inspections of medical operations in the

theater, including observations of combat on the Tunisian front. From time

to time members of the medical section

were placed on temporary duty with the

British First and Eighth Armies in Tunisia in order to study the organization

of the British medical service and its

methods of hospitalization and evacuation.

Medical planning for the Salerno assault was directed by Colonel Martin,

with Col. Jarrett M. Huddleston, the VI

Corps surgeon, participating in matters

affecting the corps. A British medical

officer representing 10 Corps was detailed

to the planning group, and close liaison

3

 Except as otherwise noted, sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA,

1943; (2) Annual Rpt, Surg, Fifth Army, 1943; (3)

Glenn Clift. Field Opns, pp. 203-19; (4) Zelen,

Hospitalization and Evacuation in MTOUSA; (5)

Unit rpts of med units mentioned in the text.
224 MEDITERRANEAN AND MINOR THEATERS

GENERAL MARTIN

was maintained throughout with the

medical section of Allied Force Headquarters. With certain important variations, the plans for medical service in

Italy followed those carried out in

Sicily.

Combat Medical Service

In addition to the medical detachments and medical battalions organic to

the divisions committed, plans for the

Italian campaign called for the use of

one ambulance company and four medical battalions to be controlled by VI

Corps. One of these—the 261st Amphibious Medical Battalion, specially

trained for beach operations—could not

be spared from Sicily and the 52d was

substituted. The other separate medical

battalions on the original troop list were

the 54th, the 161st, and 162d.

The two latter units were reorganized

just before the Salerno operation from

the 1st and 2d Battalions, respectively,

of the 16th Medical Regiment, which

went out of existence at this time. Both

battalions had seen combat service in

Tunisia. Only the 162d was scheduled

for the D-day convoy, so that it alone

was organized into three collecting-clearing companies on the Sicilian model. It

was the 162d Battalion that drew the

beach assignment.

If this combat medical support seems

inadequate in comparison to that employed in the Sicily Campaign, it must

be remembered that the Salerno assault

was to be made over only one relatively

narrow beach and that only two American divisions were to be used, in contrast to the 4-division, multiple-beach

assault in Sicily. A difference of emphasis

in the plans for Italy would also bring

evacuation hospitals into action at an

earlier stage of the fighting. As was true

in the Sicilian operation, all medical

units to be employed in the Salerno

landings were given rigorous training

in amphibious warfare, along with the

combat elements they were to serve.

The combat medical units were to be

supported by elements of the 4th Medical Supply Depot on the D-day convoy.

In addition to the regular maintenance

allowances, medical personnel in the

assault were to carry extra supplies of

critical items such as plasma, litters,

blankets, atabrine, plaster of paris, dressings, and biologicals. Medical supplies in

specially designed containers were also

to be carried ashore by the combat

troops. Developed at the Fifth Army Invasion Training Center, these containers

were made from empty mortar shell

cases, were waterproof, and would float
SALERNO TO THE GUSTAV LINE 225

easily. Maximum weight was seventy

pounds.

Hospitalization

Plans for hospitalization, both in the

assault phase and in subsequent stages

of the campaign, took full account of

delays and deficiencies in bed strength

experienced in previous Mediterranean

operations. As in Sicily, each division

(except airborne) was to be supported

by one 400-bed evacuation hospital. The

number of 750-bed evacuation hospitals

assigned to Fifth Army, however, was

double the previous allowance of one

for each two divisions. General Blesse,

who had been willing to abandon the

750-bed evacuation altogether after the

campaign in southern Tunisia, had come

to regard it as a most valuable unit when

properly used.4 In addition, four field

hospitals, and a fifth less one platoon,

were scheduled for the use of U.S.

ground forces in Italy.

The 400-bed evacuation hospitals on

the Fifth Army troop list were the 15th,

with combat experience in both Tunisia

and Sicily; the 93d, with Sicilian experience; and the 94th and 95th, both of

which had served as fixed units in Africa.

The 750-bed evacuation hospitals were

the 38th, with Tunisian experience; and

the 8th, 16th, and 56th, all of which had

operated as fixed hospitals in the theater. Field hospitals on the troop list

were the 4th, less one platoon, with experience in the Middle East; the 10th

and 11th from Sicily; and the 32d and

33d, direct from the United States. The

3,000-bed 3d Convalescent Hospital was

also assigned to Fifth Army for duty in

the combat zone.

These mobile units were to be fol

lowed into Italy within 45 days by six

500-bed station hospitals and four 1,000-

bed generals. The troop list also called

for the early arrival of a general dispensary, a food inspection detachment, a

hospital train, 2 medical laboratories, 2

medical supply depots, and 3 malaria

control units.5

The troop list thus called for 9,500

mobile beds and 7,000 fixed beds, to be

phased in as rapidly as the progress of

the campaign and the availability of

shipping permitted. Beyond this point

the preinvasion planning did not extend.

The further build-up of hospitals in

Italy would be determined by events.

The pattern for the use of mobile

hospitals laid down in plans for the

beach interlude of the Italian campaign

differed sharply from the plans followed

in Sicily. In the earlier campaign, field

hospital platoons with attached surgical

teams had gone in with the D-day convoy, but no evacuation hospitals had

been sent to Sicily before D plus 4. In

the Italian plans, nine teams of the 2d

Auxiliary Surgical Group were to be in

the assault wave, attached to the divisional clearing platoons and to the beach

battalion. Field hospitals were scheduled

for later convoys, to be used only after

the beachhead was secure; but two evacuation hospitals, the 95th (400 beds)

and the 16th (750 beds), without their

nurses, were to be on the D-day convoy.

The nurses were to come on D plus 2.

In spite of the emphasis on the early

provision of adequate hospitalization in

Italy, it would still be necessary for 4

 Col T. H. Wickert, Rpt of Visit to ETO and

NATOUSA, 1 Sep to 24 Oct 43. 5

 See pp. 327ff., below.
226 MEDITERRANEAN AND MINOR THEATERS

hospitals in the Bizerte-Tunis area to

carry the primary burden until sufficient

fixed beds could be established on the

peninsula. The Eastern Base Section was

directed accordingly to make 450 beds

a day available from D plus 4 through

D plus 30. Corresponding arrangements

were made to shift patients to the Constantine, Oran, and Casablanca areas to

provide the needed beds.6

Evacuation

Plans for evacuation from the Salerno

beachhead followed the Sicilian pattern.

The Navy was again to be responsible

for personnel on naval vessels between

ports of embarkation and the high-water

mark on the landing beaches. During the

first three days of the operation, American casualties were to be evacuated to

North Africa on troop transports, in

care of naval medical personnel, but

LST's with Army medical attendants

aboard would also be available if

needed.7 Thereafter, hospital ships were

to be used, under direct control of Allied

Force Headquarters. Two British hospital ships were to begin evacuation from

U. S. beaches at dawn on D plus 3, and a

third British vessel was to follow twentyfour hours later. The casualties in each

case were to go to Bizerte. On and after D

plus 5, hospital ships were to be dispatched to Italy on request of Fifth

Army, and routed back to such North

African ports as AFHQ might designate.8

Air evacuation was also to follow the

general pattern used in Sicily, with the

802d Medical Air Evacuation Transport

Squadron again drawing the assignment.

This time, however, litters and blankets

were given top priority on air transports

from North Africa and Sicily, rather

than being left for slower and less certain transportation by water. Air evacuation was to start as soon as suitable

landing fields were available, tentatively

forecast for D plus 7.9

Medical Support in the

Conquest of Southern Italy

Salerno Beachhead

The Salerno landings took place as

planned on the early morning of 9 September 1943. The surrender of Italy, announced over radio to the troops of Fifth

Army and to the world by General Eisenhower a few hours earlier, in no way

lessened the hazard of the operation.

Veteran German troops, including armor and heavy guns, were already

alerted in the area, with reinforcements

close at hand. Mine fields held the transports twelve miles offshore and forced

loaded landing craft to stand by for

hours at their assembly points while

channels were being cleared. All of the

assault waves were met by heavy fire.10

6

 AFHQ Msg 7235, Surg to CO EBS, CG MBS,

CG Fifth Army, 28 Aug 43. See also pp. 196-197,

above. 7

 Each LST had one medical officer and two enlisted men from the Medical Department. The

officers were detached from the 23d General Hospital, then staging at Casablanca, and the enlisted

men were drawn from a replacement depot in the

Eastern Base Section. Surg, NATOUSA, Journal,

24 Aug 43.

8

 The Italian Campaign, Western Naval Task

Force: Action Rpt of the Salerno Landings, SepOct 43, pp. 213-16. 9

 (1) Med Hist, 802d MAETS, 1942-44. (2) Med

Hist, Twelfth Air Force. 10

 (1) The Italian Campaign, Western Naval Task

Force: Action Rpt of the Salerno Landings, SepOct 43. (2) Opns Rpt, VI Corps, Sep 43. (3)

Fifth Army History, pt. I, pp. 31-42. See also, addi- tional sources cited at the beginning of this chapter.
SALERNO TO THE GUSTAV LINE 227

The first U.S. combat teams ashore,

the 141st and the 142d, met stiff opposition. One battalion of the 141st was

pinned down on the beach for more than

twelve hours, but other elements of the

36th Division advanced inland up to

three miles. Similar gains were made in

the British sector, with Ranger spearheads on the extreme left flank penetrating as far as five miles. The first day's

fighting included German tank attacks

against infantry positions. As in Sicily,

the tanks were turned back by bazookas,

grenades, and accurately directed fire

from naval guns, as well as by artillery.

Medical Service in the Assault—Collecting companies of the 111 th Medical

Battalion, organic to the 36th Division,

were split for the assault into three sections, each consisting of one medical

officer and twenty-two litter bearers.

One section accompanied each battalion

landing team, working directly with personnel of the battalion aid station. For

the first several hours of combat, medics

could do little more than administer

first aid. Casualties were left in ditches

and foxholes, or behind dunes—whereever cover of any sort could be found—

until darkness made it possible to move

them. Two of the three collecting companies of the 111th were assembled by

late afternoon and set up their stations

on the fringes of the ancient walled

town of Paestum. The clearing company

landed toward evening, but could not

establish station until its equipment

was unloaded on D plus 1.

The only clearing stations in operation

on D-day were two set up by the 162d

Medical Battalion, which constituted

part of the beach group attached to the

531 st Engineer Shore Regiment. The

beach group also included the medical

section of the 4th Naval Shore Battalion and a supply dump established

about noon by a detachment of the 4th

Medical Supply Depot.

Casualties were gradually collected as

stations were set up, and before dawn

of D plus 1 substantial numbers had

reached the beach installations. All units

were shorthanded, with some men yet

to come ashore and others wounded or

separated from their outfits. In the circumstances, it was impossible to follow

any rigid doctrine. Casualties were

brought to the beach by whatever means

were at hand, including ambulances,

jeeps, trucks, and hand-carried litters.

In some instances the naval shore battalion sent its own medical officers and

corpsmen inland to work with the Army

doctors and help bring out the wounded.

Casualties were evacuated to the

transports by the naval shore battalion

as opportunity offered and as small craft

were available. The total from the

American sector through D plus 1 was

678.11

The 179th Regimental Combat Team

of the 45th Division was committed from

the floating reserve early on 10 September, D plus 1, followed by the 157th

RCT the next day. Again each battalion

landing team was accompanied by its

The medical sources primarily relied upon for the

assault phase are: (4) Annual Rpt, Med Sec,

NATOUSA, 1943; (5) Annual Rpt, Surg, Fifth

Army, 1943; (6) Annual Rpt, Surg, VI Corps, 1943;

(7) Unit rpts of div surgs, med bns, hosps, and

other med units mentioned in the text.

11

 This figure, from the Report of the Fifth Army

Surgeon for 1943, is considerably higher than the

total of 430 for the same 2-day period listed in the

records of the Peninsular Base Section later. The

larger figure presumably includes Navy as well as

Army casualties. See also, Table 19, p. 343, below.
228 MEDITERRANEAN AND MINOR THEATERS

LITTER BEARERS WADING TO LANDING CRAFT OFF SALERNO, 9 SEPTEMBER

own aid station personnel and by a litter

section of the organic medical battalion,

in this case the 120th. Collecting companies were assembled within a few

hours. The clearing company of the

120th, although it had been divided into

three detachments for the landings, was

reassembled on the afternoon of 10 September and opened station near Paestum on the 11th.

Evacuation from the front was following a normal pattern by D plus 2,

although lengthening lines continued to

be under intermittent fire. Even the

beach installations were not secure as

enemy planes were still in the air. One

German plane was shot down and exploded a hundred yards from the clearing station of the 120th Medical Battalion. "Patients carried in but a few hours

before," observed the battalion historian, "displayed unusual agility in

jumping from operating tables into

foxholes.12

Only 128 casualties were evacuated

seaward on D plus 2 because of a shortage of small craft, which were being

used to unload ammunition, and there

was no evacuation at all on D plus 3,

12 September. The hospital ship Newfoundland stood offshore until dusk but

was ordered to move fifty miles out to

12

 Hist, 120th Med Bn, Sep 43.
SALERNO TO THE GUSTAV LINE 229

PLANNERS OF THE INVASION OF ITALY. Generals Truscott, Eisenhower, Clark, and Lucas.

sea for the night, so that her lights would

not guide enemy planes to the transport

area. She was bombed and sunk before

she could return the next morning. Evacuation by hospital ship actually began

on 13 September, D plus 4; air evacuation started four days later.

Facilities for holding casualties ashore

were still inadequate, despite careful

planning to avoid just such a contingency.13

 Personnel of the 95th and 16th

Evacuation Hospitals had landed about

noon on D-day, but their equipment was

scattered and suitable sites were not yet

available. The 95th had 250 of its 400

beds ready for occupancy by 0600 on 12

September. The larger 16th was not

able to get into operation until midnight

14-15 September. Both units were in the

vicinity of Paestum. The nurses of both

hospitals had been aboard the Newfoundland when that vessel was

bombed. Some suffered minor injuries,

and all lost personal belongings. The

nurses were carried back to Africa by

rescuing ships and did not rejoin their

units until 25 September. 13

 Surg, NATOUSA, Journal, 13 Sep 43.
230 MEDITERRANEAN AND MINOR THEATERS

The beach clearing stations of the 162d

Medical Battalion were no longer

needed by 13 September and were

closed on that date. For the remainder

of the beach phase of the operation casualties were evacuated by collecting companies of the 162d Medical Battalion

directly from the division clearing stations to the evacuation hospitals, and

thence to ships or planes. No other corps

or army medical battalions were available until after the breakout.

A massive German counterattack

launched on 13 September drove a deep

wedge between the British and American salients, penetrating to within three

miles of the beach, but the ground

troops finally stopped the attack with

the aid of naval gunfire and Allied

planes. The 504th Parachute Infantry

Regiment of the 82d Airborne Division

was dropped behind enemy lines at this

time. With Eighth Army closing in from

the south, the Germans had no time for

another attempt. They withdrew slowly,

fighting all the way, but by 20 September the beachhead was secure.

Coinciding with the German withdrawal there was a regrouping and reassignment of U.S. units. Maj. Gen. John

P. Lucas took command of VI Corps

from General Dawley on 20 September.

The 3d Division replaced the battleweary 36th in the line, and the 34th Division, which reached Salerno at about

the same time, went into reserve. On

the 10 Corps front, the British 7th Armoured Division entered combat.

The next phase of the campaign would

carry the Allied forces to Naples and

to the Volturno River beyond. The 7th

Armoured and the 82d Airborne Divisions moved up the coast on the left

flank, followed by the British 46th Division. The British 56th, a few miles

inland, drove for Capua, while the 3d

struck toward the Volturno by way of

Avellino. The 45th, on the right flank,

swung out in a wide arc toward Benevento, where the 34th, operating to the

right of the 3d since 26 September,

caught up. Attached to the 34th was the

100th Battalion, made up of Americanborn Japanese, which would later be

part of the 442d Regiment.

Hospitalization on the BeachheadAll army medical units reverted to army

control on 21 September. By this date

the build-up of medical facilities was

substantial, with new units arriving

steadily as the campaign moved northward. The 3d and 34th Divisions were

accompanied by their organic medical

battalions, the 3d and 109th, respectively. The 93d Evacuation Hospital

reached the area on 15 September, opening at Paestum the following day. The

94th, which arrived about the same

time, was established at Battipaglia a

week later. The 8th and 38th Evacuation

Hospitals, both 750-bed units, and the

52d Medical Battalion disembarked on

21 September, although all equipment

belonging to the 8th was lost by enemy

action. Still another 750-bed evacuation,

the 56th, reached the beachhead on 27

September, followed next day by the

161st Medical Battalion.

Despite the number of hospitals

ashore, beds remained at a premium

during the entire month of September.

Many units were slow in getting into operation because equipment was lost or

delayed. The rapid troop build-up made

heavy demands on hospital facilities, and

the disease rate—especially from malaria—was higher than had been antici-
SALERNO TO THE GUSTAV LINE 231

pated. Typical was the experience of the

95th Evacuation Hospital, first U.S. hospital to be established on the European

continent in World War II. The hospital's commander, Lt. Col. (later Col.)

Paul K. Sauer, reported:

At times we were overfilled to such an

extent that all cots were in use, other pa- tients remained on the litters on which

they had been brought to us in lieu of

cots, and others were given two blankets

to enable them to sleep on the ground. When the tents were filled to capacity, patients were laid on the outside along the

walls of the tents with their heads inside

and their bodies outside. On one night

even this method was insufficient to take

care of all the patients and forty of them

slept under the open sky between the tents. Fortunately the weather was balmy and

dry.14

The weather did not long remain

either balmy or dry. On the night of 28

September a violent storm leveled the

tents of the 16th Evacuation Hospital,

where 961 patients were being cared for,

and did severe damage to the installations of the 95th. By heroic effort, all

patients were rescued without injury and

moved to a tobacco warehouse about a

mile away, made available for the emergency by Services of Supply. There they

were temporarily cared for by personnel

of the 8th Evacuation. The tobacco factory was later operated as an annex

to the 16th, by personnel of the 8th.

General Blesse, who arrived on the

beachhead on 25 September, had spent

the preceding night at the 16th Evacuation and witnessed the destruction.15

As soon as the storm was over, the

38th Evacuation Hospital, still in bivouac awaiting assembling of its equipment, began setting up a hospital, using

equipment borrowed from the still

inactive 56th. The 38th began admitting

patients at 0830, 29 September. (Map

21)

Across the Volturno

Combat Medical Service—During the

drive to the Volturno, medical service in

the field followed a normal pattern. Division clearing platoons leapfrogged one

another, casualties being carried back to

the beachhead by the corps medical battalions. Collecting companies of the 52d

Medical Battalion took over evacuation

of the 45th and 3d Divisions from the

162d on 29 and 30 September, respectively. The 34th Division, the 82d Airborne, and the Rangers were evacuated

by collecting elements of the 162d Medical Battalion.16

The advancing troops were delayed

by mountainous terrain and by the expert demolitions for which the retreating Germans were noted. The enemy

chose to fight only rear-guard actions

until he reached prepared positions beyond the Volturno. Avellino fell to the

3d Division on 30 September, and a reconnaissance troop of the 45th entered

Benevento two days later. The British

7th Armoured Division had meanwhile

14

 Annual Rpt, 95th Evac, 1943. 15

 In addition to unit reports of the hospitals

mentioned, see Col Reeder, Diary of Inspection

Trip With Gen Blesse, 25 Sep-2 Oct 43. See also

Ltr, Col Bauchspies to Col Coates, 15 Apr 59,

commenting on preliminary draft of this volume.

Colonel Bauchspies was at that time commanding

officer of the 16th Evacuation Hospital. 16

 Military sources for this section are the same

as those cited in previous notes, with the addition

of Fifth Army History, pt. I, pp. 43-49; Pt. II, pp.

1-55; and Opns Rpts, VI Corps, Oct and Nov 1943.

Medical sources include theater, army, corps, and

division surgeons' reports already cited, and unit

rpts of medical units mentioned in the text.
232 MEDITERRANEAN AND MINOR THEATERS

MAP 21—Fifth Army Hospitals and Medical Supply Dumps, 9 October 1943

occupied Naples without opposition on

1 October, leaving the city to be garrisoned by the 82d Airborne.

As VI Corps neared the Volturno, the

distance between division clearing stations and evacuation hospitals lengthened, finally approaching the 100-mile

ambulance runs of the Tunisia Campaign. To cut down the long haul over

bomb-scarred and blasted roads, the

93d Evacuation moved from Paestum to

Montella, along the 3d Division's route

to Avellino, on 2 October. In Naples, on

the same date, the 307th Airborne Medical Company and a detachment from

the 162d Medical Battalion opened a

provisional evacuation hospital. The

307th had arrived from Sicily by boat

only two or three days earlier.

By 6 October forward elements of

both 10 and VI Corps had reached the

Volturno River. Eighth Army, meanwhile, had captured the vital complex

of airfields around Foggia on 1 October,

and had moved on to extend the Volturno line to Termoli on the Adriatic.

At the Volturno, Fifth Army paused

only long enough to bring up equipment

necessary to replace bridges blasted by

the retiring enemy, and to move artillery forward through hub-deep mud. In

its upper reaches the Volturno River

flows southeast, or roughly parallel to the

long axis of the Italian peninsula. At the
SALERNO TO THE GUSTAV LINE 233

point where the Calore enters the Volturno from the east, the latter river turns

west at an acute angle to reach the Tyrrhenian Sea some 20 miles north of the

Bay of Naples. The south bank, from

the coast to a point just east of Capua,

a distance of perhaps 15 miles, was held

by 10 Corps. The VI Corps front continued the river line another 15 miles

to the junction with the Calore, and on

eastward for a similar distance to the

point of contact with Eighth Army. The

3d Division crossed the Volturno through

the Triflisco Gap on the left of the VI

Corps front, while the 34th crossed 8 or

10 miles farther east, near the mouth of

the Calore. The 45th Division held the

right flank, advancing into the mountains north of the Calore and east of the

Volturno.

The 3d and 34th Divisions began

crossing the river at 0200 on 13 October,

after prolonged artillery preparation. Incessant rain during the first week of

October had turned the normally shallow stream into a swift-flowing torrent,

200 or 300 feet wide and varying in

depth from about 4 feet to the height of

a tall man's shoulders. Rubber boats and

rafts were used, and some swam the swollen river, but most of the men waded

across, clinging to guideropes with one

hand and holding their rifles overhead

with the other. All crossings were made

under continuous fire from machine

guns and small arms on the north bank

and from artillery farther to the rear.

Battalion aidmen, reinforced by litter

bearers from the collecting companies of

the organic medical battalions, forded

the river with the assault troops. Ambulance loading posts were set up on the

near shore, close to the sites previously

chosen for bridging, and casualties were

ferried back until dawn on rafts pulled

by ropes. When daylight made further

evacuation across the river impossible,

casualties were held in pools on the far

bank, wherever terrain afforded adequate protection.

On the 3d Division front, light bridges

were thrown across the river during the

first day of the attack. The engineers,

working under direct observation and

artillery fire of the enemy, had more

difficulty in the 34th Division area, but

despite the hazards managed to span the

stream by the morning of 14 October.

As soon as the bridges were available,

collecting companies of the organic medical battalions crossed the Volturno to

follow the troops. Clearing stations remained on the south bank until the

bridgehead had been pushed several

miles beyond the river. The 3d Medical

Battalion had a station in operation

north of the Volturno the morning of

16 October, and the 109th Medical Battalion clearing station, supporting the

34th Division, was functioning on the far

bank by the 18th. Thereafter, until the

Winter Line was reached about the middle of November, evacuation from both

divisions followed the normal pattern,

the clearing platoons bypassing one another as the troops advanced.

The 52d Medical Battalion took over

evacuation of the 34th Division from the

162d on 17 October, thus becoming responsible for all evacuation from VI

Corps.

Simultaneously with the Volturno

crossings of the 3d and 34th Divisions,

the 45th moved up on the east side of

the river to parallel the advance. Fighting was heaviest on the lower slopes of

the Matese Mountains, where the task

of bringing out the wounded was formi-
234 MEDITERRANEAN AND MINOR THEATERS

MEDICS TREATING ITALIAN GIRL INJURED IN THE VOLTURNO AREA

dable, but the heights of Piedimonte

d'Alife were gained by 17 October without undue casualties.

Enemy positions on the coastal plain,

meanwhile, had proved stronger than

anticipated. The British 46th Division

on the 10 Corps left flank, and the 7th

Armoured in the center, had forced

crossings of the Volturno the night of

12-13 October, but the British 56th Division in the Capua area had been unable

to cross without taking losses deemed too

heavy by the Fifth Army command.

Plans for further advance were therefore

altered by shifting the corps boundary

to the east. The 56th displaced to its

right, crossing on the 3d Division bridge

at Triflisco on 15 October. The 3d Division also shifted to the right, into the

34th Division sector, while the 34th

crossed the upper Volturno on 19 October to a position in front of the 45th.

Both corps moved slowly forward

against stubborn opposition for another

two weeks. Then on the night of 3-4

November the 45th crossed the Volturno

from east to west, south of Venafro, and

the 34th recrossed north of that town,

leaving the 504th Parachute Infantry,

which had come into the line a few days
SALERNO TO THE GUSTAV LINE 235

ROUGH GOING

earlier, to strike toward Isernia and

hold the high ground on the right flank.

The 3d Division struck toward Mignano

Gap on the left of the corps area.

By 15 November Fifth Army had

reached another German defensive position, the Winter Line. Since 6 October

a strongly fortified river line had been

breached and gains registered from

seventeen miles along the coast to fortyfive miles on the right flank of the Fifth

Army front. The new line extended

along the south bank of the Garigliano

River to the junction with Eighth Army

west of Isernia, and included the towns

of Mignano and Venafro. The mountains, however, had become steadily

more precipitous and the weather progressively worse. A halt was called for

regrouping and reconsideration of strategy.

In the immediate combat zone, the

problems of evacuation incident to a

difficult river crossing were succeeded by

those of mountain fighting in which the

enemy was dug in on every slope in mutually supporting positions that commanded every access road and trail.

Mines, booby traps, and snipers were

everywhere. Each new advance was
236 MEDITERRANEAN AND MINOR THEATERS

MAP 22—Fifth Army Hospitals and Medical Supply Dumps, 15 November 1943

made in the face of machine gun and

artillery fire from dominating slopes.

The storming of mountain peaks was

commonplace. Men suffered increasingly from exposure, and the strain began to show in a sharply rising incidence

of combat neurosis.

The tasks of the aidmen and the litter

bearers were the most arduous. Medical

officers often worked at night by flashlight, with both doctor and patient concealed under blankets. Aid stations were

generally 300 to 500 yards behind the

point of contact with the enemy, but

were sometimes as much as a week ahead

of their vehicles, restricting them to such

drugs and equipment as could be handcarried. The numerous caves found in

the Italian mountains were often used

for aid station sites because they could be

blacked out, and because they offered a

measure of protection from rain, snow,

and enemy shells. Collecting stations

were eliminated wherever possible, but
SALERNO TO THE GUSTAV LINE 237

when used were 1 to 4 miles behind the

lines, with clearing stations 6 or 8 miles

farther to the rear. The irregularities of

the front, however, and the exigencies

of mountain fighting not infrequently

brought clearing stations within range

of enemy guns. Six-man litter squads

were usually necessary, with carries

often taking eight to twelve hours. When

the corps medical battalions were

drained of personnel, additional litter

bearers were supplied from the combat

units. Casualties among medics, and particularly among litter bearers, were

high.17

Hospitalization—To keep the ambulance runs relatively short, Fifth Army

hospitals moved into the combat zone as

rapidly as suitable sites became available,

with the 400-bed evacuations leading the

way. The 95th opened in Naples on 9

October. The 93d moved hastily from

Montella to Avellino on 11 October,

after bombed-out bridges and swollen

streams threatened to isolate the unit;

then advanced again on 24 October to

Piana di Caiazzo, where it was the first

American hospital north of the Volturno.

The 94th shifted from Battipaglia in

the Salerno area to take over an Italian military hospital in Maddaloni,

where it opened on 11 October. November 5 saw the 94th Evacuation in Riardo,

a dozen miles north of Capua. Still farther forward, the 15th Evacuation, newly

arrived from Sicily, opened at Alife east

of the Volturno, on 2 November. (Map

22)

The 750-bed evacuation hospitals also

moved up to new locations during the

period of the Volturno campaign. The

56th opened at Avellino on 6 October,

shifting to Dragoni across the river from

the 15th on 2 November. The 8th and

38th Evacuation Hospitals opened in

Caserta on 16 October, followed by the

16th Evacuation on the last day of the

month. The 38th moved on to the Riardo area, just north of the site of the

94th, on 8 November.

The field hospitals, as already noted,

were late in coming into the theater,

and were used only in part for direct

support of the army. The 32d Field

opened in Caserta on 16 October, where

it functioned for ten days as an evacuation hospital before being attached to

the base section. The 10th Field moved

into Caserta on 29 October, also functioning as an evacuation hospital. The

11 th Field, though in the theater, was

inactive until the next phase of the campaign. The two available platoons of the

4th were assigned to the base section as

an air evacuation holding unit.

Only the 33d Field Hospital performed services similar to those of the

field units in the Sicily Campaign. One

platoon of the 33d joined the 120th

Medical Battalion on 17 October, operating with the 45th Division clearing station as a holding hospital for nontransportables and for forward surgery. Another platoon of the 33d joined the

11th Medical Battalion, in Army reserve with the 36th Division, on 21

October; and the remaining platoon

went into the combat area with the

109th Medical Battalion, in support of

17

 (1) Capt Robert L. Sharoff, The Infantry Battalion Aid Station in Operation, Med Hist Data,

3d Med Bn, 23 Oct 43. (2) Ltr, Col W. W. Vaughn

to Brig Gen R. W. Bliss, 18 Jan 44, sub: Observations From Overseas Casualties. (3) Annual Rpt,

Surg, 34th Div, 1943. (4) Hist, 120th Med Bn, Nov

43.
238 MEDITERRANEAN AND MINOR THEATERS

the 34th Division, the following day. All

three platoons were reinforced by teams

of the 2d Auxiliary Surgical Group.

The 3d Convalescent Hospital was also assigned to Fifth Army from its arrival in the theater on 10 October, but

functioned in Naples rather than in the

forward area until near the end of the

year.

The Winter Line

Fifth Army was substantially reorganized during the last two weeks of

November, before launching a direct

assault against the fortified positions of

the German Winter Line. The headquarters of II Corps, now under General

Keyes, arrived from Sicily in October.

On 18 November the 3d and 36th Divisions were assigned to II Corps, which

took over the center of the Fifth Army

front. The British 10 Corps remained

on the left flank; the 34th and 45th

Divisions, making up VI Corps, were on

the right.18

The 36th Division, out of combat since

20 September, began to relieve the 3d

on 17 November, the 3d going into bivouac for a rest. The strength of II Corps

was maintained, however, by attachment

of the 1st Italian Motorized Group on

22 November and of the 1st Special Service Force the following day. The 1st

Special Service Force, a commando-type

unit with six battalions organized into

three "regiments," had a strength equivalent to one regimental combat teamabout 5,000 men. It was composed of

U.S. and Canadian troops, specially

trained for mountain fighting and in

raiding tactics.

Three Ranger battalions and elements of the 504th Parachute Infantry

were also at the front, to be used as the

army commander might direct. The 1st

Armored Division began unloading at

Naples on 15 November and went into

Army reserve. Two French divisions, the

2d Moroccan and the 3d Algerian, were

also on the way from North Africa as

components of a French Expeditionary

Corps (FEC) under General Juin.

In addition to medical units already

in the Fifth Army area, the 54th Medical

Battalion and the nth Field Hospital

were assigned to II Corps. The Italian

and French units under Fifth Army

command had their own medical organizations, including field and evacuation

hospitals.

The Winter Line proved to be only

a series of strongly held outposts a few

miles in front of the heavily fortified

Gustav Line, where the Germans

planned to make their main stand. The

key to the Gustav Line was Monte Cassino, dominating the entrance to the Liri

Valley through which Highway 6 and a

doubletrack railroad ran northwest to

Rome, a distance of about eighty miles.

The approach to the Liri Valley lay

through the Mignano Gap, known to the

troops as Purple Heart Valley, which was

controlled on either side by Germanheld mountain masses and barred at its

outlet by the Rapido River. The plan of

18

 Military sources for this section include: 1st

Opns Rpts, VI Corps, Nov 43-Jan 44; (2) Opns

Rpts, II Corps, Nov 43-Jan 44; (3) Fifth Army

History, pt. III. Citations to additional military

sources will be found at the beginning of this

chapter. Medical sources for the Winter Line

campaign include: (4) Annual Rpt, Med Sec,

NATOUSA, 1943; (5) Annual Rpt, Med Sec,

MTOUSA, 1944; (6) Annual Rpts, Surg, Fifth

Army, 1943, 1944; (7) Annual Rpts, Surg, VI

Corps, 1943, 1944; (8) Annual Rpts, Surg, II Corps,

1943, 1944; (9) Unit rpts of div surgs and med

units mentioned in the text.
SALERNO TO THE GUSTAV LINE 239

campaign called first for driving the

enemy from his mountain stronghold,

and then forcing a crossing of the Rapido

south of Cassino, at the same time

executing a wide flanking movement

through the mountains northwest of the

town.

The attack began on 1 December with

an assault against the Camino hill mass

south of the Mignano Gap. The main

effort was directed at the left flank by

the 46th and 56th Divisions of 10 Corps,

while the Special Service Force of II

Corps attacked simultaneously from the

right. The infantry advance was preceded

by the heaviest concentration of artillery

fire yet used in the Italian campaign,

but the result was indecisive. It was still

necessary for foot soldiers to scale the

heights and storm the enemy positions

one by one. The operation was rendered

still more hazardous by three days of

continuous rain. Both lines of advance

and lines of supply were under enemy

fire, while bad weather prevented any

effective air support. The entire Camino

complex was nevertheless secured by 9

December.

The 34th and 45th Divisions of VI

Corps were meanwhile attacking northwest from Venafro with the ultimate

objective of outflanking Cassino by taking Sant'Elia and Atina. The VI Corps

attack, launched on 29 November, was

slow and costly. By 4 December the 34th

Division, on the left, had gained about a

mile, at a cost of 777 casualties. The 45th

continued to inch forward for another

five days, taking several important hill

positions but making little headway toward its goal.

In the second phase of the Winter

Line campaign, II Corps was to seize Mt.

Sammucro, which formed the northern rampart of the Mignano Gap, and

Mt. Lungo, which cut the center of the

valley. VI Corps, with the 2d Moroccan

Division replacing the 34th, was to try

again for Sant'Elia and Atina. The II

Corps objectives were taken by 17 December, after bitter seesaw battles for

every knob and crest, but VI Corps again

failed to make substantial headway in

its flanking attack. Lack of reserves for

speedy exploitation of gains was an important factor.

Mt. Trocchio, the last mountain

stronghold before Cassino, was II Corps'

major objective in the third phase of

the Winter Line campaign. The position

was taken, again after slow and bitter

fighting, by noon of 15 January 1944,

but the crossing of the Rapido was delayed for another week by the failure

to outflank Cassino from the north, and

by an over-all change of plans.

General Alexander, commanding the

15th Army Group, issued orders on 2

January for the seaborne flanking movement to Anzio, and VI Corps was assigned the operation. A reshuffling of

Fifth Army forces gave the 45th and 3d

Divisions to VI Corps at this time. The

34th Division went back into the line as

a II Corps unit, replacing the 36th, while

the 3d Algerian Division relieved the

45th. The VI Corps sector was taken

over by the French Expeditionary Corps

the first week in January. The 1st Armored, which had been attached to II

Corps about 15 December in hopes of a

breakthrough into the Liri Valley, remained temporarily in the line, but

went ultimately to VI Corps for the

Anzio landings.

The capture of Mt. Trocchio brought

Fifth Army up to the main defenses of

the Gustav Line. During two months of
240 MEDITERRANEAN AND MINOR THEATERS

rugged mountain fighting in the foulest

kind of weather, the Allied forces had

advanced an average of five to seven

miles. Casualties had been heavy, but

battle fatigue and exposure had taken

an even greater toll. The enemy too had

suffered heavily, but he appeared to have

gained his purpose of achieving a winter

stalemate. Eighth Army had driven up

the Adriatic coast as far as Ortona, but

Montgomery's forces also failed to force

a passage through the rocky fastnesses of

the central Apennines to Rome.

Battlefield Evacuation—As in the

Volturno campaign, the primary medical problem of the Winter Line was

evacuation of casualties from the battlefields. The difficulties inherent in carrying wounded men down steep, boulderstrewn slopes, often in total darkness,

were aggravated by cold and almost incessant rain or snow. Main highways were

frequently under enemy fire and were

overburdened with a steady stream of

combat equipment. Secondary roads and

trails were so deep in mud that ambulances could rarely come within five

miles of the lines.

All available litter bearers of the corps

medical battalions were assigned to the

divisions, and these were periodically

supplemented by assignment of combat

personnel. Toward the end of the year,

AFHQ authorized the addition of 100

litter bearers to each organic medical

battalion. Continuous replacements were

necessary at all levels of the medical

service. Litter bearers were exposed to

the same hazards as the combat troops.

Many of them camped along the evacuation routes, but without the protective

clothing worn by the infantrymen. Casualties among medical officers were also

high, but the only available replacements were men from fixed hospitals in

the base sections who lacked both battle

experience and conditioning. Collecting

companies were used sparingly, and

where used were reduced to one medical

officer each. Medical officers of the corps

medical battalions were often detached

for duty with the divisional medical

units.19

A variety of expedients were adopted

to speed the process of evacuation. Casualties from the 34th Division were

brought down from Mt. Pantano by

litter bearers who lined both sides of

the trail and passed litters from hand to

hand over their heads.20 Litter carries

ran as long as 12 to 15 hours, with 6-man

squads working in relays. The 109th

Medical Battalion reported using 16

such squads to move casualties over a

5-mile stretch on 12 January 1944. On

the longer routes, aid stations were set

up along the way to supply first aid,

plasma, and hot drinks, and to give walking wounded a chance to rest. The 120th

Medical Battalion used pack mules

to bring out trench-foot cases, and

experimented with a mule-carried litter,

apparently unaware of the similar experiments carried out by the 9th Medical Battalion in Tunisia and Sicily.

Experiments were also made with a

modified breeches buoy, improvised from

an equipment line, for lowering casualties down precipitous slopes.21

Some indication of the magnitude of

19

 (1) Pers Ltr, Gen Blesse, Surg, NATOUSA, to

Gen Kirk, 26 Nov 43. (2) Surg, NATOUSA,

Journal, 23 Dec 43. (3) Med Hist Data, 54th Med

Bn, 26 Sep 44. See also, reports of div surgs and

med bns mentioned elsewhere in the text. 20

 Bull of the U.S. Army Medical Department

(July 1944) , p. 26. 21

 Clift, Field Opns, p. 250-a.
SALERNO TO THE GUSTAV LINE 241

WOUNDED MAN BEING DUG FROM DEBRIS NEAR CASSINO

the evacuation problem may be gathered

from reports of the two corps medical

battalions primarily responsible for

moving casualties from clearing stations

to the mobile hospitals in the combat

zone. The 52d Medical Battalion evacuated 25,125 sick and wounded from

division clearing stations between 30

September and the end of the year. Between 15 November and 15 January the

54th Medical Battalion evacuated 16,186

patients. Even these figures do not tell

the whole story, since some evacuation

before 15 November was handled by the

162d Medical Battalion, while the

continued to operate through January.

Hospitalization—The heavy casualties of the Winter Line campaign, coupled with transportation difficulties over

muddy and congested roads, soon made

it necessary to bring more hospital beds

into the combat area. The 95th Evacuation Hospital moved up from Naples

on 28 November to a site just beyond

the Volturno northwest of Capua, where

it was joined by the 10th Field from

Caserta on 1 December. The 15th Evac-
242 MEDITERRANEAN AND MINOR THEATERS

MAP 23—Fifth Army Hospitals and Medical Supply Dumps, 15 February 1944

uation moved from Alife, east of the

Volturno, where it had twice been

flooded, to Riardo, where the 38th and

94th were already operating, on 15 December. The 8th Evacuation opened at

Teano, in the same general area, the following day, while the 16th Evacuation

moved from Caserta to Vairano on 28

December. For all hospitals, siting was a

problem for the engineers, with mud

the ever-present obstacle to be surmounted. The 93d and 95th Evacuation

Hospitals, designated for the Anzio operation, were closed early in January

1944, but their places were taken by the

3d Convalescent, which opened at Pignataro Maggiore on 6 January, and the

11th Evacuation, which arrived from

Sicily in time to open at Vairano on 14

January. (Map 23)

With the exception of the 56th Evacuation at Dragoni and the 93d at Piana
SALERNO TO THE GUSTAV LINE 243

di Caiazzo, all of these Fifth Army hospitals were strung out along Highway

6, within a 10- or 12-mile stretch. The

medical installations in the army area,

including clearing and collecting stations, all suffered more or less severe

damage in a New Year's Day storm, the

15th, 38th, and 94th Evacuation Hospitals being the hardest hit. All patients

of the 15th and 38th had to be moved, as

well as most of those of the 94th.

The Cassino Stalemate

By way of prelude to the Anzio landings, which were scheduled for 22 January 1944, Fifth Army sought to engage

the maximum German strength by way

of a direct assault against the Gustav Line.

The French Expeditionary Corps on the

right led off on 12 January with

a 3-day drive that carried General Juin's

colonials to the mountains north of Cassino. General McCreery's British 10

Corps, with the 5th Infantry Division

substituted for the 7th Armoured,

crossed the lower Garigliano near the

coast on 17 January. By the 20th of the

month, the 5th and 56th Divisions had

secured a bridgehead extending to high

ground north of Minturno, but the 46th

Division had failed to get across the

river farther upstream, near the II Corps

sector.22

Carnage Along the Rapido—The main

assault was launched by General Keyes'

II Corps in the center of the Fifth Army

front on the night of 20 January, only

a few hours before the Anzio armada

sailed from Naples. The assignment was

probably the most difficult of the entire Italian campaign. The U.S. 36th Division, commanded by Maj. Gen. Fred

L. Walker, was to cross the Rapido below Cassino in the vicinity of Sant' Angelo, seize that town, and advance as far

as Pignataro Interamna. Combat Command B of the 1st Armored Division

was to pass through the 36th and exploit

up the Liri Valley, while the 34th

Division was to create a diversion before

Cassino and be prepared to attack from

east or south, or to follow the armor

through the 36th, as circumstances dictated. The 45th Division was in reserve,

to be thrown into the Cassino battle or

be shipped to Anzio as the tide of battle

might require.

It was a very large order. Cassino and

the mountains surrounding it were heavily fortified anchor points in the Gustav

Line, from which enemy artillery could

rake the whole line of the Rapido River

and cover the Liri Valley with cross fire.

The river, itself, at that point, was a

swift-flowing stream 25 to 50 feet wide

and 9 to 12 feet deep, with high, brushcovered banks on either side. The approaches had been skillfully and lavishly

strewn with mines, and the low ground

was waterlogged by deliberate flooding.

On the German side the ground was

higher, with the town of Sant'Angelo

perched on a 40-foot bluff that gave perfect observation. Mines and wire entanglements were backed up by a belt of

dugouts and concrete pillboxes, from

which the entire river line could be

22

 The chief military sources for this section

include: 1st Fifth Army History, pt. IV, pp. 27-57,

87-100, 175-85; (2) Opns Rpts, II Corps, Jan-Apr

44; (3) Huff, ed., The Fighting Thirty-sixth. See

note at the beginning of this chapter for additional

sources. The more important medical sources are:

(4) Annual Rpt, Med Sec, MTOUSA, 1944; (5) Annual Rpt, Surg, Fifth Army, 1944; (6) Annual Rpt,

Surg, II Corps, 1944; (7) Unit rpts of div surgs,

med bns, and other med units mentioned in the

text.
244 MEDITERRANEAN AND MINOR THEATERS

blanketed by machine gun fire. The

failure of the British 46th Division to

cross the Garigliano earlier in the day,

moreover, had left the southern flank

unsecured.

After concentrated air and artillery

preparation, the 141st Regimental Combat Team moved through the mine fields

to its crossing points north of Sant'Angelo, while the 143d RCT took up positions along the Rapido south of the

town. The Germans were neither surprised nor unprepared. Artillery, rocket

projectors, and automatic weapons met

the assault. Boats were destroyed before

the launching or sunk in midstream.

Bridges were knocked out before they

were in place. Only a handful of men

from the 141st reached the western bank,

and the somewhat larger number from

the 143d who achieved the crossing were

quickly immobilized. Before dawn those

able to return were recalled.

A second attempt the following day

was only slightly more successful. Fog

and smoke screens covered the crossings,

but the German guns were zeroed in.

One battalion of the 143d RCT and elements of the 141st managed to advance

a half mile or so beyond the river, but

reinforcement and resupply were alike

impossible. The men were driven back

to the river, and those who could not

withdraw were isolated. When ammunition gave out, the battle was over. The

36th Division had been badly beaten.

Although many of the wounded could

not be reached, and others could be

brought out only with great difficulty,

308 battle casualties were processed

through the clearing station of the 111 th

Medical Battalion on 21 January and

291 the following day. With only five

medical officers available to handle this

record flow of wounded, it was impossible to retain them long in the clearing

station. The nontransportables were

transferred immediately to a platoon of

the 11th Field Hospital, which was adjacent. Those who could stand the

journey were sent back by ambulance

and truck to the evacuation hospitals,

which were still concentrated along

Highway 6 from Vairano, twenty miles

behind the front, to Capua on the

Volturno. Transportation was supplied

by the 54th Medical Battalion.

When the Sant'Angelo sector quieted,

a truce was arranged for 25 January

from 1400 to 1700, and litter bearers

from two collecting companies of the

111 th Medical Battalion crossed the

Rapido to remove the dead and

wounded. A German guide led them

through the mine fields and up to the

barbed-wire entanglement about 10

yards from the stream. There German

medics turned over 12 American

wounded, stating that 18 more were in

the German hospital. An opportunity to

inspect these was offered, but time did

not permit. The dead were so numerous

that all could not be removed in the 3-

hour period of the truce.

The 2-day "battle of guts" cost the

36th Division 2,019 officers and men in

killed, wounded, and missing, of whom

934 were wounded.23

Frustration at the Gustav Line—"The

failure of the 36th Division to establish

a bridgehead in the Liri Valley forced

a quick change in plans. The French Ex23

 Annual Rpt, Surg, Fifth Army, 1944, p. 40.

Fifth Army History, pt. IV, p. 47, gives a total of

1,681, broken down into 143 killed, 663 wounded,

and 875 missing but the surgeon's figures, based on

unit reports, appear the more reliable.
SALERNO TO THE GUSTAV LINE 245

peditionary Corps, which had renewed

its drive on 21 January, was ordered to

concentrate its strength on its own left

flank, while the 34th Division attempted

a crossing of the upper Rapido just below the village of Cairo, at the boundary

of the II Corps and FEC sectors. The

34th jumped off the night of 24 January.

Enemy positions were much the same

as those encountered by the 36th Division farther south, but this time the

bridgehead held. First across the river, on

the morning of 25 January, was the 100th

Battalion. Other elements of the 133d

Regimental Combat Team followed, and

all held grimly to their gains through the

night of 25-26 January. The 135th RCT

forced another crossing just north of Cassino in the early hours of 26 January, and

the 168th crossed the next day, with four

tanks. The engineers got more tanks

across early on the 29th, in time to help

repel a determined counterattack. To

exploit the gains, the 142d RCT of the

36th Division, which had not participated in the earlier action, was attached

to the 34th Division, and with the French

Expeditionary Corps gained commanding heights north of Cairo. The bridgehead was secure by 31 January.

For the next two weeks II Corps threw

all its strength and battle toughness into

an effort to break through the Cassino

defenses and cut Highway 6 behind the

main German positions. The fighting

was hard, close, and continuous. On 2

February elements of the 34th Division

broke into Cassino itself, and on the 5th

a patrol reached the walls of the Benedictine monastery high above the town.

The 36th Division, decimated though it

was, went back into the line. About a

third of the mountainous area northwest

of Cassino was overrun, and a decisive

triumph seemed almost at hand. The

Germans, however, were furiously reinforcing their crumbling lines, and the

Allied drive was stopped a bare mile

short of Highway 6. On 12 February II

Corps went over to the defensive. During the next ten days the 34th and 36th

Divisions were relieved by Lt. Gen. Sir

Bernard Freyberg's New Zealand Corps,

made up of the New Zealand 2d Division,

the Indian 4th Division, and the British

78th Division, all from the Eighth Army

front.

The pattern of evacuation during the

period from 24 January to 14 February

resembled that of the Winter Line campaign. Litter carries were long, difficult,

and exhausting since vehicles were unable to penetrate far into the mountainous area where the fighting was in progress. Again more litter bearers were

essential. The 54th Medical Battalion

loaned all that could be spared, averaging about 150, to the collecting companies of the divisional medical battalions. Others were recruited from among

Italian labor troops, and still others were

combat replacements not yet committed

to battle. But the bulk of them came

from noncombat elements of fighting

units and from among fighting men

themselves. Over 800 additional litter

bearers were used by II Corps on the

Cassino front in January and February

1944.

Casualties were heavy during the

battle for the bridgehead, but became

even heavier as tired troops penetrated

the main defenses of the Gustav Line.

The clearing station of the 109th Medical Battalion, supporting the 34th Division, had its busiest day on 3 February,

when 430 patients, 268 of them with battle wounds, were processed. For the en-
246 MEDITERRANEAN AND MINOR THEATERS

RETURNING WOUNDED FROM THE RAPIDO, JANUARY 1944

tire period from 24 January to 19

February, when relief of the 34th Division was completed, 4,795 patients passed

through the division clearing station, of

whom 2,248 were battle casualties. For

the 111 th Medical Battalion clearing station, the total processed was 5,709, including 1,733 wounded in action, for the

period from 18 January to 22 February

during which elements of the 36th Division were in the line.

The 54th Medical Battalion was taxed

to the utmost to provide transportation

to the rear. In order to shorten the ambulance run as much as possible, two hospitals were displaced forward along

Highway 6 during the Cassino assault.

The 10th Field moved from Capua to a

site four miles southeast of Mignano on

28 January. It was leapfrogged on 11

February by the 94th Evacuation from

Riardo. Set up just south of Mignano,

the 94th was the farthest forward of any

Fifth Army hospital on the Cassino front.

For a time all hospitals in the army area

were so crowded that orderly scheduling

of admissions was impossible.

After the relief of II Corps, medical

units accompanied the badly battered

34th and 36th Divisions to rest areas be-
SALERNO TO THE GUSTAV LINE 247

AID STATION IN SANT'ELIA AREA, smoke from a German shell rising in the background.

hind the lines. Neither division returned

to combat on the southern front. The

New Zealand Corps renewed the attack

on Cassino, 15-20 February, but, aside

from destroying the monastery, achieved

no more success than had the Americans.

The Cassino front lapsed into inactivity

until 15 March, when the New Zealand

Corps launched a second drive, preceded by the heaviest air and artillery

bombardment of the Italian campaign.

But again the Gustav Line held, and the

frontal attack was abandoned.

Hospitalization in the Army Area

Hospitalization Policy

All hospitalization in the army area

throughout the Italian campaign was

centrally controlled by the Fifth Army

surgeon. As long as the line of evacuation

lay along a single highway, as in the first

days of the breakout from the Salerno

beachhead, it was possible to funnel casualties through one ambulance control

point, where they were routed to the

available evacuation hospitals in groups

of fifty at a time. Since there was no

sorting of casualties at the control points,

however, the actual burden on the hospitals proved very uneven and treatment

of some patients was unnecessarily delayed.24

24

 Except as otherwise noted, this section is based

on the reports of the Fifth Army surgeon for 1943

and 1944, and on the reports of the individual

hospitals and medical battalions functioning in the

Fifth Army area.
248 MEDITERRANEAN AND MINOR THEATERS

As the troops advanced toward the

Volturno, one evacuation hospital was

designated for the support of each division, but since some units encountered

much stiffer opposition than others, this

system, too, proved unsatisfactory. Under

combat conditions, it was found that one

evacuation hospital could not safely handle more than 100 surgical admissions in

a 24-hour period. When the designated

hospital was filled, casualties had to be

rerouted to other installations, with consequent delay in treatment and longer

immobilization of ambulances.

With the establishment of additional

hospitals in the army area toward the

end of the year, two evacuation hospitals

were assigned to receive casualties from

each division. One hospital took all admissions for twenty-four hours; then

closed to catch up and rest its personnel

while the other took over for a similar

period. This system, like its predecessor,

proved only partially successful, since the

casualty load varied markedly from day

to day with the progress of the fighting.

It remained in effect only until late January 1944.

The plan next put into effect continued throughout the remainder of the

war in Italy. Hospitals were arranged in

depth along the axis of evacuation to the

rear. Corps evacuation officers were informed early each morning by the Fifth

Army evacuation officer, Maj. (later Lt.

Col.) Ralph A. Camardella, how many

surgical and how many medical cases

they might send in the course of the day

to each hospital in stated sequence. Under this system, no hospital would be

overburdened unless the aggregate casualties for the day exceeded the combined quotas of all the hospitals in the

area.

Specialization

A major factor in the orderly working

of this system was the increasing use of

specialized facilities to siphon particular

types of cases. Toward the end of October 1943, following the pattern established in Sicily, field hospital platoons

were set up adjacent to the division clearing stations for forward surgery and

retention of patients whose further transportation would be hazardous. Keeping

these patients in the division area lightened the burden on the evacuation hospitals. After the 10th Field Hospital

moved into the Capua area at the beginning of December, its facilities were used

primarily for medical cases whose hospital expectancy did not exceed twentyone days.

A further development late in 1943

was the more consistent use of clearing

companies of the army medical battalions

for hospitalization. Both the 161st and

162d Medical Battalions were reorganized in October to give each clearing

platoon 250 beds, instead of the 125 previously assigned. Additional personnel

needed to operate the larger units was

drawn from the collecting companies.

These expanded platoons were then used

to increase the bed strength of the forward hospitals. One clearing platoon of

the 162d was attached to the 56th Evacuation Hospital at Dragoni from 6 November to 21 December, while the other

clearing platoon of the same battalion

served to augment the facilities of the

15th Evacuation Hospital during its stay

at Alife. An expanded clearing platoon

of the 161st Medical Battalion was attached to the 10th Field Hospital near

Capua, where it served as a convalescent

ward. At its Vairano site, the 16th Evacu-
SALERNO TO THE GUSTAV LINE 249

ation Hospital also used a clearing platoon as a convalescent ward during most

of January 1944.

Late in December the use of clearing

platoons as hospitals was carried another

step forward. On the 21st of that month

a platoon of the 162d opened as a venereal disease diagnostic and treatment

center, and ten days later a platoon of the

161st, with psychiatrists and other additional personnel attached, became the

Fifth Army Neuropsychiatric Center.

Both of these special hospitals were in

the vicinity of Capua until the end of

March, when a general resiting of Fifth

Army hospitals took place.25 The movement of the 3d Convalescent Hospital

into the army area early in January

completed the establishment of specialized facilities immediately behind the

lines. In sum, these units went far toward

freeing the evacuation hospitals for their

primary mission, the treatment of battle

wounds.

The use of specialized facilities in the

army area was also designed to save for

combat duty as large a proportion of

those hospitalized as possible. Medical

cases such as respiratory diseases, fevers

of various types, jaundice, dysentery, venereal disease, and trench foot could

usually be treated close to the front and,

with convalescent beds available, could

often be held long enough for a cure.

Specialization also permitted adequate

care by the minimum number of medical

officers.

The extensive employment of specialist personnel was another feature of the

Fifth Army system of hospitalization. In

addition to the medical specialties represented by the establishment of separate

hospitals for venereal disease and neuropsychiatric cases, twenty-five teams of the

2d Auxiliary Surgical Group were employed in field hospital platoons and in

evacuation hospitals. Wherever possible,

Medical Corps officers were replaced by

officers of the Medical Administrative

Corps, despite the resistance of unit commanders in the field. Fifty MAC's had

been so assigned before the Winter Line

was reached, and twenty-five more had

been requested.26 These officers were

used in supply, operations, personnel,

records, and other administrative positions and increasingly, when the shortage

of medical officers became acute, as assistant battalion surgeons and in the collecting companies where evacuation

rather than medical care was the primary

mission.

Statistical Summary

U.S. bed strength in the Fifth Army

area as of 15 January 1944, including

field hospital platoons with the division

clearing companies, clearing platoons

used as expansion units, the neuropsychiatric and venereal disease hospitals,

and hospitals staging for Anzio, was approximately 10,000. The total remained

the same at the end of April, though it

was divided between the Cassino front

and the Anzio beachhead. Hospital admissions from Fifth Army to U.S. installations from 9 September 1943 through

30 April 1944 are shown in Table 5. It

should be borne in mind that the figures

for January, February, March, and April

include hospital admissions on the Anzio 25

 See pages 255-56, 258-59, below, for more detailed discussion of the NP and VD hospitals. The

resiting of hospitals before the Rome-Arno Campaign is treated on pages 290-91, below. 26

 Pers Ltr, Gen Blesse to Gen Kirk, 17 Nov 43.
250 MEDITERRANEAN AND MINOR THEATERS

TABLE 5—HOSPITAL ADMISSIONS FROM FIFTH ARMY, 9 SEPTEMBER 1943-30 APRIL 1944a

a

 All figures are for U.S. personnel only.

Source: Annual Rpt, Surg, Fifth Army, 1944.

beachhead, which are not separately

available by months. It will be noted that

the disease rate was highest in December,

when weather conditions were at their

worst, while battle casualties reached

their peak in February, when both fronts

were fully engaged.27

Evacuation From Fifth Army

Patients who could not be returned to

duty within a reasonable time—usually

twenty-one days, although there was no

general policy—were moved as rapidly as

they became transportable to fixed hospitals in North Africa and in the developing communications zone around Naples.

During the period of army control, all

evacuation out of the combat zone was to

Africa, by sea from the Salerno beachhead, and by air from Naples. Responsibility for evacuation out of Italy shifted

to the newly activated Peninsular Base

Section on 1 November, with Fifth

Army thereafter responsible only for

clearing its own hospitals.28

Evacuation in the army area, like hospitalization, was centrally controlled by

the Fifth Army surgeon. Evacuation hospitals reported daily as to the number of

patients ready for disposition, and each

was given a quota twenty-four hours in

advance of movement. Wherever possible, by arrangement with the base

surgeon, specific hospitals were designated to receive the evacuees. Though

this system was new in the theater, it

worked smoothly in most instances.

Among the practical difficulties encountered were occasional communication

failures, and a tendency on the part of

evacuation hospital commanders to move

patients who should have been retained

in order to use up the allotted quota of

fixed beds.29

27

 See pp. 273-74, below.

28

 See p. 326, below. 29

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, 10th Field Hosp, 1943. (3) Annual

Rpt, 15th Evac Hosp, 1943.
SALERNO TO THE GUSTAV LINE 251

Collecting companies of the army medical battalions were attached to the evacuation hospitals to handle the actual

transportation. Until late November

1943, when adequate transportation became available to the base section, patients from front-line hospitals were

taken by army ambulance directly to the

point of treatment or of embarkation to

Africa. Beginning on 22 November, most

were carried only to the railhead, where

they were transferred to the 41st Hospital Train and army responsibility

ended. Until near the end of the year the

train ran only between Naples and

Caserta, a distance of about twenty-five

miles. Beginning on 26 December the

loading point was extended ten miles to

Sparanise, in the immediate vicinity of

the main concentration of evacuation

hospitals behind the Winter Line.

U. S. Army ambulances also evacuated

the field hospital of the 1st Italian Motorized Group to the Italian military hospital at Maddaloni. Evacuation hospitals

of the French Expeditionary Corps were

generally cleared by French ambulances

to the Sparanise railhead, where FEC patients were allotted space on the hospital

train.

Medical Supplies and Equipment

When planning for the Salerno landings got under way, the Sicily Campaign

was at its midpoint and the defects of the

Seventh Army supply system were already clear. Chief among these defects

were the late arrival of medical depot

personnel and the failure to submit supply requisitions to Services of Supply

headquarters for editing. There were

consequent delays in the establishment of

issue points, with some unnecessary loss

of material, and excessive quantities of a

number of supply items were delivered

to the island.30

With this Sicilian experience in mind,

an effective liaison was established between the SOS Medical Section and the

office of the Fifth Army surgeon. All supply requisitions were cleared through

SOS but changes were made only by

mutual agreement. To deal with the

beach supply problem a detachment consisting of one officer and twelve enlisted

men of the 4th Medical Supply Depot

was scheduled for the D-day convoy.

All medical units going ashore in Italy

carried their full Table of Basic Allowances supply load, augmented by special

items such as plasma, atabrine, and extra

splints and dressings. In addition, considerable quantities of medical supplies

were carried ashore by the combat troops.

These were packed in the sealed, waterproof containers designed for the purpose at the Fifth Army Invasion Training

Center, and were dropped on the beach

as the men carrying them went ashore.

The assault personnel of the 4th Medical Supply Depot made their way under

fire to a previously designated site on the

beach, where they dug in. The men then

collected the scattered supply containers

and medical equipment as it was unloaded, and set up a dump. Within five

hours of its landing, the 4th Medical Supply Depot was issuing supplies to meet

emergency needs. One hundred tons of

30

 (1) Rpt of Med Supply Activities, NATOUSA,

Nov 42-Nov 43. Other sources primarily relied

upon in this section are: (2) Annual Rpt, Surg,

Fifth Army, 1943; (3) Annual Rpt, Surg, Fifth

Army, 1944; (4) Annual Rpt, Med Sec, NATOUSA,

1943; (5) Annual Rpt, Med Sec, MTOUSA, 1944;

(6) Unit rpts of the 4th and 12th Med Depot

Cos, 1943 and 1944; (7) Davidson, Med Supply in

MTOUSA, pp. 50-60.
252 MEDITERRANEAN AND MINOR THEATERS

medical supplies were unloaded during

the night of 9-10 September, together

with some 200 tons of organizational

equipment belonging to the 16th and

95th Evacuation Hospitals. Personnel of

the two hospitals collected and sorted

their own equipment, which was stored

by the supply group until hospital sites

became available.

The supply dump operated on the

beach for four days. Then on 13 September the original detachment was relieved

by a new and larger segment of its organization, consisting of two officers and

fifty-two enlisted men, who brought with

them four 21⁄2-ton trucks, a 1⁄4-ton truck,

and a weapons carrier. The enlarged detachment moved the dump to Paestum,

near the newly laid out hospital area.

The depot was gradually enlarged until

it occupied thirteen wall tents.

During the first days at the beachhead

there were some shortages of expendable

items, due primarily to losses by enemy

action, damage in handling, and accidental immersion. Replacements were

ordered by cable from North Africa and

were promptly received. By 21 September, when the advance out of the beachhead began, a 14-day level of medical

supplies was available.

A supply depot was established at

Avellino early in October, where the

medical supply responsibility for Fifth

Army was transferred from the 4th to

the 12th Medical Supply Depot, along

with fifty tons of supplies. The detachments of the 4th that had served the

beachhead then joined the remainder of

their unit in Naples, where a base section

organization was being set up.31

Thereafter, the 12th Medical Supply

Depot—12th Medical Depot Company

after 3 December 1943—followed the

Fifth Army advance as closely as terrain

and circumstances permitted. The Avellino dump was closed on 25 October,

being supplanted by a depot at Caserta.

A forward issue point was established at

Riardo on 6 November, coincident with

the launching of the attack on the

Winter Line. On 17 December a larger

depot was opened in a monastery at Calvi

Risorta. Like the Riardo depot in the

Fifth Army hospital area, the new dump

was operated by the base section platoon.

One hundred and twenty tons of medical

supplies were moved forward to Calvi

Risorta, using eighty trucks. By this date

items of medical supply were generally

plentiful.

The 1st Advance Platoon of the 12th

Medical Depot Company was assigned on

8 January 1944 to VI Corps for the Anzio

operation. On the 26th of that month, in

support of the first unsuccessful assault

on Cassino, the 2d Advance Platoon

moved from Riardo to the village of San

Pietro, just off Highway 6 about midway

between Mignano and Cassino. Since

most of the buildings in the area were destroyed, the supply dump functioned

under canvas.

Professional Services in the Army Area

Medicine and Surgery

Forward Surgery—Fifth Army followed

and further refined in Italy the techniques worked out during the late stages

of the Tunisia Campaign for bringing

the best in surgery as close as possible to

the combat soldier. Detailed instructions

as to the preferred management of

various types of wounds were issued 31

 See p. 326, below.
SALERNO TO THE GUSTAV LINE 253

shortly before the invasion,32 but initial

reliance was placed on the experienced

teams of the 2d Auxiliary Surgical

Group. In the landing phase, these

teams were attached to the clearing stations, shifting to the evacuation hospitals

as they were established. When the front

was stabilized north of the Volturno late

in October 1943, field hospital platoons,

each with two to eight surgical teams,

were set up adjacent to the division

clearing stations, on the pattern developed in Sicily. Although these 100-bed

units were somewhat larger than experience had shown to be necessary, no

suitable substitute was available.33

With the commitment of the field hospitals, a system of triage was instituted at

the clearing stations. Patients who could

stand the ambulance trip were sent back

to an evacuation hospital. Those who

could not safely be moved were carried

by litter to the field hospital for immediate surgery. The nontransportable category generally included cases of severe

shock, intra-abdominal wounds, thoracoabdominal wounds, sucking chest

wounds, and traumatic amputations. Patients treated in the field hospital units

were retained until they could be safely

moved, up to a maximum of fourteen

days. As in Sicily, personnel and equipment sufficient for postoperative care of

remaining patients were left behind

when the hospital moved.34

Important changes in management of

surgical cases during the southern phase

of the Italian campaign included the

wider use of penicillin, which had been

allocated for specific treatments in the

closing months of 1943, but became relatively plentiful early in 1944; radical

debridement and other prophylactic

measures to prevent gas gangrene; and

the extensive use of whole blood, made

possible by the establishment of a blood

bank in Naples in February 1944.35

Another significant administrative development in forward surgery was the

employment of a surgical consultant by

Fifth Army toward the end of 1943. The

assignment went to Maj. Snyder, who

had served in a similar capacity with II

Corps in the Tunisia and Sicily Campaigns. The theater consultant in surgery, Colonel Churchill, continued to

devote much of his time to the inspection

and improvement of surgery in the army

area. Fifth Army also benefited, as II

Corps and Seventh Army had not, from

the close proximity of fixed hospitals in

the base section, permitting frequent

conferences for exchange of experience

and ideas among medical officers.

Neuropsychiatry—Experience in Sicily

tended to confirm the conclusions

reached by Major Hanson and his asso32

 Fifth Army Med Cir 1, an. 2, sub: Surg Procedures, 21 Aug 43. 33

 After the Sicily Campaign, General Blesse and

Colonel Churchill concluded that the ideal unit

for forward surgery would be a 120-bed surgical

hospital, capable of operating in two 60-bed sections. See (1) Col Wickert, Rpt of Visit to ETO

and NATOUSA, 1 Sep to 24 Oct 43. Except as

otherwise noted, sources for this section are: (2)

Annual Rpts, Surg, Fifth Army, 1943, 1944; (3)

Annual Rpt, Med Sec, NATOUSA, 1943; (4) Annual Rpt, Med Sec, MTOUSA, 1944; (5) Annual

Rpt, nth Fld Hosp, 1944; (6) Annual Rpts, 33d

Field Hosp, 1943, 1944; (7) Annual Rpts, 2d

Aux Surg Gp, 1943, 1944.

34

 For a nonprofessional, but vivid and moving

account of life in one of those field hospital units,

see Margaret Bourke-White, They Called It The

Purple Heart Valley (New York: Simon and Schuster, 1944) , pp. 123-32. 35

 (1) Surg, NATOUSA, Journal, 3 Nov 43. (2)

Fifth Army Med Cir No. 4, 20 Oct 43, sub: Gas

Gangrene. For discussion of the organization and

operation of the blood bank, see pp. 352-53, below.
254 MEDITERRANEAN AND MINOR THEATERS

TEAM OF 2D AUXILIARY SURGICAL GROUP OPERATING on a wounded German soldier,

94th Evacuation Hospital, December 1943.

ciates during the Tunisia Campaign that

the majority of psychiatric cases arising

as a result of combat could be returned

to duty in a relatively short time if

treated close to the source of disturbance.

It was largely on the basis of Hanson's

findings that the War Department in

October 1943 authorized the addition of

a psychiatrist to the staff of each division

surgeon, a practice followed in World

War I but later abandoned. A group of

psychiatrists was recruited for the purpose, and Hanson himself, at the request

of the Surgeon General, returned to the

zone of interior to assist in their indoctrination.36

36

 (1) Hanson, comp. and ed., "Combat Psychiatry," Bulletin, U.S. Army Medical Department,

Suppl (November 1949) pp. 33, 45. (2) Pers Ltr,

Gen Blesse to TSG, 13 Dec 43. General Blesse was

understandably reluctant to let Hanson go, but

felt that the mission was of such importance as to

justify recalling his neuropsychiatric consultant

from Italy to undertake it. "I hope," he wrote to

General Kirk in the letter cited above, "you will

not find it necessary to keep him there very long

for I need him, and if you have no objection I

would like to have him return here just as soon

as possible." Principal sources for this section

include: (3) Hanson, comp. and ed., "Combat

Psychiatry," Bulletin, U.S. Army Medical Depart-
SALERNO TO THE GUSTAV LINE 255

From the outset of the Italian campaign, battalion and regimental aid stations were directed to retain cases of

mild neurosis such as anxiety states and

exhaustion. These were to be fed, offered

opportunity to bathe, and given a sedative sufficient to ensure sleep. Cases

requiring more than thirty-six hours

treatment were sent to the division clearing stations, where heavier sedation was

given. Those who still did not respond

after seventy-two hours were sent on to

the evacuation hospitals, where they

were given more specialized treatment

and returned to duty or evacuated to the

communications zone, according to their

hospital expectancy. Of the 2,749 cases

disposed of between 9 September and 31

December 1943, 6 percent were returned

to duty from divisional installations, and

20 percent from Fifth Army hospitals,

the remainder being evacuated out of the

army area.

Several factors combined to produce

this relatively small percentage of returns

to duty. The urgent need for beds in the

evacuation hospitals during months of almost continuous combat sent to base hospitals many psychiatric casualties that

might have been reclaimed in the combat

zone. Evacuation hospital staffs had little

time to devote to such cases, and treatment varied with each installation. Even

where adequate treatment was available,

the very atmosphere of an evacuation

hospital tended to convince the patient

that his illness was organic and to fix

rather than to allay his anxieties.

The solution adopted by Colonel

Martin was the creation of a specialized

neuropsychiatric hospital to operate as

close as possible to the actual battle lines.

Known as the Fifth Army Neuropsychiatric Center, the hospital was formed

from the 2d Platoon of the 601st Clearing Company, 161st Medical Battalion,

with beds for 250 patients. Four psychiatrists were added to the staff, others

being attached at intervals when the case

load required it. The enlisted personnel

was approximately double that of a normal clearing platoon, the Wardmen

being specially trained for the job. The

center opened on 21 December 1943 in

the Teano-Riardo area, where the bulk

of Fifth Army medical installations were

then concentrated. It continued to function at various locations throughout the

war, never out of earshot of artillery fire.

Every effort was made to avoid a hospital atmosphere. There were no nurses.

Pajamas, sheets, and pillows were not

issued. Patients slept on regulation cots,

made their own beds, policed the area. So

far as possible, routine military discipline

was maintained, and the idea of a prompt

return to duty was always kept before the

men.

After 21 December 1943, all psychiatric cases that could not be handled at

the division level were sent directly to

the Neuropsychiatric Center. There they

were kept under sedation for two days,

but were still expected to go to meals,

wash, and shave every day. After the

effects of sedation had worn off, the men

were interviewed—usually on the third or

fourth day of their stay. The interview

was designed to elicit a full story of what

had happened to the men in combat,

with probing into their premilitary histories confined to the bare essentials.

Each individual case was evaluated in

ment, Suppl (November 1949) ; (4) Annual Rpts,

Surg, Fifth Army, 1943, 1944; (5) Annual Rpt,

Med Sec, NATOUSA, 1943; (6) Annual Rpt, Med

Sec, MTOUSA, 1944; (7) Surgs' rpts for 1943 and

1944 of the divs and corps mentioned in the combat

secs of this chapter.
256 MEDITERRANEAN AND MINOR THEATERS

TABLE 6—DISPOSITION OF NEUROPSYCHIATRIC CASES IN FIFTH ARMY

SEPTEMBER 1943—APRIL 1944

Source: Annual Rpt, Surg, Fifth Army, 1945.

this interview and the decision made as

to eventual disposition. A man might be

returned to duty promptly, retained for

further treatment, or evacuated to the

rear, according to the severity of his

symptoms and the nature of his responses

under questioning.

By March 1944 each U.S. division of

Fifth Army had its own psychiatrist, who

screened the cases as they came to the

clearing stations. The system was functioning smoothly as a single process by

the time the drive to Rome was launched

in May, but was still to be significantly

improved at the division level later in

the year.37

The disposition of neuropsychiatric

cases in Fifth Army for the period from

September 1943 through April 1944 is

shown in Table 6. The sharp decline in

returns to duty from division clearing

stations in November 1943 reflects the

impact of continuous and increasingly

severe fighting under steadily deteriorating conditions of weather and terrain.

The ameliorating effect of the Fifth

Army Neuropsychiatric Center first appeared in January 1944. February was

the month of heaviest fighting at both

Anzio and Cassino. The improved figures

for April represent virtual freedom from

combat, improved weather conditions,

and the first results of the assignment of

psychiatrists at the division level.

Diseases of Special Interest: Infectious Hepatitis—The period between

the Salerno landings and the launching

of the May 1944 offensive toward Rome

showed no unusual incidence of disease

among Fifth Army troops. In the early

weeks of the drive, malaria, Sandfly 37

 See pp. 314-16, below.
SALERNO TO THE GUSTAV LINE 257

fever, and dysentery predominated.38

Respiratory diseases appeared with the

advent of the rainy season, but not in

unusual volume. The only disease

worthy of special notice as a problem

for the medical service during the period, other than those discussed under

separate headings in this chapter, was

infectious hepatitis. The disease was first

noted in July 1943 in North Africa, but

was confined mainly to units of the 34th

Division. In Italy it became general

shortly after the Salerno landings, and

reached a peak rate of 121.0 cases per

1,000 per annum for the second week in

October. The rate for the entire month

of October was 93, dropping sharply and

steadily thereafter to 11 in April 1944.

Hepatitis consumed manpower out of

all proportion to its incidence, since the

average time lost was sixty days for each

patient.39

Infectious hepatitis was intensively

studied by Fifth Army medical officers

during and after the outbreak, but without arriving at definite conclusions as to

its mode of transmission, or the factors

influencing its virulence. The disease

was seasonal in character, being most

widespread in the fall months. It appeared to be more common among seasoned troops than among men newly

arrived in the theater. There was some

evidence of a relationship between hepatitis and a previous history of diarrhea.

The studies made in the winter of 1943-

44, however, did not produce enough

information to prevent another and still

more virulent outbreak in the late fall

of 1944.40

Preventive Medicine

Venereal Disease—The control of venereal disease in Italy proved to be even

more difficult than it had been in Africa.

After more than twenty years of fascism

and three years of war, the Italian economy was a patchwork of makeshifts in

which sheer hunger often overrode moral

considerations. Food was to be had on

the black market for a price, and the

price could be obtained by prostitution.

To women whose men were dead or

broken, prisoners of war, or doing forced

labor for a conqueror, there seemed no

other way. In cities such as Naples the

opportunities for clandestine contacts

were so numerous that neither inspection of licensed brothels nor putting the

houses off-limits offered any solution.

The psychology of the soldier, moreover,

was that the longer he remained in combat, the more remote were his chances of

getting home. As time went on, his memories dimmed and he came increasingly

to live for the moment.41

Italian doctors stated, and laboratory

tests tended to confirm the estimates,

that by 1944 half the available women

in Italy had some form of venereal disease, and that in the populous areas 95

to 100 percent of all prostitutes showed

clinical evidence of one or more venereal

diseases. Add to this high rate of infection the aggressiveness of the women,

and the nature of the problem becomes

38

 Surg, NATOUSA, Journal, 11 Oct 43. 39

 (1) Annual Rpts, Surg, Fifth Army, 1943, 1944.

(2) Annual Rpts, Surgs, 3d, 34th, 36th, 45th, 1st

Armd Divs, 1943, 1944. (3) Annual Rpts, Surgs,

II and VI Corps, 1943, 1944.

40

 See detailed discussion in Annual Rpt, Surg,

Fifth Army, 1944, and p. 451, below. 41

 This section is based primarily on the annual

reports of the Fifth Army surgeon for 1943 and

1944 and on the reports of corps and division

surgeons in the Fifth Army area.
258 MEDITERRANEAN AND MINOR THEATERS

clear. For example, when the 3d Infantry Division was training near Naples

early in January 1944 for the Anzio

operation, the division surgeon reported

that "prostitutes from Naples descended

upon our encampment by the hundreds,

outflanking guards and barbed wire.

They set up 'business' in almost inaccessible caves in the surrounding bluffs.

Many of them gained entrance into

camp by posing as laundresses. . . . Each

day several large truck loads of screaming, screeching prostitutes were collected

in the Division area and delivered into

the custody of the Italian police.42

Fifth Army dispensed with its venereal

disease control officer in September 1943

when the Army went into combat. In

that month the venereal disease rate was

low, but it began to rise sharply with the

capture of Naples in October. In December the position of control officer was reestablished, and Maj. (later Lt. Col.)

Sydney Selesnick was assigned to it.

It was not practicable to attempt any

direct control of houses of prostitution.

Italian laws governing the traffic were

respected, and their enforcement was

abetted by Allied Military Government

officials in all occupied territory. The

most that could be done in the army area

was to maintain a continuous educational drive, to see that preventive devices

were issued and that prophylactic stations were readily available, and to

bring in known prostitutes for examination, and treatment if they were infectious. Line officers were held responsible

if their units showed any disproportionate incidence of venereal disease.

(Table 7)

Along with these preventive measures,

every effort was made to reduce the time

lost from duty on account of venereal

disease. An important step in this direction was the establishment on 31 December 1943 of the Fifth Army Venereal

Disease Diagnostic and Treatment Center to function in the army area. The 2d

Platoon of the 602d Medical Clearing

Company, 162d Medical Battalion,

formed the nucleus of the new organization, which was augmented by personnel

drawn from the collecting companies of

the battalion. When fully staffed, the

VD center had 4 Medical Corps officers,

a Medical Administrative Corps officer,

and 92 enlisted men. It had 250 beds. A

mobile unit of the 2d Medical Laboratory was attached, adding an officer and

5 enlisted men.

Throughout the Gustav Line and

Rome-Arno Campaigns 90 percent of all

Fifth Army venereal cases—except those

on the Anzio beachhead—were treated in

the center, which could move to a new

location in six hours, carrying its patients

with it. Uniformity and continuity of

treatment cut down materially the time

lost from duty per case. The recovery

time was further reduced after penicillin became generally available for

venereal cases in mid-February 1944.43

Disposition of patients by the Fifth

Army Venereal Disease Diagnostic and

Treatment Center in the first four

months of 1944 is shown in Table 8. Although the center did not formally open

until the end of December, a considerable number of cases were already in the

hospital on 1 January, accounting for the

42

 Annual Rpt, Surg, 3d Div, 1944.

48

 Penicillin had been used in the theater in the

treatment of gonorrhea as early as November 1943,

but only on special allocation, arranged by the

theater venereal disease control officer. Surg, NATOUSA, Journal, 16 Nov 43.
SALERNO TO THE GUSTAV LINE 259

TABLE 7—VENEREAL DISEASE RATE PER THOUSAND PER ANNUM, BY DIVISIONS, SEPTEMBER

1943-APRIL 1944

Source: Annual Rpt, Surg, Fifth Army, 1944.

large number of dispositions in that

month.

Malaria Control—The Fifth Army malaria control program was part of a theater-wide effort. The necessary organization was set up well in advance of the

malaria season, primary responsibility

being vested in the Fifth Army medical

inspector, Colonel Gilmore. Colonel Gilmore's assistant, Maj. (later Lt. Col.)

Raiford A. Roberts, was named operational director of the control program,

and Capt. Joseph J. Bowen served as

malariologist from February 1944, on

detail from the 2655th Malaria Control

Detachment. The operating groups were

the 11 th Malaria Survey Unit and the

TABLE 8—DISPOSITION OF PATIENTS, FIFTH ARMY VENEREAL DISEASE DIAGNOSTIC AND

TREATMENT CENTER, JANUARY-APRIL 1944

Source: Annual Rpt, Surg, Fifth Army, 1945.
260 MEDITERRANEAN AND MINOR THEATERS

28th and 42d Malaria Control Units,

with the effective co-operation of the

Fifth Army engineers.44

Malaria control measures were carried

out at all echelons, each echelon being

responsible for its own area. Each corps,

division, regiment, battalion, and company had its own nonmedical malaria

control officer. Each formation down to

and including the battalion had its own

malaria control committee. At corps and

division levels, these committees consisted of the medical inspector, the engineer, and the malaria control officer. For

regiments and battalions the committees

were composed of the surgeon and the

malaria control officer. Each company,

battery, and similar unit had an antimalaria detail of at least two enlisted men,

including a noncommissioned officer. In

the higher echelons the antimalaria

function was largely planning and supervisory. At the company level the antimalaria details were responsible for carrying out control measures in the unit

area and for a radius of one mile around

it. Italian doctors and sanitary engineers

familiar with the local conditions were

fitted into the control organization, and

through the Allied Military Government

(AMG) the civilian population was also

included.

The engineers conducted most of the

large-scale control activities, such as

draining flooded areas, clearing obstructions from waterways, and filling in

craters, as well as applying larvicides to

water surfaces. Italian troops and civilian

laborers were freely employed in this

work.

In order to give intelligent direction

to the whole malaria control program,

two special schools were organized by

Captain Bowen. One of these, on the

Anzio beachhead, will be discussed in the

following chapter. The other served personnel of II Corps in the highly malarious coastal region south of the Garigliano River. The school was conducted under the auspices of the 54th Medical Battalion between 1 and 27 March 1944,

during which period 101 officers and 976

enlisted men, including 466 noncommissioned officers, were trained in the techniques of malaria control. Posters were

prominently displayed throughout the

corps area, and a training film on the

cause and control of the disease was

shown continuously during the malaria

season.

The control problem was rendered

much more difficult by the thoroughness

with which the Germans had destroyed

pumping plants, dikes, culverts, and

drainage systems, flooding large sections

of reclaimed land. It was nevertheless a

successful program in terms of its ultimate results. The malaria case rate per

1,000 per annum among Fifth Army

troops rose sharply from 83 in September

1943 to 193 for the following month,

dropped to a low of 45 in December, and

was only 85 for April 1944. Even in the

most malarious months of June, July,

and August, the case rates were only 94,

82, and 70 respectively. These rates compare favorably with those for the theater

44

 Main sources for this section are: (1) Annual

Rpt, Surg, Fifth Army, 1944; (2) Annual Rpt,

Surg, II Corps, 1944; (3) Annual Rpt, Med Sec,

MTOUSA, 1944; (4) Ltr, Capt Bowen, Asst Malariologist, 2655th Malaria Control Detach (Overhead) ,

to Surg, NATOUSA, 29 Dec 44, sub: Stat Analysis

of Malaria in MTOUSA, 1944; (5) Ltr, Col Andrews, Acting Malariologist, American Sec, AFHQ,

to Surg, NATOUSA, 10 May 44, sub: Antimalaria

Inspection Tour of VI Corps, Fifth Army, II Corps

and Adriatic Areas of U.S. Military Occupation 23

March-3 May 44; (6) Andrews, "North Africa,

Italy, and the Islands of the Mediterranean," Communicable Diseases, Malaria.
SALERNO TO THE GUSTAV LINE 261

TREATING MOROCCAN MOUNTAIN TROOPS of the French Expeditionary Corps for frozen

feet at an aid station in the Venafro area.

as a whole, which were 95 for October

1943, 31 for December 1943, and 80 for

April 1944. The rates for the theater as

a whole in the summer months of 1944

were 70 for June, 81 for July, and 92 for

August.45

When II Corps moved out of the

Minturno sector in the May offensive,

responsibility for continuing malaria

control work passed to the Peninsular

Base Section.

Trench Foot—Trench foot appeared

among Fifth Army troops early in the

Winter Line campaign and continued to

plague commanders until the spring of

1944. The condition was first reported in

mid-November 1943. Within a week

more than 200 cases had been hospitalized. The total for the month was 305,

with 1,323 cases reported in December.

The January and February figures were

still higher, with a sharp decline in

March. For the first three months of

1944, upwards of 4,000 trench foot cases

were treated, divided fairly evenly be45

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Final Rpt, Preventive Medicine Officer, MTOUSA,

1945.
262 MEDITERRANEAN AND MINOR THEATERS

tween the Cassino front and the Anzio

beachhead.46

Fifth Army troops were not equipped

for the physical conditions that confronted them in the winter of 1943-44.

There had been no adequate indoctrination as to the danger of trench foot, and

no preparations to prevent it. Troops

had only the standard army shoe or combat boot, with light wool socks, which

did not give protection against either

cold or dampness. Heavy wool socks became available later in the winter, but

could not be worn until it was possible

to issue larger shoe sizes. Neither were

there enough socks on hand to permit

the daily change recommended by the

surgeon.

In the bitter mountain fighting before

Cassino, where cold and rain or snow

were almost incessant, front-line troops

could not hope to keep their feet dry,

and, continuously in range as they were

of enemy small arms fire, they could not

risk giving away their positions by movement merely to exercise their limbs.

Manpower was too short to permit rotation, so many men went for a week or

more without opportunity to dry or

warm their feet and little chance even to

walk on them. Trench foot was an almost

inevitable consequence.

While the condition was intensively

studied by medical officers of Fifth Army

and proper prophylactic measures were

determined, little headway could be

made until more suitable footgear became available.47

Typhus—An epidemic of typhus that

broke out in Naples in October 1943

posed a serious threat to Fifth Army. The

account of measures taken to combat the

epidemic and to prevent its spread to

Fifth Army troops properly belongs in

another chapter.48 It will be sufficient

here to say that vigorous action to prevent louse infestation was taken, and

was effective. For several months Naples

was off-limits to Fifth Army troops except on necessary business, and all military personnel entering or leaving the

city were treated with insecticides.

Dental Service

Facilities for dental prosthetic work

remained scarce during the summer of

1943 when Fifth Army was staging for

the invasion of Italy, but with that exception the troops were dentally in good

condition when the campaign began. In

the assault phase, only emergency dental

work was done, while most of the dental

officers and enlisted personnel performed

other duties. By 1 October, however, the

Fifth Army dental service was solidly

established. Three divisional dental laboratories were in operation and others

were functioning in connection with the

46

 Figures reported differ considerably. For the

months of November 1943 through March 1944,

Annual Report, Medical Section, MTOUSA, gives

5,058, but concedes that the 1943 figures are too

low. Annual Report, Surgeon, Fifth Army, 1944,

gives 5,710 cases for the same period, while the total

is reduced to 5,274 in Annual Report, Surgeon, Fifth

Army, 1945. The text follows Annual Report, Surgeon, Fifth Army, 1944, and Fifth Army Medical

Circular No. 6, 24 November 1943. For discussion of

trench foot at Anzio, see pages 285-86, below.

For more technical treatment, see Col. Tom

F. Whayne, USA (Ret.) and Michael E. DeBakey,

M.D. Cold Injury, Ground Type "Medical Department, United States Army, in World War II"

(Washington, 1958) , pp. 101-25. Whayne and DeBakey also accept the figures reported by the Fifth

Army Surgeon for 1944.

47

 Compare the 1943-44 record with that of the

winter of 1944-45 in the north Apennines, page 452,

below. 48

 See pp. 462-65, below.
SALERNO TO THE GUSTAV LINE 263

evacuation hospitals. By 1 December

there were twenty laboratories in the

army area, including two mobile units

built on 21⁄2-ton truck bodies by the 34th

and the 1st Armored Divisions.49

In mid-December 1943 the II Corps

surgeon, Colonel Ginn and the corps

dental surgeon, Lt. Col. Gerald A. McCracken, organized a II Corps Prosthetic

Dental Clinic and Laboratory. The clinic

was housed in a hospital ward tent supplied by the 54th Medical Battalion,

which also furnished lighting fixtures, a

generator, and the necessary laboratory

tables, benches, and operating platforms.

One dental officer was detached from

the 54th Medical Battalion, and one

from the nth Field Hospital. The same

two organizations also furnished between

them one laboratory technician, two

chair assistants, and one clerk. The remainder of the personnel consisted of

two prosthetic dental teams of one officer

and four technicians each, from the 2d

Auxiliary Surgical Group. One of these

teams was withdrawn late in February

1944. Early in January a similar clinic was

organized at the army level by the Fifth

Army dental surgeon, Colonel Cowan.

The Fifth Army Dental Clinic was

housed with the 2d Platoon of the 602d

Medical Clearing Company, 162d Medical Battalion, which was also the nucleus

of the venereal disease center. Like the

II Corps clinic, its personnel and equipment were drawn from other medical

units. The Army clinic had four dental

officers, with an appropriate complement

of enlisted men.

Both II Corps and Fifth Army dental

clinics were originally designed primarily

for prosthetic work, but both quickly enlarged their facilities to handle all aspects

of dentistry except X-ray work.

Another clinic, similarly equipped and

staffed, was set up as an organic part of

the Fifth Army rest center in Naples,

moving with the center to Caserta when

the typhus epidemic put the former city

off-limits.

As in earlier campaigns, the more extensive dental facilities of the divisions

were usually located in the service area,

with routine dental work being done

during slack periods in the clearing stations. During actual combat only emergency work was performed.

While dental officers in Fifth Army

increased from 154 in September 1943 to

233 in April 1944, their numbers did not

keep pace with the rise in troop strength.

The ratio of dental officers to mean

troop strength in September was 1:740.

In April it was 1:1010. Through better

organization and more efficient distribution, however, the amount of dental

work done showed a steady increase over

the 8-month period. (Table 9)

Veterinary Service

In the hard mountain fighting before

Cassino, pack animals were extensively

used, bringing the Veterinary Corps into

action in something more than its food

inspection capacity. Early in the Winter

Line campaign, veterinary officers of the

34th and 45th Divisions procured such

animals as they could and organized divisional pack trains. Other than the division veterinarian and his sergeant, no

49 Chief sources for this section are: (1) Annual

Rpts, Surg Fifth Army, 1943, 1944; (2) Annual

Rpt, Surg, II Corps, 1944; (3) Annual Rpt, Med

Sec, MTOUSA, 1944; (4) 1943 and 1944 rpts of

the combat and med units in Fifth Army, Sep 43-

Apr 44.
264 MEDITERRANEAN AND MINOR THEATERS

TABLE 9—DENTAL SERVICE IN FIFTH ARMY, SEPTEMBER 1943-APRIL 1944 a

a

 Includes Anzio beachhead.

Source: Annual Rpts, Surg, Fifth Army, 1943, 1944.

trained personnel were available. Food

for the animals was scarce and of poor

quality, and the animals themselves were

old, chronically lame, undersized, and

generally in poor condition. Despite

these handicaps, however, it was soon

apparent that pack trains would be a

virtual necessity if troops were to be supplied in the mountains.50

With the recognition of this necessity,

Col. Clifford E. Pickering, Fifth Army

veterinarian, was directed to help in the

procurement, care, and rehabilitation of

animals. The task was no easy one. First

the Italian Army, and later the Germans,

had systematically looted the farms; and

the Germans had killed such animals as

they could not use themselves, in order to

make still more difficult the economic

and military problem of the Allies.

Colonel Pickering learned from Italian sources that a considerable number

of animals bred for military use had been

distributed among farmers for concealment from the Germans. With the assistance of former Italian cavalry officers and

local carabinieri, these were located and

assembled. Enough feed for their immediate needs was found in a partially destroyed factory at Maddaloni. Nails and

horseshoes were made from scrap iron in

improvised blacksmith shops. An Italian

breeding depot was re-established as the

Fifth Army Remount Depot, which was

turned over to the base section at the

end of the year.

Another substantial group of animals

was located in Sardinia, where the

prompt revolt of the Italian garrison had

saved 5,000 mules, 1,500 horses, 3,000

saddles, and quantities of shoes from the

vengeful Germans. Pack trains were organized on the island with Italian per50

 This section is drawn primarily from the annual reports of the Fifth Army surgeon for 1943

and 1944, and the reports of the division surgeons

whose units participated in the Winter Line and

Cassino campaigns. See also, Miller, United States

Army Veterinary Service in World War II.
SALERNO TO THE GUSTAV LINE 265

sonnel, each train having 4 line officers,

a medical officer, a veterinary officer, 400

enlisted men, and approximately 325

animals. Two of these trains reached the

mainland of Italy before the end of 1943.

On their arrival, a Fifth Army Provisional Veterinary Hospital was organized, using 4 officers and 53 enlisted men

drawn from the pack train complements.

The hospital opened at Visciarro on 8

December. December also saw the arrival

of a French veterinary hospital, with 5

officers and 74 enlisted men from North

Africa with elements of the French Expeditionary Corps. The French also

brought their own animals in substantial

numbers.

More pack trains arrived from Sardinia in January 1944, together with two

more Italian-staffed veterinary hospitals,

the 110th and the 130th. Each of these

had four veterinary officers, one administrative officer, and 100 enlisted men.

These units were set up in the forward

area, while the provisional hospital, renamed the 210th Veterinary Hospital

(Italian), was turned over to the Peninsular Base Section.

In February an Italian cavalry officer,

Col. Berni Canani, was named liaison

officer between Colonel Pickering's office

and all Italian units, a position in which

his services proved invaluable.

A U.S. veterinary evacuation hospital

and some separate veterinary companies

were requested for Fifth Army by General Blesse in November 1943, in anticipation of a wider use of animals in the

mountain fighting approaching the Gustav Line. It was March 1944, however,

before the only American veterinary

evacuation hospital to serve in the

Mediterranean, the 17th, reached Italy,

and no veterinary company was available

to Fifth Army before the final days of

the war.51 The 17th Veterinary Evacuation Hospital was set up near Teano.

The outstanding veterinary problems

of the Winter Line and Gustav Line

campaigns were the care and rehabilitation of poor quality, poorly conditioned

animals whose very physical debility

increased their proneness to battle

wounds, and the provision of feed adequate both in quantity and quality.

Equipment for ridding the animals of

lice was very deficient during this period. While feed increased in quantity,

there was little improvement in quality

until crops were harvested in the rehabilitated areas of Italy and shipping became available.

Animal strength in Fifth Army rose

from 986 horses and 4,136 mules in January 1944 to 2,226 horses and 10,433

mules, or 12,659 animals in all, in April.

Of this peak total, 2,023 horses and 7,266

mules were with the French Expeditionary Corps, which had its own treatment

facilities. During the 4-month period,

January—April 1944, 608 U.S. and

Italian animals were admitted to the

hospital of which 368 were returned to

duty, 197 were evacuated to base, and 47

died or were destroyed.

51

 (1) Surg, NATOUSA, Journal, 15 Nov 43. (2)

Annual Rpt, 17th Vet Evac Hosp, 1944. The 45th

Veterinary Company (Separate) arrived in the

Mediterranean in the summer of 1944, but was immediately assigned to Seventh Army, then training

for the invasion of southern France.
CHAPTER VII

Anzio Beachhead

A seaborne landing on the west coast

of Italy between the Garigliano and Tiber rivers had been contemplated since

early November 1943, and plans involving various sites, including Anzio, were

developed in some detail. The stubborn

German defense of the Winter Line,

however, made it clear that the main

body of Fifth Army would not be able to

break through to support the beachhead

at any predictable time, and plans were

held in abeyance.

They were revived at a Christmas day

conference in Tunis, where Prime Minister Churchill was the moving force. All

of the military commanders concerned

were present except the one most directly involved—General Clark, who

would be immediately responsible for

the operation. Those at the conference

included General Eisenhower, soon to

leave for OVERLORD; General Sir Henry

Maitland Wilson, who was to succeed

Eisenhower as Supreme Allied Commander in the Mediterranean; General

Alexander, commanding the 15th Army

Group in Italy; Air Chief Marshal

Arthur W. Tedder, who headed the Allied Air Forces in the Mediterranean;

and Admiral Sir John Cunningham,

commanding the Allied Navies in Italian

waters. All of these men appreciated the

risks inherent in such an operation, with

the limited forces at their disposal, but

political considerations overrode the military hazard. The Prime Minister felt

that Rome must be quickly taken or the

Italian campaign would be counted a

failure, and the Allied cause would

suffer, especially with the Turks, whose

active military aid he was then strenuously soliciting.1

Medical Planning for

Operation SHINGLE

As originally proposed, the Anzio land1

 General sources for the Anzio campaign are:

(1) Fifth Army History, vol. IV; (2) Starr, ed.,

From Salerno to the Alps; (3) Oprs Rpts, VI Corps,

Jan-May 44; (4) Alexander, "The Allied Armies in

Italy from 3rd September, 1943, to 12th December

1944," Suppl. to the London Gazette, 6 June 1950,

pp. 2908-13, 2917; (5) Mark W. Clark, Calculated

Risk; (6) Truscott, Command Missions; (7) Winston S. Churchill, The Second World War: Closing

the Ring (Boston: Houghton Mifflin Company,

1951); (8) American Forces in Action, Anzio Beachhead (Washington, 1947); (9) Morison, Sicily-Salerno-Anzio; (10) Wesley Frank Craven and James,

Lea Cate, eds., "The Army Air Forces in World War

II," Europe: ARGUMENT to V-E Day, (Chicago,

The University of Chicago Press, 1951); (11) Albert Kesselring, Soldier's Record, pp. 232-37; (12)

Taggart, ed., History of the Third Infantry Division in World War II; (13) Howe, 1st Armored

Division; (14) The Fighting Forty-fifth, pp. 71-86.

The more important medical sources are: (15) Annual Rpt, Med Sec, MTOUSA, 1944; (16) Annual

Rpt, Surg, Fifth Army, 1944; (17) Annual Rpt,

Surg, VI Corps, 1944; (18) Clift, Field Oprs, pp.

265-83; (19) Rollin L. Bauchspies, "The Courageous Medics of Anzio," Military Medicine, CXXII,

(January-June 1958). 53-65, 119-28, 197-207, 267-

272, 338-359. 429-448; (20) Unit rpts of individual

med units mentioned in the text.
ANZIO BEACHHEAD 267

COLONEL BAUCHSPIES

ings, known by the code name SHINGLE,

were to be made by one division carrying supplies for seven days, by which

time it was to be in contact with forward

elements from the Cassino front. When

the stalemate before the Gustav Line precluded any hope of a quick breakthrough, plans were changed to land two

divisions, reinforced, with another two

divisions in reserve, and to provide resupply for as long as was necessary. It was

hoped that determined attacks across the

Rapido and Garigliano Rivers would divert enough enemy strength from the

Rome area to permit a quick breakout

by the Anzio forces, which would in turn

compel a German withdrawal from the

Gustav Line and bring about an early

junction of troops from the two Allied

fronts.

Operations on the Anzio front, like

those elsewhere in Italy, can be properly

understood only in terms of broad Allied

strategy for the war as a whole. The

build-up in England for the cross-Channel attack took precedence over everything else. Three veteran U.S. divisions—

the 1st, 9th, and 2d Armored— had already been diverted from the Mediterranean, together with most of the 82d

Airborne. With them went medical detachments, supporting medical battalions, and evacuation hospitals. Seasoned

commanders were also being withdrawn

for major roles in the coming campaign

in France. Eisenhower, Bradley, and Patton were followed to England in January

1944 by Montgomery, whose successor as

Eighth Army commander was General

Sir Oliver Leese; and Tedder, who

turned over command of the Mediterranean Allied Air Force to Lt. Gen. Ira

C. Eaker. Lt. Gen. Jacob L. Devers became deputy theater commander under

Wilson, and commander of the U.S.

ground forces in the Mediterranean. The

invasion of southern France, which was

already in the planning stage, would divert still more combat and service troops

from Italy. In a word, the Italian campaign remained a diversion, to immobilize as many German troops as possible.

The Allied armies in Italy were nevertheless expected to win their battles.

Medical planning for the Anzio landings, both at army and at corps levels,

followed the tactical plans, making full

use of experience gained in Africa and

Sicily and on the Salerno beaches. The

operation was to be carried out by VI

Corps, under command of General

Lucas. The assault troops were to be the

British 1st Division, assigned from

Eighth Army, and the U.S. 3d Division,

with the 45th and 1st Armored Divisions
268 MEDITERRANEAN AND MINOR THEATERS

in reserve. The landing force was also

to include two British Commando and

three Ranger battalions, the 504th Parachute Infantry regiment, and the 509th

Parachute Infantry Battalion. In addition to the normal medical detachments

and organic medical battalions, medical

support for VI Corps was to be supplied

by the 52d Medical Battalion; the 93d,

95th, and 56th Evacuation Hospitals; the

33d Field Hospital, with the British 12th

Field Transfusion Unit attached; the

British 2d Casualty Clearing Station; the

549th Ambulance Company; and a detachment of the 2d Auxiliary Surgical

Group.

Medical planning for the Anzio operation was directed by Fifth Army surgeon,

Joseph I. Martin, now a brigadier general, and Colonel Huddleston, who had

been VI Corps surgeon since Salerno.

Colonel Huddleston also directed medical services on the beachhead until he

was killed by artillery fire while emerging from corps headquarters on 9 February 1944. He was succeeded by Col.

Rollin L. Bauchspies, commanding officer of the 16th Evacuation Hospital.

Medical support was based on a projected D-day casualty rate of 10 percent

of the assault troops and 5 percent of the

remainder, with a daily hospital admission rate thereafter of five per thousand

from all causes.

All medical units were to be combatloaded for greater speed in establishing

themselves ashore. Aid stations were to

go in with the landing waves, to be followed as quickly as possible by the installations of the beach group, under

initial control of the 540th Engineer

Shore Regiment. In the latter category,

the 52d Medical Battalion was to set up

a collecting-clearing station to receive

casualties from the aid stations and evacuate to the ships, while the 33d Field

Hospital was to establish an adjacent

unit to care for nontransportables. The

collecting companies of the 3d Medical

Battalion, organic to the 3d Division,

were to land at H plus 6 and move inland to assume their normal functions,

with the 3d Division clearing station following two hours later. The two 400-bed

evacuation hospitals, the 93d and 95th,

were also to go ashore on D-day.

The British assault was to be similarly

supported, with two field dressing stations and a beach dressing station,

backed up by the 2d Casualty Clearing

Station. Hospital ships were to be available off both British and American

beaches until D plus 3, after which they

were to come when requested by the

senior surgeon on the beachhead. Normal medical supplies were to be augmented by additional items carried

ashore by aidmen, and the 1st Advance

Platoon of the 12th Medical Depot Company was to maintain a 10-day reserve on

the beachhead. During the assault phase,

task force and subtask force surgeons

were to be responsible for all medical

units accompanying their forces.

Combat Medical Service

Landing Phase

Anzio and nearby Nettuno are small

resort towns on the west coast of Italy,

about 30 miles south of Rome. (Map 24)

Ten miles to the east, the Mussolini

Canal separates the Anzio plain from the

reclaimed Pontine Marshes, while on the

northwest rolling, partially wooded farmlands, cut by deep gullies, extend about

25 miles to the Tiber. Some 20 miles
MAP 24—Anzio Beachhead and Surrounding Areas
270 MEDITERRANEAN AND MINOR THEATERS

north of Anzio rise the Alban Hills, or

Colli Laziali, with Highway 7—the ancient Appian Way—skirting the southern

shoulder of the hill mass through Albano

and Velletri, and running southeast to

Terracina on the coast, about midway between Rome and Naples. Highway 6,

the direct route from Cassino to Rome,

flanks the northern slopes of the Alban

Hills, coming at its closest point within

30 miles of Anzio.

The original mission of VI Corps was

to seize the Alban Hills and cut both

highways, which formed at once the supply lines and the escape routes of the

German Tenth Army entrenched behind

the Gustav Line. The orders finally

given to General Lucas were somewhat

modified, in the light of anticipated difficulties. VI Corps was to "seize and

secure a beachhead in the vicinity of

Anzio" and "advance on Colli Laziali,"

but the timing and extent of the advance

were not predetermined. The key points

to be enveloped were Campoleone, eighteen miles north of Anzio on the Albano

road, and Cisterna, astride Highway 7 a

similar distance to the northeast.

While German intelligence had noted

Allied preparations for an amphibious

operation, the enemy high command had

been deceived by feints and raids at various points into expecting the assault to

be made north of Rome. Vigorous

thrusts along the main Fifth Army front,

from Cassino to the mouth of the Garigliano, further confused the enemy, and

served to occupy his reserves. The Anzio

beaches were therefore virtually undefended when the first Allied troops

waded ashore at 0200 on 22 January

1944. The 3d Division, commanded by

General Truscott, landed three regiments abreast between Nettuno and the

canal, while the Commandos led the

British assault six miles northwest of

Anzio. The town itself, with mole and

port facilities nearly intact, was quickly

taken by Col. William O. Darby's

Rangers. The 509th Parachute Infantry

Battalion took Nettuno almost as

quickly.

German air attacks began shortly after

dawn, coupled with spasmodic fire from

long-range guns, but the work of unloading men and supplies was not seriously

hampered. By midnight, about 36,000

men, 3,200 vehicles, and large quantities

of supplies were ashore, approximately

90 percent of the equipment and personnel of the assault convoy.

Casualties were negligible, and so the

medical plan was altered to give priority

to combat troops and material. Battalion

aid stations went ashore with the combat

units to which they were attached, and

litter squads from the 52d Medical Battalion accompanied the 3d Division as

well as the Rangers and paratroops. The

beach collecting-clearing station of the

corps medical battalion was not needed,

however, and did not go ashore until

twenty-four hours after the first landings.

The 3d Division clearing station was not

established until the afternoon of D plus

1.

The few casualties that occurred in the

early hours of the assault were held at

battalion aid stations or carried direct to

LST's equipped to care for them. Aside

from these aid stations, the only medical

installation ashore on D-day was the 2d

Platoon of the 33d Field Hospital, which

landed its personnel and attached surgical teams at 1330, received its equipment

three hours later, and was ready to accept

patients about 1800. The hospital was

set up on the beach southeast of Nettuno.
ANZIO BEACHHEAD 271

Until the bulk of the troops had advanced inland and a normal chain of

evacuation had been set up, most casualties were littered from the battalion aid

stations directly to the field hospital.

For 48 hours this unit was the only

hospital functioning on the beachhead.

It was soon filled to capacity, with three

operating tables in constant use and a

backlog of 20 to 30 cases. Tents were

several times pierced by shell fragments

and debris, but no casualties resulted.

The remaining platoons of the 33d Field

were put ashore during the afternoon of

23 January, D plus 1, but remained in

bivouac, the 3d Platoon until 26 January, the 1st until 8 February. In the

interval, their personnel and equipment

were drawn upon to expand the facilities

of the 2d Platoon.

Both the 93d and 95th Evacuation

Hospitals were landed on D plus 1, but

were not in operation until the late afternoon of 24 January. The 93d occupied

buildings in Anzio; the 95th was under

canvas midway between Anzio and Nettuno. The British 2d Casualty Clearing

Station was established just north of

Anzio about the same time.

German air raids on the harbor area

and the rising tempo of long-range shelling quickly made these hospital sites

untenable. There was, in fact, no safe

area on the beachhead, since every foot

of the ground held by Allied troops

could be observed by the enemy and

reached by his guns. Colonel Huddleston

selected an open field about two miles

east of Nettuno as the lesser hazard, and

a hospital area was laid out. The 56th

Evacuation, which arrived on 28 January, was set up here, and took all patients over the next two or three days

while the 93d and 95th Evacuation Hospitals and the 33d Field Hospital moved

to the new location. A similar area for

British medical installations was established about two miles north of Anzio on

the road to Rome. (See Map 24.)

Evacuation was from the beach until

the harbor became available on 29 January, D plus 7. LCI's (Landing Craft, Infantry) and other small craft carried

patients to LST's or to hospital ships

standing offshore, but the process was

difficult at best. The water was rough

five days out of seven. Frequent air raids

and intermittent shelling made it dangerous to hold casualties on the beach,

while the ships standing by were easy

targets. Even the Geneva cross was scant

protection. Three British hospital ships

were deliberately bombed offshore on

the night of 24 January, and one of them,

the St. David, was sunk.

On the military side the attack, which

opened so auspiciously, was quickly

stalled. From the beaches the troops

moved inland against light opposition.

All initial objectives, including the

bridges across the Mussolini Canal, were

secured by noon of D-day, but the key

towns of Campoleone and Cisterna were

still miles away, and the Alban Hills

were but a blister in the distance. January 24 found VI Corps still occupying

an area roughly fifteen miles wide and no

more than seven miles deep. By this

time the benefit of surprise had been lost.

Air attacks were increasing in violence

and frequency. Huge railway guns that

the men came to know as "Whistling

Willie" and the "Anzio Express" were

trained on the beachhead from concealed

positions, changing nightly. All along

the 26-mile perimeter of the Allied front,

opposition was stiffening as new German

units were rushed piecemeal to the area
272 MEDITERRANEAN AND MINOR THEATERS

TRANSFERRING WOUNDED FROM AN LCI TO A BRITISH HOSPITAL SHIP OFF ANZIO

over roads and rail lines still usable despite the pounding of Allied bombers.

General Lucas decided to dig in

against an anticipated counterthrust and

wait for reinforcements before advancing his lines. The 1st Special Service

Force, the 45th Infantry Division, and

half of the 1st Armored were brought

up from Naples, and the attack was

launched on 30 January. It was too late.

The Germans had moved more swiftly,

bringing fresh divisions from northern

Italy, southern France, Yugoslavia, and

even from the static Eighth Army front

to wipe out what Hitler called the

"abscess" below Rome.

For seventeen weeks Anzio beachhead

remained a "flat and barren little strip

of Hell"; a front without a rear, where

hospitals stood only six miles from the

fighting lines and were backed against

the sea. Instead of the wildcat Churchill

had hoped to hurl at the enemy's flank,

SHINGLE had become a "stranded whale."2

2

 The first quote is from General Clark, Calculated Risk, page 7; the second is from Winston

Churchill, Closing the Ring, page 488.
ANZIO BEACHHEAD 273

Attack and Counterattack

The VI Corps attack launched on 30

January was a twopronged drive in

which the 3d Division was to cut the

railroad at Cisterna and seize the town,

and the British 1st Division was to take

Campoleone and advance to cut Highway 7 at Albano. The 1st Armored was

to pass around the British 1st to the left

and storm Colli Laziali from the west.

The attack began disastrously when the

1st and 3d Ranger Battalions, which

were to open the way for the 3d Division, were ambushed and destroyed.

Only 6 of the 767 men engaged got back.

Among the missing were 21 enlisted men

of the 52d Medical Battalion. The 4th

Ranger Battalion, following with the

15th Regimental Combat Team of the

3d Division, also suffered heavy losses.

After three days of fighting, the Cisterna assault was halted two miles short

of its goal.

The drive up the Albano road was no

more successful. The British 1st Division was met by well-placed armor, and

the U.S. 1st Armored had to be hastily

diverted to reinforce the infantry. Again

the objective was approached but not

reached, and the attack was halted at

nightfall on 31 January.

With the equivalent of four divisions

under his command, General Lucas had

been stopped by a German army of approximately equal size. Though heavy

losses had been inflicted on the enemy,

his line had not been breached. On 2

February, VI Corps was ordered to take

defensive positions, and control of hospitalization and evacuation from the

beachhead reverted to Fifth Army.

During the next two weeks both sides

worked furiously to build up strength,

but the initiative lay with the Germans,

who launched repeated attacks against

different sections of the front and kept

up an intermittent shelling of Allied

positions. Consolidated into the Fourteenth Army under General Eberhard

von Mackensen, the German strength

was impressive. The Allies brought up

the British 56th Division from the

Garigliano front, but few more units

were available. VI Corps could only compensate for deficiencies in manpower by

heavily reinforcing its artillery and

tanks.

The major German drive was

launched down the Albano road on 16

February and reached its maximum development two days later. The crisis for

the beachhead came during the night of

18-19 February when the Germans were

stopped only six miles from the sea. Allied air superiority and the support of

naval guns were contributing factors.3

General Truscott was made deputy commander of VI Corps at this time, command of the 3d Division passing to Brig.

Gen. John W. O'Daniel. Truscott replaced Lucas as corps commander on 23

February.

A renewed German drive on 28 February was also stopped after several days

of continuous fighting, much of it handto-hand. By 5 March the battle of the

beachhead was over. The Germans tacitly acknowledged defeat and went over

to the defensive, while Alexander

ordered a general regrouping of the Allied forces on the main front in preparation for a drive on Rome.

3

 Rpt, Supreme Allied Commander, Mediterranean, to CCS, on Italian Campaign, 8 Jan 44-10 May

44.
274 MEDITERRANEAN AND MINOR THEATERS

PFC. LLOYD C. HAWKS, 3d Division aidman, received the Medal of Honor for his

heroic rescue on 30 January 1944 of two

wounded men in the Anzio area from an

exposed position within 30 yards of the

counterattacking enemy, although he himself was twice wounded.

The beachhead line was approximately that of 24 January, with some expansion toward Cisterna. For the next

two and a half months VI Corps waited,

resting, reinforcing, and building reserves of ammunition and supplies.

Every part of the beachhead remained

subject to enemy fire, and limited engagements continued intermittently, but

the issue was no longer in doubt.

Early in March the British 5th Division replaced the battered 56th, and

later that month the U.S. 34th Division

was added to the Anzio forces. In May,

shortly before the final breakout, the

36th Division was also attached to VI

Corps.

Medical support of the Anzio forces

after the landing phase followed a normal pattern, though all the clearing

stations but one, through sheer necessity,

were eventually concentrated in the hospital area east of Nettuno. The 3d Division clearing station was originally established in the area later selected for

hospital use, but moved on 14 February

to Acciarella, about midway between

Nettuno and the Mussolini Canal on an

east-west line. There it was joined by a

platoon of the 33d Field Hospital, but

both units, after being heavily shelled

on the last day of the month, moved

hastily back to the hospital sector. The

45th Division clearing station was initially established somewhat closer to

Nettuno, but it too moved into the

hospital area on 8 March. The corps

clearing station of the 52d Medical Battalion was sited in the hospital area

throughout the life of the beachhead.

Clearing stations of the 34th and 36th

Divisions were set up there on arrival.

The only exception was the clearing

station of the 47th Armored Medical

Battalion, supporting the 1st Armored

Division, which was located in the

British hospital area about two miles

north of Anzio during the entire period.

Evacuation from aid stations and collecting stations was by hand litter,

ambulance, and jeep. The smallness of

the beachhead meant that evacuation

distances were never great, but by the

same token the tasks of litter bearers

and ambulance drivers were always

hazardous. Evacuation was mainly at

night because of the ability of the enemy

to sweep the beachhead with artillery

fire and the frequency of air attacks.
ANZIO BEACHHEAD 275

Hospitalization on Anzio

Beachhead

The decision to locate all hospitals in

the open, made after the 24 January

bombings, introduced many new problems, but it undoubtedly saved the beachhead medical service. Both Nettuno and

Anzio, which offered the only alternatives, were pounded to rubble by enemy

guns and bombs long before the campaign was over. The area selected for

the U.S. installations was on low ground

near the sea. Drainage was poor and the

water table so close to the surface that

disposal pits and foxholes could not be

dug to proper depth. With all installations under canvas, the prevailing dampness added to the heating problem,

making stoves, fresh straw, and extra

blankets necessary. By 2 February, when

control of the hospitals reverted to Fifth

Army, the 56th, 93d, and 95th Evacuation Hospitals and two platoons of the

33d Field Hospital were in the area with

an aggregate Table of Organization bed

strength of 1,750.4

Beachhead hospitals had been functioning at their new locations for no

more than a week when the first of a

long series of bombings and shellings

occurred. It was impossible to put the

medical installations out of range, and

equally impossible in that overcrowded

wedge of purgatory to site them a safe

distance from legitimate military targets. Even when the beachhead was

blotted out by a protective screen of

smoke, the German gunners managed to

find their marks. So good, indeed, was

their observation, and so accurate their

marksmanship, that it was impossible to

attribute all the damage in the hospital

area to accident.

On 7 February an enemy plane,

closely pursued by Allied fighters, jettisoned its load over the hospital area.

Five antipersonnel bombs landed on the

tents of the 95th Evacuation Hospital,

where 400 patients were being cared for.

Newly wounded men were being carried

in from the ambulances, the X-ray tent

was crowded, and the operating rooms

were working to capacity. Twenty-six

persons were killed and 64 wounded.

The dead included 3 nurses, 2 medical

officers, a Red Cross worker, 14 enlisted

men, and 6 patients. The hospital commander, Colonel Sauer, was among the

wounded. The X-ray equipment was a

total loss, twenty-nine ward tents were

destroyed, and numerous smaller items

of equipment were damaged.

Within an hour the dead had been

removed, the wounded hospitalized, and

surgical cases among the patients of the

95th transferred to other installations.

Doctors and nurses continued their work,

but personnel losses and damage to

equipment were too great to overcome.

General Martin, after reviewing the situation with his beachhead deputy, Col.

Henry S. Blesse of the 56th Evacuation

Hospital, ordered a replacement. The

95th changed places with the 15th Evacuation on the static Cassino front, the

latter unit moving by rail to Naples and

on two LST's to the beachhead. The

15th brought its own records, but only

such equipment and tentage as was

needed to replace that of the 95th destroyed by the bombing. The new unit

was in operation before the end of the

day on 10 February.

4

 In addition to sources cited earlier in this chapter, see Lt. Col. Henry M. Winans, 56th Evacuation Hospital, Letters, 1943-44, for a vivid personal

narrative of hospital life on the beachhead.
276 MEDITERRANEAN AND MINOR THEATERS

U.S. HOSPITAL AREA AT ANZIO

The 15th received a rough welcome to

the beachhead. On that day long-range

German guns dropped shells in the hospital area, killing two nurses, one of

them the chief nurse, and an enlisted

man at the 33d Field Hospital. Four

officers and seven enlisted men were

wounded. One tent was burned and

others damaged. Again the wounded included the hospital commander, Lt. Col.

Samuel A. Hanser. Patients were carried

on their mattresses to the adjoining 56th

Evacuation. Blood transfusions in progress at the time of the attack were not

interrupted, one attendant holding the

needle in place while another held the

bottle of plasma during the move. Unlike the 95th Evacuation, the 33d Field

was able to resume normal operation the

following day.

The U.S. and British hospital areas

were bombed on 12 February, and the

British area again on the 17th and 19th,

some casualties resulting in each instance. During the remainder of the

month, while the German counterattack

continued, and on through March there

was no letup. On 17 March the British

141st Field Ambulance suffered three

direct hits, with 14 killed and 75
ANZIO BEACHHEAD 277

wounded. On the 22d it was the turn of

the 15th Evacuation, which was blanketed by 88-mm. shells. Five persons

were killed and 14 wounded. No wonder

the combat troops called the hospital

area "Hell's half acre" and felt safer in

foxholes at the front!

General Truscott was convinced that

the 22 March shelling of the 15th Evacuation Hospital was deliberate. Following

a conference with Fifth Army and VI

Corps medical officers, he ordered his

engineers to reconstruct the British and

American hospital areas so as to give

maximum protection.5 The hospitals

could not be moved. There was no safe

place for them to go. They could not

even go under ground, but they could

be partially dug in. By this time the

rains had become less frequent and the

ground had dried up enough to permit

excavation of tent sites to a depth of 3

or 4 feet. Two ward tents were pitched

in each excavation end to end, with

earth revetments 31⁄2 feet thick at the

base and 2 feet at the top built up three

to 5 feet around the tent walls. Steel

stakes and chicken wire helped hold the

revetments in place. Sandbag baffles inside divided the double tent into four

compartments of ten beds each. Patients

and personnel were thus secure against

anything but a direct hit. Operating

tents were given the additional protection of a 2-inch plank roof covered with

sandbags.

The 94th Evacuation Hospital, with

the 402d Collecting Company of the

161st Medical Battalion attached, arrived on the beachhead late in March

with the 34th Division. The unit opened

on 29 March, taking the bulk of the new

casualties for the next five days while

the other hospitals dug in.

That same night, 29 March, the hospital area was again bombed, only a few

hours after General Clark had inspected

the installations. The 93d and 56th

Evacuation Hospitals were hit, with a

combined total of 8 killed and 68

wounded. The 56th suffered further

damage on the night of 3-4 April and

on the morning of 6 April, when longrange German guns once more pounded

the area. Too badly damaged to continue on the beachhead, the 56th was

replaced on 8 April by the 38th Evacuation Hospital, the 56th taking over

the installations of the 38th at Carinola

on the southern front. A week later the

11 th Evacuation from Casanova, also on

the southern front, changed places with

the hard-hit 93d. British hospitals were

similarly rotated with those in the Cassino area. Sporadic shelling and bombing continued throughout the life of the

beachhead, but casualties and damage

were considerably reduced by the work

of the VI Corps engineers.

Hospitalization policies at Anzio were

dictated, like everything else on the

beachhead, by the tactical and geographical situation. In the early stages of

the campaign all casualties were evacuated to Naples as quickly as they could

be made transportable. This entailed a

heavy loss of personnel, however, and at

the beginning of March the three platoons of the 33d Field Hospital were set

up as a single 400-bed unit to hold

patients expected to recover in fourteen

days. Although a platoon of the 52d

Medical Battalion clearing company set

up a 200-bed venereal disease hospital

on 19 February, the problem was never

serious at Anzio. Cases were confined to 5

 Truscott, Command Missions, p. 358.
278 MEDITERRANEAN AND MINOR THEATERS

GENERAL BLESSE CONGRATULATING

COLONEL BLESSE on receiving the Silver

Star.

recurrences and to infections among new

troops, contracted before reaching the

beachhead. The VD hospital nevertheless treated 3,000 patients, U.S. and British, during its three months of operation.

Both the 52d Medical Battalion and a

platoon of the 602d Clearing Company,

162d Medical Battalion, which arrived

at Anzio in mid-February, operated mobile dispensaries for troops in isolated

areas. The 602d also ran an aid station,

primarily for service troops working in

and around the port.

The U.S. hospitals at Anzio, after the

opening of the 94th Evacuation near the

end of March, included a 750-bed and

three 400-bed evacuation hospitals, and

a 400-bed field hospital, or a total of

2,350 Table of Organization beds. Add

to these the 200-bed VD hospital of the

52d Medical Battalion and beds available in the clearing stations of the four

U.S. divisions active on the beachhead

before the breakout of 23 May, and the

maximum T/O strength was approximately 3,500 beds, or an actual strength

with normal expansion of not more than

5,000. During the period of heaviest

fighting, bed strength, including expansion, was less than 4,000.

Yet from 22 January through 22 May

1944, these hospitals cared for 33,128

patients, of whom 10,809 suffered from

battle wounds, 4,245 from injuries, and

18,074 from disease. In addition to these

an unrecorded number of civilians were

cared for, since no other facilities were

available to them. Some 22,000 civilians

were eventually removed from the

beachhead, only 750 being allowed to

remain.6

In the same 4-month period, British

hospitals at Anzio cared for 14,700 cases,

including all causes.

Casualties among Medical Department personnel were high: 92 killed,

including 6 nurses; 387 wounded; 19

captured; and 60 missing in action—558

in all.7

Evacuation From the Beachhead

The original plans for the Anzio Campaign called for evacuation by hospital

6

 Bauchspies, "The Courageous Medics of Anzio,"

Military Medicine, CXXII (January-June 1958), p.

268.

7

 Annual Rpt, Surg, Fifth Army, 1944. Fifth Army History, pt. IV, p. 164, gives only 82 killed, but

the surgeon's report appears to be the more accurate

source.
ANZIO BEACHHEAD 279

ship. As the stay of VI Corps on the

beachhead lengthened, however, and

casualties mounted, LST's were pressed

into service. There were simply not

enough hospital ships and hospital carriers available. Even when they could be

dispatched to the beachhead, they drew

too much water to dock at the wharf, and

the sea was often too rough to permit

transfer of patients from smaller craft

offshore. There was one stretch of fourteen days during which no hospital ship

reached Anzio. To accommodate such

periods of interrupted evacuation, the

Anzio hospitals tried to maintain a reserve of 900 beds but the sudden violent

actions that characterized the Anzio

fighting often precluded maintenance of

any reserve at all.8

In these circumstances the process of

evacuation had to be carefully regulated

and controlled. Capt. Eugene F. Haverty

was sent to the beachhead by General

Martin on 1 February to assume the

duties of evacuation officer. His energy,

skill, and fortitude in the performance of

his task were outstanding, but VI Corps

did not benefit long from his presence.

Captain Haverty was killed on 29 February while directing the loading of casualties on an LST. The Fifth Army

hospitalization and evacuation officer,

Colonel Camardella, took personal

charge of evacuation from the beachhead

after Captain Haverty's death, returning

to the southern front in time to participate in planning for the forthcoming

drive on Rome. His place at Anzio was

taken by Major Selesnick, who had

started the year as Fifth Army venereal

disease control officer.

The use of LST's to supplement hospital ships for evacuation to Naples made

it necessary to equip these vessels with

medical supplies and utilities not normally carried. It was also necessary to

supply medical personnel to care for

patients on the 20- to 30-hour run to

Naples. Initially, two hospital ship platoons of limited service men carried out

this assignment. They were supplanted

at the end of March by personnel of the

56th Medical Battalion, organized into

four platoons, each with a medical officer,

an MAC officer, and twenty enlisted men.

The average load was 100 to 150 Utter

patients and a similar number of ambulatory patients, but the newer type LST's

introduced toward the end of the period

could accommodate more than 200 litter

patients. Hot meals were supplied the

litter patients from food containers. The

walking patients were fed in the ship's

mess.

Patients were moved on a prearranged

schedule from hospitals to the docks by

the 549th Ambulance Company. Loading was the responsibility of the 1st Platoon, 602d Clearing Company, of the

162d Medical Battalion. Civilians were

evacuated to Naples under the same

principles that guided the evacuation of

military personnel.

Air evacuation could not be used at

Anzio before the junction of the two

armies and the dissolution of the beachhead. The Nettuno airstrip was under

constant observation by the enemy, and

generally unsafe for anything larger than

a Piper Cub. Even these small observation planes were used only for emergencies, to bring blood or urgently

needed drugs.

From 22 January through 22 May,

23,860 U.S. casualties and 9,203 British

8

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

ETMD for Mar 44.
280 MEDITERRANEAN AND MINOR THEATERS

ANZIO HOSPITALS BEING DUG IN AFTER THE GROUND DRIED

casualties, or a total of 33,063 were evacuated safely from Anzio beachhead.

Medical Supplies and Equipment

Following the Salerno pattern, personnel of the 1st Advance Platoon, 12th

Medical Depot Company, were on the

Anzio D-day convoy, attached to the

beach group. Each unit carried all items

called for in its Table of Basic Allowances, with extra blankets and litters

added. Other additional supplies, such

as plasma, atabrine, plaster of paris,

dressings, and biologicals were carried

ashore in the special waterproof containers whose worth had been demonstrated at Salerno. On the basis of the

Salerno experience, supply estimates

were increased to compensate for losses

through accidental immersion as well as

by enemy action. The most important

departure from the earlier planning for

amphibious operations was provision

for carrying supplies adequate for a 10-

day level on the D-day convoy. This level

had not been reached at Salerno until

D plus 12.9

9

 This section is based primarily on: (1) Annual

Rpt, Surg, Fifth Army, 1944; (2) Annual Rpt,
ANZIO BEACHHEAD 281

PROTECTING OPERATING TENTS WITH TWO-INCH PLANKS AND SANDBAGS

A medical supply dump was established on the beach at 0700 on D plus 1.

The following day, 24 January, the

supply platoon was relieved from attachment to the beach group and passed

to control of the VI Corps surgeon. A

permanent site for the depot was located on the Anzio-Albano road, near the

cathedral. A 4-story building, 70 x 40

feet, housed offices, issue room, shipping

section, and living quarters for personnel. Two storage tents were set up for

items that might be damaged by water,

other supplies being stored in the open.

In the early days of the beachhead all

requisitions were honored if they were

signed by a responsible person, even

though a scrap of paper might be substituted for the proper form. The time

required to fill a requisition ranged

from one-half hour to six hours, depending on the items requested and the

extent of enemy shelling and bombing.

The build-up of supplies did not take

place according to plan, but thanks to

Surg, VI Corps, 1944; (3) Annual Rpt, 12th Med

Depot Co, 1944; (4) Maj Richard P. Gilbert, MAC,

MS, Combat Medical Supply Operations—The Anzio

Beachhead; (5) Davidson, Medical Supply in

MTOUSA, pp. 73-79.
282 MEDITERRANEAN AND MINOR THEATERS

the light opposition in the landing phase,

no damage resulted. While the 10-day

level contemplated arrived on schedule,

the water was too rough to permit offshore unloading until D plus 5, the only

medical supplies available in the interval being those carried ashore by

medical units and combat troops. This

situation was one frequently repeated

at Anzio, since the Liberty ships used for

cargo drew too much water to dock at

the wharf. On several occasions, emergency requisitions had to be sent to

Naples for items that were aboard ships

anchored out from the shore but unavailable. These emergency supplies

would be delivered by LST, creating an

overstock of some items when the cargo

vessels managed to unload. Supplies

delivered by LST were loaded on trucks

at Naples and driven directly to the depot from the landing craft, permitting

the vessels to withdraw to safety with a

minimum of delay.

Replacement items, both of supply

and equipment, were a constant problem on the beachhead because of the

continual destruction by enemy shells

and bombs. There came to be some

truth as well as humor in the remark

that "ward tents were sent up daily with

the rations." The problem was further

complicated by the rotation of hospitals

with those on the Cassino front, since the

arriving units did not always bring sufficient equipment to replace what had

been destroyed.

Another recurrent supply problem

was that of property exchange. The

hospital ships and carriers were able to

exchange litters, blankets, and splints in

normal fashion, but LST's used for

evacuation were seldom so equipped.

The time factor, moreover, precluded

any careful bookkeeping on exchangeable items. The problem was finally

solved by sending a truck to Naples

with each LST carrying patients. At

Naples the truck was loaded with litters

and blankets from the base hospitals to

be returned to Anzio in exchange for

those accompanying the patients.

Despite the difficulties inherent in the

situation, including the constant hazard

that supply personnel shared with all

others on the beachhead, the Anzio medical service at no time suffered any supply

or equipment shortage severe enough to

impair the quality of medical care.

Professional Services

on the Beachhead

Medicine and Surgery

Surgery Under Fire—At Anzio all

surgery was forward surgery. There were

no field hospital units to take nontransportable cases from the clearing stations

because the evacuation hospitals were as

close to the front as the clearing stations

themselves. There was no screening of

patients forward of the hospital area.

Neither was there more than rudimentary specialization, except for the use of

the 33d Field Hospital for short-term

cases after 1 March and the experimental concentration of neuropsychiatric

cases in the 56th Evacuation. Each hospital took all types of wounds, limited only

by its own bed capacity. Teams of the

2d Auxiliary Surgical Group operated in

all of the beachhead hospitals, including

the British installations.10

10

 Sources for this section are: (1) Annual Rpt,

Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, VI

Corps, 1944; (3) Annual Rpt, 33d Fld Hosp, 1944;
ANZIO BEACHHEAD 283

56TH EVACUATION HOSPITAL AFTER BOMBING AND SHELLING

Ten surgical teams of the group and

2 shock teams were on the D-day convoy,

working in the 33d Field Hospital and

the 95th Evacuation Hospital as soon as

those units were set up. The 12 teams

were reinforced before the Anzio interlude was over by 18 additional surgical

teams, 2 orthopedic teams, 2 neurosurgical teams, a thoracic team, and a miscellaneous team. For the landing phase,

each of the 4 British hospital carriers

also had a surgical team of the 2d Auxiliary Group assigned for temporary duty.

One officer and an enlisted man of the

group lost their lives when the St. David

was sunk by German bombs the night of

22-23 January. A nurse of the group

was killed in action in the 10 February

shelling of the 33d Field Hospital. In

addition to these deaths in action, the

2d Auxiliary Surgical Group had 11 officers, 2 nurses, and 5 enlisted men

wounded in the course of the Anzio

Campaign.

The surgical load fell heavily on the

hospital staffs as well as on the attached

teams, but the work was of a high qual-

(4) Annual Rpts, 1944, of 11th, 15th, 38th, 56th,

93d, 94th, and 95th Evacuation Hosps; (5) Annual

Rpt, 2d Aux Surg Gp, 1944.
284 MEDITERRANEAN AND MINOR THEATERS

ity despite the fact that many of the

cases were of types not normally encountered in evacuation hospitals. The

93d Evacuation, for example, handled

1,187 surgical cases during the month

of February, entirely with its own staff.

The 11th handled 1,240 surgical cases in

one 11-day period, only 72 of which were

cared for by attached teams. With the

aid of 4 auxiliary teams, the 94th performed 138 operations in 24 hours.

At the time of the German counteroffensive in February, the casualty load

was so great that some men with less

severe wounds were evacuated to Naples

for primary surgery, while others were

sent back to base hospitals for postoperative care. The Fifth Army surgical consultant, Colonel Snyder, personally followed up these cases, shuttling back and

forth between Naples and Anzio with

reports that proved most useful to beachhead surgeons.

The Anzio surgeons were greatly

aided by generous supplies of whole

blood. Where Fifth Army had relied in

the past primarily on plasma and on

donors among hospital staffs and convalescent patients, the Anzio medical service had the advantage from the outset

of the presence of a British field transfusion unit, supplied by a British blood

bank. On 26 February the first American

blood was received on the beachhead

from the newly organized Naples blood

bank. A total of 5,128 pints were received from this unit between 26 February and 25 May. Blood was delivered

regularly thereafter by LST, with an

occasional emergency shipment by Cub

plane. The British 12th Field Transfusion Unit continued to be the distributing agency throughout the life of the

beachhead. Between 22 January and 4

June 10,624 pints of whole blood were

used in U.S. hospitals, for an average of

2.01 pints per case; 3,685 pints were used

in British hospitals, averaging 2.95 pints

per case.11

Neuropsychiatry—The conditions under which VI Corps operated at Anzio,

where all positions were subject to

enemy shelling at any time and harassing actions around the perimeter were a

constant threat, were inevitably such as

to produce a high incidence of psychiatric disorders. The same conditions, however, made it impossible to retain

psychiatric casualties for treatment close

to the battle lines.12

The month of February 1944, when

fighting was most severe and the continuance of the beachhead itself was at

stake, showed a psychiatric case rate of

4 per 1,000 per month in the 1st Armored Division, 16.7 in the 3d Division,

and 23 in the 45th Division. The pressure for beds in beachhead hospitals

was so great that these psychiatric casualties had to be evacuated to base hospitals

in less than two days, despite the showing of theater experience that a high

proportion could have been returned to

duty if treated in the forward area.

The first approach to the problem was

the designation of the 56th Evacuation

Hospital on 16 February to handle all

psychiatric cases. It was hoped that this

11

 (1) Hist of the 15th Med Gen Lab, 20 Dec

42-31 May 44. (2) Annual Rpt, Surg, Fifth Army,

1944. (3) Bauchspies, "The Courageous Medics of

Anzio," Military Medicine, CXXII (January-June

1958), p.444. 12

 Sources for this section are: (1) Annual Rpt,

Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, VI

Corps, 1944; (3) Annual Rpt, Surg, 3d Inf Div,

1944; (4) Hanson, ed., "Combat Psychiatry," Bulletin, U.S. Army Medical Department, Suppl number (November 1949).
ANZIO BEACHHEAD 285

TABLE 10—DISPOSITION OF PROBLEM CASES IN THE 3D DIVISION, 4 MARCH-30 APRIL 1944

Source: Annual Rpt, Surg, Fifth Army, 1944.

specialization would permit more rapid

identification and evacuation of severe

cases, permitting longer retention of

those most likely to respond to treatment if retained on the beachhead. The

experiment did not work out. The 56th

Evacuation admitted 483 such cases in

the period 16-29 February, of which

only 9.6 percent were returned to duty.

The focus of psychiatric treatment was

then shifted, still on an experimental

basis, to the division level. On 1 March a

provisional platoon was organized in the

3d Division, with a cadre of one officer

and seven carefully selected enlisted

men, under supervision of the division

psychiatrist, Capt. Robert J. Campbell.

The platoon was attached to the 10th

Engineer Battalion. Its ranks were filled

up with "problem" cases referred by the

combat units, which continued to carry

the men on their rolls as on special duty

status. Captain Campbell screened these

cases, sending to the division clearing

company for disposition all those showing need for hospital care. The disciplinary cases, and those of mild psychiatric

disturbance, were retained in the provisional platoon, where they performed

various duties while undergoing psychiatric treatment.

Between 4 March, when the first case

was received, and 30 April the provisional platoon evaluated 171 referrals.

(Table 10) The record was encouraging

enough to warrant an extension of the

principle to other divisions later in the

Italian campaign.

Preventive Medicine

Trench Foot—Trench foot had become a problem to Fifth Army in the

Winter Line campaign, but conditions

were relatively good in the mountains

before Cassino compared to those on

Anzio beachhead. From January through

most of March the temperature remained near freezing, with frequent

rain. The whole area occupied by VI

Corps was flat, much of it reclaimed

swampland, with poor drainage and a

high ground water level. Trenches, dugouts, and foxholes were usually half

filled with water before they were completed. Add to these natural disadvantages the fact that the enemy had good

observation of the entire area and guns

to back it up, and the medical problem

may be realized. It was suicidal to leave

a foxhole in daylight, so the men stayed

in their cramped positions, their feet

often immersed in water and always

wet, for ten or twelve hours at a stretch.
286 MEDITERRANEAN AND MINOR THEATERS

Trench foot was an inescapable concomitant.13

There were many conferences on the

subject among medical officers, both

British and American, but preventive

measures were largely useless. The tactical situation made it impossible for the

men to exercise their lower limbs properly, and the shortage of manpower

precluded any effective rotation of men

or units. Dry socks were sent to the

front lines as frequently as possible, but

the supply of socks and laundry facilities

were alike limited. Even had it been

possible to issue dry socks daily, as was

done in the British sector,14 men holding

tenuously to positions on a front that

might erupt at any moment could not

be made to take off their shoes just to

change socks. Had they been willing to

do so, the new socks would have been

as wet as the old in a few minutes.

In the circumstances, it is not surprising that 2,196 cases of trench foot were

reported during the continuance of the

beachhead. Although preventive measures were thus largely ineffective, the

Anzio experience was turned to account

in determining what clothing and equipment would be used in the winter of

1944-45. A study with this end in view

was carried out by the 3d Division, and

the data obtained furnished a basis for

ordering future winter equipment for

troops in the Mediterranean theater.15

Malaria Control—The same conditions that made trench foot inevitable

also made the beachhead a natural

breeding spot for mosquitoes. Indeed,

the Anzio plain had been scourged by

malaria for centuries. As soon as it became evident that the Allied forces might

still be in the area after the onset of the

malaria season, a complete control plan

was worked out by American and British

authorities. Beginning late in February,

the beachhead was surveyed from the

air for breeding places, and as much

information as possible was collected

about the local incidence of the disease.

The results were studied by malariologists, and a control program was issued to

all VI Corps units late in March.16

Among the steps taken was the establishment of a special school, operated by

personnel of the 52d Medical Battalion,

for instruction of the officers, noncommissioned officers, and enlisted men who

were to carry out the preventive measures. Instructors were 2 Sanitary Corps

officers and 3 Medical Department enlisted men who went to Anzio for that

purpose. A total of 2,011 persons received

six hours of instruction each. Suppressive therapy was started on 26 March,

13

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, Surg, VI Corps, 1944. See also,

Whayne and DeBakey, Cold Injury, Ground Type,

pp. 101-25, passim. 14

 It should be noted that the incidence of trench

foot on the beachhead was higher among U.S.

troops than among British troops performing essentially the same duties under identical conditions.

The reasons for the difference, in addition to

changing socks daily, probably included the British

practice of treating mild cases in quarters where

they were not reported, and the British tendency

to regard cold injury as a self-inflicted wound,

subject to appropriate disciplinary action. Other

factors were the superior boots and heavier wool

socks issued by the British, and the fact that the

British soldier generally stayed in the line for

shorter periods of time than his U.S. counterpart.

15

 Final Rpt, Preventive Medicine Off, MTOUSA,

1945. 16

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, Surg, VI Corps, 1944. (3) Annual

Rpt, 52d Med Bn, 1944. See also pp. 259-61, above.
ANZIO BEACHHEAD 287

instead of 1 May as called for in

NATOUSA directives.

The entire area was divided into segments, with each troop unit being made

responsible for draining, dusting, or

oiling standing and sluggish water, and

for cleaning vegetation from the banks of

waterways. Every shell hole, every abandoned foxhole or gun emplacement,

every bomb crater was a potential breeding spot. So well were the troops indoctrinated that one beachhead soldier was

heard to complain that if he spilled a

canteen of water on the ground, someone

would rush up to spray or drain it.

The VI Corps engineers, the 42d

Malaria Control Unit, and Italian engineer battalions brought in for the purpose helped the combat troops carry

out their individual assignments. A

Corps Malaria Control Committee coordinated the whole program, receiving

weekly reports from the responsible

officers at division and unit levels, where

the control organization was identical

with that on the Cassino front.

The final success of the program cannot be fully evaluated, since the Anzio

malaria season did not reach its height

until June and July, after VI Corps had

left the area. However, daily surveys

failed to reveal the presence of the

carrier, in either adult or larval form,

while Allied troops were on the beachhead.

Dental Service

The problem of the dental service at

Anzio, like that of the medical and surgical services, was one of organizing facilities so as to make maximum use of the

limited personnel available. Laboratory

and prosthetic facilities were even less

adequate than on the Cassino front,

while conditions of operation rendered

improvisation more difficult.17

The general practice at Anzio was to

centralize the dental service of each division at the division level, leaving only

one dental officer in each regiment to

function outside the division clinic. The

95th Evacuation Hospital carried a dental clinic that began functioning on D

plus 2 as a corps installation. The corps

clinic shifted to the 33d Field Hospital

when the 95th Evacuation was withdrawn from the beachhead.

A prosthetic dental team of the 2d

Auxiliary Surgical Group was attached

to the 56th Evacuation Hospital on 22

February, after heavy casualties in the

German counteroffensive had revealed

the need for reparative dental work on

the beachhead. The team moved to the

38th Evacuation when that unit replaced

the 56th early in April, remaining at

Anzio until the end of that month. During the period 22 February-30 April this

team completed 37 full dentures, 112

partial dentures, and 2 inlays, while repairing 20 dentures and 3 bridges. No

dental laboratory facilities other than

those normally carried by the divisions

were available.

Nursing Service

The Anzio beachhead nursing service

contributed one of the great heroic

achievements of the war. As in other

amphibious operations, nurses were not

scheduled for the landings, but joined

17

 Sources for this section are: (1) MS, Hist of

Army Dental Corps, MTO, Jan 43-Jun 44; (2) Annual Rpt, Surg, Fifth Army, 1944; (3) Annual

Rpts, 1944 of med units mentioned in the text of

this chapter.
288 MEDITERRANEAN AND MINOR THEATERS

their units when hospitals were established. Thereafter they shared all the

discomfort and inconvenience, all the

personal hazard, and all the unceasing

labors of the men. If there was any

distinction at Anzio between combat

troops and medical personnel, it was that

the latter worked harder and took

greater risks. They had not even the

scant protection of a foxhole, and the

red cross was a target rather than a

shield. There were, moreover, no lulls

or quiet periods in their activities.

Through it all, the approximately 200

nurses on the beachhead carried on

their normal duties, without rest and

without complaint.

When the German drive of February

was in full swing, and conditions on the

beachhead were at their worst, the

evacuation of the nurses was considered,

but only briefly. As a morale factor, their

presence was of incalculable value. To

remove them would have been very

close to an admission of defeat in the

eyes of the combat troops. So they remained—six of them never to depart.

Among those who survived, four wore

the Silver Star, the first women ever to

receive that decoration.
CHAPTER VIII

From the Garigliano to the Arno

Preparations for the Offensive

The Strategic Concept

After the failure to crack the Gustav

Line in mid-March 1944, General Alexander revised his strategy for the whole

campaign. Plans for the spring offensive

contemplated combining another and

still heavier frontal assault with a double

flanking movement from the left. II

Corps was to move up the coast, along

the axis of Highway 7, while the French

Expeditionary Corps predominantly

skilled in mountain fighting, was to attack through the lightly held ridges that

formed the southern wall of the Liri

Valley. Simultaneously, the British

Eighth Army was to renew the assault

on Cassino, while VI Corps, at Anzio,

was to be ready at the strategic moment

to cut Highway 6 at Valmontone. If the

movement succeeded, an entire German

army would be trapped and destroyed.1

The plan of attack called for a high

degree of co-ordination and involved

logistical problems of great difficulty,

especially in the sector assigned to the

French. It was necessary, moreover, to

regroup the Allied forces all along the

line before the offensive could be

mounted, and to do it without giving

the enemy any hint of the nature of the

forthcoming operation.

Under orders issued on 5 March, the

British 10 Corps in the Minturno sector

was quietly relieved by the U.S. 88th

Infantry Division, newly arrived from

Africa where it had completed its

training. The British 5th Division from

10 Corps and the U.S. 34th Division

from II Corps went to Anzio in March,

while the 36th went into training for a

later role with the beachhead forces or

for new action on the southern front.

The French Expeditionary Corps, reinforced by the arrival of the 4th Moroccan

Mountain Division, sideslipped to positions on the right of the 88th, while

Eighth Army, leaving only one corps of

two divisions to hold the Adriatic front,

took over the Cassino sector. Moving in

small groups at night to camouflaged

positions, the reshuffling was not complete until April.

By that time the 85th Infantry Division, fresh from the United States, had

joined the 88th on the lower Garigliano.

These new American divisions were

accompanied by their organic medical

battalions, the 310th with the 85th Division and the 313th with the 88th. Both

divisions were attached to II Corps,

which had been weakened by loss of the

34th and 36th. When the British 56th

1

(1) Fifth Army History, pt. V, The Drive to

Rome (Milan Italy: Pizzi and Pizio, 1945). (2)

Alexander of Tunis, "The Allied Annies in Italy

from 3rd September, 1943, to 12th December, 1944,"

Suppl to the London Gazette, 6 June 1950, pp.

2918—40. (3) Kesselring, Soldier's Record.
290 MEDITERRANEAN AND MINOR THEATERS

MAP 25—Fifth Army Hospitals and Medical Supply Dumps on the Cassino Front,

11 May 1944

Division returned from Anzio it was assigned to Eighth Army. The remaining

10 Corps division, the 46th, was sent to

the Middle East, but returned to Italy

later in the year as an Eighth Army unit.

Regrouping of Medical

Installations

The realignment of the Allied Armies

in Italy, as the former 15th Army Group

was now called, made Highway 6 the

main artery of support for Eighth Army,

while II Corps was served by Highway

7 along the coast. U.S. medical installations were accordingly moved to positions in the new Fifth Army area as

rapidly as they could be cleared, with

due regard to deception of the enemy

in the process. (Map 25) Patients

were evacuated to base hospitals in the

Caserta area, the Naples hospitals being

largely reserved for Anzio casualties and

those from the French Expeditionary

Corps.2

2

 Major sources for this section are: (1) Annual

Rpt, Surg, Fifth Array, 1944; (2) Annual Rpt,

Surg, II Corps, 1944; (3) Unit rpts of med units

mentioned in the text.
FROM THE GARIGLIANO TO THE ARNO 291

In the new sector, all Fifth Army hospitals were grouped in the vicinity of

Carinola, adjacent both to Highway 7

and to the railroad that roughly paralleled that highway all the way to Rome.

The area was about 12 miles east of the

mouth of the Garigliano and no more

than 10 or 15 miles southwest of the

Teano-Riardo area from which most of

the installations came. The nth Evacuation Hospital opened at the new site on

11 March, followed two days later by the

95th. The 8th Evacuation Hospital and

the neuropsychiatric hospital operated

by the 601st Clearing Company were

ready to receive patients in the Carinola

area on 23 March, and the 38th Evacuation completed its move on the 29th.

The 10th Field Hospital, the 16th Evacuation, and the 3d Convalescent opened

in the Carinola area on the 3d, 16th, and

26th of April, respectively.

The 38th Evacuation had changed

places with the 56th from Anzio, and the

11th had rotated with the 93d before all

these moves were completed. The 94th

Evacuation Hospital went direct to Anzio

from its Mignano site late in March.

The venereal disease hospital operated

by the 602d Clearing Company closed at

Riardo on 27 March and went into

bivouac. Its place was taken by a temporary venereal disease hospital set up under II Corps control by the clearing

company of the 54th Medical Battalion.

The hospitalization units of the 11th

Field Hospital were brought together

late in February, operating under canvas

as a provisional 400-bed station hospital

for troops in training until early April.

The 11th Field then went into direct

support of the clearing stations of the

310th and 313th Medical Battalions.

Veterinary units serving Fifth Army

were also moved during March in the

same general pattern. The two Italianstaffed veterinary hospitals were established in the II Corps area, the 110th

on the extreme left and the 130th at

Nocelleto close to the main concentration of medical units. The first U.S. veterinary installation to reach the theater,

the 17th Veterinary Evacuation Hospital, arrived during the regrouping and

was established near Teano, on the

extreme right of Fifth Army.

For some six weeks before the launching of the drive on Rome, set for 11 May

1944, Fifth Army medical units on the

southern front had only routine functions to perform. Hospitals brought their

equipment up to standard and replaced

losses, while combat medical personnel

trained with their divisions. Emphasis

was placed on physical conditioning and

on evacuation in mountainous terrain,

but opportunities for recreation were

provided.3

Combat Medical Service

The Drive to Rome

The Southern Front—An hour before

midnight, 11 May 1944, Allied guns

pounded German positions from the

Tyrrhenian Sea to Cassino and beyond.

Immediately thereafter the 85th and

88th Divisions of II Corps, and the

French Expeditionary Corps on their

right, attacked through the mountains

north and west of Minturno. In the center of the front, the British 13 Corps of

Eighth Army forced a crossing of the

Rapido where the 36th Division had

3

 The malaria control program carried out at

this time has been discussed on pages 259-61, above.
292 MEDITERRANEAN AND MINOR THEATERS

suffered disaster in January; on the right

the Polish Corps stormed Cassino and

Monastery Hill. Though taken by surprise, the Germans rallied quickly to

fight back with their customary stubbornness and skill; but this time the

Allies were not to be stopped, and the

monastery was taken on the 18th.4

While the Germans were still off balance from the punishing blows of Allied

artillery, the French corps stormed the

heights where the British had failed in

January and within twenty-four hours

had broken through the Gustav Line.

Against stiffening but disorganized opposition, Algerian and Moroccan mountain troops then followed the ridges that

overlooked the Liri Valley from the

south, and by 19 May had outflanked

the Montedoro anchor point of the still

unfinished Hitler line, last of the German fortified positions on the southern

front.

Between the French colonials and the

sea, the 88th and 85th Divisions of II

Corps also penetrated the mountains

and, in a series of bitterly contested small

unit actions, broke through the enemy's

prepared defenses. On 19 May the important highway junction of Itri fell to

II Corps. Fondi was taken the next day,

and the corps turned southwest toward

Terracina, from which Highway 7 ran

straight across the Pontine Marshes to

Cisterna, the Alban Hills, and Rome.

On the Eighth Army front, where the

strongest German defenses were concen- trated, the advance was slower and more

difficult, but the threat posed by Fifth

Army on the left flank relieved enough

of the pressure along Highway 6 to keep

Eighth Army moving through the Liri

Valley proper and on into the Sacco

Valley beyond.

While II Corps drove through another

mountain mass toward Terracina and

the FEC stormed Pico, an important

road junction which the enemy could

not afford to lose, VI Corps at Anzio

struck on 23 May toward Valmontone,

where Highway 6 could be cut, the Sacco

Valley blocked, and the whole German

Tenth Army trapped.

In the rugged, mountainous area south

of the Liri and Sacco Rivers, medical

support was difficult in the extreme.

Medical supplies and equipment were

carried forward by jeep, by mule, by

hand carry, and in a few instances were

dropped by parachute from small planes.

jeeps and mules were also used to evacuate the wounded, supplementing the inadequate number of ambulances and

trucks whose usefulness was restricted

by the severe limitations of the road network. In some instances it was found

advantageous to hold casualties at the

4

 On the military side, major sources for this section are: (1) Fifth Army History, pt. V; (2) Alexander, "Allied Armies in Italy from 3rd September, 1943, to 12th December, 1944," Suppl to the

London Gazette, 6 June 1950; (3) Opns Rpt, II

Corps, May 1944; (4) Clark, Calculated Risk; (5)

Starr, ed., From Salerno to the Alps; (6) Paul L.

Schultz, The 85th Infantry Division in World War

II (Washington: Infantry Journal Press, 1949);

(7) John P. Delaney, The Blue Devils in Italy; A

History of the 88th Infantry Division in World

War II (Washington: Infantry Journal Press, 1947) .

Medical sources primarily relied upon are: (8)

Annual Rpt, Surg, Fifth Army, 1944; (9) Annual

Rpt, Surg, II Corps, 1944; (10) Annual Rpt, Surg,

85th Div, 1944; (11) Annual Rpt, Surg, 88th Div.

1944; (12) Opns Rpt, 310th Med Bn, May 1944;

(13) Opns Rpt, 313th Med Bn, May 1944; (14)

Hist Rcd, 54th Med Bn, May 1944. See also (15)

Ltr, Austin W. Bennett, M.D., to Col Coates, 17

Nov 58; (16) Ltr, Maurice M. Kane, M.D., to

Coates, 11 Nov 58, both commenting on preliminary draft of this volume. Colonel Bennett was at

that time commanding officer of the 33d Field

Hospital; Colonel Kane was surgeon of the 88th

Division.
FROM THE GARIGLIANO TO THE ARNO 293

TREATING 88TH DIVISION CASUALTY

at a forward aid station, May 1944.

aid stations until the advancing troops

had secured neighboring roads in order

to avoid the long and difficult litter

hauls.

As in the mountain fighting before

Cassino, the heaviest burden fell on the

litter bearers. The medical battalions

organic to the 85th and 88th Divisions—

the 310th and 313th, respectively—had

each received its authorized overstrength

of 100 litter bearers

 5 before the drive

began, but the number available was

still far short of needs, and both II Corps

divisions drew heavily upon service and

headquarters troops for additional bearers. Italian troops were also attached as

litter bearers. All together the 85th

Division had 700 litter bearers above the

normal Table of Organization allotment, and the 88th had almost as many.

The 85th Division, on the left flank of

II Corps, left its clearing station and the

1st platoon of the nth Field Hospital

in the vicinity of Cellole some five miles

southeast of the Garigliano crossing.

Casualties began coming back about an

hour after the division went into action,

and reached a record 544 during the 24

hours of 12 May. On the second day of

the drive, with admissions to the clearing station again exceeding 500, the 3d

Platoon of the nth Field Hospital

joined the 1st in support of the 85th Division. Collecting companies operated in

two sections in order to give closer support to the combat forces. All ambulances organic to the division were in

use forward of the clearing station, together with additional ambulances

borrowed from corps. Jeeps fitted with

litter racks were invaluable. Through

14 May weapons carriers and trucks were

used to bring out the walking wounded.

Evacuation from the clearing station and

field hospital was by two platoons of the

54th Medical Battalion.

The offensive was in its sixth day before the 85th Division had moved far

enough forward to permit the clearing

station to advance, but thereafter for

the next ten days its moves were frequent. On 1.7 May the station crossed the

Garigliano River to the vicinity of

Minturno, leaving one platoon of the

field hospital at the old site to care for

patients not yet in condition to be evacuated. The other field hospital platoon

similarly remained at Minturno, while

the clearing station moved forward to

Formia on 20 May and to a site near Itri

on the 21 st. On 24 May the clearing

station was established five miles west of

Fondi, with both field hospital platoons

adjacent. Two days later the clearing 5

 See p. 240, above.
294 MEDITERRANEAN AND MINOR THEATERS

ITALIAN CIVILIANS HELP CARRY A CASUALTY down a mountain near Terracina.

station again advanced without its field

hospital support, this time to Sonnino,

where it operated until the division was

withdrawn from the line on 27 May.

The 88th Division, on the right of the

85th with the French Expeditionary

Corps on its own right, followed a line

of advance parallel to that of the 85th

but somewhat farther to the north. Highway 7 was the initial axis of both divisions, and was consequently the line

along which medical installations of both

tended to be located. The starting site of

the 88th Division clearing station was

in the vicinity of Fasani, just north of the

highway and some three or four miles

east of the Garigliano.

Although casualties were not as heavy

as those of the 85th, 369 passed through

the clearing station of the 88th Division

on 12 May. The station had crossed the

river to a site a mile southeast of Minturno before it was given field hospital

support on 16 May. At that time the 2d

Platoon of the nth Field Hospital

moved into the area. Evacuation from

the clearing station was by an ambulance platoon of the 54th Medical Battalion.

Once the Gustav Line was broken, the
FROM THE GARIGLIANO TO THE ARNO 295

campaign moved more rapidly. The 88th

Division clearing station shifted to

Formia on the Gulf of Gaeta on 20 May

and the next day to a site just west of

Itri. In each move the field hospital platoon lagged behind for a day or two until

its nontransportable patients could be

transferred to one of the evacuation hospitals behind the lines.

At this point the 88th Division moved

into the mountains north of Highway 7,

and evacuation became increasingly difficult. Collecting companies were split

to establish treatment stations along

litter trails, and Italian troops were attached as litter bearers. Two collecting

stations were in the vicinity of Fondi

when that town was bombed the night

of 23—24 May and suffered considerable

damage to their vehicles.

Over the next three days, the division

cut across roadless mountains to

Priverno. In this drive litter carries were

up to twelve miles from the moving

front back to Fondi, with as many as

fourteen relay posts along a single trail.

It was the last important action on

the southern front. Once II Corps was

in contact with the Anzio forces, German

resistance south of the Liri and Sacco

Valleys collapsed. On the 88th Division

front, the entire 313th Medical Battalion moved to the vicinity of Sonnino

on 25 May, and two days later the clearing station, with its attached field hospital unit, was set up just outside Priverno.

The French Expeditionary Corps, on

the II Corps right, had the most difficult

mission of any Fifth Army formation in

the drive to Rome and suffered casualties commensurate with its success. The

French medical units supporting the

corps, though adequate for normal operations, were unable to carry the exceptional load required, and on 23 May the

403d Medical Collecting Company, 161st

Medical Battalion, with elements of the

551 st Ambulance Company attached,

was sent to reinforce the FEC. The next

day the 406th Medical Collecting Company, 162d Medical Battalion, was given

the mission of evacuating French forward hospitals.

The Anzio Front—The Germans were

retreating hastily from Terracina when

VI Corps, now more than seven divisions strong, began its drive on 23 May

from Anzio beachhead. The 1st Armored, the 3d Division, and the 1st

Special Service Force led off, passing

through the 34th to take the Germans

by surprise. The attacking forces quickly

penetrated enemy positions before the

Germans could regroup. The 45th struck

for limited objectives on the left of the

salient, while the British 1st and 5th

Divisions held defensively from the

Albano road west to the sea, and the

U.S. 36th remained in reserve.6

6

 Principal military sources for this section are:

(1) Fifth Army History, pt. V; (2) Alexander,

"Allied Armies in Italy from 3rd September, 1943,

to 12th December, 1944" Suppl to the London

Gazette, 6 June 1950; (3) Opns Rpts, VI Corps,

May, Jun 44; (4) Opns Rpts, II Corps, May, Jun

44; (5) Clark, Calculated Risk, pp. 334-88; (6)

Truscott, Command Missions, pp. 369-80; (7)

Starr, ed., From Salerno to the Alps, pp. 228-67;

(8) Taggart, ed., History of the Third Infantry

Division in World War II pp. 153-96; (9) Huff,

ed., The Fighting 36th, unpaged; (10) The Fighting Forty-Fifth, pp. 86-92; (11) Howe, 1st Armored

Division, pp. 317-68; (12) Schultz, 85th Division,

pp. 60-107; (13) Delaney, Blue Devils, pp. 62-124.

On the medical side, sources primarily relied upon

are: (14) Annual Rpt, Surg, Fifth Army, 1944;

(15) Annual Rpt, Surg, VI Corps, 1944; (16) Annual Rpt, Surg, II Corps, 1944; (17) Annual Rpts,

Surgs, 3d, 34th, 36th, 45th, 85th, 88th, 1st Armd

Divs, 1944; (18) Opns Rpts, 3d, 109th, 111th,

120th, 310th, 313th, 47th Armd Med Bns, May,

Jun 44.
296 MEDITERRANEAN AND MINOR THEATERS

In two days of violent action, the 3d

Division once more proved its right to

the name the Germans gave it of

Sturmdivision. The 7th Infantry took

Cisterna, fighting from house to battered

house. The 15th and 30th regiments

bypassed the town on either side and

converged on Cori, six miles nearer to

Highway 6. In the same two days the

Special Service Force seized the dominating height of Mt. Arrestino, southeast of

Cori, and columns of the 1st Armored

were threatening Velletri, key to the

Alban Hills and center of German resistance, from south and east. Contact

had been made with II Corps patrols on

Highway 7; the Twelfth Air Force, in

close support, had destroyed hundreds

of German vehicles on the crowded escape roads from the beachhead; and VI

Corps had taken more than 2,600 prisoners.

On 26 May a sudden change of direction again caught the Germans unprepared. The 34th and 45th Divisions

lunged west toward Campoleone Station

and Lanuvio, while the 3d held its gains.

The 1st Armored, after a final thrust

toward Velletri in terrain too rough for

tanks, was relieved by the 36th. The 1st

Armored was back in the line in the

Campoleone sector on 29 May, but the

Germans, holding fanatically along the

Albano-Lanuvio-Velletri railroad, gave

ground only by inches.

Meanwhile, the U.S. IV Corps headquarters under Maj. Gen. Willis D.

Crittenberger had relieved II Corps

headquarters on the southern front on

28 May, and II Corps had shifted to the

beachhead, where General Keyes took

command of the Valmontone sector. The

3d Division and the Special Service

Force passed to II Corps command at

this time. The 85th Division, coming up

from Terracina to reinforce the 3d,

went into the line the evening of 30

May, and the 88th Division was on the

way.

The final drive to Rome was launched

on 1 June, when Valmontone fell to the

3d Division and Highway 6 was finally

cut. The bulk of the German forces,

however, had escaped from the Sacco

Valley before the trap could be sprung,

leaving II Corps to pursue a beaten but

still dangerous enemy. At the same time

elements of the 36th Division, on a mission in the rough and wooded area north

of Velletri, penetrated the eastern slopes

of the Alban Hills without encountering

any resistance. Seizing the opportunity,

the division shifted its ground and by

evening of 1 June held commanding

positions on the heights above Velletri

that made the German position in the

town no longer tenable.

Indeed, the Germans were already

withdrawing, and only mopping up remained. Small, highly mobile units from

II Corps on Highway 6 and from VI

Corps on Highway 7, swept into Rome

on 4 June, so close behind the retreating

enemy that he had no time to destroy

the bridges across the Tiber. Highway

6 had not been cut quickly enough to

prevent the escape of the bulk of the

German forces, but enemy losses in both

men and material had been heavy.

The character of medical support on

the Anzio front differed markedly from

that dictated by the mountainous terrain

west of the Garigliano. During the first

few days of the VI Corps offensive, clearing companies remained in the hospital

area east of Nettuno. The 3d Division

clearing station, supporting both its own

division and the Special Service Force,
FROM THE GARIGLIANO TO THE ARNO 297

HALF-TRACK AMBULANCE IN THE BREAKOUT FROM ANZIO

was the first to move, setting up south of

Cori on 26 May along with a platoon of

the 33d Field Hospital.

One platoon of the 36th Division clearing company went into action with the

division on 26 May, north of Cisterna,

but did not have a platoon of the 33d

Field Hospital adjacent until the 28th.

Both clearing station and field hospital

moved to the Velletri area on 3 June.

The field hospital platoon supporting

the 3d Division moved over to support

the clearing station of the 45th after II

Corps took command of the Valmontone

sector. The remaining unit of the 33d

Field Hospital was established near the

34th Division clearing station south of

Velletri by 30 May.

In the new II Corps sector, the 10th

Field Hospital relieved the nth on 29

May, units of the 10th Field being attached to the clearing stations of the 3d,

85th, and 88th Divisions. The unit attached to the 3d Division was forced to

withdraw from its initial site south of

Valmontone by enemy shelling on 29

May. The clearing station of the 88th

Division in the same general area was
298 MEDITERRANEAN AND MINOR THEATERS

A NEWLY TAKEN GERMAN PRISONER HELPS GIVE FIRST AID to a 3d division casualty in the Cisterna area.

bombed on the night of 1-2 June. A

direct hit on the admissions tent killed

nine persons, seven of them personnel

of the 313th Medical Battalion. For the

next twenty-four hours 88th Division casualties were taken to the 85th Division

clearing station west of Valmontone on

the rim of the Alban Hills.

By this time the combat troops were

moving rapidly, and evacuation routes

between collecting and clearing stations

were lengthening. This was especially

true of the 1st Armored Division, where

treatment stations set up 2 or 3 miles to

the rear might be 10 miles behind in a

few hours. Both the 52d Medical Battalion, supporting VI Corps, and the

54th Medical Battalion, supporting II

Corps, were called upon to reinforce the

division collecting companies in the final

drive to Rome. On the II Corps front,

along Highway 6, clearing stations

moved almost daily.

Litter carries in the same period were

long, as the troops outran their medical

support. The indispensable jeep, fitted

with litter racks, was used in many places

inaccessible to ambulances, but even
FROM THE GARIGLIANO TO THE ARNO 299

jeeps were useless in much of the hill

country on the 36th Division front.

Casualties were heaviest in the first

two days of the drive out of the beachhead and on 1 June, when the Germans

made their final effort to hold open their

line of retreat along Highway 6. Field

hospital units often operated beyond normal capacity and were frequently unable

to evacuate their patients in time to

move with the division clearing stations.

Holding sections were usually left behind on these occasions, permitting the

main body of the unit to advance. In

other instances, it was necessary for one

field hospital unit to support two divisions. Additional nurses for the field hospitals were supplied by Fifth Army,

while other personnel and extra equipment were borrowed from nonoperational units. On 2 June the 1st Platoon

of the 11 th Field Hospital was attached

to the 10th Field in the II Corps sector

to help carry the load.

Pursuit to the Arno

After the fall of Rome, the German

armies in Italy might have been destroyed had Alexander been allowed to

retain adequate forces. The Combined

Chiefs of Staff, however, gave higher

priority to the expanding operations in

France. During June and July General

Clark reluctantly gave up both VI Corps

and the French Expeditionary Corps to

Seventh Army for the invasion of southern France. The equivalent of more than

eight veteran divisions, with supportingunits, were withdrawn while Fifth Army

was in pursuit of a badly beaten foe. In

addition to the medical units organic to

these divisions, Fifth Army also lost the

52d and 56th Medical Battalions, the

10th and nth Field Hospitals, and the

11th, 93d, and 95th Evacuation Hospitals. At the same time the 750-bed 9th

and 59th Evacuation Hospitals were

withdrawn from the Peninsular Base

Section.7

The combat-hardened units of the VI

Corps and the FEC were gone, and in

their place were the untested 91st and

92d Divisions and the Brazilian Expeditionary Force of somewhat more than

division strength. Of these only the 91st

saw action before the Arno River line

was reached. In effective strength, Fifth

Army numbered 379,588 on 4 June,

when Rome was taken, and only 171,026

on 15 August when the lines were

stabilized.

After the fall of Rome the Germans

fought only small rear-guard actions,

trading ground for time to regroup and

reequip their disorganized and decimated forces. Bridges, culverts, port facilities were methodically destroyed wher7

 Principal sources for military operations in the

pursuit to the Arno are: (1) Fifth Army History,

pt. VI, Pursuit to the Arno (Milan, Italy: Pizzi and

Pizio, 1945); (2) Alexander, "Allied Armies in Italy

from 3rd September to 12th December, 1944, Suppl

to the London Gazette 6 June 1950;" (3) Opns

Rpts, II Corps, Jun-Aug 44; (4) Opns Rpts, IV

Corps, Jun-Aug 44; (5) Clark, Calculated Risk,

pp. 334-88; (6) Starr, ed., From Salerno to the

Alps, pp. 268-300; (7) Howe, 1st Armored Division, pp. 317-68; (8) Delaney, Blue Devils, pp. 62-

124; (9) Maj. Robert A. Robbins, The 91st Infantry Division in World War II (Washington:

Infantry Journal Press, 1947) , pp. 26—91. The more

important medical sources are: (10) Annual Rpt,

Surg, Fifth Army, 1944; (11) Annual Rpt, Surg, II

Corps, 1944; (12) Annual Rpt, Surg, IV Corps,

1944; (13) Annual Rpts, Surgs, 34th, 88th, 91st, 1st

Armd Divs, 1944; (14) Opns Rpts, 109th Med Bn,

Jun-Aug 44; (15) Opns Rpts, 313th Med Bn, JunAug 44; (16) Opns Rpt, 111th Med Bn, Jun 44;

(17) Opns Rpts, 316th Med Bn, Jul-Aug 44; (18)

Opns Rpts, 47th Armd Med Bn, Jun-Aug 1944;

(19) Hist, 54th Med Bn, Jun-Aug 44; (20) Annual Rpt, 161st Med Bn, 1944.
300 MEDITERRANEAN AND MINOR THEATERS

WHEELED LITTER IN THE FLAT BEACHHEAD AREA

ever their destruction would impede the

Allied advance or delay the delivery of

supplies. Battles were fought on terrain

of the enemy's choosing by mobile units

that could disengage at will and outrun

the slower Allied formations. Fifth Army,

forced like the Germans to reorganize

on the march, never quite caught up with

any substantial body of enemy troops.

The pursuit opened on 6 June, the

day Allied forces crossed the English

Channel and secured the first beachhead

on French soil. VI Corps, in the coastal

sector, drove out along Highway 1 toward Civitavecchia, the largest port between Naples and Leghorn and urgently

needed to shorten supply lines. The 1st

Armored led the advance in two columns, the 34th and 36th Divisions following as closely as their transportation

permitted. Elements of the 34th passed

through the armor that night and took

the city after only a token fire fight on

the morning of 7 June. Within a week

the port had been restored sufficiently

to dock Liberty ships.

Some twenty miles inland, II Corps,

with the 85th and 88th Divisions, struck

along Highway 2 toward Viterbo with

its important complex of airfields. The
FROM THE GARIGLIANO TO THE ARNO 301

GIVING PLASMA to a 1st Special Service Force soldier while he is being evacuated by jeep to

a collecting station.

infantry was outdistanced by a task force

of the 1st Armored that swung inland

after the capture of Civitavecchia and

secured Viterbo the morning of 9 June.

By this time the pattern of the campaign was well defined. The hit-and-run

tactics of the German retreat did not

call for pursuit in force, permitting both

the reduction and the reoganization of

Fifth Army to be carried out in orderly

fashion without loss of momentum. The

3d Division, which garrisoned Rome until 14 June, did not go back into the

line, and the 45th, in VI Corps reserve,

was withdrawn on 8 June. The French

Expeditionary Corps, which had been

pinched out in the final days of the drive

to Rome, began relief of II Corps along

the Highway 2 axis on 9 June, and both

the 85th and 88th Divisions were withdrawn for needed rest. At the same time

the VI Corps sector was narrowed and

left in sole command of the 36th Division, with the 361 st RCT of the 91st Division attached, while the 34th and 1st

Armored rested. On 11 June General

Crittenberger's IV Corps relieved VI

Corps.

The reinforced 36th Division seized

the town of Grosseto on 15 June, and
302 MEDITERRANEAN AND MINOR THEATERS

crossed the Ombrone River that night.

Two days later the 517th Parachute Combat Team, in Italy to gain experience

for a mission in southern France, was

also attached to the 36th. The advance,

however, was slowing down in the face

of stiffening opposition and more diffcult terrain. In the French sector, the

fighting centered around Lake Trasimeno was becoming particularly bitter.

To relieve the French and prepare for

the first withdrawals from the FEC, the

IV Corps sector was widened, and the

1st Armored returned to the line on 21

June. Five days later the 34th Division,

with the 442d Infantry attached, relieved

the 36th, which went at once to the

Seventh Army staging area. The 361st

Infantry remained in the line, attached

to the 1st Armored, but the 517th was

withdrawn on the 28th.

The 34th Division took command of

the coastal sector just north of Piombino,

the small but immensely useful port that

had fallen on 25 June. The division

closed rapidly toward Highway 68, a

lateral road that runs roughly east from

a point on Highway 1 some twenty miles

south of Leghorn to a junction with

Highway 2 at Poggibonsi, a similar distance south of Florence. The Germans

fought hard at Cecina just below the

junction of Highways 1 and 68, in an

effort to delay the capture of Leghorn as

long as possible, but the 34th was beyond

the intersection by 2 July. The next day

the 363d Infantry of the 91st Division

was attached to the 34th, in time to take

part in a 6-day battle for Rosignano, only

a dozen miles southeast of Leghorn.

On 11 July the 88th Division came

back into the line as a IV Corps unit,

relieving the 1st Armored, and the following day the 91st was committed as a

division, though its 363d Regiment remained for the time being attached to

the 34th. IV Corps reached the Arno

plain on 17 July, and two days later the

34th Division entered the battered port

of Leghorn. Pisa fell on the 23d, and

Fifth Army moved up to the Arno on its

entire front.

The last of the French units had been

withdrawn on 22 July, and Eighth Army

had shifted west to fill the gap. Florence

fell to Eighth Army on 4 August. By

the 15th of that month the Arno River

line was secure, and the Adriatic coast

was also in Allied hands as far north as

the Metauro River above Senigallia.

The weakening of Fifth Army to supply

troops for operations in southern France,

however, had permitted the enemy to

withdraw to the Gothic Line in the

northern Apennines. Pursuit beyond the

Arno was impossible without rest, regrouping, and resupply. The enemy

would also have time to recover his

strength and to improve his fortified

positions.

On the rolling plains northwest of

Rome, clearing stations and their accompanying field hospital platoons experienced great difficulty in keeping up with

the racing troops. Advances during the

first few days of the pursuit were as much

as twenty and thirty miles a day, so that

a clearing station located within range

of enemy guns in the morning might

be miles behind by nightfall. Even with

frequent moves it was impossible to avoid

long ambulance runs. For similar reasons, litter hauls too became long as combat elements outran ambulance control

points and even aid stations.

Field hospital platoons found it impossible to move with the same frequency as the clearing stations they supported,
FROM THE GARIGLIANO TO THE ARNO 303

because of the need for giving postoperative care to their patients, and of the

inadequacy of their organic transportation. The field hospitals were given six

additional 21⁄2-ton trucks in June, making ten in all, but even this number was

sufficient to move only one platoon at

a time. The problem of caring for patients who could not be moved was

solved only by attaching additional field

hospital units and by operating the units

in two sections. On more than one occasion a single field hospital had seven

separate sections in simultaneous operation, all in support of a single division

clearing station.

The 10th Field Hospital remained in

the line in support of the 85th and 88th

Divisions until the relief of II Corps was

completed on 11 June. At that time the

11th Field was brought up from bivouac

in the Cisterna area, going into action

with IV Corps. Platoons of the 33d Field

Hospital followed the VI Corps drive to

Civitavecchia, shifting to IV Corps when

VI Corps was relieved. For the 33d, work

was light until the end of June, when

the 11th was withdrawn to stage for the

invasion of southern France. Thereafter

the 33d carried the entire burden of forward surgery for IV Corps, including the

relatively heavy casualties from the battles for Cecina and Rosignano.

The pursuit was characterized by alternating periods of heavy fighting and

comparative lull, with corresponding

peaks and valleys for the medical service.

On various occasions, corps medical battalions were compelled to fill in at the

division and regimental levels. During

the period of severe fighting in the

mountainous area around Cecina early

in July, and the subsequent advance to

Leghorn and Pisa, the clearing station of

the 109th Medical Battalion, supporting

the 34th Division, cleared casualties

from five regimental combat teams and

their attached troops.

The 316th Medical Battalion, organic

to the 91st Division, operated as a unit

in combat for the first time when the

division was committed on 12 July, although collecting companies of the battalion had been in action with the 361st

and 363d RCT's.

On 3 August, with all but mopping

up operations completed, a rest center

for Fifth Army medical personnel was

established at Castiglioncello, about fifteen miles south of Leghorn on the coast.

The camp had accommodations for 50

officers, 25 nurses, and 100 enlisted men.

Each group remained four days.

Hospitalization in the Army Area

The long period of preparation for

the May drive on Rome gave ample time

to clear Fifth Army hospitals, but the

nature of the terrain on the Garigliano

front, together with the rapid movement

of the combat troops once the Gustav

Line was broken, prevented close support. Hospitals remained in the Carinola

area until late May, while lines of evacuation stretched out to fifty and seventyfive miles along Highway 7.8

Hospitals supporting II Corps began

moving forward after the capture of Terracina. The 95th Evacuation, augmented

by the 1st Platoon of the 601st Clearing

Company, opened at Itri on 24 May, and

the 93d leapfrogged ten miles farther

forward, to Fondi, two days later. The

750-bed 56th Evacuation took over from

8

 Major sources for this section are: (1) Annual

Rpt, Surg, Fifth Army, 1944; (2) Unit Rpts of the

hosps mentioned in the text.
304 MEDITERRANEAN AND MINOR THEATERS

the 93d at Fondi on 1 June, the 93d

going to Campomorto in the Anzio area.

At the same time the 95th jumped ahead

fifty miles to Cori, southeast of the Alban

Hills. The 16th Evacuation, meanwhile,

had gone by sea to Anzio where it opened

on 27 May; and the 8th, after a brief

stay at Cellole, between Carinola and

Minturno, moved overland to Le Ferriere in the beachhead sector, opening

on 1 June. The neuropsychiatric hospital

operated by the 601st Clearing Company, and the venereal disease hospital

operated by the 602d Clearing Company, both moved into the Anzio area

on 31 May.

Two casualty clearing stations (evacuation hospitals), two field hospitals,

three mobile surgical formations, and a

mobile surgical group attached to the

French Expeditionary Corps were similarly slow in moving up for reasons of

terrain and because of the rapid movement of the corps. Additional French

hospital units, although requested early

in April, were not available in time for

the Rome-Arno Campaign.9

As the hospitals moved forward, ambulance control posts were set up to direct the flow of casualties. Movement

was facilitated by keeping new casualties out of hospitals scheduled for an

early change of location.

General Martin was with the first

group to enter Rome, where he quickly

located buildings suitable for hospital

use. The 94th Evacuation from Anzio

and the 56th from Fondi both moved

into Rome on 6 June, with the 38th and

15th from Anzio following on 9 and 10

June, respectively. The 38th exchanged

its dug-in ward tents with the 59th Evacuation Hospital, newly arrived from

Sicily to act as a Peninsular Base Section

station hospital at Anzio. (Map 26)

In Rome, the 38th Evacuation set up

under canvas in a park near Vatican

City. The 15th was located in a school

building, while the 94th and 56th shared

a large building originally constructed

for hospital use by one of the religious

orders and recently operated as a military hospital by the Germans—so recently, in fact, that pots of coffee and

vats of beans were still warm in the

kitchen when the Americans arrived. Although it was recognized that these

evacuation hospitals did not have the

organic personnel necessary for cleaning

and maintenance of fixed structures,

General Martin felt that the service they

would render in preparing the buildings

for later occupancy by PBS units would

more than outweigh the disadvantages.10

The last of the Fifth Army hospitals

from the southern front, the 3d Convalescent, moved into the Anzio area on

9 June, opening at Le Ferriere. Movement had been delayed by lack of transportation and congested roads.

In the pursuit north of Rome, where

the terrain was well adapted to the use

of armor, the combat troops quickly outdistanced their supporting hospitals, and

lines of evacuation once more lengthened out, up to 100 miles. Here the main

axis of advance for the U.S. forces was

Highway 1, along the Mediterranean

coast, with the French Expeditionary

Corps, supported in part by American

medical units, using Highway 2, farther

inland. The first hospital to move into

the new combat zone was the 11th Evacuation, which opened at Santa Marinella,

9

 (1) Fifth Army History, pt. V, p. 244. (2)

Journal of Col Reeder. 10

 Annual Rpt, Surg, Fifth Army, 1944; p. 44.
FROM THE GARIGLIANO TO THE ARNO 305

MAP 26—Fifth Army Hospitals and Medical Supply Dumps, 10 June 1944

just below Civitavecchia, on 10 June.

The new location was 40 miles northwest

of Rome and more than 80 miles from

the hospital's former Anzio site. The following day the 93d opened at Tarquinia,

some 15 miles farther north. On 13 June

the 95th Evacuation was established at

Montalto di Castro, 10 miles beyond

Tarquinia, where it was joined by the

94th two days later. The 400-bed evacuation hospitals were usually moved in

pairs, the organic transportation of the

two units being pooled to move first one,

and then the other.

Throughout this period, communication was poor and lines of evacuation

were maintained only by great effort.

The advance of the front was so rapid
306 MEDITERRANEAN AND MINOR THEATERS

INSTITUTE OF THE GOOD SHEPHERD IN ROME, occupied jointly by the 38th and 94th

Evacuation Hospitals.

that the Signal Corps was unable to include the hospitals in its telephone network. Pigeons were used to some extent,

but for the most part communication was

maintained by couriers driving jeeps

hundreds of miles a day. The 8th Evacuation Hospital, for example, sent an advance party to lay out a site near

Orbetello, 20 miles beyond the 94th and

95th, on 16 June. The party was met by

an ambulance driver who had already

come 50 miles from the front in search

of a hospital. The 8th's commander, Col.

Lewis W. Kirkman, hastily changed

plans and after making contact with the

Fifth Army surgeon by courier, ordered

the hospital established 4 miles south of

Grosseto. The new site was only 6 miles

from the point of contact with the

enemy, but by the time the hospital was

ready to receive patients the front was a

safe distance away.

Other moves were made toward the

end of June. The 15th Evacuation

moved from Rome to Grosseto on the

23d of the month. The 94th left Montalto on the same day to set up at

Montepescali, 10 miles south of Grosseto, where it was joined on 27 June by

the 16th Evacuation. The 3d Convalescent moved to Grosseto on 29 June. Also

on 29 June the 56th Evacuation opened

at Venturina, near Piombino, 30 miles

northwest of Montepescali. The vene-
FROM THE GARIGLIANO TO THE ARNO 307

real disease hospital moved on 26 June

to Guincarico, about 5 miles from the

sites of the 94th and 16th Evacuation

Hospitals. The 38th Evacuation shifted

from Rome to Massa Marittima, about

10 miles north of the venereal disease

center, on 2 July.

By this date the rate of advance had

slowed owing to the withdrawal of substantial forces for the invasion of southern France and to the more rugged terrain. For the first time since the fall of

Rome the location of hospital sites with

respect to availability of air evacuation

became a problem, requiring reconnaissance from the air as well as on the

ground. Hospitals caught up with the

combat troops, and even outdistanced

organic medical units on occasion. The

8th Evacuation for example, moved into

the outskirts of Cecina while the fighting for that town was still in progress

and was actually set up on 2 July forward

of the 34th Division clearing station.

The next series of moves came toward

the middle of July, when the nth, 93d,

and 95th Evacuation Hospitals were

withdrawn from Fifth Army. The 94th

Evacuation, with a platoon of the 601st

Clearing Company attached, moved up

to Ponteginori, about ten miles east of

Cecina along the road to Florence, on

11 July; and the venereal disease hospital moved into the same area four days

later. At the same time the neuropsychiatric hospital was established at

Cecina. The 38th Evacuation opened on

the coast road, twelve miles above

Cecina, on 18 July, after a 24-hour delay

because the area was still under fire. The

15th Evacuation moved to Volterra, a

few miles beyond the site of the 94th.

The 32d Field Hospital, released from

attachment to the Peninsular Base Section, was established at Saline, halfway

between the 15th and 94th Evacuations,

on 23 July.

The 16th Evacuation operated at

Ardenza, on the southern outskirts of

Leghorn, from 26 July to 12 August. The

3d Convalescent moved on 2 August to

Laiatico, twenty miles southeast of Leghorn; and the 56th Evacuation was established three days later about five

miles farther north, at Peccioli. On 8 August the 601 st Clearing Company set up

its neuropsychiatric hospital at Montecchio, a mile or two south of the Peccioli

site of the 56th Evacuation. The front

was stabilized at about this time, with

the actual fighting reduced to patrol

actions along the Arno River line.

(Maps 27, 28)

The Rome-Arno Campaign again

demonstrated the value of the separate

ambulance company, of the 400-bed

evacuation hospital, and of the field hospital platoon as a forward unit. The

shortcomings of these platoons with respect to size were overbalanced by their

mobility in a campaign of rapid movement. The capacity of the 400-bed evacuation could be readily increased, even

beyond its own expansion limits, by the

attachment of one or more clearing platoons from the corps medical battalions.

The field hospital platoons operating

with the division clearing stations were

also augmented from time to time by

additional personnel and beds from

other sources. In the Rome-Arno Campaign the field hospital platoons were

able to move forward with the divisions

they supported because holding units to

care for their nontransportable patients

were improvised from personnel of the

corps medical battalions, with nurses

borrowed from evacuation hospitals. As


310 MEDITERRANEAN AND MINOR THEATERS

TABLE 11—ADMISSIONS TO HOSPITAL AND QUARTERS FROM FIFTH ARMY, MAY—AUGUST

1944

a

 U.S. strength only.

Source: Annual Rpt, Surg, Fifth Army, 1944.

in previous Mediterranean campaigns,

surgical, shock, and other specialist

teams of the 2d Auxiliary Surgical

Group worked with the field hospital

platoons and the evacuation hospitals.

The usual complement was one shock

and four surgical teams for each field

hospital platoon.11

It should be noted in this connection

that the 750-bed evacuation hospitals in

the Italian campaign were moved with

much greater speed than had been the

case in Tunisia. The 8th Evacuation, for

example, struck its tents, moved 80

miles from Cellole to Le Ferriere, and

set up again for operation in 30 hours,

while the 38th closed in Rome, moved

160 miles to Massa Marittima, and reopened in 40 hours. The improvement

owed something to accumulated experience, but more to the effective co-operation of corps and army in providing the

necessary trucks when they were needed.

For the most part, however, these larger

units were not required to make rapid

changes of position. As the lines of combat moved forward, the 750-bed evacuation hospitals tended to function toward

the rear of the army area more as fixed

than as combat units, eventually being

replaced by base section hospitals.

Admissions to hospital and quarters

from Fifth Army during the period of

the Rome-Arno Campaign reached a

peak in June of more than 32,000, of

which one-third were battle casualties.

(Table 11)

Evacuation From Fifth Army

For the first two weeks of the drive on

Rome, evacuation from Fifth Army continued to follow the pattern of the preceding months. Casualties from the

southern front were evacuated from the

Carinola area by rail to Naples. The 41st

Hospital Train, controlled by the Peninsular Base Section, operated between

that city and the Sparanise railhead. The

42d Hospital Train, scheduled for southern France, was brought over from Africa

and went into service between Sessa,

near the main concentration of Fifth

Army hospitals, and Naples, starting 12

May. As had been the case in Africa, the

necessary hospital cars were converted

from local rolling stock. Holding hospi11

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, Surg, IV Corps, 1944. (3) Annual

Rpt, Surg, II Corps, 1944. (4) Annual Rpt, 2d

Aux Surg Gp, 1944. (5) Unit rpts of individual

hosps.
FROM THE GARIGLIANO TO THE ARNO 311

TABLE 12—AIR EVACUATION FROM FIFTH ARMY HOSPITALS, 26 MAY-31 AUGUST 1944a

a

 Figures include patients from the French Expeditionary Corps, from the British components of VI Corps, from the

Anzio area, and some Italian military and civilian personnel. Flights from the Eighth Army sector have been excluded,

but some Eighth Army casualties are not separable from Fifth Army figures. Excludes Air Forces casualties insofar as possible.

Source: Annual Rpts, 802d and 807th MAETS, 1944.

tals at the railheads were maintained by

the corps medical battalions. Casualties

from Anzio continued through most of

May to be evacuated exclusively by hospital ships and by LST's staffed by teams

from the 56th Medical Battalion.

On the fifth day of the attack the

encampment of the 56th Medical Battalion near Nocellito was bombed in

bright moonlight, apparently deliberately, with two enlisted men killed, seven

wounded, and extensive damage to

equipment.

After the consolidation of the two

fronts, air evacuation began from the

army area, and thereafter, for the remainder of the campaign, forward hospitals were cleared by planes of the 802d

and 807th Medical Air Evacuation

Transport Squadrons. The first flight

from the Nettuno airstrip was made on

26 May. Air evacuation for both U.S.

and French forces was directed by the

Office of the Surgeon, Fifth Army, which

had made proximity to an airfield or to

level ground where an airstrip might be

constructed a condition in the selection

of hospital sites. By 1 June approximately 400 patients a day were being

flown from the combat zone to fixed

hospitals in Naples and Caserta.12 (Table 12)

Holding units for air evacuation were

operated at various points by two collect12

 Ltr, Gen Stayer, Surg, NATOUSA, to TSG,

2 Jun 44.
312 MEDITERRANEAN AND MINOR THEATERS

TABLE 13—EVACUATION FROM FIFTH ARMY TO PBS HOSPITALS, 1 JANUARY-31 AUGUST 1944

a

 Includes U.S. Army, U.S. Navy, Allies, POW's. b

 Includes 7,136 patients for whom no means of evacuation is given. Most of these were probably evacuated by air,

which explains in part the large discrepancy between the total evacuated by that means shown in this and in the preceding table. The remainder of the discrepancy may be accounted for in British casualties, not taken to PBS hospitals.

Source: Annual Rpt, Surg, MTOUSA, 1944, an. B, app. 18.

ing companies of the 161st Medical Battalion and by the clearing company and

one collecting company of the 163d

Medical Battalion. The 56th Medical

Battalion handled both air and sea

evacuation at Anzio until 23 June, when

it was relieved by the 54th and departed

for Naples to stage for the invasion of

southern France. The 402d Collecting

Company of the 161st Medical Battalion, assigned to the French Expeditionary Corps, even helped to construct and

maintain an airstrip, and directed the

approach and take-off of the C-47 transports.

Transportation between hospitals and

airfields was handled by corps medical

battalions. The 162d Medical Battalion

also cleared patients from evacuation

hospitals in Rome to the 59th Evacuation, which functioned as a Peninsular

Base Section station hospital at Anzio

until 23 June. By this date more than

3,000 fixed beds were available in the

Italian capital, so that forward evacuation hospitals began sending casualties

to Rome instead of to Naples and

Caserta.

During the entire 7-month period of

the Anzio, Cassino, and Rome-Arno Campaigns, casualties were evacuated from

Fifth Army hospitals to Peninsular Base

Section installations by ambulance, hospital train, hospital ship, LST, and

transport plane. The figures are not reported by campaigns, only on a monthly

basis. For the period 1 January-31 August 1944 the total was 102,298.

(Table 13)

Medical Supplies and Equipment

Like the Fifth Army hospitals, the

supply dumps of the 12th Medical Depot

Company moved forward only after II

and VI Corps had joined at Anzio. The
FROM THE GARIGLIANO TO THE ARNO 313

LOADING AN AMBULANCE PLANE ON NETTUNO AIRSTRIP, JUNE 1944

company headquarters and base platoon

and the 2d Platoon went from Calvi Risorta to Nocellito on 20 April, in the

general alignment of Fifth and Eighth

Armies. The 2d Platoon moved forty-five

miles to Itri on 23 May, and went on

to Rome on 9 June. Headquarters and

the base platoon had meanwhile moved

from Nocellito to Anzio on 5 June,

where the 1st Platoon reverted to control of the parent company.13

The 1st Platoon was established in

Civitavecchia on 11 June, only four days

after the capture of the city and before

the harbor had been cleared. On 18

June, headquarters and the base platoon

went on to Grosseto. Ten days later the

2d Platoon turned over the supply function in Rome to Peninsular Base Section

installations and followed the rapidly

moving army to Piombino. The 1st Platoon was in Cecina on 9 July.

The 12th Medical Depot Company was

reorganized at this time, the personnel

complement being reduced from 178 to

150. The three platoons were redesig13

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944; (2) Annual

Rpt, 12th Med Depot Co, 1944; (3) Annual

Rpts, Surgs, II, IV, and VI Corps, 1944.
314 MEDITERRANEAN AND MINOR THEATERS

nated the 1st, 2d, and 3d Storage and

Issue Platoons.14

Headquarters and the 1st Storage and

Issue Platoon moved from Grosseto to

Saline on 30 July, where they were

joined on 14 August by the 3d Storage

and Issue Platoon. The latter unit was

established in the vicinity of Florence

at the end of the month.

In all these rapid changes of position,

one platoon of the 12th Medical Depot

Company was always in support of each

of the two U.S. corps engaged, with the

headquarters group accessible to both.

The French Expeditionary Corps had

its own system of combat medical supply,

which was organized under the same U.S.

Table of Organization as its American

counterpart, and was supplied through

the same channels.15

Medical supplies were brought up by

water, air, and truck as circumstances

dictated, with no shortages developing

except the perennial shortages of blankets, litters, and pajamas stemming from

faulty property exchange with air evacuation units. This shortage was felt at all

airstrips used for evacuation, since the

incoming planes were on other missions,

which generally precluded the carrying

of bulky medical items.

One of the features of the supply system, in the later phases of the campaign,

was the daily arrival of whole blood by

plane from the 15th Medical General

Laboratory.

Professional Services

in the Army Area

The months of March and April 1944,

when the armies were regrouping arid

re-equipping for the crushing attack that

would carry Allied power to the Arno

River, were used by the Medical Department to review past practices and

improve techniques for the future. The

conferences and seminars that medical

officers had been able to attend only

spasmodically up to that time were systematized, with all phases of the work of

the medical service being discussed. Medical officers of all levels profited by these

interchanges before they returned to active combat support.16

Medicine and Surgery

Forward Surgery—The techniques of

forward surgery in the Rome-Arno Campaign did not differ greatly from those

employed during the preceding eight

months in Italy. While there were a

number of clinical improvements, including a more extensive use of penicillin and the unrestricted availability of

whole blood in the field hospital platoons, the only important administrative

change was the withdrawal of twentyeight teams, or half of the entire complement, of the 2d Auxiliary Surgical

Group early in July to stage for the

coming invasion of southern France.17

The loss of these teams was not made up

until the next stage of the Italian campaign.

Neuropsychiatry—The early success

of the 3d Division's experiments at Anzio

in treating psychiatric cases at the division level led General Martin to initiate

similar experiments in the 88th Divi14

 TOE 8-667, 17 Mar 44. 15

 ETMD for May 1944. At the start of the RomeArno Campaign, both U.S. and French medical depot companies were organized under T/O 8-661. 16

 Annual Rpt, Surg, Fifth Army, 1944. 17

 Special Rpt, 2d Aux Surg Gp, 27 Oct 44.
FROM THE GARIGLIANO TO THE ARNO 315

sion, which had not yet been in combat.

It was hoped that the incidence of psychiatric casualties could be reduced if

adequate facilities for early treatment

existed from the start.18

The 88th Division Training and Rehabilitation Center was formally established on 18 April 1944, commanded by

a line officer with two noncommissioned

officers as assistants, all with extensive

combat experience. The division psychiatrist, Capt. (later Maj.) Joseph Slusky,

acted as consultant. The center was attached for rations and quarters to the

clearing company of the 313th Medical

Battalion. Actual operation began on

11 May when the division went into combat. The procedure was simple, but

effective.

An exhaustion or psychiatric case admitted to the clearing station was examined by the division psychiatrist, who

evaluated the severity of the symptoms.

The patient was retained at the clearing

station for two or three days, where he

was given sodium amytal three times a

day after meals. Sedation was sufficient

to ensure adequate rest and sleep, but

not heavy enough to keep the patient

from going to mess and otherwise taking

care of himself. After 24 to 48 hours of

this treatment, the patient was again

examined by the division psychiatrist.

If he appeared to be responding, he was

retained. If not, he was transferred to

the Fifth Army Neuropsychiatric Center, operated by the 601st Clearing

Company.

The patients who showed improvement under sedation were given suggestive and supportive therapy and turned

over to the division Training and Rehabilitation Center, where they were

given lectures combined with calisthenics, hikes, and other physical activities,

including tactical training with weapons.

Most were ready to return to duty after

two days at the center. Others were retained for a few days longer, while those

whose symptoms persisted were evacuated to the neuropsychiatric hospital.

Each patient was re-examined by the

division psychiatrist before returning to

combat and was given a final therapy

session oriented toward reassurance. Returns to duty were made through nonmedical channels.

The record for the period 11 May-9

June, during which the 88th was in continuous combat under particularly difficult conditions, showed a total of 248

psychiatric admissions to the division

Training and Rehabilitation Center. Of

these, 141 or 56.9 percent, were returned

to duty from the center. One hundred

and four were evacuated to the 601st

Clearing Company, from which 24 were

later returned to duty. Total returns to

duty were thus 165, or 66.5 percent.

Eighty, or 32.3 percent, were lost to the

division. Two remained under treatment

at the end of the period, and one was

absent without leave.

The results of this experiment led

to an order of 2 July 1944 directing all

divisions of Fifth Army to establish similar training and rehabilitation centers.

Thereafter, admissions to the Fifth

Army Neuropsychiatric Center were exclusively by transfer from these division

installations. A Fifth Army consultant in

neuropsychiatry, Maj. (later Lt. Col.)

18

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, Surg, 88th Div, 1944. (3) Hanson,

comp. ed., "Combat Psychiatry," Bulletin, U.S.

Army Medical Department, Suppl (November 1949).

See also pp. 284-85, above.
316 MEDITERRANEAN AND MINOR THEATERS

TABLE 14—DISPOSITION OF NEUROPSYCHIATRIC CASES IN FIFTH ARMY, MAY-AUGUST 1944

a

 Includes 95 returned to limited or Class B duty.

Source: Annual Rpt, Surg, Fifth Army, 1944.

Calvin S. Draper, was also named at this

time. A further development, which

went into effect the first of August, was

the return of certain neuropsychiatric

casualties to limited or noncombat duty

in the army area, a disposition board for

this purpose being set up by the 3d Convalescent Hospital.

In general, the psychiatric cases developing in the drive to Rome and the

subsequent pursuit to the Arno River

were less severe than those encountered

during the static fighting before Cassino

and on the Anzio beachhead. The incidence was higher in the divisions new

to combat, but the response to treatment

in these divisions was excellent. The record of the 88th Division has already

been noted. The 91st returned 68.1 percent of its 116 psychiatric casualties to

duty between 13 and 31 July when the

division was in combat. The 85th Division, out of action between 1 July and 15

August, had a smaller total of such cases,

76 being admitted in this period to the

division training and rehabilitation center, but the cases proved more obstinate,

only 51 percent being returned to duty

at the division level.

The disposition of psychiatric cases in

Fifth Army as a whole for the last four

months of the Rome-Arno Campaign is

shown in Table 14.

Common Diseases—Malaria in Fifth

Army reached the year's peak of 94

cases per 1,000 per annum in June 1944,

dropping only slightly to 82 in July. During these two months the season was at

its height, and the army was operating

in areas that had been controlled by the

enemy during the earlier part of the

breeding season. Atabrine continued to

be the primary preventive measure

available, the use of netting and gloves

being for the most part impractical in

combat.

A sharp rise in the incidence of diarrhea and dysentery (including bacterial food poisoning) from 28 per 1,000

per annum in May to 102 in June and

135 in July may be explained by the

simultaneous advent of warm weather,

the fly season, and the fresh fruit season.

Even the July figure, however, was far

below the rate of 195 cases per 1,000

per annum experienced in June 1943 in

North Africa. Insecticides were available

in adequate quantities, and the diseases

were quickly overcome when the period
FROM THE GARIGLIANO TO THE ARNO 317

TABLE 15—VENEREAL DISEASE RATES BY DIVISIONS, FIFTH ARMY, MAY-AUGUST 1944

 a

a

 Rates expressed as number per annum per 1,000 average strength. b

 Not yet in Italy. c

 Withdrawn from Fifth Army.

Source: Annual Rpt, Surg, Fifth Army, 1944.

of active fighting came to an end in early

August.

Venereal disease in the summer of

1944 followed a predictable pattern, the

rate being relatively low during periods

of combat and high during the rest and

bivouac periods. (Table 15) The rate

continued to be highest among veteran

troops.

Dental Service

On 6 May 1944, just before the

launching of the drive on Rome, the

Fifth Army dental surgeon, Colonel

Cowan, was returned to the United

States on rotation. His acting successor

was Maj. (later Lt. Col.) Clarence T.

Richardson of the 16th Evacuation

Hospital.19

Major Richardson inherited a dental

establishment much better equipped to

fulfill its mission than the one Colonel

Cowan had taken to Salerno eight

months earlier. Facilities for prosthetic

work were still less than adequate, but in

other respects Fifth Army began the

drive to Rome well prepared to meet the

dental requirements of its troops. Each

of the divisions had improvised laboratory facilities. In addition, three of the

four mobile dental laboratories—built

on 21⁄2-ton truck chassis—reaching the

theater in May were assigned to Fifth

Army, the fourth going to the Air Forces.

By June, when IV Corps went into

the line north of Rome, the Fifth Army

Dental Clinic, operated by the 602d

Medical Clearing Company, was functioning smoothly enough to care for all

cases that could not be handled by the

divisions. IV Corps, accordingly, set up

no dental clinic of its own, while the II

Corps clinic was discontinued toward

the end of the month. Aside from inadequate prosthetic facilities, the only

serious defect in the Fifth Army dental

setup at this time was the familiar problem of getting dental services to troops

in distant positions, and the correlative

loss of man-hours in sending men to the

rear to the Army clinic.

The reorganization of July gave a

19

 The major sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944; (2) Annual

Rpt, Med Sec, MTOUSA, 1944; (3) MS, Dental

History, North African and Mediterranean Theaters of Operations; (4) Unit rpts of div surgs and

med installations in Fifth Army during the period

11 May-31 Aug 44.
318 MEDITERRANEAN AND MINOR THEATERS

FIELD UNIT OF THE FIFTH ARMY DENTAL CLINIC in the Piombino area, July 1944.

dental unit to the 12th Medical Depot

Company, but personnel and facilities

for it were not available until fall.

For Fifth Army as a whole, the ratio

of dental officers to troop strength

dropped sharply from one dental officer

for each 987 men in May 1944 to one for

each 1,019 men in June. The July and

August ratios were 1:915 and 1:963, respectively. The work accomplished by

these officers and their staffs during the

last four months of the Rome-Arno Campaign is summarized in Table 16.

Veterinary Service

The May 1944 offensive carried Fifth

Army through some of the most rugged

and difficult terrain in Italy. In the drive

from the Garigliano front to Rome, II

Corps was supported by eight Italian

pack trains, with an aggregate strength

of 97 horses and 1,897 mules. Divisional

animals, including those assigned to two

pack field artillery battalions, included

106 horses and 1,270 mules. Pack trains

of the French Expeditionary Corps in the
FROM THE GARIGLIANO TO THE ARNO 319

TABLE 16—DENTAL SERVICE IN FIFTH ARMY, MAY-AUGUST 1944

Source: Annual Rpt, Surg, Fifth Army, 1944.

same operation utilized 2,023 horses and

7,266 mules. In the drive, 146 animals

were killed in action and 1,111 were

wounded. The particularly heavy animal

casualties in the French sector made it

necessary to attach the 1st Veterinary

Hospital (Italian), a Peninsular Base

Section unit, to the French Expeditionary Corps.20

Veterinary hospitals in support of

Fifth Army experienced considerable

difficulty in finding sites with buildings

suitable for animal use. Close support

was nevertheless given by these units.

The Italian-staffed 110th Veterinary

Hospital moved from the Carinola area

to Nettuno on 20 June, and to Rome on

4 July. The 130th Veterinary Hospital,

also Italian staffed, moved from Nocellito to Rome on 1 July, to Grosseto a

week later, and to Saline on 1 September. The U.S. 17th Veterinary Evacuation Hospital, supporting the 601st and

602d Field Artillery Battalions, moved

seven times between 4 April and 15 July.

Among its operating sites were Monte

San Biagio near Terracina; Cori and

Nemi in the beachhead area; Castagneto, south of Cecina; and Ponteginori

west of Cecina on Highway 68. With the

battalions it supported, the 17th was assigned to Seventh Army on 20 July.

Replacements for animal casualties

were supplied by the Base Remount Depot, operated by Peninsular Base Section. To minimize delay as much as possible, however, each veterinary hospital

maintained a small exchange unit that

supplied a sound animal for each

wounded one received. Only on the

French front, where animals were most

numerous and casualties heaviest, did

the system break down. In those cases

where hospital exchange units were exhausted, fresh animals were allotted by

Fifth Army.

When flat or rolling country was

reached after the fall of Rome, all animal units were placed in rest areas,

where they remained throughout the

summer. The only exception was a pe20

 The major sources for this section are: (1)

Annual Rpt, Surg, Fifth Army, 1944; (2) Veterinary History, Mediterranean Theater of Operations; (3) Miller, United States Army Veterinary

Service in World War II.
320 MEDITERRANEAN AND MINOR THEATERS

riod in July when elements of the 1st

Armored Division, operating in mountains between Massa Marittima and

Volterra, substituted horses for halftracks and trucks.

During the rest period, all Italian pack

trains and veterinary hospitals were reorganized in accordance with U.S. Tables

of Organization and Equipment. Four

new Italian pack companies were also

organized at this time, and the 20th Mule

Pack Group, which controlled all the

Italian pack trains, set up a center under

Colonel Canani for training recruits in

the handling of pack animals.21

Medical Support for the

Eastern Command

Before the end of 1943, negotiations

began for the use of Russian airfields by

U.S. bomber squadrons based in Italy

and in the United Kingdom. Arrangements were finally completed in the

spring of 1944, with the designation of

three bases in the Ukraine. The headquarters base was at Poltava, 200 miles

east of Kiev. The others were located at

Mirgorod, 50 miles west of Poltava, and

at Piryatin, another 50 miles in the direction of Kiev. Collectively, they were

administered as the Eastern Command

(EASCOM) . The first flight, made by

planes of the Fifteenth Air Force from

Italy on 2 June 1944, was timed to be

contemporaneous with the capture of

Rome and the launching of the Normandy invasion. The first task force of

B-17's, personally led by General Eaker,

destroyed marshaling yards and shops at

Debrecen in eastern Hungary before

ending its mission at Poltava airfield.22

Lt. Col. William M. Jackson, Eastern

Command surgeon, established his headquarters at Poltava, where his staff

included a Veterinary Corps officer and

a Sanitary Corps officer. Each of the three

bases was supported by a 75-bed provisional hospital expanded from a 24-bed

aviation dispensary. Instead of the two

medical officers called for in the TOE,

the Poltava and Piryatin hospitals had

four each, while Mirgorod had three.

Each hospital had the one dental officer

and one supply officer (MAC) provided

in the TOE, and each had four nurses.

Eighty-five enlisted men, divided among

headquarters and the three hospitals,

brought total Medical Department personnel to 117. All medical personnel and

facilities came from the United Kingdom.23

The first problem faced by Colonel

Jackson and his staff was one of sanitation. Whatever war may have left of

water and sewerage systems had been

destroyed by the Germans as they retreated, together with virtually all buildings. The Russians had been too short

of medical personnel themselves to take

21

 See also pp. 263-65, above. Colonel Canani

was official liaison officer between the Italian pack

and veterinary units and the office of the Fifth Army

veterinarian, Colonel Pickering.

22

 This section is based primarily on the following: (1) Craven and Cate, eds., Europe; ARGUMENT to V-E Day, pp. 308-19; (2) Maj Albert

Lepawsky, History of Eastern Command, USSTAF;

(3) History of Operation FRANTIC, 26 October 1943-

15 June 1944; (4) EASCOM History, 1 Oct 1944-

1 April 1945; (5) Unsgd, undtd doc, Assignment of

Nurses in Russia. 23

 (1) TOE 8-450 (2) CM 12424, 28 Mar 44,

Knerr, Spaatz, and Grow to Deane for Jackson.

(3) Hist of FRANTIC 26 Oct 43-15 Jun 44, Med an.;

(4) Link and Coleman, Medical Support of the

Army Air Forces in World War II, pp. 562-63. For

the first three weeks there were only three nurses at

Mirgorod, one of the twelve from England having

been disqualified at Tehran before entering the

USSR. She appears to have been replaced later.
FROM THE GARIGLIANO TO THE ARNO 321

adequate preventive measures, and

typhus, malaria, dysentery, and venereal

diseases were prevalent. In the absence

of buildings, the hospitals were set up in

tents, close to the airfields they served.

The hospital at Piryatin was well concealed in a wooded area near a river, but

those at Poltava and Mirgorod were in

open fields. All units were established

and ready to receive patients by 1 June.

The medical service of the Eastern

Command underwent its acid test three

weeks later. The first shuttle bombing

mission by the Eighth Air Force from

British bases arrived at Poltava the

afternoon of 22 June after a successful

raid on a synthetic oil plant south of

Berlin. The bombers were apparently

trailed to their destination by a German

plane, and that night the Poltava field

was attacked in force. At the time of the

attack there were 370 permanent and

714 transient U.S. personnel at the base.

It was estimated that no tons of

bombs were dropped over a 2-hour

period. Every one of the 73 B-17's on

the field was hit and 43 were destroyed,

together with 3 C-47's, one F-5, numerous ground vehicles, and quantities of

gasoline, oil, bombs, and ammunition.

Twenty-five Russian YAK fighters were

also damaged on the ground. Two

Americans, a pilot and copilot, were

killed and 14 wounded. The Russians,

who manned the antiaircraft batteries

and fought the fires on the field, lost 30

killed and 95 wounded. First aid was

given in the slit trenches that served for

shelter, the wounded being moved to the

hospital when the raid was over.

The following night the other two

bases were attacked, but with less disastrous results. A gasoline dump was hit

at Mirgorod, but at Piryatin the Germans failed to locate the target and

contented themselves with bombing the

town.

Poltava was nonoperational for fortyeight hours and operated to a limited

extent only for a month. Russian sappers

were still locating and detonating unexploded bombs as late as 7 September.

After the attacks of 22-23 June, installations were dispersed as much as

possible. The hospitals were relocated

some distance from the airfields, and an

attempt was made to enlarge the available medical facilities. A request for a

400-bed field hospital to replace the

three outsize dispensaries was refused,

however, on the ground that no field unit

was available for that purpose.24

The bases became steadily less important as the Russian front pushed westward and the advance of the Allied

Armies in Italy and France brought

more enemy targets into normal bomber

range. Personnel were gradually withdrawn until by 1 October only Poltava

retained a medical complement, reduced

to 3 medical officers, 4 nurses, and 14

enlisted men. Housed in three prefabricated barracks, this unit continued into

1945, but performed only routine dispensary functions.

The medical installations of the Eastern Command were supplied from

Tehran, and during the period of

greatest activity patients were evacuated

by air to the 19th Station Hospital in

24

 (1) CM 11-64940, Spaatz to ETOUSA, 15 July

44. (2) CM E-38685, 19 Jul 44, Eisenhower to USSTAF. A field hospital organized and equipped by

the French Air Force had been offered to the

Mediterranean Allied Air Force in the spring of

1944, but apparently had been diverted to other

uses. See entry, 3 Apr 44, in Journal, Col Reeder.
322 MEDITERRANEAN AND MINOR THEATERS

that city. After 1 October 1944, evacuation was to the 113th General Hospital

at Ahwaz, Iran. Considering the unsanitary conditions and the prevalence of

disease in the Eastern Command, the

medical service was excellent. The

average weekly noneffective rate was

18.32 per 1,000, only a little higher than

that for similar units in the United

Kingdom.
CHAPTER IX

The Italian Communications Zone

Southern Phase

Changes in Theater Organization

By the beginning of 1944, preparations for the frontal attack on the

European continent dominated Allied

strategy and dictated changes in the command structure in the Mediterranean.

General Wilson succeeded General

Eisenhower as Supreme Allied Commander, with General Devers as his

deputy. At the same time, in anticipation

of a probable invasion of southern

France, the theater boundaries were redrawn to include that area as well as

Austria, the Balkans, and Turkey.

Medical Organization at the

Theater Level

The invasion of Italy and subsequent

operations in the fall and winter of 1943

served to emphasize the organizational

confusion in higher headquarters. There

was no clear division of authority or function between Allied Force Headquarters

and the U.S. commands theoretically

subordinate to it, or between those commands themselves. The principal area of

overlap lay between Headquarters,

North African Theater of Operations,

and Headquarters, Services of Supply.

It was therefore these two commands

that were primarily affected by a reorganization in February 1944, under

which the Services of Supply organization became in fact a communications

zone headquarters. The Medical Section,

AFHQ, remained substantially as it was,

but operation of all U.S. medical services in the communications zone, including hospitalization and evacuation, were

transferred from the NATOUSA medical section to its SOS counterpart, whose

functions previously had been limited to

medical supply. A number of key personnel were transferred along with their

functions. After 24 February, the effective date of the reorganization, the activities of the NATOUSA medical section

were largely confined to policy making

and co-ordination.1

As a first step in the expansion of the

medical section, SOS NATOUSA

Colonel Shook, who had headed the

section since August 1943, became communications zone surgeon. His administrative officer, Maj. (later Lt. Col.)

James T. Richards of the Pharmacy

Corps, was transferred from temporary

1

 Hist of AFHQ. (2) Annual Rpt, Med Sec, MTOUSA, 1944. (3) Hist of Med Sec, Hq, COMZ

MTOUSA. (4) Interv with Col Shook, 31 Mar

52. (5) Munden, Administration of Med Dept in

MTOUSA, pp. 93-105. More detailed discussion

will be found in (6) Armfield, Organization and

Administration, pp. 275 ff. See also, (7) Ltrs, Col

Munly, to Col Coates, 7 Nov 58; and Dr. Shook to

Coates, 6 Nov 58, both commenting on preliminary

draft of this volume.
324 MEDITERRANEAN AND MINOR THEATERS

COLONEL SHOOK

duty in the NATOUSA surgeon's office.

The hospitalization and evacuation officers, Lt. Col. (later Col.) William

Warren Roe, Jr., and Lt. Col. (later

Col.) Albert A. Biederman, were also

transferred along with their functions

from the office of the surgeon, NATOUSA. The dental officer of the SOS

medical section was Lt. Col. (later Col.)

Karl H. Metz.

The chief of professional services, Lt.

Col. (later Col.) Joseph G. Cocke, assumed his new duties on 12 March,

transferring from the Mediterranean

Base Section. The basic organization was

completed on 24 March with the arrival

of Capt. (later Maj.) Elizabeth Michener, chief nurse; Lt. Col. (later Col.)

Duance L. Cady, communications zone

veterinarian; and Lt. Col. Richard P.

Mason, preventive medicine officer and

medical inspector. Additional personnel

were added as needed through March

and April, the only important shift

coming in mid-May. At that time, Cocke

became Shock's deputy, being replaced

as chief of professional services by Colonel Roe. Lt. Col. (later Col.) Jenner G.

Jones, who had been executive officer

when the SOS medical section was concerned solely with supply, became chief

of the medical supply branch. Allotted

personnel as of 21 May, when the organization was stabilized, included 21 officers, a warrant officer, and 44 enlisted

men.

As the communications zone medical

section expanded, the medical section of

NATOUSA modified its functions in

keeping with its more restricted policymaking and planning role. Personnel

declined, owing to the loss of operating

functions, by transfer to Services of Supply. On 1 March 1944 Maj. Gen. Morrison C. Stayer, former surgeon of the

Caribbean Defense Command, replaced

General Blesse as Surgeon, NATOUSA,

and Deputy Director of Medical Services, AFHQ. The British Director of

Medical Services, General Cowell, was

himself relieved on 19 May by Maj. Gen.

William C. Hartgill, another Royal

Army Medical Corps officer. General

Blesse, who was being recalled to the

zone of interior to become surgeon of

the Army Ground Forces, remained in

the theater until 24 April, acting as

General Stayer's deputy and retaining

his function as Medical Inspector,

AFHQ. General Stayer took over the

duties of medical inspector on Blesse's

departure. The section retained limited

administrative functions, including the

consultant service and various duties in

the field of preventive medicine. On the
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 325

MEDICAL SECTION OF NATOUSA AT CASERTA, 26 July 1944. Front row, left to right:

Lt. Col. Joseph Carmack, Lt. Col. Asa Barnes, Col. Lynn H. Tingay, Colonel Standlee, General Stayer, Lt. Col. Bernice M. Wilbur, Col. William C. Munly, Colonel Churchill, Colonel

Simeone; back row, left to right: Colonel Hanson, Maj. Joseph W. Still, Colonel Noonan,

Colonel Long, Colonel Stone, Col. Oscar S. Reeder, Colonel Radke, Capt. John H. Slattery.

side of professional services, there was

actually some expansion, a veterinary

section under Colonel Noonan being set

up in mid-March.

Relations between the NATOUSA

and SOS medical sections remained

close, despite early fears that the theater

medical section might seek to continue

operating activities and reluctance on

the part of some officers to be transferred

from a higher to a lower headquarters.

The policy-determining role of the

NATOUSA medical section imposed a

degree of co-ordination, while the transfer of personnel in the long run made for

friendly working relations between the

two groups.

In July, with the Allied armies approaching the Arno River, both Allied

Force Headquarters and Headquarters,

NATOUSA, moved from Algiers to

Caserta. Together with the other offices

of American headquarters, the theater

medical section was established in the

royal palace. The Air Forces medical

section was already located in the palace,

having established offices there late in

May. The British medical component

of AFHQ, while no longer sharing a

building with the Americans, was physi-
326 MEDITERRANEAN AND MINOR THEATERS

cally near enough to permit continued

co-operation. Headquarters, Communications Zone, including the SOS medical

section, was established in close proximity to the others in buildings vacated by

a general hospital on 20 July.2

The Peninsular Base Section

Plans for the Italian campaign called

for the early establishment of a base

section in the Naples area. A preliminary

organization was activated in Casablanca

on 21 August 1943 as the 6665th Base

Area Group (Provisional), with medical

personnel drawn from the Atlantic Base

Section, whose activities were rapidly

declining. An advance echelon of the

medical section debarked at Naples on

4 October from the first troopship to

enter the bay. The entire section was

ashore by 10 October.3

The 6665th Base Area Group remained under Fifth Army control until

1 November, when it was formally reconstituted as the Peninsular Base

Section. During this interval, the Fifth

Army surgeon acted also as the base

surgeon. He was succeeded in the latter

capacity on 9 November by Colonel

Arnest, who had served as surgeon of II

Corps since the North African landings.

Although both cholera and typhus had

been reported in Naples ten days before

the capture of the city, American medical officers found the general health situation good.4

 The most serious problem

was sanitation, since the water supply

had been disrupted and the sewerage

system was not functioning for lack of

water, but facilities were quickly restored by the Allied Military Government, in co-operation with British and

U.S. Army engineers. Pending the arrival of fixed installations, hospitalization for American troops in the city was

provided by the 307th Airborne Medical

Company and the 162d Medical Battalion, with the 95th Evacuation Hospital

taking over on 9 October. The 3d Convalescent Hospital also began taking patients in the Naples area on 12 October.

By the end of 1943, the Peninsular

Base Section was the largest base organization in the theater, both in terms of

personnel and in terms of the number of

fixed beds under its control. It continued

to grow at the expense of the declining

North African bases, reaching its peak

strength in August 1944.

Air Forces Medical Organization

The medical organization of the Air

Forces units in the Mediterranean was

realigned early in 1944. The over-all

Allied command remained the Mediterranean Allied Air Forces, with the Army

Air Forces, Mediterranean Theater of

Operations (AAF MTO), as its U.S.

component. The American command included three major units: the Twelfth

Air Force, now primarily a light and

medium bomber group; the Fifteenth

Air Force, a heavy bomber group; and

the Army Air Forces Service Command.

Headquarters of the U.S. command organization was set up in Caserta in

February. Twelfth Air Force headquarters was at Foggia, Fifteenth Air Force

headquarters was at Bari, and headquar2

 See p. 336, below. 3

 (1) Annual Rpt, Med Sec, NATOUSA, 1943.

(2) Annual Rpt, Surg, PBS, 1943. (3) Hq, ETOUSA, Rpt on PBS NATOUSA, 10 Feb 44. (4) Annual Rpt, Surg, Fifth Army, 1943. 4

 The ranking U.S. civil affairs officer was General

Hume. For the civil affairs aspects of the Italian

campaign, see pp. 360-62, below.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 327

ters of the service command was at

Naples.5

The Fifteenth Air Force was still being built up, reaching its peak strength

about the time of the first shuttle bombing between Italian and Russian bases.6

In that operation and in the strategic

bombing of Germany generally, the

Fifteenth Air Force was responsible to

the U.S. Strategic Air Forces in Europe,

a European theater command, but in

matters of administration, supply, and

training, as well as in its Mediterranean

operations, it remained under control of

the Mediterranean Allied Air Forces and

the U.S. Army Air Forces, Mediterranean Theater of Operations.

The top co-ordinating U.S. air command, the Army Air Forces, MTO, was

originally organized without any medical section, but the need for one was

quickly apparent and a small section was

established in February 1944. The position of surgeon went to the senior Air

Forces medical officer in the theater,

Colonel Elvins, who was succeeded in

April by Col. Edward J. Tracy. Colonel

Elvins' replacement as Twelfth Air

Force surgeon was Col. William F. Cook.

The Fifteenth Air Force surgeon was

Col. Otis O. Benson, Jr., and the surgeon

of the Army Air Forces Service Command was Col. Louis K. Pohl.

The functions of the Twelfth and Fifteenth Air Force surgeons were comparable to those of an army surgeon. The

duties of the surgeon, AAF MTO, were

confined primarily to policy matters and

to maintaining close liaison with the

medical service of the British component

of the MAAF. The service command

medical section was the effective operating agency for Air Forces medical activities at the theater level, including

administration of hospitals, evacuation,

medical supply, sanitation and preventive medicine, and medical plans. The

AAFSC surgeon was also the principal

point of contact for exchange of technical

information with the NATOUSA medical section.

Hospitalization in the

Communications Zone

Fixed Hospitals in PBS

One of the first tasks of the 6665th

Base Area Group medical section was to

survey the city of Naples for hospital

sites. Various Italian hospitals and school

buildings were examined and the best

of them were tabbed for Medical Department use. Aside from these, the most

suitable area for additional medical installations was the Mostra Fairgrounds

at Bagnoli, some three or four miles

from the heart of Naples. Site of Mussolini's colonial exposition of 1940, the

fairgrounds contained numerous relatively spacious buildings of stone and tile

construction, with water, sewerage, and

power facilities and good highway and

rail connections. Many buildings had

been badly damaged by Allied bombings, and the retreating Germans had

destroyed others, but the advantages so

far outweighed the drawbacks that the

Fifth Army surgeon got the entire area

set aside for hospital use. It quickly be5

 This section is based primarily on the following: (1) Hist, Twelfth Air Force Med Sec, 1942-44;

(2) Med Hist, Fifteenth Air Force, 1944. (3) Annual Med Hist, AAFSC MTO, 1944; (4) Link and

Coleman, Medical Support of the Army Air Forces

in World War II, pp. 438-48. See also Armfield, Organization and Administration, pp. 269-75. 6

 See pp. 320-22, above.
328 MEDITERRANEAN AND MINOR THEATERS

MEDICAL CENTER AT THE MOSTRA FAIRGROUNDS IN BAGNOLI, NEAR NAPLES

came the staging site for medical installations arriving in Italy.7

In order to realize the full possibilities

of the Mostra Fairgrounds, a provisional

medical center was tentatively organized

7

 This section is based primarily on the following:

(1) Annual Rpt, Med Sec, NATOUSA, 1943; (2)

Annual Rpt, Med Sec, MTOUSA, 1944; (3)

Annual Rpts, Surg. PBS, 1943 and 1944; (4)

Unit rpts of med units mentioned in the text.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 329

on 25 October 1943, with headquarters

personnel drawn from the 161st Medical Battalion. Other fixed hospitals went

into the Caserta area, close behind the

Fifth Army front, and still others were

attached to Air Forces units operating

in the heel of Italy and from the Foggia

bases. (Map 29)

Naples and the Medical Center—The

first American fixed hospital in Italy

was the 118th Station Hospital, which

opened 14 October in the buildings of

an Italian military hospital in Naples.

The 106th Station opened in a school

building three days later. Both hospitals

operated almost from the start in excess

of their 500-bed Table of Organization

capacities.

The first fixed hospital to open at the

fairgrounds was the 182d Station, which

received its first patients on 19 October.

The 3d Convalescent was already established on the fairgrounds but remained a

Fifth Army unit, subject to withdrawal

on call of the army surgeon. These two

hospitals, and the 4th Medical Supply

Depot, were functioning in the area

when the fairgrounds were hit by enemy

planes the night of 21 October. The toll

was 11 killed and 55 wounded among

both patients and medical personnel,

and there was severe damage to installations, but both hospitals continued to

function without interruption.

During November and December,

hospital facilities in Naples built up

rapidly. The 225th Station joined the

medical center group on 10 November,

followed by the 23d, 21st, and 45th General Hospitals on 17 November, 29

December, and 1 January 1944, respectively. The 17th General, meanwhile,

had taken over on 11 November the

Italian civil hospital in Naples formerly

occupied by the 95th Evacuation, and

the 300th General had opened in buildings of a Naples tuberculosis sanatorium

a few days later. The 70th Station, sited

in the Naples Academy of Fine Arts,

opened on 25 November.

Two more 500-bed station hospitals

were added to the concentration in the

Naples area by the end of the Winter

Line campaign. These were the 103d,

which opened a convalescent hospital in

an Italian villa on 5 January, replacing

the 3d Convalescent, which had gone

into the combat zone; and the 52d, which

opened in school buildings on 17 January. The 103d added the facilities of a

regular station hospital, sited in school

buildings a few blocks from its convalescent establishment, on 13 January.

All hospitals in the Naples area faced

problems of reconstruction and renovation. Even those sited in hospital buildings found a heritage of indescribable

filth to be cleaned out before they could

operate. Initial cleaning and minor remodeling were usually accomplished by

hospital personnel; the Chemical Warfare Service was available for disinfecting the premises. More extensive repairs

to bomb-damaged buildings, such as

those on the fairgrounds, were made by

the Army engineers, often after the

hospital was in operation.

By mid-January 1944, hospitals of the

medical center were functioning on a

partially specialized basis. The 182d

Station, in addition to its general beds,

operated a venereal disease section that

ultimately reached a capacity of 1,200

beds. The 45th General was designated

as the neuropsychiatric center for the

Peninsular Base Section.

While all hospitals took British pa-
MAP 29—Fixed Hospitals in Southern Italy, October 1943-October 1947

FIXED HOSPITALS IN SOUTHERN ITALY

Lecce

4th Field, 1st Platoon (AAFSC), 15 March-15

May 1944. 100 beds.

35th Field, 3d Platoon (AAFSC, ABC), 15 May

1944-16 April 1945. 100 beds.

Erchie

35th Field (AAFSC), 15 December 1943-15 May

1944. 400 beds.

35th Field, 1st and 2d Platoons (AAFSC), 15

May-11 November 1944. 200 beds.

35th Field, 1st Platoon (AAFSC, ABC), 11 November 1944-24 May 1945. 100 beds.

Manduria

4th Field, 1st Platoon (AAFSC), 26 November

1943-15 March 1944. 100 beds.

Battipaglia

32d Field, Island 2d Platoons, 23 October 1943-

13 February 1944. 200 beds.

32d Field, 13 February-23 July 1944. 400 beds.

154th Station, 23 July-6 September 1944. 150

beds.

59th Evacuation (as station), 16-27 July 1944.

750 beds.

Bari

26th General (AAFSC, ABC), 4 December 1943-

21 June 1945. 1,000/1,500 beds.

45th General (ABC), 21 June-26 September 1945.

1,500 beds.

Spinazzola

34th Field, 1st Platoon (AAFSC, ABC), 15 February 1944-5 June 1945. 100 beds.

Lavello

4th Field, 1st Platoon (AAFSC, ABC), 15 May

1944-3 June 1945. 100 beds.

Cerignola

34th Field (AAFSC), 13 December 1943-15 February 1944. 400/200 beds.

34th Field, 2d and 3d Platoons (AAFSC, ABC),

15 February 1944-15 June 1945. 200 beds.

4th Field, 2d Platoon, 16 June-10 July 1945.

100 beds.

Naples-Caserta Area

118th Station, Naples, 14 October 1943-20 May

1945. 500 beds.

4th Field, 2d and 3d Platoons, Pomigliano Airfield, 16 October 1943-12 January 1944. 200

beds.

106th Station, Naples, 17 October 1943-24 May

1945. 500 beds..

182d Station, Medical Center, 19 October 1943-

25 March 1945. 500 beds.

32d Field, 3d Platoon, Pomigliano Airfield, 26

October 1943-13 February 1944. 100 beds.
FIXED HOSPITALS IN SOUTHERN ITALY—Continued

36th General, Caserta, 3 November 1943-20 July

1944. 1,000/2,000 beds.

225th Station, Medical Center, 10 November

1943-26 March 1945. 500 beds.

17th General, Naples, 11 November 1943-25

October 1945. 1,000/1,500 beds.

300th General, Naples, 16 November 1943-31

March 1946. 1,000/2,000 beds.

23d General, Medical Center, 17 November 1943-

26 September 1944. 1,000/2,000 beds.

70th Station, Naples, 25 November 1943-19 September 1944. 500 beds.

262d Station, Aversa, 27 November 1943-10 June

1945. 500 beds.

74th Station, Piana di Caiazzo, 7 December 1943-

25 October 1944. 500 beds.

21st General, Medical Center, 29 December 1943-

26 September 1944. 1,000/2,000 beds.

45th General, Medical Center, 1 January 1944-

9 June 1945. 1,000/1,500 beds.

66th Station, Dugenta, 3 January-5 June 1944.

250 beds.

103d Station, Naples, 5 January-22 December

1944. 500 beds.

52d Station, Naples, 17 January 1944-3 May

1945. 500 beds.

9th Evacuation (as general, in support of FEC),

Medical Center, 28 January-6 August 1944.

750 beds.

53d Station, Medical Center, 1 February-5 June

1944. 250 beds.

58th Station, Pomigliano Airfield, 3 February5 June 1944. 250 beds.

43d Station, Caserta, 13 February-1 May 1944.

250 beds.

32d Station, Caserta, 15 February 1944-20 July

1945. 500 beds.

73d Station, Caserta, 24 February-15 June 1944.

500 beds.

64th General, Maddaloni, 17 March-18 July

1944. 1,000/1,500 beds.

51st Station, Naples, 13 May-20 September 1944.

250/500 beds.

3d General, San Leucio, 14 May-14 September

1944. 1,000/1,500 beds.

78th Station, Maddaloni, 14 May-31 August 1944.

500 beds.

37th General, Medical Center, 15 May 1944-

10 April 1945. 1,000/1,500 beds.

81st Station, Naples, 16 May-24 September 1944.

500 beds.

27th Evacuation (as station), Maddaloni, 22 May28 July 1944. 750 beds.

300th General, Detachment A, Dugenta, 5 June19 July 1944. 250 beds.

34th Station, Dugenta, 19 July-19 October 1944;

Piana di Caiazzo, 25 October 1944-3 January

1945. 250 beds.

154th Station, Piana di Caiazzo, 3 January-31

August 1945. 150 beds.

21st Station, Naples, 16 April-23 July 1945.

500 beds.

35th Field, 3d Platoon, Aversa, 10 June-1 October 1945. 100 beds.

35th Field, 1st and 2d Platoons, Sparanise, 8

July-17 September 1945. 200/100 beds.

300th General, Detachment A, Caserta, 21 July1 November 1945. 500 beds.

300th General, Detachment B, Aversa, 1 October-1 November 1945.

392d Station, Naples, 1 June 1946-15 January

1947. 200 beds.

Foggia

61st Station (AAFSC, ABC)a, 4 December 1943-

15 November 1945. 500 beds.

55th Station (AAFSC, PBS)b, 13 December 1943-

10 August 1944; 15 November 1945-22 April

1947. 250/100 beds.

Termoli

4th Field, 3d Platoon (AAFSC, ABC), 15 May

1944-24 May 1945. 100 beds.

San Severo

4th Field, 2d and 3d Platoons (AAFSC), 18 January-15 May 1944. 200 beds.

4th Field, 2d Platoon (AAFSC, ABC), 15 May

1944-22 June 1945. 100 beds.

Anzio

59th Evacuation (as station), 7 June-10 July

1944. 750 beds.

Rome

33d General, 21 June-24 September 1944. 1,500

beds.

12th General, 22 June-12 November 1944. 2,000

beds.

6th General, 30 June-22 December 1944. 1,500

beds.

114th Station, 5 July-28 September 1944. 500

beds.

73d Stationc, 5 July 1944-18 June 1945. 500

beds.

34th Stationd, 19 January 1945-9 October 1947.

250/100 beds.

40th Station, 28 April-21 July 1945. 500 beds.

37th General, Detachment A, 21 July-1 October 1945. 500 beds.

Civitavecchia

105th Station, 5 July-13 September 1944. 500

beds.

154th Station, 14 September-17 December 1944.

150 beds.

a

Assigned in place from ABC to PBS, 15 October 1945. b

Air Forces unit during first Foggia period; reassigned to Air Forces about 1 January 1946.

Reorganized as 100-bed unit and reassigned to

PBS, 31 May 1946. c

Assigned Rome Area, MTOUSA, 1 December

1944-25 May 1945. d

Assigned Rome Area, MTOUSA, 25 May 1945.
332 MEDITERRANEAN AND MINOR THEATERS

tients and those in Naples proper treated

civilians when emergency required, an

effort was made to funnel patients from

the French Expeditionary Corps to the

182d and 225th Station Hospitals, where

French-speaking personnel were available. Both of these hospitals were largely

filled with French and French colonial

casualties during January. Many problems arose as a result, particularly at the

225th, where bearded African goumiers

made turbans for themselves out of hospital towels and changed identification

tags with each other in order to exchange

beds.

Late in January the 9th Evacuation

Hospital moved over from Sicily and

opened in the medical center as a general

hospital for French troops, remaining

until the beginning of August when the

unit began staging for southern France.

Liaison personnel from the French Army

were attached to handle discipline, mail,

pay, and other administrative matters,

while French and Arab noncomissioned

officers served as interpreters.

Installations attached to the medical

center by the end of January 1944 included three general and two station

hospitals and an evacuation hospital acting as a general, with an aggregate Table

of Organization strength of 4,750 beds;

the 4th Medical Depot Company; a central dental laboratory; the 15th Medical

General Laboratory, which began operating a blood bank late in February;8

 the

41st Hospital Train; and the 51st Medical Battalion. By this date the center

was fully organized, although the 6744th

Medical Center (Overhead) was not

formally activated until 10 February

1944. Consisting of four officers and 20

enlisted men, the medical center headquarters group was responsible for functions common to all the hospitals in the

area, such as allocation of space, maintenance of roads and utilities, sanitation,

security, transportation, civilian labor,

and recreation. Included among the service units operating under the medical

center organization were a finance disbursing section, an Army post office, a

Quartermaster shower and sterilization

unit, a laundry, a fire-fighting platoon,

a message center, and a telephone switchboard. The center headquarters also controlled the staging area for medical

units. Although it resembled the typical

hospital center in its purposes, the

Naples grouping was less centralized. It

had no commanding officer in the proper

sense of the word. Colonel Jeffress,

former surgeon of the Atlantic Base Section, was responsible for administering

the overhead functions, but the medical

service as such, including the assignment

of patients, was directly under the base

surgeon.9

In addition to the center, there were

4,500 Table of Organization beds elsewhere in Naples by the close of the Winter Line campaign. The 12th General

Hospital and the 32d Station were also

staging at the Mostra Fairgrounds, but

were not in actual operation. Throughout the Italian campaign personnel and

equipment of units in the process of

staging were freely used to augment

facilities of operating hospitals, in accordance with the practice established

early in the North African campaign.

Other PBS Hospitals—When Fifth

Army medical units moved across the

8

 See pp. 352-53, below.

9

 Unit Rpts, 6744th Med Center (Ovhd), 6 Nov

44 and 15 Jun 45.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 333

Volturno to support the Winter Line

campaign, their places in the Caserta

area were taken by fixed hospitals assigned to the base section. The 36th General was the first of these, opening on 3

November in an Italian military hospital

in Caserta. Here, as in Naples, the buildings and the Italian patients hospitalized

in them were unbelievably filthy. At this

time the front lines were so near that

the 36th General took casualties directly

from battalion aid stations. An Italian

hospital at Aversa, six or eight miles

nearer the coast, served to house the

262d Station from 27 November. The

66th Station, a 250-bed unit, opened on

3 January in a prisoner-of-war enclosure

south of Caserta, where it also operated

a venereal disease hospital.

Closest of any fixed hospital to the

front during the Winter Line campaign

was the 74th Station, which opened at

Piana di Caiazzo north of the Volturno

on 7 December. Housed in the stone

buildings of a co-operative farm, with

supplementary tentage, the 74th performed routine station hospital functions

for troops resting and staging in the area.

The primary problem there was kneedeep mud, which required the construction and constant maintenance of access

roads. Two platoons of the 32d Field

Hospital performed similar services for

troops still in the Salerno-Paestum area,

while the remaining platoon served as a

holding hospital for air evacuation at

Pomigliano Airfield northeast of Naples.

Two platoons of the 4th Field shared

the load at Pomigliano until early January, when they were assigned to the Air

Forces.

Virtually all fixed hospitals under control of the Peninsular Base Section were

operating in excess of their Table of

Organization capacities, employing Italian civilians to make up for personnel

shortages.10

Hospitalization for Army Air

Forces in Italy

Following the October 1943 agreement between General Blesse for NATOUSA and Colonel Elvins for the Army

Air Forces, hospital units of various

types were designated to serve the USAAF in Corsica, Sardinia, and Italy.

Those initially scheduled for Italy were

the 26th General, the 55th and 61st Station, and the 4th, 34th, and 35th Field

Hospitals. All were located south of

Naples, and on the Adriatic side of the

peninsula.11

Only the 1st Platoon of the 4th Field

Hospital was able to open at full bed

strength and at the appointed time. This

unit was located at Manduria in the heel

of the Italian boot. Equipment of all the

other Air Forces hospitals was aboard the

Liberty ship Samuel J. Tilden, which

was destroyed in an enemy air attack on

Bari harbor on the night of 2 December.

Replacement equipment for the field

hospitals and for the 250-bed 55th Station Hospital was flown from Palermo

within ten days, but the 500-bed 61st

Station and the 1,000-bed 26th General

had to wait for slower replacement by

water. The 26th General, while it actually opened at Bari on 4 December, did

so with only 100 borrowed beds. Its

10

 See app. A-5. 11

 The chief sources for this section are: (1)

Hist, Twelfth Air Force Med Sec, 1942-44; (8)

Med Hist, Fifteenth Air Force, 1944; (3) Annual

Med Hist, AAFSC MTO, 1944; (4) Link and Coleman, Medical Support of the Army Air Forces in

World War II, pp 455-73; (5) Unit rpts of the individual hosps mentioned in the text.
334 MEDITERRANEAN AND MINOR THEATERS

quarters were the spacious modern

buildings of an Italian military hospital.

The 61st Station, until its own equipment arrived in January, operated an

American ward in a British hospital at

Foggia, using British equipment. The

55th Station opened at Foggia and the

34th Field a few miles southeast, at

Cerignola, on 13 December. The 35th

Field began taking patients at Erchie,

near the site of the 4th, two days later.

The remaining two platoons of the 4th

Field Hospital opened at San Severo,

south of Cerignola, on 18 January.

Originally assigned to the Twelfth Air

Force, these hospitals also served the

Fifteenth Air Force, which was activated

on 1 November 1943 before any of the

medical units were in operation. All

were transferred to the newly created

Army Air Forces Service Command,

Mediterranean Theater of Operations,

early in the new year.

There were some changes in the location of field hospital platoons in February and again in May 1944, but all

remained south of the latitude of Rome,

on the Adriatic side of the peninsula.

The only significant change was the release of the 55th Station Hospital to PBS

on 10 August. This hospital had been

operating near Foggia since December

1943, but the enlargement of the 26th

General Hospital at Bari to 1,500 beds

rendered the 55th Station surplus to Air

Forces needs. All field hospital units and

the 61st Station at Foggia operated on a

30-day policy, with evacuation to the

26th General. The latter installation

operated on a 90-day policy.

Reorganization of Fixed Hospitals

When General Stayer succeeded General Blesse as Surgeon, North African

Theater of Operations, on 1 March 1944,

the theater was already 8,000 beds short

of the authorized ratio of 6.6 percent of

troop strength, with new troops arriving

faster than beds. Stayer's first major

problem, with which Blesse had been

struggling for several months, was that

of substantially increasing the number

of fixed beds in the theater.12

The problem had been under discussion, both in the theater and in Washington, for a considerable time, but the

build-up for OVERLORD precluded the

diversion of either beds or medical personnel to the Mediterranean. It was first

suggested toward the end of 1943 that

the shortage might be overcome by a

more economical use of personnel already in the theater. More or less detailed plans for enlarging certain general

hospitals to 1,500- and 2,000-bed capacity

with personnel released by the inactivation of a few 250-bed station hospitals

were drawn up in The Surgeon General's Office in January 1944. No positive

action was taken, however, until after a

request to increase the bed ratio for the

North African theater to 8.5 percent was

denied in March. By that time the

deficiency had risen to 10,000 beds and

action had become imperative. Tentative Tables of Organization for 2,000-

bed and 1,500-bed general hospitals were

issued on 19 April 1944, and the reorganization went into effect on 5 June.13

12

 (1) Ltr, Gen Blesse to TSG, 6 Feb 44. (2) Ltr,

TSG to Gen Stayer, 18 Apr 44. 13

 (1) Pers Ltr, Col A. B. Welsh, Dir, Plans Div,

SGO, to Blesse, 23 Jan 44. (2) Pers Ltr, TSG to

Stayer, 18 Apr 44. (3) Cables, Devers to AGWAR,

14 Jan 44; Marshall to Devers, 20 Jan 1944; Devers

to WD, 23, 26 Mar 44; Marshall to Devers, 7 Apr

44; Devers to WD, 24 May 44. (4) Smith, Hospitalization and Evacuation, Zone of Interior, p, 226.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 335

Six 250-bed station hospitals—the 43d,

53d, 58th, and 66th in Italy; and the

64th and 151st in North Africa—were

inactivated. Five general hospitals—the

12th, 21st, 23d, 36th, and 300th, all in

Italy—were expanded from 1,000 to

2,000 beds; and the remaining twelve

general hospitals in the theater were expanded from 1,000 to 1,500 beds. Each

of the new 2,000-bed units absorbed the

personnel and equipment of one of the

inactivated hospitals, with suitable transfers and readjustments to bring all the

enlarged units into line with the new

Tables of Organization, which were

somewhat modified in July. The completed reorganization added 9,500 T/O

fixed beds to the theater total. General

hospitals in Italy began enlarging their

facilities by new construction, by conversion of additional building space, or by

erection of tentage a month or more

before the reorganization went into effect. The 21st, 23d, 36th, and 300th

General Hospitals, for example, had already expanded to 3,000 beds each by

31 May, or 50 percent above their new

Table of Organization capacities.14

Aside from this general reorganization, a few minor changes were made to

bring hospital facilities into line with

needs. The 60th Station Hospital at

Cagliari, Sardinia, was formally increased

from 250 to 500 beds, confirming the

actual operating status of the installation. The 51st Station, which had been

functioning as a neuropsychiatric hospital, was also confirmed as a 500-bed unit

in July. The 79th Station Hospital,

which was no longer needed in Algiers

after the decision to transfer Allied

Force Headquarters to Italy, was inactivated on 30 June, and its personnel and

equipment were absorbed by other

units. The provisional hospital at Marrakech, Morocco, which had been operated primarily by personnel of the 56th

Station at Casablanca since May 1943,

was reorganized as the 370th Station

Hospital, with a Table-of-Organization

strength of 25 beds.

Expansion of the Peninsular

Base Section

Throughout the Anzio Campaign, the

stalemate before Cassino, and the drive

to Rome, the build-up of fixed hospitals

in the Naples and Caserta areas continued. In February 1944 the 250-bed

53d and 58th Station Hospitals set up

in Naples, where the former took over

operation of the venereal disease hospital in the medical center from detached

personnel of the 12th General, the latter

operating the air evacuation holding hospital at Pomigliano Airfield. At the same

time the 32d, 43d, and 73d Station Hospitals—the 43d of 250 beds, the others of

500—moved into the Caserta area, where

they were followed by the 64th General

in March. All of these hospitals were

brought over from North Africa.

There were no new arrivals in April,

but the opening of the drive to Rome

brought a new contingent in May. The

37th General moved into the medical

center, while the 51st and 81st Stations

set up outside the center in Naples

proper. The 51st Station was designated

the neuropsychiatric hospital for the

Naples area. The 81st took casualties

from the French Expeditionary Corps.

14

 (1) Annual Rpt, Med Sec, MTOUSA, 1944,

an. B. (2) Med Sit reps, PBS, 31 May 44. (3) Annual Rpts, 1944, of the individual Hosps concerned.
336 MEDITERRANEAN AND MINOR THEATERS

The 3d General and the 78th Station

moved into the Caserta area. Before the

end of the month the 750-bed 27th Evacuation Hospital, a new arrival from the

zone of interior tabbed for an ultimate

role with Seventh Army in France, was

established at Maddaloni to act as a

general hospital for French and French

colonial troops. The unit was soon operating 1,500 beds.

During the periods of heavy pressure—in February and March in connection with the Anzio Campaign, and in

May during the assault on the Gustav

Line—most of the hospitals in the base

section operated at approximately twice

their Table of Organization capacities,

with station hospitals often acting as generals. Prefabricated buildings and tents

were usually used for expansion where

the buildings occupied were inadequate.

Additional personnel were obtained by

hiring Italian civilians and by drawing

upon hospital ship platoons, other hospitals staging in the area or awaiting assignment, and medical battalions. The

164th and 161st Medical Battalions, both

Seventh Army units, served PBS in

various capacities from late May until

their release in mid-July to train with

the invasion forces. The 70th Station at

Naples and the 74th at Piana di Caiazzo,

near Caserta, performed normal station

hospital functions for troops in their

respective areas. The 70th also handled

all hospitalization for the Women's

Army Corps until May. The 182d Station in the medical center was designated in July for Brazilian personnel,

who were staging in the area. Brazilian

medical officers, nurses, and enlisted

Wardmen were attached.

In the reorganization of June, the 23d

General Hospital absorbed the 53d Station, taking over the venereal disease

hospital and the disciplinary wards. The

21st General absorbed the 58th Station,

including operation of the Pomigliano

Airfield holding hospital, and the 300th

General took over personnel and equipment of the 66th Station. The 300th continued to operate the prisoner-of-war

hospital at Dugenta, which had been the

responsibility of the 66th since January.

The POW hospital was later turned over

to the 34th Station, which arrived from

Palermo in July. The 43d Station was

merged with the 36th General, which

closed at Caserta in July, releasing its

quarters for occupancy by elements of

theater headquarters, including the SOS

medical section. Pending reassignment,

personnel of the 36th were put on detached service with other hospitals in the

medical center.

The general forward movement of

PBS installations began in June. The

59th Evacuation, brought over from

Sicily, acted as a station hospital at Anzio

between 7 June and 10 July, handling

1,825 admissions in that period. The

59th then served for another two weeks

at Battipaglia, where Seventh Army was

in training for the invasion of southern

France. The 6th, 12th, and 33d General

Hospitals all opened in Rome before the

end of June and were joined there on 5

July by the 73d and 114th Stations. All

of these units came direct from Africa

except the 73d, which had been operating at Caserta, and the 12th General,

which had been inactive in Naples for

six months while its personnel served on

detached duty with other hospitals. The

previously organized Rome Area Command—Rome Allied Area Command

after 1 July 1944—had supervision over

the health of the city, but the U.S. hospi-
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 337

tals remained under the jurisdiction of

the Peninsular Base Section.15

The 12th General Hospital, now a

2,000-bed unit, had absorbed the personnel and equipment of the 151st Station,

brought over from Africa for the merger.

Like those in Naples and Caserta, all of

the fixed hospitals moving into the Rome

area were sited in permanent buildings.

The 6th General occupied the Institute

of the Good Shepherd, where the 56th

and 94th Evacuation Hospitals had already done the necessary renovation.16

The 33d General and the 114th Station,

the latter designated as neuropsychiatric

hospital for the Rome area, were also in

Italian hospital plants, while the 12th

General and the 73d Station occupied

Italian military structures. The 7th

Medical Depot Company accompanied

the fixed hospitals into Rome.

Movement north of Rome was almost

simultaneous with the establishment of

hospitals in the Italian capital. The

105th Station Hospital opened at Civitavecchia on 5 July; and the 50th, one of

the few 250-bed station hospitals remaining in the theater, opened at Castagneto,

on the coast a few miles north of

Piombino, on 20 July. The unit was so

close to the front for several days that it

took patients direct from the clearing

stations, thus functioning in effect as an

evacuation hospital.

The 24th General Hospital from

the Eastern Base Section in North Africa

went into bivouac in Rome on 20 June,

its personnel serving on detached service

with other hospitals for a month. On 21

July the 24th General opened as a 1,500-

bed unit at Grosseto, in the buildings of

a tuberculosis sanatorium previously occupied by the 15th Evacuation Hospital.

At the end of the month the 64th General Hospital moved from Caserta to

Leghorn, where it opened in a former

Fascist paratroop school adjacent to the

16th Evacuation Hospital in the suburb

of Ardenza. The 55th Station, released

at Foggia by the Air Forces, was attached

to the 64th General early in August and

was established at the same Ardenza

site. Leghorn was still within range of

German guns when the 64th General began taking patients in that city.

As of 15 August 1944, PBS had 28,900

T/O beds in operation, of which 15,000

were in Naples—8,000 in the medical

center—6,000 were in Rome, and 4,000

were north of Rome. Between 14 October 1943, when the first fixed hospital

opened in Naples, and the end of August

1944, PBS hospitals admitted 282,000

patients and returned 214,000 of them

to military duty. (Tables 17, 18)

Decline of North African

and Island Bases

As the center of activity in the Mediterranean moved up the Italian peninsula, North Africa decreased in importance as a communications zone. The

expansion of the Peninsular Base Section

was accomplished largely by stripping

the African base sections of hospital facilities. As of 15 August 1944, the Eastern

Base Section was left with only one 250-

bed station hospital, the 54th at Tunis.

The Mediterranean Base Section retained 3,000 beds, 2,500 of them in the

hospital groupment at Assi Bou Nif,

where the 70th General and the 23d and

69th Station Hospitals were still located.

The others were the 250-bed 57th Station near Constantine and the 250-bed

15

 Annual Rpt, Surg, Rome Area Comd, 1944. 16

 See p. 304, above.
338 MEDITERRANEAN AND MINOR THEATERS

TABLE 17—ADMISSIONS TO PBS HOSPITALS, 14 OCTOBER 1943-31 AUGUST 1944

Source: Annual Rpt, Surg, PBS, 1943, 1944.

TABLE 18—DISPOSITION OF PATIENTS IN PBS HOSPITALS, 14 OCTOBER 1943-31 AUGUST 1944

Source: Annual Rpt, Surg, PBS, 1943, 1944.

29th Station at Algiers. The Atlantic

Base Section retained 275 beds, 250 in

the 56th Station Hospital at Casablanca,

and 25 in the 370th Station serving primarily Air Forces units at Marrakech.

The total number of U.S. Army Table

of Organization beds in all of North

Africa was thus only 3,525.

Hospitals in MBS still held a few

long-term patients from Italy, but for

the most part the function of the fixed

hospitals in Africa after June 1944 was

that of hospitalizing military personnel

still in the area. In addition, these hospitals cared for transient French patients

en route from Italy to French hospitals
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 339

in Africa and for U.S. patients en route

to the zone of interior. Those principally

served were Air Forces and naval personnel and service troops in the vicinity of

Oran.

The Island Base Section in Sicily was

closed out on 1 July 1944. At that date,

600 beds remained under the control of

the Allied garrison on Sardinia, and

1,550 were charged to the Northern Base

Section on Corsica.

Hospitalization of Prisoners

of War

The one exception to the contraction

of medical facilities in North Africa was

installations for the care of prisoners of

war. Until the Arno River line was

stabilized, the bulk of the prisoners

taken in Italy were transferred to enclosures in North Africa. These were

gradually concentrated in the Mediterranean Base Section in the vicinity of

Oran.17

So far as Italian prisoners were concerned, the problem became less and less

important as time went on. With Italy

enjoying a cobelligerent status, few new

prisoners were taken. Those held over

from the Tunisia Campaign and from

operations in Sicily were organized into

service units of various types, scattered

throughout numerous camps and enclosures. The bulk of them, estimated as

about 70,000, were concentrated near

the centers of Army service activities,

which remained in Oran, and in Algiers

until the removal of AFHQ in July. By

that date the 7029th Station Hospital

(Italian), in prisoner of war Enclosure

129 at Ste. Barbe-dú-Tlelat near Oran,

was able to care for most of the Italian

prisoner patients. The 43d and 46th

General Hospitals in the nearby Assi

Bou Nif groupment had taken malaria

cases from the prison camp until the

departure of those units in June and

July, respectively. The 250-bed 7550th

Station Hospital (Italian), which had

been activated in EBS in March 1944,

was moved to POW Enclosure 129 at the

end of May but was never re-established

as an active unit. The 7393d Station

Hospital (Italian) continued for a time

to operate 25 beds in conjunction with

the 56th Station Hospital at Casablanca.

On the other hand, the German prisoner of war hospital in POW Enclosure

131, also at Ste. Barbe-du-Tlélat, expanded rapidly as the fortunes of war

brought a steady stream of German

prisoners into Allied hands. Originally

set up late in 1943 as a 500-bed unit,

the hospital was caring for more than

2,000 patients by July 1944. The limits

were fixed by the availability of German

medical personnel, who were never

taken in large enough numbers to care

for all of their own wounded.

The most important prisoner of war

enclosure in Italy during the early part

of 1944 was Number 326 at Dugenta in

the Caserta area. In January the 66th

Station Hospital was established in the

enclosure. Shortly after the 66th was

absorbed by the 300th General Hospital,

the 34th Station took over the task of

caring for sick and wounded German

17

 This section is based primarily on the following documents: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Hist of 7029th Station Hosp

(Italian), 27 Jul 45; (3) Annual Rpt, Med Sec,

2686th POW Administrative Co (Ovhd), 1944;

(4) Ltr, Col A. J. Vadala to Surg, NATOUSA, 29

May 44, Sub: Adequacy of Med Serv for Italian

POW's in MBS; (5) Ltr, Col Shook, Surg, SOS

NATOUSA, to Surg, NATOUSA, 3 Jun 44, Sub:

Rpts on Med Serv in Italian POW Camps; (6)

Annual Rpt, 34th Station Hosp, 1944.
340 MEDITERRANEAN AND MINOR THEATERS

prisoners in the Dugenta camp. The

hospital—a former Italian disciplinary barracks—consisted of cottage-type

buildings, prefabricated structures, and

ward tents, the whole complex being

surrounded by a high brick wall with

sentry towers. The 34th inherited from

the 66th both civilian workers and German medical corpsmen. During the

Rome-Arno and Southern France Campaigns, the hospital census fluctuated between 300 and 500 daily, with 90 to 98

percent of the cases surgical. Evacuation

was to the prisoner of war stockade or to

the zone of interior. The repatriation of

the incapacitated and long-term hospital

cases on an exchange basis began in

May.18

The 6619th Prisoner of War Administrative Company was in charge of prisoner of war Enclosure 326 until 11 August 1944, when it was relieved by the

2686th POW Administrative Company,

brought over from Africa. These POW

administrative companies each had a

small medical section that supervised

infirmary service by protected personnel

in the camp.

With the breakthrough of the Gustav

Line, the capture of Rome, and the battle of pursuit to the Arno, the number of

German prisoners taken increased substantially, and additional hospitals were

designated to share the load with the

Oran and Dugenta facilities. The 78th

Station Hospital at Maddaloni took

prisoners from its opening in mid-May,

and by June was almost exclusively a

prisoner of war hospital. POW admissions were in the neighborhood of

700 a month, the bulk of them surgical.

When the 78th Station closed to admissions late in August, the 262d Station at

Aversa became a POW hospital, admitting more than 1,100 German prisoners

in the last ten days of the month.19 Fixed

hospitals in Rome and north of that city

took prisoner patients along with U.S.

and Allied casualties as they were

brought in.

From less than 2,000 prisoners of war

in hospitals under U.S. control at the end

of January 1944, the census climbed to a

peak for the year of 5,288 at the end of

August. More than 1,600 of these were

in PBS hospitals.20

Evacuation

Fixed hospitals in the Peninsular Base

Section operated throughout the period

of the Volturno and Winter Line campaigns on a 30-day evacuation policy, all

patients with longer hospital expectancy

being sent to North Africa by sea or air

as soon as they were transportable. Bed

status in PBS hospitals, and the number

of patients awaiting evacuation, were

reported daily by telegraph to the Surgeon, NATOUSA, who requested the

Chief of Transportation, AFHQ, to provide hospital ships. Air evacuation continued to be controlled by the theater

air surgeon, but close liaison with the

base section was maintained. Patients to

be evacuated were classified in PBS, so

that those requiring special treatment

18

 (1) Undated British doc, signed H. W., Sub:

Exchange of Allied and German Sick and Wounded

POW's for Repatriation, Col Standlee's copy. (2)

Memo, Maj Gen F. C. Beaumont-Nesbitt, Chief,

Liaison Sec, AFHQ, to CofS, French Ground

Forces, 3 Jun 44.

19

 (1) Med Sitreps, PBS, May-Aug 44. (2) ETMD's 78th Station Hosp, May-Jul 44. (3) ETMD,

262d Sta Hosp, Aug 44. (4) Annual Rpts, 78th

and 262d Sta Hosp, 1944. 20

 (1) Annual Rpt, Med Sec, MTOUSA, 1944, an.

B, app. 17. (2) Med Sitrep, PBS, 16-31 Aug 44.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 341

PLACING GERMAN POW's ABOARD THE SWEDISH EXCHANGE SHIP GRIPSHOLM for

repatriation. These cases have a long hospital expectancy.

could be routed promptly to the hospital

best equipped to handle the case.21

After the activation of PBS, only one

U.S. hospital ship, Shamrock, was available for evacuation from Italy to Africa

for the rest of the year, but occasional

lifts were obtained from British vessels.

Since air evacuation was exclusively to

the Tunis-Bizerte area, hospital ships

were routed to Oran. The port of embarkation was the Paestum beaches until

8 October, the port of Salerno between

8 and 25 October, and thereafter the port

of Naples. Two other U.S. hospital ships

in the Mediterranean, Acadia and

Seminole, were used during the period

primarily for evacuation from North

Africa to the zone of interior.

Air evacuation from the Naples area

was handled by the 802d Medical Air

21

 Principal sources for this section are the following: (1) Annual Rpt, Med Sec, NATOUSA,

1943; (2) Annual Rpt, Med Sec, MTOUSA, 1944;

(3) Annual Rpts, Surg, PBS, 1943, 1944; (4) Med

Hist, 802d MAETS, 1942-44; (5) Med Hist, 807th

MAETS, 1944; (6) ETMD's for Oct 43 through

Aug 1944.
342 MEDITERRANEAN AND MINOR THEATERS

Evacuation Transport Squadron, with

the 807th MAETS evacuating from

Foggia, Bari, and more southerly fields.

The latter unit evacuated for the most

part personnel of the British Eighth

Army, with a sprinkling of U.S. Air

Forces casualties. Routes from Naples

differed with the time of day, some

flights going direct to North Africa,

others making an overnight stop at

Palermo in Sicily.

During the period between 2 January,

when orders were issued for the Anzio

landings, and 22 January when the assault troops went ashore, a determined

effort was made to evacuate as many

patients as possible from the Naples area

to provide beds for the new operation.

Two British hospital ships and two British personnel carriers were diverted to

assist with the evacuation.22 Between 9

September, when the Salerno landings

took place, and 21 January, the eve of the

Anzio landings, a total of 19,048 patients

had been evacuated from Italy by air

and 13,017 by water, or 32,065 in all.

(Table 19) After the middle of October,

most of these patients cleared through

fixed hospitals assigned to PBS.

For the first six months of 1944, longterm patients continued to be evacuated

from Italy to North Africa. By the end

of June, however, the build-up of facilities in the Peninsular Base Section at

the expense of the declining North

African bases had proceeded so far as to

permit retention of all U.S. patients in

Italy on a 90-day policy, which was extended to 120 days after 15 August. As

long as French troops remained in Italy,

French patients requiring more than 30

days hospitalization were sent to the 9th

Evacuation Hospital or were evacuated

to French hospitals in Africa.

 23

Air evacuation from Italy to Africa

was discontinued, except for Air Forces

personnel, with the arrival of additional

hospital ships in April. (Table 20) Air

evacuation from Sicily ceased entirely

with the closing out of the Island Base

Section in July. After the middle of that

month, evacuation from Corsica and

Sardinia was directed to Naples rather

than to Oran.

Within PBS itself, patients were

shifted as required from one hospital to

another, primarily to secure the advantages of specialization, but also on occasion to relieve congestion. After the

terminus of air evacuation from the

Fifth Army hospitals shifted from

Naples to Rome, patients were moved

periodically from the latter city back to

Naples to keep from overcrowding the

facilities nearer to the front. The 41st

and 42d Hospital Trains, which were

already in the theater, and the 66th

Hospital Train, brought over from

North Africa late in June, made regular

runs between the two cities during July

and early August.

Direct evacuation to the zone of interior by hospital ship from Naples began in April 1944. At the same time

restrictions on the use of unescorted

transports for evacuation from inside

the Mediterranean were lifted, and these

vessels began loading ZI patients at Oran

as well as at Casablanca. Medical care on

22

 Surg, NATOUSA, Journal, 22 Jan 44.

23

 Recorded Interv, ASD Berry, 4 Nov 58, commenting on preliminary draft of this volume. Dr.

Berry was chief of the Surgical Service, 9th Evacuation Hospital, during the Naples period. According to French officials, there were thirty available

French hospitals in North Africa, with an aggregate capacity of 20,000 beds. Surg, NATOUSA,

Journal, 16 Aug 43.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 343

TABLE 19—EVACUATION FROM ITALY TO NORTH AFRICA

9 SEPTEMBER 1943—21 JANUARY 1944

Source: Hq, ETOUSA, Rpt on PBS, 10 Feb 44, sec. VI, app. B.

transports was provided by hospital ship

platoons. Air evacuation to the zone of

interior began on a regularly scheduled

basis from Casablanca on 3 July and

from Naples on 19 July. The Naples

flights were broken by stops at Oran and

Casablanca.24

By 1 June seven U.S. Army hospital

ships and one Navy hospital ship were

available for evacuation to the zone of

interior, permitting a rapid clearing out

of the remaining North African hospitals in preparation for severe contraction

in that area. Every effort was also made

to reduce the patient load in Italy before

the invasion of southern France, scheduled for 15 August. (Table 21)

Medical Supplies

and Equipment

Theater Medical Supply

Organization for Medical Supply—Although the reorganization of the theater

24

 Hist, Med Sec, Hq, COMZ NATOUSA, FebOct 44.
344 MEDITERRANEAN AND MINOR THEATERS

TABLE 20—EVACUATION FROM ITALY TO NORTH AFRICA, JANUARY-AUGUST 1944

a

 Includes Air Forces personnel.

Source: Annual Rpt, Med Sec, MTOUSA, 1944, an. B, app. 20.

TABLE 21—EVACUATION FROM THE MEDITERRANEAN TO THE ZONE OF INTERIOR

JANUARY-AUGUST 1944

Source: Annual Rpt, Med Sec, MTOUSA, 1944, an. B, app. 21, 22.

putting all operating functions of the

Medical Department within the communications zone under the Medical Section, SOS NATOUSA, was effective on

24 February 1944, it was May before the

supply branch of that headquarters obtained sufficient personnel to properly

carry out its assigned mission. Supply

personnel in the field units were also

inadequate for the type of organization

in effect. The conversion of the medical

supply depots in the theater into medical

depot companies in December 1943 had

resulted in an aggregate loss of 260 men

in the four depot companies assigned to

NATOUSA, while a second reorganiza-
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 345

41ST HOSPITAL TRAIN LOADING NEAR RIARDO FOR RUN TO NAPLES, FEBRUARY 1944

tion late in June 1944 further reduced

personnel by 112.25

In order to make more efficient use of

the remaining supply officers and enlisted men, a new plan of organization

was worked out as early as March 1944,

whereby the 2d and 4th Medical Depot

Companies would be inactivated and

medical composite battalions substituted

for them. This plan was proposed to the

War Department by the SOS surgeon on

24 May, but approval was not received

until 15 July. In the meantime, under

direct orders, the two depot companies

concerned, together with the 7th and

12th Medical Depot Companies, had

gone through the June reorganization,

and more personnel had been lost.

The latter two companies were left

unchanged, but the 2d Medical Depot

Company, with headquarters at Oran,

was inactivated on 13 August. From the

personnel thus released, the 231st Medical Composite Battalion was organized

under TOE 8-500, with the 70th and

71st Medical Base Depot Companies

(TOE 8-187) as components. The battalion was then assigned to the southern

France operation, and the 60th Medical

Base Depot Company, which had been

organized a few weeks earlier, took over

25

 Sources for this section are: (1) Annual Rpt,

Surg, MTOUSA, 1944, an. K; (2) Hist, Med Sec,

Hq, COMZ NATOUSA; (3) Unit rpts of the med

supply organizations mentioned in the text. (4)

Davidson, Med Supply in MTOUSA, pp. 84-107.
346 MEDITERRANEAN AND MINOR THEATERS

the NATOUSA functions previously

performed by the larger organization.

The 48th Medical Depot Company,

based in Naples, was similarly inactivated on 15 August, being supplanted by

the 232d Medical Composite Battalion

with the 72d and 73d Medical Base

Depot Companies as components. Personnel released from the 7th and 12th

Medical Depot Companies in the June

reorganization were absorbed by the two

composite battalions.26

In addition to providing greater flexibility, the new arrangement was designed to handle more effectively such

problems as maintenance and repair,

and was able to make fuller use of the

Italian service companies as substitutes

for larger personnel allotments. The

greatest economy and efficiency in the

use of personnel was essential since

the 7th Medical Depot Company, like

the 231st Medical Composite Battalion,

was assigned to the assault force for the

invasion of southern France, while the

12th Medical Depot Company remained

a Fifth Army unit. The theater was thus

left with only the two medical base depot companies of the 232d Medical Composite Battalion and the 60th Medical

Base Depot Company at Oran to carry

out all supply activities at the theater

and base section levels.

Operation of the Supply System—

Medical supplies were obtained in the

North African Theater of Operations by

direct monthly requisitions on the zone

of interior. These requisitions reflected

anticipated needs three months hence,

in terms of expected troop strength. Supply and requirements were computed

from base section inventory records,

items still due on previous requisitions,

shipping time, and a replacement factor

estimated in terms of probable use between the date of inventory and the

date of delivery. The supply objective

remained a 30-day operating level plus

a 45-day reserve level.27

In cases of urgent need supplies were

sent by air, but for the most part they

were delivered by the convoys, which

reached the theater three times a month.

The system entailed various difficulties.

Ports of discharge were not always able

to handle an entire convoy, and some

vessels might be diverted to another port.

The port of discharge, moreover, was

determined by the service receiving the

larger part of the cargo, which was seldom the Medical Department. Thus

requisitions had to take into account a

possible loss of time in transshipment.

Another difficulty lay in the computation of replacement needs. Replacement factors had been under study, both

in the theater and in Washington, since

October 1943. In March 1944, revised

replacement factors were sent out by

the War Department, differing in many

respects from those previously in use.

Equipment items, except for unit assemblies, had previously been calculated as

a percentage of the amount in use, but

were now to be estimated on the basis

of troop strength, in the same manner

as expendable items. Careful comparison

26

 The new medical base depot companies organ- in the theater revealed that neither new

ized under TOE 8-187 had only about one-third

as many personnel as the old medical depot companies (TOE 8-667). It was thus possible to complete the reorganization without calling upon the

ZI for additional personnel.

27

 This section is based on: (1) Annual Rpt,

Med Sec, MTOUSA, 1944, an. K; (2) Hist, Med

Sec, Hq, COMZ NATOUSA; (3) Davidson, Med

Supply in MTOUSA, pp. 84-107.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 347

nor old replacement factors agreed with

theater experience. With the concurrence of the War Department, the consumption records of the Mediterranean

supply services were applied as modifying factors while the whole problem was

subjected to further study. Maj. Frank

C. J. Fiala, was assigned by Washington

to the Supply Branch, Medical Section,

SOS NATOUSA, on 23 May, along with

three specially trained enlisted men, to

carry out these studies.

A detailed system of stock control and

stock record forms was devised for the

purpose of keeping accurate track of

theater inventories, disbursements, receipts, and supplies on order and of the

distribution of medical supplies among

the base sections. Information for medical supply officers was included in a

series of technical bulletins initiated by

the SOS medical section in January 1944.

In addition to supplying the base sections, depots, and Air Forces service commands, and directing interbase transfers,

the supply branch of the SOS medical

section also screened all requisitions

originating in the Allied Control Commission (ACC), filling them from theater stocks wherever possible. After May

1944 requisitions of the Joint French Rearmament Committee were similarly

screened. The supply branch served as

the official channel for ordering matériel

from the zone of interior on behalf of

both of these agencies.

The problem of maintenance and

repair was particularly acute in the Mediterranean, because of a general shortage of properly trained personnel. The

TOE under which the field units were

reorganized in December 1943 contemplated only third and fourth echelon repair. Equipment needing more extensive

overhauling was sent back to the ZI,

and was usually lost to the theater. The

medical composite battalions set up in

August, however, included fifth echelon

repair units. In addition to the repair

and maintenance sections maintained at

all depots, traveling maintenance teams

began visiting hospitals and other medical installations, making on-the-spot repairs and instructing personnel in

preventive maintenance.

Medical Supply in the Base Sections

By the beginning of 1944, medical

supply for the communications zone was

concentrated in two major depots. The

2d Medical Depot Company at Oran

served North Africa and the Mediterranean islands, while the 4th Medical Depot Company at Naples supplied

the Italian mainland. Both depots requisitioned on the zone of interior until

January 1944, when the Medical Section,

SOS NATOUSA, took over that responsibility and both received ZI shipments direct.28

The North African base sections were

already in process of contraction when

the Services of Supply assumed control

over them on 24 February 1944. The

Atlantic Base Section had been without a regular supply depot since the fall

of 1943, the function being performed

incidentally by the 6th General Hospital.

When that installation closed station

on 16 May 1944, the supply function

passed to the 56th Station Hospital and

was discontinued altogether on 1 Sep28

 Sources for this section are: (1) Annual Rpt,

Med Sec, MTOUSA, 1944, an. K; (2) Hist, Med

Sec, Hq, COMZ NATOUSA. (3) Unit rpts of the

various base secs and other med organizations

mentioned in the text. (4) Davidson, Med Supply

in MTOUSA, pp. 84-107.
348 MEDITERRANEAN AND MINOR THEATERS

MEDICAL SUPPLIES STORED IN AMPHITHEATER, NAPLES MEDICAL CENTER

tember. Thereafter medical units at

Casablanca and Marrakech requisitioned supplies from the Mediterranean

Base Section.

In the Eastern Base Section, the 7th

Medical Depot Company closed at Mateur on 12 May, transferring 1,600 tons

of medical supplies to the Naples depot

for PBS. After that date the 54th Station

Hospital at Tunis maintained the only

issue point in EBS. The medical supply

section of the 6671st General Depot at

Algiers also closed on 12 May, turning

over the medical supply responsibility

to the 29th Station Hospital. On 7 August MBS assumed direct control of

supply as well as other medical services

for the Center District, which passed

out of existence at that time.

In Sicily, personnel of the 2d Medical Depot Company operating the Island

Base Section supply depot at Palermo
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 349

were transferred to Headquarters, IBS,

on 10 February 1944. A provisional

medical supply depot company was activated in April, being reorganized late

in May as the 684th Quartermaster Base

Depot Company. A supply depot for

the Northern Base Section on Corsica

was set up at Ajaccio on 1 March by

personnel of the 7th Medical Depot

Company, which established a subdepot

at Cervione in May. The following

month, the NORBS supply organization

was assigned to the 684th Quartermaster

Depot Company, which was itself transferred to PBS control when the Island

Base Section was inactivated in July.

The two Corsican depots were combined

at Cervione in September.

In Italy, in addition to the Peninsular Base Section installations, an Adriatic Depot was formed in October 1943

to serve Air Forces and supporting

troops in the Foggia-Bari area. The

medical section, located at Bari, was confined to supply activities, using overstrength personnel of the 4th Medical

Depot Company until 20 March 1944.

On that date the Medical Section, Army

Air Forces Service Command, Mediterranean Theater of Operations, took direct responsibility for the medical supply

activities of the depot, under general

supervision of the Medical Section, SOS

NATOUSA. With rising air strength

and increasing air activity, the medical

section of the Adriatic Depot was enlarged and for the first time was placed

under its own surgeon about 1 July.

At the same time the AAFSC MTO

was authorized to deal directly with the

zone of interior in matters of medical

supply peculiar to the Air Forces instead

of going through SOS NATOUSA. By

the close of the Rome-Arno Campaign

the medical section of the Adriatic Depot was performing the functions of a

medical base depot company.29

In the Peninsular Base Section proper,

the 4th Medical Depot Company, at the

medical center on the Mostra Fair

Grounds, had responsibility for all medical supplies until June 1944, when the

7th Medical Depot Company arrived

from EBS to share the load. The 7th

operated depots successively at Anzio,

Rome, and Civitavecchia between 11

June and 1 July. The Rome depot was

turned over to the 12th General Hospital for administration, and the Civitavecchia dump was transferred to control

of the 4th Medical Depot Company.

On 1 July the 7th Medical Depot Company was relieved of assignment to PBS

before being attached to Seventh Army.

The 4th Medical Depot Company, after

a week in Civitavecchia, set up a second

forward base at Piombino. By the middle of July, all medical supply installations between Naples and the Volturno

had been centered in the main supply

base on the fairgrounds, and all other

depots south of Civitavecchia had been

eliminated.

Thus, coincident with the movement

of AFHQ to Caserta, the whole supply

system for the theater was revised. The

Mediterranean Base Section was made

responsible for all medical supply in

North Africa, the Atlantic and Eastern

Base Sections were left without stocks,

and the Island Base Section was closed.

Surplus stocks in MBS were used for

mounting the invasion of southern

France, while the Peninsular Base Section took over support of the Adriatic

29

 (1) Annual Med Hist, AAFSC MTO, 1944. (2)

MS, Hist of the Adriatic Depot, OCMH files.
350 MEDITERRANEAN AND MINOR THEATERS

Depot, the Northern Base Section, and

the Allied garrison on Sardinia.

In the reorganization of 15 August,

Headquarters, 232d Medical Composite

Battalion, and the 72d Medical Base

Depot Company remained in Naples.

The detachments at Piombino and

Civitavecchia were combined at the

Piombino site and redesignated the 73d

Medical Base Depot Company. An advance group of this company departed

for Leghorn on 23 August to locate

quarters for what would eventually be

the major medical supply base for the

theater.

Professional Services

Professional services in the Italian

communications zone continued to maintain the high standards of performance

established in North Africa, unaffected

by changes in organization or command.

Medicine and Surgery

At the theater level, medical aspects

of the medical and surgical services continued to be guided and supervised by

the consultants. Both Colonel Long,

Medical Consultant, and Colonel

Churchill, Surgical Consultant, made

frequent inspection tours of base installations and combat medical units, recommending changes in procedure and

personnel wherever such changes were

considered desirable.30

Medical Service—The medical problems of the Italian communications zone

were primarily extensions of problems

discussed in connection with combat

activities. Infectious hepatitis was intensively studied at the 15th Medical General Laboratory in Naples.31

 The treatment of neuropsychiatric disorders was

centered increasingly in the forward

echelons, under general direction of the

theater consultant in neuropsychiatry,

Colonel Hanson, but specialized neuropsychiatric hospitals continued to be

maintained in the Peninsular Base Section to give the best possible care to

patients whose cure could not be effected

closer to the front. These were the 51st

Station Hospital, which opened in Naples in May 1944, and the 114th Station

Hospital, which moved from North Africa to Rome early in July. Psychiatrists

were also assigned to certain other station and general hospitals on temporary

duty to care for cases that for one reason

or another could not be sent to the specialized facilities. Other troublesome

diseases, such as trench foot, malaria,

and venereal infections were dealt with

at the communications zone level primarily as problems in preventive

medicine.

The only special problem worthy of

note for the medical service arose as a

result of the enemy bombing of Bari

harbor on the night of 2 December 1943.

One of the vessels destroyed had carried

a quantity of mustard gas, and undetermined amounts of the gas were held in

solution in oil that was floating on the

water. Of the more than 800 casualties

hospitalized after the raid, 628 suffered

30

 This section is primarily based on: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual

Rpt, Surg, PBS, 1944; (3) Annual rpts of individual med units in the theater; (4) Col. Edward D.

Churchill, "Surgical Management of Wounded in

Mediterranean Theater at the Time of the Fall of

Rome," Bulletin, U.S. Army Medical Department,

V, (January 1945), 58-65. 31

 ETMD for Aug 44.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 351

from mustard gas exposure. Sixty-nine

deaths were attributed in whole or in

part to this cause.32

Medical officers and aidmen treating

the casualties were unaware of the presence of the gas, which was diluted sufficiently to be undetected by odor. In

the belief that casualties covered with

oil but showing no physical damage were

suffering from exposure and immersion,

they were wrapped in blankets, still in

their oil-soaked clothing, given hot tea,

and left as they were for twelve to

twenty-four hours while the more urgent

blast injuries and surgical cases were

treated.

Those with the energy and will to

clean the oil from their own bodies

suffered no serious damage, but the remainder suffered varying degrees of mustard burns. Eyes began to burn about 6

hours after exposure, and were so badly

swollen in 24 hours that many of the

patients thought themselves blind. The

first death occurred without warning 18

hours after exposure.

About 90 percent of the gas casualties

were American, the bulk of them merchant seamen. Since no U.S. hospital

facilities were yet available in Bari—it

will be remembered that equipment for

all but one of the U.S. hospitals scheduled for the area was destroyed in the

bombing—casualties were hospitalized in

British installations.33

Surgical Service—One of the more important advances in surgical management during the first year of the Italian

campaign was the development of reparative surgery in the base hospitals.

The concept of wound surgery as it

developed at this time divided procedures into three phases. The first phase,

performed in field or evacuation hospitals in the army area, included all procedures necessary to save life and limb.

The second phase, called reparative surgery, took place in the general hospitals

of the communications zone. The third

phase, more properly called reconstructive or rehabilitative surgery, took place

in the zone of interior and was designed

to correct or minimize deformities and

disabilities. The techniques and limits of

initial surgery in the army and even the

division area were well established early

in the Italian campaign, but there was

much still to learn about the second

phase.

Expert opinion was that to achieve

maximum benefits, reparative surgery

must take place at the period of greatest

biological activity in wound repair, between the fourth and tenth days. As

described by Colonel Churchill,

Reparative surgery is designed to pre- vent or cut short wound infection either

before it is established or at the period of

its inception. Once established, wound in- fection is destructive of tissue and, at times, of life. In many instances it permanently

precludes the restoration of function by the

most skillful reconstructive efforts. If the

initial wound operation has been a com- plete one, wounds of the soft parts may be

closed by suture on or after the fourth day. The dressing applied in the evacuation

hospital is removed under aseptic precau- tions in an operating room of a general

hospital at the base. Following closure, the

part is immobilized preferably by a light

32

 (1) Surg, NATOUSA, Journal, 21, 23, 27 Dec

1943, 2 Jan 44. (2) Theater ETMD for Dec 43, app. S. (3) Ltr, Col Alexander, Consultant, Chemical Warfare Medicine, to DMS, AFHQ, and Surg,

NATOUSA, 27 Dec 43, sub: Toxic Gas Burns Sustained in the Bari Harbor Catastrophe. (4) Pers

Ltr, Col Alexander to Col William D. Fleming, Med

Sec, Hq, SOS ETO, 26 Dec 43. 33

 See pp. 333-34, above.
352 MEDITERRANEAN AND MINOR THEATERS

plaster, or, if this is impracticable, by bed

rest. Decision to close a wound by suture

is based solely on an appraisal of the gross

appearance at the time of removal of the

dressing.34

Churchill estimated that by the middle of 1944 "at least 25,000 soft part

wounds" had been closed in Italy alone

on the basis of gross appearance only,

with satisfactory healing in 95 percent

of the cases. The technique was also used

for more complicated wounds, including

"those with extensive muscle damage as

well as those with skeletal or joint injury

and penetration of the viscera."

The Naples Blood Bank—Shortly after

it opened in the Naples medical center

in January 1944, the 15th Medical General Laboratory was asked by the PBS

surgeon, Colonel Arnest, to establish a

small blood bank for emergency use in

the center and elsewhere in the Naples

area. Plans for a 20-bottle bank were

drawn up, but before they could be implemented, the needs of Fifth Army led

to substantial enlargement of the scheme.

When the blood bank began operations

on 23 February, its goal was 200 bottles

a day, forecast as the combined requirement of Fifth Army and the Peninsular

Base Section. Donors were drawn from

base units, replacement depots, and personnel in the process of staging. Two

thousand pints of blood were taken in

March, with an aggregate by 1 May of

4,134. The blood bank meanwhile had

been formally authorized. Two days before Allied troops opened the offensive

that would carry them to Rome and on

to the Arno, it became the 6713th Blood

Transfusion Unit (Provisional), assigned to the theater but attached to the

15th Medical General Laboratory. During May 6,362 pints of blood were drawn

with the assistance of the 1st Medical

Laboratory, which was attached to the

15th late in April. Between 14 and 31

May, when battle casualties were heaviest, 4,685 bloods were taken, for a daily

average of 260. Throughout this period

the blood bank was operated by 7 officers

and 36 enlisted men.35

Blood was carried to the Cassino front

by truck and to Anzio by LST. Beginning on 24 May, whole blood was flown

to the front daily. A distributing unit

followed the advance of Fifth Army, met

the daily blood plane and delivered the

precious cargo to the hospitals where it

was needed. The blood plane also carried penicillin, emergency medical supplies, and occasionally personnel.

Since the decision had been made by

Colonel Churchill to keep whole blood

for a maximum of only eight days, the

activities of the blood bank were necessarily keyed to combat activity. The laboratory maintained a list of donors, who 34

 Churchill, "Surgical Management of Wounded

in Mediterranean Theater at Time of the Fall of

Rome," Bulletin, U.S. Army Medical Department,

V (January 1945) , pp. 61-62. See also, "Developments in Military Medicine During the Administration of Surgeon General Norman T. Kirk,"

Bulletin, U.S. Army Medical Department, VII (July

1947), 623-24; Col. Oscar P. Hampton, Jr. (USAR),

Orthopedic Surgery in the Mediterranean Theater

of Operations, "Medical Department, United States

Army," subseries Surgery in World War II (Washington, 1957), pp. 81-114.

35

 (1) Hist, 15th Med Gen Lab, 20 Dec 42-31 May

44. (2) 15th Med Gen Lab, Quarterly Hist Rpts,

31 Oct 44. (3) Monthly Rpts, 6713th Blood Transfusion Unit. (4) Rpt of Col Virgil H. Cornell,

formerly CO, 15th Med Gen Lab, sub: Gen Lab

Overseas Experiences, 29 Jan 46. (5) Brig. Gen.

Douglas B. Kendrick, Jr., "The Blood Program,"

vol. I, Activities of Surgical Consultants, "Medical

Department, United States Army," subseries Surgery

in World War II (Washington, 1962), ch. VI.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 353

TECHNICIANS COLLECTING BLOOD FROM WAC DONORS, 15th General Medical Laboratory, Naples medical center.

were called when needed. The use of

whole blood in forward surgery undoubtedly saved many lives in the Mediterranean Theater.

Preventive Medicine

The major problems of preventive

medicine in the communications zone

remained in Italy what they had been in

Africa—venereal disease and malaria.

Such wasters of manpower as trench foot,

hepatitis, and dysentery were studied,

and care was provided where needed,

but for the most part these were combat

zone problems. Venereal disease and

malaria were dealt with on a theaterwide basis. The army aspects of both

have been discussed in earlier chapters,

but the control organization in both

cases centered at theater headquarters.

The division of function between the

Medical Section, NATOUSA, and the

Medical Section, SOS NATOUSA, was

not always clear, but the two groups

worked closely together to avoid duplication of effort and to achieve a common

goal.
354 MEDITERRANEAN AND MINOR THEATERS

TABLE 22—VENEREAL DISEASE RATES, NATOUSA, JANUARY-AUGUST 1944

Source: Annual Rpt, Med Sec, MTOUSA, 1944, an. J and apps. 32, 38.

Venereal Disease—The direction and

co-ordination of the venereal disease control program rested at the theater level

with the NATOUSA venereal disease

control officer, Lt. Col. Leonard A.

Dewey, until mid-January 1944, and

thereafter Lt. Col. Asa Barnes. The program was carried out in the base sections

under direction of the SOS venereal disease control officer, Lt. Col. William C.

Summer, who transferred from the

NATOUSA organization in May.

The practice, begun in Africa, of placing houses of prostitution off-limits to

military personnel was continued in

Italy, but the problem of the clandestine

prostitute was more serious in the Italian

cities, particularly in Naples and Rome.

The enforcement of off-limits regulations and the apprehension of unlicensed

prostitutes was in the hands of civilian

and Allied military police, while the

base surgeons, through their venereal

disease control officers, were responsible

for the dissemination of educational

materials among base installations and

troops, the establishment and maintenance of prophylactic stations, and the

keeping and analysis of venereal disease

records. Naples and Rome, the two

largest and most accessible cities in the

Italian communications zone, each had

10 "pro" stations in operation.36

While the venereal rates for the theater as a whole showed steady improvement through the spring and summer of

1944, measured in days lost, the gains

were due rather to the introduction of

penicillin therapy than to any significant

reduction in the number of cases.

(Table 22)

Malaria—The malaria control organization set up in North Africa was extended to Italy where, with some modifications, it was responsible for an

effective control program in the 1944

season. The entire program was under

the general supervision of Colonel Stone,

preventive medicine officer on the staff

of the Surgeon, NATOUSA, and was

directed by Colonel Andrews of the

Sanitary Corps, who was both theater

malariologist and commanding officer of

the 2655th Malaria Control Detachment.

Under Colonel Andrews were malariol36

 This section is primarily based on: (1) Annual

Rpt, Surg, MTOUSA, 1944; (2) Hist, Med Sec,

COMZ NATOUSA; (3) Annual Rpt, Surg, PBS,

1944; (4) Annual Rpt, Surg, Rome Area, 1944.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 355

ogists assigned to each of the base sections, to Fifth Army, and to the Army

Air Forces Service Command. A malariologist was also assigned to the Services

of Supply medical section, and close

liaison was maintained with the Malaria

Control Branch of the Allied Control

Commission, and with the British Consultant Malariologist.37

The actual work of malaria control

was directed locally by specialized units,

co-ordinated at the theater level but assigned for operational purposes to the

armies and base sections. The control

program was effected in three phases.

(1) Surveys to determine the malariousness of an area and the density of the

malaria vectors were conducted by

malaria survey units. Consisting of one

entomologist, one parasitologist, and

eleven enlisted men, these units, known

as MSU's, were in effect mobile malaria

laboratories, calculating splenic indices

and making blood analyses of persons

living in the area to determine the incidence of the disease and seeking out

mosquito breeding places. (2) The findings of the malaria survey units were

turned over to malaria control units, or

MCU's, each commanded by a sanitary

engineer with eleven enlisted men. The

MCU's carried out various forms of larviciding and physical alteration of

breeding places by draining, filling, and

other means. (3) Personal protective

measures, such as use of protective clothing, bed nets, insect repellents, and

atabrine therapy were enforced by commanding officers for all troops.

By way of advance preparation for

the 1944 malaria season, an Allied Force

Malaria Control School was conducted

in Algiers in November 1943, with

parallel American, British, and French

sections. The school was attended by

malariologists and other malaria control

personnel, who followed up with similar

schools conducted locally. Between 21

February and 25 March 1944, three

separate courses were given in Naples

under the direction of Maj. Maxwell R.

Brand, the Peninsular Base Section

malariologist. One course was for medical inspectors, one for laboratory officers

and technicians, and one for the training

of enlisted men to work as malaria control details. The latter course was

repeated in April at Caserta, primarily

for Air Forces personnel. Courses conducted for Fifth Army personnel have

been discussed in earlier chapters.

The theater malaria control plan was

distributed on 20 March 1944 to the

commanding generals of Fifth Army; the

Army Air Forces, MTO and Services of

Supply, NATOUSA. As of that date,

there were five malaria survey units and

seven malaria control units in the theater. Two additional control units were

activated in May and three survey units

in July. One MSU arrived from the

United States in June, bringing the

totals for the season to nine units of

each type. The units were distributed

according to need in North Africa,

Corsica, Sardinia, Sicily, and various

37

 This section is based primarily on: (1) Annual

Rpt, Med Sec, MTOUSA, 1944, an. J, app. 28; (2)

Hist, Med Sec, COMZ MTOUSA; (3) Annual Rpt,

Surg, PBS, 1944; (4) Annual Rpt, Med Sec, AAFSC

MTO, 1944, an. B; (5) Col. Paul F. Russell, "The

Theater Malaria Control Organization," Medical

Bulletin, North African Theater of Operations, I

(February 1944), 17-18; (6) Summary of Materials

presented at Malariologists' Conference, 1-11 Nov

44, in Naples, Italy. For comment on the capabilities and organizational inadequacies of the malaria

survey and control units, see Armfield, Organization

and Administration, pp. 288-91.
356 MEDITERRANEAN AND MINOR THEATERS

PLANES DUSTING PARIS GREEN ON MOSQUITO-INFESTED LOWLANDS in the Cassino area.

points of troop concentration in western

Italy. Eastern Italy was a British responsibility, except for a substantial area

around Foggia for which the Air Forces

Service Command was made responsible.

Control measures followed a standing

operating procedure. Each individual

combat and service unit was responsible

for its own area, while large-scale operations such as drainage and water diversion projects were conducted by the

Army engineers. Dusting and spraying

from the air was carried out by a section

of a ferrying squadron, using both British and U.S. personnel. One malaria survey unit operated a plant for mixing

paris green, at the rate of eight to ten

tons a day. DDT was used sparingly

early in the season, but more and more

freely as adequate quantities became

available toward midsummer. Supplies

and equipment were procured through

Quartermaster, Engineer and Ordnance,

and a labor force was drawn from the

civilian population, from Italian service

companies, and in combat areas from

troop detachments.

The malaria control program for the

theater as a whole, judged in terms of

malaria case rates, was effective. Rates

per 1,000 per annum for the most

malarious months of 1944 were 70 in

June, 81 in July, and 92 in August, compared to 29, 77, and 173 for the corresponding months of 1943. The higher

1944 rates for June and July reflect primarily the far higher proportion of

theater personnel stationed in malarious

areas. The August figures are more

nearly comparable, contrasting as they
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 357

do the experience of Seventh Army in

Sicily with that of Fifth Army in Italy.38

The Reconditioning Program

In the Italian communications zone

the reconditioning and rehabilitation

program launched in North Africa was

further refined and broadened. As a result of a survey conducted in late January 1944 by Colonel Munhall, commanding officer of the 6706th Conditioning

Company, each of the general hospitals

in the Peninsular Base Section established a convalescent and rehabilitation

(C&R) section. Patients were normally

transferred to this section ten days in

advance of discharge from the hospital,

but in most instances, reconditioning and

rehabilitation had already begun with

occupational therapy, light calesthenics

on the wards, short walks, and various

duties in the administration of the hospital, scaled to the abilities and physical

capacities of the individual.39

In the convalescent and rehabilitation

sections, each staffed by one line officer

and six noncommissioned officers on

temporary duty status, the program included both physical conditioning and

psychological readjustment. Lectures on

the progress of the war and world events

and lessons from past campaigns went

along with carefully graduated exercises

and military drill. To get away from the

hospital atmosphere, the C&R sections

were generally removed as far as possible

from the hospital proper. The men wore

uniforms and lived much as they would

in combat units. The 10-day program

gave each man 40 hours of physical conditioning and 25 hours of military

education.

In addition to this reconditioning program in the general hospitals, which

continued throughout the war, a more

comprehensive program was conducted

by the 6706th Conditioning Company,

which was transferred to Italy in April

1944. The conditioning company dealt

with men in need of longer periods of

rehabilitation, for the most part men

who had previously been classified for

temporary limited service up to ninety

days. The normal period of duty with

the conditioning company was three

weeks. At the end of this time the men

were examined by a board of officers

from some nearby hospital, and placed

in one of four categories: (1) those

ready to return to duty, (2) those to be

held for further conditioning, (3) those

to be returned to the hospital for additional treatment, and (4) those to be

sent before a hospital reclassification

board for determination of future status.

The company was set up temporarily

in Naples, moving in June to a site on

Lake Lucrino and in July to a permanent

location on Lake Averno. Both sites were

close to the amphibious training area at

Pozzuoli, west of Naples, and no more

than five or six miles from the medical

center.

Dental Service

The dental service throughout the

North African Theater of Operations

showed steady improvement during the

first eight months of 1944, despite the

fact that the number of dental officers

in the theater did not keep pace with

38

 Final Report of the Preventive Medicine Off,

Office of the Surgeon, MTOUSA, app. 32. 39

 (1) Clift, Field Opns, pp. 399-407. (2) Annual

Rpt, 12th Gen Hosp, 1944. (3) Annual Rpt, 21st

Gen Hosp, 1944. (4) Annual Rpt, 300th Gen Hosp,

1944
358 MEDITERRANEAN AND MINOR THEATERS

the rising troop population. At the end

of December 1943 there were 703 dental

officers in the theater, with a ratio to

troop strength of 1:850. By the end of

June the number of dental officers had

risen to 765, but this lamer figure represented only one dentist to each 938

military personnel. By the end of August

total dental officer strength had declined

to 734, or a ratio of 1:1012.40

The improvements in dental service

stemmed primarily from better and

more widely distributed equipment, and

from the concentration of dental skills.

A Central Dental Laboratory was set up

in the Naples medical center before the

end of 1943. Early in April 1944 a

maxillofacial center was established at

the 52d Station Hospital, also in Naples,

to which a maxillofacial team of the 2d

Auxiliary Surgical Group was attached

at the beginning of June, when casualties from the Rome-Arno Campaign began flowing back to the communications

zone in large numbers. The maxillofacial center reached its peak load on 7

June, with a census of 282 cases, 139 of

them with bone injury.

To meet growing personnel requirements, a training course for dental

technicians was instituted in May, under

which two enlisted men from each station hospital were given thirty days of

training at a designated general hospital,

with further instruction at the Central

Dental Laboratory.

The enlargement of the general hospitals in June served to further the tendency to concentration of dental skills.

Where the l000-bed generals had had

5 dental officers, the newly constituted

1500-bed hospitals had 8, and the 2000-

bed units 10 dental officers. The hospital

reorganization increased the Table of

Organization requirements for the theater by 55 dental officers. Concentration

at the army, corps, and division levels,

with more extensive use of clinics and

mobile laboratories, has already been

noted in chapters dealing with combat

activities.

As a result of these changes in

distribution of dental strength and of

improvements in equipment and laboratory facilities, the amount of constructive

dental work performed was substantially

increased over that performed in 1943.

Col. Lynn H. Tingay remained chief

dental surgeon for the theater throughout the period of centralization in southern Italy, while Colonel Metz served as

communications zone dental surgeon until August 1944. Both of these officers

made frequent inspection trips to dental

installations in the interest of improving

theater dental service.

The communications zone organization for the Army Air Forces in Italy

was headed by Maj. (later Lt. Col.)

Estes M. Blackburn, dental surgeon of

the Army Air Forces Service Command,

Mediterranean Theater of Operations.

Since no dental officer was assigned to

the staff of the Surgeon, AAF MTO,

Major Blackburn acted as adviser on supply and equipment and personnel to all

Air Forces dental installations, as well

as liaison with the NATOUSA and SOS

NATOUSA, dental surgeons. 40 41 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. G; (2)

Annual Rpt, Surg, PBS, 1944; (3) Hist, Med Sec,

Hq, COMZ MTOUSA; (4) Dental Hist, North

African and Mediterranean Theaters of Operations. 41

 AAFSC MTO, Annual Med Hist, 1944, an. E.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 359

Veterinary Service

Shortly after his appointment in

February 1944 to the vacant position of

theater veterinarian, Colonel Noonan

recommended that food inspection units

be placed under the supervision of SOS

NATOUSA and the corresponding Air

Forces echelon, the Army Air Forces

Service Command, MTO. The number

of food inspection units in the theater

at this time was wholly inadequate and

authority was granted in July to activate

12 medical composite sections (food inspection), each with a veterinary officer

and 4 enlisted men. These were in addition to the 3 existing veterinary food

inspection detachments bearing letter

designations, which continued to operate

in the theater under their old T/O's.

Officer personnel for the new units were

drawn from replacement pools. A cadre

of one enlisted man for each new unit

was assigned from the 3 veterinary detachments already in the theater, the

remainder of the enlisted personnel

coming from other veterinary organizations and from quartermaster depots.

At the same time, 3 veterinary food inspection detachments (aviation) and 2

sections were activated and assigned to

the AAFSC MTO, using existing Air

Forces personnel.42

The new organization brought food

inspection units under base section control, the work being carried out in ports

and in areas of heavy troop concentration

where substantial quantities of food

were stored or locally procured.

Through improved methods of packing

and storage and frequent inspections,

the loss of food through spoilage was

greatly reduced. No serious outbreak of

food poisoning occurred anywwhere in

the theater.

In addition to food inspection duties,

the Peninsular Base Section was responsible for activation of the 213th Veterinary General Hospital (Italian) on 4

July 1944, at Grosseto, with a complement of 15 Italian veterinary officers and

253 Italian enlisted men. The 6742d

Quartermaster Remount Depot also received veterinary service through PBS.

While base section veterinarians in

Italy and Sardinia aided in the local

procurement of animals for military use,

this work, as well as conditioning the

animals so procured, was directed by the

Fifth Army veterinarian, Colonel Pickering, and has been more fully treated in

the combat narrative.43

Nursing Service

The shift of emphasis from North

Africa to Italy introduced no new or

unusual problems for nurses. In communications zone installations, living

conditions were better in Italy, and

opportunities for recreation more extensive. The total number of nurses in the

theater declined from 4,398 in October

1943 to 4,000 in January 1944, owing to

the transfer of several hospitals out of

the theater in the late months of 1943.

The number of nurses remained close

to 4,000 until transfer of hospitals to

southern France late in 1944 again

42

 Sources for this section are: (1) Annual Rpt,

Med Sec, MTOUSA, 1944, an. H; (2) Hist, Med

Sec, Hq, COMZ NATOUSA; (3) AAFSC MTO,

Annual Med Hist, 1944, an. D. (4) Annual Rpt,

Surg, PBS, 1944. See also, Miller, United States

Army Veterinary Service in World War II. 43

 See especially pp. 263-65, 318-20, above.
360 MEDITERRANEAN AND MINOR THEATERS

sharply reduced the total. Approximately 75 percent of the nurses were assigned to communications zone units.44

While the number of nurses in the

theater was at all times adequate to the

number of T/O beds, there were many

periods of intensive activity when duty

hours were long and patients per nurse

high. During periods of heavy combat

activity, nurses from fixed hospitals were

often put on temporary duty with combat units, thus increasing the load for

those remaining in the communications

zone. The necessity for operating both

fixed and mobile hospitals in Italy above

T/O capacities for considerable periods

of time was another factor tending to

increase the burden on nurses as well as

on all other hospital personnel. There is

no evidence, however, that morale suffered in any way.

Lt. Col. Bernice M. Wilbur served

through most of 1944 as Chief Nurse,

NATOUSA; Capt. Michener served as

Chief Nurse, COMZ NATOUSA, from

late April 1944.

The work of the nurses in the theater

was supplemented by the activities of a

limited number of physical therapists

and dietitians attached to the larger hospitals.45

Army Public Health Activities

Organization

The Civil Affairs organization set up

under AMGOT before the invasion of

Sicily was carried over initially to the

Italian mainland. Before the Salerno

landings, Sicily had been divided into

two administrative regions, while other

regions in southern Italy had been

marked out and staffs assigned. The

senior civil affairs officer for Region III,

which included the Salerno and Naples

areas, was Colonel Hume, a Medical

Corps officer who had given up his position as Deputy Director of Public

Health, Allied Military Government,

for this purely administrative post.46

The public health and welfare officer

for Region III, Lt. Col. (later Col.)

Emeric I. Dubos, USPHS, went ashore

at Salerno on D-day, but was unable to

function during the first few days of combat. Colonel Hume and his British executive officer, Colonel Ashley, arrived

at the beachhead the evening of D plus

4. Plans were prepared on the ground

for the administration of the provinces

of Salerno, Naples, Avellino, and Benevento, and for the city of Naples, including emergency health measures to be

carried out under Army control. Allied

Military Government civil affairs person44

 Sources for this section are: (1) Annual Rpt,

Med Sec, MTOUSA, 1944, an. I; (2) Hist, Med

Sec, Hq, COMZ MTOUSA; (3) Annual Rpt, Surg,

PBS, 1944; (4) Maj Parsons and others, Hist of

Army Nurse Corps, MTOUSA. 45

 Both of these groups will be discussed in detail in a forthcoming history of the Army Medical

Specialist Corps to be published by the Office of

The Surgeon General. See also McMinn and Levin,

Personnel in World War II, pp. 88-91, 231-32. 46

 Principal sources for this section are: (1)

Komer, Civil Affairs and Military Government in

the Mediterranean Theater; (2) Thomas B. Turner,

chs. XI, XII, in forth-coming volume: Stanhope

Bayne-Jones, ed., "Preventive Medicine," vol. VIII,

Civil Affairs-Military Government Public Health

Activities, to be published by The Surgeon General; (3) John A. Lewis, Rpt to WD, MS, History of Civil Affairs in Italy, 7 Dec 45; (4) Lt Col

Leonard A. Scheele, USPHS, Civil Public Health

History, North African-Mediterranean Theater of

Operations, May 1943-January 1944; (5) Hist of

AFHQ, pt. II, sec. 3; pt. III, secs, 1, 4; (6) Monthly

Rpts, Allied Control Commission, Public Health

Sec, Nov 43-Aug 44. See also, Armfield, Organization and Administration, pp. 294-98.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 361

GENERAL HUME

nel entered Naples with the occupying

troops on 1 October and set about removing health hazards at once. According to Colonel Stone, the NATOUSA

preventive medicine officer, who was one

of the early arrivals, the population appeared well nourished. Water supply

was sufficient for one gallon per person

per day, provided none of it was used to

flush the sewers.47 As rapidly as possible

the accumulated garbage of two weeks

was disposed of, and the dead were

buried. With the aid of U.S. and British

army engineers, water and power facilities and sewers were restored. During

this period, Colonel Hume acted as military governor of Naples.

With the conclusion of the first phase

of the Italian campaign, the AMG organization was modified to fit the conditions encountered on the peninsula.

Early in November 1943, an Allied Control Commission was established under

the Military Government Section,

AFHQ. Allied Military Government

thereafter functioned in two echelons,

one attached directly to the 15th Army

Group and one at the communications

zone level, attached to theater headquarters. General Alexander, the army

group commander, acted as military

governor of all occupied territory in

Italy until the advance of the troops

made it possible to set up a civil government under supervision of the Allied

Control Commission. Public health work

of ACC was directed by the Public

Health and Welfare Subcommission

headed by Brigadier G. S. Parkinson

(British) with Lt. Col. (later Col.)

Wilson C. Williams as his American

deputy.

As part of the reorganization of the

Military Government Section, a civil affairs officer was attached to each of the

Allied armies, the Fifth Army assignment going to Colonel Hume, who received his promotion to brigadier general at that time. On 14 May 1944,

coincident with the launching of the

drive on Rome and following a pattern

already established in the European

theater, the Military Government Section became a general staff section, designated as G-5.

The normal practice was exemplified

in the capture of Rome. General Hume

took over administration of the city as

soon as it was in Allied hands, acting as

military governor for ten days. On 15

June, AMG, Rome Region, responsible

to the Allied Control Commission, replaced the Fifth Army civil affairs organization. During the period of Army 47

 Surg, NATOUSA, Journal, 11 Oct 43.
362 MEDITERRANEAN AND MINOR THEATERS

control every effort was made to clean up

the city, restore utilities, rehabilitate

hospitals, and provide adequate sanitation, as well as to issue food and drugs

where necessary. American Red Cross

personnel worked with the Army public

health officers. The more permanent

civil affairs group representing ACC

tried to re-establish a local government

with native personnel along lines familiar to the inhabitants. Administration

was eventually turned over entirely to

the Italian authorities.

In the public health field, major problems were sanitation and preventive

medicine. Such hazards to the health of

the troops as typhus, malaria and venereal disease could be effectively controlled only by including the civilian

population in control measures. While

local doctors were encouraged to practice

to the full extent of their abilities, general supervision was retained over hospitals. It was necessary, also, for the Allied

public health organization to continue

supplying drugs for civilian use.

The cities of Leghorn, Florence, and

Pisa were under AMG administration

by the end of August 1944.

Typhus Control in Naples

Even before the conquest of Sicily in

the summer of 1943, a monitored broadcast from Rome indicated the presence

of typhus in Italy. This possibility was

taken into account in the medical planning for the occupation of the Italian

mainland, both by the preventive medicine section of theater headquarters and

by AMG public health officers. This

planning was based on the use of methyl

bromide (MYL) as a delousing agent,

but difficulties in procurement prevented the stocking of adequate quantities of the powder and of suitable hand

dusters for applying it.48

Rumors of typhus in Naples were confirmed after the Salerno landings by

refugees from the city, but could not be

verified immediately. Colonel Stone, the

NATOUSA preventive medicine officer,

visited Naples along with General

Cowell, Director of Medical Services,

AFHQ, on 1 October, coincident with

the occupation of the city. Conditions

were right for an epidemic. The city was

overcrowded, its more than a million

inhabitants had not been immunized

and were heavily louse infested, and

large numbers lived jammed together

in air-raid shelters. The departing Germans, moreover, had released the prisoners from certain jails in which cases of

typhus had occurred earlier in the year

among Serbian prisoners of war. Little

could be learned from the local health

authorities, however. Lack of transpor48

 Principal sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual

Rpt, Surg, MTOUSA, 1944, an. J; (3) Final Rpt,

Preventive Med Off, MTOUSA, 1945; (4) Col D. G.

Cheyne, Notes on Typhus in Naples 5 Dec 43; (5)

ACC Public Health Sec, Monthly Rpts, Nov 43-

Mar 44; (6) Capt William L. Hawley, Notes on the

Typhus Epidemic and Control Measures in Naples,

1943-44; (7) Scheele, Civil Public Health History,

North African-Mediterranean Theater of Operations, May 43-Jan 44; (8) Memo, Col Stone to

TSG, 30 July 45, sub: Typhus Control; (9) F. L.

Soper, W. A. Davis, F. S. Markham, and L. A. Riehl,

"Typhus Fever in Italy, 1943-1945, and Its Control

with Louse Powder," American Journal of Hygiene,

XLV (May 1947), 305-34; (10) Stanhope BayneJones, "Epidemic Typhus in the Mediterranean

Area during World War II," Rickettsial Diseases

of Man (Symposium, Medical Science Section,

AAAS, 1946); (11) Pers Ltr, Gen Blesse, Surg,

NATOUSA, to TSG, 6 Feb 1944; (12) Lt. Col.

Charles M. Wheeler, "Control of Typhus in Italy

1943-1944 by Use of DDT," American Journal of

Public Health, XXXVI (February 1946), 119-29;

(13) Med Sitreps, PBS, Jan-Mar 44.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 363

tation and disruption of communications

made it impossible for those who might

have the disease to be examined by a

physician. There was also confusion in

terminology, since "tyfo abdominale,"

or typhoid fever, was often used interchangeably by Italian doctors with

"tyfo," which is the word for typhus.

On his return to Algiers, Colonel

Stone advised General Blesse of the potential danger, and precautionary steps

were taken at once. A group representing the Rockefeller Foundation was then

studying typhus control in the Middle

East, and had conducted experiments

with the newly developed and still top

secret DDT in a French prison in

Algiers. These experiments confirmed

Stone's faith in the new insecticide, a

quantity of which had already been requested for the theater. On Stone's advice Brigadier Parkinson (British)

ordered 50 tons of 10 percent DDT, 5

tons of concentrate, and dusting guns,

to be delivered to AMG by 15 December, while Stone himself ordered 60 tons

of the powder and one ton of concentrate

for Army use. Both requisitions were

disapproved by the War Department in

November.

The presence of typhus in Naples had

meanwhile been established. Colonel

Stone arranged with Dr. Fred L. Soper

of the Rockefeller group for demonstrations of delousing methods in prisonerof-war camps, and for the training of

malaria control and other sanitary personnel in these methods. Pertinent data

were distributed by the NATOUSA

surgeon's office in November.49 On the

20th of that month, Stone and Colonel

Long, theater medical consultant, conferred at length with General Fox, field

director of the U.S.A. Typhus Commission, which was also conducting studies

in the Middle East, but independently

of the Rockefeller group. General Fox

was satisfied that all necessary steps had

been taken, and pledged the full co-operation of the Typhus Commission.

Actually, control measures were lagging far behind needs. The public health

officer for AMG's Region III, now Col.

W. H. Crichton (British) , had wholly

inadequate resources, either of personnel or of equipment, to cope with the

situation, and had not succeeded in organizing the Italian health authorities

for effective assistance. By the end of

November there were more than forty

cases of typhus reported in Naples and

probably many more than that. More

vigorous control measures had become

imperative.

The AMG and NATOUSA orders for

DDT were reconsidered and finally approved by the War Department on 5

December. Observers from the Typhus

Commission arrived in Naples on 6

December, and two days later Drs. Soper

and William A. Davis of the Rockefeller

group reached the city at the invitation

of AMG and ACC authorities. The PBS

surgeon, Colonel Arnest, placed all

available supplies of MYL powder at the

disposal of the Rockefeller team, while

General Blesse dispatched DDT concentrate to Naples by air. The Typhus Commission observers took no part in actual

control work, leaving after five days.

Contact or spot delousing began on 12

December, the homes of all reported

cases being visited, and all contacts of

the patients being dusted, but neither

49

 (1) NATOUSA Surgeon, Cir Ltr No. 43, 11

Nov 43. (2) NATOUSA Cir Ltr No. 224, 15 Nov

43.
364 MEDITERRANEAN AND MINOR THEATERS

DELOUSING STATION IN NAPLES DURING THE TYPHUS THREAT

supplies nor personnel were adequate

for more extensive measures. Neither

was transportation available. Colonel

Stone arrived on 18 December and General Fox, in response to Stone's urgent

request, on the 20th. After a series of

conferences with health and medical

officers representing AMG, ACC, PBS,

and Fifth Army, General Fox, using his

personal prestige and the authority of

his position to the utmost, set the

machinery in motion for a full-scale attack on typhus. All clearances were obtained, and all necessary guarantees of

co-operation were given by 24 December.50

Delousing of occupants of some 80 or

90 air-raid shelters on a weekly basis

began 27 December, and the first two

stations for mass delousing opened the

following day. Supervised by Italian

civilian inspectors, there were 33 such

stations in operation by 15 January.

Systematic delousing of all residents of

each block in which a case occurred, and

of contiguous blocks, began on 6 Febru50

 Surg, NATOUSA, Journal, 24, 25, 26 Dec 43.
THE ITALIAN COMMUNICATIONS ZONE: SOUTHERN PHASE 365

ary. Flying squadrons began working in

suburban communities on 8 January.

General Fox and the Typhus Commission assumed full responsibility for typhus control in Naples on 2 January

1944, turning the task over to the Allied

Control Commission on 20 February,

after the crisis had passed. Dr. Soper and

his associates of the Rockefeller group

administered mass delousing throughout

the danger period, and on a reduced

scale until after the end of the war.

The turning point came around 10

January, by which date over 60,000 persons a day were being dusted with either

MYL or DDT powder. The dusting stations alone averaged 1,600 a day per

station, with an average staff of 13 each.

All told, between mid-December 1943

and the end of May 1944, more than

three million applications of dusting

powder were made in Naples and surrounding towns. Out of 1,914 reported

cases of typhus in the Naples area between July 1943 and May 1944, only 2

were U.S. military personnel, one a

soldier whose attack was mild, the other a

sailor, whose case was severe but not fatal.
CHAPTER X

Invasion of Southern France

Preparations for the Invasion

After the close of the Sicily Campaign

in August 1943, Seventh Army was

stripped of its combat units to provide

troops for operations in Italy. Seventh

Army retained some occupation duties,

however, and continued to maintain a

skeletonized headquarters in Palermo,

pending high-level decisions as to its ultimate employment.

The merits of an amphibious operation in the Toulon-Marseille area of

southern France had been discussed at

Quebec in August 1943. Under the code

name ANVIL, the proposal was approved

by Marshal Joseph Stalin at Tehran before its formal adoption at the second

Cairo conference in December 1943. By

this date a tentative outline plan, envisioning a 2- or 3-division assault with a

build-up to ten divisions, had been prepared.1

General Patton was already scheduled

for a command in the forthcoming invasion of France and would leave

Seventh Army in January. His successor

was to be General Clark, who would,

however, retain command of the Fifth

Army for the time being, confining his

new role to that of participation by a

deputy in the planning activities. The

Seventh Army planning staff, designated

for purposes of security as Force 163,

opened in Algiers on 12 January 1944

and eventually became a joint and combined staff.

Early Indecision

For the next two months the Seventh

Army planning staff, on which Brig.

Gen. Benjamin F. Caffey, Jr., represented Clark, worked in a vacuum. No

troops had been actually designated, no

staging areas set aside; even the size of

the force to be used was not known. The

only available forces were those fighting

in Italy, and no one could say when it

would be possible to withdraw any of

them. After the initial failure of the

Anzio Campaign to develop as intended

and the setback before Cassino, General

Alexander was convinced the Germans

would stand south of Rome and insisted

that every man of his command would

be needed for the spring offensive in

Italy. With VI Corps bogged down in

the mud of Anzio beachhead and the

Liri Valley still secure against every Allied thrust, Clark was relieved on 15 February of any further responsibility of

ANVIL.

On 4 March 1944 Maj. Gen. Alexander M. Patch of Guadalcanal fame had

1

 Sources relied upon for the origin and military

planning of ANVIL are: (1) Churchill, Closing the

Ring; (2) Biennial Rpt, CofS, 1943-45; (3) Rpt of

Opns, Seventh U.S. Army; (4) Truscott, Command

Missions; (5) Robert Ross Smith, The Riviera to

the Rhine, a forthcoming volume in the series

UNITED STATES ARMY IN WORLD WAR II.
INVASION OF SOUTHERN FRANCE 367

become commander of the Seventh

Army. The army's objective remained

the same—to invade southern France in

force simultaneously with, or immediately following, the Normandy landings,

and exploit up the Rhone Valley, but

the target date for both operations had

been postponed to June. In mid-April

the ANVIL D-day was again put off, this

time to late July, because of the requirements of the May offensive in Italy and

the needs of OVERLORD for landing craft.

All first priorities went elsewhere, and

the ANVIL planners were kept busy revising in terms of new unavailabilities.

Rome had fallen and the Allied forces

had secured the Normandy beaches before it was certain that ANVIL would even

be launched.

Planning and Mounting

the Invasion

On 15 June the commander of Allied

Armies in Italy, General Alexander, was

directed to release the U.S. VI Corps,

consisting of the 3d, 36th, and 45th Divisions; two French divisions; and various

auxiliary troops to Seventh Army. Alexander and General Sir Henry Maitland

Wilson, the Supreme Allied Commander

in the Mediterranean, still opposed the

southern France operation, urging most

strongly that all troops in Italy be retained there for a knockout blow against

the disorganized and retreating enemy,

and then turned east through the

Ljubljana Gap toward Hungary. In this

proposal they were backed by Prime

Minister Churchill. On the other hand,

it was probably General Eisenhower's

insistance that Marseille and other

French Mediterranean ports were essential to supply his own forces, and that

neither men nor matériel were available

for two major fronts on the Continent,

which tipped the scale in favor of

ANVIL.2 On 2 July General Wilson was

directed to launch ANVIL on 15 August.

Two days later Seventh Army headquarters moved from Algiers to Naples,

where headquarters of VI Corps and of

the French forces, known as Army B,

were also established.

Broadly, the plan called for a 3 division daylight assault by VI Corps, under

command of General Truscott, over selected beaches between Cap Cavalaire

and Agay. The night before the main

attack the 1st Special Service Force was

to seize the offshore islands of Port Cros

and Levant, a French commando group

was to go ashore at Cap Nègre on the left

flank to block the coastal road, and a

French naval assault group was to carry

out a similar mission at Pointe des

Trayas on the right flank. At the same

time, an airborne task force was to be

dropped in the vicinity of Le Muy, about

ten miles behind the landing beaches, to

cut off enemy reinforcements and neutralize gun positions. Two French corps,

which made up Army B under General

Jean de Lattre de Tassigny, were to begin landing over the secured beaches on

D plus 1, and to swing west to invest

Toulon and Marseille, while VI Corps

advanced up the Rhone Valley toward

Lyon and Vichy. The French forces were

to be made up in part of Moroccan and

Algerian troops to be withdrawn, like

VI Corps, from Italy. Army B also included the 9th Colonial Division, which

had captured the island of Elba late in

June against stubborn German resistance.

2

 Eisenhower, Crusade In Europe, pp. 281-84.
368 MEDITERRANEAN AND MINOR THEATERS

GENERAL PATCH AWARDING LEGION OF MERIT TO COLONEL BERRY

A Coastal Base Section, organized 7

July, was to follow the combat troops at

the earliest practicable date. Its commander, Maj. Gen. A. R. Wilson, was

named on 26 June, and base section personnel were attached to the planning

group near the end of July.

The training of the assault divisions

began in June, as soon as possible after

their assignment. The 36th and 45th

Divisions trained at Salerno, where the

Invasion Training Center, now attached

to Seventh Army, had been established

in the spring. The 3d Division trained at

Pozzuoli, on the northwest rim of the

Gulf of Naples; and the airborne task

force established a glider and parachute

school near Rome. Final dress rehearsals

were completed on the night of 7-8 August, after which loading of the transports began at various ports in Italy,

Sicily, North Africa and Corsica.

DRAGOON, as ANVIL had been rechristened on 1 August, was under way.

Medical Plans and Organization

By the end of 1943 the Seventh Army

medical section had been reduced to a

total of 10 officers and 18 enlisted men.
INVASION OF SOUTHERN FRANCE 369

At that time the surgeon, Colonel Daniel

Franklin, 3 officers, and 5 enlisted men

moved to Algiers to assume the medical

planning function for Force 163. At the

same time the medical supply officer, the

dental officer, and 6 enlisted men joined

other Seventh Army supply units in

Oran to work out ANVIL supply plans

with SOS NATOUSA and the base

sections. The remainder of the medical

personnel continued at Palermo until

May. The entire medical section was not

reunited until Seventh Army headquarters moved to Naples early in July.3

The Seventh Army medical organization was similar to that of the Fifth

Army, with staff sections for administration, operations, and personnel. Hospitalization, evacuation, and medical supply came under operations. There was a

medical inspector, with a venereal disease control officer under him. On the

professional side were a dental surgeon,

veterinarian, and director of nurses, with

consultants in surgery, neuropsychiatry,

and chemical warfare.

On 18 June Colonel Rudolph, who

had been surgeon of the declining Eastern Base Section, became Seventh Army

surgeon. Key officers in the medical section as D-day for DRAGOON approached

were: Colonel Robinson, executive officer; Lt. Col. (later Col.) Joseph Rich,

operations; Lt. Col. (later Col.) Norman

E. Peatfield, hospitalization; Lt. Col.

(later Col.) Robert Goldson, evacuation;

Colonel Alexander, personnel; Maj.

(later Lt. Col.) Guy H. Gowen, medical

inspector; Maj. (later Lt. Col.) Augustus J. Guenther, commander of the

7th Medical Depot Company, supply;

and Maj. (later Lt. Col.) Charles Raulerson, administrative officer. In the professional positions were Col. Frank B.

Berry, surgical consultant; Col. Alexander, who doubled as chemical warfare

consultant; Lt. Col. (later Col.) Daniel

S. Stevenson, veterinarian; Lt. Col.

(later Col.) Webb B. Gurley, dental

surgeon; Capt. (later Maj.) Alfred O.

Ludwig, neuropsychiatric consultant;

and Maj. Edith F. Frew, director of

nurses. Colonel Berry had been chief of

the surgical service, 9th Evacuation Hospital, and Major Frew had been that

unit's chief nurse. Captain Ludwig had

been commander of the Fifth Army

Neuropsychiatric Center. Colonel Stevenson had been commanding officer of

the 17th Veterinary Evacuation Hospital, while Colonel Gurley came to

Seventh Army from the 21st General

Hospital.

Like other aspects of the planning for

ANVIL-DRAGOON, the medical plans were

incomplete and subject to constant

change until the assignment of units and

final approval of the operation. The

basic work, within the limitations imposed by insufficient data, was shared at

the theater level by the NATOUSA and

the communications zone staffs, and at

the corps and division levels was directed

by Colonel Bauchspies, the VI Corps

surgeon. The point of stabilization coincided with the arrival of Colonel Rudolph, who directed the final revision of

the medical plans in terms of actual mis3

 Principal sources for this section are: (1) Annual Rpt, Surg, Seventh Army, 1944; (2) After

Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct

44, ans. 277 and 278; (3) Rpt of Naval Comdr,

Western Task Force, Invasion of Southern France,

Navy: A16-3 (01568) 15 Nov 44. (4) Annual Rpt,

Med Sec, MTOUSA, 1944; (5) Clift, Field Opns;

(6) Davidson, Medical Supply in MTOUSA; (7)

Unit rpts of the individual med units mentioned

in the text.
370 MEDITERRANEAN AND MINOR THEATERS

COLONELS GOLDSON, RUDOLPH, AND RICH

sion, combat forces involved, and target

date.

Medical Plans for the Assault—The

pattern followed in earlier amphibious

operations in the Mediterranean was

again the basic guide. The Navy was to

be responsible for all medical care on

shipboard and to the high-water mark on

the landing beaches. The Army was responsible for medical care ashore. As in

the Sicilian, Salerno, and Anzio landings,

each combat division in the assault was

to be accompanied by its own medical

detachments and its organic medical battalion. In addition, each regimental combat team was to be supported in the landing phase by a collecting company and

clearing platoon of a separate medical

battalion. This was an improvement

over the technique previously employed

in the theater, whereby one of the collecting companies of each assault medical battalion had been forced to rely upon an improvised clearing platoon made

up of station section personnel.4 The airborne task force was to be supported by

a collecting company with clearing ele4

 See pp. 149, 224, above.
INVASION OF SOUTHERN FRANCE 371

ments attached. Each assault division was

to have the services of two field hospital

platoons, with enlisted men drawn from

the fixed hospitals substituted for the

nurses who were not to arrive until D

plus 4, The field hospital platoons were

to function in immediate proximity to

the division clearing stations.

Twenty-eight surgical and other specialist teams of the 2d Auxiliary Surgical

Group were to be attached to the field

hospitals and other assault units.5 Additional teams for the troop transports

were made up of personnel of the 750-bed

evacuation hospitals and the general hospitals scheduled to come into France at

later dates. Dispensary teams of one officer and two enlisted men each, similarly drawn from personnel of hospitals

already closed for future movement,

were to serve aboard the cargo vessels

in the assault convoy. When the ships

withdrew from the beach area, these

teams were to report to the nearest evacuation hospital for reassignment until

their own units arrived. The forward distribution section of a blood transfusion

unit was to be attached to one of the

field hospitals, but was to serve the entire corps.

During the landing phase the three

separate medical battalions were to be

attached to the beach groups in the three

areas into which the invasion coast was

divided. Their commanding officers were

designated as beach group surgeons, each

being responsible for the setting up and

operation of medical installations in his

area and for co-ordination with the medical sections of the Navy beach battalions. The beach control group surgeon

was to take over all Army responsibility

for medical care and evacuation on the

beachhead when the area was secure.

The 3-plus French divisions scheduled

to go ashore on D plus 1 were to be similarly accompanied by their own medical

units, though the support available was

less extensive than that assigned to the

assault troops of VI Corps. The initial

French medical complement included a

medical battalion, a field hospital, and a

blood transfusion unit.

Hospitalization—In addition to the

beds available in the clearing stations

and field hospital platoons, each of the

three assault divisions was to be accompanied by a 400-bed evacuation hospital,

to be established between D plus 1 and

D plus 4, or as soon as the situation permitted. Two comparable evacuation

hospitals, U.S. equipped but French

staffed, were to accompany the landing

elements of Army B.

By D plus 10, when the French forces

were to have reached 7 divisions, the

medical support for Army B was to be

augmented by 2 field hospitals, 2 400-

bed evacuation hospitals, and 2 750-bed

evacuations. The 3 divisions of VI Corps

5

 Annual and Special Rpts, 2d Aux Surg Gp,

1944. The D-day troop list in Report of Operations, Seventh Army, III, 908, and Annual Report,

Medical Section, MTOUSA, 1944, are probably incorrect in placing the number at 30 teams. Annual

Report, Surgeon, Seventh Army, 15 August-31 October 1944, Annex 277, both identify only the 26

teams that were attached to the field hospitals in

the landings, leaving 2 surgical teams—or possibly

4—unaccounted for. One of these, together with 3

medical officers of the 43d General Hospital, accompanied the 1st Special Service Force in its H

minus 8 attack on the islands of Levant and Port

Cros. Another may have accompanied the airborne

task force, although no conclusive evidence to that

effect has been found. It is the recollection of Dr.

Berry, then surgical consultant to Seventh Army,

that 2 teams accompanied the 95th Evacuation Hospital, but these were probably among the 10 already

counted as being assigned to the ALPHA Attack

Force. (See recorded interv, Dr. Berry, 4 Nov 58.

commenting on preliminary draft of this volume.)
372 MEDITERRANEAN AND MINOR THEATERS

were to be backed up by 3 750-bed evacuation hospitals, with a convalescent

hospital scheduled for somewhat later

arrival.

To supplement these mobile units,

plans also called for the establishment of

14,250 fixed beds in southern France as

rapidly as the military situation permitted. Three 2,000-bed general hospitals,

three 1,500-bed generals, seven 500-bed

station hospitals, and a 250-bed station

hospital were assigned to the Coastal

Base Section, organized in Naples 6 July

by SOS NATOUSA, with Colonel

Bishop as surgeon. Bishop had been executive officer to the groups working on

typhus control in Naples, and more recently surgeon of the Mediterranean

Base Section. The assigned hospitals

were to be withdrawn from Africa, Italy,

and Corsica.

Evacuation—Evacuation from the

beaches in the early hours of the assault

was to be by landing craft and water

ambulance to the transports. During the

entire assault phase of the operation, seaward evacuation was a Navy responsibility, the Army being responsible only for

the transportation of casualties to the

Navy evacuation stations.

Two hospital ships were to arrive in

the landing area on D plus 1, after which

one ship was to arrive at dawn each day

until D plus 10. Hospital ships were

then to be sent forward on call of the

Seventh Army surgeon. Twelve such vessels were to be made available for this

purpose, operating from Corsica. All casualties were to be evacuated to Naples

until D plus 7. Thereafter U.S. and British casualties were to be evacuated to

Naples and French casualties to Oran.

Air evacuation was scheduled to begin

on D plus 7. For evacuation from the

combat zone to rear areas in France, motor ambulances were to be used until rail

lines were repaired for the operation of

hospital trains.

Medical Supply—The ANVIL-DRAGOON

plans provided for two levels of medical

supplies and equipment. The assault

forces were to carry with them supplies adequate for the landings and the

early expansion from the beachhead. A

further build-up was to be available to

meet the needs of Seventh Army and the

attached French Army B until a normal

supply system could be established by

the base section personnel scheduled to

follow the combat troops after the ports

of Toulon and Marseille had been secured. It was not possible to determine

either level until the size of the operation was known, yet if the supplies were

to be delivered on time, it was essential

that orders be placed months in advance.

It was therefore necessary to requisition

initially through SOS NATOUSA

solely on the basis of the 3-division assault and 7-division follow-up called for

in the outline plan.

Calculations were based on supply

from within the theater for 60 days,

after which there would be direct deliveries to southern France from the

States. Each subtask force in the landings

was to carry medical supplies for 7 days

maintenance, which were to be collected

at dumps and issued by the beach groups.

The assault troops were to carry individual supplies of such items as atabrine and

motion-sickness pills, while the medical

personnel going ashore were to carry litters, blankets, and splints, as well as necessary drugs in sealed, waterproof containers. The bulk of the supplies for the
INVASION OF SOUTHERN FRANCE 373

landing forces, however, was to be in the

form of the newly devised beach maintenance units, each containing a balanced stock of medical items sufficient to

maintain 5,000 troops for 30 days. These

were to be supplemented by such additional critical items as blood plasma,

morphine syrettes, plaster of paris, sulfaguanadine, paregoric, oxygen, and

dressings. Medical supplies were to be

packed in clearly marked boxes, not exceeding 70 pounds in weight. Supplies

for the French forces were to be identically packed, but marked with the tricolor.

Advance detachments of the Army

medical depot company were to accompany the assault, functioning as elements

of the beach groups for collection and

distribution of medical supplies. All

medical units in the assault, in addition

to making up any equipment shortages,

were authorized to draw supplies 20 percent in excess of their normal allowances.

Supplies for subsequent phases of the

campaign were to be delivered as operational medical maintenance units, a revised and modified version of the old

medical maintenance unit. Like the

MMU relied upon in earlier campaigns,

it was designed to provide balanced medical supplies to meet the needs of 10,000

men for 30 days.

Assignment and Training—The first

assignment of medical personnel to the

southern France operation, other than in

a purely planning capacity, was the

attachment of three officers and three enlisted men from the Seventh Army medical section to the beach control group

formed at Mostaganem, Algeria, early in

May. The group included representatives of the various supply services concerned with the coming campaign. The

medical complement was to direct the

unloading of hospitals over the beaches,

evacuate casualties, and control the flow

of medical supplies from ship to dump

until Seventh Army and the Coastal Base

Section were able to take over their own

respective supply functions. The 7th

Medical Depot Company was later assigned to Seventh Army, and the 1st Advance Section was attached to the beach

control group.

Assignment of medical personnel to

the task forces necessarily had to be delayed until the combat elements themselves were assigned and the invasion

plan completed. As finally approved,

plans called for four major task forces,

one to be airborne and three to strike

the beaches between Cap Cavalaire

and Agay from the sea. The three

attack forces known as ALPHA, DELTA,

and CAMEL, were built respectively

around the 3d, 45th, and 36th Infantry

Divisions. The medical units assigned to

each attack force trained with the combat troops, the ALPHA Force at Pozzuoli

the DELTA and CAMEL Forces at Salerno, and the 1st Airborne Task Force

near Rome.

The medical support assigned to the

task forces was as follows:

ALPHA Attack Force: 3d Division

medical detachments; 3d Medical Battalion (organic) ; 52d Medical Battalion,

including the 376th, 377th, and 378th

Medical Collecting Companies, and the

682d Medical Clearing Company; Headquarters and 1st Platoon of the 616th

Medical Clearing Company, 181st Medical Battalion; the 1st and 3d Hospitalization Units, 10th Field Hospital, with
374 MEDITERRANEAN AND MINOR THEATERS

ten teams of the 2d Auxiliary Surgical

Group, and the forward distribution section of the 6703d Blood Transfusion

Unit attached; 95th Evacuation Hospital.

DELTA Attack Force: 45th Division

medical detachments; 120th Medical

Battalion (organic); 58th Medical Battalion, including the 388th, 389th, and

390th Medical Collecting Companies

and the 514th Medical Clearing Company; the 2d Platoon, 616th Medical

Clearing Company; the 2d Hospitalization Unit, 10th Field Hospital, and the

2d Hospitalization Unit, 11th Field Hospital, with nine teams of the 2d Auxiliary Surgical Group attached; the 93d

Evacuation Hospital.

CAMEL Attack Force: 36th Division

medical detachments; 11th Medical

Battalion (organic); 56th Medical Battalion, including the 885th, 886th, and

887th Medical Collecting Companies,

and the 891st Medical Clearing Company; the 1st Platoon of the 638th Medical Clearing Company, 164th Medical

Battalion; the 1st and 3d Hospitalization

Units, 11th Field Hospital, with seven

teams of the 2d Auxiliary Surgical

Group attached; the 11th Evacuation

Hospital.

The 1st Airborne Task Force was to

receive support from the medical detachments of its own component units, which

included a British parachute brigade;

the 517th Parachute RCT and 509th

Parachute Infantry Battalion from the

Italian front; the 1st Battalion, 551st

Parachute Infantry; the 550th Infantry

Airborne Battalion; and miscellaneous

artillery, infantry, engineer, signal, antitank, chemical, ordnance, and supply

units. To serve the whole task force, the

676th Medical Collecting Company of

the 164th Medical Battalion, with clearing elements attached, went through

special glider training. Six officers, a

technician, and a team of the 2d Auxiliary Surgical Group constituted the medical support for the 1st Special Service

Force.

Training of medical troops followed

techniques similar to those used in earlier amphibious operations, including

waterproofing of vehicles and equipment, shore-to-ship evacuation, and ambulance and litter carries under simulated combat conditions.

Medical Support of Seventh Army

in the Field

The invasion of southern France, fifth

and last amphibious operation in the

Mediterranean, was by all odds the most

successful of the five. The landing

beaches were secured and all initial objectives taken within thirty-six hours. In

less than a month a German army had

been virtually destroyed, all southern

and eastern France had been liberated,

and Seventh Army had linked its front

with that of the Normandy invasion force

and was more than 400 miles north of

its landings. In this spectacular dash, the

achievements of the medical troops were

no less decisive than the triumphs of the

combat arms.

The Military Campaign

In the early evening of 14 August 1944

a mighty convoy of 855 ships, out of a

dozen Mediterranean ports, rendezvoused off the west coast of Corsica and

sailed northwest toward the famed

French Riviera. For the past 10 days the
INVASION OF SOUTHERN FRANCE 375

Mediterranean Allied Air Force had

pounded targets from Genoa to Sète,

slowly closing in to isolate the landing beaches. A feigned attack including

a dummy parachute drop on beaches 60

miles west of the real objective was then

being mounted, but there was no fake

about other preparatory missions. In the

early hours of 15 August, troops of the

1st Special Service Force scaled the cliffs

on the seaward side of Port Cros and

Levant; French commandos landed at

Cap Nègre west of the assault area; and

other French troops went ashore at

Pointe de Trayas to the east. Allied

paratroops began dropping through fog

around Le Muy 10 miles behind the

designated beaches, and were followed

by glider troops as soon as light permitted. Swarms of landing craft, covered by

carrier-based planes and naval guns,

headed for the indented shore between

St. Tropez and St. Raphael, the first

troops landing about 0800.6

The Germans, though misled for

about an hour by the covering operations to the west, had expected the Allied forces to land where they did and

had alerted their units. However, their

forces were dispersed and opposition was

relatively light on all beaches. The

French on the right flank had failed in

their mission, but the commandos on the

left and the 1st Airborne Task Force,

10,000 strong, in the rear of the landing

area, had cut off the possibility of enemy

reinforcement. The assault troops, aided

by the Maquis—or French Forces of the

Interior as the underground was officially known—pushed rapidly inland. In

the late afternoon of 15 August patrols of

the 45th Division made first contact with

the airborne force, and by the close of D

plus 1 the "blue line"—drawn far

enough inland to protect the beaches

from enemy artillery and to give control

of main routes north and west—had been

reached.

The next few days were decisive. The

36th Division on the right pushed east

far enough to protect the beachhead,

then turned north after being relieved

on 20 August by infantry elements of the

airborne task force. The 45th Division in

the center advanced northwest toward

the Durance River, and the 3d Division on the left struck west to capture

the key road center of Aix-en-Provence

just north of Marseille on 21 August. On

the 19th the German commander of

Army Group G began to withdraw all

troops, except the two divisions garrisoning Toulon and Marseille, up the Rhone

Valley.

A fast-moving armored task force led

by the VI Corps deputy commander,

Brig. Gen. Frederick B. Butler, was already ahead of the German forces. Task

Force Butler had left its assembly area

on 18 August, racing north toward Grenoble, where mountain passes had been

blocked against any attempt on the part

6

 Principal sources for this section are: (1) The

Seventh United States Army; Report of Operations,

France and Germany, 1944-1945 (Heidelberg, Germany: Aloys Gräf, 1946) , vol. I; (2) Rpt of Naval

Comdr, Western Task Force, Invasion of Southern

France; (3) Rpt of Opns, VI Corps, Aug, Sep, 44;

(4) Truscott, Command Missions; (5) General

[Jean] de Lattre de Tassigny, Histoire de la

Premiere Armée Française (Paris: Plon, 1949) ; (6)

Samuel Eliot Morison, "History of United States

Naval Operations in World War II," The Invasion

of France and Germany 1944-1945 (Boston: Little,

Brown and Company, 1957) ; (7) Craven and Cate,

eds., Europe: ARGUMENT to V-E Day, pp. 408-

38; (8) Taggert, ed., History of the Third Infantry

Division in World War II; (9) Huff, ed., The

Fighting 36th; (10) The Fighting Forty-Fifth; (11)

WD Special Staff, Hist Div, Invasion of Southern

France, OCMH files; (12) Smith, Riviera to the

Rhine.
376 MEDITERRANEAN AND MINOR THEATERS

of the enemy to reinforce from that direction. The task force had then turned

west to close the escape route in the Montélimar area, where the Rhone Valley

narrows and the corridor is dominated

by high ground to the northeast. Butler's

forces were not adequate, however, and

the Germans won the opening round on

23 August, when elements of the 141st

Regiment of the 36th Division reached

the area but were unable to seize the

city of Montélimar. The Germans

rushed forward their best unit, the 11th

Panzer Division, to force open the Montélimar Gate for their retreating columns, while the remainder of the 36th

Division from the east, the 45th from the

southeast, and the 3d from the south

hurried to the aid of hard-pressed Task

Force Butler. The battle raged for eight

days, with the larger part of the German

forces escaping before the trap was completely closed. The enemy nevertheless

suffered heavy losses and left thousands

of vehicles and guns, including five

heavy railroad guns, as wreckage lining

the route north.

Meanwhile, one corps of General de

Lattre's French Army B, consisting of the

3d Algerian, the 9th Colonial, and the

1st Armored Divisions, a provisional infantry division, and two groups of Moroccan tabors (each group equivalent to

a regiment) and special troops, had relieved VI Corps in the coastal area and

enveloped Toulon and Marseille from

the land side, in conjunction with naval

assaults from the sea. Both cities fell on

28 August, and the French forces, augmented by newly arrived divisions,

turned northward up the Rhone to join

VI Corps.

On the eastern flank the airborne task

force, with the 1st Special Service Force

attached, had taken the famous resort

towns of Cannes and Nice and had

cleared the mountainous area north and

east of those cities.

By 31 August, D plus 16, Seventh

Army had taken 57,000 prisoners, with

a loss to itself of 2,733 killed, captured,

and missing in action. U.S. patrols were

at the Italian border, French patrols

were at the Spanish border, and the Germans were fighting only with stubborn

rear-guard actions as they sought desperately to slip through the narrowing gap

between Seventh Army, now in the vicinity of Lyon, and General Patton's

Third Army, which was pushing east

from Paris.

The advance was now a pursuit. Lyon

was occupied on 3 September. The 3d

Division took Besançon after hard fighting on 8 September, and two days later

the French 1st Armored Division reached

Dijon. On 11 September patrols of Seventh and Third Armies met at Saulieu

a few miles west of Dijon, and the Allied

front was continuous from the Swiss

frontier to the English Channel.

On 15 September Army B became the

1st French Army, forming with Seventh Army the 6th Army Group under

General Devers. At this time the DRAGOON forces came under operational control of Supreme Headquarters, Allied

Expeditionary Force, and the troops were

regrouped in accordance with SHAEF

plans, 1st French Army shifted to the

right flank, hinging on the Swiss border,

while VI Corps turned north to cross

the Moselle in the vicinity of Épinal, and

advanced toward Strasbourg beyond the

Vosges Mountains.

The exploits of Seventh Army thereafter belong to the history of the European Theater of Operations.
INVASION OF SOUTHERN FRANCE 377

Field Medical Service

The Assault Phase—Although the prearranged landing schedules were not

always followed to the letter, medical

service during the beach phase of the invasion worked smoothly. Delays were

caused primarily by a more rapid advance than had been anticipated, with

consequent unexpected demands for

trucks and landing craft by the combat

troops; and in some instances by dispersal of unit equipment among several

vessels. While medical personnel supporting each task force had their own

problems, certain principles were common to the whole operation.

Litter teams from the collecting companies of the organic medical battalions

were attached for the landings to the assault units, not less than three nor more

than four 5-man teams to each infantry

battalion, and these, with the personnel

of the battalion aid stations, were the

first medical troops ashore. Ideally, they

were to be followed by the beach medical battalions, each organized for the

landings into 3 collecting-clearing companies, with the collecting element of

each company further divided into 3 sections of one officer and 22 enlisted men

each. The remaining elements of the

collecting companies of the organic medical battalions were to come next, accompanied or immediately followed by the

field hospital units, which were stripped

down to 50-bed capacity. The personnel

of the evacuation hospitals were then to

land and go into bivouac to await their

equipment. The clearing companies of

the organic medical battalions were to

be held back until it was possible to

establish them at least 5 miles inland,

where the field hospital units, already

ashore, would join them. Medical supply

personnel were to land on D plus 1.7

The 3d Division assault on the left

flank went pretty much according to

plan. Landings were made in two separate areas: on the Bay of Cavalaire, east

of the town of that name, by the 7th and

30th Regimental Combat Teams; and

on the Bay of Pampelonne, about six

miles northeast of the Cavalaire landings

and three miles southeast of St. Tropez,

by the 15th RCT. The battalion medical sections, reinforced by collecting

company litter squads, landed behind

their infantry battalions within the first

two hours. On the Cavalaire beaches,

Collecting Company C of the organic

medical battalion, supporting the 30th

Infantry, came ashore ahead of schedule

at H plus 4 and had its station established

by 1400. Company A, supporting the 7th

Infantry, did not land until H plus 12,

its station going into operation at 2200.

Neither company had any ambulances

until D plus 1.

At H plus 6 a collecting company and

the 1st Platoon of the Clearing Company, 52d Medical Battalion, went

ashore at Pampelonne beach and had

the beach clearing station in operation

by 1600. The landing of the Cavalaire

beach group medical complement—the

7

 Principal sources for this section are: (1) After

Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct

44, an. 278; (2) Rpt of Naval Comdr, Western Task

Force, Invasion of Southern France; (3) ETMD,

MTO, for Oct 44; (4) Ltr, Col Reeder to Surg,

NATOUSA, 18 Aug 44, sub: Med Observer's Rpt,

Seventh Army Opn; (5) Annual and/or Monthly

Rpts of the following med units: Surg, 3d Inf Div;

Surg, 36th Inf Div; Surg, 45th Inf Div; 3d Med Bn;

52d Med Bn, 56th Med Bn; 58th Med Bn; 111th

Med Bn; 120th Med Bn; 164th Med Bn; 181st Med

Bn; Surg, VI Corps; Surg, Seventh Army; 10th Field

Hosp; 11th Field Hosp; 11th Evac Hosp; 93d Evac

Hosp; 95th Evac Hosp; 2d Aux Surg Gp; 7th Med

Depot Co.
378 MEDITERRANEAN AND MINOR THEATERS

MAP 30—Seventh Army Hospitals and Medical Supply Dumps, 20 August 1944

remaining two collecting companies and

the 2d platoon of the clearing company,

52d Medical Battalion, and the 1st Platoon of the 616th Clearing Company, the

181st Medical Battalion—was two hours

later, the beach clearing station being set

up at 1800.

By midafternoon the ALPHA beaches

were clear and the combat spearheads

already several miles inland, making it

possible to land the remaining medical

units. At H plus 8—1600, or four in the

afternoon—the 1st and 3d Platoons of

the 10th Field Hospital came ashore,

one unit at each beach. The Pampelonne

unit was receiving patients by 2000, but

the Cavalaire unit did not recover its

equipment until D plus 1. At the same

time the 3d Medical Battalion clearing

company and personnel of the 95th

Evacuation Hospital landed at Cavalaire. The 95th went into bivouac to

await its equipment, while the 3d Division clearing company moved inland and

set up station two miles north of La

Croix, opening at 1915. The site of the

clearing station was about equidistant

from the beaches and some five miles

inland. The collecting company in support of the 15th Infantry did not debark

at Pampelonne beach until 0400 on D

plus 1, and remained without ambulances until noon. (Map 30)

The division clearing station moved

on D plus 2 to Cogolin, where it was

joined by one unit of the 10th Field Hospital and the 95th Evacuation, which

was still not in operation. All three installations moved to Gonfaron, some

twenty miles inland, on D plus 3. The
INVASION OF SOUTHERN FRANCE 379

95th opened the following morning, 19

August, at 0800. The other 3d Division

platoon of the l0th Field Hospital went

into bivouac in the same locality on 20

August.

The 45th Division, constituting with

its reinforcements the DELTA Force,

landed on a strip of beach no more than

three miles wide in the dead center of

the VI Corps landing area just northeast

of the town of Ste. Maxime. Here expediency and availability of landing craft

rather than the prearranged schedule determined the order of landing for medical units.

As on the ALPHA beaches, the medical

detachments and the litter teams of

the organic collecting companies went

ashore with the infantry battalions making the assault, closely followed by units

of the beach medical battalion and the

remainder of the 120th Medical Battalion organic to the division. One collecting-clearing unit of the 58th Medical

Battalion was ashore at H plus 21⁄2

and had its station in operation one-half

mile northwest of Ste. Maxime by 1230.

A second collecting-clearing unit landed

on the easternmost of the 45th Division

beaches at H plus 4, opening station

three miles northeast of Ste. Maxime.

The third collecting-clearing unit of the

beach battalion was delayed until 1930,

finally landing on the ALPHA beaches

south of St. Tropez and opening station

a half mile inland.

All personnel of the 120th Medical

Battalion were ashore by H plus 6. Collecting stations for the two assault regiments were in operation by 1100. Jeeps

borrowed from the infantry were used

until the ambulances arrived. The clearing company went into bivouac, the 1st

platoon setting up station about six miles

inland near Plan de la Tour late on 16

August.

Units of the 10th and 11th Field Hospitals attached to the DELTA Force both

landed about noon of D-day, but neither

went into operation. The 2d Platoon of

the 10th Field received patients at Plan

de la Tour on 17 August but the 2d

Platoon of the 11th Field did not operate

at all during the beach phase. The 93d

Evacuation Hospital, which landed near

Ste. Maxime at H plus 4, opened at Plan

de la Tour on 17 August.

Here, as on the ALPHA beaches, expansion inland was rapid. The 2d Platoon of the division clearing company

opened 5 miles south of Vidauban

and about 15 miles from the beach

shortly before noon on 18 August, while

the 1st Platoon moved more than 20

miles northwest from Plan de la Tour to

Silans-la-Cascade. Beach clearing stations

of the 58th Medical Battalion moved into Ste. Maxime and St. Tropez on Dday and D plus 1, respectively.

The westernmost of the beaches assigned to the 36th Division, or CAMEL

Force—a beach on the Gulf of Fréjus within a mile of the town of that name and

equally close to St. Raphaël—was not actually used because underwater obstacles

had not been cleared. Instead, all landings were made on three beaches east of

St. Raphael and about a mile apart. Litter sections of the organic collecting companies landed with the battalion aid stations of the assault troops. All personnel

of the 111th Medical Battalion were

ashore by H plus 8, although the equipment of the clearing company was not

unloaded until the evening of D plus 1.

By that time the fighting was so far inland that the division clearing station

was first established near Le Muy, fif
380 MEDITERRANEAN AND MINOR THEATERS

MEDICS GIVING FIRST AID on invasion

beach, 15 August.

teen miles from the beach, in the early

afternoon of 17 August. The station

moved ten miles farther inland the following day, to a site near Draguignan.

The collecting-clearing units of the

56th Medical Battalion, meanwhile, had

experienced similar delays in landing

their equipment. The first beach clearing station in the CAMEL area was set

up four miles east of St. Raphael at H

plus 14, or 2200. Before this time all

casualties were evacuated to offshore craft

by the Navy beach group. The other two

beach clearing stations were set up in

St. Raphael on D plus 2 and D plus 3,

respectively.

The two platoons of the 11th Field

Hospital attached to the CAMEL Force

and the 11th Evacuation Hospital landed

together at 1900, or H plus 11, going into

bivouac near the landing area. The evacuation hospital and one unit of the field

hospital followed the division clearing

station to Le Muy on 17 August, going

into operation the following morning.

The other field hospital platoon joined

the clearing station at Draguignan on 18

August. On the CAMEL beaches, one surgical team served with each clearing platoon of the beach medical battalion.

The 1st Airborne Task Force was supported initially by parachute medical

troops making up the parachute infantry

detachments. Personnel of the 676th

Medical Company began landing in the

vicinity of Le Muy by glider about 0800

on D-day, the last wave touching down

at 1851. Medical supplies and equipment, preloaded in 12 jeeps with 1⁄4-ton

trailers, were landed safely. A collecting

station was established in a barn at Le

Metan soon after the first wave landed,

personnel and equipment being added

as they arrived. The station moved to

larger quarters on 16 August. In all, 227

casualties were treated before evacuation

to the CAMEL beaches by Army transportation was possible on 17 August.

On the supply side, the advance section of the 7th Medical Depot Company

landed in the vicinity of Ste. Maxime

on 16 August, and a detachment consisting of one officer and twenty enlisted

men took over operation of the DELTA

beach supply dump from the 58th Medical Battalion on that date. The following day one officer and eighteen enlisted

men of the depot company were attached to the 52d Medical Battalion for

temporary duty to operate the 3d Division medical supply dump, and on 18

August a similar detachment relieved

the 56th Medical Battalion of supply

functions in the 36th Division area.

The VI Corps surgeon, Colonel
INVASION OF SOUTHERN FRANCE 381

TABLE 23—ADMISSIONS AND DISPOSITIONS, SEVENTH ARMY MEDICAL

INSTALLATIONS, 15-18 AUGUST 1944

a

 Presumably includes British naval personnel, not cared for in any U.S. installation, but evacuated by U.S. b

 To POW inclosures.

Source: After Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct 44 an. 278

Bauchspies, set up headquarters near

Ste. Maxime at 1800 on D-day, but for

the next 2 or 3 days could do little except keep in touch with medical units

functioning under divisional control.

The breakout from the beachhead was

so rapid, however, that it was possible

to resume a normal organizational pattern within 3 or 4 days. The 58th Medical Battalion reverted to Seventh Army

on 17 August and was attached to the

beach control group. The field hospitals

passed from division to corps control on

18 August, while the evacuation hospitals reverted to army control on the same

date. On 19 August the 56th Medical

Battalion was attached to VI Corps.8

Nurses of the field and evacuation hospitals and of the surgical group landed

and joined their units on 19 August.

Delays in landing equipment of clearing companies and hospitals might have

been serious had casualties been heavier

than they were. Air and naval cover attacks in widely separated areas, however,

kept the enemy from concentrating his

forces, and opposition on all beaches was

lighter than had been anticipated. Hospital admissions, including admissions to

clearing stations, for the beach phase of

the operation were approximately 3,000.

(Table 23) Mean troop strength for the

week ending 18 August was 113,854.

8

 Sources disagree as to exact dates. The text

follows the contemporary account of the theater

medical observer, Colonel Reeder. See Ltr, Reeder

to Surg, NATOUSA, 18 Aug 44, sub: Medical Observer's Rpt, Seventh Army Opn, Slightly later dates

given by some of the medical units concerned probably indicate only that there was some lag in completing the change-over.
382 MEDITERRANEAN AND MINOR THEATERS

The Montélimar Gate—With the

beaches secure and the ports of Toulon

and Marseille under siege by Army B,

VI Corps was tree to exploit up the

Rhone Valley. The road net was excellent and with the formidable aid of the

French resistance forces there was fair

prospect of trapping a large part of the

German Nineteenth Army if the corridor along the east bank of the Rhone

could be closed off somewhere below the

Drome River—the so-called Montélimar

Gate—before the enemy forces could be

withdrawn.9

The rapid pace put a heavy strain on

medical installations. The evacuation

hospitals could not keep pace, and main

reliance had necessarily to be placed on

the organic medical battalions and on

the field hospital units, supplemented

when necessary by clearing platoons of

the corps medical battalions. Collecting

companies of the same battalion were

sometimes as much as 150 miles apart.

Clearing companies often operated two

stations, while ambulances and borrowed trucks were in continuous movement over excessively long evacuation

lines. Good roads made aid stations easily accessible to ambulances, permitting

the diversion of many litter bearers for

assignment as relief drivers.

A reinforced collecting company of

the 111th Medical Battalion accompanied Task Force Butler in its dash toward Grenoble and its subsequent swing

west down the valley of the Drome.

The collecting station of this unit was

already in Sisteron, sixty-five miles north

of the battalion headquarters at Draguignan before the end of the day, 18 August. Two days later it was at Lac on the

Drome, fifty miles northwest of Sisteron;

and on 21 August it was at Marsanne,

overlooking the Rhone from the heights

northeast of Montélimar.

The 36th Division followed on the

heels of Task Force Butler, swinging

farther north to protect the flank. The

143d RCT entered Grenoble on 22 August, where a collecting station was set

up by the 885th Medical Collecting Company, borrowed from the 56th Medical

Battalion to replace the company attached to the task force. The next day

the collecting station of the 143d was

sixty miles southwest of Grenoble at

Romans, close to the junction of the

Isère and the Rhone above Valence,

thence moving south with its combat

team to the area occupied by the Butler

Task Force.

The 141st and 142d combat teams of

the 36th Division were also on the high

ground above Montélimar by 23-24 August, their supporting medical units

keeping pace by leapfrog tactics and almost continuous movement. The 36th

Division clearing company leapfrogged

its platoons from Draguignan to Sisteron

to Aspres to Crest in 4 days, single moves

covering up to 120 miles. Until the last

2 or 3 days of August, when the combat

forces began pursuit of enemy remnants

toward Lyon, 36th Division medical

units remained clustered a few miles

north and east of Montélimar evacuating

to the clearing station at Crest, a maximum distance of 10 miles.

The 1st Platoon of the 11th Field Hospital, which opened at Crest on 22 August, acted as an evacuation hospital for

three days, since there was no evacuation

nearer than the beach area, more than

9

 Principal sources for this section are: (1) After

Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct

44, an. 278; (2) Annual Rpt, Surg, Seventh Army,

1944; (3) Annual Rpt, Surg, VI Corps, 1944; (4)

Unit rpts of med units mentioned in the text.
INVASION OF SOUTHERN FRANCE 383

AMBULANCE PASSING THROUGH DEMOLISHED VILLAGE NEAR MONTÉLIMAR

200 miles distant by highway. On 25 August the 3d Platoon joined the 1st at

Crest, and the 11th Evacuation opened

in the vicinity of Aspres, 65 miles to the

rear. Thereafter evacuation was to Aspres, which became the medical center of

VI Corps with the arrival of the corps

surgeon on 26 August. During the Crest

period, from 22 through 31 August, the

clearing station of the 11th Medical

Battalion admitted 2,174 patients, of

whom 840 were battle casualties and 411

were prisoners of war. The heaviest day

was 27 August, when 202 of the 322 admissions were battle casualties. The

largest number of prisoner patients was

received on 29 and 30 August, the totals being 120 and 191, respectively.

In the Montélimar area, both the collecting stations and the clearing station

at Crest were intermittently under enemy fire.

Movement of 45th Division medical

units, following a pattern similar to those

of the 36th, was characterized by long

and frequent jumps. The 179th Regimental Combat Team, which had been

in reserve during the landings, spearheaded the drive north behind the 36th

Division, occupying Grenoble on 23 August. A collecting company of the 120th

Medical Battalion took over the station
384 MEDITERRANEAN AND MINOR THEATERS

established the day before in support of

the 143d RCT, remaining at the site for

six days. The 180th RCT turned east

from the Sisteron-Aspres-Gap triangle to

occupy Briançon, only 5 miles from the

Italian frontier. The collecting company

in support moved 140 miles from the

beach area to Embrun on 23 August,

evacuating casualties more than 50 miles

over mountain roads to the division

clearing station near Serres on the

Sisteron-Aspres road. The 3d Platoon of

the 10th Field Hospital joined the clearing station there on 23 August, the 2d

Platoon arriving the following day. The

clearing station of the 56th Medical Battalion also set up in the Serres area,

where it served as a holding hospital for

minor medical cases. During the last

week of August the 10th Field Hospital

units at Serres admitted 201 medical

cases and 64 battle casualties.

A platoon of the 120th Medical Battalion clearing company moved forward

to Pont-de-Claix just south of Grenoble

on 27 August.

The 157th RCT of the 45th Division

met strong opposition at Apt, a few miles

north of its Durance River crossing, on

22 August, but reached the Serres area

by the 24th. The regiment proceeded

north, crossing the Drome east of Crest

and protecting the north bank of the

river. Evacuation from the collecting station of the 157th for the next two days

was to the 36th Division clearing station

at Crest.

The 3d Division, meanwhile, had advanced northwest from Aix-en-Provence

to Avignon at the junction of the Durance and Rhone Rivers, taking the city

on 25 August. The division then turned

north, pursuing the retreating enemy up

Highway 7. Montélimar was finally captured by the 3d Division on 28 August,

the same day on which both Toulon and

Marseille fell to the French forces of

General de Lattre. Although badly battered, the bulk of the German troops had

already slipped through the Montélimar

Gate. Clearing stations of the 3d Division, with their accompanying field hospital units, were successively at Brignoles,

Aix, the vicinity of Carpentras northeast

of Avignon, and Nyons southeast of

Montélimar.

The last three days of August saw VI

Corps moving north from the Drome on

a wide front in another attempt to encircle the enemy before he could reach

the Belfort Gap and the Rhine. The 45th

Division swung northwest from Grenoble, and the 36th advanced north toward Lyon, while the 3d delayed only

long enough to mop up in the Montélimar battle area. French Army B began

a simultaneous march up the west bank

of the Rhone to make contact with VI

Corps in the vicinity of Lyon. Task

Force Butler was dissolved, its components reverting to their own organizations.

Expansion to the Moselle—The rapid

pursuit of the enemy north from the

Montélimar battle area put field medical units to a severe test. Lyon fell to

the French 2d Corps on 3 September, but

most of VI Corps was already well beyond that point. Four days later the 3d

Division, with the 45th on its right and

the 36th on its left, stormed the ancient

fortress city of Besançon more than 200

miles from the Drome River line of 28

August.10

10

 Sources for this section are the same as those

mentioned in n. 9 above.
INVASION OF SOUTHERN FRANCE 385

JEEP AMBULANCE BRINGING WOUNDED BACK ACROSS THE MOSELLE

During this period, clearing stations

made almost daily moves, platoons leapfrogging one another, while evacuation

hospitals were hastily brought up to the

combat area to shorten the ambulance

runs. In spite of the frequent and

lengthy changes of station, medical battalions gave close support throughout

the pursuit. For example, a clearing platoon of the 111th Medical Battalion,

moving sixty miles from Bourg to Poligny on 6 September, was held up for

four hours to allow armored and infantry

elements to pass. Collecting stations

were in almost continuous movement.

After the capture of Besançon, German resistance stiffened, and rain helped

to further retard the advance. VI Corps

units were nevertheless within twenty

miles of Belfort when Seventh Army

turned north again just after the middle

of the month in response to SHAEF orders. Medical installations were still on

the heels of the advancing lines when

the Moselle crossing began on 21 September.

In the race to the Moselle each of the

three divisions of VI Corps was supported
386 MEDITERRANEAN AND MINOR THEATERS

by its own organic medical battalion. A

collecting company and clearing platoon

of the 58th Medical Battalion supported

the 13th Field Artillery Brigade after

17 September. Units of the 10th and 11th

Field Hospitals continued to accompany

forward clearing stations of the divisions,

while evacuation rearward was the responsibility of the 56th Medical Battalion. Until the rainy season began in midSeptember, turning dirt roads into quagmires, litter bearers were used to only

a minimum extent. The well-settled nature of the country also made it possible

to site clearing stations much of the time

in buildings.

The corps surgeon's office remained

close to the front throughout the period,

moving from Aspres to Salins, twenty

miles south of Besançon on 6 September.

Headquarters were in Vesoul by the 16th

and on 22 September moved to Plombieres.

Casualties during September were

more from disease than from battle

wounds, with respiratory ailments and

exhaustion making substantial inroads.

Trench foot cases began to appear before the end of the month. Admissions

by the three division clearing companies

totaled 11,805, of which 4,101 were battle wounds. Of the aggregate admissions,

1,136, or approximately 10 percent, were

prisoners of war.

Hospitalization in the

Army Area

Hospitalization on the Beaches

Until the base organization, with its

fixed hospitals, could establish itself in

southern France, it was necessary for

Seventh Army to leave some hospital facilities in the beach area to care for service troops and for replacements and

reinforcements staging in the vicinity, as

well as to provide transient beds for those

being evacuated to Italy. This function

fell in the first instance to the 58th Medical Battalion, which reverted to Army

control on D plus 2, and was reattached

to the beach control group.11

When the last of the assault clearing

stations closed on 21 August, a provisional hospital was opened by the

clearing company of the 58th Medical

Battalion in the Hotel du Golf at Beauvallon, a resort village between St.

Tropez and Ste. Maxime. One collecting

company remained at Ste. Maxime, operating a smaller unit that served as an

annex to the main hospital. Both units

were relieved on 4 September by the

164th Medical Battalion, which continued to operate the two facilities until

fixed hospitals came into the area toward

the end of the month. During the period

24 August-1 September, twelve French

medical officers and a Senegalese

clearing platoon were attached to the

Beauvallon hospital, the majority of admissions at that time being French

troops and German prisoners.

After being relieved by the 164th

Medical Battalion, the 58th established

another provisional hospital in the Hotel

Hermitage in Nice, primarily for the

support of the 1st Airborne Task Force

and the 1st Special Service Force then

fighting along the Italian border. This

hospital was still in operation when all

11

 Sources for this section are: (1) Annual Rpt,

Surg, Seventh Army, 1944; (2) After Action Rpt,

Surg, Seventh Army, 15 Aug-31 Oct 44, an. 278;

(3) Annual Rpt, Surg, VI Corps, 1944; (4) Unit

rpts of the individual med units mentioned in the

text.
INVASION OF SOUTHERN FRANCE 387

military units in southern France were

formally transferred from the Mediterranean to the European Theater of

Operations.

Between 11 and 30 September the

675th Medical Collecting Company of

the 164th Medical Battalion operated a

provisional station hospital in Marseille—the only American hospital facility in that city. The hospital was caring

for 200 patients when it was relieved

by the 80th Station Hospital on 30

September.

The provisional hospitals in the landing areas were augmented late in August

by 750-bed evacuation hospitals, which

were brought in according to schedule.

The 9th Evacuation, which landed on

25 August, went immediately into the

combat zone, but the 51st and 59th Evacuations, which arrived at the same time,

and the 27th, which reached southern

France on 30 August, were retained initially in the coastal area. Original plans

had called for three 750-bed evacuation

hospitals for the support of VI Corps

and two to back up the forward units

of Army B. After the capture of Marseille, however, French medical commanders found it possible to make

greater use of local hospitals than had

been anticipated, and all four of the

larger evacuation hospitals were used

primarily for U.S. troops.

The 51st Evacuation opened at Draguignan on 27 August. Its personnel

served in a captured German hospital

at the site while their own tents were

being erected. The hospital remained at

Draguignan until 20 September. The

bulk of its admissions were from the 1st

Airborne Task Force, received both directly and through the provisional hospital at Nice. The staff of the 51st was

augmented during this period by 18

medical officers, a nurse, and 19 technicians attached from other organizations.

Approximately 2,000 patients were cared

for.

The 59th Evacuation Hospital opened

on 28 August at Carpentras near the site

about to be vacated by the 3d Division

clearing station. The hospital remained

in the area until 7 September, taking

a total of 611 patients and performing

222 surgical procedures in the 10 days

of operation.

The 27th Evacuation operated at

Bouc-bel-Aire, a few miles south of

Aix-en-Provençe from 1 September to 20

September. At this site it was the closest

U.S. hospital to Marseille, where it operated a prophylactic station and gave

dispensary service and station hospital

care to all U.S. troops in the area. In

addition to U.S. Army personnel, the

1,169 patients treated during the twenty

days of operation at Bouc-bel-Aire inincluded French troops and civilians,

and American and British sailors, both

naval and merchant marine.

Hospitalization in the Combat Zone

The 10th and 11th Field Hospitals,

operating in 50-bed units rather than the

100-bed units used in Italy, served

throughout the campaign as forward

surgical hospitals, remaining close to, and

moving with, the division clearing stations. They were backed up as closely

as transportation and available sites permitted by the 400-bed evacuation hospitals and later by the larger evacuation

units. During the period of rapid movement, however, the field units were often

far ahead of any evacuation hospital support. On these occasions, clearing pla-
388 MEDITERRANEAN AND MINOR THEATERS

toons of the 56th Medical Battalions

were used to increase bed capacity.12

The speed of the campaign up to late

September necessitated frequent and

long moves, with advance reconnaissance

to the front lines themselves in search of

hospital sites. The 400-bed evacuations

were generally able to move by echelons

with their own organic transportation,

but the 750-bed evacuations had to rely

on Seventh Army for trucks, which were

not always available when needed. (See

Maps 31, 32, 33.)

Long evacuation lines to the rear

meant that hospitals were often overcrowded, while periods of intense combat activity placed a severe strain upon

surgical staffs and postoperative facilities. It was frequently necessary to leave

holding units behind to care for nontransportable patients when hospitals

moved forward. All of the evacuation

hospitals used civilian personnel in various capacities, the most frequent being

as litter bearers.

The first evacuation hospital to move

away from the landing beaches was the

93d, which advanced forty-five miles

northwest from Plan de la Tour to

Barjols on 22 August. For a few days,

while elements of the 45th Division were

forcing a crossing of the Durance River

just north of Barjols and fighting their

way toward Sisteron, the hospital was

busy, but was soon left with little to do.

August 25 saw the 11th Evacuation

leap ahead 128 miles from Le Muy to

Aspremont in support of the forces fighting from Montélimar to Crest. In 15

hours after receiving movement orders,

the hospital had evacuated 300 patients,

dismantled and packed its equipment,

and was on the road. The first patient

was received at the new site just 18 hours

after the hospital had closed at the old.

Three hundred patients were admitted

on the first day of operation at Aspremont.

The 750-bed 9th Evacuation Hospital,

which arrived combat-loaded on 25

August, was sent immediately to the support of the 11th. Proceeding in 4 motor

convoys, the 9th moved to a site at Beaumont, 30 miles beyond Aspres on the

road to Crest, and began receiving patients at 0800, 28 August, just 54 hours

after touching French soil. Two hundred

and sixty patients were received and 39

surgical operations performed in the first

24 hours at Beaumont.

On the first day of September the 93d

Evacuation, moving in three echelons

with its own organic transportation,

opened at Rives, 20 miles northwest of

Grenoble and 180 miles from the hospital's previous site at Barjols. Between

noon and midnight, 1 September, 127 patients were admitted and 28 surgical procedures performed. The move was

completed on 5 September, the hospital

remaining open at Barjols until the last

echelon was ready to leave. (Map 31)

The 95th Evacuation was the next

Seventh Army unit to leapfrog from the

rear to the most forward position. The

hospital left Gonfaron on 3 September,

its personnel spending the night as guests

of the 9th at Beaumont. The intention

had been to set up about 50 miles beyond

that point, but the front lines had already

moved so far forward that a new reconnaissance was necessary. The site finally

designated by the VI Corps surgeon was

at St. Amour, more than 300 miles by

12

 Ltr, Col Rollin L. Bauchspies, USA (Ret), to

Col Coates, 15 Apr 59, commenting on preliminary

draft of this volume. Colonel Bauchspies was VI

Corps surgeon.



392 MEDITERRANEAN AND MINOR THEATERS

road from the landing area. The 95th

spent the night of 4 September in bivouac at the 3d Division clearing station

near Ambérieu, opening at St. Amour at

0900, 5 September.

As the most forward evacuation hospital, the 95th carried a heavy load of

surgical cases for the next few days. At

the same time, it was necessary to hold

patients overlong owing to the difficulties of evacuation. The railroads had not

yet been restored to service and motor

transportation was critical. The situation

was somewhat eased by the beginning of

air evacuation from Ambérieu on 9 September, but fuel shortages and bad

weather combined to make flight schedules uncertain. On the credit side, the

hospital was deluged with gifts of eggs,

chickens, rabbits, and ducks from the

local farmers, whose normal city markets

were temporarily cut off.

The 9th Evacuation, meanwhile, had

closed at Beaumont, and on 8 September

opened at Poligny, 40 miles beyond St.

Amour and 235 miles from the Beaumont site. At Poligny the 9th received

578 patients in the first 30 hours of operation. Surgical teams worked in 16-hour

shifts.

The next forward move was made on

11 September when the 11th Evacuation

opened at Aissey, 15 miles east of

Besançon, after a 265-mile jump from

Aspremont. With the aid of borrowed

trucks, the first echelon was able to carry

300 beds, all surgical nurses, and half the

officers of the medical service as well as

all those of the surgical service. The hospital admitted 158 patients during the

first 5 hours at Aissey.

On 15 September the 93d Evacuation

moved up from Rives to Rioz, 20 miles

north of Besançon. Using 15 borrowed

trucks and 25 ambulances of an attached

ambulance company, the first 2 of 3

echelons were able to move together.

The hospital opened at 1300 on 16 September. By midnight 219 patients had

been received and 27 operations performed. The 185-mile move was completed on 17 September. (Map 32)

The 59th Evacuation Hospital, which

had closed at Carpentras on 7 September,

also opened in Rioz after a l0-day wait

for transportation. For the 59th the move

covered 240 miles. September 17 was also

the opening date for the 2d Convalescent

Hospital in Besançon, though part of its

equipment remained on the docks at

Marseille where organic vehicles had

been commandeered for more urgent

uses. The unit was caring for 1,200 patients before all of its equipment was

brought up by its remaining vehicles

shuttling between Besançon and Marseille.13

The 95th Evacuation again became the

most forward Seventh Army hospital on

18 September when it opened at Saulx,

25 miles northeast of Rioz. The 11th

moved from Aissey to Conflans, 10 miles

north of Saulx, 3 days later; and on 23

September the 9th Evacuation opened at

Plombières on the Moselle. The first contingent of the 27th Evacuation arrived at

Xertigny, about eight miles north of the

9th, the following day, but the hospital

was not in full operation before the end

of the month. All but the advance detachment of the 27th made the 450-mile

jump from Bouc-bel-Aire by rail. On 25

13

 In the Southern France Campaign, the 2d Convalescent Hospital carried only 2,000 rather than

its former 3,000 beds and was organized to operate

in two independent sections of 1,000 beds each.
INVASION OF SOUTHERN FRANCE 393

September the 93d Evacuation joined the

9th in the vicinity of Plombières. (Map

With the single exception of the 51st

Evacuation, all Seventh Army hospitals

were now concentrated close to the main

highway north from Besançon to Epinal.

The 51st was packed at Draguignan and

ready to move by 23 September, but

transportation was not available until

early October.

During the last two weeks of September almost continuous rain and cold

hampered hospital movements and made

operation a constant struggle with the

elements. All tents had to be ditched,

access roads graveled, and tent pegs periodically reset in the soft ground. Heating facilities were often inadequate to

keep patients warm.

Special Hospital Facilities

In addition to field and evacuation

hospitals, Seventh Army maintained provisional hospitals for the specialized

treatment of venereal disease and neuropsychiatric cases and, until the 2d

Convalescent Hospital got into full operation, a provisional convalescent hospital

as well. The venereal disease and neuropsychiatric hospitals had been planned

in advance, on the pattern of those set up

by Fifth Army in Italy, and the clearing

platoons designated to operate them had

been given special training as well as

specialist personnel attached from other

units. The convalescent hospital was an

afterthought, made necessary by the unexpectedly rapid advance of the lines and

the late date predetermined for phasing

in the regular convalescent facility.

The convalescent hospital was the first

of the three specialized units to be established, though the procedure was very informal. On 18 August—D plus 3—the

682d Medical Clearing Company of the

52d Medical Battalion, then at Plan de la

Tour, arranged to hold the lightly

wounded and mildly ill who could return to duty in a short time if they could

be kept off the hospital ships bound for

Italy. The project grew. Beds and equipment were borrowed wherever they

could be had, and personnel were diverted from other duties. Within a week

the unit was operating 400 convalescent

beds and was unable to perform its normal functions.

The 164th Medical Battalion, less one

platoon of the 638th Medical Clearing

Company already in France, arrived on

26 August, and the following day a collecting company of the 164th took over

the convalescent hospital, which moved

forward to Aspres on the last day of the

month.

The venereal disease and neuropsychiatric hospitals, meanwhile, had both

been established according to plan on 20

August by the 616th Medical Clearing

Company of the 181st Medical Battalion,

released from its beach assignment the

previous day. Both hospitals were organized as 250-bed units, and both opened at

Le Luc, close to the Gonfaron site of the

95th Evacuation Hospital. The neuropsychiatric hospital carried a light patient load at this time, but the venereal

disease unit found it necessary almost

immediately to expand capacity to 375

beds to care for a backlog of cases arising

from contacts in Italy.

By definition both of these specialized

hospitals were forward units, and both

were moved to the Aspres area at the end

of the month. By this time long evacuation lines, scattered forces, and acceler-
394 MEDITERRANEAN AND MINOR THEATERS

TABLE 24—ADMISSIONS AND DISPOSITIONS, SEVENTH ARMY MEDICAL

INSTALLATIONS, 15 AUGUST-29 SEPTEMBER 1944

a

 Calculated from preceding columns. b

 Figure for total treated, taken from Annual Report, Surgeon, Seventh Army. Equivalent to admissions, since all

Navy patients were disposed of within the period covered by the table. Figure of 141 for admissions given in After

Action Report is obviously incorrect. c

 To PW enclosure. d

 Discharged from hospital.

Source: After Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct 44, An. 278 (admissions only) Annual Rpt, Surg,

Seventh Army, 1944.

ated build-up in the beach area had

brought about an acute shortage of mobile medical units. The 164th Medical

Battalion was given a beach assignment,

and without advance notice the 616th

Clearing Company was directed to take

over the provisional convalescent hospital on 4 September. The hospital at

that time held almost 500 patients, but

the 616th had only 3 officers and 8 enlisted men who could be spared from the

venereal disease and neuropsychiatric

centers. The 11 men staffed the convalescent hospital until additional personnel

from collecting companies of the parent

medical battalion could be rushed to

their aid.

The neuropsychiatric hospital moved

forward to Rives on 4 September; to

Samson, midway between Poligny and

Besançon, six days later; and on 24 September joined the growing group of

medical installations around Plombières

on the Moselle. The venereal disease center moved to St. Jean de Paris, a suburb

of Ambérieu, on 6 September, where the

convalescent hospital had been established the day before; to Rioz on the

13th; and to Plombières on 28 September. The convalescent hospital, its usefulness ended with the establishment of the

2d Convalescent in Besançon, closed on

25 September. An annex, operated at

Rioz in connection with the venereal disease hospital, closed two days later.

The convalescent hospital had reached

a peak load of more than 800 patients,

while the neuropsychiatric center, reflect-
INVASION OF SOUTHERN FRANCE 395

ing the growing severity of combat and

the deterioration of the weather, was

caring for 300 patients by the end of the

month.

A second venereal disease center was

operated in connection with the provisional hospital at Beauvallon by the

638th Medical Clearing Company from 4

September. This center was still in operation when the 164th Medical Battalion

passed from army to base section control

early in October.

Medical Summary: Seventh Army

Table of Organization bed strength in

Seventh Army hospitals by the end of

September was 5,000, not counting clearing stations and special hospitals operated by clearing companies, plus 2,000

convalescent beds. Admissions to Seventh

Army medical installations, including

clearing stations, totaled more than

28,000 for the period 15 August-30 September, of which 13,000 were evacuated

to the communications zone and more

than 9,000 were returned to duty.

(Table 24) Troop strength by the end of

September was approximately 140,000.

Evacuation From

Seventh Army

Evacuation Within the Combat Zone

When VI Corps pushed inland from

its landing beaches, evacuation of division clearing stations was carried out by

the 56th Medical Battalion. Highways

were generally excellent, but through

much of the advance the terrain was

mountainous and until the concentration

of evacuation hospitals along the Moselle

in late September, distances were great.

To minimize the factor of distance as

much as possible, holding hospitals were

set up during periods of rapid advance

by a platoon of the corps clearing company and a field hospital unit to retain

patients until an evacuation hospital

could move forward.14

The battalion maintained liaison with

VI Corps through an officer stationed in

the corps surgeon's office, and with the

evacuation hospitals through a noncommissioned officer stationed in the registrar's office of each hospital serving the

corps. Bed status reports from each evacuation hospital were submitted every

four hours, or oftener if the situation demanded, the reports being carried by

ambulance drivers or telephoned to battalion headquarters. This information

permitted the corps surgeon to direct the

flow of patients to the evacuation hospitals in terms of current information.

Medical support for the 1st Airborne

Task Force followed an unorthodox pattern, the three collecting stations of the

676th Medical Collecting Company

being comparable to small clearing stations. Casualties were evacuated by

ambulances of the company to the provisional hospital operated by the 514th

Medical Clearing Company of the 58th

Medical Battalion in Nice. After 6 October autorail trains staffed by personnel

of the 676th made daily runs between

the collecting stations and the hospital.

The hospital was cleared by the 58th

Medical Battalion.

14

 Principal sources for this section are: (1)

After Action Rpt, Surg, Seventh Army, 15 Aug31 Oct 44; (2) Annual Rpt, Med Sec, MTOUSA,

1944; (3) Annual Rpt. Surg, Seventh Army, 1944;

(4) Annual Rpt, Surg, VI Corps, 1944; (5) Unit

rpts of the med units mentioned in the text.
396 MEDITERRANEAN AND MINOR THEATERS

CARRYING D-DAY WOUNDED TO THE BEACH FOR TRIP BY LST TO CORSICA

Evacuation to the Communications

Zone

During the first day of the invasion of

southern France, casualties were evacuated from the beach clearing stations by

small craft to the transports and carried

by LST to Ajaccio, Corsica, where the

40th Station Hospital was prepared to receive them and to send the more serious

cases on to Naples by air. A little over

300 reached Ajaccio by LST on 15 August.15

15

 According to the Seventh Army Surgeon's After

Action Report for the period 15 August-31 October 1944, only 380 patients were evacuated from

southern France by LST. (See Table 26, below.)

The 1944 annual report of the Northern Base

Section surgeon, however, says 489 evacuees from

the Riviera beaches were received by the 40th

Station Hospital, and the report of the

hospital itself for the same period puts

the figure above 500. The presumption is

that one or more of the hospital ships discharged

some critical cases at Ajaccio to be flown to Naples,

but there is a tendency in Army reports to lump

all sea evacuation as by hospital ship. It may be

that the LST total was actually considerably higher

than indicated. For example, the report of the

Naval Commander, Western Task Force, page 368,

says that approximately 1,800 casualties were

evacuated to hospital ships during the period of

the automatic schedule (D plus 1 through D plus

6), whereas the ETMD report for August 1944

gives a figure of 3,262 for the same period.

General sources for this section are: (1) ETMD,

MTO, for Aug 1944; (2) After Action Rpt, Surg,

Seventh Army, 15 Aug-31 Oct 44; (3) Rpt of Naval

Comdr, Western Task Force, Invasion of Southern

France; (4) Annual Rpt, Surg, Seventh Army, 1944;

(5) Annual Rpt, Med Sec, MTOUSA, 1944; (6)

Unit rpts of med units mentioned in the text.
INVASION OF SOUTHERN FRANCE 397

Three hospital ships arrived off the

landing beaches on D plus 1 as planned,

although they were not there as early in

the day as had been expected. The relatively small number of casualties, however, made it possible to hold in the

clearing stations those patients whose

condition required the better accommodations of the hospital ships. The automatic schedule continued through 21

August—3 ships on D plus 2, one on D

plus 3, 2 each on D plus 4 and D plus

5, and one on D plus 6.

Vessels used during the first 3 days

carried surgical teams drawn from personnel of the 3d, 36th, and 43d General

Hospitals, and the 59th Evacuation Hospital, all on the DRAGOON troop list. The

USAHS John Clem, smallest of the hospital ships, carried only one surgical

team, while the Acadia, with a capacity of

788 patients, carried 3. The Shamrock,

Thistle, Algonquin, Chateau Thierry,

and Emily Weder carried 2 surgical

teams each.

After D plus 6, hospital ships were sent

into the area on a one-a-day basis until 28

August, and thereafter at the request of

the Seventh Army surgeon. One ship was

held in continuous readiness at Ajaccio.

Until D plus 5 hospital ships called at all

three landing beaches, but beginning on

D plus 6 all evacuees were taken by ambulance to the clearing station of the

58th Medical Battalion at Ste. Maxime,

where the ships were loaded. Through 21

August all hospital ships discharged at

Naples with no segregation of casualties

by nationality. From 22 August through

29 August vessels loaded to 60 percent or

more with French casualties or prisoners

of war were sent to Oran.

With the fall of Marseille and Toulon,

enough fixed hospital beds became available to the French forces to make evacuation out of France unnecessary. This

factor, combined with the beginning of

air evacuation on D plus 7, greatly reduced the need for hospital ships and

none were requested by Seventh Army

after 30 August.

Air evacuation from southern France

was carried out by the 802d and 807th

Medical Air Evacuation Transport

Squadrons, which continued at the same

time to clear forward areas in Italy. Beginning on 22 August, flights were made

initially from the most forward airfields

available directly to Naples and occasionally to other Italian bases. Airfields in the

vicinity of the landing beaches—St.

Tropez, Le Luc, and Aix-en-Provence—

were quickly left behind. Sisteron and

Crest both served for a time, and flights

began from Ambérieu northwest of Lyon

on 9 September.

By this date, the weather was becoming uncertain and the distances to Italian

bases were lengthening. With the great

air base at Istres, about twenty-five miles

northwest of Marseille available, flights

were directed there, where patients could

be relayed on by air to Naples or sent to

one of the fixed hospitals moving into

the Rhône delta. Before the end of September air evacuation in France had

been largely reduced to a single route,

from Luxeuil close to the bulk of Seventh Army medical installations, to

Istres.

Air evacuation from France to Italy,

and from the Seventh Army area to

Istres, for the period 22 August through

7 November, when the two air evacuation squadrons from Italy were withdrawn, is summarized in Table 25.

Seventh Army evacuation hospitals

from their first establishment were
398 MEDITERRANEAN AND MINOR THEATERS

TABLE 25—AIR EVACUATION FROM SEVENTH ARMY AND DELTA BASE SECTION

22 AUGUST-7 NOVEMBER 1944

Source: Annual Rpts, 802d and 807th MAETS, 1944.

cleared by the 52d Medical Battalion.

Patients were carried by ambulance to

the Riviera beaches for hospital ship

evacuation, to holding units at airfields

or railheads, or to fixed hospitals as these

became available close to the front. Air

evacuation holding hospitals were operated by the clearing companies of the

32d and 164th Medical Battalions. The

largest of these was at Istres, operated by

the 52d Medical Battalion until 17 September and thereafter by the 164th.

More than 1,000 beds were available,

with a daily patient turnover often

greater than 600. The fall rains made

flight schedules erratic with a highly variable patient census as a consequence.

Property exchange with air evacuation

units was a continuous problem because

the personnel carriers used generally had

full loads on the incoming trip, and often

made one or more trips in Italy before

returning to France.

As soon as the rail lines were back in

operation, hospital trains were pressed

into service for evacuating forward hospitals. The 42d Hospital Train, veteran

of both North Africa and Italy, made its
INVASION OF SOUTHERN FRANCE 399

LCI ALONGSIDE THE SHAMROCK off St.

Tropez, 17 August. The men will be

transferred to the hospital ship in the basket,

left foreground.

first run between Marseille and the railhead at Mouchard, about twenty miles

southwest of Besançon, on 25 September.

The 66th Hospital Train, also a veteran

unit, though with less service in the

theater than the 42d, left Besançon for

Marseille on its initial run on 9 October.

Both trains used reconditioned French

passenger cars.

The slower pace of the campaign after

crossing the Moselle, and the relatively

stable front, permitted the establishment

of fixed hospitals well forward before the

end of October, with ambulance evacuation taking the place of air and rail for

the shorter runs.

Throughout the campaign it was possible to handle the tremendous job of

clearing army hospitals over long distances from a rapidly moving front only

by constant juggling of the inadequate

number of ambulance platoons available.

Ambulances were kept going around the

clock and on occasion passing trucks were

commandeered to carry patients to the

rear.16

Table 26 summarizes evacuation from

forward installations to the communications zone, including Italian and North

African base sections and those established in France, for the period of

Mediterranean theater jurisdiction over

DRAGOON.

Extension of the Communications

Zone

Before DRAGOON could be transferred

completely to the European Theater of

Operations, it was necessary to free the

operation of its logistical dependence on

Italy and North Africa. It was therefore

contemplated throughout the planning

phase that the communications zone

would be extended to southern France at

the earliest possible date. To this end the

Coastal Base Section was organized in

Naples early in July.

Organization of the Base Sections

The Coastal Base surgeon, Colonel

Bishop, and key members of his staff

were in close touch with the Seventh

Army surgeon throughout the planning

stage, and were early arrivals in France.

The first echelon of the medical section

came ashore between D plus 1 and D

plus 10, and the entire section was in

France by 29 August. The early arrivals

remained in the landing areas to work

with the beach control group, and the

rear echelon set up a headquarters in

16

 See, e.g., 9th Evac Hosp, Med Hist Data, 1

Jan-31 Oct 44.
400 MEDITERRANEAN AND MINOR THEATERS

TABLE 26—SUMMARY OF EVACUATION TO THE COMMUNICATIONS ZONE

15 AUGUST-3 NOVEMBER 1944

Source: Compiled from ETMD, MTO, for Aug 44; and After Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct 44.

Marseille. The medical section was already supervising rear army installations

as well as evacuation and supply activities on the beaches when the base section

formally assumed operational control of

the coastal region of southern France on

9 September.17

By that date, Seventh Army was beyond Besançon in its spectacular dash toward the Rhine, and the communications

zone organization appeared inappropriately named. The Coastal Base Section

became the Continental Base Section on

12 September 1944, and as of 1 October

was split into the Delta Base Section,

with headquarters in Marseille, and the

Continental Advance Section (CONAD)

with headquarters in Dijon. Colonel

Bishop continued as surgeon of CONAD

while Colonel Jeffress became Delta Base

surgeon.

Both medical section organizations

were similar to those elsewhere in the

Mediterranean, with functional subdivisions for administration, personnel, hospitalization, evacuation, medical records,

medical supply, dental, and veterinary.

The Delta Base medical section was primarily concerned with incoming supply,

evacuation to Italy and to the zone of interior, and hospitalization of service

troops, long-term patients, and prisoners

of war. The medical section of CONAD

was primarily concerned with the more

immediate support of Seventh Army and

of the 6th Army Group.

Both Delta Base and CONAD came

under the general jurisdiction of the

Southern Line of Communications

(SOLOC) , on 20 November, when all

COMZ functions in southern France

17

 Sources for this section are: (1) Annual Rpts,

Med Sec, Delta Base Sec, 1944, 1946; (2) Monthly

Rpt, Delta Base Sec, Oct 1944; (3) Annual Rpt,

Continental Adv Sec, 1944; (4) CONAD History,

1944-1945; (5) Annual Rpt, Med Sec, MTOUSA,

1944; (6) Hist of Med Sec, Hq, COMZ NATOUSA;

(7) Ltr, Gen Stayer, Surg, NATOUSA, to Gen

Kirk, TSG, 26 Sep 44.
INVASION OF SOUTHERN FRANCE 401

TABLE 27—ESTABLISHMENT IN SOUTHERN FRANCE OF FIXED HOSPITALS FROM

NORTH AFRICA, ITALY, AND CORSICA

a

 Last operating site. b

 Date when bulk of personnel and equipment docked.

Source: Compiled from annual rpts of hospitals included.

passed finally from MTO to ETO.

The SOLOC medical section was essentially the medical section of COMZ,

NATOUSA, which had been functioning in Naples since February 1944, with

Colonel Shook as surgeon.18

 An advance

echelon of the COMZ medical section

had been established in Dijon early in

October by Colonel Cocke, Colonel

Shook's deputy.

Establishment of Fixed Hospitals

U.S. fixed hospitals with an aggregate

Table of Organization strength of 14,250

beds were on the DRAGOON troop list,

to be phased in between D plus 25 (9

September) and D plus 60 (14 October).

The installations included were drawn

from North Africa, Italy, and Corsica.

The unexpected speed with which Seventh Army moved north made the schedule unrealistic before the first hospital

arrived. In only three instances, however,

was it possible to advance the schedule,

and these were balanced by others in

which even the retarded landing dates

originally fixed were not met. (Table 27)

The accelerated pace of the campaign,

moreover, brought such heavy demands

for transportation that the establishment

of hospitals was often unduly delayed

after their arrival. Another delaying factor was the difficulty in locating suitable

sites in a densely populated country at a

season when tents could not be satisfactorily used.19

18

 See pp. 323-26, above, 486-88, below.

19

 Sources of this section are the same as those

for the preceding section, with the addition of unit

reports of medical units mentioned in the text.
402 MEDITERRANEAN AND MINOR THEATERS

The first U.S. fixed hospital to operate in southern France was the 36th General, which took over a captured German

hospital—originally a French tuberculosis

sanatorium—at Les Milles near Aix-enProvence on 17 September. Approximately 600 prisoner of war patients were

in the hospital at that time, but these

were concentrated in about half the ward

area. Two days later the 36th General

also began operating in Aix-en-Provence

itself, in the buildings of a French psychiatric hospital. To avoid unnecessary

dispersion of staff members, all surgical

cases were handled at Les Milles, with

medical cases going to Aix. (Map 34)

Both hospitals were turned over, with

their patients, to the 43d General—Les

Milles on 25 September and Aix on the

27th. The 3d General Hospital took over

the installation in Aix-en-Provence on 9

October, taking 763 medical patients

from the 43d at that time. The 43d General continued to administer the prisoner

of war hospital at Les Milles in addition

to its normal functions. The German

hospital captured at Draguignan was

consolidated with the Les Milles facility,

which operated under U.S. supervision

with German protected personnel. German enlisted men were used as litter

bearers throughout the hospital.

The 78th Station Hospital, meanwhile, had opened in a resort hotel in St.

Raphael on 19 September, and the 80th

Station had relieved the 675th Medical

Collecting Company, which had been

operating a provisional hospital in the

buildings of an old ladies' home in Marseille.

The first fixed hospital to open in the

forward area, which would come under

operational control of the Continental

Advance Section on 1 October, was the

46th General, which was rushed at the

request of the Seventh Army surgeon to

Besançon. The hospital opened with a

minimal portion of its equipment in the

Caserne Vauban, a former French infantry barracks, on 20 September. The

front was only a dozen miles away, and

the 9th Evacuation Hospital, from which

the first group of patients came, was at

Poligny 40 miles to the rear. The patient

census of the 46th General rose to almost

3,000 within 3 weeks.

The 36th General, after surrendering

its two sites at Aix-en-Provence, was assigned to CONAD and opened at Dijon

on 13 October in a former French cavalry barracks. The 36th had a census of

1,400 patients within a week. It was

joined at Dijon on 20 October by the

180th Station, one of the few 250-bed

units left in the theater.

On 14 October the 35th Station Hospital opened at Chalon-sur-Saône, south

of Dijon, the accommodations again being a French caserne, or military barracks. A week later the 2,000-bed 21st

General opened at Mirecourt, just west

of the Moselle, in the unfinished plant of

a large, modern French psychiatric hospital. The 51st Station, which had been

functioning as a neuropsychiatric hospital in both Africa and Italy, continued

the same specialty in France, opening at

Auxonne on 4 November. In this case the

military atmosphere of the French barracks that housed the unit was regarded

as an asset.

The 23d General Hospital opened on

5 November at Vittel, so close to the

front that its first 300 patients were received direct from Seventh Army by ambulance. The hospital was adequately

housed in a group of resort hotel buildings. Last of the CONAD hospitals trans-
INVASION OF SOUTHERN FRANCE 403

FIXED HOSPITALS AND SUPPLY UNITS

TRANSEFERRED FROM MTO TO ETO,

20 NOVEMBER 1944

Delta Base Section

Aix-en-Provence

43d General, 25 September. 1,500 beds.

3d General, 9 October. 1,500 beds.

Marseille

80th Station, 30 September. 500 beds.

70th Station, 1 November. 500 beds.

69th Station, 8 December. 500 beds.

231st Medical Composite Battalion.

St. Raphael

78th Station, 19 September. 500 beds.

La Ciotat

7607th Station (Italian), October. 500 beds-.

Continental Advance Section

Chalon-sur-Saône

35th Station, 14 October. 500 beds.

Auxonne

51st Station, 4 November. 500 beds.

Dijon

36th General, 13 October. 2,000 beds.

180th Station, 20 October. 250 beds.

70th and 71st Medical Base Depot Companies.

Besançon

46th General, 20 Sepetmber. 1,500 beds.

Vittel

23d General, 5 November. 2,000 beds.

Épinal

23d Station, 10 November. 500 beds.

Mirecourt

21st General, 21 October. 2,000 beds.

MAP 34—Fixed Hospitals Transferred From

MTO to ETO, 20 November 1944

ferred from MTO was the 23d Station,

which opened in a school building at

Épinal on 10 November, almost two

months after its arrival in France.

Two late arrivals in Delta Base, the

69th and 70th Station Hospitals, completed the DRAGOON troop list. The 70th

opened in a French mental hospital in

Marseille on 1 November and, because

of the facilities its site afforded, became

the principal center for handling closedward neuropsychiatric cases in Delta

Base. The 69th Station did not arrive in

France until 18 November and was not

ready to receive patients until 8 December.

Counting the still inoperative 69th

Station, there were 5,000 Table of Organization beds in Delta Base and 9,250

in CONAD as of 20 November 1944,
404 MEDITERRANEAN AND MINOR THEATERS

when southern France passed completely

to ETO control.

In addition to these fixed hospitals, the

7607th Station Hospital (Italian) opened

at La Ciotat, on the coast between Marseille and Toulon, in October to care for

personnel of Italian service units.

Though nominally a 500-bed hospital,

the 7607th operated 1,000 beds. The venereal disease center maintained by the

638th Medical Clearing Company of the

164th Medical Battalion at Beauvallon

was shifted on 9 October to a staging

area between Marseille and Aix-en-Provence, where it continued to carry on

the same mission under Delta Base control. The 4th Medical Laboratory, which

arrived in southern France on 9 September, served both base sections. The base

laboratory, with the 6703d Blood Transfusion Unit attached, was located in

Marseille; a mobile section consisting of

one officer and four enlisted technicians,

was sited in Dijon. Both sections occupied university laboratory buildings of

functionally suitable design.

Evacuation From CONAD

and Delta Base

As soon as the base sections were set

up, they took over responsibility for

clearing hospitals in the Army area and

distributing the patients among the available hospitals. The base sections were

also responsible for interbase transfers;

Delta Base evacuated to the zone of interior, beginning in October.20

During October 1944, CONAD evacuated from its own hospitals to Delta Base,

1,325 patients by air, 1,496 by motor, and

871 by rail. In the same month, Delta

Base transferred 2,808 patients to the

Peninsular Base Section in Italy by air

and 2,843 by sea, while 93 were evacuated by sea to the United States.

With fixed beds in the forward area

still at a premium, CONAD followed no

fixed evacuation policy, but cleared its

hospitals to Delta Base as rapidly as transportation and the condition of the patients allowed. Toward the end of

October, Delta Base established a 45-day

policy for evacuation to PBS, retaining

all patients expected to recover in less

than that time.

Delta Base continued to evacuate some

patients to Italy until 20 November, the

totals for the period 1-20 November

being 29 by air and 433 by hospital ship.

The slack was taken up by the greatly increased number of beds available in

southern and eastern France by early

November, and by the beginning of direct air evacuation from CONAD to the

United Kingdom on the 12th of that

month.

Medical Supplies and Equipment

By the time medical supplies began

coming across the landing beaches of

southern France in appreciable quantities about D plus 3, the army and base

responsibilities in the supply area were

being differentiated. Both the Seventh

Army medical supply officer, who was

also commanding officer of the 7th Medical Depot Company, and the Coastal Base

Section medical supply officer on temporary duty with Seventh Army came

ashore on D plus 1. The three beach

dumps were taken over from the beach

medical battalions by the advance sec20

 This section is based primarily on: (1) Annual

Rpt, Med Sec, CONAD, 1944; (2) Annual Rpt,

Med Sec, Delta Base, 1944; (3) Annual Rpt, Med

Sec, MTOUSA, 1944.
INVASION OF SOUTHERN FRANCE 405

tion of the 7th Medical Depot Company

on 16-18 August.21 Three days later a

single point for the receipt of incoming

medical supplies was established at Ste.

Maxime. At this time supervision passed

to the base supply organization, although

21 enlisted men of the advance section,

7th Medical Depot Company, were detached to help operate the dumps for the

beach control group. These men did not

rejoin their own unit until 15 September.

Seventh Army Medical Supply

The first forward issue point for Seventh Army was set up at Le Cannet, near

Le Luc, on 21 August, moving to St.

Maximin, about 20 miles east of Aix-enProvence, 2 days later. The main body of

the 7th Medical Depot Company joined

the advance section there on 25 August.

On 29 August the base section of the

depot moved to Meyrargues, 10 miles

north of Aix, while one storage and

issue platoon jumped forward to Aspremont in the vicinity of VI Corps' forward

medical installations.22

It was at this time that the battle of

Montélimar came to its indecisive close

and Seventh Army raced ahead to cut off

the retreating enemy before he could

slip through the Belfort Gap. In this

stage of the campaign, medical supply

dumps were hard pressed to keep within

any kind of reasonable distance of the installations they served. The Meyrargues

dump closed on 5 September, and a new

issue point opened the same day at

Voreppe, ten miles northwest of Grenoble. The Aspremont dump closed the

following day.

The next move was from Voreppe to

Sellières, ten miles north of Lons-leSaunier, on 12 September. The area was

already too far behind the advancing Seventh Army installations, however, and a

second forward dump was opened the

next day at Baume-les-Dames, fifteen

miles northeast of Besançon. With the

change of direction following the shift

to SHAEF command, the Baume dump

moved to Vesoul on 19 September, where

it was joined a day later by the group

from Sellières. At Vesoul the dump was

in a building for the first time, being

housed in a large tobacco warehouse.

On 2 October the 1st Storage and Issue

Platoon opened at Épinal, with the remainder of the company moving up

gradually until 17 October, when the

Vesoul dump was closed. On the same

day a second dump was opened at Lunéville, some thirty miles north of Épinal.

The Épinal and LunéVille dumps were

in buildings large enough to accommodate mess and billets as well as the depot

itself.

Throughout the early weeks of the

campaign, transportation presented the

greatest difficulty. While the army issue

points were still close to the beaches,

medical supplies were unloaded from the

ships to Dukws, which ferried them

ashore and delivered them directly to the

dumps. As the army moved forward,

medical supplies were brought up in organic vehicles of the 7th Medical Depot

Company, operating around the clock.

The pressure was relieved only after the

21

 See p. 380, above. 22

 Principal sources for this section are: (1) After

Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct

44, an. 278; (2) Annual Rpt, Surg, Seventh Army,

1944; (3) Annual Rpt, 7th Med Depot Co, 1944;

(4) Med Hist, 7th Med Depot Co, 25 Oct 44; (5)

Unit rpts, 9th, 11th, 27th, 51st, 59th, 93d, 95th

Evac Hosps, 1944; (6) Davidson, Med Supply in

MTOUSA, 143-50.
406 MEDITERRANEAN AND MINOR THEATERS

TABLE 28—REQUISITIONS AND TONNAGE, 7TH MEDICAL DEPOT COMPANY

AUGUST-NOVEMBER 1944

Source: Annual Rpt, 7th Med Depot Co, 1944.

Services of Supply organization was able

to build up substantial stock levels in the

rear areas and took over responsibility

for delivering supplies to Seventh Army

depots. The evacuation hospitals were

similarly pressed for vehicles to carry

their own supplies from the army issue

points, which were sometimes as much as

150 miles away. Only the extra stocks

carried by each Seventh Army hospital

prevented critical shortages of some

items.

Until the inauguration of rail transportation in late September, it was difficult to keep a sufficient volume of medical supplies in the army area. Many items

were distributed on a ration basis

through most of October, but there were

no actual failures to meet minimum requirements. Local procurement was unnecessary to any important extent since

quantities of captured German supplies

were available. Housekeeping equipment, such as wood-burning stoves, pots

and pans, knives, dishes, enamelware,

electric refrigerators, and kerosene lamps

generally came from this source. In emergencies, requisitions were filed with SOS

NATOUSA in Naples by cable and supplies were sent by air.

Two portable optical units of the 7th

Medical Depot Company averaged

twenty-four pairs of spectacles and six repair jobs a day for army troops. Two

dental prosthetic teams joined the depot

company, one in late September and one

in early October, serving variously with

the 2d Convalescent Hospital, the 35th

Field Artillery Group, and the parent

unit.

During the months in which the 7th

Medical Depot Company was supported

by the Mediterranean Theater of Operations, monthly tonnage issued rose from

64.5 in August to 356.8 in November.

(Table 28)

Medical Supply in the

Communications Zone

The 231st Medical Composite Battalion—with its two attached medical base

depot companies, the 70th with 2 officers

and 29 enlisted men, and the 71st with

one officer and 30 enlisted men—was activated in Oran on 15 August 1944, absorbing personnel and equipment of the 2d

Medical Depot Company, and was

assigned immediately to the DRAGOON

operation.23 The unit reached St.

23

 See p. 345, above.
INVASION OF SOUTHERN FRANCE 407

Raphael on 9 September. The 71st Medical Base Depot Company took over operation of the Ste. Maxime depot, while

the 70th accompanied the battalion to

Marseille. A large garage and hangar had

already been obtained by the Coastal

Base Surgeon as a depot site. Eight operational medical units, each sufficient to

maintain 10,000 men for 30 days, reached

Marseille simultaneously with the supply

personnel, and within 72 hours the depot

was able to issue supplies.24

When the depot was in full operation,

the 231st Medical Composite Battalion

was sent to Dijon to set up a more forward base, the 71st Medical Base Depot

Company moving to the Marseille depot

on 24 September. It was at this time,

however, that the decision to establish

two base sections was made, and late in

October the 231st returned to Marseille

to resume operation of the Delta Base

depot. The 70th and 71st Medical

Base Depot Companies were assigned

to CONAD, joining forces to operate

the Dijon depot, which was sited in a

French barracks. Italian service units and

French civilians were used as needed by

both base section depots.

Both Delta Base and Continental Advance were supplied by COMZ NATOUSA, but all supplies for CONAD

passed through Delta Base. They were

often transferred by Dukw from ships to

freight cars bound for the forward area

without ever entering a Delta Base

dump. For about two months supplies

were not received in Delta Base in large

enough quantities to maintain adequate

stock levels in either base section. Arrival times were uncertain, the condition

of the only partially restored port of

Marseille made unloading difficult, and

transportation shortages frequently delayed movement of supplies from the

docks to the depot. All together, the Delta Base supply organization was able to

fill during October only about 60 percent of the requisitions from Seventh

Army, 1st French Army, CONAD, and

Delta Base. All base section medical

units, however, carried 90-day supply

levels with them to France and were not

seriously handicapped by the slow buildup. The authorized stock level of 30

days of operating supplies and a 45-day

reserve was reached in mid-November.

Supplies adequate for 7 days of operation, with an 8-day reserve, were in the

CONAD depot and the remainder in

Delta Base warehouses.

As many items as possible were procured locally, including motor vehicles,

which greatly facilitated the movement

of supplies. Inducements were offered

for the return of salvage and emphasis

was placed on repair. After the return of

the 231st Medical Composite Battalion

to Delta Base, CONAD was without any

medical maintenance and repair service

of its own. Some repair work was farmed

out to other military units, but many

items had to be shipped to Marseille for

repair.

The transfer of supply functions to the

European theater was actively under discussion through October. The method

24

 Principal sources for this section are: (1)

Annual Rpt, Med Sec, MTOUSA, 1944, an. K; (2)

Rpt of Med Sec, Hq, COMZ NATOUSA; (3) Annual Rpt, Med Sec, Delta Base Sec, 1944; (4)

Annual Rpt, Med Sec, CONAD, 1944; (5) Med

Hist Data, 231st Med Composite Bn, 28 Oct 44;

(6) Hist Journal, 231st Med Composite Bn, 13 Aug

44-31 Dec 45; (7) Annual Rpt, 7th Med Depot

Co, 1944; (8) Davidson, Med Supply in MTOUSA,

150-56.
408 MEDITERRANEAN AND MINOR THEATERS

TABLE 29—RECEIPTS AND ISSUES, 231ST MEDICAL COMPOSITE BATTALION

SEPTEMBER-NOVEMBER 1944

Source: Hist Journal, 231st Med Composite Bn, 13 Aug 44-31 Dec 45.

finally adopted was to transfer six officers

and twenty-six enlisted men, all specialists in medical supply, from Headquarters, COMZ NATOUSA, to Headquarters, Southern Line of Communications.

The effective date of the transfer was 20

November 1944.

The supply build-up in southern

France is well shown by the record of

receipts and issues of the 231st Medical

Composite Battalion set forth in Table

29.

Professional Services in Southern

France

Medicine and Surgery

In both medicine and surgery, the

practices developed in earlier Mediterranean campaigns carried over to southern France. Medical officers and enlisted

technicians who had gained their combat experience in North Africa, Sicily,

and Italy supplied the continuity, while

the theater consultants—Colonel Churchill in surgery and Colonel Long in

medicine—gave the same attention to the

medical service of Seventh Army, Delta

Base, and CONAD that they gave to

other armies and the base sections in the

theater.

Forward Surgery—Field hospital platoons, operating within litter-carrying

distance of the division clearing stations,

continued to be the primary unit for forward surgery. In the Southern France

Campaign, these units were set up to

accommodate a maximum of 60 patients.

The number actually cared for at any

one time was usually between 25 and 40.

Nontransportable patients went directly

to these hospitals, where teams of the 2d

Auxiliary Surgical Group performed

such surgical procedures as were necessary to save life and limb and to put the

patient in condition to be moved to an

evacuation hospital farther to the rear.

Cases going to the field hospitals usually

included severe hemorrhage, wounds of

the abdomen, severe chest wounds, multiple fractures, traumatic amputations, and

those in immediate need of transfusion.

Other surgical cases went directly to

the evacuation hospitals, as did those

who had received initial treatment in the

field units. The forward evacuations

were organized and their tents laid out

with the efficiency of the surgical service

as the main consideration. In periods of

heavy combat, evacuation hospital surgeons worked as teams in 12- and sometimes 16-hour shifts, with operating

rooms continuously in use. The maxi-
INVASION OF SOUTHERN FRANCE 409

mum holding period was seven days.25

The theater consultant, Colonel

Churchill, spent three weeks visiting

forward and base installations in southern France, beginning 16 September. He

was followed in mid-October by the

orthopedic consultant, Lt. Col. Oscar P.

Hampton, Jr. The Seventh Army surgical consultant, Colonel Berry, was active

in organizing and supervising the surgical work of army hospitals from the

start of the campaign.26

In addition to adequate supplies of

penicillin, which had largely replaced

the sulfonamides, Seventh Army surgeons also had the advantage of daily

deliveries of whole blood. From D plus

1 until D plus 8, blood was flown from

the 15th Medical General Laboratory in

Naples to Corsica and relayed to the invasion beaches by fast PT boats. Thereafter it was flown directly to the most

forward airfield, where personnel of the

6703d Blood Transfusion Unit received

and distributed it on a priority basis first

to the field hospital units, then to the

400-bed evacuations, and finally to the

750-bed evacuations. The field hospitals

averaged 3.5 to 4 units of whole blood

per patient transfused, the evacuation

hospitals 2 to 2.5 units. Blood also came

by way of Naples from the French blood

bank in Algiers.27

As the army moved forward and flight

distances from Naples lengthened, forward hospitals drew blood locally whereever possible and maintained small blood

banks of their own. In November a section of the 6707th Blood Transfusion

Unit set up a blood bank in Marseille,

where donors were available among service troops. Many civilians were also induced to give blood by the offer of flight

rations to those who participated. A mobile section operated in the forward area,

but the number of donors was too

limited to be relied upon.28

Neuropsychiatry—The procedure for

handling neuropsychiatric cases in Seventh Army was patterned on the increasingly successful system developed in Italy

by Fifth Army under the guidance of the

theater neuropsychiatric consultant,

Colonel Hanson. Again continuity was

provided by transfer of personnel, including the army consultant Major

Ludwig, who had been commanding officer of the Fifth Army Neuropsychiatric

Center.

Owing largely to the rapid initial advance of Seventh Army, with accompanying high morale among the combat

troops, the incidence of psychiatric disorders was low during the first month

of the campaign. Beginning in mid-September, however, as the terrain became

more difficult, the weather deteriorated,

and enemy resistance stiffened, an increasing number of neuropsychiatric

casualties passed through the division

clearing stations. The three divisions of

VI Corps had been in almost continuous

combat since the Salerno landings, and

the impact of battle fatigue was cumulative.29

25

 (1) Annual Rpt, Surg, Seventh Army, 1944. (2)

Annual Rpt, 2d Aux Surg Gp, 1944. (3) Annual

Rpts, 1944, of l0th and nth Field Hosps; and 9th,

nth, 27th, 51st, 59th, 93d and 95th Evac Hosps. 26

 Annual Rpt, Med Sec, MTOUSA, 1944, an. E. 27

 (1) Annual Rpt, Surg, Seventh Army, 1944.

(2) Quarterly Rpt, 15th Med Gen Lab, 3d Quarter

1944.

28

 Annual Rpt, Delta Base, 1944. 29

 Principal sources for this section are: (1)

After Action Rpt, Surg, Seventh Army, 15 Aug-31

Oct 44, an. 278; (2) Annual Rpt, Surg, Seventh

Army, 1944; (3) Annual Rpt, 181st Med Bn, 1944;

(4) Annual Rpt, 616th Med Clearing Co, 1944;

(5) Annual Rpts, 1944, of hosps mentioned in the

text.
410 MEDITERRANEAN AND MINOR THEATERS

LAST STAGES OF WHOLE BLOOD PIPELINE.

for transfer to invasion beach.

PT boat about to deliver whole blood to Dukw

The basic consideration was to treat

neuropsychiatric casualties as far forward as possible. Cases were first examined by the division psychiatrists in

the clearing stations, where every effort

was made to get the men back into combat without delay. Those that did not

respond promptly were sent to the

Seventh Army Neuropsychiatric Center,

operated by the 2d Platoon of the 616th

Medical Clearing Company, 181st Medical Battalion. The center had a staff of

eighty-five enlisted men, with four psychiatrists attached. The chief of the

psychiatric service was Capt. (later

Maj.) Stephen W. Ranson. All cases in

which a psychiatric diagnosis was made

at an evacuation hospital were also transferred to the center without further

treatment.

At the center, treatment followed the

pattern used in Fifth Army. Patients

were kept under mild barbiturate sedation for twenty-four hours, but were

maintained in ambulatory status. After

the initial period of rest and quiet, they

were interviewed and a course of therapy

prescribed. Patients were kept active and

were urged to interest themselves in the

recreational and orientation facilities of

the hospital.

Every effort was made to dispose of
INVASION OF SOUTHERN FRANCE 411

TABLE 30—VENEREAL DISEASE RATES, SEVENTH ARMY, JULY-SEPTEMBER 1944

cases as quickly as possible. Except in

special circumstances, four days was the

maximum holding period. Those who

could be returned to duty were then reequipped and sent back to their own

divisions without passing through a replacement command. Those who needed

further care went to a fixed hospital for

more extensive treatment. Evacuation to

Italy was necessary for a time, but among

the fixed units transferred to southern

France the 3d General Hospital at Aixen-Provence was equipped to handle psychiatric cases, while the 51st Station,

which opened on 4 November at

Auxonne, was exclusively a neuropsychiatric installation.

Returns to duty from the division

clearing stations were 50 percent of all

neuropsychiatric cases treated for the

period 15-31 August, 37 percent for the

period 1-15 September, and 23 percent

for the period 16-30 September. Returns to duty from the Seventh Army

Neuropsychiatric Center and other

Seventh Army hospitals for the same

periods were 29 percent, 11 percent, and

12 percent, respectively.

Preventive Medicine

During the period that southern

France was under Mediterranean theater

control, there were few problems in preventive medicine. Most serious of these

was venereal disease control. Malaria

had been anticipated as a problem and

prepared for, but proved to be minor.

Trench foot was developing into a problem of major concern at the time operations passed to ETO.

Venereal Disease Control—The Seventh Army Venereal Disease Treatment

Center, operated by the 616th Medical

Clearing Company, 181st Medical Battalion, was initially overloaded with

cases contracted in Italy during the staging period. The hospital, staffed by 8

officers and 93 enlisted men, had a

planned capacity of 250, but had to expand almost immediately to 375 beds.30

Additional contacts were made in the

coastal area, but as the army advanced

northward through predominantly agricultural country, opportunities for sexual contacts lessened. The rapidity of

movement also helped to reduce the

30

 Primary sources for this section are: (1) Annual Rpt, Surg, Seventh Army, 1944; (2) Annual

Rpt, 181st Med Bn, 1944; (3) Ltr, Col Barnes, VD

consultant, MTOUSA, to Surg, MTOUSA, 2 Nov

44. Sub: Venereal Disease Control Activities in

Seventh Army, Continental Base and Delta Base

Secs; (4) Annual Rpt, Med Sec, MTOUSA, 1944,

an. J; (5) Annual Rpt, Med Sec, Delta Base, 1944;

(6) Annual Rpt, Med Sec, CONAD, 1944.
412 MEDITERRANEAN AND MINOR THEATERS

venereal rate. (Table 30) In the main,

the preventive measures taken under the

direction of Major (later Lt. Col.)

James E. Flinn, Seventh Army venereal

disease control officer, were effective.

These included an intensive educational

program in the individual units, with

emphasis on the importance of immediate prophylaxis; rigid enforcement of

off-limits restrictions on known brothels;

and curfew hours that limited the time

available for contacts. The rapidity of

cures, under the new penicillin treatment, tended to discourage any deliberate exposure to escape hazardous duties.

Acute gonorrhea cases were returned to

duty from the Venereal Disease Center

within twelve hours, and mild cases were

treated on duty status.

In the base sections, particularly in

Delta Base, the problem was more difficult. Two metropolitan prophylactic

stations were established in Marseille,

but more were needed. All of the 31

licensed houses of prostitution in that

city were placed off-limits, but indications were that the women simply moved

to rooms and to small hotels, where they

were even harder to control. Five

brothels in Dijon were also placed offlimits apparently with more effect. Dispensaries and fixed hospitals in CONAD

saw relatively few venereal cases.

Malaria—A malaria problem in southern France had been anticipated during

the planning of DRAGOON, and a malariologist, Maj. Arthur W. Hill, was attached to Seventh Army, together with

the 132d Malaria Control Unit. While

a considerable number of cases were

treated in the early weeks of the campaign, they were virtually all contracted

in Italian staging areas before sailing.

Individual preventive and suppressive

measures were continued until 11 October, but were then discontinued as of no

further value, and Major Hill returned

to the 2655th Malaria Control Detachment in Italy.31

The 132d MCU went to the Coastal

Base Section in September, being replaced in Seventh Army by the 131st

MCU from Corsica. In October the 132d

went to CONAD and the 131st to Delta

Base. Both passed to ETO in November.

Neither of these units, however, engaged

in actual malaria control work. Inspection of the Marseille area immediately

after occupation of the city revealed no

malaria-infested mosquitoes, and none

were found in the advance north. The

malaria control units, under both army

and base section jurisdiction, were used

primarily for fly, roach, and bedbug control, and for general sanitation work.

Trench Foot—Trench foot appeared

among Seventh Army troops toward the

end of September, becoming an increasingly severe problem through the succeeding months, but that story belongs

rather to the ETO than to the MTO

period. The major contributing factor

was the same as it had been in Italy–

cold and wet weather in which men at

the front had no opportunity to change

socks or dry their feet for days at a time.

Wool socks and shoe pacs were issued,

but only after the condition had appeared. Even had they been available at

the start of the bad weather, however,

they would have had only a minimal

31

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. J; (2)

Annual Rpt, Surg, Seventh Army, 1944; (3) Annual

Rpt, Med Sec, CONAD, 1944; (4) Annual Rpt,

9th Evac Hosp, 1944.
INVASION OF SOUTHERN FRANCE 413

preventive effect, since the nature of the

action required that men stay in the lines

for considerable periods of time.32

Dental Service

During the staging period before

leaving Italy, Seventh Army dental officers, under the direction of Colonel

Gurley, Seventh Army dental surgeon,

made every effort to bring the dental

health of the assault troops to a high

level. Except for emergencies, little dental work was possible during the early

weeks of the invasion. Ninety percent of

the division dental officers did none at

all until D plus 15, functioning during

that period in various medical and administrative capacities. The dental services of the evacuation hospitals and of

the combat divisions were supplemented

around the beginning of October by two

dental prosthetic teams assigned to the

7th Medical Depot Company and a

third assigned to serve U.S. troops operating with 1st French Army.33

Inspection of the combat dental service of Seventh Army early in October by

the theater dental surgeon, Colonel

Tingay, revealed no dental problems.

Colonel Tingay was particularly impressed by the manner in which the dental work of the 3d Division was being

carried on. He reported:

One officer from each infantry regiment,

the officer assigned to special troops and

one officer from the medical battalion have

been attached to the division surgeon's

office and thus come under the direct control of the Division Dental Surgeon. With

this nucleus of five officers, clinics are

established in rearward areas in the most

feasible locations and a large volume of

work accomplished during actual combat. The other dental officer of each infantry

regiment is left with the regiment and the

officer assigned to artillery is left with the

division artillery. In addition to providing

emergency treatment these officers are also

able to accomplish some constructive

dentistry. A prosthetic laboratory truck has

been constructed and is placed in operation

wherever the rearward clinic is established.34

In the base sections dental work was

performed by dental personnel of the

fixed hospitals.

Veterinary Service

The first veterinary unit to arrive in

southern France was the 890th Medical

Service Detachment (formerly T Detachment), which had been active in the

theater since North African days. The

unit landed on the invasion coast on D

plus 8—23 August—and began supervising the issue of field rations at quartermaster Class I supply dumps in the beach

area. Throughout the period of MTO

control, the detachment worked in close

co-operation with the Seventh Army

quartermaster section, supervising the

issue of rations at army railheads.35

The 45th Veterinary Company (Separate) arrived on schedule on D plus 20

(4 September) . The veterinary detachments, consisting of 3 officers and 12

enlisted men each, of the 601st and 602d

Field Artillery Battalions arrived about

32

 (1) Annual Rpt, Surg, Seventh Army, 1944. (2)

Annual Rpt, Surg, VI Corps, 1944. (3) Annual

Rpt, Surg, 3d Inf Div, 1944. 33

 (1) Annual Rpt, Surg, Seventh Army, 1944.

(2) Annual Rpt 7th Med Depot Co, 1944.

34

 Rpt of Inspection by Col Tingay, 9 Oct 44. 35

 Principal sources for this section are: (1) Annual Rpt, Surg, Seventh Army, 1944; (2) Annual

Rpt, 17th Vet Evac Hosp, 1944; (3) Annual Rpt,

45th Vet Co (Separate) , 1944; (4) Annual Rpt,

Med Sec, CONAD, 1944.
414 MEDITERRANEAN AND MINOR THEATERS

the same time, together with 1,200 animals of the 2 units. The 601st had come

in by glider as a component of the 1st

Airborne Task Force, and was then fighting in the Maritime Alps, where it was

joined by the 602d, its animals and its

veterinary personnel. The animals were

shipped from Italy on LST's whose holds

had been converted to stall space by the

use of earth and sandbags. The 2d Platoon of the 45th Veterinary Company

was assigned to support the two field

artillery battalions, while the balance of

the company went to Lons-le-Saunier for

staging.

The Seventh Army veterinary surgeon, Colonel Stevenson, arrived in

southern France on D plus 25, or 9

September, along with the 17th Veterinary Evacuation Hospital, of which he

had been commanding officer. The hospital staged for a few days at St. Raphael,

then opened on 18 September in a

French artillery barracks at Grenoble.

Three days later the 45th Veterinary

Company, less its 2d Platoon, moved to

Sisteron, some 75 miles south of

Grenoble. The unit moved once more,

to Gap, on 29 September.

On 24 September both the 17th Veterinary Evacuation Hospital and the 45th

Veterinary Company were attached for

operational control to First French

Army, which had 6,000 animals in the

Maritime Alps between Nice and the

Swiss border and another 6,000 in

the Vosges area. From the Vosges,

French animal casualties went to Grenoble by animal hospital train. Though

its Table of Organization stall capacity

was only 150, the 17th Veterinary Evacuation Hospital operated up to 236 stalls.

In the base sections, as distinct from

the army area, the veterinary service was

confined primarily to inspection of cold

storage plants for perishable foods and

continuous inspection of locally processed foodstuffs.
CHAPTER XI

The Northern Apennines

By the middle of August 1944, when

the lightning thrust into southern France

was being launched, the Allied armies

in Italy were halted on the south bank

of the Arno River and along the Metauro

on the Adriatic. The U.S. Fifth and British Eighth Armies had outrun their supplies; troops were exhausted after three

months of continuous fighting; and the

effective strength of Fifth Army had

been more than halved to build the military power that would enable Lt. Gen.

Alexander M. Patch to sweep from the

Riviera beaches to the Moselle River in

a month's time. Yet the strongest German positions in Italy still lay ahead,

blocking access to the rich Po Valley,

whose agricultural and industrial products continued to feed the German war

machine despite repeated sorties by Allied bombers.

Preparations for the Offensive

Allied Armies at the Arno Line

The Military Situation—When General Alexander halted the Allied Armies

for rest and regrouping at the Arno line,

Eighth Army, with sixteen divisions,

held four-fifths of the front, from the

junction of the Elsa and Arno Rivers

about twenty miles west of Florence to

the Adriatic coast at the mouth of the

Metauro River. Fifth Army, with a total

of five divisions, held the sector running

west from the Elsa along the south bank

of the Arno to the Ligurian Sea about

ten miles north of Leghorn.1

In the Fifth Army area, IV Corps,

commanded by General Crittenberger,

held about thirty miles of the river line

from the mouth of the Arno east to the

village of Capanne. Task Force 45, composed of the 45th Antiaircraft Artillery

Brigade and attached troops, was on the

left, or seaward flank; the 1st Armored

Division, reorganized and reduced to

about two-thirds of its former strength,

was on the right. The 34th Division and

the 442d Regimental Combat Team

were in army reserve in rest areas south

of Leghorn. The 5-mile front from

Capanne to the Eighth Army boundary

was held by II Corps, commanded by

General Keyes, with only one RCT of

the 91st Division in the line. The 85th

and 88th Divisions were in corps reserve,

in bivouac north of Volterra.

Until the port of Leghorn could be

restored, Fifth Army supplies had to be

unloaded at Civitavecchia or Piombino

and trucked up to 150 miles over battledamaged highways. The supply situation

would be difficult, even after reconstruction of port facilities in Leghorn, as long

as the enemy held the Arno plain and

1

 Principal sources for this section are: (1) Fifth

Army History, pt. VII, The Gothic Line (Washington [1947]); (2) Opns Rpt, II Corps,

Aug 44; (3) Opns Rpt, IV Corps, Aug 44; (4)

Clark, Calculated Risk, pp. 389-94.
416 MEDITERRANEAN AND MINOR THEATERS

remained within artillery range of the

only good lateral road south of the river,

Highway 67. The enemy, on the other

hand, controlled an excellent road network for the movement of troops and

supplies in the Po Valley, behind his

strongly fortified Gothic Line.

The northern Apennines form a rugged mountain barrier about 50 miles

wide, extending northwest from the

Adriatic Sea across the peninsula, and

studded with peaks of 3,000 feet to well

above 6,000 feet. The northern slopes

are relatively easy grades, but the southern slopes, which then faced the Allied

armies, are steep and difficult. The

Gothic Line, begun as early as the winter

of 1943-44 when Fifth Army was stalled

before Cassino, lay generally just south

of the watershed dividing the streams

flowing south to the Arno from those

flowing north to the Po. The line was

anchored on the Ligurian Sea in the

vicinity of Massa where the coastal plain

was only 2 or 3 miles wide, and extended

roughly 170 miles southeast to Pesaro on

the Adriatic.

Highways across the mountains were

few and tortuous, the best of them being

Highway 65, the most direct route from

Florence to Bologna, a distance of about

seventy miles. Though there were many

sharp curves, the road was paved and the

grades were less steep than those on

Highway 64, a few miles farther west.

Highways 6524 and 6521, somewhat east

of 65, were secondary roads, often narrow and always steep and winding. The

relative scarcity of roads made it possible

for the Germans to concentrate their

defenses, the strongpoints being astride

the highways and connected by a series

of dug-in gun emplacements, log and

concrete bunkers, and fortified trenches.

GENERAL MARTIN RECEIVING OBE

from General Alexander, making Martin an

honorary knight commander in that order.

The weakest point, topographically, in

the Gothic Line was Futa Pass, where

Highway 65 crossed the divide at an

elevation of only 2,962 feet. The strongest fortifications were at this point,

running southeast to II Giogo Pass on

Highway 6524.

Fifth Army Medical Support—Medical facilities had been stripped down

even more than the army as a whole by

the demands of the campaign in southern France. At the army level, General

Martin, Fifth Army surgeon, had at his

disposal two medical battalions, the

161st and 162d; the 32d and 33d Field

Hospitals; 2 400-bed evacuation hospitals, the 15th and 94th; 4 750-bed evacuation hospitals, the 8th, 16th, 38th, and

56th; the 3d Convalescent Hospital; the

2d Auxiliary Surgical Group, with 14
THE NORTHERN APENNINES 417

teams on temporary duty from general

hospitals in the theater only partially

replacing the twenty-eight teams withdrawn for service with Seventh Army;

the 2d Medical Laboratory; the 12th

Medical Depot Company; and miscellaneous minor units. Even to support the

divisions composing Fifth Army as of 16

August 1944, these medical units were

inadequate, particularly so in 400-bed

evacuation hospitals, which had previously been assigned in the ratio of at

least one to each combat division. Task

Force 45, moreover, had no organic medical support other than the medical detachments of its component units; the

92d Division and the Brazilian Expeditionary Force, both on the way to the

combat zone, were without hospitals.2

At the corps and division levels, medical support remained substantially as it

had been in earlier Fifth Army campaigns. Each of the two corps had a medical battalion assigned, the 54th to II

Corps and the 163d to IV Corps; and

each combat division had its own organic medical battalion. The Brazilian

medical organization at the division level

was substantially the same as the American.

The l09th Medical Battalion, organic

to the 34th Division, received an unexpected but welcome visitor on 13 August

when Capt. Francis Gallo of Company C

walked into battalion headquarters. Captain Gallo had been captured in the

Kasserine breakthrough of February

1943. He had escaped after more than

seven months in German prison camps,

and for almost a year had been serving

with a band of Italian partisans in the

Florence area.

As of 16 August, divisional and corps

medical units were with their respective

combat elements, taking advantage of

the lull to rest personnel and re-equip.

Fifth Army hospitals were disposed in a

roughly quadrangular area whose corners were Cecina and Leghorn on the

coast and Volterra and Peccioli about

twenty miles inland. All were in operation except the 16th Evacuation Hospital, which had closed at Ardenza just

south of Leghorn on 12 August but had

not yet moved elsewhere.

Mounting the Attack

Planning and Regrouping—Plans developed during July called for an early

resumption of the offensive, with Fifth

Army launching the main attack on the

Gothic Line by way of Highway 65. The

strength of the enemy positions in the

Futa Pass area, however, led General

Alexander to shift the main attack to the

Eighth Army front, where a flanking

movement along the Adriatic offered

promise of quicker results. It was anticipated that Generalfeldmarschall Albert

Kesselring would have to concentrate

the bulk of his forces against Eighth

Army. Fifth Army would then attack

along the axis of Highway 6524 toward

II Giogo Pass. The success of the operation depended on co-ordination and

timing.

By way of preparation, the boundary

between Fifth and Eighth Armies was

redrawn twenty miles east of Florence,

and 13 Corps, which had held Eighth

2

 Sources for this section are: (1) Annual Rpt,

Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, II

Corps, 1944; (3) Annual Rpt, Surg, IV Corps, 1944;

(4) Unit rpts of med units mentioned in the text.

The Brazilian Expeditionary Force brought its

own medical officers, nurses, and enlisted technicians, who were attached to U.S. hospitals. See

pp. 439, 440-41, below.
418 MEDITERRANEAN AND MINOR THEATERS

Army's left flank, was transferred to

Fifth Army. The 13 Corps left boundary

was shifted east to pass through Florence,

and II Corps, which was to spearhead

the Fifth Army attack, was concentrated

along a 5-mile front west of the city. IV

Corps, which was to perform a holding

function, occupied the remainder of the

Fifth Army front extending some forty

miles from the II Corps boundary to the

sea.

Regrouping for the assault brought

the 34th Division and the 442d Regimental Combat Team (less its l00th

Battalion)3 under II Corps control,

along with the 85th, 88th, and 91st Divisions. IV Corps retained Task Force 45

and the 1st Armored, and was given the

6th South African Armoured Division

from 13 Corps. The all-Negro 92d Division and the Brazilian Expeditionary

Force of somewhat more than division

strength were also assigned to IV Corps,

but only the 370th Combat Team of the

92d reached the corps area in time for

the attack. The first Brazilian increment,

the 6th RCT of the 1st Brazilian Division, went into the line on 15 September.

Preliminary Maneuvering—E i g h t h

Army jumped off on 25 August, and by

6 September, when heavy rains interrupted the advance, had broken through

the Adriatic anchor of the Gothic Line

to a position only six miles south of

Rimini where Highway 9, the best lateral road north of the mountains,

reached the coast. The enemy had committed all his reserves and had shifted

three of his best divisions from the Fifth

Army front to meet General McCreery's

challenge.

As early as 31 August there was evidence that the Germans all along the

Fifth Army front were pulling back to

the prepared positions of the Gothic

Line. IV Corps sent reinforced patrols

across the Arno the night of 31 August—1

September, and followed up in force

during the morning. By the end of 2

September, the bulk of IV Corps was

north of the river, and the two major

hill masses commanding the Arno plain,

Mts. Pisano and Albano, were in Allied

hands. Over the next ten days IV Corps

pushed across the plain and into the

lower slopes of the Apennines, securing

the Autostrada—the excellent road connecting Highway 1 north of Pisa with

Florence—and liberating the cities of

Lucca, Montecatini, Pistoia, and Prato.

On the right flank, 13 Corps had already secured a bridgehead north of the

Arno from Florence east to Pontesieve

during the last week of August. On 1

September II Corps crossed the river,

and both II Corps and 13 Corps moved

forward to assembly areas. Originally

scheduled for 6 September, D-day for

the Fifth Army assault on the Gothic

Line was postponed until the 10th to

take advantage of further enemy withdrawals. When the attack was finally

launched, the Fifth Army front was ten

miles north of the Arno, and by 12 September leading elements of both II and

13 Corps were probing the outer defenses of the Gothic Line.

Medical Preparations—Organic and

corps medical battalions moved forward

with the combat elements they supported. Medical troops had been rested,

and most had received additional train3

 The 442d Regiment, including the l00th Battalion from Task Force 45, was withdrawn the first

week in September for shipment to France.
THE NORTHERN APENNINES 419

ing in the handling of casualties in

mountainous terrain. To preserve

secrecy, however, the hospitals were

not moved up before the attack was

launched, but were infiltrated into new

areas. The 16th Evacuation Hospital was

established at San Casciano about 10

miles south of Florence, on 26 August,

followed four days later by the neuropsychiatric center. On 1 September the 8th

Evacuation moved into the same area.

The 94th Evacuation moved to Castelfiorentini, some 20 miles southwest of

Florence, on 17 August, and on 9 September advanced to Pratolino on Highway 65 about 6 miles north of the city.

The 15th Evacuation Hospital set up in

Florence itself on 10 September, followed by the venereal disease center on

the 13th. On 15 September the 38th Evacuation opened near Pisa to serve units

on the IV Corps left flank.4

Combat Operations

Breaching the Gothic Line

On 12 September the 34th Division

was in contact with the main defenses

of the Gothic Line to the left of Highway 65. The 91st Division was astride

Highway 6524, which branched off to the

right from Highway 65 about twelve

miles north of Florence. To the right of

the 91st, the 1st British Division of 13

Corps was abreast of the two U.S. divisions. Elements of the 91st were at the

base of Mt. Altuzzo, which overlooked

II Giogo Pass from the right, while

other 91st Division units were approaching Mt. Monticelli, the left bastion of

the pass.5

On 13 September the 91st Division

sideslipped to the left of Highway 6524

while the 85th Division moved in between that road and the British sector

on the right. After four days of hard

fighting, the 85th secured Mt. Altuzzo

on 17 September while the 91st was

storming Mt. Monticelli. By the end of

the day, 18 September, II Giogo Pass

had been outflanked from both sides,

and II Corps had broken through the

Gothic Line on a 7-mile front.

The strategically placed town of

Firenzuola fell to the 85th Division on

21 September. There the road turned

sharply left to rejoin Highway 65, while

another secondary road, Highway 6528,

branched off along the Santerno River

northeast to Imola, where it intersected

Highway 9 on the edge of the Po Valley.

The 34th Division, meanwhile, had

exerted constant pressure in the area between Highway 65 and the IV Corps

zone to keep the enemy from shifting

forces to the II Giogo battle. On 21 Sep4

 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Periodic rpts of med units mentioned in the text.

5

 Principal sources for this section are: (1) Fifth

Army History, pt. VII; (2) Opns Rpt, II Corps,

Sep 44; (3) Opns Rpt, IV Corps, Sep 44; (4) Field

Marshal the Viscount Alexander of Tunis, "The

Allied Armies in Italy from 3rd September, 1943, to

12th December, 1944," Supplement to the London

Gazette, 6 June 1950, pp. 2940-60; (5) Clark, Calculated Risk, pp. 394-403; (6) Kesselring, Soldier's

Record, pp. 254-64; (7) Howe, 1st Armored Division, pp. 369-86; (8) Schultz, 85th Division, pp.

109-84; (9) Delaney, Blue Devils, pp. 126-62;

(10) Robbins, 91st Division, pp. 92-194; (11) Maj.

Paul Goodman, A Fragment of Victory in Italy

During World War II, 1942-1945 (Carlisle Barracks, Pa.: Army War College, 1952), pp. 25-56;

(12) Sidney T. Mathews, "Breakthrough at Monte

Altuzzo," Three Battles: Arnaville Altuzzo, and

Schmidt, UNITED STATES ARMY IN WORLD

WAR II (Washington, 1952); (13) Starr, ed.,

From Salerno to the Alps, pp. 301-64.
420 MEDITERRANEAN AND MINOR THEATERS

COLLECTING POINT AT PARTIALLY DEMOLISHED HOUSE ON MT. ALTUZZO

tember the 34th also broke through the

Gothic Line to the west of Futa Pass,

which now became untenable for the

Germans. Though the strongest point of

the Gothic Line, Futa Pass fell on 22

September to a single battalion of the

91st Division.

On the right flank of Fifth Army, 13

Corps followed Highway 6521 toward

Faenza, and Highway 67, which swings

north beyond Florence in the direction

of Forli and Ravenna. Leading elements

of the corps had passed through the

Gothic Line along both axes of advance

by 21 September. Even on the left flank,

where IV Corps was thinly spread to

hold rather than to advance, the German line had been penetrated at several

points.

In less than two weeks, Fifth Army

had broken through the strong defensive

positions of the Gothic Line on a 30-mile

front from Vernio on Highway 6520 to

San Godenzo Pass on Highway 67. With

several alternatives now available to

him, General Clark sent II Corps down

the Santerno Valley toward Imola, while

13 Corps struck in the direction of

Faenza. These were the shortest routes

to the Po Valley and promised the great-
THE NORTHERN APENNINES 421

est help to Eighth Army, which was

bogged down in rain and mud in the

vicinity of Rimini.

For the new attack, the 88th Division

was brought up, passing through the

85th along Highway 6528, while the

91st and 34th continued to press forward

in their own sectors to cover the 88th.

The Santerno Valley proved impregnable. The 88th Division seized and held

commanding heights, including Mt.

Pratolungo on the left of the river and

Mts. Battaglia and Capello on the right,

but failed to advance further in the face

of mounting opposition. Between 21 September and 3 October, when the Santerno Valley drive was halted, the 88th

had 2,105 casualties—almost as many as

the whole of II Corps had suffered in

breaching the Gothic Line.

As the Santerno Valley attack stalled

on the rugged, fogbound slopes of Mt.

Battaglia, the emphasis shifted to Highway 65, where the 34th, 91st, and 88th

Divisions converged on Radicosa Pass,

about three miles north of the point

where Highway 6524 reunited with the

main route and some ten miles beyond

Futa Pass. In the face of the threat

posed by the 88th Division in the Santerno Valley, the Germans abandoned

Radicosa Pass on 28 September.

By the end of the month, three weeks

after the beginning of the campaign, all

three corps of Fifth Army were on the

northern slopes of the Apennines, an

average of ten miles beyond the Gothic

Line, but the fall rains had begun, hampering the advance and making supply

lines increasingly difficult to maintain.

The troops were weary from continuous

and bitter mountain fighting, and certain classes of ammunition were running

low.

Hall Before Bologna

Following his withdrawal from Radicosa Pass, the enemy fell back to the first

of four natural defense lines still blocking Fifth Army's approach to the Po

Valley. This first line crossed Highway

65 in the vicinity of Monghidoro; the

second line, about 4 miles beyond the

first, passed through Loiano; the third

and most formidable line had its strongpoint at the Livergnano Gap, 4 miles

beyond Loiano; and the last defensible

enemy position in the mountains was 3

miles beyond the gap, on a line crossing

Highway 65 just south of Pianoro.6

The II Corps drive was launched in

the early morning of 1 October from

Radicosa Pass, just 24 miles from Bologna. The 34th Division was on the left,

the 91st astride Highway 65, and the

85th was to the right of the highway, following the valley of the Idice River,

while the 88th, on the extreme right, was

still in the Santerno Valley. In order to

strengthen General Keyes' position as

much as possible, the 6th South African

Armoured Division, which held the sector between the 34th Division and Highway 64, was withdrawn from IV Corps

and placed under direct army control,

while 13 Corps began the relief of the

88th Division preparatory to a narrowing of the II Corp front. Combat Command B of the 1st Armored Division was

attached to the 6th South African

Armoured Division and the remainder

of the division went to II Corps as a

mobile reserve to exploit any breakthrough onto the plain.

6

 Principal sources for this section include those

cited at the beginning of the previous section, with

the addition of: (1) Opns Rpt, II Corps, Oct 44;

and (2) Opns Rpt, IV Corps, Oct 44.
422 MEDITERRANEAN AND MINOR THEATERS

Despite cold weather, driving rain,

and fog that set in the second day of the

attack, the Monghidoro line was overrun

along a 16-mile front by 4 October, and

the Loiano line by the 9th. But rain, fog,

mud, and fatigue were taking their toll,

and resistance was stiffening as the

enemy concentrated his forces to meet

the threat to Bologna, his major supply

and communications center.

For the next phase of the drive the

front was still further narrowed, the 34th

Division moving over to the right of

Highway 65, between the 91st and 85th,

and the 88th Division sideslipping to its

own left into the Sillaro Valley, as the

British 78th took over the Santerno

Valley sector. Again the objective was attained, the Livergnano line being overrun by 15 October, but again the pace

was slowed, and losses were heavy and

cumulative.

For the 6-day period 10-15 October,

II Corps lost 2,491 battle casualties. The

total since the start of the Bologna drive

on 1 October was 5,699, and since the

beginning of the offensive on 10 September, 12,210, or nearly a full division. The

loss of an actual division would have

been less severely felt, because losses

were disproportionately high among

junior officers. Returns to duty made up

only a fraction of the losses. Replacements were not available in sufficient

numbers, and were inexperienced at

best. Battlefield commissions given to

enlisted men made up some of the officer

losses, but seasoned noncommissioned

officers were in equally short supply. To

personnel shortages had to be added

general fatigue, muddy and mountainous terrain that hampered the movement of supplies and restricted the

mobility of artillery, and weather that

prevented effective air support. A massive bombing of enemy supply dumps in

the Bologna area was the only significant

air activity in the period.

For another week II Corps struggled

forward against increasingly strong opposition, but it was a losing gamble.

With Eighth Army immobilized by soft

ground and flooded streams on the

fringe of the Po plain, II Corps now

faced the best German units in Italy.

Machine guns and mortars were handcarried up mountain trails. Rations and

ammunition were brought up by mule

pack, but even mules could not move

the heavy guns through the mud. The

91st Division tried oxen, but with no

better success. After 17 October, when

the 697th and 698th Field Artillery Battalions were withdrawn for shipment to

France, there were no heavy guns to

move, and by the last week of October

ammunition was in such short supply as

to require drastic restrictions on its use.

The last straw was added on 26 October when torrential rains washed out

roads and bridges. In rare intervals of

clear weather, the Po Valley was visible

in the distance, but Bologna was still

nine heartbreaking miles away. General

Keyes ordered II Corps to fall back to

defensible positions and dig in.

On the IV Corps front, activity came

to a halt at the same time. Although

the corps had been stripped to hardly

more than the strength of a reinforced

division, some advances had been made.

Task Force 92, consisting of the 370th

RCT and antiaircraft units detached

from Task Force 45, had advanced up

the coast a few miles beyond the resort

city of Viareggio, while the Brazilian

6th Combat Team had moved so far into

the Serchio Valley in the center of the
THE NORTHERN APENNINES 423

IV Corps zone that the advance was

stopped by General Crittenberger lest it

invite counterattack, for which no reserves were available.

Winter Stalemate

After stabilization of the front late in

October, action in all sectors was largely

limited to patrols and reconnaissance.

Elements of the 92d Division, brought

under direct army control early in November, made minor gains along the

coast north of Viareggio. On 24 November, units of Task Force 45 captured Mt.

Belvedere, about 5, miles west of Highway 64 above Poretta, but were able to

hold the mountain only five days before

it was regained by the enemy. Similarly,

Mt. Castellaro in the 13 Corps zone 7

or 8 miles northeast of Livergnano, was

retaken by the Germans before the end

of the month. For the most part, forward

positions were held by reduced forces

while troops were rotated back to a rest

area near Montecatini for ten days at a

time. The men were also given passes to

Florence and even to Rome.7

On 16 December command of Fifth

Army passed to Lt. Gen. Lucian K. Truscott, Jr., former VI Corps commander.

General Clark succeeded Field Marshal

Sir Harold R. L. G. Alexander as commander of the Allied armies in Italy, to

be known thereafter by the earlier designation of 15th Army Group. Alexander

moved up to supreme command of the

theater in place of General Sir Henry

Maitland Wilson, who became representative of the British Chiefs of Staff in

Washington. Alexander's deputy and

commander of the U.S. theater was Lt.

Gen. Joseph T. McNarney, who had succeeded Devers in late October. Toward

the end of March 1945 General Eaker

was recalled to Washington to become

Chief of the Air Staff. He was succeeded

as Mediterranean Allied Air Force commander by Lt. Gen. John K. Cannon of

the Twelfth Air Force.

When Clark assumed command of the

army group, the Allied front in Italy

extended on an irregular line from a

point on the Adriatic six miles northeast

of Ravenna to the Ligurian coast three

miles south of Massa. Eighth and Fifth

Armies were in contact southwest of

Faenza.

Early in January the new command

decided to postpone further large-scale

operations until spring, when it was anticipated that some reinforcements

would be available, adequate supply

levels would have been attained, and the

weather would be favorable for rapid

exploitation by armor and motorized infantry once the Po Valley was reached.

Reinforcements were already on the

7

 Principal sources for this section are: (1)

Fifth Army History, pt. VII and VIII, The Second

Winter (Washington [1947]); (2) Opns Rpts, II

Corps, Nov 44-Mar 45; (3) Opns Rpts, IV Corps,

Nov 44-Mar 45; (4) The Allied Forces, Mediterranean Theater, Report by the Supreme Allied

Commander, Mediterranean, Field Marshal the

Viscount Alexander of Tunis, to the Combined

Chiefs of Staff on the Italian Campaign, 12 December 1944 to 2 May 1945 (London: His Majesty's Stationery Office, (1951) (hereafter cited as

Alexander, The Italian Campaign), pp. 5-32; (5)

Truscott, Command Missions, pp. 447-70; (6)

Clark, Calculated Risk, pp. 404-25; (7) Kesselring,

Soldier's Record, pp, 264-67; (8) Howe, 1st

Armored Division, pp. 386-96; (9) Schultz,

85th Division, pp. 185-96; (10) Delaney, Blue

Devils, pp. 164-84; (11) Robbins, 91st Infantry Division, pp. 195-261; (12) Goodman,

Fragment of Victory, pp. 56-119; (13) Theodore

Lockwood, ed., Mountaineers (Denver, no date),

pp. 6-23; (14) Starr, ed., Salerno to the Alps, pp.

365-85.
424 MEDITERRANEAN AND MINOR THEATERS

way. The 365th and 371st Regimental

Combat Teams of the 92d Division and

the 1st and 11th RCT's of the 1st Brazilian Division arrived in the combat zone

in October and, after intensive training,

were ready for action in November. Another combat team—the 366th, made up

of men from other branches converted to

infantry—was assigned to Fifth Army in

November and attached to the 92d Division. A newly arrived light tank battalion, the 758th, and the 1125th Armored

Field Artillery Battalion formed from

inactivated antiaircraft units, were also

attached to the 92d, while II Corps received a battery of British heavy guns.

In addition to these organized units,

Fifth Army received 5,000 individual replacements in November, but was still

7,000 men below Table of Organization

strength.

In January more antiaircraft units, including most of those operating under

Task Force 45, were reorganized as the

473d Infantry regiment. Also in January, the most important of all Fifth

Army's reinforcements arrived when the

10th Mountain Division, a highly

trained outfit of picked men, reached the

combat zone. These increments made it

possible to return 13 Corps to Eighth

Army, with a corresponding realignment

of the army boundaries, although the

6th South African Armoured and the 8th

Indian Divisions remained with Fifth

Army.

No reinforcements were received in

February, and late in March the 366th

Infantry, which had not worked out well

as a combat unit, was disbanded, its personnel being converted to service troops.

The loss was more than balanced, however, by the return of the 442d Regimental Combat Team from France,

where it had served with Seventh Army

since the end of September and had

again demonstrated its outstanding fighting qualities. The Italian Legnano

Group, with a strength of about twothirds of a division, was also attached to

Fifth Army in March.

Shifts of units between corps, and rotation in the line, were motivated primarily by the need to rest veteran troops

and to give some experience to new ones.

Training was a continuous process at all

levels, including an officer candidate

school set up in February. Meanwhile

supplies of ammunition were building

up; trucks, tanks, and other vehicles were

being repaired; worn-out equipment was

being replaced. At the staff level, plans

for the spring offensive were being

drawn.

With snow blanketing the peaks and

filling the mountain passes, little action

of any kind was possible during the winter months, although vigorous patrolling

continued along the entire front. In the

13 Corps zone an attempt to seize the key

town of Tossignano on the Imola road

early in December was repulsed with

heavy losses. Late in the same month, an

indicated build-up of enemy strength in

the thinly held IV Corps sector led to an

attack by the 92d Division in the Serchio

Valley, but the Germans, already on the

move, quickly seized the initiative and

gained considerable ground before the

8th Indian Division could move up from

army reserve to re-establish the original

line.

Early in February the 92d undertook

another limited offensive to improve its

positions on the left flank, but with little

success. The 365th and 366th RCT's secured their objective, the commanding ridge of Mt. della Stella in the
THE NORTHERN APENNINES 425

Serchio Valley, on 5 February, but could

not hold the position against counterattacks in force over the next several

days. The 370th and 371st RCT's, seeking to advance to Massa along the narrow

coastal plain, ran into dense mine fields

and fierce resistance that forced them

back to their original positions with

heavy losses in both men and tanks after

three days of fighting. In the II Corps

area, an attempt to improve their positions by elements of the 34th Division

was similarly thrown back with heavy

losses.

Only in the area to the left of Highway

64, which figured prominently in General Truscott's plans for the spring offensive, was any substantial success gained.

There the 10th Mountain Division and

the 1st Brazilian Division, in brilliant

maneuvering over terrain as rugged as

any in the Apennines, retook the longdisputed Mt. Belvedere and a dozen

peaks beyond it, giving Fifth Army both

excellent observation into the Po Valley

and good positions from which to launch

further drives, at the same time securing

a l0-mile stretch of Highway 64 from

the threat of enemy shelling. These actions, which were carried out between

18 February and 9 March, won for the

10th Mountain Division the spearhead

role in the forthcoming Po Valley Campaign.

Medical Support in the Field

The conditions under which the Fifth

Army medical service operated in the

northern Apennines were very similar to

those experienced in the fall and winter

of 1943 in the Cassino area, save only

that the northern mountains were higher

and the weather worse. During the

Gothic Line battles and the push toward

Bologna, the nature of the terrain reduced much of the fighting to a series of

small unit actions involving no more

than a battalion and often less. To care

for casualties in such engagements, the

medical service, too, had to function in

small units, with numerous forward aid

stations and long litter hauls. The period

of stalemate was an unending battle

against cold and dampness waged by

small detachments of medical troops

close to the outposts, with long evacuation lines to hospitals withdrawn to winter positions. In short, Fifth Army's

second winter in Italy was a repetition of

the first.

Period of Active Combat

Medical Support of II Corps—The

tasks imposed on the medical battalions

and field hospitals supporting II Corps

in the Gothic Line battles and the subsequent drive toward the Po Valley were

the most difficult of the Italian campaign. The main highways were heavily

traveled, often under artillery fire, and

always at a distance from the actual

fighting. Secondary roads were few, narrow, heavily mined, and by October

deep in mud. Bypasses built by II Corps

engineers were generally open only to

one-way traffic, imposing dangerous delays on ambulances.8

8

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual

Rpt, Surg, Fifth Army, 1944; (3) Annual Rpt, Surg,

II Corps, 1944; (4) Annual Rpts, Surgs, 34th, 85th,

88th, 91st Divs, 1944; (5) Annual Rpt, 54th Med

Bn, 1944; (6) Monthly Rpts, l09th Med Bn, Sep,

Oct, 44; (7) Monthly Rpts, 310th Med Bn, Sep,

Oct 44; (8) Monthly Rpts, 313th Med Bn, Sep, Oct

44; (9) Weekly Rpts, 316th Med Bn, Sep 44; 316th

Med Bn Hist. (10) Annual Rpts, 92d, 33d Field

Hosps, 1944.
426 MEDITERRANEAN AND MINOR THEATERS

Division clearing stations with their

attached field hospital units were necessarily restricted to sites accessible to the

main highways. As the rainy season advanced, suitable locations were increasingly difficult to find, making close support impossible and forcing additional

burdens on the collecting companies.

Jeeps were used to evacuate battalion

aid stations wherever possible, but even

these versatile vehicles could not negotiate many of the mountain trails, leaving long and hazardous litter carries the

only alternative. In some sectors, supplies and equipment were brought up

by mule; in others hand-carrying was

necessary.

The assault on the Gothic Line was

launched initially by the 34th and 91st

Divisions along the axis of Highway 65.

The clearing station of the 109th Medical Battalion, organic to the 34th, moved

up from the assembly area on 12 September to a site left of Highway 65, about

5 miles northwest of the point at which

Highway 6524 branches off toward

Scarperia and Firenzuola. There it was

joined by a platoon of the 33d Field

Hospital, both units remaining in place

until after the Gothic Line had been

breached. The station admitted 244 patients on 17 September, its largest single

day's total for the campaign. The clearing station moved forward on 27 September to a site on Highway 65, about

3 miles south of Futa Pass, where it remained until early October. During this

period, collecting companies of the battalion operated up to 10 miles beyond

the clearing station.

The clearing station of the 316th Medical Battalion, organic to the 91st .Division, remained in the assembly area until

15 September, when it advanced to a

point east of Highway 65 about three

miles north of the road junction. The

site was easily accessible but was surrounded by heavy guns, which invited

counterbattery fire and led the unit

historian to describe it as an ambulance

driver's dream but a psychiatrist's nightmare. The supporting platoon of the

33d Field Hospital was established in a

somewhat safer spot on the west side of

Highway 65 in the vicinity of Cafaggiolo.

Both units, for want of suitable forward

sites, remained in place throughout the

Gothic Line battles. The 91st had a more

difficult assignment than the 34th, and

heavy casualties began coming into the

clearing station on 11 September. A peak

of 409 admissions was reached on the

15th.

The 85th Division went into action on

13 September along the axis of Highway

6524. The clearing station of the organic

3l0th Medical Battalion, together with a

platoon of the 32d Field Hospital,

opened about two miles southwest of

Scarperia the following day, although

the area was well within range of enemy

guns. The field hospital stayed behind

when the clearing station moved on 23

September to a new area a mile south of

Firenzuola, another platoon of the 32d

Field moving up to take its place adjacent to the clearing station. Both hospital and station were forced by enemy fire

to abandon the site within two hours. A

new location somewhat farther to the

rear was occupied on 25 September, but

the access road was soon knee deep in

mud. Until the station moved at the end

of the month it was necessary to keep a

maintenance truck available to haul out

mired ambulances.

Two days after commitment of the

88th Division on 22 September, the
THE NORTHERN APENNINES 427

clearing station of the organic 313th

Medical Battalion opened in the vicinity

of San Pellegrino on the Imola road. A

platoon of the 32d Field Hospital caught

up with the station there on 26 September. It was here that casualties from the

bloody battle for Mt. Battaglia were received after litter carries up to 4.5 miles.

To man the relay posts along the steep,

treacherous evacuation trail, emergency

bearers were pressed into service from

among line troops, medical battalion

headquarters, and the clearing company

in addition to those borrowed from the

54th Medical Battalion at corps level.

The second phase of the North Apennines Campaign, from the 1 October

assault on the Monghidoro line to the

final breakdown in the mud before

Pianoro, saw some of the hardest fighting

of the entire war in Italy and the most

difficult period for the medical service.

Fatigue, exposure, and almost continuous rain and cold took a heavier toll in

respiratory diseases, trench foot, and psychiatric disorders than enemy weapons

took in wounded men, yet the battle

casualty rate was higher than for any

comparable period since the Salerno

landings.9

Field medical installations of II Corps

were relocated early in October, reflecting the shift of emphasis back to Highway 65. Its site below Futa Pass already

a quagmire, the 1st Platoon of the 34th

Division clearing station jumped ahead

fourteen miles on 4 October to a site

southwest of Radicosa Pass, with the 2d

Platoon moving to San Benedetto northwest of the pass four days later. Neither

site was satisfactory, and the 1st Platoon

shifted to Monghidoro on the 12th,

where it occupied a battered resort hotel

building. The 2d Platoon set up in tents

in the same area three days later. The

supporting platoon of the 33d Field Hospital was already in Monghidoro, having

moved up on 9 October.

Although 34th Division casualties

were relatively light in October, difficulties in evacuation continued to require litter bearers in excess of those

allotted. Men from kitchen and station

sections of the collecting companies were

used for this purpose, and in emergencies

line soldiers were borrowed from the

combat units. Among the hazards were

floods, landslides, and consistently poor

visibility due to fog and rain. At night

ambulance drivers benefited from "artificial moonlight" produced as an aid

to transportation generally by beaming

searchlights in low trajectory over the

area.

By 1 October, clearing stations of the

85th and 91st Divisions were in the vicinity of the road junction where Highway 6524 rejoins Highway 65, with the

2d Platoon of the 33d Field Hospital supporting both. The hospital unit received

the greatest number of patients in its

history for a comparable period at this

site—228 nontransportable priority surgical cases in a 14-day period. On 10 October the 85th Division clearing station

moved into the Idice Valley, about 5

miles southeast of Loiano. The clearing

station of the 91st moved on 21 October

to a site about 2 miles south of Loiano,

but the supporting platoon of the 33d

Field Hospital was soon rendered useless because mud made it impossible to

9

 For Fifth Army as a whole the wounded in action rate for October 1944 was 783 per 1,000 per

annum, as compared with 973 for September 1943.

For II Corps the October 1944 rate was 1,219 with

an admission rate from all causes of 2,970 per 1,000

per annum. See Annual Rpt, Surg, Fifth Army,

1945, p. 63, and Annual Rpt, Surg, II Corps, 1944.
428 MEDITERRANEAN AND MINOR THEATERS

deliver patients to it. The engineers had

to construct a special road of rocks,

straw, burlap, and landing-strip matting

to get the hospital out early in November. A platoon of the 32d Field Hospital

was established about a mile north of

Monghidoro on 13 October, primarily in

support of the 85th Division, though it

was some 3 miles distant from the division clearing station in a direct line and

nearer 10 miles by road.

With the shift of the 88th Division

to the Sillaro Valley, the clearing station

was set up 6 October at Giugnola, and

the supporting platoon of the 32d Field

Hospital at Belvedere a mile or so closer

to the front. The 54th Medical Battalion, responsible for evacuating the II

Corps clearing stations, moved its headquarters to the vicinity of Traversa, a

mile north of Futa Pass, on 3 October.

In order to give close support to the

combat troops, the collecting companies

of the divisional medical battalions often

operated in two sections, the advance

station being as close as possible to the

regimental combat zone. The ambulances were kept at the forward post and

the litter squads at the battalion aid stations, which were themselves often split

into two sections with separate evacuation routes. The rear echelon would

move up to the advance site as soon as

conditions permitted, while the advance

section again moved forward with the

combat troops.

Evacuation was to the clearing station

of another division if that was more accessible. In late October, when flood waters washed out bridges and obliterated

trails, the 85th Division clearing station

was completely isolated for two days, during which period casualties were held

at the collecting stations or evacuated to

other divisions. One regiment of the 85th

evacuated to the 88th Division clearing station by a devious route involving

the use of artillery prime movers to cross

swollen streams and the transfer of patients from one ambulance to another

on each such occasion. The 88th Division

clearing station also took casualties from

elements of the 1st Armored, which were

moved into the line on the corps right

flank at this time. In several sectors ambulances were washed into the streams

and temporarily immobilized if they

were not lost altogether. Vehicles of all

types were punished unmercifully, with

broken springs a commonplace. Nor

were vehicles the only casualties. Litter

bearers were frequently under fire and

exposed to booby traps and the hazards

of steep mountain trails in darkness. The

toll of killed and wounded among them

was high.

During the period 10 September31 October, the strength of the 54th

Medical Battalion was augmented by

a collecting company of the 162d Medical Battalion and elements of two ambulance companies from Fifth Army, all

of them being used to evacuate division

clearing stations. The corps medical battalion also supplied to the divisions 75

litter bearers from its own complement,

and approximately 150 Italian infantrymen for litter work. The Italians proved

reluctant and unreliable in this capacity,

though others of their countrymen made

themselves invaluable to the medical

service as pack-train drivers and as

guides.10 The 54th Medical Battalion also

operated a dental clinic and an eye clinic

10

 Still other Italians, it should be noted, were

formidable guerrillas behind the German lines.

Indeed, the German high command never learned

to cope successfully with the partisans of northern

Italy. Kesselring, Soldier's Record, pp. 268-79.
THE NORTHERN APENNINES 429

for II Corps throughout the period of

combat.

Medical Support of IV Corps—On the

IV Corps front, where the military mission was to hold rather than to advance,

the task of the medical service was less

arduous. The 370th Regimental Combat

Team of the 92d Division was supported

by a collecting company and clearing

platoon of the organic 317th Medical

Battalion. Task Force 45 was supported

by elements of the corps medical battalion, the 163d. Since the antiaircraft units

that made up the bulk of the task force

did not have enough medical personnel

for infantry operations, the 163d supplied aidmen and forward litter bearers as

well as performing its normal collecting

and clearing functions. The initial increment of the Brazilian Expeditionary

Force, the 6th Combat Team, was

supported by a collecting company and

clearing platoon of the 1st Brazilian

Medical Battalion; and Combat Command B of the 1st Armored Division was

cared for by Company B of the 47th

Armored Medical Battalion. The 6th

South African Armoured evacuated the

army area through its own medical

channels. Field hospital units for forward surgery were not available to reinforce the IV Corps medical service, but

the close proximity of evacuation hospitals and relatively easy evacuation

routes in large measure compensated for

the lack.11

The advent of the Brazilians created

new problems for the IV Corps surgeon,

Lt. Col. Austin W. Bennett, particularly

in matters of liaison and of sanitation,

since Brazilian standards were less rigorous than American. An American medical officer was placed on duty with the 1st

Brazilian Infantry Division to assist with

training, medical records, and equipment. At one period, when the Brazilian

sector adjoined that of the 1st Armored,

a Brazilian medical officer was detailed

to one of the treatment stations of the

47th Armored Medical Battalion to act

as interpreter and to assist with Brazilian

casualties passing through the station.

The corps collecting company evacuating the BEF sector, in addition to its

normal functions, supplied men, litter

bearers, and equipment for battalion aid

stations of the 6th Combat Team.

Medical installations of IV Corps encountered the same difficulty with rain

and mud, and the same disadvantages of

terrain that were a constant hazard in

the II Corps area, but, without the burdens of an offensive, the conditions were

more readily endured. Only in the sector

where Combat Command B operated

after 1 October, attached to the 6th South

African Armoured, were conditions comparable to those on the II Corps front.

Primarily for this reason, the unit was

brought under II Corps control at this

time. When CCB moved north on Highway 64 early in October, the supporting

treatment station for the first time in

its history was unable to find enough

level ground to pitch its tents and was

forced to set up in a village where buildings were available.

Inactive Period

With Fifth Army in defensive positions for the winter, little movement of

11

 The main sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944; (2) Annual Rpt,

Surg, IV Corps, 1944; (3) Hist, 317th Med Bn, 16

Oct 42-15 Jul 45; (4) Annual Rpt, Surg, 1st Armd

Div, 1944; (5) Hist, 47th Armd Med Bn, Sep, Oct 44;

(6) Annual Rpt, 163d Med Bn, 1944.
430 MEDITERRANEAN AND MINOR THEATERS

medical units was required. Collecting

and clearing companies of the organic

medical battalions accompanied their

combat formation as they were rotated to

the Montecatini rest area, while those remaining at the front made themselves

as secure and as comfortable as conditions permitted. Clearing stations, collecting stations, and even battalion aid

stations set up in buildings or shells of

buildings. When these were not available, tents were winterized. As had been

the case in the previous winter at the

Gustav Line, caves and cavelike rock formations were utilized, often floored with

lumber from discarded shell cases. Personnel of the forward stations within

range of enemy artillery dug in, roofing

foxholes with salvaged timbers and sandbags in a manner reminiscent of Anzio.

Stoves were issued for wards and operating rooms.12

II Corps Front—The existence of a

static front did not mean that medical

units were idle. In the II Corps sector

continuous patrol activity and intermittent shelling accounted for enough

casualties to keep forward stations in

business even without the disease and

injury toll inevitable under the circumstances of weather and terrain. At the

same time, the task of evacuation of

casualties was enormously more difficult

with the steep and twisting roads now

icy and treacherous under drifting snow,

and litter trails obliterated.

Ski litters were used successfully in

some sectors. One collecting company of

the 34th Division used a toboggan to

evacuate its forward station during

January. The 91st Division equipped one

litter squad in each collecting company

with snowshoes, but other medical battalions found them of little value. More

generally effective were ice creepers,

worn by litter bearers of all divisions in

the line.

Medical units themselves continued

to suffer casualties from enemy shells

landing in station areas or on highways,

and litter bearers were occasionally fired

upon, despite their Red Cross identification.

The 92d Field Hospital reverted to

army control in November, two of its

platoons being transferred to the IV

Corps sector, where they acted as small

evacuation hospitals. The 33d Field continued to support II Corps, with one platoon east of Monghidoro and one in the

Sillaro Valley, each serving elements of

two divisions. Both field hospitals and

clearing stations held patients somewhat

longer than would have been the case

under conditions of active combat, the

clearing stations in particular doubling

as station hospitals for garrison troops.

The four collecting companies of the

54th Medical Battalion—including one

attached from the 162d—continued to

evacuate divisional clearing stations

12

 Principal sources for this section are: (1) Annual Rpts, Surg Fifth Army, 1944, 1945; (2)

Annual Rpts, Surg, II Corps, 1944, 1945; (3) Annual Rpts, Surg, IV Corps, 1944; (4) Annual Rpt,

54th Med Bn, 1944; (5) Monthly Rpts, 54th Med

Bn, Nov 44-Mar 45; (6) Annual Rpts, 163d Med

Bn, 1944, 1945; (7) Annual Rpts, Surg, 1st Armored, 34th, 85th, 88th, 91st, 92d Divs, 1944 1945;

(8) Annual Rpt Surg, 10th Mountain Div, 1945; (9)

Unit Hist, 10th Mountain Med Bn, Jan-Mar 45; (10)

Hist, 47th Armored Med Bn, Jan-Mar 45; (11) Opn

Rpts, 109th Med Bn, Nov 44-Mar 45; (12) Opn

Rpts, 310th Med Bn, Nov 44-Mar 45; (13) Opn

Rpts, 313th Med Bn, Nov 44-Mar 45; (14) Unit Hist

316th Med. Bn, Nov 44-Mar 45; (15) Hist Data, 317th

Med Bn, Nov 44-Mar 45; (16) Annual Rpts, 32d and

33d Field Hosps, 1944; (17) Annual Rpts, 32d and

33d Field Hosps, 1945.
THE NORTHERN APENNINES 431

TREATING A WOUNDED SOLDIER in a 317th Medical Battalion collecting station near

Massa, February 1945.

through an ambulance control point on

Highway 65 below Radicosa Pass. Bed

quotas from each Fifth Army hospital

were telephoned to the control point

daily and ambulances routed accordingly. For two weeks in mid-November a

platoon of the 683d Clearing Company,

54th Medical Battalion, relieved the 88th

Division clearing station at Giugnola,

but otherwise the chief function of the

company was the operation of special

clinics for II Corps. The dental and

eye clinics at Traversa remained in

operation throughout the winter, and a

venereal disease treatment center, for

new cases of gonorrhea only, was opened

at the same site on 11 November.

IV Corps Front—IV Corps front was

more active than that of II Corps, the

92d Division fighting limited engagements in November and February, and

the 10th Mountain and 1st Brazilian

Divisions taking part in more extended

operations in February and March. Here,

too, snow and cold were limiting factors,

with rain a continuing hazard in the

coastal sector. The medical service of
432 MEDITERRANEAN AND MINOR THEATERS

IV Corps was also compelled to resort to

a variety of expedients to overcome deficiencies in the medical complement of

some of its combat units. In the early

months of the winter the 163d Medical

Battalion continued to give combat medical support to Task Force 45 and, with

the assistance of a collecting company attached from the 161st Medical Battalion,

to evacuate divisional clearing stations.

The battalion also gave first echelon support to service troops and others without

medical detachments of their own, operated a venereal disease hospital for the

corps, and supplied an expansion unit

for one of the evacuation hospitals in the

area. The 671st Collecting Company,

supporting troops on the right flank of

the corps sector, was provided with

equipment to operate a 25-bed provisional hospital, should heavy snows isolate the area. As on the II Corps front,

additional ambulances were supplied by

Fifth Army.

In order to support the 366th Infantry, which was attached to the 92d

Division on its activation in November,

one of the collecting companies of the

317th Medical Battalion operated for a

time in two sections. For the February

offensive, in which all four regiments

of the 92d were engaged simultaneously,

a provisional collecting company was

used, with 2 medical officers, 9 medical

and 6 surgical technicians, and 12 ambulance drivers drawn from the regular

companies, and Italian litter bearers.

While the division was engaged simultaneously on the coast and in the Serchio

Valley, both clearing platoons were in

operation, reinforced by ambulances

from corps. Later in February, when the

473d Infantry was also attached to the

92d, it was again necessary for one collecting company to support two combat

teams.

In the Mt. Belvedere offensive and

subsequent operations west of Highway

64, the medical units supporting the l0th

Mountain Medical Battalion did not follow the conventional organizational pattern. Equipment was designed for mule

pack or hand carry, and assigned vehicles

were reduced in number accordingly.

The Table of Organization called for

126 animals but for only 15 motor ambulances, all of them in the clearing company. Each of the 3 collecting companies

had 44 litter bearers instead of the 36

allotted to infantry companies. The

clearing company was divided into 3

rather than 2 platoons. Since the whole

division was set up for animal transportation—there were more than 6,000

animals in the T/O—there was a sizable

veterinary company, and there were

veterinary sections at the battalion level

in the medical detachment. The division

arrived in Italy, however, without its

animals. Italian mule pack trains were

supplied, but transportation deficiencies

were otherwise made up by motor vehicles. The medical battalion received 30

instead of 15 ambulances, which were

transferred from the clearing to the collecting companies. Jeeps were borrowed

from line units.

In the first battle test, the 10th Mountain Medical Battalion performed like a

veteran outfit, amply justifying the care

with which its personnel had been selected and trained. Like the combat formations, medical units moved into

position under cover of darkness. Collecting stations, and often clearing stations as well, were generally within range

of enemy artillery, and many casualties

resulted, though few of them were psy-
THE NORTHERN APENNINES 433

10TH MOUNTAIN DIVISION AID STATION ON SLOPES OF MT. BELVEDERE

chiatric. Litter squads of one company

worked the first 3 days of the offensive—

72 hours—without sleep and with very

little food. Litter carries were down

precipitous mountain sides, frequently

taking as long as 10 hours, yet the same

squad would return immediately for another casualty.

At two points, division engineers built

cable tramways to bring the wounded

out from otherwise almost inaccessible

positions. The first of these was completed the morning of 21 February from

Mt. Mancinello—Pizzo di Campiano

ridge captured the night of the 19th. A

difficult 3- or 4-hour haul down the ridge

was reduced to 4 minutes, and the carrying time between aid station and collecting station cut to 6 or 7 hours. The other

tramway, some 5 miles southwest of

Vergato, spanned a deep valley across

which the only passage was a narrow,

tortuous dirt trail unusable even by

jeeps. In the latter stages of the offensive,

when the 85th RCT was digging in on

Mt. della Spe, the only possible evacuation route lay through the village of

Castel d'Aiano, which was shelled by

German guns every time a vehicle moved

in the streets.
434 MEDITERRANEAN AND MINOR THEATERS

TRAMWAY ASCENDING TO MT. MANCINELLO-PIZZO DI CAMPIANO RIDGE

On the evening of 3 March the collecting station of Company C was hit by

a German shell that exploded a booby

trap and completely demolished the

building in which the station was

housed. Two chaplains and one enlisted

man were killed, and 13 other station personnel more or less severely wounded,

one of whom later died. Fortunately

there were no patients, since Company

B, in the most forward position, was

evacuating the entire division that day.

Between 0600 and midnight, more than

200 casualties passed through Company

B's station, including 40 prisoners of

war and a few partisans.

Training and Re-equipment—These

combat actions, involving as they did

relatively recent arrivals in the theater,

did not interfere with a general program

of training and refurnishing the field

medical service on an army-wide basis.

Officers with more than twenty-four

months of combat duty were replaced by

fresher men, while the veterans went to

field and evacuation hospitals to polish

up their techniques. Units were brought
THE NORTHERN APENNINES 435

up to strength, line soldiers being trained

as medical replacements where no others

were available. Ambulances and other

vehicles were systematically overhauled

or replaced. Supply levels were built up.

Physical conditioning went along with

recreational activities. At the same time,

the special problems anticipated for the

coming spring offensive were given individual attention.

After its own positions were stabilized

just before the middle of March, personnel of the 10th Mountain Division

conducted a school in methods of mountain evacuation. At a site near the mouth

of the Arno River, medical detachments

and battalions were given special training in the technique of river crossings

along with their respective combat elements. General Martin was no less determined than General Truscott to make

the next campaign the last.13

Hospitalization in the Army Area

Hospitalization During the

Fall Offensive

The deployment and use of Fifth

Army hospitals during the Gothic Line

battles and the subsequent advance toward Bologna were always conditioned

by the unfavorable terrain, the poor road

network, and the weather. On the II

Corps and IV Corps fronts, enemy artillery fire delayed the forward movement

of hospitals, or forced the abandonment

of otherwise acceptable sites, while evacuation lines stretched out and ambulances broke down under constant use.

To these disadvantages was added a

persistent shortage of beds that could be

compensated for only by continuous

overloading of facilities and by improvisations at all echelons of the medical

service.14

Among the expedients in general use

were the practice of employing surgical

teams from evacuation hospitals in field

hospital units or other evacuations more

strategically placed; and of putting personnel from less active units on temporary duty with those carrying heavy

patient loads. Surgeons were also exchanged between evacuation and general

hospitals for 6-week intervals to give each

group a more realistic understanding of

the problems of the other. Clearing and

collecting companies were consistently

used to augment the beds of evacuation

hospitals in the army area.

Hospital Support of II Corps—With

II Corps making the main U.S. effort

against the Gothic Line, the bulk of the

Fifth Army hospitals were eventually

deployed along the axis of Highway 65,

but there was an unavoidable lag behind

troop movements. When the assault was

launched on 10 September, the nearest

evacuation hospital was the 15th, which

opened on that date in a large school

building in Florence. All transportable

casualties of the first two days went there.

On 12 September the 94th Evacuation

moved up to Pratolino, about six miles

closer to the front but still in the rear

of the assembly area from which the 34th

and 91st Divisions had jumped off. (Map

35)

13

 For detailed preparations during this period,

see pp. 458-60, below.

14

 Principal sources for this section are: (1)

Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual Rpt, Surg, Fifth Army, 1944; (3) Unit rpts

of med units mentioned in text.
436 MEDITERRANEAN AND MINOR THEATERS

MAP 35—Fifth Army Hospitals and Medical Supply Dumps, 18 September 1944

At Pratolino, where it was housed in

buildings, the 94th Evacuation Hospital

took the more serious casualties from the

entire corps for the next two weeks, the

overflow going back to the 15th in

Florence. Medical cases and a few light

battle wounds were sent still farther

back, to the 8th and 16th Evacuations in

the San Casciano area south of Florence.

The Gothic Line had been overrun, and

the 88th Division's costly drive down the

Santerno Valley was under way before

the 56th Evacuation Hospital opened in

tents on 24 September at Scarperia, south

of II Giogo Pass on Highway 6524.

Though it was a 750-bed unit, the

capacity of the 56th was quickly overtaxed. The heavy influx of surgical cases

forced the establishment of an overflow

preoperative ward, while medical cases

also constituted an abnormally heavy

load. In an effort to lighten the burden

on the 56th, General Martin sent an advance party from the 16th Evacuation

Hospital to Firenzuola on 27 September

to locate a site for that unit, but enemy

fire drove the men back and the move

had to be postponed. Before the Firenzuola area was safe, the rainy season had

set in, and the prospective site had to be

ditched and protected by a levee from

a neighboring stream. It was 4 October

before the 16th Evacuation took over the

role of most forward army hospital.

The 16th was in position to take casualties from both flanks of the II Corps
THE NORTHERN APENNINES 437

front, and, for 10 days, admissions were

heavy, reaching a peak of 203 on 15 October. At the same time, the 56th at Scarperia continued to operate at capacity,

and the 94th, still at Pratolino, set a

new unit record for surgical cases in the

first two weeks of October.

As the weather steadily worsened, it

became increasingly important to get

hospital beds as far forward as possible.

Evacuation over mud-clogged roads was

becoming more difficult, and there was

danger that Futa Pass might be blocked

by snow. To ease the pressure, the 750-

bed 8th Evacuation Hospital moved to

Pietramala, just south of Radicosa Pass,

on 14 October; and the following day the

94th moved up to Monghidoro, about

five miles farther north on Highway 65.

The 94th was replaced at Pratolino by a

fixed hospital.

Both forward hospitals quickly ran into difficulties. The 8th was sited in a

rolling field, already churned to mud by

heavy guns that were still there when

the first loads of hospital equipment arrived. Ward tents were pitched on sloping ground, and the operating tent was

given a level base only by cutting away

the top of a knoll. Conditions at Monghidoro were even worse, for the area was

still under artillery fire. So great, indeed,

was the danger from enemy shells that

the 94th Evacuation closed 5 days after

it opened. Two medical officers, 5 nurses,

and 10 enlisted men stayed at Monghidoro to care for 30 nontransportable

chest and abdominal cases, and to guard

the equipment. Twenty-one nurses and

70 enlisted men were sent back to rest

areas; the remainder of the nurses, a

shock team, and 2 surgical teams were

put on temporary duty with other hospitals; and the rest of the personnel went

into bivouac with the 8th Evacuation at

Pietramala.15 On 29 October, after II

Corps had been ordered to take defensive

positions, surgical personnel of the 94th

returned to Monghidoro. The medical

staff and all others not needed at the forward site went back to Florence, where

they joined the 15th Evacuation, setting

up 380 beds for medical cases only.

Meanwhile a new departure had been

taken in the treatment of neuropsychiatric casualties.16

 As the strain of weeks

of bitter fighting in the most difficult

conditions of weather and terrain began

to be felt in a rising toll of psychiatric

disorders, General Martin set up a psychosomatic center toward the end of

October in the vicinity of Cafaggiolo,

just north of the point where Highway

6524 branches off from 65. Core of the

center was the 2d Platoon of the 601st

Clearing Company, 161st Medical Battalion, which had been serving as Fifth

Army neuropsychiatric hospital since December 1943. The 1st Platoon of the

same company was established on 23 October adjacent to the neuropsychiatric

hospital to specialize in gastrointestinal

cases, many of which were believed to be

of psychosomatic origin. On 1 November

the 1st Platoon of the 602d Clearing

Company, 162d Medical Battalion, which

had been operating an expansion unit

for the 15th Evacuation since 18 September, also joined the psychosomatic center,

but took minor disease as well as gastrointestinal cases.

The 3d Convalescent Hospital moved

15

 Periodic Rpt, 94th Evac Hosp, Jan-Aug 45.

The 1944 Annual Report says the Covigliaio area,

roughly three miles south of Pietramala, but the

later report is more detailed, and in this case more

probable, since mess equipment was presumably

left at Monghidoro. 16

 See pp. 450-51, below.
MAP 36—Fifth Army Hospitals and Medical Supply Dumps Supporting II Corps,

25 October 1944
THE NORTHERN APENNINES 439

38TH EVACUATION HOSPITAL FLOODED AT PISA, NOVEMBER 1944

up to Pratolino on 26 September. (Map

36)

Hospital Support of IV Corps—The

lightly held IV Corps sector started the

Gothic Line campaign with the support

of only one evacuation hospital, the 750-

bed 38th, which opened in the outskirts

of Pisa on 15 September. The safety factors were: the relatively minor military

operations anticipated; the proximity of

Florence to the IV Corps right flank,

with good roads available; and the easy

access in emergency to base hospitals in

the Leghorn area. (See Map 35.) The

38th Evacuation was augmented by a collecting company of the 162d Medical Battalion, and by 25 Brazilian medical

officers, 20 nurses, and 60 enlisted men to

care for BEF casualties.17

All efforts to secure an additional hospital for the support of IV Corps failed

until mid-October, when General Martin

was notified that the 250-bed 29th Station Hospital, then inoperative in North

Africa, would be converted into a 400-

bed evacuation hospital for Fifth Army.

The unit was brought immediately to

Italy, and the work of conversion carried

out with such dispatch that it was ready

to take patients as the 170th Evacuation

Hospital the first week of November.

17

 Figures for Brazilian personnel are from reports of the 16th Evacuation Hospital, to which

they were later transferred. The available reports

of the 38th do not specify numbers.
440 MEDITERRANEAN AND MINOR THEATERS

It was none too soon. On the night of

2-3 November the flooding Arno River

burst its banks, and a wall of water

poured into the area occupied by the

38th Evacuation. Before morning the

water was 4 to 6 feet deep in the hospital

area. The 495 patients in the hospital

were hastily carried 300 yards to the relative safety of a partially destroyed barracks being used by the 12th Medical

Depot Company. There, counting both

patients and hospital personnel, more

than 800 persons were housed in space

designed to accommodate about 200.

Enough equipment and supplies were

saved to operate the hospital for 48

hours, which proved to be long enough

for the inundated roads to become

usable.

As soon as vehicles could get through,

a pool of fifty ambulances formed by the

162d Medical Battalion picked up the

stranded patients and distributed them

among fixed hospitals in Leghorn and

Fifth Army units in the II Corps area.

Although most of its equipment was ultimately salvaged, the 38th Evacuation was

for the time being rendered inoperative,

and its personnel were placed on temporary duty with other medical installations.

To replace the 38th Evacuation, the

170th opened at Viareggio on 6 November, and a unit of the 32d Field Hospital,

augmented by a platoon of the 615th

Clearing Company, 163d Medical Battalion, established a 250-bed hospital at

Montecatini. The Viareggio site was close

to the 92d Division's front in the coastal

sector, while Montecatini was accessible

both to the center and the right flank of

IV Corps. A portion of a civilian hospital

in Lucca, about midway between the

two sites on an east-west line, was also

requisitioned for nontransportable casualties, which were cared for by surgical

teams of the 38th Evacuation.

Winter Dispositions

By early November it was clear that

military activity would be strictly limited

for some time to come, and the task of

preparing army hospitals for the winter

began. The 16th Evacuation, which had

been twice flooded at Firenzuola, was

moved back on 10 November to Pistoia,

where Highway 64 enters the mountains

from the Arno plain. The site had been

intended for the 38th, but that unit was

still immobilized.18

The Brazilian medical personnel were

transferred at this time from the 38th

Evacuation to the 16th, which was now

just behind the Brazilian sector. Normally the Brazilians took complete care of

their own wounded, but when the load

was heavy U.S. medical officers served as

assistant surgeons on Brazilian teams.

Brazilian surgeons similarly acted as assistants on U.S. teams when American

casualties were heavy.

On 19 November the 38th Evacuation

took over the Montecatini site, as well as

the clearing platoon that had been operating there. The field hospital unit from

Montecatini moved up Highway 64 to

the vicinity of Porretta in the Brazilian

sector where, with two Brazilian and

two U.S. surgical teams, it operated as a

small evacuation hospital throughout the

winter. Another unit of the 32d Field

Hospital supplanted the 170th Evacua18

 Principal sources for this section include: (1)

Annual Rpts, Surg, Fifth Array, 1944, 1945; (2) Annual Rpts, Surg, II Corps, 1944, 1945; (3) Annual

Rpt, Surg, IV Corps, 1944; (4) Unit rpts of the

med units mentioned in text.
THE NORTHERN APENNINES 441

MAP 37—Fifth Army Hospitals and Medical Supply Dumps on the IV Corps and

92d Division Fronts, 15 January 1945

tion at Viareggio after the latter had

been twice damaged by enemy shells.

The 170th moved on 25 November to

Lucca, carrying with it 150 patients,

many of them litter cases. (Map 37)

The 3d Convalescent Hospital, deep

in mud at Pratolino, found the task of

winterizing its 300 tents too great and in

late November began moving to Florence for the winter. Before the move was

completed, however, adequate quarters

were found in a group of hotel buildings

in Montecatini, where the hospital was

established just before the end of the

year. One factor involved in the change

of plans was the advantage of having a

convalescent hospital located in a rest

area where patients were able to benefit

from the recreational facilities available.

In mid-January, Brazilian personnel

were attached to the 3d Convalescent.

Other Fifth Army hospitals remained

where they were throughout most or all

of the winter, making do as best they

could against the hazards of mud, cold,

snow, and wind. A move to reopen the

94th Evacuation at Monghidoro late in

December was abandoned, and the medical service of that unit continued to

operate in Florence in conjunction with

the 15th Evacuation, taking half of the

medical cases admitted to the joint installation, which functioned under a single

administration as a 1 ,000-bed station hos-
442 MEDITERRANEAN AND MINOR THEATERS

BRAZILIAN NURSES ATTACHED TO THE 16TH EVACUATION HOSPITAL

pital. The surgical service of the 94th

remained at the forward location, despite

cold and snow that reached a depth of

four feet, until mid-February, when renewed enemy shelling again forced abandonment of the site. The surgical service

then ceased to function as such, but surgical teams were placed on temporary

duty with the 32d Field and the 8th

Evacuation. A number of the nurses also

went on detached service with other

units. Tentage was left at Monghidoro

under guard. (Map 38)

A few miles farther back on Highway

65, the 8th Evacuation stuck out the

winter at Pietramala, the coldest spot

on the II Corps front. Tents were floored

and walled to a height of 41⁄2 feet with

wood, and reinforced by overhead beams

against the weight of the snow, but even

these precautions were not always protection against the gales that swept

periodically across the sloping hospital

area. On 8 December, before the winterizing was complete, a double ward

tent, flooring sidewalls and all, was lifted

clear off the ground, carried over 6 wards

and dropped on another tent. All together, 8 tents were blown down and

others damaged. The hospital census was

low at the time and no patients were

injured, but it was necessary to send 30

or 40 postoperative cases to the 15th

Evacuation in Florence. After that ex-
MAP 38—Fifth Army Hospitals and Medical Supply Dumps on the II Corps Front,

15 January 1945
444 MEDITERRANEAN AND MINOR THEATERS

perience, wood and prefabricated steel

buildings were placed at the two ends

of each row of ward tents and secured

by steel cables anchored to buried logs.

As if wind and cold were not enough,

the 8th Evacuation also wrestled with

the perennial problem of mud. At least

5,000 truckloads of rock were used to

maintain roads in the vicinity of the hospital area before the unit left the site

late in April. As the most forward hospital in the II Corps zone, the 8th Evacuation handled the bulk of the casualties

for the first three months of 1945, battle

wounds exceeding medical cases.

The Scarperia site, where the 56th

Evacuation Hospital spent the winter,

was only slightly more favorable than

that of the 8th at Pietramala. As at the

more forward installation, cold, snow,

and wind were intermittent hazards, and

the battle against mud a never-ending

problem. Patients came mostly from the

corps right flank, down Highway 6524.

In response to General Martin's urgent appeal for more beds, the 15th Field

Hospital was returned to Italy late in

the year, one platoon coming from southern France and the other two from

Corsica. Just before the end of December the unit was set up east of Highway

65 and two or three miles north of

Cafaggiolo, where it operated as a 400-

bed hospital for medical cases. With

specialists from the 6th General Hospital

attached, the 15th Field took over the

psychosomatic work performed since

October by the 1st Platoon of the 601st

Clearing Company, the latter unit becoming a hospital for general medical

and slightly wounded cases in mid-January. The 1st Platoon of the 602d Clearing Company, which had also been

associated with the psychosomatic center

at Cafaggiolo, remained in the area for

another month as a medical hospital,

then shifted to Prato, between Florence

and Pistoia on the edge of the Arno

plain, where it continued in the same

capacity. The neuropsychiatric hospital

remained throughout the winter at

Cafaggiolo, taking cases direct from the

clearing stations and from the 15th Field

Hospital.

In connection with its general medical

work, the 15th Field made detailed

studies of the major types of medical

cases occurring among front-line troops

to determine whether a strictly medical

forward hospital could retain such cases

in the army area and thus hasten return

to duty. A section of the 2d Medical

Laboratory was attached. At the same

time, observers were sent to other field

hospitals where they studied the technique of operating as forward surgical

units in preparation for a similar role in

the spring offensive.

In the IV Corps sector no changes were

made in hospital sites after the first of the

year. The enemy thrust in the Serchio

Valley late in December led to preparations for heavy casualties including

plans for reinforcing the 170th Evacuation at Lucca, should that be necessary. Pigeons were sent to the 170th as

insurance in case phones were down, and

all of the hospital's patients were evacuated to base installations. The counterattack, however, was quickly stopped,

and medical units remained in place.

In Florence the venereal disease hospital and the Fifth Army prosthetic and

operative dental clinic, both administered by the 2d Platoon of the 602d

Clearing Company, 162d Medical Battalion, took patients from II and IV

Corps of Fifth Army. The lull in hostil-
THE NORTHERN APENNINES 445

8TH EVACUATION HOSPITAL AT PIETRAMALA, coldest spot on the II Corps front.

ities was reflected in late March by an

increase in venereal beds from 250 to

290.

Evacuation From Fifth Army

Evacuation to Army Hospitals

Throughout the North Apennines

Campaign and the winter stalemate,

evacuation from corps to army installations was carefully controlled by the

Fifth Army evacuation officer, Colonel

Camardella. As has already been noted,

the 54th Medical Battalion, responsible

for evacuation from II Corps, maintained an ambulance control point on

Highway 65 to which daily quotas for

each evacuation hospital were telephoned every morning. During the early

part of the campaign, inadequate bed

strength and heavy casualties made it

impossible to follow a fixed policy with

consistency, but so far as circumstances

permitted, the patient census of the most

forward hospital was kept relatively low

to guard against sudden emergency. In

general, evacuation during daylight

hours was to installations farther to the

rear, while the most forward unit took

the bulk of the casualties at night to

shorten the hazardous ambulance runs.

Except in emergency, not more than 100

surgical cases were admitted to any given

hospital in a single day. When the number of casualties began to decline in
446 MEDITERRANEAN AND MINOR THEATERS

AMBULANCE ON ICY ROAD, LOIANO AREA

November, a system of triage at the ambulance control point was instituted,

patients being routed to those hospitals

best equipped to care for them.19

All transportation of patients within

the corps area was by ambulance over

roads often deep in mud or heavy with

snow. During the early months of 1945,

vehicles were frequently able to cover no

more than five miles an hour. The system nevertheless worked satisfactorily

both under the most severe conditions

of combat and in the worst weather of

the winter.

On the IV Corps front, supported as

it was by only one evacuation hospital

until mid-November, no selectivity was

possible. Even after November, when

evacuation hospitals were sited at Lucca,

19

 Principal sources for this and the following

section are: (1) Annual Rpts, Surg, Fifth Army,

1944, 1945; (2) Fifth Army History, pt. VII, pp. 48-

50; (3) Annual Rpts, Surg, II Corps, 1944, 1945; (4)

Annual Rpt, Surg, IV Corps, 1944; (5) Annual

Rpts, 1944, 1945, of 54th, 161st, 162d, 163d Med

Bns; (6) Annual Rpt, Med Sec, MTOUSA, 1944;

(7) Final Rpt, Plans and Opns Off, Office of Surg,

MTOUSA; (8) Hist Rpts, 1944 and 1945, of 802d

and 807th Med Air Evac Transport Squadrons, AF;

(9) Annual Rpt, 41st Hosp Train, 1944; (10)

Annual Rpt, Surg, PBS, 1944; (11) Semimonthly

Med Sitreps, Surg, PBS, Sep 44-Mar 45.
THE NORTHERN APENNINES 447

Montecatini, and Pistoia, the road network did not permit the full application

of a quota system. The 163d Medical

Battalion found it necessary to operate

ambulance control posts on each of the

main axes of the corps' advance in order

to rout emergency cases to the nearest

hospital. It was nevertheless possible by

co-ordinating these posts to regulate the

flow of patients to some extent.

Evacuation to Base Hospitals

The problem of clearing Fifth Army

hospitals during the first several weeks

of the North Apennines Campaign was

complicated by factors outside the control of the army surgeon. At the start of

the offensive early in September there

were only two fixed hospitals in northern

Italy, the 64th General near Leghorn

and the 55th Station attached to it. A

few other units were on the way, but

the prospect of an early breakthrough

into the Po Valley precluded establishment of more beds than were absolutely

necessary south of the mountains. All

casualties from southern France, moreover, were still going to Naples, leaving

few beds available for movement elsewhere. At the same time, the shortage of

mobile beds in the Fifth Army area made

it essential to transfer patients to base

installations without unnecessary delay.

The only base hospitals available were

those in Rome and Naples, and the only

means of reaching them was by air. For

the first 10 days of the offensive, patients

from the forward evacuations were carried by ambulance to the Rosia airfield

southwest of Siena and some 50 miles

from Florence, whence they were flown

to the rear by planes of the 802d and

807th Medical Air Evacuation Transport Squadrons. Before 20 September,

936 patients went to Naples and 2,295

to Rome. On that date the Florence airfield became operable, and by the last

day of the month 1,445 Fifth Army patients had been flown from that field to

Naples, along with 1,397 to Rome.20

The 24th General Hospital opened in

Florence on 21 September with 1,500

beds, and a week later 2 station hospitals

with an aggregate of 1,250 beds moved

into the Leghorn area to which IV Corps

casualties were being routed. Despite

these additional fixed beds, the situation

became acute in the first week of October

when bad weather prevented any airlifts

to the rear. In addition to a capacity

load of patients from forward evacuation

hospitals, the 24th General also had to

find room for those already in holding

units at the Florence airfield. During the

second week of October, Fifth Army was

given air priority over Seventh Army,

but intermittent poor weather conditions prevented full use of it, and in the

last week of the month all planes were

grounded. The limited number of flying

days held air evacuation to Rome and

Naples to 5,000 for October and left forward hospitals dangerously crowded. As

a relief measure, all transportable patients from the 24th General were carried by ambulance to Leghorn late in

the month. On 21 October control of air

evacuation passed from the Surgeon,

Fifth Army, to the Surgeon, Peninsular

Base Section.

20

 These and subsequent figures for air evacuation in the text are from the reports of the two

MAETS squadrons. They do not agree entirely

with figures given in the annual report of the

Surgeon, MTOUSA, for 1944, which are for patients received by air at PBS hospitals, but it is

believed the MAETS tabulations are the more

accurate.
448 MEDITERRANEAN AND MINOR THEATERS

Meanwhile, as the prospects for a

breakthrough before winter faded, more

fixed beds were coming into northern

Italy. Two thousand more beds were

established during October in the Leghorn area, and the 250-bed 55th Station

Hospital took over the Pratolino site

from the 94th Evacuation, bringing the

total to 4,750 at Leghorn and 1,750 in

the Florence area.

In November, with southern France

no longer a drain upon the facilities of

the Mediterranean theater, the situation

eased considerably. Patients from the II

Corps area were thereafter triaged at

the Florence airfield, being flown to the

rear if aircraft were available or, it not,

distributed among fixed hospitals in the

vicinity. The 2,000-bed 12th General

Hospital joined the group at Leghorn

early in December. January saw the establishment of a 500-bed station hospital

in Florence, one in Pisa, and the 1,500-

bed 70th General in Pistoia, bringing

the T/O total to 11,000 fixed beds. In

February air evacuation began between

Florence and Leghorn, and rail evacuation was started between Florence and

Leghorn by way of Montecatini.

Evacuation from Fifth Army units to

airfields or to base hospitals in the immediate rear of the army was by the

161st and 162d Medical Battalions, both

of which had reduced their collecting

companies to ambulance companies in

order to supply personnel to their clearing platoons for the operation of special

hospitals. In the II Corps area, the 162d

detailed enlisted men late in November

to operate emergency aid stations along

Highway 65 for stranded ambulances.

Air evacuation to base hospitals in

Naples continued throughout the winter

on a modest scale, but the emphasis was

increasingly on holding in army hospitals all patients who might recover in

time for duty during the planned spring

offensive. Evacuation policy in army installations during the first three months

of 1945 was 60 to 120 days.

Medical Supplies and Equipment

In preparation for the Gothic Line

offensive the 3d Storage and Issue Platoon of the 12th Medical Depot Company moved to the vicinity of Florence

the last day of August, with the mission

of supporting II Corps. On 14 September headquarters of the company and

the 1st Storage and Issue Platoon established the main Fifth Army medical supply depot in Florence, and three days

later the 2d Storage and Issue Platoon

set up an issue point for IV Corps in

Pisa. All units were in buildings, the

main dump being located in a pharmaceutical plant that the Germans had

rendered unfit for anything but storage.21

The IV Corps dump moved to a more

central location in Lucca on 30 November, but was still too remote from portions of the long corps front to be readily

accessible to combat medical units. To

compensate for distance, the supply section of the clearing company, 163d Medical Battalion, was enlarged to maintain

a forward dump for the corps in the

vicinity of Valdibura. The II Corps

21

 This section is based on the following documents: (1) Annual Rpts, Surg, Fifth Army, 1944,

1945; (2) Annual Rpts, Surg, II Corps, 1944, 1945;

(3) Annual Rpts, Surg, IV Corps, 1944, 1945; (4)

Annual Rpts, 12th Med Depot Co, 1944, 1945;

(5) Davidson, Med Supply in MTO, pp. 108-13;

(6) Unit rpts of Fifth Army med bns and hosps.
THE NORTHERN APENNINES 449

depot moved on 15 October to Filigare

on Highway 65 just below Monghidoro.

This dump maintained heavy stocks of

intravenous solutions, dressings, blankets, litters, and cots throughout the winter as a safeguard against the possibility

that snow might interrupt communication with the Florence depot.

The Florence depot received its own

stocks by truck from the PBS dump in

Leghorn. Little in the way of local

procurement was possible, but the repair and maintenance section was active

and much equipment was salvaged. The

optical and dental sections were also

active during the winter months, which

were largely devoted to reconditioning

both men and equipment.

Professional Services in the

Army Area

Medicine and Surgery

Forward Surgery—Front-line surgery

in the North Apennines Campaign followed the pattern that had been steadily

evolving since operations in Sicily, but

with greater pressure than ever before

on the surgical staffs. The withdrawal of

three evacuation and two field hospitals

for use in southern France, together with

the loss of half of the 2d Auxiliary Surgical Group, meant that field units supporting II Corps in the northern

Apennines were overcrowded during the

weeks of heaviest combat, and surgical

teams worked without regard to hours.

Surgical teams from base hospitals were

used to replace in part the teams sent

to France, but the nature of their experience precluded their use in forward

units. Instead, they were placed in the

evacuation hospitals, while teams from

the evacuations were detailed to field

hospital units.22

Experience had shown that to perform effectively under front-line conditions, surgical teams must be able to

handle any type of case received. General surgical teams were chosen in preference of those specializing in some

particular phase that, by its infrequent

occurrence, might limit their usefulness.

Base hospital surgeons were apt to be

too specialized, but surgeons whose experience had been gained in evacuation

hospitals were likely to be possessed of a

wider range of skills. Although the loss

of surgical teams was thus minimized as

much as possible and the high standards

of forward surgery were maintained, the

output per man was less than it would

have been had the 2d Auxiliary Surgical

Group been retained in Italy intact.

Another factor tending to increase the

burden on front-line surgeons during

the North Apennines Campaign was a

more liberal policy in the selection of

nontransportable cases. Fifth Army

studies made earlier in the year indicated that many who died in evacuation

hospitals could have been saved by the

more prompt attention possible in a hospital closer to the front, and a larger

proportion of combat wounds accordingly received initial surgery in the field

hospitals. All cases of shock, or those who

had been in shock, for example, were

sent to the field units, as well as those

with wounds with extensive muscle

23

 Principal sources for this section are: (1)

Annual Rpts, Surg, Fifth Army, 1944, 1945; (2)

Rpts of 2d Aux Surg Gp, including rpts of individual teams, 1944 and 1945; (3) Annual Rpt,

Med Sec, MTOUSA, 1944; (4) Periodic Rpts, 2d

Med Lab, 1944, 1945; (5) ETMD's for Sep 44

through Mar 45.
450 MEDITERRANEAN AND MINOR THEATERS

damage.23 The triage of chest, abdominal, maxillofacial, and head wounds also

tended to route a larger proportion of

cases to the field hospital units close to

the front lines. Shell fragment wounds

continued to predominate substantially

over all other causative agents combined,

but the percentage of wounds from land

mines rose somewhat.

Penicillin and whole blood were again

major factors in the saving of life and

limb, blood being used on an expanding

scale as a result of studies made during

the Rome-Arno Campaign. A distribution section of the 6713th Blood Transfusion Unit was established with the 2d

Medical Laboratory in Florence in midSeptember, but the blood distributed

was still flown from Naples. In February

1945 a bleeding station was set up in

Florence to supplement the supply from

the Naples blood bank. Approximately

15,500 battle casualties in the last four

months of 1944 received close to 10,000

pints of whole blood in corps and army

installations.

Fifth Army hospitals were visited by

the theater orthopedic consultant, Colonel Hampton, in September and by

Colonel Churchill, theater consultant in

surgery, in October and November. Lt.

Col. (later Col.) Howard E. Snyder, the

Fifth Army surgical consultant, spent

most of his time in the forward area.

Neuropsychiatry and Rehabilitation—

Early in the North Apennines Campaign

the forward treatment of psychiatric

casualties was extended to include all

those having upper gastrointestinal tract

symptoms, since experience had shown

that 85 percent of such cases showed no

significant organic pathology. A gastrointestinal center was set up by the 1st

Platoon of the 601st Clearing Company,

161st Medical Battalion, on 23 October

1944 in the vicinity of Cafaggiolo, where

it was adjacent to the neuropsychiatric

center operated by the 2d Platoon of the

same company. Maj. (later Lt. Col.)

James A. Halstead of the 6th General

Hospital was made chief of the gastrointestinal service, continuing in that

capacity when the function was shifted

to the 15th Field Hospital in January

1945. The center was the first organization of its type to be established in an

American field army.24

All cases diagnosed as gastrointestinal

at the clearing stations were sent to the

center and others were referred from

the evacuation hospitals. No case of this

type left the army area without passing

through the gastrointestinal center

where those of psychosomatic origin

23

 See The Board for the Study of the Severely

Wounded, North African-Mediterranean Theater of

Operations, The Physiologic Effects of Wounds,

"Medical Department, United States Army," subseries Surgery in World War II (Washington,

1952). This volume contains the complete report

of a medical board, appointed 1 September 1944

by the Surgeon, NATOUSA, "to study the treatment of the severely wounded." The board was

particularly interested in the effects and control

of wound shock.

24

 Principal sources for this section are: (1) Annual Rpts Surg, Fifth Army, 1944, 1945; (2) Annual

Rpt, Surg, II Corps, 1944; (3) Annual Rpts, 161st

Med Bn, 1944, 1945; (4) Annual Rpt, 15th Field

Hosp, 1945; (5) Periodic rpts of surgs and organic

med bns of 34th, 85th, 88th, 91st, 92d, 1st Armored, and l0th Mountain Divs; (6) ETMD's,

Sep 44-Mar 45; (7) Maj. James A. Halstead and

Capt. Paul Scott Hansen, "The Management of

Intestinal Diseases in the Army Area," Medical

Bulletin, Mediterranean Theater of Operations

(May 1945); (8) Maj. James A. Halstead, "The

Management of Patients with Gastric Complaints

in the Army Area," Medical Bulletin, Mediterranean Theater of Operations (June 1945); (9)

Hanson, comp. ed., "Combat Psychiatry," Bulletin

U.S. Army Medical Department, Suppl. Number

(November 1949).
THE NORTHERN APENNINES 451

were identified and treated as such. During the 6 months of its existence, 442

patients were admitted to the center, of

whom 74 percent were returned to full

duty, 11 percent to limited duty, and

only 15 percent were evacuated to base

hospitals. Of the total, 286 cases were

diagnosed as psychogenic dyspepsia

showing definite neurosis without evidence of organic disease. Another 78

cases showed neither organic disease nor

positive evidence of neurosis. There

were 22 cases of peptic ulcer, 4 of chronic

gastritis, and 20 of acute gastritis. Thirtytwo cases were rediagnosed as hepatitis

without jaundice.

The average period of hospitalization

in the gastrointestinal center was 9.1

days, compared with 21 days for similar

cases in base hospitals. Moreover, only

55 percent of those treated in base hospitals returned to combat duty, and those

who did return lost an additional 14

days in the replacement system.

Taken as a whole, the treatment of

neuropsychiatric casualties in the army

area showed gratifying improvements

during the months of active combat,

despite the large number of such cases

in September and October. The rehabilitation and training centers established

in each of the combat divisions in the

late summer proved to be a major factor

in promoting the prompt return to duty

of hundreds of men who might otherwise have gone too far to be reclaimed

for combat. The 85th Division experimentally carried the program a step

further when the 337th Infantry regiment set up its own training and rehabilitation center. It was notable that the

337th had less than half the psychiatric

casualty rate of the other two regiments

for the same period.

In December 1944, more than 90 percent of all Fifth Army psychiatric

casualties were returned to duty, as compared with only 26 percent at the beginning of the year. (Table 31)

Diseases of Special Interest—The major disease problem of Fifth Army during the months of the North Apennines

Campaign was infectious hepatitis,

which followed the pattern of the previous fall but was more widespread. The

disease reached its peak in December

1944, whereas October had been the

month of highest incidence in 1943. The

maximum rate per 1,000 per annum was

211 for the week ending 15 December

1944, compared with a high of 121 for

the second week of October 1943. The

sharp rise in hepatitis cases began late

in October 1944, leveled off in November, rose sharply again in December,

then gradually declined to what may be

termed a "normal" rate in March.25

Again the disease appeared most frequently among combat troops, and again

revealed an amorphous relationship to

intestinal diseases, the curve for hepatitis

following by about a month the curve

for intestinal infections. In the second

winter, however, hepatitis appeared

most frequently among new troops in

contrast to the experience of 1943, which

showed a higher incidence among veterans. Evidence tended to indicate both

the intestinal and respiratory tracts as

possible sources for infection, but remained inconclusive as to the actual

mode of transmission.

25

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual

Rpts, Surg, Fifth Army, 1944, 1945; (3) ETMD's

for Sep 44 through Apr 45; (4) Whayne and DeBakey, Cold Injury, Ground Type, ch. VI. See also

pp. 261-62, above.
452 MEDITERRANEAN AND MINOR THEATERS

TABLE 31—DISPOSITION OF NEUROPSYCHIATRIC CASES, FIFTH ARMY

SEPTEMBER 1944-MARCH 1945

a Full duty. b

 Limited assignment.

Source: Annual Rpt, Surg, Fifth Army, 1945.

Atypical pneumonia struck hard at

certain units that had only physical location in common, rising from 39 cases in

November to 415 in March 1945. An outbreak of typhoid fever in the 349th

Infantry Regiment of the 88th Division

in November was quickly brought under

control and kept from spreading.

Trench foot, which had been one of

the greatest wasters of manpower in the

winter of 1943, was again a factor but

was far less destructive, thanks to prompt

preventive measures. The condition first

appeared in October. Shoe pacs were

issued in the middle of November, together with heavy wool socks, but the

pacs were not always properly fitted and

the men were not always told they were

to wear two pairs of socks. Instructions

were clarified by December, and dry

socks were issued with rations. Although

weather conditions were more severe

and the strength of the affected divisions

greater, there were only 1,572 cases of

trench foot between October 1944 and

April 1945, compared with 5,752 for the

comparable period a year earlier. Only

1.7 percent of the divisional troops were

afflicted, as against 7 percent in the winter of 1943-44. The winter months of 1944-45 also

showed a lowered incidence of venereal

disease in Fifth Army compared with

the corresponding months of 1943-44,

owing in part to less opportunity for exposure but also in part to improved

preventive discipline.

Dental Service

The mobility of the Fifth Army dental service was further increased in the
THE NORTHERN APENNINES 453

course of the North Apennines Campaign, under the direction of Col.

Thomas F. Davis, who became Fifth

Army dental surgeon late in September

1944. In addition to the army dental

clinic operated by the 2d Platoon of the

602d Clearing Company, 162d Medical

Battalion, and sited with the venereal

disease hospital in Florence, both corps

maintained prosthetic and operative

clinics of their own. The II Corps clinic,

administered by the 54th Medical Battalion, was at Traversa, while another

clinic operated by the 33d Field Hospital, was sited with the corps supply depot

just below Monghidoro. The IV Corps

clinic, staffed jointly by the 163d Medical Battalion and the 32d Field Hospital,

was located at Valdibura. Two dental

laboratory trucks and two dental operating trucks assigned to the 12th Medical Depot Company were placed in

operation in November. Two additional

operating trucks were assigned to the

2d Auxiliary Surgical Group, and were

operated in the forward areas by teams

of that unit.26

Late in 1944 the divisional dental

service of Fifth Army was reorganized to

bring the regimental and other dental

officers of each division under more

direct administrative control of the

division dental surgeon and permit concentration of skills where they were most

needed. At the same time the construction of mobile dental dispensaries on

1-ton trailer chassis was authorized on

the basis of five for each infantry division

and seven for the armored division.

Thirty-four of these trailer dispensaries

were in operation by May 1945.

The dental service of the 1st Brazilian

Division was organized along much the

same lines as that of comparable U.S.

units. There were two dental officers

with each infantry regiment, one with

the division artillery, one with special

troops, and one or two with the medical

battalion. Dental officers also served with

the Brazilian medical staffs attached to

U.S. hospitals. Arrangements were made

in November by the theater dental surgeon, Colonel Tingay, to supply U.S.

equipment wherever the Brazilian

equipment was below standard.27

The ratio of dental officers to Fifth

Army strength remained fairly constant

for the 7 months of the North Apennines

Campaign. In September 1944 there was

1 dental officer for every 902 army

troops. The ratio improved to 1:828 in

November, but fell again to 1:937 for

March 1945. The number of dental

officers in Fifth Army rose from 157 in

September 1944 to 184 in March 1945.

Dental service rendered by these officers and their enlisted technicians to

Fifth Army troops during the 7-month

period is summarized in Table 32.

Veterinary Service

In the North Apennines Campaign,

the combat divisions did not maintain

their own provisional pack trains, as they

had during the mountain fighting in

southern Italy. By September 1944 animal transportation was exclusively by

Italian pack trains, which were attached

26

 Principal sources for this section are: (1) Annual Rpts, Surg, Fifth Army, 1944, 1945; (2)

Annual Rpt, Med Sec, MTOUSA 1944; (3) Annual Rpts, Surg, II Corps, 1944, 1945; (4) Annual

Rpt, Surg, IV Corps, 1944; (5) MS, Dental History,

Mediterranean Theater of Operations; (6) Unit

rpts of div surgs and med installations in Fifth

Army during the period 1 Sep 44-31 Mar 45. 27

 Dental Inspection, by Col Tingay, 4 Nov 44.
454 MEDITERRANEAN AND MINOR THEATERS

TABLE 32—DENTAL SERVICE IN FIFTH ARMY, SEPTEMBER 1944—MARCH 1945

Source: Annual Rpt, Surg, Fifth Army, 1945.

to the combat units as circumstances

required. Ten pack mule companies

operated with Fifth Army during the

fall and winter of 1944, and five more

were organized in February 1945.28

Animal casualties from the pack mule

companies went to one of the four

Italian-staffed veterinary hospitals supporting Fifth Army. The 110th Veterinary Evacuation was at Vaglia, about

twenty miles north of Florence on Highway 65, from 14 September to 17 October, and for the remainder of the period

was sited at Pietramala, near the 8th

Evacuation Hospital. The 130th Veterinary Evacuation opened at Cafaggiolo

on 16 September where it remained,

sharing the location with the 212th

Veterinary Station Hospital between 2

October and 6 January. The 212th

moved to Lucca on 8 January to support

the animal units of IV Corps. The 211th

Veterinary Evacuation was inactive during most of the winter, opening at

Pontepetri in the IV Corps area on 24

February 1945.

It was the general consensus of American veterinary officers that all of these

Italian units were poorly equipped and

inadequately staffed. They were redesignated early in 1945 as U.S.-Italian

units, and were thereafter supplied and

equipped from U.S. sources and operated under closer supervision. The three

veterinary evacuation hospitals had

Table of Organization capacities of 150

stalls and the station hospital had a

capacity of 250, but staff and site limitations seldom permitted full operation.

The shortcomings of the Italian veterinary hospitals were felt most acutely

during the period from late September

to the end of October, when forward

positions could be supplied only by

mules, and animal casualties were high.

Aggregate animal strength of the 10 pack

trains serving Fifth Army at this time

was less than 3,000, with casualties be28

 Principal sources for this section are: (1)

Annual Rpts, Surg, Fifth Army, 1944, 1945; (2)

Vet Inspection Rpts, Sep 44, Mar 45; (3) Annual

Rpt, Med Sec, MTOUSA, 1944; (4) Annual Rpt,

Surg, 10th Mountain Div, 1945. See also, Miller,

United States Army Veterinary Service in World

War II, ch. XXII.
THE NORTHERN APENNINES 455

TREATING A WOUNDED MULE OF AN ITALIAN PACK TRAIN

tween 9 September and the end of the

year 1,110 killed and 765 wounded.

Evacuation of sick and wounded animals, both from pack trains and from

veterinary hospitals, was by truck, but

until late December no vehicles were

available except on loan from service

units. At that time Colonel Pickering,

Fifth Army veterinarian, secured authorization to supply both pack companies

and veterinary hospitals with reconditioned U.S. or captured enemy trucks,

and most of the units were so supplied

by the end of the year. Replacement

animals were received through the

6742d Quartermaster Remount Depot.

To achieve better administrative control, the Italian pack mule companies

were grouped early in 1945 into 5 battalions and brought under the supervision of the newly activated 2695th

Technical Supervision Regiment. Three

American veterinary officers were assigned to this organization, one to each

of 3 pack mule battalions. The other 2

battalions were periodically inspected

by these officers.

The relatively large veterinary staff

of the 10th Mountain Division—22 officers and 182 enlisted men—had little to
456 MEDITERRANEAN AND MINOR THEATERS

do in their first three months in Italy,

since none of the division's animals

reached the theater before spring.

In addition to horses and mules, and

the pigeons that were a normal part of

the Signal Corps organization, Fifth

Army veterinarians were called upon to

care for 125 scout dogs that reached the

front during the winter.

No unusual problems were encountered by the food inspection units operating with Fifth Army.
CHAPTER XII

Advance to the Alps

If the second winter in Italy was only

an exaggerated repetition of the first,

the second spring was a new and exhilarating experience. The months of

inching progress through mud and

mountains were forgotten when in April

1945 the U.S. Fifth and British Eighth

Armies erupted into the Po Valley and

brought the war in Italy to a decisive

end in three weeks. Both for the combat

forces and for the medical units supporting them in the field, the campaign was

a triumph of planning and preparation.

Preparations for the Final Drive

Planning and Regrouping

While the ranks were being filled,

stores of ammunition accumulated, and

equipment refurbished or replaced,

plans were being drawn up for the last

offensive of the Italian campaign. Clark's

strategy as 15th Army Group commander did not differ essentially from

that employed by Field Marshal Alexander in the assault on the Gothic Line,

save that Fifth Army, now at full

strength, rather than Eighth Army,

which had been weakened by the withdrawal of four Canadian and British divisions, was to make the main effort.1

The attack was to be staggered along

the entire Allied front. The 92d Division, under direct army control, was to

lead off on 5 April with an advance up

the Ligurian coast toward Massa and La

Spezia. Eighth Army, already out of the

mountains, was to open its drive four

days later, its first objective being to

secure a crossing of the Santerno River

east of Bologna. IV Corps was to follow

after a 3-day interval with a drive west of

Highway 64, and II Corps was to launch

its attack along the axis of Highway 65

when IV Corps had pulled abreast of the

more advanced II Corps positions. The

two armies were to converge at the Po

River, trapping as many enemy forces

as possible south of the river. In the

second phase of the campaign, both

armies were to cross the Po and exploit

to the Adige River, which runs southeastward through Verona to the Adriatic just south of Venice. In the final

phase, Fifth Army was to block the

Brenner Pass north of Verona and clear

northwestern Italy to the Swiss and

French borders, while Eighth Army was

to swing eastward to the Austrian and

Yugoslav frontiers.

As Fifth Army moved into position,

the 92d Division, on the left flank, included in addition to its own three regiments the battle-tested 442d Regimental

1

 Principal sources for this section are: (1) Fifth

Army History, pt. IX, Race to the Alps (Washington [1947]) ; (2) Clark, Calculated Risk,

pp. 426-29; (3) Truscott, Command Missions, pp.

479-83; (4) Craven and Cate, eds., Europe: ARGUMENT to V-E Day pp. 482-89.
458 MEDITERRANEAN AND MINOR THEATERS

Combat Team, which had just returned

from France, and the 473d RCT of converted antiaircraft troops that had been

fighting as infantry since August 1944.

The 365th and 371st regiments, which

had been weakened by the transfer of

selected personnel to the 370th, were to

screen the front for the attack, then be

withdrawn from the division and stationed in the inactive sector west of Mt.

Belvedere under IV Corps control. IV

Corps lined up with the Brazilian Expeditionary Force on the left, the 10th

Mountain Division in the center in the

vicinity of Castel d'Aiano, and the 1st

Armored on the right along Highway

64 south of Vergato. In the II Corps

sector, extending east from the Reno

River, the 6th South African Armoured

and the 88th Infantry Divisions were on

the left between Highways 64 and 65, the

91st was astride Highway 65, the 34th

Division was east of the highway, and

the Legnano Group on the extreme

right, in contact with 13 Corps on the

left flank of Eighth Army. The 85th Division was in army reserve. All units

were overstrength for the drive, with almost 30,000 additional officers and men

available in replacement depots.

When the diversionary attack of the

92d Division in the west and the Eighth

Army drive in the east had engaged as

many troops as the German command

was willing to commit against them, the

10th Mountain Division was to launch

the IV Corps assault driving north

through the remaining mountain ridges

to cut Highway 9 west of Bologna. The

Brazilians and the 365th and 371st regiments were to protect the left flank and

follow up any enemy withdrawals, while

the 1st Armored was to seize Vergato and

advance down Highway 64.

The II Corps attack was in effect to be

a renewal of the October drive, with all

four divisions abreast and the Legnano

Group in a defensive role on the right

flank. When the important road junction

of Praduro on Highway 64 had been

reached, the 85th Division was to pass

through the 1st Armored, leaving the

latter unit and the 6th South African

Armoured, which would be pinched out

by the 85th and 88th Divisions, available

as a mobile striking force to exploit the

breakthrough onto the plain.

Medical Preparations

Although Fifth Army's strength for

the final drive was greater by 100,000

men than it had been when the Gothic

Line was broken—almost 270,000 on 1

April 1945 compared with 170,000 six

months earlier—the resources in men

and equipment available to General

Martin, Fifth Army surgeon, were only

slightly increased over the inadequate

facilities with which he had supported

the North Apennines Campaign. The

400-bed 170th Evacuation Hospital had

been added in November 1944, and the

15th Field Hospital in January 1945.

Just before the launching of the spring

offensive one additional 400-bed evacuation—the 171st, converted like its sister

unit from a station hospital—was acquired.2

 That was all. There were no

additional medical battalions at corps

or army level, no new supply units, no

2

 See p. 439, above. The 171st Evacuation

Hospital was converted from the 250-bed 54th Station Hospital, which had moved from North Africa

to Naples in January 1945, with some additional

personnel drawn from the 57th Station Hospital,

which was reduced from 250 to 150 beds at about

the same time. See Annual Rpt, 171st Evac Hosp,

1945, and ETMD for Mar 45.
ADVANCE TO THE ALPS 459

GENERALS CLARK AND TRUSCOTT at the time General Truscott took command of the Fifth

Army.

more supporting ambulance companies;

and the increase in beds was less than

enough even to keep pace with the increase in troop strength.3

Of the new combat formations acquired by Fifth Army since the stabilization of the lines at the end of October

1944, only the Legnano Group had hospital facilities of its own—four 200-bed

field units provided through the Military Mission to the Italian Army, a

division of the Allied Control Commission. The 6th South African Armoured

Division was also independent of Fifth

Army in this respect. To provide hospitalization for the remaining 8 combat

divisions, 2 separate regiments, and combat service troops, General Martin had

at his disposal 3 field hospitals, 4 400-bed

3

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1945; (2) Annual Rpt,

Surg, II Corps, 1945; (3) Unit rpts of div surgs,

med bns, hosps, and other Fifth Army med installations.
460 MEDITERRANEAN AND MINOR THEATERS

evacuation hospitals, 4 750-bed evacuations, and a convalescent hospital.

What it lacked in facilities Fifth Army

was thus forced to make up in mobility

and efficiency of operation. During

March medical units received new equipment, including a total of 90 ambulances

and 15 21⁄2-ton trucks, to replace wornout vehicles. A move to fill personnel

vacancies with limited-service men was

successfully resisted, on the ground that

all personnel would be subjected to severe physical strain, and basic infantrymen were trained instead as medical

replacements.

By early April all medical units had

been streamlined for rapid movement.

All equipment beyond the bare essentials for operation was turned in, and

hospitals began reducing their patient

censuses to permit closing on a few hours'

notice. No hospital was to move until the

combat troops jumped off, to avoid any

possibility of giving away plans to the

enemy, but once the mountains were

passed, it was imperative that as many

beds as possible be shuttled into the Po

Valley to eliminate long and difficult

ambulance runs over highways that

would be clogged with military traffic.

It was also imperative that no hospital

be closed for longer than the absolute

minimum time necessary for movement

to a new location.

In the hope of speeding up the evacuation process, experiments were conducted early in April with small planes

that could take off, if necessary, from

improvised runways. Several patients

were flown successfully in L-5's from

the 8th Evacuation Hospital at Pietramala to Florence, but the scheme was

abandoned as impractical for use in the

coming campaign. Space permitted carrying only one patient at a time, without

medical attendance, which would greatly

restrict the scope of the operation. The

unpredictability of the weather at that

season was another limiting factor.

In planning medical support for the

Po Valley Campaign, there was no alternative to ambulance evacuation, at least

during the early stages of the action.

Neither could use of the battered and

rutted Highways 64 and 65 in the central

sector be avoided. Highway 1, which

would be the axis of evacuation for the

92d Division along the coast, had suffered little and was in excellent condition. From the II and IV Corps fronts,

evacuation by air was to begin as quickly

as the Bologna field could be repaired,

estimated as five days after the capture

of the city.

For the 92d Division, isolated as its

front was from the rest of the Fifth Army

area, a complete system of medical support had to be provided that would not

only take care of all the medical needs

of the division but also could be rapidly

expanded should the coastal drive develop into a major operation. As one

element of this plan, a bleeding section

was set up in Pisa by the 6713th Blood

Transfusion Unit.

The Po Valley Campaign

Military Operations

During February, March, and the

early days of April 1945 the Mediterranean Allied Tactical Air Force

pounded German communications in

northern Italy with increasing violence.

Favorite targets were the bridges that

kept appearing with antlike persistence

along the Po, cable crossings, ferry ter-
ADVANCE TO THE ALPS 461

minals, rail lines, and truck and wagon

convoys on the roads. The bombers gave

way on 14 April to an umbrella of

fighters that would cover the jump-off of

IV Corps.4

The flanks by this date were already

heavily engaged. The 92d Division

opened the attack according to plan on

5 April, with the 370th RCT on the

coastal plain and the 442d pushing

through the mountains that rose steeply

a few miles to the east. The assignment

was not an easy one. The mountains in

this area, known as the Apuan Alps, are

characterized by sheer rock cliffs, barren

peaks, and deep gorges, while the narrow

coastal plain is cut by numerous streams

and canals. The plain, moreover, was

heavily mined and both axes of advance

would soon be within range of the big

guns at La Spezia, which could drop

their deadly shells as far south as Massa.

Before La Spezia itself could be reached,

the attacking forces would have to break

through heavily fortified positions that

took every advantage of the natural

barriers offered by the terrain.

By the end of the first day the 442d

was approaching the high ground overlooking Massa, but the 370th encountered intense enemy fire and withdrew

in the face of strong counterattacks.

When the regiment was unable to regroup the next day because of excessive

losses in stragglers, it was relieved by the

473d Combat Team, which was brought

up from static positions in the Serchio

Valley. The 4730! took Massa on 10 April

and Carrara the next day, while the

442d outflanked both towns against

strong opposition in bitter mountain

fighting. Both regiments were now up

against the German fortified line and

both were under fire from the coastal

guns, but now had positions from which

their own field pieces could reply.

Eighth Army attacked on 9 April, was

across the Santerno River in two days of

hard fighting, and by 13 April was beyond the Sillaro on the road to Bologna.

The launching of the main drive by

IV Corps was delayed for 48 hours by

weather conditions that prevented the

air cover General Truscott deemed essential. On the morning of 14 April,

however, the corps jumped off behind intensive air and artillery preparation. On

that day the 10th Mountain Division

seized and held a series of peaks west of

Highway 64; the Brazilians took Montese;. and the 1st Armored entered the

outskirts of Vergato. All units continued

to advance on 15 April. Just before midnight the 88th and 6th South African

Armoured Divisions of II Corps joined

the battle, followed early on 16 April by

the 91st and 34th Divisions. On 17 and

18 April the 85th Division relieved the

1st Armored north of Vergato, the latter

division shifting to more favorable terrain along the Panaro River on the left

of the 10th Mountain. The intercorps

boundary was shifted to the west on 19

April as the whole German front began

to crumble. The 85th Division took

4

 Principal sources for this section are: (1) Fifth

Army History, pt. IX; (2) Rpt of Opns, IV Corps,

Apr, May 45; (3) Rpt of Opns, II Corps, 1 Apr-2

May 45; (4) Hist, 92d Div, Apr, May 45; (5) Rpt

of Opns, 473d Regt, Apr 45; (6) Narrative of

Events, 442d Regt, Apr, May 45; (7) Clark, Calculated Risk; (8) Truscott, Command Missions; (9)

Howe, 1st Armored Division, pp. 396-432; (10)

Schultz, 85th Division, pp. 197-230; (11) Delaney,

Blue Devils, pp. 186-222; (12) Robbins, 91st Infantry Division, pp. 262-332; (13) Goodman, Fragment of Victory, 1952) pp. 121-77; (14) Lockwood,

ed., Mountaineers pp. 26-58; (15) Alexander,

Italian Campaign pp. 32-49; (16) Starr, ed., From

Salerno to the Alps, pp. 387-441.
462 MEDITERRANEAN AND MINOR THEATERS

Casalecchio, where the Reno River enters the plain on 20 April, while forward

elements of the 10th Mountain cut Highway 9 west of Bologna and II Corps

broke through the last of the high

ground in its path. Bologna fell on 21

April, the 34th Division entering the

city from the south and elements of the

Polish Corps of the Eighth Army from

the east.

The main advance had already swept

beyond Bologna, with both armies racing

to reach the Po before the enemy could

withdraw his disorganized forces across

the river. The 10th Mountain Division

reached the south bank of the Po at San

Benedetto west of Ostiglia the night of

22 April, crossing the river in assault

boats the next afternoon in the face of

heavy enemy fire. By the 24th the 85th

Division was also across the river, the

88th and 91st were crossing, and the two

armored divisions were only awaiting

the placement of bridges by the engineers. The 34th Division, reassigned to

IV Corps, was sweeping west along Highway 9, already beyond Parma, while the

Brazilian Expeditionary Force kept pace

through the foothills south of the highway. Verona, gateway to the Brenner

Pass, fell to the 88th Division on 25

April, and the 10th Mountain took Villafranca airport southwest of that city the

same day.

In the final days of the war in Italy,

Fifth Army fanned out toward the borders to cut off all avenues of escape. Resistance was sometimes strong, sometimes

nonexistent, but always confined to pockets where isolated remnants of the once

proud Wehrmacht tried to break out of

the trap that was swiftly closing on all

sides. The 91st Division pushed east

through Vicenza to Treviso where the

Eighth Army sector began. The 88th

swung northeast from Verona to outflank

Bolzano, and the 10th Mountain Division fought its way to the head of Lake

Garda. The 1st Armored sent flying

columns to the Swiss frontier at Lake

Como, and west to Milan.

The 92d Division, meanwhile, after a

week of bitter fighting, broke through

the mountain defenses of La Spezia,

while Italian partisans seized the city itself. The 473d Infantry entered La

Spezia on 23 April, and four days later

entered Genoa more than a hundred

miles up the coast. From there patrols

moved west to the French border. The

442d, after driving inland from the La

Spezia area, made contact with IV Corps

near Pavia and sent patrols west to

Turin.

The first organized surrender came on

29 April when the 148th Grenadier and

Italia Bersiglieri Divisions surrendered

to Maj. Gen. Joao Mascarenhas de

Morais, commanding the Brazilian Expeditionary Force. At 1400 on 2 May

1945 all German forces in Italy were

surrendered unconditionally to General

Clark, and the Italian campaign was

over. The number of prisoners taken was

more than 250,000, bringing the total for

the Italian campaign to over half a

million.

Medical Support in the Field

Field medical support of Fifth Army

during the final drive in Italy was

characterized by an initial period of

heavy casualties and slow movement,

followed by rapid expansion over hundreds of miles with enemy casualties exceeding our own. In the last few days of

combat medical units were not only cut
ADVANCE TO THE ALPS 463

off from army and corps surgeons, they

were also frequently out of communication with their own headquarters. The

use of captured vehicles, medical installations, and supplies was both a general

practice and a necessary expedient.5

The 92d Division Front—Perhaps the

most difficult task was that assigned to

the 317th Medical Battalion, organic to

the 92d Division, which during the

greater part of the drive was required to

support five regimental combat teams

on three fronts. Casualties suffered by

the augmented 92d Division, even though

two of its five regiments had little contact with the enemy, were exceeded only

by those of the 10th Mountain Division

on the IV Corps front. (See Table 33.)

One collecting company and one platoon

of the clearing company remained with

the defensive formations in the Serchio

Valley until 25 April, when that sector

was closed out. The other two collecting

companies, sometimes operating in sections, supported the main drive of the

442d and 473d RCT's, with one platoon

of the clearing company backing up both.

Neither the terrain nor the location of

enemy long-range guns permitted the attached platoon of the 32d Field Hospital

to move up from its Viareggio site in

time to give close support during the

period of severe fighting, but the relative

slowness of the advance to La Spezia kept

the hospital within usable distance.

By 20 April communications with the

92d Division had become so tenuous that

General Martin designated the division

surgeon, Lt. Col. Eldon L. Bolton, to act

as his deputy in the coastal sector, with

full responsibility for the medical service

there.

La Spezia fell on 23 April, and two

days later medical units from the Serchio

Valley rejoined the 317th Medical Battalion in support of combat elements

now fanning out in two directions. Forward hospital facilities were urgently

needed, but the Viareggio field unit,

with no army evacuation hospital in the

vicinity, was unable to move on short

notice. To redeem the situation, General Martin sent a unit of the 15th Field

Hospital, which was still in bivouac north

of Florence, and a platoon of the 601st

Clearing Company, 161st Medical Battalion, to the 92d Division front. A 250-

bed hospital was set up on 25 April near

La Spezia, but the combat units were

already far ahead. After three days of

operation with only a handful of patients, the clearing platoon moved on 29

April to Genoa, where it was joined the

following day by the field hospital unit.

By that date one platoon of the 92d

Division clearing station was northwest

of Genoa, and the Viareggio unit of the

32d Field Hospital was on its way to

Alessandria, on the road to Turin. The

field hospital was in the vicinity of Milan

en route when hostilities ceased.

Medical Support of IV Corps—First of

the IV Corps medical units to go into

5

 This section is based primarily on the following

documents: (1) Annual Rpt, Surg, Fifth Army,

1945; (2) Annual Rpt, Surg, II Corps, 1945; (3)

Opns Rpt, IV Corps, Apr, May 45; (4) Opns Rpt,

II Corps, 1 Apr-2 May 45; (5) Hist, 92d Div, Apr,

May 45; (6) Annual Rpt, Surg, 10th Mountain

Div, 1945; (7) Annual Rpt, Surg, 91st Div, 1 Jun-12

Aug 45; (8) Hist, 47th Armored Med Bn, Apr, May

45; (9) Unit Hists, 10th Mountain Med Bn, Apr,

May 45; (10) Hist Rcd, 109th Med Bn, Apr, May

45; (11) Opns Rpts, 310th Med Bn, Apr, May 45;

(12) Hist, 313th Med Bn, Apr, May 45; (13) Unit

Hist, 316th Med Bn, Apr, May 45; (14) Hist Data,

Med Bn 92d Inf Div, Apr, May 45; (15) Annual

Rpts, 1945, of 54th, 161st, 162d, 163d Med Bns; (16)

Annual Rpts, 1945, of 15th, 32d, 33d, Field Hosps.
464 MEDITERRANEAN AND MINOR THEATERS

100TH BATTALION AIDMEN approach

wounded on "Ohio Ridge."

action was the 10th Mountain Medical

Battalion, whose collecting companies

moved out with the mountain infantry

on the morning of 14 April. Casualties

were heavy from the start, with jeeps and

ambulances inadequate to clear the aid

stations the first two days. Trucks were

used for walking wounded, and one collecting company borrowed additional vehicles from the service company of the

infantry regiment it supported. Even

when vehicles were available, there were

delays in moving casualties to collecting

and clearing stations. All roads were

operating one way, traffic moving toward

the front. Ambulances had to wait, sometimes as long as an hour and a half, to

use the roads in the other direction.

By midnight of 14 April the clearing

stations of the 10th Mountain Medical

Battalion had admitted 415 patients, including injury and illness. The total rose

to 427 the next day, then fell off to 327

on 16 April, and 210 on the 17th. The

figures are notable only because they

were the highest in Fifth Army, in keeping with the spearhead role of the

division. (See Table 33.) Admissions remained in the vicinity of 200 for several

days, dropping to 132 on 22 April and

rising to 254 the following day, when

the leading elements of the 10th Mountain crossed the Po River and won a

bridgehead on the north shore against

heavy opposition. Casualties were negligible thereafter except for the last two

days of April, when there was hard fighting along Lake Garda.

The experience of the 10th Mountain

Medical Battalion was typical of IV

Corps medical units generally. Casualties were heavy for two or three days.

Advances were minimal, and clearing

stations stayed where they were. Beginning about 19 April, when the descent

into the Po Valley began, movements

became increasingly frequent and confusion grew. Clearing stations moved

daily, collecting stations sometimes twice

a day. Collecting companies were so close

behind the retreating enemy by 20 April

that they passed through still burning

villages and ran the gantlet of artillery

and sniper fire. Indeed, as the rout developed medical units were not infrequently ahead of the retreat. Armed

Germans surrendered with increasing

frequency to unarmed medics, and by

25 April German ambulances were

bringing German wounded to U.S. installations.

Distances between stations lengthened

after the Po was crossed and the race

for the frontiers began. On 24 April a

clearing platoon and collecting company

of the 10th Mountain Medical Battalion
ADVANCE TO THE ALPS 465

MEDICS OF 10TH MOUNTAIN DIVISION EVACUATING WOUNDED IN A JEEP while

tanks wait to use the one-lane road, April 1945.

accompanied a task force on a spectacular

70-mile dash from the Po to Lake Garda,

where for two days the clearing station

constituted the left flank of the division.

On 28 April a company of the 47th

Armored Medical Battalion traveled 62

miles; and the following day a collecting

company of the 109th Medical Battalion,

organic to the 34th Division, covered 170

miles in a roundabout journey from the

vicinity of Fidenza to the outskirts of

Milan. A 30-mile jump was average.

From 20 April on, medical units were

periodically out of touch with their own

headquarters, sometimes for days at a

stretch. Fortunately, casualties by this

time were light, and could generally be

held until clearing stations or field hospitals were located. Prisoner of war

patients, who outnumbered Allied

casualties, were usually sent to captured

German hospitals in captured vehicles.

It was quickly obvious that field hospital platoons could not possibly keep pace

with division clearing stations and still

perform surgery or hold nontransportable casualties. The corps surgeon tried

to keep these units as available as possible in terms of transportation, but inevitably they fell behind, where their

functions became more nearly those of

evacuation than of forward surgical hospitals.

Of the two platoons of the 32d Field
466 MEDITERRANEAN AND MINOR THEATERS

Hospital attached to IV Corps, the 2d

Platoon followed the westward push of

the 34th Division along Highway 9 and

the BEF south of that route. Moving on

20 April from Valdibura, where it had

spent the winter, to Lama about ten

miles south of Bologna on Highway 64,

the unit was the most forward Fifth

Army hospital, but it was already too far

behind. At Castelfranco, some fifteen

miles west of Bologna on Highway 9,

there was no such complaint. The town

was being shelled when the hospital

arrived on 22 April. Four additional

surgical teams were called in, and for

seventy-two hours four operating tables

were in constant use. On 28 April the

unit moved west once more on Highway

9. Parma was passed, but Piacenza was

still held by the enemy, so the unit set

up in buildings of a civil hospital in

Fidenza. Two hours later the platoon

was ordered to close and return to

Parma, where its own functions could

be combined with administration of a

large German hospital captured there.

The 3d Platoon of the 32d Field

opened in Vergato on 18 April, moved

70 miles on 24 April to a bivouac area in

the vicinity of the corps Po crossings, and

opened in Mantova two days later. On

1 May the unit moved to the suburbs of

Milan. In the final stages of the campaign, sections of the 615th Clearing

Company, 163d Medical Battalion, accompanied the field hospital units to care

for overflow and to provide holding facilities to enable the hospitals to move

forward.

Late in the campaign, on 29-30 April,

the 3d Platoon of the 15th Field Hospital

was attached to IV Corps and set up in

the vicinity of Modena, but aside from

receiving the patients of an evacuation

hospital about to move, the unit had

little to do. There were three other field

hospital units and one evacuation hospital closer to the front at that time.

Evacuation of aid and collecting stations in the Po Valley was by ambulance,

jeep, truck, and captured vehicles of all

kinds. In this flat, well-traveled country,

there were no backbreaking litter carries. The extra litter bearers attached at

the start of the drive were released when

the plains were reached, and most of the

regular bearers were sent back for rest.

Until clearing stations crossed the Po,

boats and Dukws as well as ponton

bridges were used for evacuation. On

Lake Garda boats were used extensively,

partly to bypass stretches of highway

blocked by the destruction of tunnels,

partly because elements of the 10th

Mountain Division were operating on

the west side of the lake and casualties

could not be reached in any other way.

Medical Support of II Corps—The II

Corps medical service did not differ in

any essential from that of IV Corps.

Casualties in all divisions were heavy for

the first three or four days. After debouchment into the Po Valley, casualties declined sharply while distances

covered and speed of movement increased.

The clearing station of the 313th Medical Battalion, serving the 88th Division,

for example, was in the vicinity of

Loiano on Highway 65 when the drive

started. The station moved over to Vergato on 19 April when the intercorps

boundary was shifted, but most of its

patients there were from the 10th Mountain Division, whose clearing station was

temporarily out of contact. The clearing

station of the 88th moved to Lama on
ADVANCE TO THE ALPS 467

91 ST DIVISION MEDICS AT PIANORO, APRIL 1945

20 April, and on the 22d moved up to San

Giovanni, some distance beyond the site

originally selected. The following day

found the station at Mirandola, and on

the 26th it was beyond the Po. A series

of rapid moves on the last three days of

the month brought the station successively to Lonigo, Vicenza, and Bassano,

while the division it supported probed

into the Alps. The clearing station of the

91st Division—316th Medical Battalionwas in Praduro at the foot of the Apennines on 21 April, but daily moves thereafter brought the unit across the Po and

Adige Rivers and east to Treviso, where

the Eighth Army zone began. Battle

casualties of the 91st Division were less

than half those suffered in a comparable

time period against the Gothic Line in

September 1944.

The medical service of the 34th Division followed a similar pattern before its

transfer to the IV Corps at Bologna.

In addition to the divisional medical

units, the 383d Clearing Company, 54th

Medical Battalion, operated a collecting

station for corps troops during the first

hectic days in the Po Valley. Elements

of the 54th also performed holding

chores toward the end of the period to

enable the field hospital platoons to

move forward.
468 MEDITERRANEAN AND MINOR THEATERS

TABLE 33—WOUNDED IN ACTION IN THE Po VALLEY CAMPAIGN, FIFTH ARMY

1 APRIL-15 MAY 1945

Source: (1) Compilation by Fifth Army Casualty Section. (2) Theater ETMD Rpt for Jul 45. Totals for the 92d

Division are from the ETMD. Figures for the attached regiments—the 442d and 473d—are calculated. Wounded in action

figures for the 442d and 473d Regiments given by Goodman, Fragment of Victory, page 217, are respectively 513 and

571 for the period 5 April-2 May inclusive, or 1,084 in all, compared with 1,083 arrived at by calculation. Since there was

no combat action prior to 5 April or after 2 May the time periods may be taken as comparable for purposes of recording wounded in action.

One of these, the 1st Platoon of the

33d Field Hospital, found itself tied

down in Casalecchio on the northern

rim of the Apennines from 21 April until after the surrender because its patients could not be moved and the unit

was too far in the rear to be relieved. Its

place on the II Corps front was taken by

the 1st Platoon of the 15th Field, which

was attached north of San Giovanni on

24 April and was beyond the Adige at

Cologna by the 28th.

The 2d Platoon of the 33d Field Hospital moved quickly through Bologna,

San Giovanni, and Mirandola without

ever getting close enough to the fighting

lines to see more than a few patients. At

Isola della Scala, several miles south of

Verona, the unit finally caught up with

the war on 26 April, handling 110 surgical cases in four days before going on to

Bassano. The 3d Platoon of the 33d

Field, at Monghidoro on Highway 65,

took the nontransportable cases from the

88th and 91st Divisions in the opening

days of the campaign and was tied down

at its initial site for two weeks. On 29

April the unit made the long jump to

Vicenza, but found itself still a rear installation.

Fifth Army battle casualties, based on

hospital admissions, are shown by divisions for the period 1 April through 15

May in Table 33.

Hospitalization

in the Army Area

Deployment and Use of

Army Hospitals

The demands that would be placed

upon the Fifth Army medical service by

the Po Valley Campaign had been anticipated in the planning stage, and every

feasible preparation was made to get hospitals into the forward areas as quickly
ADVANCE TO THE ALPS 469

as the inadequate highway network and

the progress of the fighting allowed. As

a preliminary step, the newly organized

171st Evacuation Hospital relieved the

170th on 2 April at Lucca, where it was

to support the coastal drive of the 92d

Division, while the 170th went into bivouac packed for movement when called

upon. Surgical teams from the 170th

served with other Fifth Army hospitals

during this inactive period. The 15th

Evacuation closed at Florence on 10

April two days before the originally

scheduled D-day for the IV Corps attack;

and the 94th closed its Florence unit on

the 12th.6

The 15th Evacuation, which had enjoyed nearly seven months of rearechelon security in Florence, was selected

by General Martin to be the first hospital

to move into the new combat zone. A

location for the hospital was prepared

by the engineers north of Porretta on

Highway 64, only five miles from the

IV Corps line of departure, but the greatest care was taken to conceal the purpose of the work. Latrines were dug

under camouflage nets, and personnel of

the advance detail bivouacked with adjacent combat units. The entire hospital

was loaded onto 80 trucks by 12 April.

Orders were received at 0820 on 14 April

lifting the security ban and giving the

convoy clearance for 0930. With trucks

placed in the order in which they were

to be unloaded, the convoy covered the

75-mile distance in three hours. Casualties were already on the way to the

site from the clearing stations. The hospital opened at 1815 and had 78 patients,

all nontransportables, by midnight. The

next day the 1st Platoon of the 602d

Clearing Company, 162d Medical Battalion, set up beside the 15th Evacuation

to handle the overflow.

For three days the 15th Evacuation

was the most forward Fifth Army hospital in the IV Corps sector. All nontransportable casualties were routed to this

unit from an army control point farther

up the road, transportable and slightly

wounded cases going back to Pistoia and

Montecatini. The hospital staff was

augmented during this period by eleven

auxiliary surgical teams. After four days

nine of these teams were withdrawn, but

two Brazilian teams were attached.7 The

Brazilian staff of 26 officers, 21 nurses,

and 68 enlisted men who had been with

the 16th Evacuation in Pistoia since November were also attached to the 15th

Evacuation on 23 April, but remained

only three days.

The 170th Evacuation Hospital

opened on 18 April near Silla, somewhat

forward of the 15th at the same time that

a unit of the 32d Field moved into Vergato. Thereafter the 15th received mostly

lightly wounded and transportable cases,

the serious casualties going to the more

forward units, but the total number of

admissions rose. The shift of Fifth Army

strength to the west of the Reno River

had the effect of funneling the wounded

from two more divisions down Highway

64. There was no room to back up the

medical units already there, and all of

6

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1945; (2) Annual

Rpt, Surg, II Corps, 1945; (3) Unit rpts of the

hosps and other med units mentioned in text;

(4) ETMD's of hosps mentioned in text, for Apr

45.

7

 These were presumably the two teams that had

been serving throughout the winter with the 2d

Platoon of the 32d Field Hospital at Valdibura.

See p. 440, above. The field unit was closed pending

movement about the time the 15th opened at

Porretta.

ADVANCE TO THE ALPS 471

them worked around the clock until the

combat troops began to debouch into the

valley. By that time, enough ground had

been secured to permit leapfrogging another hospital ahead of those in the Porretta-Vergato area. The 750-bed 38th

Evacuation Hospital was brought up on

20 April to Marzabotto, where Highway

64 begins to level off. The Brazilian personnel from the 15th Evacuation were

shifted to the 38th, to which they had

originally been attached, about 26 April.8

(Map 39)

On the II Corps front, meanwhile, the

94th Evacuation reopened at its old

Monghidoro site on 17 April, about thirty

hours after the corps jump-off. For the

next few days the 94th shared the load

of casualties in the Highway 65 sector

with the 8th Evacuation at Pietramala.

The 56th, at Scarperia, was already

closed to admissions, and on 20 April began dismantling and loading for a quick

dash to Bologna whenever that city

should be captured.

During this period of heavy pressure

on forward evacuation hospitals, the

presence of base units in the army area

proved invaluable. The 24th General

Hospital in Florence and the 70th General in Pistoia were able to take enough

movable casualties from the army units

to permit the evacuation hospitals to

keep up with demands made upon them.

The 56th Evacuation was to set up in

tents in a large stadium, located by air

reconnaissance. Other hospitals were to

be brought into Bologna as rapidly as

buildings could be found to house them.

General Martin awaited word of the fall

of Bologna at the 94th Evacuation, and

was one of the early arrivals after the

city was captured on 21 April. Martin's

personal survey revealed no buildings

suitable for hospital sites without extensive and time-consuming repairs, which

were precluded by the unexpectedly

swift advance of Fifth Army. Only the

56th was ordered forward, arriving on

22 April and taking patients at the predetermined stadium site at noon on the

23d.

The same speed of advance that left

Bologna too far behind for the forward

medical service almost as soon as it was

captured, increased the difficulties of the

Fifth Army surgeon. Rations, fuel, ammunition, assault boats, and bridging

materials, all had to be brought by truck

across the mountains from supply depots

in the Florence area, and there were no

trucks left over to move the hospitals.

General Martin solved the problem by

pooling all the organic transportation of

his semimobile evacuations. Operating

on a 24-hour basis and alternating

drivers, these vehicles moved the bulk

of the Fifth Army hospitals into the Po

Valley on a schedule so expertly managed

that no hospital was out of action for

more than twenty-four hours.

At 0900 on 23 April, while the 56th

Evacuation was still setting up its equipment in Bologna, the 94th was ordered

to close at Monghidoro. All patients

were evacuated by 2100 and the first convoy of trucks was on the road before

dawn of 24 April. The destination was

Carpi, a village about ten miles north

of Modena. Using buildings of a civilian

hospital, the 94th was taking patients at

its new site by 2000. Even more rapid

was the move of the 750-bed 16th Evacuation, which closed at Pistoia on 23

April, moved during the night to San

Giovanni, a road junction fifteen miles 8

 See p. 440, above.

ADVANCE TO THE ALPS 473

northwest of Bologna, and was functioning as a hospital once more by 1800 on

24 April. (Map 40}

On the same day, the neuropsychiatric

and venereal disease hospitals, operated

respectively by the 601st and 602d Clearing Companies, also moved to San

Giovanni, the former from Cafaggiolo

and the latter from Florence. In each

case the move was made by organic transportation of the medical battalion to

which the unit belonged. The venereal

disease hospital carried 30 patients with

it in ambulances borrowed from one of

the battalion's collecting companies.

Penicillin treatment of these patients

was continued en route without interruption.

On 25 April the 1st Platoon of the

601st Clearing Company from Montecatini and the 2d Platoon of the 15th Field

Hospital from the Cafaggiolo area were

moved to La Spezia to act as a provisional

evacuation hospital for the 92d Division.

The 170th Evacuation, after a week

of hectic operation on Highway 64, evacuated its transportable patients to the

70th General in Pistoia on the night of

25 April. Leaving one ward behind to

care for 27 patients who could not be

moved, the 170th pulled out the morning of 26 April and reopened the same

day at Mirandola, about eighteen miles

south of Ostiglia where combat units

were still crossing the Po. Only the 171st

Evacuation at Lucca, the 8th at Pietramala, and the 15th at Porretta were still

in the mountains, and all three of these

were alerted for movement.

The 15th went first, leaving a holding

detachment of 2 officers, 2 nurses, and

15 enlisted men to care for 17 nontransportable patients. Moving the hospital

tentage and equipment on 10-ton trailers, packing was accomplished in three

hours. The 15th arrived in Mantova

north of the Po the afternoon of 28 April,

where it took over a large sanatorium

and more than 300 patients from a unit

of the 32d Field. Until 25 April the

buildings had housed a German hospital.

The 8th Evacuation, after several days

of waiting for transportation, received

its vehicles in the late afternoon of 29

April, moved out over the battle-scarred

remains of Highway 65 during the night,

and admitted its first patients at the new

site just south of Verona before the end

of the day, 30 April. The 171st also

moved out the night of 29 April, but

because its new site was Vicenza, 200

miles away, with the whole width of the

Apennines to cross, it did not open until

1 May. In the meantime, the 38th Evacuation had dismantled, packed, moved

90 miles to Fidenza west of Parma on

Highway 9, and reopened on 30 April.

(Map 41)

The last hospital moves before the

German surrender put the 92d Division's

provisional evacuation in Genoa by 1

May; the venereal disease hospital in Verona and the neuropsychiatric hospital

at Villafranca on 2 May. Since there were

no longer enough neuropsychiatric casualties to justify the existence of a hospital for that purpose alone, the 2d

Platoon of the 602d Clearing Company

reverted to air evacuation holding duties

at Villafranca airport. The 170th Evacuation was in process of moving from

Mirandola to Treviso, and the 1st Platoon of the 602d Clearing Company was

en route from Porretta to Modena when

the war in Italy came to an end.

For all Army hospitals supporting the

Po Valley Campaign, the pattern of admissions was similar. Heavy casualties,

ADVANCE TO THE ALPS 475

with a preponderance of severe wounds,

characterized the start of the drive, giving way in the later phases to relatively

few American casualties, mostly lightly

wounded, and a growing volume of prisoner patients.

The 171st Evacuation—the only evacuation hospital supporting the 92d Division's coastal attack—admitted 2,416

patients between 2 April and the end

of the month, of whom 1,128 were battle

casualties. Italian partisans made up the

greater portion of the 364 Allied patients treated.

The 15th Evacuation admitted 1,592

patients, 1,173 of them surgical cases,

during its two weeks at Porretta, with

most of the serious cases coming in the

first four days. The 170th, in the course

of a week spent in the same area, admitted 528, of whom 372 were battle

casualties. The 94th Evacuation admitted 496 surgical cases at Monghidoro

and Carpi. The 8th Evacuation, which

was for two days the only hospital backing up the II Corps attack, took 72

priority cases on 16 April and 97 more

in the next twenty-four hours, "as serious and severe" as any previously seen in

Italy. The 8th had a backlog of 80 operative cases by the morning of 18 April,

and received another 85 that day. With

the 94th set up ahead of them and the

corps breaking out of the mountains, the

load then dropped abruptly. By 20 April

the 8th Evacuation was receiving only

rear echelon cases.

The 16th Evacuation had 1,016 admissions at San Giovanni by the end of

April, 542 of them battle casualties, but

the bulk of these were transferred from

more forward units. Battle casualties also

made up the larger group of patients at

the 38th and 56th Evacuations, but almost half were prisoners of war at the

38th and more than half at the 56th.

The medical service in the Po Valley

Campaign, like the military operations,

falls into two distinct phases. Before the

breakout from the mountains the use of

field and evacuation hospitals and corps

clearing companies followed normal

lines, but with activity intensified by the

heavy influx of casualties and by long

and difficult evacuation lines. In the valley itself the whole hospitalization picture was confused, with poor communications and inadequate transportation

forcing hospitals to assume unorthodox

roles. Field hospital platoons, with or

without assistance from clearing companies, operated as evacuation hospitals,

and evacuation ran the gamut from first

priority surgery to station hospital

duties.

Hospitalization of Prisoners

of War

Until the Po River was reached,

enemy casualties were routinely evacuated to Fifth Army hospitals, where they

were cared for in the same manner as

U.S. and Allied patients. Only a trickle

of wounded Germans reached the 171st

Evacuation Hospital, owing to the

lengthening evacuation lines on the 92d

Division front. The total was no more

than 100 out of 2,000 patients treated

by that unit during its stay at Lucca. On

the IV Corps front, however, the 15th,

170th, and 38th Evacuations on Highway 64 admitted a considerable number

of German casualties after the first week

of combat. The 8th and 94th Evacuations

supporting II Corps also began taking

enemy casualties before leaving the

mountains.9

9

 This section is based primarily on the follow-
476 MEDITERRANEAN AND MINOR THEATERS

WOUNDED GERMAN RECEIVING PLASMA IN VILLAFRANCA, APRIL 1945

The number of enemy casualties became so large as to constitute a major

problem after the fighting turned into

a battle of pursuit in the Po Valley. The

bulk of the German medical facilities

had by that time been withdrawn north

of the Po, and German medical corpsmen south of the river had no alternative but to bring their casualties to Allied

clearing stations or hospitals. The 56th

Evacuation at Bologna, the 38th at Marzabotto and Fidenza, the 16th at San Giovanni, the 94th at Carpi, and the 170th

at Mirandola all received German casualties by the hundreds in the closing

days of the war in Italy. The 38th treated

close to 500, the 56th more than 800

before the end of April. At the 56th, two

German surgical teams were organized

and kept busy operating on prisoners. In

many cases German ambulance drivers

who brought their wounded to American

hospitals were allowed to return unguarded for further loads.

The first German hospital to be caping: (1) Annual Rpt, Surg, Fifth Army, 1945; (2)

Annual Rpt, Surg, II Corps, 1945; (3) Unit rpts

of the hosps and med battalions mentioned in

text; (4) ETMD's of the named hosps for Apr and

May 45.
ADVANCE TO THE ALPS 477

GERMAN HAUPTVERBANDPLATZ, equivalent to a reinforced clearing station, captured 25

April 1945.

tured intact was taken by the 10th Mountain Division on the south bank of the

Po on 23 April. The unit was fully

equipped, with its full complement of

doctors, nurses, and corpsmen, but its

supplies were virtually gone. In this case,

the patients were evacuated to U.S. units,

and the dismantled hospital was sent to

the rear. It was soon clear, however, that

the Allies could not afford to waste facilities in this fashion. A directive from

Allied Force Headquarters required

Fifth Army thereafter to use German

hospitals and personnel to care for German wounded under supervision of

American medical personnel.

In the IV Corps sector, the field hospital units were ordered to set up their

own establishments in connection with

captured German hospitals, combining

administration of the prisoner units with

their own. In the II Corps area the task

of administering enemy medical units

devolved upon the 54th Medical Battalion. The number of German hospitals

taken in the final days, however, was too

great for either technique to be used exclusively. Divisional medical units and
478 MEDITERRANEAN AND MINOR THEATERS

evacuation hospitals also participated

when occasion required.

For example, the 3d Platoon of the

32d Field Hospital, coming up from

Vergato, crossed the Po on a ponton

bridge early in the afternoon of 26 April,

entered Mantova on the heels of the

retiring enemy, and proceeded immediately to a large civilian hospital and

sanatorium known to have been used by

the Germans. Until the preceding day

the establishment had served the enemy

as a base hospital. Since that time it had

been administered by 5 British enlisted

men who had been prisoners. There

were 54 Allied patients, including a few

Americans, and 140 German patients.

The staff consisted of 3 German medical

officers, 5 volunteer Italian doctors, 3

Italian medical students, 13 volunteer

Italian nurses, a dozen or more nuns

from a nearby convent, 30 German medical corpsmen, 18 Italian medical soldiers who had been interned by the

Fascists, a German Army chaplain, and

some 15 Italian partisans acting as

guards.

Most of the Allied patients were in

fair condition, despite short supplies of

both food and drugs, but infected

wounds calling for surgery were common

among the Germans. The field hospital

unit operated the prisoner of war hospital as well as its own for two days, then

turned both over to the 15th Evacuation,

which was operating as a POW hospital

almost exclusively by the end of the war.

The field hospital unit, meanwhile,

moved on to Garbagnate near Milan,

where another German hospital was

taken over. The Garbagnate establishment had close to 600 German patients

in charge of a minimum staff, a supply

depot, and a laboratory. Here again

there was little food and no fuel for essential services such as running sterilizing equipment and cooking.

At Parma, where the 2d Platoon of

the 32d Field took over a German hospital on 28 April, 220 German patients

were being cared for by 15 German medical officers, 120 corpsmen, and 3 Italian

Red Cross nurses. The establishment had

to be put under immediate guard to protect its patients from attacks by partisans.

On 2 May the same platoon of the 32d

Field added administration of a second

German hospital, located ten miles away

at Brescello, to its duties. The Brescello

unit had 83 patients. Its existence was

reported by a German medical officer

who came to the Parma unit under Partisan guard.

In the II Corps sector, the 54th Medical Battalion took over its first German

hospital on 27 April, when the 380th

Collecting Company assumed administration of the 29th Panzer Division hospital southeast of Verona. Enemy units

at Citadella and Caldogno were taken

over on 30 April, one at Galliera on 1

May, and another at Paderno on 2 May.

All of these hospital sites were in the

Vicenza-Treviso area, where the 171st

Evacuation in the opening days of May

also took more German than Allied patients.

The condition of these captured hospitals varied markedly, both as to equipment and in terms of staff, but a unit

captured at Bergamo by the 1st Armored

Division, which had 14 doctors to care

for 1,180 patients, was more typical than

the Parma hospital with its 15 doctors

and 220 patients.

The process of rounding up and concentrating the 23,000 prisoner casualties

taken by Fifth Army was only beginning
ADVANCE TO THE ALPS 479

LAKE GARDA, used by assault boats and local craft to evacuate patients.

when the war ended. The main medical

story for prisoners of war belongs to the

postwar period.10

Evacuation From Fifth Army

Evacuation from the battlefields and

from division clearing stations in the Po

Valley Campaign followed the normal

pattern, with the 54th Medical Battalion

evacuating from II Corps and the 163d

Medical Battalion from IV Corps and

the 92d Division. Both corps medical battalions were reinforced when necessary

by the attachment of collecting companies or ambulance platoons from one of

the two Fifth Army medical battalions.

Evacuation during the mountain phases

of the fighting was by hand litter, jeep,

and ambulance. On the 92d Division

front the pack mules that brought in supplies were sometimes used to carry out

the wounded from otherwise inaccessible

positions. In the Po Valley, evacuation

was predominantly by ambulance, trucks

being used for wounded prisoners and

ambulatory cases when ambulances were

not available. Dukws and assault boats 10

 See pp. 534-43, below.
480 MEDITERRANEAN AND MINOR THEATERS

were used to ferry the wounded across

the Po, and to bypass roadblocks along

Lake Garda. The problem of evacuation

within the army area was primarily one

of distance and transportation, which

was accentuated but not altered by the

presence of large numbers of enemy

wounded in the later stages of the campaign and by the tendency of combat

units to outrun their medical support.11

Evacuation from Fifth Army hospitals

to base installations, however, posed difficulties not previously encountered by the

medical service in Italy. Until the Po

Valley itself was occupied, fixed hospitals

could not be brought closer than they

were in the Florence-Pistoia-Leghorn

area. Between these hospitals and the

battle front lay mountain ranges 50 to

100 miles in depth. All rail lines had

long since been knocked out, leaving

only highways gutted by six months of

war to supply the army as well as to

evacuate the wounded. Air evacuation

could not be used until captured airfields

in the Po Valley could be made operational, and even then might be too hazardous since the slow C-47's would be

highly vulnerable while they gained

altitude for the mountain crossing.

Since the eastern end of the Apennine

chain would be easiest to cross, two station hospitals, the 60th and the 225th,

both assigned to the Adriatic Base Command, were moved into the Ancona area

before the beginning of the campaign,

but no other shifts were practical until

sites for fixed hospitals were available

north of the mountains.

Until the closing days of the war, all

evacuation from Fifth Army to base hospitals was thus by ambulance, the bulk

of it over the battered Highways 64 and

65, with distances stretching out to a

hundred miles and more as the evacuation hospitals moved into the Po Valley.

The process was constant. The heavy

casualties of the first week forced continuous clearing of forward units to

make way for the newly wounded, and as

the casualties diminished, the distances

increased to keep ambulances unremittingly on the road. Patients were carried

to the nearest base hospital—the 24th

General in Florence and the 70th General at Pistoia for the most part—where

bed space was kept open by the daily

transfer of older cases to Leghorn and

Naples by rail and air.

The airfield at Bologna was operational by 25 April, and a detachment

of the 802d Medical Air Evacuation

Transport Squadron set up a station

there on that day.12 A second air evacuation station was established at Villafranca south of Verona on 2 May,

where the 2d Platoon of the 601st Clearing Company combined the functions of

air evacuation holding unit with those

of Fifth Army neuropsychiatric hospital.

The only fixed hospital to open north

11

 This section is based primarily on the following: (1) Annual Rpt, Surg, Fifth Army, 1945; (2)

Final Rpt, Plans and Opns Off, MTOUSA, 1945;

(3) Unit rpts, 54th, 161st, 162d, 163d Med Bns;

(4) Unit rpts of hosps and other med installations

mentioned in text; (5) G-4 Rpt in Hist, 92d Div,

Apr 45.

12

 Hist, 802d MAETS, Apr 1945. There is no record, however, either in the monthly report of the

squadron or in the medical situation reports of the

Peninsular Base Section of any patients actually

being evacuated from Bologna by air before the

end of April. The 402d Collecting Company, which

was supporting the 56th Evacuation Hospital at

Bologna until 2 May, states in its final report

(History, 161st Medical Battalion, 1 January-1 August 1945), that there was no air evacuation from

Bologna during its stay there.
ADVANCE TO THE ALPS 481

AMBULANCES FORDING RENO AT PRADURO while traffic bound for front uses Bailey

bridge (right).

of the Apennines before the German surrender was the 74th Station, which began

taking patients in Bologna on 27 April.

There were 600 cases by 1 May, and another 400 less serious cases had been

housed, fed, treated, and passed on to the

rear. The 6th General had meanwhile

arrived in Bologna and was setting up,

while the 37th General was en route to

Mantova. With the establishment of

3,000 fixed beds so near at hand, evacuation hospitals were holding as many

patients as was physically possible when

the war ended.

Medical Supplies and Equipment

In preparation for the Po Valley Campaign, the 2d Storage and Issue Platoon

of the 12th Medical Depot Company sent

an advance section up Highway 64 on

7 April. Consisting of five enlisted men

and ten tons of medical supplies, the section set up a dump at Valdibura, adjacent to 32d Field Hospital. On 16 April

the platoon joined its advance section,

moving up to Porretta where an issue

point with 40 tons of supplies was established. A small detachment was left
482 MEDITERRANEAN AND MINOR THEATERS

behind at Lucca, where it served the 92d

division and medical units still in the

immediate vicinity. Its personnel were

attached for rations and quarters to the

171st Evacuation Hospital. The Lucca

section functioned independently of the

parent platoon, forwarding any requisitions it could not fill directly to the main

depot in Florence.13

The 3d Storage and Issue Platoon,

which had supported II Corps throughout the winter from its dump near

Monghidoro, moved forward to Bologna

on 24 April with 50 tons of medical supplies. The following day the Porretta

dump displaced forward to Mirandola,

transferring again to Verona on 30 April.

The depot headquarters, maintenance

section, and 1st Storage and Issue Platoon moved on 1 May from Florence to

Modena, where the base dump was

established with 150 tons of supplies.

The 92d Division, remote as it was

from the issue points supplying II and

IV Corps, drew its medical supplies

through its own organization. The divisional medical supply dump moved from

Viareggio to Massa on 16 April, was in

Riva just south of Sestri ten days later,

and opened in Genoa on the 29th.14

On the 92d Division front, transportation difficulties were constant, with

mule pack trains being used in the mountainous areas. On the II and IV Corps

fronts, no difficulties were experienced

in keeping forward dumps supplied until 25 April. Up to that time both corps

installations could be reached from

Florence in no more than a day for the

round trip. For the rest of the month,

however, until the base depot itself could

be moved into the Po Valley, both distance and the rapid consumption of

supplies to care for prisoners of war

made resupply difficult. Maximum use

of captured German medical supplies

and equipment was made during this

period.

Despite the speed of the campaign, the

dispersion of installations, and the shortages of transportation, there is no record

that any Fifth Army medical unit failed

to obtain adequate supplies or replace

equipment through regular channels.

The success of the 12th Medical Depot

Company was achieved, moreover, while

supplying close to 300,000 troops instead

of the 75,000 normally served by such a

unit.

The optical and dental services of the

12th Medical Depot Company continued

to function without interruption

through the Po Valley Campaign.

Professional Services

in the Army Area

Medicine and Surgery

While the total number of hospital

admissions during the brief period of the

Po Valley Campaign was large—6,151

cases of disease, 1,533 cases of injury, and

5,092 battle casualties, or 12,776 admissions not counting prisoners of warthere were no outstanding developments

in combat medicine or surgery. Evacuation hospitals, especially the 15th and

170th on Highway 64 and the 8th and

94th on Highway 65, handled a larger

proportion of the priority surgical cases

than had been true in earlier campaigns,

13

 This section is based primarily on the following: (1) Annual Rpt, Surg, Fifth Array, 1945; (2)

Annual Rpt, 12th Med Depot Co, 1945; (3) Davidson, Med Supply in the MTOUSA, pp. 140-42; (4)

Unit rpts of Fifth Army hosps and med bns. 14

 G-4 Rpt in Hist, 92d Inf Div, Apr 45.
ADVANCE TO THE ALPS 483

but this was because the majority of battle wounds occurred in the opening days

of the offensive while the evacuation hospitals were still close to the action. The

field hospital platoon with attached surgical teams continued to be the preferred

installation for forward surgery. Whole

blood flown up from the Naples blood

bank and from bleeding sections in

Florence and Pisa was used extensively,

and was again delivered to forward areas

by cub plane.15

The medical problems were the normal ones, predominantly respiratory and

intestinal diseases attributable to exposure or to inadequate sanitation in newly

conquered areas. An outbreak of hepatitis in the 1st Battalion on the 86th Infantry, 10th Mountain Division, during

the first two weeks of April suggested

drinking water as the source of infection.

The 3d Battalion of the 362d Infantry,

91st Division, suffered an outbreak of

atypical pneumonia in the second and

third weeks of April, with evidence indicating a barn used for showing films and

an adjacent straw pile as the point of

origin. The incidence of venereal disease

declined in April, as was to be expected

in combat.

Psychiatric disturbances increased

markedly over the static winter months,

with a total of 1,430 cases in April, of

which 668 were returned to full duty

from the division clearing stations or

rehabilitation centers and 266 from hospitals, which also returned 293 to limited

duty. Only 203 were evacuated out of the

army area, or 14.2 percent—lower than

the percentage for any other combat

month in Fifth Army history. The number of psychiatric casualties declined

sharply during the battle of pursuit in

the Po Valley, and by the end of hostilities was no longer enough to justify the

separate existence of a neuropsychiatric

hospital at the army level.

While both medical and surgical services of Fifth Army units were pushed to

the limit of their capacities in the three

weeks of active combat, the problem was

always one of applying familiar techniques on the required scale rather than

the development of new methods to cope

with unforeseen crises.

Dental Service

Dental work during the weeks of

actual combat was largely confined to

emergency cases, with many dental officers, particularly those on the staffs of

evacuation hospitals, performing a variety of other functions. Complete dental

service was nevertheless available in the

army area throughout the campaign.16

The IV Corps dental clinic ceased operation in mid-April when the 32d Field

Hospital platoon to which it was attached

closed at Valdibura, and operations were

not resumed until after the end of hostilities. The II Corps clinic, however,

continued to operate throughout the

campaign, moving forward with the

clearing company of the 54th Medical

Battalion. The Fifth Army dental clinic,

conducted by the 2d Platoon of the 602d

Clearing Company, 162d Medical Battal15

 Principal sources for this section are: (1)

Annual Rpt, Surg, Fifth Army, 1945; (2) ETMD's

for Apr, May and Jun 45; (3) Unit rpts of Fifth

Army hosps and of 2d Aux Surg Gp.

16

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1945; (2) Annual

Rpt, 320! Field Hosp, 1945; (3) Annual Rpt, 54th

Med Bn, 1945; (4) Dental Hist, MTO.
484 MEDITERRANEAN AND MINOR THEATERS

ion, also functioned in its normal capacity, moving with the platoon, which also

operated the army venereal disease center, to San Giovanni on 24 April and to

Verona on 2 May. Mobile prosthetic and

operative trucks and the mobile dental

dispensaries of the divisions were in service as far forward as circumstances permitted.17

The ratio of dental officers to army

strength for April 1945 was 1:924, a

slight improvement over the preceding

month but higher than the average ratio

for the North Apennines Campaign. The

total number of dental operations performed in Fifth Army in April was less

than for any month since September

1944. The length of time available for

getting the troops into shape before the

beginning of the offensive was a factor in

reducing the need for dental work once

the drive was under way.

Veterinary Service

Animal transportation was as essential

to Fifth Army in the Po Valley Campaign as it had been throughout the earlier fighting in Italy. The only noteworthy changes were in the direction of

better organization and more complete

veterinary support. By the launching of

the final drive, Fifth Army had 17 Italian

pack mule companies, grouped into 5

battalions under the 2695 Technical Supervision Regiment. Each company had

269 animals and 379 men, including an

Italian veterinarian. Three U.S. veterinary officers functioned at the battalion

level. In addition to these units, the 92d

Division had its own provisional pack

mule battalion. Shortly before the start

of the campaign, the 10th Mountain Division received 180 horses for its cavalry

reconnaissance troop from the Fifth

Army Remount Depot, and 525 mules

direct from the United States. The division's animal strength ultimately reached

822, not counting attached Italian pack

rnule companies. There were approximately 4,500 horses and mules and 125

scout dogs in Fifth Army during this

period.18

Veterinary service was supplied by division and corps veterinary personnel,

which in the case of the 10th Mountain

Division was substantial.19 Fifth Army's

four Italian-staffed and U.S.-equipped

veterinary hospitals were supplemented

by the late arrival on 17 April of the 36th

Veterinary Company, whose 5 officers

and 59 enlisted men took over the bulk

of the animal evacuation thereafter. The

three semitrailers with which the company was equipped proved less satisfactory for negotiating the difficult Italian

roads than the trucks previously used.

The 212th Veterinary Station Hospital, serving IV Corps, was the first to

enter the Po Valley. The unit closed at

Lucca on 20 April and opened at Palazzo

Beccadelli, on the edge of the plain about

ten miles west of Bologna, on the 22d.

The 211 th Veterinary Evacuation, also a

IV Corps unit, closed at Riola in the

10th Mountain Division sector on 24

17

 See pp. 452-53, above.

18

 Sources for this section are: (1) Annual Rpt,

Surg, Fifth Army, 1945; (2) Opns Rpt, II Corps,

1 Apr-2 May 45; (3) Opns Rpt, IV Corps, Apr

45; (4) Hist, 92d Div, Apr 45; (5) Annual Rpt,

Surg, 10th Mountain Div, 1945; (6) Vet Rpt, Sick

and Wounded Animals, Apr 1945; (7) Hist, 36th

Vet Co (Separate) ; (8) Fifth Army History, pt. IX;

MS, Veterinary History, Mediterranean Theater of

Operations. 19

 The 10th Mountain Div had 22 veterinary officers and 182 enlisted men. See p. 432, above.
ADVANCE TO THE ALPS 485

April, opening two days later at Ghisione

just south of the Po in the vicinity of

Ostiglia. The two veterinary evacuation

hospitals attached to II Corps were somewhat later in getting across the mountains, both moving into the Verona area

in the closing days of the campaign. The

110th opened at Polvrifitto southeast of

the city on 28 April, while the 130th

opened in Verona itself on the 30th. The

Fifth Army Remount Depot moved to

San Martino, close to the site of the 211th

Veterinary Evacuation Hospital, about 1

May. (See Maps 39,40, 41.)

While animal casualties were fewer

than in the North Apennines Campaign,

the veterinary problem was complicated

by the capture of thousands of German

animals north of the Po, many of which

were in need of immediate attention.20

Veterinary food inspection detachments continued to operate with Fifth

Army throughout the Po Valley Campaign, but their work was of a routine

nature.

20

 See p. 517, below, for a discussion of the care and

disposition of these animals.
CHAPTER XIII

The Italian Communications Zone

Northern Phase

As the war in Italy moved into the

northern Apennines, the communications zone was extended up the peninsula

to the Arno Valley. The requirements of

the campaign in southern France, however, delayed the northward movement

of medical installations and placed an undue burden on the evacuation facilities.

It was not until Fifth Army had been

stalled by snow and mud a short ten

miles from the Po plain and Seventh

Army had passed to control of the European Theater of Operations that a sweeping realignment of communications zone

activities was possible.

Organizational Changes Affecting

the Medical Service

Theater Medical Organization

Since February 1944 responsibility for

the operating functions of the Medical

Department in the Italian communications zone had rested with the medical

section of the Services of Supply organization-SOS NATOUSA, redesignated

Communications Zone, NATOUSA, as

of 1 October. By midsummer of 1944, the

medical section was deeply involved in

preparations for the invasion of southern

France, and furnished key personnel for

the base organizations that followed the

Seventh Army advance. This diversion of

personnel necessarily increased the work

load of those remaining in Italy, but the

situation was understood to be temporary

since logistical support of the 6th Army

Group would ultimately become the responsibility of ETO. Shortly after the

command of Seventh Army passed to

SHAEF on 15 September, the date for

the transfer of the supporting functions,

including medical, was fixed as 1 November.1

At this time, however, the SHAEF

commander, General Eisenhower, indicated his desire that an operating communications zone organization be part of

the transfer. In effect, Communications

Zone, NATOUSA, was to go over to

ETO as the Southern Line of Communications (SOLOC) , leaving the American

component of Allied Force Headquarters

to develop a new organization to carry on

communications zone functions in the

Mediterranean theater. For the Medical

Department, the most practical solution

appeared to be the resumption of operating functions by the Medical Section,

1

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Hist, Med

Sec, Hq COMZ MTOUSA; (3) Munden, Administration of Med Dept in MTOUSA, pp. 129-78;

(4) Davidson, Med Supply in MTOUSA, pp.

155-56; (5) Logistical History of NATOUSAMTOUSA. See also pp. 399-401, above.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 487

GENERAL STAYER

NATOUSA, which would in addition assume the medical supply responsibilities

formerly exercised by the SOS organization.

On 1 November 1944 the theater

boundaries were redrawn to exclude

southern France, and the North African

Theater of Operations, United States

Army (NATOUSA), was redesignated

Mediterranean Theater of Operations,

United States Army (MTOUSA) . The

organization was completed on 20 November when Communications Zone,

MTOUSA, ceased to exist, and the functions of its medical section were formally

assumed by the Medical Section, Headquarters, MTOUSA. The consolidation

was effected with the transfer of only 5

officers and 16 enlisted men from the outgoing group, all of them specialists in

medical supply.

Few changes were necessary in the

composition of the MTOUSA medical

section. Maj. Gen. Morrison C. Stayer

continued as theater surgeon with Colonel Standlee as his deputy. Lt. Col. (later

Col.) Joseph Carmack, administrative

officer, Col. William C. Munly, medical

inspector, and Col. William S. Stone,

preventive medicine officer, were among

the section heads whose functions were

unchanged. Neither the surgical consultants section, headed by Colonel Churchill, nor the medical consultants section,

which included Colonel Long as medical

consultant and Colonel Hanson as consultant in neuropsychiatry, was affected

by the reorganization. The MTOUSA

dental officer, Colonel Tingay, and the

theater veterinarian, Colonel Noonan,

were also unaffected by the reorganization. The replacement of Colonel Wilbur, director of nurses, by Lt. Col.

Margaret E. Aaron on 14 December was

a matter of normal rotation, not related

to any change in functions. Colonel

Aaron had served in the European

theater, where she had been Director

of Nurses, SOS ETOUSA.

In the reorganized Medical Section,

MTOUSA, hospitalization and evacuation fell into the experienced hands of

Col. Albert A. Biederman, who had rejoined the section as the plans and operations officer early in September after six

months with the SOS organization. Only

in the area of medical supply, which had

never been an operating function of the

MTOUSA medical section, was it necessary to add significantly to the staff. Colonel Radke, who had been NATOUSA

medical supply officer since the spring of

1943, remained in that capacity until 20

December, but his role continued to be

confined to the policy level. The operating functions were performed under the

direction of Colonel Jones, who had
488 MEDITERRANEAN AND MINOR THEATERS

headed the SOS medical supply section

since May 1944. Jones brought with him

from the medical section of Cornzone MTOUSA, a trained staff and a

functioning organization. He succeeded

Radke as MTOUSA medical supply officer on 21 December.

The MTOUSA medical section moved

out of the royal palace in Caserta on 12

November to the quarters formerly occupied by the SOS medical section in an

Italian military hospital. On 23 November the personnel allotment of the section was increased to cover losses, and on

24 December an additional officer and 3

enlisted men were allocated to it, bringing the authorized total to 32 officers, including 2 nurses, and 80 enlisted men.

Three medical officers were added in

May 1945, bringing the aggregate personnel strength of the section to 115.

Concentration of Communications

Zone Functions in Italy

The November 1944 reorganization

brought the base sections back under the

control of theater headquarters at a time

when the progress of the war was concentrating the Mediterranean forces in

northern Italy. The invasion of southern

France had left the theater short of

troops, transportation, equipment, and

hospital beds, and it was therefore essential to eliminate so far as possible the factor of distance.2

In North Africa, which had been substantially stripped of supplies and hospital beds to build up the bases in

southern France, the Eastern and Atlantic Base Sections were absorbed by the

Mediterranean Base Section on 15 November. The base section headquarters

was moved from Oran to Casablanca

early in December and on 1 March 1945

the whole of North Africa passed to control of the Africa-Middle East Theater.3

With all of southern France and all of

Italy south of the Arno firmly in Allied

hands, the Mediterranean islands also

lost their strategic importance. The Island Base Section in Sicily had already

been closed out in mid-July, and the last

U.S. hospital left Sardinia the end of

October. The Northern Base Section,

consisting of the island of Corsica, continued in operation on a reduced scale

until the end of the war, being finally

closed out on 25 May 1945.

The Peninsular Base Section, on the

other hand, grew in importance as the

African and island bases declined. As

soon as the facilities of the port of Naples

and the hospitals concentrated in that

vicinity were no longer needed for the

logistical support of the forces in southern France, the base section began shifting its strength to the Leghorn-FlorencePisa triangle. PBS headquarters was established in Leghorn on 25 November,

the subheadquarters in Naples thereafter

being designated as PBS South. Colonel

Arnest, the PBS surgeon, moved to Leghorn with the base headquarters, leaving

Col. Leo P. A. Sweeney as his deputy in

Naples.

At the same time the U.S. component

of Rome Allied Area Command was

2

 Principal sources for this section are: (1)

Annual Rpt, Med Sec, MTOUSA, 1944; (2) Final

Rpt, Plans and Opns Off, Office of the Surg,

MTOUSA; (3) Annual Rpt, Surg, PBS, 1944; (4)

Annual Rpt, Surg, MBS, 1944; (5) Annual Rpts,

Surg, NORBS, 1944, 1945; (6) Annual Rpt, Surg,

Rome Area, 1944; (7) Monthly Hist, Med Sec, Rome

Area, Jan-May 45; (8) AAFSC MTO, Annual Med

Hist, 1945. 3

 For subsequent activities, see pp. 8off., above.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 489

redesignated Rome Area, MTOUSA, effective 1 December. The Rome Area surgeon was Lt. Col. (later Col.) Benjamin

L. Camp, who also retained his office as

deputy to the RAAC surgeon, Col. T. D.

Inch of the Royal Army Medical Corps.

The single U.S. fixed hospital scheduled

to remain in Rome was brought under

the Rome Area jurisdiction, together

with responsibility for sanitation, venereal disease control, and other miscellaneous medical functions.

Similarly, the Adriatic Depot was reconstituted on 28 February as the Adriatic Base Command (ABC) with headquarters at Bari. Though its primary

mission was still that of supporting the

U.S. Army Air Forces units in Italy, it

was made responsible directly to MTO

USA. After detailed study of the point,

the hospitals previously attached to the

Army Air Forces Service Command were

brought under the aegis of the Adriatic

Base Command.

By the end of hostilities, the medical

activities of the communications zone in

the Mediterranean theater centered in

PBS Main at Leghorn, with lesser and

largely subsidiary bases in Naples, Rome,

and Bari.

Hospitalization in the

Communications Zone

The inadequacy of medical facilities in

the Mediterranean theater was never

more obvious than at the start of the

bitter and costly campaign in the northern Apennines. In the first days of

September 1944, the Italian communications zone was as deficient in bed strength

as was Fifth Army. Nine thousand T/O

fixed beds were already closed or alerted

for closing in Italy for movement to

southern France, plus another 4,500 in

North Africa, and 750 in Corsica. In Italy

the total would be 21,900 under control

of the Peninsular Base Section and 3,200

attached to the Army Air Forces. Of the

PBS total, more than half were in the

Naples-Caserta area, 300 miles from

the Fifth Army front, and only 4,000

north of Rome.

The problem thus posed for General

Stayer and Colonel Arnest was immeasurably complicated by the necessity of hospitalizing in Italy for an indefinite time

the casualties evacuated from southern

France. Yet until the hospitals already

closed in Italy and Africa could be reestablished in France there was no alternative. For the next two months the

Italian communications zone, with 25

percent of its strength already withdrawn, would support two field armies,

each engaged in a major campaign. It

would support them, moreover, at long

range, for the patient load would be too

great to permit any substantial number

of beds to be closed for movement closer

to the front.

Casualties From Southern France

When the first casualties from the amphibious landings in southern France

reached Italy on 17 August 1944 there

were already some 25,000 patients on

hand in PBS hospitals. Between that date

and 20 November, an estimated 20,000

patients from France were received in

PBS, in addition to Fifth Army casualties

and the routine disease and injury cases

from among service and replacement

troops in Italy.4

4

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual

Rpt, Surg, PBS, 1944; (3) ETMD's for Aug-Nov
490 MEDITERRANEAN AND MINOR THEATERS

While a few Seventh Army casualties

were flown to Rome, the bulk of the evacuees from southern France went by sea

and air to Naples, where they were cared

for by the 17th, 37th, 45th, and 300th

General Hospitals. Each of these units

operated in excess of its Table of Organization capacity during the emergency

period, as did most of the PBS hospitals.

Fixed hospitals in both Naples and Rome

were still receiving thousands of casualties from Fifth Army through September

and October at the same time that the

Naples hospitals were filled with

wounded from southern France and twothirds of the beds in Rome were in process of moving to northern Italy.5

 The

only evacuation from the overcrowded

Naples hospitals at this time was to the

zone of interior, since there were no

longer any beds left in Africa for longterm patients.

Movement of Fixed Hospitals

Into Northern Italy

The overloading of PBS hospitals with

casualties from southern France and

from the Gothic Line was only one of

several reasons for the delay in moving

fixed beds into northern Italy. Another

reason was the difficulty in finding sites

for large installations. In the war-torn

Arno Valley few buildings were available

of sufficient size to house a 1,500-bed or

2,000-bed general hospital; and to set up

such an establishment in tents or prefabricated buildings with adequate power,

water, drainage, and access roads was a

major engineering project. Still another

factor was the hope, after the initial success of Fifth Army against the Gothic

Line, of a quick breakthrough into the

Po Valley. Ground haze in that region

made air evacuation impossible in the

winter months, and the rail lines had

been knocked out by Allied bombing. It

was therefore deemed essential to keep at

least a minimum of fixed beds mobile for

early movement north of the Apennines.6

At the beginning of the North Apennines Campaign the 64th General Hospital was at Ardenza, a suburb just south

of Leghorn, with the 55th Station

Hospital attached, giving the combined

installation a T/O capacity of 1,750 beds.

The 50th Station Hospital, with 250

beds, was at Castagneto some 40 miles

down the coast, and the 24th General,

with 1,500 beds, was at Grosseto, another

40 miles farther south and 75 miles from

the rearmost Fifth Army installations.

Moves made during September were

largely readjustments, not involving any

of the large hospitals in the Naples or

Rome areas.

On 13 September the 154th Station

Hospital—the only 150-bed unit in the

theater—moved up from the Battipaglia

staging area south of Naples to relieve

the 105th Station at Civitavecchia. The

105th, with 500 beds, moved on to Grosseto to relieve the 24th General and the

latter unit proceeded to Florence, where

it opened on 21 September in the extensive plant of a former Italian aeronautics

school. By mid-October the hospital was

1944; (4) Rpts of individual hosps mentioned in

text. See also pp. 396-400, above. 5

 See p. 447, above.

6

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Final

Rpt, Plans and Opns Off, MTOUSA, 1945; (3)

Annual Rpt, Surg, Fifth Army, 1944, 1945; (4)

Med Sitreps, PBS, Sep 44-Jan 45; (5) Theater

ETMD's, Sep 1944-Jan 45; (6) Unit rpts of hosps

mentioned in text; (7) Unit ETMD's of the hosps

mentioned in text, for Sep 44-Jan 45.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 491

operating 2,770 beds on a 1,500-bed

T/O.

At the same time the 750-bed 7th Station Hospital, which had been staging in

Oran since July, arrived in Leghorn and

set up at Tirrenia, a former Fascist youth

camp on the seacoast about four miles

north of the city. The unit opened on 29

September with the facilities and bed

strength of a general hospital. Shortly

after its establishment, the 7th Station

was designated to hospitalize all Brazilian

ground personnel in the area, and by

December was caring for 700 Brazilian

patients in addition to a full load of U.S.

patients. Fifteen medical officers, two

dental officers, three pharmacists, a chaplain, 23 nurses, and 32 enlisted technicians, all Brazilian, were attached.

Brazilian medical strength at the 7th

Station Hospital eventually reached a

maximum of 27 officers and 65 enlisted

men, though the nurse strength declined

to 18.

The Brazilians were given wards of

their own for routine cases, but those requiring special treatment were placed in

the regular medical and surgical wards.

Brazilian doctors were assigned to the

medical and surgical staffs of the hospital, where they dealt with all patients

and worked on teams with U.S. surgeons

as well as on surgical teams of their own.

In the course of time, as language barriers and differences in practices were

overcome, the Brazilians were fully integrated into the hospital staff. Between 7

October and 12 December five Brazilian

medical officers and six nurses also served

with the 154th Station at Civitavecchia

to care for personnel of nearby Brazilian

Air Force units.

The only other hospitals to move into

northern Italy during September were

the 81 st Station from Naples and the

114th Station from Rome, but neither

move was completed before the end of

the month. The 81st closed in Naples on

24 September, and was established adjacent to the 64th General at Ardenza by

1 October. One 250-bed expansion unit

was set up immediately, and a second

opened shortly in a prisoner of war stockade. The 81st, with the assistance of detached personnel from other units, was

thus operating 1,000 beds on a 500-bed

T/O.

The 114th Station, which moved into

an abandoned Italian military hospital in

Leghorn proper, had more difficulty getting established. Extensive repairs were

required, and it was 20 October before

the hospital was ready to receive patients.

The 114th Station continued to serve as

the PBS neuropsychiatric hospital, but

the shortage of fixed beds made it necessary to take medical cases as well. For the

first two months of operation in Leghorn

about half of its patients were medical.

The shift of the 114th Station from

Rome heralded a general exodus of medical installations from the Italian capital,

which was too far in the rear to effectively support the Fifth Army front and

lacked the port facilities that made

Naples still useful as a hospitalization

center. The 33d General Hospital was

the first of its class to go, closing on 24

September. A site was located in what

was to become the Leghorn hospital

center at Tirrenia, where the 7th Station

was already in operation, and movement

was completed on 7 October. The 33d

General opened five days later. (Map 42)

The 12th General, one of the two

2,000-bed hospitals remaining in Italy,

began closing out in Rome about 1 November, starting the roundabout journey
MAP 42—Fixed Hospitals in Northern Italy, July 1944-October 1947

FIXED HOSPITALS IN NORTHERN ITALY

Grosseto

213th Veterinary General (Italian)a, 4 July 1944-

31 March 1945.

24th General, 21 July-15 September 1944. 1,500

beds.

105th Station, 15 September-24 December 1944.

500 beds.

50th Stationb, Detachment A, 22 December 1944-

20 March 1945. 100 beds.

99th Field, 1st Platoon, 20 March-17 July 1945.

100 beds.

a

Redesignated 1st Veterinary General Hospital

(U.S.-Italian), 31 March 1945.

b

 Redesignated 99th Field Hospital, 20 March

1945.
FIXED HOSPITALS IN NORTHERN ITALY—Continued

1st Veterinary General (U.S.-Italian), 31 March15 July 1945.

Castagneto

50th Station, 20 July-22 December 1944. 250

beds.

50th Station, Detachment B, 22 December 1944-

20 March 1945. 100 beds.

99th Field, 2d Platoon, 20 March-13 July 1945.

100 beds.

Leghorn

64th General, 8 August 1944-20 December 1945.

1,500 beds.

55th Station (Attached 64th General), 9 August15 October 1944. 250 beds.

81st Station, 28 September 1944-20 June 1945.

500 beds.

7th Station, 29 September 1944-26 August 1945.

750 beds.

33d General, 12 October 1944-20 September

1945. 1,500 beds.

114th Station, 20 October 1944-31 May 1945.

500 beds.

12th General, 3 December 1944-6 July 1945.

2,000 beds.

61st Station, 15 November 1945-15 November

1947. 500 beds.

Senigallia

35th Field, 2d Platoon (AAFSC; ABC), 11 November 1944-4 April 1945. 100 beds.

60th Station (ABC), 4 April-18 July 1945. 400

beds.

4th Field (ABC), 18 July-3 September 1945.

400 beds.

Pisa

105th Station, 15 January-25 June 1945. 500

beds.

103d Station, 23 March-20 July 1945. 500 beds.

55th Station, 25 June-15 November 1945. 250

beds.

99th Field, 20 July 1945-1 May 1946. 400 beds.

Empoli

50th Station b, Detachment C, 17 January-20

March 1945. 100 beds.

99th Field, 3d Platoon, 20 March-6 August 1945.

100 beds.

Florence

24th General, 21 September 1944-1 June 1945.

1,500 beds.

103d Station, 11 January-22 March 1945. 500

beds.

Pratolino

55th Station, 16 October 1944-21 May 1945.

250 beds.

225th Station, 21 May-25 June 1945. 500 beds.

70th General, Detachment A, 25 June-1 October 1945. 500 beds.

64th General, Detachment A, 1 October-15 November 1945. 250 beds.

Fano

225th Station (ABC), 16 April-8 May 1945. 500

beds.

Pistoia

70th General, 22 January-25 June 1945. 1,500

beds.

Rimini

35th Field, 2d Platoon (ABC), 17 April-24 May

1945. 100 beds.

Montecatini

182d Station, 20 April-25 June 1945. 500 beds.

70th General, Detachment B. 25 June-25 September 1945. 500 beds.

Pontepetri

2605th Veterinary General (Overhead), with 2d

Veterinary General (U.S.-Italian) attached, 21

April-2 May 1945.

Bologna

74th Station, 27 April-20 June 1945. 500 beds.

6th General, 9 May-10 August 1945. 1,500 beds.

Mirandola

2605th Veterinary General (Overhead), with 2d

Veterinary General (U.S.-Italian) attached, 2

May-28 June 1945.

San Martino

2604th Veterinary Station (Overhead), with 1st

Veterinary Station (U.S.-Italian) attached, 5-14

May 1945.

Mantova

37th General, 9 May-25 October 1945. 1,500

beds.

Milan

15th Fieldc, 1st Platoon, 1-30 September 1945.

100 beds.

Desenzano

15th Fieldc, 3d Platoon, 1 September-8 October

1945. 100 beds.

Udine

16th Evacuation (as station), 1 September-2 October 1945. 750 beds.

15th Field (88th Division), 2 October 1945-13

May 1946. 400 beds.

391st Station (88th Division), 11 May 1946-15

October 1947. 400 beds.

Bolzano

15th Fieldc, 2d Platoon, 1 September-5 October

1945. 100 beds.

Trieste

7th Station (88th Division), 1 May-19 September

1947d. 200 beds.

c

Assigned in place from Fifth Army to PBS, 1

September 1945. Reassigned to 88th Division, 25

September 1945. d

 Turned over to Trieste-United States Troops

(TRUST) 19 September 1947.
494 MEDITERRANEAN AND MINOR THEATERS

12TH GENERAL HOSPITAL, the largest unit in the group of medical installations in the

northern outskirts of Leghorn.

to Tirrenia in the middle of the month.

Four trainloads of equipment went by

rail to Naples, and thence to Leghorn by

water. Equipment arrived on 25 November, and the first patient was received at

at the new site on 3 December. The arrival of the 12th General brought Table

of Organization bed capacity in Leghorn

to 6,750, or an operating strength of better than 10,000.

The 55th Station, meanwhile, had

been relieved of its attachment to the

64th General in the middle of October,

and on the 16th of that month opened at

Pratolino, six miles north of Florence, in

buildings vacated the day before by the

94th Evacuation Hospital. The 74th

Station, which had closed at Caiazzo

north of Caserta on 25 October and was

also scheduled for the Florence area,

was less fortunate. Its prospective site

was still occupied by the 15th Evacuation, which the Fifth Army surgeon had

decided to retain in Florence over the

winter. As no alternative site was available, the 74th Station set up headquarters with the 24th General and

placed the bulk of its personnel on detached service with other medical units.

Only two more fixed hospitals moved

into northern Italy before the launching

of the spring drive into the Po Valley.

These were the 103d Station, from

Naples, which opened in a prisoner of

war enclosure in the outskirts of Florence

on 11 January 1945; and the 70th Gen-
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 495

70TH GENERAL HOSPITAL AT PISTOIA

eral from North Africa, which opened in

Pistoia on 22 January.

There were, however, various readjustments in the hospital picture around the

end of 1944. In Rome the 73d Station

was reassigned to Rome Area, MTOUSA,

on 1 December 1944. The 6th General

closed on 22 December, but remained in

Rome with all equipment packed and

ready to move on short notice. Personnel

of the hospital were placed on temporary

duty with other medical units scattered

over Italy. The 34th Station, which had

been serving a replacement center in

the Caserta area since October, took over

the buildings vacated by the 6th General

in Rome on 19 January, while the 154th

Station closed at Civitavecchia and replaced the larger 34th at Caiazzo.

Late in December the 50th Station at

Castagneto reorganized along field hospital lines into three detachments, one of

which relieved the 105th Station at Grosseto on 24 December. Another detachment set up a small hospital to serve the

8th Replacement Depot at Empoli, twenty-five miles west of Florence, on 17

January 1945. The third detachment remained at Castagneto. The 105th Station, displaced at Grosseto, moved to Pisa

where it opened in buildings of an

Italian tuberculosis sanatorium four

miles east of the city on 15 January. At

its Pisa site, the 105th Station served an

encampment of Russians who had been

liberated from German prison camps.
496 MEDITERRANEAN AND MINOR THEATERS

Status of Hospitalization in MTOUSA

January-March 1945

By January 1945, when the decision

was made to postpone the Po Valley

offensive until spring, fixed hospitals in

MTOUSA were reporting a smaller proportion of beds occupied than ever before. This was in part due to the winter

lull in the fighting, but it was also in

large measure because of the excellence

of the Fifth Army medical service, which

was retaining the maximum number of

cases in the army area. Fixed bed

strength in MTOUSA was nevertheless

6,000 below the authorized 6.6 ratio,

and changes in the station hospital T/O

had so far reduced the number of medical officers in those units that an expansion of more than 20 percent was no

longer practical without additional personnel.7

Looking ahead to the resumption of

active hostilities in the spring, General

Stayer asked the War Department for an

additional general hospital of 1,000-bed

capacity and for a field hospital for communications zone use. The request was

denied on the ground that no such units

were available in the zone of interior.

The War Department proposed as an

alternative that existing hospitals be reorganized into larger units, but the

MTOUSA medical section considered

this proposal impractical, since there was

no specific requirement for station hospitals larger than 500 beds, and sites

could not be found for general hospitals

larger than the 1,500-bed units already

operating in the theater. Any other form

of reorganization that would add beds

would require more in additional personnel and equipment than could be

procured. General Stayer therefore prepared to operate with the hospitals then

under his control.

As of the end of January there were

10,150 fixed beds in the Naples-Caserta

area. The 37th and 45th General Hospitals, each with 1,500 beds, and the 500-

bed 182d and 225th Stations were in the

medical center at the Mostra Fairgrounds. In Naples proper were the

1,500-bed 17th General, the 2,000-bed

300th General, and the 52d, 106th, and

118th Station Hospitals, each of 500

beds. The 52d and 118th were both acting general hospitals. The 52d was also

the theater maxillofacial center. Outside

Naples the 262d Station was at Aversa,

functioning primarily as a prisoner-ofwar hospital; the 32d Station was at

Caserta, serving headquarters personnel

of MTOUSA and AFHQ; and the 154th

Station was at Caiazzo serving a replacement center.

The 34th and 73d Station Hospitals

were in Rome, housing 750 beds between

them. The 1,500 beds of the 6th General

were in that city but not available for

use, since they were packed for movement.

In the Arno Valley, overlapping the

army area, there were 11,000 beds—6,750

of them at Leghorn, 2,250 in the immediate vicinity of Florence, 500 at Pisa,

and 1,500 at Pistoia. In addition to these,

the 50th Station Hospital was operating

detachments of approximately 100 beds

each at Grosseto, Castagneto, and Em7

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, MTOUSA, 1945; (2)

Med Sitreps, PBS, Jan-Mar 45; (3) Annual Rpt,

Surg, NORBS, 1945; (4) Annual Rpt, Surg, MBS,

1944; (5) Med Hist, AAFSC MTO, 1945; (6)

Theater ETMD's, Jan-Mar 1945; (7) Unit rpts

of hospitals mentioned in text; (8) Unit ETMD's

of hosps mentioned in text.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 497

ITALIAN PARTISANS RESTING IN 26th GENERAL HOSPITAL AT BARI

poli; and the 500 beds of the 74th Station

were inoperative in Florence.

The 1,500-bed 26th General Hospital,

still attached to the Army Air Forces

Service Command, cared for Air Forces

personnel at Bari, and the 500-bed 61st

Station performed similar duties at Foggia. In addition to these, the Air Forces

controlled three field hospitals, the 4th,

34th, and 35th, which were dispersed

along the Adriatic from Lecce in the heel

of Italy to Senigallia in the latitude of

Florence. Each field hospital platoon

served one to five airfields, which had

personnel complements of three thousand to ten thousand. All of these

hospitals passed to the Adriatic Base

Command on 1 March.

In the Northern Base Section the 500-

bed 60th Station Hospital, which had

moved up from Sardinia the end of October, was preparing to close near Bastia.

The 40th Station was operating sections

at Cervione and Ghisonaccia, both on the

east coast of Corsica, and a third section

was preparing to relieve the 60th at

Bastia.

In North Africa, which was scheduled

for transfer to the Africa-Middle East

theater the first of March, the 250 beds
498 MEDITERRANEAN AND MINOR THEATERS

of the 57th Station Hospital were more

than enough to serve the Tunis area.

The last Army hospital in the Oran area,

the 54th Station, had closed late in December and was now inoperative in

Naples, leaving Naval Hospital No. 9 to

care for all U.S. personnel in Oran. The

56th Station at Casablanca, in addition to

caring for personnel in the area, was

operating a transient section of 100-150

beds for domiciliary care of patients en

route to the ZI from Italy, the middle

East, and the China-Burma-India theater.

It also supervised the operation of a 75-

bed Italian station hospital. The 25-bed

370th Station at Marrakech continued to

serve primarily Air Forces units. The

Italian and German prisoner of war hospitals near Oran were already alerted for

movement to Italy.

Preparatory to closing out in Africa,

Stayer requested permission to inactivate

the 54th Station and reduce the 57th

Station to 150 beds, the personnel and

equipment thus released to be activated

as a 400-bed evacuation hospital for

Fifth Army. At the same time permission

was requested to convert the 50th Station

Hospital in Italy into a field unit. Both

requests were granted late in February.

On 20 March, accordingly, the 171st

Evacuation Hospital was activated and

assigned to Fifth Army. On the same

date the 50th Station Hospital passed out

of existence, and the 99th Field Hospital

relieved it in place. No changes were involved, since the 50th Station had already completed its conversion to a field

hospital T/O.

The actual transfer to the Africa-Middle East Theater thus involved only 425

U.S. beds, and these were more than

made up by the transfer of the 500-bed

21 st Station Hospital from the Persian

Gulf Command to MTOUSA. The 21st

arrived in Naples in March, but did not

get into operation until mid-April. In

the inactivation of the 54th Station and

reduction of the 57th, MTOUSA lost 350

beds, but gained 150 in the conversion of

the 250-bed 50th Station to a 400-bed

field. All in all, MTOUSA lost 125 beds,

while Fifth Army gained 400.

Shortly before the new theater boundaries became effective on 1 March 1945,

the two prisoner of war hospitals serving

MTOUSA were shifted to northern Italy.

There were, of course, many station hospitals treating captured enemy troops,

but only two were fully staffed by protected personnel and formally organized

as prisoner of war rather than U.S. Army

hospitals. These were the 7029th Station

Hospital (Italian) and the 131st Station

Hospital (German), the latter so designated because it was sited at POW Enclosure No. 131. The 7029th moved by

echelons to Leghorn in January and

February, finally opening in Pisa on 6

March. Later in the month the German

unit took over the prisoner of war hospital being operated by the 103d Station

at POW Enclosure 334 in the outskirts of

Florence, and was thereafter known as

the 334th Station Hospital (German).

The 103d Station, relieved of its POW

assignment, moved to Pisa on 22 March,

where it became a contagious disease hospital, primarily for Brazilian personnel.

As of the end of March, aggregate

Table of Organization bed strength of

U.S. base hospitals in the Mediterranean

Theater of Operations, including 3,000

beds not operating, was 29,000. Troop

strength was 497,427, giving a ratio of

5.8 T/O beds per 100 troops.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 499

Support of the Po Valley Campaign

The experience of Fifth Army in evacuating casualties across the rugged northern Apennines underlined the importance of getting fixed beds into the Po

Valley with the greatest possible speed.

The 6th General Hospital at Rome and

the 74th Station at Florence were already

on a stand-by basis for quick movement

but more beds were certain to be required. Because of its obvious advantages, General Stayer planned to keep the

Naples medical center intact, though hospitals from other parts of the city were

shifting northward. General Joseph T.

McNarney, the theater commander, had

other plans, and in March, despite

Stayer's protests, the Mostra Fairgrounds

were turned over to the Replacement

Training Command. The 45th General

Hospital was to remain to care for the

replacement center personnel, but the

other units then comprising the medical

center were required to vacate the fairgrounds as soon as possible. It was these

hospitals, therefore, that were alerted for

movement to northern Italy.8

The first moves in support of the coming campaign were made in response to

an indicated need for more fixed beds on

the Adriatic side of the peninsula, where

Air Forces units were becoming increasingly active and to which air evacuation

of ground troops from the Bologna area

might be directed should weather conditions preclude the use of more westerly

routes. A platoon of the 35th Field Hospital had been in Senigallia since November 1944. This unit was replaced

early in April by the 60th Station Hospital from Corsica, the field hospital platoon moving on to Rimini. At the same

time the 225th Station in the Naples

medical center was assigned to the

Adriatic Base Command and shifted to

Fano, about fifteen miles farther north.

Next to leave the medical center was

the 182d Station, which took no new patients after 25 March. The 182d moved

on 10 April to a large villa about two

miles northwest of Montecatini. Its first

patients were received from Fifth Army

evacuation hospitals on 20 April, and

within two weeks it was operating 20 percent in excess of its 500-bed T/O capacity.

The 37th General Hospital began

closing out on 10 April, moving by

echelon to a staging area near Pisa. The

bulk of the personnel and equipment

was in Pisa by 17 April. For the next two

weeks officers and enlisted men were on

detached service with other units, but

subject to immediate recall. The 37th

also operated a 200-bed prisoner-of-war

hospital in an unused mess building on

an emergency basis, since the 103d Station, which had been reconverted to a

prisoner-of-war hospital in mid-April,

was unable to carry the full load. By the

end of the month prisoners were arriving in the area at the rate of 15,000 a day,

and the 103d was operating at more than

double its T/O capacity.

By the time the Fifth Army spearheads

had fought their way into the Po Valley,

there were thus 3,500 fixed beds on a

stand-by basis, packed and ready to move

forward in support of the ground forces.

Movement orders were not long in coming.

8

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, MTOUSA, 1945; (2)

Med Hist, AAFSC MTO, 1945; (3) Med Sitreps,

PBS, Mar-May 45; (4) Theater ETMD's, MarMay 45; (5) Unit rpts of hosps mentioned in the

text; (6) Unit ETMD's for hosps mentioned in the

text, Mar-May 45.
500 MEDITERRANEAN AND MINOR THEATERS

LOADING EQUIPMENT OF THE 37TH GENERAL HOSPITAL on freight cars at Naples for

shipment to Pisa.

The 74th Station Hospital was in

Bologna by the afternoon of 26 April,

five days after the fall of the city, and was

taking patients within twenty hours of

its arrival. By 28 April 750 beds were set

up, and German medical officers and

corpsmen had been pressed into service

to help with the prisoner patients. The

6th General was close behind, leaving its

Rome bivouac on 30 April and opening

in Bologna on 9 May. The 37th General

sent an advance detail to Mantova on 2

May, and a week later took over 26 Allied and 1,278 German patients from the

15th Evacuation Hospital. By the end of

the week the 37th General had more

than 2,000 beds in operation. The sudden end of the war made it unnecessary

to relocate any other fixed hospitals.

Also in support of the Po Valley Campaign, though on a different level, was

the 40th Station Hospital, transferred

from Corsica to the vicinity of Rome,

where a center for the conversion of ablebodied men from service units into infantry, to help fill the depleted ranks of

Fifth Army, had been set up in January.

By the middle of May, with the war in
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 501

Europe over, the period of readjustment

had set in. For the Medical Department

in Italy, the emphasis for the next few

months would be on caring for the sick

and wounded among prisoners of war,

and preparing hospitals and other medical units for redeployment to the Pacific

or for return to the zone of interior as

promptly as possible.

Problems and Policies

Throughout the period of the North

Apennines and Po Valley Campaigns until the end of April 1945, Peninsular

Base Section hospitals, including the

26th General attached to the Army Air

Forces Service Command and later assigned to the Adriatic Base Command,

operated on a 120-day evacuation policy.

The theater was too short of manpower

to return men to the zone of interior as

long as there was any prospect of recovery for further combat duty. Even

those reclassified by hospital disposition

boards for limited assignment were retained in the theater in a variety of noncombat capacities.9

One of the places where limited assignment personnel could be used effectively

was in the base hospitals. When Fifth

Army was unable to obtain replacements

for the heavy casualties suffered in the

northern Apennines, all service units in

the theater were surveyed with a view to

locating able-bodied men who could be

released and retrained for combat. The

essential consideration was that the men

must be taken from positions classified

as suitable for limited-assignment personnel. While communications zone hospitals usually had a certain number of

limited-service men already on their rolls,

the survey revealed many more hospital

positions that could be filled by such

personnel.

Although many problems were thus

created for hospital commanders, the

change-over was accepted as a necessary

expedient. The new men were for the

most part inexperienced in hospital work

and had to be given special training on

the job. There were, moreover, too many

high-ranking noncommissioned officers

among them to be absorbed without

jeopardizing promotions and damaging

the morale of the regular Medical Department enlisted staff. During the last

two months of 1944 and the first two

months of 1945, limited-assignment personnel nevertheless replaced generalassignment men in station and general

hospitals to the extent of an average 25

percent of the enlisted strength. Fortunately, the shift took place at a time

when the hospitals were not overloaded

and in most instances worked out satisfactorily.

Supplementary personnel were necessary in the operation of all PBS hospitals

during periods of emergency expansion.

Medical officers, nurses, and enlisted

technicians from temporarily inoperative

units were freely used whenever they

were available, but the greater reliance

had of necessity to be placed on Italian

civilians and Italian service troops.

Among the areas in which civilian and

Italian prisoner of war labor was effectively used were sanitary, utility, mess,

laundry, supply, motor pool, and common labor details.

9

 Sources for this section are: (1) Final Rpt,

Plans and Opns Off, MTOUSA, 1945; (2) Med

Hist, AAFSC MTO, 1945; (3) Ltr, Munly, Med

Insp, to Surg, MTOUSA, 26 Nov 44, Sub: Utilization of Limited Assignment Personnel in Hosps;

(4) Unit rpts et MTOUSA hosps, 1944, 1945.
502 MEDITERRANEAN AND MINOR THEATERS

Evacuation

In a theater such as the Mediterranean,

where bed strength was always below

authorized levels, continuous evacuation

both to the zone of interior and within

the theater itself was essential.

Transfers Within the Theater

Patients were shifted from one fixed

hospital to another within the theater to

accomplish two major purposes. One

purpose was to take advantage of specialized facilities not available in all

MTOUSA hospitals. The other was to

release beds, either to make room for an

influx of new casualties in hospitals

closest to the combat area or to prepare

a hospital for movement. The lines of

movement were well established by September 1944, with Naples the terminus

of most of them.10

French patients remaining in PBS hospitals continued to be evacuated from

Naples to North Africa through November, but their numbers were small: 592

in September, 55 in October, and 76 in

November. For U.S. patients, the line of

evacuation ran in the other direction,

cases requiring more than station hospital care being flown from Africa to

Naples. Again, however, the number was

small. All evacuation from Corsica was

to Italy, the bulk of it by air, but only

343 patients, of whom 279 were U.S. personnel, were so evacuated between 1

September 1944 and the closing out of

the Northern Base Section on 25 May

1945. Air Forces patients from eastern

Italy who required more specialized care

than was available at the 26th General

Hospital were evacuated to Naples.

Naples was also the first stop for Air

Forces patients en route to the zone of

interior.

Of much greater proportions was the

periodic transfer of patients from PBS

hospitals in Rome and northern Italy. In

September, despite heavy rains that made

rail lines intermittently unusable, the

41st Hospital Train carried 38 patients

from Grosseto and 735 from Rome to

Naples, in addition to clearing 275 patients from Grosseto to Rome when the

24th General Hospital was preparing to

move forward. The movement of substantial numbers from Rome to Naples

by both rail and air continued through

December as 5,500 beds in Rome

were closed out for transfer to northern

Italy.

Similarly, until adequate bed strength

was built up in Leghorn patients from

the 24th General Hospital in Florence

and from the 55th Station at Pratolino

were transferred, often as rapidly as they

became transportable, to the Naples area,

along with patients direct from Fifth

Army hospitals. When air evacuation was

interrupted by bad weather in October,

the 24th General was cleared by 60 ambulances of the 162d Medical Battalion,

which carried patients to Leghorn.

As the hospital facilities in Leghorn

reached their maximum late in 1944,

regular transfer of patients to Leghorn

from Florence and later from Pistoia began. Direct air and rail evacuation be10

 Sources for this section are: (1) Annual Rpt,

Med Sec, MTOUSA, 1944; (2) Final Rpt, Plans

and Opns Off, MTOUSA, 1945; (3) Annual Rpt,

Surg, PBS, 1944; (4) Med Sitreps, PBS, Jan-May

45; (5) Annual Rpt, Surg, NORBS, 1944, 1945;

(6) Med Hist, AAFSC MTO, 1944, 1945; (7) Theater ETMD's, Sep 44-May 45; (8) Unit Rpts, 41st

Hospital Train; 51st and 162d Med Bns; 802d and

807th MAETS.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 503

COVERED RAMP TO HOSPITAL SHIP FACILITATED LOADING OF PATIENTS, LEGHORN

tween Florence and Leghorn were

inaugurated in February 1945, and thereafter patients were moved at the rate of

more than a thousand a month.

From Leghorn evacuation to Naples

was primarily by hospital ship and transport but the repair of rail lines made it

possible to use hospital trains in an emergency. Such an emergency arose in the

last days of December 1944 when it was

feared that the German thrust into the

Serchio Valley might develop into a

major counteroffensive comparable to

the Ardennes breakthrough, which had

not yet been stopped. Should the German drive gain momentum, Leghorn

would be its probable objective, and a

hasty evacuation of all fixed hospitals in

that city was ordered. In late December

and early January more than 1,300 patients were sent back to Naples by water

and close to 600 by rail. In the same time

period, air evacuation from Florence to

Naples accounted for another 2,500.

The threat of an Italian "Battle of the

Bulge" was over by mid-January, and

evacuation assumed what was to be a

normal pattern for the next two months.

PBS hospitals in Florence, Pistoia, and

Pisa received casualties from Fifth Army

and kept beds free by evacuation to Leghorn. Bed strength in Leghorn was adequate to care for all patients with a

hospital expectancy of less than 120 days,

so that after 1 February only those en

route to the zone of interior were sent on

to Naples. This pattern continued until

the latter part of March, when all PBS
504 MEDITERRANEAN AND MINOR THEATERS

hospitals in the northern sector were

again cleared to Naples to provide beds

for the casualties anticipated in the

spring offensive. During April approximately 1,800 patients were transferred by

sea and air from Leghorn to Naples, but

these were more than balanced by 2,000

patients brought to Leghorn from

Florence.

All movements of hospital ships within

the Mediterranean area, including those

used to evacuate patients from southern

France, remained under control of Allied

Force Headquarters. In order to make

the greatest possible use of the limited

number of vessels available, an arrangement was worked out in October 1944

whereby all hospital ships entering the

Mediterranean called first at Oran, which

was roughly equidistant from Naples,

Leghorn, and Marseille. From Oran the

Chief of Transportation, AFHQ, directed the vessels to the port most in

need of them. The movement of the

hospital ship platoons that formed the

medical complements of troop transports

used for evacuation was also directed by

AFHQ in order to ensure maximum use

of transports for this purpose.

As the time approached for the transfer of southern France to the European

theater, a plan of evacuation was drawn

up by embodying the existing principle

of a pool of hospital ships under AFHQ

control and incorporating procedures for

requesting vessels. Base section commanders were to be responsible for making the greatest possible use of troop

transports, but AFHQ was to be notified

of the movements of such vessels and

would continue to control the assignment of hospital ship platoons arriving

anywhere in the Mediterranean. Evacuation by air was to be controlled by each

theater, but AFHQ was to be notified of

all airlifts to the ZI from southern France

as a guide to the allocation of alternative

means of transportation. General Stayer

presented this plan to Maj. Gen. Paul R.

Hawley, Chief Surgeon of the European

Theater, early in November, and Hawley

accepted it subject to further study. It

remained in effect by agreement between

the two theaters until February 1945

when, with minor modifications, it was

ratified by the War Department. The

plan continued in operation until the

end of June.

Evacuation to the Zone of Interior

Evacuation to the zone of interior

throughout the period of concentration

in Italy was by plane, hospital ship, and

troop transport. Until the end of February 1945, when North Africa was finally

divorced from the Mediterranean Theater of Operations, a small number of

patients continued to be moved to the

zone of interior from Oran and Casablanca, but the overwhelming bulk of

the lifts by all types of carrier was from

Naples.11

During the 3-month period that southern France remained under AFHQ control, most of the casualties from that area

also were routed to the continental

United States by way of Naples. In October, however, direct evacuation to the

zone of interior began from Marseille,

and some 250 patients had been evacuated to the ZI from that port before 20

11

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Final Rpt,

Plans and Opns Off, MTOUSA, 1945; (3) Annual

Rpt, Surg, PBS, 1944; (4) Med Sitreps, PBS, JanMay 45; (5) ETMD's for Sep 44-May 45.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 505

TABLE 34—EVACUATION FROM MTOUST TO THE ZONE OF INTERIOR

SEPTEMBER 1944-APRIL 1945

Source: (1) Annual Rpt, Surg, MTOUSA, 1944, an. B, apps. 21, 22. (2) Final Rpt, Plans and Opns Off, MTOUSA,

1945, apps. 14, 15.

November when the area was absorbed

by ETO. These and all patients subsequently sent to the United States from

Delta Base were evacuated in accordance

with the intertheater agreement described above.

September and October of 1944 were

the heaviest months of the war for evacuation to the zone of interior, primarily

because of the large influx of casualties

from Seventh Army. With a limited and

definitely inadequate number of fixed

beds available in MTOUSA, only largescale evacuation to the United States

would permit the Medical Department

to carry out its mission. By the end of the

year, with bed occupancy at its lowest

level of the war, evacuation to the zone

of interior from the Mediterranean theater declined sharply. (Table 34)

Evacuation of Brazilian casualties to

their homeland began in September 1944

by air. In December a Brazilian flight

surgeon and four flight nurses reached

the theater to study U.S. methods before

taking over responsibility for their own

patients in flight. Evacuation of Brazilian

casualties by sea was for the most part

by way of the United States, since there

were never enough to justify diversion of

a hospital ship. The only exception was

in January 1945 when an unescorted

troop transport sailed direct to Brazil

from Naples. (Table 35)

No prisoner of war patients were evacuated to the United States after October

1944, but 135 German patients in U.S.

custody were repatriated from Naples

and 454 from Oran in January 1945. The

prisoners were carried by hospital ship to
506 MEDITERRANEAN AND MINOR THEATERS

TABLE 35—EVACUATION OF BRAZILIAN PATIENTS TO BRAZIL

SEPTEMBER 1944-APRIL 1945

Source: Compiled from ETMD'S for Jan-Apr 45.

Marseille, where they were transferred

to a Swiss-manned hospital train and exchanged at the Swiss border for U.S.

prisoners of the Reich.12 Since the collapse of Germany was imminent, another

exchange of prisoners scheduled for

April was not carried out.

Medical Supplies and Equipment

Theater Supply Organization

and Policies

The reorganization of November 1944

brought the operation of the medical

supply system directly under the theater

surgeon for the first time, but neither

the internal organization of the Medical

Supply Branch (redesignated Medical

Supply Section) nor the operating procedures were altered in any essential particular. In keeping with the reduced staff

available, the organization was made

more compact, but without significant

change in functions. In the new alignment, an Executive Group reviewed

proposed changes in Tables of Equipment, checked the quality of equipment

in the field, prepared plans and estimated requirements in terms of disease

trends and military operations, screened

requisitions from Allied nations, and advised on civilian supply for occupied

territories. A Shipping Control Group

kept constant track of all incoming shipments and prepared shipping orders for

movement of medical supplies between

base sections. A Stock Control Group

maintained records of stocks on hand,

computed replacement factors, studied

12

 (1) Memo and attachments, Biederman to

Stayer, 14 Jan 45 sub: Arrangements for Repatriation of Allied and German POW's and Exchange

of Civilians. (2) Ltr, Lt Col W. L. Hays combined

British-American Repatriation Committee, to CG

ETO, 1 Mar 45. Figures from ETMD for Jan 1945.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 507

issue and due records to determine shortages and excesses, and recommended

stock movements to correct maladjustments. A Reports and Statistics Group

completed the supply organization.13

At the time of the reorganization, medical supply levels were established at 30

days' minimum, 30 days' operating, and

60 days' maximum for most items. In

accordance with War Department instructions, these levels were kept under

continuous review with a view to possible reductions. The only move in that

direction, however, came to nothing. In

March 1945 a recommendation by the

theater supply officer that the 90-day

stock level maintained by base hospitals

be reduced to 60 days, to conform to the

theater level, was rejected by General

Stayer as hazardous. In the light of a

detailed study begun in November 1944

of 40 medical items, which showed that

the actual elapsed time between preparation of monthly requisitions on the zone

of interior and the tallying of items into

depot stock was 149 days, Stayer was undoubtedly correct.

After southern France ceased to be a

drain on the MTOUSA supply services,

medical stock levels built up rapidly.

Low battle casualty and disease rates during the winter of 1944-45 were contributing factors, as also were the closing

out of the North African bases and a

revised accounting procedure that included Fifth Army and Air Forces stocks

in computing the theater levels. Surpluses developed of sufficient magnitude

in some items to justify the return of 500

tons of medical supplies to the zone of

interior in January.

In line with the achievement of a comfortable stock level for the theater, surgeons of major commands and base

sections were authorized in February to

modify equipment lists in accordance

with such policies as might be laid down

by the MTOUSA surgeon. In effect, hospitals were permitted to requisition various items in excess of the Tables of

Equipment if those items would make

operations more effective. Authority to

issue expansion units, which rested with

the commanding generals of the base

sections, automatically carried with it the

issue of such additional equipment as

might be necessary to the efficient operation of the unit.

After November 1944 all incoming

supplies were received at Naples or Leghorn, where the Peninsular Base Section

depots were located, and PBS was made

responsible for distribution to other base

sections on requisitions that were passed

through the MTOUSA medical supply

section. All forms of transportation were

used, the size of the shipment, the speed

necessary, and the destination being the

determining factors, along with availability. Within the theater, biologicals

were uniformly moved by air. In February the Leghorn depot became the main

medical supply point for the theater.

Repair and maintenance of medical

equipment steadily improved during the

late months of 1944, reaching a peak of

efficiency early in 1945 as Fifth Army

units began re-equipping for the spring

offensive. A spare parts catalog compiled

and distributed by the Medical Supply

Section became the basis for requisitioning and for restocking depots. The fifth

echelon repair shop, the optical repair

13

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. K; (2)

Davidson, Med Supply in MTOUSA, pp. 113-139.

For operating procedures, see pp. 346-47, above.
508 MEDITERRANEAN AND MINOR THEATERS

PORTION OF THE PBS MEDICAL STORAGE AREA

shop, and theater stocks of spare parts

and of artificial teeth were all transferred

to the Leghorn depot in January.

Local procurement remained, as it had

been throughout the Mediterranean campaigns, a negligible factor, but the distribution of medical supplies for civilian

use continued to mount in proportion to

the extent of territory occupied. After

September 1944, Army responsibility for

procurement, storage, and issue of medical supplies for civilians throughout the

theater was carried out through a Central Civilian Medical Depot in Naples.

Civilians and Italian service troops

were freely used as laborers, mess attendants, artisans, and for guard details at

medical supply depots. So many of the

supply functions were specialized, however, that the maximum use of such personnel did not appreciably lessen the

requirement for U.S. service troops for

medical supply operations in the Italian

communications zone.

Medical Supply in the Base Sections

Medical supply in the base sections
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 509

came under control of the MTOUSA

medical section with the reorganization

of November 1944, but here, as in the

Medical Supply Section itself, no essential change of function or organization

was involved. The Peninsular Base Section, already dominant in the theater,

continued to grow through the last quarter of 1944 and the early months of 1945

as other base sections declined.

Mediterranean Base Section—Following the mass transfer of medical facilities

from North Africa to southern France

and Italy, plans were made for closing

out remaining depot stocks in the Mediterranean Base Section. The 60th Medical Base Depot Company, which had

been responsible for receipt, storage, and

issue of all medical supplies in North

Africa since the beginning of September,

began transferring supplies to other bases

almost immediately, shipping out 250

tons a week during September and October. Simultaneously, the Eastern and

Atlantic Base Sections transferred their

own surpluses, brought about by diminished troop strength, to the MBS depot,

in preparation for the consolidation of

the three base sections on 15 November.14

When the MBS depot closed in midDecember, the 57th Station Hospital at

Tunis was given maintenance stocks sufficient to carry through 28 February,

when the transfer of North Africa to

AMET would be effected; a minimum

reserve of 25 tons was left with the 54th

Station, which was about to close at

Oran; and the balance of maintenance

stocks for the base section was stored with

the 56th Station Hospital at Casablanca,

the new MBS headquarters. Excess stocks

to the amount of 313 tons were returned

to the zone of interior, and 350 tons were

divided between Italy and southern

France. A small detachment of the 60th

Medical Base Depot Company remained

in Oran long enough to complete the

packaging and shipment. From the supply standpoint, MBS was closed by the

end of 1944.

Northern Base Section—Medical supply in the Northern Base Section remained in the hands of a detachment of

the 684th Quartermaster Base Depot

Company, which had been activated late

in May from personnel of the old 2d

Medical Depot Company. Until the end

of September, the group operated depots

at Ajaccio and Cervione, but the reduction of troop strength and gradual withdrawal of medical units from Corsica

made it possible to consolidate the two

depots at Cervione early in October.

Movement of supplies from Ajaccio

across the island by truck was completed

by the 13th of the month.15

For a time, portions of the depot stock

at Cervione had to be stored in the open,

but the transfer of stocks in excess of a

4-month level to other MTOUSA bases,

which began in mid-October, soon reduced quantities on hand to proportions

that could be warehoused.

14

 Sources for this section are: (1) Annual Rpt,

Surg, MBS, 1944; (2) Annual Rpt, 60th Med Base

Depot Co, 1944; (3) Annual Rpt, Surg, MTOUSA,

1944, an. K; (4) Davidson, Medical Supply in

MTOUSA.

15

 Sources for this section are: (1) Annual Rpts,

Surg, NORBS 1944, 1945; (2) Annual Rpt, 684th

QM Base Depot Co, 1944; (3) Per Rpt, 80th Med

Base Depot Co, 11 Jul 45. (4) Davidson, Med Supply.
510 MEDITERRANEAN AND MINOR THEATERS

In line with the general reduction of

functions in NORBS, 14 enlisted men of

the 684th Quartermaster Base Depot

Company detachment were transferred

to the 60th Medical Base Depot Company, then still functioning at Oran, on

16 October. The subsequent transfer of

the detachment's commanding officer to

Headquarters, NORBS, left only an officer and 17 enlisted men to operate the

Cervione depot, with the aid of some 25

Yugoslavs who made up labor and guard

details. There were times when the workday stretched out to 18 and even to 24

hours, yet despite the physical strain,

none of the men could ever be spared

long enough to take advantage of the

rest camps available on the island.

NORBS depot stocks were down to

230 tons by the end of January and to

75 tons by late March. By way of preparation for closing out the base section

supply activities, all personnel of the depot were transferred on 21 March to the

80th Medical Base Depot Company, at

that time assigned to the Adriatic Base

Command, but were left on detached

service with NORBS long enough to

wind up operations. The depot was

scheduled for closing on 15 April, but so

critical was the need for personnel in

Italy, where the Po Valley Campaign

was about to be launched, that all tonnage was packed for shipment by 6 April.

The detachment left Corsica on 10 April,

turning over to the 40th Station Hospital

responsibility for procuring and issuing

such medical supplies as might still be

required.

Adriatic Base Command—Before 1

March 1945, medical supply for Air

Forces units and hospitals serving Air

Forces personnel in eastern Italy was the

responsibility of the Army Air Forces

Service Command, which dealt directly

with the Surgeon, MTOUSA, and procured medical items peculiar to the Air

Forces direct from the zone of interior.

The function was carried out through a

number of aviation medical supply platoons, two of which operated in Bari as

the medical supply section of the Adriatic Depot. Others served airfields from

Tunis to southern France, with major

dumps at Naples and Pisa.16

When the Adriatic Base Command was

activated on 1 March 1945, the new

organization took over the supply functions previously exercised by the Army

Air Forces Service Command, Mediterranean Theater of Operations (AAFSC

MTO), through the Adriatic Depot, but

without altering the operating responsibilities of the aviation medical supply

platoons. The 80th Medical Base Depot

Company, which had been activated in

December and since that time had shared

in the operation of the PBS Leghorn

depot, was assigned to ABC in midMarch and shifted to Senigallia, where

for a month it operated the ABC advance depot. The rapid development of

the Po Valley Campaign, however, left

hospitals in the Fano-Senigallia-Ancona

area with few patients and a minimum of

supply activity. The ABC advance depot

was turned over to the detachment from

Corsica on 19 April, and a week later the

main body of the 80th Medical Base

Depot Company went to Bari, where it

took over operation of the main ABC

medical depot. 16

 Sources for this section are: (1) Med Hist,

AAFSC MTO, 1944, 1945; (2) Periodic Rpt, 80th

Med Base Depot Co, 11 Jul 45; (3) Med Sitreps,

Adriatic Base Commd, Mar-May 45; (4) MS, Adriatic Depot Hist, OCMH files; (5) Davidson, Med

Supply in MTOUSA.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 511

Peninsular Base Section—The medical

supply service of the Peninsular Base

Section had been organized in the middle

of August 1944 to place operating control in the hands of the 232d Medical

Composite Battalion. As of 1 September

this battalion had attached to it the 72d

and 73d Medical Base Depot Companies

and the 684th Quartermaster Base Depot

Company. The 72d was operating the

main medical supply dump at Naples,

the 684th the forward base at Piombino,

with a detachment on Corsica. The 73d

shared operation of the Piombino dump

and had an advance party setting up a

new supply base in Leghorn. By the end

of September the Leghorn dump boasted

510 tons of medical supplies, housed in

a large warehouse with 53,550 square feet

of floor space. Another 70,000 square feet

were available for open storage when

needed.17

The Piombino dump was closed on 14

October and all stocks remaining were

shifted to Leghorn, which was being

built up to supply all Fifth Army needs.

The problem remained, however, of distributing supplies economically between

Leghorn and Naples. Every effort was

made to keep balanced stocks at both

depots. Transfers between the two were

slow, because material arriving from the

zone of interior had to be tallied in at the

receiving depot before any of it could

be transshipped to the other. This usually took two weeks with another week

for rail transportation or three weeks for

shipment by water. Through the fall of

1944, emergency shipments had to be

made from Naples by truck convoy to

meet Fifth Army shortages. An express

truck service between Naples and Leghorn was instituted in January 1945, aiding materially in the prompt transfer of

less than carload shipments.

During November all ZI shipments

were received at Leghorn, and inventories at that base built up rapidly.

When Naples was reinstated as a port of

discharge in December, a new procedure

was worked out under which the PBS

supply section studied the manifests of

incoming vessels and prepared requisitions covering the entire cargo in advance. Distribution to the two depots was

then made directly from the dockside,

thus eliminating the delay entailed in

transporting all stock to the depot at the

port of discharge, picking it up on stock

record, and reporting it on the monthly

inventory report before any interdepot

transfers took place. Under the new system each depot submitted a separate

inventory report, the two being consolidated by the Supply Branch of the MTOUSA medical section. The Leghorn

stocks were almost as large as those in

Naples by the end of the year, and were

better balanced since the Naples inventory was padded by substantial quantities

of surplus items received from MBS and

NORBS.

With the transfer of PBS headquarters

to Leghorn in November and the steady

growth of the Leghorn supply depot, it

became necessary to redistribute supply

personnel. The 80th Medical Base Depot

17

 Principal sources for this section are (1) Annual Rpt, Surg, PBS, 1944; (2) Med Sitreps, PBS,

Sep 44-Apr 45; (3) Annual Rpt, 232d Med Serv

Bn, 1944; (4) Unit Hist, 72d Med Base Depot Co,

Jan-Jun 45; (5) Hist Rpt, 73d Med Base Depot

do, Sep 44. (6) Med Hist Data, 73d Med Base

Depot Co, 19 Oct 44; (7) Annual Rpt, 80th Med

Base Depot Co, 1944; (8) Periodic Rpt, 80th Med

Base Depot Co, 11 Jul 43; (9) Annual Rpt, 60th Med

Base Depot Co, 1944; (10) Annual Rpt, 684th QM

Base Depot Co, 1944; (11) Davidson, Med Supply

in MTOUSA.
512 MEDITERRANEAN AND MINOR THEATERS

TABLE 36—MEDICAL SUPPLIES ON HAND IN PBS DEPOTS

SEPTEMBER 1944-APRIL 1945

Source: (1) Annual Rpt, Surg, PBS, 1944. (2) Med Sitreps, PBS, Jan-Apr 45.

Company was activated at Leghorn on 4

December 1944, with a cadre drawn from

the 684th Quartermaster Base Depot

Company. A week later the 232d Medical Service Battalion, as the 232d Medical Composite Battalion had been

redesignated without change of T/O on

21 November, moved its own headquarters to Leghorn, leaving 45 enlisted men

on detached service with the 72d Medical

Base Depot Company in Naples. The

60th Medical Base Depot Company was

also assigned to PBS when its work in

North Africa was completed the middle

of December, and arrived in Leghorn in

the closing days of the month. Like the

72d, 73d, and 80th Medical Base Depot

Companies, and the 684th Quartermaster

Base Depot Company, the 60th was attached to the 232d Medical Service Battalion.

The build-up of stocks in Leghorn

halted abruptly late in December, when

a German breakthrough was feared, but

resumed in February. In March Leghorn

tonnage, for the first and only time during active hostilities, exceeded that at

Naples. (Table 36)

Except for temporary shortages in a

few items, the Peninsular Base Section

medical supply depots were able throughout the North Apennines and Po Valley

Campaigns to meet all the needs of Fifth

Army, of medical installations assigned

to the base section, and, after November

1944, of the theater. Blankets were a

critical item through most of December

and all of January. Stocks of laundry

soap were exhausted at Leghorn early in

February, but advances from quartermaster stocks tided the depots over the

crisis. In late January and early February

PBS was unable to fill Fifth Army orders

for acetone, acetic acid with caffeine,

epinephrine hydrochloride, ergotrate,

lemon oil, and operating lamps and

bulbs. Benzyl benzoate was in short supply during the first three months of 1945.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 513

In all of these items, however, hospital

reserve stocks were sufficient to carry

over until ZI shipments arrived.

The only serious shortage was penicillin, which was used during the North

Apennines Campaign at an unprecedented rate. The 15-day supply on hand

when the assault on the Gothic Line

jumped off early in September was exhausted before the end of the month.

Barely enough for current needs was being received. Deliveries were made to

forward units by the blood bank plane,

and hospitals shared what reserves they

had on hand. The situation remained

extremely tight through November, but

a comfortable margin was on hand by the

end of the year. Despite consumption of

penicillin in the first two weeks of the

Po Valley Campaign at a rate more than

double the previous maximum, a stock

sufficient for six weeks' operation at the

same high rate was on hand when the

war in Italy ended.

Professional Services

Medicine and Surgery

By early September of 1944, when the

North Apennines Campaign got under

way, medical and surgical practices in the

Mediterranean Theater of Operations

were relatively stable, continuing without significant changes for the remainder

of the war period. The scope of frontline surgery was somewhat enlarged in

the fall of 1944, and greater use was

made in each successive campaign of

both penicillin and whole blood. In the

base hospitals wound management continued to emphasize reparative surgery.18

In preventive medicine the organization and techniques for the control of

malaria had been worked out and tested

over a 2-year period and presented no

problem as the 1945 breeding season

approached. At the same time, with a

body of experience to draw upon, the

recognition of the disease was more

prompt and the treatment more effective.

Venereal disease remained a persistent

scourge, the incidence of which varied

inversely with the extent of combat operations. Preventive measures such as the

periodic examination of prostitutes, the

policing of cities to control clandestine

contacts, and the establishment of prophylactic stations were only moderately

successful. The use of penicillin in treatment of venereal diseases, however, materially reduced the time lost from duty.

The greatly reduced incidence of

trench foot in the winter months of

1944-45 as compared with the previous

winter was a tribute to the careful studies

made and effective preventive measures

taken. However, the seasonal outbreak

of infectious hepatitis in the late months

of 1944 was severe, despite the extended

studies and other efforts made by a team

of officers under Col. Marion H. Barker

at the 15th Medical General Laboratory.

The Barker group continued its studies

through the second epidemic, presenting

a consolidated report in the summer of

1945 that remains a major contribution

to the literature on hepatitis.19

Perhaps the outstanding contribution

of the Medical Department in the Medi18

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, ans. C, D, E,

and F; (2) ETMD's for Sep 44 through May 45;

(3) Unit rpts of hosps in the theater. (4) Perrin

H. Long, "Medicine during World War II," Connecticut State Medical Journal, X (August 1946),

627-36. 19

 Infectious Hepatitis in the Mediterranean Theater of Operations, United States Army.
514 MEDITERRANEAN AND MINOR THEATERS

terranean theater was in the field of

neuropsychiatry. The major developments in this area were at the division

and army levels, and have been discussed

in connection with combat medicine.20

In summary, the treatment of psychiatric

disorders was carried out at four levels.

The patient was normally first seen by

the battalion surgeon who decided

whether any treatment was indicated

and, if so, whether to treat the patient

on a duty status or refer him to the division psychiatrist. The latter officer, as a

rule, maintained a separate treatment

center adjacent to the clearing station,

with facilities for 50 to 100 patients.

Markedly disturbed patients were sent on

immediately to the Army neuropsychiatric center, the others being retained,

usually for two days, under moderate

sedation with some therapy. Those responding favorably went to the division

training and rehabilitation center for a

few days and were then returned to duty.

Those not so responding were evacuated

to the Army neuropsychiatric center.

From this unit men were returned to

full duty, were sent to the convalescent

hospital for reclassification, or were evacuated to the communications zone. The

bulk of the evacuees went to the base

section neuropsychiatric hospital, but

those too distant from that installation

were sent to a general hospital equipped

for psychiatric work. Treatment in the

base hospitals followed lines similar to

those used in civilian practice, with the

addition of orientation, training, and rehabilitation programs. The treatment

culminated in return to duty, reclassification for limited duty, or evacuation to

the zone of interior. Psychiatric cases

evacuated to the ZI decreased from 48

percent in the last six months of 1943

to 21 percent in the corresponding

months of 1944. These results, according to Colonel Hanson, theater consultant in neuropsychiatry, were the

maximum that could be expected "under

our present knowledge of psychiatry."

The number of medical officers in the

theater available for patient care declined from 5.2 per 1,000 of troop

strength in October 1944 to 4.7 in January 1945, where the ratio leveled off. In

order to keep field medical officers from

losing their skills through restricted practice and limited access to medical literature, a policy of rotation between field

and base units was carried on but the

saturation point was reached about the

end of 1944, by which date the great bulk

of medical officers in base hospitals were

on limited duty or were overage for field

service.

Noneffective rates per 1,000 per annum of troop strength by causes for the

months of September 1944 through April

1945 are shown in Table 37.

Dental Service

On a theaterwide basis, the dental

service in the Mediterranean continued

to be understaffed until early in 1945,

partly as a result of the increased number

of dental officers called for by the T/O's

of the enlarged general hospitals, and

partly as the result of losses sustained

when southern France went over to

ETO. There was a further loss of personnel late in 1944 when 20 dental officers were selected for release from active

duty under a War Department directive.

Two of the officers released were in the 20

 See pp. 253-56, 314-16, 409-11, above.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 515

TABLE 37—NONEFFECTIVE RATES PER THOUSAND OF TROOP STRENGTH PER ANNUM

SEPTEMBER 1944-APRIL 1945

a

 Includes other diseases not listed.

Source: Statistical health rpts for appropriate months.

rank of major, the remainder in the rank

of captain.21

A total of 64 replacements arrived in

January and February 1945, most of

them first lieutenants. The number was

large enough to relieve all shortages, and

at the same time permitted the replacement of older officers in combat areas

by younger men. The ratio of dental

officers to troop strength in the theater,

which had risen from 1:968 in October

to 1:1,016 in December 1944, dropped

sharply in January to 1:947. The April

ratio of 1:927 was still better, although

it remained higher than the 1:850 ratio

enjoyed at the end of 1943.

In terms of accomplishment, the dental care available to Fifth Army, the Air

Forces, and service troops in the theater

steadily improved, with prosthetic and

operating trucks taking the best in

dentistry to the front-line soldier, while

the concentration of dental skills in forward clinics allowed a more even distribution of the work load. Colonel Tingay,

the theater dental surgeon, continued to

keep up with the needs and problems of

both combat and base areas by frequent

inspections, including an extended tour

of Fifth Army dental installations shortly

before the launching of the Po Valley

Campaign.

Veterinary Service

While the withdrawal of the French

Expeditionary Corps and the U.S. VI

Corps from Fifth Army removed thousands of animals from Italy and ultimately from the Mediterranean theater,

the extensive use of pack mule trains to

supply Fifth Army in the northern

Apennines provided ample scope for

21

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. G; (2)

Annual Rpt, Surg, PBS, 1944; (3) Dental Hist,

North African and Mediterranean Theaters of Op- erations.
516 MEDITERRANEAN AND MINOR THEATERS

theater veterinarians. The Fifth Army

animal service was backed up in the

Peninsular Base Section by fixed veterinary hospitals, with both army and

communications zone activities being

directed and co-ordinated by the theater

veterinarian, Colonel Noonan.22

At the date of the launching of the

North Apennines Campaign, there were

only two fixed veterinary hospitals in the

Peninsular Base Section, both Italian

units. The 213th Veterinary General

Hospital (Italian) was occupying the

buildings of a former Italian Army veterinary hospital at Grosseto; and the 1st

Veterinary Station Hospital (Italian)

was at Persano in the Salerno area. Both

were operated in connection with stations of the 6742d Quartermaster

Remount Depot, which maintained its

own veterinary dispensaries at both

posts, and another in the vicinity of the

Naples medical center. Shortly after the

initial assault on the Gothic Line, the

remount depot opened a new station at

Pisa, again with a veterinary dispensary

to care for animals at the depot. The

station hospital at Persano was redesignated the 212th Veterinary Station Hospital (Italian) and assigned to Fifth

Army. With the departure of half of the

6742d Quartermaster Remount Depot

for southern France in mid-October, the

remount stations at Persano and Naples

were closed. Late in January the 2610th

Quartermaster Remount Depot was activated and took over the facilities at Pisa.

Three veterinary officers were assigned

to this depot and two to the 6742d Quartermaster Remount Depot at Grosseto.

Throughout the North Apennines

Campaign animals from Fifth Army veterinary installations were evacuated by

rail and truck to the 213th Veterinary

General. The physical plant was adequate to the demands made upon it, but

equipment was insufficient and the

quality of personnel was poor. "Italian

units," wrote Colonel Noonan, "are incapable of rendering satisfactory veterinary service, as their officers are for the

most part indolent, in addition to being

poorly equipped professionally."23 The

T/O of the 213th called for 15 officers

and 253 enlisted men, but actual

strength never reached those totals. At

the end of 1944 there were only 7 officers

and 177 enlisted men, being supervised

by a U.S. veterinary officer and 4 enlisted

men from the 2698th Technical Supervision Regiment. A second American

veterinary officer was on detached service

from the 24th Replacement Depot.

It was obvious by December of 1944,

when the 10th Mountain Division with

its large animal complement was assigned to Fifth Army, that the veterinary

support offered by PBS would have to

be materially improved before another

mountain campaign was undertaken.

Colonel Noonan asked at that time for

a U.S. veterinary general hospital

 24

 but

the postponement of the Fifth Army offensive until spring relieved the immedi22

 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. H; (2)

Annual Rpt, Surg, PBS, 1944; (3) Vet Hist, MTO,

(4) Med Sitreps, PBS, Sep 44-May 45; (5) Quarterly Hist, Vet, PBS, 1 Apr-30 Jun 45; (6) Med

Sitreps, 213th Vet Gen Hosp; and Vet, 6742d QM

Remount Depot, Sep and Oct 44; (7) Vet Rpts,

Sick and Wounded Animals, 6742d QM Remount

Depot, 1944; (8) Inspection of Veterinary Service,

NATOUSA and MTOUSA, 1944, 1945. (9) Misc

docs relating to MTO vet service, 1945. (10)

Monthly Hist Rpt, 2604th Vet Sta Hosp, Mar-May

45; (11) Hist, 2605th Vet Gen Hosp, 15 Mar-30

Apr 45.

23

 Memo, Col Noonan, Col, Theater Vet, to Plans

and Opns, 8 Dec 44. 24

 Memo, Noonan to Surg, MTOUSA, 24 Nov 44.
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 517

ate pressure. A realignment of the PBS

veterinary service along the lines desired

by Colonel Noonan was deferred until

March 1945.

On 15 March the 2604th Veterinary

Station Hospital (Overhead), the

2605th Veterinary General Hospital

(Overhead), and the 643d and 644th

Veterinary Detachments were all activated at Leghorn, where personnel

joined and were staged over the next

few weeks. The commanding officer of

the general hospital was Lt. Col. Walter

Smit, while the station hospital was

commanded by Capt. John L. West.

Both units were organized with skeleton

staffs in the expectation that Italian

veterinary personnel would be attached.

In a parallel move, the 213th Veterinary

General Hospital at Grosseto was given

more U.S. supervisory personnel and redesignated the 1st Veterinary General

Hospital (U.S.-Italian).

The 2605th Veterinary General was

ready by the time the main Fifth Army

drive was launched. The hospital moved

into position at Pontepetri west of Highway 64 on 19 April. The site, which had

been occupied until 1 April by the 211th

Veterinary Evacuation Hospital, was in

the rear of the 10th Mountain Division

sector. First patients were received on

21 April from the 211th, which had

moved forward to Riola. Other casualties

came direct from the 10th Mountain Division. All were transported by the 643d

Veterinary Evacuation Detachment. On

24 April the 2d Veterinary General Hospital (U.S.-Italian) was organized and

attached to the 2605th at Pontepetri, but

was of less help than had been hoped.

The Italian unit had only two veterinary

officers, and all of its enlisted men were

young inductees with only two months

in the Army and no experience with

animals.

The 2604th Veterinary Station Hospital, with the 644th Veterinary Evacuation Detachment attached, did not go

into operation until the war was over.

On 3 May the unit moved to San Martino, the site of a former Italian Army

artillery school a few miles south of the

Po River on the Bologna-Verona axis.

The Fifth Army Remount Depot was in

the area, with 5,000 captured or abandoned German animals, about 200 of

which were in need of veterinary care.

These were turned over to the hospital

when it opened on 5 May. A few days

later elements of the British remount

organization moved into San Martino,

and the area was turned over to them

on 15 May. During its brief l0-day operating span, the 2604th Veterinary Station Hospital treated more than 400

animals.

Meanwhile, the 2605th Veterinary

General Hospital had moved from Pontepetri to a site about 8 miles beyond

Mirandola, where it too opened on 5

May. Casualties were received from the

211th Veterinary Evacuation, which was

at Ghisione only about 10 miles forward,

and from the 2604th Veterinary Station,

which was no more than 12 miles away.

The food inspection work that made

up the remainder of the Veterinary

Corps mission in the theater was routine

by the fall of 1944. By the start of the Po

Valley Campaign there were thirteen

veterinary food inspection detachments

operating in MTOUSA, at ports and

base section installations, supplemented

by two port veterinarians and a quartermaster refrigerator company veterinarian. The Air Forces had three aviation

veterinary detachments and two veter-
518 MEDITERRANEAN AND MINOR THEATERS

CAPTURED HORSE AT THE 2604TH VETERINARY STATION HOSPITAL AT SAN MARTINO

inary sections engaged in the same work.

These units were adequate to provide

complete food inspection coverage for

the theater.

Nursing Service

Through the first ten months of 1944,

there had been an average of 4,000

nurses in the Mediterranean theater. In

November 1,358 were transferred to

ETO, and the year ended with only

2,446 nurses remaining in MTOUSA, or

a ratio of 4.8 per 1,000 of troop strength

compared with a 5.5 ratio in October.

No replacements were received, even for

normal attrition, leaving the theater approximately 350 nurses below authorized

strength. Hours were often long

and working conditions, especially in

the field and evacuation hospitals on the

Fifth Army front, were difficult. "The

nurses," wrote a qualified observer in

December, "are showing definite signs

of fatigue. Many of them are getting

irritable with conditions and people to

which they could formerly accommodate

themselves. Little things bother them

which previously they could laugh off.

Young faces have old masks."25

25

 Memo, Maj Margaret D. Craighill, Consultant

for Women's Health and Welfare Activities, to

TSG, 20 Dec 44. Other sources for this section are:

(1) Annual Rpt, Med Sec, MTOUSA, 1944, an. I;

(2) Annual Rpt, Surg, PBS, 1944; (3) Annual

Rpts, Surg, NORBS, 1944, 1945; (4) Med Hist,

AAFSC MTO, 1944, 1945; (5) Med Hist, 2d Aux
THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 519

Some tensions were relieved by rotation between base and army hospitals

and by sending nurses to rest areas whenever they could be spared. In terms of

strength, however, no improvement was

possible, the ratio to troop strength declining to 4.7 per 1,000 by April. The

redeeming feature was a steady improvement in the ratio of nurses to patients.

Owing primarily to light battle casualties and an excellent general health level

among theater troops, the ratio of nurses

to patients rose from 1:21 in December

1944 to 1:19 in January and February

1945; 1:17 in March; and 1:15 in April.

A morale factor was the relaxing of

promotion policies in the fall of 1944,

when authority was granted to promote

all nurses who had been in the grade of

second lieutenant for 18 months, regardless of T/O allotments. Promotions were

also authorized for first lieutenants who

had been 18 months in grade if they

were otherwise qualified for advancement. Under this authorization, 227

second lieutenants and 19 first lieutenants were advanced in rank in the closing

months of 1944. When the war ended in

Europe there were 2,267 nurses in the

Mediterranean theater, of whom one was

a lieutenant colonel, 15 were majors, 100

were captains, and 1,328 were first lieutenants. Only 823, or about 36 percent

of the total, were in the lowest rank.

Army Civil Public Health

Activities

The Allied drive into the northern

Apennines coincided with far-reaching

changes in the political and administrative structure in Italy. With the government of Ivanoe Bonomi seemingly

secure, and more than half the country

freed from German domination, it appeared an unnecessary burden to require

Field Marshal Alexander to double as

military governor. Early in September

1944, therefore, Allied Force Headquarters resumed direct jurisdiction over the

Allied Control Commission, leaving the

army group commander responsible only

for liberated territory still within the

combat zone. Shortly thereafter President Roosevelt and Prime Minister

Churchill, as one of the results of a

conference in Quebec, issued a joint

declaration promising to the Italian Government greater control over its own affairs, both political and economic. Proposals for implementing the new policy

were worked out by Harold Macmillan,

then British resident minister at AFHQ,

and with only minor changes were approved in both London and Washington

in time to go into effect in February

1945. Army responsibility in matters of

civil public health in the communications zone was thereafter primarily advisory except for medical supply, and

even here, after 20 October 1944, distribution had been in the hands of an

agency set up for that purpose by the

Italian Government.26

In the combat zone, the Allied Military Government organization continued

to exercise control through the commanders of the two Allied armies. In

Surg Gp: Rpt of Nursing Activities while Functioning with Fifth Army; (6) Parsons and others,

Hist of Army Nurse Corps in MTOUSA.

26

 Principal sources for this section are: (1) Komer, Civil Affairs and Military Government in the

Mediterranean Theater; (2) Lewis, Rpt to WD,

History of Civil Affairs in Italy, 7 Dec 1945; (3)

Turner, chs. XI, XII, in Bayne-Jones, "Preventive

Medicine," vol. VIII, Civil Affairs-Military Government.
520 MEDITERRANEAN AND MINOR THEATERS

the Fifth Army sector, General Hume

continued to administer civil affairs under both Clark and Truscott. For the

most part AMG concentrated on the

restoration of water supplies, sewage

disposal, power facilities, sanitation, and

the like. Florence and Pisa were badly

damaged, presenting on a smaller scale

a repetition of the problem of Naples a

year earlier. The work of restoration was

still going on when the heavy rains of

September and October added to the

damage, but both cities were functioning

normally by winter. There were no serious outbreaks of disease anywhere in the

Arno Valley.

In the final drive that ended the war

in Italy, Fifth Army military government and civil public health officers had

relatively few problems. The German

collapse was so swift and so complete

that the great cities of northern Italy

suffered little damage. Partisan forces,

co-operating with the Allies, were able

to save most public utilities from destruction. The civil public health problems of the occupation period were those

of food, clothing, hospitalization, and

medical supply rather than the restoration of water and power facilities and

sewers and were soon transferred from

Fifth Army AMG to the Allied Control

Commission and the Italian Government.
CHAPTER XIV

Contraction and Redeployment

Once the war in Europe was at an end,

American commanders in the Mediterranean theater turned their attention to

the war still being vigorously prosecuted

in the Pacific and to the demobilization

of troops not required for the conquest

of Japan. The prompt redeployment of

combat and service units to the Pacific

and the contraction of operations in Italy

as rapidly as circumstances permitted

were the objectives toward which all

Medical Department activities were

oriented during the summer of 1945. An

understanding of redeployment policies

and plans is therefore essential to any

evaluation of the medical service during

this period.

Redeployment Policies and Plans

A War Department redeployment

plan prepared in August 1944, when

there was reasonable prospect of an early

end to hostilities in Europe, called for

the transfer of 45,000 service troops and

37,000 Air Forces troops from Europe

and the Mediterranean each month from

October 1944 through January 1945,

with ground force troops being returned

to the United States for further disposition. The criteria that would determine

whether individual soldiers would be

sent to the Pacific, used as occupation

forces, or returned home for demobilization were essentiality, length and arduousness of service, and number of

dependents. For the Medical Department, essentiality was the primary

factor.1

The first theater plan for redeployment was published in late September

of 1944. Following the general pattern

laid down by the War Department, medical units were divided into two categories: those required to care for troops

in the theater during the demobilization

period, and those available for other

uses. Units placed in the second category

were further subdivided into those to be

transferred to another theater, those to

be used to support garrison troops in

MTO or in the United States, and those

to be returned to the United States for

inactivation. Bed requirements for garrison troops were postulated at 4 percent

of strength.

Before this program got out of the

planning stage, it was clear that there

would be no final military victory in

Europe during 1944, and the whole

question of redeployment was temporarily shelved. It came up again in March

1945 with the receipt of a War Department forecast considered by the MTOUSA medical section to be unrealistic.

For one thing, requirements for the

occupation of Austria, then regarded as

1

 This section is based primarily on the following documents: (1) Final Rpt, Plans and Opns

Off, Office of the Surg, MTOUSA. (2) Annual Rpt,

Surg, Fifth Army, 1945.
522 MEDITERRANEAN AND MINOR THEATERS

a Fifth Army responsibility, were not

known. Another objection was that the

forecast called for early redeployment of

types of units not actually present in the

theater. The 2,000-bed general hospitals,

which were also scheduled for early

transfer, were regarded by General

Stayer as unsuitable for the Pacific and

necessary during redeployment in Italy.

There was also disagreement as to the

speed with which the medical depot companies ought to be withdrawn, in view of

the volume of equipment to be prepared

for shipment. Most of the objectionable

features were eliminated from a new

War Department forecast received early

in May, and redeployment regulations

consistent with it were issued on the 12th

of that month.

Under these regulations the theater

commander was to assign each unit to

one of the following categories: (I)

units to occupy areas of Europe; (II)

units to be used in the war against

Japan; (III) units to be inactivated

within the theater; and (IV) units to be

returned to the United States for inactivation. Category II was broken

down into (A) units to be shipped to the

Pacific direct; (B) units to be shipped to

the Pacific by way of the United States;

and (C) units to be shipped to the

United States to be placed in strategic

reserve. Since the occupation of Austria

had by this date been assigned to forces

already in that area and the occupation

of cobelligerent Italy was not contemplated, no MTOUSA medical units fell

into Category I.

At the same time, each officer and enlisted man in the theater was given an

Adjusted Service Rating Score (ASRS)

as of 12 May 1945, based on a point for

each month of service since 16 September 1940, a point for each month overseas, 12 points for each child under

18 years of age up to a limit of three, and

5 points for each combat decoration and

battle participation award.2 For enlisted

men the critical score was tentatively set

as 85 points. Critical scores for Medical

Department officers, received late in

May, varied with the corps. For hygienists and dietitians, the figure was 62; for

dentists, 63; for physical therapists, 65;

for nurses, 71; for Medical Administrative Corps officers, 88; and for Medical

Corps officers 85 plus, according to

specialty. As a preliminary to redeployment, high score men were to be transferred to Category III and IV units,

while units placed in Category II were

to be staffed with officers and men whose

ASRS's were below the critical level.

High-score men in Category III units

were to be returned to the United States

as casuals after disbandment of their

organizations. High-score personnel

deemed nonessential were to be withdrawn on a continuing basis from all

units and returned to the United States

as casuals. Where enough low-score officers were not available to staff outgoing

units, essentiality became the overriding

consideration.

Although many difficulties arose owing

to the disproportionately large number

of high-score men in medical units, the

program laid down in May was carried

out faithfully until the end of July. By

that date, however, the demands for shipping to move men and equipment to the

Pacific were so great as to preclude the

movement of medical units to the United

States for disbandment. Early in August,

2

 For more detailed discussion, see McMinn and

Levin, Personnel in World War II, pp. 487 ff.
CONTRACTION AND REDEPLOYMENT 523

therefore, it was decided to inactivate

Category IV units in the theater. All

transfers to the Pacific were abruptly

halted with announcement of the Japanese surrender on 14 August, and personnel thereafter were shipped to the

United States as rapidly as possible on

the basis of point scores alone.

Medical Support of Fifth Army

Medical support of Fifth Army in the

postwar period was of two types. As long

as combat formations remained active in

the field, even though they did no more

than patrol national frontiers, they were

accompanied by their organic medical

units and were served by mobile hospitals. On the other hand, when divisions

were sent back to redeployment and

training centers for new combat assignments or demobilization, the medical

service more closely resembled that of a

fixed post, with dispensaries and station

hospitals replacing clearing platoons and

evacuation or field hospitals.

Medical Service in the Field

Immediately following the German

surrender in Italy, combat elements of

Fifth Army moved out to the frontiers,

primarily for the purpose of rounding

up prisoners and preserving order. On

the left flank, the 34th Division advanced

to the French border. The 1st Armored,

to the right of the 34th, patrolled the

Swiss frontier in the vicinity of Lake

Como. The 10th Mountain Division advanced north from the head of Lake

Garda, while the 88th swept up through

Bolzano to the Brenner Pass and the

85th reached the Austrian border farther

to the east, in the Dobbiaco area. The

91st, which had passed to operational

control of Eighth Army on 5 May, moved

to the Yugoslav border at Gorizia and

backed up the British occupation of

Trieste. The 92d Division remained in

Genoa and the Brazilian Expeditionary

Force kept its positions around Alessandria.3

Each of these divisions was supported

by its own organic medical battalion and

by one or more mobile hospital units.

The 2d Platoon of the 15th Field Hospital continued to operate at its Genoa site

until the end of June, when the 92d

Division was withdrawn for redeployment. The 1st Platoon of the 32d Field

Hospital moved from the outskirts of

Milan to Alessandria on 3 May, and two

days later the 3d Platoon opened in

Milan itself. The 2d Platoon moved up

from Parma to Turin in support of the

34th Division on 8 May.

The 15th Evacuation hospital, after

turning its patients over to the 37th

General in Mantova, opened on 12 May

near Milan as a station hospital serving

both the 34th Division and the 1st

Armored. The 3d Platoon of the 32d

Field, no longer needed in Milan, moved

to Desenzano on 23 May, where it was

replaced early in June by a 100-bed detachment from the 8th Evacuation Hospital. At the same time, the 1st Platoon

was relieved at Alessandria by a similar

detachment from the 38th Evacuation,

3

 This section is based primarily on the following: (1) Annual Rpt, Surg, Fifth Army, 1945; (2)

Opns Rpts, II Corps, May, Jun 45; (3) Opns Rpts,

IV Corps, May-Jul 45; (4) Fifth Army History,

vol. IX; (5) Schultz, 85th Infantry Division, pp.

230-34; (6) Delaney, Blue Devils, pp. 225-34; (7)

Robbins, 91st Infantry Division, pp. 335-65; (8)

Goodman, Fragment of Victory, pp. 179-82; (9)

Unit rpts of organic med bns, and of hosps mentioned in the text.

CONTRACTION AND REDEPLOYMENT 525

located since 26 May at Salsomaggiore

south of Cremona; and the 2d Platoon

at Turin turned its patients over to a detachment from the 15th Evacuation. The

32d Field was thus freed for redeployment. (Map 43)

In the center of the fan-shaped army

area, most of the Fifth Army hospitals

were tied down with prisoner of war

patients and with the supervision of German POW hospitals. The 3d Platoon of

the 15th Field at Modena, the 1st Platoon of the 15th, which moved to Vicenza

early in May, and the 8th Evacuation

south of Verona were all so engaged.

Even the 3d Convalescent Hospital,

which moved up from Montecatini to

Villafranca on 4 May, was before long

largely occupied supervising a German

POW convalescent hospital. When the

2d Platoon of the 602d Clearing Company closed on 16 May, the 3d Convalescent also took over operation of the Fifth

Army Venereal Disease Center.

The 170th Evacuation hospital,

which had been en route to Treviso

when the war ended, remained at that

site in support of the 85th and 88th Divisions until 2 June, when it closed for

redeployment. Its sister unit, the 171st

Evacuation, closed at Vicenza on 7 May,

opening the next day at Cormons in support of the 91st Division. The site was

only a stone's throw from the Yugoslav

border, about midway between Udine

and Gorizia. On 27 May the 171st also

closed for redeployment, having been

replaced in the interval by the 56th Evacuation, which moved from Bologna to

Udine on 19 May. The larger unit was

required because of a flare-up along the

border that brought the 10th Mountain

Division to the support of the 91st.

The 33d Field Hospital gave secondand third-echelon support to the 85th

and 88th Divisions. The 1st Platoon,

which had been immobilized south of

Bologna throughout the greater part of

the Po Valley Campaign, opened in

Bolzano on 7 May. The 2d Platoon, at

Bassano when the war ended, moved

north to Primolino on 3 May and on to

Belluno on the 7th. The unit backtracked to Treviso on 4 June, however,

to take the overflow from the 56th Evacuation at Udine. The 3d Platoon moved

from Vicenza to Trento on 9 May.

Fifth Army itself began closing out in

June. On the 7th of that month the 88th

Division was reassigned to MTOUSA as

the theater prisoner of war command,

though the division continued to be administered by Fifth Army. About the

middle of June the Brazilian Expeditionary Force moved to Francolise north

of Caserta for redeployment training,

and the 92d Division moved to its own

redeployment training area near Viareggio. On 25 June the 1st Armored Division left the theater for occupation duties

in Germany, and on the 29th II Corps

also passed to ETO to administer the

occupation of Austria. The bulk of the

Fifth Army service troops were moved

out during June, since a limitless reservoir of German prisoner personnel was

available to perform their functions.

Early in July the 85th Division moved

to a redeployment area along the Volturno, and the 10th Mountain Division

moved to Florence preparatory to a Pacific assignment. On 11 July General

Martin left the theater for an assignment

in the Pacific, and his executive officer,

Col. Charles O. Bruce, became Fifth

Army surgeon. About this time a longstanding territorial squabble between

France and Italy was curbed, making
526 MEDITERRANEAN AND MINOR THEATERS

COLONEL BRUCE

occupation of Aosta Province on the

French border no longer necessary. Later

in the month, therefore, the 34th Division, which had been patrolling the disputed area, was free to relieve the 91st at

Udine, releasing the latter formation for

redeployment training. With the reassignment of the 34th Division, and the

transfer of the Legnano and Cremona

Groups of Italian partisans and the 6th

South African Armoured Division to

British control, IV Corps became nonoperational as of 15 July.

As the army contracted, medical units

readjusted their positions, so that they

too could be redeployed as rapidly as

possible.

The 16th Evacuation Hospital, which

had remained at its San Giovanni site

since the end of hostilities, relieved the

56th at Udine on 4 August. On 15 August

the 1st Platoon of the 15th Field Hospital, which had been supervising German

prisoner of war installations at Vicenza,

relieved the 15th Evacuation in Milan;

and a few days later the 2d Platoon relieved the 32d Field at Bolzano. On 1

September all remaining Fifth Army

units were assigned to the Peninsular

Base Section. Fifth Army became nonoperational on 9 September 1945, the

second anniversary of the Salerno landings, and was inactivated on 2 October.

On 25 September the 15th Field Hospital was reassigned from PBS to the 88th

Division, and a week later, operating as

a single hospital for the first time since

the beginning of the Po Valley Campaign, relieved the 16th Evacuation at

Udine, where the 88th relieved the 34th

Division.

During the closing months of Fifth

Army's existence, the medical service

was largely of garrison type. The incidence of disease was low, with malaria

well under control and intestinal diseases almost nonexistent. Even the

venereal disease rate, contrary to all expectations, was surprisingly low. The

rate per 1,000 per annum rose from 34

for the week ending 4 May to 55, 91,

and 111 for the three succeeding weeks,

but was down to 81 by June. It remained

between 93 and 67 until August, when it

dropped to 58. The only disease outbreak of any significance occurred in the

last week of June, when 27 cases of

poliomyelitis suddenly appeared in the

10th Mountain Division, then in the

Udine area. Despite intensive investigation, no cause was determined.

Medical Service for Staging

Units

As soon as MTOUSA redeployment

plans were firm, Fifth Army began es-
CONTRACTION AND REDEPLOYMENT 527

tablishing redeployment and training

centers where troops could be prepared

for transfer to another theater or for

shipment home. Centers were established for nondivisional units at Montecatini and Florence, the former for Category II units, the latter for Category

IV. In June one area near Viareggio

was prepared for the 92d Division, and

another at Francolise, just north of the

Volturno in the vicinity of Capua, for the

Brazilian Expeditionary Force. About

the 1st of July another redeployment and

training center was set up along the

Volturno near Caiazzo, where a replacement center had previously been located. Later in the same month the last

of the redeployment centers was established, at Cecchignola just south of

Rome, which had also been the site of a

replacement center. Both the Volturno

and Cecchignola centers served divisional troops.4

Fifth Army supplied medical service

for each of the centers processing nondivisional units-Montecatini, Florence,

and for a time Volturno and later

Cecchignola. In each case a team of three

officers was attached to the center, one a

field-grade medical officer who served as

area surgeon; one a medical records inspector; and the third a medical supply

inspector. The surgeon was responsible

for sanitation and medical care, as well

as for checking the physical condition of

each man to determine his fitness for

further overseas duty. The team as a

whole was responsible for checking the

administrative condition of medical

units and detachments. The divisional

units received medical care through

their organic medical battalions, with

the clearing company providing dispensary service.

Fifth Army also operated dental clinics

at Montecatini, Florence, and Cecchignola, where every effort was made to send

the men out in first-class dental condition whether they were homeward

bound or destined for the Pacific. The

largest of the clinics—that at Montecatini—was staffed by thirty dental officers,

assisted by both U.S. and German dental

technicians.

Hospitalization at Montecatini was

supplied by the 182d Station Hospital

and by the 94th Evacuation, which

moved to the center from Carpi on 16

May. All facilities of the 94th except a

dispensary were closed out late in June,

and the 182d was relieved at that time by

a detachment of the 70th General Hospital under PBS control. The other centers

were supplied with hospitalization exclusively by PBS units from the start.

The Florence center was initially supported by the 55th Station Hospital at

Pratolino; then by the 225th Station, a

detachment of the 70th General, and a

detachment of the 64th General, which

succeeded one another in that order. The

105th Station at Pisa and its successor,

the 55th, were available to the Viareggio

bivouac of the 92d Division, which also

made use of hospitals in Leghorn. Two

platoons of the 35th Field Hospital that

opened at Sparanise on 8 July had

Brazilian medical personnel attached to

serve the nearby Brazilian redeployment

center. The Volturno area was served by

the 154th Station at Caiazzo; and the

Cecchignola center received hospital sup4

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1945; (2) Final Rpt,

Plans and Opns Off, Off of Surg, MTOUSA; (3)

Unit rpts of div surgs and organic med bns; (4)

Unit rpts of hosps mentioned in the text.
528 MEDITERRANEAN AND MINOR THEATERS

port from the 40th Station and its replacement, a detachment of the 37th

General Hospital. The 34th Station was

also available if needed.

Other features of the Fifth Army medical service for staging troops were the

operation of dispensaries and prophylactic stations in rest areas, and the sanitary inspection of hotels and restaurants

in the large cities of northern Italy to

which leaves were granted.

Hospitalization and Evacuation

At the theater level, hospitalization

and evacuation of the sick and injured

continued to be the primary mission of

the medical service as long as American

soldiers remained in the Mediterranean.

Both functions, however, were sharply

curtailed in keeping with the improved

health status resulting from the cessation

of hostilities and the subsequent reduction of troop strength.

Contraction of Hospital Facilities

The problem facing the MTOUSA

and PBS surgeons when the redeployment period began was one of keeping

a safe number of fixed beds in the areas

of troop concentration and a balanced

distribution of facilities and specialized

personnel, at the same time closing out

hospitals to meet the redeployment

schedule and readjusting personnel in

order to staff with low-score men units

tabbed for further combat. It was not

an easy task, but it was accomplished

smoothly and with few delays.

Since the bulk of the U.S. forces were

in northern Italy, hospital facilities in

the Naples area were the first to be surplus to theater needs. One 500-bed station hospital—the 52d—was closed the

day after the war in Italy ended, and

earlier plans to re-establish the unit at

another location were abandoned. The

118th Station closed on 20 May and the

106th four days later, leaving only

the 21st Station and the 17th, 45th, and

300th Generals in Naples, with an aggregate Table of Organization bed strength

of 5,500.5

In Rome a readjustment was made

when the 500-bed 73d Station Hospital

was reassigned to PBS from Rome Area

on 25 May, preparatory to closing, and

the 250-bed 34th Station was transferred

to the Rome Area jurisdiction. It was

possible to release only one of the Leghorn hospitals in May—the 114th Station, which closed on the 29th. The

114th, which had been the PBS psychiatric hospital since its arrival in Italy

almost a year earlier, had been receiving

patients in diminishing numbers for

several weeks.

Also closed in May were the 225th

Station Hospital at Fano and the 35th

Field Hospital, whose platoons had been

operating separately at Lecce and Erchie

in the heel of Italy and at Rimini on the

western coast of the Adriatic. Both of

these hospitals, however, were scheduled

for new assignments under PBS after

termination of their attachments to the

Adriatic Base Command.

The 225th Station was in fact the key

to a difficult situation in the Florence

area, where the 24th General Hospital

was required to vacate its quarters not

5

 Principal sources for this section are: (1) Final Rpt, Plans and Opns Off, Office of Surg, MTOUSA; (2) Med Sitreps, PBS, May-Oct 45; (3)

Unit rpts of hosps mentioned in the text; (4)

ETMD's of the hosps mentioned in the text for

May-Oct 45.
CONTRACTION AND REDEPLOYMENT 529

later than 1 June to make way for the

redeployment and training center. A

minimum of 500 beds would be required

to support the center, but no suitable site

was available in Florence. Permission to

use the theological seminary building

occupied during the North Apennines

Campaign by the 15th and 94th Evacuation Hospitals was refused by the archbishop of Florence. The only practical

solution was to replace the 250-bed 55th

Station at Pratolino with a larger unit.

Additional space was provided by converting a nearby villa into officers quarters and turning an enclosed porch into

a ward. On 9 May, ten days after it

closed at Fano, the 225th began taking

over from the 55th by infiltration. By 1

June, when the 24th General moved out

of the area, the 225th was in full operation with facilities for 750 beds.

The process of readjustment and contraction was accelerated in June. In

southern Italy the 45th General Hospital—last installation in the Naples medical center—closed on 9 June, and on the

21st replaced the 26th General at Bari

as an ABC unit. On 10 June the 262d

Station Hospital at Aversa was relieved

by a platoon of the 35th Field. The 34th

Field closed its 1st Platoon at Spinazzola

on 5 June and its 2d and 3d Platoons at

Cerignola ten days later, the latter being

replaced by the 2d Platoon of the 4th

Field. In Rome, the 73d Station closed

on 18 June.

In northern Italy, the 81st Station at

Leghorn and the 74th at Bologna both

closed on 20 June. On 25 June the 500-

bed 105th Station, having evacuated all

but sixty of its Russian patients to their

homeland, was replaced by the 250-bed

55th Station. The 55th was able to send

the remaining Russians home by 28

June. Also on 25 June, the 182d Station

closed at Montecatini and the 225th

ceased operations at Pratolino. Both

units were replaced by 500-bed detachments of the 70th General Hospital,

which ceased taking patients at Pistoia

at that time.

July saw the closing out of another

6,000 fixed beds in Italy and further readjustment to provide adequate coverage. The 1st and 2d Platoons of the 35th

Field Hospital opened at Sparanise in

support of the Brazilian redeployment

center on 8 July, and on the 12th the

70th General moved its headquarters

from Pistoia to Pratolino. The major

shutdowns began with closing of the

2,000-bed 12th General at Leghorn on

7 July. On the 18th the 60th Station at

Senigallia was relieved by the 4th Field.

The 103d Station closed at Pisa on 20

July, its place being taken by the 99th

Field, whose scattered platoons were

brought up from Grosseto, Castagneto,

and Empoli.

The 40th Station closed at Cecchignola

redeployment center south of Rome on

21 July, replaced by a detachment of the

37th General from Mantova. On the

same day the 32d Station closed at

Caserta, where it was relieved by a detachment of the 300th General. The 21st

Station closed in Naples on 23 July, and

the 6th General closed at Bologna the

following day. The 750-bed 7th Station

Hospital closed in Leghorn on 26 August, and by the end of the month the

154th Station at Caiazzo and the Cecchignola detachment of the 37th General

were also closed.

As of 1 September, nearly four months

after the end of the war in Italy, there

remained 14,350 fixed beds in MTOUSA, including the 16th Evacuation
530 MEDITERRANEAN AND MINOR THEATERS

Hospital and the 15th Field Hospital,

which were assigned to PBS from Fifth

Army at that time.6 Of this total, 2,400

were attached to the Adriatic Base Command and 250 were assigned to Rome

Area, the remainder being PBS units. In

terms of distribution, 3,900 beds were

in the Naples-Caserta area; 3,000 in Leghorn; 2,000 in the Bari-Foggia area

serving Air Forces units. There were

2,150 beds in the Arno Valley between

Florence and Pisa; 1,500 in Mantova;

750 at Udine; 400 at Senigallia; 250 in

Rome; and 100 each at Milan, Desenzano, and Bolzano.

The authorized ratio of fixed beds to

troop strength for the theater was

lowered from 6.6 to 4 percent on 15

September, and a further exodus of hospitals followed. The 33d, 37th, 45th, and

70th General Hospitals, the 16th Evacuation, and the 4th Field were closed on

or before 1 October. The closing of the

17th General and 35th Field Hospitals in

October and the 64th General in December left the Mediterranean theater with

a total of 3,800 beds at the end of the

year.

During the redeployment period hospitalization in base installations followed

a predictable pattern. The three fixed

hospitals in the Po Valley were largely

occupied through May and June with

prisoners of war, many of them with

neglected battle wounds. General hospitals foremost in the line of evacuation

from the combat zone, notably the 24th

at Florence and the 70th at Pistoia,

carried a heavy surgical load during May,

but the backlog of battle wounds was

largely caught up by the end of the

month. In the Naples and Leghorn areas,

general hospitals reported rises in venereal cases and in common respiratory

and intestinal diseases, owing primarily

to the closing out of the station hospitals

that normally handled such cases. Hospitals serving the redeployment centers

noted a considerable rise in neuropsychiatric cases as a result of the rigorous

screening of personnel for Category II

units. There were otherwise no significant disease trends, and admissions remained well below capacity despite the

continuous reductions in bed strength.

Evacuation

With both mobile and fixed hospitals

scheduled for early redeployment, it was

necessary to accelerate the evacuation

process by every possible means. The

backlog of U.S. battle casualties was

largely cleared from the army area by

the middle of May, while ZI evacuation

alone during that month released more

beds than were required for new admissions. A continuing process of moving

ZI patients to Naples and of concentrating communications zone cases in

smaller and smaller numbers of hospitals made intratheater evacuation also a

continuous process.

Intratheater Evacuation—In the period between the ending of hostilities in

Italy and the dissolution of Fifth Army

it is impossible to separate evacuation

from army hospitals and patient transfers from one base hospital to another.

The bulk of the battle casualties were

cleared from the Po Valley by the middle

6

 The difference between 14,350 fixed beds on 1

September 1945 and 13,950 as given in Appendix

A-6 for 31 August is represented by the 400 beds

of the 5th Field Hospital, assigned to PBS on 1

September.
CONTRACTION AND REDEPLOYMENT 531

TABLE 38—INTRATHEATER EVACUATION: U.S. AND ALLIED PERSONNEL

MAY-SEPTEMBER 1945

Source: Compiled from Medical Sitreps, PBS, May-September 1945.

of May, using planes exclusively to carry

the men back to base hospitals in the

Florence and Leghorn areas. More than

1,300 U.S. and Allied patients were flown

out of the Po Valley between 2 and 15

May. (Table 38) Flights from Bologna,

however, carried patients from the two

PBS hospitals in that city as well as from

the army field and evacuation hospitals.7

Air evacuation began both from Bo7

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, Office of the Surg,

MTOUSA; (2) Med Sitreps, PBS, May-Sep 45; (3)

Med Hist, 802d MAETS.
532 MEDITERRANEAN AND MINOR THEATERS

logna and from Villafranca airfield south

of Verona about 2 May, and shortly

thereafter from Treviso and Milan. In

June planes of the 802d Medical Air

Evacuation Transport Squadron began

lifts from the Udine area, but by this

date the number of patients to be evacuated was small. The squadron became

inoperative in June, and its sister squadron, the 807th, in August.

The only unusual incident in evacuating from Fifth Army units occurred

late in May in the San Remo area along

the Italian Riviera, where the 34th

Division was engaged in patrol activities. Authorization was requested and

received from SHAEF to evacuate patients from this area to the 78th Station

Hospital at Nice, France, an ETOUSA

unit that was only thirty-five miles away,

whereas the nearest MTOUSA hospital

was the 2d Platoon of the 32d Field in

Turin, more than 150 miles away.

Early in May some 500 patients were

evacuated by hospital train from Florence to Leghorn to provide beds for

new casualties coming from across the

Apennines, and later in the month

approximately 800 more were flown

from Florence to Naples to clear

the 24th General Hospital for closing.

Patients from Pratolino, Pistoia, and

Montecatini continued to go by rail to

Leghorn during June and July, as hospitals in those areas were contracted or as

patients were screened for evacuation to

the zone of interior, with a smaller

number going direct to Naples by air.

ZI patients from Leghorn were sent to

Naples by hospital ship. More than

1,800 were evacuated by this means in

May, 550 in June, and over 800 in July.

Both rail and hospital ship evacuation

within the theater were discontinued in

the latter month, all intratheater evacuation thereafter being by air. By this

date only a relatively small number of

long-term patients remained, and evacuation had been reduced to transportation

of routine illness and injury cases among

garrison troops to the nearest fixed hospital.

Evacuation to the Zone of Interior—

An essential preliminary to redeployment of hospitals and other medical

units in the Mediterranean was to reduce

the number of patients in fixed hospitals

as rapidly as possible. As early as 15

April 1945, when the Po Valley Campaign was just getting under way, the

problem was studied with a view to

speeding up the evacuation process. It

was determined at that time that of the

more than 15,000 patients then in MTOUSA hospitals, 2,400 more could be evacuated to the zone of interior on a 60-day

policy than could be sent home on the

120-day policy then in effect. A 60-day

policy, moreover, would increase future

ZI dispositions by 65 percent.8

The evacuation policy was reduced

accordingly to 60 days beginning on 1

May 1945. The change was immediately

reflected in a sharp rise in ZI evacuation,

which reached a total of 4,428 for U.S.

Army patients for the month, compared

with 1,761 in April. The backlog of ZI

patients had been so far reduced by the

end of May that one plane a day, carrying 18 litter patients, was deemed sufficient for priority cases. Early in July,

when air transports with comfortable reclining seats became available, litter and

ambulatory loads were alternated. Non- 8

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, Office of Surg, MTOUSA,

1945; (2) Theater ETMD's for May-Dec 45; (3)

Med Sitreps, PBS, May-Oct 45.
CONTRACTION AND REDEPLOYMENT 533

TABLE 39—EVACUATION FROM MTOUSA TO THE ZONE OF INTERIOR

MAY-DECEMBER 1945

a

 Does not include 55 Russians evacuated to Bruck, Austria. b

 Does not include 49 Russians evacuated to Bruck, Austria.

Source: (1) Final Rpts, Plans and Opns Off, Office of the Surg, MTOUSA, apps. 14, 15. (2) Theater ETMD's MayDec 45. (3) Medical Sitreps, PBS, May-Oct 45.

priority cases continued to be evacuated

by hospital ships and troop transports.

The arrangement under which all ZI

evacuation by sea from southern France

was under control of Allied Force Headquarters in Italy was terminated on 1

July, each theater thereafter being given

a separate allocation by the War Department.

By the beginning of August, three

months after the termination of hostilities, the number of patients in MTOUSA hospitals was low enough to justify

reversion to a longer period of hospitalization in the theater, and a 90-day

policy was instituted. On 9 August the

War Department requested resumption

of the 120-day policy, to coincide with

that in effect in ETO. A MTOUSA request that 60 days be substituted for

patients with point scores above the critical level was denied, and the 120-day

policy went into effect on 19 August.

The last of the U.S. battle casualties

was evacuated to the zone of interior in

August, and the last of the Brazilian

patients was returned to his homeland in

September.

The only unusual incident in evacuating patients from the theater during

this period occurred in June, when three

planes of the 807th Medical Air Evacuation Transport Squadron carried the

first consignment of Russians from the

105th Station Hospital at Pisa to Bruck,

Austria, for repatriation. On arrival at

Bruck, which was in the British zone but

close to the area of Russian occupation,

it was found that no preparations had

been made to receive the patients, and

the pilots were directed to go on to

Vienna. There Russian authorities were

not only reluctant to take the patients,

they were almost equally reluctant to let

the American planes and crews return to

Italy.9

9

 (1) Hist, 807th MAETS, 1945. (2) Annual

Rpt, 105th Sta Hosp, 1945.
534 MEDITERRANEAN AND MINOR THEATERS

7029TH STATION HOSPITAL (ITALIAN) AT PISA

Evacuation from the Mediterranean

theater to the zone of interior from May

through December 1945 is summarized

in Table 39.

Hospitalization and Repatriation

of Prisoners of War

Throughout the campaign in Italy sick

and wounded prisoners had been hospitalized in base installations in or adjacent

to prisoner-of-war enclosures. Long-term

cases had been evacuated to the German

POW hospital near Oran or, until the

end of October 1944, to the United

States, but the bulk of them had been

hospitalized in the Peninsular Base Section. The German-staffed POW hospital

had been moved to Florence in March

1945, so that by the launching of the Po

Valley Campaign all German prisoners

in the Mediterranean theater were hospitalized when necessary by PBS.

As of this date, the installations pri-
CONTRACTION AND REDEPLOYMENT 535

marily devoted to care of German prisoners were the 334th Station Hospital

(German) at Florence, and the 103d

Station at Pisa. The 81st Station at Leghorn had 250 T/O beds devoted to the

care of prisoners, and the 262d Station

at Aversa in the Naples-Caserta area became exclusively a POW hospital late in

April. Small numbers of prisoners were

hospitalized temporarily in most of the

fixed hospitals in northern Italy. Italian

prisoner and cobelligerent personnel

continued to be cared for primarily at

the 7029th Station Hospital (Italian),

located from early March at Pisa.

As the Po Valley Campaign neared its

climax, it was clear that prisoners would

run into the hundreds of thousands, and

that special provision, including the full

utilization of all enemy medical facilities

and personnel, would be necessary to

hospitalize the sick and wounded among

them. After the first captured hospital

was dismantled and sent to the rear by

the 10th Mountain Division, orders were

issued late in April that all German hospitals and hospitalized personnel were

to be left where they were, under suitable supervision. It was hoped that all

German casualties could be cared for in

these installations, but the speed with

which the campaign came to a close and

the disorder of the German forces,

including the medical establishment,

forced the transfer of additional thousands to base hospitals before the German medical service could be reorganized under Fifth Army control.

For medical purposes, no distinction

was made between prisoners of war, defined as those taken in combat, and surrendered personnel, meaning those

turned over by their commanders after

the termination of hostilities. The two

groups were given the best medical care

available, both in the army area and in

the base section. The only real distinction was that prisoners in base hospitals

were cared for primarily by U.S. medical

officers, with some assistance from German protected personnel, whereas in the

army area all medical care after the first

few days was by Germans in German

hospitals, with American officers performing only a supervisory function.

When a complete count was made, as

of 15 June, the U.S. share of the more

than half million prisoners taken in Italy

since Salerno was 299,124, of whom

147,227 were under Fifth Army control

and 151,897 belonged to the Peninsular

Base Section. The health of these prisoners, who were used to replace American and Italian service troops, was the

responsibility of the Fifth Army and PBS

surgeons.

Hospitalization in the

Army Area

When Fifth Army took over the German medical service at the end of the

war, field units, disorganized and for the

most part inadequately staffed and supplied, were scattered over northern Italy.

The main concentration of German fixed

hospitals was at the resort town of

Merano close to the Austrian border

northwest of Bolzano, with a smaller concentration at Cortina d'Ampezzo, about

forty miles east of Bolzano. In both of

these areas, facilities were more than

adequate. Hospitals were fully staffed

and equipped to operate without U.S.

assistance.10

10

 Except as otherwise noted, this section is based

on: (1) Fifth Army History, vol. IX; (2) Annual

Rpt, Surg, Fifth Army, 1945; (3) Delaney, Blue

Devils, pp. 234-46.
536 MEDITERRANEAN AND MINOR THEATERS

GERMAN MEDICAL CENTER IN THE ITALIAN ALPS, the largest establishment of this type

in Italy.

In accordance with AFHQ instructions, all German hospitals and patients

were held where they were when captured, pending detailed analysis of the

situation. Colonel Camardella, designated by General Martin to supervise

the hospitalization and evacuation of

prisoners of war in the Fifth Army area,

began an inspection of German medical

facilities on 3 May. He found 10,000 patients at Merano, 5,000 at Cortina

d'Ampezzo and another 5,000 in German

field units and in American and civilian

hospitals in the army area. There were

surplus supplies at Merano, and equipment for making all kinds of prosthetic

devices at a Luftwaffe hospital on Lake

Como. The German medical high command at Merano, feeling deserted by its

own army and in constant fear of reprisals by Italian partisans, was only too

eager to co-operate.

Fifth Army kept enemy formations intact insofar as possible. Personnel not in

organized units were grouped into selfsustaining organizations or attached to

units still retaining some semblance of

cohesion, and all were collected into concentration areas. The largest of these

was set up at Ghedi, about twenty miles

southwest of Desenzano and a somewhat

shorter distance south of Brescia. A

smaller concentration area was located

at Modena, with others of lesser impor-
CONTRACTION AND REDEPLOYMENT 537

A HOTEL-HOSPITAL AT MERANO

tance at Parma, Piacenza, Montichiari,

Brescia, and Verona. Sanitation of all

prisoner enclosures in northern Italy was

under the supervision of Maj. Frank H.

Connel. In the first few days after the

surrender it was necessary to remove

truckloads of refuse, and to dust all prisoners with DDT powder for body lice.

Typhus inoculations were also given.

Plans called for the early movement of

all German prisoners to Ghedi and Modena, with a parallel concentration of

medical facilities. Hospitals of 100 beds

or less were to be merged with larger

units, and patients were to be shifted as

rapidly as possible to the larger hospitals.

As soon as adequate lines of communication could be established, all long-term

prisoner patients were to be concentrated at Merano.

During the period of consolidation,

one or more medical officers of the 2d

Auxiliary Surgical Group were stationed

at each of the German hospitals to keep

a check on the number of patients and

their care. As had been the case at

Merano, German doctors for the most

part were so anxious to disassociate

themselves from the Nazis that willing

co-operation was assured. No attempts to

evade or mislead in any particular were

noted. A German increment, with two

medical officers, was attached to Fifth

Army headquarters, and the German
538 MEDITERRANEAN AND MINOR THEATERS

Director of Medical Services aided in the

assignment and disposition of enemy

medical units.

Through May the 85th and 88th Divisions guarded captured dumps in the

mountains and moved surrendered German forces to initial concentration areas.

Guard duty at Ghedi was performed by

the 10th Mountain Division until 18

May, and thereafter by the 71st Antiaircraft Brigade with the 442d Infantry

regiment under its command. The 88th

Division took over all guard duties when

it became the theater prisoner of war

command. By this time all prisoners

in the Fifth Army area had been moved

to Ghedi or Modena. Some 80,000 entered the Ghedi cages in the week of

17-24 May alone. Modena was considerably smaller, being limited to about

20,000 by poor drainage.

Medical service at Modena was supplied by German doctors under supervision of the 15th Field Hospital's 3d

Platoon. At Ghedi a 1,600-bed tent hospital was erected, staffed entirely by German medical units nominated by the

German Director of Medical Services.

Lt. Col. (later Col.) Harris Holmboe

was General Martin's choice for medical

coordinator in the Ghedi area. The Modena and Ghedi hospitals were to care

for personnel in the prisoner of war enclosures only, and were not a part of the

consolidation plan.

By the end of May about 80 percent

of all German medical personnel, equipment, and patients had been transferred

to Merano and Cortina d'Ampezzo. A

German-staffed 1,500-bed convalescent

hospital was established the first week of

June at Villafranca, under supervision of

the U.S. 3d Convalescent Hospital. Patients expected to recover within four

weeks were transferred here from Merano and Cortina, and on recovery were

moved to the Ghedi POW enclosure. By

15 June, six weeks after the victory, all

German hospitals under Fifth Army control had been closed except Merano,

Cortina, the convalescent facility, and the

units serving the Modena and Ghedi

areas. In another two weeks the hospitals

at Cortina d'Ampezzo were also cleared

to Merano and closed. The convalescent hospital was disbanded on

17 July. German medical supplies and

equipment were stored at Merano and

Ghedi, while German hospitals and

other medical units, as they became surplus, were held at Ghedi for shipment

to Germany or Austria on call.11

At the end of June there were about

12,000 patients in the German hospitals

at Merano, administered by the 380th

Medical Collecting Company of the 54th

Medical Battalion. There were about

4,000 members of the German medical

service in the town. Many items of medical supply were manufactured there,

and 9,000 tons were stored. Supplies not

needed to care for patients at Merano

were shipped to PBS and to British bases

for use in treatment of German personnel. The town itself was run by the

88th Division under strict military control.

Merano offered an excellent opportunity to evaluate German medicine, about

which little had been known since the

Nazi regime had come into power.

Consultants and medical investigators

from all parts of the theater and from

11

 (1) Annual Rpt, Surg, Fifth Army, 1945. (2)

Ltr, Stayer to CofS MTOUSA, 13 Jun 45. (3) Ltr,

Standlee, Acting Surg, MTOUSA, to Deputy Theater Comdr and CofS MTOUSA, 17 Jul 45.
CONTRACTION AND REDEPLOYMENT 539

WARD TENTS OF GERMAN POW HOSPITAL AT GHEDI, MAY 1945

the United States visited the area during

the period of its heaviest operation. The

conclusion was general that while the

German medical service was adequate,

its standards "were only mediocre in

comparison with those of the Allied

Forces in Italy."

 12

Hospitalization of Prisoners

in PBS Units

For a week or more after the close of

hostilities in Italy, prisoner of war patients continued to be evacuated to PBS

hospitals, pending survey and reorganization of the German medical service in

the Fifth Army area. The 103d Station

Hospital at Pisa had a peak load of 1,162

prisoner patients on 5 May. The 37th

General, when it opened in Mantova on

9 May, received more than 1,000 German

patients by transfer from the 15th Evacuation Hospital, and others continued to

be admitted to the 74th Station and the

6th General at Bologna.13

In order to relieve the pressure on hospitals in the forward area, about 700

prisoner patients were evacuated from

the Po Valley to Florence, where the

German-staffed 334th Station Hospital

was expanding its capacity from 500 to

12

 Annual Rpt, Surg, Fifth Army, 1945, p. 44.

13

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, Office of Surg, MTOUSA;

(2) Med Sitreps, PBS, May-Oct 45. (3) Theater ETMD's, May-Oct 45. (4) Unit rpts of individual hosps mentioned in the text; (5) ETMD's

of individual hosps mentioned in the text.
540 MEDITERRANEAN AND MINOR THEATERS

POW WARD OF

262D STATION HOSPITAL AT AVERSA

1,600 beds. This unit reached a peak

census of 1,522 about the end of May.

Both the 81st and 114th Station Hospitals in Leghorn took additional prisoner

patients early in May, and three trainloads were moved from Leghorn to

Naples. The bulk of these went to the

262d Station Hospital at Aversa, but one

consignment of about 300 was temporarily cared for at the 21st Station in

Naples, being transferred to the 262d

before the middle of the month.

German medical personnel were

utilized to the extent available by all of

the PBS hospitals caring for prisoners.

The 37th General inherited 70 German

medical officers and 400 enlisted men

from the 15th Evacuation. Only a few

German protected personnel were used

by the 74th Station and the 6th General

in Bologna, but the 103d Station at Pisa

had 26 German medical officers, 31 female nurses, and 401 enlisted men by the

end of May. The 262d. Station at Aversa

had 121 German technicians who were

used as assistants to U.S. personnel. In

addition to these groups, fully organized

and equipped German units, corresponding to the American field hospital platoons, were established in the various

prisoner of war stockades under PBS

control, where they furnished dispensary

and infirmary service.

Prisoner admissions were predominantly battle casualties during the early

part of May. Wounds had frequently

been neglected or inadequately dressed,

and the initial strain on surgical staffs of

the hospitals treating them was severe.

The 334th Station maintained a blood

bank for prisoners, the donors being

drawn from the PBS prisoner of war enclosures. At the same time the medical

services of the various POW hospitals

treated many conditions not common

among U.S. troops that arose out of a

background of malnutrition, insanitary

conditions, and the older age level of the

German Army.

The hospitalization of prisoner patients in PBS was stabilized by the first

week of June, when the 88th Division became the MTOUSA prisoner of war

command. In the Naples area, the 3d Platoon of the 35th Field Hospital relieved

the 262d Station on 8 June, taking over

487 prisoner patients and a newly arrived

German field unit consisting of 6 medical

officers, a dentist, a pharmacist, an administrative officer, 4 nurses, 6 nurses'

aides, and 82 enlisted men. The 11i4th

Station in Leghorn was already closed,

and the 81st Station in the same city and

the 74th in Bologna were preparing to

close. At the end of June the 37th General still had more than 1,000 POW pa-
CONTRACTION AND REDEPLOYMENT 541

tients, and the 6th General had about

800. Approximately 1,000 German patients remained in the 334th Station

Hospital at Florence and about 750 in

the 103d Station at Pisa. The 35th Field

at Aversa had about 500 prisoner patients.14

Evacuation of long-term cases to

Merano began on 25 June from the 37th

General Hospital and from other PBS

prisoner of war hospitals early in July.

Thereafter the prisoner of war census in

PBS hospitals declined rapidly. The 103d

Station was relieved at Pisa by the 99th

Field on 20 July, transferring 602 German patients at that time. By the end of

the month 37th General had only 341

prisoner patients, and the census of the

334th Station was down to 570. Both of

these hospitals were closed on 13 September, leaving the 35th Field at Aversa and

the 99th Field at Pisa the only PBS units

still hospitalizing prisoners of war.

On 25 September responsibility for all

prisoners of war under U.S. control in

Italy passed from MTOUSA to PBS. At

that time there were 268 prisoner patients in the 99th Field Hospital and 453

in the 35th Field, with an additional

1,200 in German units under U.S. supervision. The bulk of these were the routine sick and injured from German

service units operating in the theater.

All Italian personnel were formally released from prisoner of war status on 30

June and returned to control of the Italian Government. The 7029th Station

Hospital (Italian), which had been hospitalizing Italian prisoners first in the

Oran area and then at Pisa since the fall

of 1943, closed to admissions at this

time, and administrative control over all

Italian personnel was vested in the Italian commanding officer of the hospital.

All patients were transferred to civilian

or Italian military hospitals on 19 July,

and the unit closed the following day.15

Repatriation of Long-Term Patients

By the end of May the roundup of

prisoners of war and surrendered personnel in Italy was complete. The next

step was repatriation, beginning selectively with those whose labor was most

essential to restore the German economy

and those too old or too ill to be of any

productive use to the Allies. Toward this

end, a conference was held at Bolzano on

14-16 June between representatives of

Allied Force Headquarters in Italy and

those of Supreme Headquarters Allied

Expeditionary Forces whose responsibility extended to Germany and Austria.

Medical representatives at the conference

were General Martin and Colonel Camardella for Fifth Army; Maj. (later Lt.

Col.) Murray L. Maurer, MTOUSA

hospitalization and evacuation officer,

for the MTOUSA medical section; Maj.

(later Lt. Col.) O. S. Williams of the

British component for the medical section of AFHQ; and Col. Conn L. Millburn, Jr., executive officer to the army

group surgeon, for the 12th Army Group.

SHAEF headquarters sent no medical

representative, but Millburn was familiar with ETO's problems and policies.16

Basic agreements were reached as to

numbers to be repatriated on both sides,

routes to be used, and tentative target

14

 Ltrs, Kane, Surg, MTOUSA POW Comd, to

CG MTOUSA, 7 Jul, 6, 28 Sep, 45.

15

 (1) Hist, 7029th Sta Hosp (Italian), 27 Jul 45.

(2) Med Sitreps, PBS, 15-31, Jul 45. 16

 Ltr, Maurer to Standlee, 19 Jun 45, sub: AF

HQ-SHAEF Conference at Bolzano, 14-16 Jun 45.

POW's, Mar 44-Sep 45.
542 MEDITERRANEAN AND MINOR THEATERS

dates; but the disposition of long-term

patients was discussed only briefly at the

conference level. More detailed discussions of this problem were held by the

medical representatives meeting separately as a subcommittee, and tentative

plans were agreed upon. AFHQ was prepared to begin receiving hospitalized

Italians from Germany and Austria

whenever SHAEF requested, since 4,000

beds were already available in Italian

military hospitals. The transfer of German patients from Italy to SHAEF-controlled areas was a more complex problem. Occupation forces were still in the

process of adjustment, and beds would

not be available until all German patients could be evacuated from the Tyrol

region. It was agreed that when SHAEF

was ready, long-term German patients

from Italy would be moved north by hospital train over the Brenner route, whose

much-bombed rail line would soon be

in usable condition. The target date

selected was 10 July, at which time a

meeting between the two medical staffs

concerned was to be called by SHAEF to

complete final arrangements.

By the time the promised conference

of medical officers was held at Wiesbaden, Germany, on 12-13 July, SHAEF

had been replaced by United States

Forces, European Theater (USFET) . At

the Wiesbaden conference, the only representatives of the Allied Forces in Italy

were Col. Albert A. Biederman, plans

and operations officer in the MTOUSA

medical section; and Col. Williams,

who spoke for the British component of

AFHQ. On the USFET side, forward

headquarters was represented by Lt. Col.

Joseph W. Batch and rear headquarters

by Col. Fred H. Mowrey. Colonel Millburn and Lt. Col. James E. Sams

represented the 12th Army Group,

while Col. John Boyd Coates, Jr., and

Col. Robert Goldson represented Third

and Seventh Armies, respectively. The

British-Canadian 21 Army Group was

also represented in order to arrange the

transfer of German patients under British control in Italy.17

The Wiesbaden conference resulted in

a firm program for exchange of hospitalized prisoners between the Mediterranean and European theaters. All German

patients in U.S. custody were to go by

hospital train by the Brenner route to

Third Army at Munich, Regensburg,

and Furth; and to Seventh Army at Idstein. Beginning 25 July, one train every

second day was to go to Third Army,

and after 15 August daily trains were to

alternate to Third and Seventh Armies.

Three Italian hospital trains were to be

furnished by Fifth Army (two initially),

and two German trains were to be supplied by Third Army.

It was estimated that returns to duty

would reduce the total of U.S.-controlled

German patients to be repatriated to

about 10,000. Beds vacated by these at

Merano, up to 3,000, would be used to

hospitalize temporarily sick and wounded

Italians returned from Germany, for

whom responsibility would pass to the

Allied Commission on their arrival.

Long-term prisoner patients from the

Eighth Army zone in Italy were to go to

the 21 Army Group under separate arrangements.

Evacuation to Germany began as planned on 25 July, and by the end of the

17

 (1) Brief Minutes of Conference on Exchange

of Medical Cases, Wiesbaden, 12 Jul 45. (2) Ltr,

Biederman to Standlee, 20 Jul 45, sub: Exchange

of Sick and Wounded Between the European and

Mediterranean Theaters.
CONTRACTION AND REDEPLOYMENT 543

month 1,254 patients had been moved

to hospitals in the Third Army zone.

The hospital trains used were staffed by

German medical officers and corpsmen,

under the supervision of an American

Medical Administrative Corps officer.

On the return trip, the trains carried

Italian displaced persons to be hospitalized initially at Merano. The whole

process worked so smoothly that Third

Army agreed to take a trainload a day

beginning 9 August instead of on alternate days. The Third Army quota was

filled by the middle of August, all

evacuees thereafter going to the Seventh Army.18

By the end of August the total number

of long-term cases sent to Germany had

climbed to 7,783, and stood at 9,751 as

of 25 September, when the Peninsular

Base Section took over responsibility

from MTOUSA. For all practical purposes, the program was finished, since no

more than 500 long-term German patients remained in the U.S. zone of

Italy.

Redeployment and Inactivation

of Medical Units

At the same time that U.S. long-term

patients were being evacuated to the zone

of interior on a 60-day policy and the

burden of caring for prisoner of war patients was being reduced by consolidation

of hospitals and repatriation of those

with long hospitalization expectancy,

American medical units were being

systematically staged for shipment to the

Pacific or prepared for inactivation.

The Mediterranean theater was contracting even more rapidly than it had

grown in the early days of the Italian

campaign.

Disposition of Fifth Army Units

The readjustment of Medical Department personnel so that units destined for

the Pacific would have only men with

low adjusted service rating scores, plus

the loss of high-score men to "carrier"

units bound for the United States, posed

a more difficult problem for the Fifth

Army surgeon than even the care of prisoners of war. The Fifth had been the

first United States field army activated

on foreign soil in World War II, and

had been in virtually continuous combat

for 19 months when the war ended.

Many of its components, including hospitals and medical battalions, had seen

still earlier combat with other formations. There was, therefore, a heavy preponderance of high-score personnel in

the Fifth Army medical service. Yet 2 of

the 8 evacuation hospitals and one of the

3 field hospitals were scheduled for

direct redeployment to the Pacific, and 2

more evacuations and a field were listed

for indirect redeployment. Three of the

4 medical battalions in Fifth Army were

also placed initially in Category II, with

about the same proportions holding for

other types of medical units.19

18

 (1) Annual Rpt, Surg, Fifth Army, 1945. (2)

Final Rpt, Plans and Operations Off, Office of

Surg, MTOUSA. The figures used here, and in the

following paragraph, are from letters, M. M. Kane,

Surgeon, MTOUSA POW Command, to Commanding General, MTOUSA, 6, 28 September 1945, in

Prisoners of War, March 1944-September 1945.

These figures differ both from those given by the

Fifth Army surgeon and from those in the theater

ETMD for October 1945, but are believed to be

the more accurate.

19

 Principal sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1945; (2) Final Rpt,

Plans and Opns Off, Office of Surg, MTOUSA; (3)

Theater ETMD's for May-Aug 1945; (4) Unit rpts

of the individual med units mentioned in the text.
544 MEDITERRANEAN AND MINOR THEATERS

The first Fifth Army medical unit to

go to the Montecatini redeployment

center was the 94th Evacuation Hospital,

which arrived on 16 May, a bare two

weeks after the end of the war in Italy.

The exigencies of the situation, however,

required the 94th to go into operation

for a time at Montecatini, although it

was classified as II-A for direct redeployment to the Southwest Pacific. The 171st

Evacuation, scheduled for redeployment

to the Pacific by way of the United States,

was in Montecatini on 29 May; the 161st

Medical Battalion less its collecting and

clearing companies, the 32d Field Hospital and the 170th Evacuation all arrived at the redeployment center the first

week of June. The headquarters and

headquarters detachments of the 162d

and 163d Medical Battalions arrived

just before the end of June.

By the end of May the Category II-A

Medical units—the 94th and 170th Evacuation Hospitals, the 32d Field Hospital,

and the 161st Medical Battalion—were

staffed with low-score personnel as fully

as was consistent with efficient operation.

Other Category II units, including the

medical battalions and medical detachments of the 91st and 10th Mountain

Divisions, had had the bulk of their

high-score personnel withdrawn during June, but low-score replacements

were insufficient to bring the units up to

Table of Organization strength.

By July the personnel situation in

Fifth Army was critical. Low-score personnel to fill out the T/O's of units being redeployed to the still-active war

against Japan had of necessity to be

drawn from units scheduled for return

to the United States and ultimate inactivation. But these Category IV units

had already been stripped to a point at

which further withdrawals would jeopardize their efficiency, and they were still

needed to furnish medical service to the

remaining combat formations. A further

complication was the refusal of the War

Department to- accept the MTOUSA

Table of Organization for separate collecting companies that were to be transferred to the Pacific. These companies

had been operating with a medical officer

and 4 MAC's. It was now necessary to

make all of the 7 companies involved

conform to the official Table of Organization, which called for 3 medical officers and 2 MAC's. The required officers

were diverted from the 91st and 10th

Mountain Divisions, and replaced from

a group of 20 low-score medical officers

procured from the European theater,

but no more were available from that

source. Fourteen Medical Administrative Corps second lieutenants were commissioned from among 60 enlisted

applicants, but there remained a shortage of low-score officers in both corps,

forcing the retention of high-score men.

The supply of low-score enlisted men

was also critical by the end of July—so

much so that a requirement for 300 general service enlisted men with point

scores below 70, to be used as Pacific

replacements, could only be met by

drawing 100 men from units assigned to

the strategic reserve and replacing them

with high-score personnel from Category

IV units.

The manpower problem was finally

solved in early August. To relieve pressure on shipping, a change of policy was

inaugurated whereby all Category IV

units were to be inactivated in the theater rather than be shipped to the

United States for inactivation. Highscore personnel from Category IV that
CONTRACTION AND REDEPLOYMENT 545

had been scheduled for early shipment

and were already inoperative, were sent

home as casuals, but those with middlebracket scores—80 to 90 points—were

transferred to late Category IV units,

which were thus brought up to strength.

The process of redeployment, meanwhile, had been proceeding according to

plan. The Fifth Army veterinary service

passed out of existence on 30 June, when

the Italian pack mule trains were disbanded and the four U.S.—Italian veterinary hospitals were turned over to the

Italian Army. Two weeks later, on 14

July, the 171st Evacuation Hospital sailed for the Pacific by way of the United

States. The 32d Field and the 170th

Evacuation sailed on 17 and 25 July,

respectively, direct to the Philippines;

and the 161st Medical Battalion embarked on 7 August for the United States en

route to a Pacific station. The 94th Evacuation sailed for the Southwest Pacific

on 13 August, but was diverted at sea

to the United States after word was received of the Japanese collapse.

On 20 August all Category II units

still in the theater were ordered returned

to the United States for disposition, creating a considerable morale problem since

these had already been staffed with lowscore personnel who were thus being sent

home before the high-score men they replaced. Immediate steps were taken to

readjust personnel once more, but not

in time to alter the rosters of the 162d

and 163d Medical Battalions, already

aboard ship.

Other Fifth Army medical units were

disposed of rapidly thereafter. The 38th

Evacuation Hospital, which had originally been scheduled for return to the

United States, had been at the Florence

redeployment center since early July,

and the 56th Evacuation, which was to

be a Pacific reserve unit, had arrived at

Montecatini on 6 August. The 38th was

inactivated in the theater on 8 September. The 56th was sent home for inactivation early in October.

The 15th Evacuation and the 3d

Convalescent both closed for redeployment on 20 August, while the 54th Medical Battalion and the 601st Clearing

Company moved to Florence for final

disposition on 25 August. The 33d Field

Hospital, which had closed on 23 August,

was inactivated on 25 September. Only

the 15th Field Hospital, the 8th and 16th

Evacuation Hospitals, and a few lesser

units remained active in the army area

when the transfer to PBS took place on

1 September.

Disposition of PBS Units

The redeployment of medical units

assigned to the Peninsular Base Section

followed a pattern similar to that in Fifth

Army. The problem of personnel readjustment was equally difficult, with ten

station hospitals and one field hospital

in the II-A category for shipment in

June, July, and August; and three station

hospitals scheduled for transfer to the

Pacific by way of the United States in

July. A great deal of juggling was necessary, and a few medical officers with

ASRS's above the critical level were still

on the rosters when the hospitals sailed

for their new assignments.20

The first PBS units to leave the Medi20

 Principal sources for this section are: (1) Final

Rpt, Plans and Opns Off, Office of Surg, MTOUSA;

(2) Med Sitreps, PBS, May-Oct 45; (3) Pers Ltr,

Stayer to Kirk, 31 May 45; (4) Unit rpts of individual med units mentioned in the text; (5) AG

record cards of units mentioned in the text.
546 MEDITERRANEAN AND MINOR THEATERS

terranean theater under the redeployment plan were the 106th and 118th

Station Hospitals, both of which sailed

for Okinawa on 29 June. On 8 July the

52d Station left for indirect redeployment through the United States, and two

weeks later the 262d Station and the 34th

Field sailed for Manila. The 114th and

73d Stations sailed for the United States

and ultimate transfer to the Pacific on

20 and 27 July, respectively.

August was the heavy month for redeployment of PBS hospitals, seven 500-bed

stations sailing for Southwest Pacific

ports between the 11th and 21st of the

month. With the abrupt ending of the

war in the Pacific, all of these were

intercepted at sea and diverted to the

United States for disposition. The hospitals concerned and their sailing dates

were as follows: 74th Station, 11 August;

81st Station, 13 August, 103d Station, 15

August; 182d and 225th Stations, 16

August; 105th Station, 17 August and

60th Station, 21 August.

After the decision to inactivate Category IV units in the theater, PBS hospitals closed out rapidly. The 4th Field

Hospital was inactivated on 10 September. September 15 saw the inactivation of

the 7th Station Hospital, the 6th, 12th,

and 26th General Hospitals, and the 41st

Hospital Train. The 51st Medical Battalion and the 15th Medical General

Laboratory were inactivated on 30 September and 25 October respectively. The

33d General Hospital was inactivated on

20 September, the 8th Evacuation ten

days later, and the 154th Station on 1

October. The 35th Field Hospital and

the 17th, 37th, and 70th General Hospitals were inactivated on 25 October,

and the 16th Evacuation on 31 October.

The veterinary hospitals and veterinary

evacuation detachments assigned to PBS

were disbanded between July and

October.

The 2d Auxiliary Surgical Group,

which had been divided between the

Mediterranean and European theaters

since the invasion of southern France,

was reunited in Italy in June and was

inactivated at the Florence redeployment

center on 14 September.

After the 20 August policy order, only

four PBS hospitals left the theater as organized units. These were the 32d, 40th,

and 21st Station Hospitals, which sailed

for the United States on 22, 24, and 26

September, respectively; and the 24th

General, which sailed on 11 October.

All four of these hospitals served as

"carrier" units, transporting high-score

personnel to the United States.

Effect of Redeployment on

Supply Services

Not hospitals and medical battalions

alone, but medical supplies and equipment as well were redeployed to the Pacific. Each hospital or other medical unit

going out was completely reequipped

before it embarked. In addition quantities of medical supplies were sent to

Pacific ports without relation to the units

that would ultimately use them. Supplies and equipment for this purpose

were accumulated at the Naples and Leghorn depots as they were turned in by

inactivated and nonoperating units.21

Early in the redeployment period all

surplus equipment, including hospital

21

 Principal sources for this section are: (1) Annual Rpt, Surg. Fifth Army, 1945; (2) Final Rpt,

Plans and Opns Off, Office of Surg, MTOUSA; (3)

Med Sitreps, PBS, May-Oct 45; (4) Unit rpts of

individual med units mentioned in the text.
CONTRACTION AND REDEPLOYMENT 547

READYING MEDICAL SUPPLIES FOR TRANSSHIPMENT TO SOUTHWEST PACIFIC

expansion units, was turned in from both

Fifth Army and PBS. As medical units

closed for redeployment, all their supplies and equipment were turned in, and

the medical material thus accumulated

was reconditioned and packed for reissue

at the depots. For field and evacuation

hospitals from the army area, as much as

70 percent of the nonexpendable items

had to be salvaged, and about 30 percent

for base section units.

When the war ended in Italy, approximately 9,000 tons of medical supplies

were divided almost equally between the

Naples and Leghorn depots. Tonnage at

Naples dropped to about 4,000 in midMay, then climbed again to approximately 4,500 by mid-July as more hospitals closed in PBS South. Leghorn

tonnage rose steadily to more than 6,000

by mid-July before substantial outshipments were made. Tonnage at both depots was unbalanced, however, and

shortage lists grew as time went on, owing to the necessity of keeping hospitals

operating at the same time that complete

new assemblies for them were being

made up and set aside. The end of the

war with Japan removed the pressure and

left the Mediterranean theater with no
548 MEDITERRANEAN AND MINOR THEATERS

COLONEL STANDLEE

supply problem beyond that of storage

until surpluses could be returned to the

United States.

The activity of the supply depots did

not preclude the redeployment of medical supply units themselves, though it

did compel a change of schedule. The

12th Medical Depot Company, serving

Fifth Army, was originally placed in

Category II-A for movement to the Pacific in June, but was changed to Category

IV when General Martin protested that

the army would be left without any medical supply organization. The 12th was

assigned to PBS along with other Fifth

Army medical units on 1 September, and

was attached at that time to the 232d

Medical Service Battalion at Leghorn.

The Naples depot, although its tonnage was still climbing, was turned over

to a detachment from Leghorn early in

June in order to release the 72d Medical

Base Depot Company for redeployment.

The 80th Medical Base Depot Company,

which had been operating the Bari supply depot for the Adriatic Base Command, closed on 10 July, and the 72d and

80th sailed together for Manila on 22

July. The 232d Medical Service Battalion, with the 60th and 73d Medical

Base Depot Companies attached, continued to operate the main PBS depot at

Leghorn and the subdepot at Naples

throughout the redeployment period.

Close-out in the MTO

Organizational Changes

Through the summer and fall of 1945,

while the bulk of the Allied Forces in

Italy were being withdrawn, prisoners of

war were being returned to their homes,

and the medical service was being reduced to a minimum, various organizational changes were made to bring

overhead operations into line with requirements. At the same time assignments were changed to make the best use

of experienced officers and to replace

higher with lower ranks as responsibilities contracted.22

In June Colonel Arnest left the theater, being succeeded as Peninsular Base

Section surgeon by his deputy, Colonel

Sweeney. Colonel Sweeney was succeeded in late September by Col. William W. Nichol, formerly commanding

officer of the 37th General Hospital. At

the army level, the transfer of General

Martin and accession of Colonel Bruce as

22

 Principal sources for this section are: (1)

Munden, Administration of the Med Dept in

MTOUSA, pp. 189-205; (2) Med Sitreps, PBS,

Jun-Oct 1945.
CONTRACTION AND REDEPLOYMENT 549

Fifth Army surgeon has already been

noted. At the theater level, General

Stayer departed in June to assume the

duties of health officer for occupied Germany. He was succeeded as MTOUSA

surgeon by Colonel Standlee, who had

been deputy surgeon since the organization of the theater. Colonel Biederman

became Standlee's deputy in July without giving up his now greatly curtailed

functions as plans and operations officer.

As of 1 October, Headquarters, Mediterranean Theater of Operations, United

States Army, was formally separated from

Allied Force Headquarters. On the same

date Headquarters, Army Air Forces,

MTO, was discontinued, the Army Air

Forces Service Command passing to

MTOUSA. The functions of the supply

section of the MTOUSA surgeon's office

were transferred simultaneously to PBS.

Both shifts forecast the final consolidation a month later, when both the

Adriatic Base Command and the

MTOUSA medical section were discontinued. Colonel Standlee left the theater

at that time, but Colonel Biederman remained until the transfer of functions to

PBS was complete, well along in December. The Peninsular Base Section then

became responsible for medical service

for all U.S. forces remaining in the theater, whose boundaries now included

Hungary and the Balkans. Colonel

Nichol relieved Colonel Standlee late in

the year, and thereafter performed the

functions of theater surgeon as well as

base surgeon.

The Occupation Period

Italy, because of its cobelligerent

status, was never occupied in the same

sense that Germany and Austria were.

Because of border disputes between Italy

and Yugoslavia, however, and of the

claims of both nations to the important

city of Trieste, it was necessary to retain

some military forces in the province of

Venezia Giulia until late 1947. The 88th

Division, which had relieved the 34th at

Udine in September 1945, remained as

the occupation force and supplied personnel for the Trieste-United States

Troops (TRUST), which took over occupation of the Free Territory of Trieste

from the British in May 1947.23

During the 2-year period of occupation, medical support for the 88th Division gradually changed from combat to

garrison type. The 313th Medical Battalion, organic to the division, maintained

a collecting station in the vicinity of

Tarviso, near the Austrian-YugoslavItalian border, in support of a combat

team until mid-December 1945; and had

a clearing station at Cividale, northeast

of Udine, which soon took on the characteristics of a post hospital. Before the

end of 1946 the medical battalion was

operating aid stations that were more

like dispensaries in rest areas as far away

as Cortina d'Ampezzo and Venice.

The 15th Field Hospital was replaced

at Udine in May 1946 by a newly activated station hospital, the 391st, with 400

beds. Evacuation from the 15th Field

was by air to Leghorn or Naples, and

from the 391st was by hospital train to

Leghorn.

Fixed hospital support for the occupa23

 Principal sources for this section are: (1) Theater ETMD's for Sep 45-Dec 46; (2) Annual Rpt,

Med Activities, TRUST, 1947; (3) Delaney, Blue

Devils, pp. 249-72; (4) Komer, Civil Affairs and

Military Government in the Mediterranean Theater, ch. XV; (5) Unit rpts of med units mentioned in the text.
550 MEDITERRANEAN AND MINOR THEATERS

tion force, as well as for scattered Air

Forces and service units, continued to be

provided by PBS, but on a steadily declining scale. With the closing out of the

Adriatic Base Command on 1 November

1945, the 500-bed 61st Station Hospital

was shitted from Foggia to Leghorn to

replace the 64th General, which was preparing for inactivation. The 250-bed

55th Station moved simultaneously from

Pisa to Foggia, where it was assigned to

the Air Forces about 1 January 1946.

The 300th General Hospital at Naples,

the 34th Station at Rome, and the 99th

Field at Pisa were the only other fixed

hospitals in the theater.

A major cutback in fixed bed strength

occurred in May 1946, paralleling the

shift from combat to garrison status of

the 88th Division. The 99th Field Hospital closed on 1 May and the 300th General on the last day of the month, the

latter being replaced by a new unit, the

200-bed 392d Station Hospital. At the

same time, the 34th Station at Rome and

the 55th Station at Foggia were reduced

from 250 to 100 beds, the 55th being reassigned to PBS. As of 1 June 1946, PBS

had 800 T/O beds: 100 in Foggia, 200 in

Naples, and 500 in Leghorn; Rome Area

had 100 beds; and the 88th Division had

400.

The supply service was also reorganized in May and June, when the 232d

Medical Service Battalion, and the 60th

and 73d Medical Base Depot Companies

were inactivated. These units were replaced by the 339th Medical Supply Detachment, which was joined in August by

the 57th Medical Base Depot Company.

The 339th Medical Supply Detachment

was inactivated in January 1947, leaving

the 57th Medical Base Depot Company

in sole command of the Leghorn depot.

Bed strength in the theater was further

reduced early in 1947 by inactivation of

the 392d Station Hospital in January and

of the 55th Station in April. The 313th

Medical Battalion was inactivated on 15

May.

In keeping with the contraction of

base section functions, which were now

almost exclusively concentrated in Leghorn, the Peninsular Base Section was

disbanded in April 1947, and its installations and responsibilities were

transferred to the Port of Leghorn organization. The former PBS-MTOUSA

surgeon became Port of LeghornMTOUSA surgeon at this time.

Final Disposition of Medical Units

The first step toward a final closing out

of the theater came with the signing of

the Italian peace treaty on 10 February

1947. The treaty was not formally ratified until 15 September, but in anticipation of that event complete plans for

phasing out of all U.S. military installations in Italy within 90 days of ratification of the treaty were drawn up.24

In accordance with the phase-out

plans, the 7th Station Hospital—a 200-

bed unit that had been activated at

Trieste in May with personnel drawn

from the 391st Station and the 88th Division—was turned over to TRUST on

19 September, immediately after news of

ratification of the treaty was received.

On the same day evacuation of patients

from the 391st Station Hospital began,

and the hospital was inactivated on 15

October. In Rome, evacuation of patients

from the 34th Station Hospital was com24

 Phase-out Report of the Evacuation of Italy, 3

Dec 1947.
CONTRACTION AND REDEPLOYMENT 551

pleted by 27 September, and the unit

was inactivated on 9 October. The 61st

Station at Leghorn, which had received

patients evacuated from the 34th and

391st Stations, had cleared its own wards

by the end of October and was inactivated 15 November 1947.

During the same period lesser medical

installations were similarly disposed of.

Supply surpluses and surplus personnel

were transferred to the zone of interior,

the European Command, or to TRUST,

and the 57th Medical Base Depot Company was inactivated on 8 November.

Food inspection detachments, malaria

control detachments, ambulance units,

and finally prophylactic platoons were

disbanded as rapidly as their functions

could be closed out.

On 3 December 1947, more than five

years after the landings in North Africa,

a single army transport sailed from Leghorn with all that was left of the U.S.

forces in Italy, and the Mediterranean

Theater of Operations, United States

Army, ceased to exist.
CHAPTER XV

The Mediterranean in Retrospect

The Mediterranean was never regarded by American strategists as a

decisive theater. Its major objectives

were few and soon achieved. The commitment of U.S. forces in North Africa

indirectly eased the pressure on the

Stalingrad front, where the Russians

were preparing to launch a winter offensive, and in America it gave a needed

boost to public morale. The Tunisia

Campaign ended the threat of Axis penetration into the Middle East, with its oil

and its vital lines of communication. The

conquest of Sicily knocked Italy out of

the war and opened the Mediterranean

to Allied shipping. But Italy, aside from

the air bases it supplied for bombing the

German homeland, was a liability, without enough strategic value to balance the

concomitant responsibility for a large

and predominantly destitute civilian

population. The justification for the

Italian campaign, after the Foggia airfields were secured, was that it could be

so managed as to engage more German

than Allied troops and thus contribute

indirectly to the ultimate winning of the

war. It was, in short, a diversion in force,

in which the "force" was never quite

enough for total victory but was always

too great to invest in stalemate.

For such a campaign the theater was

kept lean. Stripped again and again of

its best troops and facilities to strengthen

the build-up for Normandy and later to

mount the invasion of southern France,

replacements were inexperienced and

slow in coming. The Medical Department through the whole period of active

fighting was plagued by shortages—of

personnel, of beds, of medical units, and

of various supplies. Yet by virtue of ingenuity, skill, organization, improvisation, and endless hours of hard work, the

medical mission was carried out with

speed and precision at every level. The

Mediterranean experience embraced in

one theater almost every condition that

would be met on any front in a war that

enveloped the globe. The innovations,

the modifications, the practical expedients that emerged from it became standing operating procedures as one crisis

followed another. Passed along to army

surgeons in Europe and the Pacific, they

also became part of the collective wartime experience of the Medical Department and gave to the medical service in

the Mediterranean an importance that

the combat forces it supported never

achieved.

Although United States Marines had

stormed ashore on Guadalcanal and Tulagi in the Solomon Islands some three

months before the Allied landings in

North Africa, that invasion was in reinforced division strength only, with all

medical support furnished by the Navy.

TORCH was the first World War II amphibious operation of any size for U.S.

Army troops, and the first in which Army

field medical installations were tested in
THE MEDITERRANEAN IN RETROSPECT 553

an assault. It succeeded only because determined opposition failed to develop.

Had the French resisted strongly, the

landing forces, spotted as they were along

a thousand miles of African coast, would

have been individually overwhelmed.

Had the casualties been even moderately

high, the medical troops in the landings

would have been unable to handle them

with the small number of beds and meager supplies at their disposal. Even the

equipment available was sometimes useless under the conditions of the invasion.

The standard army ambulance of the

time, for example, proved to have inadequate traction on the loose sand of

the African beaches, and its silhouette

was dangerously high. Medical supplies

were strewn across the landing beaches

with no one detailed to collect, sort, and

issue them. Plans for medical support of

the operation had been drawn up, some

in England and some in the United

States, without co-ordination or sufficient knowledge of local conditions that

might affect the accomplishment of the

medical mission.

In subsequent landings on Sicily, at

Salerno and Anzio, and finally over the

white sands of the French Riviera, modifications and improvements were introduced to overcome the shortcomings of

each earlier amphibious effort. For the

invasion of Sicily, a clearing element was

attached to each collecting company to

enable the companies to furnish hospitalization until the regular hospitals

arrived. Medical supply items were handcarried ashore by medical troops, but

litters and blankets were late in coming.

This lag was corrected at Salerno, where

medical depot personnel were on the Dday troop list. Additional medical supplies, in waterproof containers light

enough to float, were carried onto the

beaches by combat troops. At Anzio, field

and evacuation hospitals, combat loaded,

were added to the assault convoy. Four

and a half months later, medical troops

trained on the basis of Mediterranean

experience (and not a few who were

themselves veterans of one or more Mediterranean assaults) put their skills to the

test in the invasion of Normandy. Medical support of the army that landed in

southern France in mid-August 1944 was

as near flawless as such a thing can be.

The cumulative experience of Europe

and the Mediterranean again helped to

save American lives halfway around the

world, on Leyte, Luzon, and Okinawa.

In addition to five major amphibious

operations in the theater, Medical Department personnel supported combat

and service activities in the Tunisian desert; in the steep, wooded mountains of

Sicily and the sharper ridges of the

Apennines in Italy; slogged through

rain and mud, and shared with the infantry the perils of snow and ice; crossed

flooded rivers and miasmic marshlands,

and penetrated valleys still raked by enemy fire. Only the jungle was missing

and even that was to be found in associated minor theaters.

These widely varying conditions of

climate and terrain required many different means of bringing out the wounded. The versatile jeep was early fitted

with litter racks and used to move casualties from places inaccessible either to

wheeled or half-track ambulances. In one

operation in Africa half-ton trucks with

tires removed were run over rails, each

truck carrying six litter patients. Both in

Tunisia and in Sicily mules brought out

the wounded in country too rough for

vehicles of any kind. In the high moun-
554 MEDITERRANEAN AND MINOR THEATERS

tains of northern Italy cable tramways

made it possible to move casualties in

minutes between points that would have

taken hours on foot.

For the longer hauls, hospital ships

and trains were employed. The Mediterranean theater pioneered in the use of

transport planes to move casualties not

only in rear areas but from hospitals far

forward in the combat zone. Experiments with small Piper Cubs as ambulance planes were not successful enough

to justify general use, but the helicopters

later used for front-line evacuation in

Korea were developed out of the same

need and purpose. Necessity also taught

the medical authorities in the Mediterranean that troop transports with hospital ship platoons attached to supply

necessary medical service could safely

move all but a limited few types of

patients. It should be noted that neither

the patient-carrying planes nor the transport vessels were marked with the Geneva Cross, but none were lost through

enemy action. On the other hand, four

properly identified and lighted hospital

ships were deliberately bombed, two of

them sinking.

The backbone and single indispensable element in the evacuation system

was the litter bearer. It took strength,

stamina, gentleness, and a high order of

courage to collect the wounded on the

field while the fighting, often enough,

was still in progress, and by relays of

four-man teams to carry the casualties

sometimes as much as ten or twelve

miles over mountain trails impassable to

any vehicle, too steep even for mules. In

the Italian campaign there were never

enough litter bearers. In emergencies—

which were frequent—cooks and bandsmen and company clerks were pressed

into service, and there were many partisan volunteers whose aid was invaluable.

The stringencies of the theater forced

the Medical Department at every echelon to stretch equipment and personnel

to the utmost. Personnel assigned to hospitals temporarily not in operation, including those newly arrived and not yet

assigned, were always attached to other

units where their services could be

utilized until required by their own

installations. The cellular type of organization proved most effective because of

its versatility and mobility. Surgical

teams were an excellent example but

only one of many in a genre that included malaria control units, veterinary

food inspection detachments, and hospital ship platoons that were seen more

often ashore than at sea. As the war progressed and replacements became more

and more difficult to procure, medical

officers were replaced in every permissible assignment by Medical Administrative Corps personnel. Such substitutions

extended to medical supply, evacuation,

and numerous purely administrative

activities. Another successful expedient

was the substitution of Women's Army

Corps personnel for enlisted men in a

variety of hospital tasks. Large numbers

of Italian prisoners of war, available

after the Axis collapse in Tunisia, were

organized into service companies, and

many of them assigned to the Medical

Department where they proved themselves competent in almost all nonprofessional functions. Local civilians were

also employed extensively in all Mediterranean areas to perform tasks that

would otherwise have fallen to enlisted

men.

One of the more successful expedients
THE MEDITERRANEAN IN RETROSPECT 555

devised was the use of clearing platoons

to augment bed strength of field and

evacuation hospitals. With additional attached personnel, these platoons were also

employed as separate forward hospitals

for specialized functions, including

neuropsychiatric, venereal, and gastrointestinal cases. Such devices made it

possible to hold in the army area men

who would otherwise have been evacuated to the communications zone, and

thereby to shorten materially the time

lapse before return to duty. Mediterranean experience tended to emphasize

mobility and versatility. The more mobile a hospital was, the closer to the front

lines it could be used. The best example

is that of the field hospital platoon, deriving its strength from attached surgical

teams. These platoons were first used in

the Sicily Campaign as 100-bed forward

surgical hospitals, reduced to 50 beds by

the date of the southern France invasion.

This experience contributed much to the

development of the MASH (Mobile

Army Surgical Hospital) units employed

so effectively in Korea. Other devices

successfully used to conserve Medical Department personnel were shortening

lines of evacuation, and grouping fixed

hospitals in concentrations to permit

maximum use of skills by specialization,

at the same time reducing the overhead

by providing as many services as possible

in common.

At the army and theater levels the

Mediterranean experience underlined

certain organizational principles. In a

theater that was always a combined operation, the Americans were generally

outranked by their British counterparts,

which produced unnecessary friction. At

the same time, it was the conviction of

many officers in position to know that

the United States medical service maintained higher standards than the British,

and certainly medical skills, drugs, instruments, and equipment were more

plentiful in American hospitals. U.S.

soldiers hospitalized in British installations were quick to note the difference,

which often led to a lowering of morale.

At the army level Mediterranean experience demonstrated, as did the experience of every theater, the importance

of giving the army surgeon a place on

the staff of the commanding general.

Similarly, the mission of the theater surgeon called urgently for a staff relationship with the theater commander. It was

the absence of such a relationship that

produced the awkward dichotomy

between the theater medical organization and that of the Services of Supply.

In the European theater and elsewhere

the jurisdictional problem was resolved

by giving both surgeons' jobs to the same

man. In the Mediterranean, however,

only personal cordiality between the individuals concerned, and a strong mutual

desire to get on with the war, kept the

medical service operating smoothly in

both areas.

Emphasis in the Mediterranean was

always on the role of Army medicine in

conserving manpower—a mission often

not fully appreciated by line commanders. In addition to treatment of the

wounded and the sick, the Medical Department was responsible for preventing

illness insofar as possible. In every war

the United States has ever fought, the

man-days lost through illness far exceeded those lost by enemy action. In

World War II the ratio was approximately four days lost by disease and one

by nonbattle injury for every day lost by

combat wounds. Most of the illnesses
556 MEDITERRANEAN AND MINOR THEATERS

were preventable. In the Mediterranean

the major time wasters were malaria,

common respiratory diseases, diarrhea

and dysentery, and venereal diseases, all

of them largely, and some of them completely, preventable. In the Sicily Campaign, to take only one example, malaria

cases alone outnumbered battle wounds.

Not that the prevention of malaria was

beyond the knowledge of the theater

and army medical sections at that time;

atabrine was ordered and was supplied.

The failure was on the part of the line

commanders, who did not compel their

men to take the rather unpleasant preventive drug. Similarly, the prevention

of venereal disease was—and is—a command function. The treatment, thanks to

penicillin, was progressively shortened so

that man-days lost declined, but treatment was the lesser aspect of the problem.

Among familiar preventive measures

in the Mediterranean were the standard

inoculations for those diseases for which

an immunity could be built up; destruction of insect vectors, such as mosquitoes,

flies, and lice; educational measures; and

continuous inspection of meat and dairy

products. Outstanding achievements of

preventive medicine in the theater

were the speedy and effective elimination of the threat of typhus in Naples

at the end of 1943; the steady reduction

of malaria rates after the campaign in

Sicily; and the practical control of other

local scourges such as cholera and bubonic plague.

A major contribution of the Mediterranean theater medical service to the

management of wounds was the provision of whole blood in the forward areas.

From the blood bank established in

Naples early in 1944 whole blood was

trucked to the Cassino front and shipped

to Anzio by LST. Beginning late in May,

during the Rome-Arno campaign, a daily

blood plane carried the precious cargo

to the Fifth Army front for distribution

to the field and other hospital units where

surgery was being performed. The Naples blood bank also supported the invasion of southern France in August, by

plane to Corsica and PT boat to the landing beaches.

Another area in which the theater

medical section pioneered was that of

combat psychiatry. Begun on an experimental basis in Tunisia and Sicily, a

technique of front-line psychiatric treatment was fully evolved early in the Italian campaign. The key figure was the

division psychiatrist, formally assigned

in the spring of 1944. If a man could

not be restored to fighting trim by rest,

sedatives, and minimal therapy at the

clearing station, he was sent back to a

special neuropsychiatric hospital, in the

army area but still in the combat zone,

for more specialized treatment. Only as

a last resort, and in the full knowledge

that his combat days were probably over,

was a psychiatric case evacuated to the

communications zone.

The Mediterranean, then, was a theater in which the lessons of ground combat were learned by the Medical Department as much as by the line troops.

For Army medicine the lessons were of

general applicability: treat battle casualties, including psychiatric ones, as

promptly as possible, which is to say

in the division area; keep hospitals and

clearing stations mobile; be prepared to

augment table of organization personnel

by attaching specialized teams or other

cellular units; shorten evacuation lines

by keeping hospitals as far forward as

possible, and shorten the patient turn-
THE MEDITERRANEAN IN RETROSPECT 557

around by treating as many as possible

in the army area; never waste specialized

skills by detailing men who possess them

to work that others can do as well; treat

disease as you treat battle wounds and

anxiety states, as close to the front as you

can, but use every means in your power

to prevent disease.

No one will ever express more succinctly the creed of an army surgeon than

did General Martin, Fifth Army Surgeon,

throughout the Italian campaign. "The

useless expenditure of life and suffering," General Martin wrote, "is as criminal as murder."



APPENDIX A 561

APPENDIX A-1—FIXED BEDS AND BED RATIOS, ATLANTIC DEFENSE AREAS

JULY 1941-DECEMBER 1945—Continued

a

 Ratio of T/O beds to troop strength; also defined as percentage of the command for which beds were available. b

 Hospitalization by Corps of Engineers and in Air Corps dispensaries. Canadian hospitals available. c

 In May 1944, the format of the monthly Strength of the Army reports was modified so as to credit attached personnel

in overseas areas to commands existing in the zone of interior instead of to the areas where they were stationed. Some of

the figures given after May 1944 were not, therefore, entirely comparable with corresponding figures for earlier dates.

Further, the Strength report for May does not give a breakdown of attached strength in foreign commands. Figures corrected to include Air Transport Command personnel—the bulk of attached strength in areas included in this table—and a

much smaller group of other personnel, are determined by various methods. The average ATC strength on the North Atlantic Bases for June-September 1944 was 5,378. This figure added to the given assigned strength of 25,492 for May

1944, gives an adjusted strength of 30,868. In Eastern and Central Canada, adjusted strengths for March-April 1944 and

May-June 1945 give an average total of 2,014, while the average of assigned strength given for July 1944-April 1945 was

402. The difference of 1,612 represents the average attached strength. This figure is added to the actual assigned strength to

estimate the adjusted total strength for May 1944-April 1945. In the Caribbean Defense Command, the average of adjusted

strength for March-April and June-August 1944 is 78,519, which is used for May 1944. Using the same formula and

time span, the adjusted strength of U.S. Army Forces in the South Atlantic was estimated for May 1944 as 6,525. d

 Dispensary beds only. Canadian hospitals available. e

 Includes North Atlantic Wing, Air Transport Command.

Source: Strength of the Army; unit reports of hospitals. Strength figures for July 1941 through May 1944 from Time

Series in Strength of the Army, 1 November 1947. Figures for June 1944 through December 1945 from monthly issue of

Strength of the Army, corrected to include Air Transport Command personnel.
562 MEDITERRANEAN AND MINOR THEATERS

APPENDIX A-2—FIXED BEDS AND BED RATIOS, AFRICA AND THE MIDDLE EAST

(INCLUDES PERSIAN GULF COMMAND) , JUNE 1942-DECEMBER 1945
APPENDIX A 563

APPENDIX A-2—FIXED BEDS AND BED RATIOS, AFRICA AND THE MIDDLE EAST—Contd.

a

 Figures for Air Transport Command personnel of Central African Division and of North African Division added.

North African Division includes MTO, and there is undoubtedly some duplication, since MTO figures include Air Forces.

Figures do not permit differentiation, however, and the great bulk of the ATC personnel in this area were in Africa. It

has therefore been deemed best to include them here. See Strength of the Army, June 1944-April 1945. b

 Figure includes both assigned and attached personnel. Air Transport Command personnel fall into the "attached"

category.

Source: Strength of the Army; unit reports of individual hospitals. Ratio is percentage of troop strength for which

beds were available.
564 MEDITERRANEAN AND MINOR THEATERS

APPENDIX A-3—BED STRENGTH AND BED OCCUPANCY, NORTH AFRICAN COMMUNICATIONS

ZONE, NOVEMBER 1942-FEBRUARY 1945

a

 Estimate.

Source: T/O beds complied from unit reports. Beds established and beds occupied from daily bed status reports.

Does not include mobile or convalescent beds.
APPENDIX A 565

APPENDIX A-4—BED STRENGTH AND BED OCCUPANCY, MEDITERRANEAN ISLANDS

AUGUST 1943-APRIL 1945

a

 Estimate. b

 Not available. T/O figure used. c

 From Seventh Army bed status reports, excluding clearing stations. d

 Figure for 20 August 1943.

Source: T/O beds from unit reports. Beds established and beds occupied from daily bed status reports. Does not include mobile or convalescent beds.
566 MEDITERRANEAN AND MINOR THEATERS

APPENDIX A-5—BED STRENGTH AND BED OCCUPANCY, ITALIAN COMMUNICATIONS

ZONE, OCTOBER 1943-SEPTEMBER 1945

a

 Not available. T/O figure used. b

 Approximate, calculated from graph in Annual Report, PBS, 1943. c

 Includes 250 T/O beds on Sardinia. d

 Includes 350 T/O beds on Sardinia and 100 T/O beds on Corsica. e

 Includes 350 T/O beds on Sardinia.

Source: T/O beds compiled from unit reports. Beds established and beds occupied are from daily bed status reports,

unless otherwise noted. Does not include mobile or convalescent beds.
APPENDIX A 567

APPENDIX A-6—FIXED BED STRENGTH AND BED OCCUPANCY, MEDITERRANEAN

THEATER, NOVEMBER 1942-SEPTEMBER 1945
568 MEDITERRANEAN AND MINOR THEATERS

APPENDIX A-6—FIXED BED STRENGTH AND BED OCCUPANCY, MEDITERRANEAN

THEATER, NOVEMBER 1942-SEPTEMBER 1945—Continued

a

 From Strength of the Army, STM-30. b

 6 percent of troop strength through September 1943; 6.6 percent of troop strength to 15 September 1945; thereafter 4

percent of troop strength. c

 Compiled from unit reports. Does not include mobile hospitals, except when acting as fixed units assigned to a

base section. Does not include convalescent beds. d

 Ratio of T/O beds to troop strength. e

 From daily bed status reports of the theater. f

 Not available. g

 Includes 8,750 T/O beds in southern France. h

 Includes 4,000 beds established in southern France. i

 Includes an estimated 4,000 beds occupied in southern France.

j Includes 13,750 T/O beds in southern France. k

 Includes 12,482 beds established in southern France. l

 Includes 10,377 beds occupied in southern France.

Source: Tables A-3, A-4, A-5. Southern France data from 1944 Annual Reports, Delta Base Section, CONAD, and individual hospitals.
Appendix B

PRINCIPAL MEDICAL UNITS ACTIVE IN THE MEDITERRANEAN THEATER OF

OPERATIONS, THE ATLANTIC DEFENSE AREAS, AFRICA, AND THE MIDDLE EAST

GENERAL HOSPITALS
570 MEDITERRANEAN AND MINOR THEATERS

GENERAL HOSPITALS—Continued
APPENDIX B 571

GENERAL HOSPITALS—Continued

STATION HOSPITALS
572 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 573

STATION HOSPITALS—Continued
574 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 575

STATION HOSPITALS—Continued
576 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 577

STATION HOSPITALS—Continued
578 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 579

STATION HOSPITALS—Continued
580 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 581

STATION HOSPITALS—Continued
582 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDIX B 583

STATION HOSPITALS—Continued
584 MEDITERRANEAN AND MINOR THEATERS

STATION HOSPITALS—Continued
APPENDI

X B 58

5

FIELD HOSPITALS
586 MEDITERRANEAN AND MINOR THEATERS

FIELD HOSPITALS—Continued

SURGICAL HOSPITAL
APPENDI

X B 58

7

EVACUATION HOSPITALS
588 MEDITERRANEAN AND MINOR THEATERS

EVACUATION HOSPITALS—Continued
APPENDIX B 589

EVACUATION HOSPITALS—Continued

CONVALESCENT HOSPITALS
590 MEDITERRANEAN AND MINOR THEATERS

MEDICAL REGIMENT

MEDICAL BATTALIONS
APPENDIX B 591

MEDICAL BATTALIONS—Continued
592 MEDITERRANEAN AND MINOR THEATERS

MEDICAL BATTALIONS—Continued
APPENDIX B 593

MEDICAL BATTALIONS—Continued
594 MEDITERRANEAN AND MINOR THEATERS

AUXILIARY SURGICAL GROUPS

MEDICAL GENERAL LABORATORY

MEDICAL SUPPLY UNITS
APPENDIX B 595

MEDICAL SUPPLY UNITS—Continued
596 MEDITERRANEAN AND MINOR THEATERS

MEDICAL SUPPLY UNITS—Continued
APPENDIX B 597

MEDICAL SUPPLY UNITS—Continued
Appendix C

OBSERVATIONS ON HOSPITALIZATION AND EVACUATION SYSTEM, FRENCH

EXPEDITIONARY CORPS, ASSIGNED FIFTH ARMY*

Each infantry battalion has one medical officer (Lt.) and one auxiliary

(Medicin Auxiliare). The latter is usually a medical student. The medical

officer remains at the aid station while the auxiliary supervises and assists

aid men in care of wounded on the field.

The next link in the chain is the regimental aid station (Poste de Secours). This station is manned by a Captain, M.C., and a Dental Officer.

The number of enlisted men is the same as in the corresponding U. S.

detachment. Wounded and sick are sorted and treated. The minor cases of

sick and wounded are retained, the serious ones are evacuated via the collecting company to the division clearing station.

At the clearing station, patients are treated and sorted in much the same

way as in our Army. Beside the station is located the Formation Chirurgicale

Mobile. This unit, with 20 beds, is organized to care for the non-transportables. Operating rooms are established in converted trucks. The transportable cases are evacuated from the clearing station to the evacuation or field

hospital. The latter two units perform the same functions and are used

interchangeably.

Surgical Group. This type unit consists of personnel grouped into surgical teams. Its functions are the same as those of the U. S. auxiliary surgical group. The surgical group differs from the surgical formation in that

it has no bed capacity and no organic transportation.

Triage is effected between the clearing stations and evacuation and field

hospitals under the supervision of the evacuation officer of the Corps d'Armee.

This officer informs the clearing stations each morning as to the number

of vacant beds in each mobile hospital in rear of the division. Bed credits

are also established at each hospital for certain types of cases from each

division, such as head, chest, abdomen, orthopedic, and ordinary sick. In

this way all cases needing the care of specialists are guided to the hospitals

where such specialists are available.

Patients are evacuated directly from the mobile hospitals of the corps

to a fixed or convalescent hospital in the medical base at Naples.

All French hospitals in Italy are under control of one medical officer,

because they are in the same line of evacuation. The next segment in the

chain is between Italy and Africa and control is being assumed wholly by

* Reproduced from ETMD Rpt, Hq NATO, 1 Jun 44 (for May), pp. 6-7.
APPENDIX C 599

the U. S. Army. The Service de Sante, Hq. French Army, Algiers, assumes

responsibility for patients on their arrival in Africa.

French Evacuation Officers desire that patients being evacuated to French

base hospitals by air, train, or sea be classified as follows:

Wounded.

Fractures (total litter and total ambulatory)

Eyes and Face

Others

Disease

Tuberculosis

Mental

Others

Prisoners of War

Total Patients

Litter

Ambulatory

This system allows planning of transportation in advance and facilitates

triage of patients from airfields, railroad stations, and ports directed to

hospitals caring for each type of case.

Hygiene Sections. These organizations are normal components of the

Army or independent Corps. They are primarily bath and disinfestation

units and each is organized as follows: 1 Officer, 24 EM (must be attached

for rations and quarters), 3 vehicles and 2 trailers with showers. Each unit

can bathe 1000 men per day.

Reviving and Blood Transfusion Section. (Section de Transfusion et

Reanimation). This organization handles the French blood bank in Italy

and controls the distribution of blood and plasma to hospitals. In turn it

is supported by the Centre de Transfusion du Sang which is located in

Algiers. The training of all personnel in the treatment of shock and the

technique of preparation and administration of blood and plasma is supervised by the Centre de Transfusion du Sang.

Ambulance Service. Corps ambulance evacuation is provided by Compagnie Sanitaire #531. This organization consists of 4 sections of 20 ambulances each. Two sections have male drivers, the other two, female drivers.

Ambulance units are a component of the "Train" (Transportation) . The

personnel are non-medical. Repair and maintenance of vehicles are provided by auto repair companies (Compagnie de Reparation d'Autos) of

the Corps or Army. From a functional standpoint, ambulance companies

are under the jurisdiction of the Medical Department.

Laboratory. A laboratory is equipped with American material from

T/E 8-610. The personnel consists of 14 officers and 35 EM. There are no
600 MEDITERRANEAN AND MINOR THEATERS

vehicles. The functions are the same as those of the U. S. Medical Laboratory

T/O 8-610.

Medical Supply. This unit is modeled after T/O 8-661 and functions

in the same manner.
Appendix D

THE GERMAN MEDICAL ESTABLISHMENT*

I. INTRODUCTION

The first limitations imposed on any account purporting to assess the

German medical establishment are time and place. That is to say, observers

no matter how qualified cannot judge the standards of German medical

practice in 1939, for instance, in the light of what they found to exist in

May 1945, after the total enemy collapse; nor can they judge the quality

of practice elsewhere in Europe in the light of what they found in Italy.

Immediately following the Allied victory in Italy, the Fifth Army Surgeon

directed several qualified officers to tour the German medical installations,

and survey as completely as they could the techniques and facilities utilized

by the German medical service. These officers were: Col Hugh R. Gilmore,

Jr., MG, Chief of Preventive Medicine, Fifth Army; Col Howard E. Snyder,

MG, Surgical Consultant, Fifth Army; Col Eldridge Campbell, MG, Acting

Neurosurgical Consultant, MTOUSA; Lt Col Paul Sanger, MG, Chief of

Surgical Service, 38th Evacuation Hospital; Lt Col Manuel E. Lichtenstein,

MG, Chief of Surgical Service, 16th Evacuation Hospital; Lt Col Douglas

Donald, MG, Medical Consultant, Fifth Army; Lt Col Marcel H. Mial,

SnC, Medical Supply Officer, Fifth Army; and Captain Carroll H. Ward,

MAC, Assistant Medical Supply Officer, Fifth Army. From their reports

to the Army Surgeon, most of the material in this chapter is derived.

This, then, was the German medical establishment as it existed in Italy

just after the German collapse. How it existed in, say, Russia in 1942,

cannot be assumed from the material set down here. Nor can the various

social, or political, or economic factors which doubtless affected all German

medical practice, including the military, under National Socialism, be truly

or fully evaluated. For while many of the German medical officers interviewed volunteered opinions concerning the effect of political or racial discrimination on sound medical practice in Germany, and those opinions will

be set down here, it must be remembered that such opinions are hardly

objective: after the German collapse all elements of the German army were

busy negating their part in the Nazi regime, forswearing their allegiance

to the Nazi party, and condemning such fanatical groups as the loyal party

members, the Gestapo and the SS formations of the Wehrmacht. In other

words, if saying "the German medical service was degraded by National

* Reproduced from the Annual Rpt of the Surg, Fifth U.S. Army, MTO, 1945, pp. 191-209.
602 MEDITERRANEAN AND MINOR THEATERS

Socialism" would indicate that a German doctor was not a Nazi, he would

not hesitate for a moment to say just that.

With these limitations in mind, it is safe to view the German medical

establishment in Italy after the military defeat of May 1945, as seen through

the eyes of qualified American observers.

2. HOSPITALIZATION AND EVACUATION

The chain of evacuation of German wounded was found to be very

similar to that utilized by the US Army, but triage, that is sorting of patients for specialized hospitalization, differed in several important aspects.

First aid to the wounded was rendered in a Verwundetennest by a medical

non-commissioned officer, in an extreme forward position. This treatment

can be said to compare in echelon to that given by a US company aid man

on the field of battle. Here the first dressing, improvised splinting for

transportation ease, traction splinting, pressure bandages and tourniquets

were applied. The wounded were evacuated from the Verwundetennest to

the Truppenverbandplatz, which corresponded to the American battalion

aid station, and where the first medical officer, corresponding to the US

battalion surgeon, practiced. Treatment given at this station included: checking of the dressing (unless there was some indication the dressing was not

to be disturbed) ; tracheotomy; application of occlusive dressings to open

chest wounds; relief of pain; preparation for further evacuation to the rear;

shock therapy in the forms of peristone, physiological salt solution, coramine,

and external heat by electric heaters; prevention of infection, by injection

of tetanus antitoxin and gas gangrene antitoxin, administration of sulfapyridine by mouth, insufflation of sulfanilamide powder into wound at

time of first dressing, pressure bandage, and arrest of hemorrhage by application of tourniquet (rarely by hemostat or ligature); and catheterization.

From the Truppenverbandplatz all the wounded were evacuated to the

Hauptverbandplatz, which was established about four miles to the rear of

the combat line by the Sanitaets Kompanie of the division. This unit was

staffed to perform the functions of both clearing and hospitalization. Its

Tables of Organization provided for two operating surgeons, but in times

of stress six or eight more surgeons might be added. The unit was designed

to hospitalize two hundred patients, but often expanded to three or four

hundred. When the flow of casualties was not heavy, all those patients with

abdominal wounds and other non-transportable cases were given primary

surgery at this installation. In addition, primary surgery was performed on

minor wound cases here as well. All cases with major compound fractures,

brain wounds, and chest wounds were evacuated to the Feldlazarett or to

a Kriegslazarett, where they were treated with more definitive care. In the

German medical field manuals the functions of a Hauptverbandplatz are

listed as: tracheotomy; closure of open chest wounds; aspiration of the
APPENDIX D 603

pericardium in cardiac tamponade; emergency amputations; final arrest of

hemorrhage; administration of blood and blood substitutes; surgery on the

non-transportables; and suprapubic cystostomy.

The Feldlazarett was the next unit in the chain of evacuation. It was

an Army unit designed to care for two hundred patients. Ordinarily patients with head wounds and transportable chest wounds, severe muscle

wounds, buttock wounds, and major compound fractures received primary

surgery in the Feldlazarett. While it was attempted to perform intra-abdominal surgery as far forward as possible, such cases were often evacuated

to the Feldlazarett for surgery whenever the Hauptverbandplatz was too

busy. The Feldlazarett was staffed with only two surgeons, but in periods

of pressure, it was often augmented by surgeons from other units.

The Kriegslazarett, or General Hospital, was usually assigned to the

German Army Group. In Italy most of these installations were grouped

at Merano and Cortina d'Ampezzo. It was their function to hospitalize all

patients who were not returned to duty from the more forward units. In

addition, certain groups of the wounded received primary surgery at the

Kriegslazarett, such as penetrating head wounds complicated by involvement

of the eye or ear, and maxillofacial wounds. In very busy periods, all

patients with major wounds might be evacuated to the Kriegslazarett for

surgery while the more forward units confined their surgery to men with

wounds of such a nature that they would be able to return to their units

and full duty within reasonable short periods of time after surgery. Also,

as frequently occurred during heavy attack periods, abdominal and head

wound cases were given no surgical care.

In addition to those units already mentioned, there were hospitals for

the lightly sick, lightly wounded, and convalescent patients. In each German

division was the Ersatz company which served as a replacement depot and

reconditioning unit for lightly wounded who had received primary surgery

at the Hauptverbandplatz. The wounded sent to this Ersatz company were

given light exercise under the direction of a doctor, and were ordinarily

returned to duty after one week. There were usually between fifty and one

hundred lightly wounded in the Ersatz company, in addition to the replacements sent from Germany, who only stayed long enough to be equipped

before being sent into combat. The officers and the doctor of the Ersatz

company were limited service personnel by nature of previous wounds or

illness.

In the army areas and in the general hospital centers, hospitals for the

lightly sick and wounded were established by elements of transport units

(Krankentransportabteilungen). They received their patients from Feldlazaretten in the Army area and from Kriegslazaretten in the Army Group

area or hospital centers. Most patients sent to these particular hospitals

stayed for two or three weeks. One such hospital was located at Bolzano

not far from the hospital center at Merano. At the time this hospital was
604 MEDITERRANEAN AND MINOR THEATERS

visited on 6 May 1945 there were 1600 patients. The commanding officer

reported that 500 would be able to return to duty in two weeks, 600 in

one month, 300 in two months, 100 in three months and the remaining

100 in six months.

At the beginning of the war in Europe, all divisions had two Sanitaets

Kompanies. At the end only the armored and mountain divisions had two

each, but the Corps Surgeon had under his control one Sanitaets Kompanie

for use where needed. When two Sanitaets Kompanies were available, two

Hauptverbandplatzen were often established. In the beginning of an offensive, one Sanitaets Kompanie, horse-drawn, was placed only three or four

kilometers behind the battle line to receive casualties. The other Kompanie,

motorized, was held in reserve to be used after substantial gains had been

made. Then, if further gains were made and the Hauptverbandplatz was

required farther forward, the motorized Kompanie moved, leaving its patients to be taken over by the animal-drawn Kompanie. The patients of the

animal-drawn Kompanie were left to be taken over by a Feldlazarett. Thus

there were often two divisional units performing surgery ahead of the Army's

most forward Feldlazarett. With a large-scale offensive division, army, and

army group hospitals might all perform primary surgery only on the less

seriously wounded, putting aside the intra-abdominal and intra-cranial

wounds in favor of those who were more likely to live and return to full

duty.

There were no Auxiliary Surgical Groups, but the German Army Surgeon learned to use personnel from reserve or less active units to augment

the staffs of heavily-pressed units. Most American observers felt that the

German system of hospitalization and evacuation was certainly extremely

flexible, but its very flexibility tended to favor the lightly wounded at the

expense, and often the expense of death, of the more seriously wounded,

the group which US surgical practice terms "first priority" wounded.

3. THE SURGICAL SERVICE

Infection of wounds was found by one observer to be the most incomprehensible facet of the German surgical service. He subtitled his report

to the Army Surgeon "The Story of a Finger", to illustrate the status of

asepsis, antisepsis, wound contamination, and cross infection. In one hospital visited, the German surgeon made "rounds" looking at patients,

examining clinical records and viewing X-ray films. Extremities with soiled

bandages were examined and bandages were handled without gloves. The

surgeon made readjustments of mechanical supports and traction apparatus.

Some wounds were exposed in the wards and examined. At one bed inquiry

was made concerning the hydration and nutrition of the patient. The condition of the tongue was noted and its wetness was determined by the unwashed finger of the surgeon stroked across the tongue surface. This finger
APPENDIX D 605

was wiped on the surgeon's coat and the remark was made that the moisture

on the finger indicated that the patient was not too dry. During the course

of "rounds" the chief of the hospital entered the ward, and was first greeted

in military fashion by the surgeon, and then by a handshake. Several cases

were selected for further examination in the septic dressing room. This

dressing room had three tables, each occupied by a patient with large

wounds from which all dressings were removed. In this room no one wore

a mask over the nose and mouth. Conversations were conducted over each

wound and traffic through the doors, closing and opening, was active. A

staircase just off the dressing room was being dry-swept and clouds of dust

filled the hallway and the entrance to the dressing room.

The surgeon soon proceeded to examine one of the wounded men,

and without washing his hands or donning gloves, he felt of the extremity

from which the pus-soaked bandages were recently removed. After dressing

the wound, the surgeon placed the used instruments on a tabletop, and

proceeded to the next case without washing his hands. The American observer left the dressing room without shaking hands with the German surgeon. In later discussing the matter of infected wounds with a German

medical officer, the observer learned that the Germans assumed automatically

that all penetrating wounds received in combat would become infected,

and that pus was anticipated. Perforating wounds were rarely disturbed,

but instead were simply covered with dressings. The German medical officer

claimed that most perforating wounds did exceedingly well except that

occasionally an aneurysm developed which required treatment. All wounds

due to penetrating missiles, shell or bomb fragments, became infected and

healed by granulation following infection.

When the US observer discussed the problem of infected wounds with

another German medical officer, it was brought out that primary surgery

done immediately was most essential. Lacking this, wounds became infected

and the following reasons were given for lack of immediate care:

(1) Inadequate medical personnel were available to the German medical service. Many medical men were driven out of Germany during a

seven-year period from 1933 to 1939, for reasons unrelated to their medical

practice. Medical schools were depleted of teaching personnel and the number of graduating physicians gradually diminished. Early in the Russian

Campaign, many medical men, acting as company officers, took up positions

with the infantry in the front lines. The gradually increasing number of

patients requiring surgical care increased the number of patients for each

medical officer. As a result, this disproportion was equivalent to a decrease

in medical personnel.

(2) Large numbers of battle casualties admitted to field hospitals

in short periods of time made adequate surgery impossible. One German

surgeon interviewed pointed out that when acting as a surgeon in the city

of Naples in September 1943, it was not unusual for him to care for fresh
606 MEDITERRANEAN AND MINOR THEATERS

wounds by complete excision and primary suture. The infection rate was

approximately 4% in these fresh cases and approached favorably the infection rate to which he was accustomed in civilian practice. However, he said,

operative procedures which would require an hour had to be done in less

than one minute when he was active on the Russian front. In one three-day

period in Russia 1000 battle casualties were admitted to a field hospital

whose medical personnel consisted of two doctors, no nurses, and considerable number of enlisted men. To devote more than a few minutes to each

case was, he attested, impossible. Aside from an incision for decompression

of tissues and application of a dressing, bandages and splint, nothing else

could be done. He was aware that these steps would not prevent infection

in a wound. Perforating wounds were rarely bothered with; dressings were

applied and patients frequently returned to duty.

(3) Speaking again of the Russian Campaigns, in comparison to the

closing phases of the Italian Campaign, this German medical officer stated

that during the advance on Stalingrad the German Armies progressed at

the rate of forty to sixty kilometers a day. Patients could not be kept in

any hospital for any length of time. Frequently patients had to be evacuated to the rear without any sort of initial treatment and days were required before the patient arrived at an installation where surgery could

be accomplished. During the winter months long trips in the icy cold of

Russia made travel hazardous and for many patients, fatal. Not only were

patients frozen to death because of inadequate covering but also many

arrived in such poor condition that many hours or days were required to

resuscitate them so that they could tolerate even a small degree of surgery.

On the Italian front travel by day for wounded patients was extremely

hazardous because of the narrow roads over mountain passes, and the constant presence of Allied airplanes over German lines of communications.

Transportation of the wounded to the rear could be accomplished only

at night, and the long trips in the mountains were time-consuming and

exhausting to the patients.

(4) Lack of adequate supplies and equipment was also given by this

German medical officer as a reason for the deterioration of the Wehrmacht's

medical service. Many patients died from exsanguination because neither

blood nor a blood substitute was available at the field hospitals. Many patients with small wounds developed infection because of the precarious

condition in which they arrived at the base hospital after a long journey,

without proper dressings or immobilization of the wounds. There were no

blood banks to furnish blood for the restoration of blood volume. With

the decreasing number of medical personnel and the increasing hunger

of the Wehrmacht for more manpower the obtaining of blood for transfusions became more and more difficult. Plasma was unobtainable. Penicillin

was unknown. Sulfonamides were used but were felt by the Germans to

be most useful only in acute infections, and to have no particular value
APPENDIX D 607

in the treatment of patients from whose wounds flowed large amounts of

purulent material. No new discoveries in chemotherapy had been made,

and while patients received large amounts of drugs, ineffectiveness had

been noted in patients who had had inadequate wound surgery. (5) Finally, this medical officer felt that one of the greatest reasons

for lack of immediate care was the general deterioration in German medical

officers. The mental status of the average medical officer, and his morale,

were low for many reasons, each resulting in deteriorating care for patients. Among these factors was the large number of infected wounds, leading

doctors to feel that all wounds were automatically infected; the inadequate

number of personnel; the lack of care possible because of constant evacua- tion; the lack of liaison, there being no uniform treatment plan throughout

the German medical service; the entrance into the service of young, poorly- trained surgeons, "graduate wonders" who knew little or nothing of the

principles of surgery; the class distinction favoring the Luftwaffe, SS and

high-ranking officers; and the placement of medical officers in high positions

by political rather than professional standards. All of these points weighed

heavily on the mind of the conscientious surgeon and succeeded in wearing

down professional morale. This had been a discussion of wound infections, which, according to

the German consultant, were just as frequent in this war in the German

army as in World War I. As such, it has reported generally most of the

negative aspects of German surgery and surgical practice. There are, how- ever, many positive aspects, which somewhat redeem the German practices

in the eyes of an American observer. Therefore, a brief description of

certain German techniques, such as treatment for shock and hemorrhage,

extremity wounds, head wounds, intrathoracic wounds, and abdominal

wounds, is felt to be in order here.

Wounds received in shock were treated by the use of external heat, stimulants, infusion of peristone and direct blood transfusion. Peristone

had not been available in all German installations. The medical units in

the divisional area were given first priority on peristone, but it was fre- quently not available to them. German medical officers claimed that peris- tone was a good plasma substitute, and that its osmotic properties were such

that it was retained in the vascular system from twelve to fourteen hours. It

was furnished in 500 cc units. Usually one and never more than two units

were used in the treatment of one patient. All blood transfusions were

accomplished by the direct method. Blood was transfused in amounts of

200 cc, 300 cc, 500 cc, 800 cc, and never more than 1000 cc. Hence the

most a patient in shock might receive would be 1000 cc of peristone and

1000 cc of blood. The general German belief seemed to be that if the

pulse volume did not approach normal, after such treatment no surgery

was to be performed. Some German surgeons interviewed were opposed

to using more than 200 to 300 cc of blood at one time. The extreme
608 MEDITERRANEAN AND MINOR THEATERS

pallor of many and moderate pallor of most of the wounded seen in German

hospitals were further evidence that little blood was administered.

This type management of shock and hemorrhage was in sharp contrast

to American methods whereby plasma is made available and used in quantities sufficient for the needs in all forward medical units of a division;

and whereby banked blood is available in adequate quantities in all army

hospitals including field hospitals adjacent to division clearing stations.

The bulk of extremity wounds suffered in the Wehrmacht were given

primary surgical treatment in the Hauptverbandplatz or the Feldlazarett.

In rush periods this surgery consisted of no more than incision of skin

and fascial planes, the removal of gross debris and devitalized tissue, and

usually trimming of devitalized edges of the skin wound. The careful wound

excision practiced by Allied surgeons was done in German hospitals only

in rare instances. One German surgeon reported that he had performed

only four or five such operations in as many years of war surgery. In these

he had done a primary wound closure. It was evident in many of the

patients seen that practically no wound excision had been accomplished,

since much devitalized tissue was left behind, and frequently wounds were

primarily drained after no more than a fasciotomy. Perforating wounds

from small arms missiles or small high explosive shell fragments had no

surgery performed. This applied to wounds of joints and wounds involving

bone unless there was a large wound of exit. Splinting of extremities after

surgery varied. In several hospitals visited, surgeons stated that temporary

wooden or wire ladder splints were applied for three to five days, following

which treatment the limbs were put in plaster if infection did not develop.

Most of the other hospitals reported that plaster was applied immediately

after surgery. In either instance, the plaster was always padded and windows

were cut over the wounds to permit inspection and dressing.

Compound fractures of the femur were put up in skeletal traction in

both field and general hospitals. Kirchner wires were used in applying

skeletal traction. When infection developed, the limb was incorporated in

plaster, but some traction was usually continued. An ingenious apparatus

made of perforated metal pipes served as a substitute for the ordinary

Balkan frame. It was capable of many combinations to secure, easily and

simply, pulley wheels in the desired position for any sort of traction. In

some instances a complete Balkan frame was fashioned. In most cases, however, one pipe, which clamped to the metal hospital bed, sufficed to support

sufficient side arms to provide the necessary number of pulley wheels in

the proper positions. Walking, unpadded plaster spicas, after the method

of Boehler, were used in the management of some of the simple fractures

of the femur, and in some compound fractures after the soft tissue wounds

had healed. They were not used early in the management of fresh compound fractures from bullet or shell fragment wounds as Truetta used

them in the Spanish Civil War. In badly damaged heels, one surgeon was
APPENDIX D 609

practising excision of the talus, calcaneus, and one half of the scaphoid

and cuboid, then placing the foot in a drop position and anchoring it

there with a Steinman pin. He said that one-quarter to one-third of the

cases so treated got functional results, but the remainder required amputation. Those getting a "functional result" were fitted with a below the

knee prosthesis.

Two surgeons were found who had been using the Kuntscher nail in

the treatment of certain fractures of the long bones. It was reported by

two surgical consultants that for a time many surgeons attempted the use

of this intramedullary nail with poor results, including osteomyelitis and

death from shock. Following this experimentation, a few surgeons were designated who might use the method when they thought it indicated. The

original work in Germany on this intramedullary nail was done by Kuntscher

at the University at Kiel beginning in 1937. It was first tried on animals.

Examination of the bones histologically at various periods after nailing led

to the conclusion that approximately one-third of the marrow is destroyed

and that small fat emboli are nearly always dislodged. One surgeon who

participated in the original study at Kiel stated that he had records of

550 cases, not all his own, in which the Kuntscher nail had been used.

Fat embolism had occurred in a few of these cases but in no instance did

it lead to a fatality. This surgeon felt that its usefulness was chiefly in

closed fractures of the middle third of the femur, in which the fracture

line was transverse or nearly so. Such patients could walk without any

splinting eight to fourteen days after the operation. This surgeon did not

feel it an advisable procedure in tibial fractures and rarely used it in

fractures of the humerus, radius, or ulna. It could be used in compound

transverse fractures of the femoral shaft after the wound had healed or

when infection was absent. One surgeon had used it in a few infected

compound fractures of the humerus and femur when the desirability of

fixation seemed to outweigh the danger of using it in the presence of infection.

In the field of head surgery, only a few intracranial wounds were found

in the hospitals visited. One hospital at Merano and one at Gardone Riviera

held the largest concentrations of head wounds. Of a sample of forty head

cases, at least thirty needed further neurosurgery. There were also approximately twelve with wounds of the spinal cord, a similar proportion

of which needed further surgery. Neurosurgical techniques in practice among the German hospitals visited were generally barely adequate, and

often under the standards set in Allied armies.

Nearly all of the patients seen in German hospitals with intrathoracic

wounds had empyema. Of course, most of those seen had incurred their

wounds months or even as long as two years before. Opinion expressed by

German surgeons concerning the management of chest wounds varied in

some particulars, but regarding major policies were in unanimity. No
610 MEDITERRANEAN AND MINOR THEATERS

facilities were available for gas anesthesia or for positive pressure delivered

by anesthetic machine. A good oxygen therapy machine was available, but

according to statements of the Germans, it was seldom if ever used for expanding the lungs during the course of intrathoracic surgery. No endotracheal tubes were seen nor was the use of endotracheal anesthesia mentioned

in a hospital. Local, evipan, or ether by open drop was the anesthetic employed in what chest surgery was accomplished. Opinions concerning the

indications for and time of aspiration of hemothoraces varied considerably.

Some surgeons stated that aspiration was never performed except to relieve

dyspnea arising from a large hemothorax or hemopneumothorax. Others

stated that it was performed during the first five days after wounding.

One consulting surgeon stated that early in the war aspiration was performed

after five days unless dyspnea made it mandatory earlier, but that more

recently aspiration was performed after the patient reacted from shock,

which was usually two days after wounding. It was obvious that the policy

of early, repeated aspiration of hemothorax was not practiced as in the

Allied armies.

The incidence of empyema was reported at one hospital as 60% in shell

fragment wounds of the chest and 30% in bullet wounds of the chest. In

another hospital, an incidence of 50% in all intrathoracic wounds was reported. The treatment of empyema seemed uniform in all the hospitals.

Closed intercostal drainage was instituted as soon as the presence of pus or

infection in the pleura was demonstrated. The catheter was attached to a

water seal bottle which in most instances was in turn connected with a pair of

bottles providing suction after the Wangenstein method. This procedure

was continued until the cavity was obliterated or until after six months

the empyema was adjudged chronic and a thoracoplasty and decortication

were performed. Rib resection for drainage was rarely employed.

Only a very few patients with thoraco-abdominal wounds were seen.

These few had not had extensive wounds and their surgical care had consisted of laparotomy and simple closure of the chest wall wound. No cases

were seen in which transdiaphragmatic surgery had been accomplished at

thoracotomy. Lacking the facilities for positive pressure ether-oxygen anesthesia and well-trained anesthetists, it seemed obvious that modern intrathoracic and transdiaphragmatic surgery were not available to the German

wounded.

Only a few patients with abdominal wounds were found in the German

hospitals which were captured or which fell into Allied hands with the

collapse of the Wehrmacht. This was not surprising, if the tactical situation

of the preceding month was viewed in relation to the German policy concerning the care of the seriously wounded which was outlined in the hospitalization and evacuation section of this chapter. With the confusion and

heavy casualty load of their crushing defeat in the German stand against

the Allies' last push, it was probable that few with abdominal wounds
APPENDIX D 611

were fortunate enough to receive any surgical attention. In one hospital

two patients were found who had had abdominal surgery. One of these

had had a negative exploratory laparotomy and had developed a huge

incisional hernia. The other had a wound of the small intestine and was

making a satisfactory recovery.

In interviews with German surgeons and in studying their Army manual

on surgery, it became apparent that the Germans had been impressed with

the advantage of early surgery in forward installations for those casualties

with intra-abdominal wounds. General principles in this surgery were found

to be quite similar to those in practice among the US Forces. Wounds

of the stomach and small intestine were repaired and usually a proximal

cecostomy done. Large or severe wounds of the colon were exteriorized.

Wounds of the liver were drained. Those who did not respond to shock

therapy were not given the benefit of emergency surgery unless it was

felt that there was a continuing severe hemorrhage. Lacking whole blood

in adequate amounts and using only direct transfusions in amounts never

totaling more than 1000 cc, it is probable that the Germans would not

have bettered their mortality rate by attempting surgery on the abdominally

wounded. What the Fifth Army accomplished in this type surgery was

dependent not only on the skill of the surgeons, but as well upon the

skill and superior equipment of anesthetists, the judicious use of available

banked blood, oxygen and all the other facilities provided to insure the

best possible care of every wounded man.

This was the surgical service of the German army as it existed at the

conclusion of hostilities in Italy. Its negative aspects, viewed objectively

and dispassionately, seemed certainly to outweigh its positive. One of the

American observers seemed to express the unanimous opinion of all when

he stated: "My reaction to this visit is not one of condemnation for the

type of surgery and surgical care that the German soldier receives from

medical officers in German installations. Rather it is one of high praise

for the excellence of the American medical service. . . . To see and discuss

the German wounded offers the contrast by which to bring into better

view what has actually been accomplished in our own medical service."

4. PREVENTIVE MEDICINE AND MEDICAL CARE

Militarily, preventive medicine is far more important to the combat

effectiveness of any command, Allied or German, than the surgical or medical services. To the German Army, surgically understaffed and underequipped, and seemingly with a lower moral conception of the medical

mission than our own, a seriously wounded man who could not fight again,

even if his life were saved, was not worth bothering with, or expending

precious time and supplies upon. But if, by means of preventive medicine,

even one man could be spared an infectious disease which would incapacitate
612 MEDITERRANEAN AND MINOR THEATERS

him for only three days, then preventive medicine was the field upon which

the harshly realistic Wehrmacht would concentrate its efforts. This helps

to explain why preventive medicine was under rigid military control in the

German Army, and at the same time why German standards of preventive

medicine, considering the equipment available for their enforcement, compared more favorably with preventive medicine as instituted in the United

States Army than did German surgical standards with our own.

Mess sanitation in the Wehrmacht was limited by the type of mess

served. Food was prepared in mobile ranges, and generally consisted of

a stew, bread, tea or coffee. No attempt was made to screen field kitchens,

but if troops were situated in buildings and screening was available, the

kitchen was screened. However, one directive published by German headquarters in 1945 prohibited the use of screening except for buildings in

malarious areas. There was no system of mess kit washing similar to that

practiced in the US Army. Usually the German soldier washed his mess

kit in a stream, or at a well or cold water tap. Sometimes hot water was

supplied from the field ranges, or occasionally it was heated in a bucket

or can over a wood fire, but such procedures were the exception. Provisions

for hot water depended on the interest in sanitation evidenced by the company commander, which ordinarily was slight. No soap was issued for mess

gear washing, and the allowance of soap for bathing and washing clothing

was so small that very few soldiers ever used part of their soap ration for

washing mess kits. Instead sand or gravel was used to remove the grease from

the mess kits. Soap and washing soda were available for use in the kitchens,

in small amounts.

Bread was transported without any protective covering from the field

bakeries to unit messes. Fruits and vegetables to be eaten uncooked were

washed first in raw water and then in boiled water. In areas where amoebic

dysentery was prevalent, directives were issued ordering fruits and vegetables

to be soaked in a 1-5000 solution of potassium permanganate; in practice,

however, this procedure was reported to be seldom followed. Chlorine washing of fruits and vegetables was unheard of in the German Army in Italy.

Garbage was usually disposed of to civilians. In the last months of the

campaign, many units kept hogs to which they fed food scraps. Some garbage

was burned. Directives were issued requiring soakage pits for waste water,

but in actuality these pits were seldom constructed. Since there were no

mess kit washing facilities, German kitchens had less waste water than

normally found in US kitchens. German food handlers were inspected weekly

and stool examinations were conducted four times a year. Consumption

of raw milk or cheese made from raw milk was forbidden.

In rear areas, the Germans used box-type latrines similar to US box

latrines. A squat-type latrine with lid was also used frequently. In forward

areas, straddle trenches were dug, or each man was required to cover his

own excrement by digging a small hole with a spade, similar to US "cat-
APPENDIX D 613

holes". Latrine pits were treated with lime, never with oil of any sort.

There was never a sufficient supply of pyrethreum spray for use in latrines.

Provisions for water supply in the German Army were grossly inadequate.

In forward areas, the German soldier was given boiled tea or coffee rather

than water; he had no "GI" drinking water whatsoever. The supply of tea

and coffee depended on the tactical situation. If kitchens were far enough

forward, the supply was sufficient, but otherwise the soldier was forced

to resort to local water sources to allay his thirst. The supply of tea and

coffee even in bivouac areas was never unlimited: there the soldier received

a rationed quantity of one or two liters and no more. Nothing existed in

the German Army similar to the US water sterilizing bag, to which an

American soldier in rear areas can go at all times for additional fluids.

Water sterilizing tablets, comparable to our Halazone, and thiosulphate

tablets, such as the British use, were used only to a limited extent in the

German Army and were never popularized. In rear areas, troops ordinarily

used the town water supply, which was tested by the corps or army hygiene

officer. If four samples taken the same day at different points in the town

were reported as bacteriologically potable, the water was approved for drinking. In the field water was transported to kitchens in cans similar to the

US five-gallon water can. Sanitary companies and motorized field hospitals

had water trailers.

A few water purification units operated in the German Army, but no

attempt was made to furnish all troops with water from these units. Basically,

these units consisted of three tanks mounted on, a large lorry. Water was

pumped from one tank to another through all three, each of which contained

lime and iron chloride. From the third tank the water passed through a

Seitz type filter which rendered it bacteriologically potable. The output

of this unit was normally 5000 liters a day, but it could be increased to

8000-12000 liters for short periods. (The US portable unit delivers about

3600 liters an hour and the US mobile unit 21,160 liters an hour). These

German units were operated by the Medical Department. The chief objection to such units was that the Seitz filter discs soon became clogged and

had to be replaced. The water from these units was not chlorinated, the

Germans using chlorine only where necessary to treat city supplies. Another

type of water filter used by the Germans was a portable apparatus carried

on the back and capable of producing 200 liters a day. One such filter

was issued for each battalion, or one for each separate company if the

company had a medical officer attached. The apparatus was issued to and

operated by the Medical Department. These filters were never popular

and were seldom used except to clear up turbid water. The filter discs had

to be replaced frequently and were always difficult to obtain.

German malaria control in Italy was centralized in an antimalaria staff

at Army Group Headquarters. This staff consisted of a major in charge

assisted by two entomologists and one clerk. Operating directly under this
614 MEDITERRANEAN AND MINOR THEATERS

staff were two or three malaria stations (comparable to US Malaria Survey

Units) , each consisting of one entomologist and two drivers, one clerk

and one technician. These stations operated in malarious areas, effecting

surveys and advising on malaria control procedures. Each German division

had a sanitary officer in charge of malaria control, who was assisted by six

or eight enlisted men. If more labor was needed, civilians or prisoners were

used, and if necessary, help was given by engineer troops. In general, malaria

control measures were carried out by troop units themselves, and no malaria

control units as such were available. Division malaria control officers rendered

monthly reports to the Army Group malaria staff.

Paris green or calcium arsenite was used for larviciding since oil was

seldom available for such uses. A very limited amount of DDT was available

to the Germans, however, due to the scarcity of screening, as has been

pointed out, its use was restricted to buildings used as quarters in malarious

areas. Mosquito bed nets were used, and in heavily malarious areas, guards

used head nets and gloves. Short trousers and rolled shirt sleeves were

forbidden in malarious areas.

The 1945 German malaria directive called for atabrine prophylaxis to

begin in Italy on 15 April, south of a line from Trieste, through Gorizia,

Udine, Vicenza, Verona, Brescia, Bergamo, Novarro, Turin and Cuneo.

The dosage was .06 grams daily, and it was to be given by roster (US

dosage has been .10 grams daily) . If the malaria rate became unduly high

in any unit, the surgeon was to consult with the anti-malaria staff on the

advisability of giving all troops a therapeutic course of atabrine and then

resuming the prophylactic dosage. The therapeutic dosage of atabrine was

.10 grams three times a day for seven days, followed by .01 grams of

plasmochin three times a day for three days. In severe cases in the German

army, an intramuscular dose of .3 grams of plasmochin might be administered, or the daily dose of atabrine could be increased up to .9 grams,

or quinine could be given up to 1 gram daily. Another routine treatment

consisted of one tablet of a combination of quinine or plasmochin given

three times a day for twenty-one days. The use of thick smears was urged

in making the diagnosis of malaria, and smears were to be forwarded with

transferred patients. All malaria patients were required to be treated as

near the front as possible, and evacuation to Germany was forbidden except

in the presence of severe complications. A hospital specializing in tropical

disease was located at Cortina d'Ampezzo, and malarial cases presenting

special problems were transferred there.

For louse control, the Germans used several louse powders called Delicia,

LouseEX and Lauscto. Delicia is thought to have had a cresol base, but

the ingredients of the other powders are not known. Another powder, "Russle", is said to have contained horse "sweat" extracted from horse blankets,

but later this substance was synthesized. It had been noted that horse blankets

never became lousy, and that lice would leave an infested person if he
APPENDIX D 615

slept in a blanket which had been used to cover a horse. This latter powder

was never popular—it had a bad odor and caused skin eruptions in the

troops. The other three powders mentioned above were moderately effective.

For the most part, the Germans depended on hot air sterilization of clothing

and blankets to kill lice. Every month, battalions were required to have

the clothing and blankets of their personnel disinfested, and troops returning

from the front were bathed and disinfested routinely. A small amount of

DDT powder (called by the Germans "Gix") was available for dusting

men found to be infested with lice. Steam disinfestation of clothing was

not practical because it damaged the cellulose fibers of German ersatz fabrics. Methyl bromide was not used, but formalin in glass ampules was

available for disinfesting blankets. Impregnation of clothing with a liquid

preparation of Delicia was effective for from ten to twenty days.

A few bath units were available for front line troops, set up in connection

with hot air sterilization units, but for the most part German soldiers had

to seek out their own bathing facilities. Since they usually occupied buildings,

this was not a great problem, except for the important fact that soap was

always short.

Two types of typhus vaccine were used, the Cox type similar to US

vaccine, and the Weigl type prepared from lice. A Roumanian type vaccine

prepared from mouse lungs was tried out, but was found to be not very

effective. Only sufficient vaccine was available for vaccination of medical

personnel and key personnel over forty years of age.

The German Army in Italy had considerable trench foot in the Apennines during the winter of 1944-45 (when US rates were remarkably low),

and this was attributed by German medical officers to the wet, cold, but

not freezing weather, and to the failure of troops to guard against trench

foot. Many of the soldiers had come from the Russian front where it was

generally far colder, and they did not expect trench foot in the comparatively

mild climate of Italy. Prevention of trench foot in the German military

depended on the individual's taking proper care of his feet, and having

a supply of warm and dry socks and shoes. Medical officers were responsible

for seeing that the troops were properly instructed and that the instructions

were carried out. This was of course entirely contrary to US practice where

the command elements are responsible that anti-trench foot precautions

are properly carried out. German medical officers were also responsible for

checking shoes and socks of troops. Leather shoes were worn in temperatures above freezing, and in Russia felt boots were worn in lower temperatures. A sock exchange system operated in some units, where civilian women

were hired to launder the socks. Paper and straw were often used for extra

warmth in boots. A salicin ointment was used as an anti-frost bite cream.

The German army emphasized abstinence as its strongest venereal disease control measure, but at the same time it operated controlled brothels.

The prostitutes in these brothels were examined daily by a German doctor
616 MEDITERRANEAN AND MINOR THEATERS

or by an Italian physician. Smears were taken and serological tests were

made weekly. Civilians were not admitted to army brothels. Upon entering

a brothel the soldier was given a form in duplicate on which was recorded

his name and unit, the date, the designation of the brothel and the name

of the prostitute. He was examined for the presence of pests or venereal

disease and was given a condom. Both the prostitute and the soldier were

subject to punishment if the condom was not used. A prophylactic treatment

was administered before the soldier left the brothel. Prophylaxis consisted

of a wash with soap and water and bichloride of mercury, followed by

an intraurethral injection of 2% protargol and the application of calomel

ointment. Sulfa drugs were not used since in Russia sulfa drug prophylaxis

had resulted in strains of gonococci resistant to treatment with sulfa drugs.

Chemical prophylactic kits containing calomel ointment were available to

the German soldier but were not much used.

The simple facts of the matter are that in the German Army, controlled

prostitution was not successful in the prevention of venereal diseases. That

it was not successful was probably due in main to the fact that the average

German soldier did not choose to frequent an Army-operated house of

prostitution, for two inter-related reasons: he objected morally to having

sexual intercourse with a woman whom he knew just previous to him had

entertained other soldiers; and, following traditional male instincts, he preferred the chase and the conquest of a clandestine to the easy procurement

of an admitted prostitute, even though he probably knew that the clandestine

was quite as sexually experienced as the woman in the Army-controlled

house. That this was the case is not evident from German statistics concerning venereal disease, but all German medical officers interviewed readily

admitted the inaccuracy of their statistical procedures and records. It is

evident, however, from the following portion of a letter to all troops from

Field Marshal Albert Kesselring, Commander in Chief Army Group "C,"

dated 11 January 1945, wherein it can readily be seen that the majority

of German soldiers did not patronize Army-operated brothels:

The attitude towards illegitimate sexual intercourse is a matter of personal

ethics and world philosophy, a subject which is not to be discussed at this time.

But since such intercourse causes widespread VD in the Army, the High Command

is compelled to adopt special measures.

It has been proven that the ordered treatment and the prescribed prophylaxis

are protections against the disease. 69% of the injected soldiers, admitted to the

hospitals of the Army Group during November did not undergo the ordered preventive treatment.

This fact proves that during the past year the troops did not exercise the proper

attention towards these diseases which endanger the health, the total defense

potential and also the future generations of the German people.

The non-compliance with the ordered preventive treatments is a violation of
APPENDIX D 617

discipline and punishable as such. In addition, a six months' furlough suspension

is enforced against the infected soldier.

If the soldier conceals the disease and takes own treatments, he is charged

with self-mutilation.1

The German army had always seemed unwilling to admit that psychoneurosis existed in the members of the master race. Their statistics,

even though of unreliable accuracy, have never even allotted space to neuropsychiatric disorders of any nature. For this reason, it was extremely

difficult, even after the German collapse of May 1945, to obtain an adequate

picture of either the prevention or treatment of psychoneurosis in the German army, or to assess what little material was gathered. During the winter

of 1944-45, a captured manual for the use of German medical officers in

the field fell into US hands. The sections on "pure" psychiatry were brief

and gave little insight into the extent of the problem of combat reactions.

The section of gastric complaints, however, was quite explicit in its discussion of the psychogenic aspects. A single careful examination, including

hospitalization if necessary, was advocated, but once a man had been returned to duty, further examinations were forbidden and disciplinary

measures (including deprivation of tobacco and alcohol) were prescribed if

complaints continued.

After the German surrender on 2 May, an opportunity arose to question

a captured medical officer with psychiatric training. Although he had not

been primarily a psychiatrist in the German army, he had had two years

training in the specialty at Frankfurt as a civilian, and consequently he

was interested in psychiatric problems. This officer declared outright that

German neuropsychiatric statistics were completely inaccurate, and he confessed that he could not give a valid estimate of the actual incidence within

the army. He quoted a report of the previous year which had claimed

only 4000 cases in the entire German army during a certain period. Since

a single Bavarian division had had half that many during a similar period

of World War I, he pointed out that present figures were absurd. Apparently

there were no written directives which limited the making of psychiatric

diagnoses, but there was a definite tendency to mislabel them. Obviously,

cases did occur, and this captured medical officer attested that at one time

German Army Group "C" had a small hospital located near Verona, which

was devoted entirely to the treatment of hysterical reactions. Typically,

however, this German officer stated that Wehrmacht troops were so well

trained that casualties of a psychiatric type did not increase greatly with

heavy combat action.

In discussing German handling of neuropsychiatric cases, the German

officer said there was some variation in different commands. Chemical hypnosis, induced by pentothal sodium in US psychiatric procedures, was not

1

 Translated by G-2, Headquarters Fifth Army.
618 MEDITERRANEAN AND MINOR THEATERS

utilized in the German establishment. Shock treatments were employed

only to render patients fit for transportation. Psychotics were removed from

the Army as soon as possible to reduce the chances of the Army's being

held responsible for complications in the course of treatment.

An inspection during June of medical treatment standards in practice

among German medical officers at Merano, showed an adequacy of knowledge, methods, and diagnostic procedures, although deficient by American

standards. Of the approximately 12,000 patients hospitalized at Merano at

the time, about 20% were medical patients, mostly of the same types observed

in US general hospitals—patients severely ill or with protracted illness.

The Chiefs of Medical Service and the consultants were apparently men

of attainment, and the ward officers showed evidence of fairly good training.

Records were in excellent condition. Laboratory facilities including X-ray

and electrocardiography were available and were used intelligently. Drugs

and other therapeutic agents seemed sufficient, although penicillin and sulfadiazine were not available.

Numerous cases of infectious hepatitis were found in this inspection.

Their stay in the hospital averaged from fifty to sixty days. High carbohydrate-low fat diets were instituted, but protein was not emphasized as in

US hepatitis treatment. Such tests as the liver function, cephalin flocculation

and bromosulfalein tests were not used. The Germans considered serum

Vilirubin and Takata Ava tests best regarding liver functions. In severe

early cases of hepatitis, plasma and glucose were not given intravenously,

and the patient was given no exercise tolerance before leaving the hospital.

Field nephritis constituted an amazingly large problem in the German

army. There were 180 cases in the hospitals visited, and a consulting German "nephritis specialist" stated that he had observed over three thousand

cases on the Russian front. This incidence in the German Army was hard

to explain, since there has been so little nephritis observed among Allied

soldiers. The exact pathology or etiology was undetermined, but it seemed

probable that this incidence represented a true glomerular nephritis. Treatment consisted of the Karell diet in the early stages and later, a low protein,

salt-free diet. Protracted bed rest was necessary in all cases, none of whom

were returned to duty before at least six months.

Several cases of bacillary dysentery were observed, but since no sulfadiazine was available, they were treated with a preparation called Cibison

Elcudron, actually a sulfathiazol derivative. Results were good in most

cases. Three cases of amoebic liver abscess were seen, being treated by

a dosage of .065 grams Emetine daily for from ten to twelve days. No

operations were performed, although in one case, the abscess was drained

with a needle. These patients were improving satisfactorily.

No cases of atypical pneumonia were encountered. The Germans had

only recently become familiar with this disease, and first learned of it

from Allied medical literature obtained through Switzerland. At no time
APPENDIX D 619

had it been as prevalent among German troops as in the US Army, and

the Germans had seen no explosive outbreaks comparable to those experienced in Fifth Army early in 1945. Four cases of post-diphtheritic polyneuritis

were seen, and the German medical officers stated that about 4% of their diphtheria cases developed polyneuritis. This high rate was felt to be due

to two factors: first, it was usually three or four days after the onset of

the disease before the patient was hospitalized; and second, standard treatment consisted only of 25,000 units of antitoxin, and many cases received

only 15,000 units. Several duodenal ulcers were also encountered, diagnosis

having been established by X-ray. Treatment consisted of bed rest and

a diet similar to the American Sippy diet. Alkalies were not given. Hospitalization for duodenal ulcer lasted approximately thirty days, at the

end of which time patients were discharged to one of the "Magenbattalions",

or "Stomach" battalions, a field organization absolutely unique in the German army, where soldiers performed light work and were fed special diets.

Duodenal ulcer cases were not discharged from the army.

5. MEDICAL SUPPLY

The German medical establishment in Italy was almost completely selfsufficient, as it had to be, with the Brenner rail route to Germany under

constant Allied air attack. On 4 May, two days after the German surrender,

Fifth Army assumed control of the Base Medical Depot at Merano, along

with a large factory equipped to manufacture many items such as cotton,

bandages, drugs and narcotics. Included in the factory was a well-equipped

laboratory capable of performing biochemical and physio-chemical procedures. The equipment was extremely modern in design, and apparently

expensive and valuable. This factory employed approximately nine hundred

German military workers. A few civilian men and women were employed

by the Germans, but for the most part this factory was run by German

WACs and enlisted technicians.

The Merano medical depot, as apart from the factory, contained approximately 2000 tons of medical supplies when it was captured; with

consolidation of other north Italy depots into this one, the stock levels

were built up to 9000 tons within a few weeks. The depot did not employ

civilians, and operated with a complement of three hundred enlisted men

and forty WACs. This depot operated in similar fashion to a US base

section depot, with the exception that platoons organized from its basic

complement were attached to the various armies of Army Group "C". Thus,

each army had no depot unit solely its own, as is the case in the US army.

The medical supplies stocked at this depot were generally of an inferior

quality. A certain cheapness, typical in many ways of the entire German

medical service, was noticeable in almost all items of expendable supply.

A paper material, somewhat like crepe, was used as a substitute for gauze
620 APPENDIX D

in the dressing of wounds. Also, a still thinner paper was placed under

casts as a substitute for cotton batting. Many of the medications found

in this depot were of Italian manufacture, and not of a very high quality.

The medical equipment generally was substantial and well-made, however,

but more suited for a civilian general hospital than for issue to a field

medical service. Surgical and dental instrument sets were far too elaborate

to insure a rapid replacement. X-ray equipment, including dental X-ray

sets, was good, and especially designed chests were provided to aid in proper

handling. Chests of a standard size and design were provided for mobile

medical supply platoons. These chests were an admirable item, hinged on

opposite edges, top and bottom, so that the chest could be opened from

the top or the front, and when set up one on top of the other, provided

an efficient and orderly establishment.

Liquid medicines were dispensed from large demijohns, and requisitioning units were required to furnish their own containers. When a sufficient

supply of demijohns was lacking, bottles of all shapes and sizes were used.

The general appearance of the pharmacy at the Merano depot was not

one of orderly and neat management.

Thus German medical supply and equipment seem to summarize actually

the entire German medical establishment: a service of great potential ability

and technique, hampered by paucity of material and bogged down in the

morass of politico-military interference over a long period of time.
Bibliographical Note

Medical Service in the Mediterranean

and Minor Theaters is based upon a

wide variety of sources, by far the

largest category being the manuscript records of medical units, offices,

and commands. Probably the most

extensive and certainly the most important collection of these records is in

the custody of the Historical Unit,

USAMEDS. Others are deposited with

the National Archives in Washington

and in the Federal Records Center,

Region 3, GSA, in Alexandria, Va.; still

others are in the records centers at St.

Louis and Kansas City, Mb. The Air

Force records used are for the most part

at the Air University, Maxwell Field,

Ala.

After action and routine periodic reports—most of them annual but a few

semiannual, quarterly, and even monthly—make up both the most extensive and

the most useful body of records. These

reports came from all levels of the Medical Department, from the theater surgeon's office and its various subdivisions

through the surgeons of armies and air

forces, corps, divisions, communications

zones, base commands, and base sections.

They came from hospitals of all types,

medical battalions and often separate

companies, medical supply depots, auxiliary surgical groups, and intermittently

from all of the lesser units that made

up the combat medical organization in

a theater of operations. In some of the

larger commands unit reports were supplemented or even replaced by histories

of Medical Department activities, on a

yearly or longer basis.

Another major source of information,

like the unit reports administrative and

logistical as well as clinical, is the Essential Technical Medical Data reports

(ETMD's), issued monthly from July

1943 on by the theater medical section,

by various subordinate commands, and

by the individual hospitals. The ETMD's

often contained situation reports and

analyses of specific military operations.

At the theater level a daily journal was

maintained by the surgeon's office, highlighting important administrative developments. A series of circular letters

dealt with a wide variety of matters such

as the management of wounds; recommended therapy for specific diseases

including dysentery, malaria, and hepatitis; the preferred use of drugs such

as morphine, the sulfonamides, and

penicillin; and many housekeeping

chores on the order of record keeping

and reporting. A similar but less extensive series of circular letters emanated

from the medical section of Allied Force

Headquarters. Medical situation reports

were issued by various commands, the

most useful being those of the Peninsular

Base Section during the Italian campaign. Use has also been made of private

diaries, and of correspondence both private and official—for example, the frequent exchanges between the theater

surgeon and The Surgeon General.

Other valuable documentary sources

for the history of the Medical Department in the Mediterranean include the

medical annexes of operations reports at

army, corps, and division levels; and of

various planning documents. Inspection
622 MEDITERRANEAN AND MINOR THEATERS

reports are voluminous and in a degree

of detail not usually found elsewhere.

There are, in addition, special reports

on all manner of topics from the incidence and treatment of particular diseases to discussions of improvised equipment; from supply and sanitation problems to ways of laying out a tent hospital.

Methods of evacuation under various

conditions, use of hospitals of different

types and sizes, personnel problems,

civil affairs problems, and many other

topics swell the flood of investigations,

reports, and studies. Interviews have also

been used, supplemented by written

comments from those who reviewed all

or portions of this volume in manuscript

form. Their names will be found in the

acknowledgments at the end of the author's preface.

Although technically a secondary

source, a multivolume manuscript history of the Medical Department in the

Mediterranean Theater, prepared

under the direction of the historical subsection of the theater surgeon's office

and brought to a close in November

1945, is indispensable for its insights, for

its use of many documents now unavailable, and for the eyewitness quality it

gains by the participation of its authors

in the events they narrate. Of particular

value for the present work were: volume

1, Administration, by Kenneth W. Munden; volume 3, Hospital Construction, by

Abraham I. Zelen; volume 6, Army Nurse

Corps, by Anne F. Parsons and others;

volume 7, Medical Supply, by William

L. Davidson; volume 8, Field Operations,

by Glenn Clift; volume 10, Hospitalization and Evacuation (rough draft, by A.

I. Zelen; and volume 14, Final Report

of the Plans and Operations Officer, by

Col. Albert A. Biederman.

Another rewarding category of source

material consists of numerous special

articles on phases of military medicine

in the Mediterranean and minor theaters

in selected medical journals, most frequently in the Medical Bulletin of the

North African [Mediterranean] Theater

of Operations, published by the theater

surgeon's office during 1944 and the first

half of 1945; the Bulletin of the U.S.

Army Medical Department published by

the Office of The Surgeon General until

unification at the end of 1949; and Military Medicine (formerly The Military Surgeon], organ of the Association

of Military Surgeons. Administrative material, often of a firsthand character, will also be found in several

volumes of the clinical series published

by the Office of The Surgeon General and

cited in the footnotes to the present work.

Most frequently used were the volumes

dealing with activities of medical and

surgical consultants, the dental and veterinary histories, and the preventive

medicine subseries, of which five volumes

have so far appeared.

The broad military narrative that

forms the framework within which the

medical story becomes meaningful has, on

the other hand, been told largely from

published sources. The combat volumes

of the series UNITED STATES ARMY

IN WORLD WAR II have been followed insofar as they were available.

George F. Howe, Northwest Africa:

Seizing the Initiative in the West, appeared while the present work was in

preparation; and the volume on the Sicily Campaign, Lt. Col. Albert N. Garland and Howard McGam Smyth, Sicily

and the Surrender of Italy, was consulted

in manuscript form. Similarly, in the

preparation of Chapter I, Stetson Conn
BIBLIOGRAPHICAL NOTE 623

and Byron Fairchild, The Framework of

Hemisphere Defense., and Conn, Rose

Engelman, and Fairchild, Guarding the

United States and Its Outposts, were

used, the former in galley proof, the latter

in manuscript. Chapter II relies at many

points upon T. Vail Motter, The Persian

Corridor and Aid to Russia.

A number of titles in the AMERICAN

FORCES IN ACTION series were also

valuable in summarizing the combat

operations so essential to an understanding of the supporting medical activities.

Those used were: To Bizerte With the II

Corps; Salerno: American Operations

from the Beaches to the Volturno; Volturno: From the Volturno to the Winter

Line; Fifth Army at the Winter Line;

and Anzio Beachhead.

Appropriate volumes of Wesley Frank

Craven and James Lea Cate, editors,

"The Army Air Force in World War II,"

and of Samuel Eliot Morison, "History of

United States Naval Operations in World

War II," helped give dimension to a narrative that includes five major amphibious operations. A number of military

memoirs were also consulted, including

those of Eisenhower, Bradley, Patton,

Clark, Truscott, Montgomery, Alexander, and Kesselring, but were used with

caution.

Official histories of Fifth and Seventh

Armies complied contemporaneously

and published while the respective

armies were still in active status contain

medical and logistical as well as combat

material. The nine-volume Fifth Army

History has been usefully condensed to

a single book, From Salerno to the Alps,

by Chester G. Starr, Jr., who as a member of the Fifth Army historical staff

was one of the authors of the larger

work.
Glossary

AAF Army Air Forces

AAFSC Army Air Forces Service Command

ABC Adriatic Base Command

ABS Atlantic Base Section

ACC Allied Control Commission

ADMS Assistant Director, Medical Services

AFHQ Allied Force Headquarters

AGWAR Adjutant General, War Department

AMET Africa-Middle East Theater

AMEW Africa-Middle East Wing

AMG Allied Military Government

AMGOT Allied Military Government of Occupied Territory

ANVIL Early plan for invasion of southern France

Armd Armored

ASRS Adjusted Service Rating Score

ASW Assistant Secretary of War

ATC Air Transport Command

Atl Atlantic

AVALANCHE Invasion of Italy at Salerno

Aux Auxiliary

BBC Bermuda Base Command

BE BLUIE EAST (U.S. air bases in Greenland)

BEF Brazilian Expeditionary Force

BLACKSTONE Subtask force of Western Task Force for the attack on Safi

Bn Battalion

BRUSHWOOD Subtask force of Western Task Force for the attack on Fedala

BW BLUIE WEST (U.S. air bases in Greenland)

CBI China, Burma, India

CCB Combat Command B

CCS Combined Chiefs of Staff

CENT Task force in Sicily assault landing

CDC Caribbean Defense Command

CG Commanding general

CinC Commander in Chief

Cir Circular

CO Commanding officer

Co Company

CofS Chief of Staff

Comd Command

Comdr Commander

CONAD Continental Advance Section
GLOSSARY 625

COMZ Communications Zone

C&R Convalescent and rehabilitation

CRIMSON Air routes through central and northeastern Canada, part of the

air ferry route to the British Isles

CRYSTAL Meteorological stations in northern Canada

DCCAO Deputy Chief Civil Affairs Office

DBMS Deputy Director, Medical Services

Detach Detachment

DIME Task force in Sicily assault landing

Dir Director

Div Division

DMS Director, Medical Services

Doc Document

DRAGOON Allied invasion of southern coast of France, 15 August 1944

DSM Distinguished Service Medal

EASCOM Eastern Command

EBS Eastern Base Section

ETMD Essential technical medical data

ETO European Theater of Operations

ETOUSA European Theater of Operations, U.S. Army

Evac Evacuation hospital

FEC French Expeditionary Corps

FRANTIC AAF shuttle bombing of Axis-controlled Europe from bases in

United Kingdom, Italy, and USSR

FUO Fever undetermined origin

GBC Greenland Base Command

GOALPOST Subtask force of Western Task Force for assault landing in Mehdia-Port-Lyautey area, North Africa

Gp Group

Hist Historical, history

Hosp Hospital

HUSKY Allied invasion of Sicily, July 1943

IBC Iceland Base Command

IBS Island Base Section

IG Inspector General

Interv Interview

It Italian

Joss Task force in Sicily assault landing

KOOL Task force in Sicily assault landing
626 MEDITERRANEAN AND MINOR THEATERS

LCI Landing craft, infantry

LofC Line of communications

LST Landing ship, tank

MAAF Mediterranean Allied Air Forces

MAC Medical Administrative Corps

MAETS Medical air evacuation transport squadron

MBS Mediterranean Base Section

MCD Malaria control detachment

MCU Malaria control unit

Med Medical

MMU Medical maintenance unit

MSU Malaria survey unit

MTO Mediterranean Theater of Operations

MTOUSA Mediterranean Theater of Operations, U.S. Army

NAAF Northwest African Air Forces

NATO North African Theater of Operations

NATOUSA North African Theater of Operations, U.S. Army

NEC Newfoundland Base Command

NORBS Northern Base Section

QBE Order of the British Empire

Off Officer

Opns Operations

Ortho Orthopedic

OSS Office of Strategic Services

OVERLORD Allied cross-Channel invasion of northwest Europe, June 1944

Ovhd Overhead

PBS Peninsular Base Section

PGC Persian Gulf Command

PGSC Persian Gulf Service Command

PT boat Patrol vessel, motor torpedo boat

POW Prisoner of war

QM Quartermaster

RAAG Rome Allied Area Command

RCAF Royal Canadian Air Force

Red Record

RCT Regimental combat team

Regt Regiment

Rpt Report

Sec Section

Sep Separate

Serv Service
GLOSSARY 627

SHAEF Supreme Headquarters, Allied Expeditionary Force

SGO Surgeon General's Office

SHINGLE Amphibious operation at Anzio, Italy

Sitrep Situation report

SnC Sanitary Corps

SOLOC Southern Line of Communications

SOS Services of Supply

Sta Station

Stat Statistical

Suppl Supplement, supplementary

Surg Surgeon, surgical

SWPA Southwest Pacific Area

TAS The Air Surgeon

T/O Table of Organization

TOE Table of Organization and Equipment

TORCH Allied invasion of Northwest Africa, November 1942

TRUST Trieste-United States Troops

TSG The Surgeon General

UNRRA United Nations Relief and Rehabilitation Administration

USAAF U.S. Army Air Forces

USAFCC U.S. Army Forces in Central Canada

USAFEC U.S. Army Forces in Eastern Canada

USAFICA U.S. Army Forces in Central Africa

USAFIL U.S. Army Forces in Liberia

USAFIME U.S. Army Forces in the Middle East

USAFSA U.S. Army Forces, South Atlantic

USAHS U.S. Army hospital ship

USFET U.S. Forces, European Theater

USPHS U.S. Public Health Service

USSTAF U.S. Strategic Air Forces

Vet Veterinary

WAC Women's Army Corps

WD War Department

YAK Russian fighter plane

ZI Zone of interior
Basic Military Map Symbols*

Basic Medical Symbols

Medical treatment facility, operating 1.................

Medical treatmen supply unit............................... t facility, not operating .

Veterinary treatment facility, operating !............. .

Veterinary treatment facility, not operating 1...........

Hospital train.................................... .

Hospital ship..................................... .

Other medical units

 2

.................................. .

Basic Military Symbols

Section............................................... .

Platoon or detachment.................................. .

Company............................................. .

Battalion.............................................. .

Regiment or group; combat team (with abbreviation CT

following identifying numeral)......................... .

Division; command of an air force........................ .

Corps; Air Force....................................... .

Army................................................. .

Service command, department, or section of communications

zone ............................................... .

Communications zone.................................. .

* For complete listing of symbols in use during the World War II period, see FM 21-20, dated October 1943, from which these are taken. 1

 Includes collecting and clearing elements. 2

 Includes nontreatment facilities, other than supply, such as laboratories and headquarters of various medical facilities.
BASIC MILITARY MAP SYMBOLS 629

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. .
UNITED STATES ARMY IN WORLD WAR II

The following volumes have been published or are in press:

The War Department

Chief of Staff: Prewar Plans and Preparations

Washington Command Post: The Operations Division

Strategic Planning for Coalition Warfare: 1941-1942

Strategic Planning for Coalition Warfare: 1943-1944

Global Logistics and Strategy: 1940-1943

Global Logistics and Strategy: 1943-1945

The Army and Economic Mobilization

The Army and Industrial Manpower

The Army Ground Forces

The Organization of Ground Combat Troops

The Procurement and Training of Ground Combat Troops

The Army Service Forces

The Organization and Role of the Army Service Forces

The Western Hemisphere

The Framework of Hemisphere Defense

Guarding the United States and Its Outposts

The War in the Pacific

The Fall of the Philippines

Guadalcanal: The First Offensive

Victory in Papua

CARTWHEEL: The Reduction of Rabaul

Seizure of the Gilberts and Marshalls

Campaign in the Marianas

The Approach to the Philippines

Leyte: The Return to the Philippines

Triumph in the Philippines

Okinawa: The Last Battle

Strategy and Command: The First Two Years

The Mediterranean Theater of Operations

Northwest Africa: Seizing the Initiative in the West

Sicily and the Surrender of Italy

Salerno to Cassino

Cassino to the Alps

The European Theater of Operations

Cross-Channel Attack

Breakout and Pursuit

The Lorraine Campaign

The Seigfried Line Campaign

The Ardennes: Battle of the Bulge

The Last Offensive
The Supreme Command

Logistical Support of the Armies, Volume I

Logistical Support of the Armies, Volume II

The Middle East Theater

The Persian Corridor and Aid to Russia

The China-Burma-India Theater

Stilwell's Mission to China

Stilwell's Command Problems

Time Runs Out in CBI

The Technical Services

The Chemical Warfare Service: Organizing for War

The Chemical Warfare Service: From Laboratory to Field

The Chemical Warfare Service: Chemicals in Combat

The Corps of Engineers: Troops and Equipment

The Corps of Engineers: The War Against Japan

The Corps of Engineers: The War Against Germany

The Corps of Engineers: Military Construction in the United States

The Medical Department: Hospitalization and Evacuation; Zone of Interior

The Medical Department: Medical Service in the Mediterranean and Minor

Theaters

The Ordnance Department: Planning Munitions for War

The Ordnance Department: Procurement and Supply

The Ordnance Department: On Beachhead and Battlefront

The Quartermaster Corps: Organization, Supply, and Services, Volume I

The Quartermaster Corps: Organization, Supply, and Services, Volume II

The Quartermaster Corps: Operations in the War Against Japan

The Quartermaster Corps: Operations in the War Against Germany

The Signal Corps: The Emergency

The Signal Corps: The Test

The Signal Corps: The Outcome

The Transportation Corps: Responsibilities, Organization, and Operations

The Transportation Corps: Movements, Training, and Supply

The Transportation Corps: Operations Overseas

Special Studies

Chronology: 1941-1945

Military Relations Between the United States and Canada: 1939-1945

Rearming the French

Three Battles: Arnaville, Altuzzo, and Schmidt

The Women's Army Corps

Civil Affairs: Soldiers Become Governors

Buying Aircraft: Matériel Procurement for the Army Air Forces

The Employment of Negro Troops

Manhattan: The U.S. Army and the Atomic Bomb

Pictorial Record

The War Against Germany and Italy: Mediterranean and Adjacent Areas

The War Against Germany: Europe and Adjacent Areas

The War Against Japan

Index

AAF. See Army Air Forces.

AAFSC. See Army Air Forces Service Command.

Aaron, Lt. Col. Margaret E., 487

Abadan, 76, 86

Acadia, 168, 206, 341, 397

Acciarella, 274

Accra, 54, 65, 66, 77, 78, 81, 82, 83, 84, 89, 90

Aden, 60, 61

Adjusted Service Rating Score (ASRS), 522-23, 533,

543-46, 548

Admissions, hospital. See Hospital admissions.

Adriatic Base Command (ABC), 480, 497, 499,

501, 510, 528, 529, 530, 549, 550. See also

Adriatic Depot.

Adriatic Depot, 349-50, 489, 510. See also Adriatic

Base Command.

Adriatic Sea, 232, 240, 302

Affiliated units. See Evacuation Hospitals, numbered, 8th, 9th, 16th, 27th, 38th, 51st, 56th,

59th, 77th; General Hospitals, numbered,

3d, 6th, 12th, 17th, 21st, 23d, 24th, 26th, 33d,

36th, 37th, 38th, 43d, 45th, 46th, 64th, 70th,

300th.

Africa, 7, 46, 49, 73, 78-79, 104, 156, 164, 267

Africa-Middle East Theater of Operations, 80, 85,

103, 488, 497, 498, 509

Africa-Middle East Wing, Air Transport Command, 66, 82-83, 89. See also Central African

Wing, Air Transport Command; North African Wing, Air Transport Command.

Afrika Korps, 60, 124

Agrigento, 157, 158, 164, 167, 169, 181

Ahwaz, 60, 74, 76, 77, 86

Aid Stations, 76, 114, 125, 153, 159, 160, 268, 278,

293 302

battalion 2, 3, 111, 118, 153, 227, 255, 270, 271

beach, 119

crash, 12

provisional, 76

regimental, 255

at Salerno, 228, 236

in Winter Line campaign, 240

Aidmen, 1, 2, 60, 146, 233, 236, 268

Am Beida, 127, 142

Am et Turk, 188

Am M'lilla, 138, 142, 208

Air conditioning, use of, 76, 77, 86, 99

Air ferry routes, 10, 31, 56

Air Force, U.S. See Army Air Forces.

Air routes, transatlantic

securing of, 7-8

to Africa and the Middle East, 60

Air-sea rescue teams, 184

Air Service Command, Mediterranean Theater of

Operations, 184

Air Transport Command, 8-9, 10, 65, 89, 137, 182

commanding officer of, 47

and evacuation to the United States by way of

Greenland, 22

hospital facilities of, in the Middle East, 81, 103

and jurisdiction over Newfoundland base hospitals, 25

operations of

in Bermuda, 28

in Iceland, 10, 11, 15-16

in Newfoundland, 25 and staffing of Atlantic bases, 8

Airborne Division, 82d, 150, 152, 153-54, 156, 157,

165, 230, 231, 232, 267

Airborne divisions, 223, 225

Airborne Medical Company, 307th, 150, 232, 326

Airborne Task Force, 1st, 373, 374, 375, 380, 386,

387, 395, 414

Aircraft, spraying of. See Brazilian Port Sanitary

Service; Malaria control.

Airplanes. See B-17's; C-47's; Evacuation, by air;

L-5's; P-40's, Piper Cubs.

Ajaccio, 174, 176, 208, 509

Akureyri, 13, 15

Alafoss, 10, 12, 14, 15, 16

Alban Hills, 270, 292, 296, 304

Albano, 270, 273, 281, 295, 296

Alcohol, use of in hot climates, 99

Alcoholics, treatment of, 98

Alessandria, 523

Alexander, Field Marshal Sir Harold R. L. G., 123,

147, 159, 220, 222, 239

Alexander, Col. Stuart F., 210, 369

Alexandria, 60, 68

Algeria, 43, 62, 82, 104, 180, 181

Algeria-French Morocco Campaign, 104-21, 134,

141, 177, 218, 552

combat operations, 108-10

medical operations, 105-11

Alghero, 175

Algiers, 73, 82, 107-15, 118, 122, 123, 136, 138, 139,

146, 167, 174, 177, 180, 181, 188, 189, 206, 213,

355, 363

Algonquin, 397
634 MEDITERRANEAN AND MINOR THEATERS

Alife, 237, 242

Allied Armies in Italy, 290. See also Army Groups,

15th.

Allied Control Commission (ACC) , 347, 355, 361-

62, 364, 365, 519, 542

Allied Expeditionary Forces, Supreme Headquarters of, 541

Allied Force Headquarters (AFHQ)

and Allied Control Commission, 519

and captured German hospitals, 477

chief of transportation for, 340, 504

and hospital ships for Salerno operation, 226

and litter bearers for Winter Line, 240

medical section of, 177-79, 212, 323

and operations, 119, 123, 139, 166, 177, 178, 179,

180, 224

and problems of rank among medical officers,

177-78

Allied Force Malaria Control School, 355

Allied Military Government of Occupied Territory (AMGOT), 169, 260, 326, 360, 361, 362,

363, 519-20. See also Region III, AMG.

establishment of, 220, 221

and Italian laws governing prostitution, 258

Allied Military Governor of Sicily, 220

ALPHA Force, 373, 378

Amapa, 47, 49, 52-53, 55

Amazon River, 49

Ambulance companies, 224. See also under Medical Companies.

Ambulance control points, 247, 302, 304

Ambulance loading posts, 4, 233

Ambulance runs, excessive length of, 127, 132, 138,

245-46, 302-03

Ambulances. See also Evacuation by land, by ambulance,

capture of, 125

in Delta Service Command, 68

deadlined at Volturno River, 248

equipped for emergency crashes at airports, 84

loss of, at sea during Gela landings, 155

shortage of

in Liri Valley, 292

in North Africa, 195-96

in Sicily, 155, 167

in Tunisia, 138

for Tunisia Campaign, 127-28

in Winter Line campaign, 240

American Red Cross, 11, 14, 362

AMEW. See Africa-Middle East Wing, Air Transport Command.

AMGOT. See Allied Military Government of Occupied Territory.

Amputations, traumatic, 143-44

Ancona, 510

Anderson, Maj. Gen. Jonathan W., 117

Anderson, Lt. Gen. K. A. N., 105, 122

Andimeshk, 76, 86

Andrews, Lt. Gen. Frank M., 62

Andrews, Col. Justin, 67, 213, 354

Anglo-Egyptian Sudan, 57, 60, 61, 68, 81, 84

Angmagssalik, 19

Animal casualties, Rome-Arno Campaign, 314

Animal clinic, Middle East theater, 103

Animal strength, Fifth Army, 265

Animal transportation, 432

Animals, 11, 146, 174, 263-65, 319-20, 485. See also

Horses, use of; Mules, use of; Veterinary Corps.

Anopheles gambiae. See Disinfestation, and anopheles gambiae; Malaria control.

Antiaircraft Artillery Brigades

45th, 415. See also Task Forces, 45.

71st, 538

Antigua, 8, 41, 44

Antilles Department, 42, 43, 44, 45

ANVIL. See Southern France Campaign.

Anxiety states. See Neuropsychiatry.

Anzio Campaign, 5, 239, 258, 266-88, 289, 291, 292,

311, 312, 313, 316, 335, 336, 553, 556

British hospital area, 274, 278

compared to support in mountains west of

Garigliano River, 296-97

effect on psychiatric case rate, 256

evacuation from, 271, 277-80, 311

evacuation hospitals assigned to, 242

hospitalization in, 275-78

and malaria control school, 260

medical experience in Africa used in, 267

medical planning for, 267-68

medical support for, 269-88

projected casualty rate for, 268

serves as preparation for planning in Eastern Base Section, 206

shortage of hospital ships, 120

staging hospitals assigned to, 249

training for, 243, 258

trench foot cases, 261-62

withdrawal of commanders from, for invasion

of France, 267

Aosta Province, 526

Apennines, 240, 486, 489, 490, 519, 531, 553

Appian Way. See Highways, Italy, 7.

Arabia, 61, 62, 68, 81

Arak, 86

Ardennes, 503

Ardenza, 307, 490, 493

Argentia, 23

Armies

Third, 376, 542, 543

Fifth, 123, 149, 179, 188, 193, 211, 212, 215, 217,

221, 222-65, 266-88, 289-322, 323-65, 393, 409, 410, 415-56, 427n, 457-85, 486, 489, 490, 491,

494-504, 507, 511, 512, 515-20, 522-30, 535-41,

542, 543-44, 543n, 545, 548-49, 556, 557

Seventh, 138, 147, 149, 150-76, 181, 211, 220, 223,

253, 265, 299, 302, 319, 336, 366-414, 417, 424,

447, 486, 490, 505, 542, 543. See also Force 343.

Armored Corps, I, 148
INDEX 635

Armored Divisions

1st, 105, 111-12, 113, 122, 124, 129, 131, 134,

148, 223, 238, 239, 243, 267, 272, 274, 284, 295,

296, 298, 300-301, 302, 320, 415, 418, 421, 428,

429, 458, 461, 462, 478, 523, 525

2d, 105, 115, 117, 152, 156, 157, 267

Armored Medical Battalions. See Medical Battalions, 47th Armored and 48th Armored.

Armored Regiment, 66th, 117

Army Air Base, Newfoundland, 23

Army Air Corps. See Army Air Forces.

Army Air Forces, 8, 10-11, 31-32, 35, 44, 60, 66,

146, 175, 338, 349, 355, 358, 499, 515, 517-18,

530, 549, 550

and aid station at St. Leu, 114

and battle casualties from, treated in Delta

Service Command hospitals, 63, 68

dental service for, 317

and evacuation of patients to Naples, 502

and hospital equipment for, lost through enemy

action, 333

and hospital facilities for, in the Eastern Base

Section, 190

and hospital on Seymour Island, 38

hospitals for, in Italy, 333

medical installations of, 137

medical organization for, in the Mediterranean,

181

medical personnel of, 19, 137

represented at British-American malaria control committee, 212-13

represented at malaria control commission in

West Africa, 90

responsibility for health of personnel, Bermuda

Base Command, 27

Army Air Forces, numbered

Sixth, 38

Eighth, 31, 89, 321

Ninth, 62, 63, 65, 67, 68, 71, 72, 73, 80, 99, 151

Tenth, 60

Twelfth, 80, 105, 106, 114, 122, 123, 137, 138,

146, 181, 182, 193, 215, 296, 326, 327, 334, 423

Fifteenth, 182, 320, 326, 327, 334

Army Air Forces Service Command, 326, 334, 347,

349, 355-56, 359, 489, 497, 501, 510, 549

dental surgeon of, 358

surgeon of, 327

Army Epidermiological Board, 99

Army Forces in Central Canada, 31-32

Army Ground Forces, surgeon of, 324

Army Ground Forces Command, 62

Army Groups

6th, 376, 400, 486

12th, 541, 542

15th, 147, 156, 220, 222-23, 239, 266, 290, 361,

423, 457

Army Middle East Air Force, 60, 62. See also Army

Air Forces, numbered, Ninth.

Army Nurse Corps. See Nurse Corps.

Arnest, Col. Richard T., 106, 127, 132, 135, 148,

326, 363, 488, 489, 548

Arnim, Generaloberst Juergen von, 124

Arno Campaign. See Rome-Arno Campaign.

Arno River, 314, 340, 488

Arno River line, 299, 302, 307, 339

Arno Valley, 486, 490, 496, 520, 530

Aruba, 8, 41, 43

Arzew, 111, 112, 113, 114, 149, 150, 188, 223

Ascension Island, 8, 49, 54, 55

Ashley, Colonel, 360

Asmara, 57, 58, 63, 69, 70, 84, 85

ASRS. See Adjusted Service Rating Score. Assi Bou Nif, 194, 339

Asuncion, 54

Atabrine, 45, 165, 251, 316, 355, 372, 556

in North Africa, 145, 213-14

in Sicily, 172-73, 214

Atina, 239

Atkinson Field, 44, 47

Atlantic Base Section, 119, 180, 183-88, 204, 210,

213, 326, 338, 347, 348, 349, 488, 509

and development of medical supply system, 208

and local health authorities, 220

Atlantic bases 15-16

Atlantic Ocean, 105

Atypical pneumonia, 452, 483

Australia, 102

Austria, 323, 521-22, 523, 525, 538, 542, 549

Auxiliary Surgical Groups

2d, 107, 110, 122, 127, 128, 154, 183, 225, 238

249, 253, 263, 268, 282-83, 287, 310, 314, 358,

371, 374, 416-17, 449, 453, 537, 546

3d, 128, 153, 154, 155

AVALANCHE. See Naples-Foggia Campaign; Salerno.

Avellino, 230, 231, 237, 252

Aversa, 333, 340, 496, 529, 535, 540, 541

Axis armed forces, 62, 64, 104, 121, 124, 131, 554

Azores, 7, 29, 30

Azores Base Command, 29

B-17's, 320, 321

Baba Hassen, 122

Baffin Island, 31, 33

Bagnoli, 327

Bahama Islands, 8

Bahia, 47, 55

Balchen, Col. Bernt, 19

Balkans, 323, 549

Bandar Shahpur, 76, 86

Banton, Lt. Col. Huston J., 119

Barcellona, 162, 166

Bari, 326-7, 333, 334, 489, 497, 510, 529, 548

Barker, Col. Marion H., 513

Barnes, Lt. Col. Asa, 354

Base Area Group, 6665th (Provisional) , 326, 327

Base Depot Companies. See Medical supply units,

Base Depot Companies. Basra, 59, 60, 64
636 MEDITERRANEAN AND MINOR THEATERS

Bassano, 525

Bastia, 175, 497

Batch, Lt. Col. Joseph W., 542

Bathurst, 60

Batista Field, 44

Battipaglia, 230, 237, 336, 490

Battle casualties, 40, 293-94, 299, 310-11. See also

Hospital admissions; Medical Department personnel; Noneffective rates,

in British hospitals, 120

captured by Germans in Tunisia Campaign, 125

collection of, at Salerno, 227

evacuation of

from Italy and Sicily, 206

to Naples for primary surgery, 284

and planning for Salerno, 226

by raft, across Volturno River, 233

to troop transport by small craft from

Salerno, 227

French, 206, 332

number of

Anzio, 270, 271, 276-77, 283-84

Army Air Forces, 62, 63, 184, 342

Cassino, 239, 240, 245-46

Gela beach, 154-55

Liri Valley, 293-95

Northwest Africa, 107, 108, 111, 114, 115,

119, 121

Rapido River, 244

rerouted from overcrowded evacuation hospitals,

248

transported to beach at Salerno, 227, 230-31

Battle fatigue. See Neuropsychiatry.

Bauchspies, Col. Rollin L., 268, 369, 380

Bauxite, 41

Bay of Naples, 233

Beasley, Col. Charles H., 11

Bed ratio

in Atlantic defense areas, 9

in Persian Gulf Command, 86

Bed requirements in Atlantic base hospitals, 9

Bed strength, Table of Organization and Equipment, 9, 11, 15, 24, 25, 329, 332, 333, 334, 335,

336, 337, 338, 360, 395, 401, 403-04, 448

in Antilles Department, 44

in Anzio Campaign, 275, 278

in Atlantic Base Section, 183-86

in Eastern Base Section, 190, 190n

in Eastern Task Force, 107

in Fifth Army area, 249-50

in Mediterranean Base Section, 189

in the Middle East theater, 79, 84-85

in Newfoundland, 25

in the Panama Canal Department, 37-38

in the Persian Gulf Service Command, 77, 79,

85-86

Beds, shortage of, 144, 435, 445

and effect on rate of return to duty of psychiatric patients, 255

Beds, shortage of—Continued

in Panama Canal Department, 37-38

at Salerno, 230-31

in Tunisia Campaign, 128

in Winter Line campaign, 241-42

Beecher, Lt. Col. Henry K., 211

BEF. See Brazilian Army units, Brazilian Expeditionary Force.

Bekkaria, 142

Belem, 47, 48, 49, 52, 54, 55

Belgian Congo, 77n, 183

Belluno, 525

Benedict Field, 42

Benevento, 230, 231

Benghasi, 72, 73

Benghasi Base Command, 64. See also Levant Service Command.

Bennett, Lt. Col. Austin W., 429

Benson, Col. Otis O., Jr., 327

Benzyl benzoate, 512

Beradinelli, Lt. Col. Stephen D., 67

Berlin, 321

Bermuda, 8, 26, 27

Bermuda Base Command, 26-27

Bernadou, 115

Berrechid, 186

Berry, Col. Daniel J., 23, 369, 409

Biederman, Col. Albert A. 324, 487, 542, 549

Billick, Col Eugene W., 80

Bishop, Col. Harry A., 126, 372, 399

Bizerte, 73, 121, 130-34, 142, 145, 149, 156, 168,

181, 188, 205, 206, 226, 341

Blackburn, Lt. Col. Estes M., 358

BLACKSTONE, 115

Blesse, Brig. Gen. Frederick A., 172, 179, 181, 184,

193, 201, 223, 225, 231, 265, 275, 324, 333, 334, 363

Blesse, Col. Henry S., 275

Blida, 109

Blood, whole, 26, 144, 253, 314, 409, 450, 483, 513,

556

delivery of, 284

use of, at Anzio, 279, 284

Blood banks, 144, 253, 284, 314, 352-53, 540. See

also Medical Laboratories, numbered, 15th

General.

Blood plasma, 26, 143, 144, 149, 240

Blood Transfusion Units

6703d, 374, 404, 409

6707th, 409

6713th, 252, 450, 460

Blood transfusions, 119, 276

BLUIE EAST 2, 19-21

BLUIE WEST 1, 19-22, 31

BLUIE WEST 7, 19-20

BLUIE WEST 8, 19-21, 31

Bologna, 484, 499-500, 517, 525, 529, 531, 539, 540

Bolton, Lt. Col. Eldon L., 463

Bolzano, 523, 525, 526, 535, 541
INDEX 637

Bolzano conference, 541-42

Bomber Command, IX, 73

Bomber Command, North Africa, 181

Bomber Squadron, 9th (H), 10

Bomber squadrons, 320

Bone, 121, 132, 137-38, 142, 149, 190, 208

Bonomi, Ivanoe, 519

Borgarnes, 12

Borinquen Field, 42, 43, 44

Bou Chebka, 121, 126

Bou Guedra, 117

Bougie, 122

Bouiseville, 189

Bowen, Capt. Joseph J. 259, 260

Boyle huts, 135

Bradley, Maj. Gen. Omar, N., 127, 130, 152, 267

Brand, Maj. Maxwell R., 355

Brandon, Maj. Thomas C., 57, 58

Brazil, 8, 46, 47, 48, 49, 50, 55, 60, 83

Brazilian Air Force units, 491

Brazilian Army units. See also Brazilian medical

units.

Brazilian Expeditionary Force (BEF), 51, 299,

417, 417n, 418, 429, 439, 458, 461, 462, 466,

523, 525, 527

Infantry Division, 1st, 418, 424, 425, 429, 431, 453

Combat Team, 6th, 422, 429

Infantry Regiments

1st, 424

11th, 424

Brazilian Department of Public Health, 53, 90

Brazilian Government, and control of anopheles

gambiae, 53-54, 89

Brazilian medical personnel, 47, 336, 469, 471, 527

Brazilian medical units

dispensaries, 50

hospital, military, 48

Medical Battalion, 1st, 429

Brazilian personnel, hospitalization of, 491, 498

Brazilian Port Health Service, 90

Brazilian Port Sanitary Service, 53

Breeches buoy, use of, in evacuation, 240

Brenner Pass, 523, 542

Brereton, General Lewis H., 60, 62, 65, 80

Brescia, 536, 537

British Air Force. See Royal Air Force.

British Army, 14, 56

British Army Middle East Forces, 94

British Army units. See also British medical units.

Army Groups

18, 124, 127

21, 542

Armies

First, 105, 106, 121-22, 123, 124, 129, 130,

131, 136, 142, 189, 223

Eighth, 62, 72, 73, 80, 104, 123, 124, 127,

129, 131, 147, 152, 155-56, 160, 173, 174,

223, 230, 232, 240, 245, 267, 272, 289, 290,

291, 292, 302, 313, 342, 415, 417-18, 421,

British Army units—Continued

Armies—Continued

Eighth—Continued

422, 423, 424, 457, 461, 462, 467, 523, 542

Corps

10, 223, 230, 232, 233, 234, 238, 239, 243,

289-90

13, 291-92, 417-18, 419, 420, 421, 423, 424, 458

Divisions

1st Infantry, 151, 267, 273, 295, 419

4th Indian, 245

5th Infantry, 243, 274, 289, 295

7th Armored, 223, 230, 231-32, 234, 243

8th Indian, 424

46th Infantry, 223, 230, 234, 239, 243, 244,

290

56th Infantry, 223, 230, 234, 239, 243, 273,

274, 289-90

78th Infantry, 245, 422

Brigades, 11th Infantry, 109

Commandos

1st, 108, 109

6th, 109

British Consultant Malariologist, 355

British dental equipment, use by American dental officers, 101

British dental facilities, use by American dental

officers, 100

British destroyers, 105, 110, 113

British Director of Medical Services. See Cowell,

Maj. Gen. Ernest M.

British fixed bed ratio, 122-23, 182

British Government

agrees to establishment of U.S. base on Ascension Island, 8

securing of beef supply from New Zealand

through, 102

British Guiana, 8, 41, 43, 44, 47, 48. See also

Guianas.

British hospital area, Anzio, 274

British hospital buildings, used by American

medical units, 12, 73

British hospital carriers, 168, 283

British hospital ships, 79, 98, 108, 120, 167, 271,

283, 342

British medical supplies, surplus of, in Iceland, 17

British medical units, 151

casualty clearing stations, 123

dispensary, 49

dressing stations, 268

hospitals, 29, 43, 57, 58, 64, 71, 100, 107, 122, 123,

334

at Anzio, 271, 274, 277, 278, 282

and care of Ninth U.S. Army Air Force

personnel, 72-73

in Libya, 72-73

in the Middle East, 103, 120, 555

movement of, to avoid bombing at Anzio,

271, 277
638 MEDITERRANEAN AND MINOR THEATERS

British medical units—Continued

hospitals—Continued

withdrawal of, from Iceland, 12-13

British medical units, numbered

Casualty Clearing Stations

1st, 120

2d, 268, 271

8th, 120

12th, 136, 139

Field Ambulance

141st, 276

159th, 111, 120

Field Transfusion Unit, 12th, 268, 284

Hospitals

31st General, 189

61st Combined General, 59

94th General, 120

Motor Ambulance Convoy, 6th, 138

British nurses, attend psychiatric nursing course,

219

British paratroopers, 121

British surgical team, 111

British Navy. See Royal Navy.

British West Indies, 34, 44

Brolo, 160, 162

Brooke, General Sir Alan, 104

Brothels. See Prostitution; Venereal disease.

Brown, Lt. Col. James W., 66

Bruce, Col. Charles O., 525, 548-49

Bruck, 533

BRUSHWOOD, 117

Bubonic plague, 30, 83, 91, 99, 106, 556

Budhareyri, 13, 15

Burma, 85

Burnet, Col. Burgh S., 180

Butler, Brig. Gen. Frederick B., 375-76

C-47's, 5, 139, 312, 321, 480

C and R Sections, 357

Cady, Col. Duance L., 324

Caffey, Brig. Gen. Benjamin F., Jr., 366

Cagliari, 175

Caiazzo. See Piana di Caiazzo.

Cairo, 56, 60, 65, 68, 77, 79, 80, 82, 83, 85, 86,

91, 94, 95, 99, 102, 104, 245

Cairo Area 61-62

California, 31

Calore River, 233

Caltanissetta, 159, 167, 169, 181

Calvi Risorta, 252, 313

Camardella, Lt. Col. Ralph A., 248, 279, 445, 536,

541

CAMEL Force, 373, 374, 379, 380

Camino, 239

Camocim, 49, 50

Camp, Col. Benjamin L., 489

Campbell, Capt. Robert J., 285

Campoleone, 270, 271, 276

Campoleone Station, 296

Campomorto, 304

Camps

Amirabad, 64

Helgafell, 12, 15, 16

Huckstep, 63, 68, 81, 84, 87, 103

O'Reilly, 44

Pershing, 10

Tel Litwinsky, 58, 64, 71, 72

Tortuguero, 42, 44

Canada, 8, 30-32

Canadian Air Force. See Royal Canadian Air

Force.

Canadian Division, 1st, 147

Canadian forces, 151-52, 159

Canadian hospitals, 32, 34

Canani, Col. Berni, 265, 320

Cannon, Lt. Gen. John K., 423

Cap Bon, 131, 150

Cap de Fedala, 117

Cap Matifou, 108, 109, 110

Cap Sidi Ferruch, 108, 109

Cape of Good Hope, 57, 79

Capetown, 57

Capua, 230, 233, 234, 237, 241, 244, 246, 248, 249,

527

Cardiovascular diseases, 86

Caribbean Defense Command, 34, 324

Caribbean Sea, 60

Carinola, 291, 303, 304, 319

Carmack, Col. Joseph, 487

Carpi, 527

Casablanca, 84, 85, 92, 105, 106, 115, 117, 119,

121, 123, 180, 182, 206, 208, 209, 226, 326,

335, 339, 342, 343, 488, 498, 504, 509

Casablanca Conference, 147

Casanova, 277

Caserta, 237, 241, 242, 251, 252, 263, 290, 311, 312,

325, 326, 329, 333, 335, 336, 337, 488, 489, 494,

495, 496, 525, 529, 530, 535

Cassino, 239, 243, 245, 246, 247, 252, 262, 267,

270, 285, 287, 289, 316

effect of, on psychiatric case rate, 256

operations, 249, 275, 277, 282, 287, 289, 291,

292, 293, 556

Veterinary Corps at, 263-64

Castagneto, 319, 337, 490, 495, 529

Castelvetrano, 157, 165, 167

Castiglioncello, 303

Castle Harbour Hotel, 26, 28

Casuals. See Adjusted Service Rating Score.

Casualty clearing hospitals. See Evacuation hospitals; Evacuation Hospitals, numbered.

Catanian plain, 159, 173

Catarrhal jaundice, 26

Caves, use of, for hospital sites, 236, 430

Cayey, 42

Cecchignola, 527, 529

Cecina, 302, 303, 307, 319
INDEX 639

Cefalii, 158, 159, 162, 169

Cellole, 293, 304, 310

Cement, use of, 209

CENT Force, 152-53, 155, 169

Center Task Force, 107, 113, 115, 120

Center Town Command, North Africa Service

Command, 82

Central Africa, 65, 88, 97

Central African Command, 89

Central African Route, Air Transport Command,

70

Central African Wing, Air Transport Command,

66, 70, 82, 83, 84, 101, 102

Central America, 35, 38, 41

Central Civilian Medical Depot, 508

Central Dental Laboratory, Naples, 358

Cerami, 159

Cerignola, 334, 529

Cervione, 497, 509, 510

Cesard, 160

Chain of evacuation. See Evacuation, chain of.

Chateau Thierry, 397

Chemical Warfare Service, 331

Chemicals, shortage of, 512

Chenango, 117, 118

Cherqui, 117

Cheyne, Col. D. Gordon, 220

China-Burma-India theater, 72, 85, 86, 98, 498

China theater, 84

Cholera, 106, 220, 326, 556

Chronic gastritis, 451

Churchill, 31, 32, 33

Churchill, Col. Edward D., 144, 162, 171, 210-11, 253, 350, 351-52, 408, 409, 450, 487

Churchill, Winston S., 104, 266, 272, 367, 519

Cisterna, 270, 271, 273, 274, 292, 296, 297, 303

Cividale, 549

Civil Affairs Section, Allied Force Headquarters,

219-20

Civilian health authorities, co-operation with, in

North Africa, 62

Civilians, evacuation of, from Anzio, 278, 279

Civilians, medical treatment for, 9, 23, 33, 52-53,

57, 58, 63-64, 68, 79, 95, 103, 113-14, 155,

165, 260, 332, 387. See also Allied Military

Government; Central Civilian Medical Depot.

at Anzio, 278

in Bermuda, 27

in Brazil, 51-53

in Canada, 33

in Iceland, 11, 14

in Italian hospitals, 57

and native workers in Egyptian hospitals, 57

in Panama, 39

and typhus in the Middle East, 94

responsibility for, 57

Civilians, used in hospital work, 554

Civitavecchia, 300-301, 303, 305, 313, 337, 490,

491, 495

Clark, General Mark W., 104, 123, 222, 266, 277,

299, 366, 423, 457, 462, 520

Clearing companies, 3, 4, 110, 125, 157, 215, 227,

228, 248, 249, 291, 296, 312. See also under

Medical Companies,

battalion, 129, 164, 277

divisional, 163, 165, 296

Clearing platoons, 110, 111, 160, 233

divisional, 225, 231

and evacuation hospital, 164

used as expansion units, 165, 249

250-bed, 248

Clearing stations, 3, 4, 5, 110, 111, 119, 127,

129, 149, 153, 154, 155, 157, 161, 170, 172, 227,

228, 230, 241, 243, 244, 256, 282, 293-94, 295,

296, 297, 298, 299, 303, 307

battalion, 129, 245

beach, 230

corps, 129, 274

decline in return to duty of psychiatric patients

from, 256

difficulty of keeping up with moving troops, 302

divisional, 146, 163, 174, 230, 232, 237, 241,

245-46, 248, 253, 255, 268, 270, 274, 278, 299,

307 and handling of surgical cases at Gela beach, 154

routine dental work performed at, 263

value of establishing early, 143

Clevelandia, 49, 50

Climate adaptation to, in Canada, 33

in Brazil, 53

in Central Africa, 79

effect of

on construction in Panama Canal Department, 37

on dental rate in the Middle East, 100-101

on disease rate in Italy, 250, 257

on evacuation, 25, 386, 490

on hospital disposition in Iceland, 12

on personnel, 75

on supplies in Persian Gulf Command, 88

in Egypt, 68

in Eritrea, 70

factors overrated, 67

heat-produced illnesses, 99

in Italy, 250, 256-57

in Middle East theater, 76, 79, 88, 99, 100

in Newfoundland, 25

problems

of cold, 21, 25, 26, 33, 236, 240, 425, 430,

441-42, 444, 490

of heat, 53, 67-68, 73, 76, 79, 88-89, 96-97,

99, 100, 196

of rain, 37, 53, 240, 257, 386, 395, 426

of wind, 68, 76, 196

and use of British tropical-type tents, 73

and use of salt tablets, 99
640 MEDITERRANEAN AND MINOR THEATERS

Coastal Base Section, 368, 372, 399, 400, 412. See

also CONAD Base Section; Delta Base Section.

Coates, Col. John Boyd, Jr., 542

Cocke, Col. Joseph G., 324, 401

Cold injury, 33

Cole, 115

Collecting-clearing companies, 154, 155, 156, 157,

159, 224. See also under Medical Companies.

Collecting-clearing stations, 268, 270

Collecting companies, 3, 4, 110, 111, 118, 119, 125,

149, 227, 231, 233, 240, 244, 245, 248, 249,

251, 293, 295, 303, 311-12. See also under

Medical Companies.

Collecting stations, 143, 153, 298

bombing of, 295

damaged by storm, 243

eliminated where possible at Salerno, 236-37

Collesano, 159

Colli Laziali, 269, 273

Colombia, 34

Combat Conditioning Camp, 216-17. See also

Medical Companies, 6706th Conditioning.

Combat exhaustion. See Neuropsychiatry.

Combat wounds. See Hospital admissions, for combat wounds.

Combined Chiefs of Staff, 299

approves Salerno invasion plans, 222

approves Sicily invasion plans, 147

plans invasion of Northwest Africa, 104

Comiso, 152, 153

Communications, 139

effect of failures of, on evacuation, 250, 305-06

by jeep courier, 306

by pigeon, 306

quality of, 62, 305-06

Conditioning and rehabilitation, policy of, 357

Conditioning Center, Eastern Base Section, 217.

See also Station Hospitals, numbered, 105th.

Conditioning Company, 6706th, 217, 357

Connel, Maj. Frank H., 537

Constantine, 122, 124, 127, 132, 136, 137, 138, 142,

180, 182, 190, 206, 208, 215, 226, 337

Continental Advance Section, 402-04, 407, 412

Convalescence and rehabilitation sections, 357

Convalescent Hospitals

2d, 189, 216, 217, 392, 392n, 393, 394, 406

3d, 225, 238, 242, 249, 291, 304, 306, 307, 316,

326, 329, 416, 439, 441, 525, 538, 545

3,000-bed, 189, 225

Convalescent wards, 169

Cook, Col. William F., 327

Copper sulfate spray, 45-46

Coral Harbour, 32, 33

Corby, Col. John F., 106, 138, 177, 178, 182

Cori, 296, 297, 304, 319

Corleone, 158

Cormons, 525

Coronia, 162

Corps

II, 105, 106, 122, 123, 124, 125, 127-46, 148, 152,

156, 158, 159, 160, 165, 167, 171, 173, 190, 204,

211, 215, 238, 239, 243, 245, 246, 253, 260, 261,

263, 289, 291, 293, 295, 296, 297, 298, 299, 300,

301, 303, 317, 318, 415, 417, 418, 419, 420,

421, 422, 424, 425-28, 429, 430-31, 432, 435-39,

440, 442, 444, 445, 448-49, 457, 458, 460, 461,

466-68, 471, 475, 477, 479, 482, 483, 485, 525

IV, 296, 301, 302, 303, 317, 415, 417, 419-20,

421, 422-23, 424, 429, 430, 431-34, 435, 439-40,

444, 446, 447, 448, 453, 454, 457, 458, 460,

461, 462, 463-66, 467, 469, 475, 477, 479, 482,

483, 484, 526

VI, 223, 224, 230, 232, 233, 238, 239, 266-88, 289,

292, 295, 296, 298, 299, 300, 301, 303, 312, 366-

95, 405, 409, 423, 515

Provisional (Sicily), 156, 157, 158, 167

Corps Malaria Control Committee, 287

Corsica, 174, 175, 181, 339, 342, 488, 497, 499, 500,

502, 509, 510, 556

Cortina d'Ampezzo, 535, 536, 538, 549

Costa Rica, 39

Cowan, Col. Egbert W. D., 217, 263, 317

Cowell, Maj. Gen. Ernest M., 106, 177, 179, 201,

212, 324, 362

Cox, Col. Wesley C., 37

Cremona, 525, 526

Crichton, Col. W. H., 363

CRIMSON, 31

Crittenberger, Maj. Gen. Willis D., 296, 301, 415,

423

Crozier, Maj. Dan, 56, 57, 58

Cryolite, 18, 19, 22

CRYSTAL, 31

Cuba, 41, 44, 45

Cunningham, Admiral Sir John, 266

Curacao, 1, 8, 41, 43, 44

Cutaneous disease, 79

Dakar, 53, 54, 66, 78, 81, 83, 84, 85, 89, 90, 91, 99

Dallas, 118

Darby, Col. William O., 270

Darby's Rangers, 270

Darlan, Admiral Jean-Francois, 108, 110, 121

Davenport, Col. Walter P., 43

David (Panama), 38

Davis, Col. Thomas F., 453

Davis, William A., 363

Dawley, Maj. Gen. Ernest J., 223, 230

Debridement, radical, 253

Decamere, 69, 87

DELTA Force, 373-74, 379, 380

Delta Base Section, 403, 404, 407, 408, 412, 504.

See also Coastal Base Section.

Delta Service Command, USAFIME, 61, 63, 64, 68,

71-72, 79, 81, 89, 92, 102

de Mendonca, Fabio Carneiro, 53
INDEX 641

Demonstrations. See Educational devices.

Denit, Maj. Gen. Guy B., 180

Dent, Capt. Paul L., 110

Dental clinics, 101, 287

Fifth Army, 263, 317

IV Corps, 483

in the South Atlantic theater, 54

II Corps, 263, 317, 483

Dental Corps, 101-02, 413, 483-84

in the Africa-Middle East Theater of Operations, 80

in the Atlantic defense area, 9-10

in Brazil, 54

in the Iceland Base Command, 18

in Italy, 262-63, 287, 317-18, 357-58, 452-53, 483-

84, 514-15

in the Middle East, 100-102

in the Persian Gulf Command, 100

in Sicily, 173-74

in the South Atlantic theater, 54

Dental dispensaries, use of trailers for, 452-53

Dental equipment

and Chest MD Number 60, 54, 145

and lack of portability, 145

shortage of, 100-101, 218

for II Corps and Fifth Army clinics, 263

Dental laboratories divisional, 262-63

mobile, 263

at Mostra Fairgrounds, 332, 358

shortage of, at Anzio, 287

technicians for, 263, 527

use of trucks for, 263

Dental Laboratory, Central, 358

Dental personnel, 24, 59, 262-63, 287, 357-58, 453,

515

in Air Transport Command, 100-102

in Brazil, 54

detached from Army hospitals, 218

morale of, 101-02

in Ninth Air Force, 65

and nonprofessional assignments, 100, 146, 174,

262

in North African theater, 217-18

in Pan American Highway Medical Service, 39

ratio to troop strength, 100, 218

and rotation policy, 54

shortage of, 218, 263, 287

transport of, by air, 101

unexpected need for replacements in North Africa

and Sicily, 208-09

and use of British facilities, 100-101

Dental prosthetics, 146, 173-74, 262-63, 287, 317,

406, 413, 453, 484

Dental standards for induction, 218

Dental surgeon, North African theater, duties of,

217-18

Dental techniques, German, 527

Dental x-ray, clinics lacking in facilities for, 263

Dentists, Brazilian, 54

Depot Companies. See Medical supply units, Depot

Companies.

Desenzano, 523, 536

Desert coolers, 99

Destroyers, 115-18

Destroyers for 

Devers, Lt. Gen. Jacob L., 267, 323

Dewey, Lt. Col. Leonard A., 215, 354

Diarrhea, 77, 145, 316, 556

and infectious hepatitis, 257

nonspecific, 98

in Tunisia Campaign, 214-15

Dieppe, 108

Diets, special, 144

DIME Force, 152, 153, 154, 155

Diphtheria, 26

Disease rates, 250. See also Hospital admissions;

Noneffective rate,

in Brazil, 51, 52, 53

in Iceland, 17-18

in Persian Gulf Service Command, 86

at Salerno, 230-31, 278

Diseases, 111, 165. See also by name. in Army Air Forces, 182

chronic, among Brazilian workers, 53

endemic, 67, 79

in Greenland, 21

in Iceland, 17

in Iran, 82

intestinal, 26, 76, 79, 145, 483, 530

in Middle East, 88

preventable, lack of outbreaks of, in North Africa

and Sicily, 215-16

subtropical, 172

tropical, 52, 78, 83-84. See also by name.

Disinfestation, See also Malaria control,

and anopheles gambiae, 53-54, 89-90

of bedbugs, 172

delousing

of civilians in the Middle East, 95

instruction in, 74

in North Africa Theater of Operations, 216

and shortage of equipment for treating pack

animals, 265

disinsectization officer, Air Transport Command,

90

fleas, in Sicily, 172

flies, 76, 145, 172, 214, 556

insecticiding, 91, 262

larviciding, 45-46, 91, 213, 260

lice, 172, 262, 556

for malaria control, 45-46, 53-54, 83-84, 89-92,

212-15

mosquitos, 76, 172, 556

and prevention of typhus, 94, 262

and use of

copper sulfate, 45-46

DDT, 91, 356, 363-65, 537
642 MEDITERRANEAN AND MINOR THEATERS

Disinfestation—Continued

and use of—Continued

methyl bromide (MYL), 362

Paris green, 356

Dispensaries, 28, 29-30, 35-37, 42, 43, 45, 48, 52, 58,

59, 77, 78

in Atlantic bases, 9

in Brazil, 52

capacity

10-bed, 32-33, 39

25-bed, 32

120-bed, 29

in Iceland, 11-12

in Libya, 58

in Newfoundland, 25

in North Africa, 57, 58

operated by AAF medical detachments, 32, 137

operated by Corps of Engineers, 38

in Panama Canal Department, 35

in Persian Gulf Service Command, 76

types of

camp, 11-12

dental, 63

field, 46, 63

general, 53, 57, 63, 69, 225

headquarters, 32, 57

mobile, 278

station, 83

Djedeida, 121

Djidjelli, 122

Dobbiaco, 523

Dog tags, 2

Dooling, Brig. Gen. Henry C., 34

Doolittle, Brig. Gen. James H., 105, 138

Dorchester, 19

Douglas Aircraft Corporation hospitals, 57-58, 64,

68, 69, 79

Dragoni, 237, 242, 248

DRAGOON. See Southern France Campaign.

Drainage

and control of malaria, 45, 213, 214, 260

effect on trench foot, 285-86

and flooding, 260, 440

at hospital sites, 275

lack of, 193, 275, 285, 534

quality of

at Anzio, 275

at Cassino, 285

in Levant, 71

Drainage systems, destruction of, by Germans in

Italy, 260

Draper, Lt. Col. Calvin S., 315-16

Drugs. See by name.

Dubos, Col. Emeric I., 360

Dukws, 405, 407, 466, 479-80

Dutch Guiana, 41, 43, 44. See also Guianas.

Dutch West Indies, 34

Dysentery, 60, 67, 77, 83, 98, 106, 145, 172, 201, 214,

249, 257, 316, 321, 353, 556

Eaker, Lt. Gen. Ira C., 267, 320, 423

EASCOM. See Eastern Command.

Eastern Base Section (EBS), 132, 134, 138, 139,

180-81, 189, 190, 195, 196, 197, 201, 204, 205,

206, 208, 213, 217, 226, 337, 339, 348, 349, 369,

488, 509

Eastern Command, 320-22

Eastern Defense Command, 9, 11, 29

Eastern Task Force, 105-06, 111, 120, 122, 142

Eastern Town Command, 82

Echelons, of medical service, 211. See also Evacuation, chain of.

Ecuador, 34, 38, 39

Edmund B. Alexander, 23

Educational devices, 93, 98

Eisenhower, Lt. Gen. Dwight D., 104, 123-24, 177,

178, 226, 266, 267, 323, 367, 486

Egypt, 57, 60, 61, 72, 73, 79, 81, 84, 87, 99

Egyptian Army, surgeon of, 62, 95

Egyptian Government, and venereal disease, 92

Egyptian Ministry of Public Health, 62, 94

Egyptian Sudan, 60

Eklund, Lt. Col. William J., 24

El 'Alamein, 61, 104

El Guerrah, 136, 189

El Guettar, 129, 142, 145

El Salvador, 39

Electric lamps, generator-driven, use of, 4

Elvins, Col. Richard E., 106, 138, 181, 327, 333

Emergency Medical Tag (EMT), 2, 3, 5

Emily Weder, 397

Empoli, 496-97, 529

EMT. See Emergency Medical Tag.

Engineer Battalion, 10th, 285

Engineer Shore Regiments

531st, 154, 227

540th, 268

Engineers, Corps of, 12, 19, 23, 26, 31, 38, 39, 76,

89-90, 209, 260, 326, 329, 356, 361

at Atlantic bases, 9

in Canada, 30

and Eastern Base Section, 190

in Italy, 233, 242, 260

medical services for, 24, 26, 32, 38

in the Middle East, 99

in Newfoundland, 23

in the North African Theater of Operations, 209

operates own medical services, 38, 76

in Panama, 35

in Sicily, 160

England, 89, 105, 113, 124, 553

English Channel, 300

Enna, 158-59

Entomological detachments, from malaria survey

units, 213

Epidemics, civilian, in the Middle East, 99

Equipment. See Medical supplies and equipment.

Equipment and clothing study, for Winter Line

campaign, 286
INDEX 643

Erchie, 334, 528

Eritrea, 57, 60, 61, 68, 81, 87

Eritrea Service Command, USAFIME, 61, 68-70,

79, 81, 102

Eskimos, medical treatment for, 33

Essential Technical Medical Data Reports

(ETMD's), 179

ETMD's. See Essential Technical Medical Data Reports.

Etna Line, 159

European Theater of Operations (ETO) , 11, 16, 84,

327, 399, 411, 412, 486, 504, 514, 518, 525, 533,

541, 542, 545, 546, 552, 555

boundaries of, 178

reduction of nurses in North Africa for transfer

to, 219

European Theater of Operations, United States

Army (ETOUSA), 531

Evacuation from Antilles Department, 45

at Anzio, 271, 274, 279-80, 310-12

to the Azores, 30

in Brazil, 50-51

of Brazilians, 505

in Canada, 33-34

from Cassino, 245-46, 312

of civilians, 279

conversion of trucks for use as hospital train

cars, 133

from Eastern Base Section, 206

flexible policy in British hospitals, 123

food for patients, 16, 279

from Gela beach, 154

holding facilities, 16, 164-65, 237, 307

in Iceland, 16

lengthening lines of, 157, 159, 303, 305, 306

from the Levant Service Command, 72

from Libya, 73

from the Liri Valley, 292-94

from the Mediterranean Base Section, 205

in Newfoundland, 25-26

in North Africa, 110-11, 115, 118-23, 186

officer, Fifth Army, 168

from the Panama Canal Zone, 40-41, 45

in the Persian Gulf Service Command, 77, 86-87

planning, 43, 108, 148-49, 163-64, 203, 226, 395,

499

policy, 16, 28, 40-41, 50, 79, 85-86, 123, 128, 165,

197, 204, 250, 334, 340-42, 404, 448, 504-05, 501-

02, 532, 533, 543

problems, 12, 25, 33-34, 97-98, 392, 395

in the Rome-Arno Campaign, 303-10, 312

from Salerno, 226, 228-30

study of British methods in Tunisia, 223

in, Tunisia Campaign, 73, 122-30, 137-38, 206

to the United Kingdom, 206

in the Volturno campaign, 240

in the Winter Line campaign, 240-43, 245

Evacuation, by air

along air ferry routes, 30-32

by airplane, 16, 22, 23, 25, 33-34, 41, 45, 50, 68,

73, 77, 78, 79, 83, 85, 86, 98, 106, 123, 132, 138-

39, 140, 149, 155, 167, 168, 190, 204, 206, 226,

230, 279, 311-12, 321-22, 372, 392, 596, 397,

398, 404, 447, 448, 473, 490, 499, 502-03, 530-

32, 532

by C-47, 5, 139, 480

by commercial airline, 28

by L-5, 460

Evacuation, chain of, 73, 137, 271

first echelon, 3, 268

second echelon, 3, 73, 269, 274, 294

third echelon, 5, 232

fourth echelon, 5, 73

fifth echelon, 6, 16, 22, 25, 28-30, 40-41, 45, 50,

74, 77, 78-79, 83, 86-87, 97-98, 183, 186-88, 206,

249-50, 342-43

Evacuation, by land

by ambulance, 5, 16, 41, 45, 68, 73, 87, 111, 120,

123, 125, 126, 127, 129, 130, 138, 153, 163, 204,

244, 246, 247, 251, 274, 275, 292, 293, 294, 302,

372, 398, 404, 428, 432, 445-46, 447, 448, 460,

464, 466, 473, 479, 502

by British field ambulance, 107

by cable tramway, 433

by jeep, 120, 125-26, 134, 227, 274, 292, 293, 298- 99, 426, 464, 466

by litter bearer, 129, 133-34, 161, 227, 236, 237,

240, 244, 274, 279, 293, 298, 386, 426, 428, 432,

433

by mule, 133, 161-62, 240, 426, 479

by ski litter, 430

by toboggan, 430

by train, 23, 34, 41, 77, 87, 204-05, 310-12, 342,

372, 398, 404, 448, 532

in British hospital trains, 123, 138

in hospital trains, 138, 167, 204-05, 250, 502,

503

in Michelin cars, 123

in prisoner of war trains, 506, 540

by truck, 125-26, 129, 133, 153, 167, 227, 464, 466

Evacuation, by water, 16, 196, 205, 312, 372, 373,

466

by British hospital ships, 167, 206, 226

by Dukws, 466

by LCI, 271, 372

by LST, 149, 153, 167, 226, 271, 279, 311, 312, 396, 396n

by raft, 233

by ship, 16, 22, 28, 45, 68, 79, 166, 206, 372, 490, 506

by troop carrier, 97-98, 149, 167, 226

by weapons carrier, 293

Evacuation hospitals, 4, 5, 130, 144, 160, 163, 164,

186, 219, 244, 248, 253, 267, 304, 310, 312

300-bed, 111
644 MEDITERRANEAN AND MINOR THEATERS

Evacuation Hospitals—Continued

400-bed, 4, 119, 127, 129, 132, 134, 163, 164, 165,

170, 183, 225, 237, 268, 277, 305, 307

750-bed, 4, 107, 120, 127, 132, 135, 164, 170, 190,

230, 237, 278, 305, 307

at Anzio, 282-84

and daily reports on number of patients ready

for disposition, 250

damaged by storm, 243

dental laboratories connected with, 262-63

and French ambulances, 251

late arrival of, in Sicily, 170

psychiatric treatment in, 145

value proved during Tunisia Campaign, 255

Evacuation Hospitals, numbered

8th, 119, 186, 225, 230, 231, 237, 242, 291, 304,

306, 307, 310, 416, 419, 436, 437, 442, 444, 454,

460, 471, 473, 475, 482, 523, 525, 545, 546

9th, 120, 124, 125, 126-27, 129, 132, 134, 139, 192,

193, 195, 197, 199, 299, 332, 342, 342n, 369,

378-79, 387, 388, 392, 402

11th, 119, 132, 155, 157, 158, 160, 162, 167, 183,

197, 199, 242, 277, 291, 299, 304-05, 307, 374,

380, 383, 388, 392

15th, 129, 132, 153, 156, 159, 160, 164, 167, 197,

199, 225, 237, 241-42, 243, 248, 275-76, 277,

304, 306, 307, 337, 416, 419, 437, 441-42, 469,

471, 475, 478, 482, 494, 500, 523, 525, 526, 529,

539, 540, 545

16th, 194, 225, 229, 231, 231n, 237, 242, 248-49,

252, 268, 291, 304, 306, 307, 337, 416, 417, 419,

436-37, 439n, 440, 469, 471-73, 475, 476, 526,

529-30, 545, 546

27th, 336, 387, 392

38th, 107, 113, 114-15, 120, 132, 139, 188, 190, 192,

196, 204, 225, 230, 231, 237, 242, 243, 277, 287,

291, 304, 307, 310, 416, 419, 439, 439n, 440, 471,

473, 475, 476, 523-25, 545

51st, 387, 393,

56th, 192, 195, 225, 230, 231, 237, 242, 248, 268,

271, 275, 277, 282, 284-85, 287, 291, 303-04, 306,

307, 337, 416, 436, 437, 444, 471, 475, 476, 480n,

525, 545

59th, 119, 164, 165, 199, 299, 304, 312, 336, 387,

392, 397

77th, 107, 113, 115, 120, 124, 125, 126-27, 129,

132, 144, 149, 171, 188, 190, 192, 193, 199, 204

91st, 120, 158, 164, 174, 189, 189n, 199

93d, 155, 156, 159, 162, 167, 172, 172n, 197, 225,

230, 232, 237, 242-43, 268, 271, 275, 277, 284,

291, 299, 303-04, 305, 307, 374, 379, 392, 393

94th, 193, 225, 237, 242, 243, 246, 277, 278, 291,

304, 305, 306, 307, 337, 416, 419, 435, 436, 437,

441-42, 448, 471, 475, 476, 482, 494, 527, 529,

544, 545

95th, 193-94, 225, 229, 231, 237, 241, 242, 252,

268, 271, 275, 276, 283, 287, 299, 303, 304, 305,

306, 307, 331, 371n, 374, 388, 392, 393, 396

Evacuation Hospitals, numbered—Continued

128th, 132, 145, 159, 162, 167, 197, 199. See also

Surgical Hospital, 48th.

170th, 439, 440-41, 444, 458, 469, 473, 475, 476,

482, 525, 544, 545. See also Station Hospitals,

29th.

171st, 458, 458n, 469, 473, 475, 482, 498, 525, 544,

545

Exhaustion cases, 133, 255, 315

Exposure, at Salerno, 236

Eye clinics, 430-32

Eyeglasses, unexpected need for, in North Africa,

208-09

Faid Pass, 124, 134

Fano, 498-500, 510-12, 528

Far East, 57, 85

Farrell, Maj. Elliston, 90, 91

Fasani, 294

Fedala, 115, 117, 118, 119

Feriana, 125, 126, 129

Fernando de Noronha, 50, 55

Ferryville, 217-18

Fes, 187, 205

Fever of undetermined origin (FUO), 173

Fevers, treatment of, at specialized facilities, 249

Fiala, Maj. Frank C. J., 347

Field Ambulance Company, 159th, 90

Field Artillery Battalions

601st, 319, 414

602d, 319, 414

697th, 422

698th, 422

1125th Armored, 424

Field Artillery Brigade, 13th, 386

Field Artillery Group, 35th, 406

Field hospital platoons, 73, 79, 153, 154, 170, 171,

248, 249, 253, 302, 307

Field hospitals, 4, 74, 76, 87, 149, 155, 160, 163,

225, 237, 282, 293, 294, 295, 297, 299, 304

50-bed, 70

100-bed, 4, 76, 86, 127, 253

200-bed, 86

400-bed, 4, 127, 277, 321

and lack of combat experience, 170

in Middle East theater, 67

and retention of nontransportable patients, 253

Field Hospitals, numbered

4th, 71, 73, 84, 197, 199, 225, 333, 334, 497, 529,

530

10th, 132, 139, 155, 156, 157-58, 161, 173, 225,

237, 241, 246, 248, 291, 297, 299, 303, 373, 374,

378, 379, 384, 386, 387

11th, 154, 156-57, 159, 160-61, 162, 173-74, 225,

237, 238, 244, 263, 291, 293, 294, 297, 299, 303,

374, 379, 380, 382-83, 386, 387

15th, 70, 73, 84, 175-76, 199, 444, 450, 463, 466,

468, 473, 523, 525, 526, 530, 530n, 538, 545, 549,

558
INDEX 645

Field Hospitals, numbered—Continued

16th, 68, 70, 84

18th, 74, 76, 86

19th, 74, 76, 86

26th, 74, 76, 86

32d, 225, 237, 307, 333, 416, 426, 427, 428, 430,

440, 442, 453, 463, 469, 469n, 473, 478, 481,

483, 523-25, 526, 532, 544, 545

33d, 225, 237, 268, 269, 271, 274, 275, 276, 277,

282, 283, 287, 297, 303, 416, 426, 427-28, 430,

453, 465-66, 468, 525, 545

34th, 333, 334, 497, 529, 546

35th, 333, 334, 497, 499, 527, 528, 529, 530, 541,

546

99th, 498, 529, 541, 550

Fighter Command, 181

Filariasis, 83, 91

Finley, Lt. Col. Theodore L., 210

Firestone Tire and Rubber Company plantation,

North Africa, 66

First aid

in Eastern Command, 321

instruction, in Sicily, 150

packet, 1

for plane crash victims, 84

stations at Winter Line campaign, 240

1st Special Service Force. See Special Service Force,

1st.

Fitzgerald, Brig. Gen. Shepler W., 66

Flinn, Lt. Col. James E., 411

Flooding, 260, 440

Florence, 302, 307, 314, 488, 490, 494, 496, 497, 498,

499, 502, 503, 520, 525, 527, 529, 530, 531, 532,

535, 540, 541, 545, 546

Foggia, 182, 223, 232, 326, 334, 337, 497, 530, 550,

552

Fondi, 292, 293, 295, 303-04

Fondouk, 129-30

Food inspection, by Veterinary Corps, 263, 359, 517,

551, 556

in Brazil, 54—55

in the Fifth Army, 485

in the Middle East theater, 102

in the South Atlantic Wing, Air Transport Command, 54-55

in the Tunisia Campaign, 146

Food loss, due to improper packaging, handling,

and storage, 218-19

Food poisoning, 76, 213, 359

Food poisoning, bacterial, 98, 316

Food supply, 28, 79

Footwear, 33, 262

Force 163, 366, 369

Force 343, 148, 149-50. See also Armies, Seventh.

Foreign Liquidation Commission, 103

Formia, 293

Fort de l'Eau, 111

Fortaleza, 47, 49, 50, 55

Forts

Amador, 38

Bell, 28

Brooke, 42

Buchanan, 42, 44

Chimo, 31, 33

Clayton, 37, 38

Gulick, 37, 38

Kobbe, 37, 38

McAndrew, 23-24, 25

Pepperrell, 23, 24

Read, 43, 44, 45

Simonds, 44

Fourth Fleet, 47

Fox, Brig. Gen. Leon A., 9, 95, 363, 364, 365

France, 7, 46, 104, 525, 552

Francolise, 525

Franklin, Col. Daniel, 148, 164, 369

Franklin, Lt. Col. Joseph P., 180

Fredendall, Maj. Gen. Lloyd R., 105, 111, 123, 124,

127

Free Territory of Trieste, 549

French Army units

Armies

B, 367, 376, 381, 384, 387. See also French

Army units, Armies, 1st.

1st, 376, 407, 413, 414. See also French Army

units, Armies, B.

Corps

2d, 384

19th, 124, 131

Expeditionary, 238, 239, 243, 244-45, 251, 265,

289, 290, 291, 292, 294, 295, 299, 301, 302,

304, 312, 314, 318-19, 332, 335, 515

Divisions

1st Algerian, 367

1st Armored, 376

2d Moroccan, 238, 239

3d Algerian, 238, 239

4th Moroccan Mountain, 289

9th Colonial, 367

French doctors, 113

French Equatorial Africa, 60

French Guinea, 66

French malariologists, on British-American malaria control committee, 213

French medical units, 304

evacuation of field hospitals by, 238-39

evacuation of forward hospitals by, 295

and hospital train, 138

and support of II Corps, 295

French Morocco, 81, 83, 181

French scientists, and Typhus Commission, 95

French Somaliland, 61

French West Africa, 46, 66, 82, 99

Frew, Maj. Edith F., 369

Freyberg, Lt. Gen. Sir Bernard, 245

Frobisher Bay, 31
646 MEDITERRANEAN AND MINOR THEATERS

Fruit juice, medical value of, 99

Furth, 542

Gabes, 129

Gaffey, Maj. Gen. Hugh J., 152

Gafsa, 122, 125, 127, 129, 142, 144

Galapagos Island, 38

Gallo, Capt. Francis, 417

Gambia, 60

Gambut, 73

Gander, 23, 31

Gander Field, 23

Garigliano front, 273, 303-04, 318

Garigliano River, 235, 243, 244, 260, 266, 267, 270,

289, 291, 293, 296

Gas gangrene, 253

Gastritis, chronic, 451

Gastrointestinal disorders, 88, 98

Gastrointestinal service, 450

Gatun Lake, 41

GBC. See Greenland Base Command.

Gela, 152, 153-55, 156, 167, 169

General Depot, 6671st, 348

General Dispensaries, 63, 64, 69, 71, 225

5th, 187

6th, 189

8th, 189

General hospitals, 5, 9, 12, 79, 80, 191

500-bed, 85, 86

600-bed, 42

750-bed, 74, 84, 86

1,000-bed, 68, 74, 77, 183, 188, 190, 225

General Hospitals, numbered

3d, 192, 193, 195, 336, 397, 402, 411

6th, 180, 183, 205, 336, 337, 347, 444, 450, 481, 495,

496, 499, 500, 529, 540, 546

12th, 188, 332, 335, 336-37, 349, 448, 493-94, 529,

546

17th, 329, 490, 496, 530, 546

21st, 188, 190, 216, 329, 335, 336, 369

23d, 331, 335, 336, 402

24th, 194, 197, 337, 471, 480, 490-491, 494, 502,

528-29, 530, 532, 546

26th, 190, 204, 208, 333-34, 497, 501, 502, 529, 546

33d, 194, 196, 197, 336, 337, 493, 530, 546

36th, 333, 335, 336, 397, 402

37th, 194, 335, 481, 490, 496, 499, 500, 523, 528,

529, 530, 539, 540-41, 546, 548

38th, 63, 65, 68, 72, 73, 74, 77, 80, 81, 84, 85, 97,

102, 103

41st, 43-44. See also Station Hospitals, 359th.

43d, 194, 339, 371n, 397, 402

45th, 183, 329, 490, 496, 499, 528, 529, 530

46th, 180, 194, 339, 402

64th, 194, 335, 337, 447, 490, 491, 494, 527, 530,

550

70th, 194, 337, 448, 471, 473, 480, 494, 527, 529,

530, 546

General Hospitals, numbered—Continued

113th, 74, 76, 77, 86, 322

161st, 45

208th, 15, 16

210th, 38

218th, 38

262d, 38

300th, 329, 335, 336, 339, 490, 496, 528, 529, 550

Geneva Cross, use of, 2, 139, 271, 288, 554

Genoa, 523

Georgetown, British Guiana, 44

German Army units

Army Group G, 375

Armies

Tenth, 269, 292

Fourteenth, 273

Nineteenth, 381

Afrika Korps, 60, 124

Divisions

11th Panzer, 376

29th Panzer, 478

148th Grenadier, 462

German dental equipment, use of, 146

German doctors, Sicily, 162

German hospitals. See also Station Hospitals, numbered, 334th (Ger.).

and capacity of, 4761

and Fifth Army required to use, 477

Luftwaffe, 536

military, 304

and treatment of American casualties at the

Rapido River, 244

German Medical Service, 476-78, 500, 535-39

German troops, 226

Germany, 47, 538, 542, 543, 549

Ghana. See Gold Coast.

Ghedi, 536, 537-38

Ghedi prisoner of war area, 536, 537, 538

Ghinda, 57-58, 69

Ghisione, 485, 517

Ghisonaccia, 497

Gilmore, Col. Hugh R., 212, 259

Ginn, Col. L. Holmes, Jr., 148, 263

GOALPOST, 117

Goethals, Col. Thomas R., 180

Gold Coast, 65, 83

Goldson, Col. Robert, 369, 542

Gonorrhea, 412, 431

Goose Bay, 31, 33

Gorgas Hospital, 37, 38

Gorizia, 523

Gothic Line, 302, 416, 417, 418, 419-21, 425, 426,

435, 436, 457, 458, 467, 490, 513, 516

Goumiers, 332

Gowen, Lt. Col. Guy H., 369

Grant, Maj. Gen. David N. W., 66

Great circle route, 22

Great Falls, Montana, 31

Great Sound, Bermuda, 27
INDEX 647

Greece, 65

Green Project, 55

Greenland, 18-19, 21-22, 30, 31, 32

Greenland Base Command, 18, 19, 22

Grosseto, 301, 306, 313, 314, 319, 337, 490, 495, 496,

502, 516, 517, 529

Guadalcanal, 89, 366, 553

Guatemala, 38

Guatemala City, 38

Guenther, Lt. Col. Augustus J., 369

Guianas, 34, 47

Guincarico, 307

Gulf of Gaeta, 295

Gulf of St. Lawrence, 31

Gullickson, Lt. Col. Herbert L., 102

Gura, 57, 58, 60, 69

Gurabo, 43

Gurley, Col. Webb B., 369, 413

Gustav Line, 238, 239, 243, 245, 247, 258, 265, 267,

270, 289, 292, 294, 303, 336, 340, 430

Halazone tablets, 215

Halstead, Lt. Col. James A., 450

Hamadan, 76

Hampton, Lt. Col. Oscar P., Jr., 409, 450

Hancock, Maj. Michael Q., 32

Hanser, Lt. Col Samuel A., 276

Hanson, Col. Frederick R., 145, 210, 253, 350, 409,

487, 514

Harmon, Maj. Gen. Ernest N., 115

Harmon Field, 24, 25, 26

Hartgill, Maj. Gen. William C., 324

Haverty, Capt. Eugene F., 279

Hawley, Maj. Gen. Paul R., 504

Health officer, occupied Germany. See Stayer, Maj.

Gen. Morrison C.

Heat, prickly, 99

Heat exhaustion, 99

Heatstroke, 99

Heatstroke centers, 79, 99

Heimstra, Capt. Fred A., 47

Helgafell, 15

Heliopolis, 57, 63, 68

Heliopolis Area, 61. See also Delta Service Command, USAFIME.

Heminway, Col. Norman L., 19

Henry Barracks, 42, 44

Hepatitis, 353, 451

Hepatitis, infectious, 98-99, 216, 257, 350, 451

Highway 7, France, 384

Highways, Italy

1: 300, 302, 304, 418, 460

2: 300, 301, 302, 304

6: 238, 243, 244, 245, 246, 252, 270, 289, 290, 292,

296, 298, 299

7: 270, 289, 291, 292, 294, 295, 296, 303

9: 418, 419, 458, 462, 466, 473

64: 416, 421, 423, 425, 429, 432, 440, 457, 458, 460,

461, 466, 469, 471, 473, 480, 481, 482, 517

Highways, Italy—Continued

65: 416, 417, 419, 421, 422, 426, 427, 431, 435, 437,

444, 445, 448, 454, 457, 458, 460, 466, 468, 471,

473, 482

67: 416, 420

68: 302, 319

6520: 420

6521: 416, 420

6524: 416, 417, 419, 421, 426, 427, 436, 437

6528: 419, 421

Hill, Maj. Arthur W., 412

Hill, Lt. Col. Otho R., 19, 22

Hill 609, 134

Hilldrup, Col. Don G., 66

Hitler line, 292

Hofn, 13, 15

Holding facilities, for patients awaiting evacuation, 16, 164-65, 237, 307

Holmboe, Col. Harris, 538

Honduras, 38, 39

Horses, use of, 102, 162, 264-65, 318-20, 456, 484

Hospital admissions

for combat wounds, 1, 1n, 2-6, 29, 111, 143, 165,

173, 201, 211, 240-41, 252-53, 286, 444. See also

Battle casualties; Noneffective rate,

for disease, 6, 74, 77, 89, 97-99, 111, 115, 119, 165,

211

for injuries, 4, 21, 40, 51, 74, 79, 86, 89, 119, 165

Hospital construction

in Africa, 57, 78-79

air-conditioned wards, 86

in Brazil, 49

in Canada, 33

and civilian labor shortage in Iceland, 14

in the Eastern Base Section, 193

in Greenland, 19, 20-21

heating for, 14, 66

and lack of insulation, 33

in Levant Service Command, 64

in Newfoundland, 24-25

in the Panama Canal Department, 37, 38

in the Persian Gulf Command, 76-77

in the Puerto Rican Department, 43

shortage of materials for, 13

types of

area, 56

cantonment type, 49, 79

one-story, 78

permanent, 24, 33, 38, 43, 68, 70, 194

prefabricated, 13, 202, 336

rosette pattern, 77

temporary, 38-39, 43, 44, 49, 186, 430

tentage, use of, 73, 76, 183, 186, 188, 189, 190,

271, 275, 335, 336, 430

zone of interior, 49

and use of local materials, 49, 77

Hospital inspection

at Anzio, 277

by consultants, 211-12
648 MEDITERRANEAN AND MINOR THEATERS

Hospital inspection—Continued

by Icelandic doctors, 11

by theater surgeon, 212

Hospital rotation and replacement, 275, 277, 282,

291

Hospital Ship Platoons

5th, 205

34th, 202

36th, 202

37th, 202

Hospital ships

at Anzio, 279, 282

attacked, 177, 228-29

lack of

in Bermuda, 28

in the Middle East, 79

for North Africa invasion, 108, 115

planned use of at Anzio, 268

in Sicily Campaign, 149

under control of Allied Force Headquarters, 226

Hospital ships, British, 110, 185, 192

Hospital ships, named

Acadia, 168, 206, 341, 397

Algonquin, 357

Chateau Thierry, 397

Emily Weder, 397

John Clem, 397

Leinster, 110

Newfoundland, 228-29

St. David, 271, 283

St. Mihiel, 28

Seminole, 168, 206, 341

Shamrock, 397

Thistle, 397

Hospital sites, 43, 115, 118-19, 135, 183, 186, 188,

189, 190, 231, 237, 241-42, 252, 275, 307, 311,

402, 429

Hospital Trains, 14, 140, 155, 315, 341

41st, 205, 251, 310, 332, 342, 502, 546

42d, 205, 310, 342, 398

66th, 342, 398

Hospital trains, Italian, 542

Hospitalization policy, 6, 40-41, 247-48, 255-56,

277-78

Hospitals, 64, 76, 83, 245, 527. See also British

medical units; Convalescent Hospitals; Evacuation hospitals; Evacuation Hospitals, numbered; Field hospitals, Field Hospitals, numbered; General Hospitals; General Hospitals,

numbered; Station Hospitals, numbered; Surgical Hospital, 48th.

bombing of, 228, 271, 275-77, 283, 297-98, 311,

331

damaged by storm, 231

Fifth Army, 237, 243, 246, 250, 255, 291, 304, 310

in Iceland Base Command, 12-16

lack of, during invasion of North Africa, 110

in Levant Service Command, 71

Hospitals—Continued

maintenance and repair of, 191, 304

placement of, 248

protection of, 79

transport of, 23, 38, 67, 68-70, 84, 85, 86, 111,

119, 125, 126, 129, 132, 183, 246, 271, 275, 291, 303-10

types of

base, 28, 255, 290

civilian, use of, 23, 103, 111, 113-114, 115

Engineer Corps, 19, 24, 26, 32, 38

fixed, 5, 50, 68, 82, 120, 123, 136, 164, 182,

185, 188, 189, 206, 240, 250, 312, 329

forward, 206, 248, 311

mobile, 67, 120, 121, 123, 127, 132, 137, 143

Navy, in Bermuda, 27

post, 25, 34, 37, 38, 44

provisional, 9, 119, 183, 320

Red Cross, 119

special, 249, 555

Hot springs, use of, for heating, 14

Howard Field, 37

Hnitafjordhur, 12

Huddleston, Col. Jarrett M., 223, 268, 271

Hudson Bay, 31

Hudson Bay Company, 33

Hume, Brig. Gen. Edgar Erskine, 220-21, 360, 361,

520

Hungary, 320, 549

HUSKY. See Sicily Campaign.

Hutchinson, Lt. Col. William A., 58

Hutments, 190

Huts, types of

Boyle, 194

corrugated steel, 13

Nissen, 12, 13, 29, 188, 189, 190, 194

prefabricated, 13

Quonset, 13

Hutter, Col. Howard J., 180

Hyde, Col. James F. C., 66

IBC. See Iceland Base Command.

IBS. See Island Base Section.

Iceland, 8, 18, 30, 31

Iceland Base Command (IBC), 10-18

Idstein, 542

Immunization. See Innoculations.

Inch, Col. T. D. (RAMC) , 489

India, 60, 70, 83, 85. See also China-Burma-India theater.

India-Burma theater, 84

Infantry Battalions

100th, 230, 418, 418n. See also Infantry Regiments, 442d.

509th Parachute, 268, 270, 274

550th Airborne, 374

Infantry Divisions

1st, 105, 112, 113, 122, 124, 128, 129, 133, 152, 156, 158-60, 174, 267
INDEX 649

Infantry Divisions—Continued

3d, 105, 117, 118, 131, 152, 156, 157, 158, 159, 160,

161, 162, 169, 174, 223, 230, 231, 232, 233, 234,

235, 238, 239, 267, 268, 273, 274, 284, 295, 296-

97, 301, 314, 367, 368, 373, 375, 376, 377, 378,

379, 380, 384, 387, 392, 413

5th, 10, 12

9th, 105, 108, 115, 117, 122, 124, 127, 129, 131,

133, 146, 156, 159-60, 161, 267

34th, 105, 109, 110, 122, 124, 129, 134, 146, 223,

230, 231, 233, 234, 238, 239, 240, 243, 245, 246,

257, 263, 274, 277, 289, 295, 296, 297, 300, 302,

303, 307, 415, 417, 418, 419, 420, 421, 422, 425,

426, 427, 435, 458, 461, 462, 465, 466, 467, 523,

526, 532, 549

36th, 223, 227, 230, 237, 238, 239, 243, 244, 245,

246, 274, 289, 291-92, 295, 296, 297, 299, 301-

02, 367, 368, 373, 374, 375, 376, 379, 380, 382,

383, 384

45th, 150, 152, 153, 156, 157, 159, 160, 227, 230,

231, 233, 234, 237, 238, 239, 243, 263, 267, 272,

274, 275, 296, 297, 301, 367, 368, 373, 374, 375,

376, 379, 383, 384, 388

85th, 289, 291, 292, 293-94, 296, 297, 298, 300,

301, 303, 316, 418, 419, 421, 422, 426, 427, 428,

451, 458, 461-62, 523, 525, 538

88th, 289, 291, 292, 293-95, 296, 297-98, 300, 301,

302, 303, 314-15, 316, 415, 418, 421, 422, 426-

27, 431, 436, 452, 458, 461, 462, 466-67, 468,

523, 525, 526, 538, 540, 549, 550

91st, 299, 301, 302, 303, 316, 415, 418, 419, 421,

422, 426, 427, 435, 461, 462, 467, 468, 483, 523,

525, 544

92d, 299, 417, 418, 423, 424, 429, 431, 432, 440,

457, 458, 460, 461, 462, 463, 469, 473, 475, 479,

482, 523, 525, 527

Infantry Regiments

6th, 418

7th, 296, 377

15th, 296, 377, 378

16th, 112-13, 153, 154

18th, 112-13

26th, 112, 113, 154

30th, 157, 162, 296, 377

39th, 108, 110, 122, 156, 157, 159

47th, 115, 159, 161

60th, 117, 118, 159, 161

85th, 433

133d, 245

135th, 110, 245

141st, 227, 244, 376, 382

142d, 227, 245, 382

143d, 244, 382, 384

157th, 152, 153, 227, 384

168th, 109, 110, 111, 125, 245

179th, 152, 153, 227, 383

180th, 152, 153, 384

337th, 451

349th, 452

Infantry Regiments—Continued

361st, 301, 302

362d, 483

363d, 302, 303

365th, 424, 458

366th, 424

370th, 418, 425, 429, 461

371st, 424, 425, 458

442d, 230, 302, 415, 418, 418n, 424, 457-58, 461,

462, 463, 538

473d, 424, 432, 458, 461, 462, 463

504th Parachute, 152, 320, 234-35, 238, 268

505th Parachute, 152

509th Parachute, 105, 113, 122

517th Parachute, 302, 374

551st Parachute, 374

Infectious hepatitis. See Hepatitis, infectious.

Injuries. See Hospital admissions, for injuries.

Innoculations, 17, 94, 172, 556

Insects, in Iceland, 17. See also diseases by name.

Intestinal diseases, 26, 76, 79, 212, 483, 530

Invasion Training Centers

Fifth Army, 149, 223, 224, 251

Seventh Army, 368

Iran, 56, 60, 61, 64, 68, 73, 74, 76, 77, 82, 86, 100,

103

Iran-Iraq Service Command, 60

Iranian Army, surgeon of, 95

Iranian Engineer District, 59

Iranian Mission, United States Military, 59, 64, 100

Iraq, 59, 61, 64

Isernia, 235

Isherwood, Col. John A., 43

Island Base Section (IBS) ,181, 197-99, 208, 339,

342, 348, 349, 488

Italian Army units. See also Italian Hospitals.

Groups

1st Motorized, 238, 251

Cremona, 526

Legnano, 424, 458, 459, 526

Division, Italia Bersiglieri, 462

Italian campaign, 255. See also campaigns by name.

combat planning for, 326

justification of, 552

medical planning for, 223-24

Italian doctors, 257

Italian engineer battalion, and malaria control,

289

Italian Government, 541

Italian home guards, 152

Italian Hospitals, 57, 251, 327

304th Field, 166

10th Reserve, 166

Italian litter-bearers, 432

Italian medical depot, capture of 169

Italian peace treaty, 550

Italian personnel, released from prisoner of war

status, 541
650 MEDITERRANEAN AND MINOR THEATERS

Italian police, prostitutes given into custody of,

258

Italian Riviera, 531

Italians, use of, in U.S. hospitals, 501

Italy, 47, 63, 65, 104, 174, 500-503, 515, 519-20,

523-51

Itri, 292, 293, 303, 313

Ivigtut, 19, 22

Ivory Coast, 66

Jackson, Lt. Col. William M., 320

Jamaica, 8, 41, 44, 45

Japan, 55, 92, 521, 544, 547

Japanese-Americans. See Infantry Battalion, 100th.

Jaundice, 17, 249

Jaundice, catarrhal, 26

Jean Bart, 117

Jeep courier, 207

Jeeps, use of, 426, 432, 553. See also Evacuation, by

land, by jeep.

Jeffcott, Lt. Col. George F., 102

Jeffress, Col. Vinnie H., 180, 332, 400

John Clem, 397

Johns Hopkins faculty, medical consultant from,

210

Johnson, Col. Clyde C., 45

Johnson, Col. Cortlandt, 47

Joint French Rearmament Committee, 347

Jones, Col. Jenner G., 324, 487-88

Jorhat, 84

Joss Force, 152, 155, 169

Juin, General Alphonse P., 110, 243

Kaldadharnes, 12, 15

Karachi, 60, 82

Karr, Maj. James R., 47

Kasserine Pass, 124, 127, 129, 135, 137

Kazvin, 76

Keeney, Col. Paul A., 28

Keflavik, 10, 15

Kehoe, Lt. Col. Emmett L., 25

Kendricks, Col. Edward J., Jr., 65

Kenner, Maj. Gen. Albert W., 106, 119, 123, 138,

148, 177, 178, 179

Kesselring, Generalfeldmarschall Albert, 417

Keyes, Col. Baldwin L., 97

Keyes, Maj. Gen. Geoffrey, 147, 156, 238, 243, 296,

415, 421, 422

Khartoum, 60, 70, 84

Khorramabad, 76

Khorramshahr, 73, 74, 76, 86

Kindley Field, 28

Kings Point, 27

Kirk, Maj. Gen. Norman T., 217

Kirkman, Col. Lewis W., 181, 306

Knapp, Lt. Col. Leslie E., 66

Koeltz, General Louis-Marie, 124, 131

KOOL Force, 152

Korea, 554, 555

Kuwait, 61

L-5's, 460

La Meskiana, 127

La Senia, 112, 137, 188

Laboratories. See Dental laboratories; Medical laboratories.

Labrador, 31

Lagens, 29

Laiatico, 307

Lakes

Averno, 357

Como, 523, 536

Garda, 523

Lucrino, 357

Trasimeno, 302

Lampedusa, 151

Lampione, 151

Lanuvio, 296

Larviciding. See Disinfestation, larviciding.

Lattre de Tassigny, General Jean de, 367, 376

Lawrence, Col. Gerald P., 217

LCI's, 271, 372

Le Ferriere, 304, 310

Le Kef, 124

Lecce, 497, 528

Leese, General Sir Oliver, 267

Leghorn, 300, 302, 303, 307, 488, 489, 490, 493, 494,

496, 498, 502-04, 507-08, 511-12, 517, 527, 529,

530-31, 535, 540, 546, 547, 548, 549, 550

Legnano, 526

Lehmann, Capt. Werner, 32

Leinster, 153

Leishmaniasis (Bagdad sore), 100

Lend-Lease Act, and supplies for British hospitals

in North Africa, 57

Leone, Col. George E., 47, 48, 53

Leopoldville, 77n

Les Andalouses, 112

Levant Service Command, 61, 64, 71-72, 79, 81

Leyte, 553

Liberia, 60, 66, 67, 78, 79, 84, 89, 90, 91

Liberian Service Command, 78, 79, 89, 103

Liberian Task Force, 67

Liberty ships, 282, 300

Libya, 60, 62, 63, 65, 67, 68, 81, 99, 123, 178

Libyan Base Command, 79

Libyan campaigns, British* 59, 72

Libyan Service Command, 62, 64, 72-73. See also

Delta Service Command; Tripoli Base Command.

Licata, 152, 155-59, 164, 167, 169, 181

Lieberman, Col. John F., 11

Lice. See Disinfestation.

Lighting and power facilities, shortage of, Tunisia Campaign, 134

Limited assignment personnel, 316, 451, 460, 514
INDEX 651

Linner, Lt. Col. Gunnar, 24, 25

Linosa, 151

Liri River, 199

Liri Valley, 238, 239, 243, 244, 289, 292, 295

Litter bearers, 2, 3, 4, 293, 295, 427, 428, 554

at Cassino, 245

in the Liri Valley, 293

at the Rapido River, 244

at Salerno, 227, 236, 237

in the Winter Line campaign, 240

use of Czechoslovak prisoners as, 162

use of fighting units as, 247

use of Italians as, 247, 293

Litter squads, 2, 161, 237, 240, 270

Litters, mule, cacolet and tandum, 161, 240

Logistics. See Medical supplies and equipment.

London, 104, 121

Long, Col. Perrin H., 210, 212, 350, 363, 408, 487

Lons-le-Saunier, 414

Lourmel, 112

Louse infestation. See Disinfestation.

Losey Field, 42, 44

LST's, 149, 153, 155, 167, 169, 175, 226, 226n, 271,

275, 279, 282, 284, 311, 352, 414, 556

Lucca, 484

Lucas, Maj. Gen. John P., 230, 267, 270, 272, 273

Ludwig, Maj. Alfred O., 369, 409

Luftwaffe hospital, 536

Luzon, 553

Lyon, Maj. Champ, 211

MAAF. See Mediterranean Allied Air Forces.

MAC. See Medical Administrative Corps.

McBride, Col. John R., 19

McCracken, Lt. Col. Gerald A., 263

McCreery, Lt. Gen. Sir Richard L., 223, 243, 418

McDill, Col. John E,, 82

McFall, Lt. Col. Thomas A., 102

Mackensen, General Eberhard von, 273

Macmillan, Harold, 519

McNarney, Lt. Gen. Joseph T., 423, 499

McSween, Lt. Col. John C., 11

Maceio, 47

Maddaloni 237! 251, 336

Mai Habair, 69

Maison Blanche, 109, 110, 111

Maison Carree, 110

Maknassy, 127, 129, 142, 145

Malaria, 68, 201, 256-57, 259, 316, 321, 339, 350,

353, 354-56, 362, 411, 412, 513, 526

in the Antilles, 45

at Anzio, 286-87

in the Atlantic Base Section, 212-13

in Brazil, 47, 51-54

in Central Africa, 83, 89

in the Eighth Air Force, 89-90

in the Eighth Army, 173

in Italy, 214, 230-31, 260-61, 286-87

in Liberia, 91-92, 94

Malaria—Continued

in the MTO, 355-56

in North Africa, 60, 63, 66, 106, 145, 196, 212-14,

220, 221

in the Panama Canal Department, 39

in the Persian Gulf Service Command, 76

at Salerno, 230-31

in Seventh Army, 173

in Sicily, 150, 165, 170, 172-73, 214

VI Corps, 195

in the South Atlantic, 47

surveys, 55, 195

in Tunisia Campaign, 145

in West Africa, 78, 81, 88-92

Malaria Committee, British-American, 212-13

Malaria control. See also Atabrine; Disinfestation,

for malaria control,

complicated by German destruction of drainage

system in Italy, 260

development of Allied policy on, 90, 213-14

filling in of craters by engineers, 260

and liaision with British and French authorities,

214

planning for

for Fifth Army, 259-60

for the Middle East, 88-91

for the North Africa campaign, 212-14

for West Africa, 89-91

and suppressive therapy, 286-87

Malaria Control Branch, Allied Control Commission, 355

Malaria Control Committee, VI Corps, 287

Malaria Control Detachment (MCD), 2655th, 213,

259, 354, 412

Malaria Control Units (MCU), 89, 213, 216, 260,

355

19th, 213

20th, 173, 213

21st, 213

22d, 213

23d, 213

28th, 213, 260

42d, 213, 260, 287

131st, 412

132d, 412

Malaria Survey Units (MSU), 51-52, 88-89, 173,

213, 216

10th, 213

11th, 213, 259-60

12th, 213

13th, 213

14th, 213

Malarial Advisory Board, Allied Force Headquarters, 213

Malariologist, NATOUSA. See Moore, Col. Loren

D.; Russell, Col. Paul F.

Malariologists, 80, 90, 214

Malnutrition, 201

Malta, 151
652 MEDITERRANEAN AND MINOR THEATERS

Manduria, 333

Manila, 546, 548

Manitoba, 31, 33

Mansfield, Capt. William K., 110

Mantova, 500, 523, 530, 539

Maquis, 375

Margarita Hospital, 37

Marine Corps personnel, 10-11, 14, 552

Marrakech, 83, 85, 116, 137, 183, 187, 335, 498

Marsala, 151

Marseille, 504, 506

Martin, Maj. Gen. Joseph I., 223, 255, 268, 275,

279, 304, 314, 416, 435, 436, 437, 444, 458, 463,

469, 525, 536, 538, 541, 548, 557

Mascarenhas de Morais, Maj. Gen. Joao, 462

MASH, 555

Mason, Lt. Col. Richard P., 324

Massa Marittima, 307, 310, 320

Massaua, 57, 58, 68, 69, 70

Matese Mountains, 233

Mateur, 131, 132, 168, 181, 205, 208

Maurer, Lt. Col. Murray L., 541

Maxwell, Brig. Gen. Russell L., 56, 60, 62

Maxillofacial center, 358, 496. See also Station Hospitals, 52d.

Meat inspection. See Food inspection.

Medical Administrative Corps (MAC), 2, 64, 216,

249, 258, 279, 320, 545, 554

Medical advisory committee, Middle East Supply

Council, 62

Medical Air Evacuation Transport Squadrons

(MAETS)

802d, 139, 167, 168, 196, 204, 226, 311, 341-42,

397, 447n, 480, 531-32

805th, 83

807th, 196n, 311, 342, 397, 447, 447n, 532, 533

808th, 50, 83

830th, 28, 83

Medical battalions, 5, 120, 149, 154, 230, 248, 251,

267

corps, 129, 144, 157, 159, 164, 173, 231, 237, 240,

270, 303, 307, 311, 312

organic, 129, 153, 157, 159, 224, 228, 230, 233,

289, 293

Medical Battalions, numbered

1st, 113, 124, 154, 169

3d, 118, 154, 155, 158, 230, 233, 268, 273, 378

5th, 12

9th, 110, 111, 118,, 119, 120, 122, 133, 240

10th Mountain, 432-33, 464-65

11th, 237

47th Armored, 113, 114, 122, 124, 125, 274, 429,

465

48th Armored, 154, 155

51st, 107, 115, 124, 132, 133-34, 140, 154, 155,

156, 157, 158, 161, 165, 332, 546

52d, 224, 230, 231, 233, 241, 268, 273, 274, 277,

278, 286, 298, 299, 373, 377-78, 380, 393, 398

54th, 153, 156, 161, 162, 224, 238, 241, 244, 245,

Medical Battalions, numbered—Continued

246, 260, 263, 291, 293, 294, 298, 417, 427,

428-29, 430-31, 445, 453, 467, 477, 478, 479,

483, 538, 545

56th, 118, 119, 132, 155, 156, 157, 164, 279, 299,

311, 312, 374, 380, 381, 382, 384, 386, 388, 395

58th, 374, 379, 380, 381, 386, 395, 397

109th, 110, 120, 124, 125, 230, 233, 237-38, 240,

245, 303, 417, 426, 465

111th, 227, 244, 246, 374, 379, 382, 385

120th. 152-53, 228, 237, 240, 374, 383-84

161st, 224, 230, 248, 249, 255, 277, 295, 312, 331,

416, 432, 437, 448, 450, 463, 545

162d, 224, 227, 231, 232, 233, 241, 248, 249, 258,

263, 278, 279, 295, 312, 326, 416, 428, 430-31,

437, 439, 440, 444, 448, 453, 469, 483-84, 502,

544

163d, 312, 317, 429, 432, 440, 447, 448, 453, 466,

479, 544, 545

164th, 336, 374, 386, 387, 393, 394, 395, 398, 404

181st, 336, 373, 378, 393, 410, 411

261st Amphibious, 154, 155, 156, 164, 224

310th, 289, 291, 293, 426

313th, 289, 291, 293, 295, 315, 427, 466, 549,

550

316th, 303, 426, 467

317th, 429, 432, 463

Medical Bulletin of the North African Theater

of Operations, 179

Medical Center, 6744th, 332

Medical Companies. See also Medical supply units.

307th Airborne, 150, 232, 326

376th Collecting, 373

377th Collecting, 373

378th Collecting, 373

380th Collecting, 478, 538

383d Clearing, 467

388th Collecting, 374

389th Collecting, 374

390th Collecting, 374

402d Collecting, 277, 312, 480n

403d Collecting, 295

406th Collecting, 295

514th Clearing, 374, 395

549th Ambulance, 268, 279

551st Ambulance, 295

601st Clearing, 255, 291, 303, 304, 307, 315, 437,

444, 450, 463, 473, 480, 545

602d Clearing, 258, 263, 278, 279, 291, 304, 317,

437, 444, 453, 469, 473, 483-84, 525

615th Clearing, 440, 466

616th Clearing, 373, 374, 378, 393, 394, 410, 411

638th Clearing, 374, 393, 395, 404

675th Collecting, 387, 402

676th Collecting, 374, 380, 395

682d Clearing, 373, 393

683d Clearing, 431

885th Collecting, 374, 382

886th Collecting, 374
INDEX 653

Medical Companies—Continued

887th Collecting, 374

891st Clearing, 374

2670th Ambulance (Prov), 196

6706th Conditioning, 217, 357

Medical Department, 1, 29-30, 120, 143, 314, 486,

501, 513-14, 552, 554

and Canada, 33

and the Middle East, 63, 99

and the Panama Canal Department, 35, 39,

42-43, 44-45

Medical Department personnel, 3-6, 58, 59, 60,

63-64, 118-19, 121, 124, 223, 250, 251, 258,

259, 303, 304, 306, 307

assigned to AMGOT, 152

capture of, 125, 134

and care of construction engineers, in Liberia,

67

casualties among, 134-35, 240, 273, 275-79, 283,

311, 329

disease among, 53, 89, 134

drawn from collecting companies, 248

duties of, 1-2, 80, 82, 83-84

expanded capabilities of, due to specialized

facilities, 248

parachute training for, 150

preference for American medical supplies as

opposed to British, 87

reinforcements for, 55, 128, 134

replacement of, by officers of MAC, 169

shortage of, 119, 144, 244, 249

and study of infectious hepatitis, 256-57

transport of, 23, 97-98, 134, 543, 544, 545-46,

554

used to augment local public health staffs, 220-21

Medical depot companies. See Medical supply

units, Depot Companies.

Medical detachments, 9, 43, 110, 113, 122, 162, 373,

374

Medical Directorate, British Army Middle-East

Forces, 62

Medical equipment. See Medical supplies and

equipment.

Medical inspectors

from base sections, supervise malaria control

measures in North Africa, 213

from Fifth Army, assumes responsibility for

organizing malaria control, 259

from Libyan Service Command, 64

from USAFIME, 89

Medical laboratories, 49, 94, 99, 225, 258

Medical Laboratories, numbered

1st, 190, 352

2d, 187, 258, 417, 444, 450

4th, 404

15th General, 314, 332, 350, 352, 409, 513, 546

Medical maintenance units (MMU), 107, 142,

168, 208-09, 373

Medical Regiment, 16th, 120, 122, 122n, 123, 124, 129, 132, 134, 138, 142, 196, 215, 224. See also

Medical Battalions, 161st and 162d.

Medical section

of AFHQ, 177-79, 212, 323

of Fifth Army, 223-24

of MTOUSA, 487-88, 521-22

of NATOUSA, 211, 323, 353, 486-87

of Persian Gulf Service Command, 64-65

Medical seminars, systematized, 314

Medical supplies and equipment, 4, 87, 149, 208-09,

224, 511, 546-47, 553

automatic, 87, 88, 208

British, use of by American units, 87, 114

catalog of spare parts for, 507

delayed arrival of

at Gela beach, 154

in Iceland, 17

in the Levant Service Command, 71

at Salerno, 230

for the Levant Service Command, 57, 71

loss of

to enemy action, 230, 275, 333

to handling, 88, 120, 251

at sea, 155, 280

for the Middle East, 87-88

obsolete, 134

overstocks of, 210, 282

shipped to zone of interior, 40, 88, 507, 551

shipped to the United Kingdom, 17

in Sicily, 251

and property exchange, 282, 314, 398

problems of, 120-21, 142

policy for, 16-17, 87-88, 210, 346-47, 372, 407,

507, 550

shortages of, 39, 87, 110, 119, 140, 208-09, 252,

552

transport of, 17, 88, 252, 282, 292, 314, 346, 404,

405-06, 507-08

for the Tunisia Campaign, 99, 134

Medical Supply Branch, 506. See also Medical

supplies and equipment; Medical supply units.

Medical supply depots. See Medical supply units,

Supply Depots.

Medical supply units

Composite Battalions

231st, 345, 346, 406-08

232d, 346, 350, 511, 512

Service Battalion, 232d, 512, 548, 550

Supply Depots

2d, 124, 127, 140-42, 169-70, 208, 208n

4th, 169, 208, 208n, 224, 227, 329

7th, 208, 208n

12th, 252

Depot Companies

2d, 345, 347, 348-49, 406, 509

4th, 87, 332, 345, 347

7th, 337, 345, 346, 348, 349, 369, 380,

404-06, 413
654 MEDITERRANEAN AND MINOR THEATERS

Medical supply units—Continued

Depot Companies—Continued

12th, 252, 268, 280, 312-14, 318, 345, 346,

417, 440, 448, 453, 481-82, 548

20th, 17

48th, 346

Base Depot Companies

57th, 550, 551

60th, 346, 509-10, 512, 548, 550

70th, 345, 406, 407

71st, 345, 406, 407

72d, 346, 350, 511, 512, 548

73d, 346, 350, 511, 512, 548, 550

80th, 510, 511-12, 548

Supply Detachments

339th, 550

890th, 413

Composite Platoon, 300th, 17

Mediterranean Allied Air Forces (MAAF), 184,

326-27, 374-75, 423

Mediterranean Allied Tactical Air Force, 460

Mediterranean Base Section (MBS), 82, 180, 188-

89, 192, 193, 194, 201, 204, 205, 206, 208, 213,

219, 220, 324, 337, 338, 348, 349, 372, 488, 509,

511

Mediterranean Theater of Operations (MTO),

84, 86, 353, 355, 401, 403, 406, 412-13, 498,

504-05, 521, 534, 546, 547, 550-51

Mediterranean Theater of Operations, United

States Army (MTOUSA), 496, 498, 509, 532-33

bed ratio in, 529-30

evaluation of, 552-57

medical section of, 487-88, 521-22

responsible for prisoners of war, 540

redeployment plans and centers, 526-27

surgeon of, 506, 507, 528, 549

Tables of Equipment for, 507, 545

Medjez el Bab, 121, 122

Meeks Field, 10, 15, 16

Mehdia, 117, 119

Menfi, 157

Merano, 535, 541

Mers el Kebir, 111, 112

Mess halls, in the Middle East, 97

Messina, 158, 159-62

Metauro River, 302

Meteorological stations, 19-22, 31

Methyl bromide (MYL), 362

Metz, Col. Karl H., 324, 358

Michelin cars, 123

Michener, Capt. Elizabeth, 324, 359

Middle East, 56-103, 197

Middle East Supply Council, 62, 95

Middle East theater, 62, 63, 88, 94, 97, 99, 102. See

also Africa-Middle East Theater of Operations;

Iran-Iraq Service Command; Persian Gulf Service Command; United States Army Forces in

the Middle East (USAFIME).

Mignano, 235, 238, 246, 252, 291

Mignano Gap, 235, 238-39

Milan, 523, 526, 531

Military Government Section, Allied Force Headquarters, 361

Military Mission to the Italian Army, 459

Military police, 201

Millburn, Col. Conn L., Jr., 541

Miller, Lt. Col. Nesbitt L., 152

Mingan, 31, 33

Minturno, 243, 261, 289, 291, 293, 304

Mirandola, 517

Mirgorod, 321

Mistretta, 166

Mobile Army Surgical Hospital, 555

Modena, 525, 538

Moccasins, use by American troops, 33

Monastery Hill, 292

Monrovia, 67

Montalto di Castro, 305, 306

Montana, 31

Monte Cassino, 238

Monte San Biagio, 319

Montecantini, 499, 527, 529, 532, 544, 545

Montecchio, 307

Montedoro, 292

Montella, 232, 237

Montepescali, 306

Montesquieu, 127

Montevideo, 54

Montgomery, Field Marshal Sir Bernard L., 123,

223, 267

Montichiari, 537

Moore, Col. Loren D., 67, 213

Morale, 94, 97, 123, 545, 555

Moroccan tabors, 376

Morocco, 43, 62, 104, 105, 108, 119, 148, 335

Morphine, 373

Morris, 132, 190

Mortar shell cases, as containers for medical

supplies, 154

Mosquitoes. See Malaria control.

Mostaganem, 148, 188, 189

Mostra Fairgrounds, 327-28, 329, 332, 349, 496, 499

Mountain Division, 10th, 424, 425, 431, 435, 455-

56, 458, 461, 462, 463, 464, 466, 477, 483,

484, 484n, 516, 517, 523, 525, 526, 535, 544

Mowrey, Col. Fred H., 542

MP's, 201

Mt. Arrestino, 296

Mt. Lungo, 239

Mt. Pantano, 240

Mt. Sammucro, 239

Mt. Trocchio, 239

Mukluks, use by American troops, 33

Mule Pack Group, 20th, 320

Mules, use of, 133, 146, 160-62, 174, 240, 292, 318-

20, 422, 426, 432, 454-56, 479, 553-54

Mumps, in Iceland, 17

Munhall, Lt. Col. Lawrence M., 216-17, 357
INDEX 655

Munich, 542

Munly, Col. William C., 487

Murphy, Robert D., 219-20

Mussolini Canal, 268, 271, 274

Mustapha civil hospital, 111

Mustard gas, 350-51

Naples, 95, 216, 222, 223, 230, 233, 238, 241, 243,

250, 252, 253, 258, 262, 263, 270, 272, 275, 277,

279, 284, 290, 300, 310, 488, 489, 490, 493,

494, 496, 499, 502, 504, 505, 520, 528, 529, 530,

532, 535, 540, 546, 547, 548, 549, 550, 556

Naples-Foggia Campaign, 222-43

Narsarssuak, 18-19

Natal, 47, 49, 53, 54, 55, 60

Naval Hospital Number 9, 498

Naval Shore Battalion, 4th, 227

Navy Department, agrees to establish bases in

Greenland, 18

Navy epidemiology unit, transfer of Typhus Commission equipment to, 95

Navy medical personnel, care of casualties evacuated from Salerno, 226

Navy personnel, medical treatment for, 14-15,

49-50

Navy representative, attends British-American malaria control committee, 212-13

Netherlands West Indies, 8, 44

Nettuno, 268, 270, 271, 274, 275, 279, 296, 311

Neuropsychiatric casualties, 96-97, 256, 284-85,

432-33, 437, 450-51, 483

Neuropsychiatric Centers

Fifth Army, 249, 255-56, 315, 369, 409

Seventh Army, 410, 411

Neuropsychiatric hospitals, 249, 282, 291, 304,

307, 329, 335, 337, 393, 394, 402, 403, 444,

480, 514. See also Evacuation Hospitals, numbered, 56th; General Hospitals, numbered,

3d, 45th; Station Hospitals, numbered, 43d,

51st, 114th.

Neuropsychiatry, 253-54, 256, 314-15, 316, 556

at Anzio, 284

in Canada, 33

in Greenland, 21-22

in the Middle East, 86-87, 88, 96-98

in the Po Valley, 513-14

in Sicily, 171-72

Neuropsychiatry, problems

combat neurosis, high incidence of, at the Volturno, 236

mild neurosis, 255

percentage of patients returned to duty, in

Tunisia, 144-45

tropical syndrome, 96-97

New Guinea, 89

New Orleans, 41

New York, 115

New Zealand, 102

New Zealand Army units

Corps, 245, 247

Division, 2d, 245

Newfoundland, 8, 24, 25, 26, 30-31, 43

Newfoundland, 228-29

Newfoundland Air Base, 23

Newfoundland Base Command, 23-25

Nicaragua, 39

Nice, 531

Nichol, Col. William W., 548

Nicosia, 159, 162, 167, 169

Nigeria, 60

Nile River, 68

Ninth Air Force Service Command, 65

Nisei, 230

Nissen huts, 19, 30, 130-32, 135

Nocelleto, 291, 311

Noneffective rates, 322, 515, 555-56

in Iceland, 18

in the Middle East theater, 88

Noonan, Col. James E., 218, 325, 359, 487, 516, 517

Norman, Lt., Col. E. T., 39

Normandy, 25, 552, 553

Norris, Col. Benjamin, 210

North Africa, 29, 43, 80, 84, 85, 104, 121, 178, 502,

504, 509, 551, 552

North African Air Force, 151

North African Economic Board, 151

North African Mission. See Military North African Mission.

North African Service Command, 60-61, 81-82,

92, 103

North African Theater of Operations, United

States Army (NATOUSA), 29, 77n, 180-81, 204,

210-14, 217, 223, 323-24, 333, 334, 354, 361,

362, 363. See also Mediterranean Theater of

Operations, United States Army,

co-ordination with French Army medical section, 179

establishment of, 178

and malaria control directives, 286-87

medical section of, 211, 323, 353, 486-87

personnel requirements, 179

surgeon of, 324, 334, 340, 354

Table of Organization for, 211, 338

North African Wing, Air Transport Command,

83-84

North Apennines, 302, 486

North Apennines Campaign, 415-56, 484, 485, 490,

499, 501

Northern Base Section (NORBS) , 181, 199, 208,

349, 350, 488, 497, 502, 509-10

Northwest African Air Forces (NAAF), 151, 167,

182. See also Mediterranean Allied Air Forces.

Norton, Lt. Col. John W. R., 212

Nova Scotia, 26

Norwegian Army and Navy personnel, medical

treatment for, in Iceland, 14-15
656 MEDITERRANEAN AND MINOR THEATERS

Nurse Corps, 229, 276, 283, 299, 307, 321, 381,

437, 518-19

absent from Fifth Army Neuropsychiatric Center, 255

accompanies psychotics on Air Transport Command flights, 79-80

award of Silver Star to members of, 288

enlisted medical personnel substituted for, in

Brazil, 53

flown to Sardinia, 175

in Iceland Base Command, 14

as a morale factor at Anzio, 288

in North Africa, 104, 113

in Pan American Highway Medical Service,

39

psychiatric school conducted for, 219

rest camp privileges, 303

rotation and promotion policies, 219, 519

shortage of, in North Africa, 219

in Sicily invasion, 153

and transfers to ETO, 219

in Tunisia Campaign, 219

Nurses, Brazilian, 336, 439, 442, 469, 491, 505

Nurses, casualties among

at Anzio, 275, 278, 288

at Salerno, 229

Nurses, Director of, 219, 369

Nurses, German, 477, 540

Nurses, male, 57, 60

Nurses, Polish refugee, 60

Observation Squadron, 1st, 10

O'Daniel, Brig. Gen. John W., 273

Oil stoves, use of, to heat field hospitals, 4

Okinawa, 546, 553

Ombrone River, 302

Ondash, Lt. Col. Stephen W., 19

Oran, 82, 85, 105, 107, 108, 111-115, 118, 121,

122, 123, 124, 137, 138, 139, 150, 168, 177, 179,

180, 181, 188, 189, 192, 206, 208, 226, 488, 498,

504, 509, 510, 534, 541

Orbetello, 306

Ortona, 240

Ostiglia, 485

Ostrander, Col. Forrest R., 65

Oued Seguin, 190

Oujda, 223

Ouled Rahmoun, 138

Ousseltia Valley, 125

OVERLORD, 266, 334

P-40's, 10

Pacific Fleet, 8

Pacific theater, redeployment to, 521-23, 543, 544,

545, 546

Pack trains, Italian, 318-19, 432, 453-54, 484, 545

Padloping Island, 31, 33

Paestum, 252, 333

Palazzo Beccadelli, 484

Palestine, 57, 60, 61, 71, 81, 84, 87, 102

Palestine Area. See Levant Service Command.

Palermo, 156, 157, 158, 164, 165, 166, 167, 168, 169,

170, 174, 181

Pan American Airways, 50

Pan American Highway Medical Service, 39

Panama Canal, 34-35, 41, 45

Panama Canal Department, 34-41, 42

Panama Canal Zone, 7, 9, 34, 35, 42

Pantelleria Islands, 150-51

Pappataci fever, 77, 99, 172, 173, 256-57

Parachute Battalions. See under Infantry Battalions.

Parachute Regiments. See under Infantry Regiments.

Paraguay, 54

Paramaribo, 44

Paratyphoid, 172

Paris green, 356

Parkinson, Brigadier G. S., 361, 363

Parma, 523, 537

Pasteur Institutes, 95

Patch, Lt. Gen. Alexander M., 366-67, 415

Patton, Maj. Gen. George S., Jr., 105, 127, 130,

147, 172, 267, 366

Patton, Col. Thomas E., Jr., 66

Pearl Harbor, 8, 42

Peatfield, Col. Norman E., 369

Peccioli, 307

Pelagies, 151

Penicillin, 94, 253, 258, 258n, 314, 352, 354, 412,

450, 473, 513, 556

Peninsular Base Section (PBS), 250, 313, 349-50,

488, 511, 512, 516, 526-32, 535, 538, 540, 541,

543, 545, 546

hospitals in, 489, 490, 501, 502, 546

malariologist of, 355

psychiatric hospitals in, 493, 528

surgeon of, 352, 447, 528, 535

Peptic ulcer, 451

Perregaux, 193

Persano, 516

Persian Corridor, 56, 59

Persian Gulf, 61, 76

Persian Gulf area, 67, 69, 73, 79, 88, 99-100, 102

Persian Gulf Service Command, 61, 64-65, 68, 74-

80, 82, 84, 86-87, 103. See also Africa-Middle

East Theater of Operations; Iran-Iraq Service Command.

Peru, 38

Petain, Marshal Henri, 108

Petralia, 159

Pets, care of, 103

Pharmacy Corps, 323

Philippines, 545

Philippeville, 142

Piacenza, 537

Piana di Caiazzo, 333, 494, 495, 496, 527

Pickering, Col. Clifford E., 264-65, 359, 455
INDEX 657

Pico, 292

Pietraperzia, 159

Pigeons, use of, 306, 444, 456

Plitz, Maj. George F., 66

Piombino, 302, 306, 511

Piper Cubs, 279, 284, 483, 554

Piryatin, 320-21

Pisa, 302, 303, 488, 495, 496, 498, 510, 516, 520, 527,

533, 535, 539, 540, 541, 550

Pistoia, 495, 496, 502, 529, 530, 532

Plague, 30, 83, 91, 99, 106, 556

Ploesti, 80

Pneumonia, atypical, 452, 483

Po River, 485, 517

Po Valley, 484, 490, 494, 496, 499, 500, 501, 530, 540

Po Valley Campaign, 457-85, 500-501, 510, 513,

515, 517, 525, 531, 534

Poggibonsi, 302

Pohl, Col. Louis K., 327

Poletti, Col. Charles A., 220

Poliomyelitis, 99, 526

Polish Corps, 292, 462

Poltava, 320, 321

Polvrifitto, 485

Pomigliano Airfield, 333

Ponce, 42

Ponte Olivo, 153

Ponteginori, 307

Pontepetri, 517

Pontine Marshes, 268, 292

Port Elizabeth, 57

Port-Lyautey, 115, 117, 118, 186

Port of Leghorn Organization, 550

Port-of-Spain, 44

Port Sudan, 57

Port Surgeon's Office, 8th, 196

Porto Empedocle, 157, 181

Portuguese Government, 29

Pratolino, 494, 502, 529, 531

President of United States. See Roosevelt, Franklin D.

Presque Isle, 26, 31, 32

Prestwick, 31

Prime Minister, British. See Churchill, Winston S.

Primolino, 525

Priverno, 295

Prisoner of War Administrative Companies

2686th, 340

6619th, 340

Prisoner of war command, MTOUSA, 525, 538

Prisoner of War Enclosures

100th, 202

129th, 201, 202, 339

130th, 201

131st, 202, 339, 498

326th, 339, 340

334th, 498

Ghedi, 334

Prisoner of war evacuation, 165, 540, 541-43

Prisoner of war hospital trains, 506

Prisoner of war hospitals, 339, 478, 498, 499, 525,

530, 534-35. See also Station Hospitals, 34th,

66th, 131st (Ger.), 7029th (It.), 7550th (It.).

Prisoner of war repatriation policy, 542, 548

Prisoners of war

German, 339-40, 386, 464-65, 475-77, 505

Italian, 194, 339-40, 462, 535, 554

medical treatment for, 197, 434. See also Prisoner

of war hospitals.

Prophylactic stations. See Venereal disease.

Prosthetic Dental Clinic and Laboratory, II Corps,

263

Prosthetic dental work. See Dental Prosthetics.

Prostitution, 51, 92-94, 215, 257-58, 354, 412. See

also Venereal disease.

Provisional Corps, 156-58, 167

Provost Marshal General, 201

Psychiatric disorders. See Neuropsychiatry.

Psychogenic dyspepsia, 451

PT boats, 409, 556

Public Health

in Egypt, 62, 94-95

in Italy, 361-62, 520

in North Africa, 220-21

Public Health and Welfare Subcommission, 361

Public Health Service, United States (USPHS),

94, 220, 221, 360

Puerto Rico, 7, 8, 9, 26, 41, 42, 43, 45

Puerto Rican Department, 41—43

Puerto Rican Section. See Caribbean Defense

Command.

Pugsley, Col. Matthew C., 152

Pursuit Squadron, 33d, 10

Pyle, Ernie, 160

Quartermaster Base Depot Company, 684th, 349,

509-12

Quartermaster Corps

improvises equipment, 209

issues shoes to troops in Canada, 33

operates medical units in the Persian Gulf

Service Command, 76

operates shower and sterilization unit, 332

Quartermaster Remount Depots

2610th, 516

6742d, 359, 455, 516

Quebec, conference in, 519

Quebec Province, 31

Quinine, use of, 122

Quonset huts, 19

RAAG. See Rome Allied Area Command.

Rabat, 119, 132, 186

Radke, Col. Ryle A., 210, 487

Rafidiyah, 59

Randazzo, 159, 161

Ranger Battalions, 105, 151, 152, 223, 238

1st, 112, 273
658 MEDITERRANEAN AND MINOR THEATERS

Ranger Battalions—Continued

3d, 157, 273

4th, 273

Rangers, 153, 231, 269

Ranson, Maj. Stephen W., 410

Rapido River, 206, 238-39, 243-44, 267, 291

Rats, examination of, 17, 30

Raulerson, Lt. Col. Charles, 369

Recife, 47, 49, 54, 55

Reconditioning program, in North Africa, 216

Recreation facilities. See Rest and recreation

facilities.

Red Cross hospitals, 119, 165, 170

Red Cross insignia. See Geneva Cross.

Red Cross worker, lost to enemy action, 275

Redeployment, to Pacific, 521-22, 545

Redeployment centers

Brazilian, 527-28

in Florence, 545

Regensburg, 542

Region III, AMG, 360, 363

Remount Depot, Fifth Army, 264, 484, 485, 517

Rennell, Maj. Gen. Lord, 220

Renshaw, Col. Solon B., 218

Repatriation. See Prisoners of war repatriation

policy.

Replacement Depots

8th, 495

24th, 516

Replacement Training Command, 499

Republic of Panama, 38, 39, 41

Respiratory diseases, 249, 257, 386, 427, 530, 556

in the Azores, 30

in Canada, 33

in Greenland, 21

in Iceland, 17

in Italy, 483

in the Middle East, 77, 79, 86, 88, 98

in Newfoundland, 26

in North Africa, 145, 216

Rest and recreation facilities

recreational facilities, 93, 97, 103

rest camps, 133, 246-47, 303, 437, 510, 519, 528

rest center, Fifth Army, 263

Reykjaskoli, 12, 15

Reykjavik, 10, 12, 13, 15, 16, 31

Riardo, 237, 242, 246, 252, 255, 291

Rich, Col. Joseph, 369

Richards, Lt. Col. James T., 323-24

Richardson, Lt. Col. Clarence T., 317

Rieser, Maj. Julian M., 54

Rimini, 499, 528

Riola, 484, 517

Roberts, Lt. Col. Raiford A., 259

Roberts Field, 60, 66, 84, 90, 91, 92, 213

Robinson, Col. Albert H., 181, 199, 369

Rockefeller Foundation, 53, 94, 363, 365

Rockefeller Typhus Team, 216

Roe, Col. William Warren, Jr., 324

Rome, 80, 222, 240, 266, 267, 268, 270, 272, 273,

291-92, 295-96, 298-99, 302, 304-05, 306, 307,

310, 493, 499, 500, 502, 527, 529, 550

Rome Allied Area Command, 488-89. See also

Rome Area, MTOUSA.

Rome Area, MTOUSA, 489, 495, 530

Rome-Arno Campaign, 244-65, 289-322, 556

medical support for, 302-20

military support for, 299-302

Rommel, Generalfeldmarschall Erwin, 60-61, 124

Roosevelt, Franklin D., 10, 108, 519

Rosignano, 302

Royal Air Force, 56, 151

Royal Army Medical Corps, 324, 489

Royal Canadian Air Force, 23, 30

Royal Canadian Air Force hospital, 23

Royal Canadian Mounted Police, 33

Royal Navy, 14-15, 69, 105, 114

Royce, Maj. Gen. Ralph, 80

Rudolph, Col. Myron P., 181, 369

Rumania, 65, 80

Russell, Col. Paul F., 213

Russian Army, 56

Russian Mission, transfer of medical personnel

from, 59

Russian patients, 529, 533

Rustigan, 2d Lt. Robert, 211

Ryder, Gen. Charles W., 105

Sacco River, 292

Sacco Valley, 292, 295, 296

Sadler, Brig. Gen. Percy L., 67

Safi, 115, 116, 117, 118, 119, 183

St. Arnaud, 190

St. Cloud, 113, 115, 188

St. Croix, 42, 43

St. David, 271, 283

St. John, Lt. Col. Clement F., 119

St. John's, 23-24

St. Lawrence River, 22

St. Leu, 114

St. Lucia, 8, 41, 43, 44

St. Mihiel, 28

St. Thomas, 43, 44

Ste. Barbe-du-Tlelat, 188

Salerno, 188, 226-31, 257, 516, 526, 553

medical planning for, 223-26

military planning for, 222-23

Salinas, 38

Saline, 307

Salsomaggiore, 525

Salt tablets, 99

Sams, Col. Crawford F., 56, 57, 58, 59, 62, 63, 80

Sams, Lt. Col. James E., 542

Samuel J. Tilden, 333

San Fratello, 160, 162

San Fratello Ridge, battle for, 162

San Giovanni, 484, 526

San Juan, 42, 43, 45
INDEX 659

San Julian, 44

San Martino, 517

San Pietro, 252

San Remo, 531

San Stefano, 159, 162, 167, 172

Sandfly fever. See Pappataci fever.

Sanitary conditions

in the Africa-Middle East theater, 67, 79, 88, 98

in Brazil, 53, 54

in Eritrea, 62-63, 70-71

in Iceland, 18

in the Middle East, 79, 98

in North Africa, 106, 214

in the Persian Gulf Service Command, 77

in Sicily, 170

in Tunisia, 201, 214-15

Sanitary Corps, 320-21, 354

engineer from, attached to the surgeon, NATOUSA, 220

inadequate facilities for cleansing mess kits, 215

lack of sewage disposal systems in the Middle

East, 98

and malaria control at Anzio, 286-87

personnel, 39, 64

responsible for antimalaria control measures,

213

services to Air Transport Command personnel, 81

uses Veterinary Corps piggeries for garbage disposal, 102

value of screening established

for diarrhea and dysentery control, 145

for malaria control, 39

in West Africa, 90-91

Sanitary engineers, Italian, and malaria control,

260

Sanitary surveys, 57, 221

Sanitation team, Ninth Air Force, 65

Sant'Angelo, 243, 244

Sant'Elia, 239

Santa Maria Island, 29

Santa Marinella, 304-05

San Martino, 485

San Sano Wells, 194

Sao Luis, 47, 49, 50, 55

Sardinia, 174, 188, 264, 488, 497

Sauer, Col. Paul K., 231, 275

Saylor, Maj. Samuel L., 162

Sbeitla, 130, 132

Scheele, Lt. Col. Leonard A., 220

School of Aviation Medicine, at Randolph Field,

47

Scoglitti, 153, 167-68

Scotland, 30, 31

Scout dogs, 456, 484

Sebkra d'Oran, 112

Sebou River, 117-18

Sedation, use in treatment of psychiatric cases,

145, 171, 255

Selesnick, Lt. Col. Sydney, 258, 279

Seminole, 168, 206

Senigallia, 302, 497, 499, 510, 529

Serchio Valley, 503

Service commands, USAFIME, 63

Services of Supply (SOS), 62, 65-66, 73, 148, 180,

181, 210, 212, 214, 217, 218, 231, 251, 324-25,

405-06, 487-88

and control of base section supply activities,

181

medical section of, 207, 323-24, 336, 344-45, 349,

353, 355

and planning for Sicily Campaign, 106

surgeon of, 62

Services of Supply, NATOUSA, 207, 323, 355,

359, 369, 372, 406

Seventh Army Surgeon, 149, 166, 173, 373, 397,

399, 402

Seydhisfjordhur, 13, 15

Seymour Island, 38

Sfax, 73

SHAEF. See Supreme Headquarters, Allied Expeditionary Force (SHAEF).

Shamrock, 397

Shatt-al-Arab, 76

Shea, Maj. Andrew W., 22

Sherwood, Col. John W., 37

SHINGLE. See Anzio Campaign.

Shingler, Col. Don. G., 60

Ships. See also Hospital ships, named.

Bernadou, 115

Chenango, 117, 118

Cole, 115

Dallas, 118

Dorchester, 19

Edmund B. Alexander, 23

Jean Bart, 117

New York, 115

Shook, Col. Charles F., 210, 323, 401

Shu'aybah, 59

Sicily, 29, 63, 65, 73, 89, 130, 304, 488, 553, 556

Sicily Campaign, 144, 147-76, 181, 211, 251, 555-56

assault phase, 151-52

field medical units compared to those of Italy

campaign, 237-38

and medical experience used in planning for

Anzio, 267

medical planning for, 147-49, 220-21

and medical planning compared to Salerno

planning, 223-24

military planning for, 147

shortage of beds, 205

and training of medical troops for, 149-50

Sidi Bel Abbes, 188

Sidi Bou Hanifia, 188, 190, 216

Sidi Ferruch, 111

Sidi Smail, 138, 139

Snyder, Maj. Gen. Howard McC., 123

Souk Ahras, 123, 127, 142
660 MEDITERRANEAN AND MINOR THEATERS

Souk el Arba, 138, 139

Souk el Khemis, 123, 137

South African Armoured Division, 6th, 418, 421,

424, 429, 458, 459, 461, 526

South America, 35, 38, 44

South Atlantic, 46, 49, 60

South Atlantic ferry route, 47

Southampton Island, 32

Southeastern Europe, 63

Southern France, 267, 302, 307, 310

Southern France Campaign, 366-414

medical planning for, 369-74

military planning for, 366-68

Southern Line of Communications (SOLOC), 400- 401, 408, 486

Southern Town Command, North African Service

Command, 82

Southern Tunisia, 73, 130, 132, 135, 137, 138

Southwest Pacific, 544, 545, 546

Soviet Union 65, 76

Spanish Morocco, 113

Sparanise, 251, 310, 527, 529

Spaulding, Col. William L., 181

Special Service Force, 1st, 238, 239, 272, 295, 296,

367, 371n, 374, 375, 376, 386

Specialist personnel, 49, 191, 249

Specialist teams, 310, 371

Specialization, 248, 249, 282

Specialized hospitals gastrointestinal, 555

in Italy, 248-49

neuropsychiatric, 249, 282, 555 venereal disease, 249, 555

Spinazzola, 529

Stalin, Marshal Joseph, 366

Stalingrad, 552

Station de Sened, 128

Station hospitals, 24, 28, 44, 69, 71, 101, 103, 134,

312

in Brazil, 55

in the Panama Canal Department, 35

in the Persian Gulf Service Command, 73-74

10-bed, 42

25-bed, 23-24, 25, 70, 84, 85

40-bed, 23

50-bed, 23, 33, 44, 49, 59-60, 84, 85

60-bed, 23

75-bed, 25, 33, 44, 84

100-bed, 25, 28, 32, 42, 44, 49, 50, 58, 69

150-bed, 23, 25, 28, 33, 42, 44, 49, 76, 85, 86

200-bed, 44

250-bed, 24, 28, 44, 58, 67, 71, 74, 84, 85, 86

350-bed, 50

400-bed, 400

450-bed, 25, 58

500-bed, 43, 58, 69, 76, 86

600-bed, 45

750-bed, 43, 74

900-bed, 58

Station Hospitals—Continued

1,000-bed, 43

Station Hospitals, numbered

4th, 32, 33

6th, 33

7th, 188, 493, 529, 546, 550

111th, 12, 15

14th, 13, 15

15th, 13, 15

19th, 74, 76, 86, 321-22

21st, 68-69, 74, 76, 86, 102, 498, 528, 529, 540, 546

23d, 77n, 183, 187, 337, 403

24th, 64, 71-72, 84

25th, 5, 67, 78, 84, 103

29th, 188, 189, 196, 338, 348, 439. See also

Evacuation Hospitals, numbered, 170th. 30th, 74, 86

32d, 189, 332, 335, 496, 529, 546

34th, 193, 199, 336, 339-40, 495, 496, 528, 550-51

35th, 190, 194, 199, 402

40th, 188, 199, 396, 396n, 497, 500, 510, 528, 529, 546

43d, 192, 197, 335, 336

49th, 13, 15

50th, 183, 187, 337, 490, 495, 496, 498. See also

Field Hospitals, numbered, 99th.

51st, 183, 194, 335, 350, 402, 411

52d, 188, 329, 496, 528, 546

53d, 85, 192, 195, 197, 336

54th, 192, 197, 337, 348, 458n, 498, 509. See also

Evacuation Hospitals, numbered, 171st.

55th, 193, 333, 334, 337, 447, 448, 490, 494, 502, 527, 529, 550

56th, 81, 85, 103, 183, 186, 202, 203, 335, 338,

339, 347, 498, 509

57th, 85, 189n, 190, 190n, 204, 337, 458n, 498, 509

58th, 192-93, 335, 336

60th, 175, 193, 199, 335, 480, 497, 499, 529, 546

61st, 136, 189, 204, 333, 334, 497, 550, 551

64th, 188, 335

66th, 183-86, 333, 335, 336, 339-40

67th, 66, 77, 81, 84

69th, 183, 194, 337, 403

70th, 329, 336, 403

72d, 12, 15,

73d, 190, 204, 335, 336, 337, 495, 496, 528, 529, 546,

74th, 193, 195, 333, 336, 481, 494, 497, 499, 500,

529, 539, 540, 546

78th, 192, 195, 197, 202, 336, 340, 402, 532

79th, 193, 196, 335

80th, 192, 195, 197, 202, 387, 402

81st, 192, 195, 197, 335, 493, 529, 535, 540, 546

92d, 12, 15-16

93d, 78, 84, 85, 89

103d, 193, 197, 202, 329, 494, 498, 499, 529, 539,

540, 541, 546

104th, 69-70, 81, 84, 85

105th, 193, 197, 217, 337, 490, 495, 527, 529, 533, 546
INDEX 661

Station Hospitals, numbered—Continued

106th, 329, 496, 528, 546

113th, 74, 77. See also General Hospitals, numbered, 113th.

114th, 193, 195, 197, 219, 336, 337, 350, 493, 528,

540, 546

118th, 329, 496, 528, 546

131st, 32

131st (Ger.), 498

133d, 33

134th, 33

151st, 188, 335, 337

154th, 74, 86, 199, 490, 493, 495, 496, 527, 529, 546

167th, 12, 15

168th, 12, 13, 15

175th, 49, 54, 55

180th, 188, 199, 202, 402

182d, 329, 332, 336, 496, 499, 527, 529, 546

188th, 20-21, 22, 22n

189th, 22

190th, 21

191st, 21

192d, 13, 15

193d, 49, 54, 55

194th, 49, 54, 55

200th, 49, 54, 55

221st, 28-29

225th, 329, 332, 480, 496, 499, 527, 528, 529, 546

255th, 44

256th, 60, 74, 76, 86

262d, 333, 340, 496, 529, 535, 540, 546

292d, 44, 45

293d, 44

294th, 44

295th, 44

296th, 44

297th, 44

298th, 44, 45

299th, 44

300th, 44, 45

301st, 44

308th, 24-25

309th, 25

310th, 25

311th, 25

326th, 44

327th, 15. See also General Hospitals, numbered,

208th.

330th, 44

333d, 38

334th, (Ger.), 498, 535, 539-40, 541

352d, 44

353d, 44

354th, 44

355th, 44

356th, 44

358th, 44

359th, 44, 45. See also General Hospitals, numbered, 41st.

Station Hospitals, numbered—Continued

365th, 15. See also Station Hospitals, numbered,

14th, 15th, 167th.

366th, 15

367th, 85, 103

368th, 38

370th, 85, 183, 187, 335, 338, 498

391st, 549, 550, 551

392d, 550

7029th (It.), 202, 339, 498, 535, 541

7393d (It.), 203, 339

7550th (It.), 339

7607th (It.), 404

Standlee, Col. Earle, 106, 178, 179, 487, 549

Stayer, Maj. Gen. Morrison C., 34, 324, 334, 487,

489, 496, 498, 499, 504, 507, 521

Stephensville, 24

Stevenson, Col. Daniel S., 369, 414

Stewart, Maj. John D., 211

Stone, Col. William S., 212, 354, 361, 362, 363, 364,

487

Storage and issue platoons, 211

Strait of Messina, 157

Strait of Sicily, 155

Strategic Air Forces, 327

Strohm, Col. John G., 180

Suez Canal, 63, 99

Suez Port Command, 63, 79

Sulfa drugs, 94, 98

Sulfaguanidine, 98

Sulfanilamide crystals, 1

Sultanabad, 76

Summer, Lt. Col. William C., 354

Supplies. See Medical supplies and equipment.

Supply Depots. See Medical supply units, Supply

Depots.

Supreme Headquarters, Allied Expeditionary Force

(SHAEF), 376, 385, 405, 486, 532, 541-42

Surgeon General, Office of the, 37, 88, 89, 90, 142,

334

Surgery

evaluation of, in II Corps, 144

exchange, of surgeon, 435

forward, at Anzio, 282

reparative, 351-52, 513

Surgical Groups ,

2d Auxiliary, 107, 110, 122, 127, 128, 154, 183,

225, 238, 249, 253, 263, 282, 283, 287, 310, 314,

358, 371, 374, 408, 416-17, 449, 453, 537, 546

3d Auxiliary, 128, 153, 154, 155

Surgical Hospital, 48th, 107, 113, 113n, 120, 124,

125, 126-27, 129, 132, 144, 145, 185, 188. See

also Evacuation Hospitals, numbered, 128th.

Surgical teams, 144, 435, 449, 466, 469

Surinam, 8, 44

Sward, Col. E. M. P., 27

Sweeney, Col. Leo P. A., 488, 548

Syphilis, 144. See also Venereal disease.

Syria, 68, 81
662 MEDITERRANEAN AND MINOR THEATERS

Tabarka, 132, 137, 138, 142

Tafaraoui, 112, 114, 181

Talara, 38

Tank Battalion, 758th Light, 424

Tarquinia, 305

Tarviso, 549

Task Forces

Butler, 375, 382, 384

45: 415, 417, 418, 418n, 422, 423, 424, 429, 432

92: 422

Tassigny, General Jean de Lattre de, 367, 376

Teano, 242, 255, 265, 291

Tebessa, 121, 122, 123, 124, 125, 126, 127, 129, 130,

132, 137, 142

Technical Supervision Regiment, 2695th, 455, 484,

516

Tedder, Air Chief Marshal Arthur W., 266

Tehran, 64, 74, 76, 79, 82, 86

Tel Aviv, 58, 64, 71, 72

Tel Litwinsky. See Camps, Tel Litwinsky.

Telergma, 132, 137, 139, 142, 190

Tents, use of, 73, 183, 188, 190, 193, 194

Terceira Island, 29

Termini, 158, 164, 167, 181, 206

Terracina, 270, 292, 295, 296, 303

Terrain, 553. See also Drainage.

effect of, on hospital disposition in Iceland, 12

effect of, on neuropsychiatric rate, 256, 409

injuries caused by, in Greenland, 21

mountainous, 133, 160, 231, 233, 240, 245, 295,

395, 422, 426, 429-30, 433, 457, 460-61

muddy, 189-90, 242, 422, 429, 437, 444, 457

swampy, 285

used to protect casualties, 2, 3, 232

Termoli, 232

Tetanus, 172

Thala, 125

The Pas, 31, 32, 33

Thelepte, 139

Thistle, 397

Thurmond, Maj. Alien G., 32

Tiber River, 266, 268, 296

Tingay, Col. Lynn H., 149, 358, 413, 453, 487, 515

Tine Valley, 131

Tinsman, Col. Clarence A., 66

Tirrenia, 491, 494

Titania, 118

Tlemcen, 189

TORCH. See Algeria-French Morocco Campaign.

Tracy, Col. Edward J., 327

Training and Rehabilitation Center, 88th Infantry Division, 315

Transjordan, 61

Trapani, 157, 165

Trench foot, 249, 261-62, 285-86, 350, 353, 386,

412-13, 427, 452

Trento, 525

Treviso, 525, 531

Triage, 14, 171, 171n, 195, 196, 253, 445, 448, 450

Trieste, 523, 549, 550

Trieste-United States Troops (TRUST), 549, 550-

51

Triflisco, 234

Triflisco Gap, 233

Trinidad, 26, 41, 43, 44, 45, 48, 50

Trinidad Sector, 34, 51

Tripoli, 73, 85

Tripoli Base Command, 64, 79. See also Delta

Service Command; Libyan Service Command.

Troina, 159, 160, 161, 164

Troop Carrier Command, 168

Troop Carrier Wing, 51st, 138, 139

Tropical syndrome, 97

Truscott, Maj. Gen. Lucian K., Jr., 117, 152, 162,

270, 273, 277, 367, 423-25, 435, 461, 520

TRUST. See Trieste-United States Troops.

Tuberculosis, prevalence of

in Greenland, 21

in Newfoundland, 26

Tuberculosis sanitorium, 331. See also General Hospitals, numbered, 300th.

Tulagi, 552

Tunis, 82, 85, 121, 122, 131, 149, 156, 168, 175,

188, 205, 226, 266, 498, 509, 510

Tunisia, 63, 65, 67, 73, 83, 104, 122, 127, 139-40,

145, 150, 174, 181, 310, 553 556

Tunisia Campaign, 121-46, 173, 179, 183, 185, 186,

188, 190, 191, 208, 210, 211, 215, 225, 253, 552

Tunisian Desert, 553

Turin, 523, 532

Typhoid fever, 30, 172, 363, 452

Typhoid-paratyphoid infections, 98

Typhus, 321, 326, 363-65, 372, 537, 556

in Africa, 67, 83, 106, 216 220

epidemics of, 262

in the Middle East, 67, 94-95

in the Persian Gulf Service Command, 76

in Sicily, 172

Typhus Commission, 94-95, 363-65

Tyrol, 542

Tyrrhenian Sea, 233, 291

Udine, 525, 526, 530, 532, 549

Umm Qasr, 59, 60

United Kingdom, 30, 80, 108, 120

United Nations Relief and Rehabilitation Administration (UNRRA), 95

United States Army Forces in Canada, 33

United States Army Forces in Central Africa

(USAFICA), 65, 77

United States Forces in the Middle East

(USAFIME), 60, 62, 80

United States Army Forces, South Atlantic

(USAFSA), 47, 48

United States Forces, European Theater (USFET),

542
INDEX 663

United States Military Iranian Mission, 59, 88.

See also Iran-Iraq Service Command; Middle

East. United States Military North African Mission,

56-57, 58, 59, 88

University of Palermo Polyclinic Hospital, use of

by American personnel, 157, 158, 159, 164

Uruguay, 54

USAFICA. See United States Army Forces in

Central Africa.

USAFIME. See United States Army Forces in the

Middle East.

USAHS. See Hospital ships; Hospital ships, named.

USPHS. See Public Health Service, United States.

USSR. See Soviet Union.

Vaccine

distributed by Typhus Commission, 95

shipped by air, 88

suspected as cause of yellow fever in Iceland, 17

used against plague in the Azores, 30

Vairano, 242, 244, 248

Valdibura, 483

Valmontone, 289, 292, 296, 297, 298

Van Valin, Col. James C., 152

Van Vlack, Col. Hall G., 59, 60, 65

Vatican City, 304

Velletri, 270, 296-97

Venafro, 234, 239

Venereal disease, 249, 291, 317, 321, 333, 350,

353-54, 362, 411-12, 444-45, 452, 483, 489,

513, 526, 530, 556

in Africa, 67, 78, 93-94, 106, 221

in the Antilles, 46, 47

at Anzio, 277-78

on Ascension Island, 51

in the Azores, 29, 30

in the Bermuda Base Command, 28-29

in Brazil, 47-48

in Canada, 33

in Eritrea, 93

in Greenland, 21

and houses of prostitution, 92, 93-94, 215, 257,

321, 257-59, 412

in Iceland, 17

in Italy, 257-59

in the Levant Service Command, 93

in Liberia, 81, 93-94

in the Middle East, 79, 88, 92

in Newfoundland, 26

in North Africa, 77, 78, 79

in the Panama Canal Department, 39

in the Persian Gulf Service Command, 76, 92-93

reduction of rates of, 92, 93, 94, 257-59

use of penicillin against, 94, 258

Venereal disease control officers

in the Fifth Army, 257-58, 279

in NATO, 93, 94

Venereal Disease Diagnostic and Treatment Centers, 197, 404, 419, 484

162d Medical Battalion, 249, 258

Fifth Army, 258, 263, 419, 525

Seventh Army, 411-12

Venereal disease hospitals, 249, 277-78, 291, 304,

306-07, 333, 335, 336. See also Station Hospitals, numbered, 53d, 66th.

Venezia Giulia, 549

Venezuela, 34, 41

Venice, 549

Venturina, 306

Verona, 484, 517, 525, 531, 537

Veteran's Administration hospital, transfer of patients to, 6

Veterinarian, Ninth Division, 160

Veterinary Companies

36th, 484

45th, 265, 413-14

Veterinary Corps, 102-03, 263, 320, 517-18

in the Atlantic Defense Area, 9-10

cares for pet animals, 103

in Iceland, 18

inspects food, 102-03, 174

in the Middle East, 102

personnel, 11, 64, 103, 146, 218, 263-64

operates piggeries, 54, 102

in the South Atlantic theater, 54-55

in Tunisia, 146

Veterinary Evacuation Detachments

643d, 517

644th, 517

Veterinary hospital, French, 265

Veterinary Hospitals, numbered

1st General (U.S.-It.), 517

1st Station (It.), 319, 516

2d General (U.S.-It.), 517

Fifth Army Provisional, 265

17th Evacuation, 265, 291, 319, 369, 414

110th Evacuation (It.), 265, 291, 319, 454, 485

130th Evacuation (It.), 265, 291, 319, 454, 485

210th Evacuation (It.), 265

211th Evacuation (It.), 454, 484-85, 517

212th Station (It.), 454, 484, 516

213th General (It.), 359, 516, 517

2604th Station (Overhead), 517

2605th General (Overhead), 517

Viareggio, 527

Vicenza, 525, 526

Vichy government, 46, 66

Vienna, 533

Villafranca, 525, 531, 538

Virgin Islands, 42, 43, 44

Virgin Islands Department, 37

Virus Commission, 99

Visciarro, 265

Vitamin deficiency, chronic, 99-100

Viterbo, 300

Vittoria, 153
664 MEDITERRANEAN AND MINOR THEATERS

Volterra, 307

Volturno River, 230, 231, 232, 233, 234, 237, 241,

244, 248, 253, 527

Wade, Brigadier E. W., 106

Wadi Seidna, 70, 84

Walker, Maj Gen. Fred L., 243

Walsh, Brig. Gen. Robert L., 47

Walter Reed Army Hospital, 6

War Department, 41, 103, 219, 345, 346, 347, 363,

496, 504, 514, 521, 533, 545

Ward, Lt. Col. Thomas G., 89

Wardmen, training of, for Fifth Army Neuropsychiatric Center, 255

Water purification, 68, 73, 76, 214. See also Sanitary conditions.

Water supply

adequacy of in the Levant Service Command,

71

contamination and scarcity of, 68, 73

in Eritrea Service Command, 70

in Libya, 73

in North Africa, 106, 214

in the Persian Gulf Service Command, 76

in Sicily, 170, 172

Weather stations. See Meteorological stations.

West, Capt. John L., 517

West Africa, 60, 80-81, 88

West African Service Command, 66, 81. See also

Central African Command.

Western Desert, 63, 72, 99

Western Hemisphere, 7, 40, 44

Western Task Force, 105, 107, 108, 119, 120, 121,

140, 186

Western Town Command (Africa), 82

Wheeler, Brig. Gen. Raymond A., 59

Whole blood. See Blood, whole.

Wiesbaden conference, development of prisoner

exchange program at, 552

Wilbur, Lt. Col. Bernice M., 219, 360, 487

Williams, Lt. Col. O. S., 541

Williams, Col. Wilson C., 361

Wilson, Maj. Gen. A. R., 368

Wilson, General Sir Henry Maitland, 323, 367, 423

Winnipeg, 32, 33

Winter Line, 233, 235, 238-43, 245, 249, 251, 261,

263, 265, 285, 340

Winter Line campaign, 241, 333

incidence of trench foot during, 261-62, 285

procurement of pack animals for, 263-65

Women's Army Corps, 81, 336, 554

Wooten, Maj. Gen. Ralph H., 47

Wounds, combat. See Hospital admissions, for

combat wounds.

Wright, Lt. Col. Daniel, 90

YAK fighter planes, Russian, 321

Yaws, prevalence of, in Africa, 83

Yellow fever, 67, 83, 91

Youks-les-Bains, 129, ISO, 136, 137, 139

Yugoslavia, 326, 549

Yugoslavs, use of, in hospitals, 510

Zanderij Field, 44

Zehm, Col. Abner, 152, 157

Zone of interior, 148, 150, 498, 501, 502, 511,

514, 530, 532, 533. See also Evacuation, chain

of, fifth echelon.

U.S. GOVERNMENT PRINTING OFFICE : 1987 189-578