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Chapter VIII



The European Theater of Operations

The bulk of U.S. Army forces employed in World War II were concentrated in the United Kingdom for invasion of the European Continent. The cross-channel assault of June 1944 was followed by the establishment and buildup of a main lodgment area, and finally the breakthrough, advance to the east, and subjugation of the enemy. In combat on the Continent large armies and air forces operated over an extensive, relatively unbroken land mass. As this was the type of warfare contemplated in prewar planning, organization of the European theater accorded rather closely with Army doctrine.

At the time of the German surrender, 61 American divisions- two-thirds of the U.S. Army ground troop strength employed throughout the world during World War II- were in Europe; during the months before the surrender the total Army strength in the theater, including service and air as well as ground troops, reached over 3 million. The concentration of troops in Europe, compared with the situation in theaters of vaster extent, made it possible to use Medical Department officers, enlisted men, units, and installations to better advantage than in areas of greater troop dispersion. Nevertheless, because of the magnitude of the operation, theater organization grew highly complex. A large number of higher headquarters with medical administrative offices sprang up, but liaison among staff surgeons remained physically easy because of their close proximity. Indeed it was often possible to save administrative personnel by the employment of a single officer for similar staff positions at two or more headquarters.


A few Army medical officers, together with medical men of the Navy and the U.S. Public Health Service, were sent to Great Britain in 1940 to observe the British medicomilitary effort. One of the Army officers- Col. (later Brig. Gen.) Raymond W. Bliss, MC- reported briefly on certain phases of British medical experience during the Battle of Britain; the handling of air-raid casualties; the organization of the Emergency Medical Service, the central authority which directed the hospital, ambulance, and first aid service for both British fighting forces and civilians; medical and psychological hazards of aviators, and so forth. When the United States and Great Britain reached an agreement for continued collaboration through an exchange of missions, a representative of the Medical Department, Maj. (later Col.) Arthur B. Welsh, MC, went to England with the Army's Special Observers Group.


Major Welsh represented the Army Medical Department on the mission from May until September 1941. Like the other members of the mission, he worked directly with the British services corresponding to his own and continued to inform the Surgeon General's Office on British experience. After inspection of areas likely to be occupied by American troops, he made recommendations as to the location of, and suitable specifications for, U.S. Army hospitals. He estimated the medical facilities, personnel, and supplies which would be needed if American troops were stationed in the British Isles and discussed with British representatives their requirements for lend-lease medical supplies from the United States.

Col. (later Maj. Gen.) Paul R. Hawley, MC, became the medical representative on the Special Observers Group in the fall of 1941. Colonel Hawley had seen service in France as the sanitary inspector of Intermediate Section, Services of Supply, in World War I. He had served as chief of the medical service at Fort Riley Station Hospital, Kans., and had held various assignments at the Army Medical School in Washington, D.C., and the Medical Field Service School at Carlisle Barracks, Pa. His work with the Special Observers Group bridged the transition from the emergency period to the entry of the United States into war.1

When the USAFBI (U.S. Army Forces in the British Isles) was created in January 1942 as the top U.S. Army command in the area, the officers of the Special Observers Group were made staff officers of the command. As a member of the special staff, USAFBI, Colonel Hawley served under Maj. Gen. James E. Chaney, who was responsible (through General Headquarters in Washington) to the Chief of Staff, U.S. Army. The U.S. Army Forces in the British Isles endured until mid-1942, when ETOUSA (European Theater of Operations, U.S. Army) was Organized.2

Throughout this 6-month period the problems which the Surgeon, USAFBI, encountered in administering medical service for U.S. Army troops in the British Isles were largely typical of those f aced by the entire headquarters staff during the first months after the United States entered the war. The status, mission, and organization of the theater were still not fully determined or generally understood; key assignments were temporary and changing and staff-trained officers were insufficient in number. The token force of 3,000 troops increased to over 54,000 by mid-1942. Colonel Hawley and his small staff-until late April he had in his office only three officers, all young and inexperienced Reserves-were chiefly occupied with inspecting areas where

    1(1) Parran, T. : Medicine in England Now. Ann. Int. Med. 14: 2184-2188, 1940-41. (2) Bliss, R. W.: Compiled Reports of G-2 From Medical Observer, October-December 1940. [Official record.] (3) Special Observers Group General Orders, 19 May 1941-8 Jan. 1942. (4) Thurman, S. J., and others : The Special Observers Group Prior to Reactivation of the European Theater of Operations, October 1944. [Official record.] (5) U.S.-British Staff Conversations Report, 27 Mar. 1941, in 79th Cong., 1st sess., Hearings of the Joint Committee on the Investigation of the Pearl Harbor Attack, pt. 15, exhibit 49.
    2 Rupperthal, Roland G. : The European Theater of Operations: Logistical Support of the Armies. United States Army in World War II. Washington: U.S. Government Printing Office, 1953, vol. I.


troops were to be stationed, arranging for their immediate care in British hospitals, and negotiating with British civil and military authorities for the construction of hospital facilities under reverse lend-lease agreements.

Responsibilities were somewhat clarified in the spring of 1942; the activation of subordinate commands relieved the USAFBI medical section of some of the duties connected with the reception of the first troops. The staff surgeon of the U.S. Army Northern Ireland Forces, which was established in January 1942 to include V Corps (the first contingent of U.S. Army forces in the theater), was responsible for the medical service, including medical functions normally assigned to a base command, for Army ground troops in northern Ireland. Col. (later Maj. Gen.) Malcolm C. Grow, MC (fig. 70), became staff surgeon for the Eighth Air Force which was built up after May 1942. (The Eighth Bomber Command had preceded it in February.) Assumption of responsibility for the medical care of tactical elements by these surgeons enabled Colonel Hawley to spend more time in the medical aspects of long-range planning for the buildup of men and supplies in the British Isles (War Plan BOLERO) and in planning for the invasion of the Continent (War Plan ROUNDUP). The increase of his group to eight officers by the middle of May enabled him to staff six of the nine divisions he had planned for his office. From the spring of 1942 to the end of the year (6 months after the organization of the theater took place), he continued to press the Surgeon General's Office to send him additional officers with administrative training and experience. Himself a graduate both of the Command and General Staff School at


Fort Leavenworth and the Army War College, Colonel Hawley emphasized his need for officers with training at senior service schools. 3


After Maj. Gen. (later Lt. Gen.) John C. H. Lee arrived in England in May with a Services of Supply staff, the theater organization began to take shape. When the chiefs of services of the U.S. Army Forces in the British Isles were called on to comment on the organization proposed by General Somervell's staff in Washington, Colonel Hawley advised against any subordination of the chief of medical service of the theater to a. Services of Supply. He voiced his belief that theater organization should provide for a unified and centralized technical control of medical service throughout the theater. He especially emphasized the importance of vesting a single chief of medical service with the following responsibilities: Technical supervision of the operations and training of medical units and personnel; coordination of evacuation among several echelons of command; control of the technical aspects of communicable diseases in all echelons of command and responsibility for requiring, consolidating, and forwarding all medical records and reports. Centralized control over the operations and training of personnel and over the coordination of the stages in evacuation was necessary, he argued, because evacuation and medical care of the sick and wounded was a continuous operation. As a corollary, central responsibility for planning the steps in the process and the means of execution was also necessary. With respect to disease control Colonel Hawley pointed out that communicable diseases recognized no echelons of command and that the responsibility for establishing uniform technical standards and a coordinated organization to carry them out should rest with a single chief of medical service. He also considered it important that the theater chief of medical service have sole responsibility for liaison with the British in connection with the care of the sick of all U.S. Army commands; otherwise the British would be confused by the overlapping U.S. Army commands within the same area and Army surgeons might bid against each other for the same British facilities.

Although, like the chiefs of the other services, Colonel Hawley considered location of his office at theater headquarters advisable, he emphasized that his chief concern was not with the physical location of his office- whether at

    3 (1) General Order No. 3, Headquarters, U.S. Army Forces in the British Isles, 24 Jan. 1942. (2) Memorandum, Chief Surgeon, U.S. Army Forces in the British Isles, for G-1, 17 Apr. 1942, subject: Plan for Base Area. (3) General Order No. 5, Headquarters, U.S. Army Forces in the British Isles, 24 Jan. 1942. (4) [Elliot, Henry G.]: Administrative and Logistical History of the European Theater of Operations, Part I, the Predecessor Commands: BPOBS and USAFBI [Official record in Office of the Chief of Military History.] (5) Annual Report of Medical Department Activities, Eighth Air Force, 1942. (6) Letter, Col. Paul R. Hawley, to Chief Surgeon, General Headquarters, 19 Apr. 1942.(7) Letter, Colonel Hawley, to Col. George F. Lull, 28 Aug. 1942.


Services of Supply or theater headquarters- but that he considered it imperative that the chief of medical service exercise control over certain essential functions. He pointed out that if he were to be located within the Services of Supply he could exercise these functions properly only if the commanding general of the Services of Supply was given clear authority to issue orders or directives to the commanders of other subordinate commands in the theater otherwise he (Colonel Hawley) would have no means of making medical directives effective within commands outside the Services of Supply.4

On 8 June 1942, the European theater command was established, superseding the U.S. Army Forces in the British Isles (map 3).5 Its chief sub ordinate commands in 1942 and 1943 were V Corps, the Eighth Air Force, the Services of Supply, and, after the autumn of 1943, First Army, which be came the chief ground force command, absorbing V Corps. Medical Department personnel and units were assigned to all three elements-ground, air, and service forces. Colonel Hawley became chief surgeon on the special staff of the theater commander. On 13 June he was instructed, along with the chiefs of most of the other services, to operate under Maj. Gen. John C. H. Lee, Commanding General, Services of Supply (which had been established on 24 May).6

In July 1942, Services of Supply headquarters was established at Cheltenham, Gloucestershire, about 100 miles northwest of theater headquarters in London. Colonel Hawley's main office was moved to Cheltenham along with those of the other chiefs of supply services and remained there until March 1943. Since the Cheltenham location hindered contact of the chiefs of service With the theater headquarters in London which they also served, each chief of Service was given a representative at theater headquarters. Col. (later Brig. Gen.) Charles B. Spruit, MC (fig. 71), the former chief of Colonel Hawley's Operations Division, was made Colonel Hawley's representative at General Eisenhower's headquarters in London.

Colonel Hawley's Office

At the time of the move to Cheltenham, Colonel Hawley's office, was composed of 22 officers and 14 enlisted men. By the end of 1942 it consisted of 51 officers, 56 enlisted men, and 62 civilians, and practically all its major organ-

    4 (1) -Memorandum, Chief Surgeon, U.S. Army Forces in the British Isles, for the Adjutant General, 1 June 1942, subject: Comments on Draft of General Order Establishing the Services of Supply. (2) Memorandum, Colonel Hawley, for G-1, USAFBI, 8 June 1942, subject: Comments on "Directive for SOS, USAFBI." (3) [Coakley, Robert W]: Administrative and Logistical History of the European Theater of Operations, Part II, Organization and Command. [Official record in the Office of the Chief of Military History.]
    5 Although Iceland was included in the European theater at this date, administrative and logistic matters, including medical service, for troops there were handled by the Iceland Base Command, which operated directly under the War Department.
    6 (1) General Order No. 2, Headquarters, European Theater of Operations, U.S. Army, 8 June 1942. (2) Circular No. 2, Headquarters, European Theater of Operations, 13 June 1942. (3) See footnote 4 (3).


Map 3.- Territorial limits of the European theater, 1942-45

izational segments had been established, although they later underwent refinements in structure.7

The work of the Administrative, Personnel, and Medical Records Divisions of the office are self-explanatory. The Operations Division had charge of the movements of Medical Department units, made medical plans, and supervised medical training. It allocated medical units among the various commands in the theater and assigned and staged units for the North African invasion.

    7 (1) History of Medical Service, SOS, ETOUSA, From Inception to 31 December 1943. [Official record.] (2) Annual Report, Administrative Division, Office of the Chief Surgeon, European Theater of Operations, 1942. (3) [Larkey, Sanford H.] : Administrative and Logistical History of the Medical Service, Communications Zone, European Theater of Operations. [Official record.] For a comparison of the organization and functions of General Hawley's office at the end of December 1942 with those of May 1945, see appendix B, p. 562.


After the drain of the North African venture had subsided, this division reassumed the task of planning medical support of the buildup in the British Isles, calculating the numbers of hospital beds needed in accordance with the increases in troop strength planned for the theater and determining the, locations of Medical Department installations to suit changes in troop density in the various localities.

In carrying out its responsibilities for training, the Operations Division created the First Medical Demonstration Platoon which displayed throughout the theater the methods of training medical units. The division made arrangements for many Medical Department officers in the theater to attend courses in the various medical specialties at British institutions- both the Royal Army schools for doctors and dentists at Aldershot, Hampshire, and at the London School of Hygiene and Tropical Medicine and other medical schools, as well as at British hospitals. It planned and supervised the training of doctors and nurses at two schools within the Army's American School Center organized at Shrivenham, Berkshire, in February 1943. The Medical Field School emphasized courses in chemical warfare medicine, hygiene and sanitation, and combat medicine and surgery, while the Army Nurse School trained nurses in the military aspects of their work. The Operations Division also planned special courses for officers, and enlisted men in various specialties at selected general and station hospitals. Those who had been sent to the theater without sufficient training could make up the deficiency in the United Kingdom, and those previously trained benefited from instruction in medical problems peculiar to the theater. Training during the long months of preparation for the invasion proved a morale builder.


The planning of evacuation within the theater and to the United States was also supervised by the Operations Division. (During part of the time this function was exercised by the Hospitalization Division, and for a time by a separate Evacuation Division.) Even in the preinvasion period the evacuation system grew complex because of the number of commands concerned- naval elements assigned to the theater, as well as subcommands of the air forces and the Services of Supply- and the variety of means employed. Although the theater's ground troops were not suffering combat casualties during this period, the theater medical service had to evacuate and care for Air Force casualties, as well as for some of the wounded from the invasion of North Africa and the early months of the Tunisian campaign, brought to the United Kingdom in British hospital ships.8

The duties of the Dental, Nursing, and Veterinary Divisions of Colonel Hawley's office were all concerned with supervision of their respective services; training of personnel and control of their transfer among the base sections, preparing the necessary reports, and maintaining liaison with similar elements in the British Army. The dental and veterinary service suffered from a lack of personnel in 1942, but the Army Nurse Corps grew rapidly, increasing from 359 nurses in the theater in July 1942 to 4,627 by the end of 1943. A significant accomplishment of the Dental Division was the creation of two central dental laboratories (nonstandard units) with mobile clinic and laboratory sections. One was located in London and the other in Cheltenham. The continued concentration of troops, as well as the availability of messenger and courier service for speeding up the transfer of dental packages to and from the laboratories at London and Cheltenham made these places the logical sites for centers of dental service.

Because of the tremendous troop strength of the theater and the overcrowding to which it contributed, the Preventive Medicine Division had to undertake a comprehensive program. Its members made inquiries into conditions accountable for the spread of certain diseases among troops at intervals: the respiratory diseases in 1942 and 1943; the diarrheal diseases in 1943, and a few diseases which did not commonly occur in the British Isles but which were sporadically brought in during the war period by troops from other areas. The chief of these was malaria. Recurrent cases among divisions returning to the United Kingdom from North Africa had to be removed from the ranks before their units embarked upon the continental invasion. Activities in preventive medicine became decentralized, since many preventive tasks, such as the maintenance of sanitary conditions and the control of venereal disease, called for participation by local commands, including air force commands. The assignment of sanitary, venereal disease control, and nutrition officers to the base sections, as well as to Colonel Hawley's office, constituted an effective

    8 The number of casualties evacuated to the United Kingdom from North Africa was relatively small- 481 between 1 January and 31 March 1943- when the practice was discontinued, and no more than a handful in 1942. See Annual Report, Surgeon, North African Theater of Operations, U.S. Army, 1943.


network for prevention of disease. No widespread epidemics developed among U.S. Army troops in the theater, with the exception of a mild influenza epidemic of 1942-43. Since many diseases common to tropical areas were not present in western Europe, a large-scale program for control of malaria and other insectborne diseases was unnecessary. On the other hand, more than ordinary effort was needed to check the spread of venereal disease among troops stationed in urban areas in the United Kingdom.

The Professional Services Division, which Colonel Hawley considered the keystone of his office, consisted of the consultants in surgery and medicine and their subspecialties. Under the Director of Professional Services served the chief consultant in surgery and the chief consultant in medicine. Senior consultants were appointed to certain surgical subspecialties- ophthalmology, neurosurgery, anesthesia, orthopedic surgery, and maxillofacial surgery- and to several medical subspecialties- psychiatry, dermatology, and nutrition. By the end of 1942, 10 consultants were on duty; during the following year other consultants were assigned to additional medical subspecialties- cardiology, tuberculosis, and infectious disease- and to further surgical subspecialties- radiology, plastic surgery, otolaryngology, transfusion and shock, orthopedic surgery, and general surgery. Consultants in Europe represented more specialties than did the consultants of any other theater. The title "consultant" was also applied to those in charge of several special phases (rather than specialties) of medical work, including scientific research and medical service for the Women's Army Auxiliary Corps.

During 1942 and 1943, the consultants of Colonel Hawley's office visited fixed hospitals in the base sections; after the invasion they toured Medical Department units and hospitals in the combat zone. They evaluated the quality of work of specialists in the hospitals, offering criticism and advising changes in techniques. They also evaluated the professional complements of all newly arrived medical units, recommending transfers and substitutions in the interest of an equitable distribution of all available talent. They supervised the work of consultants assigned to the headquarters of air forces, armies, and base sections. Particularly qualified specialists in general and station hospitals were used as regional consultants (authorized in May 1943) ; these served a group of hospitals in a hospital center or hospitals in the vicinity of the one to which they were assigned. Any hospital in the United Kingdom, whether British, American, or Canadian, might employ the services of the appropriate consultant in the treatment of U.S. Army personnel hospitalized therein. Through the medium of a series of circular letters and manuals, the senior consultants in Colonel Hawley's office outlined for medical officers in the hospitals and other medical facilities techniques of treatment found to be, of greatest value in the theater. During the long buildup period, the consultants had time to develop a manual of therapy (issued in May 1944), which gave instructions on the management of all types of wounds. Although based in part on data assembled by consultants in the North African theater and British Army doctors, the manual


reflected on every page the specialized knowledge and experience of its authors. Revisions in the original principles and techniques adopted on the basis of combat experience on the European Continent after June 1944 appeared ill revised circular letters.9

Officers of the Hospitalization Division were occupied throughout 1942 and 1943 with providing hospital beds for troops pouring into the United Kingdom, inspecting hospitals in operation, and planning the design for hospital construction that might have to be undertaken on the Continent. The procurement of buildings for fixed hospitals in the United Kingdom and the establishment of an effective medical supply system, supervised by the Supply Division of General Hawley's office, were large tasks of the theater's medical service which encountered serious administrative difficulties in 1942 and 1943.

Establishing Fixed U.S. Army Hospitals in the United Kingdom

Early requirements for the hospitalization of American troops in the United Kingdom were met through arrangements made for the care of U.S. Army patients in British military hospitals, in hospitals of the Emergency Medical Service, and in two hospitals staffed by American doctors who had volunteered their services to the British Government before the entry of the United States into war. The heavy task was to obtain in crowded Britain buildings to accommodate incoming fixed hospital units and to provide sufficient beds for military patients once the attack on the Continent began. The machinery through which U.S. Army requirements for hospitalization could be established, sites chosen for construction, and satisfactory construction completed, was elaborate. The Chief Surgeon, ETOUSA, served on the Medical Service Sub-Committee of the BOLERO Combined Committee in London which was responsible for planning the buildup of 1 million U.S. Army troops and the necessary facilities and supplies for supporting the assault on the Continent. Medical officers of the British and Canadian armed services and representatives of the British governmental health agencies were fellow members. General Hawley submitted the requirements for hospital facilities for these troops as worked out in his office.

The British turned over to the U.S. Army Medical Department a few hospital plants constructed for the Emergency Medical Service, but large-scale construction was undertaken to meet the requirements for 90,000 hospital beds called for under the BOLERO plan. The British Government assumed re-

    9 (1) See footnote 7 (1) and (3), p. 308. (2) Hawley, P. R.: Advances in War Medicine and Surgery as Demonstrated in the European Theater of Operations. M. Ann. District of Columbia 15: 99-109, March 1946. (3) Report on Schools and Courses of Instruction for Personnel in the European Theater of Operations. Office of the Chief Surgeon, Services of Supply, European Theater of Opera-tions, U.S. Army, 12 Feb. 1944. (4) Memorandum, Brig. Gen. Paul R. Hawley, for G-3, European Theater of Operations, U.S. Army, 13 July 1943, subject: Continuance of the Medical Field Service School at the American School Center. (5) Gordon, John E.: A History of the Preventive Medicine Division in the European Theater of Operations, U.S. Army, 1941-1945, vol I. [Official record.] (6) Memorandum, Col. H. T. Wickert, for The Surgeon General, 29 Nov. 1943, subject: Report of Visit to U.K. and N. Africa.


sponsibility for constructing the necessary hospitals, largely because shortage of shipping space made it impracticable to bring materials and labor from the United States for the purpose. The British Ministry of Works and Planning directed British civilian contractors in the work. Officers of the Hospitalization Division of General Hawley's office worked closely with the British and the U.S. Army Engineers, who furnished some troop labor for the construction and acted as agents for the medical service with the British War Office. The Royal Engineers placed requests with the War Office, which requested the Ministry of Works and Planning to undertake the construction of buildings approved by the American theater command and the War Office. The Royal Engineer Corps inspected the completed project and accepted it or turned it down on behalf of the War Office. General Hawley could accept the project or defer acceptance until it was modified to meet his requirements.

It was hard to find general hospital sites which possessed all the desired features- adjacency to water, gas, and sewage facilities, and, in anticipation of mass evacuation from the Continent, accessibility to roads and railroads. The British lacked construction materials and suffered from an acute shortage of Skilled construction workers. Construction lagged throughout 1942 and the early months of 1943. During 1942 no hospitals were completed on schedule, despite General Hawley's repeated vigorous requests backed by General Lee, to the British representatives on the Medical Service Sub-Committee of the BOLERO Combined Committee that construction be speeded up. His pressure, together with aid in construction given by hospital unit personnel in the later stages of the program, bore fruit. By the close of 1943, 58 fixed U.S. Army hospitals were operating in the United Kingdom- 17 general, 34 station, 3 evacuation, and 4 field hospitals. The fixed hospitals in operation by mid-1944 were considered adequate to receive the expected load of evacuees from the continental invasion.10

The Medical Supply System

The Supply Division of General Hawley's office established medical sections in five general depots in the United Kingdom during 1942, and in 1943 in six additional general depots, as well as four medical supply depots. Despite this depot system of apparently adequate scope, a number of problems in the handling of medical supply developed at the outset and continued to plague the Chief Surgeon, ETOUSA, until 1944. Some- the early shortages of dental items, for instance- reflected difficulties with procurement in the United States. Others- unsatisfactory packaging and packing, incomplete or late shipments, and the shipment of hospital assemblies on two or more ships (the so-called "split shipments")- were attributable to faulty procedure at depots and shipping points in the United States rather than within the theater. Dif-

    10 (1) See footnote 7 (1) and (3), p. 308. (2) Memorandum, Maj. Gen. Paul R. Hawley, for Commanding General, Services of Supply, European Theater of Operations, U.S. Army, 13 Mar. 1944, (3) Hawley, Maj. Gen. Paul R.: The European Theater of Operations, May 1944. [Official record.]


ficulties connected with shipment from the U.S. ports of embarkation cropped up throughout the buildup period and were straightened out only by the mutual efforts of General Hawley's office and the Transportation Corps and its ports of embarkation in the United States. Faulty packing and split shipments later occurred in the United Kingdom as well, whenever hospital assemblies which had been unpacked for inspection or for use for training within the theater had to be reassembled and forwarded to their destination. Furnishing assemblies for hospital units leaving for the North African invasion placed heavy demands upon the theater's medical supply system at an early date.11

In the United Kingdom the Medical Department relied heavily- far more than in any other oversea area- upon the procurement of medical supplies locally. Medical items were bought from the British through a representative of the Chief Surgeon, ETOUSA, on the General Purchasing Board in London, which supervised the purchase of the U.S. Army supply services in the United Kingdom. The policy of making the maximum use of British supplies and services was adopted from the outset because of the critical shipping situation, as well as the opportunity (mutually advantageous to the British and the Americans) to make use of British obligations for furnishing the United States with supplies under the reverse lend-lease procedure. Items requiring a large amount of tonnage and a small amount of labor were procured from the British if possible.12

Medical supplies were also obtained from sources other than reverse lend-lease- through spotty local purchases on the open market by officers in the depots, by requisitions from the United States, and by the automatic supply procedure. (Some medical maintenance units and final reserve units went to the theater under the standard procedure.) The variety of sources made it difficult to determine the availability of specific items or to devise an adequate system of stock control. Differences in British and American nomenclature called for the preparation of lists of British items which were equivalent to the standard items of the Medical Department Supply Catalog, as well as lists of acceptable British substitutes. U.S. Army doctors frequently preferred the American-made product to the unfamiliar British item. British shortages of raw materials, packing materials, and especially of skilled workers resulted at times in inferior items, and deliveries were delayed. At the same time the British obtained from the United States through lend-lease procedure some items which they were furnishing U.S. Army doctors in Britain.

    11 See footnotes 2, p. 304; and 7 (3), P. 308.
    12 (1) Annual Report, Medical Procurement Section, Supply Division, Office of the Surgeon, European Theater of Operations, U.S. Army, 1943. (2) See footnote 2, p. 304. (3) Memorandum, Acting Director, International Division, for Commanding General, Services of Supply, 8 May 1944, subject: Procurement of Medical Supplies and Equipment in the U.K. Under Reciprocal Aid. During 1942 approximately 75 percent of all medical supplies, calculated in tonnage, for the U.S. Army were procured in the United Kingdom, either by reverse lend-lease procedure or by local purchase. The percentage dropped to 56 in 1943 and to 24 in 1944.


Throughout 1942 and 1943 the Chief Surgeon, ETOUSA, expressed doubt of the capabilities of the officers sent to take charge of medical supply duties in his office and anxiety over the critical medical supply situation. At the close of 1943, the system of stock control was still inadequate, and the preparations for supporting the invasion with hospital assemblies and medical supplies were far behind schedule. General Hawley then obtained special aid from the Surgeon General's Office in order to establish a system that would furnish adequate support for the impending invasion.13

Cooperation With the Allies

The theater surgeon and his staff, as well as Medical Department officers throughout the theater, had extensive dealings with members of the British and Canadian Army medical services- officers of the Royal Army Medical Corps, the Royal Navy Medical Corps, Royal Air Force Medical Corps, and Royal Canadian Army Medical Corps. A British Army medical officer served as liaison officer with General Hawley's medical section to the end of the war in order to facilitate contact between General Hawley's staff and that of the Director-General of the British Army Medical Service. U.S. Army Medical Department officers also had frequent contacts with British Government agencies engaged in medical work, chiefly the Emergency Medical Service and the Ministry of Health, and with the British professional associations of doctors, dentists, and veterinarians. Meetings of U.S. Army Medical Department officers with the British Medical Research Council afforded an exchange of information on recent technical developments in medicine. The British Medical Registry accepted officers of the U.S. Army Medical Corps as members, as did the Royal Society of Medicine. An Inter-Allied Medical Association was sponsored by the British Research Council and the Royal Society of Medicine. During 1943 an exchange of medical officers between British and American hospitals for the period of a month afforded each national group an opportunity to profit from the other's techniques.14

During the buildup period, proposals to turn over certain medical resources to the British or to pool U.S. Army medical personnel or installations with those of the British cropped up from time to time. A combined United States-British typhus commission was suggested at intervals. Although Gen-

    13 (1) Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, 10 Aug. 1943. (2) Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, 9 Sept. 1943. (3) Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, 14 Oct. 1943. There are many similar letters in the Kirk-Hawley file.
    14 (1) Annual Report for 1942 and 1943 of the Hospitalization Division, the Professional Services Division, the Supply Division, and the Operations Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army. (2) See footnote 7 (1) and (3), p. 308. (3) Mason, James B.; Medical Service in the European Theater of Operations, Through 16 January 1944. [Official record.] (4) Circular Letter No. 57, Office of the Chief Surgeon, Headquarters, European Theater of Operations, U.S. Army, 27 Oct. 1942, subject: British Medical Societies. (5) Circular Letter No. 69, Office of the Chief Surgeon, Headquarters, European Theater of Operations, U.S. Army, 9 Nov. 1942, subject: Consulting Service for the American Forces.


eral Hawley favored thoroughgoing exchange of technical medical information and the results of research, he consistently opposed plans for pooling American and British medical resources, holding that any merging of the two medical services would result in lowered standards for the U.S. Army medical service. Pooling of American and British doctors, for instance, would mean that the British, short of doctors, would obtain an increase in the number of doctors per thousand patients while the U.S. Army would suffer a corresponding reduction. Although no merging took place, the agreement made with the Emergency Medical Service for reciprocal care of sick and injured American and British troops prevailed after U.S. Army hospitals had become available, and the British and American army medical services cared for substantial numbers of each other's patients in their respective hospitals.15

Liaison between U.S. Army doctors and the medical authorities of most continental countries had to await the invasion, but some contact was established with the Russians in June 1943, when the senior surgical consultant of the theater surgeon's office, Col. Elliott C. Cutler, MC (fig. 72), and Lt. Col. Loyal Davis, MC, consultant in neurosurgery, accompanied a British medical mission to the Soviet Union. The purpose of the mission was to get information on the medicomilitary experience of the Russians in combat with the Germans and to establish good relations with Red Army doctors. They took 2 million units of the then scarce penicillin to the Soviet medical authorities as a gift. The British conferred honorary fellowships on a distinguished Russian surgeon and the chief surgeon of the Red Army, while the American delegation accorded them honorary membership in the leading surgical societies of the United States. Both American medical officers were impressed with the efficient organization of the Red Army medical service.16

Base Sections in the United Kingdom: 1942-43

The Services of Supply undertook, beginning in July and August 1942, to establish its area commands, the base sections. To the end of 1943, the logistic organization of the European theater followed fairly closely the principles on which the Services of Supply had been established in the United States. The corps areas (later called service commands) in the United States were taken as models for the base sections in the United Kingdom and like

    15 Memorandum, Maj. Gen. Paul R. Hawley, for Commanding General, Services of Supply, 13 Mar. 1944.
    16 (1) Report by Col. Elliott Cutler, Supplement to Notes on Staff Conference, 25 Oct. 1943. In Annual Report, Professional Services Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1944. (2) Report of Surgical Mission to Russia. [Official record.] (3) Letter, Brig. Gen. Paul R. Hawley, to Lt. Gen. E. I. Smirnov, Chief of Medical Services of the Red Army, 30 June 1943. (4) Letter, Lt. Gen. E. I. Smirnov, to Brig. Gen. Paul R. Hawley, 30 July 1943. (5) Davis, L.: Organization of the Red Army Medical Corps (Editorial). Surg., Gynec. & Obst. Vol. 79, September 1944.


them were conceived of as smaller replicas of the parent organization designed to perform its functions in a given geographic area.17

As was the case with the chiefs of technical services in the United States, the chiefs of service of the European theater had somewhat tighter control over operations within the area commands during the early development of these commands than at a later date. Since the Commanding General, SOS, ETOUSA (General Lee), placed emphasis, as did General Somervell in the United States, upon decentralizing operations to the area commands, during 1943 base section commanders were given control of Services of Supply operations within their areas. By August the duties of chiefs of service with respect to operations in the base sections were confined to technical supervision, maintained through their service representatives on the base section staffs. Hence the base section commander was given command control over the fixed hospitals within the boundaries of his base section and control over the assignments of Medical Department personnel within the base section organization.

    17 (1) Memorandum, Chief of Staff, War Department, for Commanding General, American Forces in the British Isles, 11 May 1942, subject Organization, Services of Supply. (2) See footnotes 2, p. 304 ; and 4 (3), p. 307.


General Hawley exercised supervision, in his capacity as Services of Supply surgeon, over technical matters in each base section through the surgeon on the staff of the base section commander.

As in the case of the other chiefs of the technical services, General Hawley found that the power given base section commanders interfered at times with his control over medical service afforded by base section installations. In his opinion general hospitals, which served the theater as a whole (in contrast to station hospitals which served merely the local area in which they were located), should be under the command of the chief surgeon. "If we get any sudden influx of casualties here, we have got to play with beds like you play with chessmen on a board, and this ought to be handled by one central agency."18 His reasoning was similar to that advanced for control of general hospitals in the United States by The Surgeon General, but like the latter he failed to effect a change of jurisdiction.

However, cooperative agreements were usually worked out. When General Lee sent General Hawley to look into conditions in the general hospitals of a base section and General Hawley reminded General Lee that he did not have command of the hospitals, General Lee promised him the base section commander's full support. From then on General Hawley had General Lee's full backing in solving any problems arising from base section control of certain functions. He and his staff made frequent inspections of hospitals, dispensaries, and other medical installations in the base sections, informing commanding officers of the installations, or base section surgeons, of any deficiencies. General Hawley cooperated closely with base section commanders in replacing base section surgeons or hospital commanders who proved inefficient. On the other hand, he noted some decisions of base section commanders which interfered with his ability to render the best possible medical care- for example, the decision to replace with ordinary port laborers crews of Medical Department enlisted men especially trained in loading and unloading evacuees from hospital ships. He also objected to a tendency of base section commanders to burden hospital staffs with military police duties. At such times he reemphasized his conviction that the control of certain functions should not be decentralized to base section commanders.19

The relation of the base section surgeons in the European theater to the Chief Surgeon in his Services of Supply capacity in general paralleled the relation of the corps area surgeon in the United States to The Surgeon General, and the duties of base section surgeons broadly resembled those of corps area surgeons. The internal organization of the base section surgeon's office

    18 Notes on Staff Conference, Headquarters, Services of Supply, European Theater of Operations, U.S. Army, no date.
    19 (1) Interview, Maj. Gen. Paul R. Hawley, 18 Apr. 1950. (2) Correspondence between Brig. Gen. Paul R. Hawley, the Director-General of the British Army Medical Service, and the Chief of Operations, Services of Supply, 21 Nov.-7 Dec. 1943. (8) Memorandum, Brig. Gen. Paul R. Hawley, for the Chief of Ordnance Officer, I Oct. 1942. (4) Memorandum, Brig. Gen. Paul R. Hawley, for the Chief of Operations, Services of Supply, 26 Nov. 1943. (5) Memorandum, Brig. Gen. Paul R. Hawley, for Maj. Gen. J. C. H. Lee, 8 Apr. 1943.


did not differ greatly from that of the theater surgeon's office, although the latter had considerably more personnel.

The base sections in the United Kingdom underwent several changes in name and boundary during 1942 and 1943. Though small in area by comparison with those of some other theaters, they were large in numbers of troops and installations. By the close of 1943 five were in operation, with boundary lines for the most part in correspondence with the existing British territorial commands (map 4). This design facilitated cooperation between staff surgeons of the base sections and their British counterparts. The fixed hospitals, medical supply depots, and, other Medical Department facilities operated by each base section served a composite of air, ground, and service troops. Districts- each with a surgeon- were established within each base section, functioning in relation to the base sections as the latter did to the Services of Supply headquarters.20

The duties of the base section surgeons and their staffs varied in accordance with the type and number of troops for whose care the base section command was responsible and with the kind of activity- training, staging, supply, and so forth- that burgeoned within the base section's boundaries. The Army's area commands in the United Kingdom diverged greatly as to troop, strength, and the troop census of each underwent radical fluctuations. The Northern Ireland Base Section, earliest established, had the task of receiving and processing troops from the United States on their way to the North African invasion. During the early part of 1943 relatively few troops, chiefly of the Eighth Air Force, were stationed there and the area became a district of Western Base Section, but late in 1943, when more troops began pouring in, a full-fledged base section was reestablished in Northern Ireland. In Eastern Base Section the hospitalization, medical supply, and preventive medicine service furnished went largely to the benefit of air force troops concentrated in that area for large-scale bombing of Nazi-held targets on the Continent. Center Base Section (previously known as the London Base Command) operated installations and facilities within about 700 square miles in the London area to serve the thousands of men congregated there, a large proportion of whom belonged to several large headquarters establishments (particularly ETOUSA-SOS). Its dispensaries and subdispensaries and a station hospital in London served American civilians and Navy personnel, as well as resident Army troops and thousands of soldiers on leave.

In 1943 the Western and Southern Base Sections became the chief scenes of Medical Department activity. The great majority of the station and general hospitals which began operating in the United Kingdom in that year were located in these two base sections. Western Base Section contained most of the large ports through which thousands of incoming troops passed. The establishment of many dispensaries in the base section called for decentraliza-

    20 See footnotes 4 (3), p. 307; and 14 (4), p. 315.


Map 4.- United Kingdom base sections and surgeons' offices, December 1943

tion of supply procedures, and small distributing points, strategically placed, took some of the burden from the depots. The medical service provided by Western Base Section became full fledged, comprising strong programs in control of venereal disease, nutrition, rehabilitation, and sanitary engineering, as well as the usual supply, hospitalization, dental, nursing, and veterinary func-


tions. Southern Base Section, which became the great marshaling and training area for the continental invasion dating from the spring of 1943, developed a large-scale medical service comparable to that of Western Base Section.21

Effect of the North African Invasion

The long-range buildup in the European theater was subordinated during the late summer and fall of 1942 to plans for the invasion of North Africa. Key personnel were withdrawn from established American and British commands in the United Kingdom to serve on the staff of General Eisenhower's new Allied Force Headquarters, which planned the assault on North Africa and directed the flow of supplies and tactical units from the European theater in support of the invasion.

General Hawley summed up the effect of the plans for the North African invasion upon his office as follows:

You may be amazed to learn that the general and special staff of the European Theater of Operations has, and has had, no responsibility for the North African show other than to give them all the personnel and all the supplies they asked for. This is an Allied Force, and a special staff was set up for it, which included both British and American officers. The Chief Surgeon is British and Jack Corby is the Deputy Chief Surgeon. They took from me about all the supplies I had, two 1,000-bed general hospitals, one 750-bed station hospital, four 250-bed station hospitals, and the following personnel from my office: Corby, Standlee, Norton, Hutter, and two young regulars, in addition to several reserve officers.

I watched the muddled medical planning until I could stand it no longer and then went to the Chief of Staff, ETO and told him that the stage was all set for the biggest scandal since the Spanish-American War. That jolted them a little, and General Eisenhower told me to step in and straighten things out. I did, but within a week things were right back to where they were- each separate task force doing its own planning without the least coordination. It is for this reason that no consultants have been sent to North Africa although I stand ready to send all of them back and forth as soon as I am brought into the picture.22

His picture of the situation reflects the uncertainty that prevailed during the planning period in the late months of 1942 as to whether- and when- the invaded areas of North Africa would become a new theater separate from the European theater. Throughout this period the relationship of the European theater command to the Allied organization directing the North African operation was by no means clear. Definite clarification came only in early February 1943 with the creation of the North African Theater of Operations. During the intervening months the European theater was used as a "zone of interior" for building up army resources in North Africa. Its troop strength was cut

    21 (1) Annual Reports, Surgeon, Northern Ireland Base Section, 1943, 1944. (2) Annual Report, Surgeon, Center Base Section, 1944. (3) Annual Reports, Surgeon, Eastern Base Section, 1942, 1943. (4) Annual Reports, Surgeon, Western Base Section, 1942, 1943, 1944. (5) Annual Reports, Surgeon, Southern Base Section, 1942, 1943.
    22 Letter, Brig. Gen. Paul R. Hawley, to Col. Charles C. Hillman, Office of The Surgeon General, 11 Dec. 1942.


in half, and its medical strength reduced by a third.23 Although the loss to the Medical Department was thus relatively low, the removal of key personnel made it necessary for General Hawley to rebuild his office staff, and shifts of Medical Department personnel and installations resulted at all levels of command.

The Reorganization of 1943 and Later Developments

During the months following the North African invasion, the theater and Services of Supply headquarters reviewed their organizational problems, particularly difficulties posed by the location of theater chiefs of technical services at a distance from theater headquarters. Since 20 July 1942, General Hawley and most of his office had been located with the bulk of the Services of Supply Staff at its Cheltenham headquarters. General Hawley had had to go to London frequently to consult with the theater general staff on theaterwide medical problems. Only a few Medical Department. officers had remained in London in close proximity to the theater staff.

As Colonel Spruit, General Hawley's representative at theater headquarters, was always very loyal to his chief, no such situation had developed in the administration of medical service as in that of some other technical services in the theater, where there was a tendency for the senior representatives at theater headquarters to develop their own organizations and to encroach on the functions of the Services of Supply, but all the chiefs of technical services had found their separation from the theater general staff inconvenient and conducive to delay.24

In November 1942, General Hawley proposed that his office be moved back to London and that a subsection be left with Headquarters, Services of Supply, in Cheltenham to handle functions relating to procurement, supply, operation of facilities, and the maintenance of records. He was supported by a representative of G-3, who pointed out that General Hawley was not available to the theater commander for consultation on matters of planning and for coordinating U.S. Army medical service with British agencies. Delegation of these matters to General Hawley's London office was not satisfactory since a good many of them had to be referred to General Hawley in person, in Cheltenham, for final decision.25

Although this proposal was not approved for the medical service separately, in March 1943 (soon after the North African theater was divorced from the European theater and Lt. Gen. Frank M. Andrews succeeded General

    23 Between 31 October 1942, just prior to the North African invasion, and the end of February 1943, the troop strength of the European theater dropped from 223,794 to 104,510. Medical Department strength in the same period declined from 15,792 to 10,333. See Medical Department, United States Army. Personnel in World War II. [In press.]
    24 (1) Interview, Brig. Gen. Charles B. Spruit, MC, AUS (Ret.), 20 May 1949. (2) See footnote 2, p. 304.
    25 (1) Memorandum, Chief Surgeon, European Theater of Operations, U.S. Army, for Chief of Staff, European Theater of Operations, U.S. Army, 30 Nov. 1942. (2) Memorandum, Assistant Chief of Staff, G-3, European Theater of Operations, U.S. Army, for Chief of Staff, European Theater of Operations, U.S. Army, 30 Nov. 1942.(3) See footnote 4(3), p. 307.


Eisenhower as European theater commander) a Services of Supply planning echelon was established in London. The chiefs of service placed their basic planning divisions there. After May, when Lt. Gen. Jacob L. Devers became theater commander, the chiefs of service, including General Hawley, served in their Services of Supply capacity, immediately under a Chief of Services (later renamed Chief of Operations) of the Services of Supply. General Hawley's operational staff (the bulk of his office personnel) remained in Cheltenham, while the planning staff was located in London so as to be available to the theater commander and general staff at all times. Representatives of the services at Headquarters, ETOUSA, were removed as they were no longer necessary (chart 18).

General Hawley's Cheltenham office was charged with supervising the Services of Supply medical service and with compiling and evaluating data needed for planning. The London office was responsible for the actual preparation of plans, for formulating policy, and administering and giving technical supervision to the medical service of the theater as a whole. Colonel Spruit, the former special London representative of General Hawley, was made deputy in charge of the Cheltenham office, and Col. Oramel H. Stanley, MC (fig. 73), was brought from Cheltenham to head the planning echelon in London. Under the new scheme General Hawley's own station was London, but he still spent some time in Cheltenham supervising that branch of his office.26

During the early months of 1943, the medical section (including both offices) increased in size only slightly, but with the rapid increase in troop strength after the end of May 1943 it expanded markedly. By December officers numbered 115, the enlisted strength came to 234, and the number of civilians reached 120. In November, a year after the invasion of North Africa, the theater's troop strength amounted to 638,112 men (compared with 584,596 in the North African theater) and was to go on increasing until the great concentration of troops for the cross-channel invasion had been assembled. The year 1943 saw Medical Department personnel in the theater increase sixfold, the expansion generally paralleling the growth of theater strength.27

The Ground Forces: 1942-43

Both ground and air force commands building up in the United Kingdom received their technical medical instructions from the office of the Chief Sur-

    26 (1) General Order No. 16, Headquarters, European Theater of Operations, U.S. Army, 21 Mar. 1943. (2) General Order No. 17, Headquarters, European Theater of Operations, U.S. Army, 25 Mar. 1943. (3) Circular No. 63, Headquarters, Services of Supply, European Theater of Operations, U.S. Army, 23 Nov. 1943. (4) Office Order No. 1, corrected, Office of the Chief Surgeon, Services of Supply, European Theater of Operations, U.S. Army, 31 May 1943. (5) General Order No. 25, Headquarters, Services of Supply, European Theater of Operations, U.S. Army, 12 Apr. 1943. (6) Annual Report, Administrative Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1943. (7) See footnotes 4(3), p. 307; and 7(l), p. 308.
    27 (1) See footnotes 7 (1), p. 308 ; and 23, p. 322. (2) Strength of the Army, 1 Nov. 1947, p. 42. Theater strength at the end of December 1943 was 773,753, and Medical Department strength was 65,876.


Chart 18.- Theater-SOS surgeon's office after reorganization of March 1943


geon, ETOUSA. In 1942 and 1943, the chief ground force command in the theater was V Corps, known interchangeably during the early period as the U.S. Army Northern Ireland Force; the; positions of "force" surgeon and Corps surgeon were held by the same man. The personnel of the medical section were divided into two groups to meet the needs of both corps and "force," the "force" group carrying the bulk of responsibility. By late June, when administrative functions were completely divorced from tactical duties, the "force" medical personnel (about half of the total) were lost to the newly created Northern Ireland Base Section, the first base section in the theater. The remainder continued as the V Corps Medical Section.

During their stay in Northern Ireland, the American ground forces relied heavily upon British military and civilian authorities for hospital facilities and medical supplies. The V Corps surgeon's office dealt with the chief medical officer of the British troops in Northern Ireland, the civil health officers. of the Ministry of Home Affairs for Northern' Ireland, the local health officers and Emergency Medical Service representatives, and the leading medical and surgical practitioners of the region. During 1942, members of the surgeon's office participated in a series of command exercises in which both British and American medical units participated.

Near the end of the year, V Corps left Northern Ireland and established its headquarters in Bristol, England. There during 1943 it supplied and


trained incoming units; most of the newly arrived field force units were assigned or attached to its headquarters. The composition of the corps varied from a single infantry division and corps troops in early 1943 to five divisions plus numerous corps units by October. In addition to participating in intensive amphibious exercises during the year, Medical Department personnel in the corps surgeon's office and in medical units of the corps studied reports of the North African, Sicilian, and Italian campaigns and heard talks by officers who had participated in the Mediterranean campaigns. In late October 1943, control of the field forces in the theater was assumed by the newly arrived Headquarters, First U.S. Army, which was established in Bristol, absorbing V Corps.

The introduction of a field army provided a wider basis for planning the invasion of the European Continent. The army surgeon's office was organized after the standard fashion, and the First U.S. Army surgeon, Col. (later Brig. Gen.) John A. Rogers, MC, began a series of conferences with General Hawley to determine what medical units would be allocated to First U.S. Army. As soon as the tentative troop basis had been established, training of units was started, including specialized training at the American School Center at Shrivenham. By early January 1944, the training of Medical Department units was directed at the accomplishment of a landing in Normandy.28

The Air Forces: 1942-43

The Eighth Air Force, commanded by Maj. Gen. (later Gen.) Carl Spaatz, built up in the United Kingdom during spring and midsummer of 1942; its headquarters was in London. Until the fall of 1943, this Air Force was the senior U.S. Army air command in the theater and directly subordinate to the theater command. By the end of September 1942 it had, in addition to the office of the air force surgeon- Col. Malcolm C. Grow, MC, formerly Third Air Force surgeon- a medical section headed by a surgeon in each of its five major commands- bomber, fighter, air service, air support, and composite commands. Colonel Grow and his special staff supervised the training of Medical Department personnel in the Eighth Air Force; determined the requirements for medical, dental, and veterinary supplies for the air force and supervised their procurement, storage, and distribution; advised as to the location and operation of the air force's medical establishments; supervised the operation of medical components of the subordinate units; and directed the assignment and reassignment of Medical Department personnel. Colonel Grow, as well as the surgeons of successor air commands, received technical medical instructions from General Hawley's office.

The medical organization and procedures developed during 1942 by the Eighth Air Force, and their modifications as time went on, generally exemplified those later followed by the Ninth Air Force (as well as by the Twelfth,

    28 (1) Annual Reports, Surgeon, V Corps, 1942, 1943. (2) Annual Report, Surgeon, First U.S. Army, 1944.


which was activated for service in the North African theater). The Surgeon, Eighth Air Force Service Command, originally had in his office the Eighth Air Force medical inspector, inspector of animal foods, medical supply officer, dental officer, officer in charge, of medical records and statistics, nutritionist, and personnel officer. The medical group in Colonel Grow's office included a few officers in charge of the more technical work; that is, functions directly related to the care of fliers, medical research, and the professional services. Colonel Grow found that this division of responsibility prevented his maintaining centralized control over medical service throughout the air force. He was particularly insistent upon centralized control over assignments and reassignments of Medical Department personnel among the commands, wings, groups, and squadrons, together with recommendations for promotion. Accordingly all functions except those of medical supply were removed to his office. The service command surgeon remained directly responsible to the commanding general of the service command for supervision of medical care given by medical officers throughout all the subelements of the air service command, but retained only one function with respect to the entire air force- the handling of medical supply. This division of responsibility became an accepted pattern of organization of medical service within an air force. In some air forces the supervision of food inspection by veterinarians throughout the air force, as well as the medical supply function, was also handled at the service command level.29

Eighth Air Force surgeons continued the efforts, begun by flight surgeons in the United States, to solve special problems connected with maintaining the health of fliers. On account of the rapidity of mobilization, many flying personnel arrived in the European theater with inadequate training in methods of protecting their health and safety during flight. Hence doctors of the Eighth Air Force gave training in the use and care of various pieces of protective equipment, especially the oxygen mask and electrically heated clothing. The European theater became the chief proving ground for testing protective apparatus developed in the United States. The experience of Eighth Air Force fliers with anoxia, frostbite, and aero-otitis- the three chief occupational disorders of fliers- during their long-range bombing missions over Europe at high altitudes in 1942 and 1943 led to many changes in design. Under the personal guidance of the Eighth Air Force surgeon (Colonel Grow), air force technicians in the European theater developed, after extensive research and tests, protective body armor for fliers.

In October 1943 the two numbered air forces in the United Kingdom, the Eighth and the Ninth (the latter transferred from the Middle East to join the Eighth in England), were organized under a single command- the U.S. Army

    29 (1) Link, Mae Mills, and Coleman, Hubert A.: Medical Support of the Army Air Forces in World War II. Washington: U.S. Government Printing Office, 1955, pp. 528-724. (2) Memorandum, Col. Malcolm C. Grow, for the Air Surgeon, 14 Oct. 1942, subject: Narrative Report of Activities of Medical Service of Eighth Air Force (Through Sept. 1942). (3) Army Air Force Manual 25-0-1, Flight Surgeon's File, 1 Nov. 1945.


Air Forces in the United Kingdom- which served as a theaterwide air command. The new command was responsible for coordinating the administration, including the medical service, of both the strategic Eighth and the Tactical Ninth Air Force, the latter designed to render close support to the ground forces whenever invasion of the Continent should be attempted. Both air forces were several times as large as most of those in other theaters, the Ninth reaching its peak strength of 183,987 in May 1944, while the Eighth was even larger.30

The Eighth Air Force surgeon, Colonel Grow, was made surgeon of the U.S. Army Air Forces in the United Kingdom, as well as surgeon of the Eighth Air Force. At the same time his medical section, along with other special staff sections of the Eighth Air Force, was placed, in accordance with the usual scheme for organizing a numbered air force, under the Eighth Air Force's air service command. Thus he had a triple assignment. Detailed technical supervision of medical matters remained the responsibility of small staff medical sections at the headquarters of the other commands (a bomber, a fighter, and a composite command) and of Medical Department personnel assigned to their wings, groups, and squadrons.31

In assigning a single officer as staff surgeon of the air force and surgeon of its service command, the Army Air Forces were following, within the restricted structure of the numbered air force, the scheme of the larger theater structure. In a limited sense Colonel Grow's position resembled that of General Hawley; be had the larger staff assignment, but his office was located at the service command headquarters. At the same time Colonel Grow had the task, as surgeon of the U.S. Army Air Forces in the United Kingdom, of coordinating the medical service of the Eighth Air Force with that of the Ninth. This top air command paralleled the top ground command- the Twelfth Army Group- and Colonel Grow's post as Surgeon, U.S. Army Air Forces in the United Kingdom, resembled that, of the Surgeon, Twelfth U.S. Army Group.

From the date of its arrival in the United Kingdom to its move to the Continent, the Ninth Air Force medical service underwent a rapid buildup, entailing the accumulation of 40 medical dispensaries (aviation) and 10 medical air evacuation transport squadrons, in addition to the Medical Department officers and men assigned to its increasing numbers of wings, groups, and squadrons. During this period the Ninth Air Force medical section, already experienced with directing the medical service for air force troops under field conditions in the Middle East, made plans for the revamping of its medical units to fit expected combat conditions on the Continent. It made changes, particularly in the medical dispensary (aviation) to achieve greater mobility; the dispensaries, forced to make many moves within the British Isles to accompany the tactical units to which they were assigned, needed even greater mobility for the coming continental operations. The Ninth Air Force surgeon,

    30 Annual Report, Medical Department Activities, Ninth Air Force, 29 Feb. 1945.
    31 Medical History of the Eighth Air Force, 1944.


Col. (later Brig. Gen.) Edward J. Kendricks, MC (fig. 74), obtained two field hospitals, each of which he revamped into three smaller hospital units (each staffed by one platoon) to afford medical support to fighter and bomber groups operating from fighter strips after the move to the Continent. Another field hospital, attached to the Ninth Air Force for a few months to serve units of the XIX Tactical Air Command at its airstrips along the south coast of Kent (an area remote from Services of Supply hospitals), afforded three more of these small hospital units which served men of the Ninth Air Form in rapid moves in France and Belgium.32

After February 1943, medical service for troops stationed along the eastern end of the air route between England and the United States, as well as for persons being transported over the route, was provided by the newly established European Wing of the Air Transport Command. As in the case of other Air Transport Command wings, its stations were, administratively subject to the theater within which they were located although their operations were directed from Headquarters, Air Transport Command, in the United States. After a brief period of reliance upon British medical facilities (including those of the Royal Air Force), as well as facilities of the Services of Supply, the European Wing developed dispensaries of from 10 to 25 beds to care for patients for a maximum period of 72 hours. Any further care neces-

    32 Preliminary Operational Report, Office of the Surgeon, Ninth Air Force. [Maxwell AFB files.]


sary was given at Services of Supply hospitals. By the end of the year, dispensaries were operating at the following stations: Hedon airdrome near London; Prestwick, Scotland; Nutt's Corner, Northern Ireland, St. Mawgans in Cornwall; Valley on the island of Anglesey, Wales; and Stornoway, Isle of Lewis, in the Hebrides. At that date, the wing had assigned to it only 12 medical officers, 4 dental officers, 1 Medical Administrative Corps officer, and 36 Medical Department enlisted men. It was the smallest of all Air Transport Command wings. Its heavy responsibility for evacuating large numbers of patients by air from the theater to the United States began only in June 1944 with the Normandy invasion.33

Control of Medical Service for Air Force Troops

During the preinvasion period, medical officers assigned to the Eighth Air Force advocated certain steps which tended to make the air force's medical service independent of the theater command. They made the usual claims as to special needs: medical supplies peculiar to the air forces; medical personnel trained in the special problems of aviation medicine; and special hospital facilities to care for air pilots recuperating from flying fatigue. In addition, they contended that Services of Supply installations, particularly fixed hospitals and medical supply depots in the various base sections, were not always located sufficiently near the air force bases which they served. (Services of Supply installations were concentrated in southern England whereas the majority of the air force bases were in the northeast.) The conflicts that ensued whenever air force surgeons attempted to obtain medical support through their own channels resembled the somewhat more titanic struggle waged over a separate medical service for the Army Air Forces in the United States. They reflected the irresistible trend toward the divorce of air and ground logistics. The interest of air force medical officers in controlling their own medical facilities was especially strong in the early days of the theater's existence when the proportion of air troops to ground and service troops was relatively high and when the Eighth Air Force, engaged in the strategic bombing of targets in Nazi-held territory, was the only element in the theater suffering combat casualties.

As subcommands were created within the Eighth Air Force, officers trained in aviation medicine were needed to staff them. In 1942 many air force units arrived without organic medical personnel, and many medical officers who came lacked training in aviation medicine. Moreover, the Eighth Air Force had to transfer some of its medical officers to the Twelfth Air Force for the North African invasion. Lack of training in the physiologic effects of flight and the proper use of protective equipment was held responsible for some serious plane

    33 (1) History of the Medical Department, Air Transport Command, May 1941-December 1944. [Official record.] (2) See footnotes 4(3), p. 307; and 26 (2),p. 323.


accidents in 1942, the salient example being the loss of three 4-motored heavy bombers and 10 airmen within a week or so. Hence the Eighth Air Force surgeon wanted to establish a medical field service school to train officers in aviation medicine. General Hawley, who believed that such training could and should be given at the medical field service school operated at Shrivenham by the Services of Supply, opposed the plan, but the theater command approved it, and the Provisional Medical Field Service School was officially opened by Colonel Grow in August 1942 at Pine Tree, England.34

Because of shortages of some items of medical supply in the theater in 1942, the Eighth Air Force was unable to obtain the full quantities of medical supplies which it requested through the regular channels; that is, by requisitions to General Hawley's office. By cabling the Commanding General, Army Air Forces, it was able to get a number of items directly from the United States. General Hawley protested-

All components of this theater are short of dental laboratories, Chests Nos. 4 and 60. I adhere to the now apparently unique opinion that an aching tooth hurts an infantryman just as badly as it hurts a soldier in the Air Forces; and this office is attempting to make an equitable distribution of all critical medical items so that all components of ETOUSA may be cared for as thoroughly as is possible in the circumstances. If any competition for medical supplies in this theater is tolerated, wastage is certain and chaos probable.

Inability to meet the full demands of the air forces was one of the persistent problems in the handling of medical supplies in the European theater which continued until early in 1944. It furnished the air forces an argument for building up a channel for procuring its medical supplies directly from the Zone of Interior without going through Services of Supply channels.35

A third struggle developed with regard to hospitalization for the Eighth Air Force. According to theater policy the air and ground forces were to operate only temporary hospitalization facilities capable of treating cases requiring a hospital stay of not more than 96 hours, but in July 1942 the Eighth Air Force made a request for authority to operate rest homes to treat cases of flying fatigue. General Hawley, stating that the proposed rest homes were, in effect, hospitals, and that fixed hospitals were the responsibility of the Services of Supply, opposed the move. The theater command overruled him and approved the rest home project in August 1942. A later request by the Eighth Air Force for hospital rations for its rest homes substantiated General Hawley's original contention, and, as he stated, much to the chagrin of the theater staff.

    34 (1) Narrative Report of Activities of Medical Service of the Eighth Air Force up to and including 30 September 1942. (2) Letter, Col. Paul R. Hawley, to Maj. Gen. James C. Magee, The Sur geon General, 11 Sept. 1942, and other letters in Col. Hawley's chronological file. (3) Memorandum, Lt. Col. Lloyd J. Thompson, MC, for Col. J. M. Kimbrough, MC, 24 Sept. 1942, subject: Visit to 8th Air Force. (4) Memorandum, Brig. Gen. Paul R. Hawley, for Col. Malcolm Grow, October 1942.
    35 First wrapper indorsement on incoming cable No. A671, Chief Surgeon, Services of Supply, European Theater of Operations, U.S. Army, to The Surgeon General, 9 Nov. 1942, and numerous similar documents in General Hawley's chronological file for November-December 1942.


The hospital rations were disapproved on the ground that the rest centers were, by the air force's own statement, not hospitals.36

In mid-1943, the Air Surgeon was pressing for air force control of hospitals in the European theater, about the same time that he was attempting to achieve air force control of general hospitals in the United States, but by that date, when the Services of Supply had a substantial number of fixed hospitals operating, he could not obtain very strong backing from air forces medical officers in the theater. General Hawley was able to point out early in the year, when total strength planned for the Eighth Air Force amounted to about 15 percent of that planned for the theater, that 25 percent of the 750-bed station hospitals then under construction were located in the area occupied by the Eighth Air Force. General Hawley recognized the technical aspects of aviation medicine and realized that fliers hospitalized in the general hospitals of the Services of Supply were not always returned to duty as promptly as was desirable. By agreement between General Hawley and Colonel Grow, flight surgeons were stationed in the general hospitals which cared for appreciably large numbers of air force personnel. They advised the disposition boards of the general hospitals as to whether air force patients were fit for return to flying duty and, if not, whether the air force wanted them returned for limited service. Cooperative arrangements for the expeditious handling of air force patients effectively reduced pressure within the theater for air force control of hospitals; by the end of 1943 air force medical officers appear to have become convinced that hospitalization of air force troops in Services of Supply hospitals was satisfactory. The surgeon of the Ninth Air Force, Colonel Kendricks, was disinterested in the theory of separatism and inclined to stress the cooperation which he received from General Hawley's office. As it developed, the air forces in Europe were to remain dependent on the Services of Supply for fixed hospitalization throughout the war despite renewed pressure at intervals by the Air Surgeon's office in Washington.


From April 1943 to the establishment of the Allied command under General Eisenhower early in 1944, Allied planning for invasion of the European Continent was carried on by a combined British and American staff headed by Lt. Gen. Frederick E. Morgan, the British Chief of Staff to the Supreme Allied Commander (designate). General Morgan's office in London, although a forerunner of SHAEF (Supreme Headquarters, Allied Expeditionary Force), was a planning agency rather than a command. Throughout the life of this planning staff a few Medical Department officers assigned to it from General

    36 (1) Letters, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, 8 July 1943, 10 Aug. 1943, 17 Sept. 1943, and many similar letters, General Hawley's chronological file, through 1943. (2) See footnote 29(l), p. 327. (3) Letter, Brig. Gen. Paul R. Hawley, to Col. Malcolm Grow, MC, 11 Mar. 1943.(4) Interview, Brig. Gen. Edward J. Kendricks, 23 Feb. 1950.


Hawley's office worked on medical phases of invasion plans, as well as plans for the handling of civilian affairs on the Continent. General Hawley assisted with these plans, which were drawn up in close conjunction with his office.37

SHAEF and the Theater Command

The creation of SHAEF, in London in January 1944 in preparation for invading the Continent, together with changes in the responsibilities assigned to various subordinate headquarters and commanders (British as well as American), brought about a different command structure, highly complex, under Which the U.S. Army medical service operated until the end of the war. General Eisenhower served in a dual capacity- as Supreme Allied Commander and as a commander of the European Theater of Operations, U.S. Army. Maj. Gen. Albert W. Kenner, who had served as surgeon of the North African theater, and had been Secretary Stimson's first choice to succeed General Magee as The Surgeon General, was made Chief Medical Officer, SHAEF. He acted as adviser to General Eisenhower and dealt with the surgeons of the many commands subordinate to SHAEF.38

At the same time, the headquarters of the American theater command and that of its Services of Supply were consolidated into a single headquarters. General Lee retained command of the Services of Supply and was given the additional assignment of deputy theater commander for supply and administration; that is, deputy to General Eisenhower in the latter's capacity as commander of the American theater. The chiefs of technical services, who had formerly served in a dual capacity for both theater and Services of Supply headquarters, continued in these two capacities but were now located at a combined theater and Services of Supply headquarters in London instead of, as formerly, at the Cheltenham headquarters of the Services of Supply. General Hawley (promoted to major general in March 1944) was placed under G-4, along with the other technical service chiefs.39

This reorganization seemed to strengthen General Hawley's position. He commented: "All Chiefs of Services, including myself, are Chiefs of Services of the European Theater of Operations, and in addition to their other duties, are Chiefs of Services of the SOS. This is an exact reversal of the previous organization in which the Chiefs of Services were assigned to the SOS and, in addition to their other duties, were Chiefs of Services of the European Theater of Operations. This is, of course, a small point but is proving to be a most important point."40 By the date of the invasion most of General Hawley's staff

    37 (1) Harrison, Gordon A.: Cross Channel Attack. United States Army In World War II. Washington: U.S. Government Printing Office, 1951, ch. II. (2) Interview, Col. John K. Davis, formerly Deputy Surgeon, SHAEF, 15 Sept. 1945. (3) Letter, Maj. Gen. Paul R. Hawley, USA (Ret.), to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. Army Medical Service, 29 Aug. 1955, commenting on preliminary draft of this chapter.
    38 (1) General Order No. 2, Supreme Headquarters, Allied Expeditionary Force, 14 Feb. 1944. (2) Administrative Memorandum No. 3, Supreme Headquarters, Allied Expeditionary Force, 24 Apr. 1944.
    39 See footnotes 2, p. 304 ; and 14 (4), p. 315.
    40 Letter, Brig. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, 4 Feb. 1944.


was concentrated in London at Headquarters, ETOUSA-SOS, which was soon referred to unofficially as Communications Zone, ETOUSA, in anticipation of the role that it was to fill on the Continent.

At SHAEF, General Kenner headed a medical division made up of two British officers- one of whom, a brigadier, served as his deputy- two American officers, and some British and American enlisted men. The duties of the Chief Medical Officer, SHAEF, were defined in broad terms. He was to advise the Supreme Commander on all matters pertaining to the medical service within the areas under General Eisenhower's command and to coordinate medical policy on an inter-Allied basis. Coordination of the policies of the Army's public health program in the European countries which the Army would occupy with plans of the regular medical service for troops was entrusted to him. He was authorized direct communication on technical matters with the surgeons of the naval forces, air forces, army groups and armies, and other commands-British and American-under the Supreme Commander. He reported to the Chief Administrative Officer, SHAEF, Lt. Gen. Sir Humphrey Gale, a British officer who served as a deputy chief of staff, and his recommendations were also reviewed, as a rule, by G-4, SHAEF.

During his early months at Supreme Headquarters, General Kenner conducted conferences, with representatives of the U.S. Navy and the British armed forces present, to discuss the role of hospital carriers and hospital ships in the forthcoming invasion. Similar conferences with representatives of the Royal Air Force, U.S. Strategic Air Forces, and Allied Expeditionary Air Force were conducted in order to integrate plans of all the Allied air elements with the ground elements for evacuation of casualties by air during the invasion. General Kenner attended First U.S. Army exercises at Portsmouth and prepared a written appraisal of the major problems to be anticipated in evacuating casualties. He conferred with Medical Department officers assigned to G-5, SHAEF, on problems encountered in planning the civil health program, especially the procurement of men trained in public health work. He sent his assistant, Col. J. K. Davis, MC, to Algiers, Naples, and Caserta to get information on the Fifth U.S. Army's experience with medical units and data on Fifth U.S. Army casualties, hospital admissions, and incidence of various types of wounds, during the Italian campaign.41

After the invasion, General Kenner spent much of his time traveling up and down evacuation routes on the Continent by car, inspecting the flow of evacuation and the handling of patients. He kept Supreme Headquarters informed on the placement of medical units and hospitals- British, French, and American- in relation to the disposition of combat units and on the flow

    41 (1) Diary, Maj. Gen. Albert W. Kenner. (2) Memorandum, Brig. Gen. Paul R. Hawley, for Maj. Gen. Albert W. Kenner, 25 Feb. 1944, subject: Sea Transport for Casualties. (3) Report of conference, Maj. Gen. Albert W. Kenner and others, 26 Feb. 1944. (4) Reports by Maj. Gen. Albert W. Kenner on exercises in March and April 1944. (5) Memorandum, Maj. Gen. Albert W. Kenner, for Lt. Gen. Sir Humphrey Gale, 29 Feb. 1944. (6) Report of Visit to Allied Force Headquarters by Col. John K. Davis, MC, 1 Apr. 1944.


of medical supplies to forward areas. He made appraisals of combat fatigue among troops, and other matters which would give General Eisenhower and his staff a full picture of the way in which the American and British medical services were Supporting the invasion. At times he followed a group of casual-ties from front to rear, noting any defects in coordination of the movements of evacuees-an overload of patients in the hospitals of a field army or some element of the communications zone, for instance. He reported to General Eisenhower personally about once a week. His action to improve the handling of evacuees usually took the form of personal talks with the surgeons of the commands concerned. When 6th Army Group (comprising the First French Army and the Seventh U.S. Army) entered the theater, his office made recommendations to G-4, SHAEF, for the reallocation of Medical Department units among the tactical components of 12th Army Group and the Allied 6th Army Group to provide balanced support for the two forces.42

General Hawley continued as Chief Surgeon, ETOUSA, responsible for technical instructions to the Services of Supply and to the 12th and 6th Army Groups and their subordinate commands. His title and responsibility as Chief Surgeon, ETOUSA, continued to the end of the war. His office remained at General Lee's headquarters, usually known as Communications Zone- ETOUSA after 7 June when the Services of Supply became officially known as Communications Zone. This headquarters continued to be the theater channel for communicating with the War Department on technical matters. To the end of the war General Hawley also informed The Surgeon General (General Kirk) through personal correspondence of his estimates of the medical needs of the Army in Europe.43

With time some confusion developed with respect to the mutual responsibilities and spheres of control of Supreme Headquarters and Headquarters, ETOUSA-SOS. General Eisenhower's general staff at Supreme Headquarters directed the tactical operations of the combat forces, whereas in a purely American theater, direction of these forces would normally have been exercised by the general staff of the theater headquarters. After the invasion "there was a tendency for SHAEF to assume more and more the aspect of an American theater headquarters as well as an Allied one." General Lee's activities, correspondingly, tended to contract to those properly belonging to a communications zone. The ambiguity was only deepened by the renaming of General Lee's headquarters as Headquarters, Communications Zone, ETOUSA, in June 1944 and the termination of his position as deputy theater commander

    42 (1) Letter, General Dwight D. Eisenhower, to General George C. Marshall, 28 Sept. 1944. (2) See footnote 41 (1), p. 334.
    43 (1) See footnote 2, p. 304. (2) Letters, Maj. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, from June 1943 to the end of the war. Like the chiefs of other technical services at Headquarters, ETOUSA-SOS and its successor, Communications Zone-ETOUSA, General Hawley was frequently in the position of issuing directives to himself. As theater Chief Surgeon his directives, over the signature of the theater Adjutant General, went to the Services of Supply as well as to the armies and air forces, and so were received by General Hawley in his capacity as SOS surgeon.


in July, although the chiefs of technical services, including General Hawley, continued to exercise the same theaterwide responsibilities as before.44

In the circumstances, it is hardly surprising that Medical Department staff officers disagreed as to channels of authority, or that General Kenner and General Hawley were themselves sometimes in doubt as to their respective responsibilities. General Kenner had outlined the command setup for The Surgeon General in March 1944 as follows:

I am in a rather ambiguous situation as regards my relationship to Hawley, since I am set up as the Chief Medical Officer for this composite force, which, as you know, is made up of Navy, Air, and Ground-British and American. Since I am on this higher staff level, I am concerned only with the coordinated planning and the integration of all things pertinent to the medical service. The operative part of it belongs to Hawley * * *.
It's a funny kind of a setup and is without precedent in our medical service.

General Hawley for his part noted the limitations which the command structure imposed upon his activities, specifically in connection with his attempts to get the buildings which he wanted for hospitals in France and Belgium. Because of the involvement of various governments, civilian interests, and a number of Army commands, this problem could not be solved within the communications zone headquarters.

The organization of this Theater being what it is, it is a practical impossibility for me to bring directly to the attention of the authority who can act, the urgent requirements of the medical service for hospital plant. I must, of course, work through and under General Lee and his general staff. The organization set up demands this- and I cannot, and do not desire to, go over his head.

He and his staff give me all the support that they can; but his appointment as Deputy Theater Commander was terminated after he moved his headquarters to the Continent and practically all authority to act in Theater matters has been taken over by SHAEF. This creates the anomalous situation wherein Theater Chiefs of Services have no approach to the Theater Commander and must depend upon subordinate commander and staff for support. Such an organization works as well as it obviously can.

The matter was resolved, as such conflicts generally were, by conference. Representatives of Headquarters, SOS-ETOUSA, of the Army groups, and of the Armies met on 17 January 1945 at SHAEF headquarters at Versailles, and gave General Hawley the 34 additional hospital sites he wanted.45

Many other matters turned out to be involved with Allied interests and to fall within the purview of SHAEF or one of its subordinate Allied commands. Since the Allied Expeditionary Air Force, for example, exercised,

    44 See footnote 2, p. 304.
    45 (1) Interview, Col. Alvin L. Gorby, MC, 10 Nov. 1949. (2) Recorded remarks of Maj. Gen. Albert W. Kenner at panel discussion of manuscript of this volume, Office of the Chief of Military History, 9 Sept. 1955. (3) Annual Report, Surgeon, First U.S. Army, 1944. (4) Letter, Maj. Gen. Albert W. Kenner, to Maj. Gen. Norman T. Kirk, The Surgeon General, 23 Mar. 1944. (5) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, The Surgeon General, 12 Jan. 1945. (6) Darnall, J. R.: Hospitalization in the European Theater of Operations, U.S. Army, in World War II. Mil. Surgeon 103: 426-439, December 1948. (7) Minutes, Conference on Hospital Sites, G-4, Supreme Headquarters, Allied Expeditionary Force, 17 Jan. 1945. (8) Letter, Brig. Gen. Crawford F. Sams, to Col. Joseph H. McNinch, MC, Chief, Historical Division, Office of The Surgeon General, 5 June 1950, and Colonel McNinch's recorded remarks thereon, 22 June 1950.


through its Combined Air Transport Operations Room, control over the allocation of aircraft to air transport agencies within the theater, any request for plans for air evacuation had to be submitted to CATOR, as this agency was called. General Hawley, who was empowered to act only within theater channels, found it difficult to place his statement of requirements for air evacuation before any commander who had authority to act on it.46 General Kenner, on the other hand, continued to regard General Hawley's office as the operating agency, and contented himself with an occasional statement to the theater or communications zone command calling attention to medical defi-ciencies on the purely American side; for example, a rising venereal disease rate in September 1944 and too large a backlog in the number of casualties due, under theater policy, for evacuation from the theater to the Zone of Interior.

Regardless of difficulties encountered by General Hawley on specific matters which came within the compass of SHAEF, he acted as chief of medical service for the American Forces throughout the war, working in close rapport with British Army medical authorities. His office issued under General Eisenhower's signature plans for evacuation which outlined the mutual responsibilities of armies and communications zone elements, as well as those of air forces. The regular medical service for U.S. Army troops which he headed was responsible for care of returned U.S. Army prisoners of war and served many soldiers of the Allied nations as well as many civilians. Consultants in his office visited U.S. Army hospitals in forward areas as well as the communications zone. The series of technical instructions which they issued on procedures and standards for treatment of diseases and injuries of U.S. Army troops were distributed to all Army commands in the European theater. General Hawley and his staff inspected Army hospitals throughout the theater, irrespective of the command to which they were assigned. Many administrative problems were solved by personal discussions and exchange of letters among the surgeons of the commands concerned. Others, calling for compromise among several commands and requiring a command decision, were frequently solved, as in the case of the hospital facilities in France and Belgium, by reaching a formal agreement at a top-level conference. In some instances, when General Hawley found that command channels were lacking for bringing his problems to the attention of a commander with authority to act, he called the matter to the attention of General Kenner, who was able to obtain the backing of SHAEF. General Hawley's and General Kenner's deputies worked in close cooperation.47

The Theater-SOS Medical Section

Pursuant to the January 1944 reorganization and in anticipation of the invasion, a number of changes were made in the internal organization of Gen-

    46 Memorandum, Maj. Gen. Paul R. Hawley, for Commanding General, Communications Zone, European Theater of Operations, U.S. Army, 15 Sept. 1944.
    47 (1) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. Albert W. Kenner, 21 July 1944. (2) See footnote 46. (3) Memorandum, Maj. Gen. Paul R. Hawley, for Maj. Gen. Albert W. Kenner, 21 Sept. 1944.


eral Hawley's medical section. At the beginning of 1944 the London office at the combined ETOUSA-SOS headquarters was relatively small, consisting of General Hawley, a deputy chief surgeon, the executive officer, and the Planning, Evacuation, and Administrative Division; the bulk of the office was still at Cheltenham. With the consolidation of the theater and Services of Supply headquarters, most of the remaining elements of General Hawley's office were transferred to London, and the total office, particularly its Operations Division, underwent considerable expansion. The Chief of the Operations Division, at Headquarters, ETOUSA-SOS, in London, Col. David E. Liston, MC (fig. 75), was appointed deputy to General Hawley in charge of the London office. During the months before the invasion the office was engaged in preparing the medical annexes of plans for mounting the continental invasion and for administering the communications zone. It developed exclusively medical exercises to test the arrangements for evacuating casualties arriving on the southern coast of England to fixed hospitals. It undertook large-scale reshuffling of Medical Department units to meet the requirements for medical care for troops assembling in the marshaling areas along the south coast of England, for evacuation and care of an anticipated heavy load of casualties from the Continent, for care of troops remaining in the United Kingdom, and for a full-fledged medical service on the Continent in the post-invasion months.48

The split of General Hawley's office between London and Cheltenham which had prevailed in 1942 and 1943 was considered by investigators from the Surgeon General's Office a contributory cause of the medical supply crisis that developed by early 1944. When it was evident that the theater's medical supply system would not be able to handle the assembly and distribution of the medical maintenance units and hospital equipment necessary to support the cross-channel invasion, General Hawley requested aid from The Surgeon General. In response, General Kirk sent to the theater a group of officers and some industry experts from the Supply Division, with Col. Tracy S. Voorhees, Director of the Control Division, at their head. Besides arranging for the direct shipment from the United States of sufficient medical maintenance units and hospital assemblies to take the strain off the theater medical supply system, the group proposed overhauling the system itself. The group reported in early February that the fact that General Hawley had had to spend most of his time in London near theater headquarters had prevented his giving close personal supervision to his Supply Division in Cheltenham. Responsibility had been further divided in that procurement of medical supplies from the British had been conducted by a medical supply officer of General Hawley's office who was stationed, along with representatives of the other chiefs of technical services, at the General Purchasing Board in London rather than in General Hawley's office. An insufficient number of officers trained in medi-

    48 (1) See footnote 7(3), p. 308. (2) Annual Report, Surgeon, United Kingdom Base, 1944.


cal supply had been sent to staff the Supply Division of General Hawley's office and to man the medical supply depots in the United Kingdom. A lack of coordination between the theater's medical supply network and the Supply Division of the Surgeon General's Office- as to items to be procured from the British, for example- and insufficient coordination between General Hawley's office and the army surgeons as to the medical supply needs of the armies had contributed to the confusion.

In order to remedy defects, the supply mission recommended a reorganization of General Hawley's Supply Division. The changes included increasing personnel from 17 officers and 47 enlisted men to 32 officers and 91 enlisted men, and the removal of certain officers from the division to various more suitable posts in the medical supply system. The mission drew a parallel between the problems which had developed within the European theater and those which had confronted the Supply, Service of the Surgeon General's Office in 1942, particularly in the operation of a large depot system. Its report stated: "We must recognize fundamentally that the U.K. supply service and depot problems and functions are not those of a T/O (Theater of Operations) but of a base for a Theater or Theaters and are in essence a replica. of the U.S. supply service and depot job with almost exactly the same number of depots." Pursuing this concept, the mission recommended the transfer of certain experienced officers serving in the Supply Service, Surgeon General's Office, and


in the large medical depots in the United States to the theater; they were to undertake measures found effective at home.

Two officers of the mission remained in the theater as members of the Supply Division; 15 additional officers trained in medical supply were sent from the Surgeon General's Office and the medical supply depots in the United States for 90 days' temporary duty in the theater. In early March, Col. Silas B. Hays, MC (fig. 76), who had served with the mission, became chief of the division. The changes in personnel, together with detailed revisions of policy and method, which Colonel Hays put into effect, brought about a system which General Hawley later declared to have proved highly effective for coping with the problems of the cross-channel invasion.49

General Hawley's office reached its full strength soon after the invasion. On 1 July 1944 it consisted of 147 officers, 371 enlisted men, and 125 civilians;

    49 (1) Resume of Trip to Survey Medical Supplies in ETO, 12 Apr. 1944. [Official record.] (2) Hays, S. B.: Report of Medical Supply Situation, 10 July 1944. [Official record.] (3) Memorandum, Chief, Finance and Supply Division, for Chief Surgeon, Headquarters, Services of Supply, European Theater of Operations, U.S. Army, 21 Dec. 1942. (4) Letters, Maj. Gen. Paul R. Hawley, to Maj. Gen. Norman T. Kirk, 4 Feb., 26 June 1944. (5) Annual Report, Medical Procurement Section, Supply Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1944.


on 1 September the strength amounted to 151 officers, 362 enlisted men, and 125 civilians. It was by far the largest Army medical office overseas and second in size only to the Surgeon General's Office itself. General Hawley had two deputies; Colonel Liston served in this capacity in the Paris office, while the United Kingdom Base Surgeon, Colonel Spruit, was his deputy for activities in the United Kingdom. In March 1945 three deputies were appointed: Colonel Spruit (now brigadier general) who retained his assignment as United Kingdom Base surgeon; Colonel Liston as deputy for operations; and Col. Charles F. Shook, MC (formerly Surgeon, Southern Line of Communications), as deputy for administration.

An important innovation in the office early in 1945 was the creation of a Field Survey Division. Its staff undertook to discover deficiencies of every nature in the medical service and assist commanding officers of Medical Department units in the field to carry out the policies of theater headquarters. Teams of officers from the division visited hospitals, inspecting all activities- wards, laboratories, utilities, and inquiring into patients' complaints. They accompanied patients on hospital ships and trains to check on the care being given evacuees en route.50

Other than these developments, the chief changes in General Hawley's office in 1945 resulted from added responsibilities. During the final months of the war the office became increasingly concerned- with technical military intelligence activities. In November 1944, Army Service Forces headquarters in Washington had begun taking a strong interest in this area and had sent teams representing each of the services to work with the Combined Intelligence Objectives Subcommittee established in London the previous spring. A medical officer served on the Combined Intelligence Objectives Subcommittee, which determined the fields of German military developments to be investigated. The program for exploring developments in German medicine, research, and production of medical supplies and equipment got under way in mid-May of 1945 after Germany had been overrun by the Allied armies; it was carried out at various levels of theater organization. A few officers and enlisted men served in the Medical Intelligence Branch of General Hawley's Operations Division; others were attached to Advance Section, Communications Zone; another group tested captured enemy supplies and equipment at a U.S. Army general laboratory in Paris; and four medical intelligence teams attached to the First, Third, Seventh, and Ninth U.S. Armies collected information through interrogating prisoners and examining documents and enemy medical installations. German techniques and developments in medicine (including its preventive aspects),

    50 (1) See footnote 7 (3), p. 308. (2) Annual Report, Administrative Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1944.


surgery, neurosurgery, dentistry, and veterinary medicine, as well as medical supplies used by the German Army, were thoroughly studied.51

The Communications Zone: June 1944-May 1945

During the months before the invasion the Services of Supply, or Communications Zone52 as this organization came to be termed in anticipation of its role in logistic support of the invasion, established two new agencies- Forward Echelon, Communications Zone, and Advance Section, Communications Zone. The headquarters of both agencies had medical sections which worked on the medical phases of invasion plans; each maintained liaison with the office of the Surgeon, Communications Zone, General Hawley. The Forward Echelon, Communications Zone, was a nucleus of the main headquarters designed to move quickly to the Continent in advance of the remaining staff (or rear echelon). During the planning period in the United Kingdom, its staff was attached to 21st Army Group, SHAEF's ground force subcommand, which was to have initial top responsibility on the Continent, but it worked more directly with First U.S. Army, the American component of 21st Army Group. It was organized into staff sections fashioned after those at the main headquarters of Communications Zone, in order to facilitate later reintegration of the two staffs. Its medical staff section was headed by Colonel Spruit. By May about 20 officers of General Hawley's medical section had been assigned to the planning undertaken by Colonel Spruit. In the end the work of this group was confined to planning, for the main headquarters of Communications Zone, including General Hawley's office, moved to the Continent a full month ahead of schedule. Hence Forward Echelon never assumed any direction over the territorial commands of the communications zone but was quickly absorbed into the main headquarters at Valognes, France.53

Advance Section, Communications Zone, was supervised during the planning period by Forward Echelon. Its medical section was headed by Col. Charles H. Beasley, MC (fig. 77), formerly the surgeon of Iceland Base Command. Before assuming his new duties, Colonel Beasley made a short trip to North Africa and Italy to study the organization of the medical service in the

    51(1) Period Report, Medical Intelligence Branch, Operations Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1 Jan.-30 June 1945. (2) Period Report, Medical Intelligence Branch, Operations Division, Office of the Chief Surgeon, Theater Service Forces, European Theater of Operations, U.S. Army, 8 May-30 Sept. 1945. (3) Report of Operations, Office of the Chief Surgeon, Theater Service Forces, European Theater of Operations, U.S. Army, 8 May-30 Sept. 1945.
    52 Officially named Communications Zone, European Theater of Operations, U.S. Army, only on the eve of the invasion. The term "Communications Zone" more aptly applied to the area within which a Services of Supply operated within a theater, was here used to designate the organization itself. The change of name occurred with the forward push and the expansion of the boundaries of the communications zone. In the early days of the theater, the Services of Supply had base sections as its only area commands. With the move forward, the Services of Supply was in some theaters renamed the Communications Zone. It then had both advance and intermediate sections, as well as base sections, thus fully developing the type of organization shown on chart 12, p. 246.
    53 (1) See footnotes 2, p. 304 ; 4(3), p. 307 ; and 7(3), p. 308. (2) Annual Report, Administrative Division, Office of the Chief Surgeon, Headquarters, European Theater of Operations, U.S. Army, 1944.


North African theater, particularly that of Peninsular Base Section. His medical section, first set up in London, was transferred to Bristol in March 1944. The plans of the Advance Section were coordinated with those of the First U.S. Army, then training in the Bristol area, for Advance Section was to operate under the direction of First U.S. Army during the initial days of the invasion. In addition to frequent meetings with the First U.S. Army surgeon and his staff, Colonel Beasley held conferences with General Hawley and his representatives, as well as with the medical staff of Headquarters, Third U.S. Army, and the Ninth U.S. Air Force.

A month before the invasion, the surgeon's office of the Advance Section was authorized a strength of 42 officers and 56 enlisted men, to include a nurse and a maximum of 19 Medical Corps officers. Advance Section headquarters reached France on 15 June, 9 days after D-day, when the frontlines were less than 4 miles away. During its period of attachment to First U.S. Army, about a month, its surgeon's office drew up plans for establishing Medical Department installations ashore to serve combat forces as soon as its territorial limits to the rear of First U.S. Army should be defined. When Advance Section was detached from First U.S. Army control on 14 July, the medical section began providing hospital facilities and an evacuation service, administering the procurement and storage of medical supplies, and supervising sanitation in the communications zone on the Continent. By early August, it was operating in France 12 general hospitals, 4 field hospitals, 1 evacuation hospital, and many other types of medical units, supporting both the First and


Third U.S. Armies (the latter having begun operations on the Continent on 1 August). Advance Section was now permanently under the control of Headquarters, Communications Zone.54

Headquarters, Communications Zone, ETOUSA, moved to Valognes when the rear boundaries of the armies were drawn in early August. By the end of the month most of the surgeon's office had arrived at Valognes and was established in hutments (fig. 78), absorbing the medical staff at the Forward Echelon. At first it appeared that the Communications Zone headquarters would be in Normandy for an indefinite period (planning and construction of the camp at Valognes had been extensive), but it was transferred to its permanent location in Paris in mid-September. The surgeon's office was housed with the offices of the other chiefs of technical services on the Avenue Kleber. Before the end of the year additional officers were requisitioned for the expanding medical section.

With the advance of the armies in France, many changes took place in the organization of the communication zone, but by the middle of October 1944 the structure was near its final form, although boundaries continued to be modified to accord with the changing tactical situation. The communications zone then consisted of an advance section in direct support of the armies and seven base sections: Base Section, Seine Section, Loire Section, Channel Base Section, Normandy Base Section, Brittany Base Section, and the United

    54 (1) Annual Report, Medical Section, Advance Section, Communications Zone, European Theater of Operations, U.S. Army, 7 Feb-31 Dec. 1944.(2) See footnotes 4(3), p. 307; and 7(3), p. 308.


Kingdom Base Section (map 5). The surgeons assigned to the headquarters of continental base sections served on the special staffs of the base section commanders; their offices averaged about 25 officers and 35 enlisted men each. All the continental base sections had substantial numbers of station and general hospitals, medical supply depots, and medical sections of general depots the full array of units designed to provide the standard medical service of a communications zone.55

When the area of southern France invaded from North Africa and Italy was added to the boundaries of the European theater on 1 November 1944, a whole new communications zone was fitted into the vast logistic operation in progress on the Continent. The Communications Zone, MTOUSA, supporting the Seventh U.S. and the First French Armies, had extended its sphere of control to France from Italy. When the invaded area of southern France became a part of the European theater, this command became an additional communications zone command for the European theater, known as the Southern Line of Communications. Its medical section, that of the former Communications Zone, MTOUSA, directed by Colonel Shook, continued performing its duties under a new name in a different theater. With a staff of 19 officers and 39 enlisted men, it directed the medical offices of an advance and a base section supporting the armies in the south. Its work paralleled for some months that done by General Hawley's office in directing the medical sections of the area commands in northern Europe. It supervised the standard medical service of the communications zone- operation of fixed hospitals for Army troops and thousands of prisoners of war, control of disease, and distribution of medical supplies to elements of Southern Line of Communications and the two armies. Its status was of brief duration; before the middle of February 1945 the Southern Line of Communications was disbanded and its troops absorbed by Communications Zone, ETOUSA. Colonel Shook became deputy to the Surgeon, Communications Zone, ETOUSA (General Hawley). The surgeons of the two area commands in the south continued operating with little change, now dealing directly with General Hawley is office.

Both the seven sections in the north (supporting the 12th Army Group) and the two in the south (in support of the 6th Army Group) expanded rapidly toward the German border during late 1944 and early 1945.56 After the armies and the chief battlefront in northern Europe had shifted eastward, Normandy Base Section's medical service underwent considerable change. It became a rear-area service, hospitalizing prisoners of war, evacuating casualties through the port of Cherbourg, supervising the movements of medical supplies, and furnishing care to troops passing through the staging areas within the base section's territory. When the Brittany Base Section (which bad absorbed

    55 (1) See footnotes 2, p. 304; and 4(3), p. 307. (2) Annual Reports, Surgeons, Oise, Seine, Channel, and Normandy Base Sections, 1944.
    56 (1) History, Medical Section, Southern Line of Communications, 20 Nov. 1944-1 Jan. 1945. (2) Interview, Col. Charles F. Shook, MC, USA (Ret.), 31 Mar. 1952. (3) See footnote 4(3), p. 307. (4) Annual Reports, Surgeons, Delta Base Section and Continental Advance Section, 1944.


Map 5.- European theater communications zone, November 1944

Loire Section in December 1944) was added to Normandy Base Section early in 1945, the medical service of Normandy Base Section acquired responsibility for additional troops, including those of the Fifteenth U.S. Army who were helping French forces in the coastal sector to contain German units holding out around Lorient and St. Nazaire.


The medical. service of Seine Section, situated as it was between the intermediate area and the rear of the communications zone, was largely occupied with receiving patients, distributing them to its hospitals, and evacuating them rearward by air, rail, and motor transport. To the north of Seine Section the larger area known as Channel Base Section reached the peak of its operations in the few months before the end of the war. After turning over to Normandy Base Section an area including Le Havre and Rouen, Channel Base Section acquired that part of Belgium previously within the boundaries of Advance Section. Its surgeon's office was also responsible for U.S. Army medical activities within the area of British jurisdiction along the channel coast (map 6), especially in such ports as Antwerp and Boulogne. At least one-third of Channel Base Section's medical installations were within this area at the close of the war.

During early 1945 the most important area command of the communications zone on the Continent, in terms of Medical Department strength and number of medical installations, was Oise Section (known as Oise Intermediate Section after 2 April). More than half of the fixed hospitals on the Continent (many of which were grouped into large hospital centers) were located within its boundaries by April, after it had absorbed most of the territory of the two advance sections.

Within the communications zone in the south, the most fully developed of the two sections was Continental Advance Section. The mission of its medical section continued to be that of giving immediate support to the Seventh U.S. Army, including fixed hospitalization, evacuation, and medical supply. (After this advance section moved into Germany its support of the French First Army was limited to the furnishing of supplies and equipment.) At the beginning of 1945 medical facilities in this section were fairly well stabilized, but fixed hospitals passed to Oise Intermediate Section early in April with the movement into Germany. The medical mission of Continental Advance Section then became primarily that of evacuation and supply for the Seventh U.S. Army and the continuation of medical supply for the French First Army, along with provision of medical care for its own troops, displaced persons, and prisoners of war. The other major element of the communications zone in the south was Delta Base Section, which was comparable to Normandy Base Section in the north in that it included considerable coastline- the Mediterranean coast of France. Most of its medical. installations were concentrated around Marseille. Continental Advance Section maintained the larger number of general hospitals since it provided close support for the 6th Army Group; Delta Base Section needed only enough beds for static troops and long-term patients.57

    57 (1) See footnote 4(3), p. 307. (2) First Semiannual Report, Office of the Surgeon, Continental Advance Section, 1 July 1945. (3) Final Report, Medical Section, Delta Base Section, 25 Jan. 1946. (4) First Semiannual Report, Office of the Surgeon, Normandy Base Section, 1 Jan.-30 June 1945. (5) First Semiannual Report, Office of the Surgeon, Seine Section, 1945. (6) Semiannual Report, Medical Section, Channel Base Section, 1 Jan.-1 July 1945. (7) First Semiannual Report, Medical Section, Oise Intermediate Section, 1 Jan-30 June 1945.


Map 6.- European theater communications zone, 15 April 1945


The medical service provided in the rearmost area of the communications zone, the United Kingdom, underwent considerable change during the months that troops were being readied for the cross-channel assault. Upon the surgeons of Southern and Western Base Sections fell the burden of providing medical service for the thousands of troops assembling in the marshalling areas of the southern coast. Many camp dispensaries and first aid stations were set up to care for incoming troops. The base section surgeons had to provide them. initial equipment and replacement supplies. Many fixed hospitals in Southern Base Section were designated "transit" hospitals as links in the chain of evacua-tion from the invaded areas, and mass evacuation of patients already being treated in these hospitals to the hospitals of Western Base Section was undertaken by the Southern Base Section medical service in order to make room for invasion casualties.

After the invasion and concurrently with the establishment of base sections on the Continent, all the base sections in the United Kingdom were consolidated under a single United Kingdom Base, the former base sections becoming districts of the new base. Colonel Spruit became United Kingdom Base surgeon; his office, briefly in Cheltenham, was located in London near the end of October 1944. His staff was larger than equivalent components in the continental base sections and larger than that of the theater surgeon's office in all theaters except the European and Mediterranean. At the end of 1944 it consisted of 81 officers, 1 warrant officer, 124 enlisted men, 45 members of the Women's Army Corps, and 83 civilians; its internal organization was identical with that of General Hawley's office as of May 1945 (appendix B, p. 562) except that it lacked a Field Survey Division and a Historical Division. It was made up of some personnel left at Communications Zone-ETOUSA headquarters when General Hawley's office moved to the Continent, as well as personnel of the medical section of the former Southern Base Section. At the outset it assumed technical supervision of 64 general hospitals, 43 station hospitals, 5 field hospitals, 19 hospital trains, and several medical depot companies which were operating 3 medical depots and medical sections in 13 general depots. Its numerous medical installations and units probably constituted the greatest concentration of U.S. Army medical facilities in history. From D-day to 7 May 1945, the hospitals assigned to the United Kingdom Base cared for nearly 428,000 sick and wounded soldiers (including prisoners of war) returned from the Con-tinent, and nearly 160,000 patients from troops stationed in the United Kingdom.58

An important feature of base section administration after the invasion was the hospital center- a group of fixed hospitals (general, station, and convalescent) operating under a single headquarters. Early in 1944 three groups of hospitals at Cirencester, Malvern, and Whitchurch in western England had

    58 (1) Annual Reports, Medical Section, United Kingdom Base, 1944 and 1945. (2) See footnotes 4(3), p. 307; and 7(3), p. 308. (3) Annual Report, Supply Division, Office of the Surgeon, United Kingdom Base, 1 Sept.-31 Dec. 1944.


been put under hospital center headquarters for the sake of more efficient operation. With the consolidation of the base sections of the United Kingdom into a single base, responsible for administering over 100 hospitals (at the close of 1944, 66 general hospitals, 32 station hospitals,. and 5 convalescent facilities), it became even more useful to employ an intermediate administrative headquarters between the individual hospital and the United Kingdom Base surgeon's office.

With the onset of mass evacuation from the Continent to the United Kingdom, the grouping of hospitals into a hospital center brought added advantages. A hospital center would furnish enough vacant beds for the reception and care of the 200-300 evacuees from the Continent which a hospital train would carry. Thus discharge at a single railhead, instead of at the separate localities of several hospitals (or instead of maintaining sufficient vacant beds at a single hospital, thus losing bed capacity), would be possible. Moreover, a single hospital could be chosen to render all service provided in the entire group in a given specialty such as thoracic surgery, with all the thoracic surgeons from the various hospital staffs concentrated in the one hospital. In one of the largest centers, the 12th at Great Malvern, French patients were cared for as a group, and within a single hospital at some centers were concentrated personnel skilled in chemical warfare medicine as well as the necessary supplies, in readiness for a possible large-scale influx of gas casualties.

After the invasion, additional hospital centers were established in the United Kingdom. Seven operated there, mostly in southern and western England and all under United Kingdom Base organization; they were located at Taunton (Somersetshire), Blandford (Dorsetshire), Devizes (Wiltshire), Cirencester (Gloucestershire), Great Malvern (Worcestershire), Whitchurch (Flintshire), and New Market (Cambridgeshire). By the close of December 19441 45 general hospitals, 11 station hospitals, and 2 convalescent facilities were in operation in the continental base sections, and the grouping of hospitals became practicable there as well. After January 1945, nine hospital centers were developed in the continental base sections: seven were in northern and eastern France- Cherbourg, Paris (two centers), Nancy, Le Mans (later at Vittel), Var-le-Duc, and Mourmelon-one in Liege, and one in Aachen. The commanding general of a hospital center commanded the hospitals and other units and served as the communicating agent on technical, administrative, and professional matters with the office of the base section (or base) surgeon. Hospital centers proved more practicable in the European theater than elsewhere, for their usefulness depended in large measure upon their employment in connection with the mass evacuation of large numbers of casualties.59

    59 (1) General Order No. 15, United Kingdom Base, 2 Oct. 1944. (2) See footnotes 7(3), p. 308; and 58(l),p.349. (3) Annual Reports, 12th, 15th, 801st, and 802d Hospital Centers, 1944 and 1945. (4) Letters, Maj. Gen. Paul R. Hawley, MC, USA (Ret.), to Col. John Boyd Coates, Jr., MC, USA, Director, The Historical Unit, U.S. Army Medical Service, 29 Aug. and 7 Sept. 1955, commenting on preliminary draft of this volume. (5) Report of the General Board, U.S. Forces, European Theater, on Medical Service in the Communications Zone, European Theater of Operations, Medical Section Study No. 95. [Official record.]


The Ground Forces: 1944-45

The bulk of U.S. Army ground troops arrived in the European theater after January 1944. Until the fall of 1943, the major ground force element in the theater had been V Corps; in October the First U.S. Army had assumed the position of top ground force command. The Third, Ninth, and Fifteenth U.S. Armies followed, building up in 1944 in that order. All were eventually in operation on the Continent under the command of 12th U.S. Army Group. The First U.S. Army surgeon was Col. John A. Rogers, MC. The Third U.S. Army surgeon, Col. (later Brig. Gen.) Thomas D. Hurley, MC, was succeeded by Col. Thomas J. Hartford, MC (fig. 79). The Ninth U.S. Army surgeon was Col. William E. Shambora, MC, and the surgeon of Fifteenth U.S. Army was Col. L. Holmes Ginn, MC (fig. 80). From the Mediterranean theater came another American combat force, the Seventh U.S. Army- Col. Myron P. Rudolph, MC, surgeon- which landed in southern France 10 weeks after the Normandy invasion. It and the First French Army were under the control of the 6th Army Group. The First Allied Airborne Army, organized in August 1944 without any headquarters medical section, was under the direct control of Supreme Headquarters, Allied Expeditionary Force.

In this theater, which contained the overwhelming majority of U.S. Army ground troops overseas, the army group became the highest ground force


command. After September 1944, both the 12th U.S. Army Group and the Allied 6th Army Group were under the tactical control of SHAEF The headquarters of the 12th, which controlled the bulk of the American ground troops, became in a sense the U.S. Army ground force headquarters in the theater organization.

The army group headquarters confined its activities for the most part to tactical and policy matters, being designed primarily, like the corps headquarters, for the purpose of coordinating the activities of subordinate elements. Hence the 12th Army Group surgeon- Col. Alvin L. Gorby, MC (fig. 81), who had served as Armored Force surgeon in the United States- was not concerned with the direct supervision of medical service for troops; this was the province of the field armies and their subordinate elements. No table of organization existed for the army group surgeon's office, as the army group was a new organization; Colonel Gorby kept his medical section, one of 19 special staff sections, small and its organization simple. It included no dental or veterinary officers or consultants, as the offices of army surgeons commonly did; its two chief elements were a Plans and Operations Division and Preventive Medicine Division. The peak strength of personnel assigned to it was 14: officers and 10 enlisted men, although a few additional officers assigned to the offices of army surgeons served as liaison officers between their respective medical sections and Colonel Gorby's office.


During the months of planning for the invasion, Colonel Gorby's medical section (originally created as the medical section for 1st U.S. Army Group, the progenitor of the 12th) was occupied with working out, in cooperation with the Chief Surgeon, ETOUSA, and the Chief Medical Officer, SHAEF, the respective responsibilities of the armies, air forces, and naval forces for medical supply and evacuation. Evacuation problems to which it devoted special attention were the methods of recording casualties, evacuation of casualties by water, and a system of property exchange whereby litters, blankets, and similar items transferred with evacuees would be replaced. For a brief period, from 16 May to 6 July 1944, it acted as the medical section for the American staff attached to rear headquarters of the British 21st Army Group, the higher headquarters which directed the field armies during the initial stages of the invasion. From 7 July to the end of the month, a period during which the medical section moved to France, it returned to control of 1st U.S. Army Group but functioned once more under 21st Army Group during its first month of activity on the Continent, the month of August. After 1 September, it became the medical section for General Bradley's 12th Army Group which from then on functioned directly under SHAEF.

After September, when the Ninth U.S. Army launched the attack on the Brittany Peninsula, Colonel Gorby's medical section had the task of allocating


medical units among three armies-the First, the Third, and the Ninth U.S. Armies. The shifting of units reached a peak at critical periods; some had to be loaned to 6th Army Group coming up from the south, and many had to be transferred after the German breakthrough in the middle of December 1944. The office kept the tables of organization and equipment of Medical Department units assigned to the army group under continuous review and recommended changes. It kept in close touch with the medical office of Advance Section and other elements of Communications Zone for mutual arrangements concerning medical supply, evacuation, and hospitalization. It allocated Medical Department units and critical items of medical supply, such as whole blood, among the field armies and coordinated policies and techniques designed to prevent trenchfoot, combat exhaustion, and neuropsychiatric cases- problems encountered by all the field armies in combat in Europe during the winter of 1944-45.

The 6th Army Group, composed of the Seventh U.S. and First French Armies, and commanded by Lt. Gen. Jacob L. Devers had, unlike the 12th, no special staff medical section, but a few Medical Department officers and enlisted men were assigned to G-4. Their work, limited by the size of the group and its subordination to G-4, was confined to inspecting medical units of the two armies under 6th Army Group, the coordination of successive stages of evacuation, and the development of a workable system of property exchange between air and ground forces in air evacuation.60

The Surgeon, 6th Army Group, Col.. Oscar S. Reeder, MC (fig. 82), pointed out the excessive staff work which his medical section had to undertake because of its incorporation in G-4:

Under normal staff procedure the Surgeon deals with all general and special staff sections of a headquarters. Matters that require processing through Command Channels are forwarded through the appropriate general staff section, while technical subjects are coordinated directly with the special staff section interested. Technical matters comprise approximately 90% of the work of the Surgeon. Under the initial organization of this headquarters, all such correspondence was routed through the A.C. of S., G-4. This procedure forced considerable unnecessary detail to the attention of this general staff officer, whereas, normally only the completely coordinated studies would have been presented. Furthermore, all incoming papers and messages of interest to the Surgeon only were routed through the G-4 section instead of being transmitted directly from the message center. This made the G-4 section responsible for the action regardless of the subject.61

This direct Subordination of the staff surgeon to G-4 occurred in other commands at intervals and sometimes evoked similar protests. In such cases, the surgeon frequently felt handicapped by lack of direct access to his commanding general. In May 1945, Colonel Reeder's medical section was placed

    60 (1) See footnotes 4 (3), p. 307; and 45 (1), p. 336. (2) Report of Operations, 12th Army Group, vol. XIII: Medical Section. (3) Interview, Brig. Gen. Alvin L. Gorby, 23 Jan. 1953. (4) History, Medical Section, 12th Army Group, 1 Jan.-30 June 1945. [Official record.] (5) Annual Report, Surgeon, 6th Army Group, 1945.
    61 Annual Report, Surgeon, 6th Army Group, 1944.


oil the special staff of 6th Army Group, and he noted that the Medical Department had then been placed "in its rightful position in this Army Group."62

All field armies had similar medical sections (in general conformity to a table of organization) at headquarters; they consisted of about 24 officers and 30 enlisted men. The army surgeon was a colonel or a brigadier general of the Medical Corps. Army medical sections usually included, besides the surgeon. and his executive officer, the following subsections: Administration, personnel, operations, training, preventive medicine, supply, dental service, veterinary service, nursing, and consultants. Since the field armies had hospitals (field, evacuation, and convalescent) assigned to them, representatives of the professional services were needed at army headquarters; the staff nurse of Third U.S. Army, for example, supervised the work of an average 600 nurses in the army's hospitals. Officers of the staff medical section of the field army were frequently put on liaison duty with the headquarters of the various corps under the army, and additional officers were sometimes attached to the army medical section for special purposes; for example, a medical liaison officer of the air forces for arranging evacuation of patients by air from the army area to the communications zone.

    62 Letter, Col. Oscar S. Reeder, to Maj. Gen. Albert W. Kenner, 5 May 1945.


The offices of army surgeons operated as a unit at a single headquarters only rarely. During the period of preinvasion planning in the United Kingdom, for instance, the First U.S. Army surgeon and part of his staff spent some months in London in order to work in conjunction with SHAEF and other planning headquarters in completing the invasion plans; the remainder of the staff was at the army's command post in Bristol. During periods of combat on the Continent, army surgeons' staffs Were usually split, along with the rest of the army headquarters, into forward and rear echelons. Army surgeons were usually concerned with the proper division of their staffs be-tween the two echelons. It was difficult to coordinate the work of the divided medical section, especially since Medical Department units assigned to the field army also operated at times in two echelons. The Third U.S. Army surgeon favored placing himself, his executive officer, the surgical consultant, his operations and training subsection, and his medical supply subsection at forward echelon, leaving the rest of his staff- the dental, veterinary, and preventive medicine personnel, the remaining consultants, and staff engaged in personnel and administrative matters- at the rear echelon.

The field army had a large number of Medical Department units assigned; these were mostly concerned with the evacuation of patients from the division and corps areas and their treatment in army hospitals. Units assigned to the field army in the European theater consisted chiefly of the following: Medical groups; medical battalions; separate collecting, clearing, and ambulance companies; field, evacuation, and convalescent hospitals; medical depot companies, auxiliary surgical groups, a medical laboratory, and an occasional medical gas treatment battalion. The army surgeon was responsible (subject to coordination with the army staff) for training these units in the precombat period, for planning their movement into combat areas at the proper time and in the proper proportion (the so-called "phasing in"), and for their utilization during combat. Coordination of the evacuation process from forward areas called for close liaison by the army surgeon's office with each division and corps surgeon and his staff, and with the medical staff at Communications Zone headquarters, and frequently led to a temporary redistribution of personnel or units. In December 1944, for example, the First U.S. Army surgeon had to supply from its units many Medical Department enlisted men, as well as some officers, to divisions under the army; as a result it had to borrow in turn more than 300 Medical Department personnel from Communications Zone units.63

During the European campaigns 15 corps were used among the 5 American field armies on the Continent. Most were shifted from. one army to another in the way that the many divisions in the theater were reassigned among the various corps. The medical service functioning under the corps was geared to the standard concept of the corps as a tactical unit rather than as a self-

    63 (1). Annual Reports, Medical Sections, First, Third, Seventh, and Ninth U.S. Armies, 1944. (2) Annual Report, Medical Section, Fifteenth U.S. Army, 1945.


sufficient organization like the field army or the division. Hence the corps surgeon had no Medical Department units under his control with the exception of a medical battalion which administered medical service to corps troops (as distinct from divisions under the corps) and handled medical supplies for them. Occasionally other field army medical units (such as medical groups, flexible organizations to which various types of technical units might be attached) served with the corps. Each corps headquarters had a small medical section composed typically of two Medical Corps officers, two Medical Administrative Corps officers, a warrant officer, and four enlisted men. As in the case of the medical section at army group headquarters, Dental, Veterinary, and Nurse Corps personnel were not normally assigned.64

The Air Forces: 1944-45

Early in March 1941, USSTAF (U.S. Strategic Air Forces in Europe) replaced the U.S. Army Air Forces in the United Kingdom. The new top American air command had control of the administration, including the medical service, of the Strategic Eighth and the tactical Ninth Air Forces. Am air service command of the U.S. Strategic Air Forces was also organized; it was analogous to the Air Service Command, Army Air Forces in the United States.

General Grow, the surgeon of the Eighth Air Force, the Eighth Air Service Command, and U.S. Army Air Forces in the United Kingdom, became the chief medical officer in U.S. Strategic Air Forces, serving under the Commanding General, Air Service Command, USSTAF, who was also the Deputy Commanding General for Administration, USSTAF. Although his office was placed at the service command level, General Grow had ready access to the Commanding General, USSTAF, Lt. Gen. Carl Spaatz, through the deputy commander under whom he served. His medical staff included a deputy surgeon, executive officer, professional services officer, special projects officer, medical statistics officer, care-of-fliers officers, personnel officer, administrative officer, and later a nutritionist, a veterinarian, and a sanitary officer.65

Thus, from spring 1944 to the close of the war, the following air commands of the European theater had medical sections at their headquarters: U.S. Strategic; Air Forces and Air Service Command, USSTAF, which had the combined medical section headed by General Grow; the Eighth Air Force; and the Ninth Air Force (chart 19). Both headquarters, USSTAF, and Headquarters, Air Service Command, USSTAF, were located just outside London in Bushy Park until September 1944: when they moved to the outskirts of Paris where they could maintain close liaison with SHAEF in Versailles. The headquarters of Eighth Air Force remained in Britain, but that of the tactical

    64 See periodic reports of the surgeons of V, VII, XII, XVI, and XX Corps, 1944 and 1945.
    65 (1) Report of Medical Activities. U.S. Strategic Air Forces, 1 Jan-1 Aug. 1944. (2) See footnote 29(1), p. 327.


Chart 19.- Medical sections at major U.S. Army Air Force commands in the European theater, March 1944.

Ninth Air Force which supported the armies in combat in Europe moved to France soon after the invasion of the Continent.

An Allied air command with a British-American medical office existed briefly in the European theater. The Allied Expeditionary Air Force was created in November 1943 to direct the operations of British and American tactical air forces committed to the invasion of the Continent. Since it controlled only the operations of the American tactical air force, the Ninth (administrative matters in the Ninth being directed by the highest American air force headquarters, U.S. Strategic Air Forces), the American component of the medical office at its headquarters, was never of great importance. It was headed by Lt. Col. James Jewell, MC, whose rather limited duties consisted chiefly of giving information to the commander of the Allied air command on the health of troops of the Ninth Air Force, cooperating with his British colleague, and keeping in touch with the Medical Division, Supreme Allied Headquarters. The Combined Air Transport Operations Room maintained by Allied Expeditionary Air Force allocated the requests it received for aircraft from various ground and air force commands among British and American air transport agencies and thus exercised functions with respect to medical supply and evacuation through controlling the means for furnishing these by air. With the invasion of Europe, Allied Expeditionary Air Force exercised considerably less authority than originally planned, and by mid-October 1044 it was disbanded, thus ending what has been called "the least successful venture of the entire war with a combined Anglo-American command."66

    66 (1) Craven, W. F., and Cate, J. L., editors: The Army Air Forces in World War II. Chicago: University of Chicago Press, 1951, vol. II, pp. 561-562, 620. (2) Preliminary Operational Report, Surgeon, Ninth Air Force, 18 July 1944.


After the main branch of Headquarters, USSTAF, moved to Paris in September, General Grow's office maintained a small medical section at Headquarters, USSTAF (Rear), in London to direct medical service for air troops, chiefly of the Eighth Air Force, left behind in the United Kingdom. This office acted as a link between the parent medical section in Paris and medical officers at headquarters of the Eighth Air Force. It dealt with the office of the United Kingdom Base surgeon in arranging for hospitalization of air force personnel stationed in the United Kingdom and supervised the industrial hygiene program for civilian employees at large air force depots in the United Kingdom. One of its officers was attached in a liaison capacity to the Rehabilitation Division of General Hawley's office in order to give special supervision to the rehabilitation and training of air force troops convalescing in the general hospitals of the Services of Supply.

As medical section of the Air Service Command, USSTAF, General Grow's office advised the Director of Supply of that command on procurement, receipt, storage, distribution, and issue of medical, dental, and veterinary equipment and supplies for the air forces and commands under the administrative control of the Commanding General, USSTAF. As medical section at staff level, it coordinated intra- and extra-theater air evacuation, research in aviation medicine, and activities of the air forces and commands concerned with the care of fliers and the rehabilitation of air force personnel convalescing at communications zone hospitals. Other duties included the examination of medical equipment and protective clothing and safety equipment captured from German planes and aircrews. General Grow's office also undertook measures to reduce industrial hazards in air force installations. It coordinated with other branches of USSTAF headquarters the medical planning for special projects and for postwar medical activities.

Supervision of technical work concerned with protecting the health of fliers was centered in the Care-of-Fliers' Section of the surgeon's office in the Eighth and Ninth Air Forces. The Care-of -Fliers' Section in General Grow's office had the task of coordinating their work. It planned and operated rest homes for fliers, since these were used by both the Eighth and Ninth Air Forces, and it allocated beds in the rest homes between them. Seventeen rest homes were in operation late in 1944; they served members of combat crews suffering from fatigue or tension induced by participation in a number of combat missions. The Care-of-Fliers' Sections in the surgeons' offices of the Eighth and Ninth Air Forces had ' the more immediate responsibility for protecting flying personnel of these commands against stresses, diseases, and injuries of an occupational nature. Their work was a special phase of preventive medicine. They carried out their program largely by means of the so-called "central medical establishment" developed in each air force.

In the last 2 years of the war the central medical establishment was in the process of evolution; the Air Surgeon's Office in Washington advocated the


creation of one for each numbered air force and toward the close of the war succeeded in establishing an official table of organization for this unit. The First Central Medical Establishment, which served the Eighth Air Force, was created in November 1943 by reorganizing the Medical Field Service School (Provisional) which the air force had been operating at Pine Tree, England, since mid-1942. In 1942 the school had largely confined its work to giving an indoctrination course in aviation medicine to newly arriving medical officers who had not had this training in the United States. As most medical officers arriving for service with the air forces in 1943 and later had had the course, the First Central Medical Establishment shifted its emphasis to special problems being encountered by fliers in the European theater. It also continued the training, which it had begun late in 1942, of special "oxygen and equipment officers," in the effort (later considered successful) to reduce casualties due to failures, defects, or misuse of safety equipment. Trained officers gave in their turn continuous instruction to combat crewmen in the elementary principles of aviation medicine and the use of protective equipment. The First Central Medical Establishment also engaged in some research, with the aid of an Engineer officer, on possible defects in personal flying equipment, suggesting modifications and devising several new items. A central medical board of the establishment determined the qualifications or disqualifications for flying of borderline cases referred to it, primarily from combat units. In March 1944 a similar unit, termed the Third Central Medical Establishment, was organized in the Ninth Air Force.67

Army Air Forces pressure for control of its own hospitals in the European theater increased early in 1944. Although neither General Grow nor the surgeon of the Ninth Air Force, Colonel Kendricks, shared the enthusiasm of the Air Surgeon for putting fixed hospitals under Army Air Forces control in the European theater, General Grant had kept up the fight in Europe, as well as in other oversea areas. The matter was brought to the attention of President Roosevelt, who appointed a board to survey the situation in the Euro-pean theater. The three members of the board- The Surgeon General, the Air Surgeon, and Dr. Edward A. Strecker, consultant in psychiatry to the Secretary of War- went to Europe in the spring of 1944, visiting hospitals in which patients were preponderantly of the air forces and conferring with air force commanders. The board decided in favor of the existing system of hospitalization, which, it found, was operating satisfactorily, and recommended that no changes be made on the eve of invasion of the Continent. During the remainder of the war General Hawley, strongly supported by The

    67 (1) Annual Reports, Medical Department Activities, Eighth Air Force, 1943 and 1944. (2) General Order No. 51, Headquarters, Ninth Air Force, 17 Mar. 1944. (3) Special Order No. 186, Headquarters, Ninth Air Force, 26 Mar. 1944. (4) Annual Report, 3d Central Medical Establishment, Ninth Air Force, 1944. (5) Report, Medical Department Activities, U.S. Strategic Air Force, Aug.-Dec. 1944.(6) See footnote 29(l), p. 327.


Surgeon General, maintained control of fixed hospitals in the European theater.68

Medical Department officers of the air forces in Europe took part in two special missions auxiliary to operations in the European theater but outside its boundaries. In the summer of 194:4 the Surgeon, USSTAF, aided in planning medical service for the Eastern Command, USSTAF, established in Soviet Russia to facilitate the Shuttle bombing of Germany. A command surgeon was assigned, and a 75-bed dispensary, in effect a small hospital, was set up at each of the 3 airbases established east of Kiev. During their stay in Russia, the command's medical officers found the Soviet medical authorities generally cooperative and intensely interested in methods used by the U.S. Army Air Forces. Under the close supervision of the Russians, American medical officers visited Soviet hospitals and bases. Their work was of relatively brief duration. A crippling blow to the main base at Poltava, delivered by the German Air Force 3 weeks after the first shuttle flight, reduced their effectiveness, while the westward advance of the Red Army soon left them far behind the lines.69

The Eighth Air Force also gave some medical aid to American airmen interned in Sweden, amounting by the end of July to the men of 94 aircrews. The medical officer who headed the program was assigned to the office of the U.S. Military Air Attaché of the American Legation in Stockholm. During the fall of 1944, officers sent to Sweden surveyed the health of internees at the eight camps maintained for them, determined immediate medical needs., and arranged payment for the services of Swedish physicians. In addition to their basic assignment, they assisted the Office of Strategic Services with the medical care of American personnel secretly dropped by air in Norway, advising Norwegian doctors who cared for the Americans and aiding them in obtaining medical supplies from the United States.70

As the invasion of Germany got under way, Medical Department officers of the air forces made increasingly active inquiry into developments in aviation medicine within the German air forces; this work became a special phase of the investigation of all aspects of German military medicine being undertaken by the Combined Intelligence Objectives Subcommittee. In the spring of 1945, flight surgeons of the Eighth and Ninth Air Forces were sent to Germany to work with the medical intelligence teams which accompanied the

    68 (1) Letters, Col. Edward J. Kendricks, MC, to Maj. Gen. David N. W. Grant, 18 July, 20 Aug. 1944. (2) Memorandum, Maj. Gen. Norman T. Kirk, The Surgeon General, Maj. Gen. David N. W. Grant, and Dr. Edward A. Strecker, for the Chief of Staff, through the Deputy Theater Commander, European Theater of Operations, U.S. Army, 20 Mar. 1944. (3) Letter, Maj. Gen. Paul R. Hawley, to Maj. Gen. Malcolm C. Grow, 27 Mar. 1944. (4) Annex 4 to Ninth Air Force Plan for Operation OVERLORD, pt. II, Medical Plan, 24 Mar. 1944. ((5) Interview, Brig. Gen. Edward J. Kendricks, MC, 23 Feb. 1950.
    69 (1) Craven, W. F., and Cate, J. L., editors: The Army Air Forces in World War II. Chicago: University of Chicago Press, 1951, vol. III, ch. IX. (2) Quarterly Report, Medical Department Activities, Eastern Command, U.S. Strategic Air Forces in Europe, January-March 1945. (3) Special Medical Report, Eastern Command, U.S. Strategic Air Forces in Europe, 12 June 1944.
    70 Potter, F. A.: History, Legation of the United States of America, Stockholm, Sweden, 27 Sep-tember 1944-9 July 1945. [Official record]


advancing armies and investigated German medical installations. The Director of Medical. Services, USSTAF, maintained at his rear office in London an aeromedical research section which acquired information, documents, and materiel pertaining to the medical service of the Luftwaffe. This office interrogated doctors and pilots of the Luftwaffe and forwarded documents and captured materiel of significance to aviation medicine sent them by field investigators to the Aero-Medical Research Laboratory at Wright Field, Ohio. Later an aeromedical museum established in London at the request of the Director of Medical Services, USSTAF, served as a depository for the examination of medical items, flying equipment, air-sea rescue equipment, protective chemical warfare equipment, and emergency rations used by the Luftwaffe.71

Medical Care for Civilians in Liberated Countries

The organization which handled the public health programs among the populations of Europe liberated by the advancing Allied armies eventually became an elaborate network functioning at higher levels of command under a general staff section termed G-5. This chain of control, separate from the office of staff surgeons with responsibility for the health of troops, was more completely established after the orthodox concept in the European theater than in any other area during the war. However, a number of factors- chiefly post-invasion developments on the Continent-tended to disturb the standard organization in the later months of the war and to thrust more and more responsibility for the medical. program for civilians upon the offices of command surgeons whose primary responsibility was for troops.

A Medical Department officer was assigned to the Civil Affairs Section, a special staff unit of Headquarters, ETOUSA, in July 1943.72 Only two or three Medical Department officers worked in this Public Health Department, as it was called, of the Civilian Relief Branch of the Civil Affairs Section. During this early period the specialized functions of various Wax Department corps were not closely adhered to in the organization for civil affairs. An Engineer Corps officer, for example, headed the Public Health Department at one period, while the Medical Department officer who headed the Public Health Department for a time was later put in charge of the entire Civilian Relief Branch. The work of Public Health Department officers in the fall of 1943 was largely a job of planning the desirable organization, maintaining liaison with General Hawley's office, furnishing information to visiting officers from the War Department's Civil Affairs Division, and planning for medical supplies for civilian use. A small Public Health Department (absorbing most of the medical personnel of Civil Affairs Section, ETOUSA) was established in

    71 (1) See footnotes 29(l), p. 327; and 69(2), p. 361. (2) Medical History, U.S. Air Forces in Europe, 1945. [Official record.] (3) Quarterly Report, Medical Department Activities, Eastern Command, U.S. Strategic Air Forces in Europe, Aug.-Dec. 1944.
    72 A civil affairs officer had been assigned to the theater headquarters staff as early as August 1942 (General Order No. 26, Headquarters, European Theater of Operations, U.S. Army, 1942), but no medical subelement had been developed in his office.


the Office of COSSAC (Chief of Staff to the Supreme Allied Commander), the Allied military office for planning which preceded the establishment of the full Allied command. Here, too, the Public Health Department was placed under the Civilian Relief Branch. The group of Medical Department officers which constituted it had the job of coordinating the plans for a civilian medical program being made by the Americans with those being drawn up by the British.

One medical officer, Lt. Col.. Carl R. Darnall, MC, who held a number of posts in the European civil affairs program, both medical and nonmedical, and at various command levels, noted several defects in the organization from an early date. He found the subordination of the public health branch to a "civilian relief branch" at various levels disadvantageous to the planning of health programs for occupied territories; nonmedical officers were insufficiently interested in the public health aspects of civilian relief and were inclined to discourage any communication by members of the public health branch with Medical Department officers responsible for the health of troops, including General Hawley. Colonel Darnall worked closely with Medical Department officers assigned to the normal military medical service for troops, including General Hawley and his staff at London and Cheltenham. He proposed the complete removal of public health matters from the civil affairs organization to the control of the theater surgeon and the other usual special staff medical sections of subordinate headquarters, but his ideas gained no headway during the planning period. His criticisms were echoed by other Medical Department officers in 1944 and 1945 when the public health program got under way.73

By the end of 1943, a few Medical Department officers had been assigned to the civil affairs element of theater headquarters; to that of the Office of COSSAC; and to that of 1st Army Group, as 12th Army Group was initially called. The next step in the development of the organization to handle civilian affairs was the creation of the European Civil Affairs Division, which trained both American and British personnel, including U.S. Army Medical Department officers, for field work in civil affairs.

The European Civil Affairs Division was a subordinate agency of the Civil Affairs Division (or G-5) of Supreme Headquarters, Allied Expeditionary Force. Although it was organized, like the regular tactical division, into regiments, companies, and so forth, its primary function was to train personnel in all aspects of civil affairs and hold them until the field armies should need them. American medical personnel for the division were selected by the Office of The Surgeon General and arrived in England from January 1944 on. They were trained, along with officers assigned to other aspects of the civil affairs program, at the American School Center at Shrivenham. Of the approximately 175 American officers assigned to the division to work on one aspect or

    73 (1) Darnall, C. R. : Report of Medical Civil Affairs Planning and Organization, 31 Oct. 1944. [Official record.] (2) Study No. 32, Civil Affairs and Military Government, Organization and Operations, by General Board [established 17 June 1945], U.S. Forces, European Theater, no date.


another of public health, about 60 were physicians, the remainder being dentists, sanitary engineers, nutritionists, entomologists, biologists, veterinarians, agriculturists, bacteriologists, research workers, public welfare officers, and administrative officers. A few served with the Public Health Branch, SHAEF, either on the permanent staff or as consultants, some on the staffs of army groups and armies. A good many worked eventually with the advancing armies or with the reestablished national governments.74

The civil affairs detachments (called "military government detachments" in Germany) and the country missions were the two main types of field units created out of the European Civil Affairs Division. The detachments served at the division, corps, or army level; as army rear boundaries advanced, the detachments theoretically passed to the control of the Communications Zone (that is, to its area commands) to be returned later to the European Civil Affairs Division for reassignment to forward elements of the armies. Few, however, seem ever to have been reassigned under this plan. They were so scarce that they were either husbanded by the armies for immediate reuse, intercepted by some other organization en route, or left by the armies at larger towns where local authorities were unable to cope with civil problems.75

Country missions, so-called, were organized in England within the framework of the European Civil Affairs Division in the early months of 1944 to serve as liaison agencies between the national governments of the liberated countries and Allied military authorities. Missions served in Norway, Denmark, Holland, Belgium, Germany, and France. In general, the mission for each country was provided with one or two medical officers and a Sanitary Corps officer, specialists in various fields being added according to the needs of the country in which they operated. The mission estimated the kinds and quantities of medical, sanitary, and food supplies which the national governments would have to obtain from Allied military sources. It investigated sanitary conditions, outbreaks of disease, and the status of nutrition in the civil population and aided in establishing measures to control venereal disease and to report communicable diseases. Both the Allied military authority and national governments could get from the country mission information on medical matters affecting the mutual welfare of the population and of Allied troops, and each could use the mission as a medium for representing its interest to the other.76

Shortly before the invasion of Europe, the organization for administering the Army's public health program became stabilized within the G-5 chain of control. The chief development was the establishment of a public health

    74 (1) Report, Public Health Branch, G-5, Supreme Headquarters, Allied Expeditionary Force, Observations and Comments Upon Its Organization, Operations, and Relationships, by Dr. W. F. Draper, no date. (2) See footnote 73(2), p. 363. (3) Williams, Ralph C. : The United States Public Health Service, 1798-1950. Washington: Commissioned Officers Association of the U.S. Public Health Service, 1951, p. 698ff.
    75 See footnote 73 (2), p. 363.
    76 See footnote 74 (1).


branch at Supreme Headquarters, Allied Expeditionary Force, in May. Lt. Col. Leonard A. Scheele of the U.S. Public Health Service, who had served in the public health program in North Africa and Italy, had been assigned to G-5, SHAEF, soon after the command was created, but no fully developed medical group had existed there. The establishment of the fully developed branch took place only pursuant to a visit of Col. Thomas B. Turner, MC, Director of the Civil Affairs Division of the Surgeon General's Office to the European theater early in the year. Colonel Turner noted the same lack of centralized control over the public health program at staff level in SHAEF that he had marked in Allied Force Headquarters during a previous trip to the North African theater. He recommended that a public health element be established within every level of the civil affairs organization in the European theater, with the chief public health officer directly responsible to the chief civil affairs officer.77

The Public Health Branch, G-5, SHAEF, became the top medical office directing the medical program for civilians, existing from May 1944 until the dissolution of the Allied command in July 1945. Brig. Gen. (later Maj. Gen.) Warren F. Draper, Deputy Surgeon General of the U.S. Public Health Service (fig. 83), assumed charge of the branch at the request of the Secretary of War and on recommendation by The Surgeon General (General Kirk). A British officer served as deputy chief. A few other officers and enlisted personnel were engaged in preventive medicine and medical supply activities and administrative work. Consultants in the following medical specialties or special fields were attached to the branch: Nutrition, sanitary engineering, venereal disease, veterinary disease, narcotics control, public health nursing, and general field inspection. Members of the United States of America Typhus Commission who worked on the antityphus program among civilians in western Europe were considered for administrative purposes as staff members of the branch.

Public health policies formulated by this group were conditioned, of course, by military policies and practices and tactical considerations. The Public Health Branch advocated, for instance, that the Allied command adopt, as a measure for control of venereal disease among troops, a policy of placing brothels out of bounds throughout the theater. However, existing military policy placed responsibility for control of venereal disease among troops upon the individual field commander; hence some variation occurred in the policies and procedures adopted by the field commanders after the invasion.78

    77 (1) Memorandum, Director, Civil Public Health Division, Office of The Surgeon General, for The Surgeon General, no date (covers visit to ETOUSA, 24 Feb.-8 Mar. 1944), subject: Report on Plans for Civil Public Health in the European Theater of Operations. (2) Memorandum, Col. Thomas B. Turner, MC, for The Surgeon General, no date, subject: Activities in the North African Theater of Operations. (3) See Medical Department, United States Army. Preventive Medicine in World War II. Vol. VIII. Civil Public Health Activities. [In preparation.]
    78 (1) See footnote 74 (1), p. 364. (2) Letter, Chief, Preventive Medicine Service, Office of The Surgeon General, to Field Director, United States of America Typhus Commission, 26 Apr. 1944. (3) Letter, Supreme Headquarters, Allied Expeditionary Force, to All Branches, G-5, 27 July 1944, subject: Organization and Missions of Public Health Branch, G-5. (4) Memorandum, Supreme Head-quarters, Allied Expeditionary Force, for Commander in Chief, 21st Army Group, and Commanding General, 12th Army Group, 25 Aug. 1944, subject: Revised Directive for Civil Affairs Operations in France.


Additional developments in May 1944 tended to fix the public health program within the G-5 chain of control. At that date, the civil affairs section at the combined Headquarters and Communications Zone, ETOUSA, and one at 12th Army Group headquarters, both previously elements of the special staff, were shifted to the general staff level and termed G-5. A G-5, or civil affairs division, with a small medical section or subsection, was also established at each army group and each army headquarters. Although a G-5 element was established at corps headquarters and a special staff section at division headquarters to handle civil affairs at these levels, as a rule no public health element was created on the staff of the corps or division.79

Control over the public health program was maintained for some months after May 1944 under G-5 direction at both Allied headquarters and the headquarters of arm groups and armies. Within the combined theater and communications zone organization, on the other hand, a tendency toward shifting responsibility for the public health program to the regular medical service appeared almost as soon as the program was well established under G-5 control. The major responsibility of General Hawley's office- to provide medical service for the military forces- increased with the establishment of large base sections

    79 (1) Operations Memorandum No. 19, Third U.S. Army, 21 June 1944. (2) See footnotes 73(2), p. 363; and 78(4), p. 365. (3) Monthly Public Health Reports, 12th Army Group, 1944 and 1945. (4) Annual Report, Division of Preventive Medicine, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1944.


on the Continent. Originally the large number of medically trained personnel in his office had naturally weighed against any idea of a buildup of the public health group in G-5 of the theater headquarters; consequently only one or two officers were assigned to G-5 at that level. A similar situation existed in the base sections. After May 1944, a theater-communications zone headquarters tended to place an increasing share of the responsibility upon General Hawley's office and the offices of base section surgeons.

About the same time that the Civil Affairs Division of the theater-communications zone headquarters was shifted from special staff level to G-5 (23 May 1944), a theater directive made General Hawley's office responsible for certain duties in the civil medical program. It was to requisition, procure, store, and issue medical supplies for civilian use, to supervise activities in public health and sanitation, and to rehabilitate civil hospitals; in July, a Civil Affairs Branch was established in the Operations Division of his office to handle these responsibilities. A directive of September also added to his office the responsibility for furnishing technical advice and aid to personnel directly assigned to the civil affairs program. Although these directives conflicted with similar outlines of the responsibilities f or the public health program issued by Allied headquarters, the tendency to place upon General Hawley's office additional responsibilities for civilians continued. Clearer duties for the Civil Affairs Branch of his office emerged with the advance of the armies into western Europe late in 1944. It was the obvious choice for two medical jobs, left in the wake of the advance, requiring coordination among the base sections, which could best be handled through the normal technical channels of the Communications Zone. One was the assembly of medical supplies captured from the enemy and their allocation and distribution to the various base sections for civilian use. The other was the procurement of medically trained personnel to supervise medical service for thousands of displaced persons en route to their homes by train.80

The 23 May 1944 directive was not interpreted in the same way at all echelons, and for a time there was a general confusion as to the channels of control over the public health program. At many levels, however, the staff surgeons and medical officers assigned to the G-5 sections cooperated closely with each other despite their conflicting theories and interests. At none of the army groups and army headquarters were there more than one or two Medical Department officers assigned to G-5, and many of these were inclined

    80 (1) Memorandum, Headquarters, European Theater of Operations, U.S. Army, for Chiefs of General and Special Staff Sections, European Theater of Operations, U.S. Army, 23 May 1944, subject: Staff Duties and Responsibilities for Civil Affairs. (2) Memorandum, Headquarters, European Theater of Operations, U.S. Army, for Chiefs of General and Special Staff Sections, European Theater of Operations, U.S. Army, 25 Sept. 1944, subject: Staff Duties and Responsibilities for Civil Affairs. (3) Annual Report, Civil Affairs Branch, Operations Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1944. (4) Annex 7 to Period Report, Civil Affairs Branch, Operations Division, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 1 Jan.-30 June 1945. (5) Civil Affairs Administrative Memorandums Nos. 8 and 9, Communications Zone, European Theater of Operations, U.S. Army, 8 Aug. 1944.


to work closely with the staff surgeons of their respective commands for two main reasons. The first was the conviction, fairly widespread among medical officers, that the staff surgeon should control all medical programs, whether for military personnel or for civilians, in which the command engaged. The second, a very practical reason, was the fact that the staff surgeon controlled the so-called "medical means" of the command; that is, the medical supplies, personnel, transport, and other facilities on which those assigned to the public health program with the field armies had to depend whenever their own means became scarce. The Chief Medical Officer, SHAEF (General Kenner), had declared, when Colonel Turner's plan had been proposed early in 1944, that public health officers assigned to G-5 would not be able to function properly in a combat area and had recommended that they not be so assigned at the corps and division level. He had also warned of possible difficulty if the command surgeons were called on to divert to civilian use medical supplies needed for troops and noted that medical units lacked the personnel and the means of transport to handle extra medical supplies earmarked for civilians.81

As it turned out, over the long run the staff surgeons of armies and army groups, as well as the theater surgeon and base section surgeons, had to assume more and more responsibility for handling public health problems encountered during the eastward sweep of the armies into France. By November 1944, the Third U.S. Army had had to set up a half dozen assembly centers, or camps, for displaced persons and staff them with medically trained personnel. More and more cases of diphtheria and other communicable disease were found among civilians, and rapid immunization of the population against them on a large scale had to be undertaken. Immunization of animals against foot-and-mouth disease was necessary, as well as the burial of thousands of dead animals as a protection against water contamination. The crisis came with the advance of the armies from the east and south into Germany.

The thousands of displaced persons freed by the advance into Germany added to the U.S. Army's responsibilities in sanitation and medical care for civilians; in the late spring of 1945 many had to be taken into hospitals intended for troops. The Third U.S. Army reported, for instance, more than 13,000 civilians admitted to its hospitals in May. The increasing numbers of cases of typhus encountered, particularly among displaced persons and the inmates of concentration camps, made necessary the dusting of thousands of civilians with DDT. In April the Fifteenth U.S. Army established a cordon sanitaire along the east bank of the Rhine to prevent the transfer of louse-borne typhus west of the river by displaced persons returning to their homes. Delousing stations were established at each port of entry; it was estimated that by the end of June 1945 well over a million people had been dusted with

    81 (1) See footnotes 73 (1), p. 363; and 77 (3), p. 365. (2) Letter, Brig. Gen. John A. Rogers, USA (Ret.), to Editor in Chief, Medical Department, United States Army in World War II, 5 Sept. 1950. (3) Memorandum. Maj. Gen. Albert W. Kenner, for Assistant Chief of Staff G-5, 2 Mar. 1944, subject: Directive on Public Health.


DDT. Facilities, medical supplies, and medical personnel intended for troops, and hence controlled by the staff surgeons of the armies, had to be used in the civilian public health program. Twelfth Army Group estimated that the forces under its control eventually uncovered more than 4 million displaced persons; responsibility for their care stretched available personnel to the utmost.82

A trip of inspection which General Kenner made in the latter part of March convinced him that the G-5 organization, lacking personnel and facilities, would not be able to meet its commitments. After a conference with General Draper and other G-5 medical representatives, as well as the 12th Army Group surgeon (Colonel Gorby), he prepared a SHAEF directive on 14 April which turned over the total responsibility within the army groups and armies in enemy-occupied territory to the commanding officers of all commands and their staff medical officers. Under the directive (applicable to the British and French forces, as well as the American), officers formerly assigned to public health work in G-5 of the armies and army groups were reassigned to the army or army group surgeons, who established a "public health section" in their offices.83

A few other factors, besides necessity, were instrumental in bringing about this shift of control. A significant one, of long-range importance, was the tendency of many Medical Department officers (doctors from civilian life as well as those of the Regular Army) to believe that the regular medical service was the most efficient agent for handling the Army's responsibilities for civil health. Staff surgeons pointed out that they needed control over the program for civilians in occupied territories because of the close rapport between health conditions among civilian populations and the health of troops. Some Medical Department officers assigned to G-5 did not like the subordination of the civilian medical program to "relief" or "welfare," in the standard setup; others did not like their immediate subordination to a nonmedical officer. The affinity of medically trained men for each other led some of those assigned to G-5 to work more closely with the staff surgeons of their commands than with nonmedical personnel in their own G-5 divisions.84

    82 (1) Monthly Public Health Reports, Third U.S. Army, 1944-1945. (2) Memorandum, Field Director, United States of America Typhus Commission, for Chief, Public Health Branch, G-5, Supreme Headquarters, Allied Expeditionary Force, 27 Mar. 1945, subject: Confirmation of Verbal Report on Visit to Ninth and First Armies to Investigate Typhus Control in Those Areas. (3) Letter, Head- quarters, European Theater of Operations, U.S. Army, to Commanding Generals, U.S. Strategic Air Forces in Europe, each Army Group, Communications Zone, each Army, and others, 12 April 1945, subject: Establishment of a "Cordon Sanitaire." (4) Monthly Public Health Report, G-5, 12th Army Group, June 1945. (5) Report of Operations, 12th Army Group, vol. I.
    83 (1) See footnote 82(l). (2) Monthly Public Health Reports, 6th Army Group, 1944 and 1945. (3) Cable FWD SHAEF, to Commanding Generals, 12th and 6th Army Groups, 21 Army Group, and Communications Zone, 28 Mar. 1945. (4) Memorandum, Chief, Public Health Branch, G-5, Supreme Headquarters, Allied Expeditionary Force, for Chief Medical Officer, Supreme Headquarters, Allied Expeditionary Force, 16 Mar. 1945, subject: Future Organization for Public Health Branch, SHAEF. (5) Letter, Supreme Headquarters, Allied Expeditionary Force, to Headquarters, 21 Army Group, Commanding Generals, 6th and 12th Army Groups, and Commanding General, Communications Zone, European Theater of Operations, U.S. Army, 14 Apr. 1945, subject: Public Health Functions in Occupied Territory. (6) Diary, Maj. Gen. Albert W. Kenner, entries for March-April 1945.
    84 See footnote 73 (1), p. 363.


In retrospect, the chief of the Public Health Branch, G-5, SHAEF, General Draper, pointed to the lack of sufficient trained personnel as the major stumbling block in the way of the medical program for civilians. The work had called particularly for men trained in control of communicable diseases, especially the venereal diseases, in medical supply work, sanitary engineering, nutrition, veterinary work, public health nursing, and control of narcotic drugs. It had been necessary to use specialists in other fields, unversed in public health work, in positions for which public health training was desirable. An acute shortage of British health officers in 21 Army Group had made it necessary to loan 20 American officers for a time to the British for public health work. As soon as the armies had thoroughly penetrated Germany, personnel assigned to public health duties at the G-5 level within the armies had been scarce in relation to the numbers needed to work among the thousands of displaced persons and the internees of the large concentration camps and to maintain a far-reaching typhus control program. Medical Department officers thus had had to assume complete responsibility in many public health operations. In the interest of proper assignment and use of Medical Department personnel, command surgeons responsible for the health of troops had naturally insisted that they should administer the public health program and that the personnel formerly assigned to the G-5 level should be taken over by them. Nevertheless, General Draper maintained, administration of the program through G-5 channels was organizationally sound and logical despite its partial breakdown when unusual problems confronted it.85


During the spring of 1945, when the surrender of Germany appeared certain, plans were made for dissolving the Allied command and reestablishing the usual U.S. Army theater organization. When chiefs of staff sections were announced on 12 May, General Kenner became Chief Surgeon, ETOUSA, relieving General Hawley, who had served in that capacity for almost 3 years. General Hawley soon returned to the United States as Medical Director of the Veterans' Administration. On 19 July, General Kenner became Chief Surgeon, U.S. Forces, European theater, as the postwar theater command in Europe was termed, and on 3 August, Chief Surgeon, Theater Service Forces, ETOUSA. The offices of the chiefs of technical services were located at Theater Service Forces headquarters; General Kenner's medical section was so located. For a time it was split between the main office of theater Service Forces headquarters in Frankfurt and its rear office in Versailles, the center of redeployment and supply activities, but concentration of his staff in the main office in Frankfurt was effected by the autumn of 1945.86

    85 See footnote 74 (1), p. 364.
    86 (1) General Order No. 90, Headquarters, European Theater of Operations, U.S. Army, 12 May 1945. (2) General Order No. 161, Headquarters, U.S. Forces, European Theater, 19 July 1945. (3) General Order No. 159, Headquarters, Theater Service Forces, European Theater, 3 Aug. 1945.


A letter issued by Headquarters, U.S. Forces, European Theater, on 21 August defined General Kenner's responsibilities. His position became exceptional among the chiefs of technical services in that he was to serve as a special staff officer of the theater commander when acting in the capacity of Chief Medical Inspector of all troops and installations in the theater. In supervising the furnishing of the normal medical service and supplies to U.S. Army troops and to civilians attached to the Army, he was responsible to the Commanding General, Theater Service Forces. In general this situation marked a return to the setup which had prevailed before the creation of SHAEF. In order to make sure of his control over medical administration on a theaterwide basis, General Kenner had made special effort to obtain a specific statement of his authority to make medical inspections of all troops and units in the theater. He held the tenet that this authority would assure him theaterwide control in spite of his location at the service force headquarters. With the dissolution of SHAEF, a simpler command structure had come into existence and control over the medical service for the U.S. Army during its occupation of Europe became centralized.87

    87 (1) Report of operations, Headquarters, Theater Service Forces, European Theater, 8 May 30 Sept. 1945. (2) Statement of General Kenner to the author, 26 Mar. 1956.

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