With the lull in the fighting, and the onset of autumn rains, coupled with endless hills and deepening mud, Middleton's left knee, which had been uncomfortable for more than a year, was now becoming agonizing. He had hurt his right knee many years earlier playing football, but there was no immediate explanation for the pain in his left leg. Medics studied his leg, but had no answers. In late November Middleton went to the hospital in Naples, staying well into December, still without adequate diagnosis. He was able to hobble around, and did some staff work, then flew to General Eisenhower's headquarters in North Africa. He stayed there until mid-January, when he was sent to Walter Reed Hospital back in the United States. While Middleton was at Walter Reed, General Eisenhower communicated to General George Marshall, the U.S. Army Chief of Staff, that he needed Middleton back overseas. Acknowledging Middleton's difficulty with his knees, Eisenhower said, "I don't give a damn about his knees; I want his head and his heart. And I'll take him into battle on a litter if we have to." Command of the 45th Division went to Major General William W. Eagles.