The Italian Communications Zone
As the war in Italy moved into the northern Apennines, the communications zone was extended up the peninsula to the Arno Valley. The requirements of the campaign in southern France, however, delayed the northward movement of medical installations and placed an undue burden on the evacuation facilities. It was not until Fifth Army had been stalled by snow and mud a short ten miles from the Po plain and Seventh Army had passed to control of the European Theater of Operations that a sweeping realignment of communications zone activities was possible.
Organizational Changes Affecting the Medical Service
Theater Medical Organization
Since February 1944 responsibility for the operating functions of the Medical Department in the Italian communications zone had rested with the medical section of the Services of Supply organization--SOSNATOUSA, redesignated Communications Zone, NATOUSA, as of 1 October. By midsummer of 1944, the medical section was deeply involved in preparations[or the invasion of southern France, and furnished key personnel for the base organizations that followed the Seventh Army advance. This diversion of personnel necessarily increased the work load of those remaining in Italy, but the situation was understood to be temporary since logistical support of the 6th Army Group would ultimately become the responsibility of ETO. Shortly after the command of Seventh Army passed to SHAEF on 15September, the date for the transfer of the supporting functions, including medical, was fixed as 1 November.1
At this time, however, the SHAEF commander, General Eisenhower, indicated his desire that an operating communications zone organization be part of the transfer. In effect, Communications Zone, NATOUSA, was to go over to ETO as the Southern Line of Communications (SOLOC), leaving the American component of Allied Force Headquarters to develop a new organization to carry on communications zone functions in the Mediterranean theater. For the Medical Department, the most practical solution appeared to be the resumption of operating functions by the Medical Section,
1 Principal sources for this section are: (1)Annual Rpt, Med Sec, MTOUSA, 1944; (2) Hist, Med Sec, Hq COMZ MTOUSA; (3) Munden, Administration of Med Dept in MTOUSA, pp. 129-78; (4)Davidson, Med Supply in MTOUSA, pp. 155-56; (5) Logistical History of NATOUSA-MTOUSA. See also pp 399-401, above.
NATOUSA, which would in addition assume the medical supply responsibilities formerly exercised by the SOS organization.
On 1 November 1944 the theater boundaries were redrawn to exclude southern France, and the North African Theater of Operations, United States Army (NATOUSA), was redesignated Mediterranean Theater of Operations, United States Army (MTOUSA). The organization was completed on 20 November when Communications Zone, MTOUSA, ceased to exist, and the functions of its medical section were formally assumed by the Medical Section, Headquarters, MTOUSA. The consolidation was effected with the transfer of only 5 officers and 16 enlisted men from the outgoing group, all of them specialists in medical supply.
Few changes were necessary in the composition of the MTOUSA medical section. Maj. Gen. Morrison C. Stayer continued as theater surgeon with Colonel Standlee as his deputy. Lt. Col. (later Col.) Joseph Carmack, administrative officer, Col. William C. Munly, medical inspector, and Col. William S. Stone, preventive medicine officer, were among the section heads whose functions were unchanged. Neither the surgical consultants section, headed by Colonel Churchill, nor the medical consultants section, which included Colonel Long as medical consultant and Colonel Hanson as consultant in neuropsychiatry, was affected by there organization. The MTOUSA dental officer, Colonel Tingay, and the theater veterinarian, Colonel Noonan, were also unaffected by the reorganization. The replacement of Colonel Wilbur, director of nurses, by Lt. Col. Margaret E. Aaron on 14 December was a matter of normal rotation, not related to any change in functions. Colonel Aaron had served in the European theater, where she had been Director of Nurses, SOS ETOUSA.
In the reorganized Medical Section, MTOUSA, hospitalization and evacuation fell into the experienced hands of Col. Albert A. Biederman, who had rejoined the section as the plans and operations officer early in September after six months with the SOS organization. Only in the area of medical supply, which had never been an operating function of the MTOUSA medical section, was it necessary to add significantly to the staff. Colonel Radke, who had been NATOUSA medical supply officer since the spring of 1943, remained in that capacity until 20 December, but his role continued to be confined to the policy level. The operating functions were performed under the direction of Colonel Jones, who had
headed the SOS medical supply section since May 1944. Jones brought with him from the medical section of Com Zone MTOUSA, a trained staff and a functioning organization. He succeeded Radke as MTOUSA medical supply officer on 21 December.
The MTOUSA medical section moved out of the royal palace in Caserta on 12 November to the quarters formerly occupied by the SOS medical section in an Italian military hospital. On 23 November the personnel allotment of the section was increased to cover losses, and on 24 December an additional officer and 3 enlisted men were allocated to it, bringing the authorized total to 32 officers, including2 nurses, and 80 enlisted men. Three medical officers were added in May 1945, bringing the aggregate personnel strength of the section to 115.
Concentration of Communications Zone Functions in Italy
The November 1944 reorganization brought the base sections back under the control of theater headquarters at a time when the progress of the war was concentrating the Mediterranean forces in northern Italy. The invasion of southern France had left the theater short of troops, transportation, equipment, and hospital beds, and it was therefore essential to eliminate so far as possible the factor of distance.2
In North Africa, which had been substantially stripped of supplies and hospital beds to buildup the bases in southern France, the Eastern and Atlantic Base Sections were absorbed by the Mediterranean Base Section on 15 November. The base section headquarters was moved from Oran to Casablanca early in December and on 1 March 1945 the whole of North Africa passed to control of the Africa-Middle East Theater.3
With all of southern France and all of Italy south of the Arno firmly in Allied hands, the Mediterranean islands also lost their strategic importance. The Island Base Section in Sicily had already been closed out in mid-July, and the last U.S. hospital left Sardinia the end of October. The Northern Base Section, consisting of the island of Corsica, continued in operation on a reduced scale until the end of the war, being finally closed out on 25 May 1945.
The Peninsular Base Section, on the other hand, grew in importance as the African and island bases declined. As soon as the facilities of the port of Naples and the hospitals concentrated in that vicinity were no longer needed for the logistical support of the forces in southern France, the base section began shifting its strength to the Leghorn-Florence Pisa triangle. PBS headquarters was established in Leghorn on 25 November, the sub headquarters in Naples thereafter being designated as PBS South. Colonel Arnest, the PBS surgeon, moved to Leghorn with the base headquarters, leaving Col. Leo P. A. Sweeney as his deputy in Naples.
At the same time the U.S. component of Rome Allied Area Command was
2 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Final Rpt, Plans and Opns Off, Office of the Surg, MTOUSA; (3) Annual Rpt, Surg, PBS, 1944; (4) Annual Rpt, Surg, MBS, 1944; (5) Annual Rpts, Surg. NORBS, 1944, 1945; (6) Annual Rpt, Surg, Rome Area, 1944; (7) Monthly Hist, Med Sec, Rome Area, Jan-May 45; (8) AAFSC MTO, Annual Med Hist, 1945.
3 For subsequent activities, see pp. 80ff., above.
redesignated Rome Area, MTOUSA, effective1 December. The Rome Area surgeon was Lt. Col. (later Col.) Benjamin L. Camp, who also retained his office as deputy to the RAAC surgeon, Col. T. D. Inch of the Royal Army Medical Corps. The single U.S. fixed hospital scheduled to remain in Rome was brought under the Rome Area jurisdiction ,together with responsibility for sanitation, venereal disease control, and other miscellaneous medical functions.
Similarly, the Adriatic Depot was reconstituted on 28 February as the Adriatic Base Command (ABC) with headquarters at Ban. Though its primary mission was still that of supporting the U.S. Army Air Forces units in Italy, it was made responsible directly to MTOUSA. After detailed study of the point, the hospitals previously attached to the Army Air Forces Service Command were brought under the aegis of the Adriatic Base Command.
By the end of hostilities, the medical activities of the communications zone in the Mediterranean theater centered in PBS Main at Leghorn, with lesser and largely subsidiary bases in Naples, Rome, and Bari.
Hospitalization in the Communications Zone
The inadequacy of medical facilities in the Mediterranean theater was never more obvious than at the start of the bitter and costly campaign in the northern Apennines. In the first days of September 1944, the Italian communications zone was as deficient in bed strength as was Fifth Army. Nine thousand T/O fixed beds were already closed or alerted for closing in Italy for movement to southern France, plus another 4,500 in North Africa, and 750 in Corsica. In Italy the total would be 21,900 under control of the Peninsular Base Section and 3,200 attached to the Army Air Forces. Of the PBS total, more than half were in the Naples-Caserta area, 300 miles from the Fifth Army front, and only 4,000 north of Rome.
The problem thus posed for General Stayer and Colonel Arnest was immeasurably complicated by the necessity of hospitalizing in Italy for an indefinite time the casualties evacuated from southern France. Yet until the hospitals already closed in Italy and Africa could be reestablished in France there was no alternative. For the next two months the Italian communications zone, with 25 percent of its strength already withdrawn, would support two field armies, each engaged in a major campaign. It would support them, moreover, at long range, for the patient load would be too great to permit any substantial number of beds to be closed for movement closer to the front.
Casualties From Southern France
When the first casualties from the amphibious landings in southern France reached Italy on 17 August 1944 there were already some 25,000 patients on hand in PBS hospitals. Between that date and 20 November, an estimated 20,000 patients from France were received in PBS, in addition to Fifth Army casualties and the routine disease and injury cases from among service and replacement troops in Italy.4
4 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2)Annual Rpt, Surg, PBS, 1944; (3) ETMD`s for Aug-Nov
While a few Seventh Army casualties were flown to Rome, the bulk of the evacuees from southern France went by sea and air to Naples, where they were cared for by the 17th, 37th, 45th, and 300th General Hospitals. Each of these units operated in excess of its Table of Organization capacity during the emergency period ,as did most of the PBS hospitals. Fixed hospitals in both Naples and Rome were still receiving thousands of casualties from Fifth Army through September and October at the same time that the Naples hospitals were filled with wounded from southern France and two-thirds of the beds in Rome were in process of moving to northern Italy.5 The only evacuation from the overcrowded Naples hospitals at this time was to the zone of interior, since there were no longer any beds left in Africa for long-term patients.
Movement of Fixed Hospitals Into Northern Italy
The overloading of PBS hospitals with casualties from southern France and from the Gothic Line was only one of several reasons for the delay in moving fixed beds into northern Italy. Another reason was the difficulty in finding sites for large installations. In the war-torn Arno Valley few buildings were available of sufficient size to house a 1,500-bed or 2,000-bed general hospital; and to set up such an establishment in tents or prefabricated buildings with adequate power, water, drainage, and access roads was a major engineering project. Still another factor was the hope, after the initial success of Fifth Army against the Gothic Line, of a quick breakthrough into the Po Valley. Ground haze in that region made air evacuation impossible in the winter months, and the rail lines had been knocked out by Allied bombing. It was therefore deemed essential to keep at least a minimum of fixed beds mobile for early movement north of the Apennines.6
At the beginning of the North Apennines Campaign the 64th General Hospital was at Ardenza, a suburb just south of Leghorn, with the 55th Station Hospital attached, giving the combined installation a T/O capacity of 1,750 beds. The 50th Station Hospital, with 250 beds, was at Castagneto some 40 miles down the coast, and the 24th General, with 1,500 beds, was at Grosseto, another 40 miles farther south and 75 miles from the rearmost Fifth Army installations. Moves made during September were largely readjustments, not involving any of the large hospitals in the Naples or Rome areas.
On 13 September the 154th Station Hospital--the only 150-bed unit in the theater--moved up from the Battipaglia staging area south of Naples to relieve the 105th Station at Civitavecchia. The 105th, with 500 beds, moved on to Grosseto to relieve the 24th General and the latter unit proceeded to Florence, where it opened on 21 September in the extensive plant of a former Italian aeronautics school. By mid-October the hospital was
1944; (4) Rpts of individual hops mentioned in text. See also pp. 396-400 above.
5 See p. 447, above.
6 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2)Final Rpt, Plans and Opns Off, MTOUSA, 1945; (3) Annual Rpt, Surg, Fifth Army, 1944, 1945; (4) Med Sitreps, PBS, Sep 44-Jan 45; (5) Theater ETMD`s, Sep 1944-Jan 45; (6) Unit rpts of hosps mentionedin text; (7) Unit ETMD`s of the hosps mentioned in text, for Sep44-Jan 45.
operating 2,770 beds on a 1,500-bed T/O.
At the same time the750-bed 7th Station Hospital, which had been staging in Oran since July, arrived in Leghorn and set up at Tirrenia, a former Fascist youth camp on the seacoast about four miles north of the city. The unit opened on 29 September with the facilities and bed strength of a general hospital. Shortly after its establishment, the 7th Station was designated to hospitalize all Brazilian ground personnel in the area, and by December was caring for 700 Brazilian patients in addition to a full load of U.S. patients. Fifteen medical officers, two dental officers, three pharmacists, a chaplain,23 nurses, and 32 enlisted technicians, all Brazilian, were attached. Brazilian medical strength at the 7th Station Hospital eventually reached a maximum of 27 officers and 65 enlisted men, though the nurse strength declined to 18.
The Brazilians were given wards of their own for routine cases, but those requiring special treatment were placed in the regular medical and surgical wards. Brazilian doctors were assigned to the medical and surgical staffs of the hospital, where they dealt with all patients and worked on teams with U.S. surgeons as well as on surgical teams of their own. In the course of time, as language barriers and differences in practices were overcome, the Brazilians were fully integrated into the hospital staff. Between 7 October and 12 December five Brazilian medical officers and six nurses also served with the 154thStation at Civitavecchia to care for personnel of nearby Brazilian Air Force units.
The only other hospitals to move into northern Italy during September were the 81st Station from Naples and the 114th Station from Rome, but neither move was completed before the end of the month. The 81st closed in Naples on 24 September, and was established adjacent to the 64th General at Ardenza by 1 October. One 250-bed expansion unit was set up immediately, and a second opened shortly in a prisoner of war stockade. The 81st, with the assistance of detached personnel from other units, was thus operating 1,000 beds on a500-bed T/O.
The 114th Station, which moved into an abandoned Italian military hospital in Leghorn proper, had more difficulty getting established. Extensive repairs were required, and it was 20 October before the hospital was ready to receive patients. The 114th Station continued to serve as the PBS neuropsychiatric hospital, but the shortage of fixed beds made it necessary to take medical cases as well. For the first two months of operation in Leghorn about half of its patients were medical.
The shift of the 114th Station from Rome heralded a general exodus of medical installations from the Italian capital, which was too far in the rear to effectively support the Fifth Army front and lacked the port facilities that made Naples still useful as a hospitalization center. The 33d General Hospital was the first of its class to go, closing on 24 September. A site was located in what was to become the Leghorn hospital center at Tirrenia, where the 7th Station was already in operation, and movement was completed on 7 October. The 33d General opened five days later. (Map 42)
The 12th General, one of the two 2,000-bed hospitals remaining in Italy, began closing out in Rome about 1 November, starting the roundabout journey
FIXED HOSPITALS IN NORTHERN ITALY
213th Veterinary General(Italian)a, 4 July 1944-31 March 1945.
24th General, 21 July-15 September 1944. 1,500 beds.
105th Station, 15 September-24 December 1944. 500 beds.
50th Stationb, Detachment A, 22 December 1944-20 March 1945. 100 beds.
99th Field, 1st Platoon, 20 March-17 July 1945. 100 beds.
a Redesignated 1st Veterinary General Hospital (U.S-Italian), 31 March 1945.
b Redesignated 99th Field Hospital,20 March 1945.
1st Veterinary General(U.S-Italian), 31 March-15 July 1945.
50th Station, 20 July-22 December 1944. 250 beds.
50th Station, Detachment B, 22 December 1944- 20 March 1945. 100 beds.
99th Field, 2d Platoon, 20 March-13 July 1945. 100 beds.
64th General, 8 August 1944-20 December 1945. 1,500 beds.
55th Station (Attached 64th General), 9 August-15 October 1944. 250 beds.
81st Station, 28 September 1944-20 June 1945. 500 beds.
7th Station, 29 September 1944-26 August 1945. 750 beds.
33d General, 12 October 1944-20 September 1945. 1,500 beds.
114th Station, 20 October 1944-31 May 1945. 500 beds.
12th General, 3 December 1944-6 July 1945. 2,000 beds.
61st Station, 15 November 1945-15 November 1947. 500 beds.
35th Field, 2d Platoon(AAFSC; ABC), 11 November 1944-4 April 1945. 100 beds.
60th Station (ABC),4 April-18 July 1945. 400 beds.
4th Field (ABC), 18 July-3 September 1945. 400 beds.
105th Station, 15 January-25 June 1945. 500 beds.
103d Station, 23 March-20 July 1945. 500 beds.
55th Station, 25 June-15 November 1945. 250 beds.
99th Field, 20 July 1945-1 May 1946. 400 beds.
50th Stationb, Detachment C, 17 January-20 March 1945. 100 beds.
99th Field, 3d Platoon,20 March-6 August 1945. 100 beds.
24th General, 21 September 1944-1 June 1945. 1,500 beds.
103d Station, 11 January-22 March 1945. 500 beds.
55th Station, 16 October 1944-21 May 1945. 250 beds.
225th Station, 21 May-25 June 1945. 500 beds.
70th General, Detachment A, 25 June-1 October 1945. 500 beds.
64th General, Detachment A, 1 October-15 November 1945. 250 beds.
225th Station (ABC), 16 April-8 May 1945. 500 beds.
70th General, 22 January-25 June 1945. 1,500 beds.
35th Field, 2d Platoon(ABC), 17 April-24 May 1945. 100 beds.
182d Station, 20 April-25 June 1945. 500 beds.
70th General, Detachment B. 25 June-25 September 1945. 500 beds.
2605th Veterinary General(Overhead), with 2d Veterinary General (U.S.-Italian) attached, 21 April-2 May 1945.
74th Station, 27 April-20 June 1945. 500 beds.
6th General, 9 May-10 August 1945. 1,500 beds.
2605th Veterinary General(Overhead), with 2d Veterinary General (U.S-Italian) attached, 2 May-28 June 1945.
2604th Veterinary Station(Overhead), with 1st Veterinary Station (U.S-Italian) attached, 5-14 May 1945.
37th General, 9 May-25 October 1945. 1,500 beds.
15th Fieldc, 1st Platoon, 1-30 September 1945. 100 beds.
15th Fieldc,3d Platoon, 1 September-8 October1945. 100 beds.
16th Evacuation (as station), 1 September-2 October 1945. 750 beds.
15th Field (88th Division),2 October 1945-13 May 1946. 400 beds.
391st Station (88thDivision), 11 May 1946-15 October 1947. 400 beds.
15th Fieldc,2d Platoon, 1 September-5 October 1945. 100 beds.
7th Station (88th Division),1 May-19 September l947d. 200 beds.
c Assigned in place from Fifth Army to PBS, 1 September 1945. Reassigned to 88th Division, 2S September1945.
d Turned over to Trieste-United States Troops (TRUST) 19 September 1947.
to Tirrenia in the middle of the month. Four trainloads of equipment went by rail to Naples, and thence to Leghorn by water. Equipment arrived on 25 November, and the first patient was received at at the new site on 3 December. The arrival of the 12th General brought Table of Organization bed capacity in Leghorn to 6,750, or an operating strength of better than 10,000.
The 55th Station, meanwhile, had been relieved of its attachment to the 64th General in the middle of October, and on the 16th of that month opened at Pratolino, six miles north of Florence, in buildings vacated the day before by the 94th Evacuation Hospital. The 74th Station, which had closed at Caiazzo north of Caserta on 25 October and was also scheduled for the Florence area, was less fortunate. Its prospective site was still occupied by the 15th Evacuation, which the Fifth Army surgeon had decided to retain in Florence over the winter. As no alternative site was available, the 74th Station set up headquarters with the 24th General and placed the bulk of its personnel on detached service with other medical units.
Only two more fixed hospitals moved into northern Italy before the launching of the spring drive into the Po Valley. These were the 103d Station, from Naples, which opened in a prisoner of war enclosure in the outskirts of Florence on 11January 1945; and the 70th Gen-
eral from North Africa, which opened in Pistoia on 22 January.
There were, however, various readjustments in the hospital picture around the end of 1944. In Rome the 73d Station was reassigned to Rome Area, MTOUSA, on 1 December 1944. The 6th General closed on 22 December, but remained in Rome with all equipment packed and ready to move on short notice. Personnel of the hospital were placed on temporary duty with other medical units scattered over Italy. The 34th Station, which had been serving a replacement center in the Caserta area since October, took over the buildings vacated by the6th General in Rome on 19 January, while the 154th Station closed at Civitavecchia and replaced the larger 34th at Caiazzo.
Late in December the 50th Station at Castagneto reorganized along field hospital lines into three detachments, one of which relieved the 105th Station at Grosseto on 24 December. Another detachment set up a small hospital to serve the8th Replacement Depot at Empoli, twenty-five miles west of Florence, on 17 January 1945. The third detachment remained at Castagneto. The 105thStation, displaced at Grosseto, moved to Pisa where it opened in buildings of an Italian tuberculosis sanatorium four miles east of the city on 15January. At its Pisa site, the 105th Station served an encampment of Russians who had been liberated from German prison camps.
Status of Hospitalization in MTOUSA January-March 1945
By January 1945, when the decision was made to postpone the Po Valley offensive until spring, fixed hospitals in MTOUSA were reporting a smaller proportion of beds occupied than ever before. This was in part due to the winter lull in the fighting but it was also in large measure because of the excellence of the Fifth Army medical service, which was retaining the maximum number of cases in the army area. Fixed bed strength in MTOUSA was nevertheless 6,000 below the authorized 6.6 ratio, and changes in the station hospital T/O had so far reduced the number of medical officers in those units that an expansion of more than 20 percent was no longer practical without additional personnel.7
Looking ahead to the resumption of active hostilities in the spring, General Stayer asked the War Department for an additional general hospital of 1,000-bed capacity and for a field hospital for communications zone use. The request was denied on the ground that no such units were available in the zone of interior. The War Department proposed as an alternative that existing hospitals be reorganized into larger units, but the MTOUSA medical section considered this proposal impractical, since there was no specific requirement for station hospitals larger than 500 beds, and sites could not be found for general hospitals larger than the 1,500-bed units already operating in the theater. Any other form of reorganization that would add beds would require more in additional personnel and equipment than could be procured. General Stayer therefore prepared to operate with the hospitals then under his control.
As of the end of January there were 10,150 fixed beds in the Naples-Caserta area. The 37th and 45th General Hospitals, each with 1,500 beds, and the 500-bed 182d and 225th Stations were in the medical center at the Mostra Fairgrounds. In Naples proper were the 1,500-bed 17th General, the 2,000-bed 300th General, and the 52d, 106th, and 118th Station Hospitals, each of 500 beds. The 52d and 118th were both acting general hospitals. The 52d was also the theater maxillofacial center. Outside Naples the 262d Station was at Aversa, functioning primarily as a prisoner-of-war hospital; the 32d Station was at Caserta, serving headquarters personnel of MTOUSA and AFHQ; and the154th Station was at Caiazzo serving a replacement center.
The 34th and 73d Station Hospitals were in Rome, housing 750 beds between them. The 1,500 beds of the 6th General were in that city but not available for use, since they were packed for movement.
In the Arno Valley, overlapping the army area, there were 11,000 beds-6,750 of them at Leghorn,2,250 in the immediate vicinity of Florence, 500 at Pisa, and 1,500 at Pistoia. In addition to these, the 50th Station Hospital was operating detachments of approximately 100 beds each at Grosseto, Castagneto, and Em-
7 Principal sources for this section are: (1) Final Rpt, Plans and Opns Off, MTOUSA, 1945; (2) Med Sitreps, PBS Jan-Mar 45; (3) Annual Rpt, Surg NORBS, 1945; (4) Annual Rpt, Surg MBS, 1944; (5) Med Hist, AAFSC MTO, 1945; (6) Theater ETMD`s Jan-Mar 1945; (7) Unit rpts of hospitals mentioned in text; (8) Unit ETMD`s of hosps mentioned in text.
poli; and the 500 beds of the 74th Station were inoperative in Florence.
The 1,500-bed 26th General Hospital, still attached to the Army Air Forces Service Command, cared for Air Forces personnel at Ban, and the 500-bed 61st Station performed similar duties at Foggia. In addition to these, the Air Forces controlled three field hospitals, the 4th, 34th, and 35th, which were dispersed along the Adriatic from Lecce in the heel of Italy to Senigallia in the latitude of Florence. Each field hospital platoon served one to five airfields, which had personnel complements of three thousand to ten thousand. All of these hospitals passed to the Adriatic Base Command on 1 March.
In the Northern Base Section the 500-bed 60th Station Hospital, which had moved up from Sardinia the end of October, was preparing to close near Bastia. The 40th Station was operating sections at Cervione and Ghisonaccia, both on the east coast of Corsica, and a third section was preparing to relieve the 60th at Bastia.
In North Africa, which was scheduled for transfer to the Africa-Middle East theater the first of March, the 250 beds
of the 57th Station Hospital were more than enough to serve the Tunis area. The last Army hospital in the Oran area, the 54th Station, had closed late in December and was now inoperative in Naples, leaving Naval Hospital No. 9 to care for all U.S. personnel in Oran. The 56th Station at Casablanca, in addition to caring for personnel in the area, was operating a transient section of 100-150 beds for domiciliary care of patients en route to the ZI from Italy, the middle East, and the China-Burma-India theater. It also supervised the operation of a 75-bed Italian station hospital. The 25-bed 370th Station at Marrakech continued to serve primarily Air Forces units. The Italian and German prisoner of war hospitals near Oran were already alerted for movement to Italy.
Preparatory to closing out in Africa, Stayer requested permission to inactivate the 54th Station and reduce the 57th Station to 150 beds, the personnel and equipment thus released to be activated as a 400-bed evacuation hospital for Fifth Army. At the same time permission was requested to convert the 50th Station Hospital in Italy into a field unit. Both requests were granted late in February. On 20 March, accordingly, the 171st Evacuation Hospital was activated and assigned to Fifth Army. On the same date the 50th Station Hospital passed out of existence, and the 99th Field Hospital relieved it in place. No changes were involved, since the 50th Station had already completed its conversion to a field hospital T/O.
The actual transfer to the Africa-Middle East Theater thus involved only 425 U.S. beds, and these were more than made up by the transfer of the 500-bed 21st Station Hospital from the Persian Gulf Command to MTOUSA. The 21st arrived in Naples in March, but did not get into operation until mid-April. In the inactivation of the 54th Station and reduction of the 57th, MTOUSA lost 350 beds, but gained 150 in the conversion of the 250-bed 50th Station to a 400-bed field. All in all, MTOUSA lost 125 beds, while Fifth Army gained 400.
Shortly before the new theater boundaries became effective on 1 March 1945, the two prisoner of war hospitals serving MTOUSA were shifted to northern Italy. There were, of course, many station hospitals treating captured enemy troops, but only two were fully staffed by protected personnel and formally organized as prisoner of war rather than U.S. Army hospitals. These were the 7029th Station Hospital (Italian) and the 131st Station Hospital (German), the latter so designated because it was sited at POW Enclosure No. 131. The 7029th moved by echelons to Leghorn in January and February, finally opening in Pisa on 6 March. Later in the month the German unit took over the prisoner of war hospital being operated by the 103d Station at POW Enclosure 334in the outskirts of Florence, and was thereafter known as the 334th Station Hospital (German).
The 103d Station, relieved of its POW assignment, moved to Pisa on 22 March, where it became a contagious disease hospital, primarily for Brazilian personnel.
As of the end of March, aggregate Table of Organization bed strength of U.S. base hospitals in the Mediterranean Theater of Operations, including 3,000 beds not operating, was 29,000. Troop strength was 497,427, giving a ratio of 5.8 T/O beds per 100 troops.
Support of the Po Valley Campaign
The experience of Fifth Army in evacuating casualties across the rugged northern Apennines underlined the importance of getting fixed beds into the Po Valley with the greatest possible speed. The 6th General Hospital at Rome and the 74th Station at Florence were already on a stand-by basis for quick movement but more beds were certain to be required. Because of its obvious advantages, General Stayer planned to keep the Naples medical center intact, though hospitals from other parts of the city were shifting northward. General Joseph T. McNarney, the theater commander, had other plans, and in March, despite Stayer`s protests, the Mostra Fairgrounds were turned over to the Replacement Training Command. The 45th General Hospital was to remain to care for the replacement center personnel, but the other units then comprising the medical enter were required to vacate the fairgrounds as soon as possible. It was these hospitals, therefore, that were alerted for movement to northernItaly.8
The first moves in support of the coming campaign were made in response to an indicated need for more fixed beds on the Adriatic side of the peninsula, where Air Forces units were becoming increasingly active and to which air evacuation of ground troops from the Bologna area might be directed should weather conditions preclude the use of more westerly routes. A platoon of the 35th Field Hospital had been in Senigallia since November 1944. This unit was replaced early in April by the 60th Station Hospital from Corsica, the field hospital platoon moving on to Rimini. At the same time the 225th Station in the Naples medical center was assigned to the Adriatic Base Command and shifted to Fano, about fifteen miles farther north.
Next to leave the medical center was the 182d Station, which took no new patients after 25 March. The 182d moved on to April to a large villa about two miles northwest of Montecatini. Its first patients were received from Fifth Army evacuation hospitals on 20 April, and within two weeks it was operating 20 percent in excess of its 500-bed T/O capacity.
The 37th General Hospital began closing out on 10 April, moving by echelon to a staging area near Pisa. The bulk of the personnel and equipment was in Pisa by 17 April. For the next two weeks officers and enlisted men were on detached service with other units, but subject to immediate recall. The 37th also operated a 200-bed prisoner-of-war hospital in an unused mess building on an emergency basis, since the 103d Station, which had been reconverted to a prisoner-of-war hospital in mid-April, was unable to carry the full load. By the end of the month prisoners were arriving in the area at the rate of 15,000 a day, and the 103d was operating at more than double its T/O capacity.
By the time the Fifth Army spearheads had fought their way into the Po Valley, there were thus3,500 fixed beds on a stand-by basis, packed and ready to move forward in support of the ground forces. Movement orders were not long in coming.
8 Principal sources for this section are: (1) Final Rpt, Plans and Opns Off, MTOUSA, 1945; (2) Med Hist, AAFSC MTO, 1945; (3) Med Sitreps, PBS, Mar-May 45; (4) Theater ETMD`s, Mar-May 45; (5) Unit rpts of hosps mentioned in the text; (6) Unit ETMD`s for hosps mentioned in the text, Mar-May45.
The 74th Station Hospital was in Bologna by the afternoon of 26 April, five days after the fall of the city, and was taking patients within twenty hours of its arrival. By 28 April 750 beds were set up, and German medical officers and corpsmen had been pressed into service to help with the prisoner patients. The 6th General was close behind, leaving its Rome bivouac on 30 April and opening in Bologna on 9 May. The 37th General sent an advance detail to Mantova on 2 May, and a week later took over 26 Allied and 1,278 German patients from the 15th Evacuation Hospital. By the end of the week the 37th General had more than 2,000 beds in operation. The sudden end of the war made it unnecessary to relocate any other fixed hospitals.
Also in support of the Po Valley Campaign, though on a different level, was the 40th Station Hospital, transferred from Corsica to the vicinity of Rome, where a center for the conversion of able-bodied men from service units into infantry, to help fill the depleted ranks of Fifth Army, had been set up in January.
By the middle of May, with the war in
Europe over, the period of readjustment had set in. For the Medical Department in Italy, the emphasis for the next few months would be on caring for the sick and wounded among prisoners of war, and preparing hospitals and other medical units for redeployment to the Pacific or for return to the zone of interior as promptly as possible.
Problems and Policies
Throughout the period of the North Apennines and Po Valley Campaigns until the end of April 1945,Peninsular Base Section hospitals, including the 26th General attached to the Army Air Forces Service Command and later assigned to the Adriatic Base Command, operated on a 120-day evacuation policy. The theater was too short of manpower to return men to the zone of interior as long as there was any prospect of recovery for further combat duty. Even those reclassified by hospital disposition boards for limited assignment were retained in the theater in a variety of noncombat capacities.9
One of the places where limited assignment personnel could be used effectively was in the base hospitals. When Fifth Army was unable to obtain replacements for the heavy casualties suffered in the northern Apennines, all service units in the theater were surveyed with a view to locating able-bodied men who could be released and retrained for combat. The essential consideration was that the men must be taken from positions classified as suitable for limited-assignment personnel. While communications zone hospitals usually had a certain number of limited-service men already on their rolls, the survey revealed many more hospital positions that could be filled by such personnel.
Although many problems were thus created for hospital commanders, the change-over was accepted as a necessary expedient. The new men were for the most part inexperienced in hospital work and had to be given special training on the job. There were, moreover, too many high-ranking noncommissioned officers among them to be absorbed without jeopardizing promotions and damaging the morale of the regular Medical Department enlisted staff. During the last two months of 1944 and the first two months of 1945, limited-assignment personnel nevertheless replaced general-assignment men in station and general hospitals to the extent of an average 25 percent of the enlisted strength. Fortunately, the shift took place at a time when the hospitals were not overloaded and in most instances worked out satisfactorily.
Supplementary personnel were necessary in the operation of all PBS hospitals during periods of emergency expansion. Medical officers, nurses, and enlisted technicians from temporarily inoperative units were freely used whenever they were available, but the greater reliance had of necessity to be placed on Italian civilians and Italian service troops. Among the areas in which civilian and Italian prisoner of war labor was effectively used were sanitary, utility, mess, laundry, supply, motor pool, and common labor details.
9 Sources for this section are: (1) Final Rpt, Plans and Opns Off, MTOUSA, 1945; (2) Med Hist, AAFSC MTO, 1945; (3) Ltr, Munly, Med Insp, to Surg, MTOUSA, 26 Nov 44, Sub: Utilization of Limited Assignment Personnel in Hosps; (4) Unit rpts of MTOUSA hosps, 1944, 1945.
In a theater such as the Mediterranean, where bed strength was always below authorized levels, continuous evacuation both to the zone of interior and within the theater itself was essential.
Transfers Within the Theater
Patients were shifted from one fixed hospital to another within the theater to accomplish two major purposes. One purpose was to take advantage of specialized facilities not available in all MTOUSA hospitals. The other was to release beds, either to make room for an influx of new casualties in hospitals closest to the combat area or to prepare a hospital for movement. The lines of movement were well established by September 1944, with Naples the terminus of most of them.10
French patients remaining in PBS hospitals continued to be evacuated from Naples to North Africa through November, but their numbers were small: 592 in September, 55 in October, and 76 in November. For U.S. patients, the line of evacuation ran in the other direction, cases requiring more than station hospital care being flown from Africa to Naples. Again, however, the number was small. All evacuation from Corsica was to Italy, the bulk of it by air, but only 343 patients, of whom 279 were U.S. personnel, were so evacuated between 1 September 1944 and the closing out of the Northern Base Section on 25 May 1945. Air Forces patients from eastern Italy who required more specialized care than was available at the 26th General Hospital were evacuated to Naples. Naples was also the first stop for Air Forces patients en route to the zone of interior.
Of much greater proportions was the periodic transfer of patients from PBS hospitals in Rome and northern Italy. In September, despite heavy rains that made rail lines intermittently unusable, the 41st Hospital Train carried 38 patients from Grosseto and735 from Rome to Naples, in addition to clearing 275 patients from Grosseto to Rome when the 24th General Hospital was preparing to move forward. The movement of substantial numbers from Rome to Naples by both rail and air continued through December as 5,500 beds in Rome were closed out for transfer to northern Italy.
Similarly, until adequate bed strength was built up in Leghorn patients from the 24th General Hospital in Florence and from the 55th Station at Pratolino were transferred, often as rapidly as they became transportable, to the Naples area, along with patients direct from Fifth Army hospitals. When air evacuation was interrupted by bad weather in October, the 24th General was cleared by 60 ambulances of the 162d Medical Battalion, which carried patients to Leghorn.
As the hospital facilities in Leghorn reached their maximum late in 1944, regular transfer of patients to Leghorn from Florence and later from Pistoia began. Direct air and rail evacuation be-
10 Sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2) Final Rpt, Plans and Opns Off, MTOUSA, 1945; (3) Annual Rpt, Surg, PBS,1944; (4) Med Sitreps, PBS, Jan-May 45; (5) Annual Rpt, Surg, NORBS, 1944, 1945; (6) Med Hist, AAFSC MTO, 1944, 1945; (7)Theater ETMD`s, Sep 44-May 45; (8) Unit Rpts, 41st Hospital Train;51st and 162d Med Bns; 802d and 807th MAETS.
tween Florence and Leghorn were inaugurated in February 1945, and thereafter patients were moved at the rate of more than a thousand a month.
From Leghorn evacuation to Naples was primarily by hospital ship and transport but the repair of rail lines made it possible to use hospital trains in an emergency. Such an emergency arose in the last days of December 1944 when it was feared that the German thrust into the Serchio Valley might develop into a major counteroffensive comparable to the Ardennes breakthrough, which had not yet been stopped. Should the German drive gain momentum, Leghorn would be its probable objective, and a hasty evacuation of all fixed hospitals in that city was ordered. In late December and early January more than 1,300 patients were sent back to Naples by water and close to 600 by rail. In the same time period, air evacuation from Florence to Naples accounted for another 2,500.
The threat of an Italian "Battle of the Bulge" was over by mid-January, and evacuation assumed what was to be a normal pattern for the next two months. PBS hospitals in Florence, Pistoia, and Pisa received casualties from Fifth Army and kept beds free by evacuation to Leghorn. Bed strength in Leghorn was adequate to care for all patients with a hospital expectancy of less than 120 days, so that after 1 February only those en route to the zone of interior were senton to Naples. This pattern continued until the latter part of March, when all PBS
hospitals in the northern sector were again cleared to Naples to provide beds for the casualties anticipated in the spring offensive. During April approximately 1,800 patients were transferred by sea and air from Leghorn to Naples, but these were more than balanced by 2,000 patients brought to Leghorn from Florence.
All movements of hospital ships within the Mediterranean area, including those used to evacuate patients from southern France, remained under control of Allied Force Headquarters. In order to make the greatest possible use of the limited number of vessels available, an arrangement was worked out in October 1944 whereby all hospital ships entering the Mediterranean called first at Oran, which was roughly equidistant from Naples, Leghorn, and Marseille. From Oran the Chief of Transportation, AFHQ, directed the vessels to the port most in need of them. The movement of the hospital ship platoons that formed the medical complements of troop transports used for evacuation was also directed by AFHQ in order to ensure maximum use of transports for this purpose.
As the time approached for the transfer of southern France to the European theater, a plan of evacuation was drawn up by embodying the existing principle of a pool of hospital ships under AFHQ control and incorporating procedures for requesting vessels. Base section commanders were to be responsible for making the greatest possible use of troop transports, but AFHQ was to be notified of the movements of such vessels and would continue to control the assignment of hospital ship platoons arriving anywhere in the Mediterranean. Evacuation by air was to be controlled by each theater, but AFHQ was to be notified of all airlifts to the ZI from southern France as a guide to the allocation of alternative means of transportation. General Stayer presented this plan to Maj. Gen. Paul R. Hawley, Chief Surgeon of the European Theater, early in November, and Hawley accepted it subject to further study. It remained in effect by agreement between the two theaters until February 1945 when, with minor modifications, it was ratified by the War Department. The plan continued in operation until the end of June.
Evacuation to the Zone of Interior
Evacuation to the zone of interior throughout the period of concentration in Italy was by plane, hospital ship, and troop transport. Until the end of February 1945, when North Africa was finally divorced from the Mediterranean Theater of Operations, a small number of patients continued to be moved to the zone of interior from Oran and Casablanca, but the overwhelming bulk of the lifts by all types of carrier was from Naples.11
During the 3-month period that southern France remained under AFHQ control, most of the casualties from that area also were routed to the continental United States by way of Naples. In October, however, direct evacuation to the zone of interior began from Marseille, and some 250 patients had been evacuated to the ZI from that port before 20
11 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944; (2)Final Rpt, Plans and Opns Off, MTOUSA, 1945; (3) Annual Rpt, Surg, PBS, 1944; (4) Med Sitreps, PBS, Jan-May 45; (5) ETMD`s for Sep 44-May 45.
November when the area was absorbed by ETO. These and all patients subsequently sent to the United States from Delta Base were evacuated in accordance with the inter theater agreement described above.
September and October of 1944 were the heaviest months of the war for evacuation to the zone of interior, primarily because of the large influx of casualties from Seventh Army. With a limited and definitely inadequate number of fixed beds available in MTO USA, only large-scale evacuation to the United States would permit the Medical Department to carry out its mission. By the end of the year, with bed occupancy at its lowest level of the war, evacuation to the zone of interior from the Mediterranean theater declined sharply. (Table34)
Evacuation of Brazilian casualties to their homeland began in September 1944 by air. In December a Brazilian flight surgeon and four flight nurses reached the theater to study U.S. methods before taking over responsibility for their own patients in flight. Evacuation of Brazilian casualties by sea was for the most part by way of the United States, since there were never enough to justify diversion of a hospital ship. The only exception was in January 1945 when an unescorted troop transport sailed direct to Brazil from Naples. (Table 35)
No prisoner of war patients were evacuated to the United States after October 1944, but 135 German patients in U.S. custody were repatriated from Naples and 454 from Oran in January 1945. The prisoners were carried by hospital ship to
Marseille, where they were transferred to a Swiss-manned hospital train and exchanged at the Swiss border for U.S. prisoners of the Reich.12 Since the collapse of Germany was imminent, another exchange of prisoners scheduled for April was not carried out.
Medical Supplies and Equipment
Theater Supply Organization and Policies
The reorganization of November 1944 brought the operation of the medical supply system directly under the theater surgeon for the first time, but neither the internal organization of the Medical Supply Branch (redesignated Medical Supply Section) nor the operating procedures were altered in any essential particular. In keeping with the reduced staff available, the organization was made more compact, but without significant change in functions. In the new alignment, an Executive Group reviewed proposed changes in Tables of Equipment, checked the quality of equipment in the field, prepared plans and estimated requirements in terms of disease trends and military operations, screened requisitions from Allied nations, and advised on civilian supply for occupied territories. A Shipping Control Group kept constant track of all incoming shipments and prepared shipping orders for movement of medical supplies between base sections. A Stock Control Group maintained records of stocks on hand, computed replacement factors, studied
12 (1) Memo and attachments, Biederman to Stayer, 14 Jan 45 sub: Arrangements for Repatriation of Allied and German POW`s and Exchange of Civilians. (2) Ltr. Lt Col W.L. Hays combined British-American Repatriation Committee, to CG ETO, 1 Mar45. Figures from ETMD for Jan 1945.
issue and due records to determine shortages and excesses, and recommended stock movements to correct maladjustments. A Reports and Statistics Group completed the supply organization.13
At the time of the reorganization, medical supply levels were established at 30 days minimum, 30 days` operating, and 60 days` maximum for most items. In accordance with War Department instructions, these levels were kept under continuous review with a view to possible reductions. The only move in that direction, however, came to nothing. In March 1945 a recommendation by the theater supply officer that the 90-day stock level maintained by base hospitals be reduced to60 days, to conform to the theater level, was rejected by General Stayer as hazardous. In the light of a detailed study begun in November 1944 of 40 medical items, which showed that the actual elapsed time between preparation of monthly requisitions on the zone of interior and the tallying of items into depot stock was 149 days, Stayer was undoubtedly correct.
After southern France ceased to be a drain on the MTOUSA supply services, medical stock levels built up rapidly. Low battle casualty and disease rates during the winter of 1944-45 were contributing factors, as also were the closing out of the North African bases and a revised accounting procedure that included Fifth Army and Air Forces stocks in computing the theater levels. Surpluses developed of sufficient magnitude in some items to justify the return of 500 tons of medical supplies to the zone of interior in January.
In line with the achievement of a comfortable stock level for the theater, surgeons of major commands and base sections were authorized in February to modify equipment lists in accordance with such policies as might be laid down by the MTOUSA surgeon. In effect, hospitals were permitted to requisition various items in excess of the Tables of Equipment if those items would make operations more effective. Authority to issue expansion units, which rested with the commanding generals of the base sections, automatically carried with it the issue of such additional equipment as might be necessary to the efficient operation of the unit.
After November 1944all incoming supplies were received at Naples or Leghorn, where the Peninsular Base Section depots were located, and PBS was made responsible for distribution to other base sections on requisitions that were passed through the MTOUSA medical supply section. All forms of transportation were used, the size of the shipment, the speed necessary, and the destination being the determining factors, along with availability. Within the theater, biologicals were uniformly moved by air. In February the Leghorn depot became the main medical supply point for the theater.
Repair and maintenance of medical equipment steadily improved during the late months of 1944, reaching a peak of efficiency early in 1945 as Fifth Army units began re-equipping for the spring offensive. A spare parts catalog compiled and distributed by the Medical Supply Section became the basis for requisitioning and for restocking depots. The fifth echelon repair shop, the optical repair
13 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944 an. K; (2) Davidson, Med Supply in MTOUSA, pp. 113-139. For operating procedures, see pp. 346-47, above
shop, and theater stocks of spare parts and of artificial teeth were all transferred to the Leghorn depot in January.
Local procurement remained, as it had been throughout the Mediterranean campaigns, a negligible factor, but the distribution of medical supplies for civilian use continued to mount in proportion to the extent of territory occupied. After September 1944, Army responsibility for procurement, storage, and issue of medical supplies for civilians throughout the theater was carried out through a Central Civilian Medical Depot in Naples.
Civilians and Italian service troops were freely used as laborers, mess attendants, artisans, and for guard details at medical supply depots. So many of the supply functions were specialized, however, that the maximum use of such personnel did not appreciably lessen the requirement for U.S. service troops for medical supply operations in the Italian communications zone.
Medical Supply in the Base Sections
Medical supply in the base sections
came under control of the MTOUSA medical section with the reorganization of November 1944, hut here, as in the Medical Supply Section itself, no essential change of function or organization was involved. The Peninsular Base Section, already dominant in the theater, continued to grow through the last quarter of 1944 and the early months of 1945 as other base sections declined.
Mediterranean Base Section- Following the mass transfer of medical facilities from North Africa to southern France and Italy, plans were made for closing out remaining depot stocks in the Mediterranean Base Section. The 60th Medical Base Depot Company, which had been responsible for receipt, storage, and issue of all medical supplies in North Africa since the beginning of September, began transferring supplies to other bases almost immediately, shipping out 250 tons a week during September and October. Simultaneously, the Eastern and Atlantic Base Sections transferred their own surpluses, brought about by diminished troop strength, to the MBS depot, in preparation for the consolidation of the three base sections on 15 November.14
When the MBS depot closed in mid-December, the 57th Station Hospital at Tunis was given maintenance stocks sufficient to carry through 28 February, when the transfer of North Africa to AMET would be effected; a minimum reserve of 25 tons was left with the 54th Station, which was about to close at Oran; and the balance of maintenance stocks for the base section was stored with the 56th Station Hospital at Casablanca, the new MBS headquarters. Excess stocks to the amount of 313 tons were returned to the zone of interior, and 350 tons were divided between Italy and southern France. A small detachment of the 60th Medical Base Depot Company remained in Oran long enough to complete the packaging and shipment. From the supply standpoint, MBS was closed by the end of 1944.
Northern Base Section-Medical supply in the Northern Base Section remained in the hands of a detachment of the 684th Quartermaster Base Depot Company, which had been activated late in May from personnel of the old 2d Medical Depot Company. Until the end of September, the group operated depots at Ajaccio and Cervione, but the reduction of troop strength and gradual withdrawal of medical units from Corsica made it possible to consolidate the two depots at Cervione early in October. Movement of supplies from Ajaccio across the island by truck was completed by the 13th of the month.15
For a time, portions of the depot stock at Cervione had to be stored in the open, but the transfer of stocks in excess of a 4-month level to other MTOUSA bases, which began in mid-October, soon reduced quantities on hand to proportions that could be warehoused.
14 Sources for this section are: (1) Annual Rpt, Surg, MBS, 1944; (2) Annual Rpt, 60th Med Base Depot Co, 1944; (3) Annual Rpt, Surg, MTOUSA, 1944, an. K; (4) Davidson, Medical Supply in MTOUSA.
15 Sources for this section are: (1) Annual Rpts. Surg, NORBS 1944, 1945; (2) Annual Rpt, 684th QM Base Depot Co, 1944; (3) Per Rpt, 80th Med Base Depot Co, 11 Jul 45. (4) Davidson, Med Supply.
In line with the general reduction of functions in NORBS, 14 enlisted men of the 684th Quartermaster Base Depot Company detachment were transferred to the 60th Medical Base Depot Company, then still functioning at Oran, on 16 October. The subsequent transfer of the detachment`s commanding officer to Headquarters, NORBS, eft only an officer and 17 enlisted men to operate the Cervione depot, with the aid of some 25 Yugoslavs who made up labor and guard details. There were times when the workday stretched out to 18 and even to 24 hours, yet despite the physical strain, none of the men could ever be spared long enough to take advantage of the rest camps available on the island.
NORBS depot stocks were down to 230 tons by the end of January and to 75 tons by late March. Byway of preparation for closing out the base section supply activities, all personnel of the depot were transferred on 21 March to the 80th Medical Base Depot Company, at that time assigned to the Adriatic Base Command but were left on detached service with NORBS long enough to wind up operations. The depot was scheduled for closing on 15 April, but so critical was the need for personnel in Italy, where the Po Valley Campaign was about to be launched, that all tonnage was packed for shipment by 6 April. The detachment left Corsica on 10 April, turning over to the 40th Station Hospital responsibility for procuring and issuing such medical supplies as might still be required.
Adriatic Base Command-Before 1 March 1945, medical supply for Air Forces units and hospitals serving Air Forces personnel in eastern Italy was the responsibility of the Army Air Forces Service Command, which dealt directly with the Surgeon, MTOUSA, and procured medical items peculiar to the Air Forces direct from the zone of interior. The function was carried out through a number of aviation medical supply platoons, two of which operated in Ban as the medical supply section of the Adriatic Depot. Others served airfields from Tunis to southern France, with major dumps at Naples and Pisa.16
When the Adriatic Base Command was activated on 1 March 1945, the new organization took over the supply functions previously exercised by the Army Air Forces Service Command, Mediterranean Theater of Operations (AAFSC MTO), through the Adriatic Depot, but without altering the operating responsibilities of the aviation medical supply platoons. The 80th Medical Base Depot Company, which had been activated in December and since that time had shared in the operation of the PBS Leghorn depot, was assigned to ABC in mid-March and shifted to Senigallia, where for a month it operated the ABC advance depot. The rapid development of the Po Valley Campaign, however, left hospitals in the Fano-Senigallia-Ancona area with few patients and a minimum of supply activity. The ABC advance depot was turned over to the detachment from Corsica on 19 April, and a week later the main body of the 80th Medical Base Depot Company went to Bar, where it took over operation of the main ABC medical depot.
16 Sources for this section are: (1) Med Hist, AAFSC MTO, 1944, 1945; (2) Periodic Rpt, 80th Med Base Depot Co, 11 Jul 45; (3) Med Sitreps, Adriatic Base Comd, Mar-May 45; (4) MS, Adriatic Depot Hist, OCMH files; (5) Davidson, Med Supply in MTOUSA.
Peninsular Base Section-The medical supply service of the Peninsular Base Section had been organized in the middle of August 1944 to place operating control in the hands of the 232d Medical Composite Battalion. As of 1 September this battalion had attached to it the 72d and 73d Medical Base Depot Companies and the 684th Quartermaster Base Depot Company. The 72d was operating the main medical supply dump at Naples, the 684th the forward base at Piombino, with a detachment on Corsica. The 73d shared operation of the Piombino dump and had an advance party setting up a new supply base in Leghorn. By the end of September the Leghorn dump boasted 510 tons of medical supplies, housed in a large warehouse with 53,550 square feet of floor space. Another 70,000 square feet were available for open storage when needed.17
The Piombino dump was closed on 14 October and all stocks remaining were shifted to Leghorn, which was being built up to supply all Fifth Army needs. The problem remained, however, of distributing supplies economically between Leghorn and Naples. Every effort was made to keep balanced stocks at both depots. Transfers between the two were slow, because material arriving from the zone of interior had to be tallied in at the receiving depot before any of it could be transshipped to the other. This usually took two weeks with another week for rail transportation or three weeks for shipment by water. Through the fall of 1944, emergency shipments had to be made from Naples by truck convoy to meet Fifth Army shortages. An express truck service between Naples and Leghorn was instituted in January 1945, aiding materially in the prompt transfer of less than carload shipments.
During November all ZI shipments were received at Leghorn, and inventories at that base built up rapidly. When Naples was reinstated as a port of discharge in December, a new procedure was worked out under which the PBS supply section studied the manifests of incoming vessels and prepared requisitions covering the entire cargo in advance. Distribution to the two depots was then made directly from the dockside, thus eliminating the delay entailed in transporting all stock to the depot at the port of discharge, picking it up on stock record, and reporting it on the monthly inventory report before any inter depot transfers took place. Under the new system each depot submitted a separate inventory report, the two being consolidated by the Supply Branch of the MTOUSA medical section. The Leghorn stocks were almost as large as those in Naples by the end of the year, and were better balanced since the Naples inventory was padded by substantial quantities of surplus items received from MBS and NORBS.
With the transfer of PBS headquarters to Leghorn in November and the steady growth of the Leghorn supply depot, it became necessary to redistribute supply personnel. The80th Medical Base Depot
17 Principal sources for this section are (1) Annual Rpt, Surg, PBS, 1944; (2) Med Sitreps, PBS, Sep 44-Apr 45; (3) Annual Rpt, 132d Med Serv Bn, 1944; (4) Unit Hist, 72d Med Base Depot Co, Jan-Jun 45; (5) Hist Rpt, 73d Med Base Depot Co, Sep 44. (6) Med Hist Data, 73d Med Base Depot Co, 19Oct 44; (7) Annual Rpt, 80th Med Base Depot Co, 1944; (8) Periodic Rpt, 80th Med Base Depot Co, 11 Jul 48; (9) Annual Rpt, 60th MedBase Depot Co, 1944; (10) Annual Rpt, 684th QM Base Depot Co, 1944; (11) Davidson, Med Supply in MTOUSA.
Company was activated at Leghorn on 4 December1944, with a cadre drawn from the 684th Quartermaster Base Depot Company. A week later the 232d Medical Service Battalion, as the 232d Medical Composite Battalion had been redesignated without change of T/O on 21 November, moved its own headquarters to Leghorn, leaving 45 enlisted men on detached service with the 72d Medical Base Depot Company in Naples. The 60th Medical Base Depot Company was also assigned to PBS when its work in North Africa was completed the middle of December, and arrived in Leghorn in the closing days of the month. Like the 72d, 73d, and 80th Medical Base Depot Companies, and the 684th Quartermaster Base Depot Company, the 60th was attached to the 232d Medical Service Battalion.
The build-up of stocks in Leghorn halted abruptly late in December, when a German breakthrough was feared, but resumed in February. In March Leghorn tonnage, for the first and only time during active hostilities, exceeded that at Naples.(Table36)
Except for temporary shortages in a few items, the Peninsular Base Section medical supply depots were able throughout the North Apennines and Po Valley Campaigns to meet all the needs of Fifth Army, of medical installations assigned to the base section, and, after November 1944, of the theater. Blankets were a critical item through most of December and all of January. Stocks of laundry soap were exhausted at Leghorn early in February, but advances from quartermaster stocks tided the depots over the crisis. In late January and early February PBS was unable to fill Fifth Army orders for acetone, acetic acid with caffeine, epinephrine hydrochloride, ergotrate, lemon oil, and operating lamps and bulbs. Benzyl benzoate was in short supply during the first three months of 1945.
In all of these items, however, hospital reserve stocks were sufficient to carry over until ZI shipments arrived.
The only serious shortage was penicillin, which was used during the North Apennines Campaign at an unprecedented rate. The 15-day supply on hand when the assault on the Gothic Line jumped off early in September was exhausted before the end of the month. Barely enough for current needs was being received. Deliveries were made to forward units by the blood bank plane, and hospitals shared what reserves they had on hand. The situation remained extremely tight through November, but a comfortable margin was on hand by the end of the year. Despite consumption of penicillin in the first two weeks of the Po Valley Campaign at a rate more than double the previous maximum, a stock sufficient for six weeks operation at the same high rate was on hand when the war in Italy ended.
Medicine and Surgery
By early September of 1944, when the North Apennines Campaign got under way, medical and surgical practices in the Mediterranean Theater of Operations were relatively stable, continuing without significant changes for the remainder of the war period. The scope of front-line surgery was somewhat enlarged in the fall of 1944,and greater use was made in each successive campaign of both penicillin and whole blood. In the base hospitals wound management continued to emphasize reparative surgery.18
In preventive medicine the organization and techniques for the control of malaria had been worked out and tested over a 2-year period and presented no problem as the 1945 breeding season approached. At the same time, with a body of experience to draw upon, the recognition of the disease was more prompt and the treatment more effective. Venereal disease remained a persistent scourge, the incidence of which varied inversely with the extent of combat operations. Preventive measures such as the periodic examination of prostitutes, the policing of cities to control clandestine contacts, and the establishment of prophylactic stations were only moderately successful. The use of penicillin in treatment of venereal diseases, however, materially reduced the time lost from duty.
The greatly reduced incidence of trench foot in the winter months of 1944-45 as compared with the previous winter was a tribute to the careful studies made and effective preventive measures taken. However, the seasonal outbreak of infectious hepatitis in the late months of 1944 was severe, despite the extended studies and other efforts made by a team of officers under Col. Marion H. Barkerat the 15th Medical General Laboratory. The Barker group continued its studies through the second epidemic, presenting a consolidated report in the summer of 1945 that remains a major contribution to the literature on hepatitis.19
Perhaps the outstanding contribution of the Medical Department in the Medi-
18 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944 ans. C, D,E, and F; (2) ETMD`s for Sep 44 through May 45; (3) Unit rpts of hosps in the theater. (4) Perrin H. Long, "Medicine during World War II," Connecticut State Medical Journal, X (August 1946), 627-36.
19 Infectious Hepatitis in the Mediterranean Theater of Operations, United States Army.
terranean theater was in the field of neuropsychiatry. The major developments in this area were at the division and army levels, and have been discussed in connection with combat medicine.20In summary, the treatment of psychiatric disorders was carried out at fourl evels. The patient was normally first seen by the battalion surgeon who decided whether any treatment was indicated and, if so, whether to treat the patient on a duty status or refer him to the division psychiatrist. The latter officer, as a rule, maintained a separate treatment center adjacent to the clearing station, with facilities for 50 to 100 patients. Markedly disturbed patients were sent on immediately to the Army neuropsychiatric center, the others being retained, usually for two days, under moderate sedation with some therapy. Those responding favorably went to the division training and rehabilitation center for a few days and were then returned to duty. Those not so responding were evacuated to the Army neuropsychiatric center. From this unit men were returned to full duty, were sent to the convalescent hospital for reclassification, or were evacuated to the communications zone. The bulk of the evacuees went to the base section neuropsychiatric hospital, but those too distant from that installation were sent to a general hospital equipped for psychiatric work. Treatment in the base hospitals followed lines similar to those used in civilian practice, with the addition of orientation, training, and rehabilitation programs. The treatment culminated in return to duty, reclassification for limited duty, or evacuation to the zone of interior. Psychiatric cases evacuated to the ZI decreased from 48 percent in the last six months of 1943 to 21 percent in the corresponding months of 1944. These results, according to Colonel Hanson, theater consultant in neuropsychiatry, were the maximum that could be expected "under our present knowledge of psychiatry."
The number of medical officers in the theater available for patient care declined from 5.2 per 1,000 of troop strength in October 1944 to 4.7 in January 1945, where the ratio leveled off. In order to keep field medical officers from losing their skills through restricted practice and limited access to medical literature, a policy of rotation between field and base units was carried on but the saturation point was reached about the end of 1944, by which date the great bulk of medical officers in base hospitals were on limited duty or were overage for field service.
Noneffective rates per 1,000 per annum of troop strength by causes for the months of September 1944 through April 1945 are shown in Table 37.
On a theaterwide basis, the dental service in the Mediterranean continued to be understaffed until early in 1945, partly as a result of the increased number of dental officers called for by the T/O`s of the enlarged general hospitals, and partly as the result of losses sustained when southern France went over to ETO. There was a further loss of personnel late in 1944 when 20 dental officers were selected for release from active duty under a War Department directive. Two of the officers released were in the
20 See pp. 253-56,314-16, 409-11, above
rank of major, the remainder in the rank of captain.21
A total of 64 replacements arrived in January and February 1945, most of them first lieutenants. The number was large enough to relieve all shortages, and at the same time permitted the replacement of older officers in combat areas by younger men. The ratio of dental officers to troop strength in the theater, which had risen from 1:968 in October to 1:1,016 in December 1944 dropped sharply in January to 1:947. The April ratio of 1:927 was still better, although it remained higher than the 1:850 ratio enjoyed at the end of 1943.
In terms of accomplishment, the dental care available to Fifth Army, the Air Forces, and service troops in the theater steadily improved, with prosthetic and operating truck staking the best in dentistry to the front-line soldier, while the concentration of dental skills in forward clinics allowed a more even distribution of the work load. Colonel Tingay, the theater dental surgeon, continued to keep up with the needs and problems of both combat and base areas by frequent inspections, including an extended tour of Fifth Army dental installations shortly before the launching of the Po Valley Campaign.
While the withdrawal of the French Expeditionary Corps and the U.S. VI Corps from Fifth Army removed thousands of animals from Italy and ultimately from the Mediterranean theater, the extensive use of pack mule trains to supply Fifth Army in the northern Apennines provided ample scope for
21 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. G; (2) Annual Rpt, Surg, PBS, 1944; (3) Dental Hist, North African and Mediterranean Theaters of Operations.
theater veterinarians. The Fifth Army animal service was backed up in the Peninsular Base Section by fixed veterinary hospitals, with both army and communications zone activities being directed and co-ordinated by the theater veterinarian, Colonel Noonan.22
At the date of the launching of the North Apennines Campaign, there were only two fixed veterinary hospitals in the Peninsular Base Section, both Italian units. The 213th Veterinary General Hospital (Italian) was occupying the buildings of a former Italian Army veterinary hospital at Grosseto; and the 1st Veterinary Station Hospital(Italian) was at Persano in the Salerno area. Both were operated in connection with stations of the 6742d Quartermaster Remount Depot, which maintain edits own veterinary dispensaries at both posts, and another in the vicinity of the Naples medical center. Shortly after the initial assault on the Gothic Line, the remount depot opened a new station at Pisa, again with a veterinary dispensary to care for animals at the depot. The station hospital at Persano was redesignated the 212th Veterinary Station Hospital (Italian)and assigned to Fifth Army. With the departure of half of the 6742d Quartermaster Remount Depot for southern France in mid-October, the remount stations at Persano and Naples were closed. Late in January the 2610th Quartermaster Remount Depot was activated and took over the facilities at Pisa. Three veterinary officers were assigned to this depot and two to the 6742d Quartermaster Remount Depot at Grosseto.
Throughout the North Apennines Campaign animals from Fifth Army veterinary installations were evacuated by rail and truck to the 213th Veterinary General. The physical plant was adequate to the demands made upon it, but equipment was insufficient and the quality of personnel was poor. "Italian units," wrote Colonel Noonan, "are incapable of rendering satisfactory veterinary service, as their officers are for the most part indolent, in addition to being poorly equipped professionally."23The T/O of the 213th called for 15 officers and 253 enlisted men, but actual strength never reached those totals. At the end of 1944 there were only 7 officers and 177 enlisted men, being supervised by a U.S. veterinary officer and 4 enlisted men from the 2698th Technical Supervision Regiment. A second American veterinary officer was on detached service from the 24th Replacement Depot.
It was obvious by December of 1944, when the 10th Mountain Division with its large animal complement was assigned to Fifth Army, that the veterinary support offered by PBS would have to be materially improved before another mountain campaign was undertaken. Colonel Noonan asked at that time for a U.S. veterinary general hospital 24 but the postponement of the Fifth Army offensive until spring relieved the immedi-
22 Principal sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. H; (2) Annual Rpt, Surg, PBS, 1944; (3) Vet Hist, MTO, (4) Med Sitreps, PBS, Sep 44-May 45; (5) Quarterly Hist, Vet, PBS, 1 Apr-30 Jun 45; (6) Med Sitreps, 213th Vet Gen Hosp; and Vet, 6742d QM Remount Depot, Sep and Oct 44; (7) Vet Rpts, Sick and Wounded Animals, 6742d QM Remount Depot, 1944; (8) Inspection of Veterinary Service, NATOUSA and MTOUSA, 1944, 1945. (9) Misc does relating to MTO vet service, 1945. (10) Monthly Hist Rpt, 2604th Vet Sta Hosp, Mar-May 45; (11) Hist, 2605th Vet Gen Hosp, 15 Mar-30 Apr 45.
23 Memo, Col Noonan, Col, Theater Vet, to Plans and Opns, 8 Dec 44.
24 Memo, Noonan to Surg, MTOUSA, 24 Nov 44.
ate pressure. A realignment of the PBS veterinary service along the lines desired by Colonel Noonan was deferred until March 1945.
On 15 March the 2604th Veterinary Station Hospital (Overhead), the 2605th Veterinary General Hospital(Overhead), and the 643d and 644th Veterinary Detachments were all activated at Leghorn, where personnel joined and were staged over the next few weeks. The commanding officer of the general hospital was Lt. Col. Walter Smit, while the station hospital was commanded by Capt. John L. West. Both units were organized with skeleton staffs in the expectation that Italian veterinary personnel would be attached. In a parallel move, the 213th Veterinary General Hospital at Grosseto was given more U.S. supervisory personnel and re-designated the 1st Veterinary General Hospital (U.S.-Italian).
The 2605th Veterinary General was ready by the time the main Fifth Army drive was launched. The hospital moved into position at Pontepetri west of Highway 64 on 19 April. The site, which had been occupied until 1 April by the 211th Veterinary Evacuation Hospital, was in the rear of the 10th Mountain Division sector. First patients were received on 21 April from the 211th, which had moved forward to Riola. Other casualties came direct from the 10th Mountain Division. All were transported by the 643d Veterinary Evacuation Detachment. On 24 April the 2d Veterinary General Hospital (U.S.-Italian) was organized and attached to the 2605th at Pontepetri, but was of less help than had been hoped. The Italian unit had only two veterinary officers, and all of its enlisted men were young inductees with only two months in the Army and no experience with animals.
The 2604th Veterinary Station Hospital, with the 644th Veterinary Evacuation Detachment attached, did not go into operation until the war was over. On 3 May the unit moved to San Martino, the site of a former Italian Army artillery school a few miles south of the Po River on the Bologna-Verona axis. The Fifth Army Remount Depot was in the area, with 5,000 captured or abandoned German animals, about 200 of which were in need of veterinary care. These were turned over to the hospital when it opened on 5 May. A few days later elements of the British remount organization moved into San Martino, and the area was turned over to them on 15 May. During its brief 10-day Operating span, the 2604th Veterinary Station Hospital treated more than 400 animals.
Meanwhile, the 2605th Veterinary General Hospital had moved from Pontepetri to a site about 8miles beyond Mirandola, where it too opened on 5 May. Casualties were received from the 211th Veterinary Evacuation, which was at Ghisione only about10 miles forward, and from the 2604th Veterinary Station, which was no more than 12 miles away.
The food inspection work that made up the remainder of the Veterinary Corps mission in the theater was routine by the fall of 1944. By the start of the Po Valley Campaign there were thirteen veterinary food inspection detachments operating in MTOUSA, at ports and base section installations, supplemented by two port veterinarians and a quartermaster refrigerator company veterinarian. The Air Forces had three aviation veterinary detachments and two veter-
mary sections engaged in the same work. These units were adequate to provide complete food inspection coverage for the theater.
Through the first ten months of 1944, there had been an average of 4,000 nurses in the Mediterranean theater. In November 1,358 were transferred to ETO, and the year ended with only 2,446 nurses remaining in MTOUSA, or a ratio of 4.8 per 1,000 of troop strength compared with a 5.5 ratio in October. No replacements were received, even for normal attrition, leaving the theater approximately 350 nurses below authorized strength. Hours were often long and working conditions, especially in the field and evacuation hospitals on the Fifth Army front, were difficult. "The nurses, wrote a qualified observer in December, "are showing definite signs of fatigue. Many of them are getting irritable with conditions and people to which they could formerly accommodate themselves. Little things bother them which previously they could laugh off. Young faces have old masks" 25
25 Memo, Maj Margaret D. Craighill, Consultant for Women`s Health and Welfare Activities, toTSG, 20 Dec 44. Other sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. I; (2) Annual Rpt, Surg, PBS, 1944; (3) Annual Rpts, Surg, NORBS, 1944, 1945; (4) Med Hist, AAFSC MTO,1944, 1945; (5) Med Hist, 2d Aux
Some tensions were relieved by rotation between base and army hospitals and by sending nurses to rest areas whenever they could be spared. In terms of strength, however, no improvement was possible, the ratio to troop strength declining to 4.7 per 1,000 by April. The redeeming feature was a steady improvement in the ratio of nurses to patients. Owing primarily to light battle casualties and an excellent general health level among theater troops, the ratio of nurses to patients rose from 1:21 in December 1944 to 1:19 in January and February 1945; 1:17 in March; and 1:15 in April.
A morale factor was the relaxing of promotion policies in the fall of 1944, when authority was granted to promote all nurses who had been in the grade of second lieutenant for 18 months, regardless of T/O allotments. Promotions were also authorized for first lieutenants who had been 18 months in grade if they were otherwise qualified for advancement. Under this authorization, 227 second lieutenants and 19 first lieutenants were advanced in rank in the closing months of1944. When the war ended in Europe there were 2,267 nurses in the Mediterranean theater, of whom one was a lieutenant colonel, 15 were majors, 100 were captains, and 1,328 were first lieutenants. Only 823, or about 36 percent of the total, were in the lowest rank.
Army Civil Public Health Activities
The Allied drive into the northern Apennines coincided with far-reaching changes in the political and administrative structure in Italy. With the government of Ivanoe Bonomi seemingly secure, and more than half the country freed from German domination, it appeared an unnecessary burden to require Field Marshal Alexander to double as military governor. Early in September 1944, therefore, Allied Force Headquarters resumed direct jurisdiction over the Allied Control Commission, leaving the army group commander responsible only for liberated territory still within the combat zone. Shortly thereafter President Roosevelt and Prime Minister Churchill, as one of the results of a conference in Quebec, issued a joint declaration promising to the Italian Government greater control over its own affairs, both political and economic. Proposals for implementing the new policy were worked out by Harold Macmillan, then British resident minister at AFHQ, and with only minor changes were approved in both London and Washington in time to go into effect in February 1945. Army responsibility in matters of civil public health in the communications zone was thereafter primarily advisory except for medical supply, and even here, after 20 October 1944, distribution had been in the hands of an agency set up for that purpose by the Italian Government.26
In the combat zone, the Allied Military Government organization continued to exercise control through the commanders of the two Allied armies. In
Surg Gp: Rpt of Nursing Activities while Functioning with Fifth Army; (6) Parsons and others, Hist of Army Nurse Corps in MTOUSA.
26 Principal sources for this section are: (1) Komer, Civil Affairs and Military Government in the Mediterranean Theater; (2) Lewis, Rpt to WD, History of Civil Affairs in Italy, 7 Dec 1945; (3) Turner, chs. XI, XII, in Bayne-Jones, "Preventive Medicine," vol. VIII, Civil Affairs-Military Government.
the Fifth Army sector, General Hume continued to administer civil affairs under both Clark and Truscott. For the most part AMG concentrated on the restoration of water supplies, sewage disposal, power facilities, sanitation, and the like. Florence and Pisa were badly damaged, presenting on a smaller scale a repetition of the problem of Naples a year earlier. The work of restoration was still going on when the heavy rains of September and October added to the damage, but both cities were functioning normally by winter. There were no serious outbreaks of disease anywhere in the Arno Valley.
In the final drive that ended the war in Italy, Fifth Army military government and civil public health officers had relatively few problems. The German collapse was so swift and so complete that the great cities of northern Italy suffered little damage. Partisan forces, co-operating with the Allies, were able to save most public utilities from destruction. The civil public health problems of the occupation period were those of food, clothing, hospitalization, and medical supply rather than the restoration of water and power facilities and sewers and were soon transferred from Fifth Army AMG to the Allied Control Commission and the Italian Government.