CHAPTER VII
The Mediterranean Theater of Operations
The Mediterranean Theater of Operations-originally called the NorthAfrican theater, since it was established before the final decision wastaken to extend Allied operations into Italy and southern France-was theonly oversea theater to be formed as a result of an Allied invasion ofa large land area held by hostile forces. No long-term buildup prefacedcombat activities in the area. The medical officers who first held thechief administrative posts in the theater came with the invasion forces,from the European theater and from the United States.
The organization and activities of the Medical. Department in the Mediterraneantheater followed closely the pattern laid down in the Army field manualsduring the years immediately preceding World War II. It was a doctrinedeveloped largely out of the experience of World War I, but it proved flexibleenough to be readily adapted, in the hands of imaginative men, to the variedconditions of World War II, not only in the Mediterranean but in Europe,Asia, and the Pacific as well. A brief recapitulation of the prewar doctrinewill make this and the following chapters more understandable.
PREWAR ARMY DOCTRINE FOR THEATER MEDICAL
ORGANIZATION
The chief functions of the Medical Department in a theater of operationswere broadly conceived of as evacuation, hospitalization, and sanitationand other measures for the prevention of disease; the procurement, storage,and issue of medical supplies and equipment; and the preparation of medicalrecords and reports. Responsibilities for evacuation and hospitalizationextended to animals as well as men and included the provision for, andthe operation of, the necessary units, installations, and means of transport.Sanitary measures included the inspection of meats, meat foods, and dairyproducts. Responsibilities for prevention of disease in an oversea theatercomprehended the direction and supervision of public health measures amongcivilian inhabitants of the territories occupied.1
The term "theater of operations" was defined in the fieldmanuals as the land and sea areas to be invaded or defended, includingareas necessary for administrative activities incident to the militaryoperations (chart 12). In accordance with the experience of World War I,it was usually conceived of as a large land mass over which continuousoperations would take place and was
1Unless otherwise noted, this section is basedon War Department Field Manual 100-10, Field Service Regulations, Administration,9 Dec. 1940.
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Chart 12.- Typical organization ofa theater of operations as envisaged by War Department Doctrine, 1940
divided into two chief areas-the combat zone, or the area of activefighting, and the communications zone, or area required for administrationof the theater. As the armies advanced, both these zones and the areasinto which they were divided would shift forward to new geographic areasof control.
It was recognized that the chronologic development of these elementswould vary from theater to theater. In theaters where a long buildup periodwas possible before the field forces went into combat, a fairly elaboratesystem of communications zone sections or bases would develop well in advanceof the rest of the theater elements. On the other hand, where the Armybuilt up a theater of operations by invasion, it might develop its communicationszone setup simultaneously with, or after, the combat area.
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The commanding general of a theater of operations was directly subordinateto the War Department Chief of Staff. In addition to his own general staff,he was served by a special staff, of which the chief of medical serviceof the theater, generally called the "Chief Surgeon" or simply"Surgeon" followed by designation of the command, was a member.2
The duties of the special staff surgeon of any command were broadlydefined as follows: Acting as adviser to the commander and staff on allmatters pertaining to the health and sanitation of the command, the trainingof troops in military sanitation and first aid, operations of the evacuationservice, and location and operation of hospitals and other medical establishments;supervising, within limits prescribed by the commander, the training ofmedical troops and the operation of elements of the medical service insubordinate units; determining the requirements for, and procuring, storing,and distributing medical, dental, and veterinary supplies and equipment;preparing reports and maintaining custody of records of casualties; andexamining captured medical equipment. In certain instances, the commandermight delegate to his staff surgeon authority over the Medical Departmenttroops, units, or installations of the command.3
In carrying out these diversified duties, the staff surgeon of a commandin an oversea theater dealt with all elements of the general staff of hiscommand. Although the broad phases of medical service on which he dealtwith each element of the general staff were about the same as those oilwhich The Surgeon General dealt with elements of the War Department GeneralStaff in Washington, D.C., they differed greatly in detail. The staff surgeonoverseas had to make estimates and reestimates of the medical requirementsof his command, medical plans for coming combat operations and advancecalculations of casualties, and surveys of sites for housing Medical Departmentinstallations and units. He dealt with G-1 not only on broad matters relatingto personnel, but also on sanitation and measures for the control of communicablediseases of men and animals. Intense activity in enemy intelligence inan oversea command called for collaboration with G-2 in inquiry into theorganization and operations of the enemy`s medical service, communicablediseases in enemy troops, and casualty-producing agents employed by theenemy. The staff surgeon overseas took up with G-3 problems of coordinatingmedical service with the tactical situation, future plans, and troop movements.In addition to the usual matters that called for clearance with G-4, astipulation that the staff surgeon deal with G-4 on all other matters notspecifically allotted to another general staff section, or concerning whichjurisdiction was in doubt, made clear the thoroughgoing involvement ofG-4 in matters medical.4
2(1) See footnote 1, p. 245. (2) War DepartmentField Manual 8-10, Medical Service of Field Units, 27 Nov. 1940. (3) WarDepartment Field Manual 101-5, The Staff and Combat Orders, 19 Nov. 1940.
3See footnote 2 (3).
4War Department Field Manual 8-55, Reference Data, 5 Mar. 1941.
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The theater surgeon was responsible for keeping the commander informedof the condition, responsibilities, and needs of the medical service. Hehad authority to confer or correspond with the surgeons of higher or lowerechelons on matters of general routine and on technical matters. He supervisedthe medical service of the theater by conferences and visits and by makingrecommendations to the theater commander. When his recommendations wereapproved, they were issued in the name of the theater commander as policiesor orders.
The field armies (or army groups, if two or more field armies were organizedinto a group headed by a commanding general) and the communications zoneorganization, or Services of Supply, were the principal types of subordinatecommands directly under the theater command; they held position parallelto each other in the chain of command. The headquarters of both the communicationszone organization and of armies and army groups would have, like the theaterheadquarters, a surgeon on the special staff. The subordinate area commandsof the communications zone (the advance, intermediate, and base sections)and subordinate commands of the field army (division and corps) likewisehad staff surgeons.5
The staff surgeon of the communications zone command was referred toin the 1940 manuals as the "chief of medical service, communicationszone," but soon came to be called "Surgeon, Services of Supply,"or "Surgeon, Communications Zone."
Although the manuals did not make this clear, if the, theater surgeonwas located at communications zone headquarters rather than at theaterheadquarters, he would presumably be communications zone surgeon in additionto his theater assignment. This dualism prevailed in Europe in the latterpart of World I, and existed from the beginning in the European Theaterof Operations in World War II.
The staff surgeon of a theater headquarters was not expected to occupyhimself with the immediate operations of Medical Department units and in-stallationssince most of these were assigned either to the Services of Supply forwork in the communications zone or to the field elements for serving troopsengaged in combat. His primary concern, it was believed, would be coordinatingthe medical work of the Services of Supply, or the communications, zone,organization and that of the field elements-armies and air forces and theirsubcommands. By virtue of his position at the top of the theater structurehe would issue, over the theater commander`s signature and after clear-ancewith the proper elements of the General Staff, medical policies which wouldbe put into effect on a theaterwide basis; that is, in both the communi-cationszone and the combat zone.
5See footnotes 1, p. 245 and 2 (3) p. 247.
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MEDICAL ORGANIZATION IN THE NORTH AFRICAN THEATER
The organization of medical service in North Africa, like that of theother technical services, employed British and American personnel in thehighest command, AFHQ (Allied Force Headquarters). The Allied headquarterswas originally established in London as a planning headquarters for theNorth African invasion and was under the direction of the Commander inChief of the Allied Forces, Lt. Gen. (later Gen. of the Army) Dwight D.Eisenhower. The headquarters medical section began work in London at NorfolkHouse on 14 August 1942. The chief surgeon was a British "Directorof Medical Services," Brigadier (later Maj. Gen.) Ernest M. Cowell.Col. John F. Corby, MC, became the chief American medical representativeat Allied Force Headquarters. As Colonel Corby was outranked by BrigadierCowell, he became deputy to the latter. This subordination of the Americanchief surgeon to the British chief surgeon in the Allied command of theNorth African theater prevailed throughout the war. Three other Americanmedical officers, including an executive officer to Colonel Corby-Lt. Col.(later Col.) Earle Standlee, MC (fig. 55)-joined Brigadier Cowell and theBritish-American staff in London.
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During the London days, before the invasion of North Africa got underwaythe responsibilities of the American members of the medical section ofAllied Force Headquarters were very limited. Their activities were restrictedto the framing of broad policies on preventive medicine, evacuation, andsup ply and to coordinating the American effort in England with that ofthe British. Having received little in the way of instructions from thetop, this small American medical group (four officers and four enlistedmen) tended to believe that the tactical forces and the base sections wouldbe responsible for actual operations in the area to be invaded and thatAllied Force Headquarters would not be concerned with these details. Americandoctrine emphasized policy-making rather than operations at the theaterlevel, which would not call for a large staff. In October, Brigadier Cowellsuggested that two more officers and one enlisted man be added to the Americancomponent of the medical section when it went to Africa, but even withthis addition the American component was only half the size of the British.With 12 officers, 1 warrant officer, and 10 enlisted men, the British componentof the medical section was able to make specific assignments of personnelto administer and supervise evacuation, supply, preventive medicine, professionaltreatment, and maintenance of records.6
Medical Support of the Task Forces
Plans for the invasion provided for a simultaneous strike by three taskforces, two of which consisted exclusively of U.S. Army troops, at thecoastal regions of western French Morocco and northern Algeria in the vicinityof Casablanca, Oran, and Algiers. The Western Task Force, landing in theCasablanca area with a strength of 35,000 men, was organized in the UnitedStates. Col. (later Maj. Gen.) Albert W. Kenner, MC, who had seen servicein World War I as regimental surgeon of the 26th Infantry and had mostrecently served as surgeon of the Armored Force at Fort Knox, Ky., wasthe Western Task Force surgeon. The Center Task Force, composed of 39,000American troops of the U.S. II Corps, staged in the United Kingdom andlanded in the vicinity of Oran. The II Corps surgeon, Col. Richard T. Arnest,MC (fig. 56), served also as Center Task Force surgeon. The third taskforce, designated Eastern Assault Force, sailed from the United Kingdomwith predominantly British personnel and landed 33,000 troops in the Algiersarea.
Medical plans for the task force from the United States and for theforces from the United Kingdom were drawn up separately, with little apparentco-
6(1) History of Allied Force Headquarters,Part I, Aug.-Dec. 1942. [Official record.] (2), Munden, Kenneth W. : Administrationof the Medical Department in the Mediterranean Theater of Operations, UnitedStates Army (1945). [Official record.] (3) Annual Report, Medical Section,North African Theater of Operations, U.S. Army, 1943. (4) Interview, Brig.Gen. Earle Standlee, MC, 10 Jan. 1952. (5) See also Wiltse, Charles M.:The Medical Department: Medical Service in the Mediterranean and MinorTheaters. United States Army in World War II. The Technical Services. [Inpreparation.]
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ordination among them even after the landings in North Africa. Nor wassignificant coordination achieved between the surgeons of the three taskforces, on the one hand, and the American medical staff at Allied ForceHeadquarters, on the other. In the United States, Medical Department officersof Western Task Force made plans in conjunction with the Hospitalizationand Evacuation Branch, Services of Supply, and the staff of the SurgeonGeneral`s Office for adequate medical supplies to accompany troops; thesegroups also made arrangements to have medical personnel and facilitiesat the American ports at which evacuees wounded in the invasion would arrive.Colonel Kenner and the surgeon of the Western Naval Task Force drew upthe joint formal medical plan for the Moroccan landings. The Center TaskForce surgeon achieved a limited coordination with the medical group atAllied Force Headquarters in London on broad policy issues.
Penetration of an 800-mile coastline by the approximately 107,000 troopsof the task forces a few days after landing on 8 November secured the areafrom Safi, French Morocco, to a point close to the Tunisian border. Afterthe consolidation of the landings, and with the arrival of the Services
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of Supply organizations of the task forces, the headquarters for twobase sections, including medical offices, were established in Casablancaand Oran.7
Medical Section, Allied Force Headquarters
Allied Force Headquarters, which briefly operated from a command postat Gibraltar, was at the St. George Hotel in Algiers 2 weeks after theinvasion. The personnel of the medical section arrived at Algiers in lateDecember 1942 and the following January. The deputy force surgeon, ColonelCorby, and his staff were established with the British medical componentin a building near the St. George Hotel.
The inexperienced American branch with its vaguely defined duties wasimmediately confronted with responsibility for operational details of hospitalization,evacuation, and medical supply, as well as swamped with an accumulationof medical reports and records from lower headquarters (the tactical elementsand the growing base sections). It attempted during December and Januaryto establish more effective control over U.S. Army medical service in NorthAfrica, but a clarification of responsibilities did not occur until theAmerican theater of operations, known as NATOUSA (North African Theaterof Operations, U.S. Army) was created in February 1943. Nor could an estimateof personnel requirements for the medical section be made until a well-definedplan of organization had been adopted. Expansion of the American componentwas proposed twice in January-once with a plan for the creation of 8 subsectionsand again with a proposal for a 10-division office, composed of 13 officersand 25 enlisted men-but both plans failed to develop. The office allotmentwas temporarily expanded in January to include six more officers, but bythe end of the month a new limitation of the section to five officers andfive enlisted men was announced. Several months elapsed before any substantialallotment of personnel was made.8
However, in the opinion of Brig. Gen. Howard McC. Snyder of the WarDepartment Inspector General`s Office, the problem was not one of numbers.On an inspection trip to North Africa during December 1942 and January1943, he stated: "Any faulty administration of Medical Departmentservice anywhere in North Africa was not chargeable to lack of personnel.. . . Where initiative and aggressiveness have been combined with adequatepro-
7(1) See footnote 6(4), p. 250. (2) Interview,Maj. Gen. Albert W. Kenner, MC (Ret.), 10 Jan. 1952. (3) Annual Report,Medical Section, North African Theater of Operations, U.S. Army, 1943.(4) Kenner, A. W.: Medical Service in the North African Campaign. Bull.U.S. Army M. Dept. No. 76; 76-84, May 1944. (5) Letter, Col. Clement F.St. John, MC, to Col. John Boyd Coates, Jr., MC, Director, The HistoricalUnit, U.S. Army Medical Service, 3 Nov. 1955, commenting on preliminarydraft of this volume. (6) Clift, Glenn: Field Operations of the MedicalDepartment in the Mediterranean Theater of Operations, U.S. Army (1945).[Official record.] (7) Annual Report, Surgeon, II Corps, 1942. (8) AnnualReport, Medical Section, Atlantic Base Section, 1943. (9) Biennial Reportof the Chief of Staff of the United States Army, July 1, 1941, to June30, 1943, to the Secretary of War. Washington: U.S. Government PrintingOffice, 1943. (10) See footnote 6(5), p. 250. (11) Howe, George F.: NorthwestAfrica: Seizing the Initiative in the West. U.S. Army in World War II.Washington: U.S. Government Printing Office, 1957.
8See footnotes 6(2), p. 250; and 7(3).
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fessional capabilities, good judgment, and tact in the person of theresponsible medical officer, the results have been excellent." Henoted a lack of understanding between General Cowell and Colonel Corby.The American officer found it "difficult to satisfactorily operatein his present status with the Force Surgeon." One element in theclash of personalities was that General Cowell was only a "Territorial,"equivalent to the U.S. National Guard, whereas Colonel Corby had 25 yearsin the Regular Army. Disagreements between the two officers led to therelief of Colonel Corby early in February 1943. Colonel Corby`s successor,Brig. Gen. Albert W. Kenner, later observed that American prerogativeswere being assumed by General Cowell, who ignored the American surgeon.For his part, General Kenner believed that neither General Cowell nor ColonelCorby had any definite knowledge of what was going on in the theater, sinceneither man had gotten out of headquarters in Algiers.9
Early disagreements between American and British medical officers atAllied Force Headquarters and uncertainty as to mutual responsibilitieswere natural, since these had to be worked out step by step without thebenefit of preplanned doctrine. Respective British and American responsibilities,assignments, and contributions of medical facilities, personnel, and supplieshad to be determined during this formative stage. This process was to berepeated at many levels of command in the North African theater, as wellas in other theaters where combat operations were directed by an Alliedcommand.
The Base Sections
When two American base sections, evolving from the Services of Supplyorganizations attached to the Western and Center Task Forces, were establishedin December, they took over the service functions temporarily carried onby the task forces and undertook to furnish services to the troops on anarea basis. Out of the Services of Supply attached to the Center Task Forcethe first North African base section, termed Mediterranean Base Section,was activated on 8 December at Oran. A nucleus of its medical section,attached to the office of the Surgeon, Center Task Force, arrived in NorthAfrica 3 days after the landings. By the date when the base section wasactivated, additional personnel had arrived, and the medical office forMediterranean Base Section was organized. By the first of the year 20 officers,1 nurse, and 31 enlisted men were on duty. The second base section, AtlanticBase Section, grew out of Services of Supply, Western Task Force. By Januarythe surgeon`s staff, which had arrived in echelons, was fully organized.A total of 10 officers and 4 enlisted men were assigned.
9(1) Memorandum, Brig. Gen. Howard McC. Snyder,MC, for the Inspector General, 23 Feb. 1943, subject : Special Inspectionof Medical Department Service in Western Theater of North Africa. (2) Memorandum,Brig. Gen. Howard McC. Snyder, for the Inspector General, 8 Feb. 1943,subject: Inspection of Medical Service, Eastern Sector, Western Theaterof North Africa. (3) See footnotes 7(2), p. 252; and 6 (4), p. 250.
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Both base sections were removed from task force control on 30 December1942, when Allied Force Headquarters placed them directly under its owncommand.10 However, the medical section at the Allied headquartersgained no authority over American Forces in its early days other than thatof determining broad policies, and the medical sections of the base sectionsdeveloped more or less independently. Only when the North African theaterwas established in February did the American component at Allied ForceHeadquarters achieve, in its capacity as Headquarters, NATOUSA, effectivesupervision over the two base sections.11
Medical Support of the Twelfth Air Force
The role of the American Twelfth Air Force in the invasion was to attackenemy targets in eastern Algeria and Tunisia. Formed partly of personnelin the United States and partly of personnel of the Eighth Air Force inthe United Kingdom, it was, like the base sections, a subordinate commandof Allied Force Headquarters. Its staff medical section, beaded by Col.Richard E. Elvins, MC (fig. 57), was provided with six additional officers-anexecutive officer, a medical inspector, a dental officer, a medical supplyofficer, a veterinarian, and a headquarters squadron surgeon-and six enlistedmen. With three other officers of the medical section, Colonel Elvins leftEngland in late October, arrived at St. Leu, Algeria, on 8 November witha D-day convoy, and 2 days later set up a temporary office at TafaraouiAirdrome near the city of Oran which had just surrendered. His office movedto Algiers on 19 November, and started operating there by the end of themonth.
The medical organization of the Twelfth Air Force included, in additionto the surgeon`s office, medical sections of a bomber command, a fightercommand, an air service command, and a troop carrier wing, each havinga surgeon and medical staff assigned, as well as surgeons and other MedicalDepartment personnel with wings, groups, and squadrons. The largest ofthese medical sections was that of the air service command headquarters.In early 1943 it consisted of a surgeon, an executive-medical inspector,a dental surgeon, a veterinarian, 2 supply officers, and from 7 to 10 enlistedmen. Medical supply and veterinary food inspection functions had been removedfrom the Twelfth Air Force surgeon`s office shortly after its arrival in.North Africa and placed at the service command level where these functionswere usually handled. The
10The Assistant Chief of Staff for Operations,Services of Supply, General Lutes, had expressed concern in mid-Novemberover the fact that General Eisenhower had not established an "overallSOS" in North Africa. The lack of a Services of Supply in the developingtheater appeared to him to threaten coordination of activities in evacuatingthe wounded of the three task forces, as well as coordination of the overseastage of evacuation with responsibilities of the Services of Supply ofthe War Department. Memorandum, Maj. Gen. LeRoy Lutes, for Lt. Gen. BrehonB. Somervell, 13 Nov. 1942, subject: Hospitalization and Evacuation Overseas.
11(1) Logistical History of NATOUSA-MTOUSA, 30 Nov. 1945. Naples:G. Montanino, 1945. (2) Annual Report, Medical Section, Mediterranean BaseSection, 1943. (3) See footnote 7(8), p. 252; and 6(3), p. 250. (4) Report,Medical Supply Activities, NATO (Nov. 1942-Nov. 1943). (5) Report of InspectionTrip to North Africa and the United Kingdom by Col. Ryle A. Radke, MC,28 Apr. 1943. (6) Interview, Maj. Gen. Albert W. Kenner, MC, USA (Ret.),11 Jan. 1952.
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air service command established three area commands, comparable to basesections, to operate from subheadquarters in Casablanca, Oran, and Constantine.The medical sections of the area commands operated with a surgeon and twoenlisted men each; a veterinarian was later assigned to each to inspectmeat and dairy products for air force troops.
Shortly after the landings in North Africa, the Twelfth Air Force wasabsorbed by an Allied (American, British, and French) air command, createdin December 1942 and after early February 1943 called Northwest AfricanAir Forces. It was subordinate to the Allied Commander in Chief for allits operations. During most of 1943 the status of the Twelfth Air Forcewithin this command was one of half-existence and "served mainly tomystify all but a few headquarters experts," for most of its componentcommands were combined with a similar British or French unit. The TwelfthAir Force surgeon continued to direct the medical service of the Americancomponent of the Northwest African Air Forces.12
12(1) Craven, Wesley Frank, and Cate, JamesLea, eds.: The Army Air Forces in World War II. Volume II, Torch to PointBlank. Chicago: University of Chicago Press, 1949, pp. 41-206. The quotationin the text is on page 167. (2) Link, Mae Mills, and Coleman, Hubert A.:Medical Support of the Army Air Forces in World War II. Washington: U.S.Government Printing Office, 1954, pp. 419-527. (3) History of the TwelfthAir Force Medical Section, August 1942-June 1944. [Official record.] (4)Medical Department, United States Army, Veterinary Service in World WarII. Washington U.S. Government Printing Office, 1962, pp. 249-269.
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THE NORTH AFRICAN THEATER AND SERVICES OF SUPPLY
FEBRUARY 1943-JANUARY 1944
Theater Medical Section
The need for a headquarters with a staff to administer purely Americanaffairs in North Africa was met by creating NATOUSA on 4 February 1943(map 1). Previously, because of higher rank, senior British officers atAllied Force Headquarters had had control over United States personnelassigned to the various staff sections. When General Eisenhower becametheater commander as well as Allied commander, the senior U.S. Army officerof each Allied Force Headquarters staff section became the chief of thecorresponding section of the theater headquarters. General Eisenhower`sdeputy theater commander, Maj. Gen. Everett S. Hughes, exercised immediatejurisdiction over the American theater staff. Accordingly, the chief Americanmedical officer of Allied Force Headquarters doubled as chief of the medicalsection, North African theater. His medical section served as theater medicalsection and also as the American element of the Allied Force Headquartersmedical section. It functioned mainly in its North African theater capacity,having administrative and operational supervision of all medical servicesof the U.S. Army in the North African theater. When acting as part of theAllied Force Headquarters medical section, the group was concerned jointlywith the British component with formulating policy and plans. The dualassignment served to prevent the use of too large a number of Medical Departmentofficers in administrative work in higher commands and worked out wellin practice. Only five American officers and a few enlisted men were actuallyassigned to the medical section of Allied Force Headquarters; a much largernumber were eventually assigned to that of the theater headquarters. However,the individual`s assignment had little effect upon duties performed. Thepreventive medicine officer, for example, might draft a directive for AlliedForce Headquarters even though he was assigned to the theater headquarters,and the American medical section functioned as a unit in either capacity.13
Brig. Gen. Albert, W. Kenner, formerly chief surgeon of Western TaskForce, had joined the Medical Section, AFHQ (Allied Force Headquarters),in late December 1942 as medical inspector. Earlier that month he had beenpromoted to brigadier general by General Patton, the Western Task Forcecommander. General Patton had been impressed by General Kenner`s promptand efficient handling of 400 burned and mangled men at the town of Fedala,French Morocco, the night of 12-13 November after a U-boat attack on vesselsstill in the area. As Medical Inspector, AFHQ, Kenner had later made tripsthroughout the theater of operations observing medical treatment, medicalsupply matters, personnel problems, and the tactical situation. His assignment
13(1) History of Allied Force Headquarters,pt. II, sec. 1. (2) See footnote 6(2) and 6(4), p. 250. (3) Interview,Brig. Gen. Earle Standlee, 25 Feb. 1952.
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Map 1.- North African - Mediterraneantheater boundaries, 1943-45
had accorded with the standard British concept of medical inspector.(The medical inspector in the U.S. Army was limited essentially to theinspection of sanitary conditions.) His work was of Allied scope; one ofhis first undertakings had been a field inspection during which he hadexamined the operations of all types of medical installations, Britishand American, from general hospitals in rear areas to smaller medical unitsnear the Tunisian front. He had also inquired into such nonmedical mattersas rations, morale, ammunition, and discipline; thus for a short time hehad assumed what amounted to the duties of an "inspector general"of the Allied forces for General Eisenhower. When Headquarters, NATOUSA,was formed on 4 February 1943, he became theater surgeon. He retained hisposition as medical inspector of the Allied forces and automatically becamedeputy chief surgeon under General Cowell in Allied Force Headquarters.14
Although he remained in the theater only until late March, General Kennerwas especially interested in carrying out changes in the tables of organizationof tactical medical units and their tables of basic allowances which hedeemed advisable, on the basis of experience during the invasion, for futurecampaigns in North Africa. His plans had the backing of General Eisenhower,who appointed General Kenner, his deputy surgeon (Colonel Standlee), andthe surgeons of Fifth U.S. Army, II Corps, and 1st Armored Division asmembers
14(1) Memorandum, Maj. Gen. George S. Patton,Jr., for Commanding General, American Expeditionary Force, 20 Nov. 1943.This document, loaned to the author by General Kenner, has since been destroyedalong with the rest of General Kenner`s personal files. (2) See footnote7(2), p. 252 and 11 (6), p. 254.
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of a board to study the field medical service and make recommendationsfor revision in the organization and equipment of units.15
For more than a month after the activation of the North African theaterheadquarters and its medical section, the small American medical groupalready serving at Allied Force Headquarters functioned as the North Africantheater medical section, working from morning until late at night. Thedeputy theater surgeon proposed organizing four operational sections withinthe medical section, to be labeled administration, preventive medicine,operations and planning (divided into hospitalization, evacuation, andtraining divisions), and consultants. The personnel required was estimatedas 23 officers and 30 enlisted men. By the end of April his plan was approved,and the Medical Section, NATOUSA, was formally established the followingmonth.16
With the return of General Kenner to the United States in April, theformer surgeon of the Fifth U.S. Army, Brig. Gen. Frederick A. Blesse (previouslysurgeon of Army Ground Forces), who had been on temporary duty at NorthAfrican theater headquarters during March, was named theater surgeon onthe recommendation of the Fifth U.S. Army commander, Lt. Gen. Mark W. Clark.General Blesse also became deputy chief surgeon and subsequently medicalinspector of Allied Force Headquarters as well, taking over all of GeneralKenner`s former responsibilities. Like General Kenner, General Blesse wasa thoroughgoing student of the medical service of the combat zone.
In June the staff of the theater medical section moved, along with theirBritish partners, to larger offices in Algiers. The British and Americanswere situated in separate offices, but coordination was maintained by informalconferences and weekly meetings of the entire medical staff. Accordingto the remarks of one observer, the position of General Blesse in relationto General Cowell, "is one which demands considerable tact but theyseem to be entirely en rapport and I believe that it would be difficultto find more cooperation under the present complex overall Setup."17The expansion of the theater medical section during 1943 saw the additionof many new functional subsections and a substantial increase in personnel(chart 13). By December the Medical Section, NATOUSA, contained 70 officersand enlisted men; its British counterpart now amounted to 82.
In addition to close liaison with the major theater commands and withthe other staff sections of the North African theater headquarters, aswell as the British component of Allied Force Headquarters, the theatermedical section undertook coordination with the medical service of theFrench Army during 1943. Representatives of the medical services of theAmericans, British, and French held an Allied medical conference in Oranduring November; it pre-
15(1) Special Order No. 3, Headquarters, NorthAfrican Theater of operations, 8 Feb. 1943. (2) Memorandum, Maj. Gen. BrehonB. Somervell, for The Surgeon General, 20 Feb. 1943.
16(1) History of Allied Force Headquarters, pt. II, sec. 1 and4. (2) See footnotes 6 (2), (3), and (4), p. 250; 7(2), p. 252; 11(l),p. 254; and 13(3), p. 256.
17Memorandum, Brig. Gen. Fred W. Rankin, for The Surgeon General,2 Nov. 1943, subject: Remarks on Recent Trip Accompanying Senatorial Party.
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Chart 13.- North African theater medicalsection, August 1943
sented the participants with information on recent advances in the medicalfield in the North African theater. The consulting surgeon of the FrenchArmy made frequent visits to the North African theater surgeon`s office.
A small and flexible group of consultants was developed within the medicalsection. A surgical consultant, a medical consultant, and a consultingpsychiatrist gave professional advice on the treatment of patients andthe most suitable assignments for specialists in their respective fieldson the basis of proficiency, training, and experience. Additional consultants,particularly in various surgical subspecialties such as maxillofacial surgery,orthopedic surgery, and anesthesia, were used at the headquarters of basesections and tactical commands. Some were assigned within the allocationfor the headquarters staff, but for the most part men who served as consultantsin the base sections or with army or corps medical sections were specialistswhose primary assignments were as staff members of hospitals. They wereshifted to various army, corps, or base section headquarters as needed.Thus, without a large assigned staff of specialists, the theater medicalsection profited from the effective use of men who had had training andexperience in both the specialties and the subspecialties. Both II Corps(when operating independently of the field armies) and Fifth and SeventhU.S. Armies had consultants assigned during the Tunisian, Sicilian, andItalian campaigns.
During 1943, the theater surgeon`s office undertook the preparationof several important theater reports and publications. In March, it initiateda series or circular letters which resembled those regularly issued bythe Surgeon
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General`s Office. These, giving instructions on theater medical policyand technical procedures established by the consultants, were distributedto all medical installations and offices in the theater. The report ofEssential Technical Medical Data, or so-called ETMD-initiated early inthe year and submitted by all theater surgeons-to The Surgeon General beginningin July, was a resume of theater medical experience (obtained by consolidatingthe reports of separate Medical Department units, installations, and offices)which became useful in evaluating past planning and in making new plans.It contained information on climate, organization of the medical service,surgery, medicine, nutrition, rehabilitation, preventive medicine, medicalsupply and equipment, medical records, and dental, nursing, and veterinaryactivities. The report was frequently supplemented by Statistical dataon evacuation, hospital admissions, types of wounds, rates of disease andinjury, and similar matters. In January 1944, the theater surgeon`s officebegan to publish a theater professional journal, The Medical Bulletinof the North African Theater of Operations, which appeared regularlyfor the next 17 months.18
Services of Supply Medical Section
A Services of Supply was created in February 1943 in less than 2 weeksafter the establishment of the theater command, with headquarters at theimportant port and rail center of Oran, Algeria. Although it was subordinateto the recently created theater headquarters, as initially organized itdiffered greatly from the theater SOS (Services of Supply) organizationas contem-plated in War Department doctrine, as well as that in most othertheaters, which conformed for the most part to, the doctrine. Its activitieswere restricted to supply and maintenance and did not comprehend the fullscope of activities of the technical services within a communications zoneas outlined in Army manuals. The work of its medical section, created bythe end of the month, was accordingly restricted to the control of medicalsupply for the North African theater. Its role was thus markedly differentfrom that of the medical sections of other oversea Services of Supply,which had as an important function the operation of general and stationhospitals in the communications zone. Col. Charles F. Shook, MC (fig. 58),who had handled procurement planning in the Surgeon General`s Office duringthe emergency period, became head of the Medical Section, SOS, NATOUSA,in August and remained in charge throughout the existence of the command.
In the command structure of the theater, the Services of Supply wasintermediate between the theater command and the base sections in mattersof supply, to which it was itself limited. It directed supply activitiesof the base sections and supervised base section personnel assigned tosupply work. Located at the Oran headquarters, the Medical Section, SOS,consisting of
18(1) See footnote 6 (2) and (3), p. 250. (2)Annual Report, Medical Section, Mediterranean Theater of Operations, UnitedStates Army, 1944.
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about a half dozen Medical Corps and Medical Administrative Corps officersand a few enlisted men, prepared all medical supply requisitions made uponthe Zone of Interior, regulated shipments between bases, adjusted medicaldepot stocks, and generally supervised the activities of medical depotcompanies. It made frequent inspections of installations handling medicalsupplies. Colonel Shook was responsible to the Commanding General, Servicesof Supply, NATOUSA, for the status of theater medical supplies and themaintenance of medical supply records. The medical section of Headquarters,NATOUSA, at Algiers formulated medical supply policies and was the higheragent which kept in contact with the Surgeon General`s Office on mattersof medical supply. Hence, Colonel Shook`s office at Oran maintained liaisonwith the medical supply officer in the theater surgeon`s office.
In the spring of 1943, the Services of Supply medical section directedits supply planning at support of the Sicilian campaign. During the, summerit, initiated a continuing study of the records on issue and consumptionof medical supplies in order to arrive at revisions, based on experiencein the theater, of the maintenance factors published by the Surgeon General`sOffice. Colonel Shook`s office found that the standard medical maintenanceunit (a carefully selected group of medical supplies intended to sufficefor a force of 10,000 men for 30 days) automatically shipped to the theatercontained too low a proportion of some items and excessive amounts of others.It returned some
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excess stocks to the United States, transferred others to Allied militaryforces, and turned over some to civil public health representatives ofthe Allied military government for the treatment of civilian populations.Some surplus stocks were used to fill French lend-lease demands beforethe medical section forwarded the French requisitions on to the UnitedStates.
As the theater achieved a stable organization, it abandoned (as didother theaters) the system of automatic supply by means of the medicalmaintenance unit and changed over to the system of specific requisitionsof supplies from the United States to accord with its own needs. Meanwhilethe Medical Section, SOS, worked out several types of medical supply unitsfor use in support of combat operations in the theater, including an "operationalmedical maintenance unit," designed to suffice for 10,000 men in combatfor 30 days; and a "beach medical unit" (for 5,000 men for 30days) packed in waterproof bags and designed to support troops in beachassault. With the progress of the Sicilian and Italian campaigns in thelatter half of 1943, the Services of Supply medical section became responsiblefor furnishing medical items to newly created base sections in Sicily,Italy, and Corsica, as well as those in North Africa. Personnel of thesection also aided the armies of the Allies, notably the French, in establishingtheir medical supply depots.19
The Base Sections
From February 1943 through January 1944, base sections in the NorthAfrican theater were responsible to Headquarters, NATOUSA. Each base sectioncommander was in charge of his own troops and facilities. Except for theirsupply activities, directed by the Services of Supply, the medical workof base sections was supervised by the medical section at theater headquarters.The base section surgeons, although subordinate to their respective commanders,followed medical policies and techniques formulated by the theater surgeon.In addition to the surgeon and his deputy or executive officer, the medicaloffices of the base sections usually included subsections for hospitalization,evacuation, supply, medical records, dental, veterinary, nursing, personnel,preventive medicine (including venereal disease and malaria control), fiscal,and administration. Base section surgeons collaborated with the other staffsections at base section headquarters, particularly with the following:G-4 and the Engineers in connection with hospital construction, the TransportationCorps for procedures and problems in the movement of patients within the
19(1) History [Annual Report], Medical Section,Services of Supply, North African Theater of Operations, United StatesArmy, February 1943-January 1944. (2) See footnotes 6 (2) and (3), p. 250;and 11(5), p. 254. (3) Annual Report, Medical Section, Eastern Base Section,1943. (4) Memorandum, Inspector General, for Deputy Chief of Staff, 10Aug. 1943, subject: Survey of the Organization and Operations of the MedicalDepartment Facilities in NATOUSA and Sicily. (5) Interview, Col. CharlesF. Shook, MC, 31 Mar. 1952. (6) Memorandum, Col. Charles F. Shook, MC,for Col. R. E. Hewett, MC, Office of The Surgeon General, 2 Oct. 1943.(7) Tates, Richard E.: The. Procurement and Distribution of Medical Suppliesin the Zone of Interior During World War II. Chapter X. [Official record.](8) Report on visit to AFHQ by Col. J. K. Davis, Assistant Chief MedicalOfficer, Supreme Headquarters Allied Expeditionary Force [SHAEF], 1 Apr.1944.
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theater (except by air) and to the United States by hospital ship, QuartermasterCorps and Corps of Engineers for malaria control, and G-3 for matters ofplanning and training. The base section surgeon`s office informed medicalunits and installations under the base section command of prevailing theaterpolicies. The chief Medical Department installations operated by a basesection were station and general hospitals, medical supply depots, anda laboratory.
Between February 1943 and January 1944, four additional base sectionswere established in the theater; the original two, Mediterranean and AtlanticBase Sections, continued to operate as rear areas in the communicationszone. Eastern Base Section, established in February 1943 to support IICorps during the Tunisian campaign, was first located in Algeria in therear of the forces fighting in Tunisia and later in Tunisia as the basesection closest to Sicily during the campaign for that island. After thebeginning of the Italian campaign, it was a base between the forward andrear of the communications zone-the equivalent of an intermediate section,although not so termed. island Base Section was activated in Sicily onthe first of September, in the wake of the Sicilian campaign. On 1 November,about 2 months after the invasion of Italy, what was to be the major basesection of the theater, Peninsular Base Section, was created on the Italianmainland; it operated in support of the Fifth U.S. Army throughout theItalian campaign. Finally, on 1 January 1944, Northern Base Section wasestablished in Corsica, chiefly to support air force units located there(map 2, chart 14).
During 1943, Mediterranean Base Section became the key base sectionfor storing theater supplies and for building up the adjoining EasternBase Section. By the end of its first year of operation, it had a largeconcentration of fixed hospitals; it became the major area, of fixed hospitalizationin North Africa. A subcommand designated Center District, MediterraneanBase Section, with a headquarters medical section was established withinthe base section early in June to take over service functions being carriedon by Allied Force Headquarters within a large enclave around the cityof Algiers (extending approximately 150 miles east to west and 200 milessouth). Two station hospitals and several smaller medical units were locatedthere.
Medical activities in Atlantic Base Section reached a peak in June andJuly and dropped off sharply during the remainder of the year. At the endof 1943 its fixed hospitalization represented only a small fraction ofthe total in North Africa, but it continued to be used as a collectingpoint for transport of evacuees by sea and air back to the United States.
The mission of Eastern Base Section, established in February 1943, wassupply, hospitalization, and evacuation of local and II Corps troops duringthe Tunisian campaign. After the close of the campaign many fixed hospitalswere located there, the number of fixed beds amounting to almost half thetheater total in July 1943. With succeeding campaigns to the north, a heavyvolume of patients passed through the base section, first from Sicily andlater from Italy. Near the end of the year the number of its medical unitsand in-
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Map 2.- North African theater base sectionsand important surgeons` offices, July 1944
stallations decreased, but the number of patients in its hospitals reacheda peak in December. The staff medical section at its headquarters in Constan-tine,Algeria, originally consisted of a surgeon and a few enlisted men trans-ferredfrom Mediterranean Base Section and four officers obtained from AtlanticBase Section. With the arrival in July of a new surgeon, the medical sectionwas expanded, reorganized, and moved to the new location of the base sectionheadquarters in Mateur, Tunisia. It made its final move the following monthwhen the headquarters was transferred to Bizerte.
Island Base Section was established in Sicily from the nucleus of abase section known as the 6625th Base Area Group, which had gone therewith the Seventh U.S. Army. Its headquarters medical section was formedin late August and started operating when the base section was activatedat Palermo in September. The territory under Island Base Section controlconsisted of the region around Palermo and Termini Imerese and other siteswhere U.S. Army depots were located. By October, the base section had takenover from the Seventh U.S. Army the usual administration of hospitals,the handling of medical supply, and maintenance of sanitary conditionsfor troops assigned to the base section. At the end of the year, all thebase section medical installations were centered in and around Palermo.No significant concentration of medical units occurred in Sicily, for fewevacuees from combat in Italy went to North Africa by way of Sicily, andfor these the stopover was brief.
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Chart 14.- Development of base sections,North African (Mediterranean) theater
The unit that was to become the headquarters for Peninsular Base Sectionon the Italian mainland-the 6665th Base Area Group-was activated in August1943. It obtained a medical section, made up of 8 officers, 1 warrant officer,and 14 enlisted men, from Atlantic Base Section. This group left Casablancain three echelons, all arriving in Naples by early October. Until thattime the Fifth U.S. Army Surgeon, Col. (later Brig. Gen.) Joseph I. Martin,MC (fig. 59), had acted as a base surgeon, supervising hospitalization,evacuation, supply, and sanitation, as the task force surgeons had donein the North African invasion before base section personnel arrived. Thebase area group medical section worked closely with General Martin`s staff.When the Peninsular Base Section was established in November with headquartersin Naples, Colonel Arnest, former surgeon of II Corps, became surgeon.
Table 1, indicating numbers of personnel in the medical sections ofthe various base sections at the end of 1943, shows that the surgeon`soffice of Peninsular Base Section was already larger than that of any otherbase section in the theater. With the advances into Italy, the North Africanbases had diminished in importance and Peninsular Base Section had becomethe chief base section in the theater. It furnished medical support tothe Fifth U.S. Army throughout the Italian campaign.
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Table 1.- Number of personnel in medicalsections, base sections, NATOUSA, 1943
Base Section | Officers | Warrant officers | Enlisted men | Women`s Army Corp | Total |
|
Mediterranean | 115 | 0 | 15 | 0 | 30 |
|
Atlantic | 10 | 0 | 8 | 0 | 18 |
|
Eastern | 12 | 1 | 12 | 0 | 25 |
|
Island | 9 | 1 | 10 | 0 | 20 |
|
Peninsular | 17 | 1 | 10 | 9 | 37 |
|
Total | 63 | 3 | 55 | 9 | 130 |
1Includes 3 attached.
Northern Base Section, comprising the island of Corsica, with head-quartersat Ajaccio, became the sixth base section in the theater on 1 January 1944.The original medical section had only two medical officers and dependedfor the first month of its operations upon a few additional attached personnel(chart 14).20
20(1) See footnotes 6(3), p. 250; 7(8), p.252; 11(l), p. 254; 18(2), p. 260; and 19(4), p. 262. (2) Annual Report,Medical Section, Mediterranean Base Section, 1943. (3) Annual Report, MedicalSection, Center District, 1943. (4) Annual Report, Medical Section, PeninsularBase Section, 1943. (5) Annual Report, Northern Base Section, 1944.
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The Field Army Medical Sections
Fifth U.S. Army.-Elements of both Center and Western Task Forceswere merged to form General Clark`s Fifth U.S. Army, the first Americanarmy activated overseas during World War II. When it was established, on5 January 1943, with headquarters at Oujda, French Morocco, a headquartersmedical section was organized, composed of personnel obtained from bothU.S. Army task forces and from the United States. While Fifth U.S. Armywas stationed in Morocco, during the Tunisian and Sicilian campaigns, themedical section was chiefly occupied with training. Headed briefly by GeneralBlesse, who was succeeded by Colonel Martin in April, it consisted of nineofficers and a few enlisted men assigned to veterinary, preventive, medicine,operations, supply, and administrative functions. General Blesse and hisstaff inquired into standards of sanitation in the Army units, the healthof troops, and the status of training and equipment of Medical Departmentpersonnel. They participated in exercises at several training centers organizedin the theater and attended two large-scale command post exercises heldduring March and April. During the Tunisian campaign, members of the medicalsection served on temporary duty with the British First and Eighth Armies,observing the organization of the British medical service and its methodsof hospitalization and evacuation.
Pursuant to plans in the fall of 1943 for invading Italy, a planninggroup of Fifth U.S. Army, including Colonel Martin and a few other MedicalDepartment officers and men, went to Algiers to coordinate their planswith Allied Force Headquarters and North African theater headquarters.After the invasion near Salerno in September, Colonel Martin`s office waslocated at rear headquarters of Fifth U.S. Army at various sites on theItalian mainland. When Naples was occupied early in October, the army surgeonmade a survey of the medical and sanitary situation in that city. By theend of 1943, the Fifth U.S. Army medical section had added seven officers,additional enlisted men, and three members of the Women`s Army Corps toits staff, as well as an Italian medical officer who worked in a liaisoncapacity with medical officers and units serving Italian tactical elementsoperating under the Fifth U.S. Army.
The largest segment of the surgeon`s office was the operations section,which directed training, hospitalization and evacuation, and medical supplyactivities. It formulated medical training policies and programs, directedthe assignment, movement, and location of Fifth U.S. Army medical units(in cooperation with the Army G-4 and the staff Engineer section), carriedout hospitalization and evacuation policies, and administered medical supply.The preventive medicine section was responsible for field sanitation inall army units, the direction of programs for insect control and venerealdisease control, and the prevention of cases of trenchfoot which harassedFifth U.S. Army troops in the winter of 1943. A surgical consultant anda neuropsychiatric
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consultant in Colonel Martin`s office evaluated, through personal observation,the professional capabilities of medical officers assigned to surgicaland neuropsychiatric work in the different army elements and kept theminformed of advanced techniques in their respective fields. Consultantsof the theater surgeon`s office, as well as some from the European theatersurgeon`s office, visited Fifth U.S. Army. The personnel section underthe direct control of the executive officer carried out the usual dutiesof a personnel section-promotion, assignment, classification, replacements,and maintenance of personnel records-with the advice of officers headingthe various professional services of the office, as well as that of commandingofficers of Medical Department units. The dental section reported on thecurrent status of the dental service in the army, advised the surgeon onthe dental health of Fifth U.S. Army troops, inspected the Army`s dentalunits, prepared statistical studies, and made recommendations for improvingthe dental service. Besides its usual task of supervising the inspectionof the Army`s food supplies, the veterinary section had greater responsibilitiesfor animal care than did the veterinarians of most armies, for Fifth U.S.Army used thousands of horses and mules during the Italian campaign. Theveterinary section arranged the movement of the Army`s veterinary unitsand the evacuation of its animals, recommended sites for the location ofveterinary hospitals, and checked requisitions for veterinary suppliesand equipment.21
Seventh U.S. Army.-Lt. Gen. George S. Patton`s Seventh U.S. Armycame into being in July 1943. The nucleus of what was to be its staff medicalsection had functioned first as a part of Western Task Force headquartersand later as the staff medical section for I Armored Corps (when the taskforce had been given that redesignation). By April the medical sectionhad been split between a forward echelon headquarters in Mostaganem, Algeria,and a rear echelon headquarters in Oran. The surgeon, Col. Daniel Franklin,MC (fig. 60), together with two officers, performing executive and hospitalizationand evacuation functions, and two enlisted men at Mostaganem bad made medicalplans for the invasion of Sicily, while rear echelon medical personnel,amounting to three officers and nine enlisted men, had attended to mattersof medical supply, preventive medicine, and routine administration.
The surgeon and his staff at forward echelon sailed aboard the headquartersship of the invasion force and arrived in Sicily as the medical sectionof Seventh U.S. Army, those at rear echelon following within a few days.At the conclusion of the Sicilian campaign on 17 August, the office waslocated in Palermo. It was organized in a fashion similar to that of theFifth U.S. Army surgeon`s office; after the addition of a few personnellate in the year, it totaled 9 officers and 18 enlisted men. Since SeventhU.S. Army`s duties
21(1) Annual Report, Surgeon, Fifth U.S. Army,1943. (2) Annual Report, Surgeon, Fifth U.S. Army, 1944.
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in the post-campaign period were of an occupational nature, a relativelysmall medical section sufficed.22
II Corps.-During the Tunisian campaign, where II Corps (commandedsuccessively by Maj. Gen. (later Lt. Gen.) Lloyd R. Fredendall, Lt. Gen.George S. Patton, Jr., and Maj. Gen. (later Gen.) Omar N. Bradley) operatedindependently, the corps surgeon`s office functioned in the same manneras the surgeon`s offices of Fifth and Seventh U.S. Armies. With a peakstrength Of close to 1001000, 11 Corps was in fact as large as many fieldarmies. It is not, therefore, surprising that the staff of the II Corpssurgeon-11 officers and 16 enlisted men at its maximum-was larger thanthat of most corps.23
The Army Air Forces
The air force setup in North Africa grew elaborate during the firstyear of the theater`s existence. American elements of the Northwest AfricanAir Forces, while remaining under this Allied command`s operational control,were reconstituted as the Twelfth Air Force just before the invasion ofItaly in September 1943. After the fall of Naples early in October, theTwelfth
22Annual Report, Surgeon, Seventh U.S. Army,1943.
23(1) See footnote 7 (7), p, 252. (2) Annual Report, Surgeon,II Corps, 1943.
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Chart 15.- Medical Organization inAir Force commands, 1 February 1944
Air Force became a primarily tactical force designed to support theFifth U.S. Army`s ground operations. Its heavy bombardment elements wereremoved to form the nucleus of a strategic air force, the Fifteenth, activatedin November.
Early in 1944, these two air forces were subordinated to a higher Americanair command for the theater, the AAF/MTO (Army Air Forces, MediterraneanTheater of Operations) which was in turn subordinate to the theater command(chart 15). At the same time the Air Service Command, MTO, was establishedas one of its subcommands. In the preceding month the name of the Alliedair command had been changed from Northwest African Air Forces to MAAF(Mediterranean Allied Air Forces); it remained subordinate to the AlliedCommander in Chief. Thus, at the beginning of 1944, the following Americanmedical sections existed at the major air headquarters of the theater:A small medical section which served not only the top American air command(AAF/MTO) but was also the American medical component of the Allied aircommand (MAAF) and a medical section at each of the three commands subordinateto the Army Air Forces, MTO-the Army Air Forces Service Command, MTO, andthe Twelfth and Fifteenth Air Forces. This organization prevailed to theend of the war.
Although Twelfth Air Force had lost its identity in early 1943 whenit was absorbed by the Allied air command, its administrative elementshad been retained within the larger organization and continued to serveTwelfth Air Force units. The surgeon`s office, formerly at various sitesin Algeria and Tunis, moved to Foggia, Italy, in November. The major segmentsof the office were as
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follows: Executive, including personnel and sick and wounded; medicalinspection, including professional services, physical examinations andvenereal disease control; dental surgeon; neuropsychiatry, including medicaldisposition board and statistics and records; care of flier; and physiology,including personal equipment and nutrition. The veterinary and medicalsupply services were not within the Twelfth Air Force medical section afterearly 1943, but were placed within the medical section of Twelfth Air ServiceCommand, the normal place for these activities.
The functions of most of the subsections in the Twelfth Air Force surgeon`soffice are self-explanatory. The physiology, neuropsychiatry, and care-of-fliersubsections had more distinctive functions than the rest. The first ofthese investigated physiological problems pertaining to flying, includingthe danger of anoxia, the effects of cold temperature, and problems ofnight vision. Its physiologist tested new items of clothing and protectiveequipment and armament, while its personal equipment officer directed themaintenance of emergency, flying, and oxygen equipment; gave instructionsin the proper use of it; and supervised the medical care of fliers whosurvived crashes or forced landings at sea. The neuropsychiatry subsectionformulated policy on neuropsychiatric problems; the psychiatrist who headedit instructed unit flight surgeons in neuropsychiatric matters, made recommendationsto air force staff sections regarding morale, and participated in the proceedingsof a medical disposition board which reviewed cases of men whose physiologicalor psychological fitness for flying was under question. The care-of-fliersubsection, which became a typical element of the office of an air forcesurgeon, devoted itself to consideration of all the elements, includingtype. of plans and nature of the mission flown, as well as the physiologicaland neuropsychiatric conditions which affected the health of fliers. Onthe basis of reports which the care-of-flier subsection obtained from unitsurgeons as to the flying status of their men, hours lost from flying,cause, and so forth, it evaluated the health of Twelfth Air Force fliers.This unit then worked toward the reduction of stresses on the individualflier to a minimum and the establishment of standards for rotation or reliefof fatigued fliers from duty.
By the end of November 1943, the Fifteenth Air Force, with headquartersat Bari, had built up steadily in southeastern Italy, where its operationswere based until the end of the war. From early 1944 on, its heavy bombardmentgroups aided with the strategic bombing of targets in Axis-held territorywithin the boundaries of the European theater, and for this purpose weredirected by the U.S. Strategic Air Forces based in ETO. The administrationof the Fifteenth Air Force, however, including its medical service, washandled within the Mediterranean theater`s chain of command. The organizationof its surgeon`s office resembled that of the Twelfth Air Force surgeon`soffice and its functions did not differ appreciably from those of the latter.
The surgeon`s office of AAF/MTO, the top coordinating American air command,was a small one; it was headed by Col. Richard E. Elvins, MC, former
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surgeon of the Twelfth Air Force. Its duties involved "coordinationand policymaking" rather than administrative functions, for the latterbecame the responsibility of the Office of the Surgeon, Army Air ForcesService Command, Mediterranean Theater of Operations.
Within the headquarters of Mediterranean Allied Air Forces, close liaisonwas maintained between the American medical component headed by ColonelElvins (Medical Section, AAF/MTO) and its British counterpart. The seniormedical officer of Headquarters, Mediterranean Allied Air Forces, a Britishofficer, did not assume any administrative control over medical activitiesof the Twelfth and Fifteenth Air Forces but restricted his action to coordinationof his own medical plans with those of the American medical section. Thelatter maintained liaison with American medical officers at Allied ForceHeadquarters by means of conferences.24
Designed to perform administrative functions for the Twelfth and FifteenthAir Forces, the medical staff of Army Air Forces Service Command, MTO,25handled matters of health and sanitation, venereal disease and malariacontrol, medical care, evacuation, medical plans and training, dental care,food inspection, rest camp operation, and medical supply. The air servicecommand also supervised the operation and maintenance of certain general,station, and field hospitals turned over to air force control after December1943. Most were in the Bari-Foggia area of southeastern Italy and servedtroops of the Twelfth, then of the Fifteenth, Air Force. A few hospitalson the islands of Pantelleria, Sardinia, and Corsica were also under airforce control. Officially attached to AAF/MTO (though remaining assignedto the Services of Supply), these hospitals were directly supervised andadministered by the surgeon of the air force service command organization.This was the first time that substantial responsibilities for fixed hospitalizationhad been given to the Army Air Forces in a theater of operations. The factthat the Bari-Foggia area was under the control of British military forcesand not within the territory of any North African theater base sectionaccounts in part for the attachment of the hospitals to the air forces.The theater surgeon (General Blesse), as well as the surgeons of the Twelfthand Fifteenth Air Forces, recognized the air forces` need for direct supervisionof the fixed hospitals which served air force troops-stationed at somedistance from Services of Supply hospitals and widely dispersed. The surgeonof the Fifteenth Air Force expressed his approval to the Deputy Air Surgeonin Washington: "Our relationship with the hospitals is excellent andthey have been most cooperative. However, this is an unusual
24(1) See footnotes 12 (2) and (3), p. 255; and 11 (1), p. 254. (2) Medical History, Fifteenth Air Force, November1943-May 1945. [Official record.] (3) Annual Report, Medical Section, ArmyAir Forces Service Command, Mediterranean Theater of Operations, 1944.(4) Organization and Functions of the Medical Section, Army Air ForcesService Command, Mediterranean Theater of Operations, through 1 October1944. [Official record.] (5) History of Allied Force Headquarters, pt.II, see. 1; pt. III, sec. 1.
25Personnel formerly assigned to the Twelfth Air Force ServiceCommand were used to staff this overall theater air service command. TheTwelfth Air Force Service Command was resupplied with personnel from oneof the Twelfth Air Force`s air service area commands.
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setup as you well appreciate. In the usual ASF hospital arrangementthere are numerous objectionable characteristics that you and your peopleseem well aware of."26
The office of the Surgeon, Army Air Force Service Command, MTO, wasrelatively large, amounting by mid-1944 to 15 officers, 18 enlisted men,and 4 enlisted women. It was the technical channel for the distributionof medical information from the theater surgeon to surgeons of major airforce echelons. Early in 1944, the medical section was split between advanceheadquarters at Bari, Italy, and rear headquarters in Algiers. By February,the entire section was at Naples, the new location of the air force servicecommand`s headquarters.27
The Air Transport Command in North Africa
The Air Transport Command entered the scene in the North African theatersoon after the Allied landings. The extension of its established Africa-MiddleEast Wing (a segment of the South Atlantic air route from the United Statesthrough Brazil and across central Africa into the Middle East) into thecoastal areas of northern Africa was marked by the arrival of the firsttransport plane from Accra, Gold Coast, at Oran on 17 November 1942. Duringthe following month the wing inaugurated a transport route from Dakar,French West Africa, via Casablanca to England. Daily Air Transport Commandservice through northern Africa began in late January 1943 via the followingtowns: Accra, Bathurst, Atar, Tindouf, Marrakech, Casablanca, Oran, andAlgiers. Territory covered by the wing was expanded considerably with thisnorthward extension; by the end of 1943, the Africa-Middle East Wing hadbeen split into the North African Wing, with most of its stations withinNorth African theater boundaries and some within the Middle East theater,and Central African Wing following the more southerly route, with all itsstations within the boundaries of the Middle East theater.
The North African Wing, later termed North African Division, with headquartersat Casablanca, covered not only points along the coast of northern Africaand French West Africa, but also most of the Middle East, extending fromDakar on the extreme west coast of Africa to the eastern border of Iran.By the end of January 1944, it included the following stations: Dakar,Atar, Tindouf, Marrakech, Casablanca, Oran, Algiers, Tunis, Naples, Tripoli,Bengasi, Cairo, Abadan, and Bahrein Island.
In the early part of 1944, 15 Medical Department officers and 53 enlistedmen, supervised by the wing surgeon, served these stations. The first wingsurgeon was Lt. Col. (later Col.) Clarence A. Tinsman, MC (fig. 61). Hewas succeeded by Col. Frederick C. Kelly, MC (fig. 62), in July 1944. Within
26(1) Letter Col. Otis O. Benson, Jr., to Col.Walter S. Jensen, Deputy Air Surgeon, 9 Apr. 1944. (2) Letter, Col. OtisO. Benson, Jr., to Director of Administration, Office of the Air Surgeon,30 Sept. 1944. (3) Letter, Brig. Gen. Frederick A. Blesse, to Maj. Gen.Norman T. Kirk, The Surgeon General, 6 Feb. 1944. (4) Annual Report, MedicalSection, Army Air Forces Service Command, Mediterranean Theater of Operations,1944. (5) See footnotes 6 (5), p. 250 and 12 (2), p. 255.
27See footnote 24 (4) and (5), p. 272.
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the first 6 months of 1944, the number increased to 42 officers and131 enlisted men. The scattered stations of the wing were usually servedby a dispensary, which customarily maintained a few beds, with at leastone medical officer present. Nearby station or general hospitals maintainedby the base sections, or service commands of the Middle East theater, receivedand treated Air Transport Command personnel whenever necessary. Sanitation,the control of malaria, venereal disease, and the dysenteries among troops,and efforts to prevent troops from contracting many other diseases existentin the local population constituted the major work of the wing surgeon`sstaff. It was responsible not only for the health of the military populationof each station but also for that of many transient personnel who wereunder Air Transport Command control while en route. The wing had to furnishcare to patients transported along its route, including evacuees from.the China-Burma-India theater, toward the United States. During 1944, theNorth African Wing was responsible for the return of over 6,000 patientsby air. Immediate control of the wing was exercised by the wing commander,responsible to the commanding general of the Air Transport Command in Washington,in turn subordinate to the Commanding General, Army Air Forces. Althoughthe wing commander had exclusive control over his personnel, he was responsiblefor adherence to the
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administrative policies of the commanders of the theaters in which thestations of his wing were located.28
PERIOD OF GROWTH AND REORGANIZATION
FEBRUARY-DECEMBER 1944
Reorganization of February 1944
With southern Italy, Sicily, Sardinia, and Corsica under Allied control,theater boundaries were expanded in February 1944 to include almost allterritories bordering on the Mediterranean Sea. The African boundariesremained unchanged, but the theater now included (in anticipation of aninvasion of southern Europe from North Africa) southern France, Switzerland,Austria, the Balkans, Turkey, and the Aegean Islands with the exceptionof Cyprus (map 1). Troop strength of the theater in February 1944 amountedto more than 640,000. A major reorganization of the theater setup tookplace at this date as the result of a survey made in 1943 which had revealedsome duplica-
28(1) Administrative History of the Air TransportCommand, June 1942-March 1943 (1945). [Official record.] (2) AdministrativeHistory of the Air Transport Command, March 1943-July 1944 (1946). [Officialrecord.] (3) History of the Medical Department, Air Transport Command,May 1941-December 1944. [Official record.] (4) See footnote 24(5), p. 272.(5) History, Medical Section, Africa-Middle East Theater of Operations,September 1941-September 1945.
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tion of functions and excess personnel in three high commands: AlliedForce Headquarters, North African theater headquarters, and Services ofSupply headquarters. The functions normally assigned to a communications-zonecommander by field service regulations were transferred from theater headquartersto Headquarters, Services of Supply (renamed Communications Zone in October),and the base sections became subordinate to the Services of Supply, inaccordance with Army doctrine for organization of an oversea theater.
The principal effect of this reorganization upon medical administrationwas an expansion of the responsibilities of the Services of Supply medicalsection, which had previously been concerned only with the handling ofmedical supply. From February to November 1944, it had broad medical responsibilitieswithin the communications zone, the most important of which was supervisionof the fixed hospitals operating in the base sections. It thus became morenearly the orthodox Services of Supply medical section of the type existentin other theaters.
The theater medical section was still responsible for making plans andformulating policies, including those in dental and veterinary medicine.It coordinated these with the various staff elements of the combined theaterand Allied headquarters and the medical offices of the Services of Supply,NATOUSA, of the armies (or task forces), the air force commands, the Alliedarmies, and Allied Military Government. It acted as the channel of communicationwith the War Department on all matters of policy. A significant responsibilitywhich it retained was that of recommending allocation of Medical Departmenttroops and units among the Services of Supply, the armies, air forces,and other commands.
The functions of the Services of Supply medical section, one of thespecial staff sections of that headquarters, pertained to medical activitieswithin the communications zone and its base sections, where the larger,relatively fixed, medical installations were located. It administered thefixed hospitals; after an expansion of June 1944 these amounted to 17 generalhospitals of 1,500 or 2,000 beds each, 34 station hospitals most of whichprovided 500 beds each, and 4 field hospitals of 400 beds each. The medicalsection, SOS, now selected hospital sites, and was responsible for evacuatingthe sick and wounded by land from the combat zone to the communicationszone and within the communications zone, and for sea evacuation from thecommunications zone to the United States. It made medical inspections inthe communications zone and compiled data on the sick and wounded in thatzone. It controlled and trained Medical Department units assigned to thecommunications zone. It continued to direct the supply activities of thebase sections and issued items of medical supply and equipment in excessof tables of basic allowances and tables of equipment to troop units inthe communications zone. This division of medical responsibilities betweenthe theater headquarters and Services of Supply headquarters, whereby themedical section of theater headquarters had responsibility for making theaterwideplans and establishing policies
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Chart 16.- Medical Section, Servicesof Supply, North African theater, May 1944
while the medical office at Services of Supply headquarters supervisedthe handling of medical supply, the operation of fixed hospitals as wellas medical supply depots, and the extensive preventive medicine programwhich were the responsibilities of the communications zone, prevailed inmost of the oversea theaters.29
With the assumption of new responsibilities, the medical section ofthe Services of Supply was reorganized (chart 16). The old Services ofSupply medical section as it had functioned from February 1943 throughFebruary 1944 became merely the supply branch within the new medical sectionwith a structure similar to its former organization.
After February 1944 the theater medical section reduced its personnel,since fewer numbers were needed for the planning and coordinating activitiesto which it was now restricted; some of its members were transferred tothe Services of Supply medical section. On 1 March, Maj. Gen. MorrisonC. Stayer, the former surgeon of the Caribbean Defense Command, becamehead of the theater medical section, replacing General Blesse; he servedas theater surgeon (and Deputy Surgeon, AFHQ) until mid-July 1945.
An important development in theaterwide administration of medical servicein the spring of 1944 was the establishment of a veterinary section inthe theater surgeon`s office. This was the only major phase of the MedicalDepartment`s work in the theater which had not received central directionfrom the theater surgeon`s office. Apparently supervision of veterinaryservice from
29(29) History of Allied Force Headquarters,pt. III, sec. 2. (2) See footnotes 6 (2), p. 250 18 (2), p. 260 and 19(7), p. 262.
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the Services of Supply level had originally been contemplated, for aVeterinary Corps officer attached to the theater surgeon`s office had beenshifted to Services of Supply headquarters early in 1943. However, themedical section of the Services of Supply had performed only supply functions,and the theater medical section had not shown any strong interest in directingthe work in food inspection. Nor had the medical offices at the headquartersof the base sections developed any permanent veterinary elements.30
Veterinary officers commanding veterinary food inspection detachmentsand others assigned to Quartermaster Corps depots and refrigeration companiesand to ports as port veterinarians carried out the, tasks of food inspectionand made arrangements for protecting food against contamination. Food inspectionstook place at many command levels and at many stages of procurement, storage,and issue of foods: the unloading at ports of foods shipped to the theater;storage of shipped foods at Quartermaster depots; butchering of locallybought cattle at local abattoirs; purchase of fish, eggs, fruits, vegetables,and processed foods locally; placement of foods in cold storage rooms.and mobile refrigerating units; and handling at unit messes. These inspectionscalled for close coordination with the Quartermaster Corps and Trans-portationCorps because of the responsibilities of these two services in storingand transporting food supplies. The obvious lack of uniform proceduresfor inspection and standard measures for conservation, together with thecondemnation of foods needlessly by some Veterinary Corps officers, ledthe preventive medicine officer at theater headquarters, Col. William S.Stone, MC (fig. 63), to emphasize the need for a veterinarian in that office.
In the fall of 1943, 12 Veterinary Corps officers, requisitioned bythe Quartermaster Corps to supervise abattoirs for the slaughter of cattleto be furnished the U.S. Army by the French under reverse lend-lease procedure,arrived in the theater. As this program had failed to develop, the veterinarianshad no assignments and were temporarily put in replacement pools. At thispoint, General Blesse, the theater surgeon, assigned Lt. Col. Duane L.Cady, VC, to the task of surveying the work of veterinarians throughoutthe theater and making recommendations with respect to the veterinary service.Colonel Cady found that the lack of any central organization to make theproper distribution of veterinary officers where they were needed had ledto a maldistribution of veterinary personnel and had affected the qualityof veterinary service afforded in the theater. He planned a theaterwidesystem of supervision by veterinarians assigned to the staffs of all majorcommands, including the theater command, the base sections, the Fifth U.S.Army, and the Twelfth
30(1) History of Allied Force Headquarters,pt. II, sec. 4. (2) See footnote 12(4), p. 255. The absence of any veterinarycomponent in the theater medical section may have been because the Britishmedical section at Allied Force Headquarters had no veterinarians. TheBritish Royal Army Veterinary Corps was not a part of the British ArmyMedical Services; at Allied Force Headquarters the British Veterinary andRemount Services formed an element of the office of the British AssistantDeputy Quartermaster General. See Blackham, R. J.: The American Army MedicalServices in the Field. J. Roy. Army M. Corps 80: 201-207, May 1946.
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Air Service Command. He also emphasized the need for centralized supervisionover the work of caring for animals, for Fifth U.S. Army was using mulesand horses in increasing numbers in its northward push in the mountainsof Italy. The use of Italian veterinarians and veterinary units in divisionalveterinary service, as well as at remount stations (operated by PeninsularBase Section) which furnished thousands of mules and horses for the animalpack trains of Fifth U.S. Army, made the standardization of policies andprocedures even more imperative. After the assignment of a Veterinary Corpsofficer to theater headquarters early in March 1944, a theaterwide, systemwas worked out, standard procedures adopted, and the mutual responsibilitiesof the Quartermaster Corps and the Medical Department for care and conservationof food supplies delineated.31
Movement and Further Reorganization
In July 1944, Allied Force Headquarters and Headquarters, North AfricanTheater of Operations, moved from Algiers to Caserta, Italy. Here for
31(1) Memorandum, Lt. Col. Duane L. Cady, VC,for Surgeon, NATOUSA, 21 Dec. 1943, subject: Investigation and Survey ofVeterinary Activities in North African Theater of Operations. (2) See footnote12(4), p. 255.
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the first time the British and American components were in separatebuildings, the American component, including its medical section, beinghoused in the Royal Palace, a short distance from the town. The medicalsection of AAF/MTO32 also had quarters in the Royal Palace,and Headquarters, Services of Supply, had established its offices in thetown of Caserta, moving from Oran in July. The close proximity of the theaterand Services of Supply medical sections afforded greater opportunity forcoordinating their respective programs. The 200-mile distance between Oranand Algiers had been a distinct disadvantage. It now appeared feasibleto simplify staff procedures and reduce the number of officers in administrativepositions by having the general and special staffs of the two headquartersfunction in a dual capacity. A proposal to combine the two headquarterswas soon in the offing; after the invasion of southern France in August1944-the month during which troop strength in the North African theaterreached its peak of 742,700-a development to that effect took place.
The Services of Supply, NATOUSA (renamed Communications Zone, NATOUSA,on 1 October 1944), became responsible for support of the U.S. Seventhand French First Armies which invaded southern France from the North Africantheater. An advance echelon of its headquarters staff, set up at Lyon inSeptember, moved north to Dijon in October. Communications Zone, NATOUSA,established two sections in southern France. The first, Coastal Base Section,was renamed Continental Base Section and then, on 1 October, ContinentalAdvance Section when it moved forward in direct support of the tacticalforces. On the same date Delta Base Section was established, with headquartersat Marseille, taking over a portion of the territory previously under ContinentalBase Section. The headquarters of both these area commands had medicalsections from the start.
The invaded area of southern France was transferred to the Europeantheater in mid-September, but control of supply and administration in thisarea remained until November with Communications Zone, NATOUSA, which hadextended its administrative and supply responsibilities from one theaterto the other and was now chiefly concerned with the operation in southernFrance. On 1 November, Communications Zone, NATOUSA, was renamed CommunicationsZone, MTOUSA. On 20 November, Communications Zone, MTOUSA, was dissolved,its functions so far as southern France was concerned passing to SOLOC(Southern Line of Communications), a new command subordinate to Europeantheater headquarters. At the same time Colonel Shook, former Surgeon ofCommunications Zone, NATOUSA and MTOUSA, became Surgeon of Southern Lineof Communications, taking most of his staff with him. The base sectionsin southern France, together with their medical offices, fixed hospitals,and other medical installations, likewise passed to the control of theEuropean theater.
32It will be remembered that the Army Air Forceshad substituted Mediterranean Theater for North African Theater in February1944-some 9 months before the same change was made at the headquarterslevel.
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Chart 17.- Mediterranean theater medicalsection (American medical component of Allied Force Headquarters), April1945
The North African Theater of Operations, U.S. Army, was renamed, effective1 November 1944, the Mediterranean Theater of Operations, U.S. Army, andwithin the month its medical section assumed the functions of the formermedical section of the Communications Zone (except those for southern France)in addition to its own theaterwide functions. It took over only 5 officersand 16 enlisted men from the Communications Zone medical section; SouthernLine of Communications headquarters had to retain sufficient personnelfor its operations in southern France. The reorganization simplified medicaladministration in the new Mediterranean theater considerably, since orderscould now pass directly from theater headquarters to the base sectionswithout the intermediate Communications Zone command. The November reorganizationrestored to the theater medical section all the functions it had had beforeFebruary 1944, including the administration of evacuation and hospitalization.in the base sections, and added an important new one in the form of a complexsupply section. The medical section acting at theater headquarters andAllied headquarters in Caserta was now responsible for all medical functionsof theaterwide scope.33
33(1) See footnotes 6 (2) and (5) p. 250; 11(l),p. 254; and 18(2), p. 260. (2) Coakley, Robert W.: Administrative and LogisticalHistory of the European Theater of Operations, Organization and Commandin the ETO, pt. II, ch. 7. [Official record in the Office of the Chiefof Military History.]
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ized for the office reached a peak about the same time (table 2). Theincrease in size of the theater medical section at this late date whentroop strength had declined below 500,000 was due to the fact that theoffice had assumed all the former duties of the Services of Supply medicalsection, as well as the normal responsibilities of a medical office attheater headquarters.
Table 2.- Authorized allotment of personnel,Medical Section, AFHQ-MTOUSA, October 1942- October 1945
Date | Officers | Army Nurse Corps | Enlisted men | Total |
1942 | ||||
|
17 Oct | 3 | 0 | 0 | 3 |
|
19 Nov | 4 | 0 | 4 | 8 |
1943 | ||||
|
25 Jan | 5 | 0 | 5 | 10 |
|
6 June | 22 | 0 | 30 | 52 |
|
28 Nov | 29 | 3 | 30 | 62 |
|
20 Dec | 29 | 3 | 36 | 68 |
1944 | ||||
|
3 Mar | 24 | 1 | 29 | 54 |
|
29 June | 24 | 4 | 31 | 59 |
|
8 July | 24 | 3 | 31 | 58 |
|
17 Aug | 24 | 3 | 61 | 88 |
|
19 Aug | 24 | 2 | 61 | 87 |
|
23 Nov | 29 | 2 | 77 | 108 |
|
24 Dec | 30 | 2 | 80 | 112 |
1945 | ||||
|
18 Apr | 33 | 2 | 80 | 115 |
|
9 June | 31 | 2 | 72 | 105 |
|
18 June | 31 | 2 | 68 | 101 |
|
30 Aug | 20 | 2 | 50 | 72 |
|
15 Oct | 16 | 2 | 40 | 58 |
Source: Adapted from a tabulation in Munden, Kenneth W.:Administration of the Medical Department in the Mediterranean Theater ofOperations, United Sates Army (1945), p. 157. [Official Record.]
The Base Sections
By the end of November 1944, the Mediterranean theater had only threebase sections, the Island Base Section on Sicily having been disbandedin July 1944, and Atlantic and Eastern Base Sections having been absorbedby Mediterranean Base Section following the transfer of facilities to southernFrance. The base sections had operated directly under Services of Supply(Communications Zone) throughout most of 1944, the period of heaviest responsibilityof
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the Services of Supply. With the November reorganization and the abolitionof the Services of Supply, the three remaining base sections-PeninsularBase Section, Mediterranean Base Section, and Northern Base Section, inorder of importance-again came under the direct control of theater headquarters.During 1944, Army installations in North Africa had declined in numberand importance, while base section facilities had become concentrated inItaly.
The geographic territory of Peninsular Base Section increased in 1944with the movement of Fifth U.S. Army northward. After the occupation ofRome in June, five hospitals were moved there, and a separate Rome AreaCommand, with a small headquarters medical section, responsible directlyto the theater command, directed the hospitals in the area during 1944.When Leghorn was occupied in July, Peninsular Base Section hospitals wereshifted there and to the coastal towns north of Rome. During the preparationsfor the invasion of southern France, some medical installations in PeninsularBase Section were turned over to Continental Base Section, which was tosupport the Seventh U.S. Army in its landings. Peninsular Base Sectionwas responsible for medical support of the Seventh U.S. Army while thelatter was staging in Naples, and from August through November, after theSeventh U.S. Army invaded southern France, the base section received largenumbers of patients from that area.
By August, Leghorn had become a major supply base and port; the headquartersof Peninsular Base Section, Forward, was located there, its larger half-PeninsularBase Section, Main-remaining at Naples. The base section surgeon accordinglymaintained medical staffs in both cities. In late November, the more importantheadquarters-Peninsular Base Section, Main-was shifted from Naples to Leghorn,and the Naples area was thereafter known as Peninsular Base Section, South.Near the end of the year, half of the fixed medical installations in southernItaly had been moved up to the Leghorn-Florence area. The base sectionsurgeon now had his office in Leghorn but was represented by a deputy surgeonat Naples.
At Bagnoli in the Neapolitan suburbs, certain hospitals and relatedmedi-cal units were formally activated as a "medical center"in February 1944 (fig. 64). Three (later four) general and three stationhospitals and one evacuation hospital were included, along with a supplydepot, dental laboratory, general medical laboratory, and other units.A common message center and a general utilities section were established,and the 4744th Medical Center (Provisional) was created as the centralizedadministrative headquarters of the medical units at Bagnoli. The Bagnoliconcentration constituted something atypical in organization, being a morecomprehensive grouping of Medical Department units than the "hospitalcenter" prescribed in the Army field manuals. A hospital center normallyconsisted of three or more general hospitals, a convalescent camp, detachmentsof the Quartermaster and Finance Departments, and other branches; stationand evacuation hospitals were not included. The Bagnoli medical centerincluded these, as well as the medical
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supply depot and laboratories. It resembled the hospital center, however,in carrying out the field manual doctrine for obtaining, by means of pooling,economy in the use of personnel and facilities, and increased specializationin treatment of patients. This center, the only one formally organizedin the theater, operated continuously to the end of the war.
The work of the Mediterranean Base Section`s medical office, which hadbeen very active during the first half of 1944, underwent sharp reductiontoward the close of the year. Responsibility for evacuating American patientsto the United States on transports from the ports of Oran and Algiers continued,but hospitals assigned to the base section decreased from 14 to 4 by theclose of the year. The base section took over the medical units and hospitals(with less than a thousand beds) of Atlantic and Eastern Base Sectionswhen it absorbed those two commands in mid-November. In December the medicalsection moved with the base section headquarters from Oran to a new siteat Casablanca.
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The third base section to continue in operation throughout 1944 wasNorthern Base Section in Corsica. The surgeon`s office here amounted toonly six officers and seven enlisted men. Only one field and two stationhospitals were on the island. With the station hospitals divided into detachmentsand field hospitals into their component platoons, these medical unitsserved air force and service troops at several scattered locations on Corsica.34At the beginning of 1945, the theater had three base sections and a depotarea: In North Africa, the recently consolidated Mediterranean Base Section;in Corsica, Northern Base Section; in western Italy, Peninsular Base Section;and in eastern Italy, the Adriatic Depot (under the Air Service Command),which served the air forces located in that area. At the end of February1945, the Mediterranean Base Section was discontinued, and the entire geographicarea of North Africa was transferred to the jurisdiction of the Africa-MiddleEast theater. The three station hospitals then operating in North Africapassed to the control of the latter theater. The boundaries of the Mediterraneantheater were redefined by this move to include the entire Mediterraneanarea other than North Africa, with the exception of Cyprus and a few ofthe small islands off the coast of Turkey (map 1).
Early in 1945, a new Adriatic Base Command at Bari, Italy, took overservice functions previously performed by Adriatic Depot for elements ofthe Twelfth and Fifteenth Air Forces located along the east coast of Italy,an area in which the British had primary responsibility. It was decidedto turn over the hospital units which had been attached to the AAF/MTOto the Adriatic Base Command for administration. The air force headquartersstrongly opposed the move, insisting that hospitals servicing air forcetroops should remain under air force control. A study of the problem directedby the theater surgeon granted that the control over hospitalized air forcepersonnel which the attachment of the hospitals to the air forces had affordedhad been an advantage to air force medical service. However, since airforce units would be redeployed soon after the cessation of hostilitiesin Europe, it was decided to reassign the hospitals to the more sedentaryAdriatic Base Command.
Base section medical service underwent further retrenchment in the springof 1945 with the departure of the two hospitals serving air force troopsin the Northern Base Section in Corsica and the closeout of the base sectionin May. The Peninsular Base Section in Italy, responsible for supportingthe Fifth U.S. Army during the brief Po Valley campaign, contained at the
34(1) Annual Report, Surgeon, MediterraneanBase Section, 1944. (2) Annual Report, Surgeon, Northern Base Section,1944. (3) Annual Report, Peninsular Base Section, 1944. (4) See footnotes11 (1), p. 254 ; and 18 (2), p. 260. (5) Zelen, A. I. : Hospital Constructionin the Mediterranean Theater of Operations, U.S. Army (1945). [Officialrecord.] (6) War Department Field Manual 8-5, Medical Department Unitsof a Theater of Operations, May 1945.
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end of August about four-fifths of the fixed hospital beds in the Mediterraneantheater.35 The Combat Forces
The duties of medical officers of Army Air Forces, Mediterranean Theaterof Operations, and Army Air Forces Service Command, Mediterranean Theaterof Operations, did not change appreciably during the latter part of 1944and 1945. With the cessation of hostilities in Europe on 8 May 1945, someduties increased, particularly those concerned with the disbandment ofsome units and the formation of others to render adequate medical serviceduring redeployment and the departure of some Medical Department personnelfor the United States. Several new surgeons were appointed to the two topair force headquarters during 1945, but both these headquarters were disbandedby the end of November.36
The staff medical sections of Fifth and Seventh U.S. Armies were occupiedduring 1944 with planning and supervising medical service during periodsof active combat. After a period of reduction in strength following theclose of the Sicilian campaign, Seventh U.S. Army headquarters, includingits medical section, was occupied in planning the invasion of southernFrance. Planning was carried on in Algiers, Oran, and Mostaganem successivelyuntil July, when the entire Army headquarters moved to Naples for finalpreparations. After the assault on southern France in mid-August and therapid advance up the Rhone Valley, the Seventh U.S. Army was included,by November, in the European theater and under the control of that command.By that date its medical section, headed by Col. Myron P. Rudolph, MC (fig.65), from June 1944 on, had enlarged considerably. New positions addedduring the year included an operations officer and an assistant, a surgicalconsultant, a veterinarian, a personnel officer, a director of nurses,a neuropsychiatric consultant, a liaison officer with the French forces,a historian, and two medical records officers.
Fifth U.S. Army was engaged throughout 1944 in the Italian campaign.Its headquarters medical section received a few additional assigned personnel:a malaria control officer, a chief nurse, and a historian. A consultantin psychiatry and an Italian liaison officer were attached to the office.The army surgeon, General Martin, maintained close liaison with the surgeonof the Peninsular Base Section throughout the campaign, keeping the latterinformed of the offensive plans of the army, so that fixed hospitals ofthe base section could move forward and occupy sites previously used byhospitals assigned
35(1) See footnotes 6(2), p. 250; and 11(l),p. 254. (2)Final Report, Plans and Operations Section, Office of the Surgeon,Mediterranean Theater of Operations, U.S. Army, 10 Nov. 1945. (3) FinalReport, Surgeon, Northern Base Section, 1945.
36(1) Annual Report, Army Air Forces Services Command, MediterraneanTheater of Operations, January-November 1945. (2) See footnotes 6(5), p.250; and 12(2), p. 255. For personnel changes, see appendix A.
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to the army. The two surgeons rotated doctors between forward and reararea hospital units. Centers for the rehabilitation of psychiatric casualtiesnear the front, a neuropsychiatric center in the corps or army area, anda, gastrointestinal and a venereal disease center in the army zone weredevelopments in specialized medical service of the Fifth U.S. Army.37
The rapid progress of the Po Valley campaign in the spring of 1945 confrontedthe Fifth U.S. Army medical service with the problem of hospitalizing prisonersof war. As they were enveloped, German hospitals were, taken over intactand kept in operation under American supervision. As prisoner-patientswere discharged to the prisoner-of-war camps after the war ended, Germanhospital units were consolidated, and with the repatriation of some 12,000long-term cases by September, were closed out. Anticipating that FifthU.S. Army would occupy Austria, the army surgeon`s office drew up a completeplan for medical support of this operation. As Fifth U.S. Army was notgiven this task (11 Corps, with six divisions, assumed control of the Americanzone of Austria in June 1945), General Martin`s office was mainly occupiedduring the remainder of 1945 with the medical aspects of the redeploymentprogram, in-cluding the operation of medical service in rest centers maintainedfor Fifth
37(1) Annual Report, Surgeon, Seventh U.S.Army, 1944. (2) Annual Report, Surgeon, Fifth U.S. Army, 1944. (3) Seefootnotes 6(5), p. 250; and 18(2), p. 260. (4) Interview, Maj. Gen. JosephI. Martin, MC, 21 Feb. 1942.
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U.S. Army troops in Italy. Teams from Fifth U.S. Army`s hospitals operateddispensaries at each center, and the Fifth U.S. Army medical inspectorsupervised sanitary conditions in hotels and restaurants in the vicinityof each. In July 1945, General Martin left the theater for an assignmentin the Pacific, and in September Fifth U.S. Army headquarters ceased operations.38
ORGANIZATION FOR MALARIA CONTROL
In northern Africa many natives in the coastal areas, where most ofthe military operations took place, were infected with malaria; they servedas a potential source for transmission of malaria to U.S. Army troops.A similar reservoir of infection existed in Italy, Sardinia, and Corsica;native refugees, demobilized Italian troops who had previously been infectedin the Balkans, Ethiopia, and other malarial combat areas, and Slav laborerswho had been impressed into service by the Axis were living under conditionswhich promoted the spread of malaria. Foxholes, shell and bomb craters,stretches of land flooded by the Germans, and demolished bridges and hastilybuilt fords which obstructed natural drainage-all these fostered the rapidbreeding of anopheline mosquitoes.
Control of malaria among U.S. Army troops in North Africa was eventuallycarried out under the aegis of the type of theaterwide organization plannedfor the purpose by the Surgeon General`s Office. The theater organizationinitiated its own efforts at control early in 1943. It obtained informationon the incidence of malaria in northern Africa, held conferences of American,British, and French malaria control officers, made arrangements with civilianhealth agencies for environmental control measures outside troop areas,and worked out plans for using Atabrine as a suppressant among troops.Requests for special antimalaria personnel and supplies were placed withthe War Department. Exploratory surveys of mosquito-breeding areas werebegun, and some drainage and larviciding were undertaken in year-roundbreeding areas. Medical and Sanitary Corps officers working under the supervisionof base section medical inspectors directed the early antimalaria workin the theater.
Personnel of malaria control and survey units began coming into thetheater in March 1943. By the end of May, four complete survey units andfour control units had arrived and were assigned to all three North Africanbase sections. A group of malariologists who had served with U.S. Armytroops in Liberia since mid-1942 were transferred to North Africa; in June1943 one of them, Col. Loren D. Moore, MC (fig. 66), became theater malariologist.He was succeeded in September by Col. Paul F. Russell, MC, who served untilMarch 1944. Col. Justin M. Andrews, SnC (fig. 67), followed Russell
38(1) Annual Report, Surgeon, Fifth U.S. Army,1945. (2) See footnotes 6(5), p. 250; and 36 (2), p. 286.
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as theater malariologist, and Maj. Thomas H. G. Aitken, SnC, servedin the post from January 1945 to the end of the war.
After the organization was stabilized, malaria control policy and administrativeprocedures originated in the medical section of theater headquarters. Thetheater malariologist served under the chief of preventive medicine inthe theater surgeon`s office. He maintained liaison with the Allied ControlCom-mission, in charge of the public health program among civilians, andwith the British consultant malariologist of Allied Force Headquarters.On his recommendation, malariologists and control and survey units weretransferred to areas where their work was most needed, serving with groundforce and air force commands, as well as the base sections. At its peakstrength in August 1944, during the malarial season, the malaria controlorganization consisted of 14 malariologists, 6 survey and 17 control units,and a group of men from a ferrying squadron of the Mediterranean Air TransportService. The latter sprayed and dusted extensive areas with antimalariamaterials from planes operating under the technical direction of the theatermalariologist.
An Allied Force Malaria Control School in Algiers gave concentratedtraining in malaria control in courses of a few days` duration to officersconcerned with the administrative aspects of control, to laboratory officersand
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technicians, and to enlisted men. The U.S. Army malariologists in thetheater served as instructors of the American branch of the school; theyrepeated the training courses in more than a dozen locations of troop concentrationin Algiers, Sicily, and Italy, including the hospital area at the Anzio-Nettunobeachhead.
Within the ground combat forces each company, battery, or similar unitmaintained malaria, control details made up of enlisted men. In Fifth U.S.Army, confronted with the necessity for large-scale efforts in the swampsof southern Italy before malariologists and units of Peninsular Base Sectioncould undertake control, a feature of the malaria control program was theuse of antimalaria officers and malaria control committees. In each corps,division, regiment, battalion, and company, a line officer was made responsiblefor malaria control and served as a member of a malaria control committee.At the corps and division level, the medical inspector and the engineerserved as the other members of the committee; regimental and battalioncommittees were composed of the surgeon and the antimalaria officer. Thecommittees brought together information on antimalaria activities and reportedfindings to their respective commanding officers. The effectiveness ofthe committees consisted in their bringing together representatives ofcommand, the engineers, and the doctors in the common effort.
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In the Mediterranean theater, noneffectiveness resulting from malariareached proportions significant enough to impede military operations onlyduring the Sicilian campaign. In August 1943, the malaria rate for thetheater was 116 per 1,000 men per year, but Was far in excess of that forthe troops in Sicily. By August 1944, with the bulk of the theater troopsin relatively healthy areas of Italy and southern France, the rate hadbeen reduced to 91. The 1945 malaria season found the war over and conditionsso altered as to make any valid comparison impossible. While the much higherincidence of malaria in the Southwest Pacific Area was caused mainly bymore difficult environmental and combat conditions, many observers, aswe shall see in a later chapter, attributed the higher rates there in partto faulty organization. In contrast to the situation in the Pacific, controlover antimalaria. work in the Mediterranean theater was rather highly centralized,and the lines of responsibility were clear. Secondly, not only was commandresponsible for enforcement of the program, as Army regulations required,but line officers were made a part of the machinery which carried out controlmeasures.
Nevertheless, certain questions raised with respect to the most efficaciousmeans of control were never fully resolved in the Mediterranean theater.The question of how much control work the standard malaria control unitsshould accomplish and how much troops could do for themselves was neversettled. Some personnel responsible for malaria control considered thestandard control and survey units too small to accomplish their objectivesefficiently and too dependent upon larger units for rations and quarters;moreover, a relatively high proportion of their enlisted men were neededfor administrative purposes within the unit. A plan for a medical battalionheadquarters which could have been used to consolidate antimalaria, unitswas drawn up in 1945, but it was too late to test such a unit in the Mediterraneantheater.39
TYPHUS CONTROL DURING THE NAPLES EPIDEMIC
The chief locality in which Army Medical Department officers came togrips with typhus during World War II was the Naples area. Efforts to preventthe spread of typhus to troops during the progress of the epidemic whichoccurred in the population of Naples in late 1943 were marked at firstby some confusion as to responsibilities and later by the successful teamworkof a number of agencies.
When the epidemic developed, the only representatives of the U.S.A.Typhus Commission overseas were in Cairo, headquarters of the neighboringAfrica-Middle East theater. In the North African theater the Office ofthe
39(1) See footnotes 6(3), p. 250; 11(l), p.254; and 18(2), p. 260. (2) Final Report, Preventive Medicine Officer,Surgeon`s Office, Mediterranean Theater of Operations, U.S. Army, 1945.(3) Andrews, J. M.: Malaria Control in the Mediterranean Theater of Operationsin 1944. J. Mil. Med. in Pac. 1(3): 33-38, November 1945. (4) Report ofMalariologists` Conference, Naples, 1-11 November 1944. (5) Medical Department,United States Army. Preventive Medicine in World War II. Volume VI. CommunicableDiseases: Malaria. [In press.]
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Surgeon, NATOUSA, a Rockefeller Foundation typhus team, and the PasteurInstitute had made joint preparations to combat outbreaks of the diseaseduring the summer and fall, working in close cooperation. Members of theRockefeller Foundation typhus team had worked out and demonstrated in Algiersduring the summer of 1943 methods of mass delousing in prisoner-of-warcamps, Arab villages, and a civilian prison. They used U.S. Army lousepowders which had been developed in the United States by various Governmentagencies in collaboration with the Preventive Medicine Service of the SurgeonGeneral`s Office.
Before Allied troops entered Naples in the first days of October, thetheater preventive medicine officer, Colonel Stone, had requested largequantities of the newly developed insecticide, DDT, from the United States,but because of the limited supply the highly effective powder was not shippedin quantity until late in the year. Colonel Stone had also arranged formembers of the Rockefeller Foundation team to demonstrate, to officersin base sections, hospitals, and divisional areas the methods of mass delousingwhich they bad found most rapid and effective.
Early in December, Allied Force Headquarters received information ofan incipient epidemic of typhus in Naples. The theater surgeon`s officeexerted pressure on the military government heads in Allied Force Headquartersto organize the civil health agencies in Italy to cope with the outbreak.The director of public health of the military government organization inItaly reported that his organization was aware of the danger in the Naplesarea and was taking steps to avert it. However, the typhus control programgot under way slowly because of unsatisfactory organization of the civilhealth service and lack of experience on the part of military governmentpersonnel. Dr. Soper and Dr. Davis of the Rockefeller Foundation team weresent to Naples on 8 December to undertake typhus control work under thedirection of the Allied Military Government in Naples. Confronted by apoorly functioning civilian health setup and inadequate support, the Rockefellergroup experienced difficulties in obtaining personnel and transportationfor the mass dusting of the Neapolitan population with insecticides.
The theater preventive medicine officer arrived in Naples on 18 Decemberand worked out arrangements for the cooperation of the Peninsular BaseSection surgeon and the Allied Military Government of Naples to intensifythe work of the Rockefeller Foundation team in bringing the epidemic undercontrol. The Typhus Commission officially entered the scene with the arrivalof its field director, General Fox, in Naples on 20 December. General Foxand Colonel Stone cooperated in making forceful representation to the theatercom-mand, the Fifth U.S. Army commander, and the Allied Military Governmentand made arrangements in the latter part of December for additional suppliesand personnel. The Typhus Commission was put in temporary charge, and
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Col. Harry A. Bishop, MC (fig. 68), of the theater surgeon`s office,was made coordinating and executive head. Peninsular Base Section suppliedthe much needed transportation and an effective program got underway.
The system of control employed consisted partly of case finding, followedby isolation of cases in order to remove the sources of infection, butlarge-scale dusting of the population in order to destroy the louse vectorwas the chief means of dealing with the epidemic. The campaign soon provedsuccessful, and U.S. Army troops in the Naples area escaped typhus. Thesuccess of the program substantiated the position taken by those experts-mainlythe theater preventive medicine officer, certain members of the PreventiveMedicine Service of the Surgeon General`s Office, and members of the RockefellerFoundation typhus team-who had insisted on mass delousing by insecticidesas a better means of control than immunization by vaccine. It also validatedthe use of chemical insecticides in preference to the older means of delousingby steam or dry heat.
The subsequent controversy among participating groups over who stoppedthe epidemic is beyond the scope of this volume. As expressed by Brig.Gen. Stanhope Bayne-Jones, who was both director of the Typhus Commissionand deputy chief of the Preventive Medicine Service in the Office of TheSurgeon
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General, the accomplishment was great enough to confer distinction onall who took part in it.40
ORGANIZATION FOR PUBLIC HEALTH ACTIVITIES
The standard way of organizing the civil affairs program, includingits public health work, within the oversea theaters was to establish acivil affairs division, frequently called G-5, which contained a subelementtermed "public health," as a general staff element of the Allied,theater, and various lower commands, both area and tactical. In the Mediterraneantheater, the area in which the U.S. Army first undertook a civil affairsprogram during the war, this design was not so fully carried out as inthe European theater and the Southwest Pacific Area. The less elaborateorganization and the more re-stricted scope of the Army`s program in theMediterranean area were due to several factors. This theater was the firstin which the Army was faced with responsibility for civil affairs; onlyafter experience here did it refine its organization in other theatersand standardize procedures. Moreover, the French were chiefly responsiblefor public health in the area initially invaded by the Allies-the Frenchcolonies of northern Africa; hence the U.S. Army developed no elaboratecivil health organization there. As for Italy, political and diplomaticconsiderations dictated a large measure of civilian, rather than military,sponsorship of civil activities undertaken by the U.S. Government in thatarea.
U.S. Army participation in the public health program for civilians inFrench Morocco, Algeria, and Tunisia took place under the aegis of a CivilAffairs Section, a special staff section created at Allied Force Headquarters,just before the invasion of northwest Africa. This section, consistingof both civilian and military personnel (chiefly Americans), had broadpolitical and economic functions, serving as an American diplomatic missionto French authorities in Algiers as well as exercising military functionsas a staff section of the Allied command. Its Economic Subsection constitutedthe nominally independent North African Economic Board, a special agencywhich formulated policy on economic matters in the invaded areas; it wasresponsible for importing and distributing medical supplies for reliefpurposes. A group of U.S. Public Health Service officers were assignedto the Board early in 1943, others being added in July. They made surveysto determine the status of hospital facilities for civilians in the Frenchcolonies, the need for medical supplies for relief purposes, the nutritionalstatus of the population, the presence of epidemic diseases, and the possibilityof the introduction of new disease by insect vectors on planes and by returningrefugees.41
40The text follows the more detailed accountby General Bayne-Jones in Medical Department, United States Army.Preventive Medicine in World War II. Volume VII. Communicable diseases:Arthropodborne Diseases Other Than Malaria. [In preparation.] See alsofootnote 6(5), p. 250.
41(1) History of Allied Force Headquarters, pt. I. (2) Williams,Ralph C.: The United States Public Health Service, 1798-1950. Washington:U.S. Public Health Service Commissioned Officers Association, 1951, pp.695-698.
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The combat operations of the Allies produced relatively little devastationin northwestern Africa, and U.S. Army participation in the public healthprogram there was largely limited to the aid which these few men trainedin public health work gave to the French authorities after combat had ceased.
The organization for health work among civilians in occupied areas re-ceivedits first significant test in the Italian campaign. Although the generalcivil program for Italy received direction from the highest level of Alliedcommand, no medical subelement was ever established in the Military GovernmentSection, a special staff section created in June 1943, and redesignatedG-5 in May 1944 when it was made an element of the General Staff, AFHQ.Hence the public health work in Italy lacked the direction from the topcommand headquarters that the more limited program in northwest Africa,guided by the Civil Affairs Section, had had. Control over public healthactivities in Sardinia, Sicily, and Italy was affected to some extent bythe confused situa-tion that prevailed during the period when politicalcontrol of these areas was divided between the King`s government in Brindisiand the German-dominated government in Rome. Bad local conditions-inoperativepublic health facilities and power plants, shortages of food, clothing,and medical supplies, accumulated garbage, decomposing dead, and severalincipient epidemics-complicated the problem of recovery in specific areas.In Naples the Army encountered all these problems, including the typhusepidemic among the civilian population.
The Allied Military Government, established in May 1943 to operate underthe Commanding General, Fifteenth Army Group (General Sir Harold Alexander),had a public health division headed by a British Army medical officer;Lt. Col. Leonard A. Scheele, USPHS (fig. 69), and other officers of theU.S. Public Health Service were assigned to it. It gave central supervisionto the work undertaken in each local area after the period of control byArmy combat elements had passed. Its planning staff assembled at Chrea,in the Atlas Mountains near Algiers, in a training and holding center.Because of the lack of medical men in the Military Government Section,AFHQ, the medical staff of Allied Military Government dealt directly withthe Director of Medical Services (British) of Allied Force Headquarters.The medical training at Chrea and at nearby Tizi Ouzou during the lasthalf of 1943 continued the type of training given at schools of militarygovernment in the United States.
Within the U.S. Army tactical elements the prescribed organization forsupervising health work among civilians during the period when tacticalunits controlled the various areas was fairly consistently carried out.The headquarters of both Seventh U.S. Army (during the Sicilian invasion)and Fifth U.S. Army had public health service officers assigned to G-5,and they were assigned at times of need to the lower tactical elements.In addition to these staff officers, civil affairs teams or detachmentswhich included medical officers were assigned to invasion forces landingin Sicily and Italy and later to each
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army when a stabilized front was formed. The fact that they were assignedat a late date and in inadequate numbers made it difficult for them tomaintain liaison with the regular Medical Department officers of the armiesand divisions responsible for the health of troops. More effective cooperationcame about later, but the problem of ineffective liaison at all levelsbetween the Army`s public health personnel and officers responsible forthe health of troops remained one of the outstanding difficulties facingcivil affairs authorities throughout much of the Italian campaign.
In November 1943, an Allied Control Commission (later termed simplyAllied Commission) was created. Like Allied Military Government which iteventually absorbed, the Allied Commission was subordinate to Allied ForceHeadquarters. It assumed direction of civil affairs as rapidly as directcontrol through military government became unnecessary and local authoritywas restored. The commission had a public health group assigned to it includingmost of the U.S. Public Health Service officers who had served with theAllied Military Government in North Africa. In late 1943 and early 1944,when it created and took over certain "regions" or local areas,some degree of centralized authority over public health activities ensued.The commission`s responsibility for administering public health work inItaly was vested in Brigadier
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G. S. Parkinson (British), the director of its Public Health and WelfareSubcommission; his deputy was an American, Lt. Col. Carter Williams, MC.The subcommission was located at Naples after late December 1943. It exercisedpublic health, veterinary, medical supply, and welfare functions. Duringthe period when an increasing number of regions were being establishedthe subcommission suffered from a shortage of medically-trained men. Thedirec-tor attempted to keep his own staff small and assigned as many specialistsas possible to the "regions."42
Fifth U.S. Army turned over the Italian provinces under its controlto the Allied Control Commission in step with the progress of militaryoperations; the commission organized these into "regions" andeventually returned control of them to the Italian Government. By September1944 the Public Health Subcommission, Allied Control Commission, was workinglargely through Italian channels. In its northward advance Fifth U.S. Armyfound more nearly normal conditions than had prevailed in southern Italy;local public health and welfare organizations were active. Throughout Italythe Allied Military Government and the Allied Control Commission (withthe later help of the United Nations Relief and Rehabilitation Administration)had to give medical care to thousands of displaced persons, some at campsand others en route to their homes or other areas where better care couldbe afforded. These included, besides the northern Italian refugees whohad fled southward, thousands of other European nationals, particularlyYugoslavs. By the end of May 1944, more than 20,000 Yugoslavs had beenmoved from Italy to camps in the Middle East. As the war came to a close,the responsibility continued with the rapid transfer of repatriated Italianssouthward and German prisoners of war northward through the Brenner Pass.
The public health program of the theater suffered from several seriousadministrative defects, pointed out by the director of the Civil PublicHealth Division (Col. Thomas B. Turner, MC) of the Surgeon General`s Office,who visited the Mediterranean area early in 1944. The outstanding deficiency,he thought, was the lack at Allied Force Headquarters of any one medicalofficer solely devoted to the public health program. He found that somekey personnel had been poorly selected and that liaison between publichealth officers and the surgeons of field forces in charge of the healthof troops had been inadequate. The civil health program had been characterizedby "administrative confusion," which had resulted from "ill-definedchains of command, over-lapping responsibilities, and jurisdictional disputes."An additional hindrance to the program had been the lack of adequate transportationfacilities and medical
42(1) Report of the Public Health Subcommittee,Allied Control Commission, for April 1944. (2) Monthly reports of the AlliedControl Commission, beginning with January 1944. (3) Report to the WarDepartment, History of Civil Affairs in Italy, by John A. Lewis, Jr., 7Dec. 1945. (4) Komer, Robert W.: Civil Affairs and Military Governmentin the Mediterranean Theater of Operations. [Official record in the Officeof the Chief of Military History.] (5) History of Allied Force Headquarters,Pts. II, III. (6) Medical Department, United States Army. Preventive Medicinein World War II. Volume VIII, Civil Public Health Activities. [In preparation.]
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supplies very much in evidence during the early days of the occupationof Naples when typhus spread among the civil population.
By the date of the Normandy invasion, the European theater was in aposition to profit from the Army`s experience in the Mediterranean. ColonelTurner made several recommendations to The Surgeon General for improvingthe organization in northwestern Europe based on his observations in theMediterranean. He suggested that a single individual be charged with toptechnical responsibility for public health; this man should be directlyresponsible to the chief medical officer of the theater or major fieldforce. A public health officer assigned to the headquarters of each armyand each corps would be responsible to the chief public health officerfor technical matters. The program should be organized on a territorialbasis, with major political divisions as the units and a public healthadministrator heading the program in each territorial unit. This administratorwould have technical responsibility for civil health in all the territoryactually occupied by Allied troops, regardless of whether a tactical commanderor a military government organization controlled the area.43
REDEPLOYMENT AND CLOSEOUT OF ACTIVITIES
In planning for the redeployment of troops in the Mediterranean theaterto the Pacific and China-Burma-India theaters, the theater surgeon`s officearranged for disposing of Medical Department property, provided for hospitalizationand evacuation for troops still in staging and training areas in Italy,and planned the movement of Medical Department units out of the theater.Medical and surgical consultants of the theater surgeon`s office arrangedspecial technical training for U.S. Army doctors who had been serving longperiods with combat units or who had been performing administrative duties;they were given refresher courses on medical and surgical techniques inthe general hospitals remaining in the theater. The Fifth U.S. Army medicalstaff continued its main function-medical support to the army-and at thesame time rendered service to the redeployment centers established in thesummer of 1945. Fifth U.S. Army doctors administered physical examinationsto troops in the redeployment centers to determine their fitness for furtheroversea, duty. The Fifth U.S. Army surgeon appointed teams of officersfor attachment to the staffs of the redeployment training centers. Eachteam had three medical officers: one of field grade who served as an "areasurgeon" and supervised sanitation and the medical care of troopsstationed at the centers; a medical records inspector who checked all unitmedical records and helped the units to complete their final reports andhistories; and a medical supply inspector.44
43Letter, Col. T. B. Turner, MC. to The SurgeonGeneral, 21 Feb. 1944, subject: Report of Civil Affairs Public Health Activitiesin NATOUSA, inclosures 1 and 2.
44See footnotes 6(2), p. 250; 36(2), p. 286; and 39(l), p. 291.
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As theater strength dropped from its August 1944: peak of 742,700 to404,242 in June 1945, and 55,349 at the end of the year, theater headquarterspersonnel was correspondingly reduced. Retrenchment embodied separationof the theater medical section from Allied Force Headquarters and its gradualabolition, with a transfer of its essential functions to the surgeon`soffice of Peninsular Base Section in Leghorn. Colonel Standlee, theatersurgeon, who succeeded General Stayer as theater surgeon in July, retainedresponsibility for the formation of all major policy until the completedissolution of his medical section. Certain specialized elements, suchas the consultants sections, were discontinued. By October, when theaterheadquarters was formally separated from Allied Force Headquarters, thetransfer of essential medical functions and elements of the office to Leghornhad been largely accomplished. British and American medical personnel whohad previously functioned at the Allied headquarters level were now assignedexclusively to their respective American (Mediterranean theater of operations)and British (Central Mediterranean Force) headquarters organizations. Whenthe theater medical section was disbanded on 10 November, the surgeon`soffice of Peninsular Base Section assumed full control of all theater medicalfunctions.45
At the end of 1945 and during 1946, most of the few remaining medicalinstallations and units were clustered around Leghorn and Naples. The PeninsularBase Section surgeon acted as both base section surgeon and theater surgeon.In the spring of 1947, after Peninsular Base Section was disbanded, theremaining medical responsibility in the theater was vested in the surgeonof the Port of Leghorn, where most remaining U.S. Army installations andactivities were concentrated. Before the end of the year, all medical installationswere inactivated or turned over to other commands, and in December 1947,with the departure of the last U.S. Army troops from Italy, the Medi-terraneantheater was disbanded.46
As the experience in the Mediterranean theater indicates, the organizationof medical service in a theater of operations was largely determined bythe theater organization, by the changes in its structure, and by the functionsand scope of responsibility of the various commands in the theater. Allthese, in turn, derived largely from the shifting tactical situation, whichcaused the swift creation of many new commands, the abolition of old ones,and rapid revisions in the structure, location, and jurisdiction of othersin accord with their increasing or declining importance. A medical officewas established in the headquarters of any newly created command, tookthe same relative place in theater structure as the headquarters, movedwith its headquarters or was split into groups to accompany moving echelonsof the headquarters, usually varied in size with the strength of the command,and died with the abolition of
45(1) See footnote 6 (2) and (5), p. 250. (2)Strength of the Army, 1 Feb. 1946.
46(1) Phase-out Report of Evacuation of Italy, MediterraneanTheater of Operations, Commanding General, MTOUSA, to Chief of Staff, 3Dec. 1947. (2) See footnote 6(5), p. 250. (3) Summary of Supply Activitiesin the Mediterranean Theater of Operations, 30 September 1945. [Officialrecord.]
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the command or its headquarters. Certain geographic, social, economic,and political factors also indirectly influenced the administration ofmedical service through the effect which they had upon Army command structurein the area. The organization to cope with certain special problems-suchas disease problems of theaterwide scope and the public health programfor occupied areas developed in part according to standard plans drawnup in the United States by the War Department and the Surgeon General`sOffice.
As the Mediterranean theater developed out of a large-scale invasion,the chronologic order of developments in medical administration differedfrom that in other theaters. In the European theater and Southwest PacificArea in particular, as well as in some other areas, the medical servicefor a communications zone (including fixed hospitals, medical supply depots,and other medical installations used in a communications zone) was builtup many months before the major combat period. In contrast with the situationin the South-West Pacific Area and the European theater, medical planningfor the invasion of North Africa was done in the United States and in anothertheater-the European theater-and base section medical service was builtup only in the wake of the advancing troops.
In one respect, the organization of medical service in the Mediterraneanarea varied markedly from the standard pattern taught in the manuals. Thefunctions of the staff medical section of the theater`s Services of Supplyduring the year February 1943 to February 1944-a period including its combatoperations in Tunisia and Sicily and the early stages of the Italian campaign-wererestricted to those concerning medical supply. Neither the concepts onwhich the Services of Supply in the United States had been reared nor thestandard doctrine for organizing a theater Services of Supply prevailedduring this period. In other theaters, organized according to the doctrine,the Services of Supply medical section and the surgeons` offices of itsarea commands (advance, intermediate, and base sections) administered thesystem of fixed hospitals and the movements of evacuees within the communicationszone. The retention of responsibility for evacuation and hospitalizationat Headquarters, NATOUSA, meant that for about a year in the North Africantheater evacuation. and hospitalization were handled by a single agencyas a continuous operation throughout both the combat and communicationszones; that is, from front to rear.
A unique feature of medical administration, which prevailed throughoutthe theater`s existence, was the development of a fairly complete Americanmedical section at the Allied headquarters and the dual assignment of oneofficer as chief American medical representative at that headquarters andas theater surgeon. This position of the theater medical section and thetheater surgeon in the Mediterranean theater appears to have been to theliking of Medical Department personnel there. The lack of adverse commentamong senior medical officers in key command or staff assignments withinthe theater with regard to the command system under which they operated,by compar-
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ison with the many criticisms recorded by surgeons and observers insome other theaters, shows a more general satisfaction with the organizationof medical service within theater structure in the Mediterranean area thanelsewhere. Nevertheless, the situation whereby the American theater medicalsection could operate from the level of the top command-Allied Force Headquarters-wasnever repeated in the other theaters, since the American theater headquartersand the Allied headquarters were never similarly combined elsewhere.
