The Normandy Campaign - an eyewitness account

(actualisé le ) by Henri Reinhold

A fascinating eye-witness account published in December 1995 in the Belgian medical journal La Revue de la Société Internationale d’Histoire de la Médecine by our very-much-regretted uncle Henri Reinhold, relating his campaign with a Belgian medical unit in Normandy throughout the month of August 1944 up to their triumphal entry into Brussels on the 4th of September.

With a number of remarkable photographs and maps. A must!

The original French-language text is included in an annex below.


TABLE OF CONTENTS

1. The Belgian land forces in Great Britain
2. The departure for Normandy
3. In action in the field
4. The end of the campaign
5. 50 years later
6. References
7. Biographical notice



1. The Belgian land forces in Great Britain

The Belgians who fought in Normandy were grouped into the Piron Brigade, named after their commander. Its composition is shown below.

THE PIRON BRIGADE

2,200 men — 500 vehicles

- 3 units of motorised infantry
- 1 artillery battery
- 1 squadron of armoured vehicles
- 1 engineering company
- 1 "Train Brigade" (provisioning)
- 1 "Light Aid Detachment" (mobile workshop)
- the Brigade’s medical service

Each unit of the brigade had a doctor and stretcher-bearers/male nurses who, in action, installed an advanced first-aid position, a "Regimental Aid Post" (RAP). But there were also purely medical units. The "Belgian Field Ambulance" had the mission to transport wounded men from the advanced first-aid posts to an "Advanced Dressing Station", a better-equipped relay station. There had also been created a "Belgian Field Surgical Unit" (FSU) and a "Belgian Field Transfusion Unit" (FTU). These last two units are the subject of this exposé.

As its name indicates, the FSU was a surgical unit. In the British military medical organisation the first surgical work was deployed at the level of the Army Corps, except for interventions of extreme urgency such as tracheotomies, the closing of an open pneumothorax and amputation of a destroyed member. The Belgian forces only having the effectives of a brigade, the FSU and the FTU were detached to the Army Corps of the brigade. They were thus completely integrated into the "Royal Army Medical Corps", and the Belgians who were treated there only constituted a minority of the wounded men.

What was an FSU exactly? It was a reinforcement surgical team destined to increase the work capacity at the first surgical level, the "Casualty Clearing Station" (CCS), when the situation called for it. It was designed to be entirely autonomous for its medical functions. The personnel was composed of a surgical officer, an anaesthesiologist officer, 5 male nurses, 3 drivers and an orderly. The unit had its own set of vehicles, consisting of a personnel car called a "staff car" and two 3-ton trucks. The equipment included an operations tent, a hospitalisation tent for 20 wounded men with all the bedding necessary and even an electricity generator. The material transported was sufficient for a hundred operations. The structure of these units enabled a great deal of flexibility in the organisation of the field work.

Doctor Alfred Dumont (1903-1966) was the driving force behind the creation of a Belgian FSU. This eminent colleague is always present in the memory of very many Belgian doctors, given the richness of his professional career. In the after-war period he was one of the surgeons who introduced intrathoracic surgery to Belgium. Among his later important functions one can mention his role as Director of the Department of Thoracic Surgery at the St.-Pierre Hospital in Brussels. He was also Director of the Blood-Transfusion Centre of the Belgian Red Cross and administrator of the Acta Chirurgica Belgica. Alfred Dumont had begun his training in surgery in 1933 in the department of Professor Albert Hustin at the Brugmann Hospital. Durning the campaign of May 1940 he was in command of an ambulance of the First Army Corps. Taken prisoner, he escaped and took part in the resistance movement. In 1942 he undertook to escape to England. Arrested in Spain, he was interned for 5 months in the sinister Miranda prison in Ebro where 2,000 Spanish and foreign prisoners were held in horrible conditions. In January 1943 he finally arrived in Great Britain. Wanting to contribute his surgical experience to the Allied cause, he worked for the creation of an FSU. For this an anaesthesiology specialist was necessary, a specialty unknown in Belgium at the time. Being myself a doctor with the Belgian forces in Great Britain, I solicited leave to undertake rapid training in this discipline.

The Belgian FSU was thus organised in the beginning of 1944 and the men were trained in the assembly and disassembly of the installation while waiting to pass into action.

An FTU consisted on the other hand of a medical officer, one or two technician-soldiers and a driver. It disposed of a truck equipped with refrigeration units. The officer of the Belgian FTU was the Second Lieutenant Roger Linz who, after the war, became Director of the Laboratory of Bacteriology of the St.-Pierre Hospital in Brussels. The decision to create this unit having been taken somewhat late, the specialised vehicle hadn’t been completely equipped, but the unit could go into action by integrating another existing unit.


2. The departure for Normandy

At the end of May 1944 the great offensive being prepared seemed imminent to me. Suddenly, the hospitals were refusing admission to non-urgent cases, which indicated the constitution of a reserve of available beds. After the news of the landing of June 6, many Belgian soldiers became extremely impatient. But if the Brigade had been launched with the early assault waves, I would no doubt have had less chances of being able to write up this account today.


Fig. 1: the route followed between Tilbury and Bruxelles

On the 29th of July the order arrived to get underway to join the 21st Army Group of the British Liberation Army. Military action requiring absolute secrecy, we had no idea of how the expedition would take place. But the movement of what was comparatively just a minor contingent was far from being a slight affair. We were first transferred to a transit camp. The 2,200 men and 500 vehicles were then methodically embarked in the Thames port of Tilbury (fig. 1) on four "Liberty Ships", cargos of 10,000 tons built in great series by the powerful American industry. The four ships then moved some fifty kilometres to the east to Whitstable where they occupied their designated place in the convoy being formed there (fig. 2).


Fig. 2: Officers and men of the Health Service on the transport Ship Henri Austin, gathered for instruction on life belts.

On the 6th of August, escorted by warships, the convoy raised anchor and traversed the 400 kilometres up to the coast of Normandy. The arrival at the artificial port of Mulberry B, built by the Admiralty at Arromanches, was a quite sensational discovery for us (fig. 3). The landing, that I had imagined to be hazardous and difficult, passed with the most astonishing simplicity. We accosted at a large floating dock. Some vehicles went over boarding ramps onto the dock; others were transferred by cranes with an impeccable precision and in perfect serenity. From the dock, floating piers about a half-kilometre long brought us to firm land. That all took place in an impeccable calm, like an ordinary technical operation, but not without an intense emotion at having set foot on this little zone of freshly reconquered territory. The strong emotion was rapidly overcome by the sight of notices full of typical Anglo-Saxon humour. During the crossing we had all been wearing life belts. At the landing we passed in front of a sign with the inscription "Put your May West down here". In the military jargon the life belt had this other name, evoking the American actress whose anatomical profile rendered her so popular. A little further on there was another note of humour: a panel was planted beside the trail indicating the directions to Paris and Berlin.


Fig. 3: Schema of the artificial port Mulberry B.: a) floating break-water dikes; b) barrage of sunken ships, including the cargo "Belgium"; c) barrages of sunken cases; d) docking wharves; e) floating entry piers; f) the entry channel to the port.

The Belgian fighting units were placed under the orders of the 6th Airborne Division, that had suffered heavy losses during the previous two months. Our two medical units were sent to a field hospital of the same Army Corps, the 33 CCS of the 1st Army Corps, installed near the village of St. Jean des Essartiers, in a "Medical Area" in association with three other medical units. I had imagined a field hospital in a combat zone as inevitably disorganised and rather dirty. In our itinerary from Arromanches a dense traffic on a very limited number of dirt roads had continually raised dense clouds of dust. Falling on the surrounding vegetation that had given the countryside a uniformly dull gray colouring. The hospital, that had been installed in a field apart from the crowded roads, was in a marvellously green environment. The many tents were impeccably aligned and harmoniously distanced. One could see no detritus nor any sort of garbage abandoned on the ground. The first visual contact evoked a truly aesthetic emotion in us, little compatible with the circumstances of the moment.


3. In action in the field

We were right away put to work. The ambulances delivered the wounded to the tent called "Resuscitation". This was at the same time a sorting station and a reanimation chamber. The patients underwent a detailed examination. Those who could continue further without risk were evacuated to England. The wounded needing preliminary surgical treatment were retained and were eventually reanimated.

The term reanimation makes us think of our current intensive-care units. But in 1944 the many means now available for monitoring, diagnostic investigation and therapy were mostly unknown. The state of the patient was essentially evaluated by the aspect of the skin, the frequency and the quality of the pulse and the blood pressure.

In the therapeutic domain, respiratory reanimation was inexistent. For emergency artificial respiration the methods of Schäfer, of Sylvester, of Holger-Nielsen and of Eve were taught. The first three depended on manoeuvres of compression of the thorax or of its aggrandisement by tractions on the members. In the method of Eve, the patient, tied onto his stretcher, was turned on an angle of 60° at the rate of 20 times a minute. These methods had no veritable efficacy and survival could only result from a precocious, spontaneous recuperation. The methods of artificial respiration by positive intermittent pressure that are generally used today were only developed in the nineteen-fifties by American study groups. Sophisticated machines had in fact already been developed in research centres or in advanced surgery, but these hadn’t penetrated into general practice in 1944.

Nikethamide, ephedrine and vasopressors were used as analeptics, but the only catecholamine available was the precious adrenaline. The therapeutical arsenal included oxygen canisters and excellent oxygen-therapy masks.

The wounded in a state of shock were often placed under heated bridges. These were arcs forming a half-cylinder whose interiors were lined with electric lamps. The classic description of the state of shock was paleness, cyanosed extremities with cold and moist skin. External heating was believed to be beneficial. However, in medical literature, authorised voices had already warned against an excessive reliance on external heating.

In reality the essence of the reanimation procedure was of a circulatory nature, i.e.- intra-venal perfusions and transfusions. The needs in this regards were always magnificently covered. The doctors of the "Resuscitation" tent observed the effects of this therapy and decided if there was sufficient improvement to enable operability.

Despite the absence of current means of monitoring and of veritable respiratory reanimations, the "Resuscitation" tent played a considerable role in saving the lives of the wounded. One should remember that a major cause of precocious mortality in the front lines in 1914-1918 was haemorrhagic shock. It was in 1917 that transfusions began to be practiced on a large scale and it was after that that gravely wounded men managed to survive, resulting in the large numbers of war invalids.

In 1944 blood transfusions were widely practiced in Belgium. It was moreover our compatriot Albert Hustin who discovered the method of conservation of blood by citrates. However, adequate solutions for intra-venal perfusions, conforming in particular to the criteria of the absence of pyrogen, were not obtainable and only sub-cutaneous or intramuscular injections were carried out. One cannot adequately pay homage to the efficiency of the transfusion units. Teams were in action as of June 16, 1944k and a blood bank was operational in Normandy from June 11 onwards. Deliveries, carried out by boat and by air, covered an average consumption of 400 bottles per day.

Once considered operable, the wounded man was sent to the operations tent according to the priorities that had beed determined.

For anaesthetics we disposed of three products: thiopentone or Pentothal, ethyl chloride and ether. Pentothal had been introduced in the USA in 1935 but was still unknown in Belgium in 1944. It was used for induction of narcosis on all of the patients and was often as the only aesthetic agent: in this case the initial injection by needle was often followed by a continuous drip of a solution at 0.4%. For more important operations the main anaesthetic was ether, as was also the case elsewhere on the European continent. But the method of administration was very different.

On the continent the Ombredanne apparatus, that had been described by that author in 1908 was generally used, of a very primitive conception and with an extremely imprecise dosage. In addition its functioning necessitated the re-inhalation of a portion of the expired air with a consequent augmentation of the rate of CO2 in the blood. That produced a hyperventilation that was awkward in abdominal surgery. The apparatus with which we were equipped was the Oxford Vaporiser (fig, 4), that had been invented in 1941. Feeding precise concentrations of ether, it constituted a notable progress. For field use it had in addition the advantage of being compact, easily transportable and functioned with atmospheric air with the possibility of adjoining oxygen if available. The ethyl chloride was only administered for a few minutes to facilitate the absorption of the ether.


Fig. 4: The "Oxford Vaporiser", a portable apparatus for ether narcosis.

The operational table for the surgical work was basic, mounted on trestles. With the help of cushions and of blankets we tried to place the patient in the requited position. Lighting was provided by electrical bulbs fixed to the end of six slats disposed like the spokes of a wheel about a central axis. The surgical technique used was that which had been learned by the experience of the war of 1914-1918. On the instrument table there was always a basin containing litres of an acriflavine solution at 0.1% of an intense yellow colour.

Laboratory tests had shown that wounds inoculated with a dose of pyogenic streptococci, evolving normally towards cellulitis and septicaemia, recovered well if they were cleaned within 2 hours with this antiseptic solution (5). So, no doubt still influenced by the spectre of the terrible infections that had caused such ravages during the First World War, for our wounded the wounds and open internal cavities were abundantly washed with this golden-yellow solution. In addition, instruments and gloves were periodically rinsed, conserving a satisfyingly clean aspect in the operational area. That was the style of the period, now gone by. At the end of an operation, the wounds, either closed or left open, were sprinkled with sulphonamide powder, in accordance with the favourable results obtained during the war in Spain.

I remember only three dramatic infections, all in wounded Germans who had been abandoned by their troops in retreat. One was a youth 17 years old with peritonitis who was crying desperately for his mother; the second had gangrene in a huge hole in the buttocks. The third had a possibly curable thoracic empyema. Apart from the factor of combat conditions, it was evident that the quality of German medicine had fallen to a deplorable level. For the Nazi regime, medicine didn’t contribute to the power of the nation and medical studies had therefore been shortened. As a consequence young doctors were crassly ignorant and only the oldest of the profession had a valid level of competence. J. K. Willson-Pepper (6) has described the state of 105 wounded German soldiers that he took over from German military doctors in November 1944. Many of them had drains passively left in them for between 6 weeks and 3 months. The pus dripped out into basins placed on the beds that had sometimes become adherent to the mattresses. Astonishingly, some wounded had open drains underneath their plaster. The patients were rarely washed and were covered with scabs. They had the haggard eyes of drug addicts. A nurse was seen injecting morphine in series with a needle of 10 ml. without changing needles.

In the medical services of the Allies, apart from the difference in the quality of the medicine, the year 1944 was the beginning of an important usage of penicillin. The precious product was parsimoniously administered at the rate of 20,000 units every 3 hours or in continuous intramuscular flow of a solution of 100,000 units in 500 ml. of liquid. Thus treated, the men of the armoured units, victims of extensive burns and arriving several days later in a hospital in England, had a raw tissue surface without suppuration after removal of the bandages, a truly astonishing phenomenon for the period.

For fractures of the inferior members, the Thomas Splint (fig. 5), described by that British orthopedist in 1870, was still widely used (7). That ingenious device rendered precious services, enabling efficient stabilisation of the traumatised member with facility and rapidity, to the extent that many fractures did not require any further treatment.

After the operation the wounded man was transported to a hospitalisation tent where he was taken in charge by other doctors.


Fig. 5: The "Thomas Splint" and a patient fitted with it.

The operations tent was thus practically in continuous activity. Two teams alternated every 8 hours, so that everyone was at work for 12 hours out of 24. The eight intervening hours were dedicated to sleep, to toilet care and to meals. At this work rate we no doubt had maximum efficiency, always remaining in excellent condition without suffering from an excess of fatigue, which was evidently very important for the security of the patients.

That kind of structure for the exercise of medicine had a certain Taylorist characteristic. We were anchored to the operations room without seeing the patients before the operation and without seeing them afterwards. From the point of view of civilian medicine, this seemed like dehumanised medicine. Alfred Dumont was sometimes upset by this. But the rules in place were clearly beneficial. The work-place ambience was moreover highly gratifying. We never lacked anything insofar as medicine, perfusion solutions, blood transfusions and diverse supplies were concerned. We had the conviction that we were accomplishing our tasks in optimal conditions for the existing circumstances. Surely some of the wounded had died before arriving at the operations tent, though.

On the other hand we didn’t know anything about the post-operational evolution. There were also some irrecuperable cases. I remember a wounded man arriving in a coma with a torn carotid artery. We could only extract the projectile, empty the haematoma and ligature the artery, and the patient left in an unchanged state of coma. Another moving memory of the limits of the possibilities at the first surgical level was of a very young Belgian. He was a volunteer less than 18 years old, having lied about his age. A shell shrapnel had sectioned his penis that was only hanging attached by a strip of skin. We were really distressed by the injustice of fate for this courageous young man. To try to do something, even without hope, if only for his morale, it was sutured before he was evacuated. Three years later in November 1947, I was participating in a meeting of the Belgian Society for Surgery. On the programme of the séance was a communication by the celebrated British plastic surgeon Sir Harold Gillies on his operational results during the recent war. He had arranged for a former patient to come to the meeting. He brought him up to the platform and asked him to remove his trousers. Proudly, Sir Harold made commented on the success of a plastic penis that he described as very functional for its two roles. I identified our young wounded soldier in Normandy and it was a happy surprise indeed.

Thus we never had the impression of not being able to dispose of the means to do for our wounded all that was possible. We also had the chance, thanks to that, of never having had a death on the operations table. I think it’s useful to make a further remark about the psychological atmosphere in which we were working, for the following reason. In 1970 the film MASH was distributed with great commercial success, set in the framework of the military medical services in the war in Korea. In our modern society movie images tend to be a reference for the general public. As it happens, this was a grotesque farce, shocking with regards to the subject in question. In the reality that we had lived through in Normandy, we had never felt like joking but were profoundly tormented my the dramas that we witnessed.

The register of the operations that we carried out has never been recovered. In a report by the Commander of the 33 CCS, Lieutenant-Colonel Heywood Jones, that included statistical analyses, the average duration of the operations was 1h 42 min. On this basis, we would have cared for 150 wounded during the battle of Normandy (Public Record Office, London, Doc. WO 222/701).


4. The end of the campaign

Continually absorbed by our work, we had little information about the evolution of the military situation and were only conscious of the bitterness of the fighting by the afflux of wounded, notably from the famous Falaise Pocket. Sometimes we heard far-off explosions but they in no way perturbed our activity. We were confident without knowing anything precisely.

During all the month of August the Belgian Brigade had fought towards the north-east in parallel to the Atlantic coast. It had successively crossed the natural obstacles of the rivers Orne, Dives, Touges and Risie and liberated numerous little towns and villages: Franceville, Merville, Cabourg, Pont-l’Évêque, Pont-Audemer, Auberville, Villers-sur-Mer, Deauville, Trouville, Honfleur (fig. 1). Its military missions had been carried out with brio, witness the congratulations sent on the 29th of August by Major-General Richard Gale, commander of the 6th Airborne Division (1). It’s well known that our Anglo-Saxon friends are not prodigal with their compliments, so those that they do express are doubtlessly well merited.

The next objective of the Brigade was to push on towards Le Havre, a port of strategic importance. But on the first of September it was apparent that the Germans were retreating in disorder. The orders were therefore changed and the Belgian Brigade was to take its place behind the Guards Brigade to march on Brussels.


Fig. 6: Crossing through the town of Caen on September 2, 1944.

On the first of September we suddenly received at the 33 CCS the order for the Belgians to load all their material, in priority to everything else and to leave for Rouen to join the Belgian Brigade. It was a complete surprise that was greeted with an explosion of joy. The passage through Caen gave us the spectacle of the frightful destructions of the war (fig. 6). We crossed the Seine at Rouen on a railway bridge that was filled with debris and skeletons of horses, but that was still practicable. In the afternoon of September 4th we entered liberated Brussels in an atmosphere of unforgettable joy. It was the happy end to the battle of Normandy.


Fig. 7 : Crossing the Seine at Rouen on the partially-destroyed railway bridge


5. 50 years later

Although they were only 50 years ago, the events related here have become history, belonging to a bygone past. Many of the practices described have ceased to exist. For another reason too, the military medicine of 1944 has become history. At the time, to save human lives surgery was brought to the wounded near the front lines. With the current performance of helicopters it has become possible and more rational to quickly transport the wounded towards normal civilian hospitals rather than taking care of them in boy-scout camping conditions relying on makeshift invention.

It’s difficult and would be presumptive to make an overall judgement of the work of the military surgical units of 1944. A comparison with the First World War clearly leads to the conclusion that the progress had been enormous. In comparison with the campaign of 1940, all the accounts that I have heard were of confusion, disorder and incapability, linked to the military conditions. For 1944 there remains a conviction of having participated in an action magnificently prepared and planned where everything functioned admirably, with faultless organisation and discipline.

Morally, to ponder on this past awakens mixed feelings. There were the painful dramas that every war occasions. To see a file of young and valiant men brutally annihilated or partially demolished is terribly upsetting. In the battle of Normandy the Belgian Brigade lost 28 men. Among these there was a close friend, Lieutenant Benjamin Pinkos, mortally wounded at the crossing of the Toucques. A pharmacy student, he was with me at the Training Centre of the Belgian Medical Service in Sables d’Olonne on the 18th of June 1940 when the capitulation by Pétain took place. We had escaped together to England and shared perilous adventures. He underwent training for officers at Sandhurst and then for commandos in Scotland. He fell, as one says, “on the field of honour”. But even before engaging in combat the rough training during the years of preparation made victims who died without any glory. A very dear friend, Robert Stenuit, student in philosophy and literature, a gay fellow liked by everyone, was killed during a training flight in a Spitfire. And I was a witness to the accidental death of Captain Georges Truffaut, socialist deputy, who was dearly loved by his men. Leading a grenade-throwing exercise with his men, he hadn’t applied for himself the precautions that he recommended. A fragment penetrated into his skull through an eye and he was killed on the spot.

Personally, I’m a child of the First World War. In school I was taught that the 1914-1918 War had been the last one and that henceforth conflicts between nations would be resolved in the Society of Nations. The words of my class teacher were for me, as for all of the pupils, the truth. Events however rapidly contradicted this affirmation. Aggressivity is regrettably a characteristic of human nature. We continue to see nations and groups savagely engaged in vainglorious competitions for power. Nevertheless, our struggle during the Second World War had a superior significance: to reconquer a life of liberty. To the sacrifices that we had to endure with our allies from 1939 to 1945 the alternative was a world controlled by Hitler and Mussolini and their emulators and acolytes. After a murderous war we certainly do not live in a world that satisfies us, but we can consider that we have at least avoided a worse one.


6. References

1. Didisheim R. (1946) History of the Piron Brigade (Histoire de la Brigade Piron). Bruxelles: Pim Service.
2. Weber G. (1978) History and stories of the Piron Brigade (Histoire et histoires de la Bri-gade Piron). Bruxelles: Ed. Louis Musin.
3. Crew F.A.E. (1962) The Army Medical Service, in History of the Second World War. London: H.M.S.C..
4. Cope Sir Zachary (1953) Surgery, in History of the Second World War. London: H.M.S.C..
5. Garrod L.P. (1940) Action of antiseptics on wounds. Lancet I: 798.
6. Willson-Pepper J.K. (1946) A German Military Hospital in 1944. Lancer I: 139
7. Bailey H. (1941) Surgery of Modem Warfare. Edinburgh: E & S Livingstone.


7. Biographical notice

Born in 1917 in Scheveningen, Holland, the author was in his final year of studies in medicine at the Brussels Free University when the German army invaded Belgium. Having rejoined as volunteer the medical services of the Belgian Army, he left the European continent after the capitulation of Pétain to join the Free Belgian Forces being formed in Great Britain.
There he learned the specialty of anaesthesiology, that was inexistent at the time in Belgium. Having participated as anaesthesiologist in the battle of Normandy, he made that his profession after the war. He created the first Anaesthesiology Centre of the Brussels universities at the Jules Bordel Institute. He developed there the teaching of that specialty, was one of the founders of the Belgian Society of Anaesthesia and Reanimation and was copy editor of the Acta Anaesthesiologica Belgica.
His publications were mainly centred on various anaesthetic agents that were introduced into clinical practice after 1944, on the effects of these products on cerebral circulation, on certain pre-operational and post-operational complications as well as on in the domain of the History of Medicine, Anaesthesia and Reanimation.