History

HEADQUARTERS 4TH INFANTRY DIVISION

Office of the Division Surgeon

APO 4, United States Army

10 January 1945

SUBJECT: Annual Report

TO: The Surgeon General, Washington 25, D.C., (Through Technical Channels).

In compliance with Circular Letter No. 143, Office of the Chief Surgeon, dated 18 September 1944, subject: A Annual Reports of Medical Department Activities, @the following report is submitted:

1. DATE OF ACTIVATION AND EARLY HISTORY: The Medical Department of the Fourth Infantry Division was organized at the time of the reactivation of the Division on 1 June 1940. In the beginning the 4th Division was motorized, hence the Medical Department was organized along the lines of a motorized unit. Two cadres, one from the 2d Medical Battalion, Fort Sam Houston, Texas and one from the 7th Medical Battalion, Fort Snelling, Minnesota amalgamated at Fort Benning, Georgia, in the Harmony Church areas 13 June 1940 to form the nucleus of the new4th Motorized Division Medical Service. The Medical units began training at this point and remained in the Fort Benning area until 17 December 1941. In February and March of 1941 the first selectees began to arrive at Fort Benning to joint he new division. In a short time the division was up to full strength for the first time. In July 1941 the entire division was completely motorized and was known as the first completely motorized division in the U.S. Army. On 17December 1941 the 4th Motorized Division (as it was then known) moved from Fort Benning to Camp Gordon in Augusta, Georgia. This new site was designated officially as the permanent home of the A Rolling Fourth.@ The 4th Division remained in Camp Gordon until March 1943 at which time it was moved to Fort Dix, New Jersey. In August 1943 the Division was demotorized and became a triangular division. From Fort Dix the 4th Division was moved to Camp Gordon Johnston, Florida in the later part of September 1943. In Camp Gordon Johnston the Medical units along with the division participated in amphibious training. This amphibious training lasted for two months and in December of the year the division moved to Fort Jackson, South Carolina, to round out its training. The division remained in Fort Jackson until the middle of January, 1944 when it began to move to the staging area at Camp Kilmer, New Jersey. About the middle of January 1944 the division sailed from the New York port of embarkation for England, arriving in England the first part of February 1944. The division continued its amphibious training in England until A D@Day on 6 June, at which time the A Famous Fourth@ was one of the two American Divisions to assault the beach of France then held by formidable forces of the German Army. From AD@Day, 6 June 1944 to the present time the course of the division has been one of almost constant contact with the enemy.

2. MANEUVER EXPERIENCES:

a. On arriving in England in February 1944 the division was initially stationed in the vicinity of Tiverton, Devonshire County. The plan of operations on the invasion of France called for the employment of the Fourth Division as one of the assault divisions. The plan in general was for the division to land on Utah Beach, Cotentin Peninsula., in column of regimental combat teams and join as soon as possible the 101st and 82d Airborne Divisions to establish a beachhead for the VII Corps and to advanced on Cherbourg. The airborne divisions were to drop at H minus five hours, reduce strong points, and assist these airborne elements landing at H hour.

b. The 8th Infantry Regiment was selected as the leading regiment to assault the beach followed by the 22d and 12th Infantry in that order. The tactical plans first few days were rehearsed twice near Slapton Sands, England. This involved all troops of VII Corps landing on the first three tides, the two Airborne Divisions and the Navy. These exercises were full scale, actually loading on naval craft by loading charts, timing of naval operations and assaulting the beaches realistically using live ammunition. The division medical service was involved in these exercises and gained valuable experience to provide excellent service during future operations. Some minor rearrangements of loading, timing, and supply plans were worked out at this time. For all medical detachments landing with their units, mortar cases full of medical supplies were carried ashore by each man, to be utilized until the more bulky organic equipment could be landed and made accessible. This proved very practical. See Annex No. 1, "Report of Operations, 6 June 1944 to 30 June 1944,Inclusive."

3. COMBAT EXPERIENCES:

a. The Fourth Infantry Division landed on Utah Beach on "D" Day and has been in contact with the enemy almost constantly since that date. Some of the more historical achievements during this period were: one of the first units to enter Cherbourg; fought the strong hedgerow defenses south of Carentan; spearheaded the breakthrough west of St. Lo; assisted in stopping the counterattack at Mortain which formed the western edge of the FaIaise Pocket; the first American Division to enter Paris; made rapid advances through France and Belgium which resulted in capturing or destroying much German equipment and personnel; one of the first to breach the Siegfried Line, near St. Vith; fought one of their hardest battles through the Hurtgen Forest southeast of Aachen; successfully stopped the Germans in the vicinity of Echternach, Luxembourg and formed the southern anchor on the German counter-offensive in mid-December 1944, protecting the city of Luxembourg.

4. MEDICAL SERVICE:

a. Casualties and Evacuation:

(1) The medical service from the front line to the rear has been efficient and exceptionally smooth working. It has been accomplished along the principles taught at the Medical Field Service School with minor variations. The use of the-ton "jeep" ambulances between the

battalion aid stations and forward points has worked; also between battalion aid stations and collecting companies at times. Many times field ambulances can evacuate direct from battalion air stations. Collecting company litter bearers are sometimes utilized forward of battalion aid stations. In the Hurtgen Forest, however, casualties were heavy. Absence of roads, adverse weather and terrain necessitated litter hauls sometimes in excess of two miles. The organic medical service would have been unable to handle the situation without the loan of 140 additional litter bearers and aid men from Corps and Army units during the period of about three weeks. M-29` s, "snow buggies," were used here and appreciably shortened some litter carries. During this period organic enlisted replacements fell behind the losses to the extent that was a constant organic shortage in the division medical units of from 25 to 75 men.

(2) The Clearing Company, 4th Medical Battalion had 27,393 admissions between6 June and 31 December 1944. The patients have been received in that echelon in good condition. Adequate dressings, control of hemorrhage, and initial treatment of shock has been already accomplished either in the battalion aid station or the collecting station. In the clearing station wounds are examined, often dressed, and penicillin given in prescribed amounts. Tetanus toxoid is routinely administered. In the surgical sections wounds are cleaned and debrided and the patient prepared for further evacuation. There has been 58 deaths in the clearing station during this period.

(3) The facilities of a Field Hospital Platoon in the vicinity of the clearing station has been a marked advantage. It has afforded surgery early to nontransportable casualties. Its facilities such as x-ray has helped to retain questionable patients at division level.

(4) The total casualty figures of the 4th Infantry Division during this period were obtained from AC of S, G-1, and are quoted:

	Officers	WO	EM
Cumulative Killed	237	3	3045
Cumulative wounded	746	2	13721
Cumulative missing in action	24	0	945
Cumulative captured	0	0	35
Total cumulative battle casualties	1009	5	17746
Total cumulative sick and non-BC	332	11	7426

(5) Medical Department records show the following for major division units:

(a) Casualties for each Infantry Regiment since 6 June 1944:

	Disease	Injury	Battle Casualty	Total
8th Infantry Regiment	1659	623	3965	6347
12th Infantry Regiment	2456	610	5460	8526
22d Infantry Regiment	1961	779	5345	8085
[Total]	[6176]	[2012]	[14,770]	[22,958]

(b) Medical Department losses since "D" Day:

	KIA	WIA	Others	Total
Officers	3	10	34	47
Enlisted Men	50	260	366	676

(Others includes: Missing, disease, transferred).

b. Supplies:

(1) Medica1 Department supplies have always been adequate and available. Only on one occasion has the automatic exchange failed. This failure was at the evacuation hospitals on litter and blankets which required the supply section to make a round trip of over 600 miles to the nearest depot where these items were available. This was during the first attack on the Siegfried Line after rapid advances through France and Belgium.

c. Transportation and Equipment:

(1) Transportation has been adequate but occasionally strained. It is recommended that consideration be given the addition of transportation to the following units:

Clrco One 2 1/2-ton truck and trailer

Regt Med Sections One 1/4-ton truck and trailer

Bn Med Sections One 1/4-ton truck and trailer

Coll Companies One 2 1/2-ton truck and trailer
Two field ambulances

(2) Equipment has proven suitable with the following exceptions:

(a) Clearing Company needs at least two 3 or 5 KV generators. The 1 1/KV generators are not suitable or reliable for the night load of one clearing station platoon.

(b) Collecting Company has no need for wheel litters. A jeep ambulance can go where these cannot.

d. Personnel:

(1) Replacements are of primary consideration from an efficiency standpoint. Due to loans from higher echelons the efficiency has not suffered. They should be readily available during combat because the division T/O does not have an excess to be used where needed when they are needed most. An authorized over strength would be beneficial.

(2) It has been found that battalion surgeons should be picked carefully to prevent disrupting a very important echelon of medical service. Besides certain qualities of leadership it is felt that age is of primary importance. Battalion surgeons should be under 30 years of age for the endurance and adaptability necessary. Officers near and over 35 do not do as well or 1ast as long for many

Reasons. It is also that some rotation policy for medical officers in field units after a certain period of time would be beneficial to the Army as well as to the individual.

e. Tables of Organization

(1) The present T/O has proven adequate in most instances. The change of assistant battalion surgeon from Medical Corps to Medical Administrative Corps has worked out well.

(2) There are two changes of T/O recommended. The addition of one medical officer in Division Special Troops to service the rear echelon and Casual Company in combat. Under the present setup it takes one officer from Clearing Company on a full time status. The other change is the elimination of the medical battalion S-3. It has proven to be an inactive position.

f. Dental Service:

(1) The dental officers have been able to provide dental services most of the time, even in combat. By the use of the laboratory chests in clearing company many dental casualties are saved from further evacuation.

g. Health and Sanitation:

(1) The general state of health of the division has been excellent. There has been no outbreak of acute communicable diseases. Gastro intestinal disturbances and upper respiratory infections have been at a minimum throughout. The climatic conditions have been variable with a rainy season the past three months.

(2) The troops observe sanitary policies satisfactory. They are give bath facilities and clean clothes when the situation permits. Clothing has been satisfactory in quantity and quality.

(3) It has been found that water in all streams and most villages is non-potable bacteriologically. Water points are routinely used by the division, also routinely two parts per million of chlorine is obtained in the tank reservoir before distribution is made.

(4) Rations have varied as to kinds depending on the situation. "B" rations are always available when the situation permits their use. An occasional borderline vitamin deficiency has appeared. During the present winter months vitamin supplements are available to the troops and are issued with the rations.

h. Problems Peculiar to Combat:

(1) Combat exhaustion: This condition varies markedly with different

circumstances. It can well become excessive and detrimental to military necessities if the policy is too liberal. When recognized as a possible escape route, many will take advantage of it when circumstances are arduous and physical fatigue is marked. Unit disintegration begins under these circumstances and especially where leaders have become casualties. Several techniques for coping with the problem have been utilized. The most successful method so far in the prophylaxis of exhaustion cases has been to consider them primarily a command function. By resting men in groups, keeping them informed, and only bringing those men into medical channels that show acute objective symptoms or definite deteriorating changes in personality. By maintaining more stringent criteria for evacuation a more effective military unity will be maintained. By the same token, since only the severely ill will be evacuated under this plan, the percentage of return to duty from the Clearing Station will be small. Also some borderline cases will be disposed of legally rather than medically. This division has experienced both high and low rates under different circumstances. With a recent firmer policy on evacuation under the most difficult prolonged circumstances of combat in the Hurtgen Forest, the rate in the later stages was exceptionally low. It is therefore maintained that if a man can be made ready for further combat duty in 48 hours at a clearing station, he was not a medical problem in the first place but one of command. Moreover, being placed in a medical environment tends to provoke soldiers to varying symptomatic complaints, all of which can be obviated by avoiding medical channels for fatigued soldiers.

(2) Trench foot: After the soldier has been properly equipped with suitable clothing, shoes, etc., and some knowledge of the care of the feet, the incidence depends upon circumstances. Instances where a man could or did give the feet proper care are relatively rare in developing the condition. The usual history is long continued exposure in a situation beyond their control. Thu use of overshoes, heavy wool socks with frequent changes, etc, are helpful in preventing the condition. This division has had about 762 eases since the onset in October. A command effort is made to keep the incidence at a minimum.

i. Citations and Awards to Medical Units and Personnel:

(1) 8TH INFANTRY REGIMENT:

(a) 10 August 1944-Regimental medical detachment included in Presidential Unit Citation, per General Order No. 46, Headquarters First United States Army, APO 230, dated 10 August 1944, for outstanding performance of duty in action against the enemy during the assault of the Cotention Peninsula, Normandy, France, 6 June 1944.

(b) 24 November 1944-2d Battalion Medical Section commended

in Order of the Day No. 47, Hq 4th Inf Div, for meritorious service in connection with care and evacuation of patients during operations against the enemy south of Duren, Germany, on 16 November 1944.

(2) 4TH MEDICAL BATTALION:

(a) 3 August 1944-Company C, 4th Medical Battalion commended in Order of the Day No. 10, Hq 4th Inf Div, for meritorious service in connection with operations in the vicinity of St. Gilles, France, that led to the initial breakthrough of the enemy lines.

(b) 14 August 1944-Company D, 4th Medical Battalion commended in Order ofthe Day No. 18, Hq 4th Inf Div, for coolness under fire and total disregard for personal safety in attending wounds of incoming casualties while under bombingattack by a large force of enemy planes in the vicinity of Pte. Duerie, France, between 270145 and 270205 August 1944.

(c) 19 August 1944-Company B, 4th Medical Battalion commended in Order of the Day No. 21, Hq 4th Inf Div, for meritorious service in connection with support of the 12th Infantry Regiment, 4th Inf Div, from 6 June 1944 to 19August 1944.

(d) 20 August 1944-Company C, 4th Medical Battalion, as part of the 22d Infantry Regimental Combat Team, commended in Order of the Day No. 22, Hq 4thInf Div, for meritorious service in connection with operations involved in a move from St. Poie, France, to vicinity of le Teilleul, France, and Passais, France in 10 August 1944.

(e) 31 August 1944-4th Medical Battalion commended in Order of the Day No.26, Hq 4th Inf Div, for outstanding service and ceaseless devotion to duty on D-Day and in subsequent engagements in which the 4th Infantry Division participated.

(f) 24 November 1944-Company A, 4th Medical Battalion commended in Order of the Day No. 47, Hq 4th Inf Div, for meritorious service in connection with evacuation of patients in support of the 2d Battalion Medical Section, 8thInfantry Regiment, during operations against the enemy south of Duren, Germany, on 16 November 1944.

(g) 24 December 1944-4th Medical Battalion commended for meritorious service in connection with successful processing and treatment of casualties under difficult and complicated conditions during the Hurtgen Forest operations. Letter Hq 4th Inf Div, dated 24 December 1944.

(3) 70TH TANK BATTALION:

17 June 1944-70th Tank Battalion received the Presidential

Unit Citation for extraordinary heroism and outstanding performance of duty in action in the initial assault on the northern coast of Normandy, France, 6June 1944, per General Order No. 26, Headquarters First United States Army, dated 17 June 1944.

(4) Personnel Awards: The following awards were received by Medical Department personnel of this division:

(a) Distinguished Service Cross:

Awarded to Tec 4 Daniel E. Atwell, 32043517, Co B, 4th Med Bn.

(b) Silver Star awards:

Officers	Enlisted Men
11 (2 posthumously)	44 (1 posthumously)

Officers	Enlisted Men
48 (1 posthumously)	298 (3 posthumously)

Oakleaf Clusters to Bronze Star awards:

Officers	Enlisted Men
2	19

(d) Purple Hearts:

Officers	Enlisted Men
26	390

Oakleaf Clusters to Purple Hearts:

Officers	Enlisted Men
8	26

D. O. LYNN,
Lt Col, MC
Surgeon

SOURCE: National Archives and Records Administration, Record Group 407, Records of the US Army Adjutant General`s Office, World War II Records,
4th Infantry Division, Reports of the Division Surgeon, 1943-1945, Box 6568.