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Part 3

Table of Contents

III. MEDICAL SERVICE IN THE COMBAT ZONE

The care of the sick and injured of the units operating in the Theater of Operation and the evacuation to general hospitals are important functions of the Medical Department. The efficient and systematic performance of this duty assists materially in insuring the mobility of the troops in the front area, and it is also a very important factor in maintaining the morale of the troops.

The character of cases to be treated and evacuated are:

    a. Diseases and nonbattle injuries.
    d. Battle wounds from:

      (1) Gunshot missiles.
      (2) War gases.

    L. DISEASES AND NONBATTLE INJURIES

    35. Total in the Theater of Operations. - Our experience shows (Fig. 18) that the daily admission rate from diseases and nonbattle injuries to hospital and quarters combined for seasoned troops operating under favorable conditions in a temperate climate in an area such as the American Expeditionary Forces, with a large number of men in the line of communications area, was 2.50 per 1000. It further shows (Fig. 1) that 56% of such cases were admitted to hospital and 44% were treated in quarters, infirmaries, improvised hospitals, etc. We know also, (p. 3) that approximately one half as many cases are treated as dispensary cases as in hospital and quarters combined.

    Under such conditions as outlined above the average daily sick rate per 1000 men among such troops would be:

      Hospital sick 1.40
      Quarters sick 1.10
      Dispensary sick 1.25

    If this rate is increased 20% to allow for normal variations, the daily sick rate per 1000 men in the Theater of Operations is 4.50, of which, approximately one third would be sent to station or general hospitals, one third would be cared for in quarters, dispensaries, etc., and one third would be returned to duty with their organization. In the further discussion of this subject no mention will be made of the care of the dispensary sick, but there will always be a large number of such cases to be treated, and supplies and personnel must be available for this purpose.

    36. In the Combat area. - When troops enter the combat zone and then advance to the battle line, the incidental hardships and unfavorable conditions probably would cause an increase in the sick rate. To obtain data in regard to the actual increase to be expected, a study was made of the medical records of the infantry regiments of the 1st,


    102

    Table 14. - Daily admission rates from diseases by systems by months, among each 1000 white enlisted men in combat divisions and in the total American Expeditionary Forces, June to October, 1918.

    Systems

    June

    July

    August

    September

    October

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Infections not specified

    .08

    .11*
    .29†

    .09

    .08
    .14

    .12

    .09
    .16

    .17

    .11
    .20

    .38

    .16
    .29

    Tuberculosis

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    Venereal

    .09

    .05
    .09

    .05

    .03
    .06

    .08

    .05
    .07

    .16

    .04
    .07

    .10

    .04
    .07

    General

    .06

    .02
    .04

    .07

    .02
    .04

    .04

    .02
    .04

    .11

    .03
    .06

    .25

    .04
    .07

    Nervous and mental

    .20

    .03
    .06

    .88

    .08
    .14

    .23

    .06
    .11

    .19

    .05
    .09

    .45

    .06
    .11

    Eye, ear, and nose

    .16

    .04
    .07

    .09

    .03
    .06

    .10

    .04
    .07

    .13

    .03
    .06

    .11

    .04
    .07

    Circulatory

    .10

    .03
    .06

    .09

    .03
    .06

    .10

    .04
    .07

    .14

    .04
    .07

    .19

    .04
    .07

    Respiratory

    1.67

    .34
    .61

    .41

    .21
    .38

    .46

    .25
    .45

    1.40

    .77
    1.34

    2.81

    1.15
    2.05

    Digestive

    .21

    .10
    .18

    .32

    .11
    .20

    .67

    .23
    .41

    .56

    .15
    .27

    1.39

    .28
    .50

    Genito-urinary and skin

    .34

    .06
    .11

    .27

    .06
    .11

    .22

    .07
    .13

    .28

    .07
    .13

    .58

    .09
    .16

    Bones, organs of locomotion, con. Malformation, & ill defined

    .72

    .08
    .14

    .31

    .06
    .11

    .22

    .07
    .13

    .28

    .07
    .13

    .58

    .09
    .16

    TOTAL

    3.65

    .87
    1.55

    2.63

    .71
    1.27

    2.27

    .90
    1.61

    3.57

    1.37
    2.45

    6.67

    1.98
    3.54

    *Admission rates to hospital
    †Estimated total admission rates, including cases in quarters.
    NOTE: The Combat Divisions include the Infantry Regiments of the 1st, 3rd, 26th and 42nd Divisions. The rates for the Combat Divisions apparently include as hospital cases those ordinarily treated in quarters; whereas those computed,for the total American Expeditionary Forces include only hospital cases. The estimated ones which include also quarters cases can be more properly compared with those for the Combat Divisions (Front Area).

    3rd, 26th and 42nd Divisions, all active combat divisions, for the period June I to October 31, 1918, inclusive.1


    103

    Since the Divisions selected were composed of white men, their rates are compared with those for the total white troops in the American Expeditionary Forces.3 The computed data as presented by Tables 14 and 15, and Figs. 65 and 66, shows that there was more sickness among the front area white troops than in the total, group. It is apparent also that the excess among the front line troops occurred each month and from each class of disease, the most important increase being in the number of

      Fig. 65. - Daily admission rates by classes of diseases per 1000 strength of white troops in the front area, and also in the total American Expeditionary Forces, for the period from June 1 to October 31, 1918. 1 3


    104

    cases of respiratory and digestive diseases.

    Table 15 and Fig. 66 also indicate that there was more sickness among the troops on the battle line than among the other front area troops. The data, as computed, shows that the average daily hospital admission rate from diseases only for the white troops in the front area was 3.76 per 1000, as compared with 1.26 for the total American Expeditionary Forces,3 or practically 3 to 1. If the admissions from nonbattle injuries are included the rate of 1.26 is raised to 1.40; and if the ratio of 3 to 1 is continued, the 3.76 is raised to 4.20 (hospital only).

    Before any real comparison can be made, however, of the rates for the combat divisions with those for the total American Expeditionary Forces, the character of the cases included in the two sets of rates must be considered. As stated above, many of the cases of sickness among the men in the training area were treated in quarters, infirmaries, etc., and were not made of record. Among the combat divisions, however, and especially so when in the actual combat area, a large part of the sick had to

      Fig. 66. - Daily admission rates from diseases per 1000 strength of white troops in the front area, and in the total American Expeditionary Forces, for the period June 1st to October 31st, 1918,and also for each month of that period. 1 3


    105

    be evacuated and consequently were admitted to either temporary or permanent hospitals where records were made. Apparently then, the comparison should be between the total admission rate in the American Expeditionary Forces; that is, the one including both hospital and quarters cases, and the one available for the combat division. For this purpose, the estimated rates to include both hospital and quarter cases for the total American Expeditionary Forces are shown both in the tables and on the graphs. The comparison is then between 2.50 and 4.20. Consequently, we would expect the sick rate to be 1.70 (1.68) as great among the personnel of the front line combat divisions as in a total area, such as the

    Table 15. - Daily Admission Rates from Disease by Systems among each 1000 White Enlisted Men, on the battle line, among other troops in combat divisions, and in the total American Expeditionary Forces, June to October, 1918.

    Systems of Diseases

    Combat Divisions

    Total 3
    A.E.F.

    On battle line

    Not on battle line

    Total

    Infectious, not specified

    .15

    .19

    .17

    .12*
    .21†

    Tuberculosis

    .02

    .02

    .02

    .01
    .02

    Venereal

    .10

    .09

    .09

    .04
    .07

    General

    .13

    .09

    .11

    .03
    .05

    Nervous and mental

    .57

    .20

    .39

    .06
    .11

    Eye, ear and nose

    .13

    .10

    .11

    .04
    .07

    Circulatory

    .12

    .12

    .12

    .04
    .07

    Respiratory

    1.58

    1.09

    1.35

    1.11

    Digestive

    .63

    .64

    .63

    .19
    .34

    Genito-urinary and skin

    .33

    .32

    .33

    .07
    .12

    Bones, organs of locomotion, congenital malformations and ill-defined

    .56

    .27

    .42

    .08
    .14

    TOTAL

    4.31

    3.13

    3.76

    1.26
    2.25

      *Admission rates to hospital.
      † Estimated total admission rates including cases in quarters.


    106

    American Expeditionary Forces. Furthermore, when the troops are on the actual battle line this excess may be 2.00 to 1.00 instead of 1.70 to 1.00. Even with the estimated increase added, the total American Expeditionary Forces rates are still much lower than those for the Combat Divisions (Front Area) for each month, and for each group of diseases with the two exceptions, one for infectious not specified (which is lower), and the other for tuberculosis (which is the same) (see Table 14 and Fig. 65).

    Table 16. - Relative number of cases of sickness among the front area troops as compared with the estimated total in the American Expeditionary Forces set as a standard at 1.00.

      a. By months

    Month

    Front Area

    June

    2.35 to 1.00

    July

    2.07 to 1.00

    August

    1.41 to 1.00

    September

    1.46 to 1.00

    October

    1.88 to 1.00

    TOTAL

    1.67 to 1.00

      b. By class of disease

    Disease

    Front Area

    Respiratory

    1.21 to 1.00

    Digestive

    1.85 to 1.00

    Bones & organs of locomotion

    3.00 to 1.00

    Nervous and mental

    3.55 to 1.00

    Genito-urinary and skin

    2.75 to 1.00

    Infectious, not specified

    0.81 to 1.00

    Circulatory

    1.71 to 1.00

    Eye, ear and nose

    1.57 to 1.00

    General

    2.20 to 1.00

    Venereal

    1.28 to 1.00

    Tuberculosis

    1.00 to 1.00

    M. BATTLE CASUALTIES - COLLECTION OF DATA.

    The following data show the average and maximal casualty rates, and also how often rates, of various magnitude, occurred among the United States troops in the American Expeditionary Forces during 1918. The information as assembled is for the American part of 'the First American Army and its component units, and also for other selected Divisions and regiments. The sources of the information and the method of assembling the data are as follows.

    37. Composition of Organizations. - a. First American, Army. - The Report of the First Army was used to determine its component organizations from day to day. This information was supplemented by information obtained from "Field Operations, Volume VIII, The Medical De-


    107

    partment of the United States Army in the World War".14 The Corps of the First Army were I, III, and V, from September 26 to November 11; the IV from September 26 to October 12; and the Divisions serving with the French, for this study, grouped and included as a Corps, from Sept. 26 to Nov. 11.

    b. Corps. - The report of the First Army13 was also used to determine the Divisions in each Corps from day to day, and also those in the Army Reserve. "Field Operations" 14 was again used to supplement the information obtained. In addition, "Battle Participations of Organizations of the American Expeditionary Forces in France, Belgium, and Italy"10 was used quite freely to verify the location of Divisions, and especially to determine when a Division left the line for reserve or vice versa.

      Fig. 67. - Average daily number of' American divisions in the First American Army, in each of its Corps, both in line (L) and in reserve (R), and also in the Army Reserve for the period of 47 days, from September 26 to November 11, 1918.3
      NOTE: The IV Corps was a part of the First Army only until October 12, a period of 17 days. During that time the average daily number of divisions in line was 3.18 and in reserve 1.53, whereas the figures for the entire 47 days was L-1.15 and R-.55 as shown above.


    108

    Fig. 67 shows the daily average number of American Divisions in each Corps and also in the First American Army during the Meuse-Argonne offensive.

    c. Divisions. - The information in regard to the operations of Divisions was obtained from the "Battle Participations of Organizations of the American Expeditionary Forces " etc 10. This information was supplemented by a mimeographed copy of "Brief Histories of Divisions, U. S. Army, 1917 - 1918"15, June, 1921,. from the Historical Branch, War Plans Division, General Staff.

    38. Strength of the Organizations. a. First Army. - The strength of the First Army is given on page 113 of the "Report of the First Army"13. Examination of the casualties in organizations by days, as will be referred to later, showed that only 91% of the total casualties were distributed by divisional organizations by days.* Apparently then only 91% were included in the total casualties assembled for the First Army. Therefore, the daily strength of the First Army as shown in the official report, was reduced in each instance to 91% to compensate for the difference in the total of casualties as they occurred and as assembled.

    b. Corps. - The daily strength of the individual corps was found by multiplying the assumed strength of a division; that is, 24,000, by the number of divisions, including those in reserve, in the Corps, and then adding 33% † to cover corps troops not included in divisional organizations. The total figures thus obtained were reduced then in each instance to 91 % to compensate for the unassembled casualties, as referred to above.

    c. Divisions. - An examination made by the Historical Branch of the War College of the returns of 14 Combat Divisions on or about September 26, 1918 showed that the average strength of each one was 24,128 men. It was assumed then that 24,000 was a fair figure to use in determining the strength of the corps, as referred to above. But for the purpose of calculating rates for Divisions, the 24,000 was reduced to approximately 91%, or to 22,000, to compensate for the unassembled divisional casualties.

      *The original medical cards, upon which the casualties were reported, showed the regiments or staff corps to which each patient was attached, but there was no reference to Division. The 9% of undistributed casualties occurred among staff or corps troops, not in regiments.
      †The Increase of 33% for Corps troops is based upon the strength of a type corps composed of three divisions and the equivalent of the strength of one division in corps troops. Since the daily number of divisions in the various corps was often greater than three while the number of corps troops probably remained more nearly constant, the increase of 33% for the latter probably results in too great a strength for the corps, and consequently in too low a rate. Hence an increase of from 5% to 10% in such rates as are given may be justifiable.


    109

    d. Regiment. - An examination made by the World War Division of The Adjutant General's Office of reports of the Infantry Regiments in the 1st, 42nd, and 80th Divisions on October 81, 1918 showed, that the average strength of each regiment was 2,732. To compensate for the lag in reporting casualties, the round number of 2,500 was used in calculating regimental rates.

    39. Sources of Casualty data. - a. Immediate source of information. The immediate source of the casualty data was the tables in the latter part of "Medical and Casualty Statistics, Part 2, Volume 15, The Medical Department of the United States Army in the World War"3 In these tables the number of gas wounded, gunshot wounded, and killed in action is given for each day for each Infantry, Artillery, and Engineer Regiment, and each Machine Gun Battalion.

    b. Original source of information. - The original source of the information was: (a) For the number wounded by war gasses and by gunshot missiles, the Sick and Wounded Report cards forwarded from the American Expeditionary Forces to the Office of the Surgeon General; (b) for the killed in action, a nominal list of the deaths in the American Expeditionary Forces arranged by organization and by day, prepared in the Office of The Adjutant General and loaned to the Surgeon General's Office in 1921. It will be noted that in some instances during severe engagements, such as when the 27th and 30th Divisions participated in the attack on the Hindenburg line (Somme offensive) on the 29th and 30th of September, 1918, apparently all of the killed on the two days were reported as of the first day of the engagement. This results in a too high casualty rate for the first of the two days and in one too low for the second.

    40. Engagements Studied. a. First Army and Corps. - The Meuse-Argonne offensive from September 26 to November 11.

    b. Divisions. - All of the Divisions comprising the Corps of the First Army, including those with the French. In addition, the following were included: §

      1. First Division, Aisne-Marne, July 18 - 23.
      2. Third Division, Aisne-Marne, July 18 - 31.
      3. Fourth Division, Aisne-Marne, August 2 - 7.
      4. Twenty-Sixth Division, Aisne-Marne, July 18 - 25.
      5. Twenty-Seventh Division, Somme offensive, Sept. 26 - Oct. 20.
      6. Thirtieth Division, Somme offensive, Sept. 26 - Oct. 20.
      7. Thirty-Second Division, Aisne-Marne, July 30 - August 6.
      8. Forty-Second Division, Aisne-Marne, July 25 - August 3.

      § The Second Division could not be included because the date by days for its Marine organization were not available.


    110

    c. Infantry regiments. - All of the Infantry regiments of the Divisions referred to; and, in addition, the 9th and 23rd Infantry regiments of the Second Division in the Aisne-Marne, July 18 and 19.

    41. Method of Assembling Data. - a. Infantry regiments. - In the study of casualties by regiments, only Infantry regiments were included, because the Artillery and Engineer regiments had relatively few casualties as compared with the Infantry. The tabulation of the casualties for the Infantry regiments included only those assigned to Divisions operating on the front line, and none of those assigned to Divisions in the Corps or Army Reserve. It was, however, impossible to select out the Infantry Regiments when in the reserve of the selected Divisions.

    b.Divisions. - The casualties as assembled for Divisions include those for the four Infantry regiments; three Machine Gun Battalions; the Engineer regiment; and the three Artillery regiments, when operating with the Divisions.‡ The daily casualties of these organizations, were added to find those for the Divisions. As stated above, the Division strength was reduced to 91% of the total to compensate for the casualties which occurred in the organizations of the Divisions but for whom such data could not be assembled. In the study of the Divisions per se, the casualties of a Division was included only for the days when the Division was actually on the front line.

    c. Corps. - In assembling the data for the Corps by day, the casualty data for all of the Divisions with the Corps on that date, both on the line and in reserve, were included. These were added to find the total for the Corps. In some instances, when more than one day was necessary to change a Division from the line to reserve or vice versa, the casualty rate for the Division shown as in reserve may be seemingly quite high.

    d. Army. - The daily casualties of the Divisions in the Army Reserve were added to the total of those in the Corps to find the aggregate for the Army.

    42. Percentage of gas wounded, gunshot wounded, and killed. - The term battle casualties as used here includes wounds by war gases, wounds by gunshot missiles, and the killed in action. In planning the evacuation of the wounded some approximate estimate must be made of the percentage of the gas and of the gunshot wounded in the total casualties.

    As shown by Fig. 99 p. 166, the daily proportion of gas wounded to gunshot wounded decreased as the number of the latter increased; and also as shown by Fig. 100, p. 167, the daily proportion of gas wounded to the number killed in action decreased as the latter increased, while the proportion of gunshot wounded to the number killed remains practically constant. In other words the relative number of men wounded each day by war gasses decreased as the intensity of the military combat increased.

      ‡ No allowance could be made for the absence of Artillery regiments on certain days. Consequently the casualty rates as computed for such days are slightly lower than they should be.


    111

    Fig. 68 shows how the proportion of the gas wounded, gunshot wounded, and killed in the total casualties varied according to the resistance. It is suggested that the approximate average percentage distribution of casualties in Infantry regiments in engagements with casualties varying from 100 to 400 (rates varying from 4% - to 16%) be used in estimating the percentage of killed in action, gas wounded, and gunshot wounded in the total casualties. We would then assume that in severe engagements 16% of the casualties would be the "killed in action", 64% gunshot wounded, and 20% gas wounded. There would then be 4 gunshot wounded to 1 killed in action, and 3.2 gunshot wounded to 1 gas wounded.

      The percentage of killed to wounded would then be:
      (a) 16% when there are both gas and gunshot wounded;
      (b) 20% when there are only gunshot wounded.

    Other American Expeditionary Forces experience indicates that in open warfare the killed would be 16-2/3% (1 to 5) when war gases are not used.

      Fig. 68. - Variation in the percentage that the gassed, gunshot wounded and killed in action were of the total casualties according to the severity of the engagement.3
      NOTE: It is suggested that the approximate average percentages be used in estimating the distribution of total casualties. The data on the left hand margin show the actual number of casualties.


    112

    N. BATTLE CASUALTIES - PRESENTATION OF DATA.

    In presenting the casualty data for the Infantry regiments, Divisions, Corps, and the First American Army, four items are shown for each, one: (a) The average daily casualty rate during the Meuse-Argonne offensive; (b) the frequency of various daily casualty rates, that is, how often each one occurred; (c) the maximal daily casualty rates with the proportionate part which occurred in the component unit of the Army, each Corps, and each Division; (d) important casualty rates on days either preceding or following the maximal casualty day.

    43. Infantry Regiments. - a. Frequency of casualty rates. - The summation curve, Fig. 69, shows how often casualty rates greater or less than a certain one, occurred in infantry regiments. Thus, in 97.15% of the

      Fig. 69. - Summation curve showing how often various regimental daily casualty rates occurred during major operations in the American Expeditionary Forces in 1918.3


    113

    infantry regimental combat days in question (both in line and in reserve of the Divisions operating on the line) the loss was 100 per 1000 or less; and further the loss was greater than 100 per 1000 of the regimental strength in 2.85% (100.0% - 97.15%) of the days.

    The Figure also shows how often casualty rates between certain ones occurred. Thus a rate between 90 and 100 per 1000 of the regimental strength occurred in 0.83% (97. 15% - 96.32%) of the battle days in question.

    b. Average casualty day. - It is apparent then that high casualty day rates were comparatively infrequent. The average daily casualty rate, which was 20.36 per 1000 for the days in question, was also low. Since the average includes the days spent in the reserve of the Divisions which were on the front line, it is necessarily lower than it would have been for regiments in action only, and should probably be raised to approximately 25.00 per 1000 when comparing regimental losses with those in Divisions and Corps in combat.

    c. Maximal casualty days. - An estimate of the medical personnel and equipment required for infantry regiments in severe combat cannot be based with safety on the most frequent daily casualty rates, or even on the average one, but should be based upon rates during severe combat.

    In 1.74% (100% - 98.26%) of the combat days the casualty rates were greater than 150 per 1000 regimental strength; and in .86%, or 21

    Table 17. - Maximal infantry regimental casualty day rates per 1000 men with the five next highest on days either immediately preceding or following each, one; i. e., the rates are shown for six consecutive days.

    Inf. Regt.

    Div.

    Date of highest casualty rate

    Daily casualty rates per 1000 regimental strength.

    107

    27

    Sept. 29

    30.0

    349.6

    98.4

    39.6

    25.6

    11.6

    120

    30

    Sept. 29

    298.4

    69.6

    29.2

    20.8

    14.4

    5.6

    108

    27

    Sept. 29

    28.8

    292.4

    89.2

    34.0

    18.4

    12.0

    9

    2

    July 18

    262.4

    90.0

    46.4

    25.6

    36.4

    24.0

    119

    30

    Sept. 29

    14.4

    234.8

    75.6

    22.8

    15.6

    6.4

    106

    27

    Sept. 27

    22.4

    214.0

    30.8

    78.0

    25.6

    17.2

    114

    29

    Oct. 12

    205.6

    122.0

    38.0

    30.0

    15.6

    24.8

    117

    30

    Oct. 8

    31.2

    72.4

    197.6

    63.6

    20.0

    11.2

    16

    1

    Oct. 4

    23.6

    56.8

    22.4

    190.4

    52.8

    20.0

    26

    1

    Oct. 4

    188.4

    126.8

    75.6

    25.6

    31.2

    45.6

    18

    1

    Oct. 4

    180.8

    86.0

    87.2

    26.4

    25.2

    99.2

    6

    5

    Oct. 14

    9.2

    170.8

    61.6

    19.2

    13.6

    9.2

    18

    1

    July 18

    169.2

    79.6

    92.0

    121.6

    64.4

    27.6

    105

    27

    Sept. 29

    57.2

    19.2

    168.0

    51.6

    23.2

    17.6

    165

    42

    July 28

    14.0

    166.4

    116.0

    73.2

    52.4

    33.6

    16

    1

    July 18

    165.2

    134.0

    122.8

    90.0

    68.4

    31.6

    140

    35

    Sept. 28

    21.6

    66.8

    164.8

    157.2

    70.8

    39.2

    165

    42

    Oct. 14

    162.4

    125.6

    32.0

    22.0

    19.6

    8.4

    28

    1

    July 18

    160.4

    138.4

    102.4

    140.4

    55.2

    35.2

    26

    1

    July 19

    110.4

    158.4

    142.4

    104.4

    54.4

    27.2


    114

    days, they were greater than 200 per 1000 of the regimental strength. Table 17 shows the regimental daily combat casualty rates greater than 150 per 1000 of the regimental strength, and it also shows the more important loss rates on five other days, either immediately preceding or following each maximal casualty day; i.e., on six consecutive days.

    d. Estimated combat requirements. - After considering such daily rates as above it would apparently, be expedient to make provision for a 15% casualty day for an infantry regiment in severe combat, with the following distribution of the total casualties:

    Killed in action 2.4%, gunshot wounded 9.6%, gas wounded 3%.

    44. Casualties by arms of service. - In the American Expeditionary Forces the casualty rate for the infantry was much greater than those for the other branches. The following table shows the relative standing of the casualty rates, infantry being taken as 100.2

    Infantry

    100.00

    Machine Gun

    70.12

    Signal Corps

    16.46

    Tank Corps

    15.85

    Artillery

    11.58

    Engineers

    9.15

    Medical Department

    8.54

    Quartermaster Department

    3.05

    Cavalry

    3.05

    Ordnance

    1.83

    Aviation

    1.83

    45. Infantry Divisions. - a. Frequency of casualty rates. - The summation curve, Fig. 70, shows how often during, this experience casualty rates in Infantry Divisions greater or less than any specified one occurred. Thus in 98.80% of the infantry divisional combat days in question, the loss was 50 per 1000 or less of division strength, and in 1.2% (100.0% - 98.8%) of the days it was greater.

    A casualty rate between 40 and 50 per 1000 of the divisional strength occurred in 1.28% (98.80% - 97.52%) of the battle days.

    b. Average casualty day. - The average divisional casualty rate for all of the combat days in line in question was 9.61 per 1000, or slightly less than 1 %.

    c. Maximal casualty day. - Fig. 71, shows the divisional battle days with casualty rates greater than 60.0 per 1000, of the divisional strength. The graph also shows what part of the divisional casualty rate occurred in each of its component regiments, both in line and in reserve. The regimental rates are based here upon the divisional strength, so that the sum of the several component rates are equal to the divisional one.

    The following table shows the more important loss rates on five days either immediately preceding or following each maximal one; i.e., on six consecutive days.


    115

    Table 18. - Maximal infantry divisional casualty day rates per 1000 men with the five next highest ones on days immediately preceding or following: i. e., the rates are shown for six consecutive days.

    Division

    Date of highest casualty rate

    Daily casualty rates per 1000 divisional strength.

    27

    Sept. 29

    5.2

    35.7

    13.0

    105.6

    31.7

    14.2

    1

    Oct. 4

    84.2

    51.0

    30.0

    12.7

    14.9

    41.9

    30

    Sept. 29

    8.6

    4.5

    4.1

    77.8

    25.3

    10.9

    1

    July 18

    74.8

    62.2

    58.9

    58.7

    33.3

    16.4

    5

    Oct. 14

    15.8

    12.5

    65.0

    30.4

    15.5

    7.4

    d. Estimated combat requirements. - Since a casualty day of approximately 6% or greater occured not infrequently in Divisions in severe combat, it would apparently be expedient to make provision for a 6% casualty day for infantry divisions in severe combat with the following distribution: Killed in action, 0.96%, gunshot wounded 3.84% and gas wounded 1.20%.

      Fig. 70. - Summation curve showing how often various divisional daily casualty rates occurred during major operations in the American Expeditionary Forces in 1918.3


    116

      Fig. 71. - The daily casualty rates on the five maximal casualty days for divisions (not including the 2nd) in line (not in reserve) in the First American Army during the Meuse-Argonne and selected divisions in the Aisne-Marne and Somme Offensives; also the average daily casualty rate for the divisions during those engagements.3
      NOTE: The above rates for the component regiments of the divisions are based upon the divisional strength (22,000) and are consequently only 11.36% of those in Table 17 for the infantry regiments which are computed upon the regimental strength (2,500).

    46. Army Corps. - a. Frequency of casualty rates. - The summation curve, Fig. 72, shows how often casualty rates in Army Corps greater or less than any certain one occurred during the Meuse-Argonne offensive. As stated on the graph, casualty rates greater than 20 per 1000 of corps strength, occurred in 1.95% (100% - 98.05%) of the battle days; and that rate or less in 98.05% of the combat days. Casualty rates between 15 and 20 per 1000 of the Corps strength occurred in 1.97% (98.05% - 96.08%) of the battle days.

    b. Maximal rates in each Corps. - Fig. 73 shows the maximal rate which occurred in each Corps, and also the average for each one during the period of the Meuse-Argonne offensive. The graph also shows what part of the corps rate occurred in each of its component divisions, the latter rates being based upon corps strength. It is apparent that in each instance the greater part of the maximal rate occurred in one division. If two divisions in line had been engaged in equally severe combat, the total corps maximal rate would have been nearer 30 than approximately 20 per 1000 corps strength.

    The following table shows the maximal casualty days for the Corps in


    117

    question, and also the more important loss rates on four days immediately preceding or following each such day; i. e., on five consecutive days.

    Table 19. - Maximal daily casualty rates in the Corps of the First American Army during the Meuse-Argonne offensive with the four next highest rates on either immediately preceding or following days; i. e., on five consecutive days.

    Corps

    Date of highest casualty rate

    Daily casualty rates per 1000 corps strength.

    III

    Oct. 14

    21.32

    13.34

    8.10

    4.36

    4.50

    I

    Oct. 4

    10.11

    7.46

    21.22

    14.70

    8.32

    V

    Oct.14

    20.63

    12.76

    7.14

    3.59

    3.07

    V

    Sept. 29

    15.32

    20.52

    13.77

    7.89

    4.42

    I

    Sept. 28

    13.30

    16.10

    15.27

    6.37

    12.32

    V

    Oct. 9

    15.32

    10.48

    8.17

    4.65

    3.59

       Fig. 72-Summation curve showing how often various Corps daily casualty rates occurred in the five Corps of the First American Army, including the divisions with the French as a Corps, during the Meuse-Argonne Operation, Sept. 26 to Nov. 11, 1918. 3


    118

      Fig. 73. - The maximal daily casualty rate for each Corps of the First American Army during the Mense-Argonne Sept. 26 to Nov. 11, 1918, and also the average rate for each one during the entire period. 3
      NOTE: The above rates for the component divisions of the Corps are based upon the Corps strength on the specified dates and are consequently less than those shown in Table 18 for the divisions, which are computed upon the divisional strength.

    c. Estimated combat requirements. - If an estimate is based then upon the American Expeditionary Forces experience modified as suggested above it would apparently be expedient to make provisions for a 3% casualty day for Army Corps when engaged in severe combat, with the following distribution: Killed in action 0.48%, gunshot wounded 1.92%, and gas wounded 0.60%.


    119

    47. First American Army. - a. Frequency of casualty rates. - The summation, curve, Fig. 74, shows how often casualty rates, greater or less than a certain one occurred in the First American Army during the Meuse-Argonne offensive. The lowest daily casualty rate recorded was 1.05 per 1000 Army strength, and the highest, 7.75 per 1000.

      Fig. 74. - Summation curve showing how often various Army daily casualty rates occurred among American Troops in the First American Army during the Meuse-Argonne Operation, Sept. 26 to Nov. 11, 1918.


    120

    b. Daily casualty rates. - The following table shows the Army casualty rates for each day during the operations:

    Table 20. Casualty rates for the First American Army on each day during the Meuse-Argonne Offensive.

    Date

    Rate per 1000

    Date

    Rate per 1000

    Sept.

    Oct.

    26

    5.40

    20

    2.07

    27

    4.67

    21

    2.27

    28

    6.26

    22

    1.67

    29

    6.85

    23

    2.48

    30

    4.34

    24

    2.19

    Oct.

    25

    2.05

    1

    4.17

    26

    1.56

    2

    2.84

    27

    1.80

    3

    2.61

    28

    1.63

    4

    7.15

    29

    1.05

    5

    5.41

    30

    1.20

    6

    3.72

    31

    1.50

    7

    2.68

    Nov.

    8

    3.56

    1

    5.93

    9

    4.95

    2

    2.54

    10

    4.78

    3

    2.28

    11

    4.04

    4

    3.51

    12

    3.75

    5

    2.50

    13

    3.65

    6

    1.98

    14

    7.75

    7

    1.80

    15

    7.17

    8

    1.19

    16

    5.46

    9

    1.37

    17

    3.82

    10

    2.68

    18

    3.63

    11

    2.19

    19

    1.93


    121

    c. Maximal casualty rates. - Fig. 75 and Table 21 shows the maximal Army rates, with the part which occurred in each corps, based upon Army and not Corps strength.

    Table 21 - Maximal daily casualty rates per 1000 strength in the First American Army during the Meuse-Argonne offensive.

    Date

    I
    Corps

    III
    Corps

    IV
    Corps

    V
    Corps

    American Divisions with the French

    Army Reserve

    First Army

    Oct. 14

    1.57

    3.26

    *

    2.12

    .54

    .26

    7.75

    Oct. 15

    1.76

    2.15

    *

    2.04

    1.06

    .16

    7.17

    Oct. 4

    3.22

    1.36

    .54

    1.73

    .16

    .14

    7.15

    Sept. 29

    2.33

    .86

    .37

    3.13

    .10

    .06

    6.85

    Sept. 28

    2.50

    .83

    .41

    2.38

    .08

    .06

    6.26

    * Not a part of the First Army on this date.

      Fig. 75. - The daily casualty rates on the three maximal casualty days for the First American Army in the Meuse-Argonne Sept. 26 to Nov. 11, and also the average daily casualty rate during the same period.
      The above rates for the component Corps of the Army are based upon the army strength on the specified dates and are consequently less than those shown in Table 19 for the Corps, which are based upon the Corps strength on the same date.


    122

    d. Estimated combat requirements. - On each maximal casualty day, the greater part of the casualties occurred: in two Corps out of a total of four or five. If the Corps in line had been equally engaged, the Army maximal rate would have been nearer 15.00 per 1000 than 7.75. If an estimate then is based upon the American Expeditionary Forces experience as modified, it would seem to be expedient to provide for a 1.5% casualty day for a Field Army when engaged in severe combat with the following distribution of the casualties: Killed in action 0.24%, gunshot wounded 0.96%, gas wounded 30%.

    48. Summary. - a. Estimated combat requirements. - The following table gives a summary of the daily casualty rates as suggested above, under discussion of each unit, to be used as a basis for estimating the requirement for medical personnel and equipment on severe combat days.

    Table 22. - Casualty rates per 100 (%) of unit strength suggested as a basis for estimating the necessary medical relief on severe combat days, as determined by the American Expeditionary Forces experience.

    Total
    Casualties

    Killed in action

    Wounded by:

    Gunshot missiles

    Gasses

    Inf. Regiment
    Inf. Division
    Army Corps
    Field Army

    15.0
    6.0
    3.0
    1.5

    2.40
    .96
    .48
    .24

    9.60
    3.84
    1.92
    .96

    3.00
    1.20
    .60
    .30

    b. Average casualty rates. - Fig. 76 shows the average casualty rates for infantry regiments, infantry divisions Army Corps, and the First American Army during the Meuse-Argonne offensive.

    The average rates for infantry regiments and infantry divisions referred to under the discussion of those organizations include casualty days in engagements other than in the Meuse-Argonne, and consequently differ from the ones shown here.

    Since the average rate for infantry regiments includes the days for the regiments in divisional reserve some estimated increase should be made when their rate is compared with those for other units for which only combat days are included. It is suggested that for such a purpose, the average daily regimental casualty rate be increased from 17.96 to an estimated 20.00 per 1000 regimental strength.

    O. BATTLE CASUALTIES - TRANSPORTATION REQUIRED.

    It is difficult to secure accurate. information in regard to the character of transportation required for battle casualties. During or after a severe combat day there will seldom if ever be enough litter bearers to carry all of the gassed and gunshot wounded to the Collecting Station, even if such


    123

    was desirable. Consequently a certain number of the less severely gassed or gunshot wounded must walk to advanced relief stations. After the Collecting Station is reached, the more severely wounded must be transported as "Recumbent", while the less severely wounded can be carried as "Sitters".

      Fig. 76. - Average daily casualty rates per 1000 strength, for the period from Sept. 26 to Nov. 11, 1918, inc., for the total American Expeditionary Forces, First American Army, corps of the First American Army, divisions in line (not in reserve) of the First American Army, and infantry regiments of all divisions in line (including those in divisional reserve).
      *This rate (20.00) estimated for infantry regiments in combat only.

    The following data, which have been assembled from the medical records of the American Expeditionary Forces, may be of some assistance in, arriving at an approximate estimate of the problem.

    49. Gunshot wounded. - a. Location. - It is suggested that the location of the gunshot wound, varied as the available information suggests, be used as a general index of, the gravity of the wound and of the transportation required. Wounds of the soft tissue of the extremities when associated with extensive destruction of tissue, hemorrhage, shock, etc., are obviously more serious than fracture of the corresponding long bones associated with little destruction of tissue. Probably, however, the deaths which occurred in such cases can be used as an indication of the proportion of the wounds of relatively unimportant tissues which are very severe.

    When a soldier had two or more wounds, the preference is given in the following tables to the location associated with the highest average fatality


    124

    rate. The table shows how often wounds involving various tissues occurred, and also the fatality rate for each group. Wounds involving the abdominal or pelvic organs occurred in 11.07 per 1000 cases, with a fatality rate of 66.80%; while those of the soft tissues of the lower extremity (not involving important blood vessels or nerves) occurred in 333.86 per 1000 wounds, with a fatality of 6.09%. Apparently then it may be said with safety that a patient of the latter class was a much less serious transportation problem than one of the first named group.

    Table 23. - Location of battle gunshot wounds in, the American Expeditionary Forces with rates per 1000 total cases; and percentage fatality rate of each location.16

    Location of wound

    Frequency per 1000

    Fatality rate in percentage

    Soft tissues, lower extremity

    333.86

    6.09

    Soft tissues, upper extremity

    198.61

    4.27

    Bones of wrist and hand*

    118.23

    1.47

    Long bones and joints, lower extremity*

    70.52

    17.53

    Soft tissues of face and head

    59.19

    2.31

    Metatarsus and toes*

    51.96

    2.56

    Clavicle, humerus and scapula*

    32.74

    9.46

    Other long bones of the upper extremity*

    30.24

    4.39

    Cranial bones and brain

    20.46

    37.11

    Bones of the ankle

    13.83

    2.56

    Important blood vessels & nerves, upper extremity

    13.36

    7.11

    Abdominal and pelvic organs

    11.07

    66.80

    Thoracic organs

    10.52

    47.68

    Bones of the face*

    10.24

    8.45

    Muscles of neck, chest, abdomen and back

    5.95

    21.49

    Genital organs

    4.86

    8.65

    Bones of pelvis*

    4.22

    26.98

    Spinal cord and vertebra

    3.64

    55.85

    Important blood vessels and nerves, lower extremity

    3.33

    11.90

    Important organs and blood vessels of the neck

    3.16

    11.39

    * Fractures

    The fatality rate from artillery wounds was 7.03% and from small arms 4.82%.16

    Artillery missiles caused 70% of the gunshot wounds among Ameri-can troops during the World War as compared with 10% among the Union troops during the CivilWar.2

    The following table shows that the general location of the gunshot wounds was very much the same during the two wars.2

    General location of gunshot wounds

    Percentage

    Civil War

    World War

        Head
        Trunk
        Upper Extremity
        Lower Extremity

    11
    18
    36
    35

    13
    14
    32
    40


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    Table 24. - Estimation of evacuation requirements for patients wounded by gunshot missiles.
    Number in each 1000 total wounded.

    Location of Wound

    To Collecting Station

    To Hospital Station

    To Evacuation Hospital

    Littered Expected to:

    Walking

    Recumbent Expected to:

    Sitting

    Recumbent Expected to:**

    Sitting

    Die

    Recover

    Die

    Recover

    Die

    Recover

    Severe

    Others

    Soft tissues, lower extremity

    23.71

    210.15

    100.00

    23.71

    210.15

    100.00

    23.71

    —

    210.15

    100.00

    Soft tissues, upper extremity

    8.48

    63.38

    126.76

    8.48

    63.38

    126.76

    8.48

    —

    63.38

    126.76

    Bones of wrist and hand

    1.74

    —

    116.50

    1.74

    —

    116.50

    1.74

    —

    —

    116.50

    Long bones and joints, lower ex.*

    12.36

    58.16

    —

    12.36

    58.16

    —

    12.36

    5.00

    53.16

    —

    Soft tissues, face and head

    1.36

    —

    57.83

    1.36

    —

    57.83

    1.36

    —

    —

    57.83

    Metatarsus and toes*

    1.33

    50.63

    —

    1.33

    —

    50.63

    1.33

    —

    —

    50.63

    Clavicle, humerus, &scapula*

    3.10

    29.64

    —

    3.10

    29.64

    —

    3.10

    —

    29.64

    —

    Other long bones, upper ex.*

    1.33

    —

    28.91

    1.33

    —

    28.91

    1.33

    —

    —

    28.91

    Cranial bones and brain

    7.59

    12.87

    —

    7.59

    12.87

    —

    7.59

    12.87

    —

    —

    Bones of ankle*

    .35

    13.47

    —

    .35

    13.47

    —

    .35

    —

    13.47

    —

    Important blood vessels and nerves, upper extremity

    .95

    12.41

    —

    .95

    12.41

    —

    .95

    6.00

    6.41

    —

    Abdominal and pelvic organs

    7.39

    3.67

    —

    7.39

    3.67

    —

    7.39

    3.67

    —

    —

    Thoracic organs

    5.02

    5.50

    —

    5.02

    5.50

    —

    5.02

    5.50

    —

    —

    Bones of the face*

    .87

    3.13

    6.25

    .87

    3.13

    6.25

    .87

    —

    3.13

    6.25

    Muscles of neck, chest, abdomen, and back

    1.28

    4.67

    —

    1.28

    4.67

    —

    1.28

    —

    4.67

    —

    Genital organs

    .42

    4.44

    —

    .42

    4.44

    —

    .42

    —

    4.44

    —

    Bones of the pelvis

    1.14

    3.08

    —

    1.14

    3.08

    —

    1.14

    —

    3.08

    —

    Vertebra* and spinal cord

    2.04

    1.61

    —

    2.04

    1.61

    —

    2.04

    1.61

    —

    —

    Important blood vessels and nerves, lower extremity

    .40

    2.93

    —

    .40

    2.93

    —

    .40

    2.93

    —

    —

    Important organs and blood vessels of the neck

    .36

    2.80

    —

    .36

    2.80

    —

    .36

    2.80

    —

    —

    TOTAL

    81.22

    482.53

    436.25

    81.22

    431.91

    486.88

    81.22

    40.38

    391.53

    486.88

    *Fractures.   **No attempt is made here to determine the proportion of nontransportable cases.


    126

    b. Transportation. In Table 24 all cases which ultimately died are listed as "Littered", or "Recumbent"; and the remainder, that is, the cases which recovered, as "Littered" and "Recumbent", or as "Walkers" and "Sitters," according to the location of the wounds. The division of the recovery cases into the "Littered" and "Recumbent" and "Walkers" and "Sitters", such as in the case of those involving the soft tissues of the lower extremity, was based upon the location and fatality rate of the group.

    50. Gunshot and Gas Wounded. - The medical records show the number of fatalities from war gases (1.73%) but no other information which may be used as a basis in estimating the transportation require-ments. Consequently any such estimate must be based upon general experience and supposition.

    Table 25. Estimation of evacuation requirements for patients wounded by war gases and gunshot missiles, separately and combined; rates per 1000 cases.

    (a)
    To Coll.
    Station

    Littered

    Walking

    Grand Total

    Fatal

    Recovery

    Total

    Gas

    17.80

    182.71

    200.00

    800.00

    1000.00

    Gunshot

    8.22

    482.53

    563.75

    436.25

    1000.00

    Total

    65.24

    407.57

    472.81

    527.19

    1000.00

    (b)
    To Hospital Station

    Recumbent

    Sitting

    Grand Total

    Fatal

    Recovery

    Total

    Gas

    17.30

    182.70

    200.00

    800.00

    1000.00

    Gunshot

    81.22

    431.91

    513.13

    486.88

    1000.00

    Total

    65.24

    369.61

    434.85

    565.16

    1000.00

    (c)
    To Evacuation Hospital

    Recumbent

    Sitting

    Grand Total

    Fatal

    Recovery
    Severe

    Recovery
    Others

    Total

    Gas

    17.30

    182.70

    200.00

    800.00

    1000.00

    Gunshot

    81.22

    40.38

    391.53

    513.13

    486.88

    1000.00

    Total

    65.24

    30.29

    339.32

    434.85

    565.16

    1000.00

       Note: The above totals are calculated by multiplying the rates from the gunshot wounded by three, the ones from war gases by one, adding the results, and dividing the sum by four. This procedure is based upon the assumption that in severe combat war gases cause 25% and gunshot missiles 75% of the total wounded. (As calculated from Fig. 68, It would be 23.81% and 76.19%).


    127

    In the table above, the data in regard to gunshot wounds are from Table 24, but those for, the war gas wounds are as stated.

    According to Table 25, 47 % of the wounded would be littered to the Collecting Station and 53% could walk; 43% would be transported to the Hospital stations as "Recumbent" and 57% as "Sitters"; and to the Evacuation Hospital, 43% again would be transported as "Recumbent" and 57% as "Sitters."

    Colonel Alexander N. Stark, who was Chief Surgeon of the First American Army, American Expeditionary Forces, says in his report of the Meuse-Argonne offensive, that 42% of the patients evacuated were carried "Prone" and 58% as "Sitters". He includes in his total, however, the sick as well as wounded.2

    P. BATTLE CASUALTIES - DISPOSITION OF CASES IN THE COMBAT AREA.

    The experience in the American Expeditionary Forces may be helpful in forming an approximate estimate of the relative number of the sick and wounded to be evacuated from the Combat Area. When considering this phase of the problem, the patients may be divided into two groups: (a) Long duration cases, and (b) short duration cases. The first group will require evacuation to the base and general hospitals, and second may be hospitalized somewhere within the Army Area.

    The time limit for the latter group will depend to some extent upon the existing conditions. It is subdivided into: (a) cases that return to duty, and (b) those that die within a few days.

    As stated elsewhere the medical records from the American Ex-peditionary Forces show the duration of treatment both of cases that recovered and those that died. The value of this information is reduced materially because: (a) Patients in some instances were retained for treatment in the Combat Area, and no records were made for them; and (b) trivial cases, which were sent to the base hospital, lost unnecessary time.

    51. Percentage of short duration cases.* - The following table shows the percentage of patients which: (a) Returned to duty, or (b) died during the first 10 days, treatment in hospital.

    *The method of computing the data in this section is explained on pages 140 to 143.


    128

    Table 26. - Percentage of short duration cases, as reported in the American Expeditionary Forces, leaving hospital each day from the first to the tenth.

    Day of treatment

    Percentage leaving hospital by return to duty or death by the end of each day

    Duty§

    Death‡

    Sick†

    Gassed

    Gunshot Wounded

    Sick†

    Gassed

    Gunshot Wounded

    1

    5.35

    1.97

    .10

    .06

    .18

    1.43

    2

    10.25

    3.95

    .33

    .11

    .34

    2.57

    3

    14.75

    5.94

    .66

    .16

    .48

    3.47

    4

    18.91

    7.94

    1.09

    .21

    .60

    4.20

    5

    22.74

    9.94

    1.60

    .25

    .71

    4.78

    6

    26.28

    11.94

    2.20

    .29

    .81

    5.24

    7

    29.56

    13.92

    2.86

    .32

    .90

    5.61

    8

    32.60

    15.89

    3.59

    .35

    .97

    5.91

    9

    35.42

    17.84

    4.37

    .38

    1.04

    6.16

    10

    38.05

    19.77

    5.20

    .40

    1.10

    6.36

      †Diseases and nonbattle injuries.
      §From Figs. 90, 91, and 92.
      ‡These data are 0.78 %, 1.73 %, and 8.12 % of the sick, gassed, and gunshot wounded respectively of those in Table 30.

    The maximal day of treatment shows the longest time of treatment, but the group includes all those of shorter duration. Thus, the maximal 5 days group includes cases leaving hospital at any time up to the end of the fifth day. Of the cases of diseases and nonbattle injury sent to hospital in the American Expeditionary Forces, 22.74 % returned to duty in 5 days or less, and .25% died; while of the gunshot cases, 5.20% returned to duty in 10 days or less, and, and 6.3% died, etc.

    If all duty cases requiring treatment for four days or less are retained within the Division area, 18.91% of the sick, 7.94% of the gassed, and 1.09 % of the gunshot wounded will be so held. Further, if duty cases requiring treatment from 5 to 10 days are hospitalized within the Corps or Army Area, the group will consist of 19.14% (38.05% - 18.91% ) of the sick, 11.88% (19.77% - 7.94% ) of the gassed cases, and 4.11% (5.20% - 1.09%) of the gunshot cases. Obviously the selection of sick cases whose treatment will require a maximum of 4 days, 10 days etc., must depend upon the judgment of those selecting the cases.

    The percentages can be applied to any casualty day for any unit. Assume a Division of 20,000 men with a daily casualty rate of 60 per 1000 men, and with a daily sick rate of 4.20 per 1000. Then there will be:

    Casualties

    1200

      Killed (16%)

    192

      Gassed (20%)

    240

      Gunshot wounded (64%)

    768

    Sick

    84


    129

    Assume further that all cases returning to duty in 10, days or less, and that all cases dying within 5 days or less are held within the Army Area. Then each day the number so held and evacuated from the above group will be:

    Total (a)

    Duty in 10 days or less (b)

    Death in 5 days or less (c)

    Evacuated
    (a) - [(b) + (c)]

    Sick

    84

    31.96

    .21

    51.83

    Gassed

    240

    47.45

    1.70

    190.85

    Gunshot wounded

    768

    39.94

    36.63

    691.43

      Total

    1092

    119.35

    38.54

    934.11

    Nontransportable cases held within the front area will reduce still further, at least temporarily, the number to be evacuated.

    52. Hospitalization of short duration cases. - a. Accumulation in hospital to the end of any period of cases returned to duty or dying during that length of time. - The data in Table 27 from the Amercian Expeditionary Forces records shows how short duration duty and death cases ac cumulate when the number of days of treatment varies from 1 to 5, 1 to 8, 1 to 10, etc. The table is based upon the same assumption as elsewhere in considering hospital populations; that is, that there is an average daily admission rate during the periods with a definite, number going out each day. It answers question such as; "After six combat days by an infantry division with an average daily admission rate from diseases and nonbattle injuries of 4.20 per 1000, and from casualties of 50 per 1000 how many duty and death cases of six day or less duration will there be?" Since Table 27 is based upon an average daily admission rate of 1.00. the daily number of sick and wounded must first be determined.

    Rate per 1000

    Strength

    One-day cases

    Six-day cases

    Disease & nonbattle injuries

    4.20

    20,000

    84

    504

    Casualties

    50.00

    20,000

    1,000

    6,000

      Killed (16%)

    160

    960

      Gassed (20%)

    200

    1,200

      Gunshot wounded (64%)

    640

    3,840


    130

    Table 27 shows how short duration cases accumulate in hospital.

    Table 27. - The accumulation in hospital to any day, from the first to the tenth of patients who will return to duty or die on that day or before. Admission rate from each cause is 1.00 per day.

    Maximal day of treatment

    Duty*

    Expected deaths†

    Sick§

    Gassed

    Gunshot wounded

    Sick§

    Gassed

    Gunshot wounded

    1

    .05

    .02

    .001

    .001

    .002

    .002

    2

    .15

    .06

    .005

    .002

    .005

    .04

    3

    .29

    .12

    .015

    .003

    .01

    .06

    4

    .45

    .20

    .03

    .005

    .01

    .09

    5

    .64

    .30

    .06

    .01

    .02

    .12

    6

    .86

    .42

    .09

    .01

    .03

    .15

    7

    1.09

    .56

    .14

    .01

    .03

    .18

    8

    1.33

    .71

    .20

    .01

    .04

    .20

    9

    1.58

    .89

    .27

    .02

    .04

    .22

    10

    1.84

    1.09

    .35

    .02

    .05

    .24

      *Computed from data in Tables 26 and 32, as per par. 58 a, p. 141.
      †Computed from data in Tables 30 and 32, as per par. 58 a, and 58 b, page 141.
      ‡ Also day of death or duty.
      § Diseases and nonbattle injuries.

    Then in reply to the above question, the accumulation of the 6-day or less cases in hospitals, which must be based upon each day's admissions, would be:

    Duty cases

    Death cases

    Total

    Sick

    (84 × 86)

    72.24

    (84 × .01)

    .84

    73.08

    Gassed

    (200 ×.42)

    84.00

    (200 × .03)

    6.00

    90.00

    Gunshot wounded

    (640 × .09)

    57.60

    (640 × .15)

    96.00

    153.60

    Total

    213.84

    102.84

    316.68

    The total 6-day or less cases during the six days of treatment in the front area, and the ones to be evacuated which must be based upon the total for six days, would be:

    Total in six days
    (a)

    Duty in 6 days or less
    (b)

    Death in 6 days or less
    (c)

    Evac. in six days
    (a) - [(b) + (c)]

    Sick

    504

    (26.28%)

    132.45

    (0.29%)

    1.46

    370.09

    Gassed

    1200

    (11.94%)

    143.28

    (0.81%)

    9.72

    1047.00

    Gunshot wounded

    3840

    (2.20%)

    84.48

    (5.24%)

    201.22

    3554.30

    Total

    5544

    360.21

    212.40

    4971.39


    131

    At the close then of the six combat days with the admission rates as specified, the account of a division of 20,000 men for the sick and wounded combined would be:

    Total to be accounted for (6504 - 960)

    5544.00

    Evacuated

    4971.39

    One to six-day cases in hospital in Army Area

    316.68

      Duty cases

    213.84

      Death cases

    102.84

    One to six-day cases which have left hospital

    255.93

      Duty cases (360.21 - 213.84)

    146.37

      Death cases (212.40 - 102.84)

    109.56

     b. Accumulation in hospital to the end of any period of cases return-ing to duty or dying during that length of time: - But the above question may be worded as follows, "After six combat days by an infantry division of 20,000 men with an average daily admission rate from diseases and non-battle injuries of 4.20 per 1000 and from casualties of 50 per 1000, how many duty, and death cases of 10 days or less duration win there be?" Obviously since the duration here is 10 days or less instead of 6 or less, there will be more cases retained within the Army Area. The answer to the question can be computed from the basic data in the following table.

    Table 28 - The accumulation in hospital to any day from the first to the tenth of patients who will return to duty or die on the tenth day or before. Admission rate from each cause is 1.00 per day.

    Day of duty or death‡

    Duty*

    Expected deaths†

    Sick§

    Gassed

    Gunshot wounded

    Sick§

    Gassed

    Gunshot wounded

    1

    .38

    .20

    .05

    .004

    .01

    .06

    2

    .71

    .38

    .10

    .007

    .02

    .11

    3

    .99

    .53

    .15

    .01

    .03

    .15

    4

    1.22

    .67

    .20

    .01

    .03

    .18

    5

    1.41

    .79

    .24

    .02

    .04

    .20

    6

    1.56

    .89

    .27

    .02

    .04

    .22

    7

    1.68

    .97

    .30

    .02

    .05

    .23

    8

    1.76

    1.03

    .33

    .02

    .05

    .24

    9

    1.81

    1.07

    .34

    .02

    .05

    .24

    10

    1.84

    1.09

    .35

    .02

    .05

    .24


    132

    Since this table, as the previous one is based upon a daily admission rate of 1.00, the daily number of sick and wounded must first be determined. The table from page 129 is repeated here.

    Rate per 1000

    Strength

    One-day cases

    Six-day cases

    Disease & nonbattle injuries

    4.20

    20,000

    84

    504

    Casualties

    50.00

    20,000

    1,000

    6,000

      Killed (16%)

    160

    960

      Gassed (20%)

    200

    1,200

      Gunshot wounded (64%)

    640

    3,840

    Then the accumulation in hospital in six days of 1 to 10 day cases, based upon each days admissions, would be:

    Duty cases

    Death cases

    Total

    Sick

    (84 × 1.56)

    131.04

    (84 × .02)

    1.68

    132.72

    Gassed

    (200 × .89)

    178.00

    (200 × .04)

    8.00

    186.00

    Gunshot wounded

    (640 × .27)

    172.80

    (640 × .22)

    140.80

    313.60

    Total

    481.84

    150.48

    632.32

    The total 1 to 10 day cases during six days treated in the front area, and the ones to be evacuated, based upon the total for six days, would be:

    Total in six days
    (a)

    Duty in 10 days or less
    (b)

    Deaths in 10 days or less
    (c)

    Evacuated in six days (a) - [(b) + (c)]

    Sick

    504

    (38.05%)

    191.77

    (.40%)

    2.02

    310.21

    Gassed

    1200

    (19.77%)

    237.24

    (1.10%)

    13.20

    949.56

    Gunshot wounded

    3840

    (5.20%)

    199.68

    (6.36%)

    244.22

    3396.10

    5544

    628.69

    259.44

    4655.87

    At the close then of the sixth combat day with the admission rates as specified and, with the 1 to 10 day cases treated in the front area, the account of a division of 20,000 men for the sick and wounded combined would be:

    Total to be accounted for (6504 - 960)

    5544.00

    Evacuated

    4655.87

    One to ten day cases in hospital in Army Area

    632.32

    Duty cases

    481.84

    Death cases

    150.48

    One to ten day cases which have left hospital

    255.81

    Duty cases (628.69 - 481.84)

    146.85

    Death cases (259.44 - 150.48)

    108.96

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