Though not formally trained and equipped for mountain warfare, the 351st Infantry Regiment found itself traversing rugged terrain from the moment it entered the front line. Rain, mud, snow, and ice introduced difficulties to an otherwise already challenging situation. The soldiers were continuously fording streams, crossing rivers, traversing valleys, and climbing one hill after another. There were few suitable shelters in the forward positions to ease conditions. Trench foot, hypothermia, and frostbite were common. The weather and difficult terrain together increased the complexity of addressing combat-related wounds and compounded the seriousness even of 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. Each defensive line was meant to buy enough time for other units further north to build the next line of defense. When the next line was completed the enemy withdrew, while yet another defense was constructed. Because each line consisted of pillboxes, trenches, and interlocking fields of fire, the Regiment was forced to attack against well-planned defenses occupied by experienced enemy units. As a result, the 351st often suffered heavy casualties.
By the war's end, the 351st was comprised of many inexperienced soldiers who had arrived from replacement depots. Some of the replacements were not trained as infantry, having specialties such as cook, truck driver, and anti-aircraft gunner. Regardless of their background, replacements were often integrated directly into rifle companies where casualties were high. It wasn't uncommon for soldiers to survive only a few days in combat, some a few hours. Squad and platoon leader casualties were also high. Postwar analysis suggests that commissioned and non-commissioned officer 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).
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).