HEADQUARTERS 28TH INFANTRY DIVISION
OFFICE OF THE SURGEON
APO 28, U.S. ARMY
16 February 1945
SUBJECT: Annual Report of Medical Department Activities.
TO: Surgeon General, War Department , Washington , D. C. (Through Technical
In compliance with AR 40-1005, and Cir Ltr #143, Hq. ETOUSA, Office of the Chief Surgeon, dated 18 December 1944, the following `Annul Report of Medical Department Activities` is submitted.
The 28th Division, at the beginning of the year, was still in Wales . The friendship between the civilian population and the military personnel was all that could be desired. Numerous social activities and entertainments were held by both groups. We became acquainted with the tremendous social and financial problems of these people, which was occasioned by the war. Our attitude of smugness and fault finding became one of admiration and tolerance.
The Regimental Combat Teams were undergoing rigorous training in amphibious assault, which was conducted by the Assault Training Center , Woolacomb England . The units entered into this training with a great amount of zeal, because the fundamentals of amphibious training were similar to that which we had received back in the States. In addition, they were using live ammunition which gave a realistic picture. Simulated casualties and a few actual casualties gave the medical personnel good sound training. Also during this period, the Regimental Combat Team plus a Clearing Platoon, held field exercises on the Gower Peninsula near Swansea . The artillery units were engaged in range firing at Senneybridge, North Wales .
All this training was sound. The personnel was hardened to the inclement weather, the medics were being looked upon as an asset, and the cohesion between the detachments and the Collecting Company was greater.
Also during this period the matter of administration in combat was being worked out. The Adjutant General of the Division organized a school for personnel officers and clerks. The instructors were from the AG Battle Casualty Section, the Division Surgeon`s Office, the Division Chaplain, and G-1 sections. This school paid good dividends, inasmuch as the system which was set up at that time, has worked smoothly with few minor changes.
Numerous schools for the medical, officers and enlisted personnel were conducted, but the best training was the previously mentioned field exercises.
During the middle of April the Division moved to Wiltshire , England . The regiments were under canvas and the remainder of the troops were billeted in permanent camps. Ordinary training was undergone and the
tune of equipment was stressed. Physical training and unit training was engaged in. While here the Division was released from First Army, V Corpse and assigned to Third Army XX Corps.
The Division Staff completed plans for three different amphibious operations. We were not called upon to accomplish any of these.
During the latter part of May, one Combat Team was used, in an exercise, as a defense against an Airborne landing by the 101st Airborne Division. Our Division set up a Clearing Station for actual casualties which amounted to a total of 417 cases admitted during a period of 18 hours.
June the 6th arrived and from then on we looked forward to the part we would play in the battle across the Channel. Numerous reports from the units actually engaged and from observers were read and discussed. At this time we decided to reduce to a minimum the litter carry from infantry aid stations to collecting stations. Whenever possible, the ambulances from collecting company will be used in place of collecting company litter bearers. The latter to be used as a pool of litter bearers to supplement detachments litter bearers.
The Division moved to the Marshalling Area at Southampton, July 17-18, and embarked for France . It assembled in an area (Bricqueville) and was reassigned to First Army, XIX Corps, and two weeks later was reassigned to First Army, V Corps.
On the night July 29-30, one Combat team was committed to action below St. Lo, followed by a second Combat Team later in the day. Offering stiff resistance, the enemy was pushed back and the town of Percy fell to us on August 2. This was followed by the capture of numerous small towns and villages, to St. Sever de Calvados, Gathemo, Saur de Vaul, to the area east of Mortain and on to Ger. During this action casualties were high (July 29-August 16).
To participate in the closing of the Falaise pocket, the Division moved at night a distance of 125 miles to the vicinity of Damville. The three Combat Teams continued the attack at Breiteul, Conches, Neufberg and St Quinten. Casualties were comparatively light (August 17-August 26).
After being relieved by British forces, Aug 25-26, the Division moved on through Houdan to the assembly area in the vicinity of Versailles .
On August 29, the Division was honored by being selected to march through Paris . This triumphal parade was viewed by Generals De Gaulle, Bradley, Patton, Le Clerc, Koenig and Cota.
The morale of the personnel was high, and the Division resumed the attack north of Paris , in the vicinity of St. Denis and Le Bourget. It was again a matter of keeping up the race on the heels of the enemy through Compeigne, Noyon, Soissons , Laon, Mezieres, Sedan , Belgium (Arlon-Bastogne) and on into Luxembourg . The first units of the Division moved to the Siegfried Line in Germany on September 10th. During all this move, casualties were few except in certain sectors where the enemy defended in strength a critical position. (August 27-September 10)
From this time on, two of the Combat Teams continued the attack of the forts of the Siegfried Line, suffering numerous casualties. The
remaining Combat Team was attached to CCB, 5th Armored Division and attacked east of the city of Luxembourg . Casualties here were heavy. It is well to mention the fact that evacuation from aid stations to collecting stations by ambulance, eliminating litter carry and Ambulance Loading Posts, worked fine and greatly shortened the evacuation time to clearing stations. The use of the litter jeep forward of aid stations was a considerable asset for rapid evacuation (September 11-October 4).
On October 4-5, the Division was relieved by the 8th Division and we moved north to an area along the border of Germany east of Elsenborn. Here it was possible to rotate infantry battalions on the line in order that they could bathe, change clothes, and have some recreation. Here also our first cases of Trench Foot appeared, and instructions for prevention were begun. Overshoes were recommended in our September Sanitary Report (October 5-October 25) .
On October 25 the Division was relieved by the 4th Division and we moved north to the Hurtgen Forest area relieving the 9th Division.
November 2, a coordinated attack by the air force with our Division was made with the town of Schmidt as the objective. Due to the lack of roads, `snow buggies` were used for evacuation of aid stations. One was attached to each infantry battalion aid station, and they were, of great value to us. Even so, it was necessary to have long litter hauls to battalion aid stations.
Because of the density of the forest, along the entire front and the concentration of enemy Artillery and Mortar fire, a great many `tree bursts` occurred causing an unusual large number of shell fragment wounds. The total casualty rate was very high. During the period, a four to six inch snow fall occurred and our Division admitted to the Clearing Station 625 cases of Trench Foot. This was due to the lack of Arctics in proper sizes, and to the lack of a sufficient number of arctics. Dry socks were made available at aid stations to all troops and instructions for the prevention of Trench Foot were continued. In some instances personnel used with good results, without shoe, the smaller Arctic, three pairs of socks and a card board insole.
Two aid stations were surrounded by the enemy but were later evacuated under an agreement with the enemy. This was accomplished by a temporary truce arranged by Medical Department Officers and the enemy without any violations by either side (October 26-November 17).
Our Division began to exchange positions, November 17, with the 8th Division and we moved to the South taking over a 26 mile front, extending along the Luxembourg-Germany border.
This was a comparatively quiet sector and a period of training was begun, principally for the reinforcements. Many passes and leaves were given to both officers and men. Equipment was replaced and cleaned.
The friendliness of the civilians was noticeable, and the Division morale was high. Plans for Christmas parties and recreation were in progress, when on the morning of December 16 the enemy attacked in great force along our entire front (November 18-December 15).
The Combat Team on the north fell back under great pressure and became separated from the Division. They became attached to the 106th Division until January 1945. The Combat Team in the South pivoted and became the flank, along which the enemy advanced, and was then attached to the 9th Armored Division. Evacuation of these Combat Teams was through normal channels.
The Combat Team in the center of the line was overrun but continued to defend positions until it met up with the defensive positions around the town of Wiltz . Here the Division Headquarters had organized positions with the personnel of the rear echelon. A plan of evacuation had been previously organized with an aid station located in the center of the town. A series of delaying positions were organized south of Bastogne , to Neufchateau. Evacuation of this group presented a problem and was organized according to the plan of the defense. (December 16-December 31)
One ? vehicle be added to the equipment of the Division Artillery Headquarters Detachment.
In the T/O of the Engineer Medical Detachment it would be desirable to have 3 aid men per company, ie one per platoon.
It is believed that communication for the regimental medical service is of great value. Tables of Organization and Tables of Equipment make no provision for communication. At the present time and for the past three months, one regiment has used the following communication. A telephone to all aid stations when the tactical situation permits. At all times we have radio communication. Each battalion aid station has a 300 radio and is in its respective battalion radio net. This allows direct communication with the front line companies at all times. We have found that this direct communication not only speeds up evacuation, in that casualties do not have to be hunted, but also conserves litter bearers who are able to rest while waiting for any call from the companies. During night action, the company aid man brings the casualty to a pre-arranged point and through the radio net requests litter bearers who go direct to the point and evacuate the wounded.
In addition to this we have found radio communication to our collecting company to be of value. The collecting company has a 284 radio and is in the regimental net. Through this means up to the minute casualty reports can be obtained quickly and also an ambulance convoy to a certain area of casualty density can be readily obtained rather, than the old method of ambulance liaison to the collecting company. Ambulance liaison requires time and in many cases, as in a withdrawal operation, fifteen minutes may mean the difference between successful evacuation or loss to the enemy.
The new Tables of Equipment for Infantry Medical Detachments replace one jeep and trailer with a 3/4 ton weapons carrier and trailer. This answers the problem of carrying equipment all right but it takes away one vehicle whose value can not be praised too highly. The jeep with litter rack is one of the most important tools we have to bring about rapid evacuation. It is believed that an error is being made in taking the one jeep from the battalion section. We have had many instances where a jeep was
lost or damaged due to enemy action and were this to occur with only one jeep it would leave the medical section in a bad situation. I recommend that the transportation for the Regimental Medical Detachment be as follows
7 ? ton trucks
4 ? ton trailers
3 ? ton Weapons Carriers
1 2 ? ton truck
1 1 ton trailer
The one ton trailer could be used to transport all of the gas treatment equipment and other such items which the battalion medical sections are not using but must be kept available. Many other little used but essential items could be carried on the trailer with the regimental section.
It is my opinion that the Division Medical Service could be reorganized to better service the Infantry Division. That is, have Regimental Medical Company which would be a consolidation of the Regimental Medical Detachment and the Collecting Company. Give the Regimental Surgeon the responsibility of evacuation to the Clearing Station. During all of our actions, the collecting company has been a part of the Regimental Combat Team, for tactical purposes, but for supply and administration it has been a part of the Medical Battalion. With such an organization the battalion medical sections could remain much as they are but the consolidation would take place between the Regimental Section and the Collecting Company.
Some of the advantages of such a reorganization would be: There would be a point in the Regimental Medical Service where the Regimental Surgeon could better control what cases are evacuated from the battalions if the Collecting Company were actually part of his command.
At the present time records of the Collecting Company, which are records of the Regimental Combat Team evacuation do not go to or through the Combat Team Commanding Officer or Staff but rather go direct to the Division Medical Service.
This would allow consolidation of many positions such as First Sergeant, Company Clerks, Supply Sergeants and the eleven basics carried with the Regimental section could be consolidated into the litter bearer section of the collecting company. At least one Medical Corps Officer could be released since the commanding officer of the collecting company could become the assistant Regimental Surgeon and act in a similar manner as the Service Company Commander and Regimental S-4 relationship. Having two other medical officers in the collecting unit it would allow for immediate replacement to the battalion sections, also the two Medical Administrative Officers would be available as battalion replacements if needed.
Such an organization under one command would allow for a rotation system of enlisted and officer personnel within the Regimental Medical Service. At the present time replacement officers often go directly to a battalion aid station where as with a Medical Company the more experienced officer could be shifted forward to allow the new officer to become oriented at the collecting station.
With the Regimental Medical Company operating a kitchen and also having ambulance communication with the battalion medical sections, the battalion aid stations could have hot kitchen cooked meals three times daily.
During action the personnel of the aid station have little time and often don`t eat but one meal daily which adds aggravation to an already bad situation. Combat Exhaustion cases and minor injuries kept in the aid station could also be fed.
With the present organization the Collecting Company must draw supplies of gasoline, clothing and rations from Division agencies when they are often only across the road from the Regimental Service Company. The Regimental Medical Section draws its supplies from the Service Company direct, the Battalion Medical Sections draw supplies from the Battalion Headquarters Company. With a reorganization the supply to all medical unit; of all items could be obtained by the Medical Company directly from the Service Company of the Regiment.
At the present time the Collecting Company Commander occupies an `in between` position and often faces conflict of opinion. He is under Regimental control for tactical purposes but under Medical Battalion control for administration, supply and policy. This situation could be cleared up by the proposed reorganization.
The Dental Officers could better be employed at the Regimental Medical Company which would put them in direct ambulance communication with the battalions rather than the present situation where special ambulance trips must be made to the Regimental Medical Section for dental service during combat.
Operations of the Medical Battalion:
From January to April 1944, the Medical Battalion was located at Penally, South Wales . During this time, each collecting company, in conjunction with its RCT, traveled to Braunton , England for specialized instruction in the problems of evacuation in amphibious assault operations. This was followed by Regimental Combat Team exercises on the Gower Penninsula, South Wales . In these, platoons of the clearing company also took part.
Between exercises, the battalion continued training at Camp Penally. Emphasis was placed on unit training with practical application on simulated field conditions. SOP`s were established for the loading and unloading of equipment, receipt and evacuation of a casualty from the station, property exchange, personal effects, triage, messing and liaison with higher Headquarters.
Other activities of the battalion while in South Wales included the combination of operation of fifteen ambulance posts at widely separated units of the Division. Advantage was taken of the opportunity to give student drivers practical experience in blackout driving. This was done by alternating assistant drivers on the ambulances every two weeks.
Classes for officers were continued. The instructors were office who had been to special schools and courses. In this way all officers benefited by learning or reviewing latest techniques in various medical procedures.
On the 17 May 1944, the battalion moved by motor convoy to another camp and training area, at Swindon, Wilts, England . Here the bat-
talion continued unit training and classes for officers in pertinent subjects. The companies alternated in spending a week in a bivouac area under` field conditions, practicing station operation, convoy operation, and movement of a station. Efforts were made to make this training as realistic as possible. Simulated casualties included simulated German prisoners who were questioned by the S-2 interrogation team and handled under our established SOP for wounded prisoners.
The operations of the battalion since 17 July 1944 are included in the monthly reports, copies of which are annexed to this report.
Except in a few isolated instances, we have always been able to station ambulances at battalion aid stations and in so doing, decrease the time lapse in the evacuation of casualties. The best working formula was found to be one ambulance at each aid station and one at the regimental aid station. This obviated the necessity for advanced loading posts as well as allowing sufficient ambulances at the collecting station for evacuation to clearing, and from attached units.
When a Division is covering a wide front, collecting and clearing stations can be split into sections and still function efficiently. This has likewise resulted in a definite saving of time in casualty evacuation.
The equipment and supplies of the medical battalion have been adequate for the conditions confronted, with the following exceptions: transportation, communications, and heat facilities.
Clearing Station, of the medical battalion helps the Clearing Station Tag (MD 53) on file (alphabetically and annual) after a patient leaves the station. In this manner information on any casualty that has been through the station can be obtained readily at any time, and resulted in an economy of time in tracing the diagnosis or disposition of patients.
Except for emergencies, one platoon of clearing company can adequately operate the Division Clearing Station. The other platoon is kept in reserve with equipment loaded and remains in readiness to `leapfrog` the working platoon to a new location.
The advent of cold weather brought with it the problem of adequate housing of our units. The difficulty has been in finding suitable accommodations consistent with an area tactically satisfactory. It is sometimes necessary to set up hospital stations at points other than normally would be the case if the tactical situation were alone considered.
Housing, water supply, bathing facilities and laundry.
For the first six and one half months of 1944 garrison life in the British Isles continued. Housing was not always most attractive but usually was adequate in view of the situation. Troops were garrisoned in Wales and billets were established in an area covering several hundred square miles. Houses varied from a well appointed soldiers barracks, or a large manor house, to rather ramshackle and run down houses near the coast of the Bristol channel . Standards as to floor space per man had to be lowered a bit, to the minimum requirements, and there was a flurry of respiratory disease in January with a rate of 320.8, but there was a mild epidemic at this time. Shelter half cubicles and head to foot sleeping were enforced, checked and adhered to. Bathing and laundry were adequate.
Water supply was always a bug bear. The British were satisfied with their standards of chlorination and were not desirous of raising the chlorine content chiefly because of the taste it gave their tea. As a result water was being checked constantly, water samples sent to laboratories and in most instances water was chlorinated up to U. S. Army standards either by local hypochlorite chlorination or by use of the Engineer Water Point.
In Tenby, by agreement with the British, a chlorinating plant was installed to raise the water purification standard. At Haverfordwest, the local British Engineer consented to raise the chlorine content, but due to the protests of the civilians, he was compelled to return to the usual standards. In some instances large tanks were erected and the water was chlorinated by homemade devices. Bathing and laundry facilities were always adequate until this unit went into combat.
Food and Messes, sewage and waste disposal, and insect control.
Food was as a rule good. Occasionally an issue of vegetables would be found spoiled. Under the circumstances, though, the `A` ration was as fine as one would wish. Unfortunately, as in many army messes, the cooked product was not always so laudable. The problem of dehydrated foods was one often too hastily dealt with and as a result powdered eggs or milk could have been better handled. Considerable time and effort was spent educating cooks in the handling of these items. Another point which is brought out here is the handling of meats and vegetables. Army cooks have a tendency to over cook vegetables and to prepare meat long before the regular time of serving in order to accommodate those who eat `early chow` or to `get the preparation behind them` where a large number have to be fed. This was most apparent where a battalion mess was instituted. In addition in spite of the advantages; and battalion messes were used commonly because of their advantages; the time it took to feed and the division of labor amongst the mess personnel from different kitchens, were tricky problems to work out.
Sewage and Waste.
In Great Britain because of the rain fall and the terrain, drainage was often a problem, but most of all, ancient drainage systems could not stand the over load and occasionally our engineers had to survey and drain areas to accommodate the personnel.
Occasionally the `honey bucket` type appliance was used by our
troops for disposal of human waste. They were nasty things to handle and take care of and considerable supervision was always necessary to insure that it was done properly. In the case of one camp, LLamphey, a modern sewage plant was built but unfortunately the effluent could not be disposed of properly so the camp was abandoned. Garbage was disposed of by local contract.
Insect control was not a great problem in England , except for flies. Where screening could be obtained and there was adequate waste disposal there was no problem. In one instance, flies constituted a menace in Camp Chiseldon during the spring, and the aerosol bomb was found to be a quick fly killer in a large battalion mess.
Later on in April the Division was moved to Wiltshire , England , and environs, and here the status of housing, sewage, etc, was better. Our troops in two instances started literally from the ground and built two tent camps, one at Rockley Park and one at Ramsbury Park . Here sanitary field appliances were constructed `according to the book` including grease traps, pit latrines with quartermaster boxes, urine soakage pits and Engineer Water Points. They were quite satisfactory and livable, what with the average soldier`s ability to make himself comfortable. In the other camps, Nissen huts were used, brick barracks and an improved tent camp with locally constructed shower and kitchen buildings.
Combat Operations: (July to December)
In the latter part of July, the Division was ordered into combat in France . Immediately upon landing the Division went under canvas and from then until the onset of winter, conditions as to sanitation were similar to field conditions on maneuvers. A note on housing is necessary.
The double end shelter half is a much needed improvement. The old type was inadequate in very rainy weather.
Water supply was carefully controlled from Engineer Water Points. In this case the problem of transport was important. From the stand point of expediency the five gallon can filled the bill, however, the water trailer was less of a nuisance and generally was a better means since water could be chlorinated more easily in it and the supply was more abundant. Where water was procured locally it was chlorinated at the company kitchens. Mess personnel found Halazone tablets an easy means to purify water, and preferred it to the hypochlorite ampule since five gallon cans were used.
Bathing facilities have always been limited. On the average about once a month troops had access to QM showers. The inception of the clothing exchange at shower points was a welcome and gratifying procedure.
Laundry was efficient, but in some instances clothing loss while not considerable was irritating and sometimes deprived the soldier of a needed garment. The considerable shrinkage of clothes following their introduction to a QM laundry was always puzzling. One would think that either the clothes or the laundry could be so regulated as to prevent this.
Food varied considerably. When possible `B` rations were fed, and depending on the situation `C`, `K`, `10 in 1`, and `D`s, were used. Considering the circumstances the method of feeding U. S. Army troops in the field is a wondrous achievement of military art. The `K` and 10 in 1
rations are admirable and efficient. The contributions to the American soldiers` diet by the people of France cannot be omitted. Gifts by the farmers of apples, eggs, tomatoes, onions and potatoes etc, while not a constant factor, went far toward varying the monotony of a standard `K` or `C` ration diet. It is believed that Mixed Vitamin tablets should be available in the package rations in addition to the synthetic fruit crystals. Rarely do the men use the bouillon powder, and it is believed that the bouillon should be replaced by the soluble coffee. Sewage presented little difficulty. Slit trench latrines were used routinely.
Waste was a problem, chiefly the disposal of `K` ration containers by troops on the march or in the front lines. Wherever possible burning and burial were used, especially in kitchen areas, but the `K` ration has left its mark on the battle fields of Europe . Surprisingly enough flies were no great menace. Wasps were a great nuisance getting into everything and battling the soldier for his food even as he brought it to his mouth. No remedy was found for this other than to fight back and to keep all food covered as long as possible. The stings sometimes produced were a nuisance and temporarily painful. One of the local sanitary problems was the disposal of dead cattle. Generally this was done by calling on the Engineers who with their bulldozers were able to accomplish the job quickly and efficiently.
As winter came on, troops went into billets whenever possible, using the most conveniently situated and available houses. Main efforts were directed toward keeping warm. Other factors of sanitation changed little with the exception that garbage disposal became more difficult due to the difficulty of digging pits in frozen ground, and constant supervision was necessary. Occasionally dynamite was used to loosen the earth in static situations, but often it was necessary to haul accumulated tins to local dumps.
The biggest problem at this period was the condition called Trench Foot. Due to the wet cold weather, the long cramped hours in foxholes, and the lack of overshoes this unit suffered hundreds of Trench Foot casualties. Immediate steps were taken to stem this occurrence. Galoshes were obtained but unfortunately most of them were smaller than the average soldier`s size. This was remedied later. Preventive measures taken by the soldiers were preached, and various systems of supplying dry socks used. With the supply of galoshes and the teaching of prevention the rate dropped. With the introduction of shoe pacs in the later winter, frost bite was reduced to a minimum, and at this point it is usual to investigate any occurrence to determine whether lack of galoshes, or lack of preventive measures were contributory.
Respiratory disease was not especially severe in spite of operations in severe cold. The rate of 105.3 for December was contributed, in the main, by reinforcements who came to us with Nasopharyngitis and Bronchitis contracted en route in crowded box cars for several days. A few cases of louse infestation were encountered and DDT powder was the item most commonly used to treat and prevent this. Earlier training with the delousing bag and methyl bromide ampule in England came in handy though, as this technique was used several times when it was deemed advisable to treat the clothes of a whole company.
Sanitary methods taught by the U.S. Army are simple, practical
and efficient but the average solider, in spite of instruction, will not often apply them in combat and then needs constant indoctrination. This is reasonable to the extent that his life is his main consideration. In garrison or in static situations the general sanitation is good. From the medical view point one wishes that the unit commander would, in a tactical situation, take a longer view toward sanitation and not forget it in his preoccupation with the immediate military problem. It should be possible to coordinate higher supply agencies with the sanitary and preventive measures prerequisite to a planned military operation so that items of supply, such as stoves, galoshes, winter clothing, heavy socks, rain coats etc, are readily available when the need arises. Usually requisitions are placed when the need arises and a relatively long period must elapse before these supplies can be received.
History of Venereal Disease Activities:
Venereal disease for the year has given us a rate of 7.3. The problem of Venereal Disease control is one which has always kept commanders on the qui vive as it was held the responsibility of commanders to see that Venereal Disease was held to a minimum. In Wales itself the incidence of Venereal Disease in the local small communities seemed very slight. The majority of cases were contracted by troops on pass to Llanelly, Cardiff , Bristol , Swansea or to London , where prostitution flourished. Prostitution could not be controlled by the use of `off limits` in England as it could in France where the military had a free reign. Generally, the rate for the year may be considered fairly low. Certainly considerable time and effort were employed in instructing troops, making `pro` stations available, issuing mechanical and chemical prophylactics, warning men going on pass, giving them addresses of `pro` stations in recreation towns, reporting contacts to civil authorities, and writing memo`s for the Division Daily Bulletin. The biggest single contributing factor to Venereal Disease is drunkenness. The average soldier in garrison will take care of himself if he is sober but when the status of inebriation dulls his faculties he is either clumsy and inefficient in the application of prophylactics or forgets about them all together.
On the continent in addition to the factors mentioned above, one has to combat a state of mind of the soldier which is composed of the so called `last fling attitude` with release of his repressions in the towns of relaxation. Since prostitution is wide spread it is possible that the number of combat days is the one dominant factor in controlling Venereal Disease. Although instruction and sex education have been stressed more than ever.
The fact that the soldier seeks feminine companionship could be used to advantage by making it possible for him to meet women and girls in rest areas, through reputable sources rather than in cafes and from the streets. As it is the soldier often finds himself alone in a large city and easily falls prey to roving prostitutes.
When the Division was giving passes to Paris , the group going on pass was assembled and given a lecture on Venereal Disease and Sex Hygiene. The fact that this Division has been in active combat since landing in France has minimized somewhat the dangers of too frequent sex contact. Most of our cases of Venereal Disease have occurred in those troops who went on pass to Paris although occasional cases have been picked up in smaller towns and cities, and not at time during active operations. For this
reason it was necessary to have mechanical prophylactics always available and they were distributed to all aid stations it addition to companies.
A comment on houses of prostitution is germane. It rise possible that a `well run` house of prostitution is less dangerous than street walkers. In the former the soldier is more likely to take a pro and the woman to take more care to preserve her status. With the latter the soldier may spend the night with less caution and more `insobriety, according to soldiers` statements. Certainly the many opportunities for easy sex contacts on this continent constitute a constant threat to Venereal Disease control coupled with the soldiers release of inhibition and his `tomorrow we may die` attitude.
January - The Division was located in the British Isles , where facilities were satisfactory to carry on the Division dental program. This program called for every man in the Division to be in Class IV. The dental health of the Division was excellent. A survey showed that re-inforcements did not meet the Division standards, that new small cavities had developed since coming over seas, and that it would be necessary to continue routine dental work. Laboratory facilities were satisfactory and cooperation excellent, especially with the 12th Evacuation Hospital .
February - The dental health of the Division was excellent. 75% of the reinforcements needed dental care. Dental survey completed in February 1944, it was at this time that the Division first recommended a change of T/O for the Division Artillery giving them two Dental Officers instead of one, and that the rank of well trained dental assistants should be raised Then medical detachments could not steal your technicians.
March - Types of training and amount of time spent in training areas, greatly interfered with the amount of work accomplished. Supply was satisfactory. It was at this time that the Engine Cord shortage became acute - there was an abundance of cords, and always has been, but of the wrong length - 16 ft 4 inches being the correct length for the foot-engine. To satisfactory method to my knowledge has ever been found to correct an ill fitting cord. The survey has been completed 98%.
April - An effort was made to clean up all Class I cases in the Division. Surrounding General and Station Hospitals are all very cooperative. The dental survey was completed and the dental health of the Division was excellent.
May - Dental health of the Division was excellent. There was a large amount of Prosthetic work done during the month. Supply was adequate except shortage of alloy.
June - The amount of Prosthetic work to be done in a Division seemed an endless job. This month a special effort was to clean up all cases. A mobile Prosthetic unit was attached to the Division, operated by Major Marren, and this was very satisfactory. We had just received and
started operating with our chests #61 and #62. The Central Dental Laboratory was also doing excellent work for us. A serious shortage of alloy existed.
July - The dental health of the Division was excellent. Other operations prevented normal amount of dental work being done and the supply was adequate.
August - The tactical situation prevented any dental work, except emergency treatment. Dental Officers functioned as Medical Officers in many cases. The dental health of re-inforcements was excellent, also the Division.
September - Due to combat conditions and a large number of reinforcements, particularly in the Infantry Regiments, it was impossible to make a satisfactory report. It was at this time plans were made to establish a dental clinic in the rear echelon. This plan proved very satisfactory under some conditions, especially where the Division was not too widely scattered.
October - The dental health of the Division was excellent. The Division is now operating a dental clinic in the rear echelon with excellent results. One Dental Officer was taken from each Infantry Regiment and one from the engineer battalion. The total number of fillings inserted was 2309. Using chests #61 and #62, 90 dentures were repaired and 31 models and bites were prepared for shipment to a dental laboratory. 8272 men are not surveyed.
November - A large amount of dental work was done during this month, 2500 films lings were inserted. The situation caused a discontinuance of the dental clinic on the 18th of November, units were widely scattered and hours of daylight to short. There was a critical shortage of material in the First U. S. Army to do Prosthetic work.
December - For the first sixteen days the dental department functioned at capacity. Due to tactical situation, no dental work was done the last half of the month. Three dental officers are missing (MIA) and four chests #60 were lost in action. By a transfer of chest #60 in the Division we were able to take care of all emergencies. All survey records were lost and it is impossible to give an accurate report. This condition will be corrected immediately.
1. Inclosed find #57 consolidated report of work completed in 1944.
2. It is still felt that an additional Dental Officer is necessary in the Division Artillery.
3. The efficiency of the dental service would be greatly increased by increasing the rank of dental technicians to a Tec. 3.
4. The operation of a dental clinic is an ideal setup under certain conditions, but since it does not apply to other conditions, particularly when the Division is in combat, it is not practical.
In my opinion from observation and experience, I believe the Dental Department should be a separate branch of the service. It should also be made more mobile, by this in mean only a minimum of Dental Officers
would be permanently stationed with the troops. The others to operate a mobile operative and prosthetic unit. These units could be moved from unit to unit as the tactical situation demanded. There is no question but what the same number of dental officers could accomplish more work. It would also relieve the Medical Department, particularly the Infantry Regiments and Battalions from carrying so much equipment which is always a burden in the field.
During the first half of the year 1944, in the well-trained and previously screened 28th Infantry Division, the work of the Division Neuropsychiatrist was chiefly directed to further screening out of men considered poor combat risks (especially among the new men in the organization), consultations, and the examination of men under charges pending Court Martial. This pre-combat period saw the completion of a training program in which medical officers of the Division were given a one week`s intensive course in the diagnosis and treatment of Combat Neuropsychiatric Cases at the 312th Station Hospital , England . This was an excellent course and a generous quota made this training available to almost 100% of the Division medical officers. It is felt that this preparatory instruction paid combat dividends in that the medical officers gained a certain awareness of the magnitude of this problem in combat that did not exist from civil practice nor the practice of military medicine during the training period. While there is no substitute as instructive as the actual handling of then, cases in combat, it is believed that a satisfactory understanding of their management was obtained by those officers completing this course.
Upon entry into combat in the latter part of July 1944, opportunity was soon afforded for the trial of various SOP`s set up for the care of Combat Exhaustion cases. Throughout combat the care and evacuation of these cases has been through the normal medical channels, each installation functioning as a screen for those patients it receives. Within the line units every effort has been made to prevent the return of men to the Battalion or Regimental Aid Stations except upon order from their N.C.O.`s or officers, or when properly tagged by a soldier or officer of the Medical Department. This has prevented wholesale straggling back to the aid stations on the part of men who have no real reason for being there. At the Battalion and Regimental Aid Stations those cases in need of only a night or two of rest are given reassurance and sedation and held at that level for return to duty. The more severe cases are evacuated to the Collecting Station, where again the patients are examined and those patients whom it is believed can be satisfactorily treated at that level are retained and the remainder evacuated to the Clearing Station.
The procedure for the handling of these cases at the Clearing Station has undergone several revisions since entry into combat. Originally the Combat Exhaustion cases were held in the station for sedation and rest and subsequently returned to their units through `reverse` medical channels. Those cases in which prolonged treatment at the Clearing station, and those cases in which response to treatment was unsatisfactory were evacuated to an Army NP installation. The weather during the early part of our combat was optimal and ward tents provided adequate shelter for those cases held for treatment. This system had worked well for those Divisions in operation in the static `build-up` period prior to the break-through at St. Lo, but in the new tactical situation the Clearing Station
of this Division encountered a different problem. There began a series of rapid `leap-frog` movements of the Clearing Platoons, which with the inadequate intrinsic transportation necessitated repeated shuttling by the unit vehicles. Movement of any great number of Combat Exhaustion cases, in various stages of barbiturate sedation, became a critical problem. Quartermaster vehicles were urgently needed by combat units of the Division, just as they were needed by the Clearing Station. Such movement with little advance notice several times necessitated wholesale evacuation of the Combat Exhaustion cases to an Army NP installation to permit movement of the Clearing Station.
It was then decided that the treatment section for these cases would be set up in the Division Rear Echelon area. This area was generally within a reasonable distance of the Clearing Station, and the Division Rear Echelon making its movements after the other Division units were in place permitted the use of Quartermaster vehicles for the transportation of the patients under treatment. In this new system the triage of the Combat Exhaustion cases into `salvage` and evacuation groups continued at the Clearing Station but under the care of a medical officer of that station, while the Neuropsychiatrist functioned at the treatment section with the Rear Echelon. During the period following the `break-through` and during the race across France, the incidence of Combat Exhaustion within the Division dropped to a minimum, and the new system continued in effect and the operation of the Division Rest Area presented no great problems. During this period a Division Casual Company had been set in operation at the Division Rear Echelon. Through this company passed the replacements for the Division, the men returning to the Division from medical installations (including the Clearing station), etc. Here these men were equipped and clothed, and provided transportation to their units. Similarly those men treated at the Division Rest Area, and deemed ready for duty were transferred to this Casual Company. Those cases who did not respond satisfactorily to treatment were returned to the Clearing Station for evacuation to the Army NP Installation.
Upon reaching Siegfried Line a new phase of combat began. The Divisional units became fixed in their positions and the previously moderate weather was replaced by continual cold and rain. The men were subjected to almost incessant pounding by artillery as well as the weather. The Clearing Station was for the first time set up in buildings and this posed a new problem. The former elasticity of the Station which was permitted with tentage was now lost, so that any sudden, large influx of patients could and did create a housing problem. The Division Rest Area was at this time still functioning in tents, and although its elasticity remained, the comfort of the patients was not optimal. At this point (mid-September 1944) a new Division Neuropsychiatrist was appointed and the Division Rest Area was reorganized. The Division Rest Area was incorporated into the medical set-up of the Surgeon, Special Troops (Division Headquarters) and the treatment of the Combat Exhaustion cases was carried out by the Surgeon, Special Troops, an attached medical officer of the Clearing Company, and the medical personnel of the Surgeon, Special Troops, under the supervision of the Neuropsychiatrist. The triage of these cases continued at the Clearing Station but now directly under the Neuropsychiatrist. Careful triage of these cases was considered of prime importance. The early separation of the severe cases from those of the `salvage` group was imperative for best results with treatment at the Divisional level. The severe anxiety states, the conversion hysterias, and the `mixed` cases of
a severe nature were quickly evacuated as there was a marked tendency toward the assimilation of new signs and symptoms, or exaggeration of existing ones on the part of the men in the less affected group. Severity of the reaction and the estimated time necessary for restoration to duty with treatment were the chief criteria in this triage. With the Neuropsychiatrist working at the Clearing Station the many psychosomatic or `functional` cases there afforded early examination and the loss of many of these into hospital channels was prevented. Similarly those cases admitted to the clearing Station with the diagnosis of Combat Exhaustion but in whom actual or suspected organic disease is found are afforded early hospitalization. Those cases of Recurrent Combat Exhaustion, i.e., those who have previously been treated at the Division Rest Area or at an Army NP installation and returned to duty but who are again admitted to the Clearing Station with Combat Exhaustion, are generally considered as poor treatment risks and are evacuated to an Army NP installation for further evacuation.
This policy of triage has proven satisfactory and has continued it effect since its inception, as has the following plan of treatment. The Division Rest Area is divided into a Treatment Section and a Rehabilitations Section. Upon arrival at the Division Rest Area each man is allowed to clean up and shave, and clean clothing is issued to him. He is then given a bed, and barbiturate sedation is begun, averaging nine to twelve grains of Sodium Amytal per twenty-four hours. Special attention is given to an adequate fluid intake, adequate nutrition, and periodic evacuation of bladder and bowel. This treatment is continued over a period averaging two to four ,days. Then following a twelve to twenty-four hour period without sedation the man is transferred to the Rehabilitation Section. Here under the direction of a line officer and a line N.C.O. the men go through a training program, his status no longer that of a patient but again that of a soldier. A period of two to three days is spent in an organized program of orientation drill, hikes, police, and recreation. During this period a regular sick-call is held, and further medical attention and reassurance is given as indicated. Upon the completion of this period the man is transferred to the Division Casual Company for return to duty. At any point in this program where it is decided that response to treatment is unsatisfactory the man may be returned to the Clearing Station for evacuation to an Army NP Installation. Every effort is made to hold men of the Division or its attached units within the Divisional area for treatment. Combat Exhaustion cases from other Division and units not attached to the 28th Infantry Division are automatically evacuated from the Clearing Station upon admission there, since no facility exists for the return of these men to their units after completion of treatment. At times during combat it has been impossible to adhere directly to this system of care. Special missions by Combat Teams often place a sizeable number of Division troops out of the normal Division area with their medical care and evacuation handled by some medical installation other than the Division`s own Clearing Station. In the German counter-offensive of December 1944 normal evacuation channels were severely disrupted as were facilities for the holding of patients for treatment.
During the period from entry into combat through 2400, 31 December 1944 there were 13,465 admissions to the Division Clearing Station. Of this number 6,377 were W.I.A. There were 2,352 admissions for Combat Exhaustion in this period, and incidence of 17.5%. Of the 2,352 Combat Exhaustion cases, 577 or 24.5% were returned to duty after treatment at the Clearing Station or the Division Rest Area, while 1773 or 75.5% were evacuated to Army NP installations or to hospitals. This low percentage of cases restored to duty following the stay at the Clearing level is largely
due to the very small number of cases returned to duty prior to adoption of the present system. On the 16 September 1944 two days prior to the change of Division Neuropsychiatrists and the reorganization of the Division Rest area, there had been 1,072 admissions to the Clearing Station for Combat Exhaustion. Of this number, 87 or 8.1% were returned to duty, while 985 or 91.9% were evacuated. Thus, since that date, through 31 December 1944, there have been 1,470 admissions to the Clearing Station for Combat Exhaustion, of which 583 or 40.0% were returned to duty, while 887 or 60.0% were evacuated. Of the cases returned to duty from the Division Rest Area or from Army NP installations approximately 15.0% are subsequently readmitted as Combat Exhaustion cases. This percentage is believed to be evidence that a sufficient number of doubtful cases are being returned to their units for a further trial at duty. These figures are considered satisfactory and in accord with the sustained combat of the Division and with the high rate of cazualization experienced. The percentage of Combat Exhaustion cases evacuated from the Clearing Station, and returned to the Division for duty, following, treatment at Army NP installations or hospitals is not available, as these men are returned through administrative rather than hospital channels.
Throughout combat the Division Neuropsychiatrist has continued the policy of examination of all men under charges pending appearance before a General Court Martial. His recommendations are forwarded to the Division Judge Advocate for consideration. It has been the general policy in these matters to consider that the diagnosis of Combat Exhaustion is an extenuating factor in favor of the accused, but does not excuse him from responsibility for his actions (in contrast to the diagnosis of Psychosis).
In addition to the above functions the Division Neuropsychiatrist remains available for consultations in reclassification proceedings and other administrative matters.
LARRY W. WEEST
Lt. Col . , MC
103rd Med Bn reports with overlays (1 thru 6).