II. LOSS OF MAN POWER IN WAR
J. LOSSES IN THE THEATER OF OPERATIONS
31. Cases disposed of in the Zone of the Interior. - The loss of manpower in the Theater of Operations forces of which the medical departmenthas knowledge is due to: (a) noneffectives in hospital, i.e., patientsreceiving treatment in hospital both in the Theater of Operations and Zoneof the Interior; (b) deaths from various causes within or without the hospital;(c) cases disposed of in the Zone of the Interior after being sent therefor treatment. This latter group includes the men who are permanently incapacitatedphysically for further military
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service. In the following discussion, the cases sent from the Theaterof Operations to the Zone of the Interior for further treatment are dividedinto two groups and are so treated throughout: (a) cases in hospital; (b)cases disposed of after reaching the Zone of the Interior by return toduty, death, or discharge for disability. The cases in hospital arelosses in the Theater of Operations strength no matter where the hospitalsare located, but cases disposed of in the Zone of the Interior may representan unnecessary loss in the Theater of Operations strength if too many menwho are ultimately returned to duty are sent to the Zone of the Interior.
As stated above, if sufficient care is exercised, the number of casessent to the Zone of the Interior can be limited practically to potentialdisability cases, and the additional loss of man power will be small. Thus,if as suggested, 3% of disease and nonbattle injury cases, 6% of the gassedones, and 20 % of the gunshot cases are sent to the Zone of the Interior,the excess over the physically unfit will be only 1% of the cases of diseasesand nonbattle injury cases, 2% of the gassed cases, and 5% of the gunshotones, and even this excess would consist of cases requiring prolonged treatment.
The cases remaining in hospital in the Zone of the Interior of thosesent there for treatment are shown by Figs. 41-43, but those disposed ofafter arrival there by return to duty, discharge for disability, or deathare shown by Figs. 47-49.
a. Disease and nonbattle injury patients. - The number of casesso disposed of among those admitted for diseases and nonbattle injurieswith a daily admission rate of 1.00 per 1000 Theater of Operations strengthis shown by Fig. 47. This graph illustrates that the loss of man powerin the Theater of Operations from the disposition of such cases in theZone of the Interior increases in proportion to the percentage of hospitalcases returned there for treatment. Thus the difference in such losseswhen 3% or 9 % are so sent to the Zone of the Interior, accumulated tothe end of one year would be 28.95 - 9.65, or 19.30, per 1000 Theater ofOperations strength. To visualize this, let us assume that a force of 2,000,000men is operating in the Theater of Operations in a well sanitated areain a temperate climate, and that the daily admission rate to hospital is1.40 per 1000 per day. Then the number of men leaving hospital in the Zoneof the Interior during one year if 3 % are sent there would be 27,020,and if 9% are sent 81,060, including in each instance only 18,014 disabilitycases.
If the military authorities decide to send to the Zone of the Interiorall Theater of Operations disease and nonbattle injury cases requiringhospital treatment for longer than 60 days, which will be 12.39% of alladmissions (Fig. 38), the accumulated losses from this cause at the endof the year, with a daily admission rate of 1.00 per 1000, would be 39.85(9.65 × 12.39 ÷ 3) per 1000 men. In a force of 2,000,000 .witha daily admission rate of 1.40 per 1000, the accumulated losses from casesdisposed of in the Zone of the Interior at the end of a year would be 111,580(39.85 × 1.40
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× 2000) of this number 93,566 (111,580 - 18,014) are duty cases.Obviously these men may be sent again to the Theater of Operations, timeand conditions permitting.
It will be observed from Fig. 47 that losses of this character continueto occur indefinitely as long as the basic conditions remain the same.
Fig. 47.* -Theater of Operations cases of diseases and nonbattle injuries disposedof in the Zone of the interior by return to duty, death, or disabilitydischarge when sent to the Zone of the Interior for further treatment.
*NOTE: (a) Total cases disposed of in one year equals total admissionsless all patients in hospital at the end of that period. (b) Cases disposedof in the Zone of the Interior during one year, equals those sent thereless the one in the hospital. (c) The relationship of (b) to (a) givesthe percentage of the total dispositions which occur in the Zone of theInterior. (d) It is estimated that this same percentage relationship appliesto cases disposed of during any period, as one month, etc.
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b. Gas and gunshot patients. - Similar information in regardto cases wounded by poisonous gases and by gunshot missiles are shown byFigs. 48 and 49. The same remarks apply to those two graphs as to Fig.47.
c. Total of Theater of Operations patients. - (1) With a constantrate and a constant strength. -As an illustration of the difference inthe number of cases disposed of in the Zone of the Interior in one yearwhen different percentages of cases are sent there, let us make the followingas-
Fig. 48. -Theater of Operations war gas cases disposed of in the Zone of the Interiorby return to duty, death, or disability discharge when sent to the Zoneof the Interior for further treatment.
NOTE: For explanation of the method used in calculating the above datasee Note on Fig. 47.
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sumptions: (a) Two expeditionary forces, each of 2,000,000, both inwell sanitated areas in the temperate zone and both engaged in continuedand severe military combat: (b) a daily admission rate to hospital. of1.40 per 1000 strength from diseases and nonbattle injuries, .31 from woundsby poisonous gases, and .69 from wounds by gunshot missiles; (c) that oneof the expeditionary forces sends to the Zone of Inter-
Fig. 49. -Theater of Operations gunshot cases disposed of in the Zone of the Interiorby return to duty, death, or disability discharge when sent to the Zoneof the Interior for further treatment.
NOTE: For explanation of the method used in calculating the above datasee Note on Fig. 47.
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ior 3% of admissions for diseases and nonbattle injuries, 6% of caseswounded by poisonous gases, and 20% of those wounded by gunshot missiles,while the other sends 9% of the first and second named and 30% of the third.
Table 6. - Number of casesdisposed of during one year in the Zone of Interior, from the two expeditionaryforces.
Kind of cases | Daily admission rate per 1000 strength | Number of cases disposed of in the Zone of Interiorin one year. | ||
Diseases and nonbattle injuries | 1.40 | If 3% are sent to Z. of I. | 27,020 | |
If 9%are sent to Z. of I. | 81,060 | |||
Gas wounded | .31 | If 6% are sent to Z. of I. | 11,904 | |
If 9%are sent to Z. of I. | 17,856 | |||
Gunshot wounded | .69 | If 20%are sent to Z. of I. | 74,134 | |
If 30%are sent to Z. of I. | 111,200 | |||
113,058 | 210,116 | |||
The difference (210,116 - 113,058 = 97,058) is the excess over the numberof men physically disabled or requiring prolonged treatment, and consistsof men who will be able eventually to return to duty. They must eitherbe sent again to the Theater of Operations from the Zone of the Interioror be replaced, and even if the former is done unnecessary time is lost.
(2) With a constant rate but an increasing strength. - Fig. 50shows a method of estimating the Theater of Operations patients to be disposedof in the Zone of the Interior when the admission rates from the variouscauses, as specified, are constant but when there is an increasing strength.The method of computation is the same as that outlined (see p. 36) forFig. 25, the principal difference being that in Fig. 50 there are threecauses of admissions considered, whereas in Fig. 25 there is only one.
d. Number of Theater of Operations patients to be handled in theZone of the Interior. The bottom line of Fig. 50 shows the total Theaterof Operations patients to be handled in the Zone of the Interior underthe conditions outlined. Such data may be of value when estimating requirementsfor hospital ships and hospital trains.
32. Deaths. - In addition to the noneffectives in hospital andthe cases disposed of in the Zone of the Interior from among those sentthere, losses occur as the result of deaths.
A larger part of the fatalities which result from diseases and nonbattleinjuries is among the cases admitted to hospital, but some occur
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among men not in hospital. Both classes of deaths are counted here ashospital admissions and are included in the total of such cases.
Fig. 50. -A. Method of computing the Theater of Operations hospital patients to bedisposed of in the Zone of the Interior when certain percentages of patientsare sent there from a command in the Theater of Operations where thereis an increasing strength and where there are admissions from both battleand nonbattle causes at a constant rate.
B. The total Theater of Operations patients to be hospitalized in the Zoneof the Interior. (See Fig. 46).
C. The grand total Theater of Operations patients to be handled in theZone of the Interior.
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On the other hand, the larger part of the deaths which result from militarycombat occurs on the field of action. The last named is not included inthe number of admissions for wounds, but in this study they are proportionedto the number of men wounded so that the expectancy of such losses canbe computed from the admission rate for the wounded.
a. Fatality rates. - The fatality rate for hospital cases inthe American Expeditionary Forces in 1918 from diseases and nonbattle injuries,including deaths from such causes not in hospital, was 3.70%2;while that from poisonous gases, including only such as occurred in hospital,was 1.73%2, and similarly the one from gunshot cases was 8.12% . The deaths from diseases and nonbattle injuries included, however,a large number from the unusually widespread and fatal epidemic of influenzawith accompanying pneumonias. After excluding the unusual number of deathsfrom these causes, it is estimated that 1.44% of hospital disease and nonbattleinjury cases in the Theater of Operations may be expected to die. Thisfatality rate is one and two-thirds times as great as the usual peace timeone among troops in the United States. In the following estimation of lossesamong troops in the Theater of Operations, the fatality rates used are1.44%, 1.73%, and 8.12% for hospital cases of disease and nonbattle injuries,gas, and gunshot wounds respectively.
b. Duration of treatment of fatal cases. - Men who ultimatelydie as the result of gunshot wounds do so after a shorter interval of timethan do those from either of the other two causes. Thus during the first15 days of treatment 85.36 % of the deaths from gunshot wounds occurred,as compared with 76.37% of those from gas wounds, and 64.56% of those fromdiseases and nonbattle injuries.
Table 7. - Percentage of thetotal deaths in hospital from the three classes of causes in the AmericanExpeditionary Forces, which occurred in any group at different time intervals.
Days after admission to hospital | Diseases and nonbattle injuries | Gas wounds | Gunshot wounds |
1-5 | 32.16 | 41.14 | 58.80 |
6-10 | 19.46 | 22.62 | 19.46 |
11-15 | 12.95 | 12.61 | 7.10 |
16-20 | 9.51 | 7.18 | 3.13 |
21-25 | 4.72 | 4.22 | 1.79 |
26-30 | 3.95 | 2.59 | 1.28 |
31-45 | 6.45 | 3.72 | 2.69 |
46-60 | 3.23 | 1.72 | 1.80 |
61-75 | 2.02 | 1.15 | 1.15 |
76-90 | 1.42 | .79 | .85 |
91-105 | 1.04 | .58 | .58 |
106-120 | .77 | .43 | .40 |
over 121 | 2.24 | 1.25 | .88 |
Note:- For basic formulae see Figs. 96, 97 and98.
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c. Killed in action. - In addition to 13,691 deaths from battlewounds in hospital in the American Expeditionary Forces, 36,694 men werekilled on the field of battle.*
There is no information available upon which to base an estimate ofhow many of those who were killed outright died from poisonous war gasesand how many from gunshot missiles. Hearsay evidence indicates that comparativelyfew men died as the result of poisonous gases before they reached hospital.
d. Killed in relation to number wounded. - An examination ofthe casualties of infantry regiments by combat days in the American ExpeditionaryForces shows that the proportion of the killed to the number gassed decreasedas the number of reported gassed cases increased; on the other hand, theproportion of the killed to the number of men wounded by gunshot missilesremained practically constant. Thus the proportion of the killed to thenumber wounded by gas was almost twice as great when there were 10 gassedas when there were 100, while the proportion of killed to wounded by gunshotmissiles was the same when there were 10 wounded as when there were 100.?
We have assumed here simply for ease in calculation that 1000 men werekilled in action by poisonous gases, and the remainder (35,694), by gunshotmissiles. Under this assumption the percentage of the killed to the woundedwere: Gas 1.42%; gunshot 23.25%; or as expressed in the usual way, it isassumed there was 1 killed in action by poisonous gases to 70.4 so wounded,and 1 killed by gunshot missiles to 4.3 wounded.
e. Total deaths. - These relationships of killed in action tothe wounded, and fatality rates for cases in hospital to the number ofcases of diseases and nonbattle injuries, of gas wounds, and of gunshotwounds were used in computing the data shown for deaths by Figs. 51, 52,and 53. These Figures show graphically the accumulated number of deathsas time advances computed on the basis of 1.00 admission per day to hospitalper 1000 strength in the Theater of Operations.
33. Total losses in the Theater of Operations. - a. Diseaseand non-battle injury patients. - The total accumulated losses frommonth to month in the Theater of Operations as the result of diseases andnonbattle injuries from (a) noneffectives in hospital (patients in hospital),(b) deaths, and (c) cases disposed of after being sent to the Zone of theInterior (including disability cases), are shown graphically by Fig. 51.As stated in the legend of the graph, all of the data are based upon 1.00admission per day per 1000 Theater of Operations strength.
The noneffectives, or number of patients in hospital, stabilize afterone year and consequently there is no additional loss from this factorthereafter; but the accumulated number of deaths and of cases disposedof in
* The A. G. O. figures are: Killed 37,541; died of wounds 12,934; total50,475.11 Used here: Killed 36,694; died of wounds 13,691; total,50,385.
?For basic formula see Fig. 100.
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the Zone of the Interior, from cases sent there, continues to increaseas long as the basic conditions remain the same.
The losses from noneffectives in hospital and from deaths are shownseparately and combined. To the combination of the two there must be addedlosses from the cases disposed of in the Zone of the Interior. As has beenshown on page 69 and by Fig. 47, this latter factor in the total loss rateincreases in proportion to the percentage of cases sent to the
Fig. 51.*- Loss of manpower in the Theater of Operations from diseases and non-battleinjuries due to deaths, noneffectives in hospital (patients), and casesdisposed of in the Zone of the Interior when sent there for further treatment.
* NOTE: For basic formula see: (a) Deaths, Fig. 96, (2), p. 163. (b)Patients in hospital, Fig. 84, (1), p. 151. Total losses equal sum of thetwo above (a) and (b), plus cases disposed of in the Zone of the Interioras per Fig. 47.
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Zone of the Interior. The following table shows the movement of thecases in and out of the hospital, with the summation of the losses up tothe end of 360 days, when 3%, 6 %, or 9 % of all admissions are sent tothe Zone of the Interior.
Table 8. - Disposition of diseaseand nonbattle injury patients admitted to hospital during the first 360days of operations in the Theater of Operations, when the daily admissionrate from such admissions is 1.00 per 1000 Theater of Operations strength.
Percentages of Theater of Operations admissions sent to the Zone of the Interior | 9% | 6% | 3% | |||
Time ? 360 days | ||||||
Patients admitted to hospital | 360 | 360 | 360 | |||
Losses: | ||||||
Patients in hospital:? | ||||||
In Theater of Operations | 23.75 | 24.93 | 26.11 | |||
In Zone of the Interior | 3.54 | 2.36 | 1.18 | |||
Deaths which have occurred in and out of hospital: ?? | 4.89 | 4.89 | 4.89 | |||
Cases disposed of in Z. of I.: ? | 28.95 | 19.30 | 9.65 | |||
Total losses: § | 61.13 | 51.48 | 41.83 | |||
Cases returned to duty in Theater of Operations | 298.87 | 308.52 | 318.17 | |||
Total accounted for | 360. | 360. | 360. | |||
? See Fig. 41. ?? See Fig. 51. ?See Fig. 47. § See Fig. 51.
To convert these data into terms of any admission rate with any strength,multiply any item shown above by the product of the admission rate by thestrength in thousands. Thus if the expected daily admission rate to hospitalis 1.40 per 1000 and the strength 2,000,000 multiply the items in questionby 1.40 × (2,000,000 ÷ 1000), or 2,800.
As shown on page 55 if the military authorities consider it advisableto send to the Zone of the Interior all disease and nonbattle injury Theaterof Operations hospital cases averaging more than a certain time in hospital,the percentage of cases to be so transferred can be found by referringto Fig. 38. Then by referring to Fig. 47, and multiplying the data shownthere on the 3% line by the number of times that 3 is contained in thepredetermined percentage of cases to be returned to the Zone of the Interior,the cases disposed of in the Zone of the Interior under such conditionscan be obtained (see Table 3). The results so obtained, when added to theaccumulation of patients in hospital and of deaths at any time, will showthe total losses.
b. Gas patients. - Fig. 52 shows in a similar way the losseswhich occur as the result of poisonous gases, both from the various reasonsand also the total. As stated on p. 76, there are no data available uponwhich
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to base an estimate of the number of cases killed in action by poisonousgases. It is assumed for ease of calculation that 1000 of the men killedin action died from gas. The detail in regard to the deaths is shown inthe table on the graph, and if it is desired to increase or decrease the1000, the items can be changed correspondingly and the total losses soaltered.
Fig. 52.*- Loss of manpower in hte Theater of Operations from war (poisonous) gasesdue to deaths, noneffectives in hospital (patients), and cases disposedof in the Zone of the Interior when sent there for further treatment.
*NOTE: For basic formulae see:- (a) Deaths in hospital, Fig. 97, (2), p.164. (b) Killed in action, Fig. 97, (4), p. 164. (c) Patients in hospital,Fig. 87, (a), (1), p. 154. Total losses equal sum of the above (a), (b),and (c), plus cases disposed of the the Z. of I., as per Fig. 48.
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The following table shows the movement of the gassed cases in and outof hospital with the summation of the losses up to the end of 360 days,when 3%, 6%, or 9% of all gas admissions are sent to the Zone of the Interior.
Table 9. - Disposition of gascasualties during the first 360 days of battle, when the daily admissionrate from poisonous gases is 1.00 per 1000 Theater of Operations strength.
Percentages of Theater of Operations admissions sent to the Zone of the Interior | 9% | 6% | 3% |
Time ? 360 days | |||
Total to be accounted for: | |||
Patients admitted to hospital | 360 | 360 | 360 |
Assumed number killed in action | 5.10 | 5.10 | 5.10 |
Total | 365.10 | 365.10 | 365.10 |
Losses : | |||
Patients in hospital: ? | |||
In the Theater of Operations | 38.09 | 39.31 | 40.54 |
In the Zone of the Interior | 3.68 | 2,46 | 1.22 |
Deaths which have occurred: ?? | |||
In hospital | 5.99 | 5.99 | 5.99 |
Assumed number killed | 5.10 | 5.10 | 5.10 |
Cases disposed of in Zone of the Interior? | 28.80 | 19.20 | 9.60 |
Total losses: ?? | 81.66 | 72.06 | 62.45 |
Cases returned to duty in T. of O. | 283.44 | 293.04 | 302.65 |
Total accounted for | 365.10 | 365.10 | 365.10 |
? See Fig. 42 ?? See Fig. 52. ?See Fig. 48.
To convert any of the items above into terms of any admission rate withany strength, multiply the ones in question by the product of the admissionrate by the strength in thousands. Thus if the expected daily admissionrate is .31 per 1000 and the strength 2,000,000, multiply by .31 ×(2,000,000 ÷ 1000), or 620.
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c. Gunshot patients. - Fig. 53 shows in a similar way the lossesfrom gunshot casualties in detail and in totals.
Fig. 53* -Loss of manpower in the Theater of Operations from gunshot missilies dueto deaths, noneffectives in hospital (patients), and cases disposed ofin the Zone of the Interior when sent there for further treatment.
*NOTE: For basic formulae see :-
(a) Deaths in hospital, Fig. 98, (2), p. 165. (b) Killed in action, Fig,98, (4), p. 165. (c) Patients in hospital, Fig. 88, (a), (1), p. 155. Totallosses equal sum of the three above (a), (b) and (c) plus cases disposedof in the Z. of I., as per Fig. 49.
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The following table shows the movement of such cases in and out of hospital,with the summation of the losses up to the end of 360 days, when 10 %,20 %, or 30 % of such cases are sent to the Zone of the Interior.
Table 10. - Disposition ofgunshot, casualties during the first 360 days of battle, when the dailyadmission rate from gunshot missiles is 1.00 per 1000 Theater of Operationsstrength.
Percentages of Theater of Operations admissions sent to the Zone of the Interior | 30% | 20% | 10% |
Time-360 days. | |||
Total to be accounted for: | |||
Patients admitted to hospital | 360 | 360 | 360 |
Assumed number killed in action | 83.69 | 83.69 | 83.69 |
Total | 443.69 | 443.69 | 443.69 |
Losses | |||
Patients in hospital:? | |||
In Theater of Operations | 66.45 | 75.24 | 84.03 |
In Zone of the Interior | 26.37 | 17.58 | 8.79 |
Deaths which have occurred:?? | |||
In hospital | 28.65 | 28.65 | 28.65 |
Assumed number killed | 83.69 | 83.69 | 83.69 |
Cases disposed of in Z. of I:? | 80.58 | 53.75 | 26.86 |
Total losses:§ | 285.74 | 258.88 | 232.02 |
Cases returned to duty in T. of O. | 157.95 | 184.81 | 211.67 |
Total to be accounted for | 443.69 | 443.69 | 443.69 |
? See Fig. 43 ?? See Fig. 53 §See Fig. 53
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d. Total patients. - The following table shows the movement of the totalcases in and out of hospital, with the summation of the losses up to theend of 360 days.
Table 11. - After 360 daysof battle: (1) Total cases to be accounted for, including the killed inaction; (2) cases returned to duty in the Theater of Operations; (3) totallosses.
(1) Total to be accounted for, including killed in action. | If there is sent to the Z. of I., 3% of (a), 6% of (b), and 20% of (c) (as below). | If there is sent to the Z. of I., 9% of (a) and (b), and 30% of (c) (as below). | |||
(2) Duty in T. of O. | (3) Losses | (2) Duty in T. of O. | (3) Losses | ||
If the strength is 1000 and the daily admission rate to hospital is 1.00 per 1000 from each cause. | |||||
(a) Diseases and nonbattle injuries | 360.00 | 318.17 | 41.84 | 298.87 | 61.13 |
(b) Gas | 365.10 | 293.04 | 72.06 | 283.44 | 81.66 |
(c) Gunshot | 443.69 | 184.81 | 258.88 | 157.95 | 285.74 |
Total | 1,168.79 | 786.02 | 372.78 | 740.26 | 428.53 |
If the strength is 1000 and the admission rates to hospital are from each cause (a) 1.40; (b) .31; (c) .69. | |||||
(a) Diseases and nonbattle injuries | 504.00 | 445.44 | 58.58 | 418.42 | 85.58 |
(b) Gas | 113.18 | 90.84 | 22.34 | 87.87 | 25.31 |
(c) Gunshot | 306.15 | 127.52 | 178.63 | 108.99 | 197.16 |
Total | 923.33 | 663.78 | 259.55 | 615.28 | 308.05 |
If the average daily strength is 2,000,000, and the rates are as shown. | |||||
(a) Diseases and nonbattle injuries | 1,008,000 | 890,880 | 117,160 | 836,840 | 171,160 |
(b) Gas | 226,360 | 181,680 | 44,680 | 175,740 | 50,620 |
(c) Gunshot | 612,300 | 255,040 | 357,260 | 217,980 | 394,320 |
Total | 1,846,660 | 1,327,600 | 519,100 | 1,123,560 | 616,100 |
34. Total losses by separate months. - (a) Disease and nonbattle injurypatients. - Fig. 51 shows the summation of losses from month to month fromdisease and nonbattle injuries, when the daily admission rate is 1.00 per1000 Theater of Operations strength. Each month's losses are added to theaccumulated losses of the preceding months, and the curve is consequentlya constantly ascending one, although there is a progressive decline inthe loss rate for each separate month, with a descending curve, (Fig. 54)until it stabilizes at the end of the 12th month. The rapid fall of thislatter curve (Fig. 54) during the first few months is caused by the rapidincrease in the number of patients returning to duty from the hospital(Fig. 55). After the first six months there is but little
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change in the loss rate from cases disposed of in the Zone of the Interior,among those sent there from the Theater of Operations, and also from thedeaths; but the total for each month continues to decline until the endof one year, or until the outflow of patients from hospital equals theinflow. After the end of the year, the loss rate from the deaths in theTheater of Operations and the disposition of cases in the Zone of the Interior(includ-
Fig. 54. -Loss of manpower from diseases and nonbattle injuries in the Theater ofOperations during successive months.
NOTE: Calculated from data from the three upper curves, Fig. 51.
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Fig. 55. -Cases of diseases and nonbattle injuries returned to duty in the Theaterof Operations during successive months.
NOTE: Number returned to duty by months equals number admitted during thatmonth less the month's losses as per Fig. 54.
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ing disability cases) will continue as long as the basic conditionsdo.
The decline in the loss rates during the first 12 months is thereforedue chiefly to the increasing number of patients returning to duty fromhospitals. Consequently as stated in the last sentence of the legend ofFig. 54 these data apply only to each individual group of men. This group
Fig. 56. -Loss of manpower from war (poisonous) gases in the Theater of Operations,during successive months.
NOTE: Calculated from data from the three upper curves, Fig. 52.
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Fig. 57. -Gas cases returned to duty in the Theater of Operations during successivemonths.
NOTE: Number returned to duty be months equals number admitted during thatmonth plus the number killed in action, less the month's losses as perFig. 56.
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may be a field army, corps, division, or a regiment, or lesser body,but the essential point is that each one must establish its own increasingflow of men out of hospital to replace those entering hospital before itsloss rate can decline.
The 3%, 6%, and 9% curves again show the importance as a loss factorof the disposition of cases in the Zone of the Interior from among thosesent there.
Fig. 58. -Loss of manpower from gunshot injuries in the Theater of Operations duringsuccessive months.
NOTE: Calculated from data from the three upper curves, Fig. 53.
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Fig. 59. -Gunshot cases returned to duty in the Theater of Operations during successivemonths.
NOTE: Number returned to duty by months equals number admitted duringthat month plus the number killed in action, less the month's losses asper Fig. 58.
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b. Gas patients. - Fig. 56 shows the same data for casualtiesfrom poisonous gases as Fig. 54 does for those from diseases and nonbattleinjuries. Losses from gas casualties also stabilize at the end of the 12thmonth, as does the return of patients to duty from hospital (Fig. 57).The loss rate from gas casualties after the 12th month is a little greaterthan the one from diseases and nonbattle injuries, due to the assumed numberkilled in action by gas, and to the assumed larger fatality rate for gascases.
c. Gunshot patients. - The very great and continued importanceof gunshot casualties as a loss factor is again shown by Fig. 58. As aresult of the long duration of treatment of cases of this character, theloss rate continues to decline even after the 16th month (480th day), anduntil the 920th day. During the last several months shown on the graph,the cases disposed of in the Zone of the Interior, the deaths in hospital,and the assumed number killed in action account for a stabilized loss rateof 18.37, 15.39, and 12.41, according to the percentage of admissions sentto the Zone of the Interior, and the gradual increase of the noneffectivesin hospital for the excess, as shown by Fig. 58, above them. With the largerloss rates, fewer men are returned to duty from hospital (Fig. 59).
d. With a constant strength and a constant admission rate. -Here as elsewhere the possibilities of sanitation and the climate of theTheater of Operations area, the amount of seasoning of the troops, andmilitary resistance of the enemy must be estimated before the total lossrate can be determined.
Table 12 again shows the influence of the percentage of cases whichare sent to the Zone of the Interior upon the loss rate.
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Table 12.-Losses per 1000men in any group of them by months of service in the Theater of Operations,when the daily hospital admission rate per 1000 total strength is: (a)From diseases and nonbattle injuries, 1.40; (b) from gases .31; (c) fromgunshot wounds, .69, or approximately the same rates as occurred in theAmerican Expeditionary Forces, from July 1 to November 11, 1918 (excludingthe influenza epidemic).
30 day periods | (1) When there is sent to the Z. of I. 3% of (a),6% of (b), and 20% of (c). | (2) When there is sent to Z. of I., 9% of (a),9% of (a), 9% of (b), and 30% of (c). | ||||||
(a) Diseases and nonbattle injuries | (b) Gas | (c) Gunshot | Total | (a) Diseases and nonbattle injuries | (b) Gas | (c) Gunshot | Total | |
1st | 24.42 | 7.29 | 25.11 | 56.82 | 25.56 | 7.37 | 25.41 | 58.34 |
2nd | 9.51 | 3.81 | 20.84 | 34.16 | 11.47 | 3.99 | 21.63 | 37.09 |
3rd | 5.32 | 2.28 | 18.08 | 25.68 | 7.56 | 2.51 | 19.22 | 29.29 |
4th | 3.42 | 1.53 | 16.07 | 21.02 | 5.74 | 1.79 | 17.46 | 24.99 |
5th | 2.55 | 1.17 | 14.58 | 18.30 | 4.93 | 1.44 | 16.16 | 22.53 |
6th | 2.16 | 1.00 | 13.52 | 16.68 | 4.55 | 1.28 | 15.24 | 21.07 |
7th | 1.99 | .93 | 12.72 | 15.64 | 4.44 | 1.21 | 14.52 | 20.17 |
8th | 1.88 | .89 | 12.16 | 14.93 | 4.30 | 1.17 | 14.05 | 19.52 |
9th | 1.86 | .87 | 11.76 | 14.49 | 4.28 | 1.15 | 13.70 | 19.13 |
10th | 1.85 | .86 | 11.25 | 14.16 | 4.27 | 1.14 | 13.43 | 18.84 |
11th | 1.83 | .86 | 11.23 | 13.92 | 4.27 | 1.14 | 12.23 | 18.64 |
12th | 1.82 | .86 | 11.07 | 13.75 | 4.27 | 1.13 | 13.10 | 18.50 |
58.61 | 22.35 | 178.59 | 259.55 | 85.64 | 25.32 | 197.15 | 308.11 | |
Note: Basic data from Fig. 54, 56 and 58 multiplied by 1.40,.31, and .69 respectively.
Under both sets of conditions, the. loss rate falls rapidly after thethe first month, in the first declining from 56.82 per 1000 men duringthe first month to 13.75 in the 12th, and in the second from 58.34 in thefirst to 18.50 in the 12th month.
e. With an increasing strength but constant admission rate.-(1) From one cause. The problem of determining the probable lossrate for an expeditionary force is seldom so simple as the one above, forit will rarely happen that an entire force will be sent into an expeditionaryarea at one time. Then again, while in the interest of simplicity an averagedaily admission rate from diseases and nonbattle injuries may be used throughout,the military resistance encountered and the amount of military combat engagedin will probably vary so greatly that it will be necessary to use morethan one rate.
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Let us consider first the simpler of the two situations; that is, wherewe have a constantly, although not uniformly, increasing force with anaverage daily admission rate from diseases and nonbattle injuries. Fig.60 shows the method of computing the data for such a problem. The strengthof the military force with monthly increases is approximately the sameas existed in the American Expeditionary Forces to the middle of each month;and the daily admission rate, the average one for the year (including theinfluenza epidemic).
As we have found the greatest loss rate for any one force is duringthe first month because the patients, or noneffectives, in hospital arerapidly increasing and comparatively few men are returning to duty. Aseach group enters the Theater of Operations and establishes its own flowof patients out of hospital, its loss rate declines. The strength of eachmonthly increment in the Theater of Operations (Fig. 60) is multipliedby the initial month loss rate at the basic daily admission rate of 1.00per 1000 strength, and during the following month by the loss rate
Fig. 60. -Losses from diseases and nonbattle injuries by months under approximatelythe same conditions as occurred in the American Expeditionary Forces wherethere was a material increase in the strength each month, and where theconstant average daily admission rate to hospital only from these causeswas 1.65 per 1000 American Expeditionary Forces strength. It is here assumedthat 3 % of these admissions were sent to the Zone of the Interior. Thesymbols used throughout the body of the table represents the product ofa monthly loss at a daily admission rate of 1.00 per 1000 strength multipliedby a monthly increase in strength in thousands. Thus 1 B (17.44 ×38.) = 663.
NOTE: Data for losses each month (second line from top), see Fig. 54.
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for the second month, etc. The items as computed for the men who werein the Theater of Operations on the middle of January, and for each monthlyincrement during the next 10 months, are summated from side to side, andfrom above downward. The several sums so obtained are then multiplied bythe daily admission rate of 1.65 per 1000; i.e., the one
Fig. 61. -Method of computing the losses to be expected in the Theater of Operationsin a command in which there is an increasing strength; where there areadmissions from both battle and nonbattle causes; and also when certainpercentages of the patients are sent to the Zone of the Interior.
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that occurred in the American Expeditionary Forces.
The results at the bottom of the graph (Fig. 60) shows the losses whichoccurred from diseases and nonbattle injuries during each month in thestrength of the total American Expeditionary Forces, and those on the extremeright hand margin, the total losses in each month's group of men from thetime it entered the Theater of Operations until November 11, 1918.
(2) From three causes. - Fig. 61 shows a method of computingthe losses in the Theater of Operations from the three causes with ratesaveraged for the entire American Expeditionary Forces during the year 1918.In Fig. 60, the losses are shown for each individual month, whereas inFig. 61 the accumulated losses are shown, the February figure includingthose for January; etc.
f. With an increasing strength and also an increasing admission rate.- Figs. 60 and 61 illustrate the method of calculating losses in any expedi-tionaryforce when there is an increase each month in the strength, but
Fig. 62. -Losses from war (poisonous) gases by months under approximatelythe same conditions as occurred in the American Expeditionary Forces wherethere was a material increase in: (a) The strength each month; (b) alsoin the admission rate at different periods. The average daily admissionrates from war gases per 1000 American Expeditionary Forces strength were:Jan. to June 0.10; July to Sept. 0.22; Oct. to Nov. 0.41. It is here assumedthat 6% of the admissions from gas were sent to the Zone of the Interior.The symbols used throughout the body of this table represent the pro-ductof a monthly loss by a monthly increase in strength in thousands and bya daily admission rate. Thus 1BS (23.53 × 38 × .10) = 89.
NOTE: Data for losses each month (second line from top), see Fig. 56.
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with a constant average daily admission rate. Figs. 62 and 63 show,however, how to compute the data when there is not only an increasing strength,but also an increasing admission rate. The same basic principle appliesto the latter factor as to the former. Thus a group of men with an averagedaily admission rate establishes a return flow of men from the hospitalat that rate, but when the rate increases materially and consequently moremen are admitted to hospital, the return flow from that increased numbermust be established before there can be a decline in the specific lossrate.
Fig. 20 shows the daily admission rates per 1000 total American ExpeditionaryForces strength from gas and from gunshot missiles during each month, andalso during several grouped periods. From this graph, it is apparent thatduring the early weeks in 1918 the American Expeditionary Force troopsengaged in but little military combat, but as time advanced the amountand intensity of the fighting increased and finally culminated in the prolongedand severe fighting during September, October, and early November.
Fig. 63. -Losses from gunshot injuries by months under approximately the sameconditions as occurred in the American Expeditionary Forces where therewas a material increase in: (a) The strength each month; (b) also in theadmission rate at different periods. The average daily admission ratesper 1000 American Expeditionary Forces strength were: Jan. to June 0.11;July to Sept. 0.53; Oct. to Nov. 0.96. It is here assumed that 20% of thegunshot admissions were sent to the Zone of the Interior. The symbols usedthroughout the body of this table represent the product of a monthly lossby an increase in strength in thousands and by a daily admission rate.Thus 1BS (36.39 × 38 × .11) =152.
NOTE: Data for losses each month (second line from top), see Fig. 58.
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For convenience in calculating the data on Figs. 62 and 63, the timefrom January 1 to November 11, 1918 is divided into three periods, althoughmore exact results could be obtained by dividing the entire time more nearlyin accordance with the intensity of fighting.
As an illustration of the method of determining losses from gunshotmissiles (Fig. 63), the January strength is multiplied by each loss ratefrom No. 1 to No. 11 at the basic daily admission rate of 1.00 per 1000;and also for each month of its service in the American Expeditionary Forces,(11 months) by the admission rate of .11. The increase in the admissionrate of .42 (.53 - .11) in July is then multiplied by the January strengthand the initial five loss rates. These additional losses are entered inthe table on the line with the January strength under the months from Julythrough November. The further increase in the admission rate of .43 [.96- (.42 + .11)] in October is then multiplied by the January strength andthe two initial loss rates. These additional losses as comput-ed are enteredon the January line under October and November as they occurred.
In computing the losses for the increase in strength during February,that increment is multiplied by the loss rates from No. 1 to No. 10 inclu-sive,then throughout by .11, by .42 for the last five groups, and by .43 forthe last two. For the March increase in strength, the loss rates from No.1 to No. 9 are used, for the April one, No. 1 to No. 8, etc. For the Julystrength, the only loss rates used are from No. 1 to No. 5 inclusive, andconsequently the second multiplication is by .53 (.11 + .42). Similar-lythe October increase is first multiplied by the first two loss rates andthen by .96 (.53 + .43).
The following table shows a summary of the monthly losses as computedon Figs. 60, 62, and 63
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Table 13. Total losses inthe American Expeditionary Forces by months.
Month | Strength in thousands to middle of the month. | Losses by months | |||||
Increase in strength | Accumulated strength | Diseases and nonbattle injuries. | Gas | Gunshot | Total | Per 1000 total strength | |
Jan. | 194 | 194 | 5,582 | 456 | 777 | 6,815 | 35.13 |
Feb. | 38 | 232 | 3,267 | 327 | 797 | 4,391 | 18.93 |
March | 49 | 281 | 3,051 | 304 | 881 | 4,236 | 15.07 |
April | 88 | 369 | 4,100 | 391 | 1,122 | 5,613 | 15.21 |
May | 167 | 536 | 6,834 | 630 | 1,649 | 9,113 | 17.00 |
June | 223 | 759 | 9,644 | 896 | 2,334 | 12,874 | 16.96 |
July | 258 | 1,017 | 12,022 | 4,008 | 18,612 | 34,642 | 34.06 |
August | 268 | 1,285 | 13,578 | 3,564 | 20,764 | 37,906 | 29.50 |
Sept. | 263 | 1,548 | 14,438 | 3,451 | 22,987 | 40,876 | 26.41 |
October | 222 | 1,770 | 13,969 | 11,178 | 52,095 | 77,242 | 43.64 |
Nov. 1 to 11 | 110 | 689* | 4,001 | 2,673 | 17,773 | 24,447 | 35.48 |
Aggregate | 8,680 | 90,486 | 27,878 | 139,791 | 258,155 | 29.74 | |
* 11/30 of accumulated strength for month of November
As nearly as can be estimated, the total losses in the American ExpeditionaryForces to November 11, including deaths, cases in hospital and cases returnedto the United States, was about 267,000, or about 9,000 more than the total258,155 as shown above. The results then of these calculations approximatethe actual losses as closely as could be expected from a computation inwhich grouped average rates and strengths are used.
To repeat, the rapid decline in loss rate as shown by Figs. 54, 56,and 59 occurs only when an expeditionary force has a constant strengththroughout with constant admission rates from all causes. The loss ratesper 1000 total Theater of Operations strength in the last column of Table13 show how much such rates depend upon the increases in strength and uponthe intensity of fighting.
K. LOSSES IN THE MOBILIZATION AREA.
The losses in the mobilization area consist of :
a. Noneffectives in hospital.
b. Deaths and discharges for disability among patients in hospital.
c. Deaths and discharges for disability among men not in hospital.
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After the mobilization camps are filled, there is but little increasein the strength of the command. As the troops are trained and equippedthey are sent to the expeditionary area and are replaced by incoming recruits.Consequently the number of men mobilized is greater than the average dailystrength for one year. Thus in 1918, the former was 3,310,246, and thelatter 1,310,246.
Fig. 64.*- Loss of manpower in the mobilization area (U.S.) among those actuallyenrolled in hte military service from diseases and nonbattle injuries,due to deaths, discharges for disability, and noneffectives in hospital(patients).
*NOTE: For basic formula see: (a) Patients in hospital, Fig. 82, (2) p.149. (b) Deaths and discharges in hospital, Fig. 95 (2) p. 162. (c) Deathsand discharges not on sick report based on experience in U. S., 1918.
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The troops while in training establish a. return flow of patients fromhospital, and when they depart their sick in hospital remain behind, thusacting as a replacement flow for the incoming recruits. The ultimate numberof noneffectives will then be divided among the total number of men passingthrough the mobilization area rather than among the average daily numberpresent for the year. The men in camp during the first few weeks, whenthe noneffective rate rises quite rapidly, lose a larger percentage thanthose during the later periods when it is more nearly stabilized; but forall practical purposes we may disregard this and consider that the noneffectivesare distributed evenly among the men mobilized. Then as in Fig. 64, withan ultimate noneffective rate of 20.36 to the average annual strength,the same rate to each 1000 men mobilized was
20.36 × (1,310,246/1000) ÷ (3,310,246/1000) = 8.06
The time element is an important one in connection with deaths and dischargesamong patients in hospital, for the number of cases with their associateddeaths and discharges for disability increase in proportion to the lengthof the time period, like the noneffective rate. Consequently this classof losses must be proportioned to the total number of men mobilized ratherthan to the daily strength averaged for one year. With a loss rate fromthese causes at the end of one year of 14.67 per 1000 in an average dailystrength of 1,310,246, the corresponding one for 3,310,246 men mobilizedis
14.67 × (1,310,246/1000) × (3,310,246/1000) = 5.81
The third class of losses are from deaths and from discharges for disability(of which the latter comprised 95% of the two during 1918), among men noton sick report. This group consisted chiefly of the phy-sically unfit menwhose deficiencies escaped the scrutiny of the local and camp examiningboards. The physical imperfections of such men soon became apparent toofficers of organization and to the medical officers assigned to them,and they were discharged as physically unfit. Probably all such cases canbe culled out within a month or six weeks, and there should be no materialincrease in the percentage of them there-after, no matter how long themen remain in the mobilization area. Since the time element need not beconsidered in connection with them, as it is assumed that the trainingperiod will be long enough for their detection and elimination, the ratesfor them can be based upon the actual number of men mobilized. In 1918it was 22.24 per 1000 men (Fig. 64).
Since the total losses in man power in the mobilization area is 52.05per 1000 men mobilized (See Fig. 64), or 5.20%, the number of men
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available for duty with any expedition will be 100% - 5.20% = 94.80%.For each 1000 men required for a large expeditionary force, when the troopsare to be equipped and trained in the mobilization area, the number thatwill be required, after passing the camp examining board will be:
94.80% = 1000
100% = 1054.85
Since 6.6 %,12 of all men sent to the military camps by theLocal Boards were found to be physically unfit, the percentage of the menactually called for service who will eventually be available for duty withan expeditionary force will be:
100% - (5.2% + 6.6%) = 88.2%
Then for each 1000 men required for an expeditionary force, the numberto be called after passing the rather careful scrutiny of the Local ExaminingBoards will be:
88.2% = 1000
100% = 1133.79
Of this number of men called there will be:
1. Found physically unfit by Camp Examining Boards | 74.83 |
2. Noneffectives, deaths, and discharges as physically unfit in training camps | 58.96 |
3. Available for duty with an expeditionary force | 1000.00 |
Total to be called | 1133.79 |
Since 14.6% of all Class I men were found physically disqualified forfull military service by local boards; and an additional 8.0% as availableonly for limited or domestic service by the local and camp examining boards,the percentage of Class I men between the ages of 21 and 30 who were eventuallyavailable for combat service with the expeditionary force was 100 % - (14.6%+ 8.0% + 6.6% + 5.2%) = 65.6%. Then for each 1000 men for combat duty requiredfor an expeditionary force, the number of Class I men, ages 21 to 30, whomust be available will be:
65.6% = 1000
100% = 1524.39
Of this number there will be:
1. Found physically unfit by the examining board | 222.56 |
2. Found physically fit for only limited service by local and camp examining boards | 121.95 |
3. Found physically unfit by camp examining board | 100.61 |
4. Non-effectives, deaths, and discharges as physically unfit in training camps | 79.27 |
5. Available for combat duty with an expeditionary force | 1000.00 |
Total Class I men | 1524.39 |
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