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Excerpt from Company "C", 261st Medical Battalion, APO 230, U.S. Army, 1 July 1944

Operation Overlord

EXCERPT FROM

COMPANY "C"

261ST MEDICAL BATTALION

APO 230, U.S. ARMY

1 July 1944

SUBJECT:  Report of Operations in France - 6 June 1944 to 30 June 1944

TO: Commanding Officer, 261st Medical Battalion

* * *


5

III.  OPERATIONAL REPORT

* * *

2. Voyage:

At 1730, 5 June 1944 the convoy sailed. The voyage was uneventful, and we awaked the morning of 6 June 1944 to see the hazy coast of France being shelled by our battleships and cruisers. Puffs of flame and smoke on land indicated the targets. Overhead swarmed the allied fighter planes that warded off any attempts by the Luftwaffe. Only seven enemy planes were seen by day, during the entire operation; and six fell to


6

the hail of ack ack while still in plain view.

About 0930 hours the personnel began to transfer from LCI #513 to two LCM's for the landing. The first two loads came ashore without wading; the second group waded waist deep. The first group landed at Tare Green Beach, and encountered no fire:  but the second LCM loads ran upon Uncle Red Beach and encountered heavy 88 fire that was kicking up water-spouts and bursting in the air. The two groups landed between 1030 and 1100 hours. The engineers had cleared one twelve foot lane from the beach, and toward this we were directed. There was a group of casualties at the Navy beach company station. The engineers were laying matting on the beach end of the cleared strip. Either side of the lane sappers were sweeping and lifting mines to widen it. The lieutenant in charged assure us there was a path through to the first road paralleling the beach, but damped our spirits by stating he had had casualties from snipers while clearing the path a short time before. In single file dispersal we followed the tapes, passed reserve infantry that had just landed. We had been informed that the beachhead was about 1½ miles south of the planned location. When the column reached the inland road we turned north to proceed to the predesignated area. The sound of a German machine gun ahead showed that the way was blocked. A halt was made for reconnaissance. A flat field a hundred yards south of the junction of beach road and inland road, was selected (at coordinates 443-967, GS 4490 Map of France).

The pathfinders set to work at probing, followed by group after group of probers. No mines were found. Just as the probing was finished Lt Keiser and part of the collecting platoon arrived, about 1200 hours. He brought the two trucks with him and one jeep. Unloading began at once, and setting up of the tents as soon as they were set off the trucks. By 1400 hours the four central tents were set up and equipment in order for functioning, except for surgery. The delay there was because part of the essential equipment was on the three jeeps that had drowned out in disembarking. These jeeps did not arrive until 1600 hours, and another hour was then required to complete the set-up of the surgery. This experience has led to a decision not to use jeeps again for critical equipment.

As soon as the first corner of the area had been probed one admission crew and the surgical teams began to receive and treat casualties. Plasma and oxygen were given. By the time the tents were up, and surgery ready, several cases were ready for operation.

The work of the company was fast and remarkably smooth, surpassing all expectations. The NCO's supervised every detail of setting up, and doctors were entirely free to look after the casualties. The scream of shells passing over and the explosions on the beach to the rear, scarcely caused concern, and certainly caused no hitch.

By 1800 hours the jeeps with the DUKW company had arrived after also having been drowned out. Next morning the two DUKWs discharged the balance of our equipment. There was this almost perfect coordination in the landing of personnel and equipment groups - the most nearly perfect we have ever seen. It aided immensely in the rapidity of getting to work.

This company had the distinction of setting up the first station and doing the first surgery on either beach. By late evening of D day Company "A", only part of whose equipment had arrived, had a surgery in operation. Company "B" landed about 2000 hours of D plus 1, and its officers and men relieved our personnel during that night, while the Company "B" station was being erected alongside ours. By late D plus 1, or on D plus 2, the 4th Medical Battalion Clearing Station had begun operations to help handle the flood of work. Part of the 42nd Field Hospital personnel landed D plus 2, and stayed in our area until D plus 4. Until D plus 4, the first four days, the only surgical care available was offered by the companies of the 261st Medical Battalion, and all evacuation was through them.


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3.  Analysis of Records.

The volume of work handled is reflected in the attached copies of the Combat Medical Statistical Report, Form 323m covering the month of June. A total of 5996 casualties. The work would have bogged down but for the lessons in organization learned in Sicily and applied during the training since.

Casualties by type for the period 6 June 1944 to 9 June 1944 inclusive are shown. The breakdown is given for this time only because only these days show the true casualty situation since all were coming here. Later the situation was altered by retention of non-transportables at field and evacuation hospitals. Patients with wounds of two regions are listed twice. This but gives the distribution of the wounds:

 

June 6

June 7

June 8

June 9

Total

Head

5

40

26

10

81

Neck

6

17

6

10

39

Face (eyes & jaws)

7

59

20

29

115

Chest

15

42

30

20

107

Abdomen

5

15

7

7

34

Upper Ext.

41

135

56

87

313

Lower Ext.

67

336

164

140

707

Fractures

10

210

89

41

350

Backs

12

38

20

27

97

Buttocks

3

15

5

20

43

Multiple

33

97

66

75

271


A copy of the report of the work of the two surgical teams is appended to the rear of this report.'

Of 5968 patients who arrived at the station alive during June, 25 died, or .42%.

The most significant figures concerning mortality is that for the first four days when all casualties were being received, or all types, by the company, 1459 cases were disposed of and 103 were remaining - a total of 1562. Of these 28 were dead on arrival, leaving 1534 patients who were received alive. Deaths among these during the first four days, and later post-operatively, were 18, making 1.17% for the record of one clearing company handling run-of-the-mill casualties.

There was but one casualty among the company personnel: compound fracture of the left tibia and penetrating wound of the left popliteal area from 88 shell fragments. This was suffered by one of the men doing litter bearing for the navy on the beach.

4. Discussion of Functions during operations.

(a)  From 6 to 9 June inclusive the company handled evacuations and offered surgical care to all non-transportable patients. The rush of work was too great to do more than life saving measures which included treatment of penetrating wounds of abdomen and chest, treatment of head injuries, and cleaning up of traumatic amputations. There was not sufficient time to place all the extremity fractures in plaster casts, only the more serious extremity wounds received this treatment. For the rest splints were checked and adhesive traction was applied in place of strap traction. Even with this limitation on the scope of the work a twenty four hour backlog operations occurred. To have handled the situation fully at least one more surgical team and a fifty percent increase in clearing platoon personnel would have been necessary.

(b)  With the arrival of field and evacuation hospitals on 10 June these installations began to remove a large part of the surgical load. The role of the company became


8

chiefly evacuation, by sea. In fact all evacuation from Utah Beach has been by sea. Loading has been by trucks and jeeps to dried out LST's and LCT's, and by DUKWs to LST's in the harbor, Variations such as loading LCM's and LCVP's from land vehicles and transportation to LST's and hospital carriers by these smaller boats had been used. Mostly the loading has been after high tide when the beach is dry out to the ships. Evacuation has been held in excellent manner by the 2nd Navy Beach Battalion.

The surgical work was limited to casualties from nearby areas admitted directly and to treatment of an occasional patient drawn from the evacuation line who was not holding up well on the trip, and needed further treatment.

We would like to protect against a tendency to unload undesirable cases upon the beach clearing companies. A little too often we received cases whose treatment or disposition represents a knotty problem, and which finally came to rest here at the end of the line. One of the favorite forms is gas gangrene; and on one occasion this company received eighteen cases four of whom were in no sense fit to be transported. For the most part we had merely to examine the casualties and take from the line the few who needed further holding before transportation.

(c)  On 24 June we received orders to hold patients who could be returned to duty within ten days. It is our feeling that this is an improper policy. In the first place there are no bathing facilities here; and the feeding facilities are decidedly second rate. Granted that the judgment about recovery is correct in all cases, we feel that men so long held in these surroundings is bound to feel pretty crummy and rather lacking in enthusiasm. Besides, their presence soon takes up the major portion of our tent capacity and interferes seriously with our primary mission of evacuation. This situation occurred when the large number of wounded prisoners from Cherbourg came back to us. We believe that such men wounded in combat should certainly be favored with more thoughtful provisions.

(d)  On 25 June we received instructions that we would received preoperative patients. Just when we were to expect was not made clear; but the group that arrived was made up of undebrided cases three and four days old, with infected wounds. Among them were two cases of gas gangrene. All that could be done was to lay open certain of the wounds. About this conception of the function of the surgical team that remained with the company, we would say that if the wish is to keep them occupied, that the patients be sent back the day they are wounded, and not after they have been neglected.

In general, it has not proved very satisfactory to try to mingle too much the types of things the company is expected to do.

IV.  Critique

1. Plans and Training:

It can be said that the aims of the program of training were more than fully accomplished. In action, in every department, more was performed than one could reasonable have expected. There were certain deficiencies that came to light - but these were minor, and mostly peculiar to the situation.  Certain changes were made to meet unusual demands. But the training proved to be essentially sound; and the operation revealed no glaring needs.

a.  There is need of more elasticity of personnel. More of practical work with patients is needed if any betterment of the work us to be had. It is more than certain that there is no need for the dull, didactic classroom lecturing that has been too prominent and overworked  a feature of training in the past. Not only do men who have performed so capably not need this; they will gain nothing from it.


9

b.  The shortage of personnel for the job here was acute. The only way to augment the hospital function is to train the motor assistant drivers and the litter section fully in the work of the clearing platoon. These men could then be used to augment the clearing personnel, and litter-bearers could be got from army troops or from prisoners of war. There is no way of adequately manning the five extra tents that have been used in this operation. The process of training these extra hands is already actively under way while there is opportunity to do practical work. There is no other way. It is still our conviction that the best training this organization has ever had was the period of infirmary operation in Arzew, and that after the initial week in Sicily.

2.  Surgical Teams:

a.  The value of the period of association and training with the two surgical teams cannot be overestimated. It gave time for them to inventory the equipment, to train the men, to find out the requirements of this type of work. The differences from the Sicilian experience, where the teams picked up in the beach, was most apparent. There was no lag because surgeons and our technicians did not know the abilities and wishes of each other. There was time to procure the things needed, and to train in their use.

b.   There should be some sort of standard list of supplies to be given to the companies when surgical teams are attached. This would obviate all the confusion of inventory, requisitions, and delays in delivery. Some of the prospective training of the shock, post-operative and surgical technicians could not be done because some essential equipment did not arrive until after movement to the marshaling area. There might also be some lessening of the scramble to satisfy the individual preferences and idiosyncrasies of different surgeons.

c.   A good bit of equipment had to be constructed of improvised. Tables are indispensable. One of the most useful items were Mayo-type instrument tables so made that they could be clamped to the sides of a litter.

d.  In this operation an additional surgical team could have been used. This would have lightened the burden upon those present. It would have also made available surgeons for more work in triage.

3.  Supply:

a.  The promised daily medical supplies did not arrive. Owing to this, there was a shortage of litters and blankets the first day or two.

b.  Much greater quantities of plaster must be carried.

c.  Very little citrate is necessary if whole blood is supplied, as it was during this operation. This blood supply was tremendously important, for the rush of work would have made impossible the drawing of a tenth of the blood which was actually used.

d.  The extra generator proved indispensable. One should not have carried the load; and one did break down during the operation, and had to be replaced.

e.  The fluoroscope is decidedly a luxury. As yet, no use has been made of it. It is conceivable that it could prove useful in the operation of a station such as we ran in Agrigento, where no other facilities existed.

f.  We need four dozen surgical gowns.

g.  Other isolated items needed are: one additional basic instrument set; pelvic rest; a total of three dozen intravenous sets equipped with Murphy observation tubes; 1½  dozen Levine tubes; three dozen screw clamps for regulating rate of flow in intravenous infusions; four thermos cans for serving food to patients; much more ether for anesthesia.

h.  Another set of mess equipment for feeding patients.


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4.  Loading and Movement:

The transportation allotted for this operation is adequate. But hardly less would do. The lesser ability of jeeps to withstand washing has decided us against using them to carry critical supplies. Two DUKWs and two trucks can carry the essentials for station operation. For the evacuation activity of this operation, eight jeeps were not too many.

To carry all the supplies and equipment, five 2½ ton trucks are necessary.

5.  Coordination of the different groups at landing was almost perfect. This has occurred so rarely in either practice or operations that one still wonders if this was accidental.

6.  Evacuation:

This process was well understood by all concerned. This operation demonstrated again the impossibility of using this company for forward collection of casualties. From maneuvers the 4th Medical Battalion had learned well this requirement, and they brought in a large number of ambulances that saved the forward situation. Our jeeps are fully employed in evacuating to the beach.

7.  Records:

These are still too many and too complicated for use in the heat of battle. It is stupid to have to devote so much time to these, to the neglect of more important treatment of patients. Yet this actually happened. Records cannot be full under such stress. Nor, for the sake of them is it justifiable to undo every wound, and risk the introduction of infection, just to determine the exact description of the lesion.

No record of the amount of blood and plasma consumed, or of penicillin used, was kept. The time and attention of the too few men present are too valuable to be frittered away in the keeping of tallies.

8.  Gas Gangrene has been one of the badly handled things. There should be some center established on the peninsula where only these cases are treated. A program could then be launched, and some study made to determine whether the outlook must continue to remain so grave in this not uncommon infection. The present policy has been to shunt these cases off upon whomever is meek enough to accept them; and to run the risk of cross-infection.

V.  Conclusion

The personnel of this company have come a long way, and learned much since their initial venture in Sicily. There is no question that they are proved and able veterans, and recognized general as such by all who saw their work.

To improve upon the present capabilities of the company I can see but two important possibilities

(1) To increase the number of phases of medical work of which each man is master, so that all but a few drivers and a few litter section personnel is capable of assuming full duty with the clearing platoon.

(2) To enlist litter-bearers from army or corps to replace the regular company personnel who must work in the hospital section.

[signed]

Raymond L. Skinner, Major, M.C.

Commanding


REPORT OF SURGICAL TEAMS NUMBERS 1 & 2

The following is the account of TRAUMATIC SURGICAL TEAMS 1 & 2 which left their headquarters (Third Auxiliary Surgical Group) on March 27, 1944 to be attached to Company "C", of the 261st Amphibious Medical Battalion in Truro, Cornwall, England. Six such teams were attached to this battalion, two to each company, but only the statistics are entirely available of "C" Company. Team personnel follows:

1:  Major Boyden, Captains Floyd, Jones, and Dodds;

2:  Major Zeiders, Captain Kempner, Pritchett, and Parrott.

Immediately on arrival the company moved on an amphibious maneuver off Slapton Sands, Devon, returning to Truro April 1, 1944. A training program was instituted immediately, the objects being, 1, to establish an adequate operating pavilion, 2, to establish adequate pre and post-operative setup and 3, to arrange definite duties for each officer and enlisted man. Major Boyden who had previous experience in North Africa and Sicily, had almost complete responsibility for supplies and only through his efforts did we finally obtain the essentials. It might be pointed out here that the training program was continuously balked by failure of supplies to arrive; many most important items actually did not reach us until late in the final marshaling area, period.  However, stress was laid on the operating room setup which reached maximum efficiency.  A second amphibious maneuver covering the period April 22 to May 1at. The same beach was made. Further corrections in our tents and OR setup were found necessary and subsequently made.

The company moved to the final marshaling area May 16 for instructions, briefing etc. Here contact was made with the Navy Beach Battalion, and association which on the invasion made for close cooperation and excellent evacuation of patients. The association of the surgical teams and the medical battalion was mutually beneficial, individual duties being designated, confusion being avoided, and a reasonably calm efficient unit resulting. The battalion had had previous experience in Sicily and that training under fire was later to prove of great value; certainly the surgical teams were grateful for being attached to this particular veteran company. On June 22, we moved from the marshaling area to the assembly area where we remained during stormy weather aboard LCI 513 until sailing time. We left the Dart River anchorage off Dittisham, at 1715 hours on 5 June 1944, made rendezvous with other elements of the invasion fleet of Dartmouth Harbor at 1800 hours and were off under escort from sea and air. H Hour was 0630 of 6 June; we arrived on schedule without undue incident, transferred to an LCM and beached at H-4 with the assault group. We learned later that our LCI sank fifteen minutes after

we left her. The beach and fleet had been and continued to remain under large and small enemy fire throughout D Day; parenthetically, the German's strong point on the north end of the beach was not neutralized until D-1. The medical battalion having waded ashore with full equipment and some carrying plasma and additional medical supplies, moved forward rapidly towards its pre selected area only to find it still occupied by German machine gunners. Another area was necessarily selected some distance away. Before the team tents could be pitched the group itself demined the area approximately two hundred fifty feet square since the sappers had not moved so far forward yet. When an area about twenty feet square had been cleared, casualties began to arrive and were treated in the small spot; Captain Parrott intubated and administered oxygen to a lieutenant with a serious chest wound here. Two hours were required for this demining; tents were pitched and we were in full operation by 1600 hours. It might be pointed out here that all equipment was carried on two DUKWs, two trucks and six Jeeps. Some of the jeeps were drowned out and the delay in recovering equipment from them prevented earlier erection of tents.


2

The first operation was performed about 1700 hours, a case of evisceration with trans-section of the stomach. From 1300 hours of D Day until D-4, the Surgical teams worked without rest. Until that time, when evacuation and field hospitals went into operation, all casualties from this area were treated by the medical battalion on the Utah Beach; we were told that instead of receiving from one division only, according to plan, we received from five.

Air attacks during daylight hours were minimal after D day when our own A.A. was amazing1y accurate; the rights for the two, following weeks were another matter however, especially an D-7 when as the company morning report reads "Air activity heavy; dive bombing close; tents pierced." The banging overhead of A.A. fire required getting used to and was especially annoying to the operating teams which could of course seek no other shelter than that of their helmets. The area was under small arms fire for approximately two days. The fire of German 88's on the beach persisted in decreasing amounts until D-9. Artillery fire in the distance is still clearly audible. We were not strafed at any time although for three days we mistook our   advancing A.A. fire of machine gun variety for strafing.

Some explanation of the following statistics will be necessary. What is recorded is true but due to the limited nature of reports, much is omitted; for instance only the major wound of multiple wounds is recorded. Evaluation as to slight or serious wounds is impossible. Post operative records, fluids, etc., are inaccurate occasionally and often absent. Medical admissions, battle exhaustions etc, are not included in breakdown of figures, only total admissions; accordingly  there may seem to be some discrepancies  which are not real. The great number of casualties is the only excuse for the incompleteness of the records.

Evacuation for Company "C" only follows for the first week with the original four day period bracketed;

June 6

38

1459

June 7

696

June 8

343

June 9

382

June 10

373

 

June 11

417

 

June 12

308

 
 

2557

 

Disposition of cases;

 

June 6

June 7

June 8

June 9

Total

Total Treated

155

711

446

485

1797

Ret. To Duty

1

3

1

0

5

Transferred

11

1

0

0

12

Evacuated

38

696

343

382

1459

Died

11

27

0

0

38


3

 

June 6

June 7

June 8

June 9

Total

Head

5

40

26

10

81

Neck

6

17

6

10

39

Face (eyes & jaws)

7

59

20

29

115

Chest

15

42

30

20

107

Abdomen

5

15

7

7

34

Upper Ext.

41

135

56

87

313

Lower Ext.

67

336

164

140

707

Fractures

10

210

89

41

350

Backs

12

38

20

27

97

Buttocks

3

15

5

20

43

Multiple

33

97

66

75

271


Only non-transportable cases were operated by the surgical teams, all others being evacuated as soon as possible, i.e. depending on time, weather, and condition of patient. Many were held tor treatment of shock, observation, etc. We had planned originally to treat compound and simple fractures of the femur with plaster fixation of some type but the overwhelming number of such fractures forced us to evacuate some which had suitable dressings with well applied Thomas splints.  Most chest wounds were treated by thoracentesis, firm dressing and rapid evacuation if bleeding did not recur rather than by thoracotomy. I wish to point out that such aberrations from the desired therapy occurred during the first four days.

The surgical proceedings during the first eighty hours without any breakdown for Teams I and II follows:

Heads (debridements, plaster caps, etc)                     4

Chests (         "          , thoracotomies, etc)                  3

Laparotomies                                                              21

Suprapubics                                                                 3

Extremities (debridements, casts, amputations)         27

Thoracenteses and other minor procedures are not recorded.

This is not a particularly large number of operative cases. We had hoped to run four tables more or less simultaneously but triage and treatment of shock, hemorrhage, etc demanded the presence  of one team in the pre or post-op tents most of the time. Further, on the occasions when all four tables were used, the great traffic in the OR made for confusion.  It was almost impossible to prevent backlogging and on the night of' D day it was necessary to transfer eleven operable cases to "A" Company for immediate surgery per as we were overwhelmed and they as yet had not been rushed.

The operative mortality was not high again considering the serious nature of cases:

1.  Evisceration; transsection of stomach; jejunal perforations.

2.  Gas gangrene of right arm, left femur; c. fr., right arm, both femurs, right tibia, right ankle.

3.  Gas gangrene of thigh, right, 48 hours old.

4.  Chest wound and severance of jejunum, 36 hours old.

5.  Traum. Amp. left leg, ileal perforations, liver laceration, intra. hemorrhage, bladder perforation, shock, 48 hours old.


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6.  Multiple perforations small bowel, peritonitis, 48 hours old.

7.  Thru and thru wound of abdomen with colon protruding thru right lumbar region, gaping hole in liver, hemorrhage.

8. Right lobe of liver almost destroyed, hemorrhage, bile peritonitis, 26 hours old.

A survey of the records of those killed in action or dying on arrival or dying in the station prior to treatment for the entire first week follows: Again it must be remembered that except for the occasional laconical description term "Dismemberment" one obtains little information as to the full extent of the injuries these cases.

GSW head                  8

GSW neck                   3

GSW chest                  9

GSW abdomen           10

GSN buttocks             1

GSW Ext.                   10

Dismemberment          3

Drowning                    1

As noted, two of the cases listed under operative and station deaths were of gas gangrene. Our experiences with such (8 cases of our own) was uniformly bad. Two severe reactions to intravenous, anti-gas serum were noted despite proper skin or conjunctival tests (negative), one immediately fatal in a patient whose general condition was fair (both legs previously amputated and compound fractured skull) and the other producing profound shock in which the patient died 24 hours later (general condition poor, compound fracture femurs).

One clinical fact which we had frequent occasions to observe was of penetrating wound of the lower thorax with marked bilateral splinting of the abdomen. All three companies reported negative abdominal explorations on several such wounds. Eventually we discovered that by firmly splinting the effected thorax with large bands of adhesive tape, then waiting about one hour, the abdomen became soft in those cases where the peritoneal cavity had not been penetrated. This at best is a gross diagnostic aid but was helpful.

No attempt has been made to draw inclusions from these rough figures or experiences. The report is offered only to present however inadequately the problem of casualties of the first four days of the invasion, its handling by the three companies of the 261st Medical Battalion with six attached teams from the Third Auxiliary Group, with statistics of one such company and its two surgical teams.

GLENN W. ZEIDERS

Major, M.C.

SOURCE:  National Archives and Records Administration, Record Group 407, Records of the U. S. Army Adjutant General, World War II Unit Records, 261st Medical Battalion, Box 21377.