Introduction to Battle
On 6 June 1944 U.S. and British forces went ashore along a 40-mile stretch of the Normandy coast. Following the NEPTUNE plan, 13,000 parachute and glider troops of the 82d and 101st Airborne Divisions, who landed just after midnight in the Cotentin countryside behind UTAH beach, opened the American part of the attack. Widely scattered and badly disorganized in the drop due to navigation errors, high winds, and enemy antiaircraft fire, each division managed to assemble enough men and equipment to accomplish at least part of its D-Day mission. In confused vicious fighting against initially uncoordinated but increasingly stubborn and aggressive German opponents, the airborne troops by the end of D-day had opened the way inland for the seaborne forces across the flooded areas behind UTAH beach, and they were well on the way to securing the lodgement's western and southern flanks.
The amphibious assault task forces, Force U for UTAH and Force O for OMAHA, dropped anchor in their assembly areas 12 miles off the coast at about 0230. H-hour for the first landings was 0630, when low tide would uncover for demolition the German obstacles that studded both UTAH and OMAHA between high and low water lines. As the troops transferred from transports to landing craft, a gusty northwest wind kicked up a choppy sea, tossing about the smaller craft and quickly overcoming antiseasickness efforts. At about 0530 the Germans, hitherto passive, opened artillery fire; fifteen minutes later the final Allied naval bombardment began, as the assault waves headed for the beaches. About on schedule, the first bow ramps went down.
At UTAH Maj. Gen. J. Lawton Collins' VII Corps, the 4th Infantry Division leading, went ashore almost unopposed. Quickly overcoming beach defenders, who were few in numbers and were distracted by the airborne attack behind them, the infantry pushed inland over causeways crossing the inundated areas. Elements of the 1st Engineer Special Brigade, supporting this assault, cleared away mines and obstacles; opened vehicle routes across the beach; readied the causeways for heavy traffic; and set up supply dumps, harassed only by a few snipers and by sporadic German shelling. By the end of the day 23,000 of the 32,000 troops of the initial UTAH assault force were ashore. The
4th Division had established contact with the 101st but, as yet, not with the 82d.
At OMAHA the V Corps, under Maj. Gen. Leonard T. Gerow, had the day's hardest, costliest fight. The corps landed with two regiments abreast, both under operational control of the 1st Infantry Division: the 116th Infantry of the 29th Infantry Division on the right, and the 1st Division's own 16th Infantry on the left. Two engineer units supported the infantry, the 6th Engineer Special Brigade going in with the 116th and the 5th Engineer Special Brigade with the 16th. The first assault waves ran into a strong, well-entrenched German infantry division not previously spotted by Allied reconnaissance, its defense little affected by preliminary air strikes and naval bombardments. Losses among troops and landing craft were heavy, and the attackers were pinned down along the high water mark for much of the day. Gradually, aided by naval gunfire and reinforced by later landing waves, they overcame the defenders and worked their way inland. By nightfall about 34,000 troops of the 55,000 man assault force were ashore. The corps, however, had fallen far short of its D-day objective. Its advance position constituted more a series of islands than a continuous line. German snipers and strongpoints remained unsubdued at many points on the beach, most of which still was under enemy artillery fire.
The ordeal on OMAHA notwithstanding, the Allies on D-day had broken the Nazi coastal defenses. During the next few days troops and supplies flowed in over increasingly secure and well-organized beaches. Inland from OMAHA the 1st and 29th Divisions, reinforced by the 2d Infantry Division, expanded their lodgement to the south, southwest, and west, against weakening resistance. The 4th Division at UTAH made firm contact with the airborne divisions and attacked northward. At the same time the 82d pushed westward in the Cotentin, while the 101st drove south to link up the two beachheads, an objective it achieved on 11 June (D+5).1 The human cost of securing the lodgement was substantial, but much less than expected. On D-day the hard-hit V Corps suffered about 2,400 dead, wounded, and missing; the 4th Division, by contrast, reported only 200 casualties; and the two airborne divisions together lost about 2,400 men. Of these 5,000 casualties, perhaps 3,000 were wounded-a total well under the anticipated 12 percent of the assault force. This number was within the treatment and evacuation capabilities of the medical forces ashore on D-day, even though those forces endured their share of the losses and vicissitudes of battle.2
The burden of treating and evacuating First Army casualties on D-day and during the days immediately thereafter fell largely on the medical elements of the airborne and infantry divisions and the engineer special brigades, and on the teams of the 3d Auxiliary Surgical Group. These forces worked under control of the assault corps surgeons: Col. Charles E. Brenn, MC, of V Corps on OMAHA and Col. Paul Hayes, MC, of VII Corps on UTAH.3 Hayes' area of responsibility included the airborne divisions, as well as the seaborne forces. Until the beachheads joined, these officers performed most of the tasks of an army surgeon, rather than the more limited duties usually done at corps level.
Regimental and battalion surgeons and aidmen of the two airborne divisions were the first Army Medical Department soldiers to set foot in Normandy. In each division they dropped by parachute or rode in on gliders with their organizations-nine officers and sixty enlisted men with each parachute regiment and seven officers and sixty-four men with each regiment of glider infantry. Anticipating heavy drop losses and days of isolation behind enemy lines, unit medics landed with all the extra supplies and equipment they could collect-either carried on their persons, parachuted down in special containers, or packed in glider-borne vehicles. The 101st Division, for example, went into Normandy with 250 litters and 2,500 blankets above its regular allowance, 25 instead of the regulation 7 aerial delivery containers per regiment, and 2,000 units of plasma. The 101st's field artillery battalion brought along 2 complete sets of aid station equipment. Each paratrooper carried 2 British-made individual dressings and a copper sulphate sponge for use on phosphorus burns.4
Much of this equipment-and many of the people carrying it-were lost, as paratroopers and gliders plunged into the hedgerow-lined fields and marshy river bottoms of the Cotentin and as men in the early morning darkness began the tense, deadly hide-and-seek game of finding comrades, assembling units, and getting on with their missions. Airborne medical personnel were as badly scattered in the drops as everyone else. In the 82d Division 50 percent of the medical officers were unaccounted for during the first seventy-two hours of combat; in one of the 101st's battalions, which landed in swamps, only two members of a sixteen-man medical detachment initially rallied with the unit. For some medics the war ended quickly as they ran into Germans and were captured or-rarely, if clearly identified-shot. The 101st during June lost 20 percent of its medical personnel, most of them in the first days. Equipment losses were equally heavy. The 101st recovered only 30 percent of its air-dropped supply containers, and its surgeon later concluded that it was a mistake to drop so much matériel in the early
hours, when the surgeons did not yet need it and darkness made it almost impossible to find.
During the first hours on the ground, medical officers and aidmen collected what supplies they could locate. They made contact with other paratroopers, gave first aid to men injured in the jump or in glider crashes and in the first firefights, and worked their way toward battalion assembly areas. Especially in the 82d Division, elements of which landed farthest inland, small groups of paratroopers were cut off from their units for days. Injured and wounded soldiers with these groups received at best improvised care, even if their chance-met companions included medical officers and aidmen. Some groups, forced to maneuver to avoid Germans or driven from their positions by counterattacks, had to leave their wounded behind to be captured, frequently along with medical personnel who voluntarily stayed with their patients. At isolated positions, wounded men died for lack of plasma. Other cut-off groups were more fortunate. Medical officers with them managed to salvage equipment for adequate first aid and in at least one case secured milk and food for the wounded from French farmers.
Medical officers and men who reached their battalion assembly areas set up rough-and-ready aid stations, usually near their unit command posts. At these stations improvisation was the common practice, as surgeons scavenged for supplies and commandeered farm wagons and captured enemy vehicles to collect wounded from widespread company positions. In the 1st Battalion, 502d Parachute Infantry, a 101st Division unit, the battalion commander, Lt. Col. Patrick J. Cassidy, and his surgeon, Capt. Frank Choy, MC, secured a small cart and a horse to pull it and drafted a dental technician to drive it. "All day long," according to a battalion report, "this boy drove up and down the roads, exposing himself to sniper fire, working like a Trojan, to bring in the wounded and the parachutists who had been hurt on the jump; his energy saved countless lives." During much of the day Colonel Cassidy, who had to send his surgeon to treat an untransportable casualty at an outlying position, acted as his own medical officer. Cassidy, and the medical sergeant who remained with him, decided which badly wounded men should receive their limited supply of plasma, and the battalion commander personally helped retrieve medical supply bundles from the surrounding fields. Because his drop zone was just inland from UTAH, Cassidy was able to evacuate many of his casualties to the beach late in the afternoon, after making contact with the 4th Divisions.5
Although a few units, such as Cassidy's, sent casualties directly to the beach, most airborne wounded went from battalion aid stations, and often from where they fell, to the clearing stations set up by their division medical companies. These companies, each of which included an attached team from the 3d Auxiliary Surgical Group, deployed in Normandy on D-day
in several echelons. An advance element of each company, with the division surgeon and the auxiliary surgical team, went in by glider around dawn with enough hand-carried and air-dropped instruments and equipment for a small emergency surgical station. The rest of the personnel, with the company vehicles and the balance of the clearing station outfit, arrived during the late afternoon by glider and, in the case of the 101st Division, partly by sea.
An advance element of the 101st's 326th Airborne Medical Company parachuted in with the infantry at 0100. As many of the four officers and forty-five men of this detachment as could reach their rendezvous improvised a small hospital in a French farmhouse near Hiesville, the division command post site about 5 miles from UTAH beach. The group performed first aid and emergency surgery here until well into D+ 1 (7 June), when it joined the rest of the company. About two hours behind this advance group two gliders arrived carrying the 326th Company commander, Maj. William E. Barfield, MC, and seven officers and twentyone men, including the auxiliary surgical team, with four jeeps and trailers. Although both gliders crash-landed, painfully injuring every member of the surgical team, the men retrieved most of their gear and maneuvered around German positions toward the Chateau Colombierre, just north of Hiesville, selected on the basis of preinvasion aerial reconnaissance as the site for the division clearing station. They arrived at about 0700, just as paratroopers were driving German defenders out of the buildings.
By early afternoon the members of the original party, reinforced by other medical officers and men who straggled in, had a rudimentary surgical hospital and clearing station in operation. Surgeons worked at three tables, as the chateau courtyard filled with casualties brought in on improvised litters, horses, and captured trucks. Living on D-bars and Benzedrine, the surgeons treated about 300 patients during the day. In the evening another glider lift of the company and the seaborne element, which had landed on UTAH, reached the chateau. But even with this reinforcement, which included Lt. Col. David Gold, MC, the 101st Division surgeon, the number of wounded arriving all but overwhelmed the staff. The surgical team leader, Maj. Albert J. Crandall, MC, recalled: "We had to maintain a careful priority system, operating on those who were most in need of surgery and giving the others emergency treatment." In surgery, "first we did the heads and chest and next the abdomens and extremities."6
An advance group of the 82d Division's 307th Airborne Medical Company, with the division surgeon, Col. Wolcott L. Etienne, MC, and a surgical team, also went in by glider before dawn. Shrapnel from German antiaircraft fire wounded Colonel Etienne before he even touched ground; the same fire caused the gliders to overshoot their planned landing zone at Blosville near Ste.-Mere-Eglise, a
major division objective, and crash land at Hiesville. Medics were scattered in the landing and lost much equipment. Some of them, including the surgical team leader, Maj. James J. Whitsitt, MC, found their way to Chateau Colombierre, where they assisted 326th Company doctors for the rest of the day. The bulk of the 307th Company arrived in gliders near Ste.Mere-Eglise in the late afternoon and also ran into hard luck. Many gliders plunged into flooded areas, and the landing zone came under shelling that killed the company commander. In spite of these setbacks, the company pulled itself together and had its clearing station in operation at Blosville by morning of the seventh.7
During the first few days after D-day the airborne division medical service lost its improvised, irregular character and gradually came to resemble that of a conventional infantry division. Both the 82d and the 101st Divisions remained fully committed to hard offensive combat, and the flow of wounded through their aid stations and clearing companies was steady and substantial. On 8 June alone the 326th Company treated and evacuated over 400 casualties. On the ninth the 326th was bombed out of its chateau, fortunately just after evacuating most of its patients. The company, however, lost 5 officers and 9 enlisted men wounded and 8 enlisted men killed, as well as much of its equipment. Obtaining new equipment and personnel replacements from VII Corps, the company resumed work the next day at a new site near Hiesville. On D-day the 326th Company evacuated a few wounded to the 261st Medical Battalion of the 1st Engineer Special Brigade at UTAH beach and then kept up a steady seaward flow of patients, mostly carried in Quartermaster Corps trucks (Map 7). Ambulances of the VII Corps medical battalion began evacuating the company on the ninth. The 82d Division's clearing station had accumulated 300 patients before starting evacuation to the beach on the seventh, using borrowed trucks and ambulances, many of them from the 4th Division's 4th Medical Battalion. The clearing company of the latter unit received, treated, and evacuated many airborne soldiers during its first days on shore; at times half the wounded passing through the infantry division clearing station were parachute and glider troops.8
On UTAH beach, the landing of medical units and the establishment of the initial chain of evacuation went about as smoothly as an operation could go under combat conditions. Company aidmen and battalion medical sections of the 4th Division landed first, followed closely by the nine officers and seventy-two hospital corpsmen of the 2d Naval Beach Battalion. Collecting companies of the 4th Medical Battalion came in with the regiments they supported, bringing most
of their thirty ambulances. In spite of day-long sporadic artillery fire, which killed a medical officer and several enlisted men on the beach, wounded the regimental surgeon of the 12th Infantry, and peppered the 4th Medical Battalion's ambulances with shrapnel, the division medical elements rapidly moved inland. The Navy corpsmen organized two beach aid stations, collected the few casualties of the assault, and loaded on DUKWs and landing craft for movement to LSTs offshore. At about 1000 the first engineer special brigade unit, Company C, 261st Medical Battalion, arrived on the beach, followed two hours later by Company A. These two "collecto-clearing" companies, formed by combining the litter and ambulance elements of a collecting company with a platoon from the battalion's clearing company, set up stations at a crossroads just behind the flooded area. Their attached surgical teams began performing operations at around 1800, carrying out their mission of providing emergency surgery
for nontransportable patients. These clearing stations evacuated few wounded to the beach during the first hours, as casualties from the airborne divisions and the 4th Medical Battalion did not start flowing back in significant numbers until the following day. Between 2100 and 2130 the VII Corps surgeon, Colonel Hayes, and the 4th Division surgeon, Lt. Col. Robert H. Barr, MC, landed with members of their staff sections.
During the next three days VII Corps medical support expanded, as did the corps and its beachhead. The 4th Division's clearing company, scheduled to land late on D-day but held back in favor of additional combat units, came ashore on 7 June and went into operation at Hebert, a crossroads village just beyond the inundated area. Later the company followed the 4th northward. By the ninth two more infantry divisions the 9th and 90th had disembarked, each with its full medical complement. Clearing stations of these divisions opened in the general vicinity of Ste.-Mere-Eglise. The rest of the 261st Medical Battalion, meanwhile, landed on the seventh. The battalion established a medical supply depot. Its surgical teams worked around the clock to handle an increasing flow of casualties, as the divisions attacking northward and westward from UTAH met strong German opposition. Between 8 and 12 June the VII Corps' 50th Medical Battalion disembarked. The battalion's clearing company, besides supporting corps troops, its normal role, took part of the burden of general medical and surgical care from the 261st's companies, and its collecting and ambulance companies evacuated division clearing stations to the 261st and helped move patients from that unit to the Navy beach stations. On the ninth the Lady Connaught, first of what was to be a regular series of hospital carriers, anchored Off UTAH. She discharged supplies and six additional surgical teams for the 261st Medical Battalion, allowing relief to the battalion's original teams that had worked for 36 hours with little rest. The carrier took on board 400 wounded for the return voyage to England. As the first army field and evacuation hospitals opened on 10 and 11 June, the VII Corps medical service was well into the transition from an amphibious to a conventional land organization and system of support.9
On OMAHA the story was different. This beach, about 5 miles from end to end, consisted of a tidal flat bordered at the high water mark by an embankment of loose stones, called shingle, backed on the eastern portion by sand dunes and on the western by a wooden seawall 4-5 feet high. At varying distances from the shingle, usually 200-300 yards, rose low bluffs, too steep to be negotiated by vehicles except through five draws that the Germans had mined and blocked with obstacles. The defenders, entrenched on and in front of the bluffs in pillboxes and machine-gun nests, met the first assault waves with
FIRST AID TO INVASION
UTAH (top) AND OMAHA (bottom)
heavy fire. As the landing craft nosed into shore, German machine-gun nests cut down many Americans before they even left the bow ramps and others as they struggled across the tidal flat. Artillery shells sank, set on fire, or blew up one landing craft after another. Wading and crawling across the sand, pushed by the now rising tide, dragging their wounded, and losing or abandoning weapons, radios, and equipment, the assault troops sought cover from the searching fire behind the seawall and shingle pile. The American units took their heaviest losses of the day in this movement up to the high water line; one 16th Infantry company suffered most of its 105 D-day casualties here. Exhausted from seasickness and the struggle ashore, the survivors tried to clear sand-clogged weapons, to rescue and tend wounded, to demolish beach obstacles, and to cut the barbed wire the Germans had laid along the shingle pile.
Troops and vehicles of the first and subsequent landing waves remained bunched along the high water line for much of the day. Around 0800 small intrepid groups began pushing across the beach to the foot of the bluffs and then working their way up the hills. One by one, they eliminated German strongpoints, aided after about 1030 by point-blank naval gunfire. Landing of reinforcements, temporarily halted when high tide covered the beach obstacles, resumed when landing craft commanders discovered that they could ram through safely. During the afternoon the trickle of men across the beach and over the bluff became a flood. The arrival of two additional infantry regiments gave still more momentum to the inland drive. As darkness fell, the infantry had partially secured the objective towns of Vierville on the western end of the beach, St. Laurent in the center, and Colleville on the east. The engineers, using what equipment they could salvage, cleared mines, bulldozed openings for vehicles through the shingle opposite several of the beach exit draws, and began developing roads through the draws themselves.10
The near-catastrophe of D-day morning and the resulting delay of the advance inland telescoped the elaborately sequenced arrival of medical units. Organizations landed off schedule and on the wrong beach sectors, often losing much of their equipment. Regardless of type or intended function, each unit and detachment, as it plunged into the welter between the low tide line and the bluffs, dissolved into scattered groups of men, working desperately under fire to drag wounded to places of relative safety, to give first aid, and to salvage supplies.
The battalion and regimental medical sections and attached divisional collecting companies of the 16th and 116th Regimental Combat Teams, closely followed by the officers and hospital corpsmen of the 6th and 7th Naval Beach Battalions, came ashore early in the morning, just after the first assault companies had been shot to pieces. The medical soldiers took their share of casualties. The 2d Battalion, 116th Infantry, lost five aidmen, killed leaving their landing craft, and its surgeon, wounded on
the beach by shrapnel. Other medics quickly fell as they tried to drag casualties out of the rising water. As German artillery blasted the landing craft, medical supplies went up in flames or disappeared under the waves; the 116th Infantry lost its entire regimental supply of plasma in two LCIs (landing craft, infantry) sunk off the beach.11
Maj. Charles E. Tegtmeyer, MC, regimental surgeon of the 16th Infantry, who landed at about 0815, described what faced those medical troops who survived the wade and crawl through the obstacles to the shingle pile:
The shelf on which I rested was about ten yards in width sloping upward from the water's edge to a eight of from two to ten feet at an angle of roughly 35 degrees. Face downward, as far as eyes could see in either direction were the huddled bodies of men living, wounded and dead, as tightly packed together as a layer of cigars in a box. Some were frantically but ineffectually attempting to dig into the shale shelf, a few were raising themselves above the parapet-like edge and firing toward the concrete protected enemy and those on the cliff above but the majority merely huddled together face downward. Artillery . . . and mortar shells exploded on the beach and in the water . . . and threw fragments in all directions. Uncomfortably close, overhead, machine gun and rifle bullets grazed the top of the ledge . . . and plunged into the water behind us with innumerable sharp hisses or whined away in to the distance as they richocheted off the stones of the beach. At the water's edge floating face downward with arched backs were innumerable human forms eddying to and fro with each incoming wave, the water above them a muddy pink in color. Floating equipment of all types like flotsam and jetsam rolled in the surf mingled with the bodies. . . . Everywhere, the frantic cry, `Medics, hey, Medics,' could be heard above the horrible din. 12
Among the company aidmen on OMAHA, heroism was the only standard procedure. Under the punishing fire, often themselves wounded, these soldiers worked up and down the shingle pile, bandaging, splinting, giving morphine and plasma if they had any. Many ventured repeatedly back into the water to pull in the disabled and drowning or to retrieve medical supplies. Others went into minefields to carry out injured men. A 29th Division staff officer with 116th Infantry recalled: "First-aid men of all units were the most active members of the group that huddled against the seawall. With the limited . . . facilities available to them, they did not hesitate to treat the most severe casualties. Gaping head and belly wounds were bandaged with the same rapid efficiency that was dealt to the more minor wounds." As the infantry filtered in to the base of the bluff, the medics took additional risks to drag wounded to the shelter of the hill. Paradoxically, most evacuation on OMAHA In these first hours was forward, toward the enemy.13
The work of Major Tegtmeyer and his 16th Infantry medical section typified the character of regimental medical support on OMAHA.14 Landing with the regimental commander, Col. George A. Taylor, and his staff on Easy Red sector, the left center of the beach, Tegtmeyer and his aidmen followed the command group back and forth along the shingle pile as Taylor tried to organize an advance toward the bluffs. The medical soldiers, now wading, now stumbling over prone men, bandaged and splinted wounded as they came upon them, then left them in the shelter of the embankment with instructions to call for help and evacuation to incoming landing craft. "I examined scores as I went," Tegtmeyer declared, "telling the men who to dress and who not to bother with."
At around 1040 the medical section followed the rifle companies off the beach and set up an aid station near the regimental command post, dug into the seaward slope of the bluff, which sheltered them from direct enemy fire. The group used what supplies they had carried ashore, plus two litters and some other matériel they picked up on the beach. Troops from the first waves were still thick on the shore below Tegtmeyer's position, and landing craft kept bringing in more under shelling that steadily added to the number of dead and wounded littering the sand. Tegtmeyer sent aidmen down to the beach and along the bluff to collect casualties and by nightfall had over eighty wounded at his station. Running low on blankets and plasma, he secured more from a passing battalion of the newly landed 26th Infantry, the commander of which he knew. Even with these supplies, men came in that emergency care could not save, such as the infantryman with one leg traumatically amputated and multiple compound fractures of the other. "He was conscious and cheerful," Tegtmeyer reports, "but his only hope was rapid evacuation, and at this time evacuation did not exist. An hour later he was dead."
Around 2200 an auxiliary surgical team, which had become separated from its engineer special brigade, reached Tegtmeyer's position, but the surgeons lacked equipment and did little but dig foxholes for shelter against the continuing artillery bombardment. More useful were the twelve litterbearers of Company A, 1st Medical Battalion, the 16th Infantry's attached collecting company, who appeared with their commander, Captain Ralston, shortly after the surgical team. This company was scheduled to land with the regiment in the morning, but enemy guns had set their landing craft on fire during two unsuccessful attempts to beach. Ralston and his men had worked heroically, rescuing soldiers and sailors from burning holds and compartments and treating the injured who encumbered the decks. After the craft limped seaward to a transport and unloaded its casualties, Ralston rallied his tired, shocked company; got them onto another craft; and disembarked them on OMAHA at about 1700. Then
he and part of his command found their way to Tegtmeyer.
With the help of Ralston's litterbearers Tegtmeyer began moving his patients down to the beach, the ambulatory cases walking and the rest laboriously carried on litters. All but about ten of the most severely injured arrived at the beach station the Navy now had in operation before renewed shelling halted the evacuation. Because no more landing craft were coming in, the wounded on the beach stayed there all night, tended by Navy corpsmen. Tegtmeyer's group and the remaining patients spent a cold, damp night in foxholes, during which time four more of the injured died.
During the early afternoon the engineer special brigade medical battalions began landing. Both special brigades-the 6th, responsible for organizing the western half Of OMAHA behind the 116th Infantry; and the 5th, in charge of the eastern half behind the 16th Infantry-were formed into battalion beach groups for the assault, with a group attached to each regimental combat team. Each beach group included one or more companies from the brigade medical battalion. The 6th Brigade's 60th Medical Battalion was organized conventionally in one clearing and three collecting companies; its 500th Collecting Company and a platoon of the 634th Clearing Company came ashore with the battalion beach group supporting the 116th Infantry. The 5th Brigade's 61st Medical Battalion, like its UTAH beach counterpart, had formed three provisional collect-to-clearing companies. Of these, the 391st Collect-to-Clearing Company landed first, behind the 16th Infantry. Each clearing and collect-to-clearing company had attached teams of the 3d Auxiliary Surgical Group. Besides the clearing station and operating room equipment packed into their trucks, each company went in heavily laden with hand-carried supplies. Men of the 61st's 393d Collect-to-clearing Company, for example, landed with mortar shell casing containers and waterproofed dufflebags filled with dressings, bandages, tourniquets, sulfa powder, and plasma. Every litterbearer took along an extra litter with a life belt attached, to float the litter ashore if he lost hold of it.15
During D-Day these medical battalions were only partially able to perform their evacuation tasks, and they could not undertake emergency surgery at all. For the most part, their officers and men simply joined in the general effort at casualty collection, first aid, and supply salvage. Such was the fate of the small advance party of the 60th Medical Battalion, which landed at 0855 on Easy Green sector below St.-Laurent, to reconnoiter a previously selected clearing station site. German troops still controlled the site, and the officer and enlisted men of the advance party worked all day with regimental and Navy medics along the beach. Between 1400 and 1500 the bulk of the 500th Collecting Company and part of the 634th Clearing Company came ashore on
Easy Green. The units lost men and equipment on the way in. Casualties included Lt. Col. Bernard E. Bullock, MC, the battalion commander, who landed with the 500th Company, only to be mortally wounded within minutes. Men of these two companies spread out along most of the western half of OMAHA, setting up casualty collecting points and helping Navy beach detachments load evacuation craft. Late in the day the 634th Company platoon, which had managed to land a truckload of ward and operating room equipment, moved off the beach through exit D-3 and set up an aid station part way up the draw toward St.-Laurent.16
Due to a breakdown of the landing sequence, the first men of the 61st Medical Battalion to wade ashore on Easy Red sector at about 1345 were members of the headquarters detachment. They landed with typewriters, files, and office supplies on a beach still strewn with dead and wounded. Putting this matériel aside (they later managed to save the battalion records), the headquarters men scavenged for medical equipment and went to work on the casualties around them. Around 1400 the 391st Collect-to-clearing Company, which should have landed before the headquarters element, came in on Easy Red and set up a dressing station in a captured pillbox; this unit also had to rely on hand-carried and scavenged equipment, as its heavy gear remained on board ship. A couple of hours later the 393d Collect-to-clearing Company disembarked with the 18th Infantry, far to the right of the 391st and almost in the 6th Brigade sector. This company set up a collecting station in an antitank ditch under the bluff northeast of St.-Laurent. These companies, and the 61st Battalion headquarters, suffered five enlisted men killed and five officers and twenty men wounded on D-Day.17
Forward emergency surgery never got started on OMAHA during the first twenty-four hours. Of twelve teams attached to the 60th and 61st Medical Battalions, eight succeeded in reaching shore between 1130 and 1730, after various harrowing adventures on board misdirected, damaged, and sunk landing craft. Invariably, they arrived on the beach without operating equipment. Even if they reached their assigned collect-to-clearing and clearing companies, they could do little but pitch in with everyone else in basic first aid, evacuation, and salvage. The Provisional Engineer Special Brigade Group commander commented that, although the auxiliary surgeons "did heroic work on D-day and D+ 1, their skill probably was not put to its greatest use."18
Throughout the day the naval beach medical sections, aided during the afternoon by the engineer special brigade companies, tried to keep wounded moving off the beach onto landing craft. Enemy fire, the inability of craft to approach some sectors of the beach, and the reluctance of some
MEN AND EQUIPMENT
IN SUPPORT OF THE NORMANDY
Troops, with medical
evacuation vehicles, enter Carentan, and ambulances disembark across a beach.
crews to stay exposed near shore long enough to load, limited seaward evacuation and in many places prevented it entirely. By the end of the day medics had cleared about 830 casualties off the beach. Hundreds more remained, huddled under blankets at collecting points or still lying where they fell. Long after sunset, carrying parties and a few ambulances continued to seek and pick up wounded.19
During D+1 (7 June) the organizations that had landed on D-day gradually assembled or finished bringing ashore their men and equipment and began performing more or less their intended functions (Map 8). Regimental and battalion aid stations and collecting companies of the 1st and 29th Divisions evacuated their accumulated casualties to the beach and headed inland with their units. Early in the morning the 1st Medical Battalion's clearing company, which had landed late on D-day, opened its station on the bluffs northeast of St.-Laurent. Reinforced with two auxiliary surgical teams sent up by the 61st Medical Battalion, this station was one of the first facilities on OMAHA able to operate on nontransportable cases. The 29th Division, on the other hand, had to rely for clearing for several days on the 60th Medical Battalion, as the clearing company of the division's 104th Medical Battalion was slow to disembark its equipment and could not begin work until 12 June. Most of the 60th Medical Battalion came ashore on the seventh. Its collecting companies helped Navy elements remove dead and evacuate casualties from the western half of OMAHA. In the afternoon the 634th Clearing Company opened a station just northwest of St.-Laurent, where its attached surgical teams began operating at about 2000 under generator-powered lights. The 61st Battalion's two companies on the eastern half of OMAHA, still unable to bring most of their equipment ashore, continued to function as aid and collecting stations.
Colonel Brenn, the V Corps surgeon, had landed on D-day with part of his section, losing most of his personal equipment and office records in the process. On the seventh he toured his units on foot, finding most of them short of men and matériel but doing their best with what they had. Evacuation to the beach and seaward, Brenn reported, was proceeding "in dribbles," but with "no stagnation." Part of the 1st Medical Depot Company arrived with supplies, which it and the special brigade units began organizing into rudimentary dumps. At 1900 the hospital carrier Naushon, anchored off the beach, unloaded a stock of whole blood for the clearing stations and took wounded on board. The vessel remained overnight, its surgeons operating on emergency cases, and sailed for England on the eighth.20
During the period 8-11 June, as the advance gathered momentum, the V Corps medical service fully assumed its planned shape, and its operations displayed increasing regularity. Division clearing stations moved inland. The ambulance platoons of the engineer special brigades and of the V Corps, 53d Medical Battalion, which disembarked between the seventh and the ninth, transported wounded over the increasing distance separating the divisions and beach clearing stations. On the eleventh, as the evacuation network expanded, Colonel Brenn and the medical section moved with the corps command post from St.Laurent to La Poterie, about 5 miles deeper in the Norman countryside. Back at the beach the 60th and 61st Medical Battalions, no longer under enemy harassment except for ineffectual night air raids, brought their remaining men and equipment ashore and developed into full-fledged clearing
and emergency surgical facilities. The 60th Battalion clearing station stayed near St.-Laurent, and the three 61st Battalion companies one by one moved up from the beach onto the bluffs east of that town. These movements, and a consolidation of naval shore medical activities, established a single line of seaward evacuation across roughly the center of OMAHA beach. By 11 June over 3,160 patients had passed through this chain of evacuation.21
The NEPTUNE medical planners concentrated on two objectives in their arrangements for supporting the initial assault: the provision of emergency surgery on the far shore during the first hours of combat, and the early and complete seaward evacuation of the wounded. Measured by these objectives, medical results on D-day were mixed. The First Army's decision to place as much consumable medical matériel-splints, litters, blankets, plasma, morphine, and other such items-as possible on shore with the first troops in a wide variety of packaging and means of transportation proved to be a lifesaver, in the most literal sense of the term. Even medics who reached dry land with little more than the clothes they stood up in seem to have been able to pick up on the beach or, in the airborne, scattered in the fields, enough supplies to do their jobs. Further, the ability of Medical Department officers and men to take individual initiative and improvise in carrying out their missions amid great danger and confusion testified to the effectiveness of the months of preattack training and indoctrination, both military and medical.
On the other hand, especially on heavily contested OMAHA, evacuation and forward surgery arrangements came near collapse. The tactical situation restricted early loading of wounded on landing craft and prevented the auxiliary surgical teams from doing any more than could have been done by battalion medical officers and company aidmen. The commanders of the engineer special brigade group and the 61st Medical Battalion later criticized the rigidly scheduled landing of surgical teams and clearing companies, arguing that it had resulted in the unproductive exposure to danger of valuable specialists and equipment. Instead, they suggested, the clearing companies and attached teams should have been held on vessels offshore, to be called in when beach conditions permitted orderly disembarkation and the immediate performance of their intended functions. In the meantime a few companies and teams could have staffed shipboard surgical facilities for care of wounded brought out to them in landing craft.22
Whatever the merits of these suggestions, experience on OMAHA-where casualties, though heavy, still were fewer than planners had anticipated,
and where, after the coastal assault, the rapid collapse of German resistance allowed early organization of the beach-did much to substantiate the fears of General Kenner and other officers that untreated, unevacuated wounded would pile up on the far shore. In summary, the medical service on D-day benefited from careful planning and meticulous preparation, but the success achieved also owed much to individual courage and competence, and to good fortune.
First Army Medical Buildup
Between the linkup of the beachheads on 10-11 June and the end of July, reinforcements enlarged the First Army to over 437,000 officers and men in eighteen divisions and four corps. So augmented, the army fought a hard, costly battle to take Cherbourg, to expand its continental lodgement, and to break out toward Brittany and the interior of France. In this same period the army medical service brought all of its elements into Normandy, completed its organization, and treated and evacuated a constant flow of casualties (see Map 9).
Tactically, the First Army shifted its strength and most of its offensive effort to its right wing while holding its ground on the left. Inland from OMAHA, the V Corps, reinforced after 13 June by the XIX, pushed forward about 20 miles and then stood fast. Meanwhile, in the Cotentin, the heavily reinforced VII Corps drove on Cherbourg, the Americans' most important early objective of the campaign. That major port fell on the twenty-sixth, after a stubborn German defense. With the harbor obstructed and the wharves damaged, full use of the port by the Allies was delayed for many weeks.
After the capture of Cherbourg, the First Army redeployed its Cotentin forces southward. On 3 July most of the army attacked into the swamp and hedgerow country at the base of the peninsula, with the objective of gaining roads and open ground for an armored breakout. This offensive led to bitter, apparently inconclusive fighting. The Germans, prevented by Allied air power and French partisans from massing for a major early counterattack on the beaches, nevertheless stiffened their line with a steady stream of infantry and armor. Taking advantage of very favorable defensive terrain and of rainy and cloudy weather, which limited Allied air support, the Germans fought to confine their more mobile foes within a narrow perimeter. When the so-called Battle of the Hedgerows ended on the nineteenth, with the American capture of the key road center of St. Lô, it seemed as though the Nazis had succeeded. They had restricted the First Army to a maximum advance of 7 miles, at the cost of about 40,000 casualties. In this offensive, and indeed in the entire campaign thus far, the Americans, and the British (who were stalled around Caen), fell far short of their planned objectives. Their continental lodgement at the end of July included only a fraction of the territory that NEPTUNE planners had expected to hold by that time. The Germans, however, also lost heavily in the Cotentin and the hedgerows; their defensive crust had worn very thin and was ready to crack, if the Allies
could pierce it with a hard enough blow.23
As the Normandy battle expanded, medical reinforcements flowed in across OMAHA and UTAH beaches. The first medical units not attached to corps, divisions, or engineer special brigades to arrive, First Army Medical Detachments A and B, disembarked respectively at OMAHA and UTAH on 8 and 9 June, having crossed the Channel
on hospital carriers. Each detachment included station and litter platoons of two separate collecting companies, six teams of the 4th Auxiliary Surgical Group, a platoon of a supply depot company, headquarters personnel of a medical group, and liaison officers from various medical and nonmedical commands. The collecting elements and surgical teams, and many of the other medical officers, temporarily replaced assault casualties in the divisions or reinforced the special brigade clearing stations. The group staff and liaison officers made plans for landing and setting up hospitals and other facilities and arranged for engineers to clear selected sites and prepare them for occupation. On the ninth the army surgeon, Colonel Rogers, and an advance party of his staff landed on OMAHA and established themselves at the First Army forward command post near Grandcamp-les-Bains. Rogers at once began a round of inspections and conferences with his corps surgeons, but temporarily left those officers in charge of all medical activities.24
The first field hospitals came ashore on 7 and 8 June, the 13th and 51st at OMAHA and the 42d and 45th at UTAH, bringing with them the first Army nurses to enter the beachhead. After collecting their equipment, scattered in landing on the congested and as yet only partially organized beaches, these units went into operation near the coast on the tenth and eleventh. The engineer special brigade clearing stations subsequently transferred their auxiliary surgical teams to them. So reinforced, the field hospitals took over performance of most emergency surgery. During their first days on shore they functioned as evacuation hospitals, receiving and treating all types of patients.
Even as the field hospitals were opening, the first evacuation hospital in Normandy, the 128th, disembarked at UTAH beach on 10 June and set up the next day near Boutteville, about 6 miles from the coast. Other evacuation hospitals followed at both beaches until, at the end of June, the First Army had fourteen 400-bed units in operation. The evacuation hospitals behind V and XIX Corps were concentrated around Le Cambe, just east of Carentan, and at Le Molay, well forward toward the advance V Corps positions around Caumont. Those supporting VII and VIII Corps moved more frequently during the first weeks of fighting, advancing northward up the highways toward Cherbourg and westward across the Cotentin. As the evacuation hospitals arrived, the field hospitals assumed their intended role, attaching separate platoons to division clearing stations to care for nontransportable wounded.25
NURSES OF THE 13TH
FIELD HOSPITAL, first to land in Normandy
to tend the wounded, take time out for a meal
Still more hospitals entered Normandy during late June and the July weeks of hedgerow fighting. The First Army convalescent hospital, the 4th, disembarked in two detachments, beginning on 24 June, and opened at Le Cambe. As the army expanded beyond its planned strength of three corps, the theater reinforced it with one field and eleven evacuation hospitals, temporarily transferred from the Third Army and intended to revert to that army when it finally went into operation. All of these units deployed between 26 June and 1 August.26
As hospitals came ashore on and after D-day, so did elements of the First Army's three medical groups the 31st, 68th, and 134th. Rogers organized the 31st and 68th primarily for evacuation, assigning to them three medical battalion headquarters each and all of his separate collecting and ambulance companies, and the 134th primarily for a variety of tasks, assigning to it two battalion headquarters and all of his clearing companies. Between 10 and 23 June the 31st and 68th Medical Groups and their attached units disembarked respectively at UTAH and OMAHA. Each group deployed to control and conduct evacuation for a wing of the army, the 68th supporting the V and XIX Corps and the 31st the VII and
VIII. During the same period the 134th Medical Group landed on UTAH. Its 622d Clearing Company, specially trained for this mission, on the seventeenth opened holding and treatment units for neuropsychiatric casualties at Bernescq in the OMAHA sector and at Ste.-Mere-Eglise in the Cotentin. Other clearing companies reinforced field and evacuation hospitals and division clearing stations, and one set up an air evacuation holding unit at Ste.-Mere-Eglise.27
The army medical supply system also developed, following the general pattern of temporary beach dumps during the first week on shore and then establishment of more permanent, thoroughly organized depots inland. On D-day and in the days immediately thereafter, elements of the 1st Medical Depot Company, reinforced with portions of the 31st and 32d Medical Depot Companies, temporarily attached respectively from the Advance Section and the Third Army, landed at OMAHA and UTAH. They issued supplies from improvised beach dumps near the engineer special brigade clearing stations and then set up depots in open fields a short distance inland, at St.-Laurent, Colleville, and later Le Molay behind OMAHA and at Le Grand Chemin behind UTAH. Initially, the companies stocked their dumps with salvage from the invasion flotsam on the beaches. The first scheduled medical maintenance units arrived on OMAHA on 7 and 8 June, but were lost when the tide came in and engulfed them before they could be dragged to the beach. On UTAH, as the result of early difficulties in discharging cargo, no significant amount of medical supplies came ashore until the twelfth. Supply deliveries soon increased in volume and regularity, however, as the engineers by the end of the second week in France brought cargo flow over both beaches up to over 95 percent of its planned tonnage rate. Even the storm of 19-22 June, which wrecked or beached numerous landing craft and destroyed the artificial harbor at OMAHA, only temporarily disrupted the accelerating influx. To receive, store, and issue the medical supplies arriving in such volume, the ADSEC 31st Depot Company on the thirtieth opened a new rear facility at Longueville to replace those at St.-Laurent and Colleville, while a section of the 1st Depot Company on 17 July set up an advance dump at Lison junction, convenient to the units battling for St. Lô.28
Well before all these units were in place, Colonel Rogers established centralized control of First Army hospitalization, evacuation, and medical supply. Between 12 and 19 June, after the headquarters and sufficient companies of his medical groups had landed for immediate operations, Rogers relieved the V and VII Corps surgeons of responsibility for all medical
support to the rear of the divisions. Evacuation, field, and convalescent hospitals and supply depots now reported directly to the army surgeon. His office, through the 31st and 68th Medical Groups, directed the flow of patients from division clearing stations to the beaches. On the twenty-first, deviating slightly from the NEPTUNE plan, Rogers put into effect a ten-day evacuation policy, allowing retention in France of many sick and lightly wounded men hitherto sent back across the Channel.29
During the first two months of the campaign, the buildup of the First Army medical service went essentially according to the NEPTUNE plan. By the end of the period over 35,000 army medical people were on shore. For them, and for the organization to which they belonged, these early summer weeks of activity-the first combat experience for the majority of personnel and units-provided a test of doctrine and training, taught practical lessons, brought forth field improvisations, and revealed certain anticipated and unanticipated problems.
Cherbourg and the Hedgerows
During the fighting for Cherbourg and St. Lô, First Army medical units admitted 95,172 Army personnel; they returned 22,639 of these patients to duty, evacuated 60,317 to the United Kingdom, and lost 2,027 to death. Sick men, including neuropsychiatric patients, accounted for almost 27 percent of these admissions, soldiers with nonbattle injuries for 8 percent, and combat wounded for the rest. Of the 60,279 battle casualties, the majority received their injuries from shell and bomb fragments, most often in the arms and legs-a pattern of causative agents and anatomical locations similar to that in other theaters-and over one-third suffered multiple wounds (Chart 8).30
Throughout the drive to Cherbourg and the struggle among the hedgerows, about 90 percent of all battle casualties occurred in the infantry rifle companies. For the company aidmen and battalion and regimental surgeons who first cared for these injured, as for the riflemen they accompanied, the Normandy hedgerows became the dominant fact of life, and too often of death. These earthen banks, overgrown with trees and brush, crisscrossed most of the countryside outside the marshes, transforming roads into sunken lanes ideal for ambush and breaking up the landscape into easily defended terrain compartments that had to be cleared one at a time by teams of tanks and riflemen. Each 100- or 200-yard-long rectangle of plowed ground, pasture, or orchard had its price in American dead and wounded. In five days of fighting during the July offensive one 4th Division regiment, the 22d Infantry, suffered 729 casualties, including
AND LOCATIONS OF WOUNDS,
BATTLE OF NORMANDY,
a battalion commander, a battalion executive officer, and five rifle company commanders. In one rifle company, stated a division report, there were "only five noncoms left who had been with the company more than two weeks. Four of these according to the first sergeant were battle exhaustion cases and would not have been tolerated as noncoms if there had been anyone else available."31
In this environment company aidmen who survived for any length of time acquired many skills and learned many lessons very quickly. They mastered the art of going over hedgerows low and fast. Instead of jumping up and running under fire at the first cries of "Medics," they learned to wait for a lull and then crawl to their objectives. Once an aidman reached a group of wounded, he had to make an instant decision as to who were beyond any help, who could help themselves, and who would benefit most from medical intervention. "We soon figured out," a 30th Infantry Division medic recalled,
that our most useful . . . aids were compresses and morphine. We usually used the individual soldier's sulfa powder and compress. Tourniquets were very rarely used to control bleeding, since most wounds were puncture[s] . . . and bled very little or were amputations or hits caused by hot and high velocity shell or mortar fragments which seared the wound shut.
Aidmen discarded much equipment, found to be unnecessary, and discovered unplanned use for other items. The carriers for thrown-away gas masks conveniently held extra compresses. A patch cut from the tail of a raincoat, applied with the compress to a sucking chest wound, helped keep respiration from drawing in dust and dirt. Bandage scissors also could cut through clothing, and carrying an extra pair proved to be worthwhile.32
With an extensive, if tortuous, road network behind the front, and with most medical service jeeps equipped with litter brackets, division surgeons early discovered that almost all evacuation to the rear of the battalion aid stations could be done by motor vehicles. This was fortunate, because some divisions, to avoid medical personnel casualties from artillery and mortar fire, placed their battalion aid stations as far as 1.5 miles behind their forward elements and their collecting stations, correspondingly, as much as 5 miles farther to the rear. Collecting company litter platoons, in a departure from doctrine, worked almost entirely forward of the battalion aid stations, functioning in effect as part of the unit medical detachments and often under operational control of the battalion surgeons. Even with the collecting company squads available for relief and reinforcement, litterbearers were in chronically short supply in the infantry regiments. Casualties and exhaustion, both physical and emotional, further thinned their ranks. An
INFANTRYMEN IN ACTION IN THE HEDGEROWS
aidman recalled: "I have picked up a litter with a wounded man on it and had my fingers uncurl from the handles, even though I was exerting all my willpower to keep my hands closed." For extra litterbearers during heavy, sustained combat, divisions regularly had to draw upon collecting companies of the corps medical battalions and army medical groups, or they temporarily drafted infantrymen for the additional duty-an especially unsatisfactory solution when the rifle companies were themselves understrength from battle losses.33
The hedgerow fighting imposed special strains on the first-echelon medical service of the armored divisions, principally the 2d and 3d. These divisions, instead of operating in concentrated mobile combat commands,
had to split up their tank and armored infantry battalions into platoons to help the infantry clear ground, hedgerow by hedgerow. The divisions then had to attach aidmen and litterbearers to each separate platoon, in violation of their doctrine, under which tank battalions, especially, kept all their enlisted medical personnel at their aid stations. Because tank and mechanized infantry battalions included only half as many enlisted medical people as standard infantry battalions, the armored divisions had to strip their medical battalions to build up their unit detachments. After the initial weeks of hedgerow combat, the 3d Armored Division surgeon, Col. James L. Salmon, MC, requested an additional eighty-four medical enlisted men for his division so that tank and mechanized infantry battalions could maintain what was, in effect, a conventional infantry system of evacuation. In the absence of such permanent reinforcements the XIX Corps surgeon temporarily attached men from his corps medical battalion to the armored units.34
Collecting and clearing station operations conformed closely to doctrine. Collecting stations, usually located near the command posts of the regiments they supported, changed bandages on incoming wounded, adjusted splints, administered plasma, and combated shock while preparing patients for further evacuation. Clearing stations, 4-6 miles behind the collecting companies, performed triage, maintained wards for care of shock and of minor sickness and injuries, and transferred men needing immediate emergency surgery to adjacent field hospital platoons. Moving frequently to keep up with their divisions, clearing companies handled a large volume of casualties. The 4th Division clearing station, for example, received, treated, and evacuated over 6,100 patients-an average of about 245 per day-during its first twenty-five days in operation. During the battle for St. Lô in July, the 83d Infantry Division clearing station processed 1,600 wounded in three days. To relieve the exhausted staff of this company, the VII Corps surgeon reinforced it temporarily with elements of the corps medical battalion and with an entire clearing company borrowed from the 134th Medical Group. As it had in other theaters, the combination of clearing station and field hospital platoon worked smoothly, freeing the clearing company of nontransportable patients and saving the lives of severely injured men. General Kenner reported after a mid July inspection tour: "Many men, wounded within the hour, were receiving emergency major surgical treatment in these installations. The forward disposition of these elements is responsible in large measure for the . . . low mortality rate amongst our casualties."35
Division medical elements, especially the infantry regimental detachments and the collecting company litter platoons, suffered substantial casualties. Colonel Hayes, the VII Corps surgeon, reported as early as 14 June: "All divisions in the line have lost from one to eight medical officers and from five to forty enlisted men." Between 10 and 24 July, in the already understrength regimental detachments of the 9th Division, 1 medical officer and 20 enlisted men were killed, 4 officers and 155 men wounded, and 2 officers and 19 men captured. The 83d Division, in the July offensive, had two entire battalion aid stations overrun and taken prisoner during a local German counterattack.36
Random artillery and mortar fire accounted for most medical troop casualties, as well as for frequent damage to medical service vehicles and installations. However, the killing and wounding of aidmen, litterbearers, and aid station personnel by aimed rifle fire, usually from snipers, raised the question whether the enemy, as general policy, was respecting the Geneva Convention rights of unarmed Red Cross-marked medical personnel. After two months of combat and careful analysis of many incidents, most corps, division, and lower-echelon surgeons and medical unit commanders concluded that, except for isolated cases, the Germans were following the rules. The commander of the 4th Medical Battalion, which had had men killed and wounded and ambulances damaged by artillery and machine-gun fire, summed up the prevailing opinion: "It is the consensus . . . that little of this damage was deliberate and that for the most part the enemy respects the Rules of Land Warfare. . . ." According to German prisoners, sniper incidents often resulted from difficulty in seeing Red Cross arm brassards on men moving along the hedgerows; medics in some divisions noted that a high proportion of their small-arms casualties were shot from the unbrassarded right side. Aidmen and litterbearers accordingly began wearing brassards on both arms and painted nonregulation red crosses in white squares on their helmets. The XIX Corps surgeon late in July officially authorized these and other measures to make Geneva Convention markings on men and vehicles more conspicuous.37
IMPROVISED RED CROSS
on their arms and helmets
Gestures of a chivalry supposedly dead in mechanized total war occasionally graced the Normandy battlefield. Soldiers of both sides, either as the result of formal temporary truces or more often by tacit mutual consent, at times ceased fire to allow aidmen to reach casualties. A 30th Division aidman remembered "deliberately exposing myself to enemy view and waiving at machine-gun crews in order to get them to lift fire so I could remove wounded. . . . The fire was often lifted." On D-day a trooper in the 82d Division saw German and American medics rush toward some wounded lying near a tank that had just been knocked out. "There was no firing by either side upon these aid men as they went to work." Early in July the First Army returned sixteen German nurses captured in Cherbourg to their own forces under a flag of truce. The commander of a German parachute regiment in the hedgerows sent back 83d Division medics his troops had captured. Such incidents were exceptional in the bitter fighting, but they did indicate that, in dealing with wounded and those who treated and evacuated them, both sides were following as best they could the conventions of civilized warfare.38
To the rear of the divisions the 31st and 68th Medical Groups managed the flow of casualties to evacuation hospitals and then to convalescent facilities and beach holding units. The groups deployed their attached ambulance companies as well as the ambulance platoons of their collecting companies at division clearing stations, at field hospitals, and at other installations. They placed liaison officers at clearing stations and hospitals and set up ambulance control points on the roads. Based on evacuation hospital reports, relayed through Colonel Rogers' office twice daily and containing current statistics on empty beds, on patients awaiting surgery, and on patients ready for transportation, the groups routed
ambulance convoys from the divisions to hospitals in their sectors and from the hospitals to UTAH and OMAHA beaches. Each group transported as many as 2,500 patients a day, keeping its ambulances rolling steadily in the constant bumper-to-bumper traffic of the congested beachhead. Occasionally, they massed forces to meet sudden emergencies. Between 28 June and 1 July, for instance, the 68th Group, which normally worked in the OMAHA area, sent men, trucks, and ambulances to Cherbourg to evacuate to UTAH beach over 1,300 wounded German prisoners. During July, as the intensity of combat and the number of divisions in Normandy increased, Colonel Rogers reinforced the medical groups with additional ambulance and collecting companies temporarily detached from the Third Army and with ambulance companies taken from the corps medical battalions.39
At OMAHA and UTAH the engineer special brigade medical battalions, rearmost evacuation elements of the First Army, received patients from the medical groups and prepared them for cross-Channel movement, by ship and, for an increasing proportion, by airplane. The NEPTUNE plans called for the beginning of mass air evacuation from France around D+14 (20 June), but the engineer special brigades managed to complete a temporary airstrip near St.-Laurent on the eighth. A IX Troop Carrier Command C-47 lifted out the first 13 patients, including 7 wounded POWs, two days later. With passable flying weather much of the time and plenty of returning cargo planes, the 60th and 61st Medical Battalions on some days flew out as many as 600 patients, while the number leaving OMAHA daily by ship dwindled to less than 20. On UTAH beach, by contrast, sea evacuation continued to predominate. A company of the 134th Medical Group opened an air evacuation holding unit at Ste.-Mere-Eglise on the eighteenth, but it closed after eleven days of limited operation because transport flights there interfered with combat air activities. Not until 20 July did the medical service secure more or less regular evacuation use of an airfield in the Cotentin. Air evacuation at once proved its worth. With the flight itself taking no longer than ninety minutes, General Kenner reported, "men wounded in the morning are often on the operating table of a general hospital in the UK within 10 hours." With such rapid evacuation available, surgeons could send to Britain many severely wounded men hitherto classified nontransportable, reducing the surgical burden on hard-pressed field and evacuation hospitals.40
On OMAHA the engineer special brigade units reorganized to take maximum advantage of both air and sea transportation. The Provisional Engineer Special Brigade Group, between 18 and 22 June, consolidated most of the 60th and 61st Medical Battalions into an evacuation center under the command of the group surgeon, Lt. Col. George D. Newton, MC. The 61st Battalion, of which the 393d Collect-to-Clearing Company had acted as a holding unit for the St.-Laurent strip since air evacuation began, deployed its other companies with the 393d to form a 750-bed tented holding facility for litter patients. A platoon of the 60th Battalion's 634th Clearing Company maintained temporary accommodations for 250 walking wounded, and the 499th Collecting Company sorted incoming patients and furnished litterbearers and ambulances. Working with attached Air Force liaison personnel and in direct telephone contact with the airstrip and the naval beach station, the center's evacuation control officer, borrowed from the 11th Port, dispatched patients as LSTs, hospital carriers, and aircraft became available. The center normally gave stretcher cases priority for cross-Channel flights and sent the walking wounded by ship. As Captain Dowling, the Western Naval Task Force surgeon, later reported, "This system was easily regulated and maintained, and greatly facilitated speed and ease in handling casualties...."41
While the medical battalions on OMAHA beach concentrated on air evacuation, the 261st Medical Battalion on UTAH handled most of the seaward movement of casualties out of Normandy. Acting almost entirely as a holding unit after the field and evacuation hospitals opened, the battalion funneled patients to the 2d Naval Beach Battalion, which embarked them on LSTs and hospital carriers. The naval unit stationed a radioequipped liaison team at each 261st Battalion clearing company to keep the Army units promptly informed of ship arrivals. Evacuation across UTAH beach proceeded at a steady rate, averaging about 570 men per week throughout June and July.42
Most wounded men who passed through the army evacuation chain underwent surgery in field or evacuation hospitals. Field hospital platoons, located close to division clearing stations, received the most urgent nontransportable cases, primarily, General Hawley observed, "perforating wounds of the belly and sucking wounds of the chest." Each platoon had auxiliary surgical teams attached as operating staff, and between them the three platoons of a field hospital, if all were active, could perform about thirty major and usually complex procedures a day. Death rates in these installations ranged from 11 to 14 percent of surgical admissions, about three times the rate for evacuation hospitals, which reflected the desperate nature of the cases the field units received. As the commander of the
51st Field Hospital put it, "Exsanguination, eviscerations, cardio-respiratory difficulties, and deep shock" were the normal fare of his doctors. For the attached teams, who had complete authority over the surgical service, field hospital work, while hard and demanding, offered a high level of professional challenge and satisfaction. With perhaps some exaggeration, a 3d Auxiliary Surgical Group report referred to this duty as "the surgeon's paradise." The first weeks of operation revealed only a few deficiencies in platoon organization and equipment: a shortage of litterbearers; a need for extra officers and nurses to stay behind with patients when the unit moved; and requirements for larger generators and additional suction, anesthesia, and oxygen apparatus.43
While the field hospitals proved more than equal to their task, the 400-bed army evacuation hospitals found themselves consistently overburdened. Processing all patients who were transportable and needed more than the most elementary treatment, these hospitals worked in rotation, some receiving casualties while others, cleared of patients, rested or moved forward behind the divisions. During the first weeks evacuation hospitals lived from crisis to crisis. "When a hospital moved in and set up," the 41st Evacuation Hospital commander complained, "there would always be a big influx of patients, which continued until every bed was filled and this hospital bogged down. Then the hospital would be closed and left to work itself out of the mess."44
With the arrival of more evacuation hospitals the flow of patients evened out, but in more units a chronic surgical backlog persisted. The majority of the casualties reaching these hospitals were injured men who needed surgery-for example, 894 patients out of 1,302 admitted by the 5th Evacuation Hospital during its first two weeks in Normandy and all but 360 out of 3,200 treated at the 128th Evacuation Hospital in a similar space of time. The T/O surgical staff of this type installation, working twelve-hour shifts and reinforced by as many auxiliary surgical teams as the hospital's 40 nurses and 217 enlisted men could support, could perform about 100 major operations every twenty-four hours; the patient influx during heavy combat occurred at about double that rate. Inevitably, the less urgent cases had to wait their turn on the operating tables, often developing infections in undebrided wounds or suffering other complications. To help its hospitals overcome this backlog, the First Army deployed surgical teams and mobile truck-mounted surgical and X-ray units of the 3d Auxiliary Surgical Group and, when these proved insufficient, added provisional teams from COMZ hospitals landed but not yet
functioning. The medical groups assigned a collecting company to each evacuation hospital, to provide reliefs for ward officers, additional litterbearers, and ambulances to help in moving out patients. Clearing companies, from the 134th Medical Group or the corps medical battalions, set up near evacuation hospitals to relieve them of the sick and minor surgical patients. For unskilled labor, the hospitals obtained German prisoners from the First Army provost marshal.
The First Army tried to manage evacuation so as to reduce the surgical logjam. The 31st and 68th Medical Groups directed ambulances from clearing stations to the evacuation hospitals on the basis of surgical backlog, rather than proximity or number of empty beds. As a final expedient, on 28 June, Colonel Rogers, at the urging of General Hawley and Colonel Cutler, authorized hospital commanders to send transportable minor surgery patients directly to the beach holding units for air evacuation, whenever, in their judgment, that course of action would bring the patient earlier treatment. Under this policy, evacuation hospitals could relieve themselves of between 15 and 25 percent of their surgical patients; but, even with this assistance, it was clear that this type of unit needed constant augmentation to carry out its mission.45
Clinically, surgery during the first two months of combat produced few surprises. Surgeons were impressed by the frequency and severity of the multiple wounds from artillery fire. On his July inspection trip General Kenner saw patients "with a penetrating wound of the skull, sucking wound of the chest, partial evisceration and a compound fracture. This means that one surgical team, on that one individual, must perform four major operations." The rate of use of whole blood about matched the highest pre-D-Day projections, running about one pint for each pint of plasma. According to Colonel Rogers, the Manual of Therapy "met all expectations" as a practical guide to forward surgery. Rogers' staff, working closely with the theater consultants, issued a steady stream of directives to clarify certain points in the Manual and to correct surgeons' minor deviations from it. Early debridement and liberal use of penicillin and sulfa drugs kept the incidence of serious wound infection low, in spite of surgical backlog, and in spite of the fact that many casualties occurred on pastures and farmland contaminated with animal and human feces. Of the wounded men treated in First Army installations and then evacuated across the Channel less than 1 percent died after reaching England, a result which Kenner attributed to "the echeloning of skilled surgical care throughout the evacuation chain." Colonel Cutler, after a visit to
army hospitals in late June, concluded:
It is my overall opinion that the level of professional care is very high, certainly better than in the last war. . . . The low incidence of serious infection was striking and must be related to the bacteriostatic agents . . . now employed in military surgery. The incidence of amputations seemed happily low, the incidence of gas gangrene also much lower than was expected or was present in the European War, 1914-1918.46
The First Army suffered little from disease during its early battles. Minor outbreaks of diarrhea occurred; the cool, rainy weather resulted in respiratory ailments; and prolonged diet of C- and K-rations led to cases of vitamin deficiency. Recurrent malaria continued to flare up in divisions that had served in the Mediterranean, with an Army-wide total of 175-250 hospital admissions each week during June and July. The affected units put their men back on prophylactic doses of Atabrine, and the army evacuated men with complicated malaria to the United Kingdom while retaining those with simple cases in evacuation hospitals. Late in July, to save evacuation hospital space for the wounded, the army concentrated its malaria and other communicable disease patients at the 16th Field Hospital, a newly arrived Third Army unit. With women largely absent from the beachhead towns, the army's venereal disease rate remained low, 8.5 cases per 1,000 men in June and 4.2 per 1,000 in July. Only 398 new infections appeared in the period, all traceable to preinvasion contacts in England.47
Neuropsychiatric casualties, increasing in incidence as the fighting intensified, taxed First Army medical facilities. During the July battles most infantry divisions sent one man to the rear with combat exhaustion for each three or four wounded. Before the invasion Colonel Rogers and his staff, seeking to profit by the experience of other theaters, made preparations to treat as many neuropsychiatric patients as possible near the front and return them promptly to duty. Accordingly, once operations began, battalion and regimental surgeons held the mildest cases-those likely to recover after twenty-four hours or so of sedation, rest, and food-at their unit aid stations. Men more severely disturbed went to clearing stations where division psychiatrists supervised up to seventy-two hours of treatment. Setting up and equipping these facilities taxed the ingenuity of the officers in charge. The equipment authorized a division psychiatrist included only "a sphygmomanometer, a set of five . . . tuning forks, a percussion
hammer, and an ophthalmoscope," and he had to pick up enlisted staff, tentage, cots, blankets, and a medical chest by the time-honored Army method of scrounging. Division clearing stations evacuated soldiers who required more lengthy treatment and reconditioning but were still deemed salvageable to one of the two First Army exhaustion centers, opened at Bernescq and Ste.-Mere-Eglise on 19 June by the 622d Clearing Company and staffed with psychiatrists from the evacuation hospitals. Here, patients underwent extended sedation, received counseling and limited individual and group therapy, and took part in calesthenics and military drill, followed by final examination and either return to duty or evacuation across the Channel.48
The psychiatric toll of the hedgerows forced expansion of both divisional and army facilities. Each of the army exhaustion centers doubled in size, from 500 to 1,000 beds, and the staffs worked sixteen- and eighteen-hour days. The army assigned a second clearing company, the 618th, to take over the Bernescq center, allowing the 622d to concentrate at Ste.-Mere-Eglise. Still overcrowded, even with this reinforcement, the army facilities in mid July began turning all but the worst-off patients back to their divisions. In response, some infantry divisions, notably the 29th and 35th, enlarged their clearing station psychiatric facilities into full-fledged 250-bed exhaustion centers, which kept men for up to seven days of treatment comparable to that in the army units. Between them, the division clearing stations and army exhaustion centers returned to combat duty about 62 percent of the 11,150 neuropsychiatric patients they admitted; they released another 13 percent to noncombat service and evacuated the balance to Great Britain.49
The medical supply system, which had been the subject of so much theater concern until the eve of the invasion, proved efficient and responsive in Normandy. Between them, the First Army and Hawley's Supply Division managed to include enough matériel in the assault forces to sustain the medical service in its first days on the beach. As the buildup went on, the arrival of prescheduled shipments and maintenance units, besides meeting day-to-day needs, allowed the First Army to accumulate seven-day reserves of most items by the end of June. Using theater systems for express air and sea shipment of urgently needed matériel, the army depots obtained additional oxygen, X-ray, and transfusion equipment for field and evacuation hospitals. They put together outfits for improvised non-T/E installations, such as the exhaustion centers, and they remedied omissions and inadequacies in the medical maintenance units. The medical service encountered such perennial problems
as equipment lost and damaged in landing or separated from the owning units; unexpectedly high breakdown rates for key equipment, such as autoclaves; and an unreplaced cross-Channel drainage from Normandy of pajamas, litters, and tracheal tubes with evacuated casualties. These difficulties however, remained at the nuisance rather than the crisis level. Medical maintenance units imposed extra labor on the depots in that most of the items they included were scattered among a number of containers, requiring supply people to open as many as thirty boxes of miscellaneous goods to fill a single requisition. In the shallow beachhead, with a nearly static front, divisions and other units had little difficulty drawing medical stores from army depots. Nevertheless, Colonel Rogers expressed concern late in July that the size of the reinforced army was straining the distribution capacity of his depots and that they would be unable to sustain the force if it broke through and began a rapid advance.50
Whole blood and penicillin reached the army in ample supply through a separate logistics channel. Refrigerated trucks of the 152d Station Hospital, the ETO blood bank unit, went ashore fully loaded on OMAHA beach on 7 June and on UTAH two days later; hospital carriers and LSTs landed some 3,000 additional pints of blood early in the invasion. On the twelfth, Detachment A of the blood bank disembarked and set up at the St.-Laurent airstrip to receive regular flights of blood from England, 250 pints a day until 24 June, when the theater increased the shipment to 500 pints. Refrigerated trucks of the unit, as planned, carried blood forward to hospitals and clearing stations. The same trucks also distributed penicillin, flown in on the transports that brought in blood. The First Army suffered from a penicillin shortage in mid June, the result of temporary exhaustion of stocks in the United Kingdom, and had to restrict use of the antibiotic to only the most urgent cases. But by the end of that month the chief surgeon's Supply Division, with its depots in Britain replenished from the United States, had resumed air deliveries to Normandy at a rate of 500 million units per day. These shipments continued throughout the Battle of the Hedgerows.51
The first two months of battle tested the European Theater version of a field army medical service and in the main proved it sound. Except for the understaffed 400-bed evacuation hospitals, army medical units functioned as the NEPTUNE planners hoped and expected. Colonel Rogers, in his assessment of this period of operations, praised the field hospital platoon-clearing station combination, and he also expressed satisfaction
with the flexibility and adaptability of his medical groups. Nevertheless, unresolved questions existed as the First Army paused after the capture of St. Lo and prepared for new attacks. Thus far, the army medical service had supported a static or slow-moving force; how well prepared was it to perform if the army broke out of the beachhead into truly mobile warfare? Further, if the army did start moving rapidly away from the beaches, its medical service would need a continental Communications Zone to fill in behind it and relieve it of its rearmost hospitalization, evacuation, and supply tasks. However, as the campaign approached D+50, a point well beyond the date the NEPTUNE planners had set for drawing the army rear boundary, no such boundary yet existed. The Advance Section barely had shouldered its way ashore and was in only limited operation. The slow advance of the front in June and July had disrupted COMZ plans for movement across the Channel, even as the base sections in England received and cared for the First Army's wounded as well as supported its operations.52