Books and Documents

FIRST UNITED STATES ARMY

REPORT
OF
OPERATIONS
20 OCTOBER 1943-1 AUGUST 1944


ANNEX No.16
MEDICAL PLAN

TABLE OF CONTENTS

SECTIONS SUBJECT

I INTRODUCTION

II PREPARATORY PHASE

III INITIAL LANDING
IV HOSPITALIZATION AND EVACUATION
V MEDICAL SUPPLY
VI SELF-INFLICTED WOUNDS
VII RETURN OF PATIENTS TO DUTY FROM HOSPITAL
VIII UTILIZATION OF PRISONERS OF WAR IN HOSPITALS
IX HISTORY OF NEUROPSYCHIATRIC CASES
X MEDICAL
XI DENTAL
XII VENEREAL DISEASES
XIII SURGICAL
XIV VETERINARY
XV NURSING
XVI PERSONNEL
XVII STATISTICS
XVIII SUMMARY

LIST OF APPENDICES

Appendix

1 - Operations Memorandum No. 2, Office of the Surgeon, Hq First United States Army.
2 - Equipment Authorized in Excess of T/E Prior to D Day.
3 - Medical Maintenance Units Phased in for Automatic Shipments D Day through D + 41.
4 - Equipment Authorized in Excess of T/E After D Day.
5 - Basic Admission Rates Summary.
6 - Admissions for Disease, Injury and Battle Casualty as Percent of Total.
7 - Disease Rate Summary by Major Components.
8 - Graphic Rate Summary — Admissions — Battle Casualties and Admissions All Causes.
9 - Graphic Rate Summary – Admissions - Non-Battle Injury and Admissions – Psychiatric Diseases.
10 - Graphic Rate Summary – Admissions - Common Respiratory Disease and Admissions — “New” Venereal Disease.
11 - Combat Medical Statistics.
12 - Admissions by Type – June 1944.
13 - Admissions by Type – July 1944.
14 - Daily Cumulative Totals of Admissions by Type.
15 - Daily Cumulative Totals of Admissions by Class of Personnel.
16 - Daily Cumulative Totals of Dispositions.
17 - Percentage Analysis of Combat Medical Statistics.
18 - Ratio of Battle Wounds to Combat Exhaustion.
19 - Basic Ratios — Combat Medical Statistics.
20 - Patients Evacuated – Cumulative Data.
21 - Evacuations – Utah and Omaha Beaches – June 1944.
22 - Evacuations – Utah and Omaha Beaches – July 1944.
23 - Number of Admissions to Hospitals by Weeks.
24 - Number of Admissions to Hospitals for the Communicable Diseases.
25 - Bed Status of First U. S. Army Hospitals – by Weeks.
26 - Anatomical Location of Wounds.
27 - Wounds by Anatomical Location.
28 - Comparative Data – Anatomical Location of Wounds (France and Italy).
29 - Wounds by Causative Agent.
30 - Wounds by Causative Agent.
31 - Summary of Medical Department Personnel – June and July.
32 - Malaria Admissions by Major Components.
33 - Malaria Rates by Major Components.
34 - Mean Strength – Major Components.

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ANNEX No. 16
MEDICAL SECTION

I. INTRODUCTION

The Surgeon’s Office, in compliance with directive from the Chief of Staff, First U. S. Army was organized in Bristol, England, on 20 October 1943 with nineteen (19) officers and two (2) warrant officers (one (1) of which was filling the position of Captain, M.C.), and twenty-four (24) enlisted men. With this allocation of personnel, the Surgeon's Office was organized into the following sub-sections:

[Organization of the Surgeon’s Office, Headquarters, First U.S. Army, 20 October 1943]

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The arrangement of the sub-sections as indicated above worked very well and much of the preliminary planning resulted from this group. However, in order to simplify intra-office procedures and to clarify responsibilities, a reorganization of the Surgeon's Office was instituted 24 January 1944, into the following sub-sections:

[Organization of the Surgeon’s Office, Headquarters, First U.S. Army, 24 January 1944]

Following this reorganization, the active planning phase was instituted for the operations on the continent. It will be noted that the number of officers (officers and warrant officers) remains the same, except for the attachment of one (1) Major, Army Nurse Corps, who acted in the capacity of Army Chief Nurse. The increase of the enlisted personnel from the previous twenty-four (24) to the authorized thirty-five (35) under T/O 200-1 was accomplished several weeks prior to departure from the United Kingdom. This reorganization added materially to the functional operation of the Surgeon's Office. Although the pre-planning and the planning phase, as well as the operations on the continent, were handled in an extremely satisfactory manner, it is believed that the authorized T/O as established by 200-1 should be maintained in order to provide necessary personnel adequate to perform the numerous and highly technical duties required by the Medical Department.

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II. PREPARATORY PHASE

A. PLANNING AND TRAINING


1. Upon arrival in the United Kingdom on 20 October 1943, the Army Surgeon, began a series of conferences with the Theater Surgeon, to determine what troops would be allocated to First U. S. Army. The final troop allocation was as follows :
1 convalescent hospital
5 field hospitals
1 750-bed evacuation hospital
10 400-bed evacuation hospitals
3 Hq & Hq Det, Medical Group
8 Hq & Hq Det, Medical Battalion
7 ambulance companies
11 collecting companies
6 clearing companies
1 medical gas treatment battalion
1 auxiliary surgical group
1 medical laboratory
1 medical depot company

All of these troops were assigned directly to army. In addition, there was with each of the three corps, a medical battalion consisting of one (1) Hq & Hq Det, Medical Battalion, two (2) collecting companies, one (1) ambulance company, and one (1) clearing company; one (1) medical battalion, engineer special brigade with the 1st Engineer Special Brigade and with each of the 5th and 6th Engineer Special Brigades, a medical battalion consisting of one (1) Hq & Hq Det, Medical Battalion, three (3) collecting companies, and one (1) clearing company.

2. As soon as this troop basis had been established, training of the units-was started. Full utilization was made of the schools offered by the Theater Surgeon. There were a total of thirty-five (35) courses available for officers, eight (8) for nurses and ten (10) for enlisted men, plus fourteen (14) miscellaneous conferences. To these schools, First U. S. Army sent a total of 2063 officers, 214 nurses, and 935 enlisted men.

3. Fortunately, two (2) of the 400-bed evacuation hospitals, assigned First U. S. Army, had had previous combat experience. Teams of instructors were sent out from these experienced hospitals to give practical help and instruction to all the inexperienced hospitals.

4. Training of the field hospitals presented a unique problem since these units were to be utilized by First U. S. Army in a manner completely different than that for which they were originally trained. No experienced field hospitals were available, but many members of the 3rd Auxiliary Surgical Group had previously functioned in hospitals trained and equipped along the lines to be used by First U. S. Army and these experienced personnel were used as instructors.

5. During the months of November and December, 1943, all training was along general lines, but with the beginning of the planning for the Normandy landing, early in January training became specialized and was directed toward the accomplishment of this specific mission.

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6. Fortunately, the 261st Medical Battalion of the 1st Engineer Special Brigade had had actual combat experience in the landing in Sicily. Instructors were taken from this organization and placed with the medical battalions of the 5th and 6th Engineer Special Brigades. A request was forwarded from First U. S. Army to Theater requesting authority to reorganize the medical battalions of the 5th and 6th Engineer Special Brigades under the same T/O used by the 1st Engineer Special Brigade, but this request was disapproved. Following this disapproval, the medical battalions of the 5th and 6th Engineer Special Brigades were functionally reorganized into three (3) companies each, each company having both collecting and clearing elements.

7. The Army Surgeon, his Medical Supply Officer and Planning Officer, spent the months of January, February and part of March in London with the Army planning staff. During this period, most of the medical plans were completed for medical support of the Normandy landing.

8. Many hours were spent with the Navy planning staff integrating the Army and Navy medical plans. Several combined Army and Navy training exercises were held along the south coast of England. Many lessons were learned from these exercises and many faults corrected so that at the time of the actual departure from England for the continent, the Army and Navy medical service had become a smoothly functioning team.

III. INITIAL LANDING

4. OMAHA BEACH, (6-11 June, inclusive).

1. D Day (6 June): The landing of medical units on Omaha (V Corps) Beach was delayed due to the severe opposition encountered on the beach. Upon landing it was impossible to set up the usual type medical installation. At 1350B, Headquarters & Headquarters Detachment, 61st Medical Battalion, 5th Engineer Special Brigade, closely followed by the 391st and 393rd Collecto-Clearing Companies of this battalion, landed on Easy Red Beach. Since it was impossible to proceed inland to designated locations, collecting points were set up on the beach and the task of collecting casualties and administering first aid to the wounded begun. Six (6) surgical teams of the 3rd Auxiliary Surgical Group, attached to the Collecto-Clearing Companies of the 61st Medical Battalion were able only to render first aid because their equipment had not as yet landed. By evening of D Day, these units had established two stations ; one in a tank ditch near Easy Green Beach and the other in a pillbox inland from Easy Red Beach.

At 1600B the first elements of the 60th Medical Battalion, 6th Engineer Special Brigade, landed on Easy Green Beach. An attempt was made to clear this beach, but direct artillery and small arms fire necessitated moving to a defiladed position somewhat above high water mark where a collecting station was established inland from Easy Red Beach. The personnel and equipment of the 60th and 61st Medical Battalions continued to arrive ashore during the evening and night of D Day. The collecting companies of the 1st Medical Battalion, 1st Infantry Division, landed with their respective combat teams, this date. A part of the Clearing Company, 1st Medical Battalion, landed this day, but was pinned

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to the beach. Collecting Company “ B”, 104th Medical Battalion, 29th Infantry Division, landed with its combat team as scheduled and proceeded inland.

Throughout the day and night, casualties were evacuated from the Omaha Beach to LSTs. There is no definite figure on evacuation for this day, but it is estimated by the 60th and 61st Medical Battalions that a total of approximately 830 casualties were evacuated.

2. D + 1 (7 June) : The two medical battalions, Engineer Special Brigades, plus units of the 1st Medical Battalion and Naval Beach Medical Sections made some progress in clearing the beach of casualties. The 6lst Medical Battalion had established a clearing station on Fox Green Beach and one on Easy Red Beach. Most of the equipment of these collecting companies being still afloat, their work consisted mainly of first aid treatment and evacuation of casualties over the beach. More elements of both medical battalions of the Engineer Special Brigades plus the 1st Section, Advance Detachment, 1st Medical Depot Company, came ashore during the day. By evening a nucleus of all organizations of the Engineer Special Brigade Medical Battalions had landed and were acting as aid stations and collecting and evacuation points in the locations assumed late on P Day or early on D + 1. The unloading of medical equipment was delayed so that very little definitive treatment was given by these units. Four (4) surgical teams were added to the 60th Medical Battalion and a clearing station was opened by that unit approximately 700 yards inland from Dog Red Beach. One platoon of the 1st Medical Battalion, 1st Infantry Division, opened a clearing station on the high ground overlooking the Easy Green Beach entrance, and continued to function at this site for the next 36 hours. Surgical teams were obtained from the beach and definitive treatment was rendered to the more seriously wounded. Employing all possible means, including the loading of wounded into DUKWs at the clearing station, a total of 201 patients were evacuated directly across the beach by this battalion.
At 1900B, the hospital carrier “ Naushon” arrived off Omaha (V Corps) Ecach and began taking patients aboard from craft lying offshore Contrary to plan, this hospital carrier remained overnight, giving definitive treatment by means of its medical staff and the personnel of the First U. S. Army Medical Detachment “A”, which was aboard.

This date, Headquarters and Headquarters Detachment, 104th Medical Battalion, 29th Infantry Division, Clearing Company “D “, 104th Medical Battalion, and the 382nd Collecting Company, 53rd Medical Battalion, landed. Collecting Company” A “, 104th Medical Battalion, went ashore with its combat team.

Acting upon instructions issued by the Chief of Staff, First U. S. Army, the Army Surgeon, went ashore to make a tour of medical installations and to obtain information as to the medical situation.

3. D + 2 (8 June): The remaining portions of the 634th Medical Clearing Company, 60th Medical Battalion and Headquarters and Headquarters Detachment, 60th Medical Battalion, landed and proceeded to the clearing station of the 60th Medical Battalion, 700 yards inland from Dog Red Beach. The equipment of the 392nd Collecto-Clearing Company, 5th Engineer Special Brigade was unloaded but artillery fire prevented the movement of this company inland. Between 0915B and 1000B, personnel of the First U. S. Army Medical Detachment

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“A” landed on Easy Red and Easy Green Beaches. This personnel consisted of the station and litter bearer platoons of the 45 1st and 454th Medical Collecting Companies, 68th Medical Group; the Advance Depot platoon, 32nd Medical Depot Company; six surgical teams, 4th Auxiliary Surgical Group; 10 liaison officers from various medical units including 9th Troop Carrier Command; 7 officers and 10 enlisted men of the Surgeon's Office, Headquarters First U. S. Army. At 1400 sufficient equipment was landed for the 393rd Collecto-Clearing Company to enable this unit to establish a station approximately 800 yards inland at the entrance to Easy Green Beach, and free the clearing station of the 1st Medical Battalion for forward movement. From this time onward, the evacuation of casualties proceeded according to plan.

Equipment belonging to the 13th Field Hospital was landed during the morning hours and a location was secured through G-4, V Corps, for the setting up of this hospital. The personnel of the 13th Field Hospital and a portion of the 51st Field Hospital came ashore in the late afternoon.
The 38th Combat Team, 2nd Infantry Division, landed with only two battalion medical Sections and no regimental aid station or collecting company. During the early part of the night Headquarters Detachment, 1st Medical Battalion and Collecting Company “ C”, 104th Medical Battalion landed.

4. D + 3 (9 June): The 433rd Medical Collecting Company, 60th Medical Battalion moved to a point midway between St. Laurent-sur-Mer and Vierville-sur-Mer, from which point it evacuated elements of the 2nd and 29th Infantry Divisions. The 1st Medical Battalion Clearing Station moved to the vicinity of Le Grand Hameau, and later in the day moved further south to the vicinity of Le Hau Gros, as the axis of the 1st Infantry Division swung farther to the east and south. One platoon of Clearing Company “D” and half of Collecting Company “C”, 2nd Medical Battalion, arrived on the beach without equipment or transportation. Collecting Company “B”, 2nd Medical Battalion, landed with the 23rd Infantry Regiment.

An attack was ordered to be launched on Trevieres by two combat teams of the 2nd Infantry Division. As medical support, the Division Surgeon employed one platoon of a clearing company, minus equipment, as a regimental medical detachment for the 38th Infantry Regiment and Collecting Company “A” with three ambulances, plus one-half of Collecting Company “C” with ten ambulances borrowed through the V Corps Surgeon. Evacuation was to be to the Clearing Station of the 60th Medical Battalion. Clearing Company “D”, 104th Medical Battalion, set up station at Vierville-sur-Mer to support the 2nd and 29th Infantry Divisions but was limited by lack of equipment to first aid treatment. Remaining personnel of the 51st Field Hospital landed this day as did a portion of the 684th Medical Clearing Company, 53rd Medical Battalion.

The Surgeon, V Corps, was notified at 1600B by the Commanding Officer, ist Medical Depot Company, that a medical depot was open in the vicinity of Colleville-sur-Mer. The Command Echelon, Surgeon’s Office, Headquarters First U. S. Army, consisting of the Army Surgeon, the Executive Officer, and two enlisted men landed late in the afternoon and proceeded to vicinity of Grand Camp-les-Bains.

5. D + 4 (10 June): The remaining personnel of the Clearing Company, 2nd Medical Battalion landed, plus the remainder of Collecting Company “C”

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with its transportation and equipment. During the early part of the night, the 383rd Medical Collecting Company, 53rd Medical Battalion and remainder of 684th Medical Clearing Company, 53rd Medical Battalion, came ashore.

All division clearing stations were functioning in a normal manner in spite of losses in equipment and personnel. At 1000B, one platoon of the 13th Field Hospital opened for the reception of casualties on the Colleville-St. Laurent road in rear of V Corps. The first transport planes arrived in the Omaha area on the St. Laurent air strip. Four of these planes began the evacuation of casualties by air to the U. K. The Army Surgeon's Office, Command Echelon, Headquarters First U. S. Army, was set up and ready to function in the vicinity of Grandcamp-les-Bains.

6. D + 5 (11 June): Two truckloads of critical medical supplies, plus biologicals and whole blood, were dispatched to the Utah area as requested by the VII Corps Surgeon. The 51st Field Hospital opened one hospitalization unit for the reception of casualties on Easy Green Beach. Headquarters and Headquarters Detachment, 53rd Medical Battalion, landed. The Chief Medical Officer, Supreme Headquarters, Allied Expeditionary Force, arrived at the Army Surgeon’s Office to view the medical services being rendered within the Normandy Beachhead.

B. UTAH BEACH, D TO D + 5 (6-11 June), INCLUSIVE:

1. D Day (6 June): On Utah (VII Corps) Beach, Naval Beach Medical Sections were ashore by H + 4 hours and evacuation of casualties was being carried out by H + 2 1/2 hours. These Naval Beach Medical Sections had evacuated approximately 75 casualties before the medical companies of the 261st Medical Battalion, 1st Engineer Special Brigade, were ashore and in operation. Collecting Company “C”, 261st Medical Battalion arrived ashore at H + 4 hours and established station about 400 yards inland in rear of Green Beach. A portion of Collecting Company “A”, 261st Medical Battalion arrived a little later in the. day and established station in rear of Red Beach. Six surgical teams of the 3rd Auxiliary Surgical Group landed with the Collecting Companies of the 261st Medical Battalion (2 teams per company). During the day, the three collecting companies of the 4th Medical Battalion, 4th Infantry Division landed with 26 of their combined total of 30 ambulances. These ambulances were put into operation immediately and utilized to their maximum capacity in the evacuation of casualties.

The 326th Medical Clearing Company, 101st Airborne Division, augmented with one (1) attached surgical team, landed by glider in support of its division and established station at Hiesville. The 307th Medical Clearing Company, 82nd Airborne Division, with one (1) attached surgical team, landed by glider in support of this division and established a clearing station.

2. D + 1 (7 June) : During the early part of D + 1, Collecting Companies “A” and “C” of the 26lst Medical Battalion were the only holding medical units ashore and were heavily burdened with casualties. Evacuation across the beach continued throughout the day. During the afternoon, information was received that the 307th Medical Clearing Company, 82nd Airborne Division, was established near Ste. Mere-Eglise, and that this company was holding some 300 casualties. While arrangements were being made to contact this unit for removal

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of these casualties to the beach, the. casualties began to arrive at the beach in transportation belonging to the 307th Medical Clearing Company. These casualties were mostly glider and jump casualties from both the 82nd and 101st Airborne Divisions. The 491st Medical Collecting Company and 649th Medical Clearing Company, 50th Medical Battalion, landed. The Operations Officer, and one enlisted man of the Army Surgeon’s Office arrived ashore to inspect the medical activities on this beach.

3. D + 2 (8 June): During the night of D + 1 - D + 2, Headquarters and Clearing Company of the 4th Medical Battalion and Collecting Company “B”, 261st Medical Battalion landed complete with transportation. By 0630B, Collecting Company “B”, 261st Medical Battalion was established adjacent to Collecting Company “C”, 261st Medical Battalion, and was receiving casualties. At the same time, the Clearing Company of the 4th Medical Battalion set up approximately three (3) miles inland, in support of the 4th Infantry Division. During the afternoon, the 307th Medical Clearing Company, 82nd Airborne Division, was contacted near Fauvile. It was found to be flooded with casualties, both American and enemy. Arrangements were made with the 4th Medical Battalion to furnish trucks to assist in the evacuation of these casualties part of whom were moved to the 4th Medical Battalion Clearing Station and the remainder were moved to the 261st Medical Battalion in the beach area. The 492nd Collecting Company, 50th Medical Battalion, and the 315th Medical Battalion of the 90th Infantry Division landed, as did the 2nd Section, Advance Platoon, 1st Medical Depot Company. The 4th Medical Battalion Clearing Station was receiving patients by midnight.

4. D + 3 (9 June): The hospital carrier “Lady Connaught” arrived during the night of D + 2 - D + 3 and discharged First U. S. Army Medical Detachment “B”. This personnel consisted of the station and litter bearer platoons of the 502nd and 427th Medical Collecting Companies, 31st Medical Group; six (6) surgical teams of the 4th Auxiliary Surgical Group; one Advance Depot Platoon, 31st Medical Depot Company; six (6) Medical Corps officers from the 662nd Medical Clearing Company, 134th Medical Group; and ten (10) liaison officers from various medical units, including one officer from the 9th Troop Carrier Command. Despite her rated capacity of approximately 300 casualties, 400 casualties were placed aboard the “Lady Connaught” during the day and it sailed for the United Kingdom that evening. Also, during the night of D + 2 - D + 3, personnel of the 42nd Field Hospital plus three (3) surgical teams were brought ashore after their ship bad been sunk and most of their personal and a part of their organizational equipment lost. The remainder of their organizational equipment began to be landed at this time. The equipment of the 2nd platoon was landed first, and the VII Corps Surgeon decided that this platoon would be established near Le Grand Chemin. During the morning, the medical supply dump was opened at Le Grand Chemin. Prior to this time, the dump bad been operated by the 261st Medical Battalion at location of Collecting Company “C” of this battalion. The 315th Medical Battalion set up clearing station at Ste. Mere-Eglise, but artillery fire forced them to withdraw--temporarily. However, they returned to this location later in the day. The clearing station of the 101st Airborne Division suffered a near hit from an estimated 1,000 pound bomb, which cost them six medical officers and forty enlisted

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personnel. Clearing station of the 4th Medical Battalion was set up just south of Beuzeville-au-Plain.

5. D + 4 (10 June): The 128th Evacuation Hospital, the first army evacuation hospital to land on Utah Beach, came ashore. It was followed later in the day by the 91st Evacuation Hospital and the 45th Field Hospital. The 42nd Field Hospital, which landed the night of D + 2 - D + 3, opened just northwest of Le Grand Chemin. Due to the heavy surf the unloading of medical supplies was delayed and a critical shortage of certain items developed. In view of this shortage, it was necessary for the VII Corps Surgeon to contact the Army Surgeon in the Omaha area for delivery of these items. Arrangements were made for their delivery the next day.

6. D + 5 (11 June): The 128th Evacuation Hospital, the first evacuation hospital to become operational on the Continent, opened during the evening in the vicinity of Boutteville; the 91st Evacuation Hospital opening on 12 June in the same vicinity. The 463rd Medical Collecting Company arrived ashore this day.

C. SUBSEQUENT LANDINGS OF REMAINING FIRST U. S. ARMY MEDICAL UNITS

(assigned and attached) on the Continent were as follows:

D + 6 (12 June)

    24th Evacuation Hospital Opened D + 7, vicinity of La Cambe
449th Medical Collecting Co.
450th Medical Collecting Co.
577th Ambulance Company

D + 7 (13 June)
5th Evacuation Hospital Opened D + 9, vicinity of Le Molay
41st Evacuation Hospital Opened D + 8, vicinity of Le Molay
464th Medical Collecting Co.
501st Medical Collecting Co.
564th Ambulance Company
565th Ambulance Company
452nd Medical Collecting Co. Landed night of D+ 6 - D + 7

D + 8 (14 June)
566th Ambulance Company Landed night of D + 7 - D + 8

D +9 (15 June)
575th Ambulance Company
451st Medical Collecting Co.
1st Medical Depot Co (less Advance Platoon)

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D +10 (16 June)
45th Evacuation Hospital Opened D + 18, vicinity of La Combe
96th Evacuation Hospital Opened D + 13, vicinity of Ste. Mere Eglise
493rd Medical Collecting Co.
67th Evacuation Hospital

D + 11 (17 June)
67th Evacuation Hospital Opened D + 13, vicinity of La Fiere
178th Medical Battalion, Hq & Hq Det
427th Medical Collecting Co.
502nd Medical Collecting Co.
68th Medical Group, Hq & Hq Det
175th Medical Battalion, Hq & Hq Det
176th Medical Battalion, Hq & Hq Det
576th Ambulance Company
578th Ambulance Company
618th Medical Clearing Company
97th Evacuation Hospital Opened D + 15, vicinity of St. Sauveur-le-Vicomte

D + 12 (18 June)
10th Medical Laboratory Opened D + 22, vicinity of La Cambe
31st Medical Group, Hq & Hq Det
179th Medical Battalion, Hq & Hq Det
621st Medical Clearing Company
622nd Medical Clearing Company

D + 13 (19 June)
44th Evacuation Hospital Opened D + 15, vicinity of La Cambe

D + 15 (21 June)
454th Medical Collecting Co.

D + 17 (23 June)
2nd Evacuation Hospital Opened D + 23, vicinity of Le Marais
57th Medical Battalion, Hq & Hq Det
3rd Auxiliary Surgical Group (Less 23 teams)
426th Medical Battalion, Hq & Hq Det
134th Medical Group, Hq & Hq Det

D + 18 (24 June)
4th Convalescent Hospital Opened D + 22, vicinity of La Cambe
Detachment, 91st Medical Gas Treatment Bn.

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D + 19 (25 June)
662nd Medical Clearing Co. Arrived night of D + 18 - D + 19
617th Medical Clearing Co.
633rd Medical Clearing Co.

D + 20 (26 June)
Detachment, 91st Medical Gas Treatment Bn.
177th Medical Battalion, Hq & Hq Det.

D + 21 (27 June)
47th Field Hospital

D + 34 (10 July)
180th Medical Battalion, Hq & Hq Det.

IV. HOSPITALIZATION AND EVACUATION

A. EVACUATION

1. In the initial stages of the invasion, the Surgeon, V Corps, on Omaha Beach, and the Surgeon, VII Corps, on Utah Beach, were responsible for the evacuation on their respective beaches. On D Day, the Naval Beach medical parties, Medical Battalions of the Engineer Special Brigades and unit medical detachments, all rendered medical aid and placed casualties on any available landing craft for transportation to larger vessels lying off shore. Evacuation across the beaches was carried out by elements of the medical battalions of the Engineer Special Brigades. Initially, the corps medical battalions evacuated division clearing stations to the Engineer Special Brigade medical battalions. Clearing stations of the Engineer Special Brigade Medical battalions were augmented with surgical teams which were brought in with them and were reinforced on D + 2 (8 June) by six additional surgical teams on each beach from First U. S. Army Medical Detachment “A” and “B”.

2. Definitive surgery was performed on major cases in the clearing stations of the Engineer Special Brigades from D + 2 on. Two field hospitals arriving on each beach on D + 2 were, of necessity, employed as evacuation hospitals until such time as the latter type of hospital arrived, commencing D + 5. The 261st Medical Battalion on Utah Beach became the evacuation center for that beach. On Omaha Beach, the 60th Medical Battalion operated a clearing station in the vicinity of St. Laurent, while the 61st Medical Battalion, 5th Engineer Special Brigade, operated three collecto-clearing stations ranging from Easy Green Beach to Fox White Beach. The first air strip available to transport planes on the continent opened on D + 4 in the vicinity of the 393rd Collecto-Clearing Company of the 5th Engineer Special Brigade above Easy Green Beach. Twelve (12) patients were evacuated by air on that day.

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3. Immediately thereafter, arrangements were made to divert all walking cases to the clearing station of the 60th Medical Battalion at St. Laurent for evacuation by boat, and the transferring of all litter patients to the 393rd Collecto-Clearing Company at Easy Green Beach with a priority travel by air. It was further arranged to start consolidating the entire 61st Medical Battalion in the vicinity of the 393rd Collecto-Clearing Company to perform an air holding unit for this airstrip. This was accomplished by D + 6. Commencing D + 6 all evacuation from the Omaha Beach, both litter and ambulatory, were sent to the evacuation center which was suggested by the 60th Medical Battalion, providing a capacity of 600 litter cases and 300 ambulatory cases. The evacuation from Omaha Beach was primarily by air. On Utah Beach evacuation by air never was available in appreciable amount until 21 July when an evacuation strip was completed in the vicinity of Binneville.

4. During the first three weeks of the invasion, heavy surf, at times, interfered with the evacuation of patients across the beaches and the weather, at times, prevented air evacuation. During these periods, casualties accumulated in the hospitals, but as soon as the weather permitted, these were cleared by plane and by boat to the United Kingdom. At other times when heavy surf prevented the evacuation of patients across the Utah Beach, patients were transported by ambulance from Utah Beach to the air strip on Omaha Beach for evacuation by air to the United Kingdom.

5. As elements of the Army Medical Groups arrived on the continent, they took over the evacuation from the Corps Medical Battalions. All evacuation reverted to army control on D + 6. By 21 June, all First U. S. Army 400-bed evacuation hospitals were ashore and operating. The Army Surgeon instituted a ten day evacuation policy on that . date. Prior to this time the policy had been one of total evacuation with the exception of non-transportables.

6. Some of the problems which were encountered were the separation of hospital personnel from vehicles containing equipment and from hospital equipment and stores not loaded on unit vehicles but shipped separately. In many instances, this separation caused several days delay between the arrival of the personnel and the time hospital could become operational at a time when the need for hospitalization was most critical. Another serious fault due to the separation of personnel from unit equipment was that, in the unloading of preshipped equipment and stores, material became widely dispersed, hospital equipment having been found in dumps other than medical, in personnel transit areas, in Class V dumps and even alongside the roadside. Because of this dispersion beyond the control of the hospital concerned, many of the chests, crates and boxes had been ransacked and pilfered. In some instances, unit medical detachments and organic medical units of divisions were phased in too late to support their unit when the units were initially committed to combat, necessitating a strain on the already limited resources of corps and later army medical units.

7. In general, the medical service for the invasion, as planned, was sound and required a minimum of changes. The total evacuation policy was absolutely essential and was possible through the use of medical detachments on LSTs

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to provide proper care for patients evacuated on this type of craft and by the use of hospital carriers, one being scheduled daily for each beach. The attachment of surgical teams to Engineer Special Brigades and medical companies of airborne units, and the early augmentation of additional medical personnel of First U. S. Army Medical Detachments “A” and “B” undoubtedly saved a great number of lives. The phasing in of litter bearers, technicians and medical officers of army medical groups in Medical Detachment “A” and “B” provided a much needed source of replacements to divisions and increased the capacity of clearing units of Engineer Special Brigades on the beaches. Liaison officers of Army Medical units accompanying Medical Detachments “A” and “B” made it possible to select suitable sites for hospitals and have the sites demined and cleared prior to arrival of the various units, thus enabling units to become operational at the earliest possible moment after arrival on the Continent.

8. The periodic report on evacuation from army hospitals originally was based on a six hour report. It was found from experience that this interval works a hardship on hospitals rendering the report and the units furnishing courier service for same. It was also found to be impracticable to have such reports rendered by telephone from so many units, consequently, the report was changed to twice a day as of 0600B and 1800B, which proved to give sufficient timely information on which to base evacuation planning as well as control admissions to the hospitals. The information originally called for in the report was sound, except that the information in the report should all have been based on the same period of time. This was corrected. Surgical backlog and total 24 hour evacuation figures as taken from the Combat Statistical Report also were added. See Appendix No. 1 attached hereto, for a copy of this report, and instructions pertaining to same as contained in Operations Memorandum No. 2. On the basis of the twice daily periodic report from the evacuation hospitals, hospital quotas for admission to the hospitals were established by the Army Surgeon for the next twelve hour period. These quotas were given to the medical group responsible for evacuating the division and corps clearing stations. The establishment of such quotas enabled the Army Surgeon to take into consideration the bed status of the hospital and the surgical backlog prevailing, thus enabling him to equalize the load among the available hospitals to prevent any unit from becoming bogged down in a given period. The medical group, through the employment of ambulance regulating points in front of evacuation hospitals, distributed the patients among the hospitals on the basis of quotas assigned by the Army Surgeon. The distribution of the load on the hospitals was greatly facilitated by placing evacuation hospitals in pairs in relatively close proximity to each other.

9. One major evacuation problem occurred immediately after the fall of Cherbourg when it was determined that there were approximately 1,500 wounded prisoners of war hospitalized in the three hospitals in that city. The 68th Medical Group triaged and transported 1,382 of these patients from Cherbourg to the 261st Medical Battalion on Utah Beach over a period of 36 hours. The remaining non-transportable prisoner of war patients were consolidated in one hospital in Cherbourg for treatment by captured German medical personnel, under the, supervision of American medical officers.

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10. Evacuation hospitals functioned throughout the entire operations with little, if any, relief. The number of evacuation and field hospitals set up for the First U. S. Army during the planning phase was for an army composed of three corps. With the build-up of the First U. S. Army on the continent, first by VIII Corps and later by Third U. S. Army units, the medical service of the First U. S. Army was augmented during the period 26 June to 1 August 1944, by the following field and evacuation hospitals of the Third U. S. Army

32nd Evacuation Hospital
34th Evacuation Hospital
35th Evacuation Hospital
39th Evacuation Hospital
100th Evacuation Hospital
102nd Evacuation Hospital
103rd Evacuation Hospital
104th Evacuation Hospital
106th Evacuation Hospital
107th Evacuation Hospital
109th Evacuation Hospital
16th Field Hospital

All of these units reverted to the Third U. S. Army control on 1 August with the exception of the 106th and 109th Evacuation Hospitals, which reverted at a later date. Advance Section, Communications Zone, made the 77th Evacuation Hospital available for use by the First U. S. Army on 21 July 1944, along with three ambulance companies which were given the task of evacuating from the evacuation hospitals to the beaches. Throughout this period evacuation hospitals were utilized by closing a hospital and leap frogging it forward to a new location. Hospitals were established as far forward as the tactical situation would permit, usually in front of corps rear boundaries. At the height of operations for the period 6 June 1944 to 31 July 1944, inclusive, there were twenty-two (22) evacuation and six (6) field hospitals assigned and attached to the First U. S. Army for the support of sixteen (16) active combat divisions.

11. On request of the Surgeon, First U. S. Army, Advance Section, Communications Zone, established a holding unit at the airstrip at Binneville on 21 July by utilizing the 93rd Medical Gas Treatment Battalion, augmented by one platoon of a field hospital. On 24 July 1944, by mutual arrangement between the Surgeon, First U. S. Army, and the Surgeon, Advance Section, Communications Zone, the air holding units at Binneville and Colleville and the beach evacuation center on Utah Beach reverted to the control of Advance Section, Communications Zone. Up to the time Advance Section; Communications Zone took over the evacuation centers, the First U. S. Army, had evacuated 20,117 patients by air and 36,012 by boat, a total of 56,129.

B. HOSPITALIZATION

1. Throughout the campaign hospitalization units of field hospitals, with surgical teams from the 3rd Auxiliary Surgical Group attached, were utilized at division clearing stations. By operating at the division clearing stations, these

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units were in a position to give definitive treatment to the most seriously wounded. Upon movement of a hospitalization unit forward with the division clearing station, it was necessary at times to leave sufficient medical personnel at the old site to care for the non-transportable wounded remaining in the hospital. Transportation for these units was usually furnished by one of the evacuation hospitals. Throughout the operation, field hospitals were of great value to the Army Medical Service.

2. The surgical teams assigned and attached to the First U. S. Army proved to be inadequate in number, but this situation was relieved somewhat by utilizing improvised surgical teams from general hospital personnel assigned to the Advance Section, Communications Zone, prior to the opening of these general hospitals. From time to time, it was necessary to call on Advance Section, Communications Zone, for other personnel, both commissioned and enlisted, to augment the staffs of the army hospitals.

V. MEDICAL SUPPLY

A. REORGANIZATION OF FIRST UNITED STATES ARMY

1. Immediately upon arrival in England an exhaustive study was begun of the adequacy of existing Tables of Equipment with regard to medical equipment. The question of the adequacy of the existing Tables of Organization and Equipment was examined in the light of a contemplated combined airborne and amphibious operation against the coast of France with an attendant high casualty rate.

2. After considerable deliberation the Army Surgeon arrived at lists of items by types of unit required in excess of Tables of Equipment in order to satisfactorily perform combat missions anticipated. These lists included items not only of Medical Department issue but items of Quartermasters, Signal, Ordnance and Engineer issue. (See Appendix “2").

3. After having determined the requirements of medical units in this manner it was then necessary that proper justification for the issue of the items involved be given each service and that where stocks were not available in the United Kingdom, a special project be instituted for shipment from the United States. Great difficulty was experienced initially in acquiring accurate information as to availability of the items required. However, it was later possible to see a clear picture as to the status of items involved.

4. A series of conferences followed between representatives of the Army Surgeon and representatives of the Chief Surgeon, European Theater of Operations, including the Chief Surgeon himself in an attempt to thoroughly review the actual need for the items requested.

5. At a final and informal conference on excess equipment between the Medical Supply Officer, European Theater of Operations and the Medical Supply Officer, First United States Army, a decision was made to issue, within the limits of stock availability, all items requested except those which had been disapproved by the Chief Surgeon.

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6. Concurrent with the work being done on the requirements of units for equipment in excess of Tables of Equipment was the enormous task of equipping all the units of the command. All units bad arrived in the United Kingdom without any but housekeeping equipment in accordance with the War Department plan of prescheduleä shipments of unit equipment.

7. The personnel of the Supply Division of the Chief Surgeon's Office, exhibited a cooperative and willing spirit with regard to the equipping of units with their T/E equipment. Correspondence and other time consuming elements were reduced to a minimum and an informality was present which enabled individual matters to be greatly expedited.

8. No First Army unit departed from the United Kingdom with any deficiencies in T/E allowances and the bulk of equipment requested in excess of authorized allowances likewise was received prior departure for the Continent.

B. OPERATIONS, 15 May 1944 to 1 August 1944.

1. Mounting of Operation “Neptune”.

An approach to the medical supply problems presented by Operations “Neptune” was made through the initial joint appreciation of the plan. It was immediately seen that the combined airborne and amphibious operation against prepared defenses and its expected high casualty rate presented problems beyond the scope of any previously encountered. An examination of what was available to the Medical Service of the First Army in the way of standardized maintenance units revealed that these were inadequate. It was also apparent that to establish maintenance in terms of pounds per man per day would not suffice since peak casualties would occur when the forces were smallest. A decision was made to approach the medical supply problem on an anticipated casualty basis.

Standard War Department and European Theater of Operations maintenance units were minutely examined to determine their adequacy and were found deficient in various critical items. A list was prepared of items which were deemed essential and which were either not included in medical maintenance units or were included in insufficient quantity. This list was presented to the Chief Surgeon, European Theater of Operations, U. S. Army, in the form of a request for the building of units of supply to supplement maintenance units. This list became the focal point of much professional controversy. Again a series of conferences were held between representatives of the Army Surgeon, and the Chief Surgeon, European Theater of Operations, U. S. Army. As a result of these conferences certain items were deleted from the supplemental list and others reduced in varying degrees. It may be said here that this supplemental list became the backbone of supply during the early stages of the operation. Certain of the items which were deleted from the list, and others which were reduced, actually fell into short supply in the period from “D” to “D + 10".

The European Theater of Operations Army Medical Maintenance Units the Divisional Assault Medical Maintenance Units (two portions — Surgical and Medical); and the Supplemental Unit were the primary maintenance supply. (See Appendix 3). However, individual items on which the consumption rate was anticipated to be abnormal, were phased in, over and above quantities included in any maintenance unit. Such items as plaster of paris bandage, wadding

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sheet, cocoa and nescafe and medicinal gases (oxygen, nitrous oxide, etc.), were phased in virtually every day.

Class II replacements (i. e., T/E replacements items), were phased in a descending percentage loss factor. For example, it was anticipated that troops going ashore on “D” Day would lose 15 % of their equipment; troops going ashore on “D + 4” would lose 8 % of their equipment; and by “D + 10” this factor would have leveled off at a 5 % loss factor. Class II items were phased in only in sufficient quantities to replace anticipated losses.

In view of the ever present possibility that the enemy might resort to gas warfare, provision was made to land sufficient gas casualty maintenance units with the assault elements to treat 5,000 gas casualties in each assault area. A bulk of these gas casualty maintenance units was laid down on the near shore for shipment by fast boat in the event of extensive use of gas.

Since all casualties except non-transportables were to be evacuated by boat to the United Kingdom, and by air as soon as air strips were available, it was necessary to ship to the far shore enormous quantities of litters, blankets and splints. In view of the extremely limited scheduled tonnage available to the Medical Department, a scheme had to be devised to bring these items ashore without having the tonnage charged against scheduled lift. Arrangements were made with the U. S. Navy to place aboard each LST for the first three-hundred trips a unit of supply designed to bring in quantities of these items and quantities of plasma and surgical dressings which could not be phased in under allocated tonnage. This unit of supply consisted of the following items: 100 litters; 320 blankets; 4 splint sets; 3 boxes of surgical dressings; and 96 units of normal human plasma. Thus, it was possible to bring ashore in the first fourteen days 30,000 litters, 96,000 bankets; and large quantities of the other items without having to reduce other necessary medical maintenance. An additional 19,000 litters and 40,000 blankets were included in the scheduled lift. Infantry Divisions, Engineer Special Brigades, and other combat units were issued additional quantities of these items. Adequate quantities of these items were always available until the later stages of the operation when returns from the United Kingdom of these items did not keep pace with the great outward suction through air evacuation.

For the assault troops there was also designed a special waterproof unit of supply which could be carried ashore by aid men and which would serve as additional life preservers for them. This unit consisted of seven specially treated mortar shell cases which contained the following items:

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It was issued to units scheduled to arrive on the far shore from “D” to D + 3” on the following basis: one unit per infantry battalion, artillery battalion, chemical battalion, engineer battalion and ranger battalion. Two units per collecting company, divisional. Four units per clearing company, divisional. Six units per medical battalion (Engineer Special Brigade).

This unit proved extremely valuable in the early hours of the assault when a delay in unloading scheduled medical supplies was encountered.


C. ESTABLISHMENT OF THE BEACHHEAD - Period “D + 1” to “D + 4” (7 to 10 June).

1. Omaha (V Corps Beach).

On the afternoon of “D + 1" (7 June) the first pre-scheduled Medical Maintenance Units came ashore in the Omaha Sector, although some LST property exchange units had been landed the previous day. Unfortunately a large portion of the supplies landed on “D + 1" were lost when the tide came in and covered them as they lay on the beach below the high water line.

A fairly large percentage of those supplies which were landed on “D + 2” were similarly lost. The 1st Section, Advance Depot Platoon, 1st Medical Depot Company, landed in two equal increments with the 5th and 6th Engineer Special Brigades in this sector and attempted to set up issue points virtually at the high water line in the vicinity of the brigade Collecto-Clearing Companies. Units were served here out of brigade reservestocks and those stocks which were salvaged on “D + 1 and on “D + 2". On the morning of “D + 2" the Advance Depot Platoon, 32nd Medical Depot Company (attached), and the Commanding Officer, 1st Medical Depot Company came ashore. The Commanding Officer, 1st Medical Depot Company immediately took charge, and the confusion which was apparent in the first two days immediately abated. On the afternoon of “D + 3” the first army medical dump in France was opened for issue in the vicinity of St. Laurent-sur-Mer.

2. UTAH (VII Corps Beach).

No medical supplies, except LST property exchange units were landed in this sector prior to the afternoon of” D + 2 “. Units were -forced to rely upon their reserves as well as what little could be diverted from the Omaha Sector. Here, also, there was some confusion in the landing of personnel and the Advance Depot Platoon, 31st Medical Depot Company (attached) arrived ashore prior to the 2nd Section, Advance Depot Platoon, 1st Medical Depot Company, which was supposed to have landed with medical companies of the 261st Medical Battalion, lst Engineer Special Brigade. The 3nd Section, 1st Medical Depot Company took over beach issue while the Advance Platoon of the 31st Medical Depot Company was setting up the first medical dump in this sector. This dump opened on the afternoon of “D + 3" in the vicinity of Le Grand Chemin. In this sector the 82nd and 101st Airborne Divisions landed. Both had been given adequate supplies to be self sustaining for at least three days. When contact was established between seaborne and airborne elements it was found that even though much equipment had been lost these two airborne divisions had been able to sustain themselves with the supplies they had carried in.

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3. General.

The biggest problem in this period was the gathering up of medical supplies which had been landed at scattered points along the beaches. Much confusion existed while hospitals endeavored to find their unit assemblies which had been shipped ashore in craft separate from that which carried personnel; and while medical depot company personnel endeavored to comb the beaches for maintenance supplies shipped ashore in order to centralize and localize issue points. Medical Maintenance Units were landed in several elements at scattered points along the beach and an item which was urgently needed had to be sought by beach combing tactics.

D. CAMPAIGN TO CAPTURE OF CHERBOURG

1. Supply Problems During Period. A great weakness in the Medical Maintenance Unit became apparent early in the campaign. It was a weakness that cost many man hours and much delay in the issue of supply. A Medical Maintenance Unit by its very nature attempts to furnish a broad scope of items consumed in the treatment of casualties. To this end, a Medical Maintenance Unit consists of many repacked boxes containing small quantities of several items. During this period of the campaign it was not uncommon for depot personnel to have to open as many as twenty or thirty boxes to acquire enough of one item to issue to a single requisitioning unit. This work was followed by need to repack or to place in bin stock all of the other items contained in the boxes. This problem, serious in itself, was further aggravated by the inaccuracy of, or complete absence of packing lists. Many shipments had no packing lists or had a packing list stating that the contents were unknown or were miscellaneous medical supplies. Hence, it was impossible to determine what was actually on hand until every box had been broken open and its contents inventoried and picked up on stock record.

It is strongly recommended that in any possible further operation of the nature of Operation “Neptune” that Medical Maintenance Units as such be abandoned and that Maintenance Units made up from original packages, i.e., bulk stock of items be substituted. If that is not possible an alternate recommendation would be that items be ordered by item rather than by maintenance units in bulk.

Until communications were established between the beaches it was impossible to transship regularly from one sector items which were in short supply in the other sector. Even after the two beachheads were linked this problem continued to be a serious one — due first to enemy action, and later to traffic congestion.

For an interval of seven days in this period no penicillin was available. Stocks were exhausted in the United Kingdom and the automatic daily flow of penicillin to the continent ceased. This problem was finally alleviated by the arrival of several plane loads of penicillin from the United States.

Several items on which the consumption rate was higher than anticipated fell into short supply in this period. These were requested from the United Kingdom for Air and Red Ball Express shipment. Excellent service was provided in this type of shipment and the short supply problems were rapidly solved.

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The most taxing problem during this period was the problem of hospital units locating and reassembling their hospital assemblies. Although every effort was made by the First Army Surgeon to have hospital assemblies loaded on one craft and to have these assemblies accompanied by one officer and five enlisted men of the hospital concerned, this proposal was rejected except for those hospitals which were considered part of the assault forces. As a result hospital assemblies were unloaded along with vast bulks of other supplies, at many scattered points along the beaches. Hospitals spent many days going from dump to dump, regardless of service, in an attempt to find a few boxes which might belong to their unit assemblies. The opening of several hospitals was seriously delayed, and no hospital of this command received its complete assembly. An attempt to persuade Engineer Brigades to designate unit assembly receiving points met with failure and portions of hospital assemblies were received in Quartermaster Class I Dumps, Quartermaster Class II & IV Dumps, Salvage Dumps, Engineer Dumps, etc.

It must be recognized that a hospital’s operating equipment, as differentiated from tactical organizations, is not carried, nor can be carried, on the individual or on unit transportation, and without this assembly the hospital is emasculated. In any further operations of this type every effort must be made to ship hospital personnel and the hospital equipment in one craft, and if this is not feasible to ship hospital assemblies complete in one craft, accompanied by a detachment of hospital personnel.

It became apparent early during this phase that generators on hand in First Army hospitals were inadequate to handle the power load in round-the-clock operations. Every effort had been made to secure 5 KW Generators for all First Army hospitals prior to departure from the United Kingdom. The project had been approved by the War Department, but generators were not received prior to departure. As a last minute emergency measure, double the T/E allowance of Medical Department Generators (2.5 KW) was issued. These, however, proved inadequate and once they broke down they could not be repaired, since no spare parts were available in France or in the United Kingdom. Arrangements were made through the Medical Supply Officer, Communications Zone, to ship one large generator for each evacuation hospital. These arrived in due course and the power problem was solved forthwith.

Another operational supply problem encountered during this period was the mechanical difficulty with all gasoline operated equipment, such as autoclaves, 2-burner stoves, and distilling apparata. Special spare parts and repair kits were flown from the United Kingdom, accompanied by two expert repairmen assigned to Communications Zone depots. This measure was followed shortly by the more definitive measure of acquiring white gas for the operation of these stoves through Quartermaster, First Army.

E. INLAND OPERATIONS PERIOD - “D + 20” to “D + 48” (26 June to 24 July).

1. Supply Situation During Period. During this period First Army Surgeon was faced with the problem of supplying a greatly over-size command as compared with the command for which supplies had been planned. Many units from Third Army which were operating under First Army during this period arrived on the continent with shortages of T/E equipment. It was necessary to equip these

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units prior to establishing them as functioning installations. It was also notable during this period that the Advance Section, Communications Zone, was supposed to have assumed responsibility on "D + 15" but did not begin to function, and the First Army was given the additional burden of supplying certain Advance Section troops and installations, as well as some of the Third Army.

With the increased load of work involved and the growing amount of geography, the need for additional depot personnel became apparent. Should any great movements involving much terrain become actual, there was little doubt that one Medical Depot Company could not meet the requirements of movement concurrent with servicing units of this command.

During this period it became apparent that even though issues in excess of T/E had been made to certain types of units within army, their equipment was still insufficient to meet the burdens imposed upon them. Notable among these deficiencies were the bottleneck in X-Ray in evacuation hospitals, occasioned by lack of adequate film drying facilities, and the general deficiencies in equipment for oxygen administration in all hospital units. Certain projects for equipment in excess of T/E were initiated on the far shore to the United Kingdom, and shipments were made by Air and Red Ball Express. (See Appendix 4).

Certain items developed as trouble-makers during this period. These were mainly the items which were evacuated with casualties and on which there was no property exchange. Included in this category were pajamas, levin tubes, trachea tubes, and, toward the latter part of the period, litters and blankets. An attempt to establish an automatic weekly air lift for property exchange items based on casualties evacuated during the previous week met with no success. The problem was largely solved by daily Air and Red Ball Express requests. During the period from 26 June to 24 July, certain non-T/O & E, but necessary, installations within army, presented and continue to present, considerable equipment problems. Foremost of these are the two combat exhaustion centers which were originally intended to operate as 250 bed installations, and which developed to 1,000 bed and 750 bed, respectively. In addition there was a provisional 1,020 bed hospital installation operated by the 91st Medical Gas Treatment Battalion primarily for medical cases including malarials and contagious diseases; three Neuro-Surgical Centers within three army evacuation hospitals, and a large Dental Clinic establishment within the 4th Convalescent Hospital. Issues in excess of authorized allowances, but required for the proper operation of these installations, were made in the main from existing First Army stocks, and the balance were ordered from the United Kingdom as special project items.

During this period also there was returned to Quartermaster Depots tentage and other equipment which bad been issued in the early stages of the operation, when hospitals had been operating enlarged installations. Hospitals were reduced to amounts authorized by T/E and excess authorization as indicated in Appendix 2. However, combat experience has proved the need for the following quartermaster equipment in excess of all previous authorizations for evacuation hospitals, semi-mobile:

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VI. SELF-INFLICTED WOUNDS

In the early days of the invasion it was noticed that a number of patients were being admitted to evacuation hospitals with what seemed to be self-inflicted gunshot wounds. Most of these cases were minor wounds and were taking up much needed hospital bed space.

A. POLICY

On 22 June, instructions were issued to Commanding Officers of all First U. S. Army evacuation hospitals to hold all cases of suspicious self-inflicted gunshot wounds in the hospital; that the Army Inspector General was making a round of the hospitals checking into these cases in an effort to develop a policy as regards self-infliction of wound to avoid hazardous duty. After checking into these cases, the following policy was developed. All cases of suspected self-inflicted gunshot wounds would be held in evacuation hospitals pending investigation by a representative of the Inspector General. These cases would not be evacuated from -the hospital except on orders of the Army Surgeon. The name, rank, serial number and organization of each such case in hospital at that time or thereafter admitted was to be reported to the Army Surgeon’s Office. The Army Surgeon’s Office in turn was to turn over to the Army Inspector General’s Office this list of names and the Inspector General or his representative would make an investigation of each such case. After investigation, the Inspector General would report action on each case to the Army Surgeon's Office. If the wound was determined to be really accidental, the Army Surgeon’s Office would direct the hospital concerned to include a form in the patient’s medical records to this effect, and clear patient from hospital to duty or further evacuation. To avoid further investigation, this form would indicate to proper authorities in the United Kingdom that the case had been investigated and the outcome of such investigation. Where a patient was found guilty of self-infliction of wound to avoid hazardous duty, the Inspector General or his representative consulted the Army Neuropsychiatric Consultant regarding the particular case, after which the patient was tried. This policy was presented to the Chief of Staff and approved.

B. DISPOSITION

1. Several weeks later, it became apparent that these cases were clogging up our evacuation system and were causing quite a problem for the Inspector General or his representative to visit each evacuation hospital to investigate such cases. At a conference between the Army Surgeon and the Army Inspector General, it was decided that the 4th Convalescent Hospital would receive all such cases from the evacuation hospitals. On 24 July 1944, all such cases were transferred to the 16th Field Hospital, a Third U. S. Army unit attached to First U. S. Army. Also, this unit was to receive other medical cases, including malarias. The 16th Field Hospital was responsible for reporting all such cases admitted to the Army Surgeon’s. Office ; the evacuation hospitals merely transferring these cases to the 16th Field Hospital without reporting same to this office. By this procedure, all cases of self-inflicted gunshot wounds were concentrated in one location, thereby saving much time in the investigation of cases due to shorter distances to be traveled by the Inspector General or his representative. Further, it relieved the

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evacuation hospitals of holding such cases for a period of time and thereby made bed space available for the more seriously wounded.

2. During this period 848 cases of self-inflicted wounds were reported of which 625 were found upon investigation not to be malingering or on which sufficient evidence was not obtained to warrant court-martial proceedings. Twenty-four men were returned to their organizations for court-martial and 199 were still under investigation at the end of the period.

3. Upon Third U. S. Army becoming operational on 1 August, it was necessary to turn over to that army certain medical units which had been attached to First U. S. Army for operations. Among these units was the 16th Field Hospital. At a conference held between the Surgeon, Third U. S. Army, it was agreed that all suspected self-inflicted gunshot wound cases in the 16th Field Hospital belonging to units of First U. S. Army would be transferred as soon as possible to the 91st Medical Gas Treatment Battalion, which was to be established for the reception of such cases ; Third U. S. Army retaining all such cases belonging to units of that army.

VII. RETURN OF PATIENTS TO DUTY FROM HOSPITAL

Upon announcement by the Army Surgeon that a ten-day evacuation policy was in effect (D + 15), arrangements for the return of patients to duty from hospitals were made between the Army Surgeon and the Assistant Chief of Staff, G-1, Headquarters First U. S. Army. This policy was to the effect that Commanding Officers of evacuation hospitals were to call Commanding Officers of the Corps Replacement Battalions and notify them as to the number ready for duty for that particular day and the location of the hospital. The replacement battalion would then be responsible for sending transportation to pick these men up for return to the replacement battalion. One exception to this was that all neuropsychiatric cases ready for duty were to be returned by Medical Department transportation to clearing stations from which they were admitted to hospital.

During the period 6 June 1944 to 1 August 1944, 22,942 patients were treated by hospitals of First U. S. Army and returned to duty.

VIII. UTILIZATION OF PRISONERS OF WAR IN EVACUATION HOSPITALS

Prisoners of war were utilized throughout most of the period at the evacuation hospitals. This arrangement was closely coordinated with the Assistant Chief of Staff, G-1 and the Provost Marshal, Headquarters First U. S. Army. The utilization of prisoners of war became necessary due to the fact that the T/O of evacuation hospitals is such that during periods when large numbers of casualties were being admitted to the hospitals, the enlisted personnel were needed for the more urgent work of caring for the sick and wounded. It was therefore necessary that additional personnel be made available for general work such as litter bearing, digging latrines, garbage pits and other labor. Usually, forty (40) prisoners of war (non-medical) have been attached to each evacuation hospital

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within First U. S. Army to do such work. To guard these prisoners of war, the Provost Marshal placed two (2) armed guards with each hospital. This arrangement worked out very satisfactorily, enabling the evacuation hospitals to render better care and treatment to the sick and wounded.

The prisoners, with practically no exceptions, worked well and seemed well pleased with the way in which they were being handled.

IX. HISTORY OF NEUROPSYCHIATRIC CASES

A. PLANNING PHASE

1. The approved plan for the treatment and evacuation of neuropsychiatric casualties of First Army was derived from a study of reports and circulars, outlining the policies and procedures relative to neuropsychiatry in other theatres of operation. The First Army plan was designed to provide early treatment of neuropsychiatric casualties as close to the front as was feasible and to return successfully treated individuals direct to their units with the least possible delay.

2. The number of neuropsychiatric casualties to be expected for the first thirty (30) days of the continental invasion was established at 2500-3000. This figure was used as a basis for the following plan for the treatment and evacuation of neuropsychiatric casualties.

a. A triage of neuropsychiatric casualties was to be conducted by Battalion and Regimental Surgeons of combat units and in keeping with the tactical situation. Mild cases, whose prognosis was favorable for return to duty within twenty-four (24) to thirty-six (36) hours, could be retained for treatment in the unit area, all other cases were to be evacuated without delay to the appropriate divisional clearing station.

b. Neuropsychiatric cases admitted to divisional clearing stations were to be seen by the division psychiatrist who would evacuate all cases requiring more than seventy-two (72) hours treatment. The cases which were to be held at the clearing stations were to be given accepted treatment with a view to accomplishing the early return to duty of those successfully treated.

c. During the first ten (10) days of the operation, all neuropsychiatric casualties who were evacuated to the rear of division clearing stations were to be sent to the United Kingdom, at least until evacuation hospitals were in operation.

(1) In order to avoid the possibility of congestion at the evacuation hospitals and to make available a greater number of beds for surgical patients, as well as to reduce the danger of “infecting” lightly wounded individuals with neuropsychiatric symptoms, the Surgeon, First U. S. Army, designated the 622nd Clearing Company of the 134th Medical Group to operate a neuropsychiatric hospital, the psychiatrists of the evacuation hospitals (on detached service) were to provide the professional service.

(2) The use of an installation such as indicated above would allow for standardization of treatment and would provide facilities for special procedures not necessary for surgical cases but desirable for neuropsychiatric cases. The 622nd Clearing Company was to be augmented by personnel and equipment so as to provide five-hundred (500) beds, and by arrangement with the evacuation officer was to receive all neuropsychiatric patients directly from division clearing stations.

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B. TRAINING PHASE

1. During the months of November 1943 to April 1944, representative unit medical officers, particularly Battalion and Regimental Surgeons of combat units had the advantage of a one week orientation course in military neuropsychiatry given by the staff of the 312th Station Hospital. This hospital offered additional courses, one for division neuropsychiatrists lasting one month, and another lasting two weeks for evacuation hospital personnel including the psychiatrist, two nurses, and six enlisted technicians. The three courses were presented in an excellent manner and served particularly well in acquainting medical officers not previously experienced in neuropsychiatry with many of the problems which were later met under combat conditions.

2. The Commanding Officer of the 312th Station Hospital, gave a series of orientation talks on “Combat Exhaustion” to line officers of the 28th and 29th Divisions during October and November 1943.

3. A ten (10) day course in neuropsychiatric procedures was conducted by officers of the 45th and 128th Evacuation Hospitals, respectively, for all personnel of the 622nd Clearing Company, beginning 25 April 1944. Thereafter, the company officers carried out further training and instructions for the enlisted men.

4. The above mentioned schools and indoctrination measures contributed materially to the functioning of the neuropsychatric service of First Army under combat conditions.

5. In March 1944, the Commanding Officer, 134th Medical Group, submitted requisition for equipment,. in excess of T/E, required for the operation of the 622nd Clearing Company as a five-hundred (500) bed “Exhaustion Center”. Approximately ninety (90) percent of this excess equipment was delivered to the organization prior to embarkation. The remaining deficiencies were supplied after arrival on the continent.

C. OPERATION

1. A total of three neuropsychiatric cases were reported as evacuated from D Day to D + 3, inclusive.

2. The neuropsychaitric services of the evacuation hospitals which operated initially follow:

a. The 91st Evacuation Hospital neuropsychiatric service opened on 12 June (D + 6) and closed 22 June (D + 16) — a total of thirty-four neuropsychiatric cases were treated.

b. The 41st Evacuation Hospital neuropsychiatric service opened 14 June (D + 8) and closed 24 June (D + 18) — a total of twenty-eight neuropsychiatric cases were treated.

c. The 5th Evacuation Hospital received neuropsychiatric patients on 16 June (D + 10) and closed the neuropsychiatric service on 28 June (D + 22) having received a total of ninety-one patients.

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3. By D + 7 (13 June) the number of neuropsychiatric casualties occurring in the Utah sector had increased to the point where the Surgeon, VII Corps, designated a clearing company of the 50th Medical Battalion to act as a neuropsychiatric holding unit, and in the course of the next seven days, about three-hundred cases of combat exhaustion were treated. Most of these patients were either evacuated to the United Kingdom or were transferred to the 2nd Platoon, 622nd Clearing Company, when it opened.

4. The 622nd Clearing Company landed on 18 June and the 2nd Platoon went into operation one-half mile south of Ste. Mere-Eglise on 19 June. The 1st Platoon opened at Bernesq on 19 June. The neuropsychiatric staff consisted of the psychiatrists of evacuation hospitals which were ashore at that time.

a. In general, the operation of these two (2) exhaustion centers was identical and included the following sections

(1) Admission — where a brief history was recorded, a physical examination done and a triage accomplished.

(2) Observation — on this service a more complete psychiatric study was done and treatment started and perhaps hypnosis of pentathol sodium exploration done in selected cases. Patients remained in this section for twenty-four (24) hours. Bathing facilities were available both for patients in this section as well as those in rehabilitation.

(3) Narco-therapy — the majority of “anxiety” cases were treated by this method. Deep sleep was induced by large doses of sodium amytol and carried on for forty-eight hours allowing patients to emerge sufficiently to have food, go to the latrine and expand their lungs. During this phase of treatment patients had 39-40 hours of deep sleep out of forty-eight hours.

(4) Rehabilitation — the rehabilitation section was separated from the rest of the hospital so arranged that soldiers resumed a military rather than a patient status. The day's program on this service was quite full and included military drill, calisthenics, organized athletics and both group and individual psychotherapy. It was in this section that the final evaluation of the patient’s mental and emotional status was made and suitable disposition of the man determined. The soldier returning to duty received new clothes and equipment.

(5) Disposition of Treated Cases.

(a) Duty. The expeditious return of treated patients to their original units was not consistently recognized as an important therapeutic measure. It was expected that 10 - 15 % of patients discharged to duty as asymptomatic would develop symptoms on rejoining their unit or even on reaching the division clearing station. This occasionally, was the cause for the expression of exaggerated distress on the part of the unit surgeon or commander, with the result that antagonistic attitudes were developed toward the problem as a whole and toward the returning soldier in particular.

(b) Non-combat Duty. On the whole, closer collaboration between the exhaustion centers and replacement pools would have resulted in better therapeutic results with this type of patient. The replacement pools did not have the clinical data which was available on the men they received.

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(c) Soldiers were occasionally returned to their units with recommendations for investigation relative to possible disciplinary action or institution of Section VIII proceedings.

(d) Evacuation to Communication Zone. At the end of the period under review this procedure was being accomplished without complication.

(6) Consultant Service.

(a) The Inspector General, First U. S. Army, required an investigation of all officers who developed neuropsychiatric break downs under combat with a view of determining the type of duty for which they were suited or if they were fitted to hold a commission. The opinion of the psychiatrists was reported to the Inspector General in all such cases.

(b) Judge Advocate Investigations. The Judge Advocate, First
U. S. Army, referred cases pending trial for examination. This service proved to be useful.

5. The rate of admission to the exhaustion centers of neuropsychiatric casualties during the first week of operation was in accord with the estimates made previously, however, the rate thereafter increased to such proportions, that it became necessary to reinforce each of the platoons operating the exhaustion centers by an additional platoon and later by a full clearing company. On 1 August, a full clearing company plus additional tentage, personnel and equipment was in use in each of the exhaustion centers and each provided one-thousand (1,000) beds. The reasons for this increased rate of neuropsychiatric admissions were

a. The addition of a number of divisions to the army in excess of original estimates.

b. Difficult terrain, mud, waist deep water, hedgerows, etc.

c. Stiff resistance offered by the enemy in the La Haye-du-Puits, Carentan and the St. Lo actions.

d. Troops remaining in combat for prolonged periods.

6. The value of the division psychiatrist was definitely established as indicated by the results obtained by them during the continental invasion.

7. Some divisions, 83rd, 29th, 35th and 30th, on their own initiative established division exhaustion centers. This usually was located in the division rear echelon and all neuropsychiatric casualties were sent to it from the clearing station. Such an establishment offered several advantages:

a. Provided for holding such casualties within the division, thereby continuing the individual's identification with his unit, and avoided the danger of over-emphasis of the medical aspects of his condition.

b. Kept the casualty close to the front.

c. Avoided overcrowding the division clearing stations, as well as of medical installations to the rear of divisions.

Disadvantages:

a. There was no equipment or personnel authorized for such an installation.

b. This installation tied down a division, particularly in a fast moving situation.

The mere fact that the divisions themselves established these centers strongly indicates that there was need for a table of organization for such an installation.

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D. STATISTICS

1. Admissions and dispositions of neuropsychiatric casualties to medical installations, First U. S. Army.

E. DIAGNOSTIC BREAKDOWN OF DISPOSITIONS BY THE EXHAUSTION CENTERS (6 June to 28 July 1944.)

DiagnosisNo. of Cases

1. Neurosis
Anxiety 4,137
Anxiety Hysteria 133
Hysteria 241
Reactive Depression 98
Post Traumatic 17
Others 598

Total : 5,224 — 74.6 %

2. Psychoses
Schizophrenia62
Manic Depressive 8
Others 78
Total : 148 — 2.1 %

3. Psychopaths440 — 6.3 %
4. Mental Defectives 18 — 0.3 %
5. Other Psychiatric 262 — 3 .7%
6. Concussion 603 — 8.6 %
7. Epilepsy 21 — 0.3 %
8. Other Organic 284 — 4.1 %

Total : 7,000 — 100.0 %

The preponderance of neurosis (74.6 %) among the neuropsychiatric casualties of First U. S. Army during the period 6 June to 28 July 1944, was in keeping with the rates in other theaters.

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The relatively low rate for mental defectives (0.3 %) is explained by the fact that many mental defectives who became casualties showed a predominance of symptoms of anxiety neurosis and were included under that heading. The majority of those listed in this chart were individuals who were referred for examination by the Judge Advocate General and were not actually casualties.

The number of cases having a diagnosis of concussion (602 or 8.6 %) is believed to be considerably greater than is actually the case. However, the limited time available for observation contributed to the percentage reported in this category. Any patient who showed ruptured ear drums, or gave a history of epistaxis, hemoptysis, etc., in conjunction with a history of amnesia and with headaches was evacuated as a potential case of cerebral concussion in order to give the patient the benefit of the doubt.

F. REMARKS

1. The officers and men of the clearing companies of the 134th Medical Group which functioned as exhaustion centers gave wholehearted cooperation and frequently worked for 16-18 hours a day for periods of 7-10 days on a stretch.

X. MEDICAL

A. GENERAL

1. From a study of the casualty figures from other theaters, it was estimated that approximately 30-40 % of admissions to army hospitals would be for medical causes, exclusive of N. P. cases. Fortunately, experience has shown this estimate to be too high. The total number of admissions to army hospitals for the period to 28 July was 53,991 of which 7,851 or 14.5 % were cases of disease. The table below gives, for army hospitals, the total admissions, medical admissions, and percent that were medical admissions by weeks.

(Note: Source - ETOUSA Form MD 310.)

B. OPERATION OF THE MEDICAL SERVICE

1. During the planning period prior to the operation, plans were made for the professional care of medical cases and for the use of the Medical Laboratory.

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Professional policies were established and conferences were held by the Medical Consultant with the Chiefs of the Medical Services of the evacuation and convalescent hospitals. These policies have been subsequently altered from time to time as the military situation dictated.

2. From D Day to 21 June 1944, the evacuation policy was twenty-four (24) hours. During this period, therefore, only those patients whose condition did not permit evacuation were held in the evacuation hospitals; when their condition permitted, they were evacuated to the United Kingdom.

3. On 21 June 1944, when the evacuation policy became ten (10) days, the professional policies with reference to the care of medical cases was altered in conformity therewith. Patients with short term illnesses could be kept and treated in evacuation hospitals and either returned to duty or transferred to the 4th Convalescent Hospital for a short period before return to duty. Cases of recurrent malaria were constituting a problem at this time and in order to conserve man-power “uncomplicated malaria” was defined and it was directed that such patients be treated in the evacuation hospitals and returned to duty therefrom or transferred to the 4th Convalescent Hospital. Professional policies for the handling of other medical cases were established with a view to retaining in the army area all those patients who would be fit for duty in ten (10) days. In general, this involved the defining of simple as opposed to complicated cases

4. On 24 July 1944, the 16th Field Hospital was designated as the hospital for the reception of cases of the following : uncomplicated malaria, chicken pox, mumps, measles, German measles, scarlet fever and dysentery. This centralized method of handling these cases was adopted due totlte necessity of keeping all beds possible in the evacuation hospitals for surgical casualties. Evacuation hospital commanders were made responsible for keeping in their hospitals all patients with the above diseases who were too ill to be transferred. It was also directed that all patients with meningitis, diphtheria, or pneumonia were to be held and treated in evacuation hospitals and not transported to the 16th Field Hospital in order to avoid delay in treatment and the hazards of further transportation. Professional policies, with regard to the handling of medical cases, remained as before.

5. When the 16th Field Hospital reverted to Third U. S. Army control, the 91st Medical Gas Treatment Battalion was designated to take over the functions performed by the 16th Field Hospital. One company of the battalion was designated to care for certain surgical conditions, a second company to care for cases of malaria and the third company to care for the communicable diseases. A mobile X-ray unit and laboratory chests were procured for use by the battalion and other necessary equipment, such as cots, mosquito bars, laboratory supplies, drugs, etc., were also procured. Cases of communicable disease were isolated in pyramidal tents and the unit instituted the necessary precautions and technique for the handling of such cases. Professional policies were not altered.

6. Of the 7,851 medical cases admitted to army hospitals during the period, 2,913 or 37.1 % were returned to duty.

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C. NUMBER OF REPORTABLE DISEASES

1. The following table presents the total numbers of reportable diseases for the period up to 28 July 1944 (From ETOUSA MD Form 310):

D. TREATMENT OF MALARIA

1. By far, the largest problem, medically, has been that of the treatment of malaria since it constitutes the cause of the greatest number of admissions.

a. Preventive measures. While the First U. S. Army was still in England during the winter of 1943-1944, a steadily increasing number of cases of recurrent malaria were reported from the 1st and 9th Infantry Divisions, the 2nd Armored Division, the 82nd Airborne Division and the 1st Engineer Special Brigade. All of these units had been in service in malarial regions and bad been on suppressive atabrine therapy until arrival in the U. K. The cases of malaria that occurred were all recurrent cases. With the continental operation soon to take place, it was essential that measures be taken to reduce the number of non-effectives from malaria. Accordingly, on the advice of the First U. S. Army Surgeon, the Com-

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manding General, First U. S. Army, on 19 May 1944, directed the Commanding Generals of the units mentioned above to place all personnel with a history of malaria in the past twelve (12) months on atabrine suppressive therapy. The atabrine was to be taken in doses of one-tenth (1/10) gram with the evening meal, every day except Sunday, and was to be continued indefinitely. In the table below is shown the weekly admissions to army hospitals of cases of malaria.

From the above it will be seen that, in general, the incidence of malaria increased during the period. Because of the presence of the anopheles mosquito in the area occupied by First U. S. Army, the question of new cases occurring in France from our own reservoir came up for consideration. This question was discussed with the Chief of Preventive Medicine, ETOUSA, and the Chief Medical Consultant, ETOUSA. Both expressed the opinion that there was no danger of the spread of malaria in the part of France concerned. Nonetheless, all patients with malaria were screened and were put on atabrine when returned to their units. Investigation showed that all patients who developed malaria had been in malarious regions and the vast majority were recurrent cases. A few new cases were reported. These also proved to be individuals who had been in malarious regions and on atabrine suppressive therapy while in such regions. It is believed that they became parasitized but did not develop the clinical disease because of the atabrine. Here in France, however, under combat conditions, and not on atabrine, they developed the clinical disease. The vast majority of the cases were truly recurrent. Theoretically, these recurrences should not have occurred as these individuals were ordered put on atabrine as mentioned above. A large number of these patients were interviewed and, with very few exceptions, they had not been on atabrine previous to coming down with clinical malaria. Various reasons were given by officer and enlisted patients for not taking the drug. Many of them said atabrine was not available under combat conditions when separated from their units. Others objected to the drug on the basis it disagreed with them and caused various unpleasant symptoms and, therefore, they did not take it. It is believed that there would have been few recurrent cases had all personnel with a history of malaria been provided with atabrine at all times and indoctrinated with the necessity of taking it.

b. Treatment of Malaria. On 21 June, the evacuation policy became ten (10) days and in order to conserve man-power and keep in the army area as many patients as possible, malaria was divided into two (2) groups; uncomplicated and complicated. Complicated cases of malaria were defined as

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(1) Patients with cerebral malaria.

(2) Those with a history of three (3) or more relapses who showed any of the following:

Persistently palpable spleen
Failure to regain accustomed weight
Persistent anemia
General lowering of resistance and physical status

All patients with complicated malaria were treated until transportable and then evacuated. Simple, uncomplicated cases were initially treated in the evacuation hospitals in conformity with Circular Letter No. 73, Office of the Chief Surgeon, ETO, file 710, dated 20 May 1944, with the following modifications After 7-10 days of treatment, these patients were discharged to duty (if physically fit) and therapy continued by the unit surgeon. As stated in paragraph B above, the 16th Field Hospital and later the 91st Medical Gas Treatment Battalion were designated for the treatment of uncomplicated malaria. The policy of two weeks of quinine therapy was continued, followed by atabrine suppressive therapy.

E. COMMUNICABLE DISEASES

1. The incidence of communicable diseases was surprisingly low and these diseases did not constitute a great problem. The period of contagion was redefined for each disease based on scientific data and not on custom, thereby saving many hospital days and considerable man-power. There were no epidemics during the period.

a. Diphtheria — It is doubtful whether the nine (9) cases of diphtheria reported were diphtheria. These patients all had membranes in their throat but smears and cultures were negative for C. Diphtheria. All were treated with anti-toxin and evacuated.

b. All of the twenty (20) cases of meningococcus meningitis recovered. The necessity for immediate treatment with intravenous sodium sulfadiazine in full dosage and the use of penicillin in severe infections was stressed. These factors were responsible for the recovery of all of these cases.

c. Mumps constituted a very minor problem. Patients were treated and considered contagious only as long as they were febrile and had swelling of the salivary glands.

d. Scarlet fever was treated with sulfadiazine and penicillin when necessary. The incidence was low and all patients recovered without complications.

e. The gastro-intestinal group of diseases occurred in very small numbers. The five (5) cases of bacillary dysentery were of the Sonne type. The one (1) case of amebic dysentery was a recurrence of the disease acquired elsewhere.

f. During the period of the report, only eighteen (18) cases of infectious hepatitis occurred, a surprisingly small number.

g. The few cases of primary pneumonia (28 cases) were treated with sulfadiazine and, when severe, with penicillin as well. The results were uniformly good.

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XI. DENTAL

A. PERSONNEL

1. With a very few exceptions, all units departed from the Marshalling Area with full complement of dental officers. The vacancies existing were shortly filled after arrival of units in France. Most of the dental officers accompanied their units upon landing. Dental officers in the combat zone were assigned to aid and clearing stations, rendering emergency dental treatment, and, in addition, acted as auxiliary medical officers. Some regiments had one dental officer in the combat zone, utilizing the other in the rear.

2. All the Division Dental Surgeons of the First U. S. Army were energetic, hard workers and rendered a superior service. This was also true of the dental personnel, both officers and enlisted men, assigned to the divisions. They set up their portable dental laboratories in rear echelons or in clearing stations. Some were made mobile through the ingenuity of the Division Dental Surgeon, and under trying conditions, did a remarkable amount of work in accomplishing the repair and construction of broken and lost dental prosthesis. To operate these laboratories, dental officers and men had to be withdrawn from the units they were serving.

3. Dental officers and enlisted men with some smaller units were used in capacities other than taking care of the dental needs of the command and did not render the dental service that they should have. This was especially true where the T/O did not call for a medical officer.

4. The Oral Surgeons with the evacuation hospitals were well trained and professionally qualified as such, and rendered a superior service, acting as an assistant to Plastic Surgeon in maxillo-facial cases and assumed full charge of all cases pertaining to strictly oral surgery. All these cases arrived in the United Kingdom after evacuation in excellent condition.

5. As field hospitals were utilized in First U. S. Army, it was a waste of manpower to have three dental officers assigned to each hospital. There was no dental service since these units were used as surgical hospitals adjacent to division clearing stations for operation of non-transportable wounded. Many of these dental officers were utilized on temporary duty status for dental work in other units.

B. TREATMENT

1. The Mobile Dental Laboratories, three in number, came over with the 4th Convalescent Hospital. There was no assigned personnel and the units functioned until arrival of the Army Dental Surgeon, with such personnel as the senior dental officer of the 4th Convalescent Hospital could assign from units that were attached to that hospital. Four (4) dental officers were assigned on temporary duty status from the 134th Medical Group. Two Mobile Dental Laboratories, with assigned personnel, were also borrowed from Third U. S. Army. Personnel for Mobile Dental Laboratories, three officers and nine enlisted men, were procured by requisition on Headquarters European Theater of Operations, and reported the latter part of July.

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2. The 4th Convalescent Hospital was used as a Dental Center. Officers and enlisted men were assigned on a temporary duty status to care for both patients and outpatients. At no time was there sufficient dental personnel assigned to take care of the backlog. The T/O for the 4th Convalescent Hospital only called for four (4) dental officers, whereas a complete dental service was required. A great amount of dental work may be accomplished in this type of unit on patients scheduled for early return to duty within the army.

XII. VENEREAL DISEASES

A. GENERAL

1. The venereal disease rate of the First U. S. Army for the month of June, 1944, was 8.5 per thousand per annum. The total number of venereal disease cases was two hundred and ninety-four (294), of which fifty-six (56) were primary syphilis ; two hundred and twenty-nine (229) new gonorrhea; and nine (9) chancroid. Two hundred and seventy-five (275) of the total number of cases were in white troops and nineteen (19) were in colored troops. The total number of days lost from duty was 1, 862. A large percentage of the new cases occurring in France were contracted while in the United Kingdom but symptoms did not appear until the patient arrived on the continent.

2. The venereal rate for the month of July, 1944, was 4.2 per thousand per annum. The total number of cases was one hundred and four (104), of which twenty-seven (27) were new syphilis; seventy-five (75) new gonorrhea; and two (2) were chancroid. The total number of days lost from duty was three hundred and eighty-five (385). Eleven (11) of the total number of cases were in colored troops.

B. TREATMENT

1. The great majority of patients with gonorrhea were treated on a duty status, with sulfadiazine. Prior to 28 June 1944, patients with sulfonamide resistant gonorrhea were admitted to evacuation hospitals for diagnosis and treatment. After 28 June, the 4th Convalescent Hospital received all venereal cases. A total dosage of 100,000 units of penicillin was administered intramuscularly to each patient with gonorrhea. Approximately one hundred and sixteen (116) patients were given a total of 11,600,000 units of penicillin. Two (2) patients who failed to respond to penicillin therapy were evacuated to the United Kingdom for further treatment. Both of these patients had previously received penicillin in the United Kingdom for gonorrhea contracted in that country. There were no treatment reactions from the drug.

2. Patients with early syphilis were also diagnosed and treated in evacuation hospitals and, after 28 June, in the 4th Convalescent Hospital. In compliance with Circular Letter No. 86, Office of the Chief Surgeon, European Theater of Operations, United States Army, dated 22 June 1944, each patient received a total dosage of 2,400,000 units of penicillin administered intramuscularly, with 40,000 units being given every three (3) hours for a total of sixty (60) doses. No additional therapy was given. Eighty-eight (88) patients with early syphilis completed penicillin therapy, having received a total dosage of 196,000,000 units.

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There were no treatment reactions from the drug. Luetic lesions completely epithelialized in 5-6 days and became dark field negative in 12-14 hours.

3. The venereal disease section of the 4th Convalescent Hospital was placed in operation on 28 June 1944. The base section of the 10th Medical Laboratory was established adjacent to this section which permitted smears, darkfield examinations and serological tests to be performed expeditiously. Patients with sulfonamide-resistant gonorrhea had an average hospitalization period of three (3) days and those with early syphilis were hospitalized for 8-9 days.

C. PREVENTIVE MEASURES

1. Prophylactic stations for army troops were established in the following towns: Isigny, Grandcamp, Trevieres, Cherbourg (3 stations), Balleroy (Operated by V Corps), La Mine (Operated by V Corps), Carteret, Barneville. Though all towns were off limits, stations were set up in towns whenever it was thought that the civilian venereal disease situation necessitated a station for the protection of static personnel and stragglers. Mechanical and chemical prophylactics were made available at each prophylactic station. All dispensaries had prophylactic stations.

2. Sixty (60) venereal disease control motto signs were posted on various roadways outside of towns in the army area.

3. Full use was made of off limits authority in relation to houses of prostitution. Up to the end of the period under review, the only brothels found in operation in First U. S. Army territory were in Cherbourg. All were placed off limits to all military personnel and this was enforced by posting off limit signs on the houses and stationing military police at all entrances to the brothels.

4. During the period of this report, eighteen (18) cases of venereal disease were contracted in France. The majority of these were interviewed by the Army Venereal Disease Control Officer in order to obtain pertinent data in regard to the source of infection. Epidemiological investigation resulted in three (3) prostitutes being found and interned for examination and treatment.

5. An attempt was made to learn the venereal disease problems prevailing in the various localities in the army area. The Civil Affairs officers of all town detachments were contacted. A list of names, addresses and pictures of many suspected and registered prostitutes were obtained and filed at the Venereal Disease Section of the 4th Convalescent Hospital. This information was used to help the infected soldier furnish sufficient data to trace the source of contact. French doctors were interviewed in order to ascertain the civilian venereal disease situation. The Public Health Officer in the Army Civil Affairs Office also gave his full co-operation in this regard.

6. Frequent visits to various towns were made with the vice control officer of the Army Provost Marshal's Office.

7. An arrangement was made with the Army Quartermaster to issue mechanical and chemical prophylactics at Class I railheads on a regular allowance.

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D. SUMMARY

1. The treatment of venereal disease has reached a point where the patient is cured in a minimum of time. Failure cases are practically non-existent. Patients with syphilis under penicillin therapy do not get reactions as often as occurs with the use of arsenicals.

2. The venereal disease rate was much lower than expected. This was probably due to the following factors in order of importance:

(1) The tactical situation.
(2) All towns were off limits.
(3) Civilians were scarce in areas occupied by troops.
(4) Chemical and mechanical prophylactic material was readily available.
(5) Education in regard to personal protection.

XIII. SURGICAL

A. ORGANIZATION AND PROFESSIONAL POLICIES

1. In the organization of the Surgical Service of the First United States Army, full advantage was taken of experience gained by units and individuals that had served in the African and Sicilian campaigns. A careful study of North African Theatre of Operations, United States Army, directives and information secured by a visit of the Executive Officer, Army Surgeon's Office, to the Italian Theater, were valuable guides in formulating the professional policies.

2. The principles of treatment, surgical procedures and techniques prescribed or recommended were incorporated in the Manual of Therapy ETO, 5 May 1944.

3. Each medical unit was equipped and staffed for its designed function in relation to the basic policy that only primary aid would be rendered by aid stations, collecting companies, and clearing stations with definitive treatment restricted to field and evacuation hospitals. Exceptions to this general policy were contemplated and allowed for the landing phase of an amphibious operation and for operations of the airborne units.

B. MANAGEMENT OF BATTLE CASUALTIES DURING THE ASSAULT PHASE

1. Glider Landings.

a. The earliest surgical treatment during the invasion was rendered by the medical personnel of the airborne medical companies and two surgical teams from the 3rd Auxiliary Surgical Group who accompanied the glider assault wave of airborne operations. The mission was to establish aid stations on the fields of the landing zone and to set up an operating room for major surgical procedures. A report of the activities of one of these teams reveals that the aid stations were in operation by H + 1, and that the operating room was functioning by H + 3.

b. The experiences of these surgical teams demonstrate that it is possible and advisable for surgical teams to accompany an assault wave of an airborne operation. By this means, facilities for major surgery are provided at the earliest hour and maintained until casualties can be evacuated through routine channels.

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2. Beach Landings.

a. Eighteen (18) surgical teams accompanied the medical battalions of the Engineer Special Brigades on the beach landings. They assisted the battalion medical personnel in rendering primary aid to casualties until the beach was cleared of wounded; established and operated aid stations ; and gave definitive surgical treatment to non-transportable cases after operating rooms bad been set up in tents. The first surgical teams arrived on the beach at various times from H + 4 hours to D + 1 (7 June).

b. The first major operation was performed at approximately H + 10 hours on Utah Beach. On Omaha Beach, major definitive surgery was not begun until D + 1. By the afternoon of D + 2, definitive surgery was being done extensively on both beaches. The following tables show the number and disposition of the cases handled by two surgical teams and the medical personnel of Company C of the 261st Medical Battalion

DISPOSITION OF CASES

c. All available surgical teams continued to operate in clearing stations until operating facilities were available in field hospitals.

d. As a test, definitive surgery was ordered for all admissions to one Collecto-Clearing company until it became apparent that the number of casualties being received each twenty-four (24) hours continued to exceed the capacity of the operating room.

e. In general, early surgical care of casualties on the beach was governed by the tactical situation. Adequate operating room and hospital facilities were provided as soon as enemy resistance permitted the landing of personnel and equipment and the selection of a site for hospitals. Adequate post-operative care was difficult until hospitals were established.

f. In future operations, it would seem advisable that the surgical care of battle casualties during the first twenty-four hours to forty-eight hours of an amphibious operation should be restricted to the preparation of patients for evacuation. No attempt should be made to render definitive treatment to any patient who can, by primary aid measures, be rendered transportable.

C. SURGERY IN FIELD HOSPITALS

1. As soon as field hospitals were established, major surgical procedures were discontinued in the clearing stations of the amphibious battalions. His shift of definitive surgery occurred on D + 5 with the exception that one (1) surgical team remained at the holding unit on each beach. These two teams continued to operate on patients arriving in holding units who had developed complications and on casualties occurring on the beach area.

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2. The arrival of the nurses on D + 4 and D + 5 afforded a welcome contribution to the efficiency of the operating room as well as to the quality of postoperative care.

3. At first, field hospitals functioned as evacuation hospitals instead of receiving and treating only the non-transportable cases.

4. The bulk of non-transportable cases consisted of abdominal, thoracoabdominal and major chest injuries. Non transportable patients with extremity wounds were comparatively few and comprised only those with multiple or extensive wounds associated with profound shock or active bleeding which did not respond to such shock control measures as the clearing stations could provide.

5. The employment of field hospitals in separate hospitalization units (platoons) sited adjacent to division clearing stations and moving with the clearing stations provided early and adequate care for non-transportable cases so long as only two platoons were active. When all three platoons of a field hospital were active at the same time or when a division moved forward so rapidly that a change of station occurred every few days, the system broke down because professional care and housekeeping personnel and equipment had to be left behind each time to care for the non-transportable post-operative patients. The assigned personnel of a field hospital is numerically inadequate when the hospital is functioning in platoons and the personnel is working on a twelve hour shift of duty. At least two additional officers and four additional nurses per hospitalization unit should be added to the T/O.

6. Experienced surgical teams from auxiliary groups provided the professional care of patients in field hospitals. The following statistical report shows the number and type of wounds treated by one general surgical team when attached to an amphibious battalion, a field hospital and an evacuation hospital:

7. The value of the field hospital when utilized to care for non-transportable cases is more definitely recognized when an evacuation hospital is in operation without a field hospital between it and the division clearing station. Under these conditions, the evacuation hospital receives non-transportable cases in such numbers that it is unable to give definitive treatment to a large number of casualties until the time consuming abdominal and chest cases have received definitive treatment.

8. The policy of siting platoons of field hospitals close to the front lines and adjacent to the division clearing stations is to be commended and should be continued. It saved many lives since severely wounded patients would not survive transportation to the rear. The mortality rate for surgery in field hospitals will be higher when the hospital is close to the front line in view of the fact that cases are admitted who would have died enroute to a hospital further to the rear.

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D. SURGERY IN EVACUATION HOSPITALS

1. Evacuation hospitals were sited well forward and when moved to new locations, were set up as close to the front lines as safety would permit. Consequently, battle casualties reached evacuation hospitals in surprisingly short time after being wounded. For example, one hospital received casualties on the average of four (4) hours after injury for a period of ten (10) days. During the same period, 80 % of the surgical cases admitted to this hospital were on the operating table in the first twenty (20) hours after admission.

2. The outstanding problem of surgery in evacuation hospitals was the size of the “surgical backlog” , i.e., the number of cases awaiting operation. On the beach and subsequently during each drive it was not uncommon for evacuation hospitals to have 200, occasionally 300, cases awaiting surgery. This situation was met by the addition of surgical teams from auxiliary surgical groups and ward officers and nurses from other hospitals. Mobile surgical and x-ray units augmented the surgical facilities of the hospital. When such measures failed to cope with the situation, a policy for evacuation of the lightly wounded without definitive treatment was invoked. Under such a policy from 15 % to 35 % of the patients could be so evacuated depending upon the type of casualties being received at the time.

3. The influence of the admission rate on the morbidity and mortality of a hospital is definite.

a. When 300 to 500 patients are admitted to a 400 bed evacuation hospital during a 24 hour period, it requires approximately three days to complete definitive surgery. The capacity of the operating room can be increased by the addition of surgical teams but the operative turnover is governed by other factors such as the number of operating tables available, and the percentage of severe injuries.

b. It is difficult to take patients recovering from shock to the operating room at the optimum time and some of these patients slip back into irreversible shock.

c. Gas gangrene develops in wounds that are not debrided early.

d. Pre- and post-operative care is not maintained at the highest level.

e. All facilities are taxed to the utmost and the hospital does not function as smoothly as during periods of normal activity.

4. Various control measures were instituted to solve problems of the surgical backlog. These measures served as temporary expedients to meet the current situation. Obviously, no control can be established over the number of casualties inflicted by the enemy. To increase the number of evacuation hospitals supporting each division would involve an unnecessary increase in the number of available beds and accessory equipment.

5. From a professional point of view the solution of the problem would be to increase the staff of a 400 bed evacuation hospital to approximately that of a 750 bed evacuation hospital. Such additional personnel would make the evacuation hospital independent of surgical teams and assistance from personnel of other units. The number of beds need not be increased over 400 because the large percentage of casualties admitted to evacuation hospitals can be evacuated within 24 hours after definitive treatment has been administered.

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6. In support of this recommendation, attention is directed to the fact that the 750 bed evacuation hospital assigned to First Army functioned without the assistance of surgical teams except for a few days when one three man team was attached without request and after two of the hospital̓s assigned officers had been sent to a division. On the other hand, rarely was a 400 bed evacuation hospital active for more than twenty four hours without attached surgical teams. The maximum number of surgical teams attached to an evacuation hospital at one time was eight. Often six were attached ; usually three or four teams were required.

E. MOBILE SURGICAL UNITS

1. At the time of the invasion, the Third Auxiliary Surgical Group was equipped with two (2) trucks, surgical, operating, and three (3) Proco Surgical Units.

2. The mobile surgical units landed on D + 22. On 29 June (D + 23), the first unit (a truck, operating, surgical) was set up with an evacuation hospital. From then on, both types of unit were in operational employment, chiefly with evacuation hospitals. Of three (3) units sent to field hospitals, only one (1), a truck, operating, surgical, was utilized by this type of hospital.

3. The operational employment of both types of mobile units was identical.

a. The practical value of the unit in augmenting the operating room facilities of an evacuation hospital is established. The unit provides additional self sustained two table operating rooms which may be utilized for all types of surgery or only for a special type of surgery, such as neuro-surgical, maxillofacial, or orthopedic cases. Little or no additional burden is put on the central supply of the hospital since the unit has its own autoclaves, instruments, gloves and surgical linens.

b. The mobile unit was less extensively employed by the field hospital which had two table operating rooms with each hospitalization unit.

c. The mobile unit should not be employed for definitive surgery forward of a field hospital unless provision is made for post-operative care of all patients until they have been made transportable.

F. MOBILE X-RAY UNITS

1. Three mobile X-Ray units, attached to the 3rd Auxiliary Surgical Group, functioned with evacuation hospitals under the operative direction of the Army Surgeon.

2. The first unit was set up on 29 June 1944. The other two units went into operation on 5 July 1944 and 12 July 1944, respectively.

3. The Mobile X-Ray unit demonstrated its usefulness in augmenting the X-Ray facilities of evacuation hospitals.

a. Without the assistance of a mobile X-Ray unit, the hospital X-Ray personnel were over taxed when the hospital continued to receive large numbers of casualties.

b. Not infrequently, a bottleneck developed in X-Ray when there was a large influx of casualties shortly after the evacuation hospital opens in a new location. A mobile X-Ray unit relieved this situation.

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G. TRANSFUSIONS

1. There was always a plentiful supply of plasma. It was used in a ration of approximately three (3) units to one bottle of blood but it is not a substitute for blood.

2. Blood for transfusions was supplied by the ETO blood bank supplemented by the blood banks operated by evacuation hospitals and fresh blood obtained from non-combat troops and the lightly wounded.

3. Unfortunately, the major problem in the surgical care of battle casualties developed on the beach in connection with the transfusion of blood. The rate of flow of blood through the apparatus supplied was too slow to permit resuscitation of an exsanguinated patient. Under air pressure, the flow was still unsatisfactory. To overcome the difficulty, it was necessary to transfer the blood to a salvarsan tube. Subsequently, a new filter and larger needles were supplied so that blood could be delivered at a more desirable speed.

4. Blood was always a critical item but there was no shortage during the first two weeks of the invasion when an average of 500 pints, daily, was supplied by the ETO blood bank.

5. The number of severe reactions to blood transfusions was negligible.

6. A comment by the leader of one of the 3rd Auxiliary Surgical teams reflects the universal opinion about the value of blood, “In this campaign we believe the greatest single blessing from the medical point of view has been the availability of blood bank blood. In contrast to the African and Sicilian campaigns, we are now being able to operate upon and save patients that could never have survived on plasma alone".

H. PENICILLIN

1. Penicillin therapy was carried out according to the directions incorporated in Medical News No. 6, Office of the Surgeon, First U. S. Army, 13 May 1944.

2. The supply of penicillin was inadequate for approximately two weeks beginning about 14 June. At this time its local use in wounds was discontinued. Subsequently, the administration of penicillin in clearing stations was interrupted until an adequate supply was again available.

3. No statistical data can be obtained at this writing concerning the value of penicillin therapy. The impression is that it was of definite value in minimizing wound infection. It did not prevent the development of gas gangrene, but penicillin and antitoxin were very effective in controlling the toxemia and spread of infection.

I. FORWARD SURGERY

1. The Manual of Therapy, ETO, 5 May 1944, met all expectations in providing the basic principles for surgical procedures. However, it was necessary to issue other directives in the Medical News in order to clarify or elaborate certain procedures or techniques as well as to emphasize policies that are clearly stated in the Manual.

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2. Departures from policy were, in most instances, attributable to personal preference and to the difficulty of teaching surgeons to do what is known to be safest rather than what the individual surgeon considers best. The discrepancies most frequently observed were

a. Failure to split plaster casts to the skin.

b. Improperly applied plaster.

c. Reluctance to use retention sutures in closure of abdominal wounds.

d. Delay in opening colostomies.

e. Tendency to plug wounds with vaseline gauze.

f. Too early evacuation of post-operative cases.

3. A conservative attitude was followed concerning amputations and discimination exercised in the differential diagnosis of gas gangrene.

4. It was difficult to establish a policy incorporating definite indications for the removal of foreign bodies in the chest and aspiration of hemothorax. In general, a conservative attitude was followed.

5. Personal visits and letters from the ETO Consultants, Office of the Chief Surgeon, were valuable in supplying information concerning the condition of casualties upon arrival in the United Kingdom. The cooperative spirit and the constructive suggestions of the ETO Surgical Consultants is acknowledged with appreciation. It was a contribution to the persistent endeavor to improve forward surgery.

XIV. VETERINARY

A. PERSONNEL

1. Of the nine Veterinary Officers remaining with units of this command, seven were brought into France at the beginning of operations. Officers with the 82nd and 101st Airborne Divisions were left in the United Kingdom.

B. TYPE OF SERVICES RENDERED

1. Food Inspection.

a. During the initial phases of operations, army Class I dumps were established at the Omaha and Utah Beaches. Only “ C “ and “K” rations were received for issue to the hospitals. A considerable portion of the “25 in 1" supplement required overhauling due to damage sustained. This ration, consisting largely of fruit juices and canned milk, was not properly packed for such an operation. Later, “10 in 1" rations were received, followed by “B” rations and finally by “A” rations.

b. As the troops pushed inland, truckheads were established to supply troops in forward areas. Two Veterinary Officers and two enlisted men, MD VS, were assigned to inspect supplies at army depots and truckheads. Veterinary Officers, with divisions, checked food supplies at their breakdown points. Laboratory facilities were available at the 10th Medical Field Laboratory for checking questionable supplies. In addition the above mentioned rations, enemy food stores including fresh chilled beef, frozen pork sides, fresh butter, cervelat style sausage, frozen fish fillets and a large variety of canned and dehydrated foods,

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were uncovered at Cherbourg. A considerable quantity of these supplies were inspected by Veterinary Officers of this command and issued to troops. The balance was to be salvaged by Advance Section, Communications Zone, who took over immediately from army. They had no Veterinary Officer with them and the balance of the perishable items were allowed to deteriorate. Some units purchased cattle to provide fresh meat for their troops. These cattle were slaughtered under the supervision of army Veterinary personnel. In addition, some wounded livestock was salvaged for food under Veterinary inspection. The question of purchasing dairy products was brought up, but after a thorough investigation, it was recommended that no purchases of such products be authorized for the following reasons

a. Cattle were not routinely tested for TB. Civilian authorities claimed incidence of this disease in cattle of the Normandy area to be very low, but stated that the incidence of Brucellosis (Disease producing Undulant Fever in man) to be very high.

b. Milk was not routinely pasteurized in creameries or dairy plants. Only cream to be used for butter was so treated.

c. Equipment in most dairy plants inspected was found to be in a poor state of repair.

d. Due to heavy traffic on highways and lack of civilian transportation, only about 2 5-30 % of milk produced on farms was being delivered to dairy plants. The balance was processed into butter and cheese on the farms under varying sanitary conditions.

2. Civil Affairs Work.

a. Veterinary Officers frequently were requested by G-5 Sections of this command to treat wounded civilian livestock. A large number of such animals were treated by our personnel. Due to the fact that good dairy cows were valued at $450 to $500 and good draft type horses valued up to about $1000, this service was greatly appreciated by owners of such livestock. Veterinary Officers were handicapped in this work by lack of proper equipnient: Veterinary Chests No. 80 and 81 were set up during planning for this operation, but had not arrived on the continent by 1 August. The Army Veterinarian assisted the G-5 Section of this headquarters in procuring drugs, instruments, and biologicals required by civilian veterinarians to reestablish their practices. In each case the veterinarian was investigated to determine whether he was properly licensed by the French Republic before supplies were furnished. To 1 August, there were no Outbreaks of diseases such as Anthrax, Blackleg, etc., reported in local livestock. It was recommended to G-5 Section, this headquarters, during pre-invasion planning period, that they include a Veterinary Subsection in their section. The recommendation was not favorably considered by them. The G-5 Section of this Headquarters finally requested the assignment of one (1) Major, VC, one (1) Staff Sergeant, MD VS, and one (1) Technician 5th MD VS.

3. Captured Livestock.

a. It was recommended to G-4 and the Quartermaster, this headquarters, that all horses and cattle captured from the enemy be concentrated in specified areas for processing and identification before being released to civilians through Civil Affairs town detachments.

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4. Service for Army Sentry Dogs.

a. On 1 August there were a total of forty-six Army Sentry Dogs assigned to units of this command. Veterinary Officers inspected these dogs at frequent intervals and units with such animals were informed where Veterinary Officers could be contacted in case emergency treatment was required. Arrangements were made with the Army Quartermaster for the issue of proper rations for these dogs. Veterinary Officers with the 9th Air Force Service Command ware very cooperative in providing service for units with Sentry Dogs located near their installations. Service was also provided by Veterinary Oficers of this command for privately owned and organizational mascots. A program was started to vaccinate all such dogs against rabies. All Sentry Dogs were vaccinated prior to their departure from the United Kingdom.

XV. NURSING

A. PLANNING

The three months previous to 6 June 1944 was a period of intensive training for First Army nurses. Three conferences were held to acquaint Chief Nurses and operating room supervisors with First Army policies and directives, and the importance of adequate supplies and the necessity for teaching enlisted men.

1. Supplies A mimeographed copy of the minimum amount of sterile supplies to be available for initial operations was given to each operating supervisor. Classes for enlisted men were held in each hospital, emphasizing sterile technic and preparation of sterile supplies. The 13th Field Hospital was situated close to the 91st Medical Gas Treatment Battalion. These two organizations exchanged personnel for instructional purposes. The instruction in nursing care and preparation of supplies received by the 91st Medical Gas Treatment Battalion was fully utilized as this unit functioned as a communicable disease hospital.

2. 3rd Auxiliary Surgical Group: The nurses of the 3rd Auxiliary Surgical Group devoted their time to the field hospitals to which they were to be attached making supplies, sewing, aiding in the teaching of enlisted men and in general, familiarizing themselves with this type of organization, The plan, devised by the Chief Nurse of the 3rd Auxiliary Surgical Group, for the utilization of surgical group nurses contributed immeasurably to the efficiency of First Army field hospitals. She determined, by personal observation and examination, which nurses were qualified operating supervisors. These nurses, with three others, were placed in each platoon of a field hospital and were charged with the responsibility of the operating room and central supply room, thus permitting the six field hospital platoon nurses to be responsible for patient care.

3. Equipment Conferences were held with the ETO Quartermaster and the Army Quartermaster regarding clothing and nurses supplies. In addition to the normal issue of nurses clothing, each nurse was issued a combat jacket and trousers, and one pair of arctic overshoes. Maintenance units of nurses clothing were set up to arrive with each specified number of normal troop maintenance units. Post exchange items such as kleenex, powder were provided for in the prior planning.

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4. Courses of Instruction: Short courses for selected nurses were given in anesthesia, operating room, central supply, field transfusion set, narcosis and diet at general and station hospitals throughout the United Kingdom. One hundred and ninety-one First Army nurses attended these courses.

5. Personnel: Hospital commanders were notified of the availability of physically fit and professionally qualified nurses to replace those in the First Army units not entirely fit for field duty. All together, ninety-five nurses were replaced. These replacements gave each evacuation hospital a minimum of one graduate nurse anesthetist and ten qualified operating room nurses. Those nurses in First Army units who did not wish field duty were given an opportunity to request a transfer.

Knowing the difficulty in obtaining nurse replacements in North Africa and the inadequacy of field and evacuation hospitals in nursing personnel, permission was requested from the Assistant Chief of Staff, G-1, First United States Army, to allow each unit one nurse over T/O strength and also to have a pool of ten nurses in the army area. This permission was not granted. Frequent conferences were held with the First Army Adjutant General Classification Section, the Field Force Replacement System and the Personnel Division of the Office of the Chief Surgeon, European Theater of Operations, to determine the most expeditious method of obtaining nurse replacements. A pool of fifteen nurses, fully equipped, and attached to the Field Force Replacement System was established at a hospital in Southern Base Section. This pool functioned efficiently for units under strength before embarkation to France. However, it was not effective for the prompt replacement of nurse personnel in France.

By 1 June, the nurses in First Army units were ready for duty in a combat zone. The days spent in classes, physical conditioning, and dry runs were to bring superior results.

B. OPERATIONS

1. Arrival of Nurses in France: At 1530 hours on 10 June 1944, the 45th Field Hospital nurses and 128th Evacuation Hospital nurses arrived on Utah Beach, and at 1600 hours, nurses of the 42nd Field Hospital and 91st Evacuation Hospital arrived on the same beach. Nurses of the 45th Field Hospital were the First Army nurses to do duty in France. The first nurses to arrive on Omaha Beach, those of the 51st Field Hospital, disembarked 2300 hours, 11 June 1944. They walked from the beach to one of the hospital units of the 51st Field Hospital situated alongside an air strip on the promontory overlooking the beach. Medical officers and enlisted men in these field hospitals which had been functioning since 9 June, were overjoyed to see their unit nurses. The technicians had been doing superior work. Nevertheless, the professional orderliness apparent when nurses are present, was lacking and it was only a few hours until these field hospitals assumed the appearance of efficiency and organization noted in a unit having nurse personnel. These field hospitals had been functioning entirely on sterile supplies prepared and packed in the United Kingdom. The time and effort devoted to this phase of planning had paid dividends.

2. Nursing Service: The nurses were tireless in their efforts to provide essential nursing care to such a large number of casualties. As the wards became

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better organized and the nurses became more accustomed to working under constant and increasing pressure, more nursing care was given. The nurses on duty in the Central Supply Room did a magnificent job. This department is the pivot around which the eventual efficiency of the operating room and wards revolves. in no instance did a central supply room fall short of the mission it had to perform. The nurses exercised great ingenuity in creating and improvising equipment to facilitate a more efficient service.

3. Personnel: During the period from 7 June to 28 July, thirteen nurses were lost to the army through illness. The first replacements, eight in number, arrived 14 July. The replacement system did function to the greatest efficiency in so far as nurses were concerned.

4. Uniforms: The herringbone twill uniform proved to be a satisfactory duty uniform under certain conditions. It is too heavy to wear in hot weather, particularly in the operating room and central supply room. in these departments, the brown and white seersucker can be worn effectively. The brown and white seersucker dress, however, because of the design, is totally impractical for ward duty in army units where cots are used exclusively. The brown and white seersucker slacks leave much to be desired so far as the professional appearance of the army nurse is concerned and were therefore not worn in the First United States Army.

The wearing of leggings presented another problem. Many instances of dermatitis, provoked varicosities and swelling of soft tissues resulted from the constant wearing of leggings. A request was submitted and approved for obtaining British type leggings. Nurses complained of the lack of support in the women’s field shoes. Most of the nurses preferred the Munson last field shoes for support and comfort. Paratrooper boots were made available but because of the men̓s size tariff, many nurses were unable to be fitted in this type shoe.

There still remains much to be desired in so far as an appropriate and practical field uniform for nurses is concerned. The nurse in a field army has no suitable uniform to wear for anything but duty hours. The woolen battle dress, with slacks would fill a long felt and much needed requirement.

5. Return of German Nurses: On 2 July, nine (9) German nurses arrived at the 45th Evacuation Hospital. These nurses were to be returned to the German lines. They did not know until after their arrival at this hospital they were to be returned. Needless to say, they were overjoyed. These nurses were well fed but were not in complete uniform. However, their clothing was of good quality. All wore the Nazi Ribbon for meritorious service which they very proudly displayed.

The Commanding Officer escorted the nurses through the hospital. They had an opportunity to observe supplies and equipment and talk to German patients and prisoners. They were most curious about the care and treatment given German patients and prisoners in England. They also expressed amazement at the size and amount of equipment and supplies.

After seeing the hospital, the nurses were transported in a closed ambulance to Balleroy. Here, there was a wait of approximately two (2) hours while final arrangements were being made with the German officers to whom they were to be returned. At approximately 1800 hours they were taken through the lines at Caumont.

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C. REMARKS

1. Too much emphasis cannot be placed upon the insufficiency of nurse personnel in field and evacuation hospitals. First Army field hospitals attained their effectiveness and efficiency through the judicious placement of 2nd Auxiliary Surgical Group nurses. It would have been a physical impossibility for nurses of the field hospitals to cope with the operative patient load carried by these units. As the field hospital was employed by the First Army, each platoon should have had fourteen (14) nurses. The four hundred bed evacuation hospital should have had a nurse strength of fifty-eight in order that nurses should not have been required to do duty for more than eight (8) consecutive hours. The seven hundred and fifty (750) bed evacuation hospital should have had seventy-five nurses for the efficient and adequate management of the nursing services. There should have been nurse personnel in the army convalescent hospital for supervisory purposes.

2. The woolen battle dress should be made available for army nurses in the field.

3. Nurse replacements in field and evacuation hospitals should be furnished within twenty-four to forty-eight hours.

XVI. PERSONNEL

A. GENERAL

1. All First U. S. Army medical units, with few exceptions, arrived on the continent at T/O strength. However, by 22 June, it was necessary to request forty-six Medical Corps replacements. These replacements were obtained from Communications Zone station and general hospitals and replacement battalions in the United Kingdom. The first of these replacements commenced to arrive on the continent on 24 June, forty-eight hours after the requisition was submitted, and continued to arrive until the 30th of June. Upon arrival on the continent, these replacements were reassigned to corps and by corps to divisions.

2. On 15 July, a tour of divisions and corps revealed a shortage of twenty-eight Medical Corps officers. Inasmuch as no replacements were available, each 400 bed evacuation hospital was asked to designate two Medical Corps officers to be reassigned to divisions; the 750 bed evacuation hospital was asked to designate four Medical Corps officers for reassignment. The replacement of these officers was effected within twenty-four hours, transportation being furnished by Division Surgeons.

3. A request for forty-seven Medical Corps officer replacements was submitted on 20 July, together with a request for the establishment of a pool of one hundred Medical Corps officers. This requisition for forty-seven replacements was reduced to thirty-nine. As of 31 July 1944, these replacements had still not arrived. The request for the pool of 100 Medical Corps officers was disapproved.

4. Division Surgeons were requested to furnish this office the names of Medical Corps officers who had been subjected to prolonged periods of combat duty, and who, although not yet classed as combat exhaustion cases, had shown symptoms of combat exhaustion. These officers were reassigned to the evacuation hospitals and without exception responded well.

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5. During the period, forty-nine Medical Administrative Corps officer replacements arrived on the continent for the First U. S. Army. Under the provisions of WD Circular No. 99, as amended by WD Circular No. 108, these MAC officers were reassigned to units to replace Medical Corps officers who had been performing administrative duties. This procedure relieved Medical Corps officers for further reassignment, and relieved to some extent the shortage of Medical Corps officers.

6. The problem of providing replacements through the normal replacement system proved to be entirely unsatisfactory. Required Medical Corps officers were not in replacement battalions and depots, and the period of time necessary for forwarding requisitions to the United Kingdom made it impracticable to depend upon this source.

XVII. STATISTICS

A. GENERAL

1. This section of the report is intended primarily to provide factual and quantitative data regarding the medical phase of operations of the First U. S. Army in the invasion of Northwestern Europe from D Day to D + 55 (6 June thru 31 July 1944). Tabular and graphic material are included which provide information as to the number and rates of battle casualties, the incidence of disease and non-battle injuries, the numbers and proportion of combat exhaustion cases, evacuations to the United Kingdom, admissions and dispositions reported by First U. S. Army medical installations, bed status of army hospitals and so forth.

2. In First U. S. Army the approach to the problem of securing complete, accurate, and prompt medical reports was based on a two-fold objective: first, to secure daily and with the absolute minimum of delay the essential facts regarding the current medical situation which were needed to effect the most efficient disposition and employment of medical units and personnel and thereby to provide the best possible care and treatment of the sick and wounded of this command; second, to insure that the more detailed and comprehensive reports covering longer periods of time were received, consolidated, tabulated and analysed in order that all of the factors which comprise the medical situation could be seen in their proper perspective and proportion and could be used for long range planning of succeeding phases of the campaign and of subsequent campaigns.

3. As may be seen from the foregoing, the primary concern was for the operational rather than the historical aspect of medical reporting but it was felt that in so placing the emphasis both purposes were really served. The historical validity of military medical statistics lies in their future actual and potential military usefulness.

B. PLANNING

1. During the months in England preceding the operational phase of this campaign, extensive and detailed plans were made and a program of training and familiarization for records personnel was devised and carried out. Since

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the reports and records required by War Department and Theater directives and by Army Regulations do not fully satisfy the requirements of a field army under combat conditions, reports to fill this need were designed. All information available regarding experiences in the North African, Sicilian and Italian operations was obtained. After due consideration three new report forms were proposed and were approved by the Office of the Chief Surgeon, European Theater of Operations, in fact these same reports: the Combat Medical Statistical Report (ETOUSA MD Form 323), the Daily Admission and Disposition Report (ETOUSA MD Form 324a) and the Monthly Classification of Wounded Report have since been adopted for use by the other armies operating in this Theater. Meetings and conferences were held at which personnel from the Division Surgeons' Offices and Registrar's Offices of the hospitals and other medical installations were informed and instructed in the plans, policies and detailed procedures of medical reporting in the forth-coming operation. The fact that this was time and effort well spent was demonstrated in the comparative smoothness with which the reporting system functioned during the difficult period of the initial phases of the invasion.

C. OPERATIONS

1. It was decided that a part of the Statistical Section of the Army Surgeon’s Office should land on D + 1 to insure that in the critical days of initial operation of the combat reporting system, supervision would be available and a source of information would be at hand to answer the inevitable questions that would arise when new reports were being submitted under somewhat strange and difficult conditions. It is felt that this decision was a sound one for although the statistical group did not actually come ashore until D + 2, the work that was done in the first few days in collecting erroneous procedures, explaining the reasons for certain practices and establishing a close liaison with the persons responsible for the preparation of the reports undoubtedly saved many weeks of correspondence and contacts which would have been required to begin at a later date to solve the problems that could not have been foreseen and to secure corrections on reports made necessary by minor misconceptions so easily corrected when caught early.

D. TABLES AND CHARTS

1. The tables and charts contained in Appendices 5-34 inclusive, have been prepared to show the important facts and situations relative to the medico-military experiences in this campaign for the period covered by this report.

XVIII. SUMMARY

A study of the foregoing sections shows the problems arising within the various subsections of the Surgeon's Office and the means by which these problems have been solved.

In general, it is felt that the planning for the operation "Neptune" was basically sound. Recommended changes for future operations have been included in the appropriate sections.

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Again in this operation, as in previous landing operations, the Medical Battalion, Engineer Special Brigade, proved to. be an essential part of the task force. This unit, augmented with surgical teams and certain items of equipment as shown in the supply section, is capable of receiving all casualties from the combat troops, preparing such casualties for evacuation, holding and treating the non-transportables, and placing evacuables at the high water mark for evacuation. The organization should have a landing priority just ahead of the division clearing station and should be landed not later than H + 3 or 4 hours.

Combined training with the Navy Medical Department is a must. Too much cannot be said about the part which the Navy played in the early days of the landing operation.

The division Medical Service functioned normally. In times of even moderately heavy casualties, there proved to be an insufficient number of litter bearers assigned to the infantry regiments.

The Corps Medical Service functioned normally.

Field hospitals, operating in hospitalization sections, with surgical teams attached and augmented as shown in the supply section, proved to be an essential component of the army medical troops. The hospitalization units were used in the immediate vicinity of division clearing stations and cared for the casualties which were not in condition to be transported to the evacuation hospital. This not only saved the lives of many persons but also relieved the burden on the evacuation hospitals.

The 400 bed evacuation hospital proved to be a very efficient unit. It is felt, however, that it is grossly understaffed in officers, nurses and enlisted men. Personnel augmentation whenever the hospital was in operation was necessary.

The 750 bed evacuation hospital functioned well and is still a fine organization during stable periods.

The Medical Groups have the advantage over the old medical regiments of greater flexibility. They functioned well.

Since no planning group can possibly foresee all the problems which will arise during the operational phase, the medical service must remain flexible at all times. With this in mind, no attempt has been made to present our solution to problems as the solution, but as a solution under the conditions encountered.

LIST OF APPENDICES

Appendix

1 - Operations Memorandum No. 2, Office of the Surgeon, Hq First United States Army.
2 - Equipment Authorized in Excess of T/E Prior to D Day.
3 - Medical Maintenance Units Phased in for Automatic Shipments D Day through D + 41.
4 - Equipment Authorized in Excess of T/E After D Day.
5 - Basic Admission Rates Summary.
6 - Admissions for Disease, Injury and Battle Casualty as Percent of Total.
7 - Disease Rate Summary by Major Components.
8 - Graphic Rate Summary — Admissions — Battle Casualties and Admissions All Causes.
9 - Graphic Rate Summary – Admissions - Non-Battle Injury and Admissions – Psychiatric Diseases.
10 - Graphic Rate Summary – Admissions - Common Respiratory Disease and Admissions — “New” Venereal Disease.
11 - Combat Medical Statistics.
12 - Admissions by Type – June 1944.
13 - Admissions by Type – July 1944.
14 - Daily Cumulative Totals of Admissions by Type.
15 - Daily Cumulative Totals of Admissions by Class of Personnel.
16 - Daily Cumulative Totals of Dispositions.
17 - Percentage Analysis of Combat Medical Statistics.
18 - Ratio of Battle Wounds to Combat Exhaustion.
19 - Basic Ratios — Combat Medical Statistics.
20 - Patients Evacuated – Cumulative Data.
21 - Evacuations – Utah and Omaha Beaches – June 1944.
22 - Evacuations – Utah and Omaha Beaches – July 1944.
23 - Number of Admissions to Hospitals by Weeks.
24 - Number of Admissions to Hospitals for the Communicable Diseases.
25 - Bed Status of First U. S. Army Hospitals – by Weeks.
26 - Anatomical Location of Wounds.
27 - Wounds by Anatomical Location.
28 - Comparative Data – Anatomical Location of Wounds (France and Italy).
29 - Wounds by Causative Agent.
30 - Wounds by Causative Agent.
31 - Summary of Medical Department Personnel – June and July.
32 - Malaria Admissions by Major Components.
33 - Malaria Rates by Major Components.
34 - Mean Strength – Major Components.