57
SECTION I
GENERAL SURGERY
CHAPTER III
STATISTICS
The
statistics presented in the following pages for the American
Expeditionary Forces,
unless otherwise stated, include only data for the United States Army
(not including marines),
exclusive of troops in North Russia and in Siberia.
Revised
statistics for battle casualties were published in the Surgeon
General's Annual
Report for 1920, Tables 1-43, inclusive (pp. 27-104, inclusive).As
stated in that report, 5,768
military patients, whose admission had been caused by injuries received
in battle in our
expeditionary forces (exclusive of Russia and Siberia), remained in
Army hospitals in the United
States at the close of the calendar year 1919. Data for battle
casualties published in the Surgeon
General's Annual Report of 1920 could not include final disposition and
time lost subsequent to
January 1, 1920. Here, the later date of publication has resulted in
more complete data.
Circular
No. 87, W. D., March 29, 1921, required that all patients from the war
army,
officers excepted, remaining in hospital on July 2, 1921, should be
discharged from the military
service, thus separating them finally from Army records or military
status.
In
consequence of these instructions it has been possible to include all
military data for
battle wounded, including those for the men whose military service
terminated between January
1, 1920, and July 2, 1921, and these will be found included in the
final statistical tables for battle
casualties which appear here.
Some
of the tables which appear in this chapter are reproduced from the 1920
Annual
Report of the Surgeon General, but no subsequent reference will be made
here to that report. If
any differences in the tables contained in this volume and in those
published in the Surgeon
General's Annual Report of 1920 are detected, a preference should be
given to those published
here, as every opportunity possible has been taken to perfect the
tables and to eliminate any
errors which might unavoidably have been included in the earlier
tables.
No
attempt is made to include killed in action. Reports were made to the
Surgeon
General's Office of only a small percentage of killed in action, and
the information so furnished
was too meager in character to be of any present value.
BATTLE
INJURIES
ADMISSIONS
Lacerated
wounds caused the admission of 46,549; penetrating wounds 42,374, and
fractures 25,272.
a Excepting tables 23 and
24, casualties from gases have been excluded from the tables herein. It
was not possible to do so in tables 23 and 24. Data on wounds from
gases are given in Chapter VIII, Volume XIV of this history- Ed.
58
TABLE
8.- Battle
injuries,
admissions, officers and enlisted men, United States Army, 1917-18a
DEATHS
The
total number of deaths from wounds received in action (not including
deaths on
field) was 12,470, a rate of 11.92 per 1,000 per annum; for enlisted
men 11,881 deaths, rate
11.88; and officers 589, rate 12.57. (Table 9.) The deaths from
penetrating wounds amounted to
4,976 or 4.75; multiple wounds 3,202, or 3.06; and fractures 2,751, or
2.63.
TABLE
9.- Battle
injuries, deaths
from injuries, officers and enlisted men, United States
Army, 1917-18a
a
Source of
information: Medical records sent to the Surgeon General’s Office.
59
DISCHARGES FOR DISABILITY
The number of discharges for disability among the
enlisted men
as a result of battle
injuries amounted to 21,822; among officers, 508; with a total of
22,330 for the two. (Table 10.)
Penetrating wounds caused the discharge for disability of 4,982;
multiple wounds, 3,130; and
fractures, 11,740, 46.6 percent of the total discharges.
TABLE 10.- Battle
injuries, discharge for
disability, officers and
enlisted men, United States Army, 1917-18 a
DAYS LOST
The total number of
days lost in hospital, including all time to
July 1, 1921, amounted to
14,544,536 days. (Table 11.) The amount of time lost as the result of
penetrating wounds was
3,697,759 days; multiple wounds, 2,017,208 days; fractures, 5,125,220
days, 29.3 percent of the
total. This does not really represent the total amount of time lost as
the result of fractures, for as
will be seen from Table 20, page 65, a number of fractures were
tabulated as penetrating or
perforating wounds.
60
TABLE
11.- Battle
injuries, days
lost in hospital, officers and enlisted men, United States
Army,
1917-18 a
DURATION OF TREATMENT
Of
the 141,067 wounded who were treated in hospital, whose wounds did not
result in
death, the duration of treatment for 36,922 was 29 days or less, the
average time per such case
being 14.82 days. One hundred and four thousand one hundred and
forty-five cases were treated
in hospital for over29 days, the average time for each such case being
133.25 days. (Table
12.)The average time in hospital for all cases that did not result in
death was 102.26.
Fractures
required the longest treatment the average time being 225.50days. Only
1,530
fractures in a total of 22,521, not resulting in death, were returned
to duty in 29 days Nor less.
TABLE 12.- Battle
injuries, duration of
treatment (fatal cases excepted), classification by cases under 29
and over 29 days, officers and enlisted men, 1917-18 a
61
DAY OF DEATH
For the 12,470 who died in hospital as the result of
wounds, the
day ofdeath was not
stated in 930 instances. (Table 13.) Of the 12,707 deaths, for which
the day of death was
stated, 4,742 died on the first day. The proportional number who died
on each day in hospital as
the result of battle injuries is shown in Table 14.
TABLE 13.- Battle
injuries by
diagnosis, deaths in hospital, showing the day of treatment on which
death
occurred, officers and enlisted men, United States Army,
1917-18 a
INVALIDED HOME
Forty-five thousand three hundred ninety-nine
wounded were
returned to the United
States for further treatment. (Table 14.) Of this number 12,897 had
received penetrating wounds
and 15,542, or 34.23 per cent, had received
62
fractures. Of the total number of
fracture cases (25,272) 61.5 percent were returned to the
United States for further treatment.
It
should be explained here that all cases returned to the United States
were not unfit for
further military duty with the American Expeditionary Forces, for after
the armistice, November
11, 1918, many cases were sent to' the United States which otherwise
would have been retained
for treatment in Europe and ultimately returned for duty there.
TABLE 14.-
Battle injuries by diagnosis, wounded returned to the United States for
further treatment, officers and
enlisted men, United States Army, 1917-18 a
MILITARY
DESTRUCTIVE AGENTS
The
effectiveness of the military agents used by the enemy in inflicting
wounds in battle
is of great interest and importance to the medico-military student.
Tables 15, 16, 17, and 18
show the number of cases, deaths, discharges for disability, and days
lost, for officers and
enlisted men, and for the total. which occurred as the result of the
various military agents.
TABLE 15.- Battle injuries by military
destructive
agents, admissions, officers and enlisted men, United
States Army,
1917-18 a
63
TABLE 16.- Battle
injuries by military destructive agents-deaths from injuries, officers
and enlisted men, United
States Army, 1917-18 a
TABLE
17.-
Battle injuries by
military destructive agents, discharges for disability, officers and
enlisted men, 1917-18 a
64
TABLE
18.- Battle injuries by military
destructive agents, days lost in hospital, officers and enlisted men,
United
States Army, 1917-18 a
GUNSHOT
MISSILES
There were 147,651 men wounded by missiles.
Of this number, the
kind of missile was
not specified in 74,883 cases. In the 72,768 cases for which the
missile was specified, rifle balls
caused 20,420 wounds, or 28.06 percent; shell and shrapnel 51,226, or
70.41 percent; hand
grenades 880, or 1.21 percent; and pistol balls 242, or 0.33 percent.
The cases and deaths from
missiles, with the case fatality for each, was shown in the following
table:
TABLE 19.
- Battle
injuries by
missiles, admissions, deaths, and case fatality, officers and enlisted
men, United States
Army, 1917-18
ALL CAUSES
As
shown above, a very large percentage of the wounds received by American
officers
and soldiers during the World War, which resulted in admission to
hospital, were caused by
artillery missiles. In addition to the wounds caused by the artillery
missiles, there were no doubt
many wounds by machine-gun missiles, though these would be shown in the
various tables as
rifle wounds. As a result, a large percentage of the men wounded
received multiple wounds.
Considering only two wounds to one individual, there were 42,023 more
wounds than wounded
men. Many of the multiple wounded were from artillery missiles and
consequently of a more
severe type; which factor, combined with their multiplicity, resulted
in a much higher fatality
rate--9.7 percent, as compared with 5.3 for single wounds.
65
ANATOMICAL
PART AND MILITARY DESTRUCTIVE AGENTS; CASE FATALITY RATES
Table 20 shows, by the more important anatomical
organs and
parts, the number of
wounds, deaths, and case fatality rates from rifle ball (including
machine-gun bullet), shell, and
shrapnel, and from other military agents (including the gunshot
missiles not specified). In this
table multiple wounds are included as well as single wounds;
consequently, a death may be
shown with a wound of a certain location or part, which would
ordinarily not have resulted
fatally, the patient at the same time having actually received a wound
of another part, which
caused the death. Therefore, the case fatality by regions, as here
shown, is by no means literally
true.
For
long bones it is fair to presume that when a wound is reported this
necessarily implies
a fracture. Such an inference, however, should not be made for wounds
of the joints or for those
of the extremities. With wounds of the joints, or of the extremities,
wounds were sometimes
described as penetrating or perforating wounds, rather than fractures,
even though fractures
actually existed. Consequently, in Table 20, the number of cases shown
as fractures for the joints
or extremities do not necessarily include all of the fractures which
were actually sustained.
TABLE
20.- Battle
injuries, by
anatomical part and by military agent, admissions, deaths, and case
fatalities,
single and multiple wounds, officers and enlisted men, 1917-18 a
66
TABLE
20.- Battle
injuries, by
anatomical part and by military agent, admissions, deaths, and case
fatalities,
single and multiple wounds, officers and enlisted men,
1917-18- Continued
67
TABLE
20.- Battle
injuries, by
anatomical part and by military agent, admissions, deaths, and case
fatalities,
single and multiple wounds, officers and enlisted men,
1917-18- Continued
68
TABLE
20.- Battle
injuries, by
anatomical part and by military agent, admissions, deaths, and case
fatalities,
single and multiple wounds, officers and enlisted men,
1917-18- Continued
69
TABLE 20.- Battle
injuries, by
anatomical part and by military agent,
admissions, deaths, and case fatalities,
single and multiple wounds, officers and enlisted men,
1917-18- Continued
70
BATTLE
FRACTURES
Since fractures of the long bones of the extremities
caused such
a large percentage of the
total deaths from wounds (2,019 out of 12,192, or 16.56 percent) and
such a large number of
days was consumed in convalescence (3,582,248 days out of 14,444,536,
or 24.8 percent) it is
desirable to make a special study of them. Tables 21 and 22 are devoted
to the study in question.
In Table 21 a
comparison is made by case fatality and loss of time, both for fatal
cases
and for those that did not result fatally; for the battle fractures,
and for the simple and compound
fractures, which occurred in the military service, but not as a result
of injuries received in battle.
In
Table 22 battle fractures involving the long bones of the extremities
are summarized.
In this table only the six long bones of the extremities are
considered, and when any fracture of
one of these bones was associated with a fracture of any other bone of
the body or with a wound
of any other tissue of the body, the secondary lesions are omitted from
consideration. This table
shows the number of cases involving only one of the six long bones,
those involving two of them
and lastly the total number of involvements of any of them. In this
last section the excess number
of cases, days, etc., is due to fractures involving two of these bones.
For each of these classes,
detailed information is given.
The
greatest number of patients was for the humerus, 3,549; and the
greatest number of
fractures was also for the humerus, 4,069. The largest number of deaths
among patients was for
the femur, 804; and the greatest number of deaths for fractures was
also for the femur, 971.
The
highest case fatality was for fractures involving the fibula and
radius. Since,
however, this rate was based on only three cases, it is not
significant. The highest case fatality
rate (based on a significant number of cases) was for the fractures
involving the femur and the
humerus, 35.05 percent.
TABLE
21.- Fractures
(all), battle
and nonbattle, of long bones, officers and enlisted men, 1917-1919.
Case fatality
and average days lost. Percentage rates a
71
TABLE 22.- Battle
fractures of the long
bones,
admissions, deaths, recoveries, and case fatality,
annual
admissions, deaths and non ffective. Rates per 1,000
PHYSICAL
DISABILITIES FROM WOUNDS
Tables
23, 24, and 25 show the definite physical disabilities, which resulted
from
wounds received in battle, for cases in which the information furnished
was definite and not too
general in character to catalogue. Physical disabilities are catalogued
for 19,768 men of the
25,187 who were discharged for disability. Thus in 5,419 the definite
disabilities were not
tabulated, but in many they were shown as associated diseases.
Amputations.- In
Table 25 some of the more interesting final results of definite
disabilities
are considered. From this table it will be seen that the total number
of soldiers who lost part of
one or more extremities was 4,403. So far as the Surgeon General's
Office has been able to
determine, only one soldier who recovered lost both legs and one arm;
11 had amputations
through both thighs, 1 through both legs at the knee; 9 had both legs
amputated below the
knee; 1 had both feet amputated; and 3 had one arm amputated above the
elbow and one leg
through the thigh.
72
Loss
of eyes or eyesight.- If traumatic cataract is counted as the loss
of the sight of an eye,
66 men lost either both eyes or the sight of both eyes. In 44 the loss
of sight of both eyes was
partial, and 644 men lost one eve or the sight of one eye.
Ankylosis.-Four
thousand nine hundred and seventy soldiers had a partial or complete
ankylosis of one or more joints.
TABLE
23.- Summary
of definite
physical disabilities which resulted from battle injuries, officers and
enlisted men, 1917-18 a
73
TABLE
23. – Summary
of definite
physical disabilities which resulted from battle injuries, officers and
enlisted
men, 1917-18- Continued
TABLE
24.– Associated
physical
disabilit8ies (fatal cases excepted), resulting from battle injuries in
19,768 officers
and enlisted men, 1917-18 a
74
TABLE
24. – Associated
physical
disabilities (fatal cases excepted), resulting from battle injuries, in
19,768 officers
and enlisted men, 1917-18- Continued
75
TABLE 24. – Associated
physical disabilities, (fatal cases excepted),
resulting from battle injuries, in 19,768 officers
and enlisted men, 1917-18- Continued
76
TABLE
24. – Associated
physical
disabilities (fatal cases excepted), resulting from battle injuries, in
19,768 officers
and enlisted men, 1917-18- Continued
77
TABLE 24.- Associated
physical
disabilities (fatal cases excepted), resulting from battle injuries, in
19,768 officers and enlisted men, 1917-18- Continued
78
TABLE 24. – Associated
physical disabilities (fatal cases
excepted), resulting from battle injuries in 19,768 officers
and enlisted men, 1917-18- Continued
79
TABLE 24.? Associated
physical
disabilities (fatal cases excepted), resulting from battle injuries in
19,768 officers
and enlisted men, 1917-18- Continued
80
TABLE 25.- Physical
disabilities resulting from
wounds (excepting
fatal cases), by military agents, officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases wounded by
the military agents a
81
TABLE
25.- Physical
disabilities
resulting from wounds (excepting fatal cases), by military agents,
officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases
wounded by the military agents- Continued
82
TABLE 25.- Physical
disabilities
resulting from wounds (excepting fatal cases), by military agents,
officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases wounded by
the military agents- Continued
83
TABLE 25.- Physical disabilities
resulting from wounds
(excepting
fatal cases), by military agents, officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases wounded by
the military agents- Continued
84
TABLE 25.- Physical disabilities
resulting from wounds
(excepting
fatal cases), by military agents, officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases wounded by
the military agents- Continued
85
TABLE 25.- Physical
disabilities resulting from wounds (excepting fatal
cases), by military agents, officers, and
enlisted men, 1917-18; absolute numbers and percentage of each
disability to the total number of cases wounded
by the military agents- Continued
PHYSICAL
DISABILITIES BY MILITARY AGENTS
The
number of physical disabilities which resulted from military agents was
19,140 (not
men, but disabilities). It should be noted that we are here speaking of
disabilities, and not of
individual men, although the number of the disabilities is less than
the number of men disabled,
which is shown in Table 24 as 19,768. The excess is due to the
inclusion there of men disabled
by gas. If disabilities from the latter were included in Table 25, the
total would be 21,696.
The
percentage of disabilities from the various gunshot missiles was as
follows: Shell and
shrapnel, 17.69; hand grenade, 24.20; rifle, 18.30; other gunshot
missiles, 7.43. From this we
see that the highest proportion of disabilities resulted from the
artillery missiles, with the
exception of the hand grenades, where the number of cases was small.
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