CHAPTER VI

Preparations for Invasion

Medics in Britain performed their many and complex BOLERO tasks as preliminaries to their principal and most urgent mission: support of the amphibious assault on continental Europe. In the early period of the buildup, planning and preparation for that assault engaged the attention of only a few members of the chief surgeon's staff. Then, as 1943 gave way to 1944, the pace of assault planning intensified. Medical personnel of all ranks and in all units were swept up in invasion preparations. By late spring of 1944 ETO medics, like everyone else in the theater, were tensely awaiting the rapidly approaching D-Day.

Early Planning Efforts

Medical planning for a cross-Channel assault started in April 1942, after tentative approval of the American ROUNDUP invasion concept, and ran concurrently with the BOLERO buildup. The British and U.S. ground, naval, and air commands in London set up, among other committees on the ROUNDUP operation, an administrative planning staff to deal with logistical matters. The staff, in turn, was divided into lettered sections specializing in particular aspects of logistics. Section C, which did most of the medical planning, included members of the British War Office, Admiralty, Air Ministry, Combined Operations Staff, and Ministry of Health, with the theater chief surgeon and, more often, Colonel Spruit, Hawley's London representative, speaking for the American forces.¹

Section C, in common with the other logistics planning groups, worked within uncertain parameters. By mid June the ROUNDUP tactical planners had developed a general concept for simultaneous landings on a front stretching from the Pas-de-Calais to Cherbourg, with perhaps six divisions in the initial assault; beyond that the outlines of the operation remained unclear, clouded with doubt as to its feasibility. At the same time Section C had little amphibious warfare experience to guide it. The US Navy and Marine Corps before the war had outlined a tentative amphibious doctrine, also adopted by the Army, but the resulting manuals had little useful to say about medical

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operations. Wartime British Commando raids, and even the August 1942 attack on Dieppe, offered few medical lessons but confirmed that heavy casualties were to be expected. In the face of these uncertainties and areas of ignorance, Hawley, Spruit, and their British colleagues plowed ahead as best they could.²

From the start of their deliberations the medical planners confronted a problem that would remain a central preoccupation until D-Day: treatment and evacuation of the anticipated many casualties of the first days of the invasion. The dilemma was simple. The assault force would suffer its largest proportion of wounded at precisely the time when the fewest medical troops would be on shore to care for them. Section C, on the basis of informed guesswork, assumed that there would be 22,500 Allied wounded, almost half of them stretcher cases, during the first two days of ROUNDUP. Hawley, Spruit, and their British counterparts quickly ruled out any attempt to treat these injured on the French shore (designated in plans as the "far shore" to distinguish it from the British "nearshore"), concluding that treatment would require more medics, hospitals, and equipment than could possibly be landed in the assault and early buildup and more space than would be available in the crowded beachhead.

If the wounded were not to be cared for on the far shore, they would have to be evacuated directly from the beaches to hospitals in Great Britain, but evacuated in what? Few British and no United States hospital ships were available in the theater, and in any event these large oceangoing vessels could embark patients conveniently only at ports. Besides, such scarce ships should not be risked under enemy air attack and shore battery fire. The British had developed a smaller type of hospital ship, the hospital carrier. Converted from shallowdraft coastal steamers, these vessels, each able to accommodate 100 litter and 150 ambulatory patients, could lie close to the beaches and load by means of water ambulances-motor boats carried on board the mother craft. Hospital carriers, however, also were vulnerable to hostile air and artillery and they took hours to fill to capacity. The four that would be available in England in late 1942 could not begin to evacuate all the expected casualties.

Tactical landing craft that returned to England after unloading obviously were the only means for taking many wounded off the beaches quickly, although the types of such craft in service during ROUNDUP planning were small and not well adapted to handling men on stretchers. Nevertheless, in late 1942, for lack of any real alternative, the ROUNDUP administrative planning staff, at Section C's recommendation, established in principle a policy of maximum evacuation during the initial assault and use of returning landing craft as the main

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BRITISH HOSPITAL CARRIER NAUSHON, a converted American ferryboat

casualty carrier. What types of landing craft to employ for this purpose, how many could be made available for medical use (indeed, how many would be available at all), and whether any could be earmarked exclusively for evacuation and protected by the Red Cross-these facts the committee could not determine. The principle it adopted, however, would remain in force throughout the rest of the lengthy invasion planning process.³

Besides struggling with the problem of beachhead evacuation, the ROUNDUP medical planners arrived at basic decisions on a number of other important questions. They established an army-navy division of cross-Channel evacuation responsibilities that applied to both British and American forces. Under it, the armies were to collect all wounded on the far shore and move them to the beaches; the navies would load evacuation craft and care for patients on the voyage to England; the armies then would have charge of unloading the wounded and removing them to hospitals. General Hawley, Colonel Grow of the Eighth Air Force, and British medical and RAF authorities agreed on similar plans for air evacuation from the Continent to the United Kingdom.

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The ground forces and Services of Supply were to collect evacuees at French airstrips for pickup by transport planes returning to England. Air Force medical personnel were to care for the patients in flight, and the Services of Supply would deplane them in Britain and transfer them to hospitals. For their own forces the American planners began outlining the complicated sequence in which field army and then SOS medical units would land in France. They also roughed out a system for receiving water-evacuated casualties in England, using field hospitals and clearing stations at the ports for triage and emergency surgery and distributing transportable patients at once to selected hospitals inland.⁴

Medical invasion planning, in this period of limited theater resources, at times took on an air of unreality. During July, for example, in a last effort to avoid the diversion to North Africa, General Marshall ordered the European Theater and Services of Supply to report on the feasibility of launching a small-scale cross-Channel attack, code-named SLEDGEHAMMER, on 15 September. Hawley, in response, informed General Lee that, if the buildup continued at its present pace, the medical service would be short 8,900 beds and 8,616 officers and men on the projected attack date and would have no hospital train units, ambulance battalions, or boats for water evacuation. Pressed by Lee to report positively on how he could support the operation, the chief surgeon reiterated his previous assessment, with the qualification that he would be able to support the landing if he could borrow field medical units, hospitals, and equipment from the British, who, of course, had none to spare. Reports such as this helped scuttle SLEDGEHAMMER and ROUNDUP and paved the way for the commitment to TORCH.⁵

Cross-Channel assault planning of all sorts came to a stop in late 1942, as TORCH plans and preparations monopolized the attention of British and American staffs. Yet the ROUNDUP studies and conclusions-preserved in memoranda, data books, and individual memories-would constitute a starting point for the next round of invasion planning. Many of the principles and concepts of operation first sketchily outlined in ROUNDUP would be the foundation of the much more elaborate plans to follow.⁶

OVERLORD: The Planning Process

The decision of the Allied leaders at Casablanca, in January 1943, to revive the cross-Channel attack project for execution sometime in 1944 set in motion a lengthy, complex planning process. It began with a small Anglo-American staff, eventually drew in most British and American headquarters, and ended in the final test of strength in the west with Nazi Germany.

In March 1943, to give organizational substance to the Casablanca

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decision, the Combined Chiefs of Staff established the Anglo-American staff known as COSSAC to plan the invasion and superintend preparations for it. Under the guidance of British Lt. Gen. Sir Frederick E. Morgan, COSSAC drafted the outline plan for the invasion, Operation OVERLORD, which Roosevelt, Churchill, and the Combined Chiefs approved at the Quebec conference in August. The Allies then put together the Anglo-American combined ground, naval, and air headquarters that were to fill in the details of OVERLORD and undertake its execution. In mid January 1944 the arrival of General Eisenhower in London and the activation of SHAEF around the nucleus of COSSAC capped the invasion command structure. Eisenhower, after refining and expanding the COSSAC plan, set 1 June as the attack date. To obtain more landing craft for the enlarged assault, the Combined Chiefs canceled the originally contemplated simultaneous landing in southern France. On 1 February SHAEF published its outline plan for NEPTUNE, the code-name for 1944 operations within OVERLORD. SHAEF's ground, naval, and air headquarters followed with their outline plans and various national forces then got to work on the details of tactics and logistics.

The final plan, developed by COSSAC and expanded upon by SHAEF, selected Normandy as the point of attack because it possessed more suitable invasion beaches, was located within easier reach of major ports, and was less strongly defended than the previously favored Pas-de-Calais. In contrast to the broad front contemplated for ROUNDUP, the OVERLORD plan called for a single concentrated amphibious assault. Three British Commonwealth and two American divisions were to land north and northwest of Caen, with one of the American divisions going in on the east coast of the Cotentin Peninsula to gain position for a drive on the key port of Cherbourg. Three airborne divisions-one British and two American-were to drop to secure the flanks of the beachhead and open routes inland. This force, and follow-up troops, was to secure a compact lodgement area in which the Allies could mass men and supplies and from which they could advance methodically, first to capture additional Norman and Breton ports, then to clear the region between the Seine and the Loire, and finally to take Paris and go on to the Rhine, in the process destroying as much of the German Army as possible (see Map 4).⁷

With the formation of COSSAC, medical support planning paralleled every stage of OVERLORD'S development. The COSSAC medical section began work in June 1943, under Chief Medical Officer Lt.Col.G.M.Denning Lt. Col. G. M. Denning of the Royal Army Medical Corps. Besides Denning, the small, informal section included a Royal Navy representative and Lt. Col. Thomas J. Hartford, MC, Hawley's executive officer. In September, after Hartford went to 21 Army Group to keep in touch with ground forces medical planning, Lt. Col. John K. Davis, MC, from the ETO Hospitalization Division, assumed the

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MAP 4

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COL. THOMAS J. HARTFORD
(Rank as of October 1943) 

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

Under both COSSAC and SHAEF, the medical section made no comprehensive plans for supporting the invasion. Instead, it drafted administrative directives on certain inter-Allied and interservice problems. The section established, for example, uniform casualty-estimation formulas for use by all Allied planners, and it set basic evacuation policy and decided upon the principal means for cross-Channel transport of wounded. As part of SHAEF the section reviewed and reconciled the proliferating plans of subordinate headquarters. Most COSSAC and SHAEF medical decisions in fact represented a consensus between the chiefs of the British and American medical services, reached at frequent formal and informal conferences. Throughout the invasion planning the American medics at COSSAC and SHAEF drew upon General Hawley's office for advice and information, with the staff preparing most of their studies and position papers.⁸

Detailed American medical planning for NEPTUNE, covering the invasion and the first ninety days of the battle for France, began early in February 1944, after publication of the SHAEF outline plans. Planning took place within a complex logistics organization created to accommodate national control of supply to overall British direction of NEPTUNE ground operations. General Sir Bernard L. Montgomery's 21 Army Group functioned as both tactical and administrative ground force headquarters for the invasion. Subordinate to it, the US 1st Army Group and First Army had logistical, as well as tactical, responsibility for the American troops under them, but these commands did not represent and could not control the ETO Services of Supply. To give the latter a voice in invasion planning, as well as to form the skeleton of a

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continental logistics system, General Eisenhower, as ETO commander, early in February activated two new headquarters: Advance Section, Communications Zone (ADSEC), and Forward Echelon, Communications Zone (FECOMZ).

Each of these new headquarters possessed immediate planning and future operational functions. The Advance Section was attached to the First Army, which had charge of all tactical planning for the American part of the amphibious assault and also did logistics planning for the first fifteen day on shore. Besides assisting with army planning, ADSEC worked out the details of SOS operations for the period from the sixteenth through the fortieth day after D-Day (D+16 through D+40). The Forward Echelon, at the outset an element of 21 Army Group headquarters, supervised ADSEC planning and itself made SOS plans for D+41 through D+90.

Operationally, ADSEC was to act as the supply element of the First Army until D+15, organizing the beach behind the advancing troops. From D+15 through D+40, after the army established its rear boundary, ADSEC would constitute the communications zone under the supervision of 21 Army Group, exercised through the Forward Echelon. FECOMZ itself was to become active on D+41, when a second US army went into operation and the 1st Army Group, hitherto subordinate to 21 Army Group, became a separate command directly under SHAEF (see Chart 5). The Forward Echelon then would take command of the entire American support area behind the armies (whether under the US army group or coordinate with it was never entirely settled). ADSEC at this point was to revert to the status of a movable base section under FECOMZ. The section would follow close behind the armies and link them to the Services of Supply, relinquishing supply activities nearer the shore to other base sections that would be formed as the campaign progressed. Around D+90 SHAEF and ETOUSA were expected to move to France, whereupon FECOMZ would merge back into the ETO-SOS headquarters and General Lee, as Eisenhower's deputy for logistics, would assume direct control of all elements of the Services of Supply-to be redesignated the Communications Zone (COMZ).⁹

Under this administrative arrangement the First Army surgeon, Colonel Rogers, and his staff, working closely with the surgeons of the two assault corps, the V and VII, drew up medical support plans for the initial landing and the first two weeks of combat. The ADSEC surgeon, Col. Charles H. Beasley, MC, and the FECOMZ surgeon, Colonel Spruit, prepared plans for establishing the medical portion of the continental Communications

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CHART 5

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CHART 5 cont.

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Zone. Roger's First Army medical section had come over from the United States with its parent headquarters and had been in operation in London and Bristol since October 1943, but the ADSEC and FECOMZ surgeons' staffs had to be improvised in haste (see Charts 6 and 7). Of substantial size-the ADSEC surgeon's office eventually included forty-three officers and fifty-six enlisted men-these organizations drew manpower from casuals, base section headquarters, and General Hawley's office. Colonel Beasley, for example, had been surgeon of the Eastern Base Section; his deputy, Col. James B. Mason, MC, had served as Hawley's chief of operations; and Colonel Spruit had come over to FECOMZ from running the Cheltenham branch of the chief surgeon's establishment. Each of the COMZ surgeons organized his office into divisions paralleling those under the chief surgeon. Spruit's office, indeed, was for practical purposes an advance echelon of Hawley's.¹⁰

While the First Army, ADSEC, and FECOMZ surgeons drafted the NEPTUNE plans, many of the decisions incorporated in them came from other headquarters. General Hawley, charged with supervising all theater medical planning, took part in establishing most major policies. His staff furnished information to the army and COMZ surgeons and wrote key portions of their plans, including, for instance, the basic army-navy agreement on division of cross-Channel evacuation responsibility. Hawley's office published its own standard operating procedure for medical service on the Continent and oversaw base section planning for support of the embarking invasion forces and for receiving casualties from the far shore. At SHAEF General Kenner kept in close touch with ETO medical planning and intervened in selected aspects of it. Of the higher-level ETO surgeons, Colonel Gorby of the 1st Army Group, in accord with the group's inactive role at this stage, had the least to do with NEPTUNE planning. He confined himself to keeping informed of First Army activities, assembling the medical portion of the troop buildup schedule, and participating in SHAEF medical policy discussions.¹¹

The NEPTUNE medical planners made use of the data collected by their ROUNDUP predecessors and adopted many principles worked out for the projected earlier invasion. They also availed themselves of the medical lessons learned in amphibious operations in North Africa, Sicily, and Italy. The Fifth Army late in 1943 assembled many of these lessons into

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a manual for amphibious medical support, upon which the ETO planners drew extensively. Besides using the manual and other written reports, some ETO medical officers visited the neighboring theater for firsthand observation and conferences with army and SOS surgeons. During the early 1944 planning period, Colonel Hartford of 21 Army Group, Colonel Davis of SHAEF, Colonel Beasley of ADSEC, and Colonel Darnall of Hawley's Hospitalization Division made Mediterranean tours. Their visits, besides affording a change of climate, produced useful information. Hartford, for example, confirmed from Fifth Army experience the practicability of evacuating wounded over the beaches early in amphibious assault and brought back up-to-date estimates of whole blood transfusion requirements in combat surgery.¹²

NEPTUNE medical planning extended over about four months, with the First Army plan appearing in late February and those of ADSEC and FECOMZ respectively on 30 April and 14 May. These plans, while published separately, issued from a seamless process of discussion and negotiation so complex as to defy narration. The three principal medical planning staffs worked in constant consultation with each other, with nonmedical planners at their own headquarters, and with the surgeons' staffs of higher- and lower-command echelons. They kept in close touch with Navy and Air Force medical staffs and with those of their British colleagues. The ADSEC medical section had British officers attached to it for planning. In the end, as a result of this method of working, the evolution of each plan was shaped by the evolution of each of the others. Together, the major medical plans constituted a comprehensive blueprint for the NEPTUNE campaign.¹³

The NEPTUNE Campaign

The NEPTUNE plans covered the development of a continental medical service from the time the first wave of infantry hit the beaches through the securing of the French lodgement area. Essentially, the plans addressed two problems: provision of support for a strongly opposed amphibious landing, and development of an army and then a COMZ medical establishment-all to be done from a crowded British base, across a narrow but

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own stock control procedure. In most depots, record-keeping fell behind issues, leaving both local commanders and the Supply Division unaware of developing shortages until the shelves were empty. The Supply Division required periodic reports from the depots of stores on hand; but the depots' poor record-keeping rendered this information suspect, and the Cheltenham office lacked the staff and tabulating equipment to prepare up-to-date theater-wide reports on stock levels and distribution. With incomplete and outdated information, the Supply Division could not shift matériel between depots to even out local shortages and surpluses. The more enterprising depot commanders developed their own contacts for this purpose. Medical units and hospitals, in spite of instructions to the contrary, went from one depot to another until they secured not only the items they needed but also reserves considerably over authorized allowances. These field improvisations enabled the medical service to get along from day to day, but the resulting lack of accurate information disrupted theater-wide supply planning and hindered General Hawley in dealing with his sources of medical supply in Britain and the United States.³⁴

During 1943, as American war production reached full momentum and the shipping shortage eased, the European Theater drew an increasing proportion of medical items, as well as other types of supply, from the United States. Small at the beginning of the year, the flow of matériel grew with the accelerating BOLERO buildup, but it by no means went smoothly. General Hawley complained throughout the year about delayed or only partly filled requisitions, while the surgeon general's office and the Port of New York insisted that they were meeting all ETO requirements. The stock control deficiencies in Hawley's depots contributed much to these disagreements, both by preventing timely dispatch of requisitions to the United States and by making it difficult to ascertain exactly what supplies actually had arrived.³⁵

Shipment of preassembled and packed table-of-equipment (T/E) outfits for hospitals and field medical units continued to be trouble, plagued,, in spite of War Department and ETO efforts to improve the system and in spite of the abandonment by the New York Port of Embarkation of the practice of earmarking particular outfits for individual organizations. Delivery of assemblies, instead of keeping pace with unit arrivals in Britain, fell behind. ETO depots then had to deplete their stocks to outfit disembarking units,

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with no assurance of early replenishment. Furthermore, most medical unit assemblies-especially those for hospitals-reached British depots short 15-30 percent of their components, in spite of strenuous efforts by the New York port to have them carefully marked and loaded on one ship. After much mutual recrimination between Hawley and the surgeon general's office, an investigation early in 1944 disclosed that most assemblies were entering English ports intact but that the Supply Division had made no special arrangements for keeping them together as they were unloaded. As a result, portions of hospitals and unit outfits turned up in different depots. These depots, uninstructed in handling this matériel, simply added it to their general stock without informing the Supply Division.³⁶

Although shipments from the United States increased, the medical service during 1943 procured more than half of its supplies, by tonnage, from Great Britain. British matériel, in fact, comprised 49 percent of all the goods received by the medical service between mid-1942 and mid-1944 These supplies included most hospital furniture and housekeeping equipment, as well as quantities of over 900 other items, among them surgical instruments and many drugs.

British procurement had been invaluable in meeting TORCH requirements and in tiding the medical service over its period of low priorities and limited support from the United States, but it possessed many unsatisfactory aspects. The British insisted that the Americans place very large long-term orders far in advance of deliveries, a procedure that made it all but impossible to adjust procurement to changing requirements. At the same time British deliveries on these contracts were irregular in both timing and quantity. Few quality controls existed. In the emergency of 1942 General Hawley had disregarded American specifications in accepting British supplies. He used whatever his consultants, after examining samples, declared would serve the purpose. These items underwent no inspection as they came off the production lines; shipments reaching American units frequently were poorly packed, substandard in quality, or in unusable condition. Even when British matériel arrived in good condition, US Army medical people were unaccustomed to its differences from their own and considered many items inferior to their American equivalents. Seemingly small differences in design and markings took getting used to, and at least one cost lives. British-supplied carbon dioxide, used in anesthesia, came in tanks painted green, the color used in the United States to denote oxygen. The resulting mixups caused at least eight deaths on operating tables before the Professional Services Division issued

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warnings and arranged for relabeling of tanks.³⁷

In August 1943 General Hawley began trying to reduce his dependency on the British. Aware of deficiencies in quality and slow deliveries, he also had discovered that his allies, while furnishing inferior goods to the European Theater, simultaneously were obtaining large quantities of standard American medical supplies and equipment from the United States under Lend-Lease. At Hawley's urging, Surgeon General Kirk authorized the theater chief surgeon to cancel contracts with the British for items duplicating lend-lease shipments and to requisition them directly from the New York Port of Embarkation. The War Department, at the same time, instructed the medical and other supply services to stop buying from the British a long list of items now overstocked in the United States. In spite of orders from Hawley, however, the Supply Division and Its London procurement office, through poor coordination, made no real attempt to reduce local purchases. Instead, the procurement office placed large orders for British goods to be delivered in the first half of 1944.³⁸

During the last few months of 1943, as more and more troops poured into the British Isles and invasion preparations got under way, the Supply Division obviously began to buckle under its steadily increasing work load. Disembarking units and newly opened hospitals waited for weeks for their basic equipment. The Air Force, to Hawley's embarrassment in his fight against an autonomous air medical service, continued to complain of shortages of field chests and other vital articles; the flight surgeons continued to resort, successfully, to their own channels to remedy these deficiencies. Early in 1944 the fixed hospitals in the Southern Base Section, where most American troops were concentrated, had only 75 percent of their authorized equipment. In response to complaints from all quarters, Hawley pressed the Supply Division for information but received only incomplete, inconsistent, or inaccurate replies. At the same time the tone of his correspondence with the surgeon general's office grew increasingly testy, as each side blamed the other for shortages and delays. On 7 December Hawley told General Kirk: "I have had a Hell of a lot of trouble with supply and am still having

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trouble. . . . Frankly, I am worried about my medical supply when I think of the approach of active operations."³⁹

Hawley had reason to worry. His Supply Division barely was meeting the routine requirements of the forces stationed in the United Kingdom. With much delay and inefficiency it was equipping newly landed units and recently completed hospitals, the pressures of the latter task being eased by British construction delays. Additional missions to be accomplished in early 1944 promised to swamp the floundering division. Within about five months ETO medical depots would have to assemble and place on site equipment for all the hospitals still to be opened before D-Day This entailed building thirty outfits for 1,000-bed general hospitals and twenty for 750-bed station hospitals, but the most efficient depot in late 1943 took three months to put together 60 percent of one 1,000-bed assembly. As if this were not enough, the depots would have to outfit still more incoming units, complete the equipment of organizations taking part in the assault, and pack dozens of waterproof maintenance units to supply the invasion force in its first weeks on shore. With the existing organization, personnel, and methods, these jobs could not be done in time.⁴⁰

Fortunately for General Hawley, assistance was on the way. Late in 1943 Surgeon General Kirk, responding to the chief surgeon's repeated cries for help in supply, and at the suggestion of Colonel Gorby-then in Washington preparing to join Hawley's staff decided to send a group of experts from his office to survey the ETO supply service and recommend comprehensive remedies. In doing so Kirk acted outside the established chain of command, which made the theater chief surgeon responsible only to the theater commander. The surgeon general's delegation would possess little authority beyond the moral force of its collective expertise. To lead the group, Kirk appointed the chief of his Control Division, Col. Tracy S. Voorhees, JAGD, a lawyer who had become well versed in medical organization and supply. Voorhees picked the other team members: Lt. Col. Bryan C. T. Fenton, MC; Lt. Col. Leonard H. Beers, MAC; and Mr. Herman C. Hangen, a civilian consultant to the surgeon general. All these men possessed extensive knowledge of medical supply distribution and depot operations; all earlier had helped reorganize the supply system in the United States.⁴¹

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COL. TRACY S. VOORHEES

Voorhees and his party left Washington by plane on 24 January 1944, all but Beers (who was to join the European Theater to direct stock control), under orders for sixty days of temporary duty. Once in the theater, and with the full cooperation and assistance of Hawley and his staff, they visited the Supply Division at Cheltenham, inspected depots, and talked with US Army medical officers of the Services of Supply and the air and ground forces. Very rapidly they learned the dimensions of the medical supply crisis. "Within 10 days," Voorhees recalled, "our team unanimously reached the conclusion that only a complete reorganization, undertaken immediately, would make it possible to furnish needed hospitals and medical supplies for the invasion." Breaking off any further gathering of evidence, they returned to London to report to Hawley.⁴²

On 7 February the Voorhees team met with the chief surgeon to discuss not only the findings but also a plan for improvement. Voorhees and his colleagues disavowed any intention to "fix fault or blame," and they acknowledged Hawley's "entire executive authority and responsibility" and his complete freedom to accept or reject their proposals. However, "to the extent that the program involves bringing key people from the US, stripping The Surgeon General's Office and Depots of top-notch personnel in this field, we would not feel justified in recommending this unless the plan as a substantial whole is found acceptable by you." The group then told Hawley:

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The committee laid before Hawley a three-part program, patterned, they pointed out, on the measures that had solved similar medical supply problems in the United States fifteen months earlier. First, to lighten the depots' impossible work load, they proposed that 37,000 hospital beds almost all the general and station hospital assemblies needed before D-Day - and all the required medical maintenance units for the invasion be put together in the United States, where the surgeon general's depots now had ample stocks and manpower. The ETO depots then could concentrate on equipping tactical units and on the regular receipt, storage, and issue of supplies. Second, to establish effective stock controls, Voorhees' group proposed a streamlined but more comprehensive system of reports, the development of an SOP for depot operation, reduction of the number of issuing depots, and the creation of key depots to hold reserves of scarce items. Third, the delegation addressed quantitative and qualitative manpower deficiencies, confirming Hawley's long-standing belief that here lay the source of most of his other supply difficulties. They recommended doubling the Supply Division staff, to thirty-two officers and ninety-two enlisted men, and reorganization of the division into four functional branches: Administration and Finance, Stock Control, Depot Technical Control, and Issue. Voorhees and his colleagues urged relief of Colonel Perry "without reflection upon him," and Perry's replacement with Col. Silas B. Hays, MC, who was then head of the Distribution and Requirements Division in the surgeon general's office. They presented the names of other qualified officers whom General Kirk was willing to send from the United States to the European Theater if Hawley requested them. The Voorhees group also recommended that the existing on-the-job-trained depot complements be retained and organized in permanent units, both to improve efficiency and to permit morale-enhancing promotions.⁴⁴

The chief surgeon without hesitation accepted all of the group's recommendations. To implement them following still another Voorhees proposal-he assumed direct supervision of the Supply Division, superseding his Cheltenham deputy. On 10 February, in a transatlantic teletype conference, the surgeon general's office agreed to all the main points, including assembly in the United States of hospitals and maintenance units and the assignment of Hays and the other requested officers. Hangen, Beers, and Fenton moved to Cheltenham, where they effectively took over the Supply Division, with the full cooperation of Colonel Perry, who stayed on as nominal chief until Hays arrived

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

in March. Colonel Voorhees remained in London, to work on permanent depot organization and begin a study of ways to reduce British procurement. The entire team spent February and March in sustained hard work, their efforts closely observed by General Kenner. The SHAEF chief medical officer received copies of Voorhees' reports and conferred on the supply situation with Hawley, Voorhees, and Colonel Fenton; but, as with hospital construction, he confined himself to supporting the chief surgeon's program.⁴⁵

Voorhees' men rapidly reorganized the Supply Division, establishing the four new branches. By mid-March thirteen of the officers promised by the surgeon general had arrived and gone to work. The division staff expanded to thirty officers, eighty-four enlisted men, and thirteen British civilians, and for the first time in the history of the theater the reinforcements were thoroughly qualified for their jobs. After earnest and repeated pleas from Hawley, General Kirk

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allowed the chief surgeon to retain Fenton as deputy Supply Divison chief. Hawley held onto Fenton partly as a possible replacement for Hays, who suffered a severe gastric attack early in May; but, to the chief surgeon's immense relief, his supply chief recovered and was able to resume duty before D-Day.⁴⁶

Depot reorganization went forward (Table 4). On 2 February Colonel Voorhees and the chief surgeon prevailed upon the ETO G-1 to halt all transfers of soldiers then working in medical supply depots. This action temporarily stabilized the depot force. After much negotiation between Hawley, Voorhees, and the theater G-1 and G-4, the ETO headquarters activated in Great Britain or called for from the United States eight additional field medical depot companies and assigned all depot personnel to them. While these field companies rarely matched in size and composition the requirements of any particular depot, and hence usually had to be divided among several installations, their establishment did end the transiency of depot personnel. They also provided an organization in which deserving soldiers could receive promotions.⁴⁷

Hangen and Beers revamped depot operations and stock record-keeping. To better control supply issues, they reduced the number of depots

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distributing to units from eight to five. They designated five key depots, each of which held the bulk of theater stocks of certain scarce items and filled requisitions for them passed on from issuing depots. A sixth key depot assembled and issued all tactical unit equipment. Other nonissuing depots performed maintenance and repair, received matériel from the ports, and stored reserve stocks. Hangen and Beers published a depot operations manual, establishing uniform issuing and inventory procedures that the Supply Division's Depot Technical Control Branch saw were carried out. They also set stock levels for each issuing depot, based on the number of troops it served, and redistributed on-hand matériel among installations to give each its proper allowance. To collect theater-wide supply information, Hangen and Beers replaced the three existing separate depot stock reports with a single comprehensive biweekly one. From this, the Supply Division, employing electric tabulating machines, compiled statistics on total supplies on hand and required. At the same time Hangen and Beers set a theater stock level of 75 days' supply of each item and provided for automatic reorder when quantities fell below that point plus an additional margin to allow for time taken in ordering and shipment. To bring all stocks to the 75-day level, the Supply Division placed large emergency requisitions on the New York port; it also sent initial orders for over 800 items in the surgeon general's catalog hitherto not used in the theater to reduce shipping requirements. With vessels and supplies now available, the European Theater thus expanded its supply table. By mid-May the ETO depots were well stocked, and the Supply Division knew what and how much was in them.⁴⁸

While his associates reorganized the depots, Colonel Voorhees surveyed the record of British medical supply. Reviewing the orders placed late the previous year for 1944 delivery, he and his assistants discovered that, of over 800 items involved, all but several varieties of dental burs either were in oversupply in the United States or were being shipped from America under Lend-Lease for British use. After much negotiation with the Ministry of Supply and the War Department, Hawley and Voorhees canceled most supply requests with the British except those for dental burs and a few nonstandard articles; they also retained arrangements for small local emergency purchases. The British either stopped production of the no longer wanted items or diverted them to their own forces. To assure more effective control of any additional buying within the theater, the chief surgeon, at Voorhees' suggestion, placed the London procurement office within the Supply Division's new Stock Control

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Branch, ending procurement's semi-independent status.⁴⁹

On both sides of the Atlantic, the Army Medical Department and the ETO medical service prepared to assemble and move equipment for hospitals containing a total of 35,000 beds. "This was roughly the equivalent," Voorhees pointed out, "of shipping about 12 complete New York City Bellevue Hospitals, except the buildings." By mid-March the surgeon general's office and the New York Port of Embarkation had worked out packing and loading schedules to ensure arrival of the required assemblies before the end of May. Combined with hospital assemblies requisitioned earlier, the matériel sent in response to Voorhees' special request would provide the European Theater with a large reserve of complete hospitals and components. In the United Kingdom the Supply Division, cooperating with port commanders, base section surgeons, and the Transportation Corps, established procedures for moving hospital assemblies directly from wharf to site, bypassing the depots and reducing the chance of units being broken up in transit. Under this system, between 30 March and 25 May, assemblies for twenty-nine 1,000-bed general hospitals and eight 750-bed station hospitals, as well as additional equipment for thousands of expansion beds, went from ships' holds to plants all over Britain with minimal loss or delay.⁵⁰

Colonel Voorhees and Hangen returned to the United States early in April, to report personally to Surgeon General Kirk and to supervise the dispatch of hospitals and maintenance units. They left behind a medical supply service well on the way to complete transformation-a transformation accomplished in a few months by effective leadership, sufficient manpower, first-class priority for ETO requirements, and high-level command attention. By mid-May the depots possessed full, balanced stocks. The First Army, which would make the assault, had all its medical equipment in hand. The depots were packing for over-the-beach disembarkation maintenance units to sustain the first two weeks of combat. Additional medical maintenance units at sea or in depots contained supplies for the period D+14 to D+90. Most of the operating fixed hospitals in

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Britain had received their full equipment and held at least sixty days of reserve supplies. Even the Air Force now relied for medical supply more upon SOS channels than upon its own. Three days before the invasion, a still-cautious Hawley declared: "We have just barely squeaked through on our supply. . . . I shall not, however, breathe really easily about it for another month." He had no further cause for worry. ETO medical supply, as reorganized by the Voorhees mission, was ready for war.⁵¹

Mounting the Attack

Preparations for mounting NEPTUNE-equipping, organizing, and embarking the assault troops and reinforcements so as to ensure their arrival on the far shore in the right order with the right materiel merged with the final stages of invasion planning. For its part in this process the medical service selected, assigned, and completed the training of army and COMZ units, equipped them, and packed their supplies. It furnished treatment and evacuation to troops assembling for embarkation, and it prepared to receive and care for wounded from the opening battle in Normandy.

During the final months before D-Day the surgeons of the First and Third Armies, Advance Section, and Forward Echelon, in consultation with General Hawley, developed medical troop lists for their respective commands. The ETO headquarters then assigned the requested units from the huge pool accumulating in the United Kingdom. The First Army's preinvasion allocation included one 750-bed and ten 400-bed evacuation hospitals, five field hospitals, a convalescent hospital, headquarters of three medical groups and eight medical battalions (separate), a medical gas treatment battalion, an auxiliary surgical group, a medical laboratory, a medical depot company, and eleven collecting, six clearing, and seven ambulance companies (separate). These units underwent personnel augmentations and rearrangements. To provide ready replacements for invasion casualties, medical elements of the engineer special brigades and of the assault and early buildup divisions received extra officers and men above T/O strength. Army mobile hospitals transferred doctors to balance their professional staffs. First Army field and evacuation hospitals had the painful task of replacing 95 veteran nurses who were considered too old or physically unfit for active campaigning.⁵²

The Advance Section and Forward Echelon also received their full allotments of units before D-Day ADSEC included over 1,800 medical officers, 2,300 nurses, and 16,000 enlisted men when the campaign began.

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Unlike those attached to the armies, most units assigned to the Communications Zone were operating fixed installations in Great Britain or had marshaling and casualty reception duties that would continue until embarkation; hence, they remained under base section control, except on matters directly connected with preparing for continental operations-a dual command chain that forced unit staffs to thread their way among duplicate, occasionally conflicting, directives and reporting requirements. Especially in selecting the twenty-five ADSEC and FECOMZ general hospitals, General Hawley recommended SOS units for early shipment to France on the basis of superior performance in Britain. He angrily deleted from the list one general hospital that he found "inexcusably dirty and disorderly" on a pre-D-Day Visit.⁵³

Medical units designated for early movement to France added instruction and exercises in amphibious warfare and field operations to their already crowded training schedules. The First Army, at Colonel Roger's recommendation, attached medical battalion elements to combat units early in the attack preparations so that the medical troops and the battalions they were to support could go together through the entire invasion training sequence, including the amphibious landing exercise at the army's assault training center on the Devon coast. COMZ organizations usually trained at their stations, supervised and inspected by their assigned headquarters. They also sent key people to special courses. Commanders of the twenty-five ADSEC and FECOMZ general hospitals, for instance, attended a five-day school on erecting the expeditionary tented-hutted plant. First Army and COMZ medical elements participated together in the final division and corps invasion rehearsals covering the entire process of marshaling, embarkation, and assault-TIGER, held late in April for VII Corps; and FABIUS, in early May, for V Corps and the initial buildup force. During TIGER U.S. Army medical units had real casualties to handle, the result of German torpedo boat attacks in the Channel that sank two LSTs and severely damaged a third, with the loss of some 700 American lives. At Portland-Weymouth, in an unplanned but effective test of the system for receiving wounded from France, the 33d Medical Battalion, its attached ambulance and sanitary companies, and the 50th Field Hospital efficiently met the emergency under "particularly trying and difficult conditions."⁵⁴

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Equipment and supply of the assault and early buildup units required cooperation between the First Army and the chief surgeon's Supply Division. On the basis of a First Army study of assault requirements, the Supply Division issued supplemental equipment, above T/E allowances, to army medical units of all types. In spite of duplicated and misdirected shipments, the result of frequent unit movements during marshaling, most First Army organizations had received their extra allotments, as well as nearly 100 percent of their authorized equipment, before they embarked, a tribute to the effectiveness of the newly reorganized depots. Amphibious packing received careful attention from all echelons. The Supply Division distributed standard watertight shipping boxes to First Army field and evacuation hospitals and sent an officer to advise units on how best to protect their matériel against the hazards of sea, weather, and battle. Army units prepared thousands of hand-portable assault supply containers, each a waterproof cylinder 21 inches long and 9.5 inches in diameter, originally used to ship 60-mm. mortar shells. Each case, with a carrying strap attached and painted with a Red Cross in a white circle, weighed about 14 pounds when filled with first aid dressings, sulfa crystals, dried plasma, and other small items. Each container would float, serving the medical soldier hauling it as a life preserver that he could take inland with him as he advanced or could drop on the beach for later retrieval. Eight such cases constituted a single unit of these supplies, and every battalion or company received an allowance of units. The 4th Infantry Division landed with 285 of these cases, containing over 3,500 pounds of supplies.⁵⁵

Following theater policy, the Supply Division loaded all scheduled maintenance supplies for the first sixty days on standard wooden skids, each a sled-like device weighing about 1,700 pounds with cargo, designed to be dragged across beaches and stored in open-air depots. By 8 May medical depots had finished loading these supplies for D-Day through D+15. Piled onto 955 skids, this matériel included ninety-two surgical and twenty-two medical division assault units and twenty regular maintenance units, as well as other freight. General Hawley, meanwhile, secured from the Ninth Air Force a guarantee to airlift daily across the Channel 4,000 pounds of blood, penicillin, and other perishable items, which Depot G-45 at Thatcham was to pack for emplaning at a nearby Army airfield. Late in May the theater blood bank began collecting and processing; its detachments made their first deliveries, over 1,100 pints, to LSTs and hospital carriers. The latter vessels, fitting out at English, Scottish, and Welsh ports, took on blood and biologicals, both

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for their own use and to supply the beachheads.⁵⁶

To embark the 130,000 troops and 17,000 vehicles of the assault and initial buildup forces, the US Army used a system worked out by the British early in the ROUNDUP planning. Under it each organization, in prearranged sequence, went from its permanent station through a concentration area to a dockside marshaling camp. In the course of this movement the unit dropped off men and matériel not needed for the attack, waterproofed its vehicles, and picked up assault equipment. Finally, in a marshaling camp sealed off by barbed wire and security patrols, the unit received its mission briefing and organized into ship and landing craft loads. The First Army directed these troop movements and the embarkation, while the Services of Supply built and manned the concentration and marshaling camps and provided messing, medical, and other administrative support for the combat units passing through them. The SOS headquarters, in turn, delegated most mounting tasks to the Southern Base Section, which embarked the OMAHA and UTAH seaborne attack forces and the glider elements of the airborne divisions, and to the Western Base Section, which loaded the first buildup divisions and the airborne paratroopers. Medical support for the mounting, accordingly, rested principally with Col. Robert E. Thomas, MC, the Southern Base Section surgeon, and Col. Mack M. Green, MC, the Western Base Section surgeon.⁵⁷

Medical support provisions for the embarkation were limited and straightforward. In the marshaling camps the base sections established medical supply points to make emergency pre-embarkation issues and over 150 camp dispensaries, each staffed with 1 officer and 4 enlisted men, to serve units that had dropped off or packed up their own medical detachments. Most of the officers and men for these dispensaries, and for 24 mess teams that helped feed the transient soldiers, came on temporary assignment from station and general hospitals throughout Great Britain. From the same sources the Dental Division of the chief surgeon's office assigned a dentist and an assistant to the marshaling camps for each 3,000 troops, to do last-minute fillings, extractions, and prosthesis repairs. Taken as they were from fixed hospitals, many of these temporary camp doctors had little experience and only brief predeployment training in field medicine and sanitation.⁵⁸

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The abilities of the camp surgeons, fortunately, were not sorely taxed. Marshaling and embarkation began early in May, after General Eisenhower set D-Day for 5 June, and went forward with no major enemy harassment and, from a medical standpoint, few problems. As planned, the embarking troops enjoyed hot meals of fresh, tasty food. They donned uniforms treated to resist gas and picked up seasickness preventives, insecticide powder, and water purification tablets. They heard a final one-hour preventive medicine lecture that emphasized proper eating habits, personal cleanliness in the field, and precautions against venereal disease. In many marshaling camps, sanitation left much to be desired-the result of inevitable carelessness among transient soldiers and of mistakes by the hastily assembled, sketchily trained camp and mess hall staffs. Base section preventive medicine officers, aided much of the time by Colonel Gordon and members of his division, quickly corrected these deficiencies, although lapses in mess hall cleanliness caused a few battalion-wide outbreaks of diarrhea. Filing a gap in the planning, Gordon's officers devised a system for feeding hot meals to troops held for hours on the docks by embarkation delays. One anticipated problem did not develop. The base section surgeons, expecting a rash of preinvasion emotional disorders, assigned psychiatrists to the marshaling camps. Few cases appeared, and the psychiatrists spent their time giving impromptu short courses in battlefield neuropsychiatry to unit medics.⁵⁹

As the Army embarked, the medical service completed its preparations for receiving invasion casualties (see Diagram 2). The chief surgeon's office and Southern Base Section, working closely with the British Southern Command, drafted plans for this operation, which was a complicated task in itself. Under the final plan, published in mid-March, evacuation LSTs and hospital carriers were to unload American wounded at three Channel coast ports: Brixham, Portland-Weymouth, and Southampton. The arriving patients were to undergo two stages of triage and emergency treatment. Holding units at the docks and hards (concrete ramps at which LSTs could load and unload through their bow doors) were to give surgical treatment to men tagged by LST doctors as requiring immediate attention before further transportation. The rest of the patients were to go by ambulance directly from the ships to transit hospitals, designated station and general hospitals 15-30 miles inland. These hospitals again were to separate out wounded who were unable to travel further and prepare the transportables for rail movement to general hospitals for definitive

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DIAGRAM 2

treatment. Port evacuation officers, under the base section surgeons, were to direct patient movements as far as the transit hospitals; transfers beyond that point would be controlled by the chief surgeon's office. During the first days of combat, when the beachhead was shallowest, this system not only would enable holding units and transit hospitals to assume many functions of division clearing stations and army evacuation hospitals but also would keep wounded flowing from the coast to the large hospital centers in the north and west of England.⁶⁰

The medical service tested this evacuation plan in two exercises: CRACKSHOT, in February 1944, for movement of wounded into and out of transit hospitals; and CADUCEUS, in April for unloading evacuation LSTs. Then the casualty reception forces deployed. At each of the three major receiving ports, and at many minor ones, the base sections established field hospitals under canvas or in requisitioned buildings to serve as holding units, often with platoons placed only a short litter carry from hards and wharves (Map 6). Separate medical

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MAP 6

battalions at Brixham and Portland and a gas treatment battalion at Southampton, each with sanitary, ambulance, and collecting companies attached, prepared to unload ships and transport patients between holding units and transit hospitals. Each battalion commander acted as evacuation officer for his port. Two more medical battalions, at Blandford and Exeter, held collecting, clearing, and ambulance companies in reserve for commitment at General Hawley's direction. At Ramsbury and Membury airfields, the nearshore terminals for cross-Channel air evacuation, still other field hospital platoon holding units and ambulance detachments awaited patients. Forty-nine units (nine field hospitals; one gas treatment and four medical battalions; and five sanitary, seventeen ambulance, four collecting, and two clearing companies), all temporarily detached from the Communications Zone and the field armies, made ready to receive wounded from Normandy.⁶¹

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To assist in casualty reception, treatment, and evacuation, the medical service improvised a variety of teams and special units. General Hawley drew almost 500 doctors and a comparable number of enlisted technicians from Third Army, the air forces, and station and general hospitals, to staff marshaling camp dispensaries, to form LST surgical teams, and to assist the 1st Auxiliary Surgical Group in reinforcing the staffs of holding units and transit hospitals. Hawley and the base section surgeons tried to distribute the burden of these details evenly, but some fixed hospitals suffered significant temporary losses. In the Eastern Base Section, for instance, the 303d Station Hospital, which treated Eighth Air Force battle casualties, had to give up 2 officers and 8 men for dispensaries, 2 mess sergeants and 31 enlisted people for marshaling camp details, and 1 officer for a district inspection team. To provide professional staffs for three of the British-crewed hospital carriers, the Evacuation Branch, lacking T/O units for this purpose, placed a hospital train unit and a medical hospital ship platoon on each vessel. The Western Base Section, needing a holding unit for two Welsh ports, improvised one by augmenting an engineer regiment's medical detachment with doctors from dispensaries in the marshaling camps.⁶²

The chief surgeon backed up his receiving units with reserves of transportation and supplies. General Hawley established a pool of 350 extra ambulances-American 3/4-ton vehicles not yet issued to units and surplus British Austins. He distributed these, and 18 bus ambulances, to the Southern and Western Base Sections to reinforce ambulance companies and transit hospitals. The Evacuation Branch, unable to obtain any more home ambulance trains than the 5 then in service, persuaded the Ministry of Transport to adapt 10 overseas trains to run on British lines, ensuring enough rolling stock to keep the transit hospitals cleared. The Supply Division set up temporary advance depots at Plymouth, Torquay, Winterborne Steepleton, and Lockerley in the Southern Base Section. Besides holding reserves needed by the hospitals, these dumps, and others on the docks and hards, stored Navy supplies to replenish evacuation LSTs. They also contained exchange units

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of stretchers, blankets, and splints, designed and assembled jointly by the Supply Division and the Western Naval Task Force to prevent the planned near-total evacuation policy from stripping the beachhead of these vital items. LSTs were to deliver 300 of these units-containing in all 30,000 litters, 96,000 blankets, and quantities of splints and plasma-to Normandy on their first and subsequent voyages. Permanent Southern Base Section medical depots accumulated still more supplies of all classes, among them most of the theater's available oxygen cylinders, stockpiled for possible use in treating gas casualties.⁶³

Fixed hospitals made preparations of their own. The eight station and four general hospitals assigned to transit duty cleared out patients, streamlined admission and evacuation procedures, and trained extra ambulance drivers and litterbearers. To provide more transit beds at Portland-Weymouth, where most wounded were expected to arrive, the 12th and 109th Evacuation Hospitals, detached from the Third Army, established a temporary expeditionary tented plant. General hospitals, prodded by Hawley and his consultants, sped up the return of convalescents to duty and increased the number of eligible patients evacuated to the United States. By 1 June the Southern Base Section had available for invasion wounded over 10,000 beds in transit hospitals and 18,000 more in regular station and general hospitals.⁶⁴

By 3 June the assault forces had embarked. After a 24-hour delay caused by storms over the Channel and Normandy, the 5,000-ship invasion fleet set course for France, for a landing scheduled for first light on the sixth. For many medical troops in southern England not yet embarking or preparing to do so, the first notice that the long-awaited invasion was under way came on the night of 5 June, in the form of a sky filled with the navigation lights and engine sound of hundreds of planes heading for the airborne drop zone behind UTAH beach. For General Hawley, two years of planning and preparation had reached their goal and climax. "We are all set for the kick-off," he wrote after a final tour of his holding units and transit hospitals, "and I, personally, feel as nervous as players usually feel just prior to the whistle." The chief surgeon and his SHAEF superior,

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

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Endnotes

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	Last updated 8 June 2005