New Zealand Medical Services in Middle East and Italy
MDS at Riccione
During the period 20 to 25 September when 5 MDS was open for battle casualties from this action, the operating theatre was working continuously, 144 operations being carried out. Evacuation took place to 4 Canadian CCS near Riccione, 5 Canadian CCS at Cattolica, and 1 General Hospital at Senigallia. The more serious cases, such as abdominal, thoracic and head, were evacuated as soon as possible to page 612 4 and 5 Canadian CCSs, and the less urgent cases to 1 General Hospital. An effort was made to distribute cases so that patients would receive surgical treatment in the shortest possible time.
MDS at Viserba
As it was necessary towards the end of September to have an MDS further forward than Riccione, 4 MDS moved on 26 September to the vicinity of Viserba, 2 miles north of Rimini, where it was joined by 1 FSU, 2 FTU, and NZ Section MAC. It occupied an area of hard level ground on which the tents were erected and on which was sited a large factory. Heavy and medium artillery was posted page 613 nearby and was responsible for considerable noise and also prompted enemy retaliation.
5 NZ Field Ambulance MDS Operating Theatre (2 IPP tents) For the operating theatre in Italy in a modified form either two IPP tents or two rooms were used. The staff consisted of: 1 sergeant alternated as assistant to surgeon and in supervising the sterilisation and preparation of trays. 1 corporal alternated as assistant to surgeon and in supervising the sterilisation and preparation of trays. 2 orderlies who alternated as theatre assistant and steriliser orderly.
There was a fairly steady stream of casualties—in the five days to the end of the month they totalled 140 battle casualties and 209 sickness cases. The greater proportion of battle casualties (120) was dealt with adequately by the MDS and FSU surgical teams, and after due rest many were evacuated direct to 1 General Hospital at Senigallia. In the heavy rain from 28 September onwards the MDS area with its hard roads and good drainage proved very satisfactory, but the whole divisional area became bogged. This held up operations and slowed down the tempo of the battle, with a resultant diminution in the numbers of casualties.
With the onset of winter, experience of forward evacuation in the low-lying areas proved that stretcher-carrying jeeps, even when fitted with chains, were liable to become bogged in the mud. The answer to this problem was found in Bren stretcher-carriers, which had previously been used by the armoured regiments and whose mobility and usefulness was welcomed by RMOs. A number of battalions immediately arranged for extra Bren carriers to be fitted to carry stretchers. Stretcher-carrying jeeps, however, still continued to be most useful and arrangements were made to provide them with all-weather hoods.
During the operations in September a high proportion of abdominal wounds was observed as well as many chest wounds. The percentage of bullet wounds was noted to be unusually high. The Division was under command of the Canadian Corps, which had its own medical chain; in view of the expected breakthrough beyond Rimini, and also because of the proximity of 1 General Hospital to the forward areas, 1 Mobile CCS under Lieutenant-Colonel Clark did not set up on its arrival with the Division. This resulted in the loss of the services of a valuable unit with experienced personnel at a time when there was a definite shortage of such staff in our force. There had never been throughout the war any period of active warfare when there was not ample forward surgical work for all available units and personnel. The control of our CCS at this period was under the ADMS 2 NZ Division, whose more immediate interest was naturally in the functioning of the field ambulances. A CCS is normally under Corps or Army command but in the New Zealand force our CCS, like all our New Zealand units, was retained as a rule under the command of the DMS 2 NZEF. The 1st Mobile CCS page 614 surgical team was, however, attached to 4 Canadian CCS and then to 5 Canadian CCS, which in turn dealt with many of the more serious New Zealand casualties. The surgical arrangements at the Canadian CCSs were found to be somewhat different and, in our opinion, not as satisfactory as our own, but the work of the Canadian surgeons was of a high standard. The supervision of the patients in the pre-operative room was in the hands of the transfusion officer or the general duty officer acting as his relief. There was no surgeon available for diagnosis and sorting, though the operating surgeon often had a look at the patients. This threw a very great responsibility on the transfusion officer and, in our opinion, was not as safe and sound as our custom of having an experienced surgeon in attendance in the pre-operation room. This particularly applied to the abdominal cases, where diagnosis was often difficult and always of great importance and where the use of X-rays was often of value. An experienced surgeon could often take the responsibility of deciding against abdominal exploration. This was of more than theoretical importance as abdominal exploration carried a very definite mortality as well as morbidity.
After operation the cases were looked after by ward medical officers who carried out the treatment without reference to the operating surgeon. This had certain administrative advantages in rush periods but could not compare in surgical efficiency with the system where the operating surgeon supervised the after-treatment himself. The ideal in our opinion was for the operating surgeon to retain his control but to share it with a ward officer who could watch the case and report complications to him. If a senior surgeon was acting in the pre-operative room, he could make interim rounds of the post-operative cases while the operating surgeon was in the theatre.
The utilisation to the full of the surgical abilities of 4 Field Ambulance was a feature of the unit's activity at Viserba. The commanding officer made the following comments on this phase:
Following the now accepted principle of excision and dressing of all wounds at the earliest possible opportunity, during this period as open MDS the greater proportion of cases have been dealt with surgically at the MDS. Over two-thirds of all battle casualties received complete surgical treatment and were fit to be sent on direct to 1 NZ Gen. Hosp.
As facilities for nursing are better at a CCS, all non-urgent cases of abdomens and chests were sent to a CCS for surgery.
The principle adopted was to hold cases awaiting operation only up to the time involved in evacuating to a CCS, and there awaiting treatment. In other words, holding cases at the MDS awaiting operation, if by so doing the patient will receive earlier surgical treatment, than if he is sent on to a CCS immediately.
In conclusion, the equipment of the ambulance remains at the high standard previously attained. With the advent of winter it becomes obvious that an open MDS can function satisfactorily only in buildings; as the canvas, page 615 which is excellent under summer conditions, does not provide the necessary shelter and warmth.
On the other hand, the Consultant Surgeon 2 NZEF expressed the hope that the tendency to operate at the MDS instead of the CCS would not become more prevalent. His view was that, whenever circumstances permitted, forward surgery should be performed at the CCS, which was the unit specially equipped and staffed to do the work. The cases formerly thought to be of importance as regards early operation, for example, abdominal cases, were rightly sent back to the CCS and there was no reason why the CCS should not carry the main load of other heavy cases.
In spite of the bad weather gradual progress was made in the divisional sector and the enemy was forced to withdraw completely across the Uso River. The coastal towns which anchored the sea end of the Gothic line were in the hands of Eighth Army, but the line could not be outflanked while the enemy clung to the mountains and made every river a defence line. Fifth Army, after a promising start, was blocked by a determined defence and incredibly difficult country in the mountains south of Bologna.
The country beyond Rimini was completely flat but was crisscrossed with small waterways, each of which was an adequate tank obstacle. The degree of canalisation in the area south of Ravenna was unequalled anywhere in Europe, with the exception of Holland. It was impossible to move more than a mile in any direction without encountering an obstacle requiring the building of bridges and approaches. An abundance of trees provided cover for a defending force, even in the face of a superior air power, and there were many substantial stone houses.
The weather became unsettled with frequent light rains, and the web of watercourses ahead of the New Zealand battalions as they strove to push forward held out no prospect of a swift advance. It was the German policy to fight at every ditch, using spandaus and mortars with a stiffening of tanks and self-propelled guns. His plan was to force a full-scale ‘set-piece’ attack at every possible point, and then, as the assault was made, to withdraw his main forces to the next line, perhaps only 1000 yards back, leaving small heavily-armed holding parties behind. By a counter-policy of repeating thrusts at short intervals to shorten the time for manning defences, 5 and 6 Brigades had hopes of getting the Germans on the run; but just at the end of September after they had crossed the Uso, and preparatory to their attack on the Fiumicino, the weather broke and violent gales from the Adriatic, with torrential rain, soon page 616 brought the greatest discomfort to troops in the exposed positions of the front line and prevented the movement of supporting arms for the infantry.
MDS at Igiea Marina
During the morning of 4 October 4 MDS, with 1 FSU and 2 FTU, moved to a new building, formerly an Italian children's hospital and sanatorium on the coast road at Igiea Marina, just south of Bellaria, which is at the mouth of the Uso River. This building consisted of three stories, with a central block of small rooms and two wings forming large dormitories very suitable for holding patients. It had previously been occupied by a Canadian FDS, a Greek ADS, and 5 NZ ADS.
The reduced length of the Allied salient and the general dispositions of units allowed the MDS to receive patients direct from the RAPs, with 6 ADS functioning only as a transfer and emergency aid point. On 5 October the MDS was reinforced by a surgical team from 1 Mobile CCS with equipment for a 50-bed ward, an X-ray truck, and six nursing orderlies. The unit was considerably nearer the actual battle zone than was usual, and consequently in a very noisy position from nearby guns, but it provided a fully equipped surgical and medical centre. This arrangement was commented on very favourably by visiting senior combatant officers, who expressed the view that such a set-up contributed greatly to the morale of the troops in the actual fighting zone. With the help of the engineers windows were replaced with windolite, the water supply on the ground floor was put into working order, and a portable lighting set was used to provide a lighting circuit in the building.
By 8 October the unit had three completely equipped and staffed operating theatres as well as the Field Transfusion Unit and an X-ray plant, an impressive collection of surgical facilities. Fortunately these arrangements proved over-adequate as a very limited number of casualties occurred in the divisional sector. The total admissions for the first week at Igiea Marina were 238 sickness cases and 84 battle casualties. The latter were mainly victims of sporadic shelling, as persistently wet weather forced the postponement of the actual crossing of the Fiumicino.
On 10 October 2 NZ Division moved to the adjacent western sector, which had previously been held by Canadians. No great increase in distances of evacuation resulted and 4 MDS remained at the same site receiving cases from 5 ADS, some three to four miles due west.
The weather started to improve on 11 October. An increase in the number of guns in the vicinity incited the enemy to some page 617 artillery retaliation. During the afternoon several airbursts were observed over the building, and later accurate enemy counter-battery fire on neighbouring gun sites produced a sudden influx of battle casualties. No damage to MDS property resulted but odd fragments made open-air conditions unpleasant for a while.
Crossing the Rivers
The rain which made the crossing of the Fiumicino impossible had failed entirely to pin down the infantry or to silence the artillery. Night after night, over the soft sound of drizzle and the howl of the wind in the trees, the roll of gunfire echoed from the Apennines to the sea. On 11 October 5 Brigade found the Fiumicino almost undefended and moved across to take the town of Gatteo, badly battered by shelling and bombing. Sant’ Angelo, a heavily defended enemy strongpoint, then caused a hold-up with many casualties before it was cleared by Maoris on the night of 14–15 October, when the use of searchlights playing into the night sky created an unearthly blue luminescence which covered the battlefield. This eerie artificial moonlight was a feature of the campaign from then on. The towns of Gambettola, Bulgarno, and Ruffio then fell into our hands only to bring us up against another river, the Pisciatello. This was crossed by 6 Brigade on the night of 18–19 October after a full barrage, and the getting of tanks across the river changed the aspect of the advance as the country for some thousands of yards provided a chance of better going. Discounting the risks involved because of the soft nature of the ground, it was decided to thrust with the tanks right through to the Savio, a broad river running almost north. Such a manoeuvre, involving as it did a right hook of well over 5 miles, would cut all the coastal roads leading from Cesena to the coast up to a point well above Cervia, and in conjunction with a Canadian attack up Route 9 would almost certainly bring about the fall of Cesena itself. The manoeuvre was successful. By 21 October 4 Brigade had its tanks right up to the Savio and Cesena had fallen to the Canadians. The all-important Route 9 was cleared to a point only 46 miles from Bologna.
This concluded a month of hard but unspectacular fighting by 2 NZ Division—a long-continued slogging match in the mud of the river basin against an enemy who could be forced back but not overwhelmed. The optimism of a month previously had not been fulfilled, because to fulfil it had been humanly impossible. What could be done by the Division had been done well. Our troops had advanced nearly 20 miles, in conditions which were ideally suited for defence. Here, if anywhere, was country which could well have page 618 been the scene of a vast static battlefield on the lines of those of the 1914–18 war in France.
The moving west of the battle zone in the Savio River drive necessitated the opening of 6 MDS at San Mauro, as the lateral road to the coast had become very congested. On 18 October 4 MDS vacated the building at Igiea Marina, which was taken over by 1 Mobile CCS, and then moved to remain in reserve at Viserba. The admissions for the second week at Igiea Marina had amounted to 277 sickness cases and 121 battle casualties. The sick were evacuated to 5 MDS, still sited in the large municipal building at Riccione. On 13 October four nursing sisters from 1 Mobile CCS, then closed, had been attached to 4 MDS, and proved invaluable in the nursing of serious cases and as theatre sisters. The sisters rejoined their unit when 1 Mobile CCS took over at Igiea Marina. New Zealand head, facio-maxillary, and eye cases were sent to 83 British General Hospital at Riccione, while 59 British General Hospital at Fano was used as a staging post for patients on their way to 1 General Hospital.
Withdrawal of 2 NZ Division to Fabriano
It was decided to withdraw the Division on 22 October for reorganisation and training to the Fabriano region, some 20 miles south-west of the former assembly area at Iesi. The Division, in the last days of autumn, found itself dispersed among the buildings in the villages of Matelica, Fabriano, Castelraimondo, and San Severino in the Apennines. For the remainder of the month and until 27 November, 4 MDS functioned in the agricultural school buildings in Fabriano, holding up to one hundred sickness cases, the more serious cases being evacuated to 1 General Hospital on the coast at Senigallia.
The widespread dispersal of the Division and the congestion of traffic necessitated the opening of 6 MDS at Castelraimondo, in the 6 Brigade area 10 miles to the south. Previously it had taken as long as three hours to come from 5 ADS, farther south at Camerino in 5 Brigade's area. The weather at this time continued to be most inclement, but all units were accommodated in houses, factories, or castles and were able to keep dry.
For the greater part of November the Division remained in the rest and training area from Fabriano to Camerino, accommodated in very satisfactory billets, particularly 4 Armoured Brigade which had made itself comfortable in Fabriano, which was on a main road. Some of the roads to Castelraimondo and Camerino were barely passable, and early in the month bridges and diversions were washed out by floods after heavy rain.
Reorganisation of the Field Ambulances
In 2 NZ Division discussions and schemes for reorganisation of units were a feature of this period. Reductions in unit establishments had been under consideration since early in the campaign in Italy, as the divisional organisation was designed for desert conditions. It had been hoped that the Division could be used in a mobile role in Italy, but this had proved impossible. Manpower difficulties in the supply of reinforcements from New Zealand, and the planned replacement of long-service personnel, made reductions desirable, besides which it was concluded that the superior equipment of the Allies, especially in aircraft and tanks, made reductions possible.
In the medical services the changes were confined to the field ambulances. At a conference of senior medical officers convened by ADMS 2 NZ Division, Colonel King, it was decided that Headquarters Company be increased by 34 other ranks to make a complete MDS, that A Company be reduced to 3 officers and 42 other ranks and be a permanent ADS, and that B Company be eliminated. This would result in a total saving of 35 other ranks in each field ambulance.1 There was also to be a saving of two 3-ton trucks, although two bantams were to be added. It was proposed that the ASC personnel should become members of the Medical Corps, but this change was opposed successfully by the Commander NZASC.
|HQ Coy NZMC||7||1||1||1||8||1||9||79||107|
|ASC att HQ Coy||1||1||1||4||40||47|
|A Coy NZMC||3||1||2||4||35||45|
|ASC att A Coy||1||11||12|
|Dental att HQ Coy||1||2||3|
Reorganisation to this amended establishment was carried out during November, and the reorganised units were found to work well during the difficult battle conditions in December.
The New Zealand medical units followed a pattern of adaptation and progress. As the commanding officer of 4 Field Ambulance, Colonel Edmundson, recorded in December 1944:
The past twelve months has been a period in which we have witnessed striking changes in our environment. Except for the short Balkan campaign, 2 NZ Div. was trained on, and fought over, the North African deserts for more than three years. Many modifications and improvements were evolved in all arms of the Division, and these were by no means least evident in the Medical Services.page 620
.…Just as our medical services were adapted to meet the changing desert conditions, so the evolution continues with the variations of European warfare. We now have a reorganised ADS and MDS, each with their particular job to do on the line of medical evacuation.
1 Total savings of all units in the whole Division were 104 officers and 2528 other ranks.
The Move to the Front Line
From 22 November onwards the Division moved forward again to the fighting zone, assembling in an area west of Cesena. First to return to operations was the Divisional Artillery, followed by the two infantry brigades and lastly the armoured brigade.
Although there had been some advance during November, the general position at the front was very similar to that prevailing previously. Forli, 10 miles above Cesena on Route 9, had been cleared, and Eighth Army had established itself nearly 9 miles beyond it facing Faenza on the line of the Lamone River. The Lamone was a perfect example of the type of stream across which the bitterest fighting of 1945 was to take place. Its width was only 60 to 70 feet, but on either side were massive terraced stopbanks of soft earth reaching to a height of more than 20 feet. With steeply pitched slopes into which it was easy to tunnel, and parapets about seven feet wide, these stopbanks formed a splendid defensive line. Bologna was now only 30 miles away, but seemed as unapproachable as ever.
Change of ADMS 2 NZ Division
On 3 December 1944 Colonel R. A. Elliott, who had returned from furlough, took over duty as ADMS 2 NZ Division from Colonel King, who had gone overseas with the Second Echelon and had served continuously since. For eighteen months he had held the appointment of ADMS and his work was outstanding in every respect.
Medical Units in Forli
At the beginning of December 2 NZ Division faced up to the Lamone River astride Route 9 with 5 Infantry Brigade on the left and 6 Infantry Brigade on the right, each with its respective ADS open near the main road. In Forli 5 MDS was open for battle casualties and 6 MDS for sickness cases. Both the MDS and ADS of 4 Field Ambulance were closed and in reserve. The 1st Mobile CCS was in an excellent school building in Forli, well placed to treat battle casualties and evacuate direct to 1 General Hospital by NZ Section MAC.
On the night of 10–11 December 5 Infantry Brigade passed through 46 Division, which had established a bridgehead across the page 621 Lamone River to the south-west of Faenza, and was poised to attack towards Faenza. The attack opened on the night of 14–15 December and was brilliantly successful, leading to the capture of Faenza on the evening of 16 December. The attack presented a formidable problem for the medical services as all routes up and down were very poor indeed, and only one-way traffic was possible for considerable stretches in many places.
Attack on Faenza: Medical Units and Lines of Evacuation
1 Maj N. C. Begg, m.i.d.; Dunedin; born Dunedin, 13 Apr 1916; medical practitioner; medical officer 2 Gen Hosp Jan–Oct 1943; OC 102 Mob VD Treatment Centre Oct 1943–Jul 1944; RMO 25 and 21 Bns 1944; 5 Fd Amb Mar–May 1945; Repatriation Hospital (UK) Jun–Dec 1945.
This method of evacuation with the use of the ambulance-car post worked well in the very difficult circumstances, and no case was over twelve hours in reaching the CCS, which Colonel Elliott considered a creditable performance when the state of the down routes was taken into account.
The first casualties from the attack reached 5 ADS from the RAPs at 1 a.m. on 15 December. The evacuation route was open at 1.30 a.m. so an evacuation of three AFS car loads was made, followed by another carload at 3 a.m. and five at 7.30 a.m. The ADS was then informed that no further evacuations would be possible that day as Corps had closed the road for Polish up-traffic. However, ADMS 10 Indian Division contacted Corps regarding the closing of the road and was informed that ten ambulance cars could pass down at 2 p.m. Five carloads of Indian and five carloads of New Zealand patients, all priority cases, were then evacuated. The road was again open at 4.15 p.m., when the ADS was holding seventy patients. These were loaded into the ambulances and one 3-ton truck and taken back.
Casualties were fairly heavy during the day and it was necessary to give them more treatment than usual at an ADS, as it was taking four to eight hours for the wounded to reach the MDS and CCS. Plaster was used for most fractures and thirty bottles of blood and plasma were used in resuscitation. At one time there were eight transfusions running simultaneously. Lieutenant-Colonel Coutts, CO 5 Field Ambulance, worked at the ADS and his assistance was invaluable, as Captain Miller1 was sent forward to replace Lieutenant Moore2 as RMO of 28 (Maori) Battalion when the latter and three of his RAP staff were wounded.
New Zealand casualties passing through 4 Field Ambulance car post from 11 to 17 December totalled 191 wounded and 24 sick, the biggest day being 15 December, when there were 116 battle casualties. More ambulances were obtained for this day from 4 and 5 Field Ambulances to bring up the strength to fourteen ambulances, thus ensuring that no wounded were held back for lack of transport.
The MDS and CCS were both in Forli. The CCS had taken over the school building, and the MDS had shifted to another building which had been a working men's club, but most of the casualties went direct to the CCS.
On 16 December 5 ADS moved into a building nearer to Faenza and there experienced two busy days, being assisted by 6 ADS car post. By 17 December the enemy had been cleared out of Faenza and the evacuation route was shortened. Notable work was performed at the ADS during this difficult period by the jeep and ambulance-car drivers and the medical orderlies and officers. A fine contribution was made by the AFS car drivers under the capable supervision of Lieutenant Perkins and Sergeant Fitter, whose untiring energy did much to smooth out the extremely difficult evacuation problems. An infantryman while moving up had a foot blown off by a Schu mine. An AFS car driver unhesitatingly went to his assistance and also lost a foot on a Schu mine. Stretcher-bearers brought them out of the minefield together.
MDS Opens in Faenza
After the capture of Faenza by 2 NZ Division on the evening of 16 December, 4 MDS under Lieutenant-Colonel Owen-Johnston1 left Forli at midday on 17 December and opened that afternoon in Faenza. From the time of opening there was a steady stream of patients, and as for the first few days this MDS was the only one in Faenza it handled not only New Zealand but also British, Indian, and Italian troops and a certain number of Italian civilians. Evacuation was by Route 9 to 1 Mobile CCS for New Zealand and attached troops, while seriously wounded British and Indian troops went to 57 FDS, less serious British cases to 5 British CCS, and similar Indian cases to 9 Indian CCS in Forli. Priority was given to ambulance cars on the road, with the result that patients arrived at the CCS usually within half an hour of leaving the MDS. A Bailey bridge was a big help in this sector.
The bank building used by the MDS was solidly constructed and offered fair protection from the heavy shelling of the town by the enemy, who during the night of 17–18 December had reached the page 624 outskirts of the town in a counter-attack. The reception and evacuation departments were both set up in one large room divided by a low partition, and both were within easy access of a large theatre beside which was a combined resuscitation and pre-operative ward. During busy periods two tables were conveniently accommodated in the theatre. Separated from these departments by a small courtyard was the hospital cookhouse, near enough to serve meals still hot to the patients. The members of the unit were billeted either in the bank building or in nearby houses, which they managed to heat by one means or another.
Attack Towards the Senio River
On the night of 19 December at nine o'clock, 6 Infantry Brigade and 43 Gurkha Lorried Infantry Brigade launched an attack under a heavy barrage and threw the enemy back to the line of the Senio River. Much ground was taken after heavy fighting and over 200 prisoners were captured.
The wounded included some twenty men of 25 Battalion who came from a platoon which was caught on the start line by the enemy's fire and by some ‘shorts’ fired by the artillery. Seven of them were painfully burned by a phosphorus bomb set off by a shell splinter. They found refuge in a building occupied by Tactical Headquarters 26 Battalion, taking the bodies of two dead with them. Some German wounded were also brought to this building from the forward areas. First aid was administered pending the arrival of ambulance jeeps and RAP staff to take them back to the ADS. Enemy shelling and mortaring was fairly severe and, after abating for a time, became heavy towards dawn, making the task of stretcher-bearers and ambulance drivers all the more dangerous as they moved to and from the company sectors.
Acting as ADS to 6 Brigade, the reorganised A Company of 6 Field Ambulance, now under Major Hall,1 had its first real test of strenuous action. On 20 December it received over one hundred battle casualties in ten hours. It was reported at the time that the reorganisation appeared to have strengthened the company and increased its efficiency.
There was a rush period for 4 MDS on 20 December. Between midnight and eight o'clock in the morning 102 battle casualties were admitted. These were all cleared by midday and took from thirty to forty-five minutes to reach the CCS. The total admissions for the day were 142 battle casualties and 26 sick. No chest or abdominal wounds had surgical treatment at the MDS, but where necessary page 625 these cases received resuscitation before being evacuated to the CCS. The chief types of cases treated in the theatre were those requiring urgent operation for reasons such as haemorrhage or smaller wounds, and those, such as incomplete traumatic amputations, which could not conveniently be evacuated in that condition.
On succeeding days there was a steady flow of admissions, the highest totals being reached on Christmas Eve with 40 battle casualties and 30 sickness cases. A shell hit one of the MDS buildings on 24 December causing twelve casualties in the street, but no MDS personnel were wounded.
At dawn on 24 December A Company 26 Battalion made an attack on the eastern stopbank of the Senio as a preparation for a general advance on to the stopbank, which was 15 feet high and gave the enemy observation of the battalion areas. Although the artillery fired over 2000 shells into the target area within a short time, its fire was not sufficient to drive the Germans from their deep defences and fierce fighting took place at close quarters. The company gained possession of part of the stopbank, only to be forced off it again with a number of casualties. On the morning of 25 December stretcher-bearers returned to the foot of the stop-bank, where several wounded had been left, and found that German stretcher-bearers had already bound up the New Zealanders' wounds and moved them to a safer place, although the area had been under fire from both sides. A short truce was declared when the two parties met. Cigarettes were exchanged and, after some discussion, the enemy offered every facility for the removal of the wounded to 26 Battalion's lines.
The month's admissions to 4 MDS reached the totals of 343 sick and 371 battle casualties. It was felt that casualties had definitely benefited by the MDS being located well forward in good buildings, especially as the number of serious multiple wounds appeared to have been higher than usual.
The end of 1944 found the Division along the line of the Senio River in a holding role, which resulted in a diminution of casualties and a respite for the surgical staffs of medical units.