CHAPTER XIII
The European Theater of Operations (1944-45)
Stanhope Bayne-Jones, M.D., and ColonelEdward J. Dehn?, MC, USA
THE CAMPAIGN IN NORTHWEST EUROPE
Of necessity, a successful assault by theAllied Expeditionary Force upon Normandy would ultimately involve both theUnited States and British Armies in CA/MG (civil affairs/military government) inthe countries to be liberated and during the occupation of Germany.
Before the invasion and throughout the campaign in Europe,four main centers of plans and operations dealt with public health in connectionwith the civil affairs/military government and with the medical services of thefield forces. These were SHAEF (Supreme Headquarters, Allied ExpeditionaryForce); Headquarters, 21 Army Group for the British Zone; the SHAEF Missions,connected chiefly with Headquarters, 21 Army Group; and Headquarters, ETOUSA(European Theater of Operations, U.S. Army), representing the military medicalservice of the American Zone. Various degrees of liaison and collaborationprevailed among these groups, but there was no single overall professional ormilitary authority over public health activities.
The medical services of the United States and British Armiesconducted public health operations as part of their programs of preventivemedicine for troops. The fulfillment of this obligation meant participation inthe prevention and control of diseases in civilian populations in contact withtroops. Referring specifically to U. S. components, not only was the civilaffairs organization at all levels an integral part of the Army but also in manyhealth activities directed to the civilian populations, both friendly and enemy,the theater medical service made significant contributions, some of which atcritical times were essential in accomplishing the overall mission. On thewhole, the operational relationship between the two major U.S. public healthorganizations-Office of the Chief Surgeon, ETOUSA, and the Public Health Branch,G-5 SHAEF-was such that the narrative of events cannot always separateaccounts of the activities of each element engaged in the campaign.1
1(1) Invarious capacities and positions, one of the authors ofthis chapter [Colonel Dehn?] had first-hand contact with the G-5 SHAEF civil public health operations in the Europeantheater from 26 January 1944 to 31 December 1945, from Normandy to Berlin. Muchof the material recounted here has been drawn from his personal experiences. (2)General sources of relevant information: (a) Pappas, Col. James P., MC, HQ,European Civil Affairs Medical Group, ECAD, to The Surgeon General, Washington,D.C., through Office of the Chief Surgeon USFET (Rear), 30 July 1945,subject: Annual Report, 1944, European Civil Affairs Medical Group, EuropeanCivil Affairs Division. (b) Riheldaffer, William H., M.D.: A Review of MilitaryGovernment-Public Health operations in the European Theater of Operations DuringWorld War II. Lecture presented at Walter Reed Army Institute ofResearch, Washington, D.C., 3-4 Oct. 1962. (c) Winebrenner, John D., M.D.: CivilPublic Health Operations in the European Theater of Operations in World War IIand After. Lecture presented at Walter Reed Army Institute of Research,Washington, D.C., 3-4 Oct. 1962. (d) Bailey, Lt. Col. John Wendell, SnC, USAR(Ret.): An Outline Administrative History of Civil Affairs in the ETO.Wiesbaden, Germany, 1 July 1945. (e) Dehn?, Col. Edward J., MC: History ofMilitary Government in Germany, Public Health, From V-E Day, 8 May 1945 to 30June 1946. Submitted by the Public Health Branch, International Affairs andCommunications Division, Office of Military Government for Germany. U.S. Zone,1946.
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Invasion of Normandy
The great invasion over the beaches of Normandy extended 20miles inland by the end of June. A brief report to G-5 SHAEF by a CivilAffairs officer, Maj. E. J. Boulton, on his initial visit to the FUSA (FirstU.S. Army) zone of operations, on 10-11 June, indicated that the health ofcivilians was generally good and there were no epidemics. There was no civilianhospital in the liberated area and the civilian casualties who could not betreated by indigenous physicians were cared for by the military medicalservices. From the V Corps area, civilian casualties were evacuated to Bayeux.No Civil Affairs medical officers were on the ground. Medical supplies,especially those for treating wounds of civilians, were urgently needed. Reportscovering the early days of the invasion are rather fragmentary, but apparentlyno serious civil health problems were encountered.
Small communities.-In the U.S. area, the rapid liberationof French towns-Grandcamp, Carentan, Montebourg, Valognes, Barfleur, Saint-Vaast-la-Hougue,Sainte-M?re-?glise, Bricquebec, and Saint-Pierre-?glise-byassault troops was closely followed by Civil Affairs Detachments, called forwardby the First U.S. Army. Sixteen detachments were in operation by 15 June. On 24June, two forward echelon public health teams arrived to give public healthguidance. These were sent from the 1st ECA (European Civil Affairs) MedicalDetachment of the 1st ECA Regiment, which was still in England. They were underthe command, respectively, of Capt. (later Col.) John D. Winebrenner, MC, andCapt. (later Maj.) Fred H. Burley, SnC. These teams were severely handicapped bylack of transportation and shortage of personnel, deficiencies which werealleviated by the rear echelon of the 1st ECA Medical Detachment when itdebarked on Omaha Beach on 30 June with vehicles and trained medical enlistedmen.
Operations of CA Detachments followed a common patternalthough no towns presented the same conditions. Immediate actions were thereestablishment of local government, emergency treatment and evacuation ofwounded, organization of auxiliary police, care of refugees, provision ofemergency water and food supplies for the needy, public health and sanitarysurveys, issuance of civilian travel passes, procurement of labor for Armysupport, assistance to the Army in relations with the civilian population, andearly restoration of community services and facilities. In the early phase,military progress was aided by the administration of triage and emergencytreatment of wounded civilians, by the provision of water, food,
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and shelter, and by the procurement of laborers for work onthe beaches and ports. For the Civil Affairs officer, medical as well asnonmedical, it was always essential first to make a quick estimate of thesituation, arrive at conclusions, and then take simple, clear-cut lines ofaction.
Cherbourg and vicinity.-Cherbourg,the first large city liberated in France, was administered by the first majorCivil Affairs Detachment, CAD A1A1, which included among its members one CAPHO(Civil Affairs Public Health Officer), Capt. Juan Basora-Defillo, MC. Thisdetachment landed at Utah Beach on the evening of 14 June 1944 and reported toVII Corps, First U.S. Army. Its strength of 22, later increased to 44, includedCivil Affairs personnel of various categories. On 27 June, the day the city wascaptured, the detachment moved into Cherbourg, together with the combat troopsto which it was attached. Its headquarters was set up in the chamber ofcommerce, and its officers and specialists met with the major, the healthofficials, and other principal officials of the city. The CAPHO and eachspecialist established communication with their counterparts in the municipalgovernment.2
General conditions. Although damage to the city, about 25percent, was less than expected, the population had been reduced, chiefly byforced evacuation, from about 40,000 to about 5,000. The remaining inhabitantswere patriots who, evading German evacuation orders, had stayed to witness theliberation. Civilian casualties were light, and most of the wounded could becared for in civilian hospitals. Food for 30 days was available. Some lootingoccurred during the first few days after the surrender, but police werefunctioning and law and order were maintained. Public health administration aswell as most civilian community functions and services suffered from lack oftransportation and poor communications. Early restoration of newspapers, movies,radio, and courts was achieved. The first newspaper to be published in LiberatedFrance was distributed on 3 July; and on 4 July, the Cherbourg ContinentalEdition of the Stars and Stripes was issued. Eight changes in commandwithin a short space of time resulted in repeated changes in military policy andorders.
The CAPHO concentrated on organizing and establishingcivilian health services as rapidly as possible. He assisted the detachmentcommander in dealing with the medical and public health aspects of liaisonbetween military and civilian parties. The damaged water supply system wasrepaired by 3 July. Of a large stock of food captured in the arsenal part wasturned over to the 4th Division, and the remainder to civilian authorities.Efforts were made to prevent overcrowding of accommodations, but, because largenumbers of troops had moved into the city and many civilians had returned,considerable overcrowding occurred. Problems of the control of prostitution weredealt with by city health officials assisted by the local
2Report, Civil Affairs DetachmentA1A1, June-August 1944. SHAEF G-5 HistoricalReports, Cherbourg.
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FIGURE56.-Capt. Edward J. Dehn?, MC, USA.
CAPHO who made available medical supplies and arsenicals forthe treatment of syphilis.
Early in July, the initial work in Cherbourg having beencompleted, CAD A1A1 minus its Public Health officer moved to a temporarylocation outside that city to deal with various problems in the First U.S. Armyarea and to prepare for an eventual move to Paris. One of its first duties wasto defend its own personnel. The CAPHO was missing because he had been retainedby the military commander at Cherbourg. This "cannibalizing" wasreported to the Surgeon of the Forward Echelon, ECAD, Capt. (later Lt. Col.)Edward J. Dehn?, MC (fig. 56), at Chateau-Epinquet. He succeeded in securingthe return of Captain Basora-Defillo to the unit in time for him to enter Pariswith the division. During the campaign, other instances of tactical commands'appropriating personnel and vehicles from CA detachments occurred but wereusually resolved by the Division and Regimental Surgeons of ECAD (European CivilAffairs Division).
Displaced persons and refugees. Thefirst camps for displaced persons and refugees were opened in the vicinity ofSainte M?re-?glise and Cherbourg in the First U.S. Army area. PHO 1st Lt.Samuel J. Ravitch, MC, of one of the Public Health teams of the Forward Echelon,ECAD, and Maj.
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Frank J. Laverty, SnC, of the 1st ECA Medical Detachment,supervised the public health activities in these camps.3 As combatlines advanced, additional camps were opened. Most of the refugees from theimmediate combat area were dispersed among the civilian population; the woundedand sick were sent to temporary, improvised shelters. After the capture of Caenon 9 July, refugee camps at Amblie and Bussy were expanded and more than athousand refugees were evacuated to the FUSA area.
Medical supplies. During this earlyphase, a medical supply problem was caused by the large size of the ARB (AlliedRequisition Board-British) and Civil Affairs Division-U.S. units. These hadbeen designed for the long term needs of large cities and were not suited to theshort term needs of smaller towns and camps. The consequent problem of theiraccessibility was solved in a manner that set a pattern for dealing with similarsituations in the future. These units were broken down into emergency panniersthat could be carried in jeeps or in 1?-ton trucks. In addition, 14truckloads of German and French medical supplies uncovered at Cherbourg wereremoved to a medical dump at Utah Beach, where they were inventoried andimmediately made available through Civil Affairs channels.
Communicable disease control. Acivilian laboratory for testing water samples from localities on the Normandypeninsula was established at Cherbourg, and some confirmatory testing was doneby Army medical laboratories. Health reports from newly recovered areas werealways fragmentary because of the disruption of communications, transportation,medical services, and public health administration. Communicable diseases wereseldom reported by civilian physicians, who paid little attention to them in theface of the overwhelming immediate tragedies of warfare. Furthermore, reportsoften were inaccurate or exaggerated, causing CAPHO's to be sent on hastytrips only to find mistaken diagnoses. For example, reported louse infestationoften proved to be scabies. Language barriers and unreliable reports and rumorsbrought in by nonmedical persons aggravated this problem. Reports of typhusfever led repeatedly to undue alarm since the French terms for typhus fever andtyphoid fever were easily confused. To prevent this, the term "epidemiclouseborne typhus fever" replaced the term "typhus fever."Despite the low endemicity of malaria in Normandy and Brittany, reports oflapses occurring in troops caused concern which was allayed when surveysrevealed too few Anopheles mosquitoesin the area to warrant sanitary engineering controls. The French venerealdisease control law was of assistance as it provided for the detention andtreatment of patients. Sporadic cases of diphtheria occurred, and there were afew instances of small epidemics of this disease. Outbreaks of diarrhea atrefugee camps were successfully managed.
General and nutritional problems. Atfirst, Civil Affairs Public Health Officers performed detailed operationsrather than supervising the civilians
3See Sec. III, page 4 of footnote 1(2) (e), p. 432.
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in conducting them because the area was crowded with troopsand civilian activities and travel were restricted. Experience soon indicatedthat the CAD's required only minimal supervision by public health specialists.A full-time CAPHO was seldom needed by a CAD as guidance was given by the PublicHealth Officer traveling from detachment to detachment. The contact andcommunication system of the Civil Affairs company was used also by CAPHO's togive advice and receive reports. Medical enlisted men with the CAD's assistedin following up recommended sanitary measures, helped to maintain a journal ofpublic health actions, and received and dispatched reports.
The distasteful task of burying the dead after heavy fightingwas often initiated by the CAPHO since, in many instances, shovels were notavailable from civilian sources. The survivors, dazed and helpless, oftenexisted amidst destruction and desolation but usually responded well to guidanceand leadership and showed a remarkable capacity for recovery when given onlyminimal assistance.
The mild season, the ample agricultural resources ofNormandy, and a rather widely dispersed population reduced the gravity of thecivil affairs situation. A large portion of the dietary needs was provided fromlocal resources. Malnutrition was limited to low-grade forms in children. Theliberated population was composed predominantly of women, children, and theaged, few of whom were capable of much labor, but most could care for the infirmand manage for themselves. The Civil Affairs effort was aided greatly by thestalwart, impassive character of French peasants who accepted the situation asit existed, imbued with the will to survive despite the catastrophe that hadswept over them. Fortunately, the people of this region lived close to the soil,were hard workers, and could supply most of their basic needs. Had this been ahighly industrialized area, problems might have been more numerous.
Breakthrough at Saint-L? and Advance Across France
General conditions.-The breakthrough atSaint-L? on 25 July 1944 was followed by severe combat and the rapid advance ofthe Allied armies across the northern half of France. Falaise was envelopedand Coutances, Avranches, Brest, Rennes, Vire, Mortain, and Caurmont werecaptured. The battlefield at Falaise was called by Gen. Dwight D. Eisenhower"unquestionably one of the greatest 'killing grounds' of any of the warareas."4 While many towns escaped damage, some were destroyed.Saint-L?, for example, a road center, had hardly a habitable structure standingafter the bombardment and, as it could not be rehabilitated, its inhabitantswere evacuated (fig. 57).
By mid-September, all of northern France, Belgium, and Luxembourg had been liberated, and the Dutch border and the western border of Ger-
4Eisenhower, Dwight D.: Crusade in Europe. Garden City, N.Y.: Doubleday & Co., Inc., 1948, p. 279.
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FIGURE 57.-Saint-L?, a key city of France, reduced by Allied and German shelling torubble, which is being cleared to allow reinforcements and equipment to moveforward.
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MAP 12.-Breakthrough, advance, andrapid enlargement of Civil Affairs Public Health operations, 24 July-15 September 1944.
many as far south as the Saar had been reached and crossed ina number of places (map 12).
Civil Affairs Detachments followed closely behind theadvancing columns to control the civilian population and refugees, to evacuatecivilian casualties to civilian treatment facilities, and to reestablishgovernmental organization and procedures as quickly as possible. Portions of thepublic health section of the CAD remained in place, after the combat troops hadmoved forward, to supervise the carrying out of required health measures. Withinslightly more than 6 weeks after the breakthrough at Saint-L?, Civil Affairscontrol extended over many villages, towns, and cities in France, Belgium, andLuxembourg.
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In the United States Sector, the Civil Affairs MedicalDetachments with public health functions frequently were called into action bythe field forces to which they were attached (the First and Third U.S. Armies,the 12th Army Group, and Advance Section, Communications Zone). Increasingly,they provided guidance, supervision, and direct services in public health tocivilians and occasionally, to military units. Through experience in thisregion, it became clear that civil public health operations under existingconditions required close collaboration between the theater Medical Service andCivil Affairs, as represented by the G-5 Public Health Branch and the ECADMedical Detachments. Indeed, as the restoration of civil government was basic tothe restoration of public health administration, this primary objective of CivilAffairs was, in large measure, a part of the program of public health.Consequently, accounts of public health activities include a great deal aboutthe so-called nonmedical aspects of Civil Affairs.
Communicable diseases.-The chief communicable diseases ofcivilians during this period were diphtheria, tuberculosis, entericinfections (diarrheas, dysentery, and typhoid fever), venereal diseases, andscabies.5
Diarrheas and dysentery were prevalent, at times, in thelarge camps for displaced persons and refugees. An outbreak of 104 cases oftyphoid fever occurred in the civilian population in Greater Li?ge, Belgium,from 1 August to 18 November 1944.
Throughout northwest Europe, the venereal disease rate rosein the civilian population. Army Surgeons and Civil Public Health Officers wereequally aware of the problem thus presented to the military forces; manyconferences were held, many staff papers were written, and civilian healthauthorities were prodded to act. With the scarcity of penicillin, the unusualconditions posed by two huge foreign armies in France and Belgium in succession,and the inherent difficulty of effective venereal disease control, theaccomplishments in this area were not great and all concerned felt a degree offrustration in dealing with the problem.
The incidence of diphtheria had also been mounting innorthwest Europe during the German occupation and continued to be relativelyhigh after the invasion. Immunization programs, mainly for children, werealready in effect and were developed further as diphtheria toxoid became morereadily available through local production facilities and through the CivilAffairs supply units. While no large-scale epidemic occurred, the overallincidence was far above the prewar level.
Some anxiety arose over a possible spread of epidemiclouseborne typhus fever in Normandy. Reports indicated that, during May 1944,typhus had occurred among Russian and Polish workers who had been brought into
5(1) Medical Department, United States Army. PreventiveMedicine in World War II. Washington: U.S. Government Printing Office. Vol. IV, 1958; Vol. V, 1960;and Vol. VII (see especially ch. X, Typhus Fevers), 1964. (2) Gordon, Col. John E., MC: A History ofPreventive Medicine Division in the European Theater of Operations, U.S. Army, 1941-1945. 2 vols.
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Cherbourg by the Germans to work on coastal fortifications.This anxiety was allayed by a report by Maj. Theodore E. Woodward, MC, of theUnited States of America Typhus Commission,6 who made an inspection trip toCherbourg and other places in the liberated area and found no evidence of typhusamong the civilian population. He estimated, however, that about 30 percent ofpersons whose homes had been destroyed and about 5 percent of the generalpopulation were infested with lice. In view of the potential hazard, he believedit was imperative that a DDT dusting program be instituted at once.7
French physicians and other personnel were organized intodusting teams, DDT powder and necessary equipment which had not then reached theliberated area were brought in from London, and a dusting program wasinaugurated. The program was carried out in this area, and elsewhere later,under the direction of representatives of the Typhus Commission, of the G-5 SHAEF Public Health Branch, and of the PreventiveMedicine Division, Office of the Chief Surgeon, ETOUSA.
General and nutritional problems-Thehigher regionaland departmental public health organizations in northwest France and Belgium,which were not seriously dislocated by the war, were soon able to deal with thecurrent problems. Water supplies, disposal of wastes and sewage, laboratoryservice, and related matters were put in order and functioned well. In all ofthese undertakings, CAPHO's were influential in guiding and supervisingcivilian officials. Food supplies and nutritional problems in these countrieswere subjects of serious consideration and investigation, at times requiringremedial measures (p. 444).
Displaced persons and refugees-Large numbers ofrefugees and ambulatory civilian casualties attempted to return to their homesunaided. It was necessary to clear them out of the way of military operationsand to supervise and control their movements. For these purposes, CAD's C112and D212 became "refugee control detachments" in August 1944, with thespecial mission of establishing routes over which a quarter of a millionrefugees and thousands of wounded and sick were kept away from military lines.Groups of refugees were brought under control in the French communities, andwere cared for through the Maires, the Secours National, and the CroixRouge Francaise, under guidance and supervision of CAD's,which billeted and fed them without military assistance. In only two
6A Field Headquarters of the United States of America TyphusCommission (which had been established by Executive Order No. 9285 by PresidentFranklin D. Roosevelt on 24 December 1942) was established in London in May1944. While retaining its integrity and scope as a miscellaneous activity of theWar Department, the Commission was attached to the Public Health Branch, G-5SHAEF. During the rest of the war, the Commissionworked closely with this Branch, the ECA Medical Detachments and Groups, theregular theater Medical Service, and various civilian organizations, to preventand control typhus fever in the European theater. A detailed account of this isgiven by the former Director of the Commission, Brig. Gen. S. Bayne-Jones, USAR(Ret.), in Medical Department, United StatesArmy. Preventive Medicine in World War II. Volume VII. Communicable Diseases:Arthropodborne Diseases Other Than Malaria. Washington: U.S. GovernmentPrinting Office, 1964, ch. X.
7Report, Maj. Theodore E. Woodward,MC, to Public Health Branch, G-5, SHAEF, July1944, subject: Typhus Control.
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instances was it necessary for the G-5 Section of the Third U.S. Army to furnish relief supplies.8
One of these situations occurred at Brest:
A special problem developed in the vicinity of Brest when theGermans expelled the city's civilian population in the probable hope ofembarrassing the American forces. [Civil Affairs] Detachment C112 was dispatchedto this area and the G-5 Refugee officer, together with a French liaisonofficer, surveyed the area. Instructions were issued to the Maires and the Chief of Gendarmes of each community to clearthe main highways and route individuals to communities where billetingfacilities still existed. Six thousand refugees were entrained from Landerneauto Morlaix. The refugees which came through the German lines were excellentlyhandled by the French Authorities, with the assistance of four women of theMilitary Liaison for Administrative Matters, through dispersal and billeting innearby communities. Detachment C112 provided emergency hard rations, whichincluded soap, codfish, pulses, biscuits, meat, milk, and chocolate. Itsofficers coordinated the work of the Maires. The Secours National establishedemergency feeding stations where necessary and a total of 24,000 refugees werecared for without interference to military operations or supply, and withoutsuffering to the individual.9
Along the battlelines, control routes were established formoving refugees to nearby transit camps, where they were kept for a few daysbefore being moved to more permanent camps. These camps were operated by FreeFrench volunteers, at first under the jurisdiction of CAD's or militaryauthorities. As the combat lines advanced, the camps were transferred to civilauthorities as temporary places for refugees until more permanent homes could befound for them. Military transport was used to move medical and sanitarysupplies from civilian and Civil Affairs sources. In crowded situations, therefugees slept on floors or on straw for a day or two, but cots and tents wereprovided later. In addition, during this period, Civil Affairs Detachmentsbecame responsible for the civilians in the internment camps which wereuncovered as the troops moved forward.
Camps for displaced persons and refugees, which usuallyoperated under Army control, included dispensaries. The ARB and CAD publichealth and medical supply units proved too large for meeting emergency medicalneeds. Therefore, a drug unit was augmented by dressings and other items andsmall "dispensary units" were set up. These were the Civil Affairsmedical kits, which were found to be particularly convenient and useful.Likewise, refugee camps were managed satisfactorily largely by local physiciansunder the general supervision of Civil Affairs officers.
Invasion of Southern France
The Seventh U.S. Army landed on the coast of southern France,near Toulon and Marseille, on 15 August 1944, commencing Operation ANVIL.
8(1) After ActionReport, Third U.S. Army, 1 August 1944-9 May 1945. Vol. II. Staff SectionReports, G-5 Section, Ch. 3. August Operations, Sec. IV, Refugees andDisplaced Persons, p. 6. (2) Note: The G-5 Sectionof the After Action Report of the Third U.S. Army contains monthly summaries ofevents and operations with much information about civilian conditions, CivilAffairs, Military Government, and Public Health activities in France andGermany. The relationships between G-5 Army and G-5 SHAEF are clearlyindicated, although the whole story is not told-S. B-J.
9See footnote 8 (1).
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This force moved swiftly northward up the Rhone Valley andreached the Swiss border by 1 September. With the First French Army, it formed apart of the 6th Army Group. On 11 September, just 27 days after the landing, theSeventh U.S. Army joined the Third U.S. Army in the vicinity of Dijon, and thisjunction of forces caused the disintegration of all German units in southwesternFrance.
Fortunately, in this vast and populous region of southernFrance, no conditions or situations among the civilians demanded unusual orextensive operations by CAD Medical Detachments. There were no serious healthproblems and no epidemics, and the civilian public health administration wassatisfactory.10
Communicable disease control.-There was no seriousprevalence of communicable diseases, but there was a threat of typhus, which inthe winter of 1943-44 had been epidemic in Naples. Typhus control teams,composed of French civilians, were organized and trained in methods of delousingwith DDT. Sufficient DDT was provided for a program of disinfestation of inmatesof prisons in Nice and Marseille, which were regarded as potentially the mostdangerous sources.
The only serious disruption of sanitary services occurred atToulon and Arles, where the damage to water supply systems caused shortages ofwater for drinking, household uses, and flushing out sewers. These systems wererepaired.11
Care of wounded civilians; hospital services-Thetreatment of wounded civilians by the Seventh U.S. Army Medical Servicepresented problems to the combat forces in this campaign as in other campaignsin Europe. The problems involved both military medical services and CivilAffairs. A lack of aggressive action by Civil Affairs to make maximum use ofcivilian resources is revealed by the following excerpt from a report:
During the advances wounded civilians from the forward areaswere being evacuated out of the area to Army Evacuation Hospitals. Thisovertaxed the medical, surgical, and bed facilities of these installations, andinterfered with the proper handling of U.S. patients.
Except in extreme emergencies and for immediate life-savingtreatment, civilians will not be evacuated to Army Evacuation Hospitals, butwill be hospitalized in available civilian institutions provided for thatpurpose.12
From the time of the invasion of Normandy in June1944 until at least 2 months after the fighting ended inGermany in May 1945, the military medical services were confronted with theproblem of the medical and surgical care of wounded civilians (fig. 58). Woundedcivilians were first cared for at military aid stations or at posts of CADMedical Detachments. Some were evacuated from these field stations to civilianfacilities in the
10Report, Allied Forces Headquarters, to G-5 ETO,September 1944, subject: Report, Southern France, 31 August-6 September 1944.
11Report, Headquarters, 6th Army Group, G-5, to G-5 SHAEF, Public Health Branch, dated 21 Sept. 1944, subject: Weekly Civil Affairs Summary.
12Annual Report, Headquarters, Seventh U.S. Army, Office ofthe Surgeon, 1944 (Medical Department activities).
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FIGURE58.-A Belgian refugeecasualty receives treatment at a U.S. Army aid station, atOttr?, Belgium, before evacuation to a civilian facility.
rear; others were admitted to military hospitals for surgicaloperations or medical treatment. The records of the First, Third, Seventh, andNinth U.S. Armies show that the numbers of civilians admitted to such hospitalsin each Army ranged from 150 to 650 per month. Although the total number ofcases was relatively small compared with the large number of military casualtieshandled, this extra load constituted an added burden on the military medicalservice. During 1944, French civilian casualties were held in the Army areauntil they became convalescent. Later, to reduce these burdens, efforts weremade to find suitably equipped and staffed French civilian hospitals as soon aspossible and to transfer wounded civilians to them. Civil Affairs medicalpersonnel through liaison aided in the operation of this system of evacuation.
The Liberation of Paris
The SHAEF authorities had hoped that Paris might be capturedwithout making it a battleground. Bombing of the French capital had been
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avoided and plans had been made to surround the area, thusforcing the surrender of the German garrison. Fighting in Paris, however, wasprecipitated on 19 August 1944 by an uprising of French resistance forces whoseized the Ministries and Prefectures. To support these forces, two Allieddivisions-the French 2d Armored and the U.S. 4th Infantry Divisions-enteredParis on 25 August, quickly subdued the Germans, and restored order. On thisday, the German commander surrendered formally to Gen. Jacques LeClerc,commanding the French 2d Armored Division, and Gen. Charles de Gaulle arrived inParis and announced the composition of the Provisional Government of the FrenchRepublic, with himself as President of the Council. On 28 August, Maj. Gen.Leonard T. Gerow, commanding officer of V Corps, in a letter to Gen. PierreJoseph Koenig, Military Governor of Paris, turned the city over to the French.Fortunately, no great material damage had been caused by the fighting.13
Civil affairs-public health activities in Paris began on 26August when a combined Civil Affairs "A" Detachment, containing bothAmerican and British personnel, with the same CAPHO who had served in Cherbourg(Captain Basora-Defillo), entered the city. This CAD, bringing in relief food,assumed administration over an area encompassing the departments ofSeine-et-Marne, Seine-et-Oise, and Loiret; Civil Affairs support came from the12th U.S. Army Group and the U.S. Communications Zone.
Public health activities included a survey of the nutritionalstatus of the population; investigation of the water supplies, sewage andgarbage disposal; analysis of hospital beds; and a study of the extensivemedical supply resources and requirements. Close liaison was maintained withcivilian public health authorities. Assistance was rendered through 21 CAD's,one for each arrondissement. At the governmental level, these functions wereperformed by the SHAEF Mission to France.
Immediate problems were caused by limited stocks of coal,limited electrical lighting, inadequate pumping of water and sewage, and lack offuel for the gas plant. Flour and other foods were critically short and,although there were surplus foods in the liberated areas, there was no way ofmoving them to Paris. On 26 August, the first convoys moved from the SommervieuCivil Affairs Base Port Depot; the next day, the trucks carried the Union Jackand a chalked legend: "Churchill Keeps His Promises."14 By1 September, 2,800 tons from the 21 Army Group had been delivered, and by 6September, 2,336 tons were airlifted.
Other immediate tasks were caring for civilian casualties,safeguarding food supplies, and maintaining order.
In general, by October 1944 the health situation in theliberated areas of France, which included Paris, had stabilized and no acuteproblems were
13See pages 296-298 infootnote 4, p. 436.
14Donnison, F. S. V.: Civil Affairs and Military Government,North-West Europe, 1944-1946. In History of the Second World War.United Kingdom Military Series. Edited by Sir James Butler. London: Her Majesty'sStationery Office, 1961.
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being encountered. No critical shortages of medical andsurgical supplies and equipment existed, serums for emergencies were beingobtained from the Pasteur Institute in Paris, and other shortages were being metfrom stocks of Civil Affairs medical supplies. Reports from the 12th Army Groupindicated that civilian departments of health were becoming more active,according to Lt. Col. James T. Cullyford, MC, CAPHO, who coordinated with Col.Tom F. Whayne, MC.
The Parisian situation was similar to the generalsituation regarding health. By October, the health situation in Paris was good.Although the supply of whole milk continued to improve, it was still irregularbecause of a lack of transportation and a lack of coal for pasteurization.Distribution of milk was largely limited to children under 14 years of age.15
During the period from 26 August 1944 to 31 July 1945, anumber of detachments of the 1st European Civil Affairs Regiment werestationed in Paris. At first, some were attached to the 12th Army Groupand the U.S. Communications Zone; finally, all were attached to theCommunications Zone.
PUBLIC HEALTH ORGANIZATIONS
Two Civil Affairs public health organizations wereestablished in the European theater during the period July-September 1944:the Civil Affairs Branch, Office of the Chief Surgeon, ETOUSA; and the EuropeanCivil Affairs Medical Group, ECAD, connected with G-5 SHAEF Public HealthBranch. Although some information about them has been given (p. 431), it isdesirable here to focus on them. Both were engaged in continuous operations, andboth were involved in the nebulous assignments of public health responsibilitiesand were concerned with the obvious need for collaboration between the regulartheater medical service and the public health activities of SHAEF.
Civil Affairs Branch, Office of the Chief Surgeon, ETOUSA
On 23 May 1944, a theater directive16 raisedCivilAffairs from special staff level to general staff level in the ETOUSAorganization. The same directive placed upon the Office of the Chief Surgeon(Maj. Gen. Paul R. Hawley) the following duties in connection with the medicaland public health program for civilians in liberated and occupied countries:"f. Medical Service: (1) Requisitioning, procurement, storage and issue ofmedical supplies for civilian use. (2) Supervision of public health andsanitation, including supervision of the rehabilitation of civilianhospitals."
Predicated upon this directive, the Civil Affairs Branch ofOperations Division, Office of the Chief Surgeon, ETOUSA, was established as of1
15Extract from "Daily Journal," Headquarters,Paris Civil Affairs Detachment, 25 Oct. 1944.
16Memorandum, Headquarters, ETOUSA, to Chiefs of Generaland Special Staff Sections, ETOUSA, 23 May 1944, subject: Staff Duties andResponsibilities for Civil Affairs.
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July 1944 with Lt. Col. Walter L. Tatum, MC, as chief of the branch.17Colonel Tatum was a Civil Affairs medical officer who hadbeen attached to the Office of the Chief Surgeon on 1 May 1944 by theAssistant Chief of Staff, G-5, Communications Zone, ETOUSA.
After the establishment of this Branch, but not entirely as aresult of its establishment and activities, there ensued a long period ofdifficulties, confusion, and considerable accomplishment nevertheless, most ofwhich are described and discussed by Tatum18andArmfield,19 among others.
The Chief Surgeon, ETOUSA, was unable to carry out all of theduties imposed by the directive of 23 May 1944 because, as previously explained,he had not been provided with the means and personnel for civil affairs publichealth operations. Furthermore, the directive conflicted with other directivesfrom Headquarters, ETOUSA, and from SHAEF. In addition, policies and proceduresof the G-5 Section, Headquarters, Communications Zone, were also at variancewith the plans and requirements stated in the directive. Confusion was increasedby Civil Affairs Administrative Memorandums Nos. 8 and 9 from Headquarters,ETOUSA, dated 8 August 1944, which placed certain responsibilities for medicaland public health services for civilians upon commanders of Communications ZoneSections. Finally this directive was interpreted differently at differentechelons.
In September 1944, a new directive was issued which partiallyclarified the situation.20 The Chief Surgeon was made responsiblefor (1) requisitioning, storage, and bulk issue of medical supplies (completeARB and CAD units) for civilian use; (2) supervising public health andsanitation, and issuing such regulations regarding the control of sanitation andcommunicable diseases among civilians as were necessary for the propersafeguarding of the health of the military command; and (3) furnishing technicaladvice and necessary assistance to Civil Affairs personnel.
Reports indicate that the directive of 25 September 1944 didnot settle the issues. Nevertheless, the staff surgeons and medical officersassigned to G-5 Sections cooperated closely with each other. There was alsoconsiderable collaboration between the Chief Surgeon's Civil Affairs Branchand the G-5 SHAEF Public Health Branch and the European Civil Affairs MedicalGroup, and with the European Civil Affairs Division itself. Some examples ofthis are to be found in the accounts of the rehabilitation of water supplies inCherbourg, Li?ge, and other cities, and in the control of outbreaks of typhoidfever in Belgium.
17Office Order No. 40, Office of the Chief Surgeon, Headquarters, ETOUSA, 9 July 1944.
18(1) Annual Report, Civil Affairs Branch, Operations Division, Office of the Chief Surgeon, ETOUSA, 1944. Annex 6 to the Period Report. (2) Journal, Civil Affairs Branch, Operations Division, Office of the Chief Surgeon, Headquarters, ETOUSA, 7 Dec.1944-28 July 1945.
19Armfield, Blanche B.: Medical Care for Civilians inLiberated Countries. In Medical Department, United States Army.Organization and Administration in World War II. Washington: U.S. GovernmentPrinting Office, 1963, pp. 362-370.
20Memorandum, Headquarters, ETOUSA, to Chiefs of General andSpecial Staff Sections, ETOUSA, 25 Sept. 1944, subject: Staff Duties and Responsibilities forCivil Affairs.
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In all matters relating to communicable disease control, thisCivil Affairs Branch closely coordinated its activities with the PreventiveMedicine Division, Office of the Chief Surgeon. Reports from civilian andmilitary sources were made available immediately to all interested sections,and reports were made, as required, to the Public Health Branch, G-5 SHAEF.
A close and highly beneficial liaison was maintained betweenthe Civil Affairs Branch of the Office of the Chief Surgeon and the FieldHeadquarters of the Typhus Commission, chiefly when it was located first inLondon and later in Paris, under the command of the Field Director, Brig.Gen. Leon A. Fox, MC, USA, during 1944-45.
Although there was, in fact, extensive collaborationbetween officers of the medical service of the field forces and officers of theG-5 SHAEF medical and public health organizations, important underlyingconflicts of interests and basic theories remained. On the one hand, therepresentatives of Civil Affairs who were concerned primarily with problemsamong the civilian population believed, on the basis of expressed opinions andactions, that officers of the regular medical service were only secondarilyinterested in such problems. On the other hand, officers of the regularmedical service, even some senior ones, believed firmly that public healthofficers assigned to G-5 SHAEF, in general, would not be able to functionaccording to plans and directives in combat areas. They believed that the publichealth activities of G-5 SHAEF should begin at the rear boundaries of thefield armies. Among the reasons for this opinion, aside from questions ofcompetence, two appear to have been most influential: (1) "theconviction, fairly widespread among medical officers, that the staff (command)surgeon should control all medical programs, whether for military personnel orfor civilians, in which the command engaged," and (2) "the fact thatthe staff surgeon controlled the so-called 'medical means' of the command;that is, the medical supplies, personnel, transport, and other facilities onwhich those assigned to the public health program with the field armies had todepend whenever their own means became scarce."21As the campaignprogressed and the armies advanced across France and into western Germany,events and experience confirmed these theories and opinions. The regularmedical service of the theater, including the Civil Affairs Branch of the Officeof the Chief Surgeon, had to assume increasing responsibilities for dealing withpublic health problems among civilian populations.
European Civil Affairs Medical Group
As a result of months of thoughtful and imaginative planningwhich was forced to a conclusion by the necessities of the campaign, the ECA
21See page 368 of footnote 19, p. 446.
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FIGURE 59.-Col.James P. Pappas, MC, USA.
Medical Group22wasestablished and activated within ECAD at headquarters of the Division at ChateauRochefort, Rochefort-en-Yvelines, Seine-et-Oise, France, on 14 September 1944.This was one of the principal changes in the reorganization of ECAD. Col. JamesP. Pappas, MC (fig. 59), assumed command while retaining his staff assignment asECAD chief surgeon. A headquarters was opened at Chateau Rochefort on thesame date and the 1st, 2d, 3d and 4th (Special) Medical Detachments were formed.The initial commissioned strength was approximately 95 Medical Departmentofficers with varied training and experience in public health, Army doctrine,and staff procedures. A staff for the headquarters detachment of the MedicalGroup was appointed between 26 and29 September. On this staff, Captain Dehn? served as Executive Officer. The ECAMedical Group became the medical organization designed to supervise the publichealth activities of SHAEF in liberated and occupied territory in the U.S. areaof responsibility in northwest Europe. By this action, all ECAD medical
22(1) For historical coverage, copies of documents, and manydetails of the affairs of the ECA Medical Group, see footnote 2 (2), p. 433. (2) Letter, Headquarters, ECAD, to Supreme Commander, AEF, 27 Aug. 1944, subject: Reorganization of European Civil AffairsDivision. (3) Memorandum, Operations Branch, G-5 SHAEF, to G-3 and G-4 SHAEF, 29 Aug. 1944, subject: Reorganization of European Civil Affairs Division. (4) First Endorsement AG 322-1 (ECAD) GE-AGM, SHAEF, Main, 31 Aug. 1944, to Commanding General, ETOUSA. (5) General Orders No. 36, Headquarters,ECAD, 13 Sept. 1944 [Reorganization of ECAD and establishment of the European Civil Affairs MedicalGroup as a non-T/O unit within ECAD.]
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personnel were brought under centralized administrativedirection. Also included in the Group were some of the attached officers ofthe U.S. Public Health Service, certain medical personnel of UNRRA (UnitedNations Relief and Rehabilitation Administration), branch immaterial officerswith training in public health, and other Allied medical officers previouslyunder G-5 public health sections of tactical commands. The organization didnot include all CA/MG medical (public health) personnel in northwest Europe, butonly those available at the time. Civil Affairs medical staff personnel assignedto G-5 sections in tactical commands, armies, and Army Groups were notincluded. The organization was shaped by a compromise between actual needs andpersonnel expected to be available to ECAD during combat. An analysis inDecember 1944 showed shortages of 16 Medical Corps officers, three sanitaryengineers and two nutrition officers. It was assumed that, after the cessationof hostilities, medical personnel would become available from the medicalservice of the armies.
The proposed organization of the ECA Medical Group underwenta number of changes before staff approval. Planning in detail for the staticmilitary government of Germany was impossible because the areas to beoccupied by the respective Allied armies were not known.
Movements into France-Civil affairs-public healthpersonnel of the European Civil Affairs Division moved into France with thedivision and its regiments, companies, and detachments. A forward echelon ofHeadquarters, ECAD, established on 8 June 1944 at Shrivenham, England, proceededto Omaha Beach on 21 July to administer ECAD elements in the field and toinspect, advise, and assist in Civil Affairs operations, supply, administration,and personnel problems. The Assistant Division Surgeon and six enlisted men, whooperated from Chateau Epinquet until 4 September, comprised the MedicalDepartment component of the Forward Echelon until headquarters was set up atRochefort-en-Yvelines to accommodate Headquarters, ECAD, when it arrived on 9September. An advance echelon of the 1st ECA Medical Detachment, 1st ECARegiment, with two auxiliary public health teams, arrived in France on 24 June,and the remainder of the detachment, commanded by Lt. Col. (later Col.) WilliamH. Riheldaffer, MC, debarked at Omaha Beach on 30 June. The 2d ECA MedicalDetachment, 2d ECA Regiment, commanded by Lt. Col. Roswell K. Brown, MC, arrivedat Utah Beach on 13 July, and the 4th and 3d ECA Medical Detachments arrivedat Rochefort-en-Yvelines on 17 and 19 September, respectively.
Personnel.-The Civil Affairs Center at Shrivenham had notable of organization or table of distribution for personnel spaces and grades.Therefore, there were no position vacancies, and no promotions could be made.Activation of ECAD with a table of distribution on 6 February 1944 was followedby only four promotions. Theoretically, promotions were possible, but morepersonnel were assigned without proportionate increases in
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authorizations for grades and ratings. Medical personnel werepromoted after activation of the ECA Medical Group.
Use of enlisted personnel.-The evolution anddevelopment of the use of Medical Department enlisted personnel in CivilAffairs, to supplement activities of officers, were important factors in civilaffairs-public health activities in northwest Europe; no medical enlistedpersonnel were used in the Italian campaign. A wider coverage was obtained byhaving, on each CA/MG detachment, a Medical Department enlisted man who renderedfirst aid and collected and assembled data for the officer responsible for thedetachment's area. Frequently these enlisted men were not used sufficiently,primarily because an understanding of their capabilities was lacking.
Functions.-Specific functions of the ECA Medical Groupincluded giving technical public health advice in planning, organizing, andsupervising the territorial application of principles of public health inliberated and occupied lands from frontlines to rear areas and zones. The ECAMedical Group enabled SHAEF to provide personnel, units, and teams to operatewith CA/MG regional detachments or teams in reestablishing civil public healthand in preventing the development of hazardous health conditions that mightinterfere with military operations. The Group provided personnel for technicalsupervision of public health operations, prepared technical directives toimplement public health functions, and furnished qualified personnel tosupervise and review results in the field and to obtain and interpretinformation on prevention and control of disease. The Group also providedpersonnel for consultations and conferences with responsible civilian healthauthorities, and assisted in coordinating the similar public health programs andactivities of the Allied armies.
In carrying out these functions, many difficulties had to beovercome. Coordination of efforts and supervision of personnel were especiallydifficult because of poor communication and limited contact among personnel ofthe Civil Affairs Detachments. Rapid movement, fluid combat situations, andlimited communications demanded individual reconnaissance and direct contact ifthe job were to be done.
During the period between the liberation of Paris on 25-28August 1944 and the middle of December, the Allied armies advanced to thenorthern and eastern borders of Belgium and France and were in the early stagesof the planned alinement along the western bank of the Rhine. In this interval,extensive civil affairs-public health operations had been carried out by boththe regular medical service of the field armies and by the public healthorganizations of G-5 SHAEF (p. 444).
THE GERMAN COUNTEROFFENSIVE IN THE ARDENNES
On 16 December 1944, the Germans, with the combined strengthof three armies, struck suddenly in the Ardennes in a region held relativelylightly by elements of the 12th Army Group. This fierce attack soon became
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known as the Battle of the Bulge because of the shape ofits penetration between Saint-Vith and Bastogne, almost to Dinant on the MeuseRiver. The drive was contained in about 6 weeks, the enemy was forced out of thesalient by 25 January 1945, and his defeat set the stage for the final Alliedvictory the following May.
The eruption of the Germans into Luxembourg and Belgiumduring the bitterly cold winter forced hordes of refugees and displaced personsinto liberated areas full of Allied troops adjacent to the battleground. Citieslying just beyond the area of greatest penetration, such as Li?ge, were packedwith refugees who, because of the repeated bombings, were crowded intounderground air raid shelters. Many food stores and sources were lost and food,clothing, and shelter became scarce. Local officials, ordered by the BelgianGovernment to stand fast, understandably refused to do so, fearing retaliationfrom returning Germans and Belgian collaborators. Many new and complex problemscalled for vigorous efforts of all the military and Civil Affairs medical andpublic health agencies in the region. While the most vivid available descriptionsof conditions and detailed reports on "Civil Affairs-Military GovernmentOperations-Public Health" are from FUSA units, it is known from varioussources that members of the ECA Medical Group were participants in theactivities, assisting with advice, supervision, and supplies.
Examples of the activities, extracted from FUSA reports,follows:23
1. A survey of available hospital facilities for the care ofcivilian casualties, made early in December, provided information that washighly useful during the battle.
2. The emergency hospital set up in Verviers in November wasused and emergency facilities were established at Li?ge. Less seriously injuredcivilians and convalescents were moved into private dwellings and convalescenthomes.
3. Extensive damage to hospitals by enemy action furthertaxed facilities in the First U.S. Army area. Six of eleven hospitals in Li?gewere severely damaged and one civilian and one field hospital at Verviers werebadly damaged.
4. German civilian patients in the hospital at Eupen weretransferred to their homes in Monschau; other civilian casualties in Eupen wereevacuated to Verviers.
5. When the German onslaught resulted in a large increase incivilian casualties, Civil Affairs detachments supervised rescue work and saw toit that medical care was provided.
6. In the VIII Corps area, providing hospitalization forcivilian casualties was a constant problem. In such towns as Diekirch and Eitel,detachments assisted by attached American Red Cross personnel rendered servicein transporting serious casualties and providing emergency care.
7. An adequate number of civilian medical personnel remainedat their posts except in the extreme forward areas, where some doctors wereamong the first to get out.
8. The need for emergency medical supplies was met withcaptured enemy supplies from the stockpile at the G-5 depot at Li?ge and byARB units from First U.S. Army allocations. Two ARB units were placed inLuxembourg City by mid-December, and were available for distribution in theentire Grand Duchy. Another ARB unit was placed at Libramont, Belgium, for usein the Province of Luxembourg. Large stores of supplies
23Historical Report, First U.S. Army, 1-31 December 1944.Extracts from War Diary of Detachment 11062, 6 Dec. 1944 to 5 Jan. 1945.
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were turned over to the Belgian Red Cross atLi?ge, andemergency drugs and dressings were shipped to Verviers. Late in December aLi?ge-type "Pannier" was provided for the Weywertz area.
9. Enemy shelling and bombing damaged water supply systems incities and towns, breaking water mains and causing leaks. One bomb which fellnear the Verviers refugee center demolished the water main, completelydisrupting the water supply of the center. Repairs were made by civilianagencies with some assistance from Civil Affairs.
10. In the last days of December, after the situation hadbecome better stabilized in the Eupen-Malm?dy area, a formidable task wasmaintaining sanitation among refugees. Most of the population was living inextremely crowded underground shelters, in which sanitary measures hadcompletely broken down. A public health specialist of the G-5 section made athorough survey of the situation. His recommendations, including chlorination ofthe water supply, rigorous sanitary discipline in the use of latrines, andbetter dishwashing because of the threat of dysentery, were immediately put intoeffect by the Military Government Staff of the 30th Infantry Division.Congestion in the air-raid shelters was relieved. By evacuating more than 1,500persons in Belgian Red Cross and Army trucks, and by the voluntary departure ofmore than 2,000 the special police enforced an order for cleaning all publicshelters.
11. Antitoxin was provided from Civil Affairs sources for thetreatment of five cases of diphtheria among the refugees.
12. With the retreat of the Germans, rehabilitationofcivilian hospitals and sanitary facilities and services proceeded, with the aidof the Belgian Red Cross, which provided doctors, nurses, and related personnel.A team of public health workers, equipped with trucks, ambulances, drugs,dressings, and other materials from the Belgian Military Mission (SHAEF Mission)worked in areas most acutely in need of help, from La Roche-en-Ardenne toVielsalm. Medical supplies were also received from the Civil Affairs SupplyDepot, and from civilian sources, at Li?ge.24
The German counteroffensive in the Ardennes dislocated manyCivil Affairs Detachments and caused considerable movement of public healthpersonnel. When the U.S. Armies resumed their advance after 25 January 1945,Civil Affairs officers and public health officers were drawn from MilitaryGovernment Centers and placed on duty in Belgium and Luxembourg. The advanceinto Germany called for Military Government Detachments to be deployed in localprovincial headquarters under CAD command rather than under the tacticalcommands to which they had been attached.
THE SHAEF MISSIONS
For the sake of brevity, chronological continuity will bebroken at this point by the insertion of a condensed account of the publichealth activities of the SHAEF Missions in the European theater (NorthwestEurope) from the time of their establishment in 1944 to their disbandment in1945, when SHAEF was dissolved. To do this, it is necessary to pass over for themoment the tremendous military operations of the Allied Forces immediately westof the Rhine and onward into Germany and Austria. The overpowering of Germanywill be discussed after the account of the Missions has been completed.
24Historical Report, 12th Army Group, Summary from FirstU.S. Army, Office of Assistant Chief of Staff, G-5, by Col. Damon M. Gunn, GSC, 9 Feb. 1945.
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Intelligence, Medical, and Public Health functions-Thecollection and analysis of intelligence on many subjects to obtain and usethe most up-to-date and precise information about conditions in the countriesof Northwest Europe were normal and important functions of the G-2 sectionsof SHAEF, ETO Headquarters, Army Headquarters, and, indeed, of all the majormilitary units. A similar intelligence organization existed, of course, in theWar Department and the Army Service Forces, and in their policymaking,operational, and technical components. With respect to activities concerningmedical and public health intelligence in the European theater, it is known thatthe "country houses" and the headquarters of the SHAEF missions madeconstant and extensive efforts to ascertain the conditions in the countriesof Northwest Europe as they existed from 1939 to 1944, and throughout thecampaign into 1945. There were similar activities in the G-5 Public HealthBranch, SHAEF, especially through the ECA Medical Detachments. A MedicalIntelligence Section was established in the Office of the Chief Surgeon, ETOUSA,to which a Medical Intelligence Officer from the Office of the Surgeon Generalhad been attached in August 1943.
The degree of liaison and exchange of information betweenthese various agencies and offices is not clear from available records; itappears to have been relatively small.
During the period 1942-44, a strong and active MedicalIntelligence Division had been developed in Preventive Medicine Service in theOffice of the Surgeon General under the direction, first, of Colonel Whayne and,later, Col. Gaylord W. Anderson, MC. This division collected and issued avast amount of medical and sanitary data about many countries throughout theworld, including those in Northwest Europe. As the lines of communication ofthis division with the European theater were almost entirely through the G-2intelligence system of ASF, few, if any, of its publications, circulars, andbulletins (TB MED's) reached either the Office of the Chief Surgeon, ETOUSA,or the G-5 SHAEF Public Health Branch offices or agencies. There areseveral reasons for this. One is an indication that the medical intelligencereports of the Office of the Surgeon General, based largely on previouslypublished reports, were not sufficiently up to date for use in preparing to meetthe urgent situations that the invading forces would encounter. For thispurpose, on-the-spot current information was essential. Another reason was theeffect of an added procedural hindrance. In 1944, as recorded by ColonelAnderson,25 these reports could not be sent directly to the Office ofthe Chief Surgeon, ETOUSA, because a theater Publications Screening Board hadruled against direct shipment or transmission of these and other types ofmedical reports. For some time, a ruling prevailed that only such material asmight be issued over the signature of the Chief
25Medical Department, United States Army. PreventiveMedicine in World War II. Volume IX. Special Fields. Washington: U.S. GovernmentPrinting Office, 1969, pp. 251-340.
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Surgeon could be disseminated in the theater. In ColonelAnderson's chapter, there is no mention of either G-2 ETO or G-2 SHAEF.
Organization and functions-At various times in thelatter half of 1944, the "country houses" or "state houses"which had been formed in England in 1943 were designated Military Missions ofSupreme Headquarters, Allied Expeditionary Force, or briefly, SHAEF Missions.Substantial accounts of their organization, functions, and activities, includingpublic health, have been presented in their own reports, in a special report byDraper,26 and in books by Donnison and Friedrich.27
The purpose of the Missions was to serve as liaison agenciesbetween the governments of the liberated countries and the Allied militaryauthorities for mutual assistance in prosecuting the war and in rehabilitation(p. 427). The liberated countries in northwest Europe with which the Missionswere concerned were France, Belgium, Luxembourg, the Netherlands, Denmark, andNorway. Each Mission was directed by an American or British officer, especiallyselected; the personnel of the Mission included American, British, and Canadianofficers and enlisted men. The SHAEF Mission to France, and the Mission toLuxembourg in the first phase of its deployment, were under the immediatecommand of ETOUSA; the others were under the British 21 Army Group.
The Missions were of different sizes but were generallysimilar in structure, comprising a headquarters and divisions, branches, andsections representing the main governmental and political subdivisions of theseEuropean states. Among the branches was a Public Health and Welfare Branch, withan experienced public health officer at its head. Capable public healthpersonnel were selected with the assistance of Lt. Col. Leonard A. Scheele, MC,USPHS, who served as an adviser to the ECAD personnel board. Because the Britishhad insufficient medical and public health personnel and were unable to filltheir quota of officers for civil affairs-public health activities, the PublicHealth Branch of G-5 SHAEF had to lend U.S. personnel to Missions servingunder the 21 Army Group (see pp. 32, 324).
The following additional comments on personnel problems andgeneral evaluation of service rendered by the Missions are quoted from Draper'sreport (see above).
In general each Mission was provided with one or two medicalofficers and a Sanitary Corps officer. To these might be added variousspecialists for temporary duty from time to time as the need arose. TheNetherlands Mission, for example, required the temporary services of nutritionconsultants and teams; also sanitary engineers and a veterinarian. The BelgianMission requested nutrition consultants and venereal disease consultants. TheFrench Mission has especial need for advice in venereal disease control,veterinary problems, and narcotic drug control.
The public health personnel of the Missions established aclose working relationship
26Summary Report, Dr. Warren F. Draper, Chief of thePublic Health Branch, European theater, May 1944-June 1945, to The SurgeonGeneral, U.S. Army, subject: The Public Health Branch, G-5 SHAEF-Observations and Comments Upon Its Organization,Operation and Relationships.
27(1) See footnote 14, p. 444. (2) Friedrich, Carl J., andassociates: American Experiences in Military Government in World War II. NewYork: Rinehart & Co., Inc., 1948.
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with the health authorities of the national governments andtheir activities were of great value both to the civilian and military agencies.They assisted in working out the kinds and quantities of medical, sanitary, andfood supplies required by the national governments from military sources. Theyaided in the recruitment of medical personnel for that part of the displacedpersons program for which the national governments were responsible. Theyinvestigated sanitary conditions and outbreaks of disease. They were especiallyhelpful in securing the cooperation of the liberated countries in the carryingout of anti-typhus measures. They assisted in the reporting of communicablediseases and in the establishment of measures for the control of venerealdiseases. They were instrumental in securing data in regard to the nutritionalstatus of the civil population. In short they were the liaison officers fromwhom both the military and civil authorities might obtain information on mattersof concern to both, and to whom each might turn for proper representation of itsinterests to the other. * * *
One of the difficulties was in furnishing temporary personnelto the Missions of the type and for the length of time required. As previouslystated, only two or three public health officials were on the permanent Table ofOrganization of the Missions. While a large number, including especiallyvenereologists, sanitary engineers and nutritionists could have been used toadvantage on a full time basis their services were not at all times vitallynecessary and it would probably have been felt that they were more urgentlyneeded elsewhere. However, when acute necessity arose it was difficult andsometimes impossible to supply the need or to permit such temporary personnel toremain as long as their services were required. We were frequently placed in theposition of having to ask the Missions to make provision for additional publichealth personnel in their Tables of Organization in order that we might endeavorto secure them from sources outside the ETO. Such suggestion, however, wasseldom if ever accepted and we were obliged to tide the emergencies over as bestwe could.
It is my opinion that the plan of the Missions was extremelywell conceived and afforded a means whereby the health and other problems of theliberated countries could be understood and handled with the least possibledemand upon the time of the personnel of SHAEF. Certain minor difficulties wereencountered but these were due either to shortage of personnel or to honestdifferences of opinion between administrative officers rather than to defects ofthe plan itself.
Nutrition.-Except in rare emergencies which required theArmy to participate in the relief of groups of people in distress, interest hadbeen centered on the troops, and not much thought had been given to the stepsthat the Army would have to take to supply and distribute food to remedydeficiencies, and to restore and maintain the nutrition of large populations inforeign countries liberated and occupied by victorious forces of the UnitedStates and its allies. For this new concept, new organizations and newprocedures were needed. These were developed and put into effect by CivilAffairs, chiefly by those divisions and sections that were concerned withpreventive medicine and public health.
In the Surgeon General's Office, from 1941 to the end ofthe war, the Preventive Medicine Service had a special concern in these mattersbecause of the foresight and energy of its Chief, Brig. Gen. James S. Simmons,MC. One of his chief assistants, Col. Thomas B. Turner, MC, who became chief ofthe Civil Public Health Division, dealt with the practicalities of selection andsupply of materials in his early collaborative work on devising the CAD (CivilAffairs Division) Units. Following him, Col. John B.
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Youmans, MC, as Director of the Nutrition Division,influenced further developments, some of which led for the first time to theoffering of advice, suggestions, and recommendations by the Surgeon General'sOffice to commanders (and surgeons) of forces in theaters of operations.28
In the European theater, a Nutrition Branch was establishedin the Division of Preventive Medicine of the Office of the Chief Surgeon,ETOUSA, following the arrival late in August 1942 of the Nutrition Officer, Col.Wendell H. Griffith, MC, who served as chief of the Branch for the ensuing 3years. "The Nutrition Branch was not directly concerned with civilianfeeding in Europe inasmuch as this problem was assigned to the Public HealthBranch of SHAEF. Prior to the organization of that Branch, the Nutrition Branchhad participated in early plans for this phase of the Army's general task onthe continent. It continued to cooperate with the Public Health officers andassisted the latter in the preliminary surveys in Germany."29
When the Public Health Branch of G-5 SHAEF was establishedin London on 8 May 1944, the importance of nutrition was recognized. Col. PaulE. Howe, SnC, was appointed to the staff as Chief Consultant in Nutrition. Hehad been a nutrition officer with the American Expeditionary Forces in France inWorld War I. Reports filtering through the Netherlands in October 1944 indicatedto Colonel Howe that serious malnutrition existed among the civilians.30
In London on 25 May 1944, the foundation of the nutritionprogram for Civil Affairs in the European theater was laid by the Deputy Chiefof the Public Health Branch, G-5 SHAEF, Brigadier Thomas F. Kennedy, RAMC, andthe Chief Nutrition Consultant, Colonel Howe, USA. "The task confrontingthem involved the development of a basis for solutions of a problem which wasthen of unknown proportions. Its anticipated magnitude was difficult to conveyto those in command positions, who at that time were concerned with actualcombat activities and did not visualize the extremely vital role nutrition wasto play in the overall allied operations in the near future."31
Mission to France
History and functions-After more than a year spent inplanning in the French "Country House" in London, the SHAEF Mission toFrance opened its headquarters at the Trianon Hotel in Paris on 25 August 1944,immediately after the city was liberated and the Provisional Government wasproclaimed by General de Gaulle. From here, the Mission operated throughoutFrance until 14 July 1945, when it was replaced by separate
28Conference Minutes. Nutritional Aspects of Public HealthProgram of Civil Affairs, Preventive Medicine Service, Office of the SurgeonGeneral, 15 August 1944.
29Griffith, Col. Wendell H., SnC: Part IV-Nutrition. InVol. II, page 43, of footnote 5 (2), p. 439.
30Report, Col. Paul E. Howe, SnC, SHAEF, G-5 Division, toChief, Public Health Branch, G-5 SHAEF, 28 Oct. 1944, subject: Churchill Nutrition and FoodCommission.
31Report, SHAEF, undated, subject: Part II. The Role ofNutrition in World War II, p. 21.
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U.S. and British Military Missions. This was the largest ofthe Missions but, like the others, had only a small staff of medical, sanitary,and public health officers.
The guidelines for the Mission to France were the same asthose for the other Missions and Civil Affairs Detachments, in general. Thesewere set forth in two basic directives32whichcontain both broad principles and many technical details, and in a handbook.33
In France, Civil Affairs Officers, including Public HealthOfficers, were governed by the order of the Supreme Commander that "CivilAdministration in all areas will be normally controlled by the Frenchthemselves." The Field Historian of the Third U.S. Army has stated thepoint of view and attitude of the authorities of that Army in termsapplicable to each U.S. Army in France, namely: "The Third Army went intoaction with the understanding that 'any semblance of military government inFrance was to be scrupulously avoided, and that the French would resume fullcivil activity as fast as conditions permitted.' * ** In all echelons the spirit and letter of the SupremeCommander's order were felt as corresponding to the use of the officialdesignation 'Civil Affairs' rather than that of 'Military Government,'which was to obtain in Germany."34
Refugees, repatriations, and nutrition-Theunexpectedly large number of refugees from Paris embarrassed the First and ThirdU.S. Armies. In late August 1944, there were 100,000 Parisians outside Paris inthe area of the Third U.S. Army, and on 31 August, a Civil Affairs Officerestimated 500,000 refugees were in the various army zones of operation inFrance. Severe conditions in Alsace-Lorraine during September and the Battle ofthe Bulge in December 1944 forced many thousands of displaced persons andrefugees to flee to the rear. Their problems of feeding, clothing, shelter, andsanitation were worked out, in part, by Civil Affairs Officers of variousspecialties, in collaboration with the French and the Medical Service of thearmies. During all of 1945, repatriating about 350,000 persons through Franceto their own countries involved medical and sanitary problems of the types previously described. Fortunately, nooutbreak of disease occurred in France at any time during the campaign on ascale to threaten the armies or to cause serious disturbance among thecivilians. Although there was a great increase in tuberculosis and venerealdisease among the French during the war, and some malnutrition in the largecities, public health in general was satisfactory. Contributing to thisfavorable situation were the high standards of the Allied armies, the"standfast policy" in handling refugees, and the sanitary precautionsof the French and U.S. authorities
32(1) Standard Policy and Procedure for Combined CivilAffairs Operations in North West Europe. Supreme Headquarters, AlliedExpeditionary Force, 1 May 1944. (2) Manual, Supreme Headquarters, AlliedExpeditionary Force, G-5 Division, 24 Aug. 1944, subject: Technical Manual forMilitary Government Public Health Officers.
33Field Handbook of Civil Affairs, France, part I, ch. I,par. 2. Prepared by SHAEF, G-5 Division, 16 July 1944.
34(1) See page 148 of footnote 27 (2), p. 454. (2) AfterAction Report, Third U.S. Army, 1 August 1944-9 May 1945, vo1. I, p. 63; andvol. II, pt. 6, G-5 Section,Sec. I, p. 2.
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in handling displaced persons. Another factor was the stockof biologicals at the Pasteur Institute in Paris for distribution throughcivilian channels. In addition, there was never any serious shortage in themedical supplies which the Army Medical Supply Depot furnished on civilianrequisition. Considerable use was made by Civil Affairs public healthagencies of the CAD and ARB supply units, and the "pannier" system ofpackaging in smaller lots.
A dramatic incident of relief took place at Sarreguemines andWelferding in December 1944 when public health officers took first aid andmedical supplies to several thousand refugees in caves in no man's land.
The personnel of the French Provisional Government wereunderstandably concerned with a forthcoming campaign for office, with almostoverwhelming administrative problems, and with securing the recognition of theProvisional Government itself, before the general elections. On 11 November1944, formal recognition of this Government by the United States, the UnitedKingdom, and Soviet Russia made France a member of the European AdvisoryCommission.
In 1948, 3 years after the end of the war, historiansreviewing the events concluded that the SHAEF Mission to France did much good incarrying out every responsibility, "and in the direction given to (French)authorities in reorganizing their police and fire brigades, their public healthand hospital services * * * asubstantial contribution was made."35
Mission to Belgium
On 15 September 1944, the SHAEF Mission to Belgium wasestablished under the command of the 21 Army Group with Maj. Gen. G. W. E.Erskine of the British Army at its head. This Mission became responsible alsofor civil affairs-public health activities in Luxembourg in October 1944.
During most of the first 5 months of the Mission'soperations, the civil affairs-public health problems in Belgium were severebecause of several factors. Belgium was a battlefield. Overcrowding of buildingsand underground shelters in the chief cities, destruction of water supplies andsanitary facilities by enemy bombing and shelling, and occasional shortages offood and medical supplies were some of the situations requiring public healthaction. Camps for displaced persons and refugees presented similar distressingproblems. The Battle of the Bulge drove destitute people westward into centralBelgium. Enteric disorders were prevalent, and in the summer and autumn of 1944,there was an outbreak of typhoid fever in the Li?ge area. The presence of twoenormous armies in the country added greatly to the overcrowding and createdconditions in which venereal diseases flourished.
The Mission to Belgium especially needed nutritionconsultants and
35See page 167 of footnote 27 (2),p. 454.
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venereal disease consultants. These were furnished from timeto time through the Public Health Branch, G-5 SHAEF.
During December 1944 and January 1945, at the request of theMission, a thorough and helpful sampling survey of the public water supply inBelgium was made by a team of public health personnel of the 1st European CivilAffairs Regiment. Recommendations from this study were carried out with goodresults by Belgian officials acting with advice and assistance from civilaffairs-public health officers.36
The care of sick and wounded civilians in the fall and winterof 1944 called for extensive exertions, with or without success, by personnel ofthe Ninth, First, and Third U.S. Armies, in collaboration with medical andpublic health personnel of Civil Affairs.
Mission to the Netherlands
The Netherlands were invaded by Germany on 10 May 1940 andthe center of Rotterdam, which had been declared an open city, was destroyed ina German air raid on 14 May. Queen Wilhelmina and officials of her government fled to London. A period of ruthless terrorism was instituted in Hollandunder the Reichskommissar Seyss-Inquart. Large quantities of food were removedto Germany and thousands of men were deported to work in German factories. For 5years, the Netherlands suffered the ravages of the occupying Germans. During thefinal year of the war, the country was a battleground over which the 21 ArmyGroup and the Ninth U.S. Army fought a destructive campaign against Germanforces; at the same time, the Allied armies crowded cities, towns, and ruralareas and, of necessity, made severe demands upon the civilians for billetsand other facilities.
In London in 1943, representatives of Civil Affairs in COSSAC(Chief of Staff to the Supreme Allied Commander) collaborated with theNetherlands Government in exile to establish the Netherlands "CountryHouse." Between March and September 1944, the handbook for Civil Affairs inthe Netherlands was developed, and the Public Health Branch estimated the kindsand quantities of medical and sanitary supplies and equipment which would berequired under various conditions which might arise following an Allied invasionby both land and sea. Projected analyses dealt with the health problems whichmight be caused by extensive inundation of the low country and the consequentdisplacement of the population. In September 1944, the Country House became theSHAEF Mission to the Netherlands and moved into Brussels, Belgium, shortly afterthe liberation of that city on 3 September.
The Mission's headquarters was established first at theUniversity of Brussels, where Maj. Guy V. Rice, Jr., MC, coordinated activitieswith the
36Report, Headquarters, 1st MedicalDetachment, 1st European Civil Affairs Regiment, European Civil Affairs MedicalGroup, to Commanding Officer, 1st ECA Regiment, 25 Jan. 1945, subject: Report ofPublic Water Supply in Belgium.
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21 Army Group. Lt. Col. Harold R. Sandstead, MC, USPHS,a specialist in nutrition, who headed the Public Health Branch of the Mission,and Lt. Col. Harry A. Gorman, VC, set up advance headquarters at Eindhoven,Holland. The Branch then became operational. Colonel Sandstead conferredfrequently with Maj. (later Col.) Leonid S. Snegireff, MC, who was the CivilAffairs Public Health. Officer in the G-5 Division at Ninth U.S. ArmyHeadquarters.37
Southern Holland-The period under consideration beginsinSeptember 1944 with the liberation of Eindhoven and Nijmegen by the 82d AirborneDivision, the push north by the First Canadian Army on the left, the BritishSecond Army in the center, and the Ninth U.S. Army on the right, and continuesto the Rhine crossing in the vicinity of Wesel on 22 March 1945. All during thewinter, these three Armies were deployed in Southern Holland, in the provincesof Limburg and Brabant. At times, the Allied troops outnumbered the 2 millionDutch inhabitants. During the early phases of the fighting, extreme crowdingoccurred because of the influx of refugees. Factories and monasteries were usedas centers for refugees and displaced persons and, to the great discomfiture ofthe Dutch people, the Armies requisitioned all sorts of buildings, includingprivate dwellings, for headquarters, billets, and supply depots. Civilianhospitals were overcrowded; the Armies had taken over several which had beenoccupied by the Germans. There was an extreme shortage of fuel during the entireperiod, and until December, rail, water, motor transport, and gasoline werelimited to military use. Government and commerce were disrupted because of thebreakdown of all civilian communications. Only Army transportation was availablefor moving civilian supplies.
Southern Holland was not prepared for reinstitution of civiladministration at the time of liberation because the country had a highlycentralized form of government, and local officials looked to The Hague and toAmsterdam for direction and decision. Only a few well-qualified men ingovernment and commerce were liberated. The result was confusion, fear, and, ina few instances, a lack of cooperation with Allied authorities. This last wasunderstandable considering the fact that most of the Dutch had friends andrelatives in the area under German occupation, even in concentration camps.
The first priority in public health was the reorganization ofcivilian health and medical services. Weekly conferences were held by the PublicHealth Branch with health inspectors and public health officers of the threeAllied armies, who settled problems affecting both the civilian and militarygroups. Although a number of practicing physicians were appointed as deputyinspectors, the Public Health Branch did not succeed in forming an effectivecivilian health service.
After October 1944, Civil Affairs met all essential and emergency demands for medical supplies. Through Civil Affairs guidance, a State-
37Sandstead, Lt. Col. Harold R., MC, USPHS: History of Public Health Branch of the SHAEF Mission to the Netherlands (undated).
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controlled bureau for all medical and hospital supplies andequipment, including Red Cross materials, was organized and transport was madeavailable. Physicians, hospitals, and pharmacists were required to placerequisitions through the local health inspectors for approval at the depots.Requirements for medical supplies and control of their release were under thejurisdiction of the Public Health Branch. This system worked well and preventedhoarding, inflation, and black marketing. One need that could not be fullysatisfied by Civil Affairs was that for scabicidal drugs. In some groups ofrefugees and displaced persons, scabies infestation was as high as 85 percent.The use of DDT powder for delousing was limited to refugees and displacedpersons, and civilian delousing teams were organized and trained under thehealth inspectors.
In November 1944, Major Snegireff reported succinctly on thesituation, in substance as follows: Public health problems in South LimburgProvince were closely linked with the state of nutrition of the populace. Thediet had steadily deteriorated, and had dropped from the 1,600 caloriespermitted by the Germans to 980 calories per person per day in the first weekof November 1944. The complicated rationing system of the Dutch MilitaryAdministration did not permit the immediate alleviation through increase incaloric allocation for several days after food had been delivered through G-5,Civilian Supply, Ninth U.S. Army. He found that tuberculosis was the mostserious communicable disease problem. Scabies was also prevalent.38
In December 1944, Civil Affairs food supplies could not bebrought in because Antwerp harbor and the Scheldt River basin had not beencleared. The reduced civilian ration of 1,200 calories per day added to theconfusion, apathy, and doubt in the minds of the Dutch. The incidence ofdiphtheria and scarlet fever was high. There were few isolation facilities andthe limited supply of drugs was exhausted. Fortunately, there were only sporadiccases of typhoid fever. Through urging by the Public Health Branch of theMission, the Dutch began a sizable diphtheria immunization program, about thefirst evidence that their health services were recovering.
By the time eastern and northern Holland were liberated,southern Holland had recovered sufficiently to permit civilian authorities to handle most problems with little Civil Affairs assistance other thansupplies. A large Dutch pharmaceutical manufacturing firm produced most of theneeded biologicals (except vaccines) and substantial quantities of thesulfonamides.
The eastern provinces.-The eastern provinces of Friesland,Drenthe, Overijssel, and Gelderland were liberated in a few daysduring late March 1945, without much material destruction or dislocation of thepopulation. These provinces were well supplied with food and otheressentials, were well organized, and required only minor assistance from theMission.
38Report, Maj. Leonid S. Snegireff, MC, Chief, Public Healthand Welfare Sub-Section. Headquarters, Ninth U.S. Army, Office of the AssistantChief of Staff, G-5, to Assistant Chief of Staff, G-5, Ninth U.S. Army, 10Nov. 1944, subject: Periodic Public Health Report (22 October to 10 November1944).
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Developments affecting public health activities.-Thework of the Public Health Branch of the Mission was affected indirectly by anumber of important events, particularly the following:
1. In August 1945, the four medical schools at Groningen,Utrecht, Amsterdam, and Leiden (with which the Public Health Branch had aninformal relationship) were reopened, and the veterinary school at Utrecht wasscheduled to reopen in the fall.
2. Circulation of all except German medical journals had beenprohibited. Arrangements were made through the Office of War Information, theAmerican Library Association, and the Rockefeller Foundation to import medicalbooks and journals.
3. The State Department of Health in the Netherlands hadnever been strong because the prewar high economic level of the population,statewide compulsory medical insurance, a high ratio of physicians topopulation, good hospitals, and the cleanliness of the people made itunnecessary to have a vigorous state health service. A lay Director of Healthserved under the Minister of Social Affairs; under him were four bureau chiefsand inspectors under each bureau for each of the provinces. These officials,although able and courageous, could not cope with the numerous daily problems.The Head of the Public Health Branch of the Mission conferred several times witha committee of Dutch physicians about plans for a larger and stronger Statehealth service, including public health.
4. Two important laws affecting public health were decreed bythe Government while the Mission was in Holland. One amended the narcoticscontrol laws to secure greater protection for the troops. The other was a newlaw requiring reporting of cases of venereal disease.
Displaced persons and refugees.-The medical and publichealth officers of the Armies and the Mission were responsible for supervisionof health and sanitation among displaced persons and refugees. Centers fordisplaced persons were established at strategic locations along the easternborder of the country from Maastricht in the south to Groningen in the north.Civilian medical officials were on full-time duty. Through the Mission,arrangements were made for emergency hospital accommodations or civilianhospitals were supplied with additional beds. Some of the larger centers,particularly those handling non-Dutch persons, were manned and operated by theArmies. Lt. Col. Harold Ansley, RCAMC, Public Health Officer of the FirstCanadian Army, and Major Snegireff dealt with all health problems arising amongdisplaced persons and refugees passing through their areas.
Between 400,000 and 500,000 displaced persons of Dutch originreturned to Holland from February through June 1945, with the peak influx inMarch and April. During the early days, up to 95 percent of those returning fromcertain areas were infested with body lice; however, after the centers inGermany became better organized, the louse infestation rate declined to lessthan 10 percent.
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A total of 55 cases of typhus occurred among Dutch displacedpersons after their arrival at border stations in Holland. Presumably, thesepeople were in the incubation stage of the disease when they entered thecountry. As a result of casefinding efforts, quarantine of the sick and theircontacts, immunization of contacts, and dusting with DDT of families andgroups, not a single case of typhus developed in the local civilian populationwhich was not displaced. Health officers made louse counts in groups ofcivilians and, when the incidence of infestation rose to 10 percent or greater,DDT powder was issued for use.
The western Netherlands.-Even before the liberation of thewestern Netherlands, steps were taken to assemble food supplies for thisstricken area and to arrange for medical care of the victims of malnutritionand starvation. These plans were put into effect immediately after theliberation of the region in May 1945. Simultaneously, the survey teams carriedout studies and collected an immense amount of clinical, biochemical, anddietary-nutritional information. To assemble and analyze the data would havetaken a considerable amount of time under normal conditions. To do this in theimmediate postwar period required even more time. By 1948, however, theGovernment of the Netherlands was able to publish the report of the expertcommittee, with recommendations applicable to future conditions should similarsituations occur.39
During the last months of the German occupation, from October1944 to 5 May 1945, the people in the western area of Holland were afflictedwith a famine produced by the ruthless removal of foodstuffs and the restrictionof production and importation imposed by the Germans. The experience of westernNetherlands in 1945 was almost a vast catastrophe. If the German occupyingforces had held out another 2 or 3 weeks against the Allied attack, nothingcould have saved hundreds of thousands from starvation. How many died will neverbe known, but probably at least 10,000 lost their lives because the occupyingpower failed in its obligation to sustain the civilian population under itsauthority.
Some of the events, descriptions of activities, clinicalobservations and opinions, and recommendations in the 1948 report of thecommittee follow:
(a) Lt. Col. H. R. Sandstead, in the words of the Minister ofSocial Affairs, "as head of the Health Section of the SHAEF mission to theNetherlands contributed much to the recovery of the health of the population ofour country and who was a great support of the relief action."
(b) Meetings of members of the Nutrition Advisory Committeeand Teams in Brussels and Eindhoven were held in February 1945 to draw up theoriginal plans for dealing with the rapidly deteriorating situation in westernNetherlands.
(c) At this time there was a "deplorable paucity ofknowledge regarding the treat-
39Malnutrition and Starvation in Western Netherlands,September 1944-July 1945. Published by the Netherlands Government with a foreword by the Minister ofSocial Affairs and an introduction by the Editorial Committee: Dr. G. C. E. Burger (Netherlands),Chairman; Sir Jack Drummond (British), Ministry of Food; and Dr. Harold R. Sandstead (U.S.A. and Canada),U.S. Public Health Service. 2 vols., pt. I Narrative; pt. II appendixes. The Hague: General StatePrinting Office, 1948.
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ment of individuals suffering from grave starvation* * * none ofthe experts who were consulted could say with assurance how such a famine shouldbe met."
(d) The report gives a clear picture of a condition caused bya serious deficiency of energy (calories), inevitably involving lack of protein.Specific disorders due to deficiencies of vitamins and minerals did notcomplicate the situation to any significant extent because the people were ableto get some vegetable produce from their fields.
(e) It was found that predigested foods of the type ofprotein hydrolysates for oral or intravenous administration were not essentialor effective for resuscitating patients in the late stages of exhaustion fromstarvation. The gastrointestinal tracts of such persons could digest foods suchas milk and even large amounts of butterfat. "Only in the very last stageof starvation, when the patient is almost moribund, was direct feeding of novalue; indeed, experience in the western Netherlands indicated that there is noavailable treatment that will resuscitate such cases * * * it is important to emphasize that what the starvingperson needs is food and plenty of it. The experience in western Netherlands didnot support the popular view that they need careful nursing back to a conditionin which they can take a full diet." The importance of putting a starvingperson as quickly as possible on a diet of high energy value and high proteincontent could not be overemphasized.
(f) "The psychological condition of an underfedpopulation constituted one of the greatest difficulties the teams encountered.The peculiar psychological state of individuals suffering from severe andprolonged calorie-shortage makes it necessary to pay the utmost attention tomethods of approach, imparting of information, and understanding of mentalstates. Apathy and irritability are the outstanding features of such asituation, which calls for special attention not only in regard to the relationbetween doctors and patients, but to the difficulties of dealing with civilianauthorities. Good understanding will avoid delay in action and therefore be oflife-saving importance."
(g) "Food stocks were exhausted when the Allied forcesentered in the western area. For a few days before actual liberation came, foodin considerable quantities had been reaching the area by air and by road.Notwithstanding every effort on the part of all concerned in food distribution,delays caused by sorting, stockpiling, and allocating supplies resulted in largenumbers of people going without any food at all for the best part of a week.This was a period of acute danger for those who were already in a severenutritional state at the time of liberation. In future emergencies everypossible measure should be taken to avoid such a delay."
(h) Finally, the Editorial Committee recorded its consideredopinion that "there is no justification for the ruthless sacrifice of acivilian population in such circumstances and that the United Nations shoulddevise a Convention of international scope of which the object would be toprotect civilians subjected to an occupying power from suffering grave injury tohealth as a result of inadequate nourishment."
Mission to Denmark
The Danish "Country House" was established inLondon on 7 February 1944; in mid-October of that year, at Norfolk House, St.James's Square, it became the SHAEF Mission to Denmark. The Mission moved toCopenhagen, Denmark, on 7 May 1945, 2 days after all the German forces innorthwest Germany, Holland, and Denmark had surrendered unconditionallyto the 21 Army Group.
The Mission, composed of 20 British and 17 American civilaffairs officers, had distinguished leadership. Its organization contained aPublic Health Section, of which Col. John P. Hubbard, MC, was Head from September 1944 until the unit was disbanded in July 1945.
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The following account of general and health conditions inDenmark, and of some of the public health activities, is condensed from ColonelHubbard's reports for May and June 1945.40
On arrival in Copenhagen on 7 May 1945, the Mission wasgreeted by a jubilant and healthy-looking, well-dressed people. It was evidentthat the population and the country had suffered less from the war than had anyof the other belligerent states of northwest Europe. Food appeared to beabundant and of excellent quality, especially dairy products.
During the months before the liberation, refugees, displacedpersons, and German military wounded had been swarming into Denmark. This placeda heavy burden upon the National Health Service. The displaced persons andrefugees were in poor condition and presented a danger of the spread of epidemicdiseases. In other respects, the National Health Service was in a favorableposition. The functioning of the Service and related institutions, such as theSerum Institute, had been but slightly affected by the German occupation.
Control of displaced persons-The chief concern of thePublic Health Section of the Mission during May and June 1945 was the controland management of the 200,000 to 300,000 displaced persons and refugeesestimated to be in Denmark. Several thousand DP's (displaced persons) were inDanish hospitals and German military hospitals, mingled with sick and woundedGerman military personnel. The consequent overcrowding put a strain on thehospital facilities, and the mingling of the Danes and Germans, both patientsand civilian doctors, caused serious problems. As it was found unwise to mixGerman military and civilian medical personnel in the hospitals and camps, anarrangement was made for German military medical personnel to leave Denmark assoon as they were no longer needed for the medical care of Wehrmacht personnel.
Ships crowded with displaced persons and refugees fromGermany, and crowded harbor shacks, produced dangerously unsanitary conditionsin Copenhagen Free Port. Many of these persons slept on straw spread oncement floors. There was a high degree of louse infestation. Sanitary facilitieswere inadequate and not often used. During May, under the supervision of thePublic Health Section of the Mission, all DP's and refugees were removed andthe whole port area was cleaned up.
During May and June, all Allied displaced persons wereinspected medically by Danish doctors to determine the presence of communicabledisease or other obvious illness. An extensive immunization program wasundertaken to administer two injections of diphtheria toxoid and threeinjections of triple typhoid vaccine to each of approximately 200,000 DP's andrefugees. Teams of Danish medical students assisted by visiting all DP
40Report, Col. John P.Hubbard, MC, SHAEF, G-5 Division, Denmark Mission, Public Health Section, to SHAEF Forward, G-5 Division, Public Health Branch, subject: Public Health Monthly Reports for May 1945 (dated 5 June 1945) and for June 1945 (dated 7 July 1945).
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centers. The Public Health Section of the Mission was awareof this work but did not take a direct part in it.
Communicable diseases.-No serious epidemic of infectiousdisease occurred in Denmark during May and June 1945. During the occupation,venereal diseases, scarlet fever, and diphtheria increased above the normalincidence but not to an alarming degree. Tuberculosis showed an insignificantincrease. Statistics on the occurrence of diseases were collected from Danishsources by Colonel Hubbard and were included in his reports.
Typhus fever.-From 1 May to 9 June 1945, a total of 60cases of typhus fever were reported in Denmark. The control measures applied bythe Danish health authorities, with some advice and assistance from the PublicHealth Section of the Mission, were (a) isolation of cases in the CopenhagenCommunicable Disease Hospital, (b) a thorough and effective disinfestationprogram by delousing with 5-percent DDT powder, and (c) limited use of typhusvaccine and a booster dose of this vaccine to all military personnel of theMission. Most Danish doctors previously had been immunized with typhus vaccineprepared in Denmark.41
The outbreak declined in the latter part of June and did notspread among the Danish civilian population at any time.
Typhoid fever.-During June 1945, there was an outbreak of478 cases of typhoid fever among German displaced persons, without spreading tothe civilian population of the country.42 The typhoid immunizationprogram was continued. In addition to the usual control measures, swimming alongthe coast of Zealand was prohibited by the Danish authorities because many DP'samong whom typhoid was occurring were living in boats lying off Copenhagen.
Nutrition.-Supplies of meat and milk were sufficient, butfresh fruits and green vegetables were scarce. The people had maintained anaverage daily caloric intake of 2,900 to 3,000 calories per person and therewere no significant nutritional deficiencies.
Danish medical personnel for service outside Denmark-Asoneof its final acts, the Mission and its Public Health Section served in anadvisory capacity to a committee representing the National Health Service andthe Ministry of Social Affairs which was concerned with the possibility ofmaking Danish medical personnel available for service outside Denmark. In viewof the anticipated urgent needs for medical and public health assistance inGermany, the Danish health authorities were advised to prepare a plan forsubmission to UNRRA, which had authority over any nonmilitary organization thatmight contribute medical or other aid to Germany.
41SHAEF, G-5 Division, Displaced Persons Branch, DisplacedPersons Report No. 35 of 25 June 1945, p. 13.
42SHAEF, G-5 Division, Displaced Persons Branch, DisplacedPersons Report No. 39 of 30 July 1945, p. 14.
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Mission to Norway
Planning for Civil Affairs activities, including publichealth, in Norway began in August 1943 when the Norwegian "CountryHouse" was formed in London by representatives of the Norwegian Governmentin exile and British and American Civil Affairs Officers under COSSAC. Thisorganization was designated the SHAEF Mission to Norway in February 1945 but didnot become operational as a Mission until 8 May 1945, when Norway was liberatedfrom the Germans. A month later, on 7 June, the Mission was discontinued whenKing Haakon VII returned to Norway and the responsibility for civiladministration was restored to the Norwegian Government.
Nutrition was the main problem. During the German occupation,food supplies for the Norwegians had been progressively reduced and, accordingto a Nutrition Consultant to the Office of the Surgeon General who visitedNorway in June 1945, there was still a severe food shortage. Norwegian observersreported that early famine edema had been seen just before liberation. Loss ofweight of adults in Oslo amounted to 10 to 15 kg. Although school children didnot show any serious loss of weight, they had failed to continue to increase inheight and weight as was normal for children during the period 1920-40. Foodrelief, which was put into effect immediately following liberation, usingsupplies shipped into Norway from Denmark and Sweden, apparently averted moreserious consequences and conditions rapidly improved.
In summary, the more important Civil Affairs responsibilitieswere those of rendering assistance to the Royal Norwegian Government inproviding medical and other supplies for the civil population, managingdisplaced persons and refugees, and establishing military courts for trials ofGermans.
THE RHINELAND CAMPAIGN
Advance across the Rhine.-During the period from 11September to 16 December 1944, the Ninth, First, and Third U.S. Armies conqueredthree small areas of the western fringe of Germany, lying along the Belgian,Luxembourg, and French frontiers. Military Government was inaugurated in thisterritory and U.S. Military Government detachments gained their first experiencein the European theater in dealing with enemy populations.43
The advance was interrupted by the German counteroffensive inthe Ardennes on 16 December 1944, which created severe public health problemswith which the staffs and units of Civil Affairs and the medical services of thethree U.S. Armies had to contend through a long month of the bitterly cold andwet winter (p. 451).
The advance was resumed shortly after 25 January 1945. By 8
43Starr, Joseph R.: U.S. Military Government in Germany: Operations during the Rhineland Campaign. Training Packet No. 56. Karlsruhe, Germany: Historical Division, European Command, 1950.
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February, the Germans along the Roer Riverwere forced to withdraw to the west. Within the next month, the entire Rhinelandwas conquered. A bridgehead on the Rhine was established by the 9th ArmoredDivision at Remagen on 7 March by the capture of the Ludendorff Bridge. TheThird U.S. Army drove to the south, cleared the Saar, made the first assaultcrossing of the Rhine in modern history on 22 March, and broke into the citiesof Mainz and Koblenz. Later, after the surrender of Germany, the Saar-Palatinatebecame parts of the British and French Zones of Occupation.
First Military Government in Germany.-Superseding aninterim directive of 10 September 1944, SHAEF issued a directive on 9 Novembercovering the situation that would be developed by Allied conquest and occupationof territory before the defeat or surrender of Germany.44As future operations were governed extensively by this directive, spacewill be given here to an abstract of parts of it, with special reference tospecifications of public health activities.
The SCAEF (Supreme Commander, Allied Expeditionary Force) wasannounced as initially and fully responsible for establishing and maintainingMilitary Government in areas of Germany occupied by forces under his command. Atsome time following the occupation of Germany, this responsibility would beassumed by a tripartite Control Commission. Each commander addressed was maderesponsible for the execution of SCAEF's policies in the establishment andoperation of Military Government in the areas occupied by his Group of Armies.During hostilities in Germany, the Supreme Commander was given the legislative,executive, and judicial rights of an occupying power, and his authority andpower were delegated to the Army Group Commanders, who in turn were authorizedto redelegate powers to subordinate commanders. The Army Group Commanders weredirected to establish Military Government immediately upon the occupation bytheir forces of any part of German territory.
Seven primary objectives were specified: (1) Imposition ofthe will of the Allies upon Germany; (2) Care, control, and repatriation ofdisplaced United Nations nationals, and minimum care necessary to control enemyrefugees and displaced persons; (3) Apprehension of war criminals; (4)Elimination of Nazism and German militarism, and related matters andindividuals; (5) Restoration and maintenance of law and order; (6) Protectionand control of United Nations property and assets; and (7) Preservation andestablishment of suitable civil administration.
Five restrictions were to be observed in the attainment ofthese objectives: (1) No steps to rehabilitate the German economy except asnecessary to support military operations; (2) Importation of only minimum reliefsupplies to prevent disease and disorder; (3) Removal from administrative officeof Nazis or ardent Nazi sympathizers; (4) Temporary use of
44(1) Letter, SHAEF, Office of the Chief of Staff, to Headquarters, 21 Army Group, and Commanding Generals, Sixth and Twelfth Army Groups, 9 Nov. 1944, subject: Directive for Military Government of Germany Prior to Defeat or Surrender. (2) See also Handbook for Military Government in Germany Prior to Defeat or Surrender, SHAEF, December 1944.
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Nazi administrative machinery of certaindissolved organizations when necessary to provide relief, health, andsanitation; and (5) Germany to be treated as a defeated country and not as aliberated one.
The directive pointed out that the conduct of MilitaryGovernment operations was a command responsibility and that the discharge ofthis responsibility might require the use of all resources at the disposal ofcommanders. By specific reference, this included Military Government staffs anddetachments, and functional experts, with retention as needed of Civil Affairsstaffs already assigned to Army Group Headquarters.
Public health specifications.-Public health policyof the Supreme Commander was stated in section IX of this directive, as follows:(a) Control of communicable diseases among civilians in Germany; (b) Preventionof the spread of dangerous diseases across German boundaries; (c) Removal ofNazis and ardent Nazi sympathizers in German public health services and theirreplacement by acceptable personnel; (d) Provision of medical care necessary toprotect the health of United Nations nationals in Germany; (e) Use of medicaland public health resources and productive capacity of Germany to the extentneeded to supply urgent needs of the United Nations, and sanction of the use ofthe balance for maintenance of public health in Germany; (f) Importation, ifGerman resources proved to be inadequate, of limited medical supplies for use ofGerman nationals as might be necessary to prevent disease and disorder, such asmight endanger or impede military operations; and (g) Discovery anddissemination of any new advances by Germans in the fields of public health andmedical science. In succeeding paragraphs of this directive, many particularswere specified to give effect to this policy.
Health conditions.-During the Rhineland Campaign,there were no serious epidemics and no great public health problems. No majorproblem of preventive medicine arose until typhus fever appeared in February andbecame a dangerous threat in the Rhineland and Inner Reich in March 1945.
THE DEFEAT OF GERMANY
Military situation.-Between 24 March and 1 April1945, the Rhine barrier was breached in many places by all of the Armies of theAllied Expeditionary Force. The assault crossings of the river were made nearWesel in the north and all along the river to the vicinity of Karlsruhe in thesouth. According to General Eisenhower, "the March 24 [northern] operationsealed the fate of Germany."45
In the 45 days following 24 March 1945, Germany was overrunby the victorious forces of the Allies. From the long list of advances andconquests of this period, the following achievements deserve mention tosummarize the final stage of the vast campaign. The Ruhr was enveloped andreduced by the First and Ninth U.S. Armies between 24 March and 18 April. The 21
45See page 391 of footnote 4, p. 436.
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Army Group cleared Holland and northwest Germany and receivedthe surrender of all German armed forces in those areas and in Denmark, on 4May. Bremen and Hamburg fell to the British Second Army. The Ninth U.S. Armyreached Magdeburg, and elements of the First U.S. Army met the advancingRussians at Torgau on the Elbe River, on 25 April. The Third U.S. Army was asfar east as Chemnitz, Pilsen, Regensberg, and Linz on the Danube in Austria. TheSeventh U.S. Army took Munich, the capital of Bavaria, on 30 April, and advancedthrough Salzburg, Austria, to Berchtesgaden, Bavaria, without opposition. TheFrench First Army had advanced from Strasbourg to the Swiss border near Baseland on to Lake Constance, completely encircling the enemy in the Black Forest.On 2 May, Berlin surrendered to the Russian forces; on the same day, the Germanarmies in Italy surrendered completely. On 7 May, the German High Commansurrendered all the land, sea, and air forces unconditionally to the AlliedForces, effective at 1 minute after midnight on 8-9 May. Upon receipt of thisnews in the field, all offensive operations were immediately halted.
Phases and plans of Military Government in Germany-Thefirst phase of Military Government in Germany began about 11 September 1944 whenthe First, Third, and Ninth U.S. Armies occupied small areas in the Saar-Palatinateof the Rhineland. This phase (Phase I) of the occupation continued until thesurrender of Germany when it was succeeded by a so-called Static Phase (PhaseII) of the U.S. military occupation of Germany, extending from the surrenderuntil 2 July 1949, when the Hon. John Jay McCloy as High Commissioner succeededGen. Lucius D. Clay, who had been United States Military Governor in Germanysince shortly after the fall of Berlin. On that date, as former Brig. Gen. FrankL. Howley put it: "Military rule was out; civil rule was in."46
In dealing with the two phases of Military Government andassociated public health activities, the plan of this section is to describe anddiscuss rather fully the major events of the early phase (Phase I) and topresent a relatively brief account of activities of the static phase (Phase II).The conclusion will be 31 December 1945, the closing date for this history, butsome projections beyond that date will be necessary.47
46(1) Howley, Frank L.: A Four Year Report. Office of Military Government, U.S. Sector, Berlin, July 1, 1945-September 1, 1949. Public Relations, Statistical and Historical Branch, Office of Military Government, Berlin Sector, Berlin, 1949. (2) Howley, Frank: Berlin Command. New York: G. P. Putnam's Sons, 1950, p. 5.
47Report, The General Board, U.S. Forces, European Theater. Civil Affairs and Military Government Organizations and Operations. Study No. 32, 1946. Note: This Report, a concise and detailed history of CA/MG in the European theater from 1943 through July 1945, gives the code names, designations, and descriptions, with narratives and comments, of the plans and phases of the operations; such as, CARPET PLAN; TALISMAN PLAN; ECLIPSE PLAN; PARTIAL ECLIPSE CONDITIONS; FIRST STATIC PLAN; INTERMEDIATE STATUS; FINAL PLAN; and STATIC PLAN. Parts 6, 7, and 8 deal with Military Government in Germany; Part 9 presents information on field experience of CA/MG officers, with some of their evaluations of the program. Part 10 contains conclusions and recommendations. The Report contains little or no direct reference to public health activities, but from the information given about ECA Regiments and MG Detachments, inferences may be drawn as to types of public health activities with which they were concerned.
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Health Conditions
Civil public health problems during the ebb and flow ofmilitary operations in the Ardennes were merely a prelude to those encounteredin western Germany, where disruption of the people, facilities, and governmentwas extensive, and where most of the cities had been destroyed by shelling or bybombing.48Pictures of Cologne in March 1945 are graphic examples of the destruction (figs.60 and 61).
The swiftly moving events following the capture of theRemagen bridge on 7 March 1945 brought the greatest tests of Civil Affairsactivities, including those of public health. That the health aspects of theadvance into Germany were met is a tribute to the combined medical and publichealth efforts of the Allied armies and justified the long and often frustratingplanning by a handful of public health personnel. The civil healthresponsibilities of SHAEF and of the Army Groups were substantial. They differedmore in quantity than in kind from those previously encountered in France,Belgium, and Luxembourg: emergency medical care of civilian sick and wounded,rehabilitation of sanitary services, reestablishment of civilian medicalservices and medical supply facilities, care and control of displaced personsand refugees, and the prevention and control of communicable diseases. But insheer magnitude, nothing equaled the control and movement of vast numbers ofrefugees and displaced persons, and the problems posed in the protection ofNorthwest Europe against the threat of louseborne typhus fever, which occurredin epidemic form in the Rhineland and Inner Reich. Another problem unique inmodern medicine was presented by starvation conditions in German concentrationcamps as well as among some civilians outside these camps. The account of howthese problems were met is, to a great extent, the history of CA/MG publichealth activities carried out by many types of regular and special units duringthe last phase of the European War.
Plans, personnel, and dispositions.-In October 1944,plans to use Civil Affairs public health personnel were integrated with theoverall CA/MG plans. Under "Plan 1186 South," the 3d ECA MedicalDetachment and the 3d ECA Regiment were earmarked for Military Government publichealth in Germany; Companies E, F, G, and H, 2d ECA Regiment, with 2d ECAMedical Detachment were reorganized for German occupation; and the reorganized1st ECA Regiment and the 1st ECA Medical Detachment were assigned to CivilAffairs public health in France and Belgium in support of communications lines.Thus, the already insufficient strength was spread more thinly than ever by thedeployment of one-third of it to cover rear areas, leaving but two-thirds tocover the increasingly large areas of occupied Germany.
48United States Strategic Bombing Survey, Morale Division, Medical Branch Report. The Effect of Bombing on Health and Medical Care in Germany. Washington: War Department, 30 Oct. 1945.
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FIGURE60.-The cathedral at Cologne, Germany, stands among ruins on the banks of theRhine.
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FIGURE61.-Bombed-out underground reservoir at Cologne, Germany, which normallystored more than 5 million gallons of water.
The CARPET PLAN envisioned specific MilitaryGovernment Detachments for duties in German governmental subdivisions for whichthey were trained. In theory the MG (Military Government) fabric would beunrolled like a carpet as territory was occupied in Rhine Province, Hessen-Nassau,and parts of Westphalia. The CARPET PLAN, drawn up before there were any U.S.forces in Germany, suffered from great uncertainty as to which element of anArmy Group would "lay" a particular portion of the carpet. Pinpointingof units or personnel for specific localities, regardless of their companyaffiliations, required placement of detachments with the armies which were touncover their ultimate destinations. The entity of an MG company meant littleunder such conditions. Actual situations made it necessary for commanderssometimes to disregard deployments according to plan, which also affected thedeployment of MG public health personnel. In addition, uncertainties caused bythe frequent shifting of boundaries between armies and the transferring ofdetachments persisted in the operations of PLAN TALISMAN, later named "PLANECLIPSE," the plan for
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the final penetration of Germany, withdrawal intothe final U.S. Zone of Germany, and the full establishment of MilitaryGovernment.
Public Health activities to 28 March 1945.-PublicHealth officers of ECA Medical Detachments, then serving in Germany underMilitary Government, continued to exercise the advisory and supervisoryfunctions that they had performed in France and Belgium. The problems with whichthese officers were concerned were complex and extensive and called for vigorousand sustained activity, as indicated by the scope and requirements set forth ina special SHAEF G-5 manual.49
The territory in which the problems arose was so large, andthe mass of civilians involved was so great, that the tasks proved to be beyondthe resources and competence of the relatively small group that constituted thePublic Health Branch of G-5 SHAEF and the ECA Medical Group. The situationbecame so urgent that the great resources of the regular medical service of thefield armies were called upon to meet it on 28 March 1945.
The events of the period ending on 8 May 1945 are obviouslyinterrelated and cannot be treated in isolation. It is possible, however, toexamine them separately and this will be done in succeeding sections dealingwith (1) the epidemic of typhus in 1944-45 and the "cordon sanitaire,"(2) the Nazi concentration camps, (3) the care and control of displaced personsand refugees, (4) nutritional problems among civilians, and, finally, (5) therelation of the operations of the medical and public health units and officersof G-5 SHAEF Civil Affairs/Military Government to those of the regular MedicalService of the Armies and Army Groups.
Typhus in Occupied Germany, 1944-45
As the history of epidemic louseborne typhusfever in the European theater during World War II has been presented elsewherein considerable detail, only a relatively brief account will be given here.50
At the outset, it must be remembered that numerous Army andcivilian medical, public health, and research organizations, and manyindividuals were engaged in the fight against typhus during the war. Althoughthis chapter focuses upon the activities of SHAEF G-5, Public Health Branch andits related units, such as the ECA Medical Group, many other military-medicalelements in the field and at various headquarters participated effectively inthe antityphus operations. In describing the extensive typhus control activitiesin northwest Europe, it is often difficult to identify
49SHAEF, G-5 Division: Military Government of Germany. Technical Manual for Public Health Officers. Prepared on 22 November 1944 by Public Health Branch, G-5 SHAEF, and revised on 2 February 1945.
50(1) See Vol. I, pt. III, sec. 5 of footnote 5 (2), p. 439. (2) Gordon, J. E.: Louse-Borne Typhus Fever in the European Theater of Operations, U.S. Army, 1945. In Rickettsial Diseases of Man. Washington: American Association for the Advancement of Science, 1948, pp. 16-27. (3) Bayne-Jones, S.: Typhus Fevers. In Medical Department, United States Army. Preventive Medicine in World War II. Vol. VII, Communicable Diseases. Arthropodborne Diseases Other Than Malaria. Washington: U.S. Government Printing Office, 1964, pp. 175-274.
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exactly which group should be credited with the success, orjudged responsible for the failure, of a given aspect of the overall effort.
Major policies, plans, and activities were developed andcarried out by the following organizations, working sometimes alone, but usuallyin collaboration: (1) SHAEF G-5 Division and the Public Health Branch, SHAEFG-5; (2) Preventive Medicine Division, Office of the Chief Surgeon, ETOUSA; (3)Chief of Preventive Medicine, Office of the Surgeon, 12th Army Group; (4) G-5Divisions of armies, corps, and Communications Zone, Advance Section; (5)innumerable surgeons of armies, corps, and divisions, and their staffs; (6)Preventive Medicine Service, Office of the Surgeon General, War Department; (7)the United States of America Typhus Commission; (8) Civil Affairs Division, WarDepartment Special Staff; and (9) representatives of the Medical Service of theBritish 21 Army Group. This list, though incomplete, is indicative of the largeforces that were engaged in one of the most extensive, intense, and successfulpublic health operations in history. Key individuals in this enterprise wereCol. John E. Gordon, MC, Chief, Preventive Medicine Division, Office of theChief Surgeon, ETOUSA; Colonel Scheele, Preventive Medicine Officer, PublicHealth Branch, G-5 SHAEF; Colonel Whayne, Chief of Preventive Medicine, Officeof the Surgeon, Headquarters, 12th Army Group; and Brigadier General Fox, MC,Field Director, United States of America Typhus Commission.
Awareness and preparations.-Knowledge of the ravagesof louseborne typhus fever under conditions of war coupled with destitution andmalnutrition among civilians created in the minds of all medical and publichealth authorities concerned an awareness of the potential threat of typhus. Assome of the main foci of typhus were in eastern Europe, that area was marked forparticular attention. Preparations to protect troops, and to prevent and controltyphus, were intensified in the years immediately preceding the entry of theUnited States into World War II. Improvements of chemical lousicides, of typhusvaccine, and of methods for using these agents were well underway as early as1939. The possibility of encountering typhus in northwest Europe became apparentin reports showing that typhus had become established in eastern Germany in1939, and had been spread throughout the country by German soldiers returningfrom the eastern front, by prisoners of war, and by slave laborers brought infrom infected areas.
Information concerning the prevalence of typhus in Germanyuntil near the end of 1943 was available from reports issued by German healthauthorities. Then, in January 1944, the Germans stopped the general issuance ofthese reports. Consequently, uncertainty ensued.
In July 1942, Brigadier General Simmons, Chief of thePreventive Medicine Service, Office of the Surgeon General, realized that therewas a disquieting lack of information about the occurrence of epidemic typhus inparts of Europe, including Germany, and in North Africa and other areas
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into which U.S. troops might be sent. One consequence of hisconcern in these matters was the establishment of the United States of AmericaTyphus Commission on 24 December 1942 by Executive Order No. 9285.
During 1943, stocks of DDT and typhus vaccine wereaccumulated in London, and the Division of Preventive Medicine, Office of theChief Surgeon, ETOUSA, increased activities in planning, training, and variousprecautionary measures. Typhus had been encountered in North Africa after thelandings in 1942. The outbreak of typhus at Naples, Italy, was brought undercontrol during the period December 1943 through February 1944. The extraordinarylethality of DDT powder for the body louse and its prolonged effect fromresidual amounts in clothing were well established in 1943. The use of DDTpowder applied by dusting individuals fully clothed greatly strengthened theeffects of delousing, thus preventing the spread of typhus.
Lack of definite information about the prevalence of typhusin Germany in early 1944 and for several months after the invasion of Normandyreduced in the minds of some authorities remote from the scene of action theneed to prepare for the control of typhus in the European theater. This opinion,of course, was not shared by either the Division of Preventive Medicine, Officeof the Chief Surgeon, ETOUSA, or the Public Health Branch, G-5 SHAEF,represented by Lieutenant Colonel Scheele, who urged the shipment of increasedamounts of DDT and other antityphus supplies to the theater, starting inSeptember 1944.
Some 20 years later, Dr. Scheele, at the request of thechairman of the Advisory Editorial Board of the Preventive Medicine series,recorded some of the details of this episode in a reminiscent letter, from whichthe following portions are quoted.51
My recollections of some dates in 1944 issomewhat hazy but I will try to reproduce some of the happenings of that time.The Germans in Paris surrendered on August 25, 1944, and shortly thereafter Ihad an opportunity to visit Dr. Robert Pierret, Director-General of OfficeInternationale d'Hygiene Publique, 195 Bd. St. Germaine, Paris. TheInternational Office of Public Health was a precursor of World HealthOrganization. It came into existence in 1907 and survived through the period ofthe Health Organization of the League of Nations which had fewer members.
* * * * * * *Most of the U.S. people who were working in UNRRAassumed that the International Office of Public Health had been destroyed by theGermans and had gone out of existence. However, I found when I visited Pierretthat the worst treatment he had had from the Germans was the rifling of hisfiles. They attempted to replace him with a German but finally gave up when he"sat in" his office and said that only the nations which elected himcould discharge him. He continued to collect communicable disease reports andcontinued to publish the Office's Bulletins. He took duplicate sets of these,wrapped and addressed to the USPHS, along with sets for Latin American and othercountries not under German control, who were members, to a farm for burial undera
51Letter (personal communication), Leonard A. Scheele, M.D., formerly Surgeon General, U.S. Public Health Service, to Brig. Gen. Stanhope Bayne-Jones, USAR (Ret.), formerly Director, United States of America Typhus Commission, 5 Nov. 1964.
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haystack against the day when the Germans wouldbe defeated and the back issues could be mailed.
I told Dr. Pierret of our great interest ingetting early intelligence on the possible occurrence of typhus fever in areasstill under German control, and he offered to contact the man in Switzerland whowas principal representative of that country to the meetings of the Office, toask him to contact his German counterpart in Berlin to obtain information. As aresult of this there were mailed to Paris via Switzerland, the German Ministryof Health's summaries covering the period of 23 weeks January 1 through June6, 1944, and weekly reports #31 through 34 covering July 30 through August 26,1944. These showed a slow increase in reported weekly cases of typhus in thecivilian population, especially in July and August 1944. They did not, as Irecall, distinguish between the German civilian and slave laborer cases. It wason the basis of these reports that SHAEF sent a substantial request for DDT andpower dusting equipment to the War Department through the Combined Chiefs ofStaff in Washington, its normal channel to the U.S. Military Services. You willrecall that you sent Joe Sadusk [Col. Joseph F. Sadusk, MC, Executive Officer,United States of America Typhus Commission] to Paris to visit us inmid-September, 1944, in order to explore more fully the basis for our verysubstantial DDT requirement. I believe that Joe went home satisfied with therequest and recommended it to you. I supported it further when I talked with youin the USA on my trip home during the period November 1 to 14 (1944).
United States of American TyphusCommission.-On 26 February 1944, Brigadier General Fox and Colonel Turnerconferred in London with Major General Hawley, Colonel Whayne, MC, AssistantMilitary Attach? for Medicine, American Embassy, London, and with Britishofficials concerning the participation of the Typhus Commission in typhuscontrol in the European theater. As a result of agreements and approvals, on 17May 1944, the Commission, attached to the Public Health Branch, Civil AffairsDivision, G-5 SHAEF, established its Field Headquarters in London at 44Grosvenor Square, and later acquired two refrigerated warehouses for storage oftyphus vaccine. Thereafter, most of the typhus vaccine used in ETOUSA was issuedby the Commission. DDT concentrate and powder were procured, stored, and issuedby appropriate authorities of ETOUSA and SHAEF, with the constant support of theCommission. The Field Headquarters of the Typhus Commission in the Europeantheater moved to Paris on 9 November 1944, and personnel of the Commissioncontinued to collaborate with personnel of SHAEF, the 12th Army Group, and 21Army Group, throughout the remainder of the campaign in Germany and until 27August 1945, when this field headquarters was closed. After that date, theCommission was attached to the Headquarters, USFET (U.S. Forces EuropeanTheater), at Frankfurt, Germany, working in various areas, including Poland,under Lt. Col. David M. Greeley, MC, until 22 April 1946.
Typhus in the Rhineland.-Typhus was first reportedat Aachen, in the Rhineland, in February 1945. Several Italian conscriptlaborers traveling from Holland to Aachen had fallen into the hands of a NinthU.S. Army unit. A tentative diagnosis of typhoid or typhus fever was made by aMilitary Government medical officer, and the serological diagnosis of typhus wasmade by the 10th Medical Laboratory. On 5 March 1945, five more cases werediscovered in M?nchen-Gladbach. Almost at the same time, an out-
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break of typhus was uncovered in the city of Cologne byelements of the First U.S. Army and the Cologne Military Government detachment.By 1 June 1945, 183 cases had been reported in M?nchen-Gladbach and 199 inCologne. Russian and Polish laborers and native Germans mostly living in airraid shelters and prisons were principally affected. An explosive outbreakoccurred at Herm?lheim in the last week of March. In the Rhine Province, theSaarland, and the Palatinate, about 400 cases of typhus had occurred in theweeks preceding the entry of American troops. The region of the Rhineland fromnorth to south was heavily seeded with infection and the potential for spreadingwas strong. Colonel Gordon has vividly described the conditions in this area inMarch 1945 as follows:52
The whole area seethed with foreign peoples,conscript laborers moving this way and that and in all directions, hoping toreach their homes, in search of food, seeking shelter. Most of the typhus waswithin this group and they carried the disease with them. They moved along thehighways and in country lanes-now a dozen Roumanians pulling a cart loadedwith their remaining belongings; here a little band of Frenchmen working theirway toward France, there some Netherlanders, or perhaps Belgians; andeverywhere, the varied nationalities of the East-Ukrainians, Poles, Czechs,Russians. They moved mostly on foot, halted, then gathered in great camps ofsometimes 15,000 or more, extemporized, of primitive sanitation, crowded, andwith all too little sense of order or cleanliness.
These were the people where typhuspredominated, more than half a million of them in the Rhineland, wearied withthe war, undernourished, poorly clothed and long inured to sanitaryunderprivilege and low level hygiene. Add to this shifting population thehundreds of released political prisoners, often heavily infected with typhus buthappily far fewer in numbers; the German refugees, first moving ahead of ourtroops and then sifting back to their homes through the American lines. Rarelyif ever has a situation existed so conducive to the spread of typhus.
Typhus fever in a stable population is badenough. It has demonstrated its potentialities in both war and peace. TheRhineland in those days of March, 1945, could scarcely be believed by those whosaw it-it is beyond the appreciation of those who did not. It was Wild West,the hordes of Genghis Khan, the Klondike gold rush, and Napoleon's retreatfrom Moscow all rolled up into one. Such was the typhus problem in theRhineland.
By the intensive efforts of typhus teams and medical andsanitary personnel of military (Army) medical units and CA/MG detachments,having adequate supplies and applying methods of casefinding, isolation ofcases, and delousing with DDT powder, the main centers of infection at M?nchen-Gladbachand Cologne were brought under control during March. From March to June 1945,693 cases were reported from 65 localities in the Rhineland.
Typhus in the Inner Reich.-Accordingto Colonel Gordon, the Inner Reich was defined as "that part of Germanyeast of the Rhine and north of Switzerland which fell under the influence of theUnited States Army. It included not only a major part of Germany, but also thewesternmost part of Czechoslovakia and the greater part of Austria."53
52See pages 20-21 of footnote 50 (2), p. 474.
53See pages 21-23 of footnote 50 (2), p. 474.
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The epidemic of typhus in the Inner Reich lasted about 3months, from the last week in March to the end of June 1945. About 15,800 caseswere reported from 518 localities in the environment of troops. Among theselocalities were the typhus-infested German concentration camps. Once the diseasewas suppressed, it did not recur in epidemic proportions.
The cordon sanitaire.-Shortly after the breaching ofthe Rhine barrier and the start of the rapid eastward advance of the AlliedForces, a stream of displaced persons, refugees, prisoners, and others began tomove west. To protect regions west of the Rhine, including France, Luxembourg,Belgium, and the Netherlands, special arrangements had to be made for typhuscontrol measures at the river crossings. Accordingly, there was erected asanitary border, called the "cordon sanitaire." This was doneofficially by a SHAEF directive on 31 March, implemented by an order fromHeadquarters, ETOUSA, on 12 April 1945.54Before this, however, both the First and Ninth U.S. Armies had establishedcordons in their areas.
The cordon extended from the junction of the Swiss border andthe Rhine River along the course of that river to the junction of the Rhine andWaal Rivers and, thence, along the north bank of the Waal to the North Sea. Allexisting or future crossings of the rivers were designated either as ports ofentry or as guard stations, and all civilians and liberated prisoners of wartraveling from east to west were deloused at ports of entry before crossing thecordon sanitaire. Delousing stations at ports of entry, with adequate personneland supplies of 10-percent DDT powder and hand- or power-dusters, were locatednear bridges, usually in a displaced persons center. Guard stations wereestablished and staffed with sufficient personnel at intermediate points betweenthe ports of entry to prevent crossing the cordon at places other than ports ofentry. Transportation by river or canal boats along the line of the cordon wassuspended except when persons under military control moved to a port of entry.Delousing stations were maintained at entraining points and airfields forpersons crossing the Rhine by train or plane. Each treated person was given anendorsement on his identification papers showing the date and method ofdelousing, and no person was permitted to cross the cordon without suchevidence. Persons giving evidence or suggestion of illness were placed underobservation until either their illness was diagnosed or proper disposition wasdetermined.
At some of the large stations, approximately 2,500 personswere deloused daily. The six-gun power-duster could handle 425 to 500 personsper hour. Dusting teams were organized from Quartermaster Bath and DustingUnits. These had a normal capacity of treating 1,600 persons per team per day,but in actual operations using power-dusters, this figure was considerablyexceeded.
54Letter, Brig. Gen. R. B. Lovett, Headquarters, ETOUSA, to Commanding Generals, Section Commanders, and Commanding Officers of listed groups, 12 Apr. 1945, subject: Establishment of a "Cordon Sanitaire."
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The concept of the cordon sanitaire was an oldone, having been included in the report of the Committee of Experts in 1937. Bythe fall of 1943, the original plan for such a cordon, according to ColonelGordon,55 wasprepared in his Preventive Medicine Division, Office of the Chief Surgeon,ETOUSA. At about the same time, it became a basis for planning in the PublicHealth Branch, G-5, COSSAC. Direct supervision over the cordon sanitaire was afunction of the Surgeon of the 12th Army Group, performed by his Chief ofPreventive Medicine, Colonel Whayne.
Before the establishment of the cordon sanitaire, andcomplementary to it, there was a program of rapidly searching out foci of typhus(casefinding) and, following the pattern developed in Italy, a program forseeking out and extinguishing the "flying sparks" made up of secondaryas well as primary cases which had escaped into unaffected territory.
The following excerpts from reports from Military Governmentmedical and public health detachments attached to units of the First U.S. Armyin March 1945 present typical indications of experiences.
Fifteen hundred pounds of DDT, 75 spray guns,990 cc. of typhus vaccine and other supplies have been received. Bunkers andother shelters have been assigned to disinfestors who will each appoint deputiesand spraying the bunkers will begin today.
Tactical forces have been advised to issuedirectives prohibiting troops from entering civilian shelters which are thechief foci of typhus. The shelters are being posted "Off Limits."
Arrangements were made for the evacuation of11 cases of typhus from the Couteyard plant and 25 sick persons from the Fordplant where they are a menace to the health of troops. They will be sent to St.Vincent's Hospital.56
All typhus cases in Cologne have been isolatedin hospitals, all contacts have been deloused with DDT powder, and personnelcontinuously exposed to diseased persons have been inoculated with anti-typhusvaccine. A case-finding program was instituted, involving a search for all areasof the city where focal points of louse infestations and typhus fever might befound. Based on previous experience, the portion of the population in whichninety percent (90%) of infestation might be anticipated has been thoroughlyinvestigated. Over 10% of the total population have been dusted, and no newcases have been reported since 9 March '45.
A medical officer from SHAEF has been sent toBad Godesberg, Ahrweiler, Euskirchen, and Bonn to investigate reported cases oftyphus and to brief detachments on typhus control.
Three medical officers, two (2) Sanitary Corpsofficers and one Veterinary Corps officer were obtained and attached to E1H2 forpublic health operations in Cologne, Bonn and the surrounding territory.57
Army Security Guards are in control to preventdisplaced persons from crossing the Rhine except at designated crossing points.Displaced persons in organized convoys only will be allowed to cross, and theseare to be dusted under Army Medical Corps supervision with DDT powder on theeast bank just before crossing.58
Twenty-nine sick persons, including 6 typhuscases were evacuated from the Gestapo
55See page 23 of footnote 50 (2), p. 474.
56Historical Report, Lt. Col. John K. Patterson, CAC, First U.S. Army, 1-31 March 1945, Appendix LL, Daily MG Report G-5, No. 3, 11-12 March 1945, Det. E1H2.
57Historical Report, Col. P. Seneff, GSC, Headquarters, First U.S. Army, Office of Assistant Chief of Staff, G-5, Summary No. 282, 14-15 March 1945.
58Historical Report, Col. Damon M. Gunn, GSC, Headquarters, First U.S. Army, Office of Assistant Chief of Staff, G-5, Summary No. 297, 29-30 March 1945.
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Prison. * * * All the remaining inmateshave been dusted with DDT and can be sent to a DP Center ** * A partial list of locations of typhus cases was obtained from the104th Infantry Division.59
Administrative change and summary-Colonel Gordon60has recorded that:
From the first discovery of typhus in theRhineland, it became increasingly evident that active typhus control in thefield was beyond the scope of the numbers of Military Government personnel thenavailable. On 4 March 1944 an altered plan of organization for typhus control inrespect to continental operations was recommended by the Division of PreventiveMedicine to the Chief Surgeon [ETOUSA]. Consideration was given to four groupsof people: troops in the field, casualties returned to the United Kingdom or tothe Zone of the Interior, prisoners of war, and the civilian populations inoperational areas.
Control of typhus in the first threepopulation groups had always been a responsibility of the Medical Department,United States Army. With regard to civilians [with respect to whom the G-5Division of SHAEF had primary responsibilities] the following recommendationswere made: (1) That the responsibility for immediate control measures amongcivilians rest with the Chief Surgeon, ETOUSA, (2) That the necessary pool ofsupplies be authorized and obtained by the Medical Department, United StatesArmy, (3) That joint plans be initiated with the CivilAffairs Division, UNRRA, or other agency, to the end that responsibility fortyphus control in relation to civilian populations be assumed by suchorganization within a thirty day period.
On 28 March 1945, the Supreme HeadquartersAllied Expeditionary Forces (SHAEF) issued the following order: "To protectthis command it is necessary that public health functions in enemy occupiedterritory be a responsibility of Command and under the direction of unit medicalofficers in all echelons." Within a brief period this action was broughtabout; with medical officers of all echelons responsible for typhus fever withintheir areas of responsibility, irrespective of its occurrence in civilian ormilitary personnel; and with technical supervision of the program of control bythe Chief Surgeon of ETOUSA. Unified and intensified effort led to an increasedlevel of accomplishment.
During the epidemic of typhus fever within German territoryoccupied by U.S. forces from March to the end of June 1945, 16,506 civiliancases of typhus were reported from 518 localities. Of these cases, 15,810occurred in the Inner Reich and 696 in the Rhineland. By the middle of July1945, Western Europe had returned to a satisfactory low level of typhusendemicity.
Finally, with respect to CA/MG, G-5 Public Health activitiesin the invasion of Germany, Colonel Gordon's comment was, in substance, asfollows (and this is confirmed by comments of other high authorities): ThePublic Health Section at SHAEF prepared and issued the technical directives forthe control of typhus fever among civilians. They assured the provision ofadequate supplies.
Through various echelons of command of G-5, and throughconstituted health officers and teams, active control in the field wascontributed both initially when the responsibility rested in MilitaryGovernment, and
59Historical Report, Lt. Col. John K. Patterson, CAC, First U.S. Army, G-5 Section, 1-31 March 1945; Germany Appendix LL, Daily MG Report No. 1 from Det. E1H2-C.
60See pages 18-19 of footnote 50 (1), p. 474.
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later when Public Health sections joined withthe Medical Department to serve under the direction of Surgeons of correspondingechelons.
The Nazi Concentration Camps
By 1939, the Nazi Government had established sixconcentration camps in Germany and Austria at Buchenwald, Dachau, Flossenb?rg,Mauthausen, Ravensbr?ck, and Sachsenhausen. From 1940 to 1945, more were added,some of which were in Poland. These included Arbeitsdorf, Auschwitz, Belsen,Gross Rosen, G?sen, Lublin, Natzweiler, Neuengamme, Niederhagen, and Nordhausen.Among the inmates, there was much sickness and almost universal louseinfestation, typhus fever became rampant, and from them, especially in April1945, it was spread through large portions of the Inner Reich.
The following fragmentary extracts of contemporary reportsand a published account convey some idea of the magnitude of the effort whichhad to be made by public health and medical personnel of Military Government,Army organizations, and the Typhus Commission to cope with the situation. Theseexamples relate to conditions and experiences at the concentration camps atBelsen, Buchenwald, Dachau, and Mauthausen.61
Belsen.-Among the concentration camps, Belsen, inthe area of 21 Army Group, became especially notorious because of the starvationof its inmates, the horror of the conditions imposed by the Nazis, and theepidemic of typhus fever.62
This camp was taken by the British Second Army on 15 April1945, at which time typhus had been prevalent for 4 months, and there were about3,500 cases among the 45,000 inhabitants of Camp 1. Nearly all of the interneeswere heavily infested with lice. The deplorable situation was described asfollows:
Camp 1 contained 40,000 political prisoners.There are unknown numbers of cases of typhus fever. The disease is quite wildbut definitely diagnosed and confirmed. There are generalized gastroenteriticdiseases, which in the early observations are considered to be all types,particularly typhoid and dysenteries. Malnutrition is advanced in practicallyall occupants; 50 percent of the 40,000 occupants are estimated to be unable toconsume any food by mouth, that is of the normally available foods which couldbe furnished from Army stocks. There are 1,000 to 1,500 in advanced or acutestages of starvation who will require intravenous feedings. For thesearrangements have been made to fly in 7,200 lbs. of protein hydrolysate fromLondon. The handling of typhus has been placed under the direction of CaptainWilliam A. Davis, MC, Consultant from the United
61The chief concentration camps uncovered by Allied armies were BELSEN in the Province of Hanover (after 1945 named Lower Saxony), between Bergen and Celle, entered by the British Second Army of the 21 Army Group, under a truce, on the evening of 15 April 1945; BUCHENWALD, in Thuringia, central Germany, 5 miles northwest of Weimar, taken by the Third U.S. Army about 15 April 1945; DACHAU, in Upper Bavaria, 10 miles northwest of Munich, liberated by the Seventh U.S. Army on 1 May 1945; FLOSSENB?RG, in northern Bavaria, 6 miles northeast of Weiden, near Naab, captured by the Third U.S. Army in April 1945; and MAUTHAUSEN, Austria, 3 miles northeast of Ennes, on the left bank of the Danube, near Linz, taken by the Third U.S. Army in the latter part of April 1945.
62Davis, W. A.: Typhus at Belsen. I. Control of the Typhus Epidemic. Am. J. Hyg. 46: 66-83, July 1947.
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States of America Typhus Commission. Thepersonnel of a British Field Hygiene Section are employed in delousing allindividuals. There are adequate supplies at this time for handling the typhussituation.
Camp 2 at Belsen has approximately 15,000individuals, 2,000 of whom are westbound Europeans. The remaining areindividuals who should head east.-Camp 2 is typhus free.63
Buchenwald.-Describing the medical situation atBuchenwald, a Civil Affairs Public Health Officer wrote:
Of the approximately 21,000 inmates, there are5,000 who need medical attention. Of these, 2,400 are already (15 April) caredfor in the prison hospital, 1,500 are invalids or old people who cannot fend forthemselves, and 1,000 are severely ill of dysentery, tuberculosis, severemalnutrition, and skin infections. These 1,500 invalids and 1,000 other ill arein various barracks in the so-called "Little Camp." They exist thereunder indescribable conditions, living as many as sixteen in one compartment. Onthe day of inspection, in one barrack alone, twenty-four died. There are sixtycases of typhus fever in a special barrack which was very clean and wellequipped. It was also well isolated and served as an experimental station usingprisoners as guinea pigs. * * * There is no epidemic of typhus in the camp. Mostof the sixty cases were from Ohrdruf.64
Dachau.-The situation at the Dachauconcentration camp was described as follows:
It was stated that the camp was constructed tohouse between 10,000 and 12,000 people whereas the census on 1 May '45 was31,404, all male except for 300 females. It is evident that the camp isovercrowded. Wooden shelves three tiers high serve as beds with practically nomattresses padding and a few blankets for covering. In one block visited it wasreported that four people take turns sleeping on a single bed space. Crowdingand dirt was predominant. Within the living quarters bathing facilities wereapparently not used.
From the standpoint of physical condition theinmates may be divided into two groups. About one-half are up and around thecamp and appeared to be in a fair state of nourishment, the remainder and[those] who were reported as new arrivals, were in an extremely poor state ofmalnutrition. These people were extremely emaciated and represented advancedstages of malnutrition. Muscle wasting was extreme and many so weak they wereunable to walk. Practically all gave the appearance of indifference and apathyindicative of mental changes. It is extremely doubtful if these people will everrecover. Malnutrition in many is so far advanced that irrespective of treatmentmany will go on and die.
Within this camp there are approximately 800open cases of tuberculosis and in an adjacent camp about 300 others. Thereunquestionally are many more unrecognized at this time. It is estimated thatthere are 1,200 cases of typhus in the camp, with the possibility of others notbeing recognized. Other conditions that have caused considerable difficulty froma health standpoint are erysipelas and skin diseases of which there are greatnumbers.65
Mauthausen.-Similar conditions werefound at the concentration camp at Mauthausen, Austria, as described in thefollowing account:
63Report, SHAEF, G-5 Division, Military Government. Civil Affairs Weekly Field Report No. 46, for week ending 28 April 1945.
64Report, Civil Affairs Public Health to Commanding General, Third U.S. Army, 15 Apr. 1945, subject: Health Report-Buchenwald.
65Report, Lt. Col. Joseph W. Batch, MC, to Assistant Chief of Staff, G-1 and G-5, 4 May 1945, subject: Inspection, Dachau Concentration Camp, 2 May 1945.
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The maximum capacity of the camp was from35,000 to 40,000. The 11 Armoured Division found 18,000 residents, of whom 3,000were women. * * * At the time of uncovering, the Camp could be described asutterly without sanitation. Water power had been off for weeks, and conditionswere indescribable. Triple-decker beds accommodated 16 persons-five or six toa bed. Thousands slept on the floor and on the ground. The dead-700 unburiedbodies in all-were piled up in corners of the barracks * * * Army doctorsarrived at the camp within two days of its uncovering * * * The 130th U.S. ArmyField Hospital now have full control over all medical and sanitary matters inthe camp.66
It was necessary to continue to operate thesecamps since many of the inmates were too ill to be moved. As the acute emergencyphase passed, the character of the medical problems changed. The following notewas made in early July 1945 concerning current problems at that time in theMauthausen and G?sen concentration camps:
Pulmonary tuberculosis is now the biggestmedical problem in the camps. Probably more than half of all the patients haveadvanced pulmonary tuberculosis and approximately 80 percent of presentautopsies show advanced pulmonary tuberculosis. * * * Malnutrition is the other great medicalproblem in the camps. * * * Deaths with malnutrition as a complication are stilloccurring. This is a result of conditions existing before the camps were takenover, the correction of which were, in part, complicated by the difficulttactical and supply situation.67
Displaced Persons and Refugees in U.S.Occupied Germany, September 1944-July 1945
Planning.-In preparing for Civil Affairs/MilitaryGovernment in northwest Europe, in London during 1943 and 1944, SHAEF was toassume initial responsibility for the care, control, and repatriation of UnitedNations displaced persons and refugees, and some groups of enemy (German)civilians. It was intended that these responsibilities would later betransferred to UNRRA.
In June 1944, it was estimated that there would be 11,361,000displaced persons and refugees in France, Belgium, Luxembourg, the Netherlands,Denmark, Norway, and Germany (exclusive of German refugees.). Of these,2,501,000 would be refugees within their own countries and 8,860,000 would bedisplaced persons in foreign countries. With regard to Germany, Nazi slave laborpolicies and practices resulted in the existence of some 4.2 million displacedpersons in the U.S. Zone of Germany. The release of these millions ofindividuals, coincident with combat operations, posed the gravest problems ofcare and control, confirming the understanding by the planners that care anddisposition of DP's and refugees would present not
66SHAEF, G-5 Division, Displaced Persons Branch, Displaced Persons Report No. 34 of 18 June 1945, App. A.
67Memorandum, Col. Paul E. Howe, SnC, Chief, Nutrition Consultant, and Col. William H. Sebrell, Jr., MC, USPHS, Nutrition Consultant, SHAEF, G-5 Division, to Chief. Public Health Branch, G-5 Division, SHAEF, 3 July 1945, subject: Nutrition-Mauthausen and G?sen Concentration Camps.
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only technical (medical and public health) and administrativeproblems of great magnitude but also complex political problems.68
Commanding Generals of the field armies were directed toprepare plans for dealing with displaced persons and refugees in their areas ofresponsibility.69 Theobjectives were to prevent hindrance of military operations, to prevent andcontrol outbreaks of disease among refugees and displaced persons that mightthreaten the health of military forces, and to handle the repatriation of thesepersons.
As a result of plans discussed in 1943, aDisplaced Persons Branch was established in the G-5 Division of SHAEF in June1944, or somewhat earlier. This Branch had a close association with the PublicHealth Branch, G-5 SHAEF. In future operations, planning and activities of allgroups concerned with the care and handling of displaced persons and refugeesproceeded in various degrees of collaboration, and with some changes ofresponsibilities to meet the unexpected exigencies that emerged during theoverrunning of Germany.
Details have been given of typical conditions that existedamong displaced persons and refugees and of the activities of the CA/MG PublicHealth Branch to correct and improve them. These conditions includedmalnutrition and starvation, communicable diseases, louse infestation and theepidemic of typhus fever related to the German concentration camps, generalneglect of even primitive sanitary measures, and pitiable destitution. Indealing with these situations, CA/MG personnel rendered valuable assistance tothe field armies, thereby gaining invaluable experience which was applied laterin occupied areas of Germany. Joint activities of the G-5 SHAEF Public Healthpersonnel with personnel of armies were the rule. Examples of this can be foundin many reports, of which several from the Third U.S. Army and the 6th ArmyGroup are illustrative.70
Early phase.-The first deployment of MG publichealth personnel and units in German territory began in September 1944 and, bythe end of October, 25 MG detachments in German cities and towns in the area ofthe First U.S. Army were served by MG Public Health Officers. These officerscoordinated activities regarding public health measures and communicable diseasecontrol, and maintained close supervision of sanitation in the camps andassembly centers for displaced persons and refugees. The health of DP's andrefugees at large, outside the pest-ridden Nazi concentration camps, wasgenerally fair. The diet had been reasonably adequate and
68(1) See page 152 of footnote 29, p. 456. (2) Displaced persons operations are discussed in detail from the military point of view in SHAEF, G-5 Division, Displaced Persons Branch, Displaced Persons Reports No. 32 of 28 May 1945 and No. 35 of 25 June 1946.
69Letter, SHAEF to Commander-in-Chief, 21 Army Group, and Commanding General, First U.S. Army Group, 4 June 1944, subject: Refugees and Displaced Persons. (Note: At this time, FUSAG (First U.S. Army Group) was a "paper" organization, set up to deceive the enemy.)
70(1) Reports, Headquarters, Third U.S. Army, to Commanding General, 12th Army Group, subject: Monthly Health Reports for March and April 1945, dated respectively 1 April and 8 May 1945. (2) Report, Headquarters, 6th Army Group, to Assistant Chief of Staff, G-5 SHAEF, 18 Apr. 1945, subject: Weekly Health Report.
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hygienic conditions, except in severely bombedareas, were on the whole satisfactory. Substantially similar conditionsprevailed among German civilians.
The rapid advance.-Relatively manageable conditionscontinued until the period of the rapid advance of Allied Forces east of theRhine, from March to May 1945. Hordes of displaced persons and refugees migratedwestward, knowing from the attitude of the Russians that there would be no havenfor them in the east. The number of DP's and refugees overrun by the 6th and12th Army Groups had reached 500,000 by 15 March 1945, 1 million by 1 April, and2.8 million by 9 May. Within the next few weeks, the number rose to more than 4million. The problems of medical care and public health for these masses ofpeople did not differ in principle or in detail from problems previouslydescribed. They differed in magnitude-in such magnitude, in fact, that the MGunits and the Public Health Branch personnel which had been provided accordingto plans were swamped. One aspect of this was the demand for treatment of thesick and injured. Concerning CA/MG officers, Colonel Turner stated clearly at ameeting in 1944: "The function of civil public health officers is toappraise a given situation, outline a few clear and practical objectives,organize and direct local health and medical personnel, and assist in obtainingmedical supplies essential to the program. Except under unusual circumstances,for the public health officer to attempt to treat patients or to operate aclinic would be misdirection of energy."71
Use of Army Medical Department and combat troops.-Thelarge numbers to be controlled, and the woefully smallorganization provided to handle DP work exclusively, presented commanders, asthey did the Public Health Branch, G-5 SHAEF, with a trying dilemma. Troops andservices could not be diverted to the care and control of displaced persons andrefugees without risks. A turning point, however, was reached on 12 April 1945when SHAEF declared that "Partial Eclipse Conditions" existed.Authority was given to put into effect applicable portions of Operation ECLIPSE,where defeat of the enemy had become a fact. Operation ECLIPSE was a generalplan for taking over the administration of Germany upon its sudden collapse orsurrender, dealing primarily with armistice terms, displaced persons, prisonersof war, and German courts.72Commanders were enjoined to use all resources to accomplish the displacedpersons mission. This enabled them to detail officers and men as well assupplies of combat and service units to assist MG Detachments and to carry outMG policies.
At this time also, on 14 April 1945, SHAEF directed that G-5Divisions would have general staff supervision over public health and that theSur-
71Turner, T. B., and McDonald, G. W.: Civil Public Health in Overseas Theaters of Operations. Mil. Surgeon 96: 131-134, 1945 (January-June).
72Toland, John: The Last 100 Days. New York: Random House, 1966, p. 329.
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geons of Army Groups and Armies would direct the functions,as will be discussed later.
At their peak, approximately 50,000 combat and service troopswere employed in the care, control, and repatriation of displaced persons in the6th and 12th Army Groups. This number rapidly diminished in late June asrepatriations were accomplished. Repatriation of western European DP's beganas soon as U.S. Armies entered Germany. By 10 July 1945, when responsibility forDP's passed from the 12th Army Group to Headquarters, USFET, 2.7 millionUnited Nations DP's had been repatriated from the U.S. Zone of Germany.
Command Responsibility
Brief mention has been made of the SHAEF directives issued inMarch and April 1945, which changed the relationship between the public healthorganizations under G-5 and the regular medical services of the combatant Armiesand Communications Zone in the European theater. Now that sufficient backgroundhas been provided by indications of differing conceptions and opinions, and byaccounts of events, with citations of difficulties, failures, and achievements,it is appropriate to explore the matter in greater depth.
The two separate military public health organizationsoperating in the European theater were (1) the medical units and personnel ofthe Medical Department of the Army which were connected with the Office of theChief Surgeon of the theater, and (2) the CA/MG units and personnel in SHAEFwhich were connected with the Office of the Assistant Chief of Staff, G-5, andwere components of the Public Health Branch of G-5 Division, SHAEF. In additionto the G-5 SHAEF personnel, there were G-5 sections or officers in all fieldunits down to corps, and in the Communications Zone. Civil Affairs/MilitaryGovernment in all of its aspects became a major objective of the SupremeCommander. In theory, the SHAEF public health and medical groups were to beconcerned with conditions among civilians, the strictly military medical groupswith preventive medicine among the troops. Both groups, however, were concernedwith sanitary problems and many other problems among civilians in countriesliberated or conquered and occupied by the armies. The attempted separation ofthe two was unrealistic and, until March and April 1945, the respectiveresponsibilities were not clearly drawn and, even then, were not fullyspecified.
In reviewing early deliberations on this subject, the Surgeonof the 12th Army Group, Col. (later Maj. Gen.) Alvin L. Gorby, MC, USA, referredto an important conference, attended by high-ranking officers, at PrincessGardens in London in June 1944, shortly before the invasion of Normandy.73He reported that, at this conference, the main subjects of dis-
73Period report, Headquarters, 12th Army Group, to The Surgeon General, Washington, D.C., through Chief Surgeon, Headquarters, USFET (Rear), 31 Aug. 1945, subject: Medical Department Activities: History of Medical Section, 12th Army Group, 1 January-30 June 1945.
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cussion were the contemplated parallelfunctions of the Public Health Branch, G-5 SHAEF, and the Office of the ChiefSurgeon, ETOUSA, in public health and medical operations in Northwest Europe. Hewrote:
It was pointed out by the Surgeon of the 12thArmy Group that the concept of a separate Civil Affairs and later MilitaryGovernment Public Health Service would be a duplication of effort, personnel andsupplies, and that overall economy could be effected by establishing the G-5medical personnel in the Office of the Surgeon in all echelons of the fieldforces. It was especially pointed out that the Surgeons of Armies and lowerechelons had the means, organization and experience to assume thisresponsibility.
At this conference, the decision was confirmedand supported by command that CA/MG Public Health should function as a separatemedical organization in the field forces. This was regarded as final. Actions ofSurgeons in accordance with this were determined also by SHAEF directives to theeffect that G-5 personnel would be attached to field units when called for and,then, would come under the administrative control of the local field commander.All concerned were urged to maintain the closest liaison.
During the campaign in Europe, the Surgeon of the 12th ArmyGroup, as did Surgeons at all echelons, maintained only a liaison with thePublic Health Section, G-5. However, because of the necessity for workingtogether to solve common problems, the Surgeon, 12th Army Group, and the ChiefPublic Health Officer, G-5, at that headquarters collaborated constantly andexchanged medical information fully.
Commenting further upon developments during the campaign,Colonel Gorby wrote: "As the rigors of combat increased and the demandsupon the medical service for purely medical support became great, it isunderstandable that Surgeons of Armies found little time to concern themselveswith civil public health problems, especially since they had been given nospecific responsibility in these matters, were not concerned except where thehealth of troops was involved, and no greatly important epidemic diseases hadpresented themselves."
This remark has a bearing on the statement made repeatedly byofficers of the Public Health Branch, SHAEF, that Surgeons of the field forceswere only secondarily interested in civilian health, and would have made onlyminimal exertions along the lines of Civil Affairs mission and policy. Therecords show that there is truth in both statements.
Colonel Gorby pointed out, also, that:
Another complicating factor was thedissimilarity of the chain of command between military medical services and thepublic health services, G-5. Whereas the Surgeon looked through proper channelsto the Office of the Chief Surgeon, European Theater of Operations, UnitedStates Army, for support, G-5 Public Health Section channeled directly back tothe Chief Public Health Officer, G-5, SHAEF, from the field forces, and did notgo through Theater headquarters echelons. Since the SHAEF echelon was an overallpolicy making headquarters and not an operations headquarters, innumerabledifficulties in the solving of field problems which required Communications Zoneand European Theater of Operations support, and which under the circumstancesonly could
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be obtained by liaison, became apparent. Notthe least of these was the provision of adequate personnel, of which there wasonly a handful in the Armies to cope with the overall public health problem.
In view of these conditions, 12th Army GroupHeadquarters, through its Surgeon and its Assistant Chief of Staff, G-5, beganto transfer responsibility for public health activities from the G-5 group tothe Surgeons of all echelons so that all available medical resources could bemobilized to meet the tremendous task.
Almost from the start of the invasion of Normandy, there hadbeen a tendency toward shifting responsibility for the public health program inthe European theater from G-5 organizations to the regular medical service,represented, for example, by the Office of the Chief Surgeon and by Surgeons ofArmy Groups, Armies, and the Communications Zone. This resulted from (1) theconviction held by many that all medical and public health activities in thecombat zone should be under the control of the regular theater medical service;and (2) the severe shortage of G-5 medical and public health personnel and, insome instances, their lack of fitness for the work. After the Allied Forces hadcrossed the Rhine and were advancing rapidly eastward through Germany in Marchand April 1945, the large epidemic of typhus which had to be combated, and themass of displaced persons and refugees who had to be controlled and cared for,underscored these critical deficiencies and called for a vigorous reorganizationof the program.
On an inspection trip in late March 1945, Maj. Gen. Albert W.Kenner, the Chief Medical Officer of SHAEF, became convinced that the G-5organization, short of personnel and lacking supplies and transportation, wouldbe unable to meet its commitments. Incidentally, this confirmed GeneralKenner's predictions in March 1944, when he objected to the separateestablishment of the Public Health Branch, G-5 SHAEF.
After a conference with Maj. Gen. Warren F. Draper, Chief,Public Health Branch, G-5 SHAEF, and his deputy, Col. William L. Wilson, MC, andother G-5 officers, the Surgeon and the Preventive Medicine Officer, 12th ArmyGroup (Colonels Gorby and Whayne), General Kenner arranged for the SupremeCommander to issue directives which turned over to the Army Group andCommunications Zone Commanders and their medical staffs total responsibility forpublic health in occupied enemy territory.74
The first of these directives was a SHAEF cable (TWX FWD18271) to Commanding Generals of Army Groups, Armies, and Communications Zone,dated 28 March 1945. This consisted of one sentence which stated: "Publichealth in occupied enemy territory is a responsibility of command."
Directive of 14 April 1945.-On14 April 1945, the above statement concerning command responsibility wasamplified, and orders were issued
74Diary, Maj. Gen. Albert W. Kenner, entry of 29 March 1945, subject: Public Health in Enemy Occupied Territory-A Function of Command Under Direction of Unit Medical Officers, All Echelons, pp. 306-307.
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in an "immediate action" directive, from which themain parts are abstracted or quoted here (omitting British terminology).75
1. Reference is made to cable, SHAEF,FWD-18271, dated 28 March 1945.
2. This paragraph relates to control of communicable disease in militarypersonnel.
3. The progressively increasing commitments for public health functions inoccupied enemy territory necessitate the utilization of all medical resourcesavailable within the theater.
4. Responsibilities and relationships will be as follows:
a. Supreme Headquarters, AEF:
(1) Supreme Commander-Establishespolicies for conduct of Civil Affairs operations, including public healthfunctions.
(2) General Staff-G-5 Division is responsible for plans, policies anddirectives related to public health and exercises general staff supervision.
(3) Special Staff-The Chief Medical Officer exercises overall directionof public health functions.
b. U.S. Army Groups and Communications Zone(and 21 Army Group):
(1) Commanders-The conduct of CivilAffairs operations in accordance with policies established by the SupremeCommander is a responsibility of Commanders.
(2) General Staff-G-5 Division of the staff of each Commander isresponsible for plans, policies and staff supervision of public healthfunctions.
(3) Special Staff-Under the Commander, public health functions inoccupied enemy territory are under the direction of the Surgeon in each echelon.In implementing public health plans, policies and directives, all public healthpersonnel, as well as personnel from the medical services, are placed by theCommander, through "A" Branch/G-1 at the disposal of Surgeons forassignment, attachment, relief or detachment as considered necessary to assureadequate protection of the health of the command. The foregoing requires nochange in approved Tables of Organization. All authorized equipment and suppliesrequired for public health operations are made available to Surgeons byappropriate general staff divisions.
By direction of the Supreme Commander:
T. J. Davis
Brigadier General, USA
Adjutant General.
As this directive was not entirely clear, asupplementary directive was issued by SHAEF on 15 April 1945, clarifying therelationship between the Public Health Branch, G-5 SHAEF, and the regularmedical service. It allowed the Public Health Branch to continue to be concernedwith certain aspects of the health of civilians.76
In these deliberations and rearrangements in the 12th ArmyGroup and in the forces as a whole, an influential role was played by ColonelWhayne, who had been assigned to the headquarters of this Army Group as Chief ofthe Preventive Medicine Branch on 19 April 1944.
Actions taken by the Surgeon, 12th Army Group, to implementthe SHAEF directive of 14 April 1945 may be regarded as typical of similaractions taken by the other Surgeons in the European theater. On 26 April 1945,the medical personnel assigned or attached to the Public Health
75Action Letter, SHAEF to Headquarters, 21 Army Group; Commanding Generals, 6th and 12th Army Groups, and Communications Zone, ETOUSA, 14 Apr. 1945, subject: Public Health Functions in Occupied Enemy Territory.
76See pages 65-66 of footnote 47, p. 470.
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Branch, G-5 Section of Headquarters, 12th Army Group, wereattached to the Medical Section, and a Public Health Branch was established inthe Preventive Medicine Section on 1 May 1945, all under the direction of theArmy Group Surgeon. All activities formerly carried on in the Public HealthBranch of the G-5, 12th Army Group, were integrated with related sections of theSurgeon's office. By these actions, the G-5 Public Health Sections and theArmy Medical Services were "amalgamated" in the field forces. Unifiedand centralized direction and control of public health activities in the combatzone, under unit Surgeons, resulted in increased efficiency and smootheradministration.
The foregoing section has dealt with a controversial matterwhich is still subject to debate. As Colonel Gordon put it:
The Public Health Section of the Civil AffairsDivision was the preventive medicine organization for that part of Armyactivities directed toward the maintenance of health among civilians ofliberated countries. As the Public Health Section of Military Government, itserved a similar purpose for the civilians of conquered countries. Noinconsiderable discussion arose in the course of operations, and again after thewar was over, on the nature of a health organization to accomplish theobligations associated with military occupation of conquered countries. There isserious reason for combining into a single organization twoactivities-preventive medicine for troops and public health for civilians whobecome the wards of the army-which are identical in their aims and differ onlyin the populations to which they apply. When this is not done, however, theclosest cooperation between the two activities is necessary. The obligation totroops of protection from typhus fever cannot be accomplished satisfactorily ifan epidemic among the civilians who surround the army is disregarded. Venerealdisease is not a problem of an army but of a complete population. The army andcivilians live in the same area and the environmental hygiene of that area is asclosely related to the one as to the other.77
In his summary report to The Surgeon Generalof the Army, General Draper, covering the period May 1944-June 1945, analyzed atlength the pros and cons, and "honest differences of opinion" as towhether CA/MG Public Health should be a separate organization or a function ofthe Surgeons of the field forces.78
Views of Chief, Public Health Branch, G-5 SHAEF-GeneralDraper's opinion was expressed as follows: "There is no doubt in my mindthat the G-5 public health organization and relationship to the Army MedicalServices at SHAEF [italics added] were in the best interest ofmilitary operations as a whole and I do not know how they could be improvedupon." With regard to relations with the Field Forces at Army Group level,General Draper compared the G-5 plan of operation with his understanding of theplan that the Surgeon and G-5 Public Health Officer at headquarters of the 12thArmy Group considered preferable. After consideration of the comparison, GeneralDraper wrote:
My personal opinion in regard to the foregoingis that the Surgeon at the larger formation levels is fully occupied with themanifold and exacting duties of his position.
77See vol. II, pt. XI, page 5 of footnote 5 (2), p. 439.
78See pages 6-9 of footnote 25, p. 453.
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In order to become qualified for suchresponsibility an officer must have had long and intensive training andexperience in that particular field. It would be seldom indeed that such anofficer could have received training in public health sufficient to enable himto assume complete responsibility for civilian public health administration inaddition to his other duties. I believe that the best results are obtainable bymeans of the present G-5 type of organization, but that success can be assuredonly by full compliance with the following measures:
1. That all personnel assigned as publichealth members of Formation staffs be fully trained and competent to perform theduties expected of them.
2. That the number of public health staffpositions at the several Formations which are necessary to insure proper publichealth administration be determined and specified in a manner that will insurethe presence of such personnel without relation to the number and grades ofpersonnel in the rest of the Formation.
Concerning relations between the Public HealthBranch, G-5 SHAEF, and the Office of the Chief Surgeon, ETOUSA, General Draperanalyzed the respective functions and recited numerous examples of cooperationthat existed, not because of an organic relationship but because of theextremely generous attitude and helpful actions of the Chief Surgeon, GeneralHawley. In General Draper's opinion: "The two organizations workedtogether to maximum efficiency to attain the objectives of each," and"no finer demonstration of cooperation between two medical organizationshad ever been afforded."
Thus, the Chief of the Public Health Branch, G-5 SHAEF, foundthat experience demonstrated the correctness of the policies, type oforganization, and activities that were specified in the recommendations made byColonel Turner on 9 March 1944, which resulted in the establishment of thePublic Health Branch, and the appointment of its Chief, in SHAEF (p. 413).
Views of Surgeons of Field Forces.-The views ofSurgeons of the Field Forces, the Chief Surgeon, and Surgeons and PreventiveMedicine Officers in all echelons strongly favored placing all civil publichealth activities in army areas during the combat phase entirely underthe control of commanders of Armies and Army Groups, for administration throughstaffs of the regular medical services, under the Chief Surgeon of the theaterof operations.
One of the first to formulate this concept, and to take thelead in securing its adoption as policy, was Colonel Whayne, who in 1944-45 wasChief of Preventive Medicine in the Office of the Surgeon, Headquarters, 12thArmy Group. Colonel Whayne's immediate contact with the operationaldifficulties permitted an early insight into what was needed. To supplement therecords, about 20 years after the events, Dr. Stanhope Bayne-Jones asked ColonelWhayne to confirm the opinions he had expressed in 1945. This Colonel Whaynethen did in a forceful letter to Dr. Bayne-Jones dated 7 February 1964, fromwhich the following is quoted:
It is a matter of history that it was amilitary necessity for Surgeons of large commands in combat areas in Europe inWorld War II to take over civil affairs and military government activities intheir areas. Prior to this action the dual activities and dual
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commands concerning civilian health problemsand military health affairs had failed and especially broke down under theimpact of the vast refugee and displaced persons problems in combat areas duringthe latter part of the war. Under these circumstances from Army areas [rearboundaries] forward, civil affairs military government organizations andofficers were put under the command of the Army and all medical and healthactivities under the supervision of the surgeon of the command concerned. Thiswas a situation almost entirely comparable to the management of civilian healthaffairs in the maneuver areas in the United States in the early 1940's[described in chapter IV, section 1 in this volume] * * * We have to face withcourage at the present time the necessary decision that civil affairs-militarygovernment can apply in its present sense only to territory which has beenliberated or captured and passed over. In the combat areas, there is noalternative except to combine health activities concerned with the civilianpopulations under one health authority, namely, the surgeon of the responsiblecommand.
Col. John Boyd Coates, Jr., MC, who served inthe Office of the Surgeon, Third U.S. Army, was convinced that theorganizational and operational necessity outlined by Colonel Whayne was proveddecisively in the European theater. This was also the consensus of a number ofsenior medical officers who were Chief Surgeons of Theaters of Operations, ofArmy Groups and of Armies, and of some of their assistants in administration andpreventive medicine.79
Public Health teams in forward areas.-Anotherexample of the revised arrangements which followed the SHAEF directive of 14April 1945 is provided by action taken in the Third U.S Army. The Surgeon of theThird U.S. Army assumed direct control over all public health personnel attachedto that Army and established in his office a separate Public Health Sub-Section.After observing the value of having public health personnel continuously presentin forward areas, the Surgeon organized three Public Health Teams, one to beattached to each corps. Each team consisted of one Medical Corps officer, oneSanitary Corps officer, three Army Nurse Corps officers with public healthtraining, two drivers, and two vehicles. These teams were placed under theoperational direction of Corps Surgeons. They kept in constant touch withcivilian public health problems through Military Government officers and ArmySurgeons, and could take immediate action. Their chief functions were (a) toorganize and supervise medical and sanitation services of displaced personscamps, with particular reference to delousing activities; (b) to reestablishGerman medical and health
79Records of these opinionsare to be found in the transcriptions of tape recordings of interviews withcertain Surgeons and others who served in the European or Mediterranean theatersduring World War II. The interviews took place in 1962, on the dates indicated,at The Historical Unit, U.S. Army Medical Service, Forest Glen Section, WalterReed Army Medical Center, Washington, D.C. The transcriptions were edited byCharles M. Wiltse, Ph. D., Chief Historian. Interview(s) with (1) Maj. Gen. PaulR. Hawley, USA (Ret.), formerly Chief Surgeon, ETOUSA, 16-18 June 1962; (2) Maj.Gen. Alvin L. Gorby, USA (Ret.), formerly Surgeon, 12th Army Group, 8 Oct. 1962;(3) Maj. Gen. William E. Shambora, USA (Ret.), formerly Surgeon, Ninth U.S.Army, 8 Oct. 1962; and (4) members of the Advisory Editorial Board for theHistory of the Medical Service in the European Theater in World War II, 9-10Oct. 1962. Present in this group were Major General Hawley, Major General Gorby,Major General Shambora, Maj. Gen. Joseph H. McNinch, USA (Ret.), Maj. Gen. JamesL. Snyder, MC, USA, Maj. Gen. Howard W. Doan, MC, USA, Brig. Gen. James B.Mason, AUS (Ret.), Brig. Gen. Frank B. Berry, AUS (Ret.), Col. Thair C. Rich,MC, USA, and Col. John Boyd Coates, Jr., MC, USA (ex officio).
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organizations in the larger German cities andtowns, and in districts uncovered by Corps, with special reference to the careof displaced persons; (c) to act as specialist consultant groups on medical andsanitation problems encountered by Corps, with special reference to civilianpublic health; and (d) to act on divisional and regimental problems of publichealth and sanitation upon call by forward echelons.
When the Third U.S. Army entered the static phase ofoccupation of Germany, public health teams attached toCorps were no longer needed. These teams were dissolvedand their personnel were attached to Military GovernmentDetachments at Regierungsbezirk (county) level in accordance withanticipated plans of higher authority.80
THE OCCUPATION OF GERMANY
Military Government Public Health in the U.S. Zone in 1945
The records of public health activities of MilitaryGovernment in the United States Occupation Zone of Germany, including the BerlinDistrict, are voluminous and complex. To understand what was done by whom andfor what reason, and to assess the results, a knowledge of military, political,governmental, economic, demographic, and broadly conceived epidemiologic factorsaffecting the situation is required. Only a limited account for the year 1945will be given here, stressing points of particular significance.
Conditions in Germany.-Following its surrender on 8May 1945, Germany was in a state of utter confusion. Thousands were homeless,and many had fled. Displaced persons and refugees numbered in the millions.Transportation was crippled by the destruction of railways, highways, andbridges, and by the lack of motor vehicles and fuel. Food stocks were almostexhausted in the cities, many of which had been leveled.81The movement of essential supplies was extremely difficult.
At first, there was little semblance of civil government asmost officeholders, who were Nazis or Nazi-sympathizers, had fled before theadvancing armies. The people, stunned by defeat, were concerned with immediateneeds-food and shelter. The German public health system was practicallynonexistent.
Planning and directives.-During themonths before the collapse of Germany and immediately thereafter, plans to dealwith expected situations were drawn up and directives were issued by SHAEF,Headquarters, 12th Army Group, and by Headquarters, USFET. The chief early planswere known as the ECLIPSE PLAN and the STATIC PLAN. All plans containedstatements regarding Military Government Public Health. The chief documents arelisted below. With minor variations, public health activities in
80Reports, Headquarters, Third U.S. Army, to Commanding Generals, 12th Army Group and USFET, subject: Monthly Health Reports for April, May, and June 1945, dated respectively 8 May, 28 June, and 25 July 1945.
81See footnote 48, p. 471.
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the U.S. Zone of Occupation in Germany during 1945 proceededaccording to these plans and directives.
(1) The SHAEF, G-5, Technical Manual for Public HealthOfficers,82 revised inFebruary 1945, was broad in scope and covered procedures in detail. Amimeographed copy of the first issue of November 1944 was used faithfully byColonel Wilson, who was Deputy Chief successively of Public Health Branches inSHAEF, USFET, and OMGUS (Office of Military Government of Germany, U.S.), from1944 to 1947.
(2) The Surgeon of the 12th Army Group, which was designatedas the U.S. military occupation force, recognized that the early planning, whilebased upon the best information available at the time, did not have the benefitof firsthand field observation and study. Therefore, he arranged to have twoexpert public health officers, Lt. Col. Joseph A. Bell, MC, USPHS, and Maj.Edward B. Johnwick, MC, USPHS, attached to 12th Army Group Headquarters and sentinto U.S. occupied areas of Germany to make a survey and report, withrecommendations. This was done in the first half of June 1945. Their report83influenced intermediate and final plans for publichealth in the early static phase. An important element of the plan was theprovision for control of medical and health affairs in the U.S. Zone by the U.S.Zone Surgeon.
(3) On 24 May 1945, Lt. Gen. Walter Bedell Smith, Chief ofStaff of ETOUSA, issued, by direction of General Eisenhower, a comprehensiveorganizational directive for Military Government of the United States Zone andareas in which U.S. forces were deployed in Germany, "to be implementedwhen combined command is terminated." Until that time, it was to be madeeffective insofar as practicable without violation of existing AEF policies.Combined command was terminated on 14 July 1945 when SHAEF was dissolved.Matters relating to the administration of public health are dealt with in rathergeneral terms in par. 8,c,(1) and (4) of this directive.84
(4) On 26 July 1945, Headquarters, USFET, issued an importantdirective85 whichrescinded the SHAEF letter of 14 April 1945 (p. 489), and specified certain newlines of responsibility and jurisdiction.
Public Health policy and arrangements.-The MG policymade civil government in Germany a civilian responsibility. At first, existingcivil laws continued in force, except for amendments by which members of theNazi Party and ardent sympathizers were excluded from public office. Nearly allofficials of the Nazi regime had to be replaced; unfortunately, many German
82See footnote 49, p. 474.
83(1) Letter, Lt. Col. Joseph A. Bell, MC, USPHS, Public Health Section, U.S. Group Control Commission, to Surgeon, Headquarters, 12th Army Group, 11 June 1945, subject: Military Control of German Public Health in the Early Static Phase. (2) See Annex No. 32 of 27 June 1945 in footnote 73, p. 487.
84Letter, Commander, Headquarters, ETOUSA, to Commanding General, 12th Army Group, 24 May 1945, subject: Organization for Military Government of U.S. Zone and Areas in Which U.S. Forces Are Deployed [in Germany]. Note: The attached directive was widely circulated throughout the European theater.
85Letter, Headquarters, USFET, to Commanding Generals: Eastern Military District, Western Military District, and Berlin District, 26 July 1945, subject: Public Health Functions in the United States Zone of Germany.
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persons placed in office by the Alliedmilitary authorities were inexperienced. Finally, essentially the laws of theWeimar Republic were reinstituted. Military detachments were trained to dealwith resistance, but this never developed.86
The main objectives of Military Government after hostilitiesceased were to insure that German health services and facilities werereestablished and maintained by the Germans, to prevent and control communicablediseases, and to eliminate health hazards that might interfere with the militaryadministration of Germany, threaten occupation forces, or create hazards toother countries. To accomplish these purposes, great pressure was put on theGermans, technical guidance was given, and necessary supplies were provided bythe U.S. forces when indigenous sources were insufficient.87
An effective reporting system was instituted immediately forthe rapid collection, analysis, publication, and distribution of biostatisticaldata. Weekly reports were exchanged with the other occupying powers and with theLeague of Nations.
Civil government was reestablished first at the Kreis orlocal level (composed of Stadtkreise or urban communities) and Landkreise orrural areas (comparable to U.S. townships); next, at the Regierungsbezirke(comparable to counties); and finally at the Land or state level.
The U.S. Zone of Occupation in Germany.-Effective on12 July 1945, the United States, British, French, and Soviet areas of occupationin Germany were delineated. The U.S. Zone (map 13) comprised the following:
a. The U.S. Zone comprised the Land Bavaria, excluding theLandkreis Lindau; the Land Hessen, east of the Rhine River; the Province Hessen-Nassau(existing before July 1938), less the Landkreise Oberwesterwald, Unterwesterwald,Unterlahn, and Sankt Goarshausen; the northern parts of the L?nder Baden, W?rttembergsouth to and including the Landkreise Ulm, N?rtingen, B?blingen, Leonberg,Pforzheim and Karlsruhe, and the Bremen Enclave.
b. The Land Bavaria, excluding the Landkreis Lindau, wasdesignated the Eastern Military District under the immediate MG control of theThird U.S. Army, with headquarters at Munich.
The remaining area in the final U.S. Zone was designated asthe Western Military District under the immediate MG control of the Seventh U.S.Army, with headquarters at Heidelberg.88
Withdrawal to final occupation zones involved two phases. Inthe first phase, U.S. Military Government personnel were withdrawn from areasslated for eventual occupation by France, Great Britain, or the Soviet Union. Inthe second phase, MG detachments served at each governmental
86Clay, Lucius D.: Decision in Germany. Garden City, N.Y.: Doubleday & Co., Inc., 1950.
87Letter, Lt. Gen. W. B. Smith, USA, Chief of Staff, Headquarters, ETOUSA, to Headquarters, ECAD, 26 May 1945, subject: U.S. Theater Organization Plan.
88See page 124 and app. 16 in footnote 47, p. 470.
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MAP13.-Allied Occupation Zones in Germany, 12 July 1945.
level from province on down. The redeployment ofMG Public Health Officers from initial tactical sites to final locations inaccordance with the revised plan took place rapidly. The 286 U.S. Army MGdetachments in Germany, Austria, and Czechoslovakia on 20 June 1945 increased to346 by 14 July. The five U.S. Armies in Germany on 9 May 1945 were reduced totwo by mid-July; namely, the Seventh and Third.
Organizational changes and redeployment of personnel.-Inview of changes in the situation and the need to have closer relationshipsbetween MG detachments and the command of the Military Districts, the ECAR's(European Civil Affairs Regiments) were detached from the European Civil AffairsDivision and attached to the Army Military Districts Headquarters. The 2d ECAR,with its ECA Medical Group, was assigned to the Western Military District(Seventh U.S. Army) and the 3d ECAR, with its ECA Medical Group, was assigned tothe Eastern Military District (Third
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FIGURE 62.-Lt.Col. William H. Riheldaffer, MC, USA.
FIGURE63.-Lt. Col. Charles D. Shields, MC, USA
U.S. Army). The regiments were to continue to serve thedetachments but were entirely under Military District control; the ECA MedicalGroup had been disbanded by 1 September 1945.89
The 2d ECA Medical Detachment, commanded by ColonelRiheldaffer (fig. 62), was reorganized as the 2d Military Government Detachment,and the 3d ECA Medical Detachment, commanded by Lt. Col. Charles D. Shields, MC(fig. 63), was reorganized as the 3d MG Medical Detachment. After thedisbandment of the ECA Medical Group Headquarters on 27 August 1945, theCommanding Officer, Colonel Pappas, and the Executive Officer, Colonel Dehn?,with staff and equipment, were transferred to the Public Health Branch, G-5,USFET. At that time, the chief of this branch was General Draper, and ColonelWilson was deputy chief. Later, when this branch became the Public HealthBranch, OMGUS, Maj. Gen. Morrison C. Stayer, MC, USA, served as its chief, andColonel Wilson was its deputy chief.
Each Group's elements were deployed as Public Health staffswith the MG detachments, and the medical detachment headquarters constitutedcom-
89(1) Memorandum, G-5 Section, Public Health Branch, USFET, to ECA Medical Group, 17 July 1945, subject: Dissolution of European Civil Affairs Regiment Headquarters. (2) Letter, Brig. Gen. C. L. Adock, GSC, Headquarters, USFET, to Commanding Officer, ECAD, 2 Aug. 1945, subject: Reorganization and Distribution of ECAD. (3) Letter, Col. James P. Pappas, MC, Headquarters, ECA Medical Group, to Commanding Officer, ECAD, 9 Aug. 1945, subject: Disbandment of ECA Medical Group Headquarters-Reorganization and Redesignation of European Civil Affairs Medical Group, ECAD, for Public Health Functions in the U.S. Zone of Germany. (4) Memo, Headquarters, ECAD, G-3 Section, to Commanding Officer, ECAD, 31 Aug. 1945, subject: Organizational Development of the European Civil Affairs Division, per G-3 Records.
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FIGURE64.-Lt. Col. John T. Morrison, MC, USA.
plete administrative staffs for MG Public Healthpersonnel under the MG Regiment to which they were attached. The Senior PublicHealth Officer had authority to direct travel of his personnel within thedistrict and to transfer personnel as necessary. Again, there were personnelshortages because of the redeployment of some to the Pacific and the return tocontinental United States of those with long overseas service. The plan calledfor 233 officers and 569 enlisted men, but the number assigned never exceeded150 officers and 478 enlisted men.
The 1st ECA Medical Detachment of the ECA Medical Group,active in France and the Communications Zone, was disbanded after it moved toGermany. Its commanding officer, Lt. Col. John T. Morrison, MC (fig. 64), andstaff became the Public Health staff in Hessen.
The organizational-deployment-technical channels of the 2d MGMedical Group in the Western Military District comprised a Headquarters(District Public Health Staff), three subordinate headquarters (Hessen-Nassau,Hessen, and W?rttemberg-W. Baden), one Medical Supply Team, and 32 PublicHealth Teams, of which one (No. 101) was deployed in the Bremen Enclave. The 3dMG Medical Group had a similar organization, with a main Headquarters (DistrictPublic Health Staff), five subordinate
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headquarters (Franconia, Upper and Central Franconia, LowerBavaria, and Upper Palatinate, Swabia, and Upper Swabia), one Medical SupplyTeam, two Nutrition Teams, and 26 Public Health Teams.
Command responsibility.-The SHAEF letter, dated 14April 1945 (p. 489) was rescinded by a new USFET directive on 26 July 1945.90
Tactical and administrative changes led to rescinding thoseportions of the original directive which no longer applied, but the policy thatpublic health was a responsibility of command was not rescinded. The mainstatements in the USFET letter of 26 July 1945 may be summarized as follows:
1. Rescission of the SHAEF letter of 14 April1945.
2. The establishment or reconstitution ofindigenous public health medical services in the U.S. Zone of Germany underdirection of the Military Government is essential.
3. a. The organization to accomplish publichealth functions will be in accordance with the directive of 24 May 1945 (p.495).
b. The SHAEF manual "Military Governmentof Germany. Technical Manual for Public Health Officers," dated February1945 (p. 495), will continue to govern operations in the U.S. Zone, pendingpublication of a European theater technical manual.
4. Responsibilities and relationships formilitary government public health operations in Germany were specified withrespect to:
a. Headquarters, United States Forces,European Theater:
(1) The Commanding General, USFET, establishespolicies for conduct of Military Government operations in Germany, includingpublic health functions.
(2) The General Staff G-5 Division isresponsible for plans, policies, and directives related to public health andexercises general staff supervision.
(3) The Special Staff-Under the CommandingGeneral, USFET, the Chief Surgeon exercises overall technical supervision ofmilitary medical and military government public health functions.
b. Deals with Military Districts and BerlinDistrict.
(1) Commanders-The conduct of MilitaryGovernment public health operations in accordance with policies established bythe CG, USFET, is the responsibility of commanders.
(2) General Staff G-5 Division of the staff ofeach commander is responsible for plans, policies, and directives related topublic health and exercises general staff supervision.
(3) Special Staff-Under district commanders,military government public health functions in the U.S. Zone of Germany areunder the direction of the commanding officers of the attached European civilaffairs medical detachments in the Eastern and Western Military Districts and inthe Berlin District under the direction of the Senior military governmentmedical officer of the Military Government Detachment A1A1. In implementingpublic health plans, policies, and directives, in accordance with the foregoing,military government-medical personnel are placed by commanders at the disposalof military government medical officers for assignment, attachment, relief, ordetachment as considered necessary. All authorized equipment and suppliesrequired for military government public health operations will be made availablethrough appropriate general staff divisions.
(a) When necessary, assistance will beobtained from the army medical service by coordination with the district surgeonconcerned.
(b) Under district commanders the commandingofficers of the attached European civil affairs medical detachments in theEastern and Western Military Districts and the senior military governmentmedical officer of the Military Government Detachment
90See footnote 85, p. 495.
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FIGURE65.-American and German health officials meet in Wiesbaden, Germany, todiscuss health conditions in the American Zone. Here, Dr. von Drigalsky, GermanPublic Health Officer, reports on conditions in his area.
A1A1 in the Berlin District will beresponsible for coordination, where necessary, of the military government publichealth activities in their respective districts with the military medicalservices.
(c) Under district commanders, districtsurgeons will exercise overall technical supervision of military medical andmilitary government public health functions.
By Command of General Eisenhower:
R. B. Lovett
Brigadier General, USA
Adjutant General.
Disciplines of Military Government Public Health.-Inthe U.S. Zone in Germany from 1945 on, MG Public Health and the restored Germancivilian public health organizations had objectives, procedures, and technicalproblems very similar to those of Federal, State, municipal, and local publichealth departments in the United States. Indeed, they were similar to those inall advanced countries, and included the following:
(1) The prevention of epidemics and the provision of food,shelter, fuel, and safe water supplies were the foremost concerns of the Germancivil public health authorities, with whom many conferences were held (fig. 65).
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FIGURE66.-German nutrition survey team from the W?rttemberg-Baden Public HealthOffice conducts nutrition examination at Ulm, Germany.
(2) Control of communicable diseases: diarrheas and dysentery, typhoid fever,diphtheria, scarlet fever, tuberculosis, and typhus.
(3) Venereal disease control: a huge and difficult problem of great concernto both civilian and military public health and preventive medicine. (Thegeneral methods of dealing with the problem, and the results achieved inGermany, are summarized in vol. V of footnote 5 (1), p. 439).
(4) Sanitation: supervision of environmental sanitation; repair of disruptedwater supply systems, sewers, and sewage treatment facilities; garbage andrefuse collection and disposal.
(5) Insect and rodent control.
(6) Nutrition: surveys and information derived from nutritional surveys forthe improvement of the food supply, and increase of the vitamin and caloriccontent of diets, especially in cities and in the former prison camps (fig. 66).
(7) Reestablishment of public health laboratory service.
(8) Reestablishment of pharmacy services.
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(9) The introduction of Public Health Nurses into theoperations of MG public health and into the German health services.
(10) Use of veterinary services in connection with foodsupply and the diseases of animals, both those transmissible from animals to manand those limited to animals.91
Relations with Preventive Medicine Service, Office of theSurgeon General.-In many places in this chapter and chapter XII, whichdeal with CA/MG public health activities in the European theater, mention hasbeen made of the direct and indirect participation of the Preventive MedicineService of the Office of the Surgeon General in these matters. Overtly, therelationship between the Service and the Theater was unusually close;spiritually and inconspicuously, it was even closer. The following exampleillustrates the close relation between policy and public health considerations.In July 1945, General Simmons, Chief of the Preventive Medicine Division, Officeof the Surgeon General, and Colonel Turner, director of the Civil Public HealthDivision, visited the European theater. They had an important conference atDachau on 20 July withCol. Paul A. Roy, Commanding Officer of Dachau Camp, Colonel Gordon, Chief ofPreventive Medicine, O.C., TSFET (Rear), and Colonel Scheele. After this visit,General Simmons reported to Maj. Gen. John H. Hilldring, Chief, Civil AffairsDivision, War Department Special Staff, and the Honorable John Jay McCloy,Assistant Secretary of War. He reemphasized the importance of the development ofa program of public health for Germany, free from the repressive and punitivemeasures that had been advocated in the Morgenthau proposals to reduce Germanyto a pastoral state.92
Displaced Persons
After the surrender, the problems of care and control ofdisplaced persons and refugees in Germany were enormous. Guidelines wereprovided by a SHAEF manual.93Public health activities concerning the handling of displaced persons andrefugees in Germany were essentially the same as those already described withregard to civil affairs in other countries of northwest Europe during 1944-45.
By 10 July 1945 when responsibilties for displaced personspassed from the 12th Army Group to Headquarters USFET, 2.7 million UnitedNations displaced persons had been repatriated from the U.S. occupied areas ofGermany.
91Veterinary services have not been described in this chapter because an excellent account of them has been published in this historical series. See Medical Department, United States Army. United States Army Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961, pp. 441-488.
92Report, Brig. Gen. James S. Simmons, USA, Chief, Preventive Medicine Service, OTSG, and Col. Thomas B. Turner, MC, Director, Civil Public Health Division, to The Surgeon General, U.S. Army, subject: U.S. Army Plans for German Public Health Under the Allied Control Council. Observations made [in Germany] from 6 June to 12 July 1945.
93SHAEF, G-5 Division, Displaced Persons Branch: Guide to the Care of Displaced Persons in Germany. Revised May 1945.
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As time passed, the problems became fewer.Their dimensions toward the end of the year 1945 have been described by Floyd asfollows:94
The Displaced Population Becomes Stabilized. Massrepatriation of displaced persons, which had attained a record rate during thelate spring and summer of 1945, was terminating in September. Primary emphasisimmediately after V-E Day had rested on the importance of getting the largestpossible number home before winter, while the program of care and maintenancewas in the nature of a temporary expedient. The essential needs of displacedpersons were in every case satisfied; they were fed, clothed, and sheltered, andadequate provisions were made for medical care. It was recognized that therewould be a nonrepatriatable group remaining after the momentum of massrepatriation had spent itself. During the month of October, 113,000 displacedpersons were repatriated from the United States Zone of Germany. There remained474,000 displaced persons in the United States Zone, of whom 224,000 or 47percent, were considered probably nonrepatriatable. At the end of October, theover-all level of repatriation was 85 percent complete. It was apparent thatsome half million displaced persons in the United States Zone would remain as acontinuing responsibility through the winter and that primary emphasis wouldshift from repatriation to a program of care and maintenance adequate for alonger period.
SUMMARY
The objectives of Civil Affairs/Military Government PublicHealth should be as follows:
1. Restoration of war-torn, devastated communities. The basicneeds are for water, food, clothing, shelter, police forces, and restitution ofcivil government and health services.
2. Assignment of public health officers trained andexperienced in civil public health administration, capable of adapting the bestpublic health practices to the military situations. These officers must beprovided with adequate assistance, supplies, and transportation.
3. Prevention and control of communicable diseases, includinginsect and rodent control; delousing to prevent the spread of typhus fever; andother well-known and proven control methods.
4. Good surveys to determine the nutritional state of thepeople, and arrangements for feeding civilians an adequate diet with foodstuffsfrom indigenous sources or from military sources if the former are insufficient.
5. Emergency medical care and treatment of civiliancasualties.
6. Psychiatric and mental hygiene problems to be sensed andadjusted among civilians who have been exposed to bombing, shelling, disruptedfamilies, lost children, wounded and dead relatives, and conditions produced byprolonged combat.
7. Provision of veterinary services.
Plans for Civil Affairs/Military Government public health activitiesin the European Theater of Operations (northwest Europe) in World WarII, formed in times of travail, confusion, and uncertainty, were well carried
94Floyd, Marcus W.: Displaced Persons. Occupation Forces in Europe Series, 1945-1946. Office of the Chief Historian, European Command, Frankfurt-am-Main, Germany, 1949.
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out with modifications enforced by circumstances. The taskwas prodigious and unprecedented, and the difficulties that were overcome wereenormous. In the opinion of General Grasett and General Draper, at SHAEF, and ofGeneral Clay, surveying affairs from Berlin, the accomplishments far outweighedthe deficiencies. The relationships between the G-5 groups and the regularmedical services of the theater and the field armies had to be adjusted to makeit plain that, in the combat zone (from the rear boundaries of armies forward)and in the zone of occupation, public health was a responsibility of command,and that unit surgeons should have charge of all the medical and public healthactivities in the areas of the armies in which they were serving. Although itwas not intended to do away with the public health groups of the G-5 type,regular military jurisdiction was essential. When centralization ofresponsibility, direction, and control was effected under command, theoperations in public health became more efficient and beneficial. The twogroups, working together under one type of command in the combat and occupiedareas, attained great success.95
95Report, Col. H. T. Marshall, Deputy Chief, Public Health Branch, USFET, to Internal Affairs and Communications Division [IA&CD], OMGUS, attention: Historian, 22 Apr. 1947, subject: The History of Military Government Under the U.S. Army in Germany, Public Health.
