In May 1944, a German sergeant lay in a drainage ditch at the edge of the Anzio beachhead in Italy, his legs shattered below the knee, waiting to die. The American breakthrough had swept over his position in its first rush. The men who could run had run. He could not.
He had tied a belt around his thigh to slow the bleeding, but he felt his strength draining and knew that if no one reached him within an hour or two, no one would need to. If the Americans reached him first, he had no idea what they would do. He had heard the stories every soldier hears about what happens to wounded men left behind. He had seen on other fronts what happened to wounded prisoners when the men who captured them were angry, frightened, or simply in a hurry.
He had no reason to expect better now. When the American soldier appeared at the edge of the ditch, the sergeant tried to raise his hands. The American looked at him, then at his leg, and shouted something to the men behind him. A second man came running, wearing red crosses on his helmet and armband, carrying a canvas bag.
He dropped into the ditch, knelt beside the German, and went to work. He loosened the belt and replaced it with a proper compression bandage. He cut away the trouser leg and dressed the wound. He poured powder into it.
He put a needle in the sergeant’s arm and hung a bottle from a rifle stuck in the mud, and a cold fluid began to flow into his vein. Two more Americans came with a stretcher and carried him out of the ditch, past the Americans wounded in the same attack, and placed him in the same line. He would spend the next year and a half moving through the American medical system, from that ditch to a field hospital, from Italy to America, and finally, aboard a neutral ship, back to his own country. At every stage of that journey, the thing that astonished him was the same.
They treated him as one of their own. None of it would have happened without the rules. In 1929, dozens of nations signed two international conventions in Geneva. One governed the treatment of prisoners of war.
The other dealt specifically with the wounded and sick of armies in the field. Both the United States and Germany were signatories. The medical convention contained a principle that sounded simple but proved profound: wounded and sick soldiers must be respected and cared for without distinction of nationality by whichever party held them. A wounded enemy was a patient first.
It also protected the people providing care. Doctors, medics, stretcher-bearers, and hospital staff were not to be treated as ordinary combatants. If captured, they were not to be imprisoned like other prisoners. They could be retained to care for prisoners of their own nationality, or else they were to be returned.
The prisoner-of-war convention added a clause that would mean a great deal to the sergeant in the ditch. Prisoners so seriously wounded or sick that they could not fight again were to be examined and, if they met the conditions, repatriated even while the war continued. Every army in the Second World War violated these rules somewhere, and some violated them on a vast scale. On the Eastern Front, the rules barely existed.
Even in the West, where both sides generally tried to observe them, there were terrible exceptions. Wounded prisoners killed in anger or expediency. Massacres committed by soldiers of more than one nation. But in the American medical system, the rules were not just written text.
They were embedded in the way the system itself worked. The sergeant woke in a tent. He had been moved from the ditch to a battalion aid station, then by ambulance back through a chain of medical units until he reached an evacuation hospital, a large tented facility with operating rooms, wards, X-ray equipment, and a staff of surgeons and nurses, set up a few miles behind the front lines. Along the way, he went through triage.
At every stage, an American doctor examined him and decided how urgently he needed treatment compared to the others in line. The standard was the severity of the wound, not the uniform. The surgeon who operated on his leg was American. So was the anesthesiologist.
The nurse who cared for him afterward was an American woman in olive-drab uniform. The drugs he was given, the plasma, the sulfa, the penicillin that kept infection from spreading through his leg, were American drugs shipped across the ocean for American soldiers and given to him from the same supplies. The surgeon could not save the lower part of the leg. The damage was too great.
But the amputation was done skillfully under proper anesthesia, and the penicillin protected the wound from gangrene, which the sergeant knew perfectly well was what usually killed men in his condition. He lay in a ward with other wounded. Some were Germans. Some were Americans.
In the next bed was an American infantryman wounded in the same attack, perhaps by men of the sergeant’s own unit. They could not speak each other’s language. After a few days, they were sharing cigarettes. There was another face in the tent he had not expected to see.
A German medic. The man had been captured a few days earlier and still wore his Red Cross armband, and under the rules of the convention, he had been assigned to care for the German wounded. He worked under American supervision with American supplies, side by side with American medics. He changed the sergeant’s dressings.
He told him in German what the doctors were saying. He also told him something else. In the American hospitals, he said, he had access to medicines and equipment that his own medical service had not had in sufficient quantities for a long time. Penicillin above all.
He said it with the expression of a man who had just understood something about the course of the war. Why did the Americans behave this way? It was not automatic, and it was not always easy. Part of the answer was simply that it was the law.
American military regulations incorporated the Geneva Conventions, and the Army Medical Department trained its personnel to follow them. Proper treatment of wounded prisoners was not a matter of individual kindness but of policy. Part of the answer was reciprocity. Tens of thousands of Americans were prisoners of the Germans, and many of them were wounded.
International inspectors from neutral countries visited hospitals and camps on both sides and filed reports. How the Americans treated wounded Germans could affect how the Germans treated wounded Americans, and American commanders knew it. Part of the answer was practical. A wounded prisoner who was treated well was a prisoner who could be interrogated, was less likely to resist, and might tell his comrades at home, if he ever returned, that surrender was survivable.
German soldiers who believed they would be treated well were more likely to surrender, and every surrender was a battle they did not have to fight. And part of the answer was the people themselves. Doctors and nurses are trained to treat the patient in front of them. Many American medical personnel described treating wounded Germans as strange at first, then simply routine.
A shattered leg was a shattered leg. The other side of the reciprocal arrangement was real and mattered. Wounded Americans who fell into German hands in the West were, in most cases, treated in German military hospitals by German doctors. The level of care varied widely, depending on place, time, the German doctors themselves, and above all on available supplies.
By late 1944 and 1945, Germany lacked almost everything for its own soldiers as much as for prisoners. There were German doctors who went to great lengths for wounded American prisoners. There were also cases of neglect and mistreatment, and conditions for Allied prisoners deteriorated badly in the final months of the war as food ran out and many were forced on long winter marches. The point is not that one side was perfect and the other was not.
The point is that both sides operated within the same framework of rules. Both knew the other was watching, and that the treatment of wounded prisoners on each side was, to a great extent, linked. This does not mean every American behaved well. Some mistreated prisoners, including the wounded, and some incidents were appalling.
But the system as a whole, and the vast majority of the people in it, did what the rules required. When the sergeant was healthy enough to travel, he was not sent to a prisoner-of-war camp in Italy. He was shipped to the United States. By 1944, hundreds of thousands of German prisoners were held in camps across America, and seriously wounded prisoners went with them.
Some were treated in POW camp hospitals. Others, whose needs were greater, were treated in American military hospitals. The sergeant spent months in a camp hospital recovering from the amputation. Here too, the people caring for him included both Americans and Germans.
Captured German doctors worked in camp hospitals treating their own countrymen under American supervision. A German surgeon, perhaps captured in North Africa, now practiced medicine in a wooden hospital building on the American plains. The German doctors noticed the same things the German medic had noticed in Italy. The equipment, the supplies, the drugs, the sheer abundance of everything a hospital needed.
For men who had spent years watching their own medical services struggle with severe shortages, it was a dazzling revelation. The sergeant learned to walk again. He was given crutches, then a prosthetic leg, and taught how to use it. He wrote letters home through the Red Cross, telling his family cautiously, because letters were censored by both sides, that he was alive, that he had been treated well, and that he did not know when he would come home.
Under the prisoner-of-war convention, prisoners so seriously wounded or sick that their injuries meant they would never again be fit for military service could be returned to their homelands directly, even while the war continued. The decision was not left to the detaining power. It was made by mixed medical commissions, bodies that included doctors from neutral countries such as Switzerland. They traveled to prisoner-of-war camps and hospitals, examined prisoners, and decided who was eligible for return.
The sergeant, with his amputated leg, was examined by one of these commissions and found eligible. The exchanges themselves were extraordinary events. During the war, the belligerent nations arranged a series of exchanges of seriously wounded and sick prisoners, carried out through neutral countries and ports, with ships sailing under the protection of international agreements. Among the ships used in exchanges between Germany and the Western Allies was a Swedish passenger liner called the Gripsholm, which became known for its wartime voyages carrying exchanged prisoners and civilians.
In one such operation, seriously wounded Germans returned from America to their homeland, and seriously wounded Americans returned from Germany, literally passing each other through a neutral port under the eyes of neutral officials. The men on those ships were among the most injured of the war. Amputees, the blinded, men with wounds that would never heal, men too sick to recover in captivity. Many had received treatment for months from the very people they had been fighting.
It is one of the strangest images of the entire war. In the midst of the most destructive conflict in history, enemies were sending, carefully, formally, with great diplomatic effort, their most injured men home. The sergeant from the Anzio ditch was one of them. He returned to a Germany being bombed, starved, and invaded, carrying a prosthetic leg made in America and a set of memories that matched nothing he had been told about the enemy.
What stunned the German prisoners about the American surgeons was not that the Americans were uniquely skilled. German surgeons were among the best in the world, and German military medicine was excellent for most of the war. It was not that the Americans were uniquely kind. War brutalized people on every side, and Americans committed their share of crimes.
What stunned them was the consistency. From the ditch to the tent, to the American camp hospital, to the neutral doctors and the exchange ship, the same principle held. A wounded enemy is a patient. He was triaged by the severity of his injury, treated by the same surgeons with the same drugs, cared for by his own captured countrymen with enemy supplies, and if his wounds were severe enough, sent home under the supervision of neutral doctors.
That consistency did not come from nowhere. It came from an international convention both sides signed. It came from the American decision to incorporate that convention into their regulations and their medical system. It came from the hard logic of reciprocity, and from the practical realization that an enemy who believes he will be treated decently is an enemy more willing to surrender.
And it came from an industrial system that produced so much plasma, penicillin, and medical equipment that there was enough to share with the enemy. For German prisoners, many of whom had been raised on the idea that mercy was weakness and the enemy was subhuman, the experience was deeply confusing. They expected, at best, indifference. What they received was the same treatment as the men they had been trying to kill.
Many never forgot it. The sergeant in the Anzio ditch is a composite figure. The 1929 Geneva Conventions and their provisions on the wounded, medical personnel, and the repatriation of seriously wounded and sick prisoners are documented. The American practice of triaging by severity of injury is documented.
The use of captured German medical personnel to care for German prisoners is documented. The treatment of wounded prisoners in American camps and military hospitals is documented. The mixed medical commissions of neutral doctors and the exchanges of seriously wounded prisoners of war through neutral ports, including the voyages of the Swedish ship Gripsholm, are documented. So too are the violations of those rules by all sides, which this story does not ignore.
The men who kept the wounded alive on both sides, the medics, the nurses, the surgeons who worked on the men they had been fighting, deserve to be remembered.