CMH_Pub_10-8 Medical Service in the Med

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 theU.S. Army in World War II meant for the American soldier better medicalservice than during any previous war. Improved techniques in the treatmentof wounds and in the prevention and cure of disease went far toward pre-serving the lives and bodies of Army men and women both at the fightingfronts and in the bases and lines of communication that led to them. Theauthor in this volume tells first about the medical provisions for the Atlanticoutposts of the United States established before the substantial deploymentand engagement of Army forces in Mediterranean and European areas, andthen devotes major attention to the Army medical service in the Mediter-ranean campaigns in North Africa, Sicily, the mainland of Italy, and southernFrance. An appendix suggests some similarities and contrasts between Ger-man and American practice during the war.

The book is a natural sequel to one published in this series in 1956entitled, The Medical Department: Hospitalization and Evacuation, Zoneof Interior, and is to be followed by two dealing with medical service in theEuropean Theater of Operations and in Pacific-Asiatic areas. Other relatedvolumes are being published in the series, "Medical Department UnitedStates Army in World War II." While the author of this work has addressedhimself primarily to the interests and needs of the military student andreader, a wider audience should find in his account both practical lessons inthe provision of mass medical care and assurance that such care was adequate-ly given to those who fought in the largest of American wars.

Washington, D.C. HAL C. PATTISON23 September 1963 Brigadier General, USA

Chief of Military History

Introductory Note

The invasion of North Africa on 8 November 1942 was the first groundoffensive for U.S. troops against the European Axis Powers, and so thebeaches of Algeria and Morocco, the barren hills and dry wadies of Tunisia,became the proving grounds for equipment, for tactics, and for men. FromNorth Africa the battle line moved up to Sicily, to Italy, and into southernFrance, but for the Medical Department the Mediterranean remained a"pilot" theater whose accumulated experience saved countless lives on otherfronts. Medical units that had served well in the static warfare of WorldWar I were modified or discarded on the basis of their performance in theMediterranean. New techniques, such as the treatment of psychiatric cas-ualties in the combat zone, and the use of penicillin in forward surgery,were tested. The smaller, more mobile field and evacuation hospitals be-came the workhorses of the theater. Jeeps fitted with litter racks served asfront-line ambulances, while transport planes, their cargoes delivered atforward airfields, were pressed into service to evacuate the wounded.

In the grand strategy of the war the bloody Italian campaign was a di-version, to engage as many enemy troops as possible with the smallest possi-ble commitment of Allied strength. This meant, for the combat troops,being always outnumbered. It meant over and again, for medical and linecommanders alike, giving up formations with priceless battle experience inexchange for willing but untried replacements. In physical terms thetheater imposed the extremes of desert, marsh, and mountain barrier; ofexposed plains crossed by swollen rivers; and the hazards of rain, snow,sleet and mud, each demanding of the supporting medical complementsrevised techniques and new expedients. In no other American combat zonewas there anything comparable to the desert warfare of Tunisia, to the longmartyrdom of Anzio, or to the bitter ridge-by-ridge encounters of theApennines. Small wonder that the medical service described in these pageswas often improvised and always pushed to the very limit of its means, yetnowhere did the Medical Department attain a higher level of effectiveness.

The author of Medical Service in the Mediterranean and Minor The-aters, Charles M. Wiltse, is a graduate of West Virginia University, earnedhis Ph. D. at Cornell, and holds an honorary Litt. D. from Marshall Uni-versity. In addition to numerous articles, essays, reviews, and governmentreports, 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 inthe "Making of America" series, The New Nation: 1800—1845; and is co-author of the official War Production Board history, Industrial Mobiliza-tion for War.

Washington, D.C. LEONARD D. HEATON23 September 1963 Lieutenant General, U.S. Army

The Surgeon General

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Preface

Medical Service in the Mediterranean and Minor Theaters is one ofthree volumes dealing with the overseas administrative history of the UnitedStates Army Medical Department in World War II. Companion studieswill deal respectively with the European Theater of Operations and the waragainst Japan in the Pacific and China-Burma-India Theaters. Thesevolumes differ from the more extensive clinical series, separately publishedby the Office of The Surgeon General, in that they are concerned primarilywith the support given by the Medical Department to the actual combatoperations: the collection of the wounded on the battlefield; the establish-ment of hospitals; the chain of evacuation from the point of contact withthe 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 mat-ters, such as the incidence of disease, the types of wounds predominating,and problems of sanitation, are subordinated to the less technical story ofthe Medical Department in action. The administrative volumes thus relateboth to the general combat history told elsewhere in the series UNITEDSTATES ARMY IN WORLD WAR II and to the medical story properrecorded in the 40-odd volumes of the clinical series appearing under theimprint of the Office of The Surgeon General. They are complemented byClarence McKittrick Smith's Hospitalization and Evacuation, Zone of In-terior; and by four functional volumes, being published by the Office ofThe Surgeon General, which deal respectively with Organization and Ad-ministration of the Medical Department, Personnel, Training, and MedicalSupply.

The manuscript of this volume was submitted in draft form to a sub-stantial cross section of those who participated in the actions described.Those who offered substantiation, corrections, or additions were: AbramAbeloff, 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. CharlesO. 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. JohnA. 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. Mor-rison 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. Withouttheir considerable help much authenticity would be lacking.

Sections of the volume dealing with strictly military events were checkedby knowledgeable members of the Office of the Chief of Military History(OCMH) staff, including Martin Blumenson, Ernest F. Fisher, Jr., andRobert 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 BoydCoates, Jr., Director of The Historical Unit; and by Dr. Stetson Conn, ChiefHistorian, Office of the Chief of Military History. Each of these criticsoffered pertinent and valuable suggestions for improvement.

Mr. William K. Daum did much of the research for chapters I and IIand prepared preliminary drafts of both.

For expert and unfailing aid in locating and procuring the thousandsof documentary sources on which the work is based, the author makesspecial acknowledgment to Mrs. Josephine P. Kyle, former chief of theGeneral Reference and Research Branch of The Historical Unit, and toher assistant, the late Mrs. Eleanor Alfonso, whose cheerful willingness neverfaultered despite the constant presence of fatal illness. Mrs. Kyle's suc-cessors, Maj. Albert C. Riggs, Jr., MSC, and Mr. Roderick M. Engert, didnot participate until the book had reached the stage of review and final re-vision, but both were unstinting of their time and expert knowledge.

The author is also indebted to the Medical Statistics Division, Office ofThe Surgeon General, and especially to Mr. Carroll I. Leith, Jr.,—himselfa veteran of the Mediterranean campaigns—who verified figures and tabu-lations, and in many instances proposed better ways of presenting them.

xiv

Preliminary editorial work was done by Mrs. Cyrilla E. Hickey of TheHistorical Unit, USAMEDS, and the final publications editing by MissMary Ann Bacon of OCMH. Copy editor for the volume was Mrs. MarionP. Grimes. The book is undoubtedly the better for having passed throughthe capable hands of these three editors. The excellent medical situationmaps that make the text so much easier to follow were prepared by MissElizabeth P Mason, assisted by Miss Jean A. Saffran, both of The HistoricalUnit, USAMEDS. The photographs were selected by the author. Theindex was compiled by Susan Stevens New.

Washington, D.C. CHARLES M. WILTSE23 September 1963

ContentsChapter Page

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

I. MEDICAL SERVICE IN THE ATLANTIC DEFENSE AREAS . . 7The Atlantic Approaches to War . . . . . . . . . . . . . . . . . . . . . . . . . . . 7The North Atlantic Bases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Bermuda Base Command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26U.S. Army Forces in the Azores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29U.S. Army Forces in Eastern and Central Canada .............. 30The Caribbean Defense Command . . . . . . . . . . . . . . . . . . . . . . . . . . . 34The South Atlantic Theater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

II. ARMY MEDICAL SERVICE IN AFRICA AND THE MIDDLEEAST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

The Beginnings of Medical Service in the Middle East ......... 56The Middle East as an Active Theater of Operations, 1942-43 ... 60The Middle East as a Supply and Service Theater, 1944-45 . . . . . 80Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Decline of Medical Activities in the Demobilization Period . . . . . 103

III. CONQUEST OF NORTH AFRICA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Prelude to Invasion ........................................ 104Medical Support in the Landing Phase ....................... 108Medical Support of II Corps in the Tunisia Campaign ......... 121Evacuation From II Corps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Professional Services ....................................... 142

IV. SICILY AND THE MEDITERRANEAN ISLANDS . . . . . . . . . . . . . 147Medical Preparations for Operation HUSKY . . . . . . . . . . . . . . . . . . 147Medical Support of Seventh Army in the Field ................ 150Hospitalization and Evacuation ............................. 163Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170Medical Support in the Seizure of Sardinia and Corsica ........ 174

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Chapter Page

V. THE NORTH AFRICAN COMMUNICATIONS ZONE 177Theater Organization ...................................... 177Hospitalization in the Communications Zone ................. 185Evacuation in the Communications Zone ..................... 203Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . 207Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210Army Public Health Activities .............................. 219

VI. SALERNO TO THE GUSTAV LINE . . . . 222Medical Plans for AVALANCHE ............................ 223Medical Support in the Conquest of Southern Italy ............ 226Hospitalization in the Army Area ........................... 247Evacuation From Fifth Army ................................ 250Medical Supplies and Equipment ............................ 251Professional Services in the Army Area . . . . . . . . . . . . . . . . . . . . . . . 252

VII. ANZIO BEACHHEAD . . . . . . . . . . . . . . 2 6 6Medical Planning for Operation SHINGLE .................. 266Combat Medical Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268Hospitalization on Anzio Beachhead ......................... 275Evacuation From the Beachhead ............................. 278Medical Supplies and Equipment ............................ 280Professional Services on the Beachhead . . . . . . . . . . . . . . . . . . . . . . 282

VIII. FROM THE GARIGLIANO TO THE ARNO . . . . . . . . . 289Preparations for the Offensive ............................... 289Combat Medical Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291Hospitalization in the Army Area . . . . . . . . . . . . . . . . . . . . . . . . . . . 303Evacuation From Fifth Army . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . 312Professional Services in the Army Area ...................... 314Medical Support for the Eastern Command . . . . . . . . . . . . . . . . . . 320

I.. THE ITALIAN COMMUNICATIONS ZONE: SOUTHERNPHASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

Changes in Theater Organization ............................ 323Hospitalization in the Communications Zone . . . . . . . . . . . . . . . . . 327Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350Army Public Health Activities .............................. 360

X. INVASION OF SOUTHERN FRANCE . . . . . . . . . . . 366Preparations for the Invasion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366Medical Support of Seventh Army in the Field . . . . . . . . . . . . . . . . 374

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Chapter Page

X. INVASION OF SOUTHERN FRANCE-Continued

Hospitalization in the Army Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386Evacuation From Seventh Army . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395Extension of the Communications Zone . . . . . . . . . . . . . . . . . . . . . . 399Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404Professional Services in Southern France .................... . . 408

XI. THE NORTHERN APENNINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415Preparations for the Offensive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415Combat Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419Medical Support in the Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425Hospitalization in the Army Area . . . . . . . . . . . . . . . . . . . . . . . . . . . 435Evacuation From Fifth Army . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445Medical Supplies and Equipment ............................ 448Professional Services in the Army Area ....................... 449

XII. ADVANCE TO THE ALPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457Preparations for the Final Drive ............................. 457The Po Valley Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460Hospitalization in the Army Area . . . . . . . . . . . . . . . . . . . . . . . . . . . 468Evacuation From Fifth Army . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479Medical Supplies and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481Professional Services in the Army Area . . . . . . . . . . . . . . . . . . . . . . . 482

XIII. THE ITALIAN COMMUNICATIONS ZONE: NORTHERNPHASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486

Organizational Changes Affecting the Medical Service .......... 486Hospitalization in the Communications Zone ................. 489Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502Medical Supplies and Equipment ......................... . . 506Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513Army Civil Public Health Activities . . . . . . . . . . . . . . . . . . . . . . . . . 519

XIV. CONTRACTION A N D REDEPLOYMENT . . . . . . . . . 5 2 1Redeployment Policies and Plans .......................... . . 521Medical Support of Fifth Army .............................. 523Hospitalization and Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528Hospitalization and Repatriation of Prisoners of War .......... 534Redeployment and Inactivation of Medical Units ............ . . 543Close-out in the MTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548

XV. THE MEDITERRANEAN IN RETROSPECT . . . . . . . . . 552

Appendix Page

A. HOSPITAL STATISTICS . 5 5 91. 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-Decem-ber 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562

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

4. Bed Strength and Bed Occupancy, Mediterranean IslandsAugust 1943-April 1945 . . . . . . . . . . . . . . . . . 5 6 5

5. Bed Strength and Bed Occupancy, Italian CommunicationsZone, October 1943-September 1945 . . . . . . . . . . . . . . . . . . . 566

6. Fixed Bed Strength and Bed Occupancy, MediterraneanTheater, November 1942-September 1945 . . . . . . . . . . . . . . 567

B. PRINCIPAL MEDICAL UNITS ACTIVE IN THE MEDITER-RANEAN THEATER OF OPERATIONS, THE ATLANTICDEFENSE AREAS, AFRICA, AND THE MIDDLE EAST 569

C. OBSERVATIONS ON HOSPITALIZATION AND EVACUA-TION SYSTEM, FRENCH EXPEDITIONARY CORPS, AS-SIGNED FIFTH ARMY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598

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

BIBLIOGRAPHICAL NOTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624BASIC MILITARY MAP SYMBOLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633

TablesNo.

1. Hospital Admissions and Dispositions, II Corps, 1 January-15 May1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

2. Air Evacuation From Tunisia, 16 January-23 May 1943 . . . . . . . . . . . . 1403. Intratheater Evacuation by Air, North Africa, 16 January-23 May 1943. . 2054. U.S. Army Patients Evacuated by Sea From North Africa to the Zone

of Interior, 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2075. Hospital Admissions From Fifth Army, 9 September 1943-30 April

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

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6. Disposition of Neuropsychiatric Cases in Fifth Army, September 1943-April 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5 6

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

8. Disposition of Patients, Fifth Army Venereal Disease Diagnostic andTreatment Center, January-April 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . 259

9. Dental Service in Fifth Army, September 1943-April 1944 . . . . . . . . . . . . 26410. Disposition of Problem Cases in the 3d Division, 4 March-30 April

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28511. Admissions to Hospital and Quarters From Fifth Army, May-August

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31012. Air Evacuation From Fifth Army Hospitals, 26 May-31 August 1944 ... 31113. Evacuation From Fifth Army to PBS Hospitals, 1 January—31 August

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31214. Disposition of Neuropsychiatric Cases in Fifth Army, May—August

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31615. Venereal Disease Rates by Divisions, Fifth Army, May—August 1944 . . . . 31716. Dental Service in Fifth Army, May-August 1944 . . . . . . . . . . . . . . . . . . . . 31917. Admissions to PBS Hospitals, 14 October 1943-31 August 1944 . . . . . . . . 33818. Disposition of Patients in PBS Hospitals, 14 October 1943-31 August

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33819. Evacuation From Italy to North Africa, 9 September 1943-21 January

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34320. Evacuation From Italy to North Africa, January-August 1944 . . . . . . . . 34421. Evacuation From the Mediterranean to the Zone of Interior, January-

August 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34422. Venereal Disease Rates, NATOUSA, January-August 1944 . . . . . . . . . . . 35423. Admissions and Dispositions, Seventh Army Medical Installations, 15-

18 August 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38124. Admissions and Dispositions, Seventh Army Medical Installations, 15

August-29 September 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39425. Air Evacuation From Seventh Army and Delta Base Section, 22 Au-

gust-7 November 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39826. Summary of Evacuation to the Communications Zone, 15 August-

3 November 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40027. Establishment in Southern France of Fixed Hospitals From North

Africa, Italy, and Corsica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40128. Requisitions and Tonnage, 7th Medical Depot Company, August-

November 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40629. Receipts and Issues, 231st Medical Composite Battalion, September-

November 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40830. Venereal Disease Rates, Seventh Army, July-September 1944 . . . . . . . . . 411

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31. Disposition of Neuropsychiatric Cases, Fifth Army, September 1944-March 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 2

32. Dental Service in Fifth Army, September 1944-March 1945 . . . . . . . . . . . 45433. Wounded in Action in the Po Valley Campaign, Fifth Army, 1 April-

15 May 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46834. Evacuation From MTOUSA to the Zone of Interior, September 1944-

April 1945 . . . . . . . . . . . . . . . . . . . 5 0 535. Evacuation of Brazilian Patients to Brazil, September 1944-April 1945 . . 50636. Medical Supplies on Hand in PBS Depots, September 1944-April 1945 .. 51237. Noneffective Rates per Thousand of Troop Strength per Annum, Sep-

tember 1944-April 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51538. Intratheater Evacuation: U.S. and Allied Personnel, May-September

1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53139. Evacuation From MTOUSA to the Zone of Interior, May-December

1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3 3

Maps

1. U.S. Army Hospitals Supporting North Atlantic Bases, 1 June 1943. . 132. U.S. Army Hospitals in the Caribbean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363. U.S. Army Hospitals Supporting South Atlantic Bases, 1943-45 . . . . . . . 484. U.S. Army Hospitals in USAFIME, 1 July 1943 . . . . . . . . . . . . . . . . . . . . . 695. U.S. Army Hospitals in the Persian Gulf Service Command, 1 July

1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.6. Medical Support of Eastern Task Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1097. Medical Support of Center Task Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1128. Medical Support of Western Task Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1169. II Corps Medical Installations, 14 February 1943 . . . . . . . . . . . . . . . . . . . . 125

10. II Corps Medical Installations, 24 February 1943 . . . . . . . . . . . . . . . . . . . . 12811. II Corps Medical Installations, 11 April 1943 . . . . . . . . . . . . . . . . . . . . . . . 13012. II Corps Medical Installations, 23 April 1943 . . . . . . . . . . . . . . . . . . . . . . . 13313. II Corps Medical Installations, 12 May 1943 . . . . . . . . . . . . . . . . . . . . . . . 13514. Seventh Army Hospitals, 16 July 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15415. Seventh Army Hospitals, 26 July 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15816. Seventh Army Hospitals, 5 August 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . 16017. Seventh Army Hospitals, 15 August 1943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16118. Fixed Hospitals and Base Medical Supply Depots in North Africa,

November 1942-February 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18419. 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 andCorsica, November 1943-May 1945 . . . . . . . . . . . . . . . . . 2 0 0

21. Fifth Army Hospitals and Medical Supply Dumps, 9 October 1943 . . . . 23222. Fifth Army Hospitals and Medical Supply Dumps, 15 November 1943. . 23623. Fifth Army Hospitals and Medical Supply Dumps, 15 February 1944 . . 24224. Anzio Beachhead and Surrounding Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . 26925. Fifth Army Hospitals and Medical Supply Dumps on the Cassino

Front, 11 May 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29026. Fifth Army Hospitals and Medical Supply Dumps, 10 June 1944 . . . . . . 30527. Fifth Army Hospitals and Medical Supply Dumps, 15 July 1944 . . . . . . 30828. Fifth Army Hospitals and Medical Supply Dumps, 15 August 1944 . . . . . 30929. Fixed Hospitals in Southern Italy, October 1943-October 1947 . . . . . . . 33030. Seventh Army Hospitals and Medical Supply Dumps, 20 August 1944. . 37831. Seventh Army Hospitals and Medical Supply Dumps, 1 September

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38932. Seventh Army Hospitals and Medical Supply Dumps, 15 September

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9 033. Seventh Army Hospitals and Medical Supply Dumps, 30 September

1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39134. Fixed Hospitals Transferred From MTO to ETO, 20 November 1944. . 40335. Fifth Army Hospitals and Medical Supply Dumps, 18 September 1944. . 43636. Fifth Army Hospitals and Medical Supply Dumps Supporting II

Corps, 25 October 1944 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43837. Fifth Army Hospitals and Medical Supply Dumps on the IV Corps

and 92d Division Fronts, 15 January 1945 . . . . . . . . . . . . . . . . . . . . . . . . 44138. Fifth Army Hospitals and Medical Supply Dumps on the II Corps

Front, 15 January 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44339. Hospitals and Medical Supply Dumps Supporting the Fifth Army

Offensive, 18 April 1945 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47040. Fifth Army Hospitals and Medical Supply Dumps, 26 April 1945 . . . . . . 47241. Fifth Army Hospitals and Medical Supply Dumps, 2 May 1945 . . . . . . . . 47442. Fixed Hospitals in Northern Italy, July 1944-October 1947 . . . . . . . . . . . 49243. Medical Installations Supporting Fifth Army, 1 June 1945 . . . . . . . . . . . . 524

Illustrations

. . . the Unsung Heroes of the War . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FrontispieceLt. Col. Charles H. Beasley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11167th Station Hospital, Iceland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14BLUIE WEST 1, Greenland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20308th Station Hospital, Fort Pepperrell, Newfoundland . . . . . . . . . . . . . . . . . . 24

xxiii

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Convalescent Patients, Bermuda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Col. Gordon G. Bulla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Brig. Gen. Morrison C. Stayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Air Evacuation, Panama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Col. George E. Leone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Malaria Control Unit, Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Col. Crawford F. Sams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Col. Hall G. Van Vlack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59DC-3 Over Pyramids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61King George of Greece at 38th General Hospital, Heliopolis . . . . . . . . . . . . . . 70Hospital Train, Benghasi Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Partially Dug-In Hospital Tents Near Tripoli . . . . . . . . . . . . . . . . . . . . . . . . . . 72113th General Hospital at Ahwaz, Iran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74167th Station Hospital at Accra, Gold Coast . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Loading a Patient by Fork Lift, Casablanca . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Brig. Gen. Leon A. Fox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Dental Clinic at Khorramshahr, Iran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Brig. Gen. Albert W. Kenner and General George C. Marshall . . . . . . . . . . . . . 106Col. Richard T. Arnest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Nurses Arriving in Arzew, Algeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Soldier Being Evacuated at Fedala, French Morocco . . . . . . . . . . . . . . . . . . . . . . 118Camouflaged Aid Station, Algeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Mobile Surgical Truck, Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Wrecked Ambulance, Tunisia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1372d Lt. Aleda E. Lutz in Converted C-47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Medical Supplies on Beach, Algeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Lt. Gen. George S. Patton, Jr., and Brig. Gen. Theodore Roosevelt, Jr. . . . . . 148Col. Daniel Franklin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Col. L. Holmes Ginn, Jr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Evacuating Wounded to Landing Craft, Sicily . . . . . . . . . . . . . . . . . . . . . . . . . . 156Administering Plasma, Sicily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Evacuation by Muleback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Holding Hospital, Termini Airfield, Sicily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Forward Surgical Unit, Sicily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Pack Train in Sicily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Maj. Gen. Ernest M. Cowell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Brig. Gen. Frederick A. Blesse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1806th General Hospital, Casablanca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18726th General Hospital Near Constantine, Algeria . . . . . . . . . . . . . . . . . . . . . . . 191Aerial View of Hospital Groupment, Algeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195Prison Stockade of the 180th Station Hospital Near Oran . . . . . . . . . . . . . . . . 203Interior View of Hospital Train . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207Col. William S. Stone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

xxiv

Page

Malaria Control Measures Near Algiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212Brig. Gen. Joseph I. Martin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224Litter Bearers Wading to Landing Craft, Salerno . . . . . . . . . . . . . . . . . . . . . . . 228Planners of the Invasion of Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229Medics Treating Italian Girl, Volturno Area . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Rough Going . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 5Digging Out Wounded Man, Cassino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Casualties From Rapido Crossing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246Aid Station in Sant'Elia Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Wounded German Soldier at 94th Evacuation Hospital . . . . . . . . . . . . . . . . . . 254Treating Moroccan Mountain Troops, Venafro Area . . . . . . . . . . . . . . . . . . . . 261Col. Rollin L. Bauchspies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267Evacuation of Wounded, Anzio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272Pfc. Lloyd C. Hawks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274Hospital Area, Anzio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276Brig. Gen. Frederick A. Blesse Congratulating Col. Henry S. Blesse . . . . . . . . 278Anzio Hospitals Digging In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280Protecting Operating Tents, Anzio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28156th Evacuation Hospital After Bombing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283Treating Casualty at Forward Aid Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293Italian Civilians Help Carry Casualty Down Mountain . . . . . . . . . . . . . . 294Half-Track Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297German POW Giving First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298Wheeled Litter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300Administering Plasma in Jeep Ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . 301Institute of the Good Shepherd, Rome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306Ambulance Plane, Nettuno Airstrip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313Field Unit of Dental Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318Col. Charles F. Shook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324Medical Section of NATOUSA at Caserta, 26 July 1944 . . . . . . . . . . . . . . . . . 325Medical Center at Mostra Fairgrounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328Repatriating Wounded German POW's . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34141st Hospital Train . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345Storing Medical Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348Blood Donors, Naples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353Dusting for Mosquitoes, Cassino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356Brig. Gen. Edgar Erskine Hume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361Delousing Station, Naples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364Lt. Gen. Alexander M. Patch and Col. Frank B. Berry . . . . . . . . . . . . . . . . . . . . 368Lt. Col. Robert Goldson, Col. Myron R. Rudolph, and Col. Joseph Rich ... 370Medics on Beach, Southern France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380Ambulance in Wrecked Village . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383Jeep Ambulance Crossing the Moselle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385

Page

Evacuating Wounded, Southern France Beaches . . . . . . . . . . . . . . . . . . . . . . . . 396Evacuating; Southern France Casualties by Sea . . . . . . . . . . . . . . . . . . . . . . . . . . 399Last Stages of Whole Blood Pipeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410General Martin Receiving OBE From Gen. Sir Harold R. L. G. Alexander. . 416Collecting Point, Mt. Altuzzo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420317th Medical Battalion Collecting Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431Aid Station on Mt. Belvedere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433Tramway, Mt. Mancinello-Pizzo di Campiano Ridge . . . . . . . . . . . . . . . . . . . . 43438th Evacuation Hospital Flooded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439Brazilian Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4428th Evacuation Hospital, Pietramala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445Ambulance on Icy Road . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446Treating a Wounded Mule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455Lt. Gens. Mark W. Clark and Lucian K. Truscott, Jr. . . . . . . . . . . . . . . . . . 459"Ohio Ridge" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464Medics Evacuating Wounded by Jeep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465Medics at Pianoro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467German Receiving Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476German Clearing Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477Lake Garda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479Ambulances Fording Reno River . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481Maj. Gen. Morrison C. Stayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48712th General Hospital, Leghorn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49470th General Hospital, Pistoia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495Italian Partisans at Bari . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49737th General Hospital on the Move . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500Loading Patients, Leghorn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503Storage Area, Leghorn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508Captured Horse at Veterinary Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518Col. Charles O. Bruce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5267029th Station Hospital (Italian) at Pisa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 534German Medical Center in the Alps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 536Hotel-Hospital at Merano . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537German POW Ward Tents, Ghedi . . . . . . . . . . . . . . . . . . . . . . . . . . 539POW Ward, Aversa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 540Readying Medical Supplies for the Southwest Pacific . . . . . . . . . . . . . . . . . . . . . 547Col. Earle Standlee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548

All photographs are from the Department of Defense files except theFrontispiece, which is an adaptation of a painting by Joseph Hirsch in the AbbottCollection 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 fieldof battle, if his wounds are more thansuperficial, may count his life expectancyin hours, or even minutes, unless he re-ceives prompt medical aid. To give himthat succor, and with it the gift of life,is the responsibility of the Army Med-ical Service, still called in World War IIthe Medical Department. Most of thosewhose wounds are not immediately mor-tal may be saved if the flow of blood isquickly stanched, the onset of infectionhalted, the effects of shock minimized,and, above all, if the casualty is speedilybut gently moved to a place of safetywhere needful surgery can be performed.These "ifs" are many, but all of themfall within the medical mission. Each hasits place in one of the most smoothlyfunctioning organizations ever devised.So well did the Medical Department doits work in the Mediterranean theaterthat the chances of surviving battlewounds were 27 to 1: of 112,000wounded, only 4,000 died.1

The cry "Medic!" uttered by awounded man, or by a fellow soldier

who has paused long enough to markthe spot, sets the machinery in motionand begins the chain of evacuation, of-ficially defined as "the entire group ofsuccessive installations engaged in thecollection, transportation, and hospital-ization of the sick and wounded." If thecasualty is conscious and has some mo-bility, he may help himself with anti-septics from his own first aid packet, orperhaps a tourniquet fashioned of ahandkerchief or of a strip torn from hisclothing. If he cannot help himself, andthe tide of battle leaves no one elsenearby, he waits. It will not be for long.A company aidman will soon be there,guided by voice, by some conspicuousmarker such as a rifle stuck upright inthe ground or a helmet hung from a lowbranch, or by instinct sharpened throughmonths of combat. To illustrate theprocess, let us assume a case in whichthe wound is abdominal and severe, andlet us say that the wounded man hasapplied sulfanilamide crystals and adressing before consciousness begins tofade.

The wounded soldier will probablybe found in ten to thirty minutes, de-pending on the movement of the battle,the number of wounded, the nature of

1 These figures do not include 35,000 killed inaction, 20,000 taken prisoner, nor some 9,000missing. All of these, by definition, were "battlecasualties," but did not come within the purviewof the Medical Department.

2 MEDITERRANEAN AND MINOR THEATERS

the terrain, and similar factors. The aid-man (there were normally two such menattached to each infantry company inWorld War II) is trained as a surgicaltechnician. He has earned by repeateddemonstrations of selflessness and en-durance the respect he receives from hisfellow soldiers. His mere presence in thecompany is a morale builder, becausethe men know that as long as "Doc" isthere, they will not be left to die on thebattlefield.

In this hypothetical case, a quickcheck is enough to tell the aidman thecasualty is in shock. He calls at once forone of the four-man litter squads alreadymoving out from the battalion aid sta-tion some 500-800 yards to the rear,where water and a measure of naturalprotection are available. Although hecarries morphine, he will not use itbecause the casualty is unconscious. If itis toward the latter part of the Italiancampaign, however, he will have plasmawith him, which he begins to admin-ister without delay. When the needle istaped in place and the flask suspended,perhaps from the same rifle butt thatguided him to the spot, the aidman willcheck the wound, replacing the dressingif it seems necessary, and perhaps addingtape to make transportation easier. Hethen fills out an Emergency Medical Tag(EMT), copying the man's name andserial number from his dog tag, and in-dicating the nature of the wound, theapproximate time it was inflicted, andthe treatment so far given. The EMT isconspicuously attached to the patientand will go with him along the wholechain of evacuation.

By this time the litter bearers havereached the scene. The litter bearers,along with the aidmen, are the unsung

heroes of the war. They have no weaponssave strength, courage, and dedicationbeyond the call of duty; they have noprotection save a steel helmet paintedfront and back with the red cross, anda red cross brassard on the sleeve; yetthey move among fighting men andwhining shells on the battlefield, con-cerned only for the safety and comfortof the man they lift so carefully onto alitter and carry so gently, avoiding anyunnecessary jar or change of angle, backto a place of relative security—for thecasualty but not for them. They willreturn at once to the battlefield.

At the battalion aid station, thewounded man will be examined for thefirst time by a medical officer, generallythe battalion surgeon. Perhaps an hourhas now passed since the wound wasinflicted. The man is still alive, thanksto the plasma given him on the field, buthe will not be for long without extensivesurgery. If the battle is strongly con-tested—and what battle was not, in that"forgotten theater"?—there will be manycasualties at the aid station, brought infrom the various companies of the bat-talion by the four litter-bearer squadsavailable or walking if their injuriespermit that luxury. Let us assume thatthe case we are following is the mostserious, and so receives the immediateattention of the battalion surgeon. Inthis late stage of the war, the other of-ficer at the aid station will be nonmed-ical, generally Medical AdministrativeCorps, whose duties will include firstaid, but will be primarily to keep thewounded moving—to hospitals fartherto the rear if hospitalization is indicated,or back to the front with a bandage ifthe wound is slight. Manpower is neverso plentiful that it can be dissipated by

PROLOGUE: THE GIFT OF LIFE 3

evacuating men still able-bodied. In ad-dition to the litter bearers, there willbe a group of enlisted technicians, whowill change dressings, administer drugs,keep records, and perform such otherduties as may be required.

There is nothing rigid about the fieldmedical service. Improvisation and adap-tation were the rule in World War IIas they are today. There is a job to bedone, and quickly, with whatever meansare at hand. The job, in the case we areconsidering, is to get a man to surgerywith the least possible delay consistentwith keeping him alive. The battalionsurgeon will probably not change thedressings the company aidman has ap-plied, but will administer more plasmaand perhaps morphine if the man showssigns of returning consciousness. Thewound will be immobilized so far as itslocation permits to minimize the shockof further transportation, additional en-tries will be made on the EMT, and thepatient will be speeded on the nextstage of his journey. His destination nowwill be the clearing station of his di-vision, located five to ten miles behindthe front, and the field hospital set upadjacent to it specifically for forwardsurgery. When he leaves the battalionaid station he will pass from first to sec-ond echelon medical service—from regi-mental to divisional control.

Before we move on to the divisionclearing station with our hypotheticalcasualty, some further explanation maybe in order. In the Mediterranean, as inother overseas theaters in World War II,each division was served by two differentbodies of medical troops. Up to thispoint we have been dealing with per-sonnel of the medical detachment,headed by the division surgeon. In the

medical detachment of an infantry di-vision toward the end of 1944 there were32 officers, including dental and admin-istrative as well as medical, and 383 en-listed men. Each regiment and eachbattalion had its medical section undera medical officer, with enlisted techni-cians attached as aidmen at the companylevel. In addition to the medical detach-ment, each division had an organicmedical battalion, organized into a head-quarters, three collecting companies, anda clearing company. The collecting com-panies, generally attached one to eachregiment of the division, were basicallyambulance and litter-bearer units. Theclearing company, on the other hand,was equipped to function as a small—and sometimes not so small—hospital; orrather, two hospitals, for its two platoonswere always prepared to set up inde-pendently. The usual procedure was tohave one platoon in operation, the otherpacked and ready to "leapfrog" forwardas the line of battle advanced. Betweenthe clearing station and the battalion aidstations there might or might not be acollecting station, set up by the appro-priate collecting company. In Italy,where the roads were relatively good andrugged country offered protection forclearing stations close to the front, theintermediate step was often bypassed.Ambulances, or jeeps fitted with litterracks, picked up casualties at the bat-talion aid stations, or if these were notaccessible to vehicles, at ambulance load-ing posts within reasonable litter carryof the aid stations. If a collecting stationwere established, it would be located toserve two aid stations, or three if all thebattalions of the regiment were engaged.

At the clearing station patients wereagain sorted—the French term triage is


still used in the medical service to referto this process—so that those whosewounds were critical might be cared forfirst; so that specialized needs would bereferred to specialized skills; and as atthe aid station, so that no man would besent farther to the rear than his bodilycondition required. Here there wouldbe medical cases as well as battle woundsand injuries, for the clearing station wasin effect the most forward hospital serv-ing the division and therefore the mostaccessible from the front lines, wheredisease might claim as many victims asbullets. The system that developed inthe Mediterranean about the middle of1943 was to set up as close as possible toeach division clearing station a platoonof a field hospital to receive those casual-ties in need of immediate surgery. Thefield hospital itself was a versatile newunit, capable of operating as a single400-bed hospital, or as three separate100-bed hospitals. When split three waysthe surgical staff was wholly inadequate,but the deficiencies were made up byattaching teams from an auxiliary sur-gical group, some general, some special-ized, but each a fully functioning unitwith its own equipment as well as itsown personnel.

Now let us get back to the casualtywhose progress we are following alongthe chain of evacuation. He is picked upat the battalion aid station by a squadof litter bearers from the collecting com-pany, sent forward from an ambulanceloading post that might be only 300 or400 yards away as the crow flies, but halfto three-quarters of a mile by the nar-row, winding trail that must be used.The tedious and difficult hand carryonce completed, he will be delivered atthe clearing station along with other

wounded men of his regiment in a mat-ter of minutes. It is now two hours ormore since he received his wound, buthe is still alive and his chances are nowgood, for he is only moments away fromthe finest in surgical skill and facilities.The field hospital to which he is im-mediately carried is a tent with packedearth floor, heated if necessary by oilstoves and lighted by generator-drivenelectric lamps. In physical appearance itis not at all like the fine modern hos-pitals at home, but in its equipment andin the skill and motivation of the twosurgeons, anesthetist, and surgical nursewho with two enlisted technicians makeup a surgical team, it is as good orbetter.

From the field hospital rearward prog-ress is relatively standardized. The pa-tient will be retained until he is strongenough to be moved without damage-possibly as much as a week. If the frontadvances significantly in that time, an-other field hospital platoon will set upadjacent to the new site of the divisionclearing station, leaving the old hospitalor a detachment from it to operatewhere it is until all its patients are trans-portable. Our casualty, along with otherholdovers, will next be moved to anevacuation hospital, still in the combatzone, in all probability still under can-vas, but considerably farther to the rear.These units in World War II Tables ofOrganization were of two types: a 400-bed hospital that could be moved quick-ly in two installments with its ownorganic transportation, and a 750-bedhospital in which mobility was sacrificedfor somewhat more complete facilities.Ideally one 400-bed "evac" backed upeach division, some eight to twelve milesbehind the clearing station, with one of

PROLOGUE: THE GIFT OF LIFE 5

the larger units supporting two divisions.Both types of evacuation hospital wereprepared to give definitive treatment toall casualties. They were staffed andequipped, that is, to do whatever mightbe necessary for the recovery of the pa-tient. The primary difference betweenthese hospitals and the so-called "fixed"hospitals of the communications zonewas their proximity to the front lines.For that very reason, however, theycould not hold patients for any greatlength of time. As a rule only those whocould be returned to duty within a weekor two or, alternatively, passed on to aconvalescent hospital, were retained.The convalescent hospital was anothercombat zone unit, where the man nolonger in need of constant medical orsurgical care but not yet strong enoughto fight could regain his vigor. It con-served both professional and combatmanpower by operating with a low ratioof medical officers to beds, and by re-taining in the army area men whoseservices might otherwise have been lostindefinitely in the complex machineryof the replacement center. Those whosetreatment would require a longer periodof time were transferred to the com-munications zone. The particular cas-ualty whose treatment and evacuationwe are discussing will be one of these.

Had he been less severely woundedhis injuries would have been dressedand rebandaged at the clearing stationand he would have been moved to anevacuation hospital for surgery. As it is,he will be a transient at the evac, on hisway to the communications zone. Whenhe moves from the field hospital unit tothe evacuation hospital he will pass fromdivision to army control, at the sametime entering the third echelon in the

chain of evacuation. He will be broughtto the evac by an ambulance of a col-lecting company, but this time it willbe a company of a medical battalion(separate) —not organic to any forma-tion, but in this case assigned to armyand under control of the army surgeon.The next stage of his journey, which willbring him into the fourth echelon of thechain, will be in all probability too longfor an ambulance run.

After a day or two at the evacuationhospital, with a fresh dressing on hiswound and a new entry on his Emer-gency Medical Tag, our casualty willbe moved by ambulance to a nearbyrailhead, port, or airstrip to continuerearward by whichever mode of trans-port is most convenient to the location.In Italy, except for Anzio where alltransportation was by water, it wouldhave been by hospital train, or by C-47cargo plane rigged with litter racks tohold 18 or 20 nonambulatory patientsand staffed by personnel of a medicalair evacuation transport squadron.Either way, responsibility and controlwould have rested with the communica-tions zone, most likely in the Mediter-ranean with a base section. Thisparticular casualty will require further,probably extensive, surgery before hisdamaged organs are restored to relative-ly normal use, so that a general hospitalis indicated.

The numbered general hospital over-seas (as distinct from the named generalhospital in the zone of interior), singlyor in a grouping or center, enjoys therelative safety of the communicationszone. It had in World War II 1,000 to2,000 beds, with many specialties repre-sented on its staff and equipment ade-quate for almost any situation it might


be called upon to meet. A less difficultcase than the one we are following mightgo to a station hospital, which wouldperform most of the functions of a gen-eral hospital—indeed might be acting asa general hospital—but would be smaller,with fewer specialists and less completeequipment. The World War II stationhospital had anywhere from 25 to 900beds; in the Mediterranean most were500 beds. The station hospital normallyserves a post or garrison, referring itsmore serious cases to a general hospital,but in a theater of operations require-ments dictate use. In the Mediterraneanthe station hospital in practice was oftenindistinguishable from the general hos-pital, although a larger proportion of itspatients were apt to be service or otherrear echelon troops. In both types medi-cal cases usually outnumbered surgical.

In the general hospital our casualtymight have another, more leisurely, op-eration, but this will depend on theprobable length of his stay, which willbe determined by the theater evacuationpolicy and by the judgment of the med-ical officers on his case. An evacuationpolicy establishes the number of daysof hospitalization the theater medicalauthorities feel they can give to any onecase. The policy in the MediterraneanTheater varied from 30 to 120 days, butfor most of the time it was 90. Thismeant that if a patient admitted to acommunications zone hospital would inthe opinion of his doctors be fit for dutyin 90 days or less he would be retainedand treated, being returned to his unitor sent to a replacement center when hewas recovered. If, on the other hand, thechances of his recovery within that time

were remote or nonexistent, he wouldbe sent to the zone of interior as soon ashe could safely be moved so great a dis-tance. It is clearly to the advantage of atheater to have as long an evacuationpolicy as possible, because the longer thepolicy the more sick and wounded willbe kept in the theater for future combatoperations. It is the availability of bedsand of trained personnel in relation tothe incidence of battle wounds, injuries,and disease that determines the policy.

Full recovery, in the case we are fol-lowing, will take months or possiblyyears of prolonged and specialized treat-ment. The patient will therefore notstay long at the general hospital, but willbe sent home to the United States asquickly as possible. When he boardshospital ship or plane, according to theavailability of transportation and theurgency of his case, he will enter thefifth and final echelon of the chain ofevacuation. Thus it may well be thattwo weeks after being severely woundedin the mountains of northern Italy, thisparticular soldier will be admitted toWalter Reed Army Hospital in Wash-ington, or to one of the other namedgeneral hospitals that may be closer tohis home. There he will remain untilcured, or until everything that can bedone for him has been done. If his doc-tors believe he is still in need of medicalattention, he will be transferred to aVeterans' Administration hospital. Heis perhaps not quite as whole as he was,but he is alive and capable of usefulcitizenship. That gift of life he owes tothe dedication and skill of the men andwomen who make up the medical serv-ice of the U.S. Army.

CHAPTER I

Medical Service in the Atlantic

Defense Areas

The war against Germany, which be-gan for United States ground forces withthe invasion of North Africa on 8 No-vember 1942, could never have beenwon if the Atlantic approaches had notfirst been secured. Although less spec-tacular than combat operations, theestablishment and defense of sea and airroutes to Europe, Africa, and the MiddleEast were no less essential to the finalvictory. The few permanent installationsin the Panama Canal Zone and PuertoRico were supplemented in the earlyyears of the war by new bases stretchingfrom the Arctic Circle to the Equatorand from central Canada to the Azores.1

The area involved is tremendous, andthe diversity of climate and socioeco-nomic conditions great. Each base whereArmy troops served had its own specialproblems, but there was a common pat-tern. Together, the bases formed a screenof defensive outposts. They were alsoland links in three major transatlanticair routes, and some had additionalstrategic value as jumping-off points forfuture operations.2

The Atlantic Approachesto War

Establishment of Atlantic Bases

The German conquest of France inMay 1940, with its immediate threat toGreat Britain, stimulated the formula-tion in the United States of detailedplans for a dynamic defense of the West-ern Hemisphere that would include out-posts far from the shores of the American

1 This account excludes Alaska, Hawaii, andwestern Canada, which are treated in connectionwith the war against Japan.

2 There is pertinent background material in thefollowing volumes of UNITED STATES ARMY INWORLD WAR II: (1) Mark Skinner Watson, Chief

of Staff: Prewar Plans and Preparations (Washing-ton, 1950); (2) Kent Roberts Greenfield, Robert R.Palmer, and Bell I. Wiley, The Organization ofGround Combat Troops (Washington, 1947); (3)Ray S. Cline, Washington Command Post: The Op-erations Division (Washington, 1951); (4) MauriceMatloff and Edwin M. Snell, Strategic Planning forCoalition Warfare, 1941-1942 (Washington, 1953);(5) Stetson Conn and Byron Fairchild, The Frame-work of Hemisphere Defense (Washington, 1960);(6) Stetson Conn, Rose C. Engelman, and Byron

Fairchild, Guarding the United States and Its Out-posts (Washington, 1963). Also valuable for back-ground are: (7) Samuel Eliot Morison, "History ofUnited 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 "TheArmy Air Forces in World War II," edited byWesley Frank Craven and James Lea Cate, andpublished by the University of Chicago Press: vol. I,Plans and Early Preparations: January 1939 toAugust 1942 (1948), vol. II, Europe: TORCH toPOINTBLANK, August 1942 to December 1943(1949), and vol. VII, Services Around the World(1958).


continents. The swiftly moving eventsof the summer culminated on 2 Septem-ber in a U.S.-British agreement to ex-change fifty overage U.S. destroyers forbases on British soil in the Caribbeanand the Atlantic. The agreement cov-ered Army, Navy, and Air Corps basesin the Bahamas, Jamaica, Antigua, St.Lucia, Trinidad, and British Guiana on99-year lease. At the same time the rightto establish U.S. bases in Newfoundland(then a crown colony) and in Bermudawas granted as a gift. Early in 1942 theBritish Government also authorizedestablishment of an American air baseon Ascension Island, between Brazil andAfrica. Studies of possible sites began inthe fall of 1940 and early the next yearAmerican troops began moving intosome of the new bases.

In mid-1941 American forces beganrelief of the British garrison in Iceland,after diplomatic arrangements with theIcelandic Government. A similar move-ment of U.S. forces into Greenland wasauthorized by the Danish minister inWashington, D.C., who functioned withhis staff as a government in exile afterthe absorption of his country by theNazis. Agreements with representativesof the Dutch Government led to Amer-ican relief of British troops on Arubaand Curaçao Islands, Netherlands WestIndies, and to an American occupationof Surinam. The establishment of airroutes across both the North and theSouth Atlantic led to stationing consid-erable numbers of Army Air Corps andother service personnel in central andeastern Canada, and in Brazil.

During the period before Americanentry into the war, U.S. Army strengthwas built up in Panama and PuertoRico, and the number of troops in the

newly acquired bases also increasedrapidly. An Axis attack across the SouthAtlantic against Brazil was regarded byboth the Army and the Navy as a dis-tinct possibility, whereas a Japaneseattack on Pearl Harbor was thought tobe less likely because of the presence ofthe Pacific Fleet. When the less likelyattack came on 7 December 1941, atten-tion shifted abruptly to the Pacific, andestimates of Army strength necessary tomaintain the security of the Atlanticwere revised in the light of the newconditions. Expansion continued, but ata relatively slower pace. Nevertheless,by December 1942 there were 175,000U.S. troops in the defensive bases alongthe eastern coasts of North and SouthAmerica and on the islands linking theWestern Hemisphere to Europe andAfrica. This figure exceeded the Amer-ican strength in the United Kingdomat that time, and was half of the U.S.Army strength in the Pacific, where ac-tual combat had been in progress for ayear. Troop strength in some areas be-gan to decline while others were stillbuilding, so that the over-all figure neverwas much above that at the end of 1942.The peak month was May 1942, when181,867 U.S. soldiers garrisoned the At-lantic bases.

These bases were set up as semitacticalorganizations, with enough ground com-bat troops in most instances to hold offa hostile landing force until help couldbe sent. Engineer troops were usuallypresent in considerable numbers in theearly stages of occupation, giving wayto Air Forces units, mostly Air Trans-port Command (ATC) personnel, whenthe construction work was finished.Naval forces were also stationed at manyof the bases. Administratively, the new

THE ATLANTIC DEFENSE AREAS 9

bases in the Caribbean were broughtunder the pre-existing military depart-ments having jurisdiction over PuertoRico and the Panama Canal Zone. InBrazil a theater-type organization wasset up to supersede control by the AirTransport Command. In the North At-lantic, however, the various major baseswere established as independent com-mands and were only brought togetherunder the Eastern Defense Command inthe middle of 1944. All of the NorthAtlantic bases ultimately passed to con-trol of the Air Transport Command.

Medical Service in the Atlantic Bases

In Puerto Rico and the Panama CanalZone, medical facilities were part of theArmy's peacetime establishment. War-time needs were met primarily by ex-pansion of units, just as they were inthe zone of interior. In the new bases,however, all medical facilities had to besent in. For the most part, buildingswere constructed by the Corps of Engi-neers, whose troops generally precededboth ground and air personnel. Indeed,the engineers often supplied medicalservice as well as buildings for a timeafter the combat troops arrived. To carefor thousands of civilian workers on itsvarious airfield and other projects at thenew bases, the engineers had been forcedto establish a medical service of theirown. Directing it for the eastern divisionwas Col. (later Brig. Gen.) Leon A. Fox.Usually by the time ground troops ar-rived at a base, the engineers had inoperation an infirmary or small hospital,which served until Medical Departmentunits could be unpacked and housed.3

The Air Transport Command similar-ly had its own medical service, which atsome bases co-existed with the Armymedical service, and at others mergedwith it. Where command of the base it-self passed to the ATC after the war,Army medical facilities and installationswere transferred to the new jurisdiction.

Bed requirements for the new baseswere computed on the same 5-percentratio used for hospitals in the UnitedStates, but in practice the ratio was nevermore than a rough rule of thumb, morenearly true in the aggregate than in de-tail. Initially, hospital care at the baseswas provided by medical detachments,the provisional hospitals established be-ing activated in place later on as num-bered station hospitals. It was not untilthe fall of 1941 that the first numberedhospital units activated in the UnitedStates were shipped out to Iceland. Be-fore the war was over, the number ofsuch units in the Atlantic defense areasincreased to a peak of 5 general hospi-tals, 45 numbered station hospitals, ahandful of unnumbered hospitals ofvarying sizes, and 10 or more dispen-saries equipped to function as smallhospitals. Excluding dispensaries andhospital expansion units, the Table ofOrganization (T/O) bed strengthtotaled a maximum of 10,145 in June1943, at which time the bed ratio (per-centage of the command for which bedswere available) was 5.8.4

Medical Department activities at allof the Atlantic bases included dental and

3 For more detailed treatment, see Blanche B.Armfield, "Medical Department, United States

Army," Organization and Administration, in WorldWar II (Washington, 1963), ch. II.

4 See app. A-1. For various other comparisons,including Medical Department strength, see JohnH. McMinn and Max Levin, "Medical Department,United States Army," Personnel in World War II(Washington, 1963), ch. XL


veterinary work, but for the most partno special problems were encountered incarrying out these functions.

The North Atlantic Bases

Iceland Base Command

As a precaution against possible Ger-man occupation, the British in May 1940sent troops to garrison Iceland. By thespring of 1941, however, the British weretoo hard pressed in Africa to waste man-power on a purely defensive situation.After some hesitation, but with the ap-proval of the Icelandic Government (Ice-landers felt there would be less risk inbeing occupied by a nonbelligerent)President Franklin D. Roosevelt decidedearly in June 1941 to relieve the Britishgarrison with American troops. An ini-tial force of 4,100 marines landed in Ice-land on 7 July. The marines werefollowed on 6 August by the 33d PursuitSquadron, whose P-40's were flown infrom an aircraft carrier. The first incre-ment of ground troops—some 6,000 offi-cers and men of the 5th Division-arrived on 15 September. The IcelandBase Command (IBC) was establishedas the British garrison was relieved, andU.S. forces prepared to protect the trans-atlantic air transport and ferry routesand the vital sea lanes to the BritishIsles, less than 800 miles away.6

Command headquarters was estab-lished at Camp Pershing, about twomiles east of Reykjavík. Several othercamps lay north of headquarters, withina 10-20-mile strip close to the coast andcentering around Alafoss. Eighty percentof the U.S. force was concentrated inthese camps. The remainder was scat-tered at isolated airfields and radar sta-tions around the rim of the island.

The IBC reached peak strength inMay 1943 when, with 40,712 ground,air, and service troops, it was exceededin size only by the Panama Canal Zoneamong Atlantic defense areas. Groundforces included engineer and servicetroops and the entire 5th Division. Aircombat strength was augmented, as soonas suitable fields could be made avail-able, by the 9th Bomber Squadron (H)and the 1st Observation Squadron. Thebulk of the Air Forces units in Iceland,however, were elements of the Air Trans-port Command, whose home base, sharedwith the bombers, was Meeks Field nearKeflavik on the southwest tip of theisland.

By the time peak strength was reached,the threat of German invasion of Icelandwas negligible. In August 1943 the garri-son was cut by more than 25 percent;the entire 5th Division was withdrawn.Thereafter, a steady decline in troopstrength brought the total to less than1,800 men by the end of 1945, more

5 Principal sources for this section include: (1)Conn, Engelman, and Fairchild, Guarding theUnited States and Its Outposts, chs. XVIII, XIX;(2) Narrative Hist, Iceland Base Comd, AlwaysAlert, 16 Sep 41-1 Dec 45, MS, OCMH files; (3)Lt. Col. William L. Thorkelson, The Occupationof Iceland during World War II, MA Thesis, Syra-cuse University, September, 1949; (4) Annual Rpts,Surg, IBC, 1941-44; (5) Annual Rpts, Surg, 5thDiv, 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) AnnualRpts, 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, commentingon preliminary draft of this volume.


COLONEL BEASLEY

than a third of them Air Forces person-nel. The Iceland Base Command, whichwas under the European Theater ofOperations (ETO) from June 1942 on,passed to control of the Eastern De-fense Command in the middle of 1944.The Air Transport Command, whichretained an interest in Iceland after thewar was over, assumed control of allremaining U.S. Army activities there on1 January 1946.

Medical Organization—The strengthof the Medical Department in Icelandrose from 749 at the end of 1941 to2,959 a year later. By the end of 1943the total number of officers, nurses, andenlisted men of the Medical Departmenthad declined to 1,163 and was down to429 by the end of 1944. T/O bedstrength went through a correspondingexpansion and decline, from an initial750 to a peak of 2,600 in October 1942,declining to 400 by the middle of 1944.

The base command surgeon duringthe most active period was Lt. Col.(later Col.) Charles H. Beasley, who had

accompanied the initial Marine contin-gent in July in order to make a medicalevaluation of the island. Colonel Beasleyreturned to Iceland with the Armyground troops, remaining until August1943, when he was relieved by Col. JohnF. Lieberman. Lt. Col. John C. McSweenbecame IBC surgeon in early 1944. Inaddition to its regular function as guard-ian of the health of the U.S. troops inthe command, the base surgeon's officedid much to win over the Icelandicpeople. Army hospitals treated largenumbers of Icelandic citizens who hadbeen injured in the vicinity of Americancamps, and also cared for civilians whowere struck by military vehicles. Mem-

bers of the Medical Department co-oper-ated freely with the local public healthauthorities, and Army veterinarians help-ed their Icelandic colleagues examine,test, and treat livestock, and aided themin other agricultural matters. Many ofthe most prominent doctors of Icelandinspected U.S. Army hospitals and at-tended Army medical meetings. In turnAmerican medical officers visited Ice-landic patients in consultation. On sev-eral occasions the Army supplied localhospitals with urgently needed drugs andbiologicals, while the American RedCross contributed hospital and medicalsupplies to its Icelandic counterpart.

The work of the surgeon's office re-volved around the system of hospital-ization and evacuation and the relatedmedical supply function, each of whichwill be discussed under a separate head-ing. Supplementing these activities atthe base command level was the divi-sional medical service, which operated


camp dispensaries and treated 5th Di-vision personnel wherever they werestationed. The organic 5th MedicalBattalion furnished routine evacuationservice from unit dispensaries to nearbystation hospitals and from the hospitalsback to the dispensaries. The medicalbattalion also operated a dispensary forthe port of Reykjavík and ran a provi-sional hospital in the Keflavik area untila permanent station hospital was estab-lished there. Air Forces units maintainedtheir own dispensaries and operatedcrash aid stations for emergency treat-ment at the various airfields. Engineertroops, which preceded the Army combatelements by about a month, had theirown medical detachments, but anythingof a serious or complicated nature wentto Marine and later to Army instal-lations.

Hospitalization—The disposition ofU.S. Army hospitals in Iceland wasdictated by the combination of moun-tains, lava beds, and glaciers that circum-scribed roads and airfields, and by therugged coast line, turbulent seas, andicebergs that made water evacuation haz-ardous much of the year. Although thebulk of the beds were in the Reykjavík-Alafoss area to serve the largest concen-tration of troops, it was still necessaryto supply hospital facilities whereverAmerican soldiers were stationed. Threenumbered station hospitals arrived withthe main body of troops in mid-Septem-ber 1941, and two of these were in oper-ation before the close of the year. The168th Station Hospital was establishedin Reykjavík in a permanent buildingformerly used by a British hospital. Themain 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 24September. The following week the nthand 167th Station Hospitals, both 250-bed units, which had arrived in Icelandat the same time as the 168th, were at-tached to the latter until suitable sitescould be prepared. The 11th StationHospital opened on 22 December in asection of a British hospital at CampHelgafell, some ten miles north ofReykjavík. The 167th remained at-tached to the 168th until April 1942,when it moved into newly erected Nissenhuts at nearby Alafoss. (Map I.)

During 1942 six more station hospitalsand one general hospital arrived on theisland to serve an increasing number ofArmy troops coming in from the UnitedStates. The 1,000-bed 208th GeneralHospital came in March and began oper-ating before the end of the month atCamp Helgafell, where it shared quar-ters with a British general hospital andthe U.S. 11th Station Hospital. The 11thmoved in June to Kaldadharnes, sometwenty-five miles southeast of Reykjavík,where it served personnel of an airfield.The British hospital was withdrawn tothe United Kingdom in August, leavingthe 208th General in sole possession ofthe hospital plant.

The 72d and 92d Station Hospitalsboth arrived in August 1942. The 92d,with 75 beds, began operating in Sep-tember at Reykjaskoli near the head ofHnitafjordhur on the north coast of Ice-land. The 72d—a 50-bed unit—wasscheduled for Borgarnes about thirtymiles north of Reykjavík but, becauseof a variety of construction difficulties,did not get into operation until the be-ginning of January 1943. By then changesin troop dispositions had made a hospital


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

at Borgarnes unnecessary, and the unitwas moved later in January to Kaldad-harnes, where air activity was increasing.The 75-bed 14th Station Hospital andthe 500-bed 49th both reached Icelandin September 1942 and went into opera-tion the same month. The 14th was atSeydhisfjordhur on the eastern coast; the49th enlarged a 200-bed hospital plant

taken over from the British near Akure-yri on the north coast, the second largestcity in Iceland and the site of a large sea-plane base. The 15th Station, another75-bed unit that also arrived in Septem-ber, began operating at Budhareyri,about forty miles south of the 14th, inNovember. The 75-bed 192d StationHospital arrived in October and was


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

attached to the 168th Station at Reyk-javík until its own hospital plant at Höfnon the southeastern coast was ready inJanuary 1943.

With the exception of the 168th Sta-tion at Reykjavík, all U.S. hospitalplants, including those taken over fromthe British, were Nissen, Quonset, orsimilar types of corrugated steel huts.Even with prefabricated buildings, how-ever, construction was difficult. Materialsfor drains, plumbing, and electrical fix-tures were not always available. Littlecould be accomplished during the wintermonths, when the nights were twentyhours long, and even the brief periods ofdaylight were often marred by cold,

dampness, and winds up to 130 miles anhour. A civilian labor shortage forcedreliance on troop labor, including thatof Medical Department personnel. In thevicinity of Alafoss natural hot springswere used for heating hospital buildings.

The officers, nurses, and enlisted menof Iceland Base Command's hospitals, inaddition to caring for all U.S. Army per-sonnel in the command, provided hos-pitalization for members of the AmericanRed Cross and for U.S. civil service em-ployees. They also treated and hospital-ized on occasion U.S. Navy and MarineCorps personnel, certain British Army,Air Force, and Navy men, some membersof the Norwegian Army and Navy, and


American and Allied merchant marinecasualties and survivors from sea mis-haps. However, the bulk of patients were,of course, from the various camps of thecommand.

As the threat of German invasion ofIceland faded during 1943, the with-drawal of troops and relocation of re-maining forces brought a number ofchanges in hospital dispositions. In Aprilthe 192d Station left Höfn for theReykjavík area, where most of its per-sonnel were already on detached servicewith the 168th Station, but the hospitaldid not resume independent operation.Further shifts came in June when the15th Station, no longer needed atBudhareyri, was attached to the 49th atAkureyri, and the 92d Station, includingpatients, was transferred from Reykjas-koli to Alafoss.

On 24 June the 192d Station Hospitalwas disbanded and its personnel andequipment were transferred to the 92d,which was reorganized as a 150-bed unit.On the same date the 208th GeneralHospital at Camp Helgafell was reducedfrom 1,000 to 750 beds, and the 168thStation in Reykjavík was expanded from250 to 500 beds, in preparation for amission elsewhere.

A few days later, on 2 July 1943, the208th General was redesignated the 327thStation Hospital, without change of siteor mission. On the same day the 500-bed49th Station closed at Akureyri, leavingthe smaller 15th Station to care for re-maining patients in that area, and a weeklater sailed for the United Kingdom. Itwas followed by the 168th Station on 3August.

The 11th Station, meanwhile, hadshifted from Kaldadharnes to Reykjavíkto replace the 168th. It was joined there

by the 72d Station on 19 August. Twodays later the 92d Station Hospitalopened near Keflavik, adjacent to theMeeks Field headquarters of the AirTransport Command.

By this time the bulk of the groundforce troops had left, as had many of theair and service forces. When the 15thStation from Akureyri and the 14th fromSeydhisfjordhur both moved to theAlafoss Helgafell area late in September,all U.S. hospitals were concentrated inthe Reykjavík area. It remained only toconsolidate the units for more efficientoperation.

The first step in this direction wastaken on 30 October when the 327th Sta-tion sailed for England. A consolidationof the remaining hospitals was effectedon 6 December 1943. The 11th and 72dStation Hospitals were combined atReykjavík to form the 150-bed 366thStation, while the 14th, 15th, and 167thStations were combined at Camp Helga-fell to form the 365th Station Hospital,with a T/O of 500 beds. At the end of1943 only the 92d, 365th, and 366th Sta-tion Hospitals remained in Iceland, witha combined bed strength of 800. Sevenmonths earlier there had been one gen-eral and nine station hospitals, with anaggregate of 2,600 T/O beds.

Except for Iceland's strategic functionas a stop on the air route to Europe, thewar there was over. Hospitalization wason a garrison basis, with the garrisonsteadily decreasing in size. The 365thStation transferred to the United King-dom on 26 June 1944. On the first of thatmonth the 92d Station had increased itsbed strength from 150 to 250, but thenumber of beds on the island was stillhalved. The 366th was inactivated earlyin 1945, leaving the 92d Station the only


U.S. Army hospital in Iceland. It wastransferred to the jurisdiction of the AirTransport Command on 1 January 1946,along with the remains of the IcelandBase Command.

Evacuation—From most of the armycamps in Iceland patients were evacuatedby ambulance from the unit dispensaryto the nearest station hospital. Thosewho required general hospital care weremoved on to the 208th General Hospitalat Camp Helgafell, by ambulance fromstation hospitals in the western part ofIceland, by sea or air from those in moreisolated areas. Evacuation by boatthrough coastal waters proved to be avery efficient method of handling pa-tients from the eastern and northernparts of the command except during thelong winter season, and was more fre-quently used than air evacuation.

The 120-day evacuation policy set upby the War Department for evacuationfrom Iceland to the United States provedto be entirely satisfactory. Both air andwater transportation were used. In eithercase, patients to be evacuated to the zoneof interior were cleared through the208th General Hospital or, after itsdeparture, through a station hospital act-ing as a general. Although the number ofevacuees was not unduly large—327 in1942, 1,180 in 1943, and 248 in 1944—there was generally a backlog because ofunavailability of transportation or lackof proper facilities, especially for neuro-psychiatric and other cases requiringmedical attendance. Psychiatric casesamounted to 33 percent of those evac-uated in 1942, 32 percent in 1943, and56 percent in 1944.

The medical facilities of the IcelandBase Command were also available, to

the extent needed, to care for 19,589transient patients who were flown fromthe ETO to the zone of interior byway of Iceland between 1 January 1944and 1 July 1945. To accommodate these,an unnumbered holding hospital was setup at Meeks Field, including mess facil-ities for walking patients. Litter caseswere served hot meals aboard the planes.If a plane were held because of poor fly-ing conditions, the 92d Station took careof the patients until they could continuetheir journey. The hospital also took careof any patients whose condition madeit unsafe to continue. Medical attentionwas similarly available to 5,930 able-bodied men from the ETO who passedthrough Iceland between June and Sep-tember 1945 on their way to the States.

Medical Supplies and Equipment—Medical supplies for the Iceland BaseCommand were handled through a maindepot in Reykjavík and a subdepot anda package storage depot in the Alafossarea. The main depot—two fish-dryinghouses leased for the purpose—had morethan 11,000 square feet of floor space forstorage; the subdepot, in three prefabri-cated huts, had 2,880 square feet of stor-age space; and the package warehouseabout a mile distant had 4,000 squarefeet. Individual hospital and other medi-cal units maintained supply levels offrom 90 to 180 days, the larger stocksbeing held by installations on the north-ern and eastern coasts, which were notreadily accessible in bad weather. Thedepots held a 120-day supply by the endof 1942.

Six officers and 75 enlisted men wereauthorized for operation of the medicalsupply system in Iceland, but this num-ber was never reached. Five officers and


50 enlisted men were sent, but even thesefigures were reduced by attrition to 4 and45 respectively before the end of 1942.The supply system was reorganized earlyin August 1943 and again in mid-Decem-ber. In August a Base Depot Section,20th Medical Depot Company, was or-ganized to carry on the medical supplyfunction, but was supplanted in Decem-ber by the 300th Medical CompositePlatoon. Under the latter form of organ-ization the depots were operated by twosupply teams, one with an officer and 11enlisted men, the other with 2 officersand 27 enlisted men.

While some medical units encountereda number of delays in getting their nor-mal equipment, medical supplies as awhole were plentiful. Some items, suchas quinine, mosquito bars, and variouscombat items, were never required inIceland, and other items became surplusas the strength of the command declined.During 1943 excess British medical sup-plies to a total of 130,000 pounds, and2,325,000 pounds of excess U.S. medicalsupplies were shipped to the UnitedKingdom. The year's end still found thedepots bulging with supplies for 60 daysof operation, 90 days' maintenance, anda further 90-day final reserve of certainnecessary items, held in dispersed loca-tions. These levels were sharply reducedduring 1944 to a 30-day operating and30-day maintenance level.

Professional Services—In spite of un-familiar and unfavorable climatic condi-tions, the incidence of disease amongU.S. troops in Iceland was exceptionallylow. There were no diseases peculiar tothe country, no mosquitoes, few insectsof any kind. Common respiratory dis-eases constituted overwhelmingly the

largest single cause for hospitalization.Half of all hospital admissions in 1942were for respiratory diseases. In 1943 therespiratory disease rate was 190 per 1,000per annum, including mild cases treatedin quarters as well as those hospitalized.The 1944 rate, similarly computed, wasdown to 95. The command experienceda sharp rise in rates for such diseasesafter the arrival of each new troop con-tingent, but the situation would returnto normal in about a month.

An outbreak of jaundice in May 1942claimed 478 in that month. In June thenumber of cases climbed to 661, drop-ping to 170 in July and only 11 in Au-gust. The total number of cases for the 4-month period was 1,320. There were nodeaths from jaundice. The cause was notdetermined. Large numbers of the ratsthat abounded in Iceland were exam-ined, but none were found to be diseased.There appeared, however, to be someconnection with yellow fever inocula-tions. All but 7 of the 1,320 men whocame down with jaundice had been inoc-ulated for yellow fever from the same lotof vaccine before leaving the UnitedStates.

An epidemic of mumps in the civilianpopulation in 1942 was kept from spread-ing to the troops by prompt preventivemeasures. Only 128 sporadic cases werereported. Venereal disease, scourge of theMediterranean and European theaters,was notable in Iceland chiefly for its al-most total absence. Venereal rates forthe base command were 4.4 per 1,000per annum in 1942; 5.3 in 1943; and 6.2in 1944. Only mental disorders showed asignificant rise as time went on. Isolation,boredom, lack of recreation, adjustmentproblems, and a feeling of contributinglittle to the war effort combined to pro-


duce relatively high neuropsychiatricrates.

The general health of the U.S. troopsin Iceland, excellent at all times, steadilyimproved throughout the war. The non-effective rate for 1942 was 29.5 per 1,000;in 1943 it was only 25.37; and in 1944 itwas a startling 16.28. There were, ofcourse, no combat wounds, and the acci-dent rate-primarily plane crashes—wasrelatively low.

The dental service in the Iceland BaseCommand encountered no unusual dif-ficulties. Dispersal of troops made itexpedient to assign dentists to areasrather than to clinics, but for the mostpart the work itself was routine. TheVeterinary Corps encountered moreserious problems, stemming largely frominadequate sanitary standards on the partof the local authorities. From theirarrival on the island, U.S. veterinarypersonnel worked with the Icelandicauthorities and with individual farmersand food processers to improve methodsand standards.

Greenland Base Command

After months of indecision, officialsof the State, War, and Navy Departmentsagreed early in February 1941 that air-fields and other facilities in Greenlandwould be needed for hemisphere defense,and that in view of the Monroe Doctrinethe United States could permit no otherpower—not even friendly Canada—totake the initiative there. A survey expedi-tion sailed in March. Less than a monthlater, on 9 April, the project receivedformal sanction when the Danish Minis-ter in Washington (still recognized bythe United States) and the Secretary ofState signed an agreement under which

the United States guaranteed the securityof Greenland in return for the right toconstruct, maintain, and operate the re-quired facilities. The first echelon of theGreenland force—469 officers and men-sailed from New York on 19 June andanchored off Narsarssuak on the south-west coast of Greenland on 6 July.6

To the United States and Great Brit-ain, Greenland was considerably morethan the "raw structure of rock and saltwater and ice, all united by the eternalcold" that Col. Bernt Balchen had de-scribed. It was a potential stop on an airferry route that could enable fighterplanes to move from American factoriesto British bases under their own power;it was the only known commercial sourceof natural cryolite, invaluable as anelectrolyte in the production of alumi-num; and it was the gathering point forthe storms that would influence air andnaval activity in western Europe. TheGermans had recognized the importanceof obtaining weather data in Greenlandand had established several meteorologi-cal stations that were subsequently elimi-nated by the British in the summer of

6 Sources for this section are: (1) Conn, Engel-man, and Fairchild, Guarding the United Statesand Its Outposts, ch. XVII, ch. XX; (2) Cravenand 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 Mif-flin Company, 1944); (4) Annual Rpts, Med DeptActivities, Greenland Base Comd, 1941-44; (5) An-nual Rpt, Base Hosp, Greenland Base Comd, 1946;(6) ETMD's (Essential Technical Medical Data),Greenland Base Comd, Jul 43-Nov 45; (7) Intervwith Lt Col Otho R. Hill, 6 Sep 44; (8) Intervwith 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 AtlWing, ATC; (12) Ltr, Norman L. Heminway toCol Goriup, 16 Aug 59; (13) Ltr, John R. McBrideto Goriup, 28 Jul 59. Both letters comment on pre-liminary draft of this volume.


1940. Later, however, another Germanweather station was believed to be inoperation. This was located and de-stroyed by an American force, but theGermans continued to obtain Greenlandweather reports from a submarine keptin the area for that purpose.

In addition to its responsibility for thehealth of Army and Air Corps personneland employees of civilian contractorsstationed there, the Medical Departmentin Greenland supplied hospital facilitiesfor the crews of Navy, Coast Guard, andmerchant vessels and of transient air-craft. A small detachment of MedicalDepartment officers and enlisted menarrived with the first contingent at Nar-sarssuak, where the first U.S. militarypost, BLUIE WEST 1, was established. InAugust 1941 the medical detachmentthere set up a 10-bed field-type tent hos-pital, which operated for two months be-fore a suitable building could be erected.A 5-wing cantonment-type building waseventually built. The wings were con-nected by heated corridors. Supply roomsand the mess hall were off the maincorridor, opposite the clinic and hospitalwings. Initially, only one wing withtwenty beds was required for inpatients.It was not until January 1943, when sur-vivors from the torpedoed USAT Dor-chester were brought to BLUIE WEST 1,that two other wings were made ready,expanding capacity to approximatelysixty beds.

In October 1941 a post was establishedat the head of Søndre Strømfjord on thewest coast of Greenland about fifteenmiles inside the Arctic Circle. Known asBLUIE WEST 8, this post was under com-mand of the famed arctic explorer, Capt.(later Col.) Bernt Balchen, with Maj.(later Col.) John R. McBride as sur-

geon. BLUIE WEST 8 included civilianconstruction workers, who had beenthere since September, and Army engi-neers. The engineer medical officer,Capt. (later Lt. Col.) Stephen W. On-dash, was responsible for the health ofthe civilians. The first hospital set up onthe post, an engineer unit available toall, opened on 10 December 1941.

In November a post was establishedat Angmagssalik on the eastern coast ofGreenland about forty miles below theArctic Circle. BLUIE EAST 2, as the newpost was called, was primarily a weatherand communications station. It includeda medical officer and an engineer dis-pensary operated by civilians. In March1942 a post was set up at Ivigtut, about100 air miles west of Narsarssuak, wherethe cryolite mine was located. The Ivig-tut base was called BLUIE WEST 7. ByJune a small building had been erectedfor a dispensary.

The Greenland Base Command, withheadquarters at BLUIE WEST 1, had mean-while been formally activated on 26 No-vember 1941, although Army forces inGreenland had been using that designa-tion since their arrival. There was nosurgeon for the whole command, how-ever, until November 1942, when Colo-nel McBride, as the senior Air Forcesmedical officer on the island, was assignedthat responsibility. He was succeeded inMarch 1943 by Maj. (later Col.) NormanL. Heminway, commanding officer of the188th Station Hospital and surgeon ofthe BLUIE WEST 1 base. In DecemberColonel Heminway was transferred,being succeeded in each of his threecapacities by Maj. (later Lt. Col.) OthoR. Hill.

Under War Department authoritygranted in September 1942, four num-


BLUIE WEST 1, Narsarssuak, Greenland, May 1943, with the 188th Station Hospital underconstruction in right foreground.

bered station hospitals were activated toreplace the makeshift units then func-tioning. (See Map I.) Cadres weredrawn from Medical Department person-nel already on the ground and actuallyoperating the existing hospitals and dis-pensaries that were to be elevated tonumbered status by the new arrange-ment. Authorizations were given for hos-pitals of 250, 200, 150, and 25 beds, forBW-1, BW-8, BE-2, and BW-7 re-spectively. Construction of buildings be-gan in the fall of 1942, continuing intothe late months of 1943. The bulk of the

work was completed by the end of thatyear, when the troop build-up reachedits maximum strength of about 5,300.The unduly long construction time wasdue in part to weather hazards, in part tolow priority in a very restricted labormarket, and in part to the necessity forimporting all building materials fromthe United States.

Largest of the hospitals, the 188th Sta-tion, opened at BLUIE WEST 1 in its newbuildings in December 1943. One of thefinest examples of an overseas hospital,the installation was located for maxi-


mum terrain protection. It was built at acost of $1,769,022. Its 32 cantonment-type buildings on 22.5 acres were con-nected by heated and insulated corridors.Central heating, electricity, running hotand cold water, and a modern sewagesystem made it a comfortable haven inthe frozen wasteland of Greenland. The188th Station, in addition to its functionas post hospital, received patients fromother units, mostly by air, who requiredfurther observation or treatment. It alsoacted as clearing and processing point forcases being evacuated to the UnitedStates.

Additional hospital construction at thesmaller posts in Greenland during 1943made conditions less crowded, but bedrequirements were never as great as hadbeen anticipated. The 190th StationHospital, originally authorized as a 200-bed unit, was reduced to a 50-bed hospi-tal by the time it moved into itspermanent quarters at BLUIE WEST 8.The 191st Station at BLUIE EAST 2 alsooperated as a 50-bed unit, although itsoriginal authorization had been for 150beds. The smallest of the four Green-land hospitals, the 189th at BLUIE WEST7, remained a 25-bed unit throughout itsperiod of operation. At none of the fourpost hospitals was medical service seri-ously interrupted during the period ofconstruction. New plants were occupiedby echelon, as space became available,without closing down the old until thenew was functioning. Such unavoidablecurtailment of minor services as occurredwas compensated for by treating as manycases as possible on a "quarters" basis.

During the greater part of the year,transportation by water was very difficultor impossible. Therefore, each of thefour main Army bases in Greenland had

to be largely self-sufficient from the stand-point of supply. In practice this imposedno handicap as supplies for the base com-mand as a whole were more than amplethroughout the war. The months of iso-lation envisaged by the planners nevermaterialized.

In addition to the four bases them-selves, there were a dozen or moreweather observation and radio postsoperating out of one or another of theBLUIES. For the larger outposts of thistype a medical officer was provided; forthe smaller, only a trained Medical De-partment enlisted man could be spared.

Although the climate was much moresevere and the setting far more bleakthan anything the men had before ex-perienced, there were no adverse effectson health. There were no indigenousdiseases. The native Eskimos sufferedheavily from tuberculosis, but contactsbetween the natives and the U.S. troopswere so infrequent as to remove the haz-ard. The only venereal cases were amongthose who had been infected outside ofGreenland. Respiratory diseases madeup the largest item in the disease cate-gory, with newly arrived troops the mostfrequent victims. On the whole, however,the incidence of disease in Greenlandwas very low. Injuries, directly relatedto the treacherous and rugged terrain,ship loading and unloading, and con-struction work accounted for the largestnumber of patients admitted to hospitals,as well as about a quarter of all thoseevacuated to the zone of interior. Thesecond largest group returned to the zoneof interior, accounting for about 18 per-cent of the total, were the neuropsychi-atric cases, stemming from the pro-longed service in an isolated, unpleasantenvironment, combined with constant


monotony and a complete lack of normalsocial contacts. A general apathy, calledby the men stationed in Greenland,"The Arctic Stare," developed in a ma-jority of troops after a year's stay on theisland. It was notable, however, that evenin the most difficult year, 1944, neuropsy-chiatric cases constituted only about 4percent of hospital admissions. The sui-cide rate was also relatively low. Admis-sions for all causes to the main hospitalof the command, the 188th Station Hos-pital, numbered 1,821 in 1943 and 2,137during 1944.7

Evacuation of patients within Green-land moved from the outposts to themain bases, where the permanent hospi-tals were established, and thence, if moreelaborate treatment or ZI evacuationwere indicated, to the 188th Station Hos-pital. Patients could be evacuated to the188th from other parts of Greenland onlyby air and by sea, while those withinBW-1 came in by bus or ambulance.Most of the patients sent to the zone ofinterior for further treatment were trans-ported there by air; a few went by ship.Weather problems frequently compli-cated evacuation procedures in Green-land. Poor flying conditions or ice packs—which prevented the passage of ships-were responsible for many delays. Green-land Base Command sent an average of15 to 25 patients a month to the UnitedStates for general hospital treatment. Be-ginning in 1944 the personnel of the188th Station Hospital and the AirTransport Command fed and furnishedprofessional services to transient patientsbeing evacuated by air from Europe to

the United States. From May to October,471 such cases passed through the com-mand, 34 of which were temporarilyhospitalized.

General reductions in strength during1944 resulted in practically all groundforce units being withdrawn from thecommand, leaving mostly air and servicepersonnel. The base established to pro-tect the cryolite mine at Ivigtut closedduring the summer, and the 189th Sta-tion Hospital, which was located there,ceased operations in August. At the endof that month, Colonel Hill left theGreenland Base Command, being suc-ceeded as post surgeon and commandingofficer, 188th Station Hospital, by Capt.(later Maj.) John A. Jones, and asGreenland Base Command surgeon byMaj. Andrew W. Shea. Medical units op-erated below T/O authorizations whenpossible. Excess medical personnel andlarge amounts of surplus medical sup-plies were returned to the United States.

Greenland Base Command had be-come primarily an Air Transport Com-mand stopover and a weather forecastingcenter a year before the ATC assumedfull responsibility for all U.S. activitieson the island in January 1946. Only thehospital at BLUIE WEST 1 continued ac-tive at this time.

Newfoundland Base Command

The island of Newfoundland lies onthe great circle route between New Yorkand the British Isles, controlling both seaand air lanes and blocking the mouth ofthe St. Lawrence. Its strategic import-ance had made its defense an object ofconcern to the United States and Canadaearly in the war. The right to establishU.S. bases there was given at the time of

7 No detailed admission statistics are available forthe other hospitals of Greenland Base Command,but admissions to the 188th Station Hospital con-stituted the bulk of all hospital admissions.


the destroyers for bases agreement ofearly September 1940, and an engineersurvey party arrived on the island on 13October. The first of the garrison troopsfollowed late in January 1941 when the21,000-ton USAT Edmund B. Alex-ander, first ship of her size to attemptthe narrow, rocky entrance to the harbor,anchored at St. John's. The transport car-ried 58 officers and 919 enlisted men,including personnel to operate a 40-bedhospital, which was activated on ship-board. 8

The St. John's base, to be known asFort Pepperrell, was not yet ready toreceive either troops or hospital. For thenext four and a half months the Alex-ander served as a floating barracks, whilethe hospital continued to function onthe ship. Medical supplies could not bereached until the ship was partially un-loaded, but needed items were procuredashore. Civilian hospitals in St. John'scared for engineer troops and civilianconstruction workers until late February,when an engineer medical officer arrivedand opened a small dispensary at thebase. The dispensary grew into a 25-bed

hospital, opened 16 June 1941. By thistime the transport had been recalled, andthe station hospital had moved from itsshipboard quarters to a country estateabout two miles from the city. Equip-ment for a 50-bed hospital had been un-loaded from the transport, but could notbe uncrated until covered storage spacewas found. At the beginning of Decem-ber another move put the hospital, thenknown as Station Hospital, Newfound-land Base Command, into a newlycompleted barracks at Fort Pepperrell.Designed to accommodate 125 men, thebuilding was readily converted into a 60-bed hospital, to be occupied pendingcompletion of a suitable hospital build-ing. (See Map I.) The commandingofficer of the hospital, Maj. (later Col.)Daniel J. Berry, also acted as Newfound-land Base Command surgeon.

A second U.S. hospital had meanwhilebeen established at Newfoundland AirBase near Gander. The base, still underconstruction but already occupied byunits of the Royal Canadian Air Force,was one of the largest in the world. TheAmerican portion of the base, calledofficially U.S. Army Air Base, Newfound-land, but unofficially known as GanderField, was occupied in May 1941. A 25-bed hospital to serve the base was acti-vated at the same time and sited in aportion of the RCAF hospital function-ing there. Evacuation was to Fort Pepper-rell, 250 miles away by rail but only halfof that distance by air. The hospitalmoved into its own building in Decem-ber 1942 with a rated capacity of 150beds.

A third U.S. Army hospital was set uporiginally as a 25-bed dispensary in Janu-ary 1942 at Fort McAndrew, near thenaval base of Argentia, seventy-five miles

8 The main sources for this section are: (1) Conn,Engelman, and Fairchild, Guarding the UnitedStates and Its Outposts, ch. XIV; (2) Watson, Chiefof Staff, pp. 479-81; (3) Annual Rpt, Sta Hosp,Newfoundland Base Command, 1941; (4) AnnualRpt, Med Activities, Newfoundland Comd, 1942;(5) Med Bases in Newfoundland District doc in-cluded in Health Service, Caribbean, Apr 42; (6)Annual Rpt, Sta Dispensary, U.S. Army Air Base,Newfoundland, 1941; (7) Annual Rpts, 308th StaHosp, 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, New-foundland Base Comd, Jul 43-Dec 45; (12) Ltr,Col Daniel J. Berry (Ret) to Col Goriup, 2 Aug59; (13) Ltr, Col Emmett L. Kehoe to Col Goriup,5 Aug 59; (14) Ltr, Gunnar Linner to Goriup, 10Aug 59. Last three letters comment on preliminarydraft of this chapter.


308TH STATION HOSPITAL AT FORT PEPPERRELL, Newfoundland. The basement,shown rising above ground level, was a completely self-contained bombproof unit to whichpatients could quickly be moved down ramps.

west of St. John's. For the time being asmall engineer hospital already on theground handled cases beyond the capa-bilities of the dispensary, but a stationhospital was formally activated in Mayand opened in June 1942, eventually ab-sorbing the engineer unit. Last of theU.S. bases to get into operation was Har-mon Field near Stephenville on thewestern coast of Newfoundland. Here amedical officer, a dental officer, and fourenlisted men opened a 25-bed hospitalin a small barracks in March 1942.

At each of the four U.S. bases, thehospital commander served also as sur-geon of the base and as commander ofthe medical detachment.

The four U.S. Army hospitals weredesignated as numbered station hospitalson 1 April 1943. At that time the baseunit at Fort Pepperrell became the 308thStation Hospital with a Table of Organ-ization calling for 250 beds. With thisenlargement of the hospital, its com-manding officer, Lt. Col. Gunnar Linnersince October 1942, was relieved as New-foundland Base Command surgeon byLt. Col. William J. Eklund. The 308thStation moved in June into a permanentall-concrete building designed for itsspecial needs. There were two storiesabove ground, with a basement blastedfrom solid rock and protected by a thickconcrete slab. The basement, which


could be immediately converted into anunderground hospital should the upperportion of the building be bombed, hadcomplete facilities, including operatingrooms, kitchens, refrigerators, storedfood supplies, and a diesel electric powerplant. It could be completely sealed andsupplied with air drawn in through de-contamination canisters. Patients couldbe moved down ramps from the mainhospital in a matter of minutes. Locatedat base command headquarters and ad-jacent to the capital and principal port ofNewfoundland, the 308th took patientsby transfer from the smaller and lesswell-equipped units and processed allpatients being evacuated to the UnitedStates.

The post hospital at Fort McAndrewbecame the 309th Station Hospital, witha T/O of 100 beds. The 310th Station(150 beds) succeeded the post hospitalat Gander Field, and the small HarmonField unit became the 25-bed 311th Sta-tion Hospital. Maximum T/O bedstrength of 450 was reached at this time,to serve a troop strength of approxi-mately 9,000. Troop strength increasedto a peak of 10,500 in June 1943 butsoon fell back below the 9,000 level. The310th and 311th both passed to the juris-diction of the Air Transport Commandin September but continued to report tothe base surgeon until July 1944, whenboth were disbanded. The bulk of thepersonnel and equipment were allottedto newly organized dispensaries, whichwere really small hospitals under theNorth Atlantic Wing of the Air Trans-port Command.9

By mid-1944 the Newfoundland BaseCommand was little more than a stop onthe air route to Europe. Lt. Col. EmmettL. Kehoe, who had relieved ColonelEklund as base surgeon in January 1944,also relieved Colonel Linner as com-manding officer of the 308th Station Hos-pital in March, thus recombining the twopositions. In December 1944 the 308thStation was reduced to 150 beds and the309th to 75. In September 1945 the309th was disbanded and the 308th re-duced to 25 beds. On 1 January 1946 allremaining installations were turned overto the Air Transport Command.

Evacuation from Newfoundland wasnever a problem, though evacuationwithin the island was often difficultowing to the virtual absence of roads.Gander and Harmon Fields were con-nected with St. John's by railroad butthe distances were considerable—250rail miles from Gander and close to 500from Harmon—and the service in winterwas erratic because of the heavy snow-falls. Air evacuation was faster, but itwas even more subject to the hazards ofunpredictable weather. For this reason,a medical officer of better than averagesurgical skill was assigned at each hospi-tal. Evacuation to the United States wasby sea until late 1942, when transportplanes equipped with litter racks alsobegan to be used.

After the invasion of Normandy inJune 1944, Harmon Field became in-creasingly important as a stopover pointfor patients being evacuated from Eu-rope. A 72-bed transient hospital wasbuilt to accommodate these patientswhen poor weather conditions made itimpossible to continue the flight. A newpost hospital of 75-bed capacity, com-pleted in March 1945, also had more than

9 See Clarence McKittrick Smith, The MedicalDepartment; Hospitalization and Evacuation, Zoneof Interior, UNITED STATES ARMY IN WORLDWAR II (Washington, 1956), pp. 174-75.


half of its beds available for transients.When flights were not interrupted, lit-ter patients were given a warm meal onthe planes. Plasma and whole blood wereavailable for those who needed them.Fresh milk was flown up from PresqueIsle, Maine, especially for use of evac-uees passing through Harmon Field.

In general the health of the commandwas good. The climate was relativelymild, resembling that of northern NewEngland. Although the winters werecharacterized by sudden changes fromsunshine to snow or sleet, with a pene-trating northeast wind, the thermometerseldom dropped below zero. The troopswere housed in permanent buildings andhad proper clothing. The incidence ofrespiratory diseases was not unduly high,and intestinal diseases were at a mini-mum. In 1942 there were 25 cases ofcatarrhal jaundice, which, like the paral-lel but more severe outbreak in Iceland,were apparently related to yellow feverimmunization.

A venereal disease rate that climbedto 35 per thousand per annum in Octo-ber 1942 and averaged in the neighbor-hood of 20 during 1943 was consideredexcessive by Medical Department offi-cers in Newfoundland, although thatrate compared very favorably with thosein other areas.10 The establishment ofprophylactic stations and the issue ofindividual prophylactics to the men, to-gether with a stepped-up educationalprogram and excellent co-operation fromthe local authorities, brought the ratedown to a negligible figure by 1945. Alocal health problem was tuberculosis,which was widely prevalent among theNewfoundlanders and thus constituted

a serious threat to U.S. troops. Diphthe-ria, also common among the residents,never seriously menaced the Americanforces.

On the supply side, there were earlydifficulties brought about more by lack ofstorage facilities than by lack of suppliesthemselves. After the bases were wellestablished, medical supplies were quiteadequate—large quantities were evenreturned to the United States during1944. The base medical depot at FortPepperrell was discontinued late in 1943,the function passing to the 308th StationHospital.

Bermuda Base Command

Geographically, Bermuda was the keyto the North Atlantic defenses. It liesnear the center of a line from Nova Scotiato Puerto Rico, which is to say the centerof an arc shielding the Atlantic coast ofNorth America whose ends are New-foundland and Trinidad. Only New-foundland preceded Bermuda amongthe bases acquired from Great Britain.As in Newfoundland, engineer troopswere first to reach the island, the van-guard arriving in November 1940. Anengineer medical officer reached Ber-muda in January 1941, but no engineerhospital was established until August.The Bermuda Base Command, mean-while, had been activated on shipboardon 18 April 1941 and established head-quarters two days later in the Castle Har-bour Hotel some two miles across thewater from the site selected for the U.S.Army base and airfield near the easternend 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 UnitedStates 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 withthe original troop complement and es-tablished itself in the headquarters hotel,where it eventually occupied rooms on

ground, mezzanine, second, and thirdfloors. The first patient was received on23 April. The hospital commander, Col.E. M. P. Sward, also served as surgeon,Bermuda Base Command. He was re-sponsible for the health of all Armytroops, including Air Corps, in Bermuda;for U.S. civilian construction workers;and for the on-the-job health of locallyprocured labor. The Navy had a hospitalof its own at the naval base and air sta-tion at Kings Point projecting into GreatSound at the western end of the mainisland.

of Staff, pp. 481-82; (3) Annual Rpts, Surg, Ber-muda Base Comd, 1941, 1942-45; (4) ETMD's,Bermuda Base Comd, Jul 43-Dec 45; (5) HistMonograph, U.S. Army Base, Bermuda, by N AtlDiv, CE, OCMH files; (6) Hist of Preventive Medi-cine 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 Jul59; (9) Ltr, Col Paul A. Keeney (Ret) to Col JohnBoyd Coates, Jr., 29 Oct 59. Both letters commenton preliminary draft of this chapter.


On 1 December 1942 the base hospi-tal was designated the 221st Station Hos-pital, with a T/O capacity of 250 beds.Army medical personnel in Bermuda atthis time numbered 29 officers and 137enlisted men; troop strength in theislands was approximately 4,000 climb-ing 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 coralonly a quarter of a mile from the AirTransport Command terminal at Kin-dley Field, the newly completed Ameri-can air base that was the principal in-stallation of Fort Bell. A dispensarypreviously maintained at the field wasclosed, but the hospital continued tomaintain other dispensaries whereverthe troop population warranted.

Since by mid-1943 construction waslargely finished and military activitieswere of a routine nature, the need forhospital beds was beginning to decline.An agreement with the Navy was reachedduring the summer, and in September1943 the naval hospital transferred allpatients to the 221st Station, preparatoryto closing. Thereafter all Navy personnelrequiring more than dispensary care, in-cluding transients from the AtlanticFleet, were treated at the base hospital.Col. Paul A. Keeney was hospital com-mander and base surgeon.

The work load had lightened appre-ciably before the end of 1943, with troopstrength standing at 2,800 in November.As of 1 June 1944, with less than 2,300U.S. troops still in the command, the221st Station Hospital was reorganizedas a 150-bed unit, and in August 1945was further reduced to 100 beds. Troopstrength was then below 2,000. On 1

January 1946 the hospital passed to con-trol of the Air Transport Command.

Evacuation to the United States wasirregular. In the absence of hospitalships or medical air evacuation planes,patients were evacuated by commercialairline or by any available ship equippedwith adequate hospital facilities. Theremight be weeks between planes andmonths between ships. In these circum-stances, the 120-day evacuation policy wassometimes exceeded, and the 221stfound it necessary to give more compre-hensive medical care than was normalfor station hospitals.

In August 1944 Bermuda became astop on one of the main air evacuationroutes from Europe, Africa, the MiddleEast, and the China—Burma—India The-ater. A medical air evacuation detach-ment consisting of nurses and enlistedmen was stationed at Kindley Field torotate with personnel of incoming planesof the 830th Medical Air EvacuationTransport Squadron. At the Bermudabase, the 221st Station Hospital was re-sponsible for feeding transient patients,treating them where necessary, and, ifcircumstances required, hospitalizingthem. Although the hospital had beenreduced to 150 beds before this time,ample accommodations were available.Indeed, in January 1945, when theUSAHS St. Mihiel ran aground in the vi-cinity, the 221st Station cared for morethan 500 patients of the hospital ship fortwo weeks. From September 1944 untilseveral months after the end of the war,well over 1,000 patients a month passedthrough Bermuda on their way to thezone of interior. March 1945 was thepeak month with 1,837.

The medical service of the 221st Sta-tion Hospital saw only routine cases, with


even the venereal disease rate relativelylow. The surgical service dealt with anumber of accident cases, but the onlycombat wounds hospitalized there weresuffered at sea by personnel of the Atlan-tic Fleet or one of the Allied navalunits based on Bermuda.

U.S. Army Forces in the Azores

U.S. planners in 1941 contemplatedthe occupation of the Portuguese Azoresby a U.S. military force, but the projectwas postponed in favor of relieving theBritish garrison in Iceland, where theurgency seemed greater. In mid-1943,after defeat of the German and Italianforces in North Africa and the subse-quent conquest of Sicily, the use of theAzores as a link in a new central Atlanticroute to Europe, the Middle East, andAsia was definitely planned, pendingagreement with the Portuguese Govern-ment. In October 1943 the British suc-ceeded in getting permission to use theislands for military purposes under theterms of an old treaty. A British navalbase and an air base near Lagens onTerceira Island, were quickly estab-lished, and in December American per-sonnel began to share the airfield withthe British. This joint occupancy con-tinued until September 1944, when thePortuguese finally gave the UnitedStates permission to establish an exclu-sively American base on Santa MariaIsland, about 150 miles southeast of Ter-ceira.12

Organizationally, the U.S. base in theAzores was set up as part of the NorthAfrican theater, but did not long remainin that status. In May 1944, under thedesignation U.S. Army Forces in theAzores, jurisdiction over American per-sonnel and installations in the islandspassed to the Eastern Defense Command.In February 1945 the North AtlanticDivision of the Air Transport Commandtook over control of all U.S. interests inthe Azores.

Medical support of U.S. Army troopson Terceira Island consisted initially ofa dispensary with evacuation to a Britishhospital for cases requiring more than afew days' confinement. By February 1944the dispensary had grown until it occu-pied several Nissen huts. Other prefab-ricated buildings were added betweenFebruary and May. Forty-four regularbeds enabled American troops to be hos-pitalized in their own area, which greatlyfacilitated the operation of the medicalservice. In addition, another 35 or 40beds were available to accommodateevacuees from other theaters on theirway to the zone of interior. A 170-bedmedical installation was requested bythe Azores Base Command, but no suchunit was established there until after thewar. On Santa Maria Island the MedicalDepartment began operating a dispen-sary with the arrival of the first troops inSeptember 1944. During the remainderof the year the Medical Department onthe island acquired frame buildings andtentage to maintain a 120-bed dispensary.The dispensaries on Terceira and SantaMaria remained in operation throughthe end of the war and into the postwar

12 Sources for this section are: (1) Matloff andSnell, 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 MedDept Activities, Base Hosp, Azores Air TransportSta, Atl Div, ATC, 1947.


period, when the one on Terceira Islandbecame a 50-bed hospital. Both installa-tions had been in effect hospitals fromthe start, but continued to be called dis-pensaries because of the reluctance ofthe Medical Department to assign hospi-tals to Air Forces commands. Theyserved a combined U.S. troop populationthat averaged about 1,200, plus an indefi-nite number of transients.

The threat of plague was the mostserious medical problem facing the Medi-cal Department in the Azores. It hadoccurred sporadically for a number ofyears in all three forms: bubonic, pneu-monic, and septicemic. The latter twotypes invariably proved fatal. All troopsdestined for the Azores received oneinoculation of plague vaccine beforedeparture from the United States andanother after arriving in the islands. TheMedical Department in the Azores con-ducted a vigorous rat exterminationprogram and regularly inspected thequarters and all other buildings used bythe Army. Not a single case of plaguedeveloped among U.S. Army troops inthe Azores. Typhoid fever and venerealdiseases were two other dangers to thehealth of troops, but control measuresprevented the former and lessened thelatter disease. As in most of the otherNorth Atlantic bases, respiratory diseasesand injuries accounted for the majorityof cases requiring hospitalization.

Air evacuation to the United Statesthrough the Azores began on a largescale after the invasion of western Eu-rope. When most of France fell intoAllied hands, it was possible to evacuatecasualties direct from the Continent tothe United States. By the end of 1944 awinter evacuation route using the Azoresrather than Iceland was adopted, thus

offsetting the disadvantages of coldweather operations in northern latitudesand reducing evacuation time fromFrance to the United States. About 2,000patients a month passed through theAzores during the winter of 1944-45.

U.S. Army Forces in Easternand Central Canada

The primary mission of the U. S. forcesin eastern and central Canada was tospeed delivery of planes to the UnitedKingdom—first lend-lease planes for thehard-pressed Royal Canadian Air Force,then fleets of bombers and fighters to beflown in combat by American crews.The quickest, and in the long run thesafest, way to deliver a plane was underits own power. It needed only a line ofbases close enough together to be withinthe range of fighter craft, and adequateweather information. A direct route forheavy and medium bombers from New-foundland to Scotland had been pio-neered in 1940, but it was hazardous atbest. Greenland was the key, and theway was cleared for its use in the springof 1941. The first U.S. troops in the areasdesignated for bases in eastern and cen-tral Canada were Engineer Corps per-sonnel under direct command of theGeneral Staff.13

13 Principal sources for this section are: (1) Connand Fairchild, Framework of Hemisphere Defense,ch. XV; (2) Samuel Milner, "Establishing theBolero 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 RelationsBetween the United States and Canada, 1939-1945,UNITED STATES ARMY IN WORLD WAR II(Washington, 1959); (5) Arctic Laboratory, Sep41-Jun 44, AAF N Atl Wing, ATC, pt. I, chs. 1and 2, and apps. D, G, H, and K; (6) Med HistRcd, Oct 44-Dec 44, AAF N Atl Wing ATC, apps.


The Air Ferry Routes

An air ferry route from Presque Isle,Maine, to Prestwick, Scotland, was wellalong by the end of 1941. The first hopwould be to Gander, Newfoundland, oralternatively, because of crowding atGander, to Goose Bay, Labrador, wherethe Canadian Government began con-struction of an airfield late in September.BLUIE WEST 1 at the southern tip ofGreenland, under construction sinceJuly, would be the second stop, andReykjavík, Iceland, the third. Air dis-tances were approximately 570 milesfrom Presque Isle to Goose Bay, 775miles from Goose Bay to BLUIE WEST 1,another 775 miles to Iceland, and thefinal and longest hop of 840 miles fromReykjavík to Prestwick. Fighter planeswould need extra fuel tanks, but theywould make it. Weather stations estab-lished in September 1941 at Fort Chimoin northern Quebec Province, at Frob-isher Bay on Baffin Island, and on Pad-loping Island off the shore of BaffinIsland just above the Arctic Circle wereto supply information for the guidanceof pilots. These weather stations weredesignated respectively CRYSTAL 1, CRYS-TAL 2, and CRYSTAL 3.

The air ferry route through Labrador,Greenland, and Iceland was barely oper-ational when the whole program was re-vised and enlarged in the middle of 1942.The enlarged project was known asCRIMSON. Entry of the United States into

the war had increased the pressure toget planes to the British Isles, and theentire Eighth Air Force was to be flownto its British base. The new plan in noway canceled out the old, but added toit a route through central Canada thatwould tap the aircraft production cen-ters in California and the middle west.Stations on the central route would beGreat Falls, Montana, The Pas in westcentral Manitoba, Churchill on HudsonBay in northern Manitoba, Coral Har-bour on Southampton Island just belowthe Arctic Circle, and thence to BLUIEWEST 8, the northernmost Greenlandbase, and on to Iceland and Scotland.Additional airfields were to be locatedat Mingan on the north shore of the Gulfof St. Lawrence, about midway betweenPresque Isle and Goose Bay, and at theweather posts at Fort Chimo and Fro-bisher Bay. Nine additional weather ob-servation posts were to be established inthe central area.

Work on these arctic bases went for-ward feverishly during the brief summerseason of 1942. Engineer troops weresupplemented by Air Corps groundcrews as runways neared completion, andbefore the winter of 1942-43 closed in,nearly 900 planes of the Eighth AirForce were flown to Scotland by one oranother of these routes. The number ofU.S. military personnel in central andeastern Canada, including those assignedto the CRYSTAL and CRIMSON projects,climbed from 1,891 in March 1942 tomore than 17,000 in August, thendropped abruptly to 2,571. For the firstsix months of 1943 the average troopstrength was about 1,350. By that datethe project stage was past. In July 1943the United States Army Forces in Cen-tral Canada was set up as an independent

D, G, and J; (7) ETMD's, USAFCC, Oct 43-Sep45, 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, CrimsonProject, Eastern Sector, by Brig Gen Albert W. Ken-ner to TSG, n.d., inspection between 20 and 30Jul 43.


command. At the same time jurisdictionover the bases in eastern Canada was as-signed to the North Atlantic Wing of theAir Transport Command. A theater-typeorganization, the U.S. Army Forces inEastern Canada was created early in Sep-tember, but with little change in any-thing but name. The CommandingGeneral, North Atlantic Wing, ATC,doubled as Commanding General,USAFEC, until October 1944, when thetheater organization was discontinuedand the Air Transport Command re-sumed direct control.

Medical Support on theAir Ferry Routes

No Army hospitals went into eithereastern or central Canada until Novem-ber 1942, when the airfields and weatherstations had assumed the character ofpermanent operating posts. The con-struction and maintenance crews thathad swelled the personnel totals in thesummer of that year had been cared forin temporary engineer hospitals and indispensaries set up by Air Forces medicaldetachments.

While the eastern route was in use first,the earliest U.S. medical support, otherthan the transient engineer and air units,went to bases in central Canada. Ade-quate hospital facilities were available inthe eastern sector at Presque Isle, atGander, and in Greenland. Of the majorfields along this route, only Goose Baywas without U.S. hospital facilities, butfor the time being the Royal CanadianAir Force hospital there served person-nel of both nations.

On the central route, every effort wasmade to supply medical service for allbases before the winter of 1942-43

brought varying degrees of isolation.A 25-bed dispensary was set up at CoralHarbour, Southampton Island, on 17August 1942. The 131st Station Hospital,of 100 beds, opened at The Pas on 10November, and two days later the 4thStation, also a 100-bed unit, got intooperation at Churchill. The theatersurgeon, Capt. (later Maj.) MichaelQ. Hancock, was based at the Winni-peg headquarters of the U.S. ArmyForces in Central Canada, where aone-man dispensary supplemented thefacilities available in Canadian Armyand Air Force hospitals. The variousweather observation posts, each in chargeof a noncommissioned officer with 5 to 9men, relied on the skills of medical en-listed men. Emergencies were diagnosed,and treatment was prescribed by radiountil one of the theater's 4 medical offi-cers could reach the spot, or until the pa-tient could be brought out.

By the end of 1943, with the sub-marine menace virtually eliminated andgood alternative air routes to share theload, the air ferry route through centralCanada declined in importance. The twohospitals were inactivated in Decemberand moved from the theater, each beingreplaced by a 10-bed dispensary, operatedby a medical officer and eight enlistedmen. In April 1944 Capt. (later Maj.)Alien G. Thurmond succeeded Hancockas theater surgeon, and was relieved inturn by Capt. Werner Lehmann, for-merly post surgeon at Churchill, at theend of the year. The dispensaries atChurchill and The Pas were both inacti-vated in July, as was the dispensary atCoral Harbour in August. The head-quarters dispensary, last U.S. medical in-stallation in central Canada, closed latein September 1944 as the theater itself


passed out of existence.In eastern Canada the 6th Station

Hospital (150 beds) was established atGoose Bay in April 1943. In the samemonth two 50-bed units were openedfarther north—the 133d Station Hospi-tal at Fort Chimo, Quebec, and the134th at Frobisher Bay on Baffin Island.In August a 10-bed dispensary was setup at Mingan, Quebec, south of GooseBay. The 6th Station, meanwhile, hadbeen reduced to 75 beds. The authorizedbed strength of the 133d and 134thStation Hospitals was similarly halved inSeptember. A medical officer and a quan-tity of medical supplies continued to bemaintained on Padloping Island becauseof its remote and isolated position.

All of the Army medical installationsin eastern Canada were withdrawn inJuly 1944, so that the reorganization ofOctober did not affect the Medical De-partment as such. Medical service atGoose Bay and such other fields in thesector as remained in use was thereafterexclusively supplied by the North Atlan-tic Wing, Air Transport Command. Thechange in command, so far as the medicalservice was concerned, was nominal,since the wing surgeon, Col. Gordon G.Bulla, had served also as theater surgeonthroughout the life of USAFEC.

The problems faced by the MedicalDepartment in Canada were initiallythose of getting established in an un-familiar and often inhospitable environ-ment. In arctic and subarctic stations,weather was always a factor. Clothingoriginally issued quickly proved inade-quate, but the men were not long inadopting the Eskimo mukluks, Indianmoccasins, or the heavy felt shoes soldby the Hudson Bay Company as prefer-able to the shoes issued by the Quarter-

master. There were similar difficultieswith mittens and parkas. Suitable hous-ing for medical installations offered an-other problem. The 4th Station Hospitalat Churchill, for example, occupied build-ings without insulation, with unheatedcorridors, and with cracks in eaves andwindow ledges through which snow sift-ed. A modern, completely insulated hos-pital plant, with hot and cold runningwater, electric lights, and steam heat wasconstructed, but owing to labor shortagesand low priority it was not finished untilJanuary 1944, after the hospital had beeninactivated.

In addition to Army and transient AirForces personnel, all the Army hospitalstreated civilian construction workers.Those farthest north also treated localEskimos and Indians, who were at firstsent to the American doctors by theRoyal Canadian Mounted Police andlater came of their own accord.

Once the difficulties of adjustmentwere overcome, the health record wasremarkably good. Cold injury was ararity, upper respiratory diseases wereless frequent than experience in coldclimates would have indicated, andvenereal diseases, though by no meansunknown, were largely the result of ex-posures outside of the theater. Evenneuropsychiatric disorders—a frequent ac-companiment of service in isolated posts—were relatively infrequent.

Evacuation was by plane from the re-mote areas such as Coral Harbour andPadloping Island, and emergency evacu-ation was always by plane if feasible. InManitoba routine evacuation was by rail,with one train a week between Churchilland The Pas, and on alternate days fromThe Pas to Winnipeg. The more isolatedweather stations could be reached only


COLONEL BULLA

by planes equipped with skis or pontons,and at times only by tractor or dog sled.A plane normally based in Winnipeg wasavailable on call for emergency evacua-tion and could be notified by radio whenon a mission. Evacuation from the posthospitals and dispensaries was normallydirect to Army hospitals in the UnitedStates, but Canadian hospitals werealways available in emergency.

Medical supplies were adequate, evenabundant—at times large surpluses piledup and eventually had to be returned tosupply depots in the United States.

The Caribbean DefenseCommand

The Caribbean Defense Command,authorized by the Secretary of War in

January 1941, was officially activated thefollowing month, but its organization wasnot completed until 29 May 1941. It in-cluded the existing Panama Canal andPuerto Rican Departments, and U.S.bases and other Army operations in Cen-tral America, the British and DutchWest Indies, the Guianas, Venezuela,Colombia, and Ecuador. For administra-tive purposes the command was set upwith three main subdivisions: a PuertoRican Sector, a Panama Sector, and aTrinidad Sector. The Puerto Ricanand Trinidad Sectors were merged inJune 1943. The top command and itsadministrative divisions supplementedrather than supplanted the existing com-mands in Panama and Puerto Rico,which remained throughout the war thetwo major administrative elements inthe Caribbean area.

The Caribbean Defense Commandhad no surgeon until October 1943, whenBrig. Gen. (later Maj. Gen.) MorrisonC. Stayer assumed the duties as its sur-geon, but without giving up his assign-ment as chief health officer of thePanama Canal Zone. He had been advis-ing the Commanding General, Carib-bean Defense Command, informally sincethe activation of the command. GeneralStayer was succeeded in both capacities1 March 1944 by Brig. Gen. Henry C.Dooling.

The Panama Canal Department

By the beginning of World War II thePanama Canal Department had func-tioned as a military organization formore than a quarter of a century. It wastherefore one of the well-established,permanent garrisons of the U.S. Army.Army planners regarded the canal as the


GENERAL STAYER

keystone of Western Hemisphere de-fenses. Indeed, as early as 1938 the Chiefof Staff had sought to increase thePanama garrison on the ground thattroops could be quickly dispatched fromthe Canal Zone to any threatened area inSouth America. Basically, however, theArmy's mission in Panama was to guardthe canal itself from attack by air, sea,or land, and to protect it from raids byenemy commandos or saboteurs. Thebetter to carry out this mission, the juris-diction of the Panama Canal Departmentwas extended to the various countries ofCentral America and the Pacific slope ofSouth America as it became necessaryfor U.S. forces, primarily Air Corps andEngineer Department troops, to moveinto these areas. The initial task of pro-viding proper defenses also involved theexpansion of all the necessary support-ing services, including the MedicalDepartment.14 Hospitalization—Military strength in

the Panama Canal Department re-mained at a fairly constant level in thefirst half of the decade before World WarII, ranging between 9,000 and 10,000troops. In 1936 the average strength roseto about 14,000, where it remained until1940, when it again increased markedly.Six small hospitals and four dispensariesprovided most of the necessary medicalservice. In 1939 there were approxi-mately 260 dispensary and station hospi-tal beds in the department, but only 50were actually in a hospital building. Therest were housed with other activities,usually in post administrative buildings,which were noisy and inadequate in size.In addition to these hospitals and dis-pensaries, which provided beds for lessthan 2 percent of the command, the

14 General sources for this section are: (1) Conn,Engelman, and Fairchild, Guarding the UnitedStates and Its Outposts, ch X; (2) Caribbean De-fense Comd, Organization, Development and Reor-ganization, MS, OCMH files; (3) Hist of thePanama Canal Dept, vols. I-IV, MS, OCMH files;(4) Organization and Reorganization [PanamaCanal Dept, 1911-47], MS, OCMH files; (5) WarPlans and Defense Measures [Caribbean DefenseComd], MS, OCMH files; (6) Annual Rpt of TSG,U.S. Army, 1940; (7) A Hist of Med Dept Activitiesin the Caribbean Defense Comd in World War II,vols. I-III; (8) Annual Rpts, Dept Surg, PanamaCanal 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 DefenseComd, 1943-44; (11) ETMD's, Caribbean DefenseComd, Oct 43-Dec 45; (12) Annual Rpts, 218thGen Hosp, 1941-42; (13) Annual Rpts, 210th GenHosp, 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, to30 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. Bothletters comment on preliminary draft of this chapter.


Army had an allotment of some 400 bedsin two hospitals operated by the PanamaCanal Health Department—the GorgasHospital on the Pacific side of the canaland the Margarita Hospital on the Atlan-tic side. It was the continuous availa-bility of these hospitals—especially theGorgas Hospital—for handling unusualor difficult cases that kept the medicalservice at a high level despite inadequatebed strength at the military posts. Thepolicy of allocating beds in the PanamaCanal Health Department hospitals con-tinued during the war, but with theallotment reduced to 250 beds after 1943,by which time new Army hospitals hadbecome available. (Map 2) The PanamaCanal Department surgeon when theUnited States entered the war was Col.John W. Sherwood, who was succeededin May 1943 by Col. Wesley C. Cox.

A plan for the construction of per-manent Army hospitals in the PanamaCanal Zone was developed in 1935 bythe Panama Canal Department surgeonin co-operation with The Surgeon Gen-eral of the Army. Congress approved theplan in 1937, authorizing the construc-tion of a 528-bed hospital at Fort Claytonon the Pacific side of the canal, a 401-bedhospital at Fort Gulick on the Atlanticside, and a 60-bed hospital for the com-bined posts of Fort Kobbe and HowardField in the Pacific sector. Funds for thehospital construction program did notmaterialize until a year later, by whichtime construction costs had so increasedthat it became necessary to reduce thecapacity of the two larger hospitals by150 beds each. The War Department ap-proved the plans on that basis in 1939,but there were further delays. The Med-ical Department was not satisfied thatthe program as approved was adequate;

the governor of the Canal Zone thoughtthe construction of Army hospitals un-necessary; there were delays in the prep-aration of plans and specifications; fundswere inadequate for the number of bedsdesired; there were difficulties in obtain-ing materials and equipment; the heavyrainfall hampered construction.

By June 1940 the Panama Canal De-partment had doubled its 1939 strength,but still no beds were added to the al-ready insufficient number. The bedshortage was reported critical by repre-sentatives of the Medical Departmentreturning from the Canal Zone. As anexpedient, temporary beds were in-stalled in a converted barracks, whilestation hospitals were expanded, pend-ing the construction of permanent medi-cal facilities. In general, expansion of thedepartment dictated that hospitals beoperated at nearly all posts in the com-mand.

The new Army hospitals at Fort Gu-lick and Fort Clayton, finally completedin September 1943, opened with ratedcapacities of 251 and 378 beds, respec-tively. By making full use of the veryspacious porches, the hospitals almostdoubled their capacities. A third newhospital, located at Fort Kobbe and readyfor use in June 1943, never functionedas originally intended, but served as adispensary through the war years. Themaximum strength of the Army in Pan-ama, about 65,000, had been reachedlate in 1942, well before the completionof the permanent hospitals. As a result,hospitals operating in converted bar-racks and other nonhospital buildingscared for the peak loads of patients. Withthe two largest hospitals completed andoccupied by the end of the summer of1943, the other post, or station, hospitals


in the Canal Zone were reduced to dis-pensaries. The Panama Canal Depart-ment had an average of 2,120 beds avail-able during 1943, roughly 4 percent ofthe average strength of the command.

The Medical Department units thatoperated the major hospitals in thePanama Canal Department did consider-able shifting about, both in place and indesignation, because of construction de-lays and reorganizations. The two largestunits, the 210th and 218th General Hos-pitals, arrived in Panama in January1942. The 210th upon arriving at FortGulick, the site of the new permanenthospital then still in the process of con-struction, immediately occupied fourteenrecently finished permanent barracks onthe post and began admitting patientsthree weeks later. The 218th GeneralHospital, which was to occupy the newpermanent hospital building at FortClayton, could not do so because con-struction on this post was far from com-pleted. Its personnel was thereuponsplit up and dispersed on temporaryduty mainly to post hospitals at FortAmador and Fort Kobbe on the Pacificside of the canal, and in smaller numbersto several other posts in the Canal Zone,pending the completion of the Fort Clay-ton hospital.

The 218th General was redesignatedthe 353d Station Hospital in April 1943,but the hospital's personnel were notbrought together until September 1943,when it moved into the newly completedFort Clayton hospital. It continued op-erating this plant as the 333d StationHospital until April 1944, when the unitagain became a general hospital with acapacity of 750 beds. The 262d GeneralHospital, as it was then called, ran theFort Clayton hospital for the remainder

of the war. Over on the Atlantic end ofthe canal, the 210th General Hospital,which had operated in barracks build-ings since January 1942, moved into thenew hospital plant on the Fort Gulickpost in September 1943. This generalhospital was reorganized as the 368thStation Hospital (450 beds), in April1944, the chief reason being the decreasein the number of troops in the Atlanticsector of the Canal Zone. It continuedoperating at Fort Gulick throughout theremainder of the war, but was furtherreduced to 300 beds in December 1944.

The new hospital construction in theCanal Zone followed the pattern of theGorgas Hospital, that is, tropical con-struction of reinforced concrete, withbroad overhanging eaves on each floorfor protection against the sun, and wideporches with jalousies to keep out thedriving tropical rains. The solidly con-structed buildings compared favorablywith any hospital in the United Statesand satisfied the needs of the Army inPanama for years to come.

In the Central American and SouthAmerican countries under the jurisdic-tion of the Panama Canal Department,medical service was supplied largely bysmall hospitals and dispensaries undercontrol of the Sixth Air Force or theCorps of Engineers. During 1942 hos-pitals with capacities of 25 beds eachwere established at David, Republic ofPanama; Guatemala City, Guatemala;Salinas, Ecuador, and Talara, Peru. TheAir Forces had a 75-bed hospital con-structed on Seymour Island in the Gala-pagos Island group, strategically located1,000 miles from Panama in the PacificOcean, protecting the western approachesto the canal. (See Map 2.) All of thesehospitals were constructed as tempo-


rary, theater-of-operations-type build-ings. Eight dispensaries of temporaryconstruction, having 10 beds each, werebuilt at other locations in the Repub-lic of Panama during 1942. Most ofthe hospitals expanded their capacitiesduring 1943, and an additional 25-bedhospital and two 10-bed dispensariesopened during that year. In 1944 thehospital at David and those in Ecuadorand Peru became station dispensaries.Most of the dispensaries had ceased op-erating by 1945, but three of the hospi-tals and two dispensaries remained openthrough the greater part of the year.

Still another Army group maintained amedical service in the area: the Corps ofEngineers, who were responsible forbuilding the Pan American Highway. InDecember 1942 and January 1943 medi-cal personnel arrived to operate dis-pensaries at various points along theroute of the highway in Guatemala, ElSalvador, Honduras, Nicaragua, CostaRica, and Panama. The health of be-tween 1,500 and 2,500 American work-ers and technicians employed on thehighway, together with that of thou-sands of local laborers was the chief con-cern of the Pan American Highwaymedical service, under the direction ofLt. Col. E. T. Norman. At the end ofAugust 1943 there were 13 medical offi-cers, 2 dental officers, a sanitary officer,and 50 assorted male nurses, attendants,technicians, and pharmacists supportingthe highway builders.

Health Problems—Malaria and vene-real disease were the two major med-ical problems in the Panama CanalDepartment. The work of the MedicalDepartment during 1940-45 succeededin bringing the admission rates for these

diseases down to an all-time low. Theadmission rate per thousand per year formalaria in 1940 was 57,2. It reached apeak of 116.4 in 1942, but declinedsteadily thereafter, to the rate of only 9.3in 1945. A primary factor in the upwardspurt early in the war was the establish-ment of antiaircraft batteries in remotejungle areas; and the removal oftroops from screened barracks in sani-tated zones to tent camps in more distantlocations as a precaution against antici-pated air raids. Venereal disease ratesamounting to 71.7 per thousand per yearin 1940 were also steadily brought downto 17.6 in 1945, the lowest ever recordedin the Panama Canal Department up tothat time. The malaria and venerealdisease control programs were operatedunder the guidance of the Medical De-partment in co-operation with civilhealth authorities, but basically controlmeasures rested with the individualArmy units, whose command responsi-bility in these matters consisted of thor-oughly indoctrinating their personnel.

Medical Supply—Some difficulty wasexperienced in obtaining medical sup-plies in adequate quantities during1940-42, the period of rapid growth ofmilitary strength in the Canal Zone. Pro-duction facilities were being expanded,shipping was short, and there were manyclaimants for each item available. In1942 German submarine activity in theCaribbean was responsible for the de-struction of some medical supplies andfor delay in the delivery of others. By1943, however, shortages in medical sup-plies had disappeared. The system ofautomatic supply through the shipmentof medical maintenance units, which hadprevailed during the early period, was


LOADING A SICK SOLDIER ONTO A SMALL PLANE in Darien Province, Panama, forevacuation to one of the Canal Zone hospitals.

discontinued in September 1943 whenthe department began making monthlyrequisitions for all supplies. In commonwith the usual experience of noncombatareas, an excess eventually accumulated,which was shipped back to the UnitedStates in 1943 and 1944. Because of thehigh humidity, certain medical supplies,notably metal instruments and canvas,were vulnerable to deterioration. Theuse of dry rooms, equipped with electri-cal heating units to reduce the moisturein the air, prevented the loss of muchvaluable equipment.

Evacuation—The volume of evac-uation from Panama to the UnitedStates never reached a very high level.Hospital admissions consisted largely ofdisease cases, with a lesser number ofinjuries, and no battle casualties. Manycases that would have to be evacuatedfrom more isolated areas in the WesternHemisphere could easily be treated inthe modern general hospital facilities inthe Canal Zone. Proximity to the UnitedStates facilitated the evacuation ofpatients when necessary. A 90-day hos-pitalization policy existed in the early


part of the war, but by 1943 it had in-creased to a 120-day policy, which, ineffect, precluded evacuation unless pro-tracted treatment was needed. In gen-eral, only men deemed unfit for furtherduty were returned to the zone of in-terior. Within the Canal Zone theMedical Department moved sick and in-jured men from their units to points ofhospitalization by motor ambulance. Inmost instances this procedure meant atrip of less than twenty miles. Boat evac-uation was used to transport patientsfrom installations around Gatun Lakeand from otherwise inaccessible locationsin the interior of Panama. The PanamaCanal Railroad transported most of thepatients requiring movement from oneend of the canal to the other. The airbases in the Republic of Panama and inCentral and South America evacuatedtheir patients to Canal Zone hospitalsby air. The department sent most of itsZI patients to New Orleans by ship,but a small number of cases made thetrip to the United States by air. Thelatter method was used especially inthose cases requiring an immediatechange of environment and climate, orfor patients needing very specializedtreatment of a type not available inPanama.

Puerto Rico and the Antilles

The U.S. Army had maintained agarrison on Puerto Rico from the timethat island was ceded to the UnitedStates at the conclusion of the Spanish-American War. In the period beforeWorld War II troops there were underthe jurisdiction of the Second CorpsArea. This attachment to the zone ofinterior ceased when the War Depart-

ment established Puerto Rico and theVirgin Islands as a territorial depart-ment on 1 July 1939. The Puerto RicanDepartment, as the new command wasnamed, served a dual role: first, as themost advanced U.S. possession fromwhich American sea and land operationscould be projected southward or east-ward; and, second, as a forward defen-sive barrier protecting the easternapproach to the Panama Canal. Afterthe destroyers-for-bases agreement of1940, the U.S. Army extended its fringedefenses of the canal into other islands inthe Caribbean, providing at the sametime a defense of the bauxite "lifeline"from the Guianas to Trinidad and theUnited States. Included were basesleased from the British on Jamaica, An-tigua, St. Lucia, and Trinidad, and baseson Aruba and Curaçao leased from theDutch Government. Other bases forAmerican troops were established in theGuianas and in Cuba, while U.S. soldiersremained for a considerable time inVenezuela, on training mission. ThePuerto Rican Department, renamed theAntilles Department in June 1943, ab-sorbed all the above named-areas duringthe course of the war.15

15 (1) Conn and Fairchild, Framework of Hemi-sphere Defense, ch. X. (2) War Plans and DefenseMeasures [Caribbean Defense Comd]. (3) A Histof Med Dept Activities in the Caribbean DefenseComd in World War II, vols. I-III. (4) AnnualRpts, Med Dept Activities, Puerto Rican Dept, 1941and 1942. (5) Annual Rpts, Medical Dept Activ-ities, Antilles Department, 1943-45. (6) ETMD's,Caribbean Defense Comd, Oct 43-Dec 45. (7) An-nual Rpt, Med Dept Activities, Trinidad Sector andBase Comd, 1942 and 1943. (8) Annual Rpt, MedDept Activities, British Guiana Base Comd, 1942.(9) Health Service, Caribbean, 1942. (10) AnnualRpts, 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 Ac-tivities, U.S. Army Forces in Surinam, 1942. (13)


Puerto Rico eventually had thelargest concentration of U.S. Army troopsin the Caribbean, outside the PanamaCanal Zone. When formed as a territo-rial department in July 1939, the totalstrength amounted to 931 officers and en-listed men, serving at the main post ofFort Brooke in San Juan and at thesubpost of Henry Barracks near Cayey.By December the strength had risen to2,913 and continued upward through1940, reaching more than 13,000 in De-cember of that year. These troops weredivided among six posts in Puerto Ricoand one in the Virgin Islands. Armystrength in the Puerto Rican Depart-ment continued to enlarge beyond anylegitimate military need, mainly becausethe operation of the Selective ServiceSystem brought more Puerto Ricans intothe Army than could be used elsewhere.Military strength doubled in 1941 overthat of the previous year and doubledagain during 1942. At the time of theformation of the Antilles Department,the command had a strength of over50,000. It reached a peak of more than57,000 in September 1943, whichamounted to only about 8,000 less thanthe maximum strength attained by thePanama Canal Department.

Hospitalization—The most importantprewar Medical Department facility inPuerto Rico was the old station hospitalat Fort Brooke housed in buildingsturned over to the United States by theSpanish Government at the conclusionof the Spanish-American War. The hos-pital buildings dated back to the i8thcentury, but during the course of World

War II, approximately a million dollarswas spent to modernize and improve thebuildings and to make them more suit-able for modern hospital use. In 1941the hospital had a capacity of about 600beds and acted as a general hospital forthe entire Puerto Rican Department. AtFort Buchanan, about seven miles southof San Juan, another station hospital,originally activated as a medical detach-ment on the post of Fort Buchanan inOctober 1939, became the post hospitalin late 1941, with a capacity of 150 beds.(See Map 2.)

Borinquen Field, the main air base,located in the northwest corner ofPuerto Rico, had a Medical Depart-ment dispensary servicing the field fromthe time the first troops arrived there inSeptember 1939. In May 1941, a 150-bedstation hospital began operating at thefield. Another airfield, known as LoseyField, situated near Ponce in the southcentral part of the island, was the loca-tion of a 100-bed station hospital, whichbegan operating for the garrison therein April 1941. The old established postof Henry Barracks served as a subpost ofFort Brooke until December 1939. InMarch 1940, a station hospital of 10 bedswas established for the post, and by Oc-tober of 1941 it had a capacity of 55 beds.Most troops stationed at Camp Tortu-guero, a post in the northern part of theisland west of San Juan, used the FortBrooke station hospital. A hospital ward,completed at Camp Tortuguero in July1941, took care of mild medical and sur-gical cases. A dispensary, opened inMarch 1941, administered to the needsof the garrison at Benedict Field, locatedon St. Croix, Virgin Islands.

In the year before Pearl Harbor, theMedical Department had operated these

Ltr, Col Dean M. Walker (Ret) to Col Goriup,18 Jul 59, commenting on preliminary draft of thischapter.


seven stations with a minimum of person-nel. There were less than 400 officersand enlisted men of the Medical Depart-ment in the command at the beginningof 1941, but the number had more than,doubled by the end of the year. Col.Walter P. Davenport was the surgeon ofthe Puerto Rican Department.

Growing troop strength in PuertoRico in 1942 resulted in the expansionof most existing medical facilities andthe establishment of others. The Medi-cal Department had little choice in theselection of hospital sites since medicalinstallations had to be located at pointswhere large concentrations of troopsexisted. New hospital construction inPuerto Rico and other islands of theAntilles was characterized by the use oftemporary, wooden, theater-of-opera-tions-type structures. Where a post wasplanned as a permanent military instal-lation, as in the case of Borinquen Field,hospital construction was eventually ofa permanent type.

The main hospital at San Juan in-creased its capacity to 750 beds during1942. To it were evacuated all neuro-psychiatric patients in the department,all cases requiring lengthy hospitaliza-tion, and all those destined for the zoneof interior. Most of the other hospitalsincreased their capacities in 1942, and anew 100-bed station hospital, completedduring the year, began serving the troopsstationed at Camp O'Reilly in easternPuerto Rico near the town of Gurabo.

In late 1941 and 1942 garrisons weresent to Jamaica and Antiqua after thePuerto Rican Department was expandedto include these British islands. Tem-porary hospitals of 25 beds each servedthe U.S. Army troops there. A small hos-pital of 18 beds was established on St.

Thomas, Virgin Islands, in 1942, and thedispensary that had operated on the is-land of St. Croix became a 25-bed hos-pital during the same year.

Medical service in the southern halfof the Caribbean area, which includedbases in Trinidad, St. Lucia, Aruba,Curaçao, British Guiana, and DutchGuiana, did not come under the juris-diction of the headquarters in PuertoRico until the establishment of theAntilles Department in June 1943. Priorto that time, U.S. bases in the area wereunder the jurisdiction of the TrinidadSector and Base Command, of which Col.Dean M. Walker was surgeon. Americantroops moved into Trinidad, southernanchor of a defensive arc that includedNewfoundland and Bermuda, in May1941, but for several months had no med-ical support other than that supplied bytheir own medical detachments, backedup by British hospitals. In December1941 construction was begun on a plantto house a 500-bed station hospital atFort Read, the principal U.S. base on theisland, but it was September 1942 beforethe hospital opened. By that date an ad-ditional temporary hospital plant wasunder construction to provide transienthospitalization should it be necessary toevacuate substantial numbers of casual-ties from the forthcoming invasion ofNorth Africa. Since operations inMorocco and Algeria produced only aminimal number of casualties, the tem-porary hospital was never called upon toserve its original purpose. The main unitmeanwhile was redesignated on 1 De-cember 1942 as the 41st General Hospi-tal, and was to have an ultimate capacityof 1,000 beds. The first commandingofficer was Col. John A. Isherwood.

The 41st General Hospital served as


regional unit for the whole command,taking patients from all the southernCaribbean and the Guianas. It was sup-plemented at Port-of-Spain, Trinidad,by a small 20-bed unit established earlyin 1941 and supplanted in the spring of1942 by a 200-bed hospital activated asthe 255th Station Hospital on 1 January1943. Both Trinidad hospitals were con-structed of wood and regarded as semi-permanent structures. St. Lucia had a25-bed permanent Army hospital, whichbegan operating in November 1942. Onthe two Dutch islands of Aruba andCuraçao, the Army maintained stationhospitals of 75 beds each beginning inearly 1942. The base in British Guianahad a 50-bed permanent-type station hos-pital located at Atkinson Field, nearGeorgetown. Two station hospitals op-erated at bases in Dutch Guiana, one 50-bed unit at Paramaribo and a 25-bedhospital at nearby Zanderij Field. (SeeMap 2.)

Coincident with the creation of theAntilles Department in June 1943, manyof the post hospitals scattered along theCaribbean island chain and the northcoast of the South American mainlandwere activated as numbered station hos-pitals, often with T/O bed capacities inexcess of those then existing. The posthospital at Fort Simonds, Jamaica, be-came the 292d Station Hospital, with acapacity of 75 beds. At Antigua the posthospital was converted into the 293d Sta-tion Hospital, also of 75 beds. The 294thStation (25 beds) absorbed the posthospital at St. Thomas, Virgin Islands.In Puerto Rico the 295th Station Hos-pital, of 150 beds, supplanted the posthospital at Henry Barracks; the CampTortuguero hospital was redesignatedthe 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 re-designated the 326th Station Hospitalwith a T/O of 250 beds. Two new sta-tion hospitals were also established inCuba supplanting earlier installations:the 299th (150 beds) at San Julian, andthe 300th (50 beds) at Batista Field.Most important of the midyear designa-tions was that of the post hospital at SanJuan, which became the 298th StationHospital with an authorized capacity of600 beds. Attached to it in Septemberwas the newly activated 301st StationHospital (100 beds) which was moved toLosey Field when the Air Forces resumedoperations there in June 1944. At thattime the unit was reduced to 25 beds.

Another group of hospitals had theirdesignations, and sometimes their sizes,altered in November 1943. These in-cluded the post hospital at BorinquenField, Puerto Rico, which became the150-bed 330th Station Hospital; the 41stGeneral Hospital at Fort Read, Trini-dad, which was redesignated the 359thStation Hospital with a T/O strength of600 beds; and the small post hospitals atZanderij 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 Sta-tion, 50 beds) ; Curaçao, NetherlandsWest Indies (356th Station, 75 beds); andAruba, Netherlands West Indies (358thStation, 50 beds).

With the Axis virtually no threat tothe Western Hemisphere by mid-1943,except for occasional U-boat raids onshipping, the strategic importance ofPuerto Rico and other islands in theCaribbean declined. The Medical De-


partment was at peak strength when thePuerto Rican Department and the Trini-dad Sector were merged to form theAntilles Department, with Col. Clyde C.Johnston as its surgeon. There were atthis time more than 2,200 officers and en-listed men serving in medical installa-tions from Cuba through the Guianas. Asteady contraction began in 1944, whichcontinued to the end of the war. The298th Station Hospital at San Juan be-came the 161st General Hospital in June1944, serving the entire Antilles Depart-ment, but its T/O still called for only600 beds. Other hospitals throughout thearea reduced bed strength, converted todispensary status, or disbanded alto-gether. By the end of 1945, only ninehospitals remained in the Antilles De-partment, with a total of 1,225 beds. The161st General Hospital in San Juan, with600 beds, accounted for almost half ofthe total. Outside Puerto Rico only the292d Station Hospital (25 beds) inJamaica, the 300th (25 beds) at BatistaField in Cuba, and the 359th on Trini-dad remained in operation.

Evacuation—Evacuation activities inthe Antilles Department followed a pat-tern much like that of the Panama CanalDepartment. It was necessary to evacuateonly a small number of men during theentire war. Within the various islandbases, men needing medical attentionwere taken to the nearest dispensary orhospital, usually by ambulance but oc-casionally by air in the case of isolatedunits. Further evacuation to a larger hos-pital was normally accomplished by ship,although air transport came into play ifgreat distances were involved. The largehospitals in Puerto Rico and Trinidadenabled the Antilles Department to give

fairly definitive care to most serious ill-nesses, and since the situation was notone of combat there was no pressingneed for evacuation to the zone of inte-rior. About half of the patients moreover,were Puerto Ricans, and so would notnormally have been evacuated to themainland under any circumstances.

Medical Supply—Problems of medicalsupply in the Antilles proved similar tothose in Panama, but tended to be some-what more difficult in the early days. Thelack of a well-developed military estab-lishment in Puerto Rico at the beginningof the emergency period in 1939 and theextreme dispersion of island bases in theAntilles were important factors in creat-ing supply problems. The absence of amajor United States activity comparableto the Panama Canal also complicatedmatters. The new island bases felt thescarcity of supplies in the early days ofthe war much more strongly than theestablished facilities in Panama.

Common Diseases—As in Panama, thetwo major health problems throughoutthe Antilles Department were malariaand venereal disease, and in both casesthe answer was found in improved pre-ventive measures. The malaria rate forthe department as a whole was cut from84 per thousand per annum in 1941 and88 in 1942 to 37 in 1943, 12 in 1944, and9 in 1945. Measures taken included larvi-ciding, drainage, use of atabrine, andconstant education and experimentation.A unique problem existed around FortRead, Trinidad, where a water-catchingparasite on shade trees planted to protectthe cocoa plantations proved a prolificbreeder of mosquitoes. It was eventuallydiscovered that a copper sulfate spray


COLONEL LEONE

would destroy the parasites. In the fightagainst venereal disease, eternal reitera-tion of the danger was primary, togetherwith the establishment of well-locatedprophylactic stations and steady co-opera-tion with local authorities where locallaws and customs permitted some meas-ure of control. The venereal rate was re-duced from 81 per thousand per annumin 1942 to 72 in 1943, 47 in 1944, and 31in 1945.

The South Atlantic Theater

It was clear to U.S. and Brazilian mili-

tary leaders by the summer of 1939 thatonly the United States could provide theforces necessary to defend the Brazilianbulge in the event of an attack fromAfrica, a short 1,800 miles across theSouth Atlantic. Military planning inboth countries accepted this reality, al-though Brazil accepted it with reluc-tance. The fall of France a year later andthe subsequent control of French WestAfrica by the collaborationist Vichy re-gime, gave renewed urgency to prepara-tions for defense of the strategically mostvulnerable point in the hemisphere.Army and Navy staff agreements were


negotiated in the fall of 1940. By specificagreement between the two countries inthe spring of 1941, Pan American Air-ways undertook development of airfieldsin Brazil at Amapa, Belem, Sao Luis,Fortaleza, Natal, Recife, Maceio, andBahia. Such a route, jumping off frombases in the Guianas, would permit evenshort-range planes to fly to the threat-ened sector. The work had hardly gottenunder way before Pan American, at therequest of the U.S. Government and withBrazilian concurrence, undertook toferry lend-lease planes to British forcesin the Middle East.16 After U.S. entryinto the war, the South Atlantic ferryroute passed to military control. Planswere prepared for setting up a theater ofoperations in Brazil, but were not real-ized until after Brazil, too, had declaredwar on Germany and Italy, 22 August1942.17

The theater organization had its incep-tion in late June 1942, under the aegis ofthe South Atlantic Wing, Air TransportCommand, of which Brig. Gen. RobertL. Walsh was commanding officer andMaj. (later Col.) George E. Leone was

surgeon. Wing headquarters was set upat Atkinson Field, British Guiana, on 9July, moving to Recife, Brazil, in De-cember after formal activation of UnitedStates Army Forces, South Atlantic, on24 November 1942. A few days earlierthe Air Transport Command had estab-lished its own headquarters at Natal, butthe two headquarters were bound to-gether by having the same commander.General Walsh served in both capacities,as did Maj. Gen. Ralph H. Wooten, whorelieved Walsh in May 1944. In Octoberof that year, however, the two commandswere separated at the request of the AirTransport Command. General Wootencontinued as theater commander, whilethe South Atlantic Division, ATC, passedto Col. Cortlandt S. Johnson. Leone, onthe other hand, was replaced as ATCSouth Atlantic Wing surgeon when hetook over the theater surgeon's office.The two positions remained separateduntil August 1943, when Leone wasagain named to the ATC post while re-taining his position as USAFSA surgeon.He had in the interval returned to theUnited States long enough to attend theSchool of Aviation Medicine at Ran-dolph Field, Texas, in order to qualifyas a flight surgeon. Throughout the lifeof the theater close liaison was main-tained with the medical service of theFourth Fleet, and with Brazilian doctors,military and civilian.

During the British Guiana interlude,Leone, who was promoted to lieutenantcolonel at this time, surveyed the medicalsituation in Brazil. Valuable informa-tion, particularly as to the incidence ofmalaria and venereal disease, was se-cured from the two U.S. flight surgeonsalready 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 Fair-child, Framework of Hemisphere Defense, chs. XI,XII; (3) Hist, USAFSA, MS, OCMH files; (4) Of-ficial Hist of the S Atl Div, ATC, MS, OCMH files;(5) Med Hist, World War II, USAFSA; (6) An-nual Rpts, Med Dept Activities, USAFSA, 1942-44;(7) Annual Rpt, Med Dept Activities, S Atl Div,

ATC, 1944; (8) Annual Rpt, Surgeon, CompositeForce 8012, Ascension Island, 1943; (9) AnnualRpts, 175th Sta Hosp, 1943 and 1945; 193d StaHosp, 1943-45; 194th Sta Hosp, 1943-45; and 200thSta Hosp, 1943-45. (10) ETMD's, USAFSA, Jul44-Oct 45; (11) A Med Hist of the Brazilian Ex-peditionary 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 Aug59; (14) Ltr, Frank P. Gilligan, to Goriup, 18Aug 59. Last three letters comment on preliminarydraft of this chapter.


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

Lt. Francis M. Dougherty at Belem. Thesuccessful invasion of French North Af-rica at that time by American and Brit-ish ground troops removed any dangerthat may still have existed of an attackagainst the South American mainland.

Hospitalization

Other than small dispensaries set up atstopping points along the Air TransportCommand route, there were no U.S.Army medical facilities operating in

Brazil until after activation of the the-ater. Patients requiring more care thanthese dispensaries could provide weregenerally flown to British Guiana orTrinidad. Emergency surgery was per-formed in Brazilian military hospitals.

In his capacity as surgeon, USAFSA,Colonel Leone asked for three stationhospitals in October 1942, but the unitsrequested did not leave the port of em-barkation until 29 December, arriving inBrazil in late January 1943. The hos-pitals were distributed to the major bases


of the theater—the 193d Station Hospital(50 beds) to Belem, the 194th StationHospital (100 beds) to Natal, and the200th Station Hospital (150 beds) toRecife. None of the hospital buildingshad been completed at the time the unitsarrived, but by May and early June allbegan operating. The 175th Station Hos-pital (150 beds), arrived on AscensionIsland, some 1,250 miles east of theBrazilian coast, in March 1942, beforethe creation of the South Atlantic the-ater. The U.S. Army had landed some2,000 men on this British possession withthe mission of protecting it from attackand building an airfield. The 175th wasunder the control of a composite forceheadquarters until November 1942,when the South Atlantic theater as-sumed jurisdiction over U.S. troops onthe island. (Map 3)

Hospital construction in Brazil fol-lowed closely the standard U.S. Armycantonment-type plant common in theUnited States. The use of local materials,especially hollow tile blocks, which werestuccoed on the outside and plastered onthe inside, and red tiles for roofing, re-sulted in more permanent structuresthan the wooden ZI-type station hospi-tals. The 193d Station Hospital atBelem, just below the mouth of theAmazon River, was situated in a tropicallocation almost on the equator. It fur-nished care to the immediate area andreceived patients from the jungle airbase at Amapa, the airfield at Sao Luis,and weather stations at Clevelândia andCamocim.

Nine hundred miles east on the Brazil-ian coastal "hump," the 194th StationHospital at Natal administered medicalcare to patients from the air bases atFortaleza, Fernando de Noronha Island,

and from the vicinity of Natal itself. The194th also accommodated all patients enroute from other theaters to the UnitedStates. It was a very active unit becauseof the great number of transients anddaily landings and takeoffs.

The 200th Station Hospital, just 150miles south of Natal near the city ofRecife, served as a "theater" hospitalsince no general hospital operated inBrazil. It received patients from all othermedical installations in the commandthat required prolonged hospitalizationor ultimate evacuation to the UnitedStates. The 200th was especially wellequipped and had a very well-balancedprofessional staff. Specialists from the200th made trips to other stations in thetheater where they consulted on patientswho could not be transferred to Recife.The hospital laboratory was supple-mented to function as a provisional the-ater laboratory.

On Ascension, the steppingstone be-tween Brazil and Africa, the 175th Sta-tion Hospital had started operating in anewly constructed hospital in May 1942,providing medical care for U.S. Armyand Navy personnel stationed there,transients passing through, and survivorsof torpedoed ships. Its buildings con-sisted of wood-frame tarpaper-coveredstructures, which lasted satisfactorilythrough the war. Except for a very smalldispensary operated by a retired Britishnaval officer, no other medical facilityexisted on the island. The 175th min-istered to about one-fourth of the totalstrength of the South Atlantic theater.

The medical service for the South At-lantic theater maintained itself with aminimum of personnel, but still mademedical care equally available to all per-manent and transient Army personnel, as


well as to members of the U.S. Navy andcertain civilians at each base. The the-ater strength reached its wartime peakof about 8,000 in January 1944. Therewere approximately 600 Medical Depart-ment personnel in the theater at thattime, and an aggregate of 500 T/O bedsin fixed hospitals.18 In keeping with a de-clining military population, medicalstrength was cut to 450 in July 1944when the 175th Station Hospital on As-cension was reduced to 100-bed capacity;and to 350 in November when the 175thlost another 50 beds and the 200th Sta-tion at Recife was reduced to 100 beds.In addition to the beds provided by thestation hospitals, dispensaries of from 10to 20 beds each operated at Amapa, SaoLuis, Fortaleza, Bahia, Fernando deNoronha, and Rio de Janeiro. Exceptfor the unit at Rio, which existed pri-marily to provide medical care to U.S.personnel of the Joint Brazil-UnitedStates Military Commission, these dis-pensaries were operated by medical per-sonnel of the Air Transport Command.At Clevelândia, Camocim, and PortoAlegre, very small stations where a dis-pensary could not be justified, MedicalDepartment enlisted men provided emer-gency medical care.

Evacuation

While there was limited air evacuationof nonbattle casualties from Africa, theMiddle East, and even from the China-Burma-India theater before the begin-ning of 1943 over the air ferrying routeby way of Brazil, it was on an individual

basis and records as to its extent are notavailable. Similarly, patients were flowninformally from Brazil to British Guianaor Trinidad without being officially re-corded. As the war in the Mediterraneanspread during 1943 from Africa to Sicilyand Italy, air evacuation through Brazilbecame more general. Late in Septemberof that year the 808th Medical Air Evac-uation Transport Squadron took overthe flights from northern Brazil toMiami, continuing in operation untilthe patient load declined sharply late in1944. All together, 957 patients fromother theaters passed through the SouthAtlantic theater by air on their way tothe zone of interior in 1943, and 2,092 in1944. Only 165 patients followed theBrazilian route in 1945 before the servicewas discontinued in July in favor of themore direct North Atlantic routes.

For the South Atlantic theater itself,the evacuation policy for all hospitals,except the 200th Station Hospital, was60 days. Other hospitals sent patientswhose condition precluded recoverywithin this period to the 200th for moreextended treatment, or for evacuation tothe United States if recovery within 120days seemed unlikely. Because of theabundance of air transportation avail-able, patients usually traveled to theUnited States by plane. A smaller num-ber, notably mental cases, sailed aboardships from the port of Recife. In 1943the number evacuated from the SouthAtlantic theater to the ZI was 189, ofwhom 29 went by sea; in 1944 there were78 evacuated by water and 268 by air, ora total of 346; and in 1945 the figureswere 64 by sea and 151 by air, for a totalof 215. The 3-year aggregate was 750,with more than three-fourths being sentby air.

18 See app. A-1. Theater strength exceeded 10,000for the immediate postwar months of June, Julyand August 1945, when evacuation from the Medi-terranean and redeployment brought about a sub-stantial increase in Air Transport Commandstrength at Brazilian bases.


U.S. medical officers and enlisted Med-ical Department personnel helped trainBrazilian medical troops before the de-parture of the Brazilian ExpeditionaryForce for Italy in July-November 1944,but neither time nor facilities were avail-able to do a completely satisfactory job.Medical personnel of the theater alsoassisted the Brazilian Army by unloadingsick and wounded members of the Brazil-ian Expeditionary Force returning fromItaly by ship and plane.

Medical Supply

In the early days the theater experi-enced some difficulty in procuring medi-cal supplies in sufficient quantities, butby mid-1943 enough stocks had been ac-cumulated to meet the needs of all medi-cal installations in the command. In onlytwo instances were large shiploads ofsupplies from the United States delayedfor so long that emergency air shipmentshad to be made. A general depot estab-lished at Recife in early 1943, providedmedical supplies for the entire theaterand distributed them to the widely sepa-rated medical installations of the com-mand by air and sea transportation. Mostitems of supply came from the UnitedStates, but the Army bought some of theheavier equipment such as chairs, desks,tables, and X-ray units, and also a smallquantity of drugs from Brazilian dealers.Before the Recife depot was established,the Trinidad Sector depot at Fort Readwas often called upon to send medicalsupplies both to Brazil and to AscensionIsland.

Professional Services

Common Diseases Because of the ab-

sence of land combat in the SouthAtlantic theater, the operation of a satis-factory hospital system posed no unusualdifficulties. The operation of medical in-stallations was generally routine, withemphasis on the control of venereal andtropical diseases. Patients stayed in thehospital for only short periods, sinceacute diseases of brief duration ac-counted for most of the admissions.Injuries from plane crashes and other ac-cidents made up the remainder. The gen-eral health of the troops was excellent,and tropical diseases never became aproblem, due mainly to the preventivemeasures employed by the Medical De-partment. The largest single medicalproblem was the great reservoir of vene-real disease near the U.S. Army bases.Prostitution flourished freely with verylittle being done about infected carriersof venereal diseases. Control measuresproved difficult because the Army, beingonly a visitor in a friendly foreign coun-try, did not have control over the civilianpopulation. Areas and individual housescould be placed "off limits" but resi-dents of these houses could and did findother places to carry on their trade. Con-sequently, the Army directed its controlprogram at the individual soldier bymeans of education. The incidence ofvenereal disease on Ascension Island waszero because of the absence of women,but for the theater as a whole the vene-real rate was 83 per thousand perannum for December 1942, averaged101 for 1943, and 72 for 1944. The ratedropped to a low of 36 in May 1945 butshot up again to 99 in August with theinflux of transients. The everpresentdanger of malaria in northeastern Brazilresulted in a vigorous control programin collaboration with the Brazilian


MEMBERS OF MALARIA CONTROL UNIT SPRAYING A SWAMP AREA IN BRAZIL

health authorities. Individual malariacontrol measures were also practicedwith highly successful results. At no timedid malaria become a serious threat tothe physical fitness of U.S. Army troopsin the theater, although the rate perthousand per annum reached a high of98 in March 1943. The worst month in1944 was June, when the rate was 34.The 1945 peak was reached in May andJune, with rates of 24.9 and 27.2, re-spectively.

A good example of how the Armyovercame the deteriorative effects oftropical diseases in Brazil was the workaccomplished by the Medical Depart-ment at the jungle outpost of Amapa.

This location is among the most unfavor-able of any in the world for the mainte-nance of good health. During 1943 therainfall measured around fifteen feet,and in 1944 it totaled almost thirteenfeet. The entire swampy area was alivewith malaria, which took a heavy tollamong personnel of survey teams enter-ing the vicinity in 1942. A small dis-pensary that arrived there in early 1943helped keep the state of health of Armytroops and Brazilian workers on a rea-sonably high level, mainly because ofimmediate evacuation to Belém of allpatients needing bed care. During 1944the dispensary's staff increased, and moresupplies and equipment arrived, which


made it possible to care for many morepatients on the spot. The men assignedto the dispensary had to be versatile.Each enlisted medical assistant was atsome time a laboratory technician, nurse,or even a doctor. In 1944 the base sur-geon delivered six babies for Brazilianworkers, and in every case the enlistedmen assisted the surgeon during delivery.

The Brazilians at the Amapa basesuffered from many chronic diseasesrarely found among American soldiers.The surgeon explained each case enter-ing the dispensary to the enlisted assist-ants, who were required to participatein the treatment. With all the bad en-vironment caused by the heat, tremen-dous rainfall, and poor sanitation of thelocal population, the dispensary recordsshowed only 600 per thousand illnessesor injuries among Army personnel,which amounted to 131 per thousand lessthan the South Atlantic theater rate asa whole. Not a single case of malariadeveloped among American troops dur-ing 1944, despite the fact that this diseasehad previously been highly endemic. Atthe end of that year this small group,composed of one officer and tour enlistedmen, were giving valuable medical serv-ice to approximately 1,000 people.

The Disinsectization Program—In1930 a very severe epidemic of malariahad ravaged the area around Natal. Thedisease proved to be carried by theAnopheles gambiae mosquito, a speciescommon in equatorial Africa but pre-viously unknown in Brazil. It wasbelieved that the vector had been intro-duced by fast French destroyers fromDakar. It had taken ten years of hardwork on the part of the Brazilian HealthDepartment to stamp out the gambiae,

and the Brazilian Government was notprepared to see the scourge re-introducedby aircraft from infested areas of Africa.19

Colonel Leone and his staff worked onthe problem with Brazilian health offi-cials, representatives of the RockefellerFoundation, and ground and air com-manders. Brazilian officials were not sat-isfied with the routine spraying of planesafter they had landed in Brazil. BetweenOctober 1941, when Pan American Air-ways began its flights between Brazil andAfrica, and July 1942, when U.S. Armymedical service was established in Brazil,gambiae were found on seven occasionson planes arriving in Natal from Africa.As a result aircrews were given strictregulations on the subject, which in-cluded spraying before departure fromAfrica. Early in 1943, by Presidentialdecree, the Brazilian health authoritiestook over responsibility for ridding in-coming planes of arthropods. Procedureswere stringent, including the closing ofall vents and shutting off air renovationapparatus before the plane landed, anddisinfestation before any passengers orcrewmen were allowed to deplane or anyfreight was unloaded. In August ColonelLeone accompanied Dr. Fabio Carneirode Mendonca, Director of the BrazilianPort Sanitary Service, on a visit to Africato study conditions at the fields fromwhich planes left for Brazil. At a confer-ence early in November 1943, it wasagreed that U.S. Medical Departmentpersonnel should supervise the disinfes-tation at African points of departure, andthat qualified Brazilian observers should

19 Elliston Farrell, "The Anopheles Gambiae Prob-lem in Brazil and West Africa, 1941-44," Bulletin,U.S. Army Medical Department, vol VIII, (Feb-ruary 1948), pp. 110-24.


be present at these points, most impor-tant of which were Dakar and Accra.

With these practices in effect, the rec-ord was impressive. In 1943, gambiaewere found on 100 out of 819 planesfrom Africa. The total number of gam-biae found was 281, of which 8 were stillliving. Although the number of flightsincreased in 1944 to 2,552, only 30 gam-biae, one living, were found, distributedamong 9 planes. In 1945 only 9 gambiaewere found, all of them dead, distributedamong 9 planes out of 4,841.

Dental Service—Dental service beganin the South Atlantic before a theaterorganization was set up. On AscensionIsland there was a dental officer with the175th Station Hospital, but early arrivalsat the Brazilian bases relied on localcivilian dentists until September 1942.At that time 1st Lt. (later Maj.) JulianM. Rieser of the Air Transport Com-mand arrived with one incomplete ChestMD No. 60. Deficiencies were made upby local purchase or improvisation, andLieutenant Rieser established his head-quarters at Natal, flying the rounds ofthe other bases.

The station hospitals arriving early in1943 had dental officers on their staffsbut little or no dental equipment. Thedentist attached to the 193d Station Hos-pital at Belem was unable to functionuntil March. The dental officer of the200th Station Hospital at Recife carriedon as best he could in the field dis-pensary set up by the Air TransportCommand until enough equipment wasreceived from the United States to openthe hospital dental clinic in May. The194th Station was somewhat more for-tunate in procuring equipment for itsdental officer, whose presence freed the

ATC Wing dental surgeon for more ex-tended visits to other bases.

For a time the dentist of the 194thStation also served as theater dental sur-geon. In September, with additional den-tal officers available, a policy of rotationwas put into effect, and dentists wereshifted from one base to another. At thistime Rieser, now a captain, became the-ater dental surgeon with headquartersin Recife. By the end of 1943 there wereeight dental officers in the theater, andequipment was adequate to maintain aclinic at each of the four station hos-pitals. Complete dental service was avail-able to the entire command andcontinued to be throughout the remain-ing life of the theater. The number ofdental officers increased to 10 in 1944,and the service became more mobile,dental officers going as far afield asAsuncion, Paraguay, and Montevideo,Uruguay.

Veterinary Service—Like his dentalcounterpart, the first veterinary officer inthe theater, Capt. (later Maj.) James R.Karr, was assigned to the South AtlanticWing, Air Transport Command. CaptainKarr reached Natal in November 1942and was at once placed on detached serv-ice in the theater surgeon's office. Addi-tional veterinary officers arrived in 1943,together with a few trained enlisted men.Their task, in a country of lax sanitarystandards, was immense. All meat, eggs,milk, and many other food products hadto be inspected before they could beused. Supervision of slaughterhouses andpasteurization plants was included inthe veterinarians' work, and before theend of 1943 they were themselves raisingchickens and hogs.

For purposes of food inspection, the


Brazilian bases were divided into threeareas, centering at the three station-hos-pital cities. The Belem area includedthe Amapa and Sao Luis bases; the Natalarea included Fortaleza and Fernandode Noronha; and the Recife area in-cluded Bahia. One veterinarian servedeach area, the Recife man serving also astheater veterinarian and making trips asneeded to Ascension Island.

Close-out in Brazil

The Army started planning a generalreduction and eventual discontinuanceof its activities in Brazil and on AscensionIsland in March 1945. The Green Proj-ect, which was an air redeploymentmovement of combat troops from theEuropean and Mediterranean theatersto the United States, for transshipmentto the Pacific, suddenly increased activi-ties in the South Atlantic during that

summer, but this operation came to anend after the defeat of Japan. Almosthalf of those sent to the United Statesunder the "Green Project" traveled viathe South Atlantic theater. Medical facil-ities handled the extra load by obtainingadditional medical personnel from theAir Transport Command and fromamong those being redeployed. In earlySeptember, preparations for inactivatingall station hospitals began, and the plansmade the previous spring were put intooperation. By the end of the month the175th and 193d Station Hospitals hadbeen inactivated, followed by the 194thand 200th in early October. The theateritself disbanded on 31 October 1945, andthe South Atlantic Wing of the AirTransport Command assumed responsi-bility for the administration and opera-tion of the remaining personnel andfacilities.

CHAPTER II

Army Medical Service in Africa and the

Middle East

The U.S Army entered the scene ofconflict in the Middle East on a limitedscale in 1941 as a result of the urgentneed of the British and Russian Armiesfor military supplies and equipment. Aidto the British in the Middle East beganwith the first deliveries of Americanplanes to the Royal Air Force in thespring of that year, and the arrival ofU.S. Army Signal Corps and OrdnanceDepartment technicians during the sum-mer to instruct the British in the use andmaintenance of American equipment.Aid to Russia by way of the Persian Cor-ridor began in November, but was heldto a minimum pending the enlargementof port and rail facilities and the con-struction of roads in Iran. Militaryplanes were ferried from the UnitedStates to the Middle East by way ofBrazil and central Africa before the endof 1941. Transport planes following thesame route carried both American civil-ian and military personnel.

The Beginnings of Medical Servicein the Middle East

The U.S. Military North AfricanMission

The expanding needs of the Britishforces in the Middle East were met by

the creation in September 1941 of theUnited States Military North AfricanMission, with Brig. Gen. Russell L. Max-well as its chief. The mission surgeon,Maj. (later Col.) Crawford F. Sams,joined the group in October and pre-pared a medical plan based on informa-tion available in Washington beforepersonnel of the mission went overseas.The group traveled by air across thePacific, arriving in Cairo on 22 Novem-ber. Major Sams was joined there on the27th by his assistant surgeon, 1st Lt.(later Maj.) Dan Crozier.1

Projects to be carried out under con-trol of the U.S. Military North AfricanMission included construction of portfacilities and establishment of shops forthe repair and maintenance of aircraft,tanks, locomotives, and signal equip-ment. Because the United States was nota belligerent, the work was to be done

1 Principal sources for this section are: (1) Hist,Med Sec, Africa-Middle East Theater, Sep 41-Sep45; (2) Annual Rpt, Med Dept Activities,USAFIME, 1942; (3) Annual Rpt, Med Dept Ac-tivities, Eritrea Serv Comd, USAFIME, 1942; (4)Hist of AMET to 1 Jan 46, Summary Outline, MS,OCMH files; (5) Matloff and Snell, Strategic Plan-ning 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 onpreliminary draft of this chapter.

AFRICA AND THE MIDDLE EAST 57

under lend-lease by civilian contractors,but the mission surgeon was responsiblefor the medical care of all civilians em-ployed, as well as for the health of Amer-ican military personnel in the area.2

Within a few weeks, Major Sams hadcompleted sanitary surveys of Egypt,Eritrea, Anglo-Egyptian Sudan, andPalestine, using local civilian, British,and captured Italian records as well aspersonal reconnaissance. The informa-tion so developed was used to locatebases for medical operations and to mod-ify preliminary plans in terms of actualconditions. Port Sudan was eliminatedas a hospital location, and plans to estab-lish a 100-bed unit at Port Elizabeth,near Capetown on the long Cape ofGood Hope route to India and the FarEast, were indefinitely deferred. For thetime being the British supplied hospi-talization of all U.S. personnel, bothcivilian and military, although 2,150U.S. beds were scheduled for the area.Medical supplies from the United Statesreached the area through three differentchannels: the various contractors wereresponsible for procuring suppliesneeded by civilians employed by them;medical supplies for American civilianand military personnel under militarycontrol were requisitioned by the mis-sion surgeon; British forces in the area

were supplied under the Lend-LeaseAct. Entry of the United States into thewar resulted in some interruption to de-liveries until the future status of thevarious construction projects about toget under way could be determined, butno immediate change of medical planswas required.

In Egypt, a headquarters dispensarywas set up in Cairo in mid-December1941 with Lieutenant Crozier as attend-ing physician. Another dispensary inHeliopolis, a Cairo suburb where repairand maintenance shops were under con-struction, was established in February1942. Hospitalization for all U.S. per-sonnel continued to be provided in Brit-ish hospitals, while native workers werecared for in Egyptian hospitals.

In Eritrea, where a naval base at Mas-saua, an air depot at Gura, and an arse-nal and signal installations at Asmarawere the principal projects, medicalservice began early in February 1942with the arrival of Capt. (later Maj.)Thomas C. Brandon. With a male nurse,an X-ray technician, and six hospitalattendants—all civilians—Captain Bran-don established dispensaries at Asmaraand Gura in February and, the follow-ing month, at Massaua and at Ghinda,where a large housing project forMassaua personnel was under develop-ment. Until additional medical officersarrived late in April, Brandon made therounds of all four stations himself, cover-ing a circuit of about 120 miles of moun-tainous country. American personnelwere hospitalized in British hospitals,while Italian hospitals cared for Italianand native workers under insurancecarried by the contractors.

The War Department, meanwhile,had directed on 18 February that all proj-

2 Military personnel, although not yet engaged inactual combat, were not immune to combat wounds.The first U.S. battle casualty in the Middle Eastoccurred less than a week after Major Sams's ar-rival. S. Sgt. Delmar E. Park, a Signal Corps ob-server and instructor with a British combat unit,was killed by German machine-gun fire near Sidi'Omar, Libya, on 27 November 1941, ten days be-fore the United States entered the war. The SignalCorps has erected a plaque to Sergeant Park'smemory at Fort Monmouth, N.J. Annual Rpt, MedDept Activities, USAFIME, 1942, with confirmationfrom a Signal Corps historian.


COLONEL SAMS

ects sponsored by the U.S. MilitaryNorth African Mission be convertedfrom civilian to military status within sixmonths. Two months proved sufficient.The mission was completely militarizedby 10 April. By special arrangement, some2,500 civilian employees of the DouglasAircraft Corporation were to continueoperating the Gura depot for another sixmonths, and about 2,000 employees ofengineer contractors were to remain oncivilian status, but all projects werebrought under military control.

Following militarization, three areacommands were organized to superviseconstruction work in the three maincenters of activity. These were the Heli-opolis Area; the Eritrea Area, with head-quarters at Asmara; and the PalestineArea, with headquarters at Tel Aviv.Medical plans under the new organiza-

tion called for military hospitals in theseareas with an aggregate capacity of 2,450beds. Since work had not yet been startedin Palestine and medical personnel wasat a premium, surgeons were named onlyfor Eritrea and Heliopolis.

In Eritrea, Captain Brandon was suc-ceeded as area surgeon on 1 May by Maj.(later Lt. Col.) William A. Hutchinson,

who had arrived with two other medicalofficers a few days earlier. The area wasorganized at that time into four districts—Gura, Massaua, Asmara, and Ghinda—each with its own dispensary. The firstU.S. hospital in Eritrea was a 250-bedunit established at Gura by the DouglasAircraft Corporation on 17 June 1942.Although all personnel were civilians,the Army furnished the supplies andequipment, and the hospital functionedunder control of the area surgeon. Itsservices were available to all Americansin Eritrea. In addition to this unit, planscalled for a 500-bed station hospital atAsmara, 250 beds at Ghinda, and 100beds at Massaua.

The Heliopolis Area medical sectionwas set up by Crozier, now a captain, on12 May. Captain Brandon succeededCaptain Crozier as Heliopolis Areasurgeon on 22 May. Dispensary and out-patient service was provided for Ameri-cans and for native workmen, buthospitalization continued to be providedby the British, pending construction of a900-bed station hospital planned for theHeliopolis depot. The Palestine area wasto be served by a 450-bed station hospitalin the vicinity of Camp Tel Litwinsky,near Tel Aviv, whenever it should be re-quired.

In his capacity as Surgeon, U.S. Mili-tary North African Mission, Crawford F.Sams, by then lieutenant colonel, took


COLONEL VAN VLACK

part as American observer in the fourthand fifth Libyan campaigns, in March,May, and June 1942. Particularly con-cerned with the problem of forward evac-uation from rapidly moving armoredunits, Colonel Sams was attached to theBritish 7th Armoured Division.3

The U.S. Military Iranian Mission

While the North African mission wasoperating in Egypt and Eritrea and waspreparing to move into Palestine, an-other prewar mission, formed in October1941 to help the British deliver suppliesto Russia through the Persian Corridor,was laying the groundwork for extensiveport and rail construction work in Iranand Iraq. The chief of the U.S. MilitaryIranian Mission, Brig. Gen. Raymond A.Wheeler, arrived in Basra, Iraq, withthe first contingent of officers late inNovember. The mission surgeon, Lt.Col. (later Col.) Hall G. Van Vlack, didnot reach the area until March 1942,after militarization had been ordered.Every effort was made to select medicalpersonnel who had some familiarity withthe area, and Colonel Van Vlack was noexception. He had directed missionaryhospitals in the Persian Gulf area forseveral years before serving in WorldWar I and knew well both the languageand the people. The medical staff wassoon augmented by the arrival of a den-tal officer, and by a few medical officersand enlisted men sent from the UnitedStates or transferred from the Russianmission, which dissolved in May.4

The surgeon's office was located withthe mission headquarters near Basra atthe head of the Persian Gulf, but head-quarters of the Iranian Engineer Districtwas some 30 miles south at Umm Qasr,Iraq. The surgeon made the round tripacross the desert each day to hold sickcall at the mission headquarters, at theencampment of 600 men at Umm Qasr,and at a motor and equipment assemblyplant at Rafidiyah. In addition to a head-quarters dispensary at Basra, a small dis-pensary was maintained at Umm Qasrfor emergency patients. The British 61stCombined General Hospital at Shu'aybah, 10 miles southwest of Basra, wasavailable to all U.S. personnel.

The first U.S. hospital in the PersianGulf area was a 50-bed unnumbered sta-

3 Ltr, Col Sams to TSG, 20 Jun 42, sub: ArmoredForces Med Servs in the Western Desert.

4 Principal sources for this section are: (1) Nar-rative Hist of Med Activities in the PGC; (2) An-nual 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 toRussia, UNITED STATES ARMY IN WORLDWAR II (Washington, 1952) ; (5) Ltr, Hall G. VanVlack, to Col Coates, 23 Mar 59, commenting onpreliminary draft of this chapter.


tion hospital (later designated the 256thStation Hospital), originally destined forUmm Qasr but diverted to Ahwaz, Iran,where it opened on 6 June 1942. Undercommand of Colonel Van Vlack, the hos-pital was staffed by U.S. Army medicalofficers, civilian male nurses from theconstruction companies, Polish refugeenurses, and a few first aid men borrowedfrom their regular construction jobs.

Air Routes to Africa and theMiddle East

Late in June 1941 Pan American Air-ways, at the request of the United StatesGovernment, took over the task of ferry-ing lend-lease planes to British forces inthe Middle East. The route followed ranfrom Florida across the Caribbean toNatal, Brazil, and thence over the nar-rowest point of the South Atlantic toBathurst in the British colony of Gambiain West Africa. From Gambia the planeswere flown to Khartoum in Anglo-Egyptian Sudan by way of Nigeria andFrench Equatorial Africa. A regulartransport service over this route and onto Cairo was opened in mid-November atthe request of the U.S. Military NorthAfrican Mission.5

After Pearl Harbor, the AAF tookover operation of the ferrying andtransport services. Roberts Field, Libe-ria, became the west African terminus ofthe route, which was extended east toKarachi, India, over alternative courses.One route ran from Khartoum to Cairo,Palestine, and Basra; the other was byway of Eritrea and Aden. Before medicalservice along the route was established,aircrews and passengers were treated for

malaria, dysentery, and other ills at theheadquarters dispensary of the U.S. Mili-tary North African Mission in Cairo.

The Middle East as an Active Theater ofOperations, 1942-43

Both the North African and the Ira-nian missions passed out of existence latein June 1942. They were replaced bythe United States Army Forces in theMiddle East (USAFIME), organized asa theater of operations under commandof General Maxwell. Headquarters wasin Cairo. Under USAFIME, the NorthAfrican Service Command took overoperations in Egypt and Palestine, whilethe Iran-Iraq Service Command sup-planted the existing organization in thePersian Gulf area, now commanded byCol. Don G. Shingler, without changeof functions. At the same time, a newlyorganized U.S. Army Middle East AirForce, commanded by Maj. Gen. LewisH. Brereton, former commander of theTenth Air Force in India, was broughtunder theater control.6

Coincident with activation of USA-FIME, Generalfeldmarschall ErwinRommel's Afrika Korps broke throughBritish positions in Libya and drove towithin 70 miles of Alexandria. Workwas hastily suspended on all U.S. Armyprojects in Egypt and Palestine. Civilianconstruction workers and many militarypersonnel were moved to relative safetyin Eritrea. The North African ServiceCommand shifted its headquarters toGura early in July, and the theater head-

5 Craven and Cate, eds., Plans and Early Opera-tions, pp. 320-27.

6The chief sources for this section are: (1) Hist,Med Sec, AMET; (2) Hist of AMET to 1 Jan 46,Summary Outline; (3) Motter, Persian Corridorand Aid to Russia, pp. 85-93; (4) Craven and Cate,eds., Plans and Early Operations, pp. 341-42.


AIR TRANSPORT COMMAND DC-3 OVER PYRAMIDS

quarters staff began burning its files inpreparation for the evacuation of Egypt.By August, however, Rommel had beencontained at El 'Alamein and work wasresumed in the Cairo and PalestineAreas.

After the resumption of activities inEgypt, the theater was reorganized tosimplify the command structure. TheNorth African Service Command wasabolished, and the three existing areasformerly under its jurisdiction becameservice commands responsible directly tothe theater headquarters. The Heliopolis

Area became the Delta Service Com-mand, including all of Egypt. The Pales-tine Area, with boundaries enlarged toinclude the Levant States, Transjordan,and a wedge-shaped segment of westernArabia, became the Levant Service Com-mand. Boundaries of the Eritrea ServiceCommand were drawn to include Anglo-Egyptian Sudan, Eritrea, French Somali-land, Aden, and all of Arabia south ofthe Persian Gulf. The Iran-Iraq ServiceCommand was renamed the Persian GulfService Command, with jurisdiction overIran, Iraq, Kuwait, and that portion of


Arabia not included in other commandareas. A short-lived and never importantArmy Ground Forces Command was alsoadded to the theater organization in Au-gust to provide administrative supervi-sion over U.S. tank crews operating withthe British Eighth Army. Plans to movean American armored corps into the the-ater were dropped when invasion ofMorocco and Algeria received priority,and the Army Ground Forces Commandwas eventually inactivated. That portionof Libya reconquered from the Axisforces was set up as the Libyan ServiceCommand in December 1942.

Organization at the theater level wascompleted early in November with thecreation of a Services of Supply head-quarters, to which the service commandswere thereafter responsible. GeneralMaxwell became commanding generalof the theater Services of Supply (SOS),being replaced briefly as USAFIME com-mander by Lt. Gen. Frank M. Andrews.In January 1943 Andrews was succeededby General Brereton, who also retainedhis command of the Ninth U.S. AirForce into which the Middle East AirForce had been merged. As in the Eu-ropean theater at this time, the air mis-sion was the primary combat function ofUSAFIME between May 1942 and Sep-tember 1943.

Organization of the MedicalService

Theater Headquarters—The surgeonof the North African Mission, CrawfordF. Sams—promoted to the rank of lieu-tenant colonel in February and colonelin August 1942—became USAFIME sur-geon on the creation of the theater. InNovember he was also made Services of

Supply surgeon, carrying out both as-signments with a single staff. The dualassignment favored centralized control ofthe medical service, but the distance ofsome of the service commands fromCairo, and the lack of good rail and roadcommunications put obstacles in theway. The surgeon was forced in largemeasures to rely on air travel as a meansof co-ordinating the medical affairs ofthe widely dispersed commands.7

Contact with health department rep-resentatives of the various countries ofthe Middle East, and particularly withthe Egyptian Ministry of Health, wasan essential part of the medical section'sactivities. The theater surgeon was amember of a medical advisory commit-tee of the Middle East Supply Council(and of its executive committee), whichcontrolled the requisitions of medicalsupplies for the civilian populations ofthe countries within the theater. Hekept in close touch with the medical au-thorities of the various Allied armies,especially with the Medical Directorateat General Headquarters, British ArmyMiddle East Forces, and the SurgeonGeneral, Egyptian Army.

The theater surgeon's office super-vised the provision of medical services,the operation of the medical supply sys-tem, and the program for prevention ofdisease. The staff provided professionalinformation to the theater commander;prepared medical records and reports,co-ordinating those sent in by the servicecommands; and inspected medical instal-lations. It assigned personnel to the

7 Principal sources for this section are: (1) Hist,Med Sec, AMET; (2) Annual Rpts, Med DeptActivities, USAFIME, 1942 and 1943; (3) Interv,W. K. Daum, Historian, with Col Eugene W. Bil-lick, 11 Jul 52; (4) Intervs, Blanche B. Armfield,Historian, with Gen Sams, 18 Jan and 30 Jan 50.


offices of service command surgeons andthe Ninth Air Force and advised themon local medical problems. It also super-vised the medical service supporting theNinth Air Force in its movement acrossthe Western Desert. As U.S. Army troopsengaged in little fighting in the MiddleEast theater, many of the activities un-dertaken by the theater surgeon's officewere those directed at prevention of dis-ease. The provision of a supply of purefood and water and the establishmentand maintenance of good facilities fordisposal of waste were two important un-dertakings.

The Service Commands—The servicecommands set up under the U.S. ArmyForces in the Middle East remained rela-tively stable until near the end of 1943,when the mission of the theater under-went considerable change. The head-quarters of each service command had amedical section in charge of a surgeonwho was under the direction of ColonelSams in his Services of Supply capacity.8

The administrative center of medicalservice in Delta Service Command was atthe command's headquarters in Heli-opolis, where a medical staff section op-erated an office patterned on the theaterheadquarters medical section. It also con-trolled an antimalaria unit and a general

dispensary. A few miles from Heliopolis,at Camp Russell B. Huckstep, the site ofa large quartermaster depot, was a smallmedical section consisting of a post sur-geon, a veterinarian, and a dental officer.Three dispensaries operated by unit sur-geons, a dental dispensary, and a medicalsubdepot were located there. When thesurgeon's office of Delta Service Com-mand moved from Heliopolis to CampHuckstep in May 1943, it absorbed thepost surgeon's office. The 38th GeneralHospital, which was to be the leadinghospital of the theater, was establishedat Camp Huckstep in late 1942.

Delta Service Command served a num-ber of other areas in some phase or otherof its medical programs. The medicalsubdepot at Camp Huckstep frequentlyfurnished medical supplies to the wholeMiddle East area. American air forcesbattle casualties occurring over Libya,Tunisia, Sicily, Italy, and southeasternEurope were cared for in the command'shospitals. Medical care for U.S. Armypersonnel stationed in the vicinity of theSuez Canal ports was provided by DeltaService Command, except for a brief pe-riod from March to October 1943 whenan independent Suez Port Command wasactive. A port surgeon's office, a generaldispensary, and the platoons of a fieldhospital served troops in the canal area.

A medical staff section of Eritrea Serv-ice Command was located at the com-mand headquarters, which was estab-lished in August 1942 at Asmara, thecapital city of Eritrea. A surgeon placedin each of four districts of the commandmaintained the health and sanitation ofhis particular area. Medical Departmentpersonnel stationed throughout the com-mand were responsible for the health ofArmy personnel, American civilians, and

8 This section is based primarily on the followingdocuments: (1) Hist, Med Sec, AMET; (2) AnnualRpt, Med Dept Activities, USAFIME, 1942; (3)Med Hist, Delta Serv Comd, 1942; (4) AnnualRpts, Med Dept Activities, Eritrea Serv Comd,1942, 1943; (5) Annual Rpt, Med Dept Activities,Levant Serv Comd, 1942; (6) Narrative Hist, MedActivities, PGC; (7) Annual Rpt, Med Dept Ac-tivities, PGC, 1943; (8) Ltr, Gen Sams to ColCoates, 12 Mar 59; (9) Ltr, Van Vlack to ColCoates, 23 May 59; (10) Ltr, Lt Col James J. Adamsto Col Coates, 7 Apr 59. Last three letters commenton preliminary draft of this chapter.


Italian laborers working for the U.S.Army. By the end of 1942 about 150American military hospital beds wereavailable to troops of the command; thecivilian hospital of the Douglas AircraftCorporation relieved the Army of thenecessity of caring for civilians. With thedecrease in construction of port and airbase facilities in 1943, personnel strengthin Eritrea was cut back to the minimumnecessary for servicing bases and fueldumps of the Air Transport Command,and for operating extensive radio instal-lations. The need for medical servicediminished proportionately.

In Levant Service Command, a medi-cal staff section was set up in August1942 at Tel Aviv, Palestine. The sectionincluded the surgeon of the commandand a staff of veterinary, sanitary, andadministrative officers, assisted by severalenlisted men. Because of the lack of sup-plies and incomplete construction ofAmerican hospital facilities in 1942,British military hospitals in the areafurnished most of the hospitalization ofU.S. Army patients. For a time LevantService Command was important as abase for the operation of American AirForces units, but activities never devel-oped to the extent originally antici-pated, and by June 1943 the commandwas on the decline. The headquarters ofthe command moved from Tel Aviv toCamp Tel Litwinsky, some eight milesaway, the site of a repair depot for engi-neer and ordnance equipment and of asteel container manufacturing plant. Atthis time the members of the medicalsection were relieved from duty withthe exception of the veterinarian, andthe commanding officer of the 24th Sta-tion Hospital (a unit that had arrived inFebruary 1943) assumed the additional

assignment as service command surgeon.Libyan Service Command, established

in early December 1942, did not have amedical staff section until March 1943.The surgeon's office was composed of asurgeon, a medical inspector, a veteri-nary officer, a Medical AdministrativeCorps officer, and a medical officer incharge of the headquarters general dis-pensary. This command functioned onlyuntil the end of active operations againstthe Axis in North Africa. In late May itwas divided into Tripoli Base Commandand Benghasi Base Command.9 The newcommands were disbanded in the fall of1943, and their areas and installationswere absorbed by Delta Service Com-mand.

The medical section of the PersianGulf Service Command (PGSC) was in-herited with little change from the Ira-nian mission. Headquarters remained atBasra, Iraq, until January 1943, thenmoved to Tehran, Iran, pending com-pletion of permanent headquarters atCamp Amirabad two miles from thatcity. A surgeon's office, responsible toColonel Van Vlack, the command sur-geon, was maintained in each of thethree districts into which the gulf areawas divided. The command surgeon'soffice instituted the medical policies forthe whole command, but the emphasiswas on the operating agencies—the hospi-tal units. The headquarters medical sec-tion consisted only of the surgeon, asmall staff, and a minimum of enlistedpersonnel to handle reports and records.The district headquarters also operated

9 In the Middle East theater a base command wasnormally one step below a service command. SinceLibyan Service Command no longer existed, Tripoliand Benghasi Base Commands dealt directly withtheir next highest echelon, SOS USAFIME.


with minimum staffs. In April 1943Colonel Van Vlack was succeeded asPGSC surgeon by Col. Forrest R. Ost-rander, former commanding officer ofthe 38th General Hospital.

Although it was administrativelybound to the Middle East theater, thefirst major step toward autonomy camefor the command in January 1943 whenCairo headquarters gave PGSC permis-sion to requisition supplies directly uponthe War Department, handle its ownpersonnel procurement, assignments,and promotions; and deal with the Brit-ish and Iranians without reference totheater headquarters. While the com-mand still remained in the Middle Easttheater organization, this decisive actiongave it a very independent status. Com-plete autonomy came with an order fromWashington on 10 December 1943,which redesignated the command thePersian Gulf Command and made it di-rectly responsible to the War Depart-ment through the Operations Division ofthe General Staff. With a simplified com-mand relationship solidly established,the Persian Gulf Command was betterable to carry on its mission of aid to theSoviet Union.

The Ninth Air Force—The Ninth AirForce, which at its peak had about 25,-000 troops, was the major American com-bat force in the Middle East theater. Itwas organized in August 1942 by Gen-eral Brereton, at which time the head-quarters of U.S. Army Middle East AirForce was discontinued. During 1942and 1943 the Ninth Air Force operatedagainst enemy targets in Libya, Tunisia,Sicily, Italy, Greece, and Rumania. Un-der supervision of the theater surgeon,Col. Edward J. Kendricks, Jr., who had

served as surgeon of the U.S. Army Mid-dle East Air Force became GeneralBrereton's Ninth Air Force surgeon. Atthe Cairo headquarters of the air force,Colonel Kendricks organized an officecontaining an assistant surgeon, a dentalofficer, a plans and training officer, asanitation team, an adjutant, and someenlisted men. At first Colonel Kendricksdoubled as Ninth Air Force Service Com-mand surgeon, but a separate surgeonwas later appointed to that element ofthe air force. The bomber and fightercommands had their own surgeons fromthe outset. Colonel Kendricks and hisstaff left the Middle East for Englandwith the Ninth Air Force in October1943.10

The Air Transport Command—InJuly 1942 a headquarters to administerArmy activities in the vast reaches ofcentral Africa was organized at Accra,Gold Coast, and named United StatesArmy Forces in Central Africa (USA-FICA) . Its major mission was to main-tain bases for the Air Transport Com-mand. Although it never had a largenumber of troops, the command wasoriginally organized like a theater. Un-der the theater headquarters was SOSUSAFICA, an organization that fur-nished supplies and services needed forthe operation of Air Transport Com-mand units throughout Africa.11

10 (1) Hist, Med Sec, AMET. (2) Annual Rpts,Med Dept Activities, USAFIME, 1942, 1943. Seealso 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 CentralAfrica and the Middle East, pt. 2, Hist of theAMEW, ATC (30 Jun-14 Dec 43) , vol. III, Histof 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-


As in other areas where transportationwas the Army's primary mission, com-mand of the theater was given to theAAF, in this case to the CommandingGeneral, Africa-Middle East Wing, AirTransport Command, Brig. Gen. SheplerW. Fitzgerald. The Army retained con-trol of the supply function through Col.James F. C. Hyde, commanding the SOSUSAFICA, and for the time being of themedical function, which was in the handsof Lt. Col. (later Col.) Don. G. Hilldrup,simultaneously surgeon of the theater,the SOS headquarters, and the Africa-Middle East Wing of ATC. By Decem-ber 1942, however, activities had grownto a point that made this triple duty nolonger feasible. Following an inspectionby Brig. Gen. (later Maj. Gen.) DavidN. W. Grant, the air surgeon, Lt. Col.(later Col.) James G. Moore was made

surgeon, AMEW, relieving Hilldrup ofall responsibility for Air Transport Com-mand medical service except for furnish-ing hospitalization and medical supplies,both included among his SOS functions.Colonel Hilldrup was relieved in mid-1943 by Col. Thomas E. Patton, Jr.

Later in the year the central Africancommand was dissolved and its territoryabsorbed by the Middle East theater. Inits place theater headquarters establishedthe West African Service Command,with headquarters at Accra. The com-manding officers of the 67th Station Hos-pital at Accra, Maj. George F. Piltz and,from early 1944, Maj. (later Lt. Col.)Leslie E. Knapp, served also as surgeonsof the West African Service Command.

At the end of 1943 the Africa-MiddleEast Wing of the Air Transport Com-mand was split into Central African andNorth African wings, with Maj. (laterLt. Col.) James W. Brown and Lt. Col.(later Col.) Clarence A. Tinsman therespective surgeons.

Another important base in the WestAfrican Service Command was the cityof Dakar, in French West Africa.12 Soonafter control of the area passed to theAllies with the invasion of North Africa,a complete airport had been constructedthat could handle up to 100 planes a day,and a camp for all permanent personnelhad been built and fully equipped. Itwas later necessary to move the airportto a new site because the swampy mos-quito-infested surroundings contributedto an excessively high malaria rate.

The command, known as U.S. ArmyForces in Liberia, which established itsheadquarters in mid-1942, was to provideservices along the ATC route throughLiberia, defend the U.S. Army installa-tions as well as the facilities of the Fire-stone Tire and Rubber Co. plantation,and carry out certain diplomatic com-mitments for training Liberian militaryforces and for the construction of roads.The presence of a force of about 2,000men in Liberia in this early period hadthe added advantage of posing somethreat to the pro-Vichy French aroundDakar and in French Guinea and theIvory Coast.

Medical activities in Liberia were ad-ministered at the station surgeon's officeat 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 ColCoates, 24 Mar 59, commenting on preliminarydraft of this chapter.

12 Dakar was actually within the boundaries ofthe North African theater, but the city and a smallarea around it came under control of U.S. ArmyForces in Central Africa and later of the WestAfrican Service Command.


of Monrovia, where central control overmedical matters was maintained andmedical reports on the Liberian forcewere completed. The 25th Station Hos-pital (250 beds) near the field cared forthe medical needs of the entire com-mand. From June 1942 until April 1943,Lt. Col. (later Col.) Loren D. Mooreserved as station surgeon. Under the ex-perienced direction of Lt. Col. (laterCol.) Justin M. Andrews, Colonel Moorecarried out extensive malaria survey andcontrol work. When the entire LiberianTask Force, commanded by Brig. Gen.Percy L. Sadler, arrived in the spring of1943, both Moore and Andrews weretransferred to the new North Africantheater. Lt. Col. Stephen D. Berardinelli,commanding officer of the 25th StationHospital, succeeded Moore as station sur-geon. Medical department personnel inLiberia were responsible for the medicalcare of a large force of construction engi-neers during the period when the basewas being built, and later gave supportto all elements of the defense forces inLiberia. Air Transport Command per-sonnel, some members of the Royal AirForce, and natives working for the Armyalso received medical care. In September1943, the Liberian command was sub-ordinated to the Middle East theater, butthis action did not change its basic mis-sion.

Hospitalization and Evacuation

The extreme heat of the Africa-Mid-dle East area, originally thought to beone of the greatest problems in planningfor hospitalization, proved to be less im-portant than anticipated. Except in thePersian Gulf, the experience of the Med-ical Department demonstrated that ad-

verse climatic factors were overrated asto their effect on the general health oftroops. Excessive heat lasting for 24hours of the day during the long summerseason occurred in only a few locations,but the appalling list of diseases endemicin the population of the area causedgreat concern on the part of medical of-ficers. Malaria, yellow fever, typhus,smallpox, dysentery, all forms of vene-real diseases, and many other diseasesrepresented a serious danger to troopsworking in close contact with the in-habitants of the region. In the face ofcenturies of ignorance, maintaining goodsanitation was a major task.13

Medical officers tried to create "iso-lated foci of cleanliness" in and aroundthe immediate areas of hospital plantsand other U.S. Army installations. Thismethod proved to be the only practicalway to handle the sanitation problem,since troops were concentrated in placeswidely separated from each other, mak-ing a comprehensive program impos-sible. Hospitalization in the Middle Easttheater was almost entirely associatedwith the service commands, and rear-a r ea - type hosp i t a l s predominatedthroughout the theater. No mobile hos-pitals operated in the Middle East, al-though platoons of the field hospitalssupporting the Ninth Air Force duringits operations over Libya and Tunisiamoved about more frequently than mostother hospitals.

13 General sources for hospitalization and evacua-tion in the theater as a whole are: (1) Hist, MedSec, AMET; (2) Annual Rpts, USAFIME, 1942,1943; (3) Hist of Preventive Medicine in theMiddle East, 19 Oct 41-23 Jun 44, by Lt ColThomas G. Ward; (4) Hist of AMET to 1 Jan 46,Summary Outline.


Delta Service Command—Delta Serv-ice Command occupied a central positionin 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 October1942 and moved into partially completedbuildings in the desert near Heliopolis,adjacent to a large Quartermaster depot.It began admitting patients on 11 No-vember, and by early 1943 was the focalpoint for fixed hospitalization in theMiddle East. (Map 4} Until September1943, when a general hospital was set upin the Persian Gulf Service Command,there was no other hospital with com-parable resources in the theater. Thechiefs of the medical, surgical, and neu-ropsychiatric services of the 38th alsoacted as consultants in their respectivespecialties to the theater surgeon.14

Beginning in the spring of 1943, pla-toons of the 16th Field Hospital were setup as small hospitals along the route ofthe Suez Canal, to give medical care toU.S. troops stationed there. (See Map4.) Another hospital unit served theNinth Air Force for a short time at anairfield near Alexandria. The commandalso established dispensaries in scatteredplaces having only small garrisons. Amedical supply depot operating as themedical section of the quartermaster de-pot at Heliopolis served as the main dis-tribution point for medical supplies andequipment for all parts of the theaterexcept the Persian Gulf area.

Medical Department facilities in DeltaService Command used permanent build-

ings, with the exception of the field hos-pital platoons, which were under canvas.The Egyptian climate on the whole didnot hinder operations, but spells of ex-treme heat and dust storms caused somedifficulties. An adequate supply of purewater was often lacking, except in largecities such as Cairo and Alexandria. Toavoid using the contaminated and heav-ily silted water of the Nile, the commandhad sunk deep wells and extended pipe-lines. A water purification plant was in-stalled at Camp Huckstep.

The general line of evacuation for thecommand, as well as for the whole thea-ter, pointed toward the 38th GeneralHospital, whether a patient was an Ord-nance Department soldier from the SuezCanal region sick with malaria, or anAir Force pilot wounded over Libya.Patients journeyed by ambulance fromnearby places such as the Suez Canal, butif coming from Libya, Syria, Eritrea, orIran, they traveled by air to Cairo andthen by ambulance to the 38th General.Delta Service Command also served asthe focal point for shipment of patientsto the zone of interior by ship and plane,the latter method being employed mostof the time.

Eritrea Service Command—Most of theU.S. Army medical installations in Eri-trea Service Command were withinEritrea itself, although the boundaries ofthe command embraced the Anglo-Egyp-tian Sudan and the southern half ofArabia as well. In addition to the civilianhospital operated by the Douglas Air-craft Corporation at Gura, two hospitalswere established in Eritrea. The 21stStation Hospital (500 beds), the firstcomplete Army unit to arrive, debarkedat Massaua on 13 November 1942. It was

14 (1) Annual Rpts, Med Dept Activities, DeltaServ Comd, 1942, 1943. (2) Annual Rpts, 38th GenHosp, 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.


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

sited the following day at Mai Habar, atown in the mountains between Asmaraand Gura, and took over hospital build-ings formerly occupied by the medicalservices of the Italian and British Ar-mies. Some of the personnel of the 21stwere detached to operate dispensaries atAsmara, Decamere, Ghinda, and Mas-saua. The second U.S. Army hospital tobe established in Eritrea was the 104thStation Hospital, which arrived in lateJanuary 1943. It relieved the detach-ment of the 21st Station Hospital at Mas-saua, setting up a 100-bed unit there.13

By the spring of 1943 U.S. Army activ-ities in Eritrea had diminished to thepoint where there was little need for a500-bed hospital. Consequently, the 21stStation Hospital moved on to the PersianGulf area in May 1943. During the pre-vious month the 104th had turned overto the British Navy the hospital that theunit had been operating at Massaua andmoved to the Gura air depot to share inthe operation of the Douglas Aircrafthospital there. The depot finally closedin November, resulting in the disband-ing of the Douglas hospital and the ship-

15 (1) Annual Rpts, Med Dept Activities, EritreaServ Comd, 1942, 1943. (2) Annual Rpt, 21st StaHosp, 1943. (3) Annual Rpt, 104th Sta Hosp, 1943.

(4) Annual Rpt, 15th Field Hosp, 1943. (5) An-nual Rpt, 16th Field Hosp, 1943.


KING GEORGE OF GREECE, COLONEL VAN VLACK, AND GENERAL ROYCE at 38thGeneral Hospital, Camp Huckstep, Egypt.

ment of the 104th to Asmara (the loca-tion of the headquarters of EritreaService Command), where it establisheda 25-bed hospital. This small installationremained in operation for some time asthe only U.S. Army hospital in Eritrea.A 50-bed hospital at Wadi Seidna, an im-portant junction near Khartoum alongthe Air Transport Command's centralAfrican route, cared for the ATC per-sonnel stationed there, as well as for thetransients who passed through on theirway to and from the Middle East andIndia. It was operated by a platoon ofthe 15th Field Hospital beginning inJune 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 mosthumid seaports in the world, hospitals inEritrea operated installations at placeswith fairly moderate climates due to ele-vations of 5,000 to 7,500 feet. The scar-city of potable water caused some troublefor these hospitals, and the task of main-taining good sanitary standards provedto be a constant battle, as in most otherparts of the theater. The command wasfortunate enough to secure permanentbuildings for all its hospitals. It evacu-ated almost all of its patients by air.


HOSPITAL TRAIN IMPROVISED FROM PASSENGER CARS, BENGHASI AREA

Levant Service Command—No U.S.hospital facilities were available in theLevant Service Command until February1943, nearly eight months after the com-mand was activated. General dispensa-ries at Tel Aviv and at Camp Tel Litwin-sky, both in Palestine, served the areafrom July 1942. In mid-November the4th Field Hospital arrived at the camp,took over operation of the dispensarythere, and established a small infirmary.Lack of equipment prevented it fromoperating as a hospital, but many medi-cal officers from its staff worked for shortperiods at two British general hospitalsin Jerusalem. The 24th Station Hospital(250 beds) relieved the remaining ele-ments of the 4th Field Hospital in Feb-ruary 1943. The latter then joined theparent unit, which had been assigned a

few weeks earlier to the Ninth AirForce-Libya.16

The buildings of the 24th Station Hos-pital at Camp Tel Litwinsky were ideal-ly situated on a small hill with a beauti-ful view of the countryside. The watersupply was adequate and the drainagegood. The equable Mediterranean cli-mate and the fresh air and sunshinemade the 24th a perfect place for con-valescing patients, and it operated as suchfor men who had received treatment else-where in the theater. It also performedthe usual functions of a station hospitalfor Levant Service Command personnel.Most patients arrived at the hospital byair, but some of those from Delta Serv-

16 (1) Annual Rpts, Med Dept Activities, LevantServ Comd, 1942, 1943. (2) Annual Rpt, 4th FieldHosp, 1942. (3) Annual Rpt, 24th Sta Hosp, 1943.


PARTIALLY DUG-IN HOSPITAL TENTS of the 3d Platoon, 4th Field Hospital, near Tripoli,May 1943.

ice Command came in by rail. (See Map4.)

Military activities in the commandbegan declining by mid-1943. The com-mand headquarters moved from TelAviv to Camp Tel Litwinsky, and thecommanding officer of the 24th StationHospital started serving as surgeon of thecommand in addition to his duties at thehospital. By October, the 24th StationHospital closed, evacuated its patients tothe 38th General Hospital in Egypt, andmade ready to depart for the China-Burma-India Theater.

Libyan Service Command—By thetime that the British Eighth Army hadpassed Benghasi in its advance throughthe Western Desert, a new service com-

mand was added to the original five. Ashort-lived command—formed on 7 De-cember 1942 and disbanded on 26 May1943—the Libyan Service Command in-cluded the area within the territorialboundaries of Libya not occupied byenemy forces. At first comprising onlyeastern Libya, the command grew in areaas the Eighth Army advanced westward.The major American participants in thesixth Libyan campaign were members ofthe U.S. Ninth Army Air Force. Hospi-tal care for the personnel of the forcewas provided first by British Army hospi-tals and later by hospitals of the MiddleEast theater.17

Beginning in January 1943 the pla-17 (1) Annual Rpt, 4th Field Hosp, 1943. (2) An-

nual Rpt, 15th Field Hosp, 1943.


toons of the 4th Field Hospital, assignedto the Libyan Service Command, hadthe job of receiving Ninth Air Forcepatients from their squadron aid stationsand evacuating them back to Egypt. The4th Field also cared for Services of Sup-ply troops stationed in the LibyanService Command. The first unit of the4th Field Hospital to begin work inLibya was the 1st Platoon, which arrivedat Gambut on 26 January 1943 andbegan receiving patients three days later.It relieved pressure on the British hospi-tals in the area by taking Americanpatients of the IX Bomber Commandand Services of Supply personnel in thevicinity. It changed location on 28 Feb-ruary, moving forward to Benghasiwhere it established another hospital.

The 3d Platoon and the headquarterssection of the 4th Field Hospital arrivedin Tripoli on 26 March 1943 and set upa hospital for units of the Ninth AirForce and Services of Supply troops inwestern Libya and southeastern Tunisia.The 2d Platoon entered the field last,opening on 19 April at Sfax, Tunisia,where it supported two bombardmentgroups. Soon after the surrender of theAxis forces in Africa in mid-May, itmoved back to Benghasi. Another fieldhospital, the 15th, arrived in Libya on13 May and relieved the 1st Platoon ofthe 4th Field Hospital at Benghasi. (SeeMap 4.}

The most characteristic feature offield hospital operations in Libya wasthe independent functioning of the pla-toons, often separated by hundreds ofmiles. Except for buildings obtained byone of the platoons of the 4th FieldHospital, all hospital installations usedtents. British tropical-type tents supple-mented the regular ward tents with good

results. The extreme heat of the desertwas 15° to 20°F. less inside the Britishtent. During the period of active fight-ing, the platoons of the 4th Field Hospi-tal habitually dispersed and dug theirtents in for maximum protection frombomb fragments. Life in the desert un-der field conditions made it necessary toget along with what was on hand—noth-ing was wasted that could be turned intoa useful item for the hospital. Water,though fairly adequate in quantity, hadto be hauled for considerable distances.

Evacuation from southern Tunisia andLibya was generally by ambulance orplane from squadron aid stations of theNinth Air Force and dispensaries ofServices of Supply units to the platoonsof the field hospitals, where planespicked up patients for delivery to the38th General Hospital in Egypt. A curi-osity of the situation was the parallelexistence of an evacuation system underthe control of the North African theatermoving casualties from Tunisia west-ward to Algiers, so that two supply andevacuation routes ran at an angle of 180°to each other. A similar situation pre-vailed during the invasion of Sicily whenthe Ninth Air Force again supported theBritish Eighth Army. The Middle Easttheater ran its chain of evacuation fromSicily by way of Tripoli to Egypt, whilethe North African Theater evacuatedfrom Sicily to Bizerte and thence west-ward.

Persian Gulf Service Command—Inthe Persian Gulf area the first substan-tial shipment of U.S. troops arrived atKhorramshahr, Iran, on 11 December1942. With them came the personnel of2 station hospitals, the first major in-crement of Medical Department troops


113TH GENERAL HOSPITAL AT AHWAZ, IRAN, laid out in radial pattern with connectingwings.

to arrive in the command. The 2 hospi-tals, the 19th and 30th Station Hospitals,both 250-bed units, began operating inearly January 1943, the 19th at Khorram-shahr and the 30th at Tehran. Later inJanuary the temporary 50-bed hospitalat Ahwaz was designated the 256th Sta-tion Hospital. Between January and theend of June, 3 more station hospitals(the 21st, 113th, and 154th) and 3 fieldhospitals (the 18th, 19th, and 26th) wereestablished in Iran. No additional hospi-tal units arrived there during the exist-ence of the command.18 (Map 5)

The 113th Station Hospital (750beds), the largest American hospital inIran, began acting as a general hospitalfor the command soon after it arrived atAhwaz in May. It offered complete treat-ment for all diseases and injuries andserved as a clearinghouse for patientsbeing evacuated to the zone of interiorthrough the 38th General Hospital inEgypt. It also provided station hospitalcare for nearby troops. In Septemberthe unit was reorganized as the 113thGeneral Hospital and was given person-nel to operate a 1,000-bed plant. Another

18 (1) Hist, Med Activities, PGC. (2) AnnualRpts, 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 FieldHosps, 1943.

MAP 5—U.S. Army Hospitals in the Persian Gulf Service Command, 1 July 1943


of the larger units in the command, the21st Station Hospital (500 beds), beganfunctioning at Khorramshahr in mid-May, replacing the 19th Station Hospi-tal, which moved to Tehran. The 154thStation Hospital, a smaller unit of 150beds, first established a tented hospitalat Ahwaz in February, but moved northto its permanent station at Hamadan inJune. The 50-bed 256th Station Hospital,displaced at Ahwaz by the 113th General,moved late in August to Abadan on theShatt-al-Arab near the Persian Gulf.

With one exception—the 19th FieldHospital at Andimeshk—the field hospi-tals in Iran dispersed their platoons toscattered locations where each was ableto run a hospital of at least 100 beds.Installations operated by field hospitalplatoons were, in effect, small stationhospitals and were usually housed in per-manent buildings. They shifted fromplace to place much more frequentlythan the command's station hospitals.During 1943 the 18th and 26th FieldHospitals used all their platoons sepa-rately most of the time, the 18th operat-ing hospitals at Sultanabad, Ahwaz, andBandar Shahpur, and the 26th function-ing at Abadan, Kazvin, and Khorrama-bad.

By early December 1943 almost 2,700beds, provided by one general, four sta-tion, and three field hospitals, were inoperation in the Persian Gulf Command.Provisional dispensaries and aid stationshad also been set up as they were neededat road camps, railway installations, andother work sites along the supply routesto the Soviet Union. These small unitssupplemented those maintained by theOrdnance Department and the Engi-neer, Quartermaster, and Signal Corpsfor their own personnel. Where the in-

stallation was large enough to justify it,a medical officer was placed in charge.Where the installation was no morethan an aid station, it was generally incharge of a trained enlisted man, sharingwith other such stations the supervisionof one medical officer. In the southernpart of the command, dispensaries oper-ated heatstroke centers consisting of air-conditioned rooms with beds and specialfacilities for heat cases.

Few hospitals in the Persian Gulf areaoperated under conditions that ap-proached those prevailing in the UnitedStates or even in some overseas theaters.All of the locations were deplorable asfar as sanitation was concerned, andmany were at the mercy of the swelteringheat for a good part of the year. Duststorms, combined with temperatures of150° and 160° F. in the sun (one stationreported a reading of 183°F.) , madeservice in some parts of Iran an ordealto bear. To make matters worse Iranwas a land of pestilence, the populationbeing a reservoir of malaria, typhus, ven-ereal diseases, intestinal infections, small-pox, and a variety of other diseases.Scarcely a place could be found wherethe water supply was not heavily con-taminated. Water had to be filtered andthen either boiled or chlorinated beforeit was safe to drink. Because of the prac-tice of fertilizing with human feces, mostof the locally grown vegetables andthin-skinned fruits required thoroughcooking or dipping in boiling water be-fore they could be safely eaten. Flies,mosquitoes, and other insects providedanother source of disease as well as aconstant annoyance.

Housing for hospitals posed a seriousproblem. Tented hospitals functionedbriefly, but eventually almost all hospi-


tal construction rose from the ground up,using native mud, brick, and stone. Win-dow ramps and doors fashioned fromcratings of automobiles and trucks sentto the USSR, and plastic for glass win-dowpanes put the finishing touches onmany hospital buildings. Men of thehospital detachments made many of theirown items of equipment such as tables,chairs, and desks. The buildings them-selves were always one storied andfrequently were built in a rosette patternwith central rotundas from which fivewards radiated. In the southern part ofIran, hospitals had air conditioning unitsin some of their buildings, making theheat of summer more endurable for bothpatients and hospital personnel.

By the fall of 1943 the Persian GulfCommand had reached a strength ofsome 29,500, a figure that varied nomore than 2,000 during the followingyear. Although the command had hospi-tal beds available for 10 percent of thestrength during most of 1943, at no timewas it necessary to use the full bed capac-ity. The average of hospitalizationvaried from 4.5 to 6.5 percent of the totalstrength. From the time the commandwas formed until 1 October 1943, totaladmissions numbered 24,889. The aver-age rates per 1,000 per annum for diseaseand injury admissions in 1943 were 1,172and 155 respectively. During the firstnine months of 1943 the three maincommunicable diseases treated in PGSChospitals were common diarrhea, whichaccounted for 4,348 admissions with arate of 293 per 1,000 per annum; com-mon respiratory disease, with 2,511 ad-missions and a rate of 169; and venerealdisease, accounting for 1,563 admissionswith a rate of 104. Specific dysentery,amebic dysentery, and pappataci fever

were three other important causes foradmission to hospitals.

Evacuation within the command wasby rail, motor, and air transport, themore serious cases being sent from thestation and field hospitals to the 113thStation Hospital at Ahwaz. Patients need-ing prolonged treatment traveled toCairo by air for care at the 38th GeneralHospital. Soon after the 113th officiallybecame a general hospital in mid-Sep-tember 1943, it cared for many moreserious and complicated cases. Here aboard of medical officers examinedpatients and their records, and if it de-cided that an individual could not besuccessfully treated in the Persian GulfService Command, he would be shippeddirectly to the zone of interior by theair transport route across Africa. Al-though patients from the Persian Gulfarea would frequently stop at the 38thGeneral Hospital while waiting for aplane, their status was strictly transient,and the 38th could not change the de-cision made by the 113th General Hospi-tal in Iran.

Central and West Africa—Except fora few dispensary beds at places along theroute of the Air Transport Command,there were no U.S. Army hospital facili-ties under the U.S. Army Forces in Cen-tral Africa until early December 1942,when the 67th Station Hospital (250beds) arrived at Accra.19

The following month another medicalunit, the 93d Station Hospital (150

19 The 23d Station Hospital had been set up inLéopoldville, Belgian Congo, in September 1942 toprovide medical care for a southern branch routeof the ATC, but it never got into full operationbecause the proposed route was abandoned by theend of the year. The idle 23d was finally sent tothe North African theater in April 1943.


167TH STATION HOSPITAL AT ACCRA, GOLD COAST

beds) debarked at Dakar, French WestAfrica. The major function of both hos-pitals was to give medical support to thebases of the Air Transport Command.Between Dakar and Accra a third hospi-tal, the 25th Station (250 beds), hadbeen operating since June 1942 nearRoberts Field, Liberia, a major airfieldof the Air Transport Command.20

The three major points of U.S. Armyhospitalization remained at Accra, Dakar,

and Roberts Field throughout the war.Since all three station hospitals werewell within the tropics, their personnelwere subject to high temperatures, ma-laria, venereal disease, and a host of trop-ical diseases. Malaria in particular tookits toll in thousands of man-days lost.The hospital buildings built or acquiredfor these units followed a simple one-storied hospital plant layout. The dis-pensaries at the stations of the AirTransport Command sent patients need-ing hospital care by air to the hospitalnearest their landing fields. During 1943west African hospitals evacuated some300 patients to the United States, mostof them by air transport. Since all thoseevacuated 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 Ac-tivities, West African Serv Comd, 1943. (3) AnnualRpts, Med Dept Activities, USAFIL, 1942, 1943.(4) Annual Rpt, Med Dept Activities, CentralAfrican Wing, ATC, 1943. (5) ETMD Rpt,USAFICA, Aug 1943. (6) Mae Mills Link andHubert A. Coleman, Medical Support of the ArmyAir Forces in World War II (Washington, 1955),pp. 588-90.


the return air route was preferable tosending patients farther away from thezone of interior by going east acrossAfrica to the nearest general hospital inEgypt.

Summary—From the beginning of thetheater, the medical service in the Mid-dle East was one that had served widelydispersed troop concentrations. Theprevailing pattern of small station hospi-tals and field hospital platoons operatingin the same capacity was the most logicalapproach to supplying medical service toone of the largest U.S. Army theaters inthe world in terms of land area. In phys-ical plant the hospitals of the MiddleEast theater compared favorably withmany cantonment-type hospitals in theUnited States, considering the difficul-ties imposed by unfavorable climate,poor sanitary standards, and endemicdiseases. All these factors caused extrawork that would be largely unnecessaryin some theaters. Hospital plants oftentook the additional precaution of enclos-ing their areas with barbed wire fencesto prevent pilfering.

The theater reached its peak strengthin July 1943, when it had 66,483 troops.Maximum hospital bed strength wasreached at the same time, with 6,600fixed beds scattered from Liberia toTehran.21 Approximately half of the to-tal, or 3,200, were in the Persian Gulf Serv-ice Command. Delta Service Commandhad 1,000; Eriterea Service Commandhad 450, including those in the civilianhospital of the Douglas Aircraft Corpora-tion; and U.S. Forces in Central Africawere served by 400 beds. There were 400beds under jurisdiction of the short-livedSuez Port Command; 400 in the Libyan

Base Command; 500 in the Tripoli BaseCommand; and 250 each in the LevantService Command and in Liberia.

Although the ratio of fixed beds totroop strength was high—9.9 in the peakmonth—the general average of beds oc-cupied at any one time rarely exceeded5 percent of theater strength.

Admissions to fixed hospitals in theMiddle East theater during the periodof greatest activity—1 July 1942 through30 September 1943—totaled 53,863, ofwhich 24,889 were in the Persian GulfService Command. The five leadingcauses of admissions were intestinal dis-ease, respiratory disease, injury (exclu-sive of battle casualties), cutaneous dis-ease, and venereal disease. The 120-dayevacuation policy originally planned forthe medical service of the theater provedadequate. Evacuation within the theateremphasized the use of airplanes becauseof the wide dispersal and lack of otheradequate facilities. No special ambu-lance planes operated for this purpose,but regular transport planes were usedwhen available. During the period underconsideration most evacuees to the zoneof interior traveled by Air TransportCommand plane from Cairo. By October1943, approximately 1,000 patients hadmade the trip to the United States.

At no time were U.S. hospital shipsavailable for evacuation from the Mid-dle East. In the early period, a fewpatients were sent to the zone of interiorfrom the Persian Gulf on cargo ships byway of the Cape of Good Hope. Spaceon British hospital ships in the easternMediterranean was sometimes available.The British hospital ships, however,generally excluded psychotics, and theATC planes would carry patients of thisclass only when accompanied by a medi-21 See app. A-2.


cal officer or nurse. As a result, somepsychotics were held at the 38th GeneralHospital for more than a year. In otherinstances a medical officer who could noteasily be spared was nevertheless detailedfor this service.22

The Middle East as a Supply andService Theater, 1944-45

The United States Army Forces in theMiddle East reached a peak strength ofmore than 65,000 in midsummer of 1943,but combat activities in the area wererapidly coming to a close. Ground Forcesheadquarters was discontinued duringthe summer because no American groundcombat troops remained in the MiddleEast. The Ninth Air Force supported theBritish Eighth Army in the invasion ofSicily early in July, and later that monthparticipated in the bombing of Rome,but the successful raid on the Ploesti oilfields of Rumania in August was thelast combat mission for the Ninth AirForce in the Middle East. Transfer ofpersonnel to the Twelfth Air Force inNorth Africa began in July, and head-quarters moved to the United Kingdomin October.

After departure of the Ninth AirForce, operations in the Middle Eastwere those characteristic of a large com-munications zone, consisting almost ex-clusively of maintaining supply lines andtransporting supplies and personnel.

Organizational Changes

Theater Headquarters—With the de-parture of General Brereton in Septem-

ber 1943, Maj. Gen. Ralph Royce as-sumed command of the United StatesArmy Forces in the Middle East. Theseparate services of supply headquarterswas discontinued at this time, but with-out in any way affecting the work of theMedical Department in the theater. Colo-nel Sams, who had returned to theUnited States in August, was succeededas theater surgeon by Col. Eugene W.Billick.

While activity declined in the easternMediterranean in the fall of 1943, ac-tivity in the Persian Gulf area was stillincreasing. The independent mission ofthe Persian Gulf Service Command wasrecognized early in December when itsadministrative tie with Cairo was cut andthe command was made directly respon-sible to the War Department. In effect,the redesignated Persian Gulf Commandremained an independent theater until1 March 1945, when it was merged withUSAFIME and the Mediterranean BaseSection from the Mediterranean theaterto form the Africa-Middle East Thea-ter of Operations.

The staff of the theater surgeon's officein Cairo underwent numerous changesduring 1944 and 1945. Many of the origi-nal officers on Colonel Billick's staff re-turned to the United States, their dutiesbeing carried on either by newly ap-pointed officers (of lower rank thantheir predecessors), absorbed by othersubsections of the office, or handled byofficers assigned to Medical Departmentinstallations. The head of the dentalsection, for example, had a triple assign-ment, since he was also dental surgeon ofa service command and of a general hos-pital. The preventive medicine section,the one element where expansion oc-curred, had a malariologist (stationed in

22 Ltr, Van Vlack to Col Coates, 23 Mar 59, com-menting on preliminary draft of this chapter.


West Africa) assigned to it, as well as anutrition officer.

A contingent of the Women's ArmyCorps, which arrived in the middle of1944, replaced practically all the enlistedmen in the theater surgeon's office. Theturnover in commissioned personnel washeavy in 1945, and the loss acutely felt,especially since the theater had experi-enced a substantial expansion in terri-tory. A new development during early1945 was the appointment of medical,surgical, dental, and neuropsychiatricconsultants. They worked not only asmembers of the theater surgeon's staffbut also as chiefs of services in the 38thGeneral Hospital. During the course ofthe year many sections of the surgeon'soffice were merged, and it was commonto find medical staff officers combiningtwo or more assignments.

The Service Commands—With thePersian Gulf Command autonomous bythe beginning of 1944, the remainingservice commands in Africa and the Mid-dle East were regrouped into two majorcommands. The Middle East ServiceCommand was established in February,merging the Delta, Levant, and EritreaService Commands. The Levant ServiceCommand was disbanded, while Eritreabecame a base command subordinate tothe new headquarters. The West AfricanService Command remained substan-tially as it had been organized in the fallof 1943.23

The medical service in the MiddleEast Service Command was responsiblefor the care of all American troops andassociated personnel in Egypt, the Anglo-Egyptian Sudan, Eritrea, Libya, Pales-tine, Syria, and Arabia. When formed,the commanding officer of the 38th Gen-eral Hospital at Camp Huckstep, Egypt,assumed the additional job of servicecommand surgeon. Various other officersof the command surgeon's office also hadprimary assignments with Medical De-partment units and installations. Thesurgeon's office was located at the 38thGeneral Hospital. Eritrea Base Com-mand was a subcommand of the MiddleEast Service Command during most of1944, but was established as a separatecommand directly under theater head-quarters in December. The commanderof the 104th Station Hospital at Asmaraserved as the base command surgeonthroughout the year. Activities in theWest African Service Command centeredaround the command headquarters inAccra and the base command at Dakar.The medical service, primarily for thebenefit of Air Transport Command per-sonnel, continued to provide hospitaliza-tion, medical supplies, sanitary services,and malaria control. The commandsurgeon was also the commanding officerof the 67th Station Hospital at Accra.The Medical Department in Liberiaexperienced some difficulties in carryingon medical and administrative measuresfor controlling malaria and venereal dis-ease because of reductions in medicalpersonnel.

Coincident with the territorial expan-sion of 1 March 1945, French Morocco,Algeria, and Tunisia were organized intoa new command, the North African Serv-ice Command, under the Africa-Middle

23 The main sources for this section include: (1)Hist, Med Sec, AMET; (2) Hist of AMET, Sum-mary Outline; (3) Annual Rpt, Med Dept Ac-tivities, Middle East Serv Comd, 1944; (4) AnnualRpt, Med Dept Activities, West African Serv Comd,1944; (5) Annual Rpt, Sta Surg, Roberts Field,Liberia, 1944; (6) Hist, Med Activities, PersianGulf Comd; (7) Annual Rpt, Med Dept Activities,PGC, 1944.


East theater. The offices of the Mediter-ranean Base Section at Casablancabecame the new command's headquar-ters, and the commanding officer of the56th Station Hospital in that city re-ceived the additional assignment ofNorth African Service Command sur-geon. By the end of June 1945, all U.S.Army activities in the West AfricanService Command were placed under thecontrol of the North African ServiceCommand. Medical Department unitsin West Africa were thereafter admin-istered by the Southern Town Com-mand, a subcommand whose functionit was to handle the liquidation ofU.S. Army installations in that area.Southern Town Command, with head-quarters at Accra, was one of four sub-divisions under North African ServiceCommand, the others being EasternTown Command, Center Town Com-mand, and Western Town Command,with headquarters at Tunis, Algiers, andOran, respectively. After the Central Af-rican Wing of the Air Transport Com-mand had been inactivated in July,installations along its route throughthe Southern Town Command and theMiddle East Service Command wereeither closed or greatly reduced. Thebulk of air traffic passed through thenorthern part of Africa for the remain-der of the year.

The Persian Gulf Command reachedthe peak of deliveries of war materialsto the USSR during 1944. The separationof the command from the Middle Easttheater in December 1943 had no effectupon the medical service other than theforwarding of reports, which no longerrequired routing through Cairo. TheMedical Department of the commandcontinued to provide the best possible

care for troops and carried on its never-ending task of refining preventive meas-ures to combat the numerous diseasesof Iran. Col. John E. McDill becamePGC surgeon in January 1944. In thesummer of that year, when the commandwas near its greatest strength, ColonelMcDill exercised staff supervision overmore than 2,400 Medical Departmentofficers and enlisted men.

By the end of 1944 the motor transportroutes to the Soviet Union started closingdown, narrowing the major supply activ-ities to the more confined route of therailroad from Khorramshahr to Tehran.Progressive reductions in tonnagethrough the first half of 1945 completedthe primary mission of the Persian GulfCommand by 1 June, after which itpacked and shipped excess supplies,turned over surpluses to a liquidationcommission, provided security detach-ments for remaining fixed installationsuntil they could be disposed of, and con-tinued to supply the Air Transport Com-mand. These residual duties requiredfewer troops and many soon began mov-ing out of the command. The MedicalDepartment's responsibility was to re-duce its own personnel and installationsto conform with the command's pro-gram without impairing the efficiency ofits services to the remaining troops.

Air Transport Command—During1943 the Africa-Middle East Wing ofthe Air Transport Command had de-veloped stations at many towns andcities in northern, central, and easternAfrica, and in countries of the MiddleEast, which lay along the ATC routesto Karachi, India. The northern armof its system stretched across FrenchWest Africa, French Morocco, Algeria,


Tunisia, and through the Middle East toIndia, the most important stations beingwithin the North African theater. Allthe airfields of the central route lay with-in the boundaries of the Middle East the-ater, passing through the countries ofwest, central, and eastern Africa, acrosssouthern Arabia, and on to India. By theend of 1943 the Africa-Middle EastWing had been split in two—the NorthAfrican Wing with headquarters at Mar-rakech, French Morocco, and the Cen-tral African Wing with headquarters atAccra, Gold Coast. Since the latter wasmost closely associated with the MiddleEast theater, it is discussed here in moredetail than the northern route.24

The primary objective of the CentralAfrican Wing was the delivery of high-priority freight and of military andcivilian personnel, mail, and militaryaircraft across Africa. It transferred itscargoes to the North African Wing atDakar and Cairo and to the India-ChinaWing at Karachi. The Central AfricanWing surgeon's medical responsibilitieswere limited to preventive medicinemeasures and the maintenance of dis-pensaries at the stations, including sta-tions at which theater service commandhospitals were located. The territorialcommand within which the wing oper-ated furnished medical supplies as wellas hospitalization. Near the end of 1943

the Central African Wing was relievedof the major medical problem of ma-laria control, which was placed underthe direction of the theater command.Nineteen officers and seventy-one en-listed men of the Medical Departmentserved at the thirteen stations of thewing in December 1943. At some of thesmaller stations a medical officer couldbe on duty only part of the time, butMedical Department enlisted menserved at all the dispensaries. Some dis-pensaries had facilities to handle person-nel with minor illnesses and injuries,but serious cases were evacuated by airto the nearest U.S. Army hospital.

Transportation of patients homewardfrom the Middle East along the route ofthe Central African Wing was handledby detachments of the 805th and 808thMedical Air Evacuation TransportSquadrons. Each air evacuation flightwas composed of a medical officer, sixnurses, and eight enlisted men. FromMarch 1943 to August 1944, 2,500 pa-tients traveled westward across mid-Africa, then on to Brazil and the UnitedStates. Beginning in September 1944,however, air evacuation activities weretransferred to the North African Wing.

Preventive medical problems consti-tuted the chief concern of medical menstationed at the bases of the CentralAfrican Wing. Many of its stations werein highly malarious areas and on theedge of jungles and bush country, bothinsect ridden. Despite the presence ofa large variety of tropical and other dis-eases (yaws, yellow fever, filariasis, ty-phus, dysentery, bubonic plague,smallpox, and so forth), malaria causedmore illness among wing personnel thanany other disease. Aircraft accidents re-sulted in the death of more wing person-

24 (1) Hist, Med Sec, AMET. (2) Hist of AMET,Summary Outline. (3) Rpt of Med Dept Activitiesin the Africa-Middle East Wing, ATC, for 1943,Off of Surg, Sta #1. (4) Med Hist, Central AfricanDiv, ATC, 22 Sep 44, by Maj Ralph N. Green, Jr.,Div Med Historian, Air Staff files. (5) Hist of Cen-tral 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.


nel than any other cause, and the medicalcare of pilots flying the Central Africanroute was an important matter to themedical service. Flight surgeons requiredthat pilots take a semiannual flightphysical examination to determine theflyer's fitness for duty. All airports hademergency plans in readiness in theevent of crashes, including speciallyequipped ambulances and other crashvehicles. Near the coast, air-sea rescueteams used motor launches and amphib-ious planes when an aircraft fell intothe sea. Trained Medical Departmentenlisted men extricated patients fromdowned planes and gave first aid treat-ment to the crash victims.

As the much shorter trans-Africanroute across North Africa developed, theimportance of the more southern routeunder the Central African Wing dimin-ished. However, the latter was stillthought to be a military necessity sinceit provided a sure contact with India,and it continued in operation until July1945. Its dispensaries were inactivatedas the wing closed its stations duringJune and early July, and the dispensaryequipment was shipped to the nearesthospital or medical supply depot. Themedical service provided along the north-erly route, under the North AfricanWing, now lay within the boundaries ofthe Middle East theater since the theaterhad absorbed all of northern Africa inMarch. The North African Wing oper-ated dispensaries from Dakar and Casa-blanca in the west, across the coast ofnorthern Africa to Egypt, and on throughthe Persian Gulf Command to India.During 1945 it was responsible for evacu-ating a large number of patients fromthe Mediterranean, India-Burma, andChina theaters to the United States.


The need for hospitalization in theMiddle East declined with the changingmission of the theater. Toward the endof 1943 the 4th and 15th Field Hospitalswere shifted to the Mediterranean thea-ter. In January 1944 the 24th StationHospital left Palestine for Jorhat, India;and the following month the 16th Fieldwas transferred to the European theater.In other hospitals, bed strength was re-duced as patient loads became minimal.25

In Eritrea the 104th Station Hospitalcontinued to operate a 25-bed unit atAsmara through 1944. Late in 1943 per-sonnel not needed by this hospital weredetached to form the 367th Station Hos-pital, activated as a 50-bed unit in Janu-ary 1944 and sent to Wadi Seidna, nearKhartoum, Anglo-Egyptian Sudan, whereit relieved a platoon of the 16th FieldHospital. In Egypt, the 38th GeneralHospital at Camp Huckstep was reducedfrom 1,000 to 750 beds early in 1944. InWest Africa the 67th Station Hospital(250 beds) at Accra, the 93d Station(150 beds) at Dakar, and the 25th Stationat Roberts Field, Liberia, remained inplace throughout 1944. The 25th Stationwas reduced from 250 to 50 beds inJanuary 1944, then increased to 75 bedsin September.

The acquisition of Northwest Africafrom the Mediterranean theater on 1March 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 ofhospitals mentioned in the text. (7) ETMD's for1944, 1945.


FORK-LIFTING A PATIENT aboard atransport plane, Casablanca, May 1945.

hospitals under jurisdiction of the Mid-dle East theater, and offered an oppor-tunity to relocate some of the hospitalsalready serving in the command. Thoseacquired were the 56th Station (250beds) at Casablanca; the 57th Station(150 beds) at Tunis; and the 370th Sta-tion (25 beds) at Marrakech. At thistime the 150-bed 93d Station was trans-ferred from Dakar to Tripoli, beingreplaced at Dakar by the 50-bed 367thStation from the Khartoum area. The25-bed 104th Station from Asmara re-placed the 367th at Khartoum, leaving amedical composite platoon in charge ofthe hospital at Asmara.

The end of the war in Europe broughta further reduction of activity in theMiddle East, but air traffic through thetheater increased, both from the FarEast by way of India and from Europe

by way of North Africa. In order to pro-vide medical care for thousands oftransient patients en route from Indiaand Burma to the zone of interior, the38th General Hospital—a 500-bed unitsince June 1945—was moved to Casa-blanca in August. The 56th Station,which had been more than two years atCasablanca, took over the Camp Huck-step site of the 38th General near Cairo.Also in August, the 53d Station Hospitalwas reactivated as a 50-bed unit and wasestablished at Oran.26

The evacuation of patients to the zoneof interior rose considerably during1944, due primarily to the inaugurationin August of an evacuation servicethrough the Africa-Middle East theaterfor patients from the China-Burma-In-dia theater. The Persian Gulf Commandalso sent many homeward-bound pa-tients through the theater. While thesetransient cases were not formally admit-ted to a hospital, they put a strain uponthe theater's small number of medicalinstallations because in some instancesthey had to be held several days whileawaiting a plane. Total evacuations tothe United States including patientsfrom the China-Burma-India theater,the Persian Gulf Command, and theAfrica-Middle East theater itself, num-bered well over 3,000 during 1944. Thisfigure rose to more than 5,000 for 1945,the transient patients constituting mostof the total. The evacuation policychanged from 120 days to 60 days inAugust 1945 in order to filter patientsback to the United States more rapidly.

In the Persian Gulf Command a gen-eral reduction in bed strength, based on



the experience of a year and a half ofoperation, began before the end of 1943,while activity in the area was still in-creasing. The 30th Station Hospital, with250 beds, left the Persian Gulf area forthe China-Burma-India theater in No-vember 1943. In January 1944 the 150-bed 154th Station was transferred to theMediterranean theater, and the followingmonth the 113th General Hospital wasreduced from 1,000 to 750 beds. The18th Field Hospital left the commandin July 1944, and the 26th Field inDecember.

By the beginning of 1944, practicallyall hospital construction in the PersianGulf area had been completed. Theneed for air-conditioned wards was recog-nized early, especially for hospitals lo-cated in the gulf and desert areas, butonly a limited number of cooling unitswere available during the first year ofoperation. Installation of additionalequipment in hospitals was begun inMarch 1944 and completed by the firstof July, resulting in many completelyair-conditioned wards at five hospitals.Approximately 1,248 beds in hospitalslocated at Andimeshk, Ahwaz, Khorram-shahr, Bandar Shahpur, and Abadan hadthe benefits of air conditioning readilyavailable.

The year 1944 saw a progressive re-duction of illness in the command. Atno time during the year did disease ratesapproach the peak rates of 1943. AfterJuly 1944 all the curves followed a steadydownward trend. This decline, in acountry rife with diseases, was a directresult of the effectiveness of the MedicalDepartment's preventive medicine pro-gram.

By the beginning of 1945 there were1,850 T/O beds remaining in the Persian

Gulf Command, or a ratio of 6.9 to troopstrength. Hospitals still operating at thistime were the 113th General (750 beds)at Ahwaz, the 21st Station (500 beds)at Khorramshahr, the 19th Station (250beds) at Tehran, and the 256th Station(50 beds) at Arak. The 19th FieldHospital had 200 beds in operation atAndimeshk and 100 beds at BandarShahpur.

Early in February the 21st Station wastransferred to Italy, being replaced atKhorramshahr by the 113th General. Aplatoon of the 19th Field took over theAhwaz site. At the beginning of Aprilthe 113th General was further reducedto 500 beds and was closed for movementout of the theater later that month. Theend of June 1945 found only the 19thand 256th Station Hospitals and oneplatoon of the 19th Field Hospital stillactive in the command, with an aggre-gate of 400 beds.

Patients were evacuated from thePersian Gulf Command to the zone ofinterior on a 180-day policy, movingthrough the 113th General Hospital.For the period January 1943-September1945, 1,168 patients were returned tothe zone of interior. All patients weretransported by air to Cairo and fromthere by air or water to the UnitedStates. Up to September 1944 the PersianGulf Command furnished attendantsfor patients being evacuated to Cairo,but after that date Air Transport Com-mand planes had one flight nurse andone enlisted man as attendants. A flightsurgeon examined all patients beforedeparture from Iran. The four leadingcauses for evacuation were neuropsychi-atric diseases, injuries, cardiovasculardiseases, and respiratory diseases. Mostof the evacuation within the command,


that is from the station and field hospi-tals to the general hospital, was by aweekly railroad ambulance car, motorambulance, or a combination of the two.The command used air evacuation foremergency cases occurring within itsboundaries.

Medical Supplies and Equipment

When early in the war, American unitsarrived in the Middle East short of medi-cal equipment, the British furnished thenecessary supplies, sometimes fromlend-lease stores. Occasionally difficultiesdeveloped in the use of British suppliessince American medical officers did notalways regard British standards as equalto those of the U.S. Army. During thelatter part of 1942, supplies in largerquantities began arriving from theUnited States, having been shipped byautomatic issue of medical maintenanceunits. The supply situation was one ofgeneral disorder in the early period, as itwas in most new theaters. Thousands ofunlabeled boxes had to be opened to dis-cover what had been received. To makematters worse, many Medical Depart-ment hospital units arrived without anysupplies and equipment, their assem-blies having been shipped separately.Fortunately, acquisitions from the Brit-ish, improvisations from materials onhand, and a small number of local pur-chases enabled hospitals to operate with-out waiting for all their equipment toarrive.27

The theater experienced some short-ages during 1942 and the early part of1943, but medical supply conditions im-proved after the middle of the year. The4th Medical Depot Company, which hadarrived on 1 November 1942, establishedthree medical supply subdepots in theMiddle East theater—at Camp Huckstep,Egypt; Decamere, Eritrea; and Tel Lit-winsky, Palestine. By February 1943 themilitary situation in the theater had sochanged that the subdepots in Eritreaand Palestine were closed. All medicalsupply depot work was then concentratedat Camp Huckstep, where the 4thMedical Depot Company became themedical section of the theater's quarter-master general depot. Automatic supplyfrom the zone of interior was discon-tinued in October 1943, and thereafterthe theater ordered medical supplies byquarterly requisitions on the UnitedStates.

The medical supply authorities in theMiddle East theater found that the ex-perience gained during the theater'smost active period indicated that a betterplan to equip medical troops would havebeen to establish an assembly depot wellstocked with all types of medical suppliesat or near the port of debarkation. Sucha depot could have assembled equipmentfor each unit after notification of itsembarkation from the United States hadbeen received. In effect, the Middle Easttheater used this plan for all medicalunits arriving after February 1943, andthe units so equipped were better ableto perform their duties than thoseequipped with assemblies sent themfrom the zone of interior. The actiontaken within the theater helped medicalunits 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 Ac-tivities, USAFIME, 1942, 1943; (3) Hist of MedActivities, PGC; (4) Annual Rpts, Med Dept Ac-tivities, PGC, 1943, 1944, 1945; (5) ETMD.USAFIME, Jan 1944.


had to wait many months before certainessential items arrived. Furthermore,unit assemblies from theater supplieshad fewer shortages because the elementof loss through handling was reduced tothe minimum. Only items actually re-quired by the unit to perform its missionwere issued, thereby saving both equip-ment and transportation from depot tostation.

Medical supply presented no seriousproblems in the Persian Gulf ServiceCommand. Although the flow of supplieswas slow in 1942 and early 1943, thissituation improved by the middle of1943, and adequate quantities of sup-plies were on hand after this time. Agreat deal of breakage and spoiling ofperishable items occurred because ofimproper packing, poor handling, andexposure to the terrific heat of the Per-sian Gulf climate. Stock levels that hadbeen built up during 1943 were reducedby 50 percent in January 1944, and thefinal reserve (a 90-day level of suppliesset aside for emergency use) was abol-ished. About this time the automaticshipment of selected medical supplieswas discontinued. Supplies were there-after requisitioned on the basis of Tableof Organization and Equipment (TOE)authorization and consumption. Theoverstockage that resulted was correctedby declaring excesses, which were even-tually shipped back to the United States.Vaccines, which had previously beenshipped by water, arrived in the PersianGulf Command by air beginning in1944, thus eliminating considerable lossin spoilage of vaccine before it could beused. In 1945 all surplus supplies andequipment not in use by medical instal-lations were reported to an Army-NavyLiquidation Commission for disposition.


Major Medical Problems

The relatively limited combat activity,the difficult climatic conditions, and thelow health and sanitary standards of thenative populations all combined to chan-nel the activities of the Medical Depart-ment in the direction of preventivemedicine. In Central and West Africathe most serious problem was malaria;in the Persian Gulf area, respiratory dis-eases were common. Gastrointestinaldisorders, venereal disease, and neuro-psychiatric problems swelled the non-effective rates throughout the theater.Disease patterns in the Middle East wereobserved by medical officers with theoriginal North African and Iranian mili-tary missions and the problems thatwould be encountered were fully appre-ciated from the start.

Malaria—American medical officers inthe Middle East had first hand experi-ence with malaria and other insect-bornediseases months before the standardmalaria control and survey units devel-oped by the Surgeon General's Officewere available for overseas duty. Basedon this experience, an antimalaria unitconsisting of one Sanitary Corps officerand five enlisted men was developed inthe 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 GambiaeControl and Malaria Prevention at U.S. Army Basesin West Africa, by Maj Elliston Farrell, 1944. (3)Rpt of Malaria Control at U.S. Army Installationsin West Africa, 1941-44, Hq, West African ServComd, USAFIME, to CG, USAFIME, attn ChiefSurg. (4) Malaria: Its Prevalence, Control, and Pre-vention in the Africa—Middle East Area, by J. W. H.Rehn.


In March 1943 the standard, morespecialized units developed by the Sur-geon General's Office for the purpose ofmalaria control were requested after thetheater was informed of their existence.The one survey unit and two controlunits asked for did not reach the theater,however, until September 1943 becauseof shipping delays. About that datemalaria became the most important dis-ease in terms of man-days lost in thistheater where disease problems werenow paramount and combat injuriesnonexistent. This was the date when twohighly malarious areas, those of theCentral African and Liberian commands,were included in the theater's bound-aries. In October the malaria rate atDakar reached almost 2,000 per thousandmen per year; in Accra it reached 580and in Liberia over 800. Half of all hos-pital admissions in West Africa werecaused by malaria. In Dakar 50 percent ofthe enlisted men of the 93d Station Hos-pital came down with the disease at theheight of the 1943 malaria season.

Efforts to control malaria were con-centrated in western Africa, particularlyat Dakar, in Liberia, and at Accra, thethree worst areas. At the end of 1943 amalaria survey unit was at work in eachof the three locations. In addition, Li-beria and Accra each had a malariacontrol unit, two control units were as-signed to Dakar, and a fifth one wasassigned to Delta Service Command.Early in 1944 all these units were placedunder more centralized control at thea-ter headquarters, largely as a result of avisit to the theater by a group of officersfrom the Surgeon General's Office andthe Medical Inspector, USAFIME. Thismalaria control commission made itsinvestigation in West Africa in Novem-

ber and December 1943.29 It was pri-marily concerned with ridding the WestAfrican coastal airports of anophelesgambiae mosquitoes in order to preventthe introduction of this malaria vectorby plane into Brazil.30 A secondary pur-pose was to check on the accuracy of re-ports of excessively high malaria ratesamong Eighth Air Force combat crewswho passed through Air Transport Com-mand installations in Africa on the wayto England. A third matter for investiga-tion was the appalling malaria ratesamong U.S. military personnel stationedon the West African coast. These wereamong the highest in the entire Army,not excepting the rates for combat troopsin New Guinea, Guadalcanal, and Sicily.The fact that the troops were living inrelatively permanent installations madethe theater medical inspector, Lt. Col.Thomas G. Ward, term the situation "adisgrace to the U.S. Army."

The causes were pointed out by Colo-nel Ward in a report to the ChiefSurgeon, USAFIME. The Central Afri-can command had failed to organize andmaintain malaria control even after highrates had developed. The Africa-MiddleEast Wing, ATC, had similarly failedto provide a sound malaria control or-ganization and policy after it had agreedwith the Central African command totake over malaria prevention measuresat the West African airfields. Shortagesof personnel and equipment had pre-vented the wing from carrying out effec-tive control measures. The Corps of

29 Members of the commission were Col. WilliamA. 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 theAir Surgeon, Washington, B.C.

30 See pp. 53-54, above.


Engineers and those charged with themaintenance of post utilities were inpart responsible because of their failureto make the buildings mosquitoproofwhere the permanent personnel lived andwhere combat aircrews and passengersstayed while in transit. Finally, themedical and line officers at the WestAfrican posts had not developed an ef-fective educational program to acquaintpermanent and transient personnel withthe dangers of malaria.31

The commission concluded in its re-port to The Surgeon General thatmalaria control in the theater was theresponsibility of the theater commanderand that personnel engaged in it shouldbe part of the theater organization. Thecommission pointed out that, with avail-able air transportation, one malariolo-gist could maintain close supervision overmalaria control work in the widelyseparated malarious areas around Dakar,Roberts Field, and Accra.32

The special malaria control organiza-tion that developed was headed by Maj.Elliston Farrell, the Army Air Forcesrepresentative on the visiting commis-sion. He was assigned in February 1944to the Medical Section, USAFIME, astheater malariologist, succeeding Lt.Col. Daniel Wright who had held thatpost since early 1942. Major Farrell wasstationed in Accra, where he could di-rect operations on the coast of WestAfrica. He also acted as disinsectizationofficer for the South Atlantic, NorthAfrican, and Central African Wings of

the Air Transport Command and as liai-son officer with the Brazilian PortHealth Service. Two doctors of the Bra-zilian Department of Public Healthwere stationed at Dakar and Accra asliaison officers with the U.S. Army au-thorities. They were permitted to visitother Army airports in Africa thatrouted planes to Brazil, all in the inter-est of keeping Brazil free of gambiae.33

Working with the theater malariol-ogist at the Accra, Liberia, and Dakarbases were assistant malariologists, en-tomologists, engineers, and the enlistedpersonnel of the control and survey units.Malaria control measures were usuallyrestricted to a perimeter or protectedarea around a U.S. military installation.In some areas the U.S. Army and theBritish and French carried out success-ful co-operative schemes. The interalliedscheme for malaria control developed bythe British and American forces stationedin and around Accra was one of thelarger efforts along these lines. Itachieved integration of British andAmerican direction, engineering, sur-vey, and control activities.

Although the theater malariologistwas responsible for co-ordinating and su-pervising malaria control activities inWest Africa, he had no power of com-mand. Consequently he found it difficultto deal with station commanders. MajorFarrell revealed some of the trouble hehad in Accra when he stated:

Directives were not followed and as ex-ample the station commander was inter-ested in building an officers' club and we31 Memo, Col Ward, Med Insp, USAFIME, to

Chief Surgeon, USAFIME, 21 Dec 43, sub: Malariain West Africa.

32 Memo, Col Hardenbergh, Col Lundeberg, andMaj Farrell for The Surgeon General, 4 Dec 43,sub: Mosquito and Malaria Control at West AfricanAirfields.

33 Elliston Farrell, "The Anopheles Gambiae Prob-lem in Brazil and West Africa, 1941-44," Bulletin,U.S. Army Medical Department, vol. VIII, (Feb-ruary 1948), pp. 110-24.


were interested in having screened build-ings in the camp. . . . The officers' club wasopened for general use the 5th of October[1944]. It was started the 29th of Mayand was built by men working 12 hours aday, 7 days a week, during the height ofour [malaria] season. It was built at atime when lumber was not available foressential screening work. When the officers'club was finished the screening was doneand by that time it was September and wedidn't need it. ...

We are educating the soldiers in themalaria program, but we are not sufficientlyeducating the Generals and Colonels. I amactually convinced, from the reaction ofthe station commander, that he had noidea that malaria could be eliminated fromthe base. I had breakfast with him a fewdays before he was reassigned and he askedme how many cases of malaria we had lastweek. I told him two and that in the sametime in 1943 there were forty or fifty. Hewas so obviously astonished that I realizedfor the first time that he had thought wewere just pestering him. He had thoughtthat when he had put in a good system ofmalaria discipline, nothing further couldbe done about it. He didn't know that byattacking malaria at its source it could beeliminated.34

Major Farrell also believed that theefficacy of the malaria program couldhave been greatly increased if there hadbeen a single battalion attached to the-ater headquarters under the direction ofthe theater malariologist in lieu of alarger number of scattered malaria units.In his opinion a theater battalion formalaria control would have provided amuch better system of centralized controlover the movement of units. Such a bat-talion could have had a commander re-

sponsible for the flow of orders. MajorFarrell found it a disadvantage to be3,000 miles from the theater headquar-ters in Cairo and thus out of touch withthe top command. It would have beenbetter, he thought, if he had had some-one else to do the supervisory work onthe West African coast and had himselfremained in Cairo nearer the source ofauthority. He concluded that the effec-tiveness of a malaria control program"depends on the success with which youattain the support of the highest author-ity in the theater. The only way toreach lower commanders is to get actionfrom above."35

The 1944 malaria control program inWest Africa followed traditional lines(insecticiding, larviciding, and malariadiscipline) except for the use of DDT,which was introduced during the springand summer months. By the close of 1944the rates for Army personnel at Accraand Dakar were reduced to the lowestever known at those stations. Althoughthey dropped in Liberia too, a reason-ably low rate was not attained at RobertsField until late the following year. By1945 malaria incidence throughout theentire theater had decreased greatly, thehighest theater-wide rate being onlyabout 15 per 1,000 per annum in Janu-ary. The majority of cases continued tooccur in Liberia.

The program went on to the close ofthe war, the malaria control organizationassisting, as in other theaters, with thecontrol of various insect-borne diseasesbesides malaria—bubonic plague, sleep-ing sickness, filariasis, and yellow fever.By the end of the war it had becomeevident that the small number of U.S.Army installations remaining in the the-

34 Interv, Oprs Serv, SGO, with Maj Farrell, 1Dec 44, Rpt of Med Dept Activities in Accra, GoldCoast, West Africa. See also, Ltr, Van Vlack, toCol Coates, 23 Mar 59, commenting on preliminarydraft of this chapter. 35 Farrell Interv.


ater would no longer require a malariacontrol organization of the size that haddeveloped. After the surrender of Japan,most of the survey and control units werescheduled for inactivation with the ex-ception of a survey unit located in Casa-blanca at the headquarters of the NorthAfrican Service Command and a controlunit at Roberts Field.

Venereal Diseases—The control ofvenereal disease was one of the most im-portant medical problems in the MiddleEast theater. No reliable statistics ex-isted as to the local incidence of venerealdiseases, but Medical Department offi-cers knew that the populations of all ofthe Middle Eastern countries were heav-ily infected. It was believed that in someareas almost 100 percent of the womenwith whom American soldiers came incontact had one or more venereal dis-eases. The Medical Department warnedU.S. personnel of the danger throughlectures, demonstrations, motion pic-tures, and other educational devices. Itestablished prophylactic stations, usedspecial investigation teams, and co-oper-ated with civil public health authoritiesin finding the sources of infection.36

From an average of about 40 per 1,000per annum for the period July-De-

cember 1942, the rate increased in 1943,exceeding 80 per 1,000 per annum inSeptember, October, and November.Many factors other than the heavily in-fected population contributed to thehigh rate in the Middle East theater,among them being a general moral lax-ness common among men in overseas sta-tions, and carelessness, forgetfulness, andrefusal to accept advice. The Army wasfurther handicapped because it was un-able to command the aid of governmentsthat were independent or were underthe jurisdiction of another power.

In Delta Service Command, troopsduring the first part of 1942 were al-lowed to patronize houses of prostitutionregulated by the Egyptian Government.The careless supervision of the housesand the cursory periodic medical exam-ination given the inmates could hardlybe classed as a controlled system accord-ing to officers of the U.S. Army MedicalDepartment. The Egyptian Governmentnext eliminated the houses of prostitu-tion by law, but this action actuallyworsened the situation since "undercoverhouses," streetwalkers, and "taxicabprostitutes" increased in number. Vene-real disease control activities were forthe most part confined to U.S. Armytroops, the commanders of units enforc-ing such measures as were practicable.Through an improved system of prophy-lactic treatment the venereal disease ratedropped from an average of 44.2 per1,000 per year for the period January-July 1943 to a low of 33.75 in December.

Control of venereal disease was oneof the most vexing problems facing theMedical Department in the Persian GulfService Command. During 1943 ratesaveraged 105 per 1,000 per annum, witha peak of more than 120 in September.

36 General sources for this section are: (1) An-nual Rpts, Med Dept Activities, USAFIME, 1942,1943: (2) Annual Rpt, Med Dept Activities, LevantServ Comd, 1942; (3) Hist of Med Activities,Persian Gulf Comd; (4) Annual Rpts, Med DeptActivities, PGC, 1943, 1944, 1945; (5) Annual Rpts,Med Dept Activities, Eritrea Serv Comd, 1942, 1943,1944; (6) Annual Rpts, Med Dept Activities, WestAfrican 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 ofVenereal Disease Control Activities, USAFIL, 1942-45; (10) Med Stat Div, SGO, Morbidity and Mor-tality in the United States Army, 1940-45.


Control was very difficult since a systemof publicly countenanced prostitutionprevailed throughout Iran. Medical De-partment officers believed that over 95percent of Iranian prostitutes were in-fected. Rates during 1944 showed someimprovement, chiefly because of moresatisfactory housing, better recreationalfacilities, and increased activities indelivery of supplies to the USSR. Withthe slackening of activities in the fall of1944, rates again assumed an upwardmovement. The venereal disease controlprogram was intensified, and in additionto providing convenient prophylactic sta-tions and supplying ample stocks ofmechanical and chemical prophylacticdevices, it employed educational meas-ures on a large scale. Venereal diseasefilms were shown regularly in conjunc-tion with talks by medical officers.

In one district in late 1944 three badlyinfected prostitutes agreed to participatein a demonstration for which they re-ceived medical treatment in return.Their lesions were shown to the troopsin that area in combination with theusual talk on venereal disease. Controver-sial though it was, the idea of usingdiseased prostitutes for demonstrationsspread to other parts of the command,but no appreciable lowering of the ratesresulted.37 In spite of energetic efforts toreduce the incidence of these diseases,rates continued undesirably high. Nosignificant lowering of the rate occurreduntil the summer of 1945.

In the Levant, Eritrea, and West Af-rican Service Commands, the venerealdisease problem was not as serious, butwhen the U.S. forces in Liberia cameunder the jurisdiction of the theater in

September 1943, a command having anextremely high incidence of venerealdisease added its excessive rates to thetheater totals. The situation in Liberiawas bad from the start. The venereal dis-ease rate among personnel stationedthere averaged 650 per 1,000 per year forthe period August—November 1942. Aplan to control venereal disease amongtroops and the native population wasformulated in September 1942 by theU.S. Army with the Liberian health au-thorities. It resulted in the establish-ment of areas known as "toleratedwomen's villages" conveniently locatednear the barracks of the troops, but justoutside the military reservation of Rob-erts Field. A health center for treatmentof women in the villages was also estab-lished. Once begun, the command vene-real disease officer and his assistant car-ried out the control program.

By December 1942, with the con-trolled native women's villages in fulloperation, the rate for Army personnelin Liberia had decreased to 470 per1,000 per annum for the last month ofthe year. During 1943 control measureswere intensified by giving more frequentinstructions to all enlisted men, issuingprophylactic packets and giving sulfa-thiazole tablets to men going on pass,establishing more prophylactic stations,and making chemical prophylaxis com-pulsory for all men visiting the toleratedwomen's villages. The incidence of vene-real disease decreased to an average rateof 180 per 1,000 per annum for the lastseven months of 1943.

Venereal disease rates continued todecrease during the early part of 1944,a low of 63.2 per 1,000 per annum beingrecorded for February 1944, but later inthe year a rise developed which reached

37 Ltr, Abram J. Abeloff to Col Coates, 16 Mar 59,commenting on preliminary draft of this chapter.


658.8 during November. One of the mainreasons for the increase was that troopshad started making contact with womenin ten "off limits" villages near the mili-tary area. The refusal to accept adviceand the failure to use available mechani-cal and chemical prophylaxis also contrib-uted to the increase. The commandthereupon undertook a more compre-hensive control program that includedtreatment for women outside the toler-ated villages. This extended coveragehelped reduce the rate temporarily, butduring 1945 venereal disease became soserious that it displaced malaria as theoutstanding medical problem in Li-beria. The elimination of the toleratedwomen's villages in June, low morale,general indifference, and constant turn-over in personnel all contributed to amarked rise in the venereal disease rate.In 1945, monthly rates ranged fromabout 400 to almost 1,200 per 1,000 perannum.

As in other theaters, the use of sulfadrugs, and, from early 1944, of penicil-lin, greatly reduced the number of man-days lost because of venereal disease.

Typhus—Medical officers in the Mid-dle East regarded typhus fever as one ofthe major problems of preventive medi-cine in the theater. During 1943 inEgypt alone over 25,000 cases occurredin the civilian population. Protectivemeasures such as frequent inspections ofimmunization records to be certain thatall personnel received a booster inocula-tion every three months, provision ofbathing and delousing facilities, and theplacing of native sections out of boundscontributed to the small number of casesthat occurred among members of theU.S. Army and American civilians. Only

22 cases were found during 1943, noneof them proving fatal.38

In recognition of the threat of typhusin many areas of the world, the USA Ty-phus Commission was created in Wash-ington in December 1942, and its workwas an important phase of the medicalprogram in the Middle East theater in1943 and 1944. A forward echelon of thecommission arrived in Cairo in January1943 and established the field headquar-ters of the commission. The field staffwas made up of U.S. Army, Navy, PublicHealth Service, and Rockefeller Founda-tion personnel, all under the administra-tive control of the Middle East theaterheadquarters but not a part of the the-ater organization. Experts of the com-mission worked in various theaters, butthe Cairo group was the most active, astyphus posed a greater threat in theMiddle East and the adjacent North Af-rican theater than elsewhere.

The Typhus Commission groupworked closely with the theater surgeonand also with medical officers of the Brit-ish Army Middle East Forces and withofficials in the Egyptian Ministry ofPublic Health. The commission had theuse of a laboratory at a governmentserum and vaccine institute and a clini-cal ward in a local fever hospital, andsoon began testing vaccine and lousepowders in field experiments. Duringthe first months of 1943 members of thecommission made surveys of the typhus

38 (1) Hist, Med Sec, AMET. (2) Stanhope Bayne-Jones, "The United States of America Typhus Com-mission," 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.


situation in many areas of the MiddleEast and North Africa, visiting Syria,Lebanon, Palestine, Iran, Iraq, Libya,Algeria, Morocco, and Tunisia.

The field director of the commissionduring most of its existence was Brig.Gen. Leon A. Fox.39 The Cairo fieldheadquarter was well situated so as tomove easily to Europe, other African andMiddle East locations, and the Far East.General Fox traveled during the latesummer and fall of 1943 to North Afri-ca, India, Burma, China, Iran, Iraq,and Turkey, making typhus surveys. Hisreports on the typhus situation in theseareas were forwarded to the commissionheadquarters in Washington, and copiesgiven to the Middle East theater surgeonand to U.S. Army surgeons of the NorthAfrican and China—Burma—India thea-ters.

Activities of the Typhus Commissionbenefiting the population in MiddleEast countries consisted of the distribu-tion of about 3,000,000 individual dosesof typhus vaccine, repeated typhus sur-veys, and extensive dusting of popula-tions with louse powders. The commis-sion also handled a large-scale programto instruct personnel of the United Na-

tions Relief and Rehabilitation Admin-istration in modern and effective delous-ing methods. UNRRA was planningrelief work in the Balkans, an area witha well-known history of typhus epi-demics.

The commission maintained contactwith French scientists at several of thePasteur Institutes in North Africa andthe Middle East. It also kept in touchwith the Egyptian Ministry of PublicHealth, and co-operated with it in vari-ous projects. The surgeons general of theEgyptian and Iranian Armies agreed toa vaccination program administered bythe Typhus Commission. The allocationof typhus vaccine to the various MiddleEast countries was handled by the Alliedorganization that governed the flow oflend-lease supplies, the Middle EastSupply Council. As both the theatersurgeon and the field director of theTyphus Commission were members ofthe council they were able to control theallocation, a point vital to the success ofthe program, as otherwise typhus vac-cine could easily have become a monop-oly of the privileged or have found itsway into the black market.

The Typhus Commission participatedin control activities at Naples during theoutbreak of typhus in that city duringthe winter of 1943-44. The work of thecommission was continued throughoutthe Middle East and Africa during1944, and in 1945 it put into effect atyphus control program in the Balkans.The possibility of dissolving the commis-sion's field headquarters at Cairo wasbrought up during the summer of 1944,but this did not take place until mid-summer of 1945, when it was closed andits facilities and equipment transferredto a U.S. Navy epidemiology unit.

39 The first director of the Typhus Commissionwas Rear Adm. Charles S. Stephenson, MC, USN.On a survey trip to Lebanon and Palestine duringJanuary 1943, Admiral Stephenson became ill andlater returned to the United States. In February1943 Colonel Fox relieved Admiral Stephenson ofthe directorship of the commission and arrived inCairo late the following month to assume control ofthe overseas program, having been promoted tobrigadier general en route. He served as directoruntil August 1943 when his title was changed tofield director, and another Army officer, Col. (laterBrig. Gen.) Stanhope Bayne-Jones, became directorof the commission with headquarters in Washing-ton, D.C.


GENERAL Fox

Neuropsychiatric Disorders—Ameri-can soldiers in the Middle East theaterhad to accommodate themselves towidely divergent environments and cul-tural patterns. They also were exposedto climates completely dissimilar tothose in their homeland. While the diffi-culty of adjustment in an overseas stationin itself presented some problems stem-ming from separation from loved ones,familiar work, and the relative freedomof civilian life, long periods of exposureto the tropical climate imposed psycho-logical and physiological stresses that fre-

quently resulted in neuropsychiatricdisorders.40

In the Persian Gulf area, for example,

40 (1) Maj John M. Flumerfelt, Hist of Neuro-psychiatry in the Middle East. (2) Ltr, Lt ColBaldwin L. Keyes to Chief Surgeon, USAFIME, sub:Mental Fixtures in Tropics, 18 Feb 44, in ETMDRpt, Feb 44. (3) Ltr, Maj Flumerfelt and CaptJohn T. Delehanty to Surg, Delta Serv Comd, sub:Discussion of (a) Effect of Climate upon Personnel(b) Neuropsychiatric Diseases, 9 Aug 44, in ETMDRpt, 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.


the difficult climate and the initially poorliving conditions troops endured re-sulted in neuropsychiatric casualties.The rate per 1,000 per annum was above40 for most of 1943, but with the comple-tion of semipermanent barracks, messhalls, and recreational facilities, the ratedropped to 16 in October 1943. Medicalofficers of the command considered itremarkable that in the early days therate was not higher. At first many ofthese cases were repeatedly hospitalizedin an attempt to salvage them for furtherduty, but it soon became apparent that amore liberal policy was needed in caringfor them. More neuropsychiatric pa-tients were evacuated to the zone of in-terior during the last half of 1943 andthe first half of 1944.

The chief psychiatrist of the MiddleEast theater and the chief of the psy-chiatric section of the 38th General Hos-pital studied the effect of climate uponpersonnel and found that a definite trop-ical syndrome developed among many in-dividuals assigned to tropical areas. Thetime required to develop the more severesyndromes varied with the individual andthe area. Service in small isolated unitsin the desert or the jungles of centralAfrica produced some breakdowns in 3months. In larger units stationed closerto centers of population and the morevaried environments along the coast, thebreaking point was reached in 6 monthsto a year or longer. After 18 to 24 monthsunder tropical conditions the efficiencyof almost anyone was greatly reduced.Characteristically, an individual affectedwith a tropical syndrome showed evi-dence of listlessness, slow speech, defec-tive memory, poor thought content,and narrowed perspective. Although noobvious loss of intelligence occurred, the

ability to use one's faculties was consid-erably impaired.

Col. Baldwin L. Keyes, head of theneuropsychiatric service in theater head-quarters, after investigating cases of men-tal deterioration caused by lengthy trop-ical service, recommended that personnelbe returned to the United States on ro-tation after not more than two years' serv-ice in the Middle East, and also advisedthat a rotation policy be establishedwithin the theater. The 2-year-rotationplan was favorably considered by thetheater commander in the spring of1944, but a new commanding generalof the theater who arrived soon afterwarddid not back the recommendation of thechief neuropsychiatrist.

The depressing effect of having the2-year-rotation plan scrapped was reflect-ed in the rise in the hospital admissionrates for neuropsychiatric diseases, whichreached a peak of 31 per 1 ,000 per annumfor July 1944. The increased admissionswere mostly personnel who had beenmaking borderline adjustments, buildingup hope for return on the proposed ro-tation policy. Rotation was again con-sidered later in 1944, but the difficultyof getting replacements for those eligiblefor return precluded any effective appli-cation of the policy. Intratheater rotationfinally began in 1945 when many wereshifted from the more undesirable sta-tions in the theater to places having acomparatively favorable climate.

Evacuation of mental patients to theUnited States was a serious problem inthe early days of the theater, since noAmerican hospital ships were available.Psychotics and severe psychoneuroticswhose return to the zone of interior hadbeen recommended clogged the theater'shospital wards for periods up to six


months before they could be evacuatedby infrequently departing Americantroop transports equipped with sick baysand medical personnel. The more nu-merous British hospital ships were alsoused, when they could be induced toaccept this class of patient, but carriedU.S. personnel only to North Africa orEngland for transshipment on U.S. ves-sels. In 1944, when the Air TransportCommand routes through the MiddleEast to the China-Burma-India theaterwere well established, returning aircraftcould be used for patients en route to theUnited States. Air evacuation workedadmirably, and mental patients were re-sponsible for no serious accidents to pa-tients or personnel. From July 1942 tothe end of 1944 neuropsychiatric diseaseled the list of causes for return of pa-tients from the Middle East to theUnited States, and constituted over 35percent of the total number returned.About a third of the neuropsychiatriccases evacuated had some history of psy-chiatric disorder before military service,the stresses present in the theater caus-ing recurrences.

Beginning in the latter part of 1944,as many psychiatric cases as possible—in-cluding alcoholics—were treated on anoutpatient basis, with only those whollyunable to perform their duties being ad-mitted to the hospitals. It was felt thatlong periods of hospitalization tended tointensify symptoms rather than effectcures. The result of this policy was re-flected in a substantial reduction inpsychoneurotic patients presented todisposition boards for evacuation to thezone of interior.

Other Diseases—Gastrointestinal dis-eases constituted one of the greatest

sources of lost manpower in the MiddleEast theater. Nonspecific diarrheas, ba-cillary and amebic dysentery, bacterialfood poisoning, and the typhoid-para-typhoid group of infections were foundin all areas. The factors contributing tothe high incidence of these infectionsamong natives of the Middle East werecontaminated water supplies, lack ofsewage disposal systems, generally insan-itary conditions that promoted extensivefly breeding, and the personal habits ofthe individuals. These diseases, how-ever, need not have been nearly as pre-valent as they were. Men continued toarrive in the theater without propertraining or discipline in hygiene andsanitation and continued to suffer a highdiarrhea rate until the defects weremade good. On the calendar-year aver-age, this group of diseases accounted formore man-days lost than any other, andconstituted 20 percent of hospital ad-missions for the period 1 July 1942 to 1October 1943. The rates for intestinaldiseases declined from year to year,owing in part to the intensive programof education in preventive medicine in-stituted in the theater by the MedicalDepartment and in part to the use ofsulfanilamide and later of Sulfaguani-dine.41

Contrary to most of the intelligencereports, which had indicated that respir-atory diseases in the Middle East wereof minor importance, this group of dis-eases constituted 15 percent of hospitaladmissions during the period 1 July 1942to 1 October 1943. Infectious hepatitis

41 (1) Annual Rpts, MD Activities, USAFIME,1942, 1943. (2) Col Ward, Hist of Preventive Medi-cine 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.


caused some difficulty in late 1942 andearly 1943, particularly among NinthAir Force personnel stationed in theWestern Desert of Egypt and Libya.Smallpox and bubonic plague, the for-mer being widespread among the pop-ulation, and the latter causing epidemicsamong the natives of Dakar, French WestAfrica, and the people living along theSuez Canal, were potential hazards toAmerican troops. Immunization and con-trol measures instituted by the MedicalDepartment protected American troopsso that the two diseases were of littlemilitary consequence.

A group of diseases that puzzled med-ical authorities in the Middle East re-sulted in a request by the theater surgeonto The Surgeon General for special as-sistance. A small organization known in-formally as the Virus Commissionstemming from the Army Epidermio-logical Board arrived in Cairo in April1943, and soon set to work collecting in-formation about Sandfly (pappataci)fever, poliomyelitis, and infectioushepatitis—three epidemic diseases, pre-sumably of virus origin, prevalent in theMiddle East. Members of the commis-sion set up a laboratory and office in the38th General Hospital, where they con-ducted experiments on the transmissionof the various virus diseases. Membersof the commission made field tripsto nearby Egyptian areas as well as tomore distant places during the year. Bymid-December 1943 the commissionclosed its Middle East laboratory aftermaking valuable contributions to theliterature of the diseases they studied.

The intense heat of the Persian Gulfarea was responsible for various formsof discomfort, including heatstroke, heatexhaustion, and prickly heat. Medical

Department officers fought the effects ofheat in a variety of ways. A liberal dailyintake of water and fruit juices was rec-ommended, and the men were advisedto take a salt tablet with each glass ofwater. Alcohol, recognized as one of thegreatest contributory factors, could notbe entirely eliminated, but the dangerwas constantly emphasized in the slogan"If you want to live, don't drink." In-travenous injections of normal salineswere used in treatment of heatstroke andheat exhaustion. In the summer of 1942,before the U.S. medical authorities hadlearned the use of salines, ice packs,wrapped in toweling and soaked in icewater, together with electric fans ad-justed to blow across the beds, served toreduce body temperatures by two orthree degrees.42

To make living conditions more bear-able, the Engineer Corps installed airconditioning equipment when available,but most of the time "desert coolers"were used. These improvised devicesconsisted of crates filled with straw,camel thorn, or excelsior, which were setin windows. They operated by having afan blow air through them while watertrickled down through the filler material.This equipment reduced temperaturesof rooms from twenty to thirty degrees.The adoption of special morning work-ing hours for the summer months alsohelped reduce casualties. Heatstrokecenters, where men could go at the firstsigns of heatstroke or heat exhaustion,cured many potentially serious cases.

Another problem that was commonto the whole Middle East area early inthe period was that of chronic vitamindeficiency. Detailed plans for the Persian

42 Ltr, Van Vlack to Col Coates, 23 Mar 59, com-menting on preliminary draft of this chapter.


Gulf included vegetable gardens forwhich land and water rights had alreadybeen obtained, but these were canceledwhen the troops arrived because thenormal ration was supposed to containan adequate supply of vitamins. Manymen, however, did not eat all of the ra-tions issued. Very few uncontaminatedgreen vegetables were obtainable locally,and the effects of vitamin deficiencywere clearly observable. This situationwas remedied in 1943, after a nutritionalofficer had been sent to the theater andhad testified to the need for vitamins.43

Still another disease problem peculiarto the area was leishmaniasis, or Bagdadsore. The disease was classified as exoticand so the drug required to cure it couldbe had only by special order "as re-quired," and then only in small quan-tities, so that it was impossible to combatthe condition effectively.44

Dental Service

The dental service of the MiddleEast theater began with the formationof the theater in 1942, but it was notuntil well into 1943 that the service couldbe considered adequate. A high nonef-fective rate because of adverse climaticconditions reduced the number of dentalofficers available at any one time, andthe wide dispersal of units made itnecessary to place dentists with units toosmall for the most economical function-ing. To compensate, certain dentistswere frequently moved from one smallstation to another. During the period ofgrowth in the Middle East theater therewas a strong tendency to overburden den-

tal officers with work not connected withtheir professional training. Dentists usu-ally received such nonprofessional as-signments when they were not able towork full time because of lack of equip-ment. Once this practice started, itbecame difficult to get dentists relievedof such jobs even when the burden ofdental treatment increased.45

In the Persian Gulf area, dental offi-cers arrived with the first major ship-ment of troops in December 1942, al-though one Dental Corps officer hadbeen in Iran with the Iranian Missionsince March. About eleven dental offi-cers were in the area in December 1942,but eventually their number in propor-tion to the troop strength of the com-mand became large compared to otheroverseas areas. More were needed be-cause in addition to those stationed withhospitals and dispensaries, others had tominister to the needs of units strungalong the transportation routes to theSoviet Union.

Although the British allowed U.S.Army dentists to use dental facilities inBritish Army hospitals pending comple-tion of American installations, a seriousproblem in the early days was the lackof facilities. The shortage of dentalequipment, which lasted until mid-1943,seriously handicapped the dental service

4 3Ibid.44 Ltr, Col Adams to Col Coates, 7 Apr 59, com-

menting on preliminary draft of this chapter.

45 (1) Annual Rpt, Med Dept, USAFIME, 1942and 1943. (2) Hist, Med Sec, AMET. (3) Ltr, MajGeorge F. Jeffcott, Dental Surg, USAFIME, to BrigGen 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 EastServ Comd, 1944. (10) Annual Rpt, Med Dept Ac-tivities, Central African Wing, ATC, 1943.


POST DENTAL CLINIC, KHORRAMSHAHR. TRAN

of the theater. In December 1942 thethirty-nine dental officers then in the the-ater had a total of 6 field sets, 2 units andchairs, 1 incomplete laboratory, and afew miscellaneous items purchased lo-cally. The British loaned field chests toU.S. Army units arriving in the MiddleEast without dental equipment. During1943 adequate facilities were establishedand enough equipment arrived so thatthe dentists could establish a program ofimproving the dental health of the sol-diers in the theater.

Dental service throughout the CentralAfrican Wing of the Air Transport Com-mand was provided by ATC dental offi-

cers and local station hospitals. A dentalofficer and an enlisted man with portableequipment flew to stations that did nothave resident dentists.

The greatest difficulty experienced bythe dental service related not to hard-ships or shortages in equipment, but tothe lack of promotions. The DentalCorps suffered from Table of Organiza-tion troubles about which very littlecould be done within the theater. Dentalofficers found themselves passed at regu-lar intervals by men of other brancheswho often had less experience and abil-ity. Enlisted assistants had similar mo-rale-destroying problems, for many of


them served on detached service to den-tal clinics that had no Tables of Organi-zation.

The chief dental officer of the U.S.Army Forces in the Middle East was Lt.Col. George F. Jeffcott, who was suc-ceeded at the beginning of 1944 by Lt.Col. Thomas A. McFall, already dentalsurgeon of the Delta Service Commandand chief of the dental service for the38th General Hospital. The dental activ-ities of the Persian Gulf Command, dur-ing the period of its autonomy, weredirected by Lt. Col. Herbert L. Gullick-son, who came to the theater as dentalsurgeon of the 21st Station Hospital.

Veterinary Service

Except for a small number of horsesused for recreational and military policepurposes, the Middle East theater didnot use animals for carrying on its duties.Consequently, members of the U.S.Army Veterinary Corps were chiefly con-cerned with meat and food inspectionand supervision over animals and otherfood products raised for consumption oftheater troops. The veterinary serviceconducted meat and dairy hygiene activi-ties at various stations in the commandsof the theater. Because of the low sani-tary standards prevailing throughout theMiddle East, veterinary officers experi-enced considerable difficulty in obtainingsuitable food products of local origin.All meat, dairy, and other food productshad to be inspected with great care toensure strict compliance with U.S. Armystandards. Whenever establishmentsmaintaining satisfactory standards werelocated, the veterinary service recom-mended them as sources of supply. Prod-ucts most commonly obtained in this way

were poultry, eggs, and seafood. How-ever, the majority of food products camein by ship from the United States, andlarge quantities of beef were securedthrough the British Government fromAustralia and New Zealand.

Various enterprises for the productionof food for American troops were super-vised by the veterinary service. A Cairochicken dealer built a sanitary poultry-killing and dressing establishment withthe advice and suggestions of the DeltaService Command veterinary officer. TheU.S. Army obtained fresh milk that waspasteurized under the supervision of theveterinary service in Palestine. InEritrea, the veterinary service of theEritrea Service Command and the thea-ter veterinarian put into operation asmall but modern slaughterhouse, con-structed especially for U.S. military use.In the opinion of Veterinary Corps offi-cers in the theater, it was superior to anyabattoir found anywhere in the MiddleEast. In Eritrea and Palestine the veteri-nary service operated pig farms, and inEgypt a veterinary officer rendered assist-ance in the operation of a piggery. Thesepig-raising projects helped dispose of gar-bage and provided a source of reliablepork. At the various stops along the Cen-tral African Wing, ATC, route twoveterinary officers and an enlisted maninspected the food supplies of the per-sonnel.

Veterinary officers arrived in the Per-sian Gulf area late in 1942 and quicklybegan the tasks of inspecting the foodsupplies of the troops. They also madesurveys and recommendations regardingstorage, refrigeration, and slaughter-houses. By the end of 1943, the veteri-nary strength of the command hadreached its peak of 8 Veterinary Corps


officers and 12 enlisted men, distributedin the northern, central, and southernareas of Iran. The veterinarians were ofthe opinion that an oversupply of theirprofession existed in the command andthat 2 officers and 15 enlisted men wouldhave been sufficient. Although Veteri-nary Corps officers were officially chargedonly with the inspection of meat, eggs,and other food products, the commandauthorized them to establish several ani-mal clinics to care for pets acquired bymembers of the Army. Veterinary carewas provided for these animals whenevertime could be spared from food inspec-tion.

Decline of Medical Activities in theDemobilization Period

Immediately after the surrender ofJapan on 14 August 1945, the medicalservice of the Africa-Middle East thea-ter began a program designed to keep upwith the demobilization instructionsissued by the War Department. The the-ater surgeon carried out a policy of re-ducing or reorganizing all medicalinstallations in proportion to reductionsin theater strength. Most medical unitswere either inactivated or transferredfrom the theater between September andDecember 1945. By the end of the yearonly the 38th General Hospital at Casa-blanca, the 25th Station Hospital atRoberts Field, the 56th Station Hospitalat Camp Huckstep, and the 367th atWadi Seidna in the Sudan remained inthe theater. During this period the Per-sian Gulf Command completed its mis-sion, and its liquidation was entrusted tothe Africa-Middle East theater. The the-

ater disposed of the Persian Gulf's sur-plus personnel and equipment andinactivated the command the last day ofDecember.46

Although most of the theater's com-mands were still in existence at the endof 1945, they were working toward anearly close-out date. Where station hos-pitals had formerly served, medicaldetachments operated to handle thediminishing military population ofthe commands. The two largestcommands of the theater, the NorthAfrican and the Middle East ServiceCommands, as well as the minor com-mand in Liberia, were inactivated dur-ing the first quarter of 1946, and thetheater itself disbanded on 31 May 1946.The 56th Station Hospital, the last re-maining theater hospital, closed its doorsthe day the theater was inactivated. Thepersonnel of the service commands wereassigned to 26 residual teams establishedto act as custodians of U.S. Governmentproperty awaiting sale by the ForeignLiquidation Commission. Some of theteams had one medical or surgical tech-nician assigned, and every team hadeither Air Transport Command, British,or local civilian hospital facilities avail-able for the medical care of its personnel.The remaining responsibility of theMedical Department was simply to pro-vide sufficient medical attendance for thefew 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, May46.

CHAPTER III

Conquest of North Africa

The invasion of French North Africaon 8 November 1942 was the first actionof World War II by U.S. ground forcesagainst the European Axis. The beachesof Morocco and Algeria and the ruggedmountains and barren wastes of Tunisiawere the testing grounds both for thecombat forces and for the medical troopsthat supported them in the field andbehind the lines. It was in North Africathat officers, nurses, and enlisted men ofthe Army Medical Department perfectedthe techniques and developed the organ-izations that were to save thousands oflives in Italy and France.

Prelude to Invasion

Genesis of the North AfricanCampaign

As early as January 1942, when PrimeMinister Winston S. Churchill and hisChief of Staff, General Sir Alan Brooke,were in Washington for high-level strate-gic discussions, the possibility of launch-ing an Allied military campaign innorthwest Africa was suggested, but re-sources available at that time were clearlyinadequate for such an undertaking. Thematter was again discussed in June, inconnection with the dangerous situationon the Russian front and the precariousposition of the British forces in Africa,where the Germans had been haltedbarely short of Cairo. In July, the Com-

bined Chiefs of Staff in London, understrong pressure from the President, madethe decision to mount the operation atthe earliest possible date. D-day was laterset for 8 November. Allied landings inMorocco and Algeria were to be co-ordi-nated with a planned offensive by theBritish Eighth Army, to be launchedfrom the El 'Alamein line in the fall. Lt.Gen. Dwight D. Eisenhower was desig-nated to command the operation, knownby the code name TORCH, and wasdirected to begin planning at once. Al-lied Force Headquarters (AFHQ) for theNorth African campaign was set up atNorfolk House in London in mid-Au-gust, with primary responsibility forplanning delegated to Maj. Gen. MarkW. Clark, Eisenhower's deputy com-mander.1

1 Sources for the genesis and military planning ofTORCH are: (1) Biennial Report of the Chief ofStaff of the United States Army, July 1, 1941 toJune 30, 1943, to the Secretary of War (Washing-ton, 1943) , pp. 18—20; (2) History of Allied ForceHeadquarters, 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 (GardenCity, 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 theWest, UNITED STATES ARMY IN WORLD WARII (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 "His-tory of United States Naval Operations in World

CONQUEST OF NORTH AFRICA 105

The strategical and psychological im-portance of the operation can scarcely beoverestimated. A successful TORCH wouldrelieve the hard-pressed Russians byopening a diversionary front much earlierthan an invasion of continental Europecould be launched; it would forestall thepossibility of a German breakthrough in-to the oil-rich Middle East to join handswith the Japanese; it would open theMediterranean to Allied shipping andrender more secure the sea and airroutes over the South Atlantic; itwould put U.S. ground troops into actionagainst the Germans; and, finally, if itcould be accomplished without fatallyembittering the French, it would openthe way for France to re-enter the war onthe Allied side. By the same reasoning,however, the venture was hazardous. Tofail would spell disaster.

Plans for Operation TORCH

The plans developed by General Clarkand his collaborators called for simulta-neous landings at three separate points.British naval units were to support oper-ations inside the Mediterranean; U.S.units those in the Atlantic. The TwelfthU.S. Air Force, under command of Brig.Gen. James H. Doolittle, was activatedand trained to give necessary air supportas soon as airfields could be captured andmade operational.

The Western Task Force, which wasto storm the beaches on the Atlanticcoast of Morocco in the vicinity of Casa-blanca, was commanded by Maj. Gen.George S. Patton, Jr. Totaling approxi-mately 34,000 men, it consisted of the 2d

Armored Division, the 3d Infantry Divi-sion, and two regimental combat teamsof the 9th Infantry Division. The West-ern Task Force trained in the UnitedStates and sailed for Africa under convoyof the U.S. Navy.

The Center Task Force, under com-mand of Maj. Gen. Lloyd R. Fredendall,was to go ashore on beaches flankingOran, some 250 miles inside the Mediter-ranean. This force was made up of ele-ments of II Corps, built around the 1stInfantry Division, half of the 1st Ar-mored Division, and a force from the509th Parachute Infantry Regiment, re-inforced by corps troops to a strength ofmore than 40,000. The Center TaskForce trained in England and was con-voyed by British warships.

The Eastern Task Force, with a com-plement of 23,000 British and 10,000U.S. troops and commanded by Lt. Gen.K. A. N. Anderson of the British FirstArmy, was to attack Algiers. Maj. Gen.Charles W. Ryder, commander of the34th Infantry Division, led the Americanelement, which consisted of two rein-forced regimental combat teams (RCT),one each from the 9th and 34th InfantryDivisions, and a Ranger battalion. Likethe Center force, the Eastern Task Forcetrained in England and was accompaniedto its destination by units of the BritishNavy. In the hope of securing more will-ing co-operation from the French, whowere still resentful toward their formerBritish allies for the earlier sinking ofFrench vessels at Oran, General Ryderand his American troops were to spear-head the Eastern Task Force assault.

Both personnel and equipment formedical support of the task forces were tobe held to the absolute minimum. Themedical section of Allied Force Head-

War II, vol. II, Operations in North African Waters,October 1942-June 1943 (Boston: Little, Brownand Company, 1950), pp. 3-42, 181-186.


GENERAL KENNER RECEIVING THEDSM from General George C. Marshall.

quarters was headed by a British Direc-tor of Medical Services, Brigadier, (laterMaj. Gen.) Ernest M. Cowell. The rank-ing American medical officers wereCowell's deputy, Col. John F. Corby, andCorby's executive officer, Lt. Col. (laterCol.) Earle Standlee. The decentralizednature of the operation, however, placedprimary responsibility for planning andorganizing combat medical support onthe task force surgeons. Col. Richard T.Arnest, II Corps surgeon, conductedplanning for the Center Task Force inEngland, while Col. (later Maj. Gen.)Albert W. Kenner, surgeon of the West-ern Task Force, worked in Washington.Medical service for the Eastern TaskForce was planned and largely suppliedby the British, the force surgeon beingthe Deputy Director of Medical Servicesof the British First Army, Brigadier E.W. Wade. Each force surgeon operated

pretty much on his own, within a broadpolicy framework; there was little or noco-ordination between the forces. TheTwelfth Air Force surgeon, Col. RichardE. Elvins, functioned independently ofboth AFHQ and the task force surgeonsin the preparation of medical plans, in-cluding plans for air evacuation.2

From the medical point of view, theNorth African campaign was difficult andlargely extemporized. The distances werevast: 445 miles by air from Casablanca toOran; 230 miles from Oran to Algiers;and another 400 air miles from Algiers tothe ultimate objective, the Tunisianports of Tunis and Bizerte. By way of theantiquated, single-tracked rail line thatconnected the coastal cities, the distanceswere considerably greater. Highwayswere few in number and poor in quality,not built to withstand the punishmentinflicted by tanks and heavily loadedtrucks moving in steady streams fromports to supply depots and to the fightingfronts. Water was scarce and always sub-ject to suspicion; sanitation was primi-tive; malaria, typhus, dysentery, cholera,and venereal diseases were known to bewidely prevalent, with plague a constantthreat in the seaports. All of these factorshad to be taken into account in medicalpreparations for the invasion and for thesubsequent campaign in Tunisia.

2 General sources for medical planning of Opera-tion TORCH, in addition to general sources citedabove, are: (1) 2d Lt. Glenn Clift, MS, Field Op-erations of the Medical Department in the Medi-terranean Theater of Operations, United StatesArmy (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 theSecond World War," The Army Medical Services;Campaigns (London: Her Majesty's Stationery Of-fice, 1957), vol. II; (4) Link and Coleman, MedicalSupport of the Army Air Forces in World War II,pp. 419-24.


COLONEL ARNEST

Planning for the initial assault alsohad to take into account a shortage ofshipping space that would limit suppliesand restrict medical support to littlemore than could be given by the divi-sional medical units organic to the par-ticipating formations. For the U.S.increment, supplies were to be in theform of the standard medical mainte-nance units, each sufficient to support10,000 men for thirty days, augmentedby special drugs and biologicals appropri-ate to the conditions anticipated.

In bed strength the Eastern TaskForce, which was to lead the advanceinto Tunisia, fared better than eitherof the other landing groups. In additionto the organic units, the D-day troop listincluded a British field ambulance, com-parable to an American clearing com-pany; 2 light casualty clearing stations(200 beds each), equivalent to small

evacuation hospitals, each with a fieldtransfusion unit and 2 field surgical unitsattached; 2 British general hospitals,more mobile than their U.S. counter-parts, of 600 beds each; and 4 teamsof the U.S. 2d Auxiliary Surgical Group,with enlisted men substituted for nurses.Beds would thus be available for about4.8 percent of the command during thefirst four days. The second convoy, whichwas to reach Algiers on D plus 4, was tocarry 2 British general hospitals of 200beds each and one of 1,200 beds, but theratio would not be raised since troopstrength would also be doubled by thattime.

The Center Task Force was to carrytwo hospitals in the assault—the 400-bed48th Surgical and the 750-bed 38th Evac-uation—or beds for less than 3 percent ofthe command. Another 750-bed unit, the77th Evacuation Hospital, was scheduled

for the second convoy, which wouldreach Oran on D plus 3 along with the51st Medical Battalion, but a 50-percentincrease in troop strength would keep thebed ratio barely above 3 percent.

For the Western Task Force, sailingfrom the United States, shipping waseven more restricted, and no hospitals ofany kind were included in the D-daytroop list. Since the second convoy forthe Western Task Force was not due forseveral days, transports were to be sup-plied with equipment and personnel toserve as floating hospitals during the firstdays of the assault.

In each of the landing operations theNavy—British or American—was to beresponsible for all medical care betweenthe port of embarkation and high wateron the landing beaches, and naval beachgroups were to help in the collection andcare of casualties. British hospital ships


were to evacuate patients from Algiersand Oran to the United Kingdom. Sinceno U.S. hospital ships were available,there would be no alternative for theWestern Task Force but to evacuatecasualties by returning transports or holdthem ashore for future disposition.

Plans for combat medical service inthe landing phase were spelled out inconsiderable detail, but were basedlargely upon manuals prepared withoutrealistic knowledge of amphibious opera-tions. Participation by U.S. observers inthe costly Dieppe raid of 19 August 1942was the nearest approach to a seabornelanding on a hostile shore in modernU.S. Army experience.3 It is thereforenot surprising that casualty estimateswere too high, or that conditions underwhich medical troops would operatewere misjudged.

Medical Support in theLanding Phase

The Allied assault on the Moroccanand Algerian coasts took place as sched-uled in the early hours of 8 November1942. It was hoped that the French wouldnot resist the landings. Secret negotia-tions to this end were carried on right upto D-day itself, climaxed by a personalappeal from President Roosevelt, whichwas broadcast in French over shortwaveradio as the troops began to go ashore.On most of the beaches, the first waves

of combat troops did get ashore withoutencountering more than sporadic smallarms fire, but before objectives weregained there was fighting in every sector.

Eastern Task Force

Algiers was first to surrender, owinglargely to secret contacts with militarycommanders there and to the unexpectedpresence in the city of Admiral Jean-François Darlan, Vichy naval com-mander, whose authority was second onlyto that of Marshal Henri Pétain himself.The city lies along the western rim of ahalf-moon-shaped bay, whose eastern ex-tremity is Cap Matifou. Seven or eightmiles west of the city the coast dipssharply to the south, interrupted only byCap Sidi Ferruch, which juts into theMediterranean on a line with the centerof Algiers and about ten miles distant.4

(Map 6}The 39th Regimental Combat Team

of the 9th Division, with elements of theBritish 1st Commando attached, wentashore east of Cap Matifou in the earlyhours of 8 November. Landing craft usedwere small and fragile by later standards,and boat crews were inexperienced. It isnot surprising, therefore, that many ofthem 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 Com-mand Missions, A Personal Story (New York: But-ton, 1954), pp. 62-72. The medical story of theraid, which suffered over 50 percent casualties inkilled, 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 EasternTask Force are: (1) Opns Rpt, Eastern Task Force;(2) Howe, Northwest Africa; (3) Morison, North

African Waters. Medical sources primarily reliedupon are: (4) Rcd of Events, 15 Oct—8 Nov 42, byvarious officers of the 109th Med Bn, Co C; (5)Diary, Surg Teams 1 and 2, Ortho Team 1, ShockTeam 1, 2d Aux Surg Gp, in Rpts of ProfessionalActivities of Surg Teams, vol. I; (6) Clift, FieldOpns, pp. 52-57. (7) Crew, Army Medical Services:Campaigns, pp. 293-97. Negotiations with theFrench, both before and after the landings, aredetailed in (8) Robert Murphy, Diplomat AmongWarriors (Garden City, N.Y.: Doubleday, 1964),pp. 108-43.


MAP 6—Medical Support of Eastern Task Force

were brought ashore at the wrongbeaches. Aside from sporadic fire fromcoastal batteries on Cap Matifou, how-ever, no opposition was encountered atthe beaches, and the combat teamquickly pressed inland and capturedMaison Blanche airfield.

The 168th RCT of the 34th InfantryDivision and the bulk of the British 1stCommando landed just north of CapSidi Ferruch, but here, too, the invaderswere widely scattered because of faultynavigation. Only the absence of opposi-tion enabled the force to regroup andmove inland toward Algiers by daylight.The commandos, meanwhile, had re-

ceived the surrender of the fort at SidiFerruch without a fight, and, with theaid of friendly French officers, the air-field at Blida had been neutralized. TheBritish 11th Infantry Brigade landedwithout opposition some twenty milessouth of Cap Sidi Ferruch simultane-ously with the more northerly landingsand moved inland to protect the flank ofthe 168th RCT.

The only seriously opposed landingswere those of the 6th Commando northand west of Algiers, where difficulties inassembling and loading the assault boatsdelayed the landings until after daylight.Here the commandos had to call for the


support of naval gunfire and of carrier-based planes to win their objective bylate afternoon. An attempt by two Brit-ish destroyers to enter the harbor beforedawn had proved unsuccessful. One ofthe vessels was forced to withdraw aftersuffering severe damage from shore bat-teries. The other succeeded in rammingthe boom and landing a detachment ofthe 135th RCT, 34th Division, but thetroops were pinned down and takenprisoner, while the destroyer withdrewso severely damaged that she later sank.

By late afternoon of D-day Algiers wassurrounded, its airfields were in thehands of the Allies, and those of itscoastal fortifications that had not capit-ulated were at the mercy of Allied navalguns and bombers. Darlan, who hadbeen in contact with Robert Murphy,the U.S. diplomatic representative inNorth Africa since the eve of the land-ings, met with General Ryder early inthe evening and agreed to a local cease-fire. After two days of negotiation anarmistice was signed, to be effectiveshortly after noon on 11 November. Ne-gotiations continued until 13 November,when Darlan was recognized as de factohead of the French Government inNorth Africa.

In addition to its own medical detach-ment, each of the U.S. regimental com-bat teams that spearheaded the Algierslandings was accompanied by a collectingcompany and a clearing platoon of themedical battalion organic to its parentdivision—Company A and the 2d Platoonof Company D, 9th Medical Battalion,with the 39th RCT; and Company C andthe 2d Platoon of Company D, 109thMedical Battalion, with the 168th.

On the beaches east of Cap Matifou,where the 39th RCT made its landings,

the collecting company was put ashoreduring the morning of D-day, but mostof its equipment remained on shipboard.Without vehicles to follow the combattroops and with little in the way of medi-cal supplies, the company remained ofnecessity close to the landing area in thevicinity of the beach dressing station setup by British naval personnel. Casual-ties were held at the dressing station be-cause the sea was too rough to permitevacuation to the ships and no hospitalfacilities were available on shore.

A radio call for more medical person-nel early in the afternoon brought Capt.(later Maj.) Paul L. Dent and Capt.(later Maj.) William K. Mansfield ofSurgical Team No. 1, commanding offi-cer and executive, respectively, of the 2dAuxiliary Surgical Group detachment, tothe beach about 1600, but they were un-able to bring equipment with them. Abombing raid, rough seas, and the com-ing of darkness prevented the landing ofmore surgical group personnel or of theclearing station they were to support, soCaptains Dent and Mansfield workedthrough the night at the naval beachdressing station.

The quick end of hostilities on the 8thenabled the two surgical group officers toevacuate more than twenty patients thenext morning to the dispensary at Mai-son Blanche airfield about fifteen milesinland, using trucks and borrowedFrench ambulances. The clearing pla-toon of the 9th Medical Battalion andthe remaining eighteen officers and en-listed technicians of the 2d AuxiliarySurgical Group did not come ashore un-til 11 November, when the ships carryingthem docked at Algiers. A hospital wasthen set up in a schoolhouse in MaisonCarree, about midway between the air-


field and Algiers. On 13 November thehospital moved to Fort de l'Eau on thebay north of Maison Blanche, where itwas operated jointly by the collectingcompany and the clearing platoon of the9th Medical Battalion and the four surgi-cal teams.

On the beaches west of Algiers, wherethe 168th RCT landed, the first collect-ing company personnel came ashore at0730 on D-day, but were landed at thewrong beach and were forced to make a10-mile march carrying equipment onlitters to reach the battalion aid stationthey were to support. The clearing pla-toon, meanwhile, had landed at 0800,and set up station in conjunction withthe British 159th Field Ambulance inthe basement of a winery near Sidi Fer-ruch.

The remainder of the collecting com-pany came ashore about 1000, but theonly ambulance to be unloaded on D-daywas not available until evening and didnot reach the forward station until 0900,D plus 1. A British surgical team joinedthe clearing station on 9 November.Later that day the clearing platoon andthe field ambulance took over theMustapha civil hospital in Algiers, whichquickly expanded from 100 to 300 beds,functioning as an evacuation hospital.

Fortunately, there were few casualtieson D-day when the medical service inlanding areas would not have been pre-pared to deal adequately with them. Mostof those occurring in the next few daysresulted from German bombings andfrom land mines. Only 93 U.S. soldierswere hospitalized during the first weekof the Algiers campaign. Of these, 58were admitted for battle wounds, 13 forinjuries, and 22 for disease.5

Center Task Force

In the central sector the strategy em-ployed by General Fredendall was in allrespects similar to that used by the East-ern Task Force. Like Algiers, Oran lieson a crescent-shaped bay, protected byheadlands on either side. Here the strong-points were the fortified military harborat Mers el Kebir, three miles west ofOran; and the town of Arzew, twenty-fivemiles to the east. Both positions wereoutflanked.6 (Map 7)

One armored column, comprisingabout one-third of Combat Command B,

5 Rpt, Hq SOS ETO, Off of the Chief Surgeon,

15 Feb 43. These figures cannot be fully reconciledwith those given in the Final Report, Army BattleCasualties and Nonbattle Deaths in World War II.The official tabulation shows 1,017 U.S. Army (in-cluding Air Forces) personnel wounded or injuredin action for the whole North African theater forthe month of November 1942. The combinedwounded and injured figure for the three taskforces for the week of 8-14 November as given inthe document cited above is 1,224. The time isrelatively comparable, since U.S. forces were notengaged before 8 November or during the re-mainder of the month after 14 November. Thelarger figure in the SOS report is presumably owingto the inclusion of some naval personnel in theWestern Task Force figures, but these are notseparable. Hospital admissions for injury in theTORCH operation were not differentiated as to battleor 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 andothers, Danger Forward: The Story of the FirstDivision in World War II (Washington: InfantryJournal Press, 1947); (4) George F. Howe, TheBattle History of the 1st Armored Division, "OldIronsides" (Washington: Combat Forces Press,1954): (5) Morison, North African Waters. Medicalsources primarily relied upon are: (6) Annual Rpt,Surg, II Corps, 1942; (7) After Action Rpt, 1st MedBn, 20 Nov 42; (8) Hist, 47th Armd Med Bn, 1Oct 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, 15Apr 59, commenting on preliminary draft of thisvolume.


MAP 7—Medical Support of Center Task Force

1st Armored Division, landed some thirtymiles west of Oran. The landing was un-opposed, but difficulties in getting thevehicles ashore delayed any advance untilabout 0900. The column then struckeastward to Lourmel and followed thenorth rim of the Sebkra d'Oran, the longsalt lake that parallels the coast about tenmiles inland. Against only sporadic oppo-sition, the column reached and seized LaSenia airfield, south of Oran, on themorning of 9 November.

A simultaneous landing at Les Anda-louses 15 miles west of Oran by the 26thRCT, 1st Infantry Division, was onlybriefly interrupted by an unexpectedsand bar, and the men were moving in-land by daylight when French coastalguns 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 thewest and south.

The main point of attack was in thevicinity of Arzew. There the 1st RangerBattalion got ashore undetected justnorth of the town and quickly seized thetwo forts dominating the harbor. The16th and 18th RCT's of the 1st Divisionand the larger portion of Combat Com-mand B were then able to land fromtransports moved close to shore. Therewas no opposition until daylight, bywhich time the assault units were well ontheir way to their first objectives. Com-bat Command B raced southwest sometwenty-five miles to seize Tafaraoui air-field and held it against French counter-attacks the following day. The 16th and18th RCT's moved on Oran by parallel


routes, the 18th being delayed by stub-born resistance at St. Cloud before by-passing that town.

A direct assault on Oran itself wasattempted at H plus 2 by two Britishdestroyers carrying more than 400 com-bat troops, most of them from the 1stArmored Division, but both ships weredestroyed inside the breakwater and allmen aboard were killed or captured.Equally unsuccessful, though less disas-trous, was an attempted airdrop onTafaraoui airfield by 556 men of the 2dBattalion, 509th Parachute Infantry Reg-iment, flying from England. Faulty navi-gation and a mix-up in signals dropped anumber of the men in Spanish Morocco,where they were interned. Othersdropped at various points far west oftheir objective. Only one plane reachedthe field, but it met with antiaircraft fireand turned back without dropping itsmen. Almost half of the paratrooperswere still missing by 15 November.

The end of the day, 9 November,found the invaders converging on Oranfrom all sides. Armored spearheads en-tered the city the next morning, the10th, and a cease-fire order was issuedat 1215.

The combat elements of the CenterTask Force received varying degrees ofmedical support. The armored columnlanding west of Oran was accompaniedby its own medical detachment and by asmall group from the organic 47th Ar-mored Medical Battalion. The 26thRegimental Combat Team, 1st Division,which hit the beaches east of Oran, re-ceived medical support from a collectingcompany and a clearing platoon of theorganic 1st Medical Battalion, and froma detachment of 6 officers, 6 nurses, and20 enlisted men of the 48th Surgical Hos-

pital. The 16th and 18th RCT's of the1st Division, landing at Arzew, were eachaccompanied by a collecting company ofthe 1st Medical Battalion, with one clear-ing platoon backing up both regiments.Combat Command B was supported byCompany B of the 47th Armored Medi-cal Battalion, less the detachment withthe western column. Third-echelon sup-port came from the 400-bed 48th Sur-gical Hospital and, after the surrender,from the 38th and 77th Evacuation Hos-pitals.

Arzew was already in Allied hands bythe time most of the medical personnelcame ashore. About noon of D-day aclearing platoon of the 1st Medical Bat-talion, although most of its equipmentwas still afloat, took over a dirty and in-adequate civil hospital capable of accom-modating 75 patients. The French doc-tors in attendance remained to care fornatives already there, and for Frenchand native prisoners as they werebrought in. Personnel of the 48th Surgi-cal Hospital came ashore in landing craftduring the afternoon, but without equip-ment and scattered over a 2-mile area.As soon as the unit was consolidated, 3of its surgeons and 3 nurses were sent tothe civil hospital.7 The detachment wasaugmented during the night by 4 oper-ating teams of 2 surgeons and a nurseeach. These teams worked throughoutthe night of 8—9 November by flashlight.

The 48th Surgical set up its own hos-pital in nearby French barracks on Dplus 2, taking over operation of the

7 "Having nurses arrive with the 48th SurgicalHospital at Arzew on D-day was very helpful incaring for the wounded. However, I did not feelafterwards that the risk was fully justified andwould not do it again." Ltr, Col Arnest to ColCoates, 10 Nov 58, commenting on preliminarydraft of this volume.


NURSES OF THE 48th SURGICAL HOSPITAL marching from the Arzew docks to join theirunit, 9 November.

Arzew civil hospital at the same time.Equipment and supplies were securedfrom the British Navy, Army units in thearea, the French, and the 38th Evacua-tion Hospital—which had arrived atArzew on 9 November but was not yetin operation. The 48th Surgical's ownequipment did not come ashore until 13November. The maximum number ofpatients treated at any one time was 480and included American, British, French,and native.

About noon of D-day elements ofCompany B, 47th Armored Medical Bat-talion, assisted by a detachment from theTwelfth Air Force surgeon's office, setup an aid station in the city hall at St.Leu, four or five miles southeast ofArzew. The detachment moved toTafaraoui airfield on 10 November, andthe St. Leu station was turned over toAir Forces control two days later.

On 11 November, the day after thesurrender of Oran, the 38th Evacuation


Hospital moved inland to St. Cloud,where heavy fighting had overtaxed theavailable medical facilities. While equip-ment was being gathered together at theprospective site, surgical teams from the38th joined elements of the 1st DivisionClearing Company at the civil hospitalin Oran, where about 300 casualties, in-cluding survivors of the ill-fated H plus2 attempt to land troops in the harbor,had been turned over by the Frenchauthorities. Personnel of the 77th Evacu-ation assumed responsibility for the op-eration of the Oran hospital on 12November. The surgical teams of the38th rejoined their parent unit the fol-lowing day when it opened under can-vas at St. Cloud. Responsibility for evacuation was

taken over by the 51st Medical Battalion,which had arrived with the 77th Evacua-tion on the D plus 3 convoy. Up to thattime there had been very little evacua-tion from the combat zone because of theblocked harbor and the delay in arrivalof hospital ships.

In keeping with the longer and moredetermined French resistance, combatcasualties of the Center Task Force wereconsiderably higher than those in theAlgiers area. Of the 620 U.S. patientshospitalized during the week ending 14November, 456 had combat wounds, 51had injuries, and 113 were disease cases.8

Western Task Force

The Western Task Force made threeseparate landings along more than 200miles of the Atlantic coast on both sides

of Casablanca, at Safi, Fedala, and Port-Lyautey. These landings encountered themost determined opposition of any of thethree task forces. Subtask Force BLACK-STONE, commanded by Maj. Gen. ErnestN. Harmon of the 2d Armored Divisionand built around the 47th RegimentalCombat Team, 9th Division, and twobattalion landing teams of the 2d Ar-mored, touched shore at Safi, 140 milessouth of Casablanca, about 0445, 8 No-vember. The first waves met only inter-mittent small arms fire, but the Frenchhad been alerted by the earlier landingsinside the Mediterranean.9

When the destroyer USS Bernadouslipped into Safi harbor with a battalionlanding team of the 47th Infantry aboard,she met raking cross fire. USS Bernadoureplied successfully and managed to landthe men, who quickly swarmed into thetown. The destroyer USS Cole followedwith more combat troops, but by thistime coastal guns from a nearby fortwere sweeping the transport area. Thebattleship USS New York replied, andthe 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 theWestern Task Force are: (1) Opns Rpt, WesternTask Force; (2) Howe, Northwest Africa; (3)Morison, North African Waters; (4) George S.Patton, Jr., War As I Knew It (Boston: HoughtonMifflin Company, 1947), pp. 5-14; (5) Truscott,Command Missions; (6) E. A. Trahan, ed., A His-tory of the Second United States Armored Division,1940-1946 (Atlanta: Albert Love Enterprises, 1946) ,pp. 31-45; (7) Donald G. Taggart, ed., History ofthe Third Infantry Division in World War II(Washington: Infantry Journal Press, 1947). Med-ical 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) MedHist Data, 56th Med Bn, 31 Oct 44.


MAP 8—Medical Support of Western Task Force

and harbor area were sufficiently secureby midmorning to bring tanks ashore,and the town surrendered at 1530, abouteleven hours after the action had started.

French planes from Marrakech cameover Safi in the early morning of D plus

1, but heavy fog kept all but one planefrom dropping bombs. The one planedestroyed an ammunition dump, withconsiderable damage to port installa-tions. Allied carrier-based planes neutra-lized the Marrakech field that afternoon


and broke up a truck convoy carryingFrench reinforcements to Safi. Tanks ofCombat Command B, 2d Armored Di-vision, which had landed during thenight of 8-9 November were immedi-ately dispatched to engage the Frenchcolumn. There was sharp fighting in thevicinity of Bou Guedra in the late after-noon of 9 November and early the nextmorning. After dark on the 10th thetanks withdrew and started for Casa-blanca, where they were sorely needed.

The largest of the three subtask forces—BRUSHWOOD—landed at Fedala, aboutfifteen miles north of Casablanca.(Map 8) The force consisted of the 3dInfantry Division, reinforced by a bat-talion landing team of the 2d ArmoredDivision and was commanded by Maj.Gen. Jonathan W. Anderson of the 3dDivision. Fedala lies on the southernedge of a shallow bay, enclosed by Cap deFedala jutting out behind the town andthe Cherqui headland about three milesto the northeast. The landing beachesactually used were all inside the bay, andall within range of batteries on cape orheadland. Fortunately, the defenderswere taken by surprise. Despite inexperthandling of landing craft that took sev-eral waves of assault troops to beachesmiles north of the objective and piledmany of the small boats onto rocks, therewere 3,500 troops ashore before dawnbrought organized French resistance. Allinitial objectives were quickly seized andthe beachhead was secure by sunrise.

The batteries were silenced later inthe day, and BRUSHWOOD Force began tomove inland, swinging south towardCasablanca. The movement was ham-pered by delays in unloading transportand communications equipment, andsupporting weapons, as well as by French

resistance, but the force was poised inthe outskirts of Casablanca by midnightof 10-11 November. In the interval,French warships at Casablanca, includ-ing the battleship Jean Bart, had joinedthe fight, inflicting considerable damageon the supporting naval units beforebeing blockaded in the harbor. The finalattack on Casablanca had still not beenlaunched when word arrived that theFrench were willing to lay down theirarms.

Most vigorously contested of all theWestern Task Force landings were thoseof Subtask Force GOALPOST in theMehdia-Port-Lyautey area, commandedby Maj. Gen. Lucian K. Truscott, Jr.(See Map 8.) GOALPOST'S primary mis-sion was to seize an airfield where P-40's,brought on the carrier USS Chenango,could be based to aid in the assault onCasablanca some 75 miles to the south-west. The airfield lay in a bend of theSebou River, with the town of Port-Lyautey south of it, on another andsharper bend. The airfield was about 3.5miles inland, or twice that far up thewinding river, with the town another 3or 4 miles upstream, but about equidis-tant from the coast as the crow flies. Thevillage of Mehdia was just above themouth of the river, which was closed be-yond that point by a boom.

The landing force consisted of the60th RCT of the 9th Division and a lighttank battalion of the 66th Armored Reg-iment, 2d Armored Division, with sup-porting units that included nearly 2,000ground troops of the XII Air SupportCommand. Landings on both sides of theriver mouth were marred when a num-ber of boat crews missed their beaches,landed the men as much as five miles outof position, and lost many boats in the


HOISTING WOUNDED SOLDIER ONTO ATRANSPORT for medical care, 8 November.

surf. French authorities, moreover, hadbeen alerted, like those at Safi, by thePresident's broadcast and by news of theactions already in progress at Oran andAlgiers.

Coastal batteries opened up after thefirst wave reached shore, and Frenchplanes strafed the beaches at dawn.Ground opposition increased as the dayadvanced, and darkness found only the3d Battalion of the 60th RCT more thana mile inland, opposite the airfield butnorth of the river. Units landing southof the river converged toward the airfieldthe following day and one company ofthe 3d Battalion crossed the Sebou inrubber boats, but all units were stoppedshort of their objectives.

The airfield was taken early on 10 No-vember when the destroyer USS Dallasrammed the boom and carried a raidingparty up the river to take the defendersof the field from the unprotected flank.

About 1030, planes from the USSChenango began landing at the field.There was little fighting the rest of thatday, and French resistance was formallyended at 0400 on D plus 3.

For medical support the Safi force, inaddition to attached personnel, was ac-companied by a collecting company ofthe 9th Medical Battalion and a detach-ment of the 56th Medical Battalion con-sisting of two officers and sixty-nineenlisted men. During the first hours,casualties were held at aid stations forwhich sand dunes furnished the onlycover. Early capture of the waterfrontarea made it possible to establish aid andcollecting stations in a warehouse on thedock about H plus 8. From this point,casualties were evacuated for temporaryhospitalization aboard the USAT Ti-tania. Two days after the assault began,an improvised hospital staffed by medi-cal battalion personnel was in operationin a school building with equipmentborrowed from local doctors and mer-chants and from the Navy. Patients to beretained in the theater under a 30-dayevacuation policy were brought to thisprovisional hospital from as far away asPort-Lyautey.

The 3d Division and its reinforcingarmored battalion at Fedala were sup-ported by the organic 3d Medical Bat-talion and by a detachment of the 56thMedical Battalion similar in size andcomposition to the detachment with theSafi force. Like the combat troops, medi-cal soldiers were scattered by poor navi-gation of the landing craft. Unitsexperienced considerable delay in mak-ing contact with their headquarters, aswell as in the matter of receiving sup-plies. Evacuation was also a slow and un-certain process until medical units were


assembled and vehicles were made avail-able, and the wounded were held at bat-talion aid stations for twenty-four andsometimes thirty-six hours. A clearingstation was set up by the afternoon ofD-day in a beach casino at Fedala withcapacity for 150 litter cases, the overflowbeing cared for in school buildings andprivate homes. Additional supplies wereborrowed from the Navy. During thenight of 12 November the station caredfor survivors of a U-boat attack, includ-ing over 400 burn cases, 100 of them sosevere as to require repeated transfu-sions. Flashlights furnished the only il-lumination until floodlights could beborrowed from Ordnance repair units.All available medical officers, includingColonel Kenner himself and Lt. Cols.Huston J. Banton and Clement F. St.John of the headquarters staff, workedthrough the night at the clearing station.Supplies and personnel were inadequate,and many of the more severe cases werelost.10

The Mehdia landings were supportedby a collecting company and a clearingplatoon of the 9th Medical Battalion anda detachment of the 56th Medical Bat-talion. The medical force was about halfthe size of those with the other two sub-task forces. Throughout the three daysof fighting it was possible to do no morethan set up beach aid stations. Evacua-tion by land was out of the question forwant of vehicles and a place to go; evac-uation to the transports was hazardousand at times impossible because of heavyseas and the excessive loss of landing

craft in the assault. On 12 November,after the armistice, the clearing platoontook over a Red Cross hospital in Meh-dia, which was operated as an evacuationhospital until the regular installationsarrived nearly a month later.

For the Western Task Force as awhole, 694 cases were hospitalized duringthe first week of the invasion. Of these,603 were combat wounds, 43 injuries,and 48 disease.11

Hospitalization and Evacuationof Task Force Casualties

Hospitalization and evacuation of taskforce casualties remained the responsibil-ity of the force surgeons until the medi-cal section of Allied Force Headquarterswas established in Africa and base sectionorganizations were set up. For the West-ern Task Force the provisional hospitalsat Safi and Mehdia continued to operateas long as they were needed. The Safihospital was still in operation when theAtlantic Base Section was activated latein December. The first U.S. Army hospi-tals to reach western Morocco were the750-bed 8th and the 400-bed 11th Evacu-ation Hospitals, which arrived at Casa-blanca together on 18 November on thedelayed second convoy. The 8th openedthree days later in buildings of the Ital-ian consulate, which soon proved toosmall and inadequately equipped. The11th moved on to Rabat, where it openedon 8 December, permitting return of theMehdia Red Cross hospital to civiliancontrol. The 59th Evacuation, another750-bed unit, began receiving patientsunder 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 ofthis volume.

11 Rpt, Hq SOS ETO, Off of Chief Surg, 15 Feb43. See also n. 5, p. 111, above.


her. The 400-bed 91st Evacuation wasalso in the area before the end of theyear, but was not established under taskforce control. All of these evacuationhospitals functioned as fixed installationsrather than as mobile units.12

In the Oran area the three mobilehospitals that came in with the combattroops—the 48th Surgical and the 38thand 77th Evacuation—were supple-mented on 21 November by the 9thEvacuation, with an additional 750 beds,and by the 1st Battalion, 16th MedicalRegiment. Since all of its equipment waslost at sea, the medical battalion operateda staging area for other units until Feb-ruary 1943. The Mediterranean BaseSection was activated on 8 December,and fixed hospitals under base sectioncontrol quickly supplanted the mobileunits of the Center Task Force, whichbegan staging for the next phase of theNorth African campaign.

Aside from the clearing platoons ofthe 9th and 109th Medical Battalions, allhospitalization for the Eastern TaskForce was British. Although they werenot able to land on D-day as planned,the 1st and 8th Casualty Clearing Sta-tions were established promptly after thesurrender of the city and, together withthe provisional casualty clearing sta-tion being operated by the 159th FieldAmbulance and the clearing platoon ofthe 109th Medical Battalion, were ableto care for all casualties until a sufficientnumber of general hospital beds wasestablished between 15 and 20 Novem-ber. All British units took U.S. patients,but the bulk of them went to the 94thGeneral, largest and best equipped of the

British hospitals assigned to the EasternTask Force.13

Evacuation from the Western TaskForce was by troop transport to theUnited States. From the Center and East-ern Task Forces, evacuation was by Brit-ish hospital ship to the United Kingdom.There was very little of either, however,before the period of task force controlended.

Evaluation of TORCH MedicalService

From the medical point of view, Oper-ation TORCH was relatively easy onlybecause casualties were far lower thanhad been anticipated and because medi-cal officers and enlisted men of the Medi-cal Department met unexpected situa-tions with ingenuity and skill. In noinstance did the collecting or clearingelements get ashore early enough, orhave enough equipment with them. Sup-plies hand-carried by medical personnelaccompanying the assault waves includedsome unnecessary items and omittedother items that would have been useful.Additional medical supplies were scat-tered over the beaches, where quantitieswere lost. Ambulances, in particular,were unloaded far too slowly, and whenthey finally became available they provedto have poor traction in sand and adangerously high silhouette. The jeep,on the other hand, was found to be read-ily adaptable for carrying litters overdifficult terrain.14

12 Unit reports of hospitals and base sectionsmentioned in the text.

13 (1) Diary, Surg Teams 1 and 2, Ortho Team 1,Shock Team 1, 2d Aux Surg Gp, in Rpts of ProfActivities of Surg Teams, vol. I. (2) Crew, ArmyMedical Services: Campaigns, pp. 90-93.

14 (1) Kenner, "Medical Service in the NorthAfrican Campaign," Bulletin, U.S. Army MedicalDepartment (May, June 1944). (2) Annual Rpt,


Hospital facilities provided for theWestern Task Force aboard the trans-ports proved unusable except in a singleinstance because of the heavy surf andthe heavy loss of landing craft during theassault. Mobile hospitals provided forthe Center Task Force were adequate asto bed strength, but the unloading ofequipment was not co-ordinated with thedebarkation of personnel. Hospitalequipment, moreover, often proved to beincomplete when unpacked.15 The Cen-ter and Western forces found it im-possible to obtain records of casualtiesevacuated by naval beach parties, oreven to learn how many there were.

Both the planning and the executionof the operation were at fault. Those whodrew the medical plans in Washingtonand London had very little communica-tion with each other, had only meagerintelligence reports as to the conditionsthey would actually meet, and were forthe most part either without combat ex-perience on which to base their judg-ments or had experience limited tothe static warfare of World War I. Medi-cal personnel with the assault troopswere equally inexperienced and at least

equally ignorant of what war in NorthAfrica would be like.

Medical Support of II Corpsin the Tunisia Campaign

Expansion Into Tunisia

Armistice negotiations were still goingon in Algiers and fighting still raged atCasablanca and Oran when the EasternTask Force resumed its identity as theBritish First Army and turned towardTunisia. The French commander therewas unwilling or unable to obey Darlan'scease-fire order, and Axis reinforcementswere coming in through the ports andairfields of Tunis and Bizerte. First Armyunits occupied Bougie, 100 miles east ofAlgiers, on 11 November. The followingday British paratroops and a seabornecommando group took Bone, 150 milesfarther east, unopposed. Advance ele-ments were within 60 miles of Tunis be-fore encountering German patrols on 16November. With French co-operation,forward airfields were occupied in theTébessa area, just west of the Tunisianfrontier and 100 miles south of the coast.Medjez el Bab was captured on 25 No-vember. The airfields at Djedeida, a bare15 miles from Tunis, were occupiedthree days later, but could not be heldagainst strong counterattacks.16

Surg, II Corps, 1942. (3) Recommendations ofSurg, Western Task Force, 24 Dec 42, in Med An-nex to Final Rpt of Opns.

15 "Equipment was packed and shipped with thenotation on the packing case, 'Complete except forthe following items.' The 'following items' werepieces of equipment that would deteriorate instorage—particularly rubber items. These shouldhave been included before shipment as pieces ofequipment—notably anesthesia machines—could notbe used until the missing items had been receivedfrom the U.S. It took many months to make upthese deficiencies." Ltr, Col Bauchspies to ColCoates, 15 Apr 59, commenting on preliminarydraft of this volume. Colonel Bauchspies was com-manding officer of the 38th Evacuation Hospital inthe North African invasion.

16 Military sources for the first phase of theTunisia Campaign are: (1) Field Marshal theViscount Alexander of Tunis, "The African Cam-paign from El Alamein to Tunis," Supplement tothe London Gazette, 5 February 1948, pp. 864-66;(2) Howe, Northwest Africa; (3) Howe, 1stArmored Division; (4) Craven and Cate, eds.,Europe; TORCH to POINTBLANK; (5) AlbertKesselring, Kesselring: A Soldier's Record (NewYork: William Morrow and Company, 1954). Themore important medical sources are: (6) Crew,Army Medical Services; Campaigns; (7) Clift, Field


By early December General Ander-son's troops were exhausted and his sup-plies critically short. Before a directattack on Tunis could be mounted thewinter rains set in, and the campaignbogged down in mud. After a month offutility, during which the enemyachieved superior build-up by virtue ofhis larger ports, all-weather airfields,and shorter supply lines, the front wasstabilized from Medjez el Bab in thenorth to Gafsa in the south. The FirstArmy dug in to wait.

The first phase of the Tunisia Cam-paign began in mid-November with thepiecemeal commitment of Americantroops in support of the British FirstArmy. It ended with the concentration ofII Corps in the Constantine-Tébessa areaduring early January 1943 in prepara-tion for a large-scale offensive. Immedi-ately after the armistice elements of the34th Division that had participated inthe Algiers landings relieved Britishunits occupying Bougie and Djidjelli.The 39th Regimental Combat Team,9th Division, was detailed to guard theline of communications from Algiers tothe rapidly advancing front. Elements ofthe 9th Medical Battalion that hadlanded with the 39th RCT operated anambulance service and a clearing stationin Baba Hassen, some twelve miles south-west of Algiers. The four teams of the2d Auxiliary Surgical Group that hadbeen part of the Eastern Task Force con-tinued to function in British hospitals

and other medical installations close tothe front.

As rapidly as the situation permitted,elements of II Corps that had made upthe Center Task Force were also de-ployed to eastern Algeria and Tunisia.Combat Command B of the 1st ArmoredDivision was at the front in time toparticipate in the long seesaw battle forMedjez el Bab that began around thefirst of December. The 2d Battalion,509th Parachute Infantry, flown outfrom Oran, was operating in the Gafsaarea in conjunction with Twelfth AirForce units and French ground troops.Before the end of December elements ofthe 1st Division were also in action inthe Medjez el Bab sector. In addition toattached medical personnel, Company Bof the 47th Armored Medical Battalionwas in Tunisia in support of units of the1st Armored Division. The 2d Battalionof the 16th Medical Regiment which hadlanded at Oran on 8 December, reachedthe front shortly before Christmas on de-tached service with First Army.17 In thisearly phase of the campaign the U.S.forces fought in relatively small units,with supporting medical detachmentscorrespondingly divided.

Hospitalization and evacuation in theBritish First Army area were exclusivelyBritish responsibilities. As the first phaseof the Tunisia Campaign came to a closein muddy stalemate, there were approxi-mately 250,000 Allied troops under FirstArmy 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 AlbertW. Kenner to CinC, AFHQ, 7 Jan 43, sub: Inspec-tion of Med Troops and Installations, First ArmyArea; (11) Rpt, Brig Gen Howard McC. Snyderto IG, 8 Feb 43, sub: Inspection of Medical Service,Eastern Sector, Western Theater of North Africa.

17 The 16th Medical Regiment was reorganizedimmediately upon landing in Africa into two com-posite battalions, which functioned independentlyin essentially the same manner as the separatemedical battalions. Ltr, Brig Gen Frederick A. Blesse(Ret) to Col J. H. McNinch, 4 Apr 50, commentingon MS draft of Crew, Army Medical Services: Cam-paigns.


British military hospitals were available.Although the bed ratio was thus only 4.4percent, no serious overcrowding was ob-served. Mobile units were close to thefront lines and treatment was prompt.The Western Task Force surgeon, A. W.Kenner, who had been promoted to brig-adier general and assigned to AFHQ asmedical inspector, visited the front be-tween 27 December and 4 January andconcluded that American casualties werereceiving the best medical care possibleunder the circumstances. He noted, how-ever, that British hospitals were oftenlax in forwarding records of U.S. pa-tients, so that commanders lost track oftheir men and returns to duty were un-necessarily slow; and that morale was im-paired by absence of mail from home andfailure to receive pay, though Britishwounded in the same hospitals receivedboth. Other adverse morale factors werefailure to receive the Purple Heart andthe loss of personal toilet articles.

A month later Brig. Gen. (later Maj.Gen.) Howard McC. Snyder made simi-lar observations, noting also that forwardhospitals were unheated, lacking in allbut the barest essentials in equipment,and understaffed by American standards.Nevertheless, he found treatment to beof a high order. While some installationshad few patients, others were overbur-dened, resulting in a highly flexible evac-uation policy. In some instances patientswho could have been quickly returnedto duty were sent to the rear simply tomake room for new casualties. In others,men who should have been evacuatedwere held near the front because fixedbeds were not available for them in thestill rudimentary communications zone.

Evacuation was by ambulance fromaid stations and other forward installa-

tions to railheads at Souk el Khemis,where a clearing platoon of the 2d Bat-talion, 16th Medical Regiment, sharedthe load with a British casualty clearingstation, and at Souk Ahras, where facili-ties included a casualty clearing stationand a 200-bed British general hospital.Michelin cars with capacity for 14 littercases ran over the narrow-gauge linefrom Souk el Khemis to Souk Ahras;from there three British hospital trainsmade the 24-hour run to Algiers. Hospi-tal trains were not yet available for evac-uation west of that city.

In the Tébessa sector a British casualtyclearing station and a small dispensaryoperated by the Twelfth Air Force fur-nished hospitalization. Both installationswere at Youks-les-Bains, a few miles westof Tébessa and adjacent to a large air-field. Evacuation was by air, but was notformally organized. Up to early January,most of the casualties flown out were AirForces personnel.

The Kasserine Withdrawal

At the turn of the year, U.S. unitsoperating with the British First Army,together with forces from the Casablancaand Oran areas, were transferred to IICorps under General Fredendall, andvarious changes were made in the over-all command structure. General Clarkwas detached from Allied Force Head-quarters to train the newly activatedU.S. Fifth Army for future operations inthe Mediterranean. He was succeeded asDeputy Supreme Commander in NorthAfrica by General Sir Harold R. L. G.Alexander. Lt. Gen. Sir Bernard L.Montgomery's British Eighth Army,fighting its way through Libya, was tocome under General Eisenhower's com-


mand when it reached the Tunisian bor-der. A new 18 Army Group was then tocome into being, made up of the BritishFirst and Eighth Armies, the U.S. IICorps, and the French 19th Corps underGeneral Louis-Marie Koeltz. GeneralAlexander was to be the army groupcommander.

Early in January General Fredendallestablished II Corps headquarters atConstantine and began moving hisforces into the vicinity of Tébessa. Addi-tional elements of the 1st Armored and34th Infantry Divisions, as they arrivedfrom England, were sent to the II Corpssector, while all remaining elements ofthe 1st Division were brought up fromOran. The three divisions were substan-tially assembled by 1 February, with thescattered regiments of the 9th Divisionbeing moved into position as reserves.Medical units based around Tébessa in-cluded, in addition to attached medicalpersonnel, the 1st and 109th MedicalBattalions and the 47th Armored Medi-cal Battalion, organic to the combat di-visions; the 51st Medical Battalion; the2d Battalion, 16th Medical Regiment;the 1st Advance Section of the 2d Medi-cal Supply Depot; the 48th Surgical Hos-pital; and the 9th and 77th EvacuationHospitals.18

The Germans seized the initiativewhen the rainy season ended in February.Early in the month Generaloberst Juer-gen von Arnim's army in Tunisia wasjoined by Field Marshal Rommel'sfamed Afrika Korps, and Rommel him-self was in command when the Axisforces attacked savagely toward Faïd Passin the center of the II Corps front onthe 14th. Intelligence expected the attackfarther north, and the Americans werecaught off balance. Fredendall preparedto stand at Kasserine Pass, some fortymiles west of the breakthrough, but hisarmor was out of position and poorweather conditions prevented air supportor even reconnaissance. Enemy tankcolumns forced the pass on 20 Februaryand debouched onto the plain beyond ina three-pronged drive that reached itsmaximum extent, only twenty milesfrom Tébessa, two days later. There thedrive was contained. The Germans, run-ning low on fuel and ammunition,realized they had not the strength tobreak through the Allied lines in theface of reinforcements moving in fromLe Kef and Tébessa, and withdrew totheir original positions.

Before the Faïd breakthrough therehad been relatively heavy fighting in the

18 Military sources for the Kasserine phase of theTunisia Campaign are: (1) Howe, NorthwestAfrica; (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; TORCHto POINTBLANK; (7) Eisenhower, Crusade inEurope, pp. 140-48; (8) Kesselring, Soldier's Rec-ord, pp. 177-84; (9) Alexander, "African Cam-paign," Suppl to London Gazette, 5 February 1948,pp. 866-73. Medical sources primarily relied uponare: (10) Annual Rpt, Surg, II Corps, 1943; (11)Annual Rpt, Med Sec, NATOUSA, 1943; (12) An-

nual 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 Jan-2 Feb 43; (22) Unsigned Rpt of Observations ofVisit to II Corps, 13-19 Feb 43; (23) Annual Rpt,9th Evac Hosp, 1943; (24) Annual Rpt, 77th EvacHosp, 1943; (25) Annual Rpt, 128th Evac Hosp(48th Surg Hosp), 1943; (26) Annual Rpt, 2d AuxSurg Gp, 1943; (27) Clift, Field Opns, pp. 74-94.


MAP 9—II Corps Medical Installations, 14 February 1943

Ousseltia Valley, where the II Corps sec-tor approached British positions in thenorth, and around Gafsa, more than ahundred miles distant on the southernflank. These actions had served to dis-perse collecting and clearing companiesover hundreds of miles of rough andlargely roadless country. The 9th and

77th Evacuation Hospitals were aboutten miles southeast of Tébessa, far to therear, while the 48th Surgical was operat-ing one 200-bed unit at Thala and theother at Fériana, each more than fiftymiles from the combat lines as of 14February. (Map 9)

A general withdrawal of medical in-


CAMOUFLAGED AID STATION of a fighter squadron at Youks-les-Bains, Algeria, January1943.

stallations paralleled the mid-FebruaryGerman advance. On the first day of theadvance an entire collecting company ofthe 109th Medical Battalion was cap-tured, together with most of the medicaldetachment of the 168th Infantry regi-ment-in all, 10 medical officers and morethan 100 enlisted men. On the same day,14 February, an officer of the 47th Ar-mored Medical Battalion was capturedwith four ambulances loaded with casual-ties.19 Aid stations in both Faïd and Gaf-sa sectors were hastily leapfrogged to therear, one section caring for patientswhile another moved to a safer location.Lines of evacuation were long and cir-

cuitous, over roads that could be safelytraveled only at night. Trucks and litter-jeeps were freely used to supplement theambulances that were never available insufficient numbers.

During the night of 14-15 Februarythe Feriana section of the 48th SurgicalHospital moved to Bou Chebka aboutmidway along the road to Tebéssa, usingtrucks and ambulances of the corps medi-cal battalions. Patients were placed inthe 9th Evacuation Hospital, whichshifted 107 of its own patients to bedsset up for the purpose by the still in-operative 77th. By February 17th the48th Surgical was on the road again,moving this time to Youks-les-Bains justwest of Tébessa. Within six hours of ar-

19 Interv with 1st Lt Abraham L. Batalion, andCapt Wilbur E. McKee.


rival it was receiving patients from bothevacuation hospitals, which were them-selves in process of moving.

When weather conditions made airevacuation to the communications zoneimpossible, a section of the British 6thMotor Ambulance Convoy was rushed toYouks, where it was placed at the dis-posal of the 48th Surgical Hospital on 18February. The twenty-five ambulancesand two buses of this unit were able tomove 180 patients at a time, and suc-ceeded in clearing the Tébessa area ofcasualties by the time the Germans brokethrough Kasserine Pass. Both the 9thand the 77th Evacuation Hospitals wereback in operation by 20 February, at newsites in the Aïn Beida—La Meskiana areaon the road to Constantine. The Tébessasection of the 2d Medical Supply Depotmoved into the same area on 19 Feb-ruary, followed by the Thala section ofthe 48th Surgical. The remainder of the48th went from Youks to Montesquieuon 22 February, while the 9th Evacua-tion shifted from Aïn Beida to SoukAhras, fifty miles to the north. (Map 10)

All of these moves were carried outrapidly and in good order, althoughhundreds of patients were involved. Inthis acid test of mobility, commanderswere duly impressed by the fact that a200-bed section of the 48th Surgical Hos-pital could evacuate its patients, disman-tle and load its installations, and be onthe road in four and a half hours, whilethe 750-bed evacuation hospitals, becausethey had no organic vehicles of theirown, were able to move only when trans-portation could be provided by corps.In a disintegrating situation their prior-ity was low and the danger of their beingoverrun by the enemy was proportion-ately great. The relative immobility of

these large units kept them so far behindthe fighting fronts that ambulance runsof a hundred miles or more betweenclearing station and hospital were notinfrequent. In the absence of hospitalscloser to the lines, teams of the 2d Auxil-iary Surgical Group were attached tothe clearing stations.

Operations in Southern Tunisia

During the first week of March, Gener-al Fredendall was relieved, and com-mand of II Corps was given to GeneralPatton; Maj. Gen. Omar N. Bradley wasappointed his deputy. The shift in lead-ership coincided with the penetration ofTunisia from the south by the BritishEighth Army and activation of the 18Army Group under Alexander. The IICorps' next mission was to attack in theGafsa-Maknassy area in support ofEighth Army's drive up the coast.20

Mindful of the Kasserine experience,and with troop strength brought up to90,000 by assignment of the 9th Divi-sion, Colonel Arnest, the II Corps sur-geon, asked for one of the new 400-bedfield hospitals capable of operating inthree 100-bed units, a 400-bed evacua-tion hospital, and more ambulances.Only the ambulances arrived before thesouthern phase of the Tunisia Campaign

20 Military sources for the campaign in southernTunisia are: (1) Opns Rpt, II Corps, 16 Mar-10Apr 43; (2) Howe, Northwest Africa; (3) Howe,1st Armored Division; (4) Knickerbocker andothers, Story of First Division in World War II,pp. 64-72, 92-95; (5) Omar N. Bradley, A Soldier'sStory (New York: Henry Holt and Company, 1951),pp. 43—55; (6) Kesselring, Soldier's Record, pp.184-88; (7) Alexander, "African Campaign," Supplto 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 AuxSurg Gp, 1943; (10) Clift, Field Opns, pp. 98-112.


MAP 10—II Corps Medical Installations, 24 February 1943

was over, and those only a few days be-fore the pressing need for them hadpassed. The only medical reinforcementsreceived were five teams of the 3d Auxil-iary Surgical Group, flown in withoutnurses on 18 March. Eleven teams of the2d Auxiliary Surgical Group werealready active in the II Corps area.

Shortage of beds made it impossible tomaintain any fixed evacuation policy,even the 15-day policy originallyplanned.

The corps jumped off on 17 March.The 1st Division occupied Gafsa thesame day, took El Guettar on the 18th,and seized Station de Sened on the 21st.


Maknassy fell to the 1st Armored on 22March. After a brief respite for revisionof plans and regrouping, all four divi-sions of II Corps went into action on 28March. The 9th Division attacked alongthe road from El Guettar to the coastalcity of Gabes; the 1st turned northeasttoward Maknassy, where the 1st Armoredwas concentrating on a strongly heldpass east of the town; and the 34th, to-gether with British First Army units,attacked Fondouk on the left flank.Fighting in all sectors was heavy, andfor ten days almost continuous. Contactwith the British Eighth Army was estab-lished on 7 April, and the enemy beganwithdrawing to the north. When the34th Division and its British allies brokethrough at Fondouk two days later, thesouthern campaign was over.

In the interval between recovery ofthe ground lost in the Kasserine with-drawal and the launching of the II Corpsoffensive, hospitals and other medical in-stallations were again moved forward tothe Tébessa area. The 9th EvacuationHospital set up this time at Youks-les-Bains, where proximity to the field usedfor air evacuation to the communicationszone was the primary consideration. Bothsections of the 48th Surgical were back atFeriana by 19 March. Two corps clear-ing stations established on 22 Marchremained in place until the end of thesouthern campaign, compensating inpart for the shortage of mobile hospitalbeds. These were the clearing stationsof the 51st Medical Battalion at Gafsaand of the 2d Battalion, 16th MedicalRegiment, near Maknassy. Each was re-inforced by surgical teams and was adja-cent to clearing units of the organicmedical battalions. They functioned ineffect as front-line hospitals for forward

surgery and for holding cases that couldnot be safely moved. Evacuation fromboth stations was to the 48th SurgicalHospital, fifty miles from Gafsa and al-most twice that far from Maknassy.

Coinciding with the renewal of theoffensive on 28 March, the 77th Evacua-tion returned to Tébessa and one sectionof the 48th Surgical went on to Gafsa.At Sbeitla, on the evacuation routefrom the 34th Division, 2d Battalion ofthe 16th Medical Regiment set up aclearing station that, like the other twocorps clearing stations, functioned as aforward hospital. It was relieved on 11April, after the southern campaign hadended, by the 400-bed 15th EvacuationHospital.

Facilities of the 48th Surgical Hospital,and of the corps clearing stations, werewholly inadequate for the steady streamof casualties from the three divisionsoperating in the El Guettar-Maknassysector during the final drive. Evacuationto Tébessa and Youks by ambulance andtruck was virtually a continuous process.To make room for new arrivals, the 77thand 9th Evacuation Hospitals were com-pelled to send patients to the communi-cations zone with little reference to theirhospital expectancy, and many were thuslost who could have been returned toduty in a reasonable time.

In the El Guettar-Maknassy area, ter-rain was often too rough for vehicles,even for jeeps and half-track ambulances.Litter carries, especially on the 9th Divi-sion front, were long and generally pos-sible only at night. In many instancesboth patients and medical attendantswaited in slit trenches for darkness. Thecorps medical battalions supplied addi-tional litter bearers, as many as 75 beingneeded by one combat team. Only in the


MAP 11—II Corps Medical Installations, 11 April 1943

Fondouk sector was evacuation from thebattlefield relatively easy. There, a goodroad net and adequate cover permittedlocation of aid and collecting stationsclose to the lines. The ambulance haulfrom the clearing station at Sbeitla tothe evacuation hospitals at Tébessa andYouks-les-Bains was approximately eightymiles. (Map II)

The Drive to Bizerte

Following withdrawal of the enemyfrom southern Tunisia, General Pattonwas detached to train the force thatwould become the U.S. Seventh Armyon the scheduled invasion of Sicily.

Command of II Corps passed to GeneralBradley, whose first task was to shift histroops 150 miles to the north. Althoughthe movement involved passing close to100,000 men, with all their equipment,across the communication lines of theBritish First Army, it was accomplishedwithout interruption to any supply ormilitary service, and without detectionby the enemy.21

21 Military sources for the northern phase of theTunisia Campaign are: (1) Opns Rpt, II Corps,23 Apr-9 May 43; (2) Howe, Northwest Africa;(3) Howe, 1st Armored Division; (4) Knicker-bocker and Others, Story of First Division in WorldWar II, 72-81, 95-98; (5) Bradley, Soldier'sStory; (6) Craven and Cate, eds., Europe.- TORCHto POINTBLANK; (7) To Bizerte with the II Corps


SETTING UP A TENT OVER A MOBILE SURGICAL TRUCK IN TUNISIA. Truck andtent furnished facilities and operating space for three surgical teams.

The final phase of the North Africancampaign began on 23 April, with IICorps and attached French elementspushing east along the Mediterraneancoast, First Army advancing northeast inthe center, and Eighth Army attackingnorthward on the right flank. TheFrench 19th Corps, under GeneralKoeltz, operated between the two Britisharmies. By this time the Allies had con-

trol of the air and the end was swift andsure. One after another, strongly heldhill positions were stormed. The 1stArmored swept through the Tine Valleyto capture the important communica-tions city of Mateur on 3 May. Bizertefell to the 9th Division on 7 May, simul-taneously with the entry of British unitsinto Tunis. The 3d Division was broughtup at this time, but was too late to partic-ipate in more than mopping-up opera-tions. All enemy forces in the II Corpssector surrendered on 9 May. Britisharmor quickly closed the escape routeto the Cap Bon peninsula, and the re-maining Axis forces, trapped betweenthe British First and Eighth Armies,

(Washington, 1943) ; (8) Alexander, "African Cam-paign," Suppl to London Gazette, 5 February 1948,pp. 878-84. Medical sources are substantially thesame as those already cited for the Kasserine andsouthern phases of the campaign, to which shouldbe added: (1) Annual Rpt, 10th Field Hosp, 1943;(2) Clift, Field Opns.


surrendered on 13 May. About 275,000prisoners were taken in the last week ofthe campaign.

With an independent combat missionand five divisions under its command bythe date of the German surrender, IICorps resembled a field army both insize and role. Colonel Arnest functionedmore as an army than as a corps surgeon.His staff of eleven officers and sixteenenlisted men was of a size appropriateto the responsibilities entailed.

In northern Tunisia, Tabarka servedas the nerve center for medical activities,as Tébessa had in the south. The use anddisposition of mobile hospitals wasdrastically modified on the basis of pre-vious experience. The semimobile 400-bed evacuation hospitals, with surgicalteams attached, were placed directly be-hind the advancing troops, with thelarger evacuation units farther tothe rear where they took patients fromthe more forward installations. Beforethe attack was launched, the 11th Evacu-ation was shifted more than a thousandmiles from Rabat to a site nine milessouth of Tabarka, and the 48th Surgicalwas established some ten miles fartherto the east. The 750-bed 77th Evacuationwas set up at Morris, near Bone, where itwas detached from II Corps and assignedto the Eastern Base Section, the forwardelement of the North African Communi-cations Zone.

On 21 April the 15th Evacuationmoved up from Sbeitla to a location tenmiles north of Bédja, and the followingday the 11th relieved the 48th Surgical,which closed for reorganization. Thelarger 9th Evacuation occupied theformer site of the 11th. (Map 12) The48th Surgical, converted into the 400-bed128th Evacuation Hospital, returned to

combat duty southwest of Mateur on4 May. The 15th Evacuation, displacedby the 128th, moved two days later toa site west of Mateur.

The 750-bed 38th Evacuation Hospitalmoved from the Telergma airfield westof Constantine, where it had been oper-ating as a communications zone unitsince early March,22 to the vicinity ofBédja on 4 May; and on 7 May the 9thEvacuation moved forward to the vi-cinity of Mateur. The 77th Evacuationremained throughout the campaign atMorris, where it possessed air, rail, andwater outlets to the communicationszone, though its usefulness was impairedby an ambulance run of 85 to 110 milesover roads too rough for the transporta-tion of seriously wounded men.

In the northern phase of the cam-paign, II Corps was thus supported bythree 400-bed and three 750-bed evac-uation hospitals, in contrast to the cam-paign in the south where one 400-bedunit and two 750-bed units had servedsubstantially the same troop strength. Inthe northern campaign, moreover, for-ward hospitals were only 5 to 20 milesfrom the combat areas, contrasted withdistances of 25 to 100 miles in southernTunisia. Despite these shortened lines ofevacuation, the 2d Battalion of the 16thMedical Regiment and the 51st MedicalBattalion were reinforced by elementsof the 56th Medical Battalion and weregiven additional ambulances. The 10thField Hospital, which reached Tabarkaon 30 April, was also assigned to II Corps,but did not go into operation until 7May, when it was used exclusively as aholding unit for air evacuation, and toserve personnel of an air base.

22 See p. 190, below.


MAP 12—II Corps Medical Installations, 23 April 1943

During the first ten days of the Bizertedrive, fighting was in mountainous coun-try, often covered with thick, thornyunderbrush and largely without roads.Evacuation was particularly difficult onthe 9th Division front, to the left of thecorps sector. For a time mules were used,harnessed in tandem with a litter swungbetween poles attached to the saddles.Difficult hand litter carries up to threeand a half miles necessitated the use of200 additional bearers, drawn in partfrom corps medical battalions but mainlyfrom line troops. At one point, where arailroad cut the 9th Division front, twohalf-ton trucks were fastened back toback with rims fitted over the rails. One

truck powered the vehicle on its wayto the rear, the other on the return trip.Twelve litters could be carried at a time,but the exposed position of the railroadmade it usable only at night. One collect-ing company of the 9th Medical Battal-ion operated a rest camp in the rear ofthe division area, to which approximatelyseventy-five front-line soldiers werebrought each evening for a hot shower,a full night's sleep, and a chance to writeletters. Exhaustion cases were held at theclearing stations, under heavy sedation.

Similar conditions prevailed on thenarrower fronts assigned to the otherdivisions of II Corps. The 1st Divisionborrowed litter bearers from the 51st


Medical Battalion; the 1st Armoreddrafted cooks, clerks, and other noncom-bat personnel into service as bearers.Half-track ambulances proved unable toenter the narrow wadis where casualtiesoccurred most frequently, and had to bereplaced by jeeps. In the bloody battlefor Hill 609, litter bearers of the 34thDivision brought out casualties in day-light from positions closer to the enemylines than to their own.

In the final week of the campaign,medical support of the combat forcesmore closely approximated the patternlaid down in the manuals. (Map 13)The coastal plain was adapted to easymovement in vehicles, and the road netwas good. The 400-bed evacuation hospi-tals were closed to admissions between9 and 15 May, new patients being sentthereafter only to the 9th Evacuation.The staff of this unit was reinforced bya detachment from the 16th MedicalRegiment and by captured Germanmedical personnel, who helped withprisoner-of-war patients. Two capturedGerman field hospitals were allowed tocontinue in operation, under supervisionof the 51st Medical Battalion, until 15May, when all prisoners still requiringhospitalization were turned over to the9th Evacuation. As of 12 May there were1,145 patients, including prisoners ofwar, in II Corps hospitals, and twicethat number in the two evacuation hospi-tals assigned to the Eastern Base Section.All hospital units and corps medicalbattalions passed to control of EBS asof midnight, 15 May.

Immediately after the end of hostilitiesthe 9th Evacuation Hospital, on its owninitiative, began to function as a stationhospital for all troops in the area. Mem-bers of the hospital staff were soon

treating 100 or more a day in the out-patient clinic, where their specializedskills made up for the limitations ofbattalion medical sections left with thecombat and support troops in the vi-cinity.23

Summary of Tunisian Experience

Like the combat troops, the medicalunits and personnel of the medical de-tachments went into the Tunisia Cam-paign without battle experience, or withexperience limited to the two or threedays of action in the TORCH landings.Deficiencies in training had to be madeup while operating under combat condi-tions, and in intervals when the unitswere in bivouac. More important stillwas the training of replacements. Virtu-ally no trained medical replacementswere available, yet losses were high.More than a hundred Medical Depart-ment officers and men were captured inthe Faïd Pass breakthrough alone, whiledisease, injury, and battle wounds alsotook their toll. Indeed, the personnelproblem was perhaps the most difficultone faced by the surgeon's office duringthe campaign. Constant juggling ofmedical officers, and continuing trainingof line troops as replacements, werenecessary to keep the II Corps medicalservice in operation at all. Other difficul-ties included much obsolete equipmentin the early stages of the campaign, andgenerally inadequate lighting and powerfacilities.

Casualties were progressively heavier

23 Recorded interv, Col Coates, with ASD FrankB. Berry, 4 Nov 58, commenting on preliminarydraft of this volume. Dr. Berry—then a colonelwas chief of the Surgical Service, 9th EvacuationHospital, in North Africa.


MAP 13—II Corps Medical Installations, 12 May 1943

with each stage of the campaign. Hospi-tal admissions for the period 1 Januarythrough 16 March were 4,689. Duringthe campaign in southern Tunisia, 17March through 9 April, 6,370 men wereadmitted to II Corps hospitals. For thenorthern campaign, 10 April through 15May, there were 8,629 hospital admis-sions. The consolidated casualty figures,shown in Table 1, offer tangible evidenceof the magnitude of the task successfullycarried through by Colonel Arnest andhis staff.

The early use of the 750-bed evacua-tion hospital as a forward unit was aholdover from the relatively static war-fare of World War I, and was at least

in part responsible for the siting ofhospitals so far to the rear. Anotherreason for the failure of II Corps to giveclose hospital support in the Kasserineand southern phases of the campaignwas the absence of any fixed battle lineand the necessity of giving ground beforean enemy superior both in numbers andin combat experience.24

The organization of the corps medicalservice underwent numerous changes asthe campaign progressed and more ex-perience was gained with the require-ments of modern combat. Initially thecorps surgeon's office was located at the

24 Ltr, Col Arnest to Col Coates, 10 Nov 58.


TABLE 1—HOSPITAL ADMISSIONS AND DISPOSITIONS,II CORPS, 1 JANUARY-15 MAY 1943

Source: Annual Rpt, Surg, II Corps, 1943.

corps rear echelon, where informationfiltered back too slowly to permit ade-quate advance planning. Delay in estab-lishing a base section close to the combatzone complicated both supply and evacu-ation problems in the early stages of thecampaign. The 61st Station Hospital,located at El Guerrah just south ofConstantine early in February at the re-quest of the British First Army surgeonand under British control until March,was the only U.S. fixed hospital closerthan Algiers until the end of March.This 500-bed unit, and the British 12thCasualty Clearing Station at Youks-les-Bains, aided immeasurably in the orderlywithdrawal of II Corps medical installa-tions at the time of the Kasserinebreakthrough. The contrast between themedical support available to the corpsat that time and that available duringthe final phase of the campaign in lateApril and early May shows how quicklyand how well the lesson of KasserinePass was learned.25

Air Force Medical Installations

In addition to the mobile hospitalsserving II Corps in the field, the TwelfthAir Force maintained various installa-tions of its own, which gave first- andsecond-echelon medical service to combatfliers, their counterparts in the AirTransport Command, and the support-ing ground crews. Air Forces medicalpersonnel were administratively distinctfrom the organization serving the groundforces, although the two groups workedclosely together. Air Forces installationswere confined to squadron aid stationsand dispensaries, but both types of unitfrequently had to assume hospital func-tions. At the more important airfields,such as Marrakech, La Senia, andTelergma, hospitals were set up by thebase 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, toTSG, 15 May 43, sub: Observations, North African

Theater. (3) Clift, Field Opns, pp. 129-36. (4)Observations made on a visit to II Corps, 13-19Feb 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 alsop. 189, below.


WRECKED AMBULANCE in northern Tunisia. The red cross was not always respected.

mobile hospital units of the groundforces in the immediate vicinity. Fixedhospitals in the communications zoneserved Air Forces personnel as well asground troops.26

Evacuation From II Corps

The chain of evacuation from theTunisian battlefields went from forward

evacuation hospitals by ambulance andrail to Eastern Base Section installations,and by air direct to fixed hospitals inAlgiers and in the vicinity of Oran. Dur-ing the Kasserine and southern Tunisiancampaigns, Tébessa and the nearby air-field at Youks-les-Bains served as thestarting points for evacuation to thecommunications zone. In the final stagesof the campaign, and the readjustmentperiod immediately following the closeof hostilities, evacuation was fromTabarka to Bone, from the railhead atSouk el Khemis to Constantine, and from

26 For description of Air Forces medical units, seeLink and Coleman, Medical Support of the ArmyAir Forces in World War II, pp. 455-57.


airfields at Souk el Arba and Sidi Smallto Oran.

Evacuation by Road and Rail

The 1st Battalion of the 16th MedicalRegiment, with the assistance after 18February of the British 6th Motor Ambu-lance Convoy, operated an ambulanceshuttle from Tébessa to Constantine,approximately 140 miles. The same roadserved as a main supply route for IICorps. Beginning in mid-March, the16th Medical Regiment also staffed andoperated a French hospital train, whichran from Tébessa to Ouled Rahmoun,just south of Constantine, where thenarrow-gauge Tébessa line interceptedthe main east-west railroad. A trafficcontrol post at Aïm M'lilla distributedpatients from ambulance convoys andhospital trains to vacant beds in the area.In the northern sector the ambulanceroute of the 16th Medical Regiment raneighty-five miles from Tabarka to Bone.Rail evacuation from the northern sectorwas by two British hospital trains fromSouk el Khemis, each with capacity for120 litter and 200 sitting patients.27

Evacuation from the combat zone byroad and rail was under control of IICorps, although the 1st Battalion of the16th Medical Regiment, which wasprimarily responsible for the operation,was assigned to the Eastern Base Section.For the Kasserine period, 1 January to16 March 1943, the II Corps Surgeon

reported 1,740 patients evacuated to thecommunications zone by road, none byrail. During the campaign in southernTunisia, 17 March to 9 April, 1,742patients were evacuated by road and1,052 by rail. From the northern sector,10 April to 15 May, the evacuationfigures included 5,628 by road and 436by rail.

Air Evacuation From II Corps

With the concentration of II Corps inthe Tébessa area in January, it was im-mediately clear that the informal andinfrequent use of air evacuation preva-lent up to that time would be inade-quate. The logistical demands upon thesingle-track, narrow-gauge rail line andthe one motor road between Tébessaand Constantine would preclude the ex-tensive use of either for evacuation, evenhad hospital cars and ambulances beenavailable at that early stage of the cam-paign. In an effort to solve the evacua-tion problem, General Kenner andColonel Corby met with General Doo-little and Colonel Elvins, respectivelycommanding officer and surgeon of theTwelfth Air Force, and the correspond-ing officers of the 51st Troop CarrierWing in Algiers on 14 January.28

A comprehensive plan for air evacua-tion was agreed upon, and was put into

27 (1) Annual Rpt, Med Sec, EBS, 1943. (2) An-nual Rpt, Med Sec, NATOUSA, 1943. (3) MedHist Data, 161st Med Bn (1st Bn, 16th Med Regt),22 Oct 44. (4) Unsigned Memo, n.d., sub: Noteson General Kirk's Observations of Med Serv inNorth Africa, May 43.

28 (1) Link and Coleman, Medical Support of theArmy Air Forces in World War II, pp. 473-81. (2)Hist of 12th Air Force Med Sec, ch. VIII. (3) MSgt A. I. Zelen, Med Dept, Hospitalization andEvacuation in the Mediterranean Theater of Op-erations (MS draft), p. 51. (4) Med Hist, 802dMed Air Evac Trans Squadron. (5) Statement of GenKenner to author, 26 Mar 59. See also, Ltr, MajGen Earle Standlee (Ret) to Col Coates, 15 Jan 59,commenting on preliminary draft of this volume.


effect without delay. It differed in factbut little from the plan Colonel Elvinshad prepared before the invasion, butat that time it had met with a coldreception from ground surgeons, whobelieved air evacuation to be impracti-cal. The plan called for the corps sur-geon to establish holding hospitals nearforward airfields, with the air surgeonresponsible for supervision and thetheater surgeon for over-all co-ordina-tion. It was in this connection that the38th Evacuation Hospital was establishedat Telergma.29

The planes used were C-47's,equipped with litter supports, whichmade it possible to carry 18 litter patientsand attendants. There were no regularschedules, since the planes were used forevacuation only on their return runsafter discharging cargo or passengers inthe combat zone. Requests were madethrough the medical section, AFHQ, andevacuation officers in the combat areaswere notified each evening as to howmany planes would be available thefollowing day. Communication was byteletype, telephone, radio, and air cour-ier. Patients were assembled near theairfields so they could be loaded witha minimum of delay.

Although planes were not markedwith the Geneva Cross, and flew at lowaltitudes, there were no enemy attacks.Before 10 March the medical personnelhandling air evacuation were enlistedmen from the medical sections of variousgroups of the 51st Troop Carrier Wing.After that date personnel—includingnurses as well as enlisted men—were

supplied by the 802d Medical Air Evacu-ation Transport Squadron. Surgeons onthe ground supervised loading and un-loading. The surgeon of the 51st TroopCarrier Wing was responsible for records,supplies used in flight, and propertyexchange. The ratio was two planes usedfor resupply for every ten loads of pa-tients, although one plane could be madeto serve if returning personnel were dis-persed among cargo transports.

In the Kasserine phase of the cam-paign, air evacuation was from Youks-les-Bains, with the British 12th CasualtyClearing Station serving as holding unitfor evacuees. During the II Corps oper-ations in southern Tunisia the sameairfield was used, with the holdingfunction shifted to the 9th EvacuationHospital. One planeload of 16 patientswas flown direct from Thelepte. Whenoperations shifted to the northern sector,the lines of evacuation ran from Souk elArba and Sidi Smail. The 38th Evacua-tion Hospital was close to both airfields.In the final days of the campaign, the10th Field Hospital served as a holdingunit at Souk el Arba. The overcrowdedhospitals of the Eastern Base Sectionwere bypassed, the planes returning di-rectly to their own bases at Algiers andOran, sometimes by an inland route andsometimes flying low over the water.Figures for air evacuation from theTunisian fronts between 16 January and23 May 1943, as reported by the 802dMedical Air Evacuation TransportSquadron (MAETS), are broken downby points of origin and destination inTable 2.

The Air surgeon estimated that 887patients had been evacuated by air inNorth Africa before the formal servicewas inaugurated on 16 January 1943, but29 See also p. 132, above, and pp. 204-05, below.


TABLE 2—AIR EVACUATION FROM TUNISIA, 16 JANUARY-23 MAY 1943

by no means all of these came fromTunisia.30

It was this experience in North Africathat gave both ground and air surgeonssome idea of the immense capabilitiesof air evacuation, which continued to beused increasingly through the rest of thewar.


Shipping shortages and the speed withwhich Operation TORCH was mountedheld medical supplies and equipmentcarried by the task forces to the lowestpossible level consistent with safety.There also were difficulties in gettingtogether all of the items scheduled forfollow-up convoys. Hospitals destinedfor North Africa arrived in England withno more than 25 percent of their medical

equipment and none of their quarter-master equipment. Deficiencies weremade up in the United Kingdom, butonly by stripping the European theaterof much of its reserve stock.31

Until the arrival of trained medicalsupply personnel late in December 1942,supplies for the Western Task Force werehandled by division medical supplyofficers and by personnel of a hospitalship platoon. For the Center Task Force,the 51st Medical Battalion took over themedical supply function shortly after itsarrival on the D plus 3 convoy. Heretrained medical supply personnel wereavailable within two weeks. The 1stAdvance Section, 2d Medical SupplyDepot, arrived in Oran on 21 Novemberand carried on the medical supply func-

30 The II Corps surgeon, in his annual report for1943, gives a figure of 3,313 patients evacuated byair between 1 January and 15 May. The larger fig-ure shown in Table 2 is due in part to the addi-tional week included at the heavy end of theperiod, and in part to the inclusion of Air Forcescasualties, 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) AnnualRpt, Surg, II Corps, 1943; (3) T Sgt William L.Davidson, Medical Supply in the MediterraneanTheater 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 attend-ing nurse is 2d Lt. Aleda E. Lutz, one of eight U.S. nurses killed in action in the MTO.


tion for the growing body of troops inthe area until a base section organizationwas established early in December.32

The U.S. components of the EasternTask Force were supplied, like theBritish components, through the BritishFirst Army. Even items not available inBritish depots were requisitioned fromETO sources by the British. This de-pendence upon British supplies con-tinued through the first phase of theTunisia Campaign, creating many dif-ficulties because of differences in practicebetween the two medical services. Supplylevels deemed adequate by the Britishwere insufficient by the more lavishAmerican standards.33

Medical supply in Tunisia passed intoAmerican channels with the concentra-tion of II Corps in the Constantine-Tébessaarea at the beginning of 1943.

The 1st Advance Section of the 2dMedical Supply Depot opened in Con-stantine on 8 January, moving a few dayslater to Telergma, where it relievedelements of the 16th Medical Regiment.The section shifted to Bekkaria, east ofTébessa, on 20 January, and thereafterremained as close as possible to the IICorps medical installations. The supplydepot withdrew to Am Beïda on 20February, following the Kasserine break-through, then moved up to Souk Ahrasfor a brief time, but was back at Bekkariabefore the Gafsa-Maknassy-El Guettarcampaign began in mid-March. Thedepot was in operation east of Tabarkaby 23 April in support of the drive to

Bizerte. On 15 May, immediately afterthe German surrender in Tunisia, the1st Advance Section, 2d Medical DepotCompany, moved to Mateur, where itwas later relieved by a base sectiondepot.

After activation of the Eastern BaseSection late in February, medical sup-plies for II Corps were received throughthe base depot at Aïn M'lilla, south ofConstantine, or one of the two subdepotsat Philippeville and Bone. Distance andtransportation difficulties always compli-cated the supply problem, but there wereno serious shortages of any necessaryitem at any time during the TunisiaCampaign.

Medical supplies in North Africa werefurnished initially on the basis of theMedical Maintenance Unit (MMU),designed to meet the medical require-ments of 10,000 men for thirty days.Deliveries to the theater were automatic,determined by troop strength. Combatexperience quickly revealed deficienciesand overstocks in the MMU, which wassupplanted midway through the TunisiaCampaign by the Balanced Depot Stock,worked out by supply experts in theOffice of The Surgeon General.

Items of basic equipment were themost difficult to replace, but in spite ofdepot stringencies, hospitals assigned tothe combat zone usually managed to getthere with equipment in excess of theirorganizational allowances, and so wereable to weather loss and breakage.


Combat Medicine and Surgery

The amphibious phase of the NorthAfrican campaign was too brief, and the

32 See pp. 207-09, below, for base section medicalsupply activities.

33 Rpt, Gen Kenner to CinC, AFHQ, 7 Jan 43,sub: Inspection of Med Troops and Installations,First Army Area.


MEDICAL SUPPLIES ON THE INVASION BEACH AT LES ANDALOUSES, west of Oran,9 November.

nature of the fighting too restricted, toprovide positive experience in combatmedicine and surgery. The primarylesson for the Medical Department wasthe necessity in future landing opera-tions of establishing clearing stations andhospitals ashore at the earliest possibledate, with sufficient equipment andadequate personnel for emergency sur-gery and medical care. In Tunisia, in-valuable experience was gained in themanagement of wounds, in the equip-ping and staffing of facilities for forwardsurgery, and in the handling of psychi-atric cases. Even before the campaignwas over, much of this experience wasapplied toward the improvement of

medical and surgical care in the combatzone.

Forward Surgery—In the early phasesof the Tunisia Campaign, mobile hospi-tals were located so far to the rear—often50 to 100 miles—that a far heaviersurgical load fell on the clearing stationsthan had ever been contemplated. Plasmaas a guard against shock was given inthe collecting stations and often in theaid stations, but as a general rule onlyemergency surgery was performed in thedivision area. Surgeons in the divisionclearing stations administered plasma,controlled hemorrhage, and closed suck-ing chest wounds, but completed trau-


matic amputations only where necessaryto stop hemorrhage.34

After emergency treatment, surgicalcases went to the clearing stations of thecorps medical battalions, which were setup through necessity as forward surgicalhospitals despite the fact that they wereinadequately equipped and staffed forthis purpose. Surgical and shock teamsworked together effectively in these in-stallations with minimal equipment,but there were neither beds nor person-nel for postoperative care. Intravenousfluids could not be administered; specialdiets were not available; whole-bloodtransfusions were possible only with de-tachment personnel as donors and with-out means of checking blood for malariaor syphilis. As a result, patients wereevacuated as rapidly as possible, the ma-jority in six to eight hours after surgeryand some while still under anesthesia.

Col. Edward D. Churchill, surgicalconsultant in the theater, explored thesituation during the southern campaign,and his recommendations had much todo with the improvement of conditionsin the northern sector, where smallerevacuation hospitals were set up closerto the front. Associated with ColonelChurchill in the evaluation of II Corpssurgery was Maj. (later Col.) Howard E.Snyder, of the 77th Evacuation Hospital,who reported to corps headquarters fortemporary duty on 15 March 1943, and

remained as surgical consultant to thecorps.35 In the Sicily Campaign, as willbe seen later, the whole concept of for-ward surgery was altered as a result ofthe Tunisian experience.

One of the lessons quickly driven homein the Tunisia Campaign was that plasmawas not a complete substitute for bloodin combat surgery. No supply of wholeblood was available, nor had any pro-vision been made to fly it in. To meetthe immediate and pressing need, aninformal blood bank was established atthe Gafsa section of the 48th SurgicalHospital, where 25 to 50 troops weredetailed each day as donors. Out of theII Corps blood bank of 1943 grew thetheater blood bank of 1944. 36

The Psychiatric Problem—The out-standing medical problem of the Tuni-sia Campaign was the unexpectedlyhigh incidence of psychiatric disorders.Originally diagnosed as shellshock, fol-lowing World War I terminology, or asbattle fatigue, these cases constituted aheavy burden on forward medical units.In the absence of specialized knowledgeon the part of regimental and divisionmedical personnel, most of the psychi-atric cases in the early stages of the cam-paign were evacuated to communicationszone hospitals, from which less than 3percent 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) Rptto 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: For-ward Surgery and Aux Surg Teams.

35 Howard E. Snyder, "Fifth U.S. Army," vol. 1,Activities of Surgical Consultants, "Medical De-partment, U.S. Army," subseries Surgery in WorldWar II (Washington, 1962), ch. XVI.

36 Ltrs, Col Arnest to Col Coates, 17 Nov 58; andGen Standlee to Col Coates, 15 Jan 59, both com-menting on preliminary draft of this volume. Seealso pp. 352-53. below.

37 Major sources for this section are: (1) AnnualRpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt,Surg, II Corps, 1943; (3) Surg, NATOUSA, CirLtr No. 4, 22 Mar 43, sub: Psychotic and Neurotic


In the battles of El Guettar andMaknassy in southern Tunisia, psychi-atric reactions were responsible for 20percent of all battlefield evacuations, andfor days at a time the proportion ran ashigh as 34 percent.38 Experimenting withthese cases at the corps clearing stationnear Maknassy late in March 1943, Capt.(later Col.) Frederick R. Hanson, who

had been sent out from the theater sur-geon's office to investigate the problem,found that 30 percent of all psychiatriccases could return to full duty withinthirty hours if properly treated close tothe combat lines. The treatment CaptainHanson developed was heavy sedation at

the clearing station, followed by transferto an evacuation hospital where sedationand intensive psychotherapy were con-tinued for three days. At the end of thattime, the patient was returned to dutyor was evacuated to the communicationszone for further treatment.

In the Bizerte phase of the campaign,division surgeons were made responsiblefor the initial treatment, and psychia-trists for the follow-up were attached tothe 9th, 11th, 15th, and 128th Evacua-tion Hospitals, all functioning in theforward area. Hanson himself was at-tached to the 48th Surgical Hospital,later reorganized as the 128th Evacua-tion. Cases returned to full duty withoutleaving the combat zone ranged from 58to 63 percent.

Common Diseases—Aside from surgi-cal and psychiatric problems, the TunisiaCampaign revealed little of a medicalnature that had not been anticipated.Dysentery and diarrhea were prevalentamong II Corps troops, but outbreakswere controlled by screening and bydestruction of flies. Respiratory infec-tions were a frequent occurrence, butwere not particularly severe. Malaria wasnot a source of difficulty, since the cam-paign ended before the onset of themalaria season, and combat exposurewas therefore not extensive. As a preven-tive measure, II Corps troops begantaking atabrine on 4 April, with goodcompliance and minimal reactions.

Dental Service

The Tunisia Campaign revealed thatthe standard dental chest was not suffi-ciently portable to be carried closebehind the lines. During periods of com-

Patients, 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 MedicalDepartment, Suppl Number, (November 1949) . Fora nonprofessional, but perceptive study see Brig.Gen. Elliot D. Cooke, All But Me and Thee (Wash-ington: Infantry Journal Press, 1946).

38 This terminology requires some explanation.Although the terms "casualty" and "battle casualty"were consistently applied in the Mediterraneantheater to psychiatric disorders occurring in thecombat zone, these cases are officially tabulated as"disease." Not to establish a new policy but to makeexplicit one supposedly already in effect, War De-partment Circular No. 195, dated 1 September1943, stated: "Psychoneurosis or mental diseasesdeveloping under battle conditions (commonly butimproperly designated battle neurosis, hysteria,shellshock, etc.) will not be classified as abattle casualty or reported as wounded or injuredin action." By that date, however, the practice inthe theater had become fixed, as will be seen fromthe documents cited in the preceding footnote. Aslate as 1949, Colonel Hanson and his collaboratorswere still employing the term "psychiatric casualty"in the sense in which they had used it prior toSeptember 1943. For the sake of uniformity, all psy-chiatric disorders will be statistically treated as"disease" in this volume; but in deference to viewswidely held among psychiatrists, the term "disease"will not be used in the text to categorize casesfalling under the general classification of "combatexhaustion."


bat, cases requiring emergency dentaltreatment were cared for at divisionclearing stations, and as much routinework as possible was done in the divi-sion area. For the most part, however,the routine work was deferred untilperiods of combat inactivity. Duringperiods of actual contact with the enemy,when little dental work could be done,dental personnel usually served in othercapacities such as assistant battalionsurgeon; supply, mess, records, motor,and admissions officer; and anesthetist.Enlisted dental technicians served asmedical technicians and as company aid-men.39

A need for dental prosthetics wasobserved throughout the Tunisia Cam-paign, but no facilities for such workwere available in the II Corps area, and

only inadequate facilities appeared any-where in the theater. The 34th Divisiondental surgeon found a partial solutionof this problem in March when capturedGerman equipment was used to set up aprosthetics laboratory for the division.40

Veterinary Service

The veterinary service of II Corpsduring the Tunisia Campaign waslargely confined to routine food inspec-tions by division veterinarians. Since nofresh meat was available until April, theduties were not arduous, and veterinarypersonnel, like dental personnel, werefrequently used in administrative andother capacities. Veterinary functionsincluded the care of animals only for abrief interval in late April when muleswere used for evacuation of the woundedin the 9th Division area. The veterinaryofficer attached to the Twelfth Air Forceheadquarters in Algiers carried on foodinspection work for the air force units.41

39 Sources for this section are: (1) Annual Rpt,Med Sec, NATOUSA, 1943; (2) Memo for SupplyServ, from Brig Gen R. B. Mills, 10 May 43; (3)MS, History of the United States Army DentalCorps in the North African Theater of Operations,World War II, pp. 1-24. The use of dental person-nel under combat conditions in ways similar tothose mentioned in the text was general, despiteregulations against it. See (4) Hq, NATOUSA, CirLtr No. 36, 17 Mar 43; and (5) Ltr, Brig GenLynn H. Tingay to Col Coates, 25 Feb 59, com-menting 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 AirForce Med Activities, 1943.

CHAPTER IV

Sicily and the Mediterranean Islands

Sicily was selected as the next Alliedtarget in the Mediterranean at the Casa-blanca Conference, 14-23 January 1943.The choice reflected both the Britishpredilection for a Mediterranean strat-egy and the American reluctance todetract in any way from the ultimate in-vasion of northern France. The conquestof Sicily was justified for both groups onthe ground that it would relieve someof the pressure on the Russian front, helpknock Italy out of the war, and open theMediterranean to Allied shipping. InBritish eyes Sicily was also a step alongChurchill's "soft underbelly" route tothe Continent, while the Americanstrategists looked upon such a campaignas the most profitable way to employtroops already in Africa, at a minimumcost in shipping. There was also disagree-ment on plans, which were not finallyapproved by the Combined Chiefs ofStaff until May. Like the Tunisia Cam-paign, operations in Sicily (known bythe code name HUSKY) were to becarried out by an Allied force underfield command of General Alexander,this time designated the 15th ArmyGroup. The components were Mont-gomery's British Eighth Army, rein-forced by the 1st Canadian Division, anda U.S. Seventh Army commanded byPatton, with Maj. Gen. Geoffrey Keyes

as his deputy. The date ultimately fixedfor the invasion was 10 July.1

Medical Preparations forOperation HUSKY

Medical Planning for the Assault

Medical planning for the Sicily Cam-paign began early in March 1943 under

1 Military sources for the Sicily Campaign as awhole are: (1) Field Marshal the Viscount Alex-ander of Tunis, "The Conquest of Sicily, 10th July,1943 to 17th August, 1943," Supplement to theLondon Gazette, 12 February 1948; (2) Rpt ofOpns, U.S. Seventh Army in Sicilian Campaign, 10Jul-17 Aug 43; (3) Opns of II Corps, U.S. Army, inSicily, 10 Jul-17 Aug 43; (4) Samuel Eliot Morison,"History of United States Naval Operations inWorld War II," vol. IX, Sicily-Salerno-Anzio, Jan-uary 1943-June 1944 (Boston: Little, Brown andCompany, 1954); (5) Craven and Cate, eds.,Europe-. TORCH to POINTBLANK; (6) Eisen-hower, Crusade in Europe; (7) Patton, War As IKnew It; (8) Bradley, A Soldier's Story; (9) Trus-cott, Command Missions; (10) Kesselring, A Sol-dier's Record; (11) Knickerbocker and others,Story of the First Division in World War II; (12)Trahan, ed., History of the Second United StatesArmored Division, pp. 47-59; (13) Taggert, ed.,History of the Third Infantry Division in WorldWar II, pp. 51-76; (14) The Fighting Forty-Fifth,the Combat Report of an Infantry Division (BatonRouge: Army and Navy Publishing Company,1946) ; (15) W. Forrest Dawson, ed., Saga of theAll American (Atlanta: A. Love Enterprises, 1946),unpaged; (16) Lt Col Albert N. Garland andHoward McGaw Smyth, Sicily and the Surrender ofItaly, UNITED STATES ARMY IN WORLD WARII (Washington, 1965).


GENERAL PATTON and Brig. Gen. Theo-dore Roosevelt, Jr., deputy commander ofthe 1st Division.

the general direction of Col. DanielFranklin. Colonel Franklin had suc-ceeded General Kenner as Western TaskForce surgeon in December 1942 andcontinued in the same position after thetask force was redesignated I ArmoredCorps in January 1943 and assigned tooccupation duties in Morocco. Duringthe training period, the corps was knownsimply as Force 343, the designationSeventh Army being applied only afterthe troops were at sea on the way toSicily. Colonel Franklin then becameSurgeon, Seventh Army.2

The Seventh Army medical sectionevolved from a nucleus carried over withColonel Franklin from the Western TaskForce. By April the section was split be-tween a forward echelon headquarters inMostaganem, Algeria, and a rear echelonheadquarters in Oran. The surgeon, 2officers, and 2 enlisted men at forwardechelon headquarters were occupiedwith medical planning for the invasionof Sicily. Rear echelon personnel, in-cluding 3 officers and 9 enlisted men,were engaged with matters of medicalsupply, preventive medicine, and routineadministration.

Others concerned at the staff levelwith medical planning for HUSKY wereColonel Arnest, II Corps surgeon; andCol. L. Holmes Ginn, Jr. who left the1st Armored Division in March to be-come chief surgeon of the 15th ArmyGroup. The Services of Supply medicalsection assigned an officer to the Sicilianplanning group the last week in March,and preparation of requisitions for sup-plies from the zone of interior began inmid-April.

Plans for medical support could bemade specific only after the TunisiaCampaign ended, when it became pos-sible to complete assignment of troopsand to set a timetable for the invasion.Primary emphasis was placed on mobil-ity and the shortening of evacuationlines.

2 Sources for medical preparations for the SicilyCampaign, 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, SeventhArmy, 1943; (4) Interv with Col Franklin, Surg,Seventh Army, 28 Jun 44; (5) Surg, II Corps, Rptof Med Activities, Sicilian Campaign; (6) AnnualRpt, 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) AnnualRpt, Surg, 45th Div, 1943; (11) Annual Rpt, Surg,82d A/B Div, 1943; (12) Annual Rpt, 54th MedBn, 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 andarmy control were reorganized to giveeach collecting company a clearing ele-ment, the two platoons of the clearingcompany being supplemented for thispurpose by a third clearing platoon madeup of the station sections of the threecollecting companies. Each regimentalcombat team in the assault was to beaccompanied by one of these collecting-clearing companies, which had demon-strated their efficiency in trainingexercises. Each task force was to haveone ambulance platoon in addition tothose of the medical battalions, and atleast one field hospital unit. The fieldhospital platoons were to be used forforward surgery and as holding units fornontransportables, combining the func-tions performed in Tunisia by the surgi-cal hospital and the corps medicalbattalion clearing stations.

Attached medical troops were to landwith unit equipment, augmented bysuch special supply items as bloodplasma, morphine syrettes, and extradressings. A balanced medical supplyadequate for seven days of maintenancewas to be on the D-day convoy. Thosesupplies not hand-carried by the debark-ing medical troops were to be unloadedon the beaches as rapidly as the situationpermitted.

After the initial landings, each divi-sion was to be supported by one 400-bedevacuation hospital. When they wereneeded, 750-bed evacuation hospitalswere to be sent to the island, each to backup two of the smaller units. Evacuationfrom the beaches was to be by troopcarrier or LST (Landing Ship, Tank)until hospital ships were available, withair evacuation beginning at the earliestpossible date after suitable fields had

been secured. No fixed hospitals were tobe brought into Sicily until the conquestof the island was complete, all casualtieswith hospitalization expectancy of morethan seven days being returned to NorthAfrica.

Limited shipping space made it neces-sary to mount the invasion in threeseparate convoys, to be landed at 4-dayintervals, the estimated turnaround timefrom Tunisian ports. Attached medicaltroops, the medical battalions, and thefield hospitals with their surgical teams,were scheduled for the assault group; the400-bed evacuation hospitals were to beon the second, or D plus 4 convoy; andthe 750-bed evacuations were to be senton call of the Seventh Army surgeon.Medical service at sea was to be suppliedby the Navy on the larger vessels, but theLST's, which were to sail from Tunisand Bizerte, were to be staffed by medi-cal personnel detached from the 77thEvacuation Hospital, then relatively in-active near Bone. The 77th Evacuationalso assigned personnel to the naval baseat Bizerte to assist with the returningcasualties.

Training of Medical Troops

Medical units designated to partici-pate in the Sicily Campaign were as-signed initially to the task forces.Attached medical troops, organic andseparate medical battalions, and fieldhospitals all received special trainingwith the combat forces they were toserve. Training for landing operationsbegan 10 May at the Fifth Army Inva-sion Training Center at Arzew nearOran. Here all medical personnel ofForce 343 learned how to waterproofequipment and gained realistic experi-


COLONEL FRANKLIN

ence under simulated combat conditionsin debarking from landing craft, settingup and operating beach installations,and shore-to-ship evacuation of thewounded.3

In addition to this assault training,all units were given physical condition-ing and instruction in the prevention ofdiseases likely to be encountered.Malaria came in for special attention,since the assault was to be made at theheight of the season. Where appropriate,the men received specialized medicaltraining such as the application ofsplints, treatment of shock, control ofhemorrhage, and transportation of thewounded. Both medical and combatpersonnel received instruction in firstaid.

Similar training for medical person-nel accompanying the 45th Division,which sailed for Sicily directly from theUnited States, was conducted in the zoneof interior, the division stopping at Oranjust long enough for a rehearsal on theArzew beaches.

A special problem was posed by ele-ments of the 82d Airborne Division thatwere to spearhead the invasion, sincethe organic 307th Airborne MedicalCompany normally moved by glider orby more conventional means of traveland was not included in the assault plans.Four officers and twenty-five enlistedmen from the medical company, all vol-unteers, were trained as parachutists toaugment the regimental medical detach-ments.

Medical Support of Seventh Armyin the Field

Preliminary Operations

Off the coast of Tunisia, northeast ofCap Bon, lies rocky, inhospitable Pan-telleria Island. In mid-1943 Pantelleriawas a heavily fortified Italian air basethat dominated the invasion route toSicily and so had to be taken beforeHUSKY could be mounted. Only forty-two square miles in area, the island risesprecipitously from the sea. There wasjust one beach on which a seaborne land-ing could be made, and that one wasnarrow, with tricky offshore currents anda heavy surf. The only harbor was smalland too shallow for any but light-draftvessels. Should troops succeed in forcinga landing in spite of these difficulties,the surface of the island, with its rockmasses and layers of volcanic ash, itsstone fences and square stone houses,

3 See Medical Aspects of Amphibious Operations,prepared at this center. With only minor modifica-tions, the same manual was later used to trainmedical troops for the Normandy landings. Repro-duced in full in Clift, Field Opns, pp. 146-74.


COLONEL GINN

was ideally adapted for defense by itsgarrison of more than 10,000.4

The British 1st Division was selectedfor the assault on Pantelleria, but thetroops were to go in only after the islandhad been bombed to rubble. The airoffensive against the "Italian Gibraltar"opened on 18 May, less than a week afterthe German surrender in Tunisia, andcontinued with mounting fury to D-day,set for 11 June. Heavy naval guns joinedin the bombardment the night of 10-11June as the convoy carrying the assaulttroops moved into the assembly area.The first wave of landing craft hit thebeach a few minutes before noon, to bemet by trifling small arms fire and a rushof white flags. The surrender of the is-land had in fact been ordered by itscommander for 1100, before a singlesoldier set foot upon it.

The British Army medical units in theassault were thus not called upon to func-tion in combat. The airfields on Pan-telleria were quickly converted to Allieduse, and within a week an Americanstation hospital under base section con-trol took over the medical service of theisland.5

The reduction of Pantelleria wasfollowed immediately by a bombard-ment of the island of Lampedusa, be-tween Malta and the east coast ofTunisia, which resulted in the surrenderof the island on 12 June, again withoutthe intervention of ground troops. Theneighboring island of Linosa surren-dered the next day without waiting tobe bombed. A British naval party tookpossession of uninhabited Lampione on

COLONEL GINN

14 June, completing the Allied occupa-tion of the Pelagies.

From that date until 9 July the NorthAfrican Air Force and the RAF, joinedby the U.S. Ninth Air Force from itsbases in the Middle East, concentratedon the ports and airfields of Sicily. Thegreatest amphibious operation in allhistory, measured by its initial landingstrength, was already at sea when thebombers finally retired. High windshampered but did not stop the parachut-ists who led the way, and rough seas didnot deter the landing craft. The invasionof Sicily proceeded on schedule.

The Assault Phase

The Allied assault on Sicily was con-centrated in the southeast corner of theisland. British and Canadian forceslanded at the southern tip of the Siciliantriangle, and at various points on the

4 (1) Craven and Cate, eds., Europe: TORCHto POINTBLANK, pp. 419-42. (2) Eisenhower,Crusade in Europe, pp. 164-66.

5 See p. 193, below.


east coast. The Americans enveloped a70-mile strip along the southern shore, tothe left of the British.6

Seventh Army stormed the beaches atthree separate points in the early morn-ing of 10 July 1943. CENT Force, builtaround the untested 45th Division,straddled Scoglitti on the right flank,while the DIME Force, spearheaded bytwo regimental combat teams of theveteran 1st Division and two Rangerbattalions, landed in the vicinity of Gelaabout ten miles farther west. These twoforces made up a reorganized II Corpsunder General Bradley. The Joss Forcecommanded by Maj. Gen. Lucian K.Truscott, Jr., and composed of the rein-forced 3d Division, a Ranger battalion,and a combat command of the 2d Ar-mored Division, went ashore at Licataon the left flank of the American sector.The remainder of the 2d Armored, andthe remaining RCT of the 1st Division,stood offshore as a floating reserve untilmid-afternoon of D-day, then debarkednear Gela where the fighting was heavi-est. The 505th Regimental CombatTeam and the 3d Battalion of the 504thRCT, 82d Airborne Division, whichwere dropped behind the beaches a fewhours ahead of the assault, were underarmy control.

The task force surgeons were, for theCENT Force, Lt. Col. Nesbitt L. Miller

of the 45th Division; for the DIME Force,Lt. Col. (later Col.) James C. Van Valinof the 1st Division; and for the JossForce, Lt. Col. (later Col.) Matthew C.Pugsley of the 3d Division. The floatingreserve, called the KOOL Force, wasunder command of Maj. Gen. Hugh J.Gaffey and the force surgeon was Col.Abner Zehm, both of the 2d ArmoredDivision.

Scoglitti Landings—On the CENTbeaches landings were delayed an hourby the heavy seas. Many units landed onthe wrong beaches and about 20 percentof the landing craft were destroyed onthe rocks. All assault units were never-theless ashore by 0600. Early oppositioncame from Italian home guards, whofought only halfheartedly or not all,giving the 45th Division time to estab-lish itself firmly before air activity andand German counterattacks began.The beachhead was secure by the end ofthe day.

D plus 1 saw counterattacks on theextreme right repulsed by the 180thInfantry and the 505th Parachute Com-bat Team—which had been forced downin the area instead of at its designateddrop north of Gela. In a parallel actionelements of the 157th and 179th Regi-mental Combat Teams captured Comisoairfield against strong opposition. By theend of the third day, 12 July, the Scog-litti beachhead was fifteen miles deepand the U.S. forces made contact withthe Canadians on the left flank of theBritish Eighth Army. The capture ofBiscari (Acati) airfield northwest ofComiso on D plus 4 completed theinitial mission of the CENT Force.

The medical complement of the CENTForce included the 120th Medical Bat-

6 Military sources for the assault are those citedat the beginning of this chapter. Medical sourcesprimarily relied upon for the assault phase are:(1) Rpt of Opns, U.S. Seventh Army in SicilianCampaign, an. N; (2) Annual Rpt, Surg, SeventhArmy, 1943; (3) Surg, II Corps, Rpt of Med Ac-tivities 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 sideof the story is in Crew, Army Medical Services:Campaigns, vol. III.


talion, organic to the 45th Division; the54th Medical Battalion; one platoon ofthe 11th Field Hospital; and seven teamsof the 3d Auxiliary Surgical Group.Medical detachments went ashore withtheir respective combat units, and bat-talion aid stations were established halfa mile to a mile inland within the firsttwo hours. Collecting elements of theorganic medical battalion followed aboutan hour later, moving casualties fromthe aid stations directly to the beach,where naval shore groups took over.Trucks borrowed from the infantry weresubstituted for the ambulances that hadnot yet been unloaded from the ships.The scattered collecting units reassem-bled into their companies and estab-lished their own collecting stationsshortly after noon. By 1600 hours the120th Medical Battalion had a clearingstation set up about three miles inlandin support of the 179th and 180th Regi-mental Combat Teams on the left.Casualties from the 157th RCT on theright and from the paratroop force fight-ing around Comiso airfield were evacu-ated from aid stations directly to thebeach until early afternoon of D plus 1,when the 54th Medical Battalion openeda clearing station in that area.

All medical units were ashore withtheir equipment by 12 July, although thefield hospital platoon was not in oper-ation until the 14th. Collecting andclearing stations moved frequently dur-ing the first few days of combat as troopspushed forward rapidly against crum-bling opposition. A clearing platoon ofthe 120th Medical Battalion, establishedin an Italian military hospital in Vittoriaon 13 July, served as a temporary surgicalcenter, while the 54th Medical Battaliontook over all responsibility for beach

evacuation. Shoreward movement ofcasualties was stopped on 15 July becauseavailable LST's were not properly pre-pared to receive them, but resumed thenext day after arrival of the Britishhospital carrier Leinster. Nineteennurses of the 15th Evacuation Hospitalhelped care for patients in the clearingstations from 14 July until their ownunit went into operation on the 20th.Surgical teams worked in the field hospi-tal unit and with the clearing stationsof both the medical battalions. (Map

14)

Gela Landings—The DIME Force gotashore in the vicinity of Gela beginningat 0245 according to schedule againstrelatively light opposition. Only theRangers, who landed in Gela itself, raninto trouble in the form of Italian tanks,but managed to seize and hold the town.Enemy air activity was sporadic duringthe day, and resistance stiffened aroundthe perimeter of the beachhead. Thefirst counterattack came on the morningof D plus 1, when twenty enemy tanksbroke through the 26th Infantry andgot within 2,000 yards of the beach be-fore they were stopped by artillery fire.Another forty tanks cut across the 16thRCT, but those too were turned back byartillery, bazookas, and grenades beforethe two tank columns could join andisolate the beachhead. The last counter-attack, at 1630 that afternoon, was onlystopped by accurate and deadly fire fromthe naval guns offshore.

The task force moved inland againstless vigorous opposition the next day,taking Ponte Olivo airfield and extend-ing the beachhead to a depth of fourmiles. That night the second airlift ofthe 82d Airborne arrived simultaneously


MAP 14—Seventh Army Hospitals, 16 July 1943

with a group of enemy bombers, and inthe confusion a number of the troopcarriers were shot down by U.S. fire. Allassault phase objectives were secured byD plus 4, 14 July.

Medical battalions supporting theGela operation, including both the land-ing units and the reserve, were the 1stand elements of the 48th Armored, or-ganic to the combat units; two collecting-clearing companies of the 51st; and the261st Amphibious Medical Battalion,initially attached to the 531st EngineerShore Regiment as part of the beachgroup. Supplementing these were twoplatoons of the nth Field Hospital;seven teams of the 2d Auxiliary Surgi-cal Group and three teams of the 3d;and two ambulance platoons of the 36thAmbulance Battalion.

Except for battalion medical detach-ments and naval beach parties, thelanding of medical personnel and equip-ment on the Gela beaches was undulydelayed. One company of the 261st Am-phibious Medical Battalion managed toset up a clearing station in support ofthe 26th RCT some seven hours afterthe assault began by using the equip-ment of another company. The 1st Med-ical Battalion established a clearing sta-tion for the 16th RCT at H plus 13, buthad no equipment other than one medi-cal chest. Casualties from this stationwere evacuated to the beach by ambu-lances of the 51st Medical Battalion, onecompany of which was ashore but inop-erative. The field hospital platoonslanded at H plus 6, but on the wrongbeaches. The invasion was in its fourth


day before the hospital was functioningat Gela.

Casualties were relatively heavy onthe DIME beaches, where enemy coun-teraction was most violent. Some medi-cal equipment, including ambulances,was lost at sea and by enemy action onthe beach. The medical battalions werenevertheless in normal operation by 12July. The 51st, reinforced by surgicalteams, held nontransportables until thefield hospital opened, while the 261stcared for cases expected to return to dutywithin a week. Wherever possible, sur-gery was performed on the ships ratherthan in shore installations during thefirst two or three days, but all clearingstations handled surgical cases whenevacuation from the beach was inter-rupted. The withdrawal of the trans-ports on 12 and 13 July halted evacua-tion in the DIME sector, but airevacuation from the Ponte Olivo fieldbegan on the 14th. A hospital ship wasavailable the following day, and on 16July the 400-bed 93d Evacuation Hospi-tal opened near Ponte Olivo. (See Map14.)Licata Landings—The Joss Force,

which had crossed the Strait of Sicilyfrom Tunisian ports in LST's, made thefirst real shore-to-shore landing craft op-eration, such as would later be used tocross the English Channel. Rough seasheld up the landings until shortly beforedawn, and the low gradient of thebeaches forced the craft aground too farfrom dry land. The assault troops never-theless got ashore in good order againstonly nominal opposition. The town fellquickly, and before the first day was overstrong combat patrols were 4 or 5 milesinland. The beachhead was 15 miles in

depth and all initial objectives weretaken by D plus 2.

Medical units organic to the combatdivisions were the 3d Medical Battalionand a company of the 48th ArmoredMedical Battalion. Supporting thesewere the 56th Medical Battalion and acollecting-clearing company of the 51st;the 10th Field Hospital; nine teams ofthe 3d Auxiliary Surgical Group; anda platoon of the 36th Ambulance Battal-ion. As in the CENT and DIME landings,medical detachments of Joss followedtheir combat units ashore within twohours. Collecting companies were onlyan hour or two behind. Casualties werebrought directly to the naval beach in-stallations until clearings stations couldbe set up on D plus 1. Congestion onthe beaches prevented earlier unloadingof equipment. The field hospital alsoopened on D plus 1. Troops in the Licatasector moved rapidly, and medical instal-lations kept pace, leaving only elementsof the 56th Medical Battalion at thebeach to handle evacuation from theisland. By 15 July, when the 11th Evacu-ation Hospital opened northwest ofLicata, a normal chain of evacuation wasfunctioning smoothly. (See Map 14.}

In all sectors the treatment of civilianswounded or injured as a result of theinvasion was an acute problem. Localhospital facilities were inadequate, evento care for routine illnesses, and in thelanding phase Seventh Army medicalsupplies and beds could be spared totreat only emergency cases.

The Campaign in Western Sicily

By 16 July the U.S. Seventh and Brit-ish Eighth Armies had reached the linemarking the end of the amphibious


EVACUATING WOUNDED TO LANDING CRAFT for return to transports, Gela area, 12 July.

phase, and 15th Army Group headquar-ters issued field orders for completingthe conquest of Sicily. Eighth Army wasto drive up the eastern coast to Messina;Seventh Army, which now numberedabout 142,000 troops, was to capturePalermo and reduce the western end ofthe island. To accomplish this mission,II Corps was to strike north from Gelawith the 1st and 45th Divisions, while anewly constituted Provisional Corps un-der General Keyes was to operate in theless rugged area northwest of Licata withthe 3d Infantry, 2d Armored, and 82dAirborne Divisions, the last operating asinfantry. The recently arrived 39th Reg-imental Combat Team of the 9th Divi-sion was also attached to the ProvisionalCorps at this time, the remainder of the

division being left in reserve in Africa.7

The 261st Amphibious Medical Bat-talion remained in the Gela area underarmy control to handle evacuation toTunis and Bizerte. The 54th MedicalBattalion and a collecting-clearing com-pany of the 51st were attached to IICorps, while the 56th and two companiesof the 51st went to the Provisional Corps.Two platoons of the 11th Field Hospitaland the 93d and 15th Evacuation Hospi-tals came under II Corps control, leavingthe 10th Field, one platoon of the 11th

7 Military sources are the same as those alreadycited. Medical sources include: (1) Clift, FieldOpns, pp. 187-92; (2) Surg's rpts already cited atthe theater, army, and corps levels; (3) Unit rptsof div surgs, med bns, hosps, and other med or-ganizations mentioned in the text.


Field, and the 11th Evacuation Hospitalto serve the three divisions under Keyes.The surgical teams remained with thefield hospital platoons and clearing com-panies to which they were already at-tached.

The Provisional Corps overran thewhole western end of Sicily in a week.The enemy in this area fought only de-laying actions, using reluctant Italiantroops to cover the withdrawal of Ger-man units to the more mountainousnortheastern sector, which providedboth suitable terrain for a defensivestand and an escape route to the Italianmainland by way of the Strait of Mes-sina. From Agrigento and Porto Em-pedocle, some 25 miles west of Licata,the 3d Division struck northwest forPalermo on the other side of the island,while the remainder of the corps fol-lowed the southern coast to Castel-vetrano. Here the 2d Armored veerednortheast to complete the envelopmentof the capital, while the 82d Airborne,the 39th Infantry, and the 3d RangerBattalion continued around the coast totake the western ports of Marsala andTrapani.

So rapid was the advance of the 2dArmored, and so disorganized the oppo-sition, that the division surgeon, ColonelZehm, personally brought in eight pris-oners who had surrendered when in-timidated by the colonel's flashlight.8

Advance elements of the 2d Armoredentered Palermo late in the evening of22 July, and accepted the peaceful sur-render of the city. Combat teams of both3d and 45th Divisions were already inthe outskirts.

Throughout this rapid movement,medical installations had great difficultyin keeping pace with the combat units.Organic medical battalions, by fre-quently changing position, managed tokeep clearing stations in operation from4 to 10 miles behind the constantly shift-ing points of contact with the enemy.The hospitals and corps clearing sta-tions, however, were often left 25 to 50miles in the rear of the action.

The heterogeneous nature of theforces involved also made it necessaryto use the corps medical battalions inunorthodox ways. The 56th MedicalBattalion left one collecting-clearingcompany at Licata to serve as a holdingunit for air evacuation. Another com-pany of the 56th was attached to the3d Division, performing second-echelonmedical service for the 30th RegimentalCombat Team. The battalion's thirdcollecting-clearing company went withthe 82d Airborne around the western tipof Sicily to Trapani, using its own am-bulances and captured enemy vehiclesto make up for the transportation defi-ciencies inherent in paratroop medicaldetachments. On 21 July the 51st Med-ical Battalion established a clearing sta-tion at Menfi, on the southern line ofmarch, and another at Castelvetrano,where the 3d Platoon of the 11th FieldHospital also went into operation thethe next day. By this time, however, theinfantry spearhead was at Marsala thirtymiles farther west, while the 2d Armoredwas closer to Palermo than it was toCastelvetrano.

The 10th Field Hospital shifted fromLicata to Agrigento on the 19th, whereit was joined the following day by theholding unit of the 56th Medical Battal-ion from Licata. The 10th Field moved

8 Statement of Colonel Zehm to the author, 17Aug 55.


MAP 15—Seventh Army Hospitals, 26 July 1943

on to Corleone along the 3d Division'sline of advance on the 22d, but forwardelements of the division it supportedwere already in Palermo 25 miles away.The 11th Evacuation Hospital, support-ing both prongs of the Provisional Corps'advance, did not move from Licata until21 July, and then only to Agrigento, bythat time 60 or more miles in the rear.(Map 15)

Following the conquest of westernSicily, gaps in the evacuation chain werequickly closed. A clearing platoon of the3d Medical Battalion took over an Ital-ian military hospital in Palermo the daythe city fell; a clearing platoon of the51st Medical Battalion arrived a daylater; and on 27 July the newly landed91st Evacuation Hospital opened in

buildings of the University of PalermoPolyclinic Hospital.

II Corps, pushing northwest acrosscentral Sicily, matched the pace of theProvisional Corps. The drive began on16 July, by which date the 45th Divisionhad moved across the rear of the 1stto a position on the left flank of thecorps sector. The three combat teams ofthe 45th then leapfrogged one anotherin a continuous advance to the northerncoast of the island. A patrol made contactwith the 3d Division in the outskirts ofPalermo on the afternoon of 22 July.The following day the vital coast roadwas cut at Termini and Cefalii, and the45th turned east toward Messina.

In a parallel advance, the 1st Divisioncaptured Enna, communications hub of


Sicily, on 20 July, and established contactwith the Canadians on the right. Threedays later the 1st was astride the Nicosia-Troina-Randazzo road, running east andwest about twenty miles inland. Nicosiafell on the 28th and Cerami, less thanten miles from Troina, on the 30th. Be-tween those two dates the 39th RCT ofthe 9th Division, recently withdrawnfrom the now quiet western sector, wasattached to the 1st Division. By 31 JulyII Corps had reached and passed theboundary originally assigned to SeventhArmy.

Medical support for II Corps in thisphase of the campaign followed a nor-mal, if accelerated, pattern. In hill fight-ing aid stations were kept from 100 to300 yards behind the troops; on openground they were 500 to 1,000 yards be-hind. The organic battalions were almostcontinuously in motion, backed by thecorps battalion whose collecting-clearingcompanies bypassed each other to keepwithin 10 miles of the front. Hospitalunits moved less frequently, but in ac-cordance with the same leapfrog pattern.The 11th Field opened at Pietraperziain the center of the front and perhapsa third of the way across the island on18 July. Two days later the 15th Evac-uation was receiving patients at Caltanis-setta, 10 miles farther north. July 22saw a platoon of the nth Field in op-eration 15 miles beyond Caltanissetta.The 93d Evacuation opened at Petraliaon the Nicosia road on 25 July, whilethe 11th Field moved on to Collesano,less than 10 miles from the sea, the fol-lowing day. (See Map 15.) The 128thEvacuation Hospital collected its scat-tered equipment and personnel in timeto open at Cefalii on 31 July.

The Etna Line and Messina

While the Americans swept over west-ern and central Sicily, the British werevirtually stalled on the eastern coastwhere Mt. Etna rose steeply from theCatanian plain. The rugged northeasterncorner of the island was ideally adaptedto defense, with the escape port of Mes-sina protected by a series of strongly for-tified positions in contracting arcs. Bythe end of July, therefore, General Al-exander abandoned his original strategy.Seventh Army was ordered to fight itsway to Messina along the northern coastroad, and to a junction with EighthArmy along the Troina-Randazzo road,which skirted the northern slopes of theclassical volcano. The key to the EtnaLine was Troina, a natural fortress-citybuilt of stone on top of a rocky hill.The 1st Division, with the 39th RCTof the 9th, launched an assault againstthe position on 1 August, while the 3dDivision relieved the 45th near San Stef-ano and prepared to attack the coastalanchor of the German line. The Britishhammered simultaneously at the rightflank between Mt. Etna and the sea.9

The battle of Troina, lasting until 6August, was the most bitterly contestedof the campaign. Before it was overtwenty-four separate counterattacks hadbeen repulsed. The remaining regi-ments of the 9th Division were broughtup early in the battle, with the 60th com-bat team executing a wide flankingmovement to threaten the enemy's rearand the 47th leading the advancethrough the battered town to the nextobjective. Both 1st and 9th Divisionswere slowed by difficult terrain and ex-

9 See sources cited n. 7, p. 156, above.


MAP 16—Seventh Army Hospitals, 5 August 1943

tensive enemy demolitions, but met onlynominal opposition after Troina.

The 3d Division, meanwhile, was en-countering determined resistance. Astrong enemy position on high groundaround San Fratello was finally out-flanked by an amphibious operation inthe early morning of 8 August. A secondseaborne landing behind enemy linesnear Brolo on 11 August was less success-ful, but the beleaguered landing forcewas relieved the following day. A thirdleapfrog movement by sea on the nightof 15-16 August, involving elements ofthe 45th Division, found resistancebroken and the ground forces alreadybeyond the point of the landing. Ad-vance elements of the 3d Division en-tered Messina early on 17 August, pre-ceding Eighth Army patrols by no more

than an hour.Medical units, including field and

evacuation hospitals, followed closely be-hind the combat forces along the twolines of advance—so closely, in fact, thatevacuation hospitals were sometimesahead of clearing stations.10 The heaviestconcentration was in the vicinity ofNicosia, 5 to 15 miles behind the Troinafront. The 15th Evacuation Hospitalopened in this area on 1 August, as didtwo platoons of the nth Field on the3d. The 11th Evacuation was attached toII Corps and joined the group on 5 Au-gust. (Map 16) Over the next ten days,

10 Ltr, Lt Col Perrin H. Long, Med Consultant,to Surg, NATOUSA, 26 Aug 43, sub: Random Ob-servations From EBS and Sicily, July 6th to August14th 1943.


MAP 17—Seventh Army Hospitals, 15 August 1943

platoons of the nth Field Hospital dis-placed one another forward to Cesaròand Randazzo. (Map 77) The 54th Med-ical Battalion and one company of the51st operated along the same line of ad-vance, clearing platoons being used dur-ing the battle of Troina to augment thefacilities of the evacuation hospitals.

For the most part aid stations in theTroina sector were within 400 to 800yards of the fighting and accessible tovehicles, though roads were often underenemy fire. Only the 60th RegimentalCombat Team, circling the left flankover roadless mountains, experiencedunusual difficulty in evacuation. Corpsmedical battalions supplied eighty addi-tional litter bearers, while thirty morecame from noncombat divisional units.Litter squads were stationed at intervals

of 300 to 400 yards to relay casualtiesback to the stations. Mules requisitionedfrom local farmers were also used tocarry litters, both in tandem betweenlance poles, as had been done in Tunisia,and by a device similar to the French ca-colet whereby one mule carried two lit-ters. Neither method was fully satisfac-tory but the cacolet was considerably lessso than the tandem. The care and man-agement of the animals fell to the 9thDivision veterinarian and his assistants.The 47th RCT, operating east of Troina,had hand carries up to four miles,mainly because road demolitions pre-vented the use of vehicles.

Along the narrow and precipitousnorth coast road, the 3d Division wasfighting what Ernie Pyle called a "bull-dozer campaign," the pace of the ad-


vance being limited by the speed withwhich the engineers could repair thedamage done by German demolitions.In this final drive the division was ma-terially aided by a provisional mountedtroop and a provisional mule pack train.In the two weeks between 3 and 16 Au-gust, 219 horses and 487 mules wereused, of which 43 percent were listed asbattle casualties. The animals were ac-quired by capture, requisition, and con-fiscation. Despite inexperienced handl-ers and improvised equipment, theexpedient was credited by GeneralTruscott, himself a former cavalry offi-cer, with speeding the advance and re-ducing losses. The division veterinarian,Maj. Samuel L. Saylor, was responsiblefor care and provisioning of the animals,and helped train personnel to managethem.11

The 3d Division received medicalsupport from the 10th Field Hospital,whose platoons leapfrogged one anotherfrom Cefalii to Barcellona, and from oneplatoon of the nth Field. The 93d Evac-uation Hospital moved to San Stefanoon 7 August, and a week later the 11thEvacuation shifted from Nicosia to a po-sition between San Fratello and Brolo.On the latter date, 14 August, the 128thEvacuation displaced half of its facilitiesand staff from Cefalii to Coronia some8 miles east of San Stefano. (See Map1 7 )

The most difficult evacuation problemencountered by the 3d Division was dur-ing the battle for San Fratello Ridge,where litter carries took from 5 to 7hours. One patient was carried for 9

hours by 50 bearers in relays. Corps sup-plied 40 additional litter bearers, andItalian and Czechoslovak prisoners werealso used. Some slightly wounded menwere evacuated sitting on pack mules.The long litter carries were stoppedwhen Colonel Churchill, the theatersurgical consultant, concluded that thewounded suffered more from the journeythan they would have by waiting. Thelast 52 casualties brought down from theridge were left for 24 to 48 hours in theaid stations, while bulldozers cleared aroad for the ambulances.12

The two amphibious landings in the3d Division sector, both made by the 2dBattalion of the 30th Infantry, were sup-ported by personnel of the battalion med-ical detachment, reinforced by medicaland surgical technicians from the 54thMedical Battalion. In the Brolo opera-tion of 11 August, where the landingforce was ambushed by the Germans,a medical corpsman was killed and fivewounded in action. The Americanwounded were treated by German doc-tors and left behind to be picked up bytheir own organizations when the enemywithdrew the next day.


Hospitalization in theCombat Zone

Hospitalization in the Sicily campaignshowed marked improvement over prac-

11 (1) Truscott, Command Missions, p. 230; (2)Vet Rpts, Sick and Wounded, Animals, 1943, 3dDiv.

12 Ltr, Col Churchill, Surgical Consultant, toSurg, 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 preinvasionplans were not always carried out to theletter. With occasional exceptions result-ing from rapid movement of the troops,each division clearing station under com-bat conditions had at least one field hos-pital unit adjacent to it and a 400-bedevacuation hospital within easy ambu-lance haul. Cases that could not standthe strain of further transportation wentto the field hospitals, where surgery wasperformed as required by attached surgi-cal teams. A majority of all those seri-ously wounded in Sicily received defini-

tive treatment in these units. As soon asa patient needing further care could besafely moved, he was sent back to thenearest evacuation hospital. Patients stillimmobilized when a field hospital unitwas ordered forward were left in chargeof a small detachment that rejoined theparent unit as soon as all of its patientshad been evacuated. Transportable casesat the division clearing stations, includ-ing most cases of disease, were sentdirectly to the evacuation hospitals,where they were held for treatment orevacuated to the North African com-


EVACUATION BY MULEBACK

munications zone, as circumstances dic-tated.18

The intermediate step visualized bythe planners whereby one 750-bed evac-uation hospital was to back up each two400-bed units never materialized. Al-though 750-bed evacuation hospitalswere to come on call and were repeat-edly requested by Colonel Franklin,shipping space was at such a premiumthat only one reached Sicily before theend of the campaign. This was the 59th,

which landed at Palermo on 6 Augustwith much of its equipment still at sea.The hospital joined the 91st in build-ings of the University of Palermo Poly-clinic Hospital and was in operation bythe 8th, but never functioned as planned.Its activities for the remaining ten daysof the campaign were primarily those ofa station hospital and holding unit forevacuation to Africa.

The complete absence of fixed hos-pitals, and the presence of only one evac-uation hospital large enough to holdslightly wounded men and disease casesfor return to duty, was made up in partby evacuating many short-term patientsto Africa, and in part by enlarging the400-bed units. During periods of heavyfighting, clearing platoons of the corpsmedical battalions were attached to theevacuation hospitals. Each clearing pla-toon so used was able to set up andoperate five or six wards with its ownequipment and staff, augmenting thecapacity of the hospital by 100 to 200beds. During the battle for Troina the15th Evacuation Hospital expanded bythis means to a total capacity of 950 beds.

In areas where the fighting had ceasedand conditions were relatively stable,corps and army medical battalions oper-ated holding hospitals for evacuation.One such unit, operated at Gelathroughout the campaign by the 261stAmphibious Medical Battalion, alsoserved as a station hospital for service andother troops in the area. A holding hospi-tal set up by the 56th Medical Battalionfunctioned first at Licata, then at Agri-gento, and finally at Termini on the northcoast, where the entire unit was carriedby air on 4 August. Loading required on-ly twenty-one minutes, and the flight it-self half an hour. The hospital was set up

13Ibid. See also, Memo, Churchill to Surg,NATOUSA, 5 Sep 43, sub: Use of Field Hosps inForward Surgery. General sources for hospitaliza-tion 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 hospsand med bns mentioned in the text.


to receive fifty patients in less than fourhours from the time loading began.14

The 51st Medical Battalion operatedholding hospitals at Castelvetrano andPalermo. At the latter site, the hospitalwas expanded to 400-bed capacity andwas used also for malaria and jaundiceconvalescents. In another instance a di-vision clearing company acted as a sta-tion hospital. This was a unit organic tothe 82d Airborne Division, which tookover an Italian military hospital in Tra-pani while the division performed oc-cupation duties in western Sicily. Thesame company also set up a clearing sta-tion in Castelvetrano after other medicalunits had been withdrawn from thatcity.

The original 7-day evacuation policywas extended to ten days and eventu-ally—for malaria cases—to two weeks be-fore the campaign ended. During mostof the period, however, no fixed policywas possible. Hospital facilities were soovercrowded that patients had to beevacuated as soon as they could bemoved in order to make room for newones. A 24-hour evacuation policy infront-line hospitals was not uncommon.Even those expected to return to dutywithin a week had to be removed to therear in many instances, either to the59th Evacuation at Palermo or out ofSicily altogether. As a result, a consider-able number of patients were sent toNorth Africa who could have returnedto duty if it had been possible to holdthem on the island. Malaria cases, whichoutnumbered battle wounds despiteatabrine therapy, and Sandfly fever caseswere often returned to their units for

convalescence, simply to retain physicalcontrol of the men.

Some indication of the strain placedupon medical facilities in Sicily may begathered from the statistics. With a max-imum troop strength of approximately200,000, and an average strength ofapproximately 166,000, U.S. hospitalbeds in Sicily probably never exceeded5,000 during the period of fighting, evenwith generous allowance for those oper-ated by clearing platoons. Between 10July and 20 August 1943, a total of20,734 American soldiers, 338 Allied,and 1,583 enemy troops were admittedto U.S. Army hospitals, with another20,828 Americans admitted to quarters.Of the U.S. troops hospitalized, 13,320were diseased, 5,106 had suffered battlewounds, and 2,308 cases were injuries.The quarters admissions included14,635 cases of disease and 6,193 minorwounds and injuries. A further drain onhospital facilities came from the neces-sity of caring for a number of civilianswho had no other means of treatment.Military patients discharged from U.S.hospitals in Sicily, including Americanand Allied troops returned to duty andprisoners transferred to the stockades,totaled 7,168.

All prisoners of war, except Italianmedical personnel and chaplains andItalian soldiers of Sicilian birth whowere paroled to their homes, were evac-uated to North Africa as rapidly aspossible. The medical officers and en-listed men retained in Sicily were usedto care for sick and wounded prisonersin captured facilities and in Italian RedCross hospitals, five of which were takenover by II Corps.

Two mobile Italian army hospitalswere captured, in addition to a number

14 Ltr, Col Churchill to Surg, NATOUSA, 19 Aug43, sub: Tour Rpt, Sicily, D+84 to D+35.


HOLDING HOSPITAL OPERATED BY THE 56TH MEDICAL BATTALION adjacent to theTermini airfield.

of civilian hospitals and other medicalinstallations. The 304th Field Hospital,captured on 30 July at Mistretta, had400 beds, 60 of them occupied, and astaff of 8 officers and 46 enlisted men.Located in buildings, the hospital con-tinued in operation under U.S. super-vision. A larger Italian hospital, the10th Reserve, was taken near Barcellonaon 15 August with 47 officers, 143 enlistedmen, and 522 patients. This unit was inthe area assigned for occupation by theBritish, and reverted almost immedi-ately to British control. In addition topersonnel of captured hospitals, largenumbers of enemy medical personnelwere captured with the field troops. Ap-

proximately 100 enemy medical enlistedmen and a similar number of prisoners—all Italian—from among line troops,were used to augment the staffs of IICorps hospitals, while others were at-tached to the two evacuation hospitalsin Palermo.

Evacuation

Evacuation within Sicily was con-trolled by the Seventh Army surgeon,who also arranged with the proper au-thorities for evacuation from the island.Hospital ships and carriers were undercontrol of Allied Force Headquarters,and air evacuation was the responsibility


of the Surgeon, North African Air ForceTroop Carrier Command.15

Lines of evacuation shifted with theprogress of the campaign. Until lateJuly the bulk of those destined for thecommunications zone were carried byambulance and truck to evacuation hos-pitals on the south coast. The 93d Evac-uation served II Corps at Gela until 21July, while the 11th Evacuation, at Li-cata until 20 July and at Agrigentobetween 22 July and 4 August, servedthe Provisional Corps. After 21 July, IICorps casualties also cleared through the11th, by way of a rough 4-hour ambu-lance run from the 15th Evacuation atCaltanissetta. Soon after the capture ofPalermo, that city became the focalpoint for evacuation to Africa, and IICorps casualties were moved north fromNicosia to enter a coastal chain of evacu-ation. A captured Italian hospital train,staffed by U.S. medical personnel, beganrunning from Cefalii to Palermo on 1August, the 128th Evacuation Hospitalat Cefalii serving as holding unit. Thesystem worked smoothly, despite a con-tinuous shortage of ambulances andoften badly damaged roads.

Evacuation from Sicily to North Af-rica was fairly evenly divided betweensea and air. For the first four days of thecampaign all evacuation was by return-ing troop carriers and LST's. Althoughplans called for the delivery of all these

early casualties to Tunisian ports, manywere carried to Algiers where base sec-tion facilities were inadequate to carefor them.16 Air evacuation began fromfields around Gela and Licata on 14 July,but was unorganized, with both U.S. andBritish planes participating as they hap-pened to be available. Approximately100 casualties were flown out in this way,without medical attendants, before the802d Medical Air Evacuation TransportSquadron took over on 16 July. Evacua-tion by hospital ship began from Gela on15 July, from Scoglitti the following day,and from Licata on the 17th. Air evacua-tion began from Agrigento on 23 July,and one load was flown from Castelve-trano on the 24th. As the campaignshifted to the northeast, Palermo andTermini became the principal evacua-tion centers. Air evacuation began fromPalermo on 27 July, and sea evacuationtwo days later, when the port wascleared. Air evacuation from Terminibegan 5 August. One planeload of pa-tients was flown to Africa direct fromSan Stefano.

Between 10 July and 20 August atotal of 5,391 patients were evacuatedby sea and 5,967 by air—11,358 all told.17

Sea evacuation was by two Americanand three British hospital ships, with

15 The main sources for this section are: (1) Rptof 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., LogisticalHistory of NATOUSA-MTOUSA (Naples: G. Mon-tanino, 1945), passim.

16 Surg, NATOUSA, Journal, 16 July 1943. Seealso p. 196, below.

17 The figures are from the 1943 annual reportsof the Surgeon, Seventh Army, and the Surgeon,NATOUSA. Medical History, 802d MAETS, gives6,170 for air evacuation, a figure that presumablyincludes Air Forces personnel and possibly someAllied personnel and civilians, none of whom areincluded by the Seventh Army surgeon. ColonelElvins, Air Surgeon, Twelfth Air Force, in Reportof Air Evacuation, 12 September 1943, gives 5,819through 21 August. In relation to the total, thesevariations seem too minor to justify rejecting theofficial Army figure.


capacities ranging from 370 to 800 pa-tients; and five British hospital carriers,each capable of moving between 350 and400 patients. The larger ships were usedto evacuate only from Palermo, wherethe harbor was deep enough to accom-modate them. Even in Palermo, how-ever, the condition of the docks did notpermit direct loading. The U.S. vessels,Acadia and Seminole, carried no waterambulances. Litters were individuallywinched aboard from smaller craft inrhythm with the waves. By early Au-gust a regular schedule was in effect, aship arriving in Palermo harbor at dawnevery other day. For the most part Amer-ican patients were routed to Bizerte,but at least one load was diverted toOran and one load of 125 patients wentto Tunis. The British hospital carriers,because of their shallow draft, were pre-ferred for evacuation from beaches andsmall harbors. Each carried six waterambulances, which could be lifted to thedeck for unloading.18

Air evacuation from Sicily followedthe pattern developed in Tunisia, butwas more highly organized. Medical au-thorities were notified in advance ap-proximately when each new airfieldwould be usable, so that a holding hos-pital could be set up. Personnel of the802d MAETS stationed at the fieldspassed on information as to available

planes and arrival times, supervisedloading, and provided attendants includ-ing nurses for each flight. These attend-ants were flown back to Sicily by TroopCarrier Command, but litters, blankets,and splints for property exchange cameby ship. Most of the patients flown toAfrica were landed at Mateur, but a fewwere routed to fields around Tunis.Where an evacuation hospital was closeto the airfield, as at Palermo, the moreserious cases were moved direct fromhospital to plane, with only the walkingand less urgent cases passing throughthe holding unit.


While shortages of particular items oc-curred and there were occasional delays,medical supplies presented no seriousproblems in the Sicily Campaign. Ap-proximately no dead-weight tons ofmedical supplies were landed on thebeaches between D-day and D plus 2.These initial supply loads consisted ofcombat medical maintenance units,heavily augmented by items that experi-ence in North Africa had shown to berequired. Supplies not carried ashore bypersonnel of the medical units to whichthey belonged were unloaded whereverroom to put them could be found. Theywere picked up by the beach group,which issued them as needed until medi-cal supply depot personnel cameashore.19

In the landing phase a lack of co-ordi-

18 (1) ETMD, NATO, for Jul 43, 11 Aug 43. (2)Edith A. Aynes, "The Hospital Ship Acadia," Amer-ican Journal of Nursing, XLIV, (February 1944),98-100. The carrier had a draft of only fourteenfeet compared with twenty-five feet for the hos-pital ship. Although Oran was included as a portof debarkation for patients in the original planning,it was quickly abandoned in favor of the shorterroute to Bizerte. See: (3) Ltr, Col William C.Munly (Ret) to Col Coates, 7 Nov 58, commentingon preliminary draft of this volume; (4) Ltr, ColBauchspies to Col Coates, 15 Apr 59.

19 Principal sources for this section are: (1) Rptof 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 Ac-tivities, NATOUSA, Nov 42-Nov 43; app. K; (4)Davidson, Med Supply in MTOUSA, pp. 30-41; (5)Clift, Field Opns pp. 197-98.


nation was evident. Some of the LST'sdid not carry litters, blankets and splintsas called for in the medical plans forthe operation, while other landing craftreturned to their African bases withoutleaving their supplies of these items onthe beaches. In the Scoglitti area med-ical supplies dumped on the beacheswere so widely scattered that collectingthem was a slow and difficult process.About 10 percent of the initial medicalsupply load was lost due to enemy action,while supplies on the follow-up convoyswere poorly packed. Many boxes wereonly half filled and padded with straw;there was undue breakage of bottles; andsome 20 percent of the packing lists didnot agree with the contents of the boxesthey accompanied.

Supplies, nevertheless, proved gen-erally adequate, even in the early stagesof the campaign, thanks to careful plan-ning and advance requisitioning. Medi-cal supplies and equipment estimated tobe adequate for current maintenanceplus a go-day reserve were orderedmonths in advance of the assault andwere delivered in batches by the succes-sive follow-up convoys. Immediate short-ages of such items as tincture of opium,hydrogen peroxide, litters, and cots werequickly overcome by emergency requisi-tions on base depots in North Africa,deliveries being made by air if the needwas urgent. The only articles that couldnot be immediately procured were itemsof replacement equipment and certainequipment items over and above thosenormally allowed, which had been au-thorized but could not be procured be-fore leaving Africa.

Two supply depot units distributedmedical supplies in Sicily. An advancedetachment of the 4th Medical Supply

Depot went ashore at Licata with theJoss Force on D plus 2; the 1st AdvanceSection of the 2d Medical Supply Depotlanded at Gela with the CENT Force thefollowing day.

The detachment of the 4th MedicalSupply Depot established a distributionpoint at Licata, then on 27 July set upa base depot for the island at Palermo.On 30 July an advance dump to serve the3d Division fighting along the northerncoast road was set up in Cefalii, theLicata dump being closed on 1 August.The Cefalù dump remained in operationuntil 25 August, a week after the end ofhostilities.

The 1st Advance Section of the 2dMedical Supply Depot established itsfirst distribution point at Gela, stockedwith supplies collected from the beachgroup and from the beaches themselves,where boxes had been dumped as theywere taken from the ships. Trucks usedwere borrowed from the 1st Medical Bat-talion, since the supply depot's own ve-hicles were not yet unloaded. A forwardissue point was set up at Caltanissetta on21 July in a captured Italian medical de-pot. A small dump was also operated bythis unit at Agrigento between 22 Julyand 31 July. Personnel from Agrigentoestablished an advance depot at Nicosiaon 2 August, where they were joined on12 August by personnel of the Geladepot, which was closed at that time.Personnel of the Caltanissetta depot alsomoved to Nicosia early in August, leav-ing one officer and three enlisted men tooperate the Italian depot until it couldbe transferred to the Allied MilitaryGovernment organization. The Nicosiadepot remained in operation until 27August.

The Licata depot was reopened on 24


August by personnel of the 1st AdvanceSection, 2d Medical Supply Depot, andoperated until 21 October, serving evac-uation hospitals and troops bivouackedin the area. All personnel of the 2d Med-ical Supply Depot in Sicily then movedto Palermo, relieving the advance detach-ment of the 4th for service in Italy.

In the course of the campaign, 365tons of medical supplies and 60 tons offield hospital equipment were captured.This material was used to resupply civil-ian, Red Cross, and captured militaryhospitals.


Combat Medicine and Surgery

While the problems encountered bythe Medical Department in Sicily werein some respects merely an extension ofthose already familiar in Tunisia, inother respects they were unique. Lack ofsanitation, scarcity of potable water, avermin-infested and undernourishedpopulation, and inhospitable terrainwere an old story to American medicalpersonnel by the summer of 1943, butthe problems of a large-scale amphibiousoperation and the hazards of the malariaseason were new. Sicily was at once aproving ground for the lessons learnedin Africa and a dress rehearsal for Italy.

Front-Line Surgery—In the Sicily Cam-paign organization and facilities forfront-line surgery were greatly improvedover those of the Tunisia Campaign.The most important single developmentwas the use of field hospital platoons,with attached surgical teams, for treat-ment of nontransportable casualties inthe division area. Despite careful analy-

sis of Tunisian experience and a fullexplanation of the preferred procedurein a circular letter from the theater sur-geon a month before the invasion, how-ever, various difficulties were still en-countered. Field hospital commanderswere reluctant to undertake dispersedoperation by platoons, and were gener-ally unfamiliar with the technique offunctioning in that manner. There wasalso some resistance to accepting the at-tachment of surgical teams, as implyingsome degree of reflection on the compe-tence of the regular hospital staff.20

As a result, the auxiliary teams werenot used as effectively as they might havebeen. Many teams continued to work inclearing stations, where they were handi-capped as they had been in Tunisia bylack of equipment and absence of facili-ties for postoperative care. Still otherteams were required to work in the 400-bed evacuation hospitals, because theseunits were not adequately staffed in thesubspecialties. This diversion of surgicalteams was a direct consequence of thefailure to get 750-bed evacuation hos-pitals to the island in time to carry ashare of the combat load. Another prob-lem arose from the fact that many of thesurgical teams employed, as well as thefield hospitals themselves, had little or noprevious combat experience, and sur-

20 Sources for this section are: (1) Annual Rpt,Med Sec, NATOUSA, 1943; (2) Surg, NATOUSA,Cir Ltr No. 18, 14 Jun 43, sub: Forward Surgeryand Aux Surg Teams; (3) Surg, II Corps, Cir LtrNo. 3, 7 Aug 43, sub: Care of the Wounded inSicily; (4) Memo, Churchill to Surg, NATOUSA,5 Sep 43, sub: Use of Field Hosps in ForwardSurgery; (5) Ltr, Col Long to Surg, NATOUSA,26 Aug 43, sub: Random Observations from EBSand Sicily, July 6th to August 14th 1943; (6) An-nual Rpt, 2d Aux Surg Gp, 1943; (7) Clifford L.Graves, Front Line Surgeons (San Diego [privatelyprinted] 1950), pp. 86-87.


FORWARD SURGICAL UNIT, 2d Platoon, 11th Field Hospital, near Nicosia.

geons were unfamiliar with general poli-cies as to the management of wounds.

In addition to the employment of fieldhospital platoons as forward surgicalunits, extensive use was made of surgicalconsultants during the campaign. IICorps had the services of its own surgicalconsultant, Major Snyder, detached fromthe 77th Evacuation Hospital, whileColonel Churchill, the theater consultantin surgery, served unofficially in a similarcapacity with Seventh Army. ColonelChurchill spent more than half of histime in Sicily during the period of activehostilities.

Neuropsychiatric Reactions—The basicprinciple worked out in Tunisia of treat-

ing psychiatric reactions in the combatzone was the policy laid down for Sicily.21

In the early stages of the campaign, how-ever, owing to the normal confusion con-sequent upon rapid movement, manycases did not go through the evacuationhospitals for triage22 but were evacuatedto North Africa from the clearing sta-tions with no treatment except sedation.Of those that did reach the evacua-tion hospitals, many had been three orfour days in getting there, a delay thatserved only to fix the symptoms andmake 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 bytype of wound or disease and by urgency. See pp.3-4, above.


sult, only 15 percent were returned toduty.23

Later in the campaign, after the evac-uation system had become more stabi-lized, half of all psychiatric cases werereturned to full combat duty. For thecampaign as a whole, 39 percent wentback to the lines. Sicilian experience thusreinforced the conclusions of NorthAfrica that treatment of psychiatric reac-tions must begin at once and that pa-tients must be retained in the combatzone if they were to have a reasonablechance of returning to duty.

The most publicized psychiatric casein Sicily was that of a soldier slapped byGeneral Patton in the receiving tent ofthe 93d Evacuation Hospital at SanStefano on 10 August. There had been asimilar incident in which Patton hadcursed and struck with his gloves a pa-tient with a clearing station diagnosis of"psychoneurosis anxiety state." Patton'smotivation in these cases was the sincere,if mistaken, belief that if he could makethe men angry enough with him theywould redeem themselves.24 The inci-dents were investigated by Brig. Gen.Frederick A. Blesse, Surgeon, NorthAfrican Theater of Operations, U.S.Army (NATOUSA), and Patton apolo-gized to all concerned. Without in anyway attempting to extenuate his actions,it should be noted that Patton himselfwas probably suffering from the accumu-lated tensions of the preceding weeks ofintensive combat. He was on his way backfrom the front, where every availableman was needed, when he stopped at the

93d Evacuation Hospital on 10 August,and was told by an apparently able-bodied man that he was not woundedbut only scared.25

Diseases of Special Interest—In Sicilythe American soldier encountered varie-ties of subtropical diseases for which noteven his experience in North Africa hadprepared him. The island harbored flies,fleas, lice, bedbugs, and mosquitoes. Lo-cal water and food supplies were likelyto be contaminated. Even elementarysanitation seemed unknown to the localpopulation. Dysentery, Sandfly fever,and most of all, malaria, were constantthreats.26

Preventive measures included immu-nization of all personnel destined forSicily against smallpox, typhoid, para-typhoid, typhus, and tetanus. Atabrinewas distributed with rations four timesweekly beginning on 22 April, with qui-nine substituted for flying personnel andfor 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, ColFranklin to Col Coates, 10 Nov 58, commenting onpreliminary draft of this volume.

25 The incidents have been fully documented. First-hand accounts are in two memorandums from Col.Donald E. Currier, commanding officer of the 93dEvacuation Hospital, one dated 12 August 1943 andaddressed to the Surgeon, II Corps; the other dated7 September 1943 and addressed to the InspectorGeneral, NATOUSA. The official position is statedin letter, Henry L. Stimson, Secretary of War, toSenator Robert R. Reynolds, 3 December 1943; andin General Eisenhower's report to the Senate Com-mittee on Military Affairs, dated 26 November 1943.For more personal accounts, see (1) Eisenhower,Crusade in Europe, pp. 179-83; (2) Bradley, ASoldier's Story, pp. 160-61; Capt. Harry C. Butcher,USNR, My Three Years with Eisenhower (NewYork: Simon and Schuster, 1946), pp. 390-91, 393,396, 450; (3) Garland and Smyth, Sicily and theSurrender of Italy, pp. 425-31.

26 General sources for this section are: (1) Rpt ofOpns, U.S. Seventh Army in Sicilian Campaign,an. N; (2) Annual Rpt, Surg, Seventh Army, 1943;(3) Surg, II Corps, Rpt of Med Activities, SicilianCampaign; (4) Annual Rpt, Med Sec, NATOUSA,1943.


intensive indoctrination on sanitarymeasures before embarkation, with stresson food and water supplies and waste dis-posal.

On the whole, these preventive meas-ures were effective, except for malaria.There discipline broke down in whatwas essentially a command problem, andthe disease became one of the majorhazards of the campaign.

The reasons were various. Of the twomalaria control units and one surveyunit earmarked for Seventh Army, onlyone arrived before the end of hostilities.This was the 20th Malaria Control Unit,which landed on D plus 4, but could dolittle of an effective nature while thearmy was moving at a rate of ten tothirty-five miles a day. There were un-doubtedly times when adequate suppliesof atabrine did not reach all troop units,but the greater failure was on the partof the men themselves, who found waysto avoid taking the atabrine when issued,and on the part of the command thatpermitted the laxity. To most Ameri-cans, malaria was not a reality. TheTunisia Campaign had ended before theseason started, and experience with thedisease was strictly limited. Some caseswere also breakthroughs of therapy, sincethe proper dosage was not well under-stood. It was stepped up from four toseven times a week on 12 August, withsupervision to ensure that the drug wastaken, but by that time the damage wasalready done.

The Seventh Army surgeon reported4,480 cases of malaria and 6,172 cases of"fever undetermined origin" for the 7-week period 10 July-20 August, as com-pared with 5,106 combat wounds. Thelarger portion of the FUO cases were be-lieved to be Sandfly fever, more correctly

known as pappataci fever, and the bulkof the remainder was probably malaria.American doctors were generally unfamil-iar with both diseases in their civilianexperience, and many faulty diagnoseswere inevitable under combat conditionssuch as those found in Sicily. Revisedfigures based on later study of the recordsplaced the Seventh Army malaria cases at9,892 for the period 9 July—10 Septem-ber, compared with 8,375 battle casual-ties. Eighth Army, occupying the highlymalarious Catanian plain, had 11,590 ma-laria cases in the same period.27

Dental Service

Dental service in the Sicily Campaignalso showed considerable improvementover that in Tunisia. Both 10th and nthField Hospitals were equipped to doprosthetic dental work, supplementingthe facilities of corps and division medi-cal battalions. A team consisting of oneprosthetic operator and two assistants,with its own equipment and tentage, wasset up by II Corps to visit all corps troopunits where the number of cases wassufficient to justify the procedure. Restperiods for combat troops were short,however, and so prosthetic work whilehostilities were actually in progress wasmainly confined to repairs.28

At the end of the campaign, two den-tal officers from the 11th Field Hospital

27 (1) Rpt of Opns, U.S. Seventh Army in SicilianCampaign, an. N. (2) Ltr, AG-AFHQ, to CinC,15th Army Gp, and others, 6 Nov 43, sub: Malariain the Sicilian Campaign, 9 Jul-10 Sep 43. Thebattle casualty figure in the AG letter includesslightly wounded cases treated in quarters as wellas the 5,106 hospital cases noted in the Surgeon'sreport. See also, Lt Col William A. Reilly, SandflyFever in the 59th Evacuation Hospital.

28 (1) Surg, II Corps, Rpt of Med Activities inSicilian Campaign.


were placed on detached service with the9th Division to catch up on general oper-ative work, particularly in the divisionartillery, which was too large to be ade-quately cared for by the single dentalofficer assigned. The 1st Division at thistime set up its own prosthetic clinic andlaboratory in conjunction with the divi-sion clearing station. In September per-sonnel and facilities for carrying onprosthetic work were installed in the 91stEvacuation Hospital at Palermo.29

As had been the case in Tunisia, den-tal officers and enlisted men performednumerous nonprofessional functions dur-ing combat operations, when conditionsmade it impossible to carry on dentalwork.

Veterinary Service

Two veterinary food inspection de-tachments accompanied Seventh Army toSicily, performing routine inspections ofrations and of captured food supplies.One detachment operated a cold storageand refrigeration plant in Palermo dur-ing the latter part of the campaign. Careof animals was a function of the veteri-nary service at the division level, pri-marily in the 3d Division, which boastedboth a provisional cavalry troop and aprovisional pack train, and in the 9thDivision where mules were used to carrysupplies and to evacuate wounded. Nohospital facilities for animals were avail-able.30

Medical Support in the Seizure ofSardinia and Corsica

The island of Sardinia had been de-liberately bypassed in planning Mediter-ranean operations, and the threat it hadonce held against Allied supply lines hadbeen largely neutralized by the conquestof Sicily. The invasion of Italy by theBritish Eighth Army on 2 September,and the Salerno landings a week later,once more changed the picture. Oncesubstantial forces were committed to acampaign in Italy, the strategic positionsof both Sardinia and Corsica could notbe overlooked.

The fact that no American or Britishground forces were available proved nobarrier to conquest. With the ItalianFleet no longer at their disposal, theGerman garrison on Sardinia was virtu-ally isolated. The two Italian divisionson the island needed only a minimum ofnaval support to rout their former Axispartners, and within ten days of theSalerno landings the Germans had fled toCorsica. In a parallel movement directedfrom Algiers, the French undergroundon Corsica seized the island capital ofAjaccio three hours after word of theItalian surrender—announced the nightof 8 September—was received. In Corsicathe Germans made a more determinedstand, but the 80,000 Italian troopsquickly surrendered while French rein-forcements were brought in from Africa.With the aid of Allied sea and air power,the last German had been expelled by 5October.31

29 (1) Annual Rpt, Surg, 9th Div, 1943. (2) An-nual Rpt, Surg, 1st Div, 1943. (3) MS, Dental His-tory, 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 onCorsica, OSS Rpt, 15 Nov 43, Navy: S. E. Morisonfile. (2) Lt. Harold Wright, USMCR, "The TrojanSea Horse," Sea Power (April 1946).


PROVISIONAL PACK TRAIN OF 3D DIVISION VETERINARIAN IN SICILY

No Army medical units took part inthe seizure of Sardinia or Corsica, bothoperations being confined, so far as U.S.troops were concerned, to Air Forces per-sonnel. The first hospitals to move intothese islands were therefore assigned tothe Army Air Forces. The hospitals ini-tially selected were the 60th Station, a250-bed unit that had been operating atTunis since July, and the 15th Field, re-called from the Middle East.32

In the interest of speed, equipment of

the 60th Station Hospital was loaded ontrucks, which were driven onto LST's,ferried to Cagliari on the southern endof Sardinia, and before unloading weremoved directly to the modern Italianhospital building that was to house the60th. Nurses were flown to Cagliari incombat planes, the rest of the personnelgoing with the equipment by LST. Thehospital opened with 500 beds—doubleits Table of Organization capacity—on 3November 1943.

The 15th Field Hospital was somewhatlater in getting into operation. The 2dPlatoon opened 100 beds at Bastia, onthe east coast of the Corsican panhandle,on 1 December; the 3d was establishednear Alghero in northwestern Sardinia

32 For details of the assignment of hospitals tothe Air Forces, see p. 182, below. The remainderof this section is based on: (1) Med Hist,Twelfth Air Force, 1942-44; (2) Annual Rpt, 60thSta Hosp, 1943; (3) Annual Rpt, 15th Field Hosp,1943.


on the 13th of that month. The 1st Pla-toon, which lost most of its equipmentwhen the LST carrying it was beacheddue to enemy action, was not ready to

receive patients at Ajaccio until 19 Jan-uary 1944, after a base section had beenestablished on the island.33

33See p. 199, below.

CHAPTER V

The North African Communications Zone

Theater Organization

The Medical Section, AFHQ andNATOUSA

Allied Force Headquarters movedfrom Gibraltar, from which the landingoperations for TORCH had been directed,to Algiers on 25 November 1942. Keystaff members were already in Africa, in-cluding the ranking U.S. medical officer,Colonel Corby, but the bulk of the per-sonnel of the various staff sections didnot come from England until Decemberand January. Personnel of the U.S. com-ponent of the medical section arrivedaboard a destroyer on 23 December, twodays after their ship had been torpedoedand sunk off Oran.1

The section functioned no moresmoothly in Algiers than it had in Lon-don. Under the British concept, theDirector of Medical Services, Maj. Gen.Ernest M. Cowell, was responsible forthe administration of all medical activi-ties in the theater. American practicemade the surgeon at each echelon re-sponsible to the commanding general ofhis formation. This doctrinal divergencewas aggravated by personal friction be-tween Cowell and Corby, his Americandeputy.2

An additional complication was intro-duced in December when Colonel Ken-ner, the Western Task Force surgeon,became a brigadier general. Cowell hadbeen promoted to major general in No-vember, so that his seniority was notjeopardized, but Corby's position becameincreasingly difficult. General Kenner,who now had too much rank for a taskforce surgeon, was attached to AFHQ asmedical inspector, with authority sobroad that he functioned in fact as in-spector general for the theater com-mander, General Eisenhower. In thiscapacity, he exercised varying degrees ofcontrol over both Corby and Cowell.

The staff of the American componentof the medical section, like other U.S.elements in AFHQ, was inexperiencedin meeting the demands of a combat sit-uation and was quickly bogged down ina welter of operational detail not con-templated in the preinvasion planning.The four officers and four enlisted menassigned were unable to establish any ef-fective control over Army medical servicein North Africa, or to carry out responsi-bility for hospitalization, evacuation, andsupply. Neither could they exercise anydecisive influence on Allied policy, sincethey were consistently outnumbered andoutranked by their better informed Brit-

1 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, GenSnyder to Inspector General, 8 Feb. 43, sub: Inspec-

tion of Med Serv Eastern Sector, Western Theaterof North Africa. Throughout this chapter the au-thor is indebted to Armfield, Organization andAdministration, pp. 245-301.


ish counterparts. Personnel were attachedfrom subordinate units to make up theminimum strength required, but therewas no way to compensate for the factthat the British held higher ranks andreceived intelligence information notavailable to the U.S. component.3

These difficulties were resolved onlywhen a strictly American theater wascreated to handle all purely Americanaffairs. For purposes of the invasion,North Africa had been considered a partof the European Theater of Operations,whose boundaries had been extendedsouth to the Tropic of Cancer and eastinto Libya. Once AFHQ was set up onAfrican soil, however, and supplies be-gan to come directly from the UnitedStates, the ETO connection ceased toserve any useful purpose. It was severedentirely early in February 1943 with theestablishment of the North African The-ater of Operations, United States Army(NATOUSA) .4

Under the new arrangement, Eisen-hower became American theater com-mander as well as Allied Commander inChief, and the senior United States offi-cer of each AFHQ staff section, includingthe medical section, became chief of thecorresponding segment of NATOUSA.This administrative reorganization par-alleled the command changes on theTunisian front, whereby II Corps wasgiven its own combat mission and itsown battle sector.5 It also offered anopportunity to resolve the internal diffi-

GENERAL COWELL

culties of the AFHQ medical section. On4 February, the date of the activation ofNATOUSA, General Kenner replacedColonel Corby as Deputy Director ofMedical Services—Deputy Chief Surgeon,AFHQ, in American terminology—be-coming at the same time Surgeon,NATOUSA, with Colonel Standlee,Corby's executive officer, as his deputy.General Kenner also retained his func-tions as medical inspector.

Except for broad policy matters, theAmerican medical service in the Medi-terranean was exempt from British con-trol after 4 February 1943. Thereafterthe U.S. component of the AFHQ medi-cal section functioned primarily in itsNATOUSA capacity, having administra-tive and operational supervision over allU.S. Army medical services in the the-ater.

For another three months the medical

3 (14) Annual Rpt, Med Sec, NATOUSA, 1943.(2) 1st Lt Kenneth W. Munden, MS, Administra-tion of the Medical Department in the Mediter-ranean 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 shoe-string. The original four officers and fourenlisted men who made up the Americanmedical staff of AFHQ had been in-creased by one in each category by thetime NATOUSA came into existence,but that was all. With the Tunisia Cam-paign in full swing and a steady streamof casualties flowing back to the com-munications zone, the 10-man staff of themedical section worked without regardto hours.

It was late in March before a plan oforganization, prepared by Colonel Stand-lee, was presented, and a month later be-fore it was approved. The plan called forfour operating subsections: administra-tion; preventive medicine; operationsand planning, further divided into hos-pitalization, evacuation, and training;and consultants. The personnel require-ments were 23 officers and 30 enlistedmen.6

While the organization was beingworked out, General Kenner left the the-ater on 23 March for another assignment.He was replaced on 16 April by GeneralBlesse, surgeon of Fifth Army, whichwas then training in western Algeria.General Blesse had been detailed toNATOUSA headquarters during March.Like Kenner, Blesse performed the func-tion of Deputy Surgeon and MedicalInspector, AFHQ, as well as those ofSurgeon, NATOUSA. His relations withGeneral Cowell were good, and close co-operation between the British and Amer-ican staffs continued, even after the twogroups moved into separate offices inJune.7

As the theater expanded during 1943,new subsections were added to the medi-cal section, and personnel increased cor-respondingly. In addition to close liaisonwith the major theater commands, theother staff sections of the North Africantheater headquarters, and the British, co-ordination with the medical service ofthe French Army also became necessaryas French combat units began to partici-pate in the Italian campaign. Represen-tatives of the American, British, andFrench medical services met in Oran inNovember, and thereafter the consultingsurgeon of the French Army made fre-quent visits to the office of the Chief Sur-geon, NATOUSA.

With the growth of the theater and theincreasing dispersion of medical units,more formalized means of communica-tion became necessary. A series of circu-lar letters, initiated in March, providedinstructions on theater medical policyand approved technical procedures forthe various medical installations. Begin-ning in July, theater medical experiencewas detailed in monthly Essential Tech-nical Medical Data reports, or ETMD's,prepared for the Surgeon General butserving to bring together a wide varietyof information of use within the theater.A professional journal, the Medical Bul-letin of the North African Theater ofOperations, began monthly publicationin January 1944.

The North African Base Sections

By the time NATOUSA was set upearly 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, 2Nov 43, Sub: Remarks on Recent Trip Accompany-ing Senatorial Party.


GENERAL BLESSE

sections were already operating in thetheater. The first in point of time, aswell as the longest lived, was the Medi-terranean Base Section (MBS), withheadquarters in Oran. Made up origi-nally of Services of Supply elementsattached 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, whoserved until December 1943. Col. JohnG. Strohm, commanding officer of the46th General Hospital, acted as MBSsurgeon until March 1944, when he wassucceeded by Col. Harry A. Bishop. Thesection boasted 20 officers, 1 nurse, and31 enlisted men by the beginning of1943, expanding thereafter as circum-stances required. A subdivision of theMediterranean Base Section, known asthe Center District, was set up in Algiers

on 7 June 1943, its initial medical staffconsisting of Lt. Col. Joseph P. Franklin,surgeon, and 3 enlisted men. Beginningin March 1944 no surgeon was assignedto the Center District other than theMBS surgeon.8

The second North African base sec-tion to be established was the AtlanticBase Section (ABS), activated at Casa-blanca 30 December 1942. Again the sec-tion was built around SOS elements thathad accompanied the task force. The ABSmedical section included ten officers andfour enlisted men. The surgeon was Col.(later Maj. Gen.) Guy B. Denit, who wasrecalled to the zone of interior in April enroute to the Pacific. He was succeeded byhis deputy, Lt. Col. (later Col.) VinnieH. Jeffress, who joined the group prepar-ing a communications zone organizationfor the coming invasion of Italy in Au-gust. At that time Col. Burgh S. Burnetbecame ABS surgeon. Colonel Burnetwas replaced in January 1944 by Col.Thomas R. Goethals, who combined theduties of base surgeon—by that dategreatly diminished—with those of com-manding officer of the 6th General Hos-pital.9

Both base sections were placed underthe jurisdiction of AFHQ on 30 Decem-ber 1942, but in the absence of effectivesupervision both developed more or lessindependently until brought under theNATOUSA organization in February.

The last of the base sections in NorthAfrica proper, the Eastern Base Section(EBS), was established 13 February 1943

and activated a week later, at Constan-tine 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 need for an American base closer tothe Tunisian combat zone. The EBS sur-geon was Lt. Col. (later Col.) WilliamL. Spaulding, whose original staff con-sisted of five officers and seven enlistedmen drawn from MBS and ABS. Withthe extension of the war in the Mediter-ranean, the Eastern Base Section becamethe largest and most important of thethree by virtue of its greater proximityto Sicily and Italy, and a man of morerank and experience than Spaulding thenpossessed seemed needed. Col. Myron P.Rudolph, the man General Blesse se-lected for the job, became EBS surgeonin July 1943. Headquarters was movedto Mateur immediately after the end ofthe Tunisia Campaign, and to Bizerte inAugust.10

As of 6 October 1943, the boundariesof the various base sections were shiftedto conform to territorial borders, ABSbeing made contiguous with FrenchMorocco, MBS with Algeria, and EBSwith Tunisia.

On 1 September 1943, two weeks afterthe successful conclusion of the SicilyCampaign, an Island Base Section (IBS)was activated at Palermo. Like the basesections in Africa, IBS was responsible toNATOUSA. Its medical section washeaded by Lt. Col. (later Col.) Lewis W.Kirkman, who had come direct from thezone of interior. Boundaries were drawnto include only those portions of Sicilystill being used by U.S. forces: thePalermo-Termini area, the Agrigento-Porto Empedocle area, Licata, andCaltanisetta.11

By the end of 1943, preliminary plans

for an invasion of southern France werebeing drawn up at Seventh Army's newheadquarters in Algiers, and Corsica, byaccident of geography, assumed more im-portance in Allied strategy. A NorthernBase Section (NORBS), confined to thatisland, was accordingly established on 1January 1944. The NORBS surgeon wasLt. Col. (later Col.) Albert H. Robin-son, formerly deputy surgeon of ABS.12

The base section surgeons were re-sponsible to the base section command-ers, but their policies were determinedand their work supervised by the theatersurgeon, and their offices were generallyorganized along a line closely parallelingthe organization of the NATOUSAmedical section. Only in their medicalsupply activities, which were directlyunder the Services of Supply, were theyexempt from control by the theater sur-geon, and even here close co-ordinationexisted.

Air Forces Medical Organization

The Army Air Forces in the Mediter-ranean had its own medical organization,distinct from that of the theater but op-erating in harmony with it. Col. Elvins,surgeon of the Twelfth Air Force, set uphis office at Tafaraoui airfield near Orantwo days after the Center Task Forcelandings, moving to Algiers on 19 No-vember 1942. Under Colonel Elvins, inaddition to his own headquarters, weremedical sections for the Bomber Com-mand, the Fighter Command, the AirService Command, and the Troop Car-rier Wing. Medical supply and veteri-nary (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. Noreports of the IBS itself have been located.

12 (1) Annual Rpt, Med Sec, NATOUSA, 1944.(2) Annual Rpt, Med Sec, NORBS, 1944.


under the Air Service Command, whichhad subheadquarters, each with a smallmedical section, at Casablanca, Oran,and Constantine.13

A reorganization in December 1942merged the Twelfth Air Force with Brit-ish and French air units to form theNorthwest African Air Forces (NAAF) ,but the medical organization remainedsubstantially unchanged. The TwelfthAir Force again became a separate unitjust before the invasion of Italy in Sep-tember 1943, though it continued to beunder the operational control of theNAAF. After capture of the great Foggiaair base in southern Italy in early Octo-ber, the Twelfth was reconstituted as atactical force and a new heavy-bombergroup, the Fifteenth United States AirForce, was activated. Both forces weresubordinated to a new U.S. air commandat the theater level—the Army Air Forces,Mediterranean Theater of Operations—in January 1944. An Air ServiceCommand, Mediterranean Theater ofOperations, was established at the sametime, and both were brought under con-trol of the Mediterranean Allied AirForces, which superseded the NAAF.Headquarters of all major U.S. air unitsexcept the North African Wing of theAir Transport Command were in Italyby this time.14

Experience in North Africa, where AirForces personnel were dependent on basesection installations for fixed hospitaliza-tion, demonstrated a need for attachinga minimum number of fixed beds direct-

ly to the Air Forces as the Mediterraneancampaign expanded. Air bases were oftenremote from hospitals located near con-centrations of ground troops, yet AirForces personnel were no less subject todisease and suffered casualties commen-surate with an increasing tempo of activ-ity. It was therefore agreed in October1943 between General Blesse and Colo-nel Elvins that fixed hospitals should beattached to Air Forces units operating insouthern Italy and from the newly oc-cupied islands of Sardinia and Corsica.

Hospitalization in theCommunications Zone

While the North African campaignwas still in the planning stage, The Sur-geon General had recommended a fixed-bed ratio of 12 percent of troopstrength, on the basis of World War Iexperience. British experts on militarymedicine believed 6 percent would beadequate in terms of their own combatexperience up to that date. Colonel Cor-by asked for fixed beds for 10 percentof the command, with a minimum ratioof 8 percent. The British basis wasadopted, with many misgivings, simplybecause it was believed that shippingspace for more beds would not be avail-able.15

Hospitalization During the TunisiaCampaign

Fighting incidental to the landings inNorth Africa was over and the build-up

13 (1) Hist, Twelfth Air Force Med Sec, 1942-44.(2) Link and Coleman, Medical Support of theArmy Air Forces in World War II, ch. VI.

14 Air Forces medical organization subsequent toJanuary 1944 is treated in connection with theItalian communications zone. See pp. 326-27, below.

15 (1) Ltr, Col Corby to Gen Cowell, 1 Jan 43.(2) Zelen, Hospitalization and Evacuation inMTOUSA, pp. 10, 21. For more detailed discussionof bed ratios, see Smith, Hospitalization andEvacuation, Zone of Interior, pp. 215-18.


for the campaign in Tunisia was wellunder way before any fixed hospitals ar-rived in the theater. With the single ex-ception of the 48th Surgical, attached tothe Center Task Force, even the mobileunits arrived too late to be used in theassault phase and were therefore em-ployed initially as fixed hospitals.16

Atlantic Base Section—Remote as itwas from the combat zone, the AtlanticBase Section was the first to achieve rel-ative stability in its hospital program.For the most part hospitals were sited inexisting buildings and remained in placefor considerable periods of time. Casual-ties received were mainly cases evacuatedfrom other base sections for further treat-ment, or en route to the zone of in-terior.17

When ABS took over responsibilityfrom the Western Task Force at the endof 1942 there were three evacuation hos-pitals functioning in the area as fixedunits, with an aggregate T/O strength of1 ,900 beds. A minimum number of addi-tional beds, probably not exceeding 25,were available in a provisional hospitalat Safi. Another 400-bed evacuation hos-pital, the 11th, and the 51st Station Hos-pital with 250 beds, were in the area butnot yet operating. (Map 18)

The 51st Station Hospital went intooperation in Rabat on 31 January 1943,while the 6th General, with 1,000 beds,arrived in Casablanca on 20 Februaryand opened in that city a week later.Both of these hospitals occupied schoolbuildings. Arrangements were also com-

pleted in February for a 25-bed provi-sional hospital at Marrakech to serve AirForces units stationed in that vicinity,although the hospital did not open until15 March. The Marrakech hospital oc-cupied one wing of a French hospitalbuilding. It was initially staffed by ateam of the 2d Auxiliary Surgical Group,withdrawn at that time from Safi, butwas taken over in June by a detachmentfrom the 56th Station Hospital, supple-mented as occasion required by person-nel on temporary duty from the 6thGeneral Hospital. Early in August 1944the Marrakech unit was redesignated the370th Station Hospital.

The 69th Station Hospital began op-erating 500 beds at Casablanca on 28March, in school and dispensary build-ings. A month later, on 29 April, the1,000-bed 45th General opened in Rab-at, taking over the quarters previouslyoccupied by the 51st Station. In antici-pation of the shift, the 51st had movedinto various structures connected with aracetrack on the outskirts of the city thathad just been vacated by the nth Evac-uation Hospital. The 51st Station re-mained until 17 August, while the 45thGeneral continued to receive patientsuntil 15 November.

The last group of fixed hospitals tobe established in ABS began operatingearly in May 1943, coinciding with thefinal phase of the Tunisia Campaign.The 50th Station, with 250 beds, openedin Casablanca on 5 May in tents andhastily constructed temporary buildings.The 23d Station, brought by air fromthe Belgian Congo, opened 250 bedsunder canvas at Port-Lyautey on 9 May,expanding to 500 beds late in July. The250-bed 66th Station began operating atCasablanca on 12 May, in the buildings

16 See pp. 119-20, above.17 Major sources for this section are: (1) An-

nual Rpt, Med Sec, ABS, 1943; (2) Annual Rpt,Med Sec, NATOUSA, 1943; (3) Unit Rpts of hospsand other med installations mentioned in the text.

MAP 18—Fixed Hospitals and Base Medical Supply

FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945Port-Lyautey

91st Evacuation (as station), 2 February-25 April1943. 400 beds.

23d Station, 9 May-19 September 1943. 250/500 beds.

Rabat11th 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. 500beds.

50th Station, 5 May 1943-19 May 1944. 250beds.

66th Station, 12 May-6 December 1943. 250beds.

56th Station, 14 May 1943-28 February 1945.250 beds.

Marrakech370th Station, 25 March 1943-28 February 1945.

(Unnumbered provisional hospital to 4 August1944) 25 beds.

Oujda52d 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 December1942. 750 beds.

32d Station, 28 February-28 November 1943.500 beds.

Oran Area48th Surgical (as station), Arzew, 9 November

1942-18 January 1943. 400 beds.77th Evacuation (as station), Oran, 12 Novem-

ber-1 December 1942. 750 beds.

Depots in North Africa, November 1942-February 1945

38th Evacuation (as station), St. Cloud, 13 No-vember 1942-6 February 1943. 750 beds.

151st Station, La Senia, 25 November 1942-31May 1944. 250 beds.

7th Station, Oran, 1 December 1942-31 July1944. 750 beds.

180th Station, Ste. Barbe-du-Tlelat, 7 December1942-30 September 1943; Bouisseville, 1 Oc-tober 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 December1942-30 November 1943. 1,000 beds.

12th General, Ain et Turk, 14 January-3 De-cember 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, 2May-27 June 1943. 400 beds.

94th Evacuation (as station), Perregaux, 22 May-29 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, 6July-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 1943-28August 1944. 500 beds.

51st Station, Assi Bou Nif, 28 October 1943-15April 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 De-cember 1944. 250 beds.

Algiers29th Station, 30 January 1943-25 August 1944.

250 beds.79th Station, 17 June 1943-30 June 1944. 500

beds.


FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945—Continued

St. Arnaud35th Station, 30 March-12 August 1943. 500

beds.Constantine Area

61st Station, El Guerrah, 12 February-22 October1943. 500 beds.

38th Evacuation (as station), Télergma, 9 March-30 April 1943. 750 beds.

73d Station, Constantine, 23 April 1943-20 Jan-uary 1944. 500 beds.

26th General, Bizot, 26 April-31 October 1943.1,000 beds.

57th Station, Oued Seguin, 5 May-5 September1943; 20 January-25 September 1944. 250beds.

Bone77th 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-19June 1943; Tunis, 20 June-24 August 1943.750 beds.

9th Evacuation (as station), Michaud, 10 May-7 July 1943; Ferryville, 9 July-6 September1943. 750 beds.

56th Evacuation (as station), Bizerte, 20 June-17 September 1943. .750 beds.

53d Station, Bizerte, 27 June 1943-12 January1944. 250 beds.

54th Station, Tunis, 28 June 1943-30 August1944. 250 beds.

78th Station, Bizerte, 1 July 1943-15 March 1944.500 beds.

114th Station, Ferryville, 2 July 1943-10 May1944. 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 January1944. 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 December1943. 500 beds.

35th Station, Morhrane, 28 August-22 Decem-ber 1943. 500 beds.

33d General, Bizerte, 15 September 1943-10 May1944. 1,000 beds.

24th General, Bizerte, 28 September 1943-31 May1944. 1,000 beds.

37th General, Mateur, 1 October 1943-12 April1944. 1,000 beds.

105th Station, Ferryville, 21 October 1943-29May 1944. 500 beds.

64th General, Ferryville, 23 October 1943-29February 1944. 1,000 beds.

57th Station, Bizerte, 15 July-31 October 1944;Tunis, 1 November 1944-28 February 1945.250/150 beds.

Pantelleria34th Station, 18 June-21 September 1943. 250

beds.Kairouan

55th Station, 26 June-11 October 1943. 250beds.

North African Medical Supply Bases

Atlantic Base Section4th Medical Supply Depot, Casablanca, 27 Jan-

uary-16 August 1943.Mediterranean Base Section

2d Medical Supply Depot, Oran, 8 December1942-15 August 1944.

60th Medical Base Depot Company, Oran, 15August-15 December 1944.

Eastern Base Section4th Medical Supply Depot, Am M'lilla in the

Constantine Area, with subdepots at Bone andPhilippeville, 19 March-8 June 1943.

2d Medical Supply Depot, Mateur in the Bizerte-Tunis area, 15 May-8 June 1943.

7th Medical Supply Depot, Mateur, 8 June1943-12 May 1944.

of the Italian consulate vacated whenthe 8th Evacuation moved into tents inMarch. The 56th Station opened 250beds on 14 May in a prisoner-of-war en-closure at Berrechid, temporary build-

ings being supplemented by tents whenthe patient load required.

The 56th Station moved in August tothe site of a French orphanage in Casa-blanca, where it operated a convalescent


500-BED WARD OF 6TH GENERAL HOSPITAL AT CASABLANCA

camp for the 6th General Hospital. The23d Station left ABS in September, andthe 66th in December 1943. The 50thremained until 1 May 1944. Only the56th Station at Casablanca and the 370that Marrakech were still in operationwhen the area passed to control of theAfrica—Middle East Theater on 1 March!945.18

Hospitals in the Atlantic Base Sectionwere supplemented by the 2d MedicalLaboratory, which arrived in Casablanca24 December 1942, and by the 5th Gen-

eral Dispensary, which reached that cityon 20 February 1943. The 2d MedicalLaboratory remained in the area until15 June, operating mobile units at Mar-rakech, Fes, and other Moroccan cities.The 5th General Dispensary functionedin Casablanca until 30 August 1943.

Maximum bed strength in ABS wasreached in May 1943 when 7,025 T/Obeds were available, with expansionunits capable of adding 50 percent tothat total. The greatest patient load camein June and July, the peak being reachedearly in the latter month when 5,700beds were occupied. Evacuation to the18 See pp. 80, 84-85, above.


United States brought the figure downsharply before the end of the month,and there was a steady decline there-after.19

Mediterranean Base Section—Untilthe second phase of the Tunisia Cam-paign got under way in February, thelargest concentration of United Statestroops was in the area served by theMediterranean Base Section, and thebuild-up of fixed hospitals was both morerapid and more extensive than was thecase in ABS. Oran and its environs werewell within range of enemy bombersbased on Sardinia and in the Tunis-Bizerte area. The initial policy, there-fore, was one of dispersal. Most hospitalsites, many of them selected before thebase section itself was activated, wereconsiderable distances from the city.20

Here mobile hospitals that arrived im-mediately after the assault were quicklyreplaced by fixed units. First in the areawas the 151st Station, which set up its250 beds in the infirmary building at LaSénia airport, five or six miles south ofOran, on 25 November. Although sup-plemented by tents, the site proved in-adequate, and the hospital moved at thebeginning of April 1943 to a collegeplant somewhat nearer the city. The 7thStation Hospital, with a T/O of 750beds, took over operation of a civilianhospital in Oran on 1 December, reliev-ing the 77th Evacuation. The 7th Stationwas the only U.S. military hospital in

Oran itself during the North Africancampaign. (See Map 18.)

The 180th Station Hospital opened atSte. Barbe-du-Tlelat on 7 December, its250 beds being housed in Nissen hutsand tents. The 64th Station, another 250-bed unit, began operating on 28 Decem-ber in buildings of the College Laperrineat Sidi Bel Abbes, near the home bar-racks of the famed French Foreign Le-gion. The last fixed hospital to receivepatients in MBS before the end of 1942was the 21st General, which opened on29 December in a group of resort hotelsat Sidi Bou Hanifia.

The 2,500 fixed beds in MBS on 1January 1943 were doubled by the endof the month. The 250-bed 52d StationHospital opened on 13 January at Oujda,where it was assigned to serve FifthArmy, then beginning the long period oftraining that would lead to Salerno andon to the Alps. The 12th General, with1,000 beds, opened on 14 January, oc-cupying 105 villas in the resort villageof Am et Turk overlooking the Mediter-ranean west of Oran. It was then hopedto establish a hospital center there. The40th Station operated 250 beds in theForeign Legion barracks at Arzew from18 January to 4 March, taking over fromthe 48th Surgical. The 40th then movedinto a miscellaneous group of buildingsin Mostaganem where its full T/O of500 beds was set up. Last of the mobileunits to depart the area was the 38thEvacuation Hospital, which had operatedas a station hospital at St. Cloud from13 November 1942 to 6 February 1943.

The Center District was served by the29th Station Hospital of 250 beds, whichtook over a small civilian hospital in Al-giers. Its first patients were transferredfrom 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) AnnualRpt, Med Sec, Center Dist, MBS, 1943; (4) UnitRpts of hosps and other med installations men-tioned in the text; (5) H. J. Hutter, "MedicalService of the Mediterranean Base Section,"Military Surgeon (January 1945), pp. 41-51.


Hospital facilities in MBS were con-siderably augmented when the 2d Con-valescent Hospital began receivingpatients on 18 February. Though as-signed to the base section rather than toa combat element, the 3,000 beds of thisunit were not reported as "fixed." Theyserved, however, to free an equivalentnumber of beds in other hospitals. Afterdiligent search, a suitable location forthe 2d Convalescent was found at Bouis-seville, close to Ain et Turk. The hospi-tal was in part under canvas and in parthoused in 122 villas requisitioned for thepurpose.

The 32d Station Hospital, of 500 beds,was in the theater a month before itopened on 28 February in school build-ings at Tlemcen. The only other fixedhospital to be established in MBS beforethe end of the fighting in North Africawas the 91st Evacuation, which operatedunder canvas as a station hospital atMostaganem from 2 May until 27 June1943.

In addition to these fixed hospitals,there were two general dispensaries func-tioning in MBS during the period of hos-tilities. The 8th General Dispensaryopened on 6 December 1942 in what hadbeen the British Cottage Hospital inAlgiers, where it was the only U.S. medi-cal installation until the arrival of the29th Station nearly two months later.The 6th General Dispensary opened on13 February in the French CliniqueGénérale at Oran.

The T/O bed strength of fixed hospi-tals in the Mediterranean Base Sectionwhen combat operations in North Africacame to an end on 13 May 1943 was5,400.21 The number of beds established,

however, was considerably greater, sincemost of the units were operating beyondtheir normal capacity, with tents andNissen huts frequently being used tohouse expansion beds.22 In addition tothese fixed beds, the 3,000 beds of the 2dConvalescent Hospital were fully oc-cupied.

Eastern Base Section—The first Ameri-can hospital in the Eastern Base Sectionpreceded the organization of the basesection itself. This was the 500-bed 61stStation Hospital, which arrived at ElGuerrah, some twenty-five miles south ofConstantine, on 2 February 1943. (SeeMap 18.) The hospital was brought for-ward in response to a request from theDirector of Medical Services, First Army,to relieve pressure on the British 31stGeneral Hospital in the same area.23 Itwas set up under canvas and received itsfirst patients on 12 February. The 61stoperated under British control until 1March, when it was formally transferredto EBS. In its early weeks of operation,before the rainy season ended, mud wasso deep on the hospital site that ambu-lances could not leave the road and pa-tients had to be carried by litter to thereceiving tent. "Often the bed wouldsink to the springs under the weight ofthe patient. This condition was cor-

21 The figure for T/O beds as of 13 May 1943,given in the text is the 30 April figure from Ap-

pendix A-3, less the 250 nonoperating beds of the57th Station Hospital, transferred out of the MBSin the interval, and includes the addition of the400 beds of the 91st Evacuation Hospital, whichopened in MBS as a station hospital on 2 May 1943.

22 See app. A-3.

23 (1) Deputy Surg, AFHQ, to G-4, Orders, 61stSta Hosp, 20 Jan 43, and atchmt, DDMS, FirstArmy, to Surg, AFHQ, 15 Jan 43. (2) Memo,ADMS, No. 1 LofC Subarea, to DDMS, First Army,3 Jan 43.


rected by placing rocks or large tin cansunder the legs of the bed." 24

The 750-bed 38th Evacuation Hospi-tal moved into the Constantine areaearly in March, opening on the 9th ofthat month at Telergma. Housed intents, the 38th Evacuation served pri-marily as a station hospital for AirForces personnel and as a holding unitfor air evacuation during the campaignin southern Tunisia. A week before thenorthern campaign ended, the 38thshifted to the vicinity of Bédja a fewmiles behind the fighting front, but con-tinued to be assigned to EBS, function-ing as a station hospital again as soon asthe fighting was over. The 35th Stationestablished its 500 beds at St. Arnaud,about fifty miles west of El Guerrah, on30 March, with two school buildings anda theater serving as housing.

The 77th Evacuation Hospital, whichhad served as a combat unit in the south-ern phase of the Tunisia Campaign, wasassigned to EBS on 14 April, openingin tents at Morris near Bone two dayslater. There the 750-bed unit functionedin a dual role, as an evacuation hospitalfor II Corps and as a rear installation,receiving patients from other hospitalscloser to the front. The 73d Station Hos-pital, with a T/O of 500 beds, openedat Constantine in three school buildingson 24 April.

The 26th General, with 1,000 beds,reached EBS late in March but was notready to receive patients until 26 April.During the intervening month engineershad to lay out roads, build cement plat-forms for tents and Nissen huts, and in-stall water and sewage facilities. The siteof the hospital was Bizot, a railhead a

few miles north of Constantine. The26th General was the first U.S. generalhospital to function under canvas in thetheater. The 250-bed 57th Station, whichopened on 5 May at Oued Seguin nearthe Telergma airfield, completed thefixed hospital installations in the EasternBase Section up to the close of the Tuni-sia Campaign. The 57th was housed intents and hutments. Also at Oued Seguinfrom 29 April was the 1st Medical Lab-oratory.

Counting the two assigned evacuationhospitals, there were 4,250 T/O beds inEBS as of 15 May 1943.25

Bed Shortages—T/O bed strength incommunications zone hospitals duringthe Tunisia Campaign never approachedthe 6-percent ratio approved before theinvasion. The actual ratio of T/O fixedbeds to troop strength was only 3.2 per-cent at the end of January 1943,26 whenTunisian casualties began flowing backto the fixed hospitals, and had climbedonly to 5.1 percent by the end of May.27

In order to carry the patient load,evacuation hospitals were pressed intoservice as fixed units, and emergencybeds were established in hospitals alreadyin operation. The 21st General at SidiBou Hanifia, for example, reached amaximum patient census of 4,000 andcared for an average of 1,750, although

24 Med Hist, 61st Sta Hosp, 1943.

25 This figure represents the T/O bed strengthassigned to the EBS as of 30 April 1943, plus the250 beds of the 57th Station Hospital, whichopened as an EBS unit on 5 May 1943. See app.A-3.

26 "On several occasions I heard that the hospitalsituation at the beginning was almost scandalous.It has been greatly improved, due to the energyand ability of a man named Blesse, whom I did notmeet until later." Ltr, John J. McCloy, ASW, toMaj Gen Wilhelm D. Styer, CofS SOS, 22 Mar 43.

27 See app. A-6.


26TH GENERAL HOSPITAL NEAR CONSTANTINE, ALGERIA, the first U.S. general hos-pital to be set up in tents in the North African theater.

its T/O called for only 1,000 beds. Thenecessity of operating for considerableperiods at greater than normal capacitymeant heavy demands on power, water,and mess facilities, as well as on person-nel. Maintenance and repair were con-stant problems, with the need forcarpenters, plumbers, and electriciansoften acute. Civilians were employed inconsiderable number wherever possible,while prisoners of war were used in var-ious permitted capacities.

On the professional side, the primarypersonnel problem was one of makingthe best use of the skills available. Theaffiliated units, of which there wereeleven in the theater during the periodof active combat, were uniformly staffed

with a disproportionate number of spe-cialist personnel. Promotions within theunit were usually dependent on attrition,which was a slow and uncertain process.There were thus pressures both fromwithin and outside these hospitals totransfer men to other units, where theirskills could be used to better advantageand advance in rank would be morerapid. Personnel shifts between hospitalshad become fairly common by the closeof the Tunisia Campaign, the affiliatedunits, and especially the large generalhospitals, being in effect raided to buildup the staffs of smaller installations.28

28 For more detailed, discussion of the personnelproblem in the affiliated units, see McMinn andLevin, Personnel in World War II, pp. 206-10.


Temporary additions to the staffs of anumber of fixed hospitals were alsosecured by the use of personnel not yetpermanently assigned who were drawnfrom staging areas. Many hospitals ar-riving in the theater during the cam-paign were not immediately placed inoperation, either because sites had notyet been prepared or because equipmenthad been delayed. Personnel of theseunits, both professional and enlisted,were usually assigned to temporary dutyat some other hospital in the port area.This technique served the dual purposeof breaking in the newcomers, and ofrelieving the staff of established units ofsome of the burdens entailed when oper-ating above normal capacity. Becausemost of the hospitals debarked at Oran,the greatest use of staging personnel wasin the Mediterranean Base Section.

Development of North Africaas a Hospital Base

The Hospital Build-up—Short airroutes, all-weather landing fields, ports,and rail connections all combined tomake the Bizerte-Tunis area the logicalhospital base to support the invasion ofSicily, scheduled for 10 July. With lessthan two months for preparation, thehospital build-up in the northeastern cor-ner of Tunisia went forward as rapidlyas the debris of battle could be clearedaway. The final mopping up of Axisforces was still going on when the larg-est hospital convoy yet to reach theMediterranean arrived at Oran on 11May. The units included five 500-bedstation hospitals, seven 250-bed stationhospitals, a 400-bed field hospital, and a400-bed evacuation hospital. The 1,000-bed 3d General Hospital debarked simul-

taneously at Casablanca. On 23 May 3more 500-bed station hospitals arrived atOran, bringing the total increment ofbeds to more than 7,500.29

The selection of hospital sites began assoon as an advance echelon of EBS head-quarters had been established at Mateuron 12 May. At this time there were ageneral and four station hospitals in EBS,all of them in the Constantine area, withan aggregate T/O capacity of 2,750beds. The three 750-bed evacuation hos-pitals employed during the campaign innorthern Tunisia—the 9th, 38th, and77th—continued to care for patients atnormal or greater than normal capacity,bringing the minimum bed strength forthe base section to 5,000. This total hadbeen increased to 7,500 by the date ofthe invasion of Sicily, and to 12,000 bythe beginning of August.30

The largest concentration was aroundBizerte, where the 250-bed 53d StationHospital was the first to open, on 16June. The 750-bed 56th Evacuation Hos-pital, which had operated briefly atCasablanca, opened as a station hospitalnear Bizerte on 20 June. The 78th Sta-tion opened in the same area on 1 July,followed by the 43d, the 81st, and the80th Stations on 11, 12, and 13 July, re-spectively. The 43d was a 250-bed unit,the other three were 500-bed hospitals.(See Map 18.)

In Tunis the 54th Station opened with250 beds on 19 June, followed the nextday by the 38th Evacuation, which hadmoved from its Bédja location. Twomore 250-bed station hospitals, the 58th

29 Except as otherwise noted, this section is basedon: (1) Annual Rpt, Med Sec, NATOUSA, 1943;(2) Annual Rpt, Med Sec, EBS, 1943; (3) AnnualRpts, Med Sec, MBS, 1943; (4) Unit Rpts of thehosps mentioned in the text.

30 See app. A-3.


and 60th, opened in Tunis on 5 and 23July, respectively. The 77th EvacuationHospital closed at Morris on 25 June,but remained in the area for another twomonths. The 114th Station, of 500 beds,opened in the vicinity of Ferryville on 2July, and a week later the 9th Evacuationmoved from Mateur to Ferryville. Threemore fixed hospitals were established atMateur—the 1,000-bed 3d General on 15July, in the quarters vacated by the 9thEvacuation; the 74th Station on 29 July;and the l03d Station on 2 August. Bothstation hospitals had 500 beds.

In addition to these four points ofconcentration, the 250-bed 55th StationHospital opened in the Holy City ofKairouan on 19 June and the 105thStation, of 500 beds, at Am Mokra nearBone on 25 July. The latter unit movedto Ferryville late in October. Between 18June and 21 September the 34th StationHospital was attached to the TwelfthAir Force and operated 250 beds for AirForces personnel on Pantelleria Island.

The rapid expansion of bed capacityin the Bizerte-Tunis area posed the mostdifficult siting problem encountered inthe theater. Water was scarce, the regionwas poorly drained, and the malaria sea-son was at its height. There were fewusable buildings available, and materialsfor construction were almost equally dif-ficult to procure in the brief time at thedisposal of the engineers. In addition tothese physical limitations, the militarysituation required an extensive build-upof troops and supplies in the same area,with competing demands for facilities,space, and engineering manpower. The3d General Hospital at Mateur occupiedformer French military barracks, supple-mented by tents and prefabricated huts,but the station hospitals had to rely for

the most part upon canvas and such morestable structures as could be improvised.Water supply, sewage disposal, and pow-er facilities all had to be installed.31

So great was the pressure upon theengineers for purely military construc-tion that although the hospitals werephysically in the area, only a portion ofthose relied upon to care for Sicily cas-ualties were ready when the first patientswere returned from the invasion coast.The situation was critical enough to sendthe theater surgeon, General Blesse, on ahasty flight to Mateur to size up the dif-ficulties for himself. Before he returnedto his Algiers headquarters, Blesse gotthe hospital program moving again, andtook steps to strengthen the EBS medicalsection.32

Approximately 2,000 additional bedswere also established in the Mediter-ranean Base Section between the end ofthe Tunisia Campaign and the assaulton Sicily. The only fixed installation,however, was the 500-bed 79th StationHospital, which opened at Cap Matifoujust east of Algiers on 17 June. Theothers were evacuation hospitals servingtemporarily as fixed units while stagingfor more active roles in future combatoperations. The 94th Evacuation Hospi-tal of 400 beds functioned as a stationhospital at Perregaux between 22 Mayand 29 August before taking part in theinvasion of Italy, while the 400-bed 95thEvacuation, also destined for Salerno,served Fifth Army at Oujda from 24 Mayto 4 July. The 95th then moved to Amet Turk where it took casualties from

31 A. I. Zelen, MS, Hospital Construction in theMediterranean Theater of Operations, UnitedStates Army, pp. 38-40.

32 Surg, NATOUSA, Journal, 15, 16, 17 Jul 43.See also pp. 180-81, above.


Sicily until 16 August. The 750-bed 16thEvacuation Hospital operated as a sta-tion hospital for prisoners of war at SanSeno Wells, near Ste. Barbe-du-Tlelat,between 23 May and 8 August. (See Map18.)

After the Sicily Campaign was over,there was a further concentration ofhospitals around Bizerte and Oran insupport of expanding operations in Italy.North Africa achieved its maximumstrength of approximately 25,000 T/Obeds plus 14,000 expansion beds aboutthe first of November. Even countingfixed beds already in Sicily and Italy,however, the ratio to troop strength re-mained below the original authorizationof 6 percent and well below the 6.6-per-cent figure authorized in September.33

The Eastern Base Section reached thesaturation point during September andOctober with the establishment of fouradditional 1,000-bed general hospitals.The movement started with an internalshift of the 35th Station Hospital fromSaint-Arnaud near Constantine to Morh-rane in the vicinity of Tunis. The33d General opened in tents and hut-ments on "Hospital Road" just outsideBizerte on 15 September. The 24th Gen-eral, which opened in the same area twoweeks later, was more fortunate, beingpartially housed in French military bar-racks. The 37th General Hospital, whichopened at Mateur on 12 September, andthe 64th General, which began receiv-ing patients at Ferryville on 23 October,were both under canvas supplementedby prefabricated units. (See Map 18.)

With no further hospital sites avail-able in Tunisia, such additional build-up as was required was made in the

Mediterranean Base Section, where con-ditions were good and a substantial de-gree of permanence was anticipated. Anelaborate hospital groupment was laidout at Assi Bou Nif, about eight milessoutheast of Oran. The 69th Station Hos-pital was shifted from Casablanca to thenew site on 30 September, the 23d Sta-tion from Port-Lyautey on 4 October,and the 51st Station from Rabat on the28th of the same month. In addition tothese units from the Atlantic Base Sec-tion, two new 1,000-bed generals, the43d and the 70th, opened at Assi BouNif on 31 October. The groupment wascompleted with the opening of the 46thGeneral Hospital on 4 November.

The Assi Bou Nif project was plannedfor long-term use. Starting with openfields, the engineers installed completepower, water, and waste disposal facilitiesfor a potential capacity of double the4,250 beds actually installed. Buildingswere mostly of permanent construction,many of them of stone. Those ward tentsused had wood floors and frames. Nissenand Boyle huts were insulated. Much ofthe actual labor was performed by Italianprisoners of war, whose full utilizationceased to be restricted after Italyachieved the status of a cobelligerent.Local sandstone and cement were morereadily available than lumber, and givenunlimited supplies of manpower, weremore economical.34

Hospitalization of Sicily Casualties inNorth Africa—For the first time in anyU.S. theater in World War II, selectivehospitalization was attempted for cas-ualties from Sicily. With most of theavailable surgical teams assigned to the

33 See apps. A-3, A-6.

34 Zelen, Hospital Construction in MTOUSA, pp.30-31.


HOSPITAL GROUPMENT AT ASSI BOU NIF, NEAR ORAN

combat zone, it was clear that therewould not be enough skilled surgeonsleft to staff all of the Eastern Base Sec-tion hospitals, either for general work orfor specialties. Careful plans were there-fore made to assign patients to hospitalsby type of case.

Craniocerebral, spine, and cord in-juries were to go to the 78th StationHospital, eye injuries to the 114th Sta-tion, chest cases to the 53d Station, andneuropsychiatric cases to the 43d Station.Compound fractures were to be handledby the 9th and 56th Evacuation Hospi-tals, and by the 74th, 80th, and 81stStations. For emergency periods the twoevacuation hospitals and the 3d General

were qualified to treat cases of all types.Triage for those brought by sea was tobe carried out by the 56th Evacuationat Bizerte, and for those flown from Sicilyby the 9th Evacuation near Mateur air-field.35

It was possible to carry out these plansonly in part. When the first casualtiesarrived on D plus 1 many of the EBShospitals were not yet ready for patients.The road to the 9th Evacuation was toorough for transporting serious cases.There were not enough ambulancesavailable for the extra carry involved in

35 (1) Ltr, Col Churchill to Surg, NATOUSA, 19Aug 43, sub: Tour Rpt, Sicily, D+24 to D+35. (2)Annual Rpt, Med Sec, EBS, 1943.


moving patients from the evacuation tothe station hospitals. And finally, therewere not enough beds to permit com-plete selectivity. The planning, more-over, had not taken into considerationthe high incidence of malaria, or the ac-cident rate consequent upon the stagingof large numbers of troops. On the firstday of the Sicily Campaign, more than athird of the approximately 6,500 bedsestablished in northeastern Tunisia werealready filled.

In actual practice, therefore, patientswere sorted at the Bizerte docks by per-sonnel of the 8th Port Surgeon's officeand at Mateur airfield by personnel ofthe 802d Medical Air Evacuation Trans-port Squadron.36 Representatives of theEBS surgeon assigned patients in termsof daily bed status reports from eachhospital. Transportation was by the 16thMedical Regiment. Hospital specialtieswere observed so far as possible, but bedspace was the overriding consideration.

The geography was such that there wasin fact no alternative to initial hospitali-zation of casualties from Sicily in EBS,and so no attempt was made to build upbed strength elsewhere than in northeast-ern Tunisia. When wounded from Sicilywere carried by returning shipping toAlgiers instead of Bizerte, the 250-bed29th Station Hospital was unable to car-ry the extra load. The still inoperative79th Station had to set up tents to takethe overflow. The 38th Evacuation Hos-pital at Tunis handled the relativelysmall number of U.S. casualties reachingthat city, but its location was poor. Attimes, when the wind blew in from the

desert, the temperature in the operatingtent rose to 135° F. Needless, perhaps, tosay the hospital did not remain in Tunislong.37

Hospitalization of Italy Casualties inNorth Africa—The establishment of ad-ditional hospitals in the Tunis-Bizertearea shortly after the Salerno landings of9 September 1943 led to various changesin the disposition of patients being re-ceived by air and water in EBS.38

On 20 September a triage center wasset up in the vicinity of the 33d GeneralHospital, approximately four miles fromthe Bizerte clocks, a mile from the SidiAhmed airport, and 300 yards from theoperating base of the 2670th AmbulanceCompany (Provisional). The triage cen-ter was conducted by 2 Medical Corpsofficers, and 2 Medical AdministrativeCorps officers, drawn from the variousinstallations in the area and rotatedmonthly; and 6 nurses and 6 enlistedmen from the 33d General Hospital.The center received a bed-status reporteach morning from the base surgeon'soffice. When a hospital ship arrived, thePort Surgeon notified the ambulancecompany, and word was passed along tothe triage center, to which the patientswere brought when unloaded. The 802dMedical Air Evacuation TransportSquadron at Sidi Ahmed airport was indirect telephonic communication withthe 33d General Hospital, the triagecenter, and the 2670th Ambulance Com-pany.39

36 Annual Report, Medical Section, EBS, says807th MAETS, but this squadron did not arrivein 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 basedon: (1) Annual Rpt, Med Sec, EBS, 1943; (2)Annual Rpt, Med Sec, NATOUSA, 1943; (3) Unitrpts of hosps mentioned in the text.

39 Memo, Capt Carl Schanagel, to Lt Col OscarReeder, 31 Oct 43.


The sorting station at Mateur airfieldsome 20 miles farther south continuedto be available until the field was closedlate in November, but received only onepatient after 5 October.

The 33d General Hospital at this timetook all craniocerebral, spine and cord,and maxillofacial cases. Chest and neckcases continued to go to the 53d StationHospital until 21 October, and there-after to the 24th General. Neuropsychi-atric patients continued to go to the 43dStation until 16 November, when theunit was relieved by the 114th Station.Compound fractures continued to go tothe 81st Station. All general hospitals,however, were authorized to take theoverflow of both psychiatric and fracturecases when no space remained in thedesignated station hospitals. Eye injurieswent to the nearest general hospital. Allother types of surgical and medical caseswere distributed according to the avail-ability of beds.

Navy personnel went to the 80th Sta-tion Hospital at Bizerte or to the 54th atTunis, whichever was closer; or to spe-cialized hospitals if the type of injuryso required. Prisoner-of-war patients alsowent to the specialized hospitals if triageso indicated, otherwise to the 78th or103d Station.

Late in October the 105th StationHospital opened as a convalescent hospi-tal and venereal disease treatment center,gradually increasing its capacity to 3,000beds. The 105th took patients only bytransfer from other hospitals, under suit-able controls to prevent "dumping." Atthis time, with an adequate number ofbeds available in EBS, a 90-day evacua-tion policy was established for generalhospitals and a 30-day policy for stationhospitals.

After the middle of December, withhospital facilities rapidly building upin Italy, the influx of patients into NorthAfrica fell off sharply. There was a largemovement of patients during the week of15-21 January 1944, when hospitals inthe Naples area were being cleared pre-paratory to launching the Anzio opera-tion, but after that period the majorburden of communications zone hospi-talization was carried in Italy.40

Hospitalization in Sicily, Sardinia,and Corsica

Island Base Section—With the cessa-tion of hostilities in Sicily, the 93d Evac-uation Hospital closed in preparation fora Fifth Army assignment. The 15th Evac-uation was moved to a new site a fewmiles east of Licata on the Gela road,while the 128th Evacuation went to Cas-tellammare, west of Palermo, and the11th replaced the 128th at Cefalii. Newlyarrived from the Middle East, the 1stPlatoon of the 4th Field Hospital wasestablished three days before the end ofthe campaign at Palagonia, on the south-western edge of the Catanian plain.These locations were selected with a viewto providing station hospital service fortroops remaining in Sicily, and the hos-pitals retained their Seventh Army as-signments, with IBS exercising only aco-ordinating function.41

The 9th Evacuation Hospital wasbrought from North Africa early in Sep-tember, opening at Termini on 1 Octo-

40 Hq, ETOUSA, Rpt on PBS, 10 Feb 44. See alsop. 343, below.

41 This section is based generally on: (1) AnnualRpts, Med Sec, NATOUSA, 1943, 1944. (2) Unitrpts of the hosps mentioned in the text. Nomedical section reports for the IBS have beenfound.

MAP 19—Fixed Hospitals and Base Medical Supply Depots on Sicily, August 1943-July 1944

FIXED HOSPITALS IN SICILY, JULY 1943-JULY 1944

Castellammare-AIcamo128th Evacuation (as station), 19 August-31 Oc-

tober 1943. 400 beds.

Palermo91st 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.

Termini9th Evacuation (as station), 1 October-31 De-

cember 1943. 750 beds.

Cefalii11th Evacuation (as station), 19 August-23 No-

vember 1943. 400 beds.

Licata15th Evacuation (as station), 19 August-29 Sep-

tember 1943. 400 beds.77th Evacuation (as station), 27 September-26

October 1943. 750 beds.Palegonia

4th Field, 1st Platoon (as station), 14 August-19 November 1943. 100 beds.

Island Base Section Medical SupplyInstallations

Palermo4th Medical Supply Depot, 1 September-21 Oc-

tober 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.


ber. On the same date the 77thEvacuation supplanted the 15th at Li-cata, the latter unit being withdrawn forservice in Italy. The 128th Evacuationmoved into buildings in Alcamo on 9October, a week after a hurricane hadleveled virtually all of its tentage at Cas-telammare. The 250-bed 34th StationHospital, only fixed installation on theisland, opened at Palermo on 1 Novem-ber. The maximum fixed-bed strength inSicily was reached at this time—3,700counting both IBS and Seventh Armyinstallations.42 (Map 19)

Evacuation of the remaining casualtiesfrom Sicily, reduction in the strength ofoccupation troops, and the departure ofstaging units about this time greatly re-duced the demand for hospital beds. The77th and 128th Evacuation Hospitals, to-gether with the 91st, which had re-mained in place in Palermo, left thetheater for England early in November.Later that same month the 1st Platoonof the 4th Field Hospital was attachedto the Air Forces and shifted to Italy,while the nth Evacuation moved toPalermo. Both the 9th and nth Evac-uation closed on 31 December prelimi-nary to departure for Italy. Left in Sicilyat the beginning of 1944 were the 59thEvacuation, acting as a general hospital,and the 34th Station, both at Palermo.The 59th was replaced in May 1944 bythe 150-bed 154th Station, but both thishospital and the 34th Station left Sicilytwo months later. The Island Base Sec-tion passed out of existence on 15 July1944.

Northern Base Section and Sardinia—As of 1 January 1944, the two platoons

of the 15th Field Hospital on Corsicawere reassigned to the Northern BaseSection. The NORBS surgeon, ColonelRobinson, began a survey of the islandfor hospital sites immediately after hisarrival on 8 January and prepared planscalling for the addition of 1,250 fixedbeds, to be dispersed in relation to air-fields and troop concentrations. Trans-portation shortages stemming from therequirements of the Anzio Campaignforced some delay, but the 500-bed 35thStation Hospital opened at Cervione,midway up the eastern coast of Corsica,on 1 March. Ten days later the 40thStation, also with 500 beds, replaced the1st platoon of the 15th Field at Ajaccio.The latter unit shifted to Calvi in thenorthwestern part of the island, but oper-ated there only a few weeks before beingsupplanted by the 250-bed 180th Stationon 28 April 1944. The field hospitalplatoon then went to Ghisonaccia, sometwenty miles below Cervione. All threestation hospitals on Corsica came fromNorth Africa. In the absence of suitablebuildings, all American hospitals on theisland were set up under canvas, supple-mented by prefabricated huts as the en-gineers found time to erect them.43

The two hospitals on Sardinia—the 3dPlatoon of the 15th Field, and the 60thStation—remained as Air Forces unitsuntil the first week in May, when theywere assigned to the Allied garrison onSardinia. The 60th Station opened a sec-ond 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) Seeapp. A-4.

FIXED HOSPITALS ON SARDINIA AND CORSICA,NOVEMBER 1943-MAY 1945

Cagliari, Sardinia60th Station, 3 November 1943-31 October 1944.

250/500 beds.Alghero, Sardinia

15th Field, 3d Platoon (as station), 13 December1943-30 August 1944. 100 beds.

60th Station, Detachment, 30 August-22 Sep-tember 1944. 100 beds.

Ajaccio, Corsica15th Field, 1st Platoon (as station), 19 January-

11 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 March-28 April 1944. 100 beds.

180th Station, 28 April-10 September 1944. 250beds.

Bastia, Corsica15th 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. 500beds.

40th Station, Detachment, 14 October 1944-14April 1945. 350/150 beds.

Ghisonaccia, Corsica15th 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 SupplyInstallations

Ajaccio, Corsica7th 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 June1944.

684th Quartermaster Base Depot Company, 1June 1944-21 March 1945.

80th Medical Base Depot Company, 21 March-10 April 1945.

MAP 20—Fixed Hospitals and Base Med-ical Supply Depots on Sardinia andCorsica, November 1943-May 1945


capacity on Sardinia was required.44

(Map 20}

Hospitalization of Prisonersof War in North Africa

The 275,000 prisoners taken at theclose of the Tunisia Campaign exceededall expectations and created a problemwith which the Allied authorities wereinadequately prepared to deal. By agree-ment between Generals Cowell andBlesse and the Provost Marshal General,captured medical and sanitary personnelwere divided between the U.S. and Brit-ish medical organizations according toneed, but in the confusion of mass trans-fers to less congested areas, it was not atonce possible to make use of those mento any great extent in caring for theirown sick and wounded. Initially, Tunis-ian prisoners were given medical care inregular U.S. Army hospitals, normalstaffs being supplemented as extensivelyas possible by prisoner personnel. Wherefixed hospitals were not available, dis-pensary service was given by protectedenemy personnel under supervision ofthe medical sections of the administra-tive companies operating the prisoner-of-war camps.45

The largest single cause for hospitali-zation of prisoners in the summer andearly fall of 1943 was malaria, with dys-entery also high on the list. Many ofthose taken in the Tunisia Campaignwere suffering from malnutrition, which

undoubtedly increased the disease rate,as also did unsanitary conditions in thehastily improvised prison camps andalong the crowded transportation routesto the rear. Battle wounds were a signif-icant factor only in May.46

German and Italian prisoners taken inthe final days of the Tunisia Campaignwere cared for in EBS by the 61st Stationand the 26th General Hospitals, both ofwhich remained in the Constantine areathrough October 1943. At the 26th Gen-eral prisoner wards were set up inside abarbed-wire enclosure, with guards ini-tially assigned from the medical detach-ment. These were later replaced by mili-tary police.47

In the Mediterranean Base Section,two hospitals cared for prisoner patientsfrom Tunisia, and later from Sicily.The 21st General at Sidi Bou Hanifiaopened a prisoner-of-war section on 29April to care for the sick and injured inPOW Enclosure 130. The section con-tinued to operate as such until the hospi-tal closed in Africa at the end of Novem-ber. In 200 days of operation, 2,285prisoner patients were admitted, morethan 13 percent of all patients for theperiod. The largest daily census was 538.Both German and Italian prisoners weretreated, and medical personnel of bothenemy countries assisted in their care.At Ste. Barbe-du-Tlelat, the 16th Evac-uation operated a hospital in prisoner-of-war Enclosure 129 between 23 May and8 August. Between the latter date and 30September the hospital was operated bythe 180th Station. Patients here werepredominantly Italian, as were the pro-

44 (1) Annual Rpt, Med Sec, AAFSC MTO, 1944.(2) Annual Rpt, 15th Field Hosp, 1944. (3) An-nual Rpt, 60th Sta Hosp, 1944. (4) See app. A-4.

45 (1) Annual Rpt, Med Sec, NATOUSA, 1943.(2) Hist, Med Detach, 6619th POW Administra-tive Co, 1943. The figure 275,000 for prisonerstaken in Tunisia is from Howe, Northwest Africap. 666.

46 ETMD, NATOUSA, Oct 43.47 (1) Annual Rpt, Med Sec, EBS, 1943. (2) Annual

Rpt, 61st Sta Hosp, 1943. (3) Annual Rpt, 26thGen Hosp, 1943.


tected personnel who augmented theU.S. hospital staff.48

Largest of the hospitals for Tunisiaprisoners was the 56th Station in ABS,which was set up between 4 and 14 Mayinside POW Enclosure 100 at Berrechid,some twenty miles south of Casablanca.Almost half of all prisoners taken inAfrica passed through this camp, whichhad an average population of 20,000with a maximum of 28,000. Germansand Italians there were about equal innumbers. The patient census varied from205 to 978, averaging about 750. Thehospital had nine prefabricated build-ings, supplemented by tents. In additionto hospital care, the 56th Station main-tained small dispensaries in various partsof the compound, where outpatient serv-ice was given to between 300 and 400 aday.49

The inadequate hospital staff was sup-plemented by detachments of 3 officers,6 nurses, and 22 enlisted men each fromthe 34th, 36th, and 37th Hospital ShipPlatoons; by 2 German medical officers,each of whom had charge of a ward; andby 100 to 120 German medical soldierswho worked under their own noncom-missioned officers. Nurses were quarteredoutside the compound. Their dutieswere largely supervisory, with actualnursing confined to seriously ill and sur-gical cases. They performed no nightduty.

The 56th Station Hospital closed atBerrechid on 15 August when the prisoncamp was closed.

The bulk of the prisoner-of-war pa-tients from Sicily who were not retainedon the island went initially to the 80thStation Hospital at Bizerte, where theywere guarded by French military per-sonnel. Prisoner patients from the Ital-ian campaign that were received in theEBS were routed to the 78th StationHospital at Bizerte or to the 103d Stationat Mateur.

After Italy became a cobelligerent,Italian prisoners in Africa were organ-ized into service units of various types.Their status made it necessary to keepthem completely separated from theGerman prisoners. At the same time,their numbers and the assignments giventhem increased their hospitalization re-quirements.

On 26 September, therefore, theItalian wards of the hospital then beingoperated by the 180th Station in prison-er-of-war Enclosure 129 was redesig-nated the 7029th Station Hospital (Ital-ian) . It was staffed by Italian medicalpersonnel under U.S. supervision, as-sisted for the first two months bydetachments from two U.S. hospital shipplatoons. The maximum census beforethe end of 1943 was about 800.50

The German wards of the hospital inPOW Enclosure 129 were reorganizedat the same time into a German stationhospital, under U.S. supervision butstaffed, like the Italian hospital, by cap-tured medical personnel. In Decemberthe German hospital moved to neighbor-ing POW Enclosure 131, and the 7029thmoved back into the quarters previouslyoccupied in Enclosure 129. Prisoner-of-War Hospital 131, as the German unitwas 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 StaHosp, 1943.

49 (1) Annual Rpt, Med Sec, ABS, 1943. (2) An-nual Rpt, 56th Sta Hosp, 1943. 50 Hist, 7029th Sta Hosp (Italian.), 27 Jul 45.


PRISON STOCKADE, 180th STATION HOSPITAL, STE.-BARBE-DU-TLELAT, NEAR ORAN

this time to care for 500 patients, butgradually expanded as more Germanmedical officers became available.51

The 56th Station Hospital opened a75-bed unit for prisoner personnel ofItalian service companies in the Casa-blanca area late in 1943. This unit wasformally designated the 7393d StationHospital (Italian).

Only cases that could not be handledby one of these prisoner-of-war hospitalswent to U.S. installations.

Although 3,066 sick and woundedprisoners of war were evacuated to thezone of interior during 1943, an aggre-

gate of 1,982 remained hospitalized inNorth Africa at the end of the year.

Evacuation in the CommunicationsZone

Evacuation Between Base Sections

The geographical distribution of fixedhospital beds in North Africa in relationto the changing combat zones and toports of embarkation made it necessaryto keep patients moving steadily fromone base section to another in order toaccommodate new casualties as close aspossible to the area of combat. Evacua-tion from east to west went on as longas the North African communicationszone 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).


Tunisia Campaign—Evacuation be-tween base sections in North Africa wasa continuous process after the TunisiaCampaign got well under way. Theestablished evacuation policy for theEastern Base Section of thirty days andof ninety days for the other two NorthAfrican base sections was impossible toobserve rigorously in practice. EBS hos-pitals functioned in fact as little morethan evacuation units, sending a constantflow of patients back to Algiers andOran. To make room for these, Mediter-ranean Base Section hospitals wereforced to send other patients still fartherback, to the Casablanca area or to thezone of interior. Casualties from theTunisian battle fronts began arriving inthe Atlantic Base Section toward the endof April, continuing in a steady streamuntil midsummer.52

During the southern phase of theTunisia Campaign the 61st StationHospital at El Guerrah was the principaldistributing point in the Eastern BaseSection. Each day patients from the 61stwere moved by Air Forces ambulances adistance of twenty miles to the 38thEvacuation Hospital at Telergma air-field to make room for the next convoyarriving from the front. "Admissionswere as high as 350, and evacuation byair totaled 350, in a single 24 hourperiod.53 It was not until 30 March thatanother U.S. hospital, the 35th Station atSaint-Arnaud, was available in the area,and this installation took only one train-load of 228 patients from II Corps.

In the northern phase of the cam-paign, the 77th Evacuation Hospitalnear Bone served as both a base sectionfixed unit and a combat zone hospital.Patients received from the front weresent either to the Mediterranean BaseSection or to the Constantine area,where the 73d Station and 26th GeneralHospitals opened late in April and the57th Station early in May. Evacuation toMBS from the 77th Evacuation was byair and by British hospital ship. To Con-stantine it was by motor ambulance.

For the period 1 January to 15 May1943, according to figures reported bythe NATOUSA medical section, 12,616patients were evacuated by air from thecombat zone to MBS, either direct orthrough EBS hospitals; 2,660 were evac-uated by sea and 707 by rail. In additionto these, 665 patients were flown fromMBS to ABS, and 900 came from MBSto ABS by rail. The 802d Medical AirEvacuation Transport Squadron re-ported a total of 16,300 patients evacu-ated by air, including both the 4,806flown directly from the combat zone. (SeeTable 2, p. 140.) and those moved tomore rearward areas within the theater.(Table 3) The higher MAETS figure isaccounted for, at least in part, by thesomewhat different time span—16 Janu-ary-23 May—and by the inclusion of AirForces casualties which were frequentlynot cleared through normal hospitalchannels.

Rail evacuation between base sectionsbecame increasingly important towardthe close of the Tunisia Campaign. Thefirst U.S. hospital train in the theaterwas assembled in March from Frenchrolling stock. Second- and third-classpassenger cars and box cars were con-verted into ten-litter cars, four for sitting

52 Principal sources for this section are: (1)Annual Rpt, Med Sec, NATOUSA, 1943; (2) An-nual 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 instal-lations mentioned in the text.

53 Annual Rpt, 61st Sta Hosp, 1943.


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 ini-tially by personnel of the 5th HospitalShip Platoon, the train carried 120 litterand 180 sitting patients. The first run,from Oran to Casablanca, was com-pleted on 31 March. A second hospitaltrain, converted and operated by person-nel of the 41 st Hospital Train, wasplaced in operation on 15 May. Shortlythereafter the first train was taken overby personnel of the 42d Hospital Train.A third American hospital train, con-verted from French rolling stock, wentinto operation in July, in time to helpclear casualties from Sicily through EBSand MBS. A boarding party from the6th General Hospital at Casablanca meteach incoming train at Fes, collectingvaluables, checking records, and assign-ing patients to wards while they werestill in transit.54

Sicily and Italy Campaigns—Frommid-July 1943 through the remainderof the year, movement of the sick andwounded out of the Bizerte-Mateur-Tunis area to hospitals farther to therear was almost as rapid as the inflowof casualties from Sicily and Italy. In theearly stages of the Sicily Campaign, therewere not enough beds available to per-mit extended hospitalization in Tunisia.Even the addition of 2,500 beds beforethe end of the Sicilian fighting did notappreciably improve the situation,because of the requirements of theforthcoming invasion of Italy. One con-sequence was the evacuation of manypatients with limited hospital expect-ancy, who were virtually well by thetime they reached the MediterraneanBase Section.

During the 2-month interval betweenthe Sicilian and Italian D-days, EBSforward hospitals received 5,713 pa-tients from Sicily by sea and 7,603 byair, 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.


period a total of 10,720 patients wasevacuated to installations farther re-moved from the combat zone.55

The first patients from Italy werecarried to EBS by returning transportson 12 September, and the first arrivalsby air were received on the 23d. After28 September much of the air evacuationfrom Italy was routed by way of Sicilywith an overnight stop at Termini air-field near Palermo, but hospitalizationwas not involved except in emergencies.Patients were kept in an air evacuationholding unit and flown on to Africa thenext day.

For movement out of the forward areaof EBS, hospital ships were used betweenBizerte and Oran; planes to Algiers; andhospital trains to Constantine, which wasincluded in MBS in October. FromConstantine further rearward movementwas by train or plane.56

Between 10 July and 31 December1943, 34,116 patients were received inEBS from Sicily and Italy, 12,902 bysea, and 21,214 by air. In the sameperiod, 16,116 were transferred to rearareas of the North African communica-tions zone, 9,238 by sea, 3,577 by air, and3,301 by rail. In addition to theseintratheater transfers, 801 patients wereevacuated from EBS directly to theUnited States by sea. French casualtiesfrom Italy began entering the U.S. evac-uation channels in December but wereseparated on arrival in North Africa andpassed to French control.57

In January 1944, as part of the processof clearing fixed hospitals in Italy inanticipation of heavy casualties at Anzioand along the Rapido, 5,538 U.S. pa-

tients were evacuated to EBS, 3,232 bysea and 2,306 by air.58 This was the lastheavy demand upon the North Africancommunications zone, which declinedsteadily in importance thereafter.

Evacuation from Corsica and Sardiniawas by air to North Africa during theperiod before the fall of Rome, but wasof relatively minor significance.

Evacuation to the Zone of Interior

In the early stages of the Tunisia Cam-paign, American litter patients destinedfor the zone of interior were evacuatedfrom Oran to the United Kingdom onBritish hospital ships, while neuropsy-chiatric, ambulatory, and troop-classpatients went directly to the UnitedStates by unescorted troop transport.59

Instructions were changed at the begin-ning of May to permit evacuation of allclasses of patients in transports, withCasablanca the primary port of embar-kation for this purpose. Later in theyear, convoyed troopships took occa-sional loads from Oran, while two U.S.hospital ships, the Acadia with a capacityof 806 and the Seminole with a capacityof 468, became available for evacuationfrom ports farther east in the Mediter-ranean. The Acadia, however, was toolarge to dock at Bizerte. A total of 20,358U.S. Army patients were evacuated fromNorth Africa to the zone of interior dur-ing 1943. (Table 4) Only a handful wereevacuated to the United States by air inthis period, each case being a matter forseparate 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 carefor themselves even in emergencies.


INTERIOR OF HOSPITAL TRAIN on runfrom Oran to Casablanca.


Medical supplies and equipment forU.S. forces operating in the North Afri-can theater were originally the responsi-bility of the task forces. The supplyfunction passed to the base sections whenthey were activated, with centralized co-ordination through the Medical Section,AFHQ, and later NATOUSA. After 14February 1943, central direction of thea-ter supply activities was through theMedical Section, SOS, NATOUSA.

Medical Supply in the Base Sections

The task forces making the NorthAfrican landings included no trainedpersonnel for handling medical supplies,which were scattered in chaotic fashionover the Moroccan and Algerian beaches.Records were inadequate or nonexist-ent, and there were no supply depots

TABLE 4—U.S. ARMY PATIENTS EVACUATED BY SEA FROM NORTH AFRICA TO THE ZONE OFINTERIOR, 1943

Source: Annual Rpt, Med Sec, NATOUSA, 1943, p. 184.


until the base section organizations tookcontrol.60

In the Atlantic Base Section, ware-houses and issue points were operatedduring January 1943 by personnel ofhospital ship platoons, but no inventorieswere attempted. The 4th Medical Sup-ply Depot took over the function on 27January, establishing an orderly systemof distribution centered in Casablanca.This organization remained in ABS un-til 16 August, after which personnel ofhospital ship platoons again resumed thesupply function. By that date, however,ABS had so far declined in importanceas to make the work a routine operation.

The development of a medical supplysystem in the Mediterranean Base Sec-tion followed a similar pattern. A sectionof the 2d Medical Supply Depot wasfunctioning in Oran before the end ofNovember 1942. As rapidly as possiblescattered supplies were brought to-gether and suitably housed in andaround Oran, while inventories werecorrected and brought up to date. Ashortage of organizational equipment—not included in the initial automaticdelivery of supplies on the basis of troopstrength—was made up in large part bydiverting to depot stock a complete1,000-bed hospital assembly that hadbeen shipped for the 26th General. Theequipment arrived several weeks beforethe hospital could be set up, and theneeds of operating units were too greatto permit the material to remain idle.For example, the first abdominal oper-

ation at the 21 st General Hospital afterthat unit was set up at the end of Decem-ber was performed "with three or fourborrowed clamps, a scalpel, and a pairof scissors."61

In the Eastern Base Section, a sectionof the 4th Medical Supply Depot set upa major supply base at Ain M'lilla, abouttwenty-five miles south of Constantine,on 19 March, with subdepots at Boneand Philippeville. This unit was relievedafter the close of the Tunisia Campaignby elements of the 7th Medical SupplyDepot, which also supplanted personnelof the 2d Medical Supply Depot atMateur. The latter group had served IICorps in the field during the activefighting, but had been reassigned to EBSin May.

The section of the 4th Medical SupplyDepot, which had gone to Sicily withSeventh Army,62 was reassigned to theIsland Base Section on 1 September. The4th continued to operate the supply baseat Palermo until late in October, whenthe function was transferred to the 1stAdvance Section of the 2d Medical Sup-ply Depot. In Corsica a supply dump forthe Northern Base Section was estab-lished at Ajaccio about 1 March 1944 bythe 7th Medical Depot Company.63

In general, medical supplies andequipment were adequate throughoutthe North African and Sicilian cam-paigns. Shortages in specific items, suchas prosthetic dental supplies and opticalequipment, were owing in part to in-

60 Except as otherwise noted, this section is basedon (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 inMTOUSA, pp. 1-49; (5) Rpts of individual medunits mentioned in the text.

61 Diary of Col Lee D. Cady62 See pp. 169-70, above.63 The 2d, 4th, and 7th Medical Supply Depots

were reorganized 3 December 1943 into medicaldepot companies, under TOE 8-661, dated April

1943.


adequacies in the original medical main-tenance units and in part to theunexpectedly high need for dentalreplacements and for glasses amongtroops sent to the theater. In the case ofprosthetic supplies, shortages in the zoneof interior further delayed the filling ofrequisitions, but supplies in both cate-gories were reaching Africa in sufficientquantities by the end of the year.

Shortages of various items reportedby hospital commanders were in partowing to the fact that many hospitalsreached the theater without all theirequipment, in part to breakage as a re-sult of faulty packing, and in part to thenecessity of operating above normalcapacity. The Tables of Equipmentthemselves were not entirely suitable tothe needs of the theater, but deficiencieswere quickly made up. Hospitals ar-riving during the first four or fivemonths, for example, did not have ade-quate generating equipment, but here,as in many other instances, the Corps ofEngineers made up the deficiencies.Ordnance and Quartermaster units werealso ready at all times to improviseequipment or to requisition missingitems for hospital use.

Another problem arose because somemedical officers, particularly surgeons,who were fresh from civilian practice,found it hard to adjust themselves tothe more limited range of equipmentit was possible to carry into a combattheater, and the items available did notalways correspond to individual prefer-ences in drugs and instruments. Thereis no evidence, however, that the medi-cal service rendered in North Africa wasever seriously curtailed or impaired forlack of supplies or equipment. Eventhose hospitals that were most distant

from supply points managed to get whatwas needed, by air if necessary.64

Where essential equipment was lack-ing, hospital staffs showed considerableingenuity in improvising substitutes.Cabinets and laboratory benches werebuilt of waste lumber; heating units,sterilizers, laundry equipment, andshowers were fashioned from emptygasoline drums and odd bits of pipe;soap was made from discarded kitchenfats; parts were salvaged from worn-outequipment and reused for the same orother purposes. In the cities it was some-times possible to procure local equip-ment, but more frequently equipmenthad to be made out of availablematerials. In Casablanca, for example,such items as wash basins, toilet bowls,and sinks were made with locally pro-cured cement.65

Theater Services of Supply

Supply and maintenance activities forU.S. forces in the theater were central-ized after mid-February 1943 in aNATOUSA Services of Supply organiza-tion, with headquarters at Oran. As inother theaters the Services of Supply inMTO was subordinate to theater head-quarters, but differed from comparableorganizations elsewhere in that it didnot control the fixed hospitals. The SOSmedical section was responsible only for

64 In addition to general sources cited above,see: (1) Hq, SOS, ETO, Impressions of MedicalService in NATOUSA, by Brig Gen Paul R. Haw-ley, Chief Surg, ETO; (2) Ltr, Lt Col Ryle A.Radke to TSG, 28 Apr 43, sub: Inspection of NorthAfrica and the United Kingdom; (3) Surg,NATOUSA, Journal, 16-21 Jul 43.

65 See especially unit rpts of the 26th and 45thGen Hosps, and the 7th and 35th Sta Hosps; Diaryof Col Cady. See also, Annual Rpt, Med Sec, ABS,1943.


medical supply. Lt. Col. Theodore L.Finley, formerly medical supply officerin ABS, headed the section briefly, beingsucceeded in May by Col. BenjaminNorris. Col. Charles F. Shook becamehead of the section in August. His oppo-site number in the NATOUSA medicalsection was Lt. Col. (later Col.) RyleA. Radke, who had first visited thetheater in February on an inspectiontour of supply installations and servicesfor The Surgeon General, and joined theNATOUSA staff on 18 July.66

In carrying out its supply functions,the SOS medical section requisitionedon the zone of interior and distributedthe supplies and equipment receivedamong the base sections and combat for-mations in the theater. Semimonthlystock reports submitted by the base sec-tions, and firsthand inspections, pro-vided a basis for adjustment betweendepots to ensure balanced stocks in allparts of the theater. As the staff of theSOS medical section was built up duringthe summer, its activities broadened toinclude statistical reporting and researchinto the actual consumption of medicalsupplies looking toward modification ofmaintenance factors. Shortages revealedwere made up by special requisitions onthe zone of interior, and overstocks weredisposed of by reshipment to the ZI, bytransfer to Allied Military Government,and by diversion to fill French lend-lease requisitions.

The theater medical supply level wasbased on a 30-day working supply and a

45-day reserve, plus a final reserve medi-cal unit consisting of a 90-day supply ofitems that might become critical inevent of blockade or siege. The finalreserve was discontinued in August 1943and taken into depot stock, resulting intemporary excesses in some categories.


The administration of the variousprofessional services of the Medical De-partment in the North African Theaterof Operations was centralized in theoffice of the surgeon, NATOUSA, andwas carried out through the appropriatesubsections of the medical section.

The Medical and SurgicalConsultants

In medicine and surgery the key fig-ures on the professional side were theconsultants. Lt. Col. (later Col. ) PerrinH. Long, recently of the Johns Hopkinsfaculty, assumed the duties of medicalconsultant on 3 January 1943. Before theend of the month, Lt. Col. Stuart F.Alexander joined Long's staff as consul-tant in chemical warfare and liaisonofficer with G-1. Early in June Capt.(later Lt. Col.) Frederick R. Hansonbecame consultant in neuropsychiatry,having acted in that capacity in factsince the southern phase of the TunisiaCampaign in March.67

The surgical consultant, Colonel

66 This section is based chiefly on: (1) Hist, MedSec, SOS, NATOUSA, Feb 43-Jan 44; (2) AnnualRpt, Med Sec, NATOUSA, 1943; (3) Rpt. MedSupply Activities NATOUSA, Nov 42-Nov 43, byLt Col Finley; (4) Munden, Administration of MedDept in MTOUSA, pp. 76-87. (5) Davidson, MedSupply in MTOUSA, pp. 21-27.

67 (1) Munden, Administration of Med Dept inMTOUSA, App. A, p. 212. (2) Perrin H. Long,M.D., "Mediterranean (Formerly North African)Theater of Operations," vol. I, Activities of Medi-cal Consultants, "Medical Department, UnitedStates Army," subseries Internal Medicine in WorldWar II (Washington, 1961) , ch. III. For Hanson'sactivities, see p. 145, above.


COLONEL STONE inspecting clothing of alice-infested Arab in Tunisia.

Churchill of the Harvard MedicalSchool joined the staff of the NATO-USA medical section on 7 March 1943.Colonel Churchill's office was enlargedshortly before the Salerno landings tomeet the increased demands of the Ital-ian campaign. At this time Maj. (laterLt. Col.) Fiorindo A. Simeone becameassistant to the surgical consultant; Maj.(later Lt. Col.) Henry K. Beecher be-

came consultant in anesthesia and resus-citation; and Maj. John D. Stewartbecame consultant in general surgery.Early in January 1944, in order to makefull use of the new drugs and techniques,Capt. (later Maj.) Champ Lyon becameconsultant in wound infections', chemo-therapy, and penicillin therapy. He wasassisted in the study of bacterial flora ofwounds and wound recovery by 2d Lt.Robert Rustigan.68

The consultants made frequent in-spections of medical installations withinthe theater. On the basis of their obser-vations and contacts, they kept thetheater surgeon informed as to profes-sional standards in medicine and sur-gery. They gave professional advice onthe management of patients, the pro-cedures to be followed at various eche-lons of medical service, and the mostsuitable assignments for specialists intheir respective fields in terms of profi-ciency, training, and experience. Theyalso reported on the incidence and na-ture of wounds and injuries occurringthroughout the theater.

Additional consultants were used atthe headquarters of the base sections andtactical commands. Some were assigned

within the Table of Organization, butit was the more normal practice to attachto the theater medical section as actingconsultants officers from various installa-tions, primarily hospitals, for the pur-pose of appraising and standardizingtechnical procedures within many of thesubspecialties of surgery and medicine.Thus, without having a large assignedstaff of specialists, the theater medicalsection was able to cover a wide range ofservice and study in both the broad sub-jects and the subspecialties.

II Corps, when operating independ-ently, and both Fifth and SeventhArmies had consultants assigned duringthe Tunisian, Sicilian, and Italian cam-paigns. Inspection of hospitals by theconsultants and other members of themedical staff, including the preventivemedicine officers, the medical inspector,

68 (1) Munden, Administration of Med Dept inMTOUSA. (2) Annual Rpt, Med Sec, NATOUSA,1943.


ITALIAN POW's DRAINING SWAMPY GROUND near Algiers as a malaria control measure.

and the theater surgeon, resulted in theestablishment of theater-wide profes-sional policies and procedures. Exchangeof information was facilitated by visitsto British as well as U.S. installations.

Preventive Medicine

The numerous health hazards thatwere likely to be encountered in NorthAfrica were fully appreciated while thecampaign was still in the planning stage.A preventive medicine subsection wasestablished under the medical sectionbefore Allied Force Headquarters leftLondon, and was carried over intoNATOUSA. The first preventive medi-cine officer, Maj. (later Lt. Col.) John

W. R. Norton, transferred to the Serv-ices of Supply organization in February1943. Colonel Long, the medical consul-tant, filled in until May when Lt. Col.(later Col.) Hugh R. Gilmore took overthe functions. Lt. Col. (later Col.)William S. Stone became preventivemedicine officer in August 1943 whenGilmore went to Fifth Army. Through-out the planning and early operatingphases the major problems anticipatedwere malaria, intestinal disorders, andvenereal diseases.

Malaria Control Measures—Early inJanuary 1943 a small British-Americanmalaria committee was named by Gen-eral Cowell to study the malaria problemand to recommend preventive measures.


The group was gradually enlarged toinclude Air Forces and Navy representa-tives and French malariologists familiarwith the local situation. On 20 Marchthe committee was reconstituted as theMalarial Advisory Board, AFHQ. Colo-nel Long headed the American group.69During the early months of 1943 an

Allied policy on malaria control wasworked out and measures initiated tocarry it into effect. Malaria control andsurvey units were requested to carry outdrainage and larviciding in mosquito-breeding areas but until the units ar-rived, Medical Corps and Sanitary Corpsofficers under supervision of base sectionmedical inspectors were made respon-sible for environmental control measures.In addition to this general approach, allmilitary personnel were to take atabrinetwice weekly beginning 22 April andcontinuing through November. Themen were to sleep under netting wher-ever it was feasible to carry such equip-ment, and those on outside duty at nightwere to wear gloves and head nets.Repellents were also to be issued to allpersonnel. Infested places, such aswooded and watered ravines, were to beavoided, as were native habitations. Atthe same time medical officers were to

be given refresher courses in diagnosisand treatment of the disease, and troopswere to be indoctrinated as to its cause,control, and gross manifestations.70

Entomological detachments of the10th and 13th Malaria Survey Units(MSU's) reached North Africa early inMarch, being assigned to MBS and ABS,respectively. Similar elements of the11th and 12th MSU's, arriving at aboutthe same time, were assigned to theCenter District and to EBS, but did notgo into operation until May, when therest of all four units reached the theater.The 2655th Malaria Control Detach-ment (MCD) was brought up fromRoberts Field, Liberia, in May, and wasgiven responsibility for control workaround Algiers. The 2655th MCD alsogave technical assistance to other malariaunits in the theater. By 1 July the 19th,20th, 21st, and 22d Malaria ControlUnits (MCU's) were also in North Af-rica. The 14th MSU and the 23d MCUarrived in September; the 28th and 42dMalaria Control Units joined theNATOUSA antimalaria forces in Octo-ber.71 Assignments were divided betweenthe base sections and the two armies inthe theater, units being shifted from onelocation to another in terms of need.

Col. Loren D. Moore, commandingofficer of the 2655th Malaria ControlDetachment, was named theater malari-ologist in June, with Colonel Andrewsof the same organization as assistantmalariologist. Colonel Moore was re-lieved in September by Col. Paul F.Russell. The theater malariologist wasresponsible for all malaria control activ-ities, including liaison with British and

69 (1) Perrin H. Long, Historical Survey of the Ac-tivities of the Section of Preventive Medicine,Office of the Surgeon, NATOUSA, 3 January to15 August 1943. Except as otherwise noted, thissection is based on the above document and on thefollowing: (2) Annual Rpt, Asst Malariologist,NATOUSA, 1943; (3) Justin M. Andrews, "NorthAfrica, Italy, and the Islands of the Mediterranean,"vol. VI, Communicable Diseases, Malaria, "MedicalDepartment, United States Army," subseries Pre-ventive Medicine in World War II (Washington,1963), ch. V; (4) Annual Rpt, Med Sec,NATOUSA, 1943; (5) Rpts of the base sections for1943; (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.


French authorities, and for the directionof all organizations and personnel en-gaged in such work. This control ex-tended to airplane crews engaged in thedusting of breeding places. The malariaprogram was thus highly centralized atthe theater headquarters level. Imple-menting the program was a commandresponsibility, delegated by the Com-manding General, NATOUSA, to theCommanding General, Services of Sup-ply, and the base section commanders,who were periodically reminded of theirroles in the control of the disease. At thesame time, Colonel Russell used everymedium the theater afforded to educatemedical personnel in the fundamentalsof malaria control.72

Malaria control in North Africa andSicily during the period of greatest troopconcentration was only moderately suc-cessful. Experience with atabrine hadnot been extensive enough to yield posi-tive knowledge of the quantity to beadministered or the frequency withwhich it should be taken, and the entiresuppressive therapy program received arude jolt from the violent reaction thatgenerally followed the third dose, taken30 April 1943. Men who were alreadyreluctant avoided taking the drug when-ever they could, with results that wereall too evident in the morbidity figuresfor the Sicily Campaign.73

Other factors in the comparativelypoor showing of the first year in theMediterranean were the late arrival ofthe malaria control units, which did notget into effective operation until thebreeding season was well advanced; acontinuous shortage of trained malari-

ologists; and numerous competing de-mands on engineering manpower, whichdelayed drainage work and forced vari-ous improvisations. The groundworkwas nevertheless laid for an effectivecontrol program in the 1944 and 1945seasons, in the equally malarious Italiancommunications zone.74 In the Mediter-ranean as a whole, noneffectiveness fromthe disease was never great enough tothreaten the success of any military oper-ation.

Diarrhea and Dysentery—North Africawas a region, to quote the NATOUSAconsultant in medicine, "in which thenative considered practically everysquare foot of ground a privy."75 Flieswere so thick in parts of Tunisia that itwas risky business to open one's mouthto speak.76 Water was scarce and likelyto be contaminated. These conditionsmade diarrhea and dysentery extremelyprevalent.

Among troops from countries such asthe United States and Great Britain,where sanitation is taken so much forgranted that the individual feels littlepersonal responsibility for it, outbreaksof these diseases were probably inevi-table. They reached major proportionsin May, June, and July 1943, affectingespecially units newly arrived in thetheater and Tunisian veterans whotended 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 thecombat zones is treated in the chapters dealing withcombat operations.

75 Long, Hist Survey of Preventive Medicine. Thisreport and Annual Report Medical Section,NATOUSA, 1943, are the primary sources for thissection.

76 Brig. Gen. Albert W. Kenner, "Medical Servicein the North African Campaign," Bulletin U.S.Army Medical Department (May 1944), pp. 83-84.


It was apparent that sanitary disciplineamong U.S. troops was poor, but sanita-tion improved rapidly once an organiza-tion had been "burned." Line officers,as a rule, needed only one demonstrationto remind them of their responsibilitiesin this regard.

Another factor in the high diarrheaand dysentery rates in the summer of1943 was the shortage of certain neces-sary equipment. Screening for mess halls,kitchens, and latrines was not in ade-quate supply until August. Halazonetablets for water purification by individ-uals were not always available in suffi-cient quantity, while facilities for boilingwater to cleanse mess kits were inade-quate for most of the year.

Although both diarrhea and dysenterycontinued to plague troops under com-bat conditions, they had ceased to be acommunications zone problem by thelate months of 1943.

Venereal Diseases—Venereal diseaseswere widely prevalent in North Africaand Sicily, and the opportunities forcontact were numerous. A full-timevenereal disease control officer, Lt. Col.Leonard A. Dewey, was added to thestaff of the NATOUSA preventive medi-cine section early in March 1943, and amonth later similar officers were assignedto each of the base sections and to themajor combat units, II Corps, FifthArmy, and Twelfth Air Force.77

The initial control procedure in alloccupied areas was to allow troops tohave access to some or all of the localbrothels, and to establish prophylacticstations in the immediate vicinity. Afterextensive trial, during which there ap-peared to be no decrease in the numberof contacts made outside the houses, allbrothels were placed "off limits," with anoticeable decline in the VD rate.

Both mechanical and chemical pro-phylactic kits were always available ex-cept for brief intervals in certain forwardareas, although the chemical kit wasfound to be of little value. Considerabledifficulty was experienced, however, insecuring sufficient competent personnelto operate "pro" stations in the numer-ous areas accessible to U.S. troops. Hos-pitals and other medical units were theusual sources of such personnel, but theheavy load being carried by all medicalinstallations in the North African com-munications zone precluded the detach-ment of enough trained men for thepurpose. During the last phase of theTunisia Campaign the clearing companyof the 1st Battalion, 16th Medical Regi-ment, operated a venereal disease diag-nostic and treatment hospital south ofConstantine.

Other Preventive Medicine Prob-lems—Aside from the special problemsdiscussed in the preceding pages, therewere no serious outbreaks of preventablediseases in North Africa or Sicily beforethe scene of primary activity shifted to

77 Main sources for this section are: 1st AnnualRpt, Med Sec, NATOUSA, 1943; (2) Pers Ltr,Maj Gen James C. Magee, TSG, to Kenner, 1 Mar43; (3) Ltr, Lt Col Leonard A. Dewey to Surg,NATOUSA, 9 Apr 43, sub: Rpt of Inspection ofVenereal Disease Control Facilities in MBS andABS; (4) Ltr, Dewey to Surg, NATOUSA, 11 May43, sub: Trip Rpt to MBS, ABS, and Hq, FifthArmy; (5) Ltr. Dewey to Standlee, 22 Jul. 43, sub:Problems in Venereal Disease Control inNATOUSA; (6) Ltr, Gen Blesse, Surg, NATOUSA,

to Deputy Theater Commander, NATOUSA, 11Aug 43, sub: Off Limits for Houses of Prostitutionas a Venereal Disease Control Measure; (7) Ltr,Dewey to Surg, NATOUSA, 20 Oct 43, sub: Rptof Inspection of Venereal Disease Control andTreatment Problems in the Palermo Area, Oct 13to 17.


the Italian peninsula. Some 16,000 casesof infectious hepatitis reported during1943 among U.S. Army personnel led tointensive study of the disease, which ap-peared considerably more prevalent inTunisia and Sicily than in Algeria orMorocco, but, except for the last threemonths of 1943, the rate was not exces-sive. Cases did not exceed 7 per 1,000per year until September, climbingrapidly to 108 in November and declin-ing to 71 the following month.78

Although always a potential threat inthe Mediterranean, only twenty cases oftyphus were reported among U.S. per-sonnel in the theater during 1943. Anoutbreak of the disease in Naples towardthe end of the year is discussed else-where.79 Preventive measures includeduse of insecticide powders to controlbody insects, and delousing of clothing.Malaria control and survey units weretrained in mass delousing methods, aswere combat medical units and operat-ing personnel of prisoner-of-war camps.The Rockefeller Typhus Team aidedmaterially in demonstrating powderingmethods.

While respiratory diseases accountedfor a larger number of cases than anyother cause—63,899 in 1943—the over-whelming bulk of these were mild in-fections, following nonepidemic seasonaltrends and not seriously affecting mili-tary efficiency.80

The Reconditioning Program

Early in 1943 the 21st General Hospi-tal at Sidi Bou Hanifia near Oran inau-gurated a reconditioning program for itsconvalescent patients, under which phys-ical therapy was supplemented by lightwork in and around the hospital. Whilethe program worked reasonably well, itposed a serious problem of control as thepatients neared the time of discharge.A similar but more difficult problem wasencountered at the 2d Convalescent Hos-pital, after that unit was set up in Febru-ary, because of the smaller number ofofficers in proportion to patients. Froma disciplinary point of view, it was sim-ply impossible for a second lieutenant ofthe Medical Administrative Corps tocontrol a convalescent company of 500combat wounded men. In the line, evena major would not be expected to con-trol that many men without a completestaff.81

The problem had become acute bythe end of the Tunisia Campaign. InJune the Commanding General, Medi-terranean Base Section, authorized theestablishment of a Provisional Condi-tioning Battalion of four companies with175 men each, to be operated by the2d Convalescent Hospital. Lt. Col.Lawrence M. Munhall, a field artilleryofficer who was a patient in the hospitalwas detailed to command the battalion,which came to be known as the CombatConditioning Camp. Patients were usedas a training cadre, in a course lastingthree weeks. At the end of this time, the

78 (1) Annual Rpt, Med Sec, NATOUSA, 1943(2) Rpt on Study of Epidemic Hepatitis inTunisia, by Maj Guy H. Gowan. More serious out-breaks of hepatitis occurred among Fifth Armytroops in Italy. See pp. 256-57, 513, below.

79 Annual Rpt, Med Sec, NATOUSA, 1943. Seepp. 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, withLt Col Lawrence M. Munhall, 28 Jun 45. (3)Clift, Field Opns, pp. 397-99.


men were transferred to a replacementcenter.82

The Surgeon General, Maj. Gen.Norman T. Kirk, visited the theater inJune 1943 and took cognizance of theproblem. He undertook to have a Tableof Organization for a convalescent cen-ter, similar to those operated by theBritish, prepared in his office. The unitswere to be set up near parent generalhospitals. In line with the Surgeon Gen-eral's directions, British convalescentfacilities were visited to study theirorganization and operations.83

As a result of these various approachesto the problem, the Combat Condition-ing Camp of the 2d Convalescent Hospi-tal was activated as the 6706th Condi-tioning Company Pool on 1 November1943, with its own Table of Organiza-tion. It was thus cut off from the hospitalentirely and was moved to a new areaabout a mile away, where it remaineduntil it was transferred to Italy in thespring of 1944. All patients in need ofreconditioning on discharge from thehospital were transferred to this unit,which remained under command of Col-onel Munhall.84

A similar reconditioning center forthe Eastern Base Section was set up atthe 105th Station Hospital in Ferryville.Normally a 500-bed unit, the 105th Sta-

tion became an acting convalescenthospital in September 1943 and by Janu-ary 1944 had a census of 2,500 patients.In order to control these men and torestore as many as possible to active duty,an EBS Conditioning Center was set upunder command of Col. Gerald P. Law-rence, including both the hospital and areplacement battalion. As rapidly astheir physical condition permitted, themen were placed in one of four trainingcompanies, physically removed from thehospital and its atmosphere. While medi-cal officers kept close check on "trainees"as they were now called, the primarysupervision was by personnel of the re-placement battalion. The EBS Recon-ditioning Center declined in importancewith the decline of the base section andwas closed out early in May, havinghandled 5,000 trainees in threemonths.85

Dental Service

The chief dental officer for the NorthAfrican theater was Lt. Col. (later Col.)Egbert W. D. Cowan until the end ofFebruary 1943, when personnel limits inthe NATOUSA medical section necessi-tated his transfer to the Services of Sup-ply. Colonel Cowan returned to his oldassignment on 1 June, when the positionof dental surgeon was authorized for themedical section of theater headquarters,but was assigned to Fifth Army in Au-gust. He was succeeded as NATOUSAdental 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 ConvHosp, 1943.

83 (1) Memo, Col Stone to Gen Blesse, 7 Aug 43.(2) Ltr, Maj James H. Townsend and Capt LewisT. 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 Recommen-dations. By Col Lawrence, 14 Apr 45.

86 Annual Rpt, Med Sec, NATOUSA, 1943.


the dental surgeon were primarily ad-ministrative and supervisory. He was re-sponsible for the provision of adequatedental service to all military personnelwithin the jurisdiction, which in 1943was a considerable undertaking. Therewere 310 dental officers in the NorthAfrican theater at the end of January1943 and 703 at the end of December,but this increase in numbers was pro-portionately less than the over-all rise introop strength. In January there was onedental officer for each 740 military per-sonnel; in December only one for each861.

The problem was further complicatedby the presence of a considerable num-ber of units with no dental officer intheir T/O's. These units were given out-patient care by Army hospitals whensuch were available, but where no hospi-tal was established in the vicinity, it wasnecessary to detach dental personnel fortemporary duty with the unit.

The drastic lowering of dental stand-ards for induction into the Army during1942, reaching the irreducible minimumin October just before the TORCH opera-tion was launched, put a severe and un-expected strain on the facilities of thetheater. In the troop build-up of 1943,numbers of men reached North Africawith insufficient teeth to masticate theArmy ration, but prosthetic equipmentfor dealing with these cases was not avail-able until late in the year.87

The dental service in the theatershowed progressive improvement witheach campaign as personnel gained ex-perience and facilities came to corre-spond more closely with needs.88

Veterinary Service

The veterinary section of theNATOUSA medical organization wasslow in getting started. The first theaterveterinarian, Lt. Col. (later Col.) SolonB. Renshaw, served only from December1942 through February 1943. He wastransferred at that time to SOS, NAT-OUSA, because there was no provisionfor a veterinarian in the limited allot-ment of personnel to the medical sec-tion. The position of theater veterinar-ian was approved late in April 1943,but was not filled until February 1944,when Col. James E. Noonan was as-signed.89

A group of twelve veterinary officersarrived in the theater in September, hav-ing been requested by the quartermasterfor inspection work in connection withlocal slaughterhouses, but until this pro-gram got under way, they were assignedto replacement pools and used for tem-porary duty. Since there was no centralorganization for placing veterinary per-sonnel where they were needed, a con-siderable amount of waste was entailed,with some impairment of morale.

There was also a disproportionately

87 (1) Ibid. (2) Col George F. Jeffcott, UnitedStates Army Dental Service in World War II, "Med-ical Department, United States Army" (Washing-ton, 1955), pp. 211-12. (3) Ebbe Curtis Hoff, M.D.ed., Personal Health Measures and Immunization,"Medical Department, United States Army" sub-series Preventive Medicine in World War II(Washington, 1955), p. 4.

88 For dental service in combat operations seethe chapters devoted to specific campaigns.

89 (1) Mundon, Administration of Medical Deptin 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 WorldWar II (Washington, 1961).


high loss of food items through improperpackaging, handling, and storage, whichcan be attributed only in part to thegreater activity of the Mediterranean ascompared with other theaters of opera-tion. The comparative weakness of theveterinary service in NATOUSA wasclearly apparent by the end of the year,when positive steps were taken to reor-ganize veterinary activities at theaterand base section levels. 90

Nursing Service

Until 14 August 1943, when the posi-tion of Director of Nurses, NATOUSA,was created, the chief nurse of the Medi-terranean Base Section, 2d Lt. (later Lt.Col.) Bernice M. Wilbur acted in thatcapacity. Colonel Wilbur became direc-tor of nurses when the position was setup. She made regular inspections ofnursing activities throughout the thea-ter, advised the surgeon as to policy mat-ters, and recommended assignment andtransfer of nursing personnel.91

Nurses began arriving in the theateron 8 November 1942, D-day for theNorth African landings. There weremore than 2,000 by the end of the Tuni-sia Campaign, with a peak strength of4,398 in October 1943. This figure haddropped to 4,000 by the end of January1944, owing to the transfer of three evac-uation hospitals and an auxiliary surgi-

cal group to the European theater inNovember.

While the number of nurses in theNorth African theater was adequate interms of hospital T/O's, the recurrentnecessity for operating above normal bedcapacity brought considerable strain onthe nursing service. Wherever possiblenurses from staging units were detachedfor temporary duty with operating hos-pitals. After October 1943, when therequired authority was received fromthe War Department, promotions weremade to raise half of all front line nursesto the rank of first lieutenant.

Training was a continuous process,with frequent changes in assignment toassure proper balance of specialties. Theonly severe shortages during the activeperiod in the North African communi-cations zone were nurses trained inanesthesia and in psychiatry. To makeup these shortages, several general hospi-tals gave individual training in anesthe-sia, while a school of psychiatric nursingwas conducted by the 114th StationHospital. The courses ran for 6 weeks,taking fifty nurses at a time. Threeclasses completed the training during1943. Twenty-four British nurses tookthe course.

Army Public Health Activities

Allied Force Headquarters as origi-nally organized in London in the sum-mer and early fall of 1942 included acivil affairs section, which combinedwith its military functions others of apolitical, diplomatic, and economic na-ture. It was headed after the invasionby Robert Murphy, the principal U.S.diplomatic representative in FrenchNorth Africa. Public health activities

90 (1) Memo, Col Noonan to Surg MTOUSA, 11Apr 45. (2) Ltr, Lt Col (later Col) Duance L.Cady to Surg, NATOUSA, 21 Dec 43, sub: In-vestigation and Survey of Veterinary Activities inNATOUSA.

91 Annual Rpt, Med Sec, NATOUSA, 1943. Seealso, Maj Anne F. Parsons, and others, MS, Historyof the Army Nurse Corps in the MediterraneanTheater of Operations, 1942-1945.


were administered by a subsection of thecivil affairs section.92

The situation in North Africa waswithout precedent. The political objec-tives, and to a considerable extent themilitary objectives as well, demandedthat the local population be treated asallies. Civil officials were not always cor-dial, and co-operation was often grudg-ing, but in the public health areaespecially it was essential for the protec-tion of American forces that elementarysanitary measures be extended to thecivilian inhabitants.98

At Mr. Murphy's request, three UnitedStates Public Health Service doctorswere detailed to AFHQ late in February1943 and assigned on their arrival amonth later to the nominally independ-ent North African Economic Board.Shortly thereafter they were attached tothe office of the NATOUSA surgeon, toserve as liaison between that office andthe local health authorities. Another doc-tor and a sanitary engineer joined thegroup in July.94

Before the arrival of the PublicHealth Service officers, representativesof the U.S. component of the medicalsection, AFHQ, had met with Frenchofficials and had agreed upon supplies tobe furnished, particularly for control ofmalaria and such potential threats as

cholera and typhus. The surgeons of theMediterranean and Atlantic Base Sec-tions also maintained informal liaisonwith local health authorities. After theattachment of Public Health Servicerepresentatives to the NATOUSA sur-geon's office, the over-all direction of acivil public health program passed tothem, but Army personnel continued toplay the dominant role in carrying outsuch measures as were required.95

By the date of the invasion of Sicily,a special organization for Allied Mili-tary Government of Occupied Territory(AMGOT) had been set up under aBritish major general, Lord Rennell,who was also chief civil affairs officer onthe staff of the Allied Military Governorof Sicily, General Alexander of the 15thArmy Group. The senior civil affairsofficer of Seventh Army, Col. Charles A.Poletti, headed a group of seventeencivil affairs officers who went in with theinvasion forces, setting up military gov-ernment organizations behind the ad-vancing troops. The principal U.S. pub-lic health officer for the Sicily Campaignwas Maj. (later Lt. Col.) Leonard A.Scheele. Major Scheele participated inthe planning for the Sicilian operation,serving as executive officer and later asdeputy to Col. D. Gordon Cheyne, theBritish officer in charge of public healthactivities for the 15th Army Group. Inthe latter capacity, Scheele succeededCol. (later Brig. Gen.) Edgar Erskine92 (1) Robert W. Komer, MS, Civil Affairs and

Military Government in the Mediterranean Thea-ter, ch. I, in OCMH files. (2) Harry L. Coles andAlbert Weinberg, Civil Affairs; Soldiers BecomeGovernors, UNITED STATES ARMY IN WORLDWAR II (Washington, 1963).

93 For the attitude of French officials, see Eisen-hower, Crusade in Europe, pp. 111-12.

94 Ralph C. Williams, The United States PublicHealth Service, 1798-1950 (Washington, 1951), pp.

95 (1) Annual Rpt, Med Sec, NATOUSA, 1943.(2) Long, Hist Survey of Activities of Section of Pre-

ventive Medicine, Off of Surg, NATOUSA, 3 Jan-15Aug 43. (3) Surg, NATOUSA, Journal, 12, 17 Aug, 6

Sep 43. (4) Hutter, "Medical Service of the Mediter-ranean Base Section, Military Surgeon (January1945). PP. 41-51.


Hume, who was to accompany FifthArmy to Italy.96

In both Africa and Sicily, Medical De-partment officers assigned to AMGOTworked to restore local public healthdepartments, to rebuild water and sew-erage systems, and revitalize normal pub-lic health services. Local officials werereinforced by Army medical personneland supplies wherever necessary to pro-tect the health of troops in the area.Among the problems commonly dealtwith were sanitation, threatened epi-demics, care of destitute refugees, andthe control of such ever-present scourgesas malaria and venereal disease.97

Public health officers at the theaterlevel made surveys to determine thestatus of hospital facilities, the need formedical supplies for relief purposes, thenutritional needs of the population, thepresence of epidemic diseases, and thepossibility of the introduction of newdiseases by insect vectors on planes andby returning refugees. As combat opera-tions by the Allies produced relativelylittle devastation in the French coloniesin North Africa, U.S. Army participationin the public health program in theseareas was largely limited to aid given bya few men trained in public health workto the French authorities after the cessa-tion of hostilities.96 (1) Komer, Civil Affairs and Military Govern-

ment in the Mediterranean Theater, ch. II. (2)Williams, The United States Public Health Service,pp. 698-99. (3) Ltr, D. Gordon Cheyne toDCCAO, 4 Jul 43, sub: Territorial Assignment ofPublic Health Div Personnel.

97 See: (1) Ltr, Col Long to Surg, NATOUSA, 27

Mar 43, sub: Rpt on the Sessions of the Committeeon Hygiene and Epidemiology Technical Sectionfor Public Health, French High Commissionerof North Africa; (2) Proceedings of Public HealthMeeting, 13 Aug 43.

CHAPTER VI

Salerno to the Gustav Line

By 10 July 1943, when the invasion ofSicily was launched, Lt. Gen. Mark W.dark's Fifth Army had been training inNorth Africa for six months without anyspecific objective. Alternative plans hadbeen prepared for operations againstSardinia and for landings at variouspoints in southern Italy, but a finalchoice was deferred until the end of theSicily Campaign was in sight. The suc-cessful bombing of Rome on 19 Julyhelped tip the scales in favor of the Ital-ian mainland. The Combined Chiefs ofStaff approved Operation AVALANCHEfor the Naples area on 26 July, the dayafter the fall of Mussolini.1 The site was

eventually narrowed to Salerno and thetarget date fixed as 9 September.

The Italian campaign was never anend in itself. It was not intended tostrike a decisive blow at Germanythrough the back door. Two of its pur-poses were to tie down enemy troops andacquire additional bases for air attackson German centers of production andcommunications. After strategic air basesin southern Italy were secured, thecampaign would become a giant holdingoperation, the success of which wouldbe measured not in territory gained butby the size of the enemy force immobi-lized. It was recognized from thebeginning that Italy would require ap-preciable quantities of food, clothing,fuel, and medical supplies to maintainher civilian population. The anticipatedgains nevertheless appeared to outweighthis additional logistical burden.2

As in earlier Mediterranean cam-paigns, operations in Italy were to em-ploy both American and British troops.The invading force was again to be the15th Army Group, under command ofGeneral Alexander, although Fifth

1 General sources for the Salerno-Gustav Linecampaigns 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 (Flor-ence, Italy: L'lmpronta Press, 1945; (2) ChesterG. Starr, ed., From Salerno to the Alps; A Historyof the Fifth Army, 1943-1945 (Washington: In-fantry Journal Press, 1948); (3) AMERICANFORCES IN ACTION, Salerno; American Opera-tions from the Beaches to the Volturno (Washing-ton, 1944), From the Volturno to the Winter Line(Washington, 1944), and Fifth Army at the WinterLine (Washington, 1945); (4) Craven and Cate,eds., Europe-TORCH to POINTBLANK; (5)Morison, Sicily-Salerno-Anzio; (6) Field Marshalthe Viscount Alexander of Tunis, "The AlliedArmies in Italy from 3rd September, 1943, to 12thDecember, 1944," Supplement to the London Ga-zette, 6 June 1950, pp. 2879-2918; (7) Mark W.Clark, Calculated Risk (New York: Harper andBrothers, 1950), pp. 183-282, 311-33; (8) Truscott,Command Missions; (9) Eisenhower, Crusade inEurope; (10) Kesselring, A Soldier's Record; (11)S. Sgt. Richard A. Huff, ed., The Fighting Thirty-sixth (San Angelo, Tex: Newsfoto Publishing Co.,

1946), unpaged; (12) Taggart, ed., History of theThird Infantry Division in World War II; (13)Dawson, ed., Saga of the All American; (14) TheFighting Forty-fifth; (15) Howe, 1st Armored Di-vision.

2 (1) Clark, Calculated Risk, p. 3. (2) ArmyService Forces, Final Report, Logistics in WorldWar II (Washington, 1947), p. 39. (3) LogisticalHistory of NATOUSA-MTOUSA, pp. 331-40.

SALERNO TO THE GUSTAV LINE 223

Army would replace Seventh Army withsome reshuffling of combat elements.Montgomery's British Eighth Armywas to cross the Strait of Messina andmove over the instep of the Italian bootto seize the important Foggia air base onthe Adriatic side of the peninsula. Clark'sFifth Army was to expand northwardfrom the Salerno beachhead to occupythe vital port of Naples. Operations inItaly thereafter would be determined bycircumstances and by Allied strategy forthe war as a whole.

Fifth Army was to consist initially oftwo corps, one British and one Ameri-can. The British 10 Corps, commandedby Lt. Gen. Sir Richard L. McCreery,included an armored and 2 infantrydivisions, augmented by 2 Commandounits 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. Theassault troops were to be the British46th and 56th Infantry Divisions, theCommandos, the Rangers, and theAmerican 36th Infantry Division, thelast without previous combat experiencebut fresh from intensive training in bothamphibious and mountain warfare.

Two regimental combat teams of the45th Division, which had been divertedto Fifth Army midway through theSicily Campaign, were to constitute afloating reserve. The 34th, which hadseen hard fighting in Tunisia, and the3d, which had participated in the TORCHlandings and fought throughout the cam-paign in Sicily, were to be brought in asrapidly as shipping became available.The British 7th Armoured and the U.S.1st Armored Divisions were to be heldback for later use, when terrain andcircumstances warranted.

Medical Plans for AVALANCHE

Fifth Army was activated on 5 Janu-ary 1943, with headquarters at Oujda,French Morocco. It was the first Ameri-can field army organized overseas duringWorld War II. The medical section,drawn in part from personnel of thetask forces and in part from the UnitedStates, was initially headed by GeneralBlesse. Col. (later Maj. Gen.) JosephI. Martin became Fifth Army surgeon inApril when Blesse became Surgeon,NATOUSA.3

By way of preparation for its still un-specified mission, Fifth Army establishedvarious specialized training centers, in-cluding the Invasion Training Center atArzew, Algeria, devoted to amphibioustactics. Medical personnel participatedin all training exercises. The surgeonand members of his staff made frequentinspections of medical operations in thetheater, including observations of com-bat on the Tunisian front. From timeto time members of the medical sectionwere placed on temporary duty with theBritish First and Eighth Armies in Tu-nisia in order to study the organizationof the British medical service and itsmethods of hospitalization and evacua-tion.

Medical planning for the Salerno as-sault was directed by Colonel Martin,with Col. Jarrett M. Huddleston, the VICorps surgeon, participating in mattersaffecting the corps. A British medicalofficer representing 10 Corps was detailedto the planning group, and close liaison

3 Except as otherwise noted, sources for this sec-tion 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.


GENERAL MARTIN

was maintained throughout with themedical section of Allied Force Head-quarters. With certain important varia-tions, the plans for medical service inItaly followed those carried out inSicily.

Combat Medical Service

In addition to the medical detach-ments and medical battalions organic tothe divisions committed, plans for theItalian campaign called for the use ofone ambulance company and four medi-cal battalions to be controlled by VICorps. One of these—the 261st Am-phibious Medical Battalion, speciallytrained for beach operations—could notbe spared from Sicily and the 52d wassubstituted. The other separate medicalbattalions on the original troop list werethe 54th, the 161st, and 162d.

The two latter units were reorganizedjust before the Salerno operation fromthe 1st and 2d Battalions, respectively,of the 16th Medical Regiment, whichwent out of existence at this time. Bothbattalions had seen combat service inTunisia. Only the 162d was scheduledfor the D-day convoy, so that it alonewas organized into three collecting-clear-ing companies on the Sicilian model. Itwas the 162d Battalion that drew thebeach assignment.

If this combat medical support seemsinadequate in comparison to that em-ployed in the Sicily Campaign, it mustbe remembered that the Salerno assaultwas to be made over only one relativelynarrow beach and that only two Ameri-can divisions were to be used, in con-trast to the 4-division, multiple-beachassault in Sicily. A difference of emphasisin the plans for Italy would also bringevacuation hospitals into action at anearlier stage of the fighting. As was truein the Sicilian operation, all medicalunits to be employed in the Salernolandings were given rigorous trainingin amphibious warfare, along with thecombat elements they were to serve.

The combat medical units were to besupported by elements of the 4th Medi-cal Supply Depot on the D-day convoy.In addition to the regular maintenanceallowances, medical personnel in theassault were to carry extra supplies ofcritical items such as plasma, litters,blankets, atabrine, plaster of paris, dress-ings, and biologicals. Medical supplies inspecially designed containers were alsoto be carried ashore by the combattroops. Developed at the Fifth Army In-vasion Training Center, these containerswere made from empty mortar shellcases, were waterproof, and would float


easily. Maximum weight was seventypounds.

Hospitalization

Plans for hospitalization, both in theassault phase and in subsequent stagesof the campaign, took full account ofdelays and deficiencies in bed strengthexperienced in previous Mediterraneanoperations. As in Sicily, each division(except airborne) was to be supported

by one 400-bed evacuation hospital. Thenumber of 750-bed evacuation hospitalsassigned to Fifth Army, however, wasdouble the previous allowance of onefor each two divisions. General Blesse,who had been willing to abandon the750-bed evacuation altogether after thecampaign in southern Tunisia, had cometo regard it as a most valuable unit whenproperly used.4 In addition, four fieldhospitals, and a fifth less one platoon,were scheduled for the use of U.S.ground forces in Italy.

The 400-bed evacuation hospitals onthe Fifth Army troop list were the 15th,with combat experience in both Tunisiaand Sicily; the 93d, with Sicilian experi-ence; and the 94th and 95th, both ofwhich had served as fixed units in Africa.The 750-bed evacuation hospitals werethe 38th, with Tunisian experience; andthe 8th, 16th, and 56th, all of which hadoperated as fixed hospitals in the thea-ter. Field hospitals on the troop listwere the 4th, less one platoon, with ex-perience in the Middle East; the 10thand 11th from Sicily; and the 32d and33d, direct from the United States. The3,000-bed 3d Convalescent Hospital was

also assigned to Fifth Army for duty inthe combat zone.

These mobile units were to be followed into Italy within 45 days by six500-bed station hospitals and four 1,000-bed generals. The troop list also calledfor the early arrival of a general dispen-sary, a food inspection detachment, ahospital train, 2 medical laboratories, 2medical supply depots, and 3 malariacontrol units.5

The troop list thus called for 9,500mobile beds and 7,000 fixed beds, to bephased in as rapidly as the progress ofthe campaign and the availability ofshipping permitted. Beyond this pointthe preinvasion planning did not extend.The further build-up of hospitals inItaly would be determined by events.

The pattern for the use of mobilehospitals laid down in plans for thebeach interlude of the Italian campaigndiffered sharply from the plans followedin Sicily. In the earlier campaign, fieldhospital platoons with attached surgicalteams had gone in with the D-day con-voy, but no evacuation hospitals hadbeen sent to Sicily before D plus 4. Inthe Italian plans, nine teams of the 2dAuxiliary Surgical Group were to be inthe assault wave, attached to the divi-sional clearing platoons and to the beachbattalion. Field hospitals were scheduledfor later convoys, to be used only afterthe beachhead was secure; but two evac-uation hospitals, the 95th (400 beds)and the 16th (750 beds), without theirnurses, were to be on the D-day convoy.The nurses were to come on D plus 2.

In spite of the emphasis on the earlyprovision of adequate hospitalization inItaly, it would still be necessary for

4 Col T. H. Wickert, Rpt of Visit to ETO andNATOUSA, 1 Sep to 24 Oct 43. 5 See pp. 327ff., below.


hospitals in the Bizerte-Tunis area tocarry the primary burden until sufficientfixed beds could be established on thepeninsula. The Eastern Base Section wasdirected accordingly to make 450 bedsa day available from D plus 4 throughD plus 30. Corresponding arrangementswere made to shift patients to the Con-stantine, Oran, and Casablanca areas toprovide the needed beds.6

Evacuation

Plans for evacuation from the Salernobeachhead followed the Sicilian pattern.The Navy was again to be responsiblefor personnel on naval vessels betweenports of embarkation and the high-watermark on the landing beaches. During thefirst three days of the operation, Ameri-can casualties were to be evacuated toNorth Africa on troop transports, incare of naval medical personnel, butLST's with Army medical attendantsaboard would also be available ifneeded.7 Thereafter, hospital ships wereto be used, under direct control of AlliedForce Headquarters. Two British hospi-tal ships were to begin evacuation fromU. S. beaches at dawn on D plus 3, and athird British vessel was to follow twenty-four hours later. The casualties in eachcase were to go to Bizerte. On and after Dplus 5, hospital ships were to be dis-patched to Italy on request of FifthArmy, and routed back to such North

African ports as AFHQ might desig-nate.8

Air evacuation was also to follow thegeneral pattern used in Sicily, with the802d Medical Air Evacuation TransportSquadron again drawing the assignment.This time, however, litters and blanketswere given top priority on air transportsfrom North Africa and Sicily, ratherthan being left for slower and less cer-tain transportation by water. Air evac-uation was to start as soon as suitablelanding fields were available, tentativelyforecast for D plus 7.9

Medical Support in theConquest of Southern Italy

Salerno Beachhead

The Salerno landings took place asplanned on the early morning of 9 Sep-tember 1943. The surrender of Italy, an-nounced over radio to the troops of FifthArmy and to the world by General Eisen-hower a few hours earlier, in no waylessened the hazard of the operation.Veteran German troops, including ar-mor and heavy guns, were alreadyalerted in the area, with reinforcementsclose at hand. Mine fields held the trans-ports twelve miles offshore and forcedloaded landing craft to stand by forhours at their assembly points whilechannels were being cleared. All of theassault 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 en-listed men from the Medical Department. Theofficers were detached from the 23d General Hos-pital, then staging at Casablanca, and the enlistedmen were drawn from a replacement depot in theEastern Base Section. Surg, NATOUSA, Journal,24 Aug 43.

8 The Italian Campaign, Western Naval TaskForce: Action Rpt of the Salerno Landings, Sep-Oct 43, pp. 213-16.

9 (1) Med Hist, 802d MAETS, 1942-44. (2) MedHist, Twelfth Air Force.

10 (1) The Italian Campaign, Western Naval TaskForce: Action Rpt of the Salerno Landings, Sep-Oct 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.


The first U.S. combat teams ashore,the 141st and the 142d, met stiff opposi-tion. One battalion of the 141st waspinned down on the beach for more thantwelve hours, but other elements of the36th Division advanced inland up tothree miles. Similar gains were made inthe British sector, with Ranger spear-heads on the extreme left flank pene-trating as far as five miles. The first day'sfighting included German tank attacksagainst infantry positions. As in Sicily,the tanks were turned back by bazookas,grenades, and accurately directed firefrom naval guns, as well as by artillery.

Medical Service in the Assault—Col-lecting companies of the 111 th MedicalBattalion, organic to the 36th Division,were split for the assault into three sec-tions, each consisting of one medicalofficer and twenty-two litter bearers.One section accompanied each battalionlanding team, working directly with per-sonnel of the battalion aid station. Forthe first several hours of combat, medicscould do little more than administerfirst aid. Casualties were left in ditchesand foxholes, or behind dunes—where-ever cover of any sort could be found—until darkness made it possible to movethem. Two of the three collecting com-panies of the 111th were assembled bylate afternoon and set up their stationson the fringes of the ancient walledtown of Paestum. The clearing companylanded toward evening, but could notestablish station until its equipmentwas unloaded on D plus 1.

The only clearing stations in operationon D-day were two set up by the 162dMedical Battalion, which constitutedpart of the beach group attached to the531 st Engineer Shore Regiment. Thebeach group also included the medicalsection of the 4th Naval Shore Battal-ion and a supply dump establishedabout noon by a detachment of the 4thMedical Supply Depot.

Casualties were gradually collected asstations were set up, and before dawnof D plus 1 substantial numbers hadreached the beach installations. All unitswere shorthanded, with some men yetto come ashore and others wounded orseparated from their outfits. In the cir-cumstances, it was impossible to followany rigid doctrine. Casualties werebrought to the beach by whatever meanswere at hand, including ambulances,jeeps, trucks, and hand-carried litters.In some instances the naval shore battal-ion sent its own medical officers andcorpsmen inland to work with the Armydoctors and help bring out the wounded.

Casualties were evacuated to thetransports by the naval shore battalionas opportunity offered and as small craftwere available. The total from theAmerican sector through D plus 1 was678.11

The 179th Regimental Combat Teamof the 45th Division was committed fromthe floating reserve early on 10 Septem-ber, D plus 1, followed by the 157thRCT the next day. Again each battalionlanding team was accompanied by its

The medical sources primarily relied upon for theassault phase are: (4) Annual Rpt, Med Sec,NATOUSA, 1943; (5) Annual Rpt, Surg, FifthArmy, 1943; (6) Annual Rpt, Surg, VI Corps, 1943;(7) Unit rpts of div surgs, med bns, hosps, andother med units mentioned in the text.

11 This figure, from the Report of the Fifth ArmySurgeon for 1943, is considerably higher than thetotal of 430 for the same 2-day period listed in therecords of the Peninsular Base Section later. Thelarger figure presumably includes Navy as well asArmy casualties. See also, Table 19, p. 343, below.


LITTER BEARERS WADING TO LANDING CRAFT OFF SALERNO, 9 SEPTEMBER

own aid station personnel and by a littersection of the organic medical battalion,in this case the 120th. Collecting com-panies were assembled within a fewhours. The clearing company of the120th, although it had been divided intothree detachments for the landings, wasreassembled on the afternoon of 10 Sep-tember and opened station near Paes-tum on the 11th.

Evacuation from the front was fol-lowing a normal pattern by D plus 2,although lengthening lines continued tobe under intermittent fire. Even thebeach installations were not secure asenemy planes were still in the air. OneGerman plane was shot down and ex-

ploded a hundred yards from the clear-ing station of the 120th Medical Battal-ion. "Patients carried in but a few hoursbefore," observed the battalion histo-rian, "displayed unusual agility injumping from operating tables intofoxholes.12

Only 128 casualties were evacuatedseaward on D plus 2 because of a short-age of small craft, which were beingused to unload ammunition, and therewas no evacuation at all on D plus 3,12 September. The hospital ship New-foundland stood offshore until dusk butwas ordered to move fifty miles out to

12 Hist, 120th Med Bn, Sep 43.


PLANNERS OF THE INVASION OF ITALY. Generals Truscott, Eisenhower, Clark, and Lucas.

sea for the night, so that her lights wouldnot guide enemy planes to the transportarea. She was bombed and sunk beforeshe could return the next morning. Evac-uation by hospital ship actually beganon 13 September, D plus 4; air evacua-tion started four days later.

Facilities for holding casualties ashorewere still inadequate, despite carefulplanning to avoid just such a contin-gency.13 Personnel of the 95th and 16thEvacuation Hospitals had landed aboutnoon on D-day, but their equipment was

scattered and suitable sites were not yetavailable. The 95th had 250 of its 400beds ready for occupancy by 0600 on 12September. The larger 16th was notable to get into operation until midnight14-15 September. Both units were in thevicinity of Paestum. The nurses of bothhospitals had been aboard the New-foundland when that vessel wasbombed. Some suffered minor injuries,and all lost personal belongings. Thenurses were carried back to Africa byrescuing ships and did not rejoin theirunits until 25 September.13 Surg, NATOUSA, Journal, 13 Sep 43.


The beach clearing stations of the 162dMedical Battalion were no longerneeded by 13 September and wereclosed on that date. For the remainderof the beach phase of the operation casu-alties were evacuated by collecting com-panies of the 162d Medical Battaliondirectly from the division clearing sta-tions to the evacuation hospitals, andthence to ships or planes. No other corpsor army medical battalions were avail-able until after the breakout.

A massive German counterattacklaunched on 13 September drove a deepwedge between the British and Ameri-can salients, penetrating to within threemiles of the beach, but the groundtroops finally stopped the attack withthe aid of naval gunfire and Alliedplanes. The 504th Parachute InfantryRegiment of the 82d Airborne Divisionwas dropped behind enemy lines at thistime. With Eighth Army closing in fromthe south, the Germans had no time foranother attempt. They withdrew slowly,fighting all the way, but by 20 Septem-ber the beachhead was secure.

Coinciding with the German with-drawal there was a regrouping and reas-signment of U.S. units. Maj. Gen. JohnP. Lucas took command of VI Corpsfrom General Dawley on 20 September.The 3d Division replaced the battle-weary 36th in the line, and the 34th Di-vision, which reached Salerno at aboutthe same time, went into reserve. Onthe 10 Corps front, the British 7th Ar-moured Division entered combat.

The next phase of the campaign wouldcarry the Allied forces to Naples andto the Volturno River beyond. The 7thArmoured and the 82d Airborne Divi-sions moved up the coast on the leftflank, followed by the British 46th Di-

vision. The British 56th, a few milesinland, drove for Capua, while the 3dstruck toward the Volturno by way ofAvellino. The 45th, on the right flank,swung out in a wide arc toward Bene-vento, where the 34th, operating to theright of the 3d since 26 September,caught up. Attached to the 34th was the100th Battalion, made up of American-born Japanese, which would later bepart of the 442d Regiment.

Hospitalization on the Beachhead-All army medical units reverted to armycontrol on 21 September. By this datethe build-up of medical facilities wassubstantial, with new units arrivingsteadily as the campaign moved north-ward. The 3d and 34th Divisions wereaccompanied by their organic medicalbattalions, the 3d and 109th, respec-tively. The 93d Evacuation Hospitalreached the area on 15 September, open-ing at Paestum the following day. The94th, which arrived about the sametime, was established at Battipaglia aweek later. The 8th and 38th EvacuationHospitals, both 750-bed units, and the52d Medical Battalion disembarked on21 September, although all equipmentbelonging to the 8th was lost by enemyaction. Still another 750-bed evacuation,the 56th, reached the beachhead on 27September, followed next day by the161st Medical Battalion.

Despite the number of hospitalsashore, beds remained at a premiumduring the entire month of September.Many units were slow in getting into op-eration because equipment was lost ordelayed. The rapid troop build-up madeheavy demands on hospital facilities, andthe disease rate—especially from malar-ia—was higher than had been antici-


pated. Typical was the experience of the95th Evacuation Hospital, first U.S. hos-pital to be established on the Europeancontinent in World War II. The hos-pital's commander, Lt. Col. (later Col.)Paul K. Sauer, reported:

At times we were overfilled to such anextent that all cots were in use, other pa-tients remained on the litters on whichthey had been brought to us in lieu ofcots, and others were given two blanketsto enable them to sleep on the ground.When the tents were filled to capacity,patients were laid on the outside along thewalls of the tents with their heads insideand their bodies outside. On one nighteven this method was insufficient to takecare of all the patients and forty of themslept under the open sky between the tents.Fortunately the weather was balmy anddry.14

The weather did not long remaineither balmy or dry. On the night of 28September a violent storm leveled thetents of the 16th Evacuation Hospital,where 961 patients were being cared for,and did severe damage to the installa-tions of the 95th. By heroic effort, allpatients were rescued without injury andmoved to a tobacco warehouse about amile away, made available for the emer-gency by Services of Supply. There theywere temporarily cared for by personnelof the 8th Evacuation. The tobacco fac-tory was later operated as an annexto the 16th, by personnel of the 8th.General Blesse, who arrived on thebeachhead on 25 September, had spentthe preceding night at the 16th Evacua-tion and witnessed the destruction.15

As soon as the storm was over, the38th Evacuation Hospital, still in biv-ouac awaiting assembling of its equip-ment, began setting up a hospital, usingequipment borrowed from the stillinactive 56th. The 38th began admittingpatients at 0830, 29 September. (Map21)

Across the Volturno

Combat Medical Service—During thedrive to the Volturno, medical service inthe field followed a normal pattern. Di-vision clearing platoons leapfrogged oneanother, casualties being carried back tothe beachhead by the corps medical bat-talions. Collecting companies of the 52dMedical Battalion took over evacuationof the 45th and 3d Divisions from the162d on 29 and 30 September, respec-tively. The 34th Division, the 82d Air-borne, and the Rangers were evacuatedby collecting elements of the 162d Medi-cal Battalion.16

The advancing troops were delayedby mountainous terrain and by the ex-pert demolitions for which the retreat-ing Germans were noted. The enemychose to fight only rear-guard actionsuntil he reached prepared positions be-yond the Volturno. Avellino fell to the3d Division on 30 September, and a re-connaissance troop of the 45th enteredBenevento two days later. The British7th 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 InspectionTrip With Gen Blesse, 25 Sep-2 Oct 43. See alsoLtr, Col Bauchspies to Col Coates, 15 Apr 59,commenting on preliminary draft of this volume.

Colonel Bauchspies was at that time commandingofficer of the 16th Evacuation Hospital.

16 Military sources for this section are the sameas those cited in previous notes, with the additionof 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, anddivision surgeons' reports already cited, and unitrpts of medical units mentioned in the text.


MAP 21—Fifth Army Hospitals and Medical Supply Dumps, 9 October 1943

occupied Naples without opposition on1 October, leaving the city to be garri-soned by the 82d Airborne.

As VI Corps neared the Volturno, thedistance between division clearing sta-tions and evacuation hospitals length-ened, finally approaching the 100-mileambulance runs of the Tunisia Cam-paign. To cut down the long haul overbomb-scarred and blasted roads, the93d Evacuation moved from Paestum toMontella, along the 3d Division's routeto Avellino, on 2 October. In Naples, onthe same date, the 307th Airborne Medi-cal Company and a detachment fromthe 162d Medical Battalion opened aprovisional evacuation hospital. The

307th had arrived from Sicily by boatonly two or three days earlier.

By 6 October forward elements ofboth 10 and VI Corps had reached theVolturno River. Eighth Army, mean-while, had captured the vital complexof airfields around Foggia on 1 October,and had moved on to extend the Vol-turno line to Termoli on the Adriatic.

At the Volturno, Fifth Army pausedonly long enough to bring up equipmentnecessary to replace bridges blasted bythe retiring enemy, and to move artil-lery forward through hub-deep mud. Inits upper reaches the Volturno Riverflows southeast, or roughly parallel to thelong axis of the Italian peninsula. At the


point where the Calore enters the Vol-turno from the east, the latter river turnswest at an acute angle to reach the Tyr-rhenian Sea some 20 miles north of theBay of Naples. The south bank, fromthe coast to a point just east of Capua,a distance of perhaps 15 miles, was heldby 10 Corps. The VI Corps front con-tinued the river line another 15 milesto the junction with the Calore, and oneastward for a similar distance to thepoint of contact with Eighth Army. The3d Division crossed the Volturno throughthe Triflisco Gap on the left of the VICorps front, while the 34th crossed 8 or10 miles farther east, near the mouth ofthe Calore. The 45th Division held theright flank, advancing into the moun-tains north of the Calore and east of theVolturno.

The 3d and 34th Divisions begancrossing the river at 0200 on 13 October,after prolonged artillery preparation. In-cessant rain during the first week ofOctober had turned the normally shal-low stream into a swift-flowing torrent,200 or 300 feet wide and varying indepth from about 4 feet to the height ofa tall man's shoulders. Rubber boats andrafts were used, and some swam the swol-len river, but most of the men wadedacross, clinging to guideropes with onehand and holding their rifles overheadwith the other. All crossings were madeunder continuous fire from machineguns and small arms on the north bankand from artillery farther to the rear.

Battalion aidmen, reinforced by litterbearers from the collecting companies ofthe organic medical battalions, fordedthe river with the assault troops. Ambu-lance loading posts were set up on thenear shore, close to the sites previouslychosen for bridging, and casualties were

ferried back until dawn on rafts pulledby ropes. When daylight made furtherevacuation across the river impossible,casualties were held in pools on the farbank, wherever terrain afforded ade-quate protection.

On the 3d Division front, light bridgeswere thrown across the river during thefirst day of the attack. The engineers,working under direct observation andartillery fire of the enemy, had moredifficulty in the 34th Division area, butdespite the hazards managed to span thestream by the morning of 14 October.As soon as the bridges were available,collecting companies of the organic med-ical battalions crossed the Volturno tofollow the troops. Clearing stations re-mained on the south bank until thebridgehead had been pushed severalmiles beyond the river. The 3d MedicalBattalion had a station in operationnorth of the Volturno the morning of16 October, and the 109th Medical Bat-talion clearing station, supporting the34th Division, was functioning on the farbank by the 18th. Thereafter, until theWinter Line was reached about the mid-dle of November, evacuation from bothdivisions followed the normal pattern,the clearing platoons bypassing one an-other as the troops advanced.

The 52d Medical Battalion took overevacuation of the 34th Division from the162d on 17 October, thus becoming re-sponsible for all evacuation from VICorps.

Simultaneously with the Volturnocrossings of the 3d and 34th Divisions,the 45th moved up on the east side ofthe river to parallel the advance. Fight-ing was heaviest on the lower slopes ofthe Matese Mountains, where the taskof bringing out the wounded was formi-


MEDICS TREATING ITALIAN GIRL INJURED IN THE VOLTURNO AREA

dable, but the heights of Piedimonted'Alife were gained by 17 October with-out undue casualties.

Enemy positions on the coastal plain,meanwhile, had proved stronger thananticipated. The British 46th Divisionon the 10 Corps left flank, and the 7thArmoured in the center, had forcedcrossings of the Volturno the night of12-13 October, but the British 56th Di-vision in the Capua area had been unableto cross without taking losses deemed tooheavy by the Fifth Army command.Plans for further advance were thereforealtered by shifting the corps boundary

to the east. The 56th displaced to itsright, crossing on the 3d Division bridgeat Triflisco on 15 October. The 3d Di-vision also shifted to the right, into the34th Division sector, while the 34thcrossed the upper Volturno on 19 Octo-ber to a position in front of the 45th.

Both corps moved slowly forwardagainst stubborn opposition for anothertwo weeks. Then on the night of 3-4November the 45th crossed the Volturnofrom east to west, south of Venafro, andthe 34th recrossed north of that town,leaving the 504th Parachute Infantry,which had come into the line a few days


ROUGH GOING

earlier, to strike toward Isernia andhold the high ground on the right flank.The 3d Division struck toward MignanoGap on the left of the corps area.

By 15 November Fifth Army hadreached another German defensive posi-tion, the Winter Line. Since 6 Octobera strongly fortified river line had beenbreached and gains registered fromseventeen miles along the coast to forty-five miles on the right flank of the FifthArmy front. The new line extendedalong the south bank of the GariglianoRiver to the junction with Eighth Armywest of Isernia, and included the towns

of Mignano and Venafro. The moun-tains, however, had become steadilymore precipitous and the weather pro-gressively worse. A halt was called forregrouping and reconsideration of strat-egy.

In the immediate combat zone, theproblems of evacuation incident to adifficult river crossing were succeeded bythose of mountain fighting in which theenemy was dug in on every slope in mu-tually supporting positions that com-manded every access road and trail.Mines, booby traps, and snipers wereeverywhere. Each new advance was


MAP 22—Fifth Army Hospitals and Medical Supply Dumps, 15 November 1943

made in the face of machine gun andartillery fire from dominating slopes.The storming of mountain peaks wascommonplace. Men suffered increas-ingly from exposure, and the strain be-gan to show in a sharply rising incidenceof combat neurosis.

The tasks of the aidmen and the litterbearers were the most arduous. Medicalofficers often worked at night by flash-light, with both doctor and patient con-cealed under blankets. Aid stations were

generally 300 to 500 yards behind thepoint of contact with the enemy, butwere sometimes as much as a week aheadof their vehicles, restricting them to suchdrugs and equipment as could be hand-carried. The numerous caves found inthe Italian mountains were often usedfor aid station sites because they could beblacked out, and because they offered ameasure of protection from rain, snow,and enemy shells. Collecting stationswere eliminated wherever possible, but


when used were 1 to 4 miles behind thelines, with clearing stations 6 or 8 milesfarther to the rear. The irregularities ofthe front, however, and the exigenciesof mountain fighting not infrequentlybrought clearing stations within rangeof enemy guns. Six-man litter squadswere usually necessary, with carriesoften taking eight to twelve hours. Whenthe corps medical battalions weredrained of personnel, additional litterbearers were supplied from the combatunits. Casualties among medics, and par-ticularly among litter bearers, werehigh.17

Hospitalization—To keep the ambu-lance runs relatively short, Fifth Armyhospitals moved into the combat zone asrapidly as suitable sites became available,with the 400-bed evacuations leading theway. The 95th opened in Naples on 9October. The 93d moved hastily fromMontella to Avellino on 11 October,after bombed-out bridges and swollenstreams threatened to isolate the unit;then advanced again on 24 October toPiana di Caiazzo, where it was the firstAmerican hospital north of the Volturno.The 94th shifted from Battipaglia inthe Salerno area to take over an Ital-ian military hospital in Maddaloni,where it opened on 11 October. Novem-ber 5 saw the 94th Evacuation in Riardo,a dozen miles north of Capua. Still far-ther forward, the 15th Evacuation, newly

arrived from Sicily, opened at Alife eastof the Volturno, on 2 November. (Map22)

The 750-bed evacuation hospitals alsomoved up to new locations during theperiod of the Volturno campaign. The56th opened at Avellino on 6 October,shifting to Dragoni across the river fromthe 15th on 2 November. The 8th and38th Evacuation Hospitals opened inCaserta on 16 October, followed by the16th Evacuation on the last day of themonth. The 38th moved on to the Ri-ardo area, just north of the site of the94th, on 8 November.

The field hospitals, as already noted,were late in coming into the theater,and were used only in part for directsupport of the army. The 32d Fieldopened in Caserta on 16 October, whereit functioned for ten days as an evacua-tion hospital before being attached tothe base section. The 10th Field movedinto Caserta on 29 October, also func-tioning as an evacuation hospital. The11 th Field, though in the theater, wasinactive until the next phase of the cam-paign. The two available platoons of the4th were assigned to the base section asan air evacuation holding unit.

Only the 33d Field Hospital per-formed services similar to those of thefield units in the Sicily Campaign. Oneplatoon of the 33d joined the 120thMedical Battalion on 17 October, oper-ating with the 45th Division clearing sta-tion as a holding hospital for nontrans-portables and for forward surgery. An-other platoon of the 33d joined the11th Medical Battalion, in Army re-serve with the 36th Division, on 21October; and the remaining platoonwent into the combat area with the109th Medical Battalion, in support of

17 (1) Capt Robert L. Sharoff, The Infantry Bat-talion Aid Station in Operation, Med Hist Data,3d Med Bn, 23 Oct 43. (2) Ltr, Col W. W. Vaughnto Brig Gen R. W. Bliss, 18 Jan 44, sub: Observa-tions From Overseas Casualties. (3) Annual Rpt,Surg, 34th Div, 1943. (4) Hist, 120th Med Bn, Nov43.


the 34th Division, the following day. Allthree platoons were reinforced by teamsof the 2d Auxiliary Surgical Group.

The 3d Convalescent Hospital was al-so assigned to Fifth Army from its ar-rival in the theater on 10 October, butfunctioned in Naples rather than in theforward area until near the end of theyear.

The Winter Line

Fifth Army was substantially reor-ganized during the last two weeks ofNovember, before launching a directassault against the fortified positions ofthe German Winter Line. The head-quarters of II Corps, now under GeneralKeyes, arrived from Sicily in October.On 18 November the 3d and 36th Divi-sions were assigned to II Corps, whichtook over the center of the Fifth Armyfront. The British 10 Corps remainedon the left flank; the 34th and 45thDivisions, making up VI Corps, were onthe right.18

The 36th Division, out of combat since20 September, began to relieve the 3don 17 November, the 3d going into biv-ouac for a rest. The strength of II Corpswas maintained, however, by attachmentof the 1st Italian Motorized Group on22 November and of the 1st Special Serv-

ice Force the following day. The 1stSpecial Service Force, a commando-typeunit with six battalions organized intothree "regiments," had a strength equiv-alent to one regimental combat team-about 5,000 men. It was composed ofU.S. and Canadian troops, speciallytrained for mountain fighting and inraiding tactics.

Three Ranger battalions and ele-ments of the 504th Parachute Infantrywere also at the front, to be used as thearmy commander might direct. The 1stArmored Division began unloading atNaples on 15 November and went intoArmy reserve. Two French divisions, the2d Moroccan and the 3d Algerian, werealso on the way from North Africa ascomponents of a French ExpeditionaryCorps (FEC) under General Juin.

In addition to medical units alreadyin the Fifth Army area, the 54th MedicalBattalion and the nth Field Hospitalwere assigned to II Corps. The Italianand French units under Fifth Armycommand had their own medical organ-izations, including field and evacuationhospitals.

The Winter Line proved to be onlya series of strongly held outposts a fewmiles in front of the heavily fortifiedGustav Line, where the Germansplanned to make their main stand. Thekey to the Gustav Line was Monte Cas-sino, dominating the entrance to the LiriValley through which Highway 6 and adoubletrack railroad ran northwest toRome, a distance of about eighty miles.The approach to the Liri Valley laythrough the Mignano Gap, known to thetroops as Purple Heart Valley, which wascontrolled on either side by German-held mountain masses and barred at itsoutlet by the Rapido River. The plan of

18 Military sources for this section include: 1stOpns Rpts, VI Corps, Nov 43-Jan 44; (2) OpnsRpts, II Corps, Nov 43-Jan 44; (3) Fifth ArmyHistory, pt. III. Citations to additional militarysources will be found at the beginning of thischapter. Medical sources for the Winter Linecampaign include: (4) Annual Rpt, Med Sec,NATOUSA, 1943; (5) Annual Rpt, Med Sec,MTOUSA, 1944; (6) Annual Rpts, Surg, FifthArmy, 1943, 1944; (7) Annual Rpts, Surg, VICorps, 1943, 1944; (8) Annual Rpts, Surg, II Corps,1943, 1944; (9) Unit rpts of div surgs and medunits mentioned in the text.


campaign called first for driving theenemy from his mountain stronghold,and then forcing a crossing of the Rapidosouth of Cassino, at the same timeexecuting a wide flanking movementthrough the mountains northwest of thetown.

The attack began on 1 December withan assault against the Camino hill masssouth of the Mignano Gap. The maineffort was directed at the left flank bythe 46th and 56th Divisions of 10 Corps,while the Special Service Force of IICorps attacked simultaneously from theright. The infantry advance was precededby the heaviest concentration of artilleryfire yet used in the Italian campaign,but the result was indecisive. It was stillnecessary for foot soldiers to scale theheights and storm the enemy positionsone by one. The operation was renderedstill more hazardous by three days ofcontinuous rain. Both lines of advanceand lines of supply were under enemyfire, while bad weather prevented anyeffective air support. The entire Caminocomplex was nevertheless secured by 9December.

The 34th and 45th Divisions of VICorps were meanwhile attacking north-west from Venafro with the ultimateobjective of outflanking Cassino by tak-ing Sant'Elia and Atina. The VI Corpsattack, launched on 29 November, wasslow and costly. By 4 December the 34thDivision, on the left, had gained about amile, at a cost of 777 casualties. The 45thcontinued to inch forward for anotherfive days, taking several important hillpositions but making little headway to-ward its goal.

In the second phase of the WinterLine campaign, II Corps was to seize Mt.Sammucro, which formed the north-

ern rampart of the Mignano Gap, andMt. Lungo, which cut the center of thevalley. VI Corps, with the 2d MoroccanDivision replacing the 34th, was to tryagain for Sant'Elia and Atina. The IICorps objectives were taken by 17 De-cember, after bitter seesaw battles forevery knob and crest, but VI Corps againfailed to make substantial headway inits flanking attack. Lack of reserves forspeedy exploitation of gains was an im-portant factor.

Mt. Trocchio, the last mountainstronghold before Cassino, was II Corps'major objective in the third phase ofthe Winter Line campaign. The positionwas taken, again after slow and bitterfighting, by noon of 15 January 1944,but the crossing of the Rapido was de-layed for another week by the failureto outflank Cassino from the north, andby an over-all change of plans.

General Alexander, commanding the15th Army Group, issued orders on 2January for the seaborne flanking move-ment to Anzio, and VI Corps was as-signed the operation. A reshuffling ofFifth Army forces gave the 45th and 3dDivisions to VI Corps at this time. The34th Division went back into the line asa II Corps unit, replacing the 36th, whilethe 3d Algerian Division relieved the45th. The VI Corps sector was takenover by the French Expeditionary Corpsthe first week in January. The 1st Ar-mored, which had been attached to IICorps about 15 December in hopes of abreakthrough into the Liri Valley, re-mained temporarily in the line, butwent ultimately to VI Corps for theAnzio landings.

The capture of Mt. Trocchio broughtFifth Army up to the main defenses ofthe Gustav Line. During two months of


rugged mountain fighting in the foulestkind of weather, the Allied forces hadadvanced an average of five to sevenmiles. Casualties had been heavy, butbattle fatigue and exposure had takenan even greater toll. The enemy too hadsuffered heavily, but he appeared to havegained his purpose of achieving a winterstalemate. Eighth Army had driven upthe Adriatic coast as far as Ortona, butMontgomery's forces also failed to forcea passage through the rocky fastnesses ofthe central Apennines to Rome.

Battlefield Evacuation—As in theVolturno campaign, the primary medi-cal problem of the Winter Line wasevacuation of casualties from the battle-fields. The difficulties inherent in carry-ing wounded men down steep, boulder-strewn slopes, often in total darkness,were aggravated by cold and almost in-cessant rain or snow. Main highways werefrequently under enemy fire and wereoverburdened with a steady stream ofcombat equipment. Secondary roads andtrails were so deep in mud that ambu-lances could rarely come within fivemiles of the lines.

All available litter bearers of the corpsmedical battalions were assigned to thedivisions, and these were periodicallysupplemented by assignment of combatpersonnel. Toward the end of the year,AFHQ authorized the addition of 100litter bearers to each organic medicalbattalion. Continuous replacements werenecessary at all levels of the medicalservice. Litter bearers were exposed tothe same hazards as the combat troops.Many of them camped along the evacua-tion routes, but without the protectiveclothing worn by the infantrymen. Cas-ualties among medical officers were also

high, but the only available replace-ments were men from fixed hospitals inthe base sections who lacked both battleexperience and conditioning. Collectingcompanies were used sparingly, andwhere used were reduced to one medicalofficer each. Medical officers of the corpsmedical battalions were often detachedfor duty with the divisional medicalunits.19

A variety of expedients were adoptedto speed the process of evacuation. Cas-ualties from the 34th Division werebrought down from Mt. Pantano bylitter bearers who lined both sides ofthe trail and passed litters from hand tohand over their heads.20 Litter carriesran as long as 12 to 15 hours, with 6-mansquads working in relays. The 109thMedical Battalion reported using 16such squads to move casualties over a5-mile stretch on 12 January 1944. Onthe longer routes, aid stations were setup along the way to supply first aid,plasma, and hot drinks, and to give walk-ing wounded a chance to rest. The 120thMedical Battalion used pack mulesto bring out trench-foot cases, andexperimented with a mule-carried litter,apparently unaware of the similar ex-periments carried out by the 9th Med-ical Battalion in Tunisia and Sicily.Experiments were also made with amodified breeches buoy, improvised froman equipment line, for lowering casual-ties down precipitous slopes.21

Some indication of the magnitude of

19 (1) Pers Ltr, Gen Blesse, Surg, NATOUSA, toGen Kirk, 26 Nov 43. (2) Surg, NATOUSA,Journal, 23 Dec 43. (3) Med Hist Data, 54th MedBn, 26 Sep 44. See also, reports of div surgs andmed 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.


WOUNDED MAN BEING DUG FROM DEBRIS NEAR CASSINO

the evacuation problem may be gatheredfrom reports of the two corps medicalbattalions primarily responsible formoving casualties from clearing stationsto the mobile hospitals in the combatzone. The 52d Medical Battalion evac-uated 25,125 sick and wounded fromdivision clearing stations between 30September and the end of the year. Be-tween 15 November and 15 January the54th Medical Battalion evacuated 16,186patients. Even these figures do not tellthe whole story, since some evacuationbefore 15 November was handled by the

162d Medical Battalion, while thecontinued to operate through January.

Hospitalization—The heavy casual-ties of the Winter Line campaign, cou-pled with transportation difficulties overmuddy and congested roads, soon madeit necessary to bring more hospital bedsinto the combat area. The 95th Evac-uation Hospital moved up from Napleson 28 November to a site just beyondthe Volturno northwest of Capua, whereit was joined by the 10th Field fromCaserta on 1 December. The 15th Evac-


MAP 23—Fifth Army Hospitals and Medical Supply Dumps, 15 February 1944

uation moved from Alife, east of theVolturno, where it had twice beenflooded, to Riardo, where the 38th and94th were already operating, on 15 De-cember. The 8th Evacuation opened atTeano, in the same general area, the fol-lowing day, while the 16th Evacuationmoved from Caserta to Vairano on 28December. For all hospitals, siting was aproblem for the engineers, with mudthe ever-present obstacle to be sur-

mounted. The 93d and 95th EvacuationHospitals, designated for the Anzio op-eration, were closed early in January1944, but their places were taken by the3d Convalescent, which opened at Pigna-taro Maggiore on 6 January, and the11th Evacuation, which arrived fromSicily in time to open at Vairano on 14January. (Map 23)

With the exception of the 56th Evac-uation at Dragoni and the 93d at Piana


di Caiazzo, all of these Fifth Army hos-pitals were strung out along Highway6, within a 10- or 12-mile stretch. Themedical installations in the army area,including clearing and collecting sta-tions, all suffered more or less severedamage in a New Year's Day storm, the15th, 38th, and 94th Evacuation Hospi-tals being the hardest hit. All patientsof the 15th and 38th had to be moved, aswell as most of those of the 94th.

The Cassino Stalemate

By way of prelude to the Anzio land-ings, which were scheduled for 22 Janu-ary 1944, Fifth Army sought to engagethe maximum German strength by wayof a direct assault against the Gustav Line.The French Expeditionary Corps on theright led off on 12 January witha 3-day drive that carried General Juin'scolonials to the mountains north of Cas-sino. General McCreery's British 10Corps, with the 5th Infantry Divisionsubstituted for the 7th Armoured,crossed the lower Garigliano near thecoast on 17 January. By the 20th of themonth, the 5th and 56th Divisions hadsecured a bridgehead extending to highground north of Minturno, but the 46thDivision had failed to get across theriver farther upstream, near the II Corpssector.22

Carnage Along the Rapido—The mainassault was launched by General Keyes'II Corps in the center of the Fifth Armyfront on the night of 20 January, onlya few hours before the Anzio armadasailed from Naples. The assignment wasprobably the most difficult of the en-tire Italian campaign. The U.S. 36th Di-vision, commanded by Maj. Gen. FredL. Walker, was to cross the Rapido be-low Cassino in the vicinity of Sant' An-gelo, seize that town, and advance as faras Pignataro Interamna. Combat Com-mand B of the 1st Armored Divisionwas to pass through the 36th and exploitup the Liri Valley, while the 34thDivision was to create a diversion beforeCassino and be prepared to attack fromeast or south, or to follow the armorthrough the 36th, as circumstances dic-tated. The 45th Division was in reserve,to be thrown into the Cassino battle orbe shipped to Anzio as the tide of battlemight require.

It was a very large order. Cassino andthe mountains surrounding it were heav-ily fortified anchor points in the GustavLine, from which enemy artillery couldrake the whole line of the Rapido Riverand cover the Liri Valley with cross fire.The river, itself, at that point, was aswift-flowing stream 25 to 50 feet wideand 9 to 12 feet deep, with high, brush-covered banks on either side. The ap-proaches had been skillfully and lavishlystrewn with mines, and the low groundwas waterlogged by deliberate flooding.On the German side the ground washigher, with the town of Sant'Angeloperched on a 40-foot bluff that gave per-fect observation. Mines and wire entan-glements were backed up by a belt ofdugouts and concrete pillboxes, fromwhich the entire river line could be

22 The chief military sources for this sectioninclude: 1st Fifth Army History, pt. IV, pp. 27-57,87-100, 175-85; (2) Opns Rpts, II Corps, Jan-Apr44; (3) Huff, ed., The Fighting Thirty-sixth. Seenote at the beginning of this chapter for additionalsources. The more important medical sources are:(4) Annual Rpt, Med Sec, MTOUSA, 1944; (5) An-nual 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 thetext.


blanketed by machine gun fire. Thefailure of the British 46th Division tocross the Garigliano earlier in the day,moreover, had left the southern flankunsecured.

After concentrated air and artillerypreparation, the 141st Regimental Com-bat Team moved through the mine fieldsto its crossing points north of Sant'An-gelo, while the 143d RCT took up posi-tions along the Rapido south of thetown. The Germans were neither sur-prised nor unprepared. Artillery, rocketprojectors, and automatic weapons metthe assault. Boats were destroyed beforethe launching or sunk in midstream.Bridges were knocked out before theywere in place. Only a handful of menfrom the 141st reached the western bank,and the somewhat larger number fromthe 143d who achieved the crossing werequickly immobilized. Before dawn thoseable to return were recalled.

A second attempt the following daywas only slightly more successful. Fogand smoke screens covered the crossings,but the German guns were zeroed in.One battalion of the 143d RCT and ele-ments of the 141st managed to advancea half mile or so beyond the river, butreinforcement and resupply were alikeimpossible. The men were driven backto the river, and those who could notwithdraw were isolated. When ammuni-tion gave out, the battle was over. The36th Division had been badly beaten.

Although many of the wounded couldnot be reached, and others could bebrought out only with great difficulty,308 battle casualties were processedthrough the clearing station of the 111 thMedical Battalion on 21 January and291 the following day. With only fivemedical officers available to handle this

record flow of wounded, it was impos-sible to retain them long in the clearingstation. The nontransportables weretransferred immediately to a platoon ofthe 11th Field Hospital, which was ad-jacent. Those who could stand thejourney were sent back by ambulanceand truck to the evacuation hospitals,which were still concentrated alongHighway 6 from Vairano, twenty milesbehind the front, to Capua on theVolturno. Transportation was suppliedby the 54th Medical Battalion.

When the Sant'Angelo sector quieted,a truce was arranged for 25 Januaryfrom 1400 to 1700, and litter bearersfrom two collecting companies of the111 th Medical Battalion crossed theRapido to remove the dead andwounded. A German guide led themthrough the mine fields and up to thebarbed-wire entanglement about 10yards from the stream. There Germanmedics turned over 12 Americanwounded, stating that 18 more were inthe German hospital. An opportunity toinspect these was offered, but time didnot permit. The dead were so numerousthat all could not be removed in the 3-hour period of the truce.

The 2-day "battle of guts" cost the36th Division 2,019 officers and men inkilled, wounded, and missing, of whom934 were wounded.23

Frustration at the Gustav Line—"Thefailure of the 36th Division to establisha bridgehead in the Liri Valley forceda quick change in plans. The French Ex-

23 Annual Rpt, Surg, Fifth Army, 1944, p. 40.Fifth Army History, pt. IV, p. 47, gives a total of1,681, broken down into 143 killed, 663 wounded,and 875 missing but the surgeon's figures, based onunit reports, appear the more reliable.


peditionary Corps, which had renewedits drive on 21 January, was ordered toconcentrate its strength on its own leftflank, while the 34th Division attempteda crossing of the upper Rapido just be-low the village of Cairo, at the boundaryof the II Corps and FEC sectors. The34th jumped off the night of 24 January.

Enemy positions were much the sameas those encountered by the 36th Divi-sion farther south, but this time thebridgehead held. First across the river, onthe morning of 25 January, was the 100thBattalion. Other elements of the 133dRegimental Combat Team followed, andall held grimly to their gains through thenight of 25-26 January. The 135th RCTforced another crossing just north of Cas-sino in the early hours of 26 January, andthe 168th crossed the next day, with fourtanks. The engineers got more tanksacross early on the 29th, in time to helprepel a determined counterattack. Toexploit the gains, the 142d RCT of the36th Division, which had not partici-pated in the earlier action, was attachedto the 34th Division, and with the FrenchExpeditionary Corps gained command-ing heights north of Cairo. The bridge-head was secure by 31 January.

For the next two weeks II Corps threwall its strength and battle toughness intoan effort to break through the Cassinodefenses and cut Highway 6 behind themain German positions. The fightingwas hard, close, and continuous. On 2February elements of the 34th Divisionbroke into Cassino itself, and on the 5tha patrol reached the walls of the Bene-dictine monastery high above the town.The 36th Division, decimated though itwas, went back into the line. About athird of the mountainous area northwestof Cassino was overrun, and a decisive

triumph seemed almost at hand. TheGermans, however, were furiously rein-forcing their crumbling lines, and theAllied drive was stopped a bare mileshort of Highway 6. On 12 February IICorps went over to the defensive. Dur-ing the next ten days the 34th and 36thDivisions were relieved by Lt. Gen. SirBernard Freyberg's New Zealand Corps,made up of the New Zealand 2d Division,the Indian 4th Division, and the British78th Division, all from the Eighth Armyfront.

The pattern of evacuation during theperiod from 24 January to 14 Februaryresembled that of the Winter Line cam-paign. Litter carries were long, difficult,and exhausting since vehicles were un-able to penetrate far into the mountain-ous area where the fighting was in prog-ress. Again more litter bearers wereessential. The 54th Medical Battalionloaned all that could be spared, averag-ing about 150, to the collecting com-panies of the divisional medical battal-ions. Others were recruited from amongItalian labor troops, and still others werecombat replacements not yet committedto battle. But the bulk of them camefrom noncombat elements of fightingunits and from among fighting menthemselves. Over 800 additional litterbearers were used by II Corps on theCassino front in January and February1944.

Casualties were heavy during thebattle for the bridgehead, but becameeven heavier as tired troops penetratedthe main defenses of the Gustav Line.The clearing station of the 109th Medi-cal Battalion, supporting the 34th Divi-sion, had its busiest day on 3 February,when 430 patients, 268 of them with bat-tle wounds, were processed. For the en-


RETURNING WOUNDED FROM THE RAPIDO, JANUARY 1944

tire period from 24 January to 19February, when relief of the 34th Divi-sion was completed, 4,795 patients passedthrough the division clearing station, ofwhom 2,248 were battle casualties. Forthe 111 th Medical Battalion clearing sta-tion, the total processed was 5,709, in-cluding 1,733 wounded in action, for theperiod from 18 January to 22 Februaryduring which elements of the 36th Divi-sion were in the line.

The 54th Medical Battalion was taxedto the utmost to provide transportationto the rear. In order to shorten the ambu-lance run as much as possible, two hos-

pitals were displaced forward alongHighway 6 during the Cassino assault.The 10th Field moved from Capua to asite four miles southeast of Mignano on28 January. It was leapfrogged on 11February by the 94th Evacuation fromRiardo. Set up just south of Mignano,the 94th was the farthest forward of anyFifth Army hospital on the Cassino front.For a time all hospitals in the army areawere so crowded that orderly schedulingof admissions was impossible.

After the relief of II Corps, medicalunits accompanied the badly battered34th and 36th Divisions to rest areas be-


AID STATION IN SANT'ELIA AREA, smoke from a German shell rising in the background.

hind the lines. Neither division returnedto combat on the southern front. TheNew Zealand Corps renewed the attackon Cassino, 15-20 February, but, asidefrom destroying the monastery, achievedno more success than had the Americans.The Cassino front lapsed into inactivityuntil 15 March, when the New ZealandCorps launched a second drive, pre-ceded by the heaviest air and artillerybombardment of the Italian campaign.But again the Gustav Line held, and thefrontal attack was abandoned.

Hospitalization in the Army Area

Hospitalization Policy

All hospitalization in the army areathroughout the Italian campaign was

centrally controlled by the Fifth Armysurgeon. As long as the line of evacuationlay along a single highway, as in the firstdays of the breakout from the Salernobeachhead, it was possible to funnel cas-ualties through one ambulance controlpoint, where they were routed to theavailable evacuation hospitals in groupsof fifty at a time. Since there was nosorting of casualties at the control points,however, the actual burden on the hos-pitals proved very uneven and treatmentof some patients was unnecessarily de-layed.24

24 Except as otherwise noted, this section is basedon the reports of the Fifth Army surgeon for 1943and 1944, and on the reports of the individualhospitals and medical battalions functioning in theFifth Army area.


As the troops advanced toward theVolturno, one evacuation hospital wasdesignated for the support of each divi-sion, but since some units encounteredmuch stiffer opposition than others, thissystem, too, proved unsatisfactory. Undercombat conditions, it was found that oneevacuation hospital could not safely han-dle more than 100 surgical admissions ina 24-hour period. When the designatedhospital was filled, casualties had to bererouted to other installations, with con-sequent delay in treatment and longerimmobilization of ambulances.

With the establishment of additionalhospitals in the army area toward theend of the year, two evacuation hospitalswere assigned to receive casualties fromeach division. One hospital took all ad-missions for twenty-four hours; thenclosed to catch up and rest its personnelwhile the other took over for a similarperiod. This system, like its predecessor,proved only partially successful, since thecasualty load varied markedly from dayto day with the progress of the fighting.It remained in effect only until late Jan-uary 1944.

The plan next put into effect con-tinued throughout the remainder of thewar in Italy. Hospitals were arranged indepth along the axis of evacuation to therear. Corps evacuation officers were in-formed early each morning by the FifthArmy evacuation officer, Maj. (later Lt.Col.) Ralph A. Camardella, how manysurgical and how many medical casesthey might send in the course of the dayto each hospital in stated sequence. Un-der this system, no hospital would beoverburdened unless the aggregate cas-ualties for the day exceeded the com-bined quotas of all the hospitals in thearea.

Specialization

A major factor in the orderly workingof this system was the increasing use ofspecialized facilities to siphon particulartypes of cases. Toward the end of Oc-tober 1943, following the pattern estab-lished in Sicily, field hospital platoonswere set up adjacent to the division clear-ing stations for forward surgery andretention of patients whose further trans-portation would be hazardous. Keepingthese patients in the division area light-ened the burden on the evacuation hos-pitals. After the 10th Field Hospitalmoved into the Capua area at the begin-ning of December, its facilities were usedprimarily for medical cases whose hos-pital expectancy did not exceed twenty-one days.

A further development late in 1943was the more consistent use of clearingcompanies of the army medical battalionsfor hospitalization. Both the 161st and162d Medical Battalions were reorgan-ized in October to give each clearingplatoon 250 beds, instead of the 125 pre-viously assigned. Additional personnelneeded to operate the larger units wasdrawn from the collecting companies.These expanded platoons were then usedto increase the bed strength of the for-ward hospitals. One clearing platoon ofthe 162d was attached to the 56th Evacu-ation Hospital at Dragoni from 6 No-vember to 21 December, while the otherclearing platoon of the same battalionserved to augment the facilities of the15th Evacuation Hospital during its stayat Alife. An expanded clearing platoonof the 161st Medical Battalion was at-tached to the 10th Field Hospital nearCapua, where it served as a convalescentward. At its Vairano site, the 16th Evacu-


ation Hospital also used a clearing pla-toon as a convalescent ward during mostof January 1944.

Late in December the use of clearingplatoons as hospitals was carried anotherstep forward. On the 21st of that montha platoon of the 162d opened as a vene-real disease diagnostic and treatmentcenter, and ten days later a platoon of the161st, with psychiatrists and other addi-tional personnel attached, became theFifth Army Neuropsychiatric Center.Both of these special hospitals were inthe vicinity of Capua until the end ofMarch, when a general resiting of FifthArmy hospitals took place.25 The move-ment of the 3d Convalescent Hospitalinto the army area early in Januarycompleted the establishment of special-ized facilities immediately behind thelines. In sum, these units went far towardfreeing the evacuation hospitals for theirprimary mission, the treatment of battlewounds.

The use of specialized facilities in thearmy area was also designed to save forcombat duty as large a proportion ofthose hospitalized as possible. Medicalcases such as respiratory diseases, feversof various types, jaundice, dysentery, ve-nereal disease, and trench foot couldusually be treated close to the front and,with convalescent beds available, couldoften be held long enough for a cure.Specialization also permitted adequatecare by the minimum number of medicalofficers.

The extensive employment of special-ist personnel was another feature of theFifth Army system of hospitalization. In

addition to the medical specialties repre-sented by the establishment of separatehospitals for venereal disease and neuro-psychiatric cases, twenty-five teams of the2d Auxiliary Surgical Group were em-ployed in field hospital platoons and inevacuation hospitals. Wherever possible,Medical Corps officers were replaced byofficers of the Medical AdministrativeCorps, despite the resistance of unit com-manders in the field. Fifty MAC's hadbeen so assigned before the Winter Linewas reached, and twenty-five more hadbeen requested.26 These officers wereused in supply, operations, personnel,records, and other administrative posi-tions and increasingly, when the shortageof medical officers became acute, as as-sistant battalion surgeons and in the col-lecting companies where evacuationrather than medical care was the primarymission.

Statistical Summary

U.S. bed strength in the Fifth Armyarea as of 15 January 1944, includingfield hospital platoons with the divisionclearing companies, clearing platoonsused as expansion units, the neuropsy-chiatric and venereal disease hospitals,and hospitals staging for Anzio, was ap-proximately 10,000. The total remainedthe same at the end of April, though itwas divided between the Cassino frontand the Anzio beachhead. Hospital ad-missions from Fifth Army to U.S. instal-lations from 9 September 1943 through30 April 1944 are shown in Table 5. Itshould be borne in mind that the figuresfor January, February, March, and Aprilinclude hospital admissions on the Anzio

25 See pages 255-56, 258-59, below, for more de-tailed discussion of the NP and VD hospitals. Theresiting of hospitals before the Rome-Arno Cam-paign is treated on pages 290-91, below. 26 Pers Ltr, Gen Blesse to Gen Kirk, 17 Nov 43.


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 separatelyavailable by months. It will be noted thatthe disease rate was highest in December,when weather conditions were at theirworst, while battle casualties reachedtheir peak in February, when both frontswere fully engaged.27

Evacuation From Fifth Army

Patients who could not be returned toduty within a reasonable time—usuallytwenty-one days, although there was nogeneral policy—were moved as rapidly asthey became transportable to fixed hos-pitals in North Africa and in the develop-ing communications zone around Naples.During the period of army control, allevacuation out of the combat zone was toAfrica, by sea from the Salerno beach-head, and by air from Naples. Responsi-bility for evacuation out of Italy shiftedto the newly activated Peninsular BaseSection on 1 November, with Fifth

Army thereafter responsible only forclearing its own hospitals.28

Evacuation in the army area, like hos-pitalization, was centrally controlled bythe Fifth Army surgeon. Evacuation hos-pitals reported daily as to the number ofpatients ready for disposition, and eachwas given a quota twenty-four hours inadvance of movement. Wherever pos-sible, by arrangement with the basesurgeon, specific hospitals were desig-nated to receive the evacuees. Thoughthis system was new in the theater, itworked smoothly in most instances.Among the practical difficulties encoun-tered were occasional communicationfailures, and a tendency on the part ofevacuation hospital commanders to movepatients who should have been retainedin order to use up the allotted quota offixed beds.29


28 See p. 326, below.29 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)

Annual Rpt, 10th Field Hosp, 1943. (3) AnnualRpt, 15th Evac Hosp, 1943.


Collecting companies of the army med-ical battalions were attached to the evac-uation hospitals to handle the actualtransportation. Until late November1943, when adequate transportation be-came available to the base section, pa-tients from front-line hospitals weretaken by army ambulance directly to thepoint of treatment or of embarkation toAfrica. Beginning on 22 November, mostwere carried only to the railhead, wherethey were transferred to the 41st Hos-pital Train and army responsibilityended. Until near the end of the year thetrain ran only between Naples andCaserta, a distance of about twenty-fivemiles. Beginning on 26 December theloading point was extended ten miles toSparanise, in the immediate vicinity ofthe main concentration of evacuationhospitals behind the Winter Line.

U. S. Army ambulances also evacuatedthe field hospital of the 1st Italian Motor-ized Group to the Italian military hos-pital at Maddaloni. Evacuation hospitalsof the French Expeditionary Corps weregenerally cleared by French ambulancesto the Sparanise railhead, where FEC pa-tients were allotted space on the hospitaltrain.


When planning for the Salerno land-ings got under way, the Sicily Campaignwas at its midpoint and the defects of theSeventh Army supply system were al-ready clear. Chief among these defectswere the late arrival of medical depotpersonnel and the failure to submit sup-ply requisitions to Services of Supplyheadquarters for editing. There wereconsequent delays in the establishment ofissue points, with some unnecessary loss

of material, and excessive quantities of anumber of supply items were deliveredto the island.30

With this Sicilian experience in mind,an effective liaison was established be-tween the SOS Medical Section and theoffice of the Fifth Army surgeon. All sup-ply requisitions were cleared throughSOS but changes were made only bymutual agreement. To deal with thebeach supply problem a detachment con-sisting of one officer and twelve enlistedmen of the 4th Medical Supply Depotwas scheduled for the D-day convoy.

All medical units going ashore in Italycarried their full Table of Basic Allow-ances supply load, augmented by specialitems such as plasma, atabrine, and extrasplints and dressings. In addition, con-siderable quantities of medical supplieswere carried ashore by the combat troops.These were packed in the sealed, water-proof containers designed for the pur-pose at the Fifth Army Invasion TrainingCenter, and were dropped on the beachas the men carrying them went ashore.

The assault personnel of the 4th Medi-cal Supply Depot made their way underfire to a previously designated site on thebeach, where they dug in. The men thencollected the scattered supply containersand medical equipment as it was un-loaded, and set up a dump. Within fivehours of its landing, the 4th Medical Sup-ply Depot was issuing supplies to meetemergency needs. One hundred tons of

30 (1) Rpt of Med Supply Activities, NATOUSA,Nov 42-Nov 43. Other sources primarily reliedupon in this section are: (2) Annual Rpt, Surg,Fifth Army, 1943; (3) Annual Rpt, Surg, FifthArmy, 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 inMTOUSA, pp. 50-60.


medical supplies were unloaded duringthe night of 9-10 September, togetherwith some 200 tons of organizationalequipment belonging to the 16th and95th Evacuation Hospitals. Personnel ofthe two hospitals collected and sortedtheir own equipment, which was storedby the supply group until hospital sitesbecame available.

The supply dump operated on thebeach for four days. Then on 13 Septem-ber the original detachment was relievedby a new and larger segment of its or-ganization, consisting of two officers andfifty-two enlisted men, who brought withthem four 2½-ton trucks, a ¼-ton truck,and a weapons carrier. The enlarged de-tachment moved the dump to Paestum,near the newly laid out hospital area.The depot was gradually enlarged untilit occupied thirteen wall tents.

During the first days at the beachheadthere were some shortages of expendableitems, due primarily to losses by enemyaction, damage in handling, and acci-dental immersion. Replacements wereordered by cable from North Africa andwere promptly received. By 21 Septem-ber, when the advance out of the beach-head began, a 14-day level of medicalsupplies was available.

A supply depot was established atAvellino early in October, where themedical supply responsibility for FifthArmy was transferred from the 4th tothe 12th Medical Supply Depot, alongwith fifty tons of supplies. The detach-ments of the 4th that had served thebeachhead then joined the remainder oftheir unit in Naples, where a base sectionorganization was being set up.31

Thereafter, the 12th Medical Supply

Depot—12th Medical Depot Companyafter 3 December 1943—followed theFifth Army advance as closely as terrainand circumstances permitted. The Avel-lino dump was closed on 25 October,being supplanted by a depot at Caserta.A forward issue point was established atRiardo on 6 November, coincident withthe launching of the attack on theWinter Line. On 17 December a largerdepot was opened in a monastery at CalviRisorta. Like the Riardo depot in theFifth Army hospital area, the new dumpwas operated by the base section platoon.One hundred and twenty tons of medicalsupplies were moved forward to CalviRisorta, using eighty trucks. By this dateitems of medical supply were generallyplentiful.

The 1st Advance Platoon of the 12thMedical Depot Company was assigned on8 January 1944 to VI Corps for the Anziooperation. On the 26th of that month, insupport of the first unsuccessful assaulton Cassino, the 2d Advance Platoonmoved from Riardo to the village of SanPietro, just off Highway 6 about midwaybetween Mignano and Cassino. Sincemost of the buildings in the area were de-stroyed, the supply dump functionedunder canvas.

Professional Services in the Army Area

Medicine and Surgery

Forward Surgery—Fifth Army followedand further refined in Italy the tech-niques worked out during the late stagesof the Tunisia Campaign for bringingthe best in surgery as close as possible tothe combat soldier. Detailed instructionsas to the preferred management ofvarious types of wounds were issued31 See p. 326, below.


shortly before the invasion,32 but initialreliance was placed on the experiencedteams of the 2d Auxiliary SurgicalGroup. In the landing phase, theseteams were attached to the clearing sta-tions, shifting to the evacuation hospitalsas they were established. When the frontwas stabilized north of the Volturno latein October 1943, field hospital platoons,each with two to eight surgical teams,were set up adjacent to the divisionclearing stations, on the pattern devel-oped in Sicily. Although these 100-bedunits were somewhat larger than experi-ence had shown to be necessary, nosuitable substitute was available.33

With the commitment of the field hos-pitals, a system of triage was instituted atthe clearing stations. Patients who couldstand the ambulance trip were sent backto an evacuation hospital. Those whocould not safely be moved were carriedby litter to the field hospital for immedi-ate surgery. The nontransportable cate-gory generally included cases of severeshock, intra-abdominal wounds, thoraco-abdominal wounds, sucking chestwounds, and traumatic amputations. Pa-tients treated in the field hospital unitswere retained until they could be safelymoved, up to a maximum of fourteendays. As in Sicily, personnel and equip-

ment sufficient for postoperative care ofremaining patients were left behindwhen the hospital moved.34

Important changes in management ofsurgical cases during the southern phaseof the Italian campaign included thewider use of penicillin, which had beenallocated for specific treatments in theclosing months of 1943, but became rela-tively plentiful early in 1944; radicaldebridement and other prophylacticmeasures to prevent gas gangrene; andthe extensive use of whole blood, madepossible by the establishment of a bloodbank in Naples in February 1944.35

Another significant administrative de-velopment in forward surgery was theemployment of a surgical consultant byFifth Army toward the end of 1943. Theassignment went to Maj. Snyder, whohad served in a similar capacity with IICorps in the Tunisia and Sicily Cam-paigns. The theater consultant in sur-gery, Colonel Churchill, continued todevote much of his time to the inspectionand improvement of surgery in the armyarea. Fifth Army also benefited, as IICorps and Seventh Army had not, fromthe close proximity of fixed hospitals inthe base section, permitting frequentconferences for exchange of experienceand ideas among medical officers.

Neuropsychiatry—Experience in Sicilytended to confirm the conclusionsreached by Major Hanson and his asso-

32 Fifth Army Med Cir 1, an. 2, sub: Surg Pro-cedures, 21 Aug 43.

33 After the Sicily Campaign, General Blesse andColonel Churchill concluded that the ideal unitfor forward surgery would be a 120-bed surgicalhospital, capable of operating in two 60-bed sec-tions. See (1) Col Wickert, Rpt of Visit to ETOand NATOUSA, 1 Sep to 24 Oct 43. Except asotherwise noted, sources for this section are: (2)Annual Rpts, Surg, Fifth Army, 1943, 1944; (3)Annual Rpt, Med Sec, NATOUSA, 1943; (4) An-nual Rpt, Med Sec, MTOUSA, 1944; (5) AnnualRpt, nth Fld Hosp, 1944; (6) Annual Rpts, 33dField Hosp, 1943, 1944; (7) Annual Rpts, 2dAux Surg Gp, 1943, 1944.

34 For a nonprofessional, but vivid and movingaccount of life in one of those field hospital units,see Margaret Bourke-White, They Called It ThePurple Heart Valley (New York: Simon and Schus-ter, 1944) , pp. 123-32.

35 (1) Surg, NATOUSA, Journal, 3 Nov 43. (2)Fifth Army Med Cir No. 4, 20 Oct 43, sub: GasGangrene. For discussion of the organization andoperation of the blood bank, see pp. 352-53, below.


TEAM OF 2D AUXILIARY SURGICAL GROUP OPERATING on a wounded German soldier,94th Evacuation Hospital, December 1943.

ciates during the Tunisia Campaign thatthe majority of psychiatric cases arisingas a result of combat could be returnedto duty in a relatively short time iftreated close to the source of disturbance.It was largely on the basis of Hanson'sfindings that the War Department inOctober 1943 authorized the addition ofa psychiatrist to the staff of each divisionsurgeon, a practice followed in WorldWar I but later abandoned. A group ofpsychiatrists was recruited for the pur-pose, and Hanson himself, at the requestof the Surgeon General, returned to the

zone of interior to assist in their indoc-trination.36

36 (1) Hanson, comp. and ed., "Combat Psychia-try," Bulletin, U.S. Army Medical Department,Suppl (November 1949) pp. 33, 45. (2) Pers Ltr,Gen Blesse to TSG, 13 Dec 43. General Blesse wasunderstandably reluctant to let Hanson go, butfelt that the mission was of such importance as tojust i fy recalling his neuropsychiatric consultantfrom Italy to undertake it. "I hope," he wrote toGeneral Kirk in the letter cited above, "you willnot find it necessary to keep him there very longfor I need him, and if you have no objection Iwould like to have him return here just as soonas possible." Principal sources for this sectioninclude: (3) Hanson, comp. and ed., "CombatPsychiatry," Bulletin, U.S. Army Medical Depart-


From the outset of the Italian cam-paign, battalion and regimental aid sta-tions were directed to retain cases ofmild neurosis such as anxiety states andexhaustion. These were to be fed, offeredopportunity to bathe, and given a seda-tive sufficient to ensure sleep. Casesrequiring more than thirty-six hourstreatment were sent to the division clear-ing stations, where heavier sedation wasgiven. Those who still did not respondafter seventy-two hours were sent on tothe evacuation hospitals, where theywere given more specialized treatmentand returned to duty or evacuated to thecommunications zone, according to theirhospital expectancy. Of the 2,749 casesdisposed of between 9 September and 31December 1943, 6 percent were returnedto duty from divisional installations, and20 percent from Fifth Army hospitals,the remainder being evacuated out of thearmy area.

Several factors combined to producethis relatively small percentage of returnsto duty. The urgent need for beds in theevacuation hospitals during months of al-most continuous combat sent to base hos-pitals many psychiatric casualties thatmight have been reclaimed in the combatzone. Evacuation hospital staffs had littletime to devote to such cases, and treat-ment varied with each installation. Evenwhere adequate treatment was available,the very atmosphere of an evacuationhospital tended to convince the patientthat his illness was organic and to fixrather than to allay his anxieties.

The solution adopted by Colonel

Martin was the creation of a specializedneuropsychiatric hospital to operate asclose as possible to the actual battle lines.Known as the Fifth Army Neuropsychi-atric Center, the hospital was formedfrom the 2d Platoon of the 601st Clear-ing Company, 161st Medical Battalion,with beds for 250 patients. Four psy-chiatrists were added to the staff, othersbeing attached at intervals when the caseload required it. The enlisted personnelwas approximately double that of a nor-mal clearing platoon, the Wardmenbeing specially trained for the job. Thecenter opened on 21 December 1943 inthe Teano-Riardo area, where the bulkof Fifth Army medical installations werethen concentrated. It continued to func-tion at various locations throughout thewar, never out of earshot of artillery fire.

Every effort was made to avoid a hos-pital atmosphere. There were no nurses.Pajamas, sheets, and pillows were notissued. Patients slept on regulation cots,made their own beds, policed the area. Sofar as possible, routine military disciplinewas maintained, and the idea of a promptreturn to duty was always kept before themen.

After 21 December 1943, all psychi-atric cases that could not be handled atthe division level were sent directly tothe Neuropsychiatric Center. There theywere kept under sedation for two days,but were still expected to go to meals,wash, and shave every day. After theeffects of sedation had worn off, the menwere interviewed—usually on the third orfourth day of their stay. The interviewwas designed to elicit a full story of whathad happened to the men in combat,with probing into their premilitary his-tories 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, MedSec, MTOUSA, 1944; (7) Surgs' rpts for 1943 and1944 of the divs and corps mentioned in the combatsecs of this chapter.


TABLE 6—DISPOSITION OF NEUROPSYCHIATRIC CASES IN FIFTH ARMYSEPTEMBER 1943—APRIL 1944


this interview and the decision made asto eventual disposition. A man might bereturned to duty promptly, retained forfurther treatment, or evacuated to therear, according to the severity of hissymptoms and the nature of his responsesunder questioning.

By March 1944 each U.S. division ofFifth Army had its own psychiatrist, whoscreened the cases as they came to theclearing stations. The system was func-tioning smoothly as a single process bythe time the drive to Rome was launchedin May, but was still to be significantlyimproved at the division level later inthe year.37

The disposition of neuropsychiatriccases in Fifth Army for the period fromSeptember 1943 through April 1944 isshown in Table 6. The sharp decline in

returns to duty from division clearingstations in November 1943 reflects theimpact of continuous and increasinglysevere fighting under steadily deteriorat-ing conditions of weather and terrain.The ameliorating effect of the FifthArmy Neuropsychiatric Center first ap-peared in January 1944. February wasthe month of heaviest fighting at bothAnzio and Cassino. The improved figuresfor April represent virtual freedom fromcombat, improved weather conditions,and the first results of the assignment ofpsychiatrists at the division level.

Diseases of Special Interest: Infec-tious Hepatitis—The period betweenthe Salerno landings and the launchingof the May 1944 offensive toward Romeshowed no unusual incidence of diseaseamong Fifth Army troops. In the earlyweeks of the drive, malaria, Sandfly37 See pp. 314-16, below.


fever, and dysentery predominated.38

Respiratory diseases appeared with theadvent of the rainy season, but not inunusual volume. The only diseaseworthy of special notice as a problemfor the medical service during the pe-riod, other than those discussed underseparate headings in this chapter, wasinfectious hepatitis. The disease was firstnoted in July 1943 in North Africa, butwas confined mainly to units of the 34thDivision. In Italy it became generalshortly after the Salerno landings, andreached a peak rate of 121.0 cases per1,000 per annum for the second week inOctober. The rate for the entire monthof October was 93, dropping sharply andsteadily thereafter to 11 in April 1944.Hepatitis consumed manpower out ofall proportion to its incidence, since theaverage time lost was sixty days for eachpatient.39

Infectious hepatitis was intensivelystudied by Fifth Army medical officersduring and after the outbreak, but with-out arriving at definite conclusions as toits mode of transmission, or the factorsinfluencing its virulence. The diseasewas seasonal in character, being mostwidespread in the fall months. It ap-peared to be more common among sea-soned troops than among men newlyarrived in the theater. There was someevidence of a relationship between hep-atitis and a previous history of diarrhea.The studies made in the winter of 1943-44, however, did not produce enoughinformation to prevent another and still

more virulent outbreak in the late fallof 1944.40

Preventive Medicine

Venereal Disease—The control of ve-nereal disease in Italy proved to be evenmore difficult than it had been in Africa.After more than twenty years of fascismand three years of war, the Italian econo-my was a patchwork of makeshifts inwhich sheer hunger often overrode moralconsiderations. Food was to be had onthe black market for a price, and theprice could be obtained by prostitution.To women whose men were dead orbroken, prisoners of war, or doing forcedlabor for a conqueror, there seemed noother way. In cities such as Naples theopportunities for clandestine contactswere so numerous that neither inspec-tion of licensed brothels nor putting thehouses off-limits offered any solution.The psychology of the soldier, moreover,was that the longer he remained in com-bat, the more remote were his chances ofgetting home. As time went on, his mem-ories dimmed and he came increasinglyto live for the moment.41

Italian doctors stated, and laboratorytests tended to confirm the estimates,that by 1944 half the available womenin Italy had some form of venereal dis-ease, and that in the populous areas 95to 100 percent of all prostitutes showedclinical evidence of one or more venerealdiseases. Add to this high rate of infec-tion 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, 1stArmd 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 annualreports of the Fifth Army surgeon for 1943 and1944 and on the reports of corps and divisionsurgeons in the Fifth Army area.


clear. For example, when the 3d Infan-try Division was training near Naplesearly in January 1944 for the Anziooperation, the division surgeon reportedthat "prostitutes from Naples descendedupon our encampment by the hundreds,outflanking guards and barbed wire.They set up 'business' in almost inacces-sible caves in the surrounding bluffs.Many of them gained entrance intocamp by posing as laundresses. . . . Eachday several large truck loads of scream-ing, screeching prostitutes were collectedin the Division area and delivered intothe custody of the Italian police.42

Fifth Army dispensed with its venerealdisease control officer in September 1943when the Army went into combat. Inthat month the venereal disease rate waslow, but it began to rise sharply with thecapture of Naples in October. In Decem-ber the position of control officer was re-established, and Maj. (later Lt. Col.)Sydney Selesnick was assigned to it.

It was not practicable to attempt anydirect control of houses of prostitution.Italian laws governing the traffic wererespected, and their enforcement wasabetted by Allied Military Governmentofficials in all occupied territory. Themost that could be done in the army areawas to maintain a continuous education-al drive, to see that preventive deviceswere issued and that prophylactic sta-tions were readily available, and tobring in known prostitutes for exami-nation, and treatment if they were infec-tious. Line officers were held responsibleif their units showed any disproportion-ate incidence of venereal disease.(Table 7)

Along with these preventive measures,

every effort was made to reduce the timelost from duty on account of venerealdisease. An important step in this direc-tion was the establishment on 31 Decem-ber 1943 of the Fifth Army VenerealDisease Diagnostic and Treatment Cen-ter to function in the army area. The 2dPlatoon of the 602d Medical ClearingCompany, 162d Medical Battalion,formed the nucleus of the new organiza-tion, which was augmented by personneldrawn from the collecting companies ofthe battalion. When fully staffed, theVD center had 4 Medical Corps officers,a Medical Administrative Corps officer,and 92 enlisted men. It had 250 beds. Amobile unit of the 2d Medical Labora-tory was attached, adding an officer and5 enlisted men.

Throughout the Gustav Line andRome-Arno Campaigns 90 percent of allFifth Army venereal cases—except thoseon the Anzio beachhead—were treated inthe center, which could move to a newlocation in six hours, carrying its patientswith it. Uniformity and continuity oftreatment cut down materially the timelost from duty per case. The recoverytime was further reduced after peni-cillin became generally available forvenereal cases in mid-February 1944.43

Disposition of patients by the FifthArmy Venereal Disease Diagnostic andTreatment Center in the first fourmonths of 1944 is shown in Table 8. Al-though the center did not formally openuntil the end of December, a consider-able number of cases were already in thehospital on 1 January, accounting for the

42 Annual Rpt, Surg, 3d Div, 1944.

48 Penicillin had been used in the theater in thetreatment of gonorrhea as early as November 1943,but only on special allocation, arranged by thetheater venereal disease control officer. Surg, NA-TOUSA, Journal, 16 Nov 43.


TABLE 7—VENEREAL DISEASE RATE PER THOUSAND PER ANNUM, BY DIVISIONS, SEPTEMBER1943-APRIL 1944


large number of dispositions in thatmonth.

Malaria Control—The Fifth Army ma-laria control program was part of a thea-ter-wide effort. The necessary organiza-tion was set up well in advance of themalaria season, primary responsibilitybeing vested in the Fifth Army medical

inspector, Colonel Gilmore. Colonel Gil-more's assistant, Maj. (later Lt. Col.)Raiford A. Roberts, was named opera-tional director of the control program,and Capt. Joseph J. Bowen served asmalariologist from February 1944, ondetail from the 2655th Malaria ControlDetachment. The operating groups werethe 11 th Malaria Survey Unit and the

TABLE 8—DISPOSITION OF PATIENTS, FIFTH ARMY VENEREAL DISEASE DIAGNOSTIC ANDTREATMENT CENTER, JANUARY-APRIL 1944



28th and 42d Malaria Control Units,with the effective co-operation of theFifth Army engineers.44

Malaria control measures were carriedout at all echelons, each echelon beingresponsible for its own area. Each corps,division, regiment, battalion, and com-pany had its own nonmedical malariacontrol officer. Each formation down toand including the battalion had its ownmalaria control committee. At corps anddivision levels, these committees con-sisted of the medical inspector, the engi-neer, and the malaria control officer. Forregiments and battalions the committeeswere composed of the surgeon and themalaria control officer. Each company,battery, and similar unit had an antima-laria detail of at least two enlisted men,including a noncommissioned officer. Inthe higher echelons the antimalariafunction was largely planning and super-visory. At the company level the anti-malaria details were responsible for car-rying out control measures in the unitarea and for a radius of one mile aroundit. Italian doctors and sanitary engineersfamiliar with the local conditions werefitted into the control organization, andthrough the Allied Military Government(AMG) the civilian population was alsoincluded.

The engineers conducted most of the

large-scale control activities, such asdraining flooded areas, clearing obstruc-tions from waterways, and filling incraters, as well as applying larvicides towater surfaces. Italian troops and civilianlaborers were freely employed in thiswork.

In order to give intelligent directionto the whole malaria control program,two special schools were organized byCaptain Bowen. One of these, on theAnzio beachhead, will be discussed in thefollowing chapter. The other served per-sonnel of II Corps in the highly malar-ious coastal region south of the Garigli-ano River. The school was conducted un-der the auspices of the 54th Medical Bat-talion between 1 and 27 March 1944,during which period 101 officers and 976enlisted men, including 466 noncommis-sioned officers, were trained in the tech-niques of malaria control. Posters wereprominently displayed throughout thecorps area, and a training film on thecause and control of the disease wasshown continuously during the malariaseason.

The control problem was renderedmuch more difficult by the thoroughnesswith which the Germans had destroyedpumping plants, dikes, culverts, anddrainage systems, flooding large sectionsof reclaimed land. It was nevertheless asuccessful program in terms of its ulti-mate results. The malaria case rate per1,000 per annum among Fifth Armytroops rose sharply from 83 in September1943 to 193 for the following month,dropped to a low of 45 in December, andwas only 85 for April 1944. Even in themost malarious months of June, July,and August, the case rates were only 94,82, and 70 respectively. These rates com-pare favorably with those for the theater

44 Main sources for this section are: (1) AnnualRpt, Surg, Fifth Army, 1944; (2) Annual Rpt,Surg, II Corps, 1944; (3) Annual Rpt, Med Sec,MTOUSA, 1944; (4) Ltr, Capt Bowen, Asst Malari-ologist, 2655th Malaria Control Detach (Overhead) ,to Surg, NATOUSA, 29 Dec 44, sub: Stat Analysisof Malaria in MTOUSA, 1944; (5) Ltr, Col An-drews, Acting Malariologist, American Sec, AFHQ,to Surg, NATOUSA, 10 May 44, sub: AntimalariaInspection Tour of VI Corps, Fifth Army, II Corpsand Adriatic Areas of U.S. Military Occupation 23March-3 May 44; (6) Andrews, "North Africa,Italy, and the Islands of the Mediterranean," Com-municable Diseases, Malaria.


TREATING MOROCCAN MOUNTAIN TROOPS of the French Expeditionary Corps for frozenfeet at an aid station in the Venafro area.

as a whole, which were 95 for October1943, 31 for December 1943, and 80 forApril 1944. The rates for the theater asa whole in the summer months of 1944were 70 for June, 81 for July, and 92 forAugust.45

When II Corps moved out of theMinturno sector in the May offensive,responsibility for continuing malariacontrol work passed to the PeninsularBase Section.

Trench Foot—Trench foot appearedamong Fifth Army troops early in theWinter Line campaign and continued toplague commanders until the spring of1944. The condition was first reported inmid-November 1943. Within a weekmore than 200 cases had been hospital-ized. The total for the month was 305,with 1,323 cases reported in December.The January and February figures werestill higher, with a sharp decline inMarch. For the first three months of1944, upwards of 4,000 trench foot caseswere treated, divided fairly evenly be-

45 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)Final Rpt, Preventive Medicine Officer, MTOUSA,1945.


tween the Cassino front and the Anziobeachhead.46

Fifth Army troops were not equippedfor the physical conditions that con-fronted them in the winter of 1943-44.There had been no adequate indoctrina-tion as to the danger of trench foot, andno preparations to prevent it. Troopshad only the standard army shoe or com-bat boot, with light wool socks, whichdid not give protection against eithercold or dampness. Heavy wool socks be-came available later in the winter, butcould not be worn until it was possibleto issue larger shoe sizes. Neither werethere enough socks on hand to permitthe daily change recommended by thesurgeon.

In the bitter mountain fighting beforeCassino, where cold and rain or snowwere almost incessant, front-line troopscould not hope to keep their feet dry,and, continuously in range as they wereof enemy small arms fire, they could notrisk giving away their positions by move-ment merely to exercise their limbs.Manpower was too short to permit rota-tion, so many men went for a week ormore without opportunity to dry orwarm their feet and little chance even to

walk on them. Trench foot was an almostinevitable consequence.

While the condition was intensivelystudied by medical officers of Fifth Armyand proper prophylactic measures weredetermined, little headway could bemade until more suitable footgear be-came available.47

Typhus—An epidemic of typhus thatbroke out in Naples in October 1943posed a serious threat to Fifth Army. Theaccount of measures taken to combat theepidemic and to prevent its spread toFifth Army troops properly belongs inanother chapter.48 It will be sufficienthere to say that vigorous action to pre-vent louse infestation was taken, andwas effective. For several months Napleswas off-limits to Fifth Army troops ex-cept on necessary business, and all mili-tary personnel entering or leaving thecity were treated with insecticides.

Dental Service

Facilities for dental prosthetic workremained scarce during the summer of1943 when Fifth Army was staging forthe invasion of Italy, but with that ex-ception the troops were dentally in goodcondition when the campaign began. Inthe assault phase, only emergency dentalwork was done, while most of the dentalofficers and enlisted personnel performedother duties. By 1 October, however, theFifth Army dental service was solidlyestablished. Three divisional dental lab-oratories were in operation and otherswere functioning in connection with the

46 Figures reported differ considerably. For themonths of November 1943 through March 1944,Annual Report, Medical Section, MTOUSA, gives5,058, but concedes that the 1943 figures are toolow. Annual Report, Surgeon, Fifth Army, 1944,gives 5,710 cases for the same period, while the totalis reduced to 5,274 in Annual Report, Surgeon, FifthArmy, 1945. The text follows Annual Report, Sur-geon, Fifth Army, 1944, and Fifth Army MedicalCircular No. 6, 24 November 1943. For discussion oftrench foot at Anzio, see pages 285-86, below.For more technical treatment, see Col. TomF. Whayne, USA (Ret.) and Michael E. DeBakey,M.D. Cold Injury, Ground Type "Medical Depart-ment, United States Army, in World War II"(Washington, 1958) , pp. 101-25. Whayne and De-Bakey also accept the figures reported by the FifthArmy Surgeon for 1944.

47 Compare the 1943-44 record with that of thewinter of 1944-45 in the north Apennines, page 452,below.



evacuation hospitals. By 1 Decemberthere were twenty laboratories in thearmy area, including two mobile unitsbuilt on 2½-ton truck bodies by the 34thand the 1st Armored Divisions.49

In mid-December 1943 the II Corpssurgeon, Colonel Ginn and the corpsdental surgeon, Lt. Col. Gerald A. Mc-Cracken, organized a II Corps ProstheticDental Clinic and Laboratory. The clinicwas housed in a hospital ward tent sup-plied by the 54th Medical Battalion,which also furnished lighting fixtures, agenerator, and the necessary laboratorytables, benches, and operating platforms.One dental officer was detached fromthe 54th Medical Battalion, and onefrom the nth Field Hospital. The sametwo organizations also furnished betweenthem one laboratory technician, twochair assistants, and one clerk. The re-mainder of the personnel consisted oftwo prosthetic dental teams of one officerand four technicians each, from the 2dAuxiliary Surgical Group. One of theseteams was withdrawn late in February1944.

Early in January a similar clinic wasorganized at the army level by the FifthArmy dental surgeon, Colonel Cowan.The Fifth Army Dental Clinic washoused with the 2d Platoon of the 602dMedical Clearing Company, 162d Medi-cal Battalion, which was also the nucleusof the venereal disease center. Like theII Corps clinic, its personnel and equip-ment were drawn from other medicalunits. The Army clinic had four dental

officers, with an appropriate complementof enlisted men.

Both II Corps and Fifth Army dentalclinics were originally designed primarilyfor prosthetic work, but both quickly en-larged their facilities to handle all aspectsof dentistry except X-ray work.

Another clinic, similarly equipped andstaffed, was set up as an organic part ofthe Fifth Army rest center in Naples,moving with the center to Caserta whenthe typhus epidemic put the former cityoff-limits.

As in earlier campaigns, the more ex-tensive dental facilities of the divisionswere usually located in the service area,with routine dental work being doneduring slack periods in the clearing sta-tions. During actual combat only emer-gency work was performed.

While dental officers in Fifth Armyincreased from 154 in September 1943 to233 in April 1944, their numbers did notkeep pace with the rise in troop strength.The ratio of dental officers to meantroop strength in September was 1:740.In April it was 1:1010. Through betterorganization and more efficient distribu-tion, however, the amount of dentalwork done showed a steady increase overthe 8-month period. (Table 9)

Veterinary Service

In the hard mountain fighting beforeCassino, pack animals were extensivelyused, bringing the Veterinary Corps intoaction in something more than its foodinspection capacity. Early in the WinterLine campaign, veterinary officers of the34th and 45th Divisions procured suchanimals as they could and organized divi-sional pack trains. Other than the divi-sion veterinarian and his sergeant, no

49 Chief sources for this section are: (1) AnnualRpts, Surg Fifth Army, 1943, 1944; (2) AnnualRpt, Surg, II Corps, 1944; (3) Annual Rpt, MedSec, MTOUSA, 1944; (4) 1943 and 1944 rpts ofthe combat and med units in Fifth Army, Sep 43-Apr 44.


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. Foodfor the animals was scarce and of poorquality, and the animals themselves wereold, chronically lame, undersized, andgenerally in poor condition. Despitethese handicaps, however, it was soonapparent that pack trains would be avirtual necessity if troops were to be sup-plied in the mountains.50

With the recognition of this necessity,Col. Clifford E. Pickering, Fifth Armyveterinarian, was directed to help in theprocurement, care, and rehabilitation ofanimals. The task was no easy one. Firstthe Italian Army, and later the Germans,had systematically looted the farms; andthe Germans had killed such animals asthey could not use themselves, in order to

make still more difficult the economicand military problem of the Allies.

Colonel Pickering learned from Ital-ian sources that a considerable numberof animals bred for military use had beendistributed among farmers for conceal-ment from the Germans. With the assist-ance of former Italian cavalry officers andlocal carabinieri, these were located andassembled. Enough feed for their imme-diate needs was found in a partially de-stroyed factory at Maddaloni. Nails andhorseshoes were made from scrap iron inimprovised blacksmith shops. An Italianbreeding depot was re-established as theFifth Army Remount Depot, which wasturned over to the base section at theend of the year.

Another substantial group of animalswas located in Sardinia, where theprompt revolt of the Italian garrison hadsaved 5,000 mules, 1,500 horses, 3,000saddles, and quantities of shoes from thevengeful Germans. Pack trains were or-ganized on the island with Italian per-

50 This section is drawn primarily from the an-nual reports of the Fifth Army surgeon for 1943and 1944, and the reports of the division surgeonswhose units participated in the Winter Line andCassino campaigns. See also, Miller, United StatesArmy Veterinary Service in World War II.


sonnel, each train having 4 line officers,a medical officer, a veterinary officer, 400enlisted men, and approximately 325animals. Two of these trains reached themainland of Italy before the end of 1943.On their arrival, a Fifth Army Provi-sional Veterinary Hospital was organ-ized, using 4 officers and 53 enlisted mendrawn from the pack train complements.The hospital opened at Visciarro on 8December. December also saw the arrivalof a French veterinary hospital, with 5officers and 74 enlisted men from NorthAfrica with elements of the French Ex-peditionary Corps. The French alsobrought their own animals in substantialnumbers.

More pack trains arrived from Sar-dinia in January 1944, together with twomore Italian-staffed veterinary hospitals,the 110th and the 130th. Each of thesehad four veterinary officers, one admin-istrative officer, and 100 enlisted men.These units were set up in the forwardarea, while the provisional hospital, re-named the 210th Veterinary Hospital(Italian), was turned over to the Penin-sular Base Section.

In February an Italian cavalry officer,Col. Berni Canani, was named liaisonofficer between Colonel Pickering's officeand all Italian units, a position in whichhis services proved invaluable.

A U.S. veterinary evacuation hospitaland some separate veterinary companieswere requested for Fifth Army by Gener-al Blesse in November 1943, in anticipa-tion of a wider use of animals in themountain fighting approaching the Gus-tav Line. It was March 1944, however,

before the only American veterinaryevacuation hospital to serve in theMediterranean, the 17th, reached Italy,and no veterinary company was availableto Fifth Army before the final days ofthe war.51 The 17th Veterinary Evacua-tion Hospital was set up near Teano.

The outstanding veterinary problemsof the Winter Line and Gustav Linecampaigns were the care and rehabilita-tion of poor quality, poorly conditionedanimals whose very physical debilityincreased their proneness to battlewounds, and the provision of feed ade-quate both in quantity and quality.Equipment for ridding the animals oflice was very deficient during this pe-riod. While feed increased in quantity,there was little improvement in qualityuntil crops were harvested in the reha-bilitated areas of Italy and shipping be-came available.

Animal strength in Fifth Army rosefrom 986 horses and 4,136 mules in Jan-uary 1944 to 2,226 horses and 10,433mules, or 12,659 animals in all, in April.Of this peak total, 2,023 horses and 7,266mules were with the French Expedition-ary Corps, which had its own treatmentfacilities. During the 4-month period,January—April 1944, 608 U.S. andItalian animals were admitted to thehospital of which 368 were returned toduty, 197 were evacuated to base, and 47died or were destroyed.

51 (1) Surg, NATOUSA, Journal, 15 Nov 43. (2)Annual Rpt, 17th Vet Evac Hosp, 1944. The 45thVeterinary Company (Separate) arrived in theMediterranean in the summer of 1944, but was im-mediately assigned to Seventh Army, then trainingfor the invasion of southern France.

CHAPTER VII

Anzio Beachhead

A seaborne landing on the west coastof Italy between the Garigliano and Ti-ber rivers had been contemplated sinceearly November 1943, and plans involv-ing various sites, including Anzio, weredeveloped in some detail. The stubbornGerman defense of the Winter Line,however, made it clear that the mainbody of Fifth Army would not be able tobreak through to support the beachheadat any predictable time, and plans wereheld in abeyance.

They were revived at a Christmas dayconference in Tunis, where Prime Minis-ter Churchill was the moving force. Allof the military commanders concernedwere present except the one most di-rectly involved—General Clark, whowould be immediately responsible forthe operation. Those at the conferenceincluded General Eisenhower, soon toleave for OVERLORD; General Sir HenryMaitland Wilson, who was to succeedEisenhower as Supreme Allied Com-mander in the Mediterranean; GeneralAlexander, commanding the 15th ArmyGroup in Italy; Air Chief MarshalArthur W. Tedder, who headed the Al-lied Air Forces in the Mediterranean;and Admiral Sir John Cunningham,commanding the Allied Navies in Italianwaters. All of these men appreciated therisks inherent in such an operation, withthe limited forces at their disposal, butpolitical considerations overrode the mil-

itary hazard. The Prime Minister feltthat Rome must be quickly taken or theItalian campaign would be counted afailure, and the Allied cause wouldsuffer, especially with the Turks, whoseactive military aid he was then stren-uously soliciting.1

Medical Planning forOperation SHINGLE

As originally proposed, the Anzio land-

1 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 inItaly from 3rd September, 1943, to 12th December1944," Suppl. to the London Gazette, 6 June 1950,pp. 2908-13, 2917; (5) Mark W. Clark, CalculatedRisk; (6) Truscott, Command Missions; (7) Win-ston S. Churchill, The Second World War: Closingthe Ring (Boston: Houghton Mifflin Company,1951); (8) American Forces in Action, Anzio Beach-head (Washington, 1947); (9) Morison, Sicily-Sa-lerno-Anzio; (10) Wesley Frank Craven and James,Lea Cate, eds., "The Army Air Forces in World WarII," Europe: ARGUMENT to V-E Day, (Chicago,The University of Chicago Press, 1951); (11) Al-bert Kesselring, Soldier's Record, pp. 232-37; (12)Taggart, ed., History of the Third Infantry Divi-sion in World War II; (13) Howe, 1st ArmoredDivision; (14) The Fighting Forty-fifth, pp. 71-86.The more important medical sources are: (15) An-nual Rpt, Med Sec, MTOUSA, 1944; (16) AnnualRpt, Surg, Fifth Army, 1944; (17) Annual Rpt,Surg, VI Corps, 1944; (18) Clift, Field Oprs, pp.265-83; (19) Rollin L. Bauchspies, "The Coura-geous 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 individualmed units mentioned in the text.

ANZIO BEACHHEAD 267

COLONEL BAUCHSPIES

ings, known by the code name SHINGLE,were to be made by one division carry-ing supplies for seven days, by whichtime it was to be in contact with forwardelements from the Cassino front. Whenthe stalemate before the Gustav Line pre-cluded any hope of a quick break-through, plans were changed to land twodivisions, reinforced, with another twodivisions in reserve, and to provide re-supply for as long as was necessary. It washoped that determined attacks across theRapido and Garigliano Rivers would di-vert enough enemy strength from theRome area to permit a quick breakoutby the Anzio forces, which would in turncompel a German withdrawal from theGustav Line and bring about an earlyjunction of troops from the two Alliedfronts.

Operations on the Anzio front, likethose elsewhere in Italy, can be properlyunderstood only in terms of broad Alliedstrategy for the war as a whole. Thebuild-up in England for the cross-Chan-nel attack took precedence over every-thing else. Three veteran U.S. divisions—the 1st, 9th, and 2d Armored— had al-ready been diverted from the Mediter-ranean, together with most of the 82dAirborne. With them went medical de-tachments, supporting medical battal-ions, and evacuation hospitals. Seasonedcommanders were also being withdrawnfor major roles in the coming campaignin France. Eisenhower, Bradley, and Pat-ton were followed to England in January1944 by Montgomery, whose successor asEighth Army commander was GeneralSir Oliver Leese; and Tedder, whoturned over command of the Mediter-ranean Allied Air Force to Lt. Gen. IraC. Eaker. Lt. Gen. Jacob L. Devers be-came deputy theater commander under

Wilson, and commander of the U.S.ground forces in the Mediterranean. Theinvasion of southern France, which wasalready in the planning stage, would di-vert still more combat and service troopsfrom Italy. In a word, the Italian cam-paign remained a diversion, to immobil-ize as many German troops as possible.The Allied armies in Italy were never-theless expected to win their battles.

Medical planning for the Anzio land-ings, both at army and at corps levels,followed the tactical plans, making fulluse of experience gained in Africa andSicily and on the Salerno beaches. Theoperation was to be carried out by VICorps, under command of GeneralLucas. The assault troops were to be theBritish 1st Division, assigned fromEighth Army, and the U.S. 3d Division,with the 45th and 1st Armored Divisions


in reserve. The landing force was alsoto include two British Commando andthree Ranger battalions, the 504th Para-chute Infantry regiment, and the 509thParachute Infantry Battalion. In addi-tion to the normal medical detachmentsand organic medical battalions, medicalsupport for VI Corps was to be suppliedby the 52d Medical Battalion; the 93d,95th, and 56th Evacuation Hospitals; the33d Field Hospital, with the British 12thField Transfusion Unit attached; theBritish 2d Casualty Clearing Station; the549th Ambulance Company; and a de-tachment of the 2d Auxiliary SurgicalGroup.

Medical planning for the Anzio opera-tion was directed by Fifth Army surgeon,Joseph I. Martin, now a brigadier gener-al, and Colonel Huddleston, who hadbeen VI Corps surgeon since Salerno.Colonel Huddleston also directed medi-cal services on the beachhead until hewas killed by artillery fire while emerg-ing from corps headquarters on 9 Feb-ruary 1944. He was succeeded by Col.Rollin L. Bauchspies, commanding offi-cer of the 16th Evacuation Hospital.

Medical support was based on a pro-jected D-day casualty rate of 10 percentof the assault troops and 5 percent of theremainder, with a daily hospital admis-sion rate thereafter of five per thousandfrom all causes.

All medical units were to be combat-loaded for greater speed in establishingthemselves ashore. Aid stations were togo in with the landing waves, to be fol-lowed as quickly as possible by the in-stallations of the beach group, underinitial control of the 540th EngineerShore Regiment. In the latter category,the 52d Medical Battalion was to set upa collecting-clearing station to receive

casualties from the aid stations and evac-uate to the ships, while the 33d FieldHospital was to establish an adjacentunit to care for nontransportables. Thecollecting companies of the 3d MedicalBattalion, organic to the 3d Division,were to land at H plus 6 and move in-land to assume their normal functions,with the 3d Division clearing station fol-lowing two hours later. The two 400-bedevacuation hospitals, the 93d and 95th,were also to go ashore on D-day.

The British assault was to be similarlysupported, with two field dressing sta-tions and a beach dressing station,backed up by the 2d Casualty ClearingStation. Hospital ships were to be avail-able off both British and Americanbeaches until D plus 3, after which theywere to come when requested by thesenior surgeon on the beachhead. Nor-mal medical supplies were to be aug-mented by additional items carriedashore by aidmen, and the 1st AdvancePlatoon of the 12th Medical Depot Com-pany was to maintain a 10-day reserve onthe beachhead. During the assault phase,task force and subtask force surgeonswere to be responsible for all medicalunits accompanying their forces.


Landing Phase

Anzio and nearby Nettuno are smallresort towns on the west coast of Italy,about 30 miles south of Rome. (Map 24)Ten miles to the east, the MussoliniCanal separates the Anzio plain from thereclaimed Pontine Marshes, while on thenorthwest rolling, partially wooded farm-lands, cut by deep gullies, extend about25 miles to the Tiber. Some 20 miles

MAP 24—Anzio Beachhead and Surrounding Areas


north of Anzio rise the Alban Hills, orColli Laziali, with Highway 7—the an-cient Appian Way—skirting the southernshoulder of the hill mass through Albanoand Velletri, and running southeast toTerracina on the coast, about midway be-tween Rome and Naples. Highway 6,the direct route from Cassino to Rome,flanks the northern slopes of the AlbanHills, coming at its closest point within30 miles of Anzio.

The original mission of VI Corps wasto seize the Alban Hills and cut bothhighways, which formed at once the sup-ply lines and the escape routes of theGerman Tenth Army entrenched behindthe Gustav Line. The orders finallygiven to General Lucas were somewhatmodified, in the light of anticipated dif-ficulties. VI Corps was to "seize andsecure a beachhead in the vicinity ofAnzio" and "advance on Colli Laziali,"but the timing and extent of the advancewere not predetermined. The key pointsto be enveloped were Campoleone, eight-een miles north of Anzio on the Albanoroad, and Cisterna, astride Highway 7 asimilar distance to the northeast.

While German intelligence had notedAllied preparations for an amphibiousoperation, the enemy high command hadbeen deceived by feints and raids at var-ious points into expecting the assault tobe made north of Rome. Vigorousthrusts along the main Fifth Army front,from Cassino to the mouth of the Garig-liano, further confused the enemy, andserved to occupy his reserves. The Anziobeaches were therefore virtually unde-fended when the first Allied troopswaded ashore at 0200 on 22 January1944. The 3d Division, commanded byGeneral Truscott, landed three regi-ments abreast between Nettuno and the

canal, while the Commandos led theBritish assault six miles northwest ofAnzio. The town itself, with mole andport facilities nearly intact, was quicklytaken by Col. William O. Darby'sRangers. The 509th Parachute InfantryBattalion took Nettuno almost asquickly.

German air attacks began shortly afterdawn, coupled with spasmodic fire fromlong-range guns, but the work of unload-ing men and supplies was not seriouslyhampered. By midnight, about 36,000men, 3,200 vehicles, and large quantitiesof supplies were ashore, approximately90 percent of the equipment and person-nel of the assault convoy.

Casualties were negligible, and so themedical plan was altered to give priorityto combat troops and material. Battalionaid stations went ashore with the combatunits to which they were attached, andlitter squads from the 52d Medical Bat-talion accompanied the 3d Division aswell as the Rangers and paratroops. Thebeach collecting-clearing station of thecorps medical battalion was not needed,however, and did not go ashore untiltwenty-four hours after the first landings.The 3d Division clearing station was notestablished until the afternoon of D plus1.

The few casualties that occurred in theearly hours of the assault were held atbattalion aid stations or carried direct toLST's equipped to care for them. Asidefrom these aid stations, the only medicalinstallation ashore on D-day was the 2dPlatoon of the 33d Field Hospital, whichlanded its personnel and attached surgi-cal teams at 1330, received its equipmentthree hours later, and was ready to acceptpatients about 1800. The hospital wasset up on the beach southeast of Nettuno.

ANZIO BEACHHEAD 271

Until the bulk of the troops had ad-vanced inland and a normal chain ofevacuation had been set up, most casual-ties were littered from the battalion aidstations directly to the field hospital.

For 48 hours this unit was the onlyhospital functioning on the beachhead.It was soon filled to capacity, with threeoperating tables in constant use and abacklog of 20 to 30 cases. Tents wereseveral times pierced by shell fragmentsand debris, but no casualties resulted.The remaining platoons of the 33d Fieldwere put ashore during the afternoon of23 January, D plus 1, but remained inbivouac, the 3d Platoon until 26 Jan-uary, the 1st until 8 February. In theinterval, their personnel and equipmentwere drawn upon to expand the facilitiesof the 2d Platoon.

Both the 93d and 95th EvacuationHospitals were landed on D plus 1, butwere not in operation until the late after-noon of 24 January. The 93d occupiedbuildings in Anzio; the 95th was undercanvas midway between Anzio and Net-tuno. The British 2d Casualty ClearingStation was established just north ofAnzio about the same time.

German air raids on the harbor areaand the rising tempo of long-range shel-ling quickly made these hospital sitesuntenable. There was, in fact, no safearea on the beachhead, since every footof the ground held by Allied troopscould be observed by the enemy andreached by his guns. Colonel Huddlestonselected an open field about two mileseast of Nettuno as the lesser hazard, anda hospital area was laid out. The 56thEvacuation, which arrived on 28 Jan-uary, was set up here, and took all pa-tients over the next two or three dayswhile the 93d and 95th Evacuation Hos-

pitals and the 33d Field Hospital movedto the new location. A similar area forBritish medical installations was estab-lished about two miles north of Anzio onthe road to Rome. (See Map 24.)

Evacuation was from the beach untilthe harbor became available on 29 Jan-uary, D plus 7. LCI's (Landing Craft, In-fantry) and other small craft carriedpatients to LST's or to hospital shipsstanding offshore, but the process wasdifficult at best. The water was roughfive days out of seven. Frequent air raidsand intermittent shelling made it dan-gerous to hold casualties on the beach,while the ships standing by were easytargets. Even the Geneva cross was scantprotection. Three British hospital shipswere deliberately bombed offshore onthe night of 24 January, and one of them,the St. David, was sunk.

On the military side the attack, whichopened so auspiciously, was quicklystalled. From the beaches the troopsmoved inland against light opposition.All initial objectives, including thebridges across the Mussolini Canal, weresecured by noon of D-day, but the keytowns of Campoleone and Cisterna werestill miles away, and the Alban Hillswere but a blister in the distance. Jan-uary 24 found VI Corps still occupyingan area roughly fifteen miles wide and nomore than seven miles deep. By thistime the benefit of surprise had been lost.Air attacks were increasing in violenceand frequency. Huge railway guns thatthe men came to know as "WhistlingWillie" and the "Anzio Express" weretrained on the beachhead from concealedpositions, changing nightly. All alongthe 26-mile perimeter of the Allied front,opposition was stiffening as new Germanunits were rushed piecemeal to the area


TRANSFERRING WOUNDED FROM AN LCI TO A BRITISH HOSPITAL SHIP OFF ANZIO

over roads and rail lines still usable de-spite the pounding of Allied bombers.

General Lucas decided to dig inagainst an anticipated counterthrust andwait for reinforcements before advanc-ing his lines. The 1st Special ServiceForce, the 45th Infantry Division, andhalf of the 1st Armored were broughtup from Naples, and the attack waslaunched on 30 January. It was too late.The Germans had moved more swiftly,bringing fresh divisions from northernItaly, southern France, Yugoslavia, andeven from the static Eighth Army front

to wipe out what Hitler called the"abscess" below Rome.

For seventeen weeks Anzio beachheadremained a "flat and barren little stripof Hell"; a front without a rear, wherehospitals stood only six miles from thefighting lines and were backed againstthe sea. Instead of the wildcat Churchillhad hoped to hurl at the enemy's flank,SHINGLE had become a "stranded whale."2

2 The first quote is from General Clark, Calcu-lated Risk, page 7; the second is from WinstonChurchill, Closing the Ring, page 488.

ANZIO BEACHHEAD 273

Attack and Counterattack

The VI Corps attack launched on 30January was a twopronged drive inwhich the 3d Division was to cut therailroad at Cisterna and seize the town,and the British 1st Division was to takeCampoleone and advance to cut High-way 7 at Albano. The 1st Armored wasto pass around the British 1st to the leftand storm Colli Laziali from the west.The attack began disastrously when the1st and 3d Ranger Battalions, whichwere to open the way for the 3d Divi-sion, were ambushed and destroyed.Only 6 of the 767 men engaged got back.Among the missing were 21 enlisted menof the 52d Medical Battalion. The 4thRanger Battalion, following with the15th Regimental Combat Team of the3d Division, also suffered heavy losses.After three days of fighting, the Cis-terna assault was halted two miles shortof its goal.

The drive up the Albano road was nomore successful. The British 1st Divi-sion was met by well-placed armor, andthe U.S. 1st Armored had to be hastilydiverted to reinforce the infantry. Againthe objective was approached but notreached, and the attack was halted atnightfall on 31 January.

With the equivalent of four divisionsunder his command, General Lucas hadbeen stopped by a German army of ap-proximately equal size. Though heavylosses had been inflicted on the enemy,his line had not been breached. On 2February, VI Corps was ordered to takedefensive positions, and control of hospi-talization and evacuation from thebeachhead reverted to Fifth Army.

During the next two weeks both sidesworked furiously to build up strength,

but the initiative lay with the Germans,who launched repeated attacks againstdifferent sections of the front and keptup an intermittent shelling of Alliedpositions. Consolidated into the Four-teenth Army under General Eberhardvon Mackensen, the German strengthwas impressive. The Allies brought upthe British 56th Division from theGarigliano front, but few more unitswere available. VI Corps could only com-pensate for deficiencies in manpower byheavily reinforcing its artillery andtanks.

The major German drive waslaunched down the Albano road on 16February and reached its maximum de-velopment two days later. The crisis forthe beachhead came during the night of18-19 February when the Germans werestopped only six miles from the sea. Al-lied air superiority and the support ofnaval guns were contributing factors.3

General Truscott was made deputy com-mander of VI Corps at this time, com-mand of the 3d Division passing to Brig.Gen. John W. O'Daniel. Truscott re-placed Lucas as corps commander on 23February.

A renewed German drive on 28 Feb-ruary was also stopped after several daysof continuous fighting, much of it hand-to-hand. By 5 March the battle of thebeachhead was over. The Germans tac-itly acknowledged defeat and went overto the defensive, while Alexanderordered a general regrouping of the Al-lied forces on the main front in prepara-tion for a drive on Rome.

3 Rpt, Supreme Allied Commander, Mediterrane-an, to CCS, on Italian Campaign, 8 Jan 44-10 May44.


PFC. LLOYD C. HAWKS, 3d Division aid-man, received the Medal of Honor for hisheroic rescue on 30 January 1944 of twowounded men in the Anzio area from anexposed position within 30 yards of thecounterattacking enemy, although he him-self was twice wounded.

The beachhead line was approxi-mately that of 24 January, with some ex-pansion toward Cisterna. For the nexttwo and a half months VI Corps waited,resting, reinforcing, and building re-serves of ammunition and supplies.Every part of the beachhead remainedsubject to enemy fire, and limited en-gagements continued intermittently, butthe issue was no longer in doubt.

Early in March the British 5th Divi-sion replaced the battered 56th, andlater that month the U.S. 34th Divisionwas added to the Anzio forces. In May,shortly before the final breakout, the

36th Division was also attached to VICorps.

Medical support of the Anzio forcesafter the landing phase followed a nor-mal pattern, though all the clearingstations but one, through sheer necessity,were eventually concentrated in the hos-pital area east of Nettuno. The 3d Divi-sion clearing station was originally estab-lished in the area later selected forhospital use, but moved on 14 Februaryto Acciarella, about midway betweenNettuno and the Mussolini Canal on aneast-west line. There it was joined by aplatoon of the 33d Field Hospital, butboth units, after being heavily shelledon the last day of the month, movedhastily back to the hospital sector. The45th Division clearing station was ini-tially established somewhat closer toNettuno, but it too moved into thehospital area on 8 March. The corpsclearing station of the 52d Medical Bat-talion was sited in the hospital areathroughout the life of the beachhead.Clearing stations of the 34th and 36thDivisions were set up there on arrival.

The only exception was the clearingstation of the 47th Armored MedicalBattalion, supporting the 1st ArmoredDivision, which was located in theBritish hospital area about two milesnorth of Anzio during the entire period.

Evacuation from aid stations and col-lecting stations was by hand litter,ambulance, and jeep. The smallness ofthe beachhead meant that evacuationdistances were never great, but by thesame token the tasks of litter bearersand ambulance drivers were alwayshazardous. Evacuation was mainly atnight because of the ability of the enemyto sweep the beachhead with artilleryfire and the frequency of air attacks.

ANZIO BEACHHEAD 275

Hospitalization on AnzioBeachhead

The decision to locate all hospitals inthe open, made after the 24 Januarybombings, introduced many new prob-lems, but it undoubtedly saved the beach-head medical service. Both Nettuno andAnzio, which offered the only alterna-tives, were pounded to rubble by enemyguns and bombs long before the cam-paign was over. The area selected forthe U.S. installations was on low groundnear the sea. Drainage was poor and thewater table so close to the surface thatdisposal pits and foxholes could not bedug to proper depth. With all installa-tions under canvas, the prevailing damp-ness added to the heating problem,making stoves, fresh straw, and extrablankets necessary. By 2 February, whencontrol of the hospitals reverted to FifthArmy, the 56th, 93d, and 95th Evacua-tion Hospitals and two platoons of the33d Field Hospital were in the area withan aggregate Table of Organization bedstrength of 1,750.4

Beachhead hospitals had been func-tioning at their new locations for nomore than a week when the first of along series of bombings and shellingsoccurred. It was impossible to put themedical installations out of range, andequally impossible in that overcrowdedwedge of purgatory to site them a safedistance from legitimate military tar-gets. Even when the beachhead wasblotted out by a protective screen ofsmoke, the German gunners managed tofind their marks. So good, indeed, was

their observation, and so accurate theirmarksmanship, that it was impossible toattribute all the damage in the hospitalarea to accident.

On 7 February an enemy plane,closely pursued by Allied fighters, jet-tisoned its load over the hospital area.Five antipersonnel bombs landed on thetents of the 95th Evacuation Hospital,where 400 patients were being cared for.Newly wounded men were being carriedin from the ambulances, the X-ray tentwas crowded, and the operating roomswere working to capacity. Twenty-sixpersons were killed and 64 wounded.The dead included 3 nurses, 2 medicalofficers, a Red Cross worker, 14 enlistedmen, and 6 patients. The hospital com-mander, Colonel Sauer, was among thewounded. The X-ray equipment was atotal loss, twenty-nine ward tents weredestroyed, and numerous smaller itemsof equipment were damaged.

Within an hour the dead had beenremoved, the wounded hospitalized, andsurgical cases among the patients of the95th transferred to other installations.Doctors and nurses continued their work,but personnel losses and damage toequipment were too great to overcome.General Martin, after reviewing the sit-uation with his beachhead deputy, Col.Henry S. Blesse of the 56th EvacuationHospital, ordered a replacement. The95th changed places with the 15th Evacu-ation on the static Cassino front, thelatter unit moving by rail to Naples andon two LST's to the beachhead. The15th brought its own records, but onlysuch equipment and tentage as wasneeded to replace that of the 95th de-stroyed by the bombing. The new unitwas in operation before the end of theday on 10 February.

4 In addition to sources cited earlier in this chap-ter, see Lt. Col. Henry M. Winans, 56th Evacua-tion Hospital, Letters, 1943-44, for a vivid personalnarrative of hospital life on the beachhead.


U.S. HOSPITAL AREA AT ANZIO

The 15th received a rough welcome tothe beachhead. On that day long-rangeGerman guns dropped shells in the hos-pital area, killing two nurses, one ofthem the chief nurse, and an enlistedman at the 33d Field Hospital. Fourofficers and seven enlisted men werewounded. One tent was burned andothers damaged. Again the wounded in-cluded the hospital commander, Lt. Col.Samuel A. Hanser. Patients were carriedon their mattresses to the adjoining 56thEvacuation. Blood transfusions in prog-ress at the time of the attack were notinterrupted, one attendant holding the

needle in place while another held thebottle of plasma during the move. Un-like the 95th Evacuation, the 33d Fieldwas able to resume normal operation thefollowing day.

The U.S. and British hospital areaswere bombed on 12 February, and theBritish area again on the 17th and 19th,some casualties resulting in each in-stance. During the remainder of themonth, while the German counterattackcontinued, and on through March therewas no letup. On 17 March the British141st Field Ambulance suffered threedirect hits, with 14 killed and 75

ANZIO BEACHHEAD 277

wounded. On the 22d it was the turn ofthe 15th Evacuation, which was blan-keted by 88-mm. shells. Five personswere killed and 14 wounded. No wonderthe combat troops called the hospitalarea "Hell's half acre" and felt safer infoxholes at the front!

General Truscott was convinced thatthe 22 March shelling of the 15th Evacu-ation Hospital was deliberate. Followinga conference with Fifth Army and VICorps medical officers, he ordered hisengineers to reconstruct the British andAmerican hospital areas so as to givemaximum protection.5 The hospitalscould not be moved. There was no safeplace for them to go. They could noteven go under ground, but they couldbe partially dug in. By this time therains had become less frequent and theground had dried up enough to permitexcavation of tent sites to a depth of 3or 4 feet. Two ward tents were pitchedin each excavation end to end, withearth revetments 3½ feet thick at thebase and 2 feet at the top built up threeto 5 feet around the tent walls. Steelstakes and chicken wire helped hold therevetments in place. Sandbag baffles in-side divided the double tent into fourcompartments of ten beds each. Patientsand personnel were thus secure againstanything but a direct hit. Operatingtents were given the additional protec-tion of a 2-inch plank roof covered withsandbags.

The 94th Evacuation Hospital, withthe 402d Collecting Company of the161st Medical Battalion attached, ar-rived on the beachhead late in Marchwith the 34th Division. The unit openedon 29 March, taking the bulk of the new

casualties for the next five days whilethe other hospitals dug in.

That same night, 29 March, the hospi-tal area was again bombed, only a fewhours after General Clark had inspectedthe installations. The 93d and 56thEvacuation Hospitals were hit, with acombined total of 8 killed and 68wounded. The 56th suffered furtherdamage on the night of 3-4 April andon the morning of 6 April, when long-range German guns once more poundedthe area. Too badly damaged to con-tinue on the beachhead, the 56th wasreplaced on 8 April by the 38th Evacu-ation Hospital, the 56th taking overthe installations of the 38th at Carinolaon the southern front. A week later the11 th Evacuation from Casanova, also onthe southern front, changed places withthe hard-hit 93d. British hospitals weresimilarly rotated with those in the Cas-sino area. Sporadic shelling and bomb-ing continued throughout the life of thebeachhead, but casualties and damagewere considerably reduced by the workof the VI Corps engineers.

Hospitalization policies at Anzio weredictated, like everything else on thebeachhead, by the tactical and geogra-phical situation. In the early stages ofthe campaign all casualties were evacu-ated to Naples as quickly as they couldbe made transportable. This entailed aheavy loss of personnel, however, and atthe beginning of March the three pla-toons of the 33d Field Hospital were setup as a single 400-bed unit to holdpatients expected to recover in fourteendays. Although a platoon of the 52dMedical Battalion clearing company setup a 200-bed venereal disease hospitalon 19 February, the problem was neverserious at Anzio. Cases were confined to5 Truscott, Command Missions, p. 358.


GENERAL BLESSE CONGRATULATINGCOLONEL BLESSE on receiving the SilverStar.

recurrences and to infections among newtroops, contracted before reaching thebeachhead. The VD hospital neverthe-less treated 3,000 patients, U.S. and Brit-ish, during its three months of operation.

Both the 52d Medical Battalion and aplatoon of the 602d Clearing Company,162d Medical Battalion, which arrivedat Anzio in mid-February, operated mo-bile dispensaries for troops in isolatedareas. The 602d also ran an aid station,primarily for service troops working inand around the port.

The U.S. hospitals at Anzio, after theopening of the 94th Evacuation near theend of March, included a 750-bed and

three 400-bed evacuation hospitals, anda 400-bed field hospital, or a total of2,350 Table of Organization beds. Addto these the 200-bed VD hospital of the52d Medical Battalion and beds avail-able in the clearing stations of the fourU.S. divisions active on the beachheadbefore the breakout of 23 May, and themaximum T/O strength was approxi-mately 3,500 beds, or an actual strengthwith normal expansion of not more than5,000. During the period of heaviestfighting, bed strength, including expan-sion, was less than 4,000.

Yet from 22 January through 22 May1944, these hospitals cared for 33,128patients, of whom 10,809 suffered frombattle wounds, 4,245 from injuries, and18,074 from disease. In addition to thesean unrecorded number of civilians werecared for, since no other facilities wereavailable to them. Some 22,000 civilianswere eventually removed from thebeachhead, only 750 being allowed toremain.6

In the same 4-month period, Britishhospitals at Anzio cared for 14,700 cases,including all causes.

Casualties among Medical Depart-ment personnel were high: 92 killed,including 6 nurses; 387 wounded; 19captured; and 60 missing in action—558in all.7

Evacuation From the Beachhead

The original plans for the Anzio Cam-paign 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 Ar-my History, pt. IV, p. 164, gives only 82 killed, butthe surgeon's report appears to be the more accuratesource.

ANZIO BEACHHEAD 279

ship. As the stay of VI Corps on thebeachhead lengthened, however, andcasualties mounted, LST's were pressedinto service. There were simply notenough hospital ships and hospital car-riers available. Even when they could bedispatched to the beachhead, they drewtoo much water to dock at the wharf, andthe sea was often too rough to permittransfer of patients from smaller craftoffshore. There was one stretch of four-teen days during which no hospital shipreached Anzio. To accommodate suchperiods of interrupted evacuation, theAnzio hospitals tried to maintain a re-serve of 900 beds but the sudden violentactions that characterized the Anziofighting often precluded maintenance ofany reserve at all.8

In these circumstances the process ofevacuation had to be carefully regulatedand controlled. Capt. Eugene F. Havertywas sent to the beachhead by GeneralMartin on 1 February to assume theduties of evacuation officer. His energy,skill, and fortitude in the performance ofhis task were outstanding, but VI Corpsdid not benefit long from his presence.Captain Haverty was killed on 29 Febru-ary while directing the loading of casual-ties on an LST. The Fifth Armyhospitalization and evacuation officer,Colonel Camardella, took personalcharge of evacuation from the beachheadafter Captain Haverty's death, returningto the southern front in time to partici-pate in planning for the forthcomingdrive on Rome. His place at Anzio wastaken by Major Selesnick, who hadstarted the year as Fifth Army venerealdisease control officer.

The use of LST's to supplement hos-pital ships for evacuation to Naples madeit necessary to equip these vessels withmedical supplies and utilities not nor-mally carried. It was also necessary tosupply medical personnel to care forpatients on the 20- to 30-hour run toNaples. Initially, two hospital ship pla-toons of limited service men carried outthis assignment. They were supplantedat the end of March by personnel of the56th Medical Battalion, organized intofour platoons, each with a medical officer,an MAC officer, and twenty enlisted men.The average load was 100 to 150 Utterpatients and a similar number of ambu-latory patients, but the newer type LST'sintroduced toward the end of the periodcould accommodate more than 200 litterpatients. Hot meals were supplied thelitter patients from food containers. Thewalking patients were fed in the ship'smess.

Patients were moved on a prearrangedschedule from hospitals to the docks bythe 549th Ambulance Company. Load-ing was the responsibility of the 1st Pla-toon, 602d Clearing Company, of the162d Medical Battalion. Civilians wereevacuated to Naples under the sameprinciples that guided the evacuation ofmilitary personnel.

Air evacuation could not be used atAnzio before the junction of the twoarmies and the dissolution of the beach-head. The Nettuno airstrip was underconstant observation by the enemy, andgenerally unsafe for anything larger thana Piper Cub. Even these small observa-tion planes were used only for emer-gencies, to bring blood or urgentlyneeded 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.


ANZIO HOSPITALS BEING DUG IN AFTER THE GROUND DRIED

casualties, or a total of 33,063 were evac-uated safely from Anzio beachhead.


Following the Salerno pattern, person-nel of the 1st Advance Platoon, 12thMedical Depot Company, were on theAnzio D-day convoy, attached to thebeach group. Each unit carried all itemscalled for in its Table of Basic Allow-ances, with extra blankets and littersadded. Other additional supplies, suchas plasma, atabrine, plaster of paris,dressings, and biologicals were carried

ashore in the special waterproof con-tainers whose worth had been demon-strated at Salerno. On the basis of theSalerno experience, supply estimateswere increased to compensate for lossesthrough accidental immersion as well asby enemy action. The most importantdeparture from the earlier planning foramphibious operations was provisionfor carrying supplies adequate for a 10-day level on the D-day convoy. This levelhad not been reached at Salerno untilD plus 12.9

9 This section is based primarily on: (1) AnnualRpt, Surg, Fifth Army, 1944; (2) Annual Rpt,

ANZIO BEACHHEAD 281

PROTECTING OPERATING TENTS WITH TWO-INCH PLANKS AND SANDBAGS

A medical supply dump was estab-lished on the beach at 0700 on D plus 1.The following day, 24 January, thesupply platoon was relieved from at-tachment to the beach group and passedto control of the VI Corps surgeon. Apermanent site for the depot was lo-cated on the Anzio-Albano road, near thecathedral. A 4-story building, 70 x 40feet, housed offices, issue room, shipping

section, and living quarters for person-nel. Two storage tents were set up foritems that might be damaged by water,other supplies being stored in the open.In the early days of the beachhead allrequisitions were honored if they weresigned by a responsible person, eventhough a scrap of paper might be sub-stituted for the proper form. The timerequired to fill a requisition rangedfrom one-half hour to six hours, depend-ing on the items requested and theextent of enemy shelling and bombing.

The build-up of supplies did not takeplace according to plan, but thanks to

Surg, VI Corps, 1944; (3) Annual Rpt, 12th MedDepot Co, 1944; (4) Maj Richard P. Gilbert, MAC,MS, Combat Medical Supply Operations—The AnzioBeachhead; (5) Davidson, Medical Supply inMTOUSA, pp. 73-79.


the light opposition in the landing phase,no damage resulted. While the 10-daylevel contemplated arrived on schedule,the water was too rough to permit off-shore unloading until D plus 5, the onlymedical supplies available in the inter-val being those carried ashore bymedical units and combat troops. Thissituation was one frequently repeatedat Anzio, since the Liberty ships used forcargo drew too much water to dock atthe wharf. On several occasions, emer-gency requisitions had to be sent toNaples for items that were aboard shipsanchored out from the shore but una-vailable. These emergency supplieswould be delivered by LST, creating anoverstock of some items when the cargovessels managed to unload. Suppliesdelivered by LST were loaded on trucksat Naples and driven directly to the de-pot from the landing craft, permittingthe vessels to withdraw to safety with aminimum of delay.

Replacement items, both of supplyand equipment, were a constant prob-lem on the beachhead because of thecontinual destruction by enemy shellsand bombs. There came to be sometruth as well as humor in the remarkthat "ward tents were sent up daily withthe rations." The problem was furthercomplicated by the rotation of hospitalswith those on the Cassino front, since thearriving units did not always bring suffi-cient equipment to replace what hadbeen destroyed.

Another recurrent supply problemwas that of property exchange. Thehospital ships and carriers were able toexchange litters, blankets, and splints innormal fashion, but LST's used forevacuation were seldom so equipped.The time factor, moreover, precluded

any careful bookkeeping on exchange-able items. The problem was finallysolved by sending a truck to Napleswith each LST carrying patients. AtNaples the truck was loaded with littersand blankets from the base hospitals tobe returned to Anzio in exchange forthose accompanying the patients.

Despite the difficulties inherent in thesituation, including the constant hazardthat supply personnel shared with allothers on the beachhead, the Anzio medi-cal service at no time suffered any supplyor equipment shortage severe enough toimpair the quality of medical care.

Professional Serviceson the Beachhead


Surgery Under Fire—At Anzio allsurgery was forward surgery. There wereno field hospital units to take nontrans-portable cases from the clearing stationsbecause the evacuation hospitals were asclose to the front as the clearing stationsthemselves. There was no screening ofpatients forward of the hospital area.Neither was there more than rudimen-tary specialization, except for the use ofthe 33d Field Hospital for short-termcases after 1 March and the experimen-tal concentration of neuropsychiatriccases in the 56th Evacuation. Each hospi-tal took all types of wounds, limited onlyby its own bed capacity. Teams of the2d Auxiliary Surgical Group operated inall of the beachhead hospitals, includingthe British installations.10

10 Sources for this section are: (1) Annual Rpt,Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, VICorps, 1944; (3) Annual Rpt, 33d Fld Hosp, 1944;

ANZIO BEACHHEAD 283

56TH EVACUATION HOSPITAL AFTER BOMBING AND SHELLING

Ten surgical teams of the group and2 shock teams were on the D-day convoy,working in the 33d Field Hospital andthe 95th Evacuation Hospital as soon asthose units were set up. The 12 teamswere reinforced before the Anzio inter-lude was over by 18 additional surgicalteams, 2 orthopedic teams, 2 neurosurgi-cal teams, a thoracic team, and a miscel-laneous team. For the landing phase,each of the 4 British hospital carriersalso had a surgical team of the 2d Auxil-

iary Group assigned for temporary duty.One officer and an enlisted man of thegroup lost their lives when the St. Davidwas sunk by German bombs the night of22-23 January. A nurse of the groupwas killed in action in the 10 Februaryshelling of the 33d Field Hospital. Inaddition to these deaths in action, the2d Auxiliary Surgical Group had 11 of-ficers, 2 nurses, and 5 enlisted menwounded in the course of the AnzioCampaign.

The surgical load fell heavily on thehospital staffs as well as on the attachedteams, but the work was of a high qual-

(4) Annual Rpts, 1944, of 11th, 15th, 38th, 56th,93d, 94th, and 95th Evacuation Hosps; (5) AnnualRpt, 2d Aux Surg Gp, 1944.


ity despite the fact that many of thecases were of types not normally en-countered in evacuation hospitals. The93d Evacuation, for example, handled1,187 surgical cases during the monthof February, entirely with its own staff.The 11th handled 1,240 surgical cases inone 11-day period, only 72 of which werecared for by attached teams. With theaid of 4 auxiliary teams, the 94th per-formed 138 operations in 24 hours.

At the time of the German counter-offensive in February, the casualty loadwas so great that some men with lesssevere wounds were evacuated to Naplesfor primary surgery, while others weresent back to base hospitals for postopera-tive care. The Fifth Army surgical con-sultant, Colonel Snyder, personally fol-lowed up these cases, shuttling back andforth between Naples and Anzio withreports that proved most useful to beach-head surgeons.

The Anzio surgeons were greatlyaided by generous supplies of wholeblood. Where Fifth Army had relied inthe past primarily on plasma and ondonors among hospital staffs and conva-lescent patients, the Anzio medical serv-ice had the advantage from the outsetof the presence of a British field trans-fusion unit, supplied by a British bloodbank. On 26 February the first Americanblood was received on the beachheadfrom the newly organized Naples bloodbank. A total of 5,128 pints were re-ceived from this unit between 26 Febru-ary and 25 May. Blood was deliveredregularly thereafter by LST, with anoccasional emergency shipment by Cubplane. The British 12th Field Transfu-sion Unit continued to be the distribu-ting agency throughout the life of thebeachhead. Between 22 January and 4

June 10,624 pints of whole blood wereused in U.S. hospitals, for an average of2.01 pints per case; 3,685 pints were usedin British hospitals, averaging 2.95 pintsper case.11

Neuropsychiatry—The conditions un-der which VI Corps operated at Anzio,where all positions were subject toenemy shelling at any time and harass-ing actions around the perimeter were aconstant threat, were inevitably such asto produce a high incidence of psychiat-ric disorders. The same conditions, how-ever, made it impossible to retainpsychiatric casualties for treatment closeto the battle lines.12

The month of February 1944, whenfighting was most severe and the con-tinuance of the beachhead itself was atstake, showed a psychiatric case rate of4 per 1,000 per month in the 1st Ar-mored Division, 16.7 in the 3d Division,and 23 in the 45th Division. The pres-sure for beds in beachhead hospitalswas so great that these psychiatric casual-ties had to be evacuated to base hospitalsin less than two days, despite the show-ing of theater experience that a highproportion could have been returned toduty if treated in the forward area.

The first approach to the problem wasthe designation of the 56th EvacuationHospital on 16 February to handle allpsychiatric cases. It was hoped that this

11 (1) Hist of the 15th Med Gen Lab, 20 Dec42-31 May 44. (2) Annual Rpt, Surg, Fifth Army,1944. (3) Bauchspies, "The Courageous Medics ofAnzio," Military Medicine, CXXII (January-June1958), p.444.

12 Sources for this section are: (1) Annual Rpt,Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, VICorps, 1944; (3) Annual Rpt, Surg, 3d Inf Div,1944; (4) Hanson, ed., "Combat Psychiatry," Bul-letin, U.S. Army Medical Department, Suppl num-ber (November 1949).

ANZIO BEACHHEAD 285

TABLE 10—DISPOSITION OF PROBLEM CASES IN THE 3D DIVISION, 4 MARCH-30 APRIL 1944


specialization would permit more rapididentification and evacuation of severecases, permitting longer retention ofthose most likely to respond to treat-ment if retained on the beachhead. Theexperiment did not work out. The 56thEvacuation admitted 483 such cases inthe period 16-29 February, of whichonly 9.6 percent were returned to duty.

The focus of psychiatric treatment wasthen shifted, still on an experimentalbasis, to the division level. On 1 March aprovisional platoon was organized in the3d Division, with a cadre of one officerand seven carefully selected enlistedmen, under supervision of the divisionpsychiatrist, Capt. Robert J. Campbell.The platoon was attached to the 10thEngineer Battalion. Its ranks were filledup with "problem" cases referred by thecombat units, which continued to carrythe men on their rolls as on special dutystatus. Captain Campbell screened thesecases, sending to the division clearingcompany for disposition all those show-ing need for hospital care. The discipli-nary cases, and those of mild psychiatricdisturbance, were retained in the pro-visional platoon, where they performedvarious duties while undergoing psychi-atric treatment.

Between 4 March, when the first case

was received, and 30 April the provi-sional platoon evaluated 171 referrals.(Table 10) The record was encouragingenough to warrant an extension of theprinciple to other divisions later in theItalian campaign.

Preventive Medicine

Trench Foot—Trench foot had be-come a problem to Fifth Army in theWinter Line campaign, but conditionswere relatively good in the mountainsbefore Cassino compared to those onAnzio beachhead. From January throughmost of March the temperature re-mained near freezing, with frequentrain. The whole area occupied by VICorps was flat, much of it reclaimedswampland, with poor drainage and ahigh ground water level. Trenches, dug-outs, and foxholes were usually halffilled with water before they were com-pleted. Add to these natural disadvan-tages the fact that the enemy had goodobservation of the entire area and gunsto back it up, and the medical problemmay be realized. It was suicidal to leavea foxhole in daylight, so the men stayedin their cramped positions, their feetoften immersed in water and alwayswet, for ten or twelve hours at a stretch.


Trench foot was an inescapable con-comitant.13

There were many conferences on thesubject among medical officers, bothBritish and American, but preventivemeasures were largely useless. The tacti-cal situation made it impossible for themen to exercise their lower limbs prop-erly, and the shortage of manpowerprecluded any effective rotation of menor units. Dry socks were sent to thefront lines as frequently as possible, butthe supply of socks and laundry facilitieswere alike limited. Even had it beenpossible to issue dry socks daily, as wasdone in the British sector,14 men holdingtenuously to positions on a front thatmight erupt at any moment could notbe made to take off their shoes just tochange socks. Had they been willing todo so, the new socks would have beenas wet as the old in a few minutes.

In the circumstances, it is not surpris-ing that 2,196 cases of trench foot werereported during the continuance of thebeachhead. Although preventive meas-ures were thus largely ineffective, theAnzio experience was turned to accountin determining what clothing and equip-

ment would be used in the winter of1944-45. A study with this end in viewwas carried out by the 3d Division, andthe data obtained furnished a basis forordering future winter equipment fortroops in the Mediterranean theater.15

Malaria Control—The same condi-tions that made trench foot inevitablealso made the beachhead a naturalbreeding spot for mosquitoes. Indeed,the Anzio plain had been scourged bymalaria for centuries. As soon as it be-came evident that the Allied forces mightstill be in the area after the onset of themalaria season, a complete control planwas worked out by American and Britishauthorities. Beginning late in February,the beachhead was surveyed from theair for breeding places, and as muchinformation as possible was collectedabout the local incidence of the disease.The results were studied by malariolo-gists, and a control program was issued toall VI Corps units late in March.16

Among the steps taken was the estab-lishment of a special school, operated bypersonnel of the 52d Medical Battalion,for instruction of the officers, noncommis-sioned officers, and enlisted men whowere to carry out the preventive meas-ures. Instructors were 2 Sanitary Corpsofficers and 3 Medical Department en-listed men who went to Anzio for thatpurpose. A total of 2,011 persons receivedsix hours of instruction each. Suppres-sive 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 trenchfoot on the beachhead was higher among U.S.troops than among British troops performing essen-tially the same duties under identical conditions.The reasons for the difference, in addition tochanging socks daily, probably included the Britishpractice of treating mild cases in quarters wherethey were not reported, and the British tendencyto regard cold injury as a self-inflicted wound,subject to appropriate disciplinary action. Otherfactors were the superior boots and heavier woolsocks issued by the British, and the fact that theBritish soldier generally stayed in the line forshorter 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) AnnualRpt, 52d Med Bn, 1944. See also pp. 259-61, above.

ANZIO BEACHHEAD 287

instead of 1 May as called for inNATOUSA directives.

The entire area was divided into seg-ments, with each troop unit being maderesponsible for draining, dusting, oroiling standing and sluggish water, andfor cleaning vegetation from the banks ofwaterways. Every shell hole, every aban-doned foxhole or gun emplacement,every bomb crater was a potential breed-ing spot. So well were the troops indoc-trinated that one beachhead soldier washeard to complain that if he spilled acanteen of water on the ground, someonewould rush up to spray or drain it.

The VI Corps engineers, the 42dMalaria Control Unit, and Italian engi-neer battalions brought in for the pur-pose helped the combat troops carryout their individual assignments. ACorps Malaria Control Committee co-ordinated the whole program, receivingweekly reports from the responsibleofficers at division and unit levels, wherethe control organization was identicalwith that on the Cassino front.

The final success of the program can-not be fully evaluated, since the Anziomalaria season did not reach its heightuntil June and July, after VI Corps hadleft the area. However, daily surveysfailed to reveal the presence of thecarrier, in either adult or larval form,while Allied troops were on the beach-head.

Dental Service

The problem of the dental service atAnzio, like that of the medical and surgi-cal services, was one of organizing facil-ities so as to make maximum use of thelimited personnel available. Laboratoryand prosthetic facilities were even less

adequate than on the Cassino front,while conditions of operation renderedimprovisation more difficult.17

The general practice at Anzio was tocentralize the dental service of each divi-sion at the division level, leaving onlyone dental officer in each regiment tofunction outside the division clinic. The95th Evacuation Hospital carried a den-tal clinic that began functioning on Dplus 2 as a corps installation. The corpsclinic shifted to the 33d Field Hospitalwhen the 95th Evacuation was with-drawn from the beachhead.

A prosthetic dental team of the 2dAuxiliary Surgical Group was attachedto the 56th Evacuation Hospital on 22February, after heavy casualties in theGerman counteroffensive had revealedthe need for reparative dental work onthe beachhead. The team moved to the38th Evacuation when that unit replacedthe 56th early in April, remaining atAnzio until the end of that month. Dur-ing the period 22 February-30 April thisteam completed 37 full dentures, 112partial dentures, and 2 inlays, while re-pairing 20 dentures and 3 bridges. Nodental laboratory facilities other thanthose normally carried by the divisionswere available.

Nursing Service

The Anzio beachhead nursing servicecontributed one of the great heroicachievements of the war. As in otheramphibious operations, nurses were notscheduled for the landings, but joined

17 Sources for this section are: (1) MS, Hist ofArmy Dental Corps, MTO, Jan 43-Jun 44; (2) An-nual Rpt, Surg, Fifth Army, 1944; (3) AnnualRpts, 1944 of med units mentioned in the text ofthis chapter.


their units when hospitals were estab-lished. Thereafter they shared all thediscomfort and inconvenience, all thepersonal hazard, and all the unceasinglabors of the men. If there was anydistinction at Anzio between combattroops and medical personnel, it was thatthe latter worked harder and tookgreater risks. They had not even thescant protection of a foxhole, and thered cross was a target rather than ashield. There were, moreover, no lullsor quiet periods in their activities.Through it all, the approximately 200nurses on the beachhead carried on

their normal duties, without rest andwithout complaint.

When the German drive of Februarywas in full swing, and conditions on thebeachhead were at their worst, theevacuation of the nurses was considered,but only briefly. As a morale factor, theirpresence was of incalculable value. Toremove them would have been veryclose to an admission of defeat in theeyes of the combat troops. So they re-mained—six of them never to depart.Among those who survived, four worethe Silver Star, the first women ever toreceive that decoration.

CHAPTER VIII

From the Garigliano to the Arno

Preparations for the Offensive

The Strategic Concept

After the failure to crack the GustavLine in mid-March 1944, General Alex-ander revised his strategy for the wholecampaign. Plans for the spring offensivecontemplated combining another andstill heavier frontal assault with a doubleflanking movement from the left. IICorps was to move up the coast, alongthe axis of Highway 7, while the FrenchExpeditionary Corps predominantlyskilled in mountain fighting, was to at-tack through the lightly held ridges thatformed the southern wall of the LiriValley. Simultaneously, the BritishEighth Army was to renew the assaulton Cassino, while VI Corps, at Anzio,was to be ready at the strategic momentto cut Highway 6 at Valmontone. If themovement succeeded, an entire Germanarmy would be trapped and destroyed.1

The plan of attack called for a highdegree of co-ordination and involvedlogistical problems of great difficulty,especially in the sector assigned to theFrench. It was necessary, moreover, toregroup the Allied forces all along the

line before the offensive could bemounted, and to do it without givingthe enemy any hint of the nature of theforthcoming operation.

Under orders issued on 5 March, theBritish 10 Corps in the Minturno sectorwas quietly relieved by the U.S. 88thInfantry Division, newly arrived fromAfrica where it had completed itstraining. The British 5th Division from10 Corps and the U.S. 34th Divisionfrom II Corps went to Anzio in March,while the 36th went into training for alater role with the beachhead forces orfor new action on the southern front.The French Expeditionary Corps, rein-forced by the arrival of the 4th MoroccanMountain Division, sideslipped to posi-tions on the right of the 88th, whileEighth Army, leaving only one corps oftwo divisions to hold the Adriatic front,took over the Cassino sector. Moving insmall groups at night to camouflagedpositions, the reshuffling was not com-plete until April.

By that time the 85th Infantry Divi-sion, fresh from the United States, hadjoined the 88th on the lower Garigliano.These new American divisions wereaccompanied by their organic medicalbattalions, the 310th with the 85th Divi-sion and the 313th with the 88th. Bothdivisions were attached to II Corps,which had been weakened by loss of the34th and 36th. When the British 56th

1(1) Fifth Army History, pt. V, The Drive toRome (Milan Italy: Pizzi and Pizio, 1945). (2)Alexander of Tunis, "The Allied Annies in Italyfrom 3rd September, 1943, to 12th December, 1944,"Suppl to the London Gazette, 6 June 1950, pp.2918—40. (3) Kesselring, Soldier's Record.


MAP 25—Fifth Army Hospitals and Medical Supply Dumps on the Cassino Front,11 May 1944

Division returned from Anzio it was as-signed to Eighth Army. The remaining10 Corps division, the 46th, was sent tothe Middle East, but returned to Italylater in the year as an Eighth Army unit.

Regrouping of MedicalInstallations

The realignment of the Allied Armiesin Italy, as the former 15th Army Groupwas now called, made Highway 6 themain artery of support for Eighth Army,while II Corps was served by Highway7 along the coast. U.S. medical installa-

tions were accordingly moved to posi-tions in the new Fifth Army area asrapidly as they could be cleared, withdue regard to deception of the enemyin the process. (Map 25) Patientswere evacuated to base hospitals in theCaserta area, the Naples hospitals beinglargely reserved for Anzio casualties andthose from the French ExpeditionaryCorps.2

2 Major sources for this section are: (1) AnnualRpt, Surg, Fifth Array, 1944; (2) Annual Rpt,Surg, II Corps, 1944; (3) Unit rpts of med unitsmentioned in the text.

FROM THE GARIGLIANO TO THE ARNO 291

In the new sector, all Fifth Army hos-pitals were grouped in the vicinity ofCarinola, adjacent both to Highway 7and to the railroad that roughly paral-leled that highway all the way to Rome.The area was about 12 miles east of themouth of the Garigliano and no morethan 10 or 15 miles southwest of theTeano-Riardo area from which most ofthe installations came. The nth Evacua-tion Hospital opened at the new site on11 March, followed two days later by the95th. The 8th Evacuation Hospital andthe neuropsychiatric hospital operatedby the 601st Clearing Company wereready to receive patients in the Carinolaarea on 23 March, and the 38th Evacua-tion completed its move on the 29th.The 10th Field Hospital, the 16th Evac-uation, and the 3d Convalescent openedin the Carinola area on the 3d, 16th, and26th of April, respectively.

The 38th Evacuation had changedplaces with the 56th from Anzio, and the11th had rotated with the 93d before allthese moves were completed. The 94thEvacuation Hospital went direct to Anziofrom its Mignano site late in March.The venereal disease hospital operatedby the 602d Clearing Company closed atRiardo on 27 March and went intobivouac. Its place was taken by a tempo-rary venereal disease hospital set up un-der II Corps control by the clearingcompany of the 54th Medical Battalion.The hospitalization units of the 11thField Hospital were brought togetherlate in February, operating under canvasas a provisional 400-bed station hospitalfor troops in training until early April.The 11th Field then went into directsupport of the clearing stations of the310th and 313th Medical Battalions.

Veterinary units serving Fifth Army

were also moved during March in thesame general pattern. The two Italian-staffed veterinary hospitals were estab-lished in the II Corps area, the 110thon the extreme left and the 130th atNocelleto close to the main concentra-tion of medical units. The first U.S. vet-erinary installation to reach the theater,the 17th Veterinary Evacuation Hospi-tal, arrived during the regrouping andwas established near Teano, on theextreme right of Fifth Army.

For some six weeks before the launch-ing of the drive on Rome, set for 11 May1944, Fifth Army medical units on thesouthern front had only routine func-tions to perform. Hospitals brought theirequipment up to standard and replacedlosses, while combat medical personneltrained with their divisions. Emphasiswas placed on physical conditioning andon evacuation in mountainous terrain,but opportunities for recreation wereprovided.3


The Drive to Rome

The Southern Front—An hour beforemidnight, 11 May 1944, Allied gunspounded German positions from theTyrrhenian Sea to Cassino and beyond.Immediately thereafter the 85th and88th Divisions of II Corps, and theFrench Expeditionary Corps on theirright, attacked through the mountainsnorth and west of Minturno. In the cen-ter of the front, the British 13 Corps ofEighth Army forced a crossing of theRapido where the 36th Division had

3 The malaria control program carried out atthis time has been discussed on pages 259-61, above.


suffered disaster in January; on the rightthe Polish Corps stormed Cassino andMonastery Hill. Though taken by sur-prise, the Germans rallied quickly tofight back with their customary stub-bornness and skill; but this time theAllies were not to be stopped, and themonastery was taken on the 18th.4

While the Germans were still off bal-ance from the punishing blows of Alliedartillery, the French corps stormed theheights where the British had failed inJanuary and within twenty-four hourshad broken through the Gustav Line.Against stiffening but disorganized op-position, Algerian and Moroccan moun-tain troops then followed the ridges thatoverlooked the Liri Valley from thesouth, and by 19 May had outflankedthe Montedoro anchor point of the stillunfinished Hitler line, last of the Ger-man fortified positions on the southernfront.

Between the French colonials and thesea, the 88th and 85th Divisions of IICorps also penetrated the mountainsand, in a series of bitterly contested smallunit actions, broke through the enemy'sprepared defenses. On 19 May the im-portant highway junction of Itri fell toII Corps. Fondi was taken the next day,and the corps turned southwest towardTerracina, from which Highway 7 ranstraight across the Pontine Marshes toCisterna, the Alban Hills, and Rome.

On the Eighth Army front, where thestrongest German defenses were concen-trated, the advance was slower and moredifficult, but the threat posed by FifthArmy on the left flank relieved enoughof the pressure along Highway 6 to keepEighth Army moving through the LiriValley proper and on into the SaccoValley beyond.

While II Corps drove through anothermountain mass toward Terracina andthe FEC stormed Pico, an importantroad junction which the enemy couldnot afford to lose, VI Corps at Anziostruck on 23 May toward Valmontone,where Highway 6 could be cut, the SaccoValley blocked, and the whole GermanTenth Army trapped.

In the rugged, mountainous area southof the Liri and Sacco Rivers, medicalsupport was difficult in the extreme.Medical supplies and equipment werecarried forward by jeep, by mule, byhand carry, and in a few instances weredropped by parachute from small planes.jeeps and mules were also used to evacu-ate the wounded, supplementing the in-adequate number of ambulances andtrucks whose usefulness was restrictedby the severe limitations of the road net-work. In some instances it was foundadvantageous to hold casualties at the

4 On the military side, major sources for this sec-tion are: (1) Fifth Army History, pt. V; (2) Alex-ander, "Allied Armies in Italy from 3rd Septem-ber, 1943, to 12th December, 1944," Suppl to theLondon Gazette, 6 June 1950; (3) Opns Rpt, IICorps, May 1944; (4) Clark, Calculated Risk; (5)Starr, ed., From Salerno to the Alps; (6) Paul L.Schultz, The 85th Infantry Division in World WarII (Washington: Infantry Journal Press, 1949);(7) John P. Delaney, The Blue Devils in Italy; A

History of the 88th Infantry Division in WorldWar II (Washington: Infantry Journal Press, 1947) .Medical sources primarily relied upon are: (8)Annual Rpt, Surg, Fifth Army, 1944; (9) AnnualRpt, 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, 17Nov 58; (16) Ltr, Maurice M. Kane, M.D., toCoates, 11 Nov 58, both commenting on prelimin-ary draft of this volume. Colonel Bennett was atthat time commanding officer of the 33d FieldHospital; Colonel Kane was surgeon of the 88thDivision.


TREATING 88TH DIVISION CASUALTYat a forward aid station, May 1944.

aid stations until the advancing troopshad secured neighboring roads in orderto avoid the long and difficult litterhauls.

As in the mountain fighting beforeCassino, the heaviest burden fell on thelitter bearers. The medical battalionsorganic to the 85th and 88th Divisions—the 310th and 313th, respectively—hadeach received its authorized overstrengthof 100 litter bearers 5 before the drivebegan, but the number available wasstill far short of needs, and both II Corpsdivisions drew heavily upon service andheadquarters troops for additional bear-ers. Italian troops were also attached aslitter bearers. All together the 85thDivision had 700 litter bearers above thenormal Table of Organization allot-ment, and the 88th had almost as many.

The 85th Division, on the left flank ofII Corps, left its clearing station and the1st platoon of the nth Field Hospitalin the vicinity of Cellole some five milessoutheast of the Garigliano crossing.Casualties began coming back about anhour after the division went into action,and reached a record 544 during the 24hours of 12 May. On the second day ofthe drive, with admissions to the clear-ing station again exceeding 500, the 3dPlatoon of the nth Field Hospitaljoined the 1st in support of the 85th Di-vision. Collecting companies operated intwo sections in order to give closer sup-port to the combat forces. All ambu-lances organic to the division were inuse forward of the clearing station, to-gether with additional ambulancesborrowed from corps. Jeeps fitted withlitter racks were invaluable. Through14 May weapons carriers and trucks were

used to bring out the walking wounded.Evacuation from the clearing station andfield hospital was by two platoons of the54th Medical Battalion.

The offensive was in its sixth day be-fore the 85th Division had moved farenough forward to permit the clearingstation to advance, but thereafter forthe next ten days its moves were fre-quent. On 1.7 May the station crossed theGarigliano River to the vicinity ofMinturno, leaving one platoon of thefield hospital at the old site to care forpatients not yet in condition to be evacu-ated. The other field hospital platoonsimilarly remained at Minturno, whilethe clearing station moved forward toFormia on 20 May and to a site near Itrion the 21 st. On 24 May the clearingstation was established five miles west ofFondi, with both field hospital platoonsadjacent. Two days later the clearing5 See p. 240, above.


ITALIAN CIVILIANS HELP CARRY A CASUALTY down a mountain near Terracina.

station again advanced without its fieldhospital support, this time to Sonnino,where it operated until the division waswithdrawn from the line on 27 May.

The 88th Division, on the right of the85th with the French ExpeditionaryCorps on its own right, followed a lineof advance parallel to that of the 85thbut somewhat farther to the north. High-way 7 was the initial axis of both divi-sions, and was consequently the linealong which medical installations of bothtended to be located. The starting site ofthe 88th Division clearing station wasin the vicinity of Fasani, just north of the

highway and some three or four mileseast of the Garigliano.

Although casualties were not as heavyas those of the 85th, 369 passed throughthe clearing station of the 88th Divisionon 12 May. The station had crossed theriver to a site a mile southeast of Min-turno before it was given field hospitalsupport on 16 May. At that time the 2dPlatoon of the nth Field Hospitalmoved into the area. Evacuation fromthe clearing station was by an ambu-lance platoon of the 54th Medical Bat-talion.

Once the Gustav Line was broken, the


campaign moved more rapidly. The 88thDivision clearing station shifted toFormia on the Gulf of Gaeta on 20 Mayand the next day to a site just west ofItri. In each move the field hospital pla-toon lagged behind for a day or two untilits nontransportable patients could betransferred to one of the evacuation hos-pitals behind the lines.

At this point the 88th Division movedinto the mountains north of Highway 7,and evacuation became increasingly dif-ficult. Collecting companies were splitto establish treatment stations alonglitter trails, and Italian troops were at-tached as litter bearers. Two collectingstations were in the vicinity of Fondiwhen that town was bombed the nightof 23—24 May and suffered considerabledamage to their vehicles.

Over the next three days, the divisioncut across roadless mountains toPriverno. In this drive litter carries wereup to twelve miles from the movingfront back to Fondi, with as many asfourteen relay posts along a single trail.

It was the last important action onthe southern front. Once II Corps wasin contact with the Anzio forces, Germanresistance south of the Liri and SaccoValleys collapsed. On the 88th Divisionfront, the entire 313th Medical Bat-talion moved to the vicinity of Sonninoon 25 May, and two days later the clear-ing station, with its attached field hospi-tal unit, was set up just outside Priverno.

The French Expeditionary Corps, onthe II Corps right, had the most difficultmission of any Fifth Army formation inthe drive to Rome and suffered casual-ties commensurate with its success. TheFrench medical units supporting thecorps, though adequate for normal oper-ations, were unable to carry the excep-

tional load required, and on 23 May the403d Medical Collecting Company, 161stMedical Battalion, with elements of the551 st Ambulance Company attached,was sent to reinforce the FEC. The nextday the 406th Medical Collecting Com-pany, 162d Medical Battalion, was giventhe mission of evacuating French for-ward hospitals.

The Anzio Front—The Germans wereretreating hastily from Terracina whenVI Corps, now more than seven divi-sions strong, began its drive on 23 Mayfrom Anzio beachhead. The 1st Ar-mored, the 3d Division, and the 1stSpecial Service Force led off, passingthrough the 34th to take the Germansby surprise. The attacking forces quicklypenetrated enemy positions before theGermans could regroup. The 45th struckfor limited objectives on the left of thesalient, while the British 1st and 5thDivisions held defensively from theAlbano road west to the sea, and theU.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 LondonGazette, 6 June 1950; (3) Opns Rpts, VI Corps,May, Jun 44; (4) Opns Rpts, II Corps, May, Jun44; (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 InfantryDivision in World War II pp. 153-96; (9) Huff,ed., The Fighting 36th, unpaged; (10) The Fight-ing Forty-Fifth, pp. 86-92; (11) Howe, 1st ArmoredDivision, pp. 317-68; (12) Schultz, 85th Division,pp. 60-107; (13) Delaney, Blue Devils, pp. 62-124.On the medical side, sources primarily relied uponare: (14) Annual Rpt, Surg, Fifth Army, 1944;(15) Annual Rpt, Surg, VI Corps, 1944; (16) An-

nual Rpt, Surg, II Corps, 1944; (17) Annual Rpts,Surgs, 3d, 34th, 36th, 45th, 85th, 88th, 1st ArmdDivs, 1944; (18) Opns Rpts, 3d, 109th, 111th,120th, 310th, 313th, 47th Armd Med Bns, May,Jun 44.


In two days of violent action, the 3dDivision once more proved its right tothe name the Germans gave it ofSturmdivision. The 7th Infantry tookCisterna, fighting from house to batteredhouse. The 15th and 30th regimentsbypassed the town on either side andconverged on Cori, six miles nearer toHighway 6. In the same two days theSpecial Service Force seized the dominat-ing height of Mt. Arrestino, southeast ofCori, and columns of the 1st Armoredwere threatening Velletri, key to theAlban Hills and center of German re-sistance, from south and east. Contacthad been made with II Corps patrols onHighway 7; the Twelfth Air Force, inclose support, had destroyed hundredsof German vehicles on the crowded es-cape roads from the beachhead; and VICorps had taken more than 2,600 prison-ers.

On 26 May a sudden change of direc-tion again caught the Germans unpre-pared. The 34th and 45th Divisionslunged west toward Campoleone Stationand Lanuvio, while the 3d held its gains.The 1st Armored, after a final thrusttoward Velletri in terrain too rough fortanks, was relieved by the 36th. The 1stArmored was back in the line in theCampoleone sector on 29 May, but theGermans, holding fanatically along theAlbano-Lanuvio-Velletri railroad, gaveground only by inches.

Meanwhile, the U.S. IV Corps head-quarters under Maj. Gen. Willis D.Crittenberger had relieved II Corpsheadquarters on the southern front on28 May, and II Corps had shifted to thebeachhead, where General Keyes tookcommand of the Valmontone sector. The3d Division and the Special ServiceForce passed to II Corps command at

this time. The 85th Division, coming upfrom Terracina to reinforce the 3d,went into the line the evening of 30May, and the 88th Division was on theway.

The final drive to Rome was launchedon 1 June, when Valmontone fell to the3d Division and Highway 6 was finallycut. The bulk of the German forces,however, had escaped from the SaccoValley before the trap could be sprung,leaving II Corps to pursue a beaten butstill dangerous enemy. At the same timeelements of the 36th Division, on a mis-sion in the rough and wooded area northof Velletri, penetrated the eastern slopesof the Alban Hills without encounteringany resistance. Seizing the opportunity,the division shifted its ground and byevening of 1 June held commandingpositions on the heights above Velletrithat made the German position in thetown no longer tenable.

Indeed, the Germans were alreadywithdrawing, and only mopping up re-mained. Small, highly mobile units fromII Corps on Highway 6 and from VICorps on Highway 7, swept into Romeon 4 June, so close behind the retreatingenemy that he had no time to destroythe bridges across the Tiber. Highway6 had not been cut quickly enough toprevent the escape of the bulk of theGerman forces, but enemy losses in bothmen and material had been heavy.

The character of medical support onthe Anzio front differed markedly fromthat dictated by the mountainous terrainwest of the Garigliano. During the firstfew days of the VI Corps offensive, clear-ing companies remained in the hospitalarea east of Nettuno. The 3d Divisionclearing station, supporting both its owndivision and the Special Service Force,


HALF-TRACK AMBULANCE IN THE BREAKOUT FROM ANZIO

was the first to move, setting up south ofCori on 26 May along with a platoon ofthe 33d Field Hospital.

One platoon of the 36th Division clear-ing company went into action with thedivision on 26 May, north of Cisterna,but did not have a platoon of the 33dField Hospital adjacent until the 28th.Both clearing station and field hospitalmoved to the Velletri area on 3 June.The field hospital platoon supportingthe 3d Division moved over to supportthe clearing station of the 45th after IICorps took command of the Valmontone

sector. The remaining unit of the 33dField Hospital was established near the34th Division clearing station south ofVelletri by 30 May.

In the new II Corps sector, the 10thField Hospital relieved the nth on 29May, units of the 10th Field being at-tached to the clearing stations of the 3d,85th, and 88th Divisions. The unit at-tached to the 3d Division was forced towithdraw from its initial site south ofValmontone by enemy shelling on 29May. The clearing station of the 88thDivision in the same general area was


A NEWLY TAKEN GERMAN PRISONER HELPS GIVE FIRST AID to a 3d division cas-ualty in the Cisterna area.

bombed on the night of 1-2 June. Adirect hit on the admissions tent killednine persons, seven of them personnelof the 313th Medical Battalion. For thenext twenty-four hours 88th Division cas-ualties were taken to the 85th Divisionclearing station west of Valmontone onthe rim of the Alban Hills.

By this time the combat troops weremoving rapidly, and evacuation routesbetween collecting and clearing stationswere lengthening. This was especiallytrue of the 1st Armored Division, wheretreatment stations set up 2 or 3 miles to

the rear might be 10 miles behind in afew hours. Both the 52d Medical Bat-talion, supporting VI Corps, and the54th Medical Battalion, supporting IICorps, were called upon to reinforce thedivision collecting companies in the finaldrive to Rome. On the II Corps front,along Highway 6, clearing stationsmoved almost daily.

Litter carries in the same period werelong, as the troops outran their medicalsupport. The indispensable jeep, fittedwith litter racks, was used in many placesinaccessible to ambulances, but even


jeeps were useless in much of the hillcountry on the 36th Division front.

Casualties were heaviest in the firsttwo days of the drive out of the beach-head and on 1 June, when the Germansmade their final effort to hold open theirline of retreat along Highway 6. Fieldhospital units often operated beyond nor-mal capacity and were frequently unableto evacuate their patients in time tomove with the division clearing stations.Holding sections were usually left be-hind on these occasions, permitting themain body of the unit to advance. Inother instances, it was necessary for onefield hospital unit to support two divi-sions. Additional nurses for the field hos-pitals were supplied by Fifth Army,while other personnel and extra equip-ment were borrowed from nonopera-tional units. On 2 June the 1st Platoonof the 11 th Field Hospital was attachedto the 10th Field in the II Corps sectorto help carry the load.

Pursuit to the Arno

After the fall of Rome, the Germanarmies in Italy might have been de-stroyed had Alexander been allowed toretain adequate forces. The CombinedChiefs of Staff, however, gave higherpriority to the expanding operations inFrance. During June and July GeneralClark reluctantly gave up both VI Corpsand the French Expeditionary Corps toSeventh Army for the invasion of south-ern France. The equivalent of more thaneight veteran divisions, with supporting-units, were withdrawn while Fifth Armywas in pursuit of a badly beaten foe. Inaddition to the medical units organic tothese divisions, Fifth Army also lost the52d and 56th Medical Battalions, the

10th and nth Field Hospitals, and the11th, 93d, and 95th Evacuation Hospi-tals. At the same time the 750-bed 9thand 59th Evacuation Hospitals werewithdrawn from the Peninsular BaseSection.7

The combat-hardened units of the VICorps and the FEC were gone, and intheir place were the untested 91st and92d Divisions and the Brazilian Expedi-tionary Force of somewhat more thandivision strength. Of these only the 91stsaw action before the Arno River linewas reached. In effective strength, FifthArmy numbered 379,588 on 4 June,when Rome was taken, and only 171,026on 15 August when the lines werestabilized.

After the fall of Rome the Germansfought only small rear-guard actions,trading ground for time to regroup andreequip their disorganized and decimat-ed forces. Bridges, culverts, port facili-ties were methodically destroyed wher-

7 Principal sources for military operations in thepursuit to the Arno are: (1) Fifth Army History,pt. VI, Pursuit to the Arno (Milan, Italy: Pizzi andPizio, 1945); (2) Alexander, "Allied Armies in Italyfrom 3rd September to 12th December, 1944, Supplto the London Gazette 6 June 1950;" (3) OpnsRpts, II Corps, Jun-Aug 44; (4) Opns Rpts, IVCorps, Jun-Aug 44; (5) Clark, Calculated Risk,pp. 334-88; (6) Starr, ed., From Salerno to theAlps, pp. 268-300; (7) Howe, 1st Armored Divi-sion, pp. 317-68; (8) Delaney, Blue Devils, pp. 62-124; (9) Maj. Robert A. Robbins, The 91st In-fantry Division in World War II (Washington:Infantry Journal Press, 1947) , pp. 26—91. The moreimportant medical sources are: (10) Annual Rpt,Surg, Fifth Army, 1944; (11) Annual Rpt, Surg, IICorps, 1944; (12) Annual Rpt, Surg, IV Corps,1944; (13) Annual Rpts, Surgs, 34th, 88th, 91st, 1stArmd Divs, 1944; (14) Opns Rpts, 109th Med Bn,Jun-Aug 44; (15) Opns Rpts, 313th Med Bn, Jun-Aug 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) An-nual Rpt, 161st Med Bn, 1944.


WHEELED LITTER IN THE FLAT BEACHHEAD AREA

ever their destruction would impede theAllied advance or delay the delivery ofsupplies. Battles were fought on terrainof the enemy's choosing by mobile unitsthat could disengage at will and outrunthe slower Allied formations. Fifth Army,forced like the Germans to reorganizeon the march, never quite caught up withany substantial body of enemy troops.

The pursuit opened on 6 June, theday Allied forces crossed the EnglishChannel and secured the first beachheadon French soil. VI Corps, in the coastalsector, drove out along Highway 1 to-ward Civitavecchia, the largest port be-

tween Naples and Leghorn and urgentlyneeded to shorten supply lines. The 1stArmored led the advance in two col-umns, the 34th and 36th Divisions fol-lowing as closely as their transportationpermitted. Elements of the 34th passedthrough the armor that night and tookthe city after only a token fire fight onthe morning of 7 June. Within a weekthe port had been restored sufficientlyto dock Liberty ships.

Some twenty miles inland, II Corps,with the 85th and 88th Divisions, struckalong Highway 2 toward Viterbo withits important complex of airfields. The


GIVING PLASMA to a 1st Special Service Force soldier while he is being evacuated by jeep toa collecting station.

infantry was outdistanced by a task forceof the 1st Armored that swung inlandafter the capture of Civitavecchia andsecured Viterbo the morning of 9 June.

By this time the pattern of the cam-paign was well defined. The hit-and-runtactics of the German retreat did notcall for pursuit in force, permitting boththe reduction and the reoganization ofFifth Army to be carried out in orderlyfashion without loss of momentum. The3d Division, which garrisoned Rome un-til 14 June, did not go back into theline, and the 45th, in VI Corps reserve,was withdrawn on 8 June. The French

Expeditionary Corps, which had beenpinched out in the final days of the driveto Rome, began relief of II Corps alongthe Highway 2 axis on 9 June, and boththe 85th and 88th Divisions were with-drawn for needed rest. At the same timethe VI Corps sector was narrowed andleft in sole command of the 36th Divi-sion, with the 361 st RCT of the 91st Di-vision attached, while the 34th and 1stArmored rested. On 11 June GeneralCrittenberger's IV Corps relieved VICorps.

The reinforced 36th Division seizedthe town of Grosseto on 15 June, and


crossed the Ombrone River that night.Two days later the 517th Parachute Com-bat Team, in Italy to gain experiencefor a mission in southern France, wasalso attached to the 36th. The advance,however, was slowing down in the faceof stiffening opposition and more diff-cult terrain. In the French sector, thefighting centered around Lake Trasi-meno was becoming particularly bitter.

To relieve the French and prepare forthe first withdrawals from the FEC, theIV Corps sector was widened, and the1st Armored returned to the line on 21June. Five days later the 34th Division,with the 442d Infantry attached, relievedthe 36th, which went at once to theSeventh Army staging area. The 361stInfantry remained in the line, attachedto the 1st Armored, but the 517th waswithdrawn on the 28th.

The 34th Division took command ofthe coastal sector just north of Piombino,the small but immensely useful port thathad fallen on 25 June. The divisionclosed rapidly toward Highway 68, alateral road that runs roughly east froma point on Highway 1 some twenty milessouth of Leghorn to a junction withHighway 2 at Poggibonsi, a similar dis-tance south of Florence. The Germansfought hard at Cecina just below thejunction of Highways 1 and 68, in aneffort to delay the capture of Leghorn aslong as possible, but the 34th was beyondthe intersection by 2 July. The next daythe 363d Infantry of the 91st Divisionwas attached to the 34th, in time to takepart in a 6-day battle for Rosignano, onlya dozen miles southeast of Leghorn.

On 11 July the 88th Division cameback into the line as a IV Corps unit,relieving the 1st Armored, and the fol-lowing day the 91st was committed as a

division, though its 363d Regiment re-mained for the time being attached tothe 34th. IV Corps reached the Arnoplain on 17 July, and two days later the34th Division entered the battered portof Leghorn. Pisa fell on the 23d, andFifth Army moved up to the Arno on itsentire front.

The last of the French units had beenwithdrawn on 22 July, and Eighth Armyhad shifted west to fill the gap. Florencefell to Eighth Army on 4 August. Bythe 15th of that month the Arno Riverline was secure, and the Adriatic coastwas also in Allied hands as far north asthe Metauro River above Senigallia.The weakening of Fifth Army to supplytroops for operations in southern France,however, had permitted the enemy towithdraw to the Gothic Line in thenorthern Apennines. Pursuit beyond theArno was impossible without rest, re-grouping, and resupply. The enemywould also have time to recover hisstrength and to improve his fortifiedpositions.

On the rolling plains northwest ofRome, clearing stations and their accom-panying field hospital platoons experi-enced great difficulty in keeping up withthe racing troops. Advances during thefirst few days of the pursuit were as muchas twenty and thirty miles a day, so thata clearing station located within rangeof enemy guns in the morning mightbe miles behind by nightfall. Even withfrequent moves it was impossible to avoidlong ambulance runs. For similar rea-sons, litter hauls too became long as com-bat elements outran ambulance controlpoints and even aid stations.

Field hospital platoons found it im-possible to move with the same frequen-cy as the clearing stations they supported,


because of the need for giving postopera-tive care to their patients, and of theinadequacy of their organic transporta-tion. The field hospitals were given sixadditional 2½-ton trucks in June, mak-ing ten in all, but even this number wassufficient to move only one platoon ata time. The problem of caring for pa-tients who could not be moved wassolved only by attaching additional fieldhospital units and by operating the unitsin two sections. On more than one occa-sion a single field hospital had sevenseparate sections in simultaneous opera-tion, all in support of a single divisionclearing station.

The 10th Field Hospital remained inthe line in support of the 85th and 88thDivisions until the relief of II Corps wascompleted on 11 June. At that time the11th Field was brought up from bivouacin the Cisterna area, going into actionwith IV Corps. Platoons of the 33d FieldHospital followed the VI Corps drive toCivitavecchia, shifting to IV Corps whenVI Corps was relieved. For the 33d, workwas light until the end of June, whenthe 11th was withdrawn to stage for theinvasion of southern France. Thereafterthe 33d carried the entire burden of for-ward surgery for IV Corps, including therelatively heavy casualties from the bat-tles for Cecina and Rosignano.

The pursuit was characterized by al-ternating periods of heavy fighting andcomparative lull, with correspondingpeaks and valleys for the medical service.On various occasions, corps medical bat-talions were compelled to fill in at thedivision and regimental levels. Duringthe period of severe fighting in themountainous area around Cecina earlyin July, and the subsequent advance toLeghorn and Pisa, the clearing station of

the 109th Medical Battalion, supportingthe 34th Division, cleared casualtiesfrom five regimental combat teams andtheir attached troops.

The 316th Medical Battalion, organicto the 91st Division, operated as a unitin combat for the first time when thedivision was committed on 12 July, al-though collecting companies of the bat-talion had been in action with the 361stand 363d RCT's.

On 3 August, with all but moppingup operations completed, a rest centerfor Fifth Army medical personnel wasestablished at Castiglioncello, about fif-teen miles south of Leghorn on the coast.The camp had accommodations for 50officers, 25 nurses, and 100 enlisted men.Each group remained four days.


The long period of preparation forthe May drive on Rome gave ample timeto clear Fifth Army hospitals, but thenature of the terrain on the Gariglianofront, together with the rapid movementof the combat troops once the GustavLine was broken, prevented close sup-port. Hospitals remained in the Carinolaarea until late May, while lines of evacu-ation stretched out to fifty and seventy-five miles along Highway 7.8

Hospitals supporting II Corps beganmoving forward after the capture of Ter-racina. The 95th Evacuation, augmentedby the 1st Platoon of the 601st ClearingCompany, opened at Itri on 24 May, andthe 93d leapfrogged ten miles fartherforward, to Fondi, two days later. The750-bed 56th Evacuation took over from

8 Major sources for this section are: (1) AnnualRpt, Surg, Fifth Army, 1944; (2) Unit Rpts of thehosps mentioned in the text.


the 93d at Fondi on 1 June, the 93dgoing to Campomorto in the Anzio area.At the same time the 95th jumped aheadfifty miles to Cori, southeast of the AlbanHills. The 16th Evacuation, meanwhile,had gone by sea to Anzio where it openedon 27 May; and the 8th, after a briefstay at Cellole, between Carinola andMinturno, moved overland to Le Fer-riere in the beachhead sector, openingon 1 June. The neuropsychiatric hospitaloperated by the 601st Clearing Com-pany, and the venereal disease hospitaloperated by the 602d Clearing Com-pany, both moved into the Anzio areaon 31 May.

Two casualty clearing stations (evac-uation hospitals), two field hospitals,three mobile surgical formations, and amobile surgical group attached to theFrench Expeditionary Corps were simi-larly slow in moving up for reasons ofterrain and because of the rapid move-ment of the corps. Additional Frenchhospital units, although requested earlyin April, were not available in time forthe Rome-Arno Campaign.9

As the hospitals moved forward, am-bulance control posts were set up to di-rect the flow of casualties. Movementwas facilitated by keeping new casual-ties out of hospitals scheduled for anearly change of location.

General Martin was with the firstgroup to enter Rome, where he quicklylocated buildings suitable for hospitaluse. The 94th Evacuation from Anzioand the 56th from Fondi both movedinto Rome on 6 June, with the 38th and15th from Anzio following on 9 and 10June, respectively. The 38th exchangedits dug-in ward tents with the 59th Evac-

uation Hospital, newly arrived fromSicily to act as a Peninsular Base Sectionstation hospital at Anzio. (Map 26)

In Rome, the 38th Evacuation set upunder canvas in a park near VaticanCity. The 15th was located in a schoolbuilding, while the 94th and 56th shareda large building originally constructedfor hospital use by one of the religiousorders and recently operated as a mili-tary hospital by the Germans—so re-cently, in fact, that pots of coffee andvats of beans were still warm in thekitchen when the Americans arrived. Al-though it was recognized that theseevacuation hospitals did not have theorganic personnel necessary for cleaningand maintenance of fixed structures,General Martin felt that the service theywould render in preparing the buildingsfor later occupancy by PBS units wouldmore than outweigh the disadvantages.10

The last of the Fifth Army hospitalsfrom the southern front, the 3d Con-valescent, moved into the Anzio area on9 June, opening at Le Ferriere. Move-ment had been delayed by lack of trans-portation and congested roads.

In the pursuit north of Rome, wherethe terrain was well adapted to the useof armor, the combat troops quickly out-distanced their supporting hospitals, andlines of evacuation once more length-ened out, up to 100 miles. Here the mainaxis of advance for the U.S. forces wasHighway 1, along the Mediterraneancoast, with the French ExpeditionaryCorps, supported in part by Americanmedical units, using Highway 2, fartherinland. The first hospital to move intothe new combat zone was the 11th Evac-uation, 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.


MAP 26—Fifth Army Hospitals and Medical Supply Dumps, 10 June 1944

just below Civitavecchia, on 10 June.The new location was 40 miles northwestof Rome and more than 80 miles fromthe hospital's former Anzio site. The fol-lowing day the 93d opened at Tarquinia,some 15 miles farther north. On 13 Junethe 95th Evacuation was established atMontalto di Castro, 10 miles beyondTarquinia, where it was joined by the

94th two days later. The 400-bed evac-uation hospitals were usually moved inpairs, the organic transportation of thetwo units being pooled to move first one,and then the other.

Throughout this period, communica-tion was poor and lines of evacuationwere maintained only by great effort.The advance of the front was so rapid


INSTITUTE OF THE GOOD SHEPHERD IN ROME, occupied jointly by the 38th and 94thEvacuation Hospitals.

that the Signal Corps was unable to in-clude the hospitals in its telephone net-work. Pigeons were used to some extent,but for the most part communication wasmaintained by couriers driving jeepshundreds of miles a day. The 8th Evacu-ation Hospital, for example, sent an ad-vance party to lay out a site nearOrbetello, 20 miles beyond the 94th and95th, on 16 June. The party was met byan ambulance driver who had alreadycome 50 miles from the front in searchof a hospital. The 8th's commander, Col.Lewis W. Kirkman, hastily changedplans and after making contact with theFifth Army surgeon by courier, orderedthe hospital established 4 miles south of

Grosseto. The new site was only 6 milesfrom the point of contact with theenemy, but by the time the hospital wasready to receive patients the front was asafe distance away.

Other moves were made toward theend of June. The 15th Evacuationmoved from Rome to Grosseto on the23d of the month. The 94th left Mont-alto on the same day to set up atMontepescali, 10 miles south of Gros-seto, where it was joined on 27 June bythe 16th Evacuation. The 3d Convales-cent moved to Grosseto on 29 June. Alsoon 29 June the 56th Evacuation openedat Venturina, near Piombino, 30 milesnorthwest of Montepescali. The vene-


real disease hospital moved on 26 Juneto Guincarico, about 5 miles from thesites of the 94th and 16th EvacuationHospitals. The 38th Evacuation shiftedfrom Rome to Massa Marittima, about10 miles north of the venereal diseasecenter, on 2 July.

By this date the rate of advance hadslowed owing to the withdrawal of sub-stantial forces for the invasion of south-ern France and to the more rugged ter-rain. For the first time since the fall ofRome the location of hospital sites withrespect to availability of air evacuationbecame a problem, requiring reconnais-sance from the air as well as on theground. Hospitals caught up with thecombat troops, and even outdistancedorganic medical units on occasion. The8th Evacuation for example, moved intothe outskirts of Cecina while the fight-ing for that town was still in progressand was actually set up on 2 July forwardof the 34th Division clearing station.

The next series of moves came towardthe middle of July, when the nth, 93d,and 95th Evacuation Hospitals werewithdrawn from Fifth Army. The 94thEvacuation, with a platoon of the 601stClearing Company attached, moved upto Ponteginori, about ten miles east ofCecina along the road to Florence, on11 July; and the venereal disease hos-pital moved into the same area four dayslater. At the same time the neuropsy-chiatric hospital was established atCecina. The 38th Evacuation opened onthe coast road, twelve miles aboveCecina, on 18 July, after a 24-hour delaybecause the area was still under fire. The15th Evacuation moved to Volterra, afew miles beyond the site of the 94th.The 32d Field Hospital, released fromattachment to the Peninsular Base Sec-

tion, was established at Saline, halfwaybetween the 15th and 94th Evacuations,on 23 July.

The 16th Evacuation operated atArdenza, on the southern outskirts ofLeghorn, from 26 July to 12 August. The3d Convalescent moved on 2 August toLaiatico, twenty miles southeast of Leg-horn; and the 56th Evacuation was es-tablished three days later about fivemiles farther north, at Peccioli. On 8 Au-gust the 601 st Clearing Company set upits neuropsychiatric hospital at Montec-chio, a mile or two south of the Pecciolisite of the 56th Evacuation. The frontwas stabilized at about this time, withthe actual fighting reduced to patrolactions along the Arno River line.(Maps 27, 28)

The Rome-Arno Campaign againdemonstrated the value of the separateambulance company, of the 400-bedevacuation hospital, and of the field hos-pital platoon as a forward unit. Theshortcomings of these platoons with re-spect to size were overbalanced by theirmobility in a campaign of rapid move-ment. The capacity of the 400-bed evacu-ation could be readily increased, evenbeyond its own expansion limits, by theattachment of one or more clearing pla-toons from the corps medical battalions.The field hospital platoons operatingwith the division clearing stations werealso augmented from time to time byadditional personnel and beds fromother sources. In the Rome-Arno Cam-paign the field hospital platoons wereable to move forward with the divisionsthey supported because holding units tocare for their nontransportable patientswere improvised from personnel of thecorps medical battalions, with nursesborrowed from evacuation hospitals. As


TABLE 11—ADMISSIONS TO HOSPITAL AND QUARTERS FROM FIFTH ARMY, MAY—AUGUST1944

a U.S. strength only.


in previous Mediterranean campaigns,surgical, shock, and other specialistteams of the 2d Auxiliary SurgicalGroup worked with the field hospitalplatoons and the evacuation hospitals.The usual complement was one shockand four surgical teams for each fieldhospital platoon.11

It should be noted in this connectionthat the 750-bed evacuation hospitals inthe Italian campaign were moved withmuch greater speed than had been thecase in Tunisia. The 8th Evacuation, forexample, struck its tents, moved 80miles from Cellole to Le Ferriere, andset up again for operation in 30 hours,while the 38th closed in Rome, moved160 miles to Massa Marittima, and re-opened in 40 hours. The improvementowed something to accumulated expe-rience, but more to the effective co-oper-ation of corps and army in providing thenecessary trucks when they were needed.For the most part, however, these largerunits were not required to make rapidchanges of position. As the lines of com-

bat moved forward, the 750-bed evacua-tion hospitals tended to function towardthe rear of the army area more as fixedthan as combat units, eventually beingreplaced by base section hospitals.

Admissions to hospital and quartersfrom Fifth Army during the period ofthe Rome-Arno Campaign reached apeak in June of more than 32,000, ofwhich one-third were battle casualties.(Table 11)


For the first two weeks of the drive onRome, evacuation from Fifth Army con-tinued to follow the pattern of the pre-ceding months. Casualties from thesouthern front were evacuated from theCarinola area by rail to Naples. The 41stHospital Train, controlled by the Pen-insular Base Section, operated betweenthat city and the Sparanise railhead. The42d Hospital Train, scheduled for south-ern France, was brought over from Africaand went into service between Sessa,near the main concentration of FifthArmy hospitals, and Naples, starting 12May. As had been the case in Africa, thenecessary hospital cars were convertedfrom local rolling stock. Holding hospi-

11 (1) Annual Rpt, Surg, Fifth Army, 1944. (2)Annual Rpt, Surg, IV Corps, 1944. (3) AnnualRpt, Surg, II Corps, 1944. (4) Annual Rpt, 2dAux Surg Gp, 1944. (5) Unit rpts of individualhosps.


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 theAnzio 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 pos-sible.

Source: Annual Rpts, 802d and 807th MAETS, 1944.

tals at the railheads were maintained bythe corps medical battalions. Casualtiesfrom Anzio continued through most ofMay to be evacuated exclusively by hos-pital ships and by LST's staffed by teamsfrom the 56th Medical Battalion.

On the fifth day of the attack theencampment of the 56th Medical Bat-talion near Nocellito was bombed inbright moonlight, apparently deliberate-ly, with two enlisted men killed, sevenwounded, and extensive damage toequipment.

After the consolidation of the twofronts, air evacuation began from thearmy area, and thereafter, for the re-mainder of the campaign, forward hos-pitals were cleared by planes of the 802d

and 807th Medical Air EvacuationTransport Squadrons. The first flightfrom the Nettuno airstrip was made on26 May. Air evacuation for both U.S.and French forces was directed by theOffice of the Surgeon, Fifth Army, whichhad made proximity to an airfield or tolevel ground where an airstrip might beconstructed a condition in the selectionof hospital sites. By 1 June approxi-mately 400 patients a day were beingflown from the combat zone to fixedhospitals in Naples and Caserta.12 (Ta-ble 12)

Holding units for air evacuation wereoperated at various points by two collect-

12 Ltr, Gen Stayer, Surg, NATOUSA, to TSG,2 Jun 44.


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 pre-ceding 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 Bat-talion and by the clearing company andone collecting company of the 163dMedical Battalion. The 56th MedicalBattalion handled both air and seaevacuation at Anzio until 23 June, whenit was relieved by the 54th and departedfor Naples to stage for the invasion ofsouthern France. The 402d CollectingCompany of the 161st Medical Battal-ion, assigned to the French Expedition-ary Corps, even helped to construct andmaintain an airstrip, and directed theapproach and take-off of the C-47 trans-ports.

Transportation between hospitals andairfields was handled by corps medicalbattalions. The 162d Medical Battalionalso cleared patients from evacuationhospitals in Rome to the 59th Evacua-tion, which functioned as a PeninsularBase Section station hospital at Anziountil 23 June. By this date more than

3,000 fixed beds were available in theItalian capital, so that forward evacua-tion hospitals began sending casualtiesto Rome instead of to Naples andCaserta.

During the entire 7-month period ofthe Anzio, Cassino, and Rome-Arno Cam-paigns, casualties were evacuated fromFifth Army hospitals to Peninsular BaseSection installations by ambulance, hos-pital train, hospital ship, LST, andtransport plane. The figures are not re-ported by campaigns, only on a monthlybasis. For the period 1 January-31 Au-gust 1944 the total was 102,298.(Table 13)


Like the Fifth Army hospitals, thesupply dumps of the 12th Medical DepotCompany moved forward only after IIand VI Corps had joined at Anzio. The


LOADING AN AMBULANCE PLANE ON NETTUNO AIRSTRIP, JUNE 1944

company headquarters and base platoonand the 2d Platoon went from Calvi Ri-sorta to Nocellito on 20 April, in thegeneral alignment of Fifth and EighthArmies. The 2d Platoon moved forty-fivemiles to Itri on 23 May, and went onto Rome on 9 June. Headquarters andthe base platoon had meanwhile movedfrom Nocellito to Anzio on 5 June,where the 1st Platoon reverted to con-trol of the parent company.13

The 1st Platoon was established inCivitavecchia on 11 June, only four daysafter the capture of the city and beforethe harbor had been cleared. On 18June, headquarters and the base platoonwent on to Grosseto. Ten days later the2d Platoon turned over the supply func-tion in Rome to Peninsular Base Sectioninstallations and followed the rapidlymoving army to Piombino. The 1st Pla-toon was in Cecina on 9 July.

The 12th Medical Depot Company wasreorganized at this time, the personnelcomplement being reduced from 178 to150. The three platoons were redesig-

13 Principal sources for this section are: (1) An-nual Rpt, Surg, Fifth Army, 1944; (2) AnnualRpt, 12th Med Depot Co, 1944; (3) AnnualRpts, Surgs, II, IV, and VI Corps, 1944.


nated the 1st, 2d, and 3d Storage andIssue Platoons.14

Headquarters and the 1st Storage andIssue Platoon moved from Grosseto toSaline on 30 July, where they werejoined on 14 August by the 3d Storageand Issue Platoon. The latter unit wasestablished in the vicinity of Florenceat the end of the month.

In all these rapid changes of position,one platoon of the 12th Medical DepotCompany was always in support of eachof the two U.S. corps engaged, with theheadquarters group accessible to both.The French Expeditionary Corps hadits own system of combat medical supply,which was organized under the same U.S.Table of Organization as its Americancounterpart, and was supplied throughthe same channels.15

Medical supplies were brought up bywater, air, and truck as circumstancesdictated, with no shortages developingexcept the perennial shortages of blan-kets, litters, and pajamas stemming fromfaulty property exchange with air evac-uation units. This shortage was felt at allairstrips used for evacuation, since theincoming planes were on other missions,which generally precluded the carryingof bulky medical items.

One of the features of the supply sys-tem, in the later phases of the campaign,was the daily arrival of whole blood byplane from the 15th Medical GeneralLaboratory.

Professional Servicesin the Army Area

The months of March and April 1944,when the armies were regrouping arid

re-equipping for the crushing attack thatwould carry Allied power to the ArnoRiver, were used by the Medical Depart-ment to review past practices andimprove techniques for the future. Theconferences and seminars that medicalofficers had been able to attend onlyspasmodically up to that time were sys-tematized, with all phases of the work ofthe medical service being discussed. Med-ical officers of all levels profited by theseinterchanges before they returned to ac-tive combat support.16


Forward Surgery—The techniques offorward surgery in the Rome-Arno Cam-paign did not differ greatly from thoseemployed during the preceding eightmonths in Italy. While there were anumber of clinical improvements, in-cluding a more extensive use of penicil-lin and the unrestricted availability ofwhole blood in the field hospital pla-toons, the only important administrativechange was the withdrawal of twenty-eight teams, or half of the entire com-plement, of the 2d Auxiliary SurgicalGroup early in July to stage for thecoming invasion of southern France.17

The loss of these teams was not made upuntil the next stage of the Italian cam-paign.

Neuropsychiatry—The early successof the 3d Division's experiments at Anzioin treating psychiatric cases at the divi-sion level led General Martin to initiatesimilar experiments in the 88th Divi-

14 TOE 8-667, 17 Mar 44.15 ETMD for May 1944. At the start of the Rome-

Arno Campaign, both U.S. and French medical de-pot 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.


sion, which had not yet been in combat.It was hoped that the incidence of psy-chiatric casualties could be reduced ifadequate facilities for early treatmentexisted from the start.18

The 88th Division Training and Re-habilitation Center was formally estab-lished on 18 April 1944, commanded bya line officer with two noncommissionedofficers as assistants, all with extensivecombat experience. The division psychi-atrist, Capt. (later Maj.) Joseph Slusky,acted as consultant. The center was at-tached for rations and quarters to theclearing company of the 313th MedicalBattalion. Actual operation began on11 May when the division went into com-bat. The procedure was simple, buteffective.

An exhaustion or psychiatric case ad-mitted to the clearing station was ex-amined by the division psychiatrist, whoevaluated the severity of the symptoms.The patient was retained at the clearingstation for two or three days, where hewas given sodium amytal three times aday after meals. Sedation was sufficientto ensure adequate rest and sleep, butnot heavy enough to keep the patientfrom going to mess and otherwise takingcare of himself. After 24 to 48 hours ofthis treatment, the patient was againexamined by the division psychiatrist.If he appeared to be responding, he wasretained. If not, he was transferred tothe Fifth Army Neuropsychiatric Cen-ter, operated by the 601st ClearingCompany.

The patients who showed improve-ment under sedation were given sugges-tive and supportive therapy and turnedover to the division Training and Re-habilitation Center, where they weregiven lectures combined with calisthen-ics, hikes, and other physical activities,including tactical training with weapons.Most were ready to return to duty aftertwo days at the center. Others were re-tained for a few days longer, while thosewhose symptoms persisted were evacuat-ed to the neuropsychiatric hospital.

Each patient was re-examined by thedivision psychiatrist before returning tocombat and was given a final therapysession oriented toward reassurance. Re-turns to duty were made through non-medical channels.

The record for the period 11 May-9June, during which the 88th was in con-tinuous combat under particularly diffi-cult conditions, showed a total of 248psychiatric admissions to the divisionTraining and Rehabilitation Center. Ofthese, 141 or 56.9 percent, were returnedto duty from the center. One hundredand four were evacuated to the 601stClearing Company, from which 24 werelater returned to duty. Total returns toduty were thus 165, or 66.5 percent.Eighty, or 32.3 percent, were lost to thedivision. Two remained under treatmentat the end of the period, and one wasabsent without leave.

The results of this experiment ledto an order of 2 July 1944 directing alldivisions of Fifth Army to establish sim-ilar training and rehabilitation centers.Thereafter, admissions to the FifthArmy Neuropsychiatric Center were ex-clusively by transfer from these divisioninstallations. A Fifth Army consultant inneuropsychiatry, 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.


TABLE 14—DISPOSITION OF NEUROPSYCHIATRIC CASES IN FIFTH ARMY, MAY-AUGUST 1944

a Includes 95 returned to limited or Class B duty.


Calvin S. Draper, was also named at thistime. A further development, whichwent into effect the first of August, wasthe return of certain neuropsychiatriccasualties to limited or noncombat dutyin the army area, a disposition board forthis purpose being set up by the 3d Con-valescent Hospital.

In general, the psychiatric cases devel-oping in the drive to Rome and thesubsequent pursuit to the Arno Riverwere less severe than those encounteredduring the static fighting before Cassinoand on the Anzio beachhead. The in-cidence was higher in the divisions newto combat, but the response to treatmentin these divisions was excellent. The rec-ord of the 88th Division has alreadybeen noted. The 91st returned 68.1 per-cent of its 116 psychiatric casualties toduty between 13 and 31 July when thedivision was in combat. The 85th Divi-sion, out of action between 1 July and 15August, had a smaller total of such cases,76 being admitted in this period to thedivision training and rehabilitation cen-ter, but the cases proved more obstinate,only 51 percent being returned to dutyat the division level.

The disposition of psychiatric cases in

Fifth Army as a whole for the last fourmonths of the Rome-Arno Campaign isshown in Table 14.

Common Diseases—Malaria in FifthArmy reached the year's peak of 94cases per 1,000 per annum in June 1944,dropping only slightly to 82 in July. Dur-ing these two months the season was atits height, and the army was operatingin areas that had been controlled by theenemy during the earlier part of thebreeding season. Atabrine continued tobe the primary preventive measureavailable, the use of netting and glovesbeing for the most part impractical incombat.

A sharp rise in the incidence of di-arrhea and dysentery (including bacte-rial food poisoning) from 28 per 1,000per annum in May to 102 in June and135 in July may be explained by thesimultaneous advent of warm weather,the fly season, and the fresh fruit season.Even the July figure, however, was farbelow the rate of 195 cases per 1,000per annum experienced in June 1943 inNorth Africa. Insecticides were availablein adequate quantities, and the diseaseswere quickly overcome when the period


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.


of active fighting came to an end in earlyAugust.

Venereal disease in the summer of1944 followed a predictable pattern, therate being relatively low during periodsof combat and high during the rest andbivouac periods. (Table 15) The ratecontinued to be highest among veterantroops.

Dental Service

On 6 May 1944, just before thelaunching of the drive on Rome, theFifth Army dental surgeon, ColonelCowan, was returned to the UnitedStates on rotation. His acting successorwas Maj. (later Lt. Col.) Clarence T.Richardson of the 16th EvacuationHospital.19

Major Richardson inherited a dentalestablishment much better equipped tofulfill its mission than the one Colonel

Cowan had taken to Salerno eightmonths earlier. Facilities for prostheticwork were still less than adequate, but inother respects Fifth Army began thedrive to Rome well prepared to meet thedental requirements of its troops. Eachof the divisions had improvised labora-tory facilities. In addition, three of thefour mobile dental laboratories—builton 2½-ton truck chassis—reaching thetheater in May were assigned to FifthArmy, the fourth going to the Air Forces.

By June, when IV Corps went intothe line north of Rome, the Fifth ArmyDental Clinic, operated by the 602dMedical Clearing Company, was func-tioning smoothly enough to care for allcases that could not be handled by thedivisions. IV Corps, accordingly, set upno dental clinic of its own, while the IICorps clinic was discontinued towardthe end of the month. Aside from inade-quate prosthetic facilities, the onlyserious defect in the Fifth Army dentalsetup at this time was the familiar prob-lem of getting dental services to troopsin distant positions, and the correlativeloss of man-hours in sending men to therear to the Army clinic.

The reorganization of July gave a

19 The major sources for this section are: (1) An-nual Rpt, Surg, Fifth Army, 1944; (2) AnnualRpt, Med Sec, MTOUSA, 1944; (3) MS, DentalHistory, North African and Mediterranean The-aters of Operations; (4) Unit rpts of div surgs andmed installations in Fifth Army during the period11 May-31 Aug 44.


FIELD UNIT OF THE FIFTH ARMY DENTAL CLINIC in the Piombino area, July 1944.

dental unit to the 12th Medical DepotCompany, but personnel and facilitiesfor it were not available until fall.

For Fifth Army as a whole, the ratioof dental officers to troop strengthdropped sharply from one dental officerfor each 987 men in May 1944 to one foreach 1,019 men in June. The July andAugust ratios were 1:915 and 1:963, re-spectively. The work accomplished bythese officers and their staffs during thelast four months of the Rome-Arno Cam-paign is summarized in Table 16.

Veterinary Service

The May 1944 offensive carried FifthArmy through some of the most ruggedand difficult terrain in Italy. In the drivefrom the Garigliano front to Rome, IICorps was supported by eight Italianpack trains, with an aggregate strengthof 97 horses and 1,897 mules. Divisionalanimals, including those assigned to twopack field artillery battalions, included106 horses and 1,270 mules. Pack trainsof the French Expeditionary Corps in the


TABLE 16—DENTAL SERVICE IN FIFTH ARMY, MAY-AUGUST 1944


same operation utilized 2,023 horses and7,266 mules. In the drive, 146 animalswere killed in action and 1,111 werewounded. The particularly heavy animalcasualties in the French sector made itnecessary to attach the 1st VeterinaryHospital (Italian), a Peninsular BaseSection unit, to the French Expedition-ary Corps.20

Veterinary hospitals in support ofFifth Army experienced considerabledifficulty in finding sites with buildingssuitable for animal use. Close supportwas nevertheless given by these units.The Italian-staffed 110th VeterinaryHospital moved from the Carinola areato Nettuno on 20 June, and to Rome on4 July. The 130th Veterinary Hospital,also Italian staffed, moved from Nocel-lito to Rome on 1 July, to Grosseto aweek later, and to Saline on 1 Septem-ber. The U.S. 17th Veterinary Evacua-tion Hospital, supporting the 601st and

602d Field Artillery Battalions, movedseven times between 4 April and 15 July.Among its operating sites were MonteSan Biagio near Terracina; Cori andNemi in the beachhead area; Castag-neto, south of Cecina; and Ponteginoriwest of Cecina on Highway 68. With thebattalions it supported, the 17th was as-signed to Seventh Army on 20 July.

Replacements for animal casualtieswere supplied by the Base Remount De-pot, operated by Peninsular Base Sec-tion. To minimize delay as much as pos-sible, however, each veterinary hospitalmaintained a small exchange unit thatsupplied a sound animal for eachwounded one received. Only on theFrench front, where animals were mostnumerous and casualties heaviest, didthe system break down. In those caseswhere hospital exchange units were ex-hausted, fresh animals were allotted byFifth Army.

When flat or rolling country wasreached after the fall of Rome, all ani-mal units were placed in rest areas,where they remained throughout thesummer. The only exception was a pe-

20 The major sources for this section are: (1)Annual Rpt, Surg, Fifth Army, 1944; (2) Veter-inary History, Mediterranean Theater of Opera-tions; (3) Miller, United States Army VeterinaryService in World War II.


riod in July when elements of the 1stArmored Division, operating in moun-tains between Massa Marittima andVolterra, substituted horses for half-tracks and trucks.

During the rest period, all Italian packtrains and veterinary hospitals were re-organized in accordance with U.S. Tablesof Organization and Equipment. Fournew Italian pack companies were alsoorganized at this time, and the 20th MulePack Group, which controlled all theItalian pack trains, set up a center underColonel Canani for training recruits inthe handling of pack animals.21

Medical Support for theEastern Command

Before the end of 1943, negotiationsbegan for the use of Russian airfields byU.S. bomber squadrons based in Italyand in the United Kingdom. Arrange-ments were finally completed in thespring of 1944, with the designation ofthree bases in the Ukraine. The head-quarters base was at Poltava, 200 mileseast of Kiev. The others were located atMirgorod, 50 miles west of Poltava, andat Piryatin, another 50 miles in the di-rection of Kiev. Collectively, they wereadministered as the Eastern Command(EASCOM) . The first flight, made byplanes of the Fifteenth Air Force fromItaly on 2 June 1944, was timed to becontemporaneous with the capture ofRome and the launching of the Nor-mandy invasion. The first task force ofB-17's, personally led by General Eaker,destroyed marshaling yards and shops at

Debrecen in eastern Hungary beforeending its mission at Poltava airfield.22

Lt. Col. William M. Jackson, EasternCommand surgeon, established his head-quarters at Poltava, where his staffincluded a Veterinary Corps officer anda Sanitary Corps officer. Each of the threebases was supported by a 75-bed provi-sional hospital expanded from a 24-bedaviation dispensary. Instead of the twomedical officers called for in the TOE,the Poltava and Piryatin hospitals hadfour each, while Mirgorod had three.Each hospital had the one dental officerand one supply officer (MAC) providedin the TOE, and each had four nurses.Eighty-five enlisted men, divided amongheadquarters and the three hospitals,brought total Medical Department per-sonnel to 117. All medical personnel andfacilities came from the United King-dom.23

The first problem faced by ColonelJackson and his staff was one of sanita-tion. Whatever war may have left ofwater and sewerage systems had beendestroyed by the Germans as they re-treated, together with virtually all build-ings. The Russians had been too shortof medical personnel themselves to take

21 See also pp. 263-65, above. Colonel Cananiwas official liaison officer between the Italian packand veterinary units and the office of the Fifth Armyveterinarian, Colonel Pickering.

22 This section is based primarily on the follow-ing: (1) Craven and Cate, eds., Europe; ARGU-MENT to V-E Day, pp. 308-19; (2) Maj AlbertLepawsky, 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 ofNurses 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 theArmy Air Forces in World War II, pp. 562-63. Forthe first three weeks there were only three nurses atMirgorod, one of the twelve from England havingbeen disqualified at Tehran before entering theUSSR. She appears to have been replaced later.


adequate preventive measures, andtyphus, malaria, dysentery, and venerealdiseases were prevalent. In the absenceof buildings, the hospitals were set up intents, close to the airfields they served.The hospital at Piryatin was well con-cealed in a wooded area near a river, butthose at Poltava and Mirgorod were inopen fields. All units were establishedand ready to receive patients by 1 June.

The medical service of the EasternCommand underwent its acid test threeweeks later. The first shuttle bombingmission by the Eighth Air Force fromBritish bases arrived at Poltava theafternoon of 22 June after a successfulraid on a synthetic oil plant south ofBerlin. The bombers were apparentlytrailed to their destination by a Germanplane, and that night the Poltava fieldwas attacked in force. At the time of theattack there were 370 permanent and714 transient U.S. personnel at the base.

It was estimated that no tons ofbombs were dropped over a 2-hourperiod. Every one of the 73 B-17's onthe field was hit and 43 were destroyed,together with 3 C-47's, one F-5, numer-ous ground vehicles, and quantities ofgasoline, oil, bombs, and ammunition.Twenty-five Russian YAK fighters werealso damaged on the ground. TwoAmericans, a pilot and copilot, werekilled and 14 wounded. The Russians,who manned the antiaircraft batteriesand fought the fires on the field, lost 30killed and 95 wounded. First aid wasgiven in the slit trenches that served forshelter, the wounded being moved to thehospital when the raid was over.

The following night the other twobases were attacked, but with less dis-astrous results. A gasoline dump was hitat Mirgorod, but at Piryatin the Ger-

mans failed to locate the target andcontented themselves with bombing thetown.

Poltava was nonoperational for forty-eight hours and operated to a limitedextent only for a month. Russian sapperswere still locating and detonating unex-ploded bombs as late as 7 September.

After the attacks of 22-23 June, in-stallations were dispersed as much aspossible. The hospitals were relocatedsome distance from the airfields, and anattempt was made to enlarge the avail-able medical facilities. A request for a400-bed field hospital to replace thethree outsize dispensaries was refused,however, on the ground that no field unitwas available for that purpose.24

The bases became steadily less impor-tant as the Russian front pushed west-ward and the advance of the AlliedArmies in Italy and France broughtmore enemy targets into normal bomberrange. Personnel were gradually with-drawn until by 1 October only Poltavaretained a medical complement, reducedto 3 medical officers, 4 nurses, and 14enlisted men. Housed in three prefabri-cated barracks, this unit continued into1945, but performed only routine dis-pensary functions.

The medical installations of the East-ern Command were supplied fromTehran, and during the period ofgreatest activity patients were evacuatedby air to the 19th Station Hospital in

24 (1) CM 11-64940, Spaatz to ETOUSA, 15 July44. (2) CM E-38685, 19 Jul 44, Eisenhower to USS-TAF. A field hospital organized and equipped bythe French Air Force had been offered to theMediterranean Allied Air Force in the spring of1944, but apparently had been diverted to otheruses. See entry, 3 Apr 44, in Journal, Col Reeder.


that city. After 1 October 1944, evacu-ation was to the 113th General Hospitalat Ahwaz, Iran. Considering the unsani-tary conditions and the prevalence ofdisease in the Eastern Command, the

medical service was excellent. Theaverage weekly noneffective rate was18.32 per 1,000, only a little higher thanthat for similar units in the UnitedKingdom.

CHAPTER IX

The Italian Communications ZoneSouthern Phase

Changes in Theater Organization

By the beginning of 1944, prepara-tions for the frontal attack on theEuropean continent dominated Alliedstrategy and dictated changes in the com-mand structure in the Mediterranean.General Wilson succeeded GeneralEisenhower as Supreme Allied Com-mander, with General Devers as hisdeputy. At the same time, in anticipationof a probable invasion of southernFrance, the theater boundaries were re-drawn to include that area as well asAustria, the Balkans, and Turkey.

Medical Organization at theTheater Level

The invasion of Italy and subsequentoperations in the fall and winter of 1943served to emphasize the organizationalconfusion in higher headquarters. Therewas no clear division of authority or func-tion between Allied Force Headquartersand the U.S. commands theoreticallysubordinate to it, or between those com-mands themselves. The principal area ofoverlap lay between Headquarters,North African Theater of Operations,and Headquarters, Services of Supply.It was therefore these two commandsthat were primarily affected by a reor-ganization in February 1944, under

which the Services of Supply organiza-tion became in fact a communicationszone headquarters. The Medical Section,AFHQ, remained substantially as it was,but operation of all U.S. medical serv-ices in the communications zone, includ-ing hospitalization and evacuation, weretransferred from the NATOUSA medi-cal section to its SOS counterpart, whosefunctions previously had been limited tomedical supply. A number of key person-nel were transferred along with theirfunctions. After 24 February, the effec-tive date of the reorganization, the ac-tivities of the NATOUSA medical sectionwere largely confined to policy makingand co-ordination.1

As a first step in the expansion of themedical section, SOS NATOUSAColonel Shook, who had headed thesection since August 1943, became com-munications zone surgeon. His adminis-trative officer, Maj. (later Lt. Col.)James T. Richards of the PharmacyCorps, was transferred from temporary

1 Hist of AFHQ. (2) Annual Rpt, Med Sec, MT-OUSA, 1944. (3) Hist of Med Sec, Hq, COMZMTOUSA. (4) Interv with Col Shook, 31 Mar52. (5) Munden, Administration of Med Dept inMTOUSA, pp. 93-105. More detailed discussionwill be found in (6) Armfield, Organization andAdministration, pp. 275 ff. See also, (7) Ltrs, ColMunly, to Col Coates, 7 Nov 58; and Dr. Shook toCoates, 6 Nov 58, both commenting on preliminarydraft of this volume.


COLONEL SHOOK

duty in the NATOUSA surgeon's office.The hospitalization and evacuation of-ficers, Lt. Col. (later Col.) WilliamWarren Roe, Jr., and Lt. Col. (laterCol.) Albert A. Biederman, were alsotransferred along with their functionsfrom the office of the surgeon, NATO-USA. The dental officer of the SOSmedical section was Lt. Col. (later Col.)Karl H. Metz.

The chief of professional services, Lt.Col. (later Col.) Joseph G. Cocke, as-sumed his new duties on 12 March,transferring from the MediterraneanBase Section. The basic organization wascompleted on 24 March with the arrivalof Capt. (later Maj.) Elizabeth Miche-ner, chief nurse; Lt. Col. (later Col.)Duance L. Cady, communications zoneveterinarian; and Lt. Col. Richard P.Mason, preventive medicine officer and

medical inspector. Additional personnelwere added as needed through Marchand April, the only important shiftcoming in mid-May. At that time, Cockebecame Shock's deputy, being replacedas chief of professional services by Colo-nel Roe. Lt. Col. (later Col.) Jenner G.Jones, who had been executive officerwhen the SOS medical section was con-cerned solely with supply, became chiefof the medical supply branch. Allottedpersonnel as of 21 May, when the organ-ization was stabilized, included 21 of-ficers, a warrant officer, and 44 enlistedmen.

As the communications zone medicalsection expanded, the medical section ofNATOUSA modified its functions inkeeping with its more restricted policy-making and planning role. Personneldeclined, owing to the loss of operatingfunctions, by transfer to Services of Sup-ply. On 1 March 1944 Maj. Gen. Mor-rison C. Stayer, former surgeon of theCaribbean Defense Command, replacedGeneral Blesse as Surgeon, NATOUSA,and Deputy Director of Medical Serv-ices, AFHQ. The British Director ofMedical Services, General Cowell, washimself relieved on 19 May by Maj. Gen.William C. Hartgill, another RoyalArmy Medical Corps officer. GeneralBlesse, who was being recalled to thezone of interior to become surgeon ofthe Army Ground Forces, remained inthe theater until 24 April, acting asGeneral Stayer's deputy and retaininghis function as Medical Inspector,AFHQ. General Stayer took over theduties of medical inspector on Blesse'sdeparture. The section retained limitedadministrative functions, including theconsultant service and various duties inthe 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, Gen-eral Stayer, Lt. Col. Bernice M. Wilbur, Col. William C. Munly, Colonel Churchill, ColonelSimeone; 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 wasactually some expansion, a veterinarysection under Colonel Noonan being setup in mid-March.

Relations between the NATOUSAand SOS medical sections remainedclose, despite early fears that the theatermedical section might seek to continueoperating activities and reluctance onthe part of some officers to be transferredfrom a higher to a lower headquarters.The policy-determining role of theNATOUSA medical section imposed adegree of co-ordination, while the trans-fer of personnel in the long run made for

friendly working relations between thetwo groups.

In July, with the Allied armies ap-proaching the Arno River, both AlliedForce Headquarters and Headquarters,NATOUSA, moved from Algiers toCaserta. Together with the other officesof American headquarters, the theatermedical section was established in theroyal palace. The Air Forces medicalsection was already located in the palace,having established offices there late inMay. The British medical componentof AFHQ, while no longer sharing abuilding with the Americans, was physi-


cally near enough to permit continuedco-operation. Headquarters, Communi-cations Zone, including the SOS medicalsection, was established in close proxim-ity to the others in buildings vacated bya general hospital on 20 July.2

The Peninsular Base Section

Plans for the Italian campaign calledfor the early establishment of a basesection in the Naples area. A preliminaryorganization was activated in Casablancaon 21 August 1943 as the 6665th BaseArea Group (Provisional), with medicalpersonnel drawn from the Atlantic BaseSection, whose activities were rapidlydeclining. An advance echelon of themedical section debarked at Naples on4 October from the first troopship toenter the bay. The entire section wasashore by 10 October.3

The 6665th Base Area Group re-mained under Fifth Army control until1 November, when it was formally re-constituted as the Peninsular BaseSection. During this interval, the FifthArmy surgeon acted also as the basesurgeon. He was succeeded in the lattercapacity on 9 November by ColonelArnest, who had served as surgeon of IICorps since the North African landings.

Although both cholera and typhus hadbeen reported in Naples ten days beforethe capture of the city, American medi-cal officers found the general health situ-ation good.4 The most serious problem

was sanitation, since the water supplyhad been disrupted and the seweragesystem was not functioning for lack ofwater, but facilities were quickly re-stored by the Allied Military Govern-ment, in co-operation with British andU.S. Army engineers. Pending the ar-rival of fixed installations, hospitaliza-tion for American troops in the city wasprovided by the 307th Airborne MedicalCompany and the 162d Medical Battal-ion, with the 95th Evacuation Hospitaltaking over on 9 October. The 3d Conva-lescent Hospital also began taking pa-tients in the Naples area on 12 October.

By the end of 1943, the PeninsularBase Section was the largest base organ-ization in the theater, both in terms ofpersonnel and in terms of the number offixed beds under its control. It continuedto grow at the expense of the decliningNorth African bases, reaching its peakstrength in August 1944.

Air Forces Medical Organization

The medical organization of the AirForces units in the Mediterranean wasrealigned early in 1944. The over-allAllied command remained the Mediter-ranean Allied Air Forces, with the ArmyAir Forces, Mediterranean Theater ofOperations (AAF MTO), as its U.S.component. The American command in-cluded three major units: the TwelfthAir Force, now primarily a light andmedium bomber group; the FifteenthAir Force, a heavy bomber group; andthe Army Air Forces Service Command.Headquarters of the U.S. command or-ganization was set up in Caserta inFebruary. Twelfth Air Force headquar-ters was at Foggia, Fifteenth Air Forceheadquarters was at Bari, and headquar-

2 See p. 336, below.3 (1) Annual Rpt, Med Sec, NATOUSA, 1943.

(2) Annual Rpt, Surg, PBS, 1943. (3) Hq, ETOU-SA, Rpt on PBS NATOUSA, 10 Feb 44. (4) An-nual Rpt, Surg, Fifth Army, 1943.

4 The ranking U.S. civil affairs officer was GeneralHume. For the civil affairs aspects of the Italiancampaign, see pp. 360-62, below.


ters of the service command was atNaples.5

The Fifteenth Air Force was still be-ing built up, reaching its peak strengthabout the time of the first shuttle bomb-ing between Italian and Russian bases.6

In that operation and in the strategicbombing of Germany generally, theFifteenth Air Force was responsible tothe U.S. Strategic Air Forces in Europe,a European theater command, but inmatters of administration, supply, andtraining, as well as in its Mediterraneanoperations, it remained under control ofthe Mediterranean Allied Air Forces andthe U.S. Army Air Forces, Mediter-ranean Theater of Operations.

The top co-ordinating U.S. air com-mand, the Army Air Forces, MTO, wasoriginally organized without any medi-cal section, but the need for one wasquickly apparent and a small section wasestablished in February 1944. The posi-tion of surgeon went to the senior AirForces medical officer in the theater,Colonel Elvins, who was succeeded inApril by Col. Edward J. Tracy. ColonelElvins' replacement as Twelfth AirForce surgeon was Col. William F. Cook.The Fifteenth Air Force surgeon wasCol. Otis O. Benson, Jr., and the surgeonof the Army Air Forces Service Com-mand was Col. Louis K. Pohl.

The functions of the Twelfth and Fif-teenth Air Force surgeons were com-parable to those of an army surgeon. The

duties of the surgeon, AAF MTO, wereconfined primarily to policy matters andto maintaining close liaison with themedical service of the British componentof the MAAF. The service commandmedical section was the effective operat-ing agency for Air Forces medical ac-tivities at the theater level, includingadministration of hospitals, evacuation,medical supply, sanitation and preven-tive medicine, and medical plans. TheAAFSC surgeon was also the principalpoint of contact for exchange of technicalinformation with the NATOUSA medi-cal section.


Fixed Hospitals in PBS

One of the first tasks of the 6665thBase Area Group medical section was tosurvey the city of Naples for hospitalsites. Various Italian hospitals and schoolbuildings were examined and the bestof them were tabbed for Medical De-partment use. Aside from these, the mostsuitable area for additional medical in-stallations was the Mostra Fairgroundsat Bagnoli, some three or four milesfrom the heart of Naples. Site of Mus-solini's colonial exposition of 1940, thefairgrounds contained numerous rela-tively spacious buildings of stone and tileconstruction, with water, sewerage, andpower facilities and good highway andrail connections. Many buildings hadbeen badly damaged by Allied bomb-ings, and the retreating Germans haddestroyed others, but the advantages sofar outweighed the drawbacks that theFifth Army surgeon got the entire areaset aside for hospital use. It quickly be-

5 This section is based primarily on the follow-ing: (1) Hist, Twelfth Air Force Med Sec, 1942-44;(2) Med Hist, Fifteenth Air Force, 1944. (3) An-

nual Med Hist, AAFSC MTO, 1944; (4) Link andColeman, Medical Support of the Army Air Forcesin World War II, pp. 438-48. See also Armfield, Or-ganization and Administration, pp. 269-75.



MEDICAL CENTER AT THE MOSTRA FAIRGROUNDS IN BAGNOLI, NEAR NAPLES

came the staging site for medical instal-lations arriving in Italy.7

In order to realize the full possibilities

of the Mostra Fairgrounds, a provisionalmedical 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.


on 25 October 1943, with headquarterspersonnel drawn from the 161st Medi-cal Battalion. Other fixed hospitals wentinto the Caserta area, close behind theFifth Army front, and still others wereattached to Air Forces units operatingin the heel of Italy and from the Foggiabases. (Map 29)

Naples and the Medical Center—Thefirst American fixed hospital in Italywas the 118th Station Hospital, whichopened 14 October in the buildings ofan Italian military hospital in Naples.The 106th Station opened in a schoolbuilding three days later. Both hospitalsoperated almost from the start in excessof their 500-bed Table of Organizationcapacities.

The first fixed hospital to open at thefairgrounds was the 182d Station, whichreceived its first patients on 19 October.The 3d Convalescent was already estab-lished on the fairgrounds but remained aFifth Army unit, subject to withdrawalon call of the army surgeon. These twohospitals, and the 4th Medical SupplyDepot, were functioning in the areawhen the fairgrounds were hit by enemyplanes the night of 21 October. The tollwas 11 killed and 55 wounded amongboth patients and medical personnel,and there was severe damage to instal-lations, but both hospitals continued tofunction without interruption.

During November and December,hospital facilities in Naples built uprapidly. The 225th Station joined themedical center group on 10 November,followed by the 23d, 21st, and 45th Gen-eral Hospitals on 17 November, 29December, and 1 January 1944, respec-tively. The 17th General, meanwhile,had taken over on 11 November the

Italian civil hospital in Naples formerlyoccupied by the 95th Evacuation, andthe 300th General had opened in build-ings of a Naples tuberculosis sanatoriuma few days later. The 70th Station, sitedin the Naples Academy of Fine Arts,opened on 25 November.

Two more 500-bed station hospitalswere added to the concentration in theNaples area by the end of the WinterLine campaign. These were the 103d,which opened a convalescent hospital inan Italian villa on 5 January, replacingthe 3d Convalescent, which had goneinto the combat zone; and the 52d, whichopened in school buildings on 17 Janu-ary. The 103d added the facilities of aregular station hospital, sited in schoolbuildings a few blocks from its conva-lescent establishment, on 13 January.

All hospitals in the Naples area facedproblems of reconstruction and renova-tion. Even those sited in hospital build-ings found a heritage of indescribablefilth to be cleaned out before they couldoperate. Initial cleaning and minor re-modeling were usually accomplished byhospital personnel; the Chemical War-fare Service was available for disinfect-ing the premises. More extensive repairsto bomb-damaged buildings, such asthose on the fairgrounds, were made bythe Army engineers, often after thehospital was in operation.

By mid-January 1944, hospitals of themedical center were functioning on apartially specialized basis. The 182dStation, in addition to its general beds,operated a venereal disease section thatultimately reached a capacity of 1,200beds. The 45th General was designatedas the neuropsychiatric center for thePeninsular Base Section.

While all hospitals took British pa-

MAP 29—Fixed Hospitals in Southern Italy, October 1943-October 1947

FIXED HOSPITALS IN SOUTHERN ITALYLecce

4th Field, 1st Platoon (AAFSC), 15 March-15May 1944. 100 beds.

35th Field, 3d Platoon (AAFSC, ABC), 15 May1944-16 April 1945. 100 beds.

Erchie35th 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 No-

vember 1944-24 May 1945. 100 beds.Manduria

4th Field, 1st Platoon (AAFSC), 26 November1943-15 March 1944. 100 beds.

Battipaglia32d 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.

Spinazzola34th Field, 1st Platoon (AAFSC, ABC), 15 Feb-

ruary 1944-5 June 1945. 100 beds.Lavello

4th Field, 1st Platoon (AAFSC, ABC), 15 May1944-3 June 1945. 100 beds.

Cerignola34th Field (AAFSC), 13 December 1943-15 Feb-

ruary 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 May1945. 500 beds.

4th Field, 2d and 3d Platoons, Pomigliano Air-field, 16 October 1943-12 January 1944. 200beds.

106th Station, Naples, 17 October 1943-24 May1945. 500 beds..

182d Station, Medical Center, 19 October 1943-25 March 1945. 500 beds.

32d Field, 3d Platoon, Pomigliano Airfield, 26October 1943-13 February 1944. 100 beds.

FIXED HOSPITALS IN SOUTHERN ITALY—Continued

36th General, Caserta, 3 November 1943-20 July1944. 1,000/2,000 beds.

225th Station, Medical Center, 10 November1943-26 March 1945. 500 beds.

17th General, Naples, 11 November 1943-25October 1945. 1,000/1,500 beds.

300th General, Naples, 16 November 1943-31March 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 Sep-tember 1944. 500 beds.

262d Station, Aversa, 27 November 1943-10 June1945. 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 December1944. 500 beds.

52d Station, Naples, 17 January 1944-3 May1945. 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 June1944. 250 beds.

58th Station, Pomigliano Airfield, 3 February-5 June 1944. 250 beds.

43d Station, Caserta, 13 February-1 May 1944.250 beds.

32d Station, Caserta, 15 February 1944-20 July1945. 500 beds.

73d Station, Caserta, 24 February-15 June 1944.500 beds.

64th General, Maddaloni, 17 March-18 July1944. 1,000/1,500 beds.

51st Station, Naples, 13 May-20 September 1944.250/500 beds.

3d General, San Leucio, 14 May-14 September1944. 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 May-28 July 1944. 750 beds.

300th General, Detachment A, Dugenta, 5 June-19 July 1944. 250 beds.

34th Station, Dugenta, 19 July-19 October 1944;Piana di Caiazzo, 25 October 1944-3 January1945. 250 beds.

154th Station, Piana di Caiazzo, 3 January-31August 1945. 150 beds.

21st Station, Naples, 16 April-23 July 1945.500 beds.

35th Field, 3d Platoon, Aversa, 10 June-1 Oc-tober 1945. 100 beds.

35th Field, 1st and 2d Platoons, Sparanise, 8July-17 September 1945. 200/100 beds.

300th General, Detachment A, Caserta, 21 July-1 November 1945. 500 beds.

300th General, Detachment B, Aversa, 1 Octo-ber-1 November 1945.

392d Station, Naples, 1 June 1946-15 January1947. 200 beds.

Foggia61st 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 April1947. 250/100 beds.

Termoli4th Field, 3d Platoon (AAFSC, ABC), 15 May

1944-24 May 1945. 100 beds.San Severo

4th Field, 2d and 3d Platoons (AAFSC), 18 Jan-uary-15 May 1944. 200 beds.

4th Field, 2d Platoon (AAFSC, ABC), 15 May1944-22 June 1945. 100 beds.

Anzio59th Evacuation (as station), 7 June-10 July

1944. 750 beds.Rome

33d General, 21 June-24 September 1944. 1,500beds.

12th General, 22 June-12 November 1944. 2,000beds.

6th General, 30 June-22 December 1944. 1,500beds.

114th Station, 5 July-28 September 1944. 500beds.

73d Stationc, 5 July 1944-18 June 1945. 500beds.

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 Octo-

ber 1945. 500 beds.Civitavecchia

105th Station, 5 July-13 September 1944. 500beds.

154th Station, 14 September-17 December 1944.150 beds.

aAssigned in place from ABC to PBS, 15 Octo-ber 1945.

bAir Forces unit during first Foggia period; re-assigned to Air Forces about 1 January 1946.Reorganized as 100-bed unit and reassigned toPBS, 31 May 1946.

cAssigned Rome Area, MTOUSA, 1 December1944-25 May 1945.

dAssigned Rome Area, MTOUSA, 25 May 1945.


tients and those in Naples proper treatedcivilians when emergency required, aneffort was made to funnel patients fromthe French Expeditionary Corps to the182d and 225th Station Hospitals, whereFrench-speaking personnel were avail-able. Both of these hospitals were largelyfilled with French and French colonialcasualties during January. Many prob-lems arose as a result, particularly at the225th, where bearded African goumiersmade turbans for themselves out of hos-pital towels and changed identificationtags with each other in order to exchangebeds.

Late in January the 9th EvacuationHospital moved over from Sicily andopened in the medical center as a generalhospital for French troops, remaininguntil the beginning of August when theunit began staging for southern France.Liaison personnel from the French Armywere attached to handle discipline, mail,pay, and other administrative matters,while French and Arab noncomissionedofficers served as interpreters.

Installations attached to the medicalcenter by the end of January 1944 in-cluded three general and two stationhospitals and an evacuation hospital act-ing as a general, with an aggregate Tableof Organization strength of 4,750 beds;the 4th Medical Depot Company; a cen-tral dental laboratory; the 15th MedicalGeneral Laboratory, which began operat-ing a blood bank late in February;8 the41st Hospital Train; and the 51st Medi-cal Battalion. By this date the centerwas fully organized, although the 6744thMedical Center (Overhead) was notformally activated until 10 February1944. Consisting of four officers and 20

enlisted men, the medical center head-quarters group was responsible for func-tions common to all the hospitals in thearea, such as allocation of space, mainte-nance of roads and utilities, sanitation,security, transportation, civilian labor,and recreation. Included among the serv-ice units operating under the medicalcenter organization were a finance dis-bursing section, an Army post office, aQuartermaster shower and sterilizationunit, a laundry, a fire-fighting platoon,a message center, and a telephone switch-board. The center headquarters also con-trolled the staging area for medicalunits. Although it resembled the typicalhospital center in its purposes, theNaples grouping was less centralized. Ithad no commanding officer in the propersense of the word. Colonel Jeffress,former surgeon of the Atlantic Base Sec-tion, was responsible for administeringthe overhead functions, but the medicalservice as such, including the assignmentof patients, was directly under the basesurgeon.9

In addition to the center, there were4,500 Table of Organization beds else-where in Naples by the close of the Win-ter Line campaign. The 12th GeneralHospital and the 32d Station were alsostaging at the Mostra Fairgrounds, butwere not in actual operation. Through-out the Italian campaign personnel andequipment of units in the process ofstaging were freely used to augmentfacilities of operating hospitals, in ac-cordance with the practice establishedearly in the North African campaign.

Other PBS Hospitals—When FifthArmy medical units moved across the


9 Unit Rpts, 6744th Med Center (Ovhd), 6 Nov44 and 15 Jun 45.


Volturno to support the Winter Linecampaign, their places in the Casertaarea were taken by fixed hospitals as-signed to the base section. The 36th Gen-eral was the first of these, opening on 3November in an Italian military hospitalin Caserta. Here, as in Naples, the build-ings and the Italian patients hospitalizedin them were unbelievably filthy. At thistime the front lines were so near thatthe 36th General took casualties directlyfrom battalion aid stations. An Italianhospital at Aversa, six or eight milesnearer the coast, served to house the262d Station from 27 November. The66th Station, a 250-bed unit, opened on3 January in a prisoner-of-war enclosuresouth of Caserta, where it also operateda venereal disease hospital.

Closest of any fixed hospital to thefront during the Winter Line campaignwas the 74th Station, which opened atPiana di Caiazzo north of the Volturnoon 7 December. Housed in the stonebuildings of a co-operative farm, withsupplementary tentage, the 74th per-formed routine station hospital functionsfor troops resting and staging in the area.The primary problem there was knee-deep mud, which required the construc-tion and constant maintenance of accessroads. Two platoons of the 32d FieldHospital performed similar services fortroops still in the Salerno-Paestum area,while the remaining platoon served as aholding hospital for air evacuation atPomigliano Airfield northeast of Naples.Two platoons of the 4th Field sharedthe load at Pomigliano until early Janu-ary, when they were assigned to the AirForces.

Virtually all fixed hospitals under con-trol of the Peninsular Base Section wereoperating in excess of their Table of

Organization capacities, employing Ital-ian civilians to make up for personnelshortages.10

Hospitalization for Army AirForces in Italy

Following the October 1943 agree-ment between General Blesse for NAT-OUSA and Colonel Elvins for the ArmyAir Forces, hospital units of varioustypes were designated to serve the US-AAF in Corsica, Sardinia, and Italy.Those initially scheduled for Italy werethe 26th General, the 55th and 61st Sta-tion, and the 4th, 34th, and 35th FieldHospitals. All were located south ofNaples, and on the Adriatic side of thepeninsula.11

Only the 1st Platoon of the 4th FieldHospital was able to open at full bedstrength and at the appointed time. Thisunit was located at Manduria in the heelof the Italian boot. Equipment of all theother Air Forces hospitals was aboard theLiberty ship Samuel J. Tilden, whichwas destroyed in an enemy air attack onBari harbor on the night of 2 December.Replacement equipment for the fieldhospitals and for the 250-bed 55th Sta-tion Hospital was flown from Palermowithin ten days, but the 500-bed 61stStation and the 1,000-bed 26th Generalhad to wait for slower replacement bywater. The 26th General, while it actu-ally opened at Bari on 4 December, didso 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) AnnualMed Hist, AAFSC MTO, 1944; (4) Link and Cole-man, Medical Support of the Army Air Forces inWorld War II, pp 455-73; (5) Unit rpts of the indi-vidual hosps mentioned in the text.


quarters were the spacious modernbuildings of an Italian military hospital.The 61st Station, until its own equip-ment arrived in January, operated anAmerican ward in a British hospital atFoggia, using British equipment. The55th Station opened at Foggia and the34th Field a few miles southeast, atCerignola, on 13 December. The 35thField began taking patients at Erchie,near the site of the 4th, two days later.The remaining two platoons of the 4thField Hospital opened at San Severo,south of Cerignola, on 18 January.

Originally assigned to the Twelfth AirForce, these hospitals also served theFifteenth Air Force, which was activatedon 1 November 1943 before any of themedical units were in operation. Allwere transferred to the newly createdArmy Air Forces Service Command,Mediterranean Theater of Operations,early in the new year.

There were some changes in the loca-tion of field hospital platoons in Febru-ary and again in May 1944, but allremained south of the latitude of Rome,on the Adriatic side of the peninsula.The only significant change was the re-lease of the 55th Station Hospital to PBSon 10 August. This hospital had beenoperating near Foggia since December1943, but the enlargement of the 26thGeneral Hospital at Bari to 1,500 bedsrendered the 55th Station surplus to AirForces needs. All field hospital units andthe 61st Station at Foggia operated on a30-day policy, with evacuation to the26th General. The latter installationoperated on a 90-day policy.

Reorganization of Fixed Hospitals

When General Stayer succeeded Gen-

eral Blesse as Surgeon, North AfricanTheater of Operations, on 1 March 1944,the theater was already 8,000 beds shortof the authorized ratio of 6.6 percent oftroop strength, with new troops arrivingfaster than beds. Stayer's first majorproblem, with which Blesse had beenstruggling for several months, was thatof substantially increasing the numberof fixed beds in the theater.12

The problem had been under discus-sion, both in the theater and in Wash-ington, for a considerable time, but thebuild-up for OVERLORD precluded thediversion of either beds or medical per-sonnel to the Mediterranean. It was firstsuggested toward the end of 1943 thatthe shortage might be overcome by amore economical use of personnel al-ready in the theater. More or less de-tailed plans for enlarging certain generalhospitals to 1,500- and 2,000-bed capacitywith personnel released by the inactiva-tion of a few 250-bed station hospitalswere drawn up in The Surgeon Gen-eral's Office in January 1944. No positiveaction was taken, however, until after arequest to increase the bed ratio for theNorth African theater to 8.5 percent wasdenied in March. By that time thedeficiency had risen to 10,000 beds andaction had become imperative. Tenta-tive Tables of Organization for 2,000-bed and 1,500-bed general hospitals wereissued on 19 April 1944, and the reor-ganization 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 toStayer, 18 Apr 44. (3) Cables, Devers to AGWAR,14 Jan 44; Marshall to Devers, 20 Jan 1944; Deversto WD, 23, 26 Mar 44; Marshall to Devers, 7 Apr44; Devers to WD, 24 May 44. (4) Smith, Hospi-talization and Evacuation, Zone of Interior, p, 226.


Six 250-bed station hospitals—the 43d,53d, 58th, and 66th in Italy; and the64th and 151st in North Africa—wereinactivated. Five general hospitals—the12th, 21st, 23d, 36th, and 300th, all inItaly—were expanded from 1,000 to2,000 beds; and the remaining twelvegeneral hospitals in the theater were ex-panded from 1,000 to 1,500 beds. Eachof the new 2,000-bed units absorbed thepersonnel and equipment of one of theinactivated hospitals, with suitable trans-fers and readjustments to bring all theenlarged units into line with the newTables of Organization, which weresomewhat modified in July. The com-pleted reorganization added 9,500 T/Ofixed beds to the theater total. Generalhospitals in Italy began enlarging theirfacilities by new construction, by conver-sion of additional building space, or byerection of tentage a month or morebefore the reorganization went into ef-fect. The 21st, 23d, 36th, and 300thGeneral Hospitals, for example, had al-ready expanded to 3,000 beds each by31 May, or 50 percent above their newTable of Organization capacities.14

Aside from this general reorganiza-tion, a few minor changes were made tobring hospital facilities into line withneeds. The 60th Station Hospital atCagliari, Sardinia, was formally increasedfrom 250 to 500 beds, confirming theactual operating status of the installa-tion. The 51st Station, which had beenfunctioning as a neuropsychiatric hospi-tal, was also confirmed as a 500-bed unitin July. The 79th Station Hospital,

which was no longer needed in Algiersafter the decision to transfer AlliedForce Headquarters to Italy, was inacti-vated on 30 June, and its personnel andequipment were absorbed by otherunits. The provisional hospital at Mar-rakech, Morocco, which had been oper-ated primarily by personnel of the 56thStation at Casablanca since May 1943,was reorganized as the 370th StationHospital, with a Table-of-Organizationstrength of 25 beds.

Expansion of the PeninsularBase Section

Throughout the Anzio Campaign, thestalemate before Cassino, and the driveto Rome, the build-up of fixed hospitalsin the Naples and Caserta areas con-tinued. In February 1944 the 250-bed53d and 58th Station Hospitals set upin Naples, where the former took overoperation of the venereal disease hospi-tal in the medical center from detachedpersonnel of the 12th General, the latteroperating the air evacuation holding hos-pital at Pomigliano Airfield. At the sametime the 32d, 43d, and 73d Station Hos-pitals—the 43d of 250 beds, the others of500—moved into the Caserta area, wherethey were followed by the 64th Generalin March. All of these hospitals werebrought over from North Africa.

There were no new arrivals in April,but the opening of the drive to Romebrought a new contingent in May. The37th General moved into the medicalcenter, while the 51st and 81st Stationsset up outside the center in Naplesproper. The 51st Station was designatedthe neuropsychiatric hospital for theNaples area. The 81st took casualtiesfrom the French Expeditionary Corps.

14 (1) Annual Rpt, Med Sec, MTOUSA, 1944,an. B. (2) Med Sit reps, PBS, 31 May 44. (3) An-nual Rpts, 1944, of the individual Hosps concerned.


The 3d General and the 78th Stationmoved into the Caserta area. Before theend of the month the 750-bed 27th Evac-uation Hospital, a new arrival from thezone of interior tabbed for an ultimaterole with Seventh Army in France, wasestablished at Maddaloni to act as ageneral hospital for French and Frenchcolonial troops. The unit was soon oper-ating 1,500 beds.

During the periods of heavy pres-sure—in February and March in connec-tion with the Anzio Campaign, and inMay during the assault on the GustavLine—most of the hospitals in the basesection operated at approximately twicetheir Table of Organization capacities,with station hospitals often acting as gen-erals. Prefabricated buildings and tentswere usually used for expansion wherethe buildings occupied were inadequate.Additional personnel were obtained byhiring Italian civilians and by drawingupon hospital ship platoons, other hos-pitals staging in the area or awaiting as-signment, and medical battalions. The164th and 161st Medical Battalions, bothSeventh Army units, served PBS invarious capacities from late May untiltheir release in mid-July to train withthe invasion forces. The 70th Station atNaples and the 74th at Piana di Caiazzo,near Caserta, performed normal stationhospital functions for troops in theirrespective areas. The 70th also handledall hospitalization for the Women'sArmy Corps until May. The 182d Sta-tion in the medical center was desig-nated in July for Brazilian personnel,who were staging in the area. Brazilianmedical officers, nurses, and enlistedWardmen were attached.

In the reorganization of June, the 23dGeneral Hospital absorbed the 53d Sta-

tion, taking over the venereal diseasehospital and the disciplinary wards. The21st General absorbed the 58th Station,including operation of the PomiglianoAirfield holding hospital, and the 300thGeneral took over personnel and equip-ment of the 66th Station. The 300th con-tinued to operate the prisoner-of-warhospital at Dugenta, which had been theresponsibility of the 66th since January.The POW hospital was later turned overto the 34th Station, which arrived fromPalermo in July. The 43d Station wasmerged with the 36th General, whichclosed at Caserta in July, releasing itsquarters for occupancy by elements oftheater headquarters, including the SOSmedical section. Pending reassignment,personnel of the 36th were put on de-tached service with other hospitals in themedical center.

The general forward movement ofPBS installations began in June. The59th Evacuation, brought over fromSicily, acted as a station hospital at Anziobetween 7 June and 10 July, handling1,825 admissions in that period. The59th then served for another two weeksat Battipaglia, where Seventh Army wasin training for the invasion of southernFrance. The 6th, 12th, and 33d GeneralHospitals all opened in Rome before theend of June and were joined there on 5July by the 73d and 114th Stations. Allof these units came direct from Africaexcept the 73d, which had been operat-ing at Caserta, and the 12th General,which had been inactive in Naples forsix months while its personnel served ondetached duty with other hospitals. Thepreviously organized Rome Area Com-mand—Rome Allied Area Commandafter 1 July 1944—had supervision overthe health of the city, but the U.S. hospi-


tals remained under the jurisdiction ofthe Peninsular Base Section.15

The 12th General Hospital, now a2,000-bed unit, had absorbed the person-nel and equipment of the 151st Station,brought over from Africa for the merger.Like those in Naples and Caserta, all ofthe fixed hospitals moving into the Romearea were sited in permanent buildings.The 6th General occupied the Instituteof the Good Shepherd, where the 56thand 94th Evacuation Hospitals had al-ready done the necessary renovation.16

The 33d General and the 114th Station,the latter designated as neuropsychiatrichospital for the Rome area, were also inItalian hospital plants, while the 12thGeneral and the 73d Station occupiedItalian military structures. The 7thMedical Depot Company accompaniedthe fixed hospitals into Rome.

Movement north of Rome was almostsimultaneous with the establishment ofhospitals in the Italian capital. The105th Station Hospital opened at Civita-vecchia on 5 July; and the 50th, one ofthe few 250-bed station hospitals remain-ing in the theater, opened at Castagneto,on the coast a few miles north ofPiombino, on 20 July. The unit was soclose to the front for several days that ittook patients direct from the clearingstations, thus functioning in effect as anevacuation hospital.

The 24th General Hospital fromthe Eastern Base Section in North Africawent into bivouac in Rome on 20 June,its personnel serving on detached servicewith other hospitals for a month. On 21July the 24th General opened as a 1,500-bed unit at Grosseto, in the buildings ofa tuberculosis sanatorium previously oc-

cupied by the 15th Evacuation Hospital.At the end of the month the 64th Gen-eral Hospital moved from Caserta toLeghorn, where it opened in a formerFascist paratroop school adjacent to the16th Evacuation Hospital in the suburbof Ardenza. The 55th Station, releasedat Foggia by the Air Forces, was attachedto the 64th General early in August andwas established at the same Ardenzasite. Leghorn was still within range ofGerman guns when the 64th General be-gan taking patients in that city.

As of 15 August 1944, PBS had 28,900T/O beds in operation, of which 15,000were in Naples—8,000 in the medicalcenter—6,000 were in Rome, and 4,000were north of Rome. Between 14 Octo-ber 1943, when the first fixed hospitalopened in Naples, and the end of August1944, PBS hospitals admitted 282,000patients and returned 214,000 of themto military duty. (Tables 17, 18)

Decline of North Africanand Island Bases

As the center of activity in the Medi-terranean moved up the Italian penin-sula, North Africa decreased in impor-tance as a communications zone. Theexpansion of the Peninsular Base Sectionwas accomplished largely by strippingthe African base sections of hospital fa-cilities. As of 15 August 1944, the EasternBase Section was left with only one 250-bed station hospital, the 54th at Tunis.The Mediterranean Base Section re-tained 3,000 beds, 2,500 of them in thehospital groupment at Assi Bou Nif,where the 70th General and the 23d and69th Station Hospitals were still located.The others were the 250-bed 57th Sta-tion near Constantine and the 250-bed

15 Annual Rpt, Surg, Rome Area Comd, 1944.16 See p. 304, above.


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 AtlanticBase Section retained 275 beds, 250 inthe 56th Station Hospital at Casablanca,and 25 in the 370th Station serving pri-marily Air Forces units at Marrakech.The total number of U.S. Army Tableof Organization beds in all of NorthAfrica was thus only 3,525.

Hospitals in MBS still held a fewlong-term patients from Italy, but forthe most part the function of the fixedhospitals in Africa after June 1944 wasthat of hospitalizing military personnelstill in the area. In addition, these hospi-tals cared for transient French patientsen route from Italy to French hospitals


in Africa and for U.S. patients en routeto the zone of interior. Those principallyserved were Air Forces and naval person-nel and service troops in the vicinity ofOran.

The Island Base Section in Sicily wasclosed out on 1 July 1944. At that date,600 beds remained under the control ofthe Allied garrison on Sardinia, and1,550 were charged to the Northern BaseSection on Corsica.

Hospitalization of Prisonersof War

The one exception to the contractionof medical facilities in North Africa wasinstallations for the care of prisoners ofwar. Until the Arno River line wasstabilized, the bulk of the prisonerstaken in Italy were transferred to en-closures in North Africa. These weregradually concentrated in the Mediter-ranean Base Section in the vicinity ofOran.17

So far as Italian prisoners were con-cerned, the problem became less and lessimportant as time went on. With Italyenjoying a cobelligerent status, few newprisoners were taken. Those held overfrom the Tunisia Campaign and fromoperations in Sicily were organized intoservice units of various types, scatteredthroughout numerous camps and enclo-sures. The bulk of them, estimated as

about 70,000, were concentrated nearthe centers of Army service activities,which remained in Oran, and in Algiersuntil the removal of AFHQ in July. Bythat date the 7029th Station Hospital(Italian), in prisoner of war Enclosure129 at Ste. Barbe-dú-Tlelat near Oran,was able to care for most of the Italianprisoner patients. The 43d and 46thGeneral Hospitals in the nearby AssiBou Nif groupment had taken malariacases from the prison camp until thedeparture of those units in June andJuly, respectively. The 250-bed 7550thStation Hospital (Italian), which hadbeen activated in EBS in March 1944,was moved to POW Enclosure 129 at theend of May but was never re-establishedas an active unit. The 7393d StationHospital (Italian) continued for a timeto operate 25 beds in conjunction withthe 56th Station Hospital at Casablanca.

On the other hand, the German pris-oner of war hospital in POW Enclosure131, also at Ste. Barbe-du-Tlélat, ex-panded rapidly as the fortunes of warbrought a steady stream of Germanprisoners into Allied hands. Originallyset up late in 1943 as a 500-bed unit,the hospital was caring for more than2,000 patients by July 1944. The limitswere fixed by the availability of Germanmedical personnel, who were nevertaken in large enough numbers to carefor all of their own wounded.

The most important prisoner of warenclosure in Italy during the early partof 1944 was Number 326 at Dugenta inthe Caserta area. In January the 66thStation Hospital was established in theenclosure. Shortly after the 66th wasabsorbed by the 300th General Hospital,the 34th Station took over the task ofcaring for sick and wounded German

17 This section is based primarily on the follow-ing documents: (1) Annual Rpt, Med Sec, MT-OUSA, 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 ItalianPOW's in MBS; (5) Ltr, Col Shook, Surg, SOSNATOUSA, to Surg, NATOUSA, 3 Jun 44, Sub:Rpts on Med Serv in Italian POW Camps; (6)Annual Rpt, 34th Station Hosp, 1944.


prisoners in the Dugenta camp. Thehospital—a former Italian discipli-nary barracks—consisted of cottage-typebuildings, prefabricated structures, andward tents, the whole complex beingsurrounded by a high brick wall withsentry towers. The 34th inherited fromthe 66th both civilian workers and Ger-man medical corpsmen. During theRome-Arno and Southern France Cam-paigns, the hospital census fluctuated be-tween 300 and 500 daily, with 90 to 98percent of the cases surgical. Evacuationwas to the prisoner of war stockade or tothe zone of interior. The repatriation ofthe incapacitated and long-term hospitalcases on an exchange basis began inMay.18

The 6619th Prisoner of War Adminis-trative Company was in charge of pris-oner of war Enclosure 326 until 11 Au-gust 1944, when it was relieved by the2686th POW Administrative Company,brought over from Africa. These POWadministrative companies each had asmall medical section that supervisedinfirmary service by protected personnelin the camp.

With the breakthrough of the GustavLine, the capture of Rome, and the bat-tle of pursuit to the Arno, the number ofGerman prisoners taken increased sub-stantially, and additional hospitals weredesignated to share the load with theOran and Dugenta facilities. The 78thStation Hospital at Maddaloni tookprisoners from its opening in mid-May,and by June was almost exclusively aprisoner of war hospital. POW ad-

missions were in the neighborhood of700 a month, the bulk of them surgical.When the 78th Station closed to admis-sions late in August, the 262d Station atAversa became a POW hospital, admit-ting more than 1,100 German prisonersin the last ten days of the month.19 Fixedhospitals in Rome and north of that citytook prisoner patients along with U.S.and Allied casualties as they werebrought in.

From less than 2,000 prisoners of warin hospitals under U.S. control at the endof January 1944, the census climbed to apeak for the year of 5,288 at the end ofAugust. More than 1,600 of these werein PBS hospitals.20

Evacuation

Fixed hospitals in the Peninsular BaseSection operated throughout the periodof the Volturno and Winter Line cam-paigns on a 30-day evacuation policy, allpatients with longer hospital expectancybeing sent to North Africa by sea or airas soon as they were transportable. Bedstatus in PBS hospitals, and the numberof patients awaiting evacuation, werereported daily by telegraph to the Sur-geon, NATOUSA, who requested theChief of Transportation, AFHQ, to pro-vide hospital ships. Air evacuation con-tinued to be controlled by the theaterair surgeon, but close liaison with thebase section was maintained. Patients tobe evacuated were classified in PBS, sothat those requiring special treatment

18 (1) Undated British doc, signed H. W., Sub:Exchange of Allied and German Sick and WoundedPOW's for Repatriation, Col Standlee's copy. (2)Memo, Maj Gen F. C. Beaumont-Nesbitt, Chief,Liaison Sec, AFHQ, to CofS, French GroundForces, 3 Jun 44.

19 (1) Med Sitreps, PBS, May-Aug 44. (2) ET-MD's 78th Station Hosp, May-Jul 44. (3) ETMD,262d Sta Hosp, Aug 44. (4) Annual Rpts, 78thand 262d Sta Hosp, 1944.

20 (1) Annual Rpt, Med Sec, MTOUSA, 1944, an.B, app. 17. (2) Med Sitrep, PBS, 16-31 Aug 44.


PLACING GERMAN POW's ABOARD THE SWEDISH EXCHANGE SHIP GRIPSHOLM forrepatriation. These cases have a long hospital expectancy.

could be routed promptly to the hospitalbest equipped to handle the case.21

After the activation of PBS, only oneU.S. hospital ship, Shamrock, was avail-able for evacuation from Italy to Africafor the rest of the year, but occasionallifts were obtained from British vessels.

Since air evacuation was exclusively tothe Tunis-Bizerte area, hospital shipswere routed to Oran. The port of em-barkation was the Paestum beaches until8 October, the port of Salerno between8 and 25 October, and thereafter the portof Naples. Two other U.S. hospital shipsin the Mediterranean, Acadia andSeminole, were used during the periodprimarily for evacuation from NorthAfrica to the zone of interior.

Air evacuation from the Naples areawas handled by the 802d Medical Air

21 Principal sources for this section are the fol-lowing: (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, 807thMAETS, 1944; (6) ETMD's for Oct 43 throughAug 1944.


Evacuation Transport Squadron, withthe 807th MAETS evacuating fromFoggia, Bari, and more southerly fields.The latter unit evacuated for the mostpart personnel of the British EighthArmy, with a sprinkling of U.S. AirForces casualties. Routes from Naplesdiffered with the time of day, someflights going direct to North Africa,others making an overnight stop atPalermo in Sicily.

During the period between 2 January,when orders were issued for the Anziolandings, and 22 January when the as-sault troops went ashore, a determinedeffort was made to evacuate as manypatients as possible from the Naples areato provide beds for the new operation.Two British hospital ships and two Brit-ish personnel carriers were diverted toassist with the evacuation.22 Between 9September, when the Salerno landingstook place, and 21 January, the eve of theAnzio landings, a total of 19,048 patientshad been evacuated from Italy by airand 13,017 by water, or 32,065 in all.(Table 19) After the middle of October,most of these patients cleared throughfixed hospitals assigned to PBS.

For the first six months of 1944, long-term patients continued to be evacuatedfrom Italy to North Africa. By the endof June, however, the build-up of facili-ties in the Peninsular Base Section atthe expense of the declining NorthAfrican bases had proceeded so far as topermit retention of all U.S. patients inItaly on a 90-day policy, which was ex-tended to 120 days after 15 August. Aslong as French troops remained in Italy,French patients requiring more than 30days hospitalization were sent to the 9th

Evacuation Hospital or were evacuatedto French hospitals in Africa. 23

Air evacuation from Italy to Africawas discontinued, except for Air Forcespersonnel, with the arrival of additionalhospital ships in April. (Table 20) Airevacuation from Sicily ceased entirelywith the closing out of the Island BaseSection in July. After the middle of thatmonth, evacuation from Corsica andSardinia was directed to Naples ratherthan to Oran.

Within PBS itself, patients wereshifted as required from one hospital toanother, primarily to secure the advan-tages of specialization, but also on oc-casion to relieve congestion. After theterminus of air evacuation from theFifth Army hospitals shifted fromNaples to Rome, patients were movedperiodically from the latter city back toNaples to keep from overcrowding thefacilities nearer to the front. The 41stand 42d Hospital Trains, which werealready in the theater, and the 66thHospital Train, brought over fromNorth Africa late in June, made regularruns between the two cities during Julyand early August.

Direct evacuation to the zone of in-terior by hospital ship from Naples be-gan in April 1944. At the same timerestrictions on the use of unescortedtransports for evacuation from insidethe Mediterranean were lifted, and thesevessels began loading ZI patients at Oranas well as at Casablanca. Medical care on

22 Surg, NATOUSA, Journal, 22 Jan 44.

23 Recorded Interv, ASD Berry, 4 Nov 58, com-menting on preliminary draft of this volume. Dr.Berry was chief of the Surgical Service, 9th Evacu-ation Hospital, during the Naples period. Accord-ing to French officials, there were thirty availableFrench hospitals in North Africa, with an ag-gregate capacity of 20,000 beds. Surg, NATOUSA,Journal, 16 Aug 43.


TABLE 19—EVACUATION FROM ITALY TO NORTH AFRICA9 SEPTEMBER 1943—21 JANUARY 1944

Source: Hq, ETOUSA, Rpt on PBS, 10 Feb 44, sec. VI, app. B.

transports was provided by hospital shipplatoons. Air evacuation to the zone ofinterior began on a regularly scheduledbasis from Casablanca on 3 July andfrom Naples on 19 July. The Naplesflights were broken by stops at Oran andCasablanca.24

By 1 June seven U.S. Army hospitalships and one Navy hospital ship wereavailable for evacuation to the zone ofinterior, permitting a rapid clearing out

of the remaining North African hospi-tals in preparation for severe contractionin that area. Every effort was also madeto reduce the patient load in Italy beforethe invasion of southern France, sched-uled for 15 August. (Table 21)

Medical Suppliesand Equipment

Theater Medical Supply

Organization for Medical Supply—Al-though the reorganization of the theater

24 Hist, Med Sec, Hq, COMZ NATOUSA, Feb-Oct 44.


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 INTERIORJANUARY-AUGUST 1944

Source: Annual Rpt, Med Sec, MTOUSA, 1944, an. B, app. 21, 22.

putting all operating functions of theMedical Department within the com-munications zone under the Medical Sec-tion, SOS NATOUSA, was effective on24 February 1944, it was May before thesupply branch of that headquarters ob-tained sufficient personnel to properlycarry out its assigned mission. Supply

personnel in the field units were alsoinadequate for the type of organizationin effect. The conversion of the medicalsupply depots in the theater into medicaldepot companies in December 1943 hadresulted in an aggregate loss of 260 menin the four depot companies assigned toNATOUSA, while a second reorganiza-


41ST HOSPITAL TRAIN LOADING NEAR RIARDO FOR RUN TO NAPLES, FEBRUARY 1944

tion late in June 1944 further reducedpersonnel by 112.25

In order to make more efficient use ofthe remaining supply officers and en-listed men, a new plan of organizationwas worked out as early as March 1944,whereby the 2d and 4th Medical DepotCompanies would be inactivated andmedical composite battalions substitutedfor them. This plan was proposed to theWar Department by the SOS surgeon on24 May, but approval was not receiveduntil 15 July. In the meantime, under

direct orders, the two depot companiesconcerned, together with the 7th and12th Medical Depot Companies, hadgone through the June reorganization,and more personnel had been lost.

The latter two companies were leftunchanged, but the 2d Medical DepotCompany, with headquarters at Oran,was inactivated on 13 August. From thepersonnel thus released, the 231st Medi-cal Composite Battalion was organizedunder TOE 8-500, with the 70th and71st Medical Base Depot Companies(TOE 8-187) as components. The bat-talion was then assigned to the southernFrance operation, and the 60th MedicalBase Depot Company, which had beenorganized 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 medsupply organizations mentioned in the text. (4)Davidson, Med Supply in MTOUSA, pp. 84-107.


the NATOUSA functions previouslyperformed by the larger organization.The 48th Medical Depot Company,based in Naples, was similarly inacti-vated on 15 August, being supplanted bythe 232d Medical Composite Battalionwith the 72d and 73d Medical BaseDepot Companies as components. Per-sonnel released from the 7th and 12thMedical Depot Companies in the Junereorganization were absorbed by the twocomposite battalions.26

In addition to providing greater flexi-bility, the new arrangement was de-signed to handle more effectively suchproblems as maintenance and repair,and was able to make fuller use of theItalian service companies as substitutesfor larger personnel allotments. Thegreatest economy and efficiency in theuse of personnel was essential sincethe 7th Medical Depot Company, likethe 231st Medical Composite Battalion,was assigned to the assault force for theinvasion of southern France, while the12th Medical Depot Company remaineda Fifth Army unit. The theater was thusleft with only the two medical base de-pot companies of the 232d Medical Com-posite Battalion and the 60th MedicalBase Depot Company at Oran to carryout all supply activities at the theaterand base section levels.

Operation of the Supply System—Medical supplies were obtained in theNorth African Theater of Operations bydirect monthly requisitions on the zoneof interior. These requisitions reflected

anticipated needs three months hence,in terms of expected troop strength. Sup-ply and requirements were computedfrom base section inventory records,items still due on previous requisitions,shipping time, and a replacement factorestimated in terms of probable use be-tween the date of inventory and thedate of delivery. The supply objectiveremained a 30-day operating level plusa 45-day reserve level.27

In cases of urgent need supplies weresent by air, but for the most part theywere delivered by the convoys, whichreached the theater three times a month.The system entailed various difficulties.Ports of discharge were not always ableto handle an entire convoy, and somevessels might be diverted to another port.The port of discharge, moreover, wasdetermined by the service receiving thelarger part of the cargo, which was sel-dom the Medical Department. Thusrequisitions had to take into account apossible loss of time in transshipment.

Another difficulty lay in the compu-tation of replacement needs. Replace-ment factors had been under study, bothin the theater and in Washington, sinceOctober 1943. In March 1944, revisedreplacement factors were sent out bythe War Department, differing in manyrespects from those previously in use.Equipment items, except for unit assem-blies, had previously been calculated asa percentage of the amount in use, butwere now to be estimated on the basisof troop strength, in the same manneras expendable items. Careful comparisonin the theater revealed that neither new26 The new medical base depot companies organ-

ized under TOE 8-187 had only about one-thirdas many personnel as the old medical depot com-panies (TOE 8-667). It was thus possible to com-plete the reorganization without calling upon theZI for additional personnel.

27 This section is based on: (1) Annual Rpt,Med Sec, MTOUSA, 1944, an. K; (2) Hist, MedSec, Hq, COMZ NATOUSA; (3) Davidson, MedSupply in MTOUSA, pp. 84-107.


nor old replacement factors agreed withtheater experience. With the concur-rence of the War Department, the con-sumption records of the Mediterraneansupply services were applied as modify-ing factors while the whole problem wassubjected to further study. Maj. FrankC. J. Fiala, was assigned by Washingtonto the Supply Branch, Medical Section,SOS NATOUSA, on 23 May, along withthree specially trained enlisted men, tocarry out these studies.

A detailed system of stock control andstock record forms was devised for thepurpose of keeping accurate track oftheater inventories, disbursements, re-ceipts, and supplies on order and of thedistribution of medical supplies amongthe base sections. Information for medi-cal supply officers was included in aseries of technical bulletins initiated bythe SOS medical section in January 1944.

In addition to supplying the base sec-tions, depots, and Air Forces service com-mands, and directing interbase transfers,the supply branch of the SOS medicalsection also screened all requisitionsoriginating in the Allied Control Com-mission (ACC), filling them from thea-ter stocks wherever possible. After May1944 requisitions of the Joint French Re-armament Committee were similarlyscreened. The supply branch served asthe official channel for ordering matérielfrom the zone of interior on behalf ofboth of these agencies.

The problem of maintenance andrepair was particularly acute in the Med-iterranean, because of a general short-age of properly trained personnel. TheTOE under which the field units werereorganized in December 1943 contem-plated only third and fourth echelon re-pair. Equipment needing more extensive

overhauling was sent back to the ZI,and was usually lost to the theater. Themedical composite battalions set up inAugust, however, included fifth echelonrepair units. In addition to the repairand maintenance sections maintained atall depots, traveling maintenance teamsbegan visiting hospitals and other medi-cal installations, making on-the-spot re-pairs and instructing personnel inpreventive maintenance.


By the beginning of 1944, medicalsupply for the communications zone wasconcentrated in two major depots. The2d Medical Depot Company at Oranserved North Africa and the Medi-terranean islands, while the 4th Medi-cal Depot Company at Naples suppliedthe Italian mainland. Both depots req-uisitioned on the zone of interior untilJanuary 1944, when the Medical Section,SOS NATOUSA, took over that re-sponsibility and both received ZI ship-ments direct.28

The North African base sections werealready in process of contraction whenthe Services of Supply assumed controlover them on 24 February 1944. TheAtlantic Base Section had been with-out a regular supply depot since the fallof 1943, the function being performedincidentally by the 6th General Hospital.When that installation closed stationon 16 May 1944, the supply functionpassed to the 56th Station Hospital andwas discontinued altogether on 1 Sep-

28 Sources for this section are: (1) Annual Rpt,Med Sec, MTOUSA, 1944, an. K; (2) Hist, MedSec, Hq, COMZ NATOUSA. (3) Unit rpts of thevarious base secs and other med organizationsmentioned in the text. (4) Davidson, Med Supplyin MTOUSA, pp. 84-107.


MEDICAL SUPPLIES STORED IN AMPHITHEATER, NAPLES MEDICAL CENTER

tember. Thereafter medical units atCasablanca and Marrakech requisi-tioned supplies from the MediterraneanBase Section.

In the Eastern Base Section, the 7thMedical Depot Company closed at Ma-teur on 12 May, transferring 1,600 tonsof medical supplies to the Naples depotfor PBS. After that date the 54th StationHospital at Tunis maintained the onlyissue point in EBS. The medical supply

section of the 6671st General Depot atAlgiers also closed on 12 May, turningover the medical supply responsibilityto the 29th Station Hospital. On 7 Au-gust MBS assumed direct control ofsupply as well as other medical servicesfor the Center District, which passedout of existence at that time.

In Sicily, personnel of the 2d Medi-cal Depot Company operating the IslandBase Section supply depot at Palermo


were transferred to Headquarters, IBS,on 10 February 1944. A provisionalmedical supply depot company was acti-vated in April, being reorganized latein May as the 684th Quartermaster BaseDepot Company. A supply depot forthe Northern Base Section on Corsicawas set up at Ajaccio on 1 March bypersonnel of the 7th Medical DepotCompany, which established a subdepotat Cervione in May. The followingmonth, the NORBS supply organizationwas assigned to the 684th QuartermasterDepot Company, which was itself trans-ferred to PBS control when the IslandBase Section was inactivated in July.The two Corsican depots were combinedat Cervione in September.

In Italy, in addition to the Penin-sular Base Section installations, an Adri-atic Depot was formed in October 1943to serve Air Forces and supportingtroops in the Foggia-Bari area. Themedical section, located at Bari, was con-fined to supply activities, using over-strength personnel of the 4th MedicalDepot Company until 20 March 1944.On that date the Medical Section, ArmyAir Forces Service Command, Mediter-ranean Theater of Operations, took di-rect responsibility for the medical supplyactivities of the depot, under generalsupervision of the Medical Section, SOSNATOUSA. With rising air strengthand increasing air activity, the medicalsection of the Adriatic Depot was en-larged and for the first time was placedunder its own surgeon about 1 July.At the same time the AAFSC MTOwas authorized to deal directly with thezone of interior in matters of medicalsupply peculiar to the Air Forces insteadof going through SOS NATOUSA. Bythe close of the Rome-Arno Campaign

the medical section of the Adriatic De-pot was performing the functions of amedical base depot company.29

In the Peninsular Base Section proper,the 4th Medical Depot Company, at themedical center on the Mostra FairGrounds, had responsibility for all medi-cal supplies until June 1944, when the7th Medical Depot Company arrivedfrom EBS to share the load. The 7thoperated depots successively at Anzio,Rome, and Civitavecchia between 11June and 1 July. The Rome depot wasturned over to the 12th General Hos-pital for administration, and the Civit-avecchia dump was transferred to controlof the 4th Medical Depot Company.On 1 July the 7th Medical Depot Com-pany was relieved of assignment to PBSbefore being attached to Seventh Army.The 4th Medical Depot Company, aftera week in Civitavecchia, set up a secondforward base at Piombino. By the mid-dle of July, all medical supply installa-tions between Naples and the Volturnohad been centered in the main supplybase on the fairgrounds, and all otherdepots south of Civitavecchia had beeneliminated.

Thus, coincident with the movementof AFHQ to Caserta, the whole supplysystem for the theater was revised. TheMediterranean Base Section was maderesponsible for all medical supply inNorth Africa, the Atlantic and EasternBase Sections were left without stocks,and the Island Base Section was closed.Surplus stocks in MBS were used formounting the invasion of southernFrance, while the Peninsular Base Sec-tion took over support of the Adriatic

29 (1) Annual Med Hist, AAFSC MTO, 1944. (2)MS, Hist of the Adriatic Depot, OCMH files.


Depot, the Northern Base Section, andthe Allied garrison on Sardinia.

In the reorganization of 15 August,Headquarters, 232d Medical CompositeBattalion, and the 72d Medical BaseDepot Company remained in Naples.The detachments at Piombino andCivitavecchia were combined at thePiombino site and redesignated the 73dMedical Base Depot Company. An ad-vance group of this company departedfor Leghorn on 23 August to locatequarters for what would eventually bethe major medical supply base for thetheater.


Professional services in the Italiancommunications zone continued to main-tain the high standards of performanceestablished in North Africa, unaffectedby changes in organization or command.


At the theater level, medical aspectsof the medical and surgical services con-tinued to be guided and supervised bythe consultants. Both Colonel Long,Medical Consultant, and ColonelChurchill, Surgical Consultant, madefrequent inspection tours of base instal-lations and combat medical units, recom-mending changes in procedure andpersonnel wherever such changes wereconsidered desirable.30

Medical Service—The medical prob-lems of the Italian communications zonewere primarily extensions of problemsdiscussed in connection with combatactivities. Infectious hepatitis was inten-sively studied at the 15th Medical Gen-eral Laboratory in Naples.31 The treat-ment of neuropsychiatric disorders wascentered increasingly in the forwardechelons, under general direction of thetheater consultant in neuropsychiatry,Colonel Hanson, but specialized neuro-psychiatric hospitals continued to bemaintained in the Peninsular Base Sec-tion to give the best possible care topatients whose cure could not be effectedcloser to the front. These were the 51stStation Hospital, which opened in Na-ples in May 1944, and the 114th StationHospital, which moved from North Af-rica to Rome early in July. Psychiatristswere also assigned to certain other sta-tion and general hospitals on temporaryduty to care for cases that for one reasonor another could not be sent to the spe-cialized facilities. Other troublesomediseases, such as trench foot, malaria,and venereal infections were dealt withat the communications zone level pri-marily as problems in preventivemedicine.

The only special problem worthy ofnote for the medical service arose as aresult of the enemy bombing of Bariharbor on the night of 2 December 1943.One of the vessels destroyed had carrieda quantity of mustard gas, and undeter-mined amounts of the gas were held insolution in oil that was floating on thewater. Of the more than 800 casualtieshospitalized after the raid, 628 suffered

30 This section is primarily based on: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) AnnualRpt, Surg, PBS, 1944; (3) Annual rpts of individ-ual med units in the theater; (4) Col. Edward D.Churchill, "Surgical Management of Wounded inMediterranean Theater at the Time of the Fall ofRome," Bulletin, U.S. Army Medical Department,V, (January 1945), 58-65. 31 ETMD for Aug 44.


from mustard gas exposure. Sixty-ninedeaths were attributed in whole or inpart to this cause.32

Medical officers and aidmen treatingthe casualties were unaware of the pres-ence of the gas, which was diluted suf-ficiently to be undetected by odor. Inthe belief that casualties covered withoil but showing no physical damage weresuffering from exposure and immersion,they were wrapped in blankets, still intheir oil-soaked clothing, given hot tea,and left as they were for twelve totwenty-four hours while the more urgentblast injuries and surgical cases weretreated.

Those with the energy and will toclean the oil from their own bodiessuffered no serious damage, but the re-mainder suffered varying degrees of mus-tard burns. Eyes began to burn about 6hours after exposure, and were so badlyswollen in 24 hours that many of thepatients thought themselves blind. Thefirst death occurred without warning 18hours after exposure.

About 90 percent of the gas casualtieswere American, the bulk of them mer-chant seamen. Since no U.S. hospitalfacilities were yet available in Bari—itwill be remembered that equipment forall but one of the U.S. hospitals sched-uled for the area was destroyed in thebombing—casualties were hospitalized inBritish installations.33

Surgical Service—One of the more im-portant advances in surgical manage-ment during the first year of the Italiancampaign was the development of re-parative surgery in the base hospitals.The concept of wound surgery as itdeveloped at this time divided proce-dures into three phases. The first phase,performed in field or evacuation hospi-tals in the army area, included all pro-cedures necessary to save life and limb.The second phase, called reparative sur-gery, took place in the general hospitalsof the communications zone. The thirdphase, more properly called reconstruc-tive or rehabilitative surgery, took placein the zone of interior and was designedto correct or minimize deformities anddisabilities. The techniques and limits ofinitial surgery in the army and even thedivision area were well established earlyin the Italian campaign, but there wasmuch still to learn about the secondphase.

Expert opinion was that to achievemaximum benefits, reparative surgerymust take place at the period of greatestbiological activity in wound repair, be-tween the fourth and tenth days. Asdescribed by Colonel Churchill,

Reparative surgery is designed to pre-vent or cut short wound infection eitherbefore it is established or at the period ofits inception. Once established, wound in-fection is destructive of tissue and, at times,of life. In many instances it permanentlyprecludes the restoration of function by themost skillful reconstructive efforts. If theinitial wound operation has been a com-plete one, wounds of the soft parts may beclosed by suture on or after the fourth day.The dressing applied in the evacuationhospital is removed under aseptic precau-tions in an operating room of a generalhospital at the base. Following closure, thepart is immobilized preferably by a light

32 (1) Surg, NATOUSA, Journal, 21, 23, 27 Dec1943, 2 Jan 44. (2) Theater ETMD for Dec 43,app. S. (3) Ltr, Col Alexander, Consultant, Chemi-cal Warfare Medicine, to DMS, AFHQ, and Surg,NATOUSA, 27 Dec 43, sub: Toxic Gas Burns Sus-tained in the Bari Harbor Catastrophe. (4) PersLtr, Col Alexander to Col William D. Fleming, MedSec, Hq, SOS ETO, 26 Dec 43.



plaster, or, if this is impracticable, by bedrest. Decision to close a wound by sutureis based solely on an appraisal of the grossappearance at the time of removal of thedressing.34

Churchill estimated that by the mid-dle of 1944 "at least 25,000 soft partwounds" had been closed in Italy aloneon the basis of gross appearance only,with satisfactory healing in 95 percentof the cases. The technique was also usedfor more complicated wounds, including"those with extensive muscle damage aswell as those with skeletal or joint injuryand penetration of the viscera."

The Naples Blood Bank—Shortly afterit opened in the Naples medical centerin January 1944, the 15th Medical Gen-eral Laboratory was asked by the PBSsurgeon, Colonel Arnest, to establish asmall blood bank for emergency use inthe center and elsewhere in the Naplesarea. Plans for a 20-bottle bank weredrawn up, but before they could be im-plemented, the needs of Fifth Army ledto substantial enlargement of the scheme.When the blood bank began operationson 23 February, its goal was 200 bottlesa day, forecast as the combined require-ment of Fifth Army and the PeninsularBase Section. Donors were drawn frombase units, replacement depots, and per-sonnel in the process of staging. Two

thousand pints of blood were taken inMarch, with an aggregate by 1 May of4,134. The blood bank meanwhile hadbeen formally authorized. Two days be-fore Allied troops opened the offensivethat would carry them to Rome and onto the Arno, it became the 6713th BloodTransfusion Unit (Provisional), as-signed to the theater but attached to the15th Medical General Laboratory. Dur-ing May 6,362 pints of blood were drawnwith the assistance of the 1st MedicalLaboratory, which was attached to the15th late in April. Between 14 and 31May, when battle casualties were heav-iest, 4,685 bloods were taken, for a dailyaverage of 260. Throughout this periodthe blood bank was operated by 7 officersand 36 enlisted men.35

Blood was carried to the Cassino frontby truck and to Anzio by LST. Begin-ning on 24 May, whole blood was flownto the front daily. A distributing unitfollowed the advance of Fifth Army, metthe daily blood plane and delivered theprecious cargo to the hospitals where itwas needed. The blood plane also car-ried penicillin, emergency medical sup-plies, and occasionally personnel.

Since the decision had been made byColonel Churchill to keep whole bloodfor a maximum of only eight days, theactivities of the blood bank were neces-sarily keyed to combat activity. The lab-oratory maintained a list of donors, who

34 Churchill, "Surgical Management of Woundedin Mediterranean Theater at Time of the Fall ofRome," Bulletin, U.S. Army Medical Department,V (January 1945) , pp. 61-62. See also, "Develop-ments in Military Medicine During the Adminis-tration of Surgeon General Norman T. Kirk,"Bulletin, U.S. Army Medical Department, VII (July1947), 623-24; Col. Oscar P. Hampton, Jr. (USAR),Orthopedic Surgery in the Mediterranean Theaterof Operations, "Medical Department, United StatesArmy," subseries Surgery in World War II (Wash-ington, 1957), pp. 81-114.

35 (1) Hist, 15th Med Gen Lab, 20 Dec 42-31 May44. (2) 15th Med Gen Lab, Quarterly Hist Rpts,31 Oct 44. (3) Monthly Rpts, 6713th Blood Trans-fusion Unit. (4) Rpt of Col Virgil H. Cornell,formerly CO, 15th Med Gen Lab, sub: Gen LabOverseas Experiences, 29 Jan 46. (5) Brig. Gen.Douglas B. Kendrick, Jr., "The Blood Program,"vol. I, Activities of Surgical Consultants, "MedicalDepartment, United States Army," subseries Surgeryin World War II (Washington, 1962), ch. VI.


TECHNICIANS COLLECTING BLOOD FROM WAC DONORS, 15th General Medical Labora-tory, Naples medical center.

were called when needed. The use ofwhole blood in forward surgery un-doubtedly saved many lives in the Medi-terranean Theater.

Preventive Medicine

The major problems of preventivemedicine in the communications zoneremained in Italy what they had been inAfrica—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 combatzone problems. Venereal disease andmalaria were dealt with on a theater-wide basis. The army aspects of bothhave been discussed in earlier chapters,but the control organization in bothcases centered at theater headquarters.The division of function between theMedical Section, NATOUSA, and theMedical Section, SOS NATOUSA, wasnot always clear, but the two groupsworked closely together to avoid dupli-cation of effort and to achieve a commongoal.


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 andco-ordination of the venereal disease con-trol program rested at the theater levelwith the NATOUSA venereal diseasecontrol officer, Lt. Col. Leonard A.Dewey, until mid-January 1944, andthereafter Lt. Col. Asa Barnes. The pro-gram was carried out in the base sectionsunder direction of the SOS venereal dis-ease control officer, Lt. Col. William C.Summer, who transferred from theNATOUSA organization in May.

The practice, begun in Africa, of plac-ing houses of prostitution off-limits tomilitary personnel was continued inItaly, but the problem of the clandestineprostitute was more serious in the Italiancities, particularly in Naples and Rome.The enforcement of off-limits regula-tions and the apprehension of unlicensedprostitutes was in the hands of civilianand Allied military police, while thebase surgeons, through their venerealdisease control officers, were responsiblefor the dissemination of educationalmaterials among base installations andtroops, the establishment and mainte-nance of prophylactic stations, and thekeeping and analysis of venereal diseaserecords. Naples and Rome, the two

largest and most accessible cities in theItalian communications zone, each had10 "pro" stations in operation.36

While the venereal rates for the thea-ter as a whole showed steady improve-ment through the spring and summer of1944, measured in days lost, the gainswere due rather to the introduction ofpenicillin therapy than to any significantreduction in the number of cases.(Table 22)

Malaria—The malaria control organ-ization set up in North Africa was ex-tended to Italy where, with some modi-fications, it was responsible for aneffective control program in the 1944season. The entire program was underthe general supervision of Colonel Stone,preventive medicine officer on the staffof the Surgeon, NATOUSA, and wasdirected by Colonel Andrews of theSanitary Corps, who was both theatermalariologist and commanding officer ofthe 2655th Malaria Control Detachment.Under Colonel Andrews were malariol-

36 This section is primarily based on: (1) AnnualRpt, Surg, MTOUSA, 1944; (2) Hist, Med Sec,COMZ NATOUSA; (3) Annual Rpt, Surg, PBS,1944; (4) Annual Rpt, Surg, Rome Area, 1944.


ogists assigned to each of the base sec-tions, to Fifth Army, and to the ArmyAir Forces Service Command. A malari-ologist was also assigned to the Servicesof Supply medical section, and closeliaison was maintained with the MalariaControl Branch of the Allied ControlCommission, and with the British Con-sultant Malariologist.37

The actual work of malaria controlwas directed locally by specialized units,co-ordinated at the theater level but as-signed for operational purposes to thearmies and base sections. The controlprogram was effected in three phases.(1) Surveys to determine the malarious-

ness of an area and the density of themalaria vectors were conducted bymalaria survey units. Consisting of oneentomologist, one parasitologist, andeleven enlisted men, these units, knownas MSU's, were in effect mobile malarialaboratories, calculating splenic indicesand making blood analyses of personsliving in the area to determine the inci-dence of the disease and seeking outmosquito breeding places. (2) The find-ings of the malaria survey units wereturned over to malaria control units, orMCU's, each commanded by a sanitaryengineer with eleven enlisted men. TheMCU's carried out various forms of lar-

viciding and physical alteration ofbreeding places by draining, filling, andother means. (3) Personal protectivemeasures, such as use of protective cloth-ing, bed nets, insect repellents, andatabrine therapy were enforced by com-manding officers for all troops.

By way of advance preparation forthe 1944 malaria season, an Allied ForceMalaria Control School was conductedin Algiers in November 1943, withparallel American, British, and Frenchsections. The school was attended bymalariologists and other malaria controlpersonnel, who followed up with similarschools conducted locally. Between 21February and 25 March 1944, threeseparate courses were given in Naplesunder the direction of Maj. Maxwell R.Brand, the Peninsular Base Sectionmalariologist. One course was for medi-cal inspectors, one for laboratory officersand technicians, and one for the trainingof enlisted men to work as malaria con-trol details. The latter course wasrepeated in April at Caserta, primarilyfor Air Forces personnel. Courses con-ducted for Fifth Army personnel havebeen discussed in earlier chapters.

The theater malaria control plan wasdistributed on 20 March 1944 to thecommanding generals of Fifth Army; theArmy Air Forces, MTO and Services ofSupply, NATOUSA. As of that date,there were five malaria survey units andseven malaria control units in the thea-ter. Two additional control units wereactivated in May and three survey unitsin July. One MSU arrived from theUnited States in June, bringing thetotals for the season to nine units ofeach type. The units were distributedaccording to need in North Africa,Corsica, Sardinia, Sicily, and various

37 This section is based primarily on: (1) AnnualRpt, 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, AAFSCMTO, 1944, an. B; (5) Col. Paul F. Russell, "TheTheater Malaria Control Organization," MedicalBulletin, North African Theater of Operations, I(February 1944), 17-18; (6) Summary of Materials

presented at Malariologists' Conference, 1-11 Nov44, in Naples, Italy. For comment on the capabil-ities and organizational inadequacies of the malariasurvey and control units, see Armfield, Organizationand Administration, pp. 288-91.


PLANES DUSTING PARIS GREEN ON MOSQUITO-INFESTED LOWLANDS in the Cassino area.

points of troop concentration in westernItaly. Eastern Italy was a British respon-sibility, except for a substantial areaaround Foggia for which the Air ForcesService Command was made responsible.

Control measures followed a standingoperating procedure. Each individualcombat and service unit was responsiblefor its own area, while large-scale opera-tions such as drainage and water diver-sion projects were conducted by theArmy engineers. Dusting and sprayingfrom the air was carried out by a sectionof a ferrying squadron, using both Brit-ish and U.S. personnel. One malaria sur-vey unit operated a plant for mixingparis green, at the rate of eight to tentons a day. DDT was used sparinglyearly in the season, but more and morefreely as adequate quantities became

available toward midsummer. Suppliesand equipment were procured throughQuartermaster, Engineer and Ordnance,and a labor force was drawn from thecivilian population, from Italian servicecompanies, and in combat areas fromtroop detachments.

The malaria control program for thetheater as a whole, judged in terms ofmalaria case rates, was effective. Ratesper 1,000 per annum for the mostmalarious months of 1944 were 70 inJune, 81 in July, and 92 in August, com-pared to 29, 77, and 173 for the corre-sponding months of 1943. The higher1944 rates for June and July reflect pri-marily the far higher proportion oftheater personnel stationed in malariousareas. The August figures are morenearly comparable, contrasting as they


do the experience of Seventh Army inSicily with that of Fifth Army in Italy.38

The Reconditioning Program

In the Italian communications zonethe reconditioning and rehabilitationprogram launched in North Africa wasfurther refined and broadened. As a re-sult of a survey conducted in late Janu-ary 1944 by Colonel Munhall, command-ing officer of the 6706th ConditioningCompany, each of the general hospitalsin the Peninsular Base Section estab-lished a convalescent and rehabilitation(C&R) section. Patients were normallytransferred to this section ten days inadvance of discharge from the hospital,but in most instances, reconditioning andrehabilitation had already begun withoccupational therapy, light calesthenicson the wards, short walks, and variousduties in the administration of the hospi-tal, scaled to the abilities and physicalcapacities of the individual.39

In the convalescent and rehabilitationsections, each staffed by one line officerand six noncommissioned officers ontemporary duty status, the program in-cluded both physical conditioning andpsychological readjustment. Lectures onthe progress of the war and world eventsand lessons from past campaigns wentalong with carefully graduated exercisesand military drill. To get away from thehospital atmosphere, the C&R sectionswere generally removed as far as possiblefrom the hospital proper. The men woreuniforms and lived much as they would

in combat units. The 10-day programgave each man 40 hours of physical con-ditioning and 25 hours of militaryeducation.

In addition to this reconditioning pro-gram in the general hospitals, whichcontinued throughout the war, a morecomprehensive program was conductedby the 6706th Conditioning Company,which was transferred to Italy in April1944. The conditioning company dealtwith men in need of longer periods ofrehabilitation, for the most part menwho had previously been classified fortemporary limited service up to ninetydays. The normal period of duty withthe conditioning company was threeweeks. At the end of this time the menwere examined by a board of officersfrom some nearby hospital, and placedin one of four categories: (1) thoseready to return to duty, (2) those to beheld for further conditioning, (3) thoseto be returned to the hospital for ad-ditional treatment, and (4) those to besent before a hospital reclassificationboard for determination of future status.

The company was set up temporarilyin Naples, moving in June to a site onLake Lucrino and in July to a permanentlocation on Lake Averno. Both sites wereclose to the amphibious training area atPozzuoli, west of Naples, and no morethan five or six miles from the medicalcenter.

Dental Service

The dental service throughout theNorth African Theater of Operationsshowed steady improvement during thefirst eight months of 1944, despite thefact that the number of dental officersin 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) AnnualRpt, 12th Gen Hosp, 1944. (3) Annual Rpt, 21stGen Hosp, 1944. (4) Annual Rpt, 300th Gen Hosp,1944


the rising troop population. At the endof December 1943 there were 703 dentalofficers in the theater, with a ratio totroop strength of 1:850. By the end ofJune the number of dental officers hadrisen to 765, but this lamer figurerepresented only one dentist to each 938

military personnel. By the end of Augusttotal dental officer strength had declinedto 734, or a ratio of 1:1012.40

The improvements in dental servicestemmed primarily from better andmore widely distributed equipment, andfrom the concentration of dental skills.A Central Dental Laboratory was set upin the Naples medical center before theend of 1943. Early in April 1944 amaxillofacial center was established atthe 52d Station Hospital, also in Naples,to which a maxillofacial team of the 2dAuxiliary Surgical Group was attachedat the beginning of June, when casual-ties from the Rome-Arno Campaign be-gan flowing back to the communicationszone in large numbers. The maxillo-facial center reached its peak load on 7June, with a census of 282 cases, 139 ofthem with bone injury.

To meet growing personnel require-ments, a training course for dentaltechnicians was instituted in May, underwhich two enlisted men from each sta-tion hospital were given thirty days oftraining at a designated general hospital,with further instruction at the CentralDental Laboratory.

The enlargement of the general hospi-tals in June served to further the tend-

ency to concentration of dental skills.Where the l000-bed generals had had5 dental officers, the newly constituted1500-bed hospitals had 8, and the 2000-bed units 10 dental officers. The hospitalreorganization increased the Table ofOrganization requirements for the thea-ter by 55 dental officers. Concentrationat the army, corps, and division levels,with more extensive use of clinics andmobile laboratories, has already beennoted in chapters dealing with combatactivities.

As a result of these changes indistribution of dental strength and ofimprovements in equipment and labora-tory facilities, the amount of constructivedental work performed was substantiallyincreased over that performed in 1943.

Col. Lynn H. Tingay remained chiefdental surgeon for the theater through-out the period of centralization in south-ern Italy, while Colonel Metz served ascommunications zone dental surgeon un-til August 1944. Both of these officersmade frequent inspection trips to dentalinstallations in the interest of improvingtheater dental service.

The communications zone organiza-tion for the Army Air Forces in Italywas headed by Maj. (later Lt. Col.)Estes M. Blackburn, dental surgeon ofthe Army Air Forces Service Command,Mediterranean Theater of Operations.Since no dental officer was assigned tothe staff of the Surgeon, AAF MTO,Major Blackburn acted as adviser on sup-ply and equipment and personnel to allAir Forces dental installations, as wellas liaison with the NATOUSA and SOSNATOUSA, dental surgeons.4140 Principal sources for this section are: (1) An-

nual Rpt, Med Sec, MTOUSA, 1944, an. G; (2)Annual Rpt, Surg, PBS, 1944; (3) Hist, Med Sec,Hq, COMZ MTOUSA; (4) Dental Hist, NorthAfrican and Mediterranean Theaters of Operations. 41 AAFSC MTO, Annual Med Hist, 1944, an. E.


Veterinary Service

Shortly after his appointment inFebruary 1944 to the vacant position oftheater veterinarian, Colonel Noonanrecommended that food inspection unitsbe placed under the supervision of SOSNATOUSA and the corresponding AirForces echelon, the Army Air ForcesService Command, MTO. The numberof food inspection units in the theaterat this time was wholly inadequate andauthority was granted in July to activate12 medical composite sections (food in-spection), each with a veterinary officerand 4 enlisted men. These were in addi-tion to the 3 existing veterinary foodinspection detachments bearing letterdesignations, which continued to operatein the theater under their old T/O's.Officer personnel for the new units weredrawn from replacement pools. A cadreof one enlisted man for each new unitwas assigned from the 3 veterinary de-tachments already in the theater, theremainder of the enlisted personnelcoming from other veterinary organiza-tions and from quartermaster depots.At the same time, 3 veterinary food in-spection detachments (aviation) and 2sections were activated and assigned tothe AAFSC MTO, using existing AirForces personnel.42

The new organization brought foodinspection units under base section con-trol, the work being carried out in portsand in areas of heavy troop concentrationwhere substantial quantities of food

were stored or locally procured.Through improved methods of packingand storage and frequent inspections,the loss of food through spoilage wasgreatly reduced. No serious outbreak offood poisoning occurred anywwhere inthe theater.

In addition to food inspection duties,the Peninsular Base Section was respon-sible for activation of the 213th Veteri-nary General Hospital (Italian) on 4July 1944, at Grosseto, with a comple-ment of 15 Italian veterinary officers and253 Italian enlisted men. The 6742dQuartermaster Remount Depot also re-ceived veterinary service through PBS.

While base section veterinarians inItaly and Sardinia aided in the localprocurement of animals for military use,this work, as well as conditioning theanimals so procured, was directed by theFifth Army veterinarian, Colonel Pick-ering, and has been more fully treated inthe combat narrative.43

Nursing Service

The shift of emphasis from NorthAfrica to Italy introduced no new orunusual problems for nurses. In com-munications zone installations, livingconditions were better in Italy, andopportunities for recreation more exten-sive. The total number of nurses in thetheater declined from 4,398 in October1943 to 4,000 in January 1944, owing tothe transfer of several hospitals out ofthe theater in the late months of 1943.The number of nurses remained closeto 4,000 until transfer of hospitals tosouthern France late in 1944 again

42 Sources for this section are: (1) Annual Rpt,Med Sec, MTOUSA, 1944, an. H; (2) Hist, MedSec, Hq, COMZ NATOUSA; (3) AAFSC MTO,Annual Med Hist, 1944, an. D. (4) Annual Rpt,Surg, PBS, 1944. See also, Miller, United StatesArmy Veterinary Service in World War II. 43 See especially pp. 263-65, 318-20, above.


sharply reduced the total. Approxi-mately 75 percent of the nurses were as-signed to communications zone units.44

While the number of nurses in thetheater was at all times adequate to thenumber of T/O beds, there were manyperiods of intensive activity when dutyhours were long and patients per nursehigh. During periods of heavy combatactivity, nurses from fixed hospitals wereoften put on temporary duty with com-bat units, thus increasing the load forthose remaining in the communicationszone. The necessity for operating bothfixed and mobile hospitals in Italy aboveT/O capacities for considerable periodsof time was another factor tending toincrease the burden on nurses as well ason all other hospital personnel. There isno evidence, however, that morale suf-fered in any way.

Lt. Col. Bernice M. Wilbur servedthrough most of 1944 as Chief Nurse,NATOUSA; Capt. Michener served asChief Nurse, COMZ NATOUSA, fromlate April 1944.

The work of the nurses in the theaterwas supplemented by the activities of alimited number of physical therapistsand dietitians attached to the larger hos-pitals.45

Army Public Health Activities

Organization

The Civil Affairs organization set upunder AMGOT before the invasion of

Sicily was carried over initially to theItalian mainland. Before the Salernolandings, Sicily had been divided intotwo administrative regions, while otherregions in southern Italy had beenmarked out and staffs assigned. Thesenior civil affairs officer for Region III,which included the Salerno and Naplesareas, was Colonel Hume, a MedicalCorps officer who had given up his posi-tion as Deputy Director of PublicHealth, Allied Military Government,for this purely administrative post.46

The public health and welfare officerfor Region III, Lt. Col. (later Col.)Emeric I. Dubos, USPHS, went ashoreat Salerno on D-day, but was unable tofunction during the first few days of com-bat. Colonel Hume and his British ex-ecutive officer, Colonel Ashley, arrivedat the beachhead the evening of D plus4. Plans were prepared on the groundfor the administration of the provincesof Salerno, Naples, Avellino, and Bene-vento, and for the city of Naples, includ-ing emergency health measures to becarried out under Army control. AlliedMilitary Government civil affairs person-

44 Sources for this section are: (1) Annual Rpt,Med Sec, MTOUSA, 1944, an. I; (2) Hist, MedSec, Hq, COMZ MTOUSA; (3) Annual Rpt, Surg,PBS, 1944; (4) Maj Parsons and others, Hist ofArmy Nurse Corps, MTOUSA.

45 Both of these groups will be discussed in de-tail in a forthcoming history of the Army Medical

Specialist Corps to be published by the Office ofThe 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 inthe Mediterranean Theater; (2) Thomas B. Turner,chs. XI, XII, in forth-coming volume: StanhopeBayne-Jones, ed., "Preventive Medicine," vol. VIII,Civil Affairs-Military Government Public HealthActivities, to be published by The Surgeon Gen-eral; (3) John A. Lewis, Rpt to WD, MS, His-tory of Civil Affairs in Italy, 7 Dec 45; (4) Lt ColLeonard A. Scheele, USPHS, Civil Public HealthHistory, North African-Mediterranean Theater ofOperations, May 1943-January 1944; (5) Hist ofAFHQ, pt. II, sec. 3; pt. III, secs, 1, 4; (6) MonthlyRpts, Allied Control Commission, Public HealthSec, Nov 43-Aug 44. See also, Armfield, Organiza-tion and Administration, pp. 294-98.


GENERAL HUME

nel entered Naples with the occupyingtroops on 1 October and set about re-moving health hazards at once. Accord-ing to Colonel Stone, the NATOUSApreventive medicine officer, who was oneof the early arrivals, the population ap-peared well nourished. Water supplywas sufficient for one gallon per personper day, provided none of it was used toflush the sewers.47 As rapidly as possiblethe accumulated garbage of two weekswas disposed of, and the dead wereburied. With the aid of U.S. and Britisharmy engineers, water and power facili-ties and sewers were restored. Duringthis period, Colonel Hume acted as mili-tary governor of Naples.

With the conclusion of the first phaseof the Italian campaign, the AMG or-ganization was modified to fit the condi-

tions encountered on the peninsula.Early in November 1943, an Allied Con-trol Commission was established underthe Military Government Section,AFHQ. Allied Military Governmentthereafter functioned in two echelons,one attached directly to the 15th ArmyGroup and one at the communicationszone level, attached to theater head-quarters. General Alexander, the armygroup commander, acted as militarygovernor of all occupied territory inItaly until the advance of the troopsmade it possible to set up a civil govern-ment under supervision of the AlliedControl Commission. Public health workof ACC was directed by the PublicHealth and Welfare Subcommissionheaded by Brigadier G. S. Parkinson(British) with Lt. Col. (later Col.)

Wilson C. Williams as his Americandeputy.

As part of the reorganization of theMilitary Government Section, a civil af-fairs officer was attached to each of theAllied armies, the Fifth Army assign-ment going to Colonel Hume, who re-ceived his promotion to brigadier gen-eral at that time. On 14 May 1944,coincident with the launching of thedrive on Rome and following a patternalready established in the Europeantheater, the Military Government Sec-tion became a general staff section, des-ignated as G-5.

The normal practice was exemplifiedin the capture of Rome. General Humetook over administration of the city assoon as it was in Allied hands, acting asmilitary governor for ten days. On 15June, AMG, Rome Region, responsibleto the Allied Control Commission, re-placed the Fifth Army civil affairs or-ganization. During the period of Army47 Surg, NATOUSA, Journal, 11 Oct 43.


control every effort was made to clean upthe city, restore utilities, rehabilitatehospitals, and provide adequate sanita-tion, as well as to issue food and drugswhere necessary. American Red Crosspersonnel worked with the Army publichealth officers. The more permanentcivil affairs group representing ACCtried to re-establish a local governmentwith native personnel along lines famil-iar to the inhabitants. Administrationwas eventually turned over entirely tothe Italian authorities.

In the public health field, major prob-lems were sanitation and preventivemedicine. Such hazards to the health ofthe troops as typhus, malaria and vene-real disease could be effectively con-trolled only by including the civilianpopulation in control measures. Whilelocal doctors were encouraged to practiceto the full extent of their abilities, gener-al supervision was retained over hospi-tals. It was necessary, also, for the Alliedpublic health organization to continuesupplying drugs for civilian use.

The cities of Leghorn, Florence, andPisa were under AMG administrationby the end of August 1944.

Typhus Control in Naples

Even before the conquest of Sicily inthe summer of 1943, a monitored broad-cast from Rome indicated the presenceof typhus in Italy. This possibility wastaken into account in the medical plan-ning for the occupation of the Italianmainland, both by the preventive medi-cine section of theater headquarters andby AMG public health officers. Thisplanning was based on the use of methylbromide (MYL) as a delousing agent,but difficulties in procurement pre-

vented the stocking of adequate quanti-ties of the powder and of suitable handdusters for applying it.48

Rumors of typhus in Naples were con-firmed after the Salerno landings byrefugees from the city, but could not beverified immediately. Colonel Stone, theNATOUSA preventive medicine officer,visited Naples along with GeneralCowell, Director of Medical Services,AFHQ, on 1 October, coincident withthe occupation of the city. Conditionswere right for an epidemic. The city wasovercrowded, its more than a millioninhabitants had not been immunizedand were heavily louse infested, andlarge numbers lived jammed togetherin air-raid shelters. The departing Ger-mans, moreover, had released the pris-oners from certain jails in which cases oftyphus had occurred earlier in the yearamong Serbian prisoners of war. Littlecould be learned from the local healthauthorities, however. Lack of transpor-

48 Principal sources for this section are: (1) An-nual Rpt, Med Sec, NATOUSA, 1943; (2) AnnualRpt, 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 theTyphus Epidemic and Control Measures in Naples,1943-44; (7) Scheele, Civil Public Health History,North African-Mediterranean Theater of Opera-tions, May 43-Jan 44; (8) Memo, Col Stone toTSG, 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 Controlwith Louse Powder," American Journal of Hygiene,XLV (May 1947), 305-34; (10) Stanhope Bayne-Jones, "Epidemic Typhus in the MediterraneanArea during World War II," Rickettsial Diseasesof 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 Italy1943-1944 by Use of DDT," American Journal ofPublic Health, XXXVI (February 1946), 119-29;(13) Med Sitreps, PBS, Jan-Mar 44.


tation and disruption of communicationsmade it impossible for those who mighthave the disease to be examined by aphysician. There was also confusion interminology, since "tyfo abdominale,"or typhoid fever, was often used inter-changeably by Italian doctors with"tyfo," which is the word for typhus.

On his return to Algiers, ColonelStone advised General Blesse of the po-tential danger, and precautionary stepswere taken at once. A group represent-ing the Rockefeller Foundation was thenstudying typhus control in the MiddleEast, and had conducted experimentswith the newly developed and still topsecret DDT in a French prison inAlgiers. These experiments confirmedStone's faith in the new insecticide, aquantity of which had already been re-quested for the theater. On Stone's ad-vice Brigadier Parkinson (British)ordered 50 tons of 10 percent DDT, 5tons of concentrate, and dusting guns,to be delivered to AMG by 15 Decem-ber, while Stone himself ordered 60 tonsof the powder and one ton of concentratefor Army use. Both requisitions weredisapproved by the War Department inNovember.

The presence of typhus in Naples hadmeanwhile been established. ColonelStone arranged with Dr. Fred L. Soperof the Rockefeller group for demonstra-tions of delousing methods in prisoner-of-war camps, and for the training ofmalaria control and other sanitary per-sonnel in these methods. Pertinent datawere distributed by the NATOUSAsurgeon's office in November.49 On the

20th of that month, Stone and ColonelLong, theater medical consultant, con-ferred at length with General Fox, fielddirector of the U.S.A. Typhus Commis-sion, which was also conducting studiesin the Middle East, but independentlyof the Rockefeller group. General Foxwas satisfied that all necessary steps hadbeen taken, and pledged the full co-oper-ation of the Typhus Commission.

Actually, control measures were lag-ging far behind needs. The public healthofficer for AMG's Region III, now Col.W. H. Crichton (British) , had whollyinadequate resources, either of person-nel or of equipment, to cope with thesituation, and had not succeeded in or-ganizing the Italian health authoritiesfor effective assistance. By the end ofNovember there were more than fortycases of typhus reported in Naples andprobably many more than that. Morevigorous control measures had becomeimperative.

The AMG and NATOUSA orders forDDT were reconsidered and finally ap-proved by the War Department on 5December. Observers from the TyphusCommission arrived in Naples on 6December, and two days later Drs. Soperand William A. Davis of the Rockefellergroup reached the city at the invitationof AMG and ACC authorities. The PBSsurgeon, Colonel Arnest, placed allavailable supplies of MYL powder at thedisposal of the Rockefeller team, whileGeneral Blesse dispatched DDT concen-trate to Naples by air. The Typhus Com-mission observers took no part in actualcontrol work, leaving after five days.

Contact or spot delousing began on 12December, the homes of all reportedcases being visited, and all contacts ofthe patients being dusted, but neither

49 (1) NATOUSA Surgeon, Cir Ltr No. 43, 11Nov 43. (2) NATOUSA Cir Ltr No. 224, 15 Nov43.


DELOUSING STATION IN NAPLES DURING THE TYPHUS THREAT

supplies nor personnel were adequatefor more extensive measures. Neitherwas transportation available. ColonelStone arrived on 18 December and Gen-eral Fox, in response to Stone's urgentrequest, on the 20th. After a series ofconferences with health and medicalofficers representing AMG, ACC, PBS,and Fifth Army, General Fox, using hispersonal prestige and the authority ofhis position to the utmost, set themachinery in motion for a full-scale at-tack on typhus. All clearances were ob-tained, and all necessary guarantees of

co-operation were given by 24 Decem-ber.50

Delousing of occupants of some 80 or90 air-raid shelters on a weekly basisbegan 27 December, and the first twostations for mass delousing opened thefollowing day. Supervised by Italiancivilian inspectors, there were 33 suchstations in operation by 15 January.Systematic delousing of all residents ofeach block in which a case occurred, andof contiguous blocks, began on 6 Febru-

50 Surg, NATOUSA, Journal, 24, 25, 26 Dec 43.


ary. Flying squadrons began working insuburban communities on 8 January.

General Fox and the Typhus Commis-sion assumed full responsibility for ty-phus control in Naples on 2 January1944, turning the task over to the AlliedControl Commission on 20 February,after the crisis had passed. Dr. Soper andhis associates of the Rockefeller groupadministered mass delousing throughoutthe danger period, and on a reducedscale until after the end of the war.

The turning point came around 10January, by which date over 60,000 per-

sons a day were being dusted with eitherMYL or DDT powder. The dusting sta-tions alone averaged 1,600 a day perstation, with an average staff of 13 each.All told, between mid-December 1943and the end of May 1944, more thanthree million applications of dustingpowder were made in Naples and sur-rounding towns. Out of 1,914 reportedcases of typhus in the Naples area be-tween July 1943 and May 1944, only 2were U.S. military personnel, one asoldier whose attack was mild, the other asailor, whose case was severe but not fatal.

CHAPTER X

Invasion of Southern France

Preparations for the Invasion

After the close of the Sicily Campaignin August 1943, Seventh Army wasstripped of its combat units to providetroops for operations in Italy. SeventhArmy retained some occupation duties,however, and continued to maintain askeletonized headquarters in Palermo,pending high-level decisions as to its ulti-mate employment.

The merits of an amphibious opera-tion in the Toulon-Marseille area ofsouthern France had been discussed atQuebec in August 1943. Under the codename ANVIL, the proposal was approvedby Marshal Joseph Stalin at Tehran be-fore its formal adoption at the secondCairo conference in December 1943. Bythis date a tentative outline plan, envi-sioning a 2- or 3-division assault with abuild-up to ten divisions, had been pre-pared.1

General Patton was already scheduledfor a command in the forthcoming in-vasion of France and would leaveSeventh Army in January. His successorwas to be General Clark, who would,however, retain command of the Fifth

Army for the time being, confining hisnew role to that of participation by adeputy in the planning activities. TheSeventh Army planning staff, designatedfor purposes of security as Force 163,opened in Algiers on 12 January 1944and eventually became a joint and com-bined staff.

Early Indecision

For the next two months the SeventhArmy planning staff, on which Brig.Gen. Benjamin F. Caffey, Jr., repre-sented Clark, worked in a vacuum. Notroops had been actually designated, nostaging areas set aside; even the size ofthe force to be used was not known. Theonly available forces were those fightingin Italy, and no one could say when itwould be possible to withdraw any ofthem. After the initial failure of theAnzio Campaign to develop as intendedand the setback before Cassino, GeneralAlexander was convinced the Germanswould stand south of Rome and insistedthat every man of his command wouldbe needed for the spring offensive inItaly. With VI Corps bogged down inthe mud of Anzio beachhead and theLiri Valley still secure against every Al-lied thrust, Clark was relieved on 15 Feb-ruary of any further responsibility ofANVIL.

On 4 March 1944 Maj. Gen. Alex-ander M. Patch of Guadalcanal fame had

1 Sources relied upon for the origin and militaryplanning of ANVIL are: (1) Churchill, Closing theRing; (2) Biennial Rpt, CofS, 1943-45; (3) Rpt ofOpns, Seventh U.S. Army; (4) Truscott, CommandMissions; (5) Robert Ross Smith, The Riviera tothe Rhine, a forthcoming volume in the seriesUNITED STATES ARMY IN WORLD WAR II.

INVASION OF SOUTHERN FRANCE 367

become commander of the SeventhArmy. The army's objective remainedthe same—to invade southern France inforce simultaneously with, or immedi-ately following, the Normandy landings,and exploit up the Rhone Valley, butthe target date for both operations hadbeen postponed to June. In mid-Aprilthe ANVIL D-day was again put off, thistime to late July, because of the require-ments of the May offensive in Italy andthe needs of OVERLORD for landing craft.All first priorities went elsewhere, andthe ANVIL planners were kept busy re-vising in terms of new unavailabilities.Rome had fallen and the Allied forceshad secured the Normandy beaches be-fore it was certain that ANVIL would evenbe launched.

Planning and Mountingthe Invasion

On 15 June the commander of AlliedArmies in Italy, General Alexander, wasdirected to release the U.S. VI Corps,consisting of the 3d, 36th, and 45th Divi-sions; two French divisions; and variousauxiliary troops to Seventh Army. Alex-ander and General Sir Henry MaitlandWilson, the Supreme Allied Commanderin the Mediterranean, still opposed thesouthern France operation, urging moststrongly that all troops in Italy be re-tained there for a knockout blow againstthe disorganized and retreating enemy,and then turned east through theLjubljana Gap toward Hungary. In thisproposal they were backed by PrimeMinister Churchill. On the other hand,it was probably General Eisenhower'sinsistance that Marseille and otherFrench Mediterranean ports were essen-tial to supply his own forces, and that

neither men nor matériel were availablefor two major fronts on the Continent,which tipped the scale in favor ofANVIL.2 On 2 July General Wilson wasdirected to launch ANVIL on 15 August.Two days later Seventh Army headquar-ters moved from Algiers to Naples,where headquarters of VI Corps and ofthe French forces, known as Army B,were also established.

Broadly, the plan called for a 3 divi-sion daylight assault by VI Corps, undercommand of General Truscott, over se-lected beaches between Cap Cavalaireand Agay. The night before the mainattack the 1st Special Service Force wasto seize the offshore islands of Port Crosand Levant, a French commando groupwas to go ashore at Cap Nègre on the leftflank to block the coastal road, and aFrench naval assault group was to carryout a similar mission at Pointe desTrayas on the right flank. At the sametime, an airborne task force was to bedropped in the vicinity of Le Muy, aboutten miles behind the landing beaches, tocut off enemy reinforcements and neu-tralize gun positions. Two French corps,which made up Army B under GeneralJean de Lattre de Tassigny, were to be-gin landing over the secured beaches onD plus 1, and to swing west to investToulon and Marseille, while VI Corpsadvanced up the Rhone Valley towardLyon and Vichy. The French forces wereto be made up in part of Moroccan andAlgerian troops to be withdrawn, likeVI Corps, from Italy. Army B also in-cluded the 9th Colonial Division, whichhad captured the island of Elba late inJune against stubborn German resist-ance.

2 Eisenhower, Crusade In Europe, pp. 281-84.


GENERAL PATCH AWARDING LEGION OF MERIT TO COLONEL BERRY

A Coastal Base Section, organized 7July, was to follow the combat troops atthe earliest practicable date. Its com-mander, Maj. Gen. A. R. Wilson, wasnamed on 26 June, and base section per-sonnel were attached to the planninggroup near the end of July.

The training of the assault divisionsbegan in June, as soon as possible aftertheir assignment. The 36th and 45thDivisions trained at Salerno, where theInvasion Training Center, now attachedto Seventh Army, had been establishedin the spring. The 3d Division trained atPozzuoli, on the northwest rim of the

Gulf of Naples; and the airborne taskforce established a glider and parachuteschool near Rome. Final dress rehearsalswere completed on the night of 7-8 Au-gust, after which loading of the trans-ports began at various ports in Italy,Sicily, North Africa and Corsica.

DRAGOON, as ANVIL had been rechris-tened on 1 August, was under way.

Medical Plans and Organization

By the end of 1943 the Seventh Armymedical section had been reduced to atotal of 10 officers and 18 enlisted men.


At that time the surgeon, Colonel DanielFranklin, 3 officers, and 5 enlisted menmoved to Algiers to assume the medicalplanning function for Force 163. At thesame time the medical supply officer, thedental officer, and 6 enlisted men joinedother Seventh Army supply units inOran to work out ANVIL supply planswith SOS NATOUSA and the basesections. The remainder of the medicalpersonnel continued at Palermo untilMay. The entire medical section was notreunited until Seventh Army headquar-ters moved to Naples early in July.3

The Seventh Army medical organiza-tion was similar to that of the FifthArmy, with staff sections for administra-tion, operations, and personnel. Hospi-talization, evacuation, and medical sup-ply came under operations. There was amedical inspector, with a venereal dis-ease control officer under him. On theprofessional side were a dental surgeon,veterinarian, and director of nurses, withconsultants in surgery, neuropsychiatry,and chemical warfare.

On 18 June Colonel Rudolph, whohad been surgeon of the declining East-ern Base Section, became Seventh Armysurgeon. Key officers in the medical sec-tion as D-day for DRAGOON approachedwere: Colonel Robinson, executive of-ficer; 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, medicalinspector; Maj. (later Lt. Col.) Au-gustus J. Guenther, commander of the7th Medical Depot Company, supply;and Maj. (later Lt. Col.) Charles Raul-erson, administrative officer. In the pro-fessional positions were Col. Frank B.Berry, surgical consultant; Col. Alex-ander, who doubled as chemical warfareconsultant; Lt. Col. (later Col.) DanielS. 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 ofnurses. Colonel Berry had been chief ofthe surgical service, 9th Evacuation Hos-pital, and Major Frew had been thatunit's chief nurse. Captain Ludwig hadbeen commander of the Fifth ArmyNeuropsychiatric Center. Colonel Stev-enson had been commanding officer ofthe 17th Veterinary Evacuation Hospi-tal, while Colonel Gurley came toSeventh Army from the 21st GeneralHospital.

Like other aspects of the planning forANVIL-DRAGOON, the medical plans wereincomplete and subject to constantchange until the assignment of units andfinal approval of the operation. Thebasic work, within the limitations im-posed by insufficient data, was shared atthe theater level by the NATOUSA andthe communications zone staffs, and atthe corps and division levels was directedby Colonel Bauchspies, the VI Corpssurgeon. The point of stabilization coin-cided with the arrival of Colonel Ru-dolph, who directed the final revision ofthe medical plans in terms of actual mis-

3 Principal sources for this section are: (1) An-nual Rpt, Surg, Seventh Army, 1944; (2) AfterAction Rpt, Surg, Seventh Army, 15 Aug-31 Oct44, 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 mentionedin the text.


COLONELS GOLDSON, RUDOLPH, AND RICH

sion, combat forces involved, and targetdate.

Medical Plans for the Assault—Thepattern followed in earlier amphibiousoperations in the Mediterranean wasagain the basic guide. The Navy was tobe responsible for all medical care onshipboard and to the high-water mark onthe landing beaches. The Army was re-sponsible for medical care ashore. As inthe Sicilian, Salerno, and Anzio landings,each combat division in the assault wasto be accompanied by its own medicaldetachments and its organic medical bat-

talion. In addition, each regimental com-bat team was to be supported in the land-ing phase by a collecting company andclearing platoon of a separate medicalbattalion. This was an improvementover the technique previously employedin the theater, whereby one of the col-lecting companies of each assault medi-cal battalion had been forced to rely up-on an improvised clearing platoon madeup of station section personnel.4 The air-borne task force was to be supported bya collecting company with clearing ele-

4 See pp. 149, 224, above.


ments attached. Each assault division wasto have the services of two field hospitalplatoons, with enlisted men drawn fromthe fixed hospitals substituted for thenurses who were not to arrive until Dplus 4, The field hospital platoons wereto function in immediate proximity tothe division clearing stations.

Twenty-eight surgical and other spe-cialist teams of the 2d Auxiliary SurgicalGroup were to be attached to the fieldhospitals and other assault units.5 Addi-tional teams for the troop transportswere made up of personnel of the 750-bedevacuation hospitals and the general hos-pitals scheduled to come into France atlater dates. Dispensary teams of one of-ficer and two enlisted men each, simi-larly drawn from personnel of hospitalsalready closed for future movement,were to serve aboard the cargo vesselsin the assault convoy. When the shipswithdrew from the beach area, theseteams were to report to the nearest evac-uation hospital for reassignment untiltheir own units arrived. The forward dis-tribution section of a blood transfusion

unit was to be attached to one of thefield hospitals, but was to serve the en-tire corps.

During the landing phase the threeseparate medical battalions were to beattached to the beach groups in the threeareas into which the invasion coast wasdivided. Their commanding officers weredesignated as beach group surgeons, eachbeing responsible for the setting up andoperation of medical installations in hisarea and for co-ordination with the med-ical sections of the Navy beach battal-ions. The beach control group surgeonwas to take over all Army responsibilityfor medical care and evacuation on thebeachhead when the area was secure.

The 3-plus French divisions scheduledto go ashore on D plus 1 were to be sim-ilarly accompanied by their own medicalunits, though the support available wasless extensive than that assigned to theassault troops of VI Corps. The initialFrench medical complement included amedical battalion, a field hospital, and ablood transfusion unit.

Hospitalization—In addition to thebeds available in the clearing stationsand field hospital platoons, each of thethree assault divisions was to be accom-panied by a 400-bed evacuation hospital,to be established between D plus 1 andD plus 4, or as soon as the situation per-mitted. Two comparable evacuationhospitals, U.S. equipped but Frenchstaffed, were to accompany the landingelements of Army B.

By D plus 10, when the French forceswere to have reached 7 divisions, themedical support for Army B was to beaugmented by 2 field hospitals, 2 400-bed evacuation hospitals, and 2 750-bedevacuations. The 3 divisions of VI Corps

5 Annual and Special Rpts, 2d Aux Surg Gp,1944. The D-day troop list in Report of Opera-tions, Seventh Army, III, 908, and Annual Report,Medical Section, MTOUSA, 1944, are probably in-correct in placing the number at 30 teams. AnnualReport, Surgeon, Seventh Army, 15 August-31 Oc-tober 1944, Annex 277, both identify only the 26teams that were attached to the field hospitals inthe landings, leaving 2 surgical teams—or possibly4—unaccounted for. One of these, together with 3medical officers of the 43d General Hospital, ac-companied the 1st Special Service Force in its Hminus 8 attack on the islands of Levant and PortCros. Another may have accompanied the airbornetask force, although no conclusive evidence to thateffect has been found. It is the recollection of Dr.Berry, then surgical consultant to Seventh Army,that 2 teams accompanied the 95th Evacuation Hos-pital, but these were probably among the 10 alreadycounted as being assigned to the ALPHA AttackForce. (See recorded interv, Dr. Berry, 4 Nov 58.commenting on preliminary draft of this volume.)


were to be backed up by 3 750-bed evac-uation hospitals, with a convalescenthospital scheduled for somewhat laterarrival.

To supplement these mobile units,plans also called for the establishment of14,250 fixed beds in southern France asrapidly as the military situation permit-ted. Three 2,000-bed general hospitals,three 1,500-bed generals, seven 500-bedstation hospitals, and a 250-bed stationhospital were assigned to the CoastalBase Section, organized in Naples 6 Julyby SOS NATOUSA, with ColonelBishop as surgeon. Bishop had been ex-ecutive officer to the groups working ontyphus control in Naples, and more re-cently surgeon of the MediterraneanBase Section. The assigned hospitalswere to be withdrawn from Africa, Italy,and Corsica.

Evacuation—Evacuation from thebeaches in the early hours of the assaultwas to be by landing craft and waterambulance to the transports. During theentire assault phase of the operation, sea-ward evacuation was a Navy responsibil-ity, the Army being responsible only forthe transportation of casualties to theNavy evacuation stations.

Two hospital ships were to arrive inthe landing area on D plus 1, after whichone ship was to arrive at dawn each dayuntil D plus 10. Hospital ships werethen to be sent forward on call of theSeventh Army surgeon. Twelve such ves-sels were to be made available for thispurpose, operating from Corsica. All cas-ualties were to be evacuated to Naplesuntil D plus 7. Thereafter U.S. and Brit-ish casualties were to be evacuated toNaples and French casualties to Oran.Air evacuation was scheduled to begin

on D plus 7. For evacuation from thecombat zone to rear areas in France, mo-tor ambulances were to be used until raillines were repaired for the operation ofhospital trains.

Medical Supply—The ANVIL-DRAGOONplans provided for two levels of medicalsupplies and equipment. The assaultforces were to carry with them sup-plies adequate for the landings and theearly expansion from the beachhead. Afurther build-up was to be available tomeet the needs of Seventh Army and theattached French Army B until a normalsupply system could be established bythe base section personnel scheduled tofollow the combat troops after the portsof Toulon and Marseille had been se-cured. It was not possible to determineeither level until the size of the oper-ation was known, yet if the supplies wereto be delivered on time, it was essentialthat orders be placed months in advance.It was therefore necessary to requisitioninitially through SOS NATOUSAsolely on the basis of the 3-division as-sault and 7-division follow-up called forin the outline plan.

Calculations were based on supplyfrom within the theater for 60 days,after which there would be direct de-liveries to southern France from theStates. Each subtask force in the landingswas to carry medical supplies for 7 daysmaintenance, which were to be collectedat dumps and issued by the beach groups.The assault troops were to carry individ-ual supplies of such items as atabrine andmotion-sickness pills, while the medicalpersonnel going ashore were to carry lit-ters, blankets, and splints, as well as nec-essary drugs in sealed, waterproof con-tainers. The bulk of the supplies for the


landing forces, however, was to be in theform of the newly devised beach main-tenance units, each containing a bal-anced stock of medical items sufficient tomaintain 5,000 troops for 30 days. Thesewere to be supplemented by such addi-tional critical items as blood plasma,morphine syrettes, plaster of paris, sul-faguanadine, paregoric, oxygen, anddressings. Medical supplies were to bepacked in clearly marked boxes, not ex-ceeding 70 pounds in weight. Suppliesfor the French forces were to be identi-cally packed, but marked with the tri-color.

Advance detachments of the Armymedical depot company were to accom-pany the assault, functioning as elementsof the beach groups for collection anddistribution of medical supplies. Allmedical units in the assault, in additionto making up any equipment shortages,were authorized to draw supplies 20 per-cent in excess of their normal allow-ances.

Supplies for subsequent phases of thecampaign were to be delivered as opera-tional medical maintenance units, a re-vised and modified version of the oldmedical maintenance unit. Like theMMU relied upon in earlier campaigns,it was designed to provide balanced med-ical supplies to meet the needs of 10,000men for 30 days.

Assignment and Training—The firstassignment of medical personnel to thesouthern France operation, other than ina purely planning capacity, was theattachment of three officers and three en-listed men from the Seventh Army med-ical section to the beach control groupformed at Mostaganem, Algeria, early inMay. The group included representa-

tives of the various supply services con-cerned with the coming campaign. Themedical complement was to direct theunloading of hospitals over the beaches,evacuate casualties, and control the flowof medical supplies from ship to dumpuntil Seventh Army and the Coastal BaseSection were able to take over their ownrespective supply functions. The 7thMedical Depot Company was later as-signed to Seventh Army, and the 1st Ad-vance Section was attached to the beachcontrol group.

Assignment of medical personnel tothe task forces necessarily had to be de-layed until the combat elements them-selves were assigned and the invasionplan completed. As finally approved,plans called for four major task forces,one to be airborne and three to strikethe beaches between Cap Cavalaireand Agay from the sea. The threeattack forces known as ALPHA, DELTA,and CAMEL, were built respectivelyaround the 3d, 45th, and 36th InfantryDivisions. The medical units assigned toeach attack force trained with the com-bat troops, the ALPHA Force at Pozzuolithe DELTA and CAMEL Forces at Sa-lerno, and the 1st Airborne Task Forcenear Rome.

The medical support assigned to thetask forces was as follows:

ALPHA Attack Force: 3d Divisionmedical detachments; 3d Medical Battal-ion (organic) ; 52d Medical Battalion,including the 376th, 377th, and 378thMedical Collecting Companies, and the682d Medical Clearing Company; Head-quarters and 1st Platoon of the 616thMedical Clearing Company, 181st Med-ical Battalion; the 1st and 3d Hospital-ization Units, 10th Field Hospital, with


ten teams of the 2d Auxiliary SurgicalGroup, and the forward distribution sec-tion of the 6703d Blood TransfusionUnit attached; 95th Evacuation Hospital.

DELTA Attack Force: 45th Divisionmedical detachments; 120th MedicalBattalion (organic); 58th Medical Bat-talion, including the 388th, 389th, and390th Medical Collecting Companiesand the 514th Medical Clearing Com-pany; the 2d Platoon, 616th MedicalClearing Company; the 2d Hospitaliza-tion Unit, 10th Field Hospital, and the2d Hospitalization Unit, 11th Field Hos-pital, with nine teams of the 2d Auxil-iary Surgical Group attached; the 93dEvacuation Hospital.

CAMEL Attack Force: 36th Divisionmedical detachments; 11 th MedicalBattalion (organic); 56th Medical Bat-talion, including the 885th, 886th, and887th Medical Collecting Companies,and the 891st Medical Clearing Com-pany; the 1st Platoon of the 638th Med-ical Clearing Company, 164th MedicalBattalion; the 1st and 3d HospitalizationUnits, 11th Field Hospital, with seventeams of the 2d Auxiliary SurgicalGroup attached; the 11th EvacuationHospital.

The 1st Airborne Task Force was toreceive support from the medical detach-ments of its own component units, whichincluded a British parachute brigade;the 517th Parachute RCT and 509thParachute Infantry Battalion from theItalian front; the 1st Battalion, 551stParachute Infantry; the 550th InfantryAirborne Battalion; and miscellaneousartillery, infantry, engineer, signal, anti-tank, chemical, ordnance, and supplyunits. To serve the whole task force, the

676th Medical Collecting Company ofthe 164th Medical Battalion, with clear-ing elements attached, went throughspecial glider training. Six officers, atechnician, and a team of the 2d Auxil-iary Surgical Group constituted the med-ical support for the 1st Special ServiceForce.

Training of medical troops followedtechniques similar to those used in ear-lier amphibious operations, includingwaterproofing of vehicles and equip-ment, shore-to-ship evacuation, and am-bulance and litter carries under simu-lated combat conditions.

Medical Support of Seventh Armyin the Field

The invasion of southern France, fifthand last amphibious operation in theMediterranean, was by all odds the mostsuccessful of the five. The landingbeaches were secured and all initial ob-jectives taken within thirty-six hours. Inless than a month a German army hadbeen virtually destroyed, all southernand eastern France had been liberated,and Seventh Army had linked its frontwith that of the Normandy invasion forceand was more than 400 miles north ofits landings. In this spectacular dash, theachievements of the medical troops wereno less decisive than the triumphs of thecombat arms.

The Military Campaign

In the early evening of 14 August 1944a mighty convoy of 855 ships, out of adozen Mediterranean ports, rendez-voused off the west coast of Corsica andsailed northwest toward the famedFrench Riviera. For the past 10 days the


Mediterranean Allied Air Force hadpounded targets from Genoa to Sète,slowly closing in to isolate the land-ing beaches. A feigned attack includinga dummy parachute drop on beaches 60miles west of the real objective was thenbeing mounted, but there was no fakeabout other preparatory missions. In theearly hours of 15 August, troops of the1st Special Service Force scaled the cliffson the seaward side of Port Cros andLevant; French commandos landed atCap Nègre west of the assault area; andother French troops went ashore atPointe de Trayas to the east. Alliedparatroops began dropping through fogaround Le Muy 10 miles behind thedesignated beaches, and were followedby glider troops as soon as light permit-ted. Swarms of landing craft, covered bycarrier-based planes and naval guns,headed for the indented shore betweenSt. Tropez and St. Raphael, the firsttroops landing about 0800.6

The Germans, though misled forabout an hour by the covering opera-tions to the west, had expected the Al-lied forces to land where they did and

had alerted their units. However, theirforces were dispersed and opposition wasrelatively light on all beaches. TheFrench on the right flank had failed intheir mission, but the commandos on theleft and the 1st Airborne Task Force,10,000 strong, in the rear of the landingarea, had cut off the possibility of enemyreinforcement. The assault troops, aidedby the Maquis—or French Forces of theInterior as the underground was offi-cially known—pushed rapidly inland. Inthe late afternoon of 15 August patrols ofthe 45th Division made first contact withthe airborne force, and by the close of Dplus 1 the "blue line"—drawn farenough inland to protect the beachesfrom enemy artillery and to give controlof main routes north and west—had beenreached.

The next few days were decisive. The36th Division on the right pushed eastfar enough to protect the beachhead,then turned north after being relievedon 20 August by infantry elements of theairborne task force. The 45th Division inthe center advanced northwest towardthe Durance River, and the 3d Di-vision on the left struck west to capturethe key road center of Aix-en-Provencejust north of Marseille on 21 August. Onthe 19th the German commander ofArmy Group G began to withdraw alltroops, except the two divisions garrison-ing Toulon and Marseille, up the RhoneValley.

A fast-moving armored task force ledby the VI Corps deputy commander,Brig. Gen. Frederick B. Butler, was al-ready ahead of the German forces. TaskForce Butler had left its assembly areaon 18 August, racing north toward Gre-noble, where mountain passes had beenblocked against any attempt on the part

6 Principal sources for this section are: (1) TheSeventh United States Army; Report of Operations,France and Germany, 1944-1945 (Heidelberg, Ger-many: Aloys Gräf, 1946) , vol. I; (2) Rpt of NavalComdr, Western Task Force, Invasion of SouthernFrance; (3) Rpt of Opns, VI Corps, Aug, Sep, 44;(4) Truscott, Command Missions; (5) General[Jean] de Lattre de Tassigny, Histoire de laPremiere Armée Française (Paris: Plon, 1949) ; (6)Samuel Eliot Morison, "History of United StatesNaval Operations in World War II," The Invasionof 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 InfantryDivision in World War II; (9) Huff, ed., TheFighting 36th; (10) The Fighting Forty-Fifth; (11)WD Special Staff, Hist Div, Invasion of SouthernFrance, OCMH files; (12) Smith, Riviera to theRhine.


of the enemy to reinforce from that di-rection. The task force had then turnedwest to close the escape route in the Mon-télimar area, where the Rhone Valleynarrows and the corridor is dominatedby high ground to the northeast. Butler'sforces were not adequate, however, andthe Germans won the opening round on23 August, when elements of the 141stRegiment of the 36th Division reachedthe area but were unable to seize thecity of Montélimar. The Germansrushed forward their best unit, the 11thPanzer Division, to force open the Mon-télimar Gate for their retreating col-umns, while the remainder of the 36thDivision from the east, the 45th from thesoutheast, and the 3d from the southhurried to the aid of hard-pressed TaskForce Butler. The battle raged for eightdays, with the larger part of the Germanforces escaping before the trap was com-pletely closed. The enemy neverthelesssuffered heavy losses and left thousandsof vehicles and guns, including fiveheavy railroad guns, as wreckage liningthe route north.

Meanwhile, one corps of General deLattre's French Army B, consisting of the3d Algerian, the 9th Colonial, and the1st Armored Divisions, a provisional in-fantry division, and two groups of Mo-roccan tabors (each group equivalent toa regiment) and special troops, had re-lieved VI Corps in the coastal area andenveloped Toulon and Marseille fromthe land side, in conjunction with navalassaults from the sea. Both cities fell on28 August, and the French forces, aug-mented by newly arrived divisions,turned northward up the Rhone to joinVI Corps.

On the eastern flank the airborne taskforce, with the 1st Special Service Force

attached, had taken the famous resorttowns of Cannes and Nice and hadcleared the mountainous area north andeast of those cities.

By 31 August, D plus 16, SeventhArmy had taken 57,000 prisoners, witha loss to itself of 2,733 killed, captured,and missing in action. U.S. patrols wereat the Italian border, French patrolswere at the Spanish border, and the Ger-mans were fighting only with stubbornrear-guard actions as they sought desper-ately to slip through the narrowing gapbetween Seventh Army, now in the vi-cinity of Lyon, and General Patton'sThird Army, which was pushing eastfrom Paris.

The advance was now a pursuit. Lyonwas occupied on 3 September. The 3dDivision took Besançon after hard fight-ing on 8 September, and two days laterthe French 1st Armored Division reachedDijon. On 11 September patrols of Sev-enth and Third Armies met at Saulieua few miles west of Dijon, and the Alliedfront was continuous from the Swissfrontier to the English Channel.

On 15 September Army B became the1st French Army, forming with Sev-enth Army the 6th Army Group underGeneral Devers. At this time the DRA-GOON forces came under operational con-trol of Supreme Headquarters, AlliedExpeditionary Force, and the troops wereregrouped in accordance with SHAEFplans, 1st French Army shifted to theright flank, hinging on the Swiss border,while VI Corps turned north to crossthe Moselle in the vicinity of Épinal, andadvanced toward Strasbourg beyond theVosges Mountains.

The exploits of Seventh Army there-after belong to the history of the Euro-pean Theater of Operations.


Field Medical Service

The Assault Phase—Although the pre-arranged landing schedules were notalways followed to the letter, medicalservice during the beach phase of the in-vasion worked smoothly. Delays werecaused primarily by a more rapid ad-vance than had been anticipated, withconsequent unexpected demands fortrucks and landing craft by the combattroops; and in some instances by dis-persal of unit equipment among severalvessels. While medical personnel sup-porting each task force had their ownproblems, certain principles were com-mon to the whole operation.

Litter teams from the collecting com-panies of the organic medical battalionswere attached for the landings to the as-sault units, not less than three nor morethan four 5-man teams to each infantrybattalion, and these, with the personnelof the battalion aid stations, were thefirst medical troops ashore. Ideally, theywere to be followed by the beach med-ical battalions, each organized for thelandings into 3 collecting-clearing com-panies, with the collecting element ofeach company further divided into 3 sec-tions of one officer and 22 enlisted meneach. The remaining elements of thecollecting companies of the organic med-ical battalions were to come next, accom-panied or immediately followed by thefield hospital units, which were strippeddown to 50-bed capacity. The personnelof the evacuation hospitals were then toland and go into bivouac to await theirequipment. The clearing companies ofthe organic medical battalions were tobe held back until it was possible toestablish them at least 5 miles inland,where the field hospital units, already

ashore, would join them. Medical supplypersonnel were to land on D plus 1.7

The 3d Division assault on the leftflank went pretty much according toplan. Landings were made in two sepa-rate areas: on the Bay of Cavalaire, eastof the town of that name, by the 7th and30th Regimental Combat Teams; andon the Bay of Pampelonne, about sixmiles northeast of the Cavalaire landingsand three miles southeast of St. Tropez,by the 15th RCT. The battalion med-ical sections, reinforced by collectingcompany litter squads, landed behindtheir infantry battalions within the firsttwo hours. On the Cavalaire beaches,Collecting Company C of the organicmedical battalion, supporting the 30thInfantry, came ashore ahead of scheduleat H plus 4 and had its station establishedby 1400. Company A, supporting the 7thInfantry, did not land until H plus 12,its station going into operation at 2200.Neither company had any ambulancesuntil D plus 1.

At H plus 6 a collecting company andthe 1st Platoon of the Clearing Com-pany, 52d Medical Battalion, wentashore at Pampelonne beach and hadthe beach clearing station in operationby 1600. The landing of the Cavalairebeach group medical complement—the

7 Principal sources for this section are: (1) AfterAction Rpt, Surg, Seventh Army, 15 Aug-31 Oct44, an. 278; (2) Rpt of Naval Comdr, Western TaskForce, 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 MonthlyRpts 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; 111thMed Bn; 120th Med Bn; 164th Med Bn; 181st MedBn; Surg, VI Corps; Surg, Seventh Army; 10th FieldHosp; 11th Field Hosp; 11th Evac Hosp; 93d EvacHosp; 95th Evac Hosp; 2d Aux Surg Gp; 7th MedDepot Co.


MAP 30—Seventh Army Hospitals and Medical Supply Dumps, 20 August 1944

remaining two collecting companies andthe 2d platoon of the clearing company,52d Medical Battalion, and the 1st Pla-toon of the 616th Clearing Company, the181st Medical Battalion—was two hourslater, the beach clearing station being setup at 1800.

By midafternoon the ALPHA beacheswere clear and the combat spearheadsalready several miles inland, making itpossible to land the remaining medicalunits. At H plus 8—1600, or four in theafternoon—the 1st and 3d Platoons ofthe 10th Field Hospital came ashore,one unit at each beach. The Pampelonneunit was receiving patients by 2000, butthe Cavalaire unit did not recover itsequipment until D plus 1. At the sametime the 3d Medical Battalion clearingcompany and personnel of the 95th

Evacuation Hospital landed at Cava-laire. The 95th went into bivouac toawait its equipment, while the 3d Divi-sion clearing company moved inland andset up station two miles north of LaCroix, opening at 1915. The site of theclearing station was about equidistantfrom the beaches and some five milesinland. The collecting company in sup-port of the 15th Infantry did not debarkat Pampelonne beach until 0400 on Dplus 1, and remained without ambu-lances until noon. (Map 30)

The division clearing station movedon D plus 2 to Cogolin, where it wasjoined by one unit of the 10th Field Hos-pital and the 95th Evacuation, whichwas still not in operation. All three in-stallations moved to Gonfaron, sometwenty miles inland, on D plus 3. The


95th opened the following morning, 19August, at 0800. The other 3d Divisionplatoon of the l0th Field Hospital wentinto bivouac in the same locality on 20August.

The 45th Division, constituting withits reinforcements the DELTA Force,landed on a strip of beach no more thanthree miles wide in the dead center ofthe VI Corps landing area just northeastof the town of Ste. Maxime. Here ex-pediency and availability of landing craftrather than the prearranged schedule de-termined the order of landing for med-ical units.

As on the ALPHA beaches, the medicaldetachments and the litter teams ofthe organic collecting companies wentashore with the infantry battalions mak-ing the assault, closely followed by unitsof the beach medical battalion and theremainder of the 120th Medical Battal-ion organic to the division. One collect-ing-clearing unit of the 58th MedicalBattalion was ashore at H plus 2½and had its station in operation one-halfmile northwest of Ste. Maxime by 1230.A second collecting-clearing unit landedon the easternmost of the 45th Divisionbeaches at H plus 4, opening stationthree miles northeast of Ste. Maxime.The third collecting-clearing unit of thebeach battalion was delayed until 1930,finally landing on the ALPHA beachessouth of St. Tropez and opening stationa half mile inland.

All personnel of the 120th MedicalBattalion were ashore by H plus 6. Col-lecting stations for the two assault regi-ments were in operation by 1100. Jeepsborrowed from the infantry were useduntil the ambulances arrived. The clear-ing company went into bivouac, the 1stplatoon setting up station about six miles

inland near Plan de la Tour late on 16August.

Units of the 10th and 11th Field Hos-pitals attached to the DELTA Force bothlanded about noon of D-day, but neitherwent into operation. The 2d Platoon ofthe 10th Field received patients at Plande la Tour on 17 August but the 2dPlatoon of the 11th Field did not operateat all during the beach phase. The 93dEvacuation Hospital, which landed nearSte. Maxime at H plus 4, opened at Plande la Tour on 17 August.

Here, as on the ALPHA beaches, ex-pansion inland was rapid. The 2d Pla-toon of the division clearing companyopened 5 miles south of Vidaubanand about 15 miles from the beachshortly before noon on 18 August, whilethe 1st Platoon moved more than 20miles northwest from Plan de la Tour toSilans-la-Cascade. Beach clearing stationsof the 58th Medical Battalion moved in-to Ste. Maxime and St. Tropez on D-day and D plus 1, respectively.

The westernmost of the beaches as-signed to the 36th Division, or CAMELForce—a beach on the Gulf of Fréjus with-in a mile of the town of that name andequally close to St. Raphaël—was not ac-tually used because underwater obstacleshad not been cleared. Instead, all land-ings were made on three beaches east ofSt. Raphael and about a mile apart. Lit-ter sections of the organic collecting com-panies landed with the battalion aid sta-tions of the assault troops. All personnelof the 111th Medical Battalion wereashore by H plus 8, although the equip-ment of the clearing company was notunloaded until the evening of D plus 1.By that time the fighting was so far in-land that the division clearing stationwas first established near Le Muy, fif


MEDICS GIVING FIRST AID on invasionbeach, 15 August.

teen miles from the beach, in the earlyafternoon of 17 August. The stationmoved ten miles farther inland the fol-lowing day, to a site near Draguignan.

The collecting-clearing units of the56th Medical Battalion, meanwhile, hadexperienced similar delays in landingtheir equipment. The first beach clear-ing station in the CAMEL area was setup four miles east of St. Raphael at Hplus 14, or 2200. Before this time allcasualties were evacuated to offshore craftby the Navy beach group. The other twobeach clearing stations were set up inSt. Raphael on D plus 2 and D plus 3,respectively.

The two platoons of the 11th FieldHospital attached to the CAMEL Forceand the 11th Evacuation Hospital landedtogether at 1900, or H plus 11, going intobivouac near the landing area. The evac-

uation hospital and one unit of the fieldhospital followed the division clearingstation to Le Muy on 17 August, goinginto operation the following morning.The other field hospital platoon joinedthe clearing station at Draguignan on 18August. On the CAMEL beaches, one sur-gical team served with each clearing pla-toon of the beach medical battalion.

The 1st Airborne Task Force was sup-ported initially by parachute medicaltroops making up the parachute infantrydetachments. Personnel of the 676thMedical Company began landing in thevicinity of Le Muy by glider about 0800on D-day, the last wave touching downat 1851. Medical supplies and equip-ment, preloaded in 12 jeeps with ¼-tontrailers, were landed safely. A collectingstation was established in a barn at LeMetan soon after the first wave landed,personnel and equipment being addedas they arrived. The station moved tolarger quarters on 16 August. In all, 227casualties were treated before evacuationto the CAMEL beaches by Army trans-portation was possible on 17 August.

On the supply side, the advance sec-tion of the 7th Medical Depot Companylanded in the vicinity of Ste. Maximeon 16 August, and a detachment con-sisting of one officer and twenty enlistedmen took over operation of the DELTAbeach supply dump from the 58th Med-ical Battalion on that date. The follow-ing day one officer and eighteen enlistedmen of the depot company were at-tached to the 52d Medical Battalion fortemporary duty to operate the 3d Divi-sion medical supply dump, and on 18August a similar detachment relievedthe 56th Medical Battalion of supplyfunctions in the 36th Division area.

The VI Corps surgeon, Colonel


TABLE 23—ADMISSIONS AND DISPOSITIONS, SEVENTH ARMY MEDICALINSTALLATIONS, 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 nearSte. Maxime at 1800 on D-day, but forthe next 2 or 3 days could do little ex-cept keep in touch with medical unitsfunctioning under divisional control.The breakout from the beachhead wasso rapid, however, that it was possibleto resume a normal organizational pat-tern within 3 or 4 days. The 58th Med-ical Battalion reverted to Seventh Armyon 17 August and was attached to thebeach control group. The field hospitalspassed from division to corps control on18 August, while the evacuation hospi-tals reverted to army control on the samedate. On 19 August the 56th MedicalBattalion was attached to VI Corps.8

Nurses of the field and evacuation hos-pitals and of the surgical group landedand joined their units on 19 August.

Delays in landing equipment of clear-ing companies and hospitals might havebeen serious had casualties been heavierthan they were. Air and naval cover at-tacks in widely separated areas, however,kept the enemy from concentrating hisforces, and opposition on all beaches waslighter than had been anticipated. Hos-pital admissions, including admissions toclearing stations, for the beach phase ofthe 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 textfollows the contemporary account of the theatermedical observer, Colonel Reeder. See Ltr, Reederto Surg, NATOUSA, 18 Aug 44, sub: Medical Ob-

server's Rpt, Seventh Army Opn, Slightly later datesgiven by some of the medical units concerned prob-ably indicate only that there was some lag in com-pleting the change-over.


The Montélimar Gate—With thebeaches secure and the ports of Toulonand Marseille under siege by Army B,VI Corps was tree to exploit up theRhone Valley. The road net was excel-lent and with the formidable aid of theFrench resistance forces there was fairprospect of trapping a large part of theGerman Nineteenth Army if the corri-dor along the east bank of the Rhonecould be closed off somewhere below theDrome River—the so-called MontélimarGate—before the enemy forces could bewithdrawn.9

The rapid pace put a heavy strain onmedical installations. The evacuationhospitals could not keep pace, and mainreliance had necessarily to be placed onthe organic medical battalions and onthe field hospital units, supplementedwhen necessary by clearing platoons ofthe corps medical battalions. Collectingcompanies of the same battalion weresometimes as much as 150 miles apart.Clearing companies often operated twostations, while ambulances and bor-rowed trucks were in continuous move-ment over excessively long evacuationlines. Good roads made aid stations eas-ily accessible to ambulances, permittingthe diversion of many litter bearers forassignment as relief drivers.

A reinforced collecting company ofthe 111th Medical Battalion accompa-nied Task Force Butler in its dash to-ward Grenoble and its subsequent swingwest down the valley of the Drome.The collecting station of this unit wasalready in Sisteron, sixty-five miles northof the battalion headquarters at Dragui-

gnan before the end of the day, 18 Au-gust. Two days later it was at Lac on theDrome, fifty miles northwest of Sisteron;and on 21 August it was at Marsanne,overlooking the Rhone from the heightsnortheast of Montélimar.

The 36th Division followed on theheels of Task Force Butler, swingingfarther north to protect the flank. The143d RCT entered Grenoble on 22 Au-gust, where a collecting station was setup by the 885th Medical Collecting Com-pany, borrowed from the 56th MedicalBattalion to replace the company at-tached to the task force. The next daythe collecting station of the 143d wassixty miles southwest of Grenoble atRomans, close to the junction of theIsère and the Rhone above Valence,thence moving south with its combatteam to the area occupied by the ButlerTask Force.

The 141st and 142d combat teams ofthe 36th Division were also on the highground above Montélimar by 23-24 Au-gust, their supporting medical unitskeeping pace by leapfrog tactics and al-most continuous movement. The 36thDivision clearing company leapfroggedits platoons from Draguignan to Sisteronto Aspres to Crest in 4 days, single movescovering up to 120 miles. Until the last2 or 3 days of August, when the combatforces began pursuit of enemy remnantstoward Lyon, 36th Division medicalunits remained clustered a few milesnorth and east of Montélimar evacuatingto the clearing station at Crest, a maxi-mum distance of 10 miles.

The 1st Platoon of the 11th Field Hos-pital, which opened at Crest on 22 Au-gust, acted as an evacuation hospital forthree days, since there was no evacuationnearer than the beach area, more than

9 Principal sources for this section are: (1) AfterAction Rpt, Surg, Seventh Army, 15 Aug-31 Oct44, 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.


AMBULANCE PASSING THROUGH DEMOLISHED VILLAGE NEAR MONTÉLIMAR

200 miles distant by highway. On 25 Au-gust the 3d Platoon joined the 1st atCrest, and the 11th Evacuation openedin the vicinity of Aspres, 65 miles to therear. Thereafter evacuation was to As-pres, which became the medical center ofVI Corps with the arrival of the corpssurgeon on 26 August. During the Crestperiod, from 22 through 31 August, theclearing station of the 11 th MedicalBattalion admitted 2,174 patients, ofwhom 840 were battle casualties and 411were prisoners of war. The heaviest daywas 27 August, when 202 of the 322 ad-missions were battle casualties. Thelargest number of prisoner patients was

received on 29 and 30 August, the to-tals being 120 and 191, respectively.

In the Montélimar area, both the col-lecting stations and the clearing stationat Crest were intermittently under en-emy fire.

Movement of 45th Division medicalunits, following a pattern similar to thoseof the 36th, was characterized by longand frequent jumps. The 179th Regi-mental Combat Team, which had beenin reserve during the landings, spear-headed the drive north behind the 36thDivision, occupying Grenoble on 23 Au-gust. A collecting company of the 120thMedical Battalion took over the station


established the day before in support ofthe 143d RCT, remaining at the site forsix days. The 180th RCT turned eastfrom the Sisteron-Aspres-Gap triangle tooccupy Briançon, only 5 miles from theItalian frontier. The collecting companyin support moved 140 miles from thebeach area to Embrun on 23 August,evacuating casualties more than 50 milesover mountain roads to the divisionclearing station near Serres on theSisteron-Aspres road. The 3d Platoon ofthe 10th Field Hospital joined the clear-ing station there on 23 August, the 2dPlatoon arriving the following day. Theclearing station of the 56th Medical Bat-talion also set up in the Serres area,where it served as a holding hospital forminor medical cases. During the lastweek of August the 10th Field Hospitalunits at Serres admitted 201 medicalcases and 64 battle casualties.

A platoon of the 120th Medical Bat-talion clearing company moved forwardto Pont-de-Claix just south of Grenobleon 27 August.

The 157th RCT of the 45th Divisionmet strong opposition at Apt, a few milesnorth of its Durance River crossing, on22 August, but reached the Serres areaby the 24th. The regiment proceedednorth, crossing the Drome east of Crestand protecting the north bank of theriver. Evacuation from the collecting sta-tion of the 157th for the next two dayswas to the 36th Division clearing stationat Crest.

The 3d Division, meanwhile, had ad-vanced northwest from Aix-en-Provenceto Avignon at the junction of the Dur-ance and Rhone Rivers, taking the cityon 25 August. The division then turnednorth, pursuing the retreating enemy upHighway 7. Montélimar was finally cap-

tured by the 3d Division on 28 August,the same day on which both Toulon andMarseille fell to the French forces ofGeneral de Lattre. Although badly bat-tered, the bulk of the German troops hadalready slipped through the MontélimarGate. Clearing stations of the 3d Divi-sion, with their accompanying field hos-pital units, were successively at Brignoles,Aix, the vicinity of Carpentras northeastof Avignon, and Nyons southeast ofMontélimar.

The last three days of August saw VICorps moving north from the Drome ona wide front in another attempt to en-circle the enemy before he could reachthe Belfort Gap and the Rhine. The 45thDivision swung northwest from Gre-noble, and the 36th advanced north to-ward Lyon, while the 3d delayed onlylong enough to mop up in the Monté-limar battle area. French Army B begana simultaneous march up the west bankof the Rhone to make contact with VICorps in the vicinity of Lyon. TaskForce Butler was dissolved, its compo-nents reverting to their own organiza-tions.

Expansion to the Moselle—The rapidpursuit of the enemy north from theMontélimar battle area put field med-ical units to a severe test. Lyon fell tothe French 2d Corps on 3 September, butmost of VI Corps was already well be-yond that point. Four days later the 3dDivision, with the 45th on its right andthe 36th on its left, stormed the ancientfortress city of Besançon more than 200miles from the Drome River line of 28August.10

10 Sources for this section are the same as thosementioned in n. 9 above.


JEEP AMBULANCE BRINGING WOUNDED BACK ACROSS THE MOSELLE

During this period, clearing stationsmade almost daily moves, platoons leap-frogging one another, while evacuationhospitals were hastily brought up to thecombat area to shorten the ambulanceruns. In spite of the frequent andlengthy changes of station, medical bat-talions gave close support throughoutthe pursuit. For example, a clearing pla-toon of the 111th Medical Battalion,moving sixty miles from Bourg to Po-ligny on 6 September, was held up forfour hours to allow armored and infantryelements to pass. Collecting stations

were in almost continuous movement.After the capture of Besançon, Ger-

man resistance stiffened, and rain helpedto further retard the advance. VI Corpsunits were nevertheless within twentymiles of Belfort when Seventh Armyturned north again just after the middleof the month in response to SHAEF or-ders. Medical installations were still onthe heels of the advancing lines whenthe Moselle crossing began on 21 Sep-tember.

In the race to the Moselle each of thethree divisions of VI Corps was supported


by its own organic medical battalion. Acollecting company and clearing platoonof the 58th Medical Battalion supportedthe 13th Field Artillery Brigade after17 September. Units of the 10th and 11thField Hospitals continued to accompanyforward clearing stations of the divisions,while evacuation rearward was the re-sponsibility of the 56th Medical Battal-ion. Until the rainy season began in mid-September, turning dirt roads into quag-mires, litter bearers were used to onlya minimum extent. The well-settled na-ture of the country also made it possibleto site clearing stations much of the timein buildings.

The corps surgeon's office remainedclose to the front throughout the period,moving from Aspres to Salins, twentymiles south of Besançon on 6 September.Headquarters were in Vesoul by the 16thand on 22 September moved to Plom-bieres.

Casualties during September weremore from disease than from battlewounds, with respiratory ailments andexhaustion making substantial inroads.Trench foot cases began to appear be-fore the end of the month. Admissionsby the three division clearing companiestotaled 11,805, of which 4,101 were bat-tle wounds. Of the aggregate admissions,1,136, or approximately 10 percent, wereprisoners of war.

Hospitalization in theArmy Area

Hospitalization on the Beaches

Until the base organization, with itsfixed hospitals, could establish itself insouthern France, it was necessary forSeventh Army to leave some hospital fa-

cilities in the beach area to care for serv-ice troops and for replacements andreinforcements staging in the vicinity, aswell as to provide transient beds for thosebeing evacuated to Italy. This functionfell in the first instance to the 58th Med-ical Battalion, which reverted to Armycontrol on D plus 2, and was reattachedto the beach control group.11

When the last of the assault clearingstations closed on 21 August, a pro-visional hospital was opened by theclearing company of the 58th MedicalBattalion in the Hotel du Golf at Beau-vallon, a resort village between St.Tropez and Ste. Maxime. One collectingcompany remained at Ste. Maxime, op-erating a smaller unit that served as anannex to the main hospital. Both unitswere relieved on 4 September by the164th Medical Battalion, which contin-ued to operate the two facilities untilfixed hospitals came into the area towardthe end of the month. During the period24 August-1 September, twelve Frenchmedical officers and a Senegaleseclearing platoon were attached to theBeauvallon hospital, the majority of ad-missions at that time being Frenchtroops and German prisoners.

After being relieved by the 164thMedical Battalion, the 58th establishedanother provisional hospital in the HotelHermitage in Nice, primarily for thesupport of the 1st Airborne Task Forceand the 1st Special Service Force thenfighting along the Italian border. Thishospital 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) Unitrpts of the individual med units mentioned in thetext.


military units in southern France wereformally transferred from the Mediter-ranean to the European Theater ofOperations.

Between 11 and 30 September the675th Medical Collecting Company ofthe 164th Medical Battalion operated aprovisional station hospital in Mar-seille—the only American hospital facil-ity in that city. The hospital was caringfor 200 patients when it was relievedby the 80th Station Hospital on 30September.

The provisional hospitals in the land-ing areas were augmented late in Augustby 750-bed evacuation hospitals, whichwere brought in according to schedule.The 9th Evacuation, which landed on25 August, went immediately into thecombat zone, but the 51st and 59th Evac-uations, which arrived at the same time,and the 27th, which reached southernFrance on 30 August, were retained ini-tially in the coastal area. Original planshad called for three 750-bed evacuationhospitals for the support of VI Corpsand two to back up the forward unitsof Army B. After the capture of Mar-seille, however, French medical com-manders found it possible to makegreater use of local hospitals than hadbeen anticipated, and all four of thelarger evacuation hospitals were usedprimarily for U.S. troops.

The 51st Evacuation opened at Dra-guignan on 27 August. Its personnelserved in a captured German hospitalat the site while their own tents werebeing erected. The hospital remained atDraguignan until 20 September. Thebulk of its admissions were from the 1stAirborne Task Force, received both di-rectly and through the provisional hos-pital at Nice. The staff of the 51st was

augmented during this period by 18medical officers, a nurse, and 19 techni-cians attached from other organizations.Approximately 2,000 patients were caredfor.

The 59th Evacuation Hospital openedon 28 August at Carpentras near the siteabout to be vacated by the 3d Divisionclearing station. The hospital remainedin the area until 7 September, takinga total of 611 patients and performing222 surgical procedures in the 10 daysof operation.

The 27th Evacuation operated atBouc-bel-Aire, a few miles south ofAix-en-Provençe from 1 September to 20September. At this site it was the closestU.S. hospital to Marseille, where it op-erated a prophylactic station and gavedispensary service and station hospitalcare to all U.S. troops in the area. Inaddition to U.S. Army personnel, the1,169 patients treated during the twentydays of operation at Bouc-bel-Aire in-included French troops and civilians,and American and British sailors, bothnaval and merchant marine.

Hospitalization in the Combat Zone

The 10th and 11th Field Hospitals,operating in 50-bed units rather than the100-bed units used in Italy, servedthroughout the campaign as forwardsurgical hospitals, remaining close to, andmoving with, the division clearing sta-tions. They were backed up as closelyas transportation and available sites per-mitted by the 400-bed evacuation hos-pitals and later by the larger evacuationunits. During the period of rapid move-ment, however, the field units were oftenfar ahead of any evacuation hospital sup-port. On these occasions, clearing pla-


toons of the 56th Medical Battalionswere used to increase bed capacity.12

The speed of the campaign up to lateSeptember necessitated frequent andlong moves, with advance reconnaissanceto the front lines themselves in search ofhospital sites. The 400-bed evacuationswere generally able to move by echelonswith their own organic transportation,but the 750-bed evacuations had to relyon Seventh Army for trucks, which werenot always available when needed. (SeeMaps 31, 32, 33.)

Long evacuation lines to the rearmeant that hospitals were often over-crowded, while periods of intense com-bat activity placed a severe strain uponsurgical staffs and postoperative facili-ties. It was frequently necessary to leaveholding units behind to care for non-transportable patients when hospitalsmoved forward. All of the evacuationhospitals used civilian personnel in vari-ous capacities, the most frequent beingas litter bearers.

The first evacuation hospital to moveaway from the landing beaches was the93d, which advanced forty-five milesnorthwest from Plan de la Tour toBarjols on 22 August. For a few days,while elements of the 45th Division wereforcing a crossing of the Durance Riverjust north of Barjols and fighting theirway toward Sisteron, the hospital wasbusy, but was soon left with little to do.

August 25 saw the 11th Evacuationleap ahead 128 miles from Le Muy toAspremont in support of the forces fight-ing from Montélimar to Crest. In 15hours after receiving movement orders,

the hospital had evacuated 300 patients,dismantled and packed its equipment,and was on the road. The first patientwas received at the new site just 18 hoursafter the hospital had closed at the old.Three hundred patients were admittedon the first day of operation at Aspre-mont.

The 750-bed 9th Evacuation Hospital,which arrived combat-loaded on 25August, was sent immediately to the sup-port of the 11th. Proceeding in 4 motorconvoys, the 9th moved to a site at Beau-mont, 30 miles beyond Aspres on theroad to Crest, and began receiving pa-tients at 0800, 28 August, just 54 hoursafter touching French soil. Two hundredand sixty patients were received and 39surgical operations performed in the first24 hours at Beaumont.

On the first day of September the 93dEvacuation, moving in three echelonswith its own organic transportation,opened at Rives, 20 miles northwest ofGrenoble and 180 miles from the hos-pital's previous site at Barjols. Betweennoon and midnight, 1 September, 127 pa-tients were admitted and 28 surgical pro-cedures performed. The move wascompleted on 5 September, the hospitalremaining open at Barjols until the lastechelon was ready to leave. (Map 31)

The 95th Evacuation was the nextSeventh Army unit to leapfrog from therear to the most forward position. Thehospital left Gonfaron on 3 September,its personnel spending the night as guestsof the 9th at Beaumont. The intentionhad been to set up about 50 miles beyondthat point, but the front lines had alreadymoved so far forward that a new recon-naissance was necessary. The site finallydesignated by the VI Corps surgeon wasat St. Amour, more than 300 miles by

12 Ltr, Col Rollin L. Bauchspies, USA (Ret), toCol Coates, 15 Apr 59, commenting on preliminarydraft of this volume. Colonel Bauchspies was VICorps surgeon.


road from the landing area. The 95thspent the night of 4 September in biv-ouac at the 3d Division clearing stationnear Ambérieu, opening at St. Amour at0900, 5 September.

As the most forward evacuation hos-pital, the 95th carried a heavy load ofsurgical cases for the next few days. Atthe same time, it was necessary to holdpatients overlong owing to the difficul-ties of evacuation. The railroads had notyet been restored to service and motortransportation was critical. The situationwas somewhat eased by the beginning ofair evacuation from Ambérieu on 9 Sep-tember, but fuel shortages and badweather combined to make flight sched-ules uncertain. On the credit side, thehospital was deluged with gifts of eggs,chickens, rabbits, and ducks from thelocal farmers, whose normal city marketswere temporarily cut off.

The 9th Evacuation, meanwhile, hadclosed at Beaumont, and on 8 Septemberopened at Poligny, 40 miles beyond St.Amour and 235 miles from the Beau-mont site. At Poligny the 9th received578 patients in the first 30 hours of oper-ation. Surgical teams worked in 16-hourshifts.

The next forward move was made on11 September when the 11th Evacuationopened at Aissey, 15 miles east ofBesançon, after a 265-mile jump fromAspremont. With the aid of borrowedtrucks, the first echelon was able to carry300 beds, all surgical nurses, and half theofficers of the medical service as well asall those of the surgical service. The hos-pital admitted 158 patients during thefirst 5 hours at Aissey.

On 15 September the 93d Evacuationmoved up from Rives to Rioz, 20 milesnorth of Besançon. Using 15 borrowed

trucks and 25 ambulances of an attachedambulance company, the first 2 of 3echelons were able to move together.The hospital opened at 1300 on 16 Sep-tember. By midnight 219 patients hadbeen received and 27 operations per-formed. The 185-mile move was com-pleted on 17 September. (Map 32)

The 59th Evacuation Hospital, whichhad closed at Carpentras on 7 September,also opened in Rioz after a l0-day waitfor transportation. For the 59th the movecovered 240 miles. September 17 was alsothe opening date for the 2d ConvalescentHospital in Besançon, though part of itsequipment remained on the docks atMarseille where organic vehicles hadbeen commandeered for more urgentuses. The unit was caring for 1,200 pa-tients before all of its equipment wasbrought up by its remaining vehiclesshuttling between Besançon and Mar-seille.13

The 95th Evacuation again became themost forward Seventh Army hospital on18 September when it opened at Saulx,25 miles northeast of Rioz. The 11thmoved from Aissey to Conflans, 10 milesnorth of Saulx, 3 days later; and on 23September the 9th Evacuation opened atPlombières on the Moselle. The first con-tingent of the 27th Evacuation arrived atXertigny, about eight miles north of the9th, the following day, but the hospitalwas not in full operation before the endof the month. All but the advance de-tachment of the 27th made the 450-milejump from Bouc-bel-Aire by rail. On 25

13 In the Southern France Campaign, the 2d Con-valescent Hospital carried only 2,000 rather thanits former 3,000 beds and was organized to operatein two independent sections of 1,000 beds each.


September the 93d Evacuation joined the9th in the vicinity of Plombières. (Map

With the single exception of the 51stEvacuation, all Seventh Army hospitalswere now concentrated close to the mainhighway north from Besançon to Epinal.The 51st was packed at Draguignan andready to move by 23 September, buttransportation was not available untilearly October.

During the last two weeks of Septem-ber almost continuous rain and coldhampered hospital movements and madeoperation a constant struggle with theelements. All tents had to be ditched,access roads graveled, and tent pegs pe-riodically reset in the soft ground. Heat-ing facilities were often inadequate tokeep patients warm.

Special Hospital Facilities

In addition to field and evacuationhospitals, Seventh Army maintained pro-visional hospitals for the specializedtreatment of venereal disease and neu-ropsychiatric cases and, until the 2dConvalescent Hospital got into full oper-ation, a provisional convalescent hospitalas well. The venereal disease and neuro-psychiatric hospitals had been plannedin advance, on the pattern of those set upby Fifth Army in Italy, and the clearingplatoons designated to operate them hadbeen given special training as well asspecialist personnel attached from otherunits. The convalescent hospital was anafterthought, made necessary by the un-expectedly rapid advance of the lines andthe late date predetermined for phasingin the regular convalescent facility.

The convalescent hospital was the firstof the three specialized units to be estab-

lished, though the procedure was very in-formal. On 18 August—D plus 3—the682d Medical Clearing Company of the52d Medical Battalion, then at Plan de laTour, arranged to hold the lightlywounded and mildly ill who could re-turn to duty in a short time if they couldbe kept off the hospital ships bound forItaly. The project grew. Beds and equip-ment were borrowed wherever theycould be had, and personnel were di-verted from other duties. Within a weekthe unit was operating 400 convalescentbeds and was unable to perform its nor-mal functions.

The 164th Medical Battalion, less oneplatoon of the 638th Medical ClearingCompany already in France, arrived on26 August, and the following day a col-lecting company of the 164th took overthe convalescent hospital, which movedforward to Aspres on the last day of themonth.

The venereal disease and neuropsy-chiatric hospitals, meanwhile, had bothbeen established according to plan on 20August by the 616th Medical ClearingCompany of the 181st Medical Battalion,released from its beach assignment theprevious day. Both hospitals were organ-ized as 250-bed units, and both opened atLe Luc, close to the Gonfaron site of the95th Evacuation Hospital. The neuro-psychiatric hospital carried a light pa-tient load at this time, but the venerealdisease unit found it necessary almostimmediately to expand capacity to 375beds to care for a backlog of cases arisingfrom contacts in Italy.

By definition both of these specializedhospitals were forward units, and bothwere moved to the Aspres area at the endof the month. By this time long evacua-tion lines, scattered forces, and acceler-


TABLE 24—ADMISSIONS AND DISPOSITIONS, SEVENTH ARMY MEDICALINSTALLATIONS, 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 AfterAction 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 hadbrought about an acute shortage of mo-bile medical units. The 164th MedicalBattalion was given a beach assignment,and without advance notice the 616thClearing Company was directed to takeover the provisional convalescent hos-pital on 4 September. The hospital atthat time held almost 500 patients, butthe 616th had only 3 officers and 8 en-listed men who could be spared from thevenereal disease and neuropsychiatriccenters. The 11 men staffed the convales-cent hospital until additional personnelfrom collecting companies of the parentmedical battalion could be rushed totheir aid.

The neuropsychiatric hospital movedforward to Rives on 4 September; to

Samson, midway between Poligny andBesançon, six days later; and on 24 Sep-tember joined the growing group ofmedical installations around Plombièreson the Moselle. The venereal disease cen-ter moved to St. Jean de Paris, a suburbof Ambérieu, on 6 September, where theconvalescent hospital had been estab-lished the day before; to Rioz on the13th; and to Plombières on 28 Septem-ber. The convalescent hospital, its useful-ness ended with the establishment of the2d Convalescent in Besançon, closed on25 September. An annex, operated atRioz in connection with the venereal dis-ease hospital, closed two days later.

The convalescent hospital had reacheda peak load of more than 800 patients,while the neuropsychiatric center, reflect-


ing the growing severity of combat andthe deterioration of the weather, wascaring for 300 patients by the end of themonth.

A second venereal disease center wasoperated in connection with the provi-sional hospital at Beauvallon by the638th Medical Clearing Company from 4September. This center was still in opera-tion when the 164th Medical Battalionpassed from army to base section controlearly in October.

Medical Summary: Seventh Army

Table of Organization bed strength inSeventh Army hospitals by the end ofSeptember was 5,000, not counting clear-ing stations and special hospitals oper-ated by clearing companies, plus 2,000convalescent beds. Admissions to SeventhArmy medical installations, includingclearing stations, totaled more than28,000 for the period 15 August-30 Sep-tember, of which 13,000 were evacuatedto the communications zone and morethan 9,000 were returned to duty.(Table 24) Troop strength by the end ofSeptember was approximately 140,000.

Evacuation FromSeventh Army

Evacuation Within the Combat Zone

When VI Corps pushed inland fromits landing beaches, evacuation of divi-sion clearing stations was carried out bythe 56th Medical Battalion. Highwayswere generally excellent, but throughmuch of the advance the terrain wasmountainous and until the concentrationof evacuation hospitals along the Mosellein late September, distances were great.

To minimize the factor of distance asmuch as possible, holding hospitals wereset up during periods of rapid advanceby a platoon of the corps clearing com-pany and a field hospital unit to retainpatients until an evacuation hospitalcould move forward.14

The battalion maintained liaison withVI Corps through an officer stationed inthe corps surgeon's office, and with theevacuation hospitals through a noncom-missioned officer stationed in the regis-trar's office of each hospital serving thecorps. Bed status reports from each evac-uation hospital were submitted everyfour hours, or oftener if the situation de-manded, the reports being carried byambulance drivers or telephoned to bat-talion headquarters. This informationpermitted the corps surgeon to direct theflow of patients to the evacuation hos-pitals in terms of current information.

Medical support for the 1st AirborneTask Force followed an unorthodox pat-tern, the three collecting stations of the676th Medical Collecting Companybeing comparable to small clearing sta-tions. Casualties were evacuated byambulances of the company to the pro-visional hospital operated by the 514thMedical Clearing Company of the 58thMedical Battalion in Nice. After 6 Octo-ber autorail trains staffed by personnelof the 676th made daily runs betweenthe collecting stations and the hospital.The hospital was cleared by the 58thMedical Battalion.

14 Principal sources for this section are: (1)After Action Rpt, Surg, Seventh Army, 15 Aug-31 Oct 44; (2) Annual Rpt, Med Sec, MTOUSA,1944; (3) Annual Rpt. Surg, Seventh Army, 1944;(4) Annual Rpt, Surg, VI Corps, 1944; (5) Unitrpts of the med units mentioned in the text.


CARRYING D-DAY WOUNDED TO THE BEACH FOR TRIP BY LST TO CORSICA

Evacuation to the CommunicationsZone

During the first day of the invasion ofsouthern France, casualties were evacu-ated from the beach clearing stations bysmall craft to the transports and carriedby LST to Ajaccio, Corsica, where the40th Station Hospital was prepared to re-ceive them and to send the more seriouscases on to Naples by air. A little over300 reached Ajaccio by LST on 15 Au-gust.15

15 According to the Seventh Army Surgeon's AfterAction Report for the period 15 August-31 Oc-tober 1944, only 380 patients were evacuated fromsouthern France by LST. (See Table 26, below.)The 1944 annual report of the Northern Base

Section surgeon, however, says 489 evacuees fromthe Riviera beaches were received by the 40thStation Hospital, and the report of thehospital itself for the same period putsthe figure above 500. The presumption isthat one or more of the hospital ships dischargedsome critical cases at Ajaccio to be flown to Naples,but there is a tendency in Army reports to lumpall sea evacuation as by hospital ship. It may bethat the LST total was actually considerably higherthan indicated. For example, the report of theNaval Commander, Western Task Force, page 368,says that approximately 1,800 casualties wereevacuated to hospital ships during the period ofthe automatic schedule (D plus 1 through D plus6), whereas the ETMD report for August 1944gives 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 NavalComdr, Western Task Force, Invasion of SouthernFrance; (4) Annual Rpt, Surg, Seventh Army, 1944;(5) Annual Rpt, Med Sec, MTOUSA, 1944; (6)Unit rpts of med units mentioned in the text.


Three hospital ships arrived off thelanding beaches on D plus 1 as planned,although they were not there as early inthe day as had been expected. The rela-tively small number of casualties, how-ever, made it possible to hold in theclearing stations those patients whosecondition required the better accommo-dations of the hospital ships. The auto-matic schedule continued through 21August—3 ships on D plus 2, one on Dplus 3, 2 each on D plus 4 and D plus5, and one on D plus 6.

Vessels used during the first 3 dayscarried surgical teams drawn from per-sonnel of the 3d, 36th, and 43d GeneralHospitals, and the 59th Evacuation Hos-pital, all on the DRAGOON troop list. TheUSAHS John Clem, smallest of the hos-pital ships, carried only one surgicalteam, while the Acadia, with a capacity of788 patients, carried 3. The Shamrock,Thistle, Algonquin, Chateau Thierry,and Emily Weder carried 2 surgicalteams each.

After D plus 6, hospital ships were sentinto the area on a one-a-day basis until 28August, and thereafter at the request ofthe Seventh Army surgeon. One ship washeld in continuous readiness at Ajaccio.Until D plus 5 hospital ships called at allthree landing beaches, but beginning onD plus 6 all evacuees were taken by am-bulance to the clearing station of the58th Medical Battalion at Ste. Maxime,where the ships were loaded. Through 21August all hospital ships discharged atNaples with no segregation of casualtiesby nationality. From 22 August through29 August vessels loaded to 60 percent ormore with French casualties or prisonersof war were sent to Oran.

With the fall of Marseille and Toulon,enough fixed hospital beds became avail-

able to the French forces to make evacu-ation out of France unnecessary. Thisfactor, combined with the beginning ofair evacuation on D plus 7, greatly re-duced the need for hospital ships andnone were requested by Seventh Armyafter 30 August.

Air evacuation from southern Francewas carried out by the 802d and 807thMedical Air Evacuation TransportSquadrons, which continued at the sametime to clear forward areas in Italy. Be-ginning on 22 August, flights were madeinitially from the most forward airfieldsavailable directly to Naples and occasion-ally to other Italian bases. Airfields in thevicinity of the landing beaches—St.Tropez, Le Luc, and Aix-en-Provence—were quickly left behind. Sisteron andCrest both served for a time, and flightsbegan from Ambérieu northwest of Lyonon 9 September.

By this date, the weather was becom-ing uncertain and the distances to Italianbases were lengthening. With the greatair base at Istres, about twenty-five milesnorthwest of Marseille available, flightswere directed there, where patients couldbe relayed on by air to Naples or sent toone of the fixed hospitals moving intothe Rhône delta. Before the end of Sep-tember air evacuation in France hadbeen largely reduced to a single route,from Luxeuil close to the bulk of Sev-enth Army medical installations, toIstres.

Air evacuation from France to Italy,and from the Seventh Army area toIstres, for the period 22 August through7 November, when the two air evacua-tion squadrons from Italy were with-drawn, is summarized in Table 25.

Seventh Army evacuation hospitalsfrom their first establishment were


TABLE 25—AIR EVACUATION FROM SEVENTH ARMY AND DELTA BASE SECTION22 AUGUST-7 NOVEMBER 1944

Source: Annual Rpts, 802d and 807th MAETS, 1944.

cleared by the 52d Medical Battalion.Patients were carried by ambulance tothe Riviera beaches for hospital shipevacuation, to holding units at airfieldsor railheads, or to fixed hospitals as thesebecame available close to the front. Airevacuation holding hospitals were oper-ated by the clearing companies of the32d and 164th Medical Battalions. Thelargest of these was at Istres, operated bythe 52d Medical Battalion until 17 Sep-tember and thereafter by the 164th.More than 1,000 beds were available,with a daily patient turnover often

greater than 600. The fall rains madeflight schedules erratic with a highly vari-able patient census as a consequence.Property exchange with air evacuationunits was a continuous problem becausethe personnel carriers used generally hadfull loads on the incoming trip, and oftenmade one or more trips in Italy beforereturning to France.

As soon as the rail lines were back inoperation, hospital trains were pressedinto service for evacuating forward hos-pitals. The 42d Hospital Train, veteranof both North Africa and Italy, made its


LCI ALONGSIDE THE SHAMROCK off St.Tropez, 17 August. The men will betransferred to the hospital ship in the basket,left foreground.

first run between Marseille and the rail-head at Mouchard, about twenty milessouthwest of Besançon, on 25 September.The 66th Hospital Train, also a veteranunit, though with less service in thetheater than the 42d, left Besançon forMarseille on its initial run on 9 October.Both trains used reconditioned Frenchpassenger cars.

The slower pace of the campaign aftercrossing the Moselle, and the relativelystable front, permitted the establishmentof fixed hospitals well forward before theend of October, with ambulance evacua-tion taking the place of air and rail forthe shorter runs.

Throughout the campaign it was pos-sible to handle the tremendous job ofclearing army hospitals over long dis-tances from a rapidly moving front onlyby constant juggling of the inadequatenumber of ambulance platoons available.Ambulances were kept going around theclock and on occasion passing trucks werecommandeered to carry patients to therear.16

Table 26 summarizes evacuation fromforward installations to the communica-tions zone, including Italian and NorthAfrican base sections and those estab-lished in France, for the period ofMediterranean theater jurisdiction overDRAGOON.

Extension of the CommunicationsZone

Before DRAGOON could be transferredcompletely to the European Theater ofOperations, it was necessary to free theoperation of its logistical dependence onItaly and North Africa. It was therefore

contemplated throughout the planningphase that the communications zonewould be extended to southern France atthe earliest possible date. To this end theCoastal Base Section was organized inNaples early in July.

Organization of the Base Sections

The Coastal Base surgeon, ColonelBishop, and key members of his staffwere in close touch with the SeventhArmy surgeon throughout the planningstage, and were early arrivals in France.The first echelon of the medical sectioncame ashore between D plus 1 and Dplus 10, and the entire section was inFrance by 29 August. The early arrivalsremained in the landing areas to workwith the beach control group, and therear echelon set up a headquarters in

16 See, e.g., 9th Evac Hosp, Med Hist Data, 1Jan-31 Oct 44.


TABLE 26—SUMMARY OF EVACUATION TO THE COMMUNICATIONS ZONE15 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 al-ready supervising rear army installationsas well as evacuation and supply activi-ties on the beaches when the base sectionformally assumed operational control ofthe coastal region of southern France on9 September.17

By that date, Seventh Army was be-yond Besançon in its spectacular dash to-ward the Rhine, and the communicationszone organization appeared inappropri-ately named. The Coastal Base Sectionbecame the Continental Base Section on12 September 1944, and as of 1 Octoberwas split into the Delta Base Section,with headquarters in Marseille, and theContinental Advance Section (CONAD)

with headquarters in Dijon. ColonelBishop continued as surgeon of CONADwhile Colonel Jeffress became Delta Basesurgeon.

Both medical section organizationswere similar to those elsewhere in theMediterranean, with functional subdivi-sions for administration, personnel, hos-pitalization, evacuation, medical records,medical supply, dental, and veterinary.The Delta Base medical section was pri-marily concerned with incoming supply,evacuation to Italy and to the zone of in-terior, and hospitalization of servicetroops, long-term patients, and prisonersof war. The medical section of CONADwas primarily concerned with the moreimmediate support of Seventh Army andof the 6th Army Group.

Both Delta Base and CONAD cameunder the general jurisdiction of theSouthern Line of Communications(SOLOC) , on 20 November, when allCOMZ functions in southern France

17 Sources for this section are: (1) Annual Rpts,Med Sec, Delta Base Sec, 1944, 1946; (2) MonthlyRpt, 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 GenKirk, TSG, 26 Sep 44.


TABLE 27—ESTABLISHMENT IN SOUTHERN FRANCE OF FIXED HOSPITALS FROMNORTH 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 essen-tially the medical section of COMZ,NATOUSA, which had been function-ing in Naples since February 1944, withColonel Shook as surgeon.18 An advanceechelon of the COMZ medical sectionhad been established in Dijon early inOctober by Colonel Cocke, ColonelShook's deputy.

Establishment of Fixed Hospitals

U.S. fixed hospitals with an aggregateTable of Organization strength of 14,250beds were on the DRAGOON troop list,to be phased in between D plus 25 (9September) and D plus 60 (14 October).The installations included were drawn

from North Africa, Italy, and Corsica.The unexpected speed with which Sev-enth Army moved north made the sched-ule unrealistic before the first hospitalarrived. In only three instances, however,was it possible to advance the schedule,and these were balanced by others inwhich even the retarded landing datesoriginally fixed were not met. (Table 27)The accelerated pace of the campaign,moreover, brought such heavy demandsfor transportation that the establishmentof hospitals was often unduly delayedafter their arrival. Another delaying fac-tor was the difficulty in locating suitablesites in a densely populated country at aseason when tents could not be satisfac-torily used.19

18 See pp. 323-26, above, 486-88, below.

19 Sources of this section are the same as thosefor the preceding section, with the addition of unitreports of medical units mentioned in the text.


The first U.S. fixed hospital to oper-ate in southern France was the 36th Gen-eral, which took over a captured Germanhospital—originally a French tuberculosissanatorium—at Les Milles near Aix-en-Provence on 17 September. Approxi-mately 600 prisoner of war patients werein the hospital at that time, but thesewere concentrated in about half the wardarea. Two days later the 36th Generalalso began operating in Aix-en-Provenceitself, in the buildings of a French psy-chiatric hospital. To avoid unnecessarydispersion of staff members, all surgicalcases were handled at Les Milles, withmedical cases going to Aix. (Map 34)

Both hospitals were turned over, withtheir patients, to the 43d General—LesMilles on 25 September and Aix on the27th. The 3d General Hospital took overthe installation in Aix-en-Provence on 9October, taking 763 medical patientsfrom the 43d at that time. The 43d Gen-eral continued to administer the prisonerof war hospital at Les Milles in additionto its normal functions. The Germanhospital captured at Draguignan wasconsolidated with the Les Milles facility,which operated under U.S. supervisionwith German protected personnel. Ger-man enlisted men were used as litterbearers throughout the hospital.

The 78th Station Hospital, mean-while, had opened in a resort hotel in St.Raphael on 19 September, and the 80thStation had relieved the 675th MedicalCollecting Company, which had beenoperating a provisional hospital in thebuildings of an old ladies' home in Mar-seille.

The first fixed hospital to open in theforward area, which would come underoperational control of the ContinentalAdvance Section on 1 October, was the

46th General, which was rushed at therequest of the Seventh Army surgeon toBesançon. The hospital opened with aminimal portion of its equipment in theCaserne Vauban, a former French in-fantry barracks, on 20 September. Thefront was only a dozen miles away, andthe 9th Evacuation Hospital, from whichthe first group of patients came, was atPoligny 40 miles to the rear. The patientcensus of the 46th General rose to almost3,000 within 3 weeks.

The 36th General, after surrenderingits two sites at Aix-en-Provence, was as-signed to CONAD and opened at Dijonon 13 October in a former French cav-alry barracks. The 36th had a census of1,400 patients within a week. It wasjoined at Dijon on 20 October by the180th Station, one of the few 250-bedunits left in the theater.

On 14 October the 35th Station Hos-pital opened at Chalon-sur-Saône, southof Dijon, the accommodations again be-ing a French caserne, or military bar-racks. A week later the 2,000-bed 21stGeneral opened at Mirecourt, just westof the Moselle, in the unfinished plant ofa large, modern French psychiatric hos-pital. The 51st Station, which had beenfunctioning as a neuropsychiatric hos-pital in both Africa and Italy, continuedthe same specialty in France, opening atAuxonne on 4 November. In this case themilitary atmosphere of the French bar-racks that housed the unit was regardedas an asset.

The 23d General Hospital opened on5 November at Vittel, so close to thefront that its first 300 patients were re-ceived direct from Seventh Army by am-bulance. The hospital was adequatelyhoused in a group of resort hotel build-ings. Last of the CONAD hospitals trans-


FIXED HOSPITALS AND SUPPLY UNITSTRANSEFERRED FROM MTO TO ETO,

20 NOVEMBER 1944

Delta Base Section

Aix-en-Provence43d General, 25 September. 1,500 beds.3d General, 9 October. 1,500 beds.

Marseille80th Station, 30 September. 500 beds.70th Station, 1 November. 500 beds.69th Station, 8 December. 500 beds.231st Medical Composite Battalion.

St. Raphael78th Station, 19 September. 500 beds.

La Ciotat7607th Station (Italian), October. 500 beds-.

Continental Advance Section

Chalon-sur-Saône35th Station, 14 October. 500 beds.

Auxonne51st Station, 4 November. 500 beds.

Dijon36th General, 13 October. 2,000 beds.180th Station, 20 October. 250 beds.70th and 71st Medical Base Depot Companies.

Besançon46th General, 20 Sepetmber. 1,500 beds.

Vittel23d General, 5 November. 2,000 beds.

Épinal23d Station, 10 November. 500 beds.

Mirecourt21st General, 21 October. 2,000 beds.

MAP 34—Fixed Hospitals Transferred FromMTO to ETO, 20 November 1944

ferred from MTO was the 23d Station,which opened in a school building atÉpinal on 10 November, almost twomonths after its arrival in France.

Two late arrivals in Delta Base, the69th and 70th Station Hospitals, com-pleted the DRAGOON troop list. The 70thopened in a French mental hospital inMarseille on 1 November and, becauseof the facilities its site afforded, became

the principal center for handling closed-ward neuropsychiatric cases in DeltaBase. The 69th Station did not arrive inFrance until 18 November and was notready to receive patients until 8 Decem-ber.

Counting the still inoperative 69thStation, there were 5,000 Table of Or-ganization beds in Delta Base and 9,250in CONAD as of 20 November 1944,


when southern France passed completelyto ETO control.

In addition to these fixed hospitals, the7607th Station Hospital (Italian) openedat La Ciotat, on the coast between Mar-seille and Toulon, in October to care forpersonnel of Italian service units.Though nominally a 500-bed hospital,the 7607th operated 1,000 beds. The ve-nereal disease center maintained by the638th Medical Clearing Company of the164th Medical Battalion at Beauvallonwas shifted on 9 October to a stagingarea between Marseille and Aix-en-Pro-vence, where it continued to carry onthe same mission under Delta Base con-trol. The 4th Medical Laboratory, whicharrived in southern France on 9 Septem-ber, served both base sections. The baselaboratory, with the 6703d Blood Trans-fusion Unit attached, was located inMarseille; a mobile section consisting ofone officer and four enlisted technicians,was sited in Dijon. Both sections occu-pied university laboratory buildings offunctionally suitable design.

Evacuation From CONADand Delta Base

As soon as the base sections were setup, they took over responsibility forclearing hospitals in the Army area anddistributing the patients among the avail-able hospitals. The base sections werealso responsible for interbase transfers;Delta Base evacuated to the zone of in-terior, beginning in October.20

During October 1944, CONAD evacu-ated from its own hospitals to Delta Base,

1,325 patients by air, 1,496 by motor, and871 by rail. In the same month, DeltaBase transferred 2,808 patients to thePeninsular Base Section in Italy by airand 2,843 by sea, while 93 were evacu-ated by sea to the United States.

With fixed beds in the forward areastill at a premium, CONAD followed nofixed evacuation policy, but cleared itshospitals to Delta Base as rapidly as trans-portation and the condition of the pa-tients allowed. Toward the end ofOctober, Delta Base established a 45-daypolicy for evacuation to PBS, retainingall patients expected to recover in lessthan that time.

Delta Base continued to evacuate somepatients to Italy until 20 November, thetotals for the period 1-20 Novemberbeing 29 by air and 433 by hospital ship.The slack was taken up by the greatly in-creased number of beds available insouthern and eastern France by earlyNovember, and by the beginning of di-rect air evacuation from CONAD to theUnited Kingdom on the 12th of thatmonth.


By the time medical supplies begancoming across the landing beaches ofsouthern France in appreciable quan-tities about D plus 3, the army and baseresponsibilities in the supply area werebeing differentiated. Both the SeventhArmy medical supply officer, who wasalso commanding officer of the 7th Medi-cal Depot Company, and the Coastal BaseSection medical supply officer on tem-porary duty with Seventh Army cameashore on D plus 1. The three beachdumps were taken over from the beachmedical battalions by the advance sec-

20 This section is based primarily on: (1) AnnualRpt, Med Sec, CONAD, 1944; (2) Annual Rpt,Med Sec, Delta Base, 1944; (3) Annual Rpt, MedSec, MTOUSA, 1944.


tion of the 7th Medical Depot Companyon 16-18 August.21 Three days later asingle point for the receipt of incomingmedical supplies was established at Ste.Maxime. At this time supervision passedto the base supply organization, although21 enlisted men of the advance section,7th Medical Depot Company, were de-tached to help operate the dumps for thebeach control group. These men did notrejoin their own unit until 15 Septem-ber.

Seventh Army Medical Supply

The first forward issue point for Sev-enth Army was set up at Le Cannet, nearLe Luc, on 21 August, moving to St.Maximin, about 20 miles east of Aix-en-Provence, 2 days later. The main body ofthe 7th Medical Depot Company joinedthe advance section there on 25 August.On 29 August the base section of thedepot moved to Meyrargues, 10 milesnorth of Aix, while one storage andissue platoon jumped forward to Aspre-mont in the vicinity of VI Corps' forwardmedical installations.22

It was at this time that the battle ofMontélimar came to its indecisive closeand Seventh Army raced ahead to cut offthe retreating enemy before he couldslip through the Belfort Gap. In thisstage of the campaign, medical supplydumps were hard pressed to keep withinany kind of reasonable distance of the in-

stallations they served. The Meyrarguesdump closed on 5 September, and a newissue point opened the same day atVoreppe, ten miles northwest of Greno-ble. The Aspremont dump closed thefollowing day.

The next move was from Voreppe toSellières, ten miles north of Lons-le-Saunier, on 12 September. The area wasalready too far behind the advancing Sev-enth Army installations, however, and asecond forward dump was opened thenext day at Baume-les-Dames, fifteenmiles northeast of Besançon. With thechange of direction following the shiftto SHAEF command, the Baume dumpmoved to Vesoul on 19 September, whereit was joined a day later by the groupfrom Sellières. At Vesoul the dump wasin a building for the first time, beinghoused in a large tobacco warehouse.

On 2 October the 1st Storage and IssuePlatoon opened at Épinal, with the re-mainder of the company moving upgradually until 17 October, when theVesoul dump was closed. On the sameday a second dump was opened at Luné-ville, some thirty miles north of Épinal.The Épinal and LunéVille dumps werein buildings large enough to accommo-date mess and billets as well as the depotitself.

Throughout the early weeks of thecampaign, transportation presented thegreatest difficulty. While the army issuepoints were still close to the beaches,medical supplies were unloaded from theships to Dukws, which ferried themashore and delivered them directly to thedumps. As the army moved forward,medical supplies were brought up in or-ganic vehicles of the 7th Medical DepotCompany, 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 Oct44, 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, 95thEvac Hosps, 1944; (6) Davidson, Med Supply inMTOUSA, 143-50.


TABLE 28—REQUISITIONS AND TONNAGE, 7TH MEDICAL DEPOT COMPANYAUGUST-NOVEMBER 1944

Source: Annual Rpt, 7th Med Depot Co, 1944.

Services of Supply organization was ableto build up substantial stock levels in therear areas and took over responsibilityfor delivering supplies to Seventh Armydepots. The evacuation hospitals weresimilarly pressed for vehicles to carrytheir own supplies from the army issuepoints, which were sometimes as much as150 miles away. Only the extra stockscarried by each Seventh Army hospitalprevented critical shortages of someitems.

Until the inauguration of rail trans-portation in late September, it was diffi-cult to keep a sufficient volume of medi-cal supplies in the army area. Many itemswere distributed on a ration basisthrough most of October, but there wereno actual failures to meet minimum re-quirements. Local procurement was un-necessary to any important extent sincequantities of captured German supplieswere available. Housekeeping equip-ment, such as wood-burning stoves, potsand pans, knives, dishes, enamelware,electric refrigerators, and kerosene lampsgenerally came from this source. In emer-gencies, requisitions were filed with SOSNATOUSA in Naples by cable and sup-plies were sent by air.

Two portable optical units of the 7th

Medical Depot Company averagedtwenty-four pairs of spectacles and six re-pair jobs a day for army troops. Twodental prosthetic teams joined the depotcompany, one in late September and onein early October, serving variously withthe 2d Convalescent Hospital, the 35thField Artillery Group, and the parentunit.

During the months in which the 7thMedical Depot Company was supportedby the Mediterranean Theater of Oper-ations, monthly tonnage issued rose from64.5 in August to 356.8 in November.(Table 28)

Medical Supply in theCommunications Zone

The 231st Medical Composite Battal-ion—with its two attached medical basedepot companies, the 70th with 2 officersand 29 enlisted men, and the 71st withone officer and 30 enlisted men—was acti-vated in Oran on 15 August 1944, absorb-ing personnel and equipment of the 2dMedical Depot Company, and wasassigned immediately to the DRAGOONoperation.23 The unit reached St.



Raphael on 9 September. The 71st Medi-cal Base Depot Company took over oper-ation of the Ste. Maxime depot, whilethe 70th accompanied the battalion toMarseille. A large garage and hangar hadalready been obtained by the CoastalBase Surgeon as a depot site. Eight oper-ational medical units, each sufficient tomaintain 10,000 men for 30 days, reachedMarseille simultaneously with the supplypersonnel, and within 72 hours the depotwas able to issue supplies.24

When the depot was in full operation,the 231st Medical Composite Battalionwas sent to Dijon to set up a more for-ward base, the 71st Medical Base DepotCompany moving to the Marseille depoton 24 September. It was at this time,however, that the decision to establishtwo base sections was made, and late inOctober the 231st returned to Marseilleto resume operation of the Delta Basedepot. The 70th and 71st MedicalBase Depot Companies were assignedto CONAD, joining forces to operatethe Dijon depot, which was sited in aFrench barracks. Italian service units andFrench civilians were used as needed byboth base section depots.

Both Delta Base and Continental Ad-vance were supplied by COMZ NATO-USA, but all supplies for CONADpassed through Delta Base. They wereoften transferred by Dukw from ships to

freight cars bound for the forward areawithout ever entering a Delta Basedump. For about two months supplieswere not received in Delta Base in largeenough quantities to maintain adequatestock levels in either base section. Ar-rival times were uncertain, the conditionof the only partially restored port ofMarseille made unloading difficult, andtransportation shortages frequently de-layed movement of supplies from thedocks to the depot. All together, the Del-ta Base supply organization was able tofill during October only about 60 per-cent of the requisitions from SeventhArmy, 1st French Army, CONAD, andDelta Base. All base section medicalunits, however, carried 90-day supplylevels with them to France and were notseriously handicapped by the slow build-up. The authorized stock level of 30days of operating supplies and a 45-dayreserve was reached in mid-November.Supplies adequate for 7 days of opera-tion, with an 8-day reserve, were in theCONAD depot and the remainder inDelta Base warehouses.

As many items as possible were pro-cured locally, including motor vehicles,which greatly facilitated the movementof supplies. Inducements were offeredfor the return of salvage and emphasiswas placed on repair. After the return ofthe 231st Medical Composite Battalionto Delta Base, CONAD was without anymedical maintenance and repair serviceof its own. Some repair work was farmedout to other military units, but manyitems had to be shipped to Marseille forrepair.

The transfer of supply functions to theEuropean theater was actively under dis-cussion 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) An-nual Rpt, Med Sec, Delta Base Sec, 1944; (4)Annual Rpt, Med Sec, CONAD, 1944; (5) MedHist Data, 231st Med Composite Bn, 28 Oct 44;(6) Hist Journal, 231st Med Composite Bn, 13 Aug44-31 Dec 45; (7) Annual Rpt, 7th Med DepotCo, 1944; (8) Davidson, Med Supply in MTOUSA,150-56.


TABLE 29—RECEIPTS AND ISSUES, 231ST MEDICAL COMPOSITE BATTALIONSEPTEMBER-NOVEMBER 1944

Source: Hist Journal, 231st Med Composite Bn, 13 Aug 44-31 Dec 45.

finally adopted was to transfer six officersand twenty-six enlisted men, all special-ists in medical supply, from Headquar-ters, COMZ NATOUSA, to Headquar-ters, Southern Line of Communications.The effective date of the transfer was 20November 1944.

The supply build-up in southernFrance is well shown by the record ofreceipts and issues of the 231st MedicalComposite Battalion set forth in Table29.

Professional Services in SouthernFrance


In both medicine and surgery, thepractices developed in earlier Mediter-ranean campaigns carried over to south-ern France. Medical officers and enlistedtechnicians who had gained their com-bat experience in North Africa, Sicily,and Italy supplied the continuity, whilethe theater consultants—Colonel Churc-hill in surgery and Colonel Long inmedicine—gave the same attention to themedical service of Seventh Army, DeltaBase, and CONAD that they gave toother armies and the base sections in thetheater.

Forward Surgery—Field hospital pla-toons, operating within litter-carryingdistance of the division clearing stations,continued to be the primary unit for for-ward surgery. In the Southern FranceCampaign, these units were set up toaccommodate a maximum of 60 patients.The number actually cared for at anyone time was usually between 25 and 40.Nontransportable patients went directlyto these hospitals, where teams of the 2dAuxiliary Surgical Group performedsuch surgical procedures as were neces-sary to save life and limb and to put thepatient in condition to be moved to anevacuation hospital farther to the rear.Cases going to the field hospitals usuallyincluded severe hemorrhage, wounds ofthe abdomen, severe chest wounds, multi-ple fractures, traumatic amputations, andthose in immediate need of transfusion.

Other surgical cases went directly tothe evacuation hospitals, as did thosewho had received initial treatment in thefield units. The forward evacuationswere organized and their tents laid outwith the efficiency of the surgical serviceas the main consideration. In periods ofheavy combat, evacuation hospital sur-geons worked as teams in 12- and some-times 16-hour shifts, with operatingrooms continuously in use. The maxi-


mum holding period was seven days.25

The theater consultant, ColonelChurchill, spent three weeks visitingforward and base installations in south-ern France, beginning 16 September. Hewas followed in mid-October by theorthopedic consultant, Lt. Col. Oscar P.Hampton, Jr. The Seventh Army surgi-cal consultant, Colonel Berry, was activein organizing and supervising the surgi-cal work of army hospitals from thestart of the campaign.26

In addition to adequate supplies ofpenicillin, which had largely replacedthe sulfonamides, Seventh Army sur-geons also had the advantage of dailydeliveries of whole blood. From D plus1 until D plus 8, blood was flown fromthe 15th Medical General Laboratory inNaples to Corsica and relayed to the in-vasion beaches by fast PT boats. There-after it was flown directly to the mostforward airfield, where personnel of the6703d Blood Transfusion Unit receivedand distributed it on a priority basis firstto the field hospital units, then to the400-bed evacuations, and finally to the750-bed evacuations. The field hospitalsaveraged 3.5 to 4 units of whole bloodper patient transfused, the evacuationhospitals 2 to 2.5 units. Blood also cameby way of Naples from the French bloodbank in Algiers.27

As the army moved forward and flightdistances from Naples lengthened, for-ward hospitals drew blood locally where-ever possible and maintained small bloodbanks of their own. In November a sec-

tion of the 6707th Blood TransfusionUnit set up a blood bank in Marseille,where donors were available among serv-ice troops. Many civilians were also in-duced to give blood by the offer of flightrations to those who participated. A mo-bile section operated in the forward area,but the number of donors was toolimited to be relied upon.28

Neuropsychiatry—The procedure forhandling neuropsychiatric cases in Sev-enth Army was patterned on the increas-ingly successful system developed in Italyby Fifth Army under the guidance of thetheater neuropsychiatric consultant,Colonel Hanson. Again continuity wasprovided by transfer of personnel, in-cluding the army consultant MajorLudwig, who had been commanding offi-cer of the Fifth Army NeuropsychiatricCenter.

Owing largely to the rapid initial ad-vance of Seventh Army, with accompany-ing high morale among the combattroops, the incidence of psychiatric dis-orders was low during the first monthof the campaign. Beginning in mid-Sep-tember, however, as the terrain becamemore difficult, the weather deteriorated,and enemy resistance stiffened, an in-creasing number of neuropsychiatriccasualties passed through the divisionclearing stations. The three divisions ofVI Corps had been in almost continuouscombat since the Salerno landings, andthe impact of battle fatigue was cumula-tive.29

25 (1) Annual Rpt, Surg, Seventh Army, 1944. (2)Annual Rpt, 2d Aux Surg Gp, 1944. (3) AnnualRpts, 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 Quarter1944.

28 Annual Rpt, Delta Base, 1944.29 Principal sources for this section are: (1)

After Action Rpt, Surg, Seventh Army, 15 Aug-31Oct 44, an. 278; (2) Annual Rpt, Surg, SeventhArmy, 1944; (3) Annual Rpt, 181st Med Bn, 1944;(4) Annual Rpt, 616th Med Clearing Co, 1944;(5) Annual Rpts, 1944, of hosps mentioned in thetext.


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 treatneuropsychiatric casualties as far for-ward as possible. Cases were first ex-amined by the division psychiatrists inthe clearing stations, where every effortwas made to get the men back into com-bat without delay. Those that did notrespond promptly were sent to theSeventh Army Neuropsychiatric Center,operated by the 2d Platoon of the 616thMedical Clearing Company, 181st Medi-cal Battalion. The center had a staff ofeighty-five enlisted men, with four psy-chiatrists attached. The chief of thepsychiatric service was Capt. (laterMaj.) Stephen W. Ranson. All cases in

which a psychiatric diagnosis was madeat an evacuation hospital were also trans-ferred to the center without furthertreatment.

At the center, treatment followed thepattern used in Fifth Army. Patientswere kept under mild barbiturate seda-tion for twenty-four hours, but weremaintained in ambulatory status. Afterthe initial period of rest and quiet, theywere interviewed and a course of therapyprescribed. Patients were kept active andwere urged to interest themselves in therecreational and orientation facilities ofthe hospital.

Every effort was made to dispose of


TABLE 30—VENEREAL DISEASE RATES, SEVENTH ARMY, JULY-SEPTEMBER 1944

cases as quickly as possible. Except inspecial circumstances, four days was themaximum holding period. Those whocould be returned to duty were then re-equipped and sent back to their owndivisions without passing through a re-placement command. Those who neededfurther care went to a fixed hospital formore extensive treatment. Evacuation toItaly was necessary for a time, but amongthe fixed units transferred to southernFrance the 3d General Hospital at Aix-en-Provence was equipped to handle psy-chiatric cases, while the 51st Station,which opened on 4 November atAuxonne, was exclusively a neuropsychi-atric installation.

Returns to duty from the divisionclearing stations were 50 percent of allneuropsychiatric cases treated for theperiod 15-31 August, 37 percent for theperiod 1-15 September, and 23 percentfor the period 16-30 September. Re-turns to duty from the Seventh ArmyNeuropsychiatric Center and otherSeventh Army hospitals for the sameperiods were 29 percent, 11 percent, and12 percent, respectively.

Preventive Medicine

During the period that southernFrance was under Mediterranean theater

control, there were few problems in pre-ventive medicine. Most serious of thesewas venereal disease control. Malariahad been anticipated as a problem andprepared for, but proved to be minor.Trench foot was developing into a prob-lem of major concern at the time opera-tions passed to ETO.

Venereal Disease Control—The Sev-enth Army Venereal Disease TreatmentCenter, operated by the 616th MedicalClearing Company, 181st Medical Bat-talion, was initially overloaded withcases contracted in Italy during the stag-ing period. The hospital, staffed by 8officers and 93 enlisted men, had aplanned capacity of 250, but had to ex-pand almost immediately to 375 beds.30

Additional contacts were made in thecoastal area, but as the army advancednorthward through predominantly agri-cultural country, opportunities for sex-ual contacts lessened. The rapidity ofmovement also helped to reduce the

30 Primary sources for this section are: (1) An-nual Rpt, Surg, Seventh Army, 1944; (2) AnnualRpt, 181st Med Bn, 1944; (3) Ltr, Col Barnes, VDconsultant, MTOUSA, to Surg, MTOUSA, 2 Nov44. Sub: Venereal Disease Control Activities inSeventh Army, Continental Base and Delta BaseSecs; (4) Annual Rpt, Med Sec, MTOUSA, 1944,an. J; (5) Annual Rpt, Med Sec, Delta Base, 1944;(6) Annual Rpt, Med Sec, CONAD, 1944.


venereal rate. (Table 30) In the main,the preventive measures taken under thedirection of Major (later Lt. Col.)James E. Flinn, Seventh Army venerealdisease control officer, were effective.These included an intensive educationalprogram in the individual units, withemphasis on the importance of immedi-ate prophylaxis; rigid enforcement ofoff-limits restrictions on known brothels;and curfew hours that limited the timeavailable for contacts. The rapidity ofcures, under the new penicillin treat-ment, tended to discourage any deliber-ate exposure to escape hazardous duties.Acute gonorrhea cases were returned toduty from the Venereal Disease Centerwithin twelve hours, and mild cases weretreated on duty status.

In the base sections, particularly inDelta Base, the problem was more dif-ficult. Two metropolitan prophylacticstations were established in Marseille,but more were needed. All of the 31licensed houses of prostitution in thatcity were placed off-limits, but indica-tions were that the women simply movedto rooms and to small hotels, where theywere even harder to control. Fivebrothels in Dijon were also placed off-limits apparently with more effect. Dis-pensaries and fixed hospitals in CONADsaw relatively few venereal cases.

Malaria—A malaria problem in south-ern France had been anticipated duringthe planning of DRAGOON, and a malari-ologist, Maj. Arthur W. Hill, was at-tached to Seventh Army, together withthe 132d Malaria Control Unit. Whilea considerable number of cases weretreated in the early weeks of the cam-paign, they were virtually all contractedin Italian staging areas before sailing.

Individual preventive and suppressivemeasures were continued until 11 Octo-ber, but were then discontinued as of nofurther value, and Major Hill returnedto the 2655th Malaria Control Detach-ment in Italy.31

The 132d MCU went to the CoastalBase Section in September, being re-placed in Seventh Army by the 131stMCU from Corsica. In October the 132dwent to CONAD and the 131st to DeltaBase. Both passed to ETO in November.Neither of these units, however, engagedin actual malaria control work. Inspec-tion of the Marseille area immediatelyafter occupation of the city revealed nomalaria-infested mosquitoes, and nonewere found in the advance north. Themalaria control units, under both armyand base section jurisdiction, were usedprimarily for fly, roach, and bedbug con-trol, and for general sanitation work.

Trench Foot—Trench foot appearedamong Seventh Army troops toward theend of September, becoming an increas-ingly severe problem through the suc-ceeding months, but that story belongsrather to the ETO than to the MTOperiod. The major contributing factorwas the same as it had been in Italy–cold and wet weather in which men atthe front had no opportunity to changesocks or dry their feet for days at a time.Wool socks and shoe pacs were issued,but only after the condition had ap-peared. Even had they been available atthe start of the bad weather, however,they would have had only a minimal

31 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944, an. J; (2)Annual Rpt, Surg, Seventh Army, 1944; (3) AnnualRpt, Med Sec, CONAD, 1944; (4) Annual Rpt,9th Evac Hosp, 1944.


preventive effect, since the nature of theaction required that men stay in the linesfor considerable periods of time.32

Dental Service

During the staging period beforeleaving Italy, Seventh Army dental of-ficers, under the direction of ColonelGurley, Seventh Army dental surgeon,made every effort to bring the dentalhealth of the assault troops to a highlevel. Except for emergencies, little den-tal work was possible during the earlyweeks of the invasion. Ninety percent ofthe division dental officers did none atall until D plus 15, functioning duringthat period in various medical and ad-ministrative capacities. The dental serv-ices of the evacuation hospitals and ofthe combat divisions were supplementedaround the beginning of October by twodental prosthetic teams assigned to the7th Medical Depot Company and athird assigned to serve U.S. troops oper-ating with 1st French Army.33

Inspection of the combat dental serv-ice of Seventh Army early in October bythe theater dental surgeon, ColonelTingay, revealed no dental problems.Colonel Tingay was particularly im-pressed by the manner in which the den-tal work of the 3d Division was beingcarried on. He reported:

One officer from each infantry regiment,the officer assigned to special troops andone officer from the medical battalion havebeen attached to the division surgeon'soffice and thus come under the direct con-trol of the Division Dental Surgeon. With

this nucleus of five officers, clinics areestablished in rearward areas in the mostfeasible locations and a large volume ofwork accomplished during actual combat.The other dental officer of each infantryregiment is left with the regiment and theofficer assigned to artillery is left with thedivision artillery. In addition to providingemergency treatment these officers are alsoable to accomplish some constructivedentistry. A prosthetic laboratory truck hasbeen constructed and is placed in operationwherever the rearward clinic is es-tablished.34

In the base sections dental work wasperformed by dental personnel of thefixed hospitals.

Veterinary Service

The first veterinary unit to arrive insouthern France was the 890th MedicalService Detachment (formerly T Detach-ment), which had been active in thetheater since North African days. Theunit landed on the invasion coast on Dplus 8—23 August—and began super-vising the issue of field rations at quarter-master Class I supply dumps in the beacharea. Throughout the period of MTOcontrol, the detachment worked in closeco-operation with the Seventh Armyquartermaster section, supervising theissue of rations at army railheads.35

The 45th Veterinary Company (Sep-arate) arrived on schedule on D plus 20(4 September) . The veterinary detach-

ments, consisting of 3 officers and 12enlisted men each, of the 601st and 602dField Artillery Battalions arrived about

32 (1) Annual Rpt, Surg, Seventh Army, 1944. (2)Annual Rpt, Surg, VI Corps, 1944. (3) AnnualRpt, 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) An-

nual Rpt, Surg, Seventh Army, 1944; (2) AnnualRpt, 17th Vet Evac Hosp, 1944; (3) Annual Rpt,45th Vet Co (Separate) , 1944; (4) Annual Rpt,Med Sec, CONAD, 1944.


the same time, together with 1,200 ani-mals of the 2 units. The 601st had comein by glider as a component of the 1stAirborne Task Force, and was then fight-ing in the Maritime Alps, where it wasjoined by the 602d, its animals and itsveterinary personnel. The animals wereshipped from Italy on LST's whose holdshad been converted to stall space by theuse of earth and sandbags. The 2d Pla-toon of the 45th Veterinary Companywas assigned to support the two fieldartillery battalions, while the balance ofthe company went to Lons-le-Saunier forstaging.

The Seventh Army veterinary sur-geon, Colonel Stevenson, arrived insouthern France on D plus 25, or 9September, along with the 17th Veteri-nary Evacuation Hospital, of which hehad been commanding officer. The hos-pital staged for a few days at St. Raphael,then opened on 18 September in aFrench artillery barracks at Grenoble.

Three days later the 45th VeterinaryCompany, less its 2d Platoon, moved toSisteron, some 75 miles south ofGrenoble. The unit moved once more,to Gap, on 29 September.

On 24 September both the 17th Vet-erinary Evacuation Hospital and the 45thVeterinary Company were attached foroperational control to First FrenchArmy, which had 6,000 animals in theMaritime Alps between Nice and theSwiss border and another 6,000 inthe Vosges area. From the Vosges,French animal casualties went to Gre-noble by animal hospital train. Thoughits Table of Organization stall capacitywas only 150, the 17th Veterinary Evacu-ation Hospital operated up to 236 stalls.

In the base sections, as distinct fromthe army area, the veterinary service wasconfined primarily to inspection of coldstorage plants for perishable foods andcontinuous inspection of locally proc-essed foodstuffs.

CHAPTER XI

The Northern Apennines

By the middle of August 1944, whenthe lightning thrust into southern Francewas being launched, the Allied armiesin Italy were halted on the south bankof the Arno River and along the Metauroon the Adriatic. The U.S. Fifth and Brit-ish Eighth Armies had outrun their sup-plies; troops were exhausted after threemonths of continuous fighting; and theeffective strength of Fifth Army hadbeen more than halved to build the mili-tary power that would enable Lt. Gen.Alexander M. Patch to sweep from theRiviera beaches to the Moselle River ina month's time. Yet the strongest Ger-man positions in Italy still lay ahead,blocking access to the rich Po Valley,whose agricultural and industrial prod-ucts continued to feed the German warmachine despite repeated sorties by Al-lied bombers.

Preparations for the Offensive

Allied Armies at the Arno Line

The Military Situation—When Gen-eral Alexander halted the Allied Armiesfor rest and regrouping at the Arno line,Eighth Army, with sixteen divisions,held four-fifths of the front, from thejunction of the Elsa and Arno Riversabout twenty miles west of Florence tothe Adriatic coast at the mouth of theMetauro River. Fifth Army, with a totalof five divisions, held the sector running

west from the Elsa along the south bankof the Arno to the Ligurian Sea aboutten miles north of Leghorn.1

In the Fifth Army area, IV Corps,commanded by General Crittenberger,held about thirty miles of the river linefrom the mouth of the Arno east to thevillage of Capanne. Task Force 45, com-posed of the 45th Antiaircraft ArtilleryBrigade and attached troops, was on theleft, or seaward flank; the 1st ArmoredDivision, reorganized and reduced toabout two-thirds of its former strength,was on the right. The 34th Division andthe 442d Regimental Combat Teamwere in army reserve in rest areas southof Leghorn. The 5-mile front fromCapanne to the Eighth Army boundarywas held by II Corps, commanded byGeneral Keyes, with only one RCT ofthe 91st Division in the line. The 85thand 88th Divisions were in corps reserve,in bivouac north of Volterra.

Until the port of Leghorn could berestored, Fifth Army supplies had to beunloaded at Civitavecchia or Piombinoand trucked up to 150 miles over battle-damaged highways. The supply situationwould be difficult, even after reconstruc-tion of port facilities in Leghorn, as longas the enemy held the Arno plain and

1 Principal sources for this section are: (1) FifthArmy History, pt. VII, The Gothic Line (Wash-ington [1947]); (2) Opns Rpt, II Corps,Aug 44; (3) Opns Rpt, IV Corps, Aug 44; (4)Clark, Calculated Risk, pp. 389-94.


remained within artillery range of theonly good lateral road south of the river,Highway 67. The enemy, on the otherhand, controlled an excellent road net-work for the movement of troops andsupplies in the Po Valley, behind hisstrongly fortified Gothic Line.

The northern Apennines form a rug-ged mountain barrier about 50 mileswide, extending northwest from theAdriatic Sea across the peninsula, andstudded with peaks of 3,000 feet to wellabove 6,000 feet. The northern slopesare relatively easy grades, but the south-ern slopes, which then faced the Alliedarmies, are steep and difficult. TheGothic Line, begun as early as the winterof 1943-44 when Fifth Army was stalledbefore Cassino, lay generally just southof the watershed dividing the streamsflowing south to the Arno from thoseflowing north to the Po. The line wasanchored on the Ligurian Sea in thevicinity of Massa where the coastal plainwas only 2 or 3 miles wide, and extendedroughly 170 miles southeast to Pesaro onthe Adriatic.

Highways across the mountains werefew and tortuous, the best of them beingHighway 65, the most direct route fromFlorence to Bologna, a distance of aboutseventy miles. Though there were manysharp curves, the road was paved and thegrades were less steep than those onHighway 64, a few miles farther west.Highways 6524 and 6521, somewhat eastof 65, were secondary roads, often nar-row and always steep and winding. Therelative scarcity of roads made it possiblefor the Germans to concentrate theirdefenses, the strongpoints being astridethe highways and connected by a seriesof dug-in gun emplacements, log andconcrete bunkers, and fortified trenches.

GENERAL MARTIN RECEIVING OBEfrom General Alexander, making Martin anhonorary knight commander in that order.

The weakest point, topographically, inthe Gothic Line was Futa Pass, whereHighway 65 crossed the divide at anelevation of only 2,962 feet. The strong-est fortifications were at this point,running southeast to II Giogo Pass onHighway 6524.

Fifth Army Medical Support—Medi-cal facilities had been stripped downeven more than the army as a whole bythe demands of the campaign in south-ern France. At the army level, GeneralMartin, Fifth Army surgeon, had at hisdisposal two medical battalions, the161st and 162d; the 32d and 33d FieldHospitals; 2 400-bed evacuation hospi-tals, the 15th and 94th; 4 750-bed evacua-tion hospitals, the 8th, 16th, 38th, and56th; the 3d Convalescent Hospital; the2d Auxiliary Surgical Group, with 14

THE NORTHERN APENNINES 417

teams on temporary duty from generalhospitals in the theater only partiallyreplacing the twenty-eight teams with-drawn for service with Seventh Army;the 2d Medical Laboratory; the 12thMedical Depot Company; and miscel-laneous minor units. Even to support thedivisions composing Fifth Army as of 16August 1944, these medical units wereinadequate, particularly so in 400-bedevacuation hospitals, which had previ-ously been assigned in the ratio of atleast one to each combat division. TaskForce 45, moreover, had no organic med-ical support other than the medical de-tachments of its component units; the92d Division and the Brazilian Expedi-tionary Force, both on the way to thecombat zone, were without hospitals.2

At the corps and division levels, medi-cal support remained substantially as ithad been in earlier Fifth Army cam-paigns. Each of the two corps had a medi-cal battalion assigned, the 54th to IICorps and the 163d to IV Corps; andeach combat division had its own or-ganic medical battalion. The Brazilianmedical organization at the division levelwas substantially the same as the Ameri-can.

The l09th Medical Battalion, organicto the 34th Division, received an unex-pected but welcome visitor on 13 Augustwhen Capt. Francis Gallo of Company Cwalked into battalion headquarters. Cap-tain Gallo had been captured in theKasserine breakthrough of February

1943. He had escaped after more thanseven months in German prison camps,and for almost a year had been servingwith a band of Italian partisans in theFlorence area.

As of 16 August, divisional and corpsmedical units were with their respectivecombat elements, taking advantage ofthe lull to rest personnel and re-equip.Fifth Army hospitals were disposed in aroughly quadrangular area whose cor-ners were Cecina and Leghorn on thecoast and Volterra and Peccioli abouttwenty miles inland. All were in opera-tion except the 16th Evacuation Hospi-tal, which had closed at Ardenza justsouth of Leghorn on 12 August but hadnot yet moved elsewhere.

Mounting the Attack

Planning and Regrouping—Plans de-veloped during July called for an earlyresumption of the offensive, with FifthArmy launching the main attack on theGothic Line by way of Highway 65. Thestrength of the enemy positions in theFuta Pass area, however, led GeneralAlexander to shift the main attack to theEighth Army front, where a flankingmovement along the Adriatic offeredpromise of quicker results. It was antici-pated that Generalfeldmarschall AlbertKesselring would have to concentratethe bulk of his forces against EighthArmy. Fifth Army would then attackalong the axis of Highway 6524 towardII Giogo Pass. The success of the opera-tion depended on co-ordination andtiming.

By way of preparation, the boundarybetween Fifth and Eighth Armies wasredrawn 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, IICorps, 1944; (3) Annual Rpt, Surg, IV Corps, 1944;(4) Unit rpts of med units mentioned in the text.

The Brazilian Expeditionary Force brought itsown medical officers, nurses, and enlisted tech-nicians, who were attached to U.S. hospitals. Seepp. 439, 440-41, below.


Army's left flank, was transferred toFifth Army. The 13 Corps left boundarywas shifted east to pass through Florence,and II Corps, which was to spearheadthe Fifth Army attack, was concentratedalong a 5-mile front west of the city. IVCorps, which was to perform a holdingfunction, occupied the remainder of theFifth Army front extending some fortymiles from the II Corps boundary to thesea.

Regrouping for the assault broughtthe 34th Division and the 442d Regi-mental Combat Team (less its l00thBattalion)3 under II Corps control,along with the 85th, 88th, and 91st Divi-sions. IV Corps retained Task Force 45and the 1st Armored, and was given the6th South African Armoured Divisionfrom 13 Corps. The all-Negro 92d Divi-sion and the Brazilian ExpeditionaryForce of somewhat more than divisionstrength were also assigned to IV Corps,but only the 370th Combat Team of the92d reached the corps area in time forthe attack. The first Brazilian increment,the 6th RCT of the 1st Brazilian Divi-sion, went into the line on 15 September.

Preliminary Maneuvering—E i g h t hArmy jumped off on 25 August, and by6 September, when heavy rains inter-rupted the advance, had broken throughthe Adriatic anchor of the Gothic Lineto a position only six miles south ofRimini where Highway 9, the best lat-eral road north of the mountains,reached the coast. The enemy had com-mitted all his reserves and had shiftedthree of his best divisions from the Fifth

Army front to meet General McCreery'schallenge.

As early as 31 August there was evi-dence that the Germans all along theFifth Army front were pulling back tothe prepared positions of the GothicLine. IV Corps sent reinforced patrolsacross the Arno the night of 31 August—1September, and followed up in forceduring the morning. By the end of 2September, the bulk of IV Corps wasnorth of the river, and the two majorhill masses commanding the Arno plain,Mts. Pisano and Albano, were in Alliedhands. Over the next ten days IV Corpspushed across the plain and into thelower slopes of the Apennines, securingthe Autostrada—the excellent road con-necting Highway 1 north of Pisa withFlorence—and liberating the cities ofLucca, Montecatini, Pistoia, and Prato.

On the right flank, 13 Corps had al-ready secured a bridgehead north of theArno from Florence east to Pontesieveduring the last week of August. On 1September II Corps crossed the river,and both II Corps and 13 Corps movedforward to assembly areas. Originallyscheduled for 6 September, D-day forthe Fifth Army assault on the GothicLine was postponed until the 10th totake advantage of further enemy with-drawals. When the attack was finallylaunched, the Fifth Army front was tenmiles north of the Arno, and by 12 Sep-tember leading elements of both II and13 Corps were probing the outer de-fenses of the Gothic Line.

Medical Preparations—Organic andcorps medical battalions moved forwardwith the combat elements they sup-ported. Medical troops had been rested,and most had received additional train-

3 The 442d Regiment, including the l00th Bat-talion from Task Force 45, was withdrawn the firstweek in September for shipment to France.


ing in the handling of casualties inmountainous terrain. To preservesecrecy, however, the hospitals werenot moved up before the attack waslaunched, but were infiltrated into newareas. The 16th Evacuation Hospital wasestablished at San Casciano about 10miles south of Florence, on 26 August,followed four days later by the neuropsy-chiatric center. On 1 September the 8thEvacuation moved into the same area.The 94th Evacuation moved to Castel-fiorentini, some 20 miles southwest ofFlorence, on 17 August, and on 9 Sep-tember advanced to Pratolino on High-way 65 about 6 miles north of the city.The 15th Evacuation Hospital set up inFlorence itself on 10 September, fol-lowed by the venereal disease center onthe 13th. On 15 September the 38th Evac-uation opened near Pisa to serve unitson the IV Corps left flank.4

Combat Operations

Breaching the Gothic Line

On 12 September the 34th Divisionwas in contact with the main defensesof the Gothic Line to the left of High-way 65. The 91st Division was astrideHighway 6524, which branched off to theright from Highway 65 about twelvemiles north of Florence. To the right ofthe 91st, the 1st British Division of 13Corps was abreast of the two U.S. divi-sions. Elements of the 91st were at thebase of Mt. Altuzzo, which overlookedII Giogo Pass from the right, whileother 91st Division units were approach-

ing Mt. Monticelli, the left bastion ofthe pass.5

On 13 September the 91st Divisionsideslipped to the left of Highway 6524while the 85th Division moved in be-tween that road and the British sectoron the right. After four days of hardfighting, the 85th secured Mt. Altuzzoon 17 September while the 91st wasstorming Mt. Monticelli. By the end ofthe day, 18 September, II Giogo Passhad been outflanked from both sides,and II Corps had broken through theGothic Line on a 7-mile front.

The strategically placed town ofFirenzuola fell to the 85th Division on21 September. There the road turnedsharply left to rejoin Highway 65, whileanother secondary road, Highway 6528,branched off along the Santerno Rivernortheast to Imola, where it intersectedHighway 9 on the edge of the Po Valley.

The 34th Division, meanwhile, hadexerted constant pressure in the area be-tween Highway 65 and the IV Corpszone to keep the enemy from shiftingforces to the II Giogo battle. On 21 Sep-

4 (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) FifthArmy History, pt. VII; (2) Opns Rpt, II Corps,Sep 44; (3) Opns Rpt, IV Corps, Sep 44; (4) FieldMarshal the Viscount Alexander of Tunis, "TheAllied Armies in Italy from 3rd September, 1943, to12th December, 1944," Supplement to the LondonGazette, 6 June 1950, pp. 2940-60; (5) Clark, Cal-culated Risk, pp. 394-403; (6) Kesselring, Soldier'sRecord, pp. 254-64; (7) Howe, 1st Armored Di-vision, 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 ItalyDuring World War II, 1942-1945 (Carlisle Bar-racks, Pa.: Army War College, 1952), pp. 25-56;(12) Sidney T. Mathews, "Breakthrough at Monte

Altuzzo," Three Battles: Arnaville Altuzzo, andSchmidt, UNITED STATES ARMY IN WORLDWAR II (Washington, 1952); (13) Starr, ed.,From Salerno to the Alps, pp. 301-64.


COLLECTING POINT AT PARTIALLY DEMOLISHED HOUSE ON MT. ALTUZZO

tember the 34th also broke through theGothic Line to the west of Futa Pass,which now became untenable for theGermans. Though the strongest point ofthe Gothic Line, Futa Pass fell on 22September to a single battalion of the91st Division.

On the right flank of Fifth Army, 13Corps followed Highway 6521 towardFaenza, and Highway 67, which swingsnorth beyond Florence in the directionof Forli and Ravenna. Leading elementsof the corps had passed through theGothic Line along both axes of advanceby 21 September. Even on the left flank,

where IV Corps was thinly spread tohold rather than to advance, the Ger-man line had been penetrated at severalpoints.

In less than two weeks, Fifth Armyhad broken through the strong defensivepositions of the Gothic Line on a 30-milefront from Vernio on Highway 6520 toSan Godenzo Pass on Highway 67. Withseveral alternatives now available tohim, General Clark sent II Corps downthe Santerno Valley toward Imola, while13 Corps struck in the direction ofFaenza. These were the shortest routesto the Po Valley and promised the great-


est help to Eighth Army, which wasbogged down in rain and mud in thevicinity of Rimini.

For the new attack, the 88th Divisionwas brought up, passing through the85th along Highway 6528, while the91st and 34th continued to press forwardin their own sectors to cover the 88th.The Santerno Valley proved impreg-nable. The 88th Division seized and heldcommanding heights, including Mt.Pratolungo on the left of the river andMts. Battaglia and Capello on the right,but failed to advance further in the faceof mounting opposition. Between 21 Sep-tember and 3 October, when the San-terno Valley drive was halted, the 88thhad 2,105 casualties—almost as many asthe whole of II Corps had suffered inbreaching the Gothic Line.

As the Santerno Valley attack stalledon the rugged, fogbound slopes of Mt.Battaglia, the emphasis shifted to High-way 65, where the 34th, 91st, and 88thDivisions converged on Radicosa Pass,about three miles north of the pointwhere Highway 6524 reunited with themain route and some ten miles beyondFuta Pass. In the face of the threatposed by the 88th Division in the San-terno Valley, the Germans abandonedRadicosa Pass on 28 September.

By the end of the month, three weeksafter the beginning of the campaign, allthree corps of Fifth Army were on thenorthern slopes of the Apennines, anaverage of ten miles beyond the GothicLine, but the fall rains had begun, ham-pering the advance and making supplylines increasingly difficult to maintain.The troops were weary from continuousand bitter mountain fighting, and cer-tain classes of ammunition were runninglow.

Hall Before Bologna

Following his withdrawal from Radi-cosa Pass, the enemy fell back to the firstof four natural defense lines still block-ing Fifth Army's approach to the PoValley. This first line crossed Highway65 in the vicinity of Monghidoro; thesecond line, about 4 miles beyond thefirst, passed through Loiano; the thirdand most formidable line had its strong-point at the Livergnano Gap, 4 milesbeyond Loiano; and the last defensibleenemy position in the mountains was 3miles beyond the gap, on a line crossingHighway 65 just south of Pianoro.6

The II Corps drive was launched inthe early morning of 1 October fromRadicosa Pass, just 24 miles from Bo-logna. The 34th Division was on the left,the 91st astride Highway 65, and the85th was to the right of the highway, fol-lowing the valley of the Idice River,while the 88th, on the extreme right, wasstill in the Santerno Valley. In order tostrengthen General Keyes' position asmuch as possible, the 6th South AfricanArmoured Division, which held the sec-tor between the 34th Division and High-way 64, was withdrawn from IV Corpsand placed under direct army control,while 13 Corps began the relief of the88th Division preparatory to a narrow-ing of the II Corp front. Combat Com-mand B of the 1st Armored Division wasattached to the 6th South AfricanArmoured Division and the remainderof the division went to II Corps as amobile reserve to exploit any break-through onto the plain.

6 Principal sources for this section include thosecited at the beginning of the previous section, withthe addition of: (1) Opns Rpt, II Corps, Oct 44;and (2) Opns Rpt, IV Corps, Oct 44.


Despite cold weather, driving rain,and fog that set in the second day of theattack, the Monghidoro line was overrunalong a 16-mile front by 4 October, andthe Loiano line by the 9th. But rain, fog,mud, and fatigue were taking their toll,and resistance was stiffening as theenemy concentrated his forces to meetthe threat to Bologna, his major supplyand communications center.

For the next phase of the drive thefront was still further narrowed, the 34thDivision moving over to the right ofHighway 65, between the 91st and 85th,and the 88th Division sideslipping to itsown left into the Sillaro Valley, as theBritish 78th took over the SanternoValley sector. Again the objective was at-tained, the Livergnano line being over-run by 15 October, but again the pacewas slowed, and losses were heavy andcumulative.

For the 6-day period 10-15 October,II Corps lost 2,491 battle casualties. Thetotal since the start of the Bologna driveon 1 October was 5,699, and since thebeginning of the offensive on 10 Septem-ber, 12,210, or nearly a full division. Theloss of an actual division would havebeen less severely felt, because losseswere disproportionately high amongjunior officers. Returns to duty made uponly a fraction of the losses. Replace-ments were not available in sufficientnumbers, and were inexperienced atbest. Battlefield commissions given toenlisted men made up some of the officerlosses, but seasoned noncommissionedofficers were in equally short supply. Topersonnel shortages had to be addedgeneral fatigue, muddy and mountain-ous terrain that hampered the move-ment of supplies and restricted themobility of artillery, and weather that

prevented effective air support. A mas-sive bombing of enemy supply dumps inthe Bologna area was the only significantair activity in the period.

For another week II Corps struggledforward against increasingly strong op-position, but it was a losing gamble.With Eighth Army immobilized by softground and flooded streams on thefringe of the Po plain, II Corps nowfaced the best German units in Italy.Machine guns and mortars were hand-carried up mountain trails. Rations andammunition were brought up by mulepack, but even mules could not movethe heavy guns through the mud. The91st Division tried oxen, but with nobetter success. After 17 October, whenthe 697th and 698th Field Artillery Bat-talions were withdrawn for shipment toFrance, there were no heavy guns tomove, and by the last week of Octoberammunition was in such short supply asto require drastic restrictions on its use.

The last straw was added on 26 Octo-ber when torrential rains washed outroads and bridges. In rare intervals ofclear weather, the Po Valley was visiblein the distance, but Bologna was stillnine heartbreaking miles away. GeneralKeyes ordered II Corps to fall back todefensible positions and dig in.

On the IV Corps front, activity cameto a halt at the same time. Althoughthe corps had been stripped to hardlymore than the strength of a reinforceddivision, some advances had been made.Task Force 92, consisting of the 370thRCT and antiaircraft units detachedfrom Task Force 45, had advanced upthe coast a few miles beyond the resortcity of Viareggio, while the Brazilian6th Combat Team had moved so far intothe Serchio Valley in the center of the


IV Corps zone that the advance wasstopped by General Crittenberger lest itinvite counterattack, for which no re-serves were available.

Winter Stalemate

After stabilization of the front late inOctober, action in all sectors was largelylimited to patrols and reconnaissance.Elements of the 92d Division, broughtunder direct army control early in No-vember, made minor gains along thecoast north of Viareggio. On 24 Novem-ber, units of Task Force 45 captured Mt.Belvedere, about 5, miles west of High-way 64 above Poretta, but were able tohold the mountain only five days beforeit was regained by the enemy. Similarly,Mt. Castellaro in the 13 Corps zone 7or 8 miles northeast of Livergnano, wasretaken by the Germans before the endof the month. For the most part, forwardpositions were held by reduced forceswhile troops were rotated back to a restarea near Montecatini for ten days at atime. The men were also given passes toFlorence and even to Rome.7

On 16 December command of FifthArmy passed to Lt. Gen. Lucian K. Tru-scott, Jr., former VI Corps commander.General Clark succeeded Field MarshalSir Harold R. L. G. Alexander as com-mander of the Allied armies in Italy, tobe known thereafter by the earlier desig-nation of 15th Army Group. Alexandermoved up to supreme command of thetheater in place of General Sir HenryMaitland Wilson, who became represen-tative of the British Chiefs of Staff inWashington. Alexander's deputy andcommander of the U.S. theater was Lt.Gen. Joseph T. McNarney, who had suc-ceeded Devers in late October. Towardthe end of March 1945 General Eakerwas recalled to Washington to becomeChief of the Air Staff. He was succeededas Mediterranean Allied Air Force com-mander by Lt. Gen. John K. Cannon ofthe Twelfth Air Force.

When Clark assumed command of thearmy group, the Allied front in Italyextended on an irregular line from apoint on the Adriatic six miles northeastof Ravenna to the Ligurian coast threemiles south of Massa. Eighth and FifthArmies were in contact southwest ofFaenza.

Early in January the new commanddecided to postpone further large-scaleoperations until spring, when it was an-ticipated that some reinforcementswould be available, adequate supplylevels would have been attained, and theweather would be favorable for rapidexploitation by armor and motorized in-fantry 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 SecondWinter (Washington [1947]); (2) Opns Rpts, IICorps, Nov 44-Mar 45; (3) Opns Rpts, IV Corps,Nov 44-Mar 45; (4) The Allied Forces, Mediter-ranean Theater, Report by the Supreme AlliedCommander, Mediterranean, Field Marshal theViscount Alexander of Tunis, to the CombinedChiefs of Staff on the Italian Campaign, 12 De-cember 1944 to 2 May 1945 (London: His Maj-esty's Stationery Office, (1951) (hereafter cited asAlexander, 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, 1stArmored Division, pp. 386-96; (9) Schultz,85th Division, pp. 185-96; (10) Delaney, BlueDevils, pp. 164-84; (11) Robbins, 91st In-fantry Division, pp. 195-261; (12) Goodman,

Fragment of Victory, pp. 56-119; (13) TheodoreLockwood, ed., Mountaineers (Denver, no date),pp. 6-23; (14) Starr, ed., Salerno to the Alps, pp.

365-85.


way. The 365th and 371st RegimentalCombat Teams of the 92d Division andthe 1st and 11th RCT's of the 1st Brazil-ian Division arrived in the combat zonein October and, after intensive training,were ready for action in November. An-other combat team—the 366th, made upof men from other branches converted toinfantry—was assigned to Fifth Army inNovember and attached to the 92d Divi-sion. A newly arrived light tank battal-ion, the 758th, and the 1125th ArmoredField Artillery Battalion formed frominactivated antiaircraft units, were alsoattached to the 92d, while II Corps re-ceived a battery of British heavy guns.In addition to these organized units,Fifth Army received 5,000 individual re-placements in November, but was still7,000 men below Table of Organizationstrength.

In January more antiaircraft units, in-cluding most of those operating underTask Force 45, were reorganized as the473d Infantry regiment. Also in Janu-ary, the most important of all FifthArmy's reinforcements arrived when the10th Mountain Division, a highlytrained outfit of picked men, reached thecombat zone. These increments made itpossible to return 13 Corps to EighthArmy, with a corresponding realignmentof the army boundaries, although the6th South African Armoured and the 8thIndian Divisions remained with FifthArmy.

No reinforcements were received inFebruary, and late in March the 366thInfantry, which had not worked out wellas a combat unit, was disbanded, its per-sonnel being converted to service troops.The loss was more than balanced, how-ever, by the return of the 442d Regi-mental Combat Team from France,

where it had served with Seventh Armysince the end of September and hadagain demonstrated its outstanding fight-ing qualities. The Italian LegnanoGroup, with a strength of about two-thirds of a division, was also attached toFifth Army in March.

Shifts of units between corps, and ro-tation in the line, were motivated pri-marily by the need to rest veteran troopsand to give some experience to new ones.Training was a continuous process at alllevels, including an officer candidateschool set up in February. Meanwhilesupplies of ammunition were buildingup; trucks, tanks, and other vehicles werebeing repaired; worn-out equipment wasbeing replaced. At the staff level, plansfor the spring offensive were beingdrawn.

With snow blanketing the peaks andfilling the mountain passes, little actionof any kind was possible during the win-ter months, although vigorous patrollingcontinued along the entire front. In the13 Corps zone an attempt to seize the keytown of Tossignano on the Imola roadearly in December was repulsed withheavy losses. Late in the same month, anindicated build-up of enemy strength inthe thinly held IV Corps sector led to anattack by the 92d Division in the SerchioValley, but the Germans, already on themove, quickly seized the initiative andgained considerable ground before the8th Indian Division could move up fromarmy reserve to re-establish the originalline.

Early in February the 92d undertookanother limited offensive to improve itspositions on the left flank, but with littlesuccess. The 365th and 366th RCT's se-cured their objective, the command-ing ridge of Mt. della Stella in the


Serchio Valley, on 5 February, but couldnot hold the position against counter-attacks in force over the next severaldays. The 370th and 371st RCT's, seek-ing to advance to Massa along the narrowcoastal plain, ran into dense mine fieldsand fierce resistance that forced themback to their original positions withheavy losses in both men and tanks afterthree days of fighting. In the II Corpsarea, an attempt to improve their posi-tions by elements of the 34th Divisionwas similarly thrown back with heavylosses.

Only in the area to the left of Highway64, which figured prominently in Gen-eral Truscott's plans for the spring offen-sive, was any substantial success gained.There the 10th Mountain Division andthe 1st Brazilian Division, in brilliantmaneuvering over terrain as rugged asany in the Apennines, retook the long-disputed Mt. Belvedere and a dozenpeaks beyond it, giving Fifth Army bothexcellent observation into the Po Valleyand good positions from which to launchfurther drives, at the same time securinga l0-mile stretch of Highway 64 fromthe threat of enemy shelling. These ac-tions, which were carried out between18 February and 9 March, won for the10th Mountain Division the spearheadrole in the forthcoming Po Valley Cam-paign.

Medical Support in the Field

The conditions under which the FifthArmy medical service operated in thenorthern Apennines were very similar tothose experienced in the fall and winterof 1943 in the Cassino area, save onlythat the northern mountains were higherand the weather worse. During the

Gothic Line battles and the push towardBologna, the nature of the terrain re-duced much of the fighting to a series ofsmall unit actions involving no morethan a battalion and often less. To carefor casualties in such engagements, themedical service, too, had to function insmall units, with numerous forward aidstations and long litter hauls. The periodof stalemate was an unending battleagainst cold and dampness waged bysmall detachments of medical troopsclose to the outposts, with long evacua-tion lines to hospitals withdrawn to win-ter positions. In short, Fifth Army'ssecond winter in Italy was a repetition ofthe first.

Period of Active Combat

Medical Support of II Corps—Thetasks imposed on the medical battalionsand field hospitals supporting II Corpsin the Gothic Line battles and the sub-sequent drive toward the Po Valley werethe most difficult of the Italian cam-paign. The main highways were heavilytraveled, often under artillery fire, andalways at a distance from the actualfighting. Secondary roads were few, nar-row, heavily mined, and by Octoberdeep in mud. Bypasses built by II Corpsengineers were generally open only toone-way traffic, imposing dangerous de-lays on ambulances.8

8 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) AnnualRpt, 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 MedBn, 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, Oct44; (9) Weekly Rpts, 316th Med Bn, Sep 44; 316thMed Bn Hist. (10) Annual Rpts, 92d, 33d FieldHosps, 1944.


Division clearing stations with theirattached field hospital units were neces-sarily restricted to sites accessible to themain highways. As the rainy season ad-vanced, suitable locations were increas-ingly difficult to find, making close sup-port impossible and forcing additionalburdens on the collecting companies.Jeeps were used to evacuate battalionaid stations wherever possible, but eventhese versatile vehicles could not nego-tiate many of the mountain trails, leav-ing long and hazardous litter carries theonly alternative. In some sectors, sup-plies and equipment were brought upby mule; in others hand-carrying wasnecessary.

The assault on the Gothic Line waslaunched initially by the 34th and 91stDivisions along the axis of Highway 65.The clearing station of the 109th Medi-cal Battalion, organic to the 34th, movedup from the assembly area on 12 Septem-ber to a site left of Highway 65, about5 miles northwest of the point at whichHighway 6524 branches off towardScarperia and Firenzuola. There it wasjoined by a platoon of the 33d FieldHospital, both units remaining in placeuntil after the Gothic Line had beenbreached. The station admitted 244 pa-tients on 17 September, its largest singleday's total for the campaign. The clear-ing station moved forward on 27 Sep-tember to a site on Highway 65, about3 miles south of Futa Pass, where it re-mained until early October. During thisperiod, collecting companies of the bat-talion operated up to 10 miles beyondthe clearing station.

The clearing station of the 316th Med-ical Battalion, organic to the 91st .Divi-sion, remained in the assembly area until15 September, when it advanced to a

point east of Highway 65 about threemiles north of the road junction. Thesite was easily accessible but was sur-rounded by heavy guns, which invitedcounterbattery fire and led the unithistorian to describe it as an ambulancedriver's dream but a psychiatrist's night-mare. The supporting platoon of the33d Field Hospital was established in asomewhat safer spot on the west side ofHighway 65 in the vicinity of Cafaggiolo.Both units, for want of suitable forwardsites, remained in place throughout theGothic Line battles. The 91st had a moredifficult assignment than the 34th, andheavy casualties began coming into theclearing station on 11 September. A peakof 409 admissions was reached on the15th.

The 85th Division went into action on13 September along the axis of Highway6524. The clearing station of the organic3l0th Medical Battalion, together with aplatoon of the 32d Field Hospital,opened about two miles southwest ofScarperia the following day, althoughthe area was well within range of enemyguns. The field hospital stayed behindwhen the clearing station moved on 23September to a new area a mile south ofFirenzuola, another platoon of the 32dField moving up to take its place ad-jacent to the clearing station. Both hospi-tal and station were forced by enemy fireto abandon the site within two hours. Anew location somewhat farther to therear was occupied on 25 September, butthe access road was soon knee deep inmud. Until the station moved at the endof the month it was necessary to keep amaintenance truck available to haul outmired ambulances.

Two days after commitment of the88th Division on 22 September, the


clearing station of the organic 313thMedical Battalion opened in the vicinityof San Pellegrino on the Imola road. Aplatoon of the 32d Field Hospital caughtup with the station there on 26 Septem-ber. It was here that casualties from thebloody battle for Mt. Battaglia were re-ceived after litter carries up to 4.5 miles.To man the relay posts along the steep,treacherous evacuation trail, emergencybearers were pressed into service fromamong line troops, medical battalionheadquarters, and the clearing companyin addition to those borrowed from the54th Medical Battalion at corps level.

The second phase of the North Apen-nines Campaign, from the 1 Octoberassault on the Monghidoro line to thefinal breakdown in the mud beforePianoro, saw some of the hardest fightingof the entire war in Italy and the mostdifficult period for the medical service.Fatigue, exposure, and almost contin-uous rain and cold took a heavier toll inrespiratory diseases, trench foot, and psy-chiatric disorders than enemy weaponstook in wounded men, yet the battlecasualty rate was higher than for anycomparable period since the Salernolandings.9

Field medical installations of II Corpswere relocated early in October, reflect-ing the shift of emphasis back to High-way 65. Its site below Futa Pass alreadya quagmire, the 1st Platoon of the 34thDivision clearing station jumped aheadfourteen miles on 4 October to a sitesouthwest of Radicosa Pass, with the 2d

Platoon moving to San Benedetto north-west of the pass four days later. Neithersite was satisfactory, and the 1st Platoonshifted to Monghidoro on the 12th,where it occupied a battered resort hotelbuilding. The 2d Platoon set up in tentsin the same area three days later. Thesupporting platoon of the 33d Field Hos-pital was already in Monghidoro, havingmoved up on 9 October.

Although 34th Division casualtieswere relatively light in October, diffi-culties in evacuation continued to re-quire litter bearers in excess of thoseallotted. Men from kitchen and stationsections of the collecting companies wereused for this purpose, and in emergenciesline soldiers were borrowed from thecombat units. Among the hazards werefloods, landslides, and consistently poorvisibility due to fog and rain. At nightambulance drivers benefited from "ar-tificial moonlight" produced as an aidto transportation generally by beamingsearchlights in low trajectory over thearea.

By 1 October, clearing stations of the85th and 91st Divisions were in the vi-cinity of the road junction where High-way 6524 rejoins Highway 65, with the2d Platoon of the 33d Field Hospital sup-porting both. The hospital unit receivedthe greatest number of patients in itshistory for a comparable period at thissite—228 nontransportable priority sur-gical cases in a 14-day period. On 10 Oc-tober the 85th Division clearing stationmoved into the Idice Valley, about 5miles southeast of Loiano. The clearingstation of the 91st moved on 21 Octoberto a site about 2 miles south of Loiano,but the supporting platoon of the 33dField Hospital was soon rendered use-less because mud made it impossible to

9 For Fifth Army as a whole the wounded in ac-tion rate for October 1944 was 783 per 1,000 perannum, as compared with 973 for September 1943.For II Corps the October 1944 rate was 1,219 withan admission rate from all causes of 2,970 per 1,000per annum. See Annual Rpt, Surg, Fifth Army,1945, p. 63, and Annual Rpt, Surg, II Corps, 1944.


deliver patients to it. The engineers hadto construct a special road of rocks,straw, burlap, and landing-strip mattingto get the hospital out early in Novem-ber. A platoon of the 32d Field Hospitalwas established about a mile north ofMonghidoro on 13 October, primarily insupport of the 85th Division, though itwas some 3 miles distant from the divi-sion clearing station in a direct line andnearer 10 miles by road.

With the shift of the 88th Divisionto the Sillaro Valley, the clearing stationwas set up 6 October at Giugnola, andthe supporting platoon of the 32d FieldHospital at Belvedere a mile or so closerto the front. The 54th Medical Battal-ion, responsible for evacuating the IICorps clearing stations, moved its head-quarters to the vicinity of Traversa, amile north of Futa Pass, on 3 October.

In order to give close support to thecombat troops, the collecting companiesof the divisional medical battalions oftenoperated in two sections, the advancestation being as close as possible to theregimental combat zone. The ambu-lances were kept at the forward post andthe litter squads at the battalion aid sta-tions, which were themselves often splitinto two sections with separate evacua-tion routes. The rear echelon wouldmove up to the advance site as soon asconditions permitted, while the advancesection again moved forward with thecombat troops.

Evacuation was to the clearing stationof another division if that was more ac-cessible. In late October, when flood wa-ters washed out bridges and obliteratedtrails, the 85th Division clearing stationwas completely isolated for two days, dur-ing which period casualties were heldat the collecting stations or evacuated toother divisions. One regiment of the 85th

evacuated to the 88th Division clear-ing station by a devious route involvingthe use of artillery prime movers to crossswollen streams and the transfer of pa-tients from one ambulance to anotheron each such occasion. The 88th Divisionclearing station also took casualties fromelements of the 1st Armored, which weremoved into the line on the corps rightflank at this time. In several sectors am-bulances were washed into the streamsand temporarily immobilized if theywere not lost altogether. Vehicles of alltypes were punished unmercifully, withbroken springs a commonplace. Norwere vehicles the only casualties. Litterbearers were frequently under fire andexposed to booby traps and the hazardsof steep mountain trails in darkness. Thetoll of killed and wounded among themwas high.

During the period 10 September-31 October, the strength of the 54thMedical Battalion was augmented bya collecting company of the 162d Med-ical Battalion and elements of two am-bulance companies from Fifth Army, allof them being used to evacuate divisionclearing stations. The corps medical bat-talion also supplied to the divisions 75litter bearers from its own complement,and approximately 150 Italian infantry-men for litter work. The Italians provedreluctant and unreliable in this capacity,though others of their countrymen madethemselves invaluable to the medicalservice as pack-train drivers and asguides.10 The 54th Medical Battalion alsooperated a dental clinic and an eye clinic

10 Still other Italians, it should be noted, wereformidable guerrillas behind the German lines.Indeed, the German high command never learnedto cope successfully with the partisans of northernItaly. Kesselring, Soldier's Record, pp. 268-79.


for II Corps throughout the period ofcombat.

Medical Support of IV Corps—On theIV Corps front, where the military mis-sion was to hold rather than to advance,the task of the medical service was lessarduous. The 370th Regimental CombatTeam of the 92d Division was supportedby a collecting company and clearingplatoon of the organic 317th MedicalBattalion. Task Force 45 was supportedby elements of the corps medical battal-ion, the 163d. Since the antiaircraft unitsthat made up the bulk of the task forcedid not have enough medical personnelfor infantry operations, the 163d sup-plied aidmen and forward litter bearers aswell as performing its normal collectingand clearing functions. The initial in-crement of the Brazilian ExpeditionaryForce, the 6th Combat Team, wassupported by a collecting company andclearing platoon of the 1st BrazilianMedical Battalion; and Combat Com-mand B of the 1st Armored Division wascared for by Company B of the 47thArmored Medical Battalion. The 6thSouth African Armoured evacuated thearmy area through its own medicalchannels. Field hospital units for for-ward surgery were not available to rein-force the IV Corps medical service, butthe close proximity of evacuation hos-pitals and relatively easy evacuationroutes in large measure compensated forthe lack.11

The advent of the Brazilians creatednew problems for the IV Corps surgeon,

Lt. Col. Austin W. Bennett, particularlyin matters of liaison and of sanitation,since Brazilian standards were less rigor-ous than American. An American medi-cal officer was placed on duty with the 1stBrazilian Infantry Division to assist withtraining, medical records, and equip-ment. At one period, when the Braziliansector adjoined that of the 1st Armored,a Brazilian medical officer was detailedto one of the treatment stations of the47th Armored Medical Battalion to actas interpreter and to assist with Braziliancasualties passing through the station.The corps collecting company evacuat-ing the BEF sector, in addition to itsnormal functions, supplied men, litterbearers, and equipment for battalion aidstations of the 6th Combat Team.

Medical installations of IV Corps en-countered the same difficulty with rainand mud, and the same disadvantages ofterrain that were a constant hazard inthe II Corps area, but, without the bur-dens of an offensive, the conditions weremore readily endured. Only in the sectorwhere Combat Command B operatedafter 1 October, attached to the 6th SouthAfrican Armoured, were conditions com-parable to those on the II Corps front.Primarily for this reason, the unit wasbrought under II Corps control at thistime. When CCB moved north on High-way 64 early in October, the supportingtreatment station for the first time inits history was unable to find enoughlevel ground to pitch its tents and wasforced to set up in a village where build-ings were available.

Inactive Period

With Fifth Army in defensive posi-tions for the winter, little movement of

11 The main sources for this section are: (1) An-nual Rpt, Surg, Fifth Army, 1944; (2) Annual Rpt,Surg, IV Corps, 1944; (3) Hist, 317th Med Bn, 16Oct 42-15 Jul 45; (4) Annual Rpt, Surg, 1st ArmdDiv, 1944; (5) Hist, 47th Armd Med Bn, Sep, Oct 44;(6) Annual Rpt, 163d Med Bn, 1944.


medical units was required. Collectingand clearing companies of the organicmedical battalions accompanied theircombat formation as they were rotated tothe Montecatini rest area, while those re-maining at the front made themselvesas secure and as comfortable as condi-tions permitted. Clearing stations, col-lecting stations, and even battalion aidstations set up in buildings or shells ofbuildings. When these were not avail-able, tents were winterized. As had beenthe case in the previous winter at theGustav Line, caves and cavelike rock for-mations were utilized, often floored withlumber from discarded shell cases. Per-sonnel of the forward stations withinrange of enemy artillery dug in, roofingfoxholes with salvaged timbers and sand-bags in a manner reminiscent of Anzio.Stoves were issued for wards and operat-ing rooms.12

II Corps Front—The existence of astatic front did not mean that medicalunits were idle. In the II Corps sectorcontinuous patrol activity and intermit-tent shelling accounted for enough

casualties to keep forward stations inbusiness even without the disease andinjury toll inevitable under the circum-stances of weather and terrain. At thesame time, the task of evacuation ofcasualties was enormously more difficultwith the steep and twisting roads nowicy and treacherous under drifting snow,and litter trails obliterated.

Ski litters were used successfully insome sectors. One collecting company ofthe 34th Division used a toboggan toevacuate its forward station duringJanuary. The 91st Division equipped onelitter squad in each collecting companywith snowshoes, but other medical bat-talions found them of little value. Moregenerally effective were ice creepers,worn by litter bearers of all divisions inthe line.

Medical units themselves continuedto suffer casualties from enemy shellslanding in station areas or on highways,and litter bearers were occasionally firedupon, despite their Red Cross identifi-cation.

The 92d Field Hospital reverted toarmy control in November, two of itsplatoons being transferred to the IVCorps sector, where they acted as smallevacuation hospitals. The 33d Field con-tinued to support II Corps, with one pla-toon east of Monghidoro and one in theSillaro Valley, each serving elements oftwo divisions. Both field hospitals andclearing stations held patients somewhatlonger than would have been the caseunder conditions of active combat, theclearing stations in particular doublingas station hospitals for garrison troops.

The four collecting companies of the54th Medical Battalion—including oneattached from the 162d—continued toevacuate divisional clearing stations

12 Principal sources for this section are: (1) An-nual Rpts, Surg Fifth Army, 1944, 1945; (2)Annual Rpts, Surg, II Corps, 1944, 1945; (3) An-nual Rpts, Surg, IV Corps, 1944; (4) Annual Rpt,54th Med Bn, 1944; (5) Monthly Rpts, 54th MedBn, Nov 44-Mar 45; (6) Annual Rpts, 163d MedBn, 1944, 1945; (7) Annual Rpts, Surg, 1st Ar-mored, 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) OpnRpts, 109th Med Bn, Nov 44-Mar 45; (12) OpnRpts, 310th Med Bn, Nov 44-Mar 45; (13) OpnRpts, 313th Med Bn, Nov 44-Mar 45; (14) Unit Hist316th Med. Bn, Nov 44-Mar 45; (15) Hist Data, 317thMed Bn, Nov 44-Mar 45; (16) Annual Rpts, 32d and33d Field Hosps, 1944; (17) Annual Rpts, 32d and33d Field Hosps, 1945.


TREATING A WOUNDED SOLDIER in a 317th Medical Battalion collecting station nearMassa, February 1945.

through an ambulance control point onHighway 65 below Radicosa Pass. Bedquotas from each Fifth Army hospitalwere telephoned to the control pointdaily and ambulances routed according-ly. For two weeks in mid-November aplatoon of the 683d Clearing Company,54th Medical Battalion, relieved the 88thDivision clearing station at Giugnola,but otherwise the chief function of thecompany was the operation of specialclinics for II Corps. The dental andeye clinics at Traversa remained inoperation throughout the winter, and a

venereal disease treatment center, fornew cases of gonorrhea only, was openedat the same site on 11 November.

IV Corps Front—IV Corps front wasmore active than that of II Corps, the92d Division fighting limited engage-ments in November and February, andthe 10th Mountain and 1st BrazilianDivisions taking part in more extendedoperations in February and March. Here,too, snow and cold were limiting factors,with rain a continuing hazard in thecoastal sector. The medical service of


IV Corps was also compelled to resort toa variety of expedients to overcome de-ficiencies in the medical complement ofsome of its combat units. In the earlymonths of the winter the 163d MedicalBattalion continued to give combat med-ical support to Task Force 45 and, withthe assistance of a collecting company at-tached from the 161st Medical Battalion,to evacuate divisional clearing stations.The battalion also gave first echelon sup-port to service troops and others withoutmedical detachments of their own, oper-ated a venereal disease hospital for thecorps, and supplied an expansion unitfor one of the evacuation hospitals in thearea. The 671st Collecting Company,supporting troops on the right flank ofthe corps sector, was provided withequipment to operate a 25-bed provi-sional hospital, should heavy snows iso-late the area. As on the II Corps front,additional ambulances were supplied byFifth Army.

In order to support the 366th Infan-try, which was attached to the 92dDivision on its activation in November,one of the collecting companies of the317th Medical Battalion operated for atime in two sections. For the Februaryoffensive, in which all four regimentsof the 92d were engaged simultaneously,a provisional collecting company wasused, with 2 medical officers, 9 medicaland 6 surgical technicians, and 12 ambu-lance drivers drawn from the regularcompanies, and Italian litter bearers.While the division was engaged simultan-eously on the coast and in the SerchioValley, both clearing platoons were inoperation, reinforced by ambulancesfrom corps. Later in February, when the473d Infantry was also attached to the92d, it was again necessary for one col-

lecting company to support two combatteams.

In the Mt. Belvedere offensive andsubsequent operations west of Highway64, the medical units supporting the l0thMountain Medical Battalion did not fol-low the conventional organizational pat-tern. Equipment was designed for mulepack or hand carry, and assigned vehicleswere reduced in number accordingly.The Table of Organization called for126 animals but for only 15 motor ambu-lances, all of them in the clearing com-pany. Each of the 3 collecting companieshad 44 litter bearers instead of the 36allotted to infantry companies. Theclearing company was divided into 3rather than 2 platoons. Since the wholedivision was set up for animal transport-ation—there were more than 6,000animals in the T/O—there was a sizableveterinary company, and there wereveterinary sections at the battalion levelin the medical detachment. The divisionarrived in Italy, however, without itsanimals. Italian mule pack trains weresupplied, but transportation deficiencieswere otherwise made up by motor vehi-cles. The medical battalion received 30instead of 15 ambulances, which weretransferred from the clearing to the col-lecting companies. Jeeps were borrowedfrom line units.

In the first battle test, the 10th Moun-tain Medical Battalion performed like aveteran outfit, amply justifying the carewith which its personnel had been se-lected and trained. Like the combat for-mations, medical units moved intoposition under cover of darkness. Col-lecting stations, and often clearing sta-tions as well, were generally within rangeof enemy artillery, and many casualtiesresulted, though few of them were psy-


10TH MOUNTAIN DIVISION AID STATION ON SLOPES OF MT. BELVEDERE

chiatric. Litter squads of one companyworked the first 3 days of the offensive—72 hours—without sleep and with verylittle food. Litter carries were downprecipitous mountain sides, frequentlytaking as long as 10 hours, yet the samesquad would return immediately for an-other casualty.

At two points, division engineers builtcable tramways to bring the woundedout from otherwise almost inaccessiblepositions. The first of these was com-pleted the morning of 21 February fromMt. Mancinello—Pizzo di Campianoridge captured the night of the 19th. A

difficult 3- or 4-hour haul down the ridgewas reduced to 4 minutes, and the carry-ing time between aid station and collect-ing station cut to 6 or 7 hours. The othertramway, some 5 miles southwest ofVergato, spanned a deep valley acrosswhich the only passage was a narrow,tortuous dirt trail unusable even byjeeps. In the latter stages of the offensive,when the 85th RCT was digging in onMt. della Spe, the only possible evacua-tion route lay through the village ofCastel d'Aiano, which was shelled byGerman guns every time a vehicle movedin the streets.


TRAMWAY ASCENDING TO MT. MANCINELLO-PIZZO DI CAMPIANO RIDGE

On the evening of 3 March the col-lecting station of Company C was hit bya German shell that exploded a boobytrap and completely demolished thebuilding in which the station washoused. Two chaplains and one enlistedman were killed, and 13 other station per-sonnel more or less severely wounded,one of whom later died. Fortunatelythere were no patients, since CompanyB, in the most forward position, wasevacuating the entire division that day.Between 0600 and midnight, more than200 casualties passed through Company

B's station, including 40 prisoners ofwar and a few partisans.

Training and Re-equipment—Thesecombat actions, involving as they didrelatively recent arrivals in the theater,did not interfere with a general programof training and refurnishing the fieldmedical service on an army-wide basis.Officers with more than twenty-fourmonths of combat duty were replaced byfresher men, while the veterans went tofield and evacuation hospitals to polishup their techniques. Units were brought


up to strength, line soldiers being trainedas medical replacements where no otherswere available. Ambulances and othervehicles were systematically overhauledor replaced. Supply levels were built up.Physical conditioning went along withrecreational activities. At the same time,the special problems anticipated for thecoming spring offensive were given in-dividual attention.

After its own positions were stabilizedjust before the middle of March, per-sonnel of the 10th Mountain Divisionconducted a school in methods of moun-tain evacuation. At a site near the mouthof the Arno River, medical detachmentsand battalions were given special train-ing in the technique of river crossingsalong with their respective combat ele-ments. General Martin was no less deter-mined than General Truscott to makethe next campaign the last.13


Hospitalization During theFall Offensive

The deployment and use of FifthArmy hospitals during the Gothic Linebattles and the subsequent advance to-ward Bologna were always conditionedby the unfavorable terrain, the poor roadnetwork, and the weather. On the IICorps and IV Corps fronts, enemy artil-lery fire delayed the forward movementof hospitals, or forced the abandonmentof otherwise acceptable sites, while evac-uation lines stretched out and ambu-lances broke down under constant use.To these disadvantages was added a

persistent shortage of beds that could becompensated for only by continuousoverloading of facilities and by impro-visations at all echelons of the medicalservice.14

Among the expedients in general usewere the practice of employing surgicalteams from evacuation hospitals in fieldhospital units or other evacuations morestrategically placed; and of putting per-sonnel from less active units on tempo-rary duty with those carrying heavypatient loads. Surgeons were also ex-changed between evacuation and generalhospitals for 6-week intervals to give eachgroup a more realistic understanding ofthe problems of the other. Clearing andcollecting companies were consistentlyused to augment the beds of evacuationhospitals in the army area.

Hospital Support of II Corps—WithII Corps making the main U.S. effortagainst the Gothic Line, the bulk of theFifth Army hospitals were eventuallydeployed along the axis of Highway 65,but there was an unavoidable lag behindtroop movements. When the assault waslaunched on 10 September, the nearestevacuation hospital was the 15th, whichopened on that date in a large schoolbuilding in Florence. All transportablecasualties of the first two days went there.On 12 September the 94th Evacuationmoved up to Pratolino, about six milescloser to the front but still in the rearof the assembly area from which the 34thand 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) An-nual Rpt, Surg, Fifth Army, 1944; (3) Unit rptsof med units mentioned in text.


MAP 35—Fifth Army Hospitals and Medical Supply Dumps, 18 September 1944

At Pratolino, where it was housed inbuildings, the 94th Evacuation Hospitaltook the more serious casualties from theentire corps for the next two weeks, theoverflow going back to the 15th inFlorence. Medical cases and a few lightbattle wounds were sent still fartherback, to the 8th and 16th Evacuations inthe San Casciano area south of Florence.The Gothic Line had been overrun, andthe 88th Division's costly drive down theSanterno Valley was under way beforethe 56th Evacuation Hospital opened intents on 24 September at Scarperia, southof II Giogo Pass on Highway 6524.

Though it was a 750-bed unit, thecapacity of the 56th was quickly over-taxed. The heavy influx of surgical cases

forced the establishment of an overflowpreoperative ward, while medical casesalso constituted an abnormally heavyload. In an effort to lighten the burdenon the 56th, General Martin sent an ad-vance party from the 16th EvacuationHospital to Firenzuola on 27 Septemberto locate a site for that unit, but enemyfire drove the men back and the movehad to be postponed. Before the Firen-zuola area was safe, the rainy season hadset in, and the prospective site had to beditched and protected by a levee froma neighboring stream. It was 4 Octoberbefore the 16th Evacuation took over therole of most forward army hospital.

The 16th was in position to take cas-ualties from both flanks of the II Corps


front, and, for 10 days, admissions wereheavy, reaching a peak of 203 on 15 Octo-ber. At the same time, the 56th at Scar-peria continued to operate at capacity,and the 94th, still at Pratolino, set anew unit record for surgical cases in thefirst two weeks of October.

As the weather steadily worsened, itbecame increasingly important to gethospital beds as far forward as possible.Evacuation over mud-clogged roads wasbecoming more difficult, and there wasdanger that Futa Pass might be blockedby snow. To ease the pressure, the 750-bed 8th Evacuation Hospital moved toPietramala, just south of Radicosa Pass,on 14 October; and the following day the94th moved up to Monghidoro, aboutfive miles farther north on Highway 65.The 94th was replaced at Pratolino by afixed hospital.

Both forward hospitals quickly ran in-to difficulties. The 8th was sited in arolling field, already churned to mud byheavy guns that were still there whenthe first loads of hospital equipment ar-rived. Ward tents were pitched on slop-ing ground, and the operating tent wasgiven a level base only by cutting awaythe top of a knoll. Conditions at Monghi-doro were even worse, for the area wasstill under artillery fire. So great, indeed,was the danger from enemy shells thatthe 94th Evacuation closed 5 days afterit opened. Two medical officers, 5 nurses,and 10 enlisted men stayed at Monghi-doro to care for 30 nontransportablechest and abdominal cases, and to guardthe equipment. Twenty-one nurses and70 enlisted men were sent back to restareas; the remainder of the nurses, ashock team, and 2 surgical teams wereput on temporary duty with other hos-pitals; and the rest of the personnel went

into bivouac with the 8th Evacuation atPietramala.15 On 29 October, after IICorps had been ordered to take defensivepositions, surgical personnel of the 94threturned to Monghidoro. The medicalstaff and all others not needed at the for-ward site went back to Florence, wherethey joined the 15th Evacuation, settingup 380 beds for medical cases only.

Meanwhile a new departure had beentaken in the treatment of neuropsychi-atric casualties.16 As the strain of weeksof bitter fighting in the most difficultconditions of weather and terrain beganto be felt in a rising toll of psychiatricdisorders, General Martin set up a psy-chosomatic center toward the end ofOctober in the vicinity of Cafaggiolo,just north of the point where Highway6524 branches off from 65. Core of thecenter was the 2d Platoon of the 601stClearing Company, 161st Medical Bat-talion, which had been serving as FifthArmy neuropsychiatric hospital since De-cember 1943. The 1st Platoon of thesame company was established on 23 Oc-tober adjacent to the neuropsychiatrichospital to specialize in gastrointestinalcases, many of which were believed to beof psychosomatic origin. On 1 Novemberthe 1st Platoon of the 602d ClearingCompany, 162d Medical Battalion, whichhad been operating an expansion unitfor the 15th Evacuation since 18 Septem-ber, also joined the psychosomatic center,but took minor disease as well as gastro-intestinal cases.

The 3d Convalescent Hospital moved15 Periodic Rpt, 94th Evac Hosp, Jan-Aug 45.

The 1944 Annual Report says the Covigliaio area,roughly three miles south of Pietramala, but thelater report is more detailed, and in this case moreprobable, since mess equipment was presumablyleft at Monghidoro.


MAP 36—Fifth Army Hospitals and Medical Supply Dumps Supporting II Corps,25 October 1944


38TH EVACUATION HOSPITAL FLOODED AT PISA, NOVEMBER 1944

up to Pratolino on 26 September. (Map36)

Hospital Support of IV Corps—Thelightly held IV Corps sector started theGothic Line campaign with the supportof only one evacuation hospital, the 750-bed 38th, which opened in the outskirtsof Pisa on 15 September. The safety fac-tors were: the relatively minor militaryoperations anticipated; the proximity ofFlorence to the IV Corps right flank,with good roads available; and the easyaccess in emergency to base hospitals inthe Leghorn area. (See Map 35.) The38th Evacuation was augmented by a col-lecting company of the 162d Medical Bat-talion, and by 25 Brazilian medical

officers, 20 nurses, and 60 enlisted men tocare for BEF casualties.17

All efforts to secure an additional hos-pital for the support of IV Corps faileduntil mid-October, when General Martinwas notified that the 250-bed 29th Sta-tion Hospital, then inoperative in NorthAfrica, would be converted into a 400-bed evacuation hospital for Fifth Army.The unit was brought immediately toItaly, and the work of conversion carriedout with such dispatch that it was readyto take patients as the 170th EvacuationHospital the first week of November.

17 Figures for Brazilian personnel are from re-ports of the 16th Evacuation Hospital, to whichthey were later transferred. The available reportsof the 38th do not specify numbers.


It was none too soon. On the night of2-3 November the flooding Arno Riverburst its banks, and a wall of waterpoured into the area occupied by the38th Evacuation. Before morning thewater was 4 to 6 feet deep in the hospitalarea. The 495 patients in the hospitalwere hastily carried 300 yards to the rela-tive safety of a partially destroyed bar-racks being used by the 12th MedicalDepot Company. There, counting bothpatients and hospital personnel, morethan 800 persons were housed in spacedesigned to accommodate about 200.Enough equipment and supplies weresaved to operate the hospital for 48hours, which proved to be long enoughfor the inundated roads to becomeusable.

As soon as vehicles could get through,a pool of fifty ambulances formed by the162d Medical Battalion picked up thestranded patients and distributed themamong fixed hospitals in Leghorn andFifth Army units in the II Corps area.Although most of its equipment was ulti-mately salvaged, the 38th Evacuation wasfor the time being rendered inoperative,and its personnel were placed on tem-porary duty with other medical installa-tions.

To replace the 38th Evacuation, the170th opened at Viareggio on 6 Novem-ber, and a unit of the 32d Field Hospital,augmented by a platoon of the 615thClearing Company, 163d Medical Bat-talion, established a 250-bed hospital atMontecatini. The Viareggio site was closeto the 92d Division's front in the coastalsector, while Montecatini was accessibleboth to the center and the right flank ofIV Corps. A portion of a civilian hospitalin Lucca, about midway between thetwo sites on an east-west line, was also

requisitioned for nontransportable cas-ualties, which were cared for by surgicalteams of the 38th Evacuation.

Winter Dispositions

By early November it was clear thatmilitary activity would be strictly limitedfor some time to come, and the task ofpreparing army hospitals for the winterbegan. The 16th Evacuation, which hadbeen twice flooded at Firenzuola, wasmoved back on 10 November to Pistoia,where Highway 64 enters the mountainsfrom the Arno plain. The site had beenintended for the 38th, but that unit wasstill immobilized.18

The Brazilian medical personnel weretransferred at this time from the 38thEvacuation to the 16th, which was nowjust behind the Brazilian sector. Normal-ly the Brazilians took complete care oftheir own wounded, but when the loadwas heavy U.S. medical officers served asassistant surgeons on Brazilian teams.Brazilian surgeons similarly acted as as-sistants on U.S. teams when Americancasualties were heavy.

On 19 November the 38th Evacuationtook over the Montecatini site, as well asthe clearing platoon that had been oper-ating there. The field hospital unit fromMontecatini moved up Highway 64 tothe vicinity of Porretta in the Braziliansector where, with two Brazilian andtwo U.S. surgical teams, it operated as asmall evacuation hospital throughout thewinter. Another unit of the 32d FieldHospital supplanted the 170th Evacua-

18 Principal sources for this section include: (1)Annual Rpts, Surg, Fifth Array, 1944, 1945; (2) An-nual Rpts, Surg, II Corps, 1944, 1945; (3) AnnualRpt, Surg, IV Corps, 1944; (4) Unit rpts of themed units mentioned in text.


MAP 37—Fifth Army Hospitals and Medical Supply Dumps on the IV Corps and92d Division Fronts, 15 January 1945

tion at Viareggio after the latter hadbeen twice damaged by enemy shells.The 170th moved on 25 November toLucca, carrying with it 150 patients,many of them litter cases. (Map 37)

The 3d Convalescent Hospital, deepin mud at Pratolino, found the task ofwinterizing its 300 tents too great and inlate November began moving to Flor-ence for the winter. Before the move wascompleted, however, adequate quarterswere found in a group of hotel buildingsin Montecatini, where the hospital wasestablished just before the end of theyear. One factor involved in the changeof plans was the advantage of having aconvalescent hospital located in a rest

area where patients were able to benefitfrom the recreational facilities available.In mid-January, Brazilian personnelwere attached to the 3d Convalescent.

Other Fifth Army hospitals remainedwhere they were throughout most or allof the winter, making do as best theycould against the hazards of mud, cold,snow, and wind. A move to reopen the94th Evacuation at Monghidoro late inDecember was abandoned, and the medi-cal service of that unit continued tooperate in Florence in conjunction withthe 15th Evacuation, taking half of themedical cases admitted to the joint instal-lation, which functioned under a singleadministration as a 1 ,000-bed station hos-


BRAZILIAN NURSES ATTACHED TO THE 16TH EVACUATION HOSPITAL

pital. The surgical service of the 94thremained at the forward location, despitecold and snow that reached a depth offour feet, until mid-February, when re-newed enemy shelling again forced aban-donment of the site. The surgical servicethen ceased to function as such, but sur-gical teams were placed on temporaryduty with the 32d Field and the 8thEvacuation. A number of the nurses alsowent on detached service with otherunits. Tentage was left at Monghidorounder guard. (Map 38)

A few miles farther back on Highway65, the 8th Evacuation stuck out thewinter at Pietramala, the coldest spoton the II Corps front. Tents were floored

and walled to a height of 4½ feet withwood, and reinforced by overhead beamsagainst the weight of the snow, but eventhese precautions were not always pro-tection against the gales that sweptperiodically across the sloping hospitalarea. On 8 December, before the win-terizing was complete, a double wardtent, flooring sidewalls and all, was liftedclear off the ground, carried over 6 wardsand dropped on another tent. All to-gether, 8 tents were blown down andothers damaged. The hospital census waslow at the time and no patients wereinjured, but it was necessary to send 30or 40 postoperative cases to the 15thEvacuation in Florence. After that ex-

MAP 38—Fifth Army Hospitals and Medical Supply Dumps on the II Corps Front,15 January 1945


perience, wood and prefabricated steelbuildings were placed at the two endsof each row of ward tents and securedby steel cables anchored to buried logs.As if wind and cold were not enough,the 8th Evacuation also wrestled withthe perennial problem of mud. At least5,000 truckloads of rock were used tomaintain roads in the vicinity of the hos-pital area before the unit left the sitelate in April. As the most forward hospi-tal in the II Corps zone, the 8th Evacua-tion handled the bulk of the casualtiesfor the first three months of 1945, battlewounds exceeding medical cases.

The Scarperia site, where the 56thEvacuation Hospital spent the winter,was only slightly more favorable thanthat of the 8th at Pietramala. As at themore forward installation, cold, snow,and wind were intermittent hazards, andthe battle against mud a never-endingproblem. Patients came mostly from thecorps right flank, down Highway 6524.

In response to General Martin's ur-gent appeal for more beds, the 15th FieldHospital was returned to Italy late inthe year, one platoon coming from south-ern France and the other two fromCorsica. Just before the end of Decem-ber the unit was set up east of Highway65 and two or three miles north ofCafaggiolo, where it operated as a 400-bed hospital for medical cases. Withspecialists from the 6th General Hospitalattached, the 15th Field took over thepsychosomatic work performed sinceOctober by the 1st Platoon of the 601stClearing Company, the latter unit be-coming a hospital for general medicaland slightly wounded cases in mid-Janu-ary. The 1st Platoon of the 602d Clear-ing Company, which had also beenassociated with the psychosomatic center

at Cafaggiolo, remained in the area foranother month as a medical hospital,then shifted to Prato, between Florenceand Pistoia on the edge of the Arnoplain, where it continued in the samecapacity. The neuropsychiatric hospitalremained throughout the winter atCafaggiolo, taking cases direct from theclearing stations and from the 15th FieldHospital.

In connection with its general medicalwork, the 15th Field made detailedstudies of the major types of medicalcases occurring among front-line troopsto determine whether a strictly medicalforward hospital could retain such casesin the army area and thus hasten returnto duty. A section of the 2d MedicalLaboratory was attached. At the sametime, observers were sent to other fieldhospitals where they studied the tech-nique of operating as forward surgicalunits in preparation for a similar role inthe spring offensive.

In the IV Corps sector no changes weremade in hospital sites after the first of theyear. The enemy thrust in the SerchioValley late in December led to prepara-tions for heavy casualties includingplans for reinforcing the 170th Evac-uation at Lucca, should that be neces-sary. Pigeons were sent to the 170th asinsurance in case phones were down, andall of the hospital's patients were evacu-ated to base installations. The counter-attack, however, was quickly stopped,and medical units remained in place.

In Florence the venereal disease hos-pital and the Fifth Army prosthetic andoperative dental clinic, both adminis-tered by the 2d Platoon of the 602dClearing Company, 162d Medical Bat-talion, took patients from II and IVCorps of Fifth Army. The lull in hostil-


8TH EVACUATION HOSPITAL AT PIETRAMALA, coldest spot on the II Corps front.

ities was reflected in late March by anincrease in venereal beds from 250 to290.


Evacuation to Army Hospitals

Throughout the North ApenninesCampaign and the winter stalemate,evacuation from corps to army installa-tions was carefully controlled by theFifth Army evacuation officer, ColonelCamardella. As has already been noted,the 54th Medical Battalion, responsiblefor evacuation from II Corps, main-tained an ambulance control point onHighway 65 to which daily quotas for

each evacuation hospital were tele-phoned every morning. During the earlypart of the campaign, inadequate bedstrength and heavy casualties made itimpossible to follow a fixed policy withconsistency, but so far as circumstancespermitted, the patient census of the mostforward hospital was kept relatively lowto guard against sudden emergency. Ingeneral, evacuation during daylighthours was to installations farther to therear, while the most forward unit tookthe bulk of the casualties at night toshorten the hazardous ambulance runs.Except in emergency, not more than 100surgical cases were admitted to any givenhospital in a single day. When the num-ber of casualties began to decline in


AMBULANCE ON ICY ROAD, LOIANO AREA

November, a system of triage at the am-bulance control point was instituted,patients being routed to those hospitalsbest equipped to care for them.19

All transportation of patients withinthe corps area was by ambulance overroads often deep in mud or heavy withsnow. During the early months of 1945,vehicles were frequently able to cover nomore than five miles an hour. The sys-tem nevertheless worked satisfactorilyboth under the most severe conditionsof combat and in the worst weather ofthe winter.

On the IV Corps front, supported asit was by only one evacuation hospitaluntil mid-November, no selectivity waspossible. Even after November, whenevacuation hospitals were sited at Lucca,

19 Principal sources for this and the followingsection 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) AnnualRpts, 1944, 1945, of 54th, 161st, 162d, 163d MedBns; (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 802dand 807th Med Air Evac Transport Squadrons, AF;(9) Annual Rpt, 41st Hosp Train, 1944; (10)

Annual Rpt, Surg, PBS, 1944; (11) SemimonthlyMed Sitreps, Surg, PBS, Sep 44-Mar 45.


Montecatini, and Pistoia, the road net-work did not permit the full applicationof a quota system. The 163d MedicalBattalion found it necessary to operateambulance control posts on each of themain axes of the corps' advance in orderto rout emergency cases to the nearesthospital. It was nevertheless possible byco-ordinating these posts to regulate theflow of patients to some extent.

Evacuation to Base Hospitals

The problem of clearing Fifth Armyhospitals during the first several weeksof the North Apennines Campaign wascomplicated by factors outside the con-trol of the army surgeon. At the start ofthe offensive early in September therewere only two fixed hospitals in northernItaly, the 64th General near Leghornand the 55th Station attached to it. Afew other units were on the way, butthe prospect of an early breakthroughinto the Po Valley precluded establish-ment of more beds than were absolutelynecessary south of the mountains. Allcasualties from southern France, more-over, were still going to Naples, leavingfew beds available for movement else-where. At the same time, the shortage ofmobile beds in the Fifth Army area madeit essential to transfer patients to baseinstallations without unnecessary delay.

The only base hospitals available werethose in Rome and Naples, and the onlymeans of reaching them was by air. Forthe first 10 days of the offensive, patientsfrom the forward evacuations were car-ried by ambulance to the Rosia airfieldsouthwest of Siena and some 50 milesfrom Florence, whence they were flownto the rear by planes of the 802d and807th Medical Air Evacuation Trans-

port Squadrons. Before 20 September,936 patients went to Naples and 2,295to Rome. On that date the Florence air-field became operable, and by the lastday of the month 1,445 Fifth Army pa-tients had been flown from that field toNaples, along with 1,397 to Rome.20

The 24th General Hospital opened inFlorence on 21 September with 1,500beds, and a week later 2 station hospitalswith an aggregate of 1,250 beds movedinto the Leghorn area to which IV Corpscasualties were being routed. Despitethese additional fixed beds, the situationbecame acute in the first week of Octoberwhen bad weather prevented any airliftsto the rear. In addition to a capacityload of patients from forward evacuationhospitals, the 24th General also had tofind room for those already in holdingunits at the Florence airfield. During thesecond week of October, Fifth Army wasgiven air priority over Seventh Army,but intermittent poor weather condi-tions prevented full use of it, and in thelast week of the month all planes weregrounded. The limited number of flyingdays held air evacuation to Rome andNaples to 5,000 for October and left for-ward hospitals dangerously crowded. Asa relief measure, all transportable pa-tients from the 24th General were car-ried by ambulance to Leghorn late inthe month. On 21 October control of airevacuation passed from the Surgeon,Fifth Army, to the Surgeon, PeninsularBase Section.

20 These and subsequent figures for air evacua-tion in the text are from the reports of the twoMAETS squadrons. They do not agree entirelywith figures given in the annual report of theSurgeon, MTOUSA, for 1944, which are for pa-tients received by air at PBS hospitals, but it isbelieved the MAETS tabulations are the moreaccurate.


Meanwhile, as the prospects for abreakthrough before winter faded, morefixed beds were coming into northernItaly. Two thousand more beds wereestablished during October in the Leg-horn area, and the 250-bed 55th StationHospital took over the Pratolino sitefrom the 94th Evacuation, bringing thetotal to 4,750 at Leghorn and 1,750 inthe Florence area.

In November, with southern Franceno longer a drain upon the facilities ofthe Mediterranean theater, the situationeased considerably. Patients from the IICorps area were thereafter triaged atthe Florence airfield, being flown to therear if aircraft were available or, it not,distributed among fixed hospitals in thevicinity. The 2,000-bed 12th GeneralHospital joined the group at Leghornearly in December. January saw the es-tablishment of a 500-bed station hospitalin Florence, one in Pisa, and the 1,500-bed 70th General in Pistoia, bringingthe T/O total to 11,000 fixed beds. InFebruary air evacuation began betweenFlorence and Leghorn, and rail evacu-ation was started between Florence andLeghorn by way of Montecatini.

Evacuation from Fifth Army units toairfields or to base hospitals in the im-mediate rear of the army was by the161st and 162d Medical Battalions, bothof which had reduced their collectingcompanies to ambulance companies inorder to supply personnel to their clear-ing platoons for the operation of specialhospitals. In the II Corps area, the 162ddetailed enlisted men late in Novemberto operate emergency aid stations alongHighway 65 for stranded ambulances.

Air evacuation to base hospitals inNaples continued throughout the winteron a modest scale, but the emphasis was

increasingly on holding in army hospi-tals all patients who might recover intime for duty during the planned springoffensive. Evacuation policy in army in-stallations during the first three monthsof 1945 was 60 to 120 days.


In preparation for the Gothic Lineoffensive the 3d Storage and Issue Pla-toon of the 12th Medical Depot Com-pany moved to the vicinity of Florencethe last day of August, with the missionof supporting II Corps. On 14 Septem-ber headquarters of the company andthe 1st Storage and Issue Platoon estab-lished the main Fifth Army medical sup-ply depot in Florence, and three dayslater the 2d Storage and Issue Platoonset up an issue point for IV Corps inPisa. All units were in buildings, themain dump being located in a pharma-ceutical plant that the Germans hadrendered unfit for anything but stor-age.21

The IV Corps dump moved to a morecentral location in Lucca on 30 Novem-ber, but was still too remote from por-tions of the long corps front to be readilyaccessible to combat medical units. Tocompensate for distance, the supply sec-tion of the clearing company, 163d Med-ical Battalion, was enlarged to maintaina forward dump for the corps in thevicinity of Valdibura. The II Corps

21 This section is based on the following docu-ments: (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.


depot moved on 15 October to Filigareon Highway 65 just below Monghidoro.This dump maintained heavy stocks ofintravenous solutions, dressings, blan-kets, litters, and cots throughout the win-ter as a safeguard against the possibilitythat snow might interrupt communica-tion with the Florence depot.

The Florence depot received its ownstocks by truck from the PBS dump inLeghorn. Little in the way of localprocurement was possible, but the re-pair and maintenance section was activeand much equipment was salvaged. Theoptical and dental sections were alsoactive during the winter months, whichwere largely devoted to reconditioningboth men and equipment.

Professional Services in theArmy Area


Forward Surgery—Front-line surgeryin the North Apennines Campaign fol-lowed the pattern that had been steadilyevolving since operations in Sicily, butwith greater pressure than ever beforeon the surgical staffs. The withdrawal ofthree evacuation and two field hospitalsfor use in southern France, together withthe loss of half of the 2d Auxiliary Surgi-cal Group, meant that field units sup-porting II Corps in the northernApennines were overcrowded during theweeks of heaviest combat, and surgicalteams worked without regard to hours.Surgical teams from base hospitals wereused to replace in part the teams sentto France, but the nature of their ex-perience precluded their use in forwardunits. Instead, they were placed in theevacuation hospitals, while teams from

the evacuations were detailed to fieldhospital units.22

Experience had shown that to per-form effectively under front-line condi-tions, surgical teams must be able tohandle any type of case received. Gen-eral surgical teams were chosen in pref-erence of those specializing in someparticular phase that, by its infrequentoccurrence, might limit their usefulness.Base hospital surgeons were apt to betoo specialized, but surgeons whose ex-perience had been gained in evacuationhospitals were likely to be possessed of awider range of skills. Although the lossof surgical teams was thus minimized asmuch as possible and the high standardsof forward surgery were maintained, theoutput per man was less than it wouldhave been had the 2d Auxiliary SurgicalGroup been retained in Italy intact.

Another factor tending to increase theburden on front-line surgeons duringthe North Apennines Campaign was amore liberal policy in the selection ofnontransportable cases. Fifth Armystudies made earlier in the year indi-cated that many who died in evacuationhospitals could have been saved by themore prompt attention possible in a hos-pital closer to the front, and a largerproportion of combat wounds accord-ingly received initial surgery in the fieldhospitals. All cases of shock, or those whohad been in shock, for example, weresent to the field units, as well as thosewith 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 in-dividual teams, 1944 and 1945; (3) Annual Rpt,Med Sec, MTOUSA, 1944; (4) Periodic Rpts, 2dMed Lab, 1944, 1945; (5) ETMD's for Sep 44through Mar 45.


damage.23 The triage of chest, abdomi-nal, maxillofacial, and head wounds alsotended to route a larger proportion ofcases to the field hospital units close tothe front lines. Shell fragment woundscontinued to predominate substantiallyover all other causative agents combined,but the percentage of wounds from landmines rose somewhat.

Penicillin and whole blood were againmajor factors in the saving of life andlimb, blood being used on an expandingscale as a result of studies made duringthe Rome-Arno Campaign. A distribu-tion section of the 6713th Blood Trans-fusion Unit was established with the 2dMedical Laboratory in Florence in mid-September, but the blood distributedwas still flown from Naples. In February1945 a bleeding station was set up inFlorence to supplement the supply fromthe Naples blood bank. Approximately15,500 battle casualties in the last fourmonths of 1944 received close to 10,000pints of whole blood in corps and armyinstallations.

Fifth Army hospitals were visited bythe theater orthopedic consultant, Colo-nel Hampton, in September and byColonel Churchill, theater consultant insurgery, in October and November. Lt.Col. (later Col.) Howard E. Snyder, theFifth Army surgical consultant, spentmost of his time in the forward area.

Neuropsychiatry and Rehabilitation—Early in the North Apennines Campaignthe forward treatment of psychiatriccasualties was extended to include allthose having upper gastrointestinal tractsymptoms, since experience had shownthat 85 percent of such cases showed nosignificant organic pathology. A gastro-intestinal center was set up by the 1stPlatoon of the 601st Clearing Company,161st Medical Battalion, on 23 October1944 in the vicinity of Cafaggiolo, whereit was adjacent to the neuropsychiatriccenter operated by the 2d Platoon of thesame company. Maj. (later Lt. Col.)James A. Halstead of the 6th GeneralHospital was made chief of the gastro-intestinal service, continuing in thatcapacity when the function was shiftedto the 15th Field Hospital in January1945. The center was the first organiza-tion of its type to be established in anAmerican field army.24

All cases diagnosed as gastrointestinalat the clearing stations were sent to thecenter and others were referred fromthe evacuation hospitals. No case of thistype left the army area without passingthrough the gastrointestinal centerwhere those of psychosomatic origin

23 See The Board for the Study of the SeverelyWounded, North African-Mediterranean Theater ofOperations, The Physiologic Effects of Wounds,"Medical Department, United States Army," sub-series Surgery in World War II (Washington,1952). This volume contains the complete reportof a medical board, appointed 1 September 1944by the Surgeon, NATOUSA, "to study the treat-ment of the severely wounded." The board wasparticularly interested in the effects and controlof wound shock.

24 Principal sources for this section are: (1) An-nual Rpts Surg, Fifth Army, 1944, 1945; (2) AnnualRpt, Surg, II Corps, 1944; (3) Annual Rpts, 161stMed Bn, 1944, 1945; (4) Annual Rpt, 15th FieldHosp, 1945; (5) Periodic rpts of surgs and organicmed bns of 34th, 85th, 88th, 91st, 92d, 1st Ar-mored, and l0th Mountain Divs; (6) ETMD's,Sep 44-Mar 45; (7) Maj. James A. Halstead andCapt. Paul Scott Hansen, "The Management ofIntestinal Diseases in the Army Area," MedicalBulletin, Mediterranean Theater of Operations(May 1945); (8) Maj. James A. Halstead, "TheManagement of Patients with Gastric Complaintsin the Army Area," Medical Bulletin, Mediter-ranean Theater of Operations (June 1945); (9)Hanson, comp. ed., "Combat Psychiatry," BulletinU.S. Army Medical Department, Suppl. Number(November 1949).


were identified and treated as such. Dur-ing the 6 months of its existence, 442patients were admitted to the center, ofwhom 74 percent were returned to fullduty, 11 percent to limited duty, andonly 15 percent were evacuated to basehospitals. Of the total, 286 cases werediagnosed as psychogenic dyspepsiashowing definite neurosis without evi-dence of organic disease. Another 78cases showed neither organic disease norpositive evidence of neurosis. Therewere 22 cases of peptic ulcer, 4 of chronicgastritis, and 20 of acute gastritis. Thirty-two cases were rediagnosed as hepatitiswithout jaundice.

The average period of hospitalizationin the gastrointestinal center was 9.1days, compared with 21 days for similarcases in base hospitals. Moreover, only55 percent of those treated in base hospi-tals returned to combat duty, and thosewho did return lost an additional 14days in the replacement system.

Taken as a whole, the treatment ofneuropsychiatric casualties in the armyarea showed gratifying improvementsduring the months of active combat,despite the large number of such casesin September and October. The rehabil-itation and training centers establishedin each of the combat divisions in thelate summer proved to be a major factorin promoting the prompt return to dutyof hundreds of men who might other-wise have gone too far to be reclaimedfor combat. The 85th Division experi-mentally carried the program a stepfurther when the 337th Infantry regi-ment set up its own training and rehabil-itation center. It was notable that the337th had less than half the psychiatriccasualty rate of the other two regimentsfor the same period.

In December 1944, more than 90 per-cent of all Fifth Army psychiatriccasualties were returned to duty, as com-pared with only 26 percent at the begin-ning of the year. (Table 31)

Diseases of Special Interest—The ma-jor disease problem of Fifth Army dur-ing the months of the North ApenninesCampaign was infectious hepatitis,which followed the pattern of the pre-vious fall but was more widespread. Thedisease reached its peak in December1944, whereas October had been themonth of highest incidence in 1943. Themaximum rate per 1,000 per annum was211 for the week ending 15 December1944, compared with a high of 121 forthe second week of October 1943. Thesharp rise in hepatitis cases began latein October 1944, leveled off in Novem-ber, rose sharply again in December,then gradually declined to what may betermed a "normal" rate in March.25

Again the disease appeared most fre-quently among combat troops, and againrevealed an amorphous relationship tointestinal diseases, the curve for hepatitisfollowing by about a month the curvefor intestinal infections. In the secondwinter, however, hepatitis appearedmost frequently among new troops incontrast to the experience of 1943, whichshowed a higher incidence among vet-erans. Evidence tended to indicate boththe intestinal and respiratory tracts aspossible sources for infection, but re-mained inconclusive as to the actualmode of transmission.

25 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) AnnualRpts, Surg, Fifth Army, 1944, 1945; (3) ETMD'sfor Sep 44 through Apr 45; (4) Whayne and De-Bakey, Cold Injury, Ground Type, ch. VI. See alsopp. 261-62, above.


TABLE 31—DISPOSITION OF NEUROPSYCHIATRIC CASES, FIFTH ARMYSEPTEMBER 1944-MARCH 1945

a Full duty.b Limited assignment.


Atypical pneumonia struck hard atcertain units that had only physical loca-tion in common, rising from 39 cases inNovember to 415 in March 1945. An out-break of typhoid fever in the 349thInfantry Regiment of the 88th Divisionin November was quickly brought undercontrol and kept from spreading.

Trench foot, which had been one ofthe greatest wasters of manpower in thewinter of 1943, was again a factor butwas far less destructive, thanks to promptpreventive measures. The condition firstappeared in October. Shoe pacs wereissued in the middle of November, to-gether with heavy wool socks, but thepacs were not always properly fitted andthe men were not always told they wereto wear two pairs of socks. Instructionswere clarified by December, and drysocks were issued with rations. Although

weather conditions were more severeand the strength of the affected divisionsgreater, there were only 1,572 cases oftrench foot between October 1944 andApril 1945, compared with 5,752 for thecomparable period a year earlier. Only1.7 percent of the divisional troops wereafflicted, as against 7 percent in the win-ter of 1943-44.

The winter months of 1944-45 alsoshowed a lowered incidence of venerealdisease in Fifth Army compared withthe corresponding months of 1943-44,owing in part to less opportunity for ex-posure but also in part to improvedpreventive discipline.

Dental Service

The mobility of the Fifth Army den-tal service was further increased in the


course of the North Apennines Cam-paign, under the direction of Col.Thomas F. Davis, who became FifthArmy dental surgeon late in September1944. In addition to the army dentalclinic operated by the 2d Platoon of the602d Clearing Company, 162d MedicalBattalion, and sited with the venerealdisease hospital in Florence, both corpsmaintained prosthetic and operativeclinics of their own. The II Corps clinic,administered by the 54th Medical Bat-talion, was at Traversa, while anotherclinic operated by the 33d Field Hospi-tal, was sited with the corps supply depotjust below Monghidoro. The IV Corpsclinic, staffed jointly by the 163d Medi-cal Battalion and the 32d Field Hospital,was located at Valdibura. Two dentallaboratory trucks and two dental oper-ating trucks assigned to the 12th Medi-cal Depot Company were placed inoperation in November. Two additionaloperating trucks were assigned to the2d Auxiliary Surgical Group, and wereoperated in the forward areas by teamsof that unit.26

Late in 1944 the divisional dentalservice of Fifth Army was reorganized tobring the regimental and other dentalofficers of each division under moredirect administrative control of thedivision dental surgeon and permit con-centration of skills where they were mostneeded. At the same time the construc-tion of mobile dental dispensaries on1-ton trailer chassis was authorized on

the basis of five for each infantry divisionand seven for the armored division.Thirty-four of these trailer dispensarieswere in operation by May 1945.

The dental service of the 1st BrazilianDivision was organized along much thesame lines as that of comparable U.S.units. There were two dental officerswith each infantry regiment, one withthe division artillery, one with specialtroops, and one or two with the medicalbattalion. Dental officers also served withthe Brazilian medical staffs attached toU.S. hospitals. Arrangements were madein November by the theater dental sur-geon, Colonel Tingay, to supply U.S.equipment wherever the Brazilianequipment was below standard.27

The ratio of dental officers to FifthArmy strength remained fairly constantfor the 7 months of the North ApenninesCampaign. In September 1944 there was1 dental officer for every 902 armytroops. The ratio improved to 1:828 inNovember, but fell again to 1:937 forMarch 1945. The number of dentalofficers in Fifth Army rose from 157 inSeptember 1944 to 184 in March 1945.

Dental service rendered by these offi-cers and their enlisted technicians toFifth Army troops during the 7-monthperiod is summarized in Table 32.

Veterinary Service

In the North Apennines Campaign,the combat divisions did not maintaintheir own provisional pack trains, as theyhad during the mountain fighting insouthern Italy. By September 1944 ani-mal transportation was exclusively byItalian pack trains, which were attached

26 Principal sources for this section are: (1) An-nual Rpts, Surg, Fifth Army, 1944, 1945; (2)Annual Rpt, Med Sec, MTOUSA 1944; (3) An-nual Rpts, Surg, II Corps, 1944, 1945; (4) AnnualRpt, Surg, IV Corps, 1944; (5) MS, Dental History,Mediterranean Theater of Operations; (6) Unitrpts of div surgs and med installations in FifthArmy during the period 1 Sep 44-31 Mar 45.

27 Dental Inspection, by Col Tingay, 4 Nov 44.


TABLE 32—DENTAL SERVICE IN FIFTH ARMY, SEPTEMBER 1944—MARCH 1945


to the combat units as circumstancesrequired. Ten pack mule companiesoperated with Fifth Army during thefall and winter of 1944, and five morewere organized in February 1945.28

Animal casualties from the pack mulecompanies went to one of the fourItalian-staffed veterinary hospitals sup-porting Fifth Army. The 110th Veter-inary Evacuation was at Vaglia, abouttwenty miles north of Florence on High-way 65, from 14 September to 17 Octo-ber, and for the remainder of the periodwas sited at Pietramala, near the 8thEvacuation Hospital. The 130th Veter-inary Evacuation opened at Cafaggioloon 16 September where it remained,sharing the location with the 212thVeterinary Station Hospital between 2October and 6 January. The 212th

moved to Lucca on 8 January to supportthe animal units of IV Corps. The 211thVeterinary Evacuation was inactive dur-ing most of the winter, opening atPontepetri in the IV Corps area on 24February 1945.

It was the general consensus of Ameri-can veterinary officers that all of theseItalian units were poorly equipped andinadequately staffed. They were redes-ignated early in 1945 as U.S.-Italianunits, and were thereafter supplied andequipped from U.S. sources and oper-ated under closer supervision. The threeveterinary evacuation hospitals hadTable of Organization capacities of 150stalls and the station hospital had acapacity of 250, but staff and site limita-tions seldom permitted full operation.The shortcomings of the Italian veteri-nary hospitals were felt most acutelyduring the period from late Septemberto the end of October, when forwardpositions could be supplied only bymules, and animal casualties were high.Aggregate animal strength of the 10 packtrains serving Fifth Army at this timewas less than 3,000, with casualties be-

28 Principal sources for this section are: (1)Annual Rpts, Surg, Fifth Army, 1944, 1945; (2)Vet Inspection Rpts, Sep 44, Mar 45; (3) AnnualRpt, Med Sec, MTOUSA, 1944; (4) Annual Rpt,Surg, 10th Mountain Div, 1945. See also, Miller,United States Army Veterinary Service in WorldWar II, ch. XXII.


TREATING A WOUNDED MULE OF AN ITALIAN PACK TRAIN

tween 9 September and the end of theyear 1,110 killed and 765 wounded.

Evacuation of sick and wounded ani-mals, both from pack trains and fromveterinary hospitals, was by truck, butuntil late December no vehicles wereavailable except on loan from serviceunits. At that time Colonel Pickering,Fifth Army veterinarian, secured author-ization to supply both pack companiesand veterinary hospitals with recondi-tioned U.S. or captured enemy trucks,and most of the units were so suppliedby the end of the year. Replacementanimals were received through the

6742d Quartermaster Remount Depot.To achieve better administrative con-

trol, the Italian pack mule companieswere grouped early in 1945 into 5 bat-talions and brought under the supervi-sion of the newly activated 2695thTechnical Supervision Regiment. ThreeAmerican veterinary officers were as-signed to this organization, one to eachof 3 pack mule battalions. The other 2battalions were periodically inspectedby these officers.

The relatively large veterinary staffof the 10th Mountain Division—22 offi-cers and 182 enlisted men—had little to


do in their first three months in Italy,since none of the division's animalsreached the theater before spring.

In addition to horses and mules, andthe pigeons that were a normal part ofthe Signal Corps organization, Fifth

Army veterinarians were called upon tocare for 125 scout dogs that reached thefront during the winter.

No unusual problems were encoun-tered by the food inspection units oper-ating with Fifth Army.

CHAPTER XII

Advance to the Alps

If the second winter in Italy was onlyan exaggerated repetition of the first,the second spring was a new and exhila-rating experience. The months ofinching progress through mud andmountains were forgotten when in April1945 the U.S. Fifth and British EighthArmies erupted into the Po Valley andbrought the war in Italy to a decisiveend in three weeks. Both for the combatforces and for the medical units support-ing them in the field, the campaign wasa triumph of planning and preparation.

Preparations for the Final Drive

Planning and Regrouping

While the ranks were being filled,stores of ammunition accumulated, andequipment refurbished or replaced,plans were being drawn up for the lastoffensive of the Italian campaign. Clark'sstrategy as 15th Army Group com-mander did not differ essentially fromthat employed by Field Marshal Alex-ander in the assault on the Gothic Line,save that Fifth Army, now at fullstrength, rather than Eighth Army,which had been weakened by the with-drawal of four Canadian and British di-visions, was to make the main effort.1

The attack was to be staggered alongthe entire Allied front. The 92d Divi-sion, under direct army control, was tolead off on 5 April with an advance upthe Ligurian coast toward Massa and LaSpezia. Eighth Army, already out of themountains, was to open its drive fourdays later, its first objective being tosecure a crossing of the Santerno Rivereast of Bologna. IV Corps was to followafter a 3-day interval with a drive west ofHighway 64, and II Corps was to launchits attack along the axis of Highway 65when IV Corps had pulled abreast of themore advanced II Corps positions. Thetwo armies were to converge at the PoRiver, trapping as many enemy forcesas possible south of the river. In thesecond phase of the campaign, botharmies were to cross the Po and exploitto the Adige River, which runs south-eastward through Verona to the Adri-atic just south of Venice. In the finalphase, Fifth Army was to block theBrenner Pass north of Verona and clearnorthwestern Italy to the Swiss andFrench borders, while Eighth Army wasto swing eastward to the Austrian andYugoslav frontiers.

As Fifth Army moved into position,the 92d Division, on the left flank, in-cluded in addition to its own three regi-ments the battle-tested 442d Regimental

1 Principal sources for this section are: (1) FifthArmy History, pt. IX, Race to the Alps (Wash-ington [1947]) ; (2) Clark, Calculated Risk,

pp. 426-29; (3) Truscott, Command Missions, pp.479-83; (4) Craven and Cate, eds., Europe: ARGU-MENT to V-E Day pp. 482-89.


Combat Team, which had just returnedfrom France, and the 473d RCT of con-verted antiaircraft troops that had beenfighting as infantry since August 1944.The 365th and 371st regiments, whichhad been weakened by the transfer ofselected personnel to the 370th, were toscreen the front for the attack, then bewithdrawn from the division and sta-tioned in the inactive sector west of Mt.Belvedere under IV Corps control. IVCorps lined up with the Brazilian Ex-peditionary Force on the left, the 10thMountain Division in the center in thevicinity of Castel d'Aiano, and the 1stArmored on the right along Highway64 south of Vergato. In the II Corpssector, extending east from the RenoRiver, the 6th South African Armouredand the 88th Infantry Divisions were onthe left between Highways 64 and 65, the91st was astride Highway 65, the 34thDivision was east of the highway, andthe Legnano Group on the extremeright, in contact with 13 Corps on theleft flank of Eighth Army. The 85th Di-vision was in army reserve. All unitswere overstrength for the drive, with al-most 30,000 additional officers and menavailable in replacement depots.

When the diversionary attack of the92d Division in the west and the EighthArmy drive in the east had engaged asmany troops as the German commandwas willing to commit against them, the10th Mountain Division was to launchthe IV Corps assault driving norththrough the remaining mountain ridgesto cut Highway 9 west of Bologna. TheBrazilians and the 365th and 371st regi-ments were to protect the left flank andfollow up any enemy withdrawals, whilethe 1st Armored was to seize Vergato andadvance down Highway 64.

The II Corps attack was in effect to bea renewal of the October drive, with allfour divisions abreast and the LegnanoGroup in a defensive role on the rightflank. When the important road junctionof Praduro on Highway 64 had beenreached, the 85th Division was to passthrough the 1st Armored, leaving thelatter unit and the 6th South AfricanArmoured, which would be pinched outby the 85th and 88th Divisions, availableas a mobile striking force to exploit thebreakthrough onto the plain.

Medical Preparations

Although Fifth Army's strength forthe final drive was greater by 100,000men than it had been when the GothicLine was broken—almost 270,000 on 1April 1945 compared with 170,000 sixmonths earlier—the resources in menand equipment available to GeneralMartin, Fifth Army surgeon, were onlyslightly increased over the inadequatefacilities with which he had supportedthe North Apennines Campaign. The400-bed 170th Evacuation Hospital hadbeen added in November 1944, and the15th Field Hospital in January 1945.Just before the launching of the springoffensive one additional 400-bed evacu-ation—the 171st, converted like its sisterunit from a station hospital—was ac-quired.2 That was all. There were noadditional medical battalions at corpsor army level, no new supply units, no

2 See p. 439, above. The 171st EvacuationHospital was converted from the 250-bed 54th Sta-tion Hospital, which had moved from North Africato Naples in January 1945, with some additionalpersonnel drawn from the 57th Station Hospital,which was reduced from 250 to 150 beds at aboutthe 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 FifthArmy.

more supporting ambulance companies;and the increase in beds was less thanenough even to keep pace with the in-crease in troop strength.3

Of the new combat formations ac-quired by Fifth Army since the stabiliza-tion of the lines at the end of October

1944, only the Legnano Group had hos-pital facilities of its own—four 200-bedfield units provided through the Mili-tary Mission to the Italian Army, adivision of the Allied Control Commis-sion. The 6th South African ArmouredDivision was also independent of FifthArmy in this respect. To provide hos-pitalization for the remaining 8 combatdivisions, 2 separate regiments, and com-bat service troops, General Martin hadat his disposal 3 field hospitals, 4 400-bed

3 Principal sources for this section are: (1) An-nual 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 in-stallations.


evacuation hospitals, 4 750-bed evacua-tions, and a convalescent hospital.

What it lacked in facilities Fifth Armywas thus forced to make up in mobilityand efficiency of operation. DuringMarch medical units received new equip-ment, including a total of 90 ambulancesand 15 2½-ton trucks, to replace worn-out vehicles. A move to fill personnelvacancies with limited-service men wassuccessfully resisted, on the ground thatall personnel would be subjected to se-vere physical strain, and basic infantry-men were trained instead as medicalreplacements.

By early April all medical units hadbeen streamlined for rapid movement.All equipment beyond the bare essen-tials for operation was turned in, andhospitals began reducing their patientcensuses to permit closing on a few hours'notice. No hospital was to move until thecombat troops jumped off, to avoid anypossibility of giving away plans to theenemy, but once the mountains werepassed, it was imperative that as manybeds as possible be shuttled into the PoValley to eliminate long and difficultambulance runs over highways thatwould be clogged with military traffic.It was also imperative that no hospitalbe closed for longer than the absoluteminimum time necessary for movementto a new location.

In the hope of speeding up the evacu-ation process, experiments were con-ducted early in April with small planesthat could take off, if necessary, fromimprovised runways. Several patientswere flown successfully in L-5's fromthe 8th Evacuation Hospital at Pietra-mala to Florence, but the scheme wasabandoned as impractical for use in thecoming campaign. Space permitted car-

rying only one patient at a time, withoutmedical attendance, which would greatlyrestrict the scope of the operation. Theunpredictability of the weather at thatseason was another limiting factor.

In planning medical support for thePo Valley Campaign, there was no alter-native to ambulance evacuation, at leastduring the early stages of the action.Neither could use of the battered andrutted Highways 64 and 65 in the centralsector be avoided. Highway 1, whichwould be the axis of evacuation for the92d Division along the coast, had suf-fered little and was in excellent condi-tion. From the II and IV Corps fronts,evacuation by air was to begin as quicklyas the Bologna field could be repaired,estimated as five days after the captureof the city.

For the 92d Division, isolated as itsfront was from the rest of the Fifth Armyarea, a complete system of medical sup-port had to be provided that would notonly take care of all the medical needsof the division but also could be rapidlyexpanded should the coastal drive de-velop into a major operation. As oneelement of this plan, a bleeding sectionwas set up in Pisa by the 6713th BloodTransfusion Unit.

The Po Valley Campaign

Military Operations

During February, March, and theearly days of April 1945 the Mediter-ranean Allied Tactical Air Forcepounded German communications innorthern Italy with increasing violence.Favorite targets were the bridges thatkept appearing with antlike persistencealong the Po, cable crossings, ferry ter-


minals, rail lines, and truck and wagonconvoys on the roads. The bombers gaveway on 14 April to an umbrella offighters that would cover the jump-off ofIV Corps.4

The flanks by this date were alreadyheavily engaged. The 92d Divisionopened the attack according to plan on5 April, with the 370th RCT on thecoastal plain and the 442d pushingthrough the mountains that rose steeplya few miles to the east. The assignmentwas not an easy one. The mountains inthis area, known as the Apuan Alps, arecharacterized by sheer rock cliffs, barrenpeaks, and deep gorges, while the narrowcoastal plain is cut by numerous streamsand canals. The plain, moreover, washeavily mined and both axes of advancewould soon be within range of the bigguns at La Spezia, which could droptheir deadly shells as far south as Massa.Before La Spezia itself could be reached,the attacking forces would have to breakthrough heavily fortified positions thattook every advantage of the naturalbarriers offered by the terrain.

By the end of the first day the 442dwas approaching the high ground over-looking Massa, but the 370th encoun-tered intense enemy fire and withdrew

in the face of strong counterattacks.When the regiment was unable to re-group the next day because of excessivelosses in stragglers, it was relieved by the473d Combat Team, which was broughtup from static positions in the SerchioValley. The 4730! took Massa on 10 Apriland Carrara the next day, while the442d outflanked both towns againststrong opposition in bitter mountainfighting. Both regiments were now upagainst the German fortified line andboth were under fire from the coastalguns, but now had positions from whichtheir own field pieces could reply.

Eighth Army attacked on 9 April, wasacross the Santerno River in two days ofhard fighting, and by 13 April was be-yond the Sillaro on the road to Bologna.

The launching of the main drive byIV Corps was delayed for 48 hours byweather conditions that prevented theair cover General Truscott deemed es-sential. On the morning of 14 April,however, the corps jumped off behind in-tensive air and artillery preparation. Onthat day the 10th Mountain Divisionseized and held a series of peaks west ofHighway 64; the Brazilians took Mon-tese;. and the 1st Armored entered theoutskirts of Vergato. All units continuedto advance on 15 April. Just before mid-night the 88th and 6th South AfricanArmoured Divisions of II Corps joinedthe battle, followed early on 16 April bythe 91st and 34th Divisions. On 17 and18 April the 85th Division relieved the1st Armored north of Vergato, the latterdivision shifting to more favorable ter-rain along the Panaro River on the leftof the 10th Mountain. The intercorpsboundary was shifted to the west on 19April as the whole German front beganto crumble. The 85th Division took

4 Principal sources for this section are: (1) FifthArmy History, pt. IX; (2) Rpt of Opns, IV Corps,Apr, May 45; (3) Rpt of Opns, II Corps, 1 Apr-2May 45; (4) Hist, 92d Div, Apr, May 45; (5) Rptof Opns, 473d Regt, Apr 45; (6) Narrative ofEvents, 442d Regt, Apr, May 45; (7) Clark, Cal-culated 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 In-fantry Division, pp. 262-332; (13) Goodman, Frag-ment of Victory, 1952) pp. 121-77; (14) Lockwood,ed., Mountaineers pp. 26-58; (15) Alexander,Italian Campaign pp. 32-49; (16) Starr, ed., FromSalerno to the Alps, pp. 387-441.


Casalecchio, where the Reno River en-ters the plain on 20 April, while forwardelements of the 10th Mountain cut High-way 9 west of Bologna and II Corpsbroke through the last of the highground in its path. Bologna fell on 21April, the 34th Division entering thecity from the south and elements of thePolish Corps of the Eighth Army fromthe east.

The main advance had already sweptbeyond Bologna, with both armies racingto reach the Po before the enemy couldwithdraw his disorganized forces acrossthe river. The 10th Mountain Divisionreached the south bank of the Po at SanBenedetto west of Ostiglia the night of22 April, crossing the river in assaultboats the next afternoon in the face ofheavy enemy fire. By the 24th the 85thDivision was also across the river, the88th and 91st were crossing, and the twoarmored divisions were only awaitingthe placement of bridges by the engi-neers. The 34th Division, reassigned toIV Corps, was sweeping west along High-way 9, already beyond Parma, while theBrazilian Expeditionary Force kept pacethrough the foothills south of the high-way. Verona, gateway to the BrennerPass, fell to the 88th Division on 25April, and the 10th Mountain took Villa-franca airport southwest of that city thesame day.

In the final days of the war in Italy,Fifth Army fanned out toward the bor-ders to cut off all avenues of escape. Re-sistance was sometimes strong, sometimesnonexistent, but always confined to pock-ets where isolated remnants of the onceproud Wehrmacht tried to break out ofthe trap that was swiftly closing on allsides. The 91st Division pushed eastthrough Vicenza to Treviso where the

Eighth Army sector began. The 88thswung northeast from Verona to outflankBolzano, and the 10th Mountain Divi-sion fought its way to the head of LakeGarda. The 1st Armored sent flyingcolumns to the Swiss frontier at LakeComo, and west to Milan.

The 92d Division, meanwhile, after aweek of bitter fighting, broke throughthe mountain defenses of La Spezia,while Italian partisans seized the city it-self. The 473d Infantry entered LaSpezia on 23 April, and four days laterentered Genoa more than a hundredmiles up the coast. From there patrolsmoved west to the French border. The442d, after driving inland from the LaSpezia area, made contact with IV Corpsnear Pavia and sent patrols west toTurin.

The first organized surrender came on29 April when the 148th Grenadier andItalia Bersiglieri Divisions surrenderedto Maj. Gen. Joao Mascarenhas deMorais, commanding the Brazilian Ex-peditionary Force. At 1400 on 2 May1945 all German forces in Italy weresurrendered unconditionally to GeneralClark, and the Italian campaign wasover. The number of prisoners taken wasmore than 250,000, bringing the total forthe Italian campaign to over half amillion.

Medical Support in the Field

Field medical support of Fifth Armyduring the final drive in Italy wascharacterized by an initial period ofheavy casualties and slow movement,followed by rapid expansion over hun-dreds of miles with enemy casualties ex-ceeding our own. In the last few days ofcombat medical units were not only cut


off from army and corps surgeons, theywere also frequently out of communica-tion with their own headquarters. Theuse of captured vehicles, medical instal-lations, and supplies was both a generalpractice and a necessary expedient.5

The 92d Division Front—Perhaps themost difficult task was that assigned tothe 317th Medical Battalion, organic tothe 92d Division, which during thegreater part of the drive was required tosupport five regimental combat teamson three fronts. Casualties suffered bythe augmented 92d Division, even thoughtwo of its five regiments had little con-tact with the enemy, were exceeded onlyby those of the 10th Mountain Divisionon the IV Corps front. (See Table 33.)One collecting company and one platoonof the clearing company remained withthe defensive formations in the SerchioValley until 25 April, when that sectorwas closed out. The other two collectingcompanies, sometimes operating in sec-tions, supported the main drive of the442d and 473d RCT's, with one platoonof the clearing company backing up both.Neither the terrain nor the location ofenemy long-range guns permitted the at-tached platoon of the 32d Field Hospital

to move up from its Viareggio site intime to give close support during theperiod of severe fighting, but the relativeslowness of the advance to La Spezia keptthe hospital within usable distance.

By 20 April communications with the92d Division had become so tenuous thatGeneral Martin designated the divisionsurgeon, Lt. Col. Eldon L. Bolton, to actas his deputy in the coastal sector, withfull responsibility for the medical servicethere.

La Spezia fell on 23 April, and twodays later medical units from the SerchioValley rejoined the 317th Medical Bat-talion in support of combat elementsnow fanning out in two directions. For-ward hospital facilities were urgentlyneeded, but the Viareggio field unit,with no army evacuation hospital in thevicinity, was unable to move on shortnotice. To redeem the situation, Gen-eral Martin sent a unit of the 15th FieldHospital, which was still in bivouac northof Florence, and a platoon of the 601stClearing Company, 161st Medical Bat-talion, to the 92d Division front. A 250-bed hospital was set up on 25 April nearLa Spezia, but the combat units werealready far ahead. After three days ofoperation with only a handful of pa-tients, the clearing platoon moved on 29April to Genoa, where it was joined thefollowing day by the field hospital unit.

By that date one platoon of the 92dDivision clearing station was northwestof Genoa, and the Viareggio unit of the32d Field Hospital was on its way toAlessandria, on the road to Turin. Thefield hospital was in the vicinity of Milanen route when hostilities ceased.

Medical Support of IV Corps—First ofthe IV Corps medical units to go into

5 This section is based primarily on the followingdocuments: (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 MountainDiv, 1945; (7) Annual Rpt, Surg, 91st Div, 1 Jun-12Aug 45; (8) Hist, 47th Armored Med Bn, Apr, May45; (9) Unit Hists, 10th Mountain Med Bn, Apr,May 45; (10) Hist Rcd, 109th Med Bn, Apr, May45; (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) AnnualRpts, 1945, of 54th, 161st, 162d, 163d Med Bns; (16)Annual Rpts, 1945, of 15th, 32d, 33d, Field Hosps.


100TH BATTALION AIDMEN approachwounded on "Ohio Ridge."

action was the 10th Mountain MedicalBattalion, whose collecting companiesmoved out with the mountain infantryon the morning of 14 April. Casualtieswere heavy from the start, with jeeps andambulances inadequate to clear the aidstations the first two days. Trucks wereused for walking wounded, and one col-lecting company borrowed additional ve-hicles from the service company of theinfantry regiment it supported. Evenwhen vehicles were available, there weredelays in moving casualties to collectingand clearing stations. All roads wereoperating one way, traffic moving towardthe front. Ambulances had to wait, some-times as long as an hour and a half, touse the roads in the other direction.

By midnight of 14 April the clearingstations of the 10th Mountain MedicalBattalion had admitted 415 patients, in-cluding injury and illness. The total rose

to 427 the next day, then fell off to 327on 16 April, and 210 on the 17th. Thefigures are notable only because theywere the highest in Fifth Army, in keep-ing with the spearhead role of thedivision. (See Table 33.) Admissions re-mained in the vicinity of 200 for severaldays, dropping to 132 on 22 April andrising to 254 the following day, whenthe leading elements of the 10th Moun-tain crossed the Po River and won abridgehead on the north shore againstheavy opposition. Casualties were negli-gible thereafter except for the last twodays of April, when there was hard fight-ing along Lake Garda.

The experience of the 10th MountainMedical Battalion was typical of IVCorps medical units generally. Casual-ties were heavy for two or three days.Advances were minimal, and clearingstations stayed where they were. Begin-ning about 19 April, when the descentinto the Po Valley began, movementsbecame increasingly frequent and con-fusion grew. Clearing stations moveddaily, collecting stations sometimes twicea day. Collecting companies were so closebehind the retreating enemy by 20 Aprilthat they passed through still burningvillages and ran the gantlet of artilleryand sniper fire. Indeed, as the rout de-veloped medical units were not infre-quently ahead of the retreat. ArmedGermans surrendered with increasingfrequency to unarmed medics, and by25 April German ambulances werebringing German wounded to U.S. in-stallations.

Distances between stations lengthenedafter the Po was crossed and the racefor the frontiers began. On 24 April aclearing platoon and collecting companyof the 10th Mountain Medical Battalion


MEDICS OF 10TH MOUNTAIN DIVISION EVACUATING WOUNDED IN A JEEP whiletanks wait to use the one-lane road, April 1945.

accompanied a task force on a spectacular70-mile dash from the Po to Lake Garda,where for two days the clearing stationconstituted the left flank of the division.On 28 April a company of the 47thArmored Medical Battalion traveled 62miles; and the following day a collectingcompany of the 109th Medical Battalion,organic to the 34th Division, covered 170miles in a roundabout journey from thevicinity of Fidenza to the outskirts ofMilan. A 30-mile jump was average.

From 20 April on, medical units wereperiodically out of touch with their ownheadquarters, sometimes for days at astretch. Fortunately, casualties by thistime were light, and could generally be

held until clearing stations or field hos-pitals were located. Prisoner of warpatients, who outnumbered Alliedcasualties, were usually sent to capturedGerman hospitals in captured vehicles.

It was quickly obvious that field hospi-tal platoons could not possibly keep pacewith division clearing stations and stillperform surgery or hold nontransport-able casualties. The corps surgeon triedto keep these units as available as possi-ble in terms of transportation, but in-evitably they fell behind, where theirfunctions became more nearly those ofevacuation than of forward surgical hos-pitals.

Of the two platoons of the 32d Field


Hospital attached to IV Corps, the 2dPlatoon followed the westward push ofthe 34th Division along Highway 9 andthe BEF south of that route. Moving on20 April from Valdibura, where it hadspent the winter, to Lama about tenmiles south of Bologna on Highway 64,the unit was the most forward FifthArmy hospital, but it was already too farbehind. At Castelfranco, some fifteenmiles west of Bologna on Highway 9,there was no such complaint. The townwas being shelled when the hospitalarrived on 22 April. Four additionalsurgical teams were called in, and forseventy-two hours four operating tableswere in constant use. On 28 April theunit moved west once more on Highway9. Parma was passed, but Piacenza wasstill held by the enemy, so the unit setup in buildings of a civil hospital inFidenza. Two hours later the platoonwas ordered to close and return toParma, where its own functions couldbe combined with administration of alarge German hospital captured there.

The 3d Platoon of the 32d Fieldopened in Vergato on 18 April, moved70 miles on 24 April to a bivouac area inthe vicinity of the corps Po crossings, andopened in Mantova two days later. On1 May the unit moved to the suburbs ofMilan. In the final stages of the cam-paign, sections of the 615th ClearingCompany, 163d Medical Battalion, ac-companied the field hospital units to carefor overflow and to provide holding fa-cilities to enable the hospitals to moveforward.

Late in the campaign, on 29-30 April,the 3d Platoon of the 15th Field Hospitalwas attached to IV Corps and set up inthe vicinity of Modena, but aside fromreceiving the patients of an evacuation

hospital about to move, the unit hadlittle to do. There were three other fieldhospital units and one evacuation hospi-tal closer to the front at that time.

Evacuation of aid and collecting sta-tions in the Po Valley was by ambulance,jeep, truck, and captured vehicles of allkinds. In this flat, well-traveled country,there were no backbreaking litter car-ries. The extra litter bearers attached atthe start of the drive were released whenthe plains were reached, and most of theregular bearers were sent back for rest.Until clearing stations crossed the Po,boats and Dukws as well as pontonbridges were used for evacuation. OnLake Garda boats were used extensively,partly to bypass stretches of highwayblocked by the destruction of tunnels,partly because elements of the 10thMountain Division were operating onthe west side of the lake and casualtiescould not be reached in any other way.

Medical Support of II Corps—The IICorps medical service did not differ inany essential from that of IV Corps.Casualties in all divisions were heavy forthe first three or four days. After de-bouchment into the Po Valley, casual-ties declined sharply while distancescovered and speed of movement in-creased.

The clearing station of the 313th Med-ical Battalion, serving the 88th Division,for example, was in the vicinity ofLoiano on Highway 65 when the drivestarted. The station moved over to Ver-gato on 19 April when the intercorpsboundary was shifted, but most of itspatients there were from the 10th Moun-tain Division, whose clearing station wastemporarily out of contact. The clearingstation of the 88th moved to Lama on


91 ST DIVISION MEDICS AT PIANORO, APRIL 1945

20 April, and on the 22d moved up to SanGiovanni, some distance beyond the siteoriginally selected. The following dayfound the station at Mirandola, and onthe 26th it was beyond the Po. A seriesof rapid moves on the last three days ofthe month brought the station succes-sively to Lonigo, Vicenza, and Bassano,while the division it supported probedinto the Alps. The clearing station of the91st Division—316th Medical Battalion-was in Praduro at the foot of the Apen-nines on 21 April, but daily moves there-after brought the unit across the Po andAdige Rivers and east to Treviso, wherethe Eighth Army zone began. Battle

casualties of the 91st Division were lessthan half those suffered in a comparabletime period against the Gothic Line inSeptember 1944.

The medical service of the 34th Divi-sion followed a similar pattern before itstransfer to the IV Corps at Bologna.

In addition to the divisional medicalunits, the 383d Clearing Company, 54thMedical Battalion, operated a collectingstation for corps troops during the firsthectic days in the Po Valley. Elementsof the 54th also performed holdingchores toward the end of the period toenable the field hospital platoons tomove forward.


TABLE 33—WOUNDED IN ACTION IN THE Po VALLEY CAMPAIGN, FIFTH ARMY1 APRIL-15 MAY 1945

Source: (1) Compilation by Fifth Army Casualty Section. (2) Theater ETMD Rpt for Jul 45. Totals for the 92dDivision are from the ETMD. Figures for the attached regiments—the 442d and 473d—are calculated. Wounded in actionfigures for the 442d and 473d Regiments given by Goodman, Fragment of Victory, page 217, are respectively 513 and571 for the period 5 April-2 May inclusive, or 1,084 in all, compared with 1,083 arrived at by calculation. Since there wasno combat action prior to 5 April or after 2 May the time periods may be taken as comparable for purposes of re-cording wounded in action.

One of these, the 1st Platoon of the33d Field Hospital, found itself tieddown in Casalecchio on the northernrim of the Apennines from 21 April un-til after the surrender because its pa-tients could not be moved and the unitwas too far in the rear to be relieved. Itsplace on the II Corps front was taken bythe 1st Platoon of the 15th Field, whichwas attached north of San Giovanni on24 April and was beyond the Adige atCologna by the 28th.

The 2d Platoon of the 33d Field Hos-pital moved quickly through Bologna,San Giovanni, and Mirandola withoutever getting close enough to the fightinglines to see more than a few patients. AtIsola della Scala, several miles south ofVerona, the unit finally caught up withthe war on 26 April, handling 110 surgi-cal cases in four days before going on toBassano. The 3d Platoon of the 33dField, at Monghidoro on Highway 65,took the nontransportable cases from the

88th and 91st Divisions in the openingdays of the campaign and was tied downat its initial site for two weeks. On 29April the unit made the long jump toVicenza, but found itself still a rear in-stallation.

Fifth Army battle casualties, based onhospital admissions, are shown by divi-sions for the period 1 April through 15May in Table 33.

Hospitalizationin the Army Area

Deployment and Use ofArmy Hospitals

The demands that would be placedupon the Fifth Army medical service bythe Po Valley Campaign had been an-ticipated in the planning stage, and everyfeasible preparation was made to get hos-pitals into the forward areas as quickly


as the inadequate highway network andthe progress of the fighting allowed. Asa preliminary step, the newly organized171st Evacuation Hospital relieved the170th on 2 April at Lucca, where it wasto support the coastal drive of the 92dDivision, while the 170th went into biv-ouac packed for movement when calledupon. Surgical teams from the 170thserved with other Fifth Army hospitalsduring this inactive period. The 15thEvacuation closed at Florence on 10April two days before the originallyscheduled D-day for the IV Corps attack;and the 94th closed its Florence unit onthe 12th.6

The 15th Evacuation, which had en-joyed nearly seven months of rear-echelon security in Florence, was selectedby General Martin to be the first hospitalto move into the new combat zone. Alocation for the hospital was preparedby the engineers north of Porretta onHighway 64, only five miles from theIV Corps line of departure, but the great-est care was taken to conceal the pur-pose of the work. Latrines were dugunder camouflage nets, and personnel ofthe advance detail bivouacked with ad-jacent combat units. The entire hospitalwas loaded onto 80 trucks by 12 April.Orders were received at 0820 on 14 Aprillifting the security ban and giving theconvoy clearance for 0930. With trucksplaced in the order in which they wereto be unloaded, the convoy covered the75-mile distance in three hours. Casu-alties were already on the way to thesite from the clearing stations. The hos-

pital opened at 1815 and had 78 patients,all nontransportables, by midnight. Thenext day the 1st Platoon of the 602dClearing Company, 162d Medical Battal-ion, set up beside the 15th Evacuationto handle the overflow.

For three days the 15th Evacuationwas the most forward Fifth Army hospi-tal in the IV Corps sector. All nontrans-portable casualties were routed to thisunit from an army control point fartherup the road, transportable and slightlywounded cases going back to Pistoia andMontecatini. The hospital staff wasaugmented during this period by elevenauxiliary surgical teams. After four daysnine of these teams were withdrawn, buttwo Brazilian teams were attached.7 TheBrazilian staff of 26 officers, 21 nurses,and 68 enlisted men who had been withthe 16th Evacuation in Pistoia since No-vember were also attached to the 15thEvacuation on 23 April, but remainedonly three days.

The 170th Evacuation Hospitalopened on 18 April near Silla, somewhatforward of the 15th at the same time thata unit of the 32d Field moved into Ver-gato. Thereafter the 15th received mostlylightly wounded and transportable cases,the serious casualties going to the moreforward units, but the total number ofadmissions rose. The shift of Fifth Armystrength to the west of the Reno Riverhad the effect of funneling the woundedfrom two more divisions down Highway64. There was no room to back up themedical units already there, and all of

6 Principal sources for this section are: (1) An-nual Rpt, Surg, Fifth Army, 1945; (2) AnnualRpt, Surg, II Corps, 1945; (3) Unit rpts of thehosps 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 hadbeen serving throughout the winter with the 2dPlatoon of the 32d Field Hospital at Valdibura.See p. 440, above. The field unit was closed pendingmovement about the time the 15th opened atPorretta.


them worked around the clock until thecombat troops began to debouch into thevalley. By that time, enough ground hadbeen secured to permit leapfrogging an-other hospital ahead of those in the Por-retta-Vergato area. The 750-bed 38thEvacuation Hospital was brought up on20 April to Marzabotto, where Highway64 begins to level off. The Brazilian per-sonnel from the 15th Evacuation wereshifted to the 38th, to which they hadoriginally been attached, about 26 April.8

(Map 39)On the II Corps front, meanwhile, the

94th Evacuation reopened at its oldMonghidoro site on 17 April, about thirtyhours after the corps jump-off. For thenext few days the 94th shared the loadof casualties in the Highway 65 sectorwith the 8th Evacuation at Pietramala.The 56th, at Scarperia, was alreadyclosed to admissions, and on 20 April be-gan dismantling and loading for a quickdash to Bologna whenever that cityshould be captured.

During this period of heavy pressureon forward evacuation hospitals, thepresence of base units in the army areaproved invaluable. The 24th GeneralHospital in Florence and the 70th Gen-eral in Pistoia were able to take enoughmovable casualties from the army unitsto permit the evacuation hospitals tokeep up with demands made upon them.

The 56th Evacuation was to set up intents in a large stadium, located by airreconnaissance. Other hospitals were tobe brought into Bologna as rapidly asbuildings could be found to house them.General Martin awaited word of the fallof Bologna at the 94th Evacuation, andwas one of the early arrivals after the

city was captured on 21 April. Martin'spersonal survey revealed no buildingssuitable for hospital sites without exten-sive and time-consuming repairs, whichwere precluded by the unexpectedlyswift advance of Fifth Army. Only the56th was ordered forward, arriving on22 April and taking patients at the pre-determined stadium site at noon on the23d.

The same speed of advance that leftBologna too far behind for the forwardmedical service almost as soon as it wascaptured, increased the difficulties of theFifth Army surgeon. Rations, fuel, am-munition, assault boats, and bridgingmaterials, all had to be brought by truckacross the mountains from supply depotsin the Florence area, and there were notrucks left over to move the hospitals.General Martin solved the problem bypooling all the organic transportation ofhis semimobile evacuations. Operatingon a 24-hour basis and alternatingdrivers, these vehicles moved the bulkof the Fifth Army hospitals into the PoValley on a schedule so expertly managedthat no hospital was out of action formore than twenty-four hours.

At 0900 on 23 April, while the 56thEvacuation was still setting up its equip-ment in Bologna, the 94th was orderedto close at Monghidoro. All patientswere evacuated by 2100 and the first con-voy of trucks was on the road beforedawn of 24 April. The destination wasCarpi, a village about ten miles northof Modena. Using buildings of a civilianhospital, the 94th was taking patients atits new site by 2000. Even more rapidwas the move of the 750-bed 16th Evac-uation, which closed at Pistoia on 23April, moved during the night to SanGiovanni, a road junction fifteen miles8 See p. 440, above.


northwest of Bologna, and was function-ing as a hospital once more by 1800 on24 April. (Map 40}

On the same day, the neuropsychiatricand venereal disease hospitals, operatedrespectively by the 601st and 602d Clear-ing Companies, also moved to SanGiovanni, the former from Cafaggioloand the latter from Florence. In eachcase the move was made by organic trans-portation of the medical battalion towhich the unit belonged. The venerealdisease hospital carried 30 patients withit in ambulances borrowed from one ofthe battalion's collecting companies.Penicillin treatment of these patientswas continued en route without interrup-tion.

On 25 April the 1st Platoon of the601st Clearing Company from Monteca-tini and the 2d Platoon of the 15th FieldHospital from the Cafaggiolo area weremoved to La Spezia to act as a provisionalevacuation hospital for the 92d Division.

The 170th Evacuation, after a weekof hectic operation on Highway 64, evac-uated its transportable patients to the70th General in Pistoia on the night of25 April. Leaving one ward behind tocare for 27 patients who could not bemoved, the 170th pulled out the morn-ing of 26 April and reopened the sameday at Mirandola, about eighteen milessouth of Ostiglia where combat unitswere still crossing the Po. Only the 171stEvacuation at Lucca, the 8th at Pietra-mala, and the 15th at Porretta were stillin the mountains, and all three of thesewere alerted for movement.

The 15th went first, leaving a holdingdetachment of 2 officers, 2 nurses, and15 enlisted men to care for 17 nontrans-portable patients. Moving the hospitaltentage and equipment on 10-ton trail-

ers, packing was accomplished in threehours. The 15th arrived in Mantovanorth of the Po the afternoon of 28 April,where it took over a large sanatoriumand more than 300 patients from a unitof the 32d Field. Until 25 April thebuildings had housed a German hospital.

The 8th Evacuation, after several daysof waiting for transportation, receivedits vehicles in the late afternoon of 29April, moved out over the battle-scarredremains of Highway 65 during the night,and admitted its first patients at the newsite just south of Verona before the endof the day, 30 April. The 171st alsomoved out the night of 29 April, butbecause its new site was Vicenza, 200miles away, with the whole width of theApennines to cross, it did not open until1 May. In the meantime, the 38th Evac-uation had dismantled, packed, moved90 miles to Fidenza west of Parma onHighway 9, and reopened on 30 April.(Map 41)

The last hospital moves before theGerman surrender put the 92d Division'sprovisional evacuation in Genoa by 1May; the venereal disease hospital in Ve-rona and the neuropsychiatric hospitalat Villafranca on 2 May. Since there wereno longer enough neuropsychiatric cas-ualties to justify the existence of a hos-pital for that purpose alone, the 2dPlatoon of the 602d Clearing Companyreverted to air evacuation holding dutiesat Villafranca airport. The 170th Evac-uation was in process of moving fromMirandola to Treviso, and the 1st Pla-toon of the 602d Clearing Company wasen route from Porretta to Modena whenthe war in Italy came to an end.

For all Army hospitals supporting thePo Valley Campaign, the pattern of ad-missions was similar. Heavy casualties,


with a preponderance of severe wounds,characterized the start of the drive, giv-ing way in the later phases to relativelyfew American casualties, mostly lightlywounded, and a growing volume of pris-oner patients.

The 171st Evacuation—the only evac-uation hospital supporting the 92d Di-vision's coastal attack—admitted 2,416patients between 2 April and the endof the month, of whom 1,128 were battlecasualties. Italian partisans made up thegreater portion of the 364 Allied pa-tients treated.

The 15th Evacuation admitted 1,592patients, 1,173 of them surgical cases,during its two weeks at Porretta, withmost of the serious cases coming in thefirst four days. The 170th, in the courseof a week spent in the same area, ad-mitted 528, of whom 372 were battlecasualties. The 94th Evacuation ad-mitted 496 surgical cases at Monghidoroand Carpi. The 8th Evacuation, whichwas for two days the only hospital back-ing up the II Corps attack, took 72priority cases on 16 April and 97 morein the next twenty-four hours, "as seri-ous and severe" as any previously seen inItaly. The 8th had a backlog of 80 opera-tive cases by the morning of 18 April,and received another 85 that day. Withthe 94th set up ahead of them and thecorps breaking out of the mountains, theload then dropped abruptly. By 20 Aprilthe 8th Evacuation was receiving onlyrear echelon cases.

The 16th Evacuation had 1,016 ad-missions at San Giovanni by the end ofApril, 542 of them battle casualties, butthe bulk of these were transferred frommore forward units. Battle casualties alsomade up the larger group of patients atthe 38th and 56th Evacuations, but al-

most half were prisoners of war at the38th and more than half at the 56th.

The medical service in the Po ValleyCampaign, like the military operations,falls into two distinct phases. Before thebreakout from the mountains the use offield and evacuation hospitals and corpsclearing companies followed normallines, but with activity intensified by theheavy influx of casualties and by longand difficult evacuation lines. In the val-ley itself the whole hospitalization pic-ture was confused, with poor communi-cations and inadequate transportationforcing hospitals to assume unorthodoxroles. Field hospital platoons, with orwithout assistance from clearing com-panies, operated as evacuation hospitals,and evacuation ran the gamut from firstpriority surgery to station hospitalduties.

Hospitalization of Prisonersof War

Until the Po River was reached,enemy casualties were routinely evacu-ated to Fifth Army hospitals, where theywere cared for in the same manner asU.S. and Allied patients. Only a trickleof wounded Germans reached the 171stEvacuation Hospital, owing to thelengthening evacuation lines on the 92dDivision front. The total was no morethan 100 out of 2,000 patients treatedby that unit during its stay at Lucca. Onthe IV Corps front, however, the 15th,170th, and 38th Evacuations on High-way 64 admitted a considerable numberof German casualties after the first weekof combat. The 8th and 94th Evacuationssupporting II Corps also began takingenemy casualties before leaving themountains.9

9 This section is based primarily on the follow-


WOUNDED GERMAN RECEIVING PLASMA IN VILLAFRANCA, APRIL 1945

The number of enemy casualties be-came so large as to constitute a majorproblem after the fighting turned intoa battle of pursuit in the Po Valley. Thebulk of the German medical facilitieshad by that time been withdrawn northof the Po, and German medical corps-men south of the river had no alterna-tive but to bring their casualties to Alliedclearing stations or hospitals. The 56th

Evacuation at Bologna, the 38th at Mar-zabotto and Fidenza, the 16th at San Gio-vanni, the 94th at Carpi, and the 170that Mirandola all received German cas-ualties by the hundreds in the closingdays of the war in Italy. The 38th treatedclose to 500, the 56th more than 800before the end of April. At the 56th, twoGerman surgical teams were organizedand kept busy operating on prisoners. Inmany cases German ambulance driverswho brought their wounded to Americanhospitals were allowed to return un-guarded for further loads.

The first German hospital to be cap-

ing: (1) Annual Rpt, Surg, Fifth Army, 1945; (2)Annual Rpt, Surg, II Corps, 1945; (3) Unit rptsof the hosps and med battalions mentioned intext; (4) ETMD's of the named hosps for Apr andMay 45.


GERMAN HAUPTVERBANDPLATZ, equivalent to a reinforced clearing station, captured 25April 1945.

tured intact was taken by the 10th Moun-tain Division on the south bank of thePo on 23 April. The unit was fullyequipped, with its full complement ofdoctors, nurses, and corpsmen, but itssupplies were virtually gone. In this case,the patients were evacuated to U.S. units,and the dismantled hospital was sent tothe rear. It was soon clear, however, thatthe Allies could not afford to waste fa-cilities in this fashion. A directive fromAllied Force Headquarters requiredFifth Army thereafter to use Germanhospitals and personnel to care for Ger-

man wounded under supervision ofAmerican medical personnel.

In the IV Corps sector, the field hos-pital units were ordered to set up theirown establishments in connection withcaptured German hospitals, combiningadministration of the prisoner units withtheir own. In the II Corps area the taskof administering enemy medical unitsdevolved upon the 54th Medical Battal-ion. The number of German hospitalstaken in the final days, however, was toogreat for either technique to be used ex-clusively. Divisional medical units and


evacuation hospitals also participatedwhen occasion required.

For example, the 3d Platoon of the32d Field Hospital, coming up fromVergato, crossed the Po on a pontonbridge early in the afternoon of 26 April,entered Mantova on the heels of theretiring enemy, and proceeded immedi-ately to a large civilian hospital andsanatorium known to have been used bythe Germans. Until the preceding daythe establishment had served the enemyas a base hospital. Since that time it hadbeen administered by 5 British enlistedmen who had been prisoners. Therewere 54 Allied patients, including a fewAmericans, and 140 German patients.The staff consisted of 3 German medicalofficers, 5 volunteer Italian doctors, 3Italian medical students, 13 volunteerItalian nurses, a dozen or more nunsfrom a nearby convent, 30 German med-ical corpsmen, 18 Italian medical sol-diers who had been interned by theFascists, a German Army chaplain, andsome 15 Italian partisans acting asguards.

Most of the Allied patients were infair condition, despite short supplies ofboth food and drugs, but infectedwounds calling for surgery were commonamong the Germans. The field hospitalunit operated the prisoner of war hospi-tal as well as its own for two days, thenturned both over to the 15th Evacuation,which was operating as a POW hospitalalmost exclusively by the end of the war.

The field hospital unit, meanwhile,moved on to Garbagnate near Milan,where another German hospital wastaken over. The Garbagnate establish-ment had close to 600 German patientsin charge of a minimum staff, a supplydepot, and a laboratory. Here again

there was little food and no fuel for es-sential services such as running steriliz-ing equipment and cooking.

At Parma, where the 2d Platoon ofthe 32d Field took over a German hos-pital on 28 April, 220 German patientswere being cared for by 15 German med-ical officers, 120 corpsmen, and 3 ItalianRed Cross nurses. The establishment hadto be put under immediate guard to pro-tect its patients from attacks by partisans.On 2 May the same platoon of the 32dField added administration of a secondGerman hospital, located ten miles awayat Brescello, to its duties. The Brescellounit had 83 patients. Its existence wasreported by a German medical officerwho came to the Parma unit under Par-tisan guard.

In the II Corps sector, the 54th Med-ical Battalion took over its first Germanhospital on 27 April, when the 380thCollecting Company assumed adminis-tration of the 29th Panzer Division hos-pital southeast of Verona. Enemy unitsat Citadella and Caldogno were takenover on 30 April, one at Galliera on 1May, and another at Paderno on 2 May.All of these hospital sites were in theVicenza-Treviso area, where the 171stEvacuation in the opening days of Mayalso took more German than Allied pa-tients.

The condition of these captured hos-pitals varied markedly, both as to equip-ment and in terms of staff, but a unitcaptured at Bergamo by the 1st ArmoredDivision, which had 14 doctors to carefor 1,180 patients, was more typical thanthe Parma hospital with its 15 doctorsand 220 patients.

The process of rounding up and con-centrating the 23,000 prisoner casualtiestaken by Fifth Army was only beginning


LAKE GARDA, used by assault boats and local craft to evacuate patients.

when the war ended. The main medicalstory for prisoners of war belongs to thepostwar period.10


Evacuation from the battlefields andfrom division clearing stations in the PoValley Campaign followed the normalpattern, with the 54th Medical Battalionevacuating from II Corps and the 163dMedical Battalion from IV Corps andthe 92d Division. Both corps medical bat-

talions were reinforced when necessaryby the attachment of collecting compa-nies or ambulance platoons from one ofthe two Fifth Army medical battalions.Evacuation during the mountain phasesof the fighting was by hand litter, jeep,and ambulance. On the 92d Divisionfront the pack mules that brought in sup-plies were sometimes used to carry outthe wounded from otherwise inaccessiblepositions. In the Po Valley, evacuationwas predominantly by ambulance, trucksbeing used for wounded prisoners andambulatory cases when ambulances werenot available. Dukws and assault boats10 See pp. 534-43, below.


were used to ferry the wounded acrossthe Po, and to bypass roadblocks alongLake Garda. The problem of evacuationwithin the army area was primarily oneof distance and transportation, whichwas accentuated but not altered by thepresence of large numbers of enemywounded in the later stages of the cam-paign and by the tendency of combatunits to outrun their medical support.11

Evacuation from Fifth Army hospitalsto base installations, however, posed diffi-culties not previously encountered by themedical service in Italy. Until the PoValley itself was occupied, fixed hospitalscould not be brought closer than theywere in the Florence-Pistoia-Leghornarea. Between these hospitals and thebattle front lay mountain ranges 50 to100 miles in depth. All rail lines hadlong since been knocked out, leavingonly highways gutted by six months ofwar to supply the army as well as toevacuate the wounded. Air evacuationcould not be used until captured airfieldsin the Po Valley could be made opera-tional, and even then might be too haz-ardous since the slow C-47's would behighly vulnerable while they gainedaltitude for the mountain crossing.

Since the eastern end of the Apenninechain would be easiest to cross, two sta-tion hospitals, the 60th and the 225th,both assigned to the Adriatic Base Com-mand, were moved into the Ancona areabefore the beginning of the campaign,but no other shifts were practical until

sites for fixed hospitals were availablenorth of the mountains.

Until the closing days of the war, allevacuation from Fifth Army to base hos-pitals was thus by ambulance, the bulkof it over the battered Highways 64 and65, with distances stretching out to ahundred miles and more as the evacua-tion hospitals moved into the Po Valley.The process was constant. The heavycasualties of the first week forced con-tinuous clearing of forward units tomake way for the newly wounded, and asthe casualties diminished, the distancesincreased to keep ambulances unremit-tingly on the road. Patients were carriedto the nearest base hospital—the 24thGeneral in Florence and the 70th Gen-eral at Pistoia for the most part—wherebed space was kept open by the dailytransfer of older cases to Leghorn andNaples by rail and air.

The airfield at Bologna was opera-tional by 25 April, and a detachmentof the 802d Medical Air EvacuationTransport Squadron set up a stationthere on that day.12 A second air evacua-tion station was established at Villa-franca south of Verona on 2 May,where the 2d Platoon of the 601st Clear-ing Company combined the functions ofair evacuation holding unit with thoseof Fifth Army neuropsychiatric hospital.

The only fixed hospital to open north

11 This section is based primarily on the follow-ing: (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 rec-ord, however, either in the monthly report of thesquadron or in the medical situation reports of thePeninsular Base Section of any patients actuallybeing evacuated from Bologna by air before theend of April. The 402d Collecting Company, whichwas supporting the 56th Evacuation Hospital atBologna until 2 May, states in its final report(History, 161st Medical Battalion, 1 January-1 Au-

gust 1945), that there was no air evacuation fromBologna during its stay there.


AMBULANCES FORDING RENO AT PRADURO while traffic bound for front uses Baileybridge (right).

of the Apennines before the German sur-render was the 74th Station, which begantaking patients in Bologna on 27 April.There were 600 cases by 1 May, and an-other 400 less serious cases had beenhoused, fed, treated, and passed on to therear. The 6th General had meanwhilearrived in Bologna and was setting up,while the 37th General was en route toMantova. With the establishment of3,000 fixed beds so near at hand, evacua-tion hospitals were holding as manypatients as was physically possible whenthe war ended.


In preparation for the Po Valley Cam-paign, the 2d Storage and Issue Platoonof the 12th Medical Depot Company sentan advance section up Highway 64 on7 April. Consisting of five enlisted menand ten tons of medical supplies, the sec-tion set up a dump at Valdibura, adja-cent to 32d Field Hospital. On 16 Aprilthe platoon joined its advance section,moving up to Porretta where an issuepoint with 40 tons of supplies was es-tablished. A small detachment was left


behind at Lucca, where it served the 92ddivision and medical units still in theimmediate vicinity. Its personnel wereattached for rations and quarters to the171st Evacuation Hospital. The Luccasection functioned independently of theparent platoon, forwarding any requisi-tions it could not fill directly to the maindepot in Florence.13

The 3d Storage and Issue Platoon,which had supported II Corps through-out the winter from its dump nearMonghidoro, moved forward to Bolognaon 24 April with 50 tons of medical sup-plies. The following day the Porrettadump displaced forward to Mirandola,transferring again to Verona on 30 April.The depot headquarters, maintenancesection, and 1st Storage and Issue Pla-toon moved on 1 May from Florence toModena, where the base dump wasestablished with 150 tons of supplies.

The 92d Division, remote as it wasfrom the issue points supplying II andIV Corps, drew its medical suppliesthrough its own organization. The divi-sional medical supply dump moved fromViareggio to Massa on 16 April, was inRiva just south of Sestri ten days later,and opened in Genoa on the 29th.14

On the 92d Division front, transpor-tation difficulties were constant, withmule pack trains being used in the moun-tainous areas. On the II and IV Corpsfronts, no difficulties were experiencedin keeping forward dumps supplied un-til 25 April. Up to that time both corpsinstallations could be reached from

Florence in no more than a day for theround trip. For the rest of the month,however, until the base depot itself couldbe moved into the Po Valley, both dis-tance and the rapid consumption ofsupplies to care for prisoners of warmade resupply difficult. Maximum useof captured German medical suppliesand equipment was made during thisperiod.

Despite the speed of the campaign, thedispersion of installations, and the short-ages of transportation, there is no recordthat any Fifth Army medical unit failedto obtain adequate supplies or replaceequipment through regular channels.The success of the 12th Medical DepotCompany was achieved, moreover, whilesupplying close to 300,000 troops insteadof the 75,000 normally served by such aunit.

The optical and dental services of the12th Medical Depot Company continuedto function without interruptionthrough the Po Valley Campaign.

Professional Servicesin the Army Area


While the total number of hospitaladmissions during the brief period of thePo Valley Campaign was large—6,151cases of disease, 1,533 cases of injury, and5,092 battle casualties, or 12,776 admis-sions not counting prisoners of war-there were no outstanding developmentsin combat medicine or surgery. Evacua-tion hospitals, especially the 15th and170th on Highway 64 and the 8th and94th on Highway 65, handled a largerproportion of the priority surgical casesthan had been true in earlier campaigns,

13 This section is based primarily on the follow-ing: (1) Annual Rpt, Surg, Fifth Array, 1945; (2)Annual Rpt, 12th Med Depot Co, 1945; (3) David-son, 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.


but this was because the majority of bat-tle wounds occurred in the opening daysof the offensive while the evacuation hos-pitals were still close to the action. Thefield hospital platoon with attached sur-gical teams continued to be the preferredinstallation for forward surgery. Wholeblood flown up from the Naples bloodbank and from bleeding sections inFlorence and Pisa was used extensively,and was again delivered to forward areasby cub plane.15

The medical problems were the nor-mal ones, predominantly respiratory andintestinal diseases attributable to expo-sure or to inadequate sanitation in newlyconquered areas. An outbreak of hepa-titis in the 1st Battalion on the 86th In-fantry, 10th Mountain Division, duringthe first two weeks of April suggesteddrinking water as the source of infection.The 3d Battalion of the 362d Infantry,91st Division, suffered an outbreak ofatypical pneumonia in the second andthird weeks of April, with evidence indi-cating a barn used for showing films andan adjacent straw pile as the point oforigin. The incidence of venereal diseasedeclined in April, as was to be expectedin combat.

Psychiatric disturbances increasedmarkedly over the static winter months,with a total of 1,430 cases in April, ofwhich 668 were returned to full dutyfrom the division clearing stations orrehabilitation centers and 266 from hos-pitals, which also returned 293 to limitedduty. Only 203 were evacuated out of thearmy area, or 14.2 percent—lower than

the percentage for any other combatmonth in Fifth Army history. The num-ber of psychiatric casualties declinedsharply during the battle of pursuit inthe Po Valley, and by the end of hostili-ties was no longer enough to justify theseparate existence of a neuropsychiatrichospital at the army level.

While both medical and surgical serv-ices of Fifth Army units were pushed tothe limit of their capacities in the threeweeks of active combat, the problem wasalways one of applying familiar tech-niques on the required scale rather thanthe development of new methods to copewith unforeseen crises.

Dental Service

Dental work during the weeks ofactual combat was largely confined toemergency cases, with many dental offi-cers, particularly those on the staffs ofevacuation hospitals, performing a va-riety of other functions. Complete dentalservice was nevertheless available in thearmy area throughout the campaign.16

The IV Corps dental clinic ceased op-eration in mid-April when the 32d FieldHospital platoon to which it was attachedclosed at Valdibura, and operations werenot resumed until after the end of hos-tilities. The II Corps clinic, however,continued to operate throughout thecampaign, moving forward with theclearing company of the 54th MedicalBattalion. The Fifth Army dental clinic,conducted by the 2d Platoon of the 602dClearing Company, 162d Medical Battal-

15 Principal sources for this section are: (1)Annual Rpt, Surg, Fifth Army, 1945; (2) ETMD'sfor Apr, May and Jun 45; (3) Unit rpts of FifthArmy hosps and of 2d Aux Surg Gp.

16 Principal sources for this section are: (1) An-nual Rpt, Surg, Fifth Army, 1945; (2) AnnualRpt, 320! Field Hosp, 1945; (3) Annual Rpt, 54thMed Bn, 1945; (4) Dental Hist, MTO.


ion, also functioned in its normal capac-ity, moving with the platoon, which alsooperated the army venereal disease cen-ter, to San Giovanni on 24 April and toVerona on 2 May. Mobile prosthetic andoperative trucks and the mobile dentaldispensaries of the divisions were in serv-ice as far forward as circumstances per-mitted.17

The ratio of dental officers to armystrength for April 1945 was 1:924, aslight improvement over the precedingmonth but higher than the average ratiofor the North Apennines Campaign. Thetotal number of dental operations per-formed in Fifth Army in April was lessthan for any month since September1944. The length of time available forgetting the troops into shape before thebeginning of the offensive was a factor inreducing the need for dental work oncethe drive was under way.

Veterinary Service

Animal transportation was as essentialto Fifth Army in the Po Valley Cam-paign as it had been throughout the ear-lier fighting in Italy. The only note-worthy changes were in the direction ofbetter organization and more completeveterinary support. By the launching ofthe final drive, Fifth Army had 17 Italianpack mule companies, grouped into 5battalions under the 2695 Technical Su-pervision Regiment. Each company had269 animals and 379 men, including anItalian veterinarian. Three U.S. veteri-nary officers functioned at the battalionlevel. In addition to these units, the 92dDivision had its own provisional packmule battalion. Shortly before the start

of the campaign, the 10th Mountain Di-vision received 180 horses for its cavalryreconnaissance troop from the FifthArmy Remount Depot, and 525 mulesdirect from the United States. The divi-sion's animal strength ultimately reached822, not counting attached Italian packrnule companies. There were approxi-mately 4,500 horses and mules and 125scout dogs in Fifth Army during thisperiod.18

Veterinary service was supplied by di-vision and corps veterinary personnel,which in the case of the 10th MountainDivision was substantial.19 Fifth Army'sfour Italian-staffed and U.S.-equippedveterinary hospitals were supplementedby the late arrival on 17 April of the 36thVeterinary Company, whose 5 officersand 59 enlisted men took over the bulkof the animal evacuation thereafter. Thethree semitrailers with which the com-pany was equipped proved less satisfac-tory for negotiating the difficult Italianroads than the trucks previously used.

The 212th Veterinary Station Hos-pital, serving IV Corps, was the first toenter the Po Valley. The unit closed atLucca on 20 April and opened at PalazzoBeccadelli, on the edge of the plain aboutten miles west of Bologna, on the 22d.The 211 th Veterinary Evacuation, also aIV Corps unit, closed at Riola in the10th Mountain Division sector on 24


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, Apr45; (4) Hist, 92d Div, Apr 45; (5) Annual Rpt,Surg, 10th Mountain Div, 1945; (6) Vet Rpt, Sickand Wounded Animals, Apr 1945; (7) Hist, 36thVet Co (Separate) ; (8) Fifth Army History, pt. IX;MS, Veterinary History, Mediterranean Theater ofOperations.

19 The 10th Mountain Div had 22 veterinary of-ficers and 182 enlisted men. See p. 432, above.


April, opening two days later at Ghisionejust south of the Po in the vicinity ofOstiglia. The two veterinary evacuationhospitals attached to II Corps were some-what later in getting across the moun-tains, both moving into the Verona areain the closing days of the campaign. The110th opened at Polvrifitto southeast ofthe city on 28 April, while the 130thopened in Verona itself on the 30th. TheFifth Army Remount Depot moved toSan Martino, close to the site of the 211thVeterinary Evacuation Hospital, about 1May. (See Maps 39,40, 41.)

While animal casualties were fewerthan in the North Apennines Campaign,the veterinary problem was complicatedby the capture of thousands of Germananimals north of the Po, many of whichwere in need of immediate attention.20

Veterinary food inspection detach-ments continued to operate with FifthArmy throughout the Po Valley Cam-paign, but their work was of a routinenature.

20 See p. 517, below, for a discussion of the care anddisposition of these animals.

CHAPTER XIII

The Italian Communications Zone

Northern Phase

As the war in Italy moved into thenorthern Apennines, the communica-tions zone was extended up the peninsulato the Arno Valley. The requirements ofthe campaign in southern France, how-ever, delayed the northward movementof medical installations and placed an un-due burden on the evacuation facilities.It was not until Fifth Army had beenstalled by snow and mud a short tenmiles from the Po plain and SeventhArmy had passed to control of the Euro-pean Theater of Operations that a sweep-ing realignment of communications zoneactivities was possible.

Organizational Changes Affectingthe Medical Service

Theater Medical Organization

Since February 1944 responsibility forthe operating functions of the MedicalDepartment in the Italian communica-tions zone had rested with the medicalsection of the Services of Supply organiza-tion-SOS NATOUSA, redesignatedCommunications Zone, NATOUSA, asof 1 October. By midsummer of 1944, themedical section was deeply involved inpreparations for the invasion of southernFrance, and furnished key personnel forthe base organizations that followed the

Seventh Army advance. This diversion ofpersonnel necessarily increased the workload of those remaining in Italy, but thesituation was understood to be temporarysince logistical support of the 6th ArmyGroup would ultimately become the re-sponsibility of ETO. Shortly after thecommand of Seventh Army passed toSHAEF on 15 September, the date forthe transfer of the supporting functions,including medical, was fixed as 1 No-vember.1

At this time, however, the SHAEFcommander, General Eisenhower, indi-cated his desire that an operating com-munications zone organization be part ofthe transfer. In effect, CommunicationsZone, NATOUSA, was to go over toETO as the Southern Line of Communi-cations (SOLOC) , leaving the Americancomponent of Allied Force Headquartersto develop a new organization to carry oncommunications zone functions in theMediterranean theater. For the MedicalDepartment, the most practical solutionappeared to be the resumption of operat-ing functions by the Medical Section,

1 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) Hist, MedSec, Hq COMZ MTOUSA; (3) Munden, Adminis-tration of Med Dept in MTOUSA, pp. 129-78;(4) Davidson, Med Supply in MTOUSA, pp.155-56; (5) Logistical History of NATOUSA-MTOUSA. See also pp. 399-401, above.

THE ITALIAN COMMUNICATIONS ZONE: NORTHERN PHASE 487

GENERAL STAYER

NATOUSA, which would in addition as-sume the medical supply responsibilitiesformerly exercised by the SOS organiza-tion.

On 1 November 1944 the theaterboundaries were redrawn to excludesouthern France, and the North AfricanTheater of Operations, United StatesArmy (NATOUSA), was redesignatedMediterranean Theater of Operations,United States Army (MTOUSA) . Theorganization was completed on 20 No-vember when Communications Zone,MTOUSA, ceased to exist, and the func-tions of its medical section were formallyassumed by the Medical Section, Head-quarters, MTOUSA. The consolidationwas effected with the transfer of only 5officers and 16 enlisted men from the out-going group, all of them specialists inmedical supply.

Few changes were necessary in thecomposition of the MTOUSA medical

section. Maj. Gen. Morrison C. Stayercontinued as theater surgeon with Colo-nel Standlee as his deputy. Lt. Col. (laterCol.) Joseph Carmack, administrativeofficer, Col. William C. Munly, medicalinspector, and Col. William S. Stone,preventive medicine officer, were amongthe section heads whose functions wereunchanged. Neither the surgical consult-ants section, headed by Colonel Church-ill, nor the medical consultants section,which included Colonel Long as medicalconsultant and Colonel Hanson as con-sultant in neuropsychiatry, was affectedby the reorganization. The MTOUSAdental officer, Colonel Tingay, and thetheater veterinarian, Colonel Noonan,were also unaffected by the reorganiza-tion. The replacement of Colonel Wil-bur, director of nurses, by Lt. Col.Margaret E. Aaron on 14 December wasa matter of normal rotation, not relatedto any change in functions. ColonelAaron had served in the Europeantheater, where she had been Directorof Nurses, SOS ETOUSA.

In the reorganized Medical Section,MTOUSA, hospitalization and evacua-tion fell into the experienced hands ofCol. Albert A. Biederman, who had re-joined the section as the plans and opera-tions officer early in September after sixmonths with the SOS organization. Onlyin the area of medical supply, which hadnever been an operating function of theMTOUSA medical section, was it neces-sary to add significantly to the staff. Colo-nel Radke, who had been NATOUSAmedical supply officer since the spring of1943, remained in that capacity until 20December, but his role continued to beconfined to the policy level. The operat-ing functions were performed under thedirection of Colonel Jones, who had


headed the SOS medical supply sectionsince May 1944. Jones brought with himfrom the medical section of Corn-zone MTOUSA, a trained staff and afunctioning organization. He succeededRadke as MTOUSA medical supply offi-cer on 21 December.

The MTOUSA medical section movedout of the royal palace in Caserta on 12November to the quarters formerly occu-pied by the SOS medical section in anItalian military hospital. On 23 Novem-ber the personnel allotment of the sec-tion was increased to cover losses, and on24 December an additional officer and 3enlisted men were allocated to it, bring-ing the authorized total to 32 officers, in-cluding 2 nurses, and 80 enlisted men.Three medical officers were added inMay 1945, bringing the aggregate person-nel strength of the section to 115.

Concentration of CommunicationsZone Functions in Italy

The November 1944 reorganizationbrought the base sections back under thecontrol of theater headquarters at a timewhen the progress of the war was con-centrating the Mediterranean forces innorthern Italy. The invasion of southernFrance had left the theater short oftroops, transportation, equipment, andhospital beds, and it was therefore essen-tial to eliminate so far as possible the fac-tor of distance.2

In North Africa, which had been sub-stantially stripped of supplies and hos-pital beds to build up the bases insouthern France, the Eastern and Atlan-tic Base Sections were absorbed by theMediterranean Base Section on 15 No-vember. The base section headquarterswas moved from Oran to Casablancaearly in December and on 1 March 1945the whole of North Africa passed to con-trol of the Africa-Middle East Theater.3

With all of southern France and all ofItaly south of the Arno firmly in Alliedhands, the Mediterranean islands alsolost their strategic importance. The Is-land Base Section in Sicily had alreadybeen closed out in mid-July, and the lastU.S. hospital left Sardinia the end ofOctober. The Northern Base Section,consisting of the island of Corsica, con-tinued in operation on a reduced scaleuntil the end of the war, being finallyclosed out on 25 May 1945.

The Peninsular Base Section, on theother hand, grew in importance as theAfrican and island bases declined. Assoon as the facilities of the port of Naplesand the hospitals concentrated in thatvicinity were no longer needed for thelogistical support of the forces in south-ern France, the base section began shift-ing its strength to the Leghorn-Florence-Pisa triangle. PBS headquarters was es-tablished in Leghorn on 25 November,the subheadquarters in Naples thereafterbeing designated as PBS South. ColonelArnest, the PBS surgeon, moved to Leg-horn with the base headquarters, leavingCol. Leo P. A. Sweeney as his deputy inNaples.

At the same time the U.S. componentof Rome Allied Area Command was

2 Principal sources for this section are: (1)Annual Rpt, Med Sec, MTOUSA, 1944; (2) FinalRpt, 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, RomeArea, Jan-May 45; (8) AAFSC MTO, Annual MedHist, 1945. 3 For subsequent activities, see pp. 8off., above.


redesignated Rome Area, MTOUSA, ef-fective 1 December. The Rome Area sur-geon was Lt. Col. (later Col.) BenjaminL. Camp, who also retained his office asdeputy to the RAAC surgeon, Col. T. D.Inch of the Royal Army Medical Corps.The single U.S. fixed hospital scheduledto remain in Rome was brought underthe Rome Area jurisdiction, togetherwith responsibility for sanitation, vene-real disease control, and other miscella-neous medical functions.

Similarly, the Adriatic Depot was re-constituted on 28 February as the Adri-atic Base Command (ABC) with head-quarters at Bari. Though its primarymission was still that of supporting theU.S. Army Air Forces units in Italy, itwas made responsible directly to MTOUSA. After detailed study of the point,the hospitals previously attached to theArmy Air Forces Service Command werebrought under the aegis of the AdriaticBase Command.

By the end of hostilities, the medicalactivities of the communications zone inthe Mediterranean theater centered inPBS Main at Leghorn, with lesser andlargely subsidiary bases in Naples, Rome,and Bari.


The inadequacy of medical facilities inthe Mediterranean theater was nevermore obvious than at the start of thebitter and costly campaign in the north-ern Apennines. In the first days ofSeptember 1944, the Italian communica-tions zone was as deficient in bed strengthas was Fifth Army. Nine thousand T/Ofixed beds were already closed or alertedfor closing in Italy for movement to

southern France, plus another 4,500 inNorth Africa, and 750 in Corsica. In Italythe total would be 21,900 under controlof the Peninsular Base Section and 3,200attached to the Army Air Forces. Of thePBS total, more than half were in theNaples-Caserta area, 300 miles fromthe Fifth Army front, and only 4,000north of Rome.

The problem thus posed for GeneralStayer and Colonel Arnest was immeasur-ably complicated by the necessity of hos-pitalizing in Italy for an indefinite timethe casualties evacuated from southernFrance. Yet until the hospitals alreadyclosed in Italy and Africa could be re-established in France there was no alter-native. For the next two months theItalian communications zone, with 25percent of its strength already with-drawn, would support two field armies,each engaged in a major campaign. Itwould support them, moreover, at longrange, for the patient load would be toogreat to permit any substantial numberof beds to be closed for movement closerto the front.

Casualties From Southern France

When the first casualties from the am-phibious landings in southern Francereached Italy on 17 August 1944 therewere already some 25,000 patients onhand in PBS hospitals. Between that dateand 20 November, an estimated 20,000patients from France were received inPBS, in addition to Fifth Army casualtiesand the routine disease and injury casesfrom among service and replacementtroops in Italy.4

4 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) AnnualRpt, Surg, PBS, 1944; (3) ETMD's for Aug-Nov


While a few Seventh Army casualtieswere flown to Rome, the bulk of the evac-uees from southern France went by seaand air to Naples, where they were caredfor by the 17th, 37th, 45th, and 300thGeneral Hospitals. Each of these unitsoperated in excess of its Table of Organ-ization capacity during the emergencyperiod, as did most of the PBS hospitals.Fixed hospitals in both Naples and Romewere still receiving thousands of casual-ties from Fifth Army through Septemberand October at the same time that theNaples hospitals were filled withwounded from southern France and two-thirds of the beds in Rome were in proc-ess of moving to northern Italy.5 Theonly evacuation from the overcrowdedNaples hospitals at this time was to thezone of interior, since there were nolonger any beds left in Africa for long-term patients.

Movement of Fixed HospitalsInto Northern Italy

The overloading of PBS hospitals withcasualties from southern France andfrom the Gothic Line was only one ofseveral reasons for the delay in movingfixed beds into northern Italy. Anotherreason was the difficulty in finding sitesfor large installations. In the war-tornArno Valley few buildings were availableof sufficient size to house a 1,500-bed or2,000-bed general hospital; and to set upsuch an establishment in tents or prefab-ricated buildings with adequate power,water, drainage, and access roads was amajor engineering project. Still anotherfactor was the hope, after the initial suc-

cess of Fifth Army against the GothicLine, of a quick breakthrough into thePo Valley. Ground haze in that regionmade air evacuation impossible in thewinter months, and the rail lines hadbeen knocked out by Allied bombing. Itwas therefore deemed essential to keep atleast a minimum of fixed beds mobile forearly movement north of the Apennines.6

At the beginning of the North Apen-nines Campaign the 64th General Hos-pital was at Ardenza, a suburb just southof Leghorn, with the 55th StationHospital attached, giving the combinedinstallation a T/O capacity of 1,750 beds.The 50th Station Hospital, with 250beds, was at Castagneto some 40 milesdown the coast, and the 24th General,with 1,500 beds, was at Grosseto, another40 miles farther south and 75 miles fromthe rearmost Fifth Army installations.Moves made during September werelargely readjustments, not involving anyof the large hospitals in the Naples orRome areas.

On 13 September the 154th StationHospital—the only 150-bed unit in thetheater—moved up from the Battipagliastaging area south of Naples to relievethe 105th Station at Civitavecchia. The105th, with 500 beds, moved on to Gros-seto to relieve the 24th General and thelatter unit proceeded to Florence, whereit opened on 21 September in the exten-sive plant of a former Italian aeronauticsschool. By mid-October the hospital was

1944; (4) Rpts of individual hosps mentioned intext. See also pp. 396-400, above.


6 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) FinalRpt, Plans and Opns Off, MTOUSA, 1945; (3)Annual Rpt, Surg, Fifth Army, 1944, 1945; (4)Med Sitreps, PBS, Sep 44-Jan 45; (5) TheaterETMD's, Sep 1944-Jan 45; (6) Unit rpts of hospsmentioned in text; (7) Unit ETMD's of the hospsmentioned in text, for Sep 44-Jan 45.


operating 2,770 beds on a 1,500-bedT/O.

At the same time the 750-bed 7th Sta-tion Hospital, which had been staging inOran since July, arrived in Leghorn andset up at Tirrenia, a former Fascist youthcamp on the seacoast about four milesnorth of the city. The unit opened on 29September with the facilities and bedstrength of a general hospital. Shortlyafter its establishment, the 7th Stationwas designated to hospitalize all Brazilianground personnel in the area, and byDecember was caring for 700 Brazilianpatients in addition to a full load of U.S.patients. Fifteen medical officers, twodental officers, three pharmacists, a chap-lain, 23 nurses, and 32 enlisted tech-nicians, all Brazilian, were attached.Brazilian medical strength at the 7thStation Hospital eventually reached amaximum of 27 officers and 65 enlistedmen, though the nurse strength declinedto 18.

The Brazilians were given wards oftheir own for routine cases, but those re-quiring special treatment were placed inthe regular medical and surgical wards.Brazilian doctors were assigned to themedical and surgical staffs of the hos-pital, where they dealt with all patientsand worked on teams with U.S. surgeonsas well as on surgical teams of their own.In the course of time, as language bar-riers and differences in practices wereovercome, the Brazilians were fully inte-grated into the hospital staff. Between 7October and 12 December five Brazilianmedical officers and six nurses also servedwith the 154th Station at Civitavecchiato care for personnel of nearby BrazilianAir Force units.

The only other hospitals to move intonorthern Italy during September were

the 81 st Station from Naples and the114th Station from Rome, but neithermove was completed before the end ofthe month. The 81st closed in Naples on24 September, and was established ad-jacent to the 64th General at Ardenza by1 October. One 250-bed expansion unitwas set up immediately, and a secondopened shortly in a prisoner of war stock-ade. The 81st, with the assistance of de-tached personnel from other units, wasthus operating 1,000 beds on a 500-bedT/O.

The 114th Station, which moved intoan abandoned Italian military hospital inLeghorn proper, had more difficulty get-ting established. Extensive repairs wererequired, and it was 20 October beforethe hospital was ready to receive patients.The 114th Station continued to serve asthe PBS neuropsychiatric hospital, butthe shortage of fixed beds made it neces-sary to take medical cases as well. For thefirst two months of operation in Leghornabout half of its patients were medical.

The shift of the 114th Station fromRome heralded a general exodus of medi-cal installations from the Italian capital,which was too far in the rear to effec-tively support the Fifth Army front andlacked the port facilities that madeNaples still useful as a hospitalizationcenter. The 33d General Hospital wasthe first of its class to go, closing on 24September. A site was located in whatwas to become the Leghorn hospitalcenter at Tirrenia, where the 7th Stationwas already in operation, and movementwas completed on 7 October. The 33dGeneral opened five days later. (Map 42)

The 12th General, one of the two2,000-bed hospitals remaining in Italy,began closing out in Rome about 1 No-vember, starting the roundabout journey

MAP 42—Fixed Hospitals in Northern Italy, July 1944-October 1947

FIXED HOSPITALS IN NORTHERN ITALY

Grosseto213th 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.

aRedesignated 1st Veterinary General Hospital(U.S.-Italian), 31 March 1945.

b Redesignated 99th Field Hospital, 20 March1945.

FIXED HOSPITALS IN NORTHERN ITALY—Continued

1st Veterinary General (U.S.-Italian), 31 March-15 July 1945.

Castagneto50th 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 August-15 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 September1945. 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 November1947. 500 beds.

Senigallia35th Field, 2d Platoon (AAFSC; ABC), 11 No-

vember 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. 500beds.

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.

Empoli50th 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. 500beds.

Pratolino55th 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 Octo-

ber 1945. 500 beds.

64th General, Detachment A, 1 October-15 No-vember 1945. 250 beds.

Fano225th Station (ABC), 16 April-8 May 1945. 500

beds.Pistoia

70th General, 22 January-25 June 1945. 1,500beds.

Rimini35th 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 Sep-

tember 1945. 500 beds.Pontepetri

2605th Veterinary General (Overhead), with 2dVeterinary General (U.S.-Italian) attached, 21April-2 May 1945.

Bologna74th Station, 27 April-20 June 1945. 500 beds.6th General, 9 May-10 August 1945. 1,500 beds.

Mirandola2605th Veterinary General (Overhead), with 2d

Veterinary General (U.S.-Italian) attached, 2May-28 June 1945.

San Martino2604th Veterinary Station (Overhead), with 1st

Veterinary Station (U.S.-Italian) attached, 5-14May 1945.

Mantova37th General, 9 May-25 October 1945. 1,500

beds.Milan

15th Fieldc, 1st Platoon, 1-30 September 1945.100 beds.

Desenzano15th Fieldc, 3d Platoon, 1 September-8 October

1945. 100 beds.Udine

16th Evacuation (as station), 1 September-2 Oc-tober 1945. 750 beds.

15th Field (88th Division), 2 October 1945-13May 1946. 400 beds.

391st Station (88th Division), 11 May 1946-15October 1947. 400 beds.

Bolzano15th Fieldc, 2d Platoon, 1 September-5 October

1945. 100 beds.Trieste

7th Station (88th Division), 1 May-19 September1947d. 200 beds.

cAssigned in place from Fifth Army to PBS, 1September 1945. Reassigned to 88th Division, 25September 1945.

d Turned over to Trieste-United States Troops(TRUST) 19 September 1947.


12TH GENERAL HOSPITAL, the largest unit in the group of medical installations in thenorthern outskirts of Leghorn.

to Tirrenia in the middle of the month.Four trainloads of equipment went byrail to Naples, and thence to Leghorn bywater. Equipment arrived on 25 Novem-ber, and the first patient was received atat the new site on 3 December. The ar-rival of the 12th General brought Tableof Organization bed capacity in Leghornto 6,750, or an operating strength of bet-ter than 10,000.

The 55th Station, meanwhile, hadbeen relieved of its attachment to the64th General in the middle of October,and on the 16th of that month opened atPratolino, six miles north of Florence, inbuildings vacated the day before by the94th Evacuation Hospital. The 74thStation, which had closed at Caiazzo

north of Caserta on 25 October and wasalso scheduled for the Florence area,was less fortunate. Its prospective sitewas still occupied by the 15th Evacua-tion, which the Fifth Army surgeon haddecided to retain in Florence over thewinter. As no alternative site was avail-able, the 74th Station set up head-quarters with the 24th General andplaced the bulk of its personnel on de-tached service with other medical units.

Only two more fixed hospitals movedinto northern Italy before the launchingof the spring drive into the Po Valley.These were the 103d Station, fromNaples, which opened in a prisoner ofwar enclosure in the outskirts of Florenceon 11 January 1945; and the 70th Gen-


70TH GENERAL HOSPITAL AT PISTOIA

eral from North Africa, which opened inPistoia on 22 January.

There were, however, various readjust-ments in the hospital picture around theend of 1944. In Rome the 73d Stationwas reassigned to Rome Area, MTOUSA,on 1 December 1944. The 6th Generalclosed on 22 December, but remained inRome with all equipment packed andready to move on short notice. Personnelof the hospital were placed on temporaryduty with other medical units scatteredover Italy. The 34th Station, which hadbeen serving a replacement center inthe Caserta area since October, took overthe buildings vacated by the 6th Generalin Rome on 19 January, while the 154thStation closed at Civitavecchia and re-

placed the larger 34th at Caiazzo.Late in December the 50th Station at

Castagneto reorganized along field hos-pital lines into three detachments, one ofwhich relieved the 105th Station at Gros-seto on 24 December. Another detach-ment set up a small hospital to serve the8th Replacement Depot at Empoli, twen-ty-five miles west of Florence, on 17January 1945. The third detachment re-mained at Castagneto. The 105th Sta-tion, displaced at Grosseto, moved to Pisawhere it opened in buildings of anItalian tuberculosis sanatorium fourmiles east of the city on 15 January. Atits Pisa site, the 105th Station served anencampment of Russians who had beenliberated from German prison camps.


Status of Hospitalization in MTOUSAJanuary-March 1945

By January 1945, when the decisionwas made to postpone the Po Valleyoffensive until spring, fixed hospitals inMTOUSA were reporting a smaller pro-portion of beds occupied than ever be-fore. This was in part due to the winterlull in the fighting, but it was also inlarge measure because of the excellenceof the Fifth Army medical service, whichwas retaining the maximum number ofcases in the army area. Fixed bedstrength in MTOUSA was nevertheless6,000 below the authorized 6.6 ratio,and changes in the station hospital T/Ohad so far reduced the number of medi-cal officers in those units that an expan-sion of more than 20 percent was nolonger practical without additional per-sonnel.7

Looking ahead to the resumption ofactive hostilities in the spring, GeneralStayer asked the War Department for anadditional general hospital of 1,000-bedcapacity and for a field hospital for com-munications zone use. The request wasdenied on the ground that no such unitswere available in the zone of interior.The War Department proposed as analternative that existing hospitals be re-organized into larger units, but theMTOUSA medical section consideredthis proposal impractical, since there wasno specific requirement for station hos-

pitals larger than 500 beds, and sitescould not be found for general hospitalslarger than the 1,500-bed units alreadyoperating in the theater. Any other formof reorganization that would add bedswould require more in additional per-sonnel and equipment than could beprocured. General Stayer therefore pre-pared to operate with the hospitals thenunder his control.

As of the end of January there were10,150 fixed beds in the Naples-Casertaarea. The 37th and 45th General Hos-pitals, each with 1,500 beds, and the 500-bed 182d and 225th Stations were in themedical center at the Mostra Fair-grounds. In Naples proper were the1,500-bed 17th General, the 2,000-bed300th General, and the 52d, 106th, and118th Station Hospitals, each of 500beds. The 52d and 118th were both act-ing general hospitals. The 52d was alsothe theater maxillofacial center. OutsideNaples the 262d Station was at Aversa,functioning primarily as a prisoner-of-war hospital; the 32d Station was atCaserta, serving headquarters personnelof MTOUSA and AFHQ; and the 154thStation was at Caiazzo serving a replace-ment center.

The 34th and 73d Station Hospitalswere in Rome, housing 750 beds betweenthem. The 1,500 beds of the 6th Generalwere in that city but not available foruse, since they were packed for move-ment.

In the Arno Valley, overlapping thearmy area, there were 11,000 beds—6,750of them at Leghorn, 2,250 in the imme-diate vicinity of Florence, 500 at Pisa,and 1,500 at Pistoia. In addition to these,the 50th Station Hospital was operatingdetachments of approximately 100 bedseach at Grosseto, Castagneto, and Em-

7 Principal sources for this section are: (1) FinalRpt, 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 rptsof hospitals mentioned in text; (8) Unit ETMD'sof hosps mentioned in text.


ITALIAN PARTISANS RESTING IN 26th GENERAL HOSPITAL AT BARI

poli; and the 500 beds of the 74th Stationwere inoperative in Florence.

The 1,500-bed 26th General Hospital,still attached to the Army Air ForcesService Command, cared for Air Forcespersonnel at Bari, and the 500-bed 61stStation performed similar duties at Fog-gia. In addition to these, the Air Forcescontrolled three field hospitals, the 4th,34th, and 35th, which were dispersedalong the Adriatic from Lecce in the heelof Italy to Senigallia in the latitude ofFlorence. Each field hospital platoonserved one to five airfields, which hadpersonnel complements of three thou-

sand to ten thousand. All of thesehospitals passed to the Adriatic BaseCommand on 1 March.

In the Northern Base Section the 500-bed 60th Station Hospital, which hadmoved up from Sardinia the end of Octo-ber, was preparing to close near Bastia.The 40th Station was operating sectionsat Cervione and Ghisonaccia, both on theeast coast of Corsica, and a third sectionwas preparing to relieve the 60th atBastia.

In North Africa, which was scheduledfor transfer to the Africa-Middle Easttheater the first of March, the 250 beds


of the 57th Station Hospital were morethan enough to serve the Tunis area.The last Army hospital in the Oran area,the 54th Station, had closed late in De-cember and was now inoperative inNaples, leaving Naval Hospital No. 9 tocare for all U.S. personnel in Oran. The56th Station at Casablanca, in addition tocaring for personnel in the area, wasoperating a transient section of 100-150beds for domiciliary care of patients enroute to the ZI from Italy, the middleEast, and the China-Burma-India theater.It also supervised the operation of a 75-bed Italian station hospital. The 25-bed370th Station at Marrakech continued toserve primarily Air Forces units. TheItalian and German prisoner of war hos-pitals near Oran were already alerted formovement to Italy.

Preparatory to closing out in Africa,Stayer requested permission to inactivatethe 54th Station and reduce the 57thStation to 150 beds, the personnel andequipment thus released to be activatedas a 400-bed evacuation hospital forFifth Army. At the same time permissionwas requested to convert the 50th StationHospital in Italy into a field unit. Bothrequests were granted late in February.On 20 March, accordingly, the 171stEvacuation Hospital was activated andassigned to Fifth Army. On the samedate the 50th Station Hospital passed outof existence, and the 99th Field Hospitalrelieved it in place. No changes were in-volved, since the 50th Station had al-ready completed its conversion to a fieldhospital T/O.

The actual transfer to the Africa-Mid-dle East Theater thus involved only 425U.S. beds, and these were more thanmade up by the transfer of the 500-bed

21 st Station Hospital from the PersianGulf Command to MTOUSA. The 21starrived in Naples in March, but did notget into operation until mid-April. Inthe inactivation of the 54th Station andreduction of the 57th, MTOUSA lost 350beds, but gained 150 in the conversion ofthe 250-bed 50th Station to a 400-bedfield. All in all, MTOUSA lost 125 beds,while Fifth Army gained 400.

Shortly before the new theater bound-aries became effective on 1 March 1945,the two prisoner of war hospitals servingMTOUSA were shifted to northern Italy.There were, of course, many station hos-pitals treating captured enemy troops,but only two were fully staffed by pro-tected personnel and formally organizedas prisoner of war rather than U.S. Armyhospitals. These were the 7029th StationHospital (Italian) and the 131st StationHospital (German), the latter so desig-nated because it was sited at POW En-closure No. 131. The 7029th moved byechelons to Leghorn in January andFebruary, finally opening in Pisa on 6March. Later in the month the Germanunit took over the prisoner of war hos-pital being operated by the 103d Stationat POW Enclosure 334 in the outskirts ofFlorence, and was thereafter known asthe 334th Station Hospital (German).

The 103d Station, relieved of its POWassignment, moved to Pisa on 22 March,where it became a contagious disease hos-pital, primarily for Brazilian personnel.

As of the end of March, aggregateTable of Organization bed strength ofU.S. base hospitals in the MediterraneanTheater of Operations, including 3,000beds not operating, was 29,000. Troopstrength was 497,427, giving a ratio of5.8 T/O beds per 100 troops.


Support of the Po Valley Campaign

The experience of Fifth Army in evac-uating casualties across the rugged north-ern Apennines underlined the impor-tance of getting fixed beds into the PoValley with the greatest possible speed.The 6th General Hospital at Rome andthe 74th Station at Florence were alreadyon a stand-by basis for quick movementbut more beds were certain to be re-quired. Because of its obvious advan-tages, General Stayer planned to keep theNaples medical center intact, though hos-pitals from other parts of the city wereshifting northward. General Joseph T.McNarney, the theater commander, hadother plans, and in March, despiteStayer's protests, the Mostra Fairgroundswere turned over to the ReplacementTraining Command. The 45th GeneralHospital was to remain to care for thereplacement center personnel, but theother units then comprising the medicalcenter were required to vacate the fair-grounds as soon as possible. It was thesehospitals, therefore, that were alerted formovement to northern Italy.8

The first moves in support of the com-ing campaign were made in response toan indicated need for more fixed beds onthe Adriatic side of the peninsula, whereAir Forces units were becoming increas-ingly active and to which air evacuationof ground troops from the Bologna areamight be directed should weather con-ditions preclude the use of more westerlyroutes. A platoon of the 35th Field Hos-

pital had been in Senigallia since No-vember 1944. This unit was replacedearly in April by the 60th Station Hos-pital from Corsica, the field hospital pla-toon moving on to Rimini. At the sametime the 225th Station in the Naplesmedical center was assigned to theAdriatic Base Command and shifted toFano, about fifteen miles farther north.

Next to leave the medical center wasthe 182d Station, which took no new pa-tients after 25 March. The 182d movedon 10 April to a large villa about twomiles northwest of Montecatini. Its firstpatients were received from Fifth Armyevacuation hospitals on 20 April, andwithin two weeks it was operating 20 per-cent in excess of its 500-bed T/O capac-ity.

The 37th General Hospital beganclosing out on 10 April, moving byechelon to a staging area near Pisa. Thebulk of the personnel and equipmentwas in Pisa by 17 April. For the next twoweeks officers and enlisted men were ondetached service with other units, butsubject to immediate recall. The 37thalso operated a 200-bed prisoner-of-warhospital in an unused mess building onan emergency basis, since the 103d Sta-tion, which had been reconverted to aprisoner-of-war hospital in mid-April,was unable to carry the full load. By theend of the month prisoners were arriv-ing in the area at the rate of 15,000 a day,and the 103d was operating at more thandouble its T/O capacity.

By the time the Fifth Army spearheadshad fought their way into the Po Valley,there were thus 3,500 fixed beds on astand-by basis, packed and ready to moveforward in support of the ground forces.Movement orders were not long in com-ing.

8 Principal sources for this section are: (1) FinalRpt, Plans and Opns Off, MTOUSA, 1945; (2)Med Hist, AAFSC MTO, 1945; (3) Med Sitreps,PBS, Mar-May 45; (4) Theater ETMD's, Mar-May 45; (5) Unit rpts of hosps mentioned in thetext; (6) Unit ETMD's for hosps mentioned in thetext, Mar-May 45.


LOADING EQUIPMENT OF THE 37TH GENERAL HOSPITAL on freight cars at Naples forshipment to Pisa.

The 74th Station Hospital was inBologna by the afternoon of 26 April,five days after the fall of the city, and wastaking patients within twenty hours ofits arrival. By 28 April 750 beds were setup, and German medical officers andcorpsmen had been pressed into serviceto help with the prisoner patients. The6th General was close behind, leaving itsRome bivouac on 30 April and openingin Bologna on 9 May. The 37th Generalsent an advance detail to Mantova on 2May, and a week later took over 26 Al-lied and 1,278 German patients from the

15th Evacuation Hospital. By the end ofthe week the 37th General had morethan 2,000 beds in operation. The sud-den end of the war made it unnecessaryto relocate any other fixed hospitals.

Also in support of the Po Valley Cam-paign, though on a different level, wasthe 40th Station Hospital, transferredfrom Corsica to the vicinity of Rome,where a center for the conversion of able-bodied men from service units into in-fantry, to help fill the depleted ranks ofFifth Army, had been set up in January.

By the middle of May, with the war in


Europe over, the period of readjustmenthad set in. For the Medical Departmentin Italy, the emphasis for the next fewmonths would be on caring for the sickand wounded among prisoners of war,and preparing hospitals and other medi-cal units for redeployment to the Pacificor for return to the zone of interior aspromptly as possible.

Problems and Policies

Throughout the period of the NorthApennines and Po Valley Campaigns un-til the end of April 1945, PeninsularBase Section hospitals, including the26th General attached to the Army AirForces Service Command and later as-signed to the Adriatic Base Command,operated on a 120-day evacuation policy.The theater was too short of manpowerto return men to the zone of interior aslong as there was any prospect of re-covery for further combat duty. Eventhose reclassified by hospital dispositionboards for limited assignment were re-tained in the theater in a variety of non-combat capacities.9

One of the places where limited assign-ment personnel could be used effectivelywas in the base hospitals. When FifthArmy was unable to obtain replacementsfor the heavy casualties suffered in thenorthern Apennines, all service units inthe theater were surveyed with a view tolocating able-bodied men who could bereleased and retrained for combat. Theessential consideration was that the men

must be taken from positions classifiedas suitable for limited-assignment person-nel. While communications zone hos-pitals usually had a certain number oflimited-service men already on their rolls,the survey revealed many more hospitalpositions that could be filled by suchpersonnel.

Although many problems were thuscreated for hospital commanders, thechange-over was accepted as a necessaryexpedient. The new men were for themost part inexperienced in hospital workand had to be given special training onthe job. There were, moreover, too manyhigh-ranking noncommissioned officersamong them to be absorbed withoutjeopardizing promotions and damagingthe morale of the regular Medical De-partment enlisted staff. During the lasttwo months of 1944 and the first twomonths of 1945, limited-assignment per-sonnel nevertheless replaced general-assignment men in station and generalhospitals to the extent of an average 25percent of the enlisted strength. Fortu-nately, the shift took place at a timewhen the hospitals were not overloadedand in most instances worked out satis-factorily.

Supplementary personnel were neces-sary in the operation of all PBS hospitalsduring periods of emergency expansion.Medical officers, nurses, and enlistedtechnicians from temporarily inoperativeunits were freely used whenever theywere available, but the greater reliancehad of necessity to be placed on Italiancivilians and Italian service troops.Among the areas in which civilian andItalian prisoner of war labor was effec-tively used were sanitary, utility, mess,laundry, supply, motor pool, and com-mon labor details.

9 Sources for this section are: (1) Final Rpt,Plans and Opns Off, MTOUSA, 1945; (2) MedHist, AAFSC MTO, 1945; (3) Ltr, Munly, MedInsp, to Surg, MTOUSA, 26 Nov 44, Sub: Utiliza-tion of Limited Assignment Personnel in Hosps;(4) Unit rpts et MTOUSA hosps, 1944, 1945.


Evacuation

In a theater such as the Mediterranean,where bed strength was always belowauthorized levels, continuous evacuationboth to the zone of interior and withinthe theater itself was essential.

Transfers Within the Theater

Patients were shifted from one fixedhospital to another within the theater toaccomplish two major purposes. Onepurpose was to take advantage of special-ized facilities not available in allMTOUSA hospitals. The other was torelease beds, either to make room for aninflux of new casualties in hospitalsclosest to the combat area or to preparea hospital for movement. The lines ofmovement were well established by Sep-tember 1944, with Naples the terminusof most of them.10

French patients remaining in PBS hos-pitals continued to be evacuated fromNaples to North Africa through Novem-ber, but their numbers were small: 592in September, 55 in October, and 76 inNovember. For U.S. patients, the line ofevacuation ran in the other direction,cases requiring more than station hos-pital care being flown from Africa toNaples. Again, however, the number wassmall. All evacuation from Corsica wasto Italy, the bulk of it by air, but only

343 patients, of whom 279 were U.S. per-sonnel, were so evacuated between 1September 1944 and the closing out ofthe Northern Base Section on 25 May1945. Air Forces patients from easternItaly who required more specialized carethan was available at the 26th GeneralHospital were evacuated to Naples.Naples was also the first stop for AirForces patients en route to the zone ofinterior.

Of much greater proportions was theperiodic transfer of patients from PBShospitals in Rome and northern Italy. InSeptember, despite heavy rains that maderail lines intermittently unusable, the41st Hospital Train carried 38 patientsfrom Grosseto and 735 from Rome toNaples, in addition to clearing 275 pa-tients from Grosseto to Rome when the24th General Hospital was preparing tomove forward. The movement of sub-stantial numbers from Rome to Naplesby both rail and air continued throughDecember as 5,500 beds in Romewere closed out for transfer to northernItaly.

Similarly, until adequate bed strengthwas built up in Leghorn patients fromthe 24th General Hospital in Florenceand from the 55th Station at Pratolinowere transferred, often as rapidly as theybecame transportable, to the Naples area,along with patients direct from FifthArmy hospitals. When air evacuation wasinterrupted by bad weather in October,the 24th General was cleared by 60 am-bulances of the 162d Medical Battalion,which carried patients to Leghorn.

As the hospital facilities in Leghornreached their maximum late in 1944,regular transfer of patients to Leghornfrom Florence and later from Pistoia be-gan. Direct air and rail evacuation be-

10 Sources for this section are: (1) Annual Rpt,Med Sec, MTOUSA, 1944; (2) Final Rpt, Plansand Opns Off, MTOUSA, 1945; (3) Annual Rpt,Surg, PBS, 1944; (4) Med Sitreps, PBS, Jan-May45; (5) Annual Rpt, Surg, NORBS, 1944, 1945;(6) Med Hist, AAFSC MTO, 1944, 1945; (7) Thea-ter ETMD's, Sep 44-May 45; (8) Unit Rpts, 41stHospital Train; 51st and 162d Med Bns; 802d and807th MAETS.


COVERED RAMP TO HOSPITAL SHIP FACILITATED LOADING OF PATIENTS, LEGHORN

tween Florence and Leghorn wereinaugurated in February 1945, and there-after patients were moved at the rate ofmore than a thousand a month.

From Leghorn evacuation to Napleswas primarily by hospital ship and trans-port but the repair of rail lines made itpossible to use hospital trains in an emer-gency. Such an emergency arose in thelast days of December 1944 when it wasfeared that the German thrust into theSerchio Valley might develop into amajor counteroffensive comparable tothe Ardennes breakthrough, which hadnot yet been stopped. Should the Ger-man drive gain momentum, Leghornwould be its probable objective, and ahasty evacuation of all fixed hospitals inthat city was ordered. In late December

and early January more than 1,300 pa-tients were sent back to Naples by waterand close to 600 by rail. In the same timeperiod, air evacuation from Florence toNaples accounted for another 2,500.

The threat of an Italian "Battle of theBulge" was over by mid-January, andevacuation assumed what was to be anormal pattern for the next two months.PBS hospitals in Florence, Pistoia, andPisa received casualties from Fifth Armyand kept beds free by evacuation to Leg-horn. Bed strength in Leghorn was ade-quate to care for all patients with ahospital expectancy of less than 120 days,so that after 1 February only those enroute to the zone of interior were sent onto Naples. This pattern continued untilthe latter part of March, when all PBS


hospitals in the northern sector wereagain cleared to Naples to provide bedsfor the casualties anticipated in thespring offensive. During April approxi-mately 1,800 patients were transferred bysea and air from Leghorn to Naples, butthese were more than balanced by 2,000patients brought to Leghorn fromFlorence.

All movements of hospital ships withinthe Mediterranean area, including thoseused to evacuate patients from southernFrance, remained under control of AlliedForce Headquarters. In order to makethe greatest possible use of the limitednumber of vessels available, an arrange-ment was worked out in October 1944whereby all hospital ships entering theMediterranean called first at Oran, whichwas roughly equidistant from Naples,Leghorn, and Marseille. From Oran theChief of Transportation, AFHQ, di-rected the vessels to the port most inneed of them. The movement of thehospital ship platoons that formed themedical complements of troop transportsused for evacuation was also directed byAFHQ in order to ensure maximum useof transports for this purpose.

As the time approached for the trans-fer of southern France to the Europeantheater, a plan of evacuation was drawnup by embodying the existing principleof a pool of hospital ships under AFHQcontrol and incorporating procedures forrequesting vessels. Base section com-manders were to be responsible for mak-ing the greatest possible use of trooptransports, but AFHQ was to be notifiedof the movements of such vessels andwould continue to control the assign-ment of hospital ship platoons arrivinganywhere in the Mediterranean. Evacua-tion by air was to be controlled by each

theater, but AFHQ was to be notified ofall airlifts to the ZI from southern Franceas a guide to the allocation of alternativemeans of transportation. General Stayerpresented this plan to Maj. Gen. Paul R.Hawley, Chief Surgeon of the EuropeanTheater, early in November, and Hawleyaccepted it subject to further study. Itremained in effect by agreement betweenthe two theaters until February 1945when, with minor modifications, it wasratified by the War Department. Theplan continued in operation until theend of June.

Evacuation to the Zone of Interior

Evacuation to the zone of interiorthroughout the period of concentrationin Italy was by plane, hospital ship, andtroop transport. Until the end of Febru-ary 1945, when North Africa was finallydivorced from the Mediterranean Thea-ter of Operations, a small number ofpatients continued to be moved to thezone of interior from Oran and Casa-blanca, but the overwhelming bulk ofthe lifts by all types of carrier was fromNaples.11

During the 3-month period that south-ern France remained under AFHQ con-trol, most of the casualties from that areaalso were routed to the continentalUnited States by way of Naples. In Octo-ber, however, direct evacuation to thezone of interior began from Marseille,and some 250 patients had been evacu-ated to the ZI from that port before 20

11 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944; (2) Final Rpt,Plans and Opns Off, MTOUSA, 1945; (3) AnnualRpt, Surg, PBS, 1944; (4) Med Sitreps, PBS, Jan-May 45; (5) ETMD's for Sep 44-May 45.


TABLE 34—EVACUATION FROM MTOUST TO THE ZONE OF INTERIORSEPTEMBER 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 absorbedby ETO. These and all patients subse-quently sent to the United States fromDelta Base were evacuated in accordancewith the intertheater agreement de-scribed above.

September and October of 1944 werethe heaviest months of the war for evac-uation to the zone of interior, primarilybecause of the large influx of casualtiesfrom Seventh Army. With a limited anddefinitely inadequate number of fixedbeds available in MTOUSA, only large-scale evacuation to the United Stateswould permit the Medical Departmentto carry out its mission. By the end of theyear, with bed occupancy at its lowestlevel of the war, evacuation to the zoneof interior from the Mediterranean thea-ter declined sharply. (Table 34)

Evacuation of Brazilian casualties totheir homeland began in September 1944by air. In December a Brazilian flightsurgeon and four flight nurses reachedthe theater to study U.S. methods beforetaking over responsibility for their ownpatients in flight. Evacuation of Braziliancasualties by sea was for the most partby way of the United States, since therewere never enough to justify diversion ofa hospital ship. The only exception wasin January 1945 when an unescortedtroop transport sailed direct to Brazilfrom Naples. (Table 35)

No prisoner of war patients were evac-uated to the United States after October1944, but 135 German patients in U.S.custody were repatriated from Naplesand 454 from Oran in January 1945. Theprisoners were carried by hospital ship to


TABLE 35—EVACUATION OF BRAZILIAN PATIENTS TO BRAZILSEPTEMBER 1944-APRIL 1945

Source: Compiled from ETMD'S for Jan-Apr 45.

Marseille, where they were transferredto a Swiss-manned hospital train and ex-changed at the Swiss border for U.S.prisoners of the Reich.12 Since the col-lapse of Germany was imminent, anotherexchange of prisoners scheduled forApril was not carried out.


Theater Supply Organizationand Policies

The reorganization of November 1944brought the operation of the medicalsupply system directly under the theatersurgeon for the first time, but neither

the internal organization of the MedicalSupply Branch (redesignated MedicalSupply Section) nor the operating proce-dures were altered in any essential par-ticular. In keeping with the reduced staffavailable, the organization was mademore compact, but without significantchange in functions. In the new align-ment, an Executive Group reviewedproposed changes in Tables of Equip-ment, checked the quality of equipmentin the field, prepared plans and esti-mated requirements in terms of diseasetrends and military operations, screenedrequisitions from Allied nations, and ad-vised on civilian supply for occupiedterritories. A Shipping Control Groupkept constant track of all incoming ship-ments and prepared shipping orders formovement of medical supplies betweenbase sections. A Stock Control Groupmaintained records of stocks on hand,computed replacement factors, studied

12 (1) Memo and attachments, Biederman toStayer, 14 Jan 45 sub: Arrangements for Repatria-tion of Allied and German POW's and Exchangeof Civilians. (2) Ltr, Lt Col W. L. Hays combinedBritish-American Repatriation Committee, to CGETO, 1 Mar 45. Figures from ETMD for Jan 1945.


issue and due records to determine short-ages and excesses, and recommendedstock movements to correct maladjust-ments. A Reports and Statistics Groupcompleted the supply organization.13

At the time of the reorganization, med-ical supply levels were established at 30days' minimum, 30 days' operating, and60 days' maximum for most items. Inaccordance with War Department in-structions, these levels were kept undercontinuous review with a view to pos-sible reductions. The only move in thatdirection, however, came to nothing. InMarch 1945 a recommendation by thetheater supply officer that the 90-daystock level maintained by base hospitalsbe reduced to 60 days, to conform to thetheater level, was rejected by GeneralStayer as hazardous. In the light of adetailed study begun in November 1944of 40 medical items, which showed thatthe actual elapsed time between prepara-tion of monthly requisitions on the zoneof interior and the tallying of items intodepot stock was 149 days, Stayer was un-doubtedly correct.

After southern France ceased to be adrain on the MTOUSA supply services,medical stock levels built up rapidly.Low battle casualty and disease rates dur-ing the winter of 1944-45 were contrib-uting factors, as also were the closingout of the North African bases and arevised accounting procedure that in-cluded Fifth Army and Air Forces stocksin computing the theater levels. Sur-pluses developed of sufficient magnitudein some items to justify the return of 500

tons of medical supplies to the zone ofinterior in January.

In line with the achievement of a com-fortable stock level for the theater, sur-geons of major commands and basesections were authorized in February tomodify equipment lists in accordancewith such policies as might be laid downby the MTOUSA surgeon. In effect, hos-pitals were permitted to requisition var-ious items in excess of the Tables ofEquipment if those items would makeoperations more effective. Authority toissue expansion units, which rested withthe commanding generals of the basesections, automatically carried with it theissue of such additional equipment asmight be necessary to the efficient opera-tion of the unit.

After November 1944 all incomingsupplies were received at Naples or Leg-horn, where the Peninsular Base Sectiondepots were located, and PBS was maderesponsible for distribution to other basesections on requisitions that were passedthrough the MTOUSA medical supplysection. All forms of transportation wereused, the size of the shipment, the speednecessary, and the destination being thedetermining factors, along with avail-ability. Within the theater, biologicalswere uniformly moved by air. In Febru-ary the Leghorn depot became the mainmedical supply point for the theater.

Repair and maintenance of medicalequipment steadily improved during thelate months of 1944, reaching a peak ofefficiency early in 1945 as Fifth Armyunits began re-equipping for the springoffensive. A spare parts catalog compiledand distributed by the Medical SupplySection became the basis for requisition-ing and for restocking depots. The fifthechelon repair shop, the optical repair

13 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944, an. K; (2)Davidson, Med Supply in MTOUSA, pp. 113-139.For operating procedures, see pp. 346-47, above.


PORTION OF THE PBS MEDICAL STORAGE AREA

shop, and theater stocks of spare partsand of artificial teeth were all transferredto the Leghorn depot in January.

Local procurement remained, as it hadbeen throughout the Mediterranean cam-paigns, a negligible factor, but the distri-bution of medical supplies for civilianuse continued to mount in proportion tothe extent of territory occupied. AfterSeptember 1944, Army responsibility forprocurement, storage, and issue of medi-cal supplies for civilians throughout thetheater was carried out through a Cen-tral Civilian Medical Depot in Naples.

Civilians and Italian service troopswere freely used as laborers, mess attend-ants, artisans, and for guard details atmedical supply depots. So many of thesupply functions were specialized, how-ever, that the maximum use of such per-sonnel did not appreciably lessen therequirement for U.S. service troops formedical supply operations in the Italiancommunications zone.


Medical supply in the base sections


came under control of the MTOUSAmedical section with the reorganizationof November 1944, but here, as in theMedical Supply Section itself, no essen-tial change of function or organizationwas involved. The Peninsular Base Sec-tion, already dominant in the theater,continued to grow through the last quar-ter of 1944 and the early months of 1945as other base sections declined.

Mediterranean Base Section—Follow-ing the mass transfer of medical facilitiesfrom North Africa to southern Franceand Italy, plans were made for closingout remaining depot stocks in the Medi-terranean Base Section. The 60th Medi-cal Base Depot Company, which hadbeen responsible for receipt, storage, andissue of all medical supplies in NorthAfrica since the beginning of September,began transferring supplies to other basesalmost immediately, shipping out 250tons a week during September and Octo-ber. Simultaneously, the Eastern andAtlantic Base Sections transferred theirown surpluses, brought about by dimin-ished troop strength, to the MBS depot,in preparation for the consolidation ofthe three base sections on 15 Novem-ber.14

When the MBS depot closed in mid-December, the 57th Station Hospital atTunis was given maintenance stocks suf-ficient to carry through 28 February,when the transfer of North Africa toAMET would be effected; a minimumreserve of 25 tons was left with the 54th

Station, which was about to close atOran; and the balance of maintenancestocks for the base section was stored withthe 56th Station Hospital at Casablanca,the new MBS headquarters. Excess stocksto the amount of 313 tons were returnedto the zone of interior, and 350 tons weredivided between Italy and southernFrance. A small detachment of the 60thMedical Base Depot Company remainedin Oran long enough to complete thepackaging and shipment. From the sup-ply standpoint, MBS was closed by theend of 1944.

Northern Base Section—Medical sup-ply in the Northern Base Section re-mained in the hands of a detachment ofthe 684th Quartermaster Base DepotCompany, which had been activated latein May from personnel of the old 2dMedical Depot Company. Until the endof September, the group operated depotsat Ajaccio and Cervione, but the reduc-tion of troop strength and gradual with-drawal of medical units from Corsicamade it possible to consolidate the twodepots at Cervione early in October.Movement of supplies from Ajaccioacross the island by truck was completedby the 13th of the month.15

For a time, portions of the depot stockat Cervione had to be stored in the open,but the transfer of stocks in excess of a4-month level to other MTOUSA bases,which began in mid-October, soon re-duced quantities on hand to proportionsthat could be warehoused.

14 Sources for this section are: (1) Annual Rpt,Surg, MBS, 1944; (2) Annual Rpt, 60th Med BaseDepot Co, 1944; (3) Annual Rpt, Surg, MTOUSA,1944, an. K; (4) Davidson, Medical Supply inMTOUSA.

15 Sources for this section are: (1) Annual Rpts,Surg, NORBS 1944, 1945; (2) Annual Rpt, 684thQM Base Depot Co, 1944; (3) Per Rpt, 80th MedBase Depot Co, 11 Jul 45. (4) Davidson, Med Sup-ply.


In line with the general reduction offunctions in NORBS, 14 enlisted men ofthe 684th Quartermaster Base DepotCompany detachment were transferredto the 60th Medical Base Depot Com-pany, then still functioning at Oran, on16 October. The subsequent transfer ofthe detachment's commanding officer toHeadquarters, NORBS, left only an offi-cer and 17 enlisted men to operate theCervione depot, with the aid of some 25Yugoslavs who made up labor and guarddetails. There were times when the work-day stretched out to 18 and even to 24hours, yet despite the physical strain,none of the men could ever be sparedlong enough to take advantage of therest camps available on the island.

NORBS depot stocks were down to230 tons by the end of January and to75 tons by late March. By way of prep-aration for closing out the base sectionsupply activities, all personnel of the de-pot were transferred on 21 March to the80th Medical Base Depot Company, atthat time assigned to the Adriatic BaseCommand, but were left on detachedservice with NORBS long enough towind up operations. The depot wasscheduled for closing on 15 April, but socritical was the need for personnel inItaly, where the Po Valley Campaignwas about to be launched, that all ton-nage was packed for shipment by 6 April.The detachment left Corsica on 10 April,turning over to the 40th Station Hospitalresponsibility for procuring and issuingsuch medical supplies as might still berequired.

Adriatic Base Command—Before 1March 1945, medical supply for AirForces units and hospitals serving AirForces personnel in eastern Italy was the

responsibility of the Army Air ForcesService Command, which dealt directlywith the Surgeon, MTOUSA, and pro-cured medical items peculiar to the AirForces direct from the zone of interior.The function was carried out through anumber of aviation medical supply pla-toons, two of which operated in Bari asthe medical supply section of the Adri-atic Depot. Others served airfields fromTunis to southern France, with majordumps at Naples and Pisa.16

When the Adriatic Base Command wasactivated on 1 March 1945, the neworganization took over the supply func-tions previously exercised by the ArmyAir Forces Service Command, Mediter-ranean Theater of Operations (AAFSCMTO), through the Adriatic Depot, butwithout altering the operating responsi-bilities of the aviation medical supplyplatoons. The 80th Medical Base DepotCompany, which had been activated inDecember and since that time had sharedin the operation of the PBS Leghorndepot, was assigned to ABC in mid-March and shifted to Senigallia, wherefor a month it operated the ABC ad-vance depot. The rapid development ofthe Po Valley Campaign, however, lefthospitals in the Fano-Senigallia-Anconaarea with few patients and a minimum ofsupply activity. The ABC advance depotwas turned over to the detachment fromCorsica on 19 April, and a week later themain body of the 80th Medical BaseDepot Company went to Bari, where ittook over operation of the main ABCmedical depot.

16 Sources for this section are: (1) Med Hist,AAFSC MTO, 1944, 1945; (2) Periodic Rpt, 80thMed Base Depot Co, 11 Jul 45; (3) Med Sitreps,Adriatic Base Commd, Mar-May 45; (4) MS, Adri-atic Depot Hist, OCMH files; (5) Davidson, MedSupply in MTOUSA.


Peninsular Base Section—The medicalsupply service of the Peninsular BaseSection had been organized in the middleof August 1944 to place operating con-trol in the hands of the 232d MedicalComposite Battalion. As of 1 Septemberthis battalion had attached to it the 72dand 73d Medical Base Depot Companiesand the 684th Quartermaster Base DepotCompany. The 72d was operating themain medical supply dump at Naples,the 684th the forward base at Piombino,with a detachment on Corsica. The 73dshared operation of the Piombino dumpand had an advance party setting up anew supply base in Leghorn. By the endof September the Leghorn dump boasted510 tons of medical supplies, housed ina large warehouse with 53,550 square feetof floor space. Another 70,000 square feetwere available for open storage whenneeded.17

The Piombino dump was closed on 14October and all stocks remaining wereshifted to Leghorn, which was beingbuilt up to supply all Fifth Army needs.The problem remained, however, of dis-tributing supplies economically betweenLeghorn and Naples. Every effort wasmade to keep balanced stocks at bothdepots. Transfers between the two wereslow, because material arriving from thezone of interior had to be tallied in at the

receiving depot before any of it couldbe transshipped to the other. This usu-ally took two weeks with another weekfor rail transportation or three weeks forshipment by water. Through the fall of1944, emergency shipments had to bemade from Naples by truck convoy tomeet Fifth Army shortages. An expresstruck service between Naples and Leg-horn was instituted in January 1945, aid-ing materially in the prompt transfer ofless than carload shipments.

During November all ZI shipmentswere received at Leghorn, and inven-tories at that base built up rapidly.When Naples was reinstated as a port ofdischarge in December, a new procedurewas worked out under which the PBSsupply section studied the manifests ofincoming vessels and prepared requisi-tions covering the entire cargo in ad-vance. Distribution to the two depots wasthen made directly from the dockside,thus eliminating the delay entailed intransporting all stock to the depot at theport of discharge, picking it up on stockrecord, and reporting it on the monthlyinventory report before any interdepottransfers took place. Under the new sys-tem each depot submitted a separateinventory report, the two being consoli-dated by the Supply Branch of the MTO-USA medical section. The Leghornstocks were almost as large as those inNaples by the end of the year, and werebetter balanced since the Naples inven-tory was padded by substantial quantitiesof surplus items received from MBS andNORBS.

With the transfer of PBS headquartersto Leghorn in November and the steadygrowth of the Leghorn supply depot, itbecame necessary to redistribute supplypersonnel. The 80th Medical Base Depot

17 Principal sources for this section are (1) An-nual Rpt, Surg, PBS, 1944; (2) Med Sitreps, PBS,Sep 44-Apr 45; (3) Annual Rpt, 232d Med ServBn, 1944; (4) Unit Hist, 72d Med Base Depot Co,Jan-Jun 45; (5) Hist Rpt, 73d Med Base Depotdo, Sep 44. (6) Med Hist Data, 73d Med BaseDepot Co, 19 Oct 44; (7) Annual Rpt, 80th MedBase Depot Co, 1944; (8) Periodic Rpt, 80th MedBase Depot Co, 11 Jul 43; (9) Annual Rpt, 60th MedBase Depot Co, 1944; (10) Annual Rpt, 684th QMBase Depot Co, 1944; (11) Davidson, Med Supplyin MTOUSA.


TABLE 36—MEDICAL SUPPLIES ON HAND IN PBS DEPOTSSEPTEMBER 1944-APRIL 1945

Source: (1) Annual Rpt, Surg, PBS, 1944. (2) Med Sitreps, PBS, Jan-Apr 45.

Company was activated at Leghorn on 4December 1944, with a cadre drawn fromthe 684th Quartermaster Base DepotCompany. A week later the 232d Medi-cal Service Battalion, as the 232d Medi-cal Composite Battalion had beenredesignated without change of T/O on21 November, moved its own headquar-ters to Leghorn, leaving 45 enlisted menon detached service with the 72d MedicalBase Depot Company in Naples. The60th Medical Base Depot Company wasalso assigned to PBS when its work inNorth Africa was completed the middleof December, and arrived in Leghorn inthe closing days of the month. Like the72d, 73d, and 80th Medical Base DepotCompanies, and the 684th QuartermasterBase Depot Company, the 60th was at-tached to the 232d Medical Service Bat-talion.

The build-up of stocks in Leghornhalted abruptly late in December, whena German breakthrough was feared, but

resumed in February. In March Leghorntonnage, for the first and only time dur-ing active hostilities, exceeded that atNaples. (Table 36)

Except for temporary shortages in afew items, the Peninsular Base Sectionmedical supply depots were able through-out the North Apennines and Po ValleyCampaigns to meet all the needs of FifthArmy, of medical installations assignedto the base section, and, after November1944, of the theater. Blankets were acritical item through most of Decemberand all of January. Stocks of laundrysoap were exhausted at Leghorn early inFebruary, but advances from quarter-master stocks tided the depots over thecrisis. In late January and early FebruaryPBS was unable to fill Fifth Army ordersfor acetone, acetic acid with caffeine,epinephrine hydrochloride, ergotrate,lemon oil, and operating lamps andbulbs. Benzyl benzoate was in short sup-ply during the first three months of 1945.


In all of these items, however, hospitalreserve stocks were sufficient to carryover until ZI shipments arrived.

The only serious shortage was peni-cillin, which was used during the NorthApennines Campaign at an unprece-dented rate. The 15-day supply on handwhen the assault on the Gothic Linejumped off early in September was ex-hausted before the end of the month.Barely enough for current needs was be-ing received. Deliveries were made toforward units by the blood bank plane,and hospitals shared what reserves theyhad on hand. The situation remainedextremely tight through November, buta comfortable margin was on hand by theend of the year. Despite consumption ofpenicillin in the first two weeks of thePo Valley Campaign at a rate more thandouble the previous maximum, a stocksufficient for six weeks' operation at thesame high rate was on hand when thewar in Italy ended.



By early September of 1944, when theNorth Apennines Campaign got underway, medical and surgical practices in theMediterranean Theater of Operationswere relatively stable, continuing with-out significant changes for the remainderof the war period. The scope of front-line surgery was somewhat enlarged inthe fall of 1944, and greater use wasmade in each successive campaign ofboth penicillin and whole blood. In thebase hospitals wound management con-tinued to emphasize reparative surgery.18

In preventive medicine the organiza-tion and techniques for the control ofmalaria had been worked out and testedover a 2-year period and presented noproblem as the 1945 breeding seasonapproached. At the same time, with abody of experience to draw upon, therecognition of the disease was moreprompt and the treatment more effective.Venereal disease remained a persistentscourge, the incidence of which variedinversely with the extent of combat oper-ations. Preventive measures such as theperiodic examination of prostitutes, thepolicing of cities to control clandestinecontacts, and the establishment of pro-phylactic stations were only moderatelysuccessful. The use of penicillin in treat-ment of venereal diseases, however, mate-rially reduced the time lost from duty.

The greatly reduced incidence oftrench foot in the winter months of1944-45 as compared with the previouswinter was a tribute to the careful studiesmade and effective preventive measurestaken. However, the seasonal outbreakof infectious hepatitis in the late monthsof 1944 was severe, despite the extendedstudies and other efforts made by a teamof officers under Col. Marion H. Barkerat the 15th Medical General Laboratory.The Barker group continued its studiesthrough the second epidemic, presentinga consolidated report in the summer of1945 that remains a major contributionto the literature on hepatitis.19

Perhaps the outstanding contributionof the Medical Department in the Medi-

18 Principal sources for this section are: (1) An-nual 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," Con-necticut State Medical Journal, X (August 1946),627-36.

19 Infectious Hepatitis in the Mediterranean The-ater of Operations, United States Army.


terranean theater was in the field ofneuropsychiatry. The major develop-ments in this area were at the divisionand army levels, and have been discussedin connection with combat medicine.20

In summary, the treatment of psychiatricdisorders was carried out at four levels.The patient was normally first seen bythe battalion surgeon who decidedwhether any treatment was indicatedand, if so, whether to treat the patienton a duty status or refer him to the divi-sion psychiatrist. The latter officer, as arule, maintained a separate treatmentcenter adjacent to the clearing station,with facilities for 50 to 100 patients.Markedly disturbed patients were sent onimmediately to the Army neuropsychia-tric center, the others being retained,usually for two days, under moderatesedation with some therapy. Those re-sponding favorably went to the divisiontraining and rehabilitation center for afew days and were then returned to duty.Those not so responding were evacuatedto the Army neuropsychiatric center.From this unit men were returned tofull duty, were sent to the convalescenthospital for reclassification, or were evac-uated to the communications zone. Thebulk of the evacuees went to the basesection neuropsychiatric hospital, butthose too distant from that installationwere sent to a general hospital equippedfor psychiatric work. Treatment in thebase hospitals followed lines similar tothose used in civilian practice, with theaddition of orientation, training, and re-habilitation programs. The treatmentculminated in return to duty, reclassifi-cation for limited duty, or evacuation to

the zone of interior. Psychiatric casesevacuated to the ZI decreased from 48percent in the last six months of 1943to 21 percent in the correspondingmonths of 1944. These results, accord-ing to Colonel Hanson, theater consult-ant in neuropsychiatry, were themaximum that could be expected "underour present knowledge of psychiatry."

The number of medical officers in thetheater available for patient care de-clined from 5.2 per 1,000 of troopstrength in October 1944 to 4.7 in Janu-ary 1945, where the ratio leveled off. Inorder to keep field medical officers fromlosing their skills through restricted prac-tice and limited access to medical litera-ture, a policy of rotation between fieldand base units was carried on but thesaturation point was reached about theend of 1944, by which date the great bulkof medical officers in base hospitals wereon limited duty or were overage for fieldservice.

Noneffective rates per 1,000 per an-num of troop strength by causes for themonths of September 1944 through April1945 are shown in Table 37.

Dental Service

On a theaterwide basis, the dentalservice in the Mediterranean continuedto be understaffed until early in 1945,partly as a result of the increased numberof dental officers called for by the T/O'sof the enlarged general hospitals, andpartly as the result of losses sustainedwhen southern France went over toETO. There was a further loss of per-sonnel late in 1944 when 20 dental offi-cers were selected for release from activeduty under a War Department directive.Two of the officers released were in the20 See pp. 253-56, 314-16, 409-11, above.


TABLE 37—NONEFFECTIVE RATES PER THOUSAND OF TROOP STRENGTH PER ANNUMSEPTEMBER 1944-APRIL 1945

a Includes other diseases not listed.

Source: Statistical health rpts for appropriate months.

rank of major, the remainder in the rankof captain.21

A total of 64 replacements arrived inJanuary and February 1945, most ofthem first lieutenants. The number waslarge enough to relieve all shortages, andat the same time permitted the replace-ment of older officers in combat areasby younger men. The ratio of dentalofficers to troop strength in the theater,which had risen from 1:968 in Octoberto 1:1,016 in December 1944, droppedsharply in January to 1:947. The Aprilratio of 1:927 was still better, althoughit remained higher than the 1:850 ratioenjoyed at the end of 1943.

In terms of accomplishment, the den-tal care available to Fifth Army, the AirForces, and service troops in the theater

steadily improved, with prosthetic andoperating trucks taking the best indentistry to the front-line soldier, whilethe concentration of dental skills in for-ward clinics allowed a more even distri-bution of the work load. Colonel Tingay,the theater dental surgeon, continued tokeep up with the needs and problems ofboth combat and base areas by frequentinspections, including an extended tourof Fifth Army dental installations shortlybefore the launching of the Po ValleyCampaign.

Veterinary Service

While the withdrawal of the FrenchExpeditionary Corps and the U.S. VICorps from Fifth Army removed thou-sands of animals from Italy and ulti-mately from the Mediterranean theater,the extensive use of pack mule trains tosupply Fifth Army in the northernApennines provided ample scope for

21 Principal sources for this section are: (1) An-nual Rpt, Med Sec, MTOUSA, 1944, an. G; (2)Annual Rpt, Surg, PBS, 1944; (3) Dental Hist,North African and Mediterranean Theaters of Op-erations.


theater veterinarians. The Fifth Armyanimal service was backed up in thePeninsular Base Section by fixed vet-erinary hospitals, with both army andcommunications zone activities beingdirected and co-ordinated by the theaterveterinarian, Colonel Noonan.22

At the date of the launching of theNorth Apennines Campaign, there wereonly two fixed veterinary hospitals in thePeninsular Base Section, both Italianunits. The 213th Veterinary GeneralHospital (Italian) was occupying thebuildings of a former Italian Army vet-erinary hospital at Grosseto; and the 1stVeterinary Station Hospital (Italian)was at Persano in the Salerno area. Bothwere operated in connection with sta-tions of the 6742d QuartermasterRemount Depot, which maintained itsown veterinary dispensaries at bothposts, and another in the vicinity of theNaples medical center. Shortly after theinitial assault on the Gothic Line, theremount depot opened a new station atPisa, again with a veterinary dispensaryto care for animals at the depot. Thestation hospital at Persano was redesig-nated the 212th Veterinary Station Hos-pital (Italian) and assigned to FifthArmy. With the departure of half of the6742d Quartermaster Remount Depotfor southern France in mid-October, the

remount stations at Persano and Napleswere closed. Late in January the 2610thQuartermaster Remount Depot was acti-vated and took over the facilities at Pisa.Three veterinary officers were assignedto this depot and two to the 6742d Quar-termaster Remount Depot at Grosseto.

Throughout the North ApenninesCampaign animals from Fifth Army vet-erinary installations were evacuated byrail and truck to the 213th VeterinaryGeneral. The physical plant was ade-quate to the demands made upon it, butequipment was insufficient and thequality of personnel was poor. "Italianunits," wrote Colonel Noonan, "are in-capable of rendering satisfactory veteri-nary service, as their officers are for themost part indolent, in addition to beingpoorly equipped professionally."23 TheT/O of the 213th called for 15 officersand 253 enlisted men, but actualstrength never reached those totals. Atthe end of 1944 there were only 7 officersand 177 enlisted men, being supervisedby a U.S. veterinary officer and 4 enlistedmen from the 2698th Technical Super-vision Regiment. A second Americanveterinary officer was on detached servicefrom the 24th Replacement Depot.

It was obvious by December of 1944,when the 10th Mountain Division withits large animal complement was as-signed to Fifth Army, that the veterinarysupport offered by PBS would have tobe materially improved before anothermountain campaign was undertaken.Colonel Noonan asked at that time fora U.S. veterinary general hospital 24 butthe postponement of the Fifth Army of-fensive until spring relieved the immedi-

22 Principal sources for this section are: (1) An-nual 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) Quar-terly Hist, Vet, PBS, 1 Apr-30 Jun 45; (6) MedSitreps, 213th Vet Gen Hosp; and Vet, 6742d QMRemount Depot, Sep and Oct 44; (7) Vet Rpts,Sick and Wounded Animals, 6742d QM RemountDepot, 1944; (8) Inspection of Veterinary Service,NATOUSA and MTOUSA, 1944, 1945. (9) Miscdocs relating to MTO vet service, 1945. (10)Monthly Hist Rpt, 2604th Vet Sta Hosp, Mar-May45; (11) Hist, 2605th Vet Gen Hosp, 15 Mar-30Apr 45.

23 Memo, Col Noonan, Col, Theater Vet, to Plansand Opns, 8 Dec 44.

24 Memo, Noonan to Surg, MTOUSA, 24 Nov 44.


ate pressure. A realignment of the PBSveterinary service along the lines desiredby Colonel Noonan was deferred untilMarch 1945.

On 15 March the 2604th VeterinaryStation Hospital (Overhead), the2605th Veterinary General Hospital(Overhead), and the 643d and 644th

Veterinary Detachments were all acti-vated at Leghorn, where personneljoined and were staged over the nextfew weeks. The commanding officer ofthe general hospital was Lt. Col. WalterSmit, while the station hospital wascommanded by Capt. John L. West.Both units were organized with skeletonstaffs in the expectation that Italianveterinary personnel would be attached.In a parallel move, the 213th VeterinaryGeneral Hospital at Grosseto was givenmore U.S. supervisory personnel and re-designated the 1st Veterinary GeneralHospital (U.S.-Italian).

The 2605th Veterinary General wasready by the time the main Fifth Armydrive was launched. The hospital movedinto position at Pontepetri west of High-way 64 on 19 April. The site, which hadbeen occupied until 1 April by the 211thVeterinary Evacuation Hospital, was inthe rear of the 10th Mountain Divisionsector. First patients were received on21 April from the 211th, which hadmoved forward to Riola. Other casualtiescame direct from the 10th Mountain Di-vision. All were transported by the 643dVeterinary Evacuation Detachment. On24 April the 2d Veterinary General Hos-pital (U.S.-Italian) was organized andattached to the 2605th at Pontepetri, butwas of less help than had been hoped.The Italian unit had only two veterinaryofficers, and all of its enlisted men wereyoung inductees with only two months

in the Army and no experience withanimals.

The 2604th Veterinary Station Hospi-tal, with the 644th Veterinary Evacua-tion Detachment attached, did not gointo operation until the war was over.On 3 May the unit moved to San Mar-tino, the site of a former Italian Armyartillery school a few miles south of thePo River on the Bologna-Verona axis.The Fifth Army Remount Depot was inthe area, with 5,000 captured or aban-doned German animals, about 200 ofwhich were in need of veterinary care.These were turned over to the hospitalwhen it opened on 5 May. A few dayslater elements of the British remountorganization moved into San Martino,and the area was turned over to themon 15 May. During its brief l0-day oper-ating span, the 2604th Veterinary Sta-tion Hospital treated more than 400animals.

Meanwhile, the 2605th VeterinaryGeneral Hospital had moved from Pon-tepetri to a site about 8 miles beyondMirandola, where it too opened on 5May. Casualties were received from the211th Veterinary Evacuation, which wasat 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 madeup the remainder of the VeterinaryCorps mission in the theater was routineby the fall of 1944. By the start of the PoValley Campaign there were thirteenveterinary food inspection detachmentsoperating in MTOUSA, at ports andbase section installations, supplementedby two port veterinarians and a quarter-master refrigerator company veterinar-ian. The Air Forces had three aviationveterinary detachments and two veter-


CAPTURED HORSE AT THE 2604TH VETERINARY STATION HOSPITAL AT SAN MARTINO

inary sections engaged in the same work.These units were adequate to providecomplete food inspection coverage forthe theater.

Nursing Service

Through the first ten months of 1944,there had been an average of 4,000nurses in the Mediterranean theater. InNovember 1,358 were transferred toETO, and the year ended with only2,446 nurses remaining in MTOUSA, ora ratio of 4.8 per 1,000 of troop strengthcompared with a 5.5 ratio in October.No replacements were received, even fornormal attrition, leaving the theater ap-proximately 350 nurses below authorized

strength. Hours were often longand working conditions, especially inthe field and evacuation hospitals on theFifth Army front, were difficult. "Thenurses," wrote a qualified observer inDecember, "are showing definite signsof fatigue. Many of them are gettingirritable with conditions and people towhich they could formerly accommodatethemselves. Little things bother themwhich previously they could laugh off.Young faces have old masks."25

25 Memo, Maj Margaret D. Craighill, Consultantfor Women's Health and Welfare Activities, toTSG, 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) AnnualRpts, Surg, NORBS, 1944, 1945; (4) Med Hist,AAFSC MTO, 1944, 1945; (5) Med Hist, 2d Aux


Some tensions were relieved by rota-tion between base and army hospitalsand by sending nurses to rest areas when-ever they could be spared. In terms ofstrength, however, no improvement waspossible, the ratio to troop strength de-clining to 4.7 per 1,000 by April. Theredeeming feature was a steady improve-ment in the ratio of nurses to patients.Owing primarily to light battle casual-ties and an excellent general health levelamong theater troops, the ratio of nursesto patients rose from 1:21 in December1944 to 1:19 in January and February1945; 1:17 in March; and 1:15 in April.

A morale factor was the relaxing ofpromotion policies in the fall of 1944,when authority was granted to promoteall nurses who had been in the grade ofsecond lieutenant for 18 months, regard-less of T/O allotments. Promotions werealso authorized for first lieutenants whohad been 18 months in grade if theywere otherwise qualified for advance-ment. Under this authorization, 227second lieutenants and 19 first lieuten-ants were advanced in rank in the closingmonths of 1944. When the war ended inEurope there were 2,267 nurses in theMediterranean theater, of whom one wasa lieutenant colonel, 15 were majors, 100were captains, and 1,328 were first lieu-tenants. Only 823, or about 36 percentof the total, were in the lowest rank.

Army Civil Public HealthActivities

The Allied drive into the northernApennines coincided with far-reachingchanges in the political and administra-

tive structure in Italy. With the gov-ernment of Ivanoe Bonomi seeminglysecure, and more than half the countryfreed from German domination, it ap-peared an unnecessary burden to requireField Marshal Alexander to double asmilitary governor. Early in September1944, therefore, Allied Force Headquar-ters resumed direct jurisdiction over theAllied Control Commission, leaving thearmy group commander responsible onlyfor liberated territory still within thecombat zone. Shortly thereafter Presi-dent Roosevelt and Prime MinisterChurchill, as one of the results of aconference in Quebec, issued a jointdeclaration promising to the Italian Gov-ernment greater control over its own af-fairs, both political and economic. Pro-posals for implementing the new policywere worked out by Harold Macmillan,then British resident minister at AFHQ,and with only minor changes were ap-proved in both London and Washingtonin time to go into effect in February1945. Army responsibility in matters ofcivil public health in the communica-tions zone was thereafter primarily ad-visory except for medical supply, andeven here, after 20 October 1944, distri-bution had been in the hands of anagency set up for that purpose by theItalian Government.26

In the combat zone, the Allied Mili-tary Government organization continuedto exercise control through the com-manders of the two Allied armies. In

Surg Gp: Rpt of Nursing Activities while Function-ing with Fifth Army; (6) Parsons and others,Hist of Army Nurse Corps in MTOUSA.

26 Principal sources for this section are: (1) Ko-mer, Civil Affairs and Military Government in theMediterranean Theater; (2) Lewis, Rpt to WD,History of Civil Affairs in Italy, 7 Dec 1945; (3)Turner, chs. XI, XII, in Bayne-Jones, "PreventiveMedicine," vol. VIII, Civil Affairs-Military Govern-ment.


the Fifth Army sector, General Humecontinued to administer civil affairs un-der both Clark and Truscott. For themost part AMG concentrated on therestoration of water supplies, sewagedisposal, power facilities, sanitation, andthe like. Florence and Pisa were badlydamaged, presenting on a smaller scalea repetition of the problem of Naples ayear earlier. The work of restoration wasstill going on when the heavy rains ofSeptember and October added to thedamage, but both cities were functioningnormally by winter. There were no seri-ous outbreaks of disease anywhere in theArno Valley.

In the final drive that ended the war

in Italy, Fifth Army military govern-ment and civil public health officers hadrelatively few problems. The Germancollapse was so swift and so completethat the great cities of northern Italysuffered little damage. Partisan forces,co-operating with the Allies, were ableto save most public utilities from de-struction. The civil public health prob-lems of the occupation period were thoseof food, clothing, hospitalization, andmedical supply rather than the restora-tion of water and power facilities andsewers and were soon transferred fromFifth Army AMG to the Allied ControlCommission and the Italian Govern-ment.

CHAPTER XIV

Contraction and Redeployment

Once the war in Europe was at an end,American commanders in the Mediter-ranean theater turned their attention tothe war still being vigorously prosecutedin the Pacific and to the demobilizationof troops not required for the conquestof Japan. The prompt redeployment ofcombat and service units to the Pacificand the contraction of operations in Italyas rapidly as circumstances permittedwere the objectives toward which allMedical Department activities wereoriented during the summer of 1945. Anunderstanding of redeployment policiesand plans is therefore essential to anyevaluation of the medical service duringthis period.

Redeployment Policies and Plans

A War Department redeploymentplan prepared in August 1944, whenthere was reasonable prospect of an earlyend to hostilities in Europe, called forthe transfer of 45,000 service troops and37,000 Air Forces troops from Europeand the Mediterranean each month fromOctober 1944 through January 1945,with ground force troops being returnedto the United States for further disposi-tion. The criteria that would determinewhether individual soldiers would besent to the Pacific, used as occupationforces, or returned home for demobiliza-tion were essentiality, length and ar-duousness of service, and number of

dependents. For the Medical Depart-ment, essentiality was the primaryfactor.1

The first theater plan for redeploy-ment was published in late Septemberof 1944. Following the general patternlaid down by the War Department, med-ical units were divided into two cate-gories: those required to care for troopsin the theater during the demobilizationperiod, and those available for otheruses. Units placed in the second categorywere further subdivided into those to betransferred to another theater, those tobe used to support garrison troops inMTO or in the United States, and thoseto be returned to the United States forinactivation. Bed requirements for gar-rison troops were postulated at 4 percentof strength.

Before this program got out of theplanning stage, it was clear that therewould be no final military victory inEurope during 1944, and the wholequestion of redeployment was tempo-rarily shelved. It came up again in March1945 with the receipt of a War Depart-ment forecast considered by the MTO-USA medical section to be unrealistic.For one thing, requirements for theoccupation of Austria, then regarded as

1 This section is based primarily on the follow-ing documents: (1) Final Rpt, Plans and OpnsOff, Office of the Surg, MTOUSA. (2) Annual Rpt,Surg, Fifth Army, 1945.


a Fifth Army responsibility, were notknown. Another objection was that theforecast called for early redeployment oftypes of units not actually present in thetheater. The 2,000-bed general hospitals,which were also scheduled for earlytransfer, were regarded by GeneralStayer as unsuitable for the Pacific andnecessary during redeployment in Italy.There was also disagreement as to thespeed with which the medical depot com-panies ought to be withdrawn, in view ofthe volume of equipment to be preparedfor shipment. Most of the objectionablefeatures were eliminated from a newWar Department forecast received earlyin May, and redeployment regulationsconsistent with it were issued on the 12thof that month.

Under these regulations the theatercommander was to assign each unit toone of the following categories: (I)units to occupy areas of Europe; (II)units to be used in the war againstJapan; (III) units to be inactivatedwithin the theater; and (IV) units to bereturned to the United States for inacti-vation. Category II was brokendown into (A) units to be shipped to thePacific direct; (B) units to be shipped tothe Pacific by way of the United States;and (C) units to be shipped to theUnited States to be placed in strategicreserve. Since the occupation of Austriahad by this date been assigned to forcesalready in that area and the occupationof cobelligerent Italy was not contem-plated, no MTOUSA medical units fellinto Category I.

At the same time, each officer and en-listed man in the theater was given anAdjusted Service Rating Score (ASRS)as of 12 May 1945, based on a point foreach month of service since 16 Septem-

ber 1940, a point for each month over-seas, 12 points for each child under18 years of age up to a limit of three, and5 points for each combat decoration andbattle participation award.2 For enlistedmen the critical score was tentatively setas 85 points. Critical scores for MedicalDepartment officers, received late inMay, varied with the corps. For hygien-ists and dietitians, the figure was 62; fordentists, 63; for physical therapists, 65;for nurses, 71; for Medical Administra-tive Corps officers, 88; and for MedicalCorps officers 85 plus, according tospecialty. As a preliminary to redeploy-ment, high score men were to be trans-ferred to Category III and IV units,while units placed in Category II wereto be staffed with officers and men whoseASRS's were below the critical level.High-score men in Category III unitswere to be returned to the United Statesas casuals after disbandment of theirorganizations. High-score personneldeemed nonessential were to be with-drawn on a continuing basis from allunits and returned to the United Statesas casuals. Where enough low-score offi-cers were not available to staff outgoingunits, essentiality became the overridingconsideration.

Although many difficulties arose owingto the disproportionately large numberof high-score men in medical units, theprogram laid down in May was carriedout faithfully until the end of July. Bythat date, however, the demands for ship-ping to move men and equipment to thePacific were so great as to preclude themovement of medical units to the UnitedStates for disbandment. Early in August,

2 For more detailed discussion, see McMinn andLevin, Personnel in World War II, pp. 487 ff.

CONTRACTION AND REDEPLOYMENT 523

therefore, it was decided to inactivateCategory IV units in the theater. Alltransfers to the Pacific were abruptlyhalted with announcement of the Jap-anese surrender on 14 August, and per-sonnel thereafter were shipped to theUnited States as rapidly as possible onthe basis of point scores alone.

Medical Support of Fifth Army

Medical support of Fifth Army in thepostwar period was of two types. As longas combat formations remained active inthe field, even though they did no morethan patrol national frontiers, they wereaccompanied by their organic medicalunits and were served by mobile hospi-tals. On the other hand, when divisionswere sent back to redeployment andtraining centers for new combat assign-ments or demobilization, the medicalservice more closely resembled that of afixed post, with dispensaries and stationhospitals replacing clearing platoons andevacuation or field hospitals.

Medical Service in the Field

Immediately following the Germansurrender in Italy, combat elements ofFifth Army moved out to the frontiers,primarily for the purpose of roundingup prisoners and preserving order. Onthe left flank, the 34th Division advancedto the French border. The 1st Armored,to the right of the 34th, patrolled theSwiss frontier in the vicinity of LakeComo. The 10th Mountain Division ad-vanced north from the head of LakeGarda, while the 88th swept up throughBolzano to the Brenner Pass and the85th reached the Austrian border fartherto the east, in the Dobbiaco area. The

91st, which had passed to operationalcontrol of Eighth Army on 5 May, movedto the Yugoslav border at Gorizia andbacked up the British occupation ofTrieste. The 92d Division remained inGenoa and the Brazilian ExpeditionaryForce kept its positions around Ales-sandria.3

Each of these divisions was supportedby its own organic medical battalion andby one or more mobile hospital units.The 2d Platoon of the 15th Field Hospi-tal continued to operate at its Genoa siteuntil the end of June, when the 92dDivision was withdrawn for redeploy-ment. The 1st Platoon of the 32d FieldHospital moved from the outskirts ofMilan to Alessandria on 3 May, and twodays later the 3d Platoon opened inMilan itself. The 2d Platoon moved upfrom Parma to Turin in support of the34th Division on 8 May.

The 15th Evacuation hospital, afterturning its patients over to the 37thGeneral in Mantova, opened on 12 Maynear Milan as a station hospital servingboth the 34th Division and the 1stArmored. The 3d Platoon of the 32dField, no longer needed in Milan, movedto Desenzano on 23 May, where it wasreplaced early in June by a 100-bed de-tachment from the 8th Evacuation Hos-pital. At the same time, the 1st Platoonwas relieved at Alessandria by a similardetachment from the 38th Evacuation,

3 This section is based primarily on the follow-ing: (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 men-tioned in the text.


located since 26 May at Salsomaggioresouth of Cremona; and the 2d Platoonat Turin turned its patients over to a de-tachment from the 15th Evacuation. The32d Field was thus freed for redeploy-ment. (Map 43)

In the center of the fan-shaped armyarea, most of the Fifth Army hospitalswere tied down with prisoner of warpatients and with the supervision of Ger-man POW hospitals. The 3d Platoon ofthe 15th Field at Modena, the 1st Pla-toon of the 15th, which moved to Vicenzaearly in May, and the 8th Evacuationsouth of Verona were all so engaged.Even the 3d Convalescent Hospital,which moved up from Montecatini toVillafranca on 4 May, was before longlargely occupied supervising a GermanPOW convalescent hospital. When the2d Platoon of the 602d Clearing Com-pany closed on 16 May, the 3d Convales-cent also took over operation of the FifthArmy Venereal Disease Center.

The 170th Evacuation hospital,which had been en route to Trevisowhen the war ended, remained at thatsite in support of the 85th and 88th Divi-sions until 2 June, when it closed forredeployment. Its sister unit, the 171stEvacuation, closed at Vicenza on 7 May,opening the next day at Cormons in sup-port of the 91st Division. The site wasonly a stone's throw from the Yugoslavborder, about midway between Udineand Gorizia. On 27 May the 171st alsoclosed for redeployment, having beenreplaced in the interval by the 56th Evac-uation, which moved from Bologna toUdine on 19 May. The larger unit wasrequired because of a flare-up along theborder that brought the 10th MountainDivision to the support of the 91st.

The 33d Field Hospital gave second-

and third-echelon support to the 85thand 88th Divisions. The 1st Platoon,which had been immobilized south ofBologna throughout the greater part ofthe Po Valley Campaign, opened inBolzano on 7 May. The 2d Platoon, atBassano when the war ended, movednorth to Primolino on 3 May and on toBelluno on the 7th. The unit back-tracked to Treviso on 4 June, however,to take the overflow from the 56th Evacu-ation at Udine. The 3d Platoon movedfrom Vicenza to Trento on 9 May.

Fifth Army itself began closing out inJune. On the 7th of that month the 88thDivision was reassigned to MTOUSA asthe theater prisoner of war command,though the division continued to be ad-ministered by Fifth Army. About themiddle of June the Brazilian Expedi-tionary Force moved to Francolise northof Caserta for redeployment training,and the 92d Division moved to its ownredeployment training area near Viareg-gio. On 25 June the 1st Armored Divi-sion left the theater for occupation dutiesin Germany, and on the 29th II Corpsalso passed to ETO to administer theoccupation of Austria. The bulk of theFifth Army service troops were movedout during June, since a limitless reser-voir of German prisoner personnel wasavailable to perform their functions.

Early in July the 85th Division movedto a redeployment area along the Vol-turno, and the 10th Mountain Divisionmoved to Florence preparatory to a Pa-cific assignment. On 11 July GeneralMartin left the theater for an assignmentin the Pacific, and his executive officer,Col. Charles O. Bruce, became FifthArmy surgeon. About this time a long-standing territorial squabble betweenFrance and Italy was curbed, making


COLONEL BRUCE

occupation of Aosta Province on theFrench border no longer necessary. Laterin the month, therefore, the 34th Divi-sion, which had been patrolling the dis-puted area, was free to relieve the 91st atUdine, releasing the latter formation forredeployment training. With the reas-signment of the 34th Division, and thetransfer of the Legnano and CremonaGroups of Italian partisans and the 6thSouth African Armoured Division toBritish control, IV Corps became non-operational as of 15 July.

As the army contracted, medical unitsreadjusted their positions, so that theytoo could be redeployed as rapidly aspossible.

The 16th Evacuation Hospital, whichhad remained at its San Giovanni sitesince the end of hostilities, relieved the56th at Udine on 4 August. On 15 Augustthe 1st Platoon of the 15th Field Hospi-tal, which had been supervising Germanprisoner of war installations at Vicenza,relieved the 15th Evacuation in Milan;and a few days later the 2d Platoon re-lieved the 32d Field at Bolzano. On 1September all remaining Fifth Armyunits were assigned to the PeninsularBase Section. Fifth Army became non-operational on 9 September 1945, thesecond anniversary of the Salerno land-ings, and was inactivated on 2 October.On 25 September the 15th Field Hospi-tal was reassigned from PBS to the 88thDivision, and a week later, operating asa single hospital for the first time sincethe beginning of the Po Valley Cam-paign, relieved the 16th Evacuation atUdine, where the 88th relieved the 34thDivision.

During the closing months of FifthArmy's existence, the medical servicewas largely of garrison type. The inci-

dence of disease was low, with malariawell under control and intestinal dis-eases almost nonexistent. Even thevenereal disease rate, contrary to all ex-pectations, was surprisingly low. Therate per 1,000 per annum rose from 34for the week ending 4 May to 55, 91,and 111 for the three succeeding weeks,but was down to 81 by June. It remainedbetween 93 and 67 until August, when itdropped to 58. The only disease out-break of any significance occurred in thelast week of June, when 27 cases ofpoliomyelitis suddenly appeared in the10th Mountain Division, then in theUdine area. Despite intensive investiga-tion, no cause was determined.

Medical Service for StagingUnits

As soon as MTOUSA redeploymentplans were firm, Fifth Army began es-


tablishing redeployment and trainingcenters where troops could be preparedfor transfer to another theater or forshipment home. Centers were estab-lished for nondivisional units at Monte-catini and Florence, the former for Cate-gory II units, the latter for CategoryIV. In June one area near Viareggiowas prepared for the 92d Division, andanother at Francolise, just north of theVolturno in the vicinity of Capua, for theBrazilian Expeditionary Force. Aboutthe 1st of July another redeployment andtraining center was set up along theVolturno near Caiazzo, where a replace-ment center had previously been lo-cated. Later in the same month the lastof the redeployment centers was estab-lished, at Cecchignola just south ofRome, which had also been the site of areplacement center. Both the Volturnoand Cecchignola centers served divi-sional troops.4

Fifth Army supplied medical servicefor each of the centers processing non-divisional units-Montecatini, Florence,and for a time Volturno and laterCecchignola. In each case a team of threeofficers was attached to the center, one afield-grade medical officer who served asarea surgeon; one a medical records in-spector; and the third a medical supplyinspector. The surgeon was responsiblefor sanitation and medical care, as wellas for checking the physical condition ofeach man to determine his fitness forfurther overseas duty. The team as awhole was responsible for checking the

administrative condition of medicalunits and detachments. The divisionalunits received medical care throughtheir organic medical battalions, withthe clearing company providing dispen-sary service.

Fifth Army also operated dental clinicsat Montecatini, Florence, and Cecchig-nola, where every effort was made to sendthe men out in first-class dental condi-tion whether they were homewardbound or destined for the Pacific. Thelargest of the clinics—that at Monteca-tini—was staffed by thirty dental officers,assisted by both U.S. and German dentaltechnicians.

Hospitalization at Montecatini wassupplied by the 182d Station Hospitaland by the 94th Evacuation, whichmoved to the center from Carpi on 16May. All facilities of the 94th except adispensary were closed out late in June,and the 182d was relieved at that time bya detachment of the 70th General Hospi-tal under PBS control. The other centerswere supplied with hospitalization ex-clusively by PBS units from the start.The Florence center was initially sup-ported by the 55th Station Hospital atPratolino; then by the 225th Station, adetachment of the 70th General, and adetachment of the 64th General, whichsucceeded one another in that order. The105th Station at Pisa and its successor,the 55th, were available to the Viareggiobivouac of the 92d Division, which alsomade use of hospitals in Leghorn. Twoplatoons of the 35th Field Hospital thatopened at Sparanise on 8 July hadBrazilian medical personnel attached toserve the nearby Brazilian redeploymentcenter. The Volturno area was served bythe 154th Station at Caiazzo; and theCecchignola center received hospital sup-

4 Principal sources for this section are: (1) An-nual 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.


port from the 40th Station and its re-placement, a detachment of the 37thGeneral Hospital. The 34th Station wasalso available if needed.

Other features of the Fifth Army med-ical service for staging troops were theoperation of dispensaries and prophy-lactic stations in rest areas, and the sani-tary inspection of hotels and restaurantsin the large cities of northern Italy towhich leaves were granted.


At the theater level, hospitalizationand evacuation of the sick and injuredcontinued to be the primary mission ofthe medical service as long as Americansoldiers remained in the Mediterranean.Both functions, however, were sharplycurtailed in keeping with the improvedhealth status resulting from the cessationof hostilities and the subsequent reduc-tion of troop strength.

Contraction of Hospital Facilities

The problem facing the MTOUSAand PBS surgeons when the redeploy-ment period began was one of keepinga safe number of fixed beds in the areasof troop concentration and a balanceddistribution of facilities and specializedpersonnel, at the same time closing outhospitals to meet the redeploymentschedule and readjusting personnel inorder to staff with low-score men unitstabbed for further combat. It was notan easy task, but it was accomplishedsmoothly and with few delays.

Since the bulk of the U.S. forces werein northern Italy, hospital facilities inthe Naples area were the first to be sur-plus to theater needs. One 500-bed sta-

tion hospital—the 52d—was closed theday after the war in Italy ended, andearlier plans to re-establish the unit atanother location were abandoned. The118th Station closed on 20 May and the106th four days later, leaving onlythe 21st Station and the 17th, 45th, and300th Generals in Naples, with an aggre-gate Table of Organization bed strengthof 5,500.5

In Rome a readjustment was madewhen the 500-bed 73d Station Hospitalwas reassigned to PBS from Rome Areaon 25 May, preparatory to closing, andthe 250-bed 34th Station was transferredto the Rome Area jurisdiction. It waspossible to release only one of the Leg-horn hospitals in May—the 114th Sta-tion, which closed on the 29th. The114th, which had been the PBS psychi-atric hospital since its arrival in Italyalmost a year earlier, had been receivingpatients in diminishing numbers forseveral weeks.

Also closed in May were the 225thStation Hospital at Fano and the 35thField Hospital, whose platoons had beenoperating separately at Lecce and Erchiein the heel of Italy and at Rimini on thewestern coast of the Adriatic. Both ofthese hospitals, however, were scheduledfor new assignments under PBS aftertermination of their attachments to theAdriatic Base Command.

The 225th Station was in fact the keyto a difficult situation in the Florencearea, where the 24th General Hospitalwas required to vacate its quarters not

5 Principal sources for this section are: (1) Fi-nal Rpt, Plans and Opns Off, Office of Surg, MTO-USA; (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 forMay-Oct 45.


later than 1 June to make way for theredeployment and training center. Aminimum of 500 beds would be requiredto support the center, but no suitable sitewas available in Florence. Permission touse the theological seminary buildingoccupied during the North ApenninesCampaign by the 15th and 94th Evacua-tion Hospitals was refused by the arch-bishop of Florence. The only practicalsolution was to replace the 250-bed 55thStation at Pratolino with a larger unit.Additional space was provided by con-verting a nearby villa into officers quar-ters and turning an enclosed porch intoa ward. On 9 May, ten days after itclosed at Fano, the 225th began takingover from the 55th by infiltration. By 1June, when the 24th General moved outof the area, the 225th was in full opera-tion with facilities for 750 beds.

The process of readjustment and con-traction was accelerated in June. Insouthern Italy the 45th General Hospi-tal—last installation in the Naples medi-cal center—closed on 9 June, and on the21st replaced the 26th General at Barias an ABC unit. On 10 June the 262dStation Hospital at Aversa was relievedby a platoon of the 35th Field. The 34thField closed its 1st Platoon at Spinazzolaon 5 June and its 2d and 3d Platoons atCerignola ten days later, the latter beingreplaced by the 2d Platoon of the 4thField. In Rome, the 73d Station closedon 18 June.

In northern Italy, the 81st Station atLeghorn and the 74th at Bologna bothclosed on 20 June. On 25 June the 500-bed 105th Station, having evacuated allbut sixty of its Russian patients to theirhomeland, was replaced by the 250-bed55th Station. The 55th was able to sendthe remaining Russians home by 28

June. Also on 25 June, the 182d Stationclosed at Montecatini and the 225thceased operations at Pratolino. Bothunits were replaced by 500-bed detach-ments of the 70th General Hospital,which ceased taking patients at Pistoiaat that time.

July saw the closing out of another6,000 fixed beds in Italy and further re-adjustment to provide adequate cover-age. The 1st and 2d Platoons of the 35thField Hospital opened at Sparanise insupport of the Brazilian redeploymentcenter on 8 July, and on the 12th the70th General moved its headquartersfrom Pistoia to Pratolino. The majorshutdowns began with closing of the2,000-bed 12th General at Leghorn on7 July. On the 18th the 60th Station atSenigallia was relieved by the 4th Field.The 103d Station closed at Pisa on 20July, its place being taken by the 99thField, whose scattered platoons werebrought up from Grosseto, Castagneto,and Empoli.

The 40th Station closed at Cecchignolaredeployment center south of Rome on21 July, replaced by a detachment of the37th General from Mantova. On thesame day the 32d Station closed atCaserta, where it was relieved by a de-tachment of the 300th General. The 21stStation closed in Naples on 23 July, andthe 6th General closed at Bologna thefollowing day. The 750-bed 7th StationHospital closed in Leghorn on 26 Au-gust, and by the end of the month the154th Station at Caiazzo and the Cecchig-nola detachment of the 37th Generalwere also closed.

As of 1 September, nearly four monthsafter the end of the war in Italy, thereremained 14,350 fixed beds in MTO-USA, including the 16th Evacuation


Hospital and the 15th Field Hospital,which were assigned to PBS from FifthArmy at that time.6 Of this total, 2,400were attached to the Adriatic Base Com-mand and 250 were assigned to RomeArea, the remainder being PBS units. Interms of distribution, 3,900 beds werein the Naples-Caserta area; 3,000 in Leg-horn; 2,000 in the Bari-Foggia areaserving Air Forces units. There were2,150 beds in the Arno Valley betweenFlorence and Pisa; 1,500 in Mantova;750 at Udine; 400 at Senigallia; 250 inRome; and 100 each at Milan, Desen-zano, and Bolzano.

The authorized ratio of fixed beds totroop strength for the theater waslowered from 6.6 to 4 percent on 15September, and a further exodus of hos-pitals followed. The 33d, 37th, 45th, and70th General Hospitals, the 16th Evacu-ation, and the 4th Field were closed onor before 1 October. The closing of the17th General and 35th Field Hospitals inOctober and the 64th General in Decem-ber left the Mediterranean theater witha total of 3,800 beds at the end of theyear.

During the redeployment period hos-pitalization in base installations followeda predictable pattern. The three fixedhospitals in the Po Valley were largelyoccupied through May and June withprisoners of war, many of them withneglected battle wounds. General hospi-tals foremost in the line of evacuationfrom the combat zone, notably the 24that Florence and the 70th at Pistoia,

carried a heavy surgical load during May,but the backlog of battle wounds waslargely caught up by the end of themonth. In the Naples and Leghorn areas,general hospitals reported rises in ve-nereal cases and in common respiratoryand intestinal diseases, owing primarilyto the closing out of the station hospitalsthat normally handled such cases. Hos-pitals serving the redeployment centersnoted a considerable rise in neuropsychi-atric cases as a result of the rigorousscreening of personnel for Category IIunits. There were otherwise no signifi-cant disease trends, and admissions re-mained well below capacity despite thecontinuous reductions in bed strength.

Evacuation

With both mobile and fixed hospitalsscheduled for early redeployment, it wasnecessary to accelerate the evacuationprocess by every possible means. Thebacklog of U.S. battle casualties waslargely cleared from the army area bythe middle of May, while ZI evacuationalone during that month released morebeds than were required for new admis-sions. A continuing process of movingZI patients to Naples and of concen-trating communications zone cases insmaller and smaller numbers of hospi-tals made intratheater evacuation also acontinuous process.

Intratheater Evacuation—In the pe-riod between the ending of hostilities inItaly and the dissolution of Fifth Armyit is impossible to separate evacuationfrom army hospitals and patient trans-fers from one base hospital to another.The bulk of the battle casualties werecleared from the Po Valley by the middle

6 The difference between 14,350 fixed beds on 1September 1945 and 13,950 as given in AppendixA-6 for 31 August is represented by the 400 bedsof the 5th Field Hospital, assigned to PBS on 1September.


TABLE 38—INTRATHEATER EVACUATION: U.S. AND ALLIED PERSONNELMAY-SEPTEMBER 1945

Source: Compiled from Medical Sitreps, PBS, May-September 1945.

of May, using planes exclusively to carrythe men back to base hospitals in theFlorence and Leghorn areas. More than1,300 U.S. and Allied patients were flownout of the Po Valley between 2 and 15May. (Table 38) Flights from Bologna,however, carried patients from the two

PBS hospitals in that city as well as fromthe army field and evacuation hospitals.7

Air evacuation began both from Bo-

7 Principal sources for this section are: (1) FinalRpt, Plans and Opns Off, Office of the Surg,MTOUSA; (2) Med Sitreps, PBS, May-Sep 45; (3)Med Hist, 802d MAETS.


logna and from Villafranca airfield southof Verona about 2 May, and shortlythereafter from Treviso and Milan. InJune planes of the 802d Medical AirEvacuation Transport Squadron beganlifts from the Udine area, but by thisdate the number of patients to be evacu-ated was small. The squadron becameinoperative in June, and its sister squad-ron, the 807th, in August.

The only unusual incident in evacu-ating from Fifth Army units occurredlate in May in the San Remo area alongthe Italian Riviera, where the 34thDivision was engaged in patrol activ-ities. Authorization was requested andreceived from SHAEF to evacuate pa-tients from this area to the 78th StationHospital at Nice, France, an ETOUSAunit that was only thirty-five miles away,whereas the nearest MTOUSA hospitalwas the 2d Platoon of the 32d Field inTurin, more than 150 miles away.

Early in May some 500 patients wereevacuated by hospital train from Flor-ence to Leghorn to provide beds fornew casualties coming from across theApennines, and later in the monthapproximately 800 more were flownfrom Florence to Naples to clearthe 24th General Hospital for closing.Patients from Pratolino, Pistoia, andMontecatini continued to go by rail toLeghorn during June and July, as hospi-tals in those areas were contracted or aspatients were screened for evacuation tothe zone of interior, with a smallernumber going direct to Naples by air.

ZI patients from Leghorn were sent toNaples by hospital ship. More than1,800 were evacuated by this means inMay, 550 in June, and over 800 in July.Both rail and hospital ship evacuationwithin the theater were discontinued in

the latter month, all intratheater evacu-ation thereafter being by air. By thisdate only a relatively small number oflong-term patients remained, and evacu-ation had been reduced to transportationof routine illness and injury cases amonggarrison troops to the nearest fixed hos-pital.

Evacuation to the Zone of Interior—An essential preliminary to redeploy-ment of hospitals and other medicalunits in the Mediterranean was to reducethe number of patients in fixed hospitalsas rapidly as possible. As early as 15April 1945, when the Po Valley Cam-paign was just getting under way, theproblem was studied with a view tospeeding up the evacuation process. Itwas determined at that time that of themore than 15,000 patients then in MTO-USA hospitals, 2,400 more could be evac-uated to the zone of interior on a 60-daypolicy than could be sent home on the120-day policy then in effect. A 60-daypolicy, moreover, would increase futureZI dispositions by 65 percent.8

The evacuation policy was reducedaccordingly to 60 days beginning on 1May 1945. The change was immediatelyreflected in a sharp rise in ZI evacuation,which reached a total of 4,428 for U.S.Army patients for the month, comparedwith 1,761 in April. The backlog of ZIpatients had been so far reduced by theend of May that one plane a day, carry-ing 18 litter patients, was deemed suffi-cient for priority cases. Early in July,when air transports with comfortable re-clining seats became available, litter andambulatory loads were alternated. Non-

8 Principal sources for this section are: (1) FinalRpt, Plans and Opns Off, Office of Surg, MTOUSA,1945; (2) Theater ETMD's for May-Dec 45; (3)Med Sitreps, PBS, May-Oct 45.


TABLE 39—EVACUATION FROM MTOUSA TO THE ZONE OF INTERIORMAY-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 May-Dec 45. (3) Medical Sitreps, PBS, May-Oct 45.

priority cases continued to be evacuatedby hospital ships and troop transports.

The arrangement under which all ZIevacuation by sea from southern Francewas under control of Allied Force Head-quarters in Italy was terminated on 1July, each theater thereafter being givena separate allocation by the War Depart-ment.

By the beginning of August, threemonths after the termination of hostili-ties, the number of patients in MTO-USA hospitals was low enough to justifyreversion to a longer period of hospital-ization in the theater, and a 90-daypolicy was instituted. On 9 August theWar Department requested resumptionof the 120-day policy, to coincide withthat in effect in ETO. A MTOUSA re-quest that 60 days be substituted forpatients with point scores above the criti-cal level was denied, and the 120-daypolicy went into effect on 19 August.

The last of the U.S. battle casualties

was evacuated to the zone of interior inAugust, and the last of the Brazilianpatients was returned to his homeland inSeptember.

The only unusual incident in evacu-ating patients from the theater duringthis period occurred in June, when threeplanes of the 807th Medical Air Evacu-ation Transport Squadron carried thefirst consignment of Russians from the105th Station Hospital at Pisa to Bruck,Austria, for repatriation. On arrival atBruck, which was in the British zone butclose to the area of Russian occupation,it was found that no preparations hadbeen made to receive the patients, andthe pilots were directed to go on toVienna. There Russian authorities werenot only reluctant to take the patients,they were almost equally reluctant to letthe American planes and crews return toItaly.9

9 (1) Hist, 807th MAETS, 1945. (2) AnnualRpt, 105th Sta Hosp, 1945.


7029TH STATION HOSPITAL (ITALIAN) AT PISA

Evacuation from the Mediterraneantheater to the zone of interior from Maythrough December 1945 is summarizedin Table 39.

Hospitalization and Repatriationof Prisoners of War

Throughout the campaign in Italy sickand wounded prisoners had been hospi-talized in base installations in or adjacentto prisoner-of-war enclosures. Long-term

cases had been evacuated to the GermanPOW hospital near Oran or, until theend of October 1944, to the UnitedStates, but the bulk of them had beenhospitalized in the Peninsular Base Sec-tion. The German-staffed POW hospitalhad been moved to Florence in March1945, so that by the launching of the PoValley Campaign all German prisonersin the Mediterranean theater were hos-pitalized when necessary by PBS.

As of this date, the installations pri-


marily devoted to care of German pris-oners were the 334th Station Hospital(German) at Florence, and the 103dStation at Pisa. The 81st Station at Leg-horn had 250 T/O beds devoted to thecare of prisoners, and the 262d Stationat Aversa in the Naples-Caserta area be-came exclusively a POW hospital late inApril. Small numbers of prisoners werehospitalized temporarily in most of thefixed hospitals in northern Italy. Italianprisoner and cobelligerent personnelcontinued to be cared for primarily atthe 7029th Station Hospital (Italian),located from early March at Pisa.

As the Po Valley Campaign neared itsclimax, it was clear that prisoners wouldrun into the hundreds of thousands, andthat special provision, including the fullutilization of all enemy medical facilitiesand personnel, would be necessary tohospitalize the sick and wounded amongthem. After the first captured hospitalwas dismantled and sent to the rear bythe 10th Mountain Division, orders wereissued late in April that all German hos-pitals and hospitalized personnel wereto be left where they were, under suit-able supervision. It was hoped that allGerman casualties could be cared for inthese installations, but the speed withwhich the campaign came to a close andthe disorder of the German forces,including the medical establishment,forced the transfer of additional thou-sands to base hospitals before the Ger-man medical service could be reorgan-ized under Fifth Army control.

For medical purposes, no distinctionwas made between prisoners of war, de-fined as those taken in combat, and sur-rendered personnel, meaning thoseturned over by their commanders afterthe termination of hostilities. The two

groups were given the best medical careavailable, both in the army area and inthe base section. The only real distinc-tion was that prisoners in base hospitalswere cared for primarily by U.S. medicalofficers, with some assistance from Ger-man protected personnel, whereas in thearmy area all medical care after the firstfew days was by Germans in Germanhospitals, with American officers per-forming only a supervisory function.

When a complete count was made, asof 15 June, the U.S. share of the morethan half million prisoners taken in Italysince Salerno was 299,124, of whom147,227 were under Fifth Army controland 151,897 belonged to the PeninsularBase Section. The health of these pris-oners, who were used to replace Ameri-can and Italian service troops, was theresponsibility of the Fifth Army and PBSsurgeons.

Hospitalization in theArmy Area

When Fifth Army took over the Ger-man medical service at the end of thewar, field units, disorganized and for themost part inadequately staffed and sup-plied, were scattered over northern Italy.The main concentration of German fixedhospitals was at the resort town ofMerano close to the Austrian bordernorthwest of Bolzano, with a smaller con-centration at Cortina d'Ampezzo, aboutforty miles east of Bolzano. In both ofthese areas, facilities were more thanadequate. Hospitals were fully staffedand equipped to operate without U.S.assistance.10

10 Except as otherwise noted, this section is basedon: (1) Fifth Army History, vol. IX; (2) AnnualRpt, Surg, Fifth Army, 1945; (3) Delaney, BlueDevils, pp. 234-46.


GERMAN MEDICAL CENTER IN THE ITALIAN ALPS, the largest establishment of this typein Italy.

In accordance with AFHQ instruc-tions, all German hospitals and patientswere held where they were when cap-tured, pending detailed analysis of thesituation. Colonel Camardella, desig-nated by General Martin to supervisethe hospitalization and evacuation ofprisoners of war in the Fifth Army area,began an inspection of German medicalfacilities on 3 May. He found 10,000 pa-tients at Merano, 5,000 at Cortinad'Ampezzo and another 5,000 in Germanfield units and in American and civilianhospitals in the army area. There weresurplus supplies at Merano, and equip-ment for making all kinds of prostheticdevices at a Luftwaffe hospital on Lake

Como. The German medical high com-mand at Merano, feeling deserted by itsown army and in constant fear of re-prisals by Italian partisans, was only tooeager to co-operate.

Fifth Army kept enemy formations in-tact insofar as possible. Personnel not inorganized units were grouped into self-sustaining organizations or attached tounits still retaining some semblance ofcohesion, and all were collected into con-centration areas. The largest of thesewas set up at Ghedi, about twenty milessouthwest of Desenzano and a somewhatshorter distance south of Brescia. Asmaller concentration area was locatedat Modena, with others of lesser impor-


A HOTEL-HOSPITAL AT MERANO

tance at Parma, Piacenza, Montichiari,Brescia, and Verona. Sanitation of allprisoner enclosures in northern Italy wasunder the supervision of Maj. Frank H.Connel. In the first few days after thesurrender it was necessary to removetruckloads of refuse, and to dust all pris-oners with DDT powder for body lice.Typhus inoculations were also given.

Plans called for the early movement ofall German prisoners to Ghedi and Mo-dena, with a parallel concentration ofmedical facilities. Hospitals of 100 bedsor less were to be merged with largerunits, and patients were to be shifted asrapidly as possible to the larger hospitals.As soon as adequate lines of communi-

cation could be established, all long-termprisoner patients were to be concen-trated at Merano.

During the period of consolidation,one or more medical officers of the 2dAuxiliary Surgical Group were stationedat each of the German hospitals to keepa check on the number of patients andtheir care. As had been the case atMerano, German doctors for the mostpart were so anxious to disassociatethemselves from the Nazis that willingco-operation was assured. No attempts toevade or mislead in any particular werenoted. A German increment, with twomedical officers, was attached to FifthArmy headquarters, and the German


Director of Medical Services aided in theassignment and disposition of enemymedical units.

Through May the 85th and 88th Di-visions guarded captured dumps in themountains and moved surrendered Ger-man forces to initial concentration areas.Guard duty at Ghedi was performed bythe 10th Mountain Division until 18May, and thereafter by the 71st Antiair-craft Brigade with the 442d Infantryregiment under its command. The 88thDivision took over all guard duties whenit became the theater prisoner of warcommand. By this time all prisonersin the Fifth Army area had been movedto Ghedi or Modena. Some 80,000 en-tered the Ghedi cages in the week of17-24 May alone. Modena was consider-ably smaller, being limited to about20,000 by poor drainage.

Medical service at Modena was sup-plied by German doctors under super-vision of the 15th Field Hospital's 3dPlatoon. At Ghedi a 1,600-bed tent hos-pital was erected, staffed entirely by Ger-man medical units nominated by theGerman Director of Medical Services.Lt. Col. (later Col.) Harris Holmboewas General Martin's choice for medicalcoordinator in the Ghedi area. The Mo-dena and Ghedi hospitals were to carefor personnel in the prisoner of war en-closures only, and were not a part of theconsolidation plan.

By the end of May about 80 percentof all German medical personnel, equip-ment, and patients had been transferredto Merano and Cortina d'Ampezzo. AGerman-staffed 1,500-bed convalescenthospital was established the first week ofJune at Villafranca, under supervision ofthe U.S. 3d Convalescent Hospital. Pa-tients expected to recover within four

weeks were transferred here from Mer-ano and Cortina, and on recovery weremoved to the Ghedi POW enclosure. By15 June, six weeks after the victory, allGerman hospitals under Fifth Army con-trol had been closed except Merano,Cortina, the convalescent facility, and theunits serving the Modena and Ghediareas. In another two weeks the hospitalsat Cortina d'Ampezzo were also clearedto Merano and closed. The con-valescent hospital was disbanded on17 July. German medical supplies andequipment were stored at Merano andGhedi, while German hospitals andother medical units, as they became sur-plus, were held at Ghedi for shipmentto Germany or Austria on call.11

At the end of June there were about12,000 patients in the German hospitalsat Merano, administered by the 380thMedical Collecting Company of the 54thMedical Battalion. There were about4,000 members of the German medicalservice in the town. Many items of med-ical supply were manufactured there,and 9,000 tons were stored. Supplies notneeded to care for patients at Meranowere shipped to PBS and to British basesfor use in treatment of German per-sonnel. The town itself was run by the88th Division under strict military con-trol.

Merano offered an excellent opportu-nity to evaluate German medicine, aboutwhich little had been known since theNazi regime had come into power.Consultants and medical investigatorsfrom 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 Thea-ter Comdr and CofS MTOUSA, 17 Jul 45.


WARD TENTS OF GERMAN POW HOSPITAL AT GHEDI, MAY 1945

the United States visited the area duringthe period of its heaviest operation. Theconclusion was general that while theGerman medical service was adequate,its standards "were only mediocre incomparison with those of the AlliedForces in Italy." 12

Hospitalization of Prisonersin PBS Units

For a week or more after the close ofhostilities in Italy, prisoner of war pa-tients continued to be evacuated to PBShospitals, pending survey and reorganiza-tion of the German medical service inthe Fifth Army area. The 103d StationHospital at Pisa had a peak load of 1,162

prisoner patients on 5 May. The 37thGeneral, when it opened in Mantova on9 May, received more than 1,000 Germanpatients by transfer from the 15th Evac-uation Hospital, and others continued tobe admitted to the 74th Station and the6th General at Bologna.13

In order to relieve the pressure on hos-pitals in the forward area, about 700prisoner patients were evacuated fromthe Po Valley to Florence, where theGerman-staffed 334th Station Hospitalwas expanding its capacity from 500 to

12 Annual Rpt, Surg, Fifth Army, 1945, p. 44.

13 Principal sources for this section are: (1) FinalRpt, Plans and Opns Off, Office of Surg, MTOUSA;(2) Med Sitreps, PBS, May-Oct 45. (3) The-ater ETMD's, May-Oct 45. (4) Unit rpts of in-dividual hosps mentioned in the text; (5) ETMD'sof individual hosps mentioned in the text.


POW WARD OF262D STATION HOSPITAL AT AVERSA

1,600 beds. This unit reached a peakcensus of 1,522 about the end of May.Both the 81st and 114th Station Hospi-tals in Leghorn took additional prisonerpatients early in May, and three train-loads were moved from Leghorn toNaples. The bulk of these went to the262d Station Hospital at Aversa, but oneconsignment of about 300 was tempo-rarily cared for at the 21st Station inNaples, being transferred to the 262dbefore the middle of the month.

German medical personnel wereutilized to the extent available by all ofthe PBS hospitals caring for prisoners.The 37th General inherited 70 Germanmedical officers and 400 enlisted menfrom the 15th Evacuation. Only a fewGerman protected personnel were usedby the 74th Station and the 6th Generalin Bologna, but the 103d Station at Pisahad 26 German medical officers, 31 fe-

male nurses, and 401 enlisted men by theend of May. The 262d. Station at Aversahad 121 German technicians who wereused as assistants to U.S. personnel. Inaddition to these groups, fully organizedand equipped German units, correspond-ing to the American field hospital pla-toons, were established in the variousprisoner of war stockades under PBScontrol, where they furnished dispensaryand infirmary service.

Prisoner admissions were predomi-nantly battle casualties during the earlypart of May. Wounds had frequentlybeen neglected or inadequately dressed,and the initial strain on surgical staffs ofthe hospitals treating them was severe.The 334th Station maintained a bloodbank for prisoners, the donors beingdrawn from the PBS prisoner of war en-closures. At the same time the medicalservices of the various POW hospitalstreated many conditions not commonamong U.S. troops that arose out of abackground of malnutrition, insanitaryconditions, and the older age level of theGerman Army.

The hospitalization of prisoner pa-tients in PBS was stabilized by the firstweek of June, when the 88th Division be-came the MTOUSA prisoner of warcommand. In the Naples area, the 3d Pla-toon of the 35th Field Hospital relievedthe 262d Station on 8 June, taking over487 prisoner patients and a newly arrivedGerman field unit consisting of 6 medicalofficers, a dentist, a pharmacist, an ad-ministrative officer, 4 nurses, 6 nurses'aides, and 82 enlisted men. The 11i4thStation in Leghorn was already closed,and the 81st Station in the same city andthe 74th in Bologna were preparing toclose. At the end of June the 37th Gen-eral still had more than 1,000 POW pa-


tients, and the 6th General had about800. Approximately 1,000 German pa-tients remained in the 334th StationHospital at Florence and about 750 inthe 103d Station at Pisa. The 35th Fieldat Aversa had about 500 prisoner pa-tients.14

Evacuation of long-term cases toMerano began on 25 June from the 37thGeneral Hospital and from other PBSprisoner of war hospitals early in July.Thereafter the prisoner of war census inPBS hospitals declined rapidly. The 103dStation was relieved at Pisa by the 99thField on 20 July, transferring 602 Ger-man patients at that time. By the end ofthe month 37th General had only 341prisoner patients, and the census of the334th Station was down to 570. Both ofthese hospitals were closed on 13 Septem-ber, leaving the 35th Field at Aversa andthe 99th Field at Pisa the only PBS unitsstill hospitalizing prisoners of war.

On 25 September responsibility for allprisoners of war under U.S. control inItaly passed from MTOUSA to PBS. Atthat time there were 268 prisoner pa-tients in the 99th Field Hospital and 453in the 35th Field, with an additional1,200 in German units under U.S. super-vision. The bulk of these were the rou-tine sick and injured from Germanservice units operating in the theater.

All Italian personnel were formally re-leased from prisoner of war status on 30June and returned to control of the Ital-ian Government. The 7029th StationHospital (Italian), which had been hos-pitalizing Italian prisoners first in theOran area and then at Pisa since the fallof 1943, closed to admissions at thistime, and administrative control over all

Italian personnel was vested in the Ital-ian commanding officer of the hospital.All patients were transferred to civilianor 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 ofprisoners of war and surrendered per-sonnel in Italy was complete. The nextstep was repatriation, beginning selec-tively with those whose labor was mostessential to restore the German economyand those too old or too ill to be of anyproductive use to the Allies. Toward thisend, a conference was held at Bolzano on14-16 June between representatives ofAllied Force Headquarters in Italy andthose of Supreme Headquarters AlliedExpeditionary Forces whose responsi-bility extended to Germany and Austria.Medical representatives at the conferencewere General Martin and Colonel Cam-ardella for Fifth Army; Maj. (later Lt.Col.) Murray L. Maurer, MTOUSAhospitalization and evacuation officer,for the MTOUSA medical section; Maj.(later Lt. Col.) O. S. Williams of theBritish component for the medical sec-tion of AFHQ; and Col. Conn L. Mill-burn, Jr., executive officer to the armygroup surgeon, for the 12th Army Group.SHAEF headquarters sent no medicalrepresentative, but Millburn was fami-liar with ETO's problems and policies.16

Basic agreements were reached as tonumbers to be repatriated on both sides,routes to be used, and tentative target

14 Ltrs, Kane, Surg, MTOUSA POW Comd, toCG 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: AFHQ-SHAEF Conference at Bolzano, 14-16 Jun 45.POW's, Mar 44-Sep 45.


dates; but the disposition of long-termpatients was discussed only briefly at theconference level. More detailed discus-sions of this problem were held by themedical representatives meeting sepa-rately as a subcommittee, and tentativeplans were agreed upon. AFHQ was pre-pared to begin receiving hospitalizedItalians from Germany and Austriawhenever SHAEF requested, since 4,000beds were already available in Italianmilitary hospitals. The transfer of Ger-man patients from Italy to SHAEF-con-trolled areas was a more complex prob-lem. Occupation forces were still in theprocess of adjustment, and beds wouldnot be available until all German pa-tients could be evacuated from the Tyrolregion. It was agreed that when SHAEFwas ready, long-term German patientsfrom Italy would be moved north by hos-pital train over the Brenner route, whosemuch-bombed rail line would soon bein usable condition. The target dateselected was 10 July, at which time ameeting between the two medical staffsconcerned was to be called by SHAEF tocomplete final arrangements.

By the time the promised conferenceof medical officers was held at Wiesba-den, Germany, on 12-13 July, SHAEFhad been replaced by United StatesForces, European Theater (USFET) . Atthe Wiesbaden conference, the only rep-resentatives of the Allied Forces in Italywere Col. Albert A. Biederman, plansand operations officer in the MTOUSAmedical section; and Col. Williams,who spoke for the British component ofAFHQ. On the USFET side, forwardheadquarters was represented by Lt. Col.Joseph W. Batch and rear headquartersby Col. Fred H. Mowrey. Colonel Mill-burn and Lt. Col. James E. Sams

represented the 12th Army Group,while Col. John Boyd Coates, Jr., andCol. Robert Goldson represented Thirdand Seventh Armies, respectively. TheBritish-Canadian 21 Army Group wasalso represented in order to arrange thetransfer of German patients under Brit-ish control in Italy.17

The Wiesbaden conference resulted ina firm program for exchange of hospital-ized prisoners between the Mediterran-ean and European theaters. All Germanpatients in U.S. custody were to go byhospital train by the Brenner route toThird Army at Munich, Regensburg,and Furth; and to Seventh Army at Id-stein. Beginning 25 July, one train everysecond day was to go to Third Army,and after 15 August daily trains were toalternate to Third and Seventh Armies.Three Italian hospital trains were to befurnished by Fifth Army (two initially),and two German trains were to be sup-plied by Third Army.

It was estimated that returns to dutywould reduce the total of U.S.-controlledGerman patients to be repatriated toabout 10,000. Beds vacated by these atMerano, up to 3,000, would be used tohospitalize temporarily sick and woundedItalians returned from Germany, forwhom responsibility would pass to theAllied Commission on their arrival.Long-term prisoner patients from theEighth Army zone in Italy were to go tothe 21 Army Group under separate ar-rangements.

Evacuation to Germany began as plan-ned on 25 July, and by the end of the

17 (1) Brief Minutes of Conference on Exchangeof Medical Cases, Wiesbaden, 12 Jul 45. (2) Ltr,Biederman to Standlee, 20 Jul 45, sub: Exchangeof Sick and Wounded Between the European andMediterranean Theaters.


month 1,254 patients had been movedto hospitals in the Third Army zone.The hospital trains used were staffed byGerman medical officers and corpsmen,under the supervision of an AmericanMedical Administrative Corps officer.On the return trip, the trains carriedItalian displaced persons to be hospital-ized initially at Merano. The wholeprocess worked so smoothly that ThirdArmy agreed to take a trainload a daybeginning 9 August instead of on alter-nate days. The Third Army quota wasfilled by the middle of August, allevacuees thereafter going to the Sev-enth Army.18

By the end of August the total numberof long-term cases sent to Germany hadclimbed to 7,783, and stood at 9,751 asof 25 September, when the PeninsularBase Section took over responsibilityfrom MTOUSA. For all practical pur-poses, the program was finished, since nomore than 500 long-term German pa-tients remained in the U.S. zone ofItaly.

Redeployment and Inactivationof Medical Units

At the same time that U.S. long-termpatients were being evacuated to the zoneof interior on a 60-day policy and theburden of caring for prisoner of war pa-tients was being reduced by consolidation

of hospitals and repatriation of thosewith long hospitalization expectancy,American medical units were beingsystematically staged for shipment to thePacific or prepared for inactivation.The Mediterranean theater was con-tracting even more rapidly than it hadgrown in the early days of the Italiancampaign.

Disposition of Fifth Army Units

The readjustment of Medical Depart-ment personnel so that units destined forthe Pacific would have only men withlow adjusted service rating scores, plusthe loss of high-score men to "carrier"units bound for the United States, poseda more difficult problem for the FifthArmy surgeon than even the care of pri-soners of war. The Fifth had been thefirst United States field army activatedon foreign soil in World War II, andhad been in virtually continuous combatfor 19 months when the war ended.Many of its components, including hos-pitals and medical battalions, had seenstill earlier combat with other forma-tions. There was, therefore, a heavy pre-ponderance of high-score personnel inthe Fifth Army medical service. Yet 2 ofthe 8 evacuation hospitals and one of the3 field hospitals were scheduled fordirect redeployment to the Pacific, and 2more evacuations and a field were listedfor indirect redeployment. Three of the4 medical battalions in Fifth Army werealso placed initially in Category II, withabout the same proportions holding forother types of medical units.19

18 (1) Annual Rpt, Surg, Fifth Army, 1945. (2)Final Rpt, Plans and Operations Off, Office ofSurg, MTOUSA. The figures used here, and in thefollowing paragraph, are from letters, M. M. Kane,Surgeon, MTOUSA POW Command, to Command-ing General, MTOUSA, 6, 28 September 1945, inPrisoners of War, March 1944-September 1945.These figures differ both from those given by theFifth Army surgeon and from those in the theaterETMD for October 1945, but are believed to bethe more accurate.

19 Principal sources for this section are: (1) An-nual 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 rptsof the individual med units mentioned in the text.


The first Fifth Army medical unit togo to the Montecatini redeploymentcenter was the 94th Evacuation Hospital,which arrived on 16 May, a bare twoweeks after the end of the war in Italy.The exigencies of the situation, however,required the 94th to go into operationfor a time at Montecatini, although itwas classified as II-A for direct redeploy-ment to the Southwest Pacific. The 171stEvacuation, scheduled for redeploymentto the Pacific by way of the United States,was in Montecatini on 29 May; the 161stMedical Battalion less its collecting andclearing companies, the 32d Field Hos-pital and the 170th Evacuation all ar-rived at the redeployment center the firstweek of June. The headquarters andheadquarters detachments of the 162dand 163d Medical Battalions arrivedjust before the end of June.

By the end of May the Category II-AMedical units—the 94th and 170th Evac-uation Hospitals, the 32d Field Hospital,and the 161st Medical Battalion—werestaffed with low-score personnel as fullyas was consistent with efficient operation.Other Category II units, including themedical battalions and medical detach-ments of the 91st and 10th MountainDivisions, had had the bulk of theirhigh-score personnel withdrawn dur-ing June, but low-score replacementswere insufficient to bring the units up toTable of Organization strength.

By July the personnel situation inFifth Army was critical. Low-score per-sonnel to fill out the T/O's of units be-ing redeployed to the still-active waragainst Japan had of necessity to bedrawn from units scheduled for returnto the United States and ultimate in-activation. But these Category IV unitshad already been stripped to a point at

which further withdrawals would jeop-ardize their efficiency, and they were stillneeded to furnish medical service to theremaining combat formations. A furthercomplication was the refusal of the WarDepartment toaccept the MTOUSATable of Organization for separate col-lecting companies that were to be trans-ferred to the Pacific. These companieshad been operating with a medical officerand 4 MAC's. It was now necessary tomake all of the 7 companies involvedconform to the official Table of Organi-zation, which called for 3 medical offi-cers and 2 MAC's. The required officerswere diverted from the 91st and 10thMountain Divisions, and replaced froma group of 20 low-score medical officersprocured from the European theater,but no more were available from thatsource. Fourteen Medical Administra-tive Corps second lieutenants were com-missioned from among 60 enlistedapplicants, but there remained a short-age of low-score officers in both corps,forcing the retention of high-score men.

The supply of low-score enlisted menwas also critical by the end of July—somuch so that a requirement for 300 gen-eral service enlisted men with pointscores below 70, to be used as Pacificreplacements, could only be met bydrawing 100 men from units assigned tothe strategic reserve and replacing themwith high-score personnel from CategoryIV units.

The manpower problem was finallysolved in early August. To relieve pres-sure on shipping, a change of policy wasinaugurated whereby all Category IVunits were to be inactivated in the the-ater rather than be shipped to theUnited States for inactivation. High-score personnel from Category IV that


had been scheduled for early shipmentand were already inoperative, were senthome as casuals, but those with middle-bracket scores—80 to 90 points—weretransferred to late Category IV units,which were thus brought up to strength.

The process of redeployment, mean-while, had been proceeding according toplan. The Fifth Army veterinary servicepassed out of existence on 30 June, whenthe Italian pack mule trains were dis-banded and the four U.S.—Italian vet-erinary hospitals were turned over to theItalian Army. Two weeks later, on 14July, the 171st Evacuation Hospital sail-ed for the Pacific by way of the UnitedStates. The 32d Field and the 170thEvacuation sailed on 17 and 25 July,respectively, direct to the Philippines;and the 161st Medical Battalion embark-ed on 7 August for the United States enroute to a Pacific station. The 94th E-vacuation sailed for the Southwest Pacificon 13 August, but was diverted at seato the United States after word was re-ceived of the Japanese collapse.

On 20 August all Category II unitsstill in the theater were ordered returnedto the United States for disposition, creat-ing a considerable morale problem sincethese had already been staffed with low-score personnel who were thus being senthome before the high-score men they re-placed. Immediate steps were taken toreadjust personnel once more, but notin time to alter the rosters of the 162dand 163d Medical Battalions, alreadyaboard ship.

Other Fifth Army medical units weredisposed of rapidly thereafter. The 38thEvacuation Hospital, which had origi-nally been scheduled for return to theUnited States, had been at the Florenceredeployment center since early July,

and the 56th Evacuation, which was tobe a Pacific reserve unit, had arrived atMontecatini on 6 August. The 38th wasinactivated in the theater on 8 Septem-ber. The 56th was sent home for inactiva-tion early in October.

The 15th Evacuation and the 3dConvalescent both closed for redeploy-ment on 20 August, while the 54th Med-ical Battalion and the 601st ClearingCompany moved to Florence for finaldisposition on 25 August. The 33d FieldHospital, which had closed on 23 August,was inactivated on 25 September. Onlythe 15th Field Hospital, the 8th and 16thEvacuation Hospitals, and a few lesserunits remained active in the army areawhen the transfer to PBS took place on1 September.

Disposition of PBS Units

The redeployment of medical unitsassigned to the Peninsular Base Sectionfollowed a pattern similar to that in FifthArmy. The problem of personnel read-justment was equally difficult, with tenstation hospitals and one field hospitalin the II-A category for shipment inJune, July, and August; and three stationhospitals scheduled for transfer to thePacific by way of the United States inJuly. A great deal of juggling was neces-sary, and a few medical officers withASRS's above the critical level were stillon the rosters when the hospitals sailedfor their new assignments.20

The first PBS units to leave the Medi-

20 Principal sources for this section are: (1) FinalRpt, 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 indi-vidual med units mentioned in the text; (5) AGrecord cards of units mentioned in the text.


terranean theater under the rede-ployment plan were the 106th and 118thStation Hospitals, both of which sailedfor Okinawa on 29 June. On 8 July the52d Station left for indirect redeploy-ment through the United States, and twoweeks later the 262d Station and the 34thField sailed for Manila. The 114th and73d Stations sailed for the United Statesand ultimate transfer to the Pacific on20 and 27 July, respectively.

August was the heavy month for rede-ployment of PBS hospitals, seven 500-bedstations sailing for Southwest Pacificports between the 11th and 21st of themonth. With the abrupt ending of thewar in the Pacific, all of these wereintercepted at sea and diverted to theUnited States for disposition. The hospi-tals concerned and their sailing dateswere as follows: 74th Station, 11 August;81st Station, 13 August, 103d Station, 15August; 182d and 225th Stations, 16August; 105th Station, 17 August and60th Station, 21 August.

After the decision to inactivate Cate-gory IV units in the theater, PBS hos-pitals closed out rapidly. The 4th FieldHospital was inactivated on 10 Septem-ber. September 15 saw the inactivation ofthe 7th Station Hospital, the 6th, 12th,and 26th General Hospitals, and the 41stHospital Train. The 51st Medical Bat-talion and the 15th Medical GeneralLaboratory were inactivated on 30 Sep-tember and 25 October respectively. The33d General Hospital was inactivated on20 September, the 8th Evacuation tendays later, and the 154th Station on 1October. The 35th Field Hospital andthe 17th, 37th, and 70th General Hos-pitals were inactivated on 25 October,and the 16th Evacuation on 31 October.The veterinary hospitals and veterinary

evacuation detachments assigned to PBSwere disbanded between July andOctober.

The 2d Auxiliary Surgical Group,which had been divided between theMediterranean and European theaterssince the invasion of southern France,was reunited in Italy in June and wasinactivated at the Florence redeploymentcenter on 14 September.

After the 20 August policy order, onlyfour PBS hospitals left the theater as or-ganized units. These were the 32d, 40th,and 21st Station Hospitals, which sailedfor the United States on 22, 24, and 26September, respectively; and the 24thGeneral, which sailed on 11 October.All four of these hospitals served as"carrier" units, transporting high-scorepersonnel to the United States.

Effect of Redeployment onSupply Services

Not hospitals and medical battalionsalone, but medical supplies and equip-ment as well were redeployed to the Pa-cific. Each hospital or other medical unitgoing out was completely reequippedbefore it embarked. In addition quan-tities of medical supplies were sent toPacific ports without relation to the unitsthat would ultimately use them. Sup-plies and equipment for this purposewere accumulated at the Naples and Leg-horn depots as they were turned in byinactivated and nonoperating units.21

Early in the redeployment period allsurplus equipment, including hospital

21 Principal sources for this section are: (1) An-nual 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 ofindividual med units mentioned in the text.


READYING MEDICAL SUPPLIES FOR TRANSSHIPMENT TO SOUTHWEST PACIFIC

expansion units, was turned in from bothFifth Army and PBS. As medical unitsclosed for redeployment, all their sup-plies and equipment were turned in, andthe medical material thus accumulatedwas reconditioned and packed for reissueat the depots. For field and evacuationhospitals from the army area, as much as70 percent of the nonexpendable itemshad to be salvaged, and about 30 percentfor base section units.

When the war ended in Italy, approxi-mately 9,000 tons of medical supplieswere divided almost equally between theNaples and Leghorn depots. Tonnage at

Naples dropped to about 4,000 in mid-May, then climbed again to approxi-mately 4,500 by mid-July as more hos-pitals closed in PBS South. Leghorntonnage rose steadily to more than 6,000by mid-July before substantial outship-ments were made. Tonnage at both de-pots was unbalanced, however, andshortage lists grew as time went on, ow-ing to the necessity of keeping hospitalsoperating at the same time that completenew assemblies for them were beingmade up and set aside. The end of thewar with Japan removed the pressure andleft the Mediterranean theater with no


COLONEL STANDLEE

supply problem beyond that of storageuntil surpluses could be returned to theUnited States.

The activity of the supply depots didnot preclude the redeployment of medi-cal supply units themselves, though itdid compel a change of schedule. The12th Medical Depot Company, servingFifth Army, was originally placed inCategory II-A for movement to the Pacif-ic in June, but was changed to CategoryIV when General Martin protested thatthe army would be left without any med-ical supply organization. The 12th wasassigned to PBS along with other FifthArmy medical units on 1 September, andwas attached at that time to the 232dMedical Service Battalion at Leghorn.

The Naples depot, although its ton-nage was still climbing, was turned overto a detachment from Leghorn early in

June in order to release the 72d MedicalBase Depot Company for redeployment.The 80th Medical Base Depot Company,which had been operating the Bari sup-ply depot for the Adriatic Base Com-mand, closed on 10 July, and the 72d and80th sailed together for Manila on 22July. The 232d Medical Service Bat-talion, with the 60th and 73d MedicalBase Depot Companies attached, con-tinued to operate the main PBS depot atLeghorn and the subdepot at Naplesthroughout the redeployment period.

Close-out in the MTO

Organizational Changes

Through the summer and fall of 1945,while the bulk of the Allied Forces inItaly were being withdrawn, prisoners ofwar were being returned to their homes,and the medical service was being re-duced to a minimum, various organ-izational changes were made to bringoverhead operations into line with re-quirements. At the same time assign-ments were changed to make the best useof experienced officers and to replacehigher with lower ranks as responsibili-ties contracted.22

In June Colonel Arnest left the the-ater, being succeeded as Peninsular BaseSection surgeon by his deputy, ColonelSweeney. Colonel Sweeney was suc-ceeded in late September by Col. Wil-liam W. Nichol, formerly commandingofficer of the 37th General Hospital. Atthe army level, the transfer of GeneralMartin and accession of Colonel Bruce as

22 Principal sources for this section are: (1)Munden, Administration of the Med Dept inMTOUSA, pp. 189-205; (2) Med Sitreps, PBS,Jun-Oct 1945.


Fifth Army surgeon has already beennoted. At the theater level, GeneralStayer departed in June to assume theduties of health officer for occupied Ger-many. He was succeeded as MTOUSAsurgeon by Colonel Standlee, who hadbeen deputy surgeon since the organiza-tion of the theater. Colonel Biedermanbecame Standlee's deputy in July with-out giving up his now greatly curtailedfunctions as plans and operations officer.

As of 1 October, Headquarters, Medi-terranean Theater of Operations, UnitedStates Army, was formally separated fromAllied Force Headquarters. On the samedate Headquarters, Army Air Forces,MTO, was discontinued, the Army AirForces Service Command passing toMTOUSA. The functions of the supplysection of the MTOUSA surgeon's officewere transferred simultaneously to PBS.Both shifts forecast the final consolida-tion a month later, when both theAdriatic Base Command and theMTOUSA medical section were discon-tinued. Colonel Standlee left the theaterat that time, but Colonel Biederman re-mained until the transfer of functions toPBS was complete, well along in Decem-ber. The Peninsular Base Section thenbecame responsible for medical servicefor all U.S. forces remaining in the the-ater, whose boundaries now includedHungary and the Balkans. ColonelNichol relieved Colonel Standlee late inthe year, and thereafter performed thefunctions of theater surgeon as well asbase surgeon.

The Occupation Period

Italy, because of its cobelligerentstatus, was never occupied in the samesense that Germany and Austria were.

Because of border disputes between Italyand Yugoslavia, however, and of theclaims of both nations to the importantcity of Trieste, it was necessary to retainsome military forces in the province ofVenezia Giulia until late 1947. The 88thDivision, which had relieved the 34th atUdine in September 1945, remained asthe occupation force and supplied per-sonnel for the Trieste-United StatesTroops (TRUST), which took over oc-cupation of the Free Territory of Triestefrom the British in May 1947.23

During the 2-year period of occupa-tion, medical support for the 88th Divi-sion gradually changed from combat togarrison type. The 313th Medical Battal-ion, organic to the division, maintaineda collecting station in the vicinity ofTarviso, near the Austrian-Yugoslav-Italian border, in support of a combatteam until mid-December 1945; and hada clearing station at Cividale, northeastof Udine, which soon took on the char-acteristics of a post hospital. Before theend of 1946 the medical battalion wasoperating aid stations that were morelike dispensaries in rest areas as far awayas Cortina d'Ampezzo and Venice.

The 15th Field Hospital was replacedat Udine in May 1946 by a newly acti-vated station hospital, the 391st, with 400beds. Evacuation from the 15th Fieldwas by air to Leghorn or Naples, andfrom the 391st was by hospital train toLeghorn.

Fixed hospital support for the occupa-

23 Principal sources for this section are: (1) The-ater ETMD's for Sep 45-Dec 46; (2) Annual Rpt,Med Activities, TRUST, 1947; (3) Delaney, BlueDevils, pp. 249-72; (4) Komer, Civil Affairs andMilitary Government in the Mediterranean The-ater, ch. XV; (5) Unit rpts of med units men-tioned in the text.


tion force, as well as for scattered AirForces and service units, continued to beprovided by PBS, but on a steadily de-clining scale. With the closing out of theAdriatic Base Command on 1 November1945, the 500-bed 61st Station Hospitalwas shitted from Foggia to Leghorn toreplace the 64th General, which was pre-paring for inactivation. The 250-bed55th Station moved simultaneously fromPisa to Foggia, where it was assigned tothe Air Forces about 1 January 1946.The 300th General Hospital at Naples,the 34th Station at Rome, and the 99thField at Pisa were the only other fixedhospitals in the theater.

A major cutback in fixed bed strengthoccurred in May 1946, paralleling theshift from combat to garrison status ofthe 88th Division. The 99th Field Hos-pital closed on 1 May and the 300th Gen-eral on the last day of the month, thelatter being replaced by a new unit, the200-bed 392d Station Hospital. At thesame time, the 34th Station at Rome andthe 55th Station at Foggia were reducedfrom 250 to 100 beds, the 55th being re-assigned to PBS. As of 1 June 1946, PBShad 800 T/O beds: 100 in Foggia, 200 inNaples, and 500 in Leghorn; Rome Areahad 100 beds; and the 88th Division had400.

The supply service was also reorgan-ized in May and June, when the 232dMedical Service Battalion, and the 60thand 73d Medical Base Depot Companieswere inactivated. These units were re-placed by the 339th Medical Supply De-tachment, which was joined in August bythe 57th Medical Base Depot Company.The 339th Medical Supply Detachmentwas inactivated in January 1947, leavingthe 57th Medical Base Depot Companyin sole command of the Leghorn depot.

Bed strength in the theater was furtherreduced early in 1947 by inactivation ofthe 392d Station Hospital in January andof the 55th Station in April. The 313thMedical Battalion was inactivated on 15May.

In keeping with the contraction ofbase section functions, which were nowalmost exclusively concentrated in Leg-horn, the Peninsular Base Section wasdisbanded in April 1947, and its in-stallations and responsibilities weretransferred to the Port of Leghorn organ-ization. The former PBS-MTOUSAsurgeon became Port of Leghorn-MTOUSA surgeon at this time.

Final Disposition of Medical Units

The first step toward a final closing outof the theater came with the signing ofthe Italian peace treaty on 10 February1947. The treaty was not formally rati-fied until 15 September, but in anticipa-tion of that event complete plans forphasing out of all U.S. military installa-tions in Italy within 90 days of ratifica-tion of the treaty were drawn up.24

In accordance with the phase-outplans, the 7th Station Hospital—a 200-bed unit that had been activated atTrieste in May with personnel drawnfrom the 391st Station and the 88th Di-vision—was turned over to TRUST on19 September, immediately after news ofratification of the treaty was received.On the same day evacuation of patientsfrom the 391st Station Hospital began,and the hospital was inactivated on 15October. In Rome, evacuation of patientsfrom the 34th Station Hospital was com-

24 Phase-out Report of the Evacuation of Italy, 3Dec 1947.


pleted by 27 September, and the unitwas inactivated on 9 October. The 61stStation at Leghorn, which had receivedpatients evacuated from the 34th and391st Stations, had cleared its own wardsby the end of October and was inacti-vated 15 November 1947.

During the same period lesser medicalinstallations were similarly disposed of.Supply surpluses and surplus personnelwere transferred to the zone of interior,the European Command, or to TRUST,and the 57th Medical Base Depot Com-

pany was inactivated on 8 November.Food inspection detachments, malariacontrol detachments, ambulance units,and finally prophylactic platoons weredisbanded as rapidly as their functionscould be closed out.

On 3 December 1947, more than fiveyears after the landings in North Africa,a single army transport sailed from Leg-horn with all that was left of the U.S.forces in Italy, and the MediterraneanTheater of Operations, United StatesArmy, ceased to exist.

CHAPTER XV

The Mediterranean in Retrospect

The Mediterranean was never re-garded by American strategists as adecisive theater. Its major objectiveswere few and soon achieved. The com-mitment of U.S. forces in North Africaindirectly eased the pressure on theStalingrad front, where the Russianswere preparing to launch a winter offen-sive, and in America it gave a neededboost to public morale. The TunisiaCampaign ended the threat of Axis pene-tration into the Middle East, with its oiland its vital lines of communication. Theconquest of Sicily knocked Italy out ofthe war and opened the Mediterraneanto Allied shipping. But Italy, aside fromthe air bases it supplied for bombing theGerman homeland, was a liability, with-out enough strategic value to balance theconcomitant responsibility for a largeand predominantly destitute civilianpopulation. The justification for theItalian campaign, after the Foggia air-fields were secured, was that it could beso managed as to engage more Germanthan Allied troops and thus contributeindirectly to the ultimate winning of thewar. It was, in short, a diversion in force,in which the "force" was never quiteenough for total victory but was alwaystoo great to invest in stalemate.

For such a campaign the theater waskept lean. Stripped again and again ofits best troops and facilities to strengthenthe build-up for Normandy and later tomount the invasion of southern France,

replacements were inexperienced andslow in coming. The Medical Depart-ment through the whole period of activefighting was plagued by shortages—ofpersonnel, of beds, of medical units, andof various supplies. Yet by virtue of in-genuity, skill, organization, improvisa-tion, and endless hours of hard work, themedical mission was carried out withspeed and precision at every level. TheMediterranean experience embraced inone theater almost every condition thatwould be met on any front in a war thatenveloped the globe. The innovations,the modifications, the practical expedi-ents that emerged from it became stand-ing operating procedures as one crisisfollowed another. Passed along to armysurgeons in Europe and the Pacific, theyalso became part of the collective war-time experience of the Medical Depart-ment and gave to the medical service inthe Mediterranean an importance thatthe combat forces it supported neverachieved.

Although United States Marines hadstormed ashore on Guadalcanal and Tu-lagi in the Solomon Islands some threemonths before the Allied landings inNorth Africa, that invasion was in rein-forced division strength only, with allmedical support furnished by the Navy.TORCH was the first World War II am-phibious operation of any size for U.S.Army troops, and the first in which Armyfield medical installations were tested in

THE MEDITERRANEAN IN RETROSPECT 553

an assault. It succeeded only because de-termined opposition failed to develop.Had the French resisted strongly, thelanding forces, spotted as they were alonga thousand miles of African coast, wouldhave been individually overwhelmed.Had the casualties been even moderatelyhigh, the medical troops in the landingswould have been unable to handle themwith the small number of beds and mea-ger supplies at their disposal. Even theequipment available was sometimes use-less under the conditions of the invasion.The standard army ambulance of thetime, for example, proved to have in-adequate traction on the loose sand ofthe African beaches, and its silhouettewas dangerously high. Medical supplieswere strewn across the landing beacheswith no one detailed to collect, sort, andissue them. Plans for medical support ofthe operation had been drawn up, somein England and some in the UnitedStates, without co-ordination or suffi-cient knowledge of local conditions thatmight affect the accomplishment of themedical mission.

In subsequent landings on Sicily, atSalerno and Anzio, and finally over thewhite sands of the French Riviera, modi-fications and improvements were intro-duced to overcome the shortcomings ofeach earlier amphibious effort. For theinvasion of Sicily, a clearing element wasattached to each collecting company toenable the companies to furnish hospi-talization until the regular hospitalsarrived. Medical supply items were hand-carried ashore by medical troops, butlitters and blankets were late in coming.This lag was corrected at Salerno, wheremedical depot personnel were on the D-day troop list. Additional medical sup-plies, in waterproof containers light

enough to float, were carried onto thebeaches by combat troops. At Anzio, fieldand evacuation hospitals, combat loaded,were added to the assault convoy. Fourand a half months later, medical troopstrained on the basis of Mediterraneanexperience (and not a few who werethemselves veterans of one or more Med-iterranean assaults) put their skills to thetest in the invasion of Normandy. Med-ical support of the army that landed insouthern France in mid-August 1944 wasas near flawless as such a thing can be.The cumulative experience of Europeand the Mediterranean again helped tosave American lives halfway around theworld, on Leyte, Luzon, and Okinawa.

In addition to five major amphibiousoperations in the theater, Medical De-partment personnel supported combatand service activities in the Tunisian des-ert; in the steep, wooded mountains ofSicily and the sharper ridges of theApennines in Italy; slogged throughrain and mud, and shared with the in-fantry the perils of snow and ice; crossedflooded rivers and miasmic marshlands,and penetrated valleys still raked by en-emy fire. Only the jungle was missingand even that was to be found in as-sociated minor theaters.

These widely varying conditions ofclimate and terrain required many dif-ferent means of bringing out the wound-ed. The versatile jeep was early fittedwith litter racks and used to move cas-ualties from places inaccessible either towheeled or half-track ambulances. In oneoperation in Africa half-ton trucks withtires removed were run over rails, eachtruck carrying six litter patients. Both inTunisia and in Sicily mules brought outthe wounded in country too rough forvehicles of any kind. In the high moun-


tains of northern Italy cable tramwaysmade it possible to move casualties inminutes between points that would havetaken hours on foot.

For the longer hauls, hospital shipsand trains were employed. The Mediter-ranean theater pioneered in the use oftransport planes to move casualties notonly in rear areas but from hospitals farforward in the combat zone. Experi-ments with small Piper Cubs as ambu-lance planes were not successful enoughto justify general use, but the helicopterslater used for front-line evacuation inKorea were developed out of the sameneed and purpose. Necessity also taughtthe medical authorities in the Mediter-ranean that troop transports with hos-pital ship platoons attached to supplynecessary medical service could safelymove all but a limited few types ofpatients. It should be noted that neitherthe patient-carrying planes nor the trans-port vessels were marked with the Ge-neva Cross, but none were lost throughenemy action. On the other hand, fourproperly identified and lighted hospitalships were deliberately bombed, two ofthem sinking.

The backbone and single indispen-sable element in the evacuation systemwas the litter bearer. It took strength,stamina, gentleness, and a high order ofcourage to collect the wounded on thefield while the fighting, often enough,was still in progress, and by relays offour-man teams to carry the casualtiessometimes as much as ten or twelvemiles over mountain trails impassable toany vehicle, too steep even for mules. Inthe Italian campaign there were neverenough litter bearers. In emergencies—which were frequent—cooks and bands-men and company clerks were pressed

into service, and there were many par-tisan volunteers whose aid was invalu-able.

The stringencies of the theater forcedthe Medical Department at every eche-lon to stretch equipment and personnelto the utmost. Personnel assigned to hos-pitals temporarily not in operation, in-cluding those newly arrived and not yetassigned, were always attached to otherunits where their services could beutilized until required by their owninstallations. The cellular type of organi-zation proved most effective because ofits versatility and mobility. Surgicalteams were an excellent example butonly one of many in a genre that in-cluded malaria control units, veterinaryfood inspection detachments, and hos-pital ship platoons that were seen moreoften ashore than at sea. As the war pro-gressed and replacements became moreand more difficult to procure, medicalofficers were replaced in every permis-sible assignment by Medical Administra-tive Corps personnel. Such substitutionsextended to medical supply, evacuation,and numerous purely administrativeactivities. Another successful expedientwas the substitution of Women's ArmyCorps personnel for enlisted men in avariety of hospital tasks. Large numbersof Italian prisoners of war, availableafter the Axis collapse in Tunisia, wereorganized into service companies, andmany of them assigned to the MedicalDepartment where they proved them-selves competent in almost all nonpro-fessional functions. Local civilians werealso employed extensively in all Medi-terranean areas to perform tasks thatwould otherwise have fallen to enlistedmen.

One of the more successful expedients


devised was the use of clearing platoonsto augment bed strength of field andevacuation hospitals. With additional at-tached personnel, these platoons were alsoemployed as separate forward hospitalsfor specialized functions, includingneuropsychiatric, venereal, and gastro-intestinal cases. Such devices made itpossible to hold in the army area menwho would otherwise have been evac-uated to the communications zone, andthereby to shorten materially the timelapse before return to duty. Mediter-ranean experience tended to emphasizemobility and versatility. The more mo-bile a hospital was, the closer to the frontlines it could be used. The best exampleis that of the field hospital platoon, deriv-ing its strength from attached surgicalteams. These platoons were first used inthe Sicily Campaign as 100-bed forwardsurgical hospitals, reduced to 50 beds bythe date of the southern France invasion.This experience contributed much to thedevelopment of the MASH (MobileArmy Surgical Hospital) units employedso effectively in Korea. Other devicessuccessfully used to conserve Medical De-partment personnel were shorteninglines of evacuation, and grouping fixedhospitals in concentrations to permitmaximum use of skills by specialization,at the same time reducing the overheadby providing as many services as possiblein common.

At the army and theater levels theMediterranean experience underlinedcertain organizational principles. In atheater that was always a combined op-eration, the Americans were generallyoutranked by their British counterparts,which produced unnecessary friction. Atthe same time, it was the conviction ofmany officers in position to know that

the United States medical service main-tained higher standards than the British,and certainly medical skills, drugs, in-struments, and equipment were moreplentiful in American hospitals. U.S.soldiers hospitalized in British installa-tions were quick to note the difference,which often led to a lowering of morale.At the army level Mediterranean expe-rience demonstrated, as did the expe-rience of every theater, the importanceof giving the army surgeon a place onthe staff of the commanding general.Similarly, the mission of the theater sur-geon called urgently for a staff relation-ship with the theater commander. It wasthe absence of such a relationship thatproduced the awkward dichotomybetween the theater medical organiza-tion and that of the Services of Supply.In the European theater and elsewherethe jurisdictional problem was resolvedby giving both surgeons' jobs to the sameman. In the Mediterranean, however,only personal cordiality between the in-dividuals concerned, and a strong mutualdesire to get on with the war, kept themedical service operating smoothly inboth areas.

Emphasis in the Mediterranean wasalways on the role of Army medicine inconserving manpower—a mission oftennot fully appreciated by line command-ers. In addition to treatment of thewounded and the sick, the Medical De-partment was responsible for preventingillness insofar as possible. In every warthe United States has ever fought, theman-days lost through illness far ex-ceeded those lost by enemy action. InWorld War II the ratio was approxi-mately four days lost by disease and oneby nonbattle injury for every day lost bycombat wounds. Most of the illnesses


were preventable. In the Mediterraneanthe major time wasters were malaria,common respiratory diseases, diarrheaand dysentery, and venereal diseases, allof them largely, and some of them com-pletely, preventable. In the Sicily Cam-paign, to take only one example, malariacases alone outnumbered battle wounds.Not that the prevention of malaria wasbeyond the knowledge of the theaterand army medical sections at that time;atabrine was ordered and was supplied.The failure was on the part of the linecommanders, who did not compel theirmen to take the rather unpleasant pre-ventive drug. Similarly, the preventionof venereal disease was—and is—a com-mand function. The treatment, thanks topenicillin, was progressively shortened sothat man-days lost declined, but treat-ment was the lesser aspect of the problem.

Among familiar preventive measuresin the Mediterranean were the standardinoculations for those diseases for whichan immunity could be built up; destruc-tion of insect vectors, such as mosquitoes,flies, and lice; educational measures; andcontinuous inspection of meat and dairyproducts. Outstanding achievements ofpreventive medicine in the theaterwere the speedy and effective elim-ination of the threat of typhus in Naplesat the end of 1943; the steady reductionof malaria rates after the campaign inSicily; and the practical control of otherlocal scourges such as cholera and bu-bonic plague.

A major contribution of the Mediter-ranean theater medical service to themanagement of wounds was the provi-sion of whole blood in the forward areas.From the blood bank established inNaples early in 1944 whole blood wastrucked to the Cassino front and shipped

to Anzio by LST. Beginning late in May,during the Rome-Arno campaign, a dailyblood plane carried the precious cargoto the Fifth Army front for distributionto the field and other hospital units wheresurgery was being performed. The Na-ples blood bank also supported the inva-sion of southern France in August, byplane to Corsica and PT boat to the land-ing beaches.

Another area in which the theatermedical section pioneered was that ofcombat psychiatry. Begun on an exper-imental basis in Tunisia and Sicily, atechnique of front-line psychiatric treat-ment was fully evolved early in the Ital-ian campaign. The key figure was thedivision psychiatrist, formally assignedin the spring of 1944. If a man couldnot be restored to fighting trim by rest,sedatives, and minimal therapy at theclearing station, he was sent back to aspecial neuropsychiatric hospital, in thearmy area but still in the combat zone,for more specialized treatment. Only asa last resort, and in the full knowledgethat his combat days were probably over,was a psychiatric case evacuated to thecommunications zone.

The Mediterranean, then, was a the-ater in which the lessons of ground com-bat were learned by the Medical De-partment as much as by the line troops.For Army medicine the lessons were ofgeneral applicability: treat battle cas-ualties, including psychiatric ones, aspromptly as possible, which is to sayin the division area; keep hospitals andclearing stations mobile; be prepared toaugment table of organization personnelby attaching specialized teams or othercellular units; shorten evacuation linesby keeping hospitals as far forward aspossible, and shorten the patient turn-


around by treating as many as possiblein the army area; never waste specializedskills by detailing men who possess themto work that others can do as well; treatdisease as you treat battle wounds andanxiety states, as close to the front as youcan, but use every means in your powerto prevent disease.

No one will ever express more suc-cinctly the creed of an army surgeon thandid General Martin, Fifth Army Surgeon,throughout the Italian campaign. "Theuseless expenditure of life and suffer-ing," General Martin wrote, "is as crim-inal as murder."

APPENDIX A 561

APPENDIX A-1—FIXED BEDS AND BED RATIOS, ATLANTIC DEFENSE AREASJULY 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 ofthe 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 cor-rected to include Air Transport Command personnel—the bulk of attached strength in areas included in this table—and amuch smaller group of other personnel, are determined by various methods. The average ATC strength on the North At-lantic Bases for June-September 1944 was 5,378. This figure added to the given assigned strength of 25,492 for May1944, gives an adjusted strength of 30,868. In Eastern and Central Canada, adjusted strengths for March-April 1944 andMay-June 1945 give an average total of 2,014, while the average of assigned strength given for July 1944-April 1945 was402. The difference of 1,612 represents the average attached strength. This figure is added to the actual assigned strength toestimate the adjusted total strength for May 1944-April 1945. In the Caribbean Defense Command, the average of adjustedstrength for March-April and June-August 1944 is 78,519, which is used for May 1944. Using the same formula andtime 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 TimeSeries in Strength of the Army, 1 November 1947. Figures for June 1944 through December 1945 from monthly issue ofStrength of the Army, corrected to include Air Transport Command personnel.


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. Ithas 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 whichbeds were available.


APPENDIX A-3—BED STRENGTH AND BED OCCUPANCY, NORTH AFRICAN COMMUNICATIONSZONE, 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 ISLANDSAUGUST 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 in-clude mobile or convalescent beds.


APPENDIX A-5—BED STRENGTH AND BED OCCUPANCY, ITALIAN COMMUNICATIONSZONE, 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, MEDITERRANEANTHEATER, NOVEMBER 1942-SEPTEMBER 1945


APPENDIX A-6—FIXED BED STRENGTH AND BED OCCUPANCY, MEDITERRANEANTHEATER, 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 in-dividual hospitals.

Appendix B

PRINCIPAL MEDICAL UNITS ACTIVE IN THE MEDITERRANEAN THEATER OFOPERATIONS, THE ATLANTIC DEFENSE AREAS, AFRICA, AND THE MIDDLE EAST

GENERAL HOSPITALS


GENERAL HOSPITALS—Continued

APPENDIX B 571

GENERAL HOSPITALS—Continued

STATION HOSPITALS


STATION HOSPITALS—Continued

APPENDIX B 573


APPENDIX B 575


APPENDIX B 577


APPENDIX B 579


APPENDIX B 581


APPENDIX B 583


APPENDIX B 585

FIELD HOSPITALS


FIELD HOSPITALS—Continued

SURGICAL HOSPITAL

APPENDIX B 587

EVACUATION HOSPITALS


EVACUATION HOSPITALS—Continued

APPENDIX B 589

EVACUATION HOSPITALS—Continued

CONVALESCENT HOSPITALS


MEDICAL REGIMENT

MEDICAL BATTALIONS

APPENDIX B 591

MEDICAL BATTALIONS—Continued

APPENDIX B 593



AUXILIARY SURGICAL GROUPS

MEDICAL GENERAL LABORATORY

MEDICAL SUPPLY UNITS

APPENDIX B 595

MEDICAL SUPPLY UNITS—Continued

APPENDIX B 597


Appendix C

OBSERVATIONS ON HOSPITALIZATION AND EVACUATION SYSTEM, FRENCHEXPEDITIONARY 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 assistsaid men in care of wounded on the field.

The next link in the chain is the regimental aid station (Poste de Se-cours). 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 ofsick and wounded are retained, the serious ones are evacuated via the col-lecting company to the division clearing station.

At the clearing station, patients are treated and sorted in much the sameway as in our Army. Beside the station is located the Formation ChirurgicaleMobile. This unit, with 20 beds, is organized to care for the non-transport-ables. Operating rooms are established in converted trucks. The transport-able cases are evacuated from the clearing station to the evacuation or fieldhospital. The latter two units perform the same functions and are usedinterchangeably.

Surgical Group. This type unit consists of personnel grouped into sur-gical teams. Its functions are the same as those of the U. S. auxiliary sur-gical group. The surgical group differs from the surgical formation in thatit has no bed capacity and no organic transportation.

Triage is effected between the clearing stations and evacuation and fieldhospitals under the supervision of the evacuation officer of the Corps d'Armee.This officer informs the clearing stations each morning as to the numberof vacant beds in each mobile hospital in rear of the division. Bed creditsare also established at each hospital for certain types of cases from eachdivision, such as head, chest, abdomen, orthopedic, and ordinary sick. Inthis way all cases needing the care of specialists are guided to the hospitalswhere such specialists are available.

Patients are evacuated directly from the mobile hospitals of the corpsto 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 thechain 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, assumesresponsibility for patients on their arrival in Africa.

French Evacuation Officers desire that patients being evacuated to Frenchbase hospitals by air, train, or sea be classified as follows:

Wounded.Fractures (total litter and total ambulatory)Eyes and FaceOthers

DiseaseTuberculosisMentalOthers

Prisoners of War

Total PatientsLitterAmbulatory

This system allows planning of transportation in advance and facilitatestriage of patients from airfields, railroad stations, and ports directed tohospitals caring for each type of case.

Hygiene Sections. These organizations are normal components of theArmy or independent Corps. They are primarily bath and disinfestationunits and each is organized as follows: 1 Officer, 24 EM (must be attachedfor rations and quarters), 3 vehicles and 2 trailers with showers. Each unitcan bathe 1000 men per day.

Reviving and Blood Transfusion Section. (Section de Transfusion etReanimation). This organization handles the French blood bank in Italyand controls the distribution of blood and plasma to hospitals. In turn itis supported by the Centre de Transfusion du Sang which is located inAlgiers. The training of all personnel in the treatment of shock and thetechnique of preparation and administration of blood and plasma is super-vised by the Centre de Transfusion du Sang.

Ambulance Service. Corps ambulance evacuation is provided by Com-pagnie Sanitaire #531. This organization consists of 4 sections of 20 ambu-lances each. Two sections have male drivers, the other two, female drivers.Ambulance units are a component of the "Train" (Transportation) . Thepersonnel are non-medical. Repair and maintenance of vehicles are pro-vided by auto repair companies (Compagnie de Reparation d'Autos) ofthe Corps or Army. From a functional standpoint, ambulance companiesare under the jurisdiction of the Medical Department.

Laboratory. A laboratory is equipped with American material fromT/E 8-610. The personnel consists of 14 officers and 35 EM. There are no


vehicles. The functions are the same as those of the U. S. Medical LaboratoryT/O 8-610.

Medical Supply. This unit is modeled after T/O 8-661 and functionsin the same manner.

Appendix D

THE GERMAN MEDICAL ESTABLISHMENT*

I. INTRODUCTION

The first limitations imposed on any account purporting to assess theGerman medical establishment are time and place. That is to say, observersno matter how qualified cannot judge the standards of German medicalpractice in 1939, for instance, in the light of what they found to exist inMay 1945, after the total enemy collapse; nor can they judge the qualityof practice elsewhere in Europe in the light of what they found in Italy.Immediately following the Allied victory in Italy, the Fifth Army Surgeondirected several qualified officers to tour the German medical installations,and survey as completely as they could the techniques and facilities utilizedby 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, ActingNeurosurgical Consultant, MTOUSA; Lt Col Paul Sanger, MG, Chief ofSurgical Service, 38th Evacuation Hospital; Lt Col Manuel E. Lichtenstein,MG, Chief of Surgical Service, 16th Evacuation Hospital; Lt Col DouglasDonald, 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 reportsto the Army Surgeon, most of the material in this chapter is derived.

This, then, was the German medical establishment as it existed in Italyjust after the German collapse. How it existed in, say, Russia in 1942,cannot be assumed from the material set down here. Nor can the varioussocial, or political, or economic factors which doubtless affected all Germanmedical practice, including the military, under National Socialism, be trulyor fully evaluated. For while many of the German medical officers inter-viewed volunteered opinions concerning the effect of political or racial dis-crimination on sound medical practice in Germany, and those opinions willbe set down here, it must be remembered that such opinions are hardlyobjective: after the German collapse all elements of the German army werebusy negating their part in the Nazi regime, forswearing their allegianceto the Nazi party, and condemning such fanatical groups as the loyal partymembers, the Gestapo and the SS formations of the Wehrmacht. In otherwords, 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.


Socialism" would indicate that a German doctor was not a Nazi, he wouldnot hesitate for a moment to say just that.

With these limitations in mind, it is safe to view the German medicalestablishment in Italy after the military defeat of May 1945, as seen throughthe eyes of qualified American observers.

2. HOSPITALIZATION AND EVACUATION

The chain of evacuation of German wounded was found to be verysimilar to that utilized by the US Army, but triage, that is sorting of pa-tients for specialized hospitalization, differed in several important aspects.First aid to the wounded was rendered in a Verwundetennest by a medicalnon-commissioned officer, in an extreme forward position. This treatmentcan be said to compare in echelon to that given by a US company aid manon the field of battle. Here the first dressing, improvised splinting fortransportation ease, traction splinting, pressure bandages and tourniquetswere applied. The wounded were evacuated from the Verwundetennest tothe Truppenverbandplatz, which corresponded to the American battalionaid station, and where the first medical officer, corresponding to the USbattalion surgeon, practiced. Treatment given at this station included: check-ing of the dressing (unless there was some indication the dressing was notto be disturbed) ; tracheotomy; application of occlusive dressings to openchest 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 injectionof tetanus antitoxin and gas gangrene antitoxin, administration of sulfa-pyridine by mouth, insufflation of sulfanilamide powder into wound attime of first dressing, pressure bandage, and arrest of hemorrhage by ap-plication of tourniquet (rarely by hemostat or ligature); and catheterization.

From the Truppenverbandplatz all the wounded were evacuated to theHauptverbandplatz, which was established about four miles to the rear ofthe combat line by the Sanitaets Kompanie of the division. This unit wasstaffed to perform the functions of both clearing and hospitalization. ItsTables of Organization provided for two operating surgeons, but in timesof stress six or eight more surgeons might be added. The unit was designedto hospitalize two hundred patients, but often expanded to three or fourhundred. When the flow of casualties was not heavy, all those patients withabdominal wounds and other non-transportable cases were given primarysurgery at this installation. In addition, primary surgery was performed onminor wound cases here as well. All cases with major compound fractures,brain wounds, and chest wounds were evacuated to the Feldlazarett or toa Kriegslazarett, where they were treated with more definitive care. In theGerman medical field manuals the functions of a Hauptverbandplatz arelisted as: tracheotomy; closure of open chest wounds; aspiration of the

APPENDIX D 603

pericardium in cardiac tamponade; emergency amputations; final arrest ofhemorrhage; administration of blood and blood substitutes; surgery on thenon-transportables; and suprapubic cystostomy.

The Feldlazarett was the next unit in the chain of evacuation. It wasan Army unit designed to care for two hundred patients. Ordinarily pa-tients with head wounds and transportable chest wounds, severe musclewounds, buttock wounds, and major compound fractures received primarysurgery in the Feldlazarett. While it was attempted to perform intra-abdom-inal surgery as far forward as possible, such cases were often evacuatedto the Feldlazarett for surgery whenever the Hauptverbandplatz was toobusy. The Feldlazarett was staffed with only two surgeons, but in periodsof pressure, it was often augmented by surgeons from other units.

The Kriegslazarett, or General Hospital, was usually assigned to theGerman Army Group. In Italy most of these installations were groupedat Merano and Cortina d'Ampezzo. It was their function to hospitalize allpatients who were not returned to duty from the more forward units. Inaddition, certain groups of the wounded received primary surgery at theKriegslazarett, such as penetrating head wounds complicated by involvementof the eye or ear, and maxillofacial wounds. In very busy periods, allpatients with major wounds might be evacuated to the Kriegslazarett forsurgery while the more forward units confined their surgery to men withwounds of such a nature that they would be able to return to their unitsand full duty within reasonable short periods of time after surgery. Also,as frequently occurred during heavy attack periods, abdominal and headwound cases were given no surgical care.

In addition to those units already mentioned, there were hospitals forthe lightly sick, lightly wounded, and convalescent patients. In each Germandivision was the Ersatz company which served as a replacement depot andreconditioning unit for lightly wounded who had received primary surgeryat the Hauptverbandplatz. The wounded sent to this Ersatz company weregiven light exercise under the direction of a doctor, and were ordinarilyreturned to duty after one week. There were usually between fifty and onehundred lightly wounded in the Ersatz company, in addition to the re-placements sent from Germany, who only stayed long enough to be equippedbefore being sent into combat. The officers and the doctor of the Ersatzcompany were limited service personnel by nature of previous wounds orillness.

In the army areas and in the general hospital centers, hospitals for thelightly sick and wounded were established by elements of transport units(Krankentransportabteilungen). They received their patients from Feld-lazaretten in the Army area and from Kriegslazaretten in the Army Grouparea or hospital centers. Most patients sent to these particular hospitalsstayed for two or three weeks. One such hospital was located at Bolzanonot far from the hospital center at Merano. At the time this hospital was


visited on 6 May 1945 there were 1600 patients. The commanding officerreported that 500 would be able to return to duty in two weeks, 600 inone month, 300 in two months, 100 in three months and the remaining100 in six months.

At the beginning of the war in Europe, all divisions had two SanitaetsKompanies. At the end only the armored and mountain divisions had twoeach, but the Corps Surgeon had under his control one Sanitaets Kompaniefor use where needed. When two Sanitaets Kompanies were available, twoHauptverbandplatzen were often established. In the beginning of an offen-sive, one Sanitaets Kompanie, horse-drawn, was placed only three or fourkilometers behind the battle line to receive casualties. The other Kompanie,motorized, was held in reserve to be used after substantial gains had beenmade. Then, if further gains were made and the Hauptverbandplatz wasrequired farther forward, the motorized Kompanie moved, leaving its pa-tients to be taken over by the animal-drawn Kompanie. The patients of theanimal-drawn Kompanie were left to be taken over by a Feldlazarett. Thusthere were often two divisional units performing surgery ahead of the Army'smost forward Feldlazarett. With a large-scale offensive division, army, andarmy group hospitals might all perform primary surgery only on the lessseriously wounded, putting aside the intra-abdominal and intra-cranialwounds in favor of those who were more likely to live and return to fullduty.

There were no Auxiliary Surgical Groups, but the German Army Sur-geon learned to use personnel from reserve or less active units to augmentthe staffs of heavily-pressed units. Most American observers felt that theGerman system of hospitalization and evacuation was certainly extremelyflexible, but its very flexibility tended to favor the lightly wounded at theexpense, 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 incom-prehensible facet of the German surgical service. He subtitled his reportto the Army Surgeon "The Story of a Finger", to illustrate the status ofasepsis, antisepsis, wound contamination, and cross infection. In one hos-pital visited, the German surgeon made "rounds" looking at patients,examining clinical records and viewing X-ray films. Extremities with soiledbandages were examined and bandages were handled without gloves. Thesurgeon made readjustments of mechanical supports and traction apparatus.Some wounds were exposed in the wards and examined. At one bed inquirywas made concerning the hydration and nutrition of the patient. The condi-tion of the tongue was noted and its wetness was determined by the un-washed 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 moistureon the finger indicated that the patient was not too dry. During the courseof "rounds" the chief of the hospital entered the ward, and was first greetedin military fashion by the surgeon, and then by a handshake. Several caseswere selected for further examination in the septic dressing room. Thisdressing room had three tables, each occupied by a patient with largewounds from which all dressings were removed. In this room no one worea mask over the nose and mouth. Conversations were conducted over eachwound and traffic through the doors, closing and opening, was active. Astaircase just off the dressing room was being dry-swept and clouds of dustfilled 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 extremityfrom which the pus-soaked bandages were recently removed. After dressingthe wound, the surgeon placed the used instruments on a tabletop, andproceeded to the next case without washing his hands. The American ob-server left the dressing room without shaking hands with the German sur-geon. In later discussing the matter of infected wounds with a Germanmedical officer, the observer learned that the Germans assumed automaticallythat 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 officerclaimed that most perforating wounds did exceedingly well except thatoccasionally an aneurysm developed which required treatment. All woundsdue to penetrating missiles, shell or bomb fragments, became infected andhealed by granulation following infection.

When the US observer discussed the problem of infected wounds withanother German medical officer, it was brought out that primary surgerydone immediately was most essential. Lacking this, wounds became infectedand the following reasons were given for lack of immediate care:

(1) Inadequate medical personnel were available to the German med-ical service. Many medical men were driven out of Germany during aseven-year period from 1933 to 1939, for reasons unrelated to their medicalpractice. Medical schools were depleted of teaching personnel and the num-ber of graduating physicians gradually diminished. Early in the RussianCampaign, many medical men, acting as company officers, took up positionswith the infantry in the front lines. The gradually increasing number ofpatients requiring surgical care increased the number of patients for eachmedical officer. As a result, this disproportion was equivalent to a decreasein medical personnel.

(2) Large numbers of battle casualties admitted to field hospitalsin short periods of time made adequate surgery impossible. One Germansurgeon interviewed pointed out that when acting as a surgeon in the cityof Naples in September 1943, it was not unusual for him to care for fresh


wounds by complete excision and primary suture. The infection rate wasapproximately 4% in these fresh cases and approached favorably the infec-tion rate to which he was accustomed in civilian practice. However, he said,operative procedures which would require an hour had to be done in lessthan one minute when he was active on the Russian front. In one three-dayperiod in Russia 1000 battle casualties were admitted to a field hospitalwhose medical personnel consisted of two doctors, no nurses, and consider-able number of enlisted men. To devote more than a few minutes to eachcase was, he attested, impossible. Aside from an incision for decompressionof tissues and application of a dressing, bandages and splint, nothing elsecould be done. He was aware that these steps would not prevent infectionin a wound. Perforating wounds were rarely bothered with; dressings wereapplied and patients frequently returned to duty.

(3) Speaking again of the Russian Campaigns, in comparison to theclosing phases of the Italian Campaign, this German medical officer statedthat during the advance on Stalingrad the German Armies progressed atthe rate of forty to sixty kilometers a day. Patients could not be kept inany hospital for any length of time. Frequently patients had to be evac-uated to the rear without any sort of initial treatment and days were re-quired before the patient arrived at an installation where surgery couldbe accomplished. During the winter months long trips in the icy cold ofRussia made travel hazardous and for many patients, fatal. Not only werepatients frozen to death because of inadequate covering but also manyarrived in such poor condition that many hours or days were required toresuscitate them so that they could tolerate even a small degree of surgery.On the Italian front travel by day for wounded patients was extremelyhazardous because of the narrow roads over mountain passes, and the con-stant presence of Allied airplanes over German lines of communications.Transportation of the wounded to the rear could be accomplished onlyat night, and the long trips in the mountains were time-consuming andexhausting to the patients.

(4) Lack of adequate supplies and equipment was also given by thisGerman medical officer as a reason for the deterioration of the Wehrmacht'smedical service. Many patients died from exsanguination because neitherblood nor a blood substitute was available at the field hospitals. Many pa-tients with small wounds developed infection because of the precariouscondition in which they arrived at the base hospital after a long journey,without proper dressings or immobilization of the wounds. There were noblood banks to furnish blood for the restoration of blood volume. Withthe decreasing number of medical personnel and the increasing hungerof the Wehrmacht for more manpower the obtaining of blood for trans-fusions became more and more difficult. Plasma was unobtainable. Penicillinwas unknown. Sulfonamides were used but were felt by the Germans tobe most useful only in acute infections, and to have no particular value

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in the treatment of patients from whose wounds flowed large amounts ofpurulent material. No new discoveries in chemotherapy had been made,and while patients received large amounts of drugs, ineffectiveness hadbeen noted in patients who had had inadequate wound surgery.

(5) Finally, this medical officer felt that one of the greatest reasonsfor lack of immediate care was the general deterioration in German medicalofficers. 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, leadingdoctors to feel that all wounds were automatically infected; the inadequatenumber of personnel; the lack of care possible because of constant evacua-tion; the lack of liaison, there being no uniform treatment plan throughoutthe German medical service; the entrance into the service of young, poorly-trained surgeons, "graduate wonders" who knew little or nothing of theprinciples of surgery; the class distinction favoring the Luftwaffe, SS andhigh-ranking officers; and the placement of medical officers in high positionsby political rather than professional standards. All of these points weighedheavily on the mind of the conscientious surgeon and succeeded in wearingdown professional morale.

This had been a discussion of wound infections, which, according tothe German consultant, were just as frequent in this war in the Germanarmy as in World War I. As such, it has reported generally most of thenegative aspects of German surgery and surgical practice. There are, how-ever, many positive aspects, which somewhat redeem the German practicesin the eyes of an American observer. Therefore, a brief description ofcertain German techniques, such as treatment for shock and hemorrhage,extremity wounds, head wounds, intrathoracic wounds, and abdominalwounds, 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. Peristonehad not been available in all German installations. The medical units inthe 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 suchthat it was retained in the vascular system from twelve to fourteen hours. Itwas furnished in 500 cc units. Usually one and never more than two unitswere used in the treatment of one patient. All blood transfusions wereaccomplished by the direct method. Blood was transfused in amounts of200 cc, 300 cc, 500 cc, 800 cc, and never more than 1000 cc. Hence themost a patient in shock might receive would be 1000 cc of peristone and1000 cc of blood. The general German belief seemed to be that if thepulse volume did not approach normal, after such treatment no surgerywas to be performed. Some German surgeons interviewed were opposedto using more than 200 to 300 cc of blood at one time. The extreme


pallor of many and moderate pallor of most of the wounded seen in Germanhospitals were further evidence that little blood was administered.

This type management of shock and hemorrhage was in sharp contrastto American methods whereby plasma is made available and used in quan-tities sufficient for the needs in all forward medical units of a division;and whereby banked blood is available in adequate quantities in all armyhospitals including field hospitals adjacent to division clearing stations.

The bulk of extremity wounds suffered in the Wehrmacht were givenprimary surgical treatment in the Hauptverbandplatz or the Feldlazarett.In rush periods this surgery consisted of no more than incision of skinand fascial planes, the removal of gross debris and devitalized tissue, andusually trimming of devitalized edges of the skin wound. The careful woundexcision practiced by Allied surgeons was done in German hospitals onlyin rare instances. One German surgeon reported that he had performedonly four or five such operations in as many years of war surgery. In thesehe had done a primary wound closure. It was evident in many of thepatients seen that practically no wound excision had been accomplished,since much devitalized tissue was left behind, and frequently wounds wereprimarily drained after no more than a fasciotomy. Perforating woundsfrom small arms missiles or small high explosive shell fragments had nosurgery performed. This applied to wounds of joints and wounds involvingbone unless there was a large wound of exit. Splinting of extremities aftersurgery varied. In several hospitals visited, surgeons stated that temporarywooden or wire ladder splints were applied for three to five days, followingwhich treatment the limbs were put in plaster if infection did not develop.Most of the other hospitals reported that plaster was applied immediatelyafter surgery. In either instance, the plaster was always padded and windowswere cut over the wounds to permit inspection and dressing.

Compound fractures of the femur were put up in skeletal traction inboth field and general hospitals. Kirchner wires were used in applyingskeletal traction. When infection developed, the limb was incorporated inplaster, but some traction was usually continued. An ingenious apparatusmade of perforated metal pipes served as a substitute for the ordinaryBalkan frame. It was capable of many combinations to secure, easily andsimply, pulley wheels in the desired position for any sort of traction. Insome instances a complete Balkan frame was fashioned. In most cases, how-ever, one pipe, which clamped to the metal hospital bed, sufficed to supportsufficient side arms to provide the necessary number of pulley wheels inthe proper positions. Walking, unpadded plaster spicas, after the methodof Boehler, were used in the management of some of the simple fracturesof the femur, and in some compound fractures after the soft tissue woundshad healed. They were not used early in the management of fresh com-pound fractures from bullet or shell fragment wounds as Truetta usedthem in the Spanish Civil War. In badly damaged heels, one surgeon was

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practising excision of the talus, calcaneus, and one half of the scaphoidand cuboid, then placing the foot in a drop position and anchoring itthere with a Steinman pin. He said that one-quarter to one-third of thecases so treated got functional results, but the remainder required amputa-tion. Those getting a "functional result" were fitted with a below theknee prosthesis.

Two surgeons were found who had been using the Kuntscher nail inthe treatment of certain fractures of the long bones. It was reported bytwo surgical consultants that for a time many surgeons attempted the useof this intramedullary nail with poor results, including osteomyelitis anddeath from shock. Following this experimentation, a few surgeons were des-ignated who might use the method when they thought it indicated. Theoriginal work in Germany on this intramedullary nail was done by Kuntscherat the University at Kiel beginning in 1937. It was first tried on animals.Examination of the bones histologically at various periods after nailing ledto the conclusion that approximately one-third of the marrow is destroyedand that small fat emboli are nearly always dislodged. One surgeon whoparticipated in the original study at Kiel stated that he had records of550 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 didit lead to a fatality. This surgeon felt that its usefulness was chiefly inclosed fractures of the middle third of the femur, in which the fractureline was transverse or nearly so. Such patients could walk without anysplinting eight to fourteen days after the operation. This surgeon did notfeel it an advisable procedure in tibial fractures and rarely used it infractures of the humerus, radius, or ulna. It could be used in compoundtransverse fractures of the femoral shaft after the wound had healed orwhen infection was absent. One surgeon had used it in a few infectedcompound fractures of the humerus and femur when the desirability offixation seemed to outweigh the danger of using it in the presence of infec-tion.

In the field of head surgery, only a few intracranial wounds were foundin the hospitals visited. One hospital at Merano and one at Gardone Rivieraheld the largest concentrations of head wounds. Of a sample of forty headcases, at least thirty needed further neurosurgery. There were also ap-proximately twelve with wounds of the spinal cord, a similar proportionof which needed further surgery. Neurosurgical techniques in practice a-mong the German hospitals visited were generally barely adequate, andoften under the standards set in Allied armies.

Nearly all of the patients seen in German hospitals with intrathoracicwounds had empyema. Of course, most of those seen had incurred theirwounds months or even as long as two years before. Opinion expressed byGerman surgeons concerning the management of chest wounds varied insome particulars, but regarding major policies were in unanimity. No


facilities were available for gas anesthesia or for positive pressure deliveredby anesthetic machine. A good oxygen therapy machine was available, butaccording to statements of the Germans, it was seldom if ever used for ex-panding the lungs during the course of intrathoracic surgery. No endotra-cheal tubes were seen nor was the use of endotracheal anesthesia mentionedin a hospital. Local, evipan, or ether by open drop was the anesthetic em-ployed in what chest surgery was accomplished. Opinions concerning theindications for and time of aspiration of hemothoraces varied considerably.Some surgeons stated that aspiration was never performed except to relievedyspnea arising from a large hemothorax or hemopneumothorax. Othersstated that it was performed during the first five days after wounding.One consulting surgeon stated that early in the war aspiration was performedafter five days unless dyspnea made it mandatory earlier, but that morerecently aspiration was performed after the patient reacted from shock,which was usually two days after wounding. It was obvious that the policyof early, repeated aspiration of hemothorax was not practiced as in theAllied armies.

The incidence of empyema was reported at one hospital as 60% in shellfragment wounds of the chest and 30% in bullet wounds of the chest. Inanother hospital, an incidence of 50% in all intrathoracic wounds was re-ported. The treatment of empyema seemed uniform in all the hospitals.Closed intercostal drainage was instituted as soon as the presence of pus orinfection in the pleura was demonstrated. The catheter was attached to awater seal bottle which in most instances was in turn connected with a pair ofbottles providing suction after the Wangenstein method. This procedurewas continued until the cavity was obliterated or until after six monthsthe empyema was adjudged chronic and a thoracoplasty and decorticationwere 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 con-sisted of laparotomy and simple closure of the chest wall wound. No caseswere seen in which transdiaphragmatic surgery had been accomplished atthoracotomy. Lacking the facilities for positive pressure ether-oxygen anes-thesia and well-trained anesthetists, it seemed obvious that modern intra-thoracic and transdiaphragmatic surgery were not available to the Germanwounded.

Only a few patients with abdominal wounds were found in the Germanhospitals which were captured or which fell into Allied hands with thecollapse of the Wehrmacht. This was not surprising, if the tactical situationof the preceding month was viewed in relation to the German policy con-cerning the care of the seriously wounded which was outlined in the hos-pitalization and evacuation section of this chapter. With the confusion andheavy casualty load of their crushing defeat in the German stand againstthe Allies' last push, it was probable that few with abdominal wounds

APPENDIX D 611

were fortunate enough to receive any surgical attention. In one hospitaltwo patients were found who had had abdominal surgery. One of thesehad had a negative exploratory laparotomy and had developed a hugeincisional hernia. The other had a wound of the small intestine and wasmaking a satisfactory recovery.

In interviews with German surgeons and in studying their Army manualon surgery, it became apparent that the Germans had been impressed withthe advantage of early surgery in forward installations for those casualtieswith intra-abdominal wounds. General principles in this surgery were foundto be quite similar to those in practice among the US Forces. Woundsof the stomach and small intestine were repaired and usually a proximalcecostomy done. Large or severe wounds of the colon were exteriorized.Wounds of the liver were drained. Those who did not respond to shocktherapy were not given the benefit of emergency surgery unless it wasfelt that there was a continuing severe hemorrhage. Lacking whole bloodin adequate amounts and using only direct transfusions in amounts nevertotaling more than 1000 cc, it is probable that the Germans would nothave bettered their mortality rate by attempting surgery on the abdominallywounded. What the Fifth Army accomplished in this type surgery wasdependent not only on the skill of the surgeons, but as well upon theskill and superior equipment of anesthetists, the judicious use of availablebanked blood, oxygen and all the other facilities provided to insure thebest possible care of every wounded man.

This was the surgical service of the German army as it existed at theconclusion of hostilities in Italy. Its negative aspects, viewed objectivelyand dispassionately, seemed certainly to outweigh its positive. One of theAmerican observers seemed to express the unanimous opinion of all whenhe stated: "My reaction to this visit is not one of condemnation for thetype of surgery and surgical care that the German soldier receives frommedical officers in German installations. Rather it is one of high praisefor the excellence of the American medical service. . . . To see and discussthe German wounded offers the contrast by which to bring into betterview 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 combateffectiveness of any command, Allied or German, than the surgical or med-ical services. To the German Army, surgically understaffed and under-equipped, and seemingly with a lower moral conception of the medicalmission than our own, a seriously wounded man who could not fight again,even if his life were saved, was not worth bothering with, or expendingprecious time and supplies upon. But if, by means of preventive medicine,even one man could be spared an infectious disease which would incapacitate


him for only three days, then preventive medicine was the field upon whichthe harshly realistic Wehrmacht would concentrate its efforts. This helpsto explain why preventive medicine was under rigid military control in theGerman Army, and at the same time why German standards of preventivemedicine, considering the equipment available for their enforcement, com-pared more favorably with preventive medicine as instituted in the UnitedStates Army than did German surgical standards with our own.

Mess sanitation in the Wehrmacht was limited by the type of messserved. Food was prepared in mobile ranges, and generally consisted ofa stew, bread, tea or coffee. No attempt was made to screen field kitchens,but if troops were situated in buildings and screening was available, thekitchen was screened. However, one directive published by German head-quarters in 1945 prohibited the use of screening except for buildings inmalarious areas. There was no system of mess kit washing similar to thatpracticed in the US Army. Usually the German soldier washed his messkit in a stream, or at a well or cold water tap. Sometimes hot water wassupplied from the field ranges, or occasionally it was heated in a bucketor can over a wood fire, but such procedures were the exception. Provisionsfor hot water depended on the interest in sanitation evidenced by the com-pany commander, which ordinarily was slight. No soap was issued for messgear washing, and the allowance of soap for bathing and washing clothingwas so small that very few soldiers ever used part of their soap ration forwashing mess kits. Instead sand or gravel was used to remove the grease fromthe 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 fieldbakeries to unit messes. Fruits and vegetables to be eaten uncooked werewashed first in raw water and then in boiled water. In areas where amoebicdysentery was prevalent, directives were issued ordering fruits and vegetablesto be soaked in a 1-5000 solution of potassium permanganate; in practice,however, this procedure was reported to be seldom followed. Chlorine wash-ing 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 thecampaign, many units kept hogs to which they fed food scraps. Some garbagewas burned. Directives were issued requiring soakage pits for waste water,but in actuality these pits were seldom constructed. Since there were nomess kit washing facilities, German kitchens had less waste water thannormally found in US kitchens. German food handlers were inspected weeklyand stool examinations were conducted four times a year. Consumptionof raw milk or cheese made from raw milk was forbidden.

In rear areas, the Germans used box-type latrines similar to US boxlatrines. A squat-type latrine with lid was also used frequently. In forwardareas, straddle trenches were dug, or each man was required to cover hisown excrement by digging a small hole with a spade, similar to US "cat-

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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 ratherthan water; he had no "GI" drinking water whatsoever. The supply of teaand coffee depended on the tactical situation. If kitchens were far enoughforward, the supply was sufficient, but otherwise the soldier was forcedto resort to local water sources to allay his thirst. The supply of tea andcoffee even in bivouac areas was never unlimited: there the soldier receiveda rationed quantity of one or two liters and no more. Nothing existed inthe German Army similar to the US water sterilizing bag, to which anAmerican soldier in rear areas can go at all times for additional fluids.Water sterilizing tablets, comparable to our Halazone, and thiosulphatetablets, such as the British use, were used only to a limited extent in theGerman Army and were never popularized. In rear areas, troops ordinarilyused the town water supply, which was tested by the corps or army hygieneofficer. If four samples taken the same day at different points in the townwere reported as bacteriologically potable, the water was approved for drink-ing. In the field water was transported to kitchens in cans similar to theUS five-gallon water can. Sanitary companies and motorized field hospitalshad water trailers.

A few water purification units operated in the German Army, but noattempt was made to furnish all troops with water from these units. Basically,these units consisted of three tanks mounted on, a large lorry. Water waspumped from one tank to another through all three, each of which containedlime and iron chloride. From the third tank the water passed through aSeitz type filter which rendered it bacteriologically potable. The outputof this unit was normally 5000 liters a day, but it could be increased to8000-12000 liters for short periods. (The US portable unit delivers about3600 liters an hour and the US mobile unit 21,160 liters an hour). TheseGerman units were operated by the Medical Department. The chief objec-tion to such units was that the Seitz filter discs soon became clogged andhad to be replaced. The water from these units was not chlorinated, theGermans using chlorine only where necessary to treat city supplies. Anothertype of water filter used by the Germans was a portable apparatus carriedon the back and capable of producing 200 liters a day. One such filterwas issued for each battalion, or one for each separate company if thecompany had a medical officer attached. The apparatus was issued to andoperated by the Medical Department. These filters were never popularand were seldom used except to clear up turbid water. The filter discs hadto be replaced frequently and were always difficult to obtain.

German malaria control in Italy was centralized in an antimalaria staffat Army Group Headquarters. This staff consisted of a major in chargeassisted by two entomologists and one clerk. Operating directly under this


staff were two or three malaria stations (comparable to US Malaria SurveyUnits) , each consisting of one entomologist and two drivers, one clerkand one technician. These stations operated in malarious areas, effectingsurveys and advising on malaria control procedures. Each German divisionhad a sanitary officer in charge of malaria control, who was assisted by sixor eight enlisted men. If more labor was needed, civilians or prisoners wereused, and if necessary, help was given by engineer troops. In general, malariacontrol measures were carried out by troop units themselves, and no malariacontrol units as such were available. Division malaria control officers renderedmonthly reports to the Army Group malaria staff.

Paris green or calcium arsenite was used for larviciding since oil wasseldom available for such uses. A very limited amount of DDT was availableto the Germans, however, due to the scarcity of screening, as has beenpointed out, its use was restricted to buildings used as quarters in malariousareas. Mosquito bed nets were used, and in heavily malarious areas, guardsused head nets and gloves. Short trousers and rolled shirt sleeves wereforbidden in malarious areas.

The 1945 German malaria directive called for atabrine prophylaxis tobegin 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 (USdosage has been .10 grams daily) . If the malaria rate became unduly highin any unit, the surgeon was to consult with the anti-malaria staff on theadvisability of giving all troops a therapeutic course of atabrine and thenresuming the prophylactic dosage. The therapeutic dosage of atabrine was.10 grams three times a day for seven days, followed by .01 grams ofplasmochin three times a day for three days. In severe cases in the Germanarmy, an intramuscular dose of .3 grams of plasmochin might be adminis-tered, 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 treatmentconsisted of one tablet of a combination of quinine or plasmochin giventhree times a day for twenty-one days. The use of thick smears was urgedin making the diagnosis of malaria, and smears were to be forwarded withtransferred patients. All malaria patients were required to be treated asnear the front as possible, and evacuation to Germany was forbidden exceptin the presence of severe complications. A hospital specializing in tropicaldisease was located at Cortina d'Ampezzo, and malarial cases presentingspecial 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, butthe ingredients of the other powders are not known. Another powder, "Rus-sle", is said to have contained horse "sweat" extracted from horse blankets,but later this substance was synthesized. It had been noted that horse blanketsnever 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 powderwas never popular—it had a bad odor and caused skin eruptions in thetroops. The other three powders mentioned above were moderately effective.For the most part, the Germans depended on hot air sterilization of clothingand blankets to kill lice. Every month, battalions were required to havethe clothing and blankets of their personnel disinfested, and troops returningfrom the front were bathed and disinfested routinely. A small amount ofDDT powder (called by the Germans "Gix") was available for dustingmen found to be infested with lice. Steam disinfestation of clothing wasnot practical because it damaged the cellulose fibers of German ersatz fab-rics. Methyl bromide was not used, but formalin in glass ampules wasavailable for disinfesting blankets. Impregnation of clothing with a liquidpreparation of Delicia was effective for from ten to twenty days.

A few bath units were available for front line troops, set up in connectionwith hot air sterilization units, but for the most part German soldiers hadto seek out their own bathing facilities. Since they usually occupied buildings,this was not a great problem, except for the important fact that soap wasalways short.

Two types of typhus vaccine were used, the Cox type similar to USvaccine, and the Weigl type prepared from lice. A Roumanian type vaccineprepared from mouse lungs was tried out, but was found to be not veryeffective. Only sufficient vaccine was available for vaccination of medicalpersonnel and key personnel over forty years of age.

The German Army in Italy had considerable trench foot in the Apen-nines during the winter of 1944-45 (when US rates were remarkably low),and this was attributed by German medical officers to the wet, cold, butnot freezing weather, and to the failure of troops to guard against trenchfoot. Many of the soldiers had come from the Russian front where it wasgenerally far colder, and they did not expect trench foot in the comparativelymild climate of Italy. Prevention of trench foot in the German militarydepended on the individual's taking proper care of his feet, and havinga supply of warm and dry socks and shoes. Medical officers were responsiblefor seeing that the troops were properly instructed and that the instructionswere carried out. This was of course entirely contrary to US practice wherethe command elements are responsible that anti-trench foot precautionsare properly carried out. German medical officers were also responsible forchecking shoes and socks of troops. Leather shoes were worn in tempera-tures above freezing, and in Russia felt boots were worn in lower tempera-tures. A sock exchange system operated in some units, where civilian womenwere hired to launder the socks. Paper and straw were often used for extrawarmth in boots. A salicin ointment was used as an anti-frost bite cream.

The German army emphasized abstinence as its strongest venereal dis-ease control measure, but at the same time it operated controlled brothels.The prostitutes in these brothels were examined daily by a German doctor


or by an Italian physician. Smears were taken and serological tests weremade weekly. Civilians were not admitted to army brothels. Upon enteringa brothel the soldier was given a form in duplicate on which was recordedhis name and unit, the date, the designation of the brothel and the nameof the prostitute. He was examined for the presence of pests or venerealdisease and was given a condom. Both the prostitute and the soldier weresubject to punishment if the condom was not used. A prophylactic treatmentwas administered before the soldier left the brothel. Prophylaxis consistedof a wash with soap and water and bichloride of mercury, followed byan intraurethral injection of 2% protargol and the application of calomelointment. Sulfa drugs were not used since in Russia sulfa drug prophylaxishad resulted in strains of gonococci resistant to treatment with sulfa drugs.Chemical prophylactic kits containing calomel ointment were available tothe German soldier but were not much used.

The simple facts of the matter are that in the German Army, controlledprostitution was not successful in the prevention of venereal diseases. Thatit was not successful was probably due in main to the fact that the averageGerman soldier did not choose to frequent an Army-operated house ofprostitution, for two inter-related reasons: he objected morally to havingsexual intercourse with a woman whom he knew just previous to him hadentertained other soldiers; and, following traditional male instincts, he pre-ferred the chase and the conquest of a clandestine to the easy procurementof an admitted prostitute, even though he probably knew that the clandestinewas quite as sexually experienced as the woman in the Army-controlledhouse. That this was the case is not evident from German statistics concern-ing venereal disease, but all German medical officers interviewed readilyadmitted the inaccuracy of their statistical procedures and records. It isevident, however, from the following portion of a letter to all troops fromField Marshal Albert Kesselring, Commander in Chief Army Group "C,"dated 11 January 1945, wherein it can readily be seen that the majorityof German soldiers did not patronize Army-operated brothels:

The attitude towards illegitimate sexual intercourse is a matter of personalethics 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 Commandis compelled to adopt special measures.

It has been proven that the ordered treatment and the prescribed prophylaxisare protections against the disease. 69% of the injected soldiers, admitted to thehospitals of the Army Group during November did not undergo the ordered pre-ventive treatment.

This fact proves that during the past year the troops did not exercise the properattention towards these diseases which endanger the health, the total defensepotential 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 suspensionis enforced against the infected soldier.

If the soldier conceals the disease and takes own treatments, he is chargedwith self-mutilation.1

The German army had always seemed unwilling to admit that psy-choneurosis existed in the members of the master race. Their statistics,even though of unreliable accuracy, have never even allotted space to neu-ropsychiatric disorders of any nature. For this reason, it was extremelydifficult, even after the German collapse of May 1945, to obtain an adequatepicture of either the prevention or treatment of psychoneurosis in the Ger-man army, or to assess what little material was gathered. During the winterof 1944-45, a captured manual for the use of German medical officers inthe field fell into US hands. The sections on "pure" psychiatry were briefand gave little insight into the extent of the problem of combat reactions.The section of gastric complaints, however, was quite explicit in its discus-sion of the psychogenic aspects. A single careful examination, includinghospitalization if necessary, was advocated, but once a man had been re-turned to duty, further examinations were forbidden and disciplinarymeasures (including deprivation of tobacco and alcohol) were prescribed ifcomplaints continued.

After the German surrender on 2 May, an opportunity arose to questiona captured medical officer with psychiatric training. Although he had notbeen primarily a psychiatrist in the German army, he had had two yearstraining in the specialty at Frankfurt as a civilian, and consequently hewas interested in psychiatric problems. This officer declared outright thatGerman neuropsychiatric statistics were completely inaccurate, and he con-fessed that he could not give a valid estimate of the actual incidence withinthe army. He quoted a report of the previous year which had claimedonly 4000 cases in the entire German army during a certain period. Sincea single Bavarian division had had half that many during a similar periodof World War I, he pointed out that present figures were absurd. Apparentlythere were no written directives which limited the making of psychiatricdiagnoses, but there was a definite tendency to mislabel them. Obviously,cases did occur, and this captured medical officer attested that at one timeGerman Army Group "C" had a small hospital located near Verona, whichwas devoted entirely to the treatment of hysterical reactions. Typically,however, this German officer stated that Wehrmacht troops were so welltrained that casualties of a psychiatric type did not increase greatly withheavy combat action.

In discussing German handling of neuropsychiatric cases, the Germanofficer said there was some variation in different commands. Chemical hyp-nosis, induced by pentothal sodium in US psychiatric procedures, was not

1 Translated by G-2, Headquarters Fifth Army.


utilized in the German establishment. Shock treatments were employedonly to render patients fit for transportation. Psychotics were removed fromthe Army as soon as possible to reduce the chances of the Army's beingheld responsible for complications in the course of treatment.

An inspection during June of medical treatment standards in practiceamong German medical officers at Merano, showed an adequacy of knowl-edge, methods, and diagnostic procedures, although deficient by Americanstandards. Of the approximately 12,000 patients hospitalized at Merano atthe time, about 20% were medical patients, mostly of the same types observedin US general hospitals—patients severely ill or with protracted illness.The Chiefs of Medical Service and the consultants were apparently menof attainment, and the ward officers showed evidence of fairly good training.Records were in excellent condition. Laboratory facilities including X-rayand electrocardiography were available and were used intelligently. Drugsand other therapeutic agents seemed sufficient, although penicillin and sul-fadiazine 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 carbohy-drate-low fat diets were instituted, but protein was not emphasized as inUS hepatitis treatment. Such tests as the liver function, cephalin flocculationand bromosulfalein tests were not used. The Germans considered serumVilirubin and Takata Ava tests best regarding liver functions. In severeearly 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 Germanarmy. There were 180 cases in the hospitals visited, and a consulting Ger-man "nephritis specialist" stated that he had observed over three thousandcases on the Russian front. This incidence in the German Army was hardto explain, since there has been so little nephritis observed among Alliedsoldiers. The exact pathology or etiology was undetermined, but it seemedprobable that this incidence represented a true glomerular nephritis. Treat-ment 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 whomwere returned to duty before at least six months.

Several cases of bacillary dysentery were observed, but since no sul-fadiazine was available, they were treated with a preparation called CibisonElcudron, actually a sulfathiazol derivative. Results were good in mostcases. Three cases of amoebic liver abscess were seen, being treated bya dosage of .065 grams Emetine daily for from ten to twelve days. Nooperations were performed, although in one case, the abscess was drainedwith a needle. These patients were improving satisfactorily.

No cases of atypical pneumonia were encountered. The Germans hadonly recently become familiar with this disease, and first learned of itfrom 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, andthe Germans had seen no explosive outbreaks comparable to those experi-enced in Fifth Army early in 1945. Four cases of post-diphtheritic polyneuritiswere seen, and the German medical officers stated that about 4% of their diph-theria cases developed polyneuritis. This high rate was felt to be dueto two factors: first, it was usually three or four days after the onset ofthe disease before the patient was hospitalized; and second, standard treat-ment consisted only of 25,000 units of antitoxin, and many cases receivedonly 15,000 units. Several duodenal ulcers were also encountered, diagnosishaving been established by X-ray. Treatment consisted of bed rest anda diet similar to the American Sippy diet. Alkalies were not given. Hos-pitalization for duodenal ulcer lasted approximately thirty days, at theend of which time patients were discharged to one of the "Magenbattalions",or "Stomach" battalions, a field organization absolutely unique in the Ger-man 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 self-sufficient, as it had to be, with the Brenner rail route to Germany underconstant Allied air attack. On 4 May, two days after the German surrender,Fifth Army assumed control of the Base Medical Depot at Merano, alongwith a large factory equipped to manufacture many items such as cotton,bandages, drugs and narcotics. Included in the factory was a well-equippedlaboratory capable of performing biochemical and physio-chemical proce-dures. The equipment was extremely modern in design, and apparentlyexpensive and valuable. This factory employed approximately nine hundredGerman military workers. A few civilian men and women were employedby the Germans, but for the most part this factory was run by GermanWACs and enlisted technicians.

The Merano medical depot, as apart from the factory, contained ap-proximately 2000 tons of medical supplies when it was captured; withconsolidation of other north Italy depots into this one, the stock levelswere built up to 9000 tons within a few weeks. The depot did not employcivilians, and operated with a complement of three hundred enlisted menand forty WACs. This depot operated in similar fashion to a US basesection depot, with the exception that platoons organized from its basiccomplement 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 inferiorquality. A certain cheapness, typical in many ways of the entire Germanmedical 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 undercasts as a substitute for cotton batting. Many of the medications foundin 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 fieldmedical service. Surgical and dental instrument sets were far too elaborateto insure a rapid replacement. X-ray equipment, including dental X-raysets, was good, and especially designed chests were provided to aid in properhandling. Chests of a standard size and design were provided for mobilemedical supply platoons. These chests were an admirable item, hinged onopposite edges, top and bottom, so that the chest could be opened fromthe top or the front, and when set up one on top of the other, providedan efficient and orderly establishment.

Liquid medicines were dispensed from large demijohns, and requisition-ing units were required to furnish their own containers. When a sufficientsupply of demijohns was lacking, bottles of all shapes and sizes were used.The general appearance of the pharmacy at the Merano depot was notone of orderly and neat management.

Thus German medical supply and equipment seem to summarize actuallythe entire German medical establishment: a service of great potential abilityand technique, hampered by paucity of material and bogged down in themorass of politico-military interference over a long period of time.

Bibliographical Note

Medical Service in the Mediterraneanand Minor Theaters is based upon awide variety of sources, by far thelargest category being the manu-script records of medical units, offices,and commands. Probably the mostextensive and certainly the most impor-tant collection of these records is inthe custody of the Historical Unit,USAMEDS. Others are deposited withthe National Archives in Washingtonand in the Federal Records Center,Region 3, GSA, in Alexandria, Va.; stillothers are in the records centers at St.Louis and Kansas City, Mb. The AirForce records used are for the most partat the Air University, Maxwell Field,Ala.

After action and routine periodic re-ports—most of them annual but a fewsemiannual, quarterly, and even month-ly—make up both the most extensive andthe most useful body of records. Thesereports came from all levels of the Med-ical Department, from the theater sur-geon's office and its various subdivisionsthrough the surgeons of armies and airforces, corps, divisions, communicationszones, base commands, and base sections.They came from hospitals of all types,medical battalions and often separatecompanies, medical supply depots, aux-iliary surgical groups, and intermittentlyfrom all of the lesser units that madeup the combat medical organization ina theater of operations. In some of thelarger commands unit reports were sup-plemented or even replaced by historiesof Medical Department activities, on ayearly or longer basis.

Another major source of information,like the unit reports administrative andlogistical as well as clinical, is the Essen-tial Technical Medical Data reports(ETMD's), issued monthly from July1943 on by the theater medical section,by various subordinate commands, andby the individual hospitals. The ETMD'soften contained situation reports andanalyses of specific military operations.At the theater level a daily journal wasmaintained by the surgeon's office, high-lighting important administrative devel-opments. A series of circular lettersdealt with a wide variety of matters suchas the management of wounds; recom-mended therapy for specific diseasesincluding dysentery, malaria, and hep-atitis; the preferred use of drugs suchas morphine, the sulfonamides, andpenicillin; and many housekeepingchores on the order of record keepingand reporting. A similar but less ex-tensive series of circular letters emanatedfrom the medical section of Allied ForceHeadquarters. Medical situation reportswere issued by various commands, themost useful being those of the PeninsularBase Section during the Italian cam-paign. Use has also been made of privatediaries, and of correspondence both pri-vate and official—for example, the fre-quent exchanges between the theatersurgeon and The Surgeon General.

Other valuable documentary sourcesfor the history of the Medical Depart-ment in the Mediterranean include themedical annexes of operations reports atarmy, corps, and division levels; and ofvarious planning documents. Inspection


reports are voluminous and in a degreeof detail not usually found elsewhere.There are, in addition, special reportson all manner of topics from the inci-dence and treatment of particular dis-eases to discussions of improvised equip-ment; from supply and sanitation prob-lems to ways of laying out a tent hospital.Methods of evacuation under variousconditions, use of hospitals of differenttypes and sizes, personnel problems,civil affairs problems, and many othertopics swell the flood of investigations,reports, and studies. Interviews have alsobeen used, supplemented by writtencomments from those who reviewed allor portions of this volume in manuscriptform. Their names will be found in theacknowledgments at the end of the au-thor's preface.

Although technically a secondarysource, a multivolume manuscript his-tory of the Medical Department in theMediterranean Theater, preparedunder the direction of the historical sub-section of the theater surgeon's officeand brought to a close in November1945, is indispensable for its insights, forits use of many documents now unavail-able, and for the eyewitness quality itgains by the participation of its authorsin the events they narrate. Of particularvalue for the present work were: volume1, Administration, by Kenneth W. Mun-den; volume 3, Hospital Construction, byAbraham I. Zelen; volume 6, Army NurseCorps, by Anne F. Parsons and others;volume 7, Medical Supply, by WilliamL. Davidson; volume 8, Field Operations,by Glenn Clift; volume 10, Hospitaliza-tion and Evacuation (rough draft, by A.I. Zelen; and volume 14, Final Reportof the Plans and Operations Officer, byCol. Albert A. Biederman.

Another rewarding category of sourcematerial consists of numerous specialarticles on phases of military medicinein the Mediterranean and minor theatersin selected medical journals, most fre-quently in the Medical Bulletin of theNorth African [Mediterranean] Theaterof Operations, published by the theatersurgeon's office during 1944 and the firsthalf of 1945; the Bulletin of the U.S.Army Medical Department published bythe Office of The Surgeon General untilunification at the end of 1949; and Mili-tary Medicine (formerly The Mili-tary Surgeon], organ of the Associationof Military Surgeons. Administra-tive material, often of a firsthand char-acter, will also be found in severalvolumes of the clinical series publishedby the Office of The Surgeon General andcited in the footnotes to the present work.Most frequently used were the volumesdealing with activities of medical andsurgical consultants, the dental and vet-erinary histories, and the preventivemedicine subseries, of which five volumeshave so far appeared.

The broad military narrative thatforms the framework within which themedical story becomes meaningful has, onthe other hand, been told largely frompublished sources. The combat volumesof the series UNITED STATES ARMYIN WORLD WAR II have been fol-lowed insofar as they were available.George F. Howe, Northwest Africa:Seizing the Initiative in the West, ap-peared while the present work was inpreparation; and the volume on the Sic-ily Campaign, Lt. Col. Albert N. Gar-land and Howard McGam Smyth, Sicilyand the Surrender of Italy, was consultedin manuscript form. Similarly, in thepreparation of Chapter I, Stetson Conn

BIBLIOGRAPHICAL NOTE 623

and Byron Fairchild, The Framework ofHemisphere Defense., and Conn, RoseEngelman, and Fairchild, Guarding theUnited States and Its Outposts, wereused, the former in galley proof, the latterin manuscript. Chapter II relies at manypoints upon T. Vail Motter, The PersianCorridor and Aid to Russia.

A number of titles in the AMERICANFORCES IN ACTION series were alsovaluable in summarizing the combatoperations so essential to an understand-ing of the supporting medical activities.Those used were: To Bizerte With the IICorps; Salerno: American Operationsfrom the Beaches to the Volturno; Vol-turno: From the Volturno to the WinterLine; Fifth Army at the Winter Line;and Anzio Beachhead.

Appropriate volumes of Wesley FrankCraven and James Lea Cate, editors,"The Army Air Force in World War II,"

and of Samuel Eliot Morison, "History ofUnited States Naval Operations in WorldWar II," helped give dimension to a nar-rative that includes five major amphibi-ous operations. A number of militarymemoirs were also consulted, includingthose of Eisenhower, Bradley, Patton,Clark, Truscott, Montgomery, Alexan-der, and Kesselring, but were used withcaution.

Official histories of Fifth and SeventhArmies complied contemporaneouslyand published while the respectivearmies were still in active status containmedical and logistical as well as combatmaterial. The nine-volume Fifth ArmyHistory has been usefully condensed toa single book, From Salerno to the Alps,by Chester G. Starr, Jr., who as a mem-ber of the Fifth Army historical staffwas one of the authors of the largerwork.

Glossary

AAF Army Air ForcesAAFSC Army Air Forces Service CommandABC Adriatic Base CommandABS Atlantic Base SectionACC Allied Control CommissionADMS Assistant Director, Medical ServicesAFHQ Allied Force HeadquartersAGWAR Adjutant General, War DepartmentAMET Africa-Middle East TheaterAMEW Africa-Middle East WingAMG Allied Military GovernmentAMGOT Allied Military Government of Occupied TerritoryANVIL Early plan for invasion of southern FranceArmd ArmoredASRS Adjusted Service Rating ScoreASW Assistant Secretary of WarATC Air Transport CommandAtl AtlanticAVALANCHE Invasion of Italy at SalernoAux Auxiliary

BBC Bermuda Base CommandBE BLUIE EAST (U.S. air bases in Greenland)BEF Brazilian Expeditionary ForceBLACKSTONE Subtask force of Western Task Force for the attack on SafiBn BattalionBRUSHWOOD Subtask force of Western Task Force for the attack on FedalaBW BLUIE WEST (U.S. air bases in Greenland)

CBI China, Burma, IndiaCCB Combat Command BCCS Combined Chiefs of StaffCENT Task force in Sicily assault landingCDC Caribbean Defense CommandCG Commanding generalCinC Commander in ChiefCir CircularCO Commanding officerCo CompanyCofS Chief of StaffComd CommandComdr CommanderCONAD Continental Advance Section

GLOSSARY 625

COMZ Communications ZoneC&R Convalescent and rehabilitationCRIMSON Air routes through central and northeastern Canada, part of the

air ferry route to the British IslesCRYSTAL Meteorological stations in northern Canada

DCCAO Deputy Chief Civil Affairs OfficeDBMS Deputy Director, Medical ServicesDetach DetachmentDIME Task force in Sicily assault landingDir DirectorDiv DivisionDMS Director, Medical ServicesDoc DocumentDRAGOON Allied invasion of southern coast of France, 15 August 1944DSM Distinguished Service Medal

EASCOM Eastern CommandEBS Eastern Base SectionETMD Essential technical medical dataETO European Theater of OperationsETOUSA European Theater of Operations, U.S. ArmyEvac Evacuation hospital

FEC French Expeditionary CorpsFRANTIC AAF shuttle bombing of Axis-controlled Europe from bases in

United Kingdom, Italy, and USSRFUO Fever undetermined origin

GBC Greenland Base CommandGOALPOST Subtask force of Western Task Force for assault landing in Meh-

dia-Port-Lyautey area, North AfricaGp Group

Hist Historical, historyHosp HospitalHUSKY Allied invasion of Sicily, July 1943

IBC Iceland Base CommandIBS Island Base SectionIG Inspector GeneralInterv InterviewIt Italian

Joss Task force in Sicily assault landing

KOOL Task force in Sicily assault landing


LCI Landing craft, infantryLofC Line of communicationsLST Landing ship, tank

MAAF Mediterranean Allied Air ForcesMAC Medical Administrative CorpsMAETS Medical air evacuation transport squadronMBS Mediterranean Base SectionMCD Malaria control detachmentMCU Malaria control unitMed MedicalMMU Medical maintenance unitMSU Malaria survey unitMTO Mediterranean Theater of OperationsMTOUSA Mediterranean Theater of Operations, U.S. Army

NAAF Northwest African Air ForcesNATO North African Theater of OperationsNATOUSA North African Theater of Operations, U.S. ArmyNEC Newfoundland Base CommandNORBS Northern Base Section

QBE Order of the British EmpireOff OfficerOpns OperationsOrtho OrthopedicOSS Office of Strategic ServicesOVERLORD Allied cross-Channel invasion of northwest Europe, June 1944Ovhd Overhead

PBS Peninsular Base SectionPGC Persian Gulf CommandPGSC Persian Gulf Service CommandPT boat Patrol vessel, motor torpedo boatPOW Prisoner of war

QM Quartermaster

RAAG Rome Allied Area CommandRCAF Royal Canadian Air ForceRed RecordRCT Regimental combat teamRegt RegimentRpt Report

Sec SectionSep SeparateServ Service

GLOSSARY 627

SHAEF Supreme Headquarters, Allied Expeditionary ForceSGO Surgeon General's OfficeSHINGLE Amphibious operation at Anzio, ItalySitrep Situation reportSnC Sanitary CorpsSOLOC Southern Line of CommunicationsSOS Services of SupplySta StationStat StatisticalSuppl Supplement, supplementarySurg Surgeon, surgicalSWPA Southwest Pacific Area

TAS The Air SurgeonT/O Table of OrganizationTOE Table of Organization and EquipmentTORCH Allied invasion of Northwest Africa, November 1942TRUST Trieste-United States TroopsTSG The Surgeon General

UNRRA United Nations Relief and Rehabilitation AdministrationUSAAF U.S. Army Air ForcesUSAFCC U.S. Army Forces in Central CanadaUSAFEC U.S. Army Forces in Eastern CanadaUSAFICA U.S. Army Forces in Central AfricaUSAFIL U.S. Army Forces in LiberiaUSAFIME U.S. Army Forces in the Middle EastUSAFSA U.S. Army Forces, South AtlanticUSAHS U.S. Army hospital shipUSFET U.S. Forces, European TheaterUSPHS U.S. Public Health ServiceUSSTAF U.S. Strategic Air Forces

Vet Veterinary

WAC Women's Army CorpsWD War Department

YAK Russian fighter plane

ZI Zone of interior

Basic Military Map Symbols*

Basic Medical Symbols

Medical treatment facility, operating 1.................

Medical treatment facility, not operatingMedical supply u n i t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Veterinary treatment facility, operating ! . . . . . . . . . . . . . .

Veterinary treatment facility, not operating 1...........

Hospital t r a i n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital s h i p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other medical units 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Basic Military Symbols

S e c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Platoon or d e t a c h m e n t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C o m p a n y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B a t t a l i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Regiment or group; combat team (with abbreviation CTfollowing identifying n u m e r a l ) . . . . . . . . . . . . . . . . . . . . . . . . . .

Division; command of an air f o r c e . . . . . . . . . . . . . . . . . . . . . . . . .

Corps; Air F o r c e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A r m y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Service command, department, or section of communicationszone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Communications z o n e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* 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 c o r p s . . . . . . . . . . . . . . . .

16th Field Hospital, assigned to a service c o m m a n d . . . . . . . . . .

3d Convalescent Hospital, assigned to an a r m y . . . . . . . . . . . . . .

6th Station Hospital, assigned to a base section (not operating).

38th General Hospital, assigned to a communications zone. . . .

Fifth Army Medical D e p o t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17th Veterinary Evacuation Hospital, assigned to an a r m y . . . .

213th Veterinary General Hospital (Italian), assigned to a

base s e c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41st Hospital t r a i n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital ship Acadia.....................................

54th Medical B a t t a l i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Company B, 47th Armored Medical B a t t a l i o n . . . . . . . . . . . . . . .

309th Airborne Medical C o m p a n y . . . . . . . . . . . . . . . . . . . . . . . . .

Company A, 3d Medical B a t t a l i o n . . . . . . . . . . . . . . . . . . . . . . . . .

Clearing Station, 34th Division (2d platoon, clearing company,

organic Medical b a t t a l i o n ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 DepartmentChief of Staff: Prewar Plans and PreparationsWashington Command Post: The Operations DivisionStrategic Planning for Coalition Warfare: 1941-1942Strategic Planning for Coalition Warfare: 1943-1944Global Logistics and Strategy: 1940-1943Global Logistics and Strategy: 1943-1945The Army and Economic MobilizationThe Army and Industrial Manpower

The Army Ground ForcesThe Organization of Ground Combat Troops

The Procurement and Training of Ground Combat TroopsThe Army Service Forces

The Organization and Role of the Army Service ForcesThe Western Hemisphere

The Framework of Hemisphere DefenseGuarding the United States and Its Outposts

The War in the PacificThe Fall of the PhilippinesGuadalcanal: The First OffensiveVictory in PapuaCARTWHEEL: The Reduction of RabaulSeizure of the Gilberts and MarshallsCampaign in the MarianasThe Approach to the PhilippinesLeyte: The Return to the PhilippinesTriumph in the PhilippinesOkinawa: The Last BattleStrategy and Command: The First Two Years

The Mediterranean Theater of OperationsNorthwest Africa: Seizing the Initiative in the WestSicily and the Surrender of ItalySalerno to CassinoCassino to the Alps

The European Theater of OperationsCross-Channel AttackBreakout and PursuitThe Lorraine CampaignThe Seigfried Line CampaignThe Ardennes: Battle of the BulgeThe Last Offensive

The Supreme CommandLogistical Support of the Armies, Volume ILogistical Support of the Armies, Volume II

The Middle East TheaterThe Persian Corridor and Aid to Russia

The China-Burma-India TheaterStilwell's Mission to ChinaStilwell's Command ProblemsTime Runs Out in CBI

The Technical ServicesThe Chemical Warfare Service: Organizing for WarThe Chemical Warfare Service: From Laboratory to FieldThe Chemical Warfare Service: Chemicals in CombatThe Corps of Engineers: Troops and EquipmentThe Corps of Engineers: The War Against JapanThe Corps of Engineers: The War Against GermanyThe Corps of Engineers: Military Construction in the United StatesThe Medical Department: Hospitalization and Evacuation; Zone of InteriorThe Medical Department: Medical Service in the Mediterranean and Minor

TheatersThe Ordnance Department: Planning Munitions for WarThe Ordnance Department: Procurement and SupplyThe Ordnance Department: On Beachhead and BattlefrontThe Quartermaster Corps: Organization, Supply, and Services, Volume IThe Quartermaster Corps: Organization, Supply, and Services, Volume IIThe Quartermaster Corps: Operations in the War Against JapanThe Quartermaster Corps: Operations in the War Against GermanyThe Signal Corps: The EmergencyThe Signal Corps: The TestThe Signal Corps: The OutcomeThe Transportation Corps: Responsibilities, Organization, and OperationsThe Transportation Corps: Movements, Training, and SupplyThe Transportation Corps: Operations Overseas

Special StudiesChronology: 1941-1945Military Relations Between the United States and Canada: 1939-1945Rearming the FrenchThree Battles: Arnaville, Altuzzo, and SchmidtThe Women's Army CorpsCivil Affairs: Soldiers Become GovernorsBuying Aircraft: Matériel Procurement for the Army Air ForcesThe Employment of Negro TroopsManhattan: The U.S. Army and the Atomic Bomb

Pictorial RecordThe War Against Germany and Italy: Mediterranean and Adjacent AreasThe War Against Germany: Europe and Adjacent AreasThe War Against Japan

Index

AAF. See Army Air Forces.AAFSC. See Army Air Forces Service Command.Aaron, Lt. Col. Margaret E., 487Abadan, 76, 86Acadia, 168, 206, 341, 397Acciarella, 274Accra, 54, 65, 66, 77, 78, 81, 82, 83, 84, 89, 90Aden, 60, 61Adjusted Service Rating Score (ASRS), 522-23, 533,

543-46, 548Admissions, hospital. See Hospital admissions.Adriatic Base Command (ABC), 480, 497, 499,

501, 510, 528, 529, 530, 549, 550. See alsoAdriatic Depot.

Adriatic Depot, 349-50, 489, 510. See also AdriaticBase Command.

Adriatic Sea, 232, 240, 302Affiliated units. See Evacuation Hospitals, num-

bered, 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, 267Africa-Middle East Theater of Operations, 80, 85,

103, 488, 497, 498, 509Africa-Middle East Wing, Air Transport Com-

mand, 66, 82-83, 89. See also Central AfricanWing, Air Transport Command; North Afri-can Wing, Air Transport Command.

Afrika Korps, 60, 124Agrigento, 157, 158, 164, 167, 169, 181Ahwaz, 60, 74, 76, 77, 86Aid Stations, 76, 114, 125, 153, 159, 160, 268, 278,

293 302battalion 2, 3, 111, 118, 153, 227, 255, 270, 271beach, 119crash, 12provisional, 76regimental, 255at Salerno, 228, 236in Winter Line campaign, 240

Aidmen, 1, 2, 60, 146, 233, 236, 268Am Beida, 127, 142Am et Turk, 188Am M'lilla, 138, 142, 208Air conditioning, use of, 76, 77, 86, 99Air ferry routes, 10, 31, 56Air Force, U.S. See Army Air Forces.

Air routes, transatlanticsecuring of, 7-8to Africa and the Middle East, 60

Air-sea rescue teams, 184Air Service Command, Mediterranean Theater of

Operations, 184Air Transport Command, 8-9, 10, 65, 89, 137, 182

commanding officer of, 47and evacuation to the United States by way of

Greenland, 22hospital facilities of, in the Middle East, 81, 103and jurisdiction over Newfoundland base hos-

pitals, 25operations of

in Bermuda, 28in Iceland, 10, 11, 15-16in Newfoundland, 25

and staffing of Atlantic bases, 8Airborne Division, 82d, 150, 152, 153-54, 156, 157,

165, 230, 231, 232, 267Airborne divisions, 223, 225Airborne Medical Company, 307th, 150, 232, 326Airborne Task Force, 1st, 373, 374, 375, 380, 386,

387, 395, 414Aircraft, 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, 509Akureyri, 13, 15Alafoss, 10, 12, 14, 15, 16Alban Hills, 270, 292, 296, 304Albano, 270, 273, 281, 295, 296Alcohol, use of in hot climates, 99Alcoholics, treatment of, 98Alessandria, 523Alexander, Field Marshal Sir Harold R. L. G., 123,

147, 159, 220, 222, 239Alexander, Col. Stuart F., 210, 369Alexandria, 60, 68Algeria, 43, 62, 82, 104, 180, 181Algeria-French Morocco Campaign, 104-21, 134,

141, 177, 218, 552combat operations, 108-10medical operations, 105-11

Alghero, 175Algiers, 73, 82, 107-15, 118, 122, 123, 136, 138, 139,

146, 167, 174, 177, 180, 181, 188, 189, 206, 213,355, 363

Algonquin, 397


Alife, 237, 242Allied Armies in Italy, 290. See also Army Groups,

15th.Allied Control Commission (ACC) , 347, 355, 361-

62, 364, 365, 519, 542Allied Expeditionary Forces, Supreme Headquar-

ters of, 541Allied Force Headquarters (AFHQ)

and Allied Control Commission, 519and captured German hospitals, 477chief of transportation for, 340, 504and hospital ships for Salerno operation, 226and litter bearers for Winter Line, 240medical section of, 177-79, 212, 323and operations, 119, 123, 139, 166, 177, 178, 179,

180, 224and problems of rank among medical officers,

177-78Allied Force Malaria Control School, 355Allied Military Government of Occupied Terri-

tory (AMGOT), 169, 260, 326, 360, 361, 362,363, 519-20. See also Region III, AMG.

establishment of, 220, 221and Italian laws governing prostitution, 258

Allied Military Governor of Sicily, 220ALPHA Force, 373, 378Amapa, 47, 49, 52-53, 55Amazon River, 49Ambulance companies, 224. See also under Medi-

cal Companies.Ambulance control points, 247, 302, 304Ambulance loading posts, 4, 233Ambulance runs, excessive length of, 127, 132, 138,

245-46, 302-03Ambulances. See also Evacuation by land, by am-

bulance,capture of, 125in Delta Service Command, 68deadlined at Volturno River, 248equipped for emergency crashes at airports, 84loss of, at sea during Gela landings, 155shortage of

in Liri Valley, 292in North Africa, 195-96in Sicily, 155, 167in Tunisia, 138

for Tunisia Campaign, 127-28in Winter Line campaign, 240

American Red Cross, 11, 14, 362AMEW. See Africa-Middle East Wing, Air Trans-

port Command.AMGOT. See Allied Military Government of Oc-

cupied Territory.Amputations, traumatic, 143-44Ancona, 510Anderson, Maj. Gen. Jonathan W., 117Anderson, Lt. Gen. K. A. N., 105, 122Andimeshk, 76, 86Andrews, Lt. Gen. Frank M., 62

Andrews, Col. Justin, 67, 213, 354Anglo-Egyptian Sudan, 57, 60, 61, 68, 81, 84Angmagssalik, 19Animal casualties, Rome-Arno Campaign, 314Animal clinic, Middle East theater, 103Animal strength, Fifth Army, 265Animal transportation, 432Animals, 11, 146, 174, 263-65, 319-20, 485. See also

Horses, use of; Mules, use of; Veterinary Corps.Anopheles gambiae. See Disinfestation, and ano-

pheles gambiae; Malaria control.Antiaircraft Artillery Brigades

45th, 415. See also Task Forces, 45.71st, 538

Antigua, 8, 41, 44Antilles Department, 42, 43, 44, 45ANVIL. 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, 556British hospital area, 274, 278compared to support in mountains west of

Garigliano River, 296-97effect on psychiatric case rate, 256evacuation from, 271, 277-80, 311evacuation hospitals assigned to, 242hospitalization in, 275-78and malaria control school, 260medical experience in Africa used in, 267medical planning for, 267-68medical support for, 269-88projected casualty rate for, 268serves as preparation for planning in East-

ern Base Section, 206shortage of hospital ships, 120staging hospitals assigned to, 249training for, 243, 258trench foot cases, 261-62withdrawal of commanders from, for invasion

of France, 267Aosta Province, 526Apennines, 240, 486, 489, 490, 519, 531, 553Appian Way. See Highways, Italy, 7.Arabia, 61, 62, 68, 81Arak, 86Ardennes, 503Ardenza, 307, 490, 493Argentia, 23Armies

Third, 376, 542, 543Fifth, 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 Divisions1st, 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, 267Armored Medical Battalions. See Medical Bat-

talions, 47th Armored and 48th Armored.Armored Regiment, 66th, 117Army Air Base, Newfoundland, 23Army 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, 114and battle casualties from, treated in Delta

Service Command hospitals, 63, 68dental service for, 317and evacuation of patients to Naples, 502and hospital equipment for, lost through enemy

action, 333and hospital facilities for, in the Eastern Base

Section, 190and hospital on Seymour Island, 38hospitals for, in Italy, 333medical installations of, 137medical organization for, in the Mediterranean,

181medical personnel of, 19, 137represented at British-American malaria con-

trol committee, 212-13represented at malaria control commission in

West Africa, 90responsibility for health of personnel, Bermuda

Base Command, 27Army Air Forces, numbered

Sixth, 38Eighth, 31, 89, 321Ninth, 62, 63, 65, 67, 68, 71, 72, 73, 80, 99, 151Tenth, 60Twelfth, 80, 105, 106, 114, 122, 123, 137, 138,

146, 181, 182, 193, 215, 296, 326, 327, 334, 423Fifteenth, 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, 358surgeon of, 327

Army Epidermiological Board, 99Army Forces in Central Canada, 31-32Army Ground Forces, surgeon of, 324Army Ground Forces Command, 62Army Groups

6th, 376, 400, 48612th, 541, 54215th, 147, 156, 220, 222-23, 239, 266, 290, 361,

423, 457Army 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, 124Arno Campaign. See Rome-Arno Campaign.Arno River, 314, 340, 488Arno River line, 299, 302, 307, 339Arno Valley, 486, 490, 496, 520, 530Aruba, 8, 41, 43Arzew, 111, 112, 113, 114, 149, 150, 188, 223Ascension Island, 8, 49, 54, 55Ashley, Colonel, 360Asmara, 57, 58, 63, 69, 70, 84, 85ASRS. See Adjusted Service Rating Score.Assi Bou Nif, 194, 339Asuncion, 54Atabrine, 45, 165, 251, 316, 355, 372, 556

in North Africa, 145, 213-14in Sicily, 172-73, 214

Atina, 239Atkinson Field, 44, 47Atlantic Base Section, 119, 180, 183-88, 204, 210,

213, 326, 338, 347, 348, 349, 488, 509and development of medical supply system, 208and local health authorities, 220

Atlantic bases 15-16Atlantic Ocean, 105Atypical pneumonia, 452, 483Australia, 102Austria, 323, 521-22, 523, 525, 538, 542, 549Auxiliary 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, 155AVALANCHE. See Naples-Foggia Campaign; Salerno.Avellino, 230, 231, 237, 252Aversa, 333, 340, 496, 529, 535, 540, 541Axis armed forces, 62, 64, 104, 121, 124, 131, 554Azores, 7, 29, 30Azores Base Command, 29

B-17's, 320, 321Baba Hassen, 122Baffin Island, 31, 33Bagnoli, 327Bahama Islands, 8Bahia, 47, 55Balchen, Col. Bernt, 19Balkans, 323, 549Bandar Shahpur, 76, 86Banton, Lt. Col. Huston J., 119Barcellona, 162, 166Bari, 326-7, 333, 334, 489, 497, 510, 529, 548Barker, Col. Marion H., 513Barnes, Lt. Col. Asa, 354Base Area Group, 6665th (Provisional) , 326, 327Base Depot Companies. See Medical supply units,

Base Depot Companies.Basra, 59, 60, 64


Bassano, 525Bastia, 175, 497Batch, Lt. Col. Joseph W., 542Bathurst, 60Batista Field, 44Battipaglia, 230, 237, 336, 490Battle casualties, 40, 293-94, 299, 310-11. See also

Hospital admissions; Medical Department per-sonnel; Noneffective rates,

in British hospitals, 120captured by Germans in Tunisia Campaign, 125collection of, at Salerno, 227evacuation of

from Italy and Sicily, 206to Naples for primary surgery, 284and planning for Salerno, 226by raft, across Volturno River, 233to troop transport by small craft from

Salerno, 227French, 206, 332number of

Anzio, 270, 271, 276-77, 283-84Army Air Forces, 62, 63, 184, 342Cassino, 239, 240, 245-46Gela beach, 154-55Liri Valley, 293-95Northwest Africa, 107, 108, 111, 114, 115,

119, 121Rapido River, 244

rerouted from overcrowded evacuation hospitals,248

transported to beach at Salerno, 227, 230-31Battle fatigue. See Neuropsychiatry.Bauchspies, Col. Rollin L., 268, 369, 380Bauxite, 41Bay of Naples, 233Beasley, Col. Charles H., 11Bed ratio

in Atlantic defense areas, 9in Persian Gulf Command, 86

Bed requirements in Atlantic base hospitals, 9Bed strength, Table of Organization and Equip-

ment, 9, 11, 15, 24, 25, 329, 332, 333, 334, 335,336, 337, 338, 360, 395, 401, 403-04, 448

in Antilles Department, 44in Anzio Campaign, 275, 278in Atlantic Base Section, 183-86in Eastern Base Section, 190, 190nin Eastern Task Force, 107in Fifth Army area, 249-50in Mediterranean Base Section, 189in the Middle East theater, 79, 84-85in Newfoundland, 25in the Panama Canal Department, 37-38in the Persian Gulf Service Command, 77, 79,

85-86Beds, shortage of, 144, 435, 445

and effect on rate of return to duty of psy-chiatric patients, 255

Beds, shortage of—Continuedin Panama Canal Department, 37-38at Salerno, 230-31in Tunisia Campaign, 128in Winter Line campaign, 241-42

Beecher, Lt. Col. Henry K., 211BEF. See Brazilian Army units, Brazilian Expe-

ditionary Force.Bekkaria, 142Belem, 47, 48, 49, 52, 54, 55Belgian Congo, 77n, 183Belluno, 525Benedict Field, 42Benevento, 230, 231Benghasi, 72, 73Benghasi Base Command, 64. See also Levant Serv-

ice Command.Bennett, Lt. Col. Austin W., 429Benson, Col. Otis O., Jr., 327Benzyl benzoate, 512Beradinelli, Lt. Col. Stephen D., 67Berlin, 321Bermuda, 8, 26, 27Bermuda Base Command, 26-27Bernadou, 115Berrechid, 186Berry, Col. Daniel J., 23, 369, 409Biederman, Col. Albert A. 324, 487, 542, 549Billick, Col Eugene W., 80Bishop, Col. Harry A., 126, 372, 399Bizerte, 73, 121, 130-34, 142, 145, 149, 156, 168,

181, 188, 205, 206, 226, 341Blackburn, Lt. Col. Estes M., 358BLACKSTONE, 115Blesse, Brig. Gen. Frederick A., 172, 179, 181, 184,

193, 201, 223, 225, 231, 265, 275, 324, 333,334, 363

Blesse, Col. Henry S., 275Blida, 109Blood, whole, 26, 144, 253, 314, 409, 450, 483, 513,

556delivery of, 284use of, at Anzio, 279, 284

Blood banks, 144, 253, 284, 314, 352-53, 540. Seealso Medical Laboratories, numbered, 15thGeneral.

Blood plasma, 26, 143, 144, 149, 240Blood Transfusion Units

6703d, 374, 404, 4096707th, 4096713th, 252, 450, 460

Blood transfusions, 119, 276BLUIE EAST 2, 19-21BLUIE WEST 1, 19-22, 31BLUIE WEST 7, 19-20BLUIE WEST 8, 19-21, 31Bologna, 484, 499-500, 517, 525, 529, 531, 539, 540Bolton, Lt. Col. Eldon L., 463Bolzano, 523, 525, 526, 535, 541

INDEX 637

Bolzano conference, 541-42Bomber Command, IX, 73Bomber Command, North Africa, 181Bomber Squadron, 9th (H), 10Bomber squadrons, 320Bone, 121, 132, 137-38, 142, 149, 190, 208Bonomi, Ivanoe, 519Borgarnes, 12Borinquen Field, 42, 43, 44Bou Chebka, 121, 126Bou Guedra, 117Bougie, 122Bouiseville, 189Bowen, Capt. Joseph J. 259, 260Boyle huts, 135Bradley, Maj. Gen. Omar, N., 127, 130, 152, 267Brand, Maj. Maxwell R., 355Brandon, Maj. Thomas C., 57, 58Brazil, 8, 46, 47, 48, 49, 50, 55, 60, 83Brazilian Air Force units, 491Brazilian 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, 453Combat Team, 6th, 422, 429Infantry Regiments

1st, 42411th, 424

Brazilian Department of Public Health, 53, 90Brazilian Government, and control of anopheles

gambiae, 53-54, 89Brazilian medical personnel, 47, 336, 469, 471, 527Brazilian medical units

dispensaries, 50hospital, military, 48Medical Battalion, 1st, 429

Brazilian personnel, hospitalization of, 491, 498Brazilian Port Health Service, 90Brazilian Port Sanitary Service, 53Breeches buoy, use of, in evacuation, 240Brenner Pass, 523, 542Brereton, General Lewis H., 60, 62, 65, 80Brescia, 536, 537British Air Force. See Royal Air Force.British Army, 14, 56British Army Middle East Forces, 94British Army units. See also British medical units.

Army Groups18, 124, 12721, 542

ArmiesFirst, 105, 106, 121-22, 123, 124, 129, 130,

131, 136, 142, 189, 223Eighth, 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—ContinuedArmies—Continued

Eighth—Continued422, 423, 424, 457, 461, 462, 467, 523, 542

Corps10, 223, 230, 232, 233, 234, 238, 239, 243,

289-9013, 291-92, 417-18, 419, 420, 421, 423, 424, 458

Divisions1st Infantry, 151, 267, 273, 295, 4194th Indian, 2455th Infantry, 243, 274, 289, 2957th Armored, 223, 230, 231-32, 234, 2438th Indian, 42446th Infantry, 223, 230, 234, 239, 243, 244,

29056th Infantry, 223, 230, 234, 239, 243, 273,

274, 289-9078th Infantry, 245, 422

Brigades, 11th Infantry, 109Commandos

1st, 108, 1096th, 109

British Consultant Malariologist, 355British dental equipment, use by American den-

tal officers, 101British dental facilities, use by American dental

officers, 100British destroyers, 105, 110, 113British Director of Medical Services. See Cowell,

Maj. Gen. Ernest M.British fixed bed ratio, 122-23, 182British Government

agrees to establishment of U.S. base on Ascen-sion Island, 8

securing of beef supply from New Zealandthrough, 102

British Guiana, 8, 41, 43, 44, 47, 48. See alsoGuianas.

British hospital area, Anzio, 274British hospital buildings, used by American

medical units, 12, 73British hospital carriers, 168, 283British hospital ships, 79, 98, 108, 120, 167, 271,

283, 342British medical supplies, surplus of, in Iceland, 17British medical units, 151

casualty clearing stations, 123dispensary, 49dressing stations, 268hospitals, 29, 43, 57, 58, 64, 71, 100, 107, 122, 123,

334at Anzio, 271, 274, 277, 278, 282and care of Ninth U.S. Army Air Force

personnel, 72-73in Libya, 72-73in the Middle East, 103, 120, 555movement of, to avoid bombing at Anzio,

271, 277


British medical units—Continuedhospitals—Continued

withdrawal of, from Iceland, 12-13British medical units, numbered

Casualty Clearing Stations1st, 1202d, 268, 2718th, 12012th, 136, 139

Field Ambulance141st, 276159th, 111, 120

Field Transfusion Unit, 12th, 268, 284Hospitals

31st General, 18961st Combined General, 5994th General, 120

Motor Ambulance Convoy, 6th, 138British nurses, attend psychiatric nursing course,

219British paratroopers, 121British surgical team, 111British Navy. See Royal Navy.British West Indies, 34, 44Brolo, 160, 162Brooke, General Sir Alan, 104Brothels. See Prostitution; Venereal disease.Brown, Lt. Col. James W., 66Bruce, Col. Charles O., 525, 548-49Bruck, 533BRUSHWOOD, 117Bubonic plague, 30, 83, 91, 99, 106, 556Budhareyri, 13, 15Burma, 85Burnet, Col. Burgh S., 180Butler, Brig. Gen. Frederick B., 375-76

C-47's, 5, 139, 312, 321, 480C and R Sections, 357Cady, Col. Duance L., 324Caffey, Brig. Gen. Benjamin F., Jr., 366Cagliari, 175Caiazzo. See Piana di Caiazzo.Cairo, 56, 60, 65, 68, 77, 79, 80, 82, 83, 85, 86,

91, 94, 95, 99, 102, 104, 245Cairo Area 61-62California, 31Calore River, 233Caltanissetta, 159, 167, 169, 181Calvi Risorta, 252, 313Camardella, Lt. Col. Ralph A., 248, 279, 445, 536,

541CAMEL Force, 373, 374, 379, 380Camino, 239Camocim, 49, 50Camp, Col. Benjamin L., 489Campbell, Capt. Robert J., 285Campoleone, 270, 271, 276Campoleone Station, 296

Campomorto, 304Camps

Amirabad, 64Helgafell, 12, 15, 16Huckstep, 63, 68, 81, 84, 87, 103O'Reilly, 44Pershing, 10Tel Litwinsky, 58, 64, 71, 72Tortuguero, 42, 44

Canada, 8, 30-32Canadian Air Force. See Royal Canadian Air

Force.Canadian Division, 1st, 147Canadian forces, 151-52, 159Canadian hospitals, 32, 34Canani, Col. Berni, 265, 320Cannon, Lt. Gen. John K., 423Cap Bon, 131, 150Cap de Fedala, 117Cap Matifou, 108, 109, 110Cap Sidi Ferruch, 108, 109Cape of Good Hope, 57, 79Capetown, 57Capua, 230, 233, 234, 237, 241, 244, 246, 248, 249,

527Cardiovascular diseases, 86Caribbean Defense Command, 34, 324Caribbean Sea, 60Carinola, 291, 303, 304, 319Carmack, Col. Joseph, 487Carpi, 527Casablanca, 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, 147Casanova, 277Caserta, 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, 256operations, 249, 275, 277, 282, 287, 289, 291,

292, 293, 556Veterinary Corps at, 263-64

Castagneto, 319, 337, 490, 495, 529Castelvetrano, 157, 165, 167Castiglioncello, 303Castle Harbour Hotel, 26, 28Casuals. See Adjusted Service Rating Score.Casualty clearing hospitals. See Evacuation hos-

pitals; Evacuation Hospitals, numbered.Catanian plain, 159, 173Catarrhal jaundice, 26Caves, use of, for hospital sites, 236, 430Cayey, 42Cecchignola, 527, 529Cecina, 302, 303, 307, 319

INDEX 639

Cefalii, 158, 159, 162, 169Cellole, 293, 304, 310Cement, use of, 209CENT Force, 152-53, 155, 169Center Task Force, 107, 113, 115, 120Center Town Command, North Africa Service

Command, 82Central Africa, 65, 88, 97Central African Command, 89Central African Route, Air Transport Command,

70Central African Wing, Air Transport Command,

66, 70, 82, 83, 84, 101, 102Central America, 35, 38, 41Central Civilian Medical Depot, 508Central Dental Laboratory, Naples, 358Cerami, 159Cerignola, 334, 529Cervione, 497, 509, 510Cesard, 160Chain of evacuation. See Evacuation, chain of.Chateau Thierry, 397Chemical Warfare Service, 331Chemicals, shortage of, 512Chenango, 117, 118Cherqui, 117Cheyne, Col. D. Gordon, 220China-Burma-India theater, 72, 85, 86, 98, 498China theater, 84Cholera, 106, 220, 326, 556Chronic gastritis, 451Churchill, 31, 32, 33Churchill, Col. Edward D., 144, 162, 171, 210-11,

253, 350, 351-52, 408, 409, 450, 487Churchill, Winston S., 104, 266, 272, 367, 519Cisterna, 270, 271, 273, 274, 292, 296, 297, 303Cividale, 549Civil Affairs Section, Allied Force Headquarters,

219-20Civilian health authorities, co-operation with, in

North Africa, 62Civilians, evacuation of, from Anzio, 278, 279Civilians, 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 MilitaryGovernment; Central Civilian Medical Depot.

at Anzio, 278in Bermuda, 27in Brazil, 51-53in Canada, 33in Iceland, 11, 14in Italian hospitals, 57and native workers in Egyptian hospitals, 57in Panama, 39and typhus in the Middle East, 94responsibility for, 57

Civilians, used in hospital work, 554Civitavecchia, 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 underMedical Companies,

battalion, 129, 164, 277divisional, 163, 165, 296

Clearing platoons, 110, 111, 160, 233divisional, 225, 231and evacuation hospital, 164used as expansion units, 165, 249250-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, 245beach, 230corps, 129, 274decline in return to duty of psychiatric patients

from, 256difficulty of keeping up with moving troops, 302divisional, 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, 154routine dental work performed at, 263value of establishing early, 143

Clevelandia, 49, 50Climate

adaptation to, in Canada, 33in Brazil, 53in Central Africa, 79effect of

on construction in Panama Canal Depart-ment, 37

on dental rate in the Middle East, 100-101on disease rate in Italy, 250, 257on evacuation, 25, 386, 490on hospital disposition in Iceland, 12on personnel, 75on supplies in Persian Gulf Command, 88

in Egypt, 68in Eritrea, 70factors overrated, 67heat-produced illnesses, 99in Italy, 250, 256-57in Middle East theater, 76, 79, 88, 99, 100in Newfoundland, 25problems

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, 426of wind, 68, 76, 196

and use of British tropical-type tents, 73and use of salt tablets, 99


Coastal Base Section, 368, 372, 399, 400, 412. Seealso CONAD Base Section; Delta Base Section.

Coates, Col. John Boyd, Jr., 542Cocke, Col. Joseph G., 324, 401Cold injury, 33Cole, 115Collecting-clearing companies, 154, 155, 156, 157,

159, 224. See also under Medical Companies.Collecting-clearing stations, 268, 270Collecting 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 underMedical Companies.

Collecting stations, 143, 153, 298bombing of, 295damaged by storm, 243eliminated where possible at Salerno, 236-37

Collesano, 159Colli Laziali, 269, 273Colombia, 34Combat Conditioning Camp, 216-17. See also

Medical Companies, 6706th Conditioning.Combat exhaustion. See Neuropsychiatry.Combat wounds. See Hospital admissions, for com-

bat wounds.Combined Chiefs of Staff, 299

approves Salerno invasion plans, 222approves Sicily invasion plans, 147plans invasion of Northwest Africa, 104

Comiso, 152, 153Communications, 139

effect of failures of, on evacuation, 250, 305-06by jeep courier, 306by pigeon, 306quality of, 62, 305-06

Conditioning and rehabilitation, policy of, 357Conditioning Center, Eastern Base Section, 217.

See also Station Hospitals, numbered, 105th.Conditioning Company, 6706th, 217, 357Connel, Maj. Frank H., 537Constantine, 122, 124, 127, 132, 136, 137, 138, 142,

180, 182, 190, 206, 208, 215, 226, 337Continental Advance Section, 402-04, 407, 412Convalescence and rehabilitation sections, 357Convalescent Hospitals

2d, 189, 216, 217, 392, 392n, 393, 394, 4063d, 225, 238, 242, 249, 291, 304, 306, 307, 316,

326, 329, 416, 439, 441, 525, 538, 5453,000-bed, 189, 225

Convalescent wards, 169Cook, Col. William F., 327Copper sulfate spray, 45-46Coral Harbour, 32, 33Corby, Col. John F., 106, 138, 177, 178, 182Cori, 296, 297, 304, 319Corleone, 158Cormons, 525Coronia, 162

CorpsII, 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, 167Corps Malaria Control Committee, 287Corsica, 174, 175, 181, 339, 342, 488, 497, 499, 500,

502, 509, 510, 556Cortina d'Ampezzo, 535, 536, 538, 549Costa Rica, 39Cowan, Col. Egbert W. D., 217, 263, 317Cowell, Maj. Gen. Ernest M., 106, 177, 179, 201,

212, 324, 362Cox, Col. Wesley C., 37Cremona, 525, 526Crichton, Col. W. H., 363CRIMSON, 31Crittenberger, Maj. Gen. Willis D., 296, 301, 415,

423Crozier, Maj. Dan, 56, 57, 58Cryolite, 18, 19, 22CRYSTAL, 31Cuba, 41, 44, 45Cunningham, Admiral Sir John, 266Curacao, 1, 8, 41, 43, 44Cutaneous disease, 79

Dakar, 53, 54, 66, 78, 81, 83, 84, 85, 89, 90, 91, 99Dallas, 118Darby, Col. William O., 270Darby's Rangers, 270Darlan, Admiral Jean-Francois, 108, 110, 121Davenport, Col. Walter P., 43David (Panama), 38Davis, Col. Thomas F., 453Davis, William A., 363Dawley, Maj. Gen. Ernest J., 223, 230Debridement, radical, 253Decamere, 69, 87DELTA Force, 373-74, 379, 380Delta 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, 102de Mendonca, Fabio Carneiro, 53

INDEX 641

Demonstrations. See Educational devices.Denit, Maj. Gen. Guy B., 180Dent, Capt. Paul L., 110Dental clinics, 101, 287

Fifth Army, 263, 317IV Corps, 483in the South Atlantic theater, 54II Corps, 263, 317, 483

Dental Corps, 101-02, 413, 483-84in the Africa-Middle East Theater of Opera-

tions, 80in the Atlantic defense area, 9-10in Brazil, 54in the Iceland Base Command, 18in Italy, 262-63, 287, 317-18, 357-58, 452-53, 483-

84, 514-15in the Middle East, 100-102in the Persian Gulf Command, 100in Sicily, 173-74in the South Atlantic theater, 54

Dental dispensaries, use of trailers for, 452-53Dental equipment

and Chest MD Number 60, 54, 145and lack of portability, 145shortage of, 100-101, 218for II Corps and Fifth Army clinics, 263

Dental laboratoriesdivisional, 262-63mobile, 263at Mostra Fairgrounds, 332, 358shortage of, at Anzio, 287technicians for, 263, 527use of trucks for, 263

Dental Laboratory, Central, 358Dental personnel, 24, 59, 262-63, 287, 357-58, 453,

515in Air Transport Command, 100-102in Brazil, 54detached from Army hospitals, 218morale of, 101-02in Ninth Air Force, 65and nonprofessional assignments, 100, 146, 174,

262in North African theater, 217-18in Pan American Highway Medical Service, 39ratio to troop strength, 100, 218and rotation policy, 54shortage of, 218, 263, 287transport of, by air, 101unexpected need for replacements in North Africa

and Sicily, 208-09and use of British facilities, 100-101

Dental prosthetics, 146, 173-74, 262-63, 287, 317,406, 413, 453, 484

Dental standards for induction, 218Dental surgeon, North African theater, duties of,

217-18Dental techniques, German, 527Dental x-ray, clinics lacking in facilities for, 263

Dentists, Brazilian, 54Depot Companies. See Medical supply units, Depot

Companies.Desenzano, 523, 536Desert coolers, 99Destroyers, 115-18Destroyers for bases agreement, 8, 22-23, 41Devers, Lt. Gen. Jacob L., 267, 323Dewey, Lt. Col. Leonard A., 215, 354Diarrhea, 77, 145, 316, 556

and infectious hepatitis, 257nonspecific, 98in Tunisia Campaign, 214-15

Dieppe, 108Diets, special, 144DIME Force, 152, 153, 154, 155Diphtheria, 26Disease rates, 250. See also Hospital admissions;

Noneffective rate,in Brazil, 51, 52, 53in Iceland, 17-18in Persian Gulf Service Command, 86at Salerno, 230-31, 278

Diseases, 111, 165. See also by name.in Army Air Forces, 182chronic, among Brazilian workers, 53endemic, 67, 79in Greenland, 21in Iceland, 17in Iran, 82intestinal, 26, 76, 79, 145, 483, 530in Middle East, 88preventable, lack of outbreaks of, in North Africa

and Sicily, 215-16subtropical, 172tropical, 52, 78, 83-84. See also by name.

Disinfestation, See also Malaria control,and anopheles gambiae, 53-54, 89-90of bedbugs, 172delousing

of civilians in the Middle East, 95instruction in, 74in North Africa Theater of Operations, 216and shortage of equipment for treating pack

animals, 265disinsectization officer, Air Transport Command,

90fleas, in Sicily, 172flies, 76, 145, 172, 214, 556insecticiding, 91, 262larviciding, 45-46, 91, 213, 260lice, 172, 262, 556for malaria control, 45-46, 53-54, 83-84, 89-92,

212-15mosquitos, 76, 172, 556and prevention of typhus, 94, 262and use of

copper sulfate, 45-46DDT, 91, 356, 363-65, 537


Disinfestation—Continuedand use of—Continued

methyl bromide (MYL), 362Paris green, 356

Dispensaries, 28, 29-30, 35-37, 42, 43, 45, 48, 52, 58,59, 77, 78

in Atlantic bases, 9in Brazil, 52capacity

10-bed, 32-33, 3925-bed, 32120-bed, 29

in Iceland, 11-12in Libya, 58in Newfoundland, 25in North Africa, 57, 58operated by AAF medical detachments, 32, 137operated by Corps of Engineers, 38in Panama Canal Department, 35in Persian Gulf Service Command, 76types of

camp, 11-12dental, 63field, 46, 63general, 53, 57, 63, 69, 225headquarters, 32, 57mobile, 278station, 83

Djedeida, 121Djidjelli, 122Dobbiaco, 523Dog tags, 2Dooling, Brig. Gen. Henry C., 34Doolittle, Brig. Gen. James H., 105, 138Dorchester, 19Douglas Aircraft Corporation hospitals, 57-58, 64,

68, 69, 79Dragoni, 237, 242, 248DRAGOON. See Southern France Campaign.Drainage

and control of malaria, 45, 213, 214, 260effect on trench foot, 285-86and flooding, 260, 440at hospital sites, 275lack of, 193, 275, 285, 534quality of

at Anzio, 275at Cassino, 285in Levant, 71

Drainage systems, destruction of, by Germans inItaly, 260

Draper, Lt. Col. Calvin S., 315-16Drugs. See by name.Dubos, Col. Emeric I., 360Dukws, 405, 407, 466, 479-80Dutch Guiana, 41, 43, 44. See also Guianas.Dutch West Indies, 34Dysentery, 60, 67, 77, 83, 98, 106, 145, 172, 201, 214,

249, 257, 316, 321, 353, 556

Eaker, Lt. Gen. Ira C., 267, 320, 423EASCOM. 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, 320-22Eastern Defense Command, 9, 11, 29Eastern Task Force, 105-06, 111, 120, 122, 142Eastern Town Command, 82Echelons, of medical service, 211. See also Evacua-

tion, chain of.Ecuador, 34, 38, 39Edmund B. Alexander, 23Educational devices, 93, 98Eisenhower, Lt. Gen. Dwight D., 104, 123-24, 177,

178, 226, 266, 267, 323, 367, 486Egypt, 57, 60, 61, 72, 73, 79, 81, 84, 87, 99Egyptian Army, surgeon of, 62, 95Egyptian Government, and venereal disease, 92Egyptian Ministry of Public Health, 62, 94Egyptian Sudan, 60Eklund, Lt. Col. William J., 24El 'Alamein, 61, 104El Guerrah, 136, 189El Guettar, 129, 142, 145El Salvador, 39Electric lamps, generator-driven, use of, 4Elvins, Col. Richard E., 106, 138, 181, 327, 333Emergency Medical Tag (EMT), 2, 3, 5Emily Weder, 397Empoli, 496-97, 529EMT. See Emergency Medical Tag.Engineer Battalion, 10th, 285Engineer Shore Regiments

531st, 154, 227540th, 268

Engineers, Corps of, 12, 19, 23, 26, 31, 38, 39, 76,89-90, 209, 260, 326, 329, 356, 361

at Atlantic bases, 9in Canada, 30and Eastern Base Section, 190in Italy, 233, 242, 260medical services for, 24, 26, 32, 38in the Middle East, 99in Newfoundland, 23in the North African Theater of Operations, 209operates own medical services, 38, 76in Panama, 35in Sicily, 160

England, 89, 105, 113, 124, 553English Channel, 300Enna, 158-59Entomological detachments, from malaria survey

units, 213Epidemics, civilian, in the Middle East, 99Equipment. See Medical supplies and equipment.Equipment and clothing study, for Winter Line

campaign, 286

INDEX 643

Erchie, 334, 528Eritrea, 57, 60, 61, 68, 81, 87Eritrea Service Command, USAFIME, 61, 68-70,

79, 81, 102Eskimos, medical treatment for, 33Essential Technical Medical Data Reports

(ETMD's), 179ETMD's. See Essential Technical Medical Data Re-

ports.Etna Line, 159European 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, 178reduction of nurses in North Africa for transfer

to, 219European Theater of Operations, United States

Army (ETOUSA), 531Evacuation

from Antilles Department, 45at Anzio, 271, 274, 279-80, 310-12to the Azores, 30in Brazil, 50-51of Brazilians, 505in Canada, 33-34from Cassino, 245-46, 312of civilians, 279conversion of trucks for use as hospital train

cars, 133from Eastern Base Section, 206flexible policy in British hospitals, 123food for patients, 16, 279from Gela beach, 154holding facilities, 16, 164-65, 237, 307in Iceland, 16lengthening lines of, 157, 159, 303, 305, 306from the Levant Service Command, 72from Libya, 73from the Liri Valley, 292-94from the Mediterranean Base Section, 205in Newfoundland, 25-26in North Africa, 110-11, 115, 118-23, 186officer, Fifth Army, 168from the Panama Canal Zone, 40-41, 45in the Persian Gulf Service Command, 77, 86-87planning, 43, 108, 148-49, 163-64, 203, 226, 395,

499policy, 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, 395in the Rome-Arno Campaign, 303-10, 312from Salerno, 226, 228-30study of British methods in Tunisia, 223in, Tunisia Campaign, 73, 122-30, 137-38, 206to the United Kingdom, 206in the Volturno campaign, 240in the Winter Line campaign, 240-43, 245

Evacuation, by airalong air ferry routes, 30-32by 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, 480by commercial airline, 28by L-5, 460

Evacuation, chain of, 73, 137, 271first echelon, 3, 268second echelon, 3, 73, 269, 274, 294third echelon, 5, 232fourth echelon, 5, 73fifth 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 landby 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, 107by cable tramway, 433by jeep, 120, 125-26, 134, 227, 274, 292, 293, 298-

99, 426, 464, 466by 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, 479by ski litter, 430by toboggan, 430by train, 23, 34, 41, 77, 87, 204-05, 310-12, 342,

372, 398, 404, 448, 532in British hospital trains, 123, 138in hospital trains, 138, 167, 204-05, 250, 502,

503in Michelin cars, 123in prisoner of war trains, 506, 540

by truck, 125-26, 129, 133, 153, 167, 227, 464, 466Evacuation, by water, 16, 196, 205, 312, 372, 373,

466by British hospital ships, 167, 206, 226by Dukws, 466by LCI, 271, 372by LST, 149, 153, 167, 226, 271, 279, 311, 312,

396, 396nby raft, 233by ship, 16, 22, 28, 45, 68, 79, 166, 206, 372, 490,

506by troop carrier, 97-98, 149, 167, 226by weapons carrier, 293

Evacuation hospitals, 4, 5, 130, 144, 160, 163, 164,186, 219, 244, 248, 253, 267, 304, 310, 312

300-bed, 111


Evacuation Hospitals—Continued400-bed, 4, 119, 127, 129, 132, 134, 163, 164, 165,

170, 183, 225, 237, 268, 277, 305, 307750-bed, 4, 107, 120, 127, 132, 135, 164, 170, 190,

230, 237, 278, 305, 307at Anzio, 282-84and daily reports on number of patients ready

for disposition, 250damaged by storm, 243dental laboratories connected with, 262-63and French ambulances, 251late arrival of, in Sicily, 170psychiatric treatment in, 145value proved during Tunisia Campaign, 255

Evacuation Hospitals, numbered8th, 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, 39238th, 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, 19993d, 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—Continued128th, 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, 315Exposure, at Salerno, 236Eye clinics, 430-32Eyeglasses, unexpected need for, in North Africa,

208-09

Faid Pass, 124, 134Fano, 498-500, 510-12, 528Far East, 57, 85Farrell, Maj. Elliston, 90, 91Fasani, 294Fedala, 115, 117, 118, 119Feriana, 125, 126, 129Fernando de Noronha, 50, 55Ferryville, 217-18Fes, 187, 205Fever of undetermined origin (FUO), 173Fevers, treatment of, at specialized facilities, 249Fiala, Maj. Frank C. J., 347Field Ambulance Company, 159th, 90Field Artillery Battalions

601st, 319, 414602d, 319, 414697th, 422698th, 4221125th Armored, 424

Field Artillery Brigade, 13th, 386Field Artillery Group, 35th, 406Field hospital platoons, 73, 79, 153, 154, 170, 171,

248, 249, 253, 302, 307Field hospitals, 4, 74, 76, 87, 149, 155, 160, 163,

225, 237, 282, 293, 294, 295, 297, 299, 30450-bed, 70100-bed, 4, 76, 86, 127, 253200-bed, 86400-bed, 4, 127, 277, 321and lack of combat experience, 170in Middle East theater, 67and retention of nontransportable patients, 253

Field Hospitals, numbered4th, 71, 73, 84, 197, 199, 225, 333, 334, 497, 529,

53010th, 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—Continued16th, 68, 70, 8418th, 74, 76, 8619th, 74, 76, 8626th, 74, 76, 8632d, 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, 54635th, 333, 334, 497, 499, 527, 528, 529, 530, 541,

54699th, 498, 529, 541, 550

Fighter Command, 181Filariasis, 83, 91Finley, Lt. Col. Theodore L., 210Firestone Tire and Rubber Company plantation,

North Africa, 66First aid

in Eastern Command, 321instruction, in Sicily, 150packet, 1for plane crash victims, 84stations at Winter Line campaign, 240

1st Special Service Force. See Special Service Force,1st.

Fitzgerald, Brig. Gen. Shepler W., 66Flinn, Lt. Col. James E., 411Flooding, 260, 440Florence, 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, 303-04Fondouk, 129-30Food inspection, by Veterinary Corps, 263, 359, 517,

551, 556in Brazil, 54—55in the Fifth Army, 485in the Middle East theater, 102in the South Atlantic Wing, Air Transport Com-

mand, 54-55in the Tunisia Campaign, 146

Food loss, due to improper packaging, handling,and storage, 218-19

Food poisoning, 76, 213, 359Food poisoning, bacterial, 98, 316Food supply, 28, 79Footwear, 33, 262Force 163, 366, 369Force 343, 148, 149-50. See also Armies, Seventh.Foreign Liquidation Commission, 103Formia, 293Fort de l'Eau, 111Fortaleza, 47, 49, 50, 55

FortsAmador, 38Bell, 28Brooke, 42Buchanan, 42, 44Chimo, 31, 33Clayton, 37, 38Gulick, 37, 38Kobbe, 37, 38McAndrew, 23-24, 25Pepperrell, 23, 24Read, 43, 44, 45Simonds, 44

Fourth Fleet, 47Fox, Brig. Gen. Leon A., 9, 95, 363, 364, 365France, 7, 46, 104, 525, 552Francolise, 525Franklin, Col. Daniel, 148, 164, 369Franklin, Lt. Col. Joseph P., 180Fredendall, Maj. Gen. Lloyd R., 105, 111, 123, 124,

127Free Territory of Trieste, 549French Army units

ArmiesB, 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, 38419th, 124, 131Expeditionary, 238, 239, 243, 244-45, 251, 265,

289, 290, 291, 292, 294, 295, 299, 301, 302,304, 312, 314, 318-19, 332, 335, 515

Divisions1st Algerian, 3671st Armored, 3762d Moroccan, 238, 2393d Algerian, 238, 2394th Moroccan Mountain, 2899th Colonial, 367

French doctors, 113French Equatorial Africa, 60French Guinea, 66French malariologists, on British-American ma-

laria control committee, 213French medical units, 304

evacuation of field hospitals by, 238-39evacuation of forward hospitals by, 295and hospital train, 138and support of II Corps, 295

French Morocco, 81, 83, 181French scientists, and Typhus Commission, 95French Somaliland, 61French West Africa, 46, 66, 82, 99Frew, Maj. Edith F., 369Freyberg, Lt. Gen. Sir Bernard, 245Frobisher Bay, 31


Fruit juice, medical value of, 99Furth, 542

Gabes, 129Gaffey, Maj. Gen. Hugh J., 152Gafsa, 122, 125, 127, 129, 142, 144Galapagos Island, 38Gallo, Capt. Francis, 417Gambia, 60Gambut, 73Gander, 23, 31Gander Field, 23Garigliano front, 273, 303-04, 318Garigliano River, 235, 243, 244, 260, 266, 267, 270,

289, 291, 293, 296Gas gangrene, 253Gastritis, chronic, 451Gastrointestinal disorders, 88, 98Gastrointestinal service, 450Gatun Lake, 41GBC. See Greenland Base Command.Gela, 152, 153-55, 156, 167, 169General Depot, 6671st, 348General Dispensaries, 63, 64, 69, 71, 225

5th, 1876th, 1898th, 189

General hospitals, 5, 9, 12, 79, 80, 191500-bed, 85, 86600-bed, 42750-bed, 74, 84, 861,000-bed, 68, 74, 77, 183, 188, 190, 225

General Hospitals, numbered3d, 192, 193, 195, 336, 397, 402, 4116th, 180, 183, 205, 336, 337, 347, 444, 450, 481, 495,

496, 499, 500, 529, 540, 54612th, 188, 332, 335, 336-37, 349, 448, 493-94, 529,

54617th, 329, 490, 496, 530, 54621st, 188, 190, 216, 329, 335, 336, 36923d, 331, 335, 336, 40224th, 194, 197, 337, 471, 480, 490-491, 494, 502,

528-29, 530, 532, 54626th, 190, 204, 208, 333-34, 497, 501, 502, 529, 54633d, 194, 196, 197, 336, 337, 493, 530, 54636th, 333, 335, 336, 397, 40237th, 194, 335, 481, 490, 496, 499, 500, 523, 528,

529, 530, 539, 540-41, 546, 54838th, 63, 65, 68, 72, 73, 74, 77, 80, 81, 84, 85, 97,

102, 10341st, 43-44. See also Station Hospitals, 359th.43d, 194, 339, 371n, 397, 40245th, 183, 329, 490, 496, 499, 528, 529, 53046th, 180, 194, 339, 40264th, 194, 335, 337, 447, 490, 491, 494, 527, 530,

55070th, 194, 337, 448, 471, 473, 480, 494, 527, 529,

530, 546

General Hospitals, numbered—Continued113th, 74, 76, 77, 86, 322161st, 45208th, 15, 16210th, 38218th, 38262d, 38300th, 329, 335, 336, 339, 490, 496, 528, 529, 550

Geneva Cross, use of, 2, 139, 271, 288, 554Genoa, 523Georgetown, British Guiana, 44German Army units

Army Group G, 375Armies

Tenth, 269, 292Fourteenth, 273Nineteenth, 381

Afrika Korps, 60, 124Divisions

11th Panzer, 37629th Panzer, 478148th Grenadier, 462

German dental equipment, use of, 146German doctors, Sicily, 162German hospitals. See also Station Hospitals, num-

bered, 334th (Ger.).and capacity of, 4761and Fifth Army required to use, 477Luftwaffe, 536military, 304and treatment of American casualties at the

Rapido River, 244German Medical Service, 476-78, 500, 535-39German troops, 226Germany, 47, 538, 542, 543, 549Ghana. See Gold Coast.Ghedi, 536, 537-38Ghedi prisoner of war area, 536, 537, 538Ghinda, 57-58, 69Ghisione, 485, 517Ghisonaccia, 497Gilmore, Col. Hugh R., 212, 259Ginn, Col. L. Holmes, Jr., 148, 263GOALPOST, 117Goethals, Col. Thomas R., 180Gold Coast, 65, 83Goldson, Col. Robert, 369, 542Gonorrhea, 412, 431Goose Bay, 31, 33Gorgas Hospital, 37, 38Gorizia, 523Gothic Line, 302, 416, 417, 418, 419-21, 425, 426,

435, 436, 457, 458, 467, 490, 513, 516Goumiers, 332Gowen, Lt. Col. Guy H., 369Grant, Maj. Gen. David N. W., 66Great circle route, 22Great Falls, Montana, 31Great Sound, Bermuda, 27

INDEX 647

Greece, 65Green Project, 55Greenland, 18-19, 21-22, 30, 31, 32Greenland Base Command, 18, 19, 22Grosseto, 301, 306, 313, 314, 319, 337, 490, 495, 496,

502, 516, 517, 529Guadalcanal, 89, 366, 553Guatemala, 38Guatemala City, 38Guenther, Lt. Col. Augustus J., 369Guianas, 34, 47Guincarico, 307Gulf of Gaeta, 295Gulf of St. Lawrence, 31Gullickson, Lt. Col. Herbert L., 102Gura, 57, 58, 60, 69Gurabo, 43Gurley, Col. Webb B., 369, 413Gustav Line, 238, 239, 243, 245, 247, 258, 265, 267,

270, 289, 292, 294, 303, 336, 340, 430

Halazone tablets, 215Halstead, Lt. Col. James A., 450Hamadan, 76Hampton, Lt. Col. Oscar P., Jr., 409, 450Hancock, Maj. Michael Q., 32Hanser, Lt. Col Samuel A., 276Hanson, Col. Frederick R., 145, 210, 253, 350, 409,

487, 514Harmon, Maj. Gen. Ernest N., 115Harmon Field, 24, 25, 26Hartgill, Maj. Gen. William C., 324Haverty, Capt. Eugene F., 279Hawley, Maj. Gen. Paul R., 504Health officer, occupied Germany. See Stayer, Maj.

Gen. Morrison C.Heat, prickly, 99Heat exhaustion, 99Heatstroke, 99Heatstroke centers, 79, 99Heimstra, Capt. Fred A., 47Helgafell, 15Heliopolis, 57, 63, 68Heliopolis Area, 61. See also Delta Service Com-

mand, USAFIME.Heminway, Col. Norman L., 19Henry Barracks, 42, 44Hepatitis, 353, 451Hepatitis, infectious, 98-99, 216, 257, 350, 451Highway 7, France, 384Highways, Italy

1: 300, 302, 304, 418, 4602: 300, 301, 302, 3046: 238, 243, 244, 245, 246, 252, 270, 289, 290, 292,

296, 298, 2997: 270, 289, 291, 292, 294, 295, 296, 3039: 418, 419, 458, 462, 466, 47364: 416, 421, 423, 425, 429, 432, 440, 457, 458, 460,

461, 466, 469, 471, 473, 480, 481, 482, 517

Highways, Italy—Continued65: 416, 417, 419, 421, 422, 426, 427, 431, 435, 437,

444, 445, 448, 454, 457, 458, 460, 466, 468, 471,473, 482

67: 416, 42068: 302, 3196520: 4206521: 416, 4206524: 416, 417, 419, 421, 426, 427, 436, 4376528: 419, 421

Hill, Maj. Arthur W., 412Hill, Lt. Col. Otho R., 19, 22Hill 609, 134Hilldrup, Col. Don G., 66Hitler line, 292Hofn, 13, 15Holding facilities, for patients awaiting evacua-

tion, 16, 164-65, 237, 307Holmboe, Col. Harris, 538Honduras, 38, 39Horses, use of, 102, 162, 264-65, 318-20, 456, 484Hospital admissions

for combat wounds, 1, 1n, 2-6, 29, 111, 143, 165,173, 201, 211, 240-41, 252-53, 286, 444. See alsoBattle 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, 165Hospital construction

in Africa, 57, 78-79air-conditioned wards, 86in Brazil, 49in Canada, 33and civilian labor shortage in Iceland, 14in the Eastern Base Section, 193in Greenland, 19, 20-21heating for, 14, 66and lack of insulation, 33in Levant Service Command, 64in Newfoundland, 24-25in the Panama Canal Department, 37, 38in the Persian Gulf Command, 76-77in the Puerto Rican Department, 43shortage of materials for, 13types of

area, 56cantonment type, 49, 79one-story, 78permanent, 24, 33, 38, 43, 68, 70, 194prefabricated, 13, 202, 336rosette pattern, 77temporary, 38-39, 43, 44, 49, 186, 430tentage, use of, 73, 76, 183, 186, 188, 189, 190,

271, 275, 335, 336, 430zone of interior, 49

and use of local materials, 49, 77Hospital inspection

at Anzio, 277by consultants, 211-12


Hospital inspection—Continuedby Icelandic doctors, 11by theater surgeon, 212

Hospital rotation and replacement, 275, 277, 282,291

Hospital Ship Platoons5th, 20534th, 20236th, 20237th, 202

Hospital shipsat Anzio, 279, 282attacked, 177, 228-29lack of

in Bermuda, 28in the Middle East, 79for North Africa invasion, 108, 115

planned use ofat Anzio, 268in Sicily Campaign, 149

under control of Allied Force Headquarters, 226Hospital ships, British, 110, 185, 192Hospital ships, named

Acadia, 168, 206, 341, 397Algonquin, 357Chateau Thierry, 397Emily Weder, 397John Clem, 397Leinster, 110Newfoundland, 228-29St. David, 271, 283St. Mihiel, 28Seminole, 168, 206, 341Shamrock, 397Thistle, 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, 34141st, 205, 251, 310, 332, 342, 502, 54642d, 205, 310, 342, 39866th, 342, 398

Hospital trains, Italian, 542Hospitalization policy, 6, 40-41, 247-48, 255-56,

277-78Hospitals, 64, 76, 83, 245, 527. See also British

medical units; Convalescent Hospitals; Evacu-ation hospitals; Evacuation Hospitals, num-bered; Field hospitals, Field Hospitals, num-bered; General Hospitals; General Hospitals,numbered; Station Hospitals, numbered; Sur-gical Hospital, 48th.

bombing of, 228, 271, 275-77, 283, 297-98, 311,331

damaged by storm, 231Fifth Army, 237, 243, 246, 250, 255, 291, 304, 310in Iceland Base Command, 12-16lack of, during invasion of North Africa, 110in Levant Service Command, 71

Hospitals—Continuedmaintenance and repair of, 191, 304placement of, 248protection of, 79transport of, 23, 38, 67, 68-70, 84, 85, 86, 111,

119, 125, 126, 129, 132, 183, 246, 271, 275, 291,303-10

types ofbase, 28, 255, 290civilian, use of, 23, 103, 111, 113-114, 115Engineer Corps, 19, 24, 26, 32, 38fixed, 5, 50, 68, 82, 120, 123, 136, 164, 182,

185, 188, 189, 206, 240, 250, 312, 329forward, 206, 248, 311mobile, 67, 120, 121, 123, 127, 132, 137, 143Navy, in Bermuda, 27post, 25, 34, 37, 38, 44provisional, 9, 119, 183, 320Red Cross, 119special, 249, 555

Hot springs, use of, for heating, 14Howard Field, 37Hnitafjordhur, 12Huddleston, Col. Jarrett M., 223, 268, 271Hudson Bay, 31Hudson Bay Company, 33Hume, Brig. Gen. Edgar Erskine, 220-21, 360, 361,

520Hungary, 320, 549HUSKY. See Sicily Campaign.Hutchinson, Lt. Col. William A., 58Hutments, 190Huts, types of

Boyle, 194corrugated steel, 13Nissen, 12, 13, 29, 188, 189, 190, 194prefabricated, 13Quonset, 13

Hutter, Col. Howard J., 180Hyde, Col. James F. C., 66

IBC. See Iceland Base Command.IBS. See Island Base Section.Iceland, 8, 18, 30, 31Iceland Base Command (IBC), 10-18Idstein, 542Immunization. See Innoculations.Inch, Col. T. D. (RAMC) , 489India, 60, 70, 83, 85. See also China-Burma-India

theater.India-Burma theater, 84Infantry Battalions

100th, 230, 418, 418n. See also Infantry Regi-ments, 442d.

509th Parachute, 268, 270, 274550th Airborne, 374

Infantry Divisions1st, 105, 112, 113, 122, 124, 128, 129, 133, 152,

156, 158-60, 174, 267

INDEX 649

Infantry Divisions—Continued3d, 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, 129th, 105, 108, 115, 117, 122, 124, 127, 129, 131,

133, 146, 156, 159-60, 161, 26734th, 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 Regiments6th, 4187th, 296, 37715th, 296, 377, 37816th, 112-13, 153, 15418th, 112-1326th, 112, 113, 15430th, 157, 162, 296, 37739th, 108, 110, 122, 156, 157, 15947th, 115, 159, 16160th, 117, 118, 159, 16185th, 433133d, 245135th, 110, 245141st, 227, 244, 376, 382142d, 227, 245, 382143d, 244, 382, 384157th, 152, 153, 227, 384168th, 109, 110, 111, 125, 245179th, 152, 153, 227, 383180th, 152, 153, 384337th, 451349th, 452

Infantry Regiments—Continued361st, 301, 302362d, 483363d, 302, 303365th, 424, 458366th, 424370th, 418, 425, 429, 461371st, 424, 425, 458442d, 230, 302, 415, 418, 418n, 424, 457-58, 461,

462, 463, 538473d, 424, 432, 458, 461, 462, 463504th Parachute, 152, 320, 234-35, 238, 268505th Parachute, 152509th Parachute, 105, 113, 122517th Parachute, 302, 374551st Parachute, 374

Infectious hepatitis. See Hepatitis, infectious.Injuries. See Hospital admissions, for injuries.Innoculations, 17, 94, 172, 556Insects, in Iceland, 17. See also diseases by name.Intestinal diseases, 26, 76, 79, 212, 483, 530Invasion Training Centers

Fifth Army, 149, 223, 224, 251Seventh Army, 368

Iran, 56, 60, 61, 64, 68, 73, 74, 76, 77, 82, 86, 100,103

Iran-Iraq Service Command, 60Iranian Army, surgeon of, 95Iranian Engineer District, 59Iranian Mission, United States Military, 59, 64, 100Iraq, 59, 61, 64Isernia, 235Isherwood, Col. John A., 43Island Base Section (IBS) ,181, 197-99, 208, 339,

342, 348, 349, 488Italian Army units. See also Italian Hospitals.

Groups1st Motorized, 238, 251Cremona, 526Legnano, 424, 458, 459, 526

Division, Italia Bersiglieri, 462Italian campaign, 255. See also campaigns by name.

combat planning for, 326justification of, 552medical planning for, 223-24

Italian doctors, 257Italian engineer battalion, and malaria control,

289Italian Government, 541Italian home guards, 152Italian Hospitals, 57, 251, 327

304th Field, 16610th Reserve, 166

Italian litter-bearers, 432Italian medical depot, capture of 169Italian peace treaty, 550Italian personnel, released from prisoner of war

status, 541


Italian police, prostitutes given into custody of,258

Italian Riviera, 531Italians, use of, in U.S. hospitals, 501Italy, 47, 63, 65, 104, 174, 500-503, 515, 519-20,

523-51Itri, 292, 293, 303, 313Ivigtut, 19, 22Ivory Coast, 66

Jackson, Lt. Col. William M., 320Jamaica, 8, 41, 44, 45Japan, 55, 92, 521, 544, 547Japanese-Americans. See Infantry Battalion, 100th.Jaundice, 17, 249Jaundice, catarrhal, 26Jean Bart, 117Jeep courier, 207Jeeps, use of, 426, 432, 553. See also Evacuation, by

land, by jeep.Jeffcott, Lt. Col. George F., 102Jeffress, Col. Vinnie H., 180, 332, 400John Clem, 397Johns Hopkins faculty, medical consultant from,

210Johnson, Col. Clyde C., 45Johnson, Col. Cortlandt, 47Joint French Rearmament Committee, 347Jones, Col. Jenner G., 324, 487-88Jorhat, 84Joss Force, 152, 155, 169Juin, General Alphonse P., 110, 243

Kaldadharnes, 12, 15Karachi, 60, 82Karr, Maj. James R., 47Kasserine Pass, 124, 127, 129, 135, 137Kazvin, 76Keeney, Col. Paul A., 28Keflavik, 10, 15Kehoe, Lt. Col. Emmett L., 25Kendricks, Col. Edward J., Jr., 65Kenner, Maj. Gen. Albert W., 106, 119, 123, 138,

148, 177, 178, 179Kesselring, Generalfeldmarschall Albert, 417Keyes, Col. Baldwin L., 97Keyes, Maj. Gen. Geoffrey, 147, 156, 238, 243, 296,

415, 421, 422Khartoum, 60, 70, 84Khorramabad, 76Khorramshahr, 73, 74, 76, 86Kindley Field, 28Kings Point, 27Kirk, Maj. Gen. Norman T., 217Kirkman, Col. Lewis W., 181, 306Knapp, Lt. Col. Leslie E., 66Koeltz, General Louis-Marie, 124, 131KOOL Force, 152

Korea, 554, 555Kuwait, 61

L-5's, 460La Meskiana, 127La Senia, 112, 137, 188Laboratories. See Dental laboratories; Medical lab-

oratories.Labrador, 31Lagens, 29Laiatico, 307Lakes

Averno, 357Como, 523, 536Garda, 523Lucrino, 357Trasimeno, 302

Lampedusa, 151Lampione, 151Lanuvio, 296Larviciding. See Disinfestation, larviciding.Lattre de Tassigny, General Jean de, 367, 376Lawrence, Col. Gerald P., 217LCI's, 271, 372Le Ferriere, 304, 310Le Kef, 124Lecce, 497, 528Leese, General Sir Oliver, 267Leghorn, 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, 526Lehmann, Capt. Werner, 32Leinster, 153Leishmaniasis (Bagdad sore), 100Lend-Lease Act, and supplies for British hospitals

in North Africa, 57Leone, Col. George E., 47, 48, 53Leopoldville, 77nLes Andalouses, 112Levant Service Command, 61, 64, 71-72, 79, 81Leyte, 553Liberia, 60, 66, 67, 78, 79, 84, 89, 90, 91Liberian Service Command, 78, 79, 89, 103Liberian Task Force, 67Liberty ships, 282, 300Libya, 60, 62, 63, 65, 67, 68, 81, 99, 123, 178Libyan Base Command, 79Libyan campaigns, British* 59, 72Libyan Service Command, 62, 64, 72-73. See also

Delta Service Command; Tripoli Base Com-mand.

Licata, 152, 155-59, 164, 167, 169, 181Lieberman, Col. John F., 11Lice. See Disinfestation.Lighting and power facilities, shortage of, Tu-

nisia Campaign, 134Limited assignment personnel, 316, 451, 460, 514

INDEX 651

Linner, Lt. Col. Gunnar, 24, 25Linosa, 151Liri River, 199Liri Valley, 238, 239, 243, 244, 289, 292, 295Litter bearers, 2, 3, 4, 293, 295, 427, 428, 554

at Cassino, 245in the Liri Valley, 293at the Rapido River, 244at Salerno, 227, 236, 237in the Winter Line campaign, 240use of Czechoslovak prisoners as, 162use of fighting units as, 247use of Italians as, 247, 293

Litter squads, 2, 161, 237, 240, 270Litters, mule, cacolet and tandum, 161, 240Logistics. See Medical supplies and equipment.London, 104, 121Long, Col. Perrin H., 210, 212, 350, 363, 408, 487Lons-le-Saunier, 414Lourmel, 112Louse infestation. See Disinfestation.Losey Field, 42, 44LST's, 149, 153, 155, 167, 169, 175, 226, 226n, 271,

275, 279, 282, 284, 311, 352, 414, 556Lucca, 484Lucas, Maj. Gen. John P., 230, 267, 270, 272, 273Ludwig, Maj. Alfred O., 369, 409Luftwaffe hospital, 536Luzon, 553Lyon, Maj. Champ, 211

MAAF. See Mediterranean Allied Air Forces.MAC. See Medical Administrative Corps.McBride, Col. John R., 19McCracken, Lt. Col. Gerald A., 263McCreery, Lt. Gen. Sir Richard L., 223, 243, 418McDill, Col. John E,, 82McFall, Lt. Col. Thomas A., 102Mackensen, General Eberhard von, 273Macmillan, Harold, 519McNarney, Lt. Gen. Joseph T., 423, 499McSween, Lt. Col. John C., 11Maceio, 47Maddaloni 237! 251, 336Mai Habair, 69Maison Blanche, 109, 110, 111Maison Carree, 110Maknassy, 127, 129, 142, 145Malaria, 68, 201, 256-57, 259, 316, 321, 339, 350,

353, 354-56, 362, 411, 412, 513, 526in the Antilles, 45at Anzio, 286-87in the Atlantic Base Section, 212-13in Brazil, 47, 51-54in Central Africa, 83, 89in the Eighth Air Force, 89-90in the Eighth Army, 173in Italy, 214, 230-31, 260-61, 286-87in Liberia, 91-92, 94

Malaria—Continuedin the MTO, 355-56in North Africa, 60, 63, 66, 106, 145, 196, 212-14,

220, 221in the Panama Canal Department, 39in the Persian Gulf Service Command, 76at Salerno, 230-31in Seventh Army, 173in Sicily, 150, 165, 170, 172-73, 214VI Corps, 195in the South Atlantic, 47surveys, 55, 195in Tunisia Campaign, 145in West Africa, 78, 81, 88-92

Malaria Committee, British-American, 212-13Malaria control. See also Atabrine; Disinfestation,

for malaria control,complicated by German destruction of drainage

system in Italy, 260development of Allied policy on, 90, 213-14filling in of craters by engineers, 260and liaision with British and French authorities,

214planning for

for Fifth Army, 259-60for the Middle East, 88-91for the North Africa campaign, 212-14for West Africa, 89-91

and suppressive therapy, 286-87Malaria Control Branch, Allied Control Commis-

sion, 355Malaria Control Committee, VI Corps, 287Malaria Control Detachment (MCD), 2655th, 213,

259, 354, 412Malaria Control Units (MCU), 89, 213, 216, 260,

35519th, 21320th, 173, 21321st, 21322d, 21323d, 21328th, 213, 26042d, 213, 260, 287131st, 412132d, 412

Malaria Survey Units (MSU), 51-52, 88-89, 173,213, 216

10th, 21311th, 213, 259-6012th, 21313th, 21314th, 213

Malarial Advisory Board, Allied Force Headquar-ters, 213

Malariologist, NATOUSA. See Moore, Col. LorenD.; Russell, Col. Paul F.

Malariologists, 80, 90, 214Malnutrition, 201Malta, 151


Manduria, 333Manila, 546, 548Manitoba, 31, 33Mansfield, Capt. William K., 110Mantova, 500, 523, 530, 539Maquis, 375Margarita Hospital, 37Marine Corps personnel, 10-11, 14, 552Marrakech, 83, 85, 116, 137, 183, 187, 335, 498Marsala, 151Marseille, 504, 506Martin, 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, 462MASH, 555Mason, Lt. Col. Richard P., 324Massa Marittima, 307, 310, 320Massaua, 57, 58, 68, 69, 70Matese Mountains, 233Mateur, 131, 132, 168, 181, 205, 208Maurer, Lt. Col. Murray L., 541Maxwell, Brig. Gen. Russell L., 56, 60, 62Maxillofacial center, 358, 496. See also Station Hos-

pitals, 52d.Meat inspection. See Food inspection.Medical Administrative Corps (MAC), 2, 64, 216,

249, 258, 279, 320, 545, 554Medical advisory committee, Middle East Supply

Council, 62Medical Air Evacuation Transport Squadrons

(MAETS)802d, 139, 167, 168, 196, 204, 226, 311, 341-42,

397, 447n, 480, 531-32805th, 83807th, 196n, 311, 342, 397, 447, 447n, 532, 533808th, 50, 83830th, 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, numbered1st, 113, 124, 154, 1693d, 118, 154, 155, 158, 230, 233, 268, 273, 3785th, 129th, 110, 111, 118,, 119, 120, 122, 133, 24010th Mountain, 432-33, 464-6511th, 23747th Armored, 113, 114, 122, 124, 125, 274, 429,

46548th Armored, 154, 15551st, 107, 115, 124, 132, 133-34, 140, 154, 155,

156, 157, 158, 161, 165, 332, 54652d, 224, 230, 231, 233, 241, 268, 273, 274, 277,

278, 286, 298, 299, 373, 377-78, 380, 393, 39854th, 153, 156, 161, 162, 224, 238, 241, 244, 245,

Medical Battalions, numbered—Continued246, 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, 397109th, 110, 120, 124, 125, 230, 233, 237-38, 240,

245, 303, 417, 426, 465111th, 227, 244, 246, 374, 379, 382, 385120th. 152-53, 228, 237, 240, 374, 383-84161st, 224, 230, 248, 249, 255, 277, 295, 312, 331,

416, 432, 437, 448, 450, 463, 545162d, 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, 404181st, 336, 373, 378, 393, 410, 411261st Amphibious, 154, 155, 156, 164, 224310th, 289, 291, 293, 426313th, 289, 291, 293, 295, 315, 427, 466, 549,

550316th, 303, 426, 467317th, 429, 432, 463

Medical Bulletin of the North African Theaterof Operations, 179

Medical Center, 6744th, 332Medical Companies. See also Medical supply units.

307th Airborne, 150, 232, 326376th Collecting, 373377th Collecting, 373378th Collecting, 373380th Collecting, 478, 538383d Clearing, 467388th Collecting, 374389th Collecting, 374390th Collecting, 374402d Collecting, 277, 312, 480n403d Collecting, 295406th Collecting, 295514th Clearing, 374, 395549th Ambulance, 268, 279551st Ambulance, 295601st Clearing, 255, 291, 303, 304, 307, 315, 437,

444, 450, 463, 473, 480, 545602d Clearing, 258, 263, 278, 279, 291, 304, 317,

437, 444, 453, 469, 473, 483-84, 525615th Clearing, 440, 466616th Clearing, 373, 374, 378, 393, 394, 410, 411638th Clearing, 374, 393, 395, 404675th Collecting, 387, 402676th Collecting, 374, 380, 395682d Clearing, 373, 393683d Clearing, 431885th Collecting, 374, 382886th Collecting, 374

INDEX 653

Medical Companies—Continued887th Collecting, 374891st Clearing, 3742670th Ambulance (Prov), 1966706th Conditioning, 217, 357

Medical Department, 1, 29-30, 120, 143, 314, 486,501, 513-14, 552, 554

and Canada, 33and the Middle East, 63, 99and the Panama Canal Department, 35, 39,

42-43, 44-45Medical 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, 152capture of, 125, 134and care of construction engineers, in Liberia,

67casualties among, 134-35, 240, 273, 275-79, 283,

311, 329disease among, 53, 89, 134drawn from collecting companies, 248duties of, 1-2, 80, 82, 83-84expanded capabilities of, due to specialized

facilities, 248parachute training for, 150preference for American medical supplies as

opposed to British, 87reinforcements for, 55, 128, 134replacement of, by officers of MAC, 169shortage of, 119, 144, 244, 249and study of infectious hepatitis, 256-57transport of, 23, 97-98, 134, 543, 544, 545-46,

554used to augment local public health staffs, 220-21

Medical depot companies. See Medical supplyunits, Depot Companies.

Medical detachments, 9, 43, 110, 113, 122, 162, 373,374

Medical Directorate, British Army Middle-EastForces, 62

Medical equipment. See Medical supplies andequipment.

Medical inspectorsfrom base sections, supervise malaria control

measures in North Africa, 213from Fifth Army, assumes responsibility for

organizing malaria control, 259from Libyan Service Command, 64from USAFIME, 89

Medical laboratories, 49, 94, 99, 225, 258Medical Laboratories, numbered

1st, 190, 3522d, 187, 258, 417, 444, 4504th, 40415th 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 alsoMedical Battalions, 161st and 162d.

Medical sectionof AFHQ, 177-79, 212, 323of Fifth Army, 223-24of MTOUSA, 487-88, 521-22of NATOUSA, 211, 323, 353, 486-87of Persian Gulf Service Command, 64-65

Medical seminars, systematized, 314Medical supplies and equipment, 4, 87, 149, 208-09,

224, 511, 546-47, 553automatic, 87, 88, 208British, use of by American units, 87, 114catalog of spare parts for, 507delayed arrival of

at Gela beach, 154in Iceland, 17in the Levant Service Command, 71at Salerno, 230

for the Levant Service Command, 57, 71loss of

to enemy action, 230, 275, 333to handling, 88, 120, 251at sea, 155, 280

for the Middle East, 87-88obsolete, 134overstocks of, 210, 282

shipped to zone of interior, 40, 88, 507, 551shipped to the United Kingdom, 17in Sicily, 251

and property exchange, 282, 314, 398problems of, 120-21, 142policy for, 16-17, 87-88, 210, 346-47, 372, 407,

507, 550shortages of, 39, 87, 110, 119, 140, 208-09, 252,

552transport of, 17, 88, 252, 282, 292, 314, 346, 404,

405-06, 507-08for the Tunisia Campaign, 99, 134

Medical Supply Branch, 506. See also Medicalsupplies and equipment; Medical supply units.

Medical supply depots. See Medical supply units,Supply Depots.

Medical supply unitsComposite Battalions

231st, 345, 346, 406-08232d, 346, 350, 511, 512

Service Battalion, 232d, 512, 548, 550Supply Depots

2d, 124, 127, 140-42, 169-70, 208, 208n4th, 169, 208, 208n, 224, 227, 3297th, 208, 208n12th, 252

Depot Companies2d, 345, 347, 348-49, 406, 5094th, 87, 332, 345, 3477th, 337, 345, 346, 348, 349, 369, 380,

404-06, 413


Medical supply units—ContinuedDepot Companies—Continued

12th, 252, 268, 280, 312-14, 318, 345, 346,417, 440, 448, 453, 481-82, 548

20th, 1748th, 346

Base Depot Companies57th, 550, 55160th, 346, 509-10, 512, 548, 55070th, 345, 406, 40771st, 345, 406, 40772d, 346, 350, 511, 512, 54873d, 346, 350, 511, 512, 548, 55080th, 510, 511-12, 548

Supply Detachments339th, 550890th, 413

Composite Platoon, 300th, 17Mediterranean Allied Air Forces (MAAF), 184,

326-27, 374-75, 423Mediterranean Allied Tactical Air Force, 460Mediterranean 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, UnitedStates Army (MTOUSA), 496, 498, 509, 532-33

bed ratio in, 529-30evaluation of, 552-57medical section of, 487-88, 521-22responsible for prisoners of war, 540redeployment plans and centers, 526-27surgeon of, 506, 507, 528, 549Tables of Equipment for, 507, 545

Medjez el Bab, 121, 122Meeks Field, 10, 15, 16Mehdia, 117, 119Menfi, 157Merano, 535, 541Mers el Kebir, 111, 112Mess halls, in the Middle East, 97Messina, 158, 159-62Metauro River, 302Meteorological stations, 19-22, 31Methyl bromide (MYL), 362Metz, Col. Karl H., 324, 358Michelin cars, 123Michener, Capt. Elizabeth, 324, 359Middle East, 56-103, 197Middle East Supply Council, 62, 95Middle East theater, 62, 63, 88, 94, 97, 99, 102. See

also Africa-Middle East Theater of Operations;Iran-Iraq Service Command; Persian Gulf Serv-ice Command; United States Army Forces inthe Middle East (USAFIME).

Mignano, 235, 238, 246, 252, 291

Mignano Gap, 235, 238-39Milan, 523, 526, 531Military Government Section, Allied Force Head-

quarters, 361Military Mission to the Italian Army, 459Military police, 201Millburn, Col. Conn L., Jr., 541Miller, Lt. Col. Nesbitt L., 152Mingan, 31, 33Minturno, 243, 261, 289, 291, 293, 304Mirandola, 517Mirgorod, 321Mistretta, 166Mobile Army Surgical Hospital, 555Modena, 525, 538Moccasins, use by American troops, 33Monastery Hill, 292Monrovia, 67Montalto di Castro, 305, 306Montana, 31Monte Cassino, 238Monte San Biagio, 319Montecantini, 499, 527, 529, 532, 544, 545Montecchio, 307Montedoro, 292Montella, 232, 237Montepescali, 306Montesquieu, 127Montevideo, 54Montgomery, Field Marshal Sir Bernard L., 123,

223, 267Montichiari, 537Moore, Col. Loren D., 67, 213Morale, 94, 97, 123, 545, 555Moroccan tabors, 376Morocco, 43, 62, 104, 105, 108, 119, 148, 335Morphine, 373Morris, 132, 190Mortar shell cases, as containers for medical

supplies, 154Mosquitoes. See Malaria control.Mostaganem, 148, 188, 189Mostra Fairgrounds, 327-28, 329, 332, 349, 496, 499Mountain 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., 542MP's, 201Mt. Arrestino, 296Mt. Lungo, 239Mt. Pantano, 240Mt. Sammucro, 239Mt. Trocchio, 239Mukluks, use by American troops, 33Mule Pack Group, 20th, 320Mules, use of, 133, 146, 160-62, 174, 240, 292, 318-

20, 422, 426, 432, 454-56, 479, 553-54Mumps, in Iceland, 17Munhall, Lt. Col. Lawrence M., 216-17, 357

INDEX 655

Munich, 542Munly, Col. William C., 487Murphy, Robert D., 219-20Mussolini Canal, 268, 271, 274Mustapha civil hospital, 111Mustard 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, 222-43Narsarssuak, 18-19Natal, 47, 49, 53, 54, 55, 60Naval Hospital Number 9, 498Naval Shore Battalion, 4th, 227Navy Department, agrees to establish bases in

Greenland, 18Navy epidemiology unit, transfer of Typhus Com-

mission equipment to, 95Navy medical personnel, care of casualties evac-

uated from Salerno, 226Navy personnel, medical treatment for, 14-15,

49-50Navy representative, attends British-American ma-

laria control committee, 212-13Netherlands West Indies, 8, 44Nettuno, 268, 270, 271, 274, 275, 279, 296, 311Neuropsychiatric casualties, 96-97, 256, 284-85,

432-33, 437, 450-51, 483Neuropsychiatric Centers

Fifth Army, 249, 255-56, 315, 369, 409Seventh Army, 410, 411

Neuropsychiatric hospitals, 249, 282, 291, 304,307, 329, 335, 337, 393, 394, 402, 403, 444,480, 514. See also Evacuation Hospitals, num-bered, 56th; General Hospitals, numbered,3d, 45th; Station Hospitals, numbered, 43d,51st, 114th.

Neuropsychiatry, 253-54, 256, 314-15, 316, 556at Anzio, 284in Canada, 33in Greenland, 21-22in the Middle East, 86-87, 88, 96-98in the Po Valley, 513-14in Sicily, 171-72

Neuropsychiatry, problemscombat neurosis, high incidence of, at the Vol-

turno, 236mild neurosis, 255percentage of patients returned to duty, in

Tunisia, 144-45tropical syndrome, 96-97

New Guinea, 89New Orleans, 41New York, 115New Zealand, 102

New Zealand Army unitsCorps, 245, 247Division, 2d, 245

Newfoundland, 8, 24, 25, 26, 30-31, 43Newfoundland, 228-29Newfoundland Air Base, 23Newfoundland Base Command, 23-25Nicaragua, 39Nice, 531Nichol, Col. William W., 548Nicosia, 159, 162, 167, 169Nigeria, 60Nile River, 68Ninth Air Force Service Command, 65Nisei, 230Nissen huts, 19, 30, 130-32, 135Nocelleto, 291, 311Noneffective rates, 322, 515, 555-56

in Iceland, 18in the Middle East theater, 88

Noonan, Col. James E., 218, 325, 359, 487, 516, 517Norman, Lt., Col. E. T., 39Normandy, 25, 552, 553Norris, Col. Benjamin, 210North Africa, 29, 43, 80, 84, 85, 104, 121, 178, 502,

504, 509, 551, 552North African Air Force, 151North African Economic Board, 151North African Mission. See Military North Afri-

can Mission.North African Service Command, 60-61, 81-82,

92, 103North 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 ofOperations, United States Army,

co-ordination with French Army medical sec-tion, 179

establishment of, 178and malaria control directives, 286-87medical section of, 211, 323, 353, 486-87personnel requirements, 179surgeon of, 324, 334, 340, 354Table of Organization for, 211, 338

North African Wing, Air Transport Command,83-84

North Apennines, 302, 486North Apennines Campaign, 415-56, 484, 485, 490,

499, 501Northern Base Section (NORBS) , 181, 199, 208,

349, 350, 488, 497, 502, 509-10Northwest African Air Forces (NAAF), 151, 167,

182. See also Mediterranean Allied Air Forces.Norton, Lt. Col. John W. R., 212Nova Scotia, 26Norwegian Army and Navy personnel, medical

treatment for, in Iceland, 14-15


Nurse Corps, 229, 276, 283, 299, 307, 321, 381,437, 518-19

absent from Fifth Army Neuropsychiatric Cen-ter, 255

accompanies psychotics on Air Transport Com-mand flights, 79-80

award of Silver Star to members of, 288enlisted medical personnel substituted for, in

Brazil, 53flown to Sardinia, 175in Iceland Base Command, 14as a morale factor at Anzio, 288in North Africa, 104, 113in Pan American Highway Medical Service,

39psychiatric school conducted for, 219rest camp privileges, 303rotation and promotion policies, 219, 519shortage of, in North Africa, 219in Sicily invasion, 153and transfers to ETO, 219in Tunisia Campaign, 219

Nurses, Brazilian, 336, 439, 442, 469, 491, 505Nurses, casualties among

at Anzio, 275, 278, 288at Salerno, 229

Nurses, Director of, 219, 369Nurses, German, 477, 540Nurses, male, 57, 60Nurses, Polish refugee, 60

Observation Squadron, 1st, 10O'Daniel, Brig. Gen. John W., 273Oil stoves, use of, to heat field hospitals, 4Okinawa, 546, 553Ombrone River, 302Ondash, Lt. Col. Stephen W., 19Oran, 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, 306Ortona, 240Ostiglia, 485Ostrander, Col. Forrest R., 65Oued Seguin, 190Oujda, 223Ouled Rahmoun, 138Ousseltia Valley, 125OVERLORD, 266, 334

P-40's, 10Pacific Fleet, 8Pacific theater, redeployment to, 521-23, 543, 544,

545, 546Pack trains, Italian, 318-19, 432, 453-54, 484, 545Padloping Island, 31, 33Paestum, 252, 333Palazzo Beccadelli, 484

Palestine, 57, 60, 61, 71, 81, 84, 87, 102Palestine Area. See Levant Service Command.Palermo, 156, 157, 158, 164, 165, 166, 167, 168, 169,

170, 174, 181Pan American Airways, 50Pan American Highway Medical Service, 39Panama Canal, 34-35, 41, 45Panama Canal Department, 34-41, 42Panama Canal Zone, 7, 9, 34, 35, 42Pantelleria Islands, 150-51Pappataci fever, 77, 99, 172, 173, 256-57Parachute Battalions. See under Infantry Bat-

talions.Parachute Regiments. See under Infantry Regi-

ments.Paraguay, 54Paramaribo, 44Paratyphoid, 172Paris green, 356Parkinson, Brigadier G. S., 361, 363Parma, 523, 537Pasteur Institutes, 95Patch, Lt. Gen. Alexander M., 366-67, 415Patton, Maj. Gen. George S., Jr., 105, 127, 130,

147, 172, 267, 366Patton, Col. Thomas E., Jr., 66Pearl Harbor, 8, 42Peatfield, Col. Norman E., 369Peccioli, 307Pelagies, 151Penicillin, 94, 253, 258, 258n, 314, 352, 354, 412,

450, 473, 513, 556Peninsular 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, 546malariologist of, 355psychiatric hospitals in, 493, 528surgeon of, 352, 447, 528, 535

Peptic ulcer, 451Perregaux, 193Persano, 516Persian Corridor, 56, 59Persian Gulf, 61, 76Persian Gulf area, 67, 69, 73, 79, 88, 99-100, 102Persian Gulf Service Command, 61, 64-65, 68, 74-

80, 82, 84, 86-87, 103. See also Africa-MiddleEast Theater of Operations; Iran-Iraq Serv-ice Command.

Peru, 38Petain, Marshal Henri, 108Petralia, 159Pets, care of, 103Pharmacy Corps, 323Philippines, 545Philippeville, 142Piacenza, 537Piana di Caiazzo, 333, 494, 495, 496, 527Pickering, Col. Clifford E., 264-65, 359, 455

INDEX 657

Pico, 292Pietraperzia, 159Pigeons, use of, 306, 444, 456Plitz, Maj. George F., 66Piombino, 302, 306, 511Piper Cubs, 279, 284, 483, 554Piryatin, 320-21Pisa, 302, 303, 488, 495, 496, 498, 510, 516, 520, 527,

533, 535, 539, 540, 541, 550Pistoia, 495, 496, 502, 529, 530, 532Plague, 30, 83, 91, 99, 106, 556Ploesti, 80Pneumonia, atypical, 452, 483Po River, 485, 517Po Valley, 484, 490, 494, 496, 499, 500, 501, 530, 540Po Valley Campaign, 457-85, 500-501, 510, 513,

515, 517, 525, 531, 534Poggibonsi, 302Pohl, Col. Louis K., 327Poletti, Col. Charles A., 220Poliomyelitis, 99, 526Polish Corps, 292, 462Poltava, 320, 321Polvrifitto, 485Pomigliano Airfield, 333Ponce, 42Ponte Olivo, 153Ponteginori, 307Pontepetri, 517Pontine Marshes, 268, 292Port Elizabeth, 57Port-Lyautey, 115, 117, 118, 186Port of Leghorn Organization, 550Port-of-Spain, 44Port Sudan, 57Port Surgeon's Office, 8th, 196Porto Empedocle, 157, 181Portuguese Government, 29Pratolino, 494, 502, 529, 531President of United States. See Roosevelt, Frank-

lin D.Presque Isle, 26, 31, 32Prestwick, 31Prime Minister, British. See Churchill, Winston S.Primolino, 525Priverno, 295Prisoner of War Administrative Companies

2686th, 3406619th, 340

Prisoner of war command, MTOUSA, 525, 538Prisoner of War Enclosures

100th, 202129th, 201, 202, 339130th, 201131st, 202, 339, 498326th, 339, 340334th, 498Ghedi, 334

Prisoner of war evacuation, 165, 540, 541-43

Prisoner of war hospital trains, 506Prisoner 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, 548Prisoners of war

German, 339-40, 386, 464-65, 475-77, 505Italian, 194, 339-40, 462, 535, 554medical treatment for, 197, 434. See also Prisoner

of war hospitals.Prophylactic stations. See Venereal disease.Prosthetic Dental Clinic and Laboratory, II Corps,

263Prosthetic dental work. See Dental Prosthetics.Prostitution, 51, 92-94, 215, 257-58, 354, 412. See

also Venereal disease.Provisional Corps, 156-58, 167Provost Marshal General, 201Psychiatric disorders. See Neuropsychiatry.Psychogenic dyspepsia, 451PT boats, 409, 556Public Health

in Egypt, 62, 94-95in Italy, 361-62, 520in North Africa, 220-21

Public Health and Welfare Subcommission, 361Public Health Service, United States (USPHS),

94, 220, 221, 360Puerto Rico, 7, 8, 9, 26, 41, 42, 43, 45Puerto Rican Department, 41—43Puerto Rican Section. See Caribbean Defense

Command.Pugsley, Col. Matthew C., 152Pursuit Squadron, 33d, 10Pyle, Ernie, 160

Quartermaster Base Depot Company, 684th, 349,509-12

Quartermaster Corpsimprovises equipment, 209issues shoes to troops in Canada, 33operates medical units in the Persian Gulf

Service Command, 76operates shower and sterilization unit, 332

Quartermaster Remount Depots2610th, 5166742d, 359, 455, 516

Quebec, conference in, 519Quebec Province, 31Quinine, use of, 122Quonset huts, 19

RAAG. See Rome Allied Area Command.Rabat, 119, 132, 186Radke, Col. Ryle A., 210, 487Rafidiyah, 59Randazzo, 159, 161Ranger Battalions, 105, 151, 152, 223, 238

1st, 112, 273


Ranger Battalions—Continued3d, 157, 2734th, 273

Rangers, 153, 231, 269Ranson, Maj. Stephen W., 410Rapido River, 206, 238-39, 243-44, 267, 291Rats, examination of, 17, 30Raulerson, Lt. Col. Charles, 369Recife, 47, 49, 54, 55Reconditioning program, in North Africa, 216Recreation facilities. See Rest and recreation

facilities.Red Cross hospitals, 119, 165, 170Red Cross insignia. See Geneva Cross.Red Cross worker, lost to enemy action, 275Redeployment, to Pacific, 521-22, 545Redeployment centers

Brazilian, 527-28in Florence, 545

Regensburg, 542Region III, AMG, 360, 363Remount Depot, Fifth Army, 264, 484, 485, 517Rennell, Maj. Gen. Lord, 220Renshaw, Col. Solon B., 218Repatriation. See Prisoners of war repatriation

policy.Replacement Depots

8th, 49524th, 516

Replacement Training Command, 499Republic of Panama, 38, 39, 41Respiratory diseases, 249, 257, 386, 427, 530, 556

in the Azores, 30in Canada, 33in Greenland, 21in Iceland, 17in Italy, 483in the Middle East, 77, 79, 86, 88, 98in Newfoundland, 26in North Africa, 145, 216

Rest and recreation facilitiesrecreational facilities, 93, 97, 103rest camps, 133, 246-47, 303, 437, 510, 519, 528rest center, Fifth Army, 263

Reykjaskoli, 12, 15Reykjavik, 10, 12, 13, 15, 16, 31Riardo, 237, 242, 246, 252, 255, 291Rich, Col. Joseph, 369Richards, Lt. Col. James T., 323-24Richardson, Lt. Col. Clarence T., 317Rieser, Maj. Julian M., 54Rimini, 499, 528Riola, 484, 517Roberts, Lt. Col. Raiford A., 259Roberts Field, 60, 66, 84, 90, 91, 92, 213Robinson, Col. Albert H., 181, 199, 369Rockefeller Foundation, 53, 94, 363, 365Rockefeller Typhus Team, 216Roe, 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 alsoRome Area, MTOUSA.

Rome Area, MTOUSA, 489, 495, 530Rome-Arno Campaign, 244-65, 289-322, 556

medical support for, 302-20military support for, 299-302

Rommel, Generalfeldmarschall Erwin, 60-61, 124Roosevelt, Franklin D., 10, 108, 519Rosignano, 302Royal Air Force, 56, 151Royal Army Medical Corps, 324, 489Royal Canadian Air Force, 23, 30Royal Canadian Air Force hospital, 23Royal Canadian Mounted Police, 33Royal Navy, 14-15, 69, 105, 114Royce, Maj. Gen. Ralph, 80Rudolph, Col. Myron P., 181, 369Rumania, 65, 80Russell, Col. Paul F., 213Russian Army, 56Russian Mission, transfer of medical personnel

from, 59Russian patients, 529, 533Rustigan, 2d Lt. Robert, 211Ryder, Gen. Charles W., 105

Sacco River, 292Sacco Valley, 292, 295, 296Sadler, Brig. Gen. Percy L., 67Safi, 115, 116, 117, 118, 119, 183St. Arnaud, 190St. Cloud, 113, 115, 188St. Croix, 42, 43St. David, 271, 283St. John, Lt. Col. Clement F., 119St. John's, 23-24St. Lawrence River, 22St. Leu, 114St. Lucia, 8, 41, 43, 44St. Mihiel, 28St. Thomas, 43, 44Ste. Barbe-du-Tlelat, 188Salerno, 188, 226-31, 257, 516, 526, 553

medical planning for, 223-26military planning for, 222-23

Salinas, 38Saline, 307Salsomaggiore, 525Salt tablets, 99Sams, Col. Crawford F., 56, 57, 58, 59, 62, 63, 80Sams, Lt. Col. James E., 542Samuel J. Tilden, 333San Fratello, 160, 162San Fratello Ridge, battle for, 162San Giovanni, 484, 526San Juan, 42, 43, 45

INDEX 659

San Julian, 44San Martino, 517San Pietro, 252San Remo, 531San Stefano, 159, 162, 167, 172Sandfly fever. See Pappataci fever.Sanitary conditions

in the Africa-Middle East theater, 67, 79, 88, 98in Brazil, 53, 54in Eritrea, 62-63, 70-71in Iceland, 18in the Middle East, 79, 98in North Africa, 106, 214in the Persian Gulf Service Command, 77in Sicily, 170in Tunisia, 201, 214-15

Sanitary Corps, 320-21, 354engineer from, attached to the surgeon, NATO-

USA, 220inadequate facilities for cleansing mess kits, 215lack of sewage disposal systems in the Middle

East, 98and malaria control at Anzio, 286-87personnel, 39, 64responsible for antimalaria control measures,

213services to Air Transport Command person-

nel, 81uses Veterinary Corps piggeries for garbage dis-

posal, 102value of screening established

for diarrhea and dysentery control, 145for malaria control, 39in West Africa, 90-91

Sanitary engineers, Italian, and malaria control,260

Sanitary surveys, 57, 221Sanitation team, Ninth Air Force, 65Sant'Angelo, 243, 244Sant'Elia, 239Santa Maria Island, 29Santa Marinella, 304-05San Martino, 485San Sano Wells, 194Sao Luis, 47, 49, 50, 55Sardinia, 174, 188, 264, 488, 497Sauer, Col. Paul K., 231, 275Saylor, Maj. Samuel L., 162Sbeitla, 130, 132Scheele, Lt. Col. Leonard A., 220School of Aviation Medicine, at Randolph Field,

47Scoglitti, 153, 167-68Scotland, 30, 31Scout dogs, 456, 484Sebkra d'Oran, 112Sebou River, 117-18Sedation, use in treatment of psychiatric cases,

145, 171, 255

Selesnick, Lt. Col. Sydney, 258, 279Seminole, 168, 206Senigallia, 302, 497, 499, 510, 529Serchio Valley, 503Service commands, USAFIME, 63Services 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, 106surgeon 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, 15Seymour Island, 38Sfax, 73SHAEF. See Supreme Headquarters, Allied Ex-

peditionary Force (SHAEF).Shamrock, 397Shatt-al-Arab, 76Shea, Maj. Andrew W., 22Sherwood, Col. John W., 37SHINGLE. See Anzio Campaign.Shingler, Col. Don. G., 60Ships. See also Hospital ships, named.

Bernadou, 115Chenango, 117, 118Cole, 115Dallas, 118Dorchester, 19Edmund B. Alexander, 23Jean Bart, 117New York, 115

Shook, Col. Charles F., 210, 323, 401Shu'aybah, 59Sicily, 29, 63, 65, 73, 89, 130, 304, 488, 553, 556Sicily Campaign, 144, 147-76, 181, 211, 251, 555-56

assault phase, 151-52field medical units compared to those of Italy

campaign, 237-38and medical experience used in planning for

Anzio, 267medical planning for, 147-49, 220-21and medical planning compared to Salerno

planning, 223-24military planning for, 147shortage of beds, 205and training of medical troops for, 149-50

Sidi Bel Abbes, 188Sidi Bou Hanifia, 188, 190, 216Sidi Ferruch, 111Sidi Smail, 138, 139Snyder, Maj. Gen. Howard McC., 123Souk Ahras, 123, 127, 142


Souk el Arba, 138, 139Souk el Khemis, 123, 137South African Armoured Division, 6th, 418, 421,

424, 429, 458, 459, 461, 526South America, 35, 38, 44South Atlantic, 46, 49, 60South Atlantic ferry route, 47Southampton Island, 32Southeastern Europe, 63Southern France, 267, 302, 307, 310Southern France Campaign, 366-414

medical planning for, 369-74military planning for, 366-68

Southern Line of Communications (SOLOC), 400-401, 408, 486

Southern Town Command, North African ServiceCommand, 82

Southern Tunisia, 73, 130, 132, 135, 137, 138Southwest Pacific, 544, 545, 546Soviet Union 65, 76Spanish Morocco, 113Sparanise, 251, 310, 527, 529Spaulding, Col. William L., 181Special Service Force, 1st, 238, 239, 272, 295, 296,

367, 371n, 374, 375, 376, 386Specialist personnel, 49, 191, 249Specialist teams, 310, 371Specialization, 248, 249, 282Specialized hospitals

gastrointestinal, 555in Italy, 248-49neuropsychiatric, 249, 282, 555venereal disease, 249, 555

Spinazzola, 529Stalin, Marshal Joseph, 366Stalingrad, 552Station de Sened, 128Station hospitals, 24, 28, 44, 69, 71, 101, 103, 134,

312in Brazil, 55in the Panama Canal Department, 35in the Persian Gulf Service Command, 73-7410-bed, 4225-bed, 23-24, 25, 70, 84, 8540-bed, 2350-bed, 23, 33, 44, 49, 59-60, 84, 8560-bed, 2375-bed, 25, 33, 44, 84100-bed, 25, 28, 32, 42, 44, 49, 50, 58, 69150-bed, 23, 25, 28, 33, 42, 44, 49, 76, 85, 86200-bed, 44250-bed, 24, 28, 44, 58, 67, 71, 74, 84, 85, 86350-bed, 50400-bed, 400450-bed, 25, 58500-bed, 43, 58, 69, 76, 86600-bed, 45750-bed, 43, 74900-bed, 58

Station Hospitals—Continued1,000-bed, 43

Station Hospitals, numbered4th, 32, 336th, 337th, 188, 493, 529, 546, 550111th, 12, 1514th, 13, 1515th, 13, 1519th, 74, 76, 86, 321-2221st, 68-69, 74, 76, 86, 102, 498, 528, 529, 540, 54623d, 77n, 183, 187, 337, 40324th, 64, 71-72, 8425th, 5, 67, 78, 84, 10329th, 188, 189, 196, 338, 348, 439. See also

Evacuation Hospitals, numbered, 170th.30th, 74, 8632d, 189, 332, 335, 496, 529, 54634th, 193, 199, 336, 339-40, 495, 496, 528, 550-5135th, 190, 194, 199, 40240th, 188, 199, 396, 396n, 497, 500, 510, 528, 529,

54643d, 192, 197, 335, 33649th, 13, 1550th, 183, 187, 337, 490, 495, 496, 498. See also

Field Hospitals, numbered, 99th.51st, 183, 194, 335, 350, 402, 41152d, 188, 329, 496, 528, 54653d, 85, 192, 195, 197, 33654th, 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, 55056th, 81, 85, 103, 183, 186, 202, 203, 335, 338,

339, 347, 498, 50957th, 85, 189n, 190, 190n, 204, 337, 458n, 498, 50958th, 192-93, 335, 33660th, 175, 193, 199, 335, 480, 497, 499, 529, 54661st, 136, 189, 204, 333, 334, 497, 550, 55164th, 188, 33566th, 183-86, 333, 335, 336, 339-4067th, 66, 77, 81, 8469th, 183, 194, 337, 40370th, 329, 336, 40372d, 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, 54678th, 192, 195, 197, 202, 336, 340, 402, 53279th, 193, 196, 33580th, 192, 195, 197, 202, 387, 40281st, 192, 195, 197, 335, 493, 529, 535, 540, 54692d, 12, 15-1693d, 78, 84, 85, 89103d, 193, 197, 202, 329, 494, 498, 499, 529, 539,

540, 541, 546104th, 69-70, 81, 84, 85105th, 193, 197, 217, 337, 490, 495, 527, 529, 533,

546

INDEX 661

Station Hospitals, numbered—Continued106th, 329, 496, 528, 546113th, 74, 77. See also General Hospitals, num-

bered, 113th.114th, 193, 195, 197, 219, 336, 337, 350, 493, 528,

540, 546118th, 329, 496, 528, 546131st, 32131st (Ger.), 498133d, 33134th, 33151st, 188, 335, 337154th, 74, 86, 199, 490, 493, 495, 496, 527, 529, 546167th, 12, 15168th, 12, 13, 15175th, 49, 54, 55180th, 188, 199, 202, 402182d, 329, 332, 336, 496, 499, 527, 529, 546188th, 20-21, 22, 22n189th, 22190th, 21191st, 21192d, 13, 15193d, 49, 54, 55194th, 49, 54, 55200th, 49, 54, 55221st, 28-29225th, 329, 332, 480, 496, 499, 527, 528, 529, 546255th, 44256th, 60, 74, 76, 86262d, 333, 340, 496, 529, 535, 540, 546292d, 44, 45293d, 44294th, 44295th, 44296th, 44297th, 44298th, 44, 45299th, 44300th, 44, 45301st, 44308th, 24-25309th, 25310th, 25311th, 25326th, 44327th, 15. See also General Hospitals, numbered,

208th.330th, 44333d, 38334th, (Ger.), 498, 535, 539-40, 541352d, 44353d, 44354th, 44355th, 44356th, 44358th, 44359th, 44, 45. See also General Hospitals, num-

bered, 41st.

Station Hospitals, numbered—Continued365th, 15. See also Station Hospitals, numbered,

14th, 15th, 167th.366th, 15367th, 85, 103368th, 38370th, 85, 183, 187, 335, 338, 498391st, 549, 550, 551392d, 5507029th (It.), 202, 339, 498, 535, 5417393d (It.), 203, 3397550th (It.), 3397607th (It.), 404

Standlee, Col. Earle, 106, 178, 179, 487, 549Stayer, Maj. Gen. Morrison C., 34, 324, 334, 487,

489, 496, 498, 499, 504, 507, 521Stephensville, 24Stevenson, Col. Daniel S., 369, 414Stewart, Maj. John D., 211Stone, Col. William S., 212, 354, 361, 362, 363, 364,

487Storage and issue platoons, 211Strait of Messina, 157Strait of Sicily, 155Strategic Air Forces, 327Strohm, Col. John G., 180Suez Canal, 63, 99Suez Port Command, 63, 79Sulfa drugs, 94, 98Sulfaguanidine, 98Sulfanilamide crystals, 1Sultanabad, 76Summer, Lt. Col. William C., 354Supplies. See Medical supplies and equipment.Supply Depots. See Medical supply units, Supply

Depots.Supreme Headquarters, Allied Expeditionary Force

(SHAEF), 376, 385, 405, 486, 532, 541-42Surgeon General, Office of the, 37, 88, 89, 90, 142,

334Surgery

evaluation of, in II Corps, 144exchange, of surgeon, 435forward, at Anzio, 282reparative, 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, 155Surgical Hospital, 48th, 107, 113, 113n, 120, 124,

125, 126-27, 129, 132, 144, 145, 185, 188. Seealso Evacuation Hospitals, numbered, 128th.

Surgical teams, 144, 435, 449, 466, 469Surinam, 8, 44Sward, Col. E. M. P., 27Sweeney, Col. Leo P. A., 488, 548Syphilis, 144. See also Venereal disease.Syria, 68, 81


Tabarka, 132, 137, 138, 142Tafaraoui, 112, 114, 181Talara, 38Tank Battalion, 758th Light, 424Tarquinia, 305Tarviso, 549Task Forces

Butler, 375, 382, 38445: 415, 417, 418, 418n, 422, 423, 424, 429, 43292: 422

Tassigny, General Jean de Lattre de, 367, 376Teano, 242, 255, 265, 291Tebessa, 121, 122, 123, 124, 125, 126, 127, 129, 130,

132, 137, 142Technical Supervision Regiment, 2695th, 455, 484,

516Tedder, Air Chief Marshal Arthur W., 266Tehran, 64, 74, 76, 79, 82, 86Tel Aviv, 58, 64, 71, 72Tel Litwinsky. See Camps, Tel Litwinsky.Telergma, 132, 137, 139, 142, 190Tents, use of, 73, 183, 188, 190, 193, 194Terceira Island, 29Termini, 158, 164, 167, 181, 206Terracina, 270, 292, 295, 296, 303Terrain, 553. See also Drainage.

effect of, on hospital disposition in Iceland, 12effect of, on neuropsychiatric rate, 256, 409injuries caused by, in Greenland, 21mountainous, 133, 160, 231, 233, 240, 245, 295,

395, 422, 426, 429-30, 433, 457, 460-61muddy, 189-90, 242, 422, 429, 437, 444, 457swampy, 285used to protect casualties, 2, 3, 232

Termoli, 232Tetanus, 172Thala, 125The Pas, 31, 32, 33Thelepte, 139Thistle, 397Thurmond, Maj. Alien G., 32Tiber River, 266, 268, 296Tingay, Col. Lynn H., 149, 358, 413, 453, 487, 515Tine Valley, 131Tinsman, Col. Clarence A., 66Tirrenia, 491, 494Titania, 118Tlemcen, 189TORCH. See Algeria-French Morocco Campaign.Tracy, Col. Edward J., 327Training and Rehabilitation Center, 88th Infan-

try Division, 315Transjordan, 61Trapani, 157, 165Trench foot, 249, 261-62, 285-86, 350, 353, 386,

412-13, 427, 452Trento, 525Treviso, 525, 531

Triage, 14, 171, 171n, 195, 196, 253, 445, 448, 450Trieste, 523, 549, 550Trieste-United States Troops (TRUST), 549, 550-

51Triflisco, 234Triflisco Gap, 233Trinidad, 26, 41, 43, 44, 45, 48, 50Trinidad Sector, 34, 51Tripoli, 73, 85Tripoli Base Command, 64, 79. See also Delta

Service Command; Libyan Service Command.Troina, 159, 160, 161, 164Troop Carrier Command, 168Troop Carrier Wing, 51st, 138, 139Tropical syndrome, 97Truscott, Maj. Gen. Lucian K., Jr., 117, 152, 162,

270, 273, 277, 367, 423-25, 435, 461, 520TRUST. See Trieste-United States Troops.Tuberculosis, prevalence of

in Greenland, 21in Newfoundland, 26

Tuberculosis sanitorium, 331. See also General Hos-pitals, numbered, 300th.

Tulagi, 552Tunis, 82, 85, 121, 122, 131, 149, 156, 168, 175,

188, 205, 226, 266, 498, 509, 510Tunisia, 63, 65, 67, 73, 83, 104, 122, 127, 139-40,

145, 150, 174, 181, 310, 553 556Tunisia Campaign, 121-46, 173, 179, 183, 185, 186,

188, 190, 191, 208, 210, 211, 215, 225, 253, 552Tunisian Desert, 553Turin, 523, 532Typhoid fever, 30, 172, 363, 452Typhoid-paratyphoid infections, 98Typhus, 321, 326, 363-65, 372, 537, 556

in Africa, 67, 83, 106, 216 220epidemics of, 262in the Middle East, 67, 94-95in the Persian Gulf Service Command, 76in Sicily, 172

Typhus Commission, 94-95, 363-65Tyrol, 542Tyrrhenian Sea, 233, 291

Udine, 525, 526, 530, 532, 549Umm Qasr, 59, 60United Kingdom, 30, 80, 108, 120United Nations Relief and Rehabilitation Ad-

ministration (UNRRA), 95United States Army Forces in Canada, 33United States Army Forces in Central Africa

(USAFICA), 65, 77United States Forces in the Middle East

(USAFIME), 60, 62, 80United States Army Forces, South Atlantic

(USAFSA), 47, 48United States Forces, European Theater (USFET),

542

INDEX 663

United States Military Iranian Mission, 59, 88.See also Iran-Iraq Service Command; MiddleEast.

United States Military North African Mission,56-57, 58, 59, 88

University of Palermo Polyclinic Hospital, use ofby American personnel, 157, 158, 159, 164

Uruguay, 54USAFICA. 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.

Vaccinedistributed by Typhus Commission, 95shipped by air, 88suspected as cause of yellow fever in Iceland, 17used against plague in the Azores, 30

Vairano, 242, 244, 248Valdibura, 483Valmontone, 289, 292, 296, 297, 298Van Valin, Col. James C., 152Van Vlack, Col. Hall G., 59, 60, 65Vatican City, 304Velletri, 270, 296-97Venafro, 234, 239Venereal 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, 221in the Antilles, 46, 47at Anzio, 277-78on Ascension Island, 51in the Azores, 29, 30in the Bermuda Base Command, 28-29in Brazil, 47-48in Canada, 33in Eritrea, 93in Greenland, 21and houses of prostitution, 92, 93-94, 215, 257,

321, 257-59, 412in Iceland, 17in Italy, 257-59in the Levant Service Command, 93in Liberia, 81, 93-94in the Middle East, 79, 88, 92in Newfoundland, 26in North Africa, 77, 78, 79in the Panama Canal Department, 39in the Persian Gulf Service Command, 76, 92-93reduction of rates of, 92, 93, 94, 257-59use of penicillin against, 94, 258

Venereal disease control officersin the Fifth Army, 257-58, 279in NATO, 93, 94

Venereal Disease Diagnostic and Treatment Cen-ters, 197, 404, 419, 484

162d Medical Battalion, 249, 258Fifth Army, 258, 263, 419, 525Seventh Army, 411-12

Venereal disease hospitals, 249, 277-78, 291, 304,306-07, 333, 335, 336. See also Station Hos-pitals, numbered, 53d, 66th.

Venezia Giulia, 549Venezuela, 34, 41Venice, 549Venturina, 306Verona, 484, 517, 525, 531, 537Veteran's Administration hospital, transfer of pa-

tients to, 6Veterinarian, Ninth Division, 160Veterinary Companies

36th, 48445th, 265, 413-14

Veterinary Corps, 102-03, 263, 320, 517-18in the Atlantic Defense Area, 9-10cares for pet animals, 103in Iceland, 18inspects food, 102-03, 174in the Middle East, 102personnel, 11, 64, 103, 146, 218, 263-64operates piggeries, 54, 102in the South Atlantic theater, 54-55in Tunisia, 146

Veterinary Evacuation Detachments643d, 517644th, 517

Veterinary hospital, French, 265Veterinary Hospitals, numbered

1st General (U.S.-It.), 5171st Station (It.), 319, 5162d General (U.S.-It.), 517Fifth Army Provisional, 26517th Evacuation, 265, 291, 319, 369, 414110th Evacuation (It.), 265, 291, 319, 454, 485130th Evacuation (It.), 265, 291, 319, 454, 485210th Evacuation (It.), 265211th Evacuation (It.), 454, 484-85, 517212th Station (It.), 454, 484, 516213th General (It.), 359, 516, 5172604th Station (Overhead), 5172605th General (Overhead), 517

Viareggio, 527Vicenza, 525, 526Vichy government, 46, 66Vienna, 533Villafranca, 525, 531, 538Virgin Islands, 42, 43, 44Virgin Islands Department, 37Virus Commission, 99Visciarro, 265Vitamin deficiency, chronic, 99-100Viterbo, 300Vittoria, 153


Volterra, 307Volturno River, 230, 231, 232, 233, 234, 237, 241,

244, 248, 253, 527

Wade, Brigadier E. W., 106Wadi Seidna, 70, 84Walker, Maj Gen. Fred L., 243Walsh, Brig. Gen. Robert L., 47Walter Reed Army Hospital, 6War Department, 41, 103, 219, 345, 346, 347, 363,

496, 504, 514, 521, 533, 545Ward, Lt. Col. Thomas G., 89Wardmen, training of, for Fifth Army Neuro-

psychiatric Center, 255Water purification, 68, 73, 76, 214. See also San-

itary conditions.Water supply

adequacy of in the Levant Service Command,71

contamination and scarcity of, 68, 73in Eritrea Service Command, 70in Libya, 73in North Africa, 106, 214in the Persian Gulf Service Command, 76in Sicily, 170, 172

Weather stations. See Meteorological stations.West, Capt. John L., 517West Africa, 60, 80-81, 88West African Service Command, 66, 81. See also

Central African Command.Western Desert, 63, 72, 99Western Hemisphere, 7, 40, 44Western Task Force, 105, 107, 108, 119, 120, 121,

140, 186

Western Town Command (Africa), 82Wheeler, Brig. Gen. Raymond A., 59Whole blood. See Blood, whole.Wiesbaden conference, development of prisoner

exchange program at, 552Wilbur, Lt. Col. Bernice M., 219, 360, 487Williams, Lt. Col. O. S., 541Williams, Col. Wilson C., 361Wilson, Maj. Gen. A. R., 368Wilson, General Sir Henry Maitland, 323, 367, 423Winnipeg, 32, 33Winter Line, 233, 235, 238-43, 245, 249, 251, 261,

263, 265, 285, 340Winter Line campaign, 241, 333

incidence of trench foot during, 261-62, 285procurement of pack animals for, 263-65

Women's Army Corps, 81, 336, 554Wooten, Maj. Gen. Ralph H., 47Wounds, combat. See Hospital admissions, for

combat wounds.Wright, Lt. Col. Daniel, 90

YAK fighter planes, Russian, 321Yaws, prevalence of, in Africa, 83Yellow fever, 67, 83, 91Youks-les-Bains, 129, ISO, 136, 137, 139Yugoslavia, 326, 549Yugoslavs, use of, in hospitals, 510

Zanderij Field, 44Zehm, Col. Abner, 152, 157Zone of interior, 148, 150, 498, 501, 502, 511,

514, 530, 532, 533. See also Evacuation, chainof, fifth echelon.

U.S. GOVERNMENT PRINTING OFFICE : 1987 189-578

CMH_Pub_10-8 Medical Service in the Med

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