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Part 2

Table of Contents

II. LOSS OF MAN POWER IN WAR

J. LOSSES IN THE THEATER OF OPERATIONS

31. Cases disposed of in the Zone of the Interior. - The loss of man power in the Theater of Operations forces of which the medical department has knowledge is due to: (a) noneffectives in hospital, i.e., patients receiving treatment in hospital both in the Theater of Operations and Zone of the Interior; (b) deaths from various causes within or without the hospital; (c) cases disposed of in the Zone of the Interior after being sent there for treatment. This latter group includes the men who are permanently incapacitated physically for further military


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service. In the following discussion, the cases sent from the Theater of Operations to the Zone of the Interior for further treatment are divided into two groups and are so treated throughout: (a) cases in hospital; (b) cases disposed of after reaching the Zone of the Interior by return to duty, death, or discharge for disability. The cases in hospital are losses in the Theater of Operations strength no matter where the hospitals are located, but cases disposed of in the Zone of the Interior may represent an unnecessary loss in the Theater of Operations strength if too many men who are ultimately returned to duty are sent to the Zone of the Interior.

As stated above, if sufficient care is exercised, the number of cases sent to the Zone of the Interior can be limited practically to potential disability cases, and the additional loss of man power will be small. Thus, if as suggested, 3% of disease and nonbattle injury cases, 6% of the gassed ones, and 20 % of the gunshot cases are sent to the Zone of the Interior, the excess over the physically unfit will be only 1% of the cases of diseases and nonbattle injury cases, 2% of the gassed cases, and 5% of the gunshot ones, and even this excess would consist of cases requiring prolonged treatment.

The cases remaining in hospital in the Zone of the Interior of those sent there for treatment are shown by Figs. 41-43, but those disposed of after arrival there by return to duty, discharge for disability, or death are shown by Figs. 47-49.

a. Disease and nonbattle injury patients. - The number of cases so disposed of among those admitted for diseases and nonbattle injuries with a daily admission rate of 1.00 per 1000 Theater of Operations strength is shown by Fig. 47. This graph illustrates that the loss of man power in the Theater of Operations from the disposition of such cases in the Zone of the Interior increases in proportion to the percentage of hospital cases returned there for treatment. Thus the difference in such losses when 3% or 9 % are so sent to the Zone of the Interior, accumulated to the end of one year would be 28.95 - 9.65, or 19.30, per 1000 Theater of Operations strength. To visualize this, let us assume that a force of 2,000,000 men is operating in the Theater of Operations in a well sanitated area in a temperate climate, and that the daily admission rate to hospital is 1.40 per 1000 per day. Then the number of men leaving hospital in the Zone of the Interior during one year if 3 % are sent there would be 27,020, and if 9% are sent 81,060, including in each instance only 18,014 disability cases.

If the military authorities decide to send to the Zone of the Interior all Theater of Operations disease and nonbattle injury cases requiring hospital treatment for longer than 60 days, which will be 12.39% of all admissions (Fig. 38), the accumulated losses from this cause at the end of the year, with a daily admission rate of 1.00 per 1000, would be 39.85 (9.65 × 12.39 ÷ 3) per 1000 men. In a force of 2,000,000 .with a daily admission rate of 1.40 per 1000, the accumulated losses from cases disposed of in the Zone of the Interior at the end of a year would be 111,580 (39.85 × 1.40


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× 2000) of this number 93,566 (111,580 - 18,014) are duty cases. Obviously these men may be sent again to the Theater of Operations, time and conditions permitting.

It will be observed from Fig. 47 that losses of this character continue to occur indefinitely as long as the basic conditions remain the same.

    Fig. 47.* - Theater of Operations cases of diseases and nonbattle injuries disposed of in the Zone of the interior by return to duty, death, or disability discharge when sent to the Zone of the Interior for further treatment.
    *NOTE: (a) Total cases disposed of in one year equals total admissions less all patients in hospital at the end of that period. (b) Cases disposed of in the Zone of the Interior during one year, equals those sent there less the one in the hospital. (c) The relationship of (b) to (a) gives the percentage of the total dispositions which occur in the Zone of the Interior. (d) It is estimated that this same percentage relationship applies to cases disposed of during any period, as one month, etc.


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b. Gas and gunshot patients. - Similar information in regard to cases wounded by poisonous gases and by gunshot missiles are shown by Figs. 48 and 49. The same remarks apply to those two graphs as to Fig. 47.

c. Total of Theater of Operations patients. - (1) With a constant rate and a constant strength. -As an illustration of the difference in the number of cases disposed of in the Zone of the Interior in one year when different percentages of cases are sent there, let us make the following as-

    Fig. 48. - Theater of Operations war gas cases disposed of in the Zone of the Interior by return to duty, death, or disability discharge when sent to the Zone of the Interior for further treatment.
    NOTE: For explanation of the method used in calculating the above data see Note on Fig. 47.


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sumptions: (a) Two expeditionary forces, each of 2,000,000, both in well sanitated areas in the temperate zone and both engaged in continued and severe military combat: (b) a daily admission rate to hospital. of 1.40 per 1000 strength from diseases and nonbattle injuries, .31 from wounds by poisonous gases, and .69 from wounds by gunshot missiles; (c) that one of the expeditionary forces sends to the Zone of Inter-

    Fig. 49. - Theater of Operations gunshot cases disposed of in the Zone of the Interior by return to duty, death, or disability discharge when sent to the Zone of the Interior for further treatment.
    NOTE: For explanation of the method used in calculating the above data see Note on Fig. 47.


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ior 3% of admissions for diseases and nonbattle injuries, 6% of cases wounded by poisonous gases, and 20% of those wounded by gunshot missiles, while the other sends 9% of the first and second named and 30% of the third.

Table 6. - Number of cases disposed of during one year in the Zone of Interior, from the two expeditionary forces.

Kind of cases

Daily admission rate per 1000 strength

Number of cases disposed of in the Zone of Interior in one year.

Diseases and nonbattle injuries

1.40

If 3% are sent to Z. of I.

27,020

If 9%are sent to Z. of I.

81,060

Gas wounded

.31

If 6% are sent to Z. of I.

11,904

If 9%are sent to Z. of I.

17,856

Gunshot wounded

.69

If 20%are sent to Z. of I.

74,134

If 30%are sent to Z. of I.

111,200

113,058

210,116

The difference (210,116 - 113,058 = 97,058) is the excess over the number of men physically disabled or requiring prolonged treatment, and consists of men who will be able eventually to return to duty. They must either be sent again to the Theater of Operations from the Zone of the Interior or be replaced, and even if the former is done unnecessary time is lost.

(2) With a constant rate but an increasing strength. - Fig. 50 shows a method of estimating the Theater of Operations patients to be disposed of in the Zone of the Interior when the admission rates from the various causes, as specified, are constant but when there is an increasing strength. The method of computation is the same as that outlined (see p. 36) for Fig. 25, the principal difference being that in Fig. 50 there are three causes of admissions considered, whereas in Fig. 25 there is only one.

d. Number of Theater of Operations patients to be handled in the Zone of the Interior. The bottom line of Fig. 50 shows the total Theater of Operations patients to be handled in the Zone of the Interior under the conditions outlined. Such data may be of value when estimating requirements for hospital ships and hospital trains.

32. Deaths. - In addition to the noneffectives in hospital and the cases disposed of in the Zone of the Interior from among those sent there, losses occur as the result of deaths.

A larger part of the fatalities which result from diseases and nonbattle injuries is among the cases admitted to hospital, but some occur


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among men not in hospital. Both classes of deaths are counted here as hospital admissions and are included in the total of such cases.

    Fig. 50. - A. Method of computing the Theater of Operations hospital patients to be disposed of in the Zone of the Interior when certain percentages of patients are sent there from a command in the Theater of Operations where there is an increasing strength and where there are admissions from both battle and nonbattle causes at a constant rate.
    B. The total Theater of Operations patients to be hospitalized in the Zone of the Interior. (See Fig. 46).
    C. The grand total Theater of Operations patients to be handled in the Zone of the Interior.


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On the other hand, the larger part of the deaths which result from military combat occurs on the field of action. The last named is not included in the number of admissions for wounds, but in this study they are proportioned to the number of men wounded so that the expectancy of such losses can be computed from the admission rate for the wounded.

a. Fatality rates. - The fatality rate for hospital cases in the American Expeditionary Forces in 1918 from diseases and nonbattle injuries, including deaths from such causes not in hospital, was 3.70%2; while that from poisonous gases, including only such as occurred in hospital, was 1.73%2, and similarly the one from gunshot cases was 8.12 % . The deaths from diseases and nonbattle injuries included, however, a large number from the unusually widespread and fatal epidemic of influenza with accompanying pneumonias. After excluding the unusual number of deaths from these causes, it is estimated that 1.44% of hospital disease and nonbattle injury cases in the Theater of Operations may be expected to die. This fatality rate is one and two-thirds times as great as the usual peace time one among troops in the United States. In the following estimation of losses among troops in the Theater of Operations, the fatality rates used are 1.44%, 1.73%, and 8.12% for hospital cases of disease and nonbattle injuries, gas, and gunshot wounds respectively.

b. Duration of treatment of fatal cases. - Men who ultimately die as the result of gunshot wounds do so after a shorter interval of time than do those from either of the other two causes. Thus during the first 15 days of treatment 85.36 % of the deaths from gunshot wounds occurred, as compared with 76.37% of those from gas wounds, and 64.56% of those from diseases and nonbattle injuries.

Table 7. - Percentage of the total deaths in hospital from the three classes of causes in the American Expeditionary Forces, which occurred in any group at different time intervals.

Days after admission to hospital

Diseases and nonbattle injuries

Gas wounds

Gunshot wounds

1-5

32.16

41.14

58.80

6-10

19.46

22.62

19.46

11-15

12.95

12.61

7.10

16-20

9.51

7.18

3.13

21-25

4.72

4.22

1.79

26-30

3.95

2.59

1.28

31-45

6.45

3.72

2.69

46-60

3.23

1.72

1.80

61-75

2.02

1.15

1.15

76-90

1.42

.79

.85

91-105

1.04

.58

.58

106-120

.77

.43

.40

over 121

2.24

1.25

.88

Note:- For basic formulae see Figs. 96, 97 and 98.


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c. Killed in action. - In addition to 13,691 deaths from battle wounds in hospital in the American Expeditionary Forces, 36,694 men were killed on the field of battle.*

There is no information available upon which to base an estimate of how many of those who were killed outright died from poisonous war gases and how many from gunshot missiles. Hearsay evidence indicates that comparatively few men died as the result of poisonous gases before they reached hospital.

d. Killed in relation to number wounded. - An examination of the casualties of infantry regiments by combat days in the American Expeditionary Forces shows that the proportion of the killed to the number gassed decreased as the number of reported gassed cases increased; on the other hand, the proportion of the killed to the number of men wounded by gunshot missiles remained practically constant. Thus the proportion of the killed to the number wounded by gas was almost twice as great when there were 10 gassed as when there were 100, while the proportion of killed to wounded by gunshot missiles was the same when there were 10 wounded as when there were 100.†

We have assumed here simply for ease in calculation that 1000 men were killed in action by poisonous gases, and the remainder (35,694), by gunshot missiles. Under this assumption the percentage of the killed to the wounded were: Gas 1.42%; gunshot 23.25%; or as expressed in the usual way, it is assumed there was 1 killed in action by poisonous gases to 70.4 so wounded, and 1 killed by gunshot missiles to 4.3 wounded.

e. Total deaths. - These relationships of killed in action to the wounded, and fatality rates for cases in hospital to the number of cases of diseases and nonbattle injuries, of gas wounds, and of gunshot wounds were used in computing the data shown for deaths by Figs. 51, 52, and 53. These Figures show graphically the accumulated number of deaths as time advances computed on the basis of 1.00 admission per day to hospital per 1000 strength in the Theater of Operations.

33. Total losses in the Theater of Operations. - a. Disease and non-battle injury patients. - The total accumulated losses from month to month in the Theater of Operations as the result of diseases and nonbattle injuries from (a) noneffectives in hospital (patients in hospital), (b) deaths, and (c) cases disposed of after being sent to the Zone of the Interior (including disability cases), are shown graphically by Fig. 51. As stated in the legend of the graph, all of the data are based upon 1.00 admission per day per 1000 Theater of Operations strength.

The noneffectives, or number of patients in hospital, stabilize after one year and consequently there is no additional loss from this factor thereafter; but the accumulated number of deaths and of cases disposed of in

    * The A. G. O. figures are: Killed 37,541; died of wounds 12,934; total 50,475.11 Used here: Killed 36,694; died of wounds 13,691; total, 50,385.
    †For basic formula see Fig. 100.


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the Zone of the Interior, from cases sent there, continues to increase as long as the basic conditions remain the same.

The losses from noneffectives in hospital and from deaths are shown separately and combined. To the combination of the two there must be added losses from the cases disposed of in the Zone of the Interior. As has been shown on page 69 and by Fig. 47, this latter factor in the total loss rate increases in proportion to the percentage of cases sent to the

    Fig. 51.* - Loss of manpower in the Theater of Operations from diseases and non-battle injuries due to deaths, noneffectives in hospital (patients), and cases disposed of in the Zone of the Interior when sent there for further treatment.
    * NOTE: For basic formula see: (a) Deaths, Fig. 96, (2), p. 163. (b) Patients in hospital, Fig. 84, (1), p. 151. Total losses equal sum of the two above (a) and (b), plus cases disposed of in the Zone of the Interior as per Fig. 47.


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Zone of the Interior. The following table shows the movement of the cases in and out of the hospital, with the summation of the losses up to the end of 360 days, when 3%, 6 %, or 9 % of all admissions are sent to the Zone of the Interior.

Table 8. - Disposition of disease and nonbattle injury patients admitted to hospital during the first 360 days of operations in the Theater of Operations, when the daily admission rate from such admissions is 1.00 per 1000 Theater of Operations strength.

Percentages of Theater of Operations admissions sent to the Zone of the Interior

9%

6%

3%

Time – 360 days

    Patients admitted to hospital

360

360

360

Losses:

    Patients in hospital:†

      In Theater of Operations

23.75

24.93

26.11

      In Zone of the Interior

3.54

2.36

1.18

    Deaths which have occurred in and out of hospital: ††

4.89

4.89

4.89

    Cases disposed of in Z. of I.: ‡

28.95

19.30

9.65

        Total losses: §

61.13

51.48

41.83

Cases returned to duty in Theater of Operations

298.87

308.52

318.17

        Total accounted for

360.

360.

360.

† See Fig. 41.   †† See Fig. 51.   ‡ See Fig. 47.   § See Fig. 51.

To convert these data into terms of any admission rate with any strength, multiply any item shown above by the product of the admission rate by the strength in thousands. Thus if the expected daily admission rate to hospital is 1.40 per 1000 and the strength 2,000,000 multiply the items in question by 1.40 × (2,000,000 ÷ 1000), or 2,800.

As shown on page 55 if the military authorities consider it advisable to send to the Zone of the Interior all disease and nonbattle injury Theater of Operations hospital cases averaging more than a certain time in hospital, the percentage of cases to be so transferred can be found by referring to Fig. 38. Then by referring to Fig. 47, and multiplying the data shown there on the 3% line by the number of times that 3 is contained in the predetermined percentage of cases to be returned to the Zone of the Interior, the cases disposed of in the Zone of the Interior under such conditions can be obtained (see Table 3). The results so obtained, when added to the accumulation of patients in hospital and of deaths at any time, will show the total losses.

b. Gas patients. - Fig. 52 shows in a similar way the losses which occur as the result of poisonous gases, both from the various reasons and also the total. As stated on p. 76, there are no data available upon which


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to base an estimate of the number of cases killed in action by poisonous gases. It is assumed for ease of calculation that 1000 of the men killed in action died from gas. The detail in regard to the deaths is shown in the table on the graph, and if it is desired to increase or decrease the 1000, the items can be changed correspondingly and the total losses so altered.

    Fig. 52.* - Loss of manpower in hte Theater of Operations from war (poisonous) gases due to deaths, noneffectives in hospital (patients), and cases disposed of in the Zone of the Interior when sent there for further treatment.
    *NOTE: For basic formulae see:- (a) Deaths in hospital, Fig. 97, (2), p. 164. (b) Killed in action, Fig. 97, (4), p. 164. (c) Patients in hospital, Fig. 87, (a), (1), p. 154. Total losses equal sum of the above (a), (b), and (c), plus cases disposed of the the Z. of I., as per Fig. 48.


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The following table shows the movement of the gassed cases in and out of hospital with the summation of the losses up to the end of 360 days, when 3%, 6%, or 9% of all gas admissions are sent to the Zone of the Interior.

Table 9. - Disposition of gas casualties during the first 360 days of battle, when the daily admission rate from poisonous gases is 1.00 per 1000 Theater of Operations strength.

Percentages of Theater of Operations admissions sent to the Zone of the Interior

9%

6%

3%

Time – 360 days

Total to be accounted for:

    Patients admitted to hospital

360

360

360

    Assumed number killed in action

5.10

5.10

5.10

      Total

365.10

365.10

365.10

Losses :

    Patients in hospital: †

      In the Theater of Operations

38.09

39.31

40.54

      In the Zone of the Interior

3.68

2,46

1.22

    Deaths which have occurred: ††

      In hospital

5.99

5.99

5.99

      Assumed number killed

5.10

5.10

5.10

Cases disposed of in Zone of the Interior‡

28.80

19.20

9.60

      Total losses: ††

81.66

72.06

62.45

Cases returned to duty in T. of O.

283.44

293.04

302.65

Total accounted for

365.10

365.10

365.10

† See Fig. 42   †† See Fig. 52.   ‡ See Fig. 48.

To convert any of the items above into terms of any admission rate with any strength, multiply the ones in question by the product of the admission rate by the strength in thousands. Thus if the expected daily admission rate is .31 per 1000 and the strength 2,000,000, multiply by .31 × (2,000,000 ÷ 1000), or 620.


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c. Gunshot patients. - Fig. 53 shows in a similar way the losses from gunshot casualties in detail and in totals.

    Fig. 53* - Loss of manpower in the Theater of Operations from gunshot missilies due to deaths, noneffectives in hospital (patients), and cases disposed of in the Zone of the Interior when sent there for further treatment.
    *NOTE: For basic formulae see :-
    (a) Deaths in hospital, Fig. 98, (2), p. 165. (b) Killed in action, Fig, 98, (4), p. 165. (c) Patients in hospital, Fig. 88, (a), (1), p. 155. Total losses equal sum of the three above (a), (b) and (c) plus cases disposed of in the Z. of I., as per Fig. 49.


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The following table shows the movement of such cases in and out of hospital, with the summation of the losses up to the end of 360 days, when 10 %, 20 %, or 30 % of such cases are sent to the Zone of the Interior.

Table 10. - Disposition of gunshot, casualties during the first 360 days of battle, when the daily admission rate from gunshot missiles is 1.00 per 1000 Theater of Operations strength.

Percentages of Theater of Operations admissions sent to the Zone of the Interior

30%

20%

10%

Time-360 days.

Total to be accounted for:

Patients admitted to hospital

360

360

360

Assumed number killed in action

83.69

83.69

83.69

Total

443.69

443.69

443.69

Losses

    Patients in hospital:†

In Theater of Operations

66.45

75.24

84.03

In Zone of the Interior

26.37

17.58

8.79

    Deaths which have occurred:††

In hospital

28.65

28.65

28.65

Assumed number killed

83.69

83.69

83.69

Cases disposed of in Z. of I:‡

80.58

53.75

26.86

Total losses:§

285.74

258.88

232.02

Cases returned to duty in T. of O.

157.95

184.81

211.67

Total to be accounted for

443.69

443.69

443.69

† See Fig. 43   †† See Fig. 53   § See Fig. 53


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d. Total patients. - The following table shows the movement of the total cases in and out of hospital, with the summation of the losses up to the end of 360 days.

Table 11. - After 360 days of battle: (1) Total cases to be accounted for, including the killed in action; (2) cases returned to duty in the Theater of Operations; (3) total losses.

(1) Total to be accounted for, including killed in action.

If there is sent to the Z. of I., 3% of (a), 6% of (b), and 20% of (c) (as below).

If there is sent to the Z. of I., 9% of (a) and (b), and 30% of (c) (as below).

(2) Duty in T. of O.

(3) Losses

(2) Duty in T. of O.

(3) Losses

If the strength is 1000 and the daily admission rate to hospital is 1.00 per 1000 from each cause.

(a) Diseases and nonbattle injuries

360.00

318.17

41.84

298.87

61.13

(b) Gas

365.10

293.04

72.06

283.44

81.66

(c) Gunshot

443.69

184.81

258.88

157.95

285.74

Total

1,168.79

786.02

372.78

740.26

428.53

If the strength is 1000 and the admission rates to hospital are from each cause (a) 1.40; (b) .31; (c) .69.

(a) Diseases and nonbattle injuries

504.00

445.44

58.58

418.42

85.58

(b) Gas

113.18

90.84

22.34

87.87

25.31

(c) Gunshot

306.15

127.52

178.63

108.99

197.16

Total

923.33

663.78

259.55

615.28

308.05

If the average daily strength is 2,000,000, and the rates are as shown.

(a) Diseases and nonbattle injuries

1,008,000

890,880

117,160

836,840

171,160

(b) Gas

226,360

181,680

44,680

175,740

50,620

(c) Gunshot

612,300

255,040

357,260

217,980

394,320

Total

1,846,660

1,327,600

519,100

1,123,560

616,100

34. Total losses by separate months. - (a) Disease and nonbattle injury patients. - Fig. 51 shows the summation of losses from month to month from disease and nonbattle injuries, when the daily admission rate is 1.00 per 1000 Theater of Operations strength. Each month's losses are added to the accumulated losses of the preceding months, and the curve is consequently a constantly ascending one, although there is a progressive decline in the loss rate for each separate month, with a descending curve, (Fig. 54) until it stabilizes at the end of the 12th month. The rapid fall of this latter curve (Fig. 54) during the first few months is caused by the rapid increase in the number of patients returning to duty from the hospital (Fig. 55). After the first six months there is but little


84

change in the loss rate from cases disposed of in the Zone of the Interior, among those sent there from the Theater of Operations, and also from the deaths; but the total for each month continues to decline until the end of one year, or until the outflow of patients from hospital equals the inflow. After the end of the year, the loss rate from the deaths in the Theater of Operations and the disposition of cases in the Zone of the Interior (includ-

    Fig. 54. - Loss of manpower from diseases and nonbattle injuries in the Theater of Operations during successive months.
    NOTE: Calculated from data from the three upper curves, Fig. 51.


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    Fig. 55. - Cases of diseases and nonbattle injuries returned to duty in the Theater of Operations during successive months.
    NOTE: Number returned to duty by months equals number admitted during that month less the month's losses as per Fig. 54.


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ing disability cases) will continue as long as the basic conditions do.

The decline in the loss rates during the first 12 months is therefore due chiefly to the increasing number of patients returning to duty from hospitals. Consequently as stated in the last sentence of the legend of Fig. 54 these data apply only to each individual group of men. This group

    Fig. 56. - Loss of manpower from war (poisonous) gases in the Theater of Operations, during successive months.
    NOTE: Calculated from data from the three upper curves, Fig. 52.


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    Fig. 57. - Gas cases returned to duty in the Theater of Operations during successive months.
    NOTE: Number returned to duty be months equals number admitted during that month plus the number killed in action, less the month's losses as per Fig. 56.


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may be a field army, corps, division, or a regiment, or lesser body, but the essential point is that each one must establish its own increasing flow of men out of hospital to replace those entering hospital before its loss rate can decline.

The 3%, 6%, and 9% curves again show the importance as a loss factor of the disposition of cases in the Zone of the Interior from among those sent there.

    Fig. 58. - Loss of manpower from gunshot injuries in the Theater of Operations during successive months.
    NOTE: Calculated from data from the three upper curves, Fig. 53.


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    Fig. 59. - Gunshot cases returned to duty in the Theater of Operations during successive months.
    NOTE: Number returned to duty by months equals number admitted during that month plus the number killed in action, less the month's losses as per Fig. 58.


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b. Gas patients. - Fig. 56 shows the same data for casualties from poisonous gases as Fig. 54 does for those from diseases and nonbattle injuries. Losses from gas casualties also stabilize at the end of the 12th month, as does the return of patients to duty from hospital (Fig. 57). The loss rate from gas casualties after the 12th month is a little greater than the one from diseases and nonbattle injuries, due to the assumed number killed in action by gas, and to the assumed larger fatality rate for gas cases.

c. Gunshot patients. - The very great and continued importance of gunshot casualties as a loss factor is again shown by Fig. 58. As a result of the long duration of treatment of cases of this character, the loss rate continues to decline even after the 16th month (480th day), and until the 920th day. During the last several months shown on the graph, the cases disposed of in the Zone of the Interior, the deaths in hospital, and the assumed number killed in action account for a stabilized loss rate of 18.37, 15.39, and 12.41, according to the percentage of admissions sent to the Zone of the Interior, and the gradual increase of the noneffectives in hospital for the excess, as shown by Fig. 58, above them. With the larger loss rates, fewer men are returned to duty from hospital (Fig. 59).

d. With a constant strength and a constant admission rate. - Here as elsewhere the possibilities of sanitation and the climate of the Theater of Operations area, the amount of seasoning of the troops, and military resistance of the enemy must be estimated before the total loss rate can be determined.

Table 12 again shows the influence of the percentage of cases which are sent to the Zone of the Interior upon the loss rate.


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Table 12.-Losses per 1000 men in any group of them by months of service in the Theater of Operations, when the daily hospital admission rate per 1000 total strength is: (a) From diseases and nonbattle injuries, 1.40; (b) from gases .31; (c) from gunshot wounds, .69, or approximately the same rates as occurred in the American Expeditionary Forces, from July 1 to November 11, 1918 (excluding the influenza epidemic).

30 day periods

(1) When there is sent to the Z. of I. 3% of (a), 6% of (b), and 20% of (c).

(2) When there is sent to Z. of I., 9% of (a), 9% of (a), 9% of (b), and 30% of (c).

(a) Diseases and nonbattle injuries

(b) Gas

(c) Gunshot

Total

(a) Diseases and nonbattle injuries

(b) Gas

(c) Gunshot

Total

1st

24.42

7.29

25.11

56.82

25.56

7.37

25.41

58.34

2nd

9.51

3.81

20.84

34.16

11.47

3.99

21.63

37.09

3rd

5.32

2.28

18.08

25.68

7.56

2.51

19.22

29.29

4th

3.42

1.53

16.07

21.02

5.74

1.79

17.46

24.99

5th

2.55

1.17

14.58

18.30

4.93

1.44

16.16

22.53

6th

2.16

1.00

13.52

16.68

4.55

1.28

15.24

21.07

7th

1.99

.93

12.72

15.64

4.44

1.21

14.52

20.17

8th

1.88

.89

12.16

14.93

4.30

1.17

14.05

19.52

9th

1.86

.87

11.76

14.49

4.28

1.15

13.70

19.13

10th

1.85

.86

11.25

14.16

4.27

1.14

13.43

18.84

11th

1.83

.86

11.23

13.92

4.27

1.14

12.23

18.64

12th

1.82

.86

11.07

13.75

4.27

1.13

13.10

18.50

58.61

22.35

178.59

259.55

85.64

25.32

197.15

308.11

Note: Basic data from Fig. 54, 56 and 58 multiplied by 1.40, .31, and .69 respectively.

Under both sets of conditions, the. loss rate falls rapidly after the the first month, in the first declining from 56.82 per 1000 men during the first month to 13.75 in the 12th, and in the second from 58.34 in the first to 18.50 in the 12th month.

e. With an increasing strength but constant admission rate.- (1) From one cause. The problem of determining the probable loss rate for an expeditionary force is seldom so simple as the one above, for it will rarely happen that an entire force will be sent into an expeditionary area at one time. Then again, while in the interest of simplicity an average daily admission rate from diseases and nonbattle injuries may be used throughout, the military resistance encountered and the amount of military combat engaged in will probably vary so greatly that it will be necessary to use more than one rate.


92

Let us consider first the simpler of the two situations; that is, where we have a constantly, although not uniformly, increasing force with an average daily admission rate from diseases and nonbattle injuries. Fig. 60 shows the method of computing the data for such a problem. The strength of the military force with monthly increases is approximately the same as existed in the American Expeditionary Forces to the middle of each month; and the daily admission rate, the average one for the year (including the influenza epidemic).

As we have found the greatest loss rate for any one force is during the first month because the patients, or noneffectives, in hospital are rapidly increasing and comparatively few men are returning to duty. As each group enters the Theater of Operations and establishes its own flow of patients out of hospital, its loss rate declines. The strength of each monthly increment in the Theater of Operations (Fig. 60) is multiplied by the initial month loss rate at the basic daily admission rate of 1.00 per 1000 strength, and during the following month by the loss rate

    Fig. 60. - Losses from diseases and nonbattle injuries by months under approximately the same conditions as occurred in the American Expeditionary Forces where there was a material increase in the strength each month, and where the constant average daily admission rate to hospital only from these causes was 1.65 per 1000 American Expeditionary Forces strength. It is here assumed that 3 % of these admissions were sent to the Zone of the Interior. The symbols used throughout the body of the table represents the product of a monthly loss at a daily admission rate of 1.00 per 1000 strength multiplied by a monthly increase in strength in thousands. Thus 1 B (17.44 × 38.) = 663.
    NOTE: Data for losses each month (second line from top), see Fig. 54.


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for the second month, etc. The items as computed for the men who were in the Theater of Operations on the middle of January, and for each monthly increment during the next 10 months, are summated from side to side, and from above downward. The several sums so obtained are then multiplied by the daily admission rate of 1.65 per 1000; i.e., the one

    Fig. 61. - Method of computing the losses to be expected in the Theater of Operations in a command in which there is an increasing strength; where there are admissions from both battle and nonbattle causes; and also when certain percentages of the patients are sent to the Zone of the Interior.


94

that occurred in the American Expeditionary Forces.

The results at the bottom of the graph (Fig. 60) shows the losses which occurred from diseases and nonbattle injuries during each month in the strength of the total American Expeditionary Forces, and those on the extreme right hand margin, the total losses in each month's group of men from the time it entered the Theater of Operations until November 11, 1918.

(2) From three causes. - Fig. 61 shows a method of computing the losses in the Theater of Operations from the three causes with rates averaged for the entire American Expeditionary Forces during the year 1918. In Fig. 60, the losses are shown for each individual month, whereas in Fig. 61 the accumulated losses are shown, the February figure including those for January; etc.

f. With an increasing strength and also an increasing admission rate. - Figs. 60 and 61 illustrate the method of calculating losses in any expedi-tionary force when there is an increase each month in the strength, but

    Fig. 62. - Losses from war (poisonous) gases by months under approximately the same conditions as occurred in the American Expeditionary Forces where there was a material increase in: (a) The strength each month; (b) also in the admission rate at different periods. The average daily admission rates from war gases per 1000 American Expeditionary Forces strength were: Jan. to June 0.10; July to Sept. 0.22; Oct. to Nov. 0.41. It is here assumed that 6% of the admissions from gas were sent to the Zone of the Interior. The symbols used throughout the body of this table represent the pro-duct of a monthly loss by a monthly increase in strength in thousands and by a daily admission rate. Thus 1BS (23.53 × 38 × .10) = 89.
    NOTE: Data for losses each month (second line from top), see Fig. 56.


95

with a constant average daily admission rate. Figs. 62 and 63 show, however, how to compute the data when there is not only an increasing strength, but also an increasing admission rate. The same basic principle applies to the latter factor as to the former. Thus a group of men with an average daily admission rate establishes a return flow of men from the hospital at that rate, but when the rate increases materially and consequently more men are admitted to hospital, the return flow from that increased number must be established before there can be a decline in the specific loss rate.

Fig. 20 shows the daily admission rates per 1000 total American Expeditionary Forces strength from gas and from gunshot missiles during each month, and also during several grouped periods. From this graph, it is apparent that during the early weeks in 1918 the American Expeditionary Force troops engaged in but little military combat, but as time advanced the amount and intensity of the fighting increased and finally culminated in the prolonged and severe fighting during September, October, and early November.

    Fig. 63. - Losses from gunshot injuries by months under approximately the same conditions as occurred in the American Expeditionary Forces where there was a material increase in: (a) The strength each month; (b) also in the admission rate at different periods. The average daily admission rates per 1000 American Expeditionary Forces strength were: Jan. to June 0.11; July to Sept. 0.53; Oct. to Nov. 0.96. It is here assumed that 20% of the gunshot admissions were sent to the Zone of the Interior. The symbols used throughout the body of this table represent the product of a monthly loss by an increase in strength in thousands and by a daily admission rate. Thus 1BS (36.39 × 38 × .11) =152.
    NOTE: Data for losses each month (second line from top), see Fig. 58.


96

For convenience in calculating the data on Figs. 62 and 63, the time from January 1 to November 11, 1918 is divided into three periods, although more exact results could be obtained by dividing the entire time more nearly in accordance with the intensity of fighting.

As an illustration of the method of determining losses from gunshot missiles (Fig. 63), the January strength is multiplied by each loss rate from No. 1 to No. 11 at the basic daily admission rate of 1.00 per 1000; and also for each month of its service in the American Expeditionary Forces, (11 months) by the admission rate of .11. The increase in the admission rate of .42 (.53 - .11) in July is then multiplied by the January strength and the initial five loss rates. These additional losses are entered in the table on the line with the January strength under the months from July through November. The further increase in the admission rate of .43 [.96 - (.42 + .11)] in October is then multiplied by the January strength and the two initial loss rates. These additional losses as comput-ed are entered on the January line under October and November as they occurred.

In computing the losses for the increase in strength during February, that increment is multiplied by the loss rates from No. 1 to No. 10 inclu-sive, then throughout by .11, by .42 for the last five groups, and by .43 for the last two. For the March increase in strength, the loss rates from No. 1 to No. 9 are used, for the April one, No. 1 to No. 8, etc. For the July strength, the only loss rates used are from No. 1 to No. 5 inclusive, and consequently the second multiplication is by .53 (.11 + .42). Similar-ly the October increase is first multiplied by the first two loss rates and then by .96 (.53 + .43).

The following table shows a summary of the monthly losses as computed on Figs. 60, 62, and 63


97

Table 13. Total losses in the American Expeditionary Forces by months.

Month

Strength in thousands to middle of the month.

Losses by months

Increase in strength

Accumulated strength

Diseases and nonbattle injuries.

Gas

Gunshot

Total

Per 1000 total strength

Jan.

194

194

5,582

456

777

6,815

35.13

Feb.

38

232

3,267

327

797

4,391

18.93

March

49

281

3,051

304

881

4,236

15.07

April

88

369

4,100

391

1,122

5,613

15.21

May

167

536

6,834

630

1,649

9,113

17.00

June

223

759

9,644

896

2,334

12,874

16.96

July

258

1,017

12,022

4,008

18,612

34,642

34.06

August

268

1,285

13,578

3,564

20,764

37,906

29.50

Sept.

263

1,548

14,438

3,451

22,987

40,876

26.41

October

222

1,770

13,969

11,178

52,095

77,242

43.64

Nov. 1 to 11

110

689*

4,001

2,673

17,773

24,447

35.48

Aggregate

8,680

90,486

27,878

139,791

258,155

29.74

* 11/30 of accumulated strength for month of November

As nearly as can be estimated, the total losses in the American Expeditionary Forces to November 11, including deaths, cases in hospital and cases returned to the United States, was about 267,000, or about 9,000 more than the total 258,155 as shown above. The results then of these calculations approximate the actual losses as closely as could be expected from a computation in which grouped average rates and strengths are used.

To repeat, the rapid decline in loss rate as shown by Figs. 54, 56, and 59 occurs only when an expeditionary force has a constant strength throughout with constant admission rates from all causes. The loss rates per 1000 total Theater of Operations strength in the last column of Table 13 show how much such rates depend upon the increases in strength and upon the intensity of fighting.

K. LOSSES IN THE MOBILIZATION AREA.

The losses in the mobilization area consist of :

    a. Noneffectives in hospital.
    b. Deaths and discharges for disability among patients in hospital.
    c. Deaths and discharges for disability among men not in hospital.


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After the mobilization camps are filled, there is but little increase in the strength of the command. As the troops are trained and equipped they are sent to the expeditionary area and are replaced by incoming recruits. Consequently the number of men mobilized is greater than the average daily strength for one year. Thus in 1918, the former was 3,310,246, and the latter 1,310,246.

    Fig. 64.* - Loss of manpower in the mobilization area (U.S.) among those actually enrolled in hte military service from diseases and nonbattle injuries, due to deaths, discharges for disability, and noneffectives in hospital (patients).
    *NOTE: For basic formula see: (a) Patients in hospital, Fig. 82, (2) p. 149. (b) Deaths and discharges in hospital, Fig. 95 (2) p. 162. (c) Deaths and discharges not on sick report based on experience in U. S., 1918.


99

The troops while in training establish a. return flow of patients from hospital, and when they depart their sick in hospital remain behind, thus acting as a replacement flow for the incoming recruits. The ultimate number of noneffectives will then be divided among the total number of men passing through the mobilization area rather than among the average daily number present for the year. The men in camp during the first few weeks, when the noneffective rate rises quite rapidly, lose a larger percentage than those during the later periods when it is more nearly stabilized; but for all practical purposes we may disregard this and consider that the noneffectives are distributed evenly among the men mobilized. Then as in Fig. 64, with an ultimate noneffective rate of 20.36 to the average annual strength, the same rate to each 1000 men mobilized was

20.36 × (1,310,246/1000) ÷ (3,310,246/1000) = 8.06

The time element is an important one in connection with deaths and discharges among patients in hospital, for the number of cases with their associated deaths and discharges for disability increase in proportion to the length of the time period, like the noneffective rate. Consequently this class of losses must be proportioned to the total number of men mobilized rather than to the daily strength averaged for one year. With a loss rate from these causes at the end of one year of 14.67 per 1000 in an average daily strength of 1,310,246, the corresponding one for 3,310,246 men mobilized is

14.67 × (1,310,246/1000) × (3,310,246/1000) = 5.81

The third class of losses are from deaths and from discharges for disability (of which the latter comprised 95% of the two during 1918), among men not on sick report. This group consisted chiefly of the phy-sically unfit men whose deficiencies escaped the scrutiny of the local and camp examining boards. The physical imperfections of such men soon became apparent to officers of organization and to the medical officers assigned to them, and they were discharged as physically unfit. Probably all such cases can be culled out within a month or six weeks, and there should be no material increase in the percentage of them there-after, no matter how long the men remain in the mobilization area. Since the time element need not be considered in connection with them, as it is assumed that the training period will be long enough for their detection and elimination, the rates for them can be based upon the actual number of men mobilized. In 1918 it was 22.24 per 1000 men (Fig. 64).

Since the total losses in man power in the mobilization area is 52.05 per 1000 men mobilized (See Fig. 64), or 5.20%, the number of men


100

available for duty with any expedition will be 100% - 5.20% = 94.80%. For each 1000 men required for a large expeditionary force, when the troops are to be equipped and trained in the mobilization area, the number that will be required, after passing the camp examining board will be:

94.80% = 1000
100% = 1054.85

Since 6.6 %,12 of all men sent to the military camps by the Local Boards were found to be physically unfit, the percentage of the men actually called for service who will eventually be available for duty with an expeditionary force will be:

100% - (5.2% + 6.6%) = 88.2%

Then for each 1000 men required for an expeditionary force, the number to be called after passing the rather careful scrutiny of the Local Examining Boards will be:

88.2% = 1000
100% = 1133.79

Of this number of men called there will be:

    1. Found physically unfit by Camp Examining Boards

    74.83

    2. Noneffectives, deaths, and discharges as physically unfit in training camps

    58.96

    3. Available for duty with an expeditionary force

    1000.00

        Total to be called

    1133.79

Since 14.6% of all Class I men were found physically disqualified for full military service by local boards; and an additional 8.0% as available only for limited or domestic service by the local and camp examining boards, the percentage of Class I men between the ages of 21 and 30 who were eventually available for combat service with the expeditionary force was 100 % - (14.6% + 8.0% + 6.6% + 5.2%) = 65.6%. Then for each 1000 men for combat duty required for an expeditionary force, the number of Class I men, ages 21 to 30, who must be available will be:

65.6% = 1000
100% = 1524.39

Of this number there will be:

    1. Found physically unfit by the examining board

    222.56

    2. Found physically fit for only limited service by local and camp examining boards

    121.95

    3. Found physically unfit by camp examining board

    100.61

    4. Non-effectives, deaths, and discharges as physically unfit in training camps

    79.27

    5. Available for combat duty with an expeditionary force

    1000.00

        Total Class I men

    1524.39

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