A seaborne landing on the west coast of Italy between the Garigliano and Tiber rivers had been contemplated since early November 1943, and plans involving various sites, including Anzio, were developed in some detail. The stubborn German defense of the Winter Line, however, made it clear that the main body of Fifth Army would not be able to break through to support the beachhead at any predictable time, and plans were held in abeyance.
They were revived at a Christmas day conference in Tunis, where Prime Minister Churchill was the moving force. All of the military commanders concerned were present except the one most directly involved--General Clark, who would be immediately responsible for the operation. Those at the conference included General Eisenhower, soon to leave for OVERLORD; General Sir Henry Maitland Wilson ,who was to succeed Eisenhower as Supreme Allied Commander in the Mediterranean; General Alexander, commanding the 15th Army Group in Italy; Air Chief Marshal Arthur W. Tedder, who headed the Allied Air Forces in the Mediterranean; and Admiral Sir John Cunningham, commanding the Allied Navies in Italian waters. All of these men appreciated the risks inherent in such an operation, with the limited forces at their disposal, but political considerations overrode the military hazard. The Prime Minister felt that Rome must be quickly taken or the Italian campaign would be counted a failure, and the Allied cause would suffer, especially with the Turks, whose active military aid he was then strenuously soliciting.1
Medical Planning for Operation SHINGLE
As originally proposed, the Anzio land-
1 General sources for the Anzio campaign are: (1) Fifth Army History, vol. IV; (2) Starr, ed., From Salerno to the Alps; (3) Opns Rpts, VI Corps, Jan-May 44; (4) Alexander, "The Allied Armies in Italy from 3rd September, 1943, to 12th December 1944," Suppl. to the London Gazette, 6 June 1950, pp. 2908-13, 2917; (5) Mark W. Clark, Calculated Risk; (6) Truscott, Command Missions; (7) Winston S. Churchill, The Second World War: Closing the Ring (Boston: Houghton Mifflin Company, 1951); (8) American Forces in Action, Anzio Beachhead(Washington,1947); (9) Morison, Sicily-Salerno-Anzio; (10) Wesley Frank Craven and James, Lea Cate, eds., "The Army Air Forces in World War II," Europe: ARGUMENT to V-E Day, (Chicago, The University of Chicago Press, 1951); (11) Albert Kesselring, Soldier`s Record, pp.232-37; (12) Taggart, ed., History of the Third Infantry Division in World War II; (13) Howe, 1st Armored Division; (14) The Fighting Forty-fifth, pp. 71-86. The more important medical sources are: (15) Annual Rpt, Med Sec, MTOUSA, 1944; (16) Annual Rpt, Surg, Fifth Army, 1944; (17) Annual Rpt, Surg, VI Corps, 1944; (18) Clift, Field Opns, pp. 265-83; (19) Rollin L. Bauchspies, "The Courageous Medics of Anzio," Military Medicine, CXXII, (January-June1958). 53-65, 119-28, 197-207, 267-272, 338-359, 429-448; (20) Unit rpts of individual med units mentioned in the text.
ings, known by the code name SHINGLE, were to be made by one division carrying supplies for seven days, by which time it was to be in contact with forward elements from the Cassino front. When the stalemate before the Gustav Line precluded any hope of a quick breakthrough, plans were changed to land two divisions, reinforced, with another two divisions in reserve, and to provide resupply for as long as was necessary. It was hoped that determined attacks across the Rapido and Garigliano Rivers would divert enough enemy strength from the Rome area to permit a quick breakout by the Anzio forces, which would in turn compel a German withdrawal from the Gustav Line and bring about an early junction of troops from the two Allied fronts.
Operations on the Anzio front, like those elsewhere in Italy, can be properly understood only in terms of broad Allied strategy for the war as a whole. The build-up in England for the cross-Channel attack took precedence over everything else. Three veteran U.S. divisions-- the 1st, 9th, and 2d Armored--had already been diverted from the Mediterranean, together with most of the 82d Airborne. With them went medical detachments, supporting medical battalions, and evacuation hospitals. Seasoned commanders were also being withdrawn for major roles in the coming campaign in France. Eisenhower, Bradley, and Patton were followed to England in January 1944 by Montgomery, whose successor as Eighth Army commander was General Sir Oliver Leese; and Tedder, who turned over command of the Mediterranean Allied Air Force to Lt. Gen. Ira C. Eaker. Lt. Gen. Jacob L. Devers became deputy theater commander under Wilson, and commander of the U.S. ground forces in the Mediterranean. The invasion of southern France, which was already in the planning stage, would divert still more combat and service troops from Italy. In a word, the Italian campaign remained a diversion, to immobilize as many German troops as possible. The Allied armies in Italy were nevertheless expected to win their battles.
Medical planning for the Anzio landings, both at army and at corps levels, followed the tactical plans, making full use of experience gained in Africa and Sicily and on the Salerno beaches. The operation was to be carried out by VI Corps, under command of General Lucas. The assault troops were to be the British1st Division, assigned from Eighth Army, and the U.S. 3d Division, with the 45th and 1st Armored Divisions
in reserve. The landing force was also to include two British Commando and three Ranger battalions, the 504th Parachute Infantry regiment, and the 509th Parachute Infantry Battalion. In addition to the normal medical detachments and organic medical battalions, medical support for VI Corps was to be supplied by the 52d Medical Battalion; the 93d, 95th, and 56th Evacuation Hospitals; the 33d Field Hospital, with the British 12th Field Transfusion Unit attached; the British 2d Casualty Clearing Station; the 549th Ambulance Company; and a detachment of the 2d Auxiliary Surgical Group.
Medical planning for the Anzio operation was directed by Fifth Army surgeon, Joseph I. Martin, now a brigadier general, and Colonel Huddleston, who had been VI Corps surgeon since Salerno. Colonel Huddleston also directed medical services on the beachhead until he was killed by artillery fire while emerging from corps headquarters on 9 February 1944. He was succeeded by Col. Rollin L. Bauchspies, commanding officer of the 16th Evacuation Hospital.
Medical support was based on a projected D-day casualty rate of 10 percent of the assault troops and 5 percent of the remainder, with a daily hospital admission rate thereafter of five per thousand from all causes.
All medical units were to be combat-loaded for greater speed in establishing themselves ashore. Aid stations were to go in with the landing waves, to be followed as quickly as possible by the installations of the beach group, under initial control of the 540th Engineer Shore Regiment. In the latter category, the 52d Medical Battalion was to set up a collecting-clearing station to receive casualties from the aid stations and evacuate to the ships, while the 33d Field Hospital was to establish an adjacent unit to care for nontransportables. The collecting companies of the 3d Medical Battalion, organic to the 3d Division, were to land at H plus 6 and move inland to assume their normal functions, with the 3d Division clearing station following two hours later. The two 400-bedevacuation hospitals, the 93d and 95th, were also to go ashore on D-day.
The British assault was to be similarly supported, with two field dressing stations and a beach dressing station, backed up by the 2d Casualty Clearing Station. Hospital ships were to be available off both British and American beaches until D plus 3, after which they were to come when requested by the senior surgeon on the beachhead. Normal medical supplies were to be augmented by additional items carried ashore by aidmen, and the 1st Advance Platoon of the 12th Medical Depot Company was to maintain a 10-day reserve on the beachhead. During the assault phase, task force and subtask force surgeons were to be responsible for all medical units accompanying their forces.
Combat Medical Service
Anzio and nearby Nettuno are small resort towns on the west coast of Italy, about 30 miles south of Rome. (Map 24) Ten miles to the east, the Mussolini Canal separates the Anzio plain from the reclaimed Pontine Marshes, while on the northwest rolling, partially wooded farmlands, cut by deep gullies, extend about 25 miles to the Tiber. Some 20 miles
north of Anzio rise the Alban Hills, or Colli Laziali, with Highway 7--the ancient Appian Way--skirting the southern shoulder of the hill mass through Albano and Velletri, and running southeast to Terracina on the coast, about midway between Rome and Naples. Highway 6, the direct route from Cassino to Rome, flanks the northern slopes of the Alban Hills, coming at its closest point within 30 miles of Anzio.
The original mission of VI Corps was to seize the Alban Hills and cut both highways, which formed at once the supply lines and the escape routes of the German Tenth Army entrenched behind the Gustav Line. The orders finally given to General Lucas were somewhat modified, in the light of anticipated difficulties. VI Corps was to "seize and secure a beachhead in the vicinity of Anzio" and "advance on Colli Laziali," but the timing and extent of the advance were not predetermined. The key points to be enveloped were Campoleone, eighteen miles north of Anzio on the Albano road, and Cisterna, astride Highway 7 a similar distance to the northeast.
While German intelligence had noted Allied preparations for an amphibious operation, the enemy high command had been deceived by feints and raids at various points into expectingthe assault to be made north of Rome. Vigorous thrusts along the main Fifth Army front, from Cassino to the mouth of the Garigliano, further confused the enemy, and served to occupy his reserves. The Anzio beaches were therefore virtually undefended when the first Allied troops waded ashore at 0200 on 22 January 1944. The 3d Division, commanded by General Truscott, landed three regiments abreast between Nettuno and the canal, while the Commandos led the British assault six miles northwest of Anzio. The town itself, with mole and port facilities nearly intact, was quickly taken by Col. William O. Darby`s Rangers. The 509th Parachute Infantry Battalion took Nettuno almost as quickly.
German air attacks began shortly after dawn, coupled with spasmodic fire from long-range guns, but the work of unloading men and supplies was not seriously hampered. By midnight, about 36,000 men, 3,200 vehicles, and large quantities of supplies were ashore, approximately 90 percent of the equipment and personnel of the assault convoy.
Casualties were negligible, and so the medical plan was altered to give priority to combat troops and material. Battalion aid stations went ashore with the combat units to which they were attached, and litter squads from the 52d Medical Battalion accompanied the 3d Division as well as the Rangers and paratroops. The beach collecting-clearing station of the corps medical battalion was not needed, however, and did not go ashore until twenty-four hours after the first landings. The 3d Division clearing station was not established until the afternoon of D plus1.
The few casualties that occurred in the early hours of the assault were held at battalion aid stations or carried direct to LST`s equipped to care for them. Aside from these aid stations, the only medical installation ashore on D-day was the 2d Platoon of the 33d Field Hospital, which landed its personnel nd attached surgical teams at 1330, received its equipment three hours later, and was ready to accept patients about 1800. The hospital was setup on the beach southeast of Nettuno.
Until the bulk of the troops had advanced inland and a normal chain of evacuation had been set up, most casualties were littered from the battalion aid stations directly to the field hospital.
For 48 hours this unit was the only hospital functioning on the beachhead. It was soon filled to capacity, with three operating tables in constant use and a backlog of 20 to 30 cases. Tents were several times pierced by shell fragments and debris, but no casualties resulted. The remaining platoons of the 33d Field were put ashore during the afternoon of 23 January, D plus 1, but remained in bivouac, the 3d Platoon until 26 January, the 1st until 8 February. In the interval, their personnel and equipment were drawn upon to expand the facilities of the 2d Platoon.
Both the 93d and 95th Evacuation Hospitals were landed on D plus 1, but were not in operation until the late afternoon of 24 January. The 93d occupied buildings in Anzio; the 95th was under canvas midway between Anzio and Nettuno. The British2d Casualty Clearing Station was established just north of Anzio about the same time.
German air raids on the harbor area and the rising tempo of long-range shelling quickly made these hospital sites untenable. There was, in fact, no safe area on the beachhead, since every foot of the ground held by Allied troops could be observed by the enemy and reached by his guns. Colonel Huddleston selected an open field about two miles east of Nettuno as the lesser hazard, and a hospital area was laid out. The 56th Evacuation, which arrived on 28 January, was set up here, and took all patients over the next two or three days while the 93d and 95th Evacuation Hospitals and the 33d Field Hospital moved to the new location. A similar area for British medical installations was established about two miles north of Anzio on the road to Rome. (See Map 24.)
Evacuation was from the beach until the harbor became available on 29 January, D plus 7. LCI`s (Landing Craft, Infantry) and other small craft carried patients to LST`s or to hospital ships standing offshore, but the process was difficult at best. The water was rough five days out of seven. Frequent air raids and intermittent shelling made it dangerous to hold casualties on the beach, while the ships standing by were easy targets. Even the Geneva cross was scant protection. Three British hospital ships were deliberately bombed offshore on the night of 24 January, and one of them, the St. David, was sunk.
On the military side the attack, which opened so auspiciously, was quickly stalled. From the beaches the troops moved inland against light opposition. All initial objectives, including the bridges across the Mussolini Canal, were secured by noon of D-day, but the key towns of Campoleone and Cisterna were still miles away, and the Alban Hills were but a blister in the distance. January 24 found VI Corps still occupying an area roughly fifteen miles wide and no more than seven miles deep. By this time the benefit of surprise had been lost. Air attacks were increasing in violence and frequency. Huge railway guns that the men came to know as "Whistling Willie" and the "Anzio Express" were trained on the beachhead from concealed positions, changing nightly. All along the 26-mile perimeter of the Allied front, opposition was stiffening as new German units were rushed piecemeal to the area
over roads and rail lines still usable despite the pounding of Allied bombers.
General Lucas decided to dig in against an anticipated counterthrust and wait for reinforcements before advancing his lines. The 1st Special Service Force, the 45th Infantry Division, and half of the 1st Armored were brought up from Naples, and the attack was launched on 30 January. It was too late. The Germans had moved more swiftly, bringing fresh divisions from northern Italy, southern France, Yugoslavia, and even from the static Eighth Army front to wipeout what Hitler called the "abscess" below Rome.
For seventeen weeks Anzio beachhead remained a "flat and barren little strip of Hell"; a front without a rear, where hospitals stood only six miles from the fighting lines and were backed against the sea. Instead of the wildcat Churchill had hoped to hurl at the enemy`s flank, SHINGLE had become a "stranded whale."2
2 The first quote is from General Clark, Calculated Risk, page 7 the second is from Winston Churchill, Closing the Ring, page 488.
Attack and Counterattack
The VI Corps attack launched on 30 January was a two pronged drive in which the 3d Division was to cut the railroad at Cisterna and seize the town, and the British 1st Division was to take Campoleone and advance to cut Highway 7 at Albano. The 1st Armored was to pass around the British 1st to the left and storm Colli Laziali from the west. The attack began disastrously when the 1st and 3d Ranger Battalions, which were to open the way for the 3d Division, were ambushed and destroyed. Only 6 of the 767 men engaged got back. Among the missing were 21 enlisted men of the 52d Medical Battalion. The 4thRanger Battalion, following with the 15th Regimental Combat Team of the 3d Division, also suffered heavy losses. After three days of fighting, the Cisterna assault was halted two miles short of its goal.
The drive up the Albano road was no more successful. The British 1st Division was met by well-placed armor, and the U.S. 1st Armored had to be hastily diverted to reinforce the infantry. Again the objective was approached but not reached, and the attack was halted at nightfall on 31 January.
With the equivalent of four divisions under his command, General Lucas had been stopped by a German army of approximately equal size. Though heavy losses had been inflicted on the enemy, his line had not been breached. On 2 February, VI Corps was ordered to take defensive positions, and control of hospitalization and evacuation from the beachhead reverted to Fifth Army.
During the next two weeks both sides worked furiously to build up strength, but the initiative lay with the Germans, who launched repeated attacks against different sections of the front and kept up an intermittent shelling of Allied positions. Consolidated into the Fourteenth Army under General Eberhard von Mackensen, the German strength was impressive. The Allies brought up the British 56th Division from the Garigliano front, but few more units were available. VI Corps could only compensate for deficiencies in manpower by heavily reinforcing its artillery and tanks.
The major German drive was launched down the Albano road on 16 February arid, reached its maximum development two days later. The crisis for the beachhead came during the night of 18-19 February when the Germans were stopped only six miles from the sea. Allied air superiority and the support of naval guns were contributing factors. 3 General Truscott was made deputy commander of VI Corps at this time, command of the 3d Division passing to Brig. Gen. John W. O`Daniel. Truscott replaced Lucas as corps commander on 23 February.
A renewed German drive on 28 February was also stopped after several days of continuous fighting, much of it hand-to-hand. By 5 March the battle of the beachhead was over. The Germans tacitly acknowledged defeat and went over to the defensive,, while Alexander ordered a general regrouping of the Allied forces on the main front in preparation for a drive on Rome.
3 Rpt, Supreme Allied Commander, Mediterranean, to CCS, on Italian Campaign, 8 Jan 44-10May 44.
PFC.LLOYD C. HAWKS, 3d Division aidman, received the Medal of Honor for his heroic rescue on 30 January 1944 of two wounded men in the Anzio area from an exposed position within 30 yards of the counterattacking enemy, although he himself was twice wounded.
The beachhead line was approximately that of 24 January, with some expansion toward Cisterna .For the next two and a half months VI Corps waited, resting, reinforcing, and building reserves of ammunition and supplies. Every part of the beachhead remained subject to enemy fire, and limited engagements continued intermittently ,but the issue was no longer in doubt.
Early in March the British 5th Division replaced the battered 56th, and later that month the U.S. 34th Division was added to the Anzio forces. In May, shortly before the final breakout, the 36th Division was also attached to VI Corps.
Medical support of the Anzio forces after the landing phase followed a normal pattern, though all the clearing stations but one, through sheer necessity, were eventually concentrated in the hospital area east of Nettuno. The 3d Division clearing station was originally established in the area later selected for hospital use, but moved on 14 February to Acciarella, about midway between Nettuno and the Mussolini Canal on an east-west line. There it was joined by a platoon of the 33d Field Hospital, but both units, after being heavily shelled on the last day of the month, moved hastily back to the hospital sector. The 45th Division clearing station was initially established somewhat closer to Nettuno, but it too moved into the hospital area on 8 March. The corps clearing station of the 52d Medical Battalion was sited in the hospital area throughout the life of the beachhead. Clearing stations of the 34th and 36th Divisions were set up there on arrival.
The only exception was the clearing station of the 47th Armored Medical Battalion, supporting the 1st Armored Division, which was located in the British hospital area about two miles north of Anzio during the entire period.
Evacuation from aid stations and collecting stations was by hand litter, ambulance, and jeep. The smallness of the beachhead meant that evacuation distances were never great, but by the same token the tasks of litter bearers and ambulance drivers were always hazardous. Evacuation was mainly at night because of the ability of the enemy to sweep the beachhead with artillery fire and the frequency of air attacks.
Hospitalization on Anzio Beachhead
The decision to locate all hospitals in the open, made after the 24 January bombings, introduced many new problems, but it undoubtedly saved the beachhead medical service. Both Nettuno and Anzio, which offered the only alternatives, were pounded to rubble by enemy guns and bombs long before the campaign was over. The area selected for the U.S. installations was on low ground near the sea. Drainage was poor and the water table so close to the surface that disposal pits and foxholes could not be dug to proper depth. With all installations under canvas, the prevailing dampness added to the heating problem, making stoves, fresh straw, and extra blankets necessary. By 2 February, when control of the hospitals reverted to Fifth Army, the 56th, 93d, and 95thEvacuation Hospitals and two platoons of the 33d Field Hospital were in the area with an aggregate Table of Organization bed strength of 1,750.4
Beachhead hospitals had been functioning at their new locations for no more than a week when the first of a long series of bombings and shellings occurred. It was impossible to put the medical installations out of range, and equally impossible in that overcrowded wedge of purgatory to site them a safe distance from legitimate military targets. Even when the beachhead was blotted out by a protective screen of smoke, the German gunners managed to find their marks. So good, indeed, was their observation, and so accurate their marksmanship, that it was impossible to attribute all the damage in the hospital area to accident.
On 7 February an enemy plane, closely pursued by Allied fighters, jettisoned its load over the hospital area. Five antipersonnel bombs landed on the tents of the 95th Evacuation Hospital, where 400 patients were being cared for. Newly wounded men were being carried in from the ambulances, the X-ray tent was crowded, and the operating rooms were working to capacity. Twenty-six persons were killed and 64 wounded. The dead included 3 nurses, 2 medical officers, a Red Cross worker, 14 enlisted men, and 6 patients. The hospital commander, Colonel Sauer, was among the wounded. The X-ray equipment was a total loss, twenty-nine ward tents were destroyed, and numerous smaller items of equipment were damaged.
Within an hour the dead had been removed, the wounded hospitalized, and surgical cases among the patients of the 95th transferred to other installations. Doctors and nurses continued their work, but personnel losses and damage to equipment were too great to overcome. General Martin, after reviewing the situation with his beachhead deputy, Col. Henry S. Blesse of the 56th Evacuation Hospital, ordered a replacement. The 95th changed places with the 15th Evacuation on the static Cassino front, the latter unit moving by rail to Naples and on two LST`s to the beachhead. The 15th brought its own records, but only such equipment and tentage as was needed to replace that of the 95th destroyed by the bombing. The new unit was in operation before the end of the day on 10 February.
4 In addition to sources cited earlier in this chapter, see Lt. Cot. Henry M. Winans, 56th Evacuation Hospital. Letters, 1943-44, for a vivid personal narrative of hospital life on the beachhead.
The 15th received a rough welcome to the beachhead. On that day long-range German guns dropped shells in the hospital area, killing two nurses, one of them the chief nurse, and an enlisted man at the 33d Field Hospital. Four officers and seven enlisted men were wounded. One tent was burned and others damaged. Again the wounded included the hospital commander, Lt. Col. Samuel A. Hanser. Patients were carried on their mattresses to the adjoining 56th Evacuation. Blood transfusions in progress at the time of the attack were not interrupted, one attendant holding the needle in place while another held the bottle of plasma during the move. Unlike the 95th Evacuation, the 33d Field was able to resume normal operation the following day.
The U.S. and British hospital areas were bombed on 12 February, and the British area again on the 17th and 19th, some casualties resulting in each instance. During the remainder of the month, while the German counterattack continued, and on through March there was no letup. On 17 March the British 141st Field Ambulance suffered three direct hits, with 14 killed and 75
wounded. On the 22d it was the turn of the 15th Evacuation, which was blanketed by 88-mm. shells. Five persons were killed and 14 wounded. No wonder the combat troops called the hospital area "Hell`s half acre" and felt safer in foxholes at the front!
General Truscott was convinced that the 22 March shelling of the 15th Evacuation Hospital was deliberate. Following a conference with Fifth Army and VI Corps medical officers, he ordered his engineers to reconstruct the British and American hospital areas so as to give maximum protection.5 The hospitals could not be moved. There was no safe place for them to go. They could not even go under ground, but they could be partially dug in. By this time the rains had become less frequent and the ground had dried up enough to permit excavation of tent sites to a depth of 3 or 4 feet. Two ward tents were pitched in each excavation end to end, with earth revetments 3 1/2 feet thick at the base and 2 feet at the top built up three to 5 feet around the tent walls. Steel stakes and chicken wire helped hold the revetments in place. Sandbag baffles inside divided the double tent into four compartments of ten beds each. Patients and personnel were thus secure against anything but a direct hit. Operating tents were given the additional protection of a 2-inch plank roof covered with sandbags.
The 94th Evacuation Hospital, with the 402d Collecting Company of the 161st Medical Battalion attached, arrived on the beachhead late in March with the 34th Division. The unit opened on 29 March, taking the bulk of the new casualties for the next five days while the other hospitals dug in.
That same night, 29 March, the hospital area was again bombed, only a few hours after General Clark had inspected the installations. The 93d and 56th Evacuation Hospitals were hit, with a combined total of 8 killed and 68 wounded. The 56th suffered further damage on the night of 3-4 April and on the morning of 6 April, when long-range German guns once more pounded the area. Too badly damaged to continue on the beachhead, the 56th was replaced on 8 April by the 38th Evacuation Hospital, the 56th taking over the installations of the 38th at Carinola on the southern front. A week later the 11th Evacuation from Casanova, also on the southern front, changed places with the hard-hit 93d. British hospitals were similarly rotated with those in the Cassino area. Sporadic shelling and bombing continued throughout the life of the beachhead, but casualties and damage were considerably reduced by the work of the VI Corps engineers.
Hospitalization policies at Anzio were dictated, like everything else on the beachhead, by the tactical and geographical situation. In the early stages of the campaign all casualties were evacuated to Naples as quickly as they could be made transportable. This entailed a heavy loss of personnel, however, and at the beginning of March the three platoons of the 33d Field Hospital were set up as a single 400-bed unit to hold patients expected to recoverin fourteen days. Although a platoon of the 52d Medical Battalion clearing company set up a 200-bed venereal disease hospital on 19 February, the problem was never serious at Anzio. Cases were confined to
5 Truscott, Command Missions, p. 358.
recurrences and to infections among new troops, contracted before reaching the beachhead. The VD hospital nevertheless treated 3,000 patients, U.S. and British, during its three months of operation.
Both the 52d Medical Battalion and a platoon of the 602d Clearing Company, 162d Medical Battalion, which arrived at Anzio in mid-February, operated mobile dispensaries for troops in isolated areas. The 602d also ran an aid station, primarily for service troops working in and around the port.
The U.S. hospitals at Anzio, after the opening of the 94th Evacuation near the end of March, included a 750-bed and three 400-bed evacuation hospitals, and a 400-bed field hospital, or a total of 2,350 Table of Organization beds. Add to these the 200-bed VD hospital of the 52d Medical Battalion and beds available in the clearing stations of the four U.S. divisions active on the beachhead before the breakout of 23 May, and the maximum T/O strength was approximately3,500 beds, or an actual strength with normal expansion of not more than5,000. During the period of heaviest fighting, bed strength, including expansion, was less than 4,000.
Yet from 22 January through 22 May 1944, these hospitals cared for 33,128 patients, of whom 10,809 suffered from battle wounds, 4,245 from injuries, and 18,074 from disease. In addition to these an unrecorded number of civilians were cared for, since no other facilities were available to them. Some 22,000 civilians were eventually removed from the beachhead, only 750 being allowed to remain.6
In the same 4-monthperiod, British hospitals at Anzio cared for 14,700 cases, including all causes.
Casualties among Medical Department personnel were high: 92 killed, including 6 nurses;387 wounded; 19 captured; and 60 missing in action-558 in all.7
Evacuation From the Beachhead
The original plans for the Anzio Campaign called for evacuation by hospital
6 Bauchspies, "The Courageous Medics of Anzio," Military Medicine, CXXII (January-June 1958), p.268.
7 Annual Rpt, Surg, Fifth Army, 1944. Fifth Army History, pt. IV, p.164, gives only 82 killed, hut the surgeon`s report appears to be the more accurate source.
ship. As the stay of VI Corps on the beachhead lengthened, however, and casualties mounted, LST`s were pressed into service. There were simply not enough hospital ships and hospital carriers available. Even when they could be dispatched to the beachhead, they drew too much water to dock at the wharf, and the sea was often too rough to permit transfer of patients from smaller craft offshore. There was one stretch of fourteen days during which no hospital ship reached Anzio. To accommodate such periods of interrupted evacuation, the Anzio hospitals tried to maintain a reserve of 900 beds. but the sudden violent actions that characterized the Anzio fighting often precluded maintenance of any reserve at all.8
In these circumstances the process of evacuation had to be carefully regulated and controlled. Capt. Eugene F. Haverty was sent to the beachhead by General Martin on1 February to assume the duties of evacuation officer. His energy, skill, and fortitude in the performance of his task were outstanding, but VI Corps did not benefit long from his presence. Captain Haverty was killed on 29 February while directing the loading of casualties on an LST. The Fifth Army hospitalization and evacuation officer, Colonel Camardella, took personal charge of evacuation from the beachhead after Captain Haverty`s death, returning to the southern front in time to participate in planning for the forthcoming drive on Rome. His place at Anzio was taken by Major Selesnick, who had started the year as Fifth Army venereal disease control officer.
The use of LST`s to supplement hospital ships for evacuation to Naples made it necessary to equip these vessels with medical supplies and utilities not normally carried. It was also necessary to supply medical personnel to care for patients on the 20- to 30-hour run to Naples. Initially, two hospital ship platoons of limited service men carried out this assignment. They were supplanted at the end of March by personnel of the 56th Medical Battalion, organized into four platoons, each with a medical officer, an MAC officer, and twenty enlisted men. The average load was 100 to 150 litter patients and a similar number of ambulatory patients, but the newer type LST`s introduced toward the end of the period could accommodate more than 200 litter patients. Hot meals were supplied the litter patients from food containers. The walking patients were fed in the ships mess.
Patients were moved on a prearranged schedule from hospitals to the docks by the 549th Ambulance Company. Loading was the responsibility of the 1st Platoon, 602d Clearing Company, of the 162d Medical Battalion. Civilians were evacuated to Naples under the same principles that guided the evacuation of military personnel.
Air evacuation could not be used at Anzio before the junction of the two armies and the dissolution of the beachhead. The Nettuno airstrip was under constant observation by the enemy, and generally unsafe for anything larger than a Piper Cub. Even these small observation planes were used only for emergencies, to bring blood or urgently needed drugs.
From 22 January through 22 May, 23,860 U.S. casualties and 9,203 British
8 (1) Annual Rpt, Surg, Fifth Army, 1944. (2) ETMD for Mar 44.
casualties, or a total of 33,063were evacuated safely from Anzio beachhead.
Medical Supplies and Equipment
Following the Salerno pattern, personnel of the 1st Advance Platoon, 12th Medical Depot Company, were on the Anzio D-day convoy, attached to the beach group. Each unit carried all items called for in its Table of Basic Allowances, with extra blankets and litters added. Other additional supplies, such as plasma, atabrine, plaster of paris, dressings, and biologicals were carried ashore in the special waterproof containers whose worth had been demonstrated at Salerno. On the basis of the Salerno experience, supply estimates were increased to compensate for losses through accidental immersion as well as by enemy action. The most. important departure from the earlier planning for amphibious operations was provision for carrying supplies adequate for a 10-day level on the D-day convoy. This level had not been reached at Salerno until D plus 12. 9
9 This section is based primarily on: (1) Annual Rpt, Surg, Fifth Army, 1944; (2)Annual Rpt,
A medical supply dump was established on the beach at 0700 on D plus 1. The following day, 24 January, the supply platoon was relieved from attachment to the beach group and passed to control of the VI Corps surgeon. A permanent site for the depot was located on the Anzio-Albano road, near the cathedral. A 4-story building, 70 X 40 feet, housed offices, issue room, shipping section, and living quarters for personnel. Two storage tents were set up for items that might be damaged by water, other supplies being stored in the open. In the early days of the beachhead all requisitions were honored if they were signed by a responsible person, even though a scrap of paper might be substituted for the proper form. The time required to fill a requisition ranged from one-half hour to six hours, depending on the items requested and the extent of enemy shelling and bombing.
The build-up of Supplies did not take place according to plan, but thanks to
Surg, VI Corps, 1944; (3) Annual Rpt, 12th Med Depot Co, 1944; (4) Maj Richard P. Gilbert, MAC, MS. Combat Medical Supply Operations-The Anzio Beachhead; (5)Davidson, Medical Supply in MTOUSA, pp. 73-79.
the light opposition in the landing phase, no damage resulted. While the 10-day level contemplated arrived on schedule, the water was too rough to permit offshore unloading until D plus 5, the only medical supplies available in the interval being those carried ashore by medical units and combat troops. This situation was one frequently repeated at Anzio, since the Liberty ships used for cargo drew too much water to dock at the wharf. On several occasions, emergency requisitions had to be sent to Naples for items that were aboard ships anchored out from the shore but unavailable. These emergency supplies would be delivered by LST, creating an overstock of some items when the cargo vessels managed to unload. Supplies delivered by LST were loaded on trucks at Naples and driven directly to the depot from the landing craft, permitting the vessels to withdraw to safety with a minimum of delay.
Replacement items, both of supply and equipment, were a constant problem on the beachhead because of the continual destruction by enemy shells and bombs. There came to be some truth as well as humor in the remark that "ward tents were sent up daily with the rations." The problem was further complicated by the rotation of hospitals with those on the Cassino front, since the arriving units did not always bring sufficient equipment to replace what had been destroyed.
Another recurrent supply problem was that of property exchange. The hospital ships and carriers were able to exchange litters, blankets, and splints in normal fashion, but LST`s used for evacuation were seldom so equipped. The time factor, moreover, precluded any careful bookkeeping on exchangeable items. The problem was finally solved by sending a truck to Naples with each LST carrying patients. At Naples the truck was loaded with litters and blankets from the base hospitals to be returned to Anzio in exchange for those accompanying the patients.
Despite the difficulties inherent in the situation, including the constant hazard that supply personnel shared with all others on the beachhead, the Anzio medical service at no time suffered any supply or equipment shortage severe enough to impair the quality of medical care.
Professional Services on the Beachhead
Medicine and Surgery
Surgery Under Fire- At Anzio all surgery was forward surgery. There were no field hospital units to take nontransportable cases from the clearing stations because the evacuation hospitals were as close to the front as the clearing stations themselves. There was no screening of patients forward of the hospital area. Neither was there more than rudimentary specialization, except for the use of the 33d Field Hospital for short-term cases after 1 March and the experimental concentration of neuropsychiatric cases in the 56th Evacuation. Each hospital took all types of wounds, limited only by its own bed capacity. Teams of the 2d Auxiliary Surgical Group operated in all of the beachhead hospitals, including the British installations.10
10 Sources for this section are: (1) Annual Rpt. Surg, Fifth Army, 1944; (2)Annual Rpt, Surg, VI Corps, 1944; (3) Annual Rpt, 33d Fld Hosp, 1944;
Ten surgical teams of the group and 2 shock teams were on the D-day convoy, working in the 33d Field Hospital and the 95th Evacuation Hospital as soon as those units were set up. The 12 teams were reinforced before the Anzio interlude was over by 18 additional surgical teams, 2 orthopedic teams, 2 neurosurgical teams, a thoracic team, and a miscellaneous team. For the landing phase, each of the 4 British hospital carriers also had a surgical team of the2d Auxiliary Group assigned for temporary duty. One officer and an enlisted man of the group lost their lives when the St. David was sunk by German bombs the night of 22-23 January. A nurse of the group was killed in action in the 10 February shelling of the 33d Field Hospital. In addition to these deaths in action, the 2d Auxiliary Surgical Group had 11 officers,2 nurses, and 5 enlisted men wounded in the course of the Anzio Campaign.
The surgical load fell heavily on the hospital staffs as well as on the attached teams, but the work was of a high qual-
(4) Annual Rpts, 1944,of 11th, 15th, 38th, 56th, 93d, 94th, and 95th Evacuation Hosps; (5) Annual Rpt, ad Aux Surg Gp, 1944.
ity despite the fact that many of the cases were of types not normally encountered in evacuation hospitals. The 93d Evacuation, for example, handled 1,187 surgical cases during the month of February, entirely with its own staff. The 11th handled 1,240 surgical cases in one 11-day period, only 72 of which were cared for by attached teams. With the aid of 4 auxiliary teams, the 94th performed 138 operations in 24 hours.
At the time of the German counteroffensive in February, the casualty load was so great that some men with less severe wounds were evacuated to Naples for primary surgery, while others were sent back to base hospitals for postoperative care. The Fifth Army surgical consultant, Colonel Snyder, personally followed up these cases, shuttling back and forth between Naples and Anzio with reports that proved most useful to beachhead surgeons.
The Anzio surgeons were greatly aided by generous supplies of whole blood. Where Fifth Army had relied in the past primarily on plasma and on donors among hospital staffs and convalescent patients, the Anzio medical service had the advantage from the outset of the presence of a British field transfusion unit, supplied by a British blood bank. On 26 February the first American blood was received on the beachhead from the newly organized Naples blood bank. A total of 5,128 pints were received from this unit between 26 February and 25 May. Blood was delivered regularly thereafter by LST, with an occasional emergency shipment by Cub plane. The British 12th Field Transfusion Unit continued to be the distributing agency throughout the life of the beachhead. Between 22 January and 4 June 10,624 pints of whole blood were used in U.S. hospitals, for an average of 2.01 pints per case; 3,685 pints were used in British hospitals, averaging 2.95 pints per case.11
Neuropsychiatry-The conditions under which VI Corps operated at Anzio, where all positions were subject to enemy shelling at any time and harassing actions around the perimeter were a constant threat, were inevitably such as to produce a high incidence of psychiatric disorders. The same conditions, however, made it impossible to retain psychiatric casualties for treatment close to the battle lines.12
The month of February 1944, when fighting was most severe and the continuance of the beachhead itself was at stake, showed a psychiatric case rate of 4 per 1,000 per month in the 1st Armored Division, 16.7 in the 3d Division, and 23 in the 45th Division. The pressure for beds in beachhead hospitals was so great that these psychiatric casualties had to be evacuated to base hospitals in less than two days, despite the showing of theater experience that a high proportion could have been returned to duty if treated in the forward area.
The first approach to the problem was the designation of the 56th Evacuation Hospital on 16February to handle all psychiatric cases. It was hoped that this
11 (1) Hist of the 15th Med Gen Lab, 20 Dec 42-31 May 44. (2) Annual Rpt, Surg, Fifth Army, 1944. (3) Bauchspies, "The Courageous Medics of Anzio," Military Medicine, CXXII (January-June 1958), p. 444.
12 Sources for this section are: (1) Annual Rpt, Surg, Fifth Army, 1944; (2)Annual Rpt, Surg, VI Corps, 1944; (3) Annual Rpt, Surg, 3d Inf Div,1944; (4) Hanson, ed., "Combat Psychiatry," Bulletin, U.S. Army Medical Department, Suppl number (November 1949).
specialization would permit more rapid identification and evacuation of severe cases, permitting longer retention of those most likely to respond to treatment if retained on the beachhead. The experiment did not work out. The 56th Evacuation admitted 483 such cases in the period 16-29 February, of which only 9.6 percent were returned to duty.
The focus of psychiatric treatment was then shifted, still on an experimental basis, to the division level. On 1 March a provisional platoon was organized in the 3d Division, with a cadre of one officer and seven carefully selected enlisted men, under supervision of the division psychiatrist, Capt. Robert J. Campbell. The platoon was attached to the 10th Engineer Battalion. Its ranks were filled up with "problem" cases referred by the combat units, which continued to carry the men on their rolls as on special duty status. Captain Campbell screened these cases, sending to the division clearing company for disposition all those showing need for hospital care. The disciplinary cases, and those of mild psychiatric disturbance, were retained in the provisional platoon, where they performed various duties while undergoing psychiatric treatment.
Between 4 March, when the first case was received, and 30 April the provisional platoon evaluated 171 referrals. (Table 10) The record was encouraging enough to warrant an extension of the principle to other divisions later in the Italian campaign.
Trench Foot-Trench foot had become a problem to Fifth Army in the Winter Line campaign, but conditions were relatively good in the mountains before Cassino compared to those on Anzio beachhead. From January through most of March the temperature remained near freezing, with frequent rain. The whole area occupied by VI Corps was flat, much of it reclaimed swampland, with poor drainage and a high ground water level. Trenches, dugouts, and foxholes were usually half filled with water before they were completed. Add to these natural disadvantages the fact that the enemy had good observation of the entire area and guns to back it up, and the medical problem may be realized. It was suicidal to leave a foxhole in daylight, so the men stayed in their cramped positions, their feet often immersed in water and always wet, for ten or twelve hours at a stretch.
Trench foot was an inescapable concomitant.13
There were many conferences on the subject among medical officers, both British and American, but preventive measures were largely useless. The tactical situation made it impossible for the men to exercise their lower limbs properly, and the shortage of manpower precluded any effective rotation of men or units. Dry socks were sent to the front lines as frequently as possible, but the supply of socks and laundry facilities were alike limited. Even had it been possible to issue dry socks daily, as was done in the British sector,14men holding tenuously to positions on a front that might erupt at any moment could not be made to take off their shoes just to change socks. Had they been willing to do so, the new socks would have been as wet as the old in a few minutes.
In the circumstances, it is not surprising that 2,196 cases of trench foot were reported during the continuance of the beachhead. Although preventive measures were thus largely ineffective, the Anzio experience was turned to account in determining what clothing and equipment would be used in the winter of 1944-45. A study with this end in view was carried out by the 3d Division, and the data obtained furnished a basis for ordering future winter equipment for troops in the Mediterranean theater.15
Malaria Control-The same conditions that made trench foot inevitable also made the beachhead a natural breeding spot for mosquitoes. Indeed, the Anzio plain had been scourged by malaria for centuries. As soon as it became evident that the Allied forces might still be in the area after the onset of the malaria season, a complete control plan was worked out by American and British authorities. Beginning late in February, the beachhead was surveyed from the air for breeding places, and as much information as possible was collected about the local incidence of the disease. The results were studied by malariologists, and a control program was issued to all VI Corps units late in March.16
Among the steps taken was the establishment of a special school, operated by personnel of the 52d Medical Battalion, for instruction of the officers, non commissioned officers, and enlisted men who were to carry out the preventive measures. Instructors were 2 Sanitary Corps officers and 3 Medical Department enlisted men who went to Anzio for that purpose. A total of 2,011 persons received six hours of instruction each. Suppressive therapy was started on 26 March,
13 (1) Annual Rpt, Surg, Fifth Army, 1944. (2) Annual Rpt, Surg, VI Corps, 1944.See also, Whayne and DeBakey, Cold Injury, Ground Type, pp. 101-25, passim.
14 It should be noted that the incidence of trench foot on the beachhead was higher among U.S. troops than among British troops performing essentially the same duties under identical conditions. The reasons for the difference, in addition to changing socks daily, probably included the British practice of treating mild cases in quarters where they were not reported, and the British tendency to regard cold injury as a self-inflicted wound, subject to appropriate disciplinary action. Other factors were the superior boots and heavier wool socks issued by the British, and the tact that the British soldier generally stayed in the line for shorter periods of time than his U.S. counterpart
15 "Final Rpt, Preventive Medicine Off, MTOUSA, 1945.
16 (1)Annual Rpt, Surg, Fifth Army, 1944. (2) Annual Rpt, Surg, VI Corps,1944. (3) Annual Rpt, 52d Med Bn, 1944. See also pp. 259-61, above.
instead of 1 May as called for in NATOUSA directives.
The entire area was divided into segments, with each troop unit being made responsible for draining, dusting, or oiling standing and sluggish water, and for cleaning vegetation from the banks of waterways. Every shell hole, every abandoned foxhole or gun emplacement, every bomb crater was a potential breeding spot. So well were the troops indoctrinated that one beachhead soldier was heard to complain that if he spilled a canteen of water on the ground, someone would rush up to spray or drain it.
The VI Corps engineers, the 42d Malaria Control Unit, and Italian engineer battalions brought in or the purpose helped the combat troops carry out their individual assignments. A Corps Malaria Control Committee coordinated the whole program, receiving weekly reports from the responsible officers at division and unit levels, where the control organization was identical with that on the Cassino front.
The final success of the program cannot be fully evaluated, since the Anzio malaria season did not reach its height until June and July, after VI Corps had left the area. However, daily surveys failed to reveal the presence of the carrier, in either adult or larval form, while Allied troops were on the beachhead.
The problem of the dental service at Anzio, like that of the medical and surgical services, was one of organizing facilities so as to make maximum use of the limited personnel available. Laboratory and prosthetic facilities were even less adequate than on the Cassino front, while conditions of operation rendered improvisation more difficult.17
The general practice at Anzio was to centralize the dental service of each division at the division level, leaving only one dental officer in each regiment to function outside the division clinic. The 95th Evacuation Hospital carried a dental clinic that began functioning on D plus 2 as a corps installation. The corps clinic shifted to the 33d Field Hospital when the 95th Evacuation was withdrawn from the beachhead.
A prosthetic dental team of the 2d Auxiliary Surgical Group was attached to the 56th Evacuation Hospital on 22 February, after heavy casualties in the German counter offensive had revealed the need for reparative dental work on the beachhead. The team moved to the 38th Evacuation when that unit replaced the 56th early in April, remaining at Anzio until the end of that month. During the period 22 February-30 April this team completed 37 full dentures, 112 partial dentures, and 2 inlays, while repairing 20 dentures and 3 bridges. No dental laboratory facilities other than those normally carried by the divisions were available.
The Anzio beachhead nursing service contributed one of the great heroic achievements of the war. As in other amphibious operations, nurses were not scheduled for the landings, but joined
17 Sources for this section are: (1) MS, Hist of Army Dental Corps, MTO, Jan 43-Jun44; (2) Annual Rpt, Surg, Fifth Army, 1944; (3) Annual Rpts,1944 of med units mentioned in the text of this chapter.
their units when hospitals were established. Thereafter they shared all the discomfort and inconvenience, all the personal hazard, and all the unceasing labors of the men. If there was any distinction at Anzio between combat troops and medical personnel, it was that the latter worked harder and took greater risks. They had not even the scant protection of a foxhole, and the red cross was a target rather than a shield. There were, moreover, no lulls or quiet periods in their activities. Through it all, the approximately 200 nurses on the beachhead carried on their normal duties, without rest and without complaint.
When the German drive of February was in full swing, and conditions on the beachhead were at their worst, the evacuation of the nurses was considered, but only briefly. As a morale factor, their presence was of incalculable value. To remove them would have been very close to an admission of defeat in the eyes of the combat troops. So they remained--six of them never to depart. Among those who survived, four wore the Silver Star, the first women ever to receive that decoration.