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Headquarters, 82nd Airborne Division, Office of the Surgeon, APO 469 U.S. Army, 30 January 1945

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HEADQUARTERS 82ND AIRBORNE DIVISION

Office of the Surgeon

APO 469 U. S. Army

30 January 1945

SUBJECT: Annual Report of Medical Department Activities.

TO: The Surgeon General, United States Army, Washington, D. C.

THRU: Channels.

1. Under provisions of AR 40-1005 and Letter AG 319.1 (9.15.42) EG-M WD, 22 September 1942, Subject: "Annual Reports, Medical Department Activities". The enclosed report is submitted.

WILLIAM C. LINDTROM,

Lt Colonel, MC,

Division Surgeon

1 Incl

(Annual Report of Medical Department Activities, 82d Airborne Division, for the year 1944, in duplicate.)


ANNUAL REPORT OF MEDICAL DEPARTMENT ACTIVITIES,

82ND AIRBORNE DIVISION FOR THE YEAR 1944

SECTION I HISTORY AND ORGANIZATION

SECTION II FIELD AND COMBAT EXPERIENCES

SECTION III HYGIENE AND SANITATION

SECTION IV RECOMMENDATIONS FOR MEDICAL SERVICE

SECTION V ANNEXES

SECTION I: HISTORY AND ORGANIZATION.

The early history of the 82d Airborne Division has been reported in the Annual Report for 1943. A recapitulation of the important dates follow:

August 25, 1917 82d Infantry Division activated at Camp Gordon, Georgia, under the command of Major General Eben Swift.

April 25, 1918 Embarked for overseas duty.

June 25, 1918 Entered combat on Western Front. Participated in combat almost continuously until November 1, 1918.

April 1919 Returned to the United States and demobilized.

March, 25, 1942 Reactivated at Camp Claiborne, Louisiana under the command of Major Omar N. Bradley.

June 26, 1942 Command of the Division was assumed by Major General Matthew B. Ridgway.

August 15, 1942 82d Infantry Division was redesignated 82d Airborne Division and personnel divided to form the 101st Airborne Division.

October 1, 1942 Division moved to Fort Bragg, North Carolina for airborne training.

April 29, 1943 Embarked for North African Theater of Operations.

June 6, to Spearheaded assault on Sicily and assisted in the conquest of the western one third of the island.

August 2, 1943

September 14, to Relieved Salerno beachhead by air and sea and assisted in the drive on Naples.

Oct 1, 1943

October 1, to Occupation and policing of Naples.

November 17, 1943


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November 18, 1943 Embarked for transfer to European Theater of Operations.

December 9, 1943 Division arrived in Northern Ireland.

The organization of the Airborne Division at the beginning of 1944 was unchanged from that authorized prior to departure from the United States. Actually, however, the authorized organization of two glider, one parachute Infantry Regiment, with similar battalions of artillery was never used. Instead the Division had two parachute and one glider Infantry Regiment and two each parachute and glider artillery battalions. There was no change in the' service troops. Experience had shown inadequacies in the organization and, based on recommended changes in the line organizations, a small battalion was recommended for Division medical service. In addition, an increase in personnel for the infantry regimental medical detachments was recommended. These recommendations were not favorably received and the basic organization was unchanged by the table of organization.

In February and March 1914, the Division moved to Leicester, England. There preparations were begun for the invasion of the European continent The Division had two additional parachute regiments attached at this time, bringing the Division organization to four parachute infantry regiments and one glider infantry regiment, to which had been attached one glider infantry battalion to make a three battalion regiment. No change was made in service troops except that some overstrength was authorized. The medical company at this time consisted of approximately 300 men and Officers.

In keeping with the belief of the Division Surgeon, Colonel Wolcott L. Etienne, (then Lieutenant Colonel) and the Medical Company Commander, Major William H. Houston, the company was organized into four (4) collecting detachments and a clearing platoon, all to be gliderborne, self-sufficient medically, except for evacuation in the rear of the Division. All medical Officers were to be used in the clearing station and the collection was under the direction of [Medical] Administrative Corps Officers. This, in general, was the organization used in the operation "NEPTUNE" where the organization proved itself (See Annex I "Report of Medical Service in Operation 'NEPTUNE'"). There were some changes in organization which were found to be desirable and were set forth in a recapitulation of medical service for an Airborne Division. (See Annex I) The basic principal set forth in this discussion (See Annex II) was used in the planning and execution of the operation "MARKET". (See "Report on Medical Service in Operation 'MARKET'", Annex III).

SECTION II: FIELD AND COMBAT EXPERIENCES:

The first four months of 1944 were utilized primarily for reorganization of the Division, assimilation of replacements, and re-equipping in preparation for combat. About the 1st of April, 1944, this portion of the preparation for combat was completed and an intensive training program was instituted which consisted of Battalion, Regimental, and combat team problems. The medical service during this time was that to be normally expected in garrison. Screening of unfit personnel received considerable attention throughout the period until actual time for participation in the invasion of the continent. The Medical Company utilized the combat team problems to smooth out as far as possible the rough spots in their new organization. June 6, 1944 the Division spearheaded the invasion in Normandy. (See Annex I, "Report of Medical Service in Operation 'NEPTUNE'"). Following thirty-three days of combat in Normandy, the Division was returned to England for reorganization and requipping and became a portion of the strategic reserve of the Allied Expeditionary Forces.


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During July and the early part of August, 1944, the Allied Airborne Organizations were organized into the Allied Airborne Army, under the command of Lieutenant General Lewis Brereton. It was during this period that the command of the Division passed to Major General James M. Gavin (August 17, 1944). Early in September the Division was alerted to participate in a projected airborne invasion of northeastern Belgium. However, before it could be executed, the need for such an operation had passed. Immediately an operation was set up for the invasion of Holland by the Allied Airborne Army. On September 17, 1944, operation "MARKET" was executed. (See Annex III, "Report of Medical Service in the operation 'MARKET'". On November 17, 1944, the Division was moved into the vicinity of Rheims, France, for reorganization and re-equipping to resume their role as strategic reserve for the Allied Expeditionary Forces.

On December 17, 1944 the Division was alerted and moved to the Ardennes area in eastern Belgium to participate in the operation to counter the attempted break through of the German army in that area. In as much as the operation is still in progress, data concerning it is incomplete and will be included in the Annual Report for the following year.

TECHNICAL MEDICAL DATA COLLECTED DURING PERIODS OF COMBAT

Total number of casualties handled through the Division for the two operations totaled 8,171. Of this total 5,795 were surgical conditions. 1250 operations of all types were performed with an operative mortality of 3%. Overall mortality for admissions was 1%. Wound location: 75% extremity, 3% cranial injury, 8% Chest wounds and 11% abdominal wounds. The remainder being multiple wounds and/or combination wounds of two or more parts of the body.

Triage and shock treatment was the primary consideration in the Clearing Station. At the shock treatment area the litter and blankets were inspected and rearranged as necessary to make the soldier dry and warm. The pulse, blood pressure and respiratory rates were recorded and plasma administered. Frequently an injured soldier would receive as many as 10 units. There was a total of 3,800 units of plasma used. In some individuals the external jugular or the femoral vein had to be used instead of taking time for surgical exposure and cannulation of a vein. Blood was given frequently as noted by the total of 400 pints injected. One or two units of plasma were given per pint of blood. If the patient did not improve clinically in 2 to 6 hours a check was made by the copper sulphate falling method for serum proteins, hematocrit and hemoglobin. In this way the amount and type of infusion therapy was determined. At times moving a patient from shock area to surgery caused a fall of 10 to 30 mm in the blood pressure and this is one of the many points indicating the delicate balance in which the severely wounded person is. Penicillin injections of 20,000 units every 2 hours were initiated in the shock ward and thus many received it 6 to 8 hours earlier than if one waited until arriving at the postoperative section.

SURGICAL PROCEDURES FOLLOWED

Ordinarily only non-transportables were operated but at times no evacuation means were available and all types of injuries were cared for surgically.

Chest injuries comprised 7% to 9% of the wounded and the ones operated totaled 120 with mortality rate of 15%. Oxygen by catheter was begun in shock and continued usually until 72 hours postoperatively and this accounts for the 80,000 gallons of oxygen consumed. The fluid intake was closely regulated. If in shock, the man was given 1 or 2 units of concentrated serum albumin and this was followed by plasma dissolved in 1/2 the usual amount of water, thus decreasing the actual total of necessary fluid injected.


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At times a flutter value needle made by use of an 18 gauge needle placed through 1/2 thickness ether can cork with base of a condom tied to base of needle and a 1/4 inch diameter hole cut near tip of the condom, was inserted at 2nd intercostal space 1 inch lateral to sternum for relief of pressure pneumothorax. If marked hemothorax was present, aspiration was performed and by use of sodium citrate and the empty water bottles from plasma sets, the blood was given back by vein. 'When operable the wounds were debrided under closed system inhalation anesthesia. The rents in the pleura were repaired, sharp edges of rib rongeured, bleeding controlled with ligature (about rib if necessary) and drainage tube size 22 F or larger was injected at posterior axillary line at 8th or 9th intercostal space and through it 50,000 units of penicillin in 5 cc of water were instilled. This was made a closed system drainage by attachment to a tube beneath water. Postoperatively beginning pulmonary congestion was combated by injections of 50 cc of 50% glucose every 4 to 6 hours and the use of atropine. However, greatest difficulty was paradoxical respiration which was slightly alleviated by circular lower chest adhesive bandage. More care is given if at operation present or future paradoxical breathing is suspected. Large silk suture material should be tied about the lower affected ribs at the anterior axillary region and postoperatively tied under tension to some type of bar running from anterior shoulder to anterolateral iliac crest.

Other than the chest and head cases the surgical section is primarily concerned with the arrest of hemorrhage and the thorough investigation of every penetrating wound of the abdomen. In the control of bleeding from much damaged arm or thigh wounds it was found easiest to expose the large vessels proximally, clamp them with Doyen intentinal forceps and then search for the actual place of laceration. This saved time, blood and length of vessel. Compound fractures were debrided with saucerization of flesh wound, removal of loose bone particles, rongeuring of sharp spicules of bone and dusting a mixture of 50,000 units of penicillin and 5 grams of sulfanilamide crystals locally. Casts were then applied and split routinely. Mortality in these non-transportable cases was 6%.

Abdominal wounds comprised 10 to 12% of all wounded and consisted of 175 operable, non-transportable cases. These were given inhalation anesthesia. The wounds were debrided and abdomen was exposed. Hemorrhage was first controlled and then seepage of bowel contents was stopped by rubberized Doyen forceps. The GI tract was visually and manually examined from stomach consecutively through to rectum. All other organs were explored as much as possible. Multiple lacerations of the small intestine were cared for by excision of bowel and a V segment of the mesentery followed by one anastomosis unless more than 8 feet of small intestine was to be resected. Large bowel wounds necessitated exteriorization or closure plus proximal colostomy. In instances of the missile causing retroperitoneal flank damage and/or hematoma that region was drained by stab wound cigarette drain. Liver wounds were packed with muscle and more superficially by gauze sponges with exit through incision. On the last several instances penicillin 50,000 units were added to the 5 or 10 grams of sulfanilamide crystals ordinarily dusted into the abdomen with special care to frost the intestinal suture lines. All incisions were closed with tension sutures and sulfanilamide powder was dusted on the subcutaneous tissue. At close of operation all exteriorized bowel was opened by inserting and tying in a colon tube. Immediately thereafter Levine tube Wangensteen suction was initiated. Should more decompression be necessary a Miller-Abbott tube was used. Fluids including 1 or 2 units of plasma were administered daily intravenously as were 5 grams of sodium sulfadiazine. The mortality was 15% and was in individuals with liver injury or with multiple anastomoses, or with accompanying thoracic wounds, or with operation time later than 10 hours after injury, or some combination of these.


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In a survey of the severely wounded, the most important it to assess is how much damage has been done. Dependent on this the injured man has a certain physiologic limit, the straining of which means exitus and the exact status of which cannot be adequately measured by clinical or laboratory means. It is therefore apparent that each severely wounded man must be treated with the greatest gentleness continuously. He should be exposed to the minimum of strain, whether it was in being redressed, in moving on a litter, in being carried, in type and extent of operation performed, etc. When every medical Officer and medical enlisted man: this, the greatest possible number of lives will be saved.

NEUROPSYCHIATRIC PROBLEMS

There is a general psychological problem common to all airborne troops, which should be given some consideration. It is games/hat similar in nature to the problem of combat air crews. The method of transportation of airborne troops and the assault nature of employment produces the feeling of being "expendable". There is a noticeable tension among all the troops when an airborne mission is in prospect. This begins quite early in the battle experienced airborne soldier. Even relief from the line for requipping and reorganization immediately puts forth the probability of a new mission and the tension begins. It builds up to its peak to the actual moment of landing at the objective. Then relief is experienced for the first time. This "sweating out" of missions becomes worse with each succeeding mission. Finally the troops feel they have only death, capture or being wounded to look forward to, as relief from their fate. This, of course, is amplified by the continual disappearance of their comrades. It is recognized that this particular phase of the problem is common with ordinary ground troops. The additional mental trauma produced by the airborne phase of a mission among these troops, was never so clearly demonstrated as in the move to participate in the Ardennes Campaign. The move was by truck and under considerable pressure for speed. But the general attitude of the group was one of relief from the hazards of being, airborne. Many spontaneous remarks by all ranks clearly demonstrated their relief from tension. As one soldier expressed it, "they acted as though they were going to a picnic instead of a serious threat to the Allied efforts in the west".

Because of the additional mental trauma produced by the airborne phase of employment, it is felt that serious consideration should be given to some type of rotation and rehabilitation of airborne troops who have participated in several airborne missions. A general policy, somewhat similar to that used by the Air Force for combat crews, would be of great value in relieving the situation that has been and continues to be built up in the mind of the airborne troops, that there is no goal for them but only death, capture or being wounded as their only chance for relief.

In general, the problem of combat exhaustion within the Airborne Division is minimal as compared to the ordinary Infantry Division. It is of interest to note that each operation has produced about the same volume of Neuropsychiatric casualties. It has been observed that the majority of our casualties have obvious Neurological and Psychic symptoms, almost always with loss of self esteem and do not rehabilitate at the Clearing Station level. Thus the majority of these cases are evacuated beyond the Division. Not more than 25% aril fully rehabilitated for combat duty.


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The principal reason for the low rate of this type of casualty is the high percentage of parachutists, all of whom are volunteers. The type of training they receive, further weeds out potential psychiatric casualties. Unit training exposes more of them and they are disposed of through medical channels. The non volunteer groups, the glider elements, are not so thoroughly screened by the training as airborne troops, but such screening does occur. Whenever replacements are received the mere knowledge that they are in an airborne unit exposes a certain percentage of potential psychiatric casualties. Airborne training and unit training further aids in screening personnel. It is obvious, however, that it is not so completely accomplished as with parachutists since the bulk of the casualties of this nature are found in the glider elements.

SECTION III: HYGIENE AND SANITATION.

Hygiene and sanitation during this year has been very satisfactory and has presented few problems. The conditions under which the Division has lived in garrison in Northern Ireland, England and France, have been, to a great degree, similar to the conditions under which they have lived in the United States. The sanitary facilities while limited have been satisfactory. Water has always been available from satisfactory sources and has always been chlorinated. Sewage and waste disposal has been adequate. The ration as issued, has been for the most part a "B" type ration and has been highly satisfactory.

In the field, sewage and waste disposal has been by accepted methods of burial and incineration; water has been furnished by our own Engineers in a highly satisfactory manner and rations have been "K" and "10 in 1" and the British "Compo" ration. All have been adequate for the limited time the troops of necessity have been on that type ration. There have been no epidemics and the health of the command has been satisfactory throughout the year.

Many of the troops who were in the Sicilian and Italian campaigns contracted malaria. Most of these cases have been Tertian infections and have presented a rather interesting problem, in that recurrences were extremely high. In many instances as many as ten recurrences have been reported in an individual case. These individuals, unless living under practically ideal conditions, would break down with a recurrence of their malaria. Obviously this happened most frequently during combat which placed a small additional load on the medical service, but caused considerable difficulty within the units because many of these people by this time were key personnel. All types of treatment were given these individuals and the results were uniformly poor. Only when the policy of sending these people to the Zone of Interior was adopted, was the situation remedied within- the Division.

The problem of venereal disease control continued to be our most serious problem considered under hygiene and sanitation. In spite of every method of venereal disease control known, our venereal rate has continued extremely high. Due to the adoption of penicillin treatment the time lost due to venereal disease has been very materially reduced.

SECTION IV: RECOMMENDATIONS FOR MEDICAL SERVICE.

Recent organizational changes have solved some of the problems in the medical service, especially by increasing the personnel in the Parachute Infantry Regiments. To continue the improvement the following changes are recommended:


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1. Standardization of transport in the Infantry Regiments, regardless of designation of parachute or glider. Four (4) 1/4 ton trucks and trailers per Regimental Detachment, Two (2) 3/4 ton ambulances and one (1) 1 1/2 ton truck per Regimental Detachment.

2. Organization of a small two Company Medical Battalion for the Division Medical Service.

3. Standardization of basic principal of employment of airborne medical troops.

[signed]

WILLIAM C. LINDSTROM,

Lt Colonel, MC,

Division Surgeon


ANNEX NUMBER I

Annual Report of Medical Service 1944

MEDICAL SERVICE IN OPERATION "NEPTUNE"

1. Medical service for operation "Neptune" was planned on the following basis:

a. Organic detachments would accompany their units. Supplies would be dropped or carried by glider, dependant upon the mode of transport of the parent unit.

b. The Division Medical Company would be gliderborne and travel as a unit and to arrive with the first glider lift.

c. Service was to be complete, except friendly ground units were to be contacted for evacuation.

2. Organization of the Division Medical Company was the formation of four (4) Collecting detachments, one for each Regiment of Infantry, and one central Clearing Station. All to be transported by air. Heavy equipment and transport to be carried in by sea. Attached to the Clearing Station was a general Surgical Team.

3. The parachute elements of the Division were landed H minus on D day. Accompanying this lift was a small number of parachute aid men from the Medical Company. A small glider lift went in at this time and was accompanied by the Division Surgeon and the Surgical Team. Early in the afternoon of D day the lift containing the Medical Company was dropped. Many of the gliders landed in flooded areas, so it was the morning of D + 1 before the unit was organized for functioning. The Commanding Officer of the Medical Company was killed by shell fire just after landing.

The first elements of the Division dropped were scattered badly over a large area. About 50% of the medical Officers were unaccounted for during the first 72 hours. There were pockets of our troops isolated from each other, all with wounded, and every effort was being made to consolidate these groups. By the morning of D + 1 it was possible to begin evacuation of casualties to our Clearing Station. The afternoon of D + I. the final glider lift arrived and many glider injuries occurred further loading the medical service. Evacuation to the rear was possible and every available vehicle was used to move the transportable cases to the rear. By D + 3 the tactical situation was such that the operation of the Division as a ground unit actually began.

After this phase of the operation began the medical service operated as any ground Division, but was somewhat handicapped by having only one (1) Clearing Station. As a result displacement was somewhat awkward but was always accomplished without interfering with the service.

Location of the Clearing Station was no great problem. Sites suitable for such an installation as generally conceived, were not to be had. The space on the ground was limited as the build up progressed; almost every available field was occupied by some type of unit or installation. Therefore the station was located where it best suited our need for prompt and efficient operation. It was quickly found that buildings or towns were good places to stay away from as invariably they ware shelled. In all locations the station was surrounded by artillery, but fortunately no damage was sustained by overs and shorts of counter battery fire.


ANNEX NUMBER I (continued)

In the early phase the unit Surgeons and medical men, whenever they contacted a group of the combat troops, set-up and collected and held patients until the Division Service could get to them. It was found that the very small amount of supplies they could carry and the complete lack of transport were the weakest links in their particular chain. In spite of this they, without exception, did an astounding amount of work and undoubtedly saved many lives.

4. The Division was in combat for thirty-eight (38) consecutive days. During this time the following casualties were sustained: NIA - 2610, Glider injuries - 348, Jump injuries - 290, Neuropsychiatric - 237, Disease - 464, Injury - 247, a total of 4196 casualties, of these 3618 were evacuated. Malaria, recurrent, was the leading disease producing casualties.

5. The following conclusions were draw from this operation:

a. There is a definite need for parachute elements to have transportation and a greater quantity of medical supplies.

b. Gliders can be landed early in an airborne operation.

c. The reorganization of the medical service proved sound in principal.

d. A small medical battalion will give a more elastic medical service.


ANNEX NUMBER II

MEDICAL SERVICE FOR AIRBORNE DIVISION

Based on experience in the Campaigns in Sicily, Italy and Western Europe (Normandy) the following method for employment of the Medical Service in an Airborne Division is submitted.

1. Airborne Phase:

a. Parachute units: Organic detachments 3 with unit, personnel being distributed throughout the unit. Ideally at least one (1) medical man per plane. Parachute Regiments operate with one (1) aid man per platoon which requires an increase of nine (9) men for aid men alone over the present T/O. Litter bearers are needed in greater strength, nine (9) additional having been recommended previously.

Equipment for Parachute units basically should be as for an infantry unit. There is great variance of missions that requires changes in equipment but as this primarily concerns expendable supplies it presents no problem.

Equipment for the detachment should be transported on the individual medical personnel by means of musette bags, ammunition pouches or kit devised according to individual Surgeons desires. These should be no larger than a musette bag and well adapted for carrying. Basic items to be carried are bandages, drugs and plasma. Bundles dropped from the planes have proved to be too undependable to plan on their increased use. Recovery of such bundles is very low in proportion to number dropped. Lack of transportation facilities make the utilization of the recovered bundles inadequate.

During the early phase of the action i.e., 12 to 36 hours, evacuation is non-existent for varying numbers of these troops. Medical service consists of some collection, usually treatment on the spot, and essential life saving first aid. The major deficiency is lack of sufficient quantity of supplies, especially plasma, when small units are isolated with only one or two medical personnel. In many instances it will be necessary to abandon casualties after treatment, to be picked up later.

Early landing of gliders has proved practical. The first lift of gliders should contain eight (8) glider (CG4a) loads of medical equipment and personnel from the Medical Company to supplement the supplies of the combat team and act as a Collecting unit supporting the team. One Collecting detachment per combat team jumping.

b. Glider units: Organic detachment rides with its unit well distributed throughout the flight. One medical man per 2 planes satisfactorily distributes the personnel.

Equipment for the detachment is that allowed by T/E and can be transported in gliders.

In as much as glider units land in territory largely controlled by friendly troops their problem of organization is less acute in daylight. In darkness problems or organization would be similar to that of the parachute units. However, medical equipment and transport is with the unit and gives a greater advantage in providing more adequate care. Collection can be more complete. Early evacuation can be expected. Glider units are directly supported by Collecting detachments as the parachute regiments.


ANNEX II (Con't)

c. Second echelon medical service is furnished by an Airborne Medical Company. The present T/O & T/E has been disregarded as being inadequate. Reorganization has been accomplished keeping within the allotted personnel and equipment in so far as possible. Four (4) Collecting detachments and a Clearing Section were organized.

(1) Employment: a. The Company is totally gliderborne. This is essential to transport the equipment and transportation needed for satisfactory 2nd echelon medical service. Personnel may be jumped to reduce glider requirements but should be in the same lift as the glider elements. Parachuting of equipment has not proved successful for this organization.

b. The Collecting Detachments are attached directly to the Regiments supported at time of take off and revert to Division control when reorganization of the Division on the ground is accomplished.

c. The Clearing Section is established as quickly as equipment can be recovered and performs the normal clearing station functions, plus, life saving surgery usually performed in higher echelons. This is necessary due to isolation of the Division from evacuation for a variable period of time following landing and reorganization.

2. Ground Phase:

In general this phase of action approximates normal infantry employment. The Division Medical Service must be supplemented by equipment arriving by sea or overland, consisting of cross country ambulances on basis of 3 per infantry regiment employed. (Minimum needs, 12 ambulances) 6 1 ton trucks for administrative use and that equipment not transported by air. For the regiments and separate battalions of the Division, equipment not brought in by air will normally be included in this lift.

The major variance from the normal Infantry Division in this phase of operation is the use of the Regimental Aid Station in the chain of evacuation as a nucleus for a collecting point or station. The section is supplemented by the collection detachment assigned to the particular regiment. This plan works satisfactorily due to the close in support given to the Division Medical Company, usually 3-5 miles in rear of the front line. It is desirable as it reduces the number of personnel needed and gives the Regimental Surgeon a closer check and control of the casualties from his unit.

Evacuation from the Division begins as soon as ground unit contact is made. Early, this means the channels of the Division contacted are used. However, following contact, the Army or Corps units evacuating Divisions can be quickly made and the normal procedure of evacuation proceeds.

3. Air Landing Mission:

The same personnel and equipment are transportable by air transport for landing missions and would function on the ground as in the ground phase of any operation. Early sea or overland lift is still an essential part of the needs for an air landing mission. However, it is advisable to take all air transportable equipment in the air lift and is so planned for this type of employment. (Only the cross country ambulances, trucks 1 ton and water trailer are not air transportable).


ANNEX II (Con't)

Departing planes will be used as far as possible to evacuate casualties. This will probably not be as effective as it would appear to be due to the speed with which planes must depart from the hostile air field. It may be impossible to hold planes long enough to load any giber of casualties.

COLLECTING DETACHMENT

Personnel: 2 - Officers (1 MAC)

38 - Enlisted personnel

Equipment: 4 - Trucks 1/4 ton with litter racks

3 - Trailers 1/4 ton

2 - Blanket case, large

12 - Blankets, each

1 - Blanket case, small w/dressings

1 - Chest, gas casualty

1 - Chest, drag

1 - Chest, flight service

2 - Splint set

40 - Litters

3 - Debridement set

6 - Water cans filled

2 - Coca unit

1 - Coleman stove

1 - Alarm, gas

7 - Box plasma of 12 units

CLEARING STATION

1. Clearing Station:

a. Organization:

1. Admission Section:

4 - Medical Officers

14 - EM, Medical & Surgical Technicians

4 - EM, Record Clerks

2 - EM, Equipment personnel

24 - EM, Litter Bearers

2. Shock Section:

3 - Medical Officers

7 - EM, Surgical Technicians

3. Surgical Section:

8- Medical Officers (6 Surgeons & 2 Anesthetists, one of whom may be Dental

Officer. Includes attached Surgical Team).

8 - EM, Surgical Technicians

8 - EM, Litter Bearers

4. Post Operative Section:

1 - Medical Officer

3 - Surgical Technicians

5. Neuropsychiatric Section:

1 - Medical Officer

2 - Medical Technicians


ANNEX II (Con't)

6. Disposition Section:

2 - Medical Officers (May be Dental Officers)

2 - EM, Clerks

8 - EM, Litter Bearers

7. Supply Section:

1 - MAC Officer, Division Medical Supply

1 - EM, Division Medical Supply

2 - EM, Co Supply, property exchange

8. Kitchen Section:

10 - EM, Cooks, details & KP's

9. Records Section:

3 - EM, Clerks

10. Command Post:

1 - Medical Officer

2 - EM, (1st Sgt & Co Clerk)


ANNEX NUMBER III

Annual Report of Medical Service 1944

MEDICAL SERVICE IN OPERATION "MARKET"

1. Based on experiences in Normandy the following plan was evolved for medical service for the operation.

a. Increased support to the parachute elements by means of a glider lift of second echelon medical personnel and equipment, to accompany parachute lift.

b. Plan for Clearing Element to be self sustaining for life saving surgery, holding patients and preparation of casualties for transportation when evacuation became available.

c. Air resupply to continue service beyond seventy-two (72) hour basis of a and b above.

d. The higher Command attached a platoon of the 50th Field Hospital to the organic medical unit for additional medical support, in addition to the two surgical teams requested.

2. In execution, the glider lift with the parachute element was not feasible due to tow craft shortage. Eleven parachutists of the Medical Company were dropped and by means of captured vehicles and with the aid of the Medical Detachments of the parachute combat teams, casualties were collected as much as possible in one area awaiting arrival of the Medical Company and attachments. Twenty-four hours following the initial drop, all second echelon medical service arrived by glider. The collecting detachments were dispatched to the units and evacuation began to the Clearing Station located in a field two (2) miles west of the village of Grosbeek.

The Clearing Station was composed of the clearing element of the Medical Company and the platoon of 50th Field Hospital operating one station. Forty-eight (48) hours later the station was moved to the south of Nijmegen in a Jesuit school being prepared by the Germans for a "Hitler Mother" obstetrical hospital. Here they remained throughout the campaign.

The first evacuation was available D + 3 and approximately two hundred (200) casualties were evacuated. Due to enemy action evacuation was interrupted from D + 6 to D + 10. Since that time evacuation has been adequate. On D + 17 a C-64 transport was made available by the Division Air Office for the evacuation of priority cases to the airfield at Brussels. This aircraft carries three (3) litter cases. To date twelve (12) cases have been evacuated this way.

Supply by air was not adequate to resupply the needs of the medical service. The exact cause is not known, probably a combination of causes. Many items requested were either not dropped or not recovered. As a result there were some shortages, though in practice adequate care of the casualties was not seriously affected. Once evacuation began all supplies were available and British sources insured adequate supplies for the remainder of the Campaign. The generosity and whole hearted cooperation of all the British agencies left nothing to be desired.


ANNEX III (continued)

3. Some details of the organization and statistics of the operation are of interest.

a. The organic medical detachments of the combat teams accompanied their units, taking first aid equipment which included blood plasma. Their function was to collect casualties and give essential first aid and prepare casualties for transportation. Their work has been superior throughout the Campaign.

b. Collecting Detachments of the Medical Company landed by glider D + 1 and each consisted of one (1) Medical Officer, one (1) Medical Administrative Corps Officer and thirty (30) enlisted men. Four (4) jeeps and three (3) trailers of equipment, requiring eight (8) gliders for air transport. There were four (4) such detachments. Their work has been exceptional. Evacuation has been extremely rapid. Casualties have been in the Clearing Station regularly three to five hours after being wounded. The work of these detachments has not detracted from the superior work of the unit Medical Detachments, in fact it only stresses the excellent cooperative effort that is the basis for successful operation.

c. The Clearing Station has operated as a single unit, though capable of operating as two units if needed, the Medical Company and 50th Field Hospital each as independent units. The tactical situation has not made this necessary.

The Clearing element landed D + 1 with eight Medical Officers, two Dental Officers, two Medical Administrative Corps Officers and one hundred thirty-three (133) Enlisted Men plus six Medical Officers and four Enlisted Men of two surgical teams. Eleven jeeps, twenty-two trailers filled with equipment and 3000 pounds of equipment loose in gliders. Air transport was thirty-five (35) gliders. To date (D + 22) 2971 patients have been admitted, 2141 transferred, 391 returned to duty and 85 deaths. Over 100 major surgical procedures and many more minor surgical procedures have been done. Housing conditions have been nearly ideal and the very great help of the Dutch civilians, nurses etc. has contributed, greatly to the success of this part of the operation.

On D + 9 the sea lift arrived and was composed of two Medical Officers, one Dental Officer and twenty-five enlisted men. Fifteen (15) 3/4 ton ambulances, six (6) 2 1/2 ton trucks, three (3) 3/4 ton trucks, two (2) 250 gal. water trailers, all the trucks loaded with equipment.

On D + 8 a small X-Ray unit which is organic equipment of the Field Hospital platoon was air landed at Brussels and arrived overland.

b. In summary 67 gliders were used to air land the medical service units. There were 27 Jeeps, 34 trailers, 18 Medical Officers, 2 Dental Officers, 6 Medical Administrative Corps Officers, 268 Enlisted Men and 10 tons of equipment airborne. Two (2) trailers and their equipment were not recovered. No personnel were lost in the Airborne phase.

5. Division Casualties:

a. Following is a resume of the casualties within the organic Division that were reported for the total operation:

Battle Casualties 2641 of which 1562 were evacuated and 263 were killed in action or died from wounds.

Injury 618 of which 288 were evacuated and 5 died as a result of their injuries.

Neuropsychiatric 261 of which 161 were evacuated.

Disease 1110 of which 436 were evacuated and one died (Pneumonia).


ANNEX III (continued)

6. Comments:

a. The organization as outlined and used can adequately service an Airborne Division in operation.

b. Such a unit should be the organic medical service for an airborne Division with the suggested organization: Designated a Medical Battalion, consisting of Headquarters Detachment of three Officers and twenty-two enlisted men. One Collecting Company of 8 Officers and 120 Enlisted Men. One Clearing Company of 15 Officers and 130 Enlisted Men. Total 18 Medical Officers, 3 Dental Officers, 5 Medical Administrative Corps Officers and 272 Enlisted Men.

c. Medical service for airborne operations must be self contained and dependent upon higher echelons only for supply and evacuation.

d. Air resupply should be standardized for daily delivery.

e. Each parachute combat team should have an accompanying glider lift of 2nd echelon medical personnel and equipment.

f. A sea lift as outlined is an essential supporting element for an airborne operation. In operations not over sea, a similar ground follow up is equally essential.