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