Aeromedical Operations in North Africa and the Mediterranean

The AAF faced its most difficult aeromedical challenge when the Allies attacked Adolf Hitler’s “Fortress Europe,” first from North Africa and then from Great Britain. Many AAF medical personnel joined the fighting abroad with little or no specialized training in wartime or aviation medicine. The early AAF medical problems vindicated General Grant’s insistence on AAF medical autonomy. The size of the Mediterranean theater often forced Army and AAF units to deploy to different places, making it impossible for AAF medics to depend on regular Army supply facilities and hospitals. Although the theater commander quickly saw the need to hand over some Army medical facilities to the AAF, AAF combat units had no hospitals close to the front until March 1943. No Army hospitals were located east of Algiers, and that created a critical hospital shortage for AAF units advancing into Tunisia. After March 1943, the Army finally assigned the AAF one evacuation hospital in Constantine, Algeria. But the first Army hospital truly attached to an AAF unit was the 34th Station Hospital, established in June 1943.

As the Allies forged ahead to southern Italy and the islands of Sardinia and Corsica, the Surgeon of the North African theater agreed that Army fixed hospitals should be attached to AAF units. This allowed the AAF commander-in-theater to move the hospitals as needed without coordinating the moves with the overall theater headquarters. Between 1943 and March 1945, more than ten Army hospitals were attached to the AAF in the Mediterranean region. This remedied many AAF medical administration problems. Starting in March 1944, Army medics in the attached 16 hospitals could no longer reclassify airmen patients for limited duty only; all such patients and their records returned to the AAF unit commander.

Serving the Twelfth and Fifteenth Air Forces, the attached hospitals operated under the AAF Service Command, which in July 1944 was authorized to deal directly with supply authorities in the United States rather than go through the Army SOS in theater to obtain medical supplies. In effect, the AAF soon set up its own medical service distinct from that of the Army but acting in harmony with it.

These reorganizations, however, failed to prevent many medical difficulties at the remote air bases in theater. No AAF medical dispensaries were available in 1942, and much time and effort were needed to improvise satisfactory medical support at each air base. In the summer of 1943, laboratory equipment for examinations finally arrived in theater, and refrigerators, heating units, and beds were fashioned from scrap metal.

Flight surgeons started to fly a few missions to get a feel for aerial combat, and the diagnosis “flying fatigue” emerged for aircrews whose efficiency declined after a long or intense period of combat. Nervous disorders accounted for most of the flying casualties in the Twelfth Air Force from November 1943 to May 1944. These problems continued among overworked and overstressed AAF fliers throughout the war, in all combat theaters. The problem was not new or unique to the AAF. It had been identified in World War I among ground troops as “shell shock” and “war neurosis.” But the problem had some unique features, AAF medics found, when it appeared among a group of specially selected, well-trained, highly intelligent aerial warriors. AAF psychiatrists had to devise some new procedures to diagnose the problem, distinguishing it from true cowardice, and then treat it effectively. Prevention depended on proper leave policies, and treatment later involved leave at special AAF rest homes.

In North Africa, young AAF crewmen gradually learned the value of preventive measures for their mental and physical health. One bomber tail gunner who had never worn his protective helmet on forty-three previous missions was on a combat run near Rome when he finally decided to put his “steel pot” on his head. No sooner had he put on the helmet than a burst of flak destroyed his right window, knocking his helmet spinning from his head. He received multiple slight lacerations on the back of his neck from the Plexiglas. His helmet showed three distinct, large, deep dents in the right-posterior quadrant. One large fragment of flak was recovered from the floor. It was believed that the steel helmet saved the gunner from a penetrating wound of the head that would have been fatal. The helmet was placed on display on the squadron operations board to stimulate use of the steel helmet by other combat servicemen.

Air operations in North Africa also involved the successful use of air transport to move medical assets to the front. In July 1943, during the invasion of Sicily, the AAF flew in a 50-bed hospital from North Africa. The hospital was set up and receiving patients just two-and-a-half hours after troops unpacked it from the cargo planes. Air transport began to show promise as the quickest way to deliver a medical facility to forward troops. Despite difficulties, AAF medics and crew members were learning to cope.