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Chapter VII

Contents

CHAPTER VII

Representative Hospital Experiences

298th General Hospital

Pre-D-day experiences-The 298th General Hospital, which began to function 11 November 1942, at Frenchay Park near Bristol, was the third general hospital to be established in England. Because it was located close to a major port on the west coast of England, it gained valuable experience with battle casualties before D-day, which proved of great benefit in its later work in France and Belgium. The patients first received were evacuated from North Africa, Sicily, and Italy. During 1943, this hospital received 573 true battle casualties, over 50 percent of whom were patients with bone and joint injuries, chiefly fractures of the extremities requiring long-term treatment. About 80 percent of these patients were British, it being the policy of the British to send to the 298th General Hospital the most seriously ill patients from each hospital ship, because the proximity of the hospital to the port eliminated the necessity of a long trip by train or ambulance.

These patients required considerable attention and the exercise of keen surgical judgment. They had been wounded on an average of 6 to 8 weeks before their reception. Many had not had wound debridement within the optimum time, and, as might be expected, the incidence of wound infection and osteomyelitis was significantly higher than in battle casualties later treated on the Continent. Penicillin was not then available, but all the patients had received sulfonamide therapy. The plan of treatment, because of the timelag, was chiefly to carry on with the closed plaster technique until the wound and the fracture had healed. Every endeavor was made to improve the general health of the patient during this time. Drainage operations were performed as indicated, and the position of the bone fragments was improved whenever that was possible. It was the opinion of the hospital staff at this time that the closed plaster technique was of great value in the management of war wounds and fractures and that plaster-of-paris casts served adequately for transportation.

The nonmilitary experience of the 298th General Hospital can be taken as typical of that of the general hospitals which served in the United Kingdom before D-day. Before the invasion of the Continent, like most other hospitals in Great Britain, it was performing station-hospital duty, that is, it was serving the need of troops in training. During the year ending in May 1944, the orthopedic section of this hospital treated approximately 2,300 patients with civilian-type orthopedic conditions, chiefly fractures, dislocations and sprains, arthritis, bursitis, cicatrices, osteochondritis, osteomyelitis, poliomyelitis, synovitis, an occasional amputation, and some cases of frank psychoneurosis.


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This type of work was sufficient to keep the orthopedic services of all the hospitals busy. Aside from accidental injuries, chiefly from automobiles and other mechanical equipment, most of the orthopedic material consisted of patients with disability of the feet, back, and knees. The majority of these complaints were among soldiers who were over age and who had other conditions which made them unfit for actual combat duty. The difficulties of these troops were for the most part problems in reassignment rather than actual medical or surgical problems. Line officers hesitated, and often refused outright, to reclassify them, with the result that the outpatient departments of most hospitals had large clinics filled with soldiers who were seeking downgrading. These men really needed little treatment, though they occupied a great deal of professional time. They were referred to the clinic simply because all combat units were endeavoring to streamline their personnel and to obtain as physically perfect combat teams as possible.

All combat units were finally directed to follow Circular No. 96, 15 July 1943, Headquarters, European Theater of Operations, paragraph 2,1 which emphasized the necessity of trying to find places of limited duty with individual units before men with so-called civilian-type disabilities were admitted to hospitals for reassignment. All the hospitals in England were cluttered with such cases, and many unwise elective operations (p. 185) were done in an endeavor to place essentially unfit men on full-duty status. This proved an impossible task.

Post-D-day experiences-When the 298th General Hospital was moved to Cherbourg, France, where it operated from 27 July to 28 October 1944, it supplied station and general hospital medical service to large numbers of troops stationed in this port area. It also cared for many battle casualties and acted as a holding hospital for patients to be evacuated by hospital ship to England. A maximum of 30 days was allowed for the treatment of any case. Orthopedic injuries included:

1. Acute non-combat-incurred injuries of the bone, joints, and soft tissues. These were numerous, because many thousands of troops were working at the port.

2. Minor battle-incurred wounds. Many lightly wounded battle casualties were treated, with the objective of returning them directly to duty.

3. Serious battle-incurred injuries. Patients with this type of injury were treated in large numbers before their evacuation to England.

4. Other war-connected injuries. Many patients were received who had been wounded by mines left by the Germans or in the course of handling and dismantling captured German ammunition.

From 20 November 1944 through May 1945, the 298th General Hospital was stationed at Lige, in Belgium. Here the majority of patients admitted had battle-connected wounds and injuries. Most of them were received within 1 to 3 days of primary debridement done in evacuation or field hospitals. Particularly in December 1944 and January 1945, a number of lightly and

1See appendix A, p. 319.


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moderately wounded patients were admitted because forward hospitals had been too heavily loaded with more serious cases to receive them. The patients required debridement as well as later, more definitive, surgery. Over the same period, a number of casualties were also received who had been wounded in the immediate vicinity from aerial and buzz bombs (V-1 type).

50th General Hospital

The 50th General Hospital, which had spent its time near Glasgow before D-day, was moved to Utah Beach 15 July 1944 and bivouacked near Carentan, France. At this time the front was not very far away, the beaches were close, and the bridge into the town was being shelled by Germans. The hospital did not become operational immediately. An orthopedic team, consisting of the chief of the section, an assistant surgeon, 2 surgical corpsmen, a surgical nurse, and a nurse anesthetist, worked in the 41st Evacuation Hospital for 3 weeks, during the attack on Saint-L, France.

When the 50th General Hospital became operational 15 August, the orthopedic work was heavy and diversified. There were many injuries caused by boobytraps and injuries on the beaches, as well as numerous serious automobile accidents, involving military as well as civilian personnel. German prisoners of war with combat wounds of the extremities and long bones were also treated. During this 3-month period, the hospital, which was a 1,000-bed installation, treated 1,206 casualties with bone and joint injuries, answered 820 orthopedic consultations, and treated 175 outpatients with bone and joint conditions.

On 17 November 1944, the hospital moved to Commercy, France, and a second orthopedic team was placed on detached service at Morhange with the 30th Field Hospital. This installation was supporting armored units, and the bone and joint injuries, while less numerous than previously, were extremely severe and mutilating. When the main hospital again became operational 18 December 1944, the first patients received were about 300 Russian prisoners of war who had been recaptured from the Germans by the Third United States Army. They were in poor condition, and some were starving. There were many fatalities in injuries of the knees, hips, and spine, alone or in combination, in contrast to the usually low case fatality rate in bone and joint injuries uncomplicated by other wounds.

217th General Hospital

When the 2l7th General Hospital, which was part of the 814th Hospital Center, was in Paris, there were 590 admissions to the orthopedic service during September 1944. At this time, the advance past Paris was moving rapidly, and most of the injuries were the result of small-arms fire. The percentage of untreated cases was high.


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As the front moved away from Paris, patients began to be received by hospital train and by air. There were 1,570 admissions to the orthopedic ward in November and 2,042 in December. These numbers are exclusive of the patients with bone and joint injuries admitted to other wards. From September through April, there were 8,211 admissions to the orthopedic section, of which 5,172 were battle casualties. Included in this number were 408 patients with fractures of the femur; 694 with fractures of the tibia, fibula, or both; 301 with fractures of the humerus; and 284 with fractures of the radius, the ulna, or both. Two of the patients died, one of the uremic syndrome after a blast injury and the other of a compound dislocation of the hip, with deep pelvic infection and hemorrhage. Over the same period, 1,238 orthopedic consultations were answered. Some of the patients thus seen were later transferred to the orthopedic section for care.

Fifteenth United States Army Hospitals

The evacuation and field hospitals of the Fifteenth United States Army functioned primarily in the role of station hospitals, serving all the troops in the areas to which the army was assigned. This was the last Allied army to enter the conflict with Germany. Combat work in all hospitals of the Fifteenth Army was at a minimum, because of its tactical mission. Becoming operational on 6 January 1945, this army, other than in April when it conducted operations within the Ruhr and the Lorient-Saint Nazaire pockets, was initially mainly concerned with receiving, training, and equipping organizations newly arrived on the Continent, as well as rehabilitating, reequipping, and reenforcing various units that had suffered heavy losses during the Ardennes campaign. Later, its mission was primarily to occupy, organize, and administer military government in the Rheinprovinz, Saarland, Pfalz, and a portion of Hessen. In the final stage of the war, as well as in the postwar period, the medical picture was altered by the necessity of caring for large numbers of displaced persons, RAMP's (Recovered Allied Military Personnel), and German civilians who required treatment for emergency conditions.

Because of the impossibility of evacuating eastern European displaced persons, RAMP's, and German civilians, orthopedic problems differed considerably from those usually encountered in hospitals at the army level. The four main sources of orthopedic cases encountered by this army's hospitals were motor accidents, accidental gunshot wounds, mine accidents, and injuries and diseases in RAMP's and in displaced persons from German military and civilian hospitals. The circumstances under which the injuries from general accidents and mines were received made them different from injuries received in combat. The timelag was considerably shorter than was usual in combat injuries, and exposure was not the rule. Secondary shock was less, as was the preoperative morbidity. On the other hand, inability to evacuate displaced persons rapidly or within the regulation 10-day period required that they receive a definitive type of treatment which was not ordinarily permitted in an evacuation hospital.

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