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HEADQUARTERS, THIRD U.S. ARMY

AFTER ACTION REPORT

THIRD U. S. ARMY

1 AUGUST 1944-9 MAY 1945

VOLUME II

STAFF SECTION REPORTS

PART 17: MEDICAL

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CHAPTER 7

DECEMBER OPERATIONS

The progression of the Third U. S. Army in an easterly direction up to and across the German Border and constant preparation for a major attack on the SIEGFRIED LINE led to a consequent disposition of medical units to support these operations. Relentless efforts in regard to the problem of cold injuries (trench foot and frostbite) on the part of the respective commands produced definite results and decreases in this type of injury.

In December, for the first time Third U. S. Army overran German enclosures which contained a mixture of Allied prisoners of war and Allied displaced personnel. The medical care of these abandoned personnel who were sick or wounded became the responsibility of the Medical Department. Since there was a high percentage of morbidity among them, the Medical Department assumed responsibility for a large proportion.

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Late in the month, the movement of medical units to the north, in order to support the attack of the Third U. S. Army on the southern flank of the ARDENNES bulge, was achieved with a speed as incredible as the shift of the combat elements involved.

The details of all of the above circumstances will be found below in this chapter.

Section 1 - Organization of the Medical Section

There was no change in the physical organizational setup of the Medical Section during this month.

[Organizational and Functional Chart, Medical Section, Third U.S. Army]

Shortly after the breakthrough of the Germans in the ARDENNES area, an officer from this section was placed on temporary duty with Headquarters III Corps, and one with Headquarters VIII Corps for liaison purposes. This action was necessitated by the fact that operations were somewhat nebulous during the first few days, and were also initially being carried on at a considerable distance from the location of this headquarters.

Four enlisted men from the Medical Section were furnished for training as riflemen. These men were not replaced in the section.

Section 2 - Operations

1. Training

One officer, each, from the 65th and 66th Medical Groups attended the course on "Information and Education" offered by Headquarters European Theater of Operations at Cite Universitaire, PARIS (S-04). Requests were also submitted during the month to the AC of 3, G-3 for allotment to medical units of a proportionate share of future quotas for attendance at other courses to be held at the Army Information-Education Staff School.

Officers and nurses of the 65th Field Hospital were placed on temporary duty with various hospitals for orientation purposes. The 65th Medical Group was given the responsibility of training this unit.

2. Evacuation

When the III Corps became operational on 6 December with the mission of mopping up in METZ (U-85), the 66th Medical Group assumed the responsibility for medical evacuation of this corps, in addition to its responsibility for evacuation of XX Corps. This was possible due to the fact that the latter corps was assigned a front on the SAAR River , stretching roughly from SAARBURG (L-11) to SAARBRUCKEN (Q-47), although the former had not yet been approached closely. The sector surrounding METZ (U-85) covered by III Corps was geographically in the rear of this area; and the 66th Medical Group, which was located in METZ (U-85), was in an admirable position to combine evacuation of both corps. By 15 December, the reduction of all isolated forts at METZ (U-85) had been completed, and III Corps was assigned a sector on the SAAR River front to the south of XX Corps, and responsibility for its evacuation was at that time taken over by the 65th Medical Group, located at MORHANGE (Q-23). A corps medical battalion had been attached to III Corps prior to its commencement of operations, consisting of Headquarters and Headquarters Detachment, 182d Medical Battalion, 414th Medical Collecting Company, and the 606th Clearing Company. This battalion was later augmented by the attachment of the 467th Medical Collecting Company. On 22 December, the 606th Clearing Company was relieved by the 624th Clearing Company.

Exciting days prevailed for this Army beginning 20 December, when it was given the mission of bringing pressure on the southern flank of the German bulge in the ARDENNES area to crush the German counteroffensive. The III Corps moved north to the vicinity of ARLON (P-62), and became operational in the area north of that point on 20 December. XII Corps followed two days later, moving to the vicinity of LUXEMBOURG CITY (P-81). The 65th Medical Group continued to support both of these corps during the movement of the corps and their units, establishing its own headquarters at ESCH (P-70).

VIII Corps was established west of III Corps, and was being evacuated by the 64th Medical Group. This corps was assigned to Third U. S. Army, effective 21 December. The 64th Medical Group was not actually assigned by order until 26 December, but continued to evacuate this corps, except that it was relieved of the responsibility of evacuating the evacuation hospitals in its area. The latter function was assumed by the 69th Medical Group, which moved north to ESCH (P-70). Close cooperation between the 64th and 65th Medical Groups during this period resulted in smooth evacuation in situations where the division of responsibility was not always clear.

Units attached to the 64th Medical Group, in support of VIII Corps, included:

Hq & Hq Det, 170th Med Bn
Hq & Hq Det, 240th Med Bn
580th Amb Co, Mtr.
581st Amb Co, Mtr.
590th Amb Co, Mtr.
595th Amb Co, Mtr.
623d Clearing Company
42d Field Hospital
107th Evacuation Hospital
110h Evacuation Hospital

An unusual problem developed as a result of the isolation at BASTOGNE (P-55) of the 101st Airborne Division and elements of the 9th and 10th Armored Divisions. Evacuation of casualties from these forces was not possible for a period of about six days; and, as a result of the capture of the medical company of the 101st Airborne Division, the units isolated were supported essentially by first echelon medical personnel, only. Intensive liaison activity by representatives of the Army Surgeon and of the III and VIII Corps Surgeons, under particularly difficult conditions, early established the fact that approximately 1,000 casualties were present in BASTOGNE (P-55), who would require third echelon medical care when the breakthrough to that town was completed. As an initial step, medical supplies were dropped to the besieged forces on 23, 24, and 25 December. Meanwhile, alternate plans were developed for the provision of third echelon medical care, as well as evacuation in the event that the breakthrough by the 4th Armored Division and the 80th Infantry Division occurred on any given day. The former aspect will be discussed below under the heading, "Surgery". The breakthrough actually occurred on 26 December, and on the following day, 652 of the 1,150 casualties in the town were evacuated by units of the 64th Medical Group.

To support the 101st Airborne Division and its attached units, a provisional medical battalion was formed. It included the Headquarters and Headquarters Detachment, 436th Medical Battalion, the 495th Medical Collecting Company, and Company "A", 92d Medical Gas Treatment Battalion. These units were gathered from their various and distant locations and dispatched to the vicinity of BASTOGNE (P-55) on 27 December. The first two units mentioned were relieved of this attachment on 31 December, and Company `A` of the 92d Medical Gas Treatment Battalion continued its mission of operating a clearing company for the relieved forces until transfer of that division, early in January, to the Seventh U. S. Army.

To regulate casualty flow to hospitals supporting VIII, III, and XII Corps, the 64th Medical Group established an ambulance regulating post at VIRTON (P-141), and the 65th Medical Group established similar posts at ARLON (P.41) and at LUXEMBOURG CITY (P-81).

The 69th Medical Group, assisted by ambulance companies of the Advance Section, Communications Zone, continued its mission of evacuating Army hospitals. Advance Section, Communications Zone, gradually assumed responsibility for evacuation of a total of five evacuation hospitals, as well as the provisional hospital operated by the 92d Medical Gas Treatment Battalion at THIONVILLE (U-88). In addition, Advance Section, Communications Zone, furnished ambulance service to all medical holding units supporting this Army.

The movement of Army medical troops to the southern flank of the bulge constituted a transportation achievement comparable to that of the mass movement of armor and infantry units to the same point. Movement was accomplished by infiltration, and generous credit is due to the respective Sections of G-3 and G-1 of this headquarters, without whose cooperation the achievement would not have been attained.

Four new medical collecting companies (the 413th, 460th, 467th, and 487th) and two new clearing companies (the 606th and 624th) arrived in the Army area during the month. At the end of this period, there were still four medical collecting companies and one clearing company assigned by order to Third U. S. Army which had not yet arrived.

On 26 December, the 606th Clearing Company was attached to the 64th Medical Group, which had its headquarters at SEDAN (P-25). The platoons of this clearing company were subsequently employed to operate two Army clearing stations west of the MEUSE River in support of tactical units, which included the 17th Airborne Division then protecting that river. This constituted the first orthodox use of an Army clearing company since Third U. S. Army became operational. Patients from these clearing platoons were evacuated directly to the 178th General Hospital (a Communications Zone unit) located at REIMS (V-05). Prior to the assignment of, this mission to the 606th Clearing Company, the evacuation of the 17th Airborne Division and the 11th Armored Division in this area had been provided by two provisional clearing companies formed from a Communications Zone hospital located in REIMS (V-05).

The Army air/rail medical evacuation holding unit, operated by the 94th Medical Gas Treatment Battalion, was located throughout the month at THIONVILLE (U-88). The unit opened at this location on 6 December, and two days later railroad facilities, as well as air evacuation, became available at that point. During the month, 1,711 patients were evacuated from this unit by air. This represented a minority of those evacuated, but was a considerable increase over the month of November. It was also accomplished during a period marked by snows and murky weather. When the axis of the Army turned north, the air/rail medical evacuation holding unit was still in an excellent position to support the hospitals.

Advance Section, Communications Zone continued to operate an air/ rail evacuation holding unit at ETAIN (U-147) and NANCY (U-81). The latter unit, however, had only rail evacuation facilities available. An additional field hospital of Advance Section, Communications Zone moved to NANCY (U-81) early in December, and operated an auxiliary rail evacuation holding unit until the end of the month when it was closed and prepared for movement to the north.

A total of 21,092 patients were evacuated from Third U. S. Army during the month. In addition to the 1,711 evacuated by air, 12,886 were evacuated by road to Advance Section, Communications Zone medical holding units, or to general hospitals, and 9,465 were evacuated by rail.

The locations of evacuation facilities throughout the month are shown in Annex XIX to the Medical Section report.

3. Hospitalization

The attachment of field hospitals and their platoons remained rather stable until after 16 December. The 65th Field Hospital arrived in the Army area early in the month, and was attached to the 65th Medical Group for orientation purposes.

The mass movement of divisions which occurred after the third week of the month resulted in considerable changes in the attachment of field hospital platoons. Some of the platoons accompanied the divisions to which they were attached on all movements, but others remained behind to support new divisions. One platoon, the 3d Platoon of the 60th Field Hospital, completed the following odyssey of attachments during December: XII Corps, III Corps, XX Corps, XII Corps and III Corps. At the and of the month, the following attachments of field hospitals were in effects

III Corps

    16th Fld Hosp
    2d Plat, 59th Fld Hosp
    3d Plat, 60th Fld Hosp

XII Corps

    1st Plat, 30th Fld Hosp
    3d Plat, 30th Fld Hosp
    2d Plat, 42d Fld Hosp
    2d Plat, 60th Fld Hosp

XX Corps

2d Plat, 30th Fld Hosp
3d Plat, 59th Fld Hosp

64th Medical Group

    1st Plat, 42d Fld Hosp
    3d Plat, 42d Fld Hosp
    1st Plat, 60th Fld Hosp

65th Medical Group

65th Fld Hosp

69th Medical Group

1st Plat, 59th Fld Hosp

The 42d Field Hospital was assigned to Third U. S. Army concurrently with the assignment of VIII Corps, and its various units. It had been attached to the 64th Medical Group, and was supporting the divisions of VIII Corps at the time of the German counteroffensive. The first platoon was in support of the 28th Infantry Division at WILTZ (P-75) with twenty-two non-transportable patients on hand. On 18 December, trucks were obtained and the bulk of the equipment and personnel of this platoon was removed to BASTOGNE (P-55). However, two officers, including the platoon commander, and sixteen enlisted men of the platoon, plus one general surgical team (minus nurses) from the 3d Auxiliary Surgical Group remained with the non-transportable patients. All of these personnel were captured. On the following day, the remaining personnel were removed from BASTOGNE (P-55), but it was necessary to leave the equipment behind. The third platoon of this hospital was in support of the 106th Infantry Division at ST VITH (P-88). On 17 December, the majority of the personnel withdrew, and on the following day all patients and remaining personnel, except two enlisted men, left to guard the equipment, withdrew from ST VITH (P-88). The equipment and two enlisted men were also presumed to have been captured.

In general, field hospital platoons were employed in accordance with past procedure. Through the use of holding units, consisting of a headquarters and station platoon of a medical collecting company, it was possible to free these platoons for earlier movement in support of division clearing stations when the latter displaced forward.

An innovation in the use of a field hospital in Third U. S. Army was the employment in the latter part of the month of the 65th Field Hospital as a single unit. This hospital actually opened on 31 Decem-

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ber at ARLON (P-62) with a capacity of approximately 200 beds. The capacity was limited by the size of the building available to this unit. The attachment of the 65th Field Hospital to the 65th Medical Group continued in its new operation.

During the first two weeks of December, movements of evacuation hospitals were deemed necessary to support an impending attack eastward by Third U. S. Army through the SIEGFRIED LINE. The 35th and 109th Evacuation Hospitals had moved east to TETING (Q-25) and BOULAY-MOSELLE (Q-06) respectively. The 103d Evacuation Hospital was closed at BRIEY (U-67) and prepared to move east to CREUTZWALD (Q-26). The 104th Evacuation Hospital began a move to OERMINGEN (Q-54), a move which was never completed due to subsequent radical changes in plans.

Following the German counteroffensive, the great majority of the evacuation hospitals and other medical units had to be moved north to support the Army effort in that direction. The 103d, 39th, 104th, 109th, and 101st Evacuation Hospitals moved in that order to respective new locations at LONGUYON (U-19), VIRTON (P-41), LUXEMBOURG CITY (U-81), MONTMEDY (P-20) and ARLON (P-62). The 12th Evacuation Hospital remained open at NANCY (U-81), and was the only Third U. S. Army hospital south of METZ (U-85) at the end of the month. Meanwhile, arrangements were being made for a new site for the 12th Evacuation Hospital in LUXEMBOURG CITY (U-81).

Two additional evacuation hospitals became Third U. S. Army units during the month. The 107th Evacuation Hospital, located in the vicinity of CLERVAUX (P-86) on 16 December was closed and prepared to move. The 110th Evacuation Hospital was open at ESCH (P-70) and remained there throughout the month. The 107th Evacuation Hospital was required in a period of seven days to make three retrograde movements and was located during this period at LIBIN (P-25), CARLSBOURG (P-04) and at SEDAN (P-25). This hospital, in an eighty-two-hour period at LIBIN (P-25) admitted 784 patients and performed 326 surgical operations. There were 400 patients in the hospital when the next move became necessary. In a space of three hours, 300 patients were loaded in ambulances for evacuation to the 130th General Hospital at CINEY (P-19). Several times during this period the hospital was directly in the line of advance of the enemy forces and hasty departures were in order. On the move from LIBIN (P-25) it was necessary to leave a volunteer detachment of five officers and fifty enlisted men with the remaining patients and equipment. However, all the personnel and the greater part of the equipment were recovered later.

The 6th Convalescent Hospital was reopened early in December at ST MIHIEL (U-44) with a capacity of 1,500 beds. It opened in ZIMMING (Q-15) on 15 December. Due to subsequent changes in the tactical situation after 16 December, the location at ZIMMING (Q-15) became far from ideal, and a new site was selected at MOULINS-LES-METZ (U-85) in the vicinity of METZ (U-85). By the end of the month, the unit completed its movement to the new location, but had not yet opened.

An analysis of wounded hospitalized in the month of December is shown below:

a. Number of wounded admitted "direct" (i.e., not by transfers):

(1) U. S. Army Troops	11495
(2) British Army Troops	0
(3) French Army Troops	25
(4) U. S. Navy and Marine Corps	1
(5) British and French Navy	0
(6) Enemy forces personnel	1674
(7) Civilians	235
(8) Others	35

Note: All of the following in b through f pertains to U. S. Army troops only.

b. General classification of wounds:

Serious 3396

Slight 8118

c. Anatomical classification of wounds:
(Patients with multiple wounds are classified according to most extensive wounds).

(1) Wounds other than burns	Admissions	Deaths
a. Abdominal	559	82
b. Thoracic	1129	70
c. Maxillo-facial	803	3
d. Neurologic:
Head	787	77
Spine	213	6
Nerve	10	0
e. Extremities
Upper	2830	10
Lower	3795	40
f. Buttocks	561	11
g. Others	671	12
Sub-total	11358	313
(2) Burns - all locations	137	1
Total	11495	314

d. Number of patients with multiple wounds 3183.

e. Classification of wounds by causative agent:

	Admissions	Deaths
(1) Gunshot wounds (rifle, pistol, or machine gun	2937	83
(2) Shell wounds (HE, flak, mortar, or cannon)	6981	204
(3) Bomb wounds (aerial, grenade, booby trap, or mine)	417	7
(4) Blast injuries (bomb, shell, or mine)	388	8
(5) Wounds from secondary missiles	61	1
(6) Burns (petrol, flash, flamethrower, phosphorus, etc.)	128	2
(7) Others	583	9
Total	11495	314

f. Number of deaths by primary and secondary causes:

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Number of deaths by primary and secondary causes: [Cont`d]

g. Number of transfusions of:

(1) Fresh Whole Blood	529
(2) Stored Blood	5382
(3) Dry Plasma	7844
(4) Other Blood Substitutes	441

h. Number of units of Penicillin Administered: 3,986,221,000

i. Number of Amputations:

(1) Upper Extremity	115
(2) Lower Extremity	151

j. Number of cases showing clinical evidence of Gas Gangrene:

(1) U.S. Army	59
(2) Others	16

k. Number of wounded evacuated to other hospitals:

(1) U.S. Army	8595
(2) Others	1189

Locations of hospitals during December will be found in Annex XX to the Medical Section report.

4. Additional Temporary Medical Service

The 69th Medical Group provided medical care and evacuation for three groups of Allied military prisoners recovered during the month at DENTING (Q-16), CREUTZWALD,(Q-26) and SARREGUEMINES (Q-55). On 13 December, the Commanding Officer, 69th Medical Group assumed command of the camp at DENTING (Q-16). There were approximately 800 Russian and Italian prisoners at CREUTZWALD (Q-26), about 110 being bedridden, eighty-five percent of these with nutritional deficiencies. At SARREGUEMINES (Q-55) there were 100 prisoner patients who required immediate evacuation because the prisoner of war enclosure was under enemy artillery fire. Arrangements were made to evacuate these patients to the 34th Evacuation Hospital at METE (U-85), and the 94th Medical Gas Treatment Battalion at THIONVILLE (U-88). The bedridden patients at CREUTZWALD (Q-26) were transferred to the camp at DENTING (Q-16) which was being operated as a medical installation. Arrangements were completed with Advance Section, Communications Zone for evacuation of about 300 patients from DENTING (Q-16) and for eventual operation of the camp there by Advance Section, Communications Zone. Conforming with this plan, 300 patients were evacuated to the air/rail medical evacuation holding unit at THIONVILLE (U-88) to await rail evacuation to the Communications Zone. On 19 December, these patients were still at THIONVILLE (U-88). Because of an expected flood of battle casualties, these 300 patients were, therefore, returned to DENTING (Q-16) to give the air/rail medical evacuation holding unit necessary bed space for battle casualties.

Section 3 - Professional Services

1. General

Total battle casualties during the month of December, involving actual wounds and/or burns amounted to 11,495. In addition to this total, there were 2,852 cases of trench foot and twenty-one oases of frostbite admitted to all division, corps, and Army clearing stations during this month. Approximately 600 cases were returned to duty at clearing station level, and an additional estimated 300 oases returned to duty from hospitals.

Based on total dispositions from all causes in Third U. S. Army medical installations, there was a mortality rate of one percent during this month.

2. Surgery

As will be seen from the above figures, the surgical services of Army hospital units were extremely busy in December. The fact that only 314 deaths occurred among the total battle casualties mentioned above reflects a high degree of experience and skill attained by the entire Army Medical Service.

A study of the detailed statistics presented in the paragraph devoted to "Hospitalization` in Section 2 of this report reveals an interesting breakdown of these figures according to regions of the body affected. The largest group comprises wounds of the extremities and involves 6,625 cases, or approximately sixty percent of the total battle casualties. Of these oases, only fifty died, and the great majority of the remaining oases will eventually return to duty. It is in this salvage role that the Army evacuation hospital is doing its greatest service in the present war. However, the low mortality rate in the entire Army is a great accomplishment, and is a result of a combination of the efforts of all medical personnel, from the battalion aid station on back to the rearmost hospital.

Mortality rates were as low as any in military history. The figures which support this conclusion are shown below:

TYPE OF WOUND	NUMBER	NUMBER OF DEATHS	MORTALITY RATE
Wounds of the Abdomen	559	82	14%
Chest Injuries	1129	70	6%
Head Injuries	787	77	10%
Gunshot Wounds of the Spine	213	6	2.8%
Wounds of the Buttocks	561	11	2%
Burns	137	1	0.7%

One of the epics of this war was the magnificent stand of the 101st Airborne Division, together with one combat command each of the 9th and 10th Armored Divisions, at BASTOGNE (P-55), where they were out off for approximately ten days until the 4th Armored Division and the 80th Infantry Division broke into the pocket to relieve them. When these divisions were cut off, they were completely without surgical personnel. The only medical personnel available to them were in the various medical detachments of the divisions concerned. These medical officers were equipped neither with experience nor instruments for major surgical procedures.

Outside of the pocket a field hospital platoon, with surgical team attached, was held in readiness to rush into the besieged town as soon as a corridor was established. In addition, another field hospital platoon with its surgical teams was set up just outside the encircling ring to care for those casualties which could be transported out after relief of the forces. Other measures taken are described in Section 2 of the Medical Section report, under the sub-section devoted to "Evacuation".

With the relief of the forces not yet established, a general surgeon flew into BASTOGNE (P-55) by liaison plane on 25 December. On the following day three more general surgeons, an orthopedic surgeon, an anesthetist, and four enlisted technicians were flown in by glider. In both cases, enemy fire was encountered, but all personnel and their equipment arrived safely.

The make-shift hospital consisted of a large garage with one very large room and a small adjoining room. Approximately 150 seriously wounded men were in the large room on litters and straw pallets. Four battalion aid station surgeons, who had treated all casualties until the arrival of this medical relief, were completely exhausted. The general surgeon who had flown in by liaison plane had set up as operating room in the small adjoining room. All casualties other than the most seriously wounded were scattered throughout the town in cellars, basements, and other buildings. In the garage there was no heat, and there was only one light in the larger room.

The supply of blood was very low, as most of the containers had been broken when dropped by parachute on the previous day. However, the supply of plasma was plentiful. The garage had apparently been the site of a field hospital that had hastily withdrawn prior to encirclement. Part of the hospital equipment had been left behind. An operating lamp and an autoclave were available. The surgical teams which had flown in had on hand all the surgical instruments necessary to go into immediate operation.

Within one and one-half hours, all the patients in the garage were carefully triaged by the surgical teams. Those cases that required immediate surgery were selected, and priority for surgery was thereby established. Four operating tables were set up in the small room by placing litters on tables. Two anesthetists, one of whom had accompanied the surgical teams, and the other of whom was a battalion aid station surgeon with the 10th Armored Division, alternated between the operating tables. The medical officers from the 101st Airborne Division medical detachments provided medical care for those patients in the large room. Operations were begun by 261830, and continued throughout the night until the following noon.

Concurrent with the arrival of relief on 27 December, which included twenty-three ambulances of the 614th Medical Group, a truckload of blood also arrived early in the afternoon. After a few hours` rest, the surgeons were back at work. With the evacuation of part of the casualties, the situation was greatly alleviated. The hospital was then organized into a pre-operative and post-operative section with a consequent improvement .in the post-operative care. The surgeons again operated throughout the entire night until the following afternoon (28 December), when all patients were evacuated and a field hospital platoon (1st Platoon, 60th Field Hospital) went into operation in the area. In all, fifty major operations were performed, with only three post-operative deaths occurring.

During this period, bombing and shelling of the hospital area was intermittent. On the night of 27 December, a bomb landed near the hospital and blew in the door of the hospital room, and considerable plaster fell from the ceiling. For a time, operations had to be continued by flash light.

The services of three Belgian women were secured to assist in the care of the wounded. No drapes or gowns were available, and sterile towels were used about the wounds. The wounds of the patients were from two to eight days old, with the average case about three days old.

Mortality rates were gratifyingly low in spite of the handicaps encountered. It is noteworthy that casualties in the BASTOGNE (P-55) area are included in the figures quoted in the beginning of this section.

3. Neuropsychiatry

During the first week of December, slow but steady advances were continued until Third U. S. Army was disposed along the SAAR River and within the boundaries of Germany along that river on a front of sixty miles. SAARLAUTERN (Q-28) and SARREGUEMINES (Q-55) were taken.

Enemy resistance was, at all times, stiff, and our casualties high. It had been the experience of this Army that a tactical situation which included severe artillery fire from the enemy, resulting in more or less pinning down our own troops, usually resulted in a higher neuropsychiatric rate. A slight increase during the first two weeks of December was therefore to be expected. By the end of the second week the situation again became somewhat static, and at the end of the third week, Third U. S. Army divisions were drawn from their positions and moved rapidly northward. The number of neuropsychiatric cases, therefore, evened itself off and resulted, for the entire month, in a percentage less than that which occurred during the previous month.

The figures for the month of December revealed that there were 33,222 non-fatal casualties, which was a reduction over those suffered in November. Of these, 2,587 were neuropsychiatric oases, or seven and seven-tenths percent of the total non-battle casualties. Seventy-five percent of these were returned to duty from either division clearing station or hospital level.

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THE FLIGHT TO BASTOGNE

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Med 34

A survey revealed that from 1 August to 31 December, there had been 139,893 total admissions to medical installations from all causes. Eight and nine-tenths percent of these, or 12,512, were admitted for neuropsychiatric reasons. No other Allied Army reports a neuropsychiatric incidence as low over a similar period. Of the 12,512 neuropsychiatric cases, 8,811 were returned to duty, either from a division or similar clearing station level, or from Army hospitals. Of the 3,701 cases which were not returned to duty, but were evacuated from the Army area, psychoses, epilepsy, constitutional psychopathic states, mental deficiencies, and chronic progressive neurological diseases constituted the primary causes.

4. Dental

The dental service for the month of December followed much the same course as it did in November. In spite of difficulties attending the movement of troops as they advanced into the SAAR region during the first two weeks, and the subsequent major movements of units northward into LUXEMBOURG to the southern flank of the ARDENNES bulge during the latter part of the month, more dental treatments were accomplished than during the month of November. A chart showing the breakdown of these treatments follows:

Strength (Reported) 280670
Admissions, Routine	15993
Admissions, Emergency	3604
Sittings Given	27975
Officer Personnel	391
Enlisted Personnel	404
Restorations	18721
Dentures	1701
Gingivitis	1164
Gingivitis Treatments	1614
Stomatitis V	329
Stomatitis Treatments	801

The processing of acrylic anti-concussion devices had been further refined so that they were more comfortable and more effective than before. Previously, the thickness and size of these devices had resulted in their bumping against the helmet during strenuous exertion by the wearer. Another change in the device consisted of shortening the part which fits in the meatus of the ear. This improvement allowed a longer column of air between the device and the eardrum, and offered greater protection against the shock wave produced by the blast effect of heavy artillery, which normally causes damage to the inner ear. With improvements also made in the design of flasks and presses used in the processing of the devices, together with the production of a smaller size, it was possible to speed up the processing to the point where the production could be completed for the firing personnel of an entire battalion, consisting of approximately 175 officers and enlisted men, within ten days.

The percentage of maxillo-facial injuries to the total casualties admitted to hospitals during the month was six and nine-tenths percent, there being a total of 803 such cases. Three deaths occurred as the result of maxillo-facial injuries, constituting thirty-seven one-hundred the of one percent of all maxillo-facial oases admitted during December.

5. Veterinary

Inspections were made of twenty-one Class I supply points, four division ration breakdown areas, ten messes, and one quartermaster bakery. Some improvement was noted in the proper utilization of dunnage. Sanitary conditions were also better, due to the advent of freezing weather, with a consequent diminishing in the mud. The problem of fresh supplies freezing, however, arose during December and caused some difficulty.

On 10 December 2,500 pounds of fresh beef was inspected, which had been captured by liberating troops. This beef was found to be in good condition, and was turned over to Civil Affairs representatives.

6. Personnel

The names of five Medical Corps officers were submitted to the Chief Surgeon, European Theater of Operations, for permanent rotation to general hospitals in the Communications Zone. All of these officers had been in combat units for over two years, and had served in actual combat with these units since D-Day.

The names of twenty-seven Medical Corps specialists from evacuation hospitals, the convalescent hospital, and the auxiliary surgical group were also submitted to the Chief Surgeon for temporary rotation of sixty days to Communications Zone hospitals for educational purposes.

Due to the battle casualties in this Army, as well as to shortages occasioned by the assignment of VIII Corps and its units to Third U. S. Army on 21 December, which units had suffered losses in the German counteroffensive, a total shortage of Medical Corps officers existed as of that date of approximately fifty. This shortage was a serious one, but was alleviated somewhat by the arrival of fifteen Medical Corps officers furnished by the Communications Zone. To expedite their arrival in the Army area, Headquarters European Theater of Operations directed general hospitals to cut orders placing these officers on temporary duty for a period of seven days with Headquarters Third U. S. Army. Upon their arrival, further orders were immediately issued by this headquarters placing them on temporary duty with the divisions in which the most serious shortages existed. Transportation was furnished largely by the Medical Section of this headquarters down to the corps level, where corps either furnished subsequent transportation, or had division transportation call for them at that point. Subsequent orders by Headquarters European Theater of Operations assigned these officers to this headquarters, and additional orders were then out assigning them to the division in which they had previously been placed on temporary duty. Approximately fifteen additional Medical Corps officers were placed on temporary duty with divisions from Army medical units, pending the arrival of further reinforcements.

Simultaneously, there also existed a shortage of twenty-five Medical Administrative Corps officers. Approximately sixty applications for appointment as Second Lieutenant, Medical Administrative Corps, had been forwarded from this Army to headquarters European Theater of Operations.

Due to a high rate of casualties is Third U. S. Army, which had begun in November and continued during the first two weeks of December, the nursing service of the Army was extremely hard pressed. Fifty nurses were secured on temporary duty from a Communications Zone general hospital, and were distributed among Third U. S. Army hospitals to the best advantage, thereby augmenting our own organic nurses. These nurses replaced thirty-five nurses secured previously in a similar manner who were returned to their parent unit on the same date.

On 6 December, 311 Medical Department enlisted reinforcements arrived at the reinforcement depot supporting this Army. This was the first group of Medical Department enlisted men received by Third U. S. Army since the opening of the offensive on 8 November, though constant efforts had been made to secure them.

Also during this month ten additional shook teams were borrowed from Advance Section, Communications Zone medical units. These teams were of inestimable value in handling the large flow of casualties which was being received in Army hospitals, and properly preparing these casualties for surgery.

Section 4 - Medical Supply

There were more movements of the depot companies during the month of December than there had been since the month of September. During the first week, Advance Section Number One of the 32d Medical Depot Company moved from AUMETZ (U-79) to METZ (U-85) to join its parent unit. After several days of reconnaissance, on 17 December the 33d Medical Depot Company moved from TOUL (U-61) and became operational in CHATEAU-SALINS (Q-02), prepared to support Third U. S. Army`s expected push to the East.

Due to the German breakthrough in the ARDENNES area, and the subsequent absorption by Third U. S. Army of VIII Corps, provision was made for the return to this Army of the Advance Section, 33d Medical Depot Company, which had been transferred to Ninth U. S. Army in September. This Advance Section became operational at LONGUYON (U-49) on 26 December. The remainder of the 33d Medical Depot Company moved from CHATEAU-SALINS (Q-02) to LONGUYON (U-49) and became operational there on 30 December.

With the 32d Medical Depot Company located throughout the month at METZ (U-85), the two depot companies were disposed toward the close of the month in the most advantageous positions to support both flanks, as well as the center, of this Army.

A sketch, showing the disposition of the medical depot companies throughout the months of October, November, and December, will be found in Annex XXI of the Medical Section report.

Difficulties continued to exist in the way of actual reception of medical supplies at the Army medical depot companies. During the first two weeks of December, approximately a dozen trips were necessary on the part of Army transportation to Communications Zone depots to obtain items that were in great demand. There were fifty or sixty of these items in critical shortage. The majority were Class I and Class III items. This condition was to some extent alleviated by the end of the month. In cases where transportation was sent to Communications Zone depots from Army, coordination was effected between the surgeon`s Office and AC of S, G-4 of this headquarters.

During this month, the allowance of anesthesia apparatus, portable, was increased from two to three per evacuation hospital, and field hospitals were authorized as additional three apparatus, suction, foot pump, vacuum type, Item NSB-3.

The 65th Field Hospital arrived in the Army area short a considerable percentage of its T/E equipment. Items that were not available at Army medical depot companies were extracted to the Chief Surgeon`s Office, Communications Zone by telephone for purposes of expediency.

Losses among VIII Corps units incident to the German counter-offensive shortly after the middle of the month included the following:

42d Field Hospital	All equipment of 1st and 3d Platoons was lost.
101st Airborne Division	All equipment of the medical company was lost.
28th Infantry Division	All equipment of one platoon of the clearing company was lost; in addition, all medical equipment for one complete infantry regiment and one artillery battalion was lost.
107th Evacuation Hospital	Miscellaneous Class I, III, and IX items were lost, but no major items of medical equipment were lost. The majority of the tentage and quartermaster equipment, however, was lost.

Replacement of a majority of the above equipment was attained in an expeditious manner largely through arrangements by this Army to proceed to Communications Zone medical depots for purposes of picking up the equipment and speeding up delivery of same. In the case of medical equipment for the 101st Airborne Division medical company, it was flown into the Army area by air, and transported to the 32d Medical Depot Company where it was picked up by division transportation.

Arrangements were also made with the 64th Medical Group and the 107th Evacuation Hospital , while operating in the VIII Corps Zone, to set up a provisional medical depot for VIII Corps units, to fill emergency requisitions from those units. Eight truckloads of such supplies were dispatched from the 32d Medical Depot Company to the 107th Evacuation Hospital for further distribution.

The displaced Allied personnel found in concentration camps, and referred to under Section 2, Sub-section is of the Medical Section report for December, required considerable amounts of supplies for their care. Blankets, heaters, cots, and stoves were issued to the 69th Medical Group, which was in charge of those personnel who needed treatment. Arrangements were also made with the Army Quartermaster for additional mess equipment and fire units. German medical supplies in the Army medical depot companies were set aside and issued to the 69th Medical Group for this project. Difficulty was experienced in securing DDT Powder for delousing purposes, but within forty-eight hours, 2,000 two-ounce cans were located in a Communications Zone depot and shipped to the 33d Medical Depot Company for immediate issue to the 69th Medical Group. Two days later, a release was obtained for 1,400 pounds of DDT Powder for the same purpose.

Though discussion is made elsewhere in this report of events incident to the relief of the besieged forces in BASTOGNE (P-55) on 26 December, it is pertinent to mention here that supplies, were in fact furnished to these forces by air on 23, 24, and 25 December. These supplies included whole blood, blood plasma, Carlisle dressings, and morphine syrettes, among other items.

Also toward the close of the month, it was arranged in conjunction with Advance Section, Communications Zone, that VIII Corps units might draw their medical supplies from either Depot M-408 (Communications Zone), at REIMS (V-05), from the 33d Medical Dep Company at LONGUYON (U-49), from the Advance Section, 32d Medical Dept Company at AUMETZ (U-79); or, for those for which it might be closer, from First U. S. Army depots.

Captured enemy medical supplies during the month were inspected at METZ (U-85). These approximated ten tons of miscellaneous supplies, about half of which were deemed of value to this Army and placed in depot stock. The remainder was turned over to Communications Zone depots.

Med 35

Section 5 - Preventive Medicine

1. General

Variations in the tactical situation, which ranged from the establishment of a bridgehead in the SARREGUEMINES (Q-55) and SAARLAUTERN (Q-28) areas to the dash northward to the southern edge of the ARDENNES bulge, had little effect on preventive medicine problems, compared to those of the previous month. Some problems associated with the production of potable water did arise, and these are discussed in this report under the paragraph dealing with "Sanitation". Temperatures ranged from near zero to the low thirtys throughout this period.

2. Venereal Disease Control

The fact that the latter half of December was characterized by a mass movement of many troops resulted in the discontinuance of past privileges for many, and was the main factor in reducing the venereal disease rate for the month.

Army prophylactic stations were established in PONT-A-MOUSSON (U-73), VILLERUPT (U-69), and in the rest center at NANCY (U-81). In addition to these three, eight other Army prophylactic stations were in operation. During December, these stations gave 16,728 prophylactic treatments.

All unite reported an adequate supply of individual chemical and mechanical prophylactics.

Individual venereal disease contact reports were received in 428 instances. During the period, 25 November to 29 December, inclusive, an analysis of these reports shows some decrease in the number of oases of syphilis in comparison to the month of November.

Special letters continued to be sent to commanders of units with venereal disease rates over 100 per thousand per annum, directing their attention to the excessive rates within their units and calling for more stringent action on their part.

Weekly statistics on venereal disease incidence during the month of December may be found in Annex XXII to the Medical Section report.

3. Communicable Diseases

Communicable diseases continued to be relatively few in number; and, in fact, a slight decrease occurred from the total number reported in November. Upper respiratory diseases also showed a low incidence during this period. Diarrheal diseases showed a slight increase. A few scattered oases of infectious hepatitis were reported.

Other than the minor changes reflected above, no significant outbreak occurred during the period.

A detailed breakdown of statistics on communicable diseases occurring during the month of December will be found in Annex XXII of the Medical Section report.

4. Medical Records

Due to the assignment of an additional corps to this Army during the latter part of the month, the number of reports and records processed increased over those of the previous month. There were 15,972 processed during December.

5. Non-battle Injuries

The conditions making up this type of injury remained approximately the same as during the month of November. A slight increase in accidents was noted, but a decrease occurred in the incidence of trench foot. Twenty-one oases of frostbite made their appearance.

Non-battle injuries represented twelve percent of the total direct admissions for the month of December, as well as for the month of November.

Annex XXII of the Medical Section report affords a detailed analysis of non-battle injuries during the month.

6. Army Medical Laboratory Service

During the month of December, the 7th Medical Laboratory continued to operate in two base sections as follows:

Section I------------- METZ (U-85)
Section II------------ NANCY (U-81)

There were 7,698 tests performed during this month, constituting a slight decrease over the number performed during the previous month. The five percent decrease was caused, by the suspension of the shock section and in part by the drop in serological requests.

The total work for the month of December is broken down as follows:

BASE LABORATORY SECTIONS	No. OF TESTS	PERCENTAGE OF TOTAL
Serology	4814	62.5
Bacteriology	1270	16.5
Chemistry	361	4.7
Pathology	228	3.0
Hematology	85	1.1
Parasitology	117	1.5
Sub-total	6875	89.3

MOBILE SECTIONS:
Venereal Disease Section
(6th Convalescent Hospital)	823	10.7

Shock Section, 60th Fld Hosp	Not Operating
Sub-total	823	10.7
GRAND TOTAL	7698	100.0

A breakdown of the above tests by type of unit requesting them during December is shown below:

TYPE OF UNIT	NO OF UNITS	NO OF TESTS	PERCENTAGE OF ALL TESTS
Evacuation Hospitals	11	2453	31.9
Convalescent Hospital	1	2065	26.8
Field Hospitals	7	270	3.5
Miscellaneous Medical Installations		273	3.5
Miscellaneous Tactical Installations		2637	34.3
Totals	19	7698	100.0

7. Sanitation

Intermittent rains continued during the first part of the month, and the resulting muddy terrain and camp sites increased problems of sanitation and living conditions. With the advent of consistently lower temperatures about the middle of the month, frozen ground and a snow-covered terrain improved general sanitary conditions. In spite of the varied elements, the health of the command was not noticeably affected.

Only a few insect problems were noted during the month, and those were primarily concerned with other than United States military personnel. A few oases of louse infestation were treated in accordance with current directives.

No garbage or refuse disposal problems were encountered. Rapid and fairly constant movement of units and colder weather during the month precluded any difficulty in disposing of such wastes.

There were only four minor incidents of diarrhea reported during the first part of the month. The incidence reached a peak during the last week in November and dropped rapidly in December, reaching a minimum during the continued freezing weather.

The standard of water supplies furnished troops reached a new high during the month. Over ninety-five percent of all water tested met Army standards in December, compared with fifty-one percent in August, which had increased to eighty-nine percent during November.

Some difficulties were experienced due to freezing of the tanks, filters, valves, and hose lines during the extremes of cold weather. Such difficulties were not insurmountable and were ameliorated by one or more of the following methods:

Installation of the filter and pumping equipment in a pyramidal tent heated by a

Sibley stove or other heating units.

Draining of the filter, hose lines, and pumps when not actually in use.

Recirculation of the water in the settling tank and clearing well at intervals.

Installation of an immersion type heating unit in the settling tank.

One of the major difficulties was the freezing of the canvas tanks to the ground, with ice reaching a thickness, at times, of more than six inches around the base of the tank. Movement of the tanks under such conditions was impossible and, when attempted, damage to tanks and resulting leaks developed. It was strongly recommended that an immersion type heater, a water pipe heater using gasoline engine exhaust, or some similar heating unit be provided or devised to combat the above condition.

In a few instances, it was possible and practical to permit modification of the standard treatment method to include only chlorination, after investigation of the source, as follows:

When the raw water was obtained from a protected ground water source (not including shallow dug wells or unprotected springs) available in some few municipalities.

When the raw water was consistently coagulated and filtered in a municipal treatment plant.

SOURCE: Headquarters, Third U.S. Army, After Action Report, Third U.S. Army, 1 August 1944-9 May 1945, Volume II: Staff Section Reports, Part 17: Medical, in the Research Collections, Office of The Surgeon General, Office of Medical History, Falls Church, Virginia.