CHAPTER VIII
The European Theater of Operations
The bulk of U.S. Army forces employed in World War II were concentratedin the United Kingdom for invasion of the European Continent. The cross-channelassault of June 1944 was followed by the establishment and buildup of amain lodgment area, and finally the breakthrough, advance to the east,and subjugation of the enemy. In combat on the Continent large armies andair forces operated over an extensive, relatively unbroken land mass. Asthis was the type of warfare contemplated in prewar planning, organizationof the European theater accorded rather closely with Army doctrine.
At the time of the German surrender, 61 American divisions- two-thirdsof the U.S. Army ground troop strength employed throughout the world duringWorld War II- were in Europe; during the months before the surrender thetotal Army strength in the theater, including service and air as well asground troops, reached over 3 million. The concentration of troops in Europe,compared with the situation in theaters of vaster extent, made it possibleto use Medical Department officers, enlisted men, units, and installationsto better advantage than in areas of greater troop dispersion. Nevertheless,because of the magnitude of the operation, theater organization grew highlycomplex. A large number of higher headquarters with medical administrativeoffices sprang up, but liaison among staff surgeons remained physicallyeasy because of their close proximity. Indeed it was often possible tosave administrative personnel by the employment of a single officer forsimilar staff positions at two or more headquarters.
THE BEGINNINGS
A few Army medical officers, together with medical men of the Navy andthe U.S. Public Health Service, were sent to Great Britain in 1940 to observethe British medicomilitary effort. One of the Army officers- Col. (laterBrig. Gen.) Raymond W. Bliss, MC- reported briefly on certain phases ofBritish medical experience during the Battle of Britain; the handling ofair-raid casualties; the organization of the Emergency Medical Service,the central authority which directed the hospital, ambulance, and firstaid service for both British fighting forces and civilians; medical andpsychological hazards of aviators, and so forth. When the United Statesand Great Britain reached an agreement for continued collaboration throughan exchange of missions, a representative of the Medical Department, Maj.(later Col.) Arthur B. Welsh, MC, went to England with the Army`s SpecialObservers Group.
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Major Welsh represented the Army Medical Department on the mission fromMay until September 1941. Like the other members of the mission, he workeddirectly with the British services corresponding to his own and continuedto inform the Surgeon General`s Office on British experience. After inspectionof areas likely to be occupied by American troops, he made recommendationsas to the location of, and suitable specifications for, U.S. Army hospitals.He estimated the medical facilities, personnel, and supplies which wouldbe needed if American troops were stationed in the British Isles and discussedwith British representatives their requirements for lend-lease medicalsupplies from the United States.
Col. (later Maj. Gen.) Paul R. Hawley, MC, became the medical representativeon the Special Observers Group in the fall of 1941. Colonel Hawley hadseen service in France as the sanitary inspector of Intermediate Section,Services of Supply, in World War I. He had served as chief of the medicalservice at Fort Riley Station Hospital, Kans., and had held various assignmentsat the Army Medical School in Washington, D.C., and the Medical Field ServiceSchool at Carlisle Barracks, Pa. His work with the Special Observers Groupbridged the transition from the emergency period to the entry of the UnitedStates into war.1
When the USAFBI (U.S. Army Forces in the British Isles) was createdin January 1942 as the top U.S. Army command in the area, the officersof the Special Observers Group were made staff officers of the command.As a member of the special staff, USAFBI, Colonel Hawley served under Maj.Gen. James E. Chaney, who was responsible (through General Headquartersin Washington) to the Chief of Staff, U.S. Army. The U.S. Army Forces inthe British Isles endured until mid-1942, when ETOUSA (European Theaterof Operations, U.S. Army) was Organized.2
Throughout this 6-month period the problems which the Surgeon, USAFBI,encountered in administering medical service for U.S. Army troops in theBritish Isles were largely typical of those f aced by the entire headquartersstaff during the first months after the United States entered the war.The status, mission, and organization of the theater were still not fullydetermined or generally understood; key assignments were temporary andchanging and staff-trained officers were insufficient in number. The tokenforce of 3,000 troops increased to over 54,000 by mid-1942. Colonel Hawleyand his small staff-until late April he had in his office only three officers,all young and inexperienced Reserves-were chiefly occupied with inspectingareas where
1(1) Parran, T. : Medicine in England Now.Ann. Int. Med. 14: 2184-2188, 1940-41. (2) Bliss, R. W.: Compiled Reportsof G-2 From Medical Observer, October-December 1940. [Official record.](3) Special Observers Group General Orders, 19 May 1941-8 Jan. 1942. (4)Thurman, S. J., and others : The Special Observers Group Prior to Reactivationof the European Theater of Operations, October 1944. [Official record.](5) U.S.-British Staff Conversations Report, 27 Mar. 1941, in 79th Cong.,1st sess., Hearings of the Joint Committee on the Investigation of thePearl Harbor Attack, pt. 15, exhibit 49.
2 Rupperthal, Roland G. : The European Theater of Operations:Logistical Support of the Armies. United States Army in World War II. Washington:U.S. Government Printing Office, 1953, vol. I.
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troops were to be stationed, arranging for their immediate care in Britishhospitals, and negotiating with British civil and military authoritiesfor the construction of hospital facilities under reverse lend-lease agreements.
Responsibilities were somewhat clarified in the spring of 1942; theactivation of subordinate commands relieved the USAFBI medical sectionof some of the duties connected with the reception of the first troops.The staff surgeon of the U.S. Army Northern Ireland Forces, which was establishedin January 1942 to include V Corps (the first contingent of U.S. Army forcesin the theater), was responsible for the medical service, including medicalfunctions normally assigned to a base command, for Army ground troops innorthern Ireland. Col. (later Maj. Gen.) Malcolm C. Grow, MC (fig. 70),became staff surgeon for the Eighth Air Force which was built up afterMay 1942. (The Eighth Bomber Command had preceded it in February.) Assumptionof responsibility for the medical care of tactical elements by these surgeonsenabled Colonel Hawley to spend more time in the medical aspects of long-rangeplanning for the buildup of men and supplies in the British Isles (WarPlan BOLERO) and in planning for the invasion of the Continent (War PlanROUNDUP). The increase of his group to eight officers by the middle ofMay enabled him to staff six of the nine divisions he had planned for hisoffice. From the spring of 1942 to the end of the year (6 months afterthe organization of the theater took place), he continued to press theSurgeon General`s Office to send him additional officers with administrativetraining and experience. Himself a graduate both of the Command and GeneralStaff School at
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Fort Leavenworth and the Army War College, Colonel Hawley emphasizedhis need for officers with training at senior service schools. 3
THEATER MEDICAL ORGANIZATION JUNE 1942-JANUARY 1944
After Maj. Gen. (later Lt. Gen.) John C. H. Lee arrived in England inMay with a Services of Supply staff, the theater organization began totake shape. When the chiefs of services of the U.S. Army Forces in theBritish Isles were called on to comment on the organization proposed byGeneral Somervell`s staff in Washington, Colonel Hawley advised againstany subordination of the chief of medical service of the theater to a.Services of Supply. He voiced his belief that theater organization shouldprovide for a unified and centralized technical control of medical servicethroughout the theater. He especially emphasized the importance of vestinga single chief of medical service with the following responsibilities:Technical supervision of the operations and training of medical units andpersonnel; coordination of evacuation among several echelons of command;control of the technical aspects of communicable diseases in all echelonsof command and responsibility for requiring, consolidating, and forwardingall medical records and reports. Centralized control over the operationsand training of personnel and over the coordination of the stages in evacuationwas necessary, he argued, because evacuation and medical care of the sickand wounded was a continuous operation. As a corollary, central responsibilityfor planning the steps in the process and the means of execution was alsonecessary. With respect to disease control Colonel Hawley pointed out thatcommunicable diseases recognized no echelons of command and that the responsibilityfor establishing uniform technical standards and a coordinated organizationto carry them out should rest with a single chief of medical service. Healso considered it important that the theater chief of medical servicehave sole responsibility for liaison with the British in connection withthe care of the sick of all U.S. Army commands; otherwise the British wouldbe confused by the overlapping U.S. Army commands within the same areaand Army surgeons might bid against each other for the same British facilities.
Although, like the chiefs of the other services, Colonel Hawley consideredlocation of his office at theater headquarters advisable, he emphasizedthat his chief concern was not with the physical location of his office-whether at
3 (1) General Order No. 3, Headquarters, U.S.Army Forces in the British Isles, 24 Jan. 1942. (2) Memorandum, Chief Surgeon,U.S. Army Forces in the British Isles, for G-1, 17 Apr. 1942, subject:Plan for Base Area. (3) General Order No. 5, Headquarters, U.S. Army Forcesin the British Isles, 24 Jan. 1942. (4) [Elliot, Henry G.]: Administrativeand Logistical History of the European Theater of Operations, Part I, thePredecessor Commands: BPOBS and USAFBI [Official record in Office of theChief of Military History.] (5) Annual Report of Medical Department Activities,Eighth Air Force, 1942. (6) Letter, Col. Paul R. Hawley, to Chief Surgeon,General Headquarters, 19 Apr. 1942.(7) Letter, Colonel Hawley, to Col.George F. Lull, 28 Aug. 1942.
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Services of Supply or theater headquarters- but that he considered itimperative that the chief of medical service exercise control over certainessential functions. He pointed out that if he were to be located withinthe Services of Supply he could exercise these functions properly onlyif the commanding general of the Services of Supply was given clear authorityto issue orders or directives to the commanders of other subordinate commandsin the theater otherwise he (Colonel Hawley) would have no means of makingmedical directives effective within commands outside the Services of Supply.4
On 8 June 1942, the European theater command was established, supersedingthe U.S. Army Forces in the British Isles (map 3).5 Its chiefsub ordinate commands in 1942 and 1943 were V Corps, the Eighth Air Force,the Services of Supply, and, after the autumn of 1943, First Army, whichbe came the chief ground force command, absorbing V Corps. Medical Departmentpersonnel and units were assigned to all three elements-ground, air, andservice forces. Colonel Hawley became chief surgeon on the special staffof the theater commander. On 13 June he was instructed, along with thechiefs of most of the other services, to operate under Maj. Gen. John C.H. Lee, Commanding General, Services of Supply (which had been establishedon 24 May).6
In July 1942, Services of Supply headquarters was established at Cheltenham,Gloucestershire, about 100 miles northwest of theater headquarters in London.Colonel Hawley`s main office was moved to Cheltenham along with those ofthe other chiefs of supply services and remained there until March 1943.Since the Cheltenham location hindered contact of the chiefs of serviceWith the theater headquarters in London which they also served, each chiefof Service was given a representative at theater headquarters. Col. (laterBrig. Gen.) Charles B. Spruit, MC (fig. 71), the former chief of ColonelHawley`s Operations Division, was made Colonel Hawley`s representativeat General Eisenhower`s headquarters in London.
Colonel Hawley`s Office
At the time of the move to Cheltenham, Colonel Hawley`s office, wascomposed of 22 officers and 14 enlisted men. By the end of 1942 it consistedof 51 officers, 56 enlisted men, and 62 civilians, and practically allits major organ-
4 (1) -Memorandum, Chief Surgeon, U.S. ArmyForces in the British Isles, for the Adjutant General, 1 June 1942, subject:Comments on Draft of General Order Establishing the Services of Supply.(2) Memorandum, Colonel Hawley, for G-1, USAFBI, 8 June 1942, subject:Comments on "Directive for SOS, USAFBI." (3) [Coakley, RobertW]: Administrative and Logistical History of the European Theater of Operations,Part II, Organization and Command. [Official record in the Office of theChief of Military History.]
5 Although Iceland was included in the European theater at thisdate, administrative and logistic matters, including medical service, fortroops there were handled by the Iceland Base Command, which operated directlyunder the War Department.
6 (1) General Order No. 2, Headquarters, European Theater ofOperations, U.S. Army, 8 June 1942. (2) Circular No. 2, Headquarters, EuropeanTheater of Operations, 13 June 1942. (3) See footnote 4 (3).
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Map 3.- Territorial limits of the Europeantheater, 1942-45
izational segments had been established, although they later underwentrefinements in structure.7
The work of the Administrative, Personnel, and Medical Records Divisionsof the office are self-explanatory. The Operations Division had chargeof the movements of Medical Department units, made medical plans, and supervisedmedical training. It allocated medical units among the various commandsin the theater and assigned and staged units for the North African invasion.
7 (1) History of Medical Service, SOS, ETOUSA,From Inception to 31 December 1943. [Official record.] (2) Annual Report,Administrative Division, Office of the Chief Surgeon, European Theaterof Operations, 1942. (3) [Larkey, Sanford H.] : Administrative and LogisticalHistory of the Medical Service, Communications Zone, European Theater ofOperations. [Official record.] For a comparison of the organization andfunctions of General Hawley`s office at the end of December 1942 with thoseof May 1945, see appendix B, p. 562.
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After the drain of the North African venture had subsided, this divisionreassumed the task of planning medical support of the buildup in the BritishIsles, calculating the numbers of hospital beds needed in accordance withthe increases in troop strength planned for the theater and determiningthe, locations of Medical Department installations to suit changes in troopdensity in the various localities.
In carrying out its responsibilities for training, the Operations Divisioncreated the First Medical Demonstration Platoon which displayed throughoutthe theater the methods of training medical units. The division made arrangementsfor many Medical Department officers in the theater to attend courses inthe various medical specialties at British institutions- both the RoyalArmy schools for doctors and dentists at Aldershot, Hampshire, and at theLondon School of Hygiene and Tropical Medicine and other medical schools,as well as at British hospitals. It planned and supervised the trainingof doctors and nurses at two schools within the Army`s American SchoolCenter organized at Shrivenham, Berkshire, in February 1943. The MedicalField School emphasized courses in chemical warfare medicine, hygiene andsanitation, and combat medicine and surgery, while the Army Nurse Schooltrained nurses in the military aspects of their work. The Operations Divisionalso planned special courses for officers, and enlisted men in variousspecialties at selected general and station hospitals. Those who had beensent to the theater without sufficient training could make up the deficiencyin the United Kingdom, and those previously trained benefited from instructionin medical problems peculiar to the theater. Training during the long monthsof preparation for the invasion proved a morale builder.
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The planning of evacuation within the theater and to the United Stateswas also supervised by the Operations Division. (During part of the timethis function was exercised by the Hospitalization Division, and for atime by a separate Evacuation Division.) Even in the preinvasion periodthe evacuation system grew complex because of the number of commands concerned-naval elements assigned to the theater, as well as subcommands of the airforces and the Services of Supply- and the variety of means employed. Althoughthe theater`s ground troops were not suffering combat casualties duringthis period, the theater medical service had to evacuate and care for AirForce casualties, as well as for some of the wounded from the invasionof North Africa and the early months of the Tunisian campaign, broughtto the United Kingdom in British hospital ships.8
The duties of the Dental, Nursing, and Veterinary Divisions of ColonelHawley`s office were all concerned with supervision of their respectiveservices; training of personnel and control of their transfer among thebase sections, preparing the necessary reports, and maintaining liaisonwith similar elements in the British Army. The dental and veterinary servicesuffered from a lack of personnel in 1942, but the Army Nurse Corps grewrapidly, increasing from 359 nurses in the theater in July 1942 to 4,627by the end of 1943. A significant accomplishment of the Dental Divisionwas the creation of two central dental laboratories (nonstandard units)with mobile clinic and laboratory sections. One was located in London andthe other in Cheltenham. The continued concentration of troops, as wellas the availability of messenger and courier service for speeding up thetransfer of dental packages to and from the laboratories at London andCheltenham made these places the logical sites for centers of dental service.
Because of the tremendous troop strength of the theater and the overcrowdingto which it contributed, the Preventive Medicine Division had to undertakea comprehensive program. Its members made inquiries into conditions accountablefor the spread of certain diseases among troops at intervals: the respiratorydiseases in 1942 and 1943; the diarrheal diseases in 1943, and a few diseaseswhich did not commonly occur in the British Isles but which were sporadicallybrought in during the war period by troops from other areas. The chiefof these was malaria. Recurrent cases among divisions returning to theUnited Kingdom from North Africa had to be removed from the ranks beforetheir units embarked upon the continental invasion. Activities in preventivemedicine became decentralized, since many preventive tasks, such as themaintenance of sanitary conditions and the control of venereal disease,called for participation by local commands, including air force commands.The assignment of sanitary, venereal disease control, and nutrition officersto the base sections, as well as to Colonel Hawley`s office, constitutedan effective
8 The number of casualties evacuated to theUnited Kingdom from North Africa was relatively small- 481 between 1 Januaryand 31 March 1943- when the practice was discontinued, and no more thana handful in 1942. See Annual Report, Surgeon, North African Theater ofOperations, U.S. Army, 1943.
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network for prevention of disease. No widespread epidemics developedamong U.S. Army troops in the theater, with the exception of a mild influenzaepidemic of 1942-43. Since many diseases common to tropical areas werenot present in western Europe, a large-scale program for control of malariaand other insectborne diseases was unnecessary. On the other hand, morethan ordinary effort was needed to check the spread of venereal diseaseamong troops stationed in urban areas in the United Kingdom.
The Professional Services Division, which Colonel Hawley consideredthe keystone of his office, consisted of the consultants in surgery andmedicine and their subspecialties. Under the Director of Professional Servicesserved the chief consultant in surgery and the chief consultant in medicine.Senior consultants were appointed to certain surgical subspecialties- ophthalmology,neurosurgery, anesthesia, orthopedic surgery, and maxillofacial surgery-and to several medical subspecialties- psychiatry, dermatology, and nutrition.By the end of 1942, 10 consultants were on duty; during the following yearother consultants were assigned to additional medical subspecialties- cardiology,tuberculosis, and infectious disease- and to further surgical subspecialties-radiology, plastic surgery, otolaryngology, transfusion and shock, orthopedicsurgery, and general surgery. Consultants in Europe represented more specialtiesthan did the consultants of any other theater. The title "consultant"was also applied to those in charge of several special phases (rather thanspecialties) of medical work, including scientific research and medicalservice for the Women`s Army Auxiliary Corps.
During 1942 and 1943, the consultants of Colonel Hawley`s office visitedfixed hospitals in the base sections; after the invasion they toured MedicalDepartment units and hospitals in the combat zone. They evaluated the qualityof work of specialists in the hospitals, offering criticism and advisingchanges in techniques. They also evaluated the professional complementsof all newly arrived medical units, recommending transfers and substitutionsin the interest of an equitable distribution of all available talent. Theysupervised the work of consultants assigned to the headquarters of airforces, armies, and base sections. Particularly qualified specialists ingeneral and station hospitals were used as regional consultants (authorizedin May 1943) ; these served a group of hospitals in a hospital center orhospitals in the vicinity of the one to which they were assigned. Any hospitalin the United Kingdom, whether British, American, or Canadian, might employthe services of the appropriate consultant in the treatment of U.S. Armypersonnel hospitalized therein. Through the medium of a series of circularletters and manuals, the senior consultants in Colonel Hawley`s officeoutlined for medical officers in the hospitals and other medical facilitiestechniques of treatment found to be, of greatest value in the theater.During the long buildup period, the consultants had time to develop a manualof therapy (issued in May 1944), which gave instructions on the managementof all types of wounds. Although based in part on data assembled by consultantsin the North African theater and British Army doctors, the manual
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reflected on every page the specialized knowledge and experience ofits authors. Revisions in the original principles and techniques adoptedon the basis of combat experience on the European Continent after June1944 appeared ill revised circular letters.9
Officers of the Hospitalization Division were occupied throughout 1942and 1943 with providing hospital beds for troops pouring into the UnitedKingdom, inspecting hospitals in operation, and planning the design forhospital construction that might have to be undertaken on the Continent.The procurement of buildings for fixed hospitals in the United Kingdomand the establishment of an effective medical supply system, supervisedby the Supply Division of General Hawley`s office, were large tasks ofthe theater`s medical service which encountered serious administrativedifficulties in 1942 and 1943.
Establishing Fixed U.S. Army Hospitals in the United Kingdom
Early requirements for the hospitalization of American troops in theUnited Kingdom were met through arrangements made for the care of U.S.Army patients in British military hospitals, in hospitals of the EmergencyMedical Service, and in two hospitals staffed by American doctors who hadvolunteered their services to the British Government before the entry ofthe United States into war. The heavy task was to obtain in crowded Britainbuildings to accommodate incoming fixed hospital units and to provide sufficientbeds for military patients once the attack on the Continent began. Themachinery through which U.S. Army requirements for hospitalization couldbe established, sites chosen for construction, and satisfactory constructioncompleted, was elaborate. The Chief Surgeon, ETOUSA, served on the MedicalService Sub-Committee of the BOLERO Combined Committee in London whichwas responsible for planning the buildup of 1 million U.S. Army troopsand the necessary facilities and supplies for supporting the assault onthe Continent. Medical officers of the British and Canadian armed servicesand representatives of the British governmental health agencies were fellowmembers. General Hawley submitted the requirements for hospital facilitiesfor these troops as worked out in his office.
The British turned over to the U.S. Army Medical Department a few hospitalplants constructed for the Emergency Medical Service, but large-scale constructionwas undertaken to meet the requirements for 90,000 hospital beds calledfor under the BOLERO plan. The British Government assumed re-
9 (1) See footnote 7 (1) and (3), p. 308. (2)Hawley, P. R.: Advances in War Medicine and Surgery as Demonstrated inthe European Theater of Operations. M. Ann. District of Columbia 15: 99-109,March 1946. (3) Report on Schools and Courses of Instruction for Personnelin the European Theater of Operations. Office of the Chief Surgeon, Servicesof Supply, European Theater of Opera-tions, U.S. Army, 12 Feb. 1944. (4)Memorandum, Brig. Gen. Paul R. Hawley, for G-3, European Theater of Operations,U.S. Army, 13 July 1943, subject: Continuance of the Medical Field ServiceSchool at the American School Center. (5) Gordon, John E.: A History ofthe Preventive Medicine Division in the European Theater of Operations,U.S. Army, 1941-1945, vol I. [Official record.] (6) Memorandum, Col. H.T. Wickert, for The Surgeon General, 29 Nov. 1943, subject: Report of Visitto U.K. and N. Africa.
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sponsibility for constructing the necessary hospitals, largely becauseshortage of shipping space made it impracticable to bring materials andlabor from the United States for the purpose. The British Ministry of Worksand Planning directed British civilian contractors in the work. Officersof the Hospitalization Division of General Hawley`s office worked closelywith the British and the U.S. Army Engineers, who furnished some trooplabor for the construction and acted as agents for the medical servicewith the British War Office. The Royal Engineers placed requests with theWar Office, which requested the Ministry of Works and Planning to undertakethe construction of buildings approved by the American theater commandand the War Office. The Royal Engineer Corps inspected the completed projectand accepted it or turned it down on behalf of the War Office. GeneralHawley could accept the project or defer acceptance until it was modifiedto meet his requirements.
It was hard to find general hospital sites which possessed all the desiredfeatures- adjacency to water, gas, and sewage facilities, and, in anticipationof mass evacuation from the Continent, accessibility to roads and railroads.The British lacked construction materials and suffered from an acute shortageof Skilled construction workers. Construction lagged throughout 1942 andthe early months of 1943. During 1942 no hospitals were completed on schedule,despite General Hawley`s repeated vigorous requests backed by General Lee,to the British representatives on the Medical Service Sub-Committee ofthe BOLERO Combined Committee that construction be speeded up. His pressure,together with aid in construction given by hospital unit personnel in thelater stages of the program, bore fruit. By the close of 1943, 58 fixedU.S. Army hospitals were operating in the United Kingdom- 17 general, 34station, 3 evacuation, and 4 field hospitals. The fixed hospitals in operationby mid-1944 were considered adequate to receive the expected load of evacueesfrom the continental invasion.10
The Medical Supply System
The Supply Division of General Hawley`s office established medical sectionsin five general depots in the United Kingdom during 1942, and in 1943 insix additional general depots, as well as four medical supply depots. Despitethis depot system of apparently adequate scope, a number of problems inthe handling of medical supply developed at the outset and continued toplague the Chief Surgeon, ETOUSA, until 1944. Some- the early shortagesof dental items, for instance- reflected difficulties with procurementin the United States. Others- unsatisfactory packaging and packing, incompleteor late shipments, and the shipment of hospital assemblies on two or moreships (the so-called "split shipments")- were attributable tofaulty procedure at depots and shipping points in the United States ratherthan within the theater. Dif-
10 (1) See footnote 7 (1) and (3), p. 308.(2) Memorandum, Maj. Gen. Paul R. Hawley, for Commanding General, Servicesof Supply, European Theater of Operations, U.S. Army, 13 Mar. 1944, (3)Hawley, Maj. Gen. Paul R.: The European Theater of Operations, May 1944.[Official record.]
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ficulties connected with shipment from the U.S. ports of embarkationcropped up throughout the buildup period and were straightened out onlyby the mutual efforts of General Hawley`s office and the TransportationCorps and its ports of embarkation in the United States. Faulty packingand split shipments later occurred in the United Kingdom as well, wheneverhospital assemblies which had been unpacked for inspection or for use fortraining within the theater had to be reassembled and forwarded to theirdestination. Furnishing assemblies for hospital units leaving for the NorthAfrican invasion placed heavy demands upon the theater`s medical supplysystem at an early date.11
In the United Kingdom the Medical Department relied heavily- far morethan in any other oversea area- upon the procurement of medical supplieslocally. Medical items were bought from the British through a representativeof the Chief Surgeon, ETOUSA, on the General Purchasing Board in London,which supervised the purchase of the U.S. Army supply services in the UnitedKingdom. The policy of making the maximum use of British supplies and serviceswas adopted from the outset because of the critical shipping situation,as well as the opportunity (mutually advantageous to the British and theAmericans) to make use of British obligations for furnishing the UnitedStates with supplies under the reverse lend-lease procedure. Items requiringa large amount of tonnage and a small amount of labor were procured fromthe British if possible.12
Medical supplies were also obtained from sources other than reverselend-lease- through spotty local purchases on the open market by officersin the depots, by requisitions from the United States, and by the automaticsupply procedure. (Some medical maintenance units and final reserve unitswent to the theater under the standard procedure.) The variety of sourcesmade it difficult to determine the availability of specific items or todevise an adequate system of stock control. Differences in British andAmerican nomenclature called for the preparation of lists of British itemswhich were equivalent to the standard items of the Medical Department SupplyCatalog, as well as lists of acceptable British substitutes. U.S. Armydoctors frequently preferred the American-made product to the unfamiliarBritish item. British shortages of raw materials, packing materials, andespecially of skilled workers resulted at times in inferior items, anddeliveries were delayed. At the same time the British obtained from theUnited States through lend-lease procedure some items which they were furnishingU.S. Army doctors in Britain.
11 See footnotes 2, p. 304; and 7 (3), P. 308.
12 (1) Annual Report, Medical Procurement Section, Supply Division,Office of the Surgeon, European Theater of Operations, U.S. Army, 1943.(2) See footnote 2, p. 304. (3) Memorandum, Acting Director, InternationalDivision, for Commanding General, Services of Supply, 8 May 1944, subject:Procurement of Medical Supplies and Equipment in the U.K. Under ReciprocalAid. During 1942 approximately 75 percent of all medical supplies, calculatedin tonnage, for the U.S. Army were procured in the United Kingdom, eitherby reverse lend-lease procedure or by local purchase. The percentage droppedto 56 in 1943 and to 24 in 1944.
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Throughout 1942 and 1943 the Chief Surgeon, ETOUSA, expressed doubtof the capabilities of the officers sent to take charge of medical supplyduties in his office and anxiety over the critical medical supply situation.At the close of 1943, the system of stock control was still inadequate,and the preparations for supporting the invasion with hospital assembliesand medical supplies were far behind schedule. General Hawley then obtainedspecial aid from the Surgeon General`s Office in order to establish a systemthat would furnish adequate support for the impending invasion.13
Cooperation With the Allies
The theater surgeon and his staff, as well as Medical Department officersthroughout the theater, had extensive dealings with members of the Britishand Canadian Army medical services- officers of the Royal Army MedicalCorps, the Royal Navy Medical Corps, Royal Air Force Medical Corps, andRoyal Canadian Army Medical Corps. A British Army medical officer servedas liaison officer with General Hawley`s medical section to the end ofthe war in order to facilitate contact between General Hawley`s staff andthat of the Director-General of the British Army Medical Service. U.S.Army Medical Department officers also had frequent contacts with BritishGovernment agencies engaged in medical work, chiefly the Emergency MedicalService and the Ministry of Health, and with the British professional associationsof doctors, dentists, and veterinarians. Meetings of U.S. Army MedicalDepartment officers with the British Medical Research Council affordedan exchange of information on recent technical developments in medicine.The British Medical Registry accepted officers of the U.S. Army MedicalCorps as members, as did the Royal Society of Medicine. An Inter-AlliedMedical Association was sponsored by the British Research Council and theRoyal Society of Medicine. During 1943 an exchange of medical officersbetween British and American hospitals for the period of a month affordedeach national group an opportunity to profit from the other`s techniques.14
During the buildup period, proposals to turn over certain medical resourcesto the British or to pool U.S. Army medical personnel or installationswith those of the British cropped up from time to time. A combined UnitedStates-British typhus commission was suggested at intervals. Although Gen-
13 (1) Letter, Brig. Gen. Paul R. Hawley, toMaj. Gen. Norman T. Kirk, The Surgeon General, 10 Aug. 1943. (2) Letter,Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General,9 Sept. 1943. (3) Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. NormanT. Kirk, The Surgeon General, 14 Oct. 1943. There are many similar lettersin the Kirk-Hawley file.
14 (1) Annual Report for 1942 and 1943 of the HospitalizationDivision, the Professional Services Division, the Supply Division, andthe Operations Division, Office of the Chief Surgeon, European Theaterof Operations, U.S. Army. (2) See footnote 7 (1) and (3), p. 308. (3) Mason,James B.; Medical Service in the European Theater of Operations, Through16 January 1944. [Official record.] (4) Circular Letter No. 57, Officeof the Chief Surgeon, Headquarters, European Theater of Operations, U.S.Army, 27 Oct. 1942, subject: British Medical Societies. (5) Circular LetterNo. 69, Office of the Chief Surgeon, Headquarters, European Theater ofOperations, U.S. Army, 9 Nov. 1942, subject: Consulting Service for theAmerican Forces.
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eral Hawley favored thoroughgoing exchange of technical medical informationand the results of research, he consistently opposed plans for poolingAmerican and British medical resources, holding that any merging of thetwo medical services would result in lowered standards for the U.S. Armymedical service. Pooling of American and British doctors, for instance,would mean that the British, short of doctors, would obtain an increasein the number of doctors per thousand patients while the U.S. Army wouldsuffer a corresponding reduction. Although no merging took place, the agreementmade with the Emergency Medical Service for reciprocal care of sick andinjured American and British troops prevailed after U.S. Army hospitalshad become available, and the British and American army medical servicescared for substantial numbers of each other`s patients in their respectivehospitals.15
Liaison between U.S. Army doctors and the medical authorities of mostcontinental countries had to await the invasion, but some contact was establishedwith the Russians in June 1943, when the senior surgical consultant ofthe theater surgeon`s office, Col. Elliott C. Cutler, MC (fig. 72), andLt. Col. Loyal Davis, MC, consultant in neurosurgery, accompanied a Britishmedical mission to the Soviet Union. The purpose of the mission was toget information on the medicomilitary experience of the Russians in combatwith the Germans and to establish good relations with Red Army doctors.They took 2 million units of the then scarce penicillin to the Soviet medicalauthorities as a gift. The British conferred honorary fellowships on adistinguished Russian surgeon and the chief surgeon of the Red Army, whilethe American delegation accorded them honorary membership in the leadingsurgical societies of the United States. Both American medical officerswere impressed with the efficient organization of the Red Army medicalservice.16
Base Sections in the United Kingdom: 1942-43
The Services of Supply undertook, beginning in July and August 1942,to establish its area commands, the base sections. To the end of 1943,the logistic organization of the European theater followed fairly closelythe principles on which the Services of Supply had been established inthe United States. The corps areas (later called service commands) in theUnited States were taken as models for the base sections in the UnitedKingdom and like
15 Memorandum, Maj. Gen. Paul R. Hawley, forCommanding General, Services of Supply, 13 Mar. 1944.
16 (1) Report by Col. Elliott Cutler, Supplement to Notes onStaff Conference, 25 Oct. 1943. In Annual Report, Professional ServicesDivision, Office of the Chief Surgeon, European Theater of Operations,U.S. Army, 1944. (2) Report of Surgical Mission to Russia. [Official record.](3) Letter, Brig. Gen. Paul R. Hawley, to Lt. Gen. E. I. Smirnov, Chiefof Medical Services of the Red Army, 30 June 1943. (4) Letter, Lt. Gen.E. I. Smirnov, to Brig. Gen. Paul R. Hawley, 30 July 1943. (5) Davis, L.:Organization of the Red Army Medical Corps (Editorial). Surg., Gynec. &Obst. Vol. 79, September 1944.
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them were conceived of as smaller replicas of the parent organizationdesigned to perform its functions in a given geographic area.17
As was the case with the chiefs of technical services in the UnitedStates, the chiefs of service of the European theater had somewhat tightercontrol over operations within the area commands during the early developmentof these commands than at a later date. Since the Commanding General, SOS,ETOUSA (General Lee), placed emphasis, as did General Somervell in theUnited States, upon decentralizing operations to the area commands, during1943 base section commanders were given control of Services of Supply operationswithin their areas. By August the duties of chiefs of service with respectto operations in the base sections were confined to technical supervision,maintained through their service representatives on the base section staffs.Hence the base section commander was given command control over the fixedhospitals within the boundaries of his base section and control over theassignments of Medical Department personnel within the base section organization.
17 (1) Memorandum, Chief of Staff, War Department,for Commanding General, American Forces in the British Isles, 11 May 1942,subject Organization, Services of Supply. (2) See footnotes 2, p. 304 ;and 4 (3), p. 307.
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General Hawley exercised supervision, in his capacity as Services ofSupply surgeon, over technical matters in each base section through thesurgeon on the staff of the base section commander.
As in the case of the other chiefs of the technical services, GeneralHawley found that the power given base section commanders interfered attimes with his control over medical service afforded by base section installations.In his opinion general hospitals, which served the theater as a whole (incontrast to station hospitals which served merely the local area in whichthey were located), should be under the command of the chief surgeon. "Ifwe get any sudden influx of casualties here, we have got to play with bedslike you play with chessmen on a board, and this ought to be handled byone central agency."18 His reasoning was similar to thatadvanced for control of general hospitals in the United States by The SurgeonGeneral, but like the latter he failed to effect a change of jurisdiction.
However, cooperative agreements were usually worked out. When GeneralLee sent General Hawley to look into conditions in the general hospitalsof a base section and General Hawley reminded General Lee that he did nothave command of the hospitals, General Lee promised him the base sectioncommander`s full support. From then on General Hawley had General Lee`sfull backing in solving any problems arising from base section controlof certain functions. He and his staff made frequent inspections of hospitals,dispensaries, and other medical installations in the base sections, informingcommanding officers of the installations, or base section surgeons, ofany deficiencies. General Hawley cooperated closely with base section commandersin replacing base section surgeons or hospital commanders who proved inefficient.On the other hand, he noted some decisions of base section commanders whichinterfered with his ability to render the best possible medical care- forexample, the decision to replace with ordinary port laborers crews of MedicalDepartment enlisted men especially trained in loading and unloading evacueesfrom hospital ships. He also objected to a tendency of base section commandersto burden hospital staffs with military police duties. At such times hereemphasized his conviction that the control of certain functions shouldnot be decentralized to base section commanders.19
The relation of the base section surgeons in the European theater tothe Chief Surgeon in his Services of Supply capacity in general paralleledthe relation of the corps area surgeon in the United States to The SurgeonGeneral, and the duties of base section surgeons broadly resembled thoseof corps area surgeons. The internal organization of the base section surgeon`soffice
18 Notes on Staff Conference, Headquarters,Services of Supply, European Theater of Operations, U.S. Army, no date.
19 (1) Interview, Maj. Gen. Paul R. Hawley, 18 Apr. 1950. (2)Correspondence between Brig. Gen. Paul R. Hawley, the Director-Generalof the British Army Medical Service, and the Chief of Operations, Servicesof Supply, 21 Nov.-7 Dec. 1943. (8) Memorandum, Brig. Gen. Paul R. Hawley,for the Chief of Ordnance Officer, I Oct. 1942. (4) Memorandum, Brig. Gen.Paul R. Hawley, for the Chief of Operations, Services of Supply, 26 Nov.1943. (5) Memorandum, Brig. Gen. Paul R. Hawley, for Maj. Gen. J. C. H.Lee, 8 Apr. 1943.
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did not differ greatly from that of the theater surgeon`s office, althoughthe latter had considerably more personnel.
The base sections in the United Kingdom underwent several changes inname and boundary during 1942 and 1943. Though small in area by comparisonwith those of some other theaters, they were large in numbers of troopsand installations. By the close of 1943 five were in operation, with boundarylines for the most part in correspondence with the existing British territorialcommands (map 4). This design facilitated cooperation between staff surgeonsof the base sections and their British counterparts. The fixed hospitals,medical supply depots, and, other Medical Department facilities operatedby each base section served a composite of air, ground, and service troops.Districts- each with a surgeon- were established within each base section,functioning in relation to the base sections as the latter did to the Servicesof Supply headquarters.20
The duties of the base section surgeons and their staffs varied in accordancewith the type and number of troops for whose care the base section commandwas responsible and with the kind of activity- training, staging, supply,and so forth- that burgeoned within the base section`s boundaries. TheArmy`s area commands in the United Kingdom diverged greatly as to troop,strength, and the troop census of each underwent radical fluctuations.The Northern Ireland Base Section, earliest established, had the task ofreceiving and processing troops from the United States on their way tothe North African invasion. During the early part of 1943 relatively fewtroops, chiefly of the Eighth Air Force, were stationed there and the areabecame a district of Western Base Section, but late in 1943, when moretroops began pouring in, a full-fledged base section was reestablishedin Northern Ireland. In Eastern Base Section the hospitalization, medicalsupply, and preventive medicine service furnished went largely to the benefitof air force troops concentrated in that area for large-scale bombing ofNazi-held targets on the Continent. Center Base Section (previously knownas the London Base Command) operated installations and facilities withinabout 700 square miles in the London area to serve the thousands of mencongregated there, a large proportion of whom belonged to several largeheadquarters establishments (particularly ETOUSA-SOS). Its dispensariesand subdispensaries and a station hospital in London served American civiliansand Navy personnel, as well as resident Army troops and thousands of soldierson leave.
In 1943 the Western and Southern Base Sections became the chief scenesof Medical Department activity. The great majority of the station and generalhospitals which began operating in the United Kingdom in that year werelocated in these two base sections. Western Base Section contained mostof the large ports through which thousands of incoming troops passed. Theestablishment of many dispensaries in the base section called for decentraliza-
20 See footnotes 4 (3), p. 307; and 14 (4),p. 315.
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Map 4.- United Kingdom base sectionsand surgeons` offices, December 1943
tion of supply procedures, and small distributing points, strategicallyplaced, took some of the burden from the depots. The medical service providedby Western Base Section became full fledged, comprising strong programsin control of venereal disease, nutrition, rehabilitation, and sanitaryengineering, as well as the usual supply, hospitalization, dental, nursing,and veterinary func-
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tions. Southern Base Section, which became the great marshaling andtraining area for the continental invasion dating from the spring of 1943,developed a large-scale medical service comparable to that of Western BaseSection.21
Effect of the North African Invasion
The long-range buildup in the European theater was subordinated duringthe late summer and fall of 1942 to plans for the invasion of North Africa.Key personnel were withdrawn from established American and British commandsin the United Kingdom to serve on the staff of General Eisenhower`s newAllied Force Headquarters, which planned the assault on North Africa anddirected the flow of supplies and tactical units from the European theaterin support of the invasion.
General Hawley summed up the effect of the plans for the North Africaninvasion upon his office as follows:
You may be amazed to learn that the general and specialstaff of the European Theater of Operations has, and has had, no responsibilityfor the North African show other than to give them all the personnel andall the supplies they asked for. This is an Allied Force, and a specialstaff was set up for it, which included both British and American officers.The Chief Surgeon is British and Jack Corby is the Deputy Chief Surgeon.They took from me about all the supplies I had, two 1,000-bed general hospitals,one 750-bed station hospital, four 250-bed station hospitals, and the followingpersonnel from my office: Corby, Standlee, Norton, Hutter, and two youngregulars, in addition to several reserve officers.
I watched the muddled medical planning until I could standit no longer and then went to the Chief of Staff, ETO and told him thatthe stage was all set for the biggest scandal since the Spanish-AmericanWar. That jolted them a little, and General Eisenhower told me to stepin and straighten things out. I did, but within a week things were rightback to where they were- each separate task force doing its own planningwithout the least coordination. It is for this reason that no consultantshave been sent to North Africa although I stand ready to send all of themback and forth as soon as I am brought into the picture.22
His picture of the situation reflects the uncertainty that prevailedduring the planning period in the late months of 1942 as to whether- andwhen- the invaded areas of North Africa would become a new theater separatefrom the European theater. Throughout this period the relationship of theEuropean theater command to the Allied organization directing the NorthAfrican operation was by no means clear. Definite clarification came onlyin early February 1943 with the creation of the North African Theater ofOperations. During the intervening months the European theater was usedas a "zone of interior" for building up army resources in NorthAfrica. Its troop strength was cut
21 (1) Annual Reports, Surgeon, Northern IrelandBase Section, 1943, 1944. (2) Annual Report, Surgeon, Center Base Section,1944. (3) Annual Reports, Surgeon, Eastern Base Section, 1942, 1943. (4)Annual Reports, Surgeon, Western Base Section, 1942, 1943, 1944. (5) AnnualReports, Surgeon, Southern Base Section, 1942, 1943.
22 Letter, Brig. Gen. Paul R. Hawley, to Col. Charles C. Hillman,Office of The Surgeon General, 11 Dec. 1942.
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in half, and its medical strength reduced by a third.23 Althoughthe loss to the Medical Department was thus relatively low, the removalof key personnel made it necessary for General Hawley to rebuild his officestaff, and shifts of Medical Department personnel and installations resultedat all levels of command.
The Reorganization of 1943 and Later Developments
During the months following the North African invasion, the theaterand Services of Supply headquarters reviewed their organizational problems,particularly difficulties posed by the location of theater chiefs of technicalservices at a distance from theater headquarters. Since 20 July 1942, GeneralHawley and most of his office had been located with the bulk of the Servicesof Supply Staff at its Cheltenham headquarters. General Hawley had hadto go to London frequently to consult with the theater general staff ontheaterwide medical problems. Only a few Medical Department. officers hadremained in London in close proximity to the theater staff.
As Colonel Spruit, General Hawley`s representative at theater headquarters,was always very loyal to his chief, no such situation had developed inthe administration of medical service as in that of some other technicalservices in the theater, where there was a tendency for the senior representativesat theater headquarters to develop their own organizations and to encroachon the functions of the Services of Supply, but all the chiefs of technicalservices had found their separation from the theater general staff inconvenientand conducive to delay.24
In November 1942, General Hawley proposed that his office be moved backto London and that a subsection be left with Headquarters, Services ofSupply, in Cheltenham to handle functions relating to procurement, supply,operation of facilities, and the maintenance of records. He was supportedby a representative of G-3, who pointed out that General Hawley was notavailable to the theater commander for consultation on matters of planningand for coordinating U.S. Army medical service with British agencies. Delegationof these matters to General Hawley`s London office was not satisfactorysince a good many of them had to be referred to General Hawley in person,in Cheltenham, for final decision.25
Although this proposal was not approved for the medical service separately,in March 1943 (soon after the North African theater was divorced from theEuropean theater and Lt. Gen. Frank M. Andrews succeeded General
23 Between 31 October 1942, just prior to theNorth African invasion, and the end of February 1943, the troop strengthof the European theater dropped from 223,794 to 104,510. Medical Departmentstrength in the same period declined from 15,792 to 10,333. See MedicalDepartment, United States Army. Personnel in World War II. [In press.]
24 (1) Interview, Brig. Gen. Charles B. Spruit, MC, AUS (Ret.),20 May 1949. (2) See footnote 2, p. 304.
25 (1) Memorandum, Chief Surgeon, European Theater of Operations,U.S. Army, for Chief of Staff, European Theater of Operations, U.S. Army,30 Nov. 1942. (2) Memorandum, Assistant Chief of Staff, G-3, European Theaterof Operations, U.S. Army, for Chief of Staff, European Theater of Operations,U.S. Army, 30 Nov. 1942.(3) See footnote 4(3), p. 307.
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Eisenhower as European theater commander) a Services of Supply planningechelon was established in London. The chiefs of service placed their basicplanning divisions there. After May, when Lt. Gen. Jacob L. Devers becametheater commander, the chiefs of service, including General Hawley, servedin their Services of Supply capacity, immediately under a Chief of Services(later renamed Chief of Operations) of the Services of Supply. GeneralHawley`s operational staff (the bulk of his office personnel) remainedin Cheltenham, while the planning staff was located in London so as tobe available to the theater commander and general staff at all times. Representativesof the services at Headquarters, ETOUSA, were removed as they were no longernecessary (chart 18).
General Hawley`s Cheltenham office was charged with supervising theServices of Supply medical service and with compiling and evaluating dataneeded for planning. The London office was responsible for the actual preparationof plans, for formulating policy, and administering and giving technicalsupervision to the medical service of the theater as a whole. Colonel Spruit,the former special London representative of General Hawley, was made deputyin charge of the Cheltenham office, and Col. Oramel H. Stanley, MC (fig.73), was brought from Cheltenham to head the planning echelon in London.Under the new scheme General Hawley`s own station was London, but he stillspent some time in Cheltenham supervising that branch of his office.26
During the early months of 1943, the medical section (including bothoffices) increased in size only slightly, but with the rapid increase introop strength after the end of May 1943 it expanded markedly. By Decemberofficers numbered 115, the enlisted strength came to 234, and the numberof civilians reached 120. In November, a year after the invasion of NorthAfrica, the theater`s troop strength amounted to 638,112 men (comparedwith 584,596 in the North African theater) and was to go on increasinguntil the great concentration of troops for the cross-channel invasionhad been assembled. The year 1943 saw Medical Department personnel in thetheater increase sixfold, the expansion generally paralleling the growthof theater strength.27
The Ground Forces: 1942-43
Both ground and air force commands building up in the United Kingdomreceived their technical medical instructions from the office of the ChiefSur-
26 (1) General Order No. 16, Headquarters,European Theater of Operations, U.S. Army, 21 Mar. 1943. (2) General OrderNo. 17, Headquarters, European Theater of Operations, U.S. Army, 25 Mar.1943. (3) Circular No. 63, Headquarters, Services of Supply, European Theaterof Operations, U.S. Army, 23 Nov. 1943. (4) Office Order No. 1, corrected,Office of the Chief Surgeon, Services of Supply, European Theater of Operations,U.S. Army, 31 May 1943. (5) General Order No. 25, Headquarters, Servicesof Supply, European Theater of Operations, U.S. Army, 12 Apr. 1943. (6)Annual Report, Administrative Division, Office of the Chief Surgeon, EuropeanTheater of Operations, U.S. Army, 1943. (7) See footnotes 4(3), p. 307;and 7(l), p. 308.
27 (1) See footnotes 7 (1), p. 308 ; and 23, p. 322. (2) Strengthof the Army, 1 Nov. 1947, p. 42. Theater strength at the end of December1943 was 773,753, and Medical Department strength was 65,876.
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Chart 18.- Theater-SOS surgeon`s officeafter reorganization of March 1943
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geon, ETOUSA. In 1942 and 1943, the chief ground force command in thetheater was V Corps, known interchangeably during the early period as theU.S. Army Northern Ireland Force; the; positions of "force" surgeonand Corps surgeon were held by the same man. The personnel of the medicalsection were divided into two groups to meet the needs of both corps and"force," the "force" group carrying the bulk of responsibility.By late June, when administrative functions were completely divorced fromtactical duties, the "force" medical personnel (about half ofthe total) were lost to the newly created Northern Ireland Base Section,the first base section in the theater. The remainder continued as the VCorps Medical Section.
During their stay in Northern Ireland, the American ground forces reliedheavily upon British military and civilian authorities for hospital facilitiesand medical supplies. The V Corps surgeon`s office dealt with the chiefmedical officer of the British troops in Northern Ireland, the civil healthofficers. of the Ministry of Home Affairs for Northern` Ireland, the localhealth officers and Emergency Medical Service representatives, and theleading medical and surgical practitioners of the region. During 1942,members of the surgeon`s office participated in a series of command exercisesin which both British and American medical units participated.
Near the end of the year, V Corps left Northern Ireland and establishedits headquarters in Bristol, England. There during 1943 it supplied and
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trained incoming units; most of the newly arrived field force unitswere assigned or attached to its headquarters. The composition of the corpsvaried from a single infantry division and corps troops in early 1943 tofive divisions plus numerous corps units by October. In addition to participatingin intensive amphibious exercises during the year, Medical Department personnelin the corps surgeon`s office and in medical units of the corps studiedreports of the North African, Sicilian, and Italian campaigns and heardtalks by officers who had participated in the Mediterranean campaigns.In late October 1943, control of the field forces in the theater was assumedby the newly arrived Headquarters, First U.S. Army, which was establishedin Bristol, absorbing V Corps.
The introduction of a field army provided a wider basis for planningthe invasion of the European Continent. The army surgeon`s office was organizedafter the standard fashion, and the First U.S. Army surgeon, Col. (laterBrig. Gen.) John A. Rogers, MC, began a series of conferences with GeneralHawley to determine what medical units would be allocated to First U.S.Army. As soon as the tentative troop basis had been established, trainingof units was started, including specialized training at the American SchoolCenter at Shrivenham. By early January 1944, the training of Medical Departmentunits was directed at the accomplishment of a landing in Normandy.28
The Air Forces: 1942-43
The Eighth Air Force, commanded by Maj. Gen. (later Gen.) Carl Spaatz,built up in the United Kingdom during spring and midsummer of 1942; itsheadquarters was in London. Until the fall of 1943, this Air Force wasthe senior U.S. Army air command in the theater and directly subordinateto the theater command. By the end of September 1942 it had, in additionto the office of the air force surgeon- Col. Malcolm C. Grow, MC, formerlyThird Air Force surgeon- a medical section headed by a surgeon in eachof its five major commands- bomber, fighter, air service, air support,and composite commands. Colonel Grow and his special staff supervised thetraining of Medical Department personnel in the Eighth Air Force; determinedthe requirements for medical, dental, and veterinary supplies for the airforce and supervised their procurement, storage, and distribution; advisedas to the location and operation of the air force`s medical establishments;supervised the operation of medical components of the subordinate units;and directed the assignment and reassignment of Medical Department personnel.Colonel Grow, as well as the surgeons of successor air commands, receivedtechnical medical instructions from General Hawley`s office.
The medical organization and procedures developed during 1942 by theEighth Air Force, and their modifications as time went on, generally exemplifiedthose later followed by the Ninth Air Force (as well as by the Twelfth,
28 (1) Annual Reports, Surgeon, V Corps, 1942,1943. (2) Annual Report, Surgeon, First U.S. Army, 1944.
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which was activated for service in the North African theater). The Surgeon,Eighth Air Force Service Command, originally had in his office the EighthAir Force medical inspector, inspector of animal foods, medical supplyofficer, dental officer, officer in charge, of medical records and statistics,nutritionist, and personnel officer. The medical group in Colonel Grow`soffice included a few officers in charge of the more technical work; thatis, functions directly related to the care of fliers, medical research,and the professional services. Colonel Grow found that this division ofresponsibility prevented his maintaining centralized control over medicalservice throughout the air force. He was particularly insistent upon centralizedcontrol over assignments and reassignments of Medical Department personnelamong the commands, wings, groups, and squadrons, together with recommendationsfor promotion. Accordingly all functions except those of medical supplywere removed to his office. The service command surgeon remained directlyresponsible to the commanding general of the service command for supervisionof medical care given by medical officers throughout all the subelementsof the air service command, but retained only one function with respectto the entire air force- the handling of medical supply. This divisionof responsibility became an accepted pattern of organization of medicalservice within an air force. In some air forces the supervision of foodinspection by veterinarians throughout the air force, as well as the medicalsupply function, was also handled at the service command level.29
Eighth Air Force surgeons continued the efforts, begun by flight surgeonsin the United States, to solve special problems connected with maintainingthe health of fliers. On account of the rapidity of mobilization, manyflying personnel arrived in the European theater with inadequate trainingin methods of protecting their health and safety during flight. Hence doctorsof the Eighth Air Force gave training in the use and care of various piecesof protective equipment, especially the oxygen mask and electrically heatedclothing. The European theater became the chief proving ground for testingprotective apparatus developed in the United States. The experience ofEighth Air Force fliers with anoxia, frostbite, and aero-otitis- the threechief occupational disorders of fliers- during their long-range bombingmissions over Europe at high altitudes in 1942 and 1943 led to many changesin design. Under the personal guidance of the Eighth Air Force surgeon(Colonel Grow), air force technicians in the European theater developed,after extensive research and tests, protective body armor for fliers.
In October 1943 the two numbered air forces in the United Kingdom, theEighth and the Ninth (the latter transferred from the Middle East to jointhe Eighth in England), were organized under a single command- the U.S.Army
29 (1) Link, Mae Mills, and Coleman, HubertA.: Medical Support of the Army Air Forces in World War II. Washington:U.S. Government Printing Office, 1955, pp. 528-724. (2) Memorandum, Col.Malcolm C. Grow, for the Air Surgeon, 14 Oct. 1942, subject: NarrativeReport of Activities of Medical Service of Eighth Air Force (Through Sept.1942). (3) Army Air Force Manual 25-0-1, Flight Surgeon`s File, 1 Nov.1945.
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Air Forces in the United Kingdom- which served as a theaterwide aircommand. The new command was responsible for coordinating the administration,including the medical service, of both the strategic Eighth and the TacticalNinth Air Force, the latter designed to render close support to the groundforces whenever invasion of the Continent should be attempted. Both airforces were several times as large as most of those in other theaters,the Ninth reaching its peak strength of 183,987 in May 1944, while theEighth was even larger.30
The Eighth Air Force surgeon, Colonel Grow, was made surgeon of theU.S. Army Air Forces in the United Kingdom, as well as surgeon of the EighthAir Force. At the same time his medical section, along with other specialstaff sections of the Eighth Air Force, was placed, in accordance withthe usual scheme for organizing a numbered air force, under the EighthAir Force`s air service command. Thus he had a triple assignment. Detailedtechnical supervision of medical matters remained the responsibility ofsmall staff medical sections at the headquarters of the other commands(a bomber, a fighter, and a composite command) and of Medical Departmentpersonnel assigned to their wings, groups, and squadrons.31
In assigning a single officer as staff surgeon of the air force andsurgeon of its service command, the Army Air Forces were following, withinthe restricted structure of the numbered air force, the scheme of the largertheater structure. In a limited sense Colonel Grow`s position resembledthat of General Hawley; be had the larger staff assignment, but his officewas located at the service command headquarters. At the same time ColonelGrow had the task, as surgeon of the U.S. Army Air Forces in the UnitedKingdom, of coordinating the medical service of the Eighth Air Force withthat of the Ninth. This top air command paralleled the top ground command-the Twelfth Army Group- and Colonel Grow`s post as Surgeon, U.S. Army AirForces in the United Kingdom, resembled that, of the Surgeon, Twelfth U.S.Army Group.
From the date of its arrival in the United Kingdom to its move to theContinent, the Ninth Air Force medical service underwent a rapid buildup,entailing the accumulation of 40 medical dispensaries (aviation) and 10medical air evacuation transport squadrons, in addition to the MedicalDepartment officers and men assigned to its increasing numbers of wings,groups, and squadrons. During this period the Ninth Air Force medical section,already experienced with directing the medical service for air force troopsunder field conditions in the Middle East, made plans for the revampingof its medical units to fit expected combat conditions on the Continent.It made changes, particularly in the medical dispensary (aviation) to achievegreater mobility; the dispensaries, forced to make many moves within theBritish Isles to accompany the tactical units to which they were assigned,needed even greater mobility for the coming continental operations. TheNinth Air Force surgeon,
30 Annual Report, Medical Department Activities,Ninth Air Force, 29 Feb. 1945.
31 Medical History of the Eighth Air Force, 1944.
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Col. (later Brig. Gen.) Edward J. Kendricks, MC (fig. 74), obtainedtwo field hospitals, each of which he revamped into three smaller hospitalunits (each staffed by one platoon) to afford medical support to fighterand bomber groups operating from fighter strips after the move to the Continent.Another field hospital, attached to the Ninth Air Force for a few monthsto serve units of the XIX Tactical Air Command at its airstrips along thesouth coast of Kent (an area remote from Services of Supply hospitals),afforded three more of these small hospital units which served men of theNinth Air Form in rapid moves in France and Belgium.32
After February 1943, medical service for troops stationed along theeastern end of the air route between England and the United States, aswell as for persons being transported over the route, was provided by thenewly established European Wing of the Air Transport Command. As in thecase of other Air Transport Command wings, its stations were, administrativelysubject to the theater within which they were located although their operationswere directed from Headquarters, Air Transport Command, in the United States.After a brief period of reliance upon British medical facilities (includingthose of the Royal Air Force), as well as facilities of the Services ofSupply, the European Wing developed dispensaries of from 10 to 25 bedsto care for patients for a maximum period of 72 hours. Any further careneces-
32 Preliminary Operational Report, Office ofthe Surgeon, Ninth Air Force. [Maxwell AFB files.]
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sary was given at Services of Supply hospitals. By the end of the year,dispensaries were operating at the following stations: Hedon airdrome nearLondon; Prestwick, Scotland; Nutt`s Corner, Northern Ireland, St. Mawgansin Cornwall; Valley on the island of Anglesey, Wales; and Stornoway, Isleof Lewis, in the Hebrides. At that date, the wing had assigned to it only12 medical officers, 4 dental officers, 1 Medical Administrative Corpsofficer, and 36 Medical Department enlisted men. It was the smallest ofall Air Transport Command wings. Its heavy responsibility for evacuatinglarge numbers of patients by air from the theater to the United Statesbegan only in June 1944 with the Normandy invasion.33
Control of Medical Service for Air Force Troops
During the preinvasion period, medical officers assigned to the EighthAir Force advocated certain steps which tended to make the air force`smedical service independent of the theater command. They made the usualclaims as to special needs: medical supplies peculiar to the air forces;medical personnel trained in the special problems of aviation medicine;and special hospital facilities to care for air pilots recuperating fromflying fatigue. In addition, they contended that Services of Supply installations,particularly fixed hospitals and medical supply depots in the various basesections, were not always located sufficiently near the air force baseswhich they served. (Services of Supply installations were concentratedin southern England whereas the majority of the air force bases were inthe northeast.) The conflicts that ensued whenever air force surgeons attemptedto obtain medical support through their own channels resembled the somewhatmore titanic struggle waged over a separate medical service for the ArmyAir Forces in the United States. They reflected the irresistible trendtoward the divorce of air and ground logistics. The interest of air forcemedical officers in controlling their own medical facilities was especiallystrong in the early days of the theater`s existence when the proportionof air troops to ground and service troops was relatively high and whenthe Eighth Air Force, engaged in the strategic bombing of targets in Nazi-heldterritory, was the only element in the theater suffering combat casualties.
As subcommands were created within the Eighth Air Force, officers trainedin aviation medicine were needed to staff them. In 1942 many air forceunits arrived without organic medical personnel, and many medical officerswho came lacked training in aviation medicine. Moreover, the Eighth AirForce had to transfer some of its medical officers to the Twelfth Air Forcefor the North African invasion. Lack of training in the physiologic effectsof flight and the proper use of protective equipment was held responsiblefor some serious plane
33 (1) History of the Medical Department, AirTransport Command, May 1941-December 1944. [Official record.] (2) See footnotes4(3), p. 307; and 26 (2),p. 323.
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accidents in 1942, the salient example being the loss of three 4-motoredheavy bombers and 10 airmen within a week or so. Hence the Eighth Air Forcesurgeon wanted to establish a medical field service school to train officersin aviation medicine. General Hawley, who believed that such training couldand should be given at the medical field service school operated at Shrivenhamby the Services of Supply, opposed the plan, but the theater command approvedit, and the Provisional Medical Field Service School was officially openedby Colonel Grow in August 1942 at Pine Tree, England.34
Because of shortages of some items of medical supply in the theaterin 1942, the Eighth Air Force was unable to obtain the full quantitiesof medical supplies which it requested through the regular channels; thatis, by requisitions to General Hawley`s office. By cabling the CommandingGeneral, Army Air Forces, it was able to get a number of items directlyfrom the United States. General Hawley protested-
All components of this theater are short of dental laboratories,Chests Nos. 4 and 60. I adhere to the now apparently unique opinion thatan aching tooth hurts an infantryman just as badly as it hurts a soldierin the Air Forces; and this office is attempting to make an equitable distributionof all critical medical items so that all components of ETOUSA may be caredfor as thoroughly as is possible in the circumstances. If any competitionfor medical supplies in this theater is tolerated, wastage is certain andchaos probable.
Inability to meet the full demands of the air forces was one of thepersistent problems in the handling of medical supplies in the Europeantheater which continued until early in 1944. It furnished the air forcesan argument for building up a channel for procuring its medical suppliesdirectly from the Zone of Interior without going through Services of Supplychannels.35
A third struggle developed with regard to hospitalization for the EighthAir Force. According to theater policy the air and ground forces were tooperate only temporary hospitalization facilities capable of treating casesrequiring a hospital stay of not more than 96 hours, but in July 1942 theEighth Air Force made a request for authority to operate rest homes totreat cases of flying fatigue. General Hawley, stating that the proposedrest homes were, in effect, hospitals, and that fixed hospitals were theresponsibility of the Services of Supply, opposed the move. The theatercommand overruled him and approved the rest home project in August 1942.A later request by the Eighth Air Force for hospital rations for its resthomes substantiated General Hawley`s original contention, and, as he stated,much to the chagrin of the theater staff.
34 (1) Narrative Report of Activities of MedicalService of the Eighth Air Force up to and including 30 September 1942.(2) Letter, Col. Paul R. Hawley, to Maj. Gen. James C. Magee, The Sur geonGeneral, 11 Sept. 1942, and other letters in Col. Hawley`s chronologicalfile. (3) Memorandum, Lt. Col. Lloyd J. Thompson, MC, for Col. J. M. Kimbrough,MC, 24 Sept. 1942, subject: Visit to 8th Air Force. (4) Memorandum, Brig.Gen. Paul R. Hawley, for Col. Malcolm Grow, October 1942.
35 First wrapper indorsement on incoming cable No. A671, ChiefSurgeon, Services of Supply, European Theater of Operations, U.S. Army,to The Surgeon General, 9 Nov. 1942, and numerous similar documents inGeneral Hawley`s chronological file for November-December 1942.
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The hospital rations were disapproved on the ground that the rest centerswere, by the air force`s own statement, not hospitals.36
In mid-1943, the Air Surgeon was pressing for air force control of hospitalsin the European theater, about the same time that he was attempting toachieve air force control of general hospitals in the United States, butby that date, when the Services of Supply had a substantial number of fixedhospitals operating, he could not obtain very strong backing from air forcesmedical officers in the theater. General Hawley was able to point out earlyin the year, when total strength planned for the Eighth Air Force amountedto about 15 percent of that planned for the theater, that 25 percent ofthe 750-bed station hospitals then under construction were located in thearea occupied by the Eighth Air Force. General Hawley recognized the technicalaspects of aviation medicine and realized that fliers hospitalized in thegeneral hospitals of the Services of Supply were not always returned toduty as promptly as was desirable. By agreement between General Hawleyand Colonel Grow, flight surgeons were stationed in the general hospitalswhich cared for appreciably large numbers of air force personnel. Theyadvised the disposition boards of the general hospitals as to whether airforce patients were fit for return to flying duty and, if not, whetherthe air force wanted them returned for limited service. Cooperative arrangementsfor the expeditious handling of air force patients effectively reducedpressure within the theater for air force control of hospitals; by theend of 1943 air force medical officers appear to have become convincedthat hospitalization of air force troops in Services of Supply hospitalswas satisfactory. The surgeon of the Ninth Air Force, Colonel Kendricks,was disinterested in the theory of separatism and inclined to stress thecooperation which he received from General Hawley`s office. As it developed,the air forces in Europe were to remain dependent on the Services of Supplyfor fixed hospitalization throughout the war despite renewed pressure atintervals by the Air Surgeon`s office in Washington.
MEDICAL ORGANIZATION UNDER SHAEF: JANUARY 1944-MAY 1945
From April 1943 to the establishment of the Allied command under GeneralEisenhower early in 1944, Allied planning for invasion of the EuropeanContinent was carried on by a combined British and American staff headedby Lt. Gen. Frederick E. Morgan, the British Chief of Staff to the SupremeAllied Commander (designate). General Morgan`s office in London, althougha forerunner of SHAEF (Supreme Headquarters, Allied Expeditionary Force),was a planning agency rather than a command. Throughout the life of thisplanning staff a few Medical Department officers assigned to it from General
36 (1) Letters, Brig. Gen. Paul R. Hawley,to Maj. Gen. Norman T. Kirk, The Surgeon General, 8 July 1943, 10 Aug.1943, 17 Sept. 1943, and many similar letters, General Hawley`s chronologicalfile, through 1943. (2) See footnote 29(l), p. 327. (3) Letter, Brig. Gen.Paul R. Hawley, to Col. Malcolm Grow, MC, 11 Mar. 1943.(4) Interview, Brig.Gen. Edward J. Kendricks, 23 Feb. 1950.
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Hawley`s office worked on medical phases of invasion plans, as wellas plans for the handling of civilian affairs on the Continent. GeneralHawley assisted with these plans, which were drawn up in close conjunctionwith his office.37
SHAEF and the Theater Command
The creation of SHAEF, in London in January 1944 in preparation forinvading the Continent, together with changes in the responsibilities assignedto various subordinate headquarters and commanders (British as well asAmerican), brought about a different command structure, highly complex,under Which the U.S. Army medical service operated until the end of thewar. General Eisenhower served in a dual capacity- as Supreme Allied Commanderand as a commander of the European Theater of Operations, U.S. Army. Maj.Gen. Albert W. Kenner, who had served as surgeon of the North African theater,and had been Secretary Stimson`s first choice to succeed General Mageeas The Surgeon General, was made Chief Medical Officer, SHAEF. He actedas adviser to General Eisenhower and dealt with the surgeons of the manycommands subordinate to SHAEF.38
At the same time, the headquarters of the American theater command andthat of its Services of Supply were consolidated into a single headquarters.General Lee retained command of the Services of Supply and was given theadditional assignment of deputy theater commander for supply and administration;that is, deputy to General Eisenhower in the latter`s capacity as commanderof the American theater. The chiefs of technical services, who had formerlyserved in a dual capacity for both theater and Services of Supply headquarters,continued in these two capacities but were now located at a combined theaterand Services of Supply headquarters in London instead of, as formerly,at the Cheltenham headquarters of the Services of Supply. General Hawley(promoted to major general in March 1944) was placed under G-4, along withthe other technical service chiefs.39
This reorganization seemed to strengthen General Hawley`s position.He commented: "All Chiefs of Services, including myself, are Chiefsof Services of the European Theater of Operations, and in addition to theirother duties, are Chiefs of Services of the SOS. This is an exact reversalof the previous organization in which the Chiefs of Services were assignedto the SOS and, in addition to their other duties, were Chiefs of Servicesof the European Theater of Operations. This is, of course, a small pointbut is proving to be a most important point."40 By thedate of the invasion most of General Hawley`s staff
37 (1) Harrison, Gordon A.: Cross Channel Attack.United States Army In World War II. Washington: U.S. Government PrintingOffice, 1951, ch. II. (2) Interview, Col. John K. Davis, formerly DeputySurgeon, SHAEF, 15 Sept. 1945. (3) Letter, Maj. Gen. Paul R. Hawley, USA(Ret.), to Col. John Boyd Coates, Jr., MC, USA, Director, The HistoricalUnit, U.S. Army Medical Service, 29 Aug. 1955, commenting on preliminarydraft of this chapter.
38 (1) General Order No. 2, Supreme Headquarters, Allied ExpeditionaryForce, 14 Feb. 1944. (2) Administrative Memorandum No. 3, Supreme Headquarters,Allied Expeditionary Force, 24 Apr. 1944.
39 See footnotes 2, p. 304 ; and 14 (4), p. 315.
40 Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T.Kirk, 4 Feb. 1944.
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was concentrated in London at Headquarters, ETOUSA-SOS, which was soonreferred to unofficially as Communications Zone, ETOUSA, in anticipationof the role that it was to fill on the Continent.
At SHAEF, General Kenner headed a medical division made up of two Britishofficers- one of whom, a brigadier, served as his deputy- two Americanofficers, and some British and American enlisted men. The duties of theChief Medical Officer, SHAEF, were defined in broad terms. He was to advisethe Supreme Commander on all matters pertaining to the medical servicewithin the areas under General Eisenhower`s command and to coordinate medicalpolicy on an inter-Allied basis. Coordination of the policies of the Army`spublic health program in the European countries which the Army would occupywith plans of the regular medical service for troops was entrusted to him.He was authorized direct communication on technical matters with the surgeonsof the naval forces, air forces, army groups and armies, and other commands-Britishand American-under the Supreme Commander. He reported to the Chief AdministrativeOfficer, SHAEF, Lt. Gen. Sir Humphrey Gale, a British officer who servedas a deputy chief of staff, and his recommendations were also reviewed,as a rule, by G-4, SHAEF.
During his early months at Supreme Headquarters, General Kenner conductedconferences, with representatives of the U.S. Navy and the British armedforces present, to discuss the role of hospital carriers and hospital shipsin the forthcoming invasion. Similar conferences with representatives ofthe Royal Air Force, U.S. Strategic Air Forces, and Allied ExpeditionaryAir Force were conducted in order to integrate plans of all the Alliedair elements with the ground elements for evacuation of casualties by airduring the invasion. General Kenner attended First U.S. Army exercisesat Portsmouth and prepared a written appraisal of the major problems tobe anticipated in evacuating casualties. He conferred with Medical Departmentofficers assigned to G-5, SHAEF, on problems encountered in planning thecivil health program, especially the procurement of men trained in publichealth work. He sent his assistant, Col. J. K. Davis, MC, to Algiers, Naples,and Caserta to get information on the Fifth U.S. Army`s experience withmedical units and data on Fifth U.S. Army casualties, hospital admissions,and incidence of various types of wounds, during the Italian campaign.41
After the invasion, General Kenner spent much of his time travelingup and down evacuation routes on the Continent by car, inspecting the flowof evacuation and the handling of patients. He kept Supreme Headquartersinformed on the placement of medical units and hospitals- British, French,and American- in relation to the disposition of combat units and on theflow
41 (1) Diary, Maj. Gen. Albert W. Kenner. (2)Memorandum, Brig. Gen. Paul R. Hawley, for Maj. Gen. Albert W. Kenner,25 Feb. 1944, subject: Sea Transport for Casualties. (3) Report of conference,Maj. Gen. Albert W. Kenner and others, 26 Feb. 1944. (4) Reports by Maj.Gen. Albert W. Kenner on exercises in March and April 1944. (5) Memorandum,Maj. Gen. Albert W. Kenner, for Lt. Gen. Sir Humphrey Gale, 29 Feb. 1944.(6) Report of Visit to Allied Force Headquarters by Col. John K. Davis,MC, 1 Apr. 1944.
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of medical supplies to forward areas. He made appraisals of combat fatigueamong troops, and other matters which would give General Eisenhower andhis staff a full picture of the way in which the American and British medicalservices were Supporting the invasion. At times he followed a group ofcasual-ties from front to rear, noting any defects in coordination of themovements of evacuees-an overload of patients in the hospitals of a fieldarmy or some element of the communications zone, for instance. He reportedto General Eisenhower personally about once a week. His action to improvethe handling of evacuees usually took the form of personal talks with thesurgeons of the commands concerned. When 6th Army Group (comprising theFirst French Army and the Seventh U.S. Army) entered the theater, his officemade recommendations to G-4, SHAEF, for the reallocation of Medical Departmentunits among the tactical components of 12th Army Group and the Allied 6thArmy Group to provide balanced support for the two forces.42
General Hawley continued as Chief Surgeon, ETOUSA, responsible for technicalinstructions to the Services of Supply and to the 12th and 6th Army Groupsand their subordinate commands. His title and responsibility as Chief Surgeon,ETOUSA, continued to the end of the war. His office remained at GeneralLee`s headquarters, usually known as Communications Zone- ETOUSA after7 June when the Services of Supply became officially known as CommunicationsZone. This headquarters continued to be the theater channel for communicatingwith the War Department on technical matters. To the end of the war GeneralHawley also informed The Surgeon General (General Kirk) through personalcorrespondence of his estimates of the medical needs of the Army in Europe.43
With time some confusion developed with respect to the mutual responsibilitiesand spheres of control of Supreme Headquarters and Headquarters, ETOUSA-SOS.General Eisenhower`s general staff at Supreme Headquarters directed thetactical operations of the combat forces, whereas in a purely Americantheater, direction of these forces would normally have been exercised bythe general staff of the theater headquarters. After the invasion "therewas a tendency for SHAEF to assume more and more the aspect of an Americantheater headquarters as well as an Allied one." General Lee`s activities,correspondingly, tended to contract to those properly belonging to a communicationszone. The ambiguity was only deepened by the renaming of General Lee`sheadquarters as Headquarters, Communications Zone, ETOUSA, in June 1944and the termination of his position as deputy theater commander
42 (1) Letter, General Dwight D. Eisenhower,to General George C. Marshall, 28 Sept. 1944. (2) See footnote 41 (1),p. 334.
43 (1) See footnote 2, p. 304. (2) Letters, Maj. Gen. Paul R.Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, from June 1943to the end of the war. Like the chiefs of other technical services at Headquarters,ETOUSA-SOS and its successor, Communications Zone-ETOUSA, General Hawleywas frequently in the position of issuing directives to himself. As theaterChief Surgeon his directives, over the signature of the theater AdjutantGeneral, went to the Services of Supply as well as to the armies and airforces, and so were received by General Hawley in his capacity as SOS surgeon.
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in July, although the chiefs of technical services, including GeneralHawley, continued to exercise the same theaterwide responsibilities asbefore.44
In the circumstances, it is hardly surprising that Medical Departmentstaff officers disagreed as to channels of authority, or that General Kennerand General Hawley were themselves sometimes in doubt as to their respectiveresponsibilities. General Kenner had outlined the command setup for TheSurgeon General in March 1944 as follows:
I am in a rather ambiguous situation as regards my relationshipto Hawley, since I am set up as the Chief Medical Officer for this compositeforce, which, as you know, is made up of Navy, Air, and Ground-Britishand American. Since I am on this higher staff level, I am concerned onlywith the coordinated planning and the integration of all things pertinentto the medical service. The operative part of it belongs to Hawley * **.
It`s a funny kind of a setup and is without precedent in our medical service.
General Hawley for his part noted the limitations which the commandstructure imposed upon his activities, specifically in connection withhis attempts to get the buildings which he wanted for hospitals in Franceand Belgium. Because of the involvement of various governments, civilianinterests, and a number of Army commands, this problem could not be solvedwithin the communications zone headquarters.
The organization of this Theater being what it is, itis a practical impossibility for me to bring directly to the attentionof the authority who can act, the urgent requirements of the medical servicefor hospital plant. I must, of course, work through and under General Leeand his general staff. The organization set up demands this- and I cannot,and do not desire to, go over his head.
He and his staff give me all the support that they can;but his appointment as Deputy Theater Commander was terminated after hemoved his headquarters to the Continent and practically all authority toact in Theater matters has been taken over by SHAEF. This creates the anomaloussituation wherein Theater Chiefs of Services have no approach to the TheaterCommander and must depend upon subordinate commander and staff for support.Such an organization works as well as it obviously can.
The matter was resolved, as such conflicts generally were, by conference.Representatives of Headquarters, SOS-ETOUSA, of the Army groups, and ofthe Armies met on 17 January 1945 at SHAEF headquarters at Versailles,and gave General Hawley the 34 additional hospital sites he wanted.45
Many other matters turned out to be involved with Allied interests andto fall within the purview of SHAEF or one of its subordinate Allied commands.Since the Allied Expeditionary Air Force, for example, exercised,
44 See footnote 2, p. 304.
45 (1) Interview, Col. Alvin L. Gorby, MC, 10 Nov. 1949. (2)Recorded remarks of Maj. Gen. Albert W. Kenner at panel discussion of manuscriptof this volume, Office of the Chief of Military History, 9 Sept. 1955.(3) Annual Report, Surgeon, First U.S. Army, 1944. (4) Letter, Maj. Gen.Albert W. Kenner, to Maj. Gen. Norman T. Kirk, The Surgeon General, 23Mar. 1944. (5) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. Norman T.Kirk, The Surgeon General, 12 Jan. 1945. (6) Darnall, J. R.: Hospitalizationin the European Theater of Operations, U.S. Army, in World War II. Mil.Surgeon 103: 426-439, December 1948. (7) Minutes, Conference on HospitalSites, G-4, Supreme Headquarters, Allied Expeditionary Force, 17 Jan. 1945.(8) Letter, Brig. Gen. Crawford F. Sams, to Col. Joseph H. McNinch, MC,Chief, Historical Division, Office of The Surgeon General, 5 June 1950,and Colonel McNinch`s recorded remarks thereon, 22 June 1950.
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through its Combined Air Transport Operations Room, control over theallocation of aircraft to air transport agencies within the theater, anyrequest for plans for air evacuation had to be submitted to CATOR, as thisagency was called. General Hawley, who was empowered to act only withintheater channels, found it difficult to place his statement of requirementsfor air evacuation before any commander who had authority to act on it.46General Kenner, on the other hand, continued to regard General Hawley`soffice as the operating agency, and contented himself with an occasionalstatement to the theater or communications zone command calling attentionto medical defi-ciencies on the purely American side; for example, a risingvenereal disease rate in September 1944 and too large a backlog in thenumber of casualties due, under theater policy, for evacuation from thetheater to the Zone of Interior.
Regardless of difficulties encountered by General Hawley on specificmatters which came within the compass of SHAEF, he acted as chief of medicalservice for the American Forces throughout the war, working in close rapportwith British Army medical authorities. His office issued under GeneralEisenhower`s signature plans for evacuation which outlined the mutual responsibilitiesof armies and communications zone elements, as well as those of air forces.The regular medical service for U.S. Army troops which he headed was responsiblefor care of returned U.S. Army prisoners of war and served many soldiersof the Allied nations as well as many civilians. Consultants in his officevisited U.S. Army hospitals in forward areas as well as the communicationszone. The series of technical instructions which they issued on proceduresand standards for treatment of diseases and injuries of U.S. Army troopswere distributed to all Army commands in the European theater. GeneralHawley and his staff inspected Army hospitals throughout the theater, irrespectiveof the command to which they were assigned. Many administrative problemswere solved by personal discussions and exchange of letters among the surgeonsof the commands concerned. Others, calling for compromise among severalcommands and requiring a command decision, were frequently solved, as inthe case of the hospital facilities in France and Belgium, by reachinga formal agreement at a top-level conference. In some instances, when GeneralHawley found that command channels were lacking for bringing his problemsto the attention of a commander with authority to act, he called the matterto the attention of General Kenner, who was able to obtain the backingof SHAEF. General Hawley`s and General Kenner`s deputies worked in closecooperation.47
The Theater-SOS Medical Section
Pursuant to the January 1944 reorganization and in anticipation of theinvasion, a number of changes were made in the internal organization ofGen-
46 Memorandum, Maj. Gen. Paul R. Hawley, forCommanding General, Communications Zone, European Theater of Operations,U.S. Army, 15 Sept. 1944.
47 (1) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. AlbertW. Kenner, 21 July 1944. (2) See footnote 46. (3) Memorandum, Maj. Gen.Paul R. Hawley, for Maj. Gen. Albert W. Kenner, 21 Sept. 1944.
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eral Hawley`s medical section. At the beginning of 1944 the London officeat the combined ETOUSA-SOS headquarters was relatively small, consistingof General Hawley, a deputy chief surgeon, the executive officer, and thePlanning, Evacuation, and Administrative Division; the bulk of the officewas still at Cheltenham. With the consolidation of the theater and Servicesof Supply headquarters, most of the remaining elements of General Hawley`soffice were transferred to London, and the total office, particularly itsOperations Division, underwent considerable expansion. The Chief of theOperations Division, at Headquarters, ETOUSA-SOS, in London, Col. DavidE. Liston, MC (fig. 75), was appointed deputy to General Hawley in chargeof the London office. During the months before the invasion the officewas engaged in preparing the medical annexes of plans for mounting thecontinental invasion and for administering the communications zone. Itdeveloped exclusively medical exercises to test the arrangements for evacuatingcasualties arriving on the southern coast of England to fixed hospitals.It undertook large-scale reshuffling of Medical Department units to meetthe requirements for medical care for troops assembling in the marshalingareas along the south coast of England, for evacuation and care of an anticipatedheavy load of casualties from the Continent, for care of troops remainingin the United Kingdom, and for a full-fledged medical service on the Continentin the post-invasion months.48
The split of General Hawley`s office between London and Cheltenham whichhad prevailed in 1942 and 1943 was considered by investigators from theSurgeon General`s Office a contributory cause of the medical supply crisisthat developed by early 1944. When it was evident that the theater`s medicalsupply system would not be able to handle the assembly and distributionof the medical maintenance units and hospital equipment necessary to supportthe cross-channel invasion, General Hawley requested aid from The SurgeonGeneral. In response, General Kirk sent to the theater a group of officersand some industry experts from the Supply Division, with Col. Tracy S.Voorhees, Director of the Control Division, at their head. Besides arrangingfor the direct shipment from the United States of sufficient medical maintenanceunits and hospital assemblies to take the strain off the theater medicalsupply system, the group proposed overhauling the system itself. The groupreported in early February that the fact that General Hawley had had tospend most of his time in London near theater headquarters had preventedhis giving close personal supervision to his Supply Division in Cheltenham.Responsibility had been further divided in that procurement of medicalsupplies from the British had been conducted by a medical supply officerof General Hawley`s office who was stationed, along with representativesof the other chiefs of technical services, at the General Purchasing Boardin London rather than in General Hawley`s office. An insufficient numberof officers trained in medi-
48 (1) See footnote 7(3), p. 308. (2) AnnualReport, Surgeon, United Kingdom Base, 1944.
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cal supply had been sent to staff the Supply Division of General Hawley`soffice and to man the medical supply depots in the United Kingdom. A lackof coordination between the theater`s medical supply network and the SupplyDivision of the Surgeon General`s Office- as to items to be procured fromthe British, for example- and insufficient coordination between GeneralHawley`s office and the army surgeons as to the medical supply needs ofthe armies had contributed to the confusion.
In order to remedy defects, the supply mission recommended a reorganizationof General Hawley`s Supply Division. The changes included increasing personnelfrom 17 officers and 47 enlisted men to 32 officers and 91 enlisted men,and the removal of certain officers from the division to various more suitableposts in the medical supply system. The mission drew a parallel betweenthe problems which had developed within the European theater and thosewhich had confronted the Supply, Service of the Surgeon General`s Officein 1942, particularly in the operation of a large depot system. Its reportstated: "We must recognize fundamentally that the U.K. supply serviceand depot problems and functions are not those of a T/O (Theater of Operations)but of a base for a Theater or Theaters and are in essence a replica. ofthe U.S. supply service and depot job with almost exactly the same numberof depots." Pursuing this concept, the mission recommended the transferof certain experienced officers serving in the Supply Service, SurgeonGeneral`s Office, and
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in the large medical depots in the United States to the theater; theywere to undertake measures found effective at home.
Two officers of the mission remained in the theater as members of theSupply Division; 15 additional officers trained in medical supply weresent from the Surgeon General`s Office and the medical supply depots inthe United States for 90 days` temporary duty in the theater. In earlyMarch, Col. Silas B. Hays, MC (fig. 76), who had served with the mission,became chief of the division. The changes in personnel, together with detailedrevisions of policy and method, which Colonel Hays put into effect, broughtabout a system which General Hawley later declared to have proved highlyeffective for coping with the problems of the cross-channel invasion.49
General Hawley`s office reached its full strength soon after the invasion.On 1 July 1944 it consisted of 147 officers, 371 enlisted men, and 125civilians;
49 (1) Resume of Trip to Survey Medical Suppliesin ETO, 12 Apr. 1944. [Official record.] (2) Hays, S. B.: Report of MedicalSupply Situation, 10 July 1944. [Official record.] (3) Memorandum, Chief,Finance and Supply Division, for Chief Surgeon, Headquarters, Servicesof Supply, European Theater of Operations, U.S. Army, 21 Dec. 1942. (4)Letters, Maj. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, 4 Feb.,26 June 1944. (5) Annual Report, Medical Procurement Section, Supply Division,Office of the Chief Surgeon, European Theater of Operations, U.S. Army,1944.
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on 1 September the strength amounted to 151 officers, 362 enlisted men,and 125 civilians. It was by far the largest Army medical office overseasand second in size only to the Surgeon General`s Office itself. GeneralHawley had two deputies; Colonel Liston served in this capacity in theParis office, while the United Kingdom Base Surgeon, Colonel Spruit, washis deputy for activities in the United Kingdom. In March 1945 three deputieswere appointed: Colonel Spruit (now brigadier general) who retained hisassignment as United Kingdom Base surgeon; Colonel Liston as deputy foroperations; and Col. Charles F. Shook, MC (formerly Surgeon, Southern Lineof Communications), as deputy for administration.
An important innovation in the office early in 1945 was the creationof a Field Survey Division. Its staff undertook to discover deficienciesof every nature in the medical service and assist commanding officers ofMedical Department units in the field to carry out the policies of theaterheadquarters. Teams of officers from the division visited hospitals, inspectingall activities- wards, laboratories, utilities, and inquiring into patients`complaints. They accompanied patients on hospital ships and trains to checkon the care being given evacuees en route.50
Other than these developments, the chief changes in General Hawley`soffice in 1945 resulted from added responsibilities. During the final monthsof the war the office became increasingly concerned- with technical militaryintelligence activities. In November 1944, Army Service Forces headquartersin Washington had begun taking a strong interest in this area and had sentteams representing each of the services to work with the Combined IntelligenceObjectives Subcommittee established in London the previous spring. A medicalofficer served on the Combined Intelligence Objectives Subcommittee, whichdetermined the fields of German military developments to be investigated.The program for exploring developments in German medicine, research, andproduction of medical supplies and equipment got under way in mid-May of1945 after Germany had been overrun by the Allied armies; it was carriedout at various levels of theater organization. A few officers and enlistedmen served in the Medical Intelligence Branch of General Hawley`s OperationsDivision; others were attached to Advance Section, Communications Zone;another group tested captured enemy supplies and equipment at a U.S. Armygeneral laboratory in Paris; and four medical intelligence teams attachedto the First, Third, Seventh, and Ninth U.S. Armies collected informationthrough interrogating prisoners and examining documents and enemy medicalinstallations. German techniques and developments in medicine (includingits preventive aspects),
50 (1) See footnote 7 (3), p. 308. (2) AnnualReport, Administrative Division, Office of the Chief Surgeon, EuropeanTheater of Operations, U.S. Army, 1944.
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surgery, neurosurgery, dentistry, and veterinary medicine, as well asmedical supplies used by the German Army, were thoroughly studied.51
The Communications Zone: June 1944-May 1945
During the months before the invasion the Services of Supply, or CommunicationsZone52 as this organization came to be termed in anticipationof its role in logistic support of the invasion, established two new agencies-Forward Echelon, Communications Zone, and Advance Section, CommunicationsZone. The headquarters of both agencies had medical sections which workedon the medical phases of invasion plans; each maintained liaison with theoffice of the Surgeon, Communications Zone, General Hawley. The ForwardEchelon, Communications Zone, was a nucleus of the main headquarters designedto move quickly to the Continent in advance of the remaining staff (orrear echelon). During the planning period in the United Kingdom, its staffwas attached to 21st Army Group, SHAEF`s ground force subcommand, whichwas to have initial top responsibility on the Continent, but it workedmore directly with First U.S. Army, the American component of 21st ArmyGroup. It was organized into staff sections fashioned after those at themain headquarters of Communications Zone, in order to facilitate laterreintegration of the two staffs. Its medical staff section was headed byColonel Spruit. By May about 20 officers of General Hawley`s medical sectionhad been assigned to the planning undertaken by Colonel Spruit. In theend the work of this group was confined to planning, for the main headquartersof Communications Zone, including General Hawley`s office, moved to theContinent a full month ahead of schedule. Hence Forward Echelon never assumedany direction over the territorial commands of the communications zonebut was quickly absorbed into the main headquarters at Valognes, France.53
Advance Section, Communications Zone, was supervised during the planningperiod by Forward Echelon. Its medical section was headed by Col. CharlesH. Beasley, MC (fig. 77), formerly the surgeon of Iceland Base Command.Before assuming his new duties, Colonel Beasley made a short trip to NorthAfrica and Italy to study the organization of the medical service in the
51(1) Period Report, Medical Intelligence Branch,Operations Division, Office of the Chief Surgeon, European Theater of Operations,U.S. Army, 1 Jan.-30 June 1945. (2) Period Report, Medical IntelligenceBranch, Operations Division, Office of the Chief Surgeon, Theater ServiceForces, European Theater of Operations, U.S. Army, 8 May-30 Sept. 1945.(3) Report of Operations, Office of the Chief Surgeon, Theater ServiceForces, European Theater of Operations, U.S. Army, 8 May-30 Sept. 1945.
52 Officially named Communications Zone, European Theater ofOperations, U.S. Army, only on the eve of the invasion. The term "CommunicationsZone" more aptly applied to the area within which a Services of Supplyoperated within a theater, was here used to designate the organizationitself. The change of name occurred with the forward push and the expansionof the boundaries of the communications zone. In the early days of thetheater, the Services of Supply had base sections as its only area commands.With the move forward, the Services of Supply was in some theaters renamedthe Communications Zone. It then had both advance and intermediate sections,as well as base sections, thus fully developing the type of organizationshown on chart 12, p. 246.
53 (1) See footnotes 2, p. 304 ; 4(3), p. 307 ; and 7(3), p.308. (2) Annual Report, Administrative Division, Office of the Chief Surgeon,Headquarters, European Theater of Operations, U.S. Army, 1944.
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North African theater, particularly that of Peninsular Base Section.His medical section, first set up in London, was transferred to Bristolin March 1944. The plans of the Advance Section were coordinated with thoseof the First U.S. Army, then training in the Bristol area, for AdvanceSection was to operate under the direction of First U.S. Army during theinitial days of the invasion. In addition to frequent meetings with theFirst U.S. Army surgeon and his staff, Colonel Beasley held conferenceswith General Hawley and his representatives, as well as with the medicalstaff of Headquarters, Third U.S. Army, and the Ninth U.S. Air Force.
A month before the invasion, the surgeon`s office of the Advance Sectionwas authorized a strength of 42 officers and 56 enlisted men, to includea nurse and a maximum of 19 Medical Corps officers. Advance Section headquartersreached France on 15 June, 9 days after D-day, when the frontlines wereless than 4 miles away. During its period of attachment to First U.S. Army,about a month, its surgeon`s office drew up plans for establishing MedicalDepartment installations ashore to serve combat forces as soon as its territoriallimits to the rear of First U.S. Army should be defined. When Advance Sectionwas detached from First U.S. Army control on 14 July, the medical sectionbegan providing hospital facilities and an evacuation service, administeringthe procurement and storage of medical supplies, and supervising sanitationin the communications zone on the Continent. By early August, it was operatingin France 12 general hospitals, 4 field hospitals, 1 evacuation hospital,and many other types of medical units, supporting both the First and
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Third U.S. Armies (the latter having begun operations on the Continenton 1 August). Advance Section was now permanently under the control ofHeadquarters, Communications Zone.54
Headquarters, Communications Zone, ETOUSA, moved to Valognes when therear boundaries of the armies were drawn in early August. By the end ofthe month most of the surgeon`s office had arrived at Valognes and wasestablished in hutments (fig. 78), absorbing the medical staff at the ForwardEchelon. At first it appeared that the Communications Zone headquarterswould be in Normandy for an indefinite period (planning and constructionof the camp at Valognes had been extensive), but it was transferred toits permanent location in Paris in mid-September. The surgeon`s officewas housed with the offices of the other chiefs of technical services onthe Avenue Kleber. Before the end of the year additional officers wererequisitioned for the expanding medical section.
With the advance of the armies in France, many changes took place inthe organization of the communication zone, but by the middle of October1944 the structure was near its final form, although boundaries continuedto be modified to accord with the changing tactical situation. The communicationszone then consisted of an advance section in direct support of the armiesand seven base sections: Base Section, Seine Section, Loire Section, ChannelBase Section, Normandy Base Section, Brittany Base Section, and the United
54 (1) Annual Report, Medical Section, AdvanceSection, Communications Zone, European Theater of Operations, U.S. Army,7 Feb-31 Dec. 1944.(2) See footnotes 4(3), p. 307; and 7(3), p. 308.
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Kingdom Base Section (map 5). The surgeons assigned to the headquartersof continental base sections served on the special staffs of the base sectioncommanders; their offices averaged about 25 officers and 35 enlisted meneach. All the continental base sections had substantial numbers of stationand general hospitals, medical supply depots, and medical sections of generaldepots the full array of units designed to provide the standard medicalservice of a communications zone.55
When the area of southern France invaded from North Africa and Italywas added to the boundaries of the European theater on 1 November 1944,a whole new communications zone was fitted into the vast logistic operationin progress on the Continent. The Communications Zone, MTOUSA, supportingthe Seventh U.S. and the First French Armies, had extended its sphere ofcontrol to France from Italy. When the invaded area of southern Francebecame a part of the European theater, this command became an additionalcommunications zone command for the European theater, known as the SouthernLine of Communications. Its medical section, that of the former CommunicationsZone, MTOUSA, directed by Colonel Shook, continued performing its dutiesunder a new name in a different theater. With a staff of 19 officers and39 enlisted men, it directed the medical offices of an advance and a basesection supporting the armies in the south. Its work paralleled for somemonths that done by General Hawley`s office in directing the medical sectionsof the area commands in northern Europe. It supervised the standard medicalservice of the communications zone- operation of fixed hospitals for Armytroops and thousands of prisoners of war, control of disease, and distributionof medical supplies to elements of Southern Line of Communications andthe two armies. Its status was of brief duration; before the middle ofFebruary 1945 the Southern Line of Communications was disbanded and itstroops absorbed by Communications Zone, ETOUSA. Colonel Shook became deputyto the Surgeon, Communications Zone, ETOUSA (General Hawley). The surgeonsof the two area commands in the south continued operating with little change,now dealing directly with General Hawley is office.
Both the seven sections in the north (supporting the 12th Army Group)and the two in the south (in support of the 6th Army Group) expanded rapidlytoward the German border during late 1944 and early 1945.56After the armies and the chief battlefront in northern Europe had shiftedeastward, Normandy Base Section`s medical service underwent considerablechange. It became a rear-area service, hospitalizing prisoners of war,evacuating casualties through the port of Cherbourg, supervising the movementsof medical supplies, and furnishing care to troops passing through thestaging areas within the base section`s territory. When the Brittany BaseSection (which bad absorbed
55 (1) See footnotes 2, p. 304; and 4(3), p.307. (2) Annual Reports, Surgeons, Oise, Seine, Channel, and Normandy BaseSections, 1944.
56 (1) History, Medical Section, Southern Line of Communications,20 Nov. 1944-1 Jan. 1945. (2) Interview, Col. Charles F. Shook, MC, USA(Ret.), 31 Mar. 1952. (3) See footnote 4(3), p. 307. (4) Annual Reports,Surgeons, Delta Base Section and Continental Advance Section, 1944.
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Map 5.- European theater communicationszone, November 1944
Loire Section in December 1944) was added to Normandy Base Section earlyin 1945, the medical service of Normandy Base Section acquired responsibilityfor additional troops, including those of the Fifteenth U.S. Army who werehelping French forces in the coastal sector to contain German units holdingout around Lorient and St. Nazaire.
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The medical. service of Seine Section, situated as it was between theintermediate area and the rear of the communications zone, was largelyoccupied with receiving patients, distributing them to its hospitals, andevacuating them rearward by air, rail, and motor transport. To the northof Seine Section the larger area known as Channel Base Section reachedthe peak of its operations in the few months before the end of the war.After turning over to Normandy Base Section an area including Le Havreand Rouen, Channel Base Section acquired that part of Belgium previouslywithin the boundaries of Advance Section. Its surgeon`s office was alsoresponsible for U.S. Army medical activities within the area of Britishjurisdiction along the channel coast (map 6), especially in such portsas Antwerp and Boulogne. At least one-third of Channel Base Section`s medicalinstallations were within this area at the close of the war.
During early 1945 the most important area command of the communicationszone on the Continent, in terms of Medical Department strength and numberof medical installations, was Oise Section (known as Oise IntermediateSection after 2 April). More than half of the fixed hospitals on the Continent(many of which were grouped into large hospital centers) were located withinits boundaries by April, after it had absorbed most of the territory ofthe two advance sections.
Within the communications zone in the south, the most fully developedof the two sections was Continental Advance Section. The mission of itsmedical section continued to be that of giving immediate support to theSeventh U.S. Army, including fixed hospitalization, evacuation, and medicalsupply. (After this advance section moved into Germany its support of theFrench First Army was limited to the furnishing of supplies and equipment.)At the beginning of 1945 medical facilities in this section were fairlywell stabilized, but fixed hospitals passed to Oise Intermediate Sectionearly in April with the movement into Germany. The medical mission of ContinentalAdvance Section then became primarily that of evacuation and supply forthe Seventh U.S. Army and the continuation of medical supply for the FrenchFirst Army, along with provision of medical care for its own troops, displacedpersons, and prisoners of war. The other major element of the communicationszone in the south was Delta Base Section, which was comparable to NormandyBase Section in the north in that it included considerable coastline- theMediterranean coast of France. Most of its medical. installations wereconcentrated around Marseille. Continental Advance Section maintained thelarger number of general hospitals since it provided close support forthe 6th Army Group; Delta Base Section needed only enough beds for statictroops and long-term patients.57
57 (1) See footnote 4(3), p. 307. (2) FirstSemiannual Report, Office of the Surgeon, Continental Advance Section,1 July 1945. (3) Final Report, Medical Section, Delta Base Section, 25Jan. 1946. (4) First Semiannual Report, Office of the Surgeon, NormandyBase Section, 1 Jan.-30 June 1945. (5) First Semiannual Report, Officeof the Surgeon, Seine Section, 1945. (6) Semiannual Report, Medical Section,Channel Base Section, 1 Jan.-1 July 1945. (7) First Semiannual Report,Medical Section, Oise Intermediate Section, 1 Jan-30 June 1945.
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Map 6.- European theater communicationszone, 15 April 1945
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The medical service provided in the rearmost area of the communicationszone, the United Kingdom, underwent considerable change during the monthsthat troops were being readied for the cross-channel assault. Upon thesurgeons of Southern and Western Base Sections fell the burden of providingmedical service for the thousands of troops assembling in the marshallingareas of the southern coast. Many camp dispensaries and first aid stationswere set up to care for incoming troops. The base section surgeons hadto provide them. initial equipment and replacement supplies. Many fixedhospitals in Southern Base Section were designated "transit"hospitals as links in the chain of evacua-tion from the invaded areas,and mass evacuation of patients already being treated in these hospitalsto the hospitals of Western Base Section was undertaken by the SouthernBase Section medical service in order to make room for invasion casualties.
After the invasion and concurrently with the establishment of base sectionson the Continent, all the base sections in the United Kingdom were consolidatedunder a single United Kingdom Base, the former base sections becoming districtsof the new base. Colonel Spruit became United Kingdom Base surgeon; hisoffice, briefly in Cheltenham, was located in London near the end of October1944. His staff was larger than equivalent components in the continentalbase sections and larger than that of the theater surgeon`s office in alltheaters except the European and Mediterranean. At the end of 1944 it consistedof 81 officers, 1 warrant officer, 124 enlisted men, 45 members of theWomen`s Army Corps, and 83 civilians; its internal organization was identicalwith that of General Hawley`s office as of May 1945 (appendix B, p. 562)except that it lacked a Field Survey Division and a Historical Division.It was made up of some personnel left at Communications Zone-ETOUSA headquarterswhen General Hawley`s office moved to the Continent, as well as personnelof the medical section of the former Southern Base Section. At the outsetit assumed technical supervision of 64 general hospitals, 43 station hospitals,5 field hospitals, 19 hospital trains, and several medical depot companieswhich were operating 3 medical depots and medical sections in 13 generaldepots. Its numerous medical installations and units probably constitutedthe greatest concentration of U.S. Army medical facilities in history.From D-day to 7 May 1945, the hospitals assigned to the United KingdomBase cared for nearly 428,000 sick and wounded soldiers (including prisonersof war) returned from the Con-tinent, and nearly 160,000 patients fromtroops stationed in the United Kingdom.58
An important feature of base section administration after the invasionwas the hospital center- a group of fixed hospitals (general, station,and convalescent) operating under a single headquarters. Early in 1944three groups of hospitals at Cirencester, Malvern, and Whitchurch in westernEngland had
58 (1) Annual Reports, Medical Section, UnitedKingdom Base, 1944 and 1945. (2) See footnotes 4(3), p. 307; and 7(3),p. 308. (3) Annual Report, Supply Division, Office of the Surgeon, UnitedKingdom Base, 1 Sept.-31 Dec. 1944.
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been put under hospital center headquarters for the sake of more efficientoperation. With the consolidation of the base sections of the United Kingdominto a single base, responsible for administering over 100 hospitals (atthe close of 1944, 66 general hospitals, 32 station hospitals,. and 5 convalescentfacilities), it became even more useful to employ an intermediate administrativeheadquarters between the individual hospital and the United Kingdom Basesurgeon`s office.
With the onset of mass evacuation from the Continent to the United Kingdom,the grouping of hospitals into a hospital center brought added advantages.A hospital center would furnish enough vacant beds for the reception andcare of the 200-300 evacuees from the Continent which a hospital trainwould carry. Thus discharge at a single railhead, instead of at the separatelocalities of several hospitals (or instead of maintaining sufficient vacantbeds at a single hospital, thus losing bed capacity), would be possible.Moreover, a single hospital could be chosen to render all service providedin the entire group in a given specialty such as thoracic surgery, withall the thoracic surgeons from the various hospital staffs concentratedin the one hospital. In one of the largest centers, the 12th at Great Malvern,French patients were cared for as a group, and within a single hospitalat some centers were concentrated personnel skilled in chemical warfaremedicine as well as the necessary supplies, in readiness for a possiblelarge-scale influx of gas casualties.
After the invasion, additional hospital centers were established inthe United Kingdom. Seven operated there, mostly in southern and westernEngland and all under United Kingdom Base organization; they were locatedat Taunton (Somersetshire), Blandford (Dorsetshire), Devizes (Wiltshire),Cirencester (Gloucestershire), Great Malvern (Worcestershire), Whitchurch(Flintshire), and New Market (Cambridgeshire). By the close of December19441 45 general hospitals, 11 station hospitals, and 2 convalescent facilitieswere in operation in the continental base sections, and the grouping ofhospitals became practicable there as well. After January 1945, nine hospitalcenters were developed in the continental base sections: seven were innorthern and eastern France- Cherbourg, Paris (two centers), Nancy, LeMans (later at Vittel), Var-le-Duc, and Mourmelon-one in Liege, and onein Aachen. The commanding general of a hospital center commanded the hospitalsand other units and served as the communicating agent on technical, administrative,and professional matters with the office of the base section (or base)surgeon. Hospital centers proved more practicable in the European theaterthan elsewhere, for their usefulness depended in large measure upon theiremployment in connection with the mass evacuation of large numbers of casualties.59
59 (1) General Order No. 15, United KingdomBase, 2 Oct. 1944. (2) See footnotes 7(3), p. 308; and 58(l),p.349. (3)Annual Reports, 12th, 15th, 801st, and 802d Hospital Centers, 1944 and1945. (4) Letters, Maj. Gen. Paul R. Hawley, MC, USA (Ret.), to Col. JohnBoyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. Army MedicalService, 29 Aug. and 7 Sept. 1955, commenting on preliminary draft of thisvolume. (5) Report of the General Board, U.S. Forces, European Theater,on Medical Service in the Communications Zone, European Theater of Operations,Medical Section Study No. 95. [Official record.]
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The Ground Forces: 1944-45
The bulk of U.S. Army ground troops arrived in the European theaterafter January 1944. Until the fall of 1943, the major ground force elementin the theater had been V Corps; in October the First U.S. Army had assumedthe position of top ground force command. The Third, Ninth, and FifteenthU.S. Armies followed, building up in 1944 in that order. All were eventuallyin operation on the Continent under the command of 12th U.S. Army Group.The First U.S. Army surgeon was Col. John A. Rogers, MC. The Third U.S.Army surgeon, Col. (later Brig. Gen.) Thomas D. Hurley, MC, was succeededby Col. Thomas J. Hartford, MC (fig. 79). The Ninth U.S. Army surgeon wasCol. William E. Shambora, MC, and the surgeon of Fifteenth U.S. Army wasCol. L. Holmes Ginn, MC (fig. 80). From the Mediterranean theater cameanother American combat force, the Seventh U.S. Army- Col. Myron P. Rudolph,MC, surgeon- which landed in southern France 10 weeks after the Normandyinvasion. It and the First French Army were under the control of the 6thArmy Group. The First Allied Airborne Army, organized in August 1944 withoutany headquarters medical section, was under the direct control of SupremeHeadquarters, Allied Expeditionary Force.
In this theater, which contained the overwhelming majority of U.S. Armyground troops overseas, the army group became the highest ground force
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command. After September 1944, both the 12th U.S. Army Group and theAllied 6th Army Group were under the tactical control of SHAEF The headquartersof the 12th, which controlled the bulk of the American ground troops, becamein a sense the U.S. Army ground force headquarters in the theater organization.
The army group headquarters confined its activities for the most partto tactical and policy matters, being designed primarily, like the corpsheadquarters, for the purpose of coordinating the activities of subordinateelements. Hence the 12th Army Group surgeon- Col. Alvin L. Gorby, MC (fig.81), who had served as Armored Force surgeon in the United States- wasnot concerned with the direct supervision of medical service for troops;this was the province of the field armies and their subordinate elements.No table of organization existed for the army group surgeon`s office, asthe army group was a new organization; Colonel Gorby kept his medical section,one of 19 special staff sections, small and its organization simple. Itincluded no dental or veterinary officers or consultants, as the officesof army surgeons commonly did; its two chief elements were a Plans andOperations Division and Preventive Medicine Division. The peak strengthof personnel assigned to it was 14: officers and 10 enlisted men, althougha few additional officers assigned to the offices of army surgeons servedas liaison officers between their respective medical sections and ColonelGorby`s office.
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During the months of planning for the invasion, Colonel Gorby`s medicalsection (originally created as the medical section for 1st U.S. Army Group,the progenitor of the 12th) was occupied with working out, in cooperationwith the Chief Surgeon, ETOUSA, and the Chief Medical Officer, SHAEF, therespective responsibilities of the armies, air forces, and naval forcesfor medical supply and evacuation. Evacuation problems to which it devotedspecial attention were the methods of recording casualties, evacuationof casualties by water, and a system of property exchange whereby litters,blankets, and similar items transferred with evacuees would be replaced.For a brief period, from 16 May to 6 July 1944, it acted as the medicalsection for the American staff attached to rear headquarters of the British21st Army Group, the higher headquarters which directed the field armiesduring the initial stages of the invasion. From 7 July to the end of themonth, a period during which the medical section moved to France, it returnedto control of 1st U.S. Army Group but functioned once more under 21st ArmyGroup during its first month of activity on the Continent, the month ofAugust. After 1 September, it became the medical section for General Bradley`s12th Army Group which from then on functioned directly under SHAEF.
After September, when the Ninth U.S. Army launched the attack on theBrittany Peninsula, Colonel Gorby`s medical section had the task of allocating
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medical units among three armies-the First, the Third, and the NinthU.S. Armies. The shifting of units reached a peak at critical periods;some had to be loaned to 6th Army Group coming up from the south, and manyhad to be transferred after the German breakthrough in the middle of December1944. The office kept the tables of organization and equipment of MedicalDepartment units assigned to the army group under continuous review andrecommended changes. It kept in close touch with the medical office ofAdvance Section and other elements of Communications Zone for mutual arrangementsconcerning medical supply, evacuation, and hospitalization. It allocatedMedical Department units and critical items of medical supply, such aswhole blood, among the field armies and coordinated policies and techniquesdesigned to prevent trenchfoot, combat exhaustion, and neuropsychiatriccases- problems encountered by all the field armies in combat in Europeduring the winter of 1944-45.
The 6th Army Group, composed of the Seventh U.S. and First French Armies,and commanded by Lt. Gen. Jacob L. Devers had, unlike the 12th, no specialstaff medical section, but a few Medical Department officers and enlistedmen were assigned to G-4. Their work, limited by the size of the groupand its subordination to G-4, was confined to inspecting medical unitsof the two armies under 6th Army Group, the coordination of successivestages of evacuation, and the development of a workable system of propertyexchange between air and ground forces in air evacuation.60
The Surgeon, 6th Army Group, Col.. Oscar S. Reeder, MC (fig. 82), pointedout the excessive staff work which his medical section had to undertakebecause of its incorporation in G-4:
Under normal staff procedure the Surgeon deals with all general andspecial staff sections of a headquarters. Matters that require processingthrough Command Channels are forwarded through the appropriate generalstaff section, while technical subjects are coordinated directly with thespecial staff section interested. Technical matters comprise approximately90% of the work of the Surgeon. Under the initial organization of thisheadquarters, all such correspondence was routed through the A.C. of S.,G-4. This procedure forced considerable unnecessary detail to the attentionof this general staff officer, whereas, normally only the completely coordinatedstudies would have been presented. Furthermore, all incoming papers andmessages of interest to the Surgeon only were routed through the G-4 sectioninstead of being transmitted directly from the message center. This madethe G-4 section responsible for the action regardless of the subject.61
This direct Subordination of the staff surgeon to G-4 occurred in othercommands at intervals and sometimes evoked similar protests. In such cases,the surgeon frequently felt handicapped by lack of direct access to hiscommanding general. In May 1945, Colonel Reeder`s medical section was placed
60 (1) See footnotes 4 (3), p. 307; and 45(1), p. 336. (2) Report of Operations, 12th Army Group, vol. XIII: MedicalSection. (3) Interview, Brig. Gen. Alvin L. Gorby, 23 Jan. 1953. (4) History,Medical Section, 12th Army Group, 1 Jan.-30 June 1945. [Official record.](5) Annual Report, Surgeon, 6th Army Group, 1945.
61 Annual Report, Surgeon, 6th Army Group, 1944.
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oil the special staff of 6th Army Group, and he noted that the MedicalDepartment had then been placed "in its rightful position in thisArmy Group."62
All field armies had similar medical sections (in general conformityto a table of organization) at headquarters; they consisted of about 24officers and 30 enlisted men. The army surgeon was a colonel or a brigadiergeneral of the Medical Corps. Army medical sections usually included, besidesthe surgeon. and his executive officer, the following subsections: Administration,personnel, operations, training, preventive medicine, supply, dental service,veterinary service, nursing, and consultants. Since the field armies hadhospitals (field, evacuation, and convalescent) assigned to them, representativesof the professional services were needed at army headquarters; the staffnurse of Third U.S. Army, for example, supervised the work of an average600 nurses in the army`s hospitals. Officers of the staff medical sectionof the field army were frequently put on liaison duty with the headquartersof the various corps under the army, and additional officers were sometimesattached to the army medical section for special purposes; for example,a medical liaison officer of the air forces for arranging evacuation ofpatients by air from the army area to the communications zone.
62 Letter, Col. Oscar S. Reeder, to Maj. Gen.Albert W. Kenner, 5 May 1945.
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The offices of army surgeons operated as a unit at a single headquartersonly rarely. During the period of preinvasion planning in the United Kingdom,for instance, the First U.S. Army surgeon and part of his staff spent somemonths in London in order to work in conjunction with SHAEF and other planningheadquarters in completing the invasion plans; the remainder of the staffwas at the army`s command post in Bristol. During periods of combat onthe Continent, army surgeons` staffs Were usually split, along with therest of the army headquarters, into forward and rear echelons. Army surgeonswere usually concerned with the proper division of their staffs be-tweenthe two echelons. It was difficult to coordinate the work of the dividedmedical section, especially since Medical Department units assigned tothe field army also operated at times in two echelons. The Third U.S. Armysurgeon favored placing himself, his executive officer, the surgical consultant,his operations and training subsection, and his medical supply subsectionat forward echelon, leaving the rest of his staff- the dental, veterinary,and preventive medicine personnel, the remaining consultants, and staffengaged in personnel and administrative matters- at the rear echelon.
The field army had a large number of Medical Department units assigned;these were mostly concerned with the evacuation of patients from the divisionand corps areas and their treatment in army hospitals. Units assigned tothe field army in the European theater consisted chiefly of the following:Medical groups; medical battalions; separate collecting, clearing, andambulance companies; field, evacuation, and convalescent hospitals; medicaldepot companies, auxiliary surgical groups, a medical laboratory, and anoccasional medical gas treatment battalion. The army surgeon was responsible(subject to coordination with the army staff) for training these unitsin the precombat period, for planning their movement into combat areasat the proper time and in the proper proportion (the so-called "phasingin"), and for their utilization during combat. Coordination of theevacuation process from forward areas called for close liaison by the armysurgeon`s office with each division and corps surgeon and his staff, andwith the medical staff at Communications Zone headquarters, and frequentlyled to a temporary redistribution of personnel or units. In December 1944,for example, the First U.S. Army surgeon had to supply from its units manyMedical Department enlisted men, as well as some officers, to divisionsunder the army; as a result it had to borrow in turn more than 300 MedicalDepartment personnel from Communications Zone units.63
During the European campaigns 15 corps were used among the 5 Americanfield armies on the Continent. Most were shifted from. one army to anotherin the way that the many divisions in the theater were reassigned amongthe various corps. The medical service functioning under the corps wasgeared to the standard concept of the corps as a tactical unit rather thanas a self-
63 (1). Annual Reports, Medical Sections, First,Third, Seventh, and Ninth U.S. Armies, 1944. (2) Annual Report, MedicalSection, Fifteenth U.S. Army, 1945.
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sufficient organization like the field army or the division. Hence thecorps surgeon had no Medical Department units under his control with theexception of a medical battalion which administered medical service tocorps troops (as distinct from divisions under the corps) and handled medicalsupplies for them. Occasionally other field army medical units (such asmedical groups, flexible organizations to which various types of technicalunits might be attached) served with the corps. Each corps headquartershad a small medical section composed typically of two Medical Corps officers,two Medical Administrative Corps officers, a warrant officer, and fourenlisted men. As in the case of the medical section at army group headquarters,Dental, Veterinary, and Nurse Corps personnel were not normally assigned.64
The Air Forces: 1944-45
Early in March 1941, USSTAF (U.S. Strategic Air Forces in Europe) replacedthe U.S. Army Air Forces in the United Kingdom. The new top American aircommand had control of the administration, including the medical service,of the Strategic Eighth and the tactical Ninth Air Forces. Am air servicecommand of the U.S. Strategic Air Forces was also organized; it was analogousto the Air Service Command, Army Air Forces in the United States.
General Grow, the surgeon of the Eighth Air Force, the Eighth Air ServiceCommand, and U.S. Army Air Forces in the United Kingdom, became the chiefmedical officer in U.S. Strategic Air Forces, serving under the CommandingGeneral, Air Service Command, USSTAF, who was also the Deputy CommandingGeneral for Administration, USSTAF. Although his office was placed at theservice command level, General Grow had ready access to the CommandingGeneral, USSTAF, Lt. Gen. Carl Spaatz, through the deputy commander underwhom he served. His medical staff included a deputy surgeon, executiveofficer, professional services officer, special projects officer, medicalstatistics officer, care-of-fliers officers, personnel officer, administrativeofficer, and later a nutritionist, a veterinarian, and a sanitary officer.65
Thus, from spring 1944 to the close of the war, the following air commandsof the European theater had medical sections at their headquarters: U.S.Strategic; Air Forces and Air Service Command, USSTAF, which had the combinedmedical section headed by General Grow; the Eighth Air Force; and the NinthAir Force (chart 19). Both headquarters, USSTAF, and Headquarters, AirService Command, USSTAF, were located just outside London in Bushy Parkuntil September 1944: when they moved to the outskirts of Paris where theycould maintain close liaison with SHAEF in Versailles. The headquartersof Eighth Air Force remained in Britain, but that of the tactical
64 See periodic reports of the surgeons ofV, VII, XII, XVI, and XX Corps, 1944 and 1945.
65 (1) Report of Medical Activities. U.S. Strategic Air Forces,1 Jan-1 Aug. 1944. (2) See footnote 29(1), p. 327.
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Chart 19.- Medical sections at majorU.S. Army Air Force commands in the European theater, March 1944.
Ninth Air Force which supported the armies in combat in Europe movedto France soon after the invasion of the Continent.
An Allied air command with a British-American medical office existedbriefly in the European theater. The Allied Expeditionary Air Force wascreated in November 1943 to direct the operations of British and Americantactical air forces committed to the invasion of the Continent. Since itcontrolled only the operations of the American tactical air force, theNinth (administrative matters in the Ninth being directed by the highestAmerican air force headquarters, U.S. Strategic Air Forces), the Americancomponent of the medical office at its headquarters, was never of greatimportance. It was headed by Lt. Col. James Jewell, MC, whose rather limitedduties consisted chiefly of giving information to the commander of theAllied air command on the health of troops of the Ninth Air Force, cooperatingwith his British colleague, and keeping in touch with the Medical Division,Supreme Allied Headquarters. The Combined Air Transport Operations Roommaintained by Allied Expeditionary Air Force allocated the requests itreceived for aircraft from various ground and air force commands amongBritish and American air transport agencies and thus exercised functionswith respect to medical supply and evacuation through controlling the meansfor furnishing these by air. With the invasion of Europe, Allied ExpeditionaryAir Force exercised considerably less authority than originally planned,and by mid-October 1044 it was disbanded, thus ending what has been called"the least successful venture of the entire war with a combined Anglo-Americancommand."66
66 (1) Craven, W. F., and Cate, J. L., editors:The Army Air Forces in World War II. Chicago: University of Chicago Press,1951, vol. II, pp. 561-562, 620. (2) Preliminary Operational Report, Surgeon,Ninth Air Force, 18 July 1944.
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After the main branch of Headquarters, USSTAF, moved to Paris in September,General Grow`s office maintained a small medical section at Headquarters,USSTAF (Rear), in London to direct medical service for air troops, chieflyof the Eighth Air Force, left behind in the United Kingdom. This officeacted as a link between the parent medical section in Paris and medicalofficers at headquarters of the Eighth Air Force. It dealt with the officeof the United Kingdom Base surgeon in arranging for hospitalization ofair force personnel stationed in the United Kingdom and supervised theindustrial hygiene program for civilian employees at large air force depotsin the United Kingdom. One of its officers was attached in a liaison capacityto the Rehabilitation Division of General Hawley`s office in order to givespecial supervision to the rehabilitation and training of air force troopsconvalescing in the general hospitals of the Services of Supply.
As medical section of the Air Service Command, USSTAF, General Grow`soffice advised the Director of Supply of that command on procurement, receipt,storage, distribution, and issue of medical, dental, and veterinary equipmentand supplies for the air forces and commands under the administrative controlof the Commanding General, USSTAF. As medical section at staff level, itcoordinated intra- and extra-theater air evacuation, research in aviationmedicine, and activities of the air forces and commands concerned withthe care of fliers and the rehabilitation of air force personnel convalescingat communications zone hospitals. Other duties included the examinationof medical equipment and protective clothing and safety equipment capturedfrom German planes and aircrews. General Grow`s office also undertook measuresto reduce industrial hazards in air force installations. It coordinatedwith other branches of USSTAF headquarters the medical planning for specialprojects and for postwar medical activities.
Supervision of technical work concerned with protecting the health offliers was centered in the Care-of-Fliers` Section of the surgeon`s officein the Eighth and Ninth Air Forces. The Care-of -Fliers` Section in GeneralGrow`s office had the task of coordinating their work. It planned and operatedrest homes for fliers, since these were used by both the Eighth and NinthAir Forces, and it allocated beds in the rest homes between them. Seventeenrest homes were in operation late in 1944; they served members of combatcrews suffering from fatigue or tension induced by participation in a numberof combat missions. The Care-of-Fliers` Sections in the surgeons` officesof the Eighth and Ninth Air Forces had ` the more immediate responsibilityfor protecting flying personnel of these commands against stresses, diseases,and injuries of an occupational nature. Their work was a special phaseof preventive medicine. They carried out their program largely by meansof the so-called "central medical establishment" developed ineach air force.
In the last 2 years of the war the central medical establishment wasin the process of evolution; the Air Surgeon`s Office in Washington advocatedthe
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creation of one for each numbered air force and toward the close ofthe war succeeded in establishing an official table of organization forthis unit. The First Central Medical Establishment, which served the EighthAir Force, was created in November 1943 by reorganizing the Medical FieldService School (Provisional) which the air force had been operating atPine Tree, England, since mid-1942. In 1942 the school had largely confinedits work to giving an indoctrination course in aviation medicine to newlyarriving medical officers who had not had this training in the United States.As most medical officers arriving for service with the air forces in 1943and later had had the course, the First Central Medical Establishment shiftedits emphasis to special problems being encountered by fliers in the Europeantheater. It also continued the training, which it had begun late in 1942,of special "oxygen and equipment officers," in the effort (laterconsidered successful) to reduce casualties due to failures, defects, ormisuse of safety equipment. Trained officers gave in their turn continuousinstruction to combat crewmen in the elementary principles of aviationmedicine and the use of protective equipment. The First Central MedicalEstablishment also engaged in some research, with the aid of an Engineerofficer, on possible defects in personal flying equipment, suggesting modificationsand devising several new items. A central medical board of the establishmentdetermined the qualifications or disqualifications for flying of borderlinecases referred to it, primarily from combat units. In March 1944 a similarunit, termed the Third Central Medical Establishment, was organized inthe Ninth Air Force.67
Army Air Forces pressure for control of its own hospitals in the Europeantheater increased early in 1944. Although neither General Grow nor thesurgeon of the Ninth Air Force, Colonel Kendricks, shared the enthusiasmof the Air Surgeon for putting fixed hospitals under Army Air Forces controlin the European theater, General Grant had kept up the fight in Europe,as well as in other oversea areas. The matter was brought to the attentionof President Roosevelt, who appointed a board to survey the situation inthe Euro-pean theater. The three members of the board- The Surgeon General,the Air Surgeon, and Dr. Edward A. Strecker, consultant in psychiatry tothe Secretary of War- went to Europe in the spring of 1944, visiting hospitalsin which patients were preponderantly of the air forces and conferringwith air force commanders. The board decided in favor of the existing systemof hospitalization, which, it found, was operating satisfactorily, andrecommended that no changes be made on the eve of invasion of the Continent.During the remainder of the war General Hawley, strongly supported by The
67 (1) Annual Reports, Medical Department Activities,Eighth Air Force, 1943 and 1944. (2) General Order No. 51, Headquarters,Ninth Air Force, 17 Mar. 1944. (3) Special Order No. 186, Headquarters,Ninth Air Force, 26 Mar. 1944. (4) Annual Report, 3d Central Medical Establishment,Ninth Air Force, 1944. (5) Report, Medical Department Activities, U.S.Strategic Air Force, Aug.-Dec. 1944.(6) See footnote 29(l), p. 327.
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Surgeon General, maintained control of fixed hospitals in the Europeantheater.68
Medical Department officers of the air forces in Europe took part intwo special missions auxiliary to operations in the European theater butoutside its boundaries. In the summer of 194:4 the Surgeon, USSTAF, aidedin planning medical service for the Eastern Command, USSTAF, establishedin Soviet Russia to facilitate the Shuttle bombing of Germany. A commandsurgeon was assigned, and a 75-bed dispensary, in effect a small hospital,was set up at each of the 3 airbases established east of Kiev. During theirstay in Russia, the command`s medical officers found the Soviet medicalauthorities generally cooperative and intensely interested in methods usedby the U.S. Army Air Forces. Under the close supervision of the Russians,American medical officers visited Soviet hospitals and bases. Their workwas of relatively brief duration. A crippling blow to the main base atPoltava, delivered by the German Air Force 3 weeks after the first shuttleflight, reduced their effectiveness, while the westward advance of theRed Army soon left them far behind the lines.69
The Eighth Air Force also gave some medical aid to American airmen internedin Sweden, amounting by the end of July to the men of 94 aircrews. Themedical officer who headed the program was assigned to the office of theU.S. Military Air Attaché of the American Legation in Stockholm.During the fall of 1944, officers sent to Sweden surveyed the health ofinternees at the eight camps maintained for them, determined immediatemedical needs., and arranged payment for the services of Swedish physicians.In addition to their basic assignment, they assisted the Office of StrategicServices with the medical care of American personnel secretly dropped byair in Norway, advising Norwegian doctors who cared for the Americans andaiding them in obtaining medical supplies from the United States.70
As the invasion of Germany got under way, Medical Department officersof the air forces made increasingly active inquiry into developments inaviation medicine within the German air forces; this work became a specialphase of the investigation of all aspects of German military medicine beingundertaken by the Combined Intelligence Objectives Subcommittee. In thespring of 1945, flight surgeons of the Eighth and Ninth Air Forces weresent to Germany to work with the medical intelligence teams which accompaniedthe
68 (1) Letters, Col. Edward J. Kendricks, MC,to Maj. Gen. David N. W. Grant, 18 July, 20 Aug. 1944. (2) Memorandum,Maj. Gen. Norman T. Kirk, The Surgeon General, Maj. Gen. David N. W. Grant,and Dr. Edward A. Strecker, for the Chief of Staff, through the DeputyTheater Commander, European Theater of Operations, U.S. Army, 20 Mar. 1944.(3) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. Malcolm C. Grow, 27Mar. 1944. (4) Annex 4 to Ninth Air Force Plan for Operation OVERLORD,pt. II, Medical Plan, 24 Mar. 1944. ((5) Interview, Brig. Gen. Edward J.Kendricks, MC, 23 Feb. 1950.
69 (1) Craven, W. F., and Cate, J. L., editors: The Army AirForces in World War II. Chicago: University of Chicago Press, 1951, vol.III, ch. IX. (2) Quarterly Report, Medical Department Activities, EasternCommand, U.S. Strategic Air Forces in Europe, January-March 1945. (3) SpecialMedical Report, Eastern Command, U.S. Strategic Air Forces in Europe, 12June 1944.
70 Potter, F. A.: History, Legation of the United States ofAmerica, Stockholm, Sweden, 27 Sep-tember 1944-9 July 1945. [Official record]
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advancing armies and investigated German medical installations. TheDirector of Medical. Services, USSTAF, maintained at his rear office inLondon an aeromedical research section which acquired information, documents,and materiel pertaining to the medical service of the Luftwaffe.This office interrogated doctors and pilots of the Luftwaffe andforwarded documents and captured materiel of significance to aviation medicinesent them by field investigators to the Aero-Medical Research Laboratoryat Wright Field, Ohio. Later an aeromedical museum established in Londonat the request of the Director of Medical Services, USSTAF, served as adepository for the examination of medical items, flying equipment, air-searescue equipment, protective chemical warfare equipment, and emergencyrations used by the Luftwaffe.71
Medical Care for Civilians in Liberated Countries
The organization which handled the public health programs among thepopulations of Europe liberated by the advancing Allied armies eventuallybecame an elaborate network functioning at higher levels of command undera general staff section termed G-5. This chain of control, separate fromthe office of staff surgeons with responsibility for the health of troops,was more completely established after the orthodox concept in the Europeantheater than in any other area during the war. However, a number of factors-chiefly post-invasion developments on the Continent-tended to disturb thestandard organization in the later months of the war and to thrust moreand more responsibility for the medical. program for civilians upon theoffices of command surgeons whose primary responsibility was for troops.
A Medical Department officer was assigned to the Civil Affairs Section,a special staff unit of Headquarters, ETOUSA, in July 1943.72Only two or three Medical Department officers worked in this Public HealthDepartment, as it was called, of the Civilian Relief Branch of the CivilAffairs Section. During this early period the specialized functions ofvarious Wax Department corps were not closely adhered to in the organizationfor civil affairs. An Engineer Corps officer, for example, headed the PublicHealth Department at one period, while the Medical Department officer whoheaded the Public Health Department for a time was later put in chargeof the entire Civilian Relief Branch. The work of Public Health Departmentofficers in the fall of 1943 was largely a job of planning the desirableorganization, maintaining liaison with General Hawley`s office, furnishinginformation to visiting officers from the War Department`s Civil AffairsDivision, and planning for medical supplies for civilian use. A small PublicHealth Department (absorbing most of the medical personnel of Civil AffairsSection, ETOUSA) was established in
71 (1) See footnotes 29(l), p. 327; and 69(2),p. 361. (2) Medical History, U.S. Air Forces in Europe, 1945. [Officialrecord.] (3) Quarterly Report, Medical Department Activities, Eastern Command,U.S. Strategic Air Forces in Europe, Aug.-Dec. 1944.
72 A civil affairs officer had been assigned to the theaterheadquarters staff as early as August 1942 (General Order No. 26, Headquarters,European Theater of Operations, U.S. Army, 1942), but no medical subelementhad been developed in his office.
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the Office of COSSAC (Chief of Staff to the Supreme Allied Commander),the Allied military office for planning which preceded the establishmentof the full Allied command. Here, too, the Public Health Department wasplaced under the Civilian Relief Branch. The group of Medical Departmentofficers which constituted it had the job of coordinating the plans fora civilian medical program being made by the Americans with those beingdrawn up by the British.
One medical officer, Lt. Col.. Carl R. Darnall, MC, who held a numberof posts in the European civil affairs program, both medical and nonmedical,and at various command levels, noted several defects in the organizationfrom an early date. He found the subordination of the public health branchto a "civilian relief branch" at various levels disadvantageousto the planning of health programs for occupied territories; nonmedicalofficers were insufficiently interested in the public health aspects ofcivilian relief and were inclined to discourage any communication by membersof the public health branch with Medical Department officers responsiblefor the health of troops, including General Hawley. Colonel Darnall workedclosely with Medical Department officers assigned to the normal militarymedical service for troops, including General Hawley and his staff at Londonand Cheltenham. He proposed the complete removal of public health mattersfrom the civil affairs organization to the control of the theater surgeonand the other usual special staff medical sections of subordinate headquarters,but his ideas gained no headway during the planning period. His criticismswere echoed by other Medical Department officers in 1944 and 1945 whenthe public health program got under way.73
By the end of 1943, a few Medical Department officers had been assignedto the civil affairs element of theater headquarters; to that of the Officeof COSSAC; and to that of 1st Army Group, as 12th Army Group was initiallycalled. The next step in the development of the organization to handlecivilian affairs was the creation of the European Civil Affairs Division,which trained both American and British personnel, including U.S. ArmyMedical Department officers, for field work in civil affairs.
The European Civil Affairs Division was a subordinate agency of theCivil Affairs Division (or G-5) of Supreme Headquarters, Allied ExpeditionaryForce. Although it was organized, like the regular tactical division, intoregiments, companies, and so forth, its primary function was to train personnelin all aspects of civil affairs and hold them until the field armies shouldneed them. American medical personnel for the division were selected bythe Office of The Surgeon General and arrived in England from January 1944on. They were trained, along with officers assigned to other aspects ofthe civil affairs program, at the American School Center at Shrivenham.Of the approximately 175 American officers assigned to the division towork on one aspect or
73 (1) Darnall, C. R. : Report of Medical CivilAffairs Planning and Organization, 31 Oct. 1944. [Official record.] (2)Study No. 32, Civil Affairs and Military Government, Organization and Operations,by General Board [established 17 June 1945], U.S. Forces, European Theater,no date.
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another of public health, about 60 were physicians, the remainder beingdentists, sanitary engineers, nutritionists, entomologists, biologists,veterinarians, agriculturists, bacteriologists, research workers, publicwelfare officers, and administrative officers. A few served with the PublicHealth Branch, SHAEF, either on the permanent staff or as consultants,some on the staffs of army groups and armies. A good many worked eventuallywith the advancing armies or with the reestablished national governments.74
The civil affairs detachments (called "military government detachments"in Germany) and the country missions were the two main types of field unitscreated out of the European Civil Affairs Division. The detachments servedat the division, corps, or army level; as army rear boundaries advanced,the detachments theoretically passed to the control of the CommunicationsZone (that is, to its area commands) to be returned later to the EuropeanCivil Affairs Division for reassignment to forward elements of the armies.Few, however, seem ever to have been reassigned under this plan. They wereso scarce that they were either husbanded by the armies for immediate reuse,intercepted by some other organization en route, or left by the armiesat larger towns where local authorities were unable to cope with civilproblems.75
Country missions, so-called, were organized in England within the frameworkof the European Civil Affairs Division in the early months of 1944 to serveas liaison agencies between the national governments of the liberated countriesand Allied military authorities. Missions served in Norway, Denmark, Holland,Belgium, Germany, and France. In general, the mission for each countrywas provided with one or two medical officers and a Sanitary Corps officer,specialists in various fields being added according to the needs of thecountry in which they operated. The mission estimated the kinds and quantitiesof medical, sanitary, and food supplies which the national governmentswould have to obtain from Allied military sources. It investigated sanitaryconditions, outbreaks of disease, and the status of nutrition in the civilpopulation and aided in establishing measures to control venereal diseaseand to report communicable diseases. Both the Allied military authorityand national governments could get from the country mission informationon medical matters affecting the mutual welfare of the population and ofAllied troops, and each could use the mission as a medium for representingits interest to the other.76
Shortly before the invasion of Europe, the organization for administeringthe Army`s public health program became stabilized within the G-5 chainof control. The chief development was the establishment of a public health
74 (1) Report, Public Health Branch, G-5, SupremeHeadquarters, Allied Expeditionary Force, Observations and Comments UponIts Organization, Operations, and Relationships, by Dr. W. F. Draper, nodate. (2) See footnote 73(2), p. 363. (3) Williams, Ralph C. : The UnitedStates Public Health Service, 1798-1950. Washington: Commissioned OfficersAssociation of the U.S. Public Health Service, 1951, p. 698ff.
75 See footnote 73 (2), p. 363.
76 See footnote 74 (1).
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branch at Supreme Headquarters, Allied Expeditionary Force, in May.Lt. Col. Leonard A. Scheele of the U.S. Public Health Service, who hadserved in the public health program in North Africa and Italy, had beenassigned to G-5, SHAEF, soon after the command was created, but no fullydeveloped medical group had existed there. The establishment of the fullydeveloped branch took place only pursuant to a visit of Col. Thomas B.Turner, MC, Director of the Civil Affairs Division of the Surgeon General`sOffice to the European theater early in the year. Colonel Turner notedthe same lack of centralized control over the public health program atstaff level in SHAEF that he had marked in Allied Force Headquarters duringa previous trip to the North African theater. He recommended that a publichealth element be established within every level of the civil affairs organizationin the European theater, with the chief public health officer directlyresponsible to the chief civil affairs officer.77
The Public Health Branch, G-5, SHAEF, became the top medical officedirecting the medical program for civilians, existing from May 1944 untilthe dissolution of the Allied command in July 1945. Brig. Gen. (later Maj.Gen.) Warren F. Draper, Deputy Surgeon General of the U.S. Public HealthService (fig. 83), assumed charge of the branch at the request of the Secretaryof War and on recommendation by The Surgeon General (General Kirk). A Britishofficer served as deputy chief. A few other officers and enlisted personnelwere engaged in preventive medicine and medical supply activities and administrativework. Consultants in the following medical specialties or special fieldswere attached to the branch: Nutrition, sanitary engineering, venerealdisease, veterinary disease, narcotics control, public health nursing,and general field inspection. Members of the United States of America TyphusCommission who worked on the antityphus program among civilians in westernEurope were considered for administrative purposes as staff members ofthe branch.
Public health policies formulated by this group were conditioned, ofcourse, by military policies and practices and tactical considerations.The Public Health Branch advocated, for instance, that the Allied commandadopt, as a measure for control of venereal disease among troops, a policyof placing brothels out of bounds throughout the theater. However, existingmilitary policy placed responsibility for control of venereal disease amongtroops upon the individual field commander; hence some variation occurredin the policies and procedures adopted by the field commanders after theinvasion.78
77 (1) Memorandum, Director, Civil Public HealthDivision, Office of The Surgeon General, for The Surgeon General, no date(covers visit to ETOUSA, 24 Feb.-8 Mar. 1944), subject: Report on Plansfor Civil Public Health in the European Theater of Operations. (2) Memorandum,Col. Thomas B. Turner, MC, for The Surgeon General, no date, subject: Activitiesin the North African Theater of Operations. (3) See Medical Department,United States Army. Preventive Medicine in World War II. Vol. VIII. CivilPublic Health Activities. [In preparation.]
78 (1) See footnote 74 (1), p. 364. (2) Letter, Chief, PreventiveMedicine Service, Office of The Surgeon General, to Field Director, UnitedStates of America Typhus Commission, 26 Apr. 1944. (3) Letter, SupremeHeadquarters, Allied Expeditionary Force, to All Branches, G-5, 27 July1944, subject: Organization and Missions of Public Health Branch, G-5.(4) Memorandum, Supreme Head-quarters, Allied Expeditionary Force, forCommander in Chief, 21st Army Group, and Commanding General, 12th ArmyGroup, 25 Aug. 1944, subject: Revised Directive for Civil Affairs Operationsin France.
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Additional developments in May 1944 tended to fix the public healthprogram within the G-5 chain of control. At that date, the civil affairssection at the combined Headquarters and Communications Zone, ETOUSA, andone at 12th Army Group headquarters, both previously elements of the specialstaff, were shifted to the general staff level and termed G-5. A G-5, orcivil affairs division, with a small medical section or subsection, wasalso established at each army group and each army headquarters. Althougha G-5 element was established at corps headquarters and a special staffsection at division headquarters to handle civil affairs at these levels,as a rule no public health element was created on the staff of the corpsor division.79
Control over the public health program was maintained for some monthsafter May 1944 under G-5 direction at both Allied headquarters and theheadquarters of arm groups and armies. Within the combined theater andcommunications zone organization, on the other hand, a tendency towardshifting responsibility for the public health program to the regular medicalservice appeared almost as soon as the program was well established underG-5 control. The major responsibility of General Hawley`s office- to providemedical service for the military forces- increased with the establishmentof large base sections
79 (1) Operations Memorandum No. 19, ThirdU.S. Army, 21 June 1944. (2) See footnotes 73(2), p. 363; and 78(4), p.365. (3) Monthly Public Health Reports, 12th Army Group, 1944 and 1945.(4) Annual Report, Division of Preventive Medicine, Office of the ChiefSurgeon, European Theater of Operations, U.S. Army, 1944.
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on the Continent. Originally the large number of medically trained personnelin his office had naturally weighed against any idea of a buildup of thepublic health group in G-5 of the theater headquarters; consequently onlyone or two officers were assigned to G-5 at that level. A similar situationexisted in the base sections. After May 1944, a theater-communicationszone headquarters tended to place an increasing share of the responsibilityupon General Hawley`s office and the offices of base section surgeons.
About the same time that the Civil Affairs Division of the theater-communicationszone headquarters was shifted from special staff level to G-5 (23 May 1944),a theater directive made General Hawley`s office responsible for certainduties in the civil medical program. It was to requisition, procure, store,and issue medical supplies for civilian use, to supervise activities inpublic health and sanitation, and to rehabilitate civil hospitals; in July,a Civil Affairs Branch was established in the Operations Division of hisoffice to handle these responsibilities. A directive of September alsoadded to his office the responsibility for furnishing technical adviceand aid to personnel directly assigned to the civil affairs program. Althoughthese directives conflicted with similar outlines of the responsibilitiesf or the public health program issued by Allied headquarters, the tendencyto place upon General Hawley`s office additional responsibilities for civilianscontinued. Clearer duties for the Civil Affairs Branch of his office emergedwith the advance of the armies into western Europe late in 1944. It wasthe obvious choice for two medical jobs, left in the wake of the advance,requiring coordination among the base sections, which could best be handledthrough the normal technical channels of the Communications Zone. One wasthe assembly of medical supplies captured from the enemy and their allocationand distribution to the various base sections for civilian use. The otherwas the procurement of medically trained personnel to supervise medicalservice for thousands of displaced persons en route to their homes by train.80
The 23 May 1944 directive was not interpreted in the same way at allechelons, and for a time there was a general confusion as to the channelsof control over the public health program. At many levels, however, thestaff surgeons and medical officers assigned to the G-5 sections cooperatedclosely with each other despite their conflicting theories and interests.At none of the army groups and army headquarters were there more than oneor two Medical Department officers assigned to G-5, and many of these wereinclined
80 (1) Memorandum, Headquarters, European Theaterof Operations, U.S. Army, for Chiefs of General and Special Staff Sections,European Theater of Operations, U.S. Army, 23 May 1944, subject: StaffDuties and Responsibilities for Civil Affairs. (2) Memorandum, Headquarters,European Theater of Operations, U.S. Army, for Chiefs of General and SpecialStaff Sections, European Theater of Operations, U.S. Army, 25 Sept. 1944,subject: Staff Duties and Responsibilities for Civil Affairs. (3) AnnualReport, Civil Affairs Branch, Operations Division, Office of the ChiefSurgeon, European Theater of Operations, U.S. Army, 1944. (4) Annex 7 toPeriod Report, Civil Affairs Branch, Operations Division, Office of theChief Surgeon, European Theater of Operations, U.S. Army, 1 Jan.-30 June1945. (5) Civil Affairs Administrative Memorandums Nos. 8 and 9, CommunicationsZone, European Theater of Operations, U.S. Army, 8 Aug. 1944.
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to work closely with the staff surgeons of their respective commandsfor two main reasons. The first was the conviction, fairly widespread amongmedical officers, that the staff surgeon should control all medical programs,whether for military personnel or for civilians, in which the command engaged.The second, a very practical reason, was the fact that the staff surgeoncontrolled the so-called "medical means" of the command; thatis, the medical supplies, personnel, transport, and other facilities onwhich those assigned to the public health program with the field armieshad to depend whenever their own means became scarce. The Chief MedicalOfficer, SHAEF (General Kenner), had declared, when Colonel Turner`s planhad been proposed early in 1944, that public health officers assigned toG-5 would not be able to function properly in a combat area and had recommendedthat they not be so assigned at the corps and division level. He had alsowarned of possible difficulty if the command surgeons were called on todivert to civilian use medical supplies needed for troops and noted thatmedical units lacked the personnel and the means of transport to handleextra medical supplies earmarked for civilians.81
As it turned out, over the long run the staff surgeons of armies andarmy groups, as well as the theater surgeon and base section surgeons,had to assume more and more responsibility for handling public health problemsencountered during the eastward sweep of the armies into France. By November1944, the Third U.S. Army had had to set up a half dozen assembly centers,or camps, for displaced persons and staff them with medically trained personnel.More and more cases of diphtheria and other communicable disease were foundamong civilians, and rapid immunization of the population against themon a large scale had to be undertaken. Immunization of animals againstfoot-and-mouth disease was necessary, as well as the burial of thousandsof dead animals as a protection against water contamination. The crisiscame with the advance of the armies from the east and south into Germany.
The thousands of displaced persons freed by the advance into Germanyadded to the U.S. Army`s responsibilities in sanitation and medical carefor civilians; in the late spring of 1945 many had to be taken into hospitalsintended for troops. The Third U.S. Army reported, for instance, more than13,000 civilians admitted to its hospitals in May. The increasing numbersof cases of typhus encountered, particularly among displaced persons andthe inmates of concentration camps, made necessary the dusting of thousandsof civilians with DDT. In April the Fifteenth U.S. Army established a cordonsanitaire along the east bank of the Rhine to prevent the transfer of louse-bornetyphus west of the river by displaced persons returning to their homes.Delousing stations were established at each port of entry; it was estimatedthat by the end of June 1945 well over a million people had been dustedwith
81 (1) See footnotes 73 (1), p. 363; and 77(3), p. 365. (2) Letter, Brig. Gen. John A. Rogers, USA (Ret.), to Editorin Chief, Medical Department, United States Army in World War II, 5 Sept.1950. (3) Memorandum. Maj. Gen. Albert W. Kenner, for Assistant Chief ofStaff G-5, 2 Mar. 1944, subject: Directive on Public Health.
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DDT. Facilities, medical supplies, and medical personnel intended fortroops, and hence controlled by the staff surgeons of the armies, had tobe used in the civilian public health program. Twelfth Army Group estimatedthat the forces under its control eventually uncovered more than 4 milliondisplaced persons; responsibility for their care stretched available personnelto the utmost.82
A trip of inspection which General Kenner made in the latter part ofMarch convinced him that the G-5 organization, lacking personnel and facilities,would not be able to meet its commitments. After a conference with GeneralDraper and other G-5 medical representatives, as well as the 12th ArmyGroup surgeon (Colonel Gorby), he prepared a SHAEF directive on 14 Aprilwhich turned over the total responsibility within the army groups and armiesin enemy-occupied territory to the commanding officers of all commandsand their staff medical officers. Under the directive (applicable to theBritish and French forces, as well as the American), officers formerlyassigned to public health work in G-5 of the armies and army groups werereassigned to the army or army group surgeons, who established a "publichealth section" in their offices.83
A few other factors, besides necessity, were instrumental in bringingabout this shift of control. A significant one, of long-range importance,was the tendency of many Medical Department officers (doctors from civilianlife as well as those of the Regular Army) to believe that the regularmedical service was the most efficient agent for handling the Army`s responsibilitiesfor civil health. Staff surgeons pointed out that they needed control overthe program for civilians in occupied territories because of the closerapport between health conditions among civilian populations and the healthof troops. Some Medical Department officers assigned to G-5 did not likethe subordination of the civilian medical program to "relief"or "welfare," in the standard setup; others did not like theirimmediate subordination to a nonmedical officer. The affinity of medicallytrained men for each other led some of those assigned to G-5 to work moreclosely with the staff surgeons of their commands than with nonmedicalpersonnel in their own G-5 divisions.84
82 (1) Monthly Public Health Reports, ThirdU.S. Army, 1944-1945. (2) Memorandum, Field Director, United States ofAmerica Typhus Commission, for Chief, Public Health Branch, G-5, SupremeHeadquarters, Allied Expeditionary Force, 27 Mar. 1945, subject: Confirmationof Verbal Report on Visit to Ninth and First Armies to Investigate TyphusControl in Those Areas. (3) Letter, Head- quarters, European Theater ofOperations, U.S. Army, to Commanding Generals, U.S. Strategic Air Forcesin Europe, each Army Group, Communications Zone, each Army, and others,12 April 1945, subject: Establishment of a "Cordon Sanitaire."(4) Monthly Public Health Report, G-5, 12th Army Group, June 1945. (5)Report of Operations, 12th Army Group, vol. I.
83 (1) See footnote 82(l). (2) Monthly Public Health Reports,6th Army Group, 1944 and 1945. (3) Cable FWD SHAEF, to Commanding Generals,12th and 6th Army Groups, 21 Army Group, and Communications Zone, 28 Mar.1945. (4) Memorandum, Chief, Public Health Branch, G-5, Supreme Headquarters,Allied Expeditionary Force, for Chief Medical Officer, Supreme Headquarters,Allied Expeditionary Force, 16 Mar. 1945, subject: Future Organizationfor Public Health Branch, SHAEF. (5) Letter, Supreme Headquarters, AlliedExpeditionary Force, to Headquarters, 21 Army Group, Commanding Generals,6th and 12th Army Groups, and Commanding General, Communications Zone,European Theater of Operations, U.S. Army, 14 Apr. 1945, subject: PublicHealth Functions in Occupied Territory. (6) Diary, Maj. Gen. Albert W.Kenner, entries for March-April 1945.
84 See footnote 73 (1), p. 363.
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In retrospect, the chief of the Public Health Branch, G-5, SHAEF, GeneralDraper, pointed to the lack of sufficient trained personnel as the majorstumbling block in the way of the medical program for civilians. The workhad called particularly for men trained in control of communicable diseases,especially the venereal diseases, in medical supply work, sanitary engineering,nutrition, veterinary work, public health nursing, and control of narcoticdrugs. It had been necessary to use specialists in other fields, unversedin public health work, in positions for which public health training wasdesirable. An acute shortage of British health officers in 21 Army Grouphad made it necessary to loan 20 American officers for a time to the Britishfor public health work. As soon as the armies had thoroughly penetratedGermany, personnel assigned to public health duties at the G-5 level withinthe armies had been scarce in relation to the numbers needed to work amongthe thousands of displaced persons and the internees of the large concentrationcamps and to maintain a far-reaching typhus control program. Medical Departmentofficers thus had had to assume complete responsibility in many publichealth operations. In the interest of proper assignment and use of MedicalDepartment personnel, command surgeons responsible for the health of troopshad naturally insisted that they should administer the public health programand that the personnel formerly assigned to the G-5 level should be takenover by them. Nevertheless, General Draper maintained, administration ofthe program through G-5 channels was organizationally sound and logicaldespite its partial breakdown when unusual problems confronted it.85
CLOSEOUT IN THE EUROPEAN THEATER
During the spring of 1945, when the surrender of Germany appeared certain,plans were made for dissolving the Allied command and reestablishing theusual U.S. Army theater organization. When chiefs of staff sections wereannounced on 12 May, General Kenner became Chief Surgeon, ETOUSA, relievingGeneral Hawley, who had served in that capacity for almost 3 years. GeneralHawley soon returned to the United States as Medical Director of the Veterans`Administration. On 19 July, General Kenner became Chief Surgeon, U.S. Forces,European theater, as the postwar theater command in Europe was termed,and on 3 August, Chief Surgeon, Theater Service Forces, ETOUSA. The officesof the chiefs of technical services were located at Theater Service Forcesheadquarters; General Kenner`s medical section was so located. For a timeit was split between the main office of theater Service Forces headquartersin Frankfurt and its rear office in Versailles, the center of redeploymentand supply activities, but concentration of his staff in the main officein Frankfurt was effected by the autumn of 1945.86
85 See footnote 74 (1), p. 364.
86 (1) General Order No. 90, Headquarters, European Theaterof Operations, U.S. Army, 12 May 1945. (2) General Order No. 161, Headquarters,U.S. Forces, European Theater, 19 July 1945. (3) General Order No. 159,Headquarters, Theater Service Forces, European Theater, 3 Aug. 1945.
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A letter issued by Headquarters, U.S. Forces, European Theater, on 21August defined General Kenner`s responsibilities. His position became exceptionalamong the chiefs of technical services in that he was to serve as a specialstaff officer of the theater commander when acting in the capacity of ChiefMedical Inspector of all troops and installations in the theater. In supervisingthe furnishing of the normal medical service and supplies to U.S. Armytroops and to civilians attached to the Army, he was responsible to theCommanding General, Theater Service Forces. In general this situation markeda return to the setup which had prevailed before the creation of SHAEF.In order to make sure of his control over medical administration on a theaterwidebasis, General Kenner had made special effort to obtain a specific statementof his authority to make medical inspections of all troops and units inthe theater. He held the tenet that this authority would assure him theaterwidecontrol in spite of his location at the service force headquarters. Withthe dissolution of SHAEF, a simpler command structure had come into existenceand control over the medical service for the U.S. Army during its occupationof Europe became centralized.87
87 (1) Report of operations, Headquarters,Theater Service Forces, European Theater, 8 May 30 Sept. 1945. (2) Statementof General Kenner to the author, 26 Mar. 1956.
