The North African Communications Zone
The Medical Section, AFHQ and NATOUSA
Allied Force Headquarters moved from Gibraltar, from which the landing operations for TORCH had been directed, to Algiers on 25 November 1942. Key staff members were already in Africa, including the ranking U.S. medical officer, Colonel Corby, but the bulk of the personnel of the various staff sections did not come from England until December and January. Personnel of the U.S. component of the medical section arrived aboard a destroyer on 23 December, two days after their ship had been torpedoed and sunk off Oran.1
The section functioned no more smoothly in Algiers than it had in London. Under the British concept, the Director of Medical Services, Maj. Gen. Ernest M. Cowell, was responsible for the administration of all medical activities in the theater. American practice made the surgeon at each echelon responsible to the commanding general of his formation. This doctrinal divergence was aggravated by personal friction between Cowell and Corby, his American deputy.2
An additional complication was introduced in December when Colonel Kenner, the Western Task Force surgeon, became a brigadier general. Cowell had been promoted to major general in November, so that his seniority was not jeopardized, but Corby`s position became increasingly difficult. General Kenner, who now had too much rank for a task force surgeon, was attached to AFHQ as medical inspector, with authority so broad that he functioned in fact as inspector general for the theater commander, General Eisenhower. In this capacity, he exercised varying degrees of control over both Corby and Cowell.
The staff of the American component of the medical section, like other U.S. elements in AFHQ, was inexperienced in meeting the demands of a combat situation and was quickly bogged down in a welter of operational detail not contemplated in the preinvasion planning. The four officers and four enlisted men assigned were unable to establish any effective control over Army medical service in North Africa, or to carry out responsibility for hospitalization, evacuation, and supply. Neither could they exercise any decisive influence on Allied policy, since they were consistently outnumbered and outranked by their better informed Brit-
1 Ltr, Gen Standlee to Col Coates, 15 Jan 59, commenting on preliminary draft of this volume.
2 (1) Hist of AFHQ, pp. 66, 538. (2) Ltr, Gen Snyder to Inspector General, 8Feb. 43, sub: Inspection of Med Serv Eastern Sector, Western Theater of North Africa. Throughout this chapter the author is indebted to Armfield, Organization and Administration, pp. 245-301.
ish counterparts. Personnel were attached from subordinate units to make up the minimum strength required, but there was no way to compensate for the fact that the British held higher ranks and received intelligence information not available to the U.S. component.3
These difficulties were resolved only when a strictly American theater was created to handle all purely American affairs. For purposes of the invasion, North Africa had been considered a part of the European Theater of Operations, whose boundaries had been extended south to the Tropic of Cancer and east into Libya. Once AFHQ was set up on African soil, however, and supplies began to come directly from the United States, the ETO connection ceased to serve any useful purpose. It was severed entirely early in February 1943 with the establishment of the North African Theater of Operations, United States Army (NATOUSA). 4
Under the new arrangement, Eisenhower became American theater commander as well as Allied Commander in Chief, and the senior United States officer of each AFHQ staff section, including the medical section, became chief of the corresponding segment of NATOUSA. This administrative reorganization paralleled the command changes on the Tunisian front, whereby II Corps was given its own combat mission and its own battle sector.5It also offered an opportunity to resolve the internal difficulties of the AFHQ medical section. On 4February, the date of the activation of NATOUSA, General Kenner replaced Colonel Corby as Deputy Director of Medical Services--Deputy Chief Surgeon, AFHQ, in American terminology--becoming at the same time Surgeon, NATOUSA, with Colonel Standlee, Corby`s executive officer, as his deputy. General Kenner also retained his functions as medical inspector.
Except for broad policy matters, the American medical service in the Mediterranean was exempt from British control after 4 February 1943. Thereafter the U.S. component of the AFHQ medical section functioned primarily in its NATOUSA capacity, having administrative and operational supervision over all U.S. Army medical services in the theater.
For another three months the medical
3 (1) Annual Rpt, Med Sec, NATOUSA, 1943. (2) 1st Lt Kenneth W. Munden, MS, Administration of the Medical Department in the Mediterranean Theater of Operations, United States Army, pp. 21-22. (3) Ltr, Gen Standlee to Col Coates, cited above.
4 Hist of AFHQ, pp. 183-84.
5 See pp.123-24, above.
section continued to operate on a shoestring. The original four officers and four enlisted men who made up the American medical staff of AFHQ had been increased by one in each category by the time NATOUSA came into existence, but that was all. With the Tunisia Campaign in full swing and a steady stream of casualties flowing back to the communications zone, the 10-man staff of the medical section worked without regard to hours.
It was late in March before a plan of organization, prepared by Colonel Standlee, was presented, and a month later before it was approved. The plan called for four operating subsections: administration; preventive medicine; operations and planning, further divided into hospitalization, evacuation, and training; and consultants. The personnel requirements were 23 officers and 30 enlistedmen.6
While the organization was being worked out, General Kenner left the theater on 23 March for another assignment. He was replaced on 16 April by General Blesse, surgeon of Fifth Army, which was then training in western Algeria. General Blesse had been detailed to NATOUSA headquarters during March. Like Kenner, Blesse performed the function of Deputy Surgeon and Medical Inspector, AFHQ, as well as those of Surgeon, NATOUSA. His relations with General Cowell were good, and close co-operation between the British and American staffs continued, even after the two groups moved into separate offices in June.7
As the theater expanded during 1943, new subsections were added to the medical section, and personnel increased correspondingly. In addition to close liasion with the major theater commands, the other staff sections of the North African theater headquarters, and the British, coordination with the medical service of the French Army also became necessary as French combat units began to participate in the Italian campaign. Representatives of the American, British, and French medical services met in Oran in November, and thereafter the consulting surgeon of the French Army made frequent visits to the office of the Chief Surgeon, NATOUSA.
With the growth of the theater and the increasing dispersion of medical units, more formalized means of communication became necessary. A series of circular letters, initiated in March, provided instructions on theater medical policy and approved technical procedures for the various medical installations. Beginning in July, theater medical experience was detailed in monthly Essential Technical Medical Data reports, or ETMDs, prepared for the Surgeon General but serving to bring together a wide variety of information of use within the theater. A professional journal, the Medical Bulletin of the North African Theater of Operations, began monthly publication in January 1944.
The North African Base Sections
By the time NATOUSA was set up early in February 1943, two U.S. base
6 (1) Annual Rpt, NATOUSA, 1943. (2) Munden, Administration of Med Dept in MTOUSA, pp.30-46. (3) Intervs, with Gen Kenner and Gen Standlee, 10 Jan 52.
7 Memo, Brig Gen Fred W. Rankin to TSG, 2 Nov 43, Sub: Remarks on Recent Trip Accompanying Senatorial Party.
sections were already operating in the theater. The first in point of time, as well as the longest lived, was the Mediterranean Base Section (MBS), with headquarters in Oran. Made up originally of Services of Supply elements attached to the Center Task Force, MBS was activated on 8 December 1942. Its medical section was headed by Lt. Col. (later Col.) Howard J. Hutter, who served until December 1943.Col. John G. Strohm, commanding officer of the 46th General Hospital, acted as MBS surgeon until March 1944, when he was succeeded by Col. Harry A. Bishop. The section boasted 20 officers, 1 nurse, and 31 enlisted men by the beginning of 1943, expanding thereafter as circumstances required. A subdivision of the Mediterranean Base Section, known as the Center District, was set up in Algiers on 7 June 1943, its initial medical staff consisting of Lt. Col. Joseph P. Franklin, surgeon, and 3 enlisted men. Beginning in March 1944 no surgeon was assigned to the Center District other than the MBS surgeon.8
The second North African base section to be established was the Atlantic Base Section (ABS),activated at Casablanca 30 December 1942. Again the section was built around SOS elements that had accompanied the task force. The ABS medical section included ten officers and four enlisted men. The surgeon was Col. (later Maj. Gen.) Guy B. Denit, who was recalled to the zone of interior in April en route to the Pacific. He was succeeded by his deputy, Lt. Col. (later Col.) Vinnie H. Jeffress, who joined the group preparing a communications zone organization for the coming invasion of Italy in August. At that time Col. Burgh S. Burnet became ABS surgeon. Colonel Burnet was replaced in January 1944 by Col. Thomas R. Goethals, who combined the duties of base surgeon--by that date greatly diminished--with those of commanding officer of the 6th General Hospital. 9
Both base sections were placed under the jurisdiction of AFHQ on 30 December 1942, but in the absence of effective supervision both developed more or less independently until brought under the NATOUSA organization in February.
The last of the base sections in North Africa proper, the Eastern Base Section (EBS), was established 13 February 1943 and activated a week later, at Constantine in northwestern Algeria, to meet
8 (1) Annual Rpts, Med Sec, MBS, 1943, 1944. (2) Annual Rpt, Med Sec, Center Dist, MBS, 1943
9 Annual Rpts, Med Sec, ABS, 1943, 1944.
the need for an American base closer to the Tunisian combat zone. The EBS surgeon was Lt. Col. (later Col.)William L. Spaulding, whose original staff consisted of five officers and seven enlisted men drawn from MBS and ABS. With the extension of the war in the Mediterranean, the Eastern Base Section became the largest and most important of the three by virtue of its greater proximity to Sicily and Italy, and a man of more rank and experience than Spaulding then possessed seemed needed. Col. Myron P. Rudolph, the man General Blesse selected for the job, became EBS surgeon in July 1943. Headquarters was moved to Mateur immediately after the end of the Tunisia Campaign, and to Bizerte in August.10
As of 6 October1943, the boundaries of the various base sections were shifted to conform to territorial borders, ABS being made contiguous with French Morocco, MBS with Algeria, and EBS with Tunisia.
On 1 September1943, two weeks after the successful conclusion of the Sicily Campaign, an Island Base Section (IBS) was activated at Palermo. Like the base sections in Africa, lBS was responsible to NATOUSA. Its medical section was headed by Lt. Col. (later Col.) Lewis W. Kirkman, who had come direct from the zone of interior. Boundaries were drawn to include only those portions of Sicily still being used by U.S. forces: the Palermo-Termini area, the Agrigento-Porto Empedocle area, Licata, and Caltanisetta.11
By the end of1943, preliminary plans for an invasion of southern France were being drawn up at Seventh Army`s new headquarters in Algiers, and Corsica, by accident of geography, assumed more importance in Allied strategy. A Northern Base Section (NORBS), confined to that island, was accordingly established on January 1944. The NORBS surgeon was Lt. Col. (later Col.) Albert H. Robinson, formerly deputy surgeon of ABS.12
The base section surgeons were responsible to the base section commanders, but their policies were determined and their work supervised by the theater surgeon, and their offices were generally organized along a line closely paralleling the organization of the NATOUSA medical section. Only in their medical supply activities, which were directly under the Services of Supply, were they exempt from control by the theater surgeon, and even here close co-ordination existed.
Air Forces Medical Organization
The Army Air Forces in the Mediterranean had its own medical organization, distinct from that of the theater but operating in harmony with it. Col. Elvins, surgeon of the Twelfth Air Force, set up his office at Tafaraoui airfield near Oran two days after the Center Task Force landings, moving to Algiers on 19November 1942. Under Colonel Elvins, in addition to his own headquarters, were medical sections for the Bomber Command, the Fighter Command, the Air Service Command, and the Troop Carrier Wing. Medical supply and veterinary(food inspection) functions were
10 (1) Annual Rpt, Med Sec, EBS, 1943. (2) Surg, NATOUSA, Journal, 12, 16, 17 Jul43.
11 Annual Rpt, Med Sec, NATOUSA, 1943. No reports of the IBS itself have been located.
12 (1)Annual Rpt, Med Sec, NATOUSA, 1944. (2) Annual Rpt, Med Sec, NORBS,1944.
under the Air Service Command, which had subheadquarters, each with a small medical section, at Casablanca, Oran, and Constantine.13
A reorganization in December 1942 merged the Twelfth Air Force with British and French air units to form the Northwest African Air Forces (NAAF), but the medical organization remained substantially unchanged. The Twelfth Air Force again became a separate unit just before the invasion of Italy in September 1943,though it continued to be under the operational control of the NAAF. After capture of the great Foggia air base in southern Italy in early October, the Twelfth was reconstituted as a tactical force and a new heavy-bomber group, the Fifteenth United States Air Force, was activated. Both forces were subordinated to a new U.S. air command at the theater level--the Army Air Forces, Mediterranean Theater of Operations--in January 1944. An Air Service Command, Mediterranean Theater of Operations, was established at the same time, and both were brought under control of the Mediterranean Allied Air Forces, which superseded the NAAF. Headquarters of all major U.S. air units except the North African Wing of the Air Transport Command were in Italy by this time.14
Experience in North Africa, where Air Forces personnel were dependent on base section installations for fixed hospitalization, demonstrated a need for attaching a minimum number of fixed beds directly to the Air Forces as the Mediterranean campaign expanded. Air bases were often remote from hospitals located near concentrations of ground troops, yet Air Forces personnel were no less subject to disease and suffered casualties commensurate with an increasing tempo of activity. It was therefore agreed in October 1943 between General Blesse and Colonel Elvins that fixed hospitals should be attached to Air Forces units operating in southern Italy and from the newly occupied islands of Sardinia and Corsica.
Hospitalization in the Communications Zone
While the North African campaign was still in the planning stage, The Surgeon General had recommended a fixed-bed ratio of 12 percent of troop strength, on the basis of World War I experience. British experts on military medicine believed 6 percent would be adequate in terms of their own combat experience up to that date. Colonel Corby asked for fixed beds for 10 percent of the command, with a minimum ratio of 8 percent. The British basis was adopted, with many misgivings, simply because it was believed that shipping space for more beds would not be available.15
Hospitalization During the Tunisia Campaign
Fighting incidental to the landings in North Africa was over and the build-up
13 (1) Hist, Twelfth Air Force Med Sec, 1942-44. (2) Link and Coleman, Medical Support of the Army Air Forces in World War II, ch. VI.
14 Air Forces medical organization subsequent to January 1944 is treated in connection with the Italian communications zone. See pp. 326-27, below.
15 (1) Ltr, Col Corby to Gen Cowell, 1 Jan 43. (2) Zelen, Hospitalization and Evacuation in MTOUSA, pp. 10, 21. For more detailed discussion of bed ratios, see Smith, Hospitalization and Evacuation, Zone of Interior, pp.215-18.
for the campaign in Tunisia was well under way before any fixed hospitals arrived in the theater. With the single exception of the 48th Surgical, attached to the Center Task Force, even the mobile units arrived too late to be used in the assault phase and were therefore employed initially as fixed hospitals.16
Atlantic Base Section-Remote as it was from the combat zone, the Atlantic Base Section was the first to achieve relative stability in its hospital program. For the most part hospitals were sited in existing buildings and remained in place for considerable periods of time. Casualties received were mainly cases evacuated from other base sections for further treatment, or en route to the zone of interior. 17
When ABS took over responsibility from the Western Task Force at the end of 1942 there were three evacuation hospitals functioning in the area as fixed units, with an aggregate T/O strength of 1,900 beds. A minimum number of additional beds, probably not exceeding 25, were available in a provisional hospital at Safi. Another 400-bed evacuation hospital, the 11th, and the 51st Station Hospital with 250 beds, were in the area but not yet operating. (Map18)
The 51st Station Hospital went into operation in Rabat on 31 January 1943, while the 6th General, with 1,000 beds, arrived in Casablanca on 20 February and opened in that city a week later. Both of these hospitals occupied school buildings. Arrangements were also completed in February for a 25-bed provisional hospital at Marrakech to serve Air Forces units stationed in that vicinity, although the hospital did not open until 15 March. The Marrakech hospital occupied one wing of a French hospital building. It was initially staffed by a team of the 2d Auxiliary Surgical Group, withdrawn at that time from Safi, but was taken over in June by a detachment from the 56th Station Hospital, supplemented as occasion required by personnel on temporary duty from the6th General Hospital. Early in August 1944 the Marrakech unit was redesignated the 370th Station Hospital.
The 69th Station Hospital began operating 500 beds at Casablanca on 28 March, in school and dispensary buildings. A month later, on 29 April, the 1,000-bed 45th General opened in Rabat, taking over the quarters previously occupied by the 51st Station. In anticipation of the shift, the 51st had moved into various structures connected with a racetrack on the outskirts of the city that had just been vacated by the 11th Evacuation Hospital. The 51st Station remained until 17 August, while the 45th General continued to receive patients until 15 November.
The last group of fixed hospitals to be established in ABS began operating early in May1943, coinciding with the final phase of the Tunisia Campaign. The 50thStation, with 250 beds, opened in Casablanca on 5 May in tents and hastily constructed temporary buildings. The 23d Station, brought by air from the Belgian Congo, opened 250 beds under canvas at Port-Lyautey on 9 May, expanding to 500 beds late in July. The 250-bed 66th Station began operating at Casablanca on 12 May, in the buildings
16 See pp.119-20, above.
17 Major sources for this section are: (1) Annual Rpt, Med Sec, ABS. 1943; (2) Annual Rpt, Med Sec, NATOUSA, 1943: (3) Unit Rpts of hosps and other med installations mentioned in the text.
FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945
91st Evacuation(as station), 2 February-25 April 1943. 400 beds.
23d Station,9 May-19 September 1943. 250/ 500 beds.
11th Evacuation(as station), 8 December 1942-3 April 1943. 400 beds.
51st Station,31 January-17 August 1943. 250 beds.
45th General,29 April-15 November 1943. 1,000 beds.
8th Evacuation(as general), 22 November 1942-19 June 1943. 750 beds.
59th Evacuation(as station), 30 December 1942-30 June 1943. 750 beds.
6th General, 27 February 1943-14 May 1944. 1,000 beds.
69th Station, 28 March-15 August 1943. 500 beds.
50th Station, 5 May 1943-19 May 1944. 250 beds.
66th Station, 12 May-6 December 1943. 250 beds.
56th Station, 14 May 1943-28 February 1945. 250 beds.
370th Station, 25 March 1943-28 February 1945. (Unnumbered provisional hospital to 4 August 1944) 25 beds.
52d Station,13 January-28 November 1943. 250-500 beds.
95th Evacuation(as station), 24 May-4 July 1943. 400 beds.
9th Evacuation(as station), 12-26 December 1942. 750 beds.
32d Station,28 February-28 November 1943 500 beds.
48th Surgical(as station), Arzew, 9 November 1942-18 January 1943. 400 beds.
77th Evacuation(as station), Oran, 12 November-1 December 1942. 750 beds.
Depots in North Africa, November 1942-February 1945
38th Evacuation(as station), St. Cloud, 13 November 1942-6 February 1943. 750 beds.
151st Station, La Sénia, 25 November 1942-31 May 1944. 250 beds.
7th Station, Oran, 1 December 1942-31 July 1944. 750 beds.
180th Station, Ste. Barbe-du-T1élat, 7 December 1942-30 September 1943; Bouisseville,1 October 1943-15 April 1944. 250/500 beds.
64th Station, Sidi Bel Abbes, 28 December 1942-31 May 1944. 250 beds.
21st General, Sidi Bou Hanifia, 29 December 1942-30 November 1943. 1,000 beds.
12th General, Ain et Turk, 14 January-3 December 1943. 1,000 beds.
40th. Station, Arzew, 18 January-4 March 1943; Mostaganem, 4 March 1943-15 January 1944..500 beds.
2d Convalescent, Bouisseville, 28 February 1943-31 May 1944. 3,000 beds.
91st Evacuation(as station), Mostaganem, 2 May-27 June 1943. 400 beds.
94th Evacuation(as station), Perregaux, 22 May-29 August 1943. 400 beds.
16th Evacuation(as station), Ste. Barbe-du-Tlélat, 23 May-8 August 1943. 750 beds.
95th Evacuation(as station), Am et Turk, 6 July-16 August 1943. 400 beds.
69th Station, Assi Bou Nif 30 September 1943-16 September 1944. 500 beds.
23d Station, Assi Bou Nif 4 October 1943-28 August 1944. 500 beds.
51st Station, Assi Bou Nif 28 October 1943-15 April 1944. 250 beds.
43d General, Assi Bou Nif 31 October 1943-15 June 1944. 1,000 beds.
70th General, Assi Bou Nif 31 October 1943-27 October 1944. 1,000/1,500 beds.
46th General, Assi Bou Nif 4 November 1943-31 July 1944. 1,000/1,500 beds.
54th Station, Assi Bou Nif 2 October-23 December 1944. 250 beds.
29th Station,30 January 1943-25 August 1944. 250 beds.
79th Station,17 June 1943-30 June 1944. 500 beds.
FIXED HOSPITALS IN NORTH AFRICA, NOVEMBER 1942-FEBRUARY 1945 - Continued
35th Station,30 March-12 August 1943. 500 beds.
61st Station, El Guerrah, 12 February-22 October 1943. 500 beds.
38th Evacuation(as station), Télergma, 9 March-3OApril 1943. 750beds.
73d Station, Constantine, 23 April 1943-20 January 1944. 500 beds.
26th General, Bizot, 26 April-31 October 1943. 1,000 beds.
57th Station, Oued Seguin, 5 May-5 September 1943; 20 January-25 September 1944. 250beds.
77th Evacuation(as station), 16 April-25 June 1943. 750 beds.
105th Station,25 July-7 September 1943. 500 beds.
57th Station,7 September 1943-19 January 1944. 250 beds.
38th Evacuation(as station), Bédja, 4 May-19 June 1943; Tunis, 20 June-24 August1943. 750 beds.
9th Evacuation(as station), Michaud, 10 May-7 July 1943; Ferryville, 9 July-6 September1943. 750 beds.
56th Evacuation(as station), Bizerte, 20 June-17 September 1943. 750 beds.
53d Station, Bizerte, 27 June 1943-12 January 1944. 250 beds.
54th Station, Tunis, 28 June 1943-30 August 1944. 250 beds.
78th Station, Bizerte, 1 July 1943-15 March 1944. 500 beds.
114th Station, Ferryville, 2 July 1943-10 May 1944. 500 beds.
58th Station, Tunis, 5 July-29 December 1943. 250 beds.
81st Station, Bizerte, 12 July 1943-4 April 1944. 500 beds.
3d General, Mateur,13 July 1943-22 April 1944. 1,000 beds.
43d Station, Bizerte, 19 July 1943-12 January 1944. 250 beds.
60th Station, Tunis, 23 July-21 October 1943. 250 beds.
74th Station, Mateur, 29July-17 November 1943. 500 beds.
103d Station, Mateur, 2 August-9 December 1943. 500 beds.
35th Station, Morhrane, 28 August-22 December 1943. 500 beds.
33d General, Bizerte, 15 September 1943-10 May 1944. 1,000 beds.
24th General, Bizerte, 28 September 1943-31 May 1944. 1,000 beds.
37th General, Mateur, 1 October 1943-12 April 1944. 1,000 beds.
105th Station, Ferryville, 21 October 1943-29 May 1944. 500 beds.
64th General, Ferryville, 23 October 1943-29 February 1944. 1,000 beds.
57th Station, Bizerte, 15 July-31 October 1944; Tunis, 1 November 1944-28 February 1945.250/150 beds.
34th Station,18 June-21 September 1943. 250 beds.
55th Station,26 June-11 October 1943. 250 beds.
North African Medical Supply Bases
Atlantic Base Section
4th Medical Supply Depot, Casablanca, 27 January-16 August 1943.
Mediterranean Base Section
2d Medical Supply Depot, Oran, 8 December 1942-15 August 1944.
60th Medical Base Depot Company, Oran, 15 August-15 December 1944.
Eastern Base Section
4th Medical Supply Depot, Am M`lilla in the Constantine Area, with subdepots at Bône and Philippeville, 19 March-8 June 1943.
2d Medical Supply Depot, Mateur in the Bizerte Tunis area, 15 May-8 June 1943.
7th Medical Supply Depot, Mateur, 8 June 1943-12 May 1944.
of the Italian consulate vacated when the 8th Evacuation moved into tents in March. The 56th Station opened250 beds on 14 May in a prisoner-of-war enclosure at Berrechid, temporary buildings being supplemented by tents when the patient load required.
The 56th Station moved in August to the site of a French orphanage in Casablanca, where it operated a convalescent
camp for the 6th General Hospital. The 23d Station left ABS in September, and the 66th in December 1943. The50th remained until 1 May 1944. Only the 56th Station at Casablanca and the 370th at Marrakech were still in operation when the area passed to control of the Africa-Middle East Theater on 1 March 1945.18
Hospitals in the Atlantic Base Section were supplemented by the 2d Medical Laboratory, which arrived in Casablanca 24 December 1942, and by the 5th General Dispensary, which reached that city on 20 February 1943. The 2d Medical Laboratory remained in the area until 15 June, operating mobile units at Marrakech, Fès, and other Moroccan cities. The 5th General Dispensary functioned in Casablanca until 30 August 1943.
Maximum bed strength in ABS was reached in May 1943 when 7,025 T/O beds were available, with expansion units capable of adding 50 percent to that total. The greatest patient load came in June and July, the peak being reached early in the latter month when 5,700 beds were occupied. Evacuation to the
18 See pp.80, 84-85, above.
United States brought the figure down sharply before the end of the month, and there was a steady decline thereafter. 19
Mediterranean Base Section- Until the second phase of the Tunisia Campaign got underway in February, the largest concentration of United States troops was in the area served by the Mediterranean Base Section, and the build-up of fixed hospitals was both more rapid and more extensive than was the case in ABS. Oran and its environs were well within range of enemy bombers based on Sardinia and in the Tunis-Bizerte area. The initial policy, therefore, was one of dispersal. Most hospital sites, many of them selected before the base section itself was activated, were considerable distances from the city. 20
Here mobile hospitals that arrived immediately after the assault were quickly replaced by fixed units. First in the area was the 151st Station, which set up its 250 beds in the infirmary building at La Sénia airport, five or six miles south of Oran, on 25 November. Although supplemented by tents, the site proved inadequate, and the hospital moved at the beginning of April 1943to a college plant somewhat nearer the city. The 7th Station Hospital, with a T/O of 750 beds, took over operation of a civilian hospital in Oran on 1 December, relieving the 77th Evacuation. The 7th Station was the only U.S. military hospital in Oran itself during the North African campaign.(See Map 18.)
The 180th Station Hospital opened at Ste. Barbe-du-Tlélat on 7 December, its 250 beds being housed in Nissen huts and tents. The 64th Station, another 250-bedunit, began operating on 28 December in buildings of the College Laperrine at Sidi Bel Abbès, near the home barracks of the famed French Foreign Legion. The last fixed hospital to receive patients in MBS before the end of 1942 was the 21st General, which opened on 29 December in a group of resort hotels at Sidi Bon Hanifia.
The 2,500 fixed beds in MBS on 1 January 1943 were doubled by the end of the month. The250-bed 52d Station Hospital opened on 13 January at Oujda, where it was assigned to serve Fifth Army, then beginning the long period of training that would lead to Salerno and on to the Alps. The 12th General, with 1,000beds, opened on 14 January, occupying 105 villas in the resort village of Ain et Turk overlooking the Mediterranean west of Oran. It was then hoped to establish a hospital center there. The 40th Station operated 250beds in the Foreign Legion barracks at Arzew from 18 January to 4 March, taking over from the 48th Surgical. The 40th then moved into a miscellaneous group of buildings in Mostaganem where its full T/O of 500 beds was setup. Last of the mobile units to depart the area was the 38th Evacuation Hospital, which had operated as a station hospital at St. Cloud from 13November 1942 to 6 February 1943.
The Center District was served by the 29th Station Hospital of 250 beds, which took over a small civilian hospital in Algiers. Its first patients were transferred from a British hospital on 30 January.
19 See app.A-3.
20 Principal sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Med Sec, MBS, 1943; (3) Annual Rpt, Med Sec, Center Dist, MBS, 1943; (4) Unit Rpts of hosps and other med installations mentioned in the text; (5) H. J. Hutter, "Medical Service of the Mediterranean Base Section, "Military Surgeon (January 1945) , pp.41-51.
Hospital facilities in MBS were considerably augmented when the 2d Convalescent Hospital began receiving patients on 18 February. Though assigned to the base section rather than to a combat element, the 3,000 beds of this unit were not reported as "fixed." They served, however, to free an equivalent number of beds in other hospitals. After diligent search, a suitable location for the2d Convalescent was found at Bouisseville, close to Am et Turk. The hospital was in part under canvas and in part housed in 122 villas requisitioned for the purpose.
The 32d Station Hospital, of 500 beds, was in the theater a month before it opened on 28February in school buildings at Tlemcen. The only other fixed hospital to be established in MBS before the end of the fighting in North Africa was the 91st Evacuation, which operated under canvas as a station hospital at Mostaganem from 2 May until 27 June 1943.
In addition to these fixed hospitals, there were two general dispensaries functioning in MBS during the period of hostilities. The 8th General Dispensary opened on 6 December 1942 in what had been the British Cottage Hospital in Algiers, where it was the only U.S. medical installation until the arrival of the29th Station nearly two months later. The 6th General Dispensary opened on 13 February in the French Clinique Générale at Oran.
The T/O bed strength of fixed hospitals in the Mediterranean Base Section when combat operations in North Africa came to an end on 13 May 1943 was 5,400.21 The number of beds established, however, was considerably greater, since most of the units were operating beyond their normal capacity, with tents and Nissen huts frequently being used to house expansion beds.22 In addition to these fixed beds, the 3,000 beds of the 2d Convalescent Hospital were fully occupied.
Eastern Base Section- The first American hospital in the Eastern Base Section preceded the organization of the base section itself. This was the 500-bed 61st Station Hospital, which arrived at El Guerrah, some twenty-five miles south of Constantine, on 2 February 1943.(See Map 18.)The hospital was brought forward in response to a request from the Director of Medical Services, First Army, to relieve pressure on the British 31st General Hospital in the same area.23 It was set up under canvas and received its first patients on 12 February. The 61st operated under British control until 1 March, when it was formally transferred to EBS. In its early weeks of operation, before the rainy season ended, mud was so deep on the hospital site that ambulances could not leave the road and patients had to be carried by litter to the receiving tent. "Often the bed would sink to the springs under the weight of the patient. This condition was cor-
21 The figure for T/O beds as of 13 May 1943, given in the text is the 30 April figure from Appendix A-3, less the 250 nonoperating beds of the 57th Station Hospital, transferred out of the MBS in the interval, and includes the addition of the 400 beds of the 91st Evacuation Hospital, which opened in MBS as a station hospital on 2 May 1943.
22 Sec app. A-3.
23 (1)Deputy Surg, AFHQ, to G-4, Orders, 61st Sta Hosp, 20 Jan 43, and atchmt, DDMS, First Army, to Surg, AFHQ, 15 Jan 43. (2) Memo, ADMS. No. 1 LofC Subarea, to DDMS, First Army, 3 Jan 43.
rected by placing rocks or large tin cans under the legs of the bed." 24
The 750-bed 38thEvacuation Hospital moved into the Constantine area early in March, opening on the 9th of that month at Télergma. Housed in tents, the 38thEvacuation served primarily as a station hospital for Air Forces personnel and as a holding unit for air evacuation during the campaign in southern Tunisia. A week before the northern campaign ended, the 38th shifted to the vicinity of Bédja a few miles behind the fighting front, but continued to be assigned to EBS, functioning as a station hospital again as soon as the fighting was over. The 35th Station established its 500beds at St. Arnaud, about fifty miles west of El Guerrah, on 30 March, with two school buildings and a theater serving as housing.
The 77th Evacuation Hospital, which had served as a combat unit in the southern phase of the Tunisia Campaign, was assigned to EBS on 14 April, opening in tents at Morris near B6ne two days later. There the 750-bed unit functioned in a dual role, as an evacuation hospital for II Corps and as a rear installation, receiving patients from other hospitals closer to the front. The 73d Station Hospital, with a T/O of 500 beds, opened at Constantine in three school buildings on 24 April.
The 26th General, with 1,000 beds, reached EBS late in March but was not ready to receive patients until 26 April. During the intervening month engineers had to lay out roads, build cement platforms for tents and Nissen huts, and install water and sewage facilities. The site of the hospital was Bizot, a railhead a few miles north of Constantine. The 26th General was the first U.S. genera]hospital to function under canvas in the theater. The 250-bed 57th Station, which opened on 5 May at Oued Seguin near the Télergma airfield, completed the fixed hospital installations in the Eastern Base Section up to the close of the Tunisia Campaign. The 57th was housed in tents and hutments. Also at Oued Seguin from 29 April was the 1st Medical Laboratory.
Counting the two assigned evacuation hospitals, there were 4,250 T/O beds in EBS as of 15May 1943.25
Bed Shortages-T/Obed strength in communications zone hospitals during the Tunisia Campaign never approached the 6-percent ratio approved before the invasion. The actual ratio of T/O fixed beds to troop strength was only 3.2 percent at the end of January 1943, 26 when Tunisian casualties began flowing back to the fixed hospitals, and had climbed only to 5.1 percent by the end of May.27
In order to carry the patient load, evacuation hospitals were pressed into service as fixed units, and emergency beds were established in hospitals already in operation. The 21st General at Sidi Bou Hanifia, for example, reached a maximum patient census of 4,000 and cared for an average of 1,750, although
25 This figure represents the T/O bed strength assigned to the EBS as of 30 April1943, plus the 250 beds of the 57th Station Hospital, which opened as an EBS unit on 5 May 1943. See app. A-3.
26 "On several occasions I heard that the hospital situation at the beginning was almost scandalous. It has been greatly improved, due to the energy and ability of a man named Blesse, whom I did not meet until later." Ltr, John J. McCloy, ASW, to Maj Gen Wilhelm D. Styer, CofS S0S, 22 Mar 43.
27 See app. A-6
its T/O called for only 1,000 beds. The necessity of operating for considerable periods at greater than normal capacity meant heavy demands on power, water, and mess facilities, as well as on personnel. Maintenance and repair were constant problems, with the need for carpenters, plumbers, and electricians often acute. Civilians were employed in considerable number wherever possible, while prisoners of war were used in various permitted capacities.
On the professional side, the primary personnel problem was one of making the best use of the skills available. The affiliated units, of which there were eleven in the theater during the period of active combat, were uniformly staffed with a disproportionate number of specialist personnel. Promotions within the unit were usually dependent on attrition, which was a slow and uncertain process. There were thus pressures both from within and outside these hospitals to transfer men to other units, where their skills could be used to better advantage and advance in rank would be more rapid. Personnel shifts between hospitals had become fairly common by the close of the Tunisia Campaign, the affiliated units, and especially the large general hospitals, being in effect raided to build up the staffs of smaller installations.28
28 For more detailed discussion of the personnel problem in the affiliated units, see McMinn and Levin, Personnel in World War II, pp.206-10.
Temporary additions to the staffs of a number of fixed hospitals were also secured by the use of personnel not yet permanently assigned who were drawn from staging areas. Many hospitals arriving in the theater during the campaign were not immediately placed in operation, either because sites had not yet been prepared or because equipment had been delayed. Personnel of these units, both professional and enlisted, were usually assigned to temporary duty at some other hospital in the port area. This technique served the dual purpose of breaking in the newcomers, and of relieving the staff of established units of some of the burdens entailed when operating above normal capacity. Because most of the hospitals debarked at Oran, the greatest use of staging personnel was in the Mediterranean Base Section.
Development of North Africa as a Hospital Base
The Hospital Build-up- Short air routes, all-weather landing fields, ports, and rail connections all combined to make the Bizerte-Tunis area the logical hospital base to support the invasion of Sicily, scheduled for 10 July. With less than two months for preparation, the hospital build-up in the northeastern corner of Tunisia went forward as rapidly as the debris of battle could be cleared away. The final mopping up of Axis forces was still going on when the largest hospital convoy yet to reach the Mediterranean arrived at Oran on 11 May. The units included five 500-bed station hospitals, seven 250-bed station hospitals, a 400-bed field hospital, and a 400-bedevacuation hospital. The 1,000-bed 3d General Hospital debarked simultaneously at Casablanca. On 23 May 3 more 500-bed station hospitals arrived at Oran, bringing the total increment of beds to more than 7,500. 29
The selection of hospital sites began as soon as an advance echelon of EBS headquarters had been established at Mateur on 12 May. At this time there were a general and four station hospitals in EBS, all of them in the Constantine area, with an aggregate T/O capacity of 2,750 beds. The three 750-bed evacuation hospitals employed during the campaign in northern Tunisia--the 9th, 38th, and 77th--continued to care for patients at normal or greater than normal capacity, bringing the minimum bed strength for the base section to 5,000.This total had been increased to 7,500 by the date of the invasion of Sicily, and to 12,000 by the beginning of August.30
The largest concentration was around Bizerte, where the 250-bed 53d Station Hospital was the first to open, on 16 June. The 750-bed 56th Evacuation Hospital, which had operated briefly at Casablanca, opened as a station hospital near Bizerte on 20June. The 78th Station opened in the same area on 1 July, followed by the43d, the 81st, and the 80th Stations on l1, 12, and 13 July, respectively. The 43d was a 250-bed unit, the other three were 500-bed hospitals. (See Map 18.)
In Tunis the 54thStation opened with 250 beds on 19 June, followed the next day by the 38thEvacuation, which had moved from its Bédja location. Two more 250-bedstation hospitals, the 58th
29 Except as otherwise noted, this section is based on: (1) Annual Rpt, Med Sec, NATO USA, 1943; (2) Annual Rpt, Med Sec, EBS, 1943; (3) Annual Rpts, Med Sec, MBS, 1943; (4) Unit Rpts of the hosps mentioned in the text.
30 See app. A-3.
and 60th, opened in Tunis on 5 and23 July, respectively. The 77th Evacuation Hospital closed at Morris on25 June, but remained in the area for another two months. The 114th Station, of 500 beds, opened in the vicinity of Ferryville on 2 July, and a week later the 9th Evacuation moved from Mateur to Ferryville. Three more fixed hospitals were established at Mateur--the 1,000-bed 3d General on 15 July,in the quarters vacated by the 9th Evacuation; the 74th Station on 29 July; and the 103d Station on 2 August. Both station hospitals bad 500 beds.
In addition to these four points of concentration, the 250-bed 55th Station Hospital opened in the Holy City of Kairouan on 19 June and the 105th Station, of 500 beds, at Aïn Mokra near Bône on 25 July. The latter unit moved to Ferryville late in October. Between 18 June and 21 September the 34th Station Hospital was attached to the Twelfth Air Force and operated 250 beds for Air Forces personnel on Pantelleria Island.
The rapid expansion of bed capacity in the Bizerte-Tunis area posed the most difficult siting problem encountered in the theater. Water was scarce, the region was poorly drained, and the malaria season was at its height. There were few usable buildings available, and materials for construction were almost equally difficult to procure in the brief time at the disposal of the engineers. In addition to these physical limitations, the military situation required an extensive build-up of troops and supplies in the same area, with competing demands for facilities, space, and engineering manpower. The 3d General Hospital at Mateur occupied former French military barracks, supplemented by tents and prefabricated huts, but the station hospitals had to rely for the most part upon canvas and such more stable structures as could be improvised. Water supply, sewage disposal, and power facilities all had to be installed.31
So great was the pressure upon the engineers for purely military construction that although the hospitals were physically in the area, only a portion of those relied upon to care for Sicily casualties were ready when the first patients were returned from the invasion coast. The situation was critical enough to send the theater surgeon, General Blesse, on a hasty flight to Mateur to size up the difficulties for himself. Before he returned to his Algiers headquarters, Blesse got the hospital program moving again, and took steps to strengthen the EBS medical section.32
Approximately 2,000 additional beds were also established in the Mediterranean Base Section between the end of the Tunisia Campaign and the assault on Sicily. The only fixed installation, however, was the 500-bed 79th Station Hospital, which opened at Cap Matifou just east of Algiers on 17 June. The others were evacuation hospitals serving temporarily as fixed units while staging for more active roles in future combat operations. The 94th Evacuation Hospital of 400 beds functioned as a station hospital at Perrégaux between 22 May and 29 August before taking part in the invasion of Italy, while the 400-bed 95th Evacuation, also destined for Salerno, served Fifth Army at Oujda from 24 May to 4 July. The 95th then moved to Am et Turk where it took casualties from
31 A. I. Zelen, MS. Hospital Construction in the Mediterranean Theater of Operations, United States Army, pp. 38-40.
32 Surg, NATOUSA, Journal, 15, 16, 17 Jul 43. See also pp.180-81, above.
Sicily until 16 August. The 750-bed16th Evacuation Hospital operated as a station hospital for prisoners of war at San Seno Wells, near Ste. Barbe-du-Tlélat, between 23 May and 8 August.(See Map 18.)
After the Sicily Campaign was over, there was a further concentration of hospitals around Bizerte and Oran in support of expanding operations in Italy. North Africa achieved its maximum strength of approximately 25,000 T/O beds plus 14,000expansion beds about the first of November. Even counting fixed beds already in Sicily and Italy, however, the ratio to troop strength remained below the original authorization of 6 percent and well below the 6.6-percentfigure authorized in September.33
The Eastern Base Section reached the saturation point during September and October with the establishment of four additional 1,000-bed general hospitals. The movement started with an internal shift of the 35th Station Hospital from Saint-Arnaud near Constantine to Morhrane in the vicinity of Tunis. The 33d General opened in tents and hutments on "Hospital Road" just outside Bizerte on15 September. The 24th General, which opened in the same area two weeks later, was more fortunate, being partially housed in French military barracks. The 37th General Hospital, which opened at Mateur on 12 September, and the 64th General, which began receiving patients at Ferryville on 23 October, were both under canvas supplemented by prefabricated units. (SeeMap18.)
With no further hospital sites available in Tunisia, such additional buildup as was required was made in the Mediterranean Base Section, where conditions were good and a substantial degree of permanence was anticipated. An elaborate hospital groupment was laid out at Assi Bou Nif, about eight miles southeast of Oran. The 69th Station Hospital was shifted from Casablanca to the new site on 30 September, the 23d Station from Port-Lyantey on 4 October, and the 51st Station from Rabat on the 28th of the same month. In addition to these units from the Atlantic Base Section, two new 1,000-bed generals, the 43d and the 7otb, opened at Assi Bou Nif on 31 October. The groupment was completed with the opening of the 46th General Hospital on 4 November.
The Assi Bou Nif project was planned for long-term use. Starting with open fields, the engineers installed complete power, water, and waste disposal facilities for a potential capacity of double the 4,250 beds actually installed. Buildings were mostly of permanent construction, many of them of stone. Those ward tents used had wood floors and frames. Nissen and Boyle huts were insulated. Much of the actual labor was performed by Italian prisoners of war, whose full utilization ceased to be restricted after Italy achieved the status of a cobelligerent. Local sandstone and cement were more readily available than lumber, and given unlimited supplies of manpower, were more economical.34
Hospitalization of Sicily Casualties in North Africa- For the first time in any U.S. theater in World War II, selective hospitalization was attempted for casualties from Sicily. With most of the available surgical teams assigned to the
33 See apps.A-3, A-6
34 Zelen, Hospital Construction in MTOUSA, pp.30-31.
combat zone, it was clear that there would not be enough skilled surgeons left to staff all of the Eastern Base Section hospitals, either for general work or for specialties. Careful plans were therefore made to assign patients to hospitals by type of case.
Craniocerebral, spine, and cord injuries were to go to the 78th Station Hospital, eye injuries to the 114th Station, chest cases to the 53d Station, and neuropsychiatric cases to the 43d Station. Compound fractures were to be handled by the9th and 56th Evacuation Hospitals, and by the 74th, 80th, and 81st Stations. For emergency periods the two evacuation hospitals and the 3d General were qualified to treat cases of all types. Triage for those brought by sea was to be carried out by the 56th Evacuation at Bizerte, and for those flown from Sicily by the 9th Evacuation near Mateur airfield.35
It was possible to carry out these plans only in part. When the first casualties arrived on D plus 1 many of the EBS hospitals were not yet ready for patients. The road to the 9th Evacuation was too rough for transporting serious cases. There were not enough ambulances available for the extra carry involved in
35 (1) Ltr ,Col Churchill to Surg, NATOUSA, 19 Aug 43, sub: Tour Rpt, Sicily, D+24to D+35. (2) Annual Rpt, Med Sec, EBS, 1943.
moving patients from the evacuation to the station hospitals. And finally, there were not enough beds to permit complete selectivity. The planning, moreover, had not taken into consideration the high incidence of malaria, or the accident rate consequent upon the staging of large numbers of troops. On the first day of the Sicily Campaign, more than a third of the approximately 6,500 beds established in northeastern Tunisia were already filled.
In actual practice, therefore, patients were sorted at the Bizerte docks by personnel of the8th Port Surgeons office and at Mateur airfield by personnel of the 802dMedical Air Evacuation Transport Squadron.36 Representatives of the EBS surgeon assigned patients in terms of daily bed status reports from each hospital. Transportation was by the 16th Medical Regiment. Hospital specialties were observed so far as possible, but bed space was the overriding consideration.
The geography was such that there was in fact no alternative to initial hospitalization of casualties from Sicily in EBS, and so no attempt was made to build up bed strength elsewhere than in northeastern Tunisia. When wounded from Sicily were carried by returning shipping to Algiers instead of Bizerte, the 250-bed 29th Station Hospital was unable to carry the extra load. The still inoperative 79th Station had to set up tents to take the overflow. The 38th Evacuation Hospital at Tunis handled the relatively small number of U.S. casualties reaching that city, but its location was poor. At times, when the wind blew in from the desert, the temperature in the operating tent rose to 135oF. Needless, perhaps, to say the hospital did not remain in Tunis long.37
Hospitalization of Italy Casualties in North Africa-The establishment of additional hospitals in the Tunis-Bizerte area shortly after the Salerno landings of 9 September 1943 led to various changes in the disposition of patients being received by air and water in EBS.38
On 20 September a triage center was set up in the vicinity of the 33d General Hospital, approximately four miles from the Bizerte docks, a mile from the Sidi Abmed airport, and 300 yards from the operating base of the 2670th Ambulance Company (Provisional). The triage center was conducted by 2 Medical Corps officers, and 2 Medical Administrative Corps officers, drawn from the various installations in the area and rotated monthly; and 6 nurses and 6 enlisted men from the 33d General Hospital. The center received a bed-status report each morning from the base surgeon`s office. When a hospital ship arrived, the Port Surgeon notified the ambulance company, and word was passed along to the triage center, to which the patients were brought when unloaded. The 802d Medical Air Evacuation Transport Squadron at Sidi Ahmed airport was in direct telephonic communication with the 33d General Hospital, the triage center, and the 2670th Ambulance Company.39
36 Annual Report, Medical Section, EBS, says 807th MAETS, but this squadron did not arrive in the theater until September. See Med Hist, 807th MAETS, 1 Jan45.
37 (1)Surg, NATOUSA, Journal, 16l Jul 43. (2) Annual Rpt, 38th Evac Hosp, 1943.
38 Except as otherwise noted, this section is based on: (1) Annual Rpt, Med Sec, EBS, 1943; (2) Annual Rpt, Med Sec, NATOUSA, 1943; (3) Unitrpts of hosps mentioned in the text.
39 Memo, Capt Carl Schanagel, to Lt Col Oscar Reeder, 31 Oct 43.
The sorting station at Mateur airfield some 20 miles farther south continued to be available until the field was closed late in November, but received only one patient after 5 October.
The 33d General Hospital at this time took all craniocerebral, spine and cord, and maxillo facial cases. Chest and neck cases continued to go to the 53d Station Hospital until 21 October, and thereafter to the 24th General. Neuropsychiatric patients continued to go to the 43d Station until 16 November, when the unit was relieved by the 114th Station. Compound fractures continued to go to the 81st Station. All general hospitals, however, were authorized to take the overflow of both psychiatric and fracture cases when no space remained in the designated station hospitals. Eye injuries went to the nearest general hospital. All other types of surgical and medical cases were distributed according to the availability of beds.
Navy personnel went to the 80th Station Hospital at Bizerte or to the 54th at Tunis, whichever was closer; or to specialized hospitals if the type of injury so required. Prisoner-of-war patients also went to the specialized hospitals if triage so indicated, otherwise to the 78th or 103d Station.
Late in October the 105th Station Hospital opened as a convalescent hospital and venereal disease treatment center, gradually increasing its capacity to 3,000 beds. The 105th took patients only by transfer from other hospitals, under suitable controls to prevent "dumping." At this time, with an adequate number of beds available in EBS, a 90-day evacuation policy was established for general hospitals and a 30-day policy for station hospitals.
After the middle of December, with hospital facilities rapidly building up in Italy, the influx of patients into North Africa fell off sharply. There was a large movement of patients during the week of 15-21 January 1944, when hospitals in the Naples area were being cleared preparatory to launching the Anzio operation, but after that period the major burden of communications zone hospitalization was carried in Italy.40
Hospitalization in Sicily, Sardinia, and Corsica
Island Base Section- With the cessation of hostilities in Sicily, the 93d Evacuation Hospital closed in preparation for a Fifth Army assignment. The 15th Evacuation was moved to a new site a few miles east of Licata on the Gela road, while the 128th Evacuation went to Castellammare, west of Palermo, and the 11threplaced the 128th at Cefalù. Newly arrived from the Middle East, the 1st Platoon of the 4th Field Hospital was established three days before the end of the campaign at Palagonia, on the southwestern edge of the Catanian plain. These locations were selected with a view to providing station hospital service for troops remaining in Sicily, and the hospitals retained their Seventh Army assignments, with lBS exercising only a co-ordinating function.41
The 9th Evacuation Hospital was brought from North Africa early in September, opening at Termini on 1 Octo-
40 Hq, ETOUSA, Rpt on PBS, so Feb 44. See also p.343. below.
41 This section is based generally on: (1) Annual Rpts, Med Sec, NATOUSA, 1943,1944. (2) Unit rpts of the hosps mentioned in the text. No medical section reports for the IBS have been found.
FIXED HOSPITALS IN SICILY, JULY 1943-JULY1944
128th Evacuation(as station) 19 August-31 October 1943. 400 beds.
91st Evacuation(as station), 27 July-31 October 1943. 400 beds.
59th Evacuation(as general), 8 August 1943-6 May 1944. 750 beds.
34th Station,1 November 1943-9 July 1944. 250 beds.
11th Evacuation(as station), 23 November-31 December 1943. 400 beds.
154th Station,6 May-30 June 1944. 150 beds.
9th Evacuation(as station), 1 October-31 December 1943. 750 beds.
11th Evacuation(as station), 19 August-23 November 1943. 400 beds.
15th Evacuation(as station), 19 August-29 September 1943. 400 beds.
77th Evacuation(as station), 27 September-26 October 1943. 750 beds.
4th Field, 1stPlatoon (as station), 14 August-19 November 1943. 100 beds.
Island Base Section Medical Supply Installations
4th Medical Supply Depot, 1 September-21 October 1943.
2d Medical Supply Depot, 21 October 1943-10 February 1944.
Provisional Depot Company, 10 February-1 June 1944.
684th Quartermaster Base Depot Company, June-15 July 1944.
ber. On the same date the 77th Evacuation supplanted the 15th at Licata, the latter unit being withdrawn for service in Italy. The 128th Evacuation moved into buildings in Alcamo on 9 October, a week after a hurricane had leveled virtually all of its tentage at Castelammare. The 250-bed 34th Station Hospital, only fixed installation on the island, opened at Palermo on 1 November. The maximum fixed-bed strength in Sicily was reached at this time-3,700 counting both IBS and Seventh Army installations.42(Map19)
Evacuation of the remaining casualties from Sicily, reduction in the strength of occupation troops, and the departure of staging units about this time greatly reduced the demand for hospital beds. The 77th and 128th Evacuation Hospitals, together with the 91st, which had remained in place in Palermo, left the theater for England early in November. Later that same month the 1st Platoon of the 4th Field Hospital was attached to the Air Forces and shifted to Italy, while the 11th Evacuation moved to Palermo. Both the 9th and 11thEvacuation closed on 31 December preliminary to departure for Italy. Left in Sicily at the beginning of 1944 were the 59th Evacuation, acting as a general hospital, and the 34th Station, both at Palermo. The 59th was replaced in May 1944 by the l50-bed 154th Station, but both this hospital and the 34th Station left Sicily two months later. The Island Base Section passed out of existence on 15 July 1944.
Northern Base Section and Sardinia- As of 1 January 1944, the two platoons of the15th Field Hospital on Corsica were reassigned to the Northern Base Section. The NORBS surgeon, Colonel Robinson, began a survey of the island for hospital sites immediately after his arrival on 8 January and prepared plans calling for the addition of 1,250 fixed beds, to be dispersed in relation to airfields and troop concentrations. Transportation shortages stemming from the requirements of the Anzio Campaign forced some delay, but the 500-bed 35th Station Hospital opened at Cervione, midway up the eastern coast of Corsica, on March. Ten days later the 40th Station, also with 500 beds, replaced the 1st platoon of the 15th Field at Ajaccio. The latter unit shifted to Calvi in the northwestern part of the island, but operated there only a few weeks before being supplanted by the 250-bed 180th Station on 28 April 1944. The field hospital platoon then went to Ghisonaccia, some twenty miles below Cervione. All three station hospitals on Corsica came from North Africa. In the absence of suitable buildings, all American hospitals on the island were set up under canvas, supplemented by prefabricated huts as the engineers found time to erectthem.43
The two hospitals on Sardinia--the 3d Platoon of the 15th Field, and the 60th Station--remained as Air Forces units until the first week in May, when they were assigned to the Allied garrison on Sardinia. The 60th Station opened a second 250-bedexpansion unit in January, but no further increase in U.S. hospital
42 See app. A-4.
43 (1)Annual Rpt, Med Sec, NORBS, 1944. (2) Unit rpts of hosps mentioned in the text. (3) See app. A-4.
FIXED HOSPITALS ON SARDINIA AND CORSICA,NOVEMBER 1943-MAY 1945
60th Station,3 November 1943-31 October 1944. 250/500 beds.
15th Field, 3dPlatoon (as station), 13 December 1943-30 August 1944. 100 beds.
60th Station, Detachment, 30 August-22 September 1944. 100 beds.
15th Field, 1stPlatoon (as station), 19 January-11 March 1944. 100 beds.
40th Station,11 March-4 October 1944. 500 beds.
60th Station, Detachment, 23 October 1944-20 January 1945. 150 beds.
15th Field, 1stPlatoon (as station), 20 March- 28 April 1944. 100 beds.
l80th Station,28 April-10 September 1944. 250 beds.
15th Field, 2dPlatoon (as station), 1 December 1943-16 October 1944. 100 beds.
60th Station, Bigulia, 6 November 1944-4 March 1945. 350/500 beds.
40th Station, Bigulia, 1 February-3 May 1945. 200/500 beds.
35th Station,1 March-10 September 1944. 500 beds.
40th Station, Detachment, 14 October 1944-14 April 1945. 350/150 beds.
15th Field, 1stPlatoon (as station), 28 April-28 October 1944. 100 beds.
40th Station, Detachment, 28 October 1944-8 April 1945. 150 beds.
Northern Base Section Medical Supply Installations
7th Medical Depot Company, 1 March-l June 1944.
684th Quartermaster Base Depot Company, 1 June-1 September 1944.
7th Medical Depot Company, 1 May-1 June 1944.
684th Quartermaster Base Depot Company, 1 June 1944-21 March 1945.
80th Medical Base Depot Company, 21 March-10 April 1945.
capacity on Sardinia was required.44(Map20)
Hospitalization of Prisoners of War in North Africa
The 275,000 prisoners taken at the close of the Tunisia Campaign exceeded all expectations and created a problem with which the Allied authorities were inadequately prepared to deal. By agreement between Generals Cowell and Blesse and the Provost Marshal General, captured medical and sanitary personnel were divided between the U.S. and British medical organizations according to need, but in the confusion of mass transfers to less congested areas, it was not at once possible to make use of those men to any great extent in caring for their own sick and wounded. Initially, Tunisian prisoners were given medical care in regular U.S. Army hospitals, normal staffs being supplemented as extensively as possible by prisoner personnel. Where fixed hospitals were not available, dispensary service was given by protected enemy personnel under supervision of the medical sections of the administrative companies operating the prisoner-of-war camps.45
The largest single cause for hospitalization of prisoners in the summer and early fall of1943 was malaria, with dysentery also high on the list. Many of those taken in the Tunisia Campaign were suffering from malnutrition, which undoubtedly increased the disease rate, as also did unsanitary conditions in the hastily improvised prison camps and along the crowded transportation routes to the rear. Battle wounds were a significant factor only in May.46
German and Italian prisoners taken in the final days of the Tunisia Campaign were cared for in EBS by the 61st Station and the 26th General Hospitals, both of which remained in the Constantine area through October 1943. At the 26th General prisoner wards were set up inside a barbed-wire enclosure, with guards initially assigned from the medical detachment. These were later replaced by military police.47
In the Mediterranean Base Section, two hospitals cared for prisoner patients from Tunisia, and later from Sicily. The 21st General at Sidi Bou Hanifia opened a prisoner-of-war section on 29 April to care for the sick and injured in POW Enclosure 130.The section continued to operate as such until the hospital closed in Africa at the end of November. In 200 days of operation, 2,285 prisoner patients were admitted, more than 13 percent of all patients for the period. The largest daily census was 538. Both German and Italian prisoners were treated, and medical personnel of both enemy countries assisted in their care. AtSte. Barbe-du-Tlélat, the 16th Evacuation operated a hospital in prisoner-of-war Enclosure 129 between 23 May and 8 August. Between the latter date and 30 September the hospital was operated by the 180th Station. Patients here were predominantly Italian, as were the pro-
44 (1) Annual Rpt, Med Sec, AAFSC MTO, 1944. (2) Annual Rpt, 15th Field Hosp, 1944. (3)Annual Rpt, 60th Sta Hosp, 1944. (4) See app. A-4.
45 (1)Annual Rpt, Med Sec, NATOUSA, 1943. (2) Hist, Med Detach, 6619th POW Administrative Co, 1945. The figure 275,000 for prisoners taken in Tunisia is from Howe, Northwest Africa p. 666.
46 ETMD,NATOUSA, Oct 43.
47 (1)Annual Rpt, Med Sec, EBS, 1943. (2) Annual Rpt, 61st Sta Hosp, 1943. (3)Annual Rpt, 26th Gen Hosp, 1943.
tected personnel who augmented the U.S. hospital staff.48
Largest of the hospitals for Tunisia prisoners was the 56th Station in ABS, which was set up between 4 and 14 May inside POW Enclosure 100 at Berrechid, some twenty miles south of Casablanca. Almost half of all prisoners taken in Africa passed through this camp, which had an average population of 20,000with a maximum of 28,000. Germans and Italians there were about equal in numbers. The patient census varied from 205 to 978, averaging about 750. The hospital had nine prefabricated buildings, supplemented by tents. In addition to hospital care, the 56th Station maintained small dispensaries in various parts of the compound, where outpatient service was given to between 300 and 400 a day. 49
The inadequate hospital staff was supplemented by detachments of 3 officers, 6 nurses, and 22 enlisted men each from the 34th, 36th, and 37th Hospital Ship Platoons; by 2 German medical officers, each of whom had charge of a ward; and by 100 to 120 German medical soldiers who worked under their own noncommissioned officers. Nurses were quartered outside the compound. Their duties were largely supervisory, with actual nursing confined to seriously ill and surgical cases. They performed no night duty.
The 56th Station Hospital closed at Berrechid on 15 August when the prison camp was closed.
The bulk of the prisoner-of-war patients from Sicily who were not retained on the island went initially to the 80th Station Hospital at Bizerte, where they were guarded by French military personnel. Prisoner patients from the Italian campaign that were received in the EBS were routed to the 78th Station Hospital at Bizerte or to the 103d Station at Mateur.
After Italy became a cobelligerent, Italian prisoners in Africa were organized into service units of various types. Their status made it necessary to keep them completely separated from the German prisoners. At the same time, their numbers and the assignments given them increased their hospitalization requirements.
On 26 September, therefore, the Italian wards of the hospital then being operated by the180th Station in prisoner-of-war Enclosure 129 was redesignated the 7029thStation Hospital (Italian). It was staffed by Italian medical personnel under U.S. supervision, assisted for the first two months by detachments from two U.S. hospital ship platoons. The maximum census before the end of 1943 was about 800.50
The German wards of the hospital in POW Enclosure 129 were reorganized at the same time into a German station hospital, under U.S. supervision but staffed, like the Italian hospital, by captured medical personnel. In December the German hospital moved to neighboring POW Enclosure 131, and the 7029th moved back into the quarters previously occupied in Enclosure 129. Prisoner-of-War Hospital 131, as the German unit was thereafter known, was equipped at
48 (1) Annual Rpt, Med Sec, MBS, 1943. (2) Annual Rpt, 21st Gen Hosp, 1943. (3) Annual Rpt, 16th Evac Hosp, 1943. (4) Annual Rpt, 180th Sta Hosp, 1943.
49 (1)Annual Rpt, Med Sec, ABS. 1943. (2) Annual Rpt, 56th Sta Hosp, 1943.
50 Hist,7029th Sta Hosp (Italian), 27 Jul 45.
this time to care for 500 patients, but gradually expanded as more German medical officers became available.51
The 56th Station Hospital opened a 75-bed unit for prisoner personnel of Italian service companies in the Casablanca area late in 1943. This unit was formally designated the 7393d Station Hospital (Italian).
Only cases that could not be handled by one of these prisoner-of-war hospitals went to U.S. installations.
Although 3,066sick and wounded prisoners of war were evacuated to the zone of interior during 1943, an aggregate of 1,982 remained hospitalized in North Africa at the end of the year.
Evacuation in the Communications Zone
Evacuation Between Base Sections
The geographical distribution of fixed hospital beds in North Africa in relation to the changing combat zones and to ports of embarkation made it necessary to keep patients moving steadily from one base section to another in order to accommodate new casualties as close as possible to the area of combat. Evacuation from east to west went on as long as the North African communications zone itself remained in existence.
51 (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. B. (2) Annual Rpt, Med Sec, MBS,1943. (3) Hist, 7929th Sta Hosp (Italian).
Tunisia Campaign-Evacuation between base sections in North Africa was a continuous process after the Tunisia Campaign got well under way. The established evacuation policy for the Eastern Base Section of thirty days and of ninety days for the other two North African base sections was impossible to observe rigorously in practice. EBS hospitals functioned in fact as little more than evacuation units, sending a constant flow of patients back to Algiers and Oran. To make room for these, Mediterranean Base Section hospitals were forced to send other patients still farther back, to the Casablanca area or to the zone of interior. Casualties from the Tunisian battle fronts began arriving in the Atlantic Base Section toward the end of April, continuing in a steady stream until midsummer.52
During the southern phase of the Tunisia Campaign the 61st Station Hospital at El Guerrah was the principal distributing point in the Eastern Base Section. Each day patients from the 61st were moved by Air Forces ambulances a distance of twenty miles to the 38th Evacuation Hospital at Télergma airfield to make room for the next convoy arriving from the front. "Admissions were as high as 350, and evacuation by air totaled 350, in a single 24 hourperiod.53 It was not until 30 March that another U.S. hospital, the 35th Station at Saint-Arnaud, was available in the area, and this installation took only one train-load of 228 patients from II Corps.
In the northern phase of the campaign, the 77th Evacuation Hospital near Bône served as both a base section fixed unit and a combat zone hospital. Patients received from the front were sent either to the Mediterranean Base Section or to the Constantine area, where the 73d Station and 26th General Hospitals opened late in April and the 57th Station early in May. Evacuation to MBS from the 77th Evacuation was by air and by British hospital ship. To Constantine it was by motor ambulance.
For the period 1 January to 15 May1943, according to figures reported by the NATOUSA medical section, 12,616patients were evacuated by air from the combat zone to MBS, either director through EBS hospitals; 2,660 were evacuated by sea and 707 by rail. In addition to these, 665 patients were flown from MBS to ABS, and 900came from MBS to ABS by rail. The 802d Medical Air Evacuation Transport Squadron reported a total of 16,300 patients evacuated by air, including both the 4,806 flown directly from the combat zone. (See Table 2, p.140.) and those moved to more rearward areas within the theater. (Table3) The higher MAETS figure is accounted for, at least in part, by the somewhat different time span--16 January-23 May--and by the inclusion of Air Forces casualties which were frequently not cleared through normal hospital channels.
Rail evacuation between base sections became increasingly important toward the close of the Tunisia Campaign. The first U.S. hospital train in the theater was assembled in March from French rolling stock. Second- and third-class passenger cars and box cars were converted into ten-litter cars, four for sitting
52 Principal sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Med Sec, EBS, 1943; (3) Annual Rpt, Med Sec. MBS,1943; (4) Annual Rpt, Med Sec. ABS, 1943; (5) Unit rpts of individual med installations mentioned in the text.
53 Annual Rpt, 61st Sta Hosp, 1943.
patients, a train personnel car, a kitchen, and a kitchen supply car. Manned initially by personnel of the5th Hospital Ship Platoon, the train carried 120 litter and 180 sitting patients. The first run, from Oran to Casablanca, was completed on 31 March. A second hospital train, converted and operated by personnel of the 41st Hospital Train, was placed in operation on 15 May. Shortly thereafter the first train was taken over by personnel of the 42d Hospital Train. A third American hospital train, converted from French rolling stock, went into operation in July, in time to help clear casualties from Sicily through EBS and MBS. A boarding party from the 6th General Hospital at Casablanca met each incoming train at Fès, collecting valuables, checking records, and assigning patients to wards while they were still in transit.54
Sicily and Italy Campaigns-From mid-July 1943 through the remainder of the year, movement of the sick and wounded out of the Bizerte-Mateur-Tunis area to hospitals farther to the rear was almost as rapid as the inflow of casualties from Sicily and Italy. In the early stages of the Sicily Campaign, there were not enough beds available to permit extended hospitalization in Tunisia. Even the addition of 2,500 beds before the end of the Sicilian fighting did not appreciably improve the situation, because of the requirements of the forthcoming invasion of Italy. One consequence was the evacuation of many patients with limited hospital expectancy, who were virtually well by the time they reached the Mediterranean Base Section.
During the 2-monthinterval between the Sicilian and Italian D-days, EBS forward hospitals received 5,713 patients from Sicily by sea and 7,603 by air, or 13,316all told. In the same
54 (1) Annual Rpt, 41st Hosp Train, 1943. (2) Annual Rpt, 6th Gen Hosp, 1943. (3)ETMD, NATOUSA, Jul 43.
period a total of 10,720 patients was evacuated to installations farther removed from the combat zone.55
The first patients from Italy were carried to EBS by returning transports on 12 September, and the first arrivals by air were received on the 23d. After 28 September much of the air evacuation from Italy was routed by way of Sicily with an overnight stop at Termini airfield near Palermo, but hospitalization was not involved except in emergencies. Patients were kept in an air evacuation holding unit and flown on to Africa the next day.
For movement out of the forward area of EBS, hospital ships were used between Bizerte and Oran; planes to Algiers; and hospital trains to Constantine, which was included in MBS in October. From Constantine further rearward movement was by train or plane.56
Between 10 July and 31 December 1943, 34,116 patients were received in EBS from Sicily and Italy, 12,902 by sea, and 21,214 by air. In the same period, 16,116 were transferred to rear areas of the North African communications zone, 9,238 by sea, 3,577 by air, and 3,301 by rail. In addition to these intratheater transfers, 801 patients were evacuated from EBS directly to the United States by sea. French casualties from Italy began entering the U.S. evacuation channels in December but were separated on arrival in North Africa and passed to French control.57
In January 1944,as part of the process of clearing fixed hospitals in Italy in anticipation of heavy casualties at Anzio and along the Rapido, 5,538 U.S. patients were evacuated to EBS, 3,232 by sea and 2,306 by air.58Thiswas the last heavy demand upon the North African communications zone, which declined steadily in importance thereafter.
Evacuation from Corsica and Sardinia was by air to North Africa during the period before the fall of Rome, but was of relatively minor significance.
Evacuation to the Zone of Interior
In the early stages of the Tunisia Campaign, American litter patients destined for the zone of interior were evacuated from Oran to the United Kingdom on British hospital ships, while neuropsychiatric, ambulatory, and troop-class patients went directly to the United States by unescorted troop transport.59Instructions were changed at the beginning of May to permit evacuation of all classes of patients in transports, with Casablanca the primary port of embarkation for this purpose. Later in the year, convoyed troopships took occasional loads from Oran, while two U.S. hospital ships, the Acadia with a capacity of 806 and the Seminole with a capacity of 468, became available for evacuation from ports farther east in the Mediterranean. The Acadia, however, was too large to dock at Bizerte. A total of20,358 U.S. Army patients were evacuated from North Africa to the zone of interior during 1943. (Table 4) Only a handful were evacuated to the United States by air in this period, each case being a matter for separate negotiation.
55 Annual Rpt, Med Sec, EBS, 1943.
56 Surg, NATOUSA, Journal, 12 Jul, 17 Aug 43.
57 Ibid.,27 Dec 43.
58 Rpt of Surg, MTOUSA, 1944, an. B, app. 20.
59 Troop-class patients were those who needed little medical care en route and were able to care for themselves even in emergencies.
Medical Supplies and Equipment
Medical supplies and equipment for U.S. forces operating in the North African theater were originally the responsibility of the task forces. The supply function passed to the base sections when they were activated, with centralized coordination through the Medical Section, AFHQ, and later NATOUSA. After 14 February1943, central direction of theater supply activities was through the Medical Section, SOS, NATOUSA.
Medical Supply in the Base Sections
The task forces making the North African landings included no trained personnel for handling medical supplies, which were scattered in chaotic fashion over the Moroccan and Algerian beaches. Records were inadequate or nonexistent, and there were no supply depots
until the base section organizations took control.60
In the Atlantic Base Section, warehouses and issue points were operated during January 1943 by personnel of hospital ship platoons, but no inventories were attempted. The 4th Medical Supply Depot took over the function on 27 January, establishing an orderly system of distribution centered in Casablanca. This organization remained in ABS until 16 August, after which personnel of hospital ship platoons again resumed the supply function. By that date, however, ABS had so far declined in importance as to make the work a routine operation.
The development of a medical supply system in the Mediterranean Base Section followed a similar pattern. A section of the 2d Medical Supply Depot was functioning in Oran before the end of November 1942. As rapidly as possible scattered supplies were brought together and suitably housed in and around Oran, while inventories were corrected and brought up to date. A shortage of organizational equipment-- not included in the initial automatic delivery of supplies on the basis of troop strength--was made up in large part by diverting to depot stock a complete 1,000-bed hospital assembly that had been shipped for the 26th General. The equipment arrived several weeks before the hospital could be set up, and the needs of operating units were too great to permit the material to remain idle. For example, the first abdominal operation at the 21st General Hospital after that unit was setup at the end of December was performed "with three or four borrowed clamps, a scalpel, and a pair of scissors." 61
In the Eastern Base Section, a section of the 4th Medical Supply Depot set up a major supply base at Aïn M`lilla, about twenty-five miles south of Constantine, on 19 March, with subdepots at Bone and Philippeville. This unit was relieved after the close of the Tunisia Campaign by elements of the 7th Medical Supply Depot, which also supplanted personnel of the 2d Medical Supply Depot at Mateur. The latter group had served II Corps in the field during the active fighting, but had been reassigned to EBS in May.
The section of the 4th Medical Supply Depot, which had gone to Sicily with Seventh Army,62was reassigned to the Island Base Section on September. The 4th continued to operate the supply base at Palermo until late in October, when the function was transferred to the 1st Advance Section of the 2d Medical Supply Depot. In Corsica a supply dump for the Northern Base Section was established at Ajaccio about 1 March 1944 by the 7th Medical Depot Company.63
In general, medical supplies and equipment were adequate throughout the North African and Sicilian campaigns. Shortages in specific items, such as prosthetic dental supplies and optical equipment, were owing in part to in-
60 Except as otherwise noted, this section is based on (1) Annual Rpt, Med Sec, NATOUSA,1943; (2) Annual Rpts, Med Secs, of the base sections; (3) Rpt, Med Supply Activities, NATO (Nov 42-Nov 43); (4) Davidson, Med Supply in MTOUSA, pp. 1-49; (5) Rpts of individual med units mentioned in the text.
61 Diary of Col Lee D. Cady
62 Sec pp. 169-70. above.
63 The2d, 4th, and 7th Medical Supply Depots were reorganized 3 December 1943 into medical depot companies, under TOE 8-661, dated April 1943.
adequacies in the original medical maintenance units and in part to the unexpectedly high need for dental replacements and for glasses among troops sent to the theater. In the case of prosthetic supplies, shortages in the zone of interior further delayed the filling of requisitions, but supplies in both categories were reaching Africa in sufficient quantities by the end of the year.
Shortages of various items reported by hospital commanders were in part owing to the fact that many hospitals reached the theater without all their equipment, in part to breakage as a result of faulty packing, and in part to the necessity of operating above normal capacity. The Tables of Equipment themselves were not entirely suitable to the needs of the theater, but deficiencies were quickly made up. Hospitals arriving during the first four or five months, for example, did not have adequate generating equipment, but here, as in many other instances, the Corps of Engineers made up the deficiencies. Ordnance and Quartermaster units were also ready at all times to improvise equipment or to requisition missing items for hospital use.
Another problem arose because some medical officers, particularly surgeons, who were fresh from civilian practice, found it hard to adjust themselves to the more limited range of equipment it was possible to carry into a combat theater, and the items available did not always correspond to individual preferences in drugs and instruments. There is no evidence, however, that the medical service rendered in North Africa was ever seriously curtailed or impaired for lack of supplies or equipment. Even those hospitals that were most distant from supply points managed to get what was needed, by air if necessary.64
Where essential equipment was lacking, hospital staffs showed considerable ingenuity in improvising substitutes. Cabinets and laboratory benches were built of waste lumber; heating units, sterilizers, laundry equipment, and showers were fashioned from empty gasoline drums and odd bits of pipe; soap was made from discarded kitchen fats; parts were salvaged from worn-out equipment and reused for the same or other purposes. In the cities it was sometimes possible to procure local equipment, but more frequently equipment had to be made out of available materials. In Casablanca, for example, such items as wash basins, toilet bowls, and sinks were made with locally procuredcement.65
Theater Services of Supply
Supply and maintenance activities for U.S. forces in the theater were centralized after mid-February1943 in a NATOUSA Services of Supply organization, with headquarters at Oran. As in other theaters the Services of Supply in MTO was subordinate to theater headquarters, but differed from comparable organizations elsewhere in that it did not control the fixed hospitals. The SOS medical section was responsible only for
64 In addition to general sources cited above, see: (1) Hq, SOS, ETO, Impressions of Medical Service in NATOUSA, by Brig Gen Paul R. Hawley, Chief Surg, ETO; (2) Ltr, Lt Col Ryle A. Radke to TSG, 28 Apr 43, sub: Inspection of North Africa and the United Kingdom; (3) Surg, NATOUSA, Journal, 16-21Jul 43.
65 See especially unit rpts of the 26th and 45th Gen Hosps, and the 7th and 35th Sta Hosps; Diary of Col Cady. See also, Annual Rpt, Med Sec, ABS.1943.
medical supply. Lt. Col. Theodore L. Finley, formerly medical supply officer in ABS, headed the section briefly, being succeeded in May by Col. Benjamin Norris. Col. Charles F. Shook became head of the section in August. His opposite number in the NATOUSA medical section was Lt. Col. (later Col.) Ryle A. Radke, who had first visited the theater in February on an inspection tour of supply installations and services for The Surgeon General, and joined the NATOUSA staff on 18 July66
In carrying out its supply functions, the SOS medical section requisitioned on the zone of interior and distributed the supplies and equipment received among the base sections and combat formations in the theater. Semimonthly stock reports submitted by the base sections, and firsthand inspections, provided a basis for adjustment between depots to ensure balanced stocks in all parts of the theater. As the staff of the SOS medical section was built up during the summer, its activities broadened to include statistical reporting and research into the actual consumption of medical supplies looking toward modification of maintenance factors. Shortages revealed were made up by special requisitions on the zone of interior, and overstocks were disposed of by reshipment to the ZI, by transfer to Allied Military Government, and by diversion to fill French lend-lease requisitions.
The theater medical supply level was based on a 30-day working supply and a 45-day reserve, plus a final reserve medical unit consisting of a 90-day supply of items that might become critical in event of blockade or seige. The final reserve was discontinued in August 1943 and taken into depot stock, resulting in temporary excesses in some categories.
The administration of the various professional services of the Medical Department in the North African Theater of Operations was centralized in the office of the surgeon, NATOUSA, and was carried out through the appropriate subsections of the medical section.
The Medical and Surgical Consultants
In medicine and surgery the key figures on the professional side were the consultants. Lt. Col. (later Col. ) Perrin H. Long, recently of the Johns Hopkins faculty, assumed the duties of medical consultant on 3 January 1943. Before the end of the month, Lt. Col. Stuart F. Alexander joined Longs staff as consultant in chemical warfare and liaison officer with G-1. Early in June Capt. (later Lt. Col.) Frederick R. Hanson became consultant in neuropsychiatry, having acted in that capacity in fact since the southern phase of the Tunisia Campaign in March.67
The surgical consultant, Colonel
66 This section is based chiefly on: (1) Hist, Med Sec, SOS, NATOUSA, Feb 43-Jan44; (2) Annual Rpt, Med Sec, NATOUSA, 1943; (3) Rpt, Med Supply Activities NATOUSA, Nov 42-Nov 43, by Lt Col Finley; (4) Munden, Administration of Med Dept in MTOUSA, pp. 76-87. (5) Davidson, Med Supply in MTOUSA, pp. 21-27.
67 (1) Munden, Administration of Med Dept in MTOUSA, App. A, p. 212. (2)Perrin H. Long, M.D., "Mediterranean (Formerly North African) Theater of Operations," vol. I, Activities of Medical Consultants, "Medical Department, United States Army," subseries Internal Medicine in World War II (Washington, 1961), ch. III. For Hanson`s activities, see p. 145, above.
Churchill of the Harvard Medical School joined the staff of the NATO-USA medical section on 7 March 1943.Colonel Churchill`s office was enlarged shortly before the Salerno landings to meet the increased demands of the Italian campaign. At this time Maj.(later Lt. Col.) Fiorindo A. Simeone became assistant to the surgical consultant; Maj. (later Lt. Col.) Henry K. Beecher became consultant in anesthesia and resuscitation; and Maj. John D. Stewart became consultant in general surgery. Early in January 1944, in order to make full use of the new drugs and techniques, Capt. (later Maj.) Champ Lyon became consultant in wound infections, chemotherapy, and penicillin therapy. He was assisted in the study of bacterial flora of wounds and wound recovery by 2d Lt. RobertRustigan.68
The consultants made frequent inspections of medical installations within the theater. On the basis of their observations and contacts, they kept the theater surgeon informed as to professional standards in medicine and surgery. They gave professional advice on the management of patients, the procedures to be followed at various echelons of medical service, and the most suitable assignments for specialists in their respective fields in terms of proficiency, training, and experience. They also reported on the incidence and nature of wounds and injuries occurring throughout the theater.
Additional consultants were used at the headquarters of the base sections and tactical commands. Some were assigned within the Table of Organization, but it was the more normal practice to attach to the theater medical section as acting consultants officers from various installations, primarily hospitals, for the purpose of appraising and standardizing technical procedures within many of the subspecialties of surgery and medicine. Thus, without having a large assigned staff of specialists, the theater medical section was able to cover a wide range of service and study in both the broad subjects and the subspecialties.
II Corps, when operating independently, and both Fifth and Seventh Armies had consultants assigned during the Tunisian, Sicilian, and Italian campaigns. Inspection of hospitals by the consultants and other members of the medical staff, including the preventive medicine officers, the medical inspector,
68 (1) Munden, Administration of Med Dept in MTOUSA. (2) Annual Rpt, Med Sec, NATOUSA, 1943.
and the theater surgeon, resulted in the establishment of theater-wide professional policies and procedures. Exchange of information was facilitated by visits to British as well as U.S. installations.
The numerous health hazards that were likely to be encountered in North Africa were fully appreciated while the campaign was still in the planning stage. A preventive medicine subsection was established under the medical section before Allied Force Headquarters left London, and was carried over into NATOUSA. The first preventive medicine officer, Maj. (later Lt. Col.) John W. R. Norton, transferred to the Services of Supply organization in February 1943. Colonel Long, the medical consultant, filled in until May when Lt. Col. (later Col.)Hugh R. Gilmore took over the functions. Lt. Col. (later Col.) William S. Stone became preventive medicine officer in August 1943 when Gilmore went to Fifth Army. Throughout the planning and early operating phases the major problems anticipated were malaria, intestinal disorders, and venereal diseases.
Malaria Control Measures- Early in January 1943 a small British-American malaria committee was named by General Cowell to study the malaria problem and to recommend preventive measures.
The group was gradually enlarged to include Air Forces and Navy representatives and French malariologists familiar with the local situation. On 20 March the committee was reconstituted as the Malarial Advisory Board, AFHQ. Colonel Long headed the American group.69
During the early months of 1943 an Allied policy on malaria control was worked out and measures initiated to carry it into effect. Malaria control and survey units were requested to carry out drainage and larviciding in mosquito-breeding areas but until the units arrived, Medical Corps and Sanitary Corps officers under supervision of base section medical inspectors were made responsible for environmental control measures. In addition to this general approach, all military personnel were to take atabrine twice weekly beginning 22 April and continuing through November. The men were to sleep under netting wherever it was feasible to carry such equipment, and those on outside duty at night were to wear gloves and head nets. Repellents were also to be issued to all personnel. Infested places, such as wooded and watered ravines, were to be avoided, as were native habitations. At the same time medical officers were to be given refresher courses in diagnosis and treatment of the disease, and troops were to be indoctrinated as to its cause, control, and gross manifestations.70
Entomological detachments of the 10th and 13th Malaria Survey Units (MSU`s) reached North Africa early in March, being assigned to MBS and ABS, respectively. Similar elements of the 11th and 12th MSU`s, arriving at about the same time, were assigned to the Center District and to EBS, but did not go into operation until May, when the rest of all four units reached the theater. The 2655th Malaria Control Detachment (MCD) was brought up from Roberts Field, Liberia, in May, and was given responsibility for control work around Algiers. The 2655th MCD also gave technical assistance to other malaria units in the theater. By 1 July the 19th, 20th, 21st, and 22d Malaria Control Units(MCUs) were also in North Africa. The 14th MSU and the 23d MCU arrived in September; the 28th and 42d Malaria Control Units joined the NATOUSA antimalaria forces in October.71 Assignments were divided between the base sections and the two armies in the theater, units being shifted from one location to another in terms of need.
Col. Loren D. Moore, commanding officer of the 2655th Malaria Control Detachment, was named theater malariologist in June, with Colonel Andrews of the same organization as assistant malariologist. Colonel Moore was relieved in September by Col. Paul F. Russell. The theater malariologist was responsible for all malaria control activities, including liaison with British and
69 (1) Perrin H. Long, Historical Survey of the Activities of the Section of Preventive Medicine, Office of the Surgeon, NATOUSA, 3 January to 15 August 1945. Except as otherwise noted, this section is based on the above document and on the following: (2) Annual Rpt, Asst Malariologist, NATOUSA, 1943; (3) Justin M. Andrews, "North Africa, Italy, and the Islands of the Mediterranean," vol. VI, Communicable Diseases, Malaria, "Medical Department, United States Army," subseries Preventive Medicine in World War II (Washington, 1963), ch. V; (4) Annual Rpt, Med Sec, NATOUSA,1943; (5) Rpts of the base sections for 1943; (6) Unit rpts of hosps, med bns, and army, corps, and div surgs functioning in the Mediterranean in 1943.
70 NATOUSA Cir No. 38, 20 Mar 48
71 Ltr, Blesse to TSG, 18 Oct 1943, Sub: Malaria Organization, NATOUSA.
French authorities, and for the direction of all organizations and personnel engaged in such work. This control extended to airplane crews engaged in the dusting of breeding places. The malaria program was thus highly centralized at the theater headquarters level. Implementing the program was a command responsibility, delegated by the Commanding General, NATOUSA, to the Commanding General, Services of Supply, and the base section commanders, who were periodically reminded of their roles in the control of the disease. At the same time, Colonel Russell used every medium the theater afforded to educate medical personnel in the fundamentals of malaria control.72
Malaria control in North Africa and Sicily during the period of greatest troop concentration was only moderately successful. Experience with atabrine had not been extensive enough to yield positive knowledge of the quantity to be administered or the frequency with which it should be taken, and the entire suppressive therapy program received a rude jolt from the violent reaction that generally followed the third dose, taken 30 April 1943. Men who were already reluctant avoided taking the drug whenever they could, with results that were all too evident in the morbidity figures for the Sicily Campaign.73
Other factors in the comparatively poor showing of the first year in the Mediterranean were the late arrival of the malaria control units, which did not get into effective operation until the breeding season was well advanced; a continuous shortage of trained malariologists; and numerous competing demands on engineering manpower, which delayed drainage work and forced various improvisations. The groundwork was nevertheless laid for an effective control program in the 1944 and 1945 seasons, in the equally malarious Italian communicationszone.74 In the Mediterranean as a whole, noneffectiveness from the disease was never great enough to threaten the success of any military operation.
Diarrhea and Dysentery- North Africa was a region, to quote the NATOUSA consultant in medicine, "in which the native considered practically every square foot of ground a privy."75 Flies were so thick in parts of Tunisia that it was risky business to open ones mouth to speak.76Waterwas scarce and likely to be contaminated. These conditions made diarrhea and dysentery extremely prevalent.
Among troops from countries such as the United States and Great Britain, where sanitation is taken so much for granted that the individual feels little personal responsibility for it, outbreaks of these diseases were probably inevitable. They reached major proportions in May, June, and July 1943, affecting especially units newly arrived in the theater and Tunisian veterans who tended to let down after severe fighting.
72 CG NATOUSA, to CG`s, SOS, MBS, EBS, ABS, and CD-MBS, 25 Jun 43 and 8 Jul 43.
73 Seep. 173, above.
74 See pp. 354-57, below. Malaria control in the combat zones is treated in the chapters dealing with combat operations.
75 Long, Hist Survey of Preventive Medicine. This report and Annual Report Medical Section, NATOUSA, 1943, are the primary sources for this section.
76 Brig. Gen. Albert W. Kenner, "Medical Service in the North African Campaign, "Bulletin, U.S. Army Medical Department(May 1944), pp. 83-84.
It was apparent that sanitary discipline among U.S. troops was poor, but sanitation improved rapidly once an organization had been "burned." Line officers, as a rule, needed only one demonstration to remind them of their responsibilities in this regard.
Another factor in the high diarrhea and dysentery rates in the summer of 1943 was the shortage of certain necessary equipment. Screening for mess halls, kitchens, and latrines was not in adequate supply until August. Halazone tablets for water purification by individuals were not always available in sufficient quantity, while facilities for boiling water to cleanse mess kits were inadequate for most of the year.
Although both diarrhea and dysentery continued to plague troops under combat conditions, they had ceased to be a communications zone problem by the late months of 1943.
Venereal Diseases-Venereal diseases were widely prevalent in North Africa and Sicily, and the opportunities for contact were numerous. A full-time venereal disease control officer, Lt. Col. Leonard A. Dewey, was added to the staff of the NATOUSA preventive medicine section early in March 1943, and a month later similar officers were assigned to each of the base sections and to the major combat units, II Corps, Fifth Army, and Twelfth Air Force.77
The initial control procedure in all occupied areas was to allow troops to have access to some or all of the local brothels, and to establish prophylactic stations in the immediate vicinity. After extensive trial, during which there appeared to be no decrease in the number of contacts made outside the houses, all brothels were placed "off limits," with a noticeable decline in the V Drate.
Both mechanical and chemical prophylactic kits were always available except for brief intervals in certain forward areas, although the chemical kit was found to be of little value. Considerable difficulty was experienced, however, in securing sufficient competent personnel to operate "pro" stations in the numerous are as accessible to U.S. troops. Hospitals and other medical units were the usual sources of such personnel, but the heavy load being carried by all medical installations in the North African communications zone precluded the detachment of enough trained men for the purpose. During the last phase of the Tunisia Campaign the clearing company of the 1st Battalion, 16th Medical Regiment, operated a venereal disease diagnostic and treatment hospital south of Constantine.
Other Preventive Medicine Problems- Aside from the special problems discussed in the preceding pages, there were no serious outbreaks of preventable diseases in North Africa or Sicily before the scene of primary activity shifted to
77 Main sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Pers Ltr, Maj Gen James C. Magee, TSG, to Kenner, 1 Mar 43; (3)Ltr, Lt Col Leonard A. Dewey to Surg, NATOUSA, 9 Apr 43, sub: Rpt of Inspection of Venereal Disease control Facilities in MBS and ABS; (4) Ltr, Dewey to Surg, NATOUSA, at 11 May 43, sub: Trip Rpt to MBS, ABS, and Hq, Fifth Army; (5) Ltr, Dewey to Standlee, as Jul 43, sub: Problems in Venereal Disease Control in NATOUSA; (6) Ltr, Gen Blesse, Surg, NATOUSA, to Deputy Theater Commander, NATOUSA, 11 Aug 43, sub: Off Limits for Houses of Prostitution as a Venereal Disease Control Measure; (7) Ltr, Dewey to Surg, NATOUSA, ao Oct 43, sub: Rpt of Inspection of Venereal Disease Control and Treatment Problems in the Palermo Area, Oct 13 to 17.
the Italian peninsula. Some 16,000cases of infectious hepatitis reported during 1943 among U.S. Army personnel led to intensive study of the disease, which appeared considerably more prevalent in Tunisia and Sicily than in Algeria or Morocco, but, except for the last three months of 1943, the rate was not excessive. Cases did not exceed 7 per 1,000 per year until September, climbing rapidly to 108 in November and declining to 71 the following month.78
Although always a potential threat in the Mediterranean, only twenty cases of typhus were reported among U.S. personnel in the theater during 1943. An outbreak of the disease in Naples toward the end of the year is discussed elsewhere. 79Preventive measures included use of insecticide powders to control body insects, and delousing of clothing. Malaria control and survey units were trained in mass delousing methods, as were combat medical units and operating personnel of prisoner-of-war camps. The Rockefeller Typhus Team aided materially in demonstrating powdering methods.
While respiratory diseases accounted for a larger number of cases than any other cause--63,899 in 1943--the overwhelming bulk of these were mild infections, following nonepidemic seasonal trends and not seriously affecting military efficiency.80
The Reconditioning Program
Early in 1943 the 21st General Hospital at Sidi Bou Hanifia near Oran inaugurated a reconditioning program for its convalescent patients, under which physical therapy was supplemented by light work in and around the hospital. While the program worked reasonably well, it posed a serious problem of control as the patients neared the time of discharge. A similar but more difficult problem was encountered at the 2d Convalescent Hospital, after that unit was set up in February, because of the smaller number of officers in proportion to patients. From a disciplinary point of view, it was simply impossible for a second lieutenant of the Medical Administrative Corps to control a convalescent company of 500 combat wounded men. In the line, even a major would not be expected to control that many men without a complete staff.81
The problem had become acute by the end of the Tunisia Campaign. In June the Commanding General, Mediterranean Base Section, authorized the establishment of a Provisional Conditioning Battalion of four companies with 175 men each, to be operated by the 2d Convalescent Hospital. Lt. Col. Lawrence M. Munhall, a field artillery officer who was a patient in the hospital, was detailed to command the battalion, which came to be known as the Combat Conditioning Camp. Patients were used as a training cadre, in a course lasting three weeks. At the end of this time, the
78 (1) Annual Rpt, Med Sec, NATOUSA, 1943 (2) Rpt on Study of Epidemic Hepatitis in Tunisia, by Maj Guy H. Gowan. More serious outbreaks of hepatitis occurred among Fifth Army troops in Italy. See pp. 256-57, 513, below.
79 Annual Rpt, Med Sec, NATO USA, 1943. See pp. 362-65, below.
80 Annual Rpt, Med Sec, NATOUSA, 1943.
81 (1)Annual Rpt, asst Gen Hosp, 1943. (2) Recorded Interv Lt Munden, and Sgt Zelen, with Lt Col Lawrence M. Munhall, 28 Jun 45. (3) Clift, Field Opns, pp. 397-99.
men were transferred to a replacementcenter.82
The Surgeon General, Maj. Gen. Norman T. Kirk, visited the theater in June 1943 and took cognizance of the problem. He undertook to have a Table of Organization for a convalescent center, similar to those operated by the British, prepared in his office. The units were to be set up near parent general hospitals. In line with the Surgeon Generals directions, British convalescent facilities were visited to study their organization and operations.83
As a result of these various approaches to the problem, the Combat Conditioning Camp of the 2d Convalescent Hospital was activated as the 6706th Conditioning Company Pool on 1 November 1943, with its own Table of Organization. It was thus cut off from the hospital entirely and was moved to a new area about a mile away, where it remained until it was transferred to Italy in the spring of 1944. All patients in need of reconditioning on discharge from the hospital were transferred to this unit, which remained under command of Colonel Munhall 84
A similar reconditioning center for the Eastern Base Section was set up at the l05th Station Hospital in Ferryville. Normally a 500-bed unit, the 105th Station became an acting convalescent hospital in September 1943 and by January 1944 had a census of 2,500 patients. In order to control these men and to restore as many as possible to active duty, an EBS Conditioning Center was set up under command of Col. Gerald P. Lawrence, including both the hospital and a replacement battalion. As rapidly as their physical condition permitted, the men were placed in one of four training companies, physically removed from the hospital and its atmosphere. While medical officers kept close check on "trainees" as they were now called, the primary supervision was by personnel of the replacement battalion. The EBS Reconditioning Center declined in importance with the decline of the base section and was closed out early in May, having handled 5,000 trainees in three months.85
The chief dental officer for the North African theater was Lt. Col. (later Col.) Egbert W. D. Cowan until the end of February 1943, when personnel limits in the NATOUSA medical section necessitated his transfer to the Services of Supply. Colonel Cowan returned to his old assignment on 1 June, when the position of dental surgeon was authorized for the medical section of theater headquarters, but was assigned to Fifth Army in August. He was succeeded as NATOUSA dental officer on 17 August 1943 by Col. Lynn H. Tingay.86
At the theater level, the functions of
82 (1) Lt Col William C. Munly, Med Inspector, NATOUSA, to Surg, NATOUSA, 2 Jul 43.sub: Inspection of Medical Activities, ABS and MBS. (2) Munhall Interv. (3) Annual Rpt, 2d Conv Hosp, 1943.
83 (1) Memo, Col Stone to Gen Blesse, 7 Aug 43 (2) Ltr, Maj James H. Townsend and Capt Lewis T. Stoneburner to Surg, NATOUSA, 30 Aug 43 covering rpt on British rehabilitation program. (3) Ltr, Blesse to Deputy Theater Commander, 12 Sep 43 sub: Study of Convalescent Care Facilities, NATOUSA.
84 (1) Annual Rpt, 2d Conv Hosp, 1943. (2) Munhall Interv. See also p. 357, below.
85 Rpt on Experimental Conditioning Center: Operations, Results, Conclusions, and Recommendations. By Col Lawrence, 14 Apr 45.
86 Annual Rpt, Med Sec, NATOUSA, 1943.
the dental surgeon were primarily administrative and supervisory. He was responsible for the provision of adequate dental service to all military personnel within the jurisdiction, which in 1943 was a considerable undertaking. There were 310 dental officers in the North African theater at the end of January 1943 and 703 at the end of December, but this increase in numbers was proportionately less than the over-all rise in troop strength. In January there was one dental officer for each 740 military personnel; in December only one for each861.
The problem was further complicated by the presence of a considerable number of units with no dental officer in their T/O`s. These units were given outpatient care by Army hospitals when such were available, but where no hospital was established in the vicinity, it was necessary to detach dental personnel for temporary duty with the unit.
The drastic lowering of dental standards for induction into the Army during 1942, reaching their reducible minimum in October just before the TORCH operation was launched, put a severe and unexpected strain on the facilities of the theater. In the troop build-up of 1943, numbers of men reached North Africa with insufficient teeth to masticate the Army ration, but prosthetic equipment for dealing with these cases was not available until late in the year.87
The dental service in the theater showed progressive improvement with each campaign as personnel gained experience and facilities came to correspond more closely with needs.88
The veterinary section of the NATOUSA medical organization was slow in getting started. The first theater veterinarian, Lt. Col. (later Col.) Solon B. Renshaw, served only from December 1942through February 1943. He was transferred at that time to SOS, NATOUSA, because there was no provision for a veterinarian in the limited allotment of personnel to the medical section. The position of theater veterinarian was approved late in April 1943, but was not filled until February 1944, when Col. James E. Noonan was assigned.89
A group of twelve veterinary officers arrived in the theater in September, having been requested by the quartermaster for inspection work in connection with local slaughterhouses, but until this program got under way, they were assigned to replacement pools and used for temporary duty. Since there was no central organization for placing veterinary personnel where they were needed, a considerable amount of waste was entailed, with some impairment of morale.
There was also a disproportionately
87 (1) I bid.(2) Col George F. Jeffcott, United States Army Dental Service in World War II, "Medical Department, United States Army" (Washington, 1955),pp. 211-12. (3) Ebbe Curtis Hoff, M.D. ed., Personal Health Measures and Immunization, "Medical Department, United States Army" subseries Preventive Medicine in World War II (Washington, 1955), p. 4.
88 For dental service in combat operations see the chapters devoted to specific campaigns.
89 (1) Mundon, Administration of Medical Dept in MTOUSA, p. 213. (2) Annual Rpt, Med Sec. NATOUSA, 1943. See also, Lt. Col. Everett B. Miller, "Medical Department, United States Army," United States Army Veterinary Service in World War II (Washington, 1961).
high loss of food items through improper packaging, handling, and storage, which can be attributed only in part to the greater activity of the Mediterranean as compared with other theaters of operation. The comparative weakness of the veterinary service in NATOUSA was clearly apparent by the end of the year, when positive steps were taken to reorganize veterinary activities at theater and base section levels.90
Until 14 August 1943, when the position of Director of Nurses, NATOUSA, was created, the chief nurse of the Mediterranean Base Section, 2d Lt. (later Lt. Col.) Bernice M. Wilbur acted in that capacity. Colonel Wilbur became director of nurses when the position was set up. She made regular inspections of nursing activities throughout the theater, advised the surgeon as to policy matters, and recommended assignment and transfer of nursing personnel.91
Nurses began arriving in the theater on 8 November 1942, D-day for the North African landings. There were more than 2,000 by the end of the Tunisia Campaign, with a peak strength of 4,398 in October 1943. This figure had dropped to 4,000 by the end of January 1944, owing to the transfer of three evacuation hospitals and an auxiliary surgical group to the European theater in November.
While the number of nurses in the North African theater was adequate in terms of hospital T/O`s, the recurrent necessity for operating above normal bed capacity brought considerable strain on the nursing service. Wherever possible nurses from staging units were detached for temporary duty with operating hospitals. After October 1943, when the required authority was received from the War Department, promotions were made to raise half of all front line nurses to the rank of first lieutenant.
Training was a continuous process, with frequent changes in assignment to assure proper balance of specialties. The only severe shortages during the active period in the North African communications zone were nurses trained in anesthesia and in psychiatry. To make up these shortages, several general hospitals gave individual training in anesthesia, while a school of psychiatric nursing was conducted by the 114th Station Hospital. The courses ran for 6 weeks, taking fifty nurses at a time. Three classes completed the training during 1943. Twenty-four British nurses took the course.
Army Public Health Activities
Allied Force Headquarters as originally organized in London in the summer and early fall of 1942 included a civil affairs section, which combined with its military functions others of a political, diplomatic, and economic nature. It was headed after the invasion by Robert Murphy, the principal U.S. diplomatic representative in French North Africa. Public health activities
90 (1) Memo, Col Noonan to Surg MTO USA, 11 Apr 45. (2) Ltr, Lt Col (later Col) Duance L. Cady to Surg, NATOUSA, as Dec 43, sub: Investigation and Survey of Veterinary Activities in NATOUSA.
91 Annual Rpt, Med Sec, NATOUSA, 1943. See also, Maj Anne F. Parsons, and others, MS. History of the Army Nurse Corps in the Mediterranean Theater of Operations, 1942-1945.
were administered by a subsection of the civil affairs section.92
The situation in North Africa was without precedent. The political objectives, and to a considerable extent the military objectives as well, demanded that the local population be treated as allies. Civil officials were not always cordial, and co-operation was often grudging, but in the public health area especially it was essential for the protection of American forces that elementary sanitary measures be extended to the civilian inhabitants.93
At Mr. Murphys request, three United States Public Health Service doctors were detailed to AFHQ late in February 1943 and assigned on their arrival a month later to the nominally independent North African Economic Board. Shortly thereafter they were attached to the office of the NATOUSA surgeon, to serve as liaison between that office and the local health authorities. Another doctor and a sanitary engineer joined the group in July.94
Before the arrival of the Public Health Service officers, representatives of the U.S. component of the medical section, AFHQ, had met with French officials and had agreed upon supplies to be furnished, particularly for control of malaria and such potential threats as cholera and typhus. The surgeons of the Mediterranean and Atlantic Base Sections also maintained informal liaison with local health authorities. After the attachment of Public Health Service representatives to the NATOUSA surgeons office, the over-all direction of a civil public health program passed to them, but Army personnel continued to play the dominant role in carrying out such measures as were required.95
By the date of the invasion of Sicily, a special organization for Allied Military Government of Occupied Territory (AMGOT) had been set up under a British major general, Lord Rennell, who was also chief civil affairs officer on the staff of the Allied Military Governor of Sicily, General Alexander of the 15th Army Group. The senior civil affairs officer of Seventh Army, Col. Charles A. Poletti, headed a group of seventeen civil affairs officers who went in with the invasion forces, setting up military government organizations behind the advancing troops. The principal U.S. public health officer for the Sicily Campaign was Maj. (later Lt. Col.) Leonard A. Scheele. Major Scheele participated in the planning for the Sicilian operation, serving as executive officer and later as deputy to Col. D. Gordon Cheyne, the British officer in charge of public health activities for the 15th Army Group. In the latter capacity, Scheele succeeded Col. (later Brig. Gen.) Edgar Erskine
92 (1) Robert W. Komer, MS, Civil Affairs and Military Government in the Mediterranean Theater, ch. I, in OCMH files. (2) Harry L. Coles and Albert Weinberg, Civil Affairs: Soldiers Become Governors, UNITED STATES ARMY IN WORLD WAR II (Washington, 1963).
93 For the attitude of French officials, see Eisenbower, Crusade in Europe,pp.111-12
94 Ralph C. Williams, The United States Public Health Service, 1798-1950 (Washington,1951), pp.695-98.
95 (1)Annual Rpt, Med Sec, NATOUSA, 1943. (2) Long. Hist Survey of Activities of Section of Preventive Medicine, Off of Surg, NATOUSA, 3 Jan-15 Aug 43. (3) Surg, NATOUSA, Journal, 12, 17 Aug, 6 Sep 43. (4) Hutter, "Medical Service of the Mediterranean Base Section, Military Surgeon (January1945), pp.41-51
Hume, who was to accompany Fifth Army to Italy.96
In both Africa and Sicily, Medical Department officers assigned to AMGOT worked to restore local public health departments, to rebuild water and sewerage systems, and revitalize normal public health services. Local officials were reinforced by Army medical personnel and supplies wherever necessary to protect the health of troops in the area. Among the problems commonly dealt with were sanitation, threatened epidemics, care of destitute refugees, and the control of such ever-present scourges as malaria and venereal disease.97
Public health officers at the theater level made surveys to determine the status of hospital facilities, the need for medical supplies for relief purposes, the nutritional needs of the population, the presence of epidemic diseases, and the possibility of the introduction of new diseases by insect vectors on planes and by returning refugees. As combat operations by the Allies produced relatively little devastation in the French colonies in North Africa, U.S. Army participation in the public health program in these areas was largely limited to aid given by a few men trained in public health work to the French authorities after the cessation of hostilities.
96 (1) Komer, Civil Affairs and Military Government in the Mediterranean Theater, ch.II. (2) Williams, The United States Public Health Service, pp. 698-99.(3) Ltr, D. Gordon Cheyne to DCCAO, 4 Jul 43, sub: Territorial Assignment of Public Health Div Personnel.
97 See:(1) Ltr, Col Long to Surg, NATOUSA, 27 Mar 43, sub: Rpt on the Sessions of the Committee on Hygiene and Epidemiology Technical Section for Public Health, French High Commissioner of North Africa; (2) Proceedings of Public Health Meeting, 13 Aug 43.