6 June 1944 - 25 July 1944

 

MEDICAL BUILD-UP

In the assault stage of the operation Field Ambulances landed with brigades and battalions as planned, and each beach group landed on D-day with a self-contained medical organisation comprising two Field Dressing Stations, two Field Surgical Units and a Field Transfusion Unit supplemented by small surgical teams.

With the exception of the right flank where the landings met opposition at LE HAMEL, field dressing stations were working and surgeons were performing operations in all the beach groups by H+90.

By D+2 it was possible to concentrate the Casualty Clearing Stations and the hospitals which began to arrive at the beach-head into three principal medical areas, HERMANVILLE, REVIERS and RYES.

By D+6 it was necessary to close down the area at HERMANVILLE to make way for the expansion of a neighbouring ammunition depot, and a new medical site was chosen at LA DELIVRANDE.

In the latter part of June a fourth area was developed near BAYEUX. The field dressing stations within the corps were situated near the casualty clearing stations and attended to the lightly wounded, exhaustion cases and sick, leaving the CCS clear to handle major casualties.

The hospitals in the rear medical areas received casualties from the corps CCS.

Early in July BAYEUX developed into the main L of C hospital area, and when HQ L of C took over administrative command of the bridgehead on 13 July it also took over the REVIERS concentration of hospitals.

The RYES area was closed down, and when, in the meantime, First Canadian Army assumed responsibility for the LA DELIVRANDE group, there remained two main hospital areas.

For most of July the Second Army hospitals remained static and in the latter part of the month closed in readiness to move forward.

EVACUATION BY SEA AND AIR

Casualty Evacuation Posts were established on each of the three beach sectors on D-day but enemy shelling caused the CEP (Casualty Evacuation Point) on SWORD sector to close down after the first few days, and all its casualties for evacuation were sent to the CEP on MIKE beach. Later the evacuation of casualties was further simplified by concentrating the casualties in JIG and MIKE beaches. This central CEP at COURSEULLES was enlarged and formed out of two FDS, two FSU and one FTU. It had accommodation for 1,500 casualties and held cases until shipping and weather permitted evacuation.

Evacuation to UK was carried out by means of LSTs modified to carry stretcher cases, hospital carriers and medically manned LSTs for walking wounded. These were loaded initially off-shore by DUKWS specially allotted for medical purposes.

On D-day and D+1 the rough sea made evacuation difficult and if a decision had not been taken to beach the LSTs, the evacuation of casualties would have ceased and the CEPs would have been overcrowded.

The policy of using medically adapted LSTs, and setting aside DUKWS for medical purposes worked extremely satisfactorily; there were, however, misunderstandings and difficulties concerning the arrival of hospital carriers. Eventually it became routine for an officer of the CEP to meet the carriers in a DUKW and guide them to the proper anchorage.

By 26 July 38,581 casualties (including sick) had been evacuated to UK by sea.

Evacuation by air began on 13 June which was a week. earlier than had been anticipated in planning.

Air evacuation was more uncertain than sea evacuation because the airfields on which suitable aircraft arrived changed constantly and there was always uncertainty as to the number of aircraft available. The problem was also complicated because no facilities existed on the air strip for holding casualties. Consequently no preparations could be made for evacuation until the aircraft had landed, and in a congested beachhead it was not always possible to deliver casualties at the air strip on time.

The necessity for dual documentation was another factor which caused a heavy strain on fighting units.

On 18 June ,however, the whole evacuation scheme was centralised under 11 L of C.

A Medical Air Liaison officer was attached to 83 Group RAF, 81 General Hospital, and later, 77 General Hospital at REVIERS was made the principal collecting centre for casualties to be evacuated by air, and a single air strip was selected for evacuation purposes.

RAF Casualty Air Evacuation Units began to arrive at this time and assisted in holding casualties on the airfield until aircraft were available. The holding capacity of these units was not large enough to deal with the numbers to be evacuated and on several occasions a FDS or CCS was sited to help out in this task. The number evacuated by air up to 26 July was 7,719.

MEDICAL STORES

There was no shortage of medical stores in the assault period and only minor losses of equipment occurred.

The system of supply over the beaches depended on the daily delivery of Medical Beach Maintenance Blocks, each composed of two half blocks weighing 25 cwts. and containing items of medical equipment designed to meet all reasonable demands until Advance Depots Medical Stores were established.

Two of these were sent over in split loads of five and ten tons between D+3 and D+10. This was considered necessary in view of possible sinkings. In addition six tons of medical equipment were preloaded on RASC transport to augment the medical maintenance blocks.

BLOOD TRANSFUSION

To meet the expected demands for transfusion fluids in the early days of the operation, the following arrangements were made :—

• Special issues of blood were made to the assault forces.
• Transfusion fluids were included in the maintenance blocks.
• FTUs landed with an estimated supply to last two days.
• Two Advance Blood Banks were landed on D+3 and allocated to each of the corps fronts.
• Supplies of whole blood were sent initially from UK by naval despatch launch and later from D+16 by air.

In a later stage of the campaign the two blood banks which had been allocated to the assault corps were put at the disposal of First Canadian and Second British Armies. These were supplied with blood from No. 1 Blood Transfusion Unit which landed on D+16 and set up at BAYEUX.

The supply to corps and divisional medical units was maintained by a daily service of trucks carrying blood from the army advanced blood bank. Penicillin was also distributed through the agency of the Blood Transfusion Service.

During this phase the following quantities of blood, plasma and penicillin were used : -

Blood . . . 18,000 pints
Plasma . . . 15,000 pints
Penicillin . . 2,400 mega units

EXHAUSTION

The incidence of cases of exhaustion rose steeply from the beginning of July (2.5 per 1000 per week) to the week ending 22 July (5.63 per 1000).

Enemy mortar fire was stated to be the main cause of the collapse of these psychiatric cases.

To deal with them Divisional Exhaustion Centres were opened, where casualties who could be quickly cured were admitted for four or five days. Corps Exhaustion Centres admitted casualties evacuated from divisional level for seven days’ treatment.

Beyond these at the Army Centres and at the Second Army Rest Camp men were treated and then given a period of convalescence.

Over 65 per cent of exhaustion casualties were returned to duty in the theatre. Of these 50 per cent returned to full duty, and the other 15 per cent to duty in a reduced medical category.

DENTAL

The employment of Mobile Dental Units at a distance of two or three miles in the rear of troops engaged in battle was fully justified, for the dentists were able to give treatment in the battle zone and retain the services of men of operational units, who would otherwise have been evacuated to the rear areas.

HYGIENE

The solution of hygiene questions did not present any serious difficulties. The water supply was not tampered with by the enemy, but required strict supervision. flies began to appear in large numbers and anti—fly precautions were improvised until fly-proofing materials arrived.

FEMALE NURSING

Nursing sisters began to arrive in the theatre from D+10 onwards. Their arrival was much appreciated because they improved the standard of post-operation treatment tremendously.

 

 

26 July-26 September

 

BUILD—UP OF MEDICAL BASE

In the early part of this phase the build-up of general hospitals continued in the medical area centred on RANCHY near BAYEUX. The personnel of hospitals arrived according to programme but the build-up was nevertheless disappointingly slow due to delays in the arrival of equipment.

This was shipped separately and owing to bad packing often proved deficient of small but essential items.

With one exception all hospitals at this stage were tented. The supply of Water was a major problem and even after a Water pipe line had been constructed Water carts were engaged full-time in delivering water within the hospital area.

Major medical installations in the bridgehead on 26 July amounted to twelve CCSs and nineteen general hospitals. In addition three Base Depot Medical Stores had arrived for the supply of medical equipment. By 26 September another seventeen general hospitals and two additional base depot medical stores had arrived.

One of the results of the slow build-up was that the policy of retaining patients in the theatre could not be carried out as early as it was Originally intended, and consequently during this period all patients who were fit to travel and who were unlikely to return to duty in one week were evacuated to UK.

MEDICAL LAYOUT PRIOR TO THE BREAK-OUT

Before the break-out First Canadian Army had two BRITISH general hospitals of 200 bed size at LA DELIVRANDE, which, aided by a 600 bed hospital at REVIERS, handled all casualties of l Corps.

2 Canadian Corps casualties went straight from the CCS area at ST GERMAINE to the main hospital area at BAYEUX. About 20 August the two 200 bed type general hospitals moved to the ST GERMAINE area which then became the nodal point for rearward evacuation from First Canadian Army. Second Army casualties coming back from FALAISE by-passed ST GERMAINE and Went straight back to BAYEUX.

In the main medical area Second Army hospitals remained closed in readiness to move forward.

MEDICAL LAYOUT AND CHANNELS OF EVACUATION OF CASUALTIES DURING THE PURSUIT

- FROM THE LINE OF THE SEINE

When the break-out occurred the evacuation line lengthened and a period of rapid movement and development of an air shuttle service began.

The battle of CAEN in August threw a great strain on the available number of hospital beds, but after the collapse of the enemy at FALAISE the picture changed completely. The heavy spate of casualties was for the time being finished but nearly 5,000 civilians were transferred from CAEN to other civilian hospitals, which movement fully occupied the ambulance car companies.

During the pursuit although only small rearguard actions were fought a great strain was put on the chain of evacuation: the great difficulty at this stage was lack of transport to bring hospitals forward sufficiently early.

This lack of transport was common throughout the Services and was inevitable in view of the nature of the operations.

As far as FALAISE and just beyond, all corps casualties were cleared by ambulance car company to BAYEUX. As the distance increased it was necessary to introduce staging posts and to obtain extra assistance from 227 MAC (8 Corps).

By the time the SEINE was reached the distance was far too great for large-scale evacuation by road, though a few cases were staged back via RUGLES and FALAISE. Most of the cases, however, were held by the general hospital which had opened at CAILLOUET until they could be evacuated by air from EVREUX.

On 5 September an ambulance railhead opened at MEZIDON, but four days later moved forward to LISIEUX.

Daily ambulance trains were organised from there to BAYEUX.

- FROM NORTHERN FRANCE AND BELGIUM

During the pursuit to the DUTCH frontier hospitals moved rapidly along the axes of both of the armies and by continually leap-frogging each other, ensured that the major medical services were always within reach of the forward troops and obviated the need for evacuating over long distances.

After the advance had gone beyond the SEINE and until BRUSSELS was reached, the chief method of evacuation was by Sparrow aircraft to the BAYEUX area, (the Sparrow flight consisted of six obsolete bomber Harrow aircraft).

The first air evacuation centre was at EVREUX, but this was soon moved forward to AMIENS where patients awaiting evacuation were held in the general hospital.

A few casualties were also evacuated from AMIENS by road to ROUEN, where a base hospital was established and a small number were sent by air from AMIENS direct to UK.

When BRUSSELS was reached there was at first only one way of evacuating and that was by air. Most of the cases went by Dakota aircraft to UK or were ferried by Sparrow to AMIENS. At a later stage casualties were despatched from BRUSSELS by rail.

When the DIEST area was opened the air shuttle evacuation service operated from DIEST to BRUSSELS and at the end of September was extended to EINDHOVEN.

The main method of coordinating casualty air evacuation was by direct liaison between DDsMS armies and the senior medical officers with the RAF groups. So rapid was the advance and so far were the corps removed from HQ Second Army that the DDMS had great difficulty in keeping the RAF fully informed of his requirements.

During the latter weeks of this phase steps were taken to set up a medical area at DIEPPE and later at OSTEND.

Evacuation WEST of the SEINE was planned to cease on 16 September when a daily hospital carrier service to UK from DIEPPE was instituted, but in fact it continued for approximately another week to enable the hospitals in BRUSSELS and AMIENS areas to be cleared in time to receive the expected heavy casualties of the ARNHEM airborne operation.

-EVACUATION FOR OPERATION MARKET GARDEN

The medical scheme for this operation reverted to the policy adopted in the beachhead of evacuating casualties from the theatre as quickly as possible. By 17 September two hospitals, both of 200-bed capacity, were established at DIEST, While another stood prepared in BRUSSELS, available either to open in an emergency on to move forward. A FDS was established in the DIEST area to assist the two hospitals.

The staging of casualties back to the medical area was under corps arrangements, while to assist in handling US airborne sick and wounded, an AMERICAN evacuation hospital and ambulance company was sited at BOURG LEOPOLD.

The holding capacity of the Second Army medical units when operation MARKET GARDEN started was far below that required to accommodate the estimated influx of casualties.

To overcome this problem of limited hospital accommodation 500-700 casualties were evacuated-daily by air from BRUSSELS to UK, and in addition a rail lift to AMIENS for 200~300 daily was organised.

An ambulance train formed from recaptured BRITISH and BELGIUM stock and staffed by BELGIAN Red Cross personnel made its first run from BRUSSELS to AMIENS on 20 September. To help in the evacuation of forward areas an additional ambulance car company was put at the disposal of the DDMS Second Army for the operation.

CASUALTIES EVACUATED TO UK

During this period a total of 26,039 casualties was evacuated to UK by sea and 20,964 by air.

WOUNDED PW

Many concentrations of wounded PW were over-run in BELGIUM. PW hospitals were opened at AMIENS, BRUSSELS, ANTWERP, and later at BOURG LEOPOLD, staffed by collecting all available GERMAN protected personnel.

STORES AND EQUIPMENT

When the move forward began the advanced depots medical stores were re-sited in accordance with the new positions of the corps which each served, but the system of supply based on geographical layout had to be altered to meet rapidly changing conditions.

The advanced depots medical stores could not move at the speed required to maintain a satisfactory supply system.

To overcome this, mobile elements were formed from the depots, consisting each of two three-ton lorries and a supply of medical equipment.

The mobile element was attached to the forward CCS of the corps normally served, and proved a satisfactory answer to the problem.

Following the battle of the FALAISE gap the moves of the advanced depots medical stores were long and frequent. One was retained at AUBIGNY to supply units in the rear, while the others were “leap-frogged” forward into BELGIUM. Two of those depots moved up to NIJMEGEN and EINDHOVEN in support of the MARKET GARDEN operation.

Depots were based for maintenance on base depots medical stores at BAYEUX and at DIEPPE.

GENERAL HEALTH OF TROOPS

Towards the end of July and in the early days of August there was a marked increase in enteritis and diseases of the digestive system. This was undoubtedly caused by the large increase in the fly population, due to the very crowded conditions in the bridgehead, and to the existence of hundreds of unburied carcasses of cattle.

In September as troops moved forward into unsoiled ground there was a distinct drop in the incidence of enteritis. A certain amount of malaria made its appearance, some of which was probably caused by troops transferred from the ITALIAN theatre.

The rate of VD rose from .43 per 1,000 per month in August to .74 per 1,000 per month in September.

An outbreak of typhoid fever which was immediately localised occurred in HQ 6 Guards Tank Brigade.

Seventy-three cases were reported up to 26 September, all from Brigade HQ.

This was the only real epidemic of the campaign so far and was believed to be due to a carrier in contact with the HQ personnel.