|OFFICE OF MEDICAL HISTORY AMEDD REGIMENT AMEDD MUSEUM|
HISTORY OF THE OFFICE OF MEDICAL HISTORY
The Italian Communications Zone Southern Phase
Changes in Theater Organization
By the beginning of 1944, preparations for the frontal attack on the European continent dominated Allied strategy and dictated changes in the command structure in the Mediterranean. General Wilson succeeded General Eisenhower as Supreme Allied Commander, with General Devers as his deputy. At the same time, in anticipation of a probable invasion of southern France, the theater boundaries were redrawn to include that area as well as Austria, the Balkans, and Turkey.
Medical Organization at the Theater Level
The invasion of Italy and subsequent operations in the fall and winter of served to emphasize the organizational confusion in higher headquarters. There was no clear division of authority or function between Allied Force Headquarters and the U.S. commands theoretically subordinate to it, or between those commands themselves. The principal area of overlap lay between Headquarters, North African Theater of Operations, and Headquarters, Services of Supply. It was therefore these two commands that were primarily affected by a reorganization in February 1944, under which the Services of Supply organization became in fact a communications zone headquarters. The Medical Section, AFHQ, remained substantially as it was, but operation of all U.S. medical services in the communications zone, including hospitalization and evacuation, were transferred from the NATOUSA medical section to its SOS counterpart, whose functions previously had been limited to medical supply. A number of key personnel were transferred along with their functions. After 24 February, the effective date of the reorganization, the activities of the NATOUSA medical section were largely confined to policy making and co-ordination.1
As a first step in the expansion of the medical section, SOS NATOUSA Colonel Shook, who had headed the section since August i943, became communications zone surgeon. His administrative officer, Maj. (later Lt. Col.) James T. Richards of the Pharmacy Corps, was transferred from temporary
1 Hist of AFHQ. (2) Annual Rpt, Med Sec. MTOUSA, 1944. (3) Hist of Med Sec, Hq, COMZ MTOUSA. (4) Interv with Col Shook, 31 Mar 52. (5) Munden, Administration of Med Dept in MTOUSA, pp. 93-105. More detailed discussion will he found in (6) Armfield, Organization and Administration, pp. 275 ff. See also, (7) Ltrs, Col Munly, to Col Coates, 7 Nov 58; and Dr. Shook to Coates, 6 Nov 58, both commenting on preliminary draft of this volume.
duty in the NATOUSA surgeons office. The hospitalization and evacuation officers, Lt. Col. (later Col.) William Warren Roe, Jr., and Lt. Col. (later Col.) Albert A. Biederman, were also transferred along with their functions from the office of the surgeon, NATOUSA. The dental officer of the SOS medical section was Lt. Col. (later Col.) Karl H. Metz.
The chief of professional services, Lt. Col. (later Col.) Joseph G. Cocke, assumed his new duties on 12 March, transferring from the Mediterranean Base Section. The basic organization was completed on 24 March with the arrival of Capt. (later Maj.) Elizabeth Michener, chief nurse; Lt. Col. (later Col.) Duance L. Cady, communications zone veterinarian; and Lt. Col. Richard P. Mason, preventive medicine officer and medical inspector. Additional personnel were added as needed through March and April, the only important shift coming in mid-May. At that time, Cocke became Shook's deputy, being replaced as chief of professional services by Colonel Roe. Lt. Col. (later Col.) Jenner G. Jones, who had been executive officer when the SOS medical section was concerned solely with supply, became chief of the medical supply branch. Allotted personnel as of 21 May, when the organization was stabilized, included 21 officers, a warrant officer, and 44 enlisted men.
As the communications zone medical section expanded, the medical section of NATOUSA modified its functions in keeping with its more restricted policymaking and planning role. Personnel declined, owing to the loss of operating functions, by transfer to Services of Supply. On 1 March 1944 Maj. Gen. Morrison C. Stayer, former surgeon of the Caribbean Defense Command, replaced General Blesse as Surgeon, NATOUSA, and Deputy Director of Medical Services, AFHQ. The British Director of Medical Services, General Cowell, was himself relieved on 19 May by Maj. Gen. William C. Hartgill, another Royal Army Medical Corps officer. General Blesse, who was being recalled to the zone of interior to become surgeon of the Army Ground Forces, remained in the theater until 24 April, acting as General Stayer's deputy and retaining his function as Medical Inspector, AFHQ. General Stayer took over the duties of medical inspector on Blesses departure. The section retained limited administrative functions, including the consultant service and various duties in the field of preventive medicine. On the
MEDICAL SECTION OF NATOUSA AT CASERTA, 26 July 1944. Front row, left to right: Lt. Col. Joseph Carmack, Lt. Col. Asa Barnes, Col. Lynn H. Tingay, Colonel Standlee, General Stayer, Lt. Col. Bernice M. Wilbur, Col. William C. Munly, Colonel Churchill, Colonel Simeone; back row, left to right. Colonel Hanson, Maj. Joseph W. Still, Colonel Noonan, Colonel Long, Colonel Stone, Col. Oscar S. Reeder, Colonel Radke, Capt. John H. Slattery.
side of professional services, there was actually some expansion, a veterinary section under Colonel Noonan being set up in mid-March.
Relations between the NATOUSA and SOS medical sections remained close, despite early fears that the theater medical section might seek to continue operating activities and reluctance on the, part of some officers to be transferred from a higher to a lower headquarters. The policy-determining role of the NATOUSA medical section imposed a degree of co-ordination, while the transfer of personnel in the long run made for friendly working relations between the two groups.
In July, with the Allied armies approaching the Arno River, both Allied Force Headquarters and Headquarters, NATOUSA, moved from Algiers to Caserta. Together with the other offices of American headquarters, the theater medical section was established in the royal palace. The Air Forces medical section was already located in the palace, having established offices there late in May. The British medical component of AFHQ, while no longer sharing a building with the Americans, was physi-
cally near enough to permit continued co-operation. Headquarters, Communications Zone, including the SOS medical section, was established in close proximity to the others in buildings vacated by a general hospital on 20 July.2
The Peninsular Base Section
Plans for the Italian campaign called for the early establishment of a base section in the Naples area. A preliminary organization was activated in Casablanca on 21 August 1943 as the 6665th Base Area Group (Provisional), with medical personnel drawn from the Atlantic Base Section, whose activities were rapidly declining. An advance echelon of the medical section debarked at Naples on 4 October from the first troopship to enter the bay. The entire section was ashore by 10 October.3
The 6665th Base Area Group remained under Fifth Army control until November, when it was formally reconstituted as the Peninsular Base Section. During this interval, the Fifth Army surgeon acted also as the base surgeon. He was succeeded in the latter capacity on 9 November by Colonel Arnest, who had served as surgeon of II Corps since the North African landings.
Although both cholera and typhus had been reported in Naples ten days before the capture of the city, American medical officers found the general health situation good.4 The most serious problem was sanitation, since the water supply had been disrupted and the sewerage system was not functioning for lack of water, but facilities were quickly restored by the Allied Military Government, in co-operation with British and U.S. Army engineers. Pending the arrival of fixed installations, hospitalization for American troops in the city was provided by the 307th Airborne Medical Company and the 162d Medical Battalion, with the 95th Evacuation Hospital taking over on 9 October. The 3d Convalescent Hospital also began taking patients in the Naples area on 12 October.
By the end of 1943, the Peninsular Base Section was the largest base organization in the theater, both in terms of personnel and in terms of the number of fixed beds under its control. It continued to grow at the expense of the declining North African bases, reaching its peak strength in August 1944.
Air Forces Medical Organization
The medical organization of the Air Forces units in the Mediterranean was realigned early in 1944. The over-all Allied command remained the Mediterranean Allied Air Forces, with the Army Air Forces, Mediterranean Theater of Operations (AAF MTO), as its U.S. component. The American command included three major units: the Twelfth Air Force, now primarily a light and medium bomber group; the Fifteenth Air Force, a heavy bomber group; and the Army Air Forces Service Command. Headquarters of the U.S. command organization was set up in Caserta in February. Twelfth Air Force headquarters was at Foggia, Fifteenth Air Force headquarters was at Ban, and headquar-
2 See p.
ters of the service command was at Naples.5
The Fifteenth Air Force was still being built up, reaching its peak strength about the time of the first shuttle bombing between Italian and Russian bases. In that operation and in the strategic bombing of Germany generally, the Fifteenth Air Force was responsible to the U.S. Strategic Air Forces in Europe, a European theater command, but in matters of administration, supply, and training, as well as in its Mediterranean operations, it remained under control of the Mediterranean Allied Air Forces and the U.S. Army Air Forces, Mediterranean Theater of Operations.
The top co-ordinating U.S. air command, the Army Air Forces, MTO, was originally organized without any medical section, but the need for one was quickly apparent and a small section was established in February 1944. The position of surgeon went to the senior Air Forces medical officer in the theater, Colonel Elvins, who was succeeded in April by Col. Edward J. Tracy. Colonel Elvins replacement as Twelfth Air Force surgeon was Col. William F. Cook. The Fifteenth Air Force surgeon was Col. Otis O. Benson, Jr., and the surgeon of the Army. Air Forces Service Command was Col. Louis K. Pohl.
The functions of the Twelfth and Fifteenth Air Force surgeons were comparable to those of an army surgeon. The duties of the surgeon, AAF MTO, were confined primarily to policy matters and to maintaining close liaison with the medical service of the British component of the MAAF. The service command medical section was the effective operating agency for Air Forces medical activities at the theater level, including administration of hospitals, evacuation, medical supply, sanitation and preventive medicine, and medical plans. The AAFSC surgeon was also the principal point of contact for exchange of technical information with the NATOUSA medical section.
Hospitalization in the Communications Zone
Fixed Hospitals in PBS
One of the first tasks of the 6665th Base Area Group medical section was to survey the city of Naples for hospital sites. Various Italian hospitals and school buildings were examined and the best of them were tabbed for Medical Department use. Aside from these, the most suitable area for additional medical installations was the Mostra Fairgrounds at Bagnoli, some three or four miles from the heart of Naples. Site of Mussolini's colonial exposition of 1940, the fairgrounds contained numerous relatively spacious buildings of stone and tile construction, with water, sewerage, and power facilities and good highway and rail connections. Many buildings had been badly damaged by Allied bombings, and the retreating Germans had destroyed others, but the advantages so far outweighed the drawbacks that the Fifth Army surgeon got the entire area set aside for hospital use. It quickly be-
5 This section
is based primarily on the following: (1) Hist, Twelfth Air Force Med Sec,
1942-44; (2) Med Hist, Fifteenth Air Force, 1944. (3) Annual
Med Hist. AAFSC MTO, 1944; (4) Link and Coleman, Medical Support
of the Army Air Forces in World War II, pp. 438-48. See also Armfield,
and Administration, pp. 269-75.
came the staging site for medical installations arriving in Italy.7
In order to realize the full possibilities of the Mostra Fairgrounds, a provisional medical center was tentatively organized
7 This section is based primarily on the following: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Med Sec, MTOUSA, 1944: (3) Annual Rpts. Surg. PBS, 1943 and 1944; (4) Unit rpts of med units mentioned in the text.
on 25 October 943, with headquarters personnel drawn from the 161st Medical Battalion. Other fixed hospitals went into the Caserta area, close behind the Fifth Army front, and still others were attached to Air Forces units operating in the heel of Italy and from the Foggia bases. (Map 29)
Naples and the Medical Center- The first American fixed hospital in Italy was the 118th Station Hospital, which opened 14 October in the buildings of an Italian military hospital in Naples. The 106th Station opened in a school building three days later. Both hospitals operated almost from the start in excess of their 500-bed Table of Organization capacities.
The first fixed hospital to open at the fairgrounds was the 182d Station, which received its first patients on 19 October. The 3d Convalescent was already established on the fairgrounds but remained a Fifth Army unit, subject to withdrawal on call of the army surgeon. These two hospitals, and the 4th Medical Supply Depot, were functioning in the area when the fairgrounds were hit by enemy planes the night of 21 October. The toll was 11 killed and 55 wounded among both patients and medical personnel, and there was severe damage to installations, but both hospitals continued to function without interruption.
During November and December, hospital facilities in Naples built up rapidly. The 225th Station joined the medical center group on 10 November, followed by the 23d, 21st, and 45th General Hospitals on 17 November, 29 December, and 1 January 1944, respectively. The 17th General, meanwhile, had taken over on 11 November the Italian civil hospital in Naples formerly occupied by the 95th Evacuation, and the 300th General had opened in buildings of a Naples tuberculosis sanatorium a few days later. The 70th Station, sited in the Naples Academy of Fine Arts, opened on 25 November.
Two more 500-bed station hospitals were added to the concentration in the Naples area by the end of the Winter Line campaign. These were the 103d, which opened a convalescent hospital in an Italian villa on 5 January, replacing the 3d Convalescent, which had gone into the combat zone; and the 52d, which opened in school buildings on 17 January. The 103d added the facilities of a regular station hospital, sited in school buildings a few blocks from, its convalescent establishment, on 13 January.
All hospitals in the Naples area faced problems of reconstruction and renovation. Even those sited in hospital buildings found a heritage of indescribable filth to be cleaned out before they could operate. Initial cleaning and minor remodeling were usually accomplished by hospital personnel; the Chemical Warfare Service was available for disinfecting the premises. More extensive repairs to bomb-damaged buildings, such as those on the fairgrounds, were made by the Army engineers, often after the hospital was in operation.
By mid-January 1944, hospitals of the medical center were functioning on a partially specialized basis. The 182d Station, in addition to its general beds, operated a venereal disease section that ultimately reached a capacity of 1,200 beds. The 45th General was designated as the neuropsychiatric center for the Peninsular Base Section.
While all hospitals took British pa-
FIXED HOSPITALS IN SOUTHERN ITALY
FIXED HOSPITALS IN SOUTHERN ITALY--Continued
Caserta, 3 November 1943-20 July 1944. 1,000/2,000 beds.
tients and those in Naples proper treated civilians when emergency required, an effort was made to funnel patients from the French Expeditionary Corps to the 182d and 225th Station Hospitals, where French-speaking personnel were available. Both of these hospitals were largely filled with French and French colonial casualties during January. Many problems arose as a result, particularly at the 225th, where bearded African goumiers made turbans for themselves out of hospital towels and changed identification tags with each other in order to exchange beds.
Late in January the 9th Evacuation Hospital moved over from Sicily and opened in the medical center as a general hospital for French troops, remaining until the beginning of August when the unit began staging for southern France. Liaison personnel from the French Army were attached to handle discipline, mail, pay, and other administrative matters, while French and Arab noncomissioned officers served as interpreters.
Installations attached to the medical center by the end of January 1944 included three general and two station hospitals and an evacuation hospital acting as a general, with an aggregate Table of Organization strength of 4,750 beds; the 4th Medical Depot Company; a central dental laboratory; the 15th Medical General Laboratory, which began operating a blood bank late in February;8 the 41st Hospital Train; and the 51st Medical Battalion. By this date the center was fully organized, although the 6744th Medical Center (Overhead) was not formally activated until 10 February 1944. Consisting of four officers and 20 enlisted men, the medical center headquarters group was responsible for functions common to all the hospitals in the area, such as allocation of space, maintenance of roads and utilities, sanitation, security, transportation, civilian labor, and recreation. Included among the service units operating under the medical center organization were a finance disbursing section, an Army post office, a Quartermaster shower and sterilization unit, a laundry, a fire-fighting platoon, a message center, and a telephone switchboard. The center headquarters also controlled the staging area for medical units. Although it resembled the typical hospital center in its purposes, the Naples grouping was less centralized. It had no commanding officer in the proper sense of the word. Colonel Jeffress, former surgeon of the Atlantic Base Section, was responsible for administering the overhead functions, but the medical service as such, including the assignment of patients, was directly under the base surgeon.9
In addition to the center, there were 4,500 Table of Organization beds elsewhere in Naples by the close of the Winter Line campaign. The 12th General Hospital and the 32d Station were also staging at the Mostra Fairgrounds, but were not in actual operation. Throughout the Italian campaign personnel and equipment of units in the process of staging were freely used to augment facilities of operating hospitals, in accordance with the practice established early in the North African campaign.
Other PBS Hospitals- When Fifth Army medical units moved across the
8 See pp.
Volturno to support the Winter Line campaign, their places in the Caserta area were taken by fixed hospitals assigned to the base section. The 36th General was the first of these, opening on 3 November in an Italian military hospital in Caserta. Here, as in Naples, the buildings and the Italian patients hospitalized in them were unbelievably filthy. At this time the front lines were so near that the 36th General took casualties directly from battalion aid stations. An Italian hospital at Aversa, six or eight miles nearer the coast, served to house the 262d Station from 27 November. The 66th Station, a 250-bed unit, opened on 3 January in a prisoner-of-war enclosure south of Caserta, where it also operated a venereal disease hospital.
Closest of any fixed hospital to the front during the Winter Line campaign was the 74th Station, which opened at Piana di Caiazzo north of the Volturno on 7 December. Housed in the stone buildings of a co-operative farm, with supplementary tentage, the 74th performed routine station hospital functions for troops resting and staging in the area. The primary problem there was knee-deep mud, which required the construction and constant maintenance of access roads. Two platoons of the 32d Field Hospital performed similar services for troops still in the Salerno-Paestum area, while the remaining platoon served as a holding hospital for air evacuation at Pomigliano Airfield northeast of Naples. Two platoons of the 4th Field shared the load at Pomigliano until early January, when they were assigned to the Air Forces.
Virtually all fixed hospitals under control of the Peninsular Base Section were operating in excess of their Table of Organization capacities, employing Italian civilians to make up for personnel shortages.10
Hospitalization for Army Air Forces in Italy
Following the October 1943 agreement between General Blesse for NATOUSA and Colonel Elvins for the Army Air Forces, hospital units of various types were designated to serve the USAAF in Corsica, Sardinia, and Italy. Those initially scheduled for Italy were the 26th General, the 55th and 61st Station, and the 4th, 34th, and 35th Field Hospitals. All were located south of Naples, and on the Adriatic side of the peninsula.11
Only the 1st Platoon of the 4th Field Hospital was able to open at full bed strength and at the appointed time. This unit was located at Manduria in the heel of the Italian boot. Equipment of all the other Air Forces hospitals was aboard the Liberty ship Samuel J. Tilden, which was destroyed in an enemy air attack on Bari harbor on the night of 2 December. Replacement equipment for the field hospitals and for the 250-bed 55th Station Hospital was flown from Palermo within ten days, but the 500-bed 61st Station and the 1,000-bed 26th General had to wait for slower replacement by water. The 26th General, while it actually opened at Ban on 4 December, did so with only 100 borrowed beds. Its
10 See app.
quarters were the spacious modern buildings of an Italian military hospital. The 61st Station, until its own equipment arrived in January, operated an American ward in a British hospital at Foggia, using British equipment. The 55th Station opened at Foggia and the 34th Field a few miles southeast, at Cerignola, on 13 December. The 35th Field began taking patients at Erchie, near the site of the 4th, two days later. The remaining two platoons of the 4th Field Hospital opened at San Severo, south of Cerignola, on 18 January.
Originally assigned to the Twelfth Air Force, these hospitals also served the Fifteenth Air Force, which was activated on 1 November 1943 before any of the medical units were in operation. All were transferred to the newly created Army Air Forces Service Command, Mediterranean Theater of Operations, early in the new year.
There were some changes in the location of field hospital platoons in February and again in May 1944, but all remained south of the latitude of Rome, on the Adriatic side of the peninsula. The only significant change was the release of the 55th Station Hospital to PBS on 10 August. This hospital had been operating near Foggia since December 1943, but the enlargement of the 26th General Hospital at Ban to 1,500 beds rendered the 55th Station surplus to Air Forces needs. All field hospital units and the 61st Station at Foggia operated on a 30-day policy, with evacuation to the 26th General. The latter installation operated on a 90-day policy.
Reorganization of Fixed Hospitals
When General Stayer succeeded General Blesse as Surgeon, North African Theater of Operations, on 1 March 1944, the theater was already 8,000 beds short of the authorized ratio of 6.6 percent of troop strength, with new troops arriving faster than beds. Stayer's first major problem, with which Blesse had been struggling for several months, was that of substantially increasing the number of fixed beds in the theater.12
The problem had been under discussion, both in the theater and in Washington, for a considerable time, but the build-up for OVERLORD precluded the diversion of either beds or medical personnel to the Mediterranean. It was first suggested toward the end of 1943 that the shortage might be overcome by a more economical use of personnel already in the theater. More or less detailed plans for enlarging certain general hospitals to 1,500- and 2,000-bed capacity with personnel released by the inactivation of a few 250-bed station hospitals were drawn up in The Surgeon General's Office in January 1944. No positive action was taken, however, until after a request to increase the bed ratio for the North African theater to 8.5 percent was denied in March. By that time the deficiency had risen to 10,000 beds and action had become imperative. Tentative Tables of Organization for 2,000-bed and 1 ,500-bed general hospitals were issued on 19 April 1944 and the reorganization went into effect on 5 June.13
12 (1) Ltr,
Gen Blesse to TSG, 6 Feb 44. (2) Ltr, TSG to Gen Stayer, 18 Apr 44.
Six 250-bed station hospitals--the 43d, 53d, 58th, and 66th in Italy; and the 64th and 151st in North Africa--were inactivated. Five general hospitals--the 12th, 21st, 23d, 36th, and 300th, all in Italy--were expanded from 1,000 to 2,000 beds; and the remaining twelve general hospitals in the theater were expanded from 1,000 to 1,500 beds. Each of the new 2,000-bed units absorbed the personnel and equipment of one of the inactivated hospitals, with suitable transfers and readjustments to bring all the enlarged units into line with the new Tables of Organization, which were somewhat modified in July. The completed reorganization added 9,500 T/O fixed beds to the theater total. General hospitals in Italy began enlarging their facilities by new construction, by conversion of additional building space, or by erection of tentage a month or more before the reorganization went into effect. The 21st, 23d, 36th, and 300th General Hospitals, for example, had already expanded to 3,000 beds each by 31 May, or 50 percent above their new Table of Organization capacities.14
Aside from this general reorganization, a few minor changes were made to bring hospital facilities into line with needs. The 60th Station Hospital at Cagliari, Sardinia, was formally increased from 250 to 500 beds, confirming the actual operating status of the installation. The 51st Station, which had been functioning as a neuropsychiatric hospital, was also confirmed as a 500-bed unit in July. The 79th Station Hospital, which was no longer needed in Algiers after the decision to transfer Allied Force Headquarters to Italy, was inactivated on 30 June, and its personnel and equipment were absorbed by other units. The provisional hospital at Marrakech, Morocco, which had been operated primarily by personnel of the 56th Station at Casablanca since May 1943, was reorganized as the 370th Station Hospital, with a Table-of-Organization strength of 25 beds.
Expansion of the Peninsular Base Section
Throughout the Anzio Campaign, the stalemate before Cassino, and the drive to Rome, the build-up of fixed hospitals in the Naples and Caserta areas continued. In February 1944 the 250-bed 53d and 58th Station Hospitals set up in Naples, where the former took over operation of the venereal disease hospital in the medical center from detached personnel of the 12th General, the latter operating the air evacuation holding hospital at Pomigliano Airfield. At the same time the 32d, 43d, and 73d Station Hospitals--the 43d of 250 beds, the others of 500--moved into the Caserta area, where they were followed by the 64th General in March. All of these hospitals were brought over from North Africa.
There were no new arrivals in April, but the opening of the drive to Rome brought a new contingent in May. The 37th General moved into the medical center, while the 51st and 81st Stations set up outside the center in Naples proper. The 51st Station was designated the neuropsychiatric hospital for the Naples area. The 81st took casualties from the French Expeditionary Corps.
14 (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. B. (2) Med Sit reps, PBS, 31 May 44. (3) Annual Rpts, 1944, of the individual hosps concerned.
The 3d General and the 78th Station moved into the Caserta area. Before the end of the month the 750-bed 27th Evacuation Hospital, a new arrival from the zone of interior tabbed for an ultimate role with Seventh Army in France, was established at Maddaloni to act as a general hospital for French and French colonial troops. The unit was soon operating 1,500 beds.
During the periods of heavy pressure--in February and March in connection with the Anzio Campaign, and in May during the assault on the Gustav Line--most of the hospitals in the base section operated at approximately twice their Table of Organization capacities, with station hospitals often acting as generals. Prefabricated buildings and tents were usually used for expansion where the buildings occupied were inadequate. Additional personnel were obtained by hiring Italian civilians and by drawing upon hospital ship platoons, other hospitals staging in the area or awaiting assignment, and medical battalions. The 164th and 181st Medical Battalions, both Seventh Army units, served PBS in various capacities from late May until their release in mid-July to train with the invasion forces. The 70th Station at Naples and the 74th at Piana di Caiazzo, near Caserta, performed normal station hospital functions for troops in their respective areas. The 70th also handled all hospitalization for the Women's Army Corps until May. The 182d Station in the medical center was designated in July for Brazilian personnel, who were staging in the area. Brazilian medical officers, nurses, and enlisted wardmen were attached.
In the reorganization of June, the 23d General Hospital absorbed the 53d Station, taking over the venereal disease hospital and the disciplinary wards. The 21st General absorbed the 58th Station, including operation of the Pomigliano Airfield holding hospital, and the 300th General took over personnel and equipment of the 66th Station. The 300th continued to operate the prisoner-of-war hospital at Dugenta, which had been the responsibility of the 66th since January. The POW hospital was later turned over to the 34th Station, which arrived from Palermo in July. The 43d Station was merged with the 36th General, which closed at Caserta in July, releasing its quarters for occupancy by elements of theater headquarters, including the SOS medical section. Pending reassignment, personnel of the 36th were put on detached service with other hospitals in the medical center.
The general forward movement of PBS installations began in June. The 59th Evacuation, brought over from Sicily, acted as a station hospital at Anzio between 7 June and 10 July, handling 1,825 admissions in that period. The 59th then served for another two weeks at Battipaglia, where Seventh Army was in training for the invasion of southern France. The 6th, 12th, and 33d General Hospitals all opened in Rome before the end of June and were joined there on 5 July by the 73d and 114th Stations. All of these units came direct from Africa except the 73d, which had been operating at Caserta, and the 12th General, which had been inactive in Naples for six months while its personnel served on detached duty with other hospitals. The previously organized Rome Area Command--Rome Allied Area Command after 1 July 1944--had supervision over the health of the city, but the U.S. hospi-
tals remained under the jurisdiction of the Peninsular Base Section.15
The 12th General Hospital, now a 2,000-bed unit, had absorbed the personnel and equipment of the 151st Station, brought over from Africa for the merger. Like those in Naples and Caserta, all of the fixed hospitals moving into the Rome area were sited in permanent buildings. The 6th General occupied the Institute of the Good Shepherd, where the 56th and 94th Evacuation Hospitals had already done the necessary renovation.16 The 33d General and the 114th Station, the latter designated as neuropsychiatric hospital for the Rome area, were also in Italian hospital plants, while the 12th General and the 73d Station occupied Italian military structures. The 7th Medical Depot Company accompanied the fixed hospitals into Rome.
Movement north of Rome was almost simultaneous with the establishment of hospitals in the Italian capital. The 105th Station Hospital opened at Civitavecchia on 5 July; and the 50th, one of the few 250-bed station hospitals remaining in the theater, opened at Castagneto, on the coast a few miles north of Piombino, on 20 July. The unit was so close to the front for several days that it took patients direct from the clearing stations, thus functioning in effect as an evacuation hospital.
The 24th General Hospital from the Eastern Base Section in North Africa went into bivouac in Rome on 20 June, its personnel serving on detached service with other hospitals for a month. On 21 July the 24th General opened as a 1,500-bed unit at Grosseto, in the buildings of a tuberculosis sanatorium previously occupied by the 15th Evacuation Hospital. At the end of the month the 64th General Hospital moved from Caserta to Leghorn, where it opened in a former Fascist paratroop school adjacent to the 16th Evacuation Hospital in the suburb of Ardenza. The 55th Station, released at Foggia by the Air Forces, was attached to the 64th General early in August and was established at the same Ardenza site. Leghorn was still within range of German guns when the 64th General began taking patients in that city.
As of 15 August 1944, PBS had 28,900 T/O beds in operation, of which 15,000 were in Naples--8,000 in the medical center--6,000 were in Rome, and 4,000 were north of Rome. Between 14 October 1943, when the first fixed hospital opened in Naples, and the end of August 1944, PBS hospitals admitted 282,000 patients and returned 214,000 of them to military duty. (Tables 17, 18)
Decline of North African and Island Bases
As the center of activity in the Mediterranean moved up the Italian peninsula, North Africa decreased in importance as a communications zone. The expansion of the Peninsular Base Section was accomplished largely by stripping the African base sections of hospital facilities. As of 15 August 1944, the Eastern Base Section was left with only one 250-bed station hospital, the 54th at Tunis. The Mediterranean Base Section retained 3,000 beds, 2,500 of them in the hospital groupment at Assi Bou Nif, where the 70th General and the 23d and 69th Station Hospitals were still located. The others were the 250-bed 57th Station near Constantine and the 250-bed
Rpt, Surg Rome Area Comd, 1944.
29th Station at Algiers. The Atlantic Base Section retained 275 beds, 250 in the 56th Station Hospital at Casablanca, and 25 in the 370th Station serving primarily Air Forces units at Marrakech. The total number of U.S. Army Table of Organization beds in all of North Africa was thus only 3,525.
Hospitals in MBS still held a few long-term patients from Italy, but for the most part the function of the fixed hospitals in Africa after June 1944 was that of hospitalizing military personnel still in the area. In addition, these hospitals cared for transient French patients en route from Italy to French hospitals
in Africa and for U.S. patients en route to the zone of interior. Those principally served were Air Forces and naval personnel and service troops in the vicinity of Oran.
The Island Base Section in Sicily was closed out on 1 July 1944. At that date, 600 beds remained under the control of the Allied garrison on Sardinia, and 1,550 were charged to the Northern Base Section on Corsica.
Hospitalization of Prisoners of War
The one exception to the contraction of medical facilities in North Africa was installations for the care of prisoners of war. Until the Arno River line was stabilized, the bulk of the prisoners taken in Italy were transferred to enclosures in North Africa. These were gradually concentrated in the Mediterranean Base Section in the vicinity of Oran. 17
So far as Italian prisoners were concerned, the problem became less and less important as time went on. With Italy enjoying a cobelligerent status, few new prisoners were taken. Those held over from the Tunisia Campaign and from operations in Sicily were organized into service units of various types, scattered throughout numerous camps and enclosures. The bulk of them, estimated as about 70,000, were concentrated near the centers of Army service activities, which remained in Oran, and in Algiers until the removal of AFHQ in July. By that date the 7029th Station Hospital (Italian), in prisoner of war Enclosure 129 at Ste. Barbe-du-Tlélat near Oran, was able to care for most of the Italian prisoner patients. The 43d and 46th General Hospitals in the nearby Assi Bou Nif groupment had taken malaria cases from the prison camp until the departure of those units in June and July, respectively. The 250-bed 7550th Station Hospital (Italian), which had been activated in EBS in March 1944, was moved to POW Enclosure 129 at the end of May but was never re-established as an active unit. The 7393d Station Hospital (Italian) continued for a time to operate 25 beds in conjunction with the 56th Station Hospital at Casablanca.
On the other hand, the German prisoner of war hospital in POW Enclosure 131, also at Ste. Barbe-du-Tlélat, expanded rapidly as the fortunes of war brought a steady stream of German prisoners into Allied hands. Originally set up late in 1943 as a 500-bed unit, the hospital was caring for more than 2,000 patients by July 1944. The limits were fixed by the availability of German medical personnel, who were never taken in large enough numbers to care for all of their own wounded.
The most important prisoner of war enclosure in Italy during the early part of 1944 was Number 326 at Dugenta in the Caserta area. In January the 66th Station Hospital was established in the enclosure. Shortly after the 66th was absorbed by the 300th General Hospital, the 34th Station took over the task of caring for sick and wounded German
section is based primarily on the following documents: (1) Annual Rpt,
Med Sec, MTOUSA, 1944; (2) Hist of 7029th Station Hosp (Italian),
27 Jul 45; (3) Annual Rpt, Med Sec, 2686th POW Administrative Co
(Ovhd), 1944; (4) Ltr, Col A. J. Vadala to Surg, NATOUSA, 29
prisoners in the Dugenta camp. The hospital--a former Italian disciplinary barracks--consisted of cottage-type buildings, prefabricated structures, and ward tents, the whole complex being surrounded by a high brick wall with sentry towers. The 34th inherited from the 66th both civilian workers and German medical corpsmen. During the Rome-Arno and Southern France Campaigns, the hospital census fluctuated between 300 and 500 daily, with 90 to 98 percent of the cases surgical. Evacuation was to the prisoner of war stockade or to the zone of interior. The repatriation of the incapacitated and long-term hospital cases on an exchange basis began in May.18
The 6619th Prisoner of War Administrative Company was in charge of prisoner of war Enclosure 326 until 11 August 1944, when it was relieved by the 2686th POW Administrative Company, brought over from Africa. These POW administrative companies each had a small medical section that supervised infirmary service by protected personnel in the camp.
With the breakthrough of the Gustav Line, the capture of Rome, and the battle of pursuit to the Arno, the number of German prisoners taken increased substantially, and additional hospitals were designated to share the load with the Oran and Dugenta facilities. The 78th Station Hospital at Maddaloni took prisoners from its opening in mid-May, and by June was almost exclusively a prisoner of war hospital. POW admissions were in the neighborhood of 700 a month, the bulk of them surgical. When the 78th Station closed to admissions late in August, the 262d Station at Aversa became a POW hospital, admitting more than 1,100 German prisoners in the last ten days of the month.19 Fixed hospitals in Rome and north of that city took prisoner patients along with U.S. and Allied casualties as they were brought in.
From less than 2,000 prisoners of war in hospitals under U.S. control at the end of January 1944, the census climbed to a peak for the year of 5,288 at the end of August. More than 1,600 of these were in PBS hospitals.20
Fixed hospitals in the Peninsular Base Section operated throughout the period of the Volturno and Winter Line campaigns on a 30-day evacuation policy, all patients with longer hospital expectancy being sent to North Africa by sea or air as soon as they were transportable. Bed status in PBS hospitals, and the number of patients awaiting evacuation, were reported daily by telegraph to the Surgeon, NATOUSA, who requested the Chief of Transportation, AFHQ, to provide hospital ships. Air evacuation continued to be controlled by the theater air surgeon, but close liaison with the base section was maintained. Patients to be evacuated were classified in PBS, so that those requiring special treatment
18 (1) Undated
British doe, signed H. W., Sub: Exchange of Allied and German Sick and
wounded POW's for Repatriation, Col Standlee's copy. (2) Memo, Maj Gen
F. C. Beaumont-Nesbitt, Chief, Liaison Sec, AFHQ, to CofS, French Ground
Forces, 3 Jun 44.
could be routed promptly to the hospital best equipped to handle the case.21
After the activation of PBS, only one U.S. hospital ship, Shamrock, was available for evacuation from Italy to Africa for the rest of the year, but occasional lifts were obtained from British vessels. Since air evacuation was exclusively to the Tunis-Bizerte area, hospital ships were routed to Oran. The port of embarkation was the Paestum beaches until 8 October, the port of Salerno between 8 and 25 October, and thereafter the port of Naples. Two other U.S. hospital ships in the Mediterranean, Acadia and Seminole, were used during the period primarily for evacuation from North Africa to the zone of interior.
Air evacuation from the Naples area was handled by the 802d Medical Air
21 Principal sources for this section are the following: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Med Sec, MTOUSA, 1944; (3) Annual Rpts, Surg, PBS, 1943, 1944; (4) Med Hist, 802d MAETS, 1942-44; (5) Med list, 807th MAETS, 1944; (6) ETMD's for Oct 43 through Aug 1944.
Evacuation Transport Squadron, with the 807th MAETS evacuating from Foggia, Bari, and more southerly fields. The latter unit evacuated for the most part personnel of the British Eighth Army, with a sprinkling of U.S. Air Forces casualties. Routes from Naples differed with the time of day, some flights going direct to North Africa, others making an overnight stop at Palermo in Sicily.
During the period between 2 January, when orders were issued for the Anzio landings, and 22 January when the assault troops went ashore, a determined effort was made to evacuate as many patients as possible from the Naples area to provide beds for the new operation. Two British hospital ships and two British personnel carriers were diverted to assist with the evacuation.22 Between 9 September, when the Salerno landings took place, and 21 January, the eve of the Anzio landings, a total of 19,048 patients had been evacuated from Italy by air and 13,017 by water, or 32,065 in all. (Table19) After the middle of October, most of these patients cleared through fixed hospitals assigned to PBS.
For the first six months of 1944, long-term patients continued to be evacuated from Italy to North Africa. By the end of June, however, the build-up of facilities in the Peninsular Base Section at the expense of the declining North African bases had proceeded so far as to permit retention of all U.S. patients in Italy on a 90-day policy, which was extended to 120 days after 15 August. As long as French troops remained in Italy, French patients requiring more than 30 days hospitalization were sent to the 9th Evacuation Hospital or were evacuated to French hospitals in Africa.23
Air evacuation from Italy to Africa was discontinued, except for Air Forces personnel, with the arrival of additional hospital ships in April. (Table 20) Air evacuation from Sicily ceased entirely with the closing out of the Island Base Section in July. After the middle of that month, evacuation from Corsica and Sardinia was directed to Naples rather than to Oran.
Within PBS itself, patients were shifted as required from one hospital to another, primarily to secure the advantages of specialization, but also on occasion to relieve congestion. After the terminus of air evacuation from the Fifth Army hospitals shifted from Naples to Rome, patients were moved periodically from the latter city back to Naples to keep from overcrowding the facilities nearer to the front. The 41st and 42d Hospital Trains, which were already in the theater, and the 66th Hospital Train, brought over from North Africa late in June, made regular runs between the two cities during July and early August.
Direct evacuation to the zone of interior by hospital ship from Naples began in April 1944. At the same time restrictions on the use of unescorted transports for evacuation from inside the Mediterranean were lifted, and these vessels began loading ZI patients at Oran as well as at Casablanca. Medical care on
22 Surg, NATOUSA, Journal, 22 Jan 44.
transports was provided by hospital ship platoons. Air evacuation to the zone of interior began on a regularly scheduled basis from Casablanca on 3 July and from Naples on 19 July. The Naples flights were broken by stops at Oran and Casablanca. 24
By 1 June seven U.S. Army hospital ships and one Navy hospital ship were available for evacuation to the zone of interior, permitting a rapid clearing out of the remaining North African hospitals in preparation for severe contraction in that area. Every effort was also made to reduce the patient load in Italy before the invasion of southern France, scheduled for 15 August. (Table 21)
Medical Supplies and Equipment
Theater Medical Supply
Organization for Medical Supply- Althoughthe reorganization of the theater
24 Hist, Med Sec, Hq, COMZ NATOUSA, Feb-Oct 44.
putting all operating functions of the Medical Department within the communications zone under the Medical Section, SOS NATOUSA, was effective on 24 February 1944, it was May before the supply branch of that headquarters obtained sufficient personnel to properly carry out its assigned mission. Supply personnel in the field units were also inadequate for the type of organization in effect. The conversion of the medical supply depots in the theater into medical depot companies in December 1943 had resulted in an aggregate loss of 260 men in the four depot companies assigned to NATOUSA, while a second reorganiza-
tion late in June 1944 further reduced personnel by 112.25
In order to make more efficient use of the remaining supply officers and enlisted men, a new plan of organization was worked out as early as March 1944, whereby the 2d and 4th Medical Depot Companies would be inactivated and medical composite battalions substituted for them. This plan was proposed to the War Department by the SOS surgeon on 24 May, but approval was not received until 15 July. In the meantime, under direct orders, the two depot companies concerned, together with the 7th and 12th Medical Depot Companies, had gone through the June reorganization, and more personnel had been lost.
The latter two companies were left unchanged, but the 2d Medical Depot Company, with headquarters at Oran, was inactivated on 13 August. From the personnel thus released, the 231st Medical Composite Battalion was organized under TOE 8-500, with the 70th and 71st Medical Base Depot Companies (TOE 8-187) as components. The battalion was then assigned to the southern France operation, and the 60th Medical Base Depot Company, which had been organized a few weeks earlier, took over
25 Sources for this section are: (1) Annual Rpt, Surg, MTOUSA, 1944. an. K; (2) Hist, Med Sec, Hq, COMZ NATOUSA; (3) Unit rpts of the med supply organizations mentioned in the text. (4) Davidson, Med Supply in MTOUSA, pp. 84- 107.
the NATOUSA functions previously performed by the larger organization. The 48th Medical Depot Company, based in Naples, was similarly inactivated on 15 August, being supplanted by the 232d Medical Composite Battalion with the 72d and 73d Medical Base Depot Companies as components. Personnel released from the 7th and 2th Medical Depot Companies in the June reorganization were absorbed by the two composite battalions.26
In addition to providing greater flexibility, the new arrangement was designed to handle more effectively such problems as maintenance and repair, and was able to make fuller use of the Italian service companies as substitutes for larger personnel allotments. The greatest economy and efficiency in the use of personnel was essential since the 7th Medical Depot Company, like the 231st Medical Composite Battalion, was assigned to the assault force for the invasion of southern France, while the 12th Medical Depot Company remained a Fifth Army unit. The theater was thus left with only the two medical base depot companies of the 232d Medical Composite Battalion and the 60th Medical Base Depot Company at Oran to carry out all supply activities at the theater and base section levels.
Operation of the Supply System- Medical supplies were obtained in the North African Theater of Operations by direct monthly requisitions on the zone of interior. These requisitions reflected anticipated needs three months hence, in terms of expected troop strength. Supply and requirements were computed from base section inventory records, items still due on previous requistitions, shipping time, and a replacement factor estimated in terms of probable use between the date of inventory and the date of delivery. The supply objective remained a 30-day operating level plus a 45-day reserve level.27
In cases of urgent need supplies were sent by air, but for the most part they were delivered by the convoys, which reached the theater three times a month. The system entailed various difficulties. Ports of discharge were not always able to handle an entire convoy, and some vessels might be diverted to another port. The port of discharge, moreover, was determined by the service receiving the larger part of the cargo, which was seldom the Medical Department. Thus requisitions had to take into account a possible loss of time in transshipment.
Another difficulty lay in the computation of replacement needs. Replacement factors had been under study, both in the theater and in Washington, since October 1943. In March 1944, revised replacement factors were sent out by the War Department, differing in many respects from those previously in use. Equipment items, except for unit assemblies, had previously been calculated as a percentage of the amount in use, but were now to be estimated on the basis of troop strength, in the same manner as expendable items. Careful comparison in the theater revealed that neither new
26 The new
medical base depot companies organized under TOE 8-187 had only about one-third
as many personnel as the old medical depot companies (TOE 8-667) . It was
thus possible to complete the reorganization without calling upon the ZI
for additional personnel.
nor old replacement factors agreed with theater experience. With the concurrence of the War Department, the consumption records of the Mediterranean supply services were applied as modifying factors while the whole problem was subjected to further study. Maj. Frank C. J. Fiala, was assigned by Washington to the Supply Branch, Medical Section, SOS NATOUSA, on 23 May, along with three specially trained enlisted men, to carry out these studies.
A detailed system of stock control and stock record forms was devised for the purpose of keeping accurate track of theater inventories, disbursements, receipts, and supplies on order and of the distribution of medical supplies among the base sections. Information for medical supply officers was included in a series of technical bulletins initiated by the SOS medical section in January 1944.
In addition to supplying the base sections, depots, and Air Forces service commands, and directing interbase transfers, the supply branch of the SOS medical section also screened all requisitions originating in the Allied Control Commission (ACC), filling them from theater stocks wherever possible. After May 1944 requisitions of the Joint French Rearmament Committee were similarly screened. The supply branch served as the official channel for ordering materiel from the zone of interior on behalf of both of these agencies.
The problem of maintenance and repair was particularly acute in the Mediterranean, because of a general shortage of properly trained personnel. The TOE under which the field units were reorganized in December 1943 contemplated only third and fourth echelon repair. Equipment needing more extensive overhauling was sent back to the ZI, and was usually lost to the theater. The medical composite battalions set up in August, however, included fifth echelon repair units. In addition to the repair and maintenance sections maintained at all depots, traveling maintenance teams began visiting hospitals and other medical installations, making on-the-spot repairs and instructing personnel in preventive maintenance.
Medical Supply in the Base Sections
By the beginning of 1944, medical supply for the communications zone was concentrated in two major depots. The 2d Medical Depot Company at Oran served North Africa and the Mediterranean islands, while the 4th Medical Depot Company at Naples supplied the Italian mainland. Both depots requisitioned on the zone of interior until January 1944, when the Medical Section, SOS NATOUSA, took over that responsibility and both received ZI shipments direct.28
The North African base sections were already in process of contraction when the Services of Supply assumed control over them on 24 February 1944. The Atlantic Base Section had been without a regular supply depot since the fall of 1943, the function being performed incidentally by the 6th General Hospital. When that installation closed station on 16 May 1944, the supply function passed to the 56th Station Hospital and was discontinued altogether on 1 Sep-
28 Sources for this section are: (1) Annual Rpt, Med. Sec, MTOUSA, 1944, an. K; (2) Hist, Med Sec, Hq, COMZ NATOUSA. (3) Unit rpts of the various base sees and other med organizations mentioned in the text. (4) Davidson, Med Supply in MTOUSA, pp. 84-107.
tember. Thereafter medical units at Casablanca and Marrakech requisitioned supplies from the Mediterranean Base Section.
In the Eastern Base Section, the 7th Medical Depot Company closed at Mateur on 12 May, transferring 1,600 tons of medical supplies to the Naples depot for PBS. After that date the 54th Station Hospital at Tunis maintained the only issue point in EBS. The medical supply section of the 6671st General Depot at Algiers also closed on 12 May, turning over the medical supply responsibility to the 29th Station Hospital. On 7 August MBS assumed direct control of supply as well as other medical services for the Center District, which passed out of existence at that time.
In Sicily, personnel of the 2d Medical Depot Company operating the Island Base Section supply depot at Palermo
were transferred to Headquarters, IBS, on 10 February 1944. A provisional medical supply depot company was activated in April, being reorganized late in May as the 684th Quartermaster Base Depot Company. A supply depot for the Northern Base Section on Corsica was set up at Ajaccio on 1 March by personnel of the 7th Medical Depot Company, which established a subdepot at Cervione in May. The following month, the NORBS supply organization was assigned to the 684th Quartermaster Depot Company, which was itself transferred to PBS control when the Island Base Section was inactivated in July. The two Corsican depots were combined at Cervione in September.
In Italy, in addition to the Peninsular Base Section installations, an Adriatic Depot was formed in October 1943 to serve Air Forces and supporting troops in the Foggia-Bari area. The medical section, located at Ban, was confined to supply activities, using over-strength personnel of the 4th Medical Depot Company until 20 March 1944. On that date the Medical Section, Army Air Forces Service Command, Mediterranean Theater of Operations, took direct responsibility for the medical supply activities of the depot, under general supervision of the Medical Section, SOS NATOUSA. With rising air strength and increasing air activity, the medical section of the Adriatic Depot was enlarged and for the first time was placed under its own surgeon about 1 July. At the same time the AAFSC MTO was authorized to deal directly with the zone of interior in matters of medical supply peculiar to the Air Forces instead of going through SOS NATOUSA. By the close of the Rome-Arno Campaign the medical section of the Adriatic Depot was performing the functions of a medical base depot company.29
In the Peninsular Base Section proper, the 4th Medical Depot Company, at the medical center on the Mostra Fair Grounds, had responsibility for all medical supplies until June 1944, when the 7th Medical Depot Company arrived from EBS to share the load. The 7th operated depots successively at Anzio, Rome, and Civitavecchia between 11 June and 1 July. The Rome depot was turned over to the 12th General Hospital for administration, and the Civitavecchia dump was transferred to control of the 4th Medical Depot Company. On 1 July the 7th Medical Depot Company was relieved of assignment to PBS before being attached to Seventh Army. The 4th Medical Depot Company, after a week in Civitavecchia, set up a second forward base at Piombino. By the middle of July, all medical supply installations between Naples and the Volturno had been centered in the main supply base on the fairgrounds, and all other depots south of Civitavecchia had been eliminated.
Thus, coincident with the movement of AFHQ to Caserta, the whole supply system for the theater was revised. The Mediterranean Base Section was made responsible for all medical supply in North Africa, the Atlantic and Eastern Base Sections were left without stocks, and the Island Base Section was closed. Surplus stocks in MBS were used for mounting the invasion of southern France, while the Peninsular Base Section took over support of the Adriatic
29 (1) Annual Med Hist, AAFSC MTO, 1944. (2) MS. Hist of the Adriatic Depot, OCMH files.
Depot, the Northern Base Section, and the Allied garrison on Sardinia.
In the reorganization of 15 August, Headquarters, 232d Medical Composite Battalion, and the 72d Medical Base Depot Company remained in Naples. The detachments at Piombino and Civitavecchia were combined at the Piombino site and redesignated the 73d Medical Base Depot Company. An advance group of this company departed for Leghorn on 23 August to locate quarters for what would eventually be the major medical supply base for the theater.
Professional services in the Italian communications zone continued to maintain the high standards of performance established in North Africa, unaffected by changes in organization or command.
Medicine and Surgery
At the theater level, medical aspects of the medical and surgical services continued to be guided and supervised by the consultants. Both Colonel Long, Medical Consultant, and Colonel Churchill, Surgical Consultant, made frequent inspection tours of base installations and combat medical units, recommending changes in procedure and personnel wherever such changes were considered desirable.30
Medical Service- The medical problems of the Italian communications zone were primarily extensions of problems discussed in connection with combat activities. Infectious hepatitis was intensively studied at the 15th Medical General Laboratory in Naples.31 The treatment of neuropsychiatric disorders was centered increasingly in the forward echelons, under general direction of the theater consultant in neuropsychiatry, Colonel Hanson, but specialized neuropsychiatric hospitals continued to be maintained in the Peninsular Base Section to give the best possible care to patients whose cure could not be effected closer to the front. These were the 51st Station Hospital, which opened in Naples in May 1944, and the 114th Station Hospital, which moved from North Africa to Rome early in July. Psychiatrists were also assigned to certain other station and general hospitals on temporary duty to care for cases that for one reason or another could not be sent to the specialized facilities. Other troublesome diseases, such as trench foot, malaria, and venereal infections were dealt with at the communications zone level primarily as problems in preventive medicine.
The only special problem worthy of note for the medical service arose as a result of the enemy bombing of Ban harbor on the night of 2 December 1943. One of the vessels destroyed had carried a quantity of mustard gas, and undetermined amounts of the gas were held in solution in oil that was floating on the water. Of the more than 800 casualties hospitalized after the raid, 628 suffered
section is primarily based on: (1) Annual Rpt, Med Sec, MTOUSA, 1944;
(2) Annual Rpt, Surg, PBS, 1944; (3) Annual rpts of individual med
units in the theater; (4) Col. Edward D. Churchill, "Surgical Management
of Wounded in Mediterranean Theater at the Time of the Fall of Rome," Bulletin,
U.S. Army Medical Department, V, (January 1945) , 58-65.
from mustard gas exposure. Sixty-nine deaths were attributed in whole or in part to this cause.32
Medical officers and aidmen treating the casualties were unaware of the presence of the gas, which was diluted sufficiently to be undetected by odor. In the belief that casualties covered with oil but showing no physical damage were suffering from exposure and immersion, they were wrapped in blankets, still in their oil-soaked clothing, given hot tea, and left as they were for twelve to twenty-four hours while the more urgent blast injuries and surgical cases were treated.
Those with the energy and will to clean the oil from their own bodies suffered no serious damage, but the remainder suffered varying degrees of mustard burns. Eyes began to burn about 6 hours after exposure, and were so badly swollen in 24 hours that many of the patients thought themselves blind. The first death occurred without warning 18 hours after exposure.
About 90 percent of the gas casualties were American, the bulk of them merchant seamen. Since no U.S. hospital facilities were yet available in Bari--it will be remembered that equipment for all but one of the U.S. hospitals scheduled for the area was destroyed in the bombing-casualties were hospitalized in British installations.33
Surgical Service- One of the more important advances in surgical management during the first year of the Italian campaign was the development of reparative surgery in the base hospitals. The concept of wound surgery as it developed at this time divided procedures into three phases. The first phase, performed in field or evacuation hospitals in the army area, included all procedures necessary to save life and limb. The second phase, called reparative surgery, took place in the general hospitals of the communications zone. The third phase, more properly called reconstructive or rehabilitative surgery, took place in the zone of interior and was designed to correct or minimize deformities and disabilities. The techniques and limits of initial surgery in the army and even the division area were well established early in the Italian campaign, but there was much still to learn about the second phase.
Expert opinion was that to achieve maximum benefits, reparative surgery must take place at the period of greatest biological activity in wound repair, between the fourth and tenth days. As described by Colonel Churchill,
Reparative surgery is designed to prevent or cut short wound infection either before it is established or at the period of its inception. Once established, wound infection is destructive of tissue and, at times, of life. In many instances it permanently precludes the restoration of function by the most skillful reconstructive efforts. If the initial wound operation has been a complete one, wounds of the soft parts may be closed by suture on or after the fourth day. The dressing applied in the evacuation hospital is removed under aseptic precautions in an operating room of a general hospital at the base. Following closure, the part is immobilized preferably by a light
32 (1) Surg,
NATOUSA, Journal, 21, 23, 27 Dec 1943, 2 Jan 44. (2) Theater ETMD
for Dec 43, app. S. (3) Ltr, Col Alexander, Consultant, Chemical
Warfare Medicine, to DMS, AFHQ, and Surg, NATOUSA, 27 Dec 43, sub: Toxic
Gas Burns Sustained in the Bari Harbor Catastrophe. (4) Pers Ltr, Col Alexander
to Col William D. Fleming, Med Sec, Hq, SOS ETO, 26 Dec 43.
plaster, or, if this is impracticable, by bed rest. Decision to close a wound by suture is based solely on an appraisal of the gross appearance at the time of removal of the dressing.34
Churchill estimated that by the middle of 1944 "at least 25,000 soft part wounds" had been closed in Italy alone on the basis of gross appearance only, with satisfactory healing in 95 percent of the cases. The technique was also used for more complicated wounds, including "those with extensive muscle damage as well as those with skeletal or joint injury and penetration of the viscera."
The Naples Blood Bank- Shortly after it opened in the Naples medical center in January 1944, the 15th Medical General Laboratory was asked by the PBS surgeon, Colonel Arnest, to establish a small blood bank for emergency use in the center and elsewhere in the Naples area. Plans for a 20-bottle bank were drawn up, but before they could be implemented, the needs of Fifth Army led to substantial enlargement of the scheme. When the blood bank began operations on 23 February, its goal was 200 bottles a day, forecast as the combined requirement of Fifth Army and the Peninsular Base Section. Donors were drawn from base units, replacement depots, and personnel in the process of staging. Two thousand pints of blood were taken in March, with an aggregate by 1 May of 4,134. The blood bank meanwhile had been formally authorized. Two days before Allied troops opened the offensive that would carry them to Rome and on to the Arno, it became the 6713th Blood Transfusion Unit (Provisional), assigned to the theater but attached to the 15th Medical General Laboratory. During May 6,362 pints of blood were drawn with the assistance of the 1st Medical Laboratory, which was attached to the 15th late in April. Between 14 and 31 May, when battle casualties were heaviest, 4,685 bloods were taken, for a daily average of 260. Throughout this period the blood bank was operated by 7 officers and 36 enlisted men.35
Blood was carried to the Cassino front by truck and to Anzio by LST. Beginning on 24 May, whole blood was flown to the front daily. A distributing unit followed the advance of Fifth Army, met the daily blood plane and delivered the precious cargo to the hospitals where it was needed. The blood plane also carried penicillin, emergency medical supplies, and occasionally personnel.
Since the decision had been made by Colonel Churchill to keep whole blood for a maximum of only eight days, the activities of the blood bank were necessarily keyed to combat activity. The laboratory maintained a list of donors, who
"Surgical Management of Wounded in Mediterranean Theater at Time of the
Fall of Rome," Bulletin, U.S. Army Medical Department, V (January
1945), pp. 61-62. Sec also, "Developments in Military Medicine During the
Administration of Surgeon General Norman T. Kirk," Bulletin, U.S. Army
VII (July 1947), 623-24; Col. Oscar P. Hampton,
Jr. (USAR), Orthopedic Surgery in the Mediterranean Theater of Operations,
Department, United States Army," subseries Surgery in World War II (Washington,
were called when needed. The use of whole blood in forward surgery undoubtedly saved many lives Mediterranean Theater.
The major problems of preventive medicine in the communications zone remained in Italy what they had been in Africa--venereal disease and malaria. Such wasters of manpower as trench foot, hepatitis, and dysentery were studied, and care was provided where needed, but for the most part these were combat zone problems. Venereal disease and malaria were dealt with on a theater-wide basis. The army aspects of both have been discussed in earlier chapters, but the control organization in both cases centered at theater headquarters. The division of function between the Medical Section, NATOUSA, and the Medical Section, SOS NATOUSA, was not always clear, but the two groups worked closely together to avoid duplication of effort and to achieve a common goal.
Venereal Disease- The direction and co-ordination of the venereal disease control program rested at the theater level with the NATOUSA venereal disease control officer, Lt. Col. Leonard A. Dewey, until mid-January 1944, and thereafter Lt. Col. Asa Barnes. The program was carried out in the base sections under direction of the SOS venereal disease control officer, Lt. Col. William C. Summer, who transferred from the NATO USA organization in May.
The practice, begun in Africa, of placing houses of prostitution off-limits to military personnel was continued in Italy, but the problem of the clandestine prostitute was more serious in the Italian cities, particularly in Naples and Rome. The enforcement of off-limits regulations and the apprehension of unlicensed prostitutes was in the hands of civilian and Allied military police, while the base surgeons, through their venereal disease control officers, were responsible for the dissemination of educational materials among base installations and troops, the establishment and maintenance of prophylactic stations, and the keeping and analysis of venereal disease records. Naples and Rome, the two largest and most accessible cities in the Italian communications zone, each had 10 "pro" stations in operation.36
While the venereal rates for the theater as a whole showed steady improvement through the spring and summer of 1944, measured in days lost, the gains were due rather to the introduction of penicillin therapy than to any significant reduction in the number of cases. (Table 22)
Malaria- The malaria control Organization set up in North Africa was extended to Italy where, with some modifications, it was responsible for an effective control program in the 1944 season. The entire program was under the general supervision of Colonel Stone, preventive medicine officer on the staff of the Surgeon, NATOUSA, and was directed by Colonel Andrews of the Sanitary Corps, who was both theater malariologist and commanding officer of the 2655th Malaria Control Detachment. Under Colonel Andrews were malariol-
36 This section is primarily based on: (1) Annual Rpt, Surg, MTOUSA, 1944; (2) Hist, Med Sec, COMZ NATOUSA; (3) Annual Rpt, Surg, PBS, 1944; (4) Annual Rpt, Surg, Rome Area, 1944.
ogists assigned to each of the base sections, to Fifth Army, and to the Army Air Forces Service Command. A malariologist was also assigned to the Services of Supply medical section, and close liaison was maintained with the Malaria Control Branch of the Allied Control Commission, and with the British Consultant Malariologist.37
The actual work of malaria control was directed locally by specialized units, co-ordinated at the theater level but assigned for operational purposes to the armies and base sections. The control program was effected in three phases. (1) Surveys to determine the malariousness of an area and the density of the malaria vectors were conducted by malaria survey units. Consisting of one entomologist, one parasitologist, and eleven enlisted men, these units, known as MSU's, were in effect mobile malaria laboratories, calculating splenic indices and making blood analyses of persons living in the area to determine the incidence of the disease and seeking out mosquito breeding places. (2) The findings of the malaria survey units were turned over to malaria control units, or MCU's, each commanded by a sanitary engineer with eleven enlisted men. The MCU's carried out various forms of larviciding and physical alteration of breeding places by draining, filling, and other means. (3) Personal protective measures, such as use of protective clothing, bed nets, insect repellents, and atabrine therapy were enforced by commanding officers for all troops.
By way of advance preparation for the 1944 malaria season, an Allied Force Malaria Control School was conducted in Algiers in November 1943, with parallel American, British, and French sections. The school was attended by malariologists and other malaria control personnel, who followed up with similar schools conducted locally. Between 21 February and 25 March 1944, three separate courses were given in Naples under the direction of Maj. Maxwell R. Brand, the Peninsular Base Section malariologist. One course was for medical inspectors, one for laboratory officers and technicians, and one for the training of enlisted men to work as malaria control details. The latter course was repeated in April at Caserta, primarily for Air Forces personnel. Courses conducted for Fifth Army personnel have been discussed in earlier chapters.
The theater malaria control plan was distributed on 20 March 1944 to the commanding generals of Fifth Army; the Army Air Forces, MTO and Services of Supply, NATOUSA. As of that date, there were five malaria survey units and seven malaria control units in the theater. Two additional control units were activated in May and three survey units in July. One MSU arrived from the United States in June, bringing the totals for the season to nine units of each type. The units were distributed according to need in North Africa, Corsica, Sardinia, Sicily, and various
37 This section is based primarily on: (1) Annual Rpt, Med Sec. MTOUSA, 1944, an. J, app. 28; (2) Hist, Med Sec, COMZ MTOUSA; (3) Annual Rpt, Surg, PBS, 1944; (4) Annual Rpt, Med Sec, AAFSC MTO, 1944, an. B; (5) Col. Paul F. Russell, "The Theater Malaria Control Organization," Medical Bulletin, North African Theater of Operations, I (February 1944), 17-18; (6) Summary of Materials presented at Malariologists Conference, 1-11 Nov 44, in Naples, Italy For comment on the capabilities and organizational inadequacies of the malaria survey and control units, see Armfield, Organization and Administration, pp. 288-91.
points of troop concentration in western Italy. Eastern Italy was a British responsibility, except for a substantial area around Foggia for which the Air Forces Service Command was made responsible.
Control measures followed a standing operating procedure. Each individual combat and service unit was responsible for its own area, while large-scale operations such as drainage and water diversion projects were conducted by the Army engineers. Dusting and spraying from the air was carried out by a section of a ferrying squadron, using both British and U.S. personnel. One malaria survey unit operated a plant for mixing paris green, at the rate of eight to ten tons a day. DDT was used sparingly early in the season, but more and more freely as adequate quantities became available toward midsummer. Supplies and equipment were procured through Quartermaster, Engineer and Ordnance, and a labor force was drawn from the civilian population, from Italian service companies, and in combat areas from troop detachments.
The malaria control program for the theater as a whole, judged in terms of malaria case rates, was effective. Rates per 1,000 per annum for the most malarious months of 1944 were 70 in June, 81 in July, and 92 in August, compared to 29, 77 and 173 for the corresponding months of 1943. The higher 1944 rates for June and July reflect primarily the far higher proportion of theater personnel stationed in malarious areas. The August figures are more nearly comparable, contrasting as they
do the experience of Seventh Army in Sicily with that of Fifth Army in Italy.38
The Reconditioning Program
In the Italian communications zone the reconditioning and rehabilitation program launched in North Africa was further refined and broadened. As a result of a survey conducted in late January 1944 by Colonel Munhall, commanding officer of the 6706th Conditioning Company, each of the general hospitals in the Peninsular Base Section established a convalescent and rehabilitation (C&R) section. Patients were normally transferred to this section ten days in advance of discharge from the hospital, but in most instances, reconditioning and rehabilitation had already begun with occupational therapy, light calesthenics on the wards, short walks, and various duties in the administration of the hospital, scaled to the abilities and physical capacities of the individual.39
In the convalescent and rehabilitation sections, each staffed by one line officer and six noncommissioned officers on temporary duty status, the program included both physical conditioning and psychological readjustment. Lectures on the progress of the war and world events and lessons from past campaigns went along with carefully graduated exercises and military drill. To get away from the hospital atmosphere, the C&R sections were generally removed as far as possible from the hospital proper. The men wore uniforms and lived much as they would in combat units. The 10-day program gave each man 40 hours of physical conditioning and 25 hours of military education.
In addition to this reconditioning program in the general hospitals, which continued throughout the war, a more comprehensive program was conducted by the 6706th Conditioning Company, which was transferred to Italy in April 1944. The conditioning company dealt with men in need of longer periods of rehabilitation, for the most part men who had previously been classified for temporary limited service up to ninety days. The normal period of duty with the conditioning company was three weeks. At the end of this time the men were examined by a board of officers from some nearby hospital, and placed in one of four categories: (1) those ready to return to duty, (2) those to be held for further conditioning, (3) those to be returned to the hospital for additional treatment, and (4) those to be sent before a hospital reclassification board for determination of future status.
The company was set up temporarily in Naples, moving in June to a site on Lake Lucrino and in July to a permanent location on Lake Averno. Both sites were close to the amphibious training area at Pozzuoli, west of Naples, and no more than five or six miles from the medical center.
The dental service throughout the North African Theater of Operations showed steady improvement during the first eight months of 1944, despite the fact that the number of dental officers in the theater did not keep pace with
Report of the Preventive Medicine Off, Office of the Surgeon, MTOUSA, app.
the rising troop population. At the end of December 1943 there were 703 dental officers in the theater, with a ratio to troop strength of 1:850. By the end of June the number of dental officers had risen to 765, but this larger figure represented only one dentist to each 938 military personnel. By the end of August total dental officer strength had declined to 734, or a ratio of 1:1012. 40
The improvements in dental service stemmed primarily from better and more widely distributed equipment, and from the concentration of dental skills. A Central Dental Laboratory was set up in the Naples medical center before the end of 1943. Early in April 1944 a maxillofacial center was established at the 52d Station Hospital, also in Naples, to which a maxillofacial team of the 2d Auxiliary Surgical Group was attached at the beginning of June, when casualties from the Rome-Arno Campaign began flowing back to the communications zone in large numbers. The maxillofacial center reached its peak load on 7 June, with a census of 282 cases, 139 of them with bone injury.
To meet growing personnel requirements, a training course for dental technicians was instituted in May, under which two enlisted men from each station hospital were given thirty days of training at a designated general hospital, with further instruction at the Central Dental Laboratory.
The enlargement of the general hospitals in June served to further the tendency to concentration of dental skills. Where the 1000-bed generals had had 5 dental officers, the newly constituted 1,500-bed hospitals had 8, and the 2000-bed units 10 dental officers. The hospital reorganization increased the Table of Organization requirements for the theater by 55 dental officers. Concentration at the army, corps, and division levels, with more extensive use of clinics and mobile laboratories, has already been noted in chapters dealing with combat activities.
As a result of these changes in distribution of dental strength and of improvements in equipment and laboratory facilities, the amount of constructive dental work performed was substantially increased over that performed in 1943.
Col. Lynn H. Tingay remained chief dental surgeon for the theater throughout the period of centralization in southern Italy, while Colonel Metz served as communications zone dental surgeon until August 1944. Both of these officers made frequent inspection trips to dental installations in the interest of improving theater dental service.
The communications zone organization for the Army Air Forces in Italy was headed by Maj. (later Lt. Col.) Estes M. Blackburn, dental surgeon of the Army Air Forces Service Command, Mediterranean Theater of Operations. Since no dental officer was assigned to the staff of the Surgeon, AAF MTO, Major Blackburn acted as adviser on supply and equipment and personnel to all Air Forces dental installations, as well as liaison with the NATOUSA and SOS NATOUSA, dental surgeons.41
sources for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an.G;
(2) Annual Rpt, Surg, PBS, 1944; (3) Hist, Med Sec, Hq. COMZ MTOUSA;
(4) Dental Hist, North African and Mediterranean Theaters of Operations.
Shortly after his appointment in February 1944 to the vacant position of theater veterinarian, Colonel Noonan recommended that food inspection units be placed under the supervision of SOS NATOUSA and the corresponding Air Forces echelon, the Army Air Forces Service Command, MTO. The number of food inspection units in the theater at this time was wholly inadequate and authority was granted in July to activate 12 medical composite sections (food inspection), each with a veterinary officer and 4 enlisted men. These were in addition to the 3 existing veterinary food inspection detachments bearing letter designations, which continued to operate in the theater under their old T/O's. Officer personnel for the new units were drawn from replacement pools. A cadre of one enlisted man for each new unit was assigned from the 3 veterinary detachments already in the theater, the remainder of the enlisted personnel coming from other veterinary organizations and from quartermaster depots. At the same time, 3 veterinary food inspection detachments (aviation) and 2 sections were activated and assigned to the AAFSC MTO, using existing Air Forces personnel. 42
The new organization brought food inspection units under base section control, the work being carried out in ports and in areas of heavy troop concentration where substantial quantities of food were stored or locally procured. Through improved methods of packing and storage and frequent inspections, the loss of food through spoilage was greatly reduced. No serious outbreak of food poisoning occurred anywhere in the theater.
In addition to food inspection duties, the Peninsular Base Section was responsible for activation of the 213th Veterinary General Hospital (Italian) on 4 July 1944, at Grosseto, with a complement of 15 Italian veterinary officers and 253 Italian enlisted men. The 6742d Quartermaster Remount Depot also received veterinary service through PBS.
While base section veterinarians in Italy and Sardinia aided in the local procurement of animals for military use, this work, as well as conditioning the animals so procured, was directed by the Fifth Army veterinarian, Colonel Pickering, and has been more fully treated in the combat narrative.43
The shift of emphasis from North Africa to Italy introduced no new or unusual problems for nurses. In communications zone installations, living conditions were better in Italy, and opportunities for recreation more extensive. The total number of nurses in the theater declined from 4,398 in October 1943 to 4,000 in January 1944, owing to the transfer of several hospitals out of the theater in the late months of 1943. The number of nurses remained close to 4,000 until transfer of hospitals to southern France late in 1944 again
for this section are: (1) Annual Rpt, Med Sec, MTOUSA, 1944, an. H;
(2) Hist, Med Sec, Hq, COMZ NATOUSA; (3) AAFSC MTO, Annual Med Hist,
1944, an. D. (4) Annual Rpt, Surg. PBS, 1944. See also, Miller, United
States Army Veterinary Service in World War II.
sharply reduced the total. Approximately 75 percent of the nurses were assigned to communications zone units.44
While the number of nurses in the theater was at all times adequate to the number of T/O beds, there were many periods of intensive activity when duty hours were long and patients per nurse high. During periods of heavy combat activity, nurses from fixed hospitals were often put on temporary duty with combat units, thus increasing the load for those remaining in the communications zone. The necessity for operating both fixed and mobile hospitals in Italy above T/O capacities for considerable periods of time was another factor tending to increase the burden on nurses as well as on all other hospital personnel. There is no evidence, however, that morale suffered in any way.
Lt. Col. Bernice M. Wilbur served through most of 1944 as Chief Nurse, NATOUSA; Capt. Michener served as Chief Nurse, COMZ NATOUSA, from late April 1944.
The work of the nurses in the theater was supplemented by the activities of a limited number of physical therapists and dietitians attached to the larger hospitals.45
Army Public Health Activities
The Civil Affairs organization set up under AMGOT before the invasion of Sicily was carried over initially to the Italian mainland. Before the Salerno landings, Sicily had been divided into two administrative regions, while other regions in southern Italy had been marked out and staffs assigned. The senior civil affairs officer for Region III, which included the Salerno and Naples areas, was Colonel Hume, a Medical Corps officer who had given up his position as Deputy Director of Public Health, Allied Military Government, for this purely administrative post.46
The public health and welfare officer for Region III, Lt. Col. (later Col.) Emeric I. Dubos, USPHS, went ashore at Salerno on D-day, but was unable to function during the first few days of combat. Colonel Hume and his British executive officer, Colonel Ashley, arrived at the beachhead the evening of D plus 4. Plans were prepared on the ground for the administration of the provinces of Salerno, Naples, Avellino, and Benevento, and for the city of Naples, including emergency health measures to be carried out under Army control. Allied Military Government civil affairs person-
for this section are: (1) Annual Rpt, Med Sec. MTOUSA, 1944, an. I;
(2) Hist, Med Sec, Hq, COMZ MTOUSA; (3) Annual Rpt, Surg, PBS, 1944;
(4) Maj Parsons and others, Hist of Army Nurse Corps, MTOUSA.
nel entered Naples with the occupying troops on 1 October and set about removing health hazards at once. According to Colonel Stone, the NATOUSA preventive medicine officer, who was one of the early arrivals, the population appeared well nourished. Water supply was sufficient for one gallon per person per day, provided none of it was used to flush the sewers.47 As rapidly as possible the accumulated garbage of two weeks was disposed of, and the dead were buried. With the aid of U.S. and British army engineers, water and power facilities and sewers were restored. During this period, Colonel Hume acted as military governor of Naples.
With the conclusion of the first phase of the Italian campaign, the AMG organization was modified to fit the conditions encountered on the peninsula. Early in November 1943, an Allied Control Commission was established under the Military Government Section, AFHQ. Allied Military Government thereafter functioned in two echelons, one attached directly to the 15th Army Group and one at the communications zone level, attached to theater headquarters. General Alexander, the army group commander, acted as military governor of all occupied territory in Italy until the advance of the troops made it possible to set up a civil government under supervision of the Allied Control Commission. Public health work of ACC was directed by the Public Health and Welfare Subcommission headed by Brigadier G. S. Parkinson (British) with Lt. Col. (later Col.) Wilson C. Williams as his American deputy.
As part of the reorganization of the Military Government Section, a civil affairs officer was attached to each of the Allied armies, the Fifth Army assignment going to Colonel Hume, who received his promotion to brigadier general at that time. On 14 May 1944, coincident with the launching of the drive on Rome and following a pattern already established in the European theater, the Military Government Section became a general staff section, designated as G-5.
The normal practice was exemplified in the capture of Rome. General Hume took over administration of the city as soon as it was in Allied hands, acting as military governor for ten days. On 15 June, AMG, Rome Region, responsible to the Allied Control Commission, replaced the Fifth Army civil affairs organization. During the period of Army
47 Surg, NATOUSA, Journal, 11 Oct 43.
control every effort was made to clean up the city, restore utilities, rehabilitate hospitals, and provide adequate sanitation, as well as to issue food and drugs where necessary. American Red Cross personnel worked with the Army public health officers. The more permanent civil affairs group representing ACC tried to re-establish a local government with native personnel along lines familiar to the inhabitants. Administration was eventually turned over entirely to the Italian authorities.
In the public health field, major problems were sanitation and preventive medicine. Such hazards to the health of the troops as typhus, malaria and venereal disease could be effectively controlled only by including the civilian population in control measures. While local doctors were encouraged to practice to the full extent of their abilities, general supervision was retained over hospitals. It was necessary, also, for the Allied public health organization to continue supplying drugs for civilian use.
The cities of Leghorn, Florence, and Pisa were under AMG administration by the end of August 1944.
Typhus Control in Naples
Even before the conquest of Sicily in the summer of 1943, a monitored broadcast from Rome indicated the presence of typhus in Italy. This possibility was taken into account in the medical planning for the occupation of the Italian mainland, both by the preventive medicine section of theater headquarters and by AMG public health officers. This planning was based on the use of methyl bromide (MYL) as a delousing agent, but difficulties in procurement prevented the stocking of adequate quantities of the powder and of suitable hand dusters for applying it. 48
Rumors of typhus in Naples were confirmed after the Salerno landings by refugees from the city, but could not be verified immediately. Colonel Stone, the NATOUSA preventive medicine officer, visited Naples along with General Cowell, Director of Medical Services, AFHQ, on 1 October, coincident with the occupation of the city. Conditions were right for an epidemic. The city was overcrowded, its more than a million inhabitants had not been immunized and were heavily louse infested, and large numbers lived jammed together in air-raid shelters. The departing Germans, moreover, had released the prisoners from certain jails in which cases of typhus had occurred earlier in the year among Serbian prisoners of war. Little could be learned from the local health authorities, however. Lack of transpor-
48 Principal sources for this section are: (1) Annual Rpt, Med Sec, NATOUSA, 1943; (2) Annual Rpt, Surg, MTOUSA, 1944, an. J; (3) Final Rpt, Preventive Med Off, MTOUSA, 1945; (4) Col D. G. Cheyne, Notes on Typhus in Naples 5 Dec 43; (5) ACC Public Health Sec, Monthly Rpts, Nov 43- Mar 44; (6) Capt William L. Hawley, Notes on the Typhus Epidemic and Control Measures in Naples, 1943-44; (7) Scheele, Civil Public Health History, North African-Mediterranean Theater of Operations, May 43-Jan 44; (8) Memo, Col Stone to TSG, 30 July 45, sub: Typhus Control; (9) F. L. Soper, W. A. Davis, F. S. Markham, and L. A. Riehl, "Typhus Fever in Italy, 1943-1945, and Its Control with Louse Powder," American Journal of Hygiene, XLV (May 1947). 305-34; (10) Stanhope Bayne-Jones, "Epidemic Typhus in the Mediterranean Area during World War II," Rickettsial Diseases of Man (Symposium. Medical Science Section, AAAS, 1946); (11) Pers Ltr, Gen Blesse, Surg, NATOUSA, to TSG, 6 Feb 1944; (12) Lt. Col. Charles M. Wheeler, "Control of Typhus in Italy 1943-1944 by Use of DDT," American Journal of Public Health, XXXVI (February 1946), 119-29; (13) Med Sitreps, PBS, Jan-Mar 44.
tation and disruption of communications made it impossible for those who might have the disease to be examined by a physician. There was also confusion in terminology, since "tyfo abdominale," or typhoid fever, was often used interchangeably by Italian doctors with "tyfo," which is the word for typhus.
On his return to Algiers, Colonel Stone advised General Blesse of the potential danger, and precautionary steps were taken at once. A group representing the Rockefeller Foundation was then studying typhus control in the Middle East, and had conducted experiments with the newly developed and still top secret DDT in a French prison in Algiers. These experiments confirmed Stones faith in the new insecticide, a quantity of which had already been requested for the theater. On Stone's advice Brigadier Parkinson (British) ordered 50 tons of 10 percent DDT, 5 tons of concentrate, and dusting guns, to be delivered to AMG by 15 December, while Stone himself ordered 60 tons of the powder and one ton of concentrate for Army use. Both requisitions were disapproved by the War Department in November.
The presence of typhus in Naples had meanwhile been established. Colonel Stone arranged with Dr. Fred L. Soper of the Rockefeller group for demonstrations of delousing methods in prisoner-of-war camps, and for the training of malaria control and other sanitary personnel in these methods. Pertinent data were distributed by the NATOUSA surgeons office in November.49 On the 20th of that month, Stone and Colonel Long, theater medical consultant, conferred at length with General Fox, field director of the U.S.A. Typhus Commission, which was also conducting studies in the Middle East, but independently of the Rockefeller group. General Fox was satisfied that all necessary steps had been taken, and pledged the full co-operation of the Typhus Commission.
Actually, control measures were lagging far behind needs. The public health officer for AMG's Region III, now Col. W. H. Crichton (British), had wholly inadequate resources, either of personnel or of equipment, to cope with the situation, and had not succeeded in organizing the Italian health authorities for effective assistance. By the end of November there were more than forty cases of typhus reported in Naples and probably many more than that. More vigorous control measures had become imperative.
The AMG and NATOUSA orders for DDT were reconsidered and finally approved by the War Department on 5 December. Observers from the Typhus Commission arrived in Naples on 6 December, and two days later Drs. Soper and William A. Davis of the Rockefeller group reached the city at the invitation of AMG and ACC authorities. The PBS surgeon, Colonel Arnest, placed all available supplies of MYL powder at the disposal of the Rockefeller team, while General Blesse dispatched DDT concentrate to Naples by air. The Typhus Commission observers took no part in actual control work, leaving after five days.
Contact or spot delousing began on 12 December, the homes of all reported cases being visited, and all contacts of the patients being dusted, but neither
49 (1) NATOUSA Surgeon. Cir Ltr No. 43. 11 Nov 43. (2) NATOUSA Cir Ltr No. 224, 15 Nov 43.
supplies nor personnel were adequate for more extensive measures. Neither was transportation available. Colonel Stone arrived on 18 December and General Fox, in response to Stones urgent request, on the 20th. After a series of conferences with health and medical officers representing AMG, ACC, PBS, and Fifth Army, General Fox, using his personal prestige and the authority of his position to the utmost, set the machinery in motion for a full-scale attack on typhus. All clearances were obtained, and all necessary guarantees of co-operation were given by 24 December. 50
Delousing of occupants of some 80 or 90 air-raid shelters on a weekly basis began 27 December, and the first two stations for mass delousing opened the following day. Supervised by Italian civilian inspectors, there were 33 such stations in operation by 15 January. Systematic delousing of all residents of each block in which a case occurred, and of contiguous blocks, began on 6 Febru-
50 Surg, NATOUSA. Journal, 24. 25, 26 Dec 43.
ary. Flying squadrons began working in suburban communities on 8 January.
General Fox and the Typhus Commission assumed full responsibility for typhus control in Naples on 2 January 1944, turning the task over to the Allied Control Commission on 20 February, after the crisis had passed. Dr. Soper and his associates of the Rockefeller group administered mass delousing throughout the danger period, and on a reduced scale until after the end of the war.
The turning point came around 10 January, by which date over 60,000 persons a day were being dusted with either MYL or DDT powder. The dusting stations alone averaged 1,600 a day per station, with an average staff of 13 each. All told, between mid-December 1943 and the end of May 1944, more than three million applications of dusting powder were made in Naples and surrounding towns. Out of 1,914 reported cases of typhus in the Naples area between July 1943 and May 1944, only 2 were U.S. military personnel, one a soldier whose attack was mild, the other a sailor, whose case was severe but not fatal.