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Extract From: U.S. Army in WWII, The Technical Service, The Medical Department: Medical Service in the European Theater of Operations

Operation Overlord

EXTRACT FROM:
UNITED STATES ARMY IN WORLD WAR II
The Technical Services
THE MEDICAL DEPARTMENT:
MEDICAL SERVICE IN THE
EUROPEAN THEATER OF OPERATIONS
by
Graham A. Cosmas
and
Albert E. Cowdrey
CENTER OF MILITARY HISTORY
UNITED STATES ARMY
WASHINGTON, D.C. 1992

CHAPTER VI PREPARATIONS FOR INVASION
  Early Planning Efforts
  OVERLORD: The Planning Process
  The NEPTUNE Campaign
  Technical Aspects
  Readying Medical Supply

  Mounting the Attack
CHAPTER VII   INTRODUCTION TO BATTLE
  The Assault
  First Army Medical Buildup
  Cherbourg and the Hedgerows


CHAPTER VI
Preparations for Invasion

 Medics in Britain performed their many and complex BOLERO tasks as preliminaries to their principal and most urgent mission: support of the amphibious assault on continental Europe. In the early period of the buildup, planning and preparation for that assault engaged the attention of only a few members of the chief surgeon’s staff. Then, as 1943 gave way to 1944, the pace of assault planning intensified. Medical personnel of all ranks and in all units were swept up in invasion preparations. By late spring of 1944 ETO medics, like everyone else in the theater, were tensely awaiting the rapidly approaching D-Day.
Early Planning Efforts
 Medical planning for a cross-Channel assault started in April 1942, after tentative approval of the American ROUNDUP invasion concept, and ran concurrently with the BOLERO buildup. The British and U.S. ground, naval, and air commands in London set up, among other committees on the ROUNDUP operation, an administrative planning staff to deal with logistical matters. The staff, in turn, was divided into lettered sections specializing in particular aspects of logistics. Section C, which did most of the medical planning, included members of the British War Office, Admiralty, Air Ministry, Combined Operations Staff, and Ministry of Health, with the theater chief surgeon and, more often, Colonel Spruit, Hawley's London representative, speaking for the American forces.1
 Section C, in common with the other logistics planning groups, worked within uncertain parameters. By mid-June the ROUNDUP tactical planners had developed a general concept for simultaneous landings on a front stretching from the Pas-de-Calais to Cherbourg, with perhaps six divisions in the initial assault; beyond that the outlines of the operation remained unclear, clouded with doubt as to its feasibility. At the same time Section C had little amphibious warfare experience to guide it. The U.S. Navy and Marine Corps before the war had outlined a tentative amphibious doctrine, also adopted by the Army, but the resulting manuals had little useful to say about medical op-

  1 For general ROUNDUP planning, see Harrison, Cross-Channel, pp. 5-8 and 21-23; Ruppenthal, Logistical Support, 1:175-76; Larkey, “Hist,” ch. 2, pp. 57-59.  For Spruit's role, see Hawley's recommendation for award, in file HD 024 ETO CS (Hawley Chron), April-June 1944.


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erations. Wartime British Commando raids, and even the August 1942 attack on Dieppe, offered few medical lessons but confirmed that heavy casualties were to be expected. In the face of these uncertainties and areas of ignorance, Hawley, Spruit, and their British colleagues plowed ahead as best they could.2
 From the start of their deliberations the medical planners confronted a problem that would remain a central preoccupation until D-Day: treatment and evacuation of the anticipated many casualties of the first days of the invasion. The dilemma was simple. The assault force would suffer its largest proportion of wounded at precisely the time when the fewest medical troops would be on shore to care for them. Section C, on the basis of informed guesswork, assumed that there would be 22,500 Allied wounded, almost half of them stretcher cases, during the first two days of ROUNDUP. Hawley, Spruit, and their British counterparts quickly ruled out any attempt to treat these injured on the French shore (designated in plans as the “far shore” to distinguish it from the British “nearshore”), concluding that treatment would require more medics, hospitals, and equipment than could possibly be landed in the assault and early buildup and more space than would be available in the crowded beachhead.
 If the wounded were not to be cared for on the far shore, they would have to be evacuated directly from the beaches to hospitals in Great Britain, but evacuated in what? Few British and no United States hospital ships were available in the theater, and in any event these large oceangoing vessels could embark patients conveniently only at ports. Besides, such scarce ships should not be risked under enemy air attack and shore battery fire. The British had developed a smaller type of hospital ship, the hospital carrier. Converted from shallow-draft coastal steamers, these vessels, each able to accommodate 100 litter and 150 ambulatory patients, could lie close to the beaches and load by means of water ambulances—motor boats carried on board the mother craft. Hospital carriers, however, also were vulnerable to hostile air and artillery and they took hours to fill to capacity. The four that would be available in England in late 1942 could not begin to evacuate all the expected casualties.
 Tactical landing craft that returned to England after unloading obviously were the only means for taking many wounded off the beaches quickly, although the types of such craft in service during ROUNDUP planning were small and not well adapted to handling men on stretchers. Nevertheless, in late 1942, for lack of any real alternative, the ROUNDUP administrative planning staff, at Section C’s recommendation, established in principle a policy of maximum evacuation during the initial assault and use of returning landing craft as the main
  2 For the ROUNDUP plan, see Harrison, Cross-Channel, pp. 22-23 and 54-55. Ruppenthal, Logistical Support, 1:328-30, discusses early U.S. experiments with the logistics of amphibious assault. At Dieppe, Canadian forces—the bulk of the assault group—suffered 3,367 casualties out of 4,963 troops engaged. Of the 1,154 wounded, the withdrawing Canadians had to leave 568 behind as prisoners. See C. F. Stacey, Six Years of War: The Army in Canada, Britain, and the Pacific, Official History of the Canadian Army in the Second World War (Ottawa: E. Cloutier, 1955), pp. 384-89.


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casualty carrier. What types of landing craft to employ for this purpose, how many could be made available–for medical use (indeed, how many would be available at all), and whether any could be earmarked exclusively for evacuation and protected by the Red Cross—these facts the committee could not determine. The principle it adopted, however, would remain in force throughout the rest of the lengthy invasion planning process.3
 Besides struggling with the problem of beachhead evacuation, the ROUNDUP medical planners arrived at basic decisions on a number of other important questions. They established an army-navy division of cross-Channel evacuation responsibilities that applied to both British and American forces. Under it, the armies were to collect all wounded on the far shore and move them to the beaches; the navies would load evacuation craft and care for patients on the voyage to England; the armies then would have charge of unloading the wounded and removing them to hospitals. General Hawley, Colonel Grow of the Eighth Air Force, and British medical and RAF authorities agreed on similar plans for air evacuation from the Continent to the United Kingdom.
BRITISH HOSPITAL CARRIER NAUSHON, a converted American ferryboat

  3
Larkey “Hist,” ch. 2, pp. 56-58. For memoranda detailing the reasoning behind these decisions, see file HD 024 ETO O/CS (Spruit File re Policy); Recommendations of a Sub-Committee held in . . . the Admiralty, London, 16 Jul 42, in EvacCorresp, 1942-45, file HD 024 ETO; F. A. E. Crew, The Army Medical Services (hereafter cited as AMS), History of the Second World War, United Kingdom Medical Series, 5 vols. (London: Her Majesty's Stationery Office, 1956-66), vol. 4, Campaigns: North-West Europe (1962), pp. 45-49.


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The ground forces and Services of Supply were to collect evacuees at French airstrips for pickup by transport planes returning to England. Air Force medical personnel were to care for the patients in flight, and the Services of Supply would deplane them in Britain and transfer them to hospitals. For their own forces the American planners began outlining the complicated sequence in which field army and then SOS medical units would land in France. They also roughed out a system for receiving water-evacuated casualties in England, using field hospitals and clearing stations at the ports for triage and emergency surgery and distributing transportable patients at once to selected hospitals inland.4
 Medical invasion planning, in this period of limited theater resources, at times took on an air of unreality. During July, for example, in a last effort to avoid the diversion to North Africa, General Marshall ordered the European Theater and Services of Supply to report on the feasibility of launching a small-scale cross-Channel attack, code-named SLEDGEHAMMER, on 15 September. Hawley, in response, informed General Lee that, if the buildup continued at its present pace, the medical service would be short 8,900 beds and 8,616 officers and men on the projected attack date and would have no hospital train units, ambulance battalions, or boats for water evacuation. Pressed by Lee to report positively on how he could support the operation, the chief surgeon reiterated his previous assessment, with the qualification that he would be able to support the landing if he could borrow field medical units, hospitals, and equipment from the British, who, of course, had none to spare. Reports such as this helped scuttle SLEDGEHAMMER and ROUNDUP and paved the way for the commitment to TORCH.5
 Cross-Channel assault planning of all sorts came to a stop in late 1942, as TORCH plans and preparations monopolized the attention of British and American staffs. Yet the ROUNDUP studies and conclusions—preserved in memoranda, data books, and individual memories—would constitute a starting point for the next round of invasion planning. Many of the principles and concepts of operation first sketchily outlined in ROUNDUP would be the foundation of the much more elaborate plans to follow.6
OVERLORD: The Planning Process
 The decision of the Allied leaders at Casablanca, in January 1943, to revive the cross-Channel attack project for execution sometime in 1944 set in motion a lengthy, complex planning process. It began with a small Anglo-American staff, eventually drew in most British and American headquarters, and ended in the final test of strength in the west with Nazi Germany.
 
 In March 1943, to give organizational substance to the Casablanca de-
_
 4 Larkey “Hist,” ch. 2, pp. 68-72; Miscellaneous SPOBS/ROUNDUP Papers file, CMH.
 5 An account of this incident, with documents, is in Larkey “Hist,” ch. 4, pp. 2-6 and apps. 2 and 3.
 6 Harrison, Cross-Channel, pp. 31-32; Larkey “Hist,” ch. 2, p. 73; Memo, CG, SOS, to ACoIS, G-4, and  CsofSupSvcs, SOS, 1 Apr 43, sub: Administrative Planning, file HD 024 ETO O/CS (Spruit File re Policy).


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cision, the Combined Chiefs of Staff established the Anglo-American staff known as COSSAC to plan the invasion and superintend preparations for it. Under the guidance of British Lt. Gen. Sir Frederick E. Morgan, COSSAC drafted the outline plan for the invasion, Operation OVERLORD, which Roosevelt, Churchill, and the Combined Chiefs approved at the Quebec conference in August. The Allies then put together the Anglo-American combined ground, naval, and air headquarters that were to fill in the details of OVERLORD and undertake its execution. In mid-January 1944 the arrival of General Eisenhower in London and the activation of SHAEF around the nucleus of COSSAC capped the invasion command structure. Eisenhower, after refining and expanding the COSSAC plan, set 1 June as the attack date. To obtain more landing craft for the enlarged assault, the Combined Chiefs canceled the originally contemplated simultaneous landing in southern France. On 1 February SHAEF published its outline plan for NEPTUNE, the code-name for 1944 operations within OVERLORD. SHAEF’s ground, naval, and air headquarters followed with their outline plans and various national forces then got to work on the details of tactics and logistics.
 The final plan, developed by COSSAC and expanded upon by SHAEF, selected Normandy as the point of attack because it possessed more suitable invasion beaches, was located within easier reach of major ports, and was less strongly defended than the previously favored Pas-de-Calais. In contrast to the broad front contemplated for ROUNDUP, the OVERLORD plan called for a single concentrated amphibious assault. Three British Commonwealth and two American divisions were to land north and northwest of Caen, with one of the American divisions going in on the east coast of the Cotentin Peninsula to gain position for a drive on the key port of Cherbourg. Three airborne divisions—one British and two American—were to drop to secure the flanks of the beachhead and open routes inland. This force, and follow-up troops, was to secure a compact lodgement area in which the Allies could mass men and supplies and from which they could advance methodically, first to capture additional Norman and Breton ports, then to clear the region between the Seine and the Loire, and finally to take Paris and go on to the Rhine, in the process destroying as much of the German Army as possible (see Map 4).
 With the formation of COSSAC, medical support planning paralleled every stage of OVERLORD’s development. The COSSAC medical section began work in June 1943, under Chief Medical Officer Lt. Col. G. M. Denning of the Royal Army Medical Corps. Besides Denning, the small, informal section included a Royal Navy representative and Lt. Col. Thomas J. Hartford, MC, Hawley's executive officer. In September, after Hartford went to 21 Army Group to keep in touch with ground forces medical planning, Lt. Col. John K. Davis, MC, from the ETO Hospitalization Division, assumed the
 7 This account of the OVERLORD plan and its evolution is based on Harrison, Cross-Channel, pp. 47- 59, 63-79, 98-127, 158-73; text of the outline plan is in Appendix A.


154-55

MAP 4:  OPERATION OVERLORD PLAN, 1944


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COSSAC post. Denning and Davis remained in the medical section when it became part of SHAEF, with General Kenner as chief medical officer. The section stayed small under Kenner,  never including more than four officers, evenly divided between British and Americans.
COL. THOMAS J. HARTFORD (Rank as of October 1943)

 Under both COSSAC and SHAEF, the medical section made no comprehensive plans for supporting the invasion. Instead, it drafted administrative directives on certain inter-Allied and  interservice problems. The section established, for example, uniform casualty-estimation formulas for use by all Allied planners, and it set basic evacuation policy and decided upon the principal means for cross-Channel transport of wounded. As part of SHAEF the section reviewed and reconciled the proliferating plans of subordinate headquarters.  Most COSSAC and SHAEF medical decisions in fact represented a consensus between the chiefs of the British and American medical services, reached at frequent formal and informal conferences.  Throughout the invasion planning the American medics at COSSAC and SHAEF drew upon General Hawley’s office for advice and information, with the staff preparing most of their studies and position papers.8
 Detailed American medical planning for NEPTUNE, covering the invasion and the first ninety days of the battle for France, began early in February 1944, after publication of the SHAEF outline plans.  Planning took place within a complex logistics organization created to accommodate national control of supply to overall British direction of NEPTUNE ground operations.  General Sir Bernard L. Montgomery’s 21st Army Group functioned as both tactical and administrative ground force headquarters for the invasion.  Subordinate to it, the U.S. 1st Army Group and First Army had logistical, as well as tactical, responsibility for the American troops under them, but these commands did not represent and could not control the ETO Services of Supply.  To give the latter a voice in invasion planning, as well as to form the skeleton of a
 8 For medical section activities, see Medical Division, COSSAC/SHAEF, War Diary, June 1943-May 1944; Interv, Medical History Branch, CMH, with Maj. Gen. T. J. Hartford, MC, USA (Ret.) (hereafter cited as Hartford Interv), 7-8 Oct 80, tape 1, side 1, CMH; Davis Interv, 19 Jun 45, box 222, RG 112, NARA.


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continental logistics system, General Eisenhower, as ETO commander, early in February activated two new headquarters: Advance Section, Communications Zone (ADSEC), and Forward Echelon, Communications Zone (FECOMZ).
 Each of these new headquarters possessed immediate planning and future operational functions. The Advance Section was attached to the First Army, which had charge of all tactical planning for the American part of the amphibious assault and also did logistics planning for the first fifteen day on shore. Besides assisting with army planning, ADSEC worked out the details of SOS operations for the period from the sixteenth through the fortieth day after D-Day (D + 16 through D + 40). The Forward Echelon, at the outset an element of 21 Army Group headquarters, supervised ADSEC planning and itself made SOS plans for D + 41 through D + 90.
 Operationally, ADSEC was to act as the supply element of the First Army until D + 15, organizing the beach behind the advancing troops. From D + 15 through D + 40, after the army established its rear boundary, ADSEC would constitute the communications zone under the supervision of 21 Army Group, exercised through the Forward Echelon. FECOMZ itself was to become active on D + 41, when a second U.S. army went into operation and the 1st Army Group, hitherto subordinate to 21 Army Group, became a separate command directly under SHAEF (see Chart 5). The Forward Echelon then would take command of the entire American support area behind the armies (whether under the U.S. army group or coordinate with it was never entirely settled). ADSEC at this point was to revert to the status of a movable base section under FECOMZ. The section would follow close behind the armies and link them to the Services of Supply, relinquishing supply activities nearer the shore to other base sections that would be formed as the campaign progressed. Around D + 90 SHAEF and ETOUSA were expected to move to France, whereupon FECOMZ would merge back into the ETO-SOS headquarters and General Lee, as Eisenhower's deputy for logistics, would assume direct control of all elements of the Services of Supply—to be redesignated the Communications Zone (COMZ).9
 Under this administrative arrangement the First Army surgeon, Colonel Rogers, and his staff, working closely with the surgeons of the two assault corps, the V and VII, drew up medical support plans for the initial landing and the first two weeks of combat. The ADSEC surgeon, Col. Charles H. Beasley, MC, and the FECOMZ surgeon, Colonel Spruit, prepared plans for establishing the medical portion of the continental Communications
 9 The SOS underwent formal redesignation as Communications Zone, ETOUSA, in GO No. 60, HQ ETOUSA, 7 Jun 44, but the term came into increasing use from the end of February, even on SOS letterheads. COMZ will be used in this chapter in discussing logistical and medical planning, but SOS will be used in reference to operations until the narrative reaches the actual activation of COMZ. For a description of the convoluted logistics command system, see Ruppenthal, Logistical Support, 1:203-15 and 219-27. See also First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. I, pp. 25-27; HQ Forward Echelon, COMZ, ETOUSA, Communications Zone Plan (hereafter cited as FECOMZ Plan), 14 May 44, pp. 2-5, file HD 370 ETO.


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Chart 5–Planned Command Arrangements for OVERLORD After U.S. 1st Army Group Became Operational [Part 1]


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Chart 5– [Part 2]


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Zone. Roger's First Army medical section had come over from the United States with its parent headquarters and had been in operation in London and Bristol since October 1943, but the ADSEC and FECOMZ surgeons’ staffs had to be improvised in haste (see Charts 6 and 7). Of substantial size—the ADSEC surgeon’s office eventually included forty-three officers and fifty-six enlisted men—these organizations drew manpower from casuals, base section headquarters, and General Hawley's office. Colonel Beasley, for example, had been surgeon of the Eastern Base Section; his deputy, Col. James B. Mason, MC, had served as Hawley's chief of operations; and Colonel Spruit had come over to FECOMZ from running the Cheltenham branch of the chief surgeon’s establishment. Each of the COMZ surgeons organized his office into divisions paralleling those under the chief surgeon. Spruit's office, indeed, was for practical purposes an advance echelon of Hawley’s.10
 While the First Army, ADSEC, and FECOMZ surgeons drafted the NEPTUNE plans, many of the decisions incorporated in them came from other headquarters. General Hawley, charged with supervising all theater medical planning, took part in establishing most major policies. His staff furnished information to the army and COMZ surgeons and wrote key portions of their plans, including, for instance, the basic army-navy agreement on division of cross-Channel evacuation responsibility. Hawley's office published its own standard operating procedure for medical service on the Continent and oversaw base section planning for support of the embarking invasion forces and for receiving casualties from the far shore. At SHAEF General Kenner kept in close touch with ETO medical planning and intervened in selected aspects of it. Of the higher-level ETO surgeons, Colonel Gorby of the 1st Army Group, in accord with the group's inactive role at this stage, had the least to do with NEPTUNE planning. He confined himself to keeping informed of First Army activities, assembling the medical portion of the troop buildup schedule, and participating in SHAEF medical policy discussions.11
 The NEPTUNE medical planners made use of the data collected by their ROUNDUP predecessors and adopted many principles worked out for the projected earlier invasion. They also availed themselves of the medical lessons learned in amphibious operations in North Africa, Sicily, and Italy. The Fifth Army late in 1943 assembled many of these lessons into

  10An. 9, COMZ Medical Plan (hereafter cited as An. 9-Medical), p. I, to FECOMZ Plan, 14 May 44, file HD 370 ETO; An. 8—Medical, p. 4, to ADSEC, COMZ, NEPTUNE Operation Plan D to D + 41 (hereafter cited as ADSEC Plan), 30 Apr 44, 1944, file HD 370 ETO; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 1-5; Larkey “Hist,” ch. 8, pp. 5-9; Personnel Division, OofCSurg, HQ ETOUSA, Report Annual Rpt, 1944, p. 12.
  11OofCSurg, HQ ETOUSA, Standard Operating Procedure for Medical Service in Continental Operations (hereafter cited as O/CS Continental SOP), 4 Apr 44, file 370.02. For activities of Hawley's office, see annual reports of the Operations Division—especially Planning Branch, Evacuation Branch, Medical Intelligence Branch, Statistics and Requirements Branch—and of the Hospitalization Division for 1944 as well as Middleton Interv, 1968-69, vol. 1, p. 218, NLM. On Kenner's activities, see Medical Division, COSSAC/SHAEF, War Diary, February-May 1944. On Gorby, see 12th Army Group of Operations, vol. XIII (Medical Section), p. 7.


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a manual for amphibious medical support, upon which the ETO planners drew extensively. Besides using the manual and other written reports, some ETO medical officers visited the neighboring theater for firsthand observation and conferences with army and SOS surgeons. During the early 1944 planning period, Colonel Hartford of 21 Army Group, Colonel Davis of SHAEF, Colonel Beasley of ADSEC, and Colonel Darnall of Hawley's Hospitalization Division made Mediterranean tours. Their visits, besides affording a change of climate, produced useful information. Hartford, for example, confirmed from Fifth Army experience the practicability of evacuating wounded over the beaches early in amphibious assault and brought back up-to-date estimates of whole blood transfusion requirements in combat surgery.12
  NEPTUNE medical planning extended over about four months, with the First Army plan appearing in late February and those of ADSEC and FECOMZ respectively on 30 April and 14 May. These plans, while published separately, issued from a seamless process of discussion and negotiation so complex as to defy narration. The three principal medical planning staffs worked in constant consultation  with each other, with nonmedical planners at their own headquarters, and with the surgeon's staffs of higher- and lower-command echelons. They kept in close touch with Navy and Air Force medical staffs and with those of their British colleagues. The ADSEC medical section had British officers attached to it for planning. In the end, as a result of this method of working, the evolution of each plan was shaped by the evolution of each of the others. Together, the major medical plans constituted a comprehensive blueprint for the NEPTUNE campaign.13
The NEPTUNE Campaign
  The NEPTUNE plans covered the development of a continental medical service from the time the first wave of infantry hit the beaches through the securing of the French lodgement area. Essentially, the plans addressed two problems: provision of support for a strongly opposed amphibious landing, and development of an army  and then a COMZ medical establishment—all to be done from a crowded British base, across a narrow but
  12For general contact between the theaters, see Ruppenthal, Logistical Support, 1:331-35; Wiltse, Mediterranean, pp. 120-21, 142-43, 147-50, 223-26, and 267-68; 2d Lt Glen Clift, MAC, “Field Operations of the Medical Department in the Mediterranean Theater of Operations, U.S. Army” (Office of the Surgeon, MTOUSA, 1945), pp. 146-74, file HD 314.7-2, which reproduces the Fifth Army manual; Hartford Interv, 7-8 Oct 80, tape 1, side 1, CMH; Memo, Col J. K. Davis, MC, to CMedOff, SHAEF, sub: Abstract of Report on Visit to AFHQ in Medical Division, COSSAC/SHAEF, War Diary, April 1944; HQ ADSEC, Operations History of the Advance Section, COMZ, ETOUSA. . . , August 1945 (hereafter cited as ADSEC Hist), p. 4; Hospitalization Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 2-3.
  13For chronology of planning, see Ruppenthal, Logistical Support, 1:215-16 and 269; First U.S. Army Report of Operations, 23 Oct 43-1 Aug 44, bk. VII, p. 62; Surg, VII Corps, Annual Rpt, 1944, p. 12; ADSEC Hist, pp. 13-14 and 23; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 1-6, 13, 15, 25, 31; Capt G. B. Dowling, MC, USN, Special Report to the Chief of the Bureau of Medicine and Surgery, USN, of U.S. Naval Medicine Service in the Invasion of Normandy . . . (hereafter cited as Normandy Rpt), 11 Jan 45, pp. 2-4, which gives the Navy view of medical planning.


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Chart 6:  Organization of the  Office of the Surgeon, ADSEC, COMZ, ETOUSA, May 1944


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Chart 7:  Organization of the Office of the Surgeon, FECOMZ, ETOUSA, June 1944


treacherous body of water, with limited shipping and port facilities.14
 Support for the initial attack from the sea required the most complex arrangements and caused the planners the most controversy and soul-searching. The First Army tactical plan was straightforward. On D-Day the V Corps, with elements of the 1st and 29th Infantry Divisions, was to go ashore on the army's left on OMAHA beach, a stretch of Normandy coast backed by low bluffs northwest of Bayeux. The VII Corps, with the 4th Infantry Division, was to land on the right on UTAH beach, near the base of the eastern side of the Cotentin Peninsula. The 82d and 101st Airborne Divisions, also under VII Corps, were to drop before the main attack, to secure crossings over the flooded areas immediately behind UTAH. Logistical support for the seaborne forces was to come from engineer special brigades—two, forming a provisional brigade group, for OMAHA and one for UTAH. These brigades were to begin landing soon after the first infantry elements. Assisted by shore party battalions of Rear Adm. Alan G. Kirk's Western Naval Task Force, which was responsible for transporting, landing, and supporting -the American invasion troops, the special brigades would clear the beaches of wreckage, mines, and obstacles; open roads; and establish supply dumps. Their medical battalions would set up the first nondivisional medical facilities on the far shore.15
 
 For medical support planners the number of casualties to be expected on and immediately after D-Day was the first crucial consideration. On this point COSSAC and SHAEF for a long time could not obtain agreement among the concerned staffs, although all expected losses to be very heavy. Different headquarters held to various estimates until February 1944, when General Kenner assembled the chief medical officers of the major invasion commands to reach a common figure “to establish our position for General Eisenhower.” The conferees, after much debate, decided to assume for planning purposes that the assault force would suffer 12 percent wounded on D-Day and 6.5 percent on D + 1 and D + 2, with a declining proportion thereafter. Using this ratio, First Army surgeons had to think in terms of treating or evacuating over 7,200 wounded on D-Day and another 7,800 in the next forty-eight hours, of whom about 3 percent—at least 450—would be too severely injured to
  14Unless otherwise noted, the following discussion is based on An. 6, Medical Plan (hereafter cited as An. 6.--Medical), to First U.S. Army Operations Plan, Operation NEPTUNE (hereafter cited as FUSA Plan), 25 Feb 44; An. 8--Medical to ADSEC Plan, 30 Apr 44; and An. 9—Medical to FECOMZ Plan, 14 May 44. All in file HD 370 ETO. See also O/CS Continental SOP, 4 Apr 44, file 370.02. Additional sources are cited where appropriate.
  15For the assault plan, see First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. 1, p. 26; Harrison, Cross-Channel, pp. 174-97; and Ruppenthal, Logistical Support, 1:178, 269-70, 282-85, 324-44. Each engineer special brigade employed in NEPTUNE consisted of 1 medical and 3 engineer battalions, a DUKW battalion, and various small signal, military police, and quartermaster elements. The brigade group on OMAHA also included the 11th Port, to operate the MULBERRY artificial harbor. Special brigades could break down into battalion- or company-size composite beach groups to support regimental or battalion combat teams. The Western Naval Task Force, also designated by the U.S. Navy as Task Force 122, was the U.S. component of the Allied Naval Expeditionary Force, the overall naval command under SHAEF.


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be transported any distance without definitive surgery. Even these estimates, the planners realized, were uncertain. Kenner noted: “If gas should be used, then these figures go by the board.” 16
 On the basis of these estimates COSSAC, SHAEF, and army planners confronted the same problem of care and evacuation during the first days of the invasion that had preoccupied their ROUNDUP predecessors. COSSAC early reaffirmed the ROUNDUP decision to evacuate from the beaches to England all but the most lightly wounded and, conversely, those needing immediate surgery to keep them alive. COSSAC also reiterated the ROUNDUP staffs conclusion that most casualties must go out in returning landing craft. Unlike the earlier planners, those at COSSAC and SHAEF had available a vessel suited to their requirements: the LST (landing ship, tank), which had come into service since the end of ROUNDUP. This 330-foot oceangoing craft, designed to disembark tanks and other heavy vehicles directly onto a beach, also could embark large numbers of casualties in a comparatively short time through its bow doors and ramp, which could accommodate ambulances, litter-carrying jeeps, and a newly introduced amphibian truck, the DUKW. The latter vehicle also could swim out to and board an LST offshore. Within the ship the cavernous tank deck, extending the width and most of the length of the LST, could hold up to 300 litters, either fastened to bulkhead racks or lashed to the deck surface. When not transferred from vehicles directly onto the tank deck, casualties could be hoisted on board in small craft or on individual stretchers. The ship's upper decks and crew's quarters could hold 300 additional walking wounded. Any LST could be fitted for evacuation, and could accommodate a small emergency surgical facility, without reducing its ability to perform its main task of landing combat vehicles.
 On 16 July 1943, at a conference attended by General Hawley and General Hood, the British Army medical chief, COSSAC adopted the LST as its principal evacuation craft. Reinforcing this decision, General Marshall directed in October that all cross-Channel movement of American wounded “will be handled in properly equipped combat LST[s].” 17 The U.S. Navy, which had charge of providing LSTs for the invasion, agreed to modify for casualty carrying 83 of the 98 ships allocated to the American forces and 70 of the 113 assigned to the British. After he became SHAEF's chief medical officer, General Kenner endorsed these arrangements. He directed medical planners to assume that only 75 litter and 75
  16Quotations from MFR, Medical Section, SHAEF, sub: Meeting Held 26 Feb 44 in Gen Kenner's Office re Casualty Estimates for Operation OVERLORD, in Medical Division, COSSAC/SHAEF, War Diary, February 1944. See also VII Corps NEPTUNE Assault Plan and Medical Plan (hereafter cited as VII Corps Medical Plan), which gives corps-level casualty estimates using the SHAEF formula, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Dowling, Normandy Rpt, 11 Jan 45, p. 9. The OMAHA and UTAH assault forces included about 60,000 men, with an assault-loaded follow-up of 26,500 for OMAHA and further preloaded buildup of 43,500 for both beaches. See Ruppenthal, Logistical Support, 1:298.
  17Msg, Marshall to Gen Devers, 30 Oct 43, in Medical Division, COSSAC/SHAEF, War Diary, February 1944.


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walking patients would be moved on each voyage of an LST, to allow for the fact that few ships would be able to stay near the beach long enough to load to full capacity. If practicable, of course, the vessels were to take on more than this minimum.
 To provide emergency surgery for casualties taken on board directly from clearing stations during the first days of the attack, the Western Naval Task Force surgeon, Capt. George B. Dowling, MC, planned to put two medical officers and twenty hospital corpsmen on each of his task force's LSTs. Because few of these Navy medical officers were experienced surgeons, General Hawley agreed to reinforce each LST medical complement with an Army surgical team of one officer and two enlisted technicians. To place still more emergency surgery capacity near the beaches, Kenner assigned 5 hospital carriers each to the British and American forces. These ships were to carry additional medical personnel and supplies to France and then embark patients requiring extensive early surgery.18
  18Hawley Planning Directive No. 11, 21 Jul 43, box 2, Hawley Papers, MHI; Extract from Record of Meeting of Principal Staff Officers Held on 16 Jul 43, 20 Jul 43, in Medical Division, COSSAC/SHAEF, War Diary, February 1944; COSSAC Admin Instruction No. 8, 22 Dec 43, in ibid., December 1943; Memo, Kenner to ACofS, G-4, SHAEF, 25 Apr 44, sub: Casualty Lift of Converted LSTs, in ibid., April 1944. See also diary entries and correspondence for September and November 1943 and March 1944. On LST technical details, see Davis Interv, 19 Jun 45, pp. 2-3, box 222, RG 112, NARA; Crew, AMS, Campaigns: North-West Europe, 4:49-52; and Dowling, Normandy Rpt, 11 Jan 45, pp. 4-5, E-8, E-9, E-13. On LST surgeons, see Larkey “Hist,” ch. 8, pp. 30-31, and correspondence in file HD 705 ETO (Medical Care on LSTs, 1944).
LSTS READYING FOR THE INVASION


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 COSSAC and SHAEF based their evacuation plans on the LST reluctantly and in the face of much doubt about the feasibility of the whole system for removing wounded from the beaches. The doubters included General Hood. After inspecting an LST at Portsmouth, Hood called the vessel a “cold, dirty trap” for injured men. He carried unavailing protests against its use all the way to Churchill's War Cabinet. Colonel Cutler considered LSTs “rotten ships for care of wounded American boys,” an opinion shared by many of his colleagues. The objectors had reason for concern. When emptied of their vehicular cargoes, LSTs rolled deeply in all but the calmest seas, creating, to say the least, an unstable platform for surgery. With any kind of sea running, DUKWs could not swim out to an LST and negotiate its ramp. Most important, as combatant vessels carrying troops and weapons outward bound, LSTs could not be protected with the Red Cross and were legitimate attack targets. If one foundered for any reason, the litter patients on board inevitably would go down with it. Kenner and Hawley shared their colleagues' uneasiness about the LST, Kenner calling use of the vessels “an improvised method of removing casualties forced upon the Medical Service by operational necessity.” Nevertheless, they had to override all objections to employment of the LST, for it was the only available means of large-scale cross-Channel evacuation. They took comfort from the fact that LSTs had performed well in evacuation in the Pacific and could only hope that weather severe enough to prevent the loading of wounded on LSTs also would prevent the entire invasion.19
 Until D-Day Allied medical planners considered their evacuation system a fragile structure, dependent for success on many uncontrollable variables. Kenner, in particular, feared that a “back-log” of unevacuated, untreated wounded would accumulate on the beaches, with demoralizing impact on the combat troops. He warned:
 The whole medical situation during the first few days hinges on two unknown factors, namely weather and the number of casualties. If both are in our favor then evacuation will be satisfactory. If weather is good and casualties heavy or if weather is bad and casualties light, the medical situation while becoming serious will probably remain under control. But if the weather is bad and the casualties heavy then it will be impossible to meet the situation either by local treatment or by
  19Hood words as quoted in MFR, Col Cutler, 28 Feb 44, sub: Visit and Inspection of an LST at Portsmouth . . . , 21 Feb 44, file HD 705 ETO (Medical Care on LSTs 1944). Cutler quotation from Carter, ed., Surgical Consultants, 2:184. Kenner quotation from his memorandum of 6 Mar 44, in Medical Division, COSSAC/SHAEF, War Diary, March 1944; see also other entries and documents for this month. Crew, AMS, Campaign in  North-West Europe, 4:52-55, recounts Hood’s appeal to the War Cabinet. See also Hartford Interv, 7-8 Oct 80, tape 1, side 1, CMH, and Davis Interv, 19 Jun 45, box 222, RG 112, NARA.


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evacuation and a serious medical breakdown must inevitably occur.20
 Colonel Rogers and his staff built their First Army medical support plans around the basic COSSAC-SHAEF evacuation decisions and attempted to provide against a breakdown of seaward evacuation. To this end Colonel Rogers arranged to reinforce each assault division medical battalion with an additional collecting company, to be landed as soon as possible after D-Day, and to attach six teams from the army's auxiliary surgical group to the clearing company of each engineer special brigade medical battalion. So augmented, these units—the only hospitals on shore during the first twenty-four hours or so of combat—would be able to care for a substantial number of severely wounded. On D-Day company aidmen and battalion medical sections were to go in with the first infantry waves, followed in close sequence by Navy shore party medical sections (one officer and eight hospital corpsmen per army battalion), division collecting companies, the engineer special brigade medical battalions, and the division clearing companies. This interlacing of division and special brigade elements, based on Mediterranean practice, would permit the division medical service to move inland at once and begin regular operations, leaving the shore party and special brigade medical units, in static beach positions, to collect wounded who fell in the first attack, to evacuate division medical installations, to set up emergency surgical hospitals, and to load all movable casualties on LSTs and other landing craft (Diagram 1). The beach medical elements also were to evacuate and support the airborne divisions, as soon as the seaborne forces made contact with them. Until then the airborne medical companies, landing by parachute or glider with attached surgical teams soon after the infantry touched down, would collect and treat all paratrooper wounded.21
 After the assault and the securing of the beachhead, American reinforcements were to pour in, over OMAHA and UTAH beaches and later through Cherbourg and other raptured ports, bringing U.S. strength on the Continent to over 1 million by D + 90. The First Army and 1st Army Group before D-Day established a consolidated movement schedule for this buildup, detailing the size and shipping requirements of each unit, its date and place of embarkation, and its destination and assignment on the far shore. They divided each day’s sealift among ground, air, and service forces so as to maintain a balanced flow of combat and support elements.
 Medical units were interspersed throughout the schedule, on the basis of priorities developed by the First Army, ADSEC, and FECQMZ surgeons and worked into the troop list after tortuous negotiations with all the other forces vying for space (see Table 3). The First Army's nondivisional medical units were to go in
  20Ltr Kenner to Lt Gen Sir Humphrey Gale, 29 Feb 44, in Medical Division, COSSAC/SHAEF, War Diary, February 1944.
  21VII Corps Medical Plan, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 8; Dowling, Normandy Rpt, 11 Jan 45, p. 8; Surg, 82d Airborne Division, Annual Rpt, 1944, an. 1; Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 1-2; Editorial Advisory Board, 1962, pp. 70-71, 100-101, 112.


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DIAGRAM 1—INFANTRY DIVISION LANDING PHASE EVACUATION PLAN
first, between D-Day and D + 15, with field hospitals, auxiliary surgical teams, and the corps medical battalions leading. Evacuation hospitals were to follow, beginning on D + 5, along with army medical battalions (separate) and groups, a supply depot company, a convalescent hospital, a laboratory unit, and a gas treatment battalion. A few ADSEC units were to be interspersed with those of the First Army, but most would arrive after D+ 12. The first scheduled to come were additional ambulance companies and evacuation and field hospitals, intended to function as station hospitals and holding units. On or about D + 15 the first general hospital in France, the 298th, was to disembark and go into operation in Cherbourg. By D + 90 both the Advance Section and Forward Echelon expected to have twenty-five general hospitals on the Continent, at preassigned locations in Normandy and Brittany, besides a full complement of supply depots and other COMZ medical units.22
 Medical supplies in large quantities were to start arriving on the beaches  as soon as the troops did. All First Army combat and support units land-
  22In addition to the basic plans previously cited, see Surg, VII Corps, Annual Rpt, 1944, pp. 3-4 and 6-7. Memo, Surg, FECOMZ, to G-4, FECOMZ, 6 Apr 44, file HD 370 (HQ ADSEC Plans and Corresp, 1944); Larkey “Hist,” ch. 8, app. 4.


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TABLE 3—PLANNED LANDING OF MEDICAL UNITS, 6-14 JUNE 1944
ing on D-Day and the following 3 days were to carry reserves of rapidly consumable items, in the hands and on the backs of soldiers and loaded into vehicles. Each infantry, artillery, chemical warfare, engineer, and ranger battalion; each divisional collecting and clearing company; and each engineer special brigade medical battalion was to receive a special allowance of dressings, small implements, drugs, morphine, and dried plasma packed in waterproof containers portable by a single man. Each organization also would bring ashore extra litters, field medical chests, splints, and blankets. In the Advance Section mobile hospitals were to embark with reserves of expendable supplies sufficient for 10 days of operations; other medical units were to carry 3-day reserves.
 Medical maintenance supplies were to be shipped automatically from the United Kingdom during the first 90 days of continental operations. Before D-Day the First Army, Advance Section, and Forward Echelon submitted requisitions to the chief surgeon’s Supply Division for their periods of primary logistical responsibility, with allowances calculated to replace lost and consumed materiel and to establish 14- or 21-day reserves (depending on the echelon and the class of supplies) in army and COMZ depots by D + 90. The supplies so requested were to be packed before the assault and loaded on ships on a daily schedule as the buildup proceeded.
 From D-Day until about D + 40 most maintenance supplies would consist of special division assault surgical and medical units, designed by the First Army and assembled by the Supply Division. Each of these units included dressings, drugs, and equipment for treating 500 casualties and was divided into 100-pound waterproof packages for easy, safe movement and storage. To ensure arrival


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of enough supplies on the beaches while the casualty rate was highest, the Supply Division based its scheduled shipments of these units on estimated numbers of wounded, rather than on total troop strength, as was the practice with regular medical maintenance units (which were not adapted to the assault situation in any case). As the buildup continued, standard 10,000-men-for-30-days maintenance units were to supplant the special ones. When enough depot companies reached France, the armies and the Communications Zone were to establish regular distribution procedures, with division medical supply officers drawing on army depots that those of the Advance Section would replenish. Whole blood, biologicals, and penicillin were to reach the front through special channels, delivered by the theater blood service.23
 Hospitalization and evacuation in France were to evolve as the manpower and supply buildups progressed, with the aim throughout being to retain as many patients as possible on the Continent. From D-Day until about D+ 18 the First Army was to send back to England all sick and wounded except nontransportables (defined as men with severe abdominal, chest, and head injuries and compound fractures) and casualties who could be treated and returned to duty from division facilities. As First Army hospitals went into operation, the forces in France, at the army commander's direction, were to shift to a 7-day evacuation policy. Once COMZ fixed hospitals became available, the Advance Section was to evacuate to them from the armies casualties returnable to duty within 15 days, to be extended progressively to 30 days as still more hospitals arrived. Soldiers needing longer hospitalization, or eligible for return to the United States under the 180-day theater policy, were to go directly from army installations to hospitals in England.
 Following the principles established by COSSAC, the NEPTUNE plans called for evacuation of wounded over the beaches during and after the assault, and for their transportation to Britain in LSTs and, after the first day or so, in hospital carriers. When the Allies captured and re-opened Cherbourg, the Americans were to use that port, in addition to the beaches, for evacuation to the United Kingdom. U.S. hospital ships, eleven of which were expected to reach the European Theater between 29 May and 12 August, also would load wounded at Cherbourg for direct evacuation to the United States. Air evacuation to Britain, from both the field armies and the Communications Zone, was to begin as soon as the ground forces secured airstrips usable by the C-47s of the IX Troop Carrier Command. For overland movement of patients, the NEPTUNE plans provided for improvisation of hospital trains from captured rolling stock, but the armies and COMZ were to rely primarily on ambulances and, in emergencies, on trucks and jeeps, until about D + 56. At that time hospital trains constructed in England were expected to begin

  23First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 74-75; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. IV, pp. 5-6, and sec. VI, pp. 5 and 7-8; Planning Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 8-9; Interv, OSG with Col B. C. T. Fenton, MC, 7 Jun 45, box 222, RG 112, NARA.


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rolling off ships at ports and beaches.24
 The NEPTUNE planners concerned themselves with keeping the troops on the Continent healthy, as well as with treating them when sick and injured. Army and COMZ preventive medicine plans, based on information collected and collated by the chief surgeon’s Medical Intelligence Branch, assessed the state of public health in occupied France and listed the likely major disease threats on the Continent. Troop commanders in France, the plans warned, could expect to find an ill-nourished, dirty civilian population whose hospitals and public health agencies were operating inefficiently because the occupying Germans had stripped them of much equipment and personnel. French water purification and sewage disposal facilities, never the best, could be assumed to have broken down under administrative neglect and combat damage.
 Compared to what the Army faced in the Mediterranean, the Southwest Pacific, and other non-European tropical theaters, disease in northwestern Europe posed hardly any threat to the conduct of operations. Epidemic louse-borne typhus, which the planners considered likely to be introduced from eastern Europe by German troops and slave laborers, loomed as the disease of most potential danger. Commanders and surgeons also would have to guard against typhoid, but such familiar diseases of troops in the field as dysentery, diarrhea, influenza, venereal diseases, and infectious hepatitis, as well as a variety of skin ailments and vermin infestations, were likely to constitute the campaign's principal medical problems. Even though American troops had already been immunized against typhus, the field armies and the Communications Zone planned to issue insecticide powder to their troops and prepared for mass inspection and delousing of soldiers, civilians, and prisoners of war. NEPTUNE plans for combating other diseases depended on the standard immunizations, personal hygiene, mass sanitation, water treatment, sewage disposal, and pest eradication procedures, as well as on special supervision of soldier eating habits to prevent vitamin deficiencies among men subsisting for long periods on C- and K-rations. 25
 Preventive medicine planners expected venereal diseases, the incidence of which reportedly had increased threefold in France since 1941, to constitute “one of the most difficult control problems to be encountered.” First Army and COMZ plans, backed up by a theater circular drafted by Colonel Gordon's Preventive Medicine Division in cooperation with the senior medical consultants

  24Memo, Kenner to ACoIS, G-4, SHAEF, 13 Apr 44; see also Mins, Conference of Gen Kenner with Brig Gen Grow, 11 Apr 44. Both in Medical Division, COSSAC/SHAEF, War Diary, April 1944. For a definition of nontransportables, see Ltr, Col E. C. Cutler to Lt Col Crisler, 16 Apr 44, box 3, Hawley Papers, MHI. See also Memo, Col F. H. Mowrey to Movements Division, Office of CofTrans, ETO, 29 May 44, EvacCorresp, 1942-45, file HD 024 ETO.
  25For medical intelligence, see Medical Intelligence Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 2-3, and Ltr, Hawley to TSG, 29 May 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Cir Ltr No. 53, OofCSurg, HQ ETOUSA, 8 Apr 44, sub: Improvement of Nutrition of Combat Troops, in Larkey “Hist,” ch. 8, app. 17.


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and command venereal disease control officers, prescribed essentially the same precautions tested and proven in the United Kingdom: troop education, provision of healthful recreation, widespread issue of condoms and V-Packettes (even embarking assault troops were to be offered them), establishment of prophylactic stations,  and—as far as language and local law and custom permitted—tracing of contacts. Repression of prostitution  received special emphasis. In contrast to the unorganized, barely tolerated character of the business in Great Britain, continental prostitution was an accepted, legally regulated and sanctioned social institution, featuring numerous brothels. War Department policy, confirmed by practical experience in North Africa, Sicily, and Italy, ruled out any official Army attempt to license and regulate such establishments. Hence, ETO preventive medicine officers and medical consultants inserted in NEPTUNE plans and the theater circular a strongly worded policy statement:
  The practice of prostitution is contrary to the best principle[s] of public health and plans harmful to the health, morale and efficiency of troops. No member of this command will, directly or indirectly, condone prostitution, aid in or condone the establishment or maintenance of brothels, bordellos or similar establishments, or in any way supervise prostitutes in the practice of their profession or examine them for purpose of licensure or certification. Every member of this command will use all available measures to repress prostitution in areas in which troops of the command are quartered or through which  they may pass. 26
 The NEPTUNE medical planners sought to anticipate and outline a solution for every foreseeable actual or potential problem. To keep seasickness from taking the fight out of the assault troops before they went ashore, the First Army prepared to issue newly developed antimotion sickness capsules—ten of them to be taken on a fixed schedule—to each embarking soldier, even though tests of the remedy in amphibious exercises had produced at best inconclusive results. Medical precautions against the threat of German gas attacks included intensive training for all troops in first aid for chemical warfare casualties and the issue of eye ointments and impregnated protective clothing. The various medical plans set policies and procedures for treating civilian sick and injured in Army hospitals (to be done only when necessary to save life), caring for and processing Allied casualties in the American evacuation chain, treating and evacuating wounded prisoners of war, and disposing of captured medical supplies. In detail and comprehensiveness the medical matched those for other aspects of  NEPTUNE. They also shared in the essential rigidity of the overall plan, based as it was on the assumption that Allied forces would push the Germans back at a fairly steady pace. A radical slowdown or a radical acceleration of Allied progress would re quire complicated, difficult adjust-

  26First quotation from An. 6–Medical to FUSA Plan, 25 Feb 44, file HD 370 ETO. Second quotation from Cir No. 49, HQ ETO, 2 May 44, in Larkey “Hist,” ch. 8, app. 19. See also Preventive Medicine Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 44-45; Middleton Interv, 1968-69, vol. 1, pp. 236-38, NLM. For North African and Italian experience, see Wiltse, Mediterranean, pp. 215, 257-58, 354.


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GAS DECONTAMINATION EQUIPMENT, stockpiled at Thatcham supply depot as a precaution against a German gas attack
ments throughout the elaborate medical support system.27
Technical Aspects
 Even before the OVERLORD and NEPTUNE plans took definite shape, General Hawley and his staff began searching for solutions to a variety of technical problems connected with the invasion. The chief surgeon and his assistants paid special attention to three problems: providing whole blood to forward medical units, drafting guidelines for combat zone surgical practice, and devising a system for sheltering fixed hospitals on the Continent.
The Blood Program
 U.S. Army surgeons in the European Theater learned from British experience in the Western Desert, and from early American operations in North Africa and Sicily, that whole blood—while highly perishable and difficult to store and transport—was indispensable for controlling shock in severely wounded soldiers. Blood, administered as far forward as possible in the evacuation chain, saved lives

  27 For the motion sickness preventive, see Medical Consultation Service sec., Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 15 and apps. J, K, and L; and Planning Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, encl. 6. For antigas precautions, see Gas Casualty Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, and Memo, Col. C. B. Spruit to G-2/G-3, FECOMZ, 23 Mar 44, file HD 370 (HQADSEC Plans and Corresp, 1944).


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that plasma alone could not. In response to this growing weight of evidence General Hawley in July 1943 decided to establish an ETO whole blood service, modeled on the highly successful British Army Transfusion Service.
 The American blood bank took shape during late 1943 and early 1944, planned and supervised by an ad hoc committee headed by Colonel Mason, then chief of the Operations Division, and including Colonels Cutler and Middleton, the commander of the 1st Medical General Laboratory, and the chief of the Supply Division. No T/O blood bank unit existed, so General Hawley improvised one. He reorganized the 250-bed 152d Station Hospital into a base depot, located at the 1st Medical General Laboratory at Salisbury, and mobile advance depots—two for the Communications Zone and two for the armies. The base depot was to collect type O blood (the only kind used) from volunteer SOS donors, process it, and prepare it for daily shipment to France, where the advance depots, using truck-mounted refrigerators, would distribute it as far forward as the field hospital platoons attached to division clearing stations. Equipment for the units came from the United States, under a special project for continental operations (PROCO), and from the British, who furnished indispensable refrigerators, as well as bottles, tubing, and needles for bleeding and transfusion. By mid-April 1944 the blood bank, under the overall command of the 1st Medical General Laboratory and with Maj. Robert C. Hardin, MC, in immediate charge as executive officer, had secured most of its equipment and finished organizing and training the 11 officers and 143 enlisted men of its base, COMZ, and army depots. General Hawley meanwhile secured from the theater top priority for shipments of blood to France and from the Ninth Air Force a guarantee of daily space on aircraft.28
 As the invasion approached, the ETO blood service faced a prospective supply shortage. Since whole blood could be stored for a maximum of fourteen days, the theater required a reliable flow of new blood about equal to the expected usage rate in the field, a rate which Colonel Mason's committee, applying the British planning ratio of 1 pint of blood for each 8-10 wounded, estimated as averaging about 200 pints per day during the first three months of combat. This amount was safely within the ETO blood bank’s 600-pints-per-day collection and processing capacity. Even as the bank prepared for operations, however, the medical service, on the basis of reports from the Fifth Army in Italy, increased its estimate of requirements to 1 pint for every 2.2 casualties.

  28For development of the concepts of shock and transfusion, see Douglas B. Kendrick, Blood Program in World War II, Medical Department, United States Army in World War II (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1964), pp. ix, 15-17, 30-60, 459, 469-500, 508-12.  For development of the ETO blood bank, see file 742 ETO General File (Blood Program). See also Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1943, p. 8; James B. Mason, “Planning for the ETO Blood Bank,” The Military Surgeon 102 (June 1948): 460-68; 0/CS Continental SOP, 4 Apr 44, pp. 29-32, file HD 370.02. PROCO was an Army Service Forces system for tailoring equipment for particular tasks not covered by ordinary unit allowances or T/E. See Ruppenthal, Logistical Support, 1 : 260-61.


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 On this basis the blood bank, working at full capacity, would not be able to keep up with daily demands, and it became apparent that, even if collection and processing could be increased, the supply of raw material in the theater could not. When General Lee issued the planned call for volunteer donors early in 1944, response from the Services of Supply was disappointing. By mid-April the base sections, in spite of exhortations from Lee and Hawley, had enrolled only 35,000 of 80,000 potential type O donors. As early as May 1943 Colonel Cutler and Major Hardin had suggested flying in blood from the United States, but Surgeon General Kirk, until well after D-Day, vetoed this proposal. His staff underestimated the need for whole blood in field surgery and doubted the feasibility of transporting the perishable substance across the ocean. From the available donors the ETO blood bank, by starting collection well in advance and storing blood up to the maximum safe limit, could meet immediate invasion requirements. But, as the campaign expanded and the limited SOS donor pool diminished with the movement of service troops to France, the blood supply at some point would fall short of need unless the theater could find an additional source. On D-Day, such a source still was not in sight.29
The Surgical Program
 The effort of General Hawley and his consultants to define uniform surgical practice for each step in the evacuation process had more satisfactory and definite results. During 1942 Colonel Cutler and the surgical consultants began rewriting War Department Technical Manual 8-210, Guides to Therapy for Medical Officers, to simplify it and make it more useful to surgeons in the field. Finished late in 1943, the resulting ETO Manual of Therapy, published as a pocket-sized booklet, reached medical officers before D-Day. Of the manual’s three sections, two dealt with surgery in clearing stations and evacuation and fixed hospitals.  Written in short, simple sentences, these sections concentrated on specific treatment of particular types of injury at each point in the evacuation chain and omitted lengthy expositions of theory. Generally, the manual emphasized the need to avoid definitive surgery in the forward areas, unless absolutely necessary to save life. The third section of the manual covered basic medical emergencies, from poisoning to neuropsychiatric disabilities. This manual, supplemented on 15 May 1944 by an ETO circular on “Principles of Surgical Management in the Care of Battle Casualties,” which reiterated many of the same policies, constituted a concise practical guide for surgeons fresh from civilian practice and usually inexperienced at

  29See file 742 ETO General File (Blood Program); Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 5-6. Hawley Interv, 1962, pp. 43-44, CMH, recalls the disbelief with which the ETO surgeons greeted initial reports on blood use in Italy. For the policies of the Office of the Surgeon General; see Kendrick, Blood Program, pp. 476-84, 524-26, 530; Editorial Advisory Board, 1962, pp. 108-09; and Memo, Lt Col B. N. Carter to Gen Hillman, 28 Oct 43, sub: ETMD, ETO, and Ltr, Carter to Col E. C. Cutler, 4 Nov 43, both in file HD 024 ETO O/CS (Hawley-SGO Corresp).


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treating severe injuries in primitive facilities under pressure of time.30
The Expeditionary Hospital
 General Hawley's staff early took up the problem of housing general and station hospitals on the Continent, where they had to assume that the battle would leave behind few readily usable buildings. In late 1943, after almost a year of work, the Hospitalization Division and the ETO Office of the Chief of Engineers completed draft plans for an expeditionary tented-hutted hospital. Designed to house a 1,000-bed general or 750-bed station hospital, this standardized installation was to consist initially of tents on concrete bases, on a site improved with paved roads and with water, sewer, and power lines. Each tent was to have space beside it for a parallel hut, which the Engineers were to erect during hospital operations as circumstances permitted. Passing through several stages of development, from completely tented to completely hutted, an expeditionary hospital was supposed to be able to accommodate its full capacity of patients at each stage, even as construction and the transfer of facilities from under canvas to under roofs went on.
 In October 1943, to test the newly completed plan, the Services of Supply sent the 12th Evacuation Hospital to Carmarthen, Wales, to erect and operate an expeditionary 750-bed station hospital serving troops in that area. The unit, and an Engineer company, arrived on the site, deliberately selected for unsuitability, early in November. In spite of rain, snow, obstructing hedgerows, and poorly drained marshy ground, the hospital unit and its supporting engineers had the plant in tented operation before the end of the year. The hospital was well into the hutted stage in March 1944, when the 12th turned it over to a station hospital unit. In March the Hospitalization Division issued a manual with construction specifications for the expeditionary hospital, incorporating lessons learned at Carmarthen. The system proved its worth even before the invasion, as the Services of Supply used it to set up several temporary plants needed to increase fixed bed capacity or receive casualties from France.31

Readying Medical Supply
 As invasion planning neared completion, General Hawley viewed with increasing alarm one key element of his establishment: medical supply. Throughout the renewed BOLERO

  30ETO, Manual of Therapy, 5 May 44, file Manual of Therapy, ETO, box 405, RG 112, NARA. For comparison, see War Department Technical Manual 8-210, Guides to Therapy for Medical Officers, 20 Mar42. For the 15 May 44 circular, see Canter, ed., Surgical Consultants, 2:168-73 and app. B, p. 963. See also Hawley Interv, 1962, pp. 57-61, CMH; Ltrs, Col E. C. Cutler to Lt Col N. B. Carter, 5 Oct and 15 Nov 43, and Carter to Cutler, 30 Sep and 26 Oct 43, in file HD 024 ETO O/CS (Hawley-SGO Corresp).
  31Hospitalization Division, OofCSurg, HQ ETOUSA, Annual Rpts, 1943, pp. 3-5, and 1944, pp. 5-6; 12th Evacuation Hospital Annual Rpt, 1944, pp. 1-4; Spruit Diary, 7 Jul 43. See also Memo, Hospitalization Division to CSurg; ETO, 22 Jan 43; Memos, Hospitalization Division to DepCSurg (Cheltenham), 24 and 30 Jun 43; and Memo, Col J. R. Darnall to DepCSurg (Cheltenham), 8 Jul 43. All in HospDivGenCorresp, 1943, file HD 312 ETO.


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EXPEDITIONARY HOSPITAL AT CARMARTHEN
buildup persistent shortages and administrative deficiencies had made it difficult for the supply service even to support the troops in Britain. The Supply Division of the chief surgeon’s office lacked qualified manpower and leadership to meet its expanding responsibilities, and the flow of materiel from American and British sources encountered diversions and dams at many points. By early 1944 both General Hawley and Surgeon General Kirk had been forced to realize that, unless drastically reorganized and reinforced, the medical supply service would fail in its effort to support the coming offensive.
 The Supply Division during 1942 had been the weakest element in ETO medical administration; it improved only marginally in 1943. In March Col. Walter L. Perry, MC, arrived to take over the division, replacing the third in a series of unsatisfactory chiefs. General Hawley welcomed Perry, whom the surgeon general had picked for the position and who was experienced in depot operations, and gave him a free hand in reorganizing the supply system. Perry, however, like his predecessors, found the job too much for him. Most of his difficulties stemmed from a lack of trained men. Although his Cheltenham staff doubled during the year,


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from 8 to 16 officers and from 13 to 47 enlisted men, the size of the task grew even more rapidly, and few of the additional personnel possessed the specialized training needed to manage what was, in effect, a home base rather than a field supply service. Perry also lacked direct access to General Hawley after the latter moved to London in May. Instead, the supply chief had to communicate through Colonel Spruit, the deputy chief surgeon at Cheltenham, a circumstance which reduced Perry’s ability to call attention to his requirements. Repeated Supply Division requests for more staff, for example, never went beyond Spruit’s office.32
 Manpower deficiencies plagued the theater’s medical supply depots (see Map 5). Between the beginning of 1943 and early 1944 the number of medical branch depots and medical sections of Quartermaster general depots increased from five to sixteen. Eight of these depots issued supplies to units and hospitals in their geographical areas; the others held reserve stocks or performed specialized functions, such as outfitting tactical units, receiving British supplies, and repairing medical equipment. Of the 90 officers and 1,200 enlisted men who staffed these installations, about half were members of six field depot companies, units which arrived or were activated in the theater during the last half of 1943; the rest were on temporary assignment from replacement centers. Neither the depot companies, which were organized for mobile field operations, nor the attached casuals had received any training in the operation of large permanent depots. They learned their jobs by doing them. All were on temporary assignment—the depot companies awaiting orders for field service and the casuals subject to transfer on short notice. Without a sense of permanency and, in the case of the attached men, with no promotion prospects, these troops suffered from low morale and had little incentive to excel at their often hard, demanding work.33
 Depot operations were inefficient at best and chaotic at worst. An officer who joined the medical section of Depot G-35 at Bristol early in 1944 reported: “There was no depot organization—it seemed as [if] everyone was doing what he chose to do. Responsibilities were not defined.” Each depot commander improvised his own system for filling requisitions and his

  32 “Med Svc Hist, 1942-43,” pp. 55-58, file HD 314.7-2 ETO; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. 1, p. 1. High hopes for Colonel Perry are expressed in Ltrs, Col F. C. Tyng, MC, to Hawley, 21 Jan 43, and Hawley to Tyng, 3 Mar 43, file HD 024 ETO 0/CS (Hawley-SGO Corresp). See also Col T. S. Voorhees, “Resume of Trip to Survey Medical Supplies in ETO” (hereafter cited as “Resume”), 12 Apr 44, in Survey of the Medical Supply Situation in the ETO (hereafter cited as ETO Supply Survey), January-March 1944, file HD 333 ETO.
  33At this time no standard T/O existed for the type of large, permanent depot established in the ETO. The field depot companies did not fit most depots and often had to be broken up between two or more installations. See “Med Svc Hist, 1942-43,” pp. 55-56, file HD 314.7-2 ETO; Memo, Col T. S. Voorhees, H. C. Hangen, Col B. C. T. Fenton, and Lt Col L. H. Beers to TSG, 16 Feb 44, sub:  Progress Report (hereafter cited as Progress Report, 16 Feb 44), and Voorhees, Fenton, Beers, and Hangen, Outline of Presentation to General Hawley of Supply Division Recommendations (hereafter cited as Outline Presentation), 7 Feb 44, both in ETO Supply Survey, January-March 1944, file HD 333 ETO; Interv, ETO with Lt Col Robert R. Kelley, MC (hereafter cited as Kelley Interv), 27 Jan 45, box 221, RG 112, NARA.


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MAP 5:  MEDICAL DEPOTS, UNITED KINGDOM, DECEMBER 1943


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own stock control procedure. In most depots, record-keeping fell behind issues, leaving both local commanders and the Supply Division unaware of developing shortages until the shelves were empty. The Supply Division required periodic reports from the depots of stores on hand; but the depots’ poor record-keeping rendered this information suspect, and the Cheltenham office lacked the staff and tabulating equipment to prepare up-to-date theater-wide reports on stock levels and distribution. With incomplete and outdated information, the Supply Division could not shift materiel between depots to even out local shortages and surpluses. The more enterprising depot commanders developed their own contacts for this purpose. Medical units and hospitals, in spite of instructions to the contrary, went from one depot to another until they secured not only the items they needed but also reserves considerably over authorized allowances. These field improvisations enabled the medical service to get along from day to day, but the resulting lack of accurate information disrupted theater-wide supply planning and hindered General Hawley in dealing with his sources of medical supply in Britain and the United States.34
  During 1943, as American war production reached full momentum and the shipping shortage eased, the European Theater drew an increasing proportion of medical items, as well as other types of supply, from the United States. Small at the beginning of the year, the flow of materiel grew with the accelerating BOLERO buildup, but it by no means went smoothly. General Hawley complained throughout the year about delayed or only partly filled requisitions, while the surgeon general’s office and the Port of New York insisted that they were meeting all ETO requirements. The stock control deficiencies in Hawley’s depots contributed much to these disagreements, both by preventing timely dispatch of requisitions to the United States and by making it difficult to ascertain exactly what supplies actually had arrived.35
  Shipment of preassembled and packed table-of-equipment (T/E) outfits for hospitals and field medical units continued to be trouble-plagued, in spite of War Department and ETO efforts to improve the system and in spite of the abandonment by the New York Port of Embarkation of the practice of earmarking particular outfits for individual organizations. Delivery of assemblies, instead of keeping pace with unit arrivals in Britain, fell behind. ETO depots then had to deplete their stocks to outfit disembarking units,

  34As quoted in Wiltse, ed., Medical Supply, p. 274. See also Progress Report, 16 Feb 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Kelley Interv, 27 Jan 45, box 221, RG 112, NARA; Memo, Hawley to DepCSurg (Cheltenham), 22 Sep 43, file HD 024 ETO 0/CS (Spruit Policy Notebook). In latter file Cir Ltr No. 54 (Supply No. 6), OofCSurg, HQ ETOUSA, 9 Apr 43, sub: Supply Policies and Procedures, ETO, outlines the prescribed—but often not followed—procedures. Ruppenthal, Logistical Support, 1:152-59, describes the organization, procedures, and problems of U.S. depots in Great Britain. The medical service had many difficulties in common with the other supply services.
  35“Med Svc Hist, 1942-43,” pp. 58-59, file HD 314.7-2 ETO. For typical complaints, see Ltrs, Hawley to TSG, 7 Dec 43; Hawley to Col S. B. Hays, MC, 7 Feb 44; and Hawley to Rankin, 16 Feb 44.  All in file HD 024 ETO O/CS (Hawley-SGO Corresp).


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with no assurance of early replenishment. Furthermore, most medical unit assemblies— especially those for hospitals—reached British depots short 15-30 percent of their components, in spite of strenuous efforts by the New York port to have them carefully marked and loaded on one ship. After much mutual recrimination between Hawley and the surgeon general’s office, an investigation early in 1944 disclosed that most assemblies were entering English ports intact but that the Supply Division had made no special arrangements for keeping them together as they were unloaded. As a result, portions of hospitals and unit outfits turned up in different depots. These depots, uninstructed in handling this materiel, simply added it to their general stock without informing the Supply Division. 36
 Although shipments from the United States increased, the medical service during 1943 procured more than half of its supplies, by tonnage, from Great Britain. British materiel, in fact, comprised 49 percent of all the goods received by the medical service between mid-1942 and mid-1944. These supplies included most hospital furniture and housekeeping equipment, as well as quantities of over 900 other items, among them surgical instruments and many drugs. British procurement had been invaluable in meeting TORCH requirements and in tiding the medical service over its period of low priorities and limited support from the United States, but it possessed many unsatisfactory aspects. The British insisted that the Americans place very large long-term orders far in advance of deliveries, a procedure that made it all but impossible to adjust procurement to changing requirements. At the same time British deliveries on these contracts were irregular in both timing and quantity. Few quality controls existed. In the emergency of 1942 General Hawley had disregarded American specifications in accepting British supplies. He used whatever his consultants, after examining samples, declared would serve the purpose. These items underwent no inspection as they came off the production lines; shipments reaching American units frequently were poorly packed, substandard in quality, or in unusable condition; Even when British materiel arrived in good condition, U.S. Army medical people were unaccustomed to its differences from their own and considered many items inferior to their American equivalents. Seemingly small differences in design and markings took getting used to, and at least one cost lives. British-supplied carbon dioxide, used in anesthesia, came in tanks painted green, the color used in the United States to denote oxygen. The resulting mixups caused at least eight deaths on operating tables before the Professional Services Division issued

  36 Memo, Col T. S. Voorhees to TSG, 17 Mar 44, sub: Report as to Splitting Up of Hospital Assemblies in Shipment From the U.S. to the ETO, in ETO Supply Survey, January-March 1944, file HD 333 ETO; “Med Svc Hist, 1942-43,” p. 58, file HD 314.7-2 ETO; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. IV, pp. 1-4, sec. V. p. 1, and sec. VI, p. 2; Ltr, Tyng to Hawley, 21 Jan 43, and other 1943 letters, file HD 024 ETO O/CS (Hawley-SGO Corresp). Ruppenthal, Logistical Support, 1:132-46, describes the complex problems of shipping and marking ETO-bound supplies of all kinds.


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warnings and arranged for relabeling of tanks. 37
 In August 1943 General Hawley began trying to reduce his dependency on the British. Aware of deficiencies in quality and slow deliveries, he also had discovered that his allies, while furnishing inferior goods to the European Theater, simultaneously were obtaining large quantities of standard American medical supplies and equipment from the United States under Lend-Lease. At Hawley's urging, Surgeon General Kirk authorized the theater chief surgeon to cancel contracts with the British for items duplicating lend-lease shipments and to requisition them directly from the New York Port of Embarkation. The War Department, at the same time, instructed the medical and other supply services to stop buying from the British a long list of items now overstocked in the United States. In spite of orders from Hawley, however, the Supply Division and its London procurement office through poor coordination, made no real attempt to reduce local purchases. Instead, the procurement office placed large orders for British goods to be delivered in the first half of 1944.38
 During the last few months of 1943, as more and more troops poured into the British Isles and invasion preparations got under way, the Supply Division obviously began to buckle under its steadily increasing work load. Disembarking units and newly opened hospitals waited for weeks for their basic equipment. The Air Force, to Hawley’s embarrassment in his fight against an autonomous air medical service, continued to complain of shortages of field chests and other vital articles; the flight surgeons continued to resort, successfully, to their own channels to remedy these deficiencies. Early in 1944 the fixed hospitals in the Southern Base Section, where most American troops were concentrated, had only 75 percent of their authorized equipment. In response to complaints from all quarters, Hawley pressed the Supply Division for information but received only incomplete, inconsistent, or inaccurate replies. At the same time the tone of his correspondence with the surgeon general’s office grew increasingly testy, as each side blamed the other for shortages and delays. On 7 December Hawley told General Kirk: “I have had a Hell of a lot of trouble with supply and am still having

  37 Memo, Col T. S. Voorhees to TSG, 14 Mar 44, sub: British Procurement, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Ltr, Hawley to TSG, 14 Oct 43, file HD 024 ETO 0/CS (Hawley-SGO Corresp). For statistics on British procurement, see Wiltse, ed., Medical Supply, p. 270, and Ruppenthal, Logistical Support, 1:256-57. See also Carter, ed., Surgical Consultants, 2:36-37. For the tank problem, see Senior Consultant in Anesthesiology sec., Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1943; Mins, 18th Meeting of Base Section Surgeons, 27 Mar 44, p. 10, file HD 337; Editorial Advisory Board, 1962, p. 48; and Col T. S. Voorhees, “A Lawyer Among Army Doctors” (Fort Detrick, Md.: Historical Unit, U.S. Army Medical Department, n.d.), pp. 92-94.
  38 Ltrs, Hawley to TSG, 10 Aug and 17 Sep 43; Memo, Edward Reynolds to TSG, 24 Aug 43, sub: Letter From Gen Hawley . . . ; Ltr, TSG to Hawley, 24 Aug 43; Memo, Reynolds to TSG, 18 Nov 43, sub: Data for Reply to General Hawley’s Letter. . . . All in file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Voorhees, “Resume,” 12 Apr 44, pp. 4-5, and Memo, Col T. S. Voorhees to CSurg, ETO, 18 Mar 44, sub: Report as to British Procurement, both in ETO Supply Survey, January-March 1944, file HD 333 ETO.


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trouble.  . . . Frankly, I am worried about my medical supply when I think of the approach of active operations.” 39
 Hawley had reason to worry. His Supply Division barely was meeting the routine requirements of the forces stationed in the United Kingdom. With much delay and inefficiency it was equipping newly landed units and recently completed hospitals, the pressures of the latter task being eased by British construction delays. Additional missions to be accomplished in early 1944 promised to swamp the floundering division. Within about five months ETO medical depots would have to assemble and place on site equipment for all the hospitals still to be opened before D-Day. This entailed building thirty outfits for 1,000-bed general hospitals and twenty for 750-bed station hospitals, but the most efficient depot in late 1943 took three months to put together 60 percent of one 1,000-bed assembly. As if this were not enough, the depots would have to outfit still more incoming units, complete the equipment of organizations taking part in the assault, and pack dozens of waterproof maintenance units to supply the invasion force in its first weeks on shore. With the existing organization, personnel, and methods, these jobs could not be done in time. 40
 Fortunately for General Hawley, assistance was on the way. Late in 1943 Surgeon General Kirk, responding to the chief surgeon’s repeated cries for help in supply, and at the suggestion of Colonel Gorby—then in Washington preparing to join Hawley’s staff—decided to send a group of experts from his office to survey the ETO supply service and recommend comprehensive remedies. In doing so Kirk acted outside the established chain of command, which made the theater chief surgeon responsible only to the theater commander. The surgeon general’s delegation would possess little authority beyond the moral force of its collective expertise. To lead the group, Kirk appointed the chief of his Control Division, Col. Tracy S. Voorhees, JAGD, a lawyer who had become well versed in medical organization and supply. Voorhees picked the other team members: Lt. Col. Bryan C. T. Fenton, MC; Lt. Col. Leonard H. Beers, MAC; and Mr. Herman C. Hangen, a civilian consultant to the surgeon general. All these men possessed extensive knowledge of medical supply distribution and depot operations; all earlier had helped reorganize the supply system in the United States. 41

  39 Quotation from Ltr, Hawley to TSG, 7 Dec 43, file HD 024 ETO O/CS (Hawley-SGO Corresp). In same file, see other letters for late 1943 and early 1944. See also Hawley Interv, 1962, p. 36, CMH; Hawley Operational Directive No. 40, 13 Sep 43, box 2, Hawley Papers, MHI; file HD 024 ETO O/CS (Spruit Policy Notebook); “Med Svc Hist, 1942-43,” p. 58, file 314.7-2 ETO; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. IV, pp. 1-2, and sec. VI, p. 3; Mins, 15th Meeting of Base Section Surgeons, 14 Feb 44, p. 7, file HD 337.
  40 Outline Presentation, 7 Feb 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. V, pp. 1-2; Voorhees, “Lawyer Among Army Doctors,” pp. 85-86.
  41 Fenton was Chief, Issue Branch, and Beers, Chief, Stock Control Branch, in the Supply Division, Office of the Surgeon General. Hangen, an   executive of J. C. Penney and Company, was a specialist in warehouse operations. Voorhees, a New York lawyer and friend of Under Secretary of War Robert P. Patterson, initially headed the Legal Division, Office of the Surgeon General, and became involved in supply through his work on contracts. He became the confidential agent and troubleshooter of the surgeon general. The Control Division, which he headed, oversaw the operations of other divisions of Kirk's office. See Armfield, Organization and Administration, pp. 85-90 and 203-04, and Wiltse, ed., Medical Supply, pp. 18-21 and 280. See also Voorhees, “Resume,” 12 Apr 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Voorhees, “Lawyer Among Army Doctors,” pp. 83-84; Gorby Interv, 1962, pp. 2-3, CMH; Editorial Advisory Board, 1962, p. 32.


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COL. TRACY S. VOORHEES  
 Voorhees and his party left Washington by plane on 24 January 1944, all but Beers (who was to join the European Theater to direct stock control), under orders for sixty days of temporary duty. Once in the theater, and with the full cooperation and assistance of Hawley and his staff, they visited the Supply Division at Cheltenham, inspected depots, and talked with U.S. Army medical officers of the Services of Supply and the air and ground forces. Very rapidly they learned the dimensions of the medical supply crisis. “Within 10 days,” Voorhees recalled, “our team unanimously reached the conclusion that only a complete reorganization, undertaken immediately, would make it possible to furnish needed hospitals and medical supplies for the invasion.” Breaking off any further gathering of evidence, they returned to London to report to Hawley. 42
 On 7 February the Voorhees team met with the chief surgeon to discuss not only the findings but also a plan for improvement. Voorhees and his colleagues disavowed any intention to “fix fault or blame,” and they acknowledged Hawley’s “entire executive authority and responsibility” and his complete freedom to accept or reject their proposals. However, “to the extent that the program involves bringing key people from the U.S., stripping The Surgeon General’s Office and Depots of top-notch personnel in this field, we would not feel justified in recommending this unless the plan as a substantial whole is found acceptable by you.” The group then told Hawley:
 
42 Quotation from Voorhees, “Lawyer Among Army Doctors,” p. 84: See also Voorhees, “Resume,” 12 Apr 44, pp. 1-2, in ETO Supply Survey, January-March 1944, file HD 333 ETO; correspondence for January-February 1944, file HD 024 ETO O/CS (Hawley-SGO Corresp); Hawley Planning Directive No.24, 8 Jan 44, box 2, Hawley Papers, MHI; Memo, Hawley to Chief, Planning Division, 8 Jan 44, file HD 024 ETO O/CS (Spruit Policy Notebook); Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. I, p. 1.


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We believe that your own statements . . . as to the basic inadequacies of your supply service and the grave concern which you expressed as to it, are fully justified by the facts. . . . Unless sweeping reforms are immediately instituted, the Supply Division will fail to perform its mission of furnishing on an even reasonably adequate basis the hospital equipment, field equipment and supplies asked for. 43
 The committee laid before Hawley a three-part program, patterned, they pointed out, on the measures that had solved similar medical supply problems in the United States fifteen months earlier. First; to lighten the depots’ impossible work load, they proposed that 37,000 hospital beds—almost all the general and station hospital assemblies needed before D-Day—and all the required medical maintenance units for the invasion be put together in the United States, where the surgeon general's depots now had ample stocks and manpower. The ETO depots then could concentrate on equipping tactical units and on the regular receipt, storage, and issue of supplies. Second, to establish effective stock controls, Voorhees’ group proposed a streamlined but more comprehensive system of reports, the development of an SOP for depot operation, reduction of the number of issuing depots, and the creation of key depots to hold reserves of scarce items. Third, the delegation addressed quantitative and qualitative manpower deficiencies, confirming Hawley’s long-standing belief that here lay the source of most of his other supply difficulties. They recommended doubling the Supply Division staff, to thirty-two officers and ninety-two enlisted men, and reorganization of the division into four functional branches: Administration and Finance, Stock Control, Depot Technical Control, and Issue. Voorhees and his colleagues urged relief of Colonel Perry “without reflection upon him,” and Perry’s replacement with Col. Silas B. Hays, MC, who was then head of the Distribution and Requirements Division in the surgeon general’s office. They presented the names of other qualified officers whom General Kirk was willing to send from the United States to the European Theater if Hawley requested them. The Voorhees group also recommended that the existing on-the-job-trained depot complements be retained and organized in permanent units, both to improve efficiency and to permit morale-enhancing promotions. 44
 The chief surgeon without hesitation accepted all of the group’s recommendations. To implement them following still another Voorhees proposal—he assumed direct supervision of the Supply Division, superseding his Cheltenham deputy. On 10 February, in a transatlantic teletype conference, the surgeon general’s office agreed to all the main points, including assembly in the United States of hospitals and maintenance units and the assignment of Hays and the other requested officers. Hangen, Beers, and Fenton moved to Cheltenham, where they effectively took over the Supply Division, with the full cooperation of Colonel Perry, who stayed on as nominal chief until Hays arrived
 
43 Outline Presentation, 7 Feb 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO.
  44 Ibid.


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COL. SILAS P. HAYS
COL. BYRON C. T. FENTON (Rank as of 15 August 1944)

in March. Colonel Voorhees remained in London, to work on permanent depot organization and begin a study of ways to reduce British procurement. The entire team spent February and March in sustained hard work, their efforts closely observed by General Kenner. The SHAEF chief medical officer received copies of Voorhees’ reports and conferred on the supply situation with Hawley, Voorhees, and Colonel Fenton; but, as with hospital construction, he confined himself to supporting the chief surgeon’s program. 45
 Voorhees’ men rapidly reorganized the Supply Division, establishing the four new branches. By mid-March thirteen of the officers promised by the surgeon general had arrived and gone to work. The division staff expanded to thirty officers, eighty-four enlisted men, and thirteen British civilians, and for the first time in the history of the theater the reinforcements were thoroughly-qualified for their jobs. After earnest and repeated pleas from Hawley, General Kirk al-

  45 Voorhees, “Resume,” 12 Apr 44, pp. 2-5; OofCSurg, HQ ETOUSA, Report of Teleprinter Conference . . . With Representatives of TSG, 10 Feb 44; Memo, Hawley to DepCSurg (Cheltenham), 11 Feb 44; Ltr, Voorhees to Edward Reynolds, 7 Mar 44. All in ETO Supply Survey, January-March 1944, file HD 333 ETO.  See also Voorhees, “Lawyer Among Army Doctors,” pp. 87-90; Ltr, TSG to Hawley, 12 Feb 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). For Kenner’s activities, see Medical Division, COSSAC/SHAEF, War Diary, February-April 1944.


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TABLE 4—KEY DEPOT SYSTEM, UNITED KINGDOM, 1944

lowed the chief surgeon to retain Fenton as deputy Supply Division chief. Hawley held onto Fenton partly as a possible replacement for Hays, who suffered a severe gastric attack early in May; but, to the chief surgeon’s immense relief, his supply chief recovered and was able to resume duty before D-Day. 46
 Depot reorganization went forward (Table 4). On 2 February Colonel Voorhees and the chief surgeon prevailed upon the ETO G-1 to halt all transfers of soldiers then working in medical supply depots. This action temporarily stabilized the depot force. After much negotiation between Hawley, Voorhees, and the theater G-1 and G-4, the ETO headquarters activated in Great Britain or called for from the United States eight additional field medical depot companies and assigned all depot personnel to them. While these field companies rarely matched in size and composition the requirements of any particular depot, and hence usually had to be divided among several installations, their establishment did end the transiency of depot personnel. They also provided an organization in which deserving soldiers could receive promotions. 47
 Hangen and Beers revamped depot operations and stock record-keeping. To better control supply issues, they reduced the number of depots distrib-

  46 Ltrs, Hawley to TSG, 20 Apr and 6 May 44; Ltr, TSG to Hawley, 26 Apr 44; Ltrs, Col E. Reynolds to Hawley, 16 May and 8 Jun 44; Ltr, Hawley to Reynolds, 15 Jun 44. All in file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. I, p. 1, ex. III; Kelley Interv, 27 Jan 45, box 221, RG 112, NARA; Fenton Interv, 7 Jun 45, box 222, RG 112, NARA; Memo, Voorhees to Hawley, 25 Mar 44, sub: Review of Situation as to Medical Supply, in ETO Supply Survey, January-March 1944, file HD 333 ETO.
  47 The chief surgeon tried unsuccessfully to persuade the theater to authorize permanent non-T/O organizations adapted to the various depots, but the theater insisted on standard T/O units, leaving the field companies the only alternative. Each such company included 8 officers and 167 men. Of the fourteen such companies in the ETO by D-Day, eight were used in fixed depots; the rest were assigned to field armies or the SOS for mobile operations. See Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. II, pp. 1-2; Voorhees, “Resume,” 12 Apr 44, and Ltr, Voorhees to TSG, 21 Feb 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Kelley Interv, 27 Jan 45, box 221, RG 112, NARA.


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uting to units from eight to five. They designated five key depots, which held the bulk of theater stocks of certain scarce items and filled requisitions for them passed on from issuing depots. A sixth key depot assembled and issued all tactical unit equipment. Other nonissuing depots performed maintenance and repair received materiel from the ports, and stored reserve stocks. Hangen and Beers published a depot operations manual, establishing uniform issuing and inventory procedures that the Supply Division’s Depot Technical Control Branch saw were carried out. They also set stock levels for each issuing depot, based on the number of troops it served, and redistributed on-hand materiel among installations to give each its proper allowance. To collect theater-wide supply Information, Hangen and Beers replaced the three existing separate depot stock reports with a single comprehensive bi-weekly one. From this, the Supply Division, employing electric tabulating  machines, compiled statistics on total supplies on hand and required. At the same time Hangen and Beers set a theater stock level of 75 days’ supply of each item and provided for automatic reorder when quantities fell below that point plus an additional margin to allow for time taken in ordering and shipment. To bring all stocks to the 75-day level, the Supply Division placed large emergency requisitions on the New York port; it also sent initial orders for over 800 items in the surgeon general’s catalog hitherto  not used in the theater to reduce shipping requirements. With vessels and supplies now available, the European Theater thus expanded its supply table. By mid-May the ETO each of depots were well stocked, and the Supply Division knew what and how much was in them. 48
 While his associates reorganized the depots, Colonel Voorhees surveyed the record of British supply. Reviewing the orders placed medical, late the previous year for 1944 delivery, he and his assistants discovered that, of over 800 items involved, all but several varieties of dental burs either were in oversupply in the United States or were being shipped from America under Lend-Lease for British use. After much negotiation with the Ministry of Supply and the War Department, Hawley and Voorhees canceled most supply requests with the British except those for dental burs and a few nonstandard articles; they also retained arrangements for small local emergency purchases. The British either stopped production of the no longer wanted items or diverted them to their own forces. To assure more effective control of any additional buying within the theater, the chief surgeon, at Voorhees’ suggestion, placed the London procurement office within the Supply Division’s new Stock Control

  48 Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. II, pp 2-4, and sec. VI, pp. 6-7; Ltr, Voorhees to Reynolds, 7 Mar 44, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Memo, Medical Division, SHAEF, to ACofS, G-4, SHAEF, 7 Apr 44, in Medical Division, COSSAC/SHAEF, War Diary, April 1944; Kelley, Interv, 27 Jan 45, box 221, RG 112, NARA; Memo, OofCSurg, HQ ETOUSA, to Maj. Gen. LeRoy Lutes, 1 May 44, file HD 024 ETO CS (Hawley Chron); Wiltse, ed., Medical Supply, pp. 28587. These addition medical supply shipments were only a small part of the massive last-minute flow of OVERLORD and BOLERO cargo into Britain. See Ruppenthal, Logistical Support, 1:234-40 and 258-60.


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Branch, ending procurement's semi-independent status. 49
 On both sides of the Atlantic, the Army Medical Department and the ETO medical service prepared to assemble and move equipment for hospitals containing a total of 35,000 beds. “This was roughly the equivalent,” Voorhees pointed out, “of shipping about 12 complete New York City Bellevue Hospitals, except the buildings.” By mid-March the surgeon general’s office and the New York Port of Embarkation had worked out packing and loading schedules to ensure arrival of the required assemblies before the end of May. Combined with hospital assemblies requisitioned earlier, the materiel sent in response to Voorhees’ special request would provide the European Theater with a large reserve of complete hospitals and components. In the United Kingdom the Supply Division, cooperating with port commanders, base section surgeons, and the Transportation Corps, established procedures for moving hospital assemblies directly from wharf to site, bypassing the depots and reducing the chance of units being broken up in transit. Under this system, between 30 March and 25 May, assemblies for twenty-nine 1,000-bed general hospitals and eight 750-bed station hospitals, as well as additional equipment for thousands of expansion beds, went from ships’ holds to plants all over Britain with minimal loss or delay. 50 
 Colonel Voorhees and Hangen returned to the United States early in April, to report personally to Surgeon General Kirk and to supervise the dispatch of hospitals and maintenance units. They left behind a medical supply service well on the way to complete transformation—a transformation accomplished in a few months by effective leadership, sufficient manpower, first-class priority for ETO requirements, and high-level command attention. By mid-May the depots possessed full, balanced stocks. The First Army, which would make the assault, had all its medical equipment in hand. The depots were packing for over-the-beach disembarkation maintenance units to sustain the first two weeks of combat. Additional medical maintenance units at sea or in depots contained supplies for the period D + 14 to D + 90. Most of the operating fixed hospitals in

  49 The War Department initially hesitated to stop ordering from the British because of warnings from the Allies that, without firm American orders, they would shut down production, thereby foreclosing later purchases which might become necessary.  Hawley and Voorhees, however, persuaded the Army Service Forces that the sufficiency of shipping and supplies and the inadequacies of British procurement more than justified a complete cutoff.  See Voorhees, “Resume,” 12 Apr 44, pp. 4-5; Memo, Voorhees to TSG, 14 Mar 44, sub: British Procurement; Memo, Lt Col L. H. Beers, MAC, to Voorhees, 18 Mar 44, sub: British Procurement; Memo, Voorhees to Hawley, 25 Mar 44, sub: Review of Situation as to Medical Supply.  All in ETO Supply Survey, January-March 1944, file HD 333 ETO.
  50 Before Voorhees made his request, the Office of the Surgeon General had plans to pack and ship twenty-four general hospitals for eventual use in France; it diverted these to Britain and then sent Voorhees’ full request as well. Quotation from Voorhees, “Lawyer Among Army Doctors,” p. 89. See also Memo, Voorhees to CSurg, ETO, Col Liston, Col Hays, and Maj Marshall, 16 Mar 44, sub: Status of Requirements for Hospital Assemblies, Dates of Expected Arrival, and Proposed Steps To Assure Timely Deliveries, in ETO Supply Survey, January-March 1944, file HD 333 ETO; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec. V, pp. 1-2, and sec. VI, pp. 2-3; Mins, 16th Meeting of Base Section Surgeons, 28 Feb 44, p. 3, file HD 337; Wiltse, ed., Medical Supply, pp. 297-98.


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Britain had received their full equipment and held at least sixty days of reserve supplies. Even the Air Force now relied for medical supply more upon SOS channels than upon its own. Three days before the invasion, a still-cautious Hawley declared: “We have just barely squeaked through on our supply. . . . I shall not, however, breathe really easily about it for another month.” He had no further cause for worry. ETO medical supply, as reorganized by the Voorhees mission, was ready for war. 51
Mounting the Attack
 Preparations for mounting NEPTUNE—equipping, organizing, and embarking the assault troops and reinforcements so as to ensure their arrival on the far shore in the right order with the right materiel—merged with the final stages of invasion planning. For its part in this process the medical service selected, assigned, and completed the training of army and COMZ units, equipped them, and packed their supplies. It furnished treatment and evacuation to troops assembling for embarkation, and it prepared to receive and care for wounded from the opening battle in Normandy.
 
 During the final months before D-Day the surgeons of the First and Third Armies, Advance Section, and Forward Echelon, in consultation with General Hawley, developed medical troop lists for their respective commands. The ETO headquarters then assigned the requested units from the huge pool accumulating in the United Kingdom. The First Army’s preinvasion allocation included one 750-bed and ten 400-bed evacuation hospitals, five field hospitals, a convalescent hospital, headquarters of three medical groups and eight medical battalions (separate), a medical gas treatment battalion, an auxiliary surgical group, a medical laboratory, a medical depot company, and eleven collecting, six clearing, and seven ambulance companies (separate). These units underwent personnel augmentations and rearrangements. To provide ready replacements for invasion casualties, medical elements of the engineer special brigades and of the assault and early buildup divisions received extra officers and men above T/O strength. Army mobile hospitals transferred doctors to balance their professional staffs. First Army field and evacuation hospitals had the painful task of replacing 95 veteran nurses who were considered too old or physically unfit for active campaigning. 52
 The Advance Section and Forward Echelon also received their full allotments of units before D-Day. ADSEC included over 1,800 medical officers, 2,300 nurses, and 16,000 enlisted men when the campaign began.

  51 Quotation from Ltr, Hawley to TSG, 3 Jun 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). See also Memo, Col T. S. Voorhees and H. C. Hangen to TSG, 5 Apr 44, sub: Final Report as to Survey of Medical Supplies in E.T.O., in ETO Supply Survey, January-March 1944, file HD 333 ETO; Memo, OofCSurg, HQ ETOUSA, to Lutes, 1 May 44, file HD 024 ETO CS (Hawley Chron). The medical supply situation more or less paralleled that in other technical services and the theater as a whole. See Ruppenthal, Logistical Support, 1:261-66.
  52 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 61. For personnel arrangements, see Surg, Third U.S. Army, Annual Rpt, 1944, pp. 16, 102, 105, and Nursing Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 9.


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Unlike those attached to the armies, most units assigned to the Communications Zone were operating fixed installations in Great Britain or had marshaling and casualty reception duties that would continue until embarkation; hence, they remained under base section control, except on matters directly connected with preparing for continental operations—a dual command chain that forced unit staffs to thread their way among duplicate, occasionally conflicting, directives and reporting requirements. Especially in selecting the twenty-five ADSEC and FECOMZ general hospitals, General Hawley recommended SOS units for early shipment to France on the basis of superior performance in Britain. He angrily deleted from the list one general hospital that he found “inexcusably dirty and disorderly” on a pre-D-Day visit. 53
 Medical units designated for early movement to France added instruction and exercises in amphibious warfare and field operations to their already crowded training schedules. The First Army, at Colonel Roger’s recommendation, attached medical battalion elements to combat units early in the attack preparations so that the medical troops and the battalions they were to support could go together through the entire invasion training sequence, including the amphibious landing exercise at the army’s assault training center on the Devon coast. COMZ organizations usually trained at their stations, supervised and inspected by their assigned headquarters. They also sent key people to special courses. Commanders of the twenty-five ADSEC and FECOMZ general hospitals, for instance, attended a five-day school on erecting the expeditionary tented-hutted plant. First Army and COMZ medical elements participated together in the final division and corps invasion rehearsals covering the entire process of marshaling, embarkation, and assault—TIGER, held late in April for VII Corps; and FABIUS, in early May, for V Corps and the initial buildup force. During TIGER U.S. Army medical units had real casualties to handle, the result of German torpedo boat attacks in the Channel that sank two LSTs and severely damaged a third, with the loss of some 700 American lives. At Portland-Weymouth, in an unplanned but effective test of the system for receiving wounded from France, the 33d Medical Battalion, its attached ambulance and sanitary companies, and the 50th Field Hospital efficiently met the emergency under “particularly trying and difficult conditions.” 54

  53 ADSEC Hist, p. 8; Surg, ADSEC, COMZ, Annual Rpt, 1944, pp. 3 and 38-39; Larkey “Hist,” ch. 8, pp. 23-25; file HD 370 (HQ ADSEC Plans and Corresp, 1944). For the hospital deletion, see Ltr (source of quotation), Hawley to Col A. A. Albright, MC, 19 May 44 (marked “not sent”), file HD 024 ETO CS (Hawley Chron), and Hawley Interv, 1962, p. 58, CMH.
  54 For a general account of invasion training and exercises, see Ruppenthal, Logistical Support, 1:191 and 334-54, and Harrison, Cross-Channel, pp. 162-64 and 269-70. See also remarks of Maj Gen J. L. Snyder, MC, in Editorial Advisory Board, 1962, pp. 69-70. For examples of training, see Surg, VII Corps, Annual Rpt, 1944, pp. 4-5; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 2; 53d Medical Battalion Annual Rpt, 1944, p. 2; and Force U Operations Order 2-44, an. NAN, 18 Apr 44, file HD 370 (Evaluation, Annex JIG); Surg, ADSEC, COMZ, Annual Rpt, 144, pp. 13-15, 31, 48; Hospitalization Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 5. Description of the medical response to the torpedo boat incident, from which the quotation is taken, is in OofSurg, United Kingdom Base, Historical Resume of the Planning for and Staging of Operation OVERLORD and the Preceding Exercises (hereafter cited as Surg, UKB, OVERLORD Resume), n.d., pp. 1-8, file HD 370.


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Equipment and supply of the assault and early buildup units required cooperation between the First Army and the chief surgeon’s Supply Division. On the basis of a First Army study of assault requirements, the Supply Division issued supplemental equipment, above T/E allowances, to army medical units of all types. In spite of duplicated and misdirected shipments, the result of frequent unit movements during marshaling, most First Army organizations had received their extra allotments, as well as nearly 100 percent of their authorized equipment, before they embarked, a tribute to the effectiveness of the newly reorganized depots. Amphibious packing received careful attention from all echelons. The Supply Division distributed standard watertight shipping boxes to First Army field and evacuation hospitals and sent an officer to advise units on how best to protect their materiel against the hazards of sea, weather, and battle. Army units prepared thousands of hand-portable assault supply containers, each a waterproof cylinder 21 inches long and 9.5 inches in diameter, originally used to ship 60-mm. mortar shells. Each case, with a carrying strap attached and painted with a Red Cross in a white circle, weighed about 14 pounds when filled with first aid dressings, sulfa crystals, dried plasma, and other small items. Each container would float, serving the medical soldier hauling it as a life preserver that he could take inland with him as he advanced or could drop on the beach for later retrieval. Eight such cases constituted a single unit of these supplies, and every battalion or company received an allowance of units. The 4th Infantry Division landed with 285 of these cases, containing over 3,500 pounds of supplies. 55
 Following theater policy, the Supply Division loaded all scheduled maintenance supplies for the first sixty days on standard wooden skids, each a sled-like device weighing about 1,700 pounds with cargo, designed to be dragged across beaches and stored in open-air depots. By 8 May medical depots had finished loading these supplies for D-Day through D + 15. Piled onto 955 skids, this materiel included ninety-two surgical and twenty-two medical division assault units and twenty regular maintenance units, as well as other freight. General Hawley, meanwhile, secured from the Ninth Air Force a guarantee to airlift daily across the Channel 4,000 pounds of blood, penicillin, and other perishable items, which Depot G-45 at Thatcham was to pack for emplaning at a nearby Army airfield. Late in May the theater blood bank began collecting and processing; its detachments made their first deliveries, over 1,100 pints, to LSTs and hospital carriers. The latter vessels, fitting out at English, Scottish, and Welsh ports, took on blood and biologicals, both

  55 First U.S. Army Operations Report, 20 Oct 43-1 Aug 44, bk. VII, pp. 73-74 and 114-16; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, secs. II, IV, and VI; Kelley Interv, 27 Jan 45, box 221, RG 112, NARA; Surg, United Kingdom Base, Annual Rpt, 1944, p. 35; Mins, 18th Meeting of Base Section Surgeons, 27 Mar 44, pp. 2-3, file HD 337. Surg, VII Corps, Annual Rpt, 1944, pp. 6-8, contains a detailed description of the hand-carried container.


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for their own use and to supply the beachheads. 56
 To embark the 130,000 troops and 17,000 vehicles of the assault and initial buildup forces, the U.S. Army used a system worked out by the British early in the ROUNDUP planning. Under it each organization, in prearranged sequence, went from its permanent station through a concentration area to a dockside marshaling camp. In the course of this movement the unit dropped off men and materiel not needed for the attack, waterproofed its vehicles, and picked up assault equipment. Finally, in a marshaling camp sealed off by barbed wire and security patrols, the unit received its mission briefing and organized into ship and landing craft loads. The First Army directed these troop movements and the embarkation, while the Services of Supply built and manned the concentration and marshaling camps and provided messing, medical, and other administrative support for the combat units passing through them. The SOS headquarters, in turn, delegated most mounting tasks to the Southern Base Section, which embarked the OMAHA and UTAH seaborne attack forces and the glider elements of the airborne divisions, and to the Western Base Section, which loaded the first build-up divisions and the airborne paratroopers. Medical support for the mounting, accordingly, rested principally with Col. Robert E. Thomas, MC, the Southern Base Section surgeon, and Col. Mack M. Green, MC, the Western Base Section surgeon. 57
 Medical support provisions for the embarkation were limited and straightforward. In the marshaling camps the base sections established medical supply points to make emergency preembarkation issues and over 150 camp dispensaries, each staffed with 1 officer and 4 enlisted men, to serve units that had dropped off or packed up their own medical detachments. Most of the officers and men for these dispensaries, and for 24 mess teams that helped feed the transient soldiers, came on temporary assignment from station and general hospitals throughout Great Britain. From the same sources the Dental Division of the chief surgeon’s office assigned a dentist and an assistant to the marshaling camps for each 3,000 troops, to do last-minute fillings, extractions, and prosthesis repairs. Taken as they were from fixed hospitals, many of these temporary camp doctors had little experience and only brief predeployment training in field medicine and sanitation. 58

  56 Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, secs. II and VI; Surg, ADSEC, COMZ, Annual Rpt, 1944, p. 25; HQ SOS, ETOUSA, Mounting Plan, an. 8, Medical Corps (hereafter cited as SOS Mounting Plan), 20 Mar 44, in Larkey “Hist,” ch. 8, app. 3; Evacuation Branch, Operations Division, OofCSurg, HQ ETOUSA, Daily Diary, 19 May 44, file HD 024 ETO; Kendrick, Blood Program, p. 512; Kelley Interv, 27 Jan 45, box 221, RG 112, NARA.
  57 For the mounting system, see Ruppenthal, Logistical Support, 1:218 and 357-62, and Southern Base Section History, August 1943-August 1944, pp. 6-7. See also Surg, UKB, OVERLORD Resume, pp. 1-4, file HD 370; SOS Mounting Plan, 20 Mar 44, in Larkey “Hist,” ch. 8, app. 3; Planning Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 6.
  58 Each mess team included 1 officer, 4 cooks, and 11 men. The latter medical troops were only a few of the 4,500 new cooks hastily assembled for the camps. See Ruppenthal, Logistical Support, 1:361. See also Larkey “Hist,” ch. 8, pp. 28-31; SOS Mounting Plan, 20 Mar 44, in ibid., app. 3; Surg, UKB, OVERLORD Resume, pp. 11-12, file HD 370; Surg, Western Base Section, Rpt, 1 Jan-31 Aug 44, pp. 5-6; Mins, 13th and 15th Meetings of Base Section Surgeons, 17 Jan and 14 Feb 44, file HD 337; Surg, United Kingdom Base, Annual Rpt, 1944, p. 22; Dental Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 4-5.


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 The abilities of the camp surgeons, fortunately, were not sorely taxed. Marshaling and embarkation began early in May, after General Eisenhower set D-Day for 5 June, and went forward with no major enemy harassment and, from a medical standpoint, few problems. As planned, the embarking troops enjoyed hot meals of fresh, tasty food. They donned uniforms treated to resist gas and picked up seasickness preventives, insecticide powder, and water purification tablets. They heard a final one-hour preventive medicine lecture that emphasized proper eating habits, personal cleanliness in the field, and precautions against venereal disease. In many marshaling camps, sanitation left much to be desired—the result of inevitable carelessness among transient soldiers and of mistakes by the hastily assembled, sketchily trained camp and mess hail staffs. Base section preventive medicine officers, aided much of the time by Colonel Gordon and members of his division, quickly corrected these deficiencies, although lapses in mess hall cleanliness caused a few battalion-wide outbreaks of diarrhea. Filing a gap in the planning, Gordon’s officers devised a system for feeding hot meals to troops held for hours on the docks by embarkation delays. One anticipated problem did not develop. The base section surgeons, expecting a rash of preinvasion emotional disorders, assigned psychiatrists to the marshaling camps. Few cases appeared, and the psychiatrists spent their time giving impromptu short courses in battlefield neuropsychiatry to unit medics. 59
 As the Army embarked, the medical service completed its preparations for receiving invasion casualties (see Diagram 2). The chief surgeon’s office and Southern Base Section, working closely with the British Southern Command, drafted plans for this operation, which was a complicated task in itself. Under the final plan, published in mid-March, evacuation LSTs and hospital carriers were to unload American wounded at three Channel coast ports: Brixham, Portland-Weymouth, and Southampton. The arriving patients were to undergo two stages of triage and emergency treatment. Holding units at the docks and hards (concrete ramps at which LSTs could load and unload through their bow doors) were to give surgical treatment to men tagged by LST doctors as requiring immediate attention before further transportation. The rest of the patients were to go by ambulance directly from the ships to transit hospitals, designated station and general hospitals 15-30 miles inland. These hospitals again were to separate out wounded who were unable to travel further and prepare the transportables for rail movement to general hospitals for definitive

  59 For the course of the embarkation, see Harrison, Cross-Channel, pp. 188-90 and 269-74; Ruppenthal, Logistical Support, 1:363-73; and Southern Base Section History, August 1943-August 1944, pp. 42-52. See also Surg, UKB, OVERLORD Resume, pp. 14-15, file HD 370; Surg, Infantry Division, Annual Rpt, 1944, pp. 2 and 5; ADSEC Hist, p. 8; Surg, United Kingdom Base, Annual Rpt, 1944, pp. 79-81; Surg, Western Base Section, Rpt, 1 Jan-31 Aug 44, pp. 5-6; Gordon “Hist,” vol. 2, pt. 4, pp. 38-39, CMH. For the preventive medicine briefing, see Larkey “Hist,” ch. 8, app. 15.


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DIAGRAM 2—CASUALTY RECEPTION SYSTEM IN GREAT BRITAIN, JUNE 1944

treatment. Port evacuation officers, under the base section surgeons, were to direct patient movements as far as the transit hospitals; transfers beyond that point would be controlled by the chief surgeon’s office. During the first days of combat, when the beachhead was shallowest, this system not only would enable holding units and transit hospitals to assume many functions of division clearing stations and army evacuation hospitals but also would keep wounded flowing from the coast to the large hospital centers in the north and west of England. 60
 The medical service tested this evacuation plan in two exercises: CRACKSHOT, in February 1944, for movement of wounded into and out of transit hospitals; and CADUCEUS, in April for unloading evacuation LSTs. Then the casualty reception forces deployed. At each of the three major receiving ports, and at many minor ones, the base sections established field hospitals under canvas or in requisitioned buildings to serve as holding units, often with platoons placed only a short litter carry from hards and wharves (Map 6). Separate medi-
 
  60 SOS Mounting Plan, 20 Mar 44, in Larkey  “Hist,” ch. 8, app. 3; Carter, ed., Surgical Consultants, 2:173-75. See also MFR, 5 Jan 44, sub: Decisions Made by Gen Hawley at Informal Conference With Cols Hartford and Peyton; Memo, Lt Col F. H. Mowrey, MC, n.d. sub: Evacuation and Medical Service at Hards; Memo, Col J. H. McNinch, MC, to OofCSurg, HQ ETOUSA, 15 Feb 44; Memo, Chief, Passenger Branch, Office of CofTrans, ETO, to ACofTrans, Movements, 2 Mar 44, sub: Evacuation of Sick and Wounded From the Continent. . . . All in Evac Corresp, 1942-44, file HD 024 ETO.


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cal battalions at Brixham and Portland and a gas treatment battalion at Southampton, each with sanitary, ambulance, and collecting companies attached, prepared to unload ships and transport patients between holding units and transit hospitals. Each battalion commander acted as evacuation officer for his port. Two more medical battalions, at Blandford and Exeter, held collecting, clearing, and ambulance companies in reserve for commitment at General Hawley’s direction. At Ramsbury and Membury airfields, the nearshore terminals for cross-Channel air evacuation, still other field hospital platoon holding units and ambulance detachments awaited patients. Forty-nine units (nine field hospitals; one gas treatment and four medical battalions; and five sanitary, seventeen ambulance, four collecting, and two clearing companies), all temporarily detached from the Communications Zone and the field armies, made ready to receive wounded from Normandy. 61
 
61 Surg, UKB, OVERLORD Resume, pp. 4-5, 8-13, 18, file HD 370; Larkey “Hist,” ch. 8, pp. 31-32, 55-56, and ch. 13, p. 7; Evacuation Branch, operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, pp. 2-4; Surg, United Kingdom Base, Annual Rpt, 1944, pp. 20-21, 24, 44-46. For unit procurement, see Planning Branch, Operations Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 8; SOS Mounting Plan, 20 Mar 44, in Larkey “Hist,” ch. 8, app. 3; and file HD 370 (HQ ADSEC Plans and Corresp, 1944). On unit activities, see 33d Medical Battalion Annual Rpt, 1944, pp. 5-8; 93d Medical Gas Treatment Battalion Unit History, 1943-44, pp. 3-6; and 12th and 50th Field Hospitals Annual Rpts, 1944.


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MAP 6:  CASUALTY RECEPTION FACILITIES, JUNE 1944
 To assist in casualty reception, treatment, and evacuation, the medical service improvised a variety of teams and special units. General Hawley drew almost 500 doctors and a comparable number of enlisted technicians from Third Army, the air forces, and station and general hospitals, to staff marshaling camp dispensaries, to form LST surgical teams, and to assist the 1st Auxiliary Surgical Group in reinforcing the staffs of holding units and transit hospitals. Hawley and the base section surgeons tried to distribute the burden of these details evenly, but some fixed hospitals suffered significant temporary losses. In the Eastern Base Section, for instance, the 303d Station Hospital, which treated Eighth Air Force battle casualties, had to give up 2 Officers and 8 men for dispensaries, 2 mess sergeants and 31 enlisted people for marshaling camp details, and 1 officer for a district inspection team. To provide professional staffs for three of the British-crewed hospital carriers, the Evacuation Branch, lacking T/O units for this purpose, placed a hospital train unit and a medical hospital ship platoon on each vessel. The Western Base Section, needing a holding unit for two Welsh ports, improvised one by augmenting an engineer regiment's medical detachment with doctors from dispensaries in the marshaling camps. 62
 The chief surgeon backed up his receiving units with reserves of transportation and supplies. General Hawley established a pool of 350 extra ambulances—American ¾-ton vehicles not yet issued to units and surplus British Austins. He distributed these, and 18 bus ambulances, to the Southern and Western Base Sections to reinforce ambulance companies and transit hospitals. The Evacuation Branch, unable to obtain any more home ambulance trains than the 5 then in service, persuaded the Ministry of Transport to adapt 10 overseas trains to run on British lines, ensuring enough rolling stock to keep the transit hospitals cleared. The Supply Division set up temporary advance depots at Plymouth, Torquay, Winterborne Steepleton, and Lockerley in the Southern Base Section. Besides holding reserves needed by the hospitals, these dumps, and others on the docks and hards, stored Navy supplies to replenish evacuation LSTs. They also contained exchange units

  62 Larkey “Hist,” ch. 8, pp. 28-3 1; Personnel Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, PP. 10-11; Mins, 14th, 18th, and 19th Meetings of Base Section Surgeons, respectively 31 Jan, 27 Mar,  and 10 Apr 44, file HD 337: Surg, Western Base Section, Rpt, 1 Jan-31 Aug 44, p. 6. On LST teams, see Dowling, Normandy Rpt, 11 Jan 45, pp. 6-8, and file HD 705 ETO (Medical Care on LSTs, 1944). On drafts from hospitals, see Ltrs, Hawley to Col R. E. Thomas, MC, 27 Apr 44, and Hawley to Col M. M. Green, MC, 5 May 44, file HD 024 ETO CS (Hawley Chron); see also 5th General Hospital Annual Rpt, 1944, p. 5, and 12th Evacuation Hospital Annual Rpt, 1944, p. 8. On hospital carriers, see Evacuation Branch, Operations Division, OofCSurg, HQ ETOUSA, Daily Diary, 16-30 May 44, file HD 024 ETO.


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of stretchers, blankets, and splints, designed and assembled jointly by the Supply Division and the Western Naval Task Force to prevent the planned near-total evacuation policy from stripping the beachhead of these vital items. LSTs were to deliver 300 of these units—containing in all 30,000 litters, 96,000 blankets, and quantities of splints and plasma—to Normandy on their first and subsequent voyages. Permanent Southern Base Section medical depots accumulated still more supplies of all classes, among them most of the theater’s available oxygen cylinders, stockpiled for possible use in treating gas casualties. 63
 Fixed hospitals made preparations of their own. The eight station and four general hospitals assigned to transit duty cleared out patients, streamlined admission and evacuation procedures, and trained extra ambulance drivers and litterbearers. To provide more transit beds at Portland-Weymouth, where most wounded were expected to arrive, the 12th and 109th Evacuation Hospitals, detached from the Third Army, established a temporary expeditionary tented plant. General hospitals, prodded by Hawley and his consultants, sped up the return of convalescents to duty and increased the number of eligible patients evacuated to the United States. By 1 June the Southern Base Section had available for invasion wounded over 10,000 beds in transit hospitals and 18,000 more in regular station and general hospitals.” 64
 By 3 June the assault forces had embarked. After a 24-hour delay caused by storms over the Channel and Normandy, the 5,000-ship invasion fleet set course for France, for a landing scheduled for first light on the sixth. For many medical troops in southern England not yet embarking or preparing to do so, the first notice that the long-awaited invasion was under way came on the night of 5 June, in the form of a sky filled with the navigation lights and engine sound of hundreds of planes heading for the airborne drop zone behind UTAH beach. For General Hawley, two years of planning and preparation had reached their goal and climax. “We are all set for the kick-off,” he wrote after a final tour of his holding units and transit hospitals, “and I, personally, feel as nervous as players usually feel just prior to the whistle.” The chief surgeon and his SHAEF superi-

  63 On reserve ambulances and trains, see file HD ETO 451.8 (Amb), 1942-44; Evacuation Branch, Operations Division, OofCSurg, HQ ETOUSA, Daily Diary, 19, 22, and 27 May 44, file HD 024 ETO. On supplies, see Surg, UKB, OVERLORD Resume, p. 12, file HD 370; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, sec.VI; Fenton Interv, 7 Jun 45, box 222, RG 112, NARA; Surg, United Kingdom Base, Annual Rpt. 1944, pp. 34-35. On exchange units, see First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 75; Directive, HQ ETOUSA, to CG, FUSAG, and Cdr, US Fleet, TF 122, 19 May 44, sub: Initial Evacuation of Casualties From Far to Near Shore . . . , in Larkey “Hist,” ch. 8, app. 5.
  64 For number of beds, see Memo, Maj D. J. Twohig, MC, to CSurg, 1 Jun 44, sub: Status of Evacuation, EvacCorresp, 1944-45, file HD 370.05 ETO. See also Surg, UKB, OVERLORD Resume, pp. 13-14, file HD 370; Larkey “Hist,” ch. 8, Pp. 49-50; Surg, United Kingdom Base, Annual Rpt, 1944, p. 16; Hospitalization Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 21; 12th Evacuation Hospital Annual Rpt, 1944, pp. 6-8. For bed clearing, see Evac Corresp, 1942-44, file HD 024 ETO; file HD 024 ETO CS (Hawley Chron) for April-June 1944; and Hawley Interv, 1962, p. 58, CMH.


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or, General Kenner, expressed guarded confidence in the sufficiency of their preparations. Kenner declared:
“The British and U.S. medical services are organized and prepared to adequately support Operation OVERLORD.” Confirmation of the truth of Hawley’s and Kenner’s estimates no longer rested in their hands. It depended on the performance of thousands of aidmen, doctors, technicians, and nurses on the ships and in the aircraft heading for Normandy. 65

  65 First and second quotations from Ltr, Hawley to TSG, 3 Jun 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). Third quotation from Memo, Kenner to CofS, via ACofS, G-4, and CAdminOff, 20 May 44, sub: Report of Inspection of Medical Facilities, SBS, 9-13 May 44, in Medical Division, COSSAC/SHAEF, War Diary, May 1944.


CHAPTER VII
Introduction to Battle
 On 6 June 1944 U.S. and British forces went ashore along a 40-mile stretch of the Normandy coast. Following the NEPTUNE plan, 13,000 parachute and glider troops of the 82d and 101st Airborne Divisions, who landed just after midnight in the Cotentin countryside behind UTAH beach, opened the American part of the attack. Widely scattered and badly disorganized in the drop due to navigation errors, high winds, and enemy antiaircraft fire, each division managed to assemble enough men and equipment to accomplish at least part of its D-Day mission. In confused vicious fighting against initially uncoordinated but increasingly stubborn and aggressive German opponents, the airborne troops by the end of D-Day had opened the way inland for the seaborne forces across the flooded areas behind UTAH beach, and they were well on the way to securing the lodgement's western and southern flanks.
 The amphibious assault task forces, Force U for UTAH and Force O for OMAHA, dropped anchor in their assembly areas 12 miles off the coast at about 0230. H-hour for the first landings was 0630, when low tide would uncover for demolition the German obstacles that studded both UTAH and OMAHA between high and low water lines. As the troops transferred from transports to landing craft, a gusty northwest wind kicked up a choppy sea, tossing about the smaller craft and quickly overcoming antiseasickness efforts. At about 0530 the Germans, hitherto passive, opened artillery fire; fifteen minutes later the final Allied naval bombardment began, as the assault waves headed for the beaches. About on schedule, the first bow ramps went down.
 At UTAH Maj. Gen. J. Lawton Collins’ VII Corps, the 4th Infantry Division leading, went ashore almost unopposed. Quickly overcoming beach defenders, who were few in numbers and were distracted by the airborne attack behind them, the infantry pushed inland over causeways crossing the inundated areas. Elements of the 1st Engineer Special Brigade, supporting this assault, cleared away mines and obstacles; opened vehicle routes across the beach; readied the causeways for heavy traffic; and set up supply dumps, harassed only by a few snipers and by sporadic German shelling. By the end of the day 23,000 of the 32,000 troops of the initial UTAH assault force were ashore. The


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4th Division had established contact with the 101st but, as yet, not with the 82d.
 At OMAHA the V Corps, under Maj. Gen. Leonard T. Gerow, had the day's hardest, costliest fight. The corps landed with two regiments abreast, both under operational control of the 1st Infantry Division: the 116th Infantry of the 29th Infantry Division on the right, and the 1st Division's own 16th Infantry on the left. Two engineer units supported the infantry, the 6th Engineer Special Brigade going in with the 116th and the 5th Engineer Special Brigade with the
16th. The first assault waves ran into a strong, well-entrenched German infantry division not previously spotted by Allied reconnaissance, its defense little affected by preliminary air strikes and naval bombardments. Losses among troops and landing craft were heavy, and the attackers were pinned down along the high water mark for much of the day. Gradually, aided by naval gunfire and reinforced by later landing waves, they overcame the defenders and worked their way inland. By nightfall about 34,000 troops of the 55,000-man assault force were ashore. The corps, however, had fallen far short of its D-Day objective. Its advance position constituted more a series of islands than a continuous line. German snipers and strongpoints remained unsubdued at many points on the beach, most of which still was under enemy artillery fire.
 The ordeal on OMAHA notwithstanding, the Allies on D-Day had broken the Nazi coastal defenses. During the next few days troops and supplies flowed in over increasingly secure and well-organized beaches. Inland from OMAHA the 1st and 29th Divisions, reinforced by the 2d Infantry Division, expanded their lodgement to the south, southwest, and west, against weakening resistance. The 4th Division at UTAH made firm contact with the airborne divisions and attacked northward. At the same time the 82d pushed westward in the Cotentin, while the 101st drove south to link up the two beachheads, an objective it achieved on 11 June (D+5).1
 The human cost of securing the lodgement was substantial, but much less than expected. On D-Day the hard-hit V Corps suffered about 2,400 dead, wounded, and missing; the 4th Division, by contrast, reported only 200 casualties; and the two airborne divisions together lost about 2,400 men. Of these 5,000 casualties, perhaps 3,000 were wounded—a total well under the anticipated 12 percent of the assault force. This number was within the treatment and evacuation capabilities of the medical forces ashore on D-Day, even though those forces endured their share of the losses and vicissitudes of battle. 2
_
 1 This summary of the tactical situation is based on Harrison, Cross-Channel, chs. VIII and IX; Ruppenthal, Logistical Support, 1:10; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. I, pp. 40-46; Rpt, Provisional Engineer Special Brigade Group (hereafter cited as ProvESBGp), 30 Sep 44, sub: Operation NEPTUNE, 26 Feb-26 Jun 44, pp. 75-103.
 2 D-Day casualties are summarized in Charles B. MacDonald, The Mighty Endeavor: American Armed Forces in the European Theater in World War II (New York: Oxford University Press, 1969), p. 279. V Corps casualties are broken down into dead, wounded, and missing in Rpt, V Corps, sub: Operations in the ETO, 6 January 1942 to 9 May 1945, p. 64. For airborne losses, see Harrison, Cross-Channel, pp. 28 n and 300.


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The Assault
 The burden of treating and evacuating First Army casualties on D-Day and during the days immediately thereafter fell largely on the medical elements of the airborne and infantry divisions and the engineer special brigades, and on the teams of the 3d Auxiliary Surgical Group. These forces worked under control of the assault corps surgeons: Col. Charles E. Brenn, MC, of V Corps on OMAHA and Col. Paul Hayes, MC, of VII Corps on UTAH.3  Hayes’ area of responsibility included the airborne divisions, as well as the seaborne forces. Until the beachheads joined, these officers performed most of the tasks of an army surgeon, rather than the more limited duties usually done at corps level.
 Regimental and battalion surgeons and aidmen of the two airborne divisions were the first Army Medical Department soldiers to set foot in Normandy. In each division they dropped by parachute or rode in on gliders with their organizations—nine officers and sixty enlisted men with each parachute regiment and seven officers and sixty-four men with each regiment of glider infantry. Anticipating heavy drop losses and days of isolation behind enemy lines, unit medics landed with all the extra supplies and equipment they could collect—either carried on their persons, parachuted down in special containers, or packed in glider-borne vehicles. The 101st Division, for example, went into Normandy with 250 litters and 2,500 blankets above its regular allowance, 25 instead of the regulation 7 aerial delivery containers per regiment, and 2,000 units of plasma. The 101st’s field artillery battalion brought along 2 complete set of aid station equipment. Each paratrooper carried 2 British-made individual dressings and a copper sulphate sponge for use on phosphorus burns. 4
 Much of this equipment—and many of the people carrying it—were lost, as paratroopers and gliders plunged into the hedgerow-lined fields and marshy river bottoms of the Cotentin and as men in the early morning darkness began the tense, deadly hide-and-seek game of finding comrades, assembling units, and getting on with their missions. Airborne medical personnel were as badly scattered in the drops as everyone else. In the 82d Division 50 percent of the medical officers were unaccounted for during the first seventy-two hours of combat; in one of the 101st's battalions, which landed in swamps, only two members of a sixteen-man medical detachment initially rallied with the unit. For some medics the war ended quickly as they ran into Germans and were captured or—rarely, if clearly identified—shot. The 101st during June lost 20 percent of its medical personnel, most of them in the first days. Equipment losses were equally heavy. The 101st recovered only 30 percent of its air-dropped supply containers, and its surgeon later concluded that it was a mistake to drop so much materiel in the early

 3 Col. Hayes was replaced as VII Corps surgeon on 4 July 1944 by Lt. Col. Robert H. Barr.
 4 Surg, 82d Airborne Division, Annual Rpt, 1944, an. I, p. 1; Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 1-2; Interv, OSG with Capt Ernest Gruenberg (hereafter cited as Gruenberg Interv), 13 Jun 45, box 222, RG 112, NARA.


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hours, when the surgeons did not yet need it and darkness made it almost impossible to find.
 During the first hours on the ground, medical officers and aidmen collected what supplies they could locate. They made contact with other paratroopers, gave first aid to men injured in the jump or in glider crashes and in the first firefights, and worked their way toward battalion assembly areas. Especially in the 82d Division, elements of which landed farthest inland, small groups of paratroopers were cut off from their units for days. Injured and wounded soldiers with these groups received at best improvised care, even if their chance-met companions included medical officers and aidmen. Some groups, forced to maneuver to avoid Germans or driven from their positions by counterattacks, had to leave their wounded behind to be captured, frequently along with medical personnel who voluntarily stayed with their patients. At isolated positions, wounded men died for lack of plasma. Other cut-off groups were more fortunate. Medical officers with them managed to salvage equipment for adequate first aid and in at least one case secured milk and food for the wounded from French farmers.
 Medical officers and men who reached their battalion assembly areas set up rough-and-ready aid stations, usually near their unit command posts. At these stations improvisation was the common practice, as surgeons scavenged for supplies and commandeered farm wagons and captured enemy vehicles to collect wounded from widespread company positions. In the 1st Battalion, 502d Parachute Infantry, a 101st Division unit, the battalion commander, Lt. Col. Patrick J. Cassidy, and his surgeon, Capt. Frank Choy, MC, secured a small cart and a horse to pull it and drafted a dental technician to drive it. “All day long,” according to a battalion report, “this boy drove up and down the roads, exposing himself to sniper fire, working like a Trojan, to bring in the wounded and the parachutists who had been hurt on the jump; his energy saved countless lives.” During much of the day Colonel Cassidy, who had to send his surgeon to treat an untransportable casualty at an outlying position, acted as his own medical officer. Cassidy, and the medical sergeant who remained with him, decided which badly wounded men should receive their limited supply of plasma, and the battalion commander personally helped retrieve medical supply bundles from the surrounding fields. Because his drop zone was just inland from UTAH, Cassidy was able to evacuate many of his casualties to the beach late in the afternoon, after making contact with the 4th Division.5
 Although a few units, such as Cassidy’s, sent casualties directly to the beach, most airborne wounded went from battalion aid stations, and often from where they fell, to the clearing stations set up by their division medical companies. These companies, each of which included an attached team from the 3d Auxiliary Surgical Group, deployed in Normandy on D-

 5 This account of unit medical support is based on Surg, 82d Airborne Division, Annual Rpt, 1944, an. I, pp. 1-2; Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 2-6; Gruenberg Interv, 13 Jun 45, box 222, RG 112, NARA, and in RG 407, NARA, 82d Airborne Division Combat Intervs, box 24057, and 101st Airborne Division Combat Intervs (source of quotation), box 24072.


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Day in several echelons. An advance element of each company, with the division surgeon and the auxiliary surgical team, went in by glider around dawn with enough hand-carried and air-dropped instruments and equipment for a small emergency surgical station. The rest of the personnel with the company vehicles and the balance of the clearing station outfit, arrived during the late afternoon by glider and, in the case of the 101st Division, partly by sea.
 An advance element of the 101st’s 326th Airborne  Medical Company parachuted in with the infantry at 0100. As many of the four officers and forty-five men of this detachment as could reach their rendezvous improvised a small hospital in a French farmhouse near Hiesville, the division command post site about 5 miles from UTAH beach. The group performed first aid and emergency surgery here until well into D + 1 (7 June), when it joined the rest of the company. About two hours behind this advance group two gliders arrived carrying the 326th Company commander, Maj. William E. Barfield,  MC, and seven officers and twenty-one men, including the auxiliary surgical team, with four jeeps and trailers. Although both gliders crash-landed, painfully injuring every member of the surgical team, the men retrieved most of their gear and maneuvered around German positions toward the Chateau Colombierre, just north of Hiesville, selected on the basis of preinvasion aerial reconnaissance as the site for the division clearing station. They arrived at about 0700, just as paratroopers were driving German defenders out of the buildings.
 By early afternoon the members of the original party, reinforced by other medical officers and men who straggled in, had a rudimentary surgical hospital and clearing station in operation. Surgeons worked at three tables, as the chateau courtyard filled with casualties brought in on improvised litters, horses, and captured trucks. Living on D-bars and Benzedrine, the surgeons treated about 300 patients during the day. In the evening another glider lift of the company and the seaborne element, which had landed on UTAH, reached the chateau. But even with this reinforcement, which included Lt. Col. David Gold, MC, the 101st Division surgeon, the number of wounded arriving all but overwhelmed the staff. The surgical team leader, Maj. Albert J. Crandall, MC, recalled: “We had to maintain a careful priority system, operating on those who were most in need of surgery and giving the others emergency treatment.” In surgery, “first we did the heads and chest and next the abdomens and extremities.” 6
 An advance group of the 82d Division’s 307th Airborne Medical Company, with the division surgeon, Col. Wolcott L. Etienne, MC, and a surgical team, also went in by glider before dawn. Shrapnel from German antiaircraft fire wounded Colonel Etienne before he even touched ground; the same fire caused the gliders to overshoot their planned landing zone at Blosville near Ste.-Mere-Eglise, a

  6 Surg, 101st Airborne Division, Annual Rpt, 1944, pp. 2-3; 3d Auxiliary Surgical Group Annual  Rpt, 1944, pp. 17-19; Capt W. P. McKee Recorded Rpt, pp. 2-4. Quotation from Interv, OSG with Maj A. J. Crandall (hereafter cited as Crandall Interv), 8 Jun 45, box 222, RG 112, NARA.


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major division objective, and crash land at Hiesville. Medics were scattered in the landing and lost much equipment. Some of them, including the surgical team leader, Maj. James J. Whitsitt, MC, found their way to Chateau Colombierre, where they assisted 326th Company doctors for the rest of the day. The bulk of the 307th Company arrived in gliders near Ste.-Mere-Eglise in the late afternoon and also ran into hard luck. Many gliders plunged into flooded areas, and the landing zone came under shelling that killed the company commander. In spite of these setbacks, the company pulled itself together and had its clearing station in operation at Blosville by morning of the seventh. 7 During the first few days after D-Day the airborne division medical service lost its improvised, irregular character and gradually came to resemble that of a conventional infantry division. Both the 82d and the 101st Divisions remained fully committed to hard offensive combat, and the flow of wounded through their aid stations and clearing companies was steady and substantial. On 8 June alone the 326th Company treated and evacuated over 400 casualties. On the ninth the 326th was bombed out of its chateau, fortunately just after evacuating most of its patients. The company, however, lost 5 officers and 9 enlisted men wounded and 8 enlisted men killed, as well as much of its equipment. Obtaining new equipment and personnel replacements from VII Corps, the company resumed work the next day at a new site near Hiesyule. On D-Day the 326th Company evacuated a few wounded to the 261st Medical Battalion of the 1st Engineer Special Brigade at UTAH beach and then kept up a steady seaward flow of patients, mostly carried in Quartermaster Corps trucks (Map 7). Ambulances of the VII Corps medical battalion began evacuating the company on the ninth. The 82d Division’s clearing station had accumulated 300 patients before starting evacuation to the beach on the seventh, using borrowed trucks and ambulances, many of them from the 4th Division’s 4th Medical Battalion. The clearing company of the latter unit received, treated, and evacuated many airborne soldiers during its first days on shore; at times half the wounded passing through the infantry division clearing station were parachute and glider troops. 8
 On UTAH beach, the landing of medical units and the establishment of the initial chain of evacuation went about as smoothly as an operation could go under combat conditions. Company aidmen and battalion medical sections of the 4th Division landed first, followed closely by the nine officers and seventy-two hospital corpsmen of the 2d Naval Beach Battalion. Collecting companies of the 4th Medical Battalion came in with the regiments they supported, bringing most

 7 VII Corps Medical Plan, pp. 14-15, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Surg, 82d Airborne Division, Annual Rpt, 1944, pp. 3-4 and an. I, p. 1; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 16-17; 307th Airborne Medical Company Annual Rpt, 1944.
 8 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 65-66; VII Corps Medical Plan, p. 15, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Surg, 82d Airborne Division, Annual Rpt, 1944, an. I; Surg, 101st Airborne Division, Annual Rpt, 1944, p. 2; Medical Service, 101st Airborne Division, After-Action Rpt, 6-25 Jun 44; Crandall Interv, 8 Jun 45, box 222, RG 112, NARA.


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MAP 7:  CLEARING STATIONS AT UTAH BEACH, 6 JUNE 1944
of their thirty ambulances. In spite of day-long sporadic artillery fire, which killed a medical officer and several enlisted men on the beach, wounded the regimental surgeon of the 12th Infantry, and peppered the 4th Medical Battalion’s ambulances with shrapnel, the division medical elements rapidly moved inland. The Navy corpsmen organized two beach aid stations, collected the few casualties of the assault, and loaded on DUKWs and landing craft for movement to LSTs offshore. At about 1000 the 1st Engineer Special Brigade unit, Company C, 261st Medical Battalion, arrived on the beach, followed two hours later by Company A. These two “collecto-clearing” companies, formed by combining the litter and ambulance elements of a collecting company with a platoon from the battalion’s clearing company, set up stations at a crossroads just behind the flooded area. Their attached surgical teams began performing operations at around 1800, carrying out their mission of providing emergency surgery


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for nontransportable patients. These clearing stations evacuated few wounded to the beach during the first hours, as casualties from the airborne divisions and the 4th Medical Battalion did not start flowing back in significant numbers until the following day. Between 2100 and 2130 the VII Corps surgeon, Colonel Hayes, and the 4th Division surgeon, Lt. Col. Robert H. Barr, MC, landed with members of their staff sections.
 During the next three days VII Corps medical support expanded, as did the corps and its beachhead. The 4th Division’s clearing company, scheduled to land late on D-Day but held back in favor of additional combat units, came ashore on 7 June and went into operation at Hebert, a crossroads village just beyond the inundated area. Later the company followed the 4th northward. By the ninth two more infantry divisions—the 9th and 90th—had disembarked, each with its full medical complement. Clearing stations of these divisions opened in the general vicinity of Ste.-Mere-Eglise. The rest of the 261st Medical Battalion, meanwhile, landed on the seventh. The battalion established a medical supply depot. Its surgical teams worked around the clock to handle an increasing flow of casualties, as the divisions attacking northward and westward from UTAH met strong German opposition. Between 8 and 12 June the VII Corps’ 50th Medical Battalion disembarked. The battalion’s clearing company, besides supporting corps troops, its normal role, took part of the burden of general medical and surgical care from the 261st's companies, and its collecting and ambulance companies evacuated division clearing stations to the 261st and helped move patients from that unit to the Navy beach stations. On the ninth the Lady Connaught, first of what was to be a regular series of hospital carriers, anchored off UTAH. She discharged supplies and six additional surgical teams for the 261st Medical Battalion, allowing relief to the battalion’s original teams that had worked for 36 hours with little rest. The carrier took on board 400 wounded for the return voyage to England. As the first army field and evacuation hospitals opened on 10 and 11 June, the VII Corps medical service was well into the transition from an amphibious to a conventional land organization and system of support. 9
 On OMAHA the story was different. This beach, about 5 miles from end to end, consisted of a tidal flat bordered at the high water mark by an embankment of loose stones, called shingle, backed on the eastern portion by sand dunes and on the western by a wooden seawall 4-5 feet high. At varying distances from the shingle, usually 200-300 yards, rose low bluffs, too steep to be negotiated by vehicles except through five draws that the Germans had mined and blocked with obstacles. The defenders, entrenched on and in front of the bluffs in pillboxes and machine-gun nests, met the first assault waves with

 9 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 65-67 and 96; Surg, First U.S. Army, Annual Rpt, 1944, p. 33; VII Corps Medical Plan, pp. 13-17, encl. 1 to Surg. VII Corps, Annual Rpt, 1944; Dowling, Normandy Rpt, 11 Jan 45, pp. 17-18; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 13 and 20; 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA; 50th Medical Battalion Annual Rpt, 1944, pp. 2-3.


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MEDICS ADMINISTERING FIRST AID TO INVASION CASUALTIES ON UTAH (TOP) AND OMAHA (BOTTOM)


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heavy fire. As the landing craft nosed into shore, German machine-gun nests cut down many Americans before they even left the bow ramps and others as they struggled across the tidal flat. Artillery shells sank, set on fire, or blew up one landing craft after another. Wading and crawling across the sand, pushed by the now rising tide, dragging their wounded, and losing or abandoning weapons, radios, and equipment, the assault troops sought cover from the searching fire behind the seawall and shingle pile. The American units took their heaviest losses of the day in this movement up to the high water line; one 16th Infantry company suffered most of its 105 D-Day casualties here. Exhausted from seasickness and the struggle ashore, the survivors tried to clear sand-clogged weapons, to rescue and tend wounded, to demolish beach obstacles, and to cut the barbed wire the Germans had laid along the shingle pile.
 Troops and vehicles of the first and subsequent landing waves remained bunched along the high water line for much of the day. Around 0800 small intrepid groups began pushing across the beach to the foot of the bluffs and then working their way up the hills. One by one, they eliminated German strongpoints, aided after about 1030 by point-blank naval gunfire. Landing of reinforcements, temporarily halted when high tide covered the beach obstacles, resumed when landing craft commanders discovered that they could ram through safely. During the afternoon the trickle of men across the beach and over the bluff became a flood. The arrival of two additional infantry regiments gave still more momentum to the inland drive. As darkness fell, the infantry had partially secured the objective towns of Vierville on the western end of the beach, St.-Laurent in the center, and Colleville on the east. The engineers, using what equipment they could salvage, cleared mines, bulldozed openings for vehicles through the shingle opposite several of the beach exit draws, and began developing roads through the draws themselves. 10
 The near-catastrophe of D-Day morning and the resulting delay of the advance inland telescoped the elaborately sequenced arrival of medical units. Organizations landed off schedule and on the wrong beach sectors, often losing much of their equipment. Regardless of type or intended function, each unit and detachment, as it plunged into the welter between the low tide line and the bluffs, dissolved into scattered groups of men, working desperately under fire to drag wounded to places of relative safety, to give first aid, and to salvage supplies.
 The battalion and regimental medical sections and attached divisional collecting companies of the 16th and 116th Regimental Combat Teams, closely followed by the officers and hospital corpsmen of the 6th and 7th Naval Beach Battalions, came ashore early in the morning, just after the first assault companies had been shot to pieces. The medical soldiers took their share of casualties. The 2d Battalion, 116th Infantry, lost five aidmen, killed leaving their landing craft, and its surgeon, wounded on

 10 This account is based on 1st Infantry Division Combat Intervs, box 24011, and 29th Infantry Division Combat Intervs, box 24034, RG 407, NARA.


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the beach by shrapnel. Other medics quickly fell as they tried to drag casualties out of the rising water. As German artillery blasted the landing craft, medical supplies went up in flames or disappeared under the waves; the 116th Infantry lost its entire regimental supply of plasma in
two LCIs (landing craft, infantry) sunk off the beach. 11
 Maj. Charles E. Tegtmeyer, MC, regimental surgeon of the 16th Infantry, who landed at about 0815, described what faced those medical troops who survived the wade and crawl through the obstacles to the shingle pile:
 The shelf on which I rested was about ten yards in width sloping upward from the water’s edge to a height of from two to ten feet at an angle of roughly 35 degrees. Face downward, as far as eyes could see in either direction were the huddled bodies of men living, wounded and dead, as tightly packed together as a layer of cigars in a box. Some were frantically but ineffectually attempting to dig into the shale shelf, a few were raising themselves above the parapet-like edge and firing toward the concrete protected enemy and those on the cliff above but the majority merely huddled together face downward. Artillery . . . and mortar shells exploded on the beach and in the water . . . and threw fragments in all directions. Uncomfortably close, overhead, machine gun and rifle bullets grazed the top of the ledge . . . and plunged into the water behind us with innumerable sharp hisses or whined away in to the distance as they richocheted off the stones of the beach. At the water’s edge floating face downward with arched backs were innumerable human forms eddying to and fro with each incoming wave, the water above them a muddy pink in color. Floating equipment of all types like flotsam and jetsam rolled in the surf mingled with the bodies. . . . Everywhere, the frantic cry, ‘Medics, hey, Medics,’ could be heard above the horrible din. 12
 Among the company aidmen on OMAHA, heroism was the only standard procedure. Under the punishing fire, often themselves wounded, these soldiers worked up and down the shingle pile, bandaging, splinting, giving morphine and plasma if they had any. Many ventured repeatedly back into the water to pull in the disabled and drowning or to retrieve medical supplies. Others went into minefields to carry out injured men. A 29th Division staff officer with 116th Infantry recalled: “First-aid men of all units were the most active members of the group that huddled against the seawall. With the limited . . . facilities available to them, they did not hesitate to treat the most severe casualties. Gaping head and belly wounds were bandaged with the same rapid efficiency that was dealt to the more minor wounds.” As the infantry filtered in to the base of the bluff, the medics took additional risks to drag wounded to the shelter of the hill. Paradoxically, most evacuation on OMAHA in these first hours was forward, toward the enemy. 13

 11 For overviews of D-Day medical operations on OMAHA, see First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 62-63; Surg, V Corps, Annual Rpt, 1944, pp. 2-3; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 9. For medical losses in the initial assault, see 1st Infantry Division Combat Intervs, box 24011, and 29th Infantry Division Combat Intervs, box 24034, RG 407, NARA.
 12 Col Charles E. Tegtmeyer, MC, “Personal Military Diary” (hereafter cited as Tegtmeyer “Diary”), pt. 1, ch. 20, pp. 1-5.
 13 Quotation from Lt. Jack Shea, D-Day Narrative, in 29th Infantry Division Combat Intervs, box 24034. See also other company narratives in this collection and in the 1st Infantry Division Combat Intervs, box 24011. All in RG 407, NARA.


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 The work of Major Tegtmeyer and his 16th Infantry medical section typified the character of regimental medical support on OMAHA. 14 Landing with the regimental commander, Col. George A. Taylor, and his staff on Easy Red sector, the left center of the beach, Tegtmeyer and his aidmen followed the command group back and forth along the shingle pile as Taylor tried to organize an advance toward the bluffs. The medical soldiers, now wading, now stumbling over prone men, bandaged and splinted wounded as they came upon them, then left them in the shelter of the embankment with instructions to call for help and evacuation to incoming landing craft. “I examined scores as I went,” Tegtmeyer declared, “telling the men who to dress and who not to bother with.”
 At around 1040 the medical section followed the rifle companies off the beach and set up an aid station near the regimental command post, dug into the seaward slope of the bluff, which sheltered them from direct enemy fire. The group used what supplies they had carried ashore, plus two litters and some other materiel they picked up on the beach. Troops from the first waves were still thick on the shore below Tegtmeyer’s position, and landing craft kept bringing in more under shelling that steadily added to the number of dead and wounded littering the sand. Tegtmeyer sent aidmen down to the beach and along the bluff to collect casualties and by nightfall had over eighty wounded at his station. Running low on blankets and plasma, he secured more from a passing battalion of the newly landed 26th Infantry, the commander of which he knew. Even with these supplies, men came in that emergency care could not save, such as the infantryman with one leg traumatically amputated and multiple compound fractures of the other. “He was conscious and cheerful,” Tegtmeyer reports, “but his only hope was rapid evacuation, and at this time evacuation did not exist. An hour later he was dead.”
 Around 2200 an auxiliary surgical team, which had become separated from its engineer special brigade, reached Tegtmeyer’s position, but the surgeons lacked equipment and did little but dig foxholes for shelter against the continuing artillery bombardment. More useful were the twelve litterbearers of Company A, 1st Medical Battalion, the 16th Infantry’s attached collecting company, who appeared with their commander, Captain Ralston, shortly after the surgical team. This company was scheduled to land with the regiment in the morning, but enemy guns had set their landing craft on fire during two unsuccessful attempts to beach. Ralston and his men had worked heroically, rescuing soldiers and sailors from burning holds and compartments and treating the injured who encumbered the decks. After the craft limped seaward to a transport and unloaded its casualties, Ralston rallied his tired, shocked company; got them onto another craft; and disembarked them on OMAHA at about 1700. Then

 14 This account is based on Tegtmeyer “Diary,” pt. 1, ch. 20, pp. 5-15, from which the quotations come; Rpt, Maj. Charles E. Tegtmeyer, sub: Activities of Medical Detachment, 16th Infantry, and Company A, 1st Medical Battalion, After-Action Rpt, both in 1st Infantry Division Combat Intervs, box 24011, RG 407, NARA.


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he and part of his command found their way to Tegtmeyer.
 With the help of Ralston’s litter-bearers Tegtmeyer began moving his patients down to the beach, the ambulatory cases walking and the rest laboriously carried on litters. All but about ten of the most severely injured arrived at the beach station the Navy now had in operation before renewed shelling halted the evacuation. Because no more landing craft were coming in, the wounded on the beach stayed there all night, tended by Navy corpsmen. Tegtmeyer’s group and the remaining patients spent a cold, damp night in foxholes, during which time four more of the injured died.
 During the early afternoon the engineer special brigade medical battalions began landing. Both special brigades—the 6th, responsible for organizing the western half of OMAHA behind the 116th Infantry; and the 5th, in charge of the eastern half behind the 16th Infantry—were formed into battalion beach groups for the assault, with a group attached to each regimental combat team. Each beach group included one or more companies from the brigade medical battalion. The 6th Brigade's 60th Medical Battalion was organized conventionally in one clearing and three collecting companies; its 500th Collecting Company and a platoon of the 634th Clearing Company came ashore with the battalion beach group supporting the 116th Infantry. The 5th Brigade’s 61st Medical Battalion, like its UTAH beach counterpart, had formed three provisional collecto-clearing companies. Of these, the 391st Collecto-Clearing Company landed first, behind the 16th Infantry. Each clearing and collecto-clearing company had attached teams of the 3d Auxiliary Surgical Group. Besides the clearing station and operating room equipment packed into their trucks, each company went in heavily laden with hand-carried supplies. Men of the 61st's 393d Collecto-Clearing Company, for example, landed with mortar shell casing containers and waterproofed dufflebags filled with dressings, bandages, tourniquets, sulfa powder, and plasma. Every litterbearers took along an extra litter with a life belt attached, to float the litter ashore if he lost hold of it. 15
 During D-Day these medical battalions were only partially able to perform their evacuation tasks, and they could not undertake emergency surgery at all. For the most part, their officers and men simply joined in the general effort at casualty collection, first aid, and supply salvage. Such was the fate of the small advance party of the 60th Medical Battalion, which landed at 0855 on Easy Green sector below St.-Laurent, to reconnoiter a previously selected clearing station site. German troops still controlled the site, and the officer and enlisted men of the advance party worked all day with regimental and Navy medics along the beach. Between 1400 and 1500 the bulk of the 500th Collecting Company and part of the 634th Clearing Company came ashore on

 15 For the assault, the 5th Brigade had operational control of all 6th Brigade elements, even as the 1st Division controlled the first 29th Division elements on shore. When the brigade group headquarters landed, which occurred late on D-Day, 6th Brigade units reverted to control of their parent brigade. See Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 36-38 and 327-28; 61st Medical Battalion Annual Rpt, 1944, pp. 1-6; 393d CollectoClearing Company Annual Rpt, 1944, p. 8.


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Easy Green. The units lost men and equipment on the way in. Casualties included Lt. Col. Bernard E. Bullock, MC, the battalion commander, who landed with the 500th Company, only to be mortally wounded within minutes. Men of these two companies spread out along most of the western half of OMAHA, setting up casualty collecting points and helping Navy beach detachments load evacuation craft. Late in the day the 634th Company platoon, which had managed to land a truckload of ward and operating room equipment, moved off the beach through exit D-3 and set up an aid station part way up the draw toward St.-Laurent. 16
 Due to a breakdown of the landing sequence, the first men of the 61st Medical Battalion to wade ashore on Easy Red sector at about 1345 were members of the headquarters detachment. They landed with typewriters, files, and office supplies on a beach still strewn with dead and wounded. Putting this materiel aside (they later managed to save the battalion records), the headquarters men scavenged for medical equipment and went to work on the casualties around them. Around 1400 the 391st Collecto-Clearing Company, which should have landed before the headquarters element, came in on Easy Red and set up a dressing station in a captured pillbox; this unit also had to rely on hand-carried and scavenged equipment, as its heavy gear remained on board ship. A couple of hours later the 393d Collecto-Clearing Company disembarked with the 18th Infantry, far to the right of the 391st and almost in the 6th Brigade sector. This company set up a collecting station in an antitank ditch under the bluff northeast of St.-Laurent. These companies, and the 61st Battalion headquarters, suffered five enlisted men killed and five officers and twenty men wounded on D-Day. 17
 Forward emergency surgery never got started on OMAHA during the first twenty-four hours. Of twelve teams attached to the 60th and 61st Medical Battalions, eight succeeded in reaching shore between 1130 and 1730, after various harrowing adventures on board misdirected, damaged, and sunk landing craft. Invariably, they arrived on the beach without operating equipment. Even if they reached their assigned collecto-clearing and clearing companies, they could do little but pitch in with everyone else in basic first aid, evacuation, and salvage. The Provisional Engineer Special Brigade Group commander commented that, although the auxiliary surgeons “did heroic work on D-Day and D+ 1, their skill probably was not put to its greatest use.” 18
 Throughout the day the naval beach medical sections, aided during the afternoon by the engineer special brigade companies, tried to keep wounded moving off the beach onto landing craft. Enemy fire, the inability of craft to approach some Sectors of the beach, and the reluctance of some

 16 Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 328-29; 60th Medical Battalion Annual Rpt, 1944, pp. 5-6, 8-9, 15.
 17 Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 329-31; 61st Medical Battalion Annual Rpt, 1944, pp. 4-5, 10-11, app. 3.
18 Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, p. 334; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 13-14 and 22-29; Tegtmeyer “Diary,” Pt. 1, ch. 20, p. 11.


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MEN AND EQUIPMENT IN SUPPORT OF THE NORMANDY BUILDUP. Troops, with medical evacuation vehicles, enter Carentan, and ambulances disembark across a beach.


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crews to stay exposed near shore long enough to load, limited seaward evacuation and in many places prevented  it entirely. By the end of the day medics had cleared about 830 casualties off the beach. Hundreds more remained, huddled under blankets at collecting points or still lying where they fell. Long after sunset, carrying parties and a few ambulances continued to seek and pick up wounded. 19
 During D + 1 (7 June) the organization’s two companies that had landed on D-Day gradually assembled or finished bringing ashore their men and equipment and began performing more or less their intended functions (Map 8). Regimental and battalion aid stations and collecting companies of the 1st  and 29th Divisions evacuated their accumulated casualties to the beach and headed inland with their units. Early in the morning the 1st Medical Battalion’s clearing company, which had landed late on D-Day, opened its station on the bluffs northeast of St.-Laurent. Reinforced with two auxiliary surgical teams sent up by the 61st Medical Battalion, this station was one of the first facilities on OMAHA able to operate on nontransportable cases. The 29th Division, on the other hand, had to rely for clearing for several days on the 60th Medical Battalion, as the clearing company of the division’s 104th Medical Battalion was slow to disembark its equipment and could not begin work until 12 June. Most of the 60th Medical Battalion came ashore on the seventh. Its collecting companies helped Navy elements remove dead and evacuate casualties from the western half of  OMAHA. In the afternoon the 634th Clearing Company opened a station just northwest of St.-Laurent, where its attached surgical teams began operating at about 2000 under generator-powered lights. The 61st Battalions on the eastern half of OMAHA, still unable to bring  most of their equipment ashore, continued to function as aid and collecting stations.
 
 Colonel Brenn, the V Corps surgeon, had landed on D-Day with part of his section, losing most of his personal equipment and office records in the process. On the seventh he toured his units on foot, finding most of them short of men and materiel but doing their best with what they had. Evacuation to the beach and seaward, Brenn reported, was proceeding “in dribbles,” but with “no stagnation.” Part of the 1st Medical Depot Company arrived with supplies, which it and the special brigade units began organizing into rudimentary dumps. At 1900 the hospital carrier Naushon, anchored off the beach, unloaded  a stock of whole blood for the clearing stations and took wounded on board. The vessel remained overnight, its surgeons operating on emergency cases, and sailed for England on the eighth. 20

 19 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 62-63, estimates the number evacuated. See also Dowling, Normandy Rpt, 11 Jan 45, p. 16, and Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 88 and 331. For firsthand views, see Maj Gen C. H. Gerhardt, “Battle Lessons and Conclusions”; and Lt. Jack Shea, Narrative, both in 29th Infantry Division Combat Intervs, box 24034, RG 407, NARA.
 20 Quotation from Surg, V Corps, Annual Rpt, 1944, pp. 2-3. See First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 63; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 9; Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, p. 333; Tegtmeyer “Diary,” pt. 2, ch. 1, pp. 1-6;  60th Medical Battalion Annual Rpt, 1944, pp. 6-9, 12, 15-16; 104th Medical Battalion After-Action Rpt, June 1944; 1st Medical Battalion After-Action Rpt, May-June 1944, box 5966, RG 407, NARA.


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MAP 8:  CLEARING STATIONS AT OMAHA BEACH, 7 JUNE 1944
 During the period 8-11 June, as the advance gathered momentum, the V Corps medical service fully assumed its planned shape, and its operations displayed increasing regularity. Division clearing stations moved inland. The ambulance platoons of the engineer special brigades and of the V Corps, 53d Medical Battalion, which disembarked between the seventh and the ninth, transported wounded over the increasing distance separating the divisions and beach clearing stations. On the eleventh, as the evacuation network expanded, Colonel Brenn and the medical section moved with the corps command post from St.-Laurent to La Poterie, about 5 miles deeper in the Norman countryside. Back at the beach the 60th and 61st Medical Battalions, no longer under enemy harassment except for ineffectual night air raids, brought their remaining men and equipment ashore and developed into full-fledged clear-


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ing and emergency surgical facilities. The 60th Battalion clearing station stayed near St.-Laurent, and the three 61st Battalion companies one by one moved up from the beach onto the bluffs east of that town. These movements, and a consolidation of naval shore medical activities, established a single line of seaward evacuation across roughly the center of OMAHA beach. By 11 June over 3,160 patients had passed through this chain of evacuation. 21
 The NEPTUNE medical planners concentrated on two objectives in their arrangements for supporting the initial assault: the provision of emergency surgery on the far shore during the first hours of combat, and the early and complete seaward evacuation of the wounded. Measured by these objectives, medical results on D-Day were mixed. The First Army’s decision to place as much consumable medical materiel—splints, litters, blankets, plasma, morphine, and other such items—as possible on shore with the first troops in a wide variety of packaging and means of transportation proved to be a lifesaver, in the most literal sense of the term. Even medics who reached dry land with little more than the clothes they stood up in seem to have been able to pick up on the beach or, in the airborne, scattered in the fields, enough supplies to do their jobs. Further, the ability of Medical Department officers and men to take individual initiative and improvise in carrying out their missions amid great danger and confusion testified to the effectiveness of the months of preattack training and indoctrination, both military and medical.
 On the other hand, especially on heavily contested OMAHA, evacuation and forward surgery arrangements came near collapse. The tactical situation restricted early loading of wounded on landing craft and prevented the auxiliary surgical teams from doing any more than could have been done by battalion medical officers and company aidmen. The commanders of the engineer special brigade group and the 61st Medical Battalion later criticized the rigidly scheduled landing of surgical teams and clearing companies, arguing that it had resulted in the unproductive exposure to danger of valuable specialists and equipment. Instead, they suggested, the clearing companies and attached teams should have been held on vessels offshore, to be called in when beach conditions permitted orderly disembarkation and the immediate performance of their intended functions. In the meantime a few companies and teams could have staffed shipboard surgical facilities for care of wounded brought out to them in landing craft. 22
 Whatever the merits of these suggestions, experience on OMAHA— where casualties, though heavy, still were fewer than planners had antici-
 
  21 U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 63-65 and 69; Dowling, Normandy Rpt, 11 Jan 45, p. 4; Surg, V Corps, Annual Rpt, 1944, Pp. 3-7; 53d Medical Battalion Annual Rpt, 1944, pp. 4-5; Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 333-34; 60th Medical Battalion Annual Rpt, 1944, pp. 6-7, 9-10, 12-14; 61st Medical Battalion Annual Rpt, 1944, p. 5; 104th Medical Battalion After-Action
Rpt, June 1944.
 22 Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 334 and 337-38; 61st Medical Battalion Annual Rpt, 1944, pp. 5-6.


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pated, and where, after the coastal assault, the rapid collapse of German resistance allowed early organization of the beach—did much to substantiate the fears of General Kenner and other officers that untreated, unevacuated wounded would pile up on the far shore. In summary, the medical service on D-Day benefited from careful planning and meticulous preparation, but the success achieved also owed much to individual courage and competence, and to good fortune.
First Army Medical Buildup
 Between the linkup of the beachheads on 10-11 June and the end of July, reinforcements enlarged the First Army to over 437,000 officers and men in eighteen divisions and four corps. So augmented, the army fought a hard, costly battle to take Cherbourg, to expand its continental lodgement, and to break out toward Brittany and the interior of France. In this same period the army medical service brought all of its elements into Normandy, completed its organization, and treated and evacuated a constant flow of casualties (see Map 9).
 Tactically, the First Army shifted its strength and most of its offensive effort to its right wing while holding its ground on the left. Inland from OMAHA, the V Corps, reinforced after 13 June by the XIX, pushed forward about 20 miles and then stood fast. Meanwhile, in the Cotentin, the heavily reinforced VII Corps drove on Cherbourg, the Americans’ most important early objective of the campaign. That major port fell on the twenty-sixth, after a stubborn German defense. With the harbor obstructed and the wharves damaged, full use of the port by the Allies was delayed for many weeks.
 After the capture of Cherbourg, the First Army redeployed its Cotentin forces southward. On 3 July most of the army attacked into the swamp and hedgerow country at the base of the peninsula, with the objective of gaining roads and open ground for an armored breakout. This offensive led to bitter, apparently inconclusive fighting. The Germans, prevented by Allied air power and French partisans from massing for a major early counterattack on the beaches, nevertheless stiffened their line with a steady stream of infantry and armor. Taking advantage of very favorable defensive terrain and of rainy and cloudy weather, which limited Allied air support, the Germans fought to confine their more mobile foes within a narrow perimeter. When the so-called Battle of the Hedgerows ended on the nineteenth, with the American capture of the key road center of St.-Lo, it seemed as though the Nazis had succeeded. They had restricted the First Army to a maximum advance of 7 miles, at the cost of about 40,000 casualties. In this offensive, and indeed in the entire campaign thus far, the Americans, and the British (who were stalled around Caen), fell far short of their planned objectives. Their continental lodgement at the end of July included only a fraction of the territory that NEPTUNE planners had expected to hold by that time. The Germans, however, also lost heavily in the Cotentin and the hedgerows; their defensive crust had worn very thin and was ready to crack, if the Allies


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MAP 9: BATTLE FOR NORMANDY, 6 JUNE-26 JULY 1944

could pierce it with a hard enough blow. 23
 As the Normandy battle expanded, medical reinforcements flowed in across OMAHA and UTAH beaches. The first medical units not attached to corps, divisions, or engineer special brigades to arrive, First Army Medical Detachments A and B, disembarked respectively at OMAHA and UTAH on 8 and 9 June, having crossed the Chan-

 23 This account of tactical developments is drawn from Harrison, Cross-Channel, chs. IX-X, and Martin Blumenson, Breakout and Pursuit, United States Army in World War II (Washington, D.C.: Office of the Chief of Military History, Department of the Army, 1961), chs. I-IX.


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nel on hospital carriers. Each detachment included station and litter platoons of two separate collecting companies, six teams of the 4th Auxiliary Surgical Group, a platoon of a supply depot company, headquarters personnel of a medical group, and liaison officers from various medical and nonmedical commands. The collecting elements and surgical teams, and many of the other medical officers, temporarily replaced assault casualties in the divisions or reinforced the special brigade clearing stations. The group staff and liaison officers made plans for landing and setting up hospitals and other facilities and arranged for engineers to clear selected sites and prepare them for occupation. On the ninth the army surgeon, Colonel Rogers, and an advance party of his staff landed on OMAHA and established themselves at the First Army forward command post near Grandcamp-les-Bains. Rogers at once began a round of inspections and conferences with his corps surgeons, but temporarily left those officers in charge of all medical activities. 24
 The first field hospitals came ashore on 7 and 8 June, the 13th and 51st at OMAHA and the 42d and 45th at UTAH, bringing with them the first Army nurses to enter the beachhead. After collecting their equipment, scattered in landing on the congested and as yet only partially organized beaches, these units went into operation near the coast on the tenth and eleventh. The engineer special brigade clearing stations subsequently transferred their auxiliary surgical teams to them. So reinforced, the field hospitals took over performance of most emergency surgery. During their first days on shore they functioned as evacuation hospitals, receiving and treating all types of patients.
 Even as the field hospitals were opening, the first evacuation hospital in Normandy, the 128th, disembarked at UTAH beach on 10 June and set up the next day near Boutteville, about 6 miles from the coast. Other evacuation hospitals followed at both beaches until, at the end of June, the First Army had fourteen 400-bed units in operation. The evacuation hospitals behind V and XIX Corps were concentrated around Le Cambe, just east of Carentan, and at Le Molay, well forward toward the advance V Corps positions around Caumont. Those supporting VII and VIII Corps moved more frequently during the first weeks of fighting, advancing northward up the highways toward Cherbourg and westward across the Cotentin. As the evacuation hospitals arrived, the field hospitals assumed their intended role, attaching separate platoons to division clearing stations to care for nontransportable wounded. 25

 24 Surg, First U.S. Army, Annual Rpt, 1944, pp. 30 and 33; First U.S. Army Rpt of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 64 and 70-71; Surg, V Corps, Annual Rpt, 1944, p. 4; 68th Medical Group Annual Rpt, 1944, pp. 4-5.
 25 Surg, First U.S. Army, Annual Rpt, 1944, pp. 105-06; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 67-69, 96-97, 104; Surg, V Corps, Annual Rpt, 1944, pp. 4-8; VII Corps Medical Plan, pp. 16-22, end. 1 to Surg, VII Corps, Annual Rpt, 1944; 60th Medical Battalion Annual Rpt, 1944, pp. 10-11; 13th, 45th, and 51st Field Hospitals Annual Rpts, 1944; 5th, 24th, 41st,  91st, and 128th Evacuation Hospitals Annual Rpts, 1944.


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NURSES OF THE 13TH FIELD HOSPITAL, first to land in Normandy to tend the wounded, take time out for a meal
 Still more hospitals entered Normandy during late June and the July weeks of hedgerow fighting. The First Army convalescent hospital, the 4th, disembarked in two detachments, beginning on 24 June, and opened at Le Cambe. As the army expanded beyond its planned strength of three corps, the theater reinforced it with one field and eleven evacuation hospitals, temporarily transferred from the Third Army and intended to revert to that army when it finally went into operation. All of these units deployed between 26 June and 1 August. 26
 As hospitals came ashore on and after D-Day, so did elements of the First Army’s three medical groups—the 31st, 68th, and 134th. Rogers organized the 31st and 68th primarily for evacuation, assigning to them three medical battalion headquarters each and all of his separate collecting and ambulance companies, and the 134th primarily for a variety of tasks, assigning to it two battalion headquarters and all of his clearing companies. Between 10 and 23 June the 31st and 68th Medical Groups and their attached units disembarked respectively at UTAH and OMAHA. Each group deployed to control and conduct evacuation for a wing of the army, the 68th supporting the V and XIX Corps and the 31st the VII and

 26 4th Convalescent Hospital Annual Rpt, 1944, p. 1; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 72.


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VIII. During the same period the 134th Medical Group landed on UTAH. Its 622d Clearing Company, specially trained for this mission, on the seventeenth opened holding and treatment units for neuropsychiatric casualties at Bernescq in the OMAHA sector and at Ste.-Mere-Eglise in the Cotentin. Other clearing companies reinforced field and evacuation hospitals and division clearing stations, and one set up an air evacuation holding unit at  Ste.-Mere-Eglise. 27
 The army medical supply system also developed, following the general pattern of temporary beach dumps during the first week on shore and then establishment of more permanent, thoroughly organized depots inland. On D-Day and in the days immediately thereafter, elements of the 1st Medical Depot Company, reinforced with portions of the 31st and 32d Medical Depot Companies, temporarily attached respectively from the Advance Section and the Third Army, landed at OMAHA and UTAH. They issued supplies from improvised beach dumps near the engineer special brigade clearing stations and then set up depots in open fields a short distance inland, at St.-Laurent, Colleville, and later Le Molay behind OMAHA and at Le Grand Chemin behind UTAH. Initially, the companies stocked their dumps with salvage from the invasion flotsam on the beaches. The first scheduled medical maintenance units arrived on OMAHA on 7 and 8 June, but were lost when the tide came in and engulfed them before they could be dragged to the beach. On UTAH, as the result of early difficulties in discharging cargo, no significant amount of medical supplies came ashore until the twelfth. Supply deliveries soon increased in volume and regularity, however, as the engineers by the end of the second week in France brought cargo flow over both beaches up to over 95 percent of its planned tonnage rate. Even the storm of 19-22 June, which wrecked or beached numerous landing craft and destroyed the artificial harbor at OMAHA, only temporarily disrupted the accelerating influx. To receive, store, and issue the medical supplies arriving in such volume, the ADSEC 31st Depot Company on the thirtieth opened a new rear facility at Longueville to replace those at St.-Laurent and Colleville, while a section of the 1st Depot Company on 17 July set up an advance dump at Lison junction, convenient to the units battling for St.-Lo. 28
 Well before all these units were in place, Colonel Rogers established centralized control of First Army hospitalization, evacuation, and medical supply. Between 12 and 19 June, after the headquarters and sufficient companies of his medical groups had landed for immediate operations, Rogers relieved the V and VII Corps surgeons of responsibility for all med-

 27 VII Corps Medical Plan, p. 22, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; 31st, 68th, and 134th Medical Groups Annual Rpts, 1944.
 28 For a general view of the supply situation, see Ruppenthal, Logistical Support, 1:391-422, 439, 464-74; Harrison Cross-Channel, pp. 422-23; Supply Division, OofCSurg, HQ ETOUSA, Annual Rpt, sec. II, pp. 7-8; Surg, First U.S. Army, Annual Rpt, 1944, p. 14; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 76; Surg, V Corps, Annual Rpt, 1944, pp. 4 and 8; VII Corps Medical Plan, pp. 18-19, end. 1 to Surg, VII Corps, Annual Rpt, 1944; 1st and 32d Medical Depot Companies Annual Rpts, 1944; Wiltse, ed., Medical Supply, pp. 307-13.


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ical support to the rear of the divisions. Evacuation, field, and convalescent hospitals and supply depots now reported directly to the army surgeon. His office, through the 31st and 68th Medical Groups, directed the flow of patients from division clearing stations to the beaches. On the twenty-first, deviating slightly from the NEPTUNE plan, Rogers put into effect a ten-day evacuation policy, allowing retention in France of many sick and lightly wounded men hitherto sent back across the Channel. 29
 During the first two months of the campaign, the buildup of the First Army medical service went essentially according to the NEPTUNE plan. By the end of the period over 35,000 army medical people were on shore. For them, and for the organization to which they belonged, these early summer weeks of activity—the first combat experience for the majority of personnel and units—provided a test of doctrine and training, taught practical lessons, brought forth field improvisations, and revealed certain anticipated and unanticipated problems.

Cherbourg and the Hedgerows
 During the fighting for Cherbourg and St.-Lo, First Army medical units admitted 95,172 Army personnel; they returned 22,639 of these patients to duty, evacuated 60,317 to the United Kingdom, and lost 2,027 to death. Sick men, including neuropsychiatric patients, accounted for almost 27 percent of these admissions, soldiers with nonbattle injuries for 8 percent, and combat wounded for the rest. Of the 60,279 battle casualties, the majority received their injuries from shell and bomb fragments, most often in the arms and legs—a pattern of causative agents and anatomical locations similar to that in other theaters—and over one-third suffered multiple wounds (Chart 8). 30
 Throughout the drive to Cherbourg and the struggle among the hedge-rows, about 90 percent of all battle casualties occurred in the infantry rifle companies. For the company aidmen and battalion and regimental surgeons who first cared for these injured, as for the riflemen they accompanied, the Normandy hedgerows became the dominant fact of life, and too often of death. These earthen banks, overgrown with trees and brush, crisscrossed most of the countryside outside the marshes, transforming roads into sunken lanes ideal for ambush and breaking up the landscape into easily defended terrain compartments that had to be cleared one at a time by teams of tanks and riflemen. Each 100- or 200-yard-long rectangle of plowed ground, pasture, or orchard had its price in American dead and wounded. In five days of fighting during the July offensive one 4th Division regiment, the 22d Infantry, suffered 729 casualties, including

 29 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 70-71 and 87-91; VII Corps Medical Plan, pp. 18-19, 22-23, 25, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Surg, V Corps, Annual Rpt, 1944; 31st Medical Group Annual Rpt, 1944, p. 8.
 30 In addition to U.S. soldiers, the army hospitals admitted 337 U.S. Navy men, 486 Allied personnel, 6,207 enemy POWs, and 812 civilians. For statistics, see: First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, apps. 11, 17, 26, and 29; VII Corps Medical Plan, p. 29, end. 1 to Surg, VII Corps, Annual Rpt, 1944; Medical Bulletins, 2d Infantry Division, June and July 1944, box 388, RG 112, NARA.


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CHART 8—CAUSES AND LOCATIONS OF WOUNDS, BATTLE OF NORMANDY, JUNE-JULY 1944


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a battalion commander, a battalion executive officer, and five rifle company commanders. In one rifle company, stated a division report, there were “only five noncoms left who had been with the company more than two weeks. Four of these according to the first sergeant were battle exhaustion cases and would not have been tolerated as noncoms if there had been anyone else available.” 31
 In this environment company aidmen who survived for any length of time acquired many skills and learned many lessons very quickly. They mastered the art of going over hedgerows low and fast. Instead of jumping up and running under fire at the first cries of “Medics,” they learned to wait for a lull and then crawl to their objectives. Once an aidman reached group of wounded, he had to make an instant decision as to who were beyond any help, who could help themselves, and who would benefit most from medical intervention. “We soon figured out,” a 30th Infantry Division medic recalled,
that our most useful . . . aids were compresses and morphine. We usually used the individual soldier’s sulfa powder and compress. Tourniquets were very rarely used to control bleeding, since most wounds were puncture[s] . . . and bled very little or were amputations or hits caused by hot and high velocity shell or mortar fragments which seared the wound shut.
 Aidmen discarded much equipment, found to be unnecessary, and discovered unplanned use for other items. The carriers for thrown-away gas masks conveniently held extra compresses. A patch cut from the tail of a raincoat, applied with the compress to a sucking chest wound, helped keep respiration from drawing in dust and dirt. Bandage scissors also could cut through clothing, and carrying an extra pair proved to be worthwhile. 32
 With an extensive, if tortuous, road network behind the front, and with most medical service jeeps equipped with litter brackets, division surgeons early discovered that almost all evacuation to the rear of the battalion aid stations could be done by motor vehicles. This was fortunate, because some divisions, to avoid medical personnel casualties from artillery and mortar fire, placed their battalion aid stations as far as 1.5 miles behind their forward elements and their collecting stations, correspondingly, as much as 5 miles farther to the rear. Collecting company litter platoons, in a departure from doctrine, worked almost entirely forward of the battalion aid stations, functioning in effect as part of the unit medical detachments and often under operational control of the battalion surgeons. Even with the collecting company squads available for relief and reinforcement, litterbearers were in chronically short supply in the infantry regiments. Casualties and exhaustion, both physical and emotional, further thinned their ranks. An

 31 Quotation from “Operation 4th Division between Carentan and Perriers, 6-15 July 1944,” in 4th Infantry Division Combat Intervs, box 24020, RG 407, NARA. For general descriptions of hedgerow terrain and combat, see Harrison, Cross-Channel, p. 284, and Blumenson, Breakout and Pursuit, pp. 12-13 and 40-45.
 32 Quotation from Bradley, Aid Man, p. 51. See also ibid., pp. 48-70; Tegtmeyer “Dairy,” bk. II, pp. 15-16.


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INFANTRYMEN IN ACTION IN THE HEDGEROWS
aidman recalled: “I have picked up a litter with a wounded man on it and had my fingers uncurl from the handles, even though I was exerting all my willpower to keep my hands closed.” For extra litterbearers during heavy, sustained combat, divisions regularly had to draw upon collecting companies of the corps medical battalions and army medical groups, or they temporarily drafted infantrymen for the additional duty—an especially unsatisfactory solution when the rifle companies were themselves under-strength from battle losses.33
 The hedgerow fighting imposed special strains on the first-echelon medical service of the armored divisions, principally the 2d and 3d. These divisions, instead of operating in concentrated mobile combat com-

 33 Quotation from Bradley, Aid Man, p. 59. See Surg, First U.S. Army, Annual Rpt, 1944, p. 79; Surg, VIII Corps, Annual Rpt, l944, p. 5; Surg XIX Corps, Annual Rpt, 1944, encl. 14 and an. E, p. 1; Memo, CO, 104th Medical Battalion, to Surg, Ninth Army, 12 Jun 45, sub: Division Medical Service, box 355, RG 112, NARA; Medical Bulletins, 2d Infantry Division, June and July 1944, box 388, RG 112, NARA; Rpt, Surg, 9th Infantry Division, 1944, sub: Medical Activities—Marigny Sector, box 388, RG 112, NARA; 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA; Interv, Medical History Branch, CMH, with Ambassador Elliot Richardson (hereafter cited as Richardson Interv), 8 Nov 79, tape 1, sides 1 and 2, CMH; Surg, Ninth U.S. Army, Daily Journal, 9 Jul 44, in William E. Shambora Papers, MHI; 53d Medical Battalion Annual Rpt, 1944; pp. 6-7.


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mands, had to split up their tank and armored infantry battalions into platoons to help the infantry clear ground, hedgerow by hedgerow. The divisions then had to attach aidmen and litterbearers to each separate platoon, in violation of their doctrine, under which tank battalions, especially, kept all their enlisted medical personnel at their aid stations. Because tank and mechanized infantry battalions included only half as many enlisted medical people as standard infantry battalions, the armored divisions had to strip their medical battalions to build up their unit detachments. After the initial weeks of hedgerow combat, the 3d Armored Division surgeon, Col. James L. Salmon, MC, requested an additional eighty-four medical enlisted men for his division so that tank and mechanized infantry battalions could maintain what was, in effect, a conventional infantry system of evacuation. In the absence of such permanent reinforcements the XIX Corps surgeon temporarily attached men from his corps medical battalion to the armored units. 34
 Collecting and clearing station operations conformed closely to doctrine. Collecting stations, usually located near the command posts of the regiments they supported, changed bandages on incoming wounded, adjusted splints, administered plasma, and combated shock while preparing patients for further evacuation. Clearing stations, 4-6 miles behind the collecting companies, performed triage,  maintained wards for care of shock and of minor sickness and injuries, and transferred men needing immediate emergency surgery to adjacent field hospital platoons. Moving frequently to keep up with their divisions, clearing companies handled a large volume of casualties. The 4th Division clearing station, for example, received, treated, and evacuated over 6,100 patients—an average of about 245 per day—during its first twenty-five days in operation. During the battle for St.-Lo in July, the 83d Infantry Division clearing station processed 1,600 wounded in three days. To relieve the exhausted staff of this company, the VII Corps surgeon reinforced it temporarily with elements of the corps medical battalion and with an entire clearing company borrowed from the 134th Medical Group. As it had in other theaters, the combination of clearing station and field hospital platoon worked smoothly, freeing the clearing company of non-transportable patients and saving the lives of severely injured men. General Kenner reported after a mid-July inspection tour: “Many men, wounded within the hour, were receiving emergency major surgical treatment in these installations. The forward disposition of these elements is responsible in large measure for the . . . low mortality rate amongst our casualties.” 35

 34 Surg, XIX Corps, Annual Rpt, 1994, encls. 15-16.  
 35 Quotation from Memo, Kenner, 13 Jul 44, sub: Report of Inspection of Medical Service in Liberated Areas, in Medical Division, COSSAC/SHAEF, War Diary, July 1944. For 4th Medical Battalion statistics, see 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA. On the 83d Division, see VII Corps Medical Plan, pp. 33 and 35, encl. 1 to Surg, VII Corps, Annual Rpt, 1944, and 134th Medical Group Annual Rpt, 1944, p. 8. For other examples of collecting and clearing station activities, see Medical Bulletin, 2d Infantry Division, June 1944, box 388, RG 112, NARA; Rpt, Surg, 9th Infantry Division, 1944, sub: Medical Activities—Marigny Sector, box 388, RG 112, NARA; 1st Medical Battalion After-Action Rpts, May, June, and July 1944, box 5966, RG 407, NARA; Richardson Interv, tape 2, side 1, CMH.


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 Division medical elements, especially the infantry regimental detachments and the collecting company litter platoons, suffered substantial casualties. Colonel Hayes, the VII Corps surgeon, reported as early as 14 June: “All divisions in the line have lost from one to eight medical officers and from five to forty enlisted men.” Between 10 and 24 July, in the already understrength regimental detachments of the 9th Division, 1 medical officer and 20 enlisted men were killed, 4 officers and 155 men wounded, and 2 officers and 19 men captured. The 83d Division, in the July offensive, had two entire battalion aid stations overrun and taken prisoner during a local German counterattack. 36
 Random artillery and mortar fire accounted for most medical troop casualties, as well as for frequent damage to medical service vehicles and installations. However, the killing and wounding of aidmen, litterbearers, and aid station personnel by aimed rifle fire, usually from snipers, raised the question whether the enemy, as general policy, was respecting the Geneva Convention rights of unarmed Red Cross-marked medical personnel. After two months of combat and careful analysis of many incidents, most corps, division, and lower-echelon surgeons and medical unit commanders concluded  that, except for isolated cases, the Germans were following the rules. The commander of the 4th Medical Battalion, which had had men killed and wounded and ambulances damaged by artillery and machine-gun fire, summed up the prevailing opinion: “It is the consensus . . . that little of this damage was deliberate and that for the most part the enemy respects the Rules of Land Warfare. . . .” According to German prisoners, sniper incidents often resulted from difficulty in seeing Red Cross arm brassards on men moving along the hedgerows; medics in some divisions noted that a high proportion of their small-arms casualties were shot from the unbrassarded right side. Aidmen and litter-bearers accordingly began wearing brassards on both arms and painted nonregulation red crosses in white squares on their helmets. The XIX Corps surgeon late in July officially authorized these and other measures to make Geneva Convention markings on men and vehicles more conspicuous. 37

 36 VII Corps Medical Plan, p. 20, end. 1 to Surg, VII Corps, Annual Rpt, 1944; Rpt, Surg, 9th Infantry Division, 1944, sub: Medical Activities—Marigny Sector, box 388, RG 112, NARA; Surg, 83d Infantry Division, Annual Rpt, 1944, p. 3.
 37 Quotation from 4th Medical Battalion Report of Operations, 6-30 Jun 44, box 6727, RG 407, NARA. For other expressions of this view, see Memo, Kenner to CofS, SHAEF, 20 Jun 44, sub: Report of Inspection ETO, and Memo, Kenner, 13 Jul 44, sub: Report of Inspection of Medical Service in Liberated Areas, both in Medical Division, COSSAC/SHAEF, War Diary, June and July 1944; and Medical Bulletin, 2d Infantry Division, box 388, RG 112, NARA. Less favorable views of the Germans are in VII Corps Medical Plan, p. 20, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Tegtmeyer “Diary,” bk. II, p. 15; Richardson Interv, tape 1, side 2, CMH; and Bradley, Aid Man, p. 49. On Red Cross markings, see Surg, XIX Corps, Annual Rpt, 1944; Surg, 29th Infantry Division, Annual Rpt, 1944, p. 13; Surg, 35th Infantry Division, Annual Rpt, 1944, pp. 4-5; and Rpt, Lt Col C. L. Milburn, Jr., 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 Jun 1944, in Shambora Papers, MHI.


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MEDICS WITH IMPROVISED RED CROSS INSIGNIA on their arms and helmets
  Gestures of a chivalry supposedly dead in mechanized total war occasionally graced the Normandy battlefield. Soldiers of both sides, either as the result of formal temporary truces or more often by tacit mutual consent, at times ceased fire to allow aidmen to reach casualties. A 30th Division aidman remembered “deliberately exposing myself to enemy view and waiving at machine-gun crews in order to get them to lift fire so I could remove wounded. . . . The fire was often lifted.” On D-Day a trooper in the 82d Division saw German and American medics rush toward some wounded lying near a tank that had just been knocked out. “There was no firing by either side upon these aid men as they went to work.” Early in July the First Army returned sixteen German nurses captured in Cherbourg to their own forces under a flag of truce. The commander of a German parachute regiment in the hedgerows sent back 83d Division medics his troops had captured. Such incidents were exceptional in the bitter fighting, but they did indicate that, in dealing with wounded and those who treated and evacuated them, both sides were following as best they could the conventions of civilized warfare. 38
 To the rear of the divisions the 31st and 68th Medical Groups managed the flow of casualties to evacuation hospitals and then to convalescent facilities and beach holding units. The groups deployed their attached ambulance companies as well as the ambulance platoons of their collecting companies at division clearing stations, at field hospitals, and at other installations. They placed liaison officers at clearing stations and hospitals and set up ambulance control points on the roads. Based on evacuation hospital reports, relayed through Colonel Rogers’ office twice daily and containing current statistics on empty beds, on patients awaiting surgery, and on patients ready for transportation, the groups routed am-

 38 First quotation from Bradley, Aid Man, p. 62. Second quotation from Statement by Lt. Joseph Kormylo, in 82d Airborne Division Combat Intervs, box 24057, RG 407, NARA. See also Blumenson, Breakout and Pursuit, pp. 83-84 and 137; Surg, First U.S. Army, Annual Rpt, 1944, pp. 117-18; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, P. 105; 68th Medical Group, Report of Evacuation of Enemy Casualties from Vicinity Cherbourg, 19 Jul 44, in 68th Medical Group Annual Rpt, 1944.


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bulance convoys from the divisions to hospitals in their sectors and from the hospitals to UTAH and OMAHA beaches. Each group transported as many as 2,500 patients a day, keeping its ambulances rolling steadily in the constant bumper-to-bumper traffic of the congested beachhead. Occasionally, they massed forces to meet sudden emergencies. Between 28 June and 1 July, for instance, the 68th Group, which normally worked in the OMAHA area, sent men, trucks, and ambulances to Cherbourg to evacuate to UTAH beach over 1,300 wounded German prisoners. During July, as the intensity of combat and the number of divisions in Normandy increased, Colonel Rogers reinforced the medical groups with additional ambulance and collecting companies temporarily detached from the Third Army and with ambulance companies taken from the corps medical battalions. 39
 At OMAHA and UTAH the engineer special brigade medical battalions, rearmost evacuation elements of the First Army, received patients from the medical groups and prepared them for cross-Channel movement, by ship and, for an increasing proportion, by airplane. The NEPTUNE plans called for the beginning of mass air evacuation from France around D+ 14 (20 June), but the engineer special brigades managed to complete a temporary airstrip near St.-Laurent on the eighth. A IX Troop Carrier Command C-47 lifted out the first 13 patients, including 7 wounded POWs, two days later. With passable flying weather much of the time and plenty of returning cargo planes, the 60th and 61st Medical Battalions on some days flew out as many as 600 patients, while the number leaving OMAHA daily by ship dwindled to less than 20. On UTAH beach, by contrast, sea evacuation continued to predominate. A company of the 134th Medical Group opened an air evacuation holding unit at Ste.-Mere-Eglise on the eighteenth, but it closed after eleven days of limited operation because transport flights there interfered with combat air activities. Not until 20 July did the medical service secure more or less regular evacuation use of an airfield in the Cotentin. Air evacuation at once proved its worth. With the flight itself taking no longer than ninety minutes, General Kenner reported, “men wounded in the morning are often on the operating table of a general hospital in the UK within 10 hours.” With such rapid evacuation available, surgeons could send  to Britain many severely wounded men hitherto classified nontransportable, reducing the surgical burden on hard-pressed field and evacuation hospitals.40

  39 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 71; 31st and 68th Medical Groups Annual Rpts, 1944; Surg, V Corps, Annual Rpt, 1944, p. 9; Surg, VII Corps, Annual Rpt, 1944, p. 10; Surg, XIX Corps, Annual Rpt, p. 5.
  40 Quotation from Memo, Kenner to CofS, SHAEF, 20 Jun 44, sub: Report of Inspection ETO, in Medical Division, COSSAC/SHAEF, War Diary, July 1944. In same file, see Memo, Kenner to CAdminOff, 26 Jul 44, sub: Evacuation of Casualties by Air. See also Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, Chief Consultant in Surgery sec., pp. 12-13; First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 69-70; John W. Pace, “Air Evacuation in the European Theater of Operations,” Air Surgeon’s Bulletin 2 (October 1945): 324; Dowling, Normandy Rpt, 11 Jan 45, p. 17; Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, Pp. 115, 335, 339; VII Corps Medical Plan, pp. 21-22, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; 134th Medical Group Annual Rpt, 1944, p. 8.


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  On OMAHA the engineer special brigade units reorganized to take maximum advantage of both air and sea transportation. The Provisional Engineer Special Brigade Group, between 18 and 22 June, consolidated most of the 60th and 61st Medical Battalions into an evacuation center under the command of the group surgeon, Lt. Col. George D. Newton, MC. The 61st Battalion, of which the 393d Collecto-Clearing Company had acted as a holding unit for the St.-Laurent strip since air evacuation began, deployed its other companies with the 393d to form a 750-bed tented holding facility for litter patients. A platoon of the 60th Battalion’s 634th Clearing Company maintained temporary accommodations for 250 walking wounded, and the 499th Collecting Company sorted incoming patients and furnished litterbearers and ambulances. Working with attached Air Force liaison personnel and in direct telephone contact with the airstrip and the naval beach station, the center’s evacuation control officer, borrowed from the 11th Port, dispatched patients as LSTs, hospital carriers, and aircraft became available. The center normally gave stretcher cases priority for cross-Channel flights and sent the walking wounded by ship. As Captain Dowling, the Western Naval Task Force surgeon, later reported, “This system was easily regulated and maintained, and greatly facilitated speed and ease in handling casualties. . .” 41
  While the medical battalions on OMAHA beach concentrated on air evacuation, the 261st Medical Battalion on UTAH handled most of the seaward movement of casualties out of Normandy. Acting almost entirely as a holding unit after the field and evacuation hospitals opened, the battalion funneled patients to the 2d Naval Beach Battalion, which embarked them on LSTs and hospital carriers. The naval unit stationed a radio-equipped liaison team at each 261st Battalion clearing company to keep the Army units promptly informed of ship arrivals. Evacuation across UTAH beach proceeded at a steady rate, averaging about 570 men per week throughout June and July. 42
  Most wounded men who passed through the army evacuation chain underwent surgery in field or evacuation hospitals. Field hospital platoons, located close to division clearing stations, received the most urgent nontransportable cases, primarily, General Hawley observed, “perforating wounds of the belly and sucking wounds of the chest.” Each platoon had auxiliary surgical teams attached as operating staff, and between them the three platoons of a field hospital, if all were active, could perform about thirty major and usually complex procedures a day. Death rates in these installations ranged from 11 to 14 percent of surgical admissions, about three times the rate for evacuation hospitals, which reflected the desperate nature of the cases the field units received. As the commander of the

  41 Dowling, Normandy Rpt, 11 Jan 45, p. 17; Rpt, ProvESBGp, 30 Sep 44, sub: Operation NEPTUNE, pp. 335-36; 60th Medical Battalion Annual Rpt, 1944, pp. 11-13; 61st Medical Battalion Annual Rpt, 1944, pp. 6-7 and 10; 393d Collecto-Clearing Company Annual Rpt, l944, pp. 11-12.
  42 U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 69-70; Dowling, Normandy Rpt, 11 Jan 45, pp. 17-18 and app. N; 261st Medical Battalion Annual Rpt, 1944, p. 3.


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51st Field Hospital put it, “Exsanguination, eviscerations, cardio-respiratory difficulties, and deep shock” were the normal fare of his doctors. For the attached teams, who had complete authority over the surgical service, field hospital work, while hard and demanding, offered a high level of professional challenge and satisfaction. With perhaps some exaggeration, a 3d Auxiliary Surgical Group report referred to this duty as “the surgeon’s paradise.” The first weeks of operation revealed only a few deficiencies in platoon organization and equipment: a shortage of litter-bearers; a need for extra officers and nurses to stay behind with patients when the unit moved; and requirements for larger generators and additional suction, anesthesia, and oxygen apparatus. 43
  While the field hospitals proved more than equal to their task, the 400-bed army evacuation hospitals found themselves consistently overburdened. Processing all patients who were transportable and needed more than the most elementary treatment, these hospitals worked in rotation, some receiving casualties while others, cleared of patients, rested or moved forward behind the divisions. During the first weeks evacuation hospitals lived from crisis to crisis. “When a hospital moved in and set up,” the 41st Evacuation Hospital commander complained, “there would always be a big influx of patients, which continued until every bed was filled and this hospital bogged down. Then the hospital would be closed and left to work itself out of the mess.” 44
  With the arrival of more evacuation hospitals the flow of patients evened out, but in more units a chronic surgical backlog persisted. The majority of the casualties reaching these hospitals were injured men who needed surgery—for example, 894 patients out of 1,302 admitted by the 5th Evacuation Hospital during its first two weeks in Normandy and all but 360 out of 3,200 treated at the 128th Evacuation Hospital in a similar space of time. The T/O surgical staff of this type installation, working twelve-hour shifts and reinforced by as many auxiliary surgical teams as the hospital’s 40 nurses and 217 enlisted men could support, could perform about 100 major operations every twenty-four hours; the patient influx during heavy combat occurred at about double that rate. Inevitably, the less urgent cases had to wait their turn on the operating tables, often developing infections in undebrided wounds or suffering other complications. To help its hospitals overcome this backlog, the First Army deployed surgical teams and mobile truck-mounted surgical and Xray units of the 3d Auxiliary Surgical Group and, when these proved insufficient, added provisional teams from COMZ hospitals landed but not yet

  43 First quotation from Ltr, Hawley to TSG, 26 Jun 44, file HD 024 ETO O/CS (Hawley-SGO Corresp). Second quotation from 51st Field Hospital Annual Rpt, 1944, pp. 24-25; see also pp.  8-11. Third quotation from 3d Auxiliary Surgical Group Annual Rpt, 1944, p. 33; see also pp. 3-4, 32, 34-35, 44-46. See First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 72-73 and 96-97; Rpt, Milburn, 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 June 1944, Shambora Papers, MHI.
  44 Quotation from 41st Evacuation Hospital Annual Rpt, 1944, p. 60. See also First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, p. 72.


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functioning. The medical groups assigned a collecting company to each evacuation hospital, to provide reliefs for ward officers, additional litterbearers, and ambulances to help in moving out patients. Clearing companies, from the 134th Medical Group or the corps medical battalions, set up near evacuation hospitals to relieve them of the sick and minor surgical patients. For unskilled labor, the hospitals obtained German prisoners from the First Army provost marshal.
  The First Army tried to manage evacuation so as to reduce the surgical log jam. The 31st and 68th Medical Groups directed ambulances from clearing stations to the evacuation hospitals on the basis of surgical backlog, rather than proximity or number of empty beds. As a final expedient, on 28 June, Colonel Rogers, at the urging of General Hawley and Colonel Cutler, authorized hospital commanders to send transportable minor surgery patients directly to the beach holding units for air evacuation, whenever, in their judgment, that course of action would bring the patient earlier treatment. Under this policy, evacuation hospitals could relieve themselves of between 15 and 25 percent of their surgical patients; but, even with this assistance, it was clear that this type of unit needed constant augmentation to carry out its mission. 45
  Clinically, surgery during the first two months of combat produced few surprises. Surgeons were impressed by the frequency and severity of the multiple wounds from artillery fire. On his July inspection trip General Kenner saw patients “with a penetrating wound of the skull, sucking wound of the chest, partial evisceration and a compound fracture. This means that one surgical team, on that one individual, must perform four major operations.” The rate of use of  whole blood about matched the highest pre-D-Day projections, running about one pint for each pint of plasma. According to Colonel Rogers, the Manual of Therapy “met all expectations” as a practical guide to forward surgery. Rogers’ staff, working closely with the theater consultants, issued a steady stream of directives to clarify certain points in the Manual and to correct surgeons minor deviations from it. Early debridement and liberal use of penicillin and sulfa drugs kept the incidence of serious wound infection low, in spite of surgical backlog, and in spite of the fact that many casualties occurred on pastures and farmland contaminated with animal and human feces. Of the wounded men treated in First Army installations and then evacuated across the Channel less than 1 per cent died after reaching England, a result which Kenner attributed to “the echeloning of skilled surgical care throughout the evacuation chain.” Colonel Cutler, after a visit to

  45 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 73, 81-82, 98-99; First U.S. Army Command Journal, 27 Jun 44; Mins, First U.S. Army Surgeons Conference, 25 Jun 44, in First U.S. Army Log, D-Day through D+56; Medical News No. 10, First U.S. Army, 28 Jun 44; 3d Auxiliary Surgical Group Annual Rpt, 1944, pp. 32-35 and 44-46; 31st Medical Group Annual Rpt, 1944,, pp. 10-11 and 13; Surg, XIX Corps, Annual Rpt, 1944, p. 5 and an. B; Carter, ed., Surgical Consultants, 2:220-22 and 227. For examples of the problem and its solutions in various units, see 24th, 32d, 41st, 91st, and 128th Evacuation Hospitals Annual Rpts, 1944.


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army hospitals in late June, concluded: 
It is my overall opinion that the level of professional care is very high, certainly better than in the last war. . . . The low incidence of serious infection was striking and must be related to the bacteriostatic agents . . . now employed in military surgery. The incidence of amputations seemed happily low, the incidence of gas gangrene also much lower than was expected or was present in the European War, 1914-1918.46
  The First Army suffered little from disease during its early battles. Minor outbreaks of diarrhea occurred; the cool, rainy weather resulted in respiratory ailments; and prolonged diet of C- and K-rations led to cases of vitamin deficiency. Recurrent malaria continued to flare up in divisions that had served in the Mediterranean, with an Army-wide total of 175-250 hospital admissions each week during June and July. The affected units put their men back on prophylactic doses of Atabrine, and the army evacuated men with complicated malaria to the United Kingdom while retaining those with simple cases in evacuation hospitals. Late in July, to save evacuation hospital space for the wounded, the army concentrated its malaria and other communicable disease patients at the 16th Field Hospital, a newly arrived Third Army unit. With women largely absent from the beachhead towns, the army’s venereal disease rate remained low, 8.5 cases per 1,000 men in June and 4.2 per 1,000 in July. Only 398 new infections appeared in the period, all traceable to preinvasion contacts in England. 47
  Neuropsychiatric casualties, increasing in incidence as the fighting intensified, taxed First Army medical facilities. During the July battles most infantry divisions sent one man to the rear with combat exhaustion for each three or four wounded. Before the invasion Colonel Rogers and his staff, seeking to profit by the experience of other theaters, made preparations to treat as many neuropsychiatric patients as possible near the front and return them promptly to duty. Accordingly, once operations began, battalion and regimental surgeons held the mildest cases—those likely to recover after twenty-four hours or so of sedation, rest, and food—at their unit aid stations. Men more severely disturbed went to clearing stations where division psychiatrists supervised up to seventy-two hours of treatment. Setting up and equipping these facilities taxed the ingenuity of the officers in charge. The equipment authorized a division psychiatrist included only “a sphygmomanometer, a set of five. . . tuning forks, a percus-

  47 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 88-93; VII Corps Medical Plan, pp. 29, 32, 43, encl. 1 to Surg, VII Corps, Annual Rpt, 1944; Rpt, Milburn, 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 June 1944, Shambora Papers, MHI. For orders on Atabrine, see, for example, 1st Medical Battalion Journal, 19 Jul 44, box 5967, RG 407, NARA.


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sion hammer, and an ophthalmoscope,” and he had to pick up enlisted staff, tentage, cots, blankets, and a medical chest by the time-honored Army method of scrounging. Division clearing stations evacuated soldiers who required more lengthy treatment and reconditioning but were still deemed salvageable to one of the two First Army exhaustion centers, opened at Bernescq and Ste.-MereEglise on 19 June by the 622d Clearing Company and staffed with psychiatrists from the evacuation. Here, patients underwent extended sedation, received counseling and limited individual and group therapy, and took part in calisthenics and military drill, followed by final examination and either return to duty or evacuation across the Channel. 48
 
  The psychiatric toll of the hedge rows forced expansion of both divisional and army facilities. Each of the army exhaustion centers doubled in size, from 500 to 1,000 beds, and the staffs worked sixteen- and eighteen-hour days. The army assigned a second clearing company, the 618th, to take over the Bernescq center, allowing the 622d to concentrate at Ste.-Mere-Eglise. Still overcrowded, even with this reinforcement, the army facilities in mid-July began turning all but the worst-off patients back to their divisions. In response, some infantry divisions, notably the 29th and 35th, enlarged their clearing station pyschiatric facilities into full-fledged 250-bed exhaustion centers, which kept men for up to seven days of treatment comparable to that in the army units. Between them, the division clearing stations and army exhaustion centers returned to combat duty about 62 percent of the 11,150 neuropsychiatric patients they admitted; they released another 13 percent to noncombat service and evacuated the balance to Great Britain. 49
  The medical supply system, which had been the subject of so much theater concern until the eve of the invasion, proved efficient and responsive in Normandy. Between them, the First Army and Hawley’s Supply Division managed to include enough materiel in the assault forces to sustain the medical service in its first days on the beach. As the buildup went on, the arrival of prescheduled shipments and maintenance units, besides meeting day-to-day needs, allowed the First Army to accumulate seven-day reserves of most items by the end of June. Using theater systems for express air and sea shipment of urgently needed materiel, the army depots obtained additional oxygen, X-ray, and transfusion equipment for field and. evacuation hospitals. They put together outfits for improvised non-T/E installations, such as the exhaustion centers, and they remedied omissions and inadequacies in the medical maintenance units. The medical service encountered such perennial problems
 
  48 Quotation from Memo, Maj D. L. Weintrob, 20 Oct 44, sub: Meeting the Problem of Combat Exhaustion, in 29th Infantry Division Combat Intervs, box 24035, RG 407, NARA; in same file, see Weintrob Interv, 2 Oct 44. See also First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 82-85 and 106; Surg, First U.S. Army, Annual Rpt, 1944, pp. 130-34; Surg, XIX Corps, Annual Rpt, 1944, encl. 16; 134th Medical Group Annual Rpt, 1944, p. 8; 618th and 622d Clearing Companies Annual Rpts, 1944. 
 
  49 For an extended clinical and administrative review of neuropsychiatry in the ETO, see Chapter XI of this volume.


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as equipment lost and damaged in landing or separated from the owning units; unexpectedly high breakdown rates for key equipment, such as autoclaves; and an unreplaced cross-Channel drainage from Normandy of pajamas, litters, and tracheal tubes with evacuated casualties. These difficulties however, remained at the nuisance rather than the crisis level. Medical maintenance units imposed extra labor on the depots in that most of the items they included were scattered among a number of containers, requiring supply people to open as many as thirty boxes of miscellaneous goods to fill a single requisition. In the shallow beachhead, with a nearly static front, divisions and other units had little difficulty drawing medical stores from army depots. Nevertheless, Colonel Rogers expressed concern late in July that the size of the reinforced army was straining the distribution capacity of his depots and that they would be unable to sustain the force if it broke through and began a rapid advance. 50
  Whole blood and penicillin reached the army in ample supply through a separate logistics channel. Refrigerated trucks of the 152d Station Hospital, the ETO blood bank unit, went ashore fully loaded on OMAHA beach on 7 June and on UTAH two days later; hospital carriers and LSTs landed some 3,000 additional pints of blood early in the invasion. On the twelfth, Detachment A of the blood bank disembarked and set up at the St-Laurent airstrip to receive regular flights of blood from England, 250 pints a day until 24 June, when the theater increased the shipment to 500 pints. Refrigerated trucks of the unit, as planned, carried blood forward to hospitals and clearing stations. The same trucks also distributed penicillin, flown in on the transports that brought in blood. The First Army suffered from a penicillin shortage in mid-June, the result of temporary exhaustion of stocks in the United Kingdom, and had to restrict use of the antibiotic to only the most urgent cases. But by the end of that month the chief surgeon’s Supply Division, with its depots in Britain replenished from the United States, had resumed air deliveries to Normandy at a rate of 500 million units per day. These shipments continued throughout the Battle of the Hedgerows. 51
  The first two months of battle tested the European Theater version of a field army medical service and in the main proved it sound. Except for the understaffed 400-bed evacuation hospitals, army medical units functioned as the NEPTUNE planners hoped and expected. Colonel Rogers, in his assessment of this period of operations, praised the field hospital platoon-clearing station combination, and he also expressed satisfaction
  50 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 70, 77-79, 148-53; Rpt, Milburn, 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 June 1944, Shambora Papers, MHI; Surg, XIX Corps, Annual Rpt, 1944, encl. 14; Surg, 1st Infantry Division, Annual Rpt, 1944, p. 10.
  51 First U.S. Army Report of Operations, 20 Oct 43-1 Aug 44, bk. VII, pp. 77 and 100; Chief Consultant in Surgery sec., Professional Services Division, OofCSurg, HQ ETOUSA, Annual Rpt, 1944, p. 11; Kendrick, Blood Program, pp. 484-86 and 553-54; Wiltse, ed., Medical Supply, p. 302; HQ ETOUSA, Blood Bank (152d Station Hospital) Annual Rpt, 1944, pp. 3-4; Rpt, Milburn, 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 June 1944, Shambora Papers, MHI.


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with the flexibility and adaptability of his medical groups. Nevertheless, unresolved questions existed as the First Army paused after the capture of St. Lo and prepared for new attacks. Thus far, the army medical service had supported a static or slow-moving force; how well prepared was it to perform if the army broke out of the beachhead into truly mobile warfare? Further, if the army did start moving rapidly away from the beaches, its medical service would need a continental Communications Zone to fill in behind it and relieve it of its rearmost hospitalization, evacuation, and supply tasks. However, as the campaign approached D + 50, a point well beyond the date the NEPTUNE planners had set for drawing the army rear boundary, no such boundary yet existed. The Advance Section barely had shouldered its way ashore and was in only limited operation. The slow advance of the front in June and July had disrupted COMZ plans for movement across the Channel, even as the base sections in England received and cared for the First Army’s wounded as well as supported its operations. 52

  52 First U.S. Army Report of Operations; 20 -Oct 43-1 Aug 44, bk. VII, pp. 108-09; Rpt, Milburn, 28 Jun 44, sub: Report of Medical Officer Observer in France, 19-26 June 1944, Shambora Papers, MHI; Memo, Kenner to ACofS, G-4, SHAEF, 21 Jul 44, sub: Present Status of Fixed US Hospital Beds, UK and Continent, in Medical Division, COSSAC/ SHAEF, War Diary, July 1944, which reflects the concern at the delay in organizing the Normandy COMZ.