Though not initially trained for mountain warfare, the 351st found itself traversing the mountainous terrain of the Italian interior and was forced to adapt to the style of combat that was shaped by the unique conditions. The nearly constant rain, mud, snow, and ice introduced difficulties to an otherwise already challenging situation. The unit was continuously fording streams and rivers, traversing valleys, and crossing one mountain after another. There were few suitable shelters in forward positions to ease the conditions. Trench foot, hypothermia, and frostbite were common. The weather and difficult terrain together increased the complexity of addressing combat-related wounds, compounding the seriousness of even minor injuries.
Aside from the natural elements, the 351st had to contend with defenders who tenaciously held a succession of lines built upon natural land barriers afforded by the terrain. Each defensive line was held long enough to buy time for other defending units further north to build up the next line of defense. When it was completed, the enemy withdrew from the forward line to occupy that secondary line, while yet another line of defense was built up behind that one. Because each line consisted of pillboxes, trenches, and interlocking fields of fire, the regiment was forced to attack against well-planned, dug-in defensive lines, which, for the most part, was occupied by highly experienced German units. As a result, the 351st regularly experienced heavy casualties.
By war's end the 351st was comprised mainly of replacements who were delivered to depots in Italy after arriving from training camps in the U.S., and from those "rounded up" from other theaters of war, such as unassigned troops from the beaches of Normandy. A large percentage of the replacements were not trained as infantry, having specialties such as cook, truck driver, and anti-aircraft gunner. Regardless of their background they were integrated into the 351st, mostly into rifle companies where losses were the highest. Many soldiers survived only a few hours or days in combat. Squad and platoon leader casualties were also high. Postwar analysis suggests that small unit leader replacements were in short supply, which often led to disorganization and increased casualty rates (see A Military Encyclopedia Based on Operations in the Italian Campaign, pp 3-6).
As a measure of losses, it was estimated that at the close of the war only 17% of the 88th Infantry Division's regimental personnel were left from those who started at Camp Gruber (see John Sloan Brown's Draftee Division p. 152). One post-war report from the 351st calculated that as many as 80% of its personnel received a purple heart, many posthumously (report available in the National Archives, College Park, MD). A veteran of Company C wrote, "My outfit 160 men strong (after) a little more than a year in combat (had) 2,303 through the outfit, (with) over 2,000 wounded, killed, captured or 'sent back for battle fatigue,' a nice way of saying 'nervous breakdown.' Only 5 men were in all combat operations from beginning to end - only one (1) yes '1' made it through every engagement without being wounded" (quoted from wartime recollections sent to this author).
The forces in Italy represented a true multi-national effort, encompassing soldiers from around the world. Personnel with the 351st regularly worked closely with British, French, and South African forces, as well as a multitude of other nationalities. Despite their hardships, they also developed a lasting affinity for the local people, the architecture, and the wine. Many soldiers built bonds with locals that lasted long after the war. In some cases, they even married into Italian families.