Books and Documents

Operation Overlord

ANNUAL REPORT

TO THE

SURGEON GENERAL

FROM THE

THIRD AUXILIARY SURGICAL GROUP

FOR THE YEAR 1944

TABLE OF CONTENTS


Introduction    


Part I:   Preparations

Introduction    

Chapter I:    Administrative problems
    The policy of operation    
    The team roster    
    The nurses    
    Liaison with field hospitals    

Chapter II:    Training problems
    Officers    
    Nurses    
    Enlisted men    
    The medical battalions    
            Equipment    
            Maneuvers    

Part II:  Operations

Chapter I:      The beachhead
    Survey      
    The airborne teams    
    The seaborne teams    
        Utah Beach    
        Omaha Beach    
             The teams on the SS “Empire Anvil”    
             The teams on the SS “Dorothea Dix”    25
             The teams on LST #351    
    The remainder of the Group    
    Epilogue    

Chapter II:    The teams in the field
    General surgical teams    
            In clearing stations    
            In field hospitals    
            In evacuation hospitals    
            The “model” team    
    Specialist teams    
    Nurses' teams    
    
Chapter III:    Headquarters in the field
    Station list        
    Administration    
    Transportation    
    Operations    
            General surgical teams    
            Specialist teams    
    The rotation plan    
    The table of organization    
            Medical officers    
            Medical administrative officers    
            Nurses    
            Enlisted men    

Chapter IV:    The mobile units
    Mobile surgical units    
    Mobile X-ray units    
    Mobile dental units    

Chapter V:    Team statistics
    General surgical teams    
    In clearing stations    
    In field hospitals    
    In evacuation hospitals    
    In field hospitals acting as
        Evacuation hospitals    
            Further remarks    
    Specialist teams    
            Neurosurgical    
            Maxillofacial    
    X-ray   

Awards for exceptional service   
Purple Heart awards    
Killed and missing
    
Summary and conclusions    
 
Composite Statistics

Maps
The Normandy Beaches on "D" Day
Dog, Easy, & Fox Sectors of Omaha

   
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INTRODUCTION

Like every organization committed in the invasion of Europe, the Third Auxiliary Surgical Group met its first full-scale, all-out test in 1944. It is true that there had been one previous period of combat service in another theater but this included only half the Group and lasted little more than three months. Limited and brief though it was, the experience in 1943 did serve a purpose. It taught the men why they ware essential, where they should work, when they were needed, what equipment to ask for, and how to organize their teams. It was a sort of dress rehearsal.

The North African contingent returned to the United Kingdom in November 1943 and the entire Group was assigned to First Army the following month. Gradually the plans took shape. Teams were to be deployed, first in the clearing stations on the beach and later in the field hospitals. That these plane were carried out successfully is shown by the fact that 20 of the 25 general surgical teams were landed on the hostile shore within the first 38 hours. It is also shown by the fact that in the first six months, the Group surgeons operated on well over 11,000 patients, 2,000 of them with abdominal wounds and 1200 with chest wounds. In volume alone, such a record is unique.

The year was eventful also in personnel changes, administrative as well as professional. Before the first eight months of the year had passed, the Group had had three commanding officers and three executive officers:

Commanding Officers

1 Jan - 21 Feb        Colonel John F. Blatt
21 Feb - 24 Jul       Lt. Cal. Elmer A. Lodmell
24 July - 31 Dec     Colonel Joseph A. Crisler, Jr.

Executive Officers

1 Jan - 24 Apr         Lt. Col. Harry P. Harper
24 Apr - 22 Aug     Major William F. Maley
22 Aug - 31 Dec     Lt. Col.  Carl O. Francis

As for professional personnel, the considerable turn-over is well illustrated in these figures: During 1944, 56 officers left the Group and 70 joined it; 36 nurses left

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and 34 joined. Of the medical officer transfers, about one-third were for ill health, the other two-thirds for professional expediency. The Group still has about halt of the original 119 officers that left the States more than two years ago.

In a review of the year's activities, the material falls logically into two parts: preparations and operations. Each part has a chapter on administrative problems and on team problems. There are also chapters on the Normandy landings, the mobile units, and the surgical statistics.



PART I

PREPARATIONS

Introduction

The two components of the Group which had operated separately during most of 1943 were reunited in England on 22 December at Camp Bewdley near Stourport, Worcestershire, and this camp housed the Group in dwindling numbers for the first half of 1944. During these months, two major problems presented themselves:

(1)  First, to clarify the status of the teams in the hospitals, there had to be an official policy defining tactical deployment, professional responsibility, and functional jurisdiction. Experience in the south had shown that the teams could not do their best work without such a policy. Once this matter was settled, a team roster had to be made up. Next, a cognate plan had to be laid down for the nurses and finally the function of the auxiliary surgical personnel had to be integrated with that of the hospitals.

(2)  Secondly, to prepare teams and individuals alike for the task, there had to be a comprehensive teaching program incorporating the lessons of the campaign In the south and stressing the technical aspects of surgery in the field. This program was carried out, first at the Headquarters camp and later in the medical battalions to which the teams were attached for the invasion.

The first problem was primarily administrative, the second primarily professional. How they were handled is discussed in the next two chapters.

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Chapter I

Administrative problems

The policy of operation.

The plan that was adopted by the Army Surgeon and later published in Medical News No. 5, 29 April 1944 stipulated that the teams would be used both in field hospitals and in evacuation hospitals, on the following basis:

“When the team is attached to a field hospital, or to other medical units except evacuation hospitals, the operating surgeon will supervise the preoperative treatment, decide when to operate, do the operation, and devote himself to the alert conduct of the case after operation.”

“When the team is attached to an evacuation hospital, the chief of the surgical service is responsible for the preoperative preparation of patients, their selection for operation, and the direction of their postoperative care.”

In other words, in a field hospital the team surgeon assumes the entire responsibility for the surgical care of the patient, from admission to discharge. Hospital personnel participating in this work do so under his direction. The arrangement separates the administrative from the clinical department and makes it possible to have an efficient staff for each.

To stress the implicit function of the auxiliary teams and avoid the occasional misunderstanding that occurred in some evacuation hospitals in North Africa, the following sentence was inserted in Medical News No. 5: “Attention of the hospital unit commander is invited to the fact that these teams have been especially selected and designed to function as a surgical team and that the best interest of the patient is served by placing these teams where they can properly carry out their mission.”

Because field hospitals depend entirely on auxiliary teams for a surgical service, these hospitals might be considered the primary assignment for the Group. Only after all the operating field hospitals have their full quota of teams can the evacuation hospitals draw on what is left. With five field hospitals in First Army, it was calculated that the

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supply of teams would be ample under all except the most extraordinary conditions. This proved to be true.

These plans could become effective only after the field hospitals and evacuation hospitals on the beachhead had gone into operation and this would take several days at beat. Meanwhile, there had to be some provision for early surgery and so it was decided to attach a certain number of teams to the medical battalions with the engineers special brigades. The details are discussed in the next chapter. Here, it need be mentioned only that the plans called for the establishment of clearing stations just off the beach at an early hour. The stations were to be specially equipped for this purpose. As soon as the field hospitals opened, the teams were to be transferred from the clearing stations to the hospitals.

The team roster.

With the guiding principles thus laid down, the next thing was to assess the available personnel and arrange it to best advantage.

The table of organization for an auxiliary surgical group calls for 24 general surgical teams and an assorted variety of specialty teams, most of them consisting of three officers, a nurse, and two enlisted men. Such teams function very well in evacuation hospitals where there is enough extra help but not so well in field hospitals where the many added responsibilities place a great strain on the auxiliary personnel. It is true that the table of organization provides six shock teams but these are not sufficient to supply each surgical team with one, and further, shock work is an integral part of field hospital surgery and might as well be done by a member of the surgical team, or at least under his supervision. Triage too requires much time and altogether it would seem that a four-man team is in a much better position to keep up with the work than a three-man team. This conclusion had been reached at the end of the Sicilian campaign and has been amply confirmed in the present one.

Another consequence of the policy to deploy the teams in the forward area was that specialty teams were no longer needed in the specified numbers. This question too will be discussed at greater length in the next chapter and is touched on here only to point out the tendency. For instance, in an auxiliary surgical group working with a field army there is no need for orthopedists in the sense of accredited specialists in reconstructive surgery. Extremity work

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in the field is of an entirely different kind, a kind that can be done by well-versed general surgeons. Neurosurgeons and maxillofacial surgeons can be used but not to the extent anticipated in the table of organization. The greatest need is for team leaders with a sound knowledge of traumatic surgery equally at home in all parts of the body.

As for the enlisted men, here again it had been found in the south that two per team was insufficient to do justice to an operating room with two tables. With only two technicians on the job, it is very difficult to avoid delay between cases. With four technicians, on the other hand, it becomes possible either to operate two tables simultaneously, or at least to go from one to the other without waiting. Of the four technicians, one is a scrubbed assistant, another helps the anesthetist, and the remaining two circulate.

So the Group was rebuilt into general surgical teams of four officers and four enlisted men each, with the “North African” and the “English” contingents well mixed. The three orthopedists that were still with the organization at this time were placed on teams that also had competent general surgeons and the other specialists were given assignments as consultants or held in reserve. Thus, on D-day the Group had 25 general surgical teams, each one qualified and ready for the job.


The nurses

There were 65 nurses in the Group on D-day, but few of these had ever functioned as team-nurses. Both in North Africa and in England it had bean expedient to place the nurses on detached service more for general relief purposes than with assignments to specific teams. Consequently, there had been little opportunity for officers and nurses to work together in the operating room. The situation was far from ideal and as soon as the role of the teams in the field hospitals had been defined, work began to outline the role of the nurses in a similar manner.

The plan finally adopted was to make the Group nurses responsible for the operating room of the field hospital and to attach them for this purpose to the hospital rather than to the team. With five field hospitals in First Army, each one divided into three platoons, there were enough nurses to have four with each platoon. In that way, no matter to what hospital the teams were sent, they would always find auxiliary nurses familiar with local supplies. Several decisions prompted this decision.

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In the first place, it was realized that the teams would travel about a good deal, not only from one platoon to another but also from one hospital to another. If the nurses belonged to the teams and traveled with them, they would have great difficulty in making themselves instantly and equally efficient in all these places. Even though the same supplies are on hand in every hospital, they are not always kept in the same place and a nurse would no sooner have learned one arrangement than to be forced to study another. Especially in field hospitals where many patients arrive in desperate condition, it makes a great difference whether the tracheotomy tube, the flutter valve, the phlebotomy set, or whatever the emergency calls for is quickly produced or laboriously hunted. Under the proposed plan, the nurses could organize their supplies according to their own ideas and increase in efficiency as they went along.

Secondly, when a team has finished a run with a field hospital platoon, there are anywhere from 30 to 100 patients in the postoperative ward. These patients need a great deal of attention, often more than the six nurses with the platoon can give them. Intravenous infusions, colostomy dressings, gastric auctions, and waterseal tubes are but a few of the problems that require constant attention. It is true that extra nurses can usually be called from some other, inactive platoon, but the auxiliary nurses would do away with that necessity. The constant presence of these nurses would give the platoon a greater capacity and make for a closer bond between the hospital and the auxiliary surgical personnel.

Also, when a team already has four enlisted men, one of whom is in reality doing the work of a nurse, there is less need for a regular nurse as well. The whole scheme was designed to place the nurses where their training makes them most useful, that is in the supervision of the operating room and in the postoperative ward. The purely mechanical work can be done by enlisted men almost as well as by a nurse. Thus, responsibility would be shared according to ability and the whole team would become more flexible and more efficient.

As soon as the plan had been approved, work began to make it a success.

First came a weeding-out process. All the nurses were carefully examined to determine their physical and mental fitness for the task and those found wanting were transferred to other, more static organizations. Next, ten nurses were sent on detached service with various hospitals for a

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month of practical work in the operating room. Under the direction of the chief Nurse, examinations were given in the fundamentals of operating room technique and a roster was made up according to the findings.

This roster divided the personnel into groups of four, each group headed by a nurse with considerable experience or with an exceptionally good record in the examination. The qualified nurses gave a condensed course in the organization of a field hospital operating room (see next chapter) and a committee of the more experienced ones established contact with the field hospitals to work out standards for the supply of linens and other expendables. The Group nurses then undertook to help prepare these linens and they spent much of the remaining time running off some 5500 wrappers, 2400 half-sheets, 597 cuffed gowns, and 421 laparotomy sheets. Thus, when D-day came, the nurses too were ready.


Liaison with field hospitals.

One other important task remained. It was to create functional liaison with the field hospitals. For this purpose several officers who had had experience in the North African theater were detailed to visit these hospitals and help with the standardization of supplies and procedures. This was an opportunity to discuss whether to have one or two operating tents, whether an additional anesthesia machine was necessary, whether all tents should be laced into one roof, how to make durable tent liners, how much oxygen would be required in the first few days, and a host of other problems. Here also was a chance to learn about the questions in the minds of the hospital commanders and to lay the groundwork for an understanding. It was a busy month for Major Partington and his assistants and many follow-up visits had to be made. When the task was finished, D-day was only one week away.

It is now necessary to return to the first of the year for an account of the training activities.


Chapter II

Training problems

Officers

Between the beginning of the year and the departure of the first teams were three months of purposeful, pertinent preparation.

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The main object was to disseminate and adapt the experience in the southern theater and to this end the men who had just returned were probed by questionnaire, on the speaker's stand, and in the demonstration room. The questionnaires brought enlightenment on many controversial points, the speaker's stand became an open forum, and the demonstration room illustrated the practical side of field surgery. Topics discussed ranged all the way from triage to rehabilitation. Among the practical demonstrations were such diverse entities as malleable lights, Tobruk splints, flutter valves, anesthetist’s armboards, copper sulphate test sets, Meyerding pelvic rests, lighted retractors, three-way stopcocks for pentothal, ETO transfusion equipment, improvised suction devices, jackonette skin-drapes, plaster techniques, tidal drainage systems, skin-traction methods, and a host of others too numerous to mention. To broaden the scope, speakers were brought in from the outside and the whole program was rounded out with training films.

Through the cooperation of the G-3 section of the Army Surgeon’s office, many of the officers were able to attend short courses at American and English hospitals. Through individual efforts, others took refresher courses in anatomy and pathology or studied new procedures under British surgeons in Birmingham and in London. Still others went on loan to SOS for such projects as the ETO Manual of Therapy and the anesthesia course at the 120th Station Hospital. The Group also gave its own anesthesia course for a selected group of nurses.

Most of these activities came to an end on 28 March when 12 teams left Headquarters to join the medical battalions.

Nurses

The nurses took part in two ways: In the early months they acted as instructors for the enlisted men. Later, after their status had been clarified by the Army Surgeon, they had their own practical course in operating room technique. This course was organized by the nurses themselves under the supervision of the Chief Nurse and dealt with the main problems of operating room maintenance: sterilization, instruments, linens, rubber goods, etc. Instruction was individualized and all students had to demonstrate their ability in practical tests. Among the nurses who had been in the North African theater were several with field hospital experience and these became quiz-masters, always stressing the need for inventiveness and improvisation. It was fortunate that the Group was housed in a hospital so that there were ample facilities for this type of teaching.

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Enlisted men

The enlisted men continued to work with the mobile surgical unite. They too were taken in small groups for individual attention and it was gratifying to see how many eventually mastered the principles of sterile technique.

Because the facilities were available, groups of enlisted men from the field hospitals were sent to the Headquarters camp for similar classes in operating room work. Some 56 extra men were thus included in the program.

Although the emphasis was on the operating room, other subjects were not neglected. Besides the prescribed hours, there were frequent periods in tent pitching, tent repair, motor maintenance, generator upkeep, black-out discipline, economy of materiel and other important phases of
the work. When D-day came, every team had at least one man that could handle a truck and two men that could handle a sterile stock table. Some of the technicians were later developed as assistant-anesthetists and, others as assistants at the table. All of them showed that they had profited a great deal by the efforts of their teachers.

The medical battalions

The original plans called for four surgical teams with each of the three medical battalions and two with each of the two airborne medical companies. These 14 teams left Headquarters on 28 March. Later, it was decided to add two teams to each medical battalion and so six extra teams left between 19 and 22 April. Towards the middle of May, these plans were changed again so that the 61st Medical Battalion took over two teams from the 60th. Thus, on D-day, the 20 teams were distributed as follows:

Teams 1 to 8                      261st Med Bn          First Eng Spec Bg
Teams 7 to 12, 15 & 16     61st Med Bn            Fifth Eng Spec Bg
Teams 13, 14, 17, 18         60th Med Bn            Sixth Eng Spec Bg
Team 19 *)                        307th Med Co          82nd Airborne Div
Team 20 *)                        326th Med Co          101st Airborne Div

Teams 21, 22, and 23 remained in reserve and teams 24 and 25 were charged with the supervision of the mobile surgical units.

*) These teams were made up of volunteers.

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The task of the 20 teams with the medical battalions and companies was twofold:

(1)   To make sure that the clearing stations would have the necessary equipment for major surgery.

(2)    To test men and equipment on the pre-invasion maneuvers.

(1)   Equipment

The battalion medical officers had made great efforts to prepare the ground for the teams. Nevertheless, a good deal remained to be done. Much equipment had yet to be drawn or especially constructed. Under the direction of the team members, carpenters built stock tables, sawhorses, and plaster boards. Ordnance mechanics made Mayo stands, intravenous supports and taps for running water. Nurses from nearby hospitals sewed laparotomy sheets, glove containers, and muslin wrappers. Electricians wired overhead-reflectors, stand-by batteries, and malleable lights. Technicians checked instruments, autoclaves, and chests. The officers contributed to a small fund which bought trays, jars, and bottles for cold sterilization. Some equipment, such as anesthesia machines and suction machines was obtained only at the last minute, and other equipment, such as atraumatic catgut, Levine tubes, and aspirating needles, was never obtained at all. But on the whole, an admirable job was done through the cooperation of the medical battalion and the auxiliary surgical personnel.

After this had been taken care of, the teams helped with the loading plans. Each clearing station could only take three trucks or their equivalent in the initial wave, and that meant that each item had to be carefully evaluated for priority. Chests were packed and re-packed until they contained only the absolute essentials. It took a good many dry runs before the men were satisfied that all items were in their proper place.

Teams with the airborne medical companies had special problems. Here again, the company medical officers had laid the groundwork; the teams put on the finishing touches.

Landing schedules were to be as follows:

(1)     A glider-borne echelon on the night preceding D-day
(2)    A seaborne echelon on D-day
(3)     A second glider-borne echelon on the night of D-day

The whole purpose of the teams was to staff an installation

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that would be prepared to do major surgery from the very beginning. Because evacuation of casualties would certainly be impossible until ground- and airborne troops had established contact, the teams and their equipment would have to go in with the first wave. For the same reason, initial supplies had to be sufficient to outlast this period of isolation and yet, the weight and space allowance was extremely limited. Besides that, there would be landing losses and so everything had to be distributed over as many carriers as possible. Key-equipment would have to be carried in duplicate. Only with many precautions could one make certain that it would indeed be possible to do major surgery from the very early stages.

The teams took great pains with these precautions. After several last-minute changes, all the operating equipment had to be concentrated in a 1/4-ton trailer. This held basic and supplementary instrument sets, anesthesia supplies, splints, litters, stands, plasma, plaster, and small articles. In addition, each man carried a canvas field kit containing sterile debridement sets, towels, bandages, tourniquets, drugs, and odds and ends. Parachute bundles were to be dropped with replenishments.

Subsequent experience showed that, with the possible exception of plaster, the calculated quantities were adequate.


(2)  Maneuvers

During all this time, maneuvers were held with great regularity. Teams participated as follows:

With the 261st Medical Battalion
“Beaver”    28 March-1 April    Slapton Sands
“Tiger”       22 April-1 May       Slapton Sands

With the 61st Medical Battalion
“Fabius I”      28 March-1 April    Gower Peninsula
“Fabius II”    1 May-7 May          Slapton Sands

With the 60th Medical Battalion
“Duck”          l5 April-22 April    Bristol Channel
“Fabius II”    1 May-7 May        Slapton Sands

The pattern was much the same in all these. It involved. embarkation on the same type of boats as were to be used later on, debarkation on the same type of beach as would be encountered in France, establishment of beach clearing stations,

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and evacuation of simulated casualties. The conditions were extremely realistic, in one case dramatic, and as a result the whole complicated machinery of a seaborne invasion lost some of its mystery. There is no doubt that the teams benefited much from the experience.

It was on the “Tiger” maneuver that teams 2 and 3 treated the first war casualties handled by the Group in 1944. These two teams were aboard an LST that set out for the Channel on 27 April, along with seven other LST’s and a corvette. The E-boat attack occurred on the next morning at 0200 without any warning. Those who were on deck at that time saw the LST on their portside suddenly burst into flame. A few minutes later there was a thunderous explosion on the LST immediately to starboard. The stricken ship shuddered, broke up, and sank in a few minutes. Hardly had the men recovered from this terrifying sight when tracer shells started coming towards them. Within a matter of seconds there were 18 casualties, including the captain of the ship and his executive officer. It was a moment of grave danger.

Slowly the ship broke formation and headed back to port, while the team members attended the patients. At 0630 Portland Point hove into view and the teams accompanied the casualties to the naval hospital there. The men had escaped disaster by a narrower margin than they ever did before or since.

For the teams with the airborne medical companies there was an opportunity to go on practice flights and to become familiar with the loading and unloading of the gliders, with the technique of the take-off, with the conditions aloft, with the hazards of the landing, with the process of assembly, and in general with the tactics of airborne troops. They learned to orient themselves in the field, to help set up station, and to integrate their function with that of the medical company.

Towards the middle of May the medical battalions went to their marshaling areas and the teams went with them. Here they finished their preparations, had their final briefing, and said goodbye to England. On 1 and 2 June they embarked at various points along the south coast and on 5 June they sailed for France.

The men knew that they were on the way. It was a clear evening with a waning moon and as they looked up at the pale sky and saw the endless streams of gliders, they knew that the airborne teams were on the way too. Preparations were over. Action was about to begin.

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PART II

OPERATIONS

Chapter I

The beachhead

This chapter describes how the Group arrived in Normandy, particularly the events of D-day. On that crowded day, things were happening so fast in so many different places that it is difficult to follow them unless one consults the following outline and the maps in the appendix. D-day was 6 June, H-hour 0630. The outline arranges the various components of the Group mainly according to their time of arrival. It makes a convenient framework for the story.


The airborne teams

Utah beachhead

19.      Whitsitt    307th         Glider-borne        D-day     H-4 ½      Blosville
20.      Crandall    326th        Glider-borne        D-day     H-3          Hiesville

The seaborne elements

Utah Beach
261st Med Bn, First Eng Spec Bg

Omaha Beach
61st Med Bn, Fifth Eng Spec Bg

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Omaha Beach
60th Med Bn, Sixth Eng Spec Bg

The airborne teams

Team 19

This team was split for the invasion. It will be remembered that there were to be three waves, two airborne and one seaborne. The first wave was to carry the regimental medical detachments; the other two were to bring the medical company. At the last moment, the Division General requested that one team member be attached to the Division staff for surgical attention from the very beginning. This was Major Whitsitt. He went in, prepared to undertake emergency surgery with what he could carry on his person: two medical pouches filled with dressings and a jump kit containing part of a basic instrument set, sterile linens, suture materials, anesthetic supplies, etc.

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The take-off was at H minus 7. Sweeping around the tip of the Cotentin peninsula, the planes approached Normandy from the west. It was a clear, moonlit night and after they had dropped to 1000 feet, the men could see the outlines of the coast very plainly. Suddenly, there was a little puff of smoke in front of them, as of snow in a drift, and then a clatter as of hail on a tin roof. The glider was riddled with steel fragments but no one was hurt. After that, there were many of these little puffs and those who were near the windows could see the fiery paths of the tracers arching towards them. Scattered by the terrific barrage, the gliders were now cut loose one by one to start their perilous descent alone. It was directly over St. Mere Eglise.

As Major Whitsitt’s glider volplaned steadily downwards, it was sighted by several antiaircraft batteries which would have spelled certain doom, had a landing been attempted at that point. So the pilot veered south, looking for a field along the Carentan-St. Mere highway. In another minute he had selected one. The glider eased- down, overshot, and ground to a shattering halt in the ditch. It was H minus 41. Major Whitsitt was the first member of the Third Auxiliary Surgical Group to set foot on French soil, or rather to be thrown on it.

The crash killed the pilot and spilled the men as matches out of a box. Major Whitsitt was pitched 30 feet and landed next to Colonel Eaton, the chief of staff, who was knocked unconscious and suffered severe leg injuries. At this Instant, machine gun fire raked the field and Major Whitsitt had the choice of seeking safety or looking after Colonel Eaton. He looked after Colonel Eaton.

From this time till dawn, there was little he could do except to move his patient to a ditch and wait. Patrols wandered by, sometimes German, sometimes American. One never knew. When daylight finally came, there was the added danger of recognition. Mortar squads spotted the wrecked glider and laid their fire on it. Major Whitsitt commandeered a donkey cart but their road led past the glider and as soon as they reached this point, mortar fire broke out again. One of the bursts hit Major Whitsitt in the leg, fortunately not severely. Again he carried Colonel Eaton to a ditch and again he waited. In the excitement, the cart got away.

He now went on a reconnaissance and eventually was able to orient himself. But he could hardly leave the colonel helplessly exposed to enemy tire. So he returned. alternately

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scanning and crouching, dragging and pushing, falling and limping, the two men set out on their search of the chateau where Major Whitsitt knew a first-aid post to be. When they, got there, it was high noon and they were at the end of their strength.

But there was work to be done. The rooms were jammed with casualties, the battalion medical personnel was still widely scattered, and the parachute bundles had not been found. Borrowing linens from the French household and eking out his own meager supplies with whatever came to hand, Major Whitsitt set to work. Quickly he triaged the wounded, left instructions what he wanted done, pressed a dental officer into service as his anesthetist, and started his first laparotomy at H plus 8. In the evening, a company of German riflemen attacked the chateau and for a while it looked as if the entire group might fall into enemy hands but the paratroopers stood their ground and the Germans withdrew in the face of their determined fire. Inside, the work never stopped.

That same evening, the medical company landed but Major Whitsitt never saw his teammates until noon of D plus 2. He worked at the chateau without rest for 24 hours, then evacuated the remaining patients and worked another 24 hours with Major Crandall’s team in the chateau at Hiesville. Only then did be learn of his own company’s whereabouts. He joined it at its station south of Blosville at noon of D plus 2.

The rest of the team, together with most of the 307th Medical Company, took off from England in 21 gliders in the early evening of D-day. This second wave did not circle the peninsula but made straight for the Utah beachhead and released its gliders over the St. Mere area. Standing by one of the plexiglass windows, Captain Lavieri looked down on the panorama at his feet and calculated that the landing would take place within a few minutes. The next thing he saw made him break out in a cold sweat. The glider was heading straight for two burning tanks that had been set on fire by a German 88 less than 100 yards away. The pilot noticed the danger too and tried to overshoot the tanks but it was too late. Three things happened all at once: The glider was hit by a burst from the 88, it had its wings shorn of f by a row of trees and what was left of it settled down square on the burning tanks. In an instant, the fuselage was enveloped in a sea of flames. The men were trapped like rats.

The English Horsa glider is made of heavy plywood, so heavy that a strong man cannot ordinarily break it. Captain

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Lavieri is not a strong man. He stands five foot four and weighs only 115 pounds. But at this moment he became endowed with the power of desperation. With a magnificent flying tackle he cracked the wall, shouldered his way through it, and leaped to the ground. The others quickly followed. This was just what the Germans were waiting for. They had their machine guns ready and opened fire from another corner of the field. How the eight men, stunned and singed as they were, stumbled to the nearest ditch, and how they escaped the shower of burning gasoline when the 1/4-ton truck inside the glider caught fire and exploded will always be a mystery to them. But they did and they had the satisfaction later of seeing paratroopers rush the gunsite and put the crew out of action.

Meanwhile the glider carrying Captain Osteen had landed in the next field. Its contingent was also driven to cover by machine gun fire but when darkness tell the men were able to steal away and establish contact. Both Captain Lavieri and Captain Osteen reached the assembly area before dawn of D plus 1.

Captain Donovan’s glider was wrecked when the pilot tried to avoid a heavily defended field and ran head-on into a row of tall trees. The impact tore the glider asunder, killed the pilot, and catapulted the men into the next field. They drew the usual bursts of fire but managed to reach the ditch where they stayed till dark. Their maps had been destroyed in the crash but they found a French farmer who could orient them and they reached the assembly area towards midnight.

By morning, enough personnel and equipment had reached this area to set up station and on the morning of D plus 1 the team wont into action. It has already been mentioned how Major Whitsitt joined them here the next day.

Team 19 remained with the 82nd Airborne Division for its drive north to Montebourg and then south to Pont l'Abbe in a 36-day campaign which made great demands on their endurance and gave them every opportunity to prove their worth. Then they reverted to the field hospitals.


Team 20

The 326th Medical Company of the 101st Airborne Division had a somewhat different landing schedule. The plan called for the greater part of the company and the entire team

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to land with the first wave so that it would be possible to do definitive surgery on a full scale from the very start. Instead of using tents, this company selected a chateau near Hiesville from aerial photographs. The team packed all operating room supplies in a 1/4-ton trailer and in addition carried individual canvas kits with sterile debridement sets, premixed plasma, autoclaved linen, and a variety of small articles. They distributed themselves over five gliders to decrease the risk of total loss.

The take-off was at H minus 5, the landing at H minus 3 [hours]. The last 20 minutes of the flight which approached the peninsula from the west was very much as Major Whitsitt had experienced a few hours earlier, except that in addition to the antiaircraft and machine gun fire, a nightfighter broke through the formation over St. Sauveur and fired several bursts at Major Crandall’s glider. The bullets failed to find their mark but did scatter the gliders and caused some of them to be released prematurely over the inundated area southwest of the Carentan-St. Mere highway. From their altitude of 600 feet, the gliders could not roach the vicinity of the chateau and so they came down several miles short.

There were the wild careenings and the pancake landings, the full-speed crashes and the head-on collisions, the jackknife thrusts and the hedgerow somersaults, the machine-gun volleys and the mortar bursts, but none of this was enough to incapacitate the team members more than momentarily. The men rubbed their wrenched backs and sprained ankles, their cracked ribs and bruised limbs, their jarred spines and kinked necks, and then, with the sight and sound of bullets acting as an anesthetic, they gathered themselves together and set up the first battalion aid station in Normandy.  In spite of the darkness, they worked rapidly and they had already treated dozens of casualties when their stirrings attracted the attention of German mortar squads. The first shell struck directly under the wing of the glider with the medical supplies. If it had not been a dud, it would have injured every one of them. Quickly the men scattered and waited for the dawn.

As soon as it was light enough Major Crandall started to look for the chateau. Finding it was easier than entering it because there were Germans inside and they gave every indication of intending to defend themselves. So Major Crandall made a tactical withdrawal and waited until the paratroopers arrived. There followed a brief but violent struggle and the German garrison was overpowered. The Americans took over at H plus 1.

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They could hardly have made a better choice. The building was spacious, light, and warm and it contained an almost ready-made operating room. Not only that, but there was a large courtyard which made an ideal reception station and there was plenty of timber to Improvise litters. The only inconvenience of the courtyard was that it was flanked by a huge barn from whose warren-like hayloft last-ditch German snipers kept up a sporadic fire for days. But no one paid much attention to them.

Immediately, a surgery was set up and within an hour the yard was full of casualties, brought in on anything from German furniture to French donkey carts. Now also, more and more of the medical company personnel appeared from the surrounding woods and at H plus 3 the first operation in Normandy got under way. Major Crandall took charge of the operating room and kept several tables busy without interruption. In the evening, reinforcements arrived from the second glider-borne wave and the next day, a whole German medical detachment was captured and put to work in the yard. For several days, nobody had any nest. Hundreds of casualties that would otherwise have had to wait for evacuation to the beach were taken care of in this chateau. Medically, the arrangements were a complete success.

On D plus 3 at 2345, while Major Crandall was in the midst of a laparotomy, there suddenly occurred a violent crash and part of the ceiling landed on the table. Walls caved in and clouds of plaster dust obscured the scene. As the men picked themselves up from the floor there was another, even more violent explosion, and one wing of the building became a 60-foot crater. Two heavies had found their mark. Many were killed, scores were injured, and all equipment was lost. It was a black night for the 326th.

But eventually the injured were evacuated, new equipment was obtained, and the next day the company reassembled in an area north of Carentan. For 36 days, the team followed the Division in its assault on Carentan and then in its holding action along the line Carentan-St. Sauveur. During this time, over 2000 patients were handled and over 250 operated on. Major Crandall’s men became an indispensable part of the 326th and when the Division returned to England in July, they went with it. There was more work to be done.

Without undue digression, it may be mentioned here that this same team took part in the airborne invasion of Holland on 17 September. Again, Major Crandall went in with the first wave, only this time a whole field hospital platoon was delivered from the air. The experience was the same as in Normandy,

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namely that a glider-borne hospital element is essential for early, life-saving surgery on the seriously wounded and that surgical teams should be part of this hospital element. Major Crandall's and Major Whitsitt's teams deserve much credit for their pioneer work in this field.


The seaborne elements

Utah Beach

The beach clearing stations on Utah were operated by the 261st Medical Battalion, a veteran of the Sicilian campaign. There were three companies, each one with two teams. Two of the companies set up early on D-day, the third followed on D plus 1. The experience of these teams can be described very quickly.

Teams 1, 4, 5 and 6

Company “A” with teams 4 and 5 and Company “C” with teams 1 and 6 were transferred from their LCI to landing boats at about H plus 4 and taken to the beach. The fighting had already shifted inland by this time and the medical personnel was not molested. The only untoward development was that the north sector had not been completely cleared of German gunsites so that the clearing stations were shifted south. By H plus 6 Company “A” had selected its area back of Uncle Red and Company “C” its area back of Tare Green.

Casualties began to arrive at about noon. Because of some delay in the arrival of the trucks with the equipment, the operating tents were not ready till H plus 10 but the teams did not wait. Treatment began on one side of the field while the other was being combed for mines. When the surgical theater was ready, over a hundred patients had been triaged and variously splinted, dressed, medicated, prepared, plasma-transfused, and, in some cases, even intubated. The first operation started at H plus 11 in Company “C”, ten minutes later in Company “A”. From then on, there was no respite for a week.

Teams 2 and 3

Company “B” with teams 2 and 3 arrived on D plus 1 at 1700 and set up next to Company “C”. These teams gave the others their first rest in 36 hours but the breathing spell lasted only briefly because by midnight all three companies were functioning to the limit of their capacity. On D plus 2 a system of shifts was worked out and the next day, six Fourth Auxiliary teams helped for 24 hours before going on to the 42nd Field Hospital. The three reserve teams also made a one-
night

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stand here on D plus 4 but, taken by and large, it was teams 1 to, 6 that handled the bulk of the work on Utah and this is all the more remarkable when one realizes that the 261st Medical Battalion received from five infantry divisions during this time.

The teams remained with the clearing stations for approximately a week and then joined the field hospitals. One of them stayed for two more weeks to help with the evacuation of the casualties that stopped here on their way to England. Surgery was not an important function during this time however and the figures given in the statistical section apply almost entirely to the first six days of operation on the beachhead.


Omaha Beach

A glance at the map shows that Omaha had been divided into two parts: an area to the west for the 60th Medical Battalion and an area to the east for the 61st Medical Battalion.

The 60th Medical Battalion had one clearing company, the 634th, with teams 13, 14, 17, and 18.

The 61st Medical Battalion had three provisional “collecto-clearing companies”, each one consisting of a clearing platoon and a collecting company. The teams were attached as follows:

The 391st had teams 8 and 11
The 392nd had teams 10 and 12
The 393rd had teams 7, 9, 15, and 16

The detail map shows where these companies eventually established their stations. It also shows that the teams landed over a two-mile strip, from Dog White to Easy Red. The beach here was about 300 yards wide, rising gradually from a pebbled ridge, then dipping suddenly into an 80-foot tank-ditch, and finally culminating in a steep bluff that was studded with gun emplacements. These facts were to be important to the teams.

The 12 teams with these two medical battalions made the Channel crossing in three ships and were accordingly landed in three groups. There were two exceptions: team 11 led the first group in by six hours, and team 18 trailed the third group by two. For purposes of description however, the story of the team-landings on Omaha breaks down into:

Teams 8, 11, 15, and 16, on the SS “Empire Anvil”.
Teams 7, 9, 10, and 12 on the SS “Dorothea Dix”.
Teams 13, 14, 17, and 18 on the LST #351

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Teams 8, 11, 15, and 16

The 38 “Empire Anvil” dropped anchor 10 miles off Omaha very early in the morning of D-day and the men began the tense waiting period till it was their turn to debark. The first warning that all was not well came at H plus 2 when only one of the dozens of assault craft that had left before dawn returned, its crew Injured and Its gunwales blasted. Because no other naval personnel was available, two very young and very bewildered apprentice seamen were selected to man the craft for its second run. Their bewilderment was both a bane and a boon. Their task was to take the LCVP back to the beach with one-quarter of the collecto-clearing company and all of Major Serbst’s team. At H plus 2 they pushed off.

The wind was brisk and the sea choppy. Almost immediately the small boat began to take in water. Major Serbst soon realized that they would never reach shore that way so he ordered everyone to bail the bilges with might and main. Never was an order carried out so diligently, even though the men had to use their helmets for lack of a pump. But now, another discomfiture began to beset them, a violent mal de mer. Between bailing and belching, they peered anxiously towards shore for some clue of where to land.

What they were looking at was not Omaha at all but the British beachhead. The helmsman, in his unaccustomed role of navigator, had laid the course too far to the east and was making straight for Arromanches. Without realizing it, he had violated every rule of naval traffic, steered through an unswept minefield, and put the tiny craft square in the field of fire from a British destroyer. Until that time, the men had been too busy and too miserable to watch the duel between this destroyer and a coastal battery but they became sudden startled witnesses when the destroyer bore down at 30 knots, turned sharply a stone’s throw away, and let go a broadside of six-inchers that all but bowled them over. It was a very ungentle reminder that they were not on the right track.

Convinced that he would never make Omaha with his now half-swamped boat, Major Serbst ordered the course reversed and in another hour they were again alongside the “Empire Anvil”, wet, sick, shaken, and completely exhausted. The would-be sailor’s mistake had exposed them to great danger but saved them from the still greater danger of a landing on Easy Green at H plus 3 when withering fire raked every yard of it.

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But the day was only getting started. The men still had to land and so they hastily transferred to an LOT that had meanwhile become available and pushed off for the second time. At the regulating ship they heard what they were now beginning to suspect: conditions on the beach were extremely hazardous and landings could be attempted only at intervals. They were just in time to make a run for it. When their vessel ran aground half an hour later, it delivered the first Third Auxiliary team to the Omaha beachhead. The time was H plus 5; the sector Easy Green.

The sight that greeted these men was not one to make them congratulate themselves. Dead and wounded lay everywhere. Wrecked vehicles, stranded trucks, twisted weapons, blown-up DUWKS [DUKWs], floundered bulldozers, burled landing-boats, disintegrated equipment of all sorts, these things were mute evidence of what had gone on. What was going on was equally plain: an artillery shelling that the Germans had zeroed in for years.

The only medical elements on the beach at this time were the shore party of the navy medical section and some members of the 16th Infantry Medical Detachment, but their depleted ranks and the continuous shelling made it impossible to undertake organized collection of casualties. In fact, liaison of any kind was impossible. Those who ventured out of their foxholes to give aid could never know when they would be spotted by the German riflemen on the bluff and many were the ones who had come to grief in the very act of helping their comrades. The situation called for exceptional fortitude and sangfroid.

Quickly weighing the odds and measuring his chances, Major Serbst deployed his men. There was not much to work with, but they had morphine in their bags and water in their canteens, and some of the first-aid bags that had been thrown overboard earlier were floating in the surf. Without any further thought of snipers, of mines, or of shells, they began to carry the wounded to the lee of a beached LST, to splint the broken limbs with flotsam to stop the worst hemorrhages, to recover the bags with first-aid equipment to dress the wounds, to administer the plasma, to protect the wounded from the advancing surf, and to do the few simple things that might make the difference between life and death. Their labors carried them over the most severely punished part of Omaha at a time when their slowly moving silhouettes made conspicuous targets. But the work went on.

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As the afternoon wore on, the danger increased. Each fresh boatload of vehicles would bring another series of well-aimed shells from the pillboxes. At one time, Major Serbst was within 30 yards of an ammunition truck when it was hit and the resulting explosions showered the area intermittently for over an hour. He escaped injury but Major Tansley, another team member, was burned and an enlisted man was hit in the leg. No one thought of quitting.

Towards evening, the First Division medical officers wore able to establish an improvised collecting station in the tank ditch paralleling the beach and here Major Serbst moved his patients as soon as he could. The bottom of the ditch was covered with water and the sides wired with booby traps but at least there was shelter here from grazing fire and the wounded could be placed on tiers dug out of the sand. Gradually, more help became available and DUWKS [DUKWs] started to take the most serious oases towards the ships lying offshore. All night long the team worked here with the medical officers of the First Division and of the collecto-clearing companies. It was not until noon of the next day that the men took a brief rest and went to the pillbox on Easy Red to help the teams that were working there.

Meanwhile, the other three teams had managed to land. They had boarded an LCI at H plus 6 and had made three attempts to reach the shore but .each time heavy fire had driven them back. Finally, at H plus 11, they took advantage of a brief lull on Dog Red and waded in. The lull was deceiving. They had not been on the beach ten minutes when a shell struck near them, injured Major Stahler, and forced the others to scatter.

Major Findlay and all of Major Peyton's team stayed on the beach, giving first-aid and helping with the evacuation until nightfall prevented further activity. Only then did they make their way to the pillbox where the rest of Major Findlay’s team had already gathered. Major Sutton’s team at first sought shelter behind a stalled 1/4-ton truck. When this was struck by a mortar shell soon afterwards, they decided to abandon it for an area farther up the slope but they had hardly taken three steps when the above-mentioned ammunition truck blew up and pinned the entire group down by its irregular eruptions. Later, these men were able to advance a few hundred yards where they gave first-aid to the wounded and dug in for the night.

The dug-out on Easy Red was the prize of the day, medically speaking. It was built into the side of the bluff,

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about 200 yards from the water line and it afforded room for some 50 litters, crowded. With its walls of six-foot reinforced concrete, its sanded roof, and its well-concealed approaches, it had been an impregnable strongpoint until that morning. Then a heavy naval shell scored a direct hit and ripped the doors apart, knocked the gun askew, and cracked the very floor.

Here, the teams and some of the personnel of the 61st Medical Battalion had their rendezvous that night. They worked at top-speed but top-speed was not fast in those crowded quarters where litters covered every inch of space and where the only illumination was by flashlight. To use anything more than a flashlight would have been invitation to disaster. So each time a plasma transfusion had to be given, or a splint applied, or a dressing put on, or morphine administered, patient and surgeon would be screened with blankets while a third man held the light. Then, just as the men would bend down to their task, a shell would fall nearby and the resulting blast would rip the blanket away, throw the men off balance, and cover the ground with clouds of sand. Under such conditions, the men hardly felt very easy. They would have felt more uneasy yet if they had known that there was a 15-pound charge of dynamite under their feet, but they could not know that and the dynamite was not discovered until several days later.

All night long, casualties were brought to this pill-box, to be treated and put on DUWKS [DUKWs] for seaward evacuation. The total number ran into the hundreds. At noon of D plus 1 Major Serbst reported here, and still later Major Sutton did. By now, some equipment of the 391st had been recovered and it became possible to set up a tent not far from the pillbox for added shelter. The four teams divided their attention between these two until the company had gathered enough materiel to pitch its quota of tents on the high ground behind the pillbox. This was on D plus 2 and the first operation started at 1800. The teams stayed here for an average of five days. Then, they joined the field hospitals.

Teams 7, 9, 10, and 12

The teams on the SS “Dorothea Dix” transferred to an LCT at H plus 6. They were to be taken to Easy Red.

When they paused at the regulating ship for instructions, it was obvious that trouble awaited them. The “safe”

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zone was alive with landing craft, circling for their chance, and the surf was dotted with stranded boats. At the moment the instructions came to land, the LCT just ahead struck a mine and disappeared in a geyser of foam and wreckage. There was nothing they could do but make a run for it and hope for better luck.

They had, until the ramp was let down. Then, two shells struck on either side and injured many of those standing near it. But this was no time to hesitate. In a minute, the vessel was empty. It was H plus 7 on Easy Red.

The beach was a shambles. There was not a soul to be seen, let alone a sign or clue where to go. Some personnel of the 391st and 393rd had made the landing at the same time but with German guns sweeping the beach from the top of the rise, it was foolhardy to stay together.

Obviously, the water's edge was the worst place to be. So the men tried to find a path through the minefields. The search led first over a smooth, glassy surface, then through some fine, powdery sand, and finally into a graveled, shallow ridge. Suddenly, Major Stahler saw a shiny button partly hidden under the pebbles. It was a clothespin mine. After that, the men peered as anxiously at the ground in front of them as at the white dunes in the distance.

Major Church was the first to see the taped-off corridor leading inland. Hugging it closely, the men struck out, single file. Maybe they would find cover beyond. One of the tapes presently came to an end in a crater with three dead bodies. Then the other gave out. As yet, they had gone only a third of the distance. They gathered. Their group, the only one to be seen on the beach, made a target. A mortar shell landed at their feet. Captain Ferraro's musette bag was pierced. Something had to be done and done quick.

Major Church's and Major Higginbotham's teams advanced in spite of the mines. Major Meyers' and Major Stahler's teams dug in where they were.

The advancing party was soon halted by a partly inundated stretch. They started to cross. Soon, they were in the water up to their chests. Then the shells came again. Desperately they scrambled up the far side and looked for cover. There was none. Only the rocky soil. So they started to dig. Using their helmets for entrenching tools, they scraped and they hacked and they tugged. It was too late. The next blast injured two: Captain Friedman in the head and Captain Ferraro

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in the leg. The wounds were not serious but demanded attention. The two men crawled to a crater and remained there till nightfall; the others eventually dug in. After dark, the two casualties were evacuated to the tank ditch and then to England. Such was D-day for teams 10 and 12.

The next day, the shelling was more sporadic and the teams rejoined for a reconnaissance. They found some of the personnel of the 392nd in the pillbox and stayed to help, but their own stations could not set up for lack of equipment. It was not until 1800 on D plus 2 that teams 7 and 9 started their first operation with the 393rd on Easy Green and not until 1800 on D plus 3 that teams 10 and 12 did with the 392nd on Fox Green. These teams stayed an average of four days with the clearing stations before joining the field hospitals.


Teams 13, 14, 17, and 18

The four teams with the 634th Clearing Company were transferred from their LST to a rhino ferry ten miles offshore at H minus 2. They shared this ferry with elements of their clearing company and of the 29th Division, altogether some 200 men and 50 vehicles. At H-hour they pushed off.

Progress was slow. When they arrived at the regulating ship, it was H plus 4 and they still had another two miles to go. But there was no hurry: Dog White, their sector, was under heavy fire and conditions were unsuitable for a landing.

Finally, at H plus 10 they were signaled to go ahead. As the rhino started to inch its way towards the beach, many of the men reflected that it undoubtedly was the answer to an artilleryman's dream. Events soon proved that these reflections were not far off.

The German batteries had the range perfectly. At 1600 yards, two shells straddled the bow. There were casualties. The team members swung into action. When they looked up again, the rhino was directly opposite the beach and the first bulldozers moved cautiously towards the ramp. There was a snapping sound, the ramp gave way, and the bulldozer promptly sank in ten feet of water. Obviously, Dog White was not for them.

Slowly, the rectangular monster backed away and headed for the next sector to the east, Dog Red. Here, there was trouble of a different kind. Wind and current were parallel to the beach and cooperated to deflect the unwieldy mass of steel which went into a stubborn sideslip. Shells fell again

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and the men began to wonder if they would ever make it. If they had at that time, they would have met disaster because when another rhino nosed into the same place a little later and began to discharge its vehicles, shore batteries opened up at point-blank range and demolished the entire cargo.

Once more, the barge headed back to sea. On the way to Easy Green, an underwater obstacle tore off one of the two engines. With only one engine left, with the tug long since gone, with the speed reduced to one knot, with the cargo damaged, with the crew partly disabled, and with the wounded urgently in need of attention, there was not much use continuing. As if he needed to be told, the ensign received a signal from the beach not to attempt any more landings. When the craft had painfully worked its way out of the danger zone, it was H plus 14 and the men aboard had been exposed to continuous shellfire for four hours. It seemed more like four days to them.

By now, the chance of a D-day landing was gone. The rhino moored alongside an LST, the wounded were taken off, and the men settled down for what sleep they could get on the ammunition trucks. They were very cold and very tired, so tired that they paid little attention to several bombing and strafing attacks that night.

The next morning, arrangements were made to take the teams to the beach in LCVPs. The teams of Majors Reiter, Campbell, and Williams were landed on Easy Green at 0800, that of Major Hurwitz on Dog White at 1000.

The craft carrying the first three teams was lost when it struck an underwater obstacle 200 yards offshore and sprung a leak. As the men let themselves down the ramp, they were just able to gain a footing in the neck-high water. One of them, of smaller stature than the rest, disappeared completely but quick action of the others prevented a tragedy. Very little personal equipment was saved.

On the beach, the teams quickly scattered:

Major Hurwitz and his team remained on Dog White for five hours, organizing first aid and evacuation. It was a task somewhat like Major Serbst’s the previous day because the beach was far from safe. After all the casualties had. been taken off (there were over 100), the team proceeded inland and arrived just in time to help with the setting up of  the 634th Clearing Station.

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Major Campbell and Major Williams, beaching immediately in front of the bluff where the First Division Clearing Station had just set up, stayed to help there. This station had no provisions for major surgery but it was overwhelmed with patients so the teams did what they could. When they ran out of sterile linens, they cut bath towels into strips, boiled them, and used them for skin drapes. When they had trouble with the anesthesia machine, they connected an ether can with a BLB mask and obtained their positive pressure that way. When they ran short of instruments, they split one basic set between two tables and kept the other in the sterilizer. When they accumulated postoperative patients, they detached three of their number to work in the ward. The handicaps were many but the men had the satisfaction of doing the first surgery on Omaha. It was not till evening of D plus 1 that their own station began to function.

Major Reiter was anxious to locate the station equipment so he started looking for it in the morning as soon as he had landed. His search led him to St. Laurent where he found himself in the middle of a pitched battle between German and American infantrymen but he was able to avoid the bullets and eventually ran into the commanding officer of the 634th, Major Bauer. Together they located one of the three trucks at Les Moulins where two of the company's enlisted men were giving first-aid to some 25 casualties, most of them serious. These needed attention and so Major Reiter and his men stayed behind while Major Bauer took the truck and drove it to a more protected place, a quarter of a mile away. At Les Moulins, Major Reiter worked for several hours in an exposed position while German snipers in the surrounding houses engaged passing American troops. Through his efforts, all the wounded reached the First Division station that same afternoon. There is no doubt that many of them owe their lives to this courageous intervention.

The second of the three trucks was found that evening but even before that, work had started with supplies from the first. Soon, Major Hurwitz reported and at 1800 the first operation was begun. The other teams joined the next day. Their average stay was six days.


The remainder of the Group

On the night of D plus 1, the SS “Naushon” arrived on Omaha with Detachment “A”. It brought the commanding officer, the neurosurgeon, and six teams from the Fourth Auxiliary Group. These men worked on board ship for the first 12

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hours and went ashore at 1000 the next morning. They stayed two days with the clearing stations and then worked at the field hospitals until the evacuation hospitals opened. The neurosurgeon, Major Haynes, went into action immediately with a team and has rarely been idle since.

The SS “Lady Connaught” brought six more Fourth Auxiliary teams to Utah as  Detachment “B” in the evening of D plus 2. These teams also spent one day at the clearing stations, several days at the field hospitals and the rest of the month at the evacuation hospitals. Major Longacre, the maxillofacial surgeon, who was with Detachment “B,” was sent back to England but returned later with Headquarters.

The three reserve teams 21, 22, and 23 arrived on Utah on D plus 4, worked briefly at the clearing station and then joined the field hospitals.

The last two parties were Headquarters and the motor convoy. Headquarters with the two remaining teams and all the nurses came in on D plus 16, the motor convoy on D plus 22. Within a few days, the nurses had joined the field hospitals, the last two teams had gone on duty, and the mobile units were getting their first test.

The Group was in full operation.


Epilogue on D-day

From this account it is apparent that while the conditions on the beach varied from comparative calm at Utah to extreme tumult at Omaha, the teams nevertheless accomplished much good. It is true of course that the clearing stations were universally behind schedule in establishing their stations and it is also true that the teams, at least at Omaha, arrived at a time when they could hardly function in the anticipated manner but these circumstances were owing to the tactical situation which was beyond control.

Basically, the idea of early surgery on the beach was sound. Its benefits are measured not only in the 900 patients the teams operated on before the regular hospitals arrived, not only in the 8057 patients they helped evacuate during this time, but also in the steadying influence of a group of older professional men at a time of extraordinary stress and strain. From the standpoint of service, this first week was undoubtedly the most fruitful and the most gratifying in the history of the Group.

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In retrospect, one might make certain suggestions for the consideration of those who plan future D-days.

(1)       When surgical teams go on an invasion with clearing stations, either the teams should have their own surgical equipment or the stations should have a liberal increase in their table of allowances.

(2)      When surgical teams go on an invasion with clearing stations, they should be landed at the same time, preferably on the same boat with the station personnel and the station equipment.

(3)      When surgical teams go on an invasion of a heavily defended beach, a certain number of them should be stationed on. hospital ships offshore from the very beginning. The teams on Omaha would have been more useful that way than on the beach where they could do little but look after themselves.

(4 )    When surgical teams go on an Invasion with clearing stations, they should be reinforced with extra personnel to help in the preoperative and postoperative wards.


Chapter II

The teams in the field


The following chapter describes how the teams functioned in the various installations. What they produced is presented in the last chapter.


General surgical teams

(1)  In clearing stations

Ordinarily, clearing stations do not afford proper conditions for major surgery. Their location, their equipment, and their lack of nursing personnel all militate against it. On the beach, however, it was a matter of necessity and so the teams devised their own modus operandi. As for equipment and personnel, they could. As for location, it was unalterable and irremediable.

Equipment.  To do their task properly, the teams had to

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have the wherewithal. They needed anesthesia machines, suction machines, oxygen apparatus, fracture tables, bronchoscopes, and many other articles that are not written into the table of equipment for a clearing station. That most of this did arrive on the beach in the wake of the assault waves was a triumph of supply, a triumph that was owing in the first place to the strenuous efforts of the medical supply officers and secondly to a certain amount of personal initiative, adroit wheedling, and dogged persistence of the team members. This might have been avoided. Two possible solutions suggest themselves:

When clearing stations have surgical teams attached, they should have an automatic increase in their basic allowances.

Failing this, the teams should take their own mobile surgical units with them. Such units now exist and have been found entirely practical.

Personnel.  During the first week on the beach, the clearing stations were overwhelmed. For instance, from 6 June till 12 June, 2557 patients passed through the station operated by Company “C”, 261st Medical Battalion. This created a tremendous load in the triage and preoperative wards, a load that the teams assumed in addition to their operating room work. Here, the four-man team completely justified itself. While the operating room kept on functioning with three officers, the fourth one spent full time in triage and shock work. Sometimes, in the early phases, a whole team would devote itself to this work while the second team operated.

Triage is of two kinds. The first kind separates the transportable from the non-transportable patients. This can be done by an officer of some experience but not necessarily a finished surgeon. The second kind comes after the patient has been resuscitated and is to be assessed for priority. This does call for a surgeon, or at least for an officer with a sound surgical background and good results can be expected only if the process is continuous, that is if the same officer observes the patient all through the preoperative stage. It is this latter kind of triage that preempts the team members and makes a reinforced team a necessity in a clearing station.

(2)   In field hospitals

When a surgical team works in a field hospital, it is in a privileged position, professionally speaking. It does only the most interesting kind of surgery, it has undisputed authority, and it is unencumbered by paper work. The pressure

33

may be great and the hours long, but there is an unequalled opportunity and no medical officer asks for more. The field hospital is the surgeon’s paradise.

Field hospital records show that of all patients operated on, about one third have abdominal, one third have chest wounds, and the remaining third have wounds of other parts of the body, mainly the extremities. The team must deal with all these and therefore it must have surgeons who can explore all parts of the body. Abdominal and extremity surgery is no problem for general surgeons but chest surgery may be, if they have no previous experience with it. It is true that the technique of exploratory thoracotomy is not difficult, yet it must be acquired like any other technique and that is why it is highly desirable to have a chest surgeon on every team. He can teach the others in a short time.

The anesthetist also must be versatile. He must be able to nurse the patients through a prolonged anesthesia when their vitality is at its lowest ebb, he must be able to do endotracheal intubations under difficult conditions, he must keep transfusions running when the patient has virtually no peripheral circulation, he must start preparing the next patient while the surgeon demands maximum relaxation, he must make entries on the hospital chart, the team logbook, and his own records, he must be prepared to advise the surgeon at any time about the patient̓s ability to withstand further surgery, and he must keep an eye on the fresh postoperatives. All this requires skill, judgment, and concentration. Only the best anesthetists can work in field hospitals.

What has been said about the four-man team in a clearing station applies with equal force to a field hospital. Each platoon has four medical officers that can be used to help. Many of these have a keen interest in surgery and make excellent assistants in the operating room. Others are better fitted to work on the wards. Whatever their talents or inclinations, they can be used. Their role is an essential one.

In equipment, a field hospital platoon has all that can be desired. In personnel, it becomes deficient under certain conditions. Experience has shown that, with a steady flow of patients, one team can handle about ten cases on a 12-hour shift. This means that the postoperative ward fills at the rate of 20 cases a day. Not all of these will have to be retained the full ten days and some will die, but on the average one can expect at the end of a week to have some 80 postoperative

34

patients. This is more than the six platoon nurses can take care of. The Auxiliary nurses solve this difficulty only in part because when the hospital keeps operating, they are needed in the operating room. As long as a platoon. has a rated capacity of 100 patients, the nursing staff could easily be increased from six to ten.

When a platoon is operating at full capacity, it is best to use two operating tents and at least two teams. By having its own tent, a team can carry on as long as need be without interfering with the other team. The second tent also makes it possible for two teams to work simultaneously. Two teams in one tent only cause overcrowding and confusion,

One further aspect of the experience In field hospitals should be mentioned. It has to do with the human relationships and stems from the fact that while the teams are with the hospital, they are not of it. The trouble, if it deserves that name, is two-sided. Platoon commanders are irked that teams create awkward problems of supply and transportation, that teams do not come under the administrative control of the hospital, and that teams are neither fish nor fowl. Team members on the other hand feel that they are always last in line, that they get second-best, and that they are the unwanted children. Although such undercurrents would hardly disturb the general direction of the stream, they do sometimes lead to whirls and eddies that ruffle the surface. To smooth such troubled waters is but one of the tasks of the commanding officer of the Group.

(3)  In evacuation hospitals

In an evacuation hospital, there is more physical comfort but less professional independence for a team. The chief of surgery regulates the triage, directs the flow of patients, allots the auxiliary teams their share, and supervises the postoperative treatment. Ward officers are much more plentiful than in a field hospital. Consequently, the teams are relieved of a great deal of their burden but also of their responsibility, and the work loses some of its pristine challenge.

There is another reason why evacuation hospitals hold less interest for a team and that is the type of surgery. While in a field hospital abdominal and chest cases outnumber the others, in an evacuation hospital it is just the opposite. The vast majority of the patients have extremity wounds which

35

require a stereotyped debridement and a cast. The operation is only a temporary expedient to make the patient transportable rather than an all-out attempt to make him well and the surgeon turns only the first cog of the wheel. He misses the satisfaction of accomplishing the whole task.

Because the surgery in an evacuation hospital is of a different type and because the hospital staff usually includes specialists, there can be some latitude in the make-up of an auxiliary team. In the first place, there is not the same need for versatility. An orthopedist, for instance, can be used, where he would be out of place in a field hospital. If the team lacks a chest surgeon, the evacuation hospital usually has one, so that the team can bypass chest cases. The same holds for other departments. Therefore, in order to deploy his teams to best advantage, the commanding officer of the Group must know the capabilities not only of his own men but of the evacuation hospital men as well. Then, he can fill out one with the other.

Another consequence of the altered demands on a team at an evacuation hospital is that the four-man combination is no longer a necessity. Pre- and postoperative treatment being the responsibility of the hospital staff, the team can now use all its men in the operating room and three can carry on quite well under average conditions. The fourth one is still a great help of course, especially when there is enough room to run several tables, but he is no longer the sine qua non of efficiency.

The minor disputes that teams occasionally run into at field hospitals do not come up at evacuation hospitals. Teams have found that their reception is always the most cordial and their share of the work the most impartial that could be desired. In sharp contrast to the situation in North Africa, this is proof of the fact that the Group has come to be not only accepted but appreciated.


The “model” team

From what has been said, one can see that different hospitals require different teams. In an evacuation hospital, conditions vary so much that it is difficult to lay down hard and fast rules. In a field hospital, the demands are more stringent and more uniform, and it is possible to define the “ideal” combination. It is somewhat as follows:

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(1)    A mature general surgeon whose primary interest is abdominal work.

(2)    A general surgeon whose primary interest is chest work.

(3)    A younger man with a sound surgical background. If his hospital training has been in
orthopedics, so much the better. There is no need for an orthopedic surgeon in the civilian sense of the word.

(4)    An anesthetist who masters the intricacies of general anesthesia in all its varieties.

(6)    Four enlisted men with clear heads and steady hands.


Specialist teams

The only kind of specialist team that need be considered here is the neurosurgical team and the maxillofacial team. Two questions come up: where should they work and how should they be constituted?

As for the first question, it has been the experience that the evacuation hospital provides the best locale. There are several reasons for this. In the first place, the environment of the evacuation hospital is better for these patients than the environment of the field hospital. They are patients who require a great deal of specialized nursing care and close watching. Field hospital nurses are too busy to give them this. Secondly, the operating room facilities of the field hospital become severely taxed when specialists start to work. Operations are usually prolonged and they require space in the operating room that the general surgeons can ill afford to do without. Thirdly, the patients, if they are not transportable on arrival at the field hospital can usually be made so and sent on without undue risk. They gain more in the better facilities of the evacuation hospital than they lose by the somewhat longer journey to get there. And finally, the evacuation hospital, not being under such great pressure, has more personnel and more equipment to spare. For all these reasons, the Group specialists have preferred to work in evacuation hospitals.

As for the second question, that is the proper make-up of a specialist team, the working conditions do not call for the fourth man. Cases rarely accumulate in such numbers that triage becomes a problem and for all ordinary purposes, a team of one surgeon, one assistant, one anesthetist, one nurse and two enlisted men is adequate.

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The nurses’ teams

The main task of the nurses’ teams at the field hospitals is to supply and supervise the operating room. When the hospital is busy and the operating room works top speed, this task calls f or a great deal of alertness and foresight. It also calls for steadiness and stamina because the sheer pressure of work and the nearness of the battlefield have their effect on the nerves. When one realizes that each case In a field hospital is enough to throw an ordinary civilian operating room into uproar for a day, and when one remembers that these cases pass through without respite at the rate of 20 a day, there is much to be admired in the mental stability and physical endurance of all nurses who work in field hospitals.

It may be said categorically that the auxiliary nurses have lived up to the challenge and done a remarkable job. But there is another aspect of their position. that needs to be inquired into and that is how they fit into the over-all picture of the field hospital. Is it to their own interest to be on a sort of “permanent temporary duty” or would it be better if they were divorced completely from the Group and assigned to the field hospital?

Professionally, it would make no difference; administratively, it might be a little more efficient; but from the standpoint of human relationships, it would be an improvement. The same cross-currents that crop up among the medical officers exist among the nurses also, in fact more conspicuously because women are more apt to be clannish than men. These cross-currents are hard to bring into line under the present system. Occasionally, a situation can be smoothed through transfers and other adjustments, but most of the time there remains a gap between the field hospital nurses and the auxiliary nurses, a gap that interferes with the best spirit in both. If it was right to transfer the auxiliary nurses to the field hospitals in fact, the next logical step would be to transfer them in name also.


Chapter III

Headquarters in the field

The Third Auxiliary Surgical Group has remained with First Army throughout 1944. Headquarters landed on

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D plus 16, bivouacked at St. Laurent and then followed in the wake of the advance, first east as far as Paris, then north into Belgium. From 28 September on, buildings were used. In Baelen it was a somber schoolhouse; in Spa an elegant villa; in Huy, a grim “pension”.

The complete list of stations is as follows:

22 June - 24 June     St. Laurent, France
24 June -16 July     Cricqueville, France
16 July - 5 Aug     Lison, France
5 Aug - 19 Aug     Canisy, France
19Aug - 26 Aug     Lassay, France
26 Aug - 2 Sept     Senonchos, France
2 Sept - 5 Sept     Voisins, France
5 Sept -14 Sept     La Capelle, France
14 Sept -16 Sept     Ouffet, Belgium
16 Sept - 28 Sept     Herbesthal, Belgium
28 Sept - 26 Oct     Baelen, Belgium
26 Oct -18 Dec     Spa, Belgium
18 Dec - 31 Dec     Huy, Belgium


Administration

Team personnel must be regularly supplied with mail, with clothing, with monthly pay, and, at one time even with post exchange rations. When the teams are spread out, as they were early in September, from Normandy to the French-Belgian border, a distance of 300 miles, this job assumes heroic proportions. But even with a stabilized front of 100 miles, a round-trip of the 31 teams takes from seven to ten days and proves an exhausting experience. Consequently, Headquarters has bent every effort to decentralize control over-these-matters, and with some success.

Salvage of clothing and post exchange rations are now both handled by the hospitals where the teams work. Mail is turned over to the APO that serves First Army hospitals. Even finance could be taken care of by the hospitals, at least for the nurses who are always with the same platoon. For the officers, it is best to be on the payroll at Headquarters because they are too apt to move away just before the last of the month. With these simplifications, trips have been cut down to those necessary for the issue of new clothing, for the monthly payments, and for miscellaneous liaison. Even so, the demands on transportation are out of all proportion to the number of vehicles allowed by the table of organization.

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Formidable though this roster appears on paper, it did not affect the deployment of the Group’s own teams because none of the reserve teams had the necessary four-man combination and so they were not suitable for field hospitals. Instead, they were sent to the evacuation hospitals except for the shock teams.

During the next two months the Group functioned on its own strength but since the latter part of October it has again been reinforced with six First Auxiliary teams. These too have been placed with the evacuation hospitals. These facts are mentioned to bring out that First Army field hospitals have been staffed almost exclusively with Third Auxiliary teams. It is now in order to examine the figures and determine what demands the primary mission made on the Group.

When the field hospitals functioned in their implicit capacity of handling non-transportable patients only, they absorbed from 13 to 22 teams or 50 to 85 percent of the available strength. When the field hospitals became acting evacuation hospitals, they absorbed 25 out of 26 teams or 96 percent. Leaving this latter period out of consideration one finds that, except for the second week of the invasion when conditions were still unsettled, the heaviest demands came in the first week of July and the lightest in the last week of November. The over-all average for the first six months shows that the field hospitals have claimed 75 percent of the general surgical teams.

These figures indicate that the Group has fulfilled its primary mission with personnel to spare, an achievement owing in part to the organization of four-man teams.


Specialist teams

The original plan was to use the neurosurgeons and maxillofacial surgeons not on teams but as roving consultants. This plan was given up almost from the start when it was noticed that the need for operating surgeons was greater than the need for consultants. The teams were therefore reconstituted and, in fact, increased in number so that the Group has had two neurosurgical teams and one to two maxillofacial teams most of the time. On the basis of the following considerations it is now felt that three of each would be better yet.

The need for auxiliary teams of this type depends on two factors. It depends on whether the evacuation hospitals

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already have sufficient talent of their own and on the size of the front.

If every evacuation hospital had one competent neurosurgeon and one competent maxillofacial surgeon, it could carry on quite well under average conditions and the auxiliary specialists would hardly be needed. On the other hand, if none of the evacuation hospitals had such men, there would have to be a pool of perhaps eight or ten. The truth is somewhere in the middle.

The size of the front plays a part because when a specialist is needed, he is needed in a hurry and if his journey takes him all day he is not giving his best service. Assuming 100 miles to be a norm for an Army front, one could have a satisfactory coverage with three teams. The actual number has never been more than two and the neurosurgeons especially have at times been severely overworked.

The rotation plan

After the first few hectic months had passed and the teams had accumulated hundreds of cases, the officers began to wonder about their end-results. To do effective work at one point in the line, one should know what goes on at the other. So a rotation plan was worked out. According to it, certain officers from the Group change places with officers from the general hospitals for a period of two months so that each can observe the work of the other. So far, eight surgeons and. two anesthetists have gone to hospitals of the communications zone on this basis. Although it is still too early to draw conclusions, there is every hope that this interchange of men will lead to an interchange of ideas also arid that it will infuse the members of the Group with new enthusiasm.

The table of organization

The Group still operates under Table of Organization 8-571, dated 13 July 1942 and amended by War Department circular #306, 1943. This amendment reduced the number of nurses from 70 to 64.

The internal organization of the Group into teams has already been amply discussed. It is predicated on the 36 teams mentioned in the preceding section. Gas teams, shook teams, and, miscellaneous teams no longer exist as such.

There remain only a few additional remarks.

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Transportation

The allowance is three passenger vehicles and three trucks (two 1 1/4-ton and one 3/4-ton). This is just sufficient for housekeeping when the Group is in garrison. Even then, it would be better if the trucks were 2 ½-ton. But when a vehicle is in use for one whole week on such a pedestrian errand as the delivery of the pay-checks, when an extra pair of socks for the enlisted men involves a journey of hundreds of miles, and when not a day goes by but what some team has to be moved, then it becomes inadequate. If it were not that the resting mobile units had half a dozen idle trucks that could be pressed into service, there would have been a serious impasse.

The preceding paragraph brings out that teams are moved on trucks belonging to the Group. It had always been the thought that trucks could be borrowed from the hospitals for this purpose, and this worked fairly well as long as the hospitals had enough of their own. Lately however, hospitals have been so stripped that they cannot spare even an ambulance, let alone the 2 ½-ton truck or the 1 1/4-ton truck with trailer that is needed to move one team with its baggage. So the Group has had to look elsewhere.

It is true that there are usually vehicles in the pool at the Medical Group but the team moves are mostly complicated affairs involving triple shifts, unexpected stay-avers, and sudden changes, and uninitiated drivers frequently get into trouble. Also, the Medical Group pool is at some distance and this adds a further stage to an already crowded trip ticket. But the main disadvantage of borrowed transportation is that it is uncertain and apt to fail at the most critical moment. This was well illustrated in the recent precipitous retreat from Spa when Headquarters was able to take care of its personnel and equipment plus several refugee teams only because the extra trucks were on hand.

To move its teams with dispatch and economy, the Group needs six extra trucks (2 ½-ton or 1 1/4-ton with trailer) in addition to the ones now listed on the table of organization.


Operations

With slight variations from time to time, the following teams have been available for assignment:

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General surgical teams        26
Neurosurgical teams            2
Maxillofacial teams              1
X-ray teams                        3
Dental prosthetic teams        3
    
Total:                                35

This section of the report inquires into the manner of their deployment and the pattern of their distribution.

General surgical teams

It has already been pointed out that the field hospitals have first priority on the teams and that the evacuation hospitals come next. It has also been said that a field hospital platoon normally supports one division and needs two teams. In actual practice, this has varied from one to six. When the platoon acts as a holding unit, it can get along with one team; when it supports several divisions, it has used as many as six.

Another fluctuation in the demand for teams lies in the number of hospitals committed at one time. Also, the type of warfare affects the team requirements of the hospitals. For instance, during the rapid advance across the plains of France, evacuation hospitals had so much difficulty in keeping up with the front that field hospitals had to take over their function for almost a month.

One more factor needs to be mentioned, namely that the Group handled a considerable pool of reserve teams during much of the summer. In July and August, while the front was still contained, many medical units arrived in France in whole or in part, without being able to go into action right away. These units comprised both the Fourth and the First Auxiliary Surgical Group and many general hospitals. To make the best use of the professional personnel during the waiting period, the officers were made up into surgical and shock teams, placed at the disposal of First Army, and distributed by the Third Auxiliary Surgical Group. Starting with the 12 Fourth Auxiliary teams that had landed with Detachments “A” and “B” and finishing with 11 general hospital teams in the first week of September, the Group at one time had almost 150 teams under its aegis. For example, on 31 July the team roster read as follows:

Surgical teams, Third Aux Surg Gp         29
Surgical teams, First Aux Surg Gp            8
Surgical teams, Fourth Aux Surg Gp       47
Surgical teams, general hospitals             30
S1 &2  teams, general hospitals              33

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Medical officers

The table of organization limits the anesthetists to the rank of captain. This is beginning to work a hardship on some exceedingly competent men in their late thirties or early forties who have gone through several campaigns and have acquitted themselves admirably of a difficult task. They deserve recognition and yet the present restrictions make this impossible. It is felt that there should be provision for at least some of the anesthetists to be elevated to the rank of major.

Medical administrative officers

The table of organization limits the number of medical administrative officers to one, but a second one can now be carried as orientation and education officer. Two officers can handle the administration fairly well as long as the Group is in garrison but when it is scattered, the work multiplies and really demands three. Under such conditions, the assignments are as follows:

    S-1:                   Personnel adjutant, finance officer
    S-2 and S-3:     Detachment commander, provost marshal, intelligence, mess, mail, plans and training
    S-4:                  Supply and transportation


Nurses

The present position of the nurses is tantamount to a physical transfer from the Group to the field hospitals. It has already been said that if this transfer were made administrative also, some imperfections that now exist would be eliminated.

Enlisted men

When the three X-ray teams joined, the Group acquired three captains and ten enlisted men in the grade of T/4 and T/5. The instructions were to absorb this rank within the limits of the table of organization by a process of normal attrition.

For the medical officers, this was not difficult. The Group has always had vacancies for captains. For the enlisted men, it was different because the allowable rank was already filled by surgical technicians. For a while, the X-ray technicians were carried as excess in grade but

44

eventually they came to replace an equivalent number of surgical technicians so that the Group now has ten less of these than it is entitled to. This shortage is felt acutely.

If X-ray teams are with the Group to stay, the table of organization should make allowance for them.

Of the 166 enlisted men that are left when these ten are subtracted, about 116 are with the teams and 50 with Headquarters. The 50 men are needed. Any reduction in their number would be a serious handicap.


Chapter IV

The mobile units


When the motor convoy came to Normandy on D plus 22, it brought five mobile surgical units and three mobile X-ray units. Later, three mobile dental units were added. Only the dental units belong to the Group by table of organization. The others had been attached for experimental purposes.


Mobile surgical units

The surgical units were of two types:

(1)    The “USA type” consisting of a 2 ½ -ton surgical van with 1-ton cargo trailer attached. There were two of these.

(2)    The “ETO type” consisting of three l 1/4-ton trucks and a 250-gallon water trailer. There were three of these.

During July and August, these units were tested in the field, both in evacuation hospitals and in field hospitals. The experience was as follows:

Both units have been thoughtfully conceived and lavishly executed. Each one has its own advantages. The “USA type” is superior in that it is more compact, more streamlined, easier to pack, and easier to operate. The “ETO type” is superior in that it affords more room, supplies more electric power, carries its own water trailer, and has a separate truck

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for the personnel. The best feature of the “USA type” is the operating tent which is perfectly proportioned, completely double-walled, wonderfully air-conditioned, and brightly painted on the inside. The best feature of the “ETO type” is the generous allowance of vehicles.

A team with its own surgical unit has a chance to develop much individualized equipment that is difficult to construct and impossible to transport in any other way. Such items as sawhorses that allow tilting of the patient, instrument stands that clamp on the litter, armboards that fit, traction devices that eliminate ring splints, canulas that facilitate phlebotomy, chest manometers that control aspirations, spotlights that aim the beam, retractors that are malleable, these and a great many others can make the difference between quick and halting work. The units are also well equipped with certain standard articles of which there seems to be a perennial shortage everywhere: Levine tubes, atomizers, Pezzar catheters, pressure tubing, felt, special needles, etc. In the mobile unit, a team knows exactly what it has and where to go for it.

In operation, the units fit better with evacuation hospitals than with field hospitals because the two operating tents of the field hospital platoon are already out of proportion to the postoperative facilities. A field hospital is a surgically supercharged installation and any additions only aggravate the top-heaviness. Of course, a team could operate its own unit in preference to the existing tents, but this is hardly the intent. The units are supposed to be where they are needed and field hospitals do not need them.

Evacuation hospitals do sometimes need extra operating rooms and when they do, mobile units are very useful. The 5th, the 45th, and the 91st Evacuation Hospitals were all served at a time when their regular equipment was strained to the limit, but this was in the early months when hospitals were not as plentiful as they are now. With the number of hospitals available at present, it is unlikely that they will ever again be subjected to the same pressure.

Mobile units require extra personnel and the Group is abort of personnel as it is. Replenishing the expendable items also requires much time and labor, especially the “ETO type” that has almost 20 different chests and boxes.

But the real reason why the units have passed into

46

a state of desuetude is that they cannot function independently. They must be attached to hospitals and hospitals already have all the equipment they need. When casualties are heavy and hospitals few, such as in the early days of a beachhead, mobile units are excellent. When casualties become predictable and hospitals numerous, they are excess.

Mobile X-ray units

These units were devised to augment the X-ray department of evacuation hospitals. They are mounted on a specially constructed truck and set up in a tent which attaches to the truck. Radiographs are taken in the tent and passed to the developing room in the body of the truck. Each unit is staffed with one officer and three enlisted men.

Within a few days of arrival, the units were in the field and within a few weeks they had proved their worth. When an evacuation hospital admits several hundred patients in a matter of hours and when 90 percent of these must have radiographs taken, the X-ray department is overwhelmed for days. Limitations of equipment are such that this time cannot be shortened. Surgeons are held up while patients wait their turn and progress stalls all the way along the line.

This is exactly where the mobile unit fits in. With its capacity of 30 to 50 patients a day, it can increase the pace by half again and keep abreast of the surgeons. But even in “normal” times, an auxiliary X-ray unit is helpful because it can relieve overworked personnel and materiel during long busy periods and because it can give special attention to problems for which the regular department has no time. It has also provided X-ray service for a unit that does not normally have one, the 91st Gas Treatment Battalion. As a result, the three units have done a great deal of work, at first in their own tents, later, when hospitals moved indoors, in the established X-ray departments.

On the basis of this experience it is felt that the medical service of a field army can well use three auxiliary X-ray units.

Dental units

Three dental prosthetic trucks reached the Group in the latter part of July. Personnel to staff them joined soon

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afterwards and the units have been working ever since, either separately or combined into a mobile dental laboratory.

Although these units come under the administrative control of the Group, they are functionally much closer to the office of the Army Dental Surgeon. Just as the commanding officer of the Group knows the need for surgical teams, so the Army Dental Surgeon knows the need for dental teams. Consequently, he has placed them according to his judgment at locations of maximum accessibility and maximum coverage. Because the Group has had little to do with the professional problems of these units and even less with their tactical deployment, it was thought best to do no more than mention their existence in this report.


Chapter V

Team statistics

General surgical teams

In order to convey a picture of what the teams have done, there is an overall tabulation at the end of this report. It is a master list, classifying all the patients operated on by the teams during the first six months of the campaign, that is from 6 June till the beginning of December.

In assessing the figures, one must keep several points in mind:

(1)     In the first place, because of the confused tactical situation since the middle of December, 16 percent of the teams were unable to submit returns. Assuming that their work is proportional to that of the others (and there is good reason to believe that this is so), one should increase the figures correspondingly and the tally would be as follows:

Total number of patients                         11347
Number with chest operations                  1241    or    11%
Number with abdominal operations           2l27    or    19%
Others                                                     7979    or    70%

(2)      Secondly, the figures could be collected only

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to the beginning of December. If they wore to include this month also and if they were to show the same general trend as the other six months (again a fair assumption), they would total 13162 patients.

(3)    The primary purpose of the master sheet is to record how much work was done, rather than the regional distribution of the wounds. The latter is already well known from many existing reports on the subject. Therefore, a regional classification was followed only in so far as It would indicate the type of surgery (for instance, chest and abdomen) but debridements are lumped together regardless of site. They include all the compound fractures as well as the soft tissue wounds and are defined only as “major” and “minor”.

Another thing to keep in mind is that the breakdown provides headings only for actual operations and not for the many other things that take up time such as chest aspirations and resuscitation work in general. In other words, much is omitted that could have been included.

(4)     Finally, in a classification of this sort, it is important to record not only the number of operations but also the number of patients. One patient may have had several operations and appear repeatedly on the sheet. To keep the two separate, there is an entry for each math heading stating the number of patients in that category. Obviously, the sum of patients in these various categories is larger than the total number of patients at the top of the sheet. By actual count there are 12385 operations and 9782 patients. The percentages that are given below are based on this total number of patients, not on the total number of operations.

The 9782 patients were operated on in four types of installations:
    In clearing stations on the beach                776    or    8%
    In field hospitals                                      4088    or    42%
    In evacuation hospitals                            3613    or    37%
    In field hospitals acting as evacs              1305    or    13%

The following paragraphs carry this breakdown a little further.

The clearing stations

The figures here represent seven  days' work:

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Total number of patients                        776
Number with chest operations                 63    or      9% *)
Number with abdominal operations       136    or    18% *)
Others                                                  577    or    73%

The percentage of chest, abdominal, and “other” surgery reflects, in general, the type of work that teams can expect to do with clearing stations on an invasion beach. Of course, it does not give the actual incidence of the wounds because many patients were evacuated without operation, especially at first. The criteria for retaining or evacuating a patient varied with the number on the waiting list, the outlook for rapid evacuation, the capacity of the operating room and other factors but, on the whole, one could say that the figures indicate the trend. Abdominal patients outnumbered chest patients two to one. Together, these two categories made up over one-quarter of the total. This is significant proof that the teams were justified in their request for many extra items of equipment.

On paper, the 776 patients do not look impressive, but when one remembers that the conditions were very difficult (60 hip spicas were put on without fracture tables), that this was a new kind of work to at least half the men, that there were no nurses to help, that many teams devoted more time to triage, resuscitation, and evacuation than to actual surgery, and that an appreciable fraction of these 776 patients represent pure salvage, then the figure assumes new significance and comes to stand for a prodigious amount of labor, both on the beach and in preparation. In that one crowded week, the whole long period of planning suddenly paid off. One might say that these 776 patients are the crowning achievement of the Group.

But the 776 patients are only part of the story. The other part lies in the 8057 patients that were evacuated during the first five days when there were as yet no hospitals. In point of time, these patients required more care, more insight, and more judgment even than the others. During these five days, the teams represented a nucleus of qualified, mature professional men whose opinion was sought and whose weight counted. It is difficult to estimate this factor in words and figures but that it played an important part there is no doubt.


*) Thoracoabdominal wounds required thoracotomy as often as laparotomy. Therefore, half of them have been counted under chest, the other half under abdomen.

50

The field hospitals

    Total number of patients                        7088
    Number with chest operations                 826     or    24%
    Number with abdominal operations        1341    or    37%
    Others                                                   1921    or    39%

Again, the figures give only part of the picture. They only mention the patients actually operated on and leave out the tremendous amount of accompanying work. Nor do they give any conception of the type of surgery involved.

For instance, the 1341 abdominal patients rarely had just one viscus injured; practically always multiple procedures were necessary, to be exact 2024 for the entire group. For this reason also, the figure for patients with chest wounds is considerably lower than the actual number treated. In reality, the incidence is nearer 30 percent but many of these had aspirations only and were not included. Of the 826 chest patients, 344 had a formal thoracotomy.

Extremity surgery in a field hospital is such that over 10 percent of the patients have amputations or disarticulations and another 10 percent need hip spicas. Another indication of the type of work is that 10 percent of all patients required bronchoscopic aspiration and that 70 percent of all inhalation anesthetics were given endotracheally.

A hospital in which 37 percent of the patients require emergency laparotomy and 9 percent emergency thoracotomy needs quick-thinking, quick-acting surgeons.

The evacuation hospitals

    Total number of patients                        3613
    Number with chest operations                   88    or    3%
    Number with abdominal operations         193    or    6%
    Others                                                  3332    or    91%

These figures illustrate what has been said earlier about the work In an evacuation hospital. It is predominantly extremity surgery and of a less heroic kind. For instance, the number of amputations and disarticulations is barely a third of  what it is in the forward hospital, and the number of major arterial ligations is just over half. Less than two percent of the patients require bronochoscopy. Intravenous pentothal can be used in nine cases out of ten.

51

Field hospitals acting as evacuation hospitals

    Total number of patients                                1305
    Number with chest operations                           93    or    8%
    Number with abdominal operations                 164    or    13%
    Number of others                                         1048    or    79%

From these figures it is clear that when a field hospital acts as an evacuation hospital, its surgery ranges somewhere between the two. Under these circumstances, abdominal and chest patients make up 21 percent of the total which is only one-third of what it is in field hospitals but more than twice as much as in evacuation hospitals. Other figures are in proportion. Much of the burden in these somewhat anomalous conditions is in the classifying, recording, and evacuating of large numbers of casualties and the teams spend more time in triage than in the operating room.


Further remarks

Although this completes the analysis of the statistics as far as they illustrate team-function, it is very profitable to examine them a little more closely from the surgical standpoint. A few of the salient points are brought out here.

Chest wounds

Of the 1070 chest wounds, 60 percent were treated by simple closure and 40 percent by formal thoracotomy. Of those treated by thoracotomy:

43 % had only rib resection and exploration of the lung
35 % had suture of the lung
25 % had removal of a foreign body
7 % had resection of̓ lung tissue
1 % had operations on the heart

In other words, in more than half the cases it was necessary to do pulmonary surgery.

Thoracoabdominal wounds

These were approached more often through the chest (238 times than through the abdomen (193 times), although many of course had both. The diaphragm was repaired in only 78 percent of the oases, much more often from above than from below (226 against 99). Many of these patients had bizarre dislocations. There was one case with the kidney in the thorax and another with the diaphragm at the brim of the pelvis.

52

These are extremes. In general, it may be said that thoracoabdominal wounds require the most expert surgery and expose the most unusual combinations of anatomy, especially on the left.

Abdominal wounds

Of the 1834 laparotomies:
42 % had closure of gastrointestinal perforations
34 % had colostomies and various exteriorizations
19 % were negative or not amenable to surgery
17 % had intestinal resections
14 % had operations on the liver
13 % had operations on the urinary bladder
5 % had acute inflammatory conditions
4 % had splenectomy
2 % had operations on the biliary tract
2 % had transperitoneal nephrectomy

These percentages add up to more than 100 because many patients had more than one procedure.

In almost two-third of the patients, the operation was directed towards the stomach and small intestine; in one-third towards the colon. Liver, spleen, kidney, and bladder required surgery in another third.

In one ease out of five, the abdomen was closed without intraperitoneal surgery. About half of these had a retroperitoneal hematoma or small bleeding vessel in the mesentery, the other half were entirely negative. This illustrates how difficult it is to make an accurate preoperative diagnosis, even in traumatic conditions.

The high incidence of acute inflammatory conditions is interesting. Appendicitis accounted for the bulk of it. Even on the beach, the figure was four percent. Perhaps there was a neurogenic element.

Genitourinary wounds

There were only eight nephrectomies by the conventional method through the flank, as opposed to 34 through the peritoneum. The urethra was repaired in 38 cases, the ureter in three.

Amputations and disarticulations

Of the 398 amputations and disarticulations:
52 % were of the leg
23 % were of the thigh
14 % were of the forearm
11 % were of the upper arm

53

This means that 75 percent were of the lower extremity and 25 percent of the upper.

Anesthesia

The total number of anesthetics listed is 9130 which is less than the total number of patients because two teams did not submit figures on this score. The 9130 anesthetics break down as follows:

Inhalation                        37%
Intravenous                    57%
Block & local                  5 %
Spinal                        less than 1 %

Of the inhalation anesthetics, 70 percent were given by endotracheal tube. Bronchoscopic aspirations were done on six percent of all patients. These figures emphasize anew the need for anesthetists who are familiar with endotracheal instrumentation.


Specialist teams

Neurosurgical

During the first few weeks on the beachhead, there was only one neurosurgical team. Later, another one was added. The figures are as follows:

                Pen. wounds        Comp. skull
                of  the brain           fractures        Laminectomies
Team 1           249                   98                         50
Team 2             64                   27                           4

Only one team has been consistently active. The figures that are given here apply to number of wounds, not patients. The period starts with the beginning of July and ends with the latter part of November:

Compound  fractures        Soft tissue wds.                Burns (all severe)
Mandibular    58                Face & mouth    148        Face & neck 12
Maxillary    9                     Pharynx    14                    Trunk 3
Nasal    8                          Larynx    4                        Arm & hand 18
Zygomatic    15                 Neck    10                        Thigh & buttocks 3
Frontal, ethmoid  3                                                    Legs 4
Temporal    3

54

X-ray

Statistics are available f or the three months July, August, and September:

                    Patients           Number of
                    examined         radiographs

July                1468                3229
August           1019                2184
September     1393                2823

The average number of patients per working-day was 27.

55

Awards for exceptional service

Because of the many combined acts of courage, devotion, and loyalty the commanding officer recommended the Group for a unit citation. When this was disapproved, he recommended certain members for individual citations. The following is a list of awards up to 1 January. Others are expected in the near future. The list includes only those who are now with the organization.

Silver Star
T/4 Robert J. Smith        
For gallantry in action

Bronze Star
Major Walter O. Haynes MC
For meritorious service

Major Duncan A. Cameron MC
For meritorious service

Major John A. Growdon MC
For meritorious service

Major James J. Whitsitt MC
For meritorious service

Captain Albert W. Brown MC
For meritorious service

Captain Sumner W. Brown MC
For meritorious service

Captain Thomas J. Floyd MC
For meritorious service

Captain John P. Sheldon MC
For meritorious service

Captain Sidney M. Simons MC
For meritorious service

Captain Stanley F. Smazal MC
For meritorious service

Captain Michael M. Donovan MC
For meritorious service

Captain Frank J. Lavieri MC
For meritorious service

Captain Wentworth L. Osteen MC
For meritorious service


Captain Charlotte E. Niemeyer ANC
For meritorious service

1st  Lt. Virginia O. Heath ANC   
For meritorious service

1st Lt. Ruth A. Maher ANC       
For meritorious service


T/4 Marion G. Mitcham
For heroic achievement

T/4 Lawrence E. Le Mieux
For meritorious service

T/4 Clarence C. Moody
For meritorious service

T/4 Thomas A. Owens
For meritorious service

T/4 Marvin R. Wormington
For meritorious service

T/5 Lloyd L. Kraus
For meritorious service

T/5 William F. Thomas
For meritorious service

T/5 Louis NMI Turi
For meritorious service

T/5 Asa NMI Thomas
For meritorious service

T/5 Alexander P. Milbert
For meritorious achievement

T/5 Emery W. Hopkins
For meritorious achievement

Pvt Aurelio M. De Leon
For meritorious service

55

Purple Heart Awards

The list includes only those who are with the organization at present. A number of others who were evacuated because of wounds have not returned to the Group so that it is unknown whether they received the award.

Major James J.  Whitsitt MC              6 June    France
Major Reynold. E. Church MC          6 June    France
Captain Michael M. Donovan MC     6 June    France
Captain William H. Ferraro MC         6 June    France
  
Major Albert W. Crandall MC                 21 September     Holland
Captain Saul NMI Dworkin MC              21 September     Holland
Captain John S. Rodda MC                     21 September     Holland
Captain Charles O. Van Gorder MC        21 September     Holland
T/5 Ernest E. Burgess                               21 September     Holland

1st Lt. Gladys Snyder ANC        21 October     Belgium

T/4 Allen E. Ray               9 June   France
T/5 Emil K. Natalle           9 June   France

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Killed and Missing


T/5 John H. Malone
Disappeared on 11 June near St. Laurent while on detached service with the 51st Field Hospital. Later found dead.

1st Lt. Alfred D. Sensenbach MAC
Sergeant Loren R. Mullison
T/4 Luis C. Hultine

These three men disappeared on a journey for the delivery of pay. They were last seen at 0900 21 September near Bastogne, Belgium. No trace has been found of them or their car.  [Editor’s Note: The three were captured by the Germans and were POWs for the remainder of the war.]

Major Charles A. Serbst MC
Major Evan NMI Tansley MC
Captain Harry NMI Fisher MC
Captain Eugene F. Galvin MC
T/4 James F. McDonald
T/4 George F. Broerman
T/5 Louis NMI Turi

These men, representing team 11, stayed behind with the non-transportable patients at the first platoon of the 42nd Field Hospital in Wiltz, Luxembourg when the Germans advanced on the town 16 December. They are now listed as Missing in Action.  [Editor’s Note: Maj. Serbst and his team were captured at Wiltz and spent the rest of the war as POWs.]

Major Albert J. Crandall MC
Captain John S. Rodda MC
Captain Charles O. Van Gorder MC
Captain Saul NMI Dworkin MC
T/4 Allen E. Ray
T/5 Emil K. Natalle
T/5 Ernest E. Burgess

These men, representing all but one member of team 20, were with the 326th Medical Company of the 101st Airborne Division when it was surrounded by the Germans between Bastogne and Wiltz in the recent retreat. They are now listed as Missing in Action. [Editor’s Note: Maj. Crandall and members of Team 20 were captured near Bastogne and spent the remainder of the war as POWs.  For more on Maj. Crandall’s experiences see his interview.]

58

Summary and conclusions

1.   The Group has fulfilled its mission of providing surgical teams for the medical installations of FIrst Army.

2.   This mission has been carried out by

25 general surgical teams
9 specialty teams
15 nurses' teams

3.    The experience in the invasion has been reported in detail and several suggestions are made, the main one to the effect that teams have a special issue of surgical equipment when they are with clearing stations.

4.    Airborne teams have succeeded in bringing early surgery to areas not accessible to installations of the conventional type.

5.    The “ideal” team for a field hospital consists of a general surgeon, a chest surgeon, an assistant with leanings towards orthopedics, an anesthetist, and four enlisted men. There should be at least one chest surgeon for every three teams so that no functioning field hospital platoon will be entirely without a specialist of that sort.

6.    Other specialists are better deployed In evacuation hospitals. There is room for three neurosurgical and three maxillofacial teams.

7.    Under the present system the nurses have become separated from the Group in every respect except administrative. If they are to serve with teams as contemplated by the table of organization, field hospitals should have a reinforced nursing staff for their operating rooms.

8.    The Group should have three medical administrative officers.

9.    The Group needs six more trucks for transportation of the teams.

10.  Mobile surgical. units have proved useful to a limited extent. They are not indispensable. Mobile X ray units and mobile dental units have done important and essential work.

59-60
Composite Statistics

Maps

The Normandy Beaches on "D" Day

Dog, Easy & Fox Sectors of Omaha