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The Mediterranean Theater of Operations
The Mediterranean Theater of Operations-originally called the North African theater, since it was established before the final decision was taken to extend Allied operations into Italy and southern France-was the only oversea theater to be formed as a result of an Allied invasion of a large land area held by hostile forces. No long-term buildup prefaced combat activities in the area. The medical officers who first held the chief administrative posts in the theater came with the invasion forces, from the European theater and from the United States.
The organization and activities of the Medical. Department in the Mediterranean theater followed closely the pattern laid down in the Army field manuals during the years immediately preceding World War II. It was a doctrine developed largely out of the experience of World War I, but it proved flexible enough to be readily adapted, in the hands of imaginative men, to the varied conditions of World War II, not only in the Mediterranean but in Europe, Asia, and the Pacific as well. A brief recapitulation of the prewar doctrine will make this and the following chapters more understandable.
PREWAR ARMY DOCTRINE FOR THEATER MEDICAL
The chief functions of the Medical Department in a theater of operations were broadly conceived of as evacuation, hospitalization, and sanitation and other measures for the prevention of disease; the procurement, storage, and issue of medical supplies and equipment; and the preparation of medical records and reports. Responsibilities for evacuation and hospitalization extended to animals as well as men and included the provision for, and the operation of, the necessary units, installations, and means of transport. Sanitary measures included the inspection of meats, meat foods, and dairy products. Responsibilities for prevention of disease in an oversea theater comprehended the direction and supervision of public health measures among civilian inhabitants of the territories occupied.1
The term "theater of operations" was defined in the field manuals as the land and sea areas to be invaded or defended, including areas necessary for administrative activities incident to the military operations (chart 12). In accordance with the experience of World War I, it was usually conceived of as a large land mass over which continuous operations would take place and was
1Unless otherwise noted, this section is based on War Department Field Manual 100-10, Field Service Regulations, Administration, 9 Dec. 1940.
Chart 12.- Typical organization of a theater of operations as envisaged by War Department Doctrine, 1940
divided into two chief areas-the combat zone, or the area of active fighting, and the communications zone, or area required for administration of the theater. As the armies advanced, both these zones and the areas into which they were divided would shift forward to new geographic areas of control.
It was recognized that the chronologic development of these elements would vary from theater to theater. In theaters where a long buildup period was possible before the field forces went into combat, a fairly elaborate system of communications zone sections or bases would develop well in advance of the rest of the theater elements. On the other hand, where the Army built up a theater of operations by invasion, it might develop its communications zone setup simultaneously with, or after, the combat area.
The commanding general of a theater of operations was directly subordinate to the War Department Chief of Staff. In addition to his own general staff, he was served by a special staff, of which the chief of medical service of the theater, generally called the "Chief Surgeon" or simply "Surgeon" followed by designation of the command, was a member.2
The duties of the special staff surgeon of any command were broadly defined as follows: Acting as adviser to the commander and staff on all matters pertaining to the health and sanitation of the command, the training of troops in military sanitation and first aid, operations of the evacuation service, and location and operation of hospitals and other medical establishments; supervising, within limits prescribed by the commander, the training of medical troops and the operation of elements of the medical service in subordinate units; determining the requirements for, and procuring, storing, and distributing medical, dental, and veterinary supplies and equipment; preparing reports and maintaining custody of records of casualties; and examining captured medical equipment. In certain instances, the commander might delegate to his staff surgeon authority over the Medical Department troops, units, or installations of the command.3
In carrying out these diversified duties, the staff surgeon of a command in an oversea theater dealt with all elements of the general staff of his command. Although the broad phases of medical service on which he dealt with each element of the general staff were about the same as those oil which The Surgeon General dealt with elements of the War Department General Staff in Washington, D.C., they differed greatly in detail. The staff surgeon overseas had to make estimates and reestimates of the medical requirements of his command, medical plans for coming combat operations and advance calculations of casualties, and surveys of sites for housing Medical Department installations and units. He dealt with G-1 not only on broad matters relating to personnel, but also on sanitation and measures for the control of communicable diseases of men and animals. Intense activity in enemy intelligence in an oversea command called for collaboration with G-2 in inquiry into the organization and operations of the enemy's medical service, communicable diseases in enemy troops, and casualty-producing agents employed by the enemy. The staff surgeon overseas took up with G-3 problems of coordinating medical service with the tactical situation, future plans, and troop movements. In addition to the usual matters that called for clearance with G-4, a stipulation that the staff surgeon deal with G-4 on all other matters not specifically allotted to another general staff section, or concerning which jurisdiction was in doubt, made clear the thoroughgoing involvement of G-4 in matters medical.4
2(1) See footnote 1, p. 245. (2) War Department
Field Manual 8-10, Medical Service of Field Units, 27 Nov. 1940. (3) War
Department Field Manual 101-5, The Staff and Combat Orders, 19 Nov. 1940.
The theater surgeon was responsible for keeping the commander informed of the condition, responsibilities, and needs of the medical service. He had authority to confer or correspond with the surgeons of higher or lower echelons on matters of general routine and on technical matters. He supervised the medical service of the theater by conferences and visits and by making recommendations to the theater commander. When his recommendations were approved, they were issued in the name of the theater commander as policies or orders.
The field armies (or army groups, if two or more field armies were organized into a group headed by a commanding general) and the communications zone organization, or Services of Supply, were the principal types of subordinate commands directly under the theater command; they held position parallel to each other in the chain of command. The headquarters of both the communications zone organization and of armies and army groups would have, like the theater headquarters, a surgeon on the special staff. The subordinate area commands of the communications zone (the advance, intermediate, and base sections) and subordinate commands of the field army (division and corps) likewise had staff surgeons.5
The staff surgeon of the communications zone command was referred to in the 1940 manuals as the "chief of medical service, communications zone," but soon came to be called "Surgeon, Services of Supply," or "Surgeon, Communications Zone."
Although the manuals did not make this clear, if the, theater surgeon was located at communications zone headquarters rather than at theater headquarters, he would presumably be communications zone surgeon in addition to his theater assignment. This dualism prevailed in Europe in the latter part of World I, and existed from the beginning in the European Theater of Operations in World War II.
The staff surgeon of a theater headquarters was not expected to occupy himself with the immediate operations of Medical Department units and in-stallations since most of these were assigned either to the Services of Supply for work in the communications zone or to the field elements for serving troops engaged in combat. His primary concern, it was believed, would be coordinating the medical work of the Services of Supply, or the communications, zone, organization and that of the field elements-armies and air forces and their subcommands. By virtue of his position at the top of the theater structure he would issue, over the theater commander's signature and after clear-ance with the proper elements of the General Staff, medical policies which would be put into effect on a theaterwide basis; that is, in both the communi-cations zone and the combat zone.
5See footnotes 1, p. 245 and 2 (3) p. 247.
MEDICAL ORGANIZATION IN THE NORTH AFRICAN THEATER
The organization of medical service in North Africa, like that of the other technical services, employed British and American personnel in the highest command, AFHQ (Allied Force Headquarters). The Allied headquarters was originally established in London as a planning headquarters for the North African invasion and was under the direction of the Commander in Chief of the Allied Forces, Lt. Gen. (later Gen. of the Army) Dwight D. Eisenhower. The headquarters medical section began work in London at Norfolk House on 14 August 1942. The chief surgeon was a British "Director of Medical Services," Brigadier (later Maj. Gen.) Ernest M. Cowell. Col. John F. Corby, MC, became the chief American medical representative at Allied Force Headquarters. As Colonel Corby was outranked by Brigadier Cowell, he became deputy to the latter. This subordination of the American chief surgeon to the British chief surgeon in the Allied command of the North African theater prevailed throughout the war. Three other American medical officers, including an executive officer to Colonel Corby-Lt. Col. (later Col.) Earle Standlee, MC (fig. 55)-joined Brigadier Cowell and the British-American staff in London.
During the London days, before the invasion of North Africa got underway the responsibilities of the American members of the medical section of Allied Force Headquarters were very limited. Their activities were restricted to the framing of broad policies on preventive medicine, evacuation, and sup ply and to coordinating the American effort in England with that of the British. Having received little in the way of instructions from the top, this small American medical group (four officers and four enlisted men) tended to believe that the tactical forces and the base sections would be responsible for actual operations in the area to be invaded and that Allied Force Headquarters would not be concerned with these details. American doctrine emphasized policy-making rather than operations at the theater level, which would not call for a large staff. In October, Brigadier Cowell suggested that two more officers and one enlisted man be added to the American component of the medical section when it went to Africa, but even with this addition the American component was only half the size of the British. With 12 officers, 1 warrant officer, and 10 enlisted men, the British component of the medical section was able to make specific assignments of personnel to administer and supervise evacuation, supply, preventive medicine, professional treatment, and maintenance of records.6
Medical Support of the Task Forces
Plans for the invasion provided for a simultaneous strike by three task forces, two of which consisted exclusively of U.S. Army troops, at the coastal regions of western French Morocco and northern Algeria in the vicinity of Casablanca, Oran, and Algiers. The Western Task Force, landing in the Casablanca area with a strength of 35,000 men, was organized in the United States. Col. (later Maj. Gen.) Albert W. Kenner, MC, who had seen service in World War I as regimental surgeon of the 26th Infantry and had most recently served as surgeon of the Armored Force at Fort Knox, Ky., was the Western Task Force surgeon. The Center Task Force, composed of 39,000 American troops of the U.S. II Corps, staged in the United Kingdom and landed in the vicinity of Oran. The II Corps surgeon, Col. Richard T. Arnest, MC (fig. 56), served also as Center Task Force surgeon. The third task force, designated Eastern Assault Force, sailed from the United Kingdom with predominantly British personnel and landed 33,000 troops in the Algiers area.
Medical plans for the task force from the United States and for the forces from the United Kingdom were drawn up separately, with little apparent co-
6(1) History of Allied Force Headquarters, Part I, Aug.-Dec. 1942. [Official record.] (2), Munden, Kenneth W. : Administration of the Medical Department in the Mediterranean Theater of Operations, United States Army (1945). [Official record.] (3) Annual Report, Medical Section, North African Theater of Operations, U.S. Army, 1943. (4) Interview, Brig. Gen. Earle Standlee, MC, 10 Jan. 1952. (5) See also Wiltse, Charles M.: The Medical Department: Medical Service in the Mediterranean and Minor Theaters. United States Army in World War II. The Technical Services. [In preparation.]
ordination among them even after the landings in North Africa. Nor was significant coordination achieved between the surgeons of the three task forces, on the one hand, and the American medical staff at Allied Force Headquarters, on the other. In the United States, Medical Department officers of Western Task Force made plans in conjunction with the Hospitalization and Evacuation Branch, Services of Supply, and the staff of the Surgeon General's Office for adequate medical supplies to accompany troops; these groups also made arrangements to have medical personnel and facilities at the American ports at which evacuees wounded in the invasion would arrive. Colonel Kenner and the surgeon of the Western Naval Task Force drew up the joint formal medical plan for the Moroccan landings. The Center Task Force surgeon achieved a limited coordination with the medical group at Allied Force Headquarters in London on broad policy issues.
Penetration of an 800-mile coastline by the approximately 107,000 troops of the task forces a few days after landing on 8 November secured the area from Safi, French Morocco, to a point close to the Tunisian border. After the consolidation of the landings, and with the arrival of the Services
of Supply organizations of the task forces, the headquarters for two base sections, including medical offices, were established in Casablanca and Oran.7
Medical Section, Allied Force Headquarters
Allied Force Headquarters, which briefly operated from a command post at Gibraltar, was at the St. George Hotel in Algiers 2 weeks after the invasion. The personnel of the medical section arrived at Algiers in late December 1942 and the following January. The deputy force surgeon, Colonel Corby, and his staff were established with the British medical component in a building near the St. George Hotel.
The inexperienced American branch with its vaguely defined duties was immediately confronted with responsibility for operational details of hospitalization, evacuation, and medical supply, as well as swamped with an accumulation of medical reports and records from lower headquarters (the tactical elements and the growing base sections). It attempted during December and January to establish more effective control over U.S. Army medical service in North Africa, but a clarification of responsibilities did not occur until the American theater of operations, known as NATOUSA (North African Theater of Operations, U.S. Army) was created in February 1943. Nor could an estimate of personnel requirements for the medical section be made until a well-defined plan of organization had been adopted. Expansion of the American component was proposed twice in January-once with a plan for the creation of 8 subsections and again with a proposal for a 10-division office, composed of 13 officers and 25 enlisted men-but both plans failed to develop. The office allotment was temporarily expanded in January to include six more officers, but by the end of the month a new limitation of the section to five officers and five enlisted men was announced. Several months elapsed before any substantial allotment of personnel was made.8
However, in the opinion of Brig. Gen. Howard McC. Snyder of the War Department Inspector General's Office, the problem was not one of numbers. On an inspection trip to North Africa during December 1942 and January 1943, he stated: "Any faulty administration of Medical Department service anywhere in North Africa was not chargeable to lack of personnel. . . . Where initiative and aggressiveness have been combined with adequate pro-
7(1) See footnote 6(4), p. 250. (2) Interview,
Maj. Gen. Albert W. Kenner, MC (Ret.), 10 Jan. 1952. (3) Annual Report,
Medical Section, North African Theater of Operations, U.S. Army, 1943.
(4) Kenner, A. W.: Medical Service in the North African Campaign. Bull.
U.S. Army M. Dept. No. 76; 76-84, May 1944. (5) Letter, Col. Clement F.
St. John, MC, to Col. John Boyd Coates, Jr., MC, Director, The Historical
Unit, U.S. Army Medical Service, 3 Nov. 1955, commenting on preliminary
draft of this volume. (6) Clift, Glenn: Field Operations of the Medical
Department in the Mediterranean Theater of Operations, U.S. Army (1945).
[Official record.] (7) Annual Report, Surgeon, II Corps, 1942. (8) Annual
Report, Medical Section, Atlantic Base Section, 1943. (9) Biennial Report
of the Chief of Staff of the United States Army, July 1, 1941, to June
30, 1943, to the Secretary of War. Washington: U.S. Government Printing
Office, 1943. (10) See footnote 6(5), p. 250. (11) Howe, George F.: Northwest
Africa: Seizing the Initiative in the West. U.S. Army in World War II.
Washington: U.S. Government Printing Office, 1957.
fessional capabilities, good judgment, and tact in the person of the responsible medical officer, the results have been excellent." He noted a lack of understanding between General Cowell and Colonel Corby. The American officer found it "difficult to satisfactorily operate in his present status with the Force Surgeon." One element in the clash of personalities was that General Cowell was only a "Territorial," equivalent to the U.S. National Guard, whereas Colonel Corby had 25 years in the Regular Army. Disagreements between the two officers led to the relief of Colonel Corby early in February 1943. Colonel Corby's successor, Brig. Gen. Albert W. Kenner, later observed that American prerogatives were being assumed by General Cowell, who ignored the American surgeon. For his part, General Kenner believed that neither General Cowell nor Colonel Corby had any definite knowledge of what was going on in the theater, since neither man had gotten out of headquarters in Algiers.9
Early disagreements between American and British medical officers at Allied Force Headquarters and uncertainty as to mutual responsibilities were natural, since these had to be worked out step by step without the benefit of preplanned doctrine. Respective British and American responsibilities, assignments, and contributions of medical facilities, personnel, and supplies had to be determined during this formative stage. This process was to be repeated at many levels of command in the North African theater, as well as in other theaters where combat operations were directed by an Allied command.
The Base Sections
When two American base sections, evolving from the Services of Supply organizations attached to the Western and Center Task Forces, were established in December, they took over the service functions temporarily carried on by the task forces and undertook to furnish services to the troops on an area basis. Out of the Services of Supply attached to the Center Task Force the first North African base section, termed Mediterranean Base Section, was activated on 8 December at Oran. A nucleus of its medical section, attached to the office of the Surgeon, Center Task Force, arrived in North Africa 3 days after the landings. By the date when the base section was activated, additional personnel had arrived, and the medical office for Mediterranean Base Section was organized. By the first of the year 20 officers, 1 nurse, and 31 enlisted men were on duty. The second base section, Atlantic Base Section, grew out of Services of Supply, Western Task Force. By January the surgeon's staff, which had arrived in echelons, was fully organized. A total of 10 officers and 4 enlisted men were assigned.
9(1) Memorandum, Brig. Gen. Howard McC. Snyder, MC, for the Inspector General, 23 Feb. 1943, subject : Special Inspection of Medical Department Service in Western Theater of North Africa. (2) Memorandum, Brig. Gen. Howard McC. Snyder, for the Inspector General, 8 Feb. 1943, subject: Inspection of Medical Service, Eastern Sector, Western Theater of North Africa. (3) See footnotes 7(2), p. 252; and 6 (4), p. 250.
Both base sections were removed from task force control on 30 December 1942, when Allied Force Headquarters placed them directly under its own command.10 However, the medical section at the Allied headquarters gained no authority over American Forces in its early days other than that of determining broad policies, and the medical sections of the base sections developed more or less independently. Only when the North African theater was established in February did the American component at Allied Force Headquarters achieve, in its capacity as Headquarters, NATOUSA, effective supervision over the two base sections.11
Medical Support of the Twelfth Air Force
The role of the American Twelfth Air Force in the invasion was to attack enemy targets in eastern Algeria and Tunisia. Formed partly of personnel in the United States and partly of personnel of the Eighth Air Force in the United Kingdom, it was, like the base sections, a subordinate command of Allied Force Headquarters. Its staff medical section, beaded by Col. Richard E. Elvins, MC (fig. 57), was provided with six additional officers-an executive officer, a medical inspector, a dental officer, a medical supply officer, a veterinarian, and a headquarters squadron surgeon-and six enlisted men. With three other officers of the medical section, Colonel Elvins left England in late October, arrived at St. Leu, Algeria, on 8 November with a D-day convoy, and 2 days later set up a temporary office at Tafaraoui Airdrome near the city of Oran which had just surrendered. His office moved to Algiers on 19 November, and started operating there by the end of the month.
The medical organization of the Twelfth Air Force included, in addition to the surgeon's office, medical sections of a bomber command, a fighter command, an air service command, and a troop carrier wing, each having a surgeon and medical staff assigned, as well as surgeons and other Medical Department personnel with wings, groups, and squadrons. The largest of these medical sections was that of the air service command headquarters. In early 1943 it consisted of a surgeon, an executive-medical inspector, a dental surgeon, a veterinarian, 2 supply officers, and from 7 to 10 enlisted men. Medical supply and veterinary food inspection functions had been removed from the Twelfth Air Force surgeon's office shortly after its arrival in. North Africa and placed at the service command level where these functions were usually handled. The
10The Assistant Chief of Staff for Operations,
Services of Supply, General Lutes, had expressed concern in mid-November
over the fact that General Eisenhower had not established an "overall
SOS" in North Africa. The lack of a Services of Supply in the developing
theater appeared to him to threaten coordination of activities in evacuating
the wounded of the three task forces, as well as coordination of the oversea
stage of evacuation with responsibilities of the Services of Supply of
the War Department. Memorandum, Maj. Gen. LeRoy Lutes, for Lt. Gen. Brehon
B. Somervell, 13 Nov. 1942, subject: Hospitalization and Evacuation Overseas.
air service command established three area commands, comparable to base sections, to operate from subheadquarters in Casablanca, Oran, and Constantine. The medical sections of the area commands operated with a surgeon and two enlisted men each; a veterinarian was later assigned to each to inspect meat and dairy products for air force troops.
Shortly after the landings in North Africa, the Twelfth Air Force was absorbed by an Allied (American, British, and French) air command, created in December 1942 and after early February 1943 called Northwest African Air Forces. It was subordinate to the Allied Commander in Chief for all its operations. During most of 1943 the status of the Twelfth Air Force within this command was one of half-existence and "served mainly to mystify all but a few headquarters experts," for most of its component commands were combined with a similar British or French unit. The Twelfth Air Force surgeon continued to direct the medical service of the American component of the Northwest African Air Forces.12
12(1) Craven, Wesley Frank, and Cate, James Lea, eds.: The Army Air Forces in World War II. Volume II, Torch to Point Blank. Chicago: University of Chicago Press, 1949, pp. 41-206. The quotation in the text is on page 167. (2) Link, Mae Mills, and Coleman, Hubert A.: Medical Support of the Army Air Forces in World War II. Washington: U.S. Government Printing Office, 1954, pp. 419-527. (3) History of the Twelfth Air Force Medical Section, August 1942-June 1944. [Official record.] (4) Medical Department, United States Army, Veterinary Service in World War II. Washington U.S. Government Printing Office, 1962, pp. 249-269.
THE NORTH AFRICAN THEATER AND SERVICES OF SUPPLY
Theater Medical Section
The need for a headquarters with a staff to administer purely American affairs in North Africa was met by creating NATOUSA on 4 February 1943 (map 1). Previously, because of higher rank, senior British officers at Allied Force Headquarters had had control over United States personnel assigned to the various staff sections. When General Eisenhower became theater commander as well as Allied commander, the senior U.S. Army officer of each Allied Force Headquarters staff section became the chief of the corresponding section of the theater headquarters. General Eisenhower's deputy theater commander, Maj. Gen. Everett S. Hughes, exercised immediate jurisdiction over the American theater staff. Accordingly, the chief American medical officer of Allied Force Headquarters doubled as chief of the medical section, North African theater. His medical section served as theater medical section and also as the American element of the Allied Force Headquarters medical section. It functioned mainly in its North African theater capacity, having administrative and operational supervision of all medical services of the U.S. Army in the North African theater. When acting as part of the Allied Force Headquarters medical section, the group was concerned jointly with the British component with formulating policy and plans. The dual assignment served to prevent the use of too large a number of Medical Department officers in administrative work in higher commands and worked out well in practice. Only five American officers and a few enlisted men were actually assigned to the medical section of Allied Force Headquarters; a much larger number were eventually assigned to that of the theater headquarters. However, the individual's assignment had little effect upon duties performed. The preventive medicine officer, for example, might draft a directive for Allied Force Headquarters even though he was assigned to the theater headquarters, and the American medical section functioned as a unit in either capacity.13
Brig. Gen. Albert, W. Kenner, formerly chief surgeon of Western Task Force, had joined the Medical Section, AFHQ (Allied Force Headquarters), in late December 1942 as medical inspector. Earlier that month he had been promoted to brigadier general by General Patton, the Western Task Force commander. General Patton had been impressed by General Kenner's prompt and efficient handling of 400 burned and mangled men at the town of Fedala, French Morocco, the night of 12-13 November after a U-boat attack on vessels still in the area. As Medical Inspector, AFHQ, Kenner had later made trips throughout the theater of operations observing medical treatment, medical supply matters, personnel problems, and the tactical situation. His assignment
13(1) History of Allied Force Headquarters, pt. II, sec. 1. (2) See footnote 6(2) and 6(4), p. 250. (3) Interview, Brig. Gen. Earle Standlee, 25 Feb. 1952.
Map 1.- North African - Mediterranean theater boundaries, 1943-45
had accorded with the standard British concept of medical inspector. (The medical inspector in the U.S. Army was limited essentially to the inspection of sanitary conditions.) His work was of Allied scope; one of his first undertakings had been a field inspection during which he had examined the operations of all types of medical installations, British and American, from general hospitals in rear areas to smaller medical units near the Tunisian front. He had also inquired into such nonmedical matters as rations, morale, ammunition, and discipline; thus for a short time he had assumed what amounted to the duties of an "inspector general" of the Allied forces for General Eisenhower. When Headquarters, NATOUSA, was formed on 4 February 1943, he became theater surgeon. He retained his position as medical inspector of the Allied forces and automatically became deputy chief surgeon under General Cowell in Allied Force Headquarters.14
Although he remained in the theater only until late March, General Kenner was especially interested in carrying out changes in the tables of organization of tactical medical units and their tables of basic allowances which he deemed advisable, on the basis of experience during the invasion, for future campaigns in North Africa. His plans had the backing of General Eisenhower, who appointed General Kenner, his deputy surgeon (Colonel Standlee), and the surgeons of Fifth U.S. Army, II Corps, and 1st Armored Division as members
14(1) Memorandum, Maj. Gen. George S. Patton, Jr., for Commanding General, American Expeditionary Force, 20 Nov. 1943. This document, loaned to the author by General Kenner, has since been destroyed along with the rest of General Kenner's personal files. (2) See footnote 7(2), p. 252 and 11 (6), p. 254.
of a board to study the field medical service and make recommendations for revision in the organization and equipment of units.15
For more than a month after the activation of the North African theater headquarters and its medical section, the small American medical group already serving at Allied Force Headquarters functioned as the North African theater medical section, working from morning until late at night. The deputy theater surgeon proposed organizing four operational sections within the medical section, to be labeled administration, preventive medicine, operations and planning (divided into hospitalization, evacuation, and training divisions), and consultants. The personnel required was estimated as 23 officers and 30 enlisted men. By the end of April his plan was approved, and the Medical Section, NATOUSA, was formally established the following month.16
With the return of General Kenner to the United States in April, the former surgeon of the Fifth U.S. Army, Brig. Gen. Frederick A. Blesse (previously surgeon of Army Ground Forces), who had been on temporary duty at North African theater headquarters during March, was named theater surgeon on the recommendation of the Fifth U.S. Army commander, Lt. Gen. Mark W. Clark. General Blesse also became deputy chief surgeon and subsequently medical inspector of Allied Force Headquarters as well, taking over all of General Kenner's former responsibilities. Like General Kenner, General Blesse was a thoroughgoing student of the medical service of the combat zone.
In June the staff of the theater medical section moved, along with their British partners, to larger offices in Algiers. The British and Americans were situated in separate offices, but coordination was maintained by informal conferences and weekly meetings of the entire medical staff. According to the remarks of one observer, the position of General Blesse in relation to General Cowell, "is one which demands considerable tact but they seem to be entirely en rapport and I believe that it would be difficult to find more cooperation under the present complex overall Setup."17 The expansion of the theater medical section during 1943 saw the addition of many new functional subsections and a substantial increase in personnel (chart 13). By December the Medical Section, NATOUSA, contained 70 officers and enlisted men; its British counterpart now amounted to 82.
In addition to close liaison with the major theater commands and with the other staff sections of the North African theater headquarters, as well as the British component of Allied Force Headquarters, the theater medical section undertook coordination with the medical service of the French Army during 1943. Representatives of the medical services of the Americans, British, and French held an Allied medical conference in Oran during November; it pre-
15(1) Special Order No. 3, Headquarters, North
African Theater of operations, 8 Feb. 1943. (2) Memorandum, Maj. Gen. Brehon
B. Somervell, for The Surgeon General, 20 Feb. 1943.
Chart 13.- North African theater medical section, August 1943
sented the participants with information on recent advances in the medical field in the North African theater. The consulting surgeon of the French Army made frequent visits to the North African theater surgeon's office.
A small and flexible group of consultants was developed within the medical section. A surgical consultant, a medical consultant, and a consulting psychiatrist gave professional advice on the treatment of patients and the most suitable assignments for specialists in their respective fields on the basis of proficiency, training, and experience. Additional consultants, particularly in various surgical subspecialties such as maxillofacial surgery, orthopedic surgery, and anesthesia, were used at the headquarters of base sections and tactical commands. Some were assigned within the allocation for the headquarters staff, but for the most part men who served as consultants in the base sections or with army or corps medical sections were specialists whose primary assignments were as staff members of hospitals. They were shifted to various army, corps, or base section headquarters as needed. Thus, without a large assigned staff of specialists, the theater medical section profited from the effective use of men who had had training and experience in both the specialties and the subspecialties. Both II Corps (when operating independently of the field armies) and Fifth and Seventh U.S. Armies had consultants assigned during the Tunisian, Sicilian, and Italian campaigns.
During 1943, the theater surgeon's office undertook the preparation of several important theater reports and publications. In March, it initiated a series or circular letters which resembled those regularly issued by the Surgeon
General's Office. These, giving instructions on theater medical policy and technical procedures established by the consultants, were distributed to all medical installations and offices in the theater. The report of Essential Technical Medical Data, or so-called ETMD-initiated early in the year and submitted by all theater surgeons-to The Surgeon General beginning in July, was a resume of theater medical experience (obtained by consolidating the reports of separate Medical Department units, installations, and offices) which became useful in evaluating past planning and in making new plans. It contained information on climate, organization of the medical service, surgery, medicine, nutrition, rehabilitation, preventive medicine, medical supply and equipment, medical records, and dental, nursing, and veterinary activities. The report was frequently supplemented by Statistical data on evacuation, hospital admissions, types of wounds, rates of disease and injury, and similar matters. In January 1944, the theater surgeon's office began to publish a theater professional journal, The Medical Bulletin of the North African Theater of Operations, which appeared regularly for the next 17 months.18
Services of Supply Medical Section
A Services of Supply was created in February 1943 in less than 2 weeks after the establishment of the theater command, with headquarters at the important port and rail center of Oran, Algeria. Although it was subordinate to the recently created theater headquarters, as initially organized it differed greatly from the theater SOS (Services of Supply) organization as contem-plated in War Department doctrine, as well as that in most other theaters, which conformed for the most part to, the doctrine. Its activities were restricted to supply and maintenance and did not comprehend the full scope of activities of the technical services within a communications zone as outlined in Army manuals. The work of its medical section, created by the end of the month, was accordingly restricted to the control of medical supply for the North African theater. Its role was thus markedly different from that of the medical sections of other oversea Services of Supply, which had as an important function the operation of general and station hospitals in the communications zone. Col. Charles F. Shook, MC (fig. 58), who had handled procurement planning in the Surgeon General's Office during the emergency period, became head of the Medical Section, SOS, NATOUSA, in August and remained in charge throughout the existence of the command.
In the command structure of the theater, the Services of Supply was intermediate between the theater command and the base sections in matters of supply, to which it was itself limited. It directed supply activities of the base sections and supervised base section personnel assigned to supply work. Located at the Oran headquarters, the Medical Section, SOS, consisting of
18(1) See footnote 6 (2) and (3), p. 250. (2) Annual Report, Medical Section, Mediterranean Theater of Operations, United States Army, 1944.
about a half dozen Medical Corps and Medical Administrative Corps officers and a few enlisted men, prepared all medical supply requisitions made upon the Zone of Interior, regulated shipments between bases, adjusted medical depot stocks, and generally supervised the activities of medical depot companies. It made frequent inspections of installations handling medical supplies. Colonel Shook was responsible to the Commanding General, Services of Supply, NATOUSA, for the status of theater medical supplies and the maintenance of medical supply records. The medical section of Headquarters, NATOUSA, at Algiers formulated medical supply policies and was the higher agent which kept in contact with the Surgeon General's Office on matters of medical supply. Hence, Colonel Shook's office at Oran maintained liaison with the medical supply officer in the theater surgeon's office.
In the spring of 1943, the Services of Supply medical section directed its supply planning at support of the Sicilian campaign. During the, summer it, initiated a continuing study of the records on issue and consumption of medical supplies in order to arrive at revisions, based on experience in the theater, of the maintenance factors published by the Surgeon General's Office. Colonel Shook's office found that the standard medical maintenance unit (a carefully selected group of medical supplies intended to suffice for a force of 10,000 men for 30 days) automatically shipped to the theater contained too low a proportion of some items and excessive amounts of others. It returned some
excess stocks to the United States, transferred others to Allied military forces, and turned over some to civil public health representatives of the Allied military government for the treatment of civilian populations. Some surplus stocks were used to fill French lend-lease demands before the medical section forwarded the French requisitions on to the United States.
As the theater achieved a stable organization, it abandoned (as did other theaters) the system of automatic supply by means of the medical maintenance unit and changed over to the system of specific requisitions of supplies from the United States to accord with its own needs. Meanwhile the Medical Section, SOS, worked out several types of medical supply units for use in support of combat operations in the theater, including an "operational medical maintenance unit," designed to suffice for 10,000 men in combat for 30 days; and a "beach medical unit" (for 5,000 men for 30 days) packed in waterproof bags and designed to support troops in beach assault. With the progress of the Sicilian and Italian campaigns in the latter half of 1943, the Services of Supply medical section became responsible for furnishing medical items to newly created base sections in Sicily, Italy, and Corsica, as well as those in North Africa. Personnel of the section also aided the armies of the Allies, notably the French, in establishing their medical supply depots.19
The Base Sections
From February 1943 through January 1944, base sections in the North African theater were responsible to Headquarters, NATOUSA. Each base section commander was in charge of his own troops and facilities. Except for their supply activities, directed by the Services of Supply, the medical work of base sections was supervised by the medical section at theater headquarters. The base section surgeons, although subordinate to their respective commanders, followed medical policies and techniques formulated by the theater surgeon. In addition to the surgeon and his deputy or executive officer, the medical offices of the base sections usually included subsections for hospitalization, evacuation, supply, medical records, dental, veterinary, nursing, personnel, preventive medicine (including venereal disease and malaria control), fiscal, and administration. Base section surgeons collaborated with the other staff sections at base section headquarters, particularly with the following: G-4 and the Engineers in connection with hospital construction, the Transportation Corps for procedures and problems in the movement of patients within the
19(1) History [Annual Report], Medical Section, Services of Supply, North African Theater of Operations, United States Army, February 1943-January 1944. (2) See footnotes 6 (2) and (3), p. 250; and 11(5), p. 254. (3) Annual Report, Medical Section, Eastern Base Section, 1943. (4) Memorandum, Inspector General, for Deputy Chief of Staff, 10 Aug. 1943, subject: Survey of the Organization and Operations of the Medical Department Facilities in NATOUSA and Sicily. (5) Interview, Col. Charles F. Shook, MC, 31 Mar. 1952. (6) Memorandum, Col. Charles F. Shook, MC, for Col. R. E. Hewett, MC, Office of The Surgeon General, 2 Oct. 1943. (7) Tates, Richard E.: The. Procurement and Distribution of Medical Supplies in the Zone of Interior During World War II. Chapter X. [Official record.] (8) Report on visit to AFHQ by Col. J. K. Davis, Assistant Chief Medical Officer, Supreme Headquarters Allied Expeditionary Force [SHAEF], 1 Apr. 1944.
theater (except by air) and to the United States by hospital ship, Quartermaster Corps and Corps of Engineers for malaria control, and G-3 for matters of planning and training. The base section surgeon's office informed medical units and installations under the base section command of prevailing theater policies. The chief Medical Department installations operated by a base section were station and general hospitals, medical supply depots, and a laboratory.
Between February 1943 and January 1944, four additional base sections were established in the theater; the original two, Mediterranean and Atlantic Base Sections, continued to operate as rear areas in the communications zone. Eastern Base Section, established in February 1943 to support II Corps during the Tunisian campaign, was first located in Algeria in the rear of the forces fighting in Tunisia and later in Tunisia as the base section closest to Sicily during the campaign for that island. After the beginning of the Italian campaign, it was a base between the forward and rear of the communications zone-the equivalent of an intermediate section, although not so termed. island Base Section was activated in Sicily on the first of September, in the wake of the Sicilian campaign. On 1 November, about 2 months after the invasion of Italy, what was to be the major base section of the theater, Peninsular Base Section, was created on the Italian mainland; it operated in support of the Fifth U.S. Army throughout the Italian campaign. Finally, on 1 January 1944, Northern Base Section was established in Corsica, chiefly to support air force units located there (map 2, chart 14).
During 1943, Mediterranean Base Section became the key base section for storing theater supplies and for building up the adjoining Eastern Base Section. By the end of its first year of operation, it had a large concentration of fixed hospitals; it became the major area, of fixed hospitalization in North Africa. A subcommand designated Center District, Mediterranean Base Section, with a headquarters medical section was established within the base section early in June to take over service functions being carried on by Allied Force Headquarters within a large enclave around the city of Algiers (extending approximately 150 miles east to west and 200 miles south). Two station hospitals and several smaller medical units were located there.
Medical activities in Atlantic Base Section reached a peak in June and July and dropped off sharply during the remainder of the year. At the end of 1943 its fixed hospitalization represented only a small fraction of the total in North Africa, but it continued to be used as a collecting point for transport of evacuees by sea and air back to the United States.
The mission of Eastern Base Section, established in February 1943, was supply, hospitalization, and evacuation of local and II Corps troops during the Tunisian campaign. After the close of the campaign many fixed hospitals were located there, the number of fixed beds amounting to almost half the theater total in July 1943. With succeeding campaigns to the north, a heavy volume of patients passed through the base section, first from Sicily and later from Italy. Near the end of the year the number of its medical units and in-
Map 2.- North African theater base sections and important surgeons' offices, July 1944
stallations decreased, but the number of patients in its hospitals reached a peak in December. The staff medical section at its headquarters in Constan-tine, Algeria, originally consisted of a surgeon and a few enlisted men trans-ferred from Mediterranean Base Section and four officers obtained from Atlantic Base Section. With the arrival in July of a new surgeon, the medical section was expanded, reorganized, and moved to the new location of the base section headquarters in Mateur, Tunisia. It made its final move the following month when the headquarters was transferred to Bizerte.
Island Base Section was established in Sicily from the nucleus of a base section known as the 6625th Base Area Group, which had gone there with the Seventh U.S. Army. Its headquarters medical section was formed in late August and started operating when the base section was activated at Palermo in September. The territory under Island Base Section control consisted of the region around Palermo and Termini Imerese and other sites where U.S. Army depots were located. By October, the base section had taken over from the Seventh U.S. Army the usual administration of hospitals, the handling of medical supply, and maintenance of sanitary conditions for troops assigned to the base section. At the end of the year, all the base section medical installations were centered in and around Palermo. No significant concentration of medical units occurred in Sicily, for few evacuees from combat in Italy went to North Africa by way of Sicily, and for these the stopover was brief.
Chart 14.- Development of base sections, North African (Mediterranean) theater
The unit that was to become the headquarters for Peninsular Base Section on the Italian mainland-the 6665th Base Area Group-was activated in August 1943. It obtained a medical section, made up of 8 officers, 1 warrant officer, and 14 enlisted men, from Atlantic Base Section. This group left Casablanca in three echelons, all arriving in Naples by early October. Until that time the Fifth U.S. Army Surgeon, Col. (later Brig. Gen.) Joseph I. Martin, MC (fig. 59), had acted as a base surgeon, supervising hospitalization, evacuation, supply, and sanitation, as the task force surgeons had done in the North African invasion before base section personnel arrived. The base area group medical section worked closely with General Martin's staff. When the Peninsular Base Section was established in November with headquarters in Naples, Colonel Arnest, former surgeon of II Corps, became surgeon.
Table 1, indicating numbers of personnel in the medical sections of the various base sections at the end of 1943, shows that the surgeon's office of Peninsular Base Section was already larger than that of any other base section in the theater. With the advances into Italy, the North African bases had diminished in importance and Peninsular Base Section had become the chief base section in the theater. It furnished medical support to the Fifth U.S. Army throughout the Italian campaign.
1Includes 3 attached.
Northern Base Section, comprising the island of Corsica, with head-quarters at Ajaccio, became the sixth base section in the theater on 1 January 1944. The original medical section had only two medical officers and depended for the first month of its operations upon a few additional attached personnel (chart 14).20
20(1) See footnotes 6(3), p. 250; 7(8), p. 252; 11(l), p. 254; 18(2), p. 260; and 19(4), p. 262. (2) Annual Report, Medical Section, Mediterranean Base Section, 1943. (3) Annual Report, Medical Section, Center District, 1943. (4) Annual Report, Medical Section, Peninsular Base Section, 1943. (5) Annual Report, Northern Base Section, 1944.
The Field Army Medical Sections
Fifth U.S. Army.-Elements of both Center and Western Task Forces were merged to form General Clark's Fifth U.S. Army, the first American army activated overseas during World War II. When it was established, on 5 January 1943, with headquarters at Oujda, French Morocco, a headquarters medical section was organized, composed of personnel obtained from both U.S. Army task forces and from the United States. While Fifth U.S. Army was stationed in Morocco, during the Tunisian and Sicilian campaigns, the medical section was chiefly occupied with training. Headed briefly by General Blesse, who was succeeded by Colonel Martin in April, it consisted of nine officers and a few enlisted men assigned to veterinary, preventive, medicine, operations, supply, and administrative functions. General Blesse and his staff inquired into standards of sanitation in the Army units, the health of troops, and the status of training and equipment of Medical Department personnel. They participated in exercises at several training centers organized in the theater and attended two large-scale command post exercises held during March and April. During the Tunisian campaign, members of the medical section served on temporary duty with the British First and Eighth Armies, observing the organization of the British medical service and its methods of hospitalization and evacuation.
Pursuant to plans in the fall of 1943 for invading Italy, a planning group of Fifth U.S. Army, including Colonel Martin and a few other Medical Department officers and men, went to Algiers to coordinate their plans with Allied Force Headquarters and North African theater headquarters. After the invasion near Salerno in September, Colonel Martin's office was located at rear headquarters of Fifth U.S. Army at various sites on the Italian mainland. When Naples was occupied early in October, the army surgeon made a survey of the medical and sanitary situation in that city. By the end of 1943, the Fifth U.S. Army medical section had added seven officers, additional enlisted men, and three members of the Women's Army Corps to its staff, as well as an Italian medical officer who worked in a liaison capacity with medical officers and units serving Italian tactical elements operating under the Fifth U.S. Army.
The largest segment of the surgeon's office was the operations section, which directed training, hospitalization and evacuation, and medical supply activities. It formulated medical training policies and programs, directed the assignment, movement, and location of Fifth U.S. Army medical units (in cooperation with the Army G-4 and the staff Engineer section), carried out hospitalization and evacuation policies, and administered medical supply. The preventive medicine section was responsible for field sanitation in all army units, the direction of programs for insect control and venereal disease control, and the prevention of cases of trenchfoot which harassed Fifth U.S. Army troops in the winter of 1943. A surgical consultant and a neuropsychiatric
consultant in Colonel Martin's office evaluated, through personal observation, the professional capabilities of medical officers assigned to surgical and neuropsychiatric work in the different army elements and kept them informed of advanced techniques in their respective fields. Consultants of the theater surgeon's office, as well as some from the European theater surgeon's office, visited Fifth U.S. Army. The personnel section under the direct control of the executive officer carried out the usual duties of a personnel section-promotion, assignment, classification, replacements, and maintenance of personnel records-with the advice of officers heading the various professional services of the office, as well as that of commanding officers of Medical Department units. The dental section reported on the current status of the dental service in the army, advised the surgeon on the dental health of Fifth U.S. Army troops, inspected the Army's dental units, prepared statistical studies, and made recommendations for improving the dental service. Besides its usual task of supervising the inspection of the Army's food supplies, the veterinary section had greater responsibilities for animal care than did the veterinarians of most armies, for Fifth U.S. Army used thousands of horses and mules during the Italian campaign. The veterinary section arranged the movement of the Army's veterinary units and the evacuation of its animals, recommended sites for the location of veterinary hospitals, and checked requisitions for veterinary supplies and equipment.21
Seventh U.S. Army.-Lt. Gen. George S. Patton's Seventh U.S. Army came into being in July 1943. The nucleus of what was to be its staff medical section had functioned first as a part of Western Task Force headquarters and later as the staff medical section for I Armored Corps (when the task force had been given that redesignation). By April the medical section had been split between a forward echelon headquarters in Mostaganem, Algeria, and a rear echelon headquarters in Oran. The surgeon, Col. Daniel Franklin, MC (fig. 60), together with two officers, performing executive and hospitalization and evacuation functions, and two enlisted men at Mostaganem bad made medical plans for the invasion of Sicily, while rear echelon medical personnel, amounting to three officers and nine enlisted men, had attended to matters of medical supply, preventive medicine, and routine administration.
The surgeon and his staff at forward echelon sailed aboard the headquarters ship of the invasion force and arrived in Sicily as the medical section of Seventh U.S. Army, those at rear echelon following within a few days. At the conclusion of the Sicilian campaign on 17 August, the office was located in Palermo. It was organized in a fashion similar to that of the Fifth U.S. Army surgeon's office; after the addition of a few personnel late in the year, it totaled 9 officers and 18 enlisted men. Since Seventh U.S. Army's duties
21(1) Annual Report, Surgeon, Fifth U.S. Army, 1943. (2) Annual Report, Surgeon, Fifth U.S. Army, 1944.
in the post-campaign period were of an occupational nature, a relatively small medical section sufficed.22
II Corps.-During the Tunisian campaign, where II Corps (commanded successively by Maj. Gen. (later Lt. Gen.) Lloyd R. Fredendall, Lt. Gen. George S. Patton, Jr., and Maj. Gen. (later Gen.) Omar N. Bradley) operated independently, the corps surgeon's office functioned in the same manner as the surgeon's offices of Fifth and Seventh U.S. Armies. With a peak strength Of close to 1001000, 11 Corps was in fact as large as many field armies. It is not, therefore, surprising that the staff of the II Corps surgeon-11 officers and 16 enlisted men at its maximum-was larger than that of most corps.23
The Army Air Forces
The air force setup in North Africa grew elaborate during the first year of the theater's existence. American elements of the Northwest African Air Forces, while remaining under this Allied command's operational control, were reconstituted as the Twelfth Air Force just before the invasion of Italy in September 1943. After the fall of Naples early in October, the Twelfth
22Annual Report, Surgeon, Seventh U.S. Army,
Chart 15.- Medical Organization in Air Force commands, 1 February 1944
Air Force became a primarily tactical force designed to support the Fifth U.S. Army's ground operations. Its heavy bombardment elements were removed to form the nucleus of a strategic air force, the Fifteenth, activated in November.
Early in 1944, these two air forces were subordinated to a higher American air command for the theater, the AAF/MTO (Army Air Forces, Mediterranean Theater of Operations) which was in turn subordinate to the theater command (chart 15). At the same time the Air Service Command, MTO, was established as one of its subcommands. In the preceding month the name of the Allied air command had been changed from Northwest African Air Forces to MAAF (Mediterranean Allied Air Forces); it remained subordinate to the Allied Commander in Chief. Thus, at the beginning of 1944, the following American medical sections existed at the major air headquarters of the theater: A small medical section which served not only the top American air command (AAF/MTO) but was also the American medical component of the Allied air command (MAAF) and a medical section at each of the three commands subordinate to the Army Air Forces, MTO-the Army Air Forces Service Command, MTO, and the Twelfth and Fifteenth Air Forces. This organization prevailed to the end of the war.
Although Twelfth Air Force had lost its identity in early 1943 when it was absorbed by the Allied air command, its administrative elements had been retained within the larger organization and continued to serve Twelfth Air Force units. The surgeon's office, formerly at various sites in Algeria and Tunis, moved to Foggia, Italy, in November. The major segments of the office were as
follows: Executive, including personnel and sick and wounded; medical inspection, including professional services, physical examinations and venereal disease control; dental surgeon; neuropsychiatry, including medical disposition board and statistics and records; care of flier; and physiology, including personal equipment and nutrition. The veterinary and medical supply services were not within the Twelfth Air Force medical section after early 1943, but were placed within the medical section of Twelfth Air Service Command, the normal place for these activities.
The functions of most of the subsections in the Twelfth Air Force surgeon's office are self-explanatory. The physiology, neuropsychiatry, and care-of-flier subsections had more distinctive functions than the rest. The first of these investigated physiological problems pertaining to flying, including the danger of anoxia, the effects of cold temperature, and problems of night vision. Its physiologist tested new items of clothing and protective equipment and armament, while its personal equipment officer directed the maintenance of emergency, flying, and oxygen equipment; gave instructions in the proper use of it; and supervised the medical care of fliers who survived crashes or forced landings at sea. The neuropsychiatry subsection formulated policy on neuropsychiatric problems; the psychiatrist who headed it instructed unit flight surgeons in neuropsychiatric matters, made recommendations to air force staff sections regarding morale, and participated in the proceedings of a medical disposition board which reviewed cases of men whose physiological or psychological fitness for flying was under question. The care-of-flier subsection, which became a typical element of the office of an air force surgeon, devoted itself to consideration of all the elements, including type. of plans and nature of the mission flown, as well as the physiological and neuropsychiatric conditions which affected the health of fliers. On the basis of reports which the care-of-flier subsection obtained from unit surgeons as to the flying status of their men, hours lost from flying, cause, and so forth, it evaluated the health of Twelfth Air Force fliers. This unit then worked toward the reduction of stresses on the individual flier to a minimum and the establishment of standards for rotation or relief of fatigued fliers from duty.
By the end of November 1943, the Fifteenth Air Force, with headquarters at Bari, had built up steadily in southeastern Italy, where its operations were based until the end of the war. From early 1944 on, its heavy bombardment groups aided with the strategic bombing of targets in Axis-held territory within the boundaries of the European theater, and for this purpose were directed by the U.S. Strategic Air Forces based in ETO. The administration of the Fifteenth Air Force, however, including its medical service, was handled within the Mediterranean theater's chain of command. The organization of its surgeon's office resembled that of the Twelfth Air Force surgeon's office and its functions did not differ appreciably from those of the latter.
The surgeon's office of AAF/MTO, the top coordinating American air command, was a small one; it was headed by Col. Richard E. Elvins, MC, former
surgeon of the Twelfth Air Force. Its duties involved "coordination and policymaking" rather than administrative functions, for the latter became the responsibility of the Office of the Surgeon, Army Air Forces Service Command, Mediterranean Theater of Operations.
Within the headquarters of Mediterranean Allied Air Forces, close liaison was maintained between the American medical component headed by Colonel Elvins (Medical Section, AAF/MTO) and its British counterpart. The senior medical officer of Headquarters, Mediterranean Allied Air Forces, a British officer, did not assume any administrative control over medical activities of the Twelfth and Fifteenth Air Forces but restricted his action to coordination of his own medical plans with those of the American medical section. The latter maintained liaison with American medical officers at Allied Force Headquarters by means of conferences.24
Designed to perform administrative functions for the Twelfth and Fifteenth Air Forces, the medical staff of Army Air Forces Service Command, MTO,25 handled matters of health and sanitation, venereal disease and malaria control, medical care, evacuation, medical plans and training, dental care, food inspection, rest camp operation, and medical supply. The air service command also supervised the operation and maintenance of certain general, station, and field hospitals turned over to air force control after December 1943. Most were in the Bari-Foggia area of southeastern Italy and served troops of the Twelfth, then of the Fifteenth, Air Force. A few hospitals on the islands of Pantelleria, Sardinia, and Corsica were also under air force control. Officially attached to AAF/MTO (though remaining assigned to the Services of Supply), these hospitals were directly supervised and administered by the surgeon of the air force service command organization. This was the first time that substantial responsibilities for fixed hospitalization had been given to the Army Air Forces in a theater of operations. The fact that the Bari-Foggia area was under the control of British military forces and not within the territory of any North African theater base section accounts in part for the attachment of the hospitals to the air forces. The theater surgeon (General Blesse), as well as the surgeons of the Twelfth and Fifteenth Air Forces, recognized the air forces' need for direct supervision of the fixed hospitals which served air force troops-stationed at some distance from Services of Supply hospitals and widely dispersed. The surgeon of the Fifteenth Air Force expressed his approval to the Deputy Air Surgeon in Washington: "Our relationship with the hospitals is excellent and they have been most cooperative. However, this is an unusual
24(1) See footnotes 12 (2) and (3), p. 255
; and 11 (1), p. 254. (2) Medical History, Fifteenth Air Force, November
1943-May 1945. [Official record.] (3) Annual Report, Medical Section, Army
Air Forces Service Command, Mediterranean Theater of Operations, 1944.
(4) Organization and Functions of the Medical Section, Army Air Forces
Service Command, Mediterranean Theater of Operations, through 1 October
1944. [Official record.] (5) History of Allied Force Headquarters, pt.
II, see. 1; pt. III, sec. 1.
setup as you well appreciate. In the usual ASF hospital arrangement there are numerous objectionable characteristics that you and your people seem well aware of."26
The office of the Surgeon, Army Air Force Service Command, MTO, was relatively large, amounting by mid-1944 to 15 officers, 18 enlisted men, and 4 enlisted women. It was the technical channel for the distribution of medical information from the theater surgeon to surgeons of major air force echelons. Early in 1944, the medical section was split between advance headquarters at Bari, Italy, and rear headquarters in Algiers. By February, the entire section was at Naples, the new location of the air force service command's headquarters.27
The Air Transport Command in North Africa
The Air Transport Command entered the scene in the North African theater soon after the Allied landings. The extension of its established Africa-Middle East Wing (a segment of the South Atlantic air route from the United States through Brazil and across central Africa into the Middle East) into the coastal areas of northern Africa was marked by the arrival of the first transport plane from Accra, Gold Coast, at Oran on 17 November 1942. During the following month the wing inaugurated a transport route from Dakar, French West Africa, via Casablanca to England. Daily Air Transport Command service through northern Africa began in late January 1943 via the following towns: Accra, Bathurst, Atar, Tindouf, Marrakech, Casablanca, Oran, and Algiers. Territory covered by the wing was expanded considerably with this northward extension; by the end of 1943, the Africa-Middle East Wing had been split into the North African Wing, with most of its stations within North African theater boundaries and some within the Middle East theater, and Central African Wing following the more southerly route, with all its stations within the boundaries of the Middle East theater.
The North African Wing, later termed North African Division, with headquarters at Casablanca, covered not only points along the coast of northern Africa and French West Africa, but also most of the Middle East, extending from Dakar on the extreme west coast of Africa to the eastern border of Iran. By the end of January 1944, it included the following stations: Dakar, Atar, Tindouf, Marrakech, Casablanca, Oran, Algiers, Tunis, Naples, Tripoli, Bengasi, Cairo, Abadan, and Bahrein Island.
In the early part of 1944, 15 Medical Department officers and 53 enlisted men, supervised by the wing surgeon, served these stations. The first wing surgeon was Lt. Col. (later Col.) Clarence A. Tinsman, MC (fig. 61). He was succeeded by Col. Frederick C. Kelly, MC (fig. 62), in July 1944. Within
26(1) Letter Col. Otis O. Benson, Jr., to Col.
Walter S. Jensen, Deputy Air Surgeon, 9 Apr. 1944. (2) Letter, Col. Otis
O. Benson, Jr., to Director of Administration, Office of the Air Surgeon,
30 Sept. 1944. (3) Letter, Brig. Gen. Frederick A. Blesse, to Maj. Gen.
Norman T. Kirk, The Surgeon General, 6 Feb. 1944. (4) Annual Report, Medical
Section, Army Air Forces Service Command, Mediterranean Theater of Operations,
1944. (5) See footnotes 6 (5), p. 250 and 12 (2), p. 255.
the first 6 months of 1944, the number increased to 42 officers and 131 enlisted men. The scattered stations of the wing were usually served by a dispensary, which customarily maintained a few beds, with at least one medical officer present. Nearby station or general hospitals maintained by the base sections, or service commands of the Middle East theater, received and treated Air Transport Command personnel whenever necessary. Sanitation, the control of malaria, venereal disease, and the dysenteries among troops, and efforts to prevent troops from contracting many other diseases existent in the local population constituted the major work of the wing surgeon's staff. It was responsible not only for the health of the military population of each station but also for that of many transient personnel who were under Air Transport Command control while en route. The wing had to furnish care to patients transported along its route, including evacuees from. the China-Burma-India theater, toward the United States. During 1944, the North African Wing was responsible for the return of over 6,000 patients by air. Immediate control of the wing was exercised by the wing commander, responsible to the commanding general of the Air Transport Command in Washington, in turn subordinate to the Commanding General, Army Air Forces. Although the wing commander had exclusive control over his personnel, he was responsible for adherence to the
administrative policies of the commanders of the theaters in which the stations of his wing were located.28
PERIOD OF GROWTH AND REORGANIZATION
Reorganization of February 1944
With southern Italy, Sicily, Sardinia, and Corsica under Allied control, theater boundaries were expanded in February 1944 to include almost all territories bordering on the Mediterranean Sea. The African boundaries remained unchanged, but the theater now included (in anticipation of an invasion of southern Europe from North Africa) southern France, Switzerland, Austria, the Balkans, Turkey, and the Aegean Islands with the exception of Cyprus (map 1). Troop strength of the theater in February 1944 amounted to more than 640,000. A major reorganization of the theater setup took place at this date as the result of a survey made in 1943 which had revealed some duplica-
28(1) Administrative History of the Air Transport Command, June 1942-March 1943 (1945). [Official record.] (2) Administrative History of the Air Transport Command, March 1943-July 1944 (1946). [Official record.] (3) History of the Medical Department, Air Transport Command, May 1941-December 1944. [Official record.] (4) See footnote 24(5), p. 272. (5) History, Medical Section, Africa-Middle East Theater of Operations, September 1941-September 1945.
tion of functions and excess personnel in three high commands: Allied Force Headquarters, North African theater headquarters, and Services of Supply headquarters. The functions normally assigned to a communications-zone commander by field service regulations were transferred from theater headquarters to Headquarters, Services of Supply (renamed Communications Zone in October), and the base sections became subordinate to the Services of Supply, in accordance with Army doctrine for organization of an oversea theater.
The principal effect of this reorganization upon medical administration was an expansion of the responsibilities of the Services of Supply medical section, which had previously been concerned only with the handling of medical supply. From February to November 1944, it had broad medical responsibilities within the communications zone, the most important of which was supervision of the fixed hospitals operating in the base sections. It thus became more nearly the orthodox Services of Supply medical section of the type existent in other theaters.
The theater medical section was still responsible for making plans and formulating policies, including those in dental and veterinary medicine. It coordinated these with the various staff elements of the combined theater and Allied headquarters and the medical offices of the Services of Supply, NATOUSA, of the armies (or task forces), the air force commands, the Allied armies, and Allied Military Government. It acted as the channel of communication with the War Department on all matters of policy. A significant responsibility which it retained was that of recommending allocation of Medical Department troops and units among the Services of Supply, the armies, air forces, and other commands.
The functions of the Services of Supply medical section, one of the special staff sections of that headquarters, pertained to medical activities within the communications zone and its base sections, where the larger, relatively fixed, medical installations were located. It administered the fixed hospitals; after an expansion of June 1944 these amounted to 17 general hospitals of 1,500 or 2,000 beds each, 34 station hospitals most of which provided 500 beds each, and 4 field hospitals of 400 beds each. The medical section, SOS, now selected hospital sites, and was responsible for evacuating the sick and wounded by land from the combat zone to the communications zone and within the communications zone, and for sea evacuation from the communications zone to the United States. It made medical inspections in the communications zone and compiled data on the sick and wounded in that zone. It controlled and trained Medical Department units assigned to the communications zone. It continued to direct the supply activities of the base sections and issued items of medical supply and equipment in excess of tables of basic allowances and tables of equipment to troop units in the communications zone. This division of medical responsibilities between the theater headquarters and Services of Supply headquarters, whereby the medical section of theater headquarters had responsibility for making theaterwide plans and establishing policies
Chart 16.- Medical Section, Services of Supply, North African theater, May 1944
while the medical office at Services of Supply headquarters supervised the handling of medical supply, the operation of fixed hospitals as well as medical supply depots, and the extensive preventive medicine program which were the responsibilities of the communications zone, prevailed in most of the oversea theaters.29
With the assumption of new responsibilities, the medical section of the Services of Supply was reorganized (chart 16). The old Services of Supply medical section as it had functioned from February 1943 through February 1944 became merely the supply branch within the new medical section with a structure similar to its former organization.
After February 1944 the theater medical section reduced its personnel, since fewer numbers were needed for the planning and coordinating activities to which it was now restricted; some of its members were transferred to the Services of Supply medical section. On 1 March, Maj. Gen. Morrison C. Stayer, the former surgeon of the Caribbean Defense Command, became head of the theater medical section, replacing General Blesse; he served as theater surgeon (and Deputy Surgeon, AFHQ) until mid-July 1945.
An important development in theaterwide administration of medical service in the spring of 1944 was the establishment of a veterinary section in the theater surgeon's office. This was the only major phase of the Medical Department's work in the theater which had not received central direction from the theater surgeon's office. Apparently supervision of veterinary service from
29(29) History of Allied Force Headquarters, pt. III, sec. 2. (2) See footnotes 6 (2), p. 250 18 (2), p. 260 and 19 (7), p. 262.
the Services of Supply level had originally been contemplated, for a Veterinary Corps officer attached to the theater surgeon's office had been shifted to Services of Supply headquarters early in 1943. However, the medical section of the Services of Supply had performed only supply functions, and the theater medical section had not shown any strong interest in directing the work in food inspection. Nor had the medical offices at the headquarters of the base sections developed any permanent veterinary elements.30
Veterinary officers commanding veterinary food inspection detachments and others assigned to Quartermaster Corps depots and refrigeration companies and to ports as port veterinarians carried out the, tasks of food inspection and made arrangements for protecting food against contamination. Food inspections took place at many command levels and at many stages of procurement, storage, and issue of foods: the unloading at ports of foods shipped to the theater; storage of shipped foods at Quartermaster depots; butchering of locally bought cattle at local abattoirs; purchase of fish, eggs, fruits, vegetables, and processed foods locally; placement of foods in cold storage rooms. and mobile refrigerating units; and handling at unit messes. These inspections called for close coordination with the Quartermaster Corps and Trans-portation Corps because of the responsibilities of these two services in storing and transporting food supplies. The obvious lack of uniform procedures for inspection and standard measures for conservation, together with the condemnation of foods needlessly by some Veterinary Corps officers, led the preventive medicine officer at theater headquarters, Col. William S. Stone, MC (fig. 63), to emphasize the need for a veterinarian in that office.
In the fall of 1943, 12 Veterinary Corps officers, requisitioned by the Quartermaster Corps to supervise abattoirs for the slaughter of cattle to be furnished the U.S. Army by the French under reverse lend-lease procedure, arrived in the theater. As this program had failed to develop, the veterinarians had no assignments and were temporarily put in replacement pools. At this point, General Blesse, the theater surgeon, assigned Lt. Col. Duane L. Cady, VC, to the task of surveying the work of veterinarians throughout the theater and making recommendations with respect to the veterinary service. Colonel Cady found that the lack of any central organization to make the proper distribution of veterinary officers where they were needed had led to a maldistribution of veterinary personnel and had affected the quality of veterinary service afforded in the theater. He planned a theaterwide system of supervision by veterinarians assigned to the staffs of all major commands, including the theater command, the base sections, the Fifth U.S. Army, and the Twelfth
30(1) History of Allied Force Headquarters, pt. II, sec. 4. (2) See footnote 12(4), p. 255. The absence of any veterinary component in the theater medical section may have been because the British medical section at Allied Force Headquarters had no veterinarians. The British Royal Army Veterinary Corps was not a part of the British Army Medical Services; at Allied Force Headquarters the British Veterinary and Remount Services formed an element of the office of the British Assistant Deputy Quartermaster General. See Blackham, R. J.: The American Army Medical Services in the Field. J. Roy. Army M. Corps 80: 201-207, May 1946.
Air Service Command. He also emphasized the need for centralized supervision over the work of caring for animals, for Fifth U.S. Army was using mules and horses in increasing numbers in its northward push in the mountains of Italy. The use of Italian veterinarians and veterinary units in divisional veterinary service, as well as at remount stations (operated by Peninsular Base Section) which furnished thousands of mules and horses for the animal pack trains of Fifth U.S. Army, made the standardization of policies and procedures even more imperative. After the assignment of a Veterinary Corps officer to theater headquarters early in March 1944, a theaterwide, system was worked out, standard procedures adopted, and the mutual responsibilities of the Quartermaster Corps and the Medical Department for care and conservation of food supplies delineated.31
Movement and Further Reorganization
In July 1944, Allied Force Headquarters and Headquarters, North African Theater of Operations, moved from Algiers to Caserta, Italy. Here for
31(1) Memorandum, Lt. Col. Duane L. Cady, VC, for Surgeon, NATOUSA, 21 Dec. 1943, subject: Investigation and Survey of Veterinary Activities in North African Theater of Operations. (2) See footnote 12(4), p. 255.
the first time the British and American components were in separate buildings, the American component, including its medical section, being housed in the Royal Palace, a short distance from the town. The medical section of AAF/MTO32 also had quarters in the Royal Palace, and Headquarters, Services of Supply, had established its offices in the town of Caserta, moving from Oran in July. The close proximity of the theater and Services of Supply medical sections afforded greater opportunity for coordinating their respective programs. The 200-mile distance between Oran and Algiers had been a distinct disadvantage. It now appeared feasible to simplify staff procedures and reduce the number of officers in administrative positions by having the general and special staffs of the two headquarters function in a dual capacity. A proposal to combine the two headquarters was soon in the offing; after the invasion of southern France in August 1944-the month during which troop strength in the North African theater reached its peak of 742,700-a development to that effect took place.
The Services of Supply, NATOUSA (renamed Communications Zone, NATOUSA, on 1 October 1944), became responsible for support of the U.S. Seventh and French First Armies which invaded southern France from the North African theater. An advance echelon of its headquarters staff, set up at Lyon in September, moved north to Dijon in October. Communications Zone, NATOUSA, established two sections in southern France. The first, Coastal Base Section, was renamed Continental Base Section and then, on 1 October, Continental Advance Section when it moved forward in direct support of the tactical forces. On the same date Delta Base Section was established, with headquarters at Marseille, taking over a portion of the territory previously under Continental Base Section. The headquarters of both these area commands had medical sections from the start.
The invaded area of southern France was transferred to the European theater in mid-September, but control of supply and administration in this area remained until November with Communications Zone, NATOUSA, which had extended its administrative and supply responsibilities from one theater to the other and was now chiefly concerned with the operation in southern France. On 1 November, Communications Zone, NATOUSA, was renamed Communications Zone, MTOUSA. On 20 November, Communications Zone, MTOUSA, was dissolved, its functions so far as southern France was concerned passing to SOLOC (Southern Line of Communications), a new command subordinate to European theater headquarters. At the same time Colonel Shook, former Surgeon of Communications Zone, NATOUSA and MTOUSA, became Surgeon of Southern Line of Communications, taking most of his staff with him. The base sections in southern France, together with their medical offices, fixed hospitals, and other medical installations, likewise passed to the control of the European theater.
32It will be remembered that the Army Air Forces had substituted Mediterranean Theater for North African Theater in February 1944-some 9 months before the same change was made at the headquarters level.
Chart 17.- Mediterranean theater medical section (American medical component of Allied Force Headquarters), April 1945
The North African Theater of Operations, U.S. Army, was renamed, effective 1 November 1944, the Mediterranean Theater of Operations, U.S. Army, and within the month its medical section assumed the functions of the former medical section of the Communications Zone (except those for southern France) in addition to its own theaterwide functions. It took over only 5 officers and 16 enlisted men from the Communications Zone medical section; Southern Line of Communications headquarters had to retain sufficient personnel for its operations in southern France. The reorganization simplified medical administration in the new Mediterranean theater considerably, since orders could now pass directly from theater headquarters to the base sections without the intermediate Communications Zone command. The November reorganization restored to the theater medical section all the functions it had had before February 1944, including the administration of evacuation and hospitalization. in the base sections, and added an important new one in the form of a complex supply section. The medical section acting at theater headquarters and Allied headquarters in Caserta was now responsible for all medical functions of theaterwide scope.33
33(1) See footnotes 6 (2) and (5) p. 250; 11(l), p. 254; and 18(2), p. 260. (2) Coakley, Robert W.: Administrative and Logistical History of the European Theater of Operations, Organization and Command in the ETO, pt. II, ch. 7. [Official record in the Office of the Chief of Military History.]
ized for the office reached a peak about the same time (table 2). The increase in size of the theater medical section at this late date when troop strength had declined below 500,000 was due to the fact that the office had assumed all the former duties of the Services of Supply medical section, as well as the normal responsibilities of a medical office at theater headquarters.
Source: Adapted from a tabulation in Munden, Kenneth W.: Administration of the Medical Department in the Mediterranean Theater of Operations, United Sates Army (1945), p. 157. [Official Record.]
The Base Sections
By the end of November 1944, the Mediterranean theater had only three base sections, the Island Base Section on Sicily having been disbanded in July 1944, and Atlantic and Eastern Base Sections having been absorbed by Mediterranean Base Section following the transfer of facilities to southern France. The base sections had operated directly under Services of Supply (Communications Zone) throughout most of 1944, the period of heaviest responsibility of
the Services of Supply. With the November reorganization and the abolition of the Services of Supply, the three remaining base sections-Peninsular Base Section, Mediterranean Base Section, and Northern Base Section, in order of importance-again came under the direct control of theater headquarters. During 1944, Army installations in North Africa had declined in number and importance, while base section facilities had become concentrated in Italy.
The geographic territory of Peninsular Base Section increased in 1944 with the movement of Fifth U.S. Army northward. After the occupation of Rome in June, five hospitals were moved there, and a separate Rome Area Command, with a small headquarters medical section, responsible directly to the theater command, directed the hospitals in the area during 1944. When Leghorn was occupied in July, Peninsular Base Section hospitals were shifted there and to the coastal towns north of Rome. During the preparations for the invasion of southern France, some medical installations in Peninsular Base Section were turned over to Continental Base Section, which was to support the Seventh U.S. Army in its landings. Peninsular Base Section was responsible for medical support of the Seventh U.S. Army while the latter was staging in Naples, and from August through November, after the Seventh U.S. Army invaded southern France, the base section received large numbers of patients from that area.
By August, Leghorn had become a major supply base and port; the headquarters of Peninsular Base Section, Forward, was located there, its larger half-Peninsular Base Section, Main-remaining at Naples. The base section surgeon accordingly maintained medical staffs in both cities. In late November, the more important headquarters-Peninsular Base Section, Main-was shifted from Naples to Leghorn, and the Naples area was thereafter known as Peninsular Base Section, South. Near the end of the year, half of the fixed medical installations in southern Italy had been moved up to the Leghorn-Florence area. The base section surgeon now had his office in Leghorn but was represented by a deputy surgeon at Naples.
At Bagnoli in the Neapolitan suburbs, certain hospitals and related medi-cal units were formally activated as a "medical center" in February 1944 (fig. 64). Three (later four) general and three station hospitals and one evacuation hospital were included, along with a supply depot, dental laboratory, general medical laboratory, and other units. A common message center and a general utilities section were established, and the 4744th Medical Center (Provisional) was created as the centralized administrative headquarters of the medical units at Bagnoli. The Bagnoli concentration constituted something atypical in organization, being a more comprehensive grouping of Medical Department units than the "hospital center" prescribed in the Army field manuals. A hospital center normally consisted of three or more general hospitals, a convalescent camp, detachments of the Quartermaster and Finance Departments, and other branches; station and evacuation hospitals were not included. The Bagnoli medical center included these, as well as the medical
supply depot and laboratories. It resembled the hospital center, however, in carrying out the field manual doctrine for obtaining, by means of pooling, economy in the use of personnel and facilities, and increased specialization in treatment of patients. This center, the only one formally organized in the theater, operated continuously to the end of the war.
The work of the Mediterranean Base Section's medical office, which had been very active during the first half of 1944, underwent sharp reduction toward the close of the year. Responsibility for evacuating American patients to the United States on transports from the ports of Oran and Algiers continued, but hospitals assigned to the base section decreased from 14 to 4 by the close of the year. The base section took over the medical units and hospitals (with less than a thousand beds) of Atlantic and Eastern Base Sections when it absorbed those two commands in mid-November. In December the medical section moved with the base section headquarters from Oran to a new site at Casablanca.
The third base section to continue in operation throughout 1944 was Northern Base Section in Corsica. The surgeon's office here amounted to only six officers and seven enlisted men. Only one field and two station hospitals were on the island. With the station hospitals divided into detachments and field hospitals into their component platoons, these medical units served air force and service troops at several scattered locations on Corsica.34 At the beginning of 1945, the theater had three base sections and a depot area: In North Africa, the recently consolidated Mediterranean Base Section; in Corsica, Northern Base Section; in western Italy, Peninsular Base Section; and in eastern Italy, the Adriatic Depot (under the Air Service Command), which served the air forces located in that area. At the end of February 1945, the Mediterranean Base Section was discontinued, and the entire geographic area of North Africa was transferred to the jurisdiction of the Africa-Middle East theater. The three station hospitals then operating in North Africa passed to the control of the latter theater. The boundaries of the Mediterranean theater were redefined by this move to include the entire Mediterranean area other than North Africa, with the exception of Cyprus and a few of the small islands off the coast of Turkey (map 1).
Early in 1945, a new Adriatic Base Command at Bari, Italy, took over service functions previously performed by Adriatic Depot for elements of the Twelfth and Fifteenth Air Forces located along the east coast of Italy, an area in which the British had primary responsibility. It was decided to turn over the hospital units which had been attached to the AAF/MTO to the Adriatic Base Command for administration. The air force headquarters strongly opposed the move, insisting that hospitals servicing air force troops should remain under air force control. A study of the problem directed by the theater surgeon granted that the control over hospitalized air force personnel which the attachment of the hospitals to the air forces had afforded had been an advantage to air force medical service. However, since air force units would be redeployed soon after the cessation of hostilities in Europe, it was decided to reassign the hospitals to the more sedentary Adriatic Base Command.
Base section medical service underwent further retrenchment in the spring of 1945 with the departure of the two hospitals serving air force troops in the Northern Base Section in Corsica and the closeout of the base section in May. The Peninsular Base Section in Italy, responsible for supporting the Fifth U.S. Army during the brief Po Valley campaign, contained at the
34(1) Annual Report, Surgeon, Mediterranean Base Section, 1944. (2) Annual Report, Surgeon, Northern Base Section, 1944. (3) Annual Report, Peninsular Base Section, 1944. (4) See footnotes 11 (1), p. 254 ; and 18 (2), p. 260. (5) Zelen, A. I. : Hospital Construction in the Mediterranean Theater of Operations, U.S. Army (1945). [Official record.] (6) War Department Field Manual 8-5, Medical Department Units of a Theater of Operations, May 1945.
end of August about four-fifths of the fixed hospital beds in the Mediterranean theater.35 The Combat Forces
The duties of medical officers of Army Air Forces, Mediterranean Theater of Operations, and Army Air Forces Service Command, Mediterranean Theater of Operations, did not change appreciably during the latter part of 1944 and 1945. With the cessation of hostilities in Europe on 8 May 1945, some duties increased, particularly those concerned with the disbandment of some units and the formation of others to render adequate medical service during redeployment and the departure of some Medical Department personnel for the United States. Several new surgeons were appointed to the two top air force headquarters during 1945, but both these headquarters were disbanded by the end of November.36
The staff medical sections of Fifth and Seventh U.S. Armies were occupied during 1944 with planning and supervising medical service during periods of active combat. After a period of reduction in strength following the close of the Sicilian campaign, Seventh U.S. Army headquarters, including its medical section, was occupied in planning the invasion of southern France. Planning was carried on in Algiers, Oran, and Mostaganem successively until July, when the entire Army headquarters moved to Naples for final preparations. After the assault on southern France in mid-August and the rapid advance up the Rhone Valley, the Seventh U.S. Army was included, by November, in the European theater and under the control of that command. By that date its medical section, headed by Col. Myron P. Rudolph, MC (fig. 65), from June 1944 on, had enlarged considerably. New positions added during the year included an operations officer and an assistant, a surgical consultant, a veterinarian, a personnel officer, a director of nurses, a neuropsychiatric consultant, a liaison officer with the French forces, a historian, and two medical records officers.
Fifth U.S. Army was engaged throughout 1944 in the Italian campaign. Its headquarters medical section received a few additional assigned personnel: a malaria control officer, a chief nurse, and a historian. A consultant in psychiatry and an Italian liaison officer were attached to the office. The army surgeon, General Martin, maintained close liaison with the surgeon of the Peninsular Base Section throughout the campaign, keeping the latter informed of the offensive plans of the army, so that fixed hospitals of the base section could move forward and occupy sites previously used by hospitals assigned
35(1) See footnotes 6(2), p. 250; and 11(l),
p. 254. (2)Final Report, Plans and Operations Section, Office of the Surgeon,
Mediterranean Theater of Operations, U.S. Army, 10 Nov. 1945. (3) Final
Report, Surgeon, Northern Base Section, 1945.
to the army. The two surgeons rotated doctors between forward and rear area hospital units. Centers for the rehabilitation of psychiatric casualties near the front, a neuropsychiatric center in the corps or army area, and a, gastrointestinal and a venereal disease center in the army zone were developments in specialized medical service of the Fifth U.S. Army.37
The rapid progress of the Po Valley campaign in the spring of 1945 confronted the Fifth U.S. Army medical service with the problem of hospitalizing prisoners of war. As they were enveloped, German hospitals were, taken over intact and kept in operation under American supervision. As prisoner-patients were discharged to the prisoner-of-war camps after the war ended, German hospital units were consolidated, and with the repatriation of some 12,000 long-term cases by September, were closed out. Anticipating that Fifth U.S. Army would occupy Austria, the army surgeon's office drew up a complete plan for medical support of this operation. As Fifth U.S. Army was not given this task (11 Corps, with six divisions, assumed control of the American zone of Austria in June 1945), General Martin's office was mainly occupied during the remainder of 1945 with the medical aspects of the redeployment program, in-cluding the operation of medical service in rest centers maintained for Fifth
37(1) Annual Report, Surgeon, Seventh U.S. Army, 1944. (2) Annual Report, Surgeon, Fifth U.S. Army, 1944. (3) See footnotes 6(5), p. 250; and 18(2), p. 260. (4) Interview, Maj. Gen. Joseph I. Martin, MC, 21 Feb. 1942.
U.S. Army troops in Italy. Teams from Fifth U.S. Army's hospitals operated dispensaries at each center, and the Fifth U.S. Army medical inspector supervised sanitary conditions in hotels and restaurants in the vicinity of each. In July 1945, General Martin left the theater for an assignment in the Pacific, and in September Fifth U.S. Army headquarters ceased operations.38
ORGANIZATION FOR MALARIA CONTROL
In northern Africa many natives in the coastal areas, where most of the military operations took place, were infected with malaria; they served as a potential source for transmission of malaria to U.S. Army troops. A similar reservoir of infection existed in Italy, Sardinia, and Corsica; native refugees, demobilized Italian troops who had previously been infected in the Balkans, Ethiopia, and other malarial combat areas, and Slav laborers who had been impressed into service by the Axis were living under conditions which promoted the spread of malaria. Foxholes, shell and bomb craters, stretches of land flooded by the Germans, and demolished bridges and hastily built fords which obstructed natural drainage-all these fostered the rapid breeding of anopheline mosquitoes.
Control of malaria among U.S. Army troops in North Africa was eventually carried out under the aegis of the type of theaterwide organization planned for the purpose by the Surgeon General's Office. The theater organization initiated its own efforts at control early in 1943. It obtained information on the incidence of malaria in northern Africa, held conferences of American, British, and French malaria control officers, made arrangements with civilian health agencies for environmental control measures outside troop areas, and worked out plans for using Atabrine as a suppressant among troops. Requests for special antimalaria personnel and supplies were placed with the War Department. Exploratory surveys of mosquito-breeding areas were begun, and some drainage and larviciding were undertaken in year-round breeding areas. Medical and Sanitary Corps officers working under the supervision of base section medical inspectors directed the early antimalaria work in the theater.
Personnel of malaria control and survey units began coming into the theater in March 1943. By the end of May, four complete survey units and four control units had arrived and were assigned to all three North African base sections. A group of malariologists who had served with U.S. Army troops in Liberia since mid-1942 were transferred to North Africa; in June 1943 one of them, Col. Loren D. Moore, MC (fig. 66), became theater malariologist. He was succeeded in September by Col. Paul F. Russell, MC, who served until March 1944. Col. Justin M. Andrews, SnC (fig. 67), followed Russell
38(1) Annual Report, Surgeon, Fifth U.S. Army, 1945. (2) See footnotes 6(5), p. 250; and 36 (2), p. 286.
as theater malariologist, and Maj. Thomas H. G. Aitken, SnC, served in the post from January 1945 to the end of the war.
After the organization was stabilized, malaria control policy and administrative procedures originated in the medical section of theater headquarters. The theater malariologist served under the chief of preventive medicine in the theater surgeon's office. He maintained liaison with the Allied Control Com-mission, in charge of the public health program among civilians, and with the British consultant malariologist of Allied Force Headquarters. On his recommendation, malariologists and control and survey units were transferred to areas where their work was most needed, serving with ground force and air force commands, as well as the base sections. At its peak strength in August 1944, during the malarial season, the malaria control organization consisted of 14 malariologists, 6 survey and 17 control units, and a group of men from a ferrying squadron of the Mediterranean Air Transport Service. The latter sprayed and dusted extensive areas with antimalaria materials from planes operating under the technical direction of the theater malariologist.
An Allied Force Malaria Control School in Algiers gave concentrated training in malaria control in courses of a few days' duration to officers concerned with the administrative aspects of control, to laboratory officers and
technicians, and to enlisted men. The U.S. Army malariologists in the theater served as instructors of the American branch of the school; they repeated the training courses in more than a dozen locations of troop concentration in Algiers, Sicily, and Italy, including the hospital area at the Anzio-Nettuno beachhead.
Within the ground combat forces each company, battery, or similar unit maintained malaria, control details made up of enlisted men. In Fifth U.S. Army, confronted with the necessity for large-scale efforts in the swamps of southern Italy before malariologists and units of Peninsular Base Section could undertake control, a feature of the malaria control program was the use of antimalaria officers and malaria control committees. In each corps, division, regiment, battalion, and company, a line officer was made responsible for malaria control and served as a member of a malaria control committee. At the corps and division level, the medical inspector and the engineer served as the other members of the committee; regimental and battalion committees were composed of the surgeon and the antimalaria officer. The committees brought together information on antimalaria activities and reported findings to their respective commanding officers. The effectiveness of the committees consisted in their bringing together representatives of command, the engineers, and the doctors in the common effort.
In the Mediterranean theater, noneffectiveness resulting from malaria reached proportions significant enough to impede military operations only during the Sicilian campaign. In August 1943, the malaria rate for the theater was 116 per 1,000 men per year, but Was far in excess of that for the troops in Sicily. By August 1944, with the bulk of the theater troops in relatively healthy areas of Italy and southern France, the rate had been reduced to 91. The 1945 malaria season found the war over and conditions so altered as to make any valid comparison impossible. While the much higher incidence of malaria in the Southwest Pacific Area was caused mainly by more difficult environmental and combat conditions, many observers, as we shall see in a later chapter, attributed the higher rates there in part to faulty organization. In contrast to the situation in the Pacific, control over antimalaria. work in the Mediterranean theater was rather highly centralized, and the lines of responsibility were clear. Secondly, not only was command responsible for enforcement of the program, as Army regulations required, but line officers were made a part of the machinery which carried out control measures.
Nevertheless, certain questions raised with respect to the most efficacious means of control were never fully resolved in the Mediterranean theater. The question of how much control work the standard malaria control units should accomplish and how much troops could do for themselves was never settled. Some personnel responsible for malaria control considered the standard control and survey units too small to accomplish their objectives efficiently and too dependent upon larger units for rations and quarters; moreover, a relatively high proportion of their enlisted men were needed for administrative purposes within the unit. A plan for a medical battalion headquarters which could have been used to consolidate antimalaria, units was drawn up in 1945, but it was too late to test such a unit in the Mediterranean theater.39
TYPHUS CONTROL DURING THE NAPLES EPIDEMIC
The chief locality in which Army Medical Department officers came to grips with typhus during World War II was the Naples area. Efforts to prevent the spread of typhus to troops during the progress of the epidemic which occurred in the population of Naples in late 1943 were marked at first by some confusion as to responsibilities and later by the successful teamwork of a number of agencies.
When the epidemic developed, the only representatives of the U.S.A. Typhus Commission overseas were in Cairo, headquarters of the neighboring Africa-Middle East theater. In the North African theater the Office of the
39(1) See footnotes 6(3), p. 250; 11(l), p. 254; and 18(2), p. 260. (2) Final Report, Preventive Medicine Officer, Surgeon's Office, Mediterranean Theater of Operations, U.S. Army, 1945. (3) Andrews, J. M.: Malaria Control in the Mediterranean Theater of Operations in 1944. J. Mil. Med. in Pac. 1(3): 33-38, November 1945. (4) Report of Malariologists' Conference, Naples, 1-11 November 1944. (5) Medical Department, United States Army. Preventive Medicine in World War II. Volume VI. Communicable Diseases: Malaria. [In press.]
Surgeon, NATOUSA, a Rockefeller Foundation typhus team, and the Pasteur Institute had made joint preparations to combat outbreaks of the disease during the summer and fall, working in close cooperation. Members of the Rockefeller Foundation typhus team had worked out and demonstrated in Algiers during the summer of 1943 methods of mass delousing in prisoner-of-war camps, Arab villages, and a civilian prison. They used U.S. Army louse powders which had been developed in the United States by various Government agencies in collaboration with the Preventive Medicine Service of the Surgeon General's Office.
Before Allied troops entered Naples in the first days of October, the theater preventive medicine officer, Colonel Stone, had requested large quantities of the newly developed insecticide, DDT, from the United States, but because of the limited supply the highly effective powder was not shipped in quantity until late in the year. Colonel Stone had also arranged for members of the Rockefeller Foundation team to demonstrate, to officers in base sections, hospitals, and divisional areas the methods of mass delousing which they bad found most rapid and effective.
Early in December, Allied Force Headquarters received information of an incipient epidemic of typhus in Naples. The theater surgeon's office exerted pressure on the military government heads in Allied Force Headquarters to organize the civil health agencies in Italy to cope with the outbreak. The director of public health of the military government organization in Italy reported that his organization was aware of the danger in the Naples area and was taking steps to avert it. However, the typhus control program got under way slowly because of unsatisfactory organization of the civil health service and lack of experience on the part of military government personnel. Dr. Soper and Dr. Davis of the Rockefeller Foundation team were sent to Naples on 8 December to undertake typhus control work under the direction of the Allied Military Government in Naples. Confronted by a poorly functioning civilian health setup and inadequate support, the Rockefeller group experienced difficulties in obtaining personnel and transportation for the mass dusting of the Neapolitan population with insecticides.
The theater preventive medicine officer arrived in Naples on 18 December and worked out arrangements for the cooperation of the Peninsular Base Section surgeon and the Allied Military Government of Naples to intensify the work of the Rockefeller Foundation team in bringing the epidemic under control. The Typhus Commission officially entered the scene with the arrival of its field director, General Fox, in Naples on 20 December. General Fox and Colonel Stone cooperated in making forceful representation to the theater com-mand, the Fifth U.S. Army commander, and the Allied Military Government and made arrangements in the latter part of December for additional supplies and personnel. The Typhus Commission was put in temporary charge, and
Col. Harry A. Bishop, MC (fig. 68), of the theater surgeon's office, was made coordinating and executive head. Peninsular Base Section supplied the much needed transportation and an effective program got underway.
The system of control employed consisted partly of case finding, followed by isolation of cases in order to remove the sources of infection, but large-scale dusting of the population in order to destroy the louse vector was the chief means of dealing with the epidemic. The campaign soon proved successful, and U.S. Army troops in the Naples area escaped typhus. The success of the program substantiated the position taken by those experts-mainly the theater preventive medicine officer, certain members of the Preventive Medicine Service of the Surgeon General's Office, and members of the Rockefeller Foundation typhus team-who had insisted on mass delousing by insecticides as a better means of control than immunization by vaccine. It also validated the use of chemical insecticides in preference to the older means of delousing by steam or dry heat.
The subsequent controversy among participating groups over who stopped the epidemic is beyond the scope of this volume. As expressed by Brig. Gen. Stanhope Bayne-Jones, who was both director of the Typhus Commission and deputy chief of the Preventive Medicine Service in the Office of The Surgeon
General, the accomplishment was great enough to confer distinction on all who took part in it.40
ORGANIZATION FOR PUBLIC HEALTH ACTIVITIES
The standard way of organizing the civil affairs program, including its public health work, within the oversea theaters was to establish a civil affairs division, frequently called G-5, which contained a subelement termed "public health," as a general staff element of the Allied, theater, and various lower commands, both area and tactical. In the Mediterranean theater, the area in which the U.S. Army first undertook a civil affairs program during the war, this design was not so fully carried out as in the European theater and the Southwest Pacific Area. The less elaborate organization and the more re-stricted scope of the Army's program in the Mediterranean area were due to several factors. This theater was the first in which the Army was faced with responsibility for civil affairs; only after experience here did it refine its organization in other theaters and standardize procedures. Moreover, the French were chiefly responsible for public health in the area initially invaded by the Allies-the French colonies of northern Africa; hence the U.S. Army developed no elaborate civil health organization there. As for Italy, political and diplomatic considerations dictated a large measure of civilian, rather than military, sponsorship of civil activities undertaken by the U.S. Government in that area.
U.S. Army participation in the public health program for civilians in French Morocco, Algeria, and Tunisia took place under the aegis of a Civil Affairs Section, a special staff section created at Allied Force Headquarters, just before the invasion of northwest Africa. This section, consisting of both civilian and military personnel (chiefly Americans), had broad political and economic functions, serving as an American diplomatic mission to French authorities in Algiers as well as exercising military functions as a staff section of the Allied command. Its Economic Subsection constituted the nominally independent North African Economic Board, a special agency which formulated policy on economic matters in the invaded areas; it was responsible for importing and distributing medical supplies for relief purposes. A group of U.S. Public Health Service officers were assigned to the Board early in 1943, others being added in July. They made surveys to determine the status of hospital facilities for civilians in the French colonies, the need for medical supplies for relief purposes, the nutritional status of the population, the presence of epidemic diseases, and the possibility of the introduction of new disease by insect vectors on planes and by returning refugees.41
40The text follows the more detailed account
by General Bayne-Jones in Medical Department, United States Army.
Preventive Medicine in World War II. Volume VII. Communicable diseases:
Arthropodborne Diseases Other Than Malaria. [In preparation.] See also
footnote 6(5), p. 250.
The combat operations of the Allies produced relatively little devastation in northwestern Africa, and U.S. Army participation in the public health program there was largely limited to the aid which these few men trained in public health work gave to the French authorities after combat had ceased.
The organization for health work among civilians in occupied areas re-ceived its first significant test in the Italian campaign. Although the general civil program for Italy received direction from the highest level of Allied command, no medical subelement was ever established in the Military Government Section, a special staff section created in June 1943, and redesignated G-5 in May 1944 when it was made an element of the General Staff, AFHQ. Hence the public health work in Italy lacked the direction from the top command headquarters that the more limited program in northwest Africa, guided by the Civil Affairs Section, had had. Control over public health activities in Sardinia, Sicily, and Italy was affected to some extent by the confused situa-tion that prevailed during the period when political control of these areas was divided between the King's government in Brindisi and the German-dominated government in Rome. Bad local conditions-inoperative public health facilities and power plants, shortages of food, clothing, and medical supplies, accumulated garbage, decomposing dead, and several incipient epidemics-complicated the problem of recovery in specific areas. In Naples the Army encountered all these problems, including the typhus epidemic among the civilian population.
The Allied Military Government, established in May 1943 to operate under the Commanding General, Fifteenth Army Group (General Sir Harold Alexander), had a public health division headed by a British Army medical officer; Lt. Col. Leonard A. Scheele, USPHS (fig. 69), and other officers of the U.S. Public Health Service were assigned to it. It gave central supervision to the work undertaken in each local area after the period of control by Army combat elements had passed. Its planning staff assembled at Chrea, in the Atlas Mountains near Algiers, in a training and holding center. Because of the lack of medical men in the Military Government Section, AFHQ, the medical staff of Allied Military Government dealt directly with the Director of Medical Services (British) of Allied Force Headquarters. The medical training at Chrea and at nearby Tizi Ouzou during the last half of 1943 continued the type of training given at schools of military government in the United States.
Within the U.S. Army tactical elements the prescribed organization for supervising health work among civilians during the period when tactical units controlled the various areas was fairly consistently carried out. The headquarters of both Seventh U.S. Army (during the Sicilian invasion) and Fifth U.S. Army had public health service officers assigned to G-5, and they were assigned at times of need to the lower tactical elements. In addition to these staff officers, civil affairs teams or detachments which included medical officers were assigned to invasion forces landing in Sicily and Italy and later to each
army when a stabilized front was formed. The fact that they were assigned at a late date and in inadequate numbers made it difficult for them to maintain liaison with the regular Medical Department officers of the armies and divisions responsible for the health of troops. More effective cooperation came about later, but the problem of ineffective liaison at all levels between the Army's public health personnel and officers responsible for the health of troops remained one of the outstanding difficulties facing civil affairs authorities throughout much of the Italian campaign.
In November 1943, an Allied Control Commission (later termed simply Allied Commission) was created. Like Allied Military Government which it eventually absorbed, the Allied Commission was subordinate to Allied Force Headquarters. It assumed direction of civil affairs as rapidly as direct control through military government became unnecessary and local authority was restored. The commission had a public health group assigned to it including most of the U.S. Public Health Service officers who had served with the Allied Military Government in North Africa. In late 1943 and early 1944, when it created and took over certain "regions" or local areas, some degree of centralized authority over public health activities ensued. The commission's responsibility for administering public health work in Italy was vested in Brigadier
G. S. Parkinson (British), the director of its Public Health and Welfare Subcommission; his deputy was an American, Lt. Col. Carter Williams, MC. The subcommission was located at Naples after late December 1943. It exercised public health, veterinary, medical supply, and welfare functions. During the period when an increasing number of regions were being established the subcommission suffered from a shortage of medically-trained men. The direc-tor attempted to keep his own staff small and assigned as many specialists as possible to the "regions."42
Fifth U.S. Army turned over the Italian provinces under its control to the Allied Control Commission in step with the progress of military operations; the commission organized these into "regions" and eventually returned control of them to the Italian Government. By September 1944 the Public Health Subcommission, Allied Control Commission, was working largely through Italian channels. In its northward advance Fifth U.S. Army found more nearly normal conditions than had prevailed in southern Italy; local public health and welfare organizations were active. Throughout Italy the Allied Military Government and the Allied Control Commission (with the later help of the United Nations Relief and Rehabilitation Administration) had to give medical care to thousands of displaced persons, some at camps and others en route to their homes or other areas where better care could be afforded. These included, besides the northern Italian refugees who had fled southward, thousands of other European nationals, particularly Yugoslavs. By the end of May 1944, more than 20,000 Yugoslavs had been moved from Italy to camps in the Middle East. As the war came to a close, the responsibility continued with the rapid transfer of repatriated Italians southward and German prisoners of war northward through the Brenner Pass.
The public health program of the theater suffered from several serious administrative defects, pointed out by the director of the Civil Public Health Division (Col. Thomas B. Turner, MC) of the Surgeon General's Office, who visited the Mediterranean area early in 1944. The outstanding deficiency, he thought, was the lack at Allied Force Headquarters of any one medical officer solely devoted to the public health program. He found that some key personnel had been poorly selected and that liaison between public health officers and the surgeons of field forces in charge of the health of troops had been inadequate. The civil health program had been characterized by "administrative confusion," which had resulted from "ill-defined chains of command, over-lapping responsibilities, and jurisdictional disputes." An additional hindrance to the program had been the lack of adequate transportation facilities and medical
42(1) Report of the Public Health Subcommittee, Allied Control Commission, for April 1944. (2) Monthly reports of the Allied Control Commission, beginning with January 1944. (3) Report to the War Department, History of Civil Affairs in Italy, by John A. Lewis, Jr., 7 Dec. 1945. (4) Komer, Robert W.: Civil Affairs and Military Government in the Mediterranean Theater of Operations. [Official record in the Office of the Chief of Military History.] (5) History of Allied Force Headquarters, Pts. II, III. (6) Medical Department, United States Army. Preventive Medicine in World War II. Volume VIII, Civil Public Health Activities. [In preparation.]
supplies very much in evidence during the early days of the occupation of Naples when typhus spread among the civil population.
By the date of the Normandy invasion, the European theater was in a position to profit from the Army's experience in the Mediterranean. Colonel Turner made several recommendations to The Surgeon General for improving the organization in northwestern Europe based on his observations in the Mediterranean. He suggested that a single individual be charged with top technical responsibility for public health; this man should be directly responsible to the chief medical officer of the theater or major field force. A public health officer assigned to the headquarters of each army and each corps would be responsible to the chief public health officer for technical matters. The program should be organized on a territorial basis, with major political divisions as the units and a public health administrator heading the program in each territorial unit. This administrator would have technical responsibility for civil health in all the territory actually occupied by Allied troops, regardless of whether a tactical commander or a military government organization controlled the area.43
REDEPLOYMENT AND CLOSEOUT OF ACTIVITIES
In planning for the redeployment of troops in the Mediterranean theater to the Pacific and China-Burma-India theaters, the theater surgeon's office arranged for disposing of Medical Department property, provided for hospitalization and evacuation for troops still in staging and training areas in Italy, and planned the movement of Medical Department units out of the theater. Medical and surgical consultants of the theater surgeon's office arranged special technical training for U.S. Army doctors who had been serving long periods with combat units or who had been performing administrative duties; they were given refresher courses on medical and surgical techniques in the general hospitals remaining in the theater. The Fifth U.S. Army medical staff continued its main function-medical support to the army-and at the same time rendered service to the redeployment centers established in the summer of 1945. Fifth U.S. Army doctors administered physical examinations to troops in the redeployment centers to determine their fitness for further oversea, duty. The Fifth U.S. Army surgeon appointed teams of officers for attachment to the staffs of the redeployment training centers. Each team had three medical officers: one of field grade who served as an "area surgeon" and supervised sanitation and the medical care of troops stationed at the centers; a medical records inspector who checked all unit medical records and helped the units to complete their final reports and histories; and a medical supply inspector.44
43Letter, Col. T. B. Turner, MC. to The Surgeon
General, 21 Feb. 1944, subject: Report of Civil Affairs Public Health Activities
in NATOUSA, inclosures 1 and 2.
As theater strength dropped from its August 1944: peak of 742,700 to 404,242 in June 1945, and 55,349 at the end of the year, theater headquarters personnel was correspondingly reduced. Retrenchment embodied separation of the theater medical section from Allied Force Headquarters and its gradual abolition, with a transfer of its essential functions to the surgeon's office of Peninsular Base Section in Leghorn. Colonel Standlee, theater surgeon, who succeeded General Stayer as theater surgeon in July, retained responsibility for the formation of all major policy until the complete dissolution of his medical section. Certain specialized elements, such as the consultants sections, were discontinued. By October, when theater headquarters was formally separated from Allied Force Headquarters, the transfer of essential medical functions and elements of the office to Leghorn had been largely accomplished. British and American medical personnel who had previously functioned at the Allied headquarters level were now assigned exclusively to their respective American (Mediterranean theater of operations) and British (Central Mediterranean Force) headquarters organizations. When the theater medical section was disbanded on 10 November, the surgeon's office of Peninsular Base Section assumed full control of all theater medical functions.45
At the end of 1945 and during 1946, most of the few remaining medical installations and units were clustered around Leghorn and Naples. The Peninsular Base Section surgeon acted as both base section surgeon and theater surgeon. In the spring of 1947, after Peninsular Base Section was disbanded, the remaining medical responsibility in the theater was vested in the surgeon of the Port of Leghorn, where most remaining U.S. Army installations and activities were concentrated. Before the end of the year, all medical installations were inactivated or turned over to other commands, and in December 1947, with the departure of the last U.S. Army troops from Italy, the Medi-terranean theater was disbanded.46
As the experience in the Mediterranean theater indicates, the organization of medical service in a theater of operations was largely determined by the theater organization, by the changes in its structure, and by the functions and scope of responsibility of the various commands in the theater. All these, in turn, derived largely from the shifting tactical situation, which caused the swift creation of many new commands, the abolition of old ones, and rapid revisions in the structure, location, and jurisdiction of others in accord with their increasing or declining importance. A medical office was established in the headquarters of any newly created command, took the same relative place in theater structure as the headquarters, moved with its headquarters or was split into groups to accompany moving echelons of the headquarters, usually varied in size with the strength of the command, and died with the abolition of
45(1) See footnote 6 (2) and (5), p. 250. (2)
Strength of the Army, 1 Feb. 1946.
the command or its headquarters. Certain geographic, social, economic, and political factors also indirectly influenced the administration of medical service through the effect which they had upon Army command structure in the area. The organization to cope with certain special problems-such as disease problems of theaterwide scope and the public health program for occupied areas developed in part according to standard plans drawn up in the United States by the War Department and the Surgeon General's Office.
As the Mediterranean theater developed out of a large-scale invasion, the chronologic order of developments in medical administration differed from that in other theaters. In the European theater and Southwest Pacific Area in particular, as well as in some other areas, the medical service for a communications zone (including fixed hospitals, medical supply depots, and other medical installations used in a communications zone) was built up many months before the major combat period. In contrast with the situation in the South-West Pacific Area and the European theater, medical planning for the invasion of North Africa was done in the United States and in another theater-the European theater-and base section medical service was built up only in the wake of the advancing troops.
In one respect, the organization of medical service in the Mediterranean area varied markedly from the standard pattern taught in the manuals. The functions of the staff medical section of the theater's Services of Supply during the year February 1943 to February 1944-a period including its combat operations in Tunisia and Sicily and the early stages of the Italian campaign-were restricted to those concerning medical supply. Neither the concepts on which the Services of Supply in the United States had been reared nor the standard doctrine for organizing a theater Services of Supply prevailed during this period. In other theaters, organized according to the doctrine, the Services of Supply medical section and the surgeons' offices of its area commands (advance, intermediate, and base sections) administered the system of fixed hospitals and the movements of evacuees within the communications zone. The retention of responsibility for evacuation and hospitalization at Headquarters, NATOUSA, meant that for about a year in the North African theater evacuation. and hospitalization were handled by a single agency as a continuous operation throughout both the combat and communications zones; that is, from front to rear.
A unique feature of medical administration, which prevailed throughout the theater's existence, was the development of a fairly complete American medical section at the Allied headquarters and the dual assignment of one officer as chief American medical representative at that headquarters and as theater surgeon. This position of the theater medical section and the theater surgeon in the Mediterranean theater appears to have been to the liking of Medical Department personnel there. The lack of adverse comment among senior medical officers in key command or staff assignments within the theater with regard to the command system under which they operated, by compar-
ison with the many criticisms recorded by surgeons and observers in some other theaters, shows a more general satisfaction with the organization of medical service within theater structure in the Mediterranean area than elsewhere. Nevertheless, the situation whereby the American theater medical section could operate from the level of the top command-Allied Force Headquarters-was never repeated in the other theaters, since the American theater headquarters and the Allied headquarters were never similarly combined elsewhere.