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Report of Operations, 20 Octover 1942 - 1 August 1944

Operation Overlord

FIRST
UNITED STATES
ARMY

REPORT
OF
OPERATIONS

20 OCTOBER 1943
1 AUGUST 1944


ANNEX No. 2 (contd)

ANNEX 6

TO

OPERATIONS PLAN “NEPTUNE”

MEDICAL PLAN


TABLE OF CONTENTS

                                                PARAGRAPHS                                                                                 SUBJECT
    
I.  GENERAL PLAN OF OPERATION

                                                1                                                               Medical Units (Exclusive of Brigade, Division and Corps Units    

II.  SUPPLY

                                                2                                                               Medical Supplies        

III.  PLAN OF EVACUATION

                                                3                                                                Policies    
                                                4                                                                Beach Area    
                                                5                                                                Delineation of Army and Navy Responsibility    
                                                6                                                                By Motor    
                                                7                                                                Hospital Trains    
                                                8                                                                By Air    

IV.   CONSTRUCTION

                                                9                                                                General Policy        

V.  POLICY ON THE USE OF THE GENEVA RED CROSS

                                                10                                                              Display of the Geneva Red Cross    

VI.   HOSPITALIZATION

                                                11                                                             Hospitalization            

VII. DISEASE CONTROL

                                                12                                                            Sanitary Survey of Target Area    
                                                13                                                            Responsibility    
                                                14                                                            Disease Prevention for Civilians    
                                                15                                                            Hygiene    
                                                16                                                            Physical Inspections    
                                                17                                                            Sea Sickness Prevention    
                                                18                                                            Water    
                                                19                                                            Venereal Disease    
                                                20                                                            Waste Disposal    
                                                21                                                            Treatment of Gas Casualties    
                                                22                                                            Immunizations    
                                                23                                                            Mess Sanitation    
                                                24                                                            Care and Inspection of Rations    
                                                25                                                            Milk    
                                                26                                                            Control of Respiratory Diseases    
                                                27                                                            Control of Diarrhea and Dysentery    
                                                28                                                            Rat Control    
                                                29                                                            Scabies    
                                                30                                                            Louse Control    
                                                31                                                            Fly Control    


59

VIII.   SANITARY PRECAUTIONS

                                                32                                                            Delousing of Civilians    
                                                33                                                            Tuberculous Civilians    

IX. MISCELLANEOUS

                                                34                                                            Salvage of Clothing and Equipment    
                                                35                                                            Civil Labor    
                                                36                                                            Finance    
                                                37                                                            Patient's Mail    
                                                38                                                            Medical Service for PW Enclosures    
                                                39                                                            Dental    
                                                40                                                            Burial of the Dead    
                                                41                                                            Clothing and Individual Equipment for Duty Cases    
                                                42                                                            Medical Department Reports and Returns    
                                                43                                                            Medical Department Transportation for Exhaustion Cases    


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ANNEX 6 - MEDICAL PLAN

I.  GENERAL PLAN OF OPERATION

1.     MEDICAL UNITS (Exclusive of Brigade, Division and Corps Units).

    a.    Beach OMAHA
   
        Unit                                                                Landing Day
    1st Sect, Adv Plat, 1st Med Depot Co.                 D Day
    12 Surgical Teams, 3rd Aux. Surgical Group          D Day
    13th Field Hospital                                                D Day
    51st Field Hospital                                                D + 2
    449th Collecting Company                                    D + 5
    450th Collecting Company                                    D + 5
    577th Ambulance Company                                  D + 5
    5th Evac. Hospital (QM Ldry Sect Att)                 D + 5
    24th Evac. Hospital (QM Ldry Sect Att)               D + 5
    451st Collecting Company                                    D + 6
    452nd Collecting Company                                   D + 6
    575th Ambulance Company                                  D + 6
    41st Evac. Hospital (QM Ldry Sect Att)               D + 6
    618th Clearing Company                                       D + 9
    576th Ambulance Company                                  D + 9
    578th Ambulance Company                                  D + 9
    44th Evac. Hospital (QM Ldry Sect Att)               D + 9
    176th Hq & Hq Det, Med Bn, Separate                D + 9
    175th Hq & Hq Det, Med Bn, Separate                D + 9
    68th Hq & Hq Det, Medical Group                       D + 9
    1st Medical Depot Company (-Adv. Plat)             D + 9
    10th Medical Laboratory                                      D + 9
    617th Clearing Company                                      D + 10
    45th Evac. Hospital                                              D + 10
    57th Hq & Hq Det, Med En, Separate                 D + 10
    3rd Aux. Surgical Group (-21 Teams)                  D + 13
    454th Collecting Company                                   D + 14
    2nd Evacuation Hospital                                       D + 15
    4th Convalescent Hospital                                    D + 19

    b.    Beach UTAH

    6 Surgical Teams, 3rd Aux. Surgical group                D Day
    2nd Sect, Adv Plat, 1st Med Depot Co                     D + 1
    42nd Field Hospital                                                   D + 1
    45th Field Hospital                                                    D + 3
    3 Surgical Teams, 3rd Aux. Surgical Group               D + 3
    463rd Collecting Company                                       D + 4
    564th Ambulance Company                                      D + 5


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    464th    Collecting Company                                    D + 5
    91st    Evac. Hospital (QM Ldry Sect Att)               D + 5
    565th    Ambulance Company                                  D + 6
    493rd    Collecting Company                                   D + 6
    128th    Evac. Hospital (QM Ldry Sect Att)            D + 8
    566th    Ambulance Company                                 D + 8
    501st    Collecting Company                                   D + 8
    67th    Evac. Hospital (QM Ldry Sect Att)              D + 9
    427th    Collecting Company                                   D + 9
    621st    Clearing Company                                      D + 9
    622nd Clearing Company                                        D + 9
    502nd Collecting Company                                     D + 9
    97th    Evac. Hospital (QM Ldry Sect Att)              D + 9
    178th    Hq & Hq Det, Medical Battalion                D + 9
    179th    Hq & Hq Det, Medical Battalion                D + 9
    31st    Hq & Hq Det, Medical Group                      D + 9
    426th Hq & Hq Det, Medical Battalion                   D + 11
    134th Hq & Hq Det, Medical Group                      D + 11
    96th    Evacuation Hospital                                     D + 11
    180th Hq & Hq Det, Medical Battalion                  D + 11
    633rd    Clearing Company                                    D + 14
    177th Hq & Hq Bet, Medical Battalion                   D + 14
    662nd Clearing Company                                       D + 14
    91st    Med. Gas Treatment Battalion                      D + 19


II. SUPPLY

2.    MEDICAL SUPPLIES

        a.    Basic Planning Data for Medical Components.

            (1)    T/E Equipment. All units will carry ashore essential T/E medical equipment for the assault.

            (2)    Additional Equipment. The following additional equipment will be carried ashore by units indicated through D + 3. These items are intended for use during the assault phase and will be carried as additional equipment on unit transportation. Items not used during the assault will be turned in to the beach medical dumps.

        Litter, folding, wood, or litter, straight steel:
        12 –  per Inf Bn; Arty Bn; Chem Bn; Engr Bn.
        24 –  per Ranger Bn.
        180 –  per Med Bn (Inf); Med Bn (Engr Spec Brig).

        Chest, M.D. No. 1
        2 –  per Coll Co.
        4 –  per Cir Co.
        6 –  per Med Bn (Engr Spec Brig).


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        Splint Set
        1 –  per Inf Bn; Arty Bn; Chem Bn; Engr Bn; Ranger Bn.    
        5 – per Coll Co.    
        10 –  per Med Bn (Engr Spec Brig).

        Blanket Set, Small
        3 –  per Inf Bn; Arty En; Chem En; Engr Bn; Ranger Bn.
        4 –  per Coll Co; Clr Co.
        10 –  per Med Bn (Engr Spec Brig).

            (3)    Special Units. Special units in waterproof containers will be carried ashore by enlisted Medical Department personnel for units indicated through D + 3, as follows

        1 –  unit per Inf Bn; Arty En; Chem Bn; Engr Bn; Ranger Bn.
        2 –  units per Coll Co, Division.
        4 –  units per Clr Co, Division.
        6 –  units per Med Bn (Engr Spec Brig).

            Units will consist of approximately eight (8) small containers, which personnel may float ashore using the containers for buoyancy where required. Each unit will provide the following:

        Item                                                Unit        Amount
        Dressings, first aid, large                    each        50
        Dressings, first aid, small                    each        50
        Gauze, plain, sterilized, comp.            pkg         50
        Bandage, gauze, 3-inch                     each         50
        Sulfanilamide, crystalline                    pkg          10
        Morphine, Tartrate, Syrettes              box          25
        Serum, normal human plasma,         dried pkg    7
        Sulfadiazine, USP, 7.7 gr tabs           1000        1
        Halazone, 1/10 gr tabs (100 in)         bottle        1
        Sterile gauze packet (impregnated
             with boric acid or vaseline)            each        1

            (4)    Blank Forms and Stationery. Units will carry a thirty (30) day supply of blank forms and stationery. Resupply will be through the Army Medical Supply Depot.

        b.    Medical Maintenance. (All supplies listed here under will be requisitioned, placed in dumps and issued by army).

            (1)    D Day to D + 14.

                (a)    D Day. Two (2) days supply of essential items in addition to unit supply (as indicated above) will be provided on the beaches for troops landing on D Day by the Army Medical Service.

                (b)    Subsequent to D Day. Bulk shipments will be made of critical items which will be consumed at abnormal rates (litters, splints, blankets, surgical dressings, etc.).


63

                (c)    Medical Maintenance Units. Medical maintenance units (divisional assault; army; and gas casualty types) and a special unit of supply will be shipped on the basis of anticipated casualties and desired build-up of reserve.

                (d)    Class II Items.   Replacement of critical Class II items.

                (e)    Property Exchange. See paragraph 5, b, (2).

           (2)    D + 15 - D + 29.

                (a)    Medical Maintenance Units. Medical maintenance units (army type) will be shipped on the basis of anticipated casualties and desired build-up of reserve.

                (b)    Class II Items. Replacement of the lesser critical Class II items.

            (3)  Subsequent to D +29.

                (a)    Medical Maintenance Units. Medical maintenance units (army type) will be shipped on the basis of one (1) unit per 10,000 men for thirty (30) days.

                (b)    Other Items. Other items required which are not available in army dumps and depots will be requisitioned through established channels of supply.

        c. Depot Stocks.

            (1)    Class IV Supplies. Seven (7) days reserve by D + 20, to be maintained at that level.

            (2)    Class II Supplies. Shipments will be made on the basis of anticipated losses. Class II items normally will be stocked in the Base Depot of the 1st Medical Depot Company within the army zone. During the assault phase, however, Class II items will be available in advance dumps in sufficient quantity to replace expected losses.

            (3)    Blank Forms. A ten (10) day supply of blank forms and stationery will be stocked in advance dumps and a thirty (30) day level of these items will be maintained in the Base Depot Platoon, 1st Medical Depot Company.

        d.    Scheme of Supply.

            (1)    General. The Base Depot Platoon of the 1st Medical Depot Company will establish a depot in the rear of the army service area, while the Advance Depot Platoon, or sections thereof, will establish dumps as far forward as practicable.

            (2)    Division Medical Supply. All divisional units will inform the Division Medical Supply Officer of their requirements.
        
    The Division Medical Supply Officer will consolidate the requirements of the division and will draw in bulk from the nearest Army Medical Supply installation, or reissue to divisional units.
    
            (3)    Other Units. Corps and army troops will draw medical supplies from the nearest Army Medical Supply installation. If the situation warrants, the Medical Supply Officers in the corps medical battalions will be directed by the Army Surgeon to establish auxiliary dumps to serve corps troops.

            (4)    Requisitions. All medical supply will be on an informal requisition basis. Any written instrument containing all necessary information may be used. In emergencies, oral requests for supplies will be acceptable.

            (5)    Transportation. Units normally will use their own transportation for the procurement of medical supplies from Army Medical Supply installations. In exceptional cases, corps, army, or depot transportation may be used.


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        e.    Salvage and Captured Material.

            (1)    Enemy Medical Supplies. Troops will be advised of the importance of preserving captured enemy medical supplies and documents, particularly biologicals such as vaccines. Special effort should be made to get this material; and samples of each lot captured should be sent promptly to the Army Medical Supply Officer. Captured medical supplies will, normally be used for care of prisoners of war and CIV, and will be issued for use in army' units only on authority of the Army Surgeon.

            (2)    Salvage.  See G-4 Annex.

    Medical items which have become unserviceable will be turned in to the nearest medical supply dump or depot.

        f.    Maintenance and Repair.

           (1)    Medical Department Items. Medical Department items in need of repair and maintenance will be turned in to the Base Depot Platoon of the Medical Depot Company.

            (2)    Generators. Generators will be maintained and repaired by Engineer Maintenance Companies.

            (3)    General.  See G-4 Annex.

        g.    Whole Blood Service. Whole blood will be an item of medical supply and will be distributed through medical supply channels. It will be given the highest priority in transportation. Personnel and equipment for the whole blood service will be attached to the 1st Medical Depot Company.

        h.    Award of the Purple Heart.

            (1)    Initial Supply. Hospitals will be supplied prior to departure from United Kingdom with Purple Hearts on the basis of one (1) per bed (T/O Capacity). Other medical units will be supplied as directed later.

            (2)    Additional Supply. Additional supply will be drawn from Quartermaster depots as required.

            (3)    Policy. The Purple Heart will be given to all persons entitled to the award, if returned to duty from any medical unit within First U. S. Army. Casualties evacuated from the army area will receive the decoration at a later period. NOTE : Supply levels indicated herein are tentative.


III.   PLAN OF EVACUATION


3.    POLICIES

        a.    Methods of Estimating Casualties.

            (1)    Sick and Non-Battle Injuries. The rate of 0.17 % per day will be used in estimating hospital admissions for sick and non-battle injuries.

            (2)    Battle Casualties. The following rates will be used in estimating battle casualties:

                                                            “LIGHT”                “SEVERE”            “MAXIMUM”
    Type of unit                                        Battle day             Battle day                 Battle day
                                                                  %                           %                            %
    
Division                                                        1                         8                            15
Brigade or Regiment                                    2.5                       15                          25
Corps                                                         0.5                        3                            5
Army                                                          0.35                      1                            2.5
Miscellaneous troops, including SOS           0.25                     0.6                          1


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            (3)    Categories of Battle Casualties:

                (a)    D Day and D + 1

                      Killed, captured and missing        30 %
                      Wounded                                   70 %

               (b)    D + 2 and thereafter:

                      Killed, captured and missing        25 %
                      Wounded                                   75 %

               (c)    Of the wounded, 50 % will be litter cases and 50 % will be walking cases.

        b.   Evacuation.

            (1)    Initial. On D Bay, and continuing until sufficient hospitals are ashore and in operation to permit retention of sick and wounded with a short hospitalization expectancy, a total evacuation policy will be in effect. This will call for the evacuation to the United Kingdom of all sick and wounded not able to return directly to duty after treatment at first and second echelon medical installations. The only exception to this policy will be the non-transportable cases. In order that the maximum number of experienced combat troops will be retained on the continent, the evacuation policy will be converted progressively from a total policy to a seven (7) day policy as the build-up of hospitals makes such action possible. Responsibility for changing the evacuation policy will rest with the Army Commander, on recommendation of the Army Surgeon.

            (2)    Avoidance of Unnecessary Evacuation. Every effort will be made to prevent the unnecessary evacuation of sick and wounded personnel from the continent. Medical officers of all echelons will habitually return casualties to duty as soon as their condition permits.

            (3)    Non-Transportables. Cases falling into this category will be retained in units designated for the reception of this type of case until such time as their condition warrants further evacuation.

            (4)    Via Cherbourg. As soon as Cherbourg is in operation, evacuation through that port will be started. Evacuation through the beaches will not cease with opening of Cherbourg, but will probably continue until at least D + 30 to D + 50.

            (5)    Army Responsibility for Other Troops. First U. S. Army will be responsible for medical service for Air Corps, SOS and any other U. S. Army troops on the continent until establishment of an army rear boundary. After establishment of an army rear boundary, First U. S. Army will be responsible for medical service for all troops within the army area.

4.    BEACH AREA

        a.    Battalion Medical Section. Battalion medical sections, less detachments, will land at the same time as the battalion headquarters. (See Section II, Supply Plan, for list of equipment to be landed). This section will administer first aid to the wounded, tag them and mark them so that they may be easily found and evacuated. The battalion section must follow closely its battalion and will not linger in the beach area to the exclusion of its primary mission.


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        b.    Naval Medical Beach Party. The Naval Medical Section of the Shore Party (Naval Medical Beach Party), consisting of one medical officer and eight (8) corpsmen per battalion beach, will land at the same time or very soon after the battalion medical section. The Navy medical section will establish an evacuation station in the beach area and will furnish medical service for the beach until such time as elements of the Medical Battalion, Engineer Special Brigade, are established ashore. It will be the responsibility of the Naval Medical Officer to procure landing craft other than DUKWs for evacuation to the ships.

        c.    Collecting Companies. Litters bearers from collecting companies must land soon after the battalion medical sections, to assist those sections in evacuation of casualties. The remainder of collecting companies should land not later than H + 2.

        d.    Medical Battalion, Engineer Special Brigade. The Medical Battalion, Engineer Special Brigade, with six(6) Surgical Teams and one (1) Section, Advance Platoon, 1st Medical Depot Company attached, should land not later than H + 3, complete with transportation. This battalion will establish a station in the beach area of each combat team. They will assist in collection of beach casualties, procure and load DUKWs for seaward evacuation, transport casualties to shore and load them into landing craft (in conjunction with the Naval Medical Officer), receive all casualties from Medical installations further inland, render necessary first aid to all casualties prior to evacuation and operate medical supply dumps. All non-transportable wounded will be treated at these stations until the arrival of field hospitals.

        e.    Clearing Companies. Division clearing companies will land in next priority.


5.    DELINEATION OF ARMY AND NAVY RESPONSIBILITY

        In the early stages of the operation all casualties will be transported from the continent to the United Kingdom by water. For the purpose of avoiding confusion on the beaches, the following assignment of responsibilities to Army and Navy is made:

        a.    Army (On the Far Shore).

            (1)    Medical service to all military personnel inland from the high water mark on landing beaches.

            (2)    The necessary liaison with the Navy Medical Officer required for the evacuation of casualties from the beach. The responsibility for liaison with the Navy Medical Officer in the beach area will rest with battalion surgeons until regiments are ashore and will pass permanently from regiments to the Surgeon, Engineer Special Brigade, as soon as that unit is ashore.

            (3)    The provision of sufficient DUKWs (especially allocated to the Medical Department when the military situation permits) for the evacuation of casualties from the beach to ships.

            (4)    The loading of casualties into DUKWs or other craft on the far shore ; and the loading of motor vehicles when motor transportation is used to deliver casualties to beached craft.


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            (5)    The transportation by DUKWs of casualties from shore to ship; and the transportation by the most suitable motor vehicles available in cases where motor transport may be used to deliver casualties to beached craft.

            (6)    The provision of sufficient motor transportation facilities for necessary lateral movement of casualties in the vicinity of beaches.

        b.    Navy (Far Shore and Afloat).

            (1)    The conversion of a sufficient number of LSTs for the purpose of suitably transporting casualties on return trips to United Kingdom.

            (2)    The equipping of such casualty carrying LSTs with sufficient quantities of blankets, litters, splints and medical supplies as are necessary for the proper care of patients carried aboard, and for property exchange on the far shore; insuring that each such converted LST carries such equipment at all times. In this connection, the medical supplies for treatment of casualties on shipboard will be obtained from Navy sources; the equipment for property exchange will be obtained from Army sources. The following unit of medical supplies, designed for property exchange, will be carried initially on each LST as part of ship’s medical stores, and on each successive trip until three hundred (300) such units have been delivered. The responsibility for unloading will rest with the Far Shore Engineer Special Brigade.

                                                                                              Total            Total
    Item                                              Unit         Number        Weigh         Cubage
Blanket Set, Small (8 Blankets)        each            40                2000            180
Litter, straight, steel                          each            100              2100            125
Splint Set                                         each            4                    220              14
Surgical Dressings                            box             3                    150              10
Plasma                                             box             8                    520              24
                                                    (12 units)

                                                     Total :                                4990            353

            (3)    The medical care and treatment of all casualties from the time they are loaded on a ship or craft until they are unloaded from such ship or craft.

            (4)    The transportation of casualties from Far Shore in cases where DUKWs cannot be used for that purpose; and to augment DUKW evacuation whenever necessary.

            (5)    The unloading of DUKWs, craft, or boats used to transport casualties from the Far Shore to ship; and the unloading of motor vehicles when. casualties are delivered to beached craft by motor transportation.


6.    BY MOTOR

        a.    Ambulance. The bulk of all casualties will be transported by motor transportation. All litter cases should be transported by ambulance. Ambulance service for the army will be provided by ambulances from the 68th and 134th Medical Groups. All ambulance service in rear of division boundaries will be controlled by the Army Surgeon. The routing and timing of all convoys will be coordinated with Traffic Headquarters by the Army Surgeon.


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        b.    Other Vehicles. The restricted number of ambulances available will make transportation of all casualties by ambulance impossible. Trucks will be used as required.

        c.    Maintenance. See G-4 Plan and Ordnance Plan.


7.    HOSPITAL TRAINS

       Fully equipped hospital trains will be transferred from the United Kingdom to the continent as early as practicable. Prior to this time, any trains made available on the continent will ‘be converted to hospital trains by use of the Brechot Apparatus. Staffing and equipping of any trains so converted will be the responsibility of the Communications Zone Commander. It is doubtful whether any trains except those shipped from the United Kingdom will be used since it is not anticipated that serviceable trains will be found on the continent.


8.    BY AIR

        a.    General.  Evacuation of casualties by air from the continent will begin at the earliest possible time. In the later stages, air evacuation from Army to Communications Zone installations on the continent will be used to the maximum practicable extent.

        b.    Delineation of Responsibilities. The following delineation of responsibilities has been agreed upon by First U. S. Army and Ninth Air Force, and will be in effect on the continent.

            (1) Air Force.

                (a)    The equipping of all transport aircraft with suitable litter racks and insuring that each transport aircraft carries such equipment at all times.

                (b)    The medical care and treatment of casualties from the time they are loaded on an aircraft until they are unloaded from such aircraft.

                (c)    The temporary medical care and treatment with local resources of such casualties as may be delivered in an emergency at an airdrome at which no provisions for the reception of casualties have been made.

                (d)    The delivery of casualties to airdromes convenient to fixed hospitals, unless military necessity requires that they be delivered to other airdromes.

                (e)    All transport type aircraft returning from forward areas during actual operations will be utilized for air evacuation of the wounded, unless military necessity requires otherwise.

            (2)    First U. S. Army.

                (a)    The establishment and maintenance of a holding medical unit in the immediate vicinity of each airdrome, within army zone of responsibility, from which casualties are to be evacuated.

                (b)    The delivery of casualties to such holding units.

                (c)    The loading of casualties upon aircraft, within army zone of responsibility.


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                (d)    The provision of such additional equipment, within army zone of responsibility, as may be required by the impracticability of effecting property exchange with the Air Force.

                (e)    The necessary liaison with the Air Force concerned for the
evacuation of its casualties.

                (f)    The reception of casualties without delay, when notified by the
Air Force concerned, at any airdrome within its zone of responsibility at which an aircraft transporting casualties is forced to land and remain on the ground for an extended period.


IV.   CONSTRUCTION

9.    GENERAL POLICY

        Hospitals will have first priority on existing shelter and on tentage. Every effort will be made to place hospitals in buildings; However, since the army will have no hospitals of the. fixed type, only those buildings will be utilized which lend themselves to hospital use with little or no alteration required.

        a.    Construction.  No buildings will be constructed for use of army hospitals.

        b.    Supply Storage.  Existing buildings will be used for supply storage and depot operation whenever available (See G-1 Annex re priority).



V.   POLICY ON THE USE OF THE GENEVA RED CROSS

10.    DISPLAY OF THE GENEVA RED CROSS

        a.    No unit other than a medical unit will display the Geneva Red Cross or any symbol representing or resembling it.

        b.    The Geneva Red Cross will be displayed at the discretion of the appropriate formation commander as a protective measure (visible from the air), by medical units and establishments unless there is a non-medical unit or installation within 1,000 yards.

        c.    On occasions when the Red Cross is displayed as a protective measure, every endeavor should be made to insure that it is displayed prominently and unmistakably, and that the layout of the site does not in any way give the appearance of a tactical layout. The Red Cross will NOT be illuminated at night.

        d.    On occasions when the Red Cross is not displayed as a protective measure, the maximum degree of concealment, camouflage and dispersion will be used.

        e.    The above paragraphs, a to d inclusive, apply to the use of the Geneva Red Cross as a protective measure and are not intended to prevent the use at any time of small flags or signs (not visible from the air) bearing the Red Cross to identify medical establishments.


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VI.   HOSPITALIZATION

11.    HOSPITALIZATION

        a.    U. S. Army. U. S.. Army casualties will be treated in Field, Evacuation and Convalescent hospitals. Originally, only non-transportable cases will be retained in hospitals. When sufficient hospitals have been established, cases with short hospital expectancy will be retained in army hospitals for treatment (See Evacuation, Section III).

        b.    Allied Casualties. Allied casualties in First Army zone will be hospitalized in the same manner as American casualties. When Allied personnel are admitted to American medical installations all reports of admissions, discharges, deaths and serious illness will be rendered by the medical installations through normal channels using the same forms and procedure as would be used for an American casualty. The necessary disposition of these records will be made by the, Adjutant General.

        c.    Civilian Casualties. Medical units will be prepared to receive wounded and injured civilians in army medical installations for emergency treatment only. As soon as persons so admitted become transportable, they will be moved to civilian facilities operating under supervision of the Surgeon, Civil Affairs Section.

        d.    Enemy Casualties. Enemy casualties will be hospitalized in the same manner as American and Allied casualties.



VII.   DISEASE CONTROL

12.    SANITARY SURVEY OF TARGET AREA

        a.    General. The partial failure of public health practices in existence prior to the war, the widespread effects of malnutrition and deficiency diseases, and the opportunities for the development and spread of communicable diseases in overcrowded areas have brought about a marked deterioration in the health of the people of France. However, no widespread epidemics of infectious diseases have been reported up to the present time. Facilities for the treatment of drinking water, always scarce, have gone almost completely out of existence.

        b.    French Organization. Twenty sanitary regions now exist in France, each headed by a Director of Public Health. These directors devote the major portion of their time and energy to carrying out measures for the protection of the German army with the result that there is little attention paid to the civilians. As a result of this inattention, there has been a sharp rise in the incidence of tuberculosis and typhoid fever.

        c.    Sewage. France is very poorly supplied with sewage disposal facilities. Some sanitary systems exist in the cities but these are inadequate. Rural areas resort to privies, cesspools and septic tanks. Normal sanitary standards are not maintained. Human wastes are collected and stored for use as fertilizer, which results in pollution of soil and water.


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        d.    Insects and Animals.

            (1) Mosquitoes.

                (a)    Anopheles. Anopheles mosquitoes are common in France, but all species seem to be relatively poor malaria vectors.

                (b)    Aedes. Aedes mosquitoes are present in small numbers in Northwestern France. These insects are vectors of dengue fever in Southern France. Yellow fever also is carried by Aedes Egypti, but will not be encountered in France.

                (c)    Culex. Culex mosquitoes are present, but they are important only as biting pests.

                (d)    Other. Several other species of mosquitoes are present, but they are merely pests and transmit no disease.

            (2) Flies.

                (a)    Musca Domestica. The common housefly is the most troublesome and widespread species of fly in France. It is a serious problem in rural France. The insect is closely associated with the dairying and hog-raising industries. In the former, milk supplies are likely to be heavily contaminated by flies. These insects are mechanic carriers of the enteric diseases, eye diseases and possibly poliomyelitis. In the opinion of some observers, they play a part in the transmission of acute infectious hepatitis.

                (b)    Gasterophilus Species. Several species of the horse hot flies are present in France. They are of little medical importance but in rare instances penetration and migration of larvae under the skin produce irritating, tortuous wheals several centimeters in length.

                (c)    Stomoxye Calcitrans. The stable fly, when numerous, may be an exceedingly annoying, biting, blood-sucking pest of man. These flies breed mostly in manure and damp straw contaminated by urine.

                (d)     Culicoides. A number of different species of “midges” may be important pests in localized areas. In many localities dense swarms of the tiny “midges “ attack man. Their bites produce irritating and itching lesions and, occasionally, systemic reactions. Usually culicoides develop in standing water in which organic debris is abundant.

                (e)    Calliphoridae. Flies of this species may deposit eggs that will develop as larvae in wounds. The larvae do not normally tend to destroy living tissue, but feed instead on necrotic tissue and accumulations of materials in wounds.

            (3)    Lice. In the portion of France with which we are concerned, lice are probably the insects of greatest medical importance. The crab louse (phthirus pubis), the head louse (Pediculus humanus capitus), and the body louse (Pediculus humanus corporis) are specific insect parasites of man. Their entire life cycle is spent on man’s body or in his clothing. They cannot breed off their host. All species are important from a military standpoint because of the irritation, loss of sleep, and predilection to secondary infections caused by their bites. Head lice and body lice transmit typhus fever, trench fever, and relapsing fever. While louse infestation was not particularly prominent in this section before the war, all reports indicate that the percentage of lousiness has increased tremendously. The principal predisposing factors are overcrowding and lack of soap, clean clothes and facilities for delousing.


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            (4)    Fleas. The fleas that might transmit disease in France are as follows

                    Xenopsylla cheopis        —     oriental rat flea
                    Pulex irritans            —     human flea
                    Ctenocephalides canis    —     dog flea
                    Ctenocephalides felis        —     cat flea
                    Nosopsyllus fasciatus        —     European rat flea

        The principal disease transmitted by fleas is endemic (murine) typhus fever.

            (5)    Ticks. Several species of ticks may be found but it is not believed that any of these transmit disease of any military importance.

            (6)     Mites.

                (a)    The “chigger” or “harvest mite” of Europe is Trombicula autumnal (Shaw). In the larval stage the mite is an irritating temporary external parasite of man. The common Trombicula of France is not known as a transmitter of diseases of man. The nymphs and adults of Trombicula are saprophytic and found in soil that contains organic debris. The mites are acquired by men walking through infested vegetation or coming in contact with infested straw.

                (b)    Sarcoptes scabiel var hominis. This species, the itch mite of man, also occurs in France. Its incidence has risen sharply since the war.

            (7)     Cockroaches.

                (a)    Blatella germanica, the “croton bug” or German roach, is abundant and troublesome in Europe.

                (b)    Blatta orientalis, the oriental roach, is restricted mostly to Southern Europe, but may be found in any of the ports.

            (8)    Rats. The brown sewer rat, Rattus Norvegicus, is very prevalent in Western Europe, especially in coastal and port areas. The black house rat, R. rattus rattus, is almost equally common. Both of these species may harbor plague and infected fleas.

            (9)    Snakes. The true vipers, genus Vipera, are the only poisonous snakes to be found in Europe. Some of their characteristics are a vertical pupil, relative small size, and a zigzag dark stripe down the middle of the back. The common specia to be found in Northwestern France will be the Vipera berus.

            (10)    Others. Numerous species of bees, wasps, moths, beetles and ants which are similar in habits to those found in the United States and which have painful stings, urticating hairs, or vesicating secretions, are found in the various Europeans countries.

        e.    Medical Facilities.

            (1)    Hospitals. Since the advent of war, there has been an apparent decrease in hospital facilities in continental Europe. This has been due to the increasing demands of war both in Germany and in occupied territory. In all the countries of Western Europe, the German authorities have taken over such hospitals as they need with little regard for local requirement. Hospital supplies have been stripped from many places and either transported to Germany or used to supply local German installations. With the exception of physicians, the staff of commandeered hospitals are usually required to remain and carry out their work under German supervision. There has been a marked shortage of


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such hospital supplies as linen, gauze and dressings of all types. There is also a considerable shortage of motor transport for use as ambulances. Waiting lists exist for nearly all hospitals receiving civilian patients. Four or five months may be required to have an open case of tuberculosis accepted by a sanitarium. Many individuals try to enter hospitals in the hope of obtaining better rations, but it is frequently the case that the food in hospitals is less plentiful and less palatable than that obtained outside. Up to the present time, there has been little, if any, destruction of hospital facilities. While supplies and equipment have been requisitioned, buildings have been left intact. If the usual “scorched earth” policy is carried out by the Germans however, it becomes likely that many hospitals and hospital buildings now in existence will be demolished. Most important and most likely to be destroyed are such important facilities as the Pasteur Institutes of Paris, Brussels, etc.

            (2)    Drugs, Equipment and Supplies. Although the import of such materials into German-occupied France has practically ceased, drug supplies have not decreased to critical levels except in a very few instances. There is a marked shortage of insulin and liver extract. There seems to be sufficient arsenic compounds remaining to supply the demands for antiluetic therapy. Chlorine supplies are sufficiently low to have necessitated curtailing their use for the purification of water. Bismuth stocks are dwindling. The supply of quinine and the synthetic anti-malarials is not adequate in occupied France. The Pasteur Institutes in France are still functioning and can supply adequate amounts of most of the necessary sera, vaccines and special biologicals. Difficulty has been experienced only in the manufacture of typhus vaccine. Typhus vaccine has been available only to doctors, nurses, other medical personnel and personnel of delousing units. Such surgical supplies as cotton, gauze, bandages and surgical linens are scarce.

            (3)    Medical Personnel. In occupied France, the conscription of physicians by the Germans to serve in the factories and camps in Greater Germany has created a grave medical situation. In spite of this, it seems probable that the standards of medical care have been maintained adequately. The physicians have been active participants in many of the campaigns directed against collaborationists and occupying German forces. Medical schools are still functioning and there has been no appreciative change in the medical curriculum. In general, the same statements apply to other medical personnel.

            (4)    Medical Institutions. The majority of France’s 24 medical schools are thought to be in operation though with somewhat limited resources.

            (5)    Laboratories. The principal laboratory functioning in France at the present time is the Pasteur Institute in Paris. State and municipal laboratories are also in existence.

            (6)    Social Services. The Red Cross remains active in France though its work is hampered by lack of funds.

        f.    Diseases of Military Importance.

            (1)    Enteric Infections. The enteric group of infections (typhoid fever, paratyphoid fevers, dysentery, gastro-enteritis and common diarrheas) are endemic throughout Europe, and during the war years they have increased considerably. Circumstances favoring the spread of these diseases include failure of normal water supplies, shortages of food, disruption of sewage disposal facilities, lack of pasteurization of such dairy products as are available


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the use of night soil for fertilizer, lack of control of carriers and the general deterioration of health in many localities. These diseases are spread primarily by contaminated food or water. There is increasing evidence that mechanical transmission of these diseases by the common house fly is very important in the spread of these diseases.

            (2)    Paratyphoid Fevers. The status of the paratyphoid fevers is parallel to that of typhoid fever.

            (3)    Dysentery, Diarrhea and Gastro-enteritis. It is frequently difficult to distinguish between these diseases, especially in wartime, when diagnostic facilities are curtailed or lacking. As a group, however, they are endemic throughout all of Western, Europe. Dysentery of the Flexner type is most common. Amebic dysentery is encountered infrequently, and is not considered important to the military forces. However, a seeding of the diseases may have been established by German soldiers returning from North Africa.

            (4)    Typhus Fever.

                (a)    Epidemic Typhus Fever. Epidemic louse-borne typhus fever always develops its greatest potentialities under the conditions of war and/or famine. Based on partial figures for 1942 and 1943, the incidence of the diseases is increasing throughout the continent. All the factors necessary for the propagation and spread of louse-borne typhus fever are present. The principal causes for the increased lousiness of the population are lack of soap, fuel and hot water, lack of sufficient clothing and linen, and marked overcrowding under unhygienic conditions. In addition, the qualitative and quantitative deficiency of the average diet probably has led to lowered resistance to diseases. Typhus fever has appeared in scattered localities throughout France, usually in prison or internment camps, or among repatriated workers or soldiers. These apparently have been dealt with promptly and no outbreaks among civilians have been reported. Health authorities, both German and French, have been active in stamping out such localized manifestations. Typhus fever at present is a controlled threat to the health of all Europe. Under the continued exigencies of war, with mass movement of troops and civilians, and breakdown of normal safeguards, the disease represents a serious hazard to all military forces operating on the continent. Immunity may be developed artificially by vaccination, but it should not be assumed that absolute protection is thus produced. It is probable that a few mild non-fatal cases will be encountered.

                (b)    Endemic Typhus Fever. Endemic typhus fever is a milder form of typhus transmitted through the bite of infected fleas. It is limited to a few areas in Northeastern and Southern France.

            (5)    Infectious Hepatitis. One of the major medical problems of the present war has been the development of acute infectious hepatitis. The term “hepatitis” is preferred since jaundice may not always occur. The disease has an apparently worldwide distribution and is very prevalent in Europe. This disease is sufficiently serious to be a military hazard since it attacks large groups readily, fatalities are not uncommon, and convalescence is prolonged.

            (6)    Venereal Diseases. Accurate figures on the incidence of venereal disease in Western Europe are not available, especially since many cases are not reported. Such information as can be obtained indicates that conditions are much better in Germany than in any of the occupied countries. But venereal disease continues to be an accentuated problem in wartime because of increased


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promiscuity and difficulty in applying proper control methods. According to the meager figures available, the proportionate increase in syphilis has been much greater than for gonorrhea. This may be explained in part by the large soldier population, who may ber4nfected but not reported in official statistics, and by the efficacy of the sulfonamide drugs in gonorrhea. However, if all cases could be totaled, it is very likely that gonorrhea also would show a marked increase. Germany has used every method possible to prevent spread of venereal disease, especially in the case of the Wehrmacht. Venereal diseases in France are reported to have trebled in the last three years. It becomes obvious that the increase in gonorrhea is masked, and that both this disease and syphilis are increasing steadily. It is therefore probable that these diseases will constitute one of the most difficult control problems to be encountered in France.

            (7)    Respiratory Diseases.

                (a)    Upper Respiratory Infections. These are common at all times though their periods of maximum incidence are seasonal. Regardless of the appearance of such infections in the civilian population, these diseases will always rank as important causes of non-effectiveness among military forces.

                (b)    Influenza. No accurate statistics are available on the incidence of influenza in Europe. Mild epidemics have occurred in the United Kingdom and the United States, and Berlin is reported to have experienced an attack of a respiratory infection termed  bomb-shelter disease. The Berlin epidemic, said to number more than 500,000 cases, appeared among individuals confined in bomb-shelters during the recent attacks on that city. Clinically the disease is said to have resembled influenza. Civilian epidemics of this disease represents a source of danger to military forces in the areas where it is prevalent. Because the disease is seasonal, significant attack rates will not normally be expected at this time of year.

                (c)    Pneumonia and Bronchitis. Judging from such figures as are available, there has been some gradual increase in the incidence of pneumonia and bronchitis in Western Europe. Lack of fuel for heating, poor housing facilities, overcrowding and varying degrees of malnutrition probably are responsible for the rising rate. Under ordinary circumstances the appearance of these diseases in Army forces will be due to climatic and operational difficulties rather than to their prevalence in the civilian population.

            (8)    Skin Diseases. Statistics are of little use in estimating the frequency of the parasitic and infectious diseases of the skin. There is abundant evidence that skin diseases of all types have increased markedly during the war. Dirt, filth, overcrowding and shortage of clothing, soap, fuel and hot water all contribute to the development of these conditions.

        Louse infestation has been mentioned previously, and there also has been an increase in human flea infestations. Scabies is extremely prevalent in all the countries of Central and Western Europe, and the number of cases seems to be steadily increasing. In addition to the parasitic afflictions, infestious conditions are very common. Impetigo and pemphigus are mentioned frequently, along with other types of pustular dermatitis. These diseases may be due in part to the marked qualitative deficiency of the diet of many of the infected individuals. With a normal diet and proper attention to personal hygiene, they will be of little concern to the soldier. Under combat conditions, however, skin


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infections and infestations will be frequent and troublesome, and unless properly cared for may be productive of considerable lost time.

            (9)    Trench Fever. Trench fever is a virus disease transmitted by the body louse. First knowledge of this infection was acquired during the first World War, when large numbers of cases appeared in most of the Armies fighting in Europe. Since that time the disease has been conspicuous by its absence. There have been no definite reports of the occurrence of trench fever during the present conflict, though small outbreaks of undiagnosed fevers have occurred in scattered localities which might have been trench fever. There have been no reports of the disease in Germany or the other countries of Western Europe. However, German forces in France are cautioned by medical officers that this is one of the ten principal diseases of importance to military forces in this area. This importance lies in the fact that although the disease in not fatal, the attack rate is extremely high, and the convalescent period is prolonged. It is entirely possible that outbreaks will appear during the present conflict, and if so, large numbers of cases may be expected if louse infestation is prevalent. Elimination of the louse eliminates the disease.

            (10)    Malaria. Western Europe is not considered to be highly malarious in any part. Cases occur throughout the area, including France. With the deterioration of malaria control programs and introduction of new cases from other regions, it is probable that the frequency of malaria in Western Europe will gradually increase during the course of the war. It is not anticipated that this disease will constitute a military problem in this area.

        g.    Diseases of Potential Military Importance.

            (1)    Tuberculosis. Of all the serious diseases present in Europe today, tuberculosis is considered to be the most dangerous to the general population. While no definite figures are available for France, French authorities estimate that there are over 1,500,000 infected individuals in that country at the present time. To prevent further spread of tuberculosis among civilians and to forestall any possible occurrence of cases in troops, armies of occupation must be prepared to assist in the application of control and remedial measures designed to protect soldiers and civilians alike.

            (2)    Contagious Diseases.

                (a)    Scarlet Fever. Scarlet fever has been the most prevalent of all contagious diseases in Europe during the past few years. The incidence has risen steadily and during 1942 and 1943 the disease has reached epidemic proportions in some areas. Information as to its distribution in France is inconclusive however, scarlet fever should be considered a potential hazard.

                (b)    Diphtheria. While no figures are available in France, it is known that the incidence of diphtheria has increased tremendously since the beginning of the war. Mass immunization has been ordered for the children in the rural districts of France.

                (c)    Meningitis. Epidemic cerebro-spinal meningitis appears to occur in cyclical variations of great amplitude at intervals of about ten (10) years. The last of these occurred during 1939, 1940 and 1941. It is believed that the peak has been passed and that the disease is now on the decline.

                (d)    Poliomyelitis. Poliomyelitis is endemic throughout the entire continent. It appears in epidemics at irregular intervals and at such times may be considered of importance.


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                (e)    Smallpox. France reported 63 cases of smallpox in 1942. Universal vaccination should protect troops against any possible outbreak of smallpox.

                (f)    Rabies. The incidence of rabies appears to have increased somewhat, though not to any serious extent. Normal facilities for the preparation of preventive inoculations still exist.

                (g)    Tetanus. Because of the large agricultural areas in Western Europe, it is natural that tetanus should be a fairly frequent occurrence, especially in the rural areas. Routine immunization should protect American troops against this disease.

                (h)    Additional information will be gathered by the Army Surgeon’s Office as soon as possible after arrival on the continent, and will be made available to all subordinate surgeons.

13.    RESPONSIBILITY

        Responsibility for sanitation will be as defined in 4R 40-205, FM 21-10, and FM 8-40.

14.    DISEASE PREVENTION FOR CIVILIANS

        The Medical Corps will supervise measures to be taken for the prevention of the spread of disease among civilians likely to affect the health and efficiency of the troops and will render such other assistance as the instincts of humanity dictate providing such assistance can be given without prejudice to military requirements.

15.    HYGIENE

        Troops must be impressed with the necessity of maintaining the highest possible standards of personal hygiene. This is particularly important in France, where infestation with lice which carry typhus, trench fever and relapsing fever, and mites, the cause of scabies and dermatitis, are highly prevalent. Education and training of all personnel in the importance of personal cleanliness, care of mess gear and handling of food will prevent much enteric disease.

16.    PHYSICAL INSPECTIONS

        a.    Pre-embarkation. All personnel will be given a physical examination within twenty-four (24) hours of departure from the marshalling area.

        b.    Semi-monthly. All enlisted men will be examined twice each month. Evidence of louse infestation will be searched for particularly.

17.    SEA SICKNESS PREVENTION

        a.    All troops will be supplied with Sea Sickness Prevention Capsules prior to embarkation. These capsules are safe when given as prescribed below and their efficacy has been well proven.

        b.    These capsules will be issued to the Commanding Officer of troops for each craft. Such issue will he made in the marshalling area, on the basis of ten (10) capsules for each person on the troop list.


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        c.    The capsules will be administered on the following schedule

            (1)    One (1) capsule, by mouth, one-half hour before embarkation.

            (2)    One (1) capsule, by mouth, when the ship or craft leaves the harbour, and is exposed to motion.

            (3)    One (1) capsule, by mouth, every four (4) hours night and day thereafter, for the duration of the voyage (or until the entire ten (10) capsules have been taken).

        d.    When a medical officer is included in the troop list of a craft, he will be responsible for the supervision of the administration of the sea sickness capsules. When no medical officer is included in the troop list, the capsules will be administered under supervision of the Commanding Officer of troops, in accordance with the schedule given in paragraph a (3) supra.

18.    WATER

        a.    Only water issued by the Engineers or carried in cans from U. K. will be considered safe. (See Engineer Annex.)

        b.    When necessary to use water not treated by the Engineers, or carried in cans from U. K. it will be treated in Lyster bags as outlined in paragraph 46, FM 8-40, as amended; or will be treated by Halazone tablets in the canteen by individuals.


19.    VENEREAL DISEASE

        a.    All troops will be thoroughly indoctrinated prior to embarkation with the danger from venereal diseases in the country to be occupied. (See Section VII, paragraph 12, f, (6).)

        b.    Both chemical and mechanical prophylaxis must be available to troops at all times. Mechanical prophylactics will be available to all troops in the marshalling area. While these prophylactics will not be a forced issue, the men should be advised and encouraged to accept and carry them.

        c.    Organizations with medical detachments will establish prophylactic stations at the earliest possible moment after occupying a new town. Organizations without medical detachments, or unable to establish prophylactic stations for any other reasons, will report such facts immediately to the Army Surgeon. (To Division Surgeon for division units or Corps Surgeon for corps troops.)

        d.    The Army Medical Service will be prepared to diagnose and treat the bulk of venereal cases within the army area, and thereby prevent their evacuation to the Communications Zone.


20.    WASTE DISPOSAL

        a.    Human Excreta. Waste of this type will be disposed of as dutlined in paragraphs 21-26 inclusive, FM 21-10. Troops will be impressed with the need for careful waste disposal in order to protect themselves from fly-borne diseases.

        b.    Garbage. This class of waste will be disposed of as outlined in paragraphs 29-33 inclusive, FM 21-10.

        The methods employed will depend on stability of the military situation and the type of soil encountered.


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21.    TREATMENT OF GAS CASUALTIES

        a.    All personnel must be on the alert for toxic gas at all times. The American soldier, when well trained, is adequately protected against all known types of toxic gases. (See Chemical Warfare Annex.)

       b.    The individual soldier must be prepared to use ointment, protective and —1 eye ointment in emergency treatment of vesicant injuries.

        c.    All echelons of the Medical Service are now equipped to treat chemical injuries of all types.

        d.    Army will stock supplies of necessary materials for treating chemical casualties and will be prepared to augment second and third echelon Medical Service with elements of a Medical Gas Treatment Battalion, if required.

22.    IMMUNIZATIONS

        a.    Small Pox. All personnel will be revaccinated each year.

        b.    Typhoid. All personnel will be given ½ cc of Triple Typhoid Vaccine each year.

        c.    Typhus. All personnel will receive 1 cc of Typhus Vaccine as directed later.

        d.    Tetanus. Personnel will receive 1 cc of Tetanus Toxoid each year. plus a booster dose of 1 cc if wounded.

23.    MESS SANITATION

        a.    Great care must be used in washing mess gear to avoid the intestinal diseases since the great numbers of flies will tend to cause epidemics of diarrhea and dysentery.

        b.    When possible, mess gear will be washed in one boiling soapy water and two clear boiling waters.

        c.    In addition, it is desirable that a can of boiling clear water be available for rinsing the gear prior to eating.

        d.    See paragraphs 36-44 inclusive, FM. 21-10; and paragraphs 95-107 inclusive, FM 8-40.    

24.    CARE AND INSPECTION OF RATIONS

       a.    Army and Division Veterinary Surgeons will make regular “spot” checks of rations at army and division ration dumps.

        b.    All necessary precautions will be taken to protect rations from rats, dogs and insects.

        c.    See paragraph 98 and paragraphs 108-126 inclusive, FM 8-40.

25.    MILK

        No fresh milk will be consumed on the continent by troops of the First U. S. Army.

26.    CONTROL OF RESPIRATORY DISEASES

        A relatively high incidence of respiratory diseases may be expected during the early period on the continent. Unit commanders should exercise control


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as listed in FM 8-40 “Field Sanitation”; FM 21-10 “Military Sanitation and First Aid” ; and AR 40-205.


27.    CONTROL OF DIARRHEA AND DYSENTERY

        a.    The control of the intestinal diseases depends on adequate fly and rodent control, plus adequate mess management and sanitation. Proper storage of foods and purification of water is also essential.

        b.    Any outbreak of gastro-intestinal disease will be promptly reported to the Army Surgeon who will be prepared, by use of the Army Medical Laboratory, to aid unit surgeons in making an early diagnosis in these cases.


28.    RAT CONTROL

        a.    Rats may become a very serious problem on the continent. They will be controlled as prescribed in paragraphs 179 to 196 inclusive, FM 8-40.

        b.    It must be remembered that these rodents are disease carriers in addition to being very destructive.


29.    SCABIES

        a.    Scabies is prevalent among the civilian, population and cases in the army must be anticipated.

        b.    Army Medical Supply Depots will stock adequate supplies of Sulphur Ointment and Benzyl Benzoate Ointment for the treatment of all cases.

        c.    Unit surgeons should be on the alert for this condition while carrying out their semi-monthly inspections and all troops should be encouraged to report to the unit surgeon as soon as the disease is suspected.


30.    LOUSE CONTROL

        a.    Since body lice are to be found throughout, it is inevitable that some American troops will become lousy. Lice are extremely annoying in addition to being carriers of Typhus and Trench Fever.

        b.    Each person will be issued one can of dusting powder in the marshalling area. Full directions for use of this powder are clearly printed on the can and when used as directed, will rid the individual of all or most of his lice.

        c.    Soon after D + 14, the Quartermaster will be prepared to operate delousing stations for the disinfestation of an entire unit at one time.

        d.    Methods of louse control are outlined in paragraphs 54 to 67 inclusive, FM 21-10, and paragraphs 165 to 178 inclusive, FM 8-40. DDT impregnation of clothing and mass use of DDT powder may become necessary control measures.


31.    FLY CONTROL

        a.    Many of the days lost from duty will be due to diseases carried by flies. Success of the operation might well depend on the degree of fly control exercised.

        b.    Every effort will be made to control flies, using the control measures outlined in paragraphs 34 and 35, FM 21-10 ; and paragraphs 127 to 140 inclusive, FM 8-40.


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VIII.  SPECIAL SANITARY PRECAUTIONS

32.    DELOUSING OF CIVILIANS

        Civilian laborers will be required to remove their clothing and thoroughly dust the clothing and body with anti-louse powder before working in the same area with American troops.

33.    TUBERCULOUS CIVILIANS

        Since the incidence of Tuberculosis is extremely high in France, especial care must be taken to protect the troops. No civilian laborer with a persistent cough or any other sign of Tuberculosis will be allowed to work in close proximity to American troops until such laborer has been examined and found free of Tuberculosis by an American Army Medical Officer.


IX.   MISCELLANEOUS

34.    SALVAGE OF CLOTHING AND EQUIPMENT

        a.    For disposition of salvage clothing and individual equipment accumulated at medical installations, see Quartermaster Annex.

        b.    Army medical installations will notify the Army Ordnance Officer or the nearest Ordnance installation when any bulk of Ordnance equipment (rifles, grenades, etc.) has been accumulated.

35.    CIVIL LABOR

        (See Civil Affairs Annex and G-4 Annex.)

36.    FINANCE

        Funds will be available for the local purchase of items which are required and are not available from Army sources. The Army Medical Supply Officer is the designated Purchasing and Contracting Officer for such items (See G-4 Annex).

37.    PATIENT’S MAIL

        (See paragraphs 2, b (4) and 2, b (5), G-1 Annex.)

38.    MEDICAL SERVICE FOR PW ENCLOSURES

        The Army Surgeon will be prepared to furnish medical service to army PW enclosures on call, utilizing detachments from the Army Medical Groups. Later, this task should be assumed by enemy medical personnel under American Army supervision.

39.    DENTAL

        a.    Organizations requiring dental care will contact the Army or Division Dental Surgeon. (Army Surgeon for army and corps troops; Division Surgeon for division troops.)


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        b.    Facilities for repair of dentures and other emergency prosthetic procedures will be available at all evacuation hospitals and at such other installations as the Army Dental Surgeon may designate.

40.    BURIAL OF THE DEAD (See Quartermaster Annex.)

41.    CLOTHING AND INDIVIDUAL EQUIPMENT FOR DUTY CASES

        a.    Hospitals will be authorized to carry in stock approximately fifty (50) sets of clothing and individual equipment to be issued to cases, principally exhaustion cases, returning directly to their units from hospitals.

        b.    Those cases going to duty through the Army Replacement System will be issued their individual equipment and the bulk of their clothing at the Replacement Depot.

42.    MEDICAL DEPARTMENT REPORTS AND RETURNS

        Any special instructions covering Medical Department reports and returns will be issued under a separate cover at a later date.

43.    MEDICAL DEPARTMENT TRANSPORTATION RETURNING TO THE FRONT FROM ARMY

        Corps and divisional medical installations will be utilized to transport exhaustion cases which are ready for duty.