CHAPTER XI
The Northern Apennines
By the middle of August 1944, when the lightning thrust into southern France was being launched, the Allied armies in Italy were halted on the south bank of the Arno River and along the Metauro on the Adriatic. The U.S. Fifth and British Eighth Armies had outrun their supplies; troops were exhausted after three months of continuous fighting; and the effective strength of Fifth Army had been more than halved to build the military power that would enable Lt. Gen. Alexander M. Patch to sweep from the Riviera beaches to the Moselle River in a months time. Yet the strongest German positions in Italy still lay ahead, blocking access to the rich Po Valley, whose agricultural and industrial products continued to feed the German war machine despite repeated sorties by Allied bombers.
Preparations for the Offensive Allied Armies at the Arno Line
The Military Situation- When General Alexander halted the Allied Armies for rest and regrouping at the Arno line, Eighth Army, with sixteen divisions, held four-fifths of the front, from the junction of the Elsa and Arno Rivers about twenty miles west of Florence to the Adriatic coast at the mouth of the Metauro River. Fifth Army, with a total of five divisions, heldt he sector running west from the Elsa along the south bank of the Arno to the Ligurian Sea about ten miles north of Leghorn.1
In the Fifth Army area, IV Corps, commanded by General Crittenberger, held about thirty miles of the river line from the mouth of the Arno east to the village of Capanne. Task Force 45, composed of the 45th Antiaircraft Artillery Brigade and attached troops, was on the left, or seaward flank; the 1st Armored Division, reorganized and reduced to about two-thirds of its former strength, was on the right. The 34th Division and the 442d Regimental Combat Team were in army reserve in rest areas south of Leghorn. The 5-mile front from Capanneto the Eighth Army boundary was held by II Corps, commanded by General Keyes, with only one RCT of the 91st Division in the line. The 85th and 88th Divisions were in corps reserve, in bivouac north of Volterra.
Until the port of Leghorn could be restored, Fifth Army supplies had to be unloaded at Civitavecchia or Piombino and trucked up to 50 miles over battle-damaged highways. The supply situation would be difficult, even after reconstruction of port facilities in Leghorn, as long as the enemy held the Arno plain and
1 Principal sources for this Section are: (1) Fifth Army History, pt. VII, The Gothic Line(Washington [1947]); (2) Opns Rpt, II Corps, Aug 44; (3)Opns Rpt, IV Corps, Aug 44; (4) Clark, Calculated Risk, pp. 389-94.
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remained within artillery range of the only good lateral road south of the river, Highway 67. The enemy, on the other hand, controlled an excellent road network for the movement of troops and supplies in the Po Valley, behind his strongly fortified Gothic Line.
The northern Apennines form a rugged mountain barrier about 50 miles wide, extending northwest from the Adriatic Sea across the peninsula, and studded with peaks of 3,000 feet to well above 6,000 feet. The northern slopes are relatively easy grades, but the southern slopes, which then faced the Allied armies, are steep and difficult. The Gothic Line, begun as early as the winter of 1943-44 when Fifth Army was stalled before Cassino, lay generally just south of the watershed dividing the streams flowing south to the Arno from those flowing north to the Po. The line was anchored on the Ligurian Sea in the vicinity of Massa where the coastal plain was only 2 or 3 miles wide, and extended roughly 170 miles southeast to Pesaro on the Adriatic.
Highways across the mountains were few and tortuous, the best of them being Highway 65, the most direct route from Florence to Bologna, a distance of about seventy miles. Though there were many sharp curves, the road was paved and the grades were less steep than those on Highway 64, a few miles farther west. Highways 6524 and 6521, somewhat east of 65, were secondary roads, often narrow and always steep and winding. The relative scarcity of roads made it possible for the Germans to concentrate their defenses, the strongpoints being astride the highways and connected by a series of dug-in gun emplacements, log and concrete bunkers, and fortified trenches.
The weakest point, topographically, in the Gothic Line was Futa Pass, where Highway 65 crossed the divide at an elevation of only 2,962 feet. The strongest fortifications were at this point, running southeast to Il Giogo Pass on Highway 6524.
Fifth Army Medical Support- Medical facilities had been stripped down even more than the army as a whole by the demands of the campaign in southern France. At the army level, General Martin, Fifth Army surgeon, had at his disposal two medical battalions, the 161st and 162d; the 32d and 33d Field Hospitals; 2 400-bed evacuation hospitals, the 15th and 94th; 4 750-bed evacuation hospitals, the 8th, 16th, 38th, and 56th; the 3d Convalescent Hospital; the 2d Auxiliary Surgical Group, with 14
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teams on temporary duty from general hospitals in the theater only partially replacing the twenty-eight teams withdrawn for service with Seventh Army; the 2d Medical Laboratory; the 12th Medical Depot Company; and miscellaneous minor units. Even to support the divisions composing Fifth Army as of 16 August 1944, these medical units were inadequate, particularly so in 400-bed evacuation hospitals, which had previously been assigned in the ratio of at least one to each combat division. Task Force 45, moreover, had no organic medical support other than the medical detachments of its component units; the 92d Division and the Brazilian Expeditionary Force, both on the way to the combat zone, were without hospitals.2 At the corps and division levels, medical support remained substantially as it had been in earlier Fifth Army campaigns. Each of the two corps had a medical battalion assigned, the 54th to II Corps and the 163d to IV Corps; and each combat division had its own organic medical battalion. The Brazilian medical organization at the division level was substantially the same as the American.
The 109th Medical Battalion, organic to the 34th Division, received an unexpected but welcome visitor on 13 August when Capt. Francis Gallo of Company C walked into battalion headquarters. Captain Gallo had been captured in the Kasserine breakthrough of February 1943. He had escaped after more than seven months in German prison camps, and for almost a year had been serving with a band of Italian partisans in the Florence area.
As of 16 August, divisional and corps medical units were with their respective combat elements, taking advantage of the lull to rest personnel and re-equip. Fifth Army hospitals were disposed in a roughly quadrangular area whose corners were Cecina and Leghorn on the coast and Volterra and Peccioli about twenty miles inland. All were in operation except the 16th Evacuation Hospital, which had closed at Ardenza just south of Leghorn on 12 August but had not yet moved elsewhere.
Mounting the Attack
Planning and Regrouping- Plans developed during July called for an early resumption of the offensive, with Fifth Army launching the main attack on the Gothic Line by way of Highway 65. The strength of the enemy positions in the Futa Pass area, however, led General Alexander to shift the main attack to the Eighth Army front, where a flanking movement along the Adriatic offered promise of quicker results. It was anticipated that Generalfeld marschall Albert Kesselring would have to concentrate the bulk of his forces against Eighth Army. Fifth Army would then attack along the axis of Highway 6524 toward Il Giogo Pass. The success of the operation depended on co-ordination and timing.
By way of preparation, the boundary between Fifth and Eighth Armies was redrawn twenty miles east of Florence, and 13 Corps, which had held Eighth
2 Sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944; (2) Annual Rpt, Surg, II Corps, 1944; (3) Annual Rpt, Surg, IV Corps, 1944; (4) Unit rpts of med units mentioned in the text. The Brazilian Expeditionary Force brought its own medical officers, nurses, and enlisted technicians, who were attached to U.S. hospitals. See pp. 439, 440-41, below.
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Army`s left flank, was transferred to Fifth Army. The 13 Corps left boundary was shifted east to pass through Florence, and II Corps, which was to spearhead the Fifth Army attack, was concentrated along a 5-mile front west of the city. IV Corps, which was to perform a holding function, occupied the remainder of the Fifth Army front extending some forty miles from the II Corps boundary to the sea.
Regrouping for the assault brought the 34th Division and the 442d Regimental Combat Team(less its 100th Battalion) 3 under II Corps control, along with the 85th, 88th, and 91st Divisions. IV Corps retained Task Force 45 and the 1st Armored, and was given the 6th South African Armoured Division from 13 Corps. The all-Negro 92d Division and the Brazilian Expeditionary Force of somewhat more than division strength were also assigned to IV Corps, but only the 370th Combat Team of the 92d reached the corps area in time for the attack. The first Brazilian increment, the 6th RCT of the1st Brazilian Division, went into the line on 15 September.
Preliminary Maneuvering- Eighth Army jumped off on 25 August, and by 6 September, when heavy rains interrupted the advance, had broken through the Adriatic anchor of the Gothic Line to a position only six miles south of Rimini where Highway 9, the best lateral road north of the mountains, reached the coast. The enemy had committed all his reserves and had shifted three of his best divisions from the Fifth Army front to meet General McCreery`s challenge.
As early as 31 August there was evidence that the Germans all along the Fifth Army front were pulling back to the prepared positions of the Gothic Line. IV Corps sent reinforced patrols across the Arno the night of 31 August-1 September, and followed up in force during the morning. By the end of 2 September, the bulk of IV Corps was north of the river, and the two major hill masses commanding the Arno plain, Mts. Pisano and Albano, were in Allied hands. Over the next ten days IV Corps pushed across the plain and into the lower slopes of the Apennines, securing the Autostrada--the excellent road connecting Highway 1 north of Pisa with Florence--and liberating the cities of Lucca, Montecatini, Pistoia, and Prato.
On the right flank,13 Corps had already secured a bridgehead north of the Arno from Florence east to Pontesieve during the last week of August. On 1 September II Corps crossed the river, and both II Corps and 13 Corps moved forward to assembly areas. Originally scheduled for 6 September, D-day for the Fifth Army assault on the Gothic Line was postponed until the 10th to take advantage of further enemy withdrawals. When the attack was finally launched, the Fifth Army front was ten miles north of the Arno, and by 12 September leading elements of both II and 13 Corps were probing the outer defenses of the Gothic Line.
Medical Preparations-Organic and corps medical battalions moved forward with the combat elements they supported. Medical troops had been rested, and most had received additional train-
3 The 442dRegiment, including the 100th Battalion from Task Force 45, was withdrawn the first week in September for shipment to France.
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ing in the handling of casualties in mountainous terrain. To preserve secrecy, however, the hospitals were not moved up before the attack was launched, but were infiltrated into new areas. The 16th Evacuation Hospital was established at San Casciano about 10 miles south of Florence, on 26 August, followed four days later by the neuropsychiatric center. On 1 September the 8th Evacuation moved into the same area. The 94th Evacuation moved to Castel fiorentini, some 20 miles southwest of Florence, on 17 August, and on 9 September advanced to Pratolino on Highway 65 about 6 miles north of the city. The 15th Evacuation Hospital set up in Florence itself on 10 September, followed by the venereal disease center on the 13th. On 15 September the 38th Evacuation opened near Pisa to serve units on the IV Corps left flank.4
Combat Operations
Breaching the Gothic Line
On 12 September the 34th Division was in contact with the main defenses of the Gothic Line to the left of Highway 65. The 91st Division was astride Highway 6524,which branched off to the right from Highway 65 about twelve miles north of Florence. To the right of the 91st, the 1st British Division of 13 Corps was abreast of the two U.S. divisions. Elements of the 91st were at the base of Mt. Altuzzo, which overlooked Il Giogo Pass from the right, while other 91st Division units were approaching Mt. Monticelli, the left bastion of the pass.5
On 13 September the 91st Division side slipped to the left of Highway 6524 while the 85th Division moved in between that road and the British sector on the right. After four days of hard fighting, the 85th secured Mt. Altuzzo on 17 September while the 91st was storming Mt. Monticelli. By the end of the day, 18 September, Il Giogo Pass had been outflanked from both sides, and II Corps had broken through the Gothic Line on a 7-mile front.
The strategically placed town of Firenzuola fell to the 85th Division on 21 September. There the road turned sharply left to rejoin Highway 65, while another secondary road, Highway 6528, branched off along the Santerno River northeast to Imola, where it intersected Highway 9 on the edge of the Po Valley.
The 34th Division, meanwhile, had exerted constant pressure in the area between Highway 65and the IV Corps zone to keep the enemy from shifting forces to the IlGiogo battle. On 21 Sep-
4 (1) Annual Rpt, Surg, Fifth Army, 1944. (2) Periodic rpts of med units mentioned in the text
5 Principal sources for this section are: (1) Fifth Army History, pt. VII; (2) Opns Rpt, II Corps, Sep 44; (3) Opns Rpt, IV Corps, Sep 44; (4) Field Marshal the Viscount Alexander of Tunis, "The Allied Armies in Italy from 3rd September, 1943, to 12th December, 1944," Supplement to the London Gazette, 6 June 1950, pp. 2940-60; (5) Clark, Calculated Risk, pp. 394-403; (6) Kesselring, Soldier`s Record, pp.254-64; (7) Howe, 1st Armored Division, pp. 369-86; (8) Schultz, 85th Division, pp. 109-84; (9) Delaney, Blue Devils, pp. 126-62; (10) Robbins, 91st Division, pp. 92-194; (11) Maj. Paul Goodman, A Fragment of Victory in Italy During World War II, 1942-1945 (Carlisle Barracks, Pa.: Army War College, 1952), pp. 25-56; (12) Sidney T. Mathews, "Breakthrough at Monte Altuzzo," Three Battles: Arnaville Altuzzo, and Schmidt, UNITED STATES ARMY IN WORLD WAR II (Washington, 1952); (13) Starr, ed., From Salerno to the Alps, pp. 301-64.
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COLLECTING POINT AT PARTIALLY DEMOLISHED HOUSE ON MT. ALTUZZO
tember the 34th also broke through the Gothic Line to the west of Futa Pass, which now became untenable for the Germans. Though the strongest point of the Gothic Line, Futa Pass fell on 22 September to a single battalion of the 91st Division.
On the right flank of Fifth Army, 13 Corps followed Highway 6521 toward Faenza, and Highway 67, which swings north beyond Florence in the direction of Forli and Ravenna. Leading elements of the corps had passed through the Gothic Line along both axes of advance by 21 September. Even on the left flank, where IVCorps was thinly spread to hold rather than to advance, the German line had been penetrated at several points.
In less than two weeks, Fifth Army had broken through the strong defensive positions of the Gothic Line on a 30-mile front from Vernio on Highway 6520 to San Godenzo Pass on Highway 67. With several alternatives now available to him, General Clark sent II Corps down the Santerno Valley toward Imola, while 13 Corps struck in the direction of Faenza. These were the shortest routes to the Po Valley and promised the great-
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est help to Eighth Army, which was bogged down in rain and mud in the vicinity of Rimini.
For the new attack, the 88th Division was brought up, passing through the 85th along Highway 6528, while the 91st and 34th continued to press forward in their own sectors to cover the 88th. The Santerno Valley proved impregnable. The 88th Division seized and held commanding heights, including Mt. Pratolungo on the left of the river and Mts. Battaglia and Capello on the right, but failed to advance further in the face of mounting opposition. Between 21 September and 3 October, when the Santerno Valley drive was halted, the 88th had2,105 casualties--almost as many as the whole of II Corps had suffered in breaching the Gothic Line.
As the Santerno Valley attack stalled on the rugged, fogbound slopes of Mt. Battaglia, the emphasis shifted to Highway 65, where the 34th, 91st, and 88th Divisions converged on Radicosa Pass, about three miles north of the point where Highway 6524 reunited with the main route and some ten miles beyond Futa Pass. In the face of the threat posed by the 88th Division in the Santerno Valley, the Germans abandoned Radicosa Pass on 28 September.
By the end of the month, three weeks after the beginning of the campaign, all three corps of Fifth Army were on the northern slopes of the Apennines, an average of ten miles beyond the Gothic Line, but the fall rains had begun, hampering the advance and making supply lines increasingly difficult to maintain. The troops were weary from continuous and bitter mountain fighting, and certain classes of ammunition were running low.
Halt Before Bologna
Following his withdrawal from Radicosa Pass, the enemy fell back to the first of four natural defense lines still blocking Fifth Army`s approach to the Po Valley. This first line crossed Highway 65 in the vicinity of Monghidoro; the second line, about 4 miles beyond the first, passed through Loiano; the third and most formidable line had its strong-point at the Livergnano Gap, 4miles beyond Loiano; and the last defensible enemy position in the mountains was 3 miles beyond the gap, on a line crossing Highway 65 just south ofPianoro.6
The II Corps drive was launched in the early morning of 1 October from Radicosa Pass, just 24 miles from Bologna. The 34th Division was on the left, the 91st astride Highway 65, and the 85th was to the right of the highway, following the valley of the Idice River, while the 88th, on the extreme right, was still in the Santerno Valley. In order to strengthen General Keyes` position as much as possible, the 6th South African Armoured Division, which held the sector between the 34th Division and Highway 64, was withdrawn from IV Corps and placed under direct army control, while 13 Corps began the relief of the 88th Division preparatory to a narrowing of the II Corps front. Combat Command B of the 1st Armored Division was attached to the6th South African Armoured Division and the remainder of the division went to II Corps as a mobile reserve to exploit any breakthrough onto the plain.
6 Principal sources for this section include those cited at the beginning of the previous section, with the addition of: (1) Opns Rpt, II Corps, Oct 44; and (2)Opns Rpt, IV Corps, Oct 44.
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Despite cold weather, driving rain, and fog that set in the second day of the attack, the Monghidoroline was overrun along a 16-mile front by 4 October, and the Loiano line by the 9th. But rain, fog, mud, and fatigue were taking their toll, and resistance was stiffening as the enemy concentrated his forces to meet the threat to Bologna, his major supply and communications center.
For the next phase of the drive the front was still further narrowed, the 34th Division moving over to the right of Highway 65, between the 91st and 85th, and the 88th Division side slipping to its own left into the Sillaro Valley, as the British 78th took over the Santerno Valley sector. Again the objective was attained, the Livergnano line being overrun by 15 October, but again the pace was slowed, and losses were heavy and cumulative.
For the 6-dayperiod 10-15 October, II Corps lost 2,491 battle casualties. The total since the start of the Bologna drive on 1 October was 5,699, and since the beginning of the offensive on 10 September, 12,210, or nearly a full division. The loss of an actual division would have been less severely felt, because losses were disproportionately high among junior officers. Returns to duty made up only a fraction of the losses. Replacements were not available in sufficient numbers, and were inexperienced at best. Battlefield commissions given to enlisted men made up some of the officer losses, but seasoned noncommissioned officers were in equally short supply. To personnel shortages had to be added general fatigue, muddy and mountainous terrain that hampered the movement of supplies and restricted the mobility of artillery, and weather that prevented effective air support. A massive bombing of enemy supply dumps in the Bologna area was the only significant air activity in the period.
For another week II Corps struggled forward against increasingly strong opposition, but it was a losing gamble. With Eighth Army immobilized by soft ground and flooded streams on the fringe of the Po plain, II Corps now faced the best German units in Italy. Machine guns and mortars were hand-carried up mountain trails. Rations and ammunition were brought up by mule pack, but even mules could not move the heavy guns through the mud. The 91st Division tried oxen, but with no better success. After 17 October, when the 697th and 698th Field Artillery Battalions were withdrawn for shipment to France, there were no heavy guns to move, and by the last week of October ammunition was in such short supply as to require drastic restrictions on its use.
The last straw was added on 26 October when torrential rains washed out roads and bridges. In rare intervals of clear weather, the Po Valley was visible in the distance, but Bologna was still nine heartbreaking miles away. General Keyes ordered II Corps to fall back to defensible positions and dig in.
On the IV Corps front, activity came to a halt at the same time. Although the corps had been stripped to hardly more than the strength of a reinforced division, some advances had been made. Task Force 92, consisting of the 370th RCT and antiaircraft units detached from Task Force 45, had advanced up the coast a few miles beyond the resort city of Viareggio, while the Brazilian6th Combat Team had moved so far into the Serchio Valley in the center of the
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IV Corps zone that the advance was stopped by General Crittenberger lest it invite counterattack, for which no reserves were available.
Winter Stalemate
After stabilization, of the front late in October, action in all sectors was largely limited to patrols and reconnaissance. Elements of the 92d Division, brought under direct army control early in November, made minor gains along the coast north of Viareggio. On 24 November, units of Task Force 45 captured Mt. Belvedere, about 5 miles west of Highway 64 above Poretta, but were able to hold the mountain only five days before it was regained by the enemy. Similarly, Mt. Castellaro in the 13 Corps zone 7 or 8 miles northeast of Livergnano, was retaken by the Germans before the end of the month. For the most part, forward positions were held by reduced forces while troops were rotated back to a rest area near Montecatini for ten days at a time. The men were also given passes to Florence and even to Rome.7
On 16 December command of Fifth Army passed to Lt. Gen. Lucian K. Truscott, Jr., former VI Corps commander. General Clark succeeded Field Marshal Sir Harold R.L. G. Alexander as commander of the Allied armies in Italy, to be known thereafter by the earlier designation of 15th Army Group. Alexander moved up to supreme command of the theater in place of General Sir Henry Maitland Wilson, who became representative of the British Chiefs of Staff in Washington. Alexander`s deputy and commander of the U.S. theater was Lt. Gen. Joseph T. McNarney, who had succeeded Devers in late October. Toward the end of March 1945 General Eaker was recalled to Washington to become Chief of the Air Staff. He was succeeded as Mediterranean Allied Air Force commander by Lt. Gen. John K. Cannon of the Twelfth Air Force.
When Clark assumed command of the army group, the Allied front in Italy extended on an irregular line from a point on the Adriatic six miles northeast of Ravenna to the Ligurian coast three miles south of Massa. Eighth and Fifth Armies were in contact southwest of Faenza.
Early in January the new command decided to postpone further large-scale operations until spring, when it was anticipated that some reinforcements would be available, adequate supply levels would have been attained, and the weather would be favorable for rapid exploitation by armor and motorized infantry once the Po Valley was reached.
Reinforcements were already on the
7 Principal sources for this section are: (1) Fifth Army History, pt. VII and VIII, The Second Winter (Washington [1947]); (2) Opns Rpts, II Corps, Nov 44-Mar 45; (3) Opns Rpts, IV Corps, Nov 44-Mar 45;(4) The Allied Forces, Mediterranean Theater, Report by the Supreme Allied Commander, Mediterranean, Field Marshal the Viscount Alexander of Tunis, to the Combined Chiefs of Staff on the Italian Campaign, 12 December1944 to 2 May 1945 (London: His Majesty`s Stationery Office, (1951)(hereafter cited as Alexander, The Italian Campaign),pp. 5-32;(5) Truscott, Command Missions, pp. 447-70; (6) Clark, Calculated Risk, pp. 404-25; (7) Kesselring, Soldier`s Record, pp.264-67; (8) Howe, 1st Armored Division, pp. 386-96; (9) Schultz, 85th Division, pp. 185-96; (10) Delaney, Blue Devils, pp. 164-84; (11) Robbins, 91st Infantry Division,pp.195-261; (12) Goodman, Fragment of Victory, pp. 56-119; (13)Theodore Lockwood, ed., Mountaineers (Denver, no date), pp. 6-23;(14) Starr, ed., Salerno to the Alps, pp. 365-85.
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way. The 365th and 371st Regimental Combat Teams of the 92d Division and the 1st and 11th RCT`s of the 1st Brazilian Division arrived in the combat zone in October and, after intensive training, were ready br action in November. Another combat team--the 366th, made up of men from other branches converted to infantry--was assigned to Fifth Army in November and attached to the 92d Division. A newly arrived l ight tank battalion, the 758th, and the 1125th Armored Field Artillery Battalion formed from inactivated antiaircraft units, were also attached to the 92d, while II Corps received a battery of British heavy guns. In addition to these organized units, Fifth Army received 5,000 individual replacements in November, but was still 7,000 men below Table of Organization strength.
In January more antiaircraft units, including most of those operating under Task Force 45, were reorganized as the 473d Infantry regiment. Also in January, the most important of all Fifth Army`s reinforcements arrived when the 10th Mountain Division, a highly trained outfit of picked men, reached the combat zone. These increments made it possible to return 13 Corps to Eighth Army, with a corresponding realignment of the army boundaries, although the 6th South African Armoured and the 8th Indian Divisions remained with Fifth Army.
No reinforcements were received in February, and late in March the 366th Infantry, which had not worked out well as a combat unit, was disbanded, its personnel being converted to service troops. The loss was more than balanced, however, by the return of the 442d Regimental Combat Team from France, where it had served with Seventh Army since the end of September and had again demonstrated its outstanding fighting qualities. The Italian Legnano Group, with a strength of about two-thirds of a division, was also attached to Fifth Army in March.
Shifts of units between corps, and rotation in the line, were motivated primarily by the need to rest veteran troops and to give some experience to new ones. Training was a continuous process at all levels, including an officer candidate school set up in February. Meanwhile supplies of ammunition were building up; trucks, tanks, and other vehicles were being repaired; worn-out equipment was being replaced. At the staff level, plans for the spring offensive were being drawn.
With snow blanketing the peaks and filling the mountain passes, little action of any kind was possible during the winter months, although vigorous patrolling continued along the entire front. In the 13 Corps zone an attempt to seize the key town of Tossignano on the Imola road early in December was repulsed with heavy losses. Late in the same month, an indicated build-up of enemy strength in the thinly held IV Corps sector led to an attack by the 92d Division in the Serchio Valley, but the Germans, already on the move, quickly seized the initiative and gained considerable ground before the 8th Indian Division could move up from army reserve to re-establish the original line.
Early in February the 92d undertook another limited offensive to improve its positions on the left flank, but with little success. The 365th and 366th RCT`s secured their objective, the commanding ridge of Mt. della Stella in the
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Serchio Valley, on 5 February, but could not hold the position against counterattacks in force over the next several days. The 370th and 371st RCT`s, seeking to advance to Massa along the narrow coastal plain, ran into dense mine fields and fierce resistance that forced them back to their original positions with heavy losses in both men and tanks after three days of fighting. In the II Corps area, an attempt to improve their positions by elements of the 34th Division was similarly thrown back with heavy losses.
Only in the area to the left of Highway 64, which figured prominently in General Truscott`s plans for the spring offensive, was any substantial success gained. There the 10th Mountain Division and the 1st Brazilian Division, in brilliant maneuvering over terrain as rugged as any in the Apennines, retook the long-disputed Mt. Belvedere and a dozen peaks beyond it, giving Fifth Army both excellent observation into the Po Valley and good positions from which to launch further drives, at the same time securing a 10-mile stretch of Highway 64 from the threat of enemy shelling. These actions, which were carried out between 18 February and 9 March, won for the 10th Mountain Division the spearhead role in the forthcoming Po Valley Campaign.
Medical Support in the Field
The conditions under which the Fifth Army medical service operated in the northern Apennines were very similar to those experienced in the fall and winter of 1943 in the Cassino area, save only that the northern mountains were higher and the weather worse. During the Gothic Line battles and the push toward Bologna, the nature of the terrain reduced much of the fighting to a series of small unit actions involving no more than a battalion and often less. To care for casualties in such engagements, the medical service, too, had to function in small units, with numerous forward aid stations and long litter hauls. The period of stalemate was an unending battle against cold and dampness waged by small detachments of medical troops close to the outposts, with long evacuation lines to hospitals withdrawn to winter positions. In short, Fifth Army`s second winter in Italy was a repetition of the first.
Period of Active Combat
Medical Support of II Corps- The tasks imposed on the medical battalions and field hospitals supporting II Corps in the Gothic Line battles and the subsequent drive toward the Po Valley were the most difficult of the Italian campaign. The main highway is were heavily traveled, often under artillery fire, and always at a distance from the actual fighting. Secondary roads were few, narrow, heavily mined, and by October deep in mud. Bypasses built by II Corps engineers were generally open only to one-way traffic, imposing dangerous delays on ambulances.8
8 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2)Annual Rpt, Surg, Fifth Army, 1944; (3) Annual Rpt, Surg, II Corps, 1944; (4) Annual Rpts, Surgs, 34th, 85th, 88th, 91st Divs, 1944; (5) Annual Rpt, 54th Med Bn, 1944; (6) Monthly Rpts, 109th Med Bn, Sep. Oct, 44; (7) Monthly Rpts, 310th Med Bn, Sep, Oct 44; (8) Monthly Rpts, 313th Med Bn, Sep. Oct 44; (9) Weekly Rpts, 316th Med Bn, Sep 44; 316th Med Bn Hist. (10) Annual Rpts, 32d, 33d Field Hosps,1944.
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Division clearing stations with their attached field hospital units were necessarily restricted to sites accessible to the main highways. As the rainy season advanced, suitable locations were increasingly difficult to find, making close support impossible and forcing additional burdens on the collecting companies. Jeeps were used to evacuate battalion aid stations wherever possible, but even these versatile vehicles could not negotiate many of the mountain trails, leaving long and hazardous litter carries the only alternative. In some sectors, supplies and equipment were brought up by mule; in others hand-carrying was necessary.
The assault on the Gothic Line was launched initially by the 34th and 91st Divisions along the axis of Highway 65. The clearing station of the 109th Medical Battalion, organic to the 34th, moved up from the assembly area on 12 September to a site left of Highway 65, about 5 miles northwest of the point at which Highway 6524 branches off toward Scarperia and Firenzuola. There it was joined by a platoon of the 33d Field Hospital, both units remaining in place until after the Gothic Line had been breached. The station admitted244 patients on 17 September, its largest single days total for the campaign. The clearing station moved forward on 27 September to a site on Highway65, about 3 miles south of Futa Pass, where it remained until early October. During this period, collecting companies of the battalion operated up to10 miles beyond the clearing station.
The clearing station of the 316th Medical Battalion, organic to the 91st Division, remained in the assembly area until 15 September, when it advanced to a point east of Highway 65 about three miles north of the road junction. The site was easily accessible but was surrounded by heavy guns, which invited counter battery fire and led the unit historian to describe it as an ambulance drivers dream but a psychiatrists nightmare. The supporting platoon of the 33d Field Hospital was established in a somewhat safer spot on the west side of Highway 65 in the vicinity of Cafaggiolo. Both units, for want of suitable forward sites, remained in place throughout the Gothic Line battles. The 91st had a more difficult assignment than the 34th, and heavy casualties began coming into the clearing station on 11 September. A peak of 409 admissions was reached on the 15th.
The 85th Division went into action on 13 September along the axis of Highway 6524. The clearing station of the organic 310th Medical Battalion, together with a platoon of the 32d Field Hospital, opened about two miles southwest of Scarperia the following day, although the area was well within range of enemy guns. The field hospital stayed behind when tile clearing station moved on 23 September to a new area a mile south of Firenzuola, another platoon of the 32d Field moving up to take its place adjacent to the clearing station. Both hospital and station were forced by enemy fire to abandon the site within two hours. A new location somewhat farther to the rear was occupied on 25 September, but the access road was soon knee deep in mud. Until the station moved at the end of the month it was necessary to keep a maintenance truck available to haul out mired ambulances.
Two days after commitment of the 88th Division on 22 September, the
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clearing station of the organic 313th Medical Battalion opened in the vicinity of San Pellegrmno on the Imola road. A platoon of the 32d Field Hospital caught up with the station thereon 26 September. It was here that casualties from the bloody battle for Mt. Battaglia were received after litter carries up to 4.5 miles. To man the relay posts along the steep, treacherous evacuation trail, emergency bearers were pressed into service from among line troops, medical battalion headquarters, and the clearing company in addition to those borrowed from the 54th Medical Battalion at corps level.
The second phase of the North Apennines Campaign, from the 1 October assault on the Monghidoroline to the final breakdown in the mud before Pianoro, saw some of the hardest fighting of the entire war in Italy and the most difficult period for the medical service. Fatigue, exposure, and almost continuous rain and cold took a heavier toll in respiratory diseases, trench foot, and psychiatric disorders than enemy weapons took in wounded men, yet the battle casualty rate was higher than for any comparable period since the Salernolandings.9
Field medical installations of II Corps were relocated early in October, reflecting the shift of emphasis back to Highway 65. Its site below Futa Pass already a quagmire, the 1st Platoon of the 34th Division clearing station jumped ahead fourteen miles on 4 October to a site southwest of Radicosa Pass, with the 2d Platoon moving to San Benedetto northwest of the pass four days later. Neither site was satisfactory, and the 1st Platoon shifted to Monghidoro on the 12th, where it occupied a battered resort hotel building. The 2d Platoon set up in tents in the same area three days later. The supporting platoon of the 33d Field Hospital was already in Monghidoro, having moved up on 9 October.
Although 34th Division casualties were relatively light in October, difficulties in evacuation continued to require litter bearers in excess of those allotted. Men from kitchen and station sections of the collecting companies were used for this purpose, and in emergencies line soldiers were borrowed from the combat units. Among the hazards were floods, landslides, and consistently poor visibility due to fog and rain. At night ambulance drivers benefited from "artificial moonlight" produced as an aid to transportation generally by beaming searchlights in low trajectory over the area.
By 1 October ,clearing stations of the 85th and 91st Divisions were in the vicinity of the road junction where Highway 6524 rejoins Highway 65, with the 2d Platoon of the 33d Field Hospital supporting both. The hospital unit received the greatest number of patients in its history for a comparable period at this site--228 nontransportable priority surgical cases in a 14-day period. On 10 October the 85th Division clearing station moved into the Idice Valley, about 5 miles southeast of Loiano. The clearing station of the 91st moved on 21 October to a site about 2 miles south of Loiano, but the supporting platoon of the 33d Field Hospital was soon rendered useless because mud made it impossible to
9 For Fifth Army as a whole the wounded in action rate for October 1944 was 783 per 1,000 per annum, as compared with 973 for September 1943. For II Corps the October 1944 rate was 1,219 with an admission rate from all causes of 2,970 per 1,000 per annum. See Annual Rpt, Surg, Fifth Army, 1945, p.63, and Annual Rpt, Surg, II Corps, 1944.
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deliver patients to it. The engineers had to construct a special road of rocks, straw, burlap, and landing-strip matting to get the hospital out early in November. A platoon of the 32d Field Hospital was established about a mile north of Monghidoro on 13 October, primarily in support of the 85th Division, though it was some 3 miles distant from the division clearing station in a direct line and nearer 10 miles by road.
With the shift of the 88th Division to the Sillaro Valley, the clearing station was setup 6 October at Giugnola, and the supporting platoon of the 32d Field Hospital at Belvedere a mile or so closer to the front. The 54th Medical Battalion, responsible for evacuating the II Corps clearing stations, moved its headquarters to the vicinity of Traversa, a mile north of Futa Pass, on 3 October.
In order to give close support to the combat troops, the collecting companies of the divisional medical battalions often operated in two sections, the advance station being as close as possible to the regimental combat zone. The ambulances were kept at the forward post and the litter squads at the battalion aid stations, which were themselves often split into two sections with separate evacuation routes. The rear echelon would move up to the advance site as soon as conditions permitted, while the advance section again moved forward with the combat troops.
Evacuation was to the clearing station of another division if that was more accessible. In late October, when flood waters washed out bridges and obliterated trails, the 85th Division clearing station was completely isolated for two days, during which period casualties were held at the collecting stations or evacuated to other divisions. One regiment of the 85th evacuated to the 88th Division clearing station by a devious route involving the use of artillery prime movers to cross swollen streams and the transfer of patients from one ambulance to another on each such occasion. The 88th Division clearing station also took casualties from elements of the 1st Armored, which were moved into the line on the corps right flank at this time. In several sectors ambulances were washed into the streams and temporarily immobilized if they were not lost altogether. Vehicles of all types were punished unmercifully, with broken springs a commonplace. Nor were vehicles the only casualties. Litter bearers were frequently under fire and exposed to booby traps and the hazards of steep mountain trails in darkness. The toll of killed and wounded among them was high.
During the period 10 September-31 October, the strength of the 54th Medical Battalion was augmented by a collecting company of the 162d Medical Battalion and elements of two ambulance companies from Fifth Army, all of them being used to evacuate division clearing stations. The corps medical battalion also supplied to the divisions 75 litter bearers from its own complement, and approximately 150 Italian infantrymen for litter work. The Italians proved reluctant and unreliable in this capacity, though others of their countrymen made themselves invaluable to the medical service as pack-train drivers and as guides.10 The 54th Medical Battalion also operated a dental clinic and an eye clinic
10 Still other Italians, it should be noted, were formidable guerrillas behind the German lines. Indeed, the German high command never learned to cope successfully with the partisans of northern Italy. Kesselring, Soldier`s Record,pp.268-79.
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for II Corps throughout the period of combat.
Medical Support of IV Corps- On the IV Corps front, where the military mission was to hold rather than to advance, the task of the medical service was lessarduous. The 370th Regimental Combat Team of the 92d Division was supported by a collecting company and clearing platoon of the organic 317th Medical Battalion. Task Force 45 was supported by elements of the corps medical battalion, the 163d. Since the antiaircraft units that made up the bulk of the task force did not have enough medical personnel for infantry operations ,the 163d supplied aidmen and forward litter bearers as well as performing its normal collecting and clearing functions. The initial increment of the Brazilian Expeditionary Force, the 6th Combat Team, was supported by a collecting company and clearing platoon of the 1st Brazilian Medical Battalion; and Combat Command B of the 1st Armored Division was cared for by Company B of the 47th Armored Medical Battalion. The 6th South African Armoured evacuated the army area through its own medical channels. Field hospital units for forward surgery were not available to reinforce the IV Corps medical service, but the close proximity of evacuation hospitals and relatively easy evacuation routes in large measure compensated for the lack.11
The advent of the Brazilians created new problems for the IV Corps surgeon, Lt. Col. Austin W. Bennett, particularly in matters of liaison and of sanitation, since Brazilian standards were less rigorous than American. An American medical officer was placed on duty with the 1st Brazilian Infantry Division to assist with training, medical records, and equipment. At one period, when the Brazilian sector adjoined that of the 1st Armored, a Brazilian medical officer was detailed to one of the treatment stations of the 47th Armored Medical Battalion to act as interpreter and to assist with Brazilian casualties passing through the station. The corps collecting company evacuating the BEF sector, in addition to its normal functions, supplied men, litter bearers, and equipment for battalion aid stations of the 6th Combat Team.
Medical installations of IV Corps encountered the same difficulty with rain and mud, and the same disadvantages of terrain that were a constant hazard in the II Corps area, but, without the burdens of an offensive, the conditions were more readily endured. Only in the sector where Combat Command B operated after 1 October, attached to the 6th South African Armoured, were conditions comparable to those on the II Corps front. Primarily for this reason, the unit was brought under II Corps control at this time. When CCB moved north on Highway 64 early in October, the supporting treatment station for the first time in its history was unable to find enough level ground to pitch its tents and was forced to set up in a village where buildings were available.
Inactive Period
With Fifth Army in defensive positions for the winter, little movement of
11 The main sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944 (2) Annual Rpt, Surg, IV Corps, 1944; (3) Hist, 317th Med Bn, 16 Oct 42-15 Jul 45; (4) Annual Rpt, Surg, 1st Armd Div, 1944; (5) Hist, 47th Armd Med Bn, Sep, Oct 44; (6) Annual Rpt, 163d Med Bn, 1944.
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medical units was required. Collecting and clearing companies of the organic medical battalions accompanied their combat formation as they were rotated to the Montecatini rest area, while those remaining at the front made themselves as secure and as comfortable as conditions permitted. Clearing stations, collecting stations, and even battalion aid stations set up in buildings or shells of buildings. When these were not available, tents were winterized. As had been the case in the previous winter at the Gustav Line, caves and cave like rock formations were utilized, often floored with lumber from discarded shell cases. Personnel of the forward stations within range of enemy artillery dug in, roofing foxholes with salvaged timbers and sandbags in a manner reminiscent of Anzio. Stoves were issued for wards and operating rooms.12
II Corps Front-The existence of a static front did not mean that medical units were idle. In the II Corps sector continuous patrol activity and intermittent shelling accounted for enough casualties to keep forward stations in business even without the disease and injury toll inevitable under the circumstances of weather and terrain. At the same time, the task of evacuation of casualties was enormously more difficult with the steep and twisting roads now icy and treacherous under drifting snow, and litter trails obliterated.
Ski litters were used successfully in some sectors. One collecting company of the 34th Division used a toboggan to evacuate its forward station during January. The 91st Division equipped one litter squad in each collecting company with snow shoes, but other medical battalions found them of little value. More generally effective were ice creepers, worn by litter bearers of all divisions in the line.
Medical units themselves continued to suffer casualties from enemy shells landing in station areas or on highways, and litter bearers were occasionally fired upon, despite their Red Cross identification.
The 32d Field Hospital reverted to army control in November, two of its platoons being transferred to the IV Corps sector, where they acted as small evacuation hospitals. The 33d Field continued to support II Corps, with one platoon east of Monghidoro and one in the Sillaro Valley, each serving elements of two divisions. Both field hospitals and clearing stations held patients somewhat longer than would have been the case under conditions of active combat, the clearing stations in particular doubling as station hospitals for garrison troops.
The four collecting companies of the 54th Medical Battalion--including one attached from the162d--continued to evacuate divisional clearing stations
12 Principal sources for this section are: (1) Annual Rpts, Surg Fifth Army, 1944, 1945; (2) Annual Rpts, Surg, II Corps, 1944, 1945; (3) Annual Rpts, Surg, IV Corps, 1944; (4) Annual Rpt, 54th Med Bn, 1944; (5) Monthly Rpts, 54th Med Bn, Nov 44-Mar 45; (6) Annual Rpts, 163d Med Bn, 1944, 1945; (7) Annual Rpts, Surg, 1st Armored, 34th, 85th, 88th, 91st, 92d Divs, 1944 1945; (8) Annual Rpt Surg, 10th Mountain Div, 1945;(9) Unit Hist, 10th Mountain Med Bn, Jan-Mar 45; (10) Hist, 47th Armored Med Bn, Jan-Mar 45; (11) Opn Rpts, 109th Med Bn, Nov 44-Mar 45; (12)Opn Rpts, 310th Med Bn, Nov 44-Mar 45; (13) Opn Rpts, 313th Med Bn, Nov 44-Mar 45; (14) Unit Hist 316th Med Bn, Nov 44-Mar 45; (15) Hist Data,317th Med Bn, Nov 44-Mar 45; (16) Annual Rpts, 32 and 33d Field Hosps, 1944; (17) Annual Rpts, 32d and 33d Field Hosps, 1945.
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through an ambulance control point on Highway 65 below Radicosa Pass. Bed quotas from each Fifth Army hospital were telephoned to the control point daily and ambulances routed accordingly. For two weeks in mid-November a platoon of the 683d Clearing Company, 54th Medical Battalion, relieved the 88th Division clearing station at Giugnola, but otherwise the chief function of the company was the operation of special clinics for II Corps. The dental and eye clinics at Traversa remained in operation throughout the winter, and a venereal disease treatment center, for new cases of gonorrhea only, was opened at the same site on 11 November.
IV Corps Front-IV Corps front was more active than that of II Corps, the 92d Division fighting limited engagements in November and February, and the 10th Mountain and1st Brazilian Divisions taking part in more extended operations in February and March. Here, too, snow and cold were limiting factors, with rain a continuing hazard in the coastal sector. The medical service of
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IV Corps was also compelled to resort to a variety of expedients to overcome deficiencies in the medical complement of some of its combat units. In the early months of the winter the 163d Medical Battalion continued to give combat medical support to Task Force 45 and, with the assistance of a collecting company attached from the 161st Medical Battalion, to evacuate divisional clearing stations. The battalion also gave first echelon support to service troops and others without medical detachments of their own, operated a venereal disease hospital for the corps, and supplied an expansion unit for one of the evacuation hospitals in the area. The 671st Collecting Company, supporting troops on the right flank of the corps sector, was provided with equipment to operate a 25-bed provisional hospital, should heavy snows isolate the area. As on the II Corps front, additional ambulances were supplied by Fifth Army.
In order to support the 366th Infantry, which was attached to the 92d Division on its activation in November, one of the collecting companies of the 317th Medical Battalion operated for a time in two sections. For the February offensive, in which all four regiments of the 92d were engaged simultaneously, a provisional collecting company was used, with 2 medical officers, 9 medical and 6 surgical technicians, and 12 ambulance drivers drawn from the regular companies, and Italian litter bearers. While the division was engaged simultaneously on the coast and in the Serchio Valley, both clearing platoons were in operation, reinforced by ambulances from corps. Later in February, when the 473d Infantry was also attached to the 92d, it was again necessary for one collecting company to support two combat teams.
In the Mt. Belvedere offensive and subsequent operations west of Highway 64, the medical units supporting the 10th Mountain Medical Battalion did not follow the conventional organizational pattern. Equipment was designed for mule pack or hand carry, and assigned vehicles were reduced in number accordingly. The Table of Organization called for 126 animals but for only 15 motor ambulances, all of them in the clearing company. Each of the 3 collecting companies had 44 litter bearers instead of the 36 allotted to infantry companies. The clearing company was divided into 3 rather than 2 platoons. Since the whole division was set up for animal transportation--there were more than 6,000 animals in the T/O--there was a sizable veterinary company, and there were veterinary sections at the battalion level in the medical detachment. The division arrived in Italy, however, without its animals. Italian mule pack trains were supplied, but transportation deficiencies were otherwise made up by motor vehicles. The medical battalion received 30 instead of 15 ambulances, which were transferred from the clearing to the collecting companies. Jeeps were borrowed from line units.
In the first battle test, the 10th Mountain Medical Battalion performed like a veteran outfit, amply justifying the care with which its personnel had been selected and trained. Like the combat formations, medical units moved into position under cover of darkness. Collecting stations, and often clearing stations as well, were generally within range of enemy artillery, and many casualties resulted, though few of them were psy-
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10TH MOUNTAIN DIVISION AID STATION ON SLOPES OF MT. BELVEDERE
chiatric. Litter squads of one company worked the first 3 days of the offensive--72 hours--without sleep and with very little food. Litter carries were down precipitous mountain sides, frequently taking as long as 10 hours, yet the same squad would return immediately for another casualty.
At two points, division engineers built cable tramways to bring the wounded out from otherwise almost inaccessible positions. The first of these was completed the morning of 21 February from Mt. Mancinello-Pizzo di Campiano ridge captured the night of the 19th. A difficult 3- or 4-hour haul down the ridge was reduced to 4 minutes, and the carrying time between aid station and collecting station cut to 6 or 7 hours. The other tramway, some 5 miles southwest of Vergato, spanned a deep valley across which the only passage was a narrow, tortuous dirt trail unusable even by jeeps. In the latter stages of the offensive, when the 85th RCT was digging in on Mt. della Spe, the only possible evacuation route lay through the village of Castel d`Aiano, which was shelled by German guns every time a vehicle moved in the streets.
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TRAMWAY ASCENDING TO MT. MANCINELLO- PIZZO DI CAMPIANO RIDGE
On the evening of 3 March the collecting station of Company C was hit by a German shell that exploded a booby trap and completely demolished the building in which the station was housed. Two chaplains and one enlisted man were killed, and 13 other station personnel more or less severely wounded, one of whom later died. Fortunately there were no patients, since Company B, in the most forward position, was evacuating the entire division that day. Between 0600 and midnight, more than 200 casualties passed through Company Bs station, including 40 prisoners of war and a few partisans.
Training and Re-equipment- These combat actions, involving as they did relatively recent arrivals in the theater, did not interfere with a general program of training and refurnishing the field medical service on an army-wide basis. Officers with more than twenty-four months of combat duty were replaced by fresher men, while the veterans went to field and evacuation hospitals to polish up their techniques. Units were brought
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up to strength, line soldiers being trained as medical replacements where no others were available. Ambulances and other vehicles were systematically overhauled or replaced. Supply levels were built up. Physical conditioning went along with recreational activities. At the same time, the special problems anticipated for the coming spring offensive were given individual attention.
After its own positions were stabilized just before the middle of March, personnel of the 10th Mountain Division conducted a school in methods of mountain evacuation. At a site near the mouth of the Arno River, medical detachments and battalions were given special training in the technique of river crossings along with their respective combat elements. General Martin was no less determined than General Truscott to make the next campaign the last.13
Hospitalization in the Army Area
Hospitalization During the Fall Offensive
The deployment and use of Fifth Army hospitals during the Gothic Line battles and the subsequent advance toward Bologna were always conditioned by the unfavorable terrain, the poor road network, and the weather. On the II Corps and IV Corps fronts, enemy artillery fire delayed the forward movement of hospitals, or forced the abandonment of otherwise acceptable sites, while evacuation lines stretched out and ambulances broke down under constant use. To these disadvantages was added a persistent shortage of beds that could be compensated for only by continuous overloading of facilities and by improvisations at all echelons of the medical service.14
Among the expedients in general use were the practice of employing surgical teams from evacuation hospitals in field hospital units or other evacuations more strategically placed; and of putting personnel from less active units on temporary duty with those carrying heavy patient loads. Surgeons were also exchanged between evacuation and general hospitals for 6-week intervals to give each group a more realistic understanding of the problems of the other. Clearing and collecting companies were consistently used to augment the beds of evacuation hospitals in the army area.
Hospital Support of II Corps- With II Corps making the main U.S. effort against the Gothic Line, the bulk of the Fifth Army hospitals were eventually deployed along the axis of Highway 65, but there was an unavoidable lag behind troop movements. When the assault was launched on 10 September, the nearest evacuation hospital was the 15th, which opened on that date in a large school building in Florence. All transportable casualties of the first two days went there. On 12 September the 94th Evacuation moved up to Pratolino, about six miles closer to the front but still in the rear of the assembly area from which the 34th and 91st Divisions had jumped off. (Map 35)
13 For detailed preparations during this period, see pp. 458-60, below.
14 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual Rpt, Surg, Fifth Army. 1944; (3) Unit rpts of med units mentioned in text.
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MAP35--Fifth Army Hospitals and Medical Supply Dumps, 18 September 1944
At Pratolino, where it was housed in buildings, the 94th Evacuation Hospital took the more serious casualties from the entire corps for the next two weeks, the overflow going back to the 15th in Florence. Medical cases and a few light battle wounds were sent still farther back, to the 8th and 16th Evacuations in the San Casciano area south of Florence. The Gothic Line had been overrun, and the 88th Division`s costly drive down the Santerno Valley was underway before the 56th Evacuation Hospital opened in tents on 24 September at Scarperia, south of Il Giogo Pass on Highway 6524.
Though it was a 750-bed unit, the capacity of the 56th was quickly overtaxed. The heavy influx of surgical cases forced the establishment of an overflow preoperative ward, while medical cases also constituted an abnormally heavy load. In an effort to lighten the burden on the 56th, General Martin sent an advance party from the 16th Evacuation Hospital to Firenzuola on 27 September to locate a site for that unit, but enemy fire drove the men back and the move had to be postponed. Before the Firenzuola area was safe, the rainy season had set in, and the prospective site had to be ditched and protected by a levee from a neighboring stream. It was 4 October before the 16thEvacuation took over the role of most forward army hospital.
The 16th was in position to take casualties from both flanks of the II Corps
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front, and, for 10 days, admissions were heavy, reaching a peak of 203 on 15 October. At the same time, the 56th at Scarperia continued to operate at capacity, and the 94th, still at Pratolino, set a new unit record for surgical cases in the first two weeks of October.
As the weather steadily worsened, it became increasingly important to get hospital beds as far forward as possible. Evacuation over mud-clogged roads was becoming more difficult, and there was danger that Futa Pass might be blocked bys now. To ease the pressure, the 750-bed 8th Evacuation Hospital moved to Pietramala, just south of Radicosa Pass, on 14 October; and the following day the 94th moved up to Monghidoro, about five miles farther north on Highway 65. The 94th was replaced at Pratolino by a fixed hospital.
Both forward hospitals quickly ran into difficulties. The 8th was sited in a rolling field, already churned to mud by heavy guns that were still there when the first loads of hospital equipment arrived. Ward tents were pitched on sloping ground, and the operating tent was given a level base only by cutting away the top of a knoll. Conditions at Monghidoro were even worse, for the area was still under artillery fire. So great, indeed, was the danger from enemy shells that the 94th Evacuation closed 5 days after it opened. Two medical officers, 5 nurses, and 10 enlisted men stayed at Monghidoro to care for 30 nontransportable chest and abdominal cases, and to guard the equipment. Twenty-one nurses and 70 enlisted men were sent back to rest areas; the remainder of the nurses, a shock team, and 2 surgical teams were put on temporary duty with other hospitals; and the rest of the personnel went into bivouac with the 8th Evacuation at Pietramala. 15 On 29 October, after II Corps had been ordered to take defensive positions, surgical personnel of the 94th returned to Monghidoro. The medical staff and all others not needed at the forward site went back to Florence, where they joined the15th Evacuation, setting up 380 beds for medical cases only.
Meanwhile a new departure had been taken in the treatment of neuropsychiatric casualties.16Asthe strain of weeks of bitter fighting in the most difficult conditions of weather and terrain began to be felt in a rising toll of psychiatric disorders, General Martin set up a psychosomatic center toward the end of October in the vicinity of Cafaggiolo, just north of the point where Highway 6524 branches off from 65. Core of the center was the 2d Platoon of the 601st Clearing Company, 161st Medical Battalion, which had been serving as Fifth Army neuropsychiatric hospital since December 1943. The1st Platoon of the same company was established on 23 October adjacent to the neuropsychiatric hospital to specialize in gastrointestinal cases, many of which were believed to be of psychosomatic origin. On 1 November the 1st Platoon of the 602d Clearing Company, 162d Medical Battalion, which had been operating an expansion unit for the 15th Evacuation since 18 September, also joined the psychosomatic center, but took minor disease as well as gastrointestinal cases.
The 3d Convalescent Hospital moved
15 Periodic Rpt, 94th Evac Hosp, Jan-Aug 45. The 1944 Annual Report says the Covigliaio area, roughly three miles south of Pietramala, but the later report is more detailed, and in this case more probable, since mess equipment was presumably left at Monghidoro.
16 Seepp. 450-51, below.
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MAP36--Fifth Army Hospitals and Medical Supply Dumps Supporting II Corps, 25 October 1944
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38TH EVACUATION HOSPITAL FLOODED AT PISA, NOVEMBER 1944
up to Pratolino on 26 September.(Map36)
Hospital Support of IV Corps- The lightly held IV Corps sector started the Gothic Line campaign with the support of only one evacuation hospital, the 750-bed 38th, which opened in the outskirts of Pisa on 15 September. The safety factors were: the relatively minor military operations anticipated; the proximity of Florence to the IV Corps right flank, with good roads available; and the easy access in emergency to base hospitals in the Leghorn area.(See Map 35.) The 38th Evacuation was augmented by a collecting company of the 162d Medical Battalion, and by 25 Brazilian medical officers, 20nurses, and 60 enlisted men to care for BEF casualties.17
All efforts to secure an additional hospital for the support of IV Corps failed until mid-October, when General Martin was notified that the 250-bed 29th Station Hospital, then inoperative in North Africa, would be converted into a 400-bedevacuation hospital for Fifth Army. The unit was brought immediately to Italy, and the work of conversion carried out with such dispatch that it was ready to take patients as the 170th Evacuation Hospital the first week of November.
17 Figures for Brazilian personnel are from reports of the 16th Evacuation Hospital, to which they were later transferred. The available reports of the 38thdo not specify numbers.
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It was none too soon. On the night of 2-3 November the flooding Arno River burst its banks, and a wall of water poured into the area occupied by the 38th Evacuation. Before morning the water was 4 to 6 feet deep in the hospital area. The495 patients in the hospital were hastily carried 300 yards to the relative safety of a partially destroyed barracks being used by the 12th Medical Depot Company. There, counting both patients and hospital personnel, more than 800 persons were housed in space designed to accommodate about 200. Enough equipment and supplies were saved to operate the hospital for 48 hours, which proved to be long enough for the inundated roads to become usable.
As soon as vehicles could get through, a pool of fifty ambulances formed by the 162d Medical Battalion picked up the stranded patients and distributed them among fixed hospitals in Leghorn and Fifth Army units in the II Corps area. Although most of its equipment was ultimately salvaged, the 38th Evacuation was for the time being rendered inoperative, and its personnel were placed on temporary duty with other medical installations.
To replace the 38th Evacuation, the 170th opened at Viareggio on 6 November, and a unit of the 32d Field Hospital, augmented by a platoon of the 615th Clearing Company, 163d Medical Battalion, established a 250-bed hospital at Montecatini. The Viareggio site was closeto the 92d Division`s front in the coastal sector, while Montecatini was accessible both to the center and the right flank of IV Corps. A portion of a civilian hospital in Lucca, about midway between the two sites on an east-west line, was also requisitioned for nontransportable casualties, which were cared for by surgical teams of the 38th Evacuation.
Winter Dispositions
By early November it was clear that military activity would be strictly limited for sometime to come, and the task of preparing army hospitals for the winter began. The 16th Evacuation, which had been twice flooded at Firenzuola, was moved back on 10 November to Pistoia, where Highway 64 enters the mountains from the Arno plain. The site had been intended for the 38th, but that unit was still immobilized.18
The Brazilian medical personnel were transferred at this time from the 38th Evacuation to the 16th, which was now just behind the Brazilian sector. Normally the Brazilians took complete care of their own wounded, but when the load was heavy U.S. medical officers served as assistant surgeons on Brazilian teams. Brazilian surgeons similarly acted as assistants on U.S. teams when American casualties were heavy.
On 19 November the 38th Evacuation took over the Montecatini site, as well as the clearing platoon that had been operating there. The field hospital unit from Montecatini moved up Highway 64 to the vicinity of Porretta in the Brazilian sector where, with two Brazilian and two U.S. surgical teams, it operated as asmall evacuation hospital throughout the winter. Another unit of the 32dField Hospital supplanted the 170th Evacua-
18 Principal sources for this section include: (1) Annual Rpts, Surg, Fifth Army, 1944,1945; (2) Annual Rpts, Surg, II Corps, 1944, 1945; (3) Annual Rpt, Surg, IV Corps, 1944; (4) Unit rpts of the med units mentioned in text.
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tion at Viareggio after the latter had been twice damaged by enemy shells. The 170th moved on 25 November to Lucca, carrying with it 150 patients, many of them litter cases. (Map37)
The 3d Convalescent Hospital, deep in mud at Pratolino, found the task of winterizing its 300 tents too great and in late November began moving to Florence for the winter. Before the move was completed, however, adequate quarters were found in a group of hotel buildings in Montecatini, where the hospital was established just before the end of the year. One factor involved in the change of plans was the advantage of having a convalescent hospital located in a rest area where patients were able to benefit from the recreational facilities available. In mid-January, Brazilian personnel were attached to the 3d Convalescent.
Other Fifth Army hospitals remained where they were throughout most or all of the winter, making do as best they could against the hazards of mud, cold, snow, and wind. A move to reopen the 94th Evacuation at Monghidoro late in December was abandoned, and the medical service of that unit continued to operate in Florence in conjunction with the 15th Evacuation, taking half of the medical cases admitted to the joint installation, which functioned under a single administration as a 1,000-bed station hos-
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BRAZILIAN NURSES ATTACHED TO THE 16TH EVACUATION HOSPITAL
pital. The surgical service of the 94th remained at the forward location, despite cold and snow that reached a depth of four feet, until mid-February, when renewed enemy shelling again forced abandonment of the site. The surgical service then ceased to function as such, but surgical teams were placed on temporary duty with the 32dField and the 8th Evacuation. A number of the nurses also went on detached service with other units. Tentage was left at Monghidoro under guard. (Map38)
A few miles farther back on Highway 65, the 8th Evacuation stuck out the winter at Pietramala, the coldest spot on the II Corps front. Tents were floored and walled to a height of 4 1/2 feet with wood, and reinforced by overhead beams against the weight of the snow, but even these precautions were not always protection against the gales that swept periodically across the sloping hospital area. On 8 December, before the winterizing was complete, a double ward tent, flooring sidewalls and all, was lifted clear off the ground, carried over6 wards and dropped on another tent. All together, 8 tents were blown down and others damaged. The hospital census was low at the time and no patients were injured, but it was necessary to send 30 or 40 postoperative cases to the 15th Evacuation in Florence. After that ex-
443
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perience, wood and prefabricated steel buildings were placed at the two ends of each row of ward tents and secured by steel cables anchored to buried logs. As if wind and cold were not enough, the 8th Evacuation also wrestled with the perennial problem of mud. At least 5,000 truck loads of rock were used to maintain roads in the vicinity of the hospital area before the unit left the site late in April. As the most forward hospital in the II Corps zone, the 8th Evacuation handled the bulk of the casualties for the first three months of 1945, battle wounds exceeding medical cases.
The Scarperia site, where the 56th Evacuation Hospital spent the winter, was only slightly more favorable than that of the 8th at Pietramala. As at the more forward installation, cold, snow, and wind were intermittent hazards, and the battle against mud a never-ending problem. Patients came mostly from the corps right flank, down Highway 6524.
In response to General Martins urgent appeal for more beds, the 15th Field Hospital was returned to Italy late in the year, one platoon coming from southern France and the other two from Corsica. Just before the end of December the unit was set up east of Highway 65 and two or three miles north of Cafaggiolo, where it operated as a 400-bed hospital for medical cases. With specialists from the 6th General Hospital attached, the 15th Field took over the psychosomatic work performed since October by the 1st Platoon of the 601st Clearing Company, the latter unit becoming a hospital for general medical and slightly wounded cases in mid-January. The 1st Platoon of the 602d Clearing Company, which had also been associated with the psychosomatic center at Cafaggiolo, remained in the area for another month as a medical hospital, then shifted to Prato, between Florence and Pistoia on the edge of the Arno plain, where it continued in the same capacity. The neuropsychiatric hospital remained throughout the winter at Cafaggiolo, taking cases direct from the clearing stations and from the 15th Field Hospital.
In connection with its general medical work, the 15th Field made detailed studies of the major types of medical cases occurring among front-line troops to determine whether a strictly medical forward hospital could retain such cases in the army area and thus hasten return to duty. A section of the 2d Medical Laboratory was attached. At the same time, observers were sent to other field hospitals where they studied the technique of operating as forward surgical units in preparation for a similar role in the spring offensive.
In the IV Corps sector no changes were made in hospital sites after the first of the year. The enemy thrust in the Serchio Valley late in December led to preparations for heavy casualties including plans for reinforcing the 170th Evacuation at Lucca, should that be necessary. Pigeons were sent to the 170th as insurance in case phones were down, and all of the hospitals patients were evacuated to base installations. The counterattack, however, was quickly stopped, and medical units remained in place.
In Florence the venereal disease hospital and the Fifth Army prosthetic and operative dental clinic, both administered by the 2d Platoon of the 602d Clearing Company, 162d Medical Battalion, took patients from II and IV Corps of Fifth Army. The lull in hostil-
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8TH EVACUATION HOSPITAL AT PIETRAMALA, coldest spot on the II Corps front.
ities was reflected in late March by an increase in venereal beds from 250 to 290.
Evacuation From Fifth Army
Evacuation to Army Hospitals
Throughout the North Apennines Campaign and the winter stalemate, evacuation from corps to army installations was carefully controlled by the Fifth Army evacuation officer, Colonel Camardella. As has already been noted, the 54th Medical Battalion, responsible for evacuation from II Corps, maintained an ambulance control point on Highway 65 to which daily quotas for each evacuation hospital were telephoned every morning. During the early part of the campaign, inadequate bed strength and heavy casualties made it impossible to follow a fixed policy with consistency, but so far as circumstances permitted, the patient census of the most forward hospital was kept relatively low to guard against sudden emergency. In general, evacuation during daylight hours was to installations farther to the rear, while the most forward unit took the bulk of the casualties at night to shorten the hazardous ambulance runs. Except in emergency, not more than 100 surgical cases were admitted to any given hospital in a single day. When the number of casualties began to decline in
446
AMBULANCE ON ICY ROAD, LOIANO AREA
November, a system of triage at the ambulance control point was instituted, patients being routed to those hospitals best equipped to care for them.19
All transportation of patients within the corps area was by ambulance over roads often deep in mud or heavy with snow. During the early months of 1945, vehicles were frequently able to cover no more than five miles an hour. The system nevertheless worked satisfactorily both under the most severe conditions of combat and in the worst weather of the winter.
On the IV Corps front, supported as it was by only one evacuation hospital until mid-November, no selectivity was possible. Even after November, when evacuation hospitals were sited at Lucca,
19 Principal sources for this and the following section are: (1) Annual Rpts, Surg Fifth Army, 1944, 1945; (2)Fifth Army History, pt. VII, pp. 48-50; (3) Annual Rpts, Surg, II Corps, 1944, 1945; (4) Annual Rpt, Surg, IV Corps, 1944; (5) Annual Rpts, 1944, 1945, of 54th, 161st, 162d, 163d Med Bns; (6) Annual Rpt, Med Sec, MTOUSA, 1944; (7) Final Rpt, Plans and Opns Off, Office of Surg, MTOUSA; (8) Hist Rpts, 1944 and 1945, of 802d and 807th Med Air Evac Transport Squadrons, AF; (9) Annual Rpt, 41st Hosp Train, 1944; (10) Annual Rpt, Surg, PBS, 1944; (11) Semimonthly Med Sitreps, Surg, PBS, Sep 44-Mar 45.
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Montecatini, and Pistoia, the road network did not permit the full application of a quota system. The 163d Medical Battalion found it necessary to operate ambulance control posts on each of the main axes of the corps advance in order to rout emergency cases to the nearest hospital. It was nevertheless possible by co-ordinating these posts to regulate the flow of patients to some extent.
Evacuation to Base Hospitals
The problem of clearing Fifth Army hospitals during the first several weeks of the North Apennines Campaign was complicated by factors outside the control of the army surgeon. At the start of the offensive early in September there were only two fixed hospitals in northern Italy, the 64th General near Leghorn and the 55th Station attached to it. A few other units were on the way, but the prospect of an early breakthrough into the Po Valley precluded establishment of more beds than were absolutely necessary south of the mountains. All casualties from southern France, moreover, were still going to Naples, leaving few beds available for movement elsewhere. At the same time, the shortage of mobile beds in the Fifth Army area made it essential to transfer patients to base installations without unnecessary delay.
The only base hospitals available were those in Rome and Naples, and the only means of reaching them was by air. For the first 10 days of the offensive, patients from the forward evacuations were carried by ambulance to the Rosia airfield southwest of Siena and some 50 miles from Florence, whence they were flown to the rear by planes of the 802d and 807th Medical Air Evacuation Transport Squadrons. Before 20 September, 936 patients went to Naples and 2,295 to Rome. On that date the Florence airfield became operable, and by the last day of the month 1,445 Fifth Army patients had been flown from that field to Naples, along with 1,397 to Rome.20
The 24th General Hospital opened in Florence on 21 September with 1,000 beds, and a week later 2 station hospitals with an aggregate of 1,250 beds moved into the Leghorn area to which IV Corps casualties were being routed. Despite these additional fixed beds, the situation became acute in the first week of October when bad weather prevented any airlifts to the rear. In addition to a capacity load of patients from forward evacuation hospitals, the 24th General also had to find room for those already in holding units at the Florence airfield. During the second week of October, Fifth Army was given air priority over Seventh Army, but intermittent poor weather conditions prevented full use of it, and in the last week of the month all planes were grounded. The limited number of flying days held air evacuation to Rome and Naples to 5,000 for October and left forward hospitals dangerously crowded. As a relief measure, all transportable patients from the 24th General were carried by ambulance to Leghorn late in the month. On 21 October control of air evacuation passed from the Surgeon, Fifth Army, to the Surgeon, Peninsular Base Section.
20 These and subsequent figures for air evacuation in the text are from the reports of the two MAETS squadrons. They do not agree entirely with figures given in the annual report of the Surgeon, MTOUSA, for 1944, which are for patients received by air at PBS hospitals, but it is believed the MAETS tabulations are the more accurate.
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Meanwhile, as the prospects for a breakthrough before winter faded, more fixed beds were coming into northern Italy. Two thousand more beds were established during October in the Leghorn area, and the 250-bed 55th Station Hospital took over the Pratolino site from the 94th Evacuation, bringing the total to 4,750 at Leghorn and 1,750 in the Florence area.
In November, with southern France no longer a drain upon the facilities of the Mediterranean theater, the situation eased considerably. Patients from the II Corps area were thereafter triaged at the Florence airfield, being flown to the rear if aircraft were available or, it not, distributed among fixed hospitals in the vicinity. The 2,000-bed 12th General Hospital joined the group at Leghorn early in December. January saw the establishment of a 500-bed station hospital in Florence, one in Pisa, and the 1,500-bed 70th General in Pistoia bringing the T/O total to 11,000 fixed beds. In February air evacuation began between Florence and Leghorn, and rail evacuation was started between Florence and Leghorn by way of Montecatini.
Evacuation from Fifth Army units to airfields or to base hospitals in the immediate rear of the army was by the 161st and 162d Medical Battalions, both of which had reduced their collecting companies to ambulance companies in order to supply personnel to their clearing platoons for the operation of special hospitals. In the II Corps area, the 162d detailed enlisted men late in November to operate emergency aid stations along Highway 65 for stranded ambulances.
Air evacuation to base hospitals in Naples continued throughout the winter on a modest scale, but the emphasis was increasingly on holding in army hospitals all patients who might recover in time for duty during the planned spring offensive. Evacuation policy in army installations during the first three months of 1945 was 60 to 120 days.
Medical Supplies and Equipment
In preparation for the Gothic Line offensive the 3d Storage and Issue Platoon of the 12th Medical Depot Company moved to the vicinity of Florence the last day of August, with the mission of supporting II Corps. On 14 September headquarters of the company and the 1st Storage and Issue Platoon established the main Fifth Army medical supply depot in Florence, and three days later the 2dStorage and Issue Platoon set up an issue point for IV Corps in Pisa. All units were in buildings, the main dump being located in a pharmaceutical plant that the Germans had rendered unfit for anything but storage.21
The IV Corps dump moved to a more central location in Lucca on 30 November, but was still too remote from portions of the long corps front to be readily accessible to combat medical units. To compensate for distance, the supply section of the clearing company, 163d Medical Battalion, was enlarged to maintain a forward dump for the corps in the vicinity of Valdibura. The II Corps
21 This section is based on the following documents: (1) Annual Rpts, Surg, Fifth Army, 1944, 1945; (2) Annual Rpts, Surg, II Corps, 1944, 1945; (3) Annual Rpts, Surg, IV Corps, 1944, 1945; (4) Annual Rpts, 12hMed Depot Co, 1944, 1945; (5) Davidson, Med Supply in MTO, pp. 108-13;(6) Unit rpts of Fifth Army med bns and hosps.
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depot moved on 15 October to Filigare on Highway 65 just below Monghidoro. This dump maintained heavy stocks of intravenous solutions, dressings, blankets, litters, and cots throughout the winter as a safeguard against the possibility that snow might interrupt communication with the Florence depot.
The Florence depot received its own stocks by truck from the PBS dump in Leghorn. Little in the way of local procurement was possible, but the repair and maintenance section was active and much equipment was salvaged. The optical and dental sections were also active during the winter months, which were largely devoted to reconditioning both men and equipment.
Professional Services in the Army Area
Medicine and Surgery
Forward Surgery-Front-line surgery in the North Apennines Campaign followed the pattern that had been steadily evolving since operations in Sicily, but with greater pressure than ever before on the surgical staffs. The withdrawal of three evacuation and two field hospitals for use in southern France, together with the loss of half of the 2d Auxiliary Surgical Group, meant that field units supporting II Corps in the northern Apennines were overcrowded during the weeks of heaviest combat, and surgical teams worked without regard to hours. Surgical teams from base hospitals were used to replace in part the teams sent to France, but the nature of their experience precluded their use in forward units. Instead, they were placed in the evacuation hospitals, while teams from the evacuations were detailed to field hospitalunits.22
Experience had shown that to perform effectively under front-line conditions, surgical teams must be able to handle any type of case received. General surgical teams were chosen in preference of those specializing in some particular phase that, by its infrequent occurrence, might limit their usefulness. Base hospital surgeons were apt to be too specialized, but surgeons whose experience had been gained in evacuation hospitals were likely to be possessed of a wider range of skills. Although the loss of surgical teams was thus minimized as much as possible and the high standards of forward surgery were maintained, the output per man was less than it would have been had the 2d Auxiliary Surgical Group been retained in Italy intact.
Another factor tending to increase the burden on front-line surgeons during the North Apennines Campaign was a more liberal policy in the selection of nontransportable cases. Fifth Army studies made earlier in the year indicated that many who died in evacuation hospitals could have been saved by the more prompt attention possible in a hospital closer to the front, and a larger proportion of combat wounds accordingly received initial surgery in the field hospitals. All cases of shock, or those who had been in shock, for example, were sent to the field units, as well as those with wounds with extensive muscle
22 Principal sources for this section are: (1) Annual Rpts, Surg, Fifth Army, 1944,1945; (2) Rpts of 2d Aux Surg Gp, including rpts of individual teams, 1944 and 1945; (3) Annual Rpt, Med Sec, MTOUSA, 1944; (4) Periodic Rpts, ad Med Lab, 1944, 1945; (5) ETMD`s for Sep 44 through Mar 45.
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amage 23 The triage of chest, abdominal, maxillofacial, and head wounds also tended to route a larger proportion of cases to the field hospital units close to the frontlines. Shell fragment wounds continued to predominate substantially overall other causative agents combined, but the percentage of wounds from land mines rose somewhat.
Penicillin and whole blood were again major factors in the saving of life and limb, blood being used on an expanding scale as a result of studies made during the Rome-Arno Campaign. A distribution section of the 6713th Blood Transfusion Unit was established with the 2d Medical Laboratory in Florence in mid-September, but the blood distributed was still flown from Naples. In February 1945 a bleeding station was set up in Florence to supplement the supply from the Naples blood bank. Approximately 15,500 battle casualties in the last four months of 1944 received close to 10,000 pints of whole blood in corps and army installations.
Fifth Army hospitals were visited by the theater orthopedic consultant, Colonel Hampton, in September and by Colonel Churchill, theater consultant in surgery, in October and November. Lt. Col. (later Col.) Howard F. Snyder, the Fifth Army surgical consultant, spent most of his time in the forward area.
Neuropsychiatry and Rehabilitation- Early in the North Apennines Campaign the forward treatment of psychiatric casualties was extended to include all those having upper gastrointestinal tract symptoms, since experience had shown that 85 percent of such cases showed no significant organic pathology. A gastrointestinal center was set up by the 1st Platoon of the 601st Clearing Company, 161st Medical Battalion, on 23 October 1944 in the vicinity of Cafaggiolo, where it was adjacent to the neuropsychiatric center operated by the 2d Platoon of the same company. Maj. (later Lt. Col.) James A. Halstead of the 6th General Hospital was made chief of the gastrointestinal service, continuing in that capacity when the function was shifted to the 15th Field Hospital in January 1945. The center was the first organization of its type to be established in an American field army.24
All cases diagnosed as gastrointestinal at the clearing stations were sent to the center and others were referred from the evacuation hospitals. No case of this type left the army area without passing through the gastrointestinal center where those of psychosomatic origin
23 See The Board for the Study of the Severely Wounded, North African-Mediterranean Theater of Operations, The Physiologic Effects of Wounds, "Medical Department, United States Army," sub-series Surgery in World War II (Washington,1952). This volume contains the complete report of a medical board, appointed 1 September 1944 by the Surgeon, NATOUSA, "to study the treatment of the severely wounded." The board was particularly interested in the effects and control of wound shock.
24 Principal sources for this section are: (1) Annual Rpts Surg, Fifth Army, 1944, 1945; (2) Annual Rpt, Surg, II Corps, 1944; (3) Annual Rpts, 161st MedBn, 1944, 1945; (4) Annual Rpt, 15th Field Hosp, 1945; (5)Periodic rpts of surgs and organic med bns of 34th, 85th, 88th, 91st, 92d, 1st Armored, and 10th Mountain Divs; (6) ETMD`s, Sep 44-Mar 45; (7) Maj. James A. Halstead and Capt. Paul Scott Hansen, "The Management of Intestinal Diseases in the Army Area," Medical Bulletin, Mediterranean Theater of Operations (May 1945); (8) Maj. James A. Halstead, "The Management of Patients with Gastric Complaints in the Army Area, "Medical Bulletin, Mediterranean Theater of Operations (June 1945); (9) Hanson, comp. ed., "Combat Psychiatry," Bulletin U.S. Army Medical Department, Suppl. Number (November 1949).
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were identified and treated as such. During the 6 months of its existence, 442 patients were admitted to the center, of whom 74 percent were returned to full duty, 11 percent to limited duty, and only 15 percent were evacuated to base hospitals. Of the total, 286 cases were diagnosed as psychogenic dyspepsia showing definite neurosis without evidence of organic disease. Another 78 cases showed neither organic disease nor positive evidence of neurosis. There were 22 cases of peptic ulcer, 4 of chronic gastritis, and 20 of acute gastritis. Thirty-two cases were rediagnosed as hepatitis without jaundice.
The average period of hospitalization in the gastrointestinal center was 9.1 days, compared with 21 days for similar cases in base hospitals. Moreover, only 55 percent of those treated in base hospitals returned to combat duty, and those who did return lost an additional 14 days in the replacement system.
Taken as a whole, the treatment of neuropsychiatric casualties in the army area showed gratifying improvements during the months of active combat, despite the large number of such cases in September and October. The rehabilitation and training centers established in each of the combat divisions in the late summer proved to be a major factor in promoting the prompt return to duty of hundreds of men who might otherwise have gone too far to be reclaimed for combat. The 85th Division experimentally carried the program a step further when the 337th Infantry regiment set up its own training and rehabilitation center. It was notable that the 337th had less than half the psychiatric casualty rate of the other two regiments in the same period.
In December 1944,more than 90 percent of all Fifth Army psychiatric casualties were returned to duty, as compared with only 26 percent at the beginning of the year.(Table31)
Diseases of Special Interest- The major disease problem of Fifth Army during the months of the North Apennines Campaign was infectious hepatitis, which followed the pattern of the previous fall but was more widespread. The disease reached its peak in December 1944, whereas October had been the month of highest incidence in 1943. The maximum rate per 1,000 per annum was 211 for the week ending 15 December 1944, compared with a high of 121for the second week of October 1943. The sharp rise in hepatitis cases began late in October 1944, leveled off in November, rose sharply again in December, then gradually declined to what may be termed a "normal" rate in March.25
Again the disease appeared most frequently among combat troops, and again revealed an amorphous relationship to intestinal diseases, the curve for hepatitis following by about a month the curve for intestinal infections. In the second winter, however, hepatitis appeared most frequently among new troops in contrast to the experience of 1943, which showed a higher incidence among veterans. Evidence tended to indicate both the intestinal and respiratory tracts as possible sources for infection, but remained inconclusive as to the actual mode of transmission.
25 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Annual Rpts, Surg, Fifth Army. 1944, 1945; (3) ETMD`s for Sep44 through Apr 45; (4) Whayne and DeBakey, Cold Injury, Ground Type, ch. VI. See also pp. 261-62. above.
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TABLE31- DISPOSITION OF NEUROPSYCHIATRIC CASES, FIFTH ARMY SEPTEMBER 1944-MARCH1945
Atypical pneumonia struck hard at certain units that had only physical location in common, rising from 39 cases in November to 415 in March 1945. An outbreak of typhoid fever in the 349th Infantry Regiment of the 88th Division in November was quickly brought under control and kept from spreading.
Trench foot, which had been one of the greatest wasters of manpower in the winter of 1943, was again a factor but was far less destructive, thanks to prompt preventive measures. The condition first appeared in October. Shoe pacs were issued in the middle of November, together with heavy wool socks, but the pacs were not always properly fitted and the men were not always told they were to wear two pairs of socks. Instructions were clarified by December, and dry socks were issued with rations. Although weather conditions were more severe and the strength of the affected divisions greater, there were only 1,572 cases of trench foot between October 1944 and April 1945, compared with 5,752 for the comparable period a year earlier. Only 1.7 percent of the divisional troops were afflicted, as against 7 percent in the winter of 1943-44.
The winter months of 1944-45 also showed a lowered incidence of venereal disease in Fifth Army compared with the corresponding months of 1943-44, owing in part to less opportunity for exposure but also in part to improved preventive discipline.
Dental Service
The mobility of the Fifth Army dental service was further increased in the
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course of the North Apennines Campaign, under the direction of Col. Thomas F. Davis, who became Fifth Army dental surgeon late in September 1944. In addition to the army dental clinic operated by the 2d Platoon of the 602d Clearing Company, 162d Medical Battalion, and sited with the venereal disease hospital in Florence, both corps maintained prosthetic and operative clinics of their own. The II Corps clinic, administered by the 54th Medical Battalion, was at Traversa, while another clinic operated by the 33d Field Hospital, was sited with the corps supply depot just below Monghidoro. The IV Corps clinic, staffed jointly by the 163d Medical Battalion and the 32d Field Hospital, was located at Valdibura. Two dental laboratory trucks and two dental operating trucks assigned to the 12th Medical Depot Company were placed in operation in November. Two additional operating trucks were assigned to the 2d Auxiliary Surgical Group, and were operated in the forward areas by teams of that unit.26
Late in 1944 the divisional dental service of Fifth Army was reorganized to bring the regimental and other dental officers of each division under more direct administrative control of the division dental surgeon and permit concentration of skills where they were most needed. At the same time the construction of mobile dental dispensaries on 1-ton trailer chassis was authorized on the basis of five for each infantry division and seven for the armored division. Thirty-four of these trailer dispensaries were in operation by May 1945.
The dental service of the 1st Brazilian Division was organized along much the same lines as that of comparable U.S. units. There were two dental officers with each infantry regiment, one with the division artillery, one with special troops, and one or two with the medical battalion. Dental officers also served with the Brazilian medical staffs attached to U.S. hospitals. Arrangements were made in November by the theater dental surgeon, Colonel Tingay, to supply U.S. equipment wherever the Brazilian equipment was below standard.27
The ratio of dental officers to Fifth Army strength remained fairly constant for the 7 months of the North Apennines Campaign. In September 1944 there was 1 dental officer for every 902 army troops. The ratio improved to 1 :828 in November, but fell again to 1:937 for March 1945. The number of dental officers in Fifth Army rose from 157 in September 1944 to 184 in March 1945.
Dental service rendered by these officers and their enlisted technicians to Fifth Army troops during the 7-month period is summarized in Table 32.
Veterinary Service
In the North Apennines Campaign, the combat divisions did not maintain their own provisional pack trains, as they had during the mountain fighting in southern Italy. By September 1944 animal transportation was exclusively by Italian pack trains, which were attached
26 Principal sources for this section are: (1) Annual Rpts, Surg, Fifth Army, 1944,1945; (2) Annual Rpt, Med Sec, MTOUSA 1944; (3) Annual Rpts, Surg, II Corps, 1944, 1945; (4) Annual Rpt, Surg, IV Corps, 1944; (5) MS, Dental History, Mediterranean Theater of Operations; (6)Unit rpts of div surgs and med installations in Fifth Army during the period1 Sep 44-31 Mar 45.
27 Dental Inspection, by Col Tingay, 4 Nov 44.
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TABLE32- DENTAL SERVICE IN FIFTH ARMY, SEPTEMBER 1944-MARCH 1945
to the combat units as circumstances required. Ten pack mule companies operated with Fifth Army during the fall and winter of 1944, and five more were organized in February 1945.28
Animal casualties from the pack mule companies went to one of the four Italian-staffed veterinary hospitals supporting Fifth Army. The 110th Veterinary Evacuation was at Vaglia, about twenty miles north of Florence on Highway 65, from 14 September to 17 October, and for the remainder of the period was sited at Pietramala, near the 8th Evacuation Hospital. The 130th Veterinary Evacuation opened at Cafaggiolo on 16 September where it remained, sharing the location with the 212th Veterinary Station Hospital between 2 October and 6 January. The 212th moved to Lucca on 8 January to support the animal units of IV Corps. The 211th Veterinary Evacuation was inactive during most of the winter, opening at Pontepetri in the IV Corps area on 24 February 1945.
It was the general consensus of American veterinary officers that all of these Italian units were poorly equipped and inadequately staffed. They were redesignated early in 1945 as U.S.-Italian units, and were thereafter supplied and equipped from U.S. sources and operated under closer supervision. The three veterinary evacuation hospitals had Table of Organization capacities of 150 stalls and the station hospital had a capacity of 250, but staff and site limitations seldom permitted full operation. The shortcomings of the Italian veterinary hospitals were felt most acutely during the period from late September to the end of October, when forward positions could be supplied only by mules, and animal casualties were high. Aggregate animal strength of the10 pack trains serving Fifth Army at this time was less than 3,000, with casualties be-
28 Principal sources for this section are: (1) Annual Rpts, Surg, Fifth Army, 1944,1945; (2) Vet Inspection Rpts, Sep 44, Mar 45; (3) Annual Rpt, Med Sec, MTOUSA, 1944; (4) Annual Rpt, Surg, 10th Mountain Div, 1945.See also, Miller, United States Army Veterinary Service in World War II, ch. XXII
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TREATING A WOUNDED MULE OF AN ITALIAN PACK TRAIN
tween 9 September and the end of the year 1,110 killed and 765 wounded.
Evacuation of sick and wounded animals, both from pack trains and from veterinary hospitals, was by truck, but until late December no vehicles were available except on loan from service units. At that time Colonel Pickering, Fifth Army veterinarian, secured authorization to supply both pack companies and veterinary hospitals with reconditioned U.S. or captured enemy trucks, and most of the units were so supplied by the end of the year. Replacement animals were received through the 6742d Quartermaster Remount Depot. To achieve better administrative control, the Italian pack mule companies were grouped early in 1945 into 5 battalions and brought under the supervision of the newly activated 2695th Technical Supervision Regiment. Three American veterinary officers were assigned to this organization, one to each of 3 pack mule battalions. The other 2 battalions were periodically inspected by these officers.
The relatively large veterinary staff of the 10th Mountain Division--22 officers and 182enlisted men--had little to
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do in their first three months in Italy, since none of the divisions animals reached the theater before spring.
In addition to horses and mules, and the pigeons that were a normal part of the Signal Corps organization, Fifth Army veterinarians were called upon to care for 125 scout dogs that reached the front during the winter.
No unusual problems were encountered by the food inspection units operating with Fifth Army.
