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HISTORY OF THE OFFICE OF MEDICAL HISTORY
Conquest of North Africa
The invasion of French North Africa on 8 November 1942 was the first action of World War II by U.S. ground forces against the European Axis. The beaches of Morocco and Algeria and the rugged mountains and barren wastes of Tunisia were the testing grounds both for the combat forces and for the medical troops that supported them in the field and behind the lines. It was in North Africa that officers, nurses, and enlisted men of the Army Medical Department perfected the techniques and developed the organizations that were to save thousands of lives in Italy and France.
Prelude to Invasion
Genesis of the North African Campaign
As early as January 1942, when Prime Minister Winston S. Churchill and his Chief of Staff, General Sir Alan Brooke, were in Washington for high-level strategic discussions, the possibility of launching an Allied military campaign in northwest Africa was suggested, but resources available at that time were clearly inadequate for such an undertaking. The matter was again discussed in June, in connection with the dangerous situation on the Russian front and the precarious position of the British forces in Africa, where the Germans had been halted barely short of Cairo. In July, the Combined Chiefs of Staff in London, under strong pressure from the President, made the decision to mount the operation at the earliest possible date. D-day was later set for 8 November. Allied landings in Morocco and Algeria were to be co-ordinated with a planned offensive by the British Eighth Army, to be launched from the El 'Alamein line in the fall. Lt. Gen. Dwight D. Eisenhower was designated to command the operation, known by the code name TORCH, and was directed to begin planning at once. Allied Force Headquarters (AFHQ) for the North African campaign was set up at Norfolk House in London in mid-August, with primary responsibility for planning delegated to Maj. Gen. Mark W. Clark, Eisenhower's deputy commander.1
1 Sources for the genesis and military planning of TORCH are: (1) Biennial Report of the Chief of Staff of the United States Army, July 1, 1941 to June 30, 1943, to the Secretary of War (Washington, 1943), pp. 18-20; (2) History of Allied Force Headquarters, August 1942-December 1942, vol. I; (3) Winston S. Churchill, The Hinge of Fate (Boston: Houghton Muffin Company, 1950); (4) Dwight D. Eisenhower, Crusade in Europe (Garden City, New York: Doubleday and Company, 1948); (5) Mark W. Clark, Calculated Risk (New York: Harper and Brothers, 1950); (6) George F. Howe, Northwest Africa: Seizing the Initiative in the West, UNITED STATES ARMY IN WORLD WAR II (Washington, 1957); (7) Craven and Cate, eds., Europe: TORCH to POINTBLANK; (8) Leo J. Meyer, "The Decision To Invade North Africa (TORCH)," Command Decisions (Washington, 1960), pp. 173ff; (9) Samuel Eliot Morison "History of United States Naval Operations in World War II, vol. II, Operations in North African Waters, October 1942-June 1943 (Boston: Little, Brown and Company, 1950). pp. 3-42, 181-186.
The strategical and psychological importance of the operation can scarcely be overestimated. A successful TORCH would relieve the hard-pressed Russians by opening a diversionary front much earlier than an invasion of continental Europe could be launched; it would forestall the possibility of a German breakthrough into the oil-rich Middle East to join hands with the Japanese; it would open the Mediterranean to Allied shipping and render more secure the sea and air routes over the South Atlantic; it would put U.S. ground troops into action against the Germans; and, finally, if it could be accomplished without fatally embittering the French, it would open the way for France to re-enter the war on the Allied side. By the same reasoning, however, the venture was hazardous. To fail would spell disaster.
Plans for Operation TORCH
The plans developed by General Clark and his collaborators called for simultaneous landings at three separate points. British naval units were to support operations inside the Mediterranean; U.S. units those in the Atlantic. The Twelfth U.S. Air Force, under command of Brig. Gen. James H. Doolittle, was activated and trained to give necessary air support as soon as airfields could be captured and made operational.
The Western Task Force, which was to storm the beaches on the Atlantic coast of Morocco in the vicinity of Casablanca, was commanded by Maj. Gen. George S. Patton, Jr. Totaling approximately 34,000 men, it consisted of the 2d Armored Division, the 3d Infantry Division, and two regimental combat teams of the 9th Infantry Division. The Western Task Force trained in the United States and sailed for Africa under convoy of the U.S. Navy.
The Center Task Force, under command of Maj. Gen. Lloyd R. Fredendall, was to go ashore on beaches flanking Oran, some 250 miles inside the Mediterranean. This force was made up of elements of II Corps, built around the 1st Infantry Division, half of the 1st Armored Division, and a force from the 509th Parachute Infantry Regiment, reinforced by corps troops to a strength of more than 40,000. The Center Task Force trained in England and was convoyed by British warships.
The Eastern Task Force, with a complement of 23,000 British and 10,000 U.S. troops and commanded by Lt. Gen. K.A. N. Anderson of the British First Army, was to attack Algiers. Maj. Gen. Charles W. Ryder, commander of the 34th Infantry Division, led the American element, which consisted of two reinforced regimental combat teams (RCT), one each from the 9th and 34th Infantry Divisions, and a Ranger battalion. Like the Center force, the Eastern Task Force trained in England and was accompanied to its destination by units of the British Navy. In the hope of securing more willing co-operation from the French, who were still resentful toward their former British allies for the earlier sinking of French vessels at Oran, General Ryder and his American troops were to spearhead the Eastern Task Force assault.
Both personnel and equipment for medical support of the task forces were to be held to the absolute minimum. The medical section of Allied Force Head-
quarters was headed by a British Director of Medical Services, Brigadier, (later Maj. Gen.) Ernest M. Cowell. The ranking American medical officers were Cowell's deputy, Col. John F. Corby, and Corby's executive officer, Lt. Col. (later Col.) Earle Standlee. The decentralized nature of the operation, however, placed primary responsibility for planning and organizing combat medical support on the task force surgeons. Col. Richard T. Arnest, II Corps surgeon, conducted planning for the Center Task Force in England, while Col. (later Maj. Gen.) Albert W. Kenner, surgeon of the Western Task Force, worked in Washington. Medical service for the Eastern Task Force was planned and largely supplied by the British, the force surgeon being the Deputy Director of Medical Services of the British First Army, Brigadier E. W. Wade. Each force surgeon operated pretty much on his own, within a broad policy framework; there was little or no co-ordination between the forces. The Twelfth Air Force surgeon, Col. Richard E. Elvins, functioned independently of both AFHQ and the task force surgeons in the preparation of medical plans, including plans for air evacuation.2
From the medical point of view, the North African campaign was difficult and largely extemporized. The distances were vast: 445 miles by air from Casablanca to Oran; 230 miles from Oran to Algiers; and another 400 air miles from Algiers to the ultimate objective, the Tunisian ports of Tunis and Bizerte. By way of the antiquated, single-tracked rail line that connected the coastal cities, the distances were considerably greater. Highways were few in number and poor in quality, not built to withstand the punishment inflicted by tanks and heavily loaded trucks moving in steady streams from ports to supply depots and to the fighting fronts. Water was scarce and always subject to suspicion; sanitation was primitive; malaria, typhus, dysentery, cholera, and venereal diseases were known to be widely prevalent, with plague a constant threat in the seaports. All of these factors had to be taken into account in medical preparations for the invasion and for the subsequent campaign in Tunisia.
2 General sources for medical planning of Operation TORCH, in addition to general sources cited above, are: (1) 2d Lt. Glenn Clift, MS, Field Operations of the Medical Department in the Mediterranean Theater of Operations, United States Army (hereafter cited as Clift, Field Opns) pp. 1-20; (2) Hist of the Twelfth Air Force Med Sec, Aug 42-Jun 44; (3) F. A. E. Crew, "History of the Second World War," The Army Medical Services: Campaigns (London: Her Majesty's Stationery Office, 1957) vol. II; (4) Link and Coleman, Medical Support of the Army Air Forces in World War II, pp. 419-24.
Planning for the initial assault also had to take into account a shortage of shipping space that would limit supplies and restrict medical support to little more than could be given by the divisional medical units organic to the participating formations. For the U.S. increment, supplies were to be in the form of the standard medical maintenance units, each sufficient to support 10,000 men for thirty days, augmented by special drugs and biologicals appropriate to the conditions anticipated.
In bed strength the Eastern Task Force, which was to lead the advance into Tunisia, fared better than either of the other landing groups. In addition to the organic units, the D-day troop list included a British field ambulance, comparable to an American clearing company; 2 light casualty clearing stations (200 beds each), equivalent to small evacuation hospitals, each with a field transfusion unit and 2 field surgical units attached; 2 British general hospitals, more mobile than their U.S. counterparts, of 600 beds each; and 4 teams of the U.S. 2d Auxiliary Surgical Group, with enlisted men substituted for nurses. Beds would thus be available for about 4.8 percent of the command during the first four days. The second convoy, which was to reach Algiers on D plus 4, was to carry 2 British general hospitals of 200 beds each and one of 1,200 beds, but the ratio would not be raised since troop strength would also be doubled by that time.
The Center Task Force was to carry two hospitals in the assault--the 400-bed 48th Surgical and the 750-bed 38th Evacuation--or beds for less than 3 percent of the command. Another 750-bed unit, the 77th Evacuation Hospital, was scheduled for the second convoy, which would reach Oran on D plus 3 along with the 51st Medical Battalion, but a 50-percent increase in troop strength would keep the bed ratio barely above 3 percent.
For the Western Task Force, sailing from the United States, shipping was even more restricted, and no hospitals of any kind were included in the D-day troop list. Since the second convoy for the Western Task Force was not due for several days, transports were to be supplied with equipment and personnel to serve as floating hospitals during the first days of the assault.
In each of the landing operations the Navy--British or American--was to be responsible for all medical care between the port of embarkation and high water on the landing beaches, and naval beach groups were to help in the collection and care of casualties. British hospital ships
were to evacuate patients from Algiers and Oran to the United Kingdom. Since no U.S. hospital ships were available, there would be no alternative for the Western Task Force but to evacuate casualties by returning transports or hold them ashore for future disposition.
Plans for combat medical service in the landing phase were spelled out in considerable detail, but were based largely upon manuals prepared without realistic knowledge of amphibious operations. Participation by U.S. observers in the costly Dieppe raid of 19 August 1942 was the nearest approach to a seaborne landing on a hostile shore in modern U.S. Army experience.3 It is therefore not surprising that casualty estimates were too high, or that conditions under which medical troops would operate were misjudged.
Medical Support in the Landing Phase
The Allied assault on the Moroccan and Algerian coasts took place as scheduled in the early hours of 8 November 1942. It was hoped that the French would not resist the landings. Secret negotiations to this end were carried on right up to D-day itself, climaxed by a personal appeal from President Roosevelt, which was broadcast in French over shortwave radio as the troops began to go ashore. On most of the beaches, the first waves of combat troops did get ashore without encountering more than sporadic small arms fire, but before objectives were gained there was fighting in every sector.
Eastern Task Force
Algiers was first to surrender, owing largely to secret contacts with military commanders there and to the unexpected presence in the city of Admiral Jean-Francois Darlan, Vichy naval commander, whose authority was second only to that of Marshal Henri Pétain himself. The city lies along the western rim of a half-moon-shaped bay, whose eastern extremity is Cap Matifou. Seven or eight miles west of the city the coast dips sharply to the south, interrupted only by Cap Sidi Ferruch, which juts into the Mediterranean on a line with the center of Algiers and about ten miles distant.4(Map 6)
The 39th Regimental Combat Team of the 9th Division, with elements of the British 1st Commando attached, went ashore east of Cap Matifon in the early hours of 8 November. Landing craft used were small and fragile by later standards, and boat crews were inexperienced. It is not surprising, therefore, that many of them piled up in the surf and others
3 Gen. Lucian
K. Truscott, Jr., the chief U.S. observer at Dieppe, gives his own account
in Command Missions, A Personal Story (New York: Dutton, 1954),
pp. 62-72. The medical story of the raid, which suffered over 50 percent
casualties in killed, wounded, and missing, is in W. R. Feasby, Official
History of the Canadian Medical Services,
1939-1945 (Ottawa: E. Cloutier,
Queen's Printer, 1956), pp. 113-22.
were brought ashore at the wrong beaches. Aside from sporadic fire from coastal batteries on Cap Matifou, however, no opposition was encountered at the beaches, and the combat team quickly pressed inland and captured Maison Blanche airfield.
The 168th RCT of the 34th Infantry Division and the bulk of the British 1st Commando landed just north of Cap Sidi Ferruch, but here, too, the invaders were widely scattered because of faulty navigation. Only the absence of opposition enabled the force to regroup and move inland toward Algiers by daylight. The commandos, meanwhile, had received the surrender of the fort at Sidi Ferruch without a fight, and, with the aid of friendly French officers, the airfield at Blida had been neutralized. The British 11 Infantry Brigade landed without opposition some twenty miles south of Cap Sidi Ferruch simultaneously with the more northerly landings and moved inland to protect the flank of the 168th RCT.
The only seriously opposed landings were those of the 6th Commando north and west of Algiers, where difficulties in assembling and loading the assault boats delayed the landings until after daylight. Here the commandos had to call for the
support of naval gunfire and of carrier-based planes to win their objective by late afternoon. An attempt by two British destroyers to enter the harbor before dawn had proved unsuccessful. One of the vessels was forced to withdraw after suffering severe damage from shore batteries. The other succeeded in ramming the boom and landing a detachment of the 135th RCT, 34th Division, but the troops were pinned down and taken prisoner, while the destroyer withdrew so severely damaged that she later sank.
By late afternoon of D-day Algiers was surrounded, its airfields were in the hands of the Allies, and those of its coastal fortifications that had not capitulated were at the mercy of Allied naval guns and bombers. Darlan, who had been in contact with Robert Murphy, the U.S. diplomatic representative in North Africa since the eve of the landings, met with General Ryder early in the evening and agreed to a local cease-fire. After two days of negotiation an armistice was signed, to be effective shortly after noon on 11 November. Negotiations continued until 13 November, when Darlan was recognized as de facto head of the French Government in North Africa.
In addition to its own medical detachment, each of the U.S. regimental combat teams that spearheaded the Algiers landings was accompanied by a collecting company and a clearing platoon of the medical battalion organic to its parent division--Company A and the 2d Platoon of Company D, 9th Medical Battalion, with the 39th RCT; and Company C and the 2d Platoon of Company D, 109th Medical Battalion, with the 168th.
On the beaches east of Cap Matifou, where the 39th RCT made its landings, the collecting company was put ashore during the morning of D-day, but most of its equipment remained on shipboard. Without vehicles to follow the combat troops and with little in the way of medical supplies, the company remained of necessity close to the landing area in the vicinity of the beach dressing station set up by British naval personnel. Casualties were held at the dressing station because the sea was too rough to permit evacuation to the ships and no hospital facilities were available on shore.
A radio call for more medical personnel early in the afternoon brought Capt. (later Maj.) Paul L. Dent and Capt. (later Maj.) William K. Mansfield of Surgical Team No. 1, commanding officer and executive, respectively, of the 2d Auxiliary Surgical Group detachment, to the beach about 1600, but they were unable to bring equipment with them. A bombing raid, rough seas, and the coming of darkness prevented the landing of more surgical group personnel or of the clearing station they were to support, so Captains Dent and Mansfield worked through the night at the naval beach dressing station.
The quick end of hostilities on the 8th enabled the two surgical group officers to evacuate more than twenty patients the next morning to the dispensary at Maison Blanche airfield about fifteen miles inland, using trucks and borrowed French ambulances. The clearing platoon of the 9th Medical Battalion and the remaining eighteen officers and enlisted technicians of the 2d Auxiliary Surgical Group did not come ashore until 11 November, when the ships carrying them docked at Algiers. A hospital was then set up in a schoolhouse in Maison Carrée, about midway between the air-
field and Algiers. On 13 November the hospital moved to Fort de l'Eau on the bay north of Maison Blanche, where it was operated jointly by the collecting company and the clearing platoon of the 9th Medical Battalion and the four surgical teams.
On the beaches west of Algiers, where the 168th RCT landed, the first collecting company personnel came ashore at 0730 on D-day, but were landed at the wrong beach and were forced to make a 10-mile march carrying equipment on litters to reach the battalion aid station they were to support. The clearing platoon, meanwhile, had landed at 0800, and set up station in conjunction with the British 159th Field Ambulance in the basement of a winery near Sidi Ferruch.
The remainder of the collecting company came ashore about 1,000, but the only ambulance to be unloaded on D-day was not available until evening and did not reach the forward station until 0900, D plus 1. A British surgical team joined the clearing station on 9 November. Later that day the clearing platoon and the field ambulance took over the Mustapha civil hospital in Algiers, which quickly expanded from 100 to 300 beds, functioning as an evacuation hospital.
Fortunately, there were few casualties on D-day when the medical service in landing areas would not have been prepared to deal adequately with them. Most of those occurring in the next few days resulted from German bombings and from land mines. Only 93 U.S. soldiers were hospitalized during the first week of the Algiers campaign. Of these, 58 were admitted for battle wounds, 13 for injuries, and 22 for disease.5
Center Task Force
In the central sector the strategy employed by General Fredendall was in all respects similar to that used by the Eastern Task Force. Like Algiers, Oran lies on a crescent-shaped bay, protected by headlands on either side. Here the strong-points were the fortified military harbor at Mers el Kebir, three miles west of Oran; and the town of Arzew, twenty-five miles to the east. Both positions were outflanked.6 (Map 7)
One armored column, comprising about one-third of Combat Command B,
5 Rpt. Hq
S0S ETO, Off of the Chief Surgeon, 15 Feb 43. These figures cannot be fully
reconciled with those given in the Final Report, Army Battle Casualties
and Nonbattle Deaths in World War II. The official tabulation shows 1,017
U.S. Army (including Air Forces) personnel wounded or injured in action
for the whole North African theater for the month of November 1942. The
combined wounded and injured figure for the three task forces for the week
of 8-14 November as given in the document cited above is 1,224. The time
is relatively comparable, since U.S. forces were not engaged before 8 November
or during the remainder of the month after 14 November. The larger figure
in the S0S report is presumably owing to the inclusion of some naval personnel
in the Western Task Force figures, but these are not separable. Hospital
admissions for injury in the TORCH operation were not differentiated as
to battle or nonbattle origin.
1st Armored Division, landed some thirty miles west of Oran. The landing was unopposed, but difficulties in getting the vehicles ashore delayed any advance until about 0900. The column then struck eastward to Lourmel and followed the north rim of the Sebkra d'Oran, the long salt lake that parallels the coast about ten miles inland. Against only sporadic opposition, the column reached and seized La Sénia airfield, south of Oran, on the morning of 9 November.
A simultaneous landing at Les Andalouses 15 miles west of Oran by the 26th RCT, 1st Infantry Division, was only briefly interrupted by an unexpected sand bar, and the men were moving inland by daylight when French coastal guns began shelling the transport area. By the end of the day, elements of the 26th had pushed beyond Mers el Kébir, and that strongpoint was cut off from the west and south.
The main point of attack was in the vicinity of Arzew. There the 1st Ranger Battalion got ashore undetected just north of the town and quickly seized the two forts dominating the harbor. The 16th and 18th RCTs of the 1st Division and the larger portion of Combat Command B were then able to land from transports moved close to shore. There was no opposition until daylight, by which time the assault units were well on their way to their first objectives. Combat Command B raced southwest some twenty-five miles to seize Tafaraoui airfield and held it against French counterattacks the following day. The 16th and 18th RCTs moved on Oran by parallel
routes, the 18th being delayed by stubborn resistance at St. Cloud before bypassing that town.
A direct assault on Oran itself was attempted at H plus 2 by two British destroyers carrying more than 400 combat troops, most of them from the 1st Armored Division, but both ships were destroyed inside the breakwater and all men aboard were killed or captured. Equally unsuccessful, though less disastrous, was an attempted airdrop on Tafaraoui airfield by 556 men of the 2d Battalion, 509th Parachute Infantry Regiment, flying from England. Faulty navigation and a mix-up in signals dropped a number of the men in Spanish Morocco, where they were interned. Others dropped at various points far west of their objective. Only one plane reached the field, but it met with antiaircraft fire and turned back without dropping its men. Almost half of the paratroopers were still missing by 15 November.
The end of the day, 9 November, found the invaders converging on Oran from all sides. Armored spearheads entered the city the next morning, the 10th, and a cease-fire order was issued at 1215.
The combat elements of the Center Task Force received varying degrees of medical support. The armored column landing west of Oran was accompanied by its own medical detachment and by a small group from the organic 47th Armored Medical Battalion. The 26th Regimental Combat Team, 1st Division, which hit the beaches east of Oran, received medical support from a collecting company and a clearing platoon of the organic 1st Medical Battalion, and from a detachment of 6 officers, 6 nurses, and 20 enlisted men of the 48th Surgical Hospital. The 16th and 18th RCT's of the 1st Division, landing at Arzew, were each accompanied by a collecting company of the 1st Medical Battalion, with one clearing platoon backing up both regiments. Combat Command B was supported by Company B of the 47th Armored Medical Battalion, less the detachment with the western column. Third-echelon support came from the 400-bed 48th Surgical Hospital and, after the surrender, from the 38th and 77th Evacuation Hospitals.
Arzew was already in Allied hands by the time most of the medical personnel came ashore. About noon of D-day a clearing platoon of the 1st Medical Battalion, although most of its equipment was still afloat, took over a dirty and inadequate civil hospital capable of accommodating 75 patients. The French doctors in attendance remained to care for natives already there, and for French and native prisoners as they were brought in. Personnel of the 48th Surgical Hospital came ashore in landing craft during the afternoon, but without equipment and scattered over a 2-mile area. As soon as the unit was consolidated, 3 of its surgeons and 3 nurses were sent to the civil hospital.7 The detachment was augmented during the night by 4 operating teams of 2 surgeons and a nurse each. These teams worked throughout the night of 8-9 November by flashlight.
The 48th Surgical set up its own hospital in nearby French barracks on D plus 2, taking over operation of the
7 "Having nurses arrive with the 48th Surgical Hospital at Arzew on D-day was very helpful in caring for the wounded. However, I did not feel afterwards that the risk was fully justified and would not do it again." Ltr, Col Arnest to Col Coates, 10 Nov 58, commenting on preliminary draft of this volume.
Arzew civil hospital at the same time. Equipment and supplies were secured from the British Navy, Army units in the area, the French, and the 38th Evacuation Hospital--which had arrived at Arzew on 9 November but was not yet in operation. The 48th Surgical's own equipment did not come ashore until 13 November. The maximum number of patients treated at any one time was 480 and included American, British, French, and native.
About noon of D-day elements of Company B, 47th Armored Medical Battalion, assisted by a detachment from the Twelfth Air Force surgeon's office, set up an aid station in the city hall at St. Leu, four or five miles southeast of Arzew. The detachment moved to Tafaraoui airfield on 10 November, and the St. Leu station was turned over to Air Forces control two days later.
On 11 November, the day after the surrender of Oran, the 38th Evacuation
Hospital moved inland to St. Cloud, where heavy fighting had overtaxed the available medical facilities. While equipment was being gathered together at the prospective site, surgical teams from the 38th joined elements of the 1st Division Clearing Company at the civil hospital in Oran, where about 300 casualties, including survivors of the ill-fated H plus 2 attempt to land troops in the harbor, had been turned over by the French authorities. Personnel of the 77th Evacuation assumed responsibility for the operation of the Oran hospital on 12 November. The surgical teams of the 38th rejoined their parent unit the following day when it opened under canvas at St. Cloud.
Responsibility for evacuation was taken over by the 51st Medical Battalion, which had arrived with the 77th Evacuation on the D plus 3 convoy. Up to that time there had been very little evacuation from the combat zone because of the blocked harbor and the delay in arrival of hospital ships.
In keeping with the longer and more determined French resistance, combat casualties of the Center Task Force were considerably higher than those in the Algiers area. Of the 620 U.S. patients hospitalized during the week ending 14 November, 456 had combat wounds, 51 had injuries, and 113 were disease cases.8
Western Task Force
The Western Task Force made three separate landings along more than 200 miles of the Atlantic coast on both sides of Casablanca, at Safi, Fedala, and Port-Lyautey. These landings encountered the most determined opposition of any of the three task forces. Subtask Force BLACKSTONE, commanded by Maj. Gen. Ernest N. Harmon of the 2d Armored Division and built around the 47th Regimental Combat Team, 9th Division, and two battalion landing teams of the 2d Armored, touched shore at Safi, 140 miles south of Casablanca, about 0445, 8 November. The first waves met only intermittent small arms fire, but the French had been alerted by the earlier landings inside the Mediterranean.9
When the destroyer USS Bernadou slipped into Safi harbor with a battalion landing team of the 47th Infantry aboard, she met raking cross fire. USS Bernadou replied successfully and managed to land the men, who quickly swarmed into the town. The destroyer USS Cole followed with more combat troops, but by this time coastal guns from a nearby fort were sweeping the transport area. The battleship USS New York replied, and the guns were silenced. The beachhead
8 Rpt, Hq
S0S ETO, Office of the Chief Surg, 15 Feb 43. See also n. 5. p. 111, above.
and harbor area were sufficiently secure by midmorning to bring tanks ashore, and the town surrendered at 1530, about eleven hours after the action had started.
French planes from Marrakech came over Safi in the early morning of D plus 1, but heavy fog kept all but one plane from dropping bombs. The one plane destroyed an ammunition dump, with considerable damage to port installations. Allied carrier-based planes neutralized the Marrakech field that afternoon
and broke up a truck convoy carrying French reinforcements to Safi. Tanks of Combat Command B, 2d Armored Division, which had landed during the night of 8-9 November were immediately dispatched to engage the French column. There was sharp fighting in the vicinity of Bou Guedra in the late afternoon of 9 November and early the next morning. After dark on the 10th the tanks withdrew and started for Casablanca, where they were sorely needed.
The largest of the three subtask forces--BRUSHWOOD--landed at Fedala, about fifteen miles north of Casablanca. (Map 8) The force consisted of the 3d Infantry Division, reinforced by a battalion landing team of the 2d Armored Division and was commanded by Maj. Gen. Jonathan W. Anderson of the 3d Division. Fedala lies on the southern edge of a shallow bay, enclosed by Cap de Fedala jutting out behind the town and the Cherqui headland about three miles to the northeast. The landing beaches actually used were all inside the bay, and all within range of batteries on cape or headland. Fortunately, the defenders were taken by surprise. Despite inexpert handling of landing craft that took several waves of assault troops to beaches miles north of the objective and piled many of the small boats onto rocks, there were 3,500 troops ashore before dawn brought organized French resistance. All initial objectives were quickly seized and the beachhead was secure by sunrise.
The batteries were silenced later in the day, and BRUSHWOOD Force began to move inland, swinging south toward Casablanca. The movement was hampered by delays in unloading transport and communications equipment, and supporting weapons, as well as by French resistance, but the force was poised in the outskirts of Casablanca by midnight of 10-11 November. In the interval, French warships at Casablanca, including the battleship Jean Bart, had joined the fight, inflicting considerable damage on the supporting naval units before being blockaded in the harbor. The final attack on Casablanca had still not been launched when word arrived that the French were willing to lay down their arms.
Most vigorously contested of all the Western Task Force landings were those of Subtask Force GOALPOST in the Mehdia-Port-Lyautey area, commanded by Maj. Gen. Lucian K. Truscott, Jr. (See Map 8.) GOALPOST'S primary mission was to seize an airfield where P-40's, brought on the carrier USS Chenango, could be based to aid in the assault on Casablanca some 75 miles to the southwest. The airfield lay in a bend of the Sebou River, with the town of Port-Lyautey south of it, on another and sharper bend. The airfield was about 3.5 miles inland, or twice that far up the winding river, with the town another 3 or 4 miles upstream, but about equidistant from the coast as the crow flies. The village of Mehdia was just above the mouth of the river, which was closed beyond that point by a boom.
The landing force consisted of the 60th RCT of the 9th Division and a light tank battalion of the 66th Armored Regiment, 2d Armored Division, with supporting units that included nearly 2,000 ground troops of the XII Air Support Command. Landings on both sides of the river mouth were marred when a number of boat crews missed their beaches, landed the men as much as five miles out of position, and lost many boats in the
surf. French authorities, moreover, had been alerted, like those at Safi, by the President's broadcast and by news of the actions already in progress at Oran and Algiers.
Coastal batteries opened up after the first wave reached shore, and French planes strafed the beaches at dawn. Ground opposition increased as the day advanced, and darkness found only the 3d Battalion of the 60th RCT more than a mile inland, opposite the airfield but north of the river. Units landing south of the river converged toward the airfield the following day and one company of the 3d Battalion crossed the Sebou in rubber boats, but all units were stopped short of their objectives.
The airfield was taken early on 10 November when the destroyer USS Dallas rammed the boom and carried a raiding party up the river to take the defenders of the field from the unprotected flank. About 1030, planes from the USS Chenango began landing at the field. There was little fighting the rest of that day, and French resistance was formally ended at 0400 on D plus 3.
For medical support the Safi force, in addition to attached personnel, was accompanied by a collecting company of the 9th Medical Battalion and a detachment of the 56th Medical Battalion consisting of two officers and sixty-nine enlisted men. During the first hours, casualties were held at aid stations for which sand dunes furnished the only cover. Early capture of the waterfront area made it possible to establish aid and collecting stations in a warehouse on the dock about H plus 8. From this point, casualties were evacuated for temporary hospitalization aboard the USAT Titania. Two days after the assault began, an improvised hospital staffed by medical battalion personnel was in operation in a school building with equipment borrowed from local doctors and merchants and from the Navy. Patients to be retained in the theater under a 30-day evacuation policy were brought to this provisional hospital from as far away as Port-Lyautey.
The 3d Division and its reinforcing armored battalion at Fedala were supported by the organic 3d Medical Battalion and by a detachment of the 56th Medical Battalion similar in size and composition to the detachment with the Safi force. Like the combat troops, medical soldiers were scattered by poor navigation of the landing craft. Units experienced considerable delay in making contact with their headquarters, as well as in the matter of receiving supplies. Evacuation was also a slow and uncertain process until medical units were
assembled and vehicles were made available, and the wounded were held at battalion aid stations for twenty-four and sometimes thirty-six hours. A clearing station was set up by the afternoon of D-day in a beach casino at Fedala with capacity for 150 litter cases, the overflow being cared for in school buildings and private homes. Additional supplies were borrowed from the Navy. During the night of 12 November the station cared for survivors of a U-boat attack, including over 400 burn cases, 100 of them so severe as to require repeated transfusions. Flashlights furnished the only illumination until floodlights could be borrowed from Ordnance repair units. All available medical officers, including Colonel Kenner himself and Lt. Cols. Huston J. Banton and Clement F. St. John of the headquarters staff, worked through the night at the clearing station. Supplies and personnel were inadequate, and many of the more severe cases were lost.10
The Mehdia landings were supported by a collecting company and a clearing platoon of the 9th Medical Battalion and a detachment of the 56th Medical Battalion. The medical force was about half the size of those with the other two sub-task forces. Throughout the three days of fighting it was possible to do no more than set up beach aid stations. Evacuation by land was out of the question for want of vehicles and a place to go; evacuation to the transports was hazardous and at times impossible because of heavy seas and the excessive loss of landing craft in the assault. On 12 November, after the armistice, the clearing platoon took over a Red Cross hospital in Mehdia, which was operated as an evacuation hospital until the regular installations arrived nearly a month later.
For the Western Task Force as a whole, 694 cases were hospitalized during the first week of the invasion. Of these, 603 were combat wounds, 43 injuries, and 48 disease.11
Hospitalization and Evacuation of Task Force Casualties
Hospitalization and evacuation of task force casualties remained the responsibility of the force surgeons until the medical section of Allied Force Headquarters was established in Africa and base section organizations were set up. For the Western Task Force the provisional hospitals at Safi and Mehdia continued to operate as long as they were needed. The Safi hospital was still in operation when the Atlantic Base Section was activated late in December. The first U.S. Army hospitals to reach western Morocco were the 750-bed 8th and the 400-bed 11th Evacuation Hospitals, which arrived at Casablanca together on 18 November on the delayed second convoy. The 8th opened three days later in buildings of the Italian consulate, which soon proved too small and inadequately equipped. The 11th moved on to Rabat, where it opened on 8 December, permitting return of the Mehdia Red Cross hospital to civilian control. The 59th Evacuation, another 750-bed unit, began receiving patients under canvas at Casablanca on 30 Decem-
10 (1) Memo,
Brig Gen Arthur R. Wilson for A/S, 12 Dec 42. sub: Rpt of Opns in N. Africa.
(2) Ltr, Brig Gen Clement F. St. John to Col Coates, 28 Oct 58, commenting
on preliminary draft of this volume.
ber. The 400-bed 91st Evacuation was also in the area before the end of the year, but was not established under task force control. All of these evacuation hospitals functioned as fixed installations rather than as mobile units.12
In the Oran area the three mobile hospitals that came in with the combat troops--the 48th Surgical and the 38th and 77th Evacuation--were supplemented on 21 November by the 9th Evacuation, with an additional 750 beds, and by the 1st Battalion, 16th Medical Regiment. Since all of its equipment was lost at sea, the medical battalion operated a staging area for other units until February 1943. The Mediterranean Base Section was activated on 8 December, and fixed hospitals under base section control quickly supplanted the mobile units of the Center Task Force, which began staging for the next phase of the North African campaign.
Aside from the clearing platoons of the 9th and 109th Medical Battalions, all hospitalization for the Eastern Task Force was British. Although they were not able to land on D-day as planned, the 1st and 8th Casualty Clearing Stations were established promptly after the surrender of the city and, together with the provisional casualty clearing station being operated by the 159th Field Ambulance and the clearing platoon of the 109th Medical Battalion, were able to care for all casualties until a sufficient number of general hospital beds was established between 15 and 20 November. All British units took U.S. patients, but the bulk of them went to the 94th General, largest and best equipped of the British hospitals assigned to the Eastern Task Force.13
Evacuation from the Western Task Force was by troop transport to the United States. From the Center and Eastern Task Forces, evacuation was by British hospital ship to the United Kingdom. There was very little of either, however, before the period of task force control ended.
Evaluation of TORCH Medical Service
From the medical point of view, Operation TORCH was relatively easy only because casualties were far lower than had been anticipated and because medical officers and enlisted men of the Medical Department met unexpected situations with ingenuity and skill. In no instance did the collecting or clearing elements get ashore early enough, or have enough equipment with them. Supplies hand-carried by medical personnel accompanying the assault waves included some unnecessary items and omitted other items that would have been useful. Additional medical supplies were scattered over the beaches, where quantities were lost. Ambulances, in particular, were unloaded far too slowly, and when they finally became available they proved to have poor traction in sand and a dangerously high silhouette. The jeep, on the other hand, was found to be readily adaptable for carrying litters over difficult terrain.14
reports of hospitals and base sections mentioned in the text.
Hospital facilities provided for the Western Task Force aboard the transports proved unusable except in a single instance because of the heavy surf and the heavy loss of landing craft during the assault. Mobile hospitals provided for the Center Task Force were adequate as to bed strength, but the unloading of equipment was not co-ordinated with the debarkation of personnel. Hospital equipment, moreover, often proved to be incomplete when unpacked.15 The Center and Western forces found it impossible to obtain records of casualties evacuated by naval beach parties, or even to learn how many there were.
Both the planning and the execution of the operation were at fault. Those who drew the medical plans in Washington and London had very little communication with each other, had only meager intelligence reports as to the conditions they would actually meet, and were for the most part either without combat experience on which to base their judgments or had experience limited to the static warfare of World War I. Medical personnel with the assault troops were equally inexperienced and at least equally ignorant of what war in North Africa would be like.
Medical Support of II Corps in the Tunisia Campaign
Expansion Into Tunisia
Armistice negotiations were still going on in Algiers and fighting still raged at Casablanca and Oran when the Eastern Task Force resumed its identity as the British First Army and turned toward Tunisia. The French commander there was unwilling or unable to obey Darlans cease-fire order, and Axis reinforcements were coming in through the ports and airfields of Tunis and Bizerte. First Army units occupied Bougie, 100 miles east of Algiers, on 11 November. The following day British paratroops and a seaborne commando group took Bône, 150 miles farther east, unopposed. Advance elements were within 60 miles of Tunis before encountering German patrols on 16 November. With French co-operation, forward airfields were occupied in the Tébessa area, just west of the Tunisian frontier and 100 miles south of the coast. Medjez el Bab was captured on 25 November. The airfields at Djedeida, a bare 15 miles from Tunis, were occupied three days later, but could not be held against strong counterattacks.16
Surg, II Corps, 1942.
(3) Recommendations of Surg, Western Task Force, 24 Dec 42, in Med Annex
to Final Rpt of Opns.
By early December General Anderson's troops were exhausted and his supplies critically short. Before a direct attack on Tunis could be mounted the winter rains set in, and the campaign bogged down in mud. After a month of futility, during which the enemy achieved superior build-up by virtue of his larger ports, all-weather airfields, and shorter supply lines, the front was stabilized from Medjez el Bab in the north to Gafsa in the south. The First Army dug in to wait.
The first phase of the Tunisia Campaign began in mid-November with the piecemeal commitment of American troops in support of the British First Army. It ended with the concentration of II Corps in the Constantine-Tébessa area during early January 1943 in preparation for a large-scale offensive. Immediately after the armistice elements of the 34th Division that had participated in the Algiers landings relieved British units occupying Bougie and Djidjelli. The 39th Regimental Combat Team, 9th Division, was detailed to guard the line of communications from Algiers to the rapidly advancing front. Elements of the 9th Medical Battalion that had landed with the 39th RCT operated an ambulance service and a clearing station in Baba Hassen, some twelve miles southwest of Algiers. The four teams of the 2d Auxiliary Surgical Group that had been part of the Eastern Task Force continued to function in British hospitals and other medical installations close to the front.
As rapidly as the situation permitted, elements of II Corps that had made up the Center Task Force were also deployed to eastern Algeria and Tunisia. Combat Command B of the 1st Armored Division was at the front in time to participate in the long seesaw battle for Medjez el Bab that began around the first of December. The 2d Battalion, 509th Parachute Infantry, flown out from Oran, was operating in the Gafsa area in conjunction with Twelfth Air Force units and French ground troops. Before the end of December elements of the 1st Division were also in action in the Medjez el Bab sector. In addition to attached medical personnel, Company B of the 47th Armored Medical Battalion was in Tunisia in support of units of the1 Armored Division. The 2d Battalion of the 16th Medical Regiment which had landed at Oran on 8 December, reached the front shortly before Christmas on detached service with First Army.17 In this early phase of the campaign the U.S. forces fought in relatively small units, with supporting medical detachments correspondingly divided.
Hospitalization and evacuation in the British First Army area were exclusively British responsibilities. As the first phase of the Tunisia Campaign came to a close in muddy stalemate, there were approximately 250,000 Allied troops under First Army control, for which 11,000 beds in
Opns. pp. 62-68; (8)
Hist, 47th Armed Med Rn, 1 Oct 42-9 May 43; (9) Opns Rpt, 1st Med
Bn, 11 Nov 42-14 Apr 43 (10) Rpt, Brig Gen Albert W. Kenner to CinC.
AFHQ, 7 Jan 43 sub: Inspection of Med Troops and Installations, First Army
Area; (11) Rpt, Brig Gen Howard McC. Snyder to IG, 8 Feb 43, sub:
Inspection of Medical Service. Eastern Sector, Western Theater of North
British military hospitals were available. Although the bed ratio was thus only 4.4 percent, no serious overcrowding was observed. Mobile units were close to the front lines and treatment was prompt. The Western Task Force surgeon, A. W. Kenner, who had been promoted to brigadier general and assigned to AFHQ as medical inspector, visited the front between 27 December and 4 January and concluded that American casualties were receiving the best medical care possible under the circumstances. He noted, however, that British hospitals were often lax in forwarding records of U.S. patients, so that commanders lost track of their men and returns to duty were unnecessarily slow; and that morale was impaired by absence of mail from home and failure to receive pay, though British wounded in the same hospitals received both. Other adverse morale factors were failure to receive the Purple Heart and the loss of personal toilet articles.
A month later Brig. Gen. (later Maj. Gen.) Howard McC. Snyder made similar observations, noting also that forward hospitals were unheated, lacking in all but the barest essentials in equipment, and understaffed by American standards. Nevertheless, he found treatment to be of a high order. While some installations had few patients, others were overburdened, resulting in a highly flexible evacuation policy. In some instances patients who could have been quickly returned to duty were sent to the rear simply to make room for new casualties. In others, men who should have been evacuated were held near the front because fixed beds were not available for them in the still rudimentary communications zone.
Evacuation was by ambulance from aid stations and other forward installations to railheads at Souk el Khemis, where a clearing platoon of the 2d Battalion, 16th Medical Regiment, shared the load with a British casualty clearing station, and at Souk Ahras, where facilities included a casualty clearing station and a 200-bed British general hospital. Michelin cars with capacity for 14 litter cases ran over the narrow-gauge line from Souk el Khemis to Souk Ahras; from there three British hospital trains made the 24-hour run to Algiers. Hospital trains were not yet available for evacuation west of that city.
In the Tébessa sector a British casualty clearing station and a small dispensary operated by the Twelfth Air Force furnished hospitalization. Both installations were at Youks-les-Bains, a few miles west of Tébessa and adjacent to a large airfield. Evacuation was by air, but was not formally organized. Up to early January, most of the casualties flown out were Air Forces personnel.
The Kasserine Withdrawal
At the turn of the year, U.S. units operating with the British First Army, together with forces from the Casablanca and Oran areas, were transferred to II Corps under General Fredendall, and various changes were made in the overall command structure. General Clark was detached from Allied Force Headquarters to train the newly activated U.S. Fifth Army for future operations in the Mediterranean. He was succeeded as Deputy Supreme Commander in North Africa by General Sir Harold R. L. G. Alexander. Lt. Gen. Sir Bernard L. Montgomerys British Eighth Army, fighting its way through Libya, was to come under General Eisenhowers com-
mand when it reached the Tunisian border. A new 18 Army Group was then to come into being, made up of the British First and Eighth Armies, the U.S. II Corps, and the French 19th Corps under General Louis-Marie Koeltz. General Alexander was to be the army group commander.
Early in January General Fredendall established II Corps headquarters at Constantine and began moving his forces into the vicinity of Tébessa. Additional elements of the 1st Armored and 34th Infantry Divisions, as they arrived from England, were sent to the II Corps sector, while all remaining elements of the 1st Division were brought up from Oran. The three divisions were substantially assembled by 1 February, with the scattered regiments of the 9th Division being moved into position as reserves. Medical units based around Tébessa included, in addition to attached medical personnel, the 1st and 109th Medical Battalions and the 47th Armored Medical Battalion, organic to the combat divisions; the 51st Medical Battalion; the 2d Battalion, 16th Medical Regiment; the 1st Advance Section of the 2d Medical Supply Depot; the 48th Surgical Hospital; and the 9th and 77th Evacuation Hospitals.18
The Germans seized the initiative when the rainy season ended in February. Early in the month Generaloberst Juergen von Arnims army in Tunisia was joined by Field Marshal Rommels famed Afrika Korps, and Rommel himself was in command when the Axis forces attacked savagely toward Faïd Pass in the center of the II Corps front on the l4th. Intelligence expected the attack farther north, and the Americans were caught off balance. Fredendall prepared to stand at Kasserine Pass, some forty miles west of the breakthrough, but his armor was out of position and poor weather conditions prevented air support or even reconnaissance. Enemy tank columns forced the pass on 20 February and debouched onto the plain beyond in a three-pronged drive that reached its maximum extent, only twenty miles from Tébessa, two days later. There the drive was contained. The Germans, running low on fuel and ammunition, realized they had not the strength to break through the Allied lines in the face of reinforcements moving in from Le Kef and Tébessa, and withdrew to their original positions.
Before the Faid breakthrough there had been relatively heavy fighting in the
18 Military sources for the Kasserine phase of the Tunisia Campaign are: (1) Howe, Northwest Africa; (2) Opns Rpt, II Corps, 1 Jan-15 Mar 43; (3) Truscott. Command Missions; (4) Howe, 1st Armored Division; (5) Knickerbocker and others, Story of First Division in World War II, pp. 58-64, 81-92; (6) Craven and Cate, eds., Europe: TORCH to POINTBLANK; (7)Eisenhower, Crusade in Europe, pp. 140-48; (8) Kesselring, Soldier's Record, pp. 177-84; (9) Alexander, "African Campaign," Suppl to London Gazette, 5 February 1948, pp. 866-73. Medical sources primarily relied upon are: (10) Annual Rpt, Surg, II Corps, 1943; (11) Annual Rpt, Med Sec, NATOUSA, 1943; (12) Annual Rpt, 51st Med Bn, 1943; (13) Annual Rpt, Surg, 1st Armd Div, 1943; (14) Annual Rpt, Surg, 1st Div, 1943; (15) Annual Rpt. Surg. 34th Div.1943; (16) Annual Rpt, Surg, 9th Div. 1943; (17) Hist, 47th Armd Med Bn, 1 Oct 42-9 May 43; (18) Opns Rpt. 1st Med Bn, 11 Nov 42-12 May 43; (19) Hist, 9th Med Rn, 1943; (20) Diary, Hq Detach, 109th Med Bn, 1 Feb Mar 43; (21) Cowell, Kenner, Rpts of Visit to II Corps, 29 Jan- 2 Feb 43; (22) Unsigned Rpt of Observations of Visit to II Corps, 13-19 Feb 43; (23) Annual Rpt, 9th Evac Hosp. 1943; (24) Annual Rpt, 77th Evac Hosp, 1943; (25) Annual Rpt, 128th Evac Hosp (48th Surg Hosp). 1943; (26) Annual Rpt, 2d Aux Surg Gp, 1943; (27) Clift. Field Opns, pp. 74-94.
Ousseltia Valley, where the II Corps sector approached British positions in the north, and around Gafsa, more than a hundred miles distant on the southern flank. These actions had served to disperse collecting and clearing companies over hundreds of miles of rough and largely roadless country. The 9th and 7th Evacuation Hospitals were about ten miles southeast of Tébessa, far to the rear, while the 48th Surgical was operating one 200-bed unit at Thala and the other at Fériana, each more than fifty miles from the combat lines as of 14 February. (Map 9)
A general withdrawal of medical in-
stallations paralleled the mid-February German advance. On the first day of the advance an entire collecting company of the 109th Medical Battalion was captured, together with most of the medical detachment of the 168th Infantry regiment--in all, 10 medical officers and more than 100 enlisted men. On the same day, 14 February, an officer of the 47th Armored Medical Battalion was captured with four ambulances loaded with casualties.19 Aid stations in both Faid and Gafsa sectors were hastily leapfrogged to the rear, one section caring for patients while another moved to a safer location. Lines of evacuation were long and circuitous, over roads that could be safely traveled only at night. Trucks and litter-jeeps were freely used to supplement the ambulances that were never available in sufficient numbers.
During the night of 14-15 February the Fériana section of the 48th Surgical Hospital moved to Bou Chebka about midway along the road to Tébessa, using trucks and ambulances of the corps medical battalions. Patients were placed in the 9th Evacuation Hospital, which shifted 107 of its own patients to beds set up for the purpose by the still inoperative 77th. By February 17th the 48th Surgical was on the road again, moving this time to Youks-les-Bains just west of Tébessa. Within six hours of ar-
19 Interv with 1st Lt Abraham L. Batalion, and Capt Wilbur E. McKee.
rival it was receiving patients from both evacuation hospitals, which were themselves in process of moving.
When weather conditions made air evacuation to the communications zone impossible, a section of the British 6th Motor Ambulance Convoy was rushed to Youks, where it was placed at the disposal of the 48th Surgical Hospital on 18 February. The twenty-five ambulances and two buses of this unit were able to move 180 patients at a time, and succeeded in clearing the Tebessa area of casualties by the time the Germans broke through Kasserine Pass. Both the 9th and the 77th Evacuation Hospitals were back in operation by 20 February, at new sites in the Ain Beida-La Meskiana area on the road to Constantine. The Tebessa section of the 2d Medical Supply Depot moved into the same area on 19 February, followed by the Thala section of the 48th Surgical. The remainder of the 48th went from Youks to Montesquieu on 22 February, while the 9th Evacuation shifted from Ain Beida to Souk Ahras, fifty miles to the north. (Map 10)
All of these moves were carried out rapidly and in good order, although hundreds of patients were involved. In this acid test of mobility, commanders were duly impressed by the fact that a 200-bed section of the 48th Surgical Hospital could evacuate its patients, dismantle and load its installations, and be on the road in four and a half hours, while the 750-bed evacuation hospitals, because they had no organic vehicles of their own, were able to move only when transportation could be provided by corps. In a disintegrating situation their priority was low and the danger of their being overrun by the enemy was proportionately great. The relative immobility of these large units kept them so far behind the fighting fronts that ambulance runs of a hundred miles or more between clearing station and hospital were not infrequent. In the absence of hospitals closer to the lines, teams of the 2d Auxiliary Surgical Group were attached to the clearing stations.
Operations in Southern Tunisia
During the first week of March, General Fredendall was relieved, and command of II Corps was given to General Patton; Maj. Gen. Omar N. Bradley was appointed his deputy. The shift in leadership coincided with the penetration of Tunisia from the south by the British Eighth Army and activitation of the 18 Army Group under Alexander. The II Corps' next mission was to attack in the Gafsa-Maknassy area in support of Eighth Army's drive up the coast.20
Mindful of the Kasserine experience, and with troop strength brought up to 90,000 by assignment of the 9th Division, Colonel Arnest, the II Corps surgeon, asked for one of the new 400-bed field hospitals capable of operating in three 100-bed units, a 400-bed evacuation hospital, and more ambulances. Only the ambulances arrived before the southern phase of the Tunisia Campaign
20 Military sources for the campaign in southern Tunisia are: (1) Opns Rpt, II Corps, 16 Mar-10 Apr 43; (2) Howe, Northwest Africa; (3) Howe, 1st Armored Division; (4) Knickerbocker and others. Story of First Division in World War II, pp. 64-72, 92-95; (5) Omar N. Bradley, A Soldier's Story (New York: Henry Holt and Company, 1951), pp. 43-55; (6) Kesselring. Soldier's Record, pp.184-88; (7) Alexander, "African Campaign," Suppl to London Gazette, 5 February 1948, pp. 873-78. Medical sources are the same as those cited in n. 18, above, with the addition of: (8) Annual Rpt, 15th Evac Hosp, 1943; (9) Annual Rpt, 3d Aux Surg Gp, 1943; (10) Clift, Field Opns, pp. 98-112.
was over, and those only a few days before the pressing need for them had passed. The only medical reinforcements received were five teams of the 3d Auxiliary Surgical Group, flown in without nurses on 18 March. Eleven teams of the 2d Auxiliary Surgical Group were already active in the II Corps area. Shortage of beds made it impossible to maintain any fixed evacuation policy, even the 15-day policy originally planned.
The corps jumped off on 17 March. The1st Division occupied Gafsa the same day, took El Guettar on the 18th, and seized Station de Sened on the 21th.
Maknassy fell to the 1st Armored on 22 March. After a brief respite for revision of plans and regrouping, all four divisions of II Corps went into action on 28 March. The 9th Division attacked along the road from El Guettar to the coastal city of Gabès; the 1st turned northeast toward Maknassy, where the 1st Armored was concentrating on a strongly held pass east of the town; and the 34th, together with British First Army units, attacked Fondouk on the left flank. Fighting in all sectors was heavy, and for ten days almost continuous. Contact with the British Eighth Army was established on 7 April, and the enemy began withdrawing to the north. When the 34th Division and its British allies broke through at Fondouk two days later, the southern campaign was over.
In the interval between recovery of the ground lost in the Kasserine withdrawal and the launching of the II Corps offensive, hospitals and other medical installations were again moved forward to the Tébessa area. The 9th Evacuation Hospital set up this time at Youks-les-Bains, where proximity to the field used for air evacuation to the communications zone was the primary consideration. Both sections of the 48th Surgical were back at Fériana by 19 March. Two corps clearing stations established on 22 March remained in place until the end of the southern campaign, compensating in part for the shortage of mobile hospital beds. These were the clearing stations of the 51st Medical Battalion at Gafsa and of the 2d Battalion, 16th Medical Regiment, near Maknassy. Each was reinforced by surgical teams and was adjacent to clearing units of the organic medical battalions. They functioned in effect as front-line hospitals for forward surgery and for holding cases that could not be safely moved. Evacuation from both stations was to the 48th Surgical Hospital, fifty miles from Gafsa and almost twice that far from Maknassy.
Coinciding with the renewal of the offensive on 28 March, the 77th Evacuation returned to Tébessa and one section of the 48th Surgical went on to Gafsa. At Sbeitla, on the evacuation route from the 34th Division, 2d Battalion of the 16th Medical Regiment set up a clearing station that, like the other two corps clearing stations, functioned as a forward hospital. It was relieved on 11 April, after the southern campaign had ended, by the 400-bed 15th Evacuation Hospital.
Facilities of the 48th Surgical Hospital, and of the corps clearing stations, were wholly inadequate for the steady stream of casualties from the three divisions operating in the El Guettar-Maknassy sector during the final drive. Evacuation to Tébessa and Youks by ambulance and truck was virtually a continuous process. To make room for new arrivals, the 77th and 9th Evacuation Hospitals were compelled to send patients to the communications zone with little reference to their hospital expectancy, and many were thus lost who could have been returned to duty in a reasonable time.
In the El Guettar-Maknassy area, terrain was often too rough for vehicles, even for jeeps and half-track ambulances. Litter carries, especially on the 9th Division front, were long and generally possible only at night. In many instances both patients and medical attendants waited in slit trenches for darkness. The corps medical battalions supplied additional litter bearers, as many as 75 being needed by one combat team. Only in the
Fondouk sector was evacuation from the battlefield relatively easy. There, a good road net and adequate cover permitted location of aid and collecting stations close to the lines. The ambulance haul from the clearing station at Sbeitla to the evacuation hospitals at Tébessa and Youks-les-Bains was approximately eighty miles. (Map 11)
The Drive to Bizerte
Following withdrawal of the enemy from southern Tunisia, General Patton was detached to train the force that would become the U.S. Seventh Army on the scheduled invasion of Sicily. Command of II Corps passed to General Bradley, whose first task was to shift his troops 150 miles to the north. Although the movement involved passing close to 100,000 men, with all their equipment, across the communication lines of the British First Army, it was accomplished without interruption to any supply or military service, and without detection by the enemy.21
21 Military sources for the northern phase of the Tunisia Campaign are: (1) Opns Rpt. II Corps, 23 Apr-9 May 43 (2) Howe. Northwest Africa; (3) Howe, 1st Armored Division; (4) Knickerbocker and Others, Story of First Division in World War II, 72-81, 95-98; (5) Bradley, Soldier's Story; (6) Craven and Care, eds., Europe: TORCH to POINTBLANK; (7) To Bizerte with the II Corps
The final phase of the North African campaign began on 23 April, with II Corps and attached French elements pushing east along the Mediterranean coast, First Army advancing northeast in the center, and Eighth Army attacking northward on the right flank. The French l9th Corps, under General Koeltz, operated between the two British armies. By this time the Allies had control of the air and the end was swift and sure. One after another, strongly held hill positions were stormed. The 1st Armored swept through the Tine Valley to capture the important communications city of Mateur on 3 May. Bizerte fell to the 9th Division on 7 May, simultaneously with the entry of British units into Tunis. The 3d Division was brought up at this time, but was too late to participate in more than mopping-up operations. All enemy forces in the II Corps sector surrendered on 9 May. British armor quickly closed the escape route to the Cap Bon peninsula, and the remaining Axis forces, trapped between the British First and Eighth Armies,
(Washington, 1943); (8) Alexander, "African Campaign," Suppl to London Gazette, 5 February 1948, pp. 878-84. Medical sources are substantially the same as those already cited for the Kasserine and southern phases of the campaign, to which should be added: (1) Annual Rpt, 10th Field Hosp, 1943; (2) Clift, Field Opns.
surrendered on 13 May. About 275,000 prisoners were taken in the last week of the campaign.
With an independent combat mission and five divisions under its command by the date of the German surrender, II Corps resembled a field army both in size and role. Colonel Arnest functioned more as an army than as a corps surgeon. His staff of eleven officers and sixteen enlisted men was of a size appropriate to the responsibilities entailed.
In northern Tunisia, Tabarka served as the nerve center for medical activities, as Tébessa had in the south. The use and disposition of mobile hospitals was drastically modified on the basis of previous experience. The semimobile 400-bed evacuation hospitals, with surgical teams attached, were placed directly behind the advancing troops, with the larger evacuation units farther to the rear where they took patients from the more forward installations. Before the attack was launched, the 11th Evacuation was shifted more than a thousand miles from Rabat to a site nine miles south of Tabarka, and the 48th Surgical was established some ten miles farther to the east. The 750-bed 77th Evacuation was set up at Morris, near Bône, where it was detached from II Corps and assigned to the Eastern Base Section, the forward element of the North African Communications Zone.
On 21 April the 15th Evacuation moved up from Sbeitla to a location ten miles north of Bédja, and the following day the 11th relieved the 48th Surgical, which closed for reorganization. The larger 9th Evacuation occupied the former site of the 11th. (Map 12) The 48th Surgical, converted into the 400-bed 128th Evacuation Hospital, returned to combat duty southwest of Mateur on 4 May. The l5th Evacuation, displaced by the 128th, moved two days later to a site west of Mateur.
The 750-bed 38th Evacuation Hospital moved from the Télergma airfield west of Constantine, where it had been operating as a communications zone unit since early March,22 to the vicinity of Bedja on 4 May; and on 7 May the 9th Evacuation moved forward to the vicinity of Mateur. The 77th Evacuation remained throughout the campaign at Morris, where it possessed air, rail, and water outlets to the communications zone, though its usefulness was impaired by an ambulance run of 85 to 110 miles over roads too rough for the transportation of seriously wounded men.
In the northern phase of the campaign, II Corps was thus supported by three 400-bed and three 750-bed evacuation hospitals, in contrast to the campaign in the south where one 400-bed unit and two 750-bed units had served substantially the same troop strength. In the northern campaign, moreover, forward hospitals were only 5 to 20 miles from the combat areas, contrasted with distances of 25 to 100 miles in southern Tunisia. Despite these shortened lines of evacuation, the 2d Battalion of the 16th Medical Regiment and the 51st Medical Battalion were reinforced by elements of the 56th Medical Battalion and were given additional ambulances. The 10th Field Hospital, which reached Tabarka on 30 April, was also assigned to II Corps, but did not go into operation until 7 May, when it was used exclusively as a holding unit for air evacuation, and to serve personnel of an air base.
22 See p. 190. below.
During the first ten days of the Bizerte drive, fighting was in mountainous country, often covered with thick, thorny underbrush and largely without roads. Evacuation was particularly difficult on the 9th Division front, to the left of the corps sector. For a time mules were used, harnessed in tandem with a litter swung between poles attached to the saddles. Difficult hand litter carries up to three and a half miles necessitated the use of 200 additional bearers, drawn in part from corps medical battalions but mainly from line troops. At one point, where a railroad cut the 9th Division front, two half-ton trucks were fastened back to back with rims fitted over the rails. One truck powered the vehicle on its way to the rear, the other on the return trip. Twelve litters could be carried at a time, but the exposed position of the railroad made it usable only at night. One collecting company of the 9th Medical Battalion operated a rest camp in the rear of the division area, to which approximately seventy-five front-line soldiers were brought each evening for a hot shower, a full nights sleep, and a chance to write letters. Exhaustion cases were held at the clearing stations, under heavy sedation.
Similar conditions prevailed on the narrower fronts assigned to the other divisions of II Corps. The 1st Division borrowed litter bearers from the 51st
Medical Battalion; the 1st Armored drafted cooks, clerks, and other noncombat personnel into service as bearers. Half-track ambulances proved unable to enter the narrow wadis where casualties occurred most frequently, and had to be replaced by jeeps. In the bloody battle for Hill 609, litter bearers of the 34th Division brought out casualties in daylight from positions closer to the enemy lines than to their own.
In the final week of the campaign, medical support of the combat forces more closely approximated the pattern laid down in the manuals. (Map 13) The coastal plain was adapted to easy movement in vehicles, and the road net was good. The 400-bed evacuation hospitals were closed to admissions between 9 and 15 May, new patients being sent thereafter only to the 9th Evacuation. The staff of this unit was reinforced by a detachment from the 16th Medical Regiment and by captured German medical personnel, who helped with prisoner-of-war patients. Two captured German field hospitals were allowed to continue in operation, under supervision of the 51st Medical Battalion, until 15 May, when all prisoners still requiring hospitalization were turned over to the 9th Evacuation. As of 12 May there were 1,145 patients, including prisoners of war, in II Corps hospitals, and twice that number in the two evacuation hospitals assigned to the Eastern Base Section. All hospital units and corps medical battalions passed to control of EBS as of midnight, 15 May.
Immediately after the end of hostilities the 9th Evacuation Hospital, on its own initiative, began to function as a station hospital for all troops in the area. Members of the hospital staff were soon treating 100 or more a day in the outpatient clinic, where their specialized skills made up for the limitations of battalion medical sections left with the combat and support troops in the vicinity.23
Summary of Tunisian Experience
Like the combat troops, the medical units and personnel of the medical detachments went into the Tunisia Campaign without battle experience, or with experience limited to the two or three days of action in the TORCH landings. Deficiencies in training had to be made up while operating under combat conditions, and in intervals when the units were in bivouac. More important still was the training of replacements. Virtually no trained medical replacements were available, yet losses were high. More than a hundred Medical Department officers and men were captured in the Faïd Pass breakthrough alone, while disease, injury, and battle wounds also took their toll. Indeed, the personnel problem was perhaps the most difficult one faced by the surgeons office during the campaign. Constant juggling of medical officers, and continuing training of line troops as replacements, were necessary to keep the II Corps medical service in operation at all. Other difficulties included much obsolete equipment in the early stages of the campaign, and generally inadequate lighting and power facilities.
Casualties were progressively heavier
23 Recorded interv, Col Coates, with ASD Frank B. Berry, 4 Nov 58, commenting on preliminary draft of this volume. Dr. Berry--then a colonel-- was chief of the Surgical Service, 9th Evacuation Hospital, in North Africa.
with each stage of the campaign. Hospital admissions for the period 1 January through 16 March were 4,689. During the campaign in southern Tunisia, 17 March through 9 April, 6,370 men were admitted to II Corps hospitals. For the northern campaign, 10 April through 15 May, there were 8,629 hospital admissions. The consolidated casualty figures, shown in Table 1, offer tangible evidence of the magnitude of the task successfully carried through by Colonel Arnest and his staff.
The early use of the 750-bed evacuation hospital as a forward unit was a holdover from the relatively static warfare of World War I, and was at least in part responsible for the siting of hospitals so far to the rear. Another reason for the failure of II Corps to give close hospital support in the Kasserine and southern phases of the campaign was the absence of any fixed battle line and the necessity of giving ground before an enemy superior both in numbers and in combat experience.24
The organization of the corps medical service underwent numerous changes as the campaign progressed and more experience was gained with the requirements of modern combat. Initially the corps surgeon's office was located at the
24 Ltr, Col Arnest to Col Coates, 10 Nov 58.
corps rear echelon, where information filtered back too slowly to permit adequate advance planning. Delay in establishing a base section close to the combat zone complicated both supply and evacuation problems in the early stages of the campaign. The 61st Station Hospital, located at El Guerrah just south of Constantine early in February at the request of the British First Army surgeon and under British control until March, was the only U.S. fixed hospital closer than Algiers until the end of March. This 500-bed unit, and the British 12th Casualty Clearing Station at Youks-les-Bains, aided immeasurably in the orderly withdrawal of II Corps medical installations at the time of the Kasserine breakthrough. The contrast between the medical support available to the corps at that time and that available during the final phase of the campaign in late April and early May shows how quickly and how well the lesson of Kasserine Pass was learned.25
Air Force Medical Installations
In addition to the mobile hospitals serving II Corps in the field, the Twelfth Air Force maintained various installations of its own, which gave first- and second-echelon medical service to combat fliers, their counterparts in the Air Transport Command, and the supporting ground crews. Air Forces medical personnel were administratively distinct from the organization serving the ground forces, although the two groups worked closely together. Air Forces installations were confined to squadron aid stations and dispensaries, but both types of unit frequently had to assume hospital functions. At the more important airfields, such as Marrakech, La Sénia, and Télergma, hospitals were set up by the base sections, while combat zone airfields, such as Youks-les-Bains, generally had
25 (1) Ltr, Surg. II Corps, to TSG, 1 Jun 43, sub: Care of Wounded. (2) Ltr, Surg. NATOUSA, to TSG, 15 May 43, sub: Observations, North AfricanTheater. (3) Clift, Field Opns, pp. 129-36. (4) Observations made on a visit to II Corps, 13-19 Feb 43. (5) Deputy Surg, AFHQ, to G-4. Orders, 61st Sta Hosp, 20 Jan 43; and attachment, DDMS, First Army, to Surg, AFHQ, 15 Jan 43. See also p.189, below.
mobile hospital units of the ground forces in the immediate vicinity. Fixed hospitals in the communications zone served Air Forces personnel as well as ground troops.26
Evacuation From II Corps
The chain of evacuation from the Tunisian battlefields went from forward evacuation hospitals by ambulance and rail to Eastern Base Section installations, and by air direct to fixed hospitals in Algiers and in the vicinity of Oran. During the Kasserine and southern Tunisian campaigns, Tébessa and the nearby airfield at Youks-les-Bains served as the starting points for evacuation to the communications zone. In the final stages of the campaign, and the readjustment period immediately following the close of hostilities, evacuation was from Tabarka to Bone, from the railhead at Souk el Khemis to Constantine, and from
26 For description of Air Forces medical units, see Link and Coleman, Medical Support of the Army Air Forces in World War II, pp. 455-57.
airfields at Souk el Arba and Sidi Smaïl to Oran.
Evacuation by Road and Rail
The 1st Battalion of the 16th Medical Regiment, with the assistance after 18 February of the British 6th Motor Ambulance Convoy, operated an ambulance shuttle from Tébessa to Constantine, approximately 140 miles. The same road served as a main supply route for II Corps. Beginning in mid-March, the 16th Medical Regiment also staffed and operated a French hospital train, which ran from Tébessa to Ouled Rahmoun, just south of Constantine, where the narrow-gauge Tébessa line intercepted the main east-west railroad. A traffic control post at Aïn Mlilla distributed patients from ambulance convoys and hospital trains to vacant beds in the area. In the northern sector the ambulance route of the 16th Medical Regiment ran eighty-five miles from Tabarka to Bône. Rail evacuation from the northern sector was by two British hospital trains from Souk el Khemis, each with capacity for 120 litter and 200 sitting patients.27
Evacuation from the combat zone by road and rail was under control of II Corps, although the 1st Battalion of the 16th Medical Regiment, which was primarily responsible for the operation, was assigned to the Eastern Base Section. For the Kasserine period, 1 January to 16 March 1943, the II Corps Surgeon reported 1,740 patients evacuated to the communications zone by road, none by rail. During the campaign in southern Tunisia, 17 March to 9 April, 1,742 patients were evacuated by road and 1,052 by rail. From the northern sector, 10 April to 15 May, the evacuation figures included 5,628 by road and 436 by rail.
Air Evacuation From II Corps
With the concentration of II Corps in the Tébessa area in January, it was immediately clear that the informal and infrequent use of air evacuation prevalent up to that time would be inadequate. The logistical demands upon the single-track, narrow-gauge rail line and the one motor road between Tébessa and Constantine would preclude the extensive use of either for evacuation, even had hospital cars and ambulances been available at that early stage of the campaign. In an effort to solve the evacuation problem, General Kenner and Colonel Corby met with General Doolittle and Colonel Elvins, respectively commanding officer and surgeon of the Twelfth Air Force, and the corresponding officers of the 51st Troop Carrier Wing in Algiers on 14 January.28
A comprehensive plan for air evacuation was agreed upon, and was put into
27 (1) Annual
Rpt, Med Sec, EBS, 1943. (2) Annual Rpt, Med Sec. NATOUSA, 1943.
(3) Med Hist Data, 161st Med Bn (1st Bn, 16th Med Regt), 22 Oct 44.
(4) Unsigned Memo, n.d., sub: Notes on General Kirk's Observations of Med
Serv in North Africa, May 43.
effect without delay. It differed in fact but little from the plan Colonel Elvins had prepared before the invasion, but at that time it had met with a cold reception from ground surgeons, who believed air evacuation to be impractical. The plan called for the corps surgeon to establish holding hospitals near forward airfields, with the air surgeon responsible for supervision and the theater surgeon for over-all co-ordination. It was in this connection that the 38th Evacuation Hospital was established at Télergma. 29
The planes used were C-47's, equipped with litter supports, which made it possible to carry 18 litter patients and attendants. There were no regular schedules, since the planes were used for evacuation only on their return runs after discharging cargo or passengers in the combat zone. Requests were made through the medical section, AFHQ, and evacuation officers in the combat areas were notified each evening as to how many planes would be available the following day. Communication was by teletype, telephone, radio, and air courier. Patients were assembled near the airfields so they could be loaded with a minimum of delay.
Although planes were not marked with the Geneva Cross, and flew at low altitudes, there were no enemy attacks. Before 10 March the medical personnel handling air evacuation were enlisted men from the medical sections of various groups of the 51st Troop Carrier Wing. After that date personnel--including nurses as well as enlisted men--were supplied by the 802d Medical Air Evacuation Transport Squadron. Surgeons on the ground supervised loading and unloading. The surgeon of the 51st Troop Carrier Wing was responsible for records, supplies used in flight, and property exchange. The ratio was two planes used for resupply for every ten loads of patients, although one plane could be made to serve if returning personnel were dispersed among cargo transports.
In the Kasserine phase of the campaign, air evacuation was from Youks-les-Bains, with the British 12th Casualty Clearing Station serving as holding unit for evacuees. During the II Corps operations in southern Tunisia the same airfield was used, with the holding function shifted to the 9th Evacuation Hospital. One planeload of 16 patients was flown direct from Thèlepte. When operations shifted to the northern sector, the lines of evacuation ran from Souk el Arba and Sidi Smaïl. The 38th Evacuation Hospital was close to both airfields. In the final days of the campaign, the 10th Field Hospital served as a holding unit at Souk el Arba. The overcrowded hospitals of the Eastern Base Section were bypassed, the planes returning directly to their own bases at Algiers and Oran, sometimes by an inland route and sometimes flying low over the water. Figures for air evacuation from the Tunisian fronts between 16 January and 23 May 1943, as reported by the 802d Medical Air Evacuation Transport Squadron (MAETS), are broken down by points of origin and destination in Table 2.
The Air surgeon estimated that 887 patients had been evacuated by air in North Africa before the formal service was inaugurated on 16 January 1943, but
29 See also p. 132, above, and pp. 204-05, below.
by no means all of these came from Tunisia.30
It was this experience in North Africa that gave both ground and air surgeons some idea of the immense capabilities of air evacuation, which continued to be used increasingly through the rest of the war.
Medical Supplies and Equipment
Shipping shortages and the speed with which Operation TORCH was mounted held medical supplies and equipment carried by the task forces to the lowest possible level consistent with safety. There also were difficulties in getting together all of the items scheduled for follow-up convoys. Hospitals destined for North Africa arrived in England with no more than 25 percent of their medical equipment and none of their quartermaster equipment. Deficiencies were made up in the United Kingdom, but only by stripping the European theater of much of its reserve stock.31
Until the arrival
of trained medical supply personnel late in December 1942, supplies for
the Western Task Force were handled by division medical supply officers
and by personnel of a hospital ship platoon. For the Center Task Force,
the 51st Medical Battalion took over the medical supply function shortly
after its arrival on the D plus 3 convoy. Here trained medical supply personnel
were available within two weeks. The 1st Advance Section, 2d Medical Supply
Depot, arrived in Oran on 21 November and carried on the medical supply
30 The II
Corps surgeon, in his annual report for 1943, gives a figure of 3,313 patients
evacuated by air between January and 15 May. The larger figure shown in
Table 2 is due in part to the additional week included at the heavy end
of the period, and in part to the inclusion of Air Forces casualties, not
reported by II Corps.
tion for the growing body of troops in the area until a base section organization was established early in December. 32
The U.S. components of the Eastern Task Force were supplied, like the British components, through the British First Army. Even items not available in British depots were requisitioned from ETO sources by the British. This dependence upon British supplies continued through the first phase of the Tunisia Campaign, creating many difficulties because of differences in practice between the two medical services. Supply levels deemed adequate by the British were insufficient by the more lavish American standards.33
Medical supply in Tunisia passed into American channels with the concentration of II Corps in the Constantine-Tébessa area at the beginning of 1943. The 1st Advance Section of the 2d Medical Supply Depot opened in Constantine on 8 January, moving a few days later to Télergma, where it relieved elements of the 16th Medical Regiment. The section shifted to Bekkaria, east of Tébessa, on 20 January, and thereafter remained as close as possible to the II Corps medical installations. The supply depot withdrew to Am Beida on 20 February, following the Kasserine breakthrough, then moved up to Souk Ahras for a brief time, but was back at Bekkaria before the Gafsa-Maknassy-El Guettar campaign began in mid-March. The depot was in operation east of Tabarka by 23 April in support of the drive to Bizerte. On 15 May, immediately after the German surrender in Tunisia, the 1st Advance Section, 2d Medical Depot Company, moved to Mateur, where it was later relieved by a base section depot.
After activation of the Eastern Base Section late in February, medical supplies for II Corps were received through the base depot at Aïn Mlilla, south of Constantine, or one of the two subdepots at Philippeville and Bone. Distance and transportation difficulties always complicated the supply problem, but there were no serious shortages of any necessary item at any time during the Tunisia Campaign.
Medical supplies in North Africa were furnished initially on the basis of the Medical Maintenance Unit (MMU), designed to meet the medical requirements of 10,000 men for thirty days. Deliveries to the theater were automatic, determined by troop strength. Combat experience quickly revealed deficiencies and overstocks in the MMU, which was supplanted midway through the Tunisia Campaign by the Balanced Depot Stock, worked out by supply experts in the Office of The Surgeon General.
Items of basic equipment were the most difficult to replace, but in spite of depot stringencies, hospitals assigned to the combat zone usually managed to get there with equipment in excess of their organizational allowances, and so were able to weather loss and breakage.
Combat Medicine and Surgery
The amphibious phase of the North
African campaign was too brief, and the
32 See pp.
207-09, below, for base section medical supply activities.
nature of the fighting too restricted, to provide positive experience in combat medicine and surgery. The primary lesson for the Medical Department was the necessity in future landing operations of establishing clearing stations and hospitals ashore at the earliest possible date, with sufficient equipment and adequate personnel for emergency surgery and medical care. In Tunisia, invaluable experience was gained in the management of wounds, in the equipping and staffing of facilities for forward surgery, and in the handling of psychiatric cases. Even before the campaign was over, much of this experience was applied toward the improvement of medical and surgical care in the combat zone.
Forward Surgery- In the early phases of the Tunisia Campaign, mobile hospitals were located so far to the rear--often 50 to 100 miles--that a far heavier surgical load fell on the clearing stations than had ever been contemplated. Plasma as a guard against shock was given in the collecting stations and often in the aid stations, but as a general rule only emergency surgery was performed in the division area. Surgeons in the division clearing stations administered plasma, controlled hemorrhage, and closed sucking chest wounds, but completed trau-
matic amputations only where necessary to stop hemorrhage.34
After emergency treatment, surgical cases went to the clearing stations of the corps medical battalions, which were set up through necessity as forward surgical hospitals despite the fact that they were inadequately equipped and staffed for this purpose. Surgical and shock teams worked together effectively in these installations with minimal equipment, but there were neither beds nor personnel for postoperative care. Intravenous fluids could not be administered; special diets were not available; whole-blood transfusions were possible only with detachment personnel as donors and without means of checking blood for malaria or syphilis. As a result, patients were evacuated as rapidly as possible, the majority in six to eight hours after surgery and some while still under anesthesia.
Col. Edward D. Churchill, surgical consultant in the theater, explored the situation during the southern campaign, and his recommendations had much to do with the improvement of conditions in the northern sector, where smaller evacuation hospitals were set up closer to the front. Associated with Colonel Churchill in the evaluation of II Corps surgery was Maj. (later Col.) Howard E. Snyder, of the 77th Evacuation Hospital, who reported to corps headquarters for temporary duty on 15 March 1943, and remained as surgical consultant to the corps.35 In the Sicily Campaign, as will be seen later, the whole concept of forward surgery was altered as a result of the Tunisian experience.
One of the lessons quickly driven home in the Tunisia Campaign was that plasma was not a complete substitute for blood in combat surgery. No supply of whole blood was available, nor had any provision been made to fly it in. To meet the immediate and pressing need, an informal blood bank was established at the Gafsa section of the 48th Surgical Hospital, where 25 to 50 troops were detailed each day as donors. Out of the II Corps blood bank of 1943 grew the theater blood bank of 1944.36
The Psychiatric Problem- The outstanding medical problem of the Tunisia Campaign was the unexpectedly high incidence of psychiatric disorders. Originally diagnosed as shellshock, following World War I terminology, or as battle fatigue, these cases constituted a heavy burden on forward medical units. In the absence of specialized knowledge on the part of regimental and division medical personnel, most of the psychiatric cases in the early stages of the campaign were evacuated to communications zone hospitals, from which less than 3 percent returned to combat duty.37
for this section are: (1) Annual Rpt. Med Sec. NATOUSA, 1943; (2) Annual
Rpt, Surg, II Corps, 1943; (3) Rpt to CO, 2d Aux Surg Gp, by Maj Kenneth
F. Lowry, and Capt Forrest E. Lowry, 13 Aug 43 sub: Forward Surgery; (4)
Rpt to Surg, NATOUSA, by Col Edward D. Churchill, 16 Apr 43, sub: Memoranda
on Forward Surgery; (5) Surg, NATOUSA, Cir Ltr No. 13, 15 May 43. sub:
Memoranda on Forward Surgery; (6) Surg, NATOUSA, Cir Ltr No. 18,
14 Jun 43, sub: Forward Surgery and Aux Surg Teams.
In the battles of El Guettar and Maknassy in southern Tunisia, psychiatric reactions were responsible for 20 percent of all battlefield evacuations, and for days at a time the proportion ran as high as 34 percent 38 Experimenting with these cases at the corps clearing station near Maknassy late in March 1943, Capt. (later Col.) Frederick R. Hanson, who had been sent out from the theater surgeons office to investigate the problem, found that 30 percent of all psychiatric cases could return to full duty within thirty hours if properly treated close to the combat lines. The treatment Captain Hanson developed was heavy sedation at the clearing station, followed by transfer to an evacuation hospital where sedation and intensive psychotherapy were continued for three days. At the end of that time, the patient was returned to duty or was evacuated to the communications zone for further treatment.
In the Bizerte phase of the campaign, division surgeons were made responsible for the initial treatment, and psychiatrists for the follow-up were attached to the 9th, 11th, 15th, and 128th Evacuation Hospitals, all functioning in the forward area. Hanson himself was attached to the 48th Surgical Hospital, later reorganized as the 128th Evacuation. Cases returned to full duty without leaving the combat zone ranged from 58 to 63 percent.
Common Diseases- Aside from surgical and psychiatric problems, the Tunisia Campaign revealed little of a medical nature that had not been anticipated. Dysentery and diarrhea were prevalent among II Corps troops, but outbreaks were controlled by screening and by destruction of flies. Respiratory infections were a frequent occurrence, but were not particularly severe. Malaria was not a source of difficulty, since the campaign ended before the onset of the malaria season, and combat exposure was therefore not extensive. As a preventive measure, II Corps troops began taking atabrine on 4 April, with good compliance and minimal reactions.
The Tunisia Campaign revealed that the standard dental chest was not sufficiently portable to be carried close behind the lines. During periods of com-
38 This terminology requires some explanation. Although the terms "casualty" and "battle casualty" were consistently applied in the Mediterranean theater to psychiatric disorders occurring in the combat zone, these cases are officially tabulated as "disease." Not to establish a new policy but to make explicit one supposedly already in effect, War Department Circular No. 195, dated 1 September 1943, stated: "Psychoneurosis or mental diseases developing under battle conditions (commonly but improperly designated battle neurosis, hysteria, shellshock, etc.) will not be classified as a battle casualty or reported as wounded or injured in action." By that date, however, the practice in the theater had become fixed, as will be seen from the documents cited in the preceding footnote. As late as 1949, Colonel Hanson and his collaborators were still employing the term "psychiatric casualty" in the sense in which they had used it prior to September 1943. For the sake of uniformity, all psychiatric disorders will be statistically treated as "disease" in this volume; but in deference to views widely held among psychiatrists, the term "disease" will not be used in the text to categorize cases falling under the general classification of "combat exhaustion."
bat, cases requiring emergency dental treatment were cared for at division clearing stations, and as much routine work as possible was done in the division area. For the most part, however, the routine work was deferred until periods of combat inactivity. During periods of actual contact with the enemy, when little dental work could be done, dental personnel usually served in other capacities such as assistant battalion surgeon; supply, mess, records, motor, and admissions officer; and anesthetist. Enlisted dental technicians served as medical technicians and as company aid-men.39
A need for dental prosthetics was observed throughout the Tunisia Campaign, but no facilities for such work were available in the II Corps area, and only inadequate facilities appeared anywhere in the theater. The 34th Division dental surgeon found a partial solution of this problem in March when captured German equipment was used to set up a prosthetics laboratory for the division.40
The veterinary service of II Corps during the Tunisia Campaign was largely confined to routine food inspections by division veterinarians. Since no fresh meat was available until April, the duties were not arduous, and veterinary personnel, like dental personnel, were frequently used in administrative and other capacities. Veterinary functions included the care of animals only for a brief interval in late April when mules were used for evacuation of the wounded in die 9th Division area. The veterinary officer attached to the Twelfth Air Force headquarters in Algiers carried on food inspection work for the air force units.41
for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943;
(2) Memo for Supply Serv, from Brig Gen R. B. Mills, i10 May 43;
(3) MS, History of the United States Army Dental Corps in the North African
Theater of Operations. World War II, pp. 1-24. The use of dental personnel
under combat conditions in ways similar to those mentioned in the text
was general, despite regulations against it. See (4) Hq, NATOUSA,
Cir Ltr No. 36, 17 Mar 43; and (5) Ltr, Brig Gen Lynn H. Tingay to
Col Coates, 25 Feb 59 commenting on preliminary draft of this volume.