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    Improvements in medical practice and in standards of living in the U.S. Army in World War II meant for the American soldier better medical service than during any previous war. Improved techniques in the treatment of wounds and in the prevention and cure of disease went far toward preserving the lives and bodies of Army men and women both at the fighting fronts and in the bases and lines of communication that led to them. The author in this volume tells first about the medical provisions for the Atlantic outposts of the United States established before the substantial deployment and engagement of Army forces in Mediterranean and European areas, and then devotes major attention to the Army medical service in the Mediterranean campaigns in North Africa, Sicily, the mainland of Italy, and southern France. An appendix suggests some similarities and contrasts between German and American practice during the war.

    The book is a natural sequel to one published in this series in 1956 entitled, The Medical Department: Hospitalization and Evacuation, Zone of Interior, and is to be followed by two dealing with medical service in the European Theater of Operations and in Pacific-Asiatic areas. Other related volumes are being published in the series, "Medical Department United States Army in World War II., While the author of this work has addressed himself primarily to the interests and needs of the military student and reader, a wider audience should find in his account both practical lessons in the provision of mass medical care and assurance that such care was adequately given to those who fought in the largest of American wars.

Brigadier General, USA
Chief of Military History

Washington, D.C.
23 September 1963


    Medical Service in the Mediterranean and Minor Theaters is one of three volumes dealing with the overseas administrative history of the United States Army Medical Department in World War II. Companion studies will deal respectively with the European Theater of Operations and the war against Japan in the Pacific and China-Burma-India Theaters. These volumes differ from the more extensive clinical series, separately published by the Office of The Surgeon General, in that they are concerned primarily with the support given by the Medical Department to the actual combat operations: the collection of the wounded on the battlefield; the establishment of hospitals; the chain of evacuation from the point of contact with the enemy back to the communications zone and on to the zone of interior; and the methods and problems of medical supply in the field. Clinical matters, such as the incidence of disease, the types of wounds predominating, and problems of sanitation, are subordinated to the less technical story of the Medical Department in action. The administrative volumes thus relate both to -the general combat history told else wherein the series UNITED STATES ARMY IN WORLD WAR II and to the medical story proper recorded in the 40-odd volumes of the clinical series appearing under the imprint of the Office of The Surgeon General. They are complemented by Clarence McKittrick Smiths Hospitalization and Evacuation, Zone of Interior; and by four functional volumes, being published by the Office of The Surgeon General, which deal respectively with Organization and Administration of the Medical Department, Personnel, Training, and Medical Supply.

    The manuscript of this volume was submitted in draft form to a substantial cross section of those who participated in the actions described. Those who offered substantiation, corrections, or additions were: Abram Abeloff, M.D.; Lt. Col. James J. Adams, MSC; William H. Amspacher, M.D.; Col. Richard T. Arnest, MC, USA(Ret.); Col. Rollin L. Bauchspies, MC, USA (Ret.); Col. Charles H. Beasley,MC, USA (Ret.) ; Austin W. Bennett, M.D.; Lt. Col. Stephen D. Berardinelli, MC; Col. Daniel J. Berry, MC, USA (Ret.); Frank B. Berry, M.D.; Col. Albert A. Biederman, MC; Col. Charles O. Bruce, MC; Col. Gordon G. Bulla, MC,USAF; J. P. Cameron, M.D.; Col. Joseph Carmack, MSC, USA (Ret.); Lt. Col. Dan Crozier, MC; Brig. Gen. Henry C. Dooling, MC, USA (Ret.); Col. Daniel Franklin, MC, USA

(Ret.); Frank P. Gilligan, M.D.; Brig. Gen. L. Holmes Ginn, Jr., MC, USA Ret.); Michael Q. Hancock, M.D.; Norman L. Heminway, M.D; Col. John A. Isherwood, MC; Maurice M. Kane, M.D.; Col. Paul A. Keeney, MC, USA (Ret.); Col. Emmett L. Kehoe, MC; Maj. Gen. Albert W. Kenner, MC, USA (Ret.); Col. William F. Lawrence, MSC; Col. George E. Leone, MC; Col. John F. Lieberman, MC, USA (Ret.); Gunnar Linner, M.D.; John R. McBride, M.D.; John C. McSween, M.D.; Col. William C. Munly, MC, USA (Ret.); Robert Bruce Nye, M.D.; Col. Forrest R. Ostrander, MC, USA (Ret.); Benjamin M. Primer, M.D.; Col. Matthew C. Pugsley, MC, USA (Ret.); Maj. Gen. Clement F. St. John, MC; Brig. Gen. Crawford F. Sams, MC, USA (Ret.); Col. John W. Sherwood, MC, USA (Ret.); Charles F. Shook, M.D.; Maj. Gen. Earle Standlee, MC, USA (Ret.); Maj. Gen. Morrison C. Stayer, MC, USA (Ret.); William S. Stone, M.D.; Col. John H. Sturgeon, MC, USA (Ret.); Col. E. M. P. Sward, MC, USA (Ret.); Brig. Gen. Lynn H. Tingay, DC, USA (Ret.); Col. Hall G. Van Vlack, MC, USA (Ret.); Col. Dean M. Walker, MC, USA (Ret.); and Thomas G. Ward, M.D. To each of these the author wishes to express his thanks. Without their considerable help much authenticity would be lacking.

    Sections of the volume dealing with strictly military events were checked by knowledgeable members of the Office of the Chief of Military History (OCMH) staff, including Martin Blumenson, Ernest F. Fisher, Jr., and Robert Ross Smith. If the combat narrative lacks at any point in accuracy, it is through no fault of these conscientious reviewers.

    The manuscript was read in its entirety by Dr. Donald O. Wagner, former Chief Historian, The Historical Unit, U.S. Army Medical Service (USAMEDS), before his retirement early in 1960; by Col. John Boyd Coates, Jr., Director of The Historical Unit; and by Dr. Stetson Conn, Chief Historian, Office of the Chief of Military History. Each of these critics offered pertinent and valuable suggestions for improvement.

    Mr. William K. Daum did much of the research for chapters I and II and prepared preliminary drafts of both.

    For expert and unfailing aid in locating and procuring the thousands of documentary sources on which the work is based, the author makes special acknowledgment to Mrs. Josephine P. Kyle, former chief of the General Reference and Research Branch of The Historical Unit, and to her assistant, the late Mrs. Eleanor Alfonso, whose cheerful willingness never faultered despite the constant presence of fatal illness. Mrs. Kyles successors, Maj. Albert C. Riggs, Jr., MSC, and Mr. Roderick M. Engert, did not participate until the book had reached the stage of review and final revision, but both were unstinting of their time and expert knowledge.

    The author is also indebted to the Medical Statistics Division, Office of The Surgeon General, and especially to Mr. Carroll I. Leith, Jr.,--himself a veteran of the Mediterranean campaigns--who verified figures and tabulations, and in many instances proposed better ways of presenting them.

    Preliminary editorial work was done by Mrs. Cyrilla E. Hickey of The Historical Unit, USAMEDS, and the final publications editing by Miss Mary Ann Bacon of OCMH. Copy editor for the volume was Mrs. Marion P. Grimes. The book is undoubtedly the better for having passed through the capable hands of these three editors. The excellent medical situation maps that make the text so much easier to follow were prepared by Miss Elizabeth P Mason, assisted by Miss Jean A. Saffran, both of The Historical Unit, USAMEDS. The photographs were selected by the author. The index was compiled by Susan Stevens New.

Washington, D.C.
23 September 1963

Introductory Note

    The invasion of North Africa on 8 November 1942 was the first ground offensive for U.S. troops against the European Axis Powers, and so the beaches of Algeria and Morocco, the barren hills and dry wadies of Tunisia, became the proving grounds for equipment, for tactics, and for men. From North Africa the battle line moved up to Sicily, to Italy, and into southern France, but for the Medical Department the Mediterranean remained a "pilot" theater whose accumulated experience saved countless lives on other fronts. Medical units that had served well in the static warfare of World War I were modified or discarded on the basis of their performance in the Mediterranean. New techniques, such as the treatment of psychiatric casualties in the combat zone, and the use of penicillin in forward surgery, were tested. The smaller, more mobile field and evacuation hospitals became the workhorses of the theater. Jeeps fitted with litter racks served as front-line ambulances, while transport planes, their cargoes delivered at forward airfields, were pressed into service to evacuate the wounded.

    In the grand strategy of the war the bloody Italian campaign was a diversion, to engage as many enemy troops as possible with the smallest possible commitment of Allied strength. This meant, for the combat troops, being always outnumbered.  It meant over and again, for medical and line commanders alike, giving up formations with priceless battle experience in exchange for willing but untried replacements. In physical terms the theater imposed the extremes of desert, marsh, and mountain barrier; of exposed plains crossed by swollen rivers; and the hazards of rain, snow, sleet and mud, each demanding of the supporting medical complements revised techniques and new expedients.  In no other American combat zone was there anything comparable to the desert warfare of Tunisia, to the long martyrdom of Anzio, or to the bitter ridge-by-ridge encounters of the Apennines. Small wonder that the medical service described in these pages was often improvised and always pushed to the very limit of its means, yet nowhere did the Medical Department attain a higher level of effectiveness.

    The author of Medical Service in the Mediterranean and Minor Theaters, Charles M. Wiltse, is a graduate of West Virginia University, earned his Ph. D. at Cornell, and holds an honorary Litt. D. from Marshall University. In addition to numerous articles, essays, reviews, and government reports, Dr. Wiltse is the author of The Jeffersonian Tradition in American Democracy; of a three-volume historical biography of John C. Calhoun, completed with the aid of two Guggenheim Fellowships; of a volume in the "Making of America" series, The New Nation: 1800-1845; and is coauthor of the official War Production Board history, Industrial Mobilization for War.

Lieutenant General, U.S. Army
The Surgeon General

Washington, D.C.
23 September 1963