WAR CASUALTIES

By

Albert G. Love,
Lt. Colonel, Medical Corps, U.S.A.

MEDICAL FIELD SERVICE SCHOOL
CARLISLE BARRACKS, PENNSYLVANIA

1931

THE ARMY MEDICAL BULLETIN
NUMBER 24

The Army Medical Bulletin is published from time to time for the general dissemination of information relating to administrative reports, statistics of disease, Medical Department training projects and other matters of a medico-military nature to members of the Medical Department of the Army of the United States--Regular Army, National Guard and Organized Reserves.

1930.

By direction of the Secretary of War the matter contained herein is published as administrative information and is required for the proper transaction of the public business.

M. W. IRELAND,
The Surgeon General.

.


FOREWORD

The statistical records of the World War, setting forth the incidence of disease, injuries and battle casualties and of the work of the Medical Department during that period have been inscribed in history. As in the case of the Civil War, these records are of great interest from the standpoint of medical science and, for military purposes, furnish the soundest basis for war planning. For the latter purpose, however, these data must be subjected to careful analysis, taking into consideration all evident and conceivable factors creating or influencing them. Upon the figures of experience thus obtained, and comparing the past with present and future conditions, must be based our estimates of the losses to be expected and of medical service requirements in future military operations.

In his official position in the Surgeon General's Office, Colonel Love has had before him the records of the World War and his study of them has been painstaking and exhaustive. The facts and deductions from Colonel Love's study are now available for use by the war planning agencies in estimating Medical Department requirements as to supply, transportation, evacuation, hospitalization, and other essential features that enter into the development of the medical service. Particularly is this study valuable in determining more accurately than by previous methods the hospitalization requirements in any given situation, so that the result can become an entry in the special plan under consideration and thus constitute a directive rather than a contention.

As the wounded and sick returned to duty afford a valuable source of trained replacements, this work will also be of value in studies relating to personnel procurement and replacement.

C. R. REYNOLDS,
Colonel, Medical Corps, U. S. Army,
Commandant, Medical Field Service School.

 

PREFACE

An attempt is made in the following pages to outline a system for estimating, on the basis of our casualty experience in past wars, the requirements for medical service including hospitalization and evacuation of front line casualties; and further to show how intimately the question of replacements for all branches of an army is related to casualty rates, and also to prompt and efficient medical care.

It has been recognized for a number of years both here and abroad that the more efficient the medical service and the nearer the hospitals are to the combat zone, other conditions being equal, the smaller the demands for untrained replacements. Consequently, provisions for an adequate medical service and sufficient hospitalization should be an essential part of every war plan.

The only excuses that can be offered by the author, who makes no claim of having any more than a rudimentary knowledge of mathematics, for not leaving the task to some one better qualified are: First, that he felt that he was reasonably well acquainted with the sources of information and the available basic material; second, that no one better qualified had sufficient time or interest in the subject to undertake it.

For the convenience of the reader, a great many figures have been drawn so as to serve the double purpose of illustrations and tables, although this has often resulted in unorthodox construction.

This work was made possible by General M. W. Ireland, whose thorough knowledge of the medico-military organization and his sympathetic appreciation of the various problems that are connected with it, are a constant help and inspiration to all members of the Medical Department.

Grateful acknowledgement is made to Dr. L. J. Reed, Professor of Biostatistics, Johns Hopkins University, for training in statistical methods while in that institution and for his assistance during the early stages of the work. He has not had an opportunity to follow the development of the study nor to examine the completed manuscript.

Lt. Colonels H. C. Gibner, G. L. McKinney, A. D. Tuttle and C. C. McCornack have made many helpful criticisms and suggestions.

Grateful acknowledgment must be made also to Mr. B. M. Oppenheim for his construction of the Figures, and also for his assistance in the computations.

ALBERT G. LOVE
December 17, 1930.


CONTENTS

FOREWORD
PREFACE
LIST OF TABLES
LIST OF ILLUSTRATIONS

 

SECTION I. PRACTICAL APPLICATION

CHAPTER I.---MEDICAL SERVICE IN WAR

A. Introduction

B. Terms used and constants employed:

1. Strength
2. Causes of sickness and injury .
3. Place of treatment
4. Percentage of cases treated in hospital and in quarters .
5. Admission rates
6. Average days lost per case
7. Noneffective rates

C. Admission rates for troops in the United States:

8. Decline since 1819
9. Increase during war
10. Decline in succeeding war rates
11. Estimation of future admission rates for unseasoned troops
12. Causes of variations in admission rates in United States
13. Admission rates in United States camps, 1918

D. Admission rates for overseas troops:

14. Admission rates for seasoned and unseasoned troops
15. Comparison of overseas and United States admission rates
16. Relative standing of overseas and U. S. admission rates
17. Influence of climate on admission rates
18. Combined effect of seasoning and of climate

E. Admission rates from battle casualties:

19. Civil War and Philippine Insurrection
20. World War

F. Method of estimating the constant increase in the total sick and the hospital populations

21. Basis of the method
22. Total sick in United States
23. Sick in hospital only in United States during the World War
24. Hospital patients in the American Expeditionary Force

G. Disposition of patients:

25. Disposition of Zone of Interior cases in the United States
26. Disposition of Theater of Operations cases in the American Expeditionary Forces
27. Total duration of treatment of Theater of Operations cases

H. Hospital care of Theater of Operations patients in Theater of Operations and in the Zone of the Interior

28. Character of patients to be sent to the Zone of Interior
29. Duration of hospital treatment of Theater of Operations patients
30. Percentage of Theater of Operations patients sent to the Zone of the Interior in relation to hospital beds required in each area

I. Total hospital beds required in the Zone of the Interior

 

CHAPTER II.---LOSS OF MAN POWER IN WAR

J. Losses in the Theater of Operations:

31. Cases disposed of in Zone of the Interior
32. Deaths
33. Total losses in the Theater of Operations
34. Total losses by separate months

K. Losses in the mobilization area

 

CHAPTER III.---MEDICAL SERVICE IN THE COMBAT ZONE

L. Diseases and non-battle injuries

35. Total in the Theater of Operations
36. In the combat area

M. Battle casualties---collection of

37. Composition of organizations
38. Strength of organizations
39. Sources of casualty data
40. Engagements studied
41. Method of assembling data
42. Percentage of gas wounded, gunshot wounded, and killed

N. Battle Casualties---Presentation of data.

43. Infantry regiment.
44. Casualties by arm of service
45. Infantry divisions
46. Army Corps
47. First American Army I
48. Summary of the estimated combat requirements and average casualty rates

O. Battle Casualties---Transportation required

49. Gunshot wounded
50. Gunshot and gas wounded

P. Battle Casualties---Disposition of eases in the combat area

51. Percentage of short duration cases
52. Hospitalization of short duration cases

 

SECTION II. TECHNICAL DETAILS

CHAPTER IV.---EXPLANATORY NOTES AND DEVELOPMENT OF FORMULAE

Q. Explanatory notes

R. Development of formulae

53. Patients leaving sick report
54. Graduation of material
55. Patients remaining on sick report
56. Exponential curve

S. Computation of data for short duration cases

57. Percentage leaving hospital each day by return to duty or death
58. Average days of treatment
59. Patients in hospital OD the maximal day
60. Patients in hospital on any day when the maximal one is the tenth, etc.


Chapter One