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III. MEDICAL SERVICE IN THE COMBAT ZONE

The care of the sick and injured of the units operating in the Theaterof Operation and the evacuation to general hospitals are important functionsof the Medical Department. The efficient and systematic performance ofthis duty assists materially in insuring the mobility of the troops inthe front area, and it is also a very important factor in maintaining themorale of the troops.

The character of cases to be treated and evacuated are:

    a. Diseases and nonbattle injuries.
    d. Battle wounds from:

      (1) Gunshot missiles.
      (2) War gases.

    L. DISEASES AND NONBATTLE INJURIES

    35. Total in the Theater of Operations. - Our experience shows(Fig. 18) that the daily admission rate from diseases and nonbattle injuriesto hospital and quarters combined for seasoned troops operating under favorableconditions in a temperate climate in an area such as the American ExpeditionaryForces, with a large number of men in the line of communications area,was 2.50 per 1000. It further shows (Fig. 1) that 56% of such cases wereadmitted to hospital and 44% were treated in quarters, infirmaries, improvisedhospitals, etc. We know also, (p. 3) that approximately one half as manycases are treated as dispensary cases as in hospital and quarters combined.

    Under such conditions as outlined above the average daily sick rateper 1000 men among such troops would be:

      Hospital sick 1.40
      Quarters sick 1.10
      Dispensary sick 1.25

    If this rate is increased 20% to allow for normal variations, the dailysick rate per 1000 men in the Theater of Operations is 4.50, of which,approximately one third would be sent to station or general hospitals,one third would be cared for in quarters, dispensaries, etc., and one thirdwould be returned to duty with their organization. In the further discussionof this subject no mention will be made of the care of the dispensary sick,but there will always be a large number of such cases to be treated, andsupplies and personnel must be available for this purpose.

    36. In the Combat area. - When troops enter the combat zone andthen advance to the battle line, the incidental hardships and unfavorableconditions probably would cause an increase in the sick rate. To obtaindata in regard to the actual increase to be expected, a study was madeof the medical records of the infantry regiments of the 1st,

    102

    Table 14. - Daily admissionrates from diseases by systems by months, among each 1000 white enlistedmen in combat divisions and in the total American Expeditionary Forces,June to October, 1918.

    Systems

    June

    July

    August

    September

    October

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Combat Divisions

    Total A.E.F.

    Infections not specified

    .08

    .11*
    .29?

    .09

    .08
    .14

    .12

    .09
    .16

    .17

    .11
    .20

    .38

    .16
    .29

    Tuberculosis

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    .02

    .01
    .02

    Venereal

    .09

    .05
    .09

    .05

    .03
    .06

    .08

    .05
    .07

    .16

    .04
    .07

    .10

    .04
    .07

    General

    .06

    .02
    .04

    .07

    .02
    .04

    .04

    .02
    .04

    .11

    .03
    .06

    .25

    .04
    .07

    Nervous and mental

    .20

    .03
    .06

    .88

    .08
    .14

    .23

    .06
    .11

    .19

    .05
    .09

    .45

    .06
    .11

    Eye, ear, and nose

    .16

    .04
    .07

    .09

    .03
    .06

    .10

    .04
    .07

    .13

    .03
    .06

    .11

    .04
    .07

    Circulatory

    .10

    .03
    .06

    .09

    .03
    .06

    .10

    .04
    .07

    .14

    .04
    .07

    .19

    .04
    .07

    Respiratory

    1.67

    .34
    .61

    .41

    .21
    .38

    .46

    .25
    .45

    1.40

    .77
    1.34

    2.81

    1.15
    2.05

    Digestive

    .21

    .10
    .18

    .32

    .11
    .20

    .67

    .23
    .41

    .56

    .15
    .27

    1.39

    .28
    .50

    Genito-urinary and skin

    .34

    .06
    .11

    .27

    .06
    .11

    .22

    .07
    .13

    .28

    .07
    .13

    .58

    .09
    .16

    Bones, organs of locomotion, con. Malformation, & ill defined

    .72

    .08
    .14

    .31

    .06
    .11

    .22

    .07
    .13

    .28

    .07
    .13

    .58

    .09
    .16

    TOTAL

    3.65

    .87
    1.55

    2.63

    .71
    1.27

    2.27

    .90
    1.61

    3.57

    1.37
    2.45

    6.67

    1.98
    3.54

    *Admission rates to hospital
    ?Estimated total admission rates, including cases in quarters.
    NOTE: The Combat Divisions include the Infantry Regiments of the 1st, 3rd,26th and 42nd Divisions. The rates for the Combat Divisions apparentlyinclude as hospital cases those ordinarily treated in quarters; whereasthose computed,for the total American Expeditionary Forces include onlyhospital cases. The estimated ones which include also quarters cases canbe more properly compared with those for the Combat Divisions (Front Area).

    3rd, 26th and 42nd Divisions, all active combat divisions, for the periodJune I to October 31, 1918, inclusive.1

    103

    Since the Divisions selected were composed of white men, their ratesare compared with those for the total white troops in the American ExpeditionaryForces.3 The computed data as presented by Tables 14 and 15,and Figs. 65 and 66, shows that there was more sickness among the frontarea white troops than in the total, group. It is apparent also that theexcess among the front line troops occurred each month and from each classof disease, the most important increase being in the number of

      Fig. 65. -Daily admission rates by classes of diseases per 1000 strength of whitetroops in the front area, and also in the total American ExpeditionaryForces, for the period from June 1 to October 31, 1918. 1 3

    104

    cases of respiratory and digestive diseases.

    Table 15 and Fig. 66 also indicate that there was more sickness amongthe troops on the battle line than among the other front area troops. Thedata, as computed, shows that the average daily hospital admissionrate from diseases only for the white troops in the front area was 3.76per 1000, as compared with 1.26 for the total American Expeditionary Forces,3or practically 3 to 1. If the admissions from nonbattle injuries are includedthe rate of 1.26 is raised to 1.40; and if the ratio of 3 to 1 is continued,the 3.76 is raised to 4.20 (hospital only).

    Before any real comparison can be made, however, of the rates for thecombat divisions with those for the total American Expeditionary Forces,the character of the cases included in the two sets of rates must be considered.As stated above, many of the cases of sickness among the men in the trainingarea were treated in quarters, infirmaries, etc., and were not made ofrecord. Among the combat divisions, however, and especially so when inthe actual combat area, a large part of the sick had to

      Fig. 66. -Daily admission rates from diseases per 1000 strength of white troops inthe front area, and in the total American Expeditionary Forces, for theperiod June 1st to October 31st, 1918,and also for each month of that period.1 3

    105

    be evacuated and consequently were admitted to either temporary or permanenthospitals where records were made. Apparently then, the comparison shouldbe between the total admission rate in the American Expeditionary Forces;that is, the one including both hospital and quarters cases, and the oneavailable for the combat division. For this purpose, the estimated ratesto include both hospital and quarter cases for the total AmericanExpeditionary Forces are shown both in the tables and on the graphs. Thecomparison is then between 2.50 and 4.20. Consequently, we would expectthe sick rate to be 1.70 (1.68) as great among the personnel of the frontline combat divisions as in a total area, such as the

    Table 15. - Daily AdmissionRates from Disease by Systems among each 1000 White Enlisted Men, on thebattle line, among other troops in combat divisions, and in the total AmericanExpeditionary Forces, June to October, 1918.

    Systems of Diseases

    Combat Divisions

    Total 3
    A.E.F.

    On battle line

    Not on battle line

    Total

    Infectious, not specified

    .15

    .19

    .17

    .12*
    .21?

    Tuberculosis

    .02

    .02

    .02

    .01
    .02

    Venereal

    .10

    .09

    .09

    .04
    .07

    General

    .13

    .09

    .11

    .03
    .05

    Nervous and mental

    .57

    .20

    .39

    .06
    .11

    Eye, ear and nose

    .13

    .10

    .11

    .04
    .07

    Circulatory

    .12

    .12

    .12

    .04
    .07

    Respiratory

    1.58

    1.09

    1.35

    1.11

    Digestive

    .63

    .64

    .63

    .19
    .34

    Genito-urinary and skin

    .33

    .32

    .33

    .07
    .12

    Bones, organs of locomotion, congenital malformations and ill-defined

    .56

    .27

    .42

    .08
    .14

    TOTAL

    4.31

    3.13

    3.76

    1.26
    2.25

      *Admission rates to hospital.
      ? Estimated total admission rates including cases in quarters.

    106

    American Expeditionary Forces. Furthermore, when the troops are on theactual battle line this excess may be 2.00 to 1.00 instead of 1.70 to 1.00.Even with the estimated increase added, the total American ExpeditionaryForces rates are still much lower than those for the Combat Divisions (FrontArea) for each month, and for each group of diseases with the two exceptions,one for infectious not specified (which is lower), and the other for tuberculosis(which is the same) (see Table 14 and Fig. 65).

    Table 16. - Relative numberof cases of sickness among the front area troops as compared with the estimatedtotal in the American Expeditionary Forces set as a standard at 1.00.

      a. By months

    Month

    Front Area

    June

    2.35 to 1.00

    July

    2.07 to 1.00

    August

    1.41 to 1.00

    September

    1.46 to 1.00

    October

    1.88 to 1.00

    TOTAL

    1.67 to 1.00

      b. By class of disease

    Disease

    Front Area

    Respiratory

    1.21 to 1.00

    Digestive

    1.85 to 1.00

    Bones & organs of locomotion

    3.00 to 1.00

    Nervous and mental

    3.55 to 1.00

    Genito-urinary and skin

    2.75 to 1.00

    Infectious, not specified

    0.81 to 1.00

    Circulatory

    1.71 to 1.00

    Eye, ear and nose

    1.57 to 1.00

    General

    2.20 to 1.00

    Venereal

    1.28 to 1.00

    Tuberculosis

    1.00 to 1.00

    M. BATTLE CASUALTIES - COLLECTION OF DATA.

    The following data show the average and maximal casualty rates, andalso how often rates, of various magnitude, occurred among the United Statestroops in the American Expeditionary Forces during 1918. The informationas assembled is for the American part of 'the First American Army and itscomponent units, and also for other selected Divisions and regiments. Thesources of the information and the method of assembling the data are asfollows.

    37. Composition of Organizations. - a. First American, Army.- The Report of the First Army was used to determine its component organizationsfrom day to day. This information was supplemented by information obtainedfrom "Field Operations, Volume VIII, The Medical De-

    107

    partment of the United States Army in the World War".14The Corps of the First Army were I, III, and V, from September 26 to November11; the IV from September 26 to October 12; and the Divisions serving withthe French, for this study, grouped and included as a Corps, from Sept.26 to Nov. 11.

    b. Corps. - The report of the First Army13 was alsoused to determine the Divisions in each Corps from day to day, and alsothose in the Army Reserve. "Field Operations" 14 wasagain used to supplement the information obtained. In addition, "BattleParticipations of Organizations of the American Expeditionary Forces inFrance, Belgium, and Italy"10 was used quite freely toverify the location of Divisions, and especially to determine when a Divisionleft the line for reserve or vice versa.

      Fig. 67. -Average daily number of' American divisions in the First American Army,in each of its Corps, both in line (L) and in reserve (R), and also inthe Army Reserve for the period of 47 days, from September 26 to November11, 1918.3
      NOTE: The IV Corps was a part of the First Army only until October12, a period of 17 days. During that time the average daily number of divisionsin line was 3.18 and in reserve 1.53, whereas the figures for the entire47 days was L-1.15 and R-.55 as shown above.

    108

    Fig. 67 shows the daily average number of American Divisions in eachCorps and also in the First American Army during the Meuse-Argonne offensive.

    c. Divisions. - The information in regard to the operations ofDivisions was obtained from the "Battle Participations of Organizationsof the American Expeditionary Forces " etc 10. This informationwas supplemented by a mimeographed copy of "Brief Histories of Divisions,U. S. Army, 1917 - 1918"15, June, 1921,. from the HistoricalBranch, War Plans Division, General Staff.

    38. Strength of the Organizations. a. First Army. - Thestrength of the First Army is given on page 113 of the "Report ofthe First Army"13. Examination of the casualties in organizationsby days, as will be referred to later, showed that only 91% of the totalcasualties were distributed by divisional organizations by days.* Apparentlythen only 91% were included in the total casualties assembled for the FirstArmy. Therefore, the daily strength of the First Army as shown in the officialreport, was reduced in each instance to 91% to compensate for the differencein the total of casualties as they occurred and as assembled.

    b. Corps. - The daily strength of the individual corps was foundby multiplying the assumed strength of a division; that is, 24,000, bythe number of divisions, including those in reserve, in the Corps, andthen adding 33% ? to cover corps troops not included in divisional organizations.The total figures thus obtained were reduced then in each instance to 91% to compensate for the unassembled casualties, as referred to above.

    c. Divisions. - An examination made by the Historical Branchof the War College of the returns of 14 Combat Divisions on or about September26, 1918 showed that the average strength of each one was 24,128 men. Itwas assumed then that 24,000 was a fair figure to use in determining thestrength of the corps, as referred to above. But for the purpose of calculatingrates for Divisions, the 24,000 was reduced to approximately 91%, or to22,000, to compensate for the unassembled divisional casualties.

      *The original medical cards, upon which the casualtieswere reported, showed the regiments or staff corps to which each patientwas attached, but there was no reference to Division. The 9% of undistributedcasualties occurred among staff or corps troops, not in regiments.
      ?The Increase of 33% for Corps troops is based upon the strength of a typecorps composed of three divisions and the equivalent of the strength ofone division in corps troops. Since the daily number of divisions in thevarious corps was often greater than three while the number of corps troopsprobably remained more nearly constant, the increase of 33% for the latterprobably results in too great a strength for the corps, and consequentlyin too low a rate. Hence an increase of from 5% to 10% in such rates asare given may be justifiable.

    109

    d. Regiment. - An examination made by the World War Divisionof The Adjutant General's Office of reports of the Infantry Regiments inthe 1st, 42nd, and 80th Divisions on October 81, 1918 showed, that theaverage strength of each regiment was 2,732. To compensate for the lagin reporting casualties, the round number of 2,500 was used in calculatingregimental rates.

    39. Sources of Casualty data. - a. Immediate source of information.The immediate source of the casualty data was the tables in the latterpart of "Medical and Casualty Statistics, Part 2, Volume 15, The MedicalDepartment of the United States Army in the World War"3In these tables the number of gas wounded, gunshot wounded, and killedin action is given for each day for each Infantry, Artillery, and EngineerRegiment, and each Machine Gun Battalion.

    b. Original source of information. - The original source of theinformation was: (a) For the number wounded by war gasses and by gunshotmissiles, the Sick and Wounded Report cards forwarded from the AmericanExpeditionary Forces to the Office of the Surgeon General; (b) for thekilled in action, a nominal list of the deaths in the American ExpeditionaryForces arranged by organization and by day, prepared in the Office of TheAdjutant General and loaned to the Surgeon General's Office in 1921. Itwill be noted that in some instances during severe engagements, such aswhen the 27th and 30th Divisions participated in the attack on the Hindenburgline (Somme offensive) on the 29th and 30th of September, 1918, apparentlyall of the killed on the two days were reported as of the first day ofthe engagement. This results in a too high casualty rate for the firstof the two days and in one too low for the second.

    40. Engagements Studied. a. First Army and Corps. - The Meuse-Argonneoffensive from September 26 to November 11.

    b. Divisions. - All of the Divisions comprising the Corps ofthe First Army, including those with the French. In addition, the followingwere included: §

      1. First Division, Aisne-Marne, July 18 - 23.
      2. Third Division, Aisne-Marne, July 18 - 31.
      3. Fourth Division, Aisne-Marne, August 2 - 7.
      4. Twenty-Sixth Division, Aisne-Marne, July 18 - 25.
      5. Twenty-Seventh Division, Somme offensive, Sept. 26 - Oct. 20.
      6. Thirtieth Division, Somme offensive, Sept. 26 - Oct. 20.
      7. Thirty-Second Division, Aisne-Marne, July 30 - August 6.
      8. Forty-Second Division, Aisne-Marne, July 25 - August 3.

      § The Second Division could not be included becausethe date by days for its Marine organization were not available.

    110

    c. Infantry regiments. - All of the Infantry regiments of theDivisions referred to; and, in addition, the 9th and 23rd Infantry regimentsof the Second Division in the Aisne-Marne, July 18 and 19.

    41. Method of Assembling Data. - a. Infantry regiments.- In the study of casualties by regiments, only Infantry regiments wereincluded, because the Artillery and Engineer regiments had relatively fewcasualties as compared with the Infantry. The tabulation of the casualtiesfor the Infantry regiments included only those assigned to Divisions operatingon the front line, and none of those assigned to Divisions in the Corpsor Army Reserve. It was, however, impossible to select out the InfantryRegiments when in the reserve of the selected Divisions.

    b.Divisions. - The casualties as assembled for Divisions includethose for the four Infantry regiments; three Machine Gun Battalions; theEngineer regiment; and the three Artillery regiments, when operating withthe Divisions.? The daily casualties of these organizations, were addedto find those for the Divisions. As stated above, the Division strengthwas reduced to 91% of the total to compensate for the casualties whichoccurred in the organizations of the Divisions but for whom such data couldnot be assembled. In the study of the Divisions per se, the casualtiesof a Division was included only for the days when the Division was actuallyon the front line.

    c. Corps. - In assembling the data for the Corps by day, thecasualty data for all of the Divisions with the Corps on that date, bothon the line and in reserve, were included. These were added to find thetotal for the Corps. In some instances, when more than one day was necessaryto change a Division from the line to reserve or vice versa, the casualtyrate for the Division shown as in reserve may be seemingly quite high.

    d. Army. - The daily casualties of the Divisions in the ArmyReserve were added to the total of those in the Corps to find the aggregatefor the Army.

    42. Percentage of gas wounded, gunshot wounded, and killed. -The term battle casualties as used here includes wounds by war gases, woundsby gunshot missiles, and the killed in action. In planning the evacuationof the wounded some approximate estimate must be made of the percentageof the gas and of the gunshot wounded in the total casualties.

    As shown by Fig. 99 p. 166, the daily proportion of gas wounded to gunshotwounded decreased as the number of the latter increased; and also as shownby Fig. 100, p. 167, the daily proportion of gas wounded to the numberkilled in action decreased as the latter increased, while the proportionof gunshot wounded to the number killed remains practically constant. Inother words the relative number of men wounded each day by war gasses decreasedas the intensity of the military combat increased.

      ? No allowance could be made for the absence of Artilleryregiments on certain days. Consequently the casualty rates as computedfor such days are slightly lower than they should be.

    111

    Fig. 68 shows how the proportion of the gas wounded, gunshot wounded,and killed in the total casualties varied according to the resistance.It is suggested that the approximate average percentage distribution ofcasualties in Infantry regiments in engagements with casualties varyingfrom 100 to 400 (rates varying from 4% - to 16%) be used in estimatingthe percentage of killed in action, gas wounded, and gunshot wounded inthe total casualties. We would then assume that in severe engagements 16%of the casualties would be the "killed in action", 64% gunshotwounded, and 20% gas wounded. There would then be 4 gunshot wounded to1 killed in action, and 3.2 gunshot wounded to 1 gas wounded.

      The percentage of killed to wounded would then be:
      (a) 16% when there are both gas and gunshot wounded;
      (b) 20% when there are only gunshot wounded.

    Other American Expeditionary Forces experience indicates that in openwarfare the killed would be 16-2/3% (1 to 5) when war gases are not used.

      Fig. 68. -Variation in the percentage that the gassed, gunshot wounded and killedin action were of the total casualties according to the severity of theengagement.3
      NOTE: It is suggested that the approximate average percentages beused in estimating the distribution of total casualties. The data on theleft hand margin show the actual number of casualties.

    112

    N. BATTLE CASUALTIES - PRESENTATION OF DATA.

    In presenting the casualty data for the Infantry regiments, Divisions,Corps, and the First American Army, four items are shown for each, one:(a) The average daily casualty rate during the Meuse-Argonne offensive;(b) the frequency of various daily casualty rates, that is, how often eachone occurred; (c) the maximal daily casualty rates with the proportionatepart which occurred in the component unit of the Army, each Corps, andeach Division; (d) important casualty rates on days either preceding orfollowing the maximal casualty day.

    43. Infantry Regiments. - a. Frequency of casualty rates.- The summation curve, Fig. 69, shows how often casualty rates greateror less than a certain one, occurred in infantry regiments. Thus, in 97.15%of the

      Fig. 69. -Summation curve showing how often various regimental daily casualty ratesoccurred during major operations in the American Expeditionary Forces in1918.3

    113

    infantry regimental combat days in question (both in line and in reserveof the Divisions operating on the line) the loss was 100 per 1000 or less;and further the loss was greater than 100 per 1000 of the regimental strengthin 2.85% (100.0% - 97.15%) of the days.

    The Figure also shows how often casualty rates between certain onesoccurred. Thus a rate between 90 and 100 per 1000 of the regimental strengthoccurred in 0.83% (97. 15% - 96.32%) of the battle days in question.

    b. Average casualty day. - It is apparent then that high casualtyday rates were comparatively infrequent. The average daily casualty rate,which was 20.36 per 1000 for the days in question, was also low. Sincethe average includes the days spent in the reserve of the Divisions whichwere on the front line, it is necessarily lower than it would have beenfor regiments in action only, and should probably be raised to approximately25.00 per 1000 when comparing regimental losses with those in Divisionsand Corps in combat.

    c. Maximal casualty days. - An estimate of the medical personneland equipment required for infantry regiments in severe combat cannot bebased with safety on the most frequent daily casualty rates, or even onthe average one, but should be based upon rates during severe combat.

    In 1.74% (100% - 98.26%) of the combat days the casualty rates weregreater than 150 per 1000 regimental strength; and in .86%, or 21

    Table 17. - Maximal infantryregimental casualty day rates per 1000 men with the five next highest ondays either immediately preceding or following each, one; i. e., the ratesare shown for six consecutive days.

    Inf. Regt.

    Div.

    Date of highest casualty rate

    Daily casualty rates per 1000 regimental strength.

    107

    27

    Sept. 29

    30.0

    349.6

    98.4

    39.6

    25.6

    11.6

    120

    30

    Sept. 29

    298.4

    69.6

    29.2

    20.8

    14.4

    5.6

    108

    27

    Sept. 29

    28.8

    292.4

    89.2

    34.0

    18.4

    12.0

    9

    2

    July 18

    262.4

    90.0

    46.4

    25.6

    36.4

    24.0

    119

    30

    Sept. 29

    14.4

    234.8

    75.6

    22.8

    15.6

    6.4

    106

    27

    Sept. 27

    22.4

    214.0

    30.8

    78.0

    25.6

    17.2

    114

    29

    Oct. 12

    205.6

    122.0

    38.0

    30.0

    15.6

    24.8

    117

    30

    Oct. 8

    31.2

    72.4

    197.6

    63.6

    20.0

    11.2

    16

    1

    Oct. 4

    23.6

    56.8

    22.4

    190.4

    52.8

    20.0

    26

    1

    Oct. 4

    188.4

    126.8

    75.6

    25.6

    31.2

    45.6

    18

    1

    Oct. 4

    180.8

    86.0

    87.2

    26.4

    25.2

    99.2

    6

    5

    Oct. 14

    9.2

    170.8

    61.6

    19.2

    13.6

    9.2

    18

    1

    July 18

    169.2

    79.6

    92.0

    121.6

    64.4

    27.6

    105

    27

    Sept. 29

    57.2

    19.2

    168.0

    51.6

    23.2

    17.6

    165

    42

    July 28

    14.0

    166.4

    116.0

    73.2

    52.4

    33.6

    16

    1

    July 18

    165.2

    134.0

    122.8

    90.0

    68.4

    31.6

    140

    35

    Sept. 28

    21.6

    66.8

    164.8

    157.2

    70.8

    39.2

    165

    42

    Oct. 14

    162.4

    125.6

    32.0

    22.0

    19.6

    8.4

    28

    1

    July 18

    160.4

    138.4

    102.4

    140.4

    55.2

    35.2

    26

    1

    July 19

    110.4

    158.4

    142.4

    104.4

    54.4

    27.2

    114

    days, they were greater than 200 per 1000 of the regimental strength.Table 17 shows the regimental daily combat casualty rates greater than150 per 1000 of the regimental strength, and it also shows the more importantloss rates on five other days, either immediately preceding or followingeach maximal casualty day; i.e., on six consecutive days.

    d. Estimated combat requirements. - After considering such dailyrates as above it would apparently, be expedient to make provision fora 15% casualty day for an infantry regiment in severe combat, with thefollowing distribution of the total casualties:

    Killed in action 2.4%, gunshot wounded 9.6%, gas wounded 3%.

    44. Casualties by arms of service. - In the American ExpeditionaryForces the casualty rate for the infantry was much greater than those forthe other branches. The following table shows the relative standing ofthe casualty rates, infantry being taken as 100.2

    Infantry

    100.00

    Machine Gun

    70.12

    Signal Corps

    16.46

    Tank Corps

    15.85

    Artillery

    11.58

    Engineers

    9.15

    Medical Department

    8.54

    Quartermaster Department

    3.05

    Cavalry

    3.05

    Ordnance

    1.83

    Aviation

    1.83

    45. Infantry Divisions. - a. Frequency of casualty rates.- The summation curve, Fig. 70, shows how often during, this experiencecasualty rates in Infantry Divisions greater or less than any specifiedone occurred. Thus in 98.80% of the infantry divisional combat days inquestion, the loss was 50 per 1000 or less of division strength, and in1.2% (100.0% - 98.8%) of the days it was greater.

    A casualty rate between 40 and 50 per 1000 of the divisional strengthoccurred in 1.28% (98.80% - 97.52%) of the battle days.

    b. Average casualty day. - The average divisional casualty ratefor all of the combat days in line in question was 9.61 per 1000, or slightlyless than 1 %.

    c. Maximal casualty day. - Fig. 71, shows the divisional battledays with casualty rates greater than 60.0 per 1000, of the divisionalstrength. The graph also shows what part of the divisional casualty rateoccurred in each of its component regiments, both in line and in reserve.The regimental rates are based here upon the divisional strength, so thatthe sum of the several component rates are equal to the divisional one.

    The following table shows the more important loss rates on five dayseither immediately preceding or following each maximal one; i.e., on sixconsecutive days.

    115

    Table 18. - Maximal infantry divisionalcasualty day rates per 1000 men with the five next highest ones on daysimmediately preceding or following: i. e., the rates are shown for sixconsecutive days.

    Division

    Date of highest casualty rate

    Daily casualty rates per 1000 divisional strength.

    27

    Sept. 29

    5.2

    35.7

    13.0

    105.6

    31.7

    14.2

    1

    Oct. 4

    84.2

    51.0

    30.0

    12.7

    14.9

    41.9

    30

    Sept. 29

    8.6

    4.5

    4.1

    77.8

    25.3

    10.9

    1

    July 18

    74.8

    62.2

    58.9

    58.7

    33.3

    16.4

    5

    Oct. 14

    15.8

    12.5

    65.0

    30.4

    15.5

    7.4

    d. Estimated combat requirements. - Since a casualty day of approximately6% or greater occured not infrequently in Divisions in severe combat, itwould apparently be expedient to make provision for a 6% casualty day forinfantry divisions in severe combat with the following distribution: Killedin action, 0.96%, gunshot wounded 3.84% and gas wounded 1.20%.

      Fig. 70. -Summation curve showing how often various divisional daily casualty ratesoccurred during major operations in the American Expeditionary Forces in1918.3

    116

      Fig. 71. -The daily casualty rates on the five maximal casualty days for divisions(not including the 2nd) in line (not in reserve) in the First AmericanArmy during the Meuse-Argonne and selected divisions in the Aisne-Marneand Somme Offensives; also the average daily casualty rate for the divisionsduring those engagements.3
      NOTE: The above rates for the component regiments of the divisions arebased upon the divisional strength (22,000) and are consequently only 11.36%of those in Table 17 for the infantry regiments which are computed uponthe regimental strength (2,500).

    46. Army Corps. - a. Frequency of casualty rates. - Thesummation curve, Fig. 72, shows how often casualty rates in Army Corpsgreater or less than any certain one occurred during the Meuse-Argonneoffensive. As stated on the graph, casualty rates greater than 20 per 1000of corps strength, occurred in 1.95% (100% - 98.05%) of the battle days;and that rate or less in 98.05% of the combat days. Casualty rates between15 and 20 per 1000 of the Corps strength occurred in 1.97% (98.05% - 96.08%)of the battle days.

    b. Maximal rates in each Corps. - Fig. 73 shows the maximal ratewhich occurred in each Corps, and also the average for each one duringthe period of the Meuse-Argonne offensive. The graph also shows what partof the corps rate occurred in each of its component divisions, the latterrates being based upon corps strength. It is apparent that in each instancethe greater part of the maximal rate occurred in one division. If two divisionsin line had been engaged in equally severe combat, the total corps maximalrate would have been nearer 30 than approximately 20 per 1000 corps strength.

    The following table shows the maximal casualty days for the Corps in

    117

    question, and also the more important loss rates on four days immediatelypreceding or following each such day; i. e., on five consecutive days.

    Table 19. - Maximal dailycasualty rates in the Corps of the First American Army during the Meuse-Argonneoffensive with the four next highest rates on either immediately precedingor following days; i. e., on five consecutive days.

    Corps

    Date of highest casualty rate

    Daily casualty rates per 1000 corps strength.

    III

    Oct. 14

    21.32

    13.34

    8.10

    4.36

    4.50

    I

    Oct. 4

    10.11

    7.46

    21.22

    14.70

    8.32

    V

    Oct.14

    20.63

    12.76

    7.14

    3.59

    3.07

    V

    Sept. 29

    15.32

    20.52

    13.77

    7.89

    4.42

    I

    Sept. 28

    13.30

    16.10

    15.27

    6.37

    12.32

    V

    Oct. 9

    15.32

    10.48

    8.17

    4.65

    3.59

       Fig.72-Summation curve showing how often various Corps daily casualty ratesoccurred in the five Corps of the First American Army, including the divisionswith the French as a Corps, during the Meuse-Argonne Operation, Sept. 26to Nov. 11, 1918. 3

    118

      Fig. 73. -The maximal daily casualty rate for each Corps of the First American Armyduring the Mense-Argonne Sept. 26 to Nov. 11, 1918, and also the averagerate for each one during the entire period. 3
      NOTE: The above rates for the component divisions of the Corps arebased upon the Corps strength on the specified dates and are consequentlyless than those shown in Table 18 for the divisions, which are computedupon the divisional strength.

    c. Estimated combat requirements. - If an estimate is based thenupon the American Expeditionary Forces experience modified as suggestedabove it would apparently be expedient to make provisions for a 3% casualtyday for Army Corps when engaged in severe combat, with the following distribution:Killed in action 0.48%, gunshot wounded 1.92%, and gas wounded 0.60%.

    119

    47. First American Army. - a. Frequency of casualty rates.- The summation, curve, Fig. 74, shows how often casualty rates, greateror less than a certain one occurred in the First American Army during theMeuse-Argonne offensive. The lowest daily casualty rate recorded was 1.05per 1000 Army strength, and the highest, 7.75 per 1000.

      Fig. 74. -Summation curve showing how often various Army daily casualty rates occurredamong American Troops in the First American Army during the Meuse-ArgonneOperation, Sept. 26 to Nov. 11, 1918.

    120

    b. Daily casualty rates. - The following table shows the Armycasualty rates for each day during the operations:

    Table 20. Casualty rates forthe First American Army on each day during the Meuse-Argonne Offensive.

    Date

    Rate per 1000

    Date

    Rate per 1000

    Sept.

    Oct.

    26

    5.40

    20

    2.07

    27

    4.67

    21

    2.27

    28

    6.26

    22

    1.67

    29

    6.85

    23

    2.48

    30

    4.34

    24

    2.19

    Oct.

    25

    2.05

    1

    4.17

    26

    1.56

    2

    2.84

    27

    1.80

    3

    2.61

    28

    1.63

    4

    7.15

    29

    1.05

    5

    5.41

    30

    1.20

    6

    3.72

    31

    1.50

    7

    2.68

    Nov.

    8

    3.56

    1

    5.93

    9

    4.95

    2

    2.54

    10

    4.78

    3

    2.28

    11

    4.04

    4

    3.51

    12

    3.75

    5

    2.50

    13

    3.65

    6

    1.98

    14

    7.75

    7

    1.80

    15

    7.17

    8

    1.19

    16

    5.46

    9

    1.37

    17

    3.82

    10

    2.68

    18

    3.63

    11

    2.19

    19

    1.93

    121

    c. Maximal casualty rates. - Fig. 75 and Table 21 shows the maximalArmy rates, with the part which occurred in each corps, based upon Armyand not Corps strength.

    Table 21 - Maximal daily casualtyrates per 1000 strength in the First American Army during the Meuse-Argonneoffensive.

    Date

    I
    Corps

    III
    Corps

    IV
    Corps

    V
    Corps

    American Divisions with the French

    Army Reserve

    First Army

    Oct. 14

    1.57

    3.26

    *

    2.12

    .54

    .26

    7.75

    Oct. 15

    1.76

    2.15

    *

    2.04

    1.06

    .16

    7.17

    Oct. 4

    3.22

    1.36

    .54

    1.73

    .16

    .14

    7.15

    Sept. 29

    2.33

    .86

    .37

    3.13

    .10

    .06

    6.85

    Sept. 28

    2.50

    .83

    .41

    2.38

    .08

    .06

    6.26

    * Not a part of the First Army on this date.

      Fig. 75. -The daily casualty rates on the three maximal casualty days for the FirstAmerican Army in the Meuse-Argonne Sept. 26 to Nov. 11, and also the averagedaily casualty rate during the same period.
      The above rates for the component Corps of the Army are based upon thearmy strength on the specified dates and are consequently less than thoseshown in Table 19 for the Corps, which are based upon the Corps strengthon the same date.

    122

    d. Estimated combat requirements. - On each maximal casualtyday, the greater part of the casualties occurred: in two Corps out of atotal of four or five. If the Corps in line had been equally engaged, theArmy maximal rate would have been nearer 15.00 per 1000 than 7.75. If anestimate then is based upon the American Expeditionary Forces experienceas modified, it would seem to be expedient to provide for a 1.5% casualtyday for a Field Army when engaged in severe combat with the following distributionof the casualties: Killed in action 0.24%, gunshot wounded 0.96%, gas wounded30%.

    48. Summary. - a. Estimated combat requirements. - Thefollowing table gives a summary of the daily casualty rates as suggestedabove, under discussion of each unit, to be used as a basis for estimatingthe requirement for medical personnel and equipment on severe combat days.

    Table 22. - Casualty ratesper 100 (%) of unit strength suggested as a basis for estimating the necessarymedical relief on severe combat days, as determined by the American ExpeditionaryForces experience.

    Total
    Casualties

    Killed in action

    Wounded by:

    Gunshot missiles

    Gasses

    Inf. Regiment
    Inf. Division
    Army Corps
    Field Army

    15.0
    6.0
    3.0
    1.5

    2.40
    .96
    .48
    .24

    9.60
    3.84
    1.92
    .96

    3.00
    1.20
    .60
    .30

    b. Average casualty rates. - Fig. 76 shows the average casualtyrates for infantry regiments, infantry divisions Army Corps, and the FirstAmerican Army during the Meuse-Argonne offensive.

    The average rates for infantry regiments and infantry divisions referredto under the discussion of those organizations include casualty days inengagements other than in the Meuse-Argonne, and consequently differ fromthe ones shown here.

    Since the average rate for infantry regiments includes the days forthe regiments in divisional reserve some estimated increase should be madewhen their rate is compared with those for other units for which only combatdays are included. It is suggested that for such a purpose, the averagedaily regimental casualty rate be increased from 17.96 to an estimated20.00 per 1000 regimental strength.

    O. BATTLE CASUALTIES - TRANSPORTATION REQUIRED.

    It is difficult to secure accurate. information in regard to the characterof transportation required for battle casualties. During or after a severecombat day there will seldom if ever be enough litter bearers to carryall of the gassed and gunshot wounded to the Collecting Station, even ifsuch

    123

    was desirable. Consequently a certain number of the less severely gassedor gunshot wounded must walk to advanced relief stations. After the CollectingStation is reached, the more severely wounded must be transported as "Recumbent",while the less severely wounded can be carried as "Sitters".

      Fig. 76. -Average daily casualty rates per 1000 strength, for the period from Sept.26 to Nov. 11, 1918, inc., for the total American Expeditionary Forces,First American Army, corps of the First American Army, divisions in line(not in reserve) of the First American Army, and infantry regiments ofall divisions in line (including those in divisional reserve).
      *This rate (20.00) estimated for infantry regiments in combat only.

    The following data, which have been assembled from the medical recordsof the American Expeditionary Forces, may be of some assistance in, arrivingat an approximate estimate of the problem.

    49. Gunshot wounded. - a. Location. - It is suggestedthat the location of the gunshot wound, varied as the available informationsuggests, be used as a general index of, the gravity of the wound and ofthe transportation required. Wounds of the soft tissue of the extremitieswhen associated with extensive destruction of tissue, hemorrhage, shock,etc., are obviously more serious than fracture of the corresponding longbones associated with little destruction of tissue. Probably, however,the deaths which occurred in such cases can be used as an indication ofthe proportion of the wounds of relatively unimportant tissues which arevery severe.

    When a soldier had two or more wounds, the preference is given in thefollowing tables to the location associated with the highest average fatality

    124

    rate. The table shows how often wounds involving various tissues occurred,and also the fatality rate for each group. Wounds involving the abdominalor pelvic organs occurred in 11.07 per 1000 cases, with a fatality rateof 66.80%; while those of the soft tissues of the lower extremity (notinvolving important blood vessels or nerves) occurred in 333.86 per 1000wounds, with a fatality of 6.09%. Apparently then it may be said with safetythat a patient of the latter class was a much less serious transportationproblem than one of the first named group.

    Table 23. - Location of battlegunshot wounds in, the American Expeditionary Forces with rates per 1000total cases; and percentage fatality rate of each location.16

    Location of wound

    Frequency per 1000

    Fatality rate in percentage

    Soft tissues, lower extremity

    333.86

    6.09

    Soft tissues, upper extremity

    198.61

    4.27

    Bones of wrist and hand*

    118.23

    1.47

    Long bones and joints, lower extremity*

    70.52

    17.53

    Soft tissues of face and head

    59.19

    2.31

    Metatarsus and toes*

    51.96

    2.56

    Clavicle, humerus and scapula*

    32.74

    9.46

    Other long bones of the upper extremity*

    30.24

    4.39

    Cranial bones and brain

    20.46

    37.11

    Bones of the ankle

    13.83

    2.56

    Important blood vessels & nerves, upper extremity

    13.36

    7.11

    Abdominal and pelvic organs

    11.07

    66.80

    Thoracic organs

    10.52

    47.68

    Bones of the face*

    10.24

    8.45

    Muscles of neck, chest, abdomen and back

    5.95

    21.49

    Genital organs

    4.86

    8.65

    Bones of pelvis*

    4.22

    26.98

    Spinal cord and vertebra

    3.64

    55.85

    Important blood vessels and nerves, lower extremity

    3.33

    11.90

    Important organs and blood vessels of the neck

    3.16

    11.39

    * Fractures

    The fatality rate from artillery wounds was 7.03% and from small arms4.82%.16

    Artillery missiles caused 70% of the gunshot wounds among Ameri-cantroops during the World War as compared with 10% among the Union troopsduring the CivilWar.2

    The following table shows that the general location of the gunshot woundswas very much the same during the two wars.2

    General location of gunshot wounds

    Percentage

    Civil War

    World War

        Head
        Trunk
        Upper Extremity
        Lower Extremity

    11
    18
    36
    35

    13
    14
    32
    40

    125

    Table 24. - Estimation ofevacuation requirements for patients wounded by gunshot missiles.
    Number in each 1000 total wounded.

    Location of Wound

    To Collecting Station

    To Hospital Station

    To Evacuation Hospital

    Littered Expected to:

    Walking

    Recumbent Expected to:

    Sitting

    Recumbent Expected to:**

    Sitting

    Die

    Recover

    Die

    Recover

    Die

    Recover

    Severe

    Others

    Soft tissues, lower extremity

    23.71

    210.15

    100.00

    23.71

    210.15

    100.00

    23.71

    ?

    210.15

    100.00

    Soft tissues, upper extremity

    8.48

    63.38

    126.76

    8.48

    63.38

    126.76

    8.48

    ?

    63.38

    126.76

    Bones of wrist and hand

    1.74

    ?

    116.50

    1.74

    ?

    116.50

    1.74

    ?

    ?

    116.50

    Long bones and joints, lower ex.*

    12.36

    58.16

    ?

    12.36

    58.16

    ?

    12.36

    5.00

    53.16

    ?

    Soft tissues, face and head

    1.36

    ?

    57.83

    1.36

    ?

    57.83

    1.36

    ?

    ?

    57.83

    Metatarsus and toes*

    1.33

    50.63

    ?

    1.33

    ?

    50.63

    1.33

    ?

    ?

    50.63

    Clavicle, humerus, &scapula*

    3.10

    29.64

    ?

    3.10

    29.64

    ?

    3.10

    ?

    29.64

    ?

    Other long bones, upper ex.*

    1.33

    ?

    28.91

    1.33

    ?

    28.91

    1.33

    ?

    ?

    28.91

    Cranial bones and brain

    7.59

    12.87

    ?

    7.59

    12.87

    ?

    7.59

    12.87

    ?

    ?

    Bones of ankle*

    .35

    13.47

    ?

    .35

    13.47

    ?

    .35

    ?

    13.47

    ?

    Important blood vessels and nerves, upper extremity

    .95

    12.41

    ?

    .95

    12.41

    ?

    .95

    6.00

    6.41

    ?

    Abdominal and pelvic organs

    7.39

    3.67

    ?

    7.39

    3.67

    ?

    7.39

    3.67

    ?

    ?

    Thoracic organs

    5.02

    5.50

    ?

    5.02

    5.50

    ?

    5.02

    5.50

    ?

    ?

    Bones of the face*

    .87

    3.13

    6.25

    .87

    3.13

    6.25

    .87

    ?

    3.13

    6.25

    Muscles of neck, chest, abdomen, and back

    1.28

    4.67

    ?

    1.28

    4.67

    ?

    1.28

    ?

    4.67

    ?

    Genital organs

    .42

    4.44

    ?

    .42

    4.44

    ?

    .42

    ?

    4.44

    ?

    Bones of the pelvis

    1.14

    3.08

    ?

    1.14

    3.08

    ?

    1.14

    ?

    3.08

    ?

    Vertebra* and spinal cord

    2.04

    1.61

    ?

    2.04

    1.61

    ?

    2.04

    1.61

    ?

    ?

    Important blood vessels and nerves, lower extremity

    .40

    2.93

    ?

    .40

    2.93

    ?

    .40

    2.93

    ?

    ?

    Important organs and blood vessels of the neck

    .36

    2.80

    ?

    .36

    2.80

    ?

    .36

    2.80

    ?

    ?

    TOTAL

    81.22

    482.53

    436.25

    81.22

    431.91

    486.88

    81.22

    40.38

    391.53

    486.88

    *Fractures.   **No attempt is madehere to determine the proportion of nontransportable cases.

    126

    b. Transportation. In Table 24 all cases which ultimately diedare listed as "Littered", or "Recumbent"; and the remainder,that is, the cases which recovered, as "Littered" and "Recumbent",or as "Walkers" and "Sitters," according to the locationof the wounds. The division of the recovery cases into the "Littered"and "Recumbent" and "Walkers" and "Sitters",such as in the case of those involving the soft tissues of the lower extremity,was based upon the location and fatality rate of the group.

    50. Gunshot and Gas Wounded. - The medical records show the numberof fatalities from war gases (1.73%) but no other information which maybe used as a basis in estimating the transportation require-ments. Consequentlyany such estimate must be based upon general experience and supposition.

    Table 25. Estimation of evacuationrequirements for patients wounded by war gases and gunshot missiles, separatelyand combined; rates per 1000 cases.

    (a)
    To Coll.
    Station

    Littered

    Walking

    Grand Total

    Fatal

    Recovery

    Total

    Gas

    17.80

    182.71

    200.00

    800.00

    1000.00

    Gunshot

    8.22

    482.53

    563.75

    436.25

    1000.00

    Total

    65.24

    407.57

    472.81

    527.19

    1000.00

    (b)
    To Hospital Station

    Recumbent

    Sitting

    Grand Total

    Fatal

    Recovery

    Total

    Gas

    17.30

    182.70

    200.00

    800.00

    1000.00

    Gunshot

    81.22

    431.91

    513.13

    486.88

    1000.00

    Total

    65.24

    369.61

    434.85

    565.16

    1000.00

    (c)
    To Evacuation Hospital

    Recumbent

    Sitting

    Grand Total

    Fatal

    Recovery
    Severe

    Recovery
    Others

    Total

    Gas

    17.30

    182.70

    200.00

    800.00

    1000.00

    Gunshot

    81.22

    40.38

    391.53

    513.13

    486.88

    1000.00

    Total

    65.24

    30.29

    339.32

    434.85

    565.16

    1000.00

       Note: The above totals are calculated by multiplyingthe rates from the gunshot wounded by three, the ones from war gases byone, adding the results, and dividing the sum by four. This procedure isbased upon the assumption that in severe combat war gases cause 25% andgunshot missiles 75% of the total wounded. (As calculated from Fig. 68,It would be 23.81% and 76.19%).

    127

    In the table above, the data in regard to gunshot wounds are from Table24, but those for, the war gas wounds are as stated.

    According to Table 25, 47 % of the wounded would be littered to theCollecting Station and 53% could walk; 43% would be transported to theHospital stations as "Recumbent" and 57% as "Sitters";and to the Evacuation Hospital, 43% again would be transported as "Recumbent"and 57% as "Sitters."

    Colonel Alexander N. Stark, who was Chief Surgeon of the First AmericanArmy, American Expeditionary Forces, says in his report of the Meuse-Argonneoffensive, that 42% of the patients evacuated were carried "Prone"and 58% as "Sitters". He includes in his total, however, thesick as well as wounded.2

    P. BATTLE CASUALTIES - DISPOSITION OF CASESIN THE COMBAT AREA.

    The experience in the American Expeditionary Forces may be helpful informing an approximate estimate of the relative number of the sick andwounded to be evacuated from the Combat Area. When considering this phaseof the problem, the patients may be divided into two groups: (a) Long durationcases, and (b) short duration cases. The first group will require evacuationto the base and general hospitals, and second may be hospitalized somewherewithin the Army Area.

    The time limit for the latter group will depend to some extent uponthe existing conditions. It is subdivided into: (a) cases that return toduty, and (b) those that die within a few days.

    As stated elsewhere the medical records from the American Ex-peditionaryForces show the duration of treatment both of cases that recovered andthose that died. The value of this information is reduced materially because:(a) Patients in some instances were retained for treatment in the CombatArea, and no records were made for them; and (b) trivial cases, which weresent to the base hospital, lost unnecessary time.

    51. Percentage of short duration cases.* - The following tableshows the percentage of patients which: (a) Returned to duty, or (b) diedduring the first 10 days, treatment in hospital.

    *The method of computing the data in this section is explained on pages140 to 143.

    128

    Table 26. - Percentage ofshort duration cases, as reported in the American Expeditionary Forces,leaving hospital each day from the first to the tenth.

    Day of treatment

    Percentage leaving hospital by return to dutyor death by the end of each day

    Duty§

    Death?

    Sick?

    Gassed

    Gunshot Wounded

    Sick?

    Gassed

    Gunshot Wounded

    1

    5.35

    1.97

    .10

    .06

    .18

    1.43

    2

    10.25

    3.95

    .33

    .11

    .34

    2.57

    3

    14.75

    5.94

    .66

    .16

    .48

    3.47

    4

    18.91

    7.94

    1.09

    .21

    .60

    4.20

    5

    22.74

    9.94

    1.60

    .25

    .71

    4.78

    6

    26.28

    11.94

    2.20

    .29

    .81

    5.24

    7

    29.56

    13.92

    2.86

    .32

    .90

    5.61

    8

    32.60

    15.89

    3.59

    .35

    .97

    5.91

    9

    35.42

    17.84

    4.37

    .38

    1.04

    6.16

    10

    38.05

    19.77

    5.20

    .40

    1.10

    6.36

      ?Diseases and nonbattle injuries.
      §From Figs. 90, 91, and 92.
      ?These data are 0.78 %, 1.73 %, and 8.12 % of the sick, gassed, and gunshotwounded respectively of those in Table 30.

    The maximal day of treatment shows the longest time of treatment, butthe group includes all those of shorter duration. Thus, the maximal 5 daysgroup includes cases leaving hospital at any time up to the end of thefifth day. Of the cases of diseases and nonbattle injury sent to hospitalin the American Expeditionary Forces, 22.74 % returned to duty in 5 daysor less, and .25% died; while of the gunshot cases, 5.20% returned to dutyin 10 days or less, and, and 6.3% died, etc.

    If all duty cases requiring treatment for four days or less are retainedwithin the Division area, 18.91% of the sick, 7.94% of the gassed, and1.09 % of the gunshot wounded will be so held. Further, if duty cases requiringtreatment from 5 to 10 days are hospitalized within the Corps or Army Area,the group will consist of 19.14% (38.05% - 18.91% ) of the sick, 11.88%(19.77% - 7.94% ) of the gassed cases, and 4.11% (5.20% - 1.09%) of thegunshot cases. Obviously the selection of sick cases whose treatment willrequire a maximum of 4 days, 10 days etc., must depend upon the judgmentof those selecting the cases.

    The percentages can be applied to any casualty day for any unit. Assumea Division of 20,000 men with a daily casualty rate of 60 per 1000 men,and with a daily sick rate of 4.20 per 1000. Then there will be:

    Casualties

    1200

      Killed (16%)

    192

      Gassed (20%)

    240

      Gunshot wounded (64%)

    768

    Sick

    84

    129

    Assume further that all cases returning to duty in 10, days or less,and that all cases dying within 5 days or less are held within the ArmyArea. Then each day the number so held and evacuated from the above groupwill be:

    Total (a)

    Duty in 10 days or less (b)

    Death in 5 days or less (c)

    Evacuated
    (a) - [(b) + (c)]

    Sick

    84

    31.96

    .21

    51.83

    Gassed

    240

    47.45

    1.70

    190.85

    Gunshot wounded

    768

    39.94

    36.63

    691.43

      Total

    1092

    119.35

    38.54

    934.11

    Nontransportable cases held within the front area will reduce stillfurther, at least temporarily, the number to be evacuated.

    52. Hospitalization of short duration cases. - a. Accumulationin hospital to the end of any period of cases returned to duty or dyingduring that length of time. - The data in Table 27 from the AmercianExpeditionary Forces records shows how short duration duty and death casesac cumulate when the number of days of treatment varies from 1 to 5, 1to 8, 1 to 10, etc. The table is based upon the same assumption as elsewherein considering hospital populations; that is, that there is an averagedaily admission rate during the periods with a definite, number going outeach day. It answers question such as; "After six combat days by aninfantry division with an average daily admission rate from diseases andnonbattle injuries of 4.20 per 1000, and from casualties of 50 per 1000how many duty and death cases of six day or less duration will there be?"Since Table 27 is based upon an average daily admission rate of 1.00. thedaily number of sick and wounded must first be determined.

    Rate per 1000

    Strength

    One-day cases

    Six-day cases

    Disease & nonbattle injuries

    4.20

    20,000

    84

    504

    Casualties

    50.00

    20,000

    1,000

    6,000

      Killed (16%)

    160

    960

      Gassed (20%)

    200

    1,200

      Gunshot wounded (64%)

    640

    3,840

    130

    Table 27 shows how short duration cases accumulate in hospital.

    Table 27. - The accumulationin hospital to any day, from the first to the tenth of patients who willreturn to duty or die on that day or before. Admission rate from each causeis 1.00 per day.

    Maximal day of treatment

    Duty*

    Expected deaths?

    Sick§

    Gassed

    Gunshot wounded

    Sick§

    Gassed

    Gunshot wounded

    1

    .05

    .02

    .001

    .001

    .002

    .002

    2

    .15

    .06

    .005

    .002

    .005

    .04

    3

    .29

    .12

    .015

    .003

    .01

    .06

    4

    .45

    .20

    .03

    .005

    .01

    .09

    5

    .64

    .30

    .06

    .01

    .02

    .12

    6

    .86

    .42

    .09

    .01

    .03

    .15

    7

    1.09

    .56

    .14

    .01

    .03

    .18

    8

    1.33

    .71

    .20

    .01

    .04

    .20

    9

    1.58

    .89

    .27

    .02

    .04

    .22

    10

    1.84

    1.09

    .35

    .02

    .05

    .24

      *Computed from data in Tables 26 and 32, as per par. 58a, p. 141.
      ?Computed from data in Tables 30 and 32, as per par. 58 a, and 58 b, page141.
      ? Also day of death or duty.
      § Diseases and nonbattle injuries.

    Then in reply to the above question, the accumulation of the 6-day orless cases in hospitals, which must be based upon each day's admissions,would be:

    Duty cases

    Death cases

    Total

    Sick

    (84 × 86)

    72.24

    (84 × .01)

    .84

    73.08

    Gassed

    (200 ×.42)

    84.00

    (200 × .03)

    6.00

    90.00

    Gunshot wounded

    (640 × .09)

    57.60

    (640 × .15)

    96.00

    153.60

    Total

    213.84

    102.84

    316.68

    The total 6-day or less cases during the six days of treatment in thefront area, and the ones to be evacuated which must be based upon the totalfor six days, would be:

    Total in six days
    (a)

    Duty in 6 days or less
    (b)

    Death in 6 days or less
    (c)

    Evac. in six days
    (a) - [(b) + (c)]

    Sick

    504

    (26.28%)

    132.45

    (0.29%)

    1.46

    370.09

    Gassed

    1200

    (11.94%)

    143.28

    (0.81%)

    9.72

    1047.00

    Gunshot wounded

    3840

    (2.20%)

    84.48

    (5.24%)

    201.22

    3554.30

    Total

    5544

    360.21

    212.40

    4971.39

    131

    At the close then of the six combat days with the admission rates asspecified, the account of a division of 20,000 men for the sick and woundedcombined would be:

    Total to be accounted for (6504 - 960)

    5544.00

    Evacuated

    4971.39

    One to six-day cases in hospital in Army Area

    316.68

      Duty cases

    213.84

      Death cases

    102.84

    One to six-day cases which have left hospital

    255.93

      Duty cases (360.21 - 213.84)

    146.37

      Death cases (212.40 - 102.84)

    109.56

     b. Accumulation in hospital to the end of any period of casesreturn-ing to duty or dying during that length of time: - But the abovequestion may be worded as follows, "After six combat days by an infantrydivision of 20,000 men with an average daily admission rate from diseasesand non-battle injuries of 4.20 per 1000 and from casualties of 50 per1000, how many duty, and death cases of 10 days or less duration win therebe?" Obviously since the duration here is 10 days or less insteadof 6 or less, there will be more cases retained within the Army Area. Theanswer to the question can be computed from the basic data in the followingtable.

    Table 28 - The accumulationin hospital to any day from the first to the tenth of patients who willreturn to duty or die on the tenth day or before. Admission rate from eachcause is 1.00 per day.

    Day of duty or death?

    Duty*

    Expected deaths?

    Sick§

    Gassed

    Gunshot wounded

    Sick§

    Gassed

    Gunshot wounded

    1

    .38

    .20

    .05

    .004

    .01

    .06

    2

    .71

    .38

    .10

    .007

    .02

    .11

    3

    .99

    .53

    .15

    .01

    .03

    .15

    4

    1.22

    .67

    .20

    .01

    .03

    .18

    5

    1.41

    .79

    .24

    .02

    .04

    .20

    6

    1.56

    .89

    .27

    .02

    .04

    .22

    7

    1.68

    .97

    .30

    .02

    .05

    .23

    8

    1.76

    1.03

    .33

    .02

    .05

    .24

    9

    1.81

    1.07

    .34

    .02

    .05

    .24

    10

    1.84

    1.09

    .35

    .02

    .05

    .24

    132

    Since this table, as the previous one is based upon a daily admissionrate of 1.00, the daily number of sick and wounded must first be determined.The table from page 129 is repeated here.

    Rate per 1000

    Strength

    One-day cases

    Six-day cases

    Disease & nonbattle injuries

    4.20

    20,000

    84

    504

    Casualties

    50.00

    20,000

    1,000

    6,000

      Killed (16%)

    160

    960

      Gassed (20%)

    200

    1,200

      Gunshot wounded (64%)

    640

    3,840

    Then the accumulation in hospital in six days of 1 to 10 day cases,based upon each days admissions, would be:

    Duty cases

    Death cases

    Total

    Sick

    (84 × 1.56)

    131.04

    (84 × .02)

    1.68

    132.72

    Gassed

    (200 × .89)

    178.00

    (200 × .04)

    8.00

    186.00

    Gunshot wounded

    (640 × .27)

    172.80

    (640 × .22)

    140.80

    313.60

    Total

    481.84

    150.48

    632.32

    The total 1 to 10 day cases during six days treated in the front area,and the ones to be evacuated, based upon the total for six days, wouldbe:

    Total in six days
    (a)

    Duty in 10 days or less
    (b)

    Deaths in 10 days or less
    (c)

    Evacuated in six days (a) - [(b) + (c)]

    Sick

    504

    (38.05%)

    191.77

    (.40%)

    2.02

    310.21

    Gassed

    1200

    (19.77%)

    237.24

    (1.10%)

    13.20

    949.56

    Gunshot wounded

    3840

    (5.20%)

    199.68

    (6.36%)

    244.22

    3396.10

    5544

    628.69

    259.44

    4655.87

    At the close then of the sixth combat day with the admission rates asspecified and, with the 1 to 10 day cases treated in the front area, theaccount of a division of 20,000 men for the sick and wounded combined wouldbe:

    Total to be accounted for (6504 - 960)

    5544.00

    Evacuated

    4655.87

    One to ten day cases in hospital in Army Area

    632.32

    Duty cases

    481.84

    Death cases

    150.48

    One to ten day cases which have left hospital

    255.81

    Duty cases (628.69 - 481.84)

    146.85

    Death cases (259.44 - 150.48)

    108.96

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