History

This chapter is concerned with policies, programs, operations, and events in activities of preventive medicine for enemy prisoners of war during World War II. The prisoners of war were Italian, German, and Japanese soldiers who had been captured by U.S. Army forces, or transferred to U.S. Army control by British forces. In the former group, the numbers were in the millions; in the latter, there were less than a hundred thousand. Included among the Germans was a small number of Poles, Czechoslovaks, Russians, Danes, Netherlanders, Frenchmen, Italians, Turks, Belgians, and Arabs who claimed to have been coerced into the ranks of the German Wehrmacht. The captives were taken in the North African and Mediterranean Theaters of Operations (1942-45), the European Theater of Operations (1944-45), the Southwest Pacific Area (1942-45), and the Central Pacific Area (Okinawa, April-June 1945). Most of these prisoners of war were detained in the theaters or areas in which they had been captured. In an unprecedented operation, however, 425,871 Italian, German, and Japanese prisoners of war were transported across the oceans and interned in the continental United States.²

¹ Brigadier General, USAR (Ret.), formerly Deputy Chief, Preventive Medicine Service, Surgeon General`s Office, War Department.

² (1) Bibliographic and documentary notes.—In 1955, the Advisory Editorial Board for the “Preventive Medicine in World War II” historical series decided that it would be serviceable to include, in the official history of the Medical Department of the United States Army, a chapter on preventive medicine for enemy prisoners of war since no comprehensive account had been published.

Although there are numerous pertinent records in official files and some narratives of the problems of both captors and prisoners, these accounts are scattered. Many are embedded in other reports without separate indexing of the subject of the health of prisoners of war. Often, the actual conditions are not described or the scenes are blurred. Nevertheless, much hitherto unpublished material was found in the archives of The Historical Unit, U.S. Army Medical Department: Office of the Chief of Military History and Office of The Provost Marshal General, Department of the Army; Federal Records Center, Kansas City, Mo.; and the World War II Division, National Archives and Records Service, Alexandria, Va. Information was enriched and enlarged by interviews with several wartime provost marshals and medical officers who supervised the care of prisoners of war in transit, in enclosures, and in camps. When details from these sources were combined with appropriate portions of histories of commands and field armies and with parts of chapters of other volumes of the official history of the Medical Department of the U.S. Army in World War II, a large amount of relevant and revealing material was assembled.

(2) Acknowledgments.—For an immense amount of assistance in the preparation of this chapter, the author is indebted to members of the staff of The Historical Unit, U.S. Army Medical Department. So many gave so much help that it is not possible in this place to cite the individuals by name.

The author acknowledges with special appreciation the guidance and information given by Brig. Gen. John Boyd Coates, Jr., formerly Director of The Historical Unit, U.S. Army Medical Department, and Editor in Chief of the History of the Medical Department of the U.S. Army in World War II. The type of assistance that he gave was not only that of a chief editor, but also that of a veteran of some of the most important campaigns in the European Theater of Operations, U.S. Army, in World War II. As Executive Officer, Office of the Surgeon, and as Deputy Surgeon, Headquarters, Third U.S. Army, throughout the war, he had the firsthand knowledge of a participant in many of the events with which this chapter is concerned. His informed suggestions and critiques were of great value.

On a similar plane, the author is indebted to Col. Valentine M. Barnes, MPC (Ret.). During 1944-45, Colonel Barnes was Deputy Provost Marshal, Advance Section, Communications Zone, European theater. He had much to do with the handling of German prisoners of war. After the war, when he was a member of the staff of the Military Police School, Camp Gordon, Ga., he compiled a volume of “Extracts From Military Police Operational Reports, World War II.” This volume is a historical account of the ways in which many of the problems concerning the handling of prisoners of war arose in the field and were solved. During 1961-63, while the author was at work on this chapter, Colonel Barnes was Provost Marshal in the Surgeon General`s Office, Washington, D.C. Consultation with Colonel Barnes was frequent and valuable.

Finally, the author is greatly indebted to the following who reviewed a draft of the manuscript and made helpful comments on it: Maj. Gen. Ralph J. Butchers, The Provost Marshal General, Department of the Army, 1960-64; Stetson Conn, Ph. D., Chief Historian, Office of the Chief of Military History, Office Chief of Staff, Department of the Army; Col. Tom F. Whayne, MC (Ret.), during World War II, Director, Medical Intelligence Division, Preventive Medicine Service, Surgeon General`s Office, Military Attaché, U.S. Embassy, London, Chief of Preventive Medicine, Office of the Surgeon, Headquarters, U.S. Forces, European Theater, and after the war, Chief, Preventive Medicine Division, Surgeon General`s Office; Col. John E. Gordon, MC, AUS (Ret.), during World War II, Chief, Preventive Medicine Division, Office of the Chief Surgeon, Headquarters, European theater; Col. Herbert Pollack, MC, AUS (Ret.), during World War II, member of the staff of the Nutrition Branches in the Offices of the Chief Surgeon, European theater, and U.S. Forces, European Theater; Lt. Col. Charles J. Simpson, MSC, AUS (Ret.), veteran of wartime medical administrative experience with U.S. Army Forces, China-Burma-India, and Executive Officer, The Historical Unit, U.S. Army Medical Department, while this chapter was being completed; Ebbe Curtis Hoff, Ph. D., M.D., and Mrs. Phebe M. Hoff, M.A., Editor for Preventive Medicine, and Assistant Editor, respectively.—S. B.-J.?

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In addition to the hundreds of thousands of enemy prisoners of war in U.S. custody in Europe in 1945, there were other hundreds of thousands of persons in states of destitution and in need of care by the military. There were three groups: recovered Allied military personnel, displaced persons, and refugees. All of these people had to be moved on foot or transported in vehicles and trains in attempts to return them to their homes or countries. They had to be fed, sheltered, supervised medically, controlled hygienically, and policed. These masses of forlorn people added greatly to the burdens and complexities of the tasks that had to be performed by the victorious troops which were engaged in combat during a large part of the time. Although, in general, the problems of handling these groups were similar to those of handling prisoners of war and were solved by applying similar principles, they are considered only secondarily in this chapter. Accounts of the diseases and nutritional disorders found among recovered Allied military personnel, particularly U.S. soldiers recovered from German prison camps in the spring of 1945, have been published in the “Internal Medicine in World War”³ historical series.

THE GENEVA CONVENTIONS OF 1929

Throughout World War II the treatment of prisoners of war was governed basically by two international agreements: the Prisoner of War Convention⁴ and the Red Cross Convention.⁵

³ (1) Middleton, William S.: European Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 263-264, 452-457, 470-471. (2) Long, Esmond R.: Tuberculosis. In Medical Department, United States Army. Internal Medicine in World War II. Volume II. Infectious Diseases. Washington: U.S. Government Printing Office, 1963, pp. 344-349, 390-392.

⁴ U.S. Treaties, etc.. 1929. Prisoners of War. Convention Between the United States of America and Other Powers. Signed at Geneva, July 27, 1929. Washington: U.S. Government Printing Office, 1932. Treaty Series, No. 846, 66 pp.

⁵ U.S. Treaties, etc., 1929. Amelioration of the Condition of the Wounded and the Sick of Armies in the Field (Red Cross Convention). Convention Between the United States of America and Other Powers. Signed at Geneva, July 27, 1929. Washington: U.S. Government Printing Office, 1932. Treaty Series, No. 847, 37 pp.

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Legal Status

Through ratification by the President on the advice of the Senate, these two Geneva Conventions acquired statutory authority as integral portions of the laws of the United States of America.

During the 1930`s, by processes of ratification appropriate to various countries, these treaties became binding upon many governments, notably, to mention only the principal belligerents of World War II, Great Britain, Canada, Australia, France, Union of Soviet Socialist Republics, Germany, and Italy. Japan ratified the Red Cross Convention on 18 December 1934, but did not ratify the Prisoner of War Convention. The latter received a quasi-official status in Japan when, on 4 February 1942, in answer to an inquiry from the U.S. Government, the Japanese Government stated: “* * * Japan is strictly observing Geneva Red Cross Convention as a signatory state. * * * Although not bound by the Convention relative treatment prisoners of war Japan will apply mutatis mutandis provisions of that Convention to American prisoners of war in its power.”

Red Cross Convention

In the treatment of prisoners of war, the Red Cross Convention is less significant than the Prisoner of War Convention. It is important, however, for two provisions, as follows: (1) In Articles 9, 10, and 11, it defines protected personnel (medical and sanitary personnel, and chaplains) who had certain privileges after capture, and who could be used by the detaining Power to help care for the enemy sick and wounded prisoners and for sanitary details and work. (2) Article 2 confers the status and rights of prisoners of war upon the sick and wounded in the field and the patients in overrun military hospitals.

Prisoner of War Convention

Although the Prisoner of War Convention of 1929 was imperfect, untried, and soon outranged by the unforeseen developments of the global war of 1939-45, it was an elaboration of principles and regulations embodied in earlier similar conventions which had been applied and tested to some extent. As pointed out by Brig. Gen. Joseph Vincent Dillon, USAF: “The effort of the nations represented at Geneva in 1929 was to make International Law regarding the treatment of prisoners of war and not to draft a set of rules declaratory of existing customary international law. The Convention signed by the delegates on July 27, 1929 was a signal advance in the codification of the law of war.”⁶

⁶ (1) Dillon, J. V.: The Genesis of the 1949 Convention Relative to the Treatment of Prisoners of War. Miami Law Quarterly 5: 40-63, December 1950. [Reprinted by the Department of the Air Force. Washington: U.S. Government Printing Office, 1951.] (2) Interview, Maj. Gen. J. V. Dillon, USAF (Ret.), formerly Provost Marshal General, North African Theater of Operations (1943-44); Provost Marshal General, European Theater of Operations; and Provost Marshal General, U.S. Forces European Theater (1944-45), 31 Oct. 1962. He was a representative of the United States at the Geneva Conference of 1947, the International Red Cross Conference of 1948, and the Diplomatic Conference at Geneva in 1949, at which meetings the revised, and current, Prisoner of War Convention of 1949 was developed.—S. B.-J.?

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The Convention’s Concern With Preventive Medicine?

While codification of portions of the law of war was a primary contribution of the Prisoner of War Convention of 1929, the convention`s content and promulgation of principles and requirements of preventive medicine for enemy prisoners of war made it a principal document among pronouncements in that field. The framers of the convention recognized that the solution of problems of hygiene, broadly conceived, were of vital importance for the physical and moral well-being of prisoners of war as well as for the prevention and control of disease.

Among the 97 Articles of the convention, and the paragraphs of the Annex, approximately 42 Articles contain provisions which may be considered as forming two main divisions, direct and contributory, of a program to prevent moral and physical deterioration, to prevent and control communicable disease, and to maintain health. The direct provisions deal with sanitation, environmental and personal hygiene, with food, water, and clothing, and with medical care and supervision. The contributory provisions relate to general factors, such as morale, intellectual occupations, rights, humane treatment, fair dealing, personal and official associations, protection of honor, and prospects of repatriation. The grouping of the provisions in direct and contributory categories, somewhat arbitrarily, is presented in the following section.

PREVENTIVE MEDICINE PROGRAM FOR ENEMY PRISONERS OF WAR
The following Articles of the Prisoner of War Convention of 1929 (some presented in full, some in abstract) were those most pertinent to the treatment of prisoners of war in World War II. They outline a comprehensive program of preventive medicine, as follows:

A. Direct Provisions:

Article 9. Prisoners captured in regions unhealthful because of diseases or injurious climate shall be transported, as soon as possible, to more favorable locations.

Article 10. Prisoners of war shall be lodged in buildings or barracks affording all possible guarantees of hygiene and healthfulness.

The quarters must be fully protected from dampness, sufficiently heated and lighted. In dormitories, with regard to surface area, minimum cubic amount of air, arrangement and material of bedding, the conditions shall be the same as for the troops at base camps of the detaining Power.

Article 11. The food ration of prisoners of war shall be equal in quantity and quality to that of troops at base camps.

Prisoners shall receive facilities for preparing, themselves, additional food which they might have.?

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Prisoners may be employed in kitchens.

All disciplinary measures affecting food are prohibited.

A sufficiency of potable water shall be furnished prisoners of war.

Article 12. Clothing, linen and footwear shall be furnished prisoners of war by the detaining Power. Replacement and repairing of these effects must be assured regularly. Laborers must receive work clothes whenever the nature of the work requires it.

Article 13. The detaining Power shall be bound to take all sanitary measures necessary to assure the cleanliness and healthfulness of camps and to prevent epidemics.

Prisoners of war shall have at their disposal, day and night, installations (latrines) conforming to sanitary rules and constantly maintained in a state of cleanliness.

Prisoners shall be furnished a sufficient quantity of water for the care of their own bodily cleanliness, in addition to baths and showers.

Prisoners shall have opportunity to take physical exercise and enjoy the open air.

Article 14. Every camp shall have an infirmary, where prisoners of war shall receive every kind of attention they need. If necessary, isolated quarters shall be reserved for the sick affected with contagious diseases.

Article 15. Medical inspections of prisoners of war shall be arranged at least once a month. Their purpose shall be the supervision of the general state of health and cleanliness, and the detection of contagious diseases, particularly tuberculosis and venereal diseases.

Article 32. It is forbidden to use prisoners of war at unhealthful or dangerous work.

Article 98. The system of labor detachments must be similar to that of prisoner-of-war camps, particularly with regard to sanitary conditions, food, and attention in case of accident or sickness.

Article 56. The quarters in which prisoners of war undergo disciplinary punishment shall conform to sanitary requirements.

B. Contributory Provisions:

Article 2. Prisoners of war are in the power of the hostile Power, but not of the corps or individuals who have captured them.

They must at all times be humanely treated and protected, particularly against acts of violence, insults and public curiosity.

Measures of reprisal against prisoners of war are prohibited.

Article 3. Prisoners of war have the right to have their person and honor respected; retain their full civil status.

Article 5. No coercion may be used on prisoners to secure information about their army or their country. Prisoners who refuse to answer may not be threatened, insulted, or exposed to unpleasant or disadvantageous treatment; [may not be tortured].

Article 6. Prisoners of war may keep all effects of personal use, including a certain amount of money, identification documents, insignia of rank, decorations, metal helmets and gas masks, [and mess gear].

Article 7. Prisoners of war shall be evacuated to places far enough from the zone of combat to be out of danger; and shall not needlessly be exposed to danger while awaiting evacuation from the combat zone.

Marches on foot must not exceed 20 kilometers a day.

Article 8. Mutual exchange of information about prisoners of war is required between belligerents. [This includes addresses and arrangements for prisoners of war to correspond with their friends and families.]

Article 9. Prisoners of war may be interned in a town, fortress, or enclosed camps; they may not be confined or imprisoned except as an indispensable measure of safety or sanitation. Assembling in a single camp prisoners of different races or nationalities [or of rabid differences of loyalties or opinions] shall be avoided, so far as possible.?

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Article 12. In all camps there shall be canteens where prisoners of war may obtain, at the local market price, food products and ordinary objects.

Article 16. Prisoners of war shall enjoy complete liberty in the exercise of their religion, * * * on the sole condition that they comply with measures of order and police issued by the military authorities.

Article 17. So far as possible, the detaining Power shall encourage intellectual diversions and sports organized by prisoners of war.

Articles 27-34. Section III (provisions governing utilization of prisoners of war for labor) contains numerous safeguards that have implications for preventive medicine.

Articles 85-41. Section IV (external relations of prisoners of war) provides for correspondence, various types of communication with the outside, and for the receipt of books, newspapers, food parcels, nutritive supplements, vaccines, and so forth.

Article 42. Prisoners of war shall have the right to inform the military authorities of the detaining Power, and the representatives of the protecting Powers, with regard to the conditions of their captivity. [This includes the right to complain about unsanitary conditions or undue exposure to disease.]

Article 43. In every place where there are prisoners of war, they shall be allowed to appoint agents entrusted with representing them directly with the military authorities and protecting Powers. [Such representatives could transmit and present complaints, including those relating to sanitary conditions of camps.]

Article 45. Prisoners of war shall be subject to the laws, regulations, and orders in force in the armies of the detaining Power. [This includes the enforcement of medical and sanitary regulations and provides the basis for penalties for infraction of such rules.]

Article 46. Any corporal punishment, any imprisonment in quarters without daylight and, in general, any form of cruelty, is forbidden.

Article 56. Prisoners undergoing punishment shall be enabled to keep themselves in a state of cleanliness, and shall every day be allowed to exercise or stay in the open air at least two hours.

Articles 68, 70-74. Title IV. Termination of Captivity. This contains many salutary provisions which bear on medical care and preventive medicine.

Article 69. Provides for the naming and functioning of Mixed Medical Commissions. Each Commission shall be composed of three members, two of them belonging to a neutral country and one appointed by the detaining Power. The function of these Mixed Medical Commissions is to examine sick or wounded prisoners, either on their own initiative or upon request by the prisoner, and to make all due decisions regarding them [including repatriation].

Articles 77-80. Title VI. Bureaus of Relief and Information Concerning Prisoners of War. These provisions bring multiple functions of the International Committee of the Red Cross to bear upon conditions of captivity, including medical and sanitary conditions. They provide also for the establishment by the detaining Power of Prisoner of War Information Bureaus with valuable statistical functions, in additions to functions of communication.

It was not until the author assembled the foregoing statements of policy and requirements that he appreciated the depth and range of the program of preventive medicine for prisoners of war that is embodied in the Geneva Convention. Even in condensed form, this program is large; when certain of its provisions are expanded by listing and abstracting the referenced regulations, it takes on the proportions of an army-like system of preventive medicine and public health. For example, such phrases as “affording

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all possible guarantees of hygiene and healthfulness,” and the detaining Power “shall be bound to take all sanitary measures necessary to assure the cleanliness and healthfulness of camps and to prevent epidemics,” invoke Army Regulations Nos. 40-205 (Military Hygiene and Sanitation) and 40-210 (Prevention and Control of Communicable Diseases of Man). The requirement that “the food ration of prisoners of war shall be equal in quantity and quality to that of troops at base camps” brings a series of regulations, circulars, and memorandums to bear on the feeding of enemy prisoners of war.

There is, however, an error in the basis of these requirements. They are based upon national standards and not upon absolute standards. A nation having a high standard of living, abundant resources, and advanced ethical views would be required by the terms of the Geneva Convention to treat enemy prisoners of war in its custody according to the standards of maintenance and preventive medicine that it applied to its own troops. On the other hand, an impoverished and backward nation, with low standards, would be permitted to treat its captives on the same deficient basis that it used for its own troops. For the American prisoner of war, the customary Japanese military hygiene and dietary, consisting of uncleanliness and a ration of rice and dried fish, or the deficient preventive medicine program and inadequate food allowances of the depleted German Army in 1944-45, were unacceptable and deleterious. In contrast, American standards, when it was possible to apply them, were adequate for the well-being of American-held enemy prisoners of war.

The application of this national standard had an unanticipated and disturbing effect, at times, upon relations among the Allies. In a number of situations in France and Belgium, and even in the United States, the German prisoners of war, fed and cared for according to U.S. Army standards, in compliance with the Geneva Convention, were better fed than the surrounding Allied civilian population that was suffering from food shortages. This led to accusations of pampering the prisoners of war and to complaints against U.S. authorities that were settled only by investigations and much correspondence.?

PUBLICATIONS AND DIRECTIVES?

To plan and prepare for the handling of prisoners of war, it was necessary to make available, quite widely, information about what had been done in this field in the great wars of the preceding three-quarters of a century, the prevailing national and international policies, and rules and regulations relative to the treatment of prisoners of war. Implementing directives also had to be issued.

Soon after Pearl Harbor, Col. (later Brig. Gen.) Albert G. Love, MC, Surgeon General`s Office, U.S. Army, undertook to provide this type of information for the Medical Department. For the convenience of medical?

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officers and others, his historical account of the development of the two Geneva Conventions, with texts, notes, and commentary, was published in May 1942.⁷

Even earlier than this, the provisions of the Geneva Conventions of 1929, abstracted by The Judge Advocate General, had been incorporated in a War Department field manual on the rules of land warfare and issued in 1940.⁸

During World War II, many manuals, circulars, pronouncements, orders, regulations, amendments, and amendments of amendments, explaining and supplementing the convention relative to the treatment of prisoners of war, were issued by the War Department; the Office of The Provost Marshal General, U.S. Army ; commanders of theaters or areas; and subordinate commands. Most of the directives issued by the War Department were concerned with the treatment of prisoners of war held in custody in the continental United States, although Circular No. 1 is entitled broadly: “Regulations Governing Prisoners of War.”⁹Its first sentence is of special interest in showing the respect of the War Department for the powers accorded theater or area commanders and indicating the main reason for the partial lack of centralization of details of prisoner-of-war policy and information in Washington: “These regulations are published for the guidance of those concerned with the military custody of prisoners of war in [the] continental United States, and will also be applied in theaters outside the continental United States to such extent as is deemed feasible by the theater commanders concerned [italics added.]”

The multiplicity of directives issued by the War Department and various other governmental organizations in the United States became so great and confusing that it became necessary to reconcile them and bring them together in a single publication. On 5 October 1944, a War Department technical manual¹⁰ accomplished the codification, and this, with some 16 changes through October 1945, guided prisoner-of-war procedures in the continental United States during the last year of the war and in the immediate aftermath.

ORGANIZATIONS FOR HANDLING ENEMY PRISONERS OF WAR?

Large resources in men, materials, and organizations were required to handle the hundreds of thousands of prisoners of war captured by U.S. field armies in North Africa, Italy, and Northwest Europe during the campaigns of 1942-45. The forces needed for this work were drawn from several technical services and from various kinds of tactical units.

⁷ The Geneva Red Cross Movement, European and American Influence on Its Development. A compilation with Notes by Albert G. Love. Army M. Bull. No. 62, May 1942. This publication contains the texts of the two Geneva Conventions of 1929 (Red Cross Convention, pp. 116—130; Prisoner of War Convention, pp. 131-165) and the text of the Japanese note (in part, p.181).

⁸War Department Basic Field Manual 27—10, Rules of Land Warfare, 1 Oct. 1940.

⁹War Department Prisoner of War Circular No. 1, 24 Sept. 1943.

¹⁰War Department Technical Manual 19-500, Enemy Prisoners of War, 5 Oct. 1944.

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Contributors to the custodial and professional contingents included: (1) The Office of The Provost Marshal General and its associated Corps of Military Police, (2) the provost marshals and military police under their control at headquarters and communications zones in theaters or areas and in field armies and army groups, (3) the Medical Department, (4) the Quartermaster Corps, (5) the Transportation Corps, (6) the Corps of Engineers, (7) staffs and troops of headquarters from the highest to the lowest echelon, (8) entire infantry divisions (106th and 88th Infantry Divisions), and (9) many artillery, armored, and infantry detachments. Nearly all provided personnel, both specialized and general. Various military organizations supplied food, water, clothing, railroad cars, buses, trucks, ships, airplanes, tents, barracks, structural materials, and buildings. Of the operating agencies just mentioned, those which will be considered most extensively here are (1) the Office of The Provost Marshal General and the provost marshal organizations in the field forces, (2) the Corps of Military Police, and (3) the Medical Department.

The Provost Marshal General and Provost Marshals

In the summer of 1941, the primary responsibility for the handling and treatment of enemy prisoners of war was assigned by the War Department to the Office of The Provost Marshal General,¹¹ newly re-created by order of the President in July of that year. To assist the chief law-enforcement officer of the Army, his office was supported by an organized Corps of Military Police, reactivated on 26 September 1941. As time passed, each Army in the United States, each overseas theater or area, each territorial force, and each major unit of the field forces (divisions, corps, field armies, and army groups) acquired provost marshals and military police units. Among the numerous and varied functions of this entire organization, one of the chief was the handling of enemy prisoners of war.¹²

During the 4 years from 1937 to 1940, more or less active planning in the offices of the War Department Assistant Chief of Staff for Personnel, G-1, and The Judge Advocate General had. been concerned with problems that would be presented by the custody of enemy prisoners of war in the event of an outbreak of hostilities in which the United States might be involved. For doctrine, procedures, and precedents, the planners had to depend largely upon the final World War I report of the Provost Marshal General of the American Expeditionary Forces in France, 1918-19, the

¹¹ It is to be regretted that there is no published full-length history of the Office of The Provost Marshal General, or of the activities of provost marshals and military police during World War II. To obtain some comprehension of the system and descriptions of important events in the handling of prisoners of war, the author spent much time in the study of masses of provost marshal records. Unfortunately, there is space in this chapter for only a few notes from that rich historical material.—S. B.-J.

¹² Historical Monograph, Prisoner of War Operations Division, Office of The Provost Marshal General, 1945. [Official record.]

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Geneva Conventions of 1929, and derivative publications.¹³Finally, after an episodic history that had started in 1776, the provost marshal system in the Army was established in its modern and comprehensive form in 1941.¹⁴

In July 1941, the President appointed Maj. Gen. Allen W. Gullion Provost Marshal General, in addition to his other duties as The Judge Advocate General. His office and staff were placed under the War Department Assistant Chief of Staff for Personnel, G-1, pending total Army mobilization.

In addition to the maintenance of law and order in the Army, the control of military traffic, the protection of property, and the prevention and investigation of crime, the Office of The Provost Marshal General also exercised administrative supervision over the enemy alien control program, with special responsibility for the custody of aliens ordered to be interned by the Department of Justice; supervised the internment, care, treatment, labor, and repatriation of prisoners of war held in the continental United States; and maintained the Enemy Prisoner of War Information Bureau and the official information bureau of United States military, naval, and civilian personnel detained by enemy Powers (American Prisoners of War Information Bureau).

In the reorganization of the Army in March 1942, the Office of The Provost Marshal General was brought under the command of Army Service Forces. Thereby, like The Surgeon General, The Provost Marshal General lost most of his higher staff standing. His office then functioned as a staff agency under the Commanding General, Army Service Forces, who had been charged with all matters pertaining to enemy prisoners of war in custody in the continental United States. Until 25 June 1945, The Provost Marshal General reported to the Deputy Chief of Staff, Army Service Forces, meanwhile retaining to a considerable extent harmonious and helpful relations with the War Department Assistant Chief of Staff for Personnel, G-1.

By April 1944, the Office of The Provost Marshal General included 10 divisions and 17 branches. Among them were a Prisoner of War Operations Division, which contained a Medical Liaison Branch linked to the Office of The Surgeon General for matters related to prisoners of war in U.S. custody in the continental United States;¹⁵ a Military Police Division; and a Military Government Division, which administered the School of Military Government, Charlottesville, Va. This school contributed importantly to the operations of the Civil Affairs Division, War Department

¹³ (1) War Department Basic Field Manual. Volume IX. Military Police. Washington: U.S. Government Printing Office, 1938; revised and reissued as War Department Basic Field Manual 19-5, Military Police, 14 June 1944. (2) See footnote 8, p. 348.

¹⁴Lewis, George G., and Mewha, John: History of Prisoner of War Utilization by the United States Army, 1776-1945. Department of the Army Pamphlet No. 20-213, 24 June 1955.

¹⁵Juchli, Rene H.: Record of Events in the Treatment of Prisoners of War, World War II, September 1945. [Official record.]?

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Special Staff; had a close relationship with the Preventive Medicine Service, Surgeon General`s Office; and trained many civil affairs officers for service in overseas theaters or areas. Neither The Provost Marshal General nor The Surgeon General included in his office branches or sections designed and staffed to deal centrally with hygiene, sanitation, and preventive medicine for enemy prisoners of war in theaters or areas.

The Corps of Military Police?

Soon after its establishment in September 1941, the Corps of Military Police was organized as a part of the Office of The Provost Marshal General, which, under higher staff direction, formulated military police policy for the Army as a whole and supervised the technical training and functions of the Corps of Military Police in all parts of the world.

The units of the Corps of Military Police which were particularly concerned with the handling of enemy prisoners of war were the military police battalion, the military police escort guard company, and the military police prisoner-of-war processing company. The tables of organization and equipment¹⁶allowed these units personnel and equipment for guard duties and for processing, but did not provide for any sanitary or medical personnel and equipment beyond elements needed to care for the unit itself. They made no allowance for the extra medical and sanitary formations required for a preventive medicine program for enemy prisoners of war, in transit or in enclosures, as outlined in the Geneva Convention; and as mentioned briefly in the military police field manual.

The same can be said about the lack of provisions for transportation of enemy prisoners of war in the field. In the tables of organization and equipment for the Corps of Military Police, there were few motor vehicles beyond those needed for the particular military police unit itself that could be used to move prisoners of war along the lines of evacuation to the rear areas. Dependence had to be placed upon assignments (including boxcars and gondola freight cars) from the Transportation Corps or upon trucks belonging to other units returning to supply depots. These arrangements were often uncertain and inadequate, often frustrating, and generally exhausting.

From three battalions and four separate companies in September 1941, the Corps of Military Police grew to a peak strength of 200,000 enlisted men and 9,250 officers in June 1945. The portion of this force that could be assigned to the European Theater of Operations, U.S. Army, was not large enough to handle the hundreds of thousands of prisoners of war captured in the European theater in 1944 and 1945. It became necessary to draw reinforcements from combat troops, much to their displeasure and disgust, and to some degree of disregard of the humane

¹⁶War Department Tables of Organization and Equipment Nos. 19-35, 19 Aug. 1943; 19-47, 25 Nov. 1943; 19-55, 27 Nov. 1943; 19-57, 27 Nov. 1943; 19-237, 18 Nov. 1943; 19-7, 12 Sept. 1944; 19-500, 22 Apr. 1944, and Cl, 25 Sept. 1945.?

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policies of the Geneva Convention. The use of combat troops to guard and escort enemy prisoners of war was sanctioned, of necessity, in situations in which the captures were en masse. It was generally recognized, however, that such assignments were unwise and should be avoided as much as possible.

The system of collection and evacuation of enemy prisoners of war was devised in the planning stage before the United States entered World War II. Modified by experience, it was utilized during the war especially in the European theater. Its essential features are outlined in chart 6.

In the frontline areas, combat troops conducted their captured enemy prisoners of war to regimental and divisional collecting points where they were turned over to Army military police. A few selected prisoners were evacuated from divisional collecting points to a corps prisoner-of-war cage by corps military police and retained, for a time, at corps headquarters for interrogation. The mass of prisoners were taken from divisional collecting points by personnel of Army military police escort guard companies to an Army enclosure. (Or, in 1945, they were also taken to Prisoner of War Transient Enclosures. These transient enclosures are not shown in chart 6, but are indicated in map 8 (p. 384).) At these collecting points, they were processed as thoroughly as possible. Occasionally, prisoners of war were held in these enclosures for several weeks. Evacuation of prisoners from Army enclosures, or from Central Prisoner Of War Enclosures in base sections, to ports in the communications zone, and to ports and camps in the Zone of Interior, was carried out in part by Army military police and in part by Zone of Interior military police. Movement was by bus, truck, rail, and ship, and occasionally by air, according to the situation.

Medical Department Activities?

Units and individuals of the Medical Department of the U.S. Army were detailed to prisoner-of-war enclosures or to base and branch camps at home and abroad. Sometimes U.S. medical personnel rendered medical care to prisoners of war. Usually, they assisted or supervised and directed captured German medical and sanitary personnel in the care of the sick, wounded, and injured enemy prisoners of war, and in the operation of some type of preventive medicine program. At times, medical groups¹⁷ which could be moved about readily, as well as parts of medical sections of combat units, were employed in the field to render medical and sanitary services to enemy prisoners of war. Chief surgeons of theaters or areas and their preventive medicine officers were among the authorities who were directly concerned with these matters.

In the Office of The Surgeon General, in addition to auxiliary services,

¹⁷War Department and Department of the Army Table of Organization and Equipment No. 8-22, Headquarters and Headquarters Detachment, Medical Group, 20 May 1943 and 31 Jan 1949.

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CHART 6.–Diagram of system of collection of enemy prisoners of war

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valuable activities for the health and welfare of enemy prisoners of war were carried out by the Hospital Administration Division and the Preventive Medicine Service. In the Hospital Administration Division, there was a Medical Liaison Unit¹⁸ linked to the Office of The Provost Marshal General, with Maj. (later Lt. Col.) Rene H. Juchli, MC, as chief, charged with dealing with innumerable and complicated affairs of enemy prisoners of war in the custody of the United States who were being held in the continental United States. In the Preventive Medicine Service, several branches at various times dealt with special conditions among enemy prisoners of war overseas and in the United States. These matters included infectious diseases that might be introduced into the country by prisoners of war; a survey of immunizations that German captives may have received as protection against possible biological warfare agents; malaria control at prisoner-of-war camps in the Southern United States; and a host of procedures relating to water supply, hygiene, sanitation, and nutrition.

NORTH AFRICAN THEATER OF OPERATIONS

Casablanca to Tunis, 8 November 1942 to 13 May 1943

In the North African Theater of Operations,¹⁹ U.S. Army forces experienced their first massive commitments in World War II 20 (map 6). From the landings at Casablanca, Oran, and Algiers on 8-10 November 1942 to the liberation of Tunis on 13 May 1943, the American soldier experienced a rough apprenticeship in mid-20th century warfare. It was full of severe trials, unexpected complications, and lessons for all arms and services. In its final victorious phase, it included the sudden capture of masses of enemy prisoners of war. More than a quarter of a million Italian and German soldiers were captured within about a week, producing conditions in which practicalities often transcended planning and demands exceeded resources. These conditions presaged events which were to occur later in other theaters.

Actually, two campaigns were fought in Northwest Africa during this period: “Operation TORCH which swiftly liberated French North Africa from Vichy French control, followed by a longer Allied effort to

¹⁸See footnote 15, p. 350.

¹⁹On 8 November 1942, when Allied forces invaded North Africa, the region of concern to the U.S. task force was a part of the European Theater of Operations, U.S. Army. The controlling organization was Allied Force Headquarters until 4 February 1943 when the theater became jointly administered, and the North African Theater of Operations, U.S. Army, was established. Among the areas included in the North African theater were Northwest Africa, Sicily, and portions of the Mediterranean Sea. On 1 November 1944, the theater was renamed the Mediterranean Theater of Operations, U.S. Army, and was enlarged to include Greece, the Balkans, and all of the Mediterranean Sea. On 20 November 1944, base sections in southern France were transferred from the Mediterranean theater to the European theater. Early in 1945, the Mediterranean theater was further diminished by the assignment of its African territory to the Africa Middle East Theater. On 1 October 1945, Allied Force Headquarters was separated from the Mediterranean theater and ceased to function.

²⁰Howe, George F.: Northwest Africa: Seizing the Initiative in the West. United States Army in World War II. The Mediterranean Theater of Operations. Washington: U.S. Government Printing Office, 1957.

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MAP 6.– Campaigns in the North African and Mediterranean Theaters of Operations, U.S. Army, 1942-45.

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destroy all the military forces of the Axis powers in Africa. The latter concentrated in Tunisia, where the front at one time extended more than 375 miles, and fighting progressed from scattered meeting engagements to the final concentric thrust of American, British, and French ground and air forces against two German and Italian armies massed in the vicinity of Bizerte and Tunis.”²¹ Following the breakthrough, the cleanup was so complete General Dwight D. Eisenhower could later write that, “except for a few stragglers in the mountains, the only living Germans left in Tunisia were safely within prison cages.”²² The conditions and management of those prison cages and their inmates will be the main topics of this section of the chapter.

Transfer of prisoners of war to the continental United States.—Ear1y in 1942, an agreement was made between Great Britain and the United States that some 150,000 British-captured prisoners of war (Italian and German) then being held in Great Britain would be interned in the continental United States to lighten a burden that was hard for the British to carry. Later in the same year, as the campaign progressed, all prisoners of war captured in Northwest Africa became, by agreement, American controlled.²³General Eisenhower desired to relieve the North African theater of the drain upon its resources of food, shelter, shipping, and personnel imposed by the requirements of caring for thousands of prisoners of war. The transfers were made, and thereby a special portion of the operation of the preventive medicine program for enemy prisoners of war was shifted to the continental United States. The consequences of this transfer of prisoners are described later (p. 411).

Prisoners of war captured to 14 April 1943.—Captures of German and Italian prisoners by the Allied Task Force as it fought its way from Casablanca to Tunis were few in number. Of this period, General Omar N. Bradley wrote: “ * * * we had counted ourselves fortunate in capturing a dozen of them at a time.”²⁴ After 1 January 1943, in Tunisia, the captures increased sporadically. Expressing the figures in round numbers, it was reported that the British took 7,000 prisoners of war at the Mareth Line on 29 March and another 7,000 at Akarit wadi on 7 April, and that the French took 1,000 at Kairouan on 10 April. The U.S. 1st Infantry Division captured 700 prisoners at El Guettar and the 1st Armored Division another 700 at Maknassy Pass, during the period 17-25 March. The total number of enemy prisoners of war captured on all fronts in North Africa from 20 March to 14 April 1943 was estimated to be 28,000 (6,000 Germans and 22,000 Italians). Most of these prisoners were evacuated to incompletely

²¹ Howe, George F.: Northwest Africa: Seizing the Initiative in the West. United States Army in World War II. The Mediterranean Theater of Operations. Washington: U.S. Government Printing Office, 1957, p. vii.

²² Eisenhower, Dwight D.: Crusade in Europe. Garden City, New York: Doubleday & Co., Inc., 1949, p. 157.

²³Lewis, George G., and Mewha, John: History of Prisoner of War Utilization by the United States Army, 1776-1945. Department of the Army Pamphlet No. 20-213, 24 June 1955, p. 83 and fn. 43, p. 90.

²⁴ Bradley, Omar N.: A Soldier`s Story. New York: Henry Holt & Co., 1951, p. 98.

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constructed and inadequately sanitated enclosures, cages, or camps located along the Mediterranean coastal area in the vicinities of headquarters of Atlantic, Mediterranean, and Eastern Base Sections. It was a time when there were shortages of supplies and confusion in distribution of supplies for U.S. troops. It was to be expected that enemy prisoners of war would be subjected to the same fateful deficiencies. It must be admitted, however, that not as much was done as might have been done to provide more nearly adequate preventive medicine services for these prisoners.

Preventive medicine planning for prisoners of war.—With a clear foresight of coming events and problems, Lt. Col. (later Col.) Perrin H. Long, MC, Chief Consultant in Medicine, Allied Force Headquarters, and North African theater, wrote a vigorous memorandum for the theater surgeon, Brig. Gen. Frederick A. Blessé, on 18 March 1943, on “Prevention of Disease in Prisoners of War.”²⁵ The essential contents of Colonel Long`s memorandum follow:

1. Colonel Long pointed out that the coming battle in Tunisia would put a heavy strain upon existing medical and sanitary arrangements and facilities in the U.S. Army, because in addition to the care of the sick and wounded, the Army medical service would be charged with the prevention of disease among captured enemy troops. The burden was expected to fall mainly upon the U.S. Army component of the Allied Task Force because the current plans called for the evacuation of prisoners of war along American lines of communication. This plan was changed somewhat in the first part of May 1943, when, in the battle for northern Tunisia, initial responsibility for supervision of prisoners of war was placed upon the British.

2. Every effort must be made to prevent the outbreak of epidemic disease among the anticipated prisoners of war not only because of the humane aspects of the problem, but also because of the dangers to our own forces which would be created by such outbreaks.”

3. Knowledge about the status of immunizations in enemy troops was scanty, although there were reports from nonmilitary sources that the Germans had been vaccinated against typhoid, typhus, and smallpox; the Italians had been vaccinated against typhoid, tetanus, and smallpox.

4. The three main health problems which would concern prisoners of war were noted to be typhus, malaria, and dysentery. Information about the occurrence of these diseases in enemy troops in action, and after capture, was summarized and discussed. Preventive measures, as used for the protection of U.S. troops, were advised for prisoners of war, with some modifications to fit circumstances. Against typhus, the major measures were to be delousing with insecticide powder and vaccination with Cox-type rickettsial vaccine. Mosquito control, coupled with suppressive Atabrine therapy, was recommended against malaria. With regard to dysentery prevention, a truism was stated: “Due to the necessarily exposed conditions of prison camps, the lack of sanitary facilities, and the impossibility of screening cook shacks and messhalls, it is likely that dysentery will be a problem among prisoners of war. To offset this threat, a most rigid and severe sanitary discipline must be enforced in all prison camps in respect to the disposal of human excreta and every effort must be made to remove fly breeding sources from the environs of prison camps to a distance of at least one and one-half miles.

²⁵ Long, Perrin H.: Mediterranean (Formerly North African) Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 193-195.

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Even if such measures are enforced it is likely that a considerable amount of dysentery will occur * * *”– a prediction amply verified by experience!

Medical care for prisoners of war.—In another memorandum, dated 19 March 1943, to the Surgeon, North African theater, on “Professional Services for Prisoners of War,”²⁶ Colonel Long pointed out that to reduce the demands for medical care of the sick “every effort should be made to initiate preventive measures * * * for prisoners of war.” Furthermore, he advised that “medical officers be detailed to each secondary forward concentration area to initiate and supervise sanitary and preventive procedures and to look after the health of prisoners.”

Unfortunately, this enlightened advice was frustrated by neglect or could not be carried out in some instances because of the swift capture of many thousands of prisoners whose mere numbers swamped all facilities for their sanitary care. There were also troubles in communications. Colonel Long records that “by some accident of fate, instead of their [these memorandums] being returned to the surgeon`s office they were buried in the records section of the Adjutant General`s Office, AFHQ, and no action was taken upon the recommendations made in them. By May 1943, the battle for northern Tunisia was well under way [as well as the season for flies and mosquitoes], and prisoners of war began to stream in by the thousands.”

In the closing days of the campaign in northern Tunisia, the Chief Consultant in Medicine, North African theater, noted that the recommended measures for the prevention of disease among prisoners of war were being disregarded by both British and American forces, and that little use was being made of enemy medical officers and sanitary personnel (protected personnel) for the care of their own nationals. He reported these conditions to the Provost Marshal General, North African theater, on 17 May 1943, and advised that increased numbers of “protected” enemy personnel be retained “to assist in the prevention of disease and the care of the sick and wounded in prison compounds.” He urged, further, that prisoners of war be given a stimulating dose of TAB vaccine and be placed on Atabrine therapy for the suppression of malaria.

Prisoner-of-war enclosure at Mateur.—The most famous, and notorious, prisoner-of-war enclosure in northern Tunisia was located just north of Mateur (captured on 3 May 1943) on the farmyard plain at the foot of Djebel Achkel. A photograph (fig. 32) of the crowding there on the unsheltered sand on 9 May is more expressive than many words. These men were a large portion of the 275,000 prisoners that were captured by the Allies in the last week of the fighting in Tunisia.

In spite of the overflow of defeated Axis soldiers, some efforts at preventive medicine were made, even in the teeming barbed wire enclosure

²⁶ Long, Perrin H.: Mediterranean (Formerly North African) Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 196-197.

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FIGURE 32.—Aerial view of German prisoner-of-war enclosure west of Mateur, Tunisia, North Africa, 9 May 1943. (U.S. Army photograph.)

at Mateur. General Bradley,²⁷who watched the scene unfold, wrote, as follows:

* * * We anticipated 12,000 or 14,000 PWs. By nightfall, however, the Germans had overrun our cages. German engineers were conscripted under their own noncoms to expand the enclosure. We doubled and soon tripled that original compound.

For two days, as far as one could see, a strange procession of PWs trailed up the road from Mateur as though on a holiday junket.

Some came in long convoys of GMC`s guarded only by an occasional MP * * * atop each cab with a rifle. [As in the European theater, most of the prisoners were so docile that they did not need guards, but guides to the enclosures.] Others traveled in giant sand-colored Wehrmacht trucks bearing the palm-tree markings of the Africa Korps. On bicycles, farm carts, motorcycles, gun carriages, even burros, they trailed contentedly toward the cages. By the time this flow thinned down we had counted 40,000.

* * * * * * *

A carnival air soon pervaded the Italian cages as the PWs squatted round their fires and sang to the accordions they had brought in with them. In contrast, the Germans busied themselves in tidying up the compound. Noncoms issued orders and soon colonies of camouflaged ponchos mushroomed on the desert floor. The men were

²⁷Bradley, Omar N.: A Soldier`s Story. New York: Henry Holt & Co., 1951 pp. 97-98.

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formed into companies, latrines excavated, cooking areas assigned them, and water rationed from Lyster bags. German quartermasters trucked tons of their own rations into the cages.

However, the latrines could not be covered and protection against flies and mosquitoes was feeble. Soon dysentery, hepatitis, and malaria became major causes of sickness, which under the circumstances could not be prevented.

Problems of handling large numbers of prisoners of war.—When General Eisenhower saw something of the handling of hordes of enemy prisoners of war in the European theater in 1945, he recalled “the time in Tunisia when the sudden capture of 275,000 Axis prisoners caused me rather ruefully to remark to my operations officers, Rooks and Nevins:

‘Why didn’t some staff college ever tell us what to do with a quarter of a million prisoners so located at the end of a rickety railroad that it`s impossible to move them and where guarding and feeding them are so difficult.` ²⁸

On more than one occasion during World War II, surgeons, preventive medicine officers, and provost marshals uttered the same cry. To the author, it seems fair to say that, while all the disease-producing conditions associated with prisoners of war, enclosed as herds and evacuated in droves, could not have been prevented, their frequency could have been reduced by more imaginative forecasts, clearer planning, and sharper indoctrination at all levels, including the Army War College—the postgraduate school of the Army.

From May to July 1943, the evacuation of prisoners of war captured in Tunisia continued westward slowly along the coastal roads, highways, and railroads from the Eastern Base Section in the Constantine area. By the first week in June, they were arriving by the thousands in the ill-prepared compounds in the Mediterranean and Atlantic Base Sections. Bringing dysentery with them, the prisoners polluted roadsides and stations with infected excrement. Traveling hosts of malarial parasites, they were potential new reservoirs of paludism and intensified problems of malaria control.

Preparation for the Sicilian Campaign.—During this period, the theater was preoccupied not only with rehabilitation after the Tunisian Campaign, but also with the enormous task of planning and preparing for the invasion of Sicily. Under the North African theater, the planning for this campaign (Operation HUSKY), to be based in North Africa, began in February 1943. Even before the end of the fighting in Tunisia, and continuing to the taking of Messina on 17 August 1943, the area of the North African theater, particularly along the coast of the Mediterranean Sea, became a very large and busy training ground for air and amphibious assault and the storage arsenal for much of the ground, air, and naval

²⁸ Eisenhower, Dwight D.: Crusade in Europe. Garden City, New York: Doubleday & Co., Inc., 1949, p. 386.

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equipment and supplies. Naturally, these matters took precedence over some considerations of preventive medicine for enemy prisoners of war already in the theater.

In view of the just cited facts, and since most of the Italian and German prisoners of war captured later in Sicily were evacuated to North Africa, it is advisable to turn now to a brief review of some aspects of the Sicilian Campaign, and to return later to an additional description of prisoner-of-war conditions in North Africa during a period after the completion of the invasion of Sicily (p. 363).

Sicily—Gela to Messina, 10 July to 17 August 1943

The campaign in Sicily lasted from the landings of American and British forces on 10 July 1943, on the southern and southeastern portions of the island, to the taking of Messina on 17 August 1943—38 days. It was a hard-fought campaign, bravely and brilliantly carried out by the Seventh U.S. Army under General George S. Patton, Jr., the British Eighth Army under General Sir Bernard L. Montgomery, and by strong bodies of American and British naval and air forces. A total of 122,204 prisoners of war were captured.²⁹

During the Sicilian Campaign, the most notable event that affected the status of Italian prisoners of war was the fall of Mussolini on 25 July 1943 and the surrender of Italy announced by General Eisenhower on 8 September 1943. Thereafter, when some prolonged and difficult negotiations with Badoglio had been completed, Italy was recognized as a cobelligerent with the Allies, and her captured military personnel became organized into Italian Service Units. The members of these units were eligible for all of the rights and privileges provided by the Geneva Conventions of 1929, as if they were still in the status of prisoners of war. On the other hand, they had considerable freedom. These units rendered valuable services in labor, agriculture, and industry, and assisted in specialized activities, such as the care of the sick and wounded in hospitals and as sanitary police in prisoner-of-war camps.

During the campaign in Sicily, neither Allied nor Axis troops encountered problems of field or camp sanitation and preventive medicine that were basically different from those which had been met in Northwest Africa. Problems of handling enemy prisoners of war by U.S. forces were similar to those of the North African Campaign. An example of this was the shortage of drinking water for prisoners of war (fig. 33).

The chief newly encountered disease in Sicily was sandfly fever (pappataci fever).³⁰Not recognized at first, several hundred cases of this

²⁹ Report of Operations of the United States Seventh Army in the Sicilian Campaign, 10 July-17 August 1943.

³⁰Hertig, Marshall, and Sabin, Albert B.: Sandfly Fever (Pappataci, Phlebotomus, Three-Day Fever). In Medical Department, United States Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases. Washington: U.S. Government Printing Office, 1964, pp. 109-174.

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FIGURE 33.—Italian prisoners of war captured by the 3d U.S. Infantry Division, Seventh U.S. Army, in Sicily, waiting in line for water at a prisoner-of-war enclosure, 8 August 1943. (U.S. Army photograph.)

disease were diagnosed as “fever of undetermined origin,” “three-day fever,” or malaria. It caused much noneffectiveness. Control, not entirely satisfactory, was based upon attempts to avoid the bite of the vector, Phlebotomus papatasii, by the use of insect repellent, and by the use of fine-mesh screening. Sandfly fever was occurring in prisoners of war when they were evacuated to North Africa, but the disease was not a continuing problem there.

Malaria, especially prevalent in the Catanian plain facing the southeastern bastion of Mount Etna, caused relatively heavy losses among troops on both sides. Infected prisoners captured in malarious areas carried parasites into prisoner-of-war enclosures across the seas.

Preparations for handling prisoners of war.—At the beginning of the Sicilian Campaign, the preparations for the reception and handling of prisoners of war evacuated to the Eastern Base Section were still primitive,

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according to a report to the Surgeon, North African theater, by the Chief Consultant in Medicine, on 25 August 1943, as follows: ³¹

* * * When the first prisoners of war arrived, the stockades were half completed, latrine pits not dug, latrine boxes not flyproofed, kitchen facilities and waste disposal were primitive, water and rations were short, delousing facilities were lacking, medical supplies were short, one medical officer was in the area, and a battalion of the 135th Infantry had to be used to guard prisoners because but a handful of the P.M. [Provost Marshal] representatives were available. The POW (especially the Italians) arrived exhausted and ill with dysentery and malaria. Scabies was frequent and venereal diseases were not uncommon. They were herded off the LST`s (on which water was frequently short), lined up in the hot sun, and then marched along the main roads to the POW compound. * * * En route many fell out from heat exhaustion or from other causes. On one occasion a large group of POW burst through their road guards like a bunch of wild animals and practically threw themselves into a badly contaminated well, so great was their thirst. Such conditions [of stress] were undoubtedly responsible for the lighting up of chronic malarial infections in the prisoners, with the result that they took up hospital beds in the Bizerte-Mateur area which otherwise would have been available for use by American patients.?

At the Mediterranean Base Section (Oran area), from May to October 1943, diarrhea and dysentery were prevalent among both U.S. troops and prisoners of war. In addition, the increase of lice among the prisoners was appreciable. Improvements, however, were in the making. Col. Myron P. Rudolph, MC, the base surgeon, was able to report that: “As supplies became available and as proper control could be exercised the standards gradually improved. Towards the end of 1943 the general sanitation and living conditions [in POW compounds] were approximately as good as among MBS troops.” ³²

From September 1943 to the end of the year, the handling and treatment of enemy prisoners of war detained in North African base sections constantly improved.

Diseases among prisoners of war.—The available statistics are not sufficient to disclose all that one would like to know about morbidity and mortality among prisoners of war captured in Tunisia and Sicily and detained in North Africa. Although rates cannot be calculated, the numbers of reported cases of various diseases give interesting indications of at least a recorded portion of the experience. These data, extracted from the reports of Colonel Long and others, are presented in table 19. Other causes of mortality among these prisoners were: wounded in action, 12; hypertension, 1; brain abscess, 2; dermatitis exfoliativa (arsenical), 1; nephritis, acute, 1; colitis, amebic, 1; colitis, ulcerative, 1; carcinoma, 1; dehydration and exhaustion, 2; coronary thrombosis, 4; suicide, 1; killed by guards, 8; accident, 1; ruptured appendix, 1.

³¹ Long, Perrin H.: Mediterranean (Formerly North African) Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 199-200.

³² Annual Report, Surgeon, Headquarters, Mediterranean Base Section, North African Theater of Operations, U.S. Army, 1943, p. 18.

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TABLE 19.—Morbidity and mortality from disease among enemy prisoners of war captured in the Tunisian and Sicilian Campaigns and hospitalized in North Africa between 15 June and 15 September1943

In commenting on these statistics, Colonel Long³³noted that: (1) The case fatality rate from malaria in prisoners of war (1.14 percent) was considerably higher than the rate in American troops. (2) Two great causes of morbidity (malaria and dysentery) could have been markedly reduced if adequate preparations for the reception and care of prisoners of war had been made. (3) The following figures (which are based upon average periods of hospitalization noted for American patients) are presented to show the number of hospital-bed days taken up by prisoners of war sick with preventable diseases:

Malaria . . . . . 31,425

Dysentery . . . 4,135

Typhoid . . . . 745

In conclusion, it was the judgment of the Chief Consultant in Medicine, North African theater, that the record of the prevention and treatment of disease among prisoners of war was fair.

MEDITERRANEAN (FORMERLY NORTH AFRICAN) THEATER OF OPERATIONS

Rarely, if ever, has a flank attack been so large, powerful, sustained, and successful as the Italian Campaign of the Fifth U.S. Army and the British Eighth Army, from August 1943 to May 1945. Although called a secondary theater of operations in comparison with the European theater,³⁵

³³ Long, Perrin H.: Mediterranean (Formerly North African) Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, p. 202.

³⁴Fifth Army History, Parts I-IX, 1946.

³⁵Eisenhower, Dwight D.: Crusade in Europe. Garden City, New York: Doubleday & Co., Inc., 1949, p. 190.

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this campaign contributed mightily to the defeat of Germany and to the winning of the war in Europe.³⁶

The Italian Campaign, lasting approximately 22 months, included two bitter winters. Under the command of Lt. Gen. Mark W. Clark from August 1943 to December 1944, and thereafter under Lt. Gen. Lucius K. Truscott, Jr., the Fifth U.S. Army fought northward along the mountainous length of Italy. It was opposed stubbornly by large skillful German forces, fully and appropriately equipped, well-supplied, ably led, and usually so dug in or protected by buildings and caves, rivers and cliffs, that they had to be destroyed in place or forced to withdraw. This was so until the final weeks of their collapse and total defeat (map 6, p. 355).

German Prisoners of War in Italy?

Number captured.—Relatively few prisoners of war were taken by the Fifth U.S. Army along the route from Salerno in southern Italy to Bologna, one of the gateways to the Po River Valley, in the northern Appenines, during the period from September 1943 to April 1945. In the latter month, the trickle of enemy prisoners of war became a deluge of thousands, including large numbers of patients in overrun German military hospitals. This followed the surrender of the German forces on 2 May 1945, by General der Panzertruppen Heinrich von Vietinghoff genannt Scheel, who, on 23 March 1945, had succeeded Feldmarschall Albert Kesselring as supreme commander of the Nazi forces in Italy. The intake of German prisoners of war by the Fifth U.S. Army from 4 January 1944 to 6 May 1945 is shown in table 20.

All prisoner-of-war enclosures in northern Italy became overcrowded and sanitary conditions temporarily foul, placing a great strain upon the medical and related components of the victorious army. The severe problem of handling masses of enemy prisoners of war fell upon the Fifth U.S. Army after the hard fighting was over and the war in Europe was coming to its end.³⁷

As the Italian Army had surrendered on 8 September 1943, no Italians were taken as prisoners of war after that date.

Prisoner-of-war enclosures.—The chief prisoner-of-war enclosures in Italy were in the Naples-Foggia area in the Peninsular Base Command; in the areas of Caserta, Rome, Florence, and Leghorn; and after Bologna, at Ghedi, Cortina d`Ampezzo, Boizano, Merano, and Verona. In May 1945 and later, the largest enclosures were at Ghedi, just southwest of Lake Garda, and at Merano, northeast of the 1ake on the route to the Brenner Pass.

³⁶(1) Blumenson, Martin: Salerno to Cassino. United States Army in World War II. The Mediterranean Theater of Operations. Washington: U.S. Government Printing Office, 1969. (2) Fisher, Ernest F., Jr.: Cassino to the Alps. United States Army in World War II. The Mediterranean Theater of Operations. [In preparation.]

³⁷See footnote 34, p. 364.

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TABLE 20.– Prisoners of war (German) captured by the Fifth U.S. Army in Italy from 4 January 1944 to 6 May 1945

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Some of the German prisoners of war were organized into service units (labor units), and were carefully nurtured to keep them fit for hard work. Others were evacuated through Naples to base sections or hospitals in North Africa or to the United States.

The retention in the communications zones in the North African-Mediterranean theater of German prisoners of war captured during the Italian Campaign does not appear to have caused serious problems of either supply or sanitation. Constant effort was made to observe the Geneva Conventions of 1929, and a degree of preventive medicine for enemy prisoners of war was practiced. These efforts are to be judged against the needs of U.S. troops who suffered at times from shortages of food, shelter, adequate footgear, and other necessities, while they were engaged almost constantly in combat (except for lulls during parts of two bitter winters) on what they called the forgotten front.

Activities and conditions in northern Italy.-In northern Italy, in May 1945, the breakthrough into the Po River Valley and the battle of pursuit to the Dolomite Alps resulted in the capture of multitudes of prisoners of war from two main sources. One was the overrun large German military hospitals; the other was the disintegrating combat units of the Wehrmacht whose personnel surrendered en masse. Paraphrasing accounts by the Office of the Surgeon, Fifth U.S. Army,³⁸and Wiltse,³⁹ the situation may be described as a vast mixture of hospitalization for the medical care of German sick and wounded and of field preventive medicine for captured soldiers who it was desirable to maintain in as healthy a condition as possible.

Number and condition of prisoners of war.-`When a complete count was made, as of 15 June [1945], the U.S. share of the more than half million prisoners taken in Italy since Salerno was 299,124, of whom 147,227 were under Fifth Army control and 151,897 belonged to the Peninsular Base Section.`⁴⁰

In the first weeks after the German surrender, most of the new prisoners were in poor condition nutritionally. It was not possible for the Fifth U.S. Army to remedy these deficiencies at once, but within a few weeks, supplies of rations became adequate. This was a notable achievement considering the complexities of the terminal fighting, the beginning of redeployment, and the reception and care of thousands of recovered Allied military personnel returning from German prison camps.

³⁸ (1) Report, Surgeon, MTOUSA, Headquarters Fifth Army, Office of the Surgeon, 4 Sept. 1945, subject: Fifth Army Medical Service, 1 January-31 August 1945. (2) Fifth Army Medical Service History, 1 January 1945-9 September 1945. See especially Ch. III, pp. 41-49, Prisoners of War, by Capt. Sidney Hyman, MAC, Medical Historian.

³⁹ Wiltse, Charles M.: The Medical Department: Medical Service in the Mediterranean and Minor Theaters. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1965.

⁴⁰ Wiltse, Charles M.: The Medical Department: Medical Service in the Mediterranean and Minor Theaters. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1965, p. 535.

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Special Measures for Handling Prisoners of War?

For supervision of the handling of enemy prisoners of war, particularly those derived from defeated or disbanded combat elements, two intelligent and effective measures were taken by the Fifth U.S. Army in May 1945, as follows:

1. Assignment of combat troops.-The 88th Infantry Division was assigned as the Mediterranean theater Prisoner of War Command. It assumed responsibility for guarding hospital areas and equipment, disciplinary action, and the myriad details involved in the handling of prisoners of war throughout northern Italy, according to comprehensive directives issued by Allied Force Headquarters and Fifth U.S. Army Headquarters. As the Prisoner of War Command, the 88th Infantry Division had its main headquarters at Modena and Ghedi (80,000 prisoners entered these enclosures during the week of 17-24 May 1945). The Prisoner of War Subcommand of the 88th Infantry Division supervised the Pisa-Leghorn system of enclosures.⁴¹

Assistance was given to the medical service by appropriate details from the 88th Infantry Division. During the first weeks after the surrender, prisoners entering the cages were mostly infested with lice. They were thoroughly dusted with DDT powder. Intense efforts were made to cleanup the cages at Ghedi, Modena, Piacenza, Verona, and at other locations. In 2 days, for example, 80 truckloads of manure, tin cans, and other refuse left by the fleeing Germans were carted away.⁴²

2. Assignment of sanitation supervisor.-An officer from the Surgeon`s Office, Maj. Frank H. Connell, SnC, Assistant Medical Inspector, was assigned as supervisor of sanitation of prisoner-of-war cages throughout northern Italy. Later, Lt. Col. Harris S. Holmboe, MC, supervised all sanitary and medical matters at Ghedi. `Sanitation facilities at Ghedi rapidly improved during the summer, until by July [1945], under constant US supervision, they had reached as near US standards as the facilities available permitted. An adequate water supply for washing and cooking was available, latrine boxes were erected, pits were sprayed daily with diesel oil, messkit laundries were established at all messes, and bathing facilities were gradually built up to the acceptability required for the maintenance of a good state of health among so many concentrated personnel.` ⁴³

Repatriation of Prisoners of War

Repatriation of enemy prisoners of war was a major task, which, undertaken shortly after the German surrender on 2 May 1945, increased

⁴¹ History, 88th Infantry Division, 25 Aug. 1945.

⁴² A similar assignment of combat troops was made in the European Theater of Operations, U.S. Army, in April 1945, when the 106th Infantry Division, reinforced, was designated to assist the Theater Provost Marshal in handling the huge numbers of captives.

⁴³ See footnote 38 (2), p. 367.

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in complexity and urgency as time passed. It involved not only transportation of sick and wounded, but also the movement of well soldiers in a manner that required application of principles of preventive medicine suitable to the transport of troops. The movement was chiefly through Ghedi, Merano, Bolzano, and the Brenner Pass into Austria and Germany. This constituted a transfer of individuals from Italy to an area controlled by Supreme Headquarters, Allied Expeditionary Force.

To resolve jurisdictional problems and to draw up schedules and priorities for adjustment of sick and wounded prisoners of war, Col. Alvin L. Gorby, MC, Surgeon, 12th Army Group, called a conference of medical officers at Wiesbaden, Germany, on 12 and 13 July 1945. About this time, Supreme Headquarters, Allied Expeditionary Force, was replaced by United States Forces, European Theater. Both British and American representatives were present at the meeting. Among the American representatives at the conference were Lt. Col. Albert A. Biederman, MC, Plans and Operations Officer, Medical Section, Mediterranean theater, and Col. John Boyd Coates, Jr., MC, and Lt. Col. Robert J. Goldson, MC, representing, respectively, the Third and the Seventh U.S. Armies. The representatives were concerned primarily with problems of the return of prisoners of war who were under medical jurisdiction. They desired to move these individuals to the vicinities of their homes, both in the U.S. Zone as well as in the British Zone of Germany. The American representatives wished to prevent saddling U.S. forces with the burden of caring for the thousands of sick and wounded German prisoners of war whose native homes were in the British Zone. A satisfactory program was worked out. The Fifth U.S. Army carried out its part so well that, by 1 September 1945, the job had been completed as far as the evacuation of former enemy patients from northern Italy was concerned.⁴⁴

Status of Surrendered Enemy Personnel?

The question of the status of surrendered enemy military personnel came up for special consideration in the last stages of the Italian Campaign and its immediate aftermath. The question was (and is) whether the Geneva Convention of 1929 `Relative to the Treatment of Prisoners of War` was violated by the decision of the Allies to place surrendered enemy personnel in a special category which deprived the surrendered individual of the rights and privileges inherent in the status of prisoner of war, as defined by the convention. In the Medical Service History of the Fifth U.S. Army,⁴⁵the difference between `prisoners of war` and `surrendered [enemy] personnel` was overlooked. They were treated alike-`all were afforded equal treatment, equal rations, and equal rights.` On the other hand, the Assistant Chief of Staff for Intelligence, G-2, 88th Infantry

⁴⁴ From official records and personal communication, Col. John Boyd Coates, Jr., MC, to the author, 6 Sept. 1963.

⁴⁵ See footnote 38 (2), p.367.?

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Division, which was then the Prisoner of War Command, recorded a contrary point of view. On 15 August 1945, he wrote, `Occasionally, this office received strongly worded communications from individuals who felt they were being treated unjustly and who quoted freely the Geneva Convention to back up their claims. These people evidently were not aware of the fact that all enemy personnel in Italy under this command are classified as `Surrendered Enemy Forces` and since the German surrender was an unconditional one surrendered enemy forces have no rights under the Geneva Convention. In order to eliminate further instances, such as these, the German `Guard House Lawyers` were reminded that their propounded rights as PW`s would not be tolerated in the future.` ⁴⁶

This is not the place to discuss the difficult question: `Can the status of prisoners of war be altered?` It has been dealt with exhaustively by Wilhelm in a legal monograph for the International Committee of the Red Cross.⁴⁷In his opinion, the rights of prisoners of war are inalienable; surrendered enemy personnel should have been regarded as prisoners of war. `Military necessity`-the inability of the Allies to care properly for the hundreds of thousands of German soldiers surrendered in the final debacle-might have been invoked as a better reason for depriving them of their status as prisoners of war.⁴⁸

Diseases Among Prisoners of War?

The diarrheas and dysenteries were common among enemy prisoners of war in northern Italy from May to September 1945, but not so prevalent as they were among prisoners of war in Tunisia in 1943. With regard to other diseases among German troops in Italy during the period 1943-45, Colonel Long, Chief Consultant in Medicine, Mediterranean theater, made observations and collected information when he visited, in May and June 1945, the overrun German military hospitals in Merano, Bolzano, and Cortina d`Ampezzo and conferred with German medical officers. The following is an abstract of a portion of his report,⁴⁹as follows:

⁴⁶ See footnote 41, p. 368.

⁴⁷ Wilhelm, Ren?-Jean: Pent-on modifier le statut des prisonniers de guerre? Rev. internat. Croix-Rouge 35: 516-543. July; 681-690, September 1953.

⁴⁸ Experience in World War II indicated the need for a more detailed instrument than the Geneva Convention of 1929. One of the deficiencies was the imprecise definition of prisoners of war. This was remedied by the revised Geneva Prisoner of War Convention which was adopted on 12 August 1949, ratified by the U.S. Government on 14 July 1955, and entered into force in the United States of America on 2 February 1956 (Treaty Series, No. 3364). This treaty retains under the designation of prisoners of war all those included in the 1929 text and adds several other classes of persons who, when they fall into the power of the enemy, are entitled to be treated as prisoners of war. In addition, the 1949 convention specifies in detail a number of provisions which had not been so clearly stated in the 1929 convention. With regard to the apparent redundancy of the 1949 text, Maj. Gen. Joseph Vincent Dillon has pointed out, quoting a statement attributed to a Lord Chief Justice of England in the 18th century with respect to Common Law Pleading, `that it is better to err on the side of pleonasm than on that of exiguity.` This point of view influenced the drafters of the 1949 convention. They sought `to expressly cover as much as possible and leave as little as possible to imagination or discretion.` (See footnote 6 (1), p. 343.)-S. B.-J.

⁴⁹ Long, Perrin H.: Mediterranean (Formerly North African) Theater of Operations. In Medical Department, United States Army. Internal Medicine in World War II. Volume I. Activities of Medical Consultants. Washington: U.S. Government Printing Office, 1961, pp. 203-208.

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a. Field or war nephritis, present among German but not among American troops.

b. Infectious hepatitis.

c. Trench fever (Volhynia fever). `There were hundreds of cases of this louseborne disease among [German] troops in the Mediterranean area in the winters of 1943-44, 1944-45. It reached epidemic proportions in German troops in Russia.`

d. Atypical primary pneumonia-probably several diseases in addition to the usual virus pneumonia; referred to as the Grecian disease or Balkan grippe, as it was prevalent among German troops in Greece. (In 1945, `Balkan grippe` was shown by the Commission on Acute Respiratory Diseases of the Army Epidemiological Board to be Q fever, caused by Rickettsia burneti.)

e. Trenchfoot-notable by its absence from German troops even during the winter campaigns in Italy. `As the Germans said, a word for this condition does not exist in the German language.` Plenty of true frostbite was seen in the Russian Campaign but all German medical officers stated that they had not seen `Trench Foot` in German soldiers in MTOUSA during the winter of 1943-44 and 1944-45. In fact some of them said that they had traveled many miles to observe American prisoners of war who suffered from `Trench Foot.` They attributed this absence of `Trench Foot` to:

(1) Excellent foot hygiene and discipline.

(2) The easily removable high leather German field boot.

(3) The four pairs of thick but loosely woven all-wool high stockings provided to forward troops in winter.

f. Peptic ulcer.

g. Diphtheria-increased incidence during the past year, 1944-45, with a fair amount of diphtheritic paralysis following the acute disease.

h. Amebic disease (dysentery).

i. Streptococcal infections.

j. Typhoid and paratyphoid fevers.

k. Nutritional deficiencies.

Evaluation?

In his summary of the just cited report, years later, Colonel Long wrote:

In summary, it may be said that . . . the consultant in medicine frequently encountered serious problems in carrying out the duties specifically given to him by a verbal order of Maj. Gen. Everett Hughes, Deputy Theater Commander, NATOUSA.

General Hughes had stated unequivocally, `I want prison camps, both disciplinary and POW, run in a strict but humane fashion.` At times, the level of care in prisoner-of-war camps was excellent and in full accord with these orders. At other times, it was considerably less good, chiefly because of thoughtless administrative practices in lower echelons. The solution of the problem was strict adherence to the Geneva Convention dealing with the treatment of prisoners of war, and the consultant in medicine . . . made it his business to see that those in charge of these men fully understood their responsibilities toward them.

Proud of its accomplishments, particularly those of the final 4 months of operations, the medical service of the Fifth U.S. Army ended its prisoner-of-war history with this cheerful note: ⁵⁰

What had promised on 2 May [1945] to be an almost overwhelming burden for the Army Medical Service, . . . by 9 September, when Fifth Army became inoperational,

⁵⁰ See footnote 38 (2), p. 367.

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[had] been completely resolved. Hospitalization and evacuation of the German military in Italy had been successfully accomplished. The health of the German Army was actually far better than in the days before the surrender.

EUROPEAN THEATER OF OPERATIONS⁵¹

Within 336 days, the Allied Expeditionary Force entered the continent of Europe, occupied the heartland of Germany (map 7), and destroyed her armed forces, fulfilling the mission which the Combined Chiefs of Staff had communicated to General Eisenhower as Supreme Commander of `the mightiest force which the two western Allies could muster.` ⁵²

Operation OVERLORD

From 6 June 1944, D-day, when the landings on the Normandy beaches were begun, to 8 May 1945, V-E Day, when Germany surrendered, this host had crossed the English Channel, had advanced through the length and breadth of northwest Europe, had crossed the Rhine River, and had proceeded to regions near the Elbe and Danube Rivers (map 7). This tremendous accomplishment, phenomenally achieved in less than a year, was crowded with unexpected and almost inconceivable events. Among these, the capture of vast masses of enemy prisoners of war, tantamount to the major portion of the residual German Army, constituted a spectacular feature of the continental envelopment. As a consequence, the handling and treatment of those thousands of prisoners became an onerous responsibility and brought to the fore a multitude of problems, both old and new, complicated by the exigencies of total war.

In the first portion of this chapter, a program of preventive medicine for enemy prisoners of war has been presented. The account of activities along the same lines in the North African and Mediterranean theaters included descriptions and discussions of the problems that arose in many situations during the campaigns in those theaters. In fundamentals and episodes, the administrative, medical, and sanitary events in the handling of prisoners of war were typical of occurrences in the same fields of preventive medicine as in other theaters. They were so similar, in general, that names, places, and dates could be interchanged without serious distortion of the realities. In view of these similarities, the account of events

⁵¹ The European Theater of Operations, U.S. Army, was redesignated United States Forces, European Theater, on 1 July 1945. Supreme Headquarters, Allied Expeditionary Force was officially activated on 13 February 1944. After its establishment, the U.S. component at Supreme Headquarters tended to assume the functions of a theater headquarters, while the European theater at the same time became increasingly a communications-zone organization only. The mission of the European theater after V-E Day became primarily one of redeployment.

⁵²(1) Eisenhower, Dwight D.: Report by the Supreme Commander to the Combined Chiefs of Staff on the Operations in Europe of the Allied Expeditionary Force, 6 June 1944 to 8 May 1945, dated 13 July 1945. Washington: U.S. Government Printing Office, 1946. See especially pp. vi-vii. (2) Harrison, Gordon A.: Cross-Channel Attack. United States Army in World War II. The European Theater of Operations. Washington: U.S. Government Printing Office, 1951, pp. 457-458. (3) Eisenhower, Dwight D.: Crusade in Europe. Garden City, New York: Doubleday & Co., Inc., 1949, p. 225.

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MAP 7.- Advance of the British 21 Army Group and the Ninth, First, Third, and Seventh U.S. Armies from the west bank of the Rhine River to the Elbe and Danube Rivers, 15 March to 8 May 1945.

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that happened in the European theater can be shortened, and a monotonous and distressing repetition of a catalog of miseries can be somewhat avoided.

Plans and Directives?

To gather information for use in planning Operation OVERLORD (the invasion of Europe), officers of headquarters in London visited North Africa and Italy in 1943 and 1944 to look into the handling of enemy prisoners of war. In addition, surgeons and provost marshals of the First and Third U.S. Armies held conferences at several headquarters on how best to handle prisoners of war and made estimates, which turned out to be underestimates, of the numbers likely to be captured monthly during 1944. Apparently, no new lessons were learned, particularly with reference to problems imposed by mass-captures, although the inadequate enclosures at the Mediterranean base sections and the overcrowded, dismaying compound at Mateur were there to be seen. This preinvasion planning and its unimaginative forecast of needs were summarized in a report from the Third U.S. Army: `Inasmuch as the material available concerning Prisoners of War was negligible, excellent use was made of Field Manual 27-10, Rules of Land Warfare, and reports from the African, Sicilian and Italian Campaigns.` ⁵³

As this lack of directives indicates, the Geneva Conventions of 1929 and the Rules of Land Warfare were the main sources of material that was incorporated in standing operating procedures, circulars, and orders. The best overall example is Standing Operating Procedure No. 16 ⁵⁴issued first in June 1944 by Headquarters, European theater, for the governance of the theater. From this regulation, paragraph lb is quoted in part, as follows:

Basis of Responsibility for Prisoners of War. The overall responsibility with regard to prisoners of war is based on the undertakings of the US government pursuant to the provisions of the Geneva Convention of 27 Jul 1929 and the Red Cross Convention of the same date. Commanders of combat units and other units responsible for the handling of prisoners of war will insure that afl personnel have a thorough knowledge of the principles to be observed in relation to prisoners of war, as set forth in FM 27-10, `Rules of Land Warfare.` Emphasis will be placed on the provisions of the Geneva Convention relative to the treatment of prisoners of war. Attention will be especially

⁵³(1) After Action Report, Third U.S. Army, 1 August 1944-9 May 1945. Vol. II, Staff Section Reports; Part 19, Provost Marshal, pp. PM 1-31 and annexes PM I-XVIII. (2) In commenting on this paragraph, one of the reviewers, who was Deputy Provost Marshal, Advance Section, Communications Zone, European Theater of Operations, U.S. Army, stated that the Third U.S. Army made radical departures from the established policies and procedures of evacuation of enemy prisoners of war.-S. B.-J.

⁵⁴ (1) Headquarters, European Theater of Operations, U.S. Army, Standing Operating Procedure No. 16, Evacuation, Processing and Handling of Prisoners of War, issued 21 June 1944, superseded 3 Dec. 1944. (2) It is to be noted that Standing Operating Procedure No. 16 was not issued until 15 days after the invasion of Europe had started. It did not reach provost marshals `until months after the operation started. Advance Section was attached to First Army for the initial phase of the operation and ADSEC followed First Army SOP.` (Personal communication from Col. Valentine M. Barnes, Jr., MPC, to the author.-S. B.-J.)

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directed to the fact that the rights of prisoners of war, as set forth by treaty, . . . are binding on all US troops in the same manner as are the Constitution and laws of the United States.

From time to time, the First, Third, and Ninth U.S. Armies, Headquarters, Advance Section, Communications Zone, and Headquarters, 12th Army Group, issued similar statements coupled with detailed instructions for sanitary arrangements and supervision of prisoner-of-war enclosures and camps. On the whole, these were motivated by good intentions and were sound in principle. On review, however, in the light of events, they seem to lack an appreciation of the ghastly realities of the situations and were a bit naive. For example, they repeated often such an impossible requirement as that prisoners should have access, night and day, to toilet facilities (latrines and so forth) equal in equipment and sanitary maintenance to those that were standard for U.S. troops. The absurdity of this requirement will become more obvious when conditions in enclosures like the one at Remagen during March and April 1945 are described, where the dysenteric feces of the penned-in thousands were trampled and emulsified in the muddy surface of the ground.

Collection and Evacuation of Enemy Prisoners of War

The system of collecting points, routes of evacuation, and enclosures for enemy prisoners of war, as shown in chart 6 (p. 353), was adhered to as closely as circumstances permitted during the advance to the Rhine. After that barrier was breached in March 1945, and the avalanche of prisoners began to pour through the river crossings, modifications had to be made, as will be described later.

Planned capacity of Central Prisoner of War Enclosures in France.- Even at the beginning, Central Prisoner of War Enclosures were too few, too small, and understaffed. This led to overcrowding (fig. 34) and impeded the application of preventive medicine measures as well as the processing and handling of prisoners. The following report and comments give information about the deficient planning and its consequences.

Theater planning for the handling of enemy prisoners of war was rather unrealistic. It left much to be desired and apparently ignored the difficulty experienced in North Africa in handling a large influx of POW`s. This cannot be completely laid to inadequacies in the Theater Provost Marshal`s Office which was planning within the restrictions imposed by the overall concept of the operation. For instance, the planners asked for 49 Military Police Escort Guard Companies; only 19 were authorized by the War Department. As there was no T/O&E for a Prisoner of War Camp Overhead Detachment, the Theater Provost Marshal planned a provisional one and got authority to activate eight of them, one for a POW camp in England and seven for use in France. Each of these POW Camp Overhead Detachments was estimated by the planners to be able to handle 6,000 POW`s. Thus the planning was geared to accommodate at any one time a total of 48,000 POW` in the eight camps. The capture rate for the first 90 days was estimated at 1,000 a day. This would require that about one-half of the number captured during the first 90 days would have to be shipped out of the theater.

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FIGURE 34.- Approximately 10,000 German prisoners of war waiting to be fed at the enclosure near Nonat Le Pin, France, 21 August 1944. (U.S. Army photograph.)

The ETOUSA plan up to the time of the beginning of the operation consisted of provision for the following enclosures:

Burton on the Hill, England

1,000-man Evacuation Enclosure, Omaha Beach, D+20

1,000-man Evacuation Enclosure, Cherbourg, D + 20

1,000-man Evacuation Enclosure, Saint-L?, D+20

2,000-man Evacuation Enclosure, Rennes, D+30

1,000-man Evacuation Enclosure, Saint Malo, D+40

1,000-man Labor Enclosure, Rennes, D+75

6,000-man POW Enclosure, Saint Nazaire, D+90

Insofar as ADSEC was concerned, only one small enclosure was constructed in France, at Cherbourg. ADSEC thereafter took over the small (3,000 maximum capacity) enclosures constructed by First and Third U.S. Army engineers as these units fought forward or found other places suitable for use as POW enclosures. Such places were the partially completed casern at Namur, in Belgium, and the badly damaged old French post at Stenay. The ADSEC Provost Marshal got places of this type after it was determined that no one else wanted them. An old French post was taken over at Suippes, in France. After it had been fenced and repaired to some extent by POW`s, the XVIII Airborne Corps wanted it and the POW`s had to be moved.

None of the enclosures taken over from the Armies was suitable for expansion, and they were not well located. Each was quickly closed. Search was made for fenced areas with buildings or prisons for use as POW enclosures. Some such places were

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available in France, but no advance knowledge about them was at hand, and they were never noted to be a part of any theater plan for POW use.

In fact, the POW situation `just grew like Topsy` and places that normally would not house more than 5,000 or 6,000 persons were rated as 30,000-man camps, primarily because that was the number crowded in. If there was any comprehensive theater plan it was `after the fact` and not before. After it was all over, however, and had to be written up, there suddenly developed a plan. In effect, ADSEC was the tail that wagged the dog, for places in which POW`s were put originally were usually retained as POW camps.⁵⁵

In addition to division, corps, and Army collecting points, about 21 Central- Prisoner- of War Enclosures and a number of subcamps were established during 1944 on the continent of Europe, in Advance Section, Communications Zone, and in the Communications Zone base sections (Normandy, Brittany, Oise, Loire). Of these, the enclosures at Namur, Belgium, and Stenay, France, in the Advance Section (1944 and early 1945), were the busiest receiving, holding, and transfer points. A typical scene in a collecting point enclosure is shown in figure 35.

There were two large enclosures in the Southern Line of Communication, the more important of which was in the area of the port of Marseille on the route of evacuation to the continental United States. Although it is impossible to be sure of the figures, the total capacity of the prisoner-of-war enclosures in Advance Section, Communications Zone, and in the base sections in France, in late 1944 and early 1945, may be taken to have been about 330,000 with distributions of 10,000 to 40,000 in the various camps.⁵⁶In addition, as of midnight 31 January 1945, 342,371 prisoners of war were being held in the Southern Line of Communication.⁵⁷

Incidents in the evacuation of enemy prisoners of war.-As the military police and other units under the jurisdiction of the provost marshals were primarily responsible for the holding and evacuation of prisoners of war, their reports are full of accounts of events and discussions of problems involving preventive medicine.⁵⁸

Although more details about prisoner-of-war enclosures will be supplied in the next section (pp. 380-384), a few examples of the unsatisfactory, and occasionally fatal, conditions along the lines of evacuation will be mentioned here. Food, drinking water, and latrine cans were insufficient on some of the rail shipments. Often, prisoners of war were transported long distances in open gondola freight cars or in open trucks ingeniously packed with men (fig. 36).

⁵⁵ Personal communication, 16 July 1963, Col. Valentine M. Barnes, Jr., MPC, former Deputy Provost Marshal, Advance Section, Communications Zone, European Theater of Operations, U.S. Army, to the author.-S.B.-J.

⁵⁶History of the Office of the Theater Provost Marshal, ETOUSA, 1 Oct. 1944-8 May 1945, sec. VII, History, Prisoner of War Division. [Official record.]

⁵⁷ Memorandum for Record, Planning Branch, Operations Division, Office of the Chief Surgeon, Headquarters, ETOUSA, 10 Feb. 1945, subject: Prisoners of War Held by US Forces in ETO.

⁵⁸ Extracts From Military Police Operational Reports, World War II. Military Police School, Camp Gordon, Ga., vol. I, July 1950.

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FIGURE 35.-Collecting point for German prisoners of war at Beaugency, France, 19 September 1944. These are some of the 20,000 Germans who surrendered and awaited transport farther to the rear. (U.S. Army photograph.)

Two tragic episodes occurred in the shipments of prisoners of war from Stenay and Namur to Mailly-le-Camp, on 16 March 1945, in overcrowded, closed `40 and 8` boxcars that had been renovated by lining them with plywood, leaving no openings for ventilation. On arrival, 127 of the prisoners were found dead from suffocation. These two incidents occurred while the prisoners were being escorted and guarded by combat troops borrowed for the purpose from the 16th Armored Division, then waiting in a staging area for the arrival of its equipment. These troops were inexperienced in handling prisoners of war. They had received briefing in their guard and escort duty from experienced personnel, but they did not understand German. Therefore, they did not realize that the commotion being raised by the prisoners in the boxcars was for air. The Deputy Provost Marshal concerned in this case believed that, if the escort guards had been experienced military police personnel, this unfortunate incident probably would not have occurred. At this time, the flow of prisoners was so great that combat troops had to be `borrowed` to assist in handling them. One hundred escort and guard teams were borrowed, each consisting of 29 enlisted men and 1 officer. These teams each escorted trainloads of from 1,500 to 1,600 prisoners of war.

To prevent recurrences of defective handling of prisoners of war,

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FIGURE 36.-Evacuation of enemy prisoners of war to the rear in crowded open trucks. German soldiers captured by the 99th Infantry Division, First U.S. Army, board trucks at Sundwig, Germany, 16 April 1945. (U.S. Army photograph.)

special correctional directives were issued by Headquarters, European theater.⁵⁹

Review by the General Board.-After the end of the war, in the latter half of 1945, a General Board of United States Forces, European Theater, reviewed the military police activities in connection with the evacuation of prisoners of war. The report of this board⁶⁰ is comprehensive, and contains valuable recommendations. It is, however, essentially an administrative and logistical document. The severe and unsatisfactory medical and sanitary conditions (fig. 37) of the evacuation operations are indicated in it, but not dealt with in detail, since, having no special medical organization for the care of enemy prisoners of war, the military police had to depend upon the theater medical and sanitary services, which in a sense were adventitious. The board concluded `that the procedure for the handling and evacuation of prisoners of war as set forth in Field Manuals 19-5, 29-5, and 100-10, as modified by European Theater of Operations Standing Operating Procedure Number 16, dated 3 December 1944 and 12th Army Group Administrative Standing Operating Procedure, dated

⁵⁹ (Directive) Hq., ETOUSA, 26 Mar. 1945, subject: Movement of Prisoners of War. See also: Book message, Hq., ETOUSA, 25 Mar. 1945, same subject, to Base Sections, ADSEC COMZ, CONAD, etc., signed Lee.

⁶⁰ Report, The General Board, United States Forces, European Theater, The Military Police Activities in Connection With the Evacuation and Detention of Prisoners of War, Civilian Internees, and Military Personnel Recovered From the Enemy, Provost Marshal Section, Study No. 103, 1945.

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FIGURE 37.-Part of an estimated group of 82,000 German soldiers captured in the Ruhr pocket cleanup by the XVIII Airborne Corps, near Gummersbach, Germany, 17 April 1945. (U.S. Army photograph.)

18 October 1944, was followed whenever practicable, and that there were many variations from this procedure.`

Prisoner-of-War Transient Enclosures on the Rhine

By early 1945, all prisoner-of-war central enclosures in Belgium and France were overcrowded. They would not be able to receive and contain the droves of German prisoners that would be captured from the middle of March onward by the First, Third, and Ninth U.S. Armies, after the Rhine was crossed. To provide for temporary holding of approximately 1? million of these anticipated captives, 17 Prisoner of War Transient Enclosures were hurriedly constructed by Advance Section, Communications Zone, in April and May 1945, They were mostly fenced pasture land. The planned capacities ranged from 25,000 to 100,000. Prisoners of war evacuated from the field armies advancing into Germany and Austria crossed the Rhine River over a railroad bridge near Wesel in the north, a pontoon bridge near Remagen in the center, and another railroad bridge

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FIGURE 38.-At a prisoner-of-war enclosure near Remagen, Germany, a U.S. soldier takes part in keeping guard over thousands of German soldiers captured in the Ruhr area, 25 April 1945. (U.S. Army photograph.)

near Mainz in the south. The transient enclosures were constructed on the west side of the Rhine in the vicinities of these river crossings. At this time, no rails crossed the Rhine and if the new enclosures were constructed on the east side, it would be too large a trucking job to supply them from railheads on the west side (fig. 38).

In the first phase of construction, which was rather prolonged, these enclosures consisted of only barbed wire fences in fields. Later, some canvas was provided, and still later, some buildings were put up. For most of the time, prisoners were without cover and were exposed to rain and snow and mud in the ending winter, and to heat, dust, or rain and mud as spring advanced to early summer. Some of the enclosures resembled Andersonville Prison in 1864, as suggested by the scene shown in figure 39, depicting a portion of the Prisoner of War Transient Enclosure at Sinzig, Germany, on 12 May 1945.

Assistance from medical groups.-The transient enclosures were served by Advance Section, Communications Zone, medical and sanitary organizations in their areas and administered by the 106th Infantry Division.⁶¹

⁶¹Annual Report, Surgeon, 106th Infantry Division, 1 Jan.-17 Sept. 1945, dated 18 Sept. 1945.

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FIGURE 39.-Prisoner of War Transient Enclosure at Sinzig, Germany, 12 May 1945. On that date, 116,000 German prisoners of war were held there, the rated capacity was 100,000. These prisoners are in a barbed wire fenced open field with little or no shelter. (U.S. Army photograph.)

In addition, medical groups⁶² serving the field armies in the forward areas were supplementary sanitary agencies. The 65th, 66th, 67th, 68th, and 69th Medical Groups, late in 1944 and during the first half of 1945, greatly assisted the medical and provost marshal units of the First, Third, and Ninth U.S. Armies in the handling of prisoners of war at Army enclosures and in combat regions in which derogating circumstances due to military operations prevented the full application of the sanitary requirements of the Geneva Convention. Indeed, these requirements could not be met on the line of evacuation until the prisoners of war had entered the better types of camps or enclosures. In many cases, overcrowding, shortages of sanitary personnel, and lack of supplies, equipment, and facilities prevented the practice of preventive medicine.⁶³

Overcrowding.-Even the Prisoner of War Transient Enclosures became overcrowded. For example, the enlarged enclosure near Remagen,

⁶² (1) See footnote 16, p. 351. (2) Annual reports for the years 1944 and 1945 (various periods and dates) of the 65th, 66th, 67th, 68th, and 69th Headquarters and Headquarters Detachment, Medical Groups.

⁶³ Memorandum, Headquarters, Advance Section, Communications Zone, 24 May 1945, subject: Administrative Instructions for Prisoner of War Enclosures.

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intended for 100,000 men was packed with 184,000. When the flow of prisoners from Army enclosures ceased, in May 1945, 1,611,979 prisoners of war had been evacuated from the Armies by Advance Section, Communications Zone.

Location of transient enclosures.-The designations, locations, and rated capacities of Prisoner of War Transient Enclosures, which were constructed in the region of the west bank of the Rhine in Germany from March to May 1945, are given in numerous documents. Most accessible is a vivid and informative article by Col. James B. Mason, MC, and Col. Charles H. Beasley, MC (respectively Deputy Surgeon and Surgeon, Advance Section; Communications Zone).⁶⁴ In these transient enclosures, medical and sanitary conditions were similar to those already described, but were more primitive and intensified.⁶⁵

The locations and authorized capacities of the Prisoner of War Transient Enclosures along the western side of the Rhine in Germany are shown in table 21 and map 8.

TABLE 21.-Number, location, and authorized prisoner-of-war capacity of the 17 Prisoner of War Transient Enclosures along the western side of the Rhine River, Germany, May 1945

Source: Mason, James B., and Beasley, Charles H.: Medical Arrangements for Prisoners of War En Masse. Mil. Surgeon 107: 341-443, December, 1950.

⁶⁴Mason, James B., and Beasley, Charles H.: Medical Arrangements for Prisoners of War En Masse. Mil. Surgeon 107: 431-443, December 1950.

⁶⁵ Semiannual Report, Office of the Surgeon, Headquarters, Advance Section, Communications Zone, European Theater of Operations, U.S. Army, 1 Jan.-30 June 1945.

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MAP 8.-Location of the 17 Prisoner of War Transient Enclosures in the region of the west bank of the Rhine River, Germany, May 1945.

German Prisoner-of-War Statistics?

General mention has been made of the large numbers of enemy prisoners of war captured by U.S. forces in the European theater. The bearing of these masses upon preventive medicine activities has been emphatically indicated. It is desirable now to examine some of the figures. During 1944, when the troubles were blamed more on deficient pre-invasion planning than on mere numbers of prisoners, the groups were fairly manageable. But after the Rhine had been crossed, early in 1945, the numbers of captives became almost overwhelming. A glance at the gross statistics, presented in table 22 and chart 7, is almost enough to disclose the entire story.

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TABLE 22.-German prisoners of war captured by U.S. forces, European Theater of Operations, U.S. Army, by months, June 1944-June 1945

From table 22 and chart 7, it is seen at once that the major captures, totaling 2,132,413 prisoners of war, were made by the First, Third, and Ninth U.S. Armies during March, April, and May 1945. These captures occurred during the swift campaigns identified, as follows:

First U.S. Army, from the Rhine to the Elbe; from Bonn to Torgau, including the double envelopment of the Ruhr in April: March (54,223), April (388,948), May (169,414). Total: 612,585.

Third U.S. Army, from the Rhine to the Danube; from Mainz, Germany, to Linz, Austria: March (136,926), April (236,724), May (90,698). Total: 464,348.

Ninth U.S. Army, from the Rhine to the Elbe; from Wesel to Magdeberg, including the double envelopment of the Ruhr in April: March (28,530), April (323,871), May (703,079). Total: 1,055,480.

A word should be said about the variance of the statistics of enemy prisoners of war captured in the European theater. Reports of the First,

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CHART 7.-German prisoners of war captured by U.S. forces, European Theater of Operations, U.S. Army, by months, June 1944 to June 1945

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Third, and Ninth U.S. Armies differ from those of the 12th Army Group,⁶⁶ of which they were the main components, while the statistics reported by Advance Section, Communications Zone, furnished by the Theater Provost Marshal, differ in detail and totals from the others. Even within an Army, the figures vary. For example, the Provost Marshal of the Third U.S. Army⁶⁷ reported that the total number of prisoners of war captured in the period from August 1944 to May 1945 was 636,529, the Theater Provost Marshal⁶⁸ reported 546,947, while in his General Orders No. 98, dated 9 May 1945, entitled `Soldiers of the Third Army, Past and Present,` General Patton stated, `Prior to the termination of active hostilities, you had captured in battle 956,000 enemy soldiers * * *.` Although the author spent much time examining various records in the attempts to reconcile these and other discrepancies, and although several explanations were furnished personally by former provost marshals, he was not able to discover all the reasons for the disparities. He came to the conclusion that corrected figures do not exist and that adjustments cannot be made from the available records. He concluded further that, for the purposes of this chapter, the magnitudes, which were real and confirmed by all eyewitnesses, are all that matter. Little would be gained for the comprehension of the medical and sanitary problems of such multitudes of prisoners of war by refinement of statistics to the point of numerical accuracy.

Sanitary and Preventive Medicine Problems Consequent

Upon Mass Captures

The inferences to be drawn regarding the problems of preventive medicine for enemy prisoners in the European theater are obvious. Their factual occurrence are matters of record, particularly in the writings of several preventive medicine officers, notably Col. John E. Gordon, MC,⁶⁹ Chief of the Division of Preventive Medicine, Office of the Chief Surgeon, European theater. Writing about the great difficulties that came with the last 3 months of the war, Colonel Gordon stated:

* * * The debacle overwhelmed many services of the Army * * * German soldiers surrendered by armies; hundreds of thousands within days. The facilities provided for receiving prisoners of war were wholly insufficient. * * * The enclosures for prisoners of war met their name. They were cages and little more. So great were the numbers that scarcely more than a pretext of proper care could be provided. Water supplies were alright as far as they went, but the amount of water available per man was hopelessly small. Messing equipment did not begin to go around and thousands ate out of tin cans discarded from the ration. Facilities for sterilizing kitchen equipment and mess

⁶⁶Report of Operations (Final After Action Report), 12th Army Group, vol. X, sec. V. pp. 212-250.

⁶⁷ See footnote 53 (1), p. 374.

⁶⁸ Operations History of the Advance Section, Communications Zone, ETOUSA, covering the period from initial organization, October 1943. to inactivation, 10 July 1945, app. E, p. 5, Prisoners of War Received by Months for the Operation 4 July 1944 to 30 June 1945. [Official record.]

⁶⁹ Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. I, pt. III, sec. 2, No. 1, pp. 18-19. [Official record.]

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gear were greatly overtaxed. Some cages were so crowded that the men scarcely had room to lie down and they slept in pup tents, improvised shelters, fox holes or in the open. The approaching warm weather led to an increase in flies, but never to the extent that would have existed without * * * DDT spray. The situation was further aggravated in [some] areas * * * by a series of unprecedented rains which turned the enclosures into a morass and the prisoners into shivering wretches. Dysentery was inevitable.

Water supplies.-Water supplies for the enclosures were obtained from wells, streams, and rivers. These were in better condition and the water was more thoroughly treated at the older enclosures than at the newer transient enclosures. At the transient enclosures, all water for drinking had to be heavily chlorinated, and this was done in Lyster bags when possible. It was not possible always to furnish completely treated water and chlorinated river water was frequently piped into the enclosures along the Rhine. At some enclosures (Remagen, for example), gasoline tank trucks, after some washing out, were filled with Rhine water and then driven around the barbed wire boundary of the camp, hour after hour, 18 hours a day, to fill barrels and drums from which the prisoners dipped water for drinking, for washing messkits, and for the care of bodily cleanliness, as specified by the Geneva Convention, which meant douching of the perineum after defecation. It was recorded that this part of the toilet was done by hand, usually, and that the contaminated hand was then rinsed in a barrel of water intended for drinking. Thus, waterborne enteric infection was promoted by the militarily created situation. Later, of course, when a quieter stage was reached, this abuse of sanitary rules was eliminated.

Disposal of urine and feces.-Within the enclosure, U.S. sanitary and medical officers supervised the construction, by German protected personnel, of various types of soakage pits and latrines for the disposal of urine and feces. In Advance Section, Communications Zone, these efforts were often frustrated. They were more successful in the more stable enclosures in base sections. In the crowded forward enclosures, thousands of prisoners of war afflicted with diarrhea and dysentery defecated on the ground profusely and randomly. Their deposits could not have been covered even if they had been provided with paddles and drilled in the Mosaic code of camp sanitation. Slit trenches were dug, but apparently many German prisoners did not understand the orientation required for their proper use. Instead of straddling a trench and depositing feces in the trough, they squatted on one edge and ejected bowel contents upon the opposite bank. All of this added to contamination of soil, utensils, persons, and food.

Similar deficiencies of sanitation occurred on vehicles used to transport prisoners of war along the lines of evacuation.

With reference to sanitation during evacuation of prisoners of war in the early months of the campaign, a decision that the Theater Provost Marshal was forced by circumstances to make may have had an inhibitory?

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effect. In July 1944, the Assistant Chief of Staff for Logistics, G-4, Advance Section, Communications Zone, received an opinion from the Provost Marshal that `prisoners retained [on the continent for labor] were entitled to certain privileges under the Geneva Convention which might be disregarded while prisoners were in evacuation channels.`⁷⁰ Evidence indicates that this was not an arbitrary decision by the Provost Marshal, Advance Section, Communications Zone. He was forced to render this decision by the unexpected and urgent demands for speedily making available German prisoners of war for the performance of labor, such as burial of the dead. At this time, provisions (personnel and facilities) for processing prisoners were lacking, and also, while they were in evacuation channels, they could not be housed, bathed, clothed, fed, or otherwise attended to as well as in established camps. As soon as possible, this state of affairs was corrected by Headquarters, European theater, and constant attempts were made to apply the terms of the Geneva Convention from the moment of capture.

Nutrition?

The maintenance of an adequate state of nutrition is an important element of a military preventive medicine program, whether it is to be applied to a belligerent`s own troops or to a belligerent`s captives. This fact was appreciated by the Offices of The Surgeon General and The Quartermaster General in Washington, and by the staffs of the Medical Department and the Quartermaster Corps in the European theater during the campaigns of 1944-45. It was well understood also that, in accordance with the terms of the Geneva Convention, the food rations for enemy prisoners of war should be equal in quantity and quality to those furnished U.S. troops at base camps.

Although these requirements were recognized, their fulfillment varied from adequate in 1944 to marginal and deficient in 1945 with a gradual improvement after July of that year. The deficiencies arose from a number of causes which have been mentioned in preceding parts of this chapter. In the period from March to the end of July 1945, the decrements were caused by (1) lack of planning for feeding the unexpectedly large numbers of rapidly captured prisoners of war, (2) the continuance of issue based upon troop strength, although there were many extra thousands to be fed prisoners of war, recovered Allied military personnel, and displaced persons, (3) food shortages in the United States and in the United Kingdom in 1945, which required reduction of food supplies for prisoners of war, (4) lack of mess gear and cooking equipment for prisoners of war- a secondary but important deficiency, since ability to serve food is second only to ability to supply food, and (5) inter-Allied dissatisfactions over

⁷⁰ Operations History of the Advance Section, Communications Zone, ETOUSA, covering the period from initial organization, October 1943, to inactivation, 10 July 1945, p. 238. [Official record.]

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food allowances for prisoners of war as compared to the more austere diets for civilians forced to live under conditions of scarcity of food.⁷¹

Information about rations for prisoners of war was summarized by Col. Wendell H. Griffith, SnC, Chief of the Nutritional Branch, Division of Preventive Medicine, Office of the Chief Surgeon, European theater, as follows:⁷²

* * * Prisoners captured in Normandy in 1944 [and held in the United Kingdom] * * * were issued a ration which did not differ greatly from that supplied American troops [balanced; 3612 calories]. No distinction was made in the rations for working and nonworking prisoners.

POW on the continent were issued a similar ration until 7 December 1944, except that nonworkers received 20% less than workers. At this time the worker`s ration was reduced from 3860 to 3258 calories; nonworkers received 10% less. Another reduction was made in April 1945. For the first time separate rations were authorized nonworkers because it was not feasible to make an overall percentage deduction in the worker`s ration to bring the caloric level down to the 2000 calorie level ordered by the Theater Commander for nonworkers. These ration decreases were the result of the disparity between tremendous numbers of captured prisoners and the relatively small stocks of available foodstuffs. Furthermore, the 2000 calorie ration was authorized as the theater ration for displaced persons and others whose subsistence was the responsibility of G-5 [Assistant Chief of Staff for Civil Affairs-Military Government, G-5, SHAEF]. The earlier rations supplied nonworkers were in accordance with the Geneva Convention and were in excess of the actual requirements of the prisoners. This original policy was bitterly criticized by allied civilians because nonworking prisoners had more to eat than allied workers. Following the German surrender in May 1945, practically all the prisoners held by the Armies inside of Germany were classified as `disarmed forces` and their subsistence became the responsibility of the civilian food administration. POW in the Communications Zone remained on the POW ration.

The components of POW rations were mostly Quartermaster supplies originally intended for use in the troop ration. The quality, therefore, was good. The method of preparation preferred by the Germans was the concoction of a stew containing nearly all of the ration components. This was fortunate because it was possible to issue dehydrated potatoes and vegetables, which served the purpose admirably and which were less acceptable in the troop ration. Captured enemy flour was used as long as it lasted.

In February and March 1945 the Nutrition Branch was directed to investigate the nutritional status of POW in American custody. The survey team * * * examined 800 prisoners in representative work camps and enclosures. The results showed that the nutrition of prisoners who had been in American hands for 50 days or more was satisfactory and considerably superior to that of newly captured Germans. This indicated

⁷¹ There are voluminous records and reports on these matters in the historical files of the Medical Department and the Quartermaster Corps. Two main groups of Quartermaster Corps materials in archival, manuscript, and published forms are listed here. The Medical Department reports will be cited separately. (1) Ross, William F., and Romanus, Charles F.: The Quartermaster Corps: Operations in the War Against Germany. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1965. (2) Littlejohn, Robert M., editor and compiler, Passing in Review. This highly important collection of documents and commentaries, assembled and written in part by the former Chief Quartermaster, European Theater of Operations, U.S. Army, is in manuscript form in the Office of the Chief of Military History, Department of the Army, Washington, D.C.

⁷² Griffith, Wendell H.: The Nutrition of Prisoners of War, Allied Nationals, and Others. In Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. II, pt. IV, pp. 41-45. [Official record.]

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that the POW ration in use during the early part of 1945 was superior to the ration of the German Army.

In August 1945 the Nutrition Branch was directed to make a second theater survey of the adequacy of the feeding of POW and of German disarmed forces. The 2000 calorie ration was found to be insufficient for German prisoners under 21 years of age and for others who were classed as nonworkers but whose caloric needs were significantly increased by fatigue duties, calisthenics or marching. The 2000 calorie ration was adequate for individuals who were inactive in fact. The German civilian ration issued to disarmed forces varied from 1200 to 1500 calories at that time and was inadequate. This was especially true because there was no opportunity for the men in the enclosures to supplement their rations as German civilians were able to do from gardens, household supplies, etc.

The two surveys referred to by Colonel Griffith were conducted in prisoner-of-war camps and enclosures in France, Germany, and Austria by Lt. Col. Herbert Pollack, MC, and his assistants, during April, May, and August 1945. The conditions found during April and May were essentially satisfactory. The survey made in August, however, disclosed evidence of very extensive malnutrition among prisoners of war and disarmed enemy elements in the large enclosures maintained by the Third and Seventh U.S. Armies and by the Communications Zone. There was a lack of uniformity in the ration scales in various areas, and the caloric scales averaged below 2,000. There was consistent evidence of insufficient amounts of riboflavin and nicotinic acid in the prisoner-of-war diet.

There were several factors responsible for the vitamin deficiency of the German prisoner-of-war ration. Colonel Pollack reported as follows:

Previous survey, * * * 15 May 1945, has shown that the standard German Army ration had been deficient in riboflavin and nicotinic acid for some time. Superimposed upon this deficiency intake of fairly long standing was the variable period of severe deprivation of all nutrients during the final weeks of active campaign and [of unavoidably inadequate rations] in the forward POW enclosures. At best, the POW ration could only be expected to maintain an existing state; it was never designed as a therapeutic diet.

Florid deficiency syndromes related to the B complex vitamins were evident in the non-workers subsisting on American rations. While there was evidence, of these deficiency syndromes in those prisoners subsisting on locally procured German food, it was not as marked as in the group subsisting on the American ration. It is believed that this difference is due to the usage of some highly milled unenriched flour in the American ration, which furnishes a large proportion of the energy value of the ration. The German ration included a 95% extraction [of] flour [which supplied many of the B vitamins].

On the other hand, rations were good in the overrun German-operated hospitals caring for sick and wounded German prisoners of war.

⁷⁸ (1) Letter, Lt. Col. Herbert Pollack, MC, Headquarters, Theater Service Forces, European Theater, Office of the Theater Chief Surgeon, to Chief, Preventive Medicine Division, Office of the Chief Surgeon, European Theater, 31 Aug. 1945, subject: Report of Nutritional Survey of German Prisoners of War and Disarmed Enemy Elements Under Control of the United States Army on the European Continent. (2) Pollack, Herbert: Nutritional Disorders. In Medical Department, United States Army. Internal Medicine in World War II. Volume III. Infectious Diseases and General Medicine. Washington: U.S. Government Printing Office, 1968.

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Increase in caloric value of prisoner-of-war rations.-The findings, and recommendations for increased caloric value of prisoner-of-war rations, as set forth in Colonel Pollack`s report (August 1945), had an immediate and beneficial effect. On 15 September 1945, Maj. Gen. Robert M. Littlejohn, Chief Quartermaster of the European theater, forwarded the report to the Deputy Chief of Staff, European theater,⁷⁴with this comment, among others: `From the attached report you will see that certain corrective action is immediately needed.` Thereafter, the caloric value of the prisoner-of-war ration for nonworkers was increased to 2,200 calories, and was held at 2,900 calories for workers.

Food shortages.-Authorities of U.S. occupying forces were well aware of the food shortages in Germany and Austria and also in U.S. supply after V-E Day. The nutritional state of civilians, displaced persons, prisoners of war, and disarmed enemy forces was, therefore, a matter of constant concern, as many reports attest. Nutritional surveys were made by teams of experts. One of these, undertaken upon instructions from the Surgeon, Headquarters, 12th Army Group, with the concurrences of the Surgeon, Third U.S. Army, and the Surgeon, 65th Infantry Division,⁷⁵ was carried out from 8 to 23 July 1945 under the direction of Dr. Charles S. Davidson, Consultant, Surgeon General`s Office, with two assistants. Among their investigations was a study of starvation in a group of men, disarmed forces (formerly prisoners of war), who had been held in an SS (Schutzstaffel (Elite Guard)) lager at Linz, Upper Austria, from 2 to 3 months, and used as laborers. The energy value of their diet varied from 650 to 850 calories-a starvation diet. These findings were reported to the Surgeon, 12th Army Group, and were published.⁷⁶

Feeding prisoners of war.-Experience with messing problems and nutritionally inadequate diets among prisoners of war because of lack of mess gear and cooking facilities pointed out the need for forethought and action regarding supplies, disciplining capturing troops in obedience to the Geneva Convention, and maintaining the interests of preventive medicine. Mess gear and water canteens are among the `effects and objects of personal use` which Article 6 of the convention specifies `shall remain in the possession of prisoners of war` (fig. 40) Through violations of this requirement, and through both thoughtlessness and misjudgment, mess gear and canteens were often taken from prisoners of war to their detriment and to the increase of the burden upon the detaining forces.

⁷⁴ Letter, Maj. Gen. Robert M. Littlejohn, Chief Quartermaster, Headquarters. Theater Service Forces, European Theater, Office of the Chief Quartermaster, to Brig. Gen. M. W. Gilland, Deputy Chief of Staff, Theater Service Forces, European Theater, 15 Sept. 1945, subject: Feeding and Care of Prisoners of War and Other Persons Under Military Custody of the United States.

⁷⁵ Hq., 65th Infantry Division, Office of the Surgeon, Report of Medical Department Activities in the 65th Infantry Division, January to June 1945.

⁷⁶(1) Letter, Maj. Harold L. Wilcke. SnC, Charles S. Davidson, M.D., Consultant, and Pvt. Philip J. Reiner, Technician, to Surgeon, Headquarters, 12th Army Group, U.S. Army, 24 July 1945, subject: Nutritional Survey of the Population of Linz, Oberdonau, Austria. (2) Davidson, C. S., Wilcke, H. L., and Reiner, P. J.: A Nutritional Survey of Starvation in a Group of Young Men. J. Lab. & Clin. Med. 31: 721-734, July 1946.

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FIGURE 40.-German prisoners of war in a mess line at a camp under the control of the Seventh U.S. Army, Sarrebourg, France, 10 January 1945. (U.S. Army photograph.)Admittedly, however, the lack of these implements and facilities was frequently caused by the fact that U.S. supply could not furnish them in the numbers needed. Whatever the reasons, numerous reports and photographs testify to those deprivations. The following is an example:

During the closing phase of the war, General Bradley received a message that a German corps commander wanted to surrender his entire corps. General Littlejohn, who was at dinner with General Bradley, recommended that the offer of surrender be declined unless the Germans brought in all their unit mess equipment, and also all individual mess gear, blankets, and bedding.⁷⁷

General Bradley told about the following episode:⁷⁸

The PW tally [on 14 April 1945] had now outrun our ability to keep daily count. In one cantonment alone we had caged 160,000. The feeding of these PWs and DPs exerted an additional strain upon our overburdened supply lines and we instructed Army commanders not to accept prisoners streaming westward from the Russians. When a few days later the 11th Panzer Division in Czechoslovakia sent word that it

⁷⁷ Ross, William F., and Romanus, Charles F.: The Quartermaster Corps: Operations in the War Against Germany. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1965, p. 731.

⁷⁸ Bradley, Omar N.: A Soldier`s Story. New York: Henry Holt & Co., 1951, pp. 544-545.

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wished to surrender to U.S. forces, we invited them to come in `but only if you bring your own kitchens and can take care of yourselves.`

Diseases Among Prisoners of War

It is not unusual that verifiable statistics of morbidity are an understatement of the amount of sickness occurring in a given place over a period of time. Certainly, this was true of the frequency of illnesses among German prisoners of war in the European theater during 1944-45. The statistics of diseases in this group are in terms of admissions to hospitals or dispensaries. It was well recognized, however, that in addition to those admitted to hospital there were many thousands among the hundreds of thousands remaining in the enclosures who were afflicted with acute attacks of diarrhea and dysentery. Casual reports of observers, lay as well as medical, support this estimate not only for enteric diseases, but also for acute respiratory tract diseases, malnutrition, and other disorders. The exact number of cases cannot be supplied; however, table 23 and the following tabulation on morbidity and mortality among German prisoners of war are informative and valuable as a basis for future planning of preventive medicine care for enemy prisoners.

During the period from September 1944 to the end of February 1945, there was a moderate amount of sickness among German prisoners of war in the enclosures in France and Belgium. This did not present any especially difficult problems. Beginning in March 1945, however, when the number of captives started to increase greatly and rapidly, overcrowding the compounds, sickness and death among prisoners increased importantly. Attention, therefore, will be given chiefly to the last 10 months of the war and a final 6-week period ending 15 June 1945, because the most reliable figures have been found in the records of those two periods.

For the 6-week period ending 15 June 1945, admissions and admission rates for diseases among prisoners of war in enclosures in Advance Section, Communications Zone, were greatly in excess of those in the U.S. Army in the same regions. In the enclosures during this period there were 345,324 admissions to hospital, giving a rate of 4,285 per 1,000 average strength. Among U.S. troops, there were 155,785 admissions, with a rate of 551. Among the German prisoners of war, there were 2,754 deaths from disease (34.2) and among U.S. troops there were 161 deaths (0.6). The admission rate for German prisoners of war was 7.8 times greater than for U.S. troops; the death rate from disease was 20.5 times greater than for U.S. troops. An average of 23 percent of all prisoners of war in Advance Section, Communications Zone, were seen at sick call each week.

Diarrhea and dysentery.-As Gordon has pointed out, the most seri-

⁷⁹ Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. I, pt. III, sec. 2, No. 1, table 14, and p. 19.

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TABLE 23.-Admissions for 23 selected causes among German prisoners of war i n enclosures, European Theater of Operations, U.S. Army, for 6-week period ending 15 June 1945

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ous problems were the diarrheas and bacillary dysenteries (chiefly Flexner types) which occurred among enemy prisoners of war in the enclosures on the continent of Europe. During 1944 and the first quarter of 1945, rates relatively low for these diseases among prisoners of war were about 10 times as great as those for U.S. troops. The high rate for December 1944, 185.4 per 1,000 prisoners per annum, was associated with the reception of large numbers captured in the Battle of the Bulge. The rates gradually dropped to 74.6 in April 1945. In May 1945, following the capture of many thousands of prisoners and their crowding in inadequate enclosures in bad weather under unsanitary conditions, 80,952 cases of diarrhea and dysentery were reported, raising the rate to 734.6 per 1,000. In June, 60,978 cases were reported, with a rate of 326.9 per 1,000. There were 833 deaths from diarrhea and dysentery among prisoners in the enclosures in Advance Section, Communications Zone, during the 6-week period ending 15 June 1945.

In a final comment on diarrhea and dysentery among prisoners of war in encloures, Philbrook and Gordon wrote:⁸⁰

Hospitals had been established to take care of seriously ill patients. As rapidly as possible, water supplies were increased, and messing and sanitary facilities were Improved. Before the end of May, remarkable accomplishments in prison-enclosure sanitation had been made. But dysentery had taken over with a speed greater than that necessary for the institution of proper preventive measures.

Typhoid and paratyphoid fevers.-The record of prisoners of war with respect to typhoid and paratyphoid fevers had been excellent during the early months of the campaign.⁸¹ The German Army was well immunized, but the protection provided by typhoid-paratyphoid immunization could not withstand the infectious assaults delivered by contaminated water and the foul conditions which existed in the enclosures when the avalanche of prisoners poured into them in May 1945. Among German prisoners of war from September 1944 through April 1945, there were only 11 cases of typhoid and 4 cases of paratyphoid. In May, there were 29 and 4 cases, respectively. Suddenly, in June 1945, there were 453 cases of typhoid and 412 cases of paratyphoid. Numerous cases among recently captured German soldiers indicated that infection had occurred at some of the forward collecting points. In the 6-week period ending 15 June 1945, there were 30 deaths from typhoid fever among 403,142 German prisoners of war in Advance Section, Communications Zone.⁸²

Diphtheria.-Diphtheria was prevalent in France, the Netherlands, and

⁸⁰ Philbrook, Frank R., and Gordon, John E.: Diarrhea and Dysentery. In Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts. Washington: U.S. Government Printing Office, 1958, p. 358.

⁸¹ Kuhns, Dwight M., and Learnard, Donald L.: Typhoid and Paratyphoid Fevers. In Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts. Washington: U.S. Government Printing Office, 1958, p. 477.

⁸² Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. I, pt. III, sec. 2, No. 3, pp. 1-11 and tables 1-6.

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Germany in 1941, throughout the war years, and afterward. It was not surprising, therefore, as Gordon⁸³ and McGuinness⁸⁴ have pointed out, that the incidence among U.S. troops, who were largely nonimmune, should have increased during the campaign on the Continent. During the first 6 months of 1945, 1,037 cases were reported in U.S. troops, with an overall rate of 0.76 per 1,000 per annum, rising to 1.05 for April. Among German prisoners of war, a smaller population, the number of cases (2,859) was double, and the rates greater by about 10 times those among U.S. troops. The carrier rate for diphtheria bacilli in some of the enclosures was exceedingly high. Diphtheria was a serious problem among German prisoners of war in enclosures on the continent of Europe.

While the war was coming to its end, it was recognized that the high incidence of diphtheria among German prisoners and civilians indicated that this disease was to become one of the major health hazards fOr the army of occupation after the war. With his usual foresight, Maj. Gen. Paul R. Hawley, Chief Surgeon, European theater, requested The Surgeon General to arrange for an investigation of problems of diphtheria in the military and civilian populations of the European theater. This investigation was carried out by Lt. Col. Aims C. McGuinness, MC, and Dr. J. Howard Mueller, representing the Army Epidemiological Board (formerly Board for the Investigation and Control of Influenza and Other Epidemic Diseases in the Army), during the period 19 June to 18 August 1945. The findings and conclusions will not be reviewed here. The later beneficial work is mentioned here because one stimulus for the undertaking was the experience with diphtheria among German prisoners of war.

Typhus fever (epidemic, louseborne) .-Under the direction of Colonel Gordon,⁸⁵and in part, the United States of America Typhus Commission, through the awareness of medical officers, and by the abundant use of DDT insecticide powder (fig. 41), typhus control was so intelligently and effectively carried out that the disease, which might have been catastrophic, was of minor significance among German prisoners of war in the European theater. Colonel Gordon reported, as follows:

The first confirmed typhus fever to appear among German prisoners of war was in March 1945 [at Remagen]. A large proportion of recently taken prisoners were found infested with lice, and very few had been vaccinated against typhus fever. Theoretically the conditions favored sizeable outbreaks, but because of the strict control under which prisoners were held, preventive measures [particularly mass delousing, however, as just noted] were more than usually effective.

The number of cases of typhus fever reported among German prisoners of war was 90: 3 in March, 21 in April, and 66 in May 1945. No

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⁸³ Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. I, Pt. III, sec. 4, p. 9 and tables 11 and 12.

⁸⁴ McGuinness, Aims C.: Diphtheria. In Medical Department, United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Ali. mentary Tracts. Washington: U.S. Government Printing Office, 1958, pp. 182-183.

⁸⁵ Gordon, John E.: A History of Preventive Medicine in the European Theater of Operations, U.S. Army, 1941-45, vol. I, pt. III, Sec. 5, No. 1, p. 46.

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FIGURE 41.-German prisoners of war captured by the Third U.S. Army delouse new arrivals at an enclosure near Stenay, France, by dusting them with DDT insecticide powder, 28 March 1945. (U.S. Army photograph.)

frank outbreaks of typhus fever occurred in any of the prisoner-of-war enclosures.

Nephritis (field or trench).-The incidence of acute nephritis was much higher among German prisoners of war than among American troops. The German medical officers were of the opinion that included in this group was a distinctive disease which they called `field nephritis` or `trench nephritis.` The disease was not reported in U.S. troops.

This type of nephritis among German prisoners of war was investigated by Col. Yale Kneeland, Jr., MC, Colonel Pollack, and Capt. Leonard Horn, MC.⁸⁶One difficulty was that trench nephritis had never been described as a clear-cut clinical entity. Nevertheless, German medical officers thought that they could distinguish it sufficiently. As a result of his serologic investigations, Colonel Kneeland concluded, in general, `that the thought among U.S. medical officers is toward glomerulonephritis of streptococcal origin.` This was in line with German opinion. Colonel Pollack and Captain Horn, on the other hand, concluded that: `The evidence suggests that there is a nutritional factor in the etiology of this syndrome. No specific nutrient has been implicated. The nutritional factor may be secondary and an infective agent may be the primary factor.`

⁸⁶ Essential Technical Medical Data, European Theater of Operations, U.S. Army, for June 1945, dated 13 Aug. 1945. Inclosure 16. 10 June 1945, subject: Report of Survey of Edema of Undetermined Etiology (`Trench Nephritis`); Inclosure 17, 20 June 1945, subject: Report on Acute Nephritis in Prisoners of War.

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Supervision of Captured Military Hospitals?

When German military hospitals were overrun, the patients in them became prisoners of war. Another responsibility which fell upon the victors was the supervision of sanitary matters and the medical and surgical care of the sick and wounded therein. Adequate consideration of these affairs is beyond the scope of this chapter, but mention of the problems is appropriate here because the consequent burden made it all the more difficult for personnel in combat to carry out a preventive medicine program for enemy prisoners of war. A vivid indication of these aspects of the work is given by the following personal communication from Colonel Coates, Deputy Surgeon, Third U.S. Army.

Indeed this became a heavy chore for the field armies. At one time (at the conclusion of the war), the Third U.S. Army was operating 144 captured hospitals filled with sick and wounded prisoner-of-war patients. As quickly as possible, men were discharged from the Army and hospitals. (SS troops of grade of corporal and above were the exception for some time.) Malingering by POW`s was a problem for a time. To deal with this required special judgment on the part of U.S. military personnel. Drugs, medicines, food, and sanitary materials (soap, etc.) had to be supplied by U.S. personnel. Captured goods were used where possible. But logistics was a problem, with transport critical very often. Because of heavy demands on MC officers elsewhere, it was not unusual for an MSC officer or high-ranking NCO to be in charge of a captured German hospital or group of hospitals.

Discharge and Disbandment of Enemy Forces

Although the terminal date for the official history of the Medical Department of the U.S. Army in World War II is 31 December 1945, the author of this chapter felt that it would be better to end it as of about 30 June 1945, after introducing accounts of a few episodes needed to complete bits of an ongoing record. Actually, after V-E Day, 8 May 1945, there were, technically speaking, no more German prisoners of war in the European theater. The remnants of the German Army were classed as surrendered military personnel or disarmed enemy forces (at no little strain upon provisions of the Geneva Convention). Although these people were discharged and disbanded as rapidly as possible, a year or more was required to complete the process, during which much of the misery in the enclosures, previously described, was repeated. Another volume of this history would be needed to record the events in the immediate aftermath of the war relative to former enemy prisoners of war.

Commenting on the disbandment of enemy forces, the Assistant Chief of Staff for Personnel, G-1, Third U.S. Army, stated:⁸⁷?

While the subject of disbandment of enemy forces is one of a post-hostilities nature, experience proved that grandiose plans for complete and orderly disbandment of a___

⁸⁷ After Action Report, Third U.S. Army, 1 August 1944-9 May 1945. Vol. II, Staff Section Reports; Part 2, G-1 Section. p. (G-1) 15.

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defeated enemy are useless when no semblance of enemy organization remains. Procedures prescribed and reports required for the disbandment of German disarmed forces proved highly impracticable in that they anticipated the complete utilization of the enemy army as an integral unit. Effective use was made of German individuals as interpreters, but German units as such were in most cases non-existent.

The disappearance of organized German units increased the difficulties of carrying on preventive medicine activities.

The European theater came to an end on 30 June 1945. It was succeeded by United States Forces, European Theater, with a Division of Preventive Medicine, whose chief was Col. Tom F. Whayne, MC, to take over from the Division of Preventive Medicine, European theater, and to deal with many complex problems.

Evaluation

One optimistic estimate and one considered accolade is quoted to uplift the preceding dreary narrative of the handling of enemy prisoners of war in the European theater during the victorious campaign of 1944-45.⁸⁸

In addition to being able to move huge tonnages in the last months [of the war], the logistic organization was in a much better position to meet the demand for specific items of supply. The U.S. Communications Zone was supporting 3,675,000 troops, plus 1,560,000 prisoners of war as hostilities came to an end early in May 1945. On the whole, supply of these forces was better than it had been at any time since the beginning of the pursuit in the summer of 1944.

In 1950, General Lucius D. Clay expressed a retrospective opinion with an appreciative and generally favorable assessment, as follows:⁸⁹

In looking back, I think that if we had then realized the confusion and chaos which existed we would indeed have thought ours a hopeless task. Certainly the authorities in Washington who had prepared our policy directive did not visualize these conditions. They did not know of the heavy burden performed so well under the circumstances by the Military Government teams which accompanied the combat troops and were engaged even before the surrender of Germany in re-creating some form of local administrative machinery at the city and county level and in re-establishing at least locally law, order, and public services.

* * * * * *

Food shortages made it more difficult and more important to take adequate measures to maintain public health for humanitarian reasons and to protect the health of the occupying forces. Bombed and partially destroyed cities, damaged water supplies, crowded dwellings, and hundreds of thousands of displaced persons, refugees, [disarmed enemy forces], and expellees leaving and arriving daily, created the conditions in which epidemics develop. Our Military Government teams [and the regular Medical Department organizations] were staffed with public health specialists under the able leadership of Major General Morrison C. Stayer, and their work was little short of miraculous.

⁸⁸ Ruppenthal, Roland G.: Logistical Support of the Armies. United States Army in World War II. The European Theater of Operations. Washington: U.S. Government Printing Office, 1959, Volume II, September 1944-May 1945, p. 433.

⁸⁹ Clay, Lucius D.: Decision in Germany. Garden City, N.Y.: Doubleday & Co., Inc., 1950, pp. 16, 272.

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THE PACIFIC AREAS

The problems of operating a program of preventive medicine for prisoners of war in the Pacific areas were smaller than they were in North Africa and Europe. Nevertheless, they were arduous and had special peculiarities. At times, these problems put a heavy burden upon personnel of the medical, provost marshal, quartermaster, and transportation services, and also upon combat troops used for guard and escort duties. The satisfaction of even the minimal needs Of the program taxed supplies in areas that often had barely enough for U.S. troops, operating in a region larger than the entire continental United States. Jungle warfare and tropical diseases created new and difficult conditions.

For the convenience of this account, these vast areas, shown in map 9, are divided into the following somewhat unorthodox sections:

1. The southern portion of the Pacific Ocean Areas (the Mariana, Marshall, Caroline, and Gilbert Islands), and the northern third of the South Pacific Area (the Solomon Islands, especially Guadalcanal), 1942 - 44.

2. New Guinea and adjacent islands (the Papuan Campaign, the long approach to the Philippines, and the landing on Leyte Island), 23 July 1942 - 17 October 1944.

3. The Philippine Islands (from the conquest of Leyte to the liberation of Luzon, and the succeeding 6 months), 17 October 1944 - 30 June 1945; 31 December 1945.

4. The Ryukus Campaign (Okinawa), 1: April - 14 August1945 (V-J Day), and official surrender of Japan, 2 September.

Guadalcanal

Only brief mention will be made of the scarcity of Japanese prisoners of war and the attitudes of soldiers, although many severe amphibious assaults and island battles were fought to destroy the Japanese forces. Thousands of troops were engaged, but few prisoners were taken. This characteristic of the first fighting persisted throughout the war against Japan until the general breakdown a few weeks before V-J Day in August 1945. The small numbers of the captures of Japanese prisoners of war is explained by the attitudes of the soldiers on both sides. The reason has been clearly stated by Miller⁹⁰ in his account of the Guadalcanal Campaign. During this campaign, which lasted from 7 August 1942 to 21 February 1943, very few Japanese prisoners were taken. Writing retrospectively, Miller has stated:

* * * Apparently the Japanese belief that it is dishonorable to surrender had led the imperial Army to neglect to instruct soldiers on what to do if captured * * * But

⁹⁰ Miller, John, Jr.: Guadalcanal: The First Offensive. United States Army in World War II. The War in the Pacific. Washington: U.S. Government Printing Office, 1949, p. 310.

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MAP 9.-Pacific Ocean Areas, Southwest Pacific Area, and a portion of the South Pacific Area (lower right corner), showing the approximate boundaries, 1942-45.

very few Japanese soldiers ever gave themselves up voluntarily. The American troops, who were fearful of the widely publicized treacherousness of the enemy, were reluctant to take prisoners, and the Japanese soldiery usually fought until they were killed rather than capitulate.

This is abundantly confirmed by comments in documents from the Pacific area.

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Papua

During the Papuan Campaign⁹¹ (23 July 1942 - 23 January 1943) , less than 100 Japanese soldiers were captured, and they were so debilitated by malnutrition, malaria, and neglected wounds that they were treated as hospital patients rather than as able-bodied prisoners. While extra surveillance was needed to make them eat, and to keep the stronger prisoners from kicking the weaker to death, no special provisions had to be made for preventive medicine for them. An episode described in a report of the 3d Portable Surgical Hospital,⁹²January 1943, at the end of the Buna Campaign, is typical:

We received eleven Japanese patients and about fifteen Chinese. One Jap * * * had a fulminating peritonitis and died in four days. The remaining cases were compound fractures and shrapnel wounds requiring debridement and reductions and casts. All of the Japanese had malaria and most of them had worms of one sort or another, usually ascaris. They were a terribly malnourished and debilitated lot. As patients they were uncooperative and surly, often refusing food or care. Eight of them were placed in one tent together. * * * The stronger ones at night would try to kick the weaker ones to death and had to be carefully watched.

Shortly after the end of the campaign in Papua, and at about the beginning of General Douglas MacArthur`s advance along the northern coast of New Guinea in the approach to the Philippines, two actions were taken by General Headquarters, Southwest Pacific Area, and General Headquarters, U.S. Army Forces in the Far East, that had an overall good influence upon the handling of Japanese prisoners of war. These were:

1. Detainment in Australia.-Early in 1943, the Commander in Chief, General Headquarters, made an agreement with the Australian Government providing that all prisoners of war captured by U.S. forces in the Southwest Pacific Area south of 5? north latitude would be detained in Australia. Such prisoners were thereafter evacuated to Australia and were administered by the Royal Australian Army`s Department of Prisoners of War. Compounds were established in healthy places, chiefly at Brisbane, where the Gaythorne Internment Camp was designated as the reception center for all prisoners of war entering Australia. As the detaining power, Australia maintained contact with the International Committee of the Red Cross, and made all reports required by the Geneva Convention, sending copies to the provost marshal of the area. This arrangement worked out well, except for an occurrence of violence at a prison camp in New South Wales in August 1944 when shackled prisoners and others not bound tried to break out of the barbed wire enclosure. Of these rioters, 200 were killed and 200 were wounded.

⁹¹Milner, Samuel: Victory in Papua. United States Army in World War II. The War in the Pacific. Washington: U.S. Government Printing Office, 1957.

⁹² Quarterly Report, Headquarters, 3d Portable Surgical Hospital, USASOS, 1 Jan. - 31 Mar. 1943, dated 1 July 1943.

⁹³ (1) Administrative History, Office of the Chief Provost Marshal, General Headquarters, U.S. Army Forces in the Pacific, 6 Apr. 1945 to 31 Dec. 1946. [Official record.1 (2) The Provost Marshal`s History, 1941-47. Campaigns in the Pacific. Chapter VI, Prisoner of War Operations.

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By August 1943, only 160 enemy prisoners of war had been held for the U.S. Army by Australian authorities. But this changed in the succeeding months. By the end of 1943, American-captured Japanese prisoners of war in Australian custody numbered 604, and by the beginning of the Philippine Campaign in October 1944, the number had risen to 4,435. These were chiefly enemy prisoners of war captured by the Sixth U.S. Army, under General Walter Krueger,⁹⁴during the advances in New Guinea and the Bismark Archipelago, as follows:

Arawe, Cape Gloucester, Saidor (15 Dec. 43 - 10 Feb. 44). . . . .367

Admiralty Islands (29 Feb. - 18 May 44). . . . . . . . . . . . . . . . . . . 124

Hollandia, Aitape, Tanahmerah (22 Apr - 25 Aug. 44) . . . . . . . . 819

Wadke and Biak Islands (17 May - 2 Sept. 44) . . . . . . . . . . . . . 835

Noemfoor Island (2 July - 31 Aug. 44) . . . . . . . . . . . . . . . . . . . . 889

Sansapor (30 July - 31 Aug. 44) . . . . . . . . . . . . . . . . . . . . . . . . .246

Morotai Island (15 Sept. - 4 Oct. 44). . . . . . . . . . . . . . . . . . . . . . 1

Total 3,281

Evacuation to Australia of Japanese prisoners of war captured by U.S. forces ended soon after the American landing on Leyte Island on 17 October 1944.

2. USAFFE Regulations No. 80-40.-On 30 May 1943, the Provost Marshal`s Office at General Headquarters, U.S. Forces in the Far East, secured the issuance of a broad and detailed regulation prescribing policy and procedures for dealing with enemy prisoners of war, `for the guidance of all concerned with custody and administration of prisoners of war and enemy alien civilian internees in areas under jurisdiction of this Headquarters.` The basic authorities cited were the Geneva Prisoner of War Convention of July 1929, the War Department prisoner-of-war circulars, and the pertinent technical manuals and Army regulations.

Philippine Islands

In the Philippine Islands Campaign, from Leyte⁹⁶ in 1944 to Luzon in 1945, U.S. Army forces provided facilities for the detention of Japanese prisoners of war, and hence had increased responsibilities for the program of preventive medicine for those prisoners. Numerous prison camps, large and small, were established, as the Sixth and Eighth U.S. Armies advanced on Leyte, Samar, Mindanao, Mindoro, and Luzon Islands (fig. 42). Medical and sanitary officers were detailed to these camps. All of the main prisoner-of-war camps included some type of hospital (station or evacuation)

⁹⁴ (1) Krueger, Walter: From Down Under to Nippon. The Story of Sixth Army in World War II. Washington: Combat Forces Press, 1953. (2) Smith, Robert Ross: The Approach to the Philippines. United States Army in World War II. The War in the Pacific. Washington: U.S. Government Printing Office, 1953.

⁹⁵ USAFFE Regulations No. 80 - 40, Processing Prisoners of War Captured by United States Forces and Disposition of Personal Effects of Enemy Dead, 20 May 1943, and final reissue as AFPAC Regulations No. 80 - 40, Prisoners of War and Enemy Alien Civilian Internees, 7 May 1946.

⁹⁶ Cannon, M. Hamlin: Leyte: The Return to the Philippines. United States Army in World War II. The War in the Pacific. Washington: U.S. Government Printing Office, 1954.

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FIGURE 42.-Japanese prisoners of war captured by the 38th Infantry Division in the mopping-up operation east of Manila, Philippine Islands, are detained in a barbed wire enclosure, 19 July 1945. (U.S. Army photograph.)

within the compound or enclosure in which were confined both able-bodied and sick and wounded prisoners.

The sanitary conditions and preventive medicine measures varied from poor in the early stages of shortages of personnel and facilities to satisfactory in the later stages when the entire public health situation in Manila and the islands was improved, notably through the intelligence and energy of Col. Maurice C. Pincoffs, MC, who in addition to many duties as Chief, Professional Services, and Chief Consultant in Medicine, directed the policies and activities of the Preventive Medicine Section, Office of the Chief Surgeon, U.S. Army Forces in the Far East, Southwest Pacific Area. As soon as possible after prisoners had been assembled at a camp, the requirements of Regulations No. 80-40 were applied faithfully. This was not easy to do, however, because of the extent of problems that could not be solved with the means at hand. In addition, among the captors there were impulses toward revenge and retaliation which tended to impede preventive medicine practices. It was clearly understood that the Geneva Convention and implementing rules required `decent treatment` of Japanese prisoners, no matter what stories were circulating of the?

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cruelty of Japanese masters. At the time when these prisoners in increasing numbers were coming into the custody of U.S. Army units, accounts of atrocities committed by the Japanese upon American prisoners of war in their hands became widespread. Reports of prison camps under U.S. administration, however, indicate that barbarism manifested by the enemy was met by strict adherence to humanitarian principles, and by constant efforts to raise the level of sanitation in the prison enclosures (fig. 43).

A few examples of the initial physical conditions of the Japanese prisoners of war are cited:

During April, May, and June 1945, at Old Bilibid Prison, New Bilibid Prison, and Iwahig Penal Colony, the rapid increase in prisoners of war confined in those places made it very difficult to maintain satisfactory sanitary standards. A high percentage of prisoners were found to be infected with malaria and dysentery; many showed extreme malnutrition. Malaria Control Units worked in the New Bilibid area and elsewhere to reduce the prevalence of flies and mosquitoes. Additional latrines were built. A sanitary officer was placed on duty at New Bilibid Prison to assist in the supervision of sanitation. In addition, sanitary inspections were made at Cavite, Leyte, Tarlac, and Pangasinan Provinces.⁹⁷

The prevalence of amebic and bacillary dysentery among prisoners of war at a camp near Manila overtaxed latrine facilities during July, August, and September 1945, causing a health hazard for the surrounding U.S. personnel as well as for the prisoners.⁹⁸

The poor nutritional state of Japanese prisoners of war taken in the Philippines in 1945 created serious difficulties for both hospitals and sanitary facilities. With regard to these nutritional disorders and their consequences, Pollack wrote,⁹⁹as follows:?

When the tide of battle had turned, with defeat after defeat f6r the Japanese In the Philippine Islands in the spring of 1945, these enemy troops, as evacuation from the islands presented difficulties, retreated into the hills back of Luzon, breaking up into small groups and living off the land. Owing to the hostility of the natives and the scarcity of eatable food in the mountains, these men suffered severe deprivation, particularly starvation phenomena. [The diet had furnished from 800 to 1,000 calories per day.] Coupled with this were the dysenteries, malaria, and other diseases indigenous to this part of the world-maladies that ordinarily deplete metabolic reserves of human beings.

After * * * 2 September 1945, these isolated Japanese troop units surrendered by the thousands to the U.S. Army. By early October, approximately 80,000 had been confined in New Bilibid Prison, Manila. Nearby was the 174th Station Hospital, a 250-bed installation. This hospital was burdened suddenly with the care of approximately 5,700 of these returned Japanese, many of whom were too ill even to move from their cots. It is reported that many died en route on the troop trains that brought the prisoners in. It was decided, as recommended by the Chief Surgeon, AFWESPAC (U.S.

⁹⁷ Headquarters, Military Police Command, AFWESPAC Office of the Surgeon, subject: Quarterly History of Medical Department Activities (April, May, and June 1945), dated 28 July 1945.

⁹⁸ Headquarters, 17th Station Hospital, Manila, subject: Quarterly Report for History of Medical Activities (July, August, and September 1945), dated 17 Oct. 1945.

⁹⁹ See footnote 73 (2), p. 391.

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FIGURE 43.-Japanese prisoner-of-war camp near Dagupan, Luzon, Philippine Islands, 24 February 1945. (U.S. Army photograph.)

Army Forces, Western Pacific), and by others, that a special study should be made of the clinical aspects of this severe malnutrition. [Ben-ben, both wet and dry types, was common.]?

During July, August, and September 1945, Japanese prisoners of war were received at `strong points` of the 129th Infantry Regiment and other units, as at Gonzaga, Capissayan, San Jose, Tuguegarao, Lal-Lo, and Aparri. At the time of surrender, they crowded in, bringing their diseases with them. Regimental surgeons and other officers inspected the stockades periodically to make sure that proper medical facilities were available and that a satisfactory state of camp sanitation was being maintained. Mimeographed Japanese translations of sanitary regulations were posted. These regulations `did not differ appreciably from the usual regulations in force in our own camps except that the importance of and the technique to be observed in maintaining good sanitation was more strongly emphasized.`¹⁰⁰

Toward the end of 1945, conditions in the prison camps and their associated hospitals had greatly improved. An inspection ordered by the Chief Surgeon, General Headquarters, U.S. Army Forces in the Pacific, Brig. Gen. Guy B. Denit, was made on 2 and 3 November 1945 at New

¹⁰⁰ Quarterly Report, Medical Detachment, 129th Infantry Regiment, SWPA, July, August, and September 1945.

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Bilibid Prison and Prisoner of War Camp No. 1 at Canlubang by Col. I. Ridgeway Trimble, MC, Consultant in Surgery, Lt. Col. Clarke H. Barnacle, MC, and Col. Albert R. Dreisbach, MC, chairman of this special committee. Their report¹⁰¹ included observations on the sanitary conditions of the camps as well as on medical and surgical care of the patients. Illustrated by snapshots of screened kitchens, well-built and screened latrines, and a variety of sanitary facilities, the report presented good evidence that a preventive medicine program for enemy prisoners of war was in effective operation on Luzon at this time,

Okinawa

During the 83 days (1 April-22 June 1945) of the costly conquest of Okinawa - the last battle of the U.S. Army in the war against Japan - 7,401 Japanese soldiers were captured by the Tenth U.S. Army. Of these prisoners, less than 4 a day were taken during the first 70 days. This number increased to more than 50 a day between 12 and 18 June. On 19 June, 343 enemy soldiers surrendered voluntarily, and on 20 June, 977 prisoners were taken. Mass surrender of the fanatical enemy soldiers occurred only during the last days of the fighting, when the remnants of the Japanese 32d Army were driven almost to the water`s edge in the southern point of the island-at Hill 89 near Mabuni and in pockets between Medeera and Makabe, Hill 85, on 22 June. This shortened the period of preventive medicine activities in relation to enemy prisoners of war, but the difficulties were considerable.

The authors of the volume Okinawa: The Last Battle¹⁰² have noted certain characteristics of the fighting which show how little need, or opportunity, there was for a preventive medicine program for enemy prisoners of war during that battle, as follows:

Nothing illustrates so well the great difference between the fighting in the Pacific and that in Europe as the small number of military prisoners taken on Okinawa. At the end of May the III Amphibious Corps had captured only 128 Japanese soldiers. At the same time, after two months of fighting in southern Okinawa, the four divisions of the XXIV Corps had taken only 90 military prisoners. The 77th Division, which had been in the center of the line from the last days of April through May, had taken only 9 during all that time. Most of the enemy taken prisoner either were badly wounded or were unconscious; they could not prevent capture or commit suicide before falling into American hands.

¹⁰¹ (1) Report, Col. Albert R. Dreisbach, MC, Col. I. Ridgeway Trimble, MC, and Lt. Col. Clarke H. Barnacle, MC, Office of the Chief Surgeon, General Headquarters, U.S. Army Forces in the Pacific, to Chief Surgeon, General Headquarters, U.S. Army Forces in the Pacific, 9 Nov. 1945, subject: To Determine and Report the Status of Medical Care Being Furnished Japanese Prisoners of War and Internee Patients at New Bilibid Prison and POW Camp #1 at Canlubarig. (2) Parsons, Wm. Barclay, Trimble, I. Ridgeway, and Eaton. George O.: Southwest Pacific Area. In Medical Department, United States Army. Surgery in World War II. Activities of Surgical Consultants. Volume II. Washington: U.S. Government Printing Office, 1964, pp. 687 - 765.

¹⁰² Appleman, Roy E., Burns, James M., Gugeler, Russell A., and Stevens, John: Okinawa: The Last Battle. United States Army in World War II. The War in the Pacific. Washington: U.S. Government Printing Office, 1948, p. 384.

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In the light of these prisoner figures there is no question as to the state of Japanese morale. The Japanese soldier fought until he was killed. There was only one kind of Japanese casualty-the dead. Those that were wounded either died of their wounds or returned to the front to be killed. The Japanese soldier gave his all. [There were 110,071 Japanese soldiers killed on Okinawa, as compared with 12,281 American soldiers, sailors, and marines killed.]

Disease conditions among Japanese troops and prisoners of war on Okinawa.-More than half of all the Japanese prisoners of war captured on Okinawa were sick or wounded, and most of them were undernourished, indicating conditions against which planning for a preventive medicine program for enemy prisoners of war in that region would have to be directed. As in the Philippines, the prisoner-of-war enclosures were a combination of. hospital and prison, about both of which the medical officers could speak with authority. One medical officer, Col. James B. Stapleton, MC, Surgeon, Okinawa Base Command, vividly described conditions in his report for the year 1945.¹⁰³ A few illustrative excerpts are quoted, as follows:

The unprecedented surrender of Japanese soldiers towards the close of the combat phase brought with it a proportionate increase in the number of Prisoner of War patients. This was not fully anticipated and special provisions for their hospitalization had to be made. On 30 June 1945, Island Command hospital units were treating 1,065 patients in their wards. The majority of patients were received in very poor physical condition in addition to the severity of their wounds. Approximately 75 percent suffered from partial starvation, dehydration and avitaminosis. The Japanese had been given no protective inoculations against tetanus and about fifty cases of tetanus were treated. None contracted tetanus after operations at our hospitals. * * * The first approach to mass surrender witnessed in the Pacific Theater gave some indication of the extensive medical care [and preventive medicine activities] which had to be provided for prisoners-of-war and enemy civilians as we entered the final phase of the war with Japan.

The 88th Field Hospital * * * was designated as the Prisoner of War Hospital for the Ryukyu Islands. Since it began operation in that capacity this hospital has treated over 3,000 Prisoners of War. The most trying period was the last week of June when it treated both American and Japanese patients. The days were spent in treating American casualties and the nights in caring for the Japanese. The latter patients were grossly infected; their bodies were unwashed and their wounds were filled with maggots. * * * The variety of lesions were legion: compound fractures, aneurysms, foreign bodies in every conceivable location, malnutrition, ben-ben, tetanus, osteomyelitis and empyema.

Colonel Stapleton continued with a description of some of the insanitary conditions discovered by malaria control units in former Japanese positions.

* * * One of the first special assignments which the unit [222d Malaria Survey Detachment] received was to survey the area around the town of Shun to determine the amount of work necessary to eliminate a fly hazard from the decaying bodies of Japs who had not yet been buried. One fly breeding place was discovered in the network of caves which ran under the castle of Shun. After one investigation it was decided that attempting to clean up these caves was too hazardous, and they were finally

¹⁰³ Headquarters, Okinawa Base Command, Office of the Surgeon, subject: Annual Medical History. 1945, dated 5 Jan. 1946.

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blasted shut to eliminate the nuisance. The filth encountered during the inspection was a vivid revelation of the unbelievable conditions under which the Jap troops defending Shun lived during the siege. One cave, which was explored for some hundreds of feet, was ankle deep in a fermenting, slimy mud which reeked of decaying rice and filth and from which myriads of tropical green-bottle flies (Chrysomyia megacephala) were emerging. This passage apparently had been the sleeping quarters of around two hundred soldiers. Upon emerging, our personnel had to dust themselves thoroughly with DDT insecticide to drive off hundreds of fleas (Pulex irritans-the human flea) which had gotten into their clothes in the caves. Yet the Japs lived in these underground barracks for weeks, and some were doubtlessly still hiding there since one was shot nearby the next night.

Risk of spread of filariasis from Okinawa by prisoners of war-During the period from April to the end of December 1945, surveys revealed that there was no schistosomiasis, no scrub typhus, and very little malaria on Okinawa. Among the natives, however, 30 percent were found to be infected with filaria (Wuchereria bancrofti). It was estimated later that a similar high incidence of filariasis existed among the Japanese prisoners of war captured on the island. As these prisoners, in considerable numbers, approximately 4,000, were transferred to Hawaii (Oahu) and to the continental United States, the possibility of the introduction of the disease into previously exempt areas, where the vector was present, became a matter of urgent concern. However, the danger was promptly eliminated by vigorous action on the part of Col. Arthur B. Welsh, MC, Acting Surgeon, Headquarters, U.S. Army Forces, Middle Pacific, in July 1945, and through vigorous support of The Surgeon General, as recommended by his Preventive Medicine Service.¹⁰⁴The shipment through Hawaii of prisoners of war known to have microfilariae in their blood was stopped, and previously detected cases were returned to islands in the Pacific where filariasis was endemic.

Japan

Fortunately, V-J Day (14 August) and the signing of the surrender agreement (2 September) saved the Army from enormous tasks that otherwise would have had to be carried out under combat exigencies. One of these would have been concerned with preventive medicine for enemy prisoners of war.

According to General Charles A. Willoughby`s account¹⁰⁵ of the situation, on the day of surrender, the Imperial Japanese Forces numbered 6,983,000. Of these, 2,576,085 were stationed on the home islands of Japan and the remainder were `spread in a great arc from Manchuria to the Solomons * * *` Although thousands of these Japanese were in the status of prisoners of war, having been taken into U.S. custody before the cessa-

¹⁰⁴ Letter, Col. Arthur B. Welsh, MC, Acting Surgeon, Headquarters, U.S. Army Forces, Middle Pacific, to The Surgeon General, 31 July 1945, subject: Filariasis in Okinawan Prisoners of War, with 1st indorsement, Office of The Surgeon General, to Assistant Chief of Staff, G-1, 14 Aug. 1945.

¹⁰⁵ Willoughby, Charles A., and Chamberlain, John: MacArthur, 1941-1951. New York: McGraw Hill Book Co., Inc., 1954, pp. 309-310.

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tion of hostilities, they and the forces on the home islands rapidly passed into the process of demobilization and repatriation. The landing of U.S. Army forces on Atsugi Airfield put in motion General MacArthur`s uncontested occupation of Japan. `By the tactful utilization and suitable modification of existing Japanese government organs [including military ministries and the high command], all Japanese armed forces in the homeland were physically disarmed by early December 1945. * * * By the middle of 1946, a total of about 2,170,000 Army and Navy personnel had been demobilized in the homeland and 3,880,000 [had been demobilized] on repatriation from overseas.` By the return of Japanese military personnel to civilian status, the enormous task of administering them as prisoners of war was obviated. There was no longer any need in Japan for a special program of preventive medicine for enemy prisoners of war. The problems and needs in that field were handled by the Public Health and Welfare Section, General Headquarters, Supreme Commander for the Allied Powers. As consideration of those affairs is properly placed in Volume VIII of the preventive medicine history series (Civil Affairs-Military Government Public Health Activities), it is not discussed in this chapter.

In his final evaluations of activities in the Pacific areas, the Provost Marshal made the following comments:

In general, prisoner of war camps were operated in the same manner as other military establishments. * * * Generally, sanitary conditions and health of prisoners were excellent. However, due to the physical conditions of many prisoners upon capture or surrender their hospitalization at times developed into major problems. Medical facilities were provided at all camps, but because of the advanced conditions of wounds, malnutrition and tropical diseases, favorable reaction to treatment was not always possible and a high death rate resulted. Prisoners who survived after three weeks of capture rapidly recovered from their conditions.¹⁰⁶

During the period covered in this narrative [April 1945-December 1946], approximately 270,000 prisoners of war were taken into custody, processed, and repatriated. * * * During the International Prisoner of War Committee meeting at Geneva early in 1947, there was no adverse comment of criticism or censure of this theater in the handling of prisoners of war during World War II.¹⁰⁷

CONTINENTAL UNITED STATES

Camps for Enemy Prisoners of War

To relieve the theaters of operations of a part of the burden of custody of enemy prisoners of war, and to provide a supplemental labor force, decision was made by highest authority, early in 1942, to intern within the continental United States numbers of captured German, Italian, and Japanese soldiers, including military medical personnel and other specialists, who would be utilized for work under the general supervision of the

¹⁰⁶ The Provost Marshal`s History, 1941-47. Campaigns in the Pacific. Chapter VI, Prisoner of War Operations, pp. 21-22.

¹⁰⁷ Administrative History, Office of the Chief Provost Marshal, General Headquarters, U.S. Army Forces in the Pacific, 6 Apr. 1945 to 31 Dec. 1946, p. 27. [Official record.]

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War Department. The importation of the prisoners began in May 1942. During that year, the numbers were small. They rose to a total peak of 425,871 in May 1945, of which 371,683 were German, 50,273 Italian, and 3,915 Japanese. While the German component decreased steadily in the succeeding months, entries and discharges affected the others differently. The Italian peak of 50,571 had been reached in February 1945, and the largest number of Japanese, 5,413, was attained in August 1945. After these peak dates, the number of prisoners of war interned in the United States decreased by discharge and repatriation until 30 June 1946, when the only ones remaining were 141 German, 20 Italian, and 1 Japanese serving sentences in U.S. penal institutions.

For the accommodation, care, and guarding of these prisoners, there were, by April 1945, 150 base camps located at or near Army posts, and 340 branch camps-all located in various sections of the United States. The camp varied in capacity from 250 to 3,000 men and served military, agricultural, and industrial needs.

The operation was unprecedented. The problems were new and urgent, and there was no previous experience upon which to draw for their solution. Never before had the United States brought prisoners of war in such numbers into its own territory. Never before in the history of warfare had prisoners been transported in such numbers across such long distances, by sea and air, to the homeland of a nation which was waging a vast war in foreign lands. The operation involved almost every main division and service under the War Department and Army organizations, at home and overseas. As it had public, political, economic, legal, financial, ethical, medical, national, and international aspects, it involved most of the departments and offices of the U.S. Government and a number of State governments. Even a simple listing of these relationships would exceed the scope of this chapter. Therefore, recourse must be made to other writings on the subject. For comprehensive accounts which, however, contain little about preventive medicine, the reader is referred to other sources.¹⁰⁸

Selected Features of Administration?

All the camps were under U.S. Army authority and were administered through various Army organizations, such as service commands; posts, camps, and stations; hospitals; and miscellaneous military units. There were appropriate channels of communication to the Office of The Provost Marshal General, the Offices of the Chiefs of Technical Services, and finally

¹⁰⁸ (1) Lewis, George G., and Mewha, John: History of Prisoner of War Utilization by the United States Army, 1776-1945. Department of the Army Pamphlet No. 20-213, 24 June 1955. (2) Mason, John Brown: German Prisoners of War in the United States. Am. J. of International Law 39: 198-215, 1945. (3) Report No. 1992, Investigations of the National War Effort, Committee on Military Affairs, House of Representatives, 78th Congress, 2d Session, 30 November 1944. Washington: U.S. Government Printing Office. 1944. (4) Historical Monograph, Prisoner of War Operations Division, Office of The Provost Marshal General, 1945. [Official record.] (5) Juchli, Rene H.: Record of Events in the Treatment of Prisoners of War. World War II, September 1945. [Official record.]

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to the Headquarters of the Army Service Forces and the War Department, especially the Office of the Assistant Chief of Staff for Personnel, G-1.

When medical affairs required central direction, they were handled in various divisions of the Surgeon General`s Office. Those divisions most directly concerned were Preventive Medicine, Operations, Supply, and Hospitalization. Although no single division in the Office of The Surgeon General was charged with overall responsibility for this operation, a specially created Prisoner of War Liaison Unit dealt broadly with many medical matters relating to inspections, sanitary supervision, repatriation, and the activities of the Mixed Medical Commissions. This unit, established on 16 July 1943 under the Operations Service, provided for liaison between the Office of The Surgeon General and the Office of The Provost Marshal General. Later, when it was located in the Office of The Provost Marshal General, it was named the Medical Liaison Branch. The unit consisted of a chief (Lt. Col. Rene H. Juchli, MC), an executive officer, a medical certifying officer, and U.S. members of the Mixed Medical Commissions. Its service was beneficial and brilliant.

The administrative and professional arrangements included extensive provisions for hospitalization.¹⁰⁹Medical and surgical care was provided in abundance in dispensaries and in hospitals of various types and sizes, staffed by both U.S. Army doctors, nurses, technicians, and attendants, and protected medical personnel drawn from Italian and German prisoners of war. In addition to the customary functions of hospitalization, these arrangements played an important role in preventive medicine by providing for diagnostic studies, isolation of patients with infectious diseases, and by curing the sick, thus through therapy preventing the spread of communicable disease.

Control of Communicable Diseases

Commanding officers of prisoner-of-war camps in the United States were charged with initiating and enforcing all sanitary and preventive measures necessary to protect and safeguard the health of prisoners of war, the attending military personnel, and the surrounding civilian population. Preventive medicine for enemy prisoners of war interned in the United States included attention to all the features specified in the Geneva Convention of 27 July 1929, and the implementing War Department circulars, technical manuals, and Army regulations that have been referred to and summarized in the first portions of this chapter. In accordance, however, with the ordinary conception of preventive medicine, the chief emphasis was placed upon the control of communicable diseases among the prisoners. There were four objectives:

¹⁰⁹ (1) McGibony, James T.: Hospitalization, Evacuation and Disposition of Prisoner of War Patients in the United States, 1946. [Official record.] (2) Smith, Clarence McKittrick: The Medical Department: Hospitalization and Evacuation, Zone of the Interior. United States Army in World War II. The Technical Services. Washington: U.S. Government Printing Office, 1956.

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1. Prevention of the introduction of communicable disease into the United States by infected prisoners of war.

2. Protection of persons having contact with prisoners directly or indirectly in communities adjacent to their camps.

3. Protection and maintenance of the health of the prisoners.

4. Prevention of transmission of infectious disease abroad by repatriated prisoners.

Although these objectives overlap somewhat, to the extent that the accomplishment of one might assist the attainment of another, examples of several of the activities will be presented briefly.

The communicable diseases against which special measures were taken to prevent their introduction into the United States by prisoners of war were specified in the quarantine regulations of the U.S. Public Health Service and the policies promulgated in the Army Foreign Quarantine Program,¹¹⁰ as developed in the Quarantine Branch, Preventive Medicine Service, Surgeon General`s Office. Among these, smallpox, malaria, filariasis, schistosomiasis, the typhus fevers, and enteric infections (especially the dysenteries), were considered to be the most important. Yellow fever, plague, cholera, and leprosy were regarded as of secondary importance.

The first guard was raised, of course, by medical inspection of prisoners of war at the time of their embarkation abroad and at the ports of debarkation in the United States. If found to have suspicious illness, the affected prisoner was isolated in a hospital.

Although there was a requirement that prisoners should be deloused before shipment, the rule was often not observed. Many prisoners were found to be infested with lice when they arrived at U.S. ports. All prisoners and their effects, therefore, were disinfested at the port of debarkation. In 1942-43, methyl bromide gas liberated in special wooden chambers was used for the disinfestation of clothing and other articles. The early apparatus, however, was defective, and steam treatment was employed instead.¹¹¹ Later, DDT insecticide powder was dusted on clothing, as on persons, to get rid of lice. By repeated applications of DDT insecticide powder, lousiness of prisoners of war in the camps was kept at a low incidence. Eleven cases of epidemic typhus developed in newly received prisoners, but no spread occurred; and there were no outbreaks of fleaborne endemic typhus. Four prisoners of war were found to have leprosy.

At ports of debarkation, prisoners of war were vaccinated against smallpox and injected with typhoid-paratyphoid vaccine.

The threat of the introduction of filariasis into Hawaii and the United States by Japanese prisoners of war from Okinawa has been discussed earlier (p. 410). The risk was obviated by stopping the importation of

¹¹⁰ Knies, Philip T.: Foreign Quarantine. In Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 271-324.

¹¹¹ Wheeler, William Reginald: The Road to Victory. A History of Hampton Roads Port of Embarkation in World War II. New Haven: Yale University Press, 1946, 2 vols.

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infected prisoners and by deportation to Pacific areas of endemic filariasis in prisoners found by blood examinations to be harboring microfilariae. No known spread of filariasis from this source occurred in either Hawaii or the United States.

Many Italian and German prisoners of war, and numerous Japanese, were found to be infected with malarial parasites. As the Japanese were interned in Wisconsin and other areas that were free from anopheline vectors, they were not a malarial danger. Thousands of Italians and Germans, however, infected with malaria, were interned in camps in the Southern States, in locations in which they could be sources of spread of the infection to the extra-cantonment populations. This danger, recognized in 1943, was the subject of a memorandum issued from Headquarters, Army Service Forces, on the recommendation of the Preventive Medicine Service.¹¹²

Col. William A. Hardenbergh, SnC,¹⁰³Chief, Sanitary Engineering Division, Preventive Medicine Service, has published a succinct statement of the measures taken to prevent the spread of malaria from camps in which malarial prisoners of war captured in North Africa, Sicily, and Italy, were held. He wrote, as follows:?

* * * When these prisoners were established in branch camps, the dual problem arose of protecting both the local populations and the prisoners against malaria. Because branch camps were often established on short notice, perhaps in the middle of the mosquito season, and sometimes in highly malarious areas, it was not considered feasible or possible to conduct mosquito control measures. * * * Therefore special emphasis was placed on surveys of proposed campsites to avoid the most unfavorable locations, and on strict enforcement of malaria discipline among prisoners.

Details of the numerous, standard, control measures are given in the remainder of Colonel Hardenbergh`s section on `Prisoners of War` in the cited publication.

Examples of special efforts. to protect prisoners of war from infections impinging upon them from the external environment in one situation and from the internal environment in another are the occurrence of coccidioidomycosis in the prisoner-of-war camp at Florence, Ariz., and at the prisoner-of-war base, Camp Cooke, Calif., and the presence of carriers of dysentery bacilli among German prisoners of war at Camp Hood, Tex. In both instances, after reports had been received in the Preventive Medicine Service, special investigations were made and control measures instituted through the Army Epidemiological Board. The problems of the recognition and control of coccidioidomycosis, coming from the external environment of the prisoner-of-war camps, were dealt with effectively by Dr. Charles

¹¹² War Department, Headquarters, Army Service Forces, Memorandum No. S40-10-43, Malaria Among Prisoners of War, 19 June 1943.

¹¹³ Hardenbergh, William A.: Control of Insects. In Medical Department, United States Army. Preventive Medicine in World War II. Volume II. Environmental Hygiene. Washington: U.S. Government Printing Office, 1955, pp. 179 - 232, esp. p. 200.?

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Edward Smith,¹¹⁴Director of the Commission on Epidemiological Survey. The problems of recognition of dysentery carriers and of the control of outbreaks of bacillary dysentery, spread in an internal environment by infected prisoners, were worked out well by Dr. Carl TenBroeck¹¹⁵of the Commission on Tropical Diseases.

For the prevention of the transmission of communicable diseases by repatriates returning to their homes, every effort was made to be sure that the individuals had clean bills of health, or if ill, as possibly with tuberculosis, were placed under hygienic control.

Food and Nutrition

Some prisoners of war interned in the United States complained about their food, as any soldier would, and as foreigners are apt to do because even good alien food may not be acceptable to their tastes. These complaints, however, were not serious and did not indicate nutritional deficiencies. Reported nutritional surveys were made, particularly during 1945, at the instigation of The Surgeon General, The Provost Marshal General, and The Quartermaster General, to ascertain whether the program for feeding prisoners of war was sound. In general, it was found that approved allowances provided balanced diets having caloric values ranging from 2,800 calories for prisoners engaged in sedentary activities to 4,300 calories for maximum labor. This was a satisfactory feeding regime. Indeed, the feeding of interned prisoners of war, together with their housing and provision for their other needs, was generally regarded as a credit to the good name of the United States.¹¹⁶

Health of Prisoners of War in the United States

During 1945, the typical year, the health of prisoners of war in camps in the United States was quite as good, and sometimes better, than that of U.S. Army personnel in the same region. For all diseases, the rate for U.S. Army troops was 563 per 1,000 per annum and 480 for prisoners of war. The incidence of respiratory diseases among prisoners was less than among U.S. Army troops. Injury admissions for prisoners were almost 50 percent higher than those for U.S. troops, apparently due to work details of prisoners involving greater exposure to relatively minor injuries as well as very vigorous participation in athletics. On the other hand, `death rates for prisoners was less than a third of the corresponding rates for U.S. troops. However, about three-quarters of the deaths among U.S. Army troops were

¹¹⁴ Smith, Charles Edward: Coccidioidomycosis. In Medical United States Army. Preventive Medicine in World War II. Volume IV. Communicable Diseases Transmitted Chiefly Through Respiratory and Alimentary Tracts. Washington: U.S. Government Printing Office, 1958, pp. 285-316.

¹¹⁵TenBroeck, Carl: Report on Dysentery Carriers Among German Prisoners. The Rockefeller Institute for Medical Research, Princeton, N.J., 10 Jan 1944. [Official record.]

¹¹⁶ Annual Report. Preventive Medicine Service, Office of The Surgeon General, for Fiscal Year 1945, section XIII, Nutrition Division.

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the result of aviation and automobile accidents, hazards to which prisoners are obviously not exposed.`¹¹⁷

CONCLUSION

The foregoing pages have presented an account of preventive medicine for enemy prisoners of war captured by U.S. Army forces in each of the main theaters or areas during World War II. The extraordinary events of the war were unprecedented in the experience of those forces. In the handling of prisoners of war and related groups, masses of humanity and swiftness of developments were unanticipated determinants of conditions and problems. In this chapter, the attempt has been made to describe the resultant situations, and to analyze and evaluate them, with special reference to old and novel features of preventive medicine.

In addition to the hundreds of thousands of enemy prisoners of war in U.S. custody in 1945, there were more hundreds of thousands of persons in states of destitution and in need of care by the military in the European theater. These people were recovered Allied military personnel, displaced persons, and refugees. In attempting to return them to their homes or countries, all of these persons had to be moved on foot or transported in vehicles, fed, sheltered, supervised medically, and controlled hygienically, to whatever extent was possible. These groups of people added greatly to the burdens and complexities of the task that had to be performed by the victorious troops-still fighting during part of the time. Although the problems of handling these groups were similar to those of handling enemy prisoners of war, and were solved by applying similar principles, they were considered only secondarily in this chapter.

It was the intention of the U.S. custodians of captured enemy military personnel to live up to the humane, mutually advantageous, and legal provisions of the Geneva Conventions of 1929. In large measure, this was done. Often, however, circumstances made observance impossible. Occasionally, the requirements and spirit of the two conventions were willfully violated or neglected through ignorance or carelessness. Enormous problems had to be solved as quickly as possible. In the midst of devastation and disorder resulting from swiftly evolving continental campaigns and from vast battles whose compressive power herded together populations of captives, the burdens had to be carried by organizations that lacked personnel, performed in confusion, and were impeded by shortages of transportation, supplies, and facilities. Indeed, the Geneva Convention itself allows for such derogations as might be rendered inevitable by the conditions of capture, and commentators have concurred in the view that impossibility of performance is an acceptable excuse for noncompliance.

¹¹⁷ (1) Monthly Progress Report, Army Service Forces, War Department, 28 Feb. 1945, Section 7: Health, p. 15. (2) Health of Prisoners of War. Army M. Bull. No. 88, pp. 61-62, May 1945.

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Advance planning was deficient. This was largely due to inexperience, lack of foresight, and to the occurrence of unanticipated situations which showed that many of the untried provisions of the Geneva Prisoners of War Convention of 1929 were not applicable to the unprecedented developments that erupted during the years 1942-45. Although good instructions were issued at the start, they were slow in getting to the front, and many had to be revised or supplemented as the war progressed.

Considerable morbidity and mortality, discomfort and misery, afflicted the hordes of captives crowded in enclosures. But no serious epidemics of disease occurred, except the ever-present diarrheas and dysenteries, which were spread and intensified by conditions in the prison camps. The dreadful state of affairs in a number of the enemy prisoner-of-war enclosures along the Rhine were not wittingly devised by the captors; they were forced into occurrence by the enormous successes of the Armies. This was so particularly during the last months of the war in the European theater where forces under the command of General Eisenhower were reaching the objective, which had been given him by the Combined Chiefs of Staff on 12 February 1944, to `enter the continent of Europe and, in conjunction with the other United Nations, undertake operations aimed at the heart of Germany and the destruction of her armed forces.`