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Sicily and the Mediterranean Islands
Sicily was selected as the next Allied target in the Mediterranean at the Casablanca Conference, 14-23 January 1943. The choice reflected both the British predilection for a Mediterranean strategy and the American reluctance to detract in any way from the ultimate invasion of northern France. The conquest of Sicily was justified for both groups on the ground that it would relieve some of the pressure on tile Russian front, help knock Italy out of the war, and open the Mediterranean to Allied shipping. In British eyes Sicily was also a step along Churchill's "soft underbelly" route to the Continent, while the American strategists looked upon such a campaign as the most profitable way to employ troops already in Africa, at a minimum cost in shipping. There was also disagreement on plans, which were not finally approved by the Combined Chiefs of Staff until May. Like the Tunisia Campaign, operations in Sicily (known by the code name HUSKY) were to be carried out by an Allied force under field command of General Alexander, this time designated the 15th Army Group. The components were Montgomery's British Eighth Army, reinforced by the 1st Canadian Division, and a U.S. Seventh Army commanded by Patton, with Maj. Gen. Geoffrey Keyes as his deputy. The date ultimately fixed for the invasion was l0 July.1
Medical Preparations for Operation HUSKY
Medical Planning for the Assault
Medical planning for the Sicily Campaign began early in March 1943 under
1 Military sources for the Sicily Campaign as a whole are: (1) Field Marshal the Viscount Alexander of Tunis, "The Conquest of Sicily. 10th July, 1943 to 17th August, 1943. Supplement to the London Gazette, 12 February 1948; (2) Rpt of Opns, U.S. Seventh Army in Sicilian Campaign, 10 Jul-17 Aug 43; (3) Opns of II Corps, U.S. Army, in Sicily, 10 Jul-17 Aug 43; (4) Samuel Eliot Morison, "History of United States Naval Operations in World War II," vol. IX, Sicily-Salerno-Anzio, January 1943-June 1944 (Boston: Little. Brown and Company. 1954); (5) Craven and Cate, eds., Europe: TORCH to POINTBLANK; (6) Eisenhower, Crusade in Europe; (7) Patton, War As I Knew It; (8) Bradley, A Soldier's Story; (9) Truscott, Command Missions; (10) Kesselring, A Soldier's Record; (11) Knickerbocker and others, Story of the First Division in World War II; (12) Trahan, ed., History of the Second United States Armored Division, pp. 47-59; (13) Taggert, ed., History of the Third Infantry Division in World War II, pp. 51-76; (14) The Fighting Forty-Fifth, the Combat Report of an Infantry Division (Baton Rouge: Army and Navy Publishing Company, 1946); (15) W. Forrest Dawson, ed., Saga of the All American (Atlanta: A. Love Enterprises, 1946), unpaged; (16) Lt Col Albert N. Garland and Howard McGaw Smyth, Sicily and the Surrender of Italy, UNITED STATES ARMY IN WORLD WAR II (Washington, 1965).
the general direction of Col. Daniel Franklin. Colonel Franklin had succeeded General Kenner as Western Task Force surgeon in December 1942 and continued in the same position after the task force was redesignated I Armored Corps in January 1943 and assigned to occupation duties in Morocco. During the training period, the corps was known simply as Force 343, the designation Seventh Army being applied only after the troops were at sea on the way to Sicily. Colonel Franklin then became Surgeon, Seventh Army.2
The Seventh Army medical section evolved from a nucleus carried over with Colonel Franklin from the Western Task Force. By April the section was split between a forward echelon headquarters in Mostaganem, Algeria, and a rear echelon headquarters in Oran. The surgeon, 2 officers, and 2 enlisted men at forward echelon headquarters were occupied with medical planning for the invasion of Sicily. Rear echelon personnel, including 3 officers and 9 enlisted men, were engaged with matters of medical supply, preventive medicine, and routine administration.
Others concerned at the staff level with medical planning for HUSKY were Colonel Arnest, II Corps surgeon; and Col. L. Holmes Ginn, Jr. who left the 1st Armored Division in March to become chief surgeon of the 15th Army Group. The Services of Supply medical section assigned an officer to the Sicilian planning group the last week in March, and preparation of requisitions for supplies from the zone of interior began in mid-April.
Plans for medical support could be made specific only after the Tunisia Campaign ended, when it became possible to complete assignment of troops and to set a timetable for the invasion. Primary emphasis was placed on mobility and the shortening of evacuation lines.
2 Sources for medical preparations for the Sicily Campaign, including both planning and training, are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Rpt of Opns, U.S. Seventh Army, in Sicilian Campaign, an. N; (3) Annual Rpt, Surg, Seventh Army, 1943 (4) Interv with Col Franklin, Surg, Seventh Army, 28 Jun 44; (5) Surg, II Corps, Rpt of Med Activities, Sicilian Campaign; (6) Annual Rpt, Surg, 1st Div, 1943; (7) Annual Rpt, Surg, 2d Armed Div, 1943; (8) Med Hist, 3d Div, 1943; (9 ) Annual Rpt, Surg, 9th Div, 1943; (10) Annual Rpt, Surg, 45th Div, 1943; (11) Annual Rpt, Surg, 82d A/B Div, 1943; (12) Annual Rpt, 54th Med Bn, 1943; (13) Annual Rpt, 11th Fld Hosp, 1944; (14) Clift, Field Opns pp. 145-79.
Medical battalions under corps and army control were reorganized to give each collecting company a clearing element, the two platoons of the clearing company being supplemented for this purpose by a third clearing platoon made up of the station sections of the three collecting companies. Each regimental combat team in the assault was to be accompanied by one of these collecting-clearing companies, which had demonstrated their efficiency in training exercises. Each task force was to have one ambulance platoon in addition to those of the medical battalions, and at least one field hospital unit. The field hospital platoons were to be used for forward surgery and as holding units for nontransportables, combining the functions performed in Tunisia by the surgical hospital and the corps medical battalion clearing stations.
Attached medical troops were to land with unit equipment, augmented by such special supply items as blood plasma, morphine syrettes, and extra dressings. A balanced medical supply adequate for seven days of maintenance was to be on the D-day convoy. Those supplies not hand-carried by the debarking medical troops were to be unloaded on the beaches as rapidly as the situation permitted.
After the initial landings, each division was to be supported by one 400-bed evacuation hospital. When they were needed, 750-bed evacuation hospitals were to be sent to the island, each to back up two of the smaller units. Evacuation from the beaches was to be by troop carrier or LST (Landing Ship, Tank) until hospital ships were available, with air evacuation beginning at the earliest possible date after suitable fields had been secured. No fixed hospitals were to be brought into Sicily until the conquest of the island was complete, all casualties with hospitalization expectancy of more than seven days being returned to North Africa.
Limited shipping space made it necessary to mount the invasion in three separate convoys, to be landed at 4-day intervals, the estimated turnaround time from Tunisian ports. Attached medical troops, the medical battalions, and the field hospitals with their surgical teams, were scheduled for the assault group; the 400-bed evacuation hospitals were to be on the second, or D plus 4 convoy; and the 750-bed evacuations were to be sent on call of the Seventh Army surgeon. Medical service at sea was to be supplied by the Navy on the larger vessels, but the LST's, which were to sail from Tunis and Bizerte, were to be staffed by medical personnel detached from the 77th Evacuation Hospital, then relatively inactive near Bone. The 77th Evacuation also assigned personnel to the naval base at Bizerte to assist with the returning casualties.
Training of Medical Troops
Medical units designated to participate in the Sicily Campaign were assigned initially to the task forces. Attached medical troops, organic and separate medical battalions, and field hospitals all received special training with the combat forces they were to serve. Training for landing operations began 10 May at the Fifth Army Invasion Training Center at Arzew near Oran. Here all medical personnel of Force 343 learned how to waterproof equipment and gained realistic experi-
ence under simulated combat conditions in debarking from landing craft, setting up and operating beach installations, and shore-to-ship evacuation of the wounded. 3
In addition to this assault training, all units were given physical conditioning and instruction in the prevention of diseases likely to be encountered. Malaria came in for special attention, since the assault was to be made at the height of the season. Where appropriate, the men received specialized medical training such as the application of splints, treatment of shock, control of hemorrhage, and transportation of the wounded. Both medical and combat personnel received instruction in first aid.
Similar training for medical personnel accompanying the 45th Division, which sailed for Sicily directly from the United States, was conducted in the zone of interior, the division stopping at Oran just long enough for a rehearsal on the Arzew beaches.
A special problem was posed by elements of the 82d Airborne Division that were to spearhead the invasion, since the organic 307th Airborne Medical Company normally moved by glider or by more conventional means of travel and was not included in the assault plans. Four officers and twenty-five enlisted men from the medical company, all volunteers, were trained as parachutists to augment the regimental medical detachments.
Medical Support of Seventh Army in the Field
Off the coast of Tunisia, northeast of Cap Bon, lies rocky, inhospitable Pantelleria Island. In mid-l943 Pantelleria was a heavily fortified Italian air base that dominated the invasion route to Sicily and so had to be taken before HUSKY could be mounted. Only forty-two square miles in area, the island rises precipitously from the sea. There was just one beach on which a seaborne landing could be made, and that one was narrow, with tricky offshore currents and a heavy surf. The only harbor was small and too shallow for any but light-draft vessels. Should troops succeed in forcing a landing in spite of these difficulties, the surface of the island, with its rock masses and layers of volcanic ash, its stone fences and square stone houses,
3 See Medical Aspects of Amphibious Operations, prepared at this center. With only minor modifications, the same manual was later used to train medical troops for the Normandy landings. Reproduced in full in Clift, Field Opns, pp. 146-74.
was ideally adapted for defense by its garrison of more than 10,000.4
The British 1st Division was selected for the assault on Pantelleria, but the troops were to go in only after the island had been bombed to rubble. The air offensive against the "Italian Gibraltar" opened on 18 May, less than a week after the German surrender in Tunisia, and continued with mounting fury to D-day, set for 11 June. Heavy naval guns joined in the bombardment the night of 10-11 June as the convoy carrying the assault troops moved into the assembly area. The first wave of landing craft hit the beach a few minutes before noon, to be met by trifling small arms fire and a rush of white flags. The surrender of the island had in fact been ordered by its commander for 1100, before a single soldier set foot upon it.
The British Army medical units in the assault were thus not called upon to function in combat. The airfields on Pantelleria were quickly converted to Allied use, and within a week an American station hospital under base section control took over the medical service of the island.5
The reduction of Pantelleria was followed immediately by a bombardment of the island of Lampedusa, between Malta and the east coast of Tunisia, which resulted in the surrender of the island on 12 June, again without the intervention of ground troops. The neighboring island of Linosa surrendered the next day without waiting to be bombed. A British naval party took possession of uninhabited Lampione on 14 June, completing the Allied Occupation of the Pelagies.
From that date until 9 July the North African Air Force and the RAF, joined by the U.S. Ninth Air Force from its bases in the Middle East, concentrated on the ports and airfields of Sicily. The greatest amphibious operation in all history, measured by its initial landing strength, was already at sea when the bombers finally retired. High winds hampered but did not stop the parachutists who led the way, and rough seas did not deter the landing craft. The invasion of Sicily proceeded on schedule.
The Assault Phase
The Allied assault on Sicily was concentrated in the southeast corner of the island. British and Canadian forces landed at the southern tip of the Sicilian triangle, and at various points on the
4 (1) Craven
and Cate. eds., Europe: TORCH to POINTBLANK, pp. 419-42.
(2) Eisenhower, Crusade in Europe,
east coast. The Americans enveloped a 70-mile strip along the southern shore, to the left of the British.6
Seventh Army stormed the beaches at three separate points in the early morning of 10 July 1943. CENT FORCE, built around the untested 45th Division, straddled Scoglitti on the right flank, while the DIME FORCE, spearheaded by two regimental combat teams of the veteran 1st Division and two Ranger battalions, landed in the vicinity of Gela about ten miles farther west. These two forces made up a reorganized II Corps under General Bradley. The JOSS FORCE commanded by Maj. Gen. Lucian K. Truscott, Jr., and composed of the reinforced 3d Division, a Ranger battalion, and a combat command of the 2d Armored Division, went ashore at Licata on the left flank of the American sector. The remainder of the 2d Armored, and the remaining RCT of the 1st Division, stood offshore as a floating reserve until mid-afternoon of D-day, then debarked near Gela where the fighting was heaviest. The 505th Regimental Combat Team and the 3d Battalion of the 504th RCT, 82d Airborne Division, which were dropped behind the beaches a few hours ahead of the assault, were under army control.
The task force surgeons were, for the CENT FORCE, Lt. Col. Nesbitt L. Miller of the 45th Division; for the DIME FORCE, Lt. Col. (later Col.) James C. Van Valin of the 1st Division; and for the JOSS FORCE, Lt. Col. (later Col.) Matthew C. Pugsley of the 3d Division. The floating reserve, called the KOOL FORCE, was under command of Maj. Gen. Hugh J. Gaffey and the force surgeon was Col. Abner Zehm, both of the 2d Armored Division.
Scoglitti Landings- On the CENT beaches landings were delayed an hour by the heavy seas. Many units landed on the wrong beaches and about 20 percent of the landing craft were destroyed on the rocks. All assault units were nevertheless ashore by 0600. Early opposition came from Italian home guards, who fought only halfheartedly or not all, giving the 45th Division time to establish itself firmly before air activity and and German counterattacks began. The beachhead was secure by the end of the day.
D plus 1 saw counterattacks on the extreme right repulsed by the 180th Infantry and the 505th Parachute Combat Team--which had been forced down in the area instead of at its designated drop north of Gela. In a parallel action elements of the 157th and 179th Regimental Combat Teams captured Comiso airfield against strong opposition. By the end of the third day, 12 July, the Scoglitti beachhead was fifteen miles deep and the U.S. forces made contact with the Canadians on the left flank of the British Eighth Army. The capture of Biscari (Acati) airfield northwest of Comiso on D plus 4 completed the initial mission of the CENT Force.
The medical complement of the CENT Force included the 120th Medical Bat-
6 Military sources for the assault are those cited at the beginning of this chapter. Medical sources primarily relied upon for the assault phase are: (1) Rpt of Opns, U.S. Seventh Army in Sicilian Campaign, an. N; (2) Annual Rpt, Surg, Seventh Army, 1943; (3) Surg, II Corps, Rpt of Med Activities in Sicilian Campaign; (4) Annual Rpt, Med Sec, NATOUSA, 1943; (5) Clift, Field Opns, pp. 180-86; (6) Unit rpts of div surgs, med bus, and hosps mentioned in the text. The British side of the story is in Crew, Army Medical Services: Campaigns, vol. III.
talion, organic to the 45th Division; the 54th Medical Battalion; one platoon of the 11th Field Hospital; and seven teams of the 3d Auxiliary Surgical Group. Medical detachments went ashore with their respective combat units, and battalion aid stations were established half a mile to a mile inland within the first two hours. Collecting elements of the organic medical battalion followed about an hour later, moving casualties from the aid stations directly to the beach, where naval shore groups took over. Trucks borrowed from the infantry were substituted for the ambulances that had not yet been unloaded from the ships. The scattered collecting units reassembled into their companies and established their own collecting stations shortly after noon. By 1600 hours the 120th Medical Battalion had a clearing station set up about three miles inland in support of the 179th and 180th Regimental Combat Teams on the left. Casualties from the 157th RCT on the right and from the paratroop force fighting around Comiso airfield were evacuated from aid stations directly to the beach until early afternoon of D plus 1, when the 54th Medical Battalion opened a clearing station in that area.
All medical units were ashore with their equipment by 12 July, although the field hospital platoon was not in operation until the 14th. Collecting and clearing stations moved frequently during the first few days of combat as troops pushed forward rapidly against crumbling opposition. A clearing platoon of the 120th Medical Battalion, established in an Italian military hospital in Vittoria on 13 July, served as a temporary surgical center, while the 54th Medical Battalion took over all responsibility for beach evacuation. Shoreward movement of casualties was stopped on 15 July because available LST's were not properly prepared to receive them, but resumed the next day after arrival of the British hospital carrier Leinster. Nineteen nurses of the 15th Evacuation Hospital helped care for patients in the clearing stations from 14 July until their own unit went into operation on the 20th. Surgical teams worked in the field hospital unit and with the clearing stations of both the medical battalions. (Map 14)
Gela Landings- The DIME FORCE got ashore in the vicinity of Gela beginning at 0245 according to schedule against relatively light opposition. Only the Rangers, who landed in Gela itself, ran into trouble in the form of Italian tanks, but managed to seize and hold the town. Enemy air activity was sporadic during the day, and resistance stiffened around the perimeter of the beachhead. The first counterattack came on the morning of D plus 1, when twenty enemy tanks broke through the 26th Infantry and got within 2,000 yards of the beach before they were stopped by artillery fire. Another forty tanks cut across the 16th RCT, but those too were turned back by artillery, bazookas, and grenades before the two tank columns could join and isolate the beachhead. The last counterattack, at 1630 that afternoon, was only stopped by accurate and deadly fire from the naval guns offshore.
The task force moved inland against less vigorous opposition the next day, taking Ponte Olivo airfield and extending the beachhead to a depth of four miles. That night the second airlift of the 82d Airborne arrived simultaneously
with a group of enemy bombers, and in the confusion a number of the troop carriers were shot down by U.S. fire. All assault phase objectives were secured by D plus 4, 14 July.
Medical battalions supporting the Gela operation, including both the landing units and the reserve, were the 1st and elements of the 48th Armored, organic to the combat units; two collecting-clearing companies of the 51st; and the 261st Amphibious Medical Battalion, initially attached to the 531st Engineer Shore Regiment as part of the beach group. Supplementing these were two platoons of the 11th Field Hospital; seven teams of the 2d Auxiliary Surgical Group and three teams of the 3d; and two ambulance platoons of the 36th Ambulance Battalion.
Except for battalion medical detachments and naval beach parties, the landing of medical personnel and equipment on the Gela beaches was unduly delayed. One company of the 261st Amphibious Medical Battalion managed to set up a clearing station in support of the 26th RCT some seven hours after the assault began by using the equipment of another company. The 1st Medical Battalion established a clearing station for the 16th RCT at H plus 13, but had no equipment other than one medical chest. Casualties from this station were evacuated to the beach by ambulances of the 51st Medical Battalion, one company of which was ashore but inoperative. The field hospital platoons landed at H plus 6, but on the wrong beaches. The invasion was in its fourth
day before the hospital was functioning at Gela.
Casualties were relatively heavy on the DIME beaches, where enemy counteraction was most violent. Some medical equipment, including ambulances, was lost at sea and by enemy action on the beach. The medical battalions were nevertheless in normal operation by 12 July. The 51st, reinforced by surgical teams, held nontransportables until the field hospital opened, while the 261st cared for cases expected to return to duty within a week. Wherever possible, surgery was performed on the ships rather than in shore installations during the first two or three days, but all clearing stations handled surgical cases when evacuation from the beach was interrupted. The withdrawal of the transports on 12 and 13 July halted evacuation in the DIME sector, but air evacuation from the Ponte Olivo field began on the 14th. A hospital ship was available the following day, and on 16 July the 400-bed 93d Evacuation Hospital opened near Ponte Olivo. (See Map 14.)
Licata Landings- TheJoss Force, which had crossed the Strait of Sicily from Tunisian ports in LST's, made the first real shore-to-shore landing craft operation, such as would later be used to cross the English Channel. Rough seas held up the landings until shortly before dawn, and the low gradient of the beaches forced the craft aground too far from dry land. The assault troops nevertheless got ashore in good order against only nominal opposition. The town fell quickly, and before the first day was over strong combat patrols were 4 or 5 miles inland. The beachhead was 15 miles in depth and all initial objectives were taken by D plus 2.
Medical units organic to the combat divisions were the 3d Medical Battalion and a company of the 48th Armored Medical Battalion. Supporting these were the 56th Medical Battalion and a collecting-clearing company of the 51st; the 10th Field Hospital; nine teams of the 3d Auxiliary Surgical Group; and a platoon of the 36th Ambulance Battalion. As in the CENT and DIME landings, medical detachments of Joss followed their combat units ashore within two hours. Collecting companies were only an hour or two behind. Casualties were brought directly to the naval beach installations until clearings stations could be set up on D plus 1. Congestion on the beaches prevented earlier unloading of equipment. The field hospital also opened on D plus 1. Troops in the Licata sector moved rapidly, and medical installations kept pace, leaving only elements of the 56th Medical Battalion at the beach to handle evacuation from the island. By 15 July, when the 11th Evacuation Hospital opened northwest of Licata, a normal chain of evacuation was functioning smoothly. (See Map 14.)
In all sectors the treatment of civilians wounded or injured as a result of the invasion was an acute problem. Local hospital facilities were inadequate, even to care for routine illnesses, and in the landing phase Seventh Army medical supplies and beds could be spared to treat only emergency cases.
The Campaign in Western Sicily
By 16 July the U.S. Seventh and British Eighth Armies had reached the line marking the end of the amphibious
phase, and 15th Army Group headquarters
issued field orders for completing the conquest of Sicily. Eighth Army
was to drive up the eastern coast to Messina; Seventh Army, which now numbered
about 142,000 troops, was to capture Palermo and reduce the western end
of the island. To accomplish this mission, II Corps was to strike north
from Gela with the 1st and 45th Divisions, while a newly constituted Provisional
Corps under General Keyes was to operate in the less rugged area northwest
of Licata with the 3d Infantry, 2d Armored, and 82d Airborne Divisions,
the last operating as infantry. The recently arrived 39th Regimental Combat
Team of the 9th Division was also attached to the Provisional Corps at
this time, the remainder of the
The 261st Amphibious Medical Battalion remained in the Gela area under army control to handle evacuation to Tunis and Bizerte. The 54th Medical Battalion and a collecting-clearing company of the 51st were attached to II Corps, while the 56th and two companies of the 51st went to the Provisional Corps. Two platoons of the 11th Field Hospital and the 93d and 15th Evacuation Hospitals came under II Corps control, leaving the 10th Field, one platoon of the 11th
7 Military sources are the same as those already cited. Medical sources include: (1) Clift, Field Opns, pp. 187-92; (2) Surg's rpts already cited at the theater, army, and corps levels; (3) Unit rpts of div surgs, med bns, hosps, and other med organizations mentioned in the text.
Field, and the 11th Evacuation Hospital to serve the three divisions under Keyes. The surgical teams remained with the field hospital platoons and clearing companies to which they were already attached.
The Provisional Corps overran the whole western end of Sicily in a week. The enemy in this area fought only delaying actions, using reluctant Italian troops to cover the withdrawal of German units to the more mountainous northeastern sector, which provided both suitable terrain for a defensive stand and an escape route to the Italian mainland by way of the Strait of Messina. From Agrigento and Porto Empedocle, some 25 miles west of Licata, the 3d Division struck northwest for Palermo on the other side of the island, while the remainder of the corps followed the southern coast to Castelvetrano. Here the 2d Armored veered northeast to complete the envelopment of the capital, while the 82d Airborne, the 39th Infantry, and the 3d Ranger Battalion continued around the coast to take the western ports of Marsala and Trapani.
So rapid was the advance of the 2d Armored, and so disorganized the opposition, that the division surgeon, Colonel Zehm, personally brought in eight prisoners who had surrendered when intimidated by the colonel's flashlight.8 Advance elements of the 2d Armored entered Palermo late in the evening of 22 July, and accepted the peaceful surrender of the city. Combat teams of both 3d and 45th Divisions were already in the outskirts.
Throughout this rapid movement, medical installations had great difficulty in keeping pace with the combat units. Organic medical battalions, by frequently changing position, managed to keep clearing stations in operation from 4 to 10 miles behind the constantly shifting points of contact with the enemy. The hospitals and corps clearing stations, however, were often left 25 to 50 miles in the rear of the action.
The heterogeneous nature of the forces involved also made it necessary to use the corps medical battalions in unorthodox ways. The 56th Medical Battalion left one collecting-clearing company at Licata to serve as a holding unit for air evacuation. Another company of the 56th was attached to the 3d Division, performing second-echelon medical service for the 30th Regimental Combat Team. The battalions third collecting-clearing company went with the 82d Airborne around the western tip of Sicily to Trapani, using its own ambulances and captured enemy vehicles to make up for the transportation deficiencies inherent in paratroop medical detachments. On 21 July the 51st Medical Battalion established a clearing station at Menfi, on the southern line of march, and another at Castelvetrano, where the 3d Platoon of the 11th Field Hospital also went into operation the next day. By this time, however, the infantry spearhead was at Marsala thirty miles farther west, while the 2d Armored was closer to Palermo than it was to Castelvetrano.
The 10th Field Hospital shifted from Licata to Agrigento on the 19th, where it was joined the following day by the holding unit of the 56th Medical Battalion from Licata. The 10th Field moved
8 Statement of Colonel Zehm to the author, 17 Aug 55
on to Corleone along the 3d Division's line of advance on the 22d, but forward elements of the division it supported were already in Palermo 25 miles away. The 11th Evacuation Hospital, supporting both prongs of the Provisional Corps advance, did not move from Licata until 21 July, and then only to Agrigento, by that time 60 or more miles in the rear. (Map 15)
Following the conquest of western Sicily, gaps in the evacuation chain were quickly closed. A clearing platoon of the 3d Medical Battalion took over an Italian military hospital in Palermo the day the city fell; a clearing platoon of the 51st Medical Battalion arrived a day later; and on 27 July the newly landed 91st Evacuation Hospital opened in buildings of the University of Palermo Polyclinic Hospital.
II Corps, pushing northwest across central Sicily, matched the pace of the Provisional Corps. The drive began on 16 July, by which date the 45th Division had moved across the rear of the 1st to a position on the left flank of the corps sector. The three combat teams of the 45th then leapfrogged one another in a continuous advance to the northern coast of the island. A patrol made contact with the 3d Division in the outskirts of Palermo on the afternoon of 22 July. The following day the vital coast road was cut at Termini and Cefalci, and the 45th turned east toward Messina.
In a parallel advance, the 1st Division captured Enna, communications hub of
Sicily, on 20 July, and established contact with the Canadians on the right. Three days later the 1st was astride the Nicosia-Troina-Randazzo road, running east and west about twenty miles inland. Nicosia fell on the 28th and Cerami, less than ten miles from Troina, on the 30th. Between those two dates the 39th RCT of the 9th Division, recently withdrawn from the now quiet western sector, was attached to the 1st Division. By 31 July II Corps had reached and passed the boundary originally assigned to Seventh Army.
Medical support for II Corps in this phase of the campaign followed a normal, if accelerated, pattern. In hill fighting aid stations were kept from 100 to 300 yards behind the troops; on open ground they were 500 to 1,000 yards behind. The organic battalions were almost continuously in motion, backed by the corps battalion whose collecting-clearing companies bypassed each other to keep within 10 miles of the front. Hospital units moved less frequently, but in accordance with the same leapfrog pattern. The 11th Field opened at Pietraperzia in the center of the front and perhaps a third of the way across the island on 18 July. Two days later the 15th Evacuation was receiving patients at Caltanissetta, 10 miles farther north. July 22 saw a platoon of the 11th Field in operation 15 miles beyond Caltanissetta. The 93d Evacuation opened at Petralia on the Nicosia road on 25 July, while the 11th Field moved on to Collesano, less than 10 miles from the sea, the following day. (See Map 15.) The 128th Evacuation Hospital collected its scattered equipment and personnel in time to open at Cefalù on 31 July.
The Etna Line and Messina
While the Americans swept over western and central Sicily, the British were virtually stalled on the eastern coast where Mt. Etna rose steeply from the Catanian plain. The rugged northeastern corner of the island was ideally adapted to defense, with the escape port of Messina protected by a series of strongly fortified positions in contracting arcs. By the end of July, therefore, General Alexander abandoned his original strategy. Seventh Army was ordered to fight its way to Messina along the northern coast road, and to a junction with Eighth Army along the Troina-Randazzo road, which skirted the northern slopes of the classical volcano. The key to the Etna Line was Troina, a natural fortress-city built of stone on top of a rocky hill. The 1st Division, with the 39th RCT of the 9th, launched an assault against the position on 1 August, while the 3d Division relieved the 45th near San Stefano and prepared to attack the coastal anchor of the German line. The British hammered simultaneously at the right flank between Mt. Etna and the sea.9
The battle of Troina, lasting until 6 August, was the most bitterly contested of the campaign. Before it was over twenty-four separate counterattacks had been repulsed. The remaining regiments of the 9th Division were brought up early in the battle, with the 60th combat team executing a wide flanking movement to threaten the enemy's rear and the 47th leading the advance through the battered town to the next objective. Both 1st and 9th Divisions were slowed by difficult terrain and ex-
9 See sources cited n. 7, p. 156, above.
tensive enemy demolitions, but met only nominal opposition after Troina.
The 3d Division, meanwhile, was encountering determined resistance. A strong enemy position on high ground around San Fratello was finally outflanked by an amphibious operation in the early morning of 8 August. A second seaborne landing behind enemy lines near Brolo on 1 August was less successful, but the beleaguered landing force was relieved the following day. A third leapfrog movement by sea on the night of 15-16 August, involving elements of the 45th Division, found resistance broken and the ground forces already beyond the point of the landing. Advance elements of the 3d Division entered Messina early on 17 August, preceding Eighth Army patrols by no more than an hour.
Medical units, including field and evacuation hospitals, followed closely behind the combat forces along the two lines of advance--so closely, in fact, that evacuation hospitals were sometimes ahead of clearing stations.10 The heaviest concentration was in the vicinity of Nicosia, 5 to 15 miles behind the Troina front. The 15th Evacuation Hospital opened in this area on August, as did two platoons of the 11th Field on the 3d. The 11th Evacuation was attached to II Corps and joined the group on 5 August. (Map 16) Over the next ten days,
10 Ltr, Lt Col Perrin H. Long, Med Consultant, to Surg, NATOUSA, 26 Aug 43, sub: Random Observations From EBS and Sicily, July 6th to August 14th 1943.
platoons of the 11th Field Hospital displaced one another forward to Cesaro and Randazzo. (Map 17) The 54th Medical Battalion and one company of the 51st operated along the same line of advance, clearing platoons being used during the battle of Troina to augment the facilities of the evacuation hospitals.
For the most part aid stations in the Troina sector were within 400 to 800 yards of the fighting and accessible to vehicles, though roads were often under enemy fire. Only the 60th Regimental Combat Team, circling the left flank over roadless mountains, experienced unusual difficulty in evacuation. Corps medical battalions supplied eighty additional litter bearers, while thirty more came from noncombat divisional units. Litter squads were stationed at intervals of 300 to 400 yards to relay casualties back to the stations. Mules requisitioned from local farmers were also used to carry litters, both in tandem between lance poles, as had been done in Tunisia, and by a device similar to the French cacolet whereby one mule carried two litters. Neither method was fully satisfactory but the cacolet was considerably less so than the tandem. The care and management of the animals fell to the 9th Division veterinarian and his assistants. The 47th RCT, operating east of Troina, had hand carries up to four miles, mainly because road demolitions prevented the use of vehicles.
Along the narrow and precipitous north coast road, the 3d Division was fighting what Ernie Pyle called a "bulldozer campaign," the pace of the ad-
vance being limited by the speed with which the engineers could repair the damage done by German demolitions. In this final drive the division was materially aided by a provisional mounted troop and a provisional mule pack train. In the two weeks between 3 and 16 August, 219 horses and 487 mules were used, of which 43 percent were listed as battle casualties. The animals were acquired by capture, requisition, and confiscation. Despite inexperienced handlers and improvised equipment, the expedient was credited by General Truscott, himself a former cavalry officer, with speeding the advance and reducing losses. The division veterinarian, Maj. Samuel L. Saylor, was responsible for care and provisioning of the animals, and helped train personnel to manage them.11
The 3d Division received medical support from the 10th Field Hospital, whose platoons leapfrogged one another from Cefalù to Barcellona, and from one platoon of the 11th Field. The 93d Evacuation Hospital moved to San Stefano on 7 August, and a week later the 11th Evacuation shifted from Nicosia to a position between San Fratello and Brolo. On the latter date, 14 August, the 128th Evacuation displaced half of its facilities and staff from Cefalù to Coronia some 8 miles east of San Stefano. (See Map 17.)
The most difficult evacuation problem encountered by the 3d Division was during the battle for San Fratello Ridge, where litter carries took from 5 to 7 hours. One patient was carried for 9 hours by 50 bearers in relays. Corps supplied 40 additional litter bearers, and Italian and Czechoslovak prisoners were also used. Some slightly wounded men were evacuated sitting on pack mules. The long litter carries were stopped when Colonel Churchill, the theater surgical consultant, concluded that the wounded suffered more from the journey than they would have by waiting. The last 52 casualties brought down from the ridge were left for 24 to 48 hours in the aid stations, while bulldozers cleared a road for the ambulances.12
The two amphibious landings in the 3d Division sector, both made by the 2d Battalion of the 30th Infantry, were supported by personnel of the battalion medical detachment, reinforced by medical and surgical technicians from the 54th Medical Battalion. In the Brolo operation of 11 August, where the landing force was ambushed by the Germans, a medical corpsman was killed and five wounded in action. The American wounded were treated by German doctors and left behind to be picked up by their own organizations when the enemy withdrew the next day.
Hospitalization and Evacuation
Hospitalization in the Combat Zone
Hospitalization in the Sicily campaign showed marked improvement over prac-
11 (1) Truscott,
Missions, p.230; (2) Vet Rpts, Sick and Wounded, Animals, 1943,
tices in Tunisia, even though preinvasion plans were not always carried out to the letter. With occasional exceptions resulting from rapid movement of the troops, each division clearing station under combat conditions had at least one field hospital unit adjacent to it and a 400-bed evacuation hospital within easy ambulance haul. Cases that could not stand the strain of further transportation went to the field hospitals, where surgery was performed as required by attached surgical teams. A majority of all those seriously wounded in Sicily received definitive treatment in these units. As soon as a patient needing further care could be safely moved, he was sent back to the nearest evacuation hospital. Patients still immobilized when a field hospital unit was ordered forward were left in charge of a small detachment that rejoined the parent unit as soon as all of its patients had been evacuated. Transportable cases at the division clearing stations, including most cases of disease, were sent directly to the evacuation hospitals, where they were held for treatment or evacuated to the North African com-
munications zone, as circumstances dictated.13
The intermediate step visualized by the planners whereby one 750-bed evacuation hospital was to back up each two 400-bed units never materialized. Although 750-bed evacuation hospitals were to come on call and were repeatedly requested by Colonel Franklin, shipping space was at such a premium that only one reached Sicily before the end of the campaign. This was the 59th, which landed at Palermo on 6 August with much of its equipment still at sea. The hospital joined the 91st in buildings of the University of Palermo Polyclinic Hospital and was in operation by the 8th, but never functioned as planned. Its activities for the remaining ten days of the campaign were primarily those of a station hospital and holding unit for evacuation to Africa.
The complete absence of fixed hospitals, and the presence of only one evacuation hospital large enough to hold slightly wounded men and disease cases for return to duty, was made up in part by evacuating many short-term patients to Africa, and in part by enlarging the 400-bed units. During periods of heavy fighting, clearing platoons of the corps medical battalions were attached to the evacuation hospitals. Each clearing platoon so used was able to set up and operate five or six wards with its own equipment and staff, augmenting the capacity of the hospital by 100 to 200 beds. During the battle for Troina the 15th Evacuation Hospital expanded by this means to a total capacity of 950 beds.
In areas where the fighting had ceased and conditions were relatively stable, corps and army medical battalions Operated holding hospitals for evacuation. One such unit, operated at Gela throughout the campaign by the 261st Amphibious Medical Battalion, also served as a station hospital for service and other troops in the area. A holding hospital set up by the 56th Medical Battalion functioned first at Licata, then at Agrigento, and finally at Termini on the north coast, where the entire unit was carried by air on 4 August. Loading required only twenty-one minutes, and the flight itself half an hour. The hospital was set up
13 Ibid. See also, Memo, Churchill to Surg, NATOUSA, 5 Sep 43, sub: Use of Field Hosps in Forward Surgery. General sources for hospitalization in the Sicilian campaign are: (1) Annual Rpt, Med Sec. NATOUSA, 1943; (2) Rpt of Opns, U.S. Seventh Army in Sicilian Campaign, an. N; (3) Clift, Field Opns, pp. 193-95; (4) Surg, II Corps, Rpt of Med Activities, Sicilian Campaign; (5) Unit rpts of individual evacuation and field hosps and med bns mentioned in the text.
to receive fifty patients in less than four hours from the time loading began.14
The 51st Medical Battalion operated holding hospitals at Castelvetrano and Palermo. At the latter site, the hospital was expanded to 400-bed capacity and was used also for malaria and jaundice convalescents. In another instance a division clearing company acted as a station hospital. This was a unit organic to the 82d Airborne Division, which took over an Italian military hospital in Trapani while the division performed occupation duties in western Sicily. The same company also set up a clearing station in Castelvetrano after other medical units had been withdrawn from that city.
The original 7-day evacuation policy was extended to ten days and eventually--for malaria cases--to two weeks before the campaign ended. During most of the period, however, no fixed policy was possible. Hospital facilities were so overcrowded that patients had to be evacuated as soon as they could be moved in order to make room for new ones. A 24-hour evacuation policy in front-line hospitals was not uncommon. Even those expected to return to duty within a week had to be removed to the rear in many instances, either to the 59th Evacuation at Palermo or out of Sicily altogether. As a result, a considerable number of patients were sent to North Africa who could have returned to duty if it had been possible to hold them on the island. Malaria cases, which outnumbered battle wounds despite atabrine therapy, and sandfly fever cases were often returned to their units for convalescence, simply to retain physical control of the men.
Some indication of the strain placed upon medical facilities in Sicily may be gathered from the statistics. With a maximum troop strength of approximately 200,000, and an average strength of approximately 166,000, U.S. hospital beds in Sicily probably never exceeded 5,000 during the period of fighting, even with generous allowance for those operated by clearing platoons. Between 10 July and 20 August 1943, a total of 20,734 American soldiers, 338 Allied, and 1,583 enemy troops were admitted to U.S. Army hospitals, with another 20,828 Americans admitted to quarters. Of the U.S. troops hospitalized, 13,320 were diseased, 5,106 had suffered battle wounds, and 2,308 cases were injuries. The quarters admissions included 14,635 cases of disease and 6,193 minor wounds and injuries. A further drain on hospital facilities came from the necessity of caring for a number of civilians who had no other means of treatment. Military patients discharged from U.S. hospitals in Sicily, including American and Allied troops returned to duty and prisoners transferred to the stockades, totaled 7,168.
All prisoners of war, except Italian medical personnel and chaplains and Italian soldiers of Sicilian birth who were paroled to their homes, were evacuated to North Africa as rapidly as possible. The medical officers and enlisted men retained in Sicily were used to care for sick and wounded prisoners in captured facilities and in Italian Red Cross hospitals, five of which were taken over by II Corps.
Two mobile Italian
army hospitals were capture, in addition to a number
14 Ltr, Col Churchill to Surg, NATOUSA, 19 Aug 43, sub: Tour Rpt, Sicily, D+24 to D+35.
of civilian hospitals and other medical installations. The 304th Field Hospital, captured on 30 July at Mistretta, had 400 beds, 60 of them occupied, and a staff of 8 officers and 46 enlisted men. Located in buildings, the hospital continued in operation under U.S. supervision. A larger Italian hospital, the 10th Reserve, was taken near Barcellona on 15 August with 47 officers, 143 enlisted men, and 522 patients. This unit was in the area assigned for occupation by the British, and reverted almost immediately to British control. In addition to personnel of captured hospitals, large numbers of enemy medical personnel were captured with the field troops. Approximately 100 enemy medical enlisted men and a similar number of prisoners-- all Italian--from among line troops, were used to augment the staffs of II Corps hospitals, while others were attached to the two evacuation hospitals in Palermo.
Evacuation within Sicily was controlled by the Seventh Army surgeon, who also arranged with the proper authorities for evacuation from the island. Hospital ships and carriers were under control of Allied Force Headquarters, and air evacuation was the responsibility
of the Surgeon, North African Air Force Troop Carrier Command.15
Lines of evacuation shifted with the progress of the campaign. Until late July the bulk of those destined for the communications zone were carried by ambulance and truck to evacuation hospitals on the south coast. The 93d Evacuation served II Corps at Gela until 21 July, while the 11th Evacuation, at Licata until 20 July and at Agrigento between 22 July and 4 August, served the Provisional Corps. After 21 July, II Corps casualties also cleared through the 11th, by way of a rough 4-hour ambulance run from the 15th Evacuation at Caltanissetta. Soon after the capture of Palermo, that city became the focal point for evacuation to Africa, and II Corps casualties were moved north from Nicosia to enter a coastal chain of evacuation. A captured Italian hospital train, staffed by U.S. medical personnel, began running from Cefalù to Palermo on 1 August, the 128th Evacuation Hospital at Cefalù serving as holding unit. The system worked smoothly, despite a continuous shortage of ambulances and often badly damaged roads.
Evacuation from Sicily to North Africa was fairly evenly divided between sea and air. For the first four days of the campaign all evacuation was by returning troop carriers and LST's. Although plans called for the delivery of all these early casualties to Tunisian ports, many were carried to Algiers where base section facilities were inadequate to care for them.16 Air evacuation began from fields around Gela and Licata on 14 July, but was unorganized, with both U.S. and British planes participating as they happened to be available. Approximately 100 casualties were flown out in this way, without medical attendants, before the 802d Medical Air Evacuation Transport Squadron took over on 16 July. Evacuation by hospital ship began from Gela on 15 July, from Scoglitti the following day, and from Licata on the 17th. Air evacuation began from Agrigento on 23 July, and one load was flown from Castelvetrano on the 24th. As the campaign shifted to the northeast, Palermo and Termini became the principal evacuation centers. Air evacuation began from Palermo on 27 July, and sea evacuation two days later, when the port was cleared. Air evacuation from Termini began 5 August. One planeload of patients was flown to Africa direct from San Stefano.
Between 10 July and 20 August a total of 5,391 patients were evacuated by sea and 5,967 by air--11,358 all told. 17
Sea evacuation was by two American and three British hospital ships, with
15 The main
sources for this section are: (1) Rpt of Opns, U.S. Seventh Army
in Sicilian Campaign, an. N; (2) Surg, II Corps, Rpt of Med Activities,
Sicilian Campaign; (3) Annual Rpt, 54th Med Bn, 1943; (4) Annual
Rpt, Med Sec, NATOUSA, 1943; (5) Annual Rpt, 91st Evac Hosp, 1943;
(6) ETMD, NATOUSA, Jul 43; (7) Clift, Field Opns, pp. 195- 97;
(8) Col Criswell G. Blakeney, ed., Logistical History of NATOUSA-MTOUSA
G. Montanino, 1945), passim.
capacities ranging from 370 to 800 patients; and five British hospital carriers, each capable of moving between 350 and 400 patients. The larger ships were used to evacuate only from Palermo, where the harbor was deep enough to accommodate them. Even in Palermo, however, the condition of the docks did not permit direct loading. The U.S. vessels, Acadia and Seminole, carried no water ambulances. Litters were individually winched aboard from smaller craft in rhythm with the waves. By early August a regular schedule was in effect, a ship arriving in Palermo harbor at dawn every other day. For the most part American patients were routed to Bizerte, but at least one load was diverted to Oran and one load of 125 patients went to Tunis. The British hospital carriers, because of their shallow draft, were preferred for evacuation from beaches and small harbors. Each carried six water ambulances, which could be lifted to the deck for unloading.18
Air evacuation from Sicily followed the pattern developed in Tunisia, but was more highly organized. Medical authorities were notified in advance approximately when each new airfield would be usable, so that a holding hospital could be set up. Personnel of the 802d MAETS stationed at the fields passed on information as to available planes and arrival times, supervised loading, and provided attendants including nurses for each flight. These attendants were flown back to Sicily by Troop Carrier Command, but litters, blankets, and splints for property exchange came by ship. Most of the patients flown to Africa were landed at Mateur, but a few were routed to fields around Tunis. Where an evacuation hospital was close to the airfield, as at Palermo, the more serious cases were moved direct from hospital to plane, with only the walking and less urgent cases passing through the holding unit.
Medical Supplies and Equipment
While shortages of particular items occurred and there were occasional delays, medical supplies presented no serious problems in the Sicily Campaign. Approximately 110 dead-weight tons of medical supplies were landed on the beaches between D-day and D plus 2. These initial supply loads consisted of combat medical maintenance units, heavily augmented by items that experience in North Africa had shown to be required. Supplies not carried ashore by personnel of the medical units to which they belonged were unloaded wherever room to put them could be found. They were picked up by the beach group, which issued them as needed until medical supply depot personnel came ashore.19
In the landing phase a lack of co-ordi-
18 (1) ETMD,
NATO, for Jul 43, 11 Aug 43. (2) Edith A. Aynes, "The Hospital Ship
Acadia," American Journal of Nursing,
XLIV, (February 1944), 98-100.
The carrier had a draft of only fourteen feet compared with twenty-five
feet for the hospital ship. Although Oran was included as a port of debarkation
for patients in the original planning, it was quickly abandoned in favor
of the shorter route to Bizerte. See: (3) Ltr, Col William C. Munly
(Ret) to Col Coates, 7 Nov 58, commenting on preliminary draft of this
volume; (4) Ltr, Col Bauchspies to Col Coates, 15 Apr 59.
nation was evident. Some of the LST's did not carry litters, blankets and splints as called for in the medical plans for the operation, while other landing craft returned to their African bases without leaving their supplies of these items on the beaches. In the Scoglitti area medical supplies dumped on the beaches were so widely scattered that collecting them was a slow and difficult process. About 10 percent of the initial medical supply load was lost due to enemy action, while supplies on the follow-up convoys were poorly packed. Many boxes were only half filled and padded with straw; there was undue breakage of bottles; and some 20 percent of the packing lists did not agree with the contents of the boxes they accompanied.
Supplies, nevertheless, proved generally adequate, even in the early stages of the campaign, thanks to careful planning and advance requisitioning. Medical supplies and equipment estimated to be adequate for current maintenance plus a 30-day reserve were ordered months in advance of the assault and were delivered in batches by the successive follow-up convoys. Immediate shortages of such items as tincture of opium, hydrogen peroxide, litters, and cots were quickly overcome by emergency requisitions on base depots in North Africa, deliveries being made by air if the need was urgent. The only articles that could not be immediately procured were items of replacement equipment and certain equipment items over and above those normally allowed, which had been authorized but could not be procured before leaving Africa.
Two supply depot units distributed medical supplies in Sicily. An advance detachment of the 4th Medical Supply Depot went ashore at Licata with the JOSS FORCE on D plus 2; the 1st Advance Section of the 2d Medical Supply Depot landed at Gela with the CENT FORCE the following day.
The detachment of the 4th Medical Supply Depot established a distribution point at Licata, then on 27 July set up a base depot for the island at Palermo. On 30 July an advance dump to serve the 3d Division fighting along the northern coast road was set up in Cefalù, the Licata dump being closed on 1 August. The Cefalù dump remained in operation until 25 August, a week after the end of hostilities.
The 1st Advance Section of the 2d Medical Supply Depot established its first distribution point at Gela, stocked with supplies collected from the beach group and from the beaches themselves, where boxes had been dumped as they were taken from the ships. Trucks used were borrowed from the 1st Medical Battalion, since the supply depot's own vehicles were not yet unloaded. A forward issue point was set up at Caltanissetta on 21 July in a captured Italian medical depot. A small dump was also operated by this unit at Agrigento between 22 July and 31 July. Personnel from Agrigento established an advance depot at Nicosia on 2 August, where they were joined on 12 August by personnel of the Gela depot, which was closed at that time. Personnel of the Caltanissetta depot also moved to Nicosia early in August, leaving one officer and three enlisted men to operate the Italian depot until it could be transferred to the Allied Military Government organization. The Nicosia depot remained in operation until 27 August.
The Licata depot was reopened on 24
August by personnel of the 1st Advance Section, 2d Medical Supply Depot, and operated until 21 October, serving evacuation hospitals and troops bivouacked in the area. All personnel of the 2d Medical Supply Depot in Sicily then moved to Palermo, relieving the advance detachment of the 4th for service in Italy.
In the course of the campaign, 365 tons of medical supplies and 60 tons of field hospital equipment were captured. This material was used to resupply civilian, Red Cross, and captured military hospitals.
Combat Medicine and Surgery
While the problems encountered by the Medical Department in Sicily were in some respects merely an extension of those already familiar in Tunisia, in other respects they were unique. Lack of sanitation, scarcity of potable water, a vermin-infested and undernourished population, and inhospitable terrain were an old story to American medical personnel by the summer of 1943, but the problems of a large-scale amphibious operation and the hazards of the malaria season were new. Sicily was at once a proving ground for the lessons learned in Africa and a dress rehearsal for Italy.
Front-Line Surgery- In the Sicily Campaign organization and facilities for front-line surgery were greatly improved over those of the Tunisia Campaign. The most important single development was the use of field hospital platoons, with attached surgical teams, for treatment of nontransportable casualties in the division area. Despite careful analysis of Tunisian experience and a full explanation of the preferred procedure in a circular letter from the theater surgeon a month before the invasion, however, various difficulties were still encountered. Field hospital commanders were reluctant to undertake dispersed operation by platoons, and were generally unfamiliar with the technique of functioning in that manner. There was also some resistance to accepting the attachment of surgical teams, as implying some degree of reflection on the competence of the regular hospital staff.20
As a result, the auxiliary teams were not used as effectively as they might have been. Many teams continued to work in clearing stations, where they were handicapped as they had been in Tunisia by lack of equipment and absence of facilities for postoperative care. Still other teams were required to work in the 400-bed evacuation hospitals, because these units were not adequately staffed in the subspecialties. This diversion of surgical teams was a direct consequence of the failure to get 750-bed evacuation hospitals to the island in time to carry a share of the combat load. Another problem arose from the fact that many of the surgical teams employed, as well as the field hospitals themselves, had little or no previous combat experience, and sur
20Sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Surg, NATOUSA, Cir Ltr No. 18, 14 Jun 43, sub: Forward Surgery and Aux Surg Teams; (3) Surg, II Corps, Cir Ltr No. 3, 7 Aug 43, sub: Care of the Wounded in Sicily; (4) Memo, Churchill to Surg, NATOUSA, 5 Sep 43, sub: Use of Field Hosps in Forward Surgery; (5) Ltr, Col Long to Surg, NATOUSA, 26 Aug 43, sub: Random Observations from EBS and Sicily, July 6th to August 14th 1943; (6) Annual Rpt, ad Aux Surg Gp, 1943; (7) Clifford L. Graves, Front Line Surgeons (San Diego [privately printed] 1950) , pp. 86-87.
geons were unfamiliar with general policies as to the management of wounds.
In addition to the employment of field hospital platoons as forward surgical units, extensive use was made of surgical consultants during the campaign. II Corps had the services of its own surgical consultant, Major Snyder, detached from the 77th Evacuation Hospital, while Colonel Churchill, the theater consultant in surgery, served unofficially in a similar capacity with Seventh Army. Colonel Churchill spent more than half of his time in Sicily during the period of active hostilities.
Neuropsychiatric Reactions- The basic principle worked out in Tunisia of treating psychiatric reactions in the combat zone was the policy laid down for Sicily.21 In the early stages of the campaign, however, owing to the normal confusion consequent upon rapid movement, many cases did not go through the evacuation hospitals for triage22 but were evacuated to North Africa from the clearing stations with no treatment except sedation. Of those that did reach the evacuation hospitals, many had been three or four days in getting there, a delay that served only to fix the symptoms and make treatment more difficult. As a re-
NATOUSA, Cir Ltr No. 17, 12 Jun 43, sub: Neuropsychiatric Treatment in
the Combat Zone.
sult, only 15 percent were returned to duty.23
Later in the campaign, after the evacuation system had become more stabilized, half of all psychiatric cases were returned to full combat duty. For the campaign as a whole, 39 percent went back to the lines. Sicilian experience thus reinforced the conclusions of North Africa that treatment of psychiatric reactions must begin at once and that patients must be retained in the combat zone if they were to have a reasonable chance of returning to duty.
The most publicized psychiatric case in Sicily was that of a soldier slapped by General Patton in the receiving tent of the 93d Evacuation Hospital at San Stefano on 10 August. There had been a similar incident in which Patton had cursed and struck with his gloves a patient with a clearing station diagnosis of "psychoneurosis anxiety state." Patton's motivation in these cases was the sincere, if mistaken, belief that if he could make the men angry enough with him they would redeem themselves.24 The incidents were investigated by Brig. Gen. Frederick A. Blesse, Surgeon, North African Theater of Operations, U.S. Army (NATO USA), and Patton apologized to all concerned. Without in any way attempting to extenuate his actions, it should be noted that Patton himself was probably suffering from the accumulated tensions of the preceding weeks of intensive combat. He was on his way back from the front, where every available man was needed, when he stopped at the 93d Evacuation Hospital on 10 August, and was told by an apparently able-bodied man that he was not wounded but only scared. 25
Diseases of Special Interest- In Sicily the American soldier encountered varieties of subtropical diseases for which not even his experience in North Africa had prepared him. The island harbored flies, fleas, lice, bedbugs, and mosquitoes. Local water and food supplies were likely to be contaminated. Even elementary sanitation seemed unknown to the local population. Dysentery, sandfly fever, and most of all, malaria, were constant threats.26
Preventive measures included immunization of all personnel destined for Sicily against smallpox, typhoid, paratyphoid, typhus, and tetanus. Atabrine was distributed with rations four times weekly beginning on 22 April, with quinine substituted for flying personnel and for those sensitive to atabrine. There was
Rpt, Med Sec, NATOUSA, 1943.
intensive indoctrination on sanitary measures before embarkation, with stress on food and water supplies and waste disposal.
On the whole, these preventive measures were effective, except for malaria. There discipline broke down in what was essentially a command problem, and the disease became one of the major hazards of the campaign.
The reasons were various. Of the two malaria control units and one survey unit earmarked for Seventh Army, only one arrived before the end of hostilities. This was the 20th Malaria Control Unit, which landed on D plus 4, but could do little of an effective nature while the army was moving at a rate of ten to thirty-five miles a day. There were undoubtedly times when adequate supplies of atabrine did not reach all troop units, but the greater failure was on the part of the men themselves, who found ways to avoid taking the atabrine when issued, and on the part of the command that permitted the laxity. To most Americans, malaria was not a reality. The Tunisia Campaign had ended before the season started, and experience with the disease was strictly limited. Some cases were also breakthroughs of therapy, since the proper dosage was not well understood. It was stepped up from four to seven times a week on 12 August, with supervision to ensure that the drug was taken, but by that time the damage was already done.
The Seventh Army surgeon reported 4,480 cases of malaria and 6,172 cases of "fever undetermined origin" for the 7-week period 10 July-20 August, as compared with 5,106 combat wounds. The larger portion of the FUO cases were believed to be sandfly fever, more correctly known as pappataci fever, and the bulk of the remainder was probably malaria. American doctors were generally unfamiliar with both diseases in their civilian experience, and many faulty diagnoses were inevitable under combat conditions such as those found in Sicily. Revised figures based on later study of the records placed the Seventh Army malaria cases at 9,892 for the period 9 July-10 September, compared with 8,375 battle casualties. Eighth Army, occupying the highly malarious Catanian plain, had 11,590 malaria cases in the same period.27
Dental service in the Sicily Campaign also showed considerable improvement over that in Tunisia. Both 10th and 11th Field Hospitals were equipped to do prosthetic dental work, supplementing the facilities of corps and division medical battalions. A team consisting of one prosthetic operator and two assistants, with its own equipment and tentage, was set up by II Corps to visit all corps troop units where the number of cases was sufficient to justify the procedure. Rest periods for combat troops were short, however, and so prosthetic work while hostilities were actually in progress was mainly confined to repairs.28
At the end of the campaign, two dental officers from the 11th Field Hospital
27 (1) Rpt
of Opns, U.S. Seventh Army in Sicilian Campaign, an. N. (2) Ltr, AG-AFHQ,
to CinC, 15th Army Gp, and others, 6 Nov 43, sub: Malaria in the Sicilian
Campaign, 9 Jul-10 Sep 43. The battle casualty figure in the AG letter
includes slightly wounded cases treated in quarters as well as the 5,106
hospital cases noted in the Surgeons report. See also, Lt Col William A.
Reilly, Sandfly Fever in the 59th Evacuation Hospital.
were placed on detached service with the 9th Division to catch up on general operative work, particularly in the division artillery, which was too large to be adequately cared for by the single dental officer assigned. The 1st Division at this time set up its own prosthetic clinic and laboratory in conjunction with the division clearing station. In September personnel and facilities for carrying on prosthetic work were installed in the 91st Evacuation Hospital at Palermo.29
As had been the case in Tunisia, dental officers and enlisted men performed numerous nonprofessional functions during combat operations, when conditions made it impossible to carry on dental work.
Two veterinary food inspection detachments accompanied Seventh Army to Sicily, performing routine inspections of rations and of captured food supplies. One detachment operated a cold storage and refrigeration plant in Palermo during the latter part of the campaign. Care of animals was a function of the veterinary service at the division level, primarily in the 3d Division, which boasted both a provisional cavalry troop and a provisional pack train, and in the 9th Division where mules were used to carry supplies and to evacuate wounded. No hospital facilities for animals were available.30
Medical Support in the Seizure of Sardinia and Corsica
The island of Sardinia had been deliberately bypassed in planning Mediterranean operations, and the threat it had once held against Allied supply lines had been largely neutralized by the conquest of Sicily. The invasion of Italy by the British Eighth Army on 2 September, and the Salerno landings a week later, once more changed the picture. Once substantial forces were committed to a campaign in Italy, the strategic positions of both Sardinia and Corsica could not be overlooked.
The fact that no American or British ground forces were available proved no barrier to conquest. With the Italian Fleet no longer at their disposal, the German garrison on Sardinia was virtually isolated. The two Italian divisions on the island needed only a minimum of naval support to rout their former Axis partners, and within ten days of the Salerno landings the Germans had fled to Corsica. In a parallel movement directed from Algiers, the French underground on Corsica seized the island capital of Ajaccio three hours after word of the Italian surrender--announced the night of 8 September--was received. In Corsica the Germans made a more determined stand, but the 80,000 Italian troops quickly surrendered while French reinforcements were brought in from Africa. With the aid of Allied sea and air power, the last German had been expelled by 5 October. 31
29 (1) Annual
Rpt, Surg, 9th Div, 1943. (2) Annual Rpt, Surg, 1st Div 1943.
(3) MS, Dental History, MTO.
No Army medical units took part in the seizure of Sardinia or Corsica, both operations being confined, so far as U.S. troops were concerned, to Air Forces personnel. The first hospitals to move into these islands were therefore assigned to the Army Air Forces. The hospitals initially selected were the 60th Station, a 250-bed unit that had been operating at Tunis since July, and the 15th Field, recalled from the Middle East 32
In the interest of speed, equipment of the 60th Station Hospital was loaded on trucks, which were driven onto LST's, ferried to Cagliari on the southern end of Sardinia, and before unloading were moved directly to the modern Italian hospital building that was to house the 60th. Nurses were flown to Cagliari in combat planes, the rest of the personnel going with the equipment by LST. The hospital opened with 500 beds--double its Table of Organization capacity--on 3 November 1943.
The 15th Field Hospital was somewhat later in getting into operation. The 2d Platoon opened 100 beds at Bastia, on the east coast of the Corsican panhandle, on 1 December; the 3d was established near Alghero in northwestern Sardinia
32 For details of the assignment of hospitals to the Air Forces, see p. 182, below. The remainder of this section is based on: (1) Med Hist, Twelfth Air Force, 1942-44; (2) Annual Rpt, 60th Sta Hosp, 1943; (3) Annual Rpt, 15th Field Hosp, 1943.
on the 13th of that month. The 1st Platoon, which lost most of its equipment when the LST carrying it was beached due to enemy action, was not ready to receive patients at Ajaccio until 19 January 1944, after a base section had been established on the island.33
33 See p.199,